Fixation

By Steve Smart

The unexpected death of a facial cosmetic surgery patient appears to result from a post-operative complication. Dr. Celeste Noles, pathologist, finds clues during autopsy which stir the Army hospital medical staff, the Korean populace and the local legal community. Questions swirl, allegations are made, a trial ensues, and a second death results. The author fills in unknown portions of a real story with entertaining and suspenseful possibilities that will keep you reading.

• Language: English
• Publisher: Page Publishing, Inc.
• Release date: Jan 1, 2018
• ISBN: 9781640277786

Book preview

CHAPTER 1

July 18, 1984

Kaiphon, South Korea

5:10 a.m.

Skirting the perimeter of Quansan US Army military base, Second Platoon of Company C ran in formation. The daily four-mile jog at an easy pace had become a minimal challenge for the fit infantrymen. As they fulfilled their mandatory daily physical training, the men chanted familiar Army Jodies in unison.

Normally humid and dusty, today was different. Overnight rain had firmed the dirt roads. Puddles of standing water quickly soaked the soldiers’ shoes and socks. A misty rainfall refreshed them in the early morning darkness. Each recognized the landmarks that identified miles 1, 2, and 3.

Passing the mess hall at mile 1, they inhaled the aroma of bacon cooking, knowing that breakfast awaited only completion of this jog.

Passing the infirmary at mile 2, they set their sights on the power station, which all knew was the three-quarter of the way home mark—one mile from their goal. Like horses headed for the barn, their pace quickened. As they made the final turn toward the main post gate, the formation slowed. The chants faded.

Platoon, halt! The platoon came to a disorderly stop at the command of their second lieutenant.

At ease!

Warily, he approached the body of a young Korean woman crumpled in the middle of the soggy dirt road. The troops strained to get a better view while their feet remained planted. The novice lieutenant had no tolerance for breaking rank.

PFC Casey Crawford stood third man from the left in squad 3. Eyes bloodshot and reeling with a hangover from hell, he could have cared less what distracted the other soldiers. He just wanted to get back to the barracks . . . until, from the corner of his eye, he saw the body. He was unable to see the girl’s face, but the sight of her red tank top awakened his senses and restored sobriety.

The lieutenant called for his platoon sergeant to step forward alongside.

He gently shook the petite sopping female body. No response. Pulse check. None detected. Her skin was cold. He knew the importance of checking for a clear airway but recognized it as unnecessary since her neck was contorted and she was obviously not breathing.

Her face was expressionless; her eyes, half open. A small pool of dried blood trickled from the corner of her mouth, staining the dirt beneath her face. Her skin was blue; her body, rigid.

Panic overwhelmed Casey. His eyes searched for and found those of Private Rick Elliott standing at ease in first squad. Casey’s gaze was wide-eyed and fearful; Rick’s was steely and stern.

Casey felt light-headed, fearing that he might faint. He steadied himself against the adjacent soldier and fought tears. Straining to see more clearly, he confirmed the nightmare now engaging his brain. He recognized the body . . . It was Li.

Regaining his strength and composure, he turned again to Elliott, who was now laughing it up with another of his squad members.

The platoon, under the command of their sergeant, reluctantly returned to barracks to prepare for morning inspection and contact the military police. In the interim, the young butter bars and two troops stood vigil over the body.

The sun was cresting the horizon as the MPs arrived. The lieutenant and his soldiers stepped aside, but morbid fascination delayed their departure.

The body had been left in plain view on an oft traveled road. Her position suggested that she had been dumped in the road from the bed of a truck or from the trunk of a car.

Practically a child, the lieutenant thought, lost in impossible attempts to rationalize the death.

She was pretty. Her attire hinted at her profession. A red tank top, short black skirt with a revealing slit, and stiletto pumps suggested inclusion with the hordes of young Korean women who worked the strip just outside the east entrance to Camp Quansan.

Not only did the income entice these women into prostitution with inherent risks of crime and disease, but more so the dream of meeting soldiers who might take them as brides to their perception of Utopia—America.

No identification or personal items were found on the body except a tarnished silver-plated cross hanging from a cheap golden chain around her neck.

As the MPs began searching the area for clues, the lieutenant checked his watch, surprised that it was almost 6:30 a.m.

The sun had risen. Duty waited.

He allowed a brisk walk rather than run back to barracks, permitting the privates to speak about what they had seen.

Murder was only a speculation, but none of the three could imagine another reason for the presence of her crumpled body in the middle of that road.

Listening but not hearing, the lieutenant was preoccupied with questions of his own. Who would assume responsibility for the investigation—US Army MPs or Korean civil authorities?

