It's another typical day in the life of Holmes and Watson, he is throttling a corpse in the morgue of a New York hospital, while she looks on impatiently. He insists that this is important empirical research, and tells her that if she is uncomfortable, she can wait outside. She denies any such feeling, but he points out that she has had her arms crossed - an unconscious defensive gesture - for 13 of the 15 minutes they've been there.
As Holmes finishes up, and bid goodbye to the attendant, Holmes's friend Bruce, Holmes notices a fresh body and asks how the man died. Bruce said the man died of heart failure about an hour ago. The man was suffering from terminal brain cancer, and Watson mentions that blood clots are a common side effect, which can cause coronary embolisms. Holmes has a different theory, the man was poisoned with ephenephrine (adrenaline).
Holmes drags Watson upstairs to the man's room to confirm his theory, and rudely ejects the janitor cleaning up the man's room, and bars the door with a chair. Watson suggests that Holmes explain the basis of his theory before hospital security breaks down the door and drags them out. Holmes shows Watson a close-up photograph of a lesion on the man's finger. Watson recognizes it as ischemia, a minor tissue death commonly caused by ephenephrine dosing. She says that doesn't prove anything, since the ephenephrine is administered to all patients going into cardiac arrest, but Holmes asks, if the man was already flat-lining when the adrenaline was administered, would he have been dosed for long enough for the ischemia to occur? Watson realizes the answer is no, and Holmes is right: the man was murdered.
With security guards pounding on the door, Sherlock examines the crime scene. He invites Watson to examine the intravenous machine, and she confirms that it has been turned up high, to administer a hefty dose of some agent, probably the epenephrine. Sherlock then upends the room's wastebasket and finds two coffee cups, one smudged with lipstick, and a receipt from a nearby coffee shop. When the security guards finally break down the door, Sherlock politely asks to be directed to the hospital administrator's office.
A short time later, Captain Gregson is inside the administrator's office, trying to calm the man down. Holmes and Watson are waiting outside, when Watson is hailed by her old colleague, Dr. Carrie Dwyer. Carrie asks innocently if Joan is applying for a new residency. Sherlock is intrigued to heard that Joan's suspension was only for three months.
Called into the administrator, Mr. Sanchez' office, Gregson explains that as soon as Holmes apologizes for his behavior, the hospital will release the patient's body to the police for autopsy.
A few moments later, Holmes walks out of the hospital, fuming at having to apologize without receiving a single piece of useful information, beginning with the patient's name. He says their next promising lead is "Dave," the barista who wrote his name and phone number on the back of the coffee receipt, obviously smitten with his female customer, the woman who brought the dead man coffee.
While they are waiting in line at the coffee shop, Holmes points out that Watson deceived him: her suspension from medicine was only temporary, and she deliberately chose not to renew her license, despite being able to. She demurs, repeating that she is finished with medicine.
Dave admits that he was flirting with a customer; he doesn't know the woman's name, only that she was a doctor, because of her white lab coat. Both Sherlock and Joan know that a doctor would not wear her lab coat outside the hospital, nor would she wear the revealing attire and strong perfume described by Dave. Watson hits on the solution, and they find the woman, Jacqueline, working at a local perfumery. Jacqueline said she and the patient, Trent Kelty, were neighbors, and she visited him more frequently after he lost his eyesight. Based on the time she left the hospital, confirmed by her subway ticket, Holmes concludes that she left the hospital before the fatal adrenaline dose was administered.
When they ask Jacqueline if Trent had any enemies, or anyone who would wish to harm him, Holmes and Watson are surprised to hear that Trent had terminal cancer, and one of the reasons she made a point of visiting him was because he had virtually no one left, no family or friends. According to Trent, his only other companion was a doctor (other than his oncologist) who conversed with him late at night. The same "doctor" apparently cut Trent's food into small, manageable bites, before killing him.
Leaving the shop, Holmes is disturbed. He had avoided theorizing ahead of his data, but now he is fairly sure that what they are dealing with is an "angel of death": a serial killer hiding his crimes by killing patients who are already terminally ill.
Holmes and Watson converse with Dr. Mason Baldwin, the hospital's head of surgery. Baldwin is doubtful at first, but Holmes says that Trent Kelty's autopsy confirmed that he was dosed with ephenephrine, in a dosage much larger than what he would have received when he coded. Holmes says he needs access to all records of in-hospital deaths, and the use of ephenephrine. Although Mr. Sanchez, the administrator, normally handles those requests, Holmes has already guessed, correctly, that Baldwin doesn't like Sanchez any more than Holmes did. Baldwin agrees to make the request to Sanchez, backed up by a threat to hold a press conference alleging that the hospital is indifferent to the possibility of a serial killer among its employees.
