Do No Harm (2002) Read online

  He found Ralph down in the ER, leaning against a cart, arms folded across his chest. He seemed perturbed and didn't look over when David stood beside him.

  "Goddamn cops," Ralph said. "Get a guy in that uniform, takes about two days before he's a USDA-certified prick."

  "What happened?" David asked.

  "They just want what they want, and they want it immediately. No consideration for the fact that I've got other responsibilities here. I'm running security for this facility, I'm not an errand boy for LAPD." Ralph jerked his thumb at his chest. "I was Third Battalion, Second Marines, Charlie Company. Two tours. Two fucking tours, and some doughnut-muncher expects me to how-high his shit."

  "Who?"

  "Yale. Dalton."

  "What did they want?"

  Ralph cast a look in both directions, and David took a step closer so Ralph could lower his voice. The conspiratorial nature of the exchange diluted Ralph's anger considerably. "They confiscated records on a dude, name of Douglas DaVella," Ralph said. "He's a suspect, I guess. Used to work upstairs with Horace the Hacker."

  "Oh? Anything interesting?"

  Ralph homed in on David's interest like a dog spotting prey. "Oh no, Doc. You don't want to step into this too far. You're playing with a new brand of fire here."

  David studied Ralph closely. "I was in over my head before I knew what was going on. I can either sink or swim. What would you do?"

  Ralph rubbed his nose and it gave easily, the cartilage flexible from a few breaks. He studied David's face for a moment and seemed to reach some conclusion. "They were mostly after his address and phone and stuff," he said. "But the guy was a bit uneven. He had a couple of complaints filed against him. Nothing I investigated personally, but the records were there."

  A few interns walked by without saying hello to David. For the first time, he appreciated the privacy his estrangement from the staff permitted him. "What were the complaints for?" he asked.

  "He got a bit uppity once when confronted by a gal over in Human Resources. Something about him taking too many sick days. Turned out to be nothing. She claimed he got aggressive, but he was settled down by the time it was checked out. Afterward, she couldn't point to anything concrete. Then there was another complaint, from a patient over in the NPI, just before DaVella got fired. Guy's a real whackjob, I guess--six fingers on each hand. He said Mr. DaVella was trying to steal his meds, but the guy's a bit cuckoo for Cocoa Puffs, so no one took the complaint too seriously."

  "What was DaVella doing over at the NPI? As a transporter of body parts, the psych ward should've been the last place he wound up."

  "He said he got lost coming back from making a delivery to the Reed Institute next door. I know--it's kinda loose. But he was pretty cooperative during questioning, and the patient had some type of paranoid disorder, so it all kind of washed out."

  "Who questioned Mr. DaVella?"

  "A fellow named Tommy Jones was point on both complaints."

  "Can I talk to him?"

  "Moved to Baltimore. Divorced. Fell out." Ralph shrugged. "You know how that tune spins."

  Diane swept past them in the hall, did a double take, and stopped. "Oh. Glad you're here. We need you in Four."

  "I'm off today." David was anxious to get over to the Neuropsychiatric Institute to follow up on the complaint that had been issued there.

  "I know, but it's Alberto," Diane said. "Sore throat. He said he'll only see you--you know how he is."

  During the summer months, Alberto followed his father, who was a gardener for UCLA, around campus on his skateboard, causing damage to stairs, curbs, and himself. David had always treated him warmly, and Alberto sometimes made up excuses to come in and talk. David excused himself and headed down the hall, walking beside Diane.

  "I hear they ID'd someone," she said. "You have something to do with that?"

  He nodded. "Fill you in later. What time are you off?"

  "Six. Then I'm on again at ten, filling in for Marcy."

  "Okay. Let's meet over at Carson's around six-thirty. Make sure he still has his head screwed on."

  "Ever try to suck your own dick, Doc?" The boy's smooth-skinned face looked up at David. Alberto wore his hair long in the back, and it bunched above the collar of his jacket. Sitting on the examination table with a beat-up skateboard across his lap, he looked even younger than his twelve years. His eyes always squinted, ever so slightly, as if needing constant protection.

