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CHAPTER THIRTY-TWO

She met us at the entry and without a word of conversation led us to a room that looked out over the grounds.

Based on the box of tissues within reach of each seat around a table, I suspected it was for meetings between staff and family.

She gestured us to the chairs at the table.

And then we could have sat there in silence for all the effort she made.

I flicked a look at Clara. Usually, she’d take the lead. But if Clara’s usual manner didn’t work with Rose Gleiner, that would leave me trying to get through to her. Better the other way around.

Aiming for tact and connection, I said, “Working in hospice must take a special kind of caregiver.”

“It does not. Some people fear the closeness to death of hospice. Some people imbue it with a near-mystical experience. Both are wrong.”

Why did I have the feeling she didn’t hesitate to say that people — lots of people — were wrong. Frequently.

Hoping to edge closer to the reason we were here, I asked, “With Derrick Dorrio obtaining a compassionate leave from the prison system, were there more issues with him than other patients? Requirements they had or...?”

For several long beats of silence, I thought she wasn’t going to take up the specific question nor the open-ended one.

At last, she said, “No additional issues. He was like every other hospice patient in that he had his CTI. His MAC and BMI qualified him for hospice, though whether an IPU or in-home was not specified.”

So much for me going first.

“BMI — I know that.” Clara is a warrior in case I haven’t mentioned that. Unlike me, who prefers to stand behind a column, hoping the battle skirts around me and — especially — hoping no one recognizes me. “But not what those other letters stand for.”

Rose Gleiner breathed out shortly in one of those signs of impatience that was hard to call someone on, but also hard to miss. “CTI is Certificate of Terminal Illness. Required for this hospice — most hospices.

“MAC is mid-arm circumference. It and BMI — body mass index — are indicators of nutritional deficit which is frequently tied to a patient’s decline.”

When she paused, Clara prompted her with, “IPU?”

Definitely a warrior. I would have let it slide.

“Inpatient unit. A residential facility such as this, as opposed to in-home hospice care.”

“Was in-home care considered for Derrick? Why did he come to Kentucky Manor?”

“Home care was listed as a medical option in his case. I do not know why the family opted for our facility. For some it is the practicality of the care required. Others don’t want to be as close to it as is required when it is in their home.

Having the dying patient in a residential facility gives them an illusion of being buffered from death.

“Death is as natural a part of life as every other aspect. Meeting that death while in hospice care is as varied as the humans about to meet their death. Then multiply the differences by the people in their lives. It’s exponential.

Pain. Fear. Sorrow. Confusion. Acceptance.

Even, at times, joy. Very few in hospice, however, have serenity. ”

“Grief,” Clara said. “You didn’t include grief.”

Rose turned to Clara. “I knew your mother-in-law.”

“I know.”

“I didn’t make the connection when I spoke with you previously.” Something I interpreted as respect edged into her voice. “I didn’t make the connection with the person who cared for her.”

I’d take any odds that Donna had filled in that gap for her. Though, possibly it was Carol or Linda.

Whoever did, it was another display of the kind of network that existed in the community. The community that had suffered a fissure, as Clara said, that hadn’t fully healed after Jaylynn’s murder and now was reopened.

Briskly, Rose added, “What do you want to know?”

Clara didn’t hesitate. “For starters, why did he come here — I mean rather than another facility?”

“We’re by far the best.”

Her professional pride didn’t leave room for any other possibility and might have seemed a roadblock to Clara’s questioning, but she didn’t hesitate.

“How did people react to Derrick being brought here? The patients—”

“Few were aware enough to know his identity and even fewer to care. The dying seldom succumb to the self-indulgence of outrage.”

The self-indulgence of outrage. That was quite the phrase. I’d have to share it with Kit.

Clara’s eyes widened and I knew she’d been struck by it, too. But that didn’t stop her.

“The families of patients?” she asked.

“More aware of his presence than the patients, but few made the connection to my knowledge. Or, if they did, they didn’t care enough to raise it. The families are, understandably, focused on their dying relative, as well as each other. It takes a great deal to draw them out of that circle.”

Like a murder? I’d bet a lot more of them knew now that Kentucky Manor had housed the notorious murderer, Derrick Dorrio. For a short time, anyway.

“But the staff — the staff had to be aware,” Clara said.

“Yes. The administration informed the medical staff and caregivers. The word quickly spread among all employees.”

I wondered if the sheriff’s department was checking for connections to Jaylynn among Kentucky Manor employees.

“What was their reaction?” Clara asked.

“Mixed. Decidedly mixed.” Rose looked at Clara. “You might be too young to have recognized the divisions that investigation and trial caused, but not to see that Derrick going to prison did not end the divisions.”

“Fissures,” Clara murmured.

“Yes,” the older woman said.

I jumped in. “The administration had to know that, didn’t they? Or are they not from here?”

“They’re from here,” she said a little grimly.

“Then why accept him as a patient? Seems like a lot of downsides. The real threat of discord among the staff, not to mention a PR nightmare.”

“When we — the senior staff — were informed, we were also told that the administration was confident we would put the needs and comfort of the patient ahead of all else, as was our professional obligation.”

In other words, the managers used their professionalism against them to stymie any complaints.

