“Warren? Is that you? It’s me, Yuki. What’s this about?”
“That’s what I want to know.”
Yuki was getting soaked, her hair falling over her eyes, making her look like a wet Yorkie. She was wearing sweatpants, a thin T-shirt, beaded bedroom slippers, no socks. Her teeth were chattering.
Jacobi flashed his light briefly around the interior of the Acura, then told Yuki, “Okay, you can get back in.”
He watched her buckle up, handed her back her license, and said, “I’ve been behind you for quite a while, Yuki. What the hell were you doing?”
“You were following me?”
“Please answer my question.”
“I was just going for a drive, okay?” she said, getting pissed off now.
“Don’t lie to me. You were following that Mercedes.”
“No—okay. But so what? I’m just, I’m just—it’s nothing!”
“Think about what you’re saying,” he said, raising his voice, wanting to shake her up, wanting to scare her a little.
“If that guy is the whackjob you believe he is, don’t you think he’s going to get you out of his way? C’mon, Yuki, think.”
He watched Yuki make fish lips, coming up with nothing.
“I’m not being a prick here because it gives me a thrill. You’re a nice person and way too smart for this. You’re looking for trouble, and I hope to God you don’t find it.”
Yuki wiped the water off her face with her hands, nodded her head. “Do you have to tell Lindsay?”
“That depends on you.”
“I’ll go home, Warren. I won’t even stop for gas. How’s that sound?”
“That’s fine. By the way, your inspection sticker has expired. Take care of that.”
“Thank you, Warren.”
“Okay. Drive safe. Be good.”
Jacobi walked back to his car, thinking about the job. He had a wistful thought about stopping for a hot meal at the diner near his apartment. Then home for a nightcap and the 49ers game.
He heard the radio sputtering his call numbers as he opened the car door.
Chapter 93
JACOBI PULLED UP behind the blue Ford on the corner of Taylor and Washington. He climbed out into the freaking rain again, walked over and exchanged a few words with Chi and Lemke.
As their Ford took off, Jacobi crossed Washington, ducked under the black awning with gold letters spelling “Venticello Ristorante.”
He labored up the stairs of the cream-colored two-story building, warm air and the smell of garlic and oregano greeting him as he entered the foyer, making his stomach growl.
To his right, the hatcheck girl asked for his coat, an offer he declined.
He stood for a moment, dripping wet, taking in the L-shaped bar in the entryway, the down staircase to his left, the only public stairway to the main floor of the restaurant.
Jacobi took a barstool, ordered a Buckler’s, put his coat on the stool next to him. Then he told the bartender he wanted to use the washroom.
He took the dozen carpeted steps down to the small rectangular dining room, ten occupied tables overlooking the streets through tall corner windows, a blue-tiled fireplace dominating the space.
The doctor’s table was near the fire, his back to Jacobi, an attractive woman smiling into his face. Red wine glowed in the glasses in front of them.
Jacobi walked past the table, bumping the doctor’s chair, enjoying the way Garza whipped his head around, his face an outraged scowl.
Jacobi apologized as if he meant it. “Hey, I’m sorry. Sorry. Excuse me.” Then he walked across the floor, used the washroom, and returned upstairs to the bar.
He drank his near-beer and nursed another, settling the bill after each round. He dropped another five on the bar as the dark-haired doctor and his date passed him on their way to the cloakroom.
Jacobi slipped out the door just before them, and went out into the inclement night. He started up his car, turned on the windshield wipers, and called in his location.
The black Mercedes pulled out of the parking lot on Taylor, and Jacobi followed, this time keeping close, confident that the doctor wouldn’t make him in this weather. Not with the pretty blond woman sitting almost on his lap, wrapping her arm around his neck, kissing him behind the ear.
The doctor turned onto Pacific for two blocks, taking a right onto Leavenworth, then four more blocks to Filbert.
Jacobi saw Garza nose the Mercedes into his driveway and open the automatic garage door, drive his car inside.
Jacobi drove past the pale-yellow house to the end of the block. He made a U-turn, coming back, parking on Garza’s side of the street where he could watch the house.
His hip was stiffening up, and his bladder was full again. He was thinking of getting out, taking a leak against his rear tire, when the downstairs lights in Garza’s house went out. A long fifteen minutes later, the upstairs lights winked out as well.
Jacobi called Lindsay on his Nextel. Told her he’d been tailing Garza since he left the hospital. Yeah, overtime. Free overtime.
“He didn’t even run a stoplight, Boxer. The man had dinner with a babe about forty, a willowy blonde. Held her hand at the table; then she climbed all over him on the drive home.
“As far as I can tell,” Jacobi said, “the doctor is guilty of having a girlfriend.”
Chapter 94
I WAS FRETTING and stalking the corridors outside the ICU at Municipal when Jacobi called saying that Garza was tucked in for the night.
I dropped into a blue plastic chair in the hospital waiting room, thinking what an idiot I was for sending my buddy out into the foul night for nothing. Still, I couldn’t shake my prickling sense of wrongness about Garza.
Images flickered—Keiko’s mom, her knees buckling, dropping to the sidewalk, that feisty, funny lady who should still be alive.
I thought about brass buttons on her dead eyes and on the eyes of the thirty-one others who’d been marked that way.
Those freaking buttons. Markers.