If a GI was suspected of the murder, he knew that the already fragile relationship between local American military leaders and the Korean civilian political establishment could be aggravated.

Meanwhile, the four military policemen on the scene wrestled with some of the same unspoken questions. They had contacted their commander and awaited a response by radio. They were unsure how thorough they should be investigating the crime scene and whether Korean officials should be present before they began.

The soldiers stood over the body, reverently quiet.

The company commander was probably contacting battalion headquarters. The brass there had probably deferred to post command. Big shots were weighing options in a potentially explosive situation.

Except for the lieutenant’s initial assessment, the body had not been touched since it was discovered.

As the sun rose above the tree line, shadows previously covering the body began to disappear.

With full illumination of the corpse, one of the soldiers called attention to faint bruising now visible around the girl’s neck. The finding wasn’t dramatic, but it was noticeable and particularly intriguing to these amateur detectives.

As their self-esteems for investigative genius inflated by the minute, they scanned all visible skin for other signs of trauma.

CHAPTER 2

Six years later

March 1990

Fort Riley, Kansas

Reflections of revolving red lights and white strobes from the EMS ambulance caught Dr. Jake Starnes’s attention as he helped his wife, Lorie, into the passenger seat of their jet black BMW. Freshly washed and waxed, the six-year-old car was still a source of pride for the Starneses, still considered an indulgence by both.

As Starnes closed the door, he glanced down the street, watching the ambulance pass through the intersection of Riley Place and Huebner Road.

As an Army oral and maxillofacial surgeon, he had been required to live on post to be near the hospital. His duplex was one block from the center of his family’s social life, the Officers’ Club, and three blocks from the center of his professional life, Irwin Army Hospital.

Daily background sounds of the neighborhood conflicted as children splashed playfully in the O’Club pool and ambulances sped toward Irwin Hospital.

As a child, Starnes had feared ambulances, assuming that a family member lay dying inside when he saw or heard one. Even as an adult, he suffered this paranoia. As a surgeon, however, the focus of concern had shifted from family members to his patients.

He was able to find humor in his fear but couldn’t help wondering if this ambulance might carry one of his postoperative patients.

More rationally, the ambulance reminded him that his evening with Lorie could soon be interrupted by the annoying vibration of his beeper. Though not on call for his specialty, he was responsible to back up the Ear Nose and Throat Department (ENT) for facial trauma tonight.

Jake and Lorie’s destination was Manhattan, Kansas, a twenty-five-minute drive from Fort Riley to meet friends for dinner.

The evening already was invigorating. To the west, the sun was setting, leaving a beautiful red hue in the sky. A stimulating breeze blew through the open windows and sunroof. Gino Vannelli’s Crazy Life reverberated through the BMW’s cockpit as Jake and Lorie sped toward the hometown of Kansas State University.

Starnes enjoyed a single glass of Bell cabernet with a pasta dinner, respecting his hospital responsibility. The food was good, friends entertaining, but the delight of his evening was seeing the glow of Lorie’s face as she transformed from busy mom to appealing wife.

The evening was therapeutic for both.

Lorie needed these restful evenings as much as Jake did to unclutter her mind of the ever-present pressures of being a military wife and mother of three active children. She was the partner in marriage who carried the burden of family finances, budgeting, household purchasing, and social scheduling.

Lorie had sacrificed a lot for her husband’s career, including her own profession. Her career as a pediatric nurse practitioner had been a good one, though short-lived. She loved nursing and had been employed long enough to support the couple’s hungry years, but motherhood had rearranged her priorities.

They had met while students at Arkansas State University and married after their junior year at age twenty.

After marriage, an impulse decision to change majors led Jake Starnes away from his passion for broadcasting and into pre-dentistry. This senior year change in career path proved to be one of the best decisions of his life, second only to his earlier decision to propose to Lorie.

Even during the early years of living in a mobile home and dining on fast-food coupons, life had been good for the two.

CHAPTER 3

Only the kitchen light remained on as the Starneses pulled into their driveway.

The red brick duplex had housed cavalry troops many years before. Their garage had once been the stable for horses of soldiers who lived in these quarters.

Limited in space, the dwelling had charm. The two-story abode shared the narrow Riley Place road with six identical homes, all surrounded by towering hardwood and evergreen trees. A large manicured field abutted the backside of their yards with a similar group of housing units lining the other side of the field on Magazine Road.

Lorie was relaxed and content as she entered her home, knowing that her three children were warm and happy in their little beds covered by their favorite blankies.

