Читать книгу Hunting for Hippocrates - Warren J. Stucki - Страница 9

The first message hinted of concern, the second, a definite chord of panic. Moe punched the rewind button of the telephone answering machine. “Dr. Mathis—uh—I mean Moe, this is Tommie Rheinhart, you know from next door.” Tommie sounded flustered and he paused. “Anyway, your colt looks mighty sick. I called the number you left, but they said you’d already gone. When you get home, check on the colt.”

Next there was a message from the E.R. “Dr. Mathis, we have a Mr. Harry Baranski here. You did a TURP on him three weeks ago and now he’s blocked off with clots. Give us a call.”

Another message form the E.R. “Dr. Mathis, we are still trying to arrange a disposition for Mr. Baranski. Who is on call for urology? We’ve tried both you and Dr. Wright and can’t find anybody. We’ll try Dr. Rasmussen.”

Those messages made Moe flinch. He hoped Mr. Baranski was okay. They must have eventually found Dr. Ramussen, since they didn’t call back. Even though he was not part of the group, Moe liked Ed Rasmussen. He was a conscientious physician and a nice guy. In a way, Moe would have preferred Ed as a partner instead of Rusty. Anyway, like it or not, Rusty would be back from his medical convention tomorrow night.

It was the final message from Tommie that made him shiver. “Moe, the colt looks much worse.” Tommie’s voice sounded shrill as he measured his words. “It’s shi—it’s droppings are black and real runny. If you’re not home in the morning, I’m having my dad call the vet.”

Not waiting to hear the rest of his messages, Moe bolted for the closet, rummaging frantically for a flashlight. He should’ve come directly home after the funeral, but he hadn’t. He had needed some time to clear his head, try to find some perspective and arrive at some sort of closure. Try to make some sense of the culmination of a life. Someone he was supposed to be close to, but wasn’t.

From Salt Lake, he’d driven to Wendover where he’d spent the night. The endless stream of scotch-on-the rocks had helped, but the gambling, the whirring of the slot machines, the constant background noise spiced with raucous laughter, had not. The next morning, taking his headache with him, he had left Wendover and headed on home. It was close to midnight when he had arrived back at the ranch.

With a sense of urgency, he chucked winter coats, sleeping bags, tents and other camping gear from the closet. Where was that damn flashlight? His mind raced back to the horse as he searched. That colt, with his long gangly legs and trusting dark eyes, was the only thing Moe was looking forward to as he drove home from the funeral. If not for the horse, it would have been just fine to just keep on driving—driving right on past his medical practice in St. George, past the twenty-acre ranch in Diamond Valley to God only knew where. Wherever SR 18 would take him.

Goddamn it! No flashlight stored with the camping gear. He always left a flashlight there. But that little horse! That was the light, the only beacon of his life. He’d been there at 1:45 in the morning when he was born. Through the night, he’d continuously checked on the mother, Dorey. She was a full month over due and Moe had been worried. He’d called the vet twice, who had checked her and reported everything was fine, sometimes they just go over. Then finally Dorey went into labor about 6 p.m. and at 1:45 he was there to help her get rid of the vernix caseosa. After Dorey licked most of it with her tongue, Moe rubbed the rest off it off with a towel. At that moment, he christened the colt Casey. He watched him take his first faltering steps, then rubbed him again, this time without the towel. He’d read somewhere about human imprinting for colts—why not? It couldn’t hurt.

Maybe the flashlight was in the junk drawer in the kitchen. As he ran to the kitchen, his mind raced along. The funeral had been depressing. What did he expect? Not just because his father had died. They hadn’t been that close anyway. But death, particularly of the second parent, always seemed to compel one to take inventory of his own life. After all this meant, in the great cycle of human biology, that he would be next.

The results of that inventory had depressed him. What did he have to show for his forty-one years of life? On the credit side of the ledger, he was a successful physician with a booming urological practice. He was financially solvent. In fact, the ranch, house, and medical office building were all mortgage-free. His only major monthly payment was alimony. But that should really go in the debit column of his life, along with his divorce. Also, add to this column the minor fact that he was basically alone in the world. No children. Not even a girlfriend unless you counted Judy. He was not sure he could count on Judy for anything, even for the up coming vacation they’d planned together.

He’d been gone a week. First, there was the brain stem stroke, which should have killed his father immediately, but it didn’t. Then a week later, the funeral. When he had received the news, he had dropped everything. Moe had Sally cancel all his clinic appointments, giving each patient the choice of seeing Rusty or waiting for him to return. Not surprising, few had wanted to see Rusty. Then, of course, the whole week’s surgery schedule had to be cleared and rescheduled.

