Chapter One

Somebody had been stealing drugs from the medication closet at Morton Hospital. It had been going on for months, mysterious shortages of Tylenol Codeine. The tablets were painkillers, and they were addictive.

Anne Capute, a licensed practical nurse, had stolen one tablet. She stole it when a nurse's aide had arrived for work almost in tears from the pain of an abscessed tooth. Anne, feeling sorry for the girl and anxious to stop her pain, got the key to the medication closet. She took one Tylenol Codeine tablet from a patient's drawer and gave it to the girl.

And so when they came to get Anne at ten-thirty on the night of May 22, 1980, her first thought was, Oh, God, they're going to accuse me of stealing drugs.

"They" came first in the form of Nurse Lorraine Hickey, a stout, gray-haired woman who was the clinical manager of surgical ward 2, known as S-2. Anne, with a half hour left on her shift, was standing at the nurses' station looking at a chart. Nurse Hickey, as precise in speech as in motion, approached Anne and said, "Anne. Costello wants to see you."

"God wants to see me? What for?" Anne said. She sounded flippant, but she was scared, and before the words had even stumbled from her mouth, she could feel fear rattling inside her. Being invited to Costello's office was like suddenly being thrown back to Catholic elementary school and sent to the mother superior's office.

"Just come with me to her office," Hickey said. Before Anne could ask another question, Hickey swung around and marched back down the corridor of S-2.

The pills, Anne thought, the goddamn pills. Her heart thundered in her chest as she struggled to keep up with Hickey. Anne was sure that they were going to accuse her of stealing pills, that they were going to take her license away. The frightening thought became more and more real. She thought she would be sick. Anne had spent the first forty years of her life wanting nothing as much as she wanted to be a nurse, and she had spent only the past three years actually being a nurse, and now she was afraid it would be taken away from her. Anne was a mother even more than she was a nurse, and her worry now was for her three teenaged daughters at home and the things they would have to do without if she got fired.

Hickey didn't take the elevator. Anne followed her down two flights of stairs and out the back door of Morton's main building, one of three buildings sprawled across two city blocks in downtown Taunton, Massachusetts. The night was balmy, and Anne could hear the rumble of traffic behind her as she followed Hickey across the parking lot toward the small brick administration building. Anne's heart fluttered. It wasn't just the fear of being accused of stealing pills that was getting to her. It was Costello. The idea of being brought before Costello for anything at all was terrifying.

To the nursing staff, Maureen Costello was known, respectfully, as the "Iron Maiden," and was a person to be reckoned with. Her title was assistant administrator for nursing services. But the title was not nearly as intimidating as the person. A licensed practical nurse, Anne Capute was on the bottom step of the nursing hierarchy at Morton. Maureen Costello was at the top.

Anne had met Maureen Costello only once, a few days after Anne had been hired. She and ten other new employees were led into a conference room, where they sat at a long wooden table, with Maureen Costello presiding. She greeted the new employees, she told them in detail who she was, and she rattled off a list of her professional credits that almost bowled Anne over.

The list included service with some of the best hospitals in the nation. By comparison, Anne felt like two cents. Costello had spent her entire adult life succeeding gloriously in a world that Anne had only dreamed of entering. When Costello finished reciting her list of credits, she had asked each person at the table who he or she was and what that person hoped to get from his or her job at Morton. After that first day, Anne watched in admiration as the Iron Maiden patrolled the wards like some visiting general. Anne soon realized that the assistant administrator for nursing services remembered every word that had been spoken at that first meeting. Anne was in total awe of the woman.

By the time Nurse Hickey led Anne into the administration building on the night of May 22, and they entered Maureen Costello's office on the first floor, Anne was breathless. She was forty-three and recklessly overweight.

Maureen Costello's office was small and well-ordered. Costello sat calmly behind her assistant administrator for nursing services placard. When Anne entered the room, Costello stood and greeted her. Costello is a small woman, trim, attractive, a woman not easily ruffled. Though she had worn nursing whites for many years, she now wore the suit and blouse of a professional manager.

"Take a seat, please," Maureen Costello said, exuding graciousness without warmth. Anne came in and sat in a metal office chair in front of Costello's desk. Automatically she glanced down to see if her white shoes were properly polished.

