The cathedral murders, p.4
The Cathedral Murders, page 4
“How are you feeling today, Mrs. Jimenez?” Isabella asked.
“I’m doing very well, my dear.” She smiled. Her husband, sitting in a chair at the bedside, stopped reading the newspaper and said, “You guys have such a great team!”
“The other doctor that works with you, Dr. Arenas. He’s very nice, too. Is he your boss?”
“Guillermo. Yes, he’s an intern.” That apparently didn’t mean anything to the old lady as she just stared at Isabella with a blank face. “He’s in his last year of medical school,” Isabella explained.
“And what about you, dear?”
“I’ll be an intern next year.”
Carol, the head nurse, was watching the interaction from a short distance. “She’s such a sweetheart. Isn’t she, Dr. Castle?”
“Yes, she is,” Isabella said with a not very confident smile. “Can I talk to you for a second?” She whispered as they both walked away. Isabella looked at her closely for the first time. Carol had pale skin, delicate facial features and big black eyes, and despite being probably in her mid-sixties she was still a beautiful woman. “I’m worried about her, Carol. Her leg remains swollen and red, she still has low-grade fevers and her white blood count is still very high.”
“During rounds, the team’s plan was to add a second drug to broaden the antibiotic activity.”
“I know, and that’s okay, but what if it’s something else?”
Could she have something else? Isabella was especially worried about a deep venous thrombosis—a blood clot—in the leg, since lack of mobility is a risk factor and Mrs. Jimenez had been mostly bedridden for over two weeks. Unfortunately, most public hospitals in Peru didn’t have the technology needed to make the diagnosis. As with many other modern imaging exams, ultrasound Dopplers were only available in private clinics. And they usually had to be paid by the patients and their families with out-of-pocket cash.
Isabella spoke with the husband. He could pay for the test but couldn’t afford the expensive hospital ambulance for the ride.
“How do you like rounding with Casals?” Guillermo interrupted her thoughts suddenly.
“Very much. He’s a really good teacher.”
“Let me tell you something most people don’t know about him. During his college years, he had long hair and a big bushy beard. He was the Latin-American hippie of the sixties, occasional marihuana smoker.”
“Ha! No way! He’s so serious, I can’t even imagine him like that.”
“It was trendy for university students and intellectuals those days to have this idealized romantic version of socialism, the Cuban revolution and Che Guevara. Someone mentioned that he even joined a left-wing party. I guess at some point he chose science over politics and decided to apply to medical school.”
“How do you know all these things?”
“Doctor Carlos Zubieta shared with us after rounds a while ago.”
“I’ve never met Dr. Zubieta. He’s the one who introduced the bedside teaching rounds the way they are now, right?”
“Correct. He trained Casals, too. I guess he represents the classic master clinician model that Casals loves. He is retired now but occasionally attends rounds.”
Isabella didn’t say anything. Her thoughts were already somewhere else.
“Something wrong?”
“Sorry, I’m fine,” she said politely. “Hey Guillermo, I wanted to ask you something about our patient, Mrs. Jimenez.”
15
“Good morning, Mr. Prime Minister,” Bishop Silvestri said, holding the telephone in between his right shoulder and neck while lighting up a cigarette with his left hand.
“Father Silvestri! It’s nice to hear from you!”
“I read the very sad news about Dr. Loayza in today’s paper,” he said as he walked back and forth around his desk in the dioceses of Ayacucho.
“Yes, very sad.”
“What exactly happened?”
“A terrorist ambush. Dr. Loayza was driving back to Lima after a weekend at his beach house in Punta Hermosa when the car in front of him suddenly stopped. A young man, probably in his early twenties, came out of the car and shot the Minister in the head twice from a short distance. He died a few minutes later before the ambulance could make it to the scene.”
“That is terribly sad. We really need to stop this madness.”
“We received a video that we haven’t made public, showing one of the terrorist leaders claiming authorship of the attack. The bastards!”
“Like I said, this madness needs to end. In any case, if the president has not chosen his next minister of health yet, if I may suggest, I think I know somebody that would be an excellent candidate for that position.”
“I don’t believe he has any serious candidates yet. Who do you have in mind, Father?”
“Dr. Augusto La Mota, a well-known and highly respected surgeon who also has leadership experience in healthcare administration as he’s currently the director of Santa Maria Hospital.”
“I know Dr. La Mota. Great guy indeed. I will definitely bring it up to the president for sure, Father.”
“Thank you, Mr. Prime Minister.”
16
Isabella noticed Guillermo’s brown eyes narrowing down as she explained her plan “What do you think?” she asked, worried he was going to say no.
“You wanna get Mrs. Jimenez, who can barely walk, in your pickup truck and drive her to a private doctor’s office to get a venous ultrasound? You can’t be serious!”
“Yes, Carol already called the office and they’re holding a spot for us if you agree. The husband will pay for the test—for which, by the way, Carol got them to drop the price by fifty percent.”
“You’ve got to be crazy! What if something happens to her on the way? What if she falls and breaks her hip? What are we going to tell Casals?”
“We can tell him tomorrow once it’s done.”
