The Fragrance Shed By A Violet- Murder in the Medical Center by @linwilder is a Christmas and Holida
Title: The Fragrance Shed By A Violet- Murder in the Medical Center
Author: Lin Wilder
Genre: Courtroom Mystery, Medical Mystery
Why did a Houston district attorney decide to involve the state in an area of the law that it has historically treated as sacrosanct: that of medical decision-making?
Why did the DA decide to charge McCall with murder rather than criminal negligence in a civil court?
In a city where the Texas Medical Center reigns as one of the top employers in Houston, housing over three thousand medical researchers making the news with new pharmaceutical discoveries almost daily, why did twelve Houstonians unanimously decide to convict Dr. McCall for intentional murder following her trial?
These are the questions that lead investigative reporter Kate Townsend to write a Pulitzer Prize winning series called Murder in the Texas Medical Center. Haunted by the knowledge that her new-found fame has been purchased at too high a price; Kate is sure that McCall is not guilty.
Texas Governor Greg Bell hires former homicide detective and criminal defense attorney Rich Jansen to fix the escalating problems at the Huntsville Prisons recently inflamed by a lawsuit against infamous inmate Dr. Lindsey McCall.
Dr. McCall is an internationally acclaimed cardiologist, researcher, and a 2002 nominee for the Nobel Prize for Medicine. When Jansen skillfully persuades an incompetent prison medical director to resign, he realizes that this strange saga is just beginning.
Mark Twain wrote that forgiveness was the fragrance shed by a violet upon the heel of the boot that has crushed it. This medical mystery weaves together the lives of two sisters, Lindsey, and Paula, with those of strangers as each cope with loss, betrayal, jealousy, and the exquisitely painful journey to forgiveness.
She lay listening to the unfamiliar night sounds: the pacing of other sleepless prisoners, the occasional echo of a heavy-footed guard making his rounds. Mostly though, she waited for the terror of the dream to subside, for the iron bands around her heart to loosen, and for the awful pressure on her chest to lighten so that she could breathe. And she waited for her heart to climb back down into her chest and out of her throat.
The dream was a familiar one. It had begun four years before following the sudden death of a fifty-two-year-old man whose heart she had catheterized. Dr. Lindsey McCall had surgical hands—a reference to the skill and dexterity that she brought to the Cardiac Catheterization Laboratory at Houston General Hospital. A colleague had made the comment during rounds one day during her cardiology fellowship at Houston General, and it had stuck.
There had been no reason for his death. Nate Morrison was a healthy senior executive with Southwest Oil, one of the largest oil conglomerates in the world. During his annual physical, Morrison had been referred to Houston General for a work up based on nonspecific changes in his cardiac diagnostic tests. Upon reviewing his tests, Lindsey had suspected that the man’s coronaries might be clean—free of coronary artery disease. She was well aware of the numbers. Of the sixty thousand cardiac catheterizations performed each year in the United States, over 30 percent revealed clean coronaries: absence of plaque in the vessels supplying the heart with oxygenated blood. And the procedure was not benign. Complications of cardiac catheterization were not uncommon and ranged from mild hematoma to death. In twelve years, Lindsey had done over five hundred cardiac catheterizations and more than three hundred angioplasties. She had never lost a patient.
But close to 75 percent of the revenue of her department came from referrals from doctors practicing in Texas and the Houston metropolitan area; the physicians at Southwest Oil referred hundreds of patients to Houston General per year, usually for an angioplasty or cardiac cath. Furthermore, McCall was well acquainted with the financial realities of her profession—turning down lucrative procedures such as cardiac catheterizations was not smart.
For some reason she could no longer recall, she, rather than one of the cath lab nurses, had gone to see this man the night before the procedure. While she had been reviewing the potential complications with her patient and obtaining his informed consent, Morrison had asked with a wink, “Just how many patients have you lost in your twelve-year career, Dr. McCall?”
His quick-grinned response to her answer had been, “Well then, let’s you and I make sure that I’m not the first, deal?”
Lindsey could picture that conversation as if it had happened a moment ago. Fourteen hours later, he was dead.
As she had done hundreds of times before upon awakening from the dream, Lindsey lay there second-guessing herself—asking all the questions that had been asked by his family, by the morbidity and mortality committee at the hospital, and by her chairman of medicine. The final diagnosis had been sudden death caused by a massive left ventricular infarct most likely from coronary spasm. Neither his family nor the hospital held her responsible. There had never been even the suggestion of negligence on her part.