Sitting to Anne's right in front of Costello was Noel "Tom" Bosanquet, director of personnel for Morton Hospital.

"You know Mr. Bosanquet," Costello said. Anne nodded. "Tom is here as an employee advocate. He'll give you support whenever needed."

"Employee advocate? Support?" The words activated an alarm button in Anne's mind. Here it comes, she thought, the goddamn pills. Anne noticed that Nurse Hickey was staying in the office, hovering just beyond Anne's shoulder. A phrase rushed back to Anne from girlhood afternoons spent watching cowboys-and-Indians movies at the Rivoli Theater: They've got us surrounded.

They sat—Anne Capute, Lorraine Hickey, Maureen Costello, Tom Bosanquet—for a single silent moment that ticked with tension. Everyone fidgeted. It seemed as if they all wished they were someplace else.

"Anne," Maureen Costello finally said, "we're here on a pretty serious matter, and we need your help in sorting out the information."

"Sure," Anne said, "shoot." This was typical of a frightened Anne, shielding herself with some flippant remark at the most inappropriate time.

"Anne, can you tell us about Norma Leanues?" Costello said.

The name Norma Leanues was music to Anne's ears. She was thrilled to hear the name of a patient, any patient, because to her that meant she was facing Costello over a patient-related matter, not those damned missing pills. Anne felt ridiculous for having been so afraid. This whole thing was probably about some minor infraction in filling out forms or something equally insignificant. The knot in Anne's stomach began to unravel. She rolled her eyes toward the ceiling as if to say, Thank you, God, for getting me out of this mess.

It was a small thing, but it was one of many small things that would take on importance later. Maureen Costello saw this rolling of Anne's eyes and took it as proof that the name Norma Leanues had special significance to Anne. Eventually Costello would so testify in court.

Anne told Costello that Norma Leanues had been a very frightened patient, and with good reason. Afflicted by cancer, Norma lived in constant pain. Anne said that most of the medication given to Norma Leanues had not stopped the pain.

"How was she on May sixteenth?" Costello asked.

"Friday?"

"In exquisite pain," Anne said. "Exquisite" was a word Anne used often to describe pain. It sounded right to her. She had even looked it up in the dictionary once to be sure she was using it correctly. When she found that "exquisite" could mean "intense," she continued to use it in reference to pain.

Costello asked, "How do you know she was in pain?"

"She cried out a lot so we'd hear her," Anne said. Costello looked down at her desk, where Norma

Leanues's medical records were spread out. Among them were the narcotics proof-of-use sheet, the medication chart for Norma Leanues. And the nurse's notes. Costello read out loud the nurse's notes that Anne had written for the three-to-eleven-thirty shift on Friday, May 16.

After one medication note Anne had written, "with poor results."

"What does 'with poor results' mean?" Costello asked.

"She wasn't able to swallow all of her oral medication," Anne said. "She was suffering, she was in agony."

As she spoke, Anne began to get edgy again. Her fingers began to tremble. Why, she wondered, would it take four people to discuss a minor infraction? Anne didn't know what was going on, but once more she began to feel that her lifelong dream of being a nurse was threatened.

"It says here 'crying all the time.' What does that mean?" Costello asked.

"Tears were streaming down her face," Anne said, "and she was clutching her chest." Anne searched Costello's face for some hint of what this was all about but found nothing.

Bosanquet and Hickey were silent.

"Did Dr. Hillier make the rounds that night?" Costello asked.

"Yes," Anne said. "Around seven o'clock."

"Were you with him?"

"I wasn't on rounds with him. I was with Nancy Robbins. She was talking to Dr. Hillier. He seemed to be in a rush. In fact, I had to hold his sleeve so that Nancy could ask him some questions."

"Can you tell us about that conversation?" Costello asked.

"There's not much to tell," Anne thought, never imagining that the conversation with Hillier would affect her whole life and career. "Nancy told Dr. Hillier that the morphine solution was not helping Mrs. Leanues, and she asked if we could try some other medication. Hillier said "Sure, give her anything she wants, just make her comfortable—"

Costello broke in abruptly. "Is that exactly how Dr. Hillier said it?" she asked. Costello looked at her intensely.

