Phantom files, p.2
Phantom Files, page 2
“Sue. Sue! Snap out of it. We need to intubate him, now!” I insisted.
Sue shook her head and started moving, slowly at first, but regained control of herself, as she recovered. “Sorry. I know him. This is Dr. Nielsen, Chief of Ob/Gyn, and he’s been my own doctor for years.”
I filed that information away along with the thousand other questions I had about how he ended up being stabbed by a bunch of nails in an MRI machine. “I’m sorry. Let’s get him intubated and over to the trauma room. Dirk, what do you have down there?”
Dirk, working efficiently, had hooked up IV fluids and a monitor. “I’ve got a liter of normal saline running full blast with a pressure bag. Pulse is 175 and weak. Not gonna even try for a blood pressure. This guy’s about to code.”
I agreed. The massive blood loss would kill him soon, unless we could replace it and at least slow the bleeding. I opened his mouth and slid the laryngoscope into the back of his throat. I had to avoid a couple of nails that had penetrated his cheeks, as well as the tip of another visible near his airway. Through a fair amount of blood, the intubation was successful, and a respiratory therapist took over bagging the patient.
“Dirk, grab that end of the sheet and let’s move him to the stretcher. We need him in the emergency room for a chance to save him.”
Dirk grabbed the lower body, while I grabbed the sheet under his head and shoulders, and we slid him onto the stretcher, leaving a trail of blood. The respiratory therapist took her place at the head of the bed, while Dirk placed the monitor on the bed and grabbed the IV bag. We moved toward the emergency room with a trail of blood marking our passage.
We weren’t even out of the radiology suite, when the monitor screamed an alarm for asystole, as the heart tracing flat lined.
“Dirk, begin compressions and keep moving.”
Dirk walked alongside the stretcher, placed his massive hand on the patient’s sternum, and pressed down as he walked. With the first compression I heard ribs snapping, but Dirk continued pushing down at a rate of one hundred beats per minute. With each compression, fresh blood seeped from the wounds in the neck.
Thirty seconds later, we were in the trauma room, and the team went to work to start a second IV. Two units of blood were hung under pressure bags to both IVs, as CPR continued. Pressure was applied to the areas that were bleeding the most, but the majority of the blood loss came from the neck with no way to compress the area and adequately stop blood flow. Removing the nails was not an option, as it would only increase blood loss.
Our efforts continued for another twenty minutes, but ultimately proved futile. At 7:41 a.m, we stopped, and I pronounced Dr. Nielsen dead. The team stepped back in defeat and evaluated the scene in silence. Dr. Nielsen lay naked on the table, his skin white beyond any natural skin tone, marred by the bright red blood that covered his body like an obscene Jackson Pollock painting. The only sound was the constant drip of blood splashing against the floor.
The nails had pierced him like a pincushion all over his upper body. There had to be more than fifty of them. Some caused only superficial cuts, especially across his scalp, but the fatal damage was to the soft tissue of the neck, where the nails had penetrated deeply into major blood vessels. I picked up a nail that had fallen out during our attempted resuscitation and examined it more closely. Typical three-inch nails, commonly found in every hardware store, had been turned into hideous murder weapons.
I addressed the team. “Thanks for the effort, everyone. Unfortunately, the injuries were too great, and he didn’t have a chance. Let’s get him covered with a sheet, and make sure to leave everything as is. This is going to be a murder investigation, and we need to leave everything intact for the authorities. Please maintain patient privacy with no gossip about this, especially when the press shows up.”
I scanned their stunned faces. They were used to seeing the effects of violence in all kinds of brutal forms, but this savagery reeked of a special kind of evil. A colleague from the hospital had been horrifically murdered in an MRI machine. Even the calloused hearts of an experienced emergency room staff were emotionally unprepared for this kind of cruelty.
I saw Sue in the back of the room with tears pooling in her eyes. She made eye contact with me and immediately turned to leave the room.
