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Unnatural Causes by Dawn Eastman (10)

Sunday morning, Katie drove to the clinic. She’d taken a phone call for the practice the night before and wanted to look at the patient’s chart. There was something about the patient that struck her as odd, and she was hoping the chart would shed some light on it.

She also wanted some time alone in the office.

She unlocked and pushed open the door. The alarm pad flashed and beeped, and she quickly entered the code to disarm it. The hallway of exam rooms was dark. Natural light spilled from the doctors’ offices—the only rooms with windows at this end of the hall.

Without making a conscious decision, she walked toward Emmett’s office and stepped inside. She felt weird being in his private space, but the patient she’d talked to was his, and she thought the chart might be in his office. That’s what she told herself at least. Emmett had been acting strangely since she’d started with him at the beginning of the summer. She’d shrugged it off at first, but now she was convinced something was bothering him. She’d noticed that Angie had been bringing stacks of charts into his office.

Katie wondered if he was checking up on her. Not that she would really mind. In residency, she’d become used to people double-checking everything she did. But the idea that he was doing it in secret made her think that he didn’t trust her.

His office was in its usual state of disarray. She had yet to see a doctor’s private office that didn’t have journals piled in a corner and charts stacked on most flat surfaces. He had a corkboard on one wall with pictures of all the babies he’d delivered when he was still doing obstetrics. It was a rare family doctor who still delivered babies in Katie’s generation, but Emmett had done so for the first twenty years of practice. The photos were yellowed with age and filled the board, newer pictures obscuring the old.

She walked to the table by his window and ran her finger down the pile of charts. None of them were her patients. But she recognized a couple of the names as Nick’s patients. She quickly flipped through the pile and saw Nick’s sloppy scrawl on all of them.

He was checking up on Nick?

She turned to his desk and saw a note—“Missing: 2 v. Dem, 1 v. Fent.” Demerol and fentanyl? Both were strong narcotics and often abused.

She reached to pick up the note when she heard the back door click shut.

Her heart began to race. Had she locked the door? She’d heard stories of small clinics being burgled for their drugs. If she had locked it, who was here? She didn’t want to be caught in Emmett’s office. She tiptoed to the doorway and listened.

Whoever it was, he was walking toward the chart room. He wore heavy shoes and had an uneven gait. Nick?

Nick had been in a motorcycle accident a few years ago and still walked with a limp. His experience with recovery was what prompted him to open the pain clinic.

Katie stepped into the hall.

She walked slowly past the break room and the storage room. Just in case it wasn’t Nick, she ducked into the cleaning closet and grabbed a broom. Holding it up like a bat, she continued down the hallway. All the exam room doors stood open, and the rooms were empty. She peeked around the doorway to the records room—empty. Then she heard a noise toward the back of the records room in the small medication room.

Katie froze. There was a narrow shaft of light underneath the door to the medication room. It was a drug thief! Had someone stolen the Demerol and fentanyl and now come back for more? She crept to the door and put her ear up to it. It didn’t sound like a crazed drug seeker. She only heard an occasional soft clinking of glass as if someone was looking through the med cabinet.

Katie turned the knob slowly and pushed the door open.

“Aah!” Nick dropped a vial, and it shattered on the floor.

Katie lowered her broomstick. “What are you doing here? You scared me.”

I scared you? What are you doing with that?” Nick gestured to the broom that Katie was trying to hide behind her back.

“I heard you come in, but I didn’t know who was here.”

“And you thought I was a burglar? And you were going to stop me with an old broomstick?”

Katie shrugged. She turned the broom around and handed it to Nick to sweep up the shards of glass.

“Thanks,” he said and began sweeping the glass into a small pile.

“What was it?” Katie hoped it wasn’t something expensive.

“Just insulin,” he said. He kept the broom over the mess so she couldn’t see the label.

Katie wondered what he was hiding. It didn’t smell like insulin, which had a strange Band-Aidy smell.

“It doesn’t smell like insulin,” Katie said.

Nick stopped sweeping. “Did my dad ask you to check up on me?”

“I’m just here to look at a chart.” Katie held her hands up in surrender. “Sorry to have startled you.”

Nick nodded and pulled a paper towel out of the dispenser by the sink. He carefully picked up the larger pieces with the towel and used another one to mop up the liquid.