"Well … yes," she said. "'Give her anything she wants anytime, just make her comfortable. She'll be dead in twenty-four to forty-eight hours.'"

"Then what happened?" Costello asked.

Hickey and Bosanquet leaned forward.

"Well, Nancy said, 'How about morphine, fifteen milligrams, subcutaneous, no time limit?' Then Nancy went to the desk to write the order, and I went to the medication closet to get the fifteen milligrams of morphine and also the ten milligrams of Valium, intramuscular, which Dr. Hillier had ordered for Mrs. Leanues."

"Did the Valium and morphine help Mrs. Leanues?" Costello asked.

"Not much," Anne said. "She was still crying out in pain."

Costello studied her notes again. To Anne it looked as if she were trying to figure out a word for a crossword puzzle. "Anne, tell me about the rest of the evening."

Anne shifted in her chair. "I finished up with the other patients about ten p.m.," she said. "When I got back to Leanues she was in a lot of pain."

"Vital signs?" Costello asked.

"Blood pressure about a hundred eight over seventy, I think, pulse about a hundred to a hundred twenty, respiration around eighteen."

"Was she having trouble breathing?"

"No."

"Then what?"

"She was crying out in pain," Anne said. For an instant Anne's memory was haunted by the sounds of Norma Leanues's tragic wailing. "So I gave her thirty milligrams of morphine."

"Did you realize the order was for fifteen milligrams?" Costello asked.

"Yes."

"Then why did you give her thirty?"

Anne shifted again in her chair. Her hands, clammy with sweat, clutched the arms of the chair.

"Anne, why did you give her thirty?" Costello asked again.

"I wanted to make her comfortable."

For a minute nobody spoke. Costello stared down at her charts. Bosanquet and Hickey glanced around the room, looked at their hands, looked at the floor, looked at the ceiling, looked everywhere except into Anne's eyes. Anne squirmed. In her mind she reran the images she had of Norma Leanues, like a coach studying game films to find mistakes. Anne found none. It seemed as if everybody else in the room knew something she didn't.

"Anne, what about Saturday night?" Costello finally asked. "Were you assigned to Mrs. Leanues?"

"Yes."

"Did you specifically request that assignment?"

"Yes."

"You did?"

"I mean no," Anne said. "I mean I didn't request Leanues. But I did ask for the same assignment. It's easier if you have the same assignment on consecutive nights."

"How was Mrs. Leanues that night?"

"She was going down."

"What do you mean?"

"She'd gotten worse," Anne said. "Her color was lousy, blood pressure about a hundred over sixty, rapid pulse, respirations twelve to sixteen."

"Was she still crying out?"

"She was moaning," Anne said. "She was obviously in pain."

"How could you tell that?"

"She had tears streaming down her face and she was clutching at her chest the way she had before."

"Clutching her chest?" Costello said. "That could mean she was having difficulty breathing. You gave her thirty milligrams of morphine s.c. at five P.M.?"

"Yes."

"Why?"

"I thought she needed it."

"Did Nancy Robbins know about the dose of morphine you were giving?"

"Yes," Anne said.

"I see," Costello said. She looked at her nurse's notes and medication records again.

"'Morphine sulfate, 30 milligrams, s.c., right arm, with poor results at 7 p.m.,'" Costello read. "'Morphine sulfate, 30 milligrams, s.c., left leg muscles, with fair results at 8 P.M. 9:15, morphine sulfate, 30 milligrams, s.c. in the right thigh. 10:15, morphine sulfate, 30 milligrams, s.c., in the left arm with apnea 10 seconds in duration.'"

Costello stared at Anne. "Anne," she said. "What does 'apnea ten seconds in duration' mean to you?"

"Huh? Well it means she wasn't breathing for ten seconds at a time. What else could it mean?"

"Nothing," Costello said. "I just wanted to be sure we are clear about this."

Costello read the last entry on Anne's nurse's notes for Saturday. Written just hours before Norma Leanues died, it stated: "'11:15, morphine sulfate, 45 milligrams, s.c. in right arm, nail beds are bluish, extremities warm, apnea 10 to 15 seconds in duration. Not responding. Condition very poor. Valium 10 milligrams, IM times two at 6 P.M. and 9:45.'"

