To Sleep... Perchance to Die Read online

  Appearing bothered by an intrusion into her personal thoughts, Corrie said in a snotty manner, “Well, if you must know, I’m referring to the fact that Frankie Grimaldi is scheduled to have her wisdom teeth removed by Dr. Manley this Thursday.”

  “Are you sure?” Pearlie asked. “Thursday is his day off. And what’s your problem with Frankie Grimaldi?”

  The conversation attracted the other staff members who sensed the possibility of a confrontation between Pearlie and Corrie. Everyone knew they disliked each other. Sandy, Sue, and Brittney joined them.

  “What’s going on?” Brittney said.

  Corrie ignored the new arrivals and addressed Pearlie in the tone of one who’s privy to insider information, “Yes, I’m certain of it. It says so right here.” She pointed to the schedule. “Dr. Manley’s going to come in especially for her.”

  Pearlie said, “So? It’s his business if he wants to work on his day off. I’m asking again, what’s wrong with Frankie Grimaldi?”

  Corrie placed her face as close to Pearlie’s as she dared without getting it slapped. “I guess you don’t know Dr. Manley doesn’t like the Grimaldi woman.”

  All eyes were on Corrie. “Mrs. Manley told me about it when we had dinner at Roscoe’s.” She paused for emphasis, “You know. The terrific bistro that opened a few months ago in downtown Willi?” Corrie enjoyed boasting to the others about her relationship with Mai Manley.

  Pearlie rebutted, “That’s a load of bull. Dr. Manley likes Frankie Grimaldi. He always says nice things about her, like she’s a good neighbor and a friend of theirs.”

  “No, you’re wrong,” snapped Corrie whose facial expression was as condescending as she could make it. “He really doesn’t like her. Hasn’t for quite a while. Just tolerates her because she’s a neighbor. That’s what Mai, I mean, Mrs. Manley, told me.”

  “I don’t believe it,” Pearlie challenged as she rolled the pearl around her neck between her thumb and forefinger. Her equivalent of a security blanket was always within easy reach to calm her when she was nervous or angry. And she was angry.

  Corrie had everyone’s attention. “You see, the Grimaldi woman . . . or should I say man, it fits her better . . . made inappropriate advances toward Mrs. Manley.”

  The group uttered a collective “Oohhhh.”

  Having unleashed her shocking tidbit of gossip, it was time to press the attack in her effort to destroy Frankie’s character and to sow the seeds of Bret’s animosity toward Frankie. “Ms. Grimaldi is a lesbian, as you’re all aware.”

  The listeners nodded in unison. The relationship between Frankie and Sara Cunningham was not a secret in Windham.

  “According to what I’ve been told me, not long after they moved next door to her, Frankie began to make sexual overtures toward Mrs. Manley. Mrs. Manley quickly put a stop it, but when she told Dr. Manley what happened, he wanted to let Frankie know she wasn’t welcome in their house any more. Mrs. Manley disagreed. Said they were neighbors, and it was important they keep up the appearance of friendship.”

  The jaws of each of the staff members dropped registering their disbelief.

  “What happened then?” asked Brittney.

  “Dr. Manley reluctantly agreed.” Corrie had her audience hooked. “But he told his wife he would keep an eye on Frankie Grimaldi to make sure it didn’t happen again.”

  “Then, you think Dr. Manley decided to treat her just to keep up the appearance of friendship?” asked Brittney.

  Appearing to think about the question, Corrie said, “I’m not sure. Probably. I know Dr. Manley would never refuse to treat a patient who sought his help. No matter who they were.” In a cynical manner she said, “You know oral surgeons. Principles, ethics, and patient care above everything else.”

  “You said it.” It was Brittney, the unelected spokesperson for the listening group.

  “One final thing,” Corrie admonished, “Not a word of what I’ve told you to Dr. Manley. I’m sure he would be terribly embarrassed if he were aware of our discussion. Okay?”

  The group nodded their agreement.

  On Tuesday evening, Carlton called Jake. “Is the secure phone I overnighted you working okay?”

  Jake said, “Yeah, fine. Got it this morning. I’ll destroy it when we finish this call.”

