TAYLOR JONES SAYS: In Quality Murders by Dan Shine, Amir Baum is a new resident at College Hospital. And when his patients start dying, he gets the blame. His girlfriend Grace is a statistician and sees the deaths as something much more sinister than Amir’s lack of medical ability. She begins to investigate, and that starts a chain of events that even Grace can’t predict. As the bodies pile up, Grace resorts to desperate measures, and so do the villains.

The story is technical in places, but the author tells it with a subtle humor that is delightful, even if it is hard to follow on occasion. It is incredibly complicated, fascinating, and entertaining. Once you pick it up, you won’t be able to put it down.

REGAN MURPHY SAYS: Quality Murders by Dan Shine is an interesting book. College Hospital is experiencing some unexpected deaths among their patients, and thus their quality rating—the number of expected deaths vs. the number of real deaths—is spiking, giving them low quality ratings, which can ultimately affect the amount of money they get from the government and Medicare. Three of the deaths are patients of a new resident at the hospital, Amir Baum. But his girlfriend Grace, a statistician who is a lot smarter than she looks, gets suspicious and begins to investigate, uncovering more than one wicked plot designed to bring the hospital down. The only problem is the people involved will obviously kill to keep their activities secret and Grace has just painted a great big bulls-eye on her back.

Quality murders is a well-written, complex, highly entertaining medical thriller that approaches murder and mayhem from a whole new angle. The story will keep you on the edge of your seat from beginning to end.

Chapter 1

Orientation

Everything that I am going to say to you this morning you will find in the ‘Value and Values’ booklet in front of you,” said Gary Steinman, President of College Hospital Medical Center. “I call it the brown booklet. Let’s take a minute and make sure you have a copy of the brown booklet in your welcome packet.”

There was a shuffle of papers in the room.

“I call it the brown booklet, although it’s obviously not completely brown. There is some red on the cover, and the print, if you examine it, is actually closer to green. But I think we can agree that, on the whole, looking at it as a whole, the booklet is mainly brown. So I call it the brown booklet, although that is not completely accurate. This is the best way I know to let you know which booklet I mean. The brown booklet is about value, and it is value that I want to talk to you about today.” Dr. Steinman, but not his audience, knew that this academic and methodical beginning was only to lend contrast and crescendo to the heights that his talk would soon attain.

“Where is value?” Steinman said suddenly, and he ducked as if value were an incoming projectile. Smiling and calm again, he answered his own question. “The value of College Hospital Medical Center is already in this room. I would urge you to look around.” Steinman himself succumbed to that urge. Like a searchlight, he rotated his gray but boyish head from left to right without hurry and then from right to left, shining light on all with patient equanimity. “That value may be great,” he said at last. “It may be small.” He paused again, allowing his audience to contemplate the alternatives.

“It all depends, ladies and gentlemen, on what we–we in this room–decide.” Amazingly, his voice and eyes dropped on this last crucial word, tossing that pearl negligently away. But it was not lost. For after a pause he retrieved it, even brighter for its moment in the mire, with a loud and rallying cry: “We decide!”

Every other Monday, Steinman, no matter how busy, conducted, by himself, the initial orientation of all new medical center employees. Articulating institutional values was too important. Clearly identifying who led this institution was too key.

Janitors and neurosurgeons sat in the same room together, mere interns and the expensively recruited heads of departments. Once, a new resident in Emergency Medicine showed up in torn jeans and fell asleep. The resident was gone next day, and the ER limped along one shy.

Amongst the hundred or so there that Monday in June was Grace Paine, newly hired junior statistician, and Amir Baum, newly hired medical intern. Both sat quietly next to each other, but there was nothing quiet in the attentive focus of Grace Paine, the dark unwavering ferocity of her eyes and her tensed, immobility.

“And what is value?” Steinman asked, his voice suddenly quick and light and his shoulders lightly shrugged. The answer, he implied, was not at all as light as his voice and gesture pretended, but deep and portentous. He studied his audience to see if he had communicated this hidden meaning, and found that he had, so he repeated with a negligent shrug, “What is it?”

If Grace Paine had been a crouched leopard and President Steinman a baby rabbit, her stillness could not have been more profound. “Yes,” she breathed. And then “Yes, yes, yes.”

Amir leaned over to murmur gently into her ear, “Grace, ‘yesing.’”

“I will give you a clue,” continued President Steinman. “Value,” he declared, “is not a thing.” A hint of merriment crept into his eyes, letting those truly attentive in the audience know that here was a puzzle to be enjoyed and that there might even be more riddles yet to savor in his talk. “Value, is a relationship. A relationship.” He paused and intertwined his fingers.

Amir sensed that now might be the time for them to take a break from this lecture. He gestured to Grace that he really had to speak to her outside. The deep pause that President Steinman had inserted between his introduction and exposition provided decent cover. Sitting far in the back, Amir judged the political risk of a quiet departure against the risk of a disturbance that he felt growing more and more likely from the intense young woman beside him They were just gathering themselves to leave when the president resumed and they settled back in their seats.

