“Did you hear about Ellen Riley? It’s alarming!” exclaimed Mrs. Winchester.

“I did hear about it, Mrs. Winchester,” Katie said. “But what is equally alarming is your blood pressure.”

Mrs. Winchester was normally one of her favorite patients, but Katie’s lack of sleep had made her cranky. Katie turned to wash her hands in the sink and wondered yet again how she’d gotten through her residency. It had been routine in the beginning to get only moments of sleep in a thirty-six-hour period, but now that she was on a more normal schedule, it was as if her brain refused to go back to functioning on so little sleep ever again. Even her hair was tired. It hadn’t put up any fight when she twisted it into a clip that morning and not one curl had sprung loose. Mrs. Winchester was only the fourth patient of the morning, and Katie was already running almost an hour late.

At eighty-four years old, Mrs. Winchester took care of Mr. Winchester, her dying sister-in-law Gladys, and a gang of cats. Her blood pressure was frequently out of control, particularly on housecleaning days. Fighting the dust and dirt that accumulated over one week’s time—an alarming amount—got her worked up.

Each of Katie’s patients had heard a version of Ellen Riley’s death. Those that had been out of the loop due to the lack of a phone or the appropriate gossip contacts got all the information they needed by sitting in Katie’s waiting room. Katie tried to steer Mrs. Winchester back to the matter of her blood pressure, but she was already plowing ahead.

“Such a nice woman—although probably too city for Baxter,” she mused. “She may have done better in Ann Arbor. There’s more traffic there, you know.” She looked at Katie over the rim of her glasses as if the traffic were her fault. “How you young people can drive with all those other cars on the road is beyond me. Why, when we had to go to the University Hospital in Ann Arbor for those tests, I thought we’d never make it back. Even driving here today, we must have passed fifteen cars! Right here in Baxter! What is the world coming to?” She tilted her head so Katie could look in her ears. “And driving so fast, it’s alarming! But poor Mrs. Riley, I just can’t believe it. Why anyone married to Christopher Riley would want to die I just can’t understand. Such a handsome man, like my Henry when he was young . . .” She stopped talking while Katie listened to her heart. “What’s the verdict, dear?”

“You’re just as healthy as last time, but your blood pressure is still too high,” Katie said. “I’m going to change your dosage and see you back in three months.”

“All right, dear.” Mrs. Winchester cocked her head. “You look tired today. I hope you aren’t working too hard. And you’re too thin. I’ll drop off a casserole.”

Katie smiled at her and held out a hand to help her off the exam table. “I’m fine, Mrs. Winchester. I don’t think I work nearly as hard as you do. Say hello to Gladys and Mr. Winchester for me. I’ll see you in a few months, okay?”

Katie quickly stepped into the hall before Mrs. Winchester could continue her diatribe against all things modern. Or question Katie’s health and lifestyle choices.

She closed the door, turned, and saw Nick Hawkins standing behind the nurse’s desk watching her. He was tall with slicked-back blond hair and a penetrating stare.

“I’ve been looking for you,” he said. “Every time I’m out of a room, you’re in one.” He came around the desk and lowered his voice. “I’m really sorry about the call last night. I don’t know what happened. I must have been in a dead zone.” He winced, realizing his poor choice of words. Katie knew that he and Christopher Riley had been friends for years. It was probably just as well that she had been the one to take the call.

“It’s fine. Ellen was my patient anyway.” Katie took a step back. “I’m sorry; I know you were friends.”

Nick nodded. He ran a hand over his face and Katie noticed the purple smudges beneath his eyes. She wondered if he’d been up all night too.

“Thanks,” he said. “Christopher is devastated.” He looked like he was about to say more, but his nurse peeked around the corner and held up three fingers. Nick ran a pain clinic three days a week as well as a regular family medicine clinic. He specialized in palliative care and treating chronic pain. It seemed to Katie that he managed to see twice as many patients as she did.

“I’m falling behind,” he said. “Better get back to work.” And he disappeared around the corner.

Katie walked down the hall to her office and shut the door. She gulped down her third cup of coffee and pulled her schedule up on the computer. What a day this was going to be. Her already full calendar had been crammed with add-ons. Scanning the list of ailments, Katie suspected word had gotten out that she had information on Ellen. Debra Gallagher, the receptionist, was less than discreet and was probably passing out information in the waiting room. With any luck, some of her appointments would get the gossip they needed and have miraculous recoveries.