  Carlton began, “I’ve arranged for a mid-level manager who works in our Hartford branch to utilize trusted intermediaries to open a Bahamian bank account in a fictitious name. I can rely on this manager. He owes me a big favor, something like the one I owed you.”

  Jake noted Carlton’s use of the past tense.

  Carlton explained, “When you give the go-ahead, the fifty thousand will be deposited in the account, and a debit card with a withdrawal limit of two thousand dollars per month will be issued. My man will make several withdrawals each month from ATM machines at various locations in Connecticut equaling the two thousand. The money limit is my decision. Safer that way. Won’t attract anyone’s attention like a large lump sum would.”

  “Right,” Jake said. Can’t blame him, although it’s another thing Corrie isn’t going to like.

  “That’s not all. Close to, but no later than, the last day of each month, the money will be left at a secure drop box we pulled strings to get. It’s located in a private administrative office area of Union Station, the main Hartford train and bus station. The drop will always take place during a busy time in order to mask what’s being done. Obviously, my manager knows something irregular is going on, but he’s not the type to ask questions.”

  Carlton paused, “What do you think? Any comments so far?”

  “None. It’s clever, extremely clever.”

  Carlton continued, “Sometime during the first four days of the following month, the person getting the money must . . . emphasis on must . . . remove it from the lock box. That should also be done during a busy time at the station. Only the courier and recipient will have keys to the box.”

  Carlton’s tone was serious, “This is important, Jake. Let the person getting the money know if my manager checks the box after the money was to be removed and finds it wasn’t, no more will be left, and the entire arrangement will be cancelled. There are few extenuating circumstances that will make us resume the drops.” Carlton chuckled, “Impress upon her . . . I assume it’s a her . . . absolute secrecy is mandatory, and only she can be involved in the pick-up.”

  Jake knew Carlton was thinking he had gotten someone pregnant and didn’t want Mai, his new love, to find out. He was paying for silence. His friend was aware of similar “female problems” in Jake’s life. Carlton was wrong, but Jake didn’t deny it. As close as they were, Carlton must never know the truth.

  “When the time comes to make the bank deposit, we’ll review everything again and you’ll get the box key. As for repayment it can be done anytime. For security reasons you have to give it to me in person and in cash. Like your other loan, only principal is required.” Carlton closed, “And Jake, this will square us.”

  Jake thought about the plan laid out to him. It was designed to keep Carlton’s involvement hidden under layers of cloaking. It was the smart way to handle things. The weak links from Carlton’s point of view would be the Hartford branch manager, Jake, and the person receiving the money. Carlton would have insured the manager couldn’t implicate him in what was being done. Jake and the person receiving the money had no way of connecting Carlton to it. It was impossible to trace anything to him.

  For Jake, Corrie was the problem. It would be difficult to convince her to accept the restrictions placed on receipt of the money. He’d deal with the issue when the time came. As for Carlton, he was certain the man would not grant him another favor. Carlton had done more than anyone should ask of a friend. Jake was grateful.

  On Wednesday, Corrie approached Brittney at the scheduling desk.

  “I’ll be late tomorrow. Mrs. Manley is driving Frankie Grimaldi to the office and wants me to accompany them.” She leaned and whispered, “
I guess she feels a bit uncomfortable alone in a car with the woman.”

  Brittney raised her eyebrows, “Really? Does Dr. Warden know you’ll be late?”

  “Yes, he does. In fact it works out perfectly. He called me earlier and said he wasn’t coming in tomorrow. Hasn’t been feeling well lately and is going to take an extra day off. Said to tell you to cancel his Thursday patients.”

  That evening Corrie called Dr. Warden. Being cryptic, she said, “I cleaned the office like you asked.”

  “Thanks. Really appreciate what you’ve done.”

  Mai and Corrie drove into Frankie’s driveway. As Frankie entered the car, Mai referred to Corrie who was sitting in the back seat, “I asked Corrie to come with us if it’s okay with you. She has lots of experience with pre- and post-op patients. I feel better with her here.”

  Frankie looked at Corrie, smiled, and tried to hide her nerves by saying, “Sure. You know what they say, the more the merrier.”

