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  Karen tried to say, “Please, help me,” but she was unable to engage her voice, and all that came out was a small, squeaky whimper. Except for her mouth and nose, she could no longer feel her own body. The footsteps grew louder, then stopped. Someone was standing by the urn. She heard a voice say, “If I laugh now, you’ll probably divorce me.”

  It was Jake. Karen found her voice. “Get me out. Get me out now!”

  Jake sounded startled by Karen’s pathetic tone. “Don’t worry, I’ll get you out if I have to smash the thing. Everything’s going to be all right. I promise you. Just hold on.” Jake tried to push the heavy urn over, but quickly realized he could not control it. With Karen inside, the container seemed to weigh close to three hundred pounds.

  Jake sat down on the floor and straddled the urn. He braced one foot against the desk and the other against a wall, grabbed the lip of the urn, and pulled. When the urn tipped onto him, he moved his hands underneath it and lowered it slowly. When it was almost resting on him, he slithered out from under it and repositioned his feet on the base of the urn.

  Karen felt one of Jake’s hands on her neck, the other sliding in over the top of her head. She heard her own voice, saying, “Oh, oh, oh, oh!” The hand on the top of her head slid in between the lip of the urn and her left ear and pushed downward, gently. Jake made a quick, twisting motion, like a chiropractor making an adjustment, and her head popped out.

  Jake’s eyes teared when he saw Karen’s face, grayish-purple and blotchy. Her skin was cold and dilated blood vessels bloomed around her mouth and nose. She gasped hungrily for the fresh air outside the urn.

  “Head’s clear!” Jake called out. “Now, here come the shoulders.” He put one hand on each of Karen’s shoulders and folded them forward. “Push!” he yelled. “Push!”

  Karen tried but couldn’t move her numb legs. Jake gripped her shoulders and pulled them through the mouth of the urn. Her face landed on his belly.

  “Shoulders are clear!” he exclaimed. “Come on now, just one more, here come the hips. One more. Push! Push!” Karen tried but her legs were completely asleep. Jake grabbed her waist and pulled and her hips squirted through.

  Karen landed this time with her face on Jake’s neck, weeping and gasping, her dread and stupor evaporating with astonishing quickness. Jake craned his head up, patted the urn with his hand, and said, “Congratulations, Mrs. Decker. You have a beautiful daughter.”

  Jake’s attempt at levity penetrated, and Karen began, to her own surprise, to laugh. Fearing laughter would delay her recovery from the shakes, she caught her breath. “You’re a miracle,” she gasped. “However did you find me?”

  “Ah,” replied Jake, “a brilliant bit of ratiocination. On the phone you said you were going to Grimes’s office. So when you didn’t show up at home, I went to Grimes’s office. When I got here, I heard someone whimpering inside this big clay pot. There you were.”

  Karen pushed herself up onto her elbows and said, “My hero.”

  While Jake returned the urn to its original position, Karen broke into Joe’s e-mail and erased her memo. Joe was clumsy with his computer, so Karen knew it was unlikely that the disappearance of her message would be noticed. She retrieved her shoes from under the potted palm, and she and Jake escaped the office.

  In the hall outside, Karen saw the silhouetted figure of a large, muscular man approaching. A huge key chain and a nightstick dangled from his belt. His right hand clutched a long, cylindrical object. When he was about twenty feet away, he stopped, raised his hand and pointed the object directly at Karen’s face.

  A bright light obliterated Karen’s vision. The man was shining a flashlight at her.

  “Mrs. Hayes!” said the man. “Are you all right?”

  Karen recognized the voice of Max Schumacher, the head of Security.

  “Turn off the flashlight, Max. You’re blinding me.”

  Max lowered the flashlight and flicked the switch off. Karen’s heart was pounding again. She was surprised her adrenal glands had anything left after her hours of terror. Her vision had started to clear, although everything appeared to be tinted red, and she could see Max standing in the dark hallway, walking toward her. She realized with dismay that she had no explanation to offer for her presence in Joe’s office in the middle of the night.

  Max had the thick neck of an ex-wrestler and could carry two hundred and fifty pounds and still appear to be in decent shape. Karen knew him to be friendly and good-natured, but she also knew he was an ex-cop and that little got by him.