  "Not recently, no," David said. "I have a bad back." He walked over and closed the door, then studied Alberto. The boy was clearly sick, his face pale and tired, except where his lips were stained purple from some candy he must've eaten earlier. "Something you want to talk about?"

  Alberto shrugged. "I tried once," he confessed. His heels drummed against the base of the examination table. "Does that make me gay?"

  David touched Alberto's forehead--hot--then walked his fingertips up along the back of Alberto's jaw, feeling for swollen glands. "Why would that make you gay?"

  Alberto pulled away. "Well, I like girls. I'm dying to get laid, even. I don't want to be gay." His eyes pooled with concern. "But, I mean, I almost had a dick in my mouth."

  David inhaled deeply and held it for a moment. "Well," he began, in a textbook voice, "gender roles are a complicated and . . . " He paused, then rubbed his eyes with a thumb and forefinger. "No, Alberto, it doesn't make you gay."

  The relief in Alberto's eyes was palpable.

  "Now can we focus on your sore throat?" David felt again for Alberto's glands, and Alberto winced slightly when David found them. David grabbed a tongue depressor from a Pyrex beaker. "Open up. Open." Alberto refused, and David squeezed his cheeks gently until he complied. Red beefy throat, enlarged tonsils with exudate mucus--what David's mother would have called "angry throat." "Oh boy, kiddo. We have some activity going on in here. Does it hurt?"

  "I had to spit into a bag last night because it hurt too much to swallow."

  "Why didn't you come in?"

  Alberto looked down. One of his untied shoelaces trailed along the tiled floor. "We don't got insurance no more. My dad got laid off, and I didn't want to cost him nothing more."

  David crouched, resting his hands on Alberto's knees. "Alberto, listen to me. If you ever feel sick, you come in here. Don't worry about money. Okay? Now say aah."

  Alberto opened his mouth, and before he realized what was going on, David had already swabbed him with the elongated Q-tip. He handed it to Jill outside. "Let's get a Rapid Strep on this."

  He ducked into the doctors' lounge and called Carson but got the machine. Someone had taped Clyde's police composite to the wall, and David studied it as he left a message. "Carson, it's Dr. Spier. I hope you're doing all right. I'm going to stop by around six-thirty, and I hope we'll be able to talk then."

  Jill met him in the hall on his way back to Alberto's exam room and walked alongside him. "It's positive," she said. "First strep of the day."

  "All right. The patient has a penicillin allergy. He's also got no insurance, but I just met with a rep from Biaxin, and I stowed a bunch of samples in the locked drawer in Three. Would you mind grabbing them for me?"

  David swung into the exam room and faced Alberto with a resigned smile. "You have group A betahemolytic streptococci, aka strep throat. I'm going to get you some antibiotics. You'll take one in the morning, one at night, for ten days. Now, this particular drug has a side effect. It'll give you a dry metallic taste in your mouth, so you'll want to get some Altoids or strong suckers so you can-- " He froze.

  Two minutes later, having paged Ed three times consecutively from the doctors' lounge, he had him on the phone. "I have something," he said.

  "L' Ermitage. Twenty minutes."

  Chapter 40

  A man impeccably dressed in a charcoal suit with a shimmering blue tie, his gray hair coifed, paused in front of David. Still dressed in his scrubs and white medical coat, David slumped on a leather couch in the elegant cocktail lounge of the m
odern, upscale hotel. A fire flickered beneath the screen to his right, though it was August. Before him, on a simple glass table, sat a tray containing jars of wasabi peas, Parmesan twists, and herb-cured olives.

  "Nice outfit, Spier," the man said. "I appreciate your not calling attention to us."

  David literally did a double take as Ed shook his hand roughly and slid into the love seat opposite the couch, slightly favoring his left side. "Don't say anything loud," Ed said softly. "Don't raise your voice, don't act surprised. Just start talking."

  David swallowed hard, finding his train of thought. "The orange zinc lozenges that Clyde was sucking--I think he uses them because he's taking meds that can cause a dry or metallic mouth as a side effect. Doctors usually recommend Altoids or zinc lozenges to cover it." David's voice was high and shaky; he could feel his heart hammering.