“No problem. You can report back that I was just checking our supplies. We have to place an order next week.”

“I don’t know what you’re talking about,” Katie said.

“Okay, we’ll play it your way.” Nick turned his back on her and continued to mop up the spill.

Katie backed out of the room. She’d heard from the nurses that he could be grouchy, but she’d never seen it herself. She turned to the shelves of files but kept one eye on the door to the med room. Angie usually took care of ordering the medication for the practice. Why was Nick here on a weekend taking inventory? Maybe she should be checking up on him.

She found the chart that she was looking for and went to her office. It only took a few minutes to confirm that the medication dose was correct. She could see that Emmett had tried the usual dose with no effect. She picked up her phone and called the pharmacy the patient used to order the beta-blocker.

She hung up the phone and glanced at her bottom drawer. She’d stashed Ellen’s file there and hadn’t gotten around to putting it back together properly. Katie pulled the drawer open and reached inside. The file wasn’t there.

She sat back in her chair and ran that evening through her mind again. She was sure she had put it in that drawer. It was her “pending” drawer where she put anything she didn’t want sitting out but that wasn’t ready to file.

She opened the drawer again and flipped through the contents: medical journals, nonurgent mail, a crayon drawing from one of her pediatric patients, but no file.

She looked in every other drawer in her office and still couldn’t find it.

Finally, she headed back to the records room. Before she entered the room, she heard Nick’s voice.

“I can’t,” he said in a low voice.

He was on his cell phone and pacing in the medication room. The cabinet was still open.

She wasn’t sure why, but Katie stepped back into the hallway before Nick saw her. She didn’t want to give his spying theory any more credence.

She raised her voice. “See you later, Nick!”

She heard Nick stop his pacing. “See you tomorrow. I’ll lock up when I’m done.”

Katie grabbed her bag from her office and let herself out the back door.

She stood in the parking lot, trying to calm the thoughts that swirled in her head. Nick was up to something, and Emmett was checking up on him. He could have called in that prescription for Ellen and put the medication in some food or drink. If they were having an affair, she would trust him. So one partner was checking up on the other, and he might be a murderer.

Her idea of an idyllic rural practice was rapidly evaporating.

* * *

She had arranged to talk to John Carlson at three o’clock. Now she sat in his office checking her watch and nervously doodling in her notebook. He had just as many files and magazines piled around his office as Emmett. There was a picture of his wife, Linda, on his desk and several pictures of Bubba hanging on the wall. She added another item to her “plan” section: “find out what Nick is up to and why Emmett is monitoring his charts.”

She heard footsteps in the hall and quickly stashed the notebook in her bag as she tried to compose a neutral expression.

“Hi, Doc,” John said as he hurried into the room. “Sorry you’ve been waiting. I always forget about the gauntlet of coming in on a weekend. Things that no one wants to call me about pile up, and then when I show up, they’re suddenly elevated to emergencies.” He sat in the chair behind his desk and swiveled to face her.

Katie smiled, thinking of times she had been met at the door by her nurse or receptionist with a list of “urgent” questions.

“Thanks for coming in,” he said. “I just have a couple of questions for you.” He pulled a notepad out of the center drawer of his desk and flipped it open.

Katie cleared her throat. “Sure, John. Happy to help.”

“You were Mrs. Riley’s primary care doctor?”

Katie nodded.

“How long have you been her doctor?”

“I met her a year or so ago when I was doing a month-long rotation with Dr. Hawkins. She switched her care to me when I joined the practice three months ago.”

“Have you seen her recently in your clinic?” Carlson kept his eyes on his notes.

“About a week ago. She came in complaining of feeling tired and wondered if she needed a different dose of her thyroid replacement medication. But as we talked further, it seemed more likely she was dealing with mild stress.”

Carlson looked up. “What kind of stress?”

Katie consciously loosened her clasped hands and took a deep breath. “She was working on some sort of research project, and she said she hadn’t been sleeping.”

“Other than the recent stress, what can you tell me about Ellen Riley’s state of mind in the past month or so?”

Katie sat up straighter in her chair. “I thought she was basically happy. She’d been a little bit tired and was maybe working too much, but in general, she was the same as always.”

John scribbled a note. “You didn’t see any signs of depression or a desire to harm herself?”

“No. I had no inkling that anything like that was bothering her,” Katie said. She leaned forward and looked him in the eye. “I was very surprised that she killed herself.”