Thinking about her clinic as compared to Nick’s, Katie got an idea. He turned over almost all the paperwork to his nurse. They had preprinted prescription pads, and all he did was sign them. Katie wrote most of her own prescriptions, but she realized that she didn’t know if prescriptions were logged somewhere when the nurses called them in to the pharmacies. They must be. A doctor would need to sign off on them.

She took the back hall to Angie’s office. Angie Moon was the head nurse and office manager. Katie peeked around the door and saw that Angie was scribbling notes on a yellow legal pad. Her straight dark hair fell forward as she worked. She startled when Katie knocked on the doorframe.

“Oh, Dr. LeClair, you surprised me,” she said. She slid the pad under a pile of charts on the corner of her desk.

“Sorry, Angie.” Katie leaned into the office. “I was hoping you could help me understand some of the charting.”

Angie nodded and gestured toward a chair in front of her desk.

Katie entered and sat, suddenly feeling unsure. She didn’t want to focus attention on the prescription until she knew more. However, she needed to know how Ellen had gotten the medication that had killed her. Curiosity won over discretion. She clasped her hands tightly in her lap and jumped in. “If I make a note to call in a prescription to the pharmacy, is there a separate place where that gets recorded, or does it go directly into the patient’s chart?”

“Did something not get called in?” Angie pulled out a different note pad and prepared to take notes on this breach of protocol.

“No, everything is fine. I just wondered . . .” Katie hadn’t thought this through. But then she had an idea. “If I call in a refill while I’m on call, do I just make a note in the chart, or do I have to enter it somewhere else?”

“Oh, I see.” Angie put her pen down. “You can write it in the chart, but if you don’t want to bother, you can fill out a call sheet, and Pauline will file it in the chart—eventually. However, if you prescribe something new, it would be better if you put it in the chart itself so that you’re sure it gets recorded properly—especially if it’s Dr. Emmett’s or Dr. Nick’s patient so they know what you’ve changed.”

Katie nodded. “And if I ask my nurse to call in a prescription, where does it get recorded?”

“Usually, she’ll make a note in the chart. But no matter what, we log it into the med book so we have a record of what was called in and when.”

“So if a prescription is called in, there is always a note in the med book?”

Angie nodded. “We’re especially careful about Dr. Nick’s pain patients. Any patient on narcotics is closely monitored.”

“And you have the book here in your office?”

“No. It’s in the med room.” Angie narrowed her eyes. “Are you sure there isn’t a problem?”

“No, no problem. Thanks, Angie.” Katie stood and went to the door. “I just wanted to be sure I’d checked all the boxes.”

“I have no worries about you, Dr. LeClair,” Angie said, “and I’m really sorry about Ellen Riley. I heard you were there in the ER.”

“I was, but it was too late to do anything for her.”

Angie shook her head. “Sometimes this job sucks.”

Katie gave a brief nod and returned to her office—she had a plan, but it would have to wait until after she’d seen her patients.

At six o’clock, Katie was finally done with clinic. A few no-shows and cancellations in the afternoon had lightened the load and confirmed her suspicions.

Katie sat at her desk with a stale half sandwich from lunch and a pile of charts. The electronic medical record system hadn’t found its way into this small practice just yet, and the doctors still handwrote their clinic notes. Katie was pretty sure the oldest partner, Emmett, hoped to hold out until retirement. He wasn’t a fan of computers, and Katie had learned not to bring it up for fear of inviting another rant against the digital age.

An hour passed quickly as she scribbled notes while reliving each patient encounter. In residency, she’d done this with a click of a mouse. The computer saved time, but she found the writing reassuring. She revisited the complicated patients and made sure she’d thought of all the options. Sometimes she found things she’d missed.

Katie put the last chart on top of the “done” pile and sat back, suppressing a yawn. She wanted to go home and get some sleep. But she couldn’t let go of the feeling that there was more to Ellen’s death than suicide. And the question of where she got the prescription still loomed.

She pushed away from the desk and grabbed the pile of charts. When she opened her office door, she realized that everyone else had left. She’d hoped to have the place to herself so she could discreetly check into Ellen Riley’s medical records. She found a sticky note on the door asking her to lock up on the way out.

The receptionist, Debra, left every day at five on the dot. Her kids were in some sort of strict day care that charged her for every minute that she was late picking them up. If there were still patients to be seen, she’d be sure the charts were ready to go, and she’d lock the front door. After five, everyone was shown out the back door to the parking lot. Caleb thought it was a creepy system. It meant the patients still waiting never saw anyone leave. How did they know there wasn’t something wrong? Katie had pointed out that most people didn’t see conspiracies, evil plots, and zombie apocalypses in every situation the way he did.