  "Slow down. Calm down. Can't you use anything to cover the taste? Like gum?"

  "You can, but generally something stronger is more effective."

  The waitress came over, and Ed ordered a Sapphire martini, up, chilled, with three olives. David ordered cranberry juice.

  "And guess which drugs most commonly have that side effect?" David said, as soon as she departed. "Psychiatric drugs. Sure, now and then an antihistamine like Claritin will dry you out, but classically it's antipyschotics--clozapine, Mellaril, Haldol, Prolixin, risperidone, Zyprexa--or antidepressants, like Paxil or Prozac."

  David pulled a sheet of paper from his pocket and smoothed it on the cocktail table between them. "I made a list of Clyde's symptoms. Jerking pupils, headaches, difficulty concentrating, clouding of consciousness, slurred speech, restlessness, and drunken walking. These all pointed me to nervous system diseases and conditions."

  "But you think these traits are actually drug side effects, not symptoms of a disease?"

  "Exactly. I was so focused on the nervous system presentation, I neglected to write down other relevant traits. So I went back in my mind and tried to think of what I might have missed." Pulling a pen from his scrub top, David added dry or metallic-tasting mouth to the list. "Remember I told you he had swollen hands? Well, I recalled his neck was a bit swollen as well, which could indicate hypothyroidism. He left hair behind on the pillow when he fled, so it could be falling out. Acne and pitted fingernails should be on the list as well." He wrote down swollen hands--hypothyroidism?; alopecia--loss of hair; acne; pitted fingernails.

  David glanced down at the potential diagnoses he'd written beneath. The new symptoms did not fit the symptom clusters for most of the diagnoses on the list. He drew a line through them all except drug toxicity and insecticide poisoning. But insecticide poisoning generally causes excessive salivation, the opposite of a dry or metallic-tasting mouth, so he crossed that one out as well. "We're probably dealing with a drug toxicity issue here. Whatever he's taking, he's taking too much of it and it's poisoning him."

  David looked at Ed with sudden irritation. "And you--where have you been? What happened with the print? When did you tip off the police? Did you know Clyde's not even Clyde anymore? He's Douglas DaVella. He used to work at the hospital."

  "No," Ed said. "Douglas DaVella died three years ago Sunday of colon cancer. He was a sixty-seven-year-old veteran of the Korean War. I ran the print, and the results came back this morning." Before David could say anything, Ed held up his hand. "I got the print results over to the police, as I promised I would. Our boy is indeed Clyde. Clyde C. Slade, to be precise. DOB January 2, 1963." He adjusted his wig with a subtle gesture that looked as if he were straightening his hair in the front.

  "Holy shit," David said. "So he really is named Clyde. But how did he . . . ?"

  "Clyde took Douglas DaVella over. Someone's social security number isn't placed on the social security death index when they die, it gets put there when their death benefit gets claimed. As far as the records go, no claimed death benefit, no dead guy."

  "Don't registrars cross-index birth and death certificates?"

  "Only by county, sometimes state. California does it statewide, but our boy Doug was from Virginia. He didn't move out here till after his tour in Korea. When he died, Clyde stole his social security number so he could apply for a job at the hospital under a false name. One might argue that showed premeditation, were one prone to legal arguing."

  "How did you find out about DaVella?"

  "Public Utilities Commission records. The cops always go the DMV route, which takes longer and is easier for criminals to deceive. But no one thinks to lie to the gas company. My scanner gave me a heads-up they were going after a Douglas DaVella, and my intelligence showed that Clyde C. Slade had changed his name on a gas bill to Douglas DaVella three years back, right after DaVella kicked. Unfortunately, he's not at that address anymore, and there's no new utilities listing for either name. So either he's living in some economy shithole where utilities are provided or he's got a new fake name. Back to square one."

  "They got a current address on DaVella from security. I listened to the news on the way over to see if there was anything about an arrest. Or a shooting. Have you heard?"

  "It was a fake address--some crib off Palms in West LA."

  "How'd he get his paychecks?"

  Ed shrugged. "Maybe he picked them up himself. All I know is, the address is a bust."

  "How did Clyde know Douglas died? There could be a connection there. Maybe they lived in the same apartment complex."

