Patrice Benjamin Piebald is an abrasive endocrinologist with bipolar disorder who meets an unexpected fate after a series of confrontations with colleagues.
This medical fiction tale is one of a collection of stories that are like “Final Destination” meets “The Monkey’s Paw” (W. W. Jacobs, 1902). As such, they are tragedies more than either mysteries or horror, and would appeal most to readers who enjoy the inexorable pull of a story arc that leads to doom. In each story, a protagonist makes a wish that comes true with fatal results for someone, often the person making the wish. Nothing supernatural, but just how things work out. (Or is it?) The technical details surrounding the fatal (or near-fatal) event are drawn from real cases in the US OSHA incident report database or similar sources and are therefore entirely realistic, even if seemingly outlandish. The plots draw lightly from cultural beliefs around actions such as pointing at someone with a stick or knife, wishing in front of a mirror, or stepping on a crack.
Dr. Patrice Benjamin Piebald died three times. Pat, as he hated to be called, was an endocrinologist at St. Raphael Hospital. He was not a well-liked man on the whole due to his querulous nature, poor frustration tolerance, and somewhat excitable temperament. It was not his fault that he lived with bipolar disorder, but it was his fault that he took his medications irregularly, scoffed at therapy, and seldom attended group sessions.
A lean man, Pat maintained a short ginger beard trimmed narrowly along his jawline that made him resemble a rat peering through a toilet brush loop. He liked to think he had an athletic build but, in spite of his daily workout routine, regular cycling, and intermittent kayaking, he was more scrawny than svelte. He was also off-target when it came to self-awareness: He saw himself as an even-tempered and fair-minded perfectionist, but most who worked with him saw a frequently shrill nitpicker. Pat was an above-average diagnostician, though, and knew how to present well to management. This combination translated to work relationships that were more grudging than eager, more transactional than collaborative, and mostly about tolerating Pat’s abrasive manner and frequent surprise demands.
The three groups of people with whom he clashed the most were nurse managers, the whole of the gynecology department, and the hospital pharmacy. In the first case, Pat had a habit of tasking nurses without consulting the nurse manager, giving them things to do that were outside their scope of practice and often more about environmental services or personal favors than patient care. On top of that, he would pester the nurses constantly for progress reports, but fail to have his pager turned on for follow-up questions. Pat also had a habit of breezing into a patient area where a nurse was busy, and not bothering to even look at the nurse, let alone greeting them or explaining what he was up to. He would then regularly walk off with the patient’s chart or specimens without explanation.
Likewise, Pat’s feuds with OB/GYN were the stuff of hospital legends, and often erupted over sharp differences in a department member’s chosen care plan. The most common gripe was that he would start, change, or stop medications without first communicating or discussing it with OB/GYN, leaving them mystified or scrambling to adjust.
Lastly, there was the hospital pharmacy. The ways in which Pat irritated them were legion, from writing scrips for formulations that required bothersome compounding, doses that needed hand titration or pill splitting, or specific branded drugs not in the formulary. Additionally, there were his habits of returning orders without explanation, making repeated status requests on orders, and—most infuriatingly—not answering his pager. Dr. Tess Chapman of the pharmacy was generally a very patient—albeit hurried—person, but one thing that frayed her nerves was that Pat kept returning drugs after opening the bottles or pouches, thereby dashing any hope of sterility or safety. This habit resulted in having to toss perfectly good medication that could otherwise have been returned to stock. It also meant she had to complete a lengthy disposal form for each drug explaining why it was being destroyed unused.
It was a bright sunny Thursday when the wheels came off.
Pat was outraged that his instructions to the nurses in 5 North to repack the drug trolley remained unheeded. The nurse manager advised Pat that the nurses did not report to him, and that how they chose to pack the medication trolley was actually “none of his damned business.” Further words were exchanged, and both parties stomped off in opposite directions. A very ruffled Pat was still seething as he entered 3 West OB/GYN to check on a patient and spontaneously change her medication. Then, task completed, he was on his way out feeling almost calm when the head of OB/GYN confronted him, tearing into him about making “yet another medication change without the decency to communicate with, let alone consult, the OB/GYN attending.” Terse words were exchanged, tempers skyrocketed, and both stomped off in opposite directions.
Back in endocrinology, feeling more confident in his own domain, Pat impatiently reviewed meds of three patients, opening each bottle and pouch to count and examine, then deciding they were all wrong. He ordered the drugs returned to the pharmacy forthwith, dropped his pager on his desk, and vacated the hospital for a leisurely, calming lunch. Upon return, he discovered several messages: The first was from the pharmacy, scrawled in red Sharpie on a Post-it note and stuck to his pager. Feeling a little unsettled, Pat next scrolled through a series of texts from a nurse manager, the CNO, and the head of OB/GYN, as well as several from the pharmacy. Lastly, a legion of voicemails increased his anxiety and greatly elevated his blood pressure.
With a slightly trembling hand, Pat took his bipolar meds, then finished charting for the day, grabbed his laptop bag, and hastily exited his office. An orange kayak awaited on the roof of his white BMW, his chalet was booked, and the river beckoned. At 3:46 on Thursday afternoon, with a growing sense of relief, Pat escaped the building while his pager sat lonely on his office desk, buzzing to itself.
Pat had been planning this long weekend of white-water kayaking for quite some time, and had mentioned his plans to several staff members. The park authority security camera recorded him arriving Friday morning at 7:55, removing a kayak his BMW SUV roof rack, attaching it to a wheeled cart, and heading to the launch ramp. On Saturday at 5:27 p.m., the park rangers recovered his body from the river 80 miles downstream.
The coroner reviewed the many injuries sustained by Pat’s body, but regarded the majority as resulting from postmortem effects of floating into rocks and other river obstacles. However, one injury could not be ruled as having been sustained after death, so was listed as perimortem. Since there was water in the lungs, the coroner concluded that it was death by misadventure—but, because of the perimortem injury to the head, he passed the case on to the district medical examiner. The first death of Dr. Patrice B. Piebald was recorded, attested to on an official form, and captured in the state electronic reporting system.
Next up, the medical examiner was a methodical person not to be rushed. She carefully examined the wounds and agreed, one by one, with the coroner’s report about them being postmortem. The gash on the forehead, she decided, came prior to death, but she noted the lack of coincidental defensive wounds. She also noted the gastric contents: the remains of several enteric capsules. Adding a dictated note for the lab to clarify the capsule type and provide full toxicology screening, she continued her work. By the time she completed the autopsy and remaining tests, her notes showed she had settled on this being an intentional death. She adjusted the record to a query suicide, pending corroboration from the lab, and so the death of Dr. Patrice B. Piebald was recorded a second time.
Three days later, the lab results came back and the medical examiner sat down to review the full puzzle. She picked through the facts—linking this one with that, splitting one fact into two, and deriving new facts—repeatedly grouping, shuffling, and piecing them back together: the slow enteric capsules, the Fentanyl, the paralytic agent that might explain the lack of defensive wounds, and the likely sequence. She adjusted the summary, ticked a new box, and forwarded her completed report to the police. The third and final death of Dr. Patrice B. Piebald was thus recorded a homicide.