  Corrie’s smile was reptilian, as Mai shifted the lever into reverse.

  Having spent the night tossing and turning, Mai drained several cups of coffee that morning. In spite of the caffeine jolt, she was worn and tired. Bouts of diarrhea added to her woes. Frankie’s appearance impressed her. The normally unkempt hair was combed, and her face sported lipstick and make-up. In place of her trademark overalls were black designer jeans. On top she wore a lime-green, v-neck, lightweight sweater with a pale yellow blouse under it. Even her sandals were stylishly two-toned and worn without stockings.

  Mai couldn’t recall more than one or two times, like the past Thanksgiving, when she saw Frankie wearing anything other than paint stained overalls or grubby cut-off jeans. Frankie exuded electrifying sophistication and glamour, and Mai understood why Sara Cunningham was attracted to her.

  Frankie’s facial infection had responded to the antibiotics, and the associated swelling and pain were gone. As she sat in the front passenger seat of the Camry, Frankie turned to Mai and said, “I can’t wait to get this thing over with and put my tooth problems behind me.”

  Chuckling, Corrie chimed, “Well, I’m sure it won’t be long before you’ll have nothing to worry about.”

  Mai was angered by the double entendre and could feel the reddening of her face. Just what we need, a wing-nut like Corrie trying to be clever. It’s bad enough I can’t look at Frankie without conjuring up ghastly images. Corrie better keep her mouth shut, or I’ll shut it for her. God, I hope I don’t have to stop to go to the bathroom.

  They pulled into the office parking lot five minutes before the nine a.m. appointment. Mai remained in the reception room on the pretense of waiting to take Frankie home after the surgery. She paced.

  No other patients were scheduled, and preparations for Frankie’s surgery had been completed prior to her arrival. She was taken to the operating suite. A covered tray of sterile instruments rested on a stainless steel stand next to the dental chair, and on one of the walls a six-inch wide shelf held vials of anesthetic medicines and syringes. Midazolam, a tranquillizer, fentanyl, a narcotic, and propofol, a general anesthetic, were the drugs used in various ratios to obtain the degree of sedation required for surgery.

  Frankie’s vital signs were taken and recorded. After reviewing them, Bret remarked, “In spite of your smoking, your lungs are fine, and you’re in excellent shape. This should be a piece of cake.”

  “I hope so,” was the anxious reply.

  To keep Frankie occupied, Bret said, “One of these days, I’m going to get you to stop smoking.”

  “Good luck with that,” was accompanied by a soft chuckle.

  Oxygen was administered via a nasal cannula, and Bret started an intravenous line in Frankie’s left arm.

  “The first medicine I’m going to give you will dry your mouth so don’t be nervous if you notice it.” As Frankie watched, he injected the drug into the intravenous line and followed with two milligrams of midazolam saying. “This second one will take the edge off your nerves.”

  From a third syringe he administered fifty micrograms of fentanyl to diminish pain. Frankie yawned. She was in a light sedative state. Although Bret knew Frankie was unable to respond in a coherent way, he said, “Pretty soon you’ll be in la-la land.”

  Bret checked his patient’s vital signs to confirm no untoward reaction to the initial medications before administering a dose of thirty milligrams of propofol to deepen her sedation.

  In spite of their awesome power, the anesthetics were innocuous looking liquids. The syringes of midazolam and fentanyl appeared to be filled with water, and the propofol looked like the cream you put into coffee.

  “She’s doing great,” Bret said to Pearlie and Corrie who were in the surgical room with him.

  Pearlie was assisting with the extractions and Corrie was keeping the anesthetic record and monitoring Frankie’s vital signs. Corrie was doing Sandy’s job, but Bret decided to use her since she was the most experienced of the staff. Jake’s absence from the office made her available.

  Less than two minutes after the procedure began, Frankie had a mild convulsion that ceased after a few seconds. At the same time her face took on a grayish pallor. A small amount of frothy saliva dripped from one side of her mouth. Bret, on the alert for potential problems, checked Frankie and the monitors to see if anything abnormal was developing. There was a slight duskiness to her skin, but all readings and recordings were within normal ranges.

  He let out a breath to relax himself and, as was his habit, checked his impressions with his assistants. “Do either of you see anything wrong?”