  "I'm checking it out, as, evidently, are the cops. Nothing yet."

  "DaVella had two complaints filed against him when he worked at the hospital, one of them over at the Neuropsychiatric Institute where he wasn't supposed to be. He also had a violent reaction to one of our psychiatrists, who's black, and we'd hypothesized that he was afraid of shrinks or blacks. Now I'm thinking he's got a hang-up revolving around the NPI. I'm planning on checking it out when I get back to the hospital. The cops took the security records, but I can get at the medical records. In this case, I'm hoping, that'll give me the upper hand."

  "Looks that way so far."

  "What did you get on Clyde's background?"

  "Thirty-eight years old. Spent his childhood shuttled from foster home to foster home. Eleven different homes in the first fifteen years of his life. Then he ran away. His juvenile record's expunged--which is odd for someone in his demographic, given the resources that takes--but he's got two adult priors. An indecent exposure and a 647.6."

  "Which is?"

  "Child molestation." He took note of David's expression. "Not like you think. It's not necessarily sexual. It can be anytime someone annoys a kid under eighteen. This was your standard Peeping Tom scenario. He was staring at a seventeen-year-old girl through an open window. They tried to get a resburg" --Ed caught himself and backed up-- "a residential burglary, but they couldn't prove he crossed the plane of the window." He bit his lip. "It was a dusty sill, so they would've seen prints if he had. He just stood there and stared at her--freaked her out. It's pretty much just that and the weenie wagger."

  "Who'd he flash?"

  "A hooker."

  "And she reported it?"

  "She got picked up ten minutes later. She claimed she was merely propositioning the UC--the undercover cop--to catch a ride out of the area, because there was a flasher on the prowl. When they rounded up Clyde, he copped to. Said he was just trying to scare her."

  Ed leaned back, took a sip of his drink, and grimaced.

  "You don't like martinis?" David asked.

  "I hate them."

  "So why . . . ?"

  "Because two grown men sipping juice in a bar are bound to be remembered, just as a waitress might remember a man dressed in a thousand-dollar suit for ordering a Bud. Which is what I really want." He leaned back, crossing his legs daintily. He had indeed mastered the affect of a polished businessman. "Besides, one should always change one's habits. Habits are trails that lead back to you. Never drive the same route, never shop at the same stores, never order the same thing twice
."

  David realized from the expression on Ed's face that his brief speech was more than informational--he was consciously showing David that a trust and rapport was growing between them. Information was Ed's currency, and he spent it cautiously.

  "I'm working a sting right now in the financial district. Thus the attire."

  "I thought you were on the wrong side of the law."

  "When you have a particular skill set," Ed said, "there are no sides of the law. Just things that need to get done." His tone changed quickly; the small talk was over. "So, now that we know that Clyde is, in all likelihood, taking psychiatric medication--too much psychiatric medication from the sound of it--how does that help us?"

  "I can find out which drugs were prescribed for Douglas DaVella while he was at UCLA, who prescribed them, and what pharmacies they were called in to. That gives us a few trails. Plus, the NPI incident involved an alleged attempt on his part to steal a patient's meds, so when I look into that, it may dovetail."

  Ed sucked an olive; the pimiento left the core with a popping sound. "I'm beginning to like you more and more. When can you get on that?"

  "Right now. I'm off today, and I'll have someone cover my shift tomorrow."

  "But you haven't taken a single vacation day in two years," Ed said. "Two years and fourteen days, to be precise."

  "How do you know that?"

  "You think I'd do anything for you without running you? I know how much you owe on your mortgage. I know that asshole Jenkins gave you a fix-it ticket last night, and that the word is it was a break-it fix-it. I know the only B you ever got in your life was in embryology your first year of medical school."

  David smiled, impressed. "Goddamn embryology." He straightened up on the couch. "I have to proceed somewhat cautiously--too much time off in the midst of this could further damage my reputation at the hospital."

  Ed arched a red eyebrow. "Still care about that, do we?"

  "If it undercuts my effectiveness, yes."

  Ed's pale face remained blank. "Let me keep shaking on the paper trail. Get back to me with any info about the meds--that front seems stronger."