Guillermo shook his head and looked down in disbelief. “I can’t believe we’re doing this.”
There was no time to waste, a blood clot in the leg can break and travel through the circulation into the lung vasculature—a potentially lethal condition called pulmonary embolism. She squeezed Mr. and Mrs. Jimenez, Guillermo and a wheelchair into her truck and drove them to a well-known vascular surgeon’s private practice clinic thirty minutes away.
“This is a pretty big car you have,” Guillermo said as she was looking for a parking space.
“I know, the style is not very ladylike.” She smiled. “My Dad got it on my twenty-fourth birthday and specifically chose a vehicle this size to protect me from the out-of-control traffic of Lima.”
“I don’t blame him. Driving in this city can be a dangerous adventure,” he said laughing.
Once they were checked in, they all sat down around Mrs. Jimenez’ wheelchair. Isabella felt the entire group was completely out of place in the swanky office’s waiting area.
“How long have you guys been together for?” Guillermo asked the old couple.
“We’ve been married for forty-nine years,” Mr. Jimenez said proudly. “But we‘ve been together since she was twelve and I was fifteen.”
“Next year we will celebrate our golden anniversary,” Mrs. Jimenez added while looking at her husband in awe.
“Fifty years! Wow, that is incredible!” Guillermo said.
Isabella just sat there smiling. Sometimes she wished she was naturally more outgoing. She wanted to ask: Do you have any advice on how to have a long, loving relationship?
Once Mrs. Jimenez got on the exam table, the ultrasound took only a few minutes and demonstrated a blood clot extending from the veins mid-thigh to right below the knee.
“It’s called a deep venous thrombosis, or DVT for short. It’s a blood clot in the leg veins,” Isabella explained. “If we don’t treat it right away with blood-thinning medicines, the clots can break, travel with the circulation up to the chest and cause a blood clot in the lungs. A blood clot in the lung can be extremely dangerous, sometimes even fatal.”
“Thank you very much, doctors. You’ve been really good to my wife and I. I really appreciate all that you’re doing. I really do,” Mr. Jimenez said with tears in his eyes.
“You don’t have to thank us for anything. We’re just doing our work,” Guillermo said.
Once back to the hospital, Mrs. Jimenez was started on intravenous blood thinners the same evening.
By the time Isabella got home that evening, her parents were already in bed. She was exhausted but in a way feeling accomplished, knowing the extra effort had paid off. Despite the limitations, they were able to appropriately diagnose and treat Mrs. Jimenez. She noticed that lately, her mind had been occupied with more positive thoughts rather than self-destructive ideas. She was not thinking about her ex anymore. The previous year had been a difficult one. Her brother Diego had moved away to the United States. With no close friends, she had spent her last summer off mostly by herself, in her bedroom, reading and re-exploring some old music. She stared for a few seconds at her cassette tapes and CDs: The Smiths, Joy Division and Depeche Mode. Certainly not the most uplifting music. Things have not gotten much better during the Ob Gyn rotation, which she could not have hated more. Nevertheless, Isabella had not felt content like this in a long time. It felt good to be away from the classroom setting and able to apply the basic sciences knowledge learnt through the first years in real-life cases. She was excited about the intellectual challenge of the search for the diagnosis. A good patient’s outcome was the best reward. She was able to appropriately diagnose Mrs. Jimenez, and hopefully she could soon go home to be with her charming husband.
I’ll bring them a present for their fiftieth anniversary.
17
Isabella knew Casals would be mad the next morning but she didn’t lose much sleep about it. She had no doubts she had made the right decision. In a way she felt a little sense of accomplishment. She had broken the rules but it was for a good cause. As she drove to work that day, she couldn’t wait to check on Mrs. Jimenez, hoping her leg was already showing signs of improvement. And she couldn’t wait to see Mr. Jimenez’ face of happiness, thinking his wife will be discharged from the hospital soon.
“Where is Mrs. Jimenez?” she asked Carol, the charge nurse, after noticing her bed was empty. “Did you move her somewhere else?”
“She died, Doctor.”
“What? “ For a second she thought she heard the wrong thing. She died? How is that even possible? “I don’t understand. How?”
“It happened in the middle of the night. All of a sudden, she went into cardiac arrest. Probably a pulmonary embolism, I would say. Regardless of the cause they told me she passed peacefully. Thank God for that.”
Mrs. Jimenez died. She stood up there in the middle of the unit unable to move. What could have happened? A pulmonary embolism makes sense, she thought; one of the blood clots in her legs traveling to the lungs. If large enough, the clot can obstruct the blood flow to the heart, causing the blood pressure to drop, in severe cases leading to a cardiac arrest. However, she had been started on intravenous blood thinners immediately after they arrived from the test.
Suddenly, with no explanation, she had the urge to see her body.
“Where is the body, Carol?”
“Excuse me doctor, what did you just say?” Carol asked, her eyes wide open in surprise.
“Her body, Carol. Mrs. Jimenez’ body.”
“It’s probably still in the morgue, waiting for the family or the funeral home to pick it up.”