Her technique had been flawless. She had been calm and confident throughout the two-hour procedure, explaining what she was doing to her patient and laughing at his quick-witted responses. Lindsey had completed the injection of dye into the man’s left anterior coronary artery, and after satisfying herself that it, too, was free of plaque, had almost completely extracted the catheter from his coronary in preparation to end the procedure when she heard the startled cry of her technician.
“Lindsey, he’s fibrillating, he’s fibrillating!”
For just a second, her gaze met that of her lead tech, Ben, who responded to her unspoken question. “He’s been in sinus rhythm for the whole exam—there was never any arrhythmia, not even a PVC!”
Ben was referring to premature ventricular contractions that are frequently harbingers of serious cardiac arrhythmias. Lindsey trusted this guy implicitly; they had worked together for over ten years. If Ben said there had been no warning of this potentially fatal arrhythmia, she believed him. So she and her staff went to work, certain that in just a few minutes, they would get control and be back to the routine work of winding down the procedure.
But they couldn’t.
They had worked for over three hours, along with six members of the hospital’s on-call code team who had responded to the emergency in the Cath lab. They were never able to restore a normal cardiac rhythm, despite massive amounts of antiarrhythmic and other emergency drugs and numerous attempts at electrical defibrillation.
It was the head of the code team who called the code, suspecting that Lindsey was unable to do so. She had dropped her hands and stood staring at the futile electric signals displayed on the cardiac monitor, at the virtually unrecognizable semi-nude and mottled body of Nate Morrison and remembered joking with this man the night before. She remembered his smiles, good humor, and, most of all, his vitality. Then she walked out of the lab to tell his wife that her husband was dead. To tell her that he had had no coronary arterial disease but that he had died. And that she had no idea why.
That was the last time she had accepted a patient for catheterization.
The chairman of Medicine at Houston General had spent hours with Lindsey during that first year following the death of this patient. He had known her since she had been accepted into the cardiology fellowship almost fifteen years earlier and had followed the young woman’s career at first with interest and later with excitement. For that entire year, Lindsey had been exceedingly grateful to Bayer for his concern and, yes, the love she knew he felt for her. She had tried, God knows, she had tried to return to the cath labs at the hospital, but she could not do it. Just opening the door to the labs and beginning to scrub for the procedure evoked a panic reaction so severe that she could not tolerate it. And the idea of seeking a psychiatrist for treatment was unacceptable to her. Naturally, many of her colleagues in Houston and around the country had suggested that some of the newer antianxiety drugs could mitigate her reaction, but the only one who could force her to seek psychiatric and pharmacologic help was Dr. Bayer, and he refused to do so.
During their last conversation on this matter, a luncheon he had scheduled to discuss her future at the medical school, Lindsey managed to convince Dr. Bayer that she would now have the time and the energy to focus on her drug research. And once more, that wonderful man had supported her. He had even shared her excitement when she explained again the vision she had for a modification of the digitalis molecule.
Dr. Simon Bayer was known to many as the cardiologists’ cardiologist. He, too, had been excellent in diagnostics, research, and in education. Author of several textbooks and principal investigator of countless experimental drug protocols, Dr. Bayer was internationally admired and respected. But in close to forty years as chairman of Internal Medicine at Houston Medical, Dr. Bayer had never before seen the talent exhibited by this young physician.
Early in her fellowship, Lindsey had talked with Dr. Bayer about her preliminary doctoral work exploring alteration of the molecule for digitalis. At that time, he had listened politely. Lindsey remembered sensing that her chairman believed she was chasing windmills—the drug had been around forever, after all.
For centuries, physicians have treated heart failure with digitalis. Its effect on strengthening a failing left ventricle—the main pump of the four-chambered heart—remains unparalleled. But the drug has serious systemic side effects ranging from mild to potentially fatal depending on dosage and frequency. Lindsey had become interested in the drug in high school when her mother had been diagnosed with idiopathic cardiomyopathy—heart failure of unknown origin—at the age of forty-three.
Cardiomyopathies are a strange and almost-universally-fatal type of heart failure. Thought to be caused by a virus, the actual mechanism of disease is poorly understood. But the course of the disease is all too well known: increasing heart failure and incapacitation over time and death if not treated with heart transplantation. Despite living fifty miles from the premiere transplant center of the world, the Texas Medical Center in Houston, Lindsey’s mother would not consider transplantation. That she lived for close to thirty years without surgical intervention was regarded as a minor miracle by her physicians. Then, as now, digitalis was the drug of choice for heart failure, and so the balancing act of dosing had begun—sufficient medication to keep the heart out of failure but not so much as to cause severe nausea and vomiting and toxicity to the heart.