“Dirk, please get him covered and secure this room until the authorities arrive. I’m gonna run back to MRI real quick.”
“You got it, Doc.”
I dropped my gloves into the trash and pulled on some booties to prevent blood tracking all over the place. Banshee watched attentively, as I exited, highly attuned to the presence of so much adrenaline, blood, and drama.
“Here, boy, with me.”
Banshee fell in at my side, his nose working overtime to categorize the scents. I didn’t have to worry about getting lost, as I followed the bloody trail back to radiology. I arrived at the MRI suite just as Carmen was pushing her cleaning cart into the room.
“Hold up a moment, please,” I said.
Carmen turned her attention to me and smiled softly. She was part of the cleaning crew for the emergency room and always offered friendly warmth.
“What are you doing in here?”
“Radiology asked me to clean the MRI room.”
“There must be a mistake. We need to keep this room untouched for the authorities. I think they meant they wanted the hallways cleaned.”
“They said to clean the MRI room first.”
“It’s been a chaotic morning. We need to keep this room untouched, so please focus on cleaning the hallways first, and we’ll let you know when this room is ready to be cleaned.”
“Okay, Doctor. Did the poor man die?”
“Yes, he didn’t make it.”
“I will pray for him and his family.”
One of the many good souls who kept the hospital functioning, Carmen pulled her cart back into the hallway and began to mop the blood off the floor. I stepped into the room for a quick survey before the circus arrived. The bloody table looked like it had suffered through a war zone, and dozens of nails were spread on the table and floor around the machine.
I turned my attention to the perimeter of the room. Three small cardboard boxes did not belong in the room, one directly opposite the head of the machine and the other two on a diagonal line about forty-five degrees from the MRI machine. The three had been positioned to launch their nails toward the machine as soon as the magnet turned on, definitely intentional.
I studied the box at the head of the machine and saw that it sat on a piece of paper. The box partially obscured words printed on the paper. Wearing a pair of fresh gloves, I gently lifted the box to expose the message. I stared at the words in disbelief, as the mystery deepened. I took a picture of the message before returning the box to its original place.
Outside the room, I found a radiology technician bent over, racked with sobbing.
“Hey, man, what’s your name?”
“Henry. I didn’t know the nails were in there. How could they even get there? He’s dead, isn’t he? I saw you coding him in the hallway. I can’t believe he died!”
Henry was losing it, understandably, given the trauma he had witnessed. “Listen to me. It’s not your fault. Someone did this on purpose. You didn’t do anything wrong, okay? Why don’t you come back with me to the emergency room and step away from here?”
In no condition to argue, Henry nodded. A hospital security guard arrived and peered through the doorway with wide eyes. I reached past him and closed the door. “Officer, please stay here, and make sure no one enters this room or the control room until the police arrive. This area is a crime scene and needs to be processed before anyone else contaminates it. Understood?”
The young officer straightened with his new responsibility and assured me that the room would remain secure. Banshee and I led Henry to the emergency room.
“What do you do now?” Henry asked.
“Make about a thousand phone calls and write up the mother of all incident reports.” I left unspoken my growing plans to figure out who had murdered Dr. Nielsen and left that message in the MRI suite.
CHAPTER THREE
Monday, 8:21 a.m.
Banshee and I stopped at Sue’s office on the way back to the emergency room. I gently knocked on the closed door and called her name.
“Come in,” she stammered.
I found her dabbing her red-rimmed eyes, as she slumped in her desk chair. I quietly closed the door and sat across from her. Banshee, sensing the intense emotions, eased up to her and nuzzled her leg. She appreciated the brief distraction and stroked his head.
“You okay? That hit you pretty hard.”
“In twenty years, I have never walked out of a code, but seeing what happened to Dr. Nielsen was too much. That poor man.” She held the tissue up as a new round of crying overtook her.