“The one hand of this relationship is quality,” said President Steinman, holding up one hand. “The other is cost.” He suddenly and “magically” brought his other hand out from behind the lectern. “When we put the quality hand–” He raised and extended the “quality” hand. “–over the cost hand–” He straightened and lowered that one. “–we have created…” Here, he slowly brought together his two hands and united them, holding them up before the audience and gently rocking them to demonstrate the strength of the joined concepts. “…value!”

“No!” Grace cried. “That is foolish. It is shallow. The relationship is not reciprocal. It is sigmoid,” she blurted out, not really speaking to Amir. But she had not just spoken aloud, she had spoken too loud–much too loud to be a local comment, decibels past a question, really into the territory of a struggling removal by uniformed officers.

“A question?” asked Steinman, who had not accurately processed her tone. He was surprised and pleased. “Yes?” He pointed to Grace, and all turned in their seats.

“Sorry,” Amir said, half-standing awkwardly. “No. We were just…the value concept.”

President Steinman understood that these were challenging and rewarding ideas. He nodded appreciatively and went on.

Chapter 2

Nights

Night in the hospital was always a wild card, and what waited for him on Twelve South had night written all over it.

Amir heard the angry voice when he was still five floors away, getting louder and louder as his elevator got nearer.

“I am going to have your license, and your license, and, girlie, you can bet your tuchas I am going to have your goddam license!”

A short, stout, frantic woman, actually stamping her sneakered feet, blocked the entrance to the nursing station. Her broad back fixed the center of Amir’s view as he stepped from the elevator. Even quiet and standing still, she would have looked unhinged. What must have been part of a pink flannel sleep garment was tucked unevenly into her outsized jeans, and her feet were bare in the sneakers. She clutched some kind of crumpled document.

This was the sort of thing that made Amir apprehensive, but then so did many things. Arriving just before six that morning, the eighth day of his internship at New York’s prestigious College Hospital, he still perceived his long white MD coat as very much longer than his medical student jacket. He still considered himself to be Dr. Baum*, the internal asterisk explaining to himself that he wasn’t really a real doctor.

Entering the nursing station from the side, Amir took from his backpack what seemed, to him, to be a fraudulent white MD coat and toy stethoscope. He approached Jocelyn, charge nurse on Twelve South and the “girlie” whose license was about to be had.

“What’s going on?”

“Mrs. Weingarten, here?” Jocelyn indicated the woman with her eyes only. She appeared to be hiding from her tormentor in the recessed interior of the nursing station, now gazing intently at swimming fish on the screen saver. “Her husband had a stroke overnight, and I think maybe night coverage didn’t handle it like they should have. He was in for pneumonia, and this just happened.”

“Teaching patient? Was a resident covering?” he asked.

Mrs. Weingarten was not so much louder than before as she was more inclusive, now addressing not just the Twelve South nursing station and the nurses in it, but the howling elements on a wild and storm-wracked heath.

“No!” she cried and paused dramatically. “No!” she repeated and paused once again. “You hear what I’m saying? No! I’m very sorry. I don’t care who the hell you think you are, but you can’t do this to Sol Weingarten in an American hospital.”

“Non-teach,” Jocelyn told him, “a non-teaching patient. It was moonlighters, Dr. Habib and Dr. Nkrule. You know, Firs and Bento?”

Firs Habib and Bento Nkrule were two foreign medical graduates who worked together quite a lot as moonlighters at College Hospital, especially on weekends, responsible for the patients that training doctors–residents–didn’t take care of. Amir knew both Firs and Bento a little, admired them, he supposed, for their determination and pioneer spirit, starting all over again like that, after years of training and practice, in a land so very far from theirs. Well, and far indeed. Both Bento and Firs viewed as interchangeably desirable a career in Alaska’s north, on Hollywood Boulevard, or up river in a Mississippi town. It was all America to them.

“Do you want me to speak to her?” Amir asked.

“Do you really want to speak to her?” Jocelyn said doubtfully. “We did call patient relations, and he isn’t your team’s patient.”

In the old days, at academic hospitals all over the country, there were no non-teaching patients. Residents took care of everybody all day and took turns covering every third night. Night was supposed to teach independent decision-making. Exhaustion was a rite of passage. And there was always a doctor on duty who knew, not from a scribbled sign-over list, but first hand, the events of the preceding day.

There were good medical and educational reasons for night call, but the reality of being there as a resident, at night and alone, dwarfed them. Residents were the princes of night, that kingdom full of terrors, tall stories, and urban legends. Like a fairy tale, night call was the fertile dark that, within only hours, grew a magic seed into regrets, terrors, entanglements, or lifelong friends.

Residents still took night call, although less often, and still glimpsed the dark hours where illness incubated crisis, and the impossible lurked in quiet corners. Amir was glad that morning that he hadn’t had to deal with Mrs. Weingarten.

Looking more carefully at her now, he recognized the kind of face he saw all the time on the subway–a tough woman in late middle age, could be a secretary on her way to work. A little too much makeup on the eyes and lips, matte dyed hair, and a “we’ll just see about that” set into her lined white face. Now that face was fearful, smeared with displaced makeup, and, of course, very angry.