  He now studied Karen’s face. “Are you sure you’re okay? No offense, Mrs. Hayes, but you look like something the cat left outside.”

  “I’m okay, Max.”

  “Your skin is blotchy and your eyes look funny and your hair is all tangled. And why are you shaking?”

  “Too much coffee.”

  “Why are you carrying your shoes?”

  “Sore feet.”

  “Why is your skirt all wrinkled?”

  “Bad dry cleaner.”

  “Why were you in Mr. Grimes’s office?”

  “Hi, Max,” interjected Jake.

  Max turned to Jake. “Oh, yeah, hi there, Mr. Hayes. Say, what gives? You guys are in Grimes’s office after hours, Mrs. Hayes looks like hell—no offense, Mrs. Hayes—and I’m getting answers that sound like horse doodoo.”

  “Didn’t you need something from your office?” Jake said to Karen.

  Karen stared at him for a moment. “Oh, that’s right.”

  Jake was buying time for her to think of an explanation. She walked slowly to her office. Every bone in her body ached. She was still trembling and dazed. Her mind was not working the way it usually did. Why was I in Grimes’s office? Come on, think of something. Maybe I needed some documents from Joe’s office. So where were they? I just went in to water Joe’s palm tree. No good, Max could check the soil and it would be dry. How about, Joe left his computer on and I went in to turn it off. No! The worst thing to do would be to call attention to Joe’s computer.

  Exhausted and drained of ideas, she found her office. The light from a street lamp faintly illuminated the room. Shadows cast by the branches of the sugar maple outside her window fractured the walls and ceiling into jagged pieces. She shuddered. She was not ready to be alone right then.

  “Jake!” He was just outside the door. Max was gone. Karen heard someone whistling beyond the stairwell door.

  “Where’s Max?” said Karen.

  “He went back to his rounds,” said Jake.

  “How did you get rid of him?”

  “I talked to him dude-to-dude.”

  “About what?”

  “Stuff like, you know, how some couples might enjoy doing a certain thing in a lot of different places, and how that certain thing might get the woman’s hair and skirt messed up, stuff like that.”

  “Jake, you didn’t.”

  “Did.”

  “How embarrassing.”

  “I didn’t say we did it. I said some couples. He may have jumped to a conclusion.”

  “Judas priest. Max will do a report on the incident. This will be all over the hospital within hours.”

  “I don’t think Max will do a report.”

  “Why not?”

  “Because he has too many other things to do. Like, he’s going in to Chicago for a Bulls game. Oh yeah, remember to put those tickets Larry gave us in the interoffice mail tomorrow.”

  Karen put her hand on her face. “Jake, you didn’t bribe the head of Security!”

  “Did.”

  She moved her hand to his face. “Clever boy,” she said.

  Jake looked down and pointed at Karen’s other hand. “Is that what you supposedly went back to your office for?”

  Karen looked down. She was holding the crystal paperweight from her desktop.

  Around midnight, Karen decided she would not need to be hospitalized after all. An extended hot bath, accompanied by two cold martinis and four ibuprofen tabl
ets, followed by an hour-long full body massage accompanied by candlelight, incense and a tape of Japanese lute music selected by Jake, had restored her sense of physical and mental well-being to a remarkable degree.

  As Jake put the finishing touches on the massage, kneading Karen’s calves and ankles with scented oil, Karen told him about Carl Gellhorn’s opinion that Bernard and Herwitz had mismanaged Larry’s case. She speculated that Bernard or Herwitz might have known about Larry’s investigation into the Jefferson Clinic billing fraud.

  “If they did, Larry must not have known it or nothing anybody said could have made him change his mind and have his biopsy at Memorial,” she said aloud. “Larry wasn’t foolish enough to let Bernard operate on him if Larry was about to send Bernard to the slammer and he thought Bernard was on to him. Not even after I told him to think about the effect on his career of ticking off Grimes.”

  “Are you still feeling guilty about that?” asked Jake.