Before her illness, Lindsey’s mom had been physically active with many outside interests and lots of friends. Although she had never worked outside her home, she had been active in volunteer and church work. The disease completely changed her personality; Ann became incapable of focusing on much other than her symptoms and the acute anxiety brought about by the facts of her illness and incapacitation. Formerly a dominant force in the McCall family, Mrs. McCall rapidly took on the role of a cardiac cripple. Unable to accept that her lifestyle need not change so long as she rested frequently and did not unduly exert herself, the terrors of her diagnosis imprisoned her and her family. The results were all too predictable. Lindsey’s dad, a bit of a workaholic by nature, accepted the more risky assignments at NASA, and Paula, now twenty-three and a graduate nurse, took on the care of her mother by default. For Paula, a gravely ill mother provided the perfect excuse to avoid the realities of an already unhappy life.
Only thirteen at the time, Lindsey handled the virtual loss of her mother through intense study: of the heart, of her mother’s disease, and of the drugs that manage heart failure, specifically digitalis. This intellectual response to loss, crisis, and fear worked exceedingly well for the young girl and would become her primary response to trauma throughout her life.
At the age of seven, Lindsey had decided that she would be a cardiologist and a research scientist; the acute onset of Ann McCall’s illness served to augment and crystallize Lindsey’s ambition. Throughout her junior and senior high school years, the young girl persuaded her chemistry and biology teachers to support her determination to alter the digitalis molecule in ways that would optimize its inotropic, or strengthening, effects on the heart, while mitigating its toxic effects.
Lindsey’s chemistry teachers were impressed with the exceptional motivation she demonstrated at her age. Recognizing and respecting his daughter’s ambition, Tom McCall, Lindsey’s father, a NASA test pilot, made certain that Lindsey received the best of what the Clear Lake Texas schools offered in their advanced science courses. Therefore, Lindsey received quality tutors throughout the six years of junior and senior high school. Lindsey McCall’s cardiac models were entered at each science fair and, without fail, received first prize.
By the time of Lindsey’s talk with Dr. Bayer, Lindsey had been studying digitalis off and on for close to thirty years. But actual research in the laboratory had been limited to her doctoral studies. After explaining the preliminary work she had done, and the abstract of her dissertation findings that had appeared in Science the year after she received the doctorate, she quietly asked, “So do you still think that I’m chasing windmills, Dr. Bayer?”
He had placed his hand on hers and smiled affectionately as he said, “Lindsey, you lost me three models ago; it has been too long since I’ve done basic science research. But here is what I can do for us.” Noting her widened eyes at his use of the pronoun us, Dr. Bayer continued speaking in that measured, thoughtful, and precise tone of his, “Yes, of course, Lindsey, the medical school will benefit in immeasurable ways when you develop this drug. And you will, I have no doubt at all that you can do this. The clinical benefit of your work is immeasurable, and the monetary gain to both the medical school and the company with the patent is in the billions.”
Waving off her attempts to thank him for his trust and confidence in her, Dr. Bayer explained that a close friend of his had just taken over as CEO of Andrews, Sacks, and Levine (ASL), one of the largest drug companies in the world, a company that badly needed new drugs since the patents for the company’s top three drugs were due to expire within the next twenty-four months. According to Dr. Bayer, Hank Reardon, ASL’s new CEO, owed him some favors; Bayer would set up the meeting between Lindsey and Reardon within the next couple of weeks.
Now fully awake, lying on her cell bed, Lindsey considered the irony of her current circumstances. She almost laughed out loud in the dark at herself—at least the terror of this dream was familiar and lay buried in her past; her real nightmare was no dream, no mere memory. And she could feel the fear uncoil, stretch, and begin to take her over once again. Closing her eyes, she began to pray:
Let nothing dismay thee.
All things pass.
God never changes.
Patience acquires all that is strived for.
She who has God finds that she lacks nothing.
God alone suffices.
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Forgiveness, Redemption, Hope- Isn’t that what we celebrate?
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Lin Wilder is the author of the Lindsey McCall medical mystery series, which includes The Fragrance Shed By A Violet, Do You Solemnly Swear? A Price for Genius and Malthus Revisited. Her memoir, Finding the Narrow Path recounts her journey away from God and back again. She is the recipient of numerous awards for her work, including a Feathered Quill, three NABE Pinnacles, two IAN Best Books, two Literary Titans and a Readers Favorite Best Book. She lives in northern Nevada. Her latest book is I, Claudia: A Novel of the Ancient World.
All her books are available at Amazon, Barnes & Noble and at her website, linwilder.com where she writes weekly articles.
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