Mr. Weingarten’s stretcher glided past his wife on the way to a magnetic brain scan. Amir only glimpsed the man within this medical mummy, wrapped for consignment in layers of thin blue waffled blankets up to his nose.

“Mrs. Weingarten? Mrs. Weingarten? I have to ask you to wait here.” Jocelyn was almost physically restraining her, standing between the two Weingartens. “He’s going to be right back. Mrs. Weingarten, you need to wait here. Look, I’m going to ask the resident to speak to you, okay? I’m going to ask him right now. You need to speak to him here, though. Okay?”

Mr. Weingarten served as his own shelf for the electronic gadgets and clear plastic tubes that traveled with him, beeping or flashing or quietly awaiting use. Apart from performing this function, Mr. Weingarten himself did not appear to be a particularly necessary part of the package now conveyed by the nurse from radiology and the twelfth floor transporter, brisk and wary as Brinks guards, into a waiting elevator.

Amir, seeing Bento and Firs in trouble with their adopted land, wondered again and more seriously what ambition or compulsion could ever have sent him to be an intern in Burundi or Syria. Or for that matter Iraq, the land of his mother and of his birth. Would he go–go back–with Grace? Would she leave everything and go with him as his mother had with his father? And why was he always patronizing Bento and Firs? Just what part of his American MD, other than its eye-popping cost, made Amir Baum, the Americanized Iraqi refugee, a better doctor than Bento Nkrule?

Bento and all the moonlighters viewed nights quite simply as a financial opportunity until a permanent job turned up. Last night had passed quietly until 4 a.m., when he was called to the bedside of Marion Weingarten’s husband. Bento found a man, newly paralyzed on the right side, who had trouble speaking. This was apparently quite unexpected in what Bento’s sign-over notes called a sixty-two-year-old White male with history of high blood pressure admitted because of extensive pneumonia.

As necessary medical tasks were being done, a nurse called the patient’s wife to come to the hospital. Bento heard the nurse’s consoling words. Her husband had taken a turn for the worse. He was stable, in no danger, and the doctor would explain everything.

Sitting with Mrs. Weingarten in the break room of the nursing station Bento mulled over the exact wording of how he would tell her what had happened. Clarity is best, he decided. I will put it to her clearly. I will just say your husband has a blood clot on the brain.

He cleared his throat. “Jo hub,” he said, leaning forward with great sympathy and good eye contact, “habby blow cloth ony brang.”

The woman blinked. “I want to know what happened to my husband. What the hell happened?” She paused. “He’s here with pneumonia, and now I don’t know what happened. He didn’t speak to me. Is he all right? What’s happening?”

Nodding to acknowledge her natural distress and speaking much more slowly and distinctly so as to emphasize each separate word, Bento repeated, “Jo Hub. Habby. Blow cloth. Ony. Brang,” He added, encouragingly, the real possibility of improvement: “Ez posl mproo.”

Now, she yelled, “Are you out of your goddam mind? I want to speak to an American. I want an American doctor who speaks American.”

The charge nurse heard this storm in her break room and immediately paged the other covering physician for non-teaching patients. Dr. Firs Habib was on the floor already, in a nearby patient’s room. She explained the situation. “Get in there now and talk to this woman,” she commanded, almost dragging the young man into the room. “Here’s Dr. Firs. He can explain to you about your husband.”

“Doctor, you tell me right now what has happened to my husband. Right now! Right now!”

Firs took a steadying breath. A blood clot, he thought, I will honestly and simply tell her he has a blood clot. “A bloo cloo,” he said. “E godda bloo cloo.”

“Ez posl mproo,” Bento reminded her, to which Firs firmly concurred.

“Bey, bey pozl.”

It was into the aftermath of this, with all the marks of a crazy night on it, that young Amir entered at 6:00 a.m. this Monday in July. Non-teaching patient. Not at all Amir’s problem. Dr. Miles, who presumably had also been called last night, was the attending, the senior physician in charge, and he would be in to make rounds, probably soon. He could sort it all out, and he would have the scan result too.

But Amir was there right now. And Mrs. Weingarten was very upset right now. And it looked like Jocelyn had taken him up on his impulsive offer to speak with her. He came to her gently and not so much as a doctor, but more, really, as a son. And more even than that, simply as a human being. The empathy he was clearly showing filled Amir with a brief warm glow of self-regard. He began very gently. “Mrs. Weingarten?”

“Who the hell are you. Who are you? What happened to my husband? Who are you?”

“My name is Amir–”

“No! No! No Amir. No Amir. No boogy woogy. I am on Forty-Fourth Street and I want an American doctor.” Her breathing became loud and angry through little saliva strings, and her foot stamping began again. “Police!” she bellowed now, “Police…”

Internship was said to be a time of intense learning. One thing Amir learned that morning was that he would have done much better to lead with “Dr. Baum.”

© 2016 by Dan Shine