Without answering, Isabella left the unit. She didn’t care that she had still not seen any of her other patients. There was a strange force pulling her to see her patient one more time.
The morgue was a cold, desolate place in the lower level of the hospital. For Isabella, it felt more like a dungeon. She was familiar with the area since it’s next to the pathology lab, where they used to look at slides of diseased organs under the microscope. As she approached she could feel the unmistakable smell of formaldehyde.
She opened the door with hesitancy hoping nobody was going to yell at her. Hospital workers tend to be very protective of their territory. An impressively overweight individual was sitting on a chair, leaning against the stainless steel autopsy table. He was wearing a dirty white lab coat and appeared to have fallen asleep while reading the newspaper.
“Hi,” she said, “I was the intern in charge of Mrs. Jimenez. Would it be okay if I take a look at her body?”
“That’s a very unusual request” he said as he slowly woke up from his state of hibernation. “Why would you wanna look at the body?”
Isabella didn’t quite know what to say right away. She looked around. The room was relatively small, surrounded by old metal shelves with books and cabinets with many specimen jars.
“She was my patient for more than a week. She passed overnight. I didn’t have the chance to say goodbye.”
“Fine. Go ahead,” said the guy while trying to remember what was the last part of the paper he read.
She uncovered the cadaver lying on the stretcher. It was her. Mrs. Jimenez’ aura of kindness looked unchanged from before. Only her color was different. Something in between white, purple and gray. She grabbed her hand. It was room temperature cold. Although they had not talked as much as she would have liked to, Isabella felt they had developed a special bond. She had finally started to think that it was possible for her to empathize with people. Maybe I have some feelings. Maybe I’m not that weird. But at the same time, she could not stop having some sort of guilt for not being able to prevent her death.
The morgue guy did not look happy with the unexpected presence of the young doctor. Isabella caught him staring at her possibly with curiosity at the beginning but slowly she felt the sense of lust on his face was becoming too much to ignore. Clearly uncomfortable, she needed to wrap things up and go back to the unit.
Isabella explored Mrs. Jimenez’ body up and down. Her leg was still swollen and the redness had more of a purplish tone now. She appeared in peace, almost smiling. Her face…there was something new about her face.
“Who did this to her face?”
“Excuse me?”
“Her face!”
“What are you talking about?”
“Her face. Look at it.”
He let out an exasperated sigh and approached in slow motion. “What is it?”
He got closer. Now he could see it. Somebody had painted a small black cross on her left cheek.
“What is this?” she asked him again.
“I have no idea, ma’am. That’s the way she came. Nobody had touched the body since she’s been here. Maybe a priest said a prayer for her on the floor. I don’t know.”
“A prayer and face painting? Never heard of anything like that before.”
The obese guy now looked clearly irritated. He had enough questions.
“You better go. I have stuff to do here. Go before I call your supervisor. “
18
Guillermo had anticipated this moment. Unfortunately, he did not foresee how bad it was going to feel.
“I can’t believe what you did! Why didn’t you tell me before?” Casals raised his voice. He didn’t look like he was trying to hide how mad he was.
Isabella and Guillermo were standing in front of him, avoiding all eye contact.
“I’m gonna have to talk to Dr. La Mota, who is not only the director but also in charge of all the clinical rotations in the hospital, and Dr. Cazorla the Dean. I’m afraid you are gonna be in trouble, you may even get suspended. I don’t know. I’ve never seen a situation like this before,” he said, shaking his head.
“It was my idea, sir. Guillermo is completely innocent.”
“Guillermo is your intern, he is your supervisor during this rotation and he’s also responsible for what you do, too. If he wasn’t sure about it, he should have asked Hugo, your resident.”
“I thought the test was necessary to make the diagnosis, sir,” she said, looking down.
“Unfortunately, this is a poor country and this is a poor hospital and our patients are also poor. There are going to be many instances where we may not be able to make the diagnosis because the test needed is not available or it’s just too expensive and the patients can’t afford it. It happens every day. We try to do our best with the tools that we have. What would have happened if she had an emergency while you were driving? If she became unresponsive or developed an irregular heartbeat or went into cardiac arrest? She could have died while in your car and we all would be liable for that!”
Guillermo looked at Isabella’s eyes for a second. “We’re very sorry, sir. This will not happen again,” he said. She understood this was not the time to argue with the boss.
“Well, she died later the same night, how do we know she didn’t die from a pulmonary embolism triggered by the car ride?” Hugo, who had been listening in silence, added more uncertainty.
“Long car trips are a risk factor for venous clots for sure. The car ride to the vascular office was relatively short. Although unlikely, it’s certainly a possibility that we cannot disprove,” Casals said as he was leaving.
Hugo waited until Casals was gone and then turned towards Guillermo. “Listen my friend, you need to keep your student under control. She doesn’t tell you what to do. Okay. Start practicing now and maybe your future wife won’t be the one in charge at your home.”
Thank you for your invaluable input, asshole.
“Let’s take a break, Isabella. Let’s go have a snack.”
“Okay. Cafeteria?”
“No, there’s this little stand next to the surgery building where you can get soda and crackers.”
