Hunting for Hippocrates. Warren J. Stucki

colt’s death?

      With a grim sense of foreboding, Moe closed Casey’s abdominal wall with the O-silk, then wrapped him in a blanket. Tomorrow he would give Casey a proper burial, and he’d have to save his grief till tomorrow too. Tonight he still had work to do. Tomorrow, after he had buried Casey, he would take some of those gastric contents into Ray Mosdell and have him do a proper toxicology screen, but tonight he had to do some studying.

      After washing the blood from his arms, Moe trudged up the stairs to his study. He scanned his bookcase for a minute, then pulled the PDR, Physician’s Desk Reference, from the shelf and turned to the section marked: PRODUCT IDENTIFICATION GUIDE. This section displayed color pictures of each pill, arranged alphabetically by the manufacturer. First, was Abana Pharmaceutical with all its pills shown in graphic color, then Abbott. Moe thumbed through the section, stopping briefly to look at any blue colored pill. For instance, Bristol-Myer-Squibb made a blue pill, Megace, which was sometimes used to treat prostate cancer. Flipping the page, Moe continued to search. After a few minutes, he stopped at Dupont Pharmaceutical. They had a blue pill also. It—by god—it was a four milligram Coumadin. That had to be it!

      In a flash, it all made sense. Someone had been crushing and feeding Casey Coumadin, a blood thinner. His blood had gotten so thin that he began to hemorrhage from the stomach and bowel, not an uncommon side-effect of Coumadin, and simply bled to death. He had died tonight and Moe hadn’t been there to help him or at least provide a degree of comfort. Alone in the rain, Casey had died, separated from his mother by a pipe fence.

      In his mind, he ran through several different scenarios, but there was only one that made any sense. Horses didn’t go to the medicine cabinet, open a vial of pills, then chase them down with a glass of water. Horses had to be fed pills. Casey had been deliberately murdered!

       TWO

      Moe dressed for work the next morning without having ever closed his eyes. He had finally flopped on the bed at about 3:00 a.m., but sleep did not come. The only possible positive spin of Casey’s murder (yes, it had to be murder) was it had occupied his mind. As a consequence, he had spent little time dwelling on the funeral and his miserable relationship with his father and his family in general. Lying in bed with his eyes wide open, he’d whiled away hours trying to answer the questions, who and why?

      The when was easy. Probably the entire week he’d been in Salt Lake City to be at his father’s bedside and subsequent funeral. In a way, that tied into the who. It had to be someone who knew he was going to be out of town, someone he was familiar with. But the why, had him completely baffled. To do something so cruel, so heinous, pointed to someone who literally hated him. Someone who was mentally warped and at least marginally, if not a full blown, psychotic. Someone who was unpredictable and dangerous. Would the killing of Casey satisfy his or her vendetta? Or would there be more?

      Moe searched his brain, looking for enemies. Sure there were a few people who didn’t like him: the occasional disgruntled patient, the neighbor with the ranch to the west (not the Rheinhart’s) with whom he had a boundary dispute a few years ago and his ex-wife, Annie. That was about it, except his office nurse who had been harboring a grudge for a few months and Rusty, his partner. They had never got along. But murder a defenseless baby colt, Moe just couldn’t imagine any of them being capable of that. And try as he might, he could think of no one else.

      Without stopping to taste, Moe wolfed down a bowl of cornflakes sweetened with Nutrasweet. If he hurried, he could stop by the pathology department before clinic started and give Ray the gastric fluid sample. But it was probably a waste of time. Toxicology would undoubtedly confirm what he already knew. Casey had been overdosed with Coumadin..

      At the front door Moe suddenly stopped. He had forgotten to take his insulin this morning, and last night as well. God, his blood sugar must be three hundred. Quickly, he pricked his left middle finger, squeezed out a drop of blood and ran it through the glucometer. Two hundred and sixty-three. Not as bad as he thought. Adroitly, he drew up twenty-five units of regular insulin (five more than his usual dose) and fifteen of lente, bunched the skin of his abdomen between his thumb and forefinger, and injected the insulin. Tossing the syringe in a plastic sharps container, he then sprinted out the door for the garage.

      A little late, Moe trudged through the door marked Private Entrance, Moses A. Maihis, M.D. Normally he liked going to the office, seeing patients and his work in general, but not today. Today he was irritable and depressed. Why shouldn’t he be? He glanced at the waiting room for a moment, then immediately felt guilty for what he was thinking. It reminded him of a scene from his childhood. On Tuesdays his father would sometimes take him and Abe to the cattle auction in Cedar City. Prior to the auction, they would corral the cattle in a holding pen. There the cows would sniff each other, mill about and bellow. Usually, they bawled at nothing in particular, except to express their general displeasure at being confined in this strange environment. In a way, Moe thought of his waiting room as a holding pen for patients to trample about, bellow and to voice their displeasure.

      Today, the patients seemed especially restless, wandering about, grumbling to each other about the already long wait and debating their excessively high bills with Sally. No doubt about it, this was going to be another impossible day. Lately, they had all been like this, and after taking a week off, today would be worse than usual. Moe scanned the waiting room once again. Would there ever be an end to this uninterrupted stampede of patients? He couldn’t help but think of a story he had heard years ago in world civics class: If all the Red Chinese were assembled in a straight line and then marched into the sea, the line would never end. Just the sheer numbers from childbirth would make it self-perpetuating. Surely, this anecdote would apply to his patients, specifically his Medicare patients. Thousands of people were turning sixty-five every day.

      Fortunately, Moe realized that today was a bad day and tomorrow he would not feel this way. Sighing, he looked up at his office wall clock. Though it was only 9:30 a.m., he was already tired. It had been one-hell-of-a-week. Rusty had been in New Orleans at the annual American Urological Association convention, leaving the entire load to Moe. Then he had to cancel out for the funeral, so they were way behind. If it wasn’t for the enormous amount of work, Moe would be just as happy if Rusty never returned. Unfortunately, that was unlikely. Rusty had such a sweet deal with Moe, why go anywhere else? For bad or worse, he was due to return this evening.

      Moe had been to those national conventions before and he knew they were basically a guise for a tax-deductible vacation, particularly in New Orleans. How could one hold a serious scientific session in New Orleans? However, knowing Rusty, he probably was actually going to the meetings and not taking in New Orleans’ notorious nightlife.

      Rusty would return with some new, irritating, and currently fashionable procedure that he would want to try, hinting that if Urology Associates didn’t incorporate this procedure in their surgical repertoire, they were somehow practicing archaic medicine. In general, Rusty was becoming more and more annoying as the years went by.

      “Morning, Sally. What’s the chance of canceling out the day?”

      Sally was a small energetic woman with fading good looks. Her once empathetic smile had eroded to indifference, not from personal problems or excessive use of make-up, but from years of haggling with patients over bills, co-payments, secondary insurances, and over what indeed constituted an emergency.

      “Don’t even think about it, Dr. Mathis.” She didn’t smile as she swung her right hand in an arc, gesturing at the waiting room. “You’re not leaving me with that. Anyway, I’m sorry about your father. It must be hard.”

      “We were never very close,” Moe said. “But sometimes that makes it harder.”

      “I know,” Sally smiled sympathetically. “Sometimes it drives you nuts, just trying to make sense of it all.”

      “Thanks Sally. Looks like the patients are restless, I better get to work.”

      “Moe, you look like hell. If you want me to cancel—”

      “Nah, sometimes work is