Claire, the neighborhood’s most sought-after babysitter, greeted them at the door with a favorable report of the children’s behavior. The house was quiet. As they walked from the back door through the kitchen, Lorie noticed clean dishes drying on the plate rack. The kitchen counters were spotless. She expected no less from Claire but was again reminded of the great fortune of having her conveniently living two doors away.

Starnes eyed two sticky note messages on the refrigerator door.

When did these calls come in, Claire? Starnes asked.

Lorie peered from behind him, affectionately resting her chin on his shoulder, to see who had called.

When I was putting the kids down for the night, at about nine. As soon as I got off the phone from the first call, the phone rang for the second, Claire replied as she gathered her books and jacket. Good night.

Good night. Still on for tomorrow night? Starnes asked.

Sure. Is it OK if I take the kids to the pool for the evening?

They’ll love it. Thanks for offering.

Lorie escorted Claire home while Starnes reviewed the two slips of paper, both asking him to return the call before going to bed.

The first was from the chief of the Department of Oral and Maxillofacial Surgery (OMS), Dr. Gus Jennings, Starnes’s boss and a full bird colonel by rank. Starnes knew him as an early to bed, early to rise kind of guy. A request to return his call late at night was out of character.

Starnes chose to delay the call to Jennings. He would deal with Evan’s call first.

Major Evan Leonard was a career Army officer assigned to the Artillery Division. Though not close personal friends, he and his family lived just across the field behind the Starneses’ home.

The Leonards’ eight-year-old only child played often in the field with the Starneses’ much smaller seven-year-old Craig. Turf battles occasionally erupted into squabbles between the two. Craig usually claimed victory.

Jake smiled, hoping that this phone call again was a protective tattletelling parent, which by precedent had become expected.

The phone rang only twice. Evan answered. He sounded wide awake.

I’m really sorry to call so late, Evan, but I have a message that said to call you regardless of the time. Everything OK?

Jake, I’ve got officer-of-the-day duty for the post tonight, and I’m responsible for handling any out-of-the-ordinary events. There has been a death on post. I think it may be one of your patients.

Feeling his face flush, Starnes took a seat at the breakfast table, anticipating the need for support.

What makes you think it’s one of my patients, Evan? Starnes replied, hoping desperately that Evan was wrong.

Because her teeth were wired together, Evan replied.

Assumption confirmed, Starnes thought aloud.

For a moment, he flashed back to the ambulance passing earlier in the evening. Maybe his paranoia was not as neurotic as he had felt since childhood.

He made an immediate mental inventory of his female patients whose teeth were wired together. Five patients came to mind, all recovering from trauma or orthognathic surgery. She could just as easily be one of Dr. Jennings’s patients, doubling the possibilities.

One name gripped him—the most recent major surgery he had performed . . . Jin Elliott.

What was her name? he asked, not really wanting to hear the answer.

Jin Cho Elliott, Evan answered.

Starnes’s strength fled from his body. He found it difficult to hold the phone to his ear. He was glad he had anticipated the need to sit.

How did she die? Starnes asked, hoping selfishly that she was in a car accident or anything besides a postoperative complication.

The way I understand it, Evan continued, your partner, whom I was told is on call for you, let her out of the hospital at about noon today. She rested at home most of the day and, about four o’clock, asked her husband to help her into the bathtub. About an hour later, after falling asleep in his recliner, listening to music and drinking beer, he went back to the bathroom to check on her. He found her unconscious and not breathing in the bathtub. An ambulance took her to Irwin Hospital after his 911 call. She was pronounced dead by the ER doc.

What did the doctor think she died of? Starnes nervously asked.

He thought she might have suffocated on her own vomit since her teeth were wired together. Didn’t seem to know for sure, but since it’s a postsurgery patient, I heard they’re planning an autopsy. I’m really sorry, Jake.

Yeah, me too, Evan. Thanks for the call. Anyone else I need to contact? Starnes’s voice quivered.

The ER doctor was hoping to talk to you, but he went off duty at 23:00 hours. You should probably get hold of Dr. Rogers. The charge nurse at the ER called him about the death, but he apparently wants to know all the details. Since it’s so late, I’m sure you could wait till morning to call him.

Starnes knew Dr. Rogers (lieutenant colonel) as a capable but compulsive chief of professional services. Before Rogers was assigned to this hospital administrative role, he had been a well-respected Army pediatrician.

One fateful error, a missed diagnosis, had led to not only the death of a six-year-old child but also the death of his love for medicine.

Starnes was sure that Dr. Rogers would be fair and empathetic but would obsessively follow Army regulations when investigating Jin’s death.

