The 5th Horseman - James Patterson [68]
“You saw him when he came in?”
“Yes. We did a lung scan. Turned out he had a big pulmonary embolus. We also did an ultrasound on the broken leg, found another big clot there.
“We gave him a blood thinner, an anticoagulant called heparin, to break up the clots; then we put him on a respirator in the ICU.
“Next thing I hear, he’s vomiting blood, excreting blood, and then he goes into shock.”
“What caused this to happen?”
“I didn’t know at the time. We rushed him into surgery, found out he was bleeding massively from a stomach ulcer. Because of the heparin, his blood was superthin. . . .”
The doctor shook her head, her curls swinging as she described what happened next, seemingly trying to get her own mind around the patient’s death.
“Bill Rosen,” she said. “A great surgeon. Tried like crazy to tie off the major vessel to the ulcer.
“We gave the patient a bunch of transfusions, but he was exsanguinating and we couldn’t keep up with him. He was already in severe respiratory distress, and everything just went all to hell in surgery.”
“Meaning?”
“We lost him on the table. Rosen brought him back. Stabilized him. Ruffio was in the ICU for about twenty minutes when he died.”
I was having a horrible sense of déjà vu. Keiko Castellano had received too much of a different blood thinner, streptokinase. It had caused her death.
“Forgive my ignorance, Doctor, but how often does heparin cause ‘superthin’ blood?”
She looked at me, her dark eyes going as hard as onyx.
“What in God’s name are you asking me?”
“Is it possible that Ruffio received too much heparin?”
“Anything’s possible. But there’s a more obvious cause of death, and that’s what’s going into my report,” Calhoun said emphatically. I could almost hear her teeth grinding.
“The man’s blood alcohol level was point two six when he came in. In medical terms, that’s blotto. He was definitely tippling on the plane. Maybe drinking is why he broke his leg on the slopes.”
“Sorry. I’m not making the connection.”
“Bleeding ulcers are common in alcoholics. He didn’t tell anyone about his ulcer,” Calhoun continued. “Maybe he was embarrassed that he was a drunk. There’s a reason for patient intake forms, and this is it.”
“So you’re saying it was death by omission.”
“Exactly! Now, are we finished?”
“Not quite,” I said.
A young man was brought into the ER on a gurney. I saw blood oozing from a gunshot wound to the leg, and the kid was screaming. I stepped in front of Calhoun before she could brush past me.
“Was Dr. Garza in the hospital when Ruffio was admitted?”
“I really don’t remember. I have no idea. Why don’t you ask him?”
“I will. Do you know about the buttons an orderly found on Ruffio’s eyes postmortem?”
“Buttons? I don’t know what you’re talking about, Lieutenant. But Anthony Ruffio didn’t die from buttons. His bleeding ulcer got him.”
Chapter 97
THE NEXT MORNING, I sat inside my battered Explorer thinking about the long hours I’d just spent with CSU and Jacobi, mulling over Ruffio’s dead body.
Now I watched the light silver rain in my headlight beams as a pale sun rose over the skyline.
I pulled out of the parking lot onto Pine, still wondering if Ruffio’s death had happened as Calhoun had described it—a medical accident. Not the hospital’s fault.
I remembered the despair on Calhoun’s face when she said “superthin blood,” her expression as well as her words sticking with me.
I knew this for sure: no fewer than sixty hospital employees had been near Ruffio as he lay unconscious in the ICU, a respirator doing his breathing for him.
Someone could have injected Ruffio’s IV bag with an overdose of heparin before or after his surgery.
Garza could have done it before he left work for the evening.
But one piece of the puzzle troubled me.
How could Garza have put buttons on the dead man’s eyes?
Chapter 98
CINDY WAS AT HER DESK in the City room at the Chronicle, fine-tuning her story, tweaking it again. She was on deadline, but still, she was glad when the phone