“I’m a consultant pharmacist for CommCare.”
“What’s that?”
“CommunityCare. It’s a pharmacy that provides medications to patients at nursing homes and rehabilitation centers. It’s a federal regulation that a pharmacist reviews all patients’ charts. And that’s what I do—visit nursing homes once or twice a month to review charts and look for possible medication-related problems. If problems are seen, I’ll make recommendations for changes to the patient’s doctor.”
“Interesting. And what if the doctor doesn’t agree with your recommendations?”
“She or he has that right, but they’re obligated to respond to the recommendation in order to comply with federal regulations.”
“Uh-huh. So how well do you get to know the patients personally?”
“Well, I mostly get my information about them from their medical records and talking with the nursing home staff. But I’m getting to know some of them.”
“And when was the last time you visited Broadview?”
“I guess about three weeks ago.”
“And you’re saying you didn’t know the perpetrator.”
“But she’s one of your patients.” It sounded like an accusation.
“She’s on my list. Officer, you say this happened in the CVS. Where were the nurse and aides at the time? When patients go on outings, they’re heavily chaperoned.”
Menard looked up at her. “She was alone.”
“Alone? How could she be alone?”
“There were no staffers from the home with her.”
“But residents never leave the ward without staffers. How did she get there? How did she leave the home?”
“That’s what we’d like to know.”
Rene’s mouth made an O of comprehension. “You mean she eloped, she escaped?”
“Our guess.”
“But … that’s impossible.”
“Well, that’s what happened.” Menard flipped a few pages on the clipboard. “I’m wondering if you could check your records. According to the Broadview nursing staff, Mrs. Devine was not taking any antipsychotic medications. Is that your understanding?”
Rene scrolled through Clara Devine’s file. The woman had mild heart problems, high blood pressure, high cholesterol, and had been diagnosed with depression and moderate dementia. She had been admitted to Broadview by her sister a year ago at age seventy-two. The sister, Cassandra Gould from Dudley, N.H., was the listed sole survivor. Clara was also designated a ward of the state, which meant that her sister had not been willing to assume power of attorney. “As you know, without a search warrant I’m bound by patient confidentiality not to reveal details, including the medications she was on.”
“Of course, but that can be taken care of if something comes up.” And he gave her a look that said,
They both knew that he could have the records subpoenaed; but that would take time, and he wanted to know if the woman was on any medications that might have made her nutty. She scrolled down the list: Atorvastatin for high cholesterol, hydrochlorothiazide, Atenolol, Captopril, and a baby aspirin daily for her heart disease and high blood pressure; paroxetine for depression; donepezil for dementia. It was a pretty standard menu of medications for an elderly nursing home patient. And while some of the drugs had the potential to affect mental status, none could account for a volcanic urge to kill. According to her medication profile, Clara Devine had been on these same medications at the same doses for months, also decreasing the likelihood that any had caused her sudden homicidal behavior. “Looks like the standard laundry list for elderly patients.”
“No smoking gun?”
“No smoking gun.” Then she moved ahead toward the present. Suddenly Rene hit a blank. She went back and double-checked. “That’s odd,” she said.
“What’s odd?”
Clara Devine did not appear on Rene’s patient census for the last six months. And all of the woman’s medication orders were from last February or earlier. Rene felt Menard’s eyes scratch at her for an explanation. If she overreacted, he’d want to know how she could have a half-year hole in her records; then he’d go to Broadview to complain, and in no time her superiors at CommCare would wonder why they hired her. “A little computer glitch. Okay, here we are,” she pretended. “From what I can tell, she hadn’t been on any kinds of meds that would cause such behavior.”
“Any record of psychotic behavior on the ward or before?”
Rene checked the nurses’ notes to the six-month dead-end, feeling her face flush, and trying not to let on that she somehow had screwed up. “No. In fact, she was pretty well behaved.” Then some nurse’s notes made her smile. “Apparently she came out with some funny lyrics.” And she read: “‘Roses are red, violets are blue, look at my titties and say I do! ‘Had us laughing out loud,’ one nurse wrote. She also once announced that she was having a baby. Doesn’t sound like someone who’d attack a perfect stranger.”
“No, but she sounds delusional.”
“Many dementia patients are, but that doesn’t mean violent.”
Menard laid his pen hand on the clipboard. “So what do you think happened, Ms. Ballard?”
“I don’t have a clue.” But she’d go back to the home and double-check the master charts to see what she’d missed—and why there was a six-month blank in her files. She closed her laptop, feeling distracted that something was amiss. She had prided herself on keeping meticulous details, of being able to hold in her head the hundreds of unpronounceable syllables that made up drug indices, the technical details of complex chemical arrangements, their intended effects and side effects. And she had worked to attach names and faces to the reams of data. Yet here she was missing records of a patient who was the epicenter of a murder investigation. “So what happens to her now?”
“Well, she’s been sent to McLean’s for evaluation.”
McLean’s Hospital in Belmont, Massachusetts—part of Harvard Medical School—was one of the top psychiatric hospitals in the nation, and where dangerous patients were evaluated.
Menard got up and headed for the door, stopping by a table with an array of photographs. One of them was a shot of Rene in her cap and gown posing with her parents and Nick Mavros, her favorite professor at the New England School of Pharmacy. Beside it were pictures of her father, before he got sick. Also one of him as a little boy in a porch rocking chair—an image of him that she adored. Menard picked up a close-up portrait of Silky. “Is this the guy I met earlier?”
“Yes. Silky.” In the picture, the black longhaired tabby with the white nose patch looked like a mobster with a menacing wide-eyed gaze—the kind of photo you’d imagine hanging in a mouse post office stamped WANTED. At the moment he was out back thinking about chipmunks.
“For the record, are you living alone?”
The question sent a little ripple of unease through her. Until a few months ago, she had been living in Boston with Todd and planning a June marriage—June 26, to be exact. Then after nearly two years of cohabitation—bridal gown purchase, Mr. Tux reservations, seat upgrades on Delta flights to Maui, seaside view at the Kapalua Bay Hotel, honeymoon-special sunset-mai-tai-catamaran cruise, and one hundred and twenty unused “Rene and Todd” invitations—dear old Todd, in a last-moment panic, decided he couldn’t go through with it and moved back to New Jersey, where he took up with his high school girlfriend.
If the jilting hadn’t been so painful, it would’ve been comic. In her twenty-nine years, Rene had never met or heard of any woman or man actually being jilted. Todd’s announcement raised a lot of screaming and accusations, but he still left. And after three months of wound licking, Rene quit her job at the local pharmacy and with the help of Nick Mavros accepted an offer with CommCare that brought her here to Dover Falls where she now lived in a converted barn, stripped down to bare happiness. Since then, Rene had resolved that she didn’t need Todd—that she would embrace the split as an opportunity to find new traction in life and a chance to become a part of something good—something bigger than herself, the welfare of others. “Yes, I live alone.”