Being alone after-hours was kind of creepy though. The only lights left on were the ones in the reception area, and the whole office was silent. It was an old building, and as she walked to the chart room, the creaking floor made it sound as if someone was following right behind her. Katie was glad no one was there to see how many times she stopped and turned to check that she was alone.

She flicked on the light in the chart room and set the pile of folders on the cart to be filed. The windowless room was filled with row after row of metal shelves. She walked to the back of the chart room to the small medicine room where they kept all the medications that they used in the office. Katie pulled her key ring out of her pocket and briefly wondered how many keys there were for this room. She hadn’t needed to use hers yet. So far, the couple of times she’d needed something during her clinic, one of the nurses had gotten it for her. She found the med book right away and turned to mid-August. She ran her finger down the list of patients. Katie caught her breath when she found Ellen’s name in early September. But it was only a refill for her thyroid medication. There were no other entries for Ellen Riley. So no one had called it in from the office. Katie was both relieved and more confused. She had dreaded finding a note reading, “per Dr. LeClair diazepam 5 mg called to such-and-such pharmacy.” But not finding a note left her no closer to finding out how Ellen had gotten that prescription.

Katie locked up and turned to face the shelves of charts. She went to the section that held the Rs and found Ellen’s chart easily enough, flipping it open. Ellen had come to the practice right after her marriage two years ago. Emmett had treated her for a sinus infection, and she’d been in for a few other minor ailments until three months ago, when she’d switched her care to Katie.

She remembered Ellen’s visit because it had been during her first week in practice with Emmett and Nick. Katie had been nervous and double-checked everything. Which meant that she was painfully slow and looked up every diagnosis in the evenings to be sure she hadn’t missed anything. All through medical school and residency, there’d always been someone else in charge. Someone else to check that the correct medication was being prescribed or the right test ordered. Katie knew she was a good doctor. But that first couple of weeks had been a leap of faith.

She skipped ahead in Ellen’s chart to the last time she’d seen her. It had been a week before her death, and Ellen had come in complaining of feeling “run down.” She hadn’t been sleeping, she said. Katie had sensed that she was worried about something, and when she’d asked Ellen about it, she had admitted feeling stressed about something to do with “research” and too many late nights. Katie only vaguely remembered that clinic—Nick had been at the hospital dealing with an emergency, so Emmett and Katie had been seeing his patients plus their own. It had been a crazy, busy day. She scanned to the bottom of the note. There was no mention of diazepam.

No matter how busy her clinics became, she didn’t think she would forget to chart a medication. And she was sure that she would remember calling it in herself to the pharmacy.

Katie looked in the other tabs to see if anyone had noted the prescription. She went to the “to be filed” bin and set the chart on the edge of the counter. She’d flipped through half the pile and was into dates from August when a loud crash in the hallway made her jump, and she knocked the chart off the counter. On its way to the floor, she saw that the clips were undone. It hit the ground and scattered papers everywhere. Katie listened at the door, her heart racing.

Then she heard the rattling and clanking of a mop in a bucket. Marilyn Swanson, the office cleaning lady. Katie had only met her once when she had stayed late to finish up notes. She took several deep breaths to calm her panic. She knelt down next to the spilled chart and had almost finished piling all the pages back into the folder when the door opened.

“Oh, hello, Dr. LeClair. I thought I heard someone in here,” Marilyn said and looked from the messy pile of papers to Katie. “Can I help?”

She was taller than Katie and very thin with long, straight dark hair and severe bangs. She had an exhausted manner as if she carried too many burdens. Katie felt tired in her presence.

“No, but thank you, Marilyn.” Katie crammed the pages into the folder and clutched it to her chest. She’d put it all back together later. “I was just finishing up.” Katie moved past Marilyn and stepped toward the door. She hoped Marilyn couldn’t see which chart she was holding.

Katie pulled open the door.

“Wait.” Marilyn held out a registration sheet. “I think you dropped this.”

Katie took the document.

Marilyn nodded at the paper in Katie’s hand. “It was sure a shame about Ellen Riley,” she said.

“Did you know her?” Katie tried to hide her surprise.

Marilyn nodded. “Christopher Riley and I were in school together, so I’ve known him all my life. Our parents were friends, and we were like cousins growing up. He’s always been very . . . supportive. When I started my cleaning business, he was the first one to sign up and told everyone about it. He helped me get clients all over town.”

“You must have known Ellen fairly well then,” Katie said.

“Not really.” Marilyn shook her head. “I only saw her briefly if she was home when I went to do their house. She was always busy with one thing or another.”

Marilyn bent to plug in her vacuum. Katie took the opportunity to say good evening and escape back to her office.