“It’s always harder when you know the person. A few months back, I had to take care of my girlfriend’s son after his heart stopped at school. It was one of the hardest cases I’ve ever had to deal with.”
“But you didn’t walk away from it.”
“No, but at the time, no other doctor was available. If there had been, I probably would have turned the case over to them. You stepped away, but we had a full resuscitation team for Dr. Nielsen. It was necessary for your mental health, and the patient’s care didn’t suffer at all from it.”
“Thanks, Doc. Makes me feel a little better. I can’t imagine why anyone would do such a horrible thing.”
“I can’t either. I went back to look at the room and fortunately stopped Carmen before she cleaned it. I found this message under one of the boxes that held the nails. What do you make of it?”
I passed her my phone to show her the picture. The message had been printed on white paper from a black and white printer.
Purification of the hospital has begun.
A price must be paid for past sins.
The Avenging Angel will show no mercy.
Puzzled, Sue reread the message before handing the phone back. “Who the hell is the Avenging Angel?”
“No idea, but I think a lot of people will be working to answer that question. You good? I need to make a few calls, but if you’d like me to stay, I’m happy to.”
“I’m okay. Thanks for checking in, Doc. I’ll be out in a minute.”
Banshee and I strode to the emergency room, where a sense of normalcy had returned. No matter how bad the last case was, the Emergency Department had to keep taking care of the next patient. The staff never had enough time to process emotions, let alone grieve, after trying to repair brutal damage done to people, which explained the high rate of burnout among emergency personnel.
A regular member of the emergency room security team, Officer Tom Hill guarded the door to the trauma room. His bulk and inability to crack a smile resolved most issues before they escalated. In the rare case when a patient chose violence, Officer Hill made them quickly realize that they had chosen poorly.
“I assume you called this in, and the cavalry is on the way?” I said.
“Yes, sir. Circus should arrive within the next ten minutes.”
“Thanks. I have one of the hospital security guards watching over the MRI suite.”
“I’ll send an officer over there as soon as I can. Hospital security is limited to frowning and harsh language. Probably couldn’t stop a motivated toddler if they had to.”
Hospitals are risk averse, and most have unarmed security personnel who are not allowed to intervene physically with visitors. They generally wear spiffy sport jackets, usually yellow for some unknown reason, and carry only walkie-talkies to call for help. Administrations overlook the irony of calling for help from more people who are not allowed to get physical. In the end, hospital security is nothing more than public relations who help lost visitors find their way.
“Hopefully, they can handle the radiology crowd who tend to be more passive than the emergency room crowd.”
Officer Tom rolled his eyes before returning to staring at the wall across from him. He was a patient man until he wasn’t. One thing was clear; no one would enter that room without his permission. I returned to my desk to make the call I dreaded.
I was new to this hospital and hadn’t interacted with this administration yet, but I strongly suspected that they were all the same. The whole top floor was full of folks in suits making decisions based on financial outcomes instead of on quality outcomes. They knew a lot about PowerPoint but nothing about patient care. They would not like this news at all. I decided to start at the top, as the process would end more quickly that way. I dialed the number and waited for an answer.
“Mr. Gentry’s office, how can I help you?”
“This is Dr. Docker in the emergency room, and I need to speak to Mr. Gentry right away.”
“I’m sorry. He’s busy.”
“This is pretty important. Can you please get him on the line?”
“Mr. Gentry does not break his schedule for every doctor that calls. Would you like to leave a message or make an appointment?”
“Sure. Tell him that some lunatic murdered Dr. Lenny Nielsen, the former Chief of Obstetrics and Gynecology, in the MRI suite, and within ten minutes, police and media will be swarming the hospital.”
The personal assistant paused. “Is this a joke?”
“I’m afraid not.”
“One moment, please.”
I listened to peaceful hold music.
“That’s an aggressive approach.” Anna Guidry, another physician in the emergency room, observed. Only three years out of residency, she looked impossibly young to be a doctor, let alone an attending, but she knew her stuff. Compassionate, kind, smart, and energetic, she had a great career ahead of her.