“As for the public relations having a negative impact, the administration counted on the staff adhering to our ethical obligation not to discuss patients, even the fact of someone being here. They accepted him only after prison officials agreed to keep it quiet that he was in our care. They did not want the word to get out. They did want the state stipend. They’ll still get the stipend. ”

That was her understated way of saying they would not get what they wanted as far as the word not getting out. That word was out — way out — the words weren’t good, and she didn’t mind one little bit.

I wondered which side of the He-did-it-He-didn’t-do-it fissure she occupied.

“Did they put in any precautions? Security?” Clara asked.

“No. They and the prison official declared no added security was required because they rated him at twenty to thirty percent, when his other main caretaker and I considered him thirty to forty percent.”

“That’s how they grade patients for palliative care,” Clara said to me.

“The Palliative Performance Scale,” Rose said. “It assesses patients on self-care, intake, ambulatory status, activity, and consciousness. There was no question Derrick’s disease was quite advanced. At the same time, he was largely bedridden, he had consciousness, though sleeping more.”

“How long do you think he could have lived? In your professional opinion.” Perhaps seeing resistance in Rose Gleiner, Clara quickly added, “A range, say.”

“It is never completely predictable,” she started. Then she narrowed her eyes, considering. “I would not have been surprised at all to have had him as a patient for another two weeks to a month.”

Clara and I exchanged a look.

“So, you must have been surprised when you found him dead.”

“Very.”

And immediately suspicious, her tone indicated.

“Did you try lifesaving measures?” I asked. Better I draw any ire that might attach to that question, while Clara remained the good... cop is what comes to mind, but really, she’s more like Glinda, the Good Witch, as played by Billie Burke in The Wizard of Oz .

Which, I suppose, makes me the Wicked Witch of the West.

I could live with that if it produced more information.

“The DNR required me not to,” she said carefully. “I confirmed that he was dead but did not otherwise compromise the scene.”

“You considered it a crime scene from the beginning?” Clara asked.

“Yes.”

“Why?”

“I am not at liberty to say.”

“The sheriff’s department asked you not to?” I asked.

She didn’t answer.

So, I added, with conviction, “And the hospice’s administration told you not to.”

“Neither of which was necessary,” she said by way of confirmation. “I will not gossip about the circumstances of a patient’s death.”

“Oh, but Rose,” Clara said earnestly, “this is not gossip. We’re trying to find out who killed him so everyone — well, everyone except the murderer — can go on with their lives.

They need those answers. Just as family members of hospice patients need the — I hate the word, but it is a kind of closure . ”

“That’s the job of the sheriff’s department. Leave it to them.”

“If you hadn’t stepped forward and said there was something wrong, no one — the sheriff’s department or us — would be looking into his death,” I said. “So you must also care about justice being done. That’s why you notified the sheriff’s department, isn’t it?”

She gave me a sharp look. “I didn’t notify the sheriff’s department.”

“Really? But everyone said you did.” Clara delivered that with innocent curiosity, when I probably would have sounded accusatory.

“I... urged the hospice administrator to call the sheriff’s department. I might have, eventually, done so myself if that was necessary. But I preferred it go through normal channels.”

“So, the administrator called the sheriff’s department?” I asked.

“No. The administrator resisted calling the sheriff’s department, but agreed to my calling an assistant coroner.

” Her mouth shifted. It wasn’t a grin or a smile, but it did convey a modicum of satisfaction.

“The assistant coroner and I were medics together for the regional emergency response unit. She called in the sheriff’s department immediately. ”

The not-a-grin-not-a-smile disappeared. “A satisfactory conclusion, but an unnecessary delay. And it meant keeping people out of the room for a period of time that called more attention to the situation than the administrator wanted, as I told her it would.

“It also meant the family arrived before it was settled. Would have been much better not having the widow screeching in the hallway for us to leave her baby alone.”

I didn’t bother trying a soft transition to the next topic.

“How are drugs handled here?”

She gave me a sharp look. Unclear if it was admonitory or appreciative. I had my suspicions.

“Carefully and professionally.”

“You have protocols for the patients’ drugs,” Clara suggested.

“Of course we do. A secured area for all drugs. Within that secured area, locked compartments for drugs included in Schedules II, III, IV, and V. Inventory is closely monitored, as is administration to patients. I have no criticism of the procedures or their implementation here.”

The highest praise from her, I guessed.

“So, if one patient’s meds were administered to another patient by accident—?”

“It would not happen.” Rose’s lip curled. “Even indulging a fictional hypothesis, it would have been apparent immediately when the sheriff’s department looked into the medication protocols.”

“But no one would know if someone brought in potentially fatal drugs from outside the building, would they? Because visitors and family—” And staff , I mentally added, but didn’t say. “—are not frisked or their possessions searched.”

Her lip uncurled. I could hope it was admiration. Might have been shock.

“ Frisked ...? Are you saying a visitor—”

Or staff , I mentally added again.

“—administered a lethal dose of a drug to Derrick Dorrio?”

“We’re exploring possibilities,” I said. “From what you said, it is possible.”

“Possible,” she said grudgingly. “But it didn’t happen.”

Clara came to my defense. “How do you know? You said it’s possible—”

“Because he wasn’t killed by an overdose or incorrect medication. He was killed by—”