  “No, not anymore,” said Karen, sounding unconvinced. “Larry must have kept the investigation a total secret, or thought he had. Larry’s secretary told me Herwitz was in Larry’s office this morning looking for something. Maybe it was the fraud investigation file. Still, even with Carl’s report there’s no proof Bernard or Herwitz did anything intentional to cause Larry’s death.” She told Jake about Gilbert Austin’s verbal report that the catheter that broke up inside Larry was heated far beyond sterilization.

  Jake’s massage moved down to Karen’s feet. The candlelight flickered rhythmically; for a moment it strobed in time with the music. The fragrance of the massage oil blossomed in the room. The skin on the tops of Karen’s feet looked opalescent in the candlelight.

  “So someone who knew what would happen to the catheter cooked the hell out of it and somehow made sure it got into Larry?” asked Jake.

  “Annie Delaney told me a cath lab nurse said there was only one catheter on the cart the morning they did Larry. Normally there would be several Somebody rigged it so Larry would get the bad catheter.”

  “Who could’ve done that?”

  “I’m having Annie check out who had access to the cart before Larry’s procedure. I suppose it could have been any doctor in the hospital, any cath lab nurse or tech. Maybe someone walked in off the street.”

  Jake slid his hands up the length of Karen’s legs, to redo her buttocks and lower back. “So then the question is, who would want to bump off Larry?”

  “Oh, that feels good. Now Grimes had multiple reasons.”

  “Yeah, good old Joltin’ Joe. You told me about the missing file implicating the hospital in the clinic’s billing fraud. Plus maybe he’s boffing the Conk’s wife. Any other reasons?”

  Karen explained Joe’s premature urging of a $2 million settlement and his quick hatching of the MRI kickback scheme, with its mysterious million-dollar donor. She postulated, “Larry’s death would have simultaneously ended the fraud investigation and created a source for the funds Joe needed to do his precious deal. If Joe killed Larry, he killed a whole flock of birds with one stone.”

  “And what about Paula?” asked Jake. “She’s not coming out too badly. Big damage claim, life insurance, the house. Plus, she saves on divorce lawyer’s fees.”

  “Her best friend, Lisa Fuller, is a nurse at Shoreview Memorial. Lisa might have boiled the catheter and planted it on the cart for Paula.”

  Jake sat up and extinguished the candle with his thumb and forefinger. “Not to step on your part, sweetheart, but is this really included in an in-house attorney’s gig? Stewing about motive and opportunity?”

  Karen closed her eyes and yawned. “It could affect the wrongful death case against the hospital if Larry was murdered. It’s my job to defend the hospital Besides, it looks like Shoreview Memorial has no insurance. If we lose that case, it could go broke; I’d be out of a job. Plus, I’m curious.”

  Jake lay down beside her and placed his hand gently on the nape of her tender neck. “Plus, you still feel responsible for Larry’s decision to have his biopsy at Shoreview.”

  “Right,” said Karen, drifting off to sleep.

  CHAPTER

  14

  Anne Delaney popped an antacid tablet in her mouth and sat down across from Karen at the long polished fruitwood table in Conference Room I, which was located in the old section of the hospital Slashes of sunlight through Venetian blinds illuminated a blizzard of dust motes, which Karen in her darker moods speculated might include asbestos fibers from ancient floor tiles and pipe wrap. Old steam radiators clanked like box-cars coupling.

  “What happened to your neck?” asked Anne. “Rear-ender?”

  “Must have slept on it funny,” said Karen, touching the cervical collar she was wearing. A stiff neck was the only remnant of her incarceration in the urn. She gulped tepid coffee from a white Styrofoam cup.

  “Apparently at the bottom of a pile of rocks,” said Anne. “Why didn’t you stay home?”

  “Last Tuesday of the month,” replied Karen. “Can’t miss Ethics Committee.”

  The Ethics Committee of Shoreview Memorial Hospital consisted of nine persons: Karen, Anne, a social worker, an assistant minister from Our Redeemer Lutheran Church, and five doctors. This made it difficult for the committee to seat a quorum, since the physicians were frequently too busy to attend. But today when the chairman of the committee, Edward Bernard, the cardiologist who had done Larry Conkel’s biopsy, arrived, the quorum was achieved.