John nodded. “That seems to be the consensus from everyone who knew her.” He sighed and put his pen down on the desk. “The autopsy report should clear things up for us. There was no indication other than suicide at the scene.” He spread his hands out, palms up. “Unless it was a terrible accident, I have to conclude that she took the diazepam knowing that she would overdose.”

Katie tensed and waited for the next question. If he asked about the diazepam, what should she say? That she suspected that someone had forged the prescription? Would that implicate Ellen or someone in Katie’s office? Would it just make it look as if Katie was incompetent?

“Did you prescribe the diazepam due to the stress she reported?” John’s hand hovered over his notepad.

Katie swallowed. “I didn’t prescribe the diazepam.”

John looked up from his notepad. “What do you mean? Did one of your partners prescribe it?”

Katie shook her head. “As far as I can tell, it didn’t come from our office. I’ve looked in all the places where it should have been recorded, and it wasn’t.”

“Why didn’t you tell me this earlier?” Carlson put his pen down again and leaned forward.

Katie looked down at her lap. “I had to be sure that I hadn’t just forgotten. It was bad enough that I couldn’t remember, but if I checked the chart and it was recorded, then I didn’t want to make a big deal out of it. Now I wonder how she got it.”

“The paramedics were quite sure your name was on the bottle.”

“I know. All I can think of is that maybe she called it in herself.” Katie held out her hands palms up. “It’s not that farfetched. Anyone can look up the dose online. She would know how to order it from her work as a psychologist.”

“Do you think that’s what happened?” Carlson’s voice had taken on a hard edge. “Did she ask for medication, and you refused?”

“No. In general she didn’t like to take medicine. Even over-the-counter stuff. And I can’t imagine her doing that. It’s illegal, for one thing, and it was unnecessary. If she had asked for diazepam to help her sleep, I probably would have given her some or another sleeping medicine. But I can’t come up with any other explanation for the diazepam that the EMTs found.” Except that maybe Nick was dealing drugs. Or someone in her office was writing prescriptions and not recording them. But she didn’t want to make that accusation until she knew more. She owed Emmett that much.

“Okay, we’ll try to look into that.” Carlson sat back in his chair and picked up the pen. “I’ll talk to the guys again and see if any of them remember which pharmacy it was from, and we’ll try to track it down that way.”

Katie relaxed into her chair. She’d been dreading admitting to her concerns about the diazepam, but giving Chief Carlson this piece of information was the right thing to do. And if she found out where it came from first, she’d find a way to get the information to him.

Carlson’s pen scratched along the paper. He looked up at Katie and changed the subject. “You told me that you weren’t on call that night. Did you ever find out where Nick Hawkins was that evening?”

Katie shook her head. He had already asked her this question when they had coffee yesterday. Why the interest in Nick? Did Carlson know something? Maybe her silence wouldn’t protect Nick at all. “No. He didn’t say. He just said he must have been in an area where his phone didn’t work.”

Carlson glanced at his papers and flipped a couple of pages. “They tried to reach him for half an hour before they called you. That seems pretty irresponsible of him.”

“It happens.” Katie shrugged. “Maybe he didn’t realize his phone wasn’t picking up the calls. Maybe some other glitch prevented the calls from going through. It’s why we have a backup plan.”

“And you were the backup?”

“Yes. If they can’t reach his cell, the answering service is supposed to call his house and maybe his wife’s cell phone. If they still can’t reach him, they call the next person on the list. On Wednesday night, that was me.”

“Cecily Hawkins might have also gotten a call?”

“You’d have to check with the service. I don’t know how he has it set up. I have them call my house and then my brother’s cell, figuring that he’s likely to know where I am and could track me down if needed.”

Carlson made more notes.

“John, why does it matter that Nick didn’t answer the call?” Katie asked. “She ended up in the ER anyway. He wouldn’t have had anything to do with her care initially.”

John flipped his pad shut. “Just following all the lines of inquiry.”

He stood and held out his hand. “Thanks for coming in, Doc. You need to come out to the house again soon. Bubba misses you.”

“I’d be happy to come check on him; he’s a sweet dog.” Katie clasped his hand.

“Tell my wife that. He dug up her flower bed this week.”

John walked her to the front door and waved as she got in her car. She waved back and let out a sigh of relief when he went back inside.

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