When she finished reading, Costello leaned back in her chair. She stared grimly across the desk at Anne as if to ask, Well, is it true? Are these numbers correct? And Anne, frightened, shaken, stared helplessly back. All the numbers were correct.

"Anne," Costello said, "do you know the effects of that dosage on a patient?"

Anne pushed herself up in her chair. Once more dredging up a wisecrack, she grinned and said, "My God, it would be enough to kill an elephant!"

Costello was not amused.

"Why did you give her all this medication, Anne?"

"I wanted to keep her comfortable."

"In the notes it says she was unresponsive. So how did you know she was in pain?"

"She had tears streaming down her face and she was clutching her chest." Anne's hands fell limp in her lap, and her body slumped once more into the hard office chair. She could feel the weight of the narrow room on her.

For another hour they covered the same ground, line by painful line. "How much morphine did you give her?" Costello asked. "What did Leanues look like? Why did you give her this medication?" And Anne once again tried to make them all understand the pain of a dying woman. "There were tears in her eyes, tears streaming down her face, and she was always clutching her chest."

"Do you know the effects of morphine?" Costello asked.

"Yes," she said, gripping the arms of the chair. Her voice cracked. "It's a CNS depressant, it's a narcotic, respirations have to be watched carefully."

"And Valium?" Costello said. "Do you know the effects of Valium?"

"Yes," Anne said, "yes." She was so scared. "Same thing, respirations have to be watched."

There were more questions covering the same ground, and Anne kept trying to explain about the tears streaming down Norma Leanues's face and the trembling little hands futilely clutching at her chest as if to strangle the pain. Anne could not imagine what further explanation was needed. And after an hour of being badgered and forced to recall Norma's pain, Anne started crying.

"I didn't want her to feel any more pain," Anne said.

Tom Bosanquet spoke. His voice floated softly on the tension in the room. "What do you mean by that?" he said.

"I wanted her to be comfortable, not to suffer…." Anne sobbed. "I …" and then the immense implication of Bosanquet's question struck with all the shocking force of a rock crashing through the window. The truth hit Anne. These people were not looking for "help in sorting out the information."

"WELL, I KILLED HER!" Anne cried. "I must have killed her, I guess that's plain to everybody in this room."

"Now, Anne," Costello said, her icy surface melting slightly, "we're not trying to make you think that."

"Well, I do feel that way," Anne snapped.

"We just want to find out what happened. We'll support you in any way we can. Do you understand our concern?"

Anne did not answer. She was drowning in her own tears. Her first desperate thoughts were of money. Losing her job would mean losing her paycheck, and the bills were already piling up at home. Even with Charlie working full time as a carpenter and Anne working a full week at the hospital, they were lucky if they could keep up with all the expenses.

"Do you understand our concern?" Costello repeated.

"Yes, yes," Anne muttered through her sobs, but she didn't really understand much of anything. As far as she could see, she hadn't done anything wrong. She had merely followed doctor's orders and her own conscience, just as any other nurse would. She was allowing herself to be bullied, but she didn't know how to fight back.

"Do you have any questions?" she heard Costello ask.

"What's going to happen to me?" Anne asked.

Costello answered, "I don't know. But I have to put you on administrative suspension for three days. I'll get back to you by next Wednesday."

"Do you think you're being treated fairly?" Bosanquet asked.

"Yes, I'm being treated fairly," Anne said, delivering her words in an icy monotone.

"Do you want a ride home?"

"No," Anne cried, feeling as if someone close to her had just died. She searched her mind for some cutting remark with which to slash out at these people, something that would make them ashamed of themselves. But at that moment Anne was just too weak, too thoroughly beaten to fight back.

For a long time Anne just sat, slumped in the office chair, her head down, her eyes closed and wet. No one spoke. She was worried, she was embarrassed, and she was angry. She wanted no more than to take care of her patients and work on that bottom step of the hierarchy at Morton Hospital. And now they were trying to kick her off of it.

Finally she wiped her tears and she walked out of the office. It was almost midnight.