  “Meeting of the Ethics Committee will come to order,” he announced, lighting up a panatella. With his head craned forward, he surveyed the room with bulging, bloodshot eyes. He wore the standard physician’s white lab coat over a white shirt and a brown knit necktie in an overlarge Windsor knot. To his lapel was clipped an ID badge bearing a photo of himself as a much younger man, also wearing a brown necktie with a bad Windsor knot. “Do I have a motion to waive the reading of the minutes of the last meeting?”

  “Sure, why not,” Karen muttered. “All they say is ‘there being no quorum, the meeting was adjourned’.”

  Bernard shot her a glance. “Reading of the minutes is waived,” he said sternly. “New business. Miss Beauchamp, our social worker, has the floor.”

  The purpose of the Hospital Ethics Committee, according to its charter, was to “serve as a resource for the medical staff, other hospital committees, patients and their families in resolving issues with bioethical implications.” This sometimes meant advising the Medical Research Committee on the ethics of medical experimentation using human subjects. It sometimes meant recommending policies on procreative matters, such as sterilization of low-IQ patients, or the use of advanced reproductive techniques like in-vitro fertilization or frozen embryos. Often, it meant helping settle disagreements over when to give up trying to keep a terminal patient alive who was either suffering or vegetative.

  “We have a patient who needs heart-bypass surgery, but she lacks capacity to give consent,” began the social worker. She was in her twenties, dressed in faded jeans, bulky sweater, chunky necklace, and hiking boots. “Her husband is deceased,” she said. “She has two daughters who disagree. One wants her to have the surgery, one doesn’t.”

  “I saw the case summary on this one,” Anne interjected. “This patient is eighty-four years old. Besides the heart disease, she has chronic kidney disease. She’s on dialysis.”

  “Why isn’t she able to give consent for herself?” asked Karen.

  “PVS,” said the social worker. PVS was medical slang for “persistent vegetative state,” where some functions such as blood circulation operated, but the cerebral cortex was totally and permanently defunct.

  The minister spoke. “What have we done to help the family reach a consensus?”

  “I talked with both daughters,” said the social worker, “as did both the attending physician and the cardiac surgeon. One daughter is angry at the hospital for keeping her mother on dialysis. The other wants everything possible done to keep her mother alive. We�
��ve called a code to resuscitate this patient seven times.”

  Karen rubbed her eyes with her fists and opened them comically wide, surveying the room. “This is not a hard one, folks.” She had read volumes on ethical health care decision-making. She believed it was part of her duty as a member of the Ethics Committee to know and apply the accepted principles of biomedical ethics. The principles had lofty-sounding names, such as nonmaleficence, beneficence, autonomy, and justice, but they could be boiled down to “do unto others” with a few twists and were the same principles Karen used to make decisions in her life. Other members of the committee applied different principles.

  “Who’s the cardiac surgeon on the case?” asked Dr. Bernard.

  “What difference does that make?” asked Karen.

  Dr. Bernard’s brow furrowed. “I just need to know who’s exercising the medical judgment on the patient’s need for surgery.”

  You just need to know if the Jefferson Clinic will get the fee, thought Karen. A radiator clanked. The clergyman spoke again.

  “I think the important thing here is that we help restore harmony to the family. Perhaps we could offer some counseling.”

  Karen spoke. “There is no need to resolve the disagreement between the daughters to answer the bypass question. That question never should have come to this committee. It’s not a question of ethics. It’s a question of medical appropriateness. This patient is not a candidate for bypass surgery.”

  Dr. Bernard sat forward, projecting the smell of cigar smoke into Karen’s space. “And when did you get your medical degree, Doctor Hayes?”

  Karen plowed ahead. “The ethical question is whether the dialysis should be discontinued, and the patient no-coded.” To “no-code” the patient meant that next time her heart stopped, she would not be resuscitated. “We have a permanently vegetative patient with chronic renal failure, two daughters who are suffering, and an unconscionable waste of resources. We’re turning away children who need renal dialysis time. The consent of one daughter to make the patient a no-code would be adequate both legally and as a matter of hospital policy.”