After hanging up from Evan, Starnes grabbed the dog and leash and headed for the backyard.

Walking the family dog, Chump, an aging palomino shar-pei, was one of the few household chores that he voluntarily assumed. The Kansas sky was unusually clear and beautiful. The stars tonight shone with extra brilliance.

Though his legs were wobbly, he shivered, not from the cold but from fear and uncertainty. He felt somewhat calmed, however, by the brisk breeze and sparkling stars.

Chump obliged his master by doing his business. Jake was forced to return inside to the ugly reality of Jin’s death.

Sitting again at the breakfast table with the phone in front of him, Jake contemplated his second phone call.

Jake dialed Gus’ familiar number.

Three rings. Hello.

Gus?

Jake.

Neither could speak. They just sat with phones to their ears, frozen with similar thoughts.

Jennings had assisted Starnes on Jin’s surgery. Both men were dealing privately with the same issues. Patients aren’t supposed to die from elective facial surgery. This was a cosmetic case, not a heart transplant.

Though Starnes and Jennings were military surgeons, they were allowed by the Army to operate these bony cosmetic procedures to maintain skills necessary for potential facial war injuries.

Lorie had checked on her offspring and had found them camped out together in the same bed. She returned to the kitchen to check on Jake, unaware of the news. She was frightened, seeing sorrow on Jake’s face that she had never seen before.

She felt sure that if the bad news involved family, she would have been told right away.

He was sitting silently, holding on to the phone receiver, head in hand.

She kissed him on the forehead, stroked his blond hair, and retreated to the bedroom. This could be a long night.

I’m so sorry, Jake. This is my fault. I shouldn’t have let her out of the hospital this morning.

Cut it out, Gus. Don’t even think it. With all due respect, Colonel, I made the decision to release her.

Starnes remembered the parting conversation the previous day as he signed his patients off to Jennings for the weekend. He had told Gus to release Jin Saturday morning if her vital signs were normal and if she was clinically stable with no orthostatic hypotension. Jennings would assess adequacy of vascular fluid volume by doing tilts before releasing her. These were routine determinants for discharge of a healing patient.

Tilts are an exercise to determine this volume. The test required taking the patient’s blood pressure and pulse rates—first while lying flat in bed, then while sitting on the edge of the bed, and finally while standing. The values are compared to each other to make sure that the patient can function normally without a significant drop in blood pressure with positional change.

If blood pressure falls, inadequate fluid volume could cause a syncopal, or fainting episode. IV fluids, blood replacement, or extended hospitalization might be necessary with positive tilts or significantly abnormal blood values.

Her tilts had been normal Friday afternoon. She had walked the ward without weakness or dizziness. Her spirits were great, and she was thrilled that her surgery had gone so well. Her hematocrit and hemoglobin were a little low, but her clinical condition was the overriding determinant of low risk.

Tired of the noises and hospital odors, she had kindly requested discharge from Dr. Starnes on Friday.

Even so, Starnes’s protective nature would not allow her to be released until Saturday. It had been only forty-eight hours since surgery, considered in the literature to be adequate. Starnes and Jennings had often released patients twenty-four hours after similar surgery, but this had been her second major surgery in three weeks, and she had lost a lot of blood.

How were her tilts this morning, Gus?

Identical to yesterday’s. Jake, she was happy, full of energy. I could hardly get her to sit down long enough to give her instructions for the weekend. I wrote routine orders for a post-op pass, and she was out the door with her husband before I could say good-bye.

Starnes thought aloud, In four days, we do Anna Ferrell’s surgery. I’ve briefed you on her case. You may not remember, but it’s almost identical to Jin’s.

The two sat in silence for an uncomfortable few moments.

I can’t think of anything we’ll do differently, Gus. We gave Jin good care. Starnes tried to convince himself.

I know. It’s just hard to think about doing another case right now. This just hurts so damn bad.

A call to the emergency room after the conversation with Jennings yielded no new details. The ER doc and nursing staff attending at the time of the code had finished their shift. The replacement staff was abuzz with the story but had nothing to add.

CHAPTER 4

The night was a sleepless one. What-ifs occupied Starnes’s tired brain.

Night sweats pestered him throughout his adult life, sometimes when worried about difficult upcoming surgery cases.

Most often, the sweats appeared during baseball season, worrying about the thirteen boys he coached in little league.

The boys’ parents were his biggest worry. Most of the fathers outranked him and felt comfortable challenging him about lack of playing time or their sons’ assigned positions.

Even more difficult was dealing with the moms, who, by virtue of their