The flashlight was not in the junk drawer. When did he use it last? Probably when he rotated the irrigation sprinklers last week in the east pasture. More than likely, he’d set it down in the garage.

In his haste to leave town, to get to his father’s bedside before he died and maybe achieve some kind of closure to their stormy relationship, he’d almost forgotten about the horses. On his way out of Diamond Valley, he stopped at his nearest neighbor, Mel Rheinhart, and asked his son Tommie to look after the horses. Hurriedly he gave instructions: two scoop-shovels of hay cubes morning and night, one quarter of a coffee can of grain per horse per day, keep the water trough full. Then he gave Tommie the phone number for the motel where he would be staying. His sister, whom his father had been living with, had invited him to stay with her, but she would have her hands full with other out-of-town relatives and she still had five kids of her own at home. He would stay in a motel. It was not as if he couldn’t afford it.

Probably, he should have shared the five-hour ride to Salt Lake City with his older brother, Abraham. That was a laugh! Though Abe also lived in St. George, they had not spoken in years, ever since his mother’s death. Moe had never been to Abe’s new home in the posh Stone Cliff section of St. George and Abe had never set foot on the ranch. Also, Moe did not approve of Abe’s vocation: a lawyer who made a handsome living harassing and suing other hardworking people, often doctors. On the other hand, Abe did not condone Moe’s lifestyle of a Jack-Mormon, the divorce, his drinking and inactivity in the church. They had not said two words to each other at mother’s funeral. To drive to Salt Lake City with Abe would have been an exercise in self-flagellation.

There it was, on his workbench. Moe snatched up the flashlight and bolted from the garage. With each step, the flashlight punched beacon-like holes through the raven blackness of the night. As Moe sprinted toward the corrals, raindrops slapped his face and stung his eyes. With the thick cloud cover, the night was especially dark. The corrals and tack shed were barely visible, looking like shrouded silhouettes of a nineteenth century ghost town.

Black stools! That could only mean one thing, the horse was bleeding. Even in the darkness and the pounding rain, Moe could see Dorey, the mother horse, milling around the pipe fence that separated her from Casey. He had been weaning Casey. As Moe fumbled with the chain around the gate, he noticed a dark mound, motionless in the center of the corral. In exasperation, he jerked gate, breaking the chain and charging into the corral.

With his heart pounding and breath coming in quick, short wheezes, Moe expected the worst. He pointed the flashlight on the mound. The sight made him gasp. It was Casey and he was obviously dead. His head lay on the ground, his mouth and dark eyes were wide open and his purple swollen tongue hung lifelessly from the corner of his mouth. From his gaping mouth, a river of clotted blood had run a tortuous path through the corral as it searched for lower ground. Moe reached for the congealed blood, picking it up like a rubber ribbon. It smelled musty and stretched a bit, like taffy. A smaller piece broke free, as Moe jerked it from the ground. With a jolt, he remembered the black stools Tommie’s message had mentioned. Quickly, he arched the light toward the back of the horse. It was a similar ghastly sight. A river of clotted blood exited the rectum.

Moe was numb with grief. Even though the old-timers had told him it was a mistake, he had made a pet of the horse. He had thoroughly enjoyed watching the little buckskin grow up, from his first halting steps to his graceful lope as he raced about the pasture. Casey had been gentle, inquisitive and trusting. Really, all the same qualities of human babies. Now he was dead! First the divorce, then his father, now this. Would it never end? Moe collapsed in the mud by the colt and wept.

After a few minutes, Moe gritted his teeth and stood up, brushing clumps of mud from his pants. Why did Casey die? Obviously, he bled to death, but why? Six-month-old, healthy horses do not just bleed to death, not without a cause. His years of medical training had taught him that there always had to be a reason, even if not immediately understood. The universal law of medicine: cause and effect.

Maybe milkweed? Milkweed could poison horses. With milkweed poisoning, the horses had a ton of G.I. symptoms, but they did not bleed to death. Anyway, where would he have gotten milkweed, or any toxin for that matter, in a twenty by twenty-foot corral?

Maybe, a rattlesnake bite? The toxin of western diamondbacks could cause hemorrhage, but there should also be intense swelling at the site of the bite. As a thunder clap boomed and lightening flashed, Moe inspected all four appendages and Casey’s underbelly for sign of injury. There was none. No sign of fang marks or any type of penetrating wound.

Perhaps Casey had a hepatic disease, preventing the liver from producing the normal clotting factors, but he wasn’t jaundiced. And how would a horse get liver disease anyway? Certainly, not from alcohol.