“A benefit of being a traveling doctor on a short-term contract is that I don’t have to concern myself with kissing up to administrators.”
“I may have to look into a traveling position.”
“It has some advantages, like not having to care who you piss off.” I turned my attention back to the phone, as an angry voice yelled at me. Bill Gentry was the CEO of the hospital and not known for his friendliness.
“Who the hell is this?”
Practicing the art of de-escalation, I answered in my most calming voice. “This is Dr. Docker from the emergency room, and there has been an unfortunate incident you need to know about.”
“Then call your Chief. Don’t bother me.”
“Normally I would, but soon, your hospital is gonna be trending on the app formerly known as Twitter for all the wrong reasons. You need to get ahead of this thing quickly.” I proceeded to explain what had happened, and to his credit, Mr. Gentry listened without interruption.
“Tell the staff I want a lid on this. No one talks to the press except for our media team. I’ll make sure police provide security to lock down the first floor. I need to make some calls.” He abruptly disconnected.
“That went better than I expected,” Dr. Guidry said.
“Agreed. Who knows, we may even get a pizza lunch out of this mess.”
“The ultimate sign of thanks from administration, a hundred dollars worth of pizza for twenty-eight employees with no time to eat.”
“You learn fast, Dr. Guidry.”
“Do you think his highness will come down and mingle with us common people?”
“He should. Leadership starts with being present, which means it’s two to one against him showing up down here.”
“Either way, I need to go see some patients. Do you have time later today to talk about something? I have a bit of a strange situation, and I would appreciate your advice.”
“I’ll make time. We should both be done about the same time today, so we’ll figure it out. Right now, I have to go talk to the cops and then figure out who is gonna tell the family. Even for a Monday, this day sucks.”
. . .
Officer Hill watched the pair of detectives approach with his signature blank stare. The woman was dressed smartly in a white blouse and a navy blazer, designer jeans and dark designer athletic shoes. Her height and build were average, and her remarkable eyes constantly scanned her surroundings like a hawk hunting for its next meal.
While the woman gave off a serious vibe, her partner resembled a laid back surfer dude. A wrinkled jacket covered his light blue button down shirt, and neither his khakis nor his loafers looked like they were fresh from a wash. Sandy blond hair in an overgrown mess topped off his image. The man was sharing an animated story, as they approached the trauma room. Officer Hill maintained his statuesque pose.
The woman approached until she was uncomfortably close to the officer and looked up to meet his blank stare. “Good morning, Officer Hill. Are you going to move, or do I have to shoot you?”
After a pause Officer Hill peered down at her. “Threatening an officer is a felony offense. You could go to jail for that.”
“Lucky for me, you’re a lazy piece of shit who hates paperwork. How have you been, Tom?”
Tom flashed a rare smile. “Been doing all right, Detective. So this mess belongs to the First Team?”
“You got that right. They send the best for the biggest cases. Plus, we were on call this morning for the next homicide. Sounds like a bad one,” the man said.
“They’re all bad. This one is unique. The victim was killed with nails left by the MRI machine.”
Officer Hill stood aside and opened the door for Detectives Ellen Frist and Johnny Teamont of the Phoenix police department. Frist and Teamont had worked together for years on the homicide squad and were its most senior detectives. Their nickname of “First Team” was a play on their names and seniority.
“That’s a bit of a mess,” Teamont said, as they looked at the blood covered room. The once white sheet that covered the body was now stained red, and the nails poking up from underneath gave it an especially ominous appearance.
Officer Hill pointed to the shelf inside the door. “Booties and gloves are there, if you want them.”
Frist and Teamont covered their shoes with booties and snapped the gloves in place before they approached the body. Teamont gently lifted the sheet. “I’m no medical expert, but I’m pretty sure that’s not a known complication of an MRI machine.”
