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“I have to tell someone in authority here.”
“Go straight to the top, Doctor.”
I took latex gloves and a glassine envelope from my jacket pocket, scooped up the buttons before they could disappear. I phoned CSU and located a pair of night-duty criminalists, who said they’d be right over. And I called Jacobi. Got him out of bed.
While I waited for support to arrive, I mounted my own investigation. It was like gunning a motorboat across the chop in a squall-tossed sea.
I flashed my badge repeatedly, questioned harried, irritated doctors, nurses, aides, and orderlies, asking, “Where were you when Anthony Ruffio was admitted to Municipal?”
“Where were you when he died?”
During each interview, I looked for a gesture, a tone of voice, a “tell” that would light up the board and spell out killer.
I detected nothing of the kind, nothing at all.
Chapter 96
DR. MARIE CALHOUN was the attending physician in the ER that night. She was in her early thirties with springy brunette curls, ragged cuticles, and an energy level I’d call manic.
We stood together behind a bank of nurses at the hub of the ER. Looking past me much of the time, speaking in a clipped, hurry-up manner, Dr. Calhoun tried to explain Anthony Ruffio’s death.
“Mr. Ruffio had been on a flight from Geneva by way of New York,” she said tersely. “It was a long flight, and his left leg was in a cast. He developed acute shortness of breath on the plane. As soon as it landed, he was rushed to the ER.”
“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.”