How about a bone marrow disease like leukemia, suppressing the production of platelets? Moe was not even sure horses got leukemia, but Casey had not been sick. It was hard to postulate leukemia severe enough to destroy the bone marrow or a liver disease severe enough to affect clotting factors without any other symptoms.

There was one way to find out what was going on. Moe gathered the little horse in his arms, staggering under the weight. Six-month-old horses were heavier than they looked. As he grappled for a secure grip on the horse, it started raining harder. Carrying Casey as gently as he could, Moe struggled toward the garage, his tears blending with the rain.

In medical school Moe had taken an elective class in clinical pathology, this included a somewhat disturbing two-week stint in forensic pathology. Obviously this did not make him an expert, but Moe remembered a bit about how to properly conduct autopsies. Also, after years of doing abdominal surgery, he was pretty damn sure he could recognize a diseased organ when he saw it, even if it was from a horse. Moe carefully laid Casey on a work bench next to the sink. Then he went to the house and rummaged through his extensive first aid kit, retrieving some latex gloves, a scalpel and a suture set with some O-silk suture. Cradling his supplies in his arms, he returned to the garage.

Moe took a deep breath and steadied his shaking hands, he needed a moment to disassociate himself from the task he was about to perform. It was like operating on a relative, which was never a good idea. He had to put aside the idea that this was Casey and just focus on the task ahead. After a moment, he picked up the scalpel and with jaw set, approached the colt.

Almost immediately, he realized how awkward it was to do an autopsy on a horse. Horses were not at all like humans, with a fully exposed abdomen and all appendages in the neutral position, lying in the same plane as the body. Even though Casey’s knees were stiffly bent, his legs protruded straight out from his body, like fence posts, and would be in the way.

With some difficulty, Moe placed Casey on his back and propped his legs against the wall to keep him from rolling. Finally, he wedged his shoulders between the hind legs and gritting his teeth, made a midline abdominal incision. With the skill of an experienced surgeon, he continued the incision sharply through the subcutaneous fat, through the midline fascia, finally opening the peritoneum. On entering the peritoneum, Moe was immediately hit with a nauseating rush of rank air. Casey’s internal organs already smelled like unrefrigerated, three-day-old fish.

As per his training from surgical residency, Moe began to systematically examine each organ. First, he palpated the kidneys. It was habit. After all he was a urologist. They felt smooth, no masses or hydronephrosis, and were normal size. Next, he inspected the liver and spleen. They also looked normal, no grainy leukemic infiltrates and no scarring associated with cirrhosis. Next, he examined the stomach. It looked full, but had normal consistency and color. Finally, Moe ran the entire length of the small bowel and colon, inspecting every inch.

Then there it was, the first abnormal finding. Moe had seen that blue sheen to the bowel before in humans, it simply meant the bowel was full of old blood. When looking from the outside through the relatively thin walls of the bowel, the blood looked blue, like venous blood. Other than that, the bowel looked okay, no palpable lesions, no dilation to make one think of obstruction.

Gripping his scalpel like a pencil, Moe sliced through a longitudinal muscular band, one of the taeniae, opening the large bowel. There was a myriad of small, petechial hemorrhages, but certainly not a single, major bleeding site or lesion.

Somewhat confused, Moe went back to the stomach, incising through the fundus. The stomach was full of clotted blood, which Moe simply scooped out with his gloved hands. Again, there were those same petechial hemorrhages, but there was more. In the most dependent portion of the stomach, there was still a small amount of gastric content that had layered out when peristalsis ceased, the heavier particles at the bottom, the liquid at the top. Systematically, Moe inspected this gooey amalgam. It contained mainly gastric juices that formed the top layer, but underneath this veneer, were a few intact grains of barley and some particles of undigested alfalfa cubes.

Moe dredged up the stomach contents in cupped hands, dumping them into a coffee can. Slowly, Moe swirled the stomach contents in the can, almost like panning for gold.

Wait! There was a fleck, something blue in an amorphous sea of pea green. What the hell could that be? What could a horse eat that was blue? Moe reached down with the tip of his scalpel and retrieved the fleck. It was robin-egg blue and about one third the size of a pea. It resembled a jagged piece of a pill. Moe examined it more closely. By god, that’s what it was, a piece of a crushed up pill!

Moe had done that plenty of times with his horses. More than once, he had ground up butazoladine and put it in the horses’ feed when they had gone lame. But he’d never given any pills to Casey, never had any call to. Furthermore, butazoladine was white, this pill was blue. For the life of him, Moe could not think of a common horse pill that was blue. Obviously, someone had been giving Casey blue pills, but why? And who? It didn’t make any sense. Were the blue pills somehow connected to the 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!