  “Everything seems fine to me,” said Corrie.

  “Same here,” said Pearlie as she suctioned the froth from Frankie’s mouth, “Except I smell something like the hand cream my mother used to use.”

  Bret sniffed the air, “So do I. Most likely its Frankie. Probably put it on before she came.”

  Corrie was monitoring breath sounds with a stethoscope taped to Frankie’s chest. She alerted Bret, “Her breathing has diminished. And take a look at the oximeter”

  Bret glanced at the Pulse Oximeter which measured oxygen in the blood. The reading had dropped from one hundred percent to ninety two percent. What the hell’s going on? “Keep an eye on it, Corrie, and let me know if it falls below ninety.” He put the instruments he was using on the tray. “I’ll check her airway.”

  To ensure Frankie’s breathing passages weren’t blocked, he repositioned her head and inserted a plastic device into her mouth to keep her respiratory tract open. Frankie didn’t respond to the placement of the device indicating she was in a deeper level of anesthesia than he intended at that stage of the procedure. Realizing something untoward might be happening, he instructed Corrie, “Connect the oxygen to the Ambu bag and assist her breathing. Run the oxygen at six liters.”

  Corrie grabbed the Ambu Bag, connected it to the one hundred percent oxygen line, and augmented Frankie’s shallow breaths. “The oximeter’s down to eighty-eight and falling,” she said.

  As trained to do in emergency situations, Pearlie pressed the intercom button and called for assistance. “We need help in Surgery One.”

  Sandy was working in the sterilization room and heard the ruckus in the operatory. Realizing there was a problem, she hand-signaled Sue and both were on their way to the operatory when Pearlie summoned. The staff was trained in handling emergencies. Each had a specific role in the management of problems like the one they were facing.

  “I can take over breathing for her,” Sandy said as she relieved Corrie of that duty. It freed Corrie to concentrate on monitoring Frankie’s vital signs and to record medications administered to correct the problem they were facing.

  Remaining on standby and prepared to be of assistance, Sue said, “I’m ready to help, Dr. Manley.”

  “Thanks Sue,” he said without looking at her. Perspiration dripped from his face and sweat stains darkened the brim his surgical cap and the underarms of his surgical shirt.


  The most common cause of what was happening to Frankie was improper head position resulting in diminished oxygen flow to the lungs. Bret knew if that were the case, the placement of the airway device and the use of the Ambu bag with one hundred percent oxygen would have corrected the problem. Those steps hadn’t resulted in improving Frankie’s condition. He feared he was overlooking something, something obvious he should recognize and correct.

  The frothy saliva Pearlie continued to suction from Frankie’s mouth remained unexplained, and Bret turned his attention to it. He ordered, “Sandy, turn the oxygen all the way up.” Sandy twisted the knob on the oxygen valve to its highest setting. Ten liters per minute of one-hundred-percent oxygen flowed through the Ambu Bag. It hissed as it surged into the unconscious woman’s lungs.

  Frankie’s color darkened to a bluish-black indicating a serious lack of oxygen in her body.

  “If I don’t assist her breathing, her breath sounds are almost nonexistent,” Sandy reported.

  “Her blood pressure is dropping rapidly, sixty over forty, and her pulse is forty-eight with occasional extra beats.” Corrie said.

  Bret’s mind and heart were racing. Frankie’s condition was inexplicable. She was healthy and had been given minimal drugs. There were possible esoteric causes for what was happening, but they were unlikely. Established procedure demanded he look for the most probable ones. His patient seemed about to go into cardiac arrest for no reason he could discern.

  “Sue, get the Automatic External Defibrillator and make it ready for use.”

  Without answering, Sue hurried from the room to fetch the device.

  Frankie began to develop bright red swellings over the exposed parts of her body.

  “Now, I’m hearing wheezing and I can feel resistance when I bag her.” said Sandy.

  Frankie began another short period of convulsing.

  Bret pushed on Frankie’s shoulder saying, “Can you hear me?” She remained unresponsive. The stench of feces began to waft about the operatory. A urine stain appeared on Frankie’s jeans. She had lost control of bowels and bladder.