Where was the killer’s fun if no one understood what he was doing or why?
I remembered the arrogance of the man who’d overseen the care of many of the deceased. The doctor who’d said, “Sometimes a bad wind blows.”
And I wondered for the hundredth time if Dennis Garza was one of those deranged and profligate killers, like Charles Cullen and Swango, that surgeon from Ohio, medical practitioners addicted to the power of snuffing out life.
I shifted in my chair, knocked over a half-full coffee container on the floor, watched the lazy brown pool seep around my Nikes. “Jeez, Lindsay. You expect to catch a killer.” Can’t even drink coffee.
I sopped up the spill with a piece of newspaper, threw the cup into the trash, thinking, The day is done.
Garza had gone to bed, and if I had any brains, I’d do the same.
I was zipping up my jacket when my cell phone rang again.
“Lieutenant?” a woman’s voice whispered. “It’s Noddie Wilkins. The nurse from Municipal? You told me to call you,” Noddie said. “Another patient has died. There were buttons —”
A sick feeling washed through me.
“When did this happen?”
“Just now.”
“What was the patient’s name?”
“Anthony Ruffio. His body’s still in the ICU.”
I started running toward the stairs, wondering how many patients had died in this hospital, how many had been found with caduceus buttons on their dead eyes.
But there was one difference this time.
I was in the hospital, and the killer was probably here, too.
Chapter 95
I TOOK THE STAIRS to the ICU two fast steps at a time. A homicidal maniac might be roaming the hospital, and right now might be my best opportunity to tag him.
I badged the senior nurse at her station outside the ICU, and stayed in her face as she paged the ICU’s attending physician.
Dr. Daniel Wassel materiali
zed moments later. He was a thin man in his thirties with a long, narrow nose and sleepy, red-rimmed eyes.
I identified myself, told him that I was doing an investigation and needed a list of everyone on the staff who was on the floor when a patient named Anthony Ruffio was checked into the ICU after surgery.
And I told him I wanted to see Ruffio’s body right now.
The doctor became alarmed, his sleepy eyes widening as he shook off his torpor. “I don’t understand, Lieutenant. Why is this patient’s death a police matter?”
“For now, I’m calling it a suspicious death.”
“You are so off base, I can’t believe it,” he said.
Dr. Wassel opened the sliding door to the darkened stall, flipped on the light switch. The fluorescent light flickered.
My eyes went right to the body.
I felt a shiver of apprehension as I peeled the sheet down from the dead man’s face.
Ruffio looked shocked that he’d been wrenched from life. His mouth was open, his skin pale, almost translucent.
There was dried blood around his nostrils and the sticky remains of tape in the corner of his mouth where the respirator tube had been.
Pulling the sheet down farther, I saw the shocking, fresh surgical incision, a stitched line from his sternum to his navel.
I covered Mr. Ruffio with the sheet right up to his hairline.
When I turned away, I saw a pair of caduceus buttons winking at me from the console beside the bed. I stood between the buttons and Dr. Wassel.
“For now, this room is off-limits to hospital personnel,” I said. “Someone from the crime lab will be here shortly, and as soon as they’re done, the ME will transport Mr. Ruffio to the city morgue.”
“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.”
“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 rang and she saw the name on her caller ID.
She picked up the line, thinking, Great. Maybe we’ll grab a quick lunch.
“Cindy, what the hell?” Lindsay barked, almost shouted, over the phone. “I asked you please not to do a story on Garza and you agreed!”
“Linds, I had to do it,” Cindy said, keeping her voice low so that everyone in the world didn’t tune in. “My sour
ce at Municipal has told me that Garza is being questioned by the board —”
“That’s not proof of anything, Cindy.”
“Did you read the story? I wrote, and I quote, ‘Suspicion has fallen on ER chief Dr. Dennis Garza.’ Suspicion means speculation with foundation. Jeez, Lindsay. Last week the guy completely melted down in court. He warrants some ink of his own!”
“What if he’s guilty of more than malpractice? What if the spotlight you just threw on him drives him underground? What if he packs up and leaves San Francisco?”
“What do you mean ‘more than malpractice’?”
“I don’t know what I mean,” Lindsay said, her voice stiff with pique. “I’m working on it.”
“So am I,” Cindy said. “Look, you haven’t given me anything on this story. It’s mine. It’s been mine from the beginning. And it’s not right for you to come down on me for doing my job.”
A static, gray silence followed, Cindy feeling the seconds mount up, thinking a lot of things she didn’t want to say. But it all came down to this: Lindsay was leaning on her because of their friendship—and she was out of line, way out of line.
“Dozens of reporters are on this story, Lindsay! Whether I break the story or someone else does, Garza’s going to get press.”
Lindsay sighed in her ear, said, “I hoped I’d have more time.”
“Well, you were dreaming.”
Cool good-byes followed.
Cindy hung up the phone and looked down at her notepad. She read the words she’d just scribbled: guilty of more than malpractice.
Chapter 99
MY ALL-NIGHTER at Municipal Hospital had left me bone weary and frustrated beyond belief. I tossed the morning paper into the trash can under my desk, pretty sure that Cindy’s next story would be about how people were being murdered at Municipal—and how the SFPD was doing nothing about it.
The time had come to abandon my off-the-books investigation and make “the brass button case” official before a very large sinkhole opened under the Hall of Justice.