At the station, Holmes is poring over the records, but without success. He summarizes his findings, or lack of them, to Watson, when she brings coffee: 73 patients have died of cardiac events in the last two years, but there are no corresponding disappearances or excessive uses of ephenephrine reported by the hospital's pharmacy. Without knowing who the killer's victims are, Holmes cannot establish a pattern. Watson has an alternative theory: ephenephrine can be lifted from "crash carts," which are considered low-profile targets by hospitals, who are more concerned about opiates and other drugs being stolen. Looking at the records, Watson reports ephenephrine going missing from crash carts on 9 dates - each of which, Holmes sees, corresponds to the death of a cardiac patient. Now they have their pattern.
At the hospital, Holmes says that he has narrowed the field to 23 doctors and nurses that were on duty when the 9 patients died. That is a lot of suspects, he concedes, but much fewer than the approximately 2,000 doctors and nurses on staff. While Holmes heads upstairs to meet Detective Bell and start interviewing the suspects, Watson says she is going to meet Dr. Dwyer for coffee, who hopefully can identify any "weirdos" the hospital may have on staff. Holmes finds himself sharing the elevator with the same janitor he ejected from Trent Kelty's room the previous day. Sheepishly, Holmes apologizes for his getting "carried away," and the janitor amiably accepts this. Then, as he is stepping off, he presses the button for every floor between Holmes and his destination.
Before meeting Detective Bell, however, Holmes's first stop is Dr. Baldwin's office. The records indicate that Baldwin is on unofficial probation, having made two prior surgical mistakes, both of which resulted in the death of a patient and a lawsuit against the hospital. Holmes asks if Baldwin can account for his movements at the time of Trent Kelty's death. Baldwin says he can: he was on a train from his home in upstate New York. Moreover, he confides, he is an unlikely suspect; the angel, if there is one, kills patients who are in serious pain, out of a sense of mercy. Baldwin, on the other hand, freely admits to being indifferent to his patients' suffering - he simply does what he has to in order to heal them.
Over coffee, Carrie Dwyer tells Joan that she cannot think of any likely suspects for the angel, but invites her to accompany her for a pre-op consultation, since she could use another pair of eyes. Joan tries to beg off, but Carrie insists. Together they meet Morgan Duncan, a high school soccer player who tore her ACL. While Carrie is examining her, Joan notices something on her foot that troubles her. After the consultation, she tells Carrie that she noticed a small haemmorhage under the girl's toenail, which may be indicative of endocarditis. If she has that condition, her heart could fail during surgery. Carrie is disbelieving, reminding Joan that it has been a long time for her, but agrees to run the test needed.
Bell and Holmes interview Dr. Cahill, who is a nervous wreck. Bell likes him as a suspect, but Holmes points out that Cahill's nervous tics stopped as soon as he realized they were questioning him about the deaths of patients. Cahill may well have something to hide, but he is not the angel.
Holmes and Watson exit the hospital together. Holmes is frustrated because no strong suspects revealed themselves, but asks Watson what was the source of the rift between her and Dwyer, since they were clearly good friends, but haven't kept in contact. Watson says simply that, after her patient died, she wanted to make a clean break from her medical past, and Dwyer couldn't understand why. In the middle of their conversation, Watson receives a text message from Dwyer, confirming that the test for endocarditis was negative. Holmes asks her if the test is absolutely conclusive. Watson says no, but most cases... Holmes tells her to forget about most cases. If Watson's first instinct was that Morgan has endocarditis, that first instinct is likely to be the right one.
Holmes gets distracted, staring past Watson at a car, which Holmes identifies as Dr. Cahill's, by its match to the keychain he was tapping nervously during their interview. Cahill said that he'd been on call for 29 hours and was almost unhinged from lack of sleep, yet why is his car still at the hospital hours after his rotation ended?
In the almost deserted hallway of the hospital, Cahill lifts a syringe from a crash cart, then sneaks into a patient's room and starts to connect it to the intravenous machine. Holmes and Watson burst in with security guards, who haul Cahill out. But Sherlock's triumph is short-lived, when Watson points out that the syringe was empty; Cahill was not administering epenephrine to the patient, he was stealing morphine from the patient's supply. Cahill is a drug addict, but he is not the angel.
As Holmes and Watson return home, Holmes is furious with himself, not only for failing to find the angel, but because he, of all people, should have been able to see Cahill for what he was. Watson reminds him that Cahill was endangering his patients' lives by using morphine while on call, and catching him was an important service. Holmes refuses to be consoled, pointing out that he and Bell interviewed all 23 potential suspects, and Cahill was their only "blip on the radar." But Watson looks again at the list of victims, and spots another blip. The second-to-last victim, Samantha Cropsey, was recovering from coronary bypass surgery, but she was not terminal - the only one of the angel's victims who was not doomed to die anyway. Why the exception?
Then Captain Gregson calls, telling Holmes that Dr. Cahill may be able to help find the angel after all. At the police station, Cahill describes an episode when he stole morphine from a patient's room, then snuck into the bathroom to shoot up. While he was in there, he heard another doctor come in and talk to the patient, at length, and the man died the next day of a heart attack. He didn't mention it before, since he would have had to admit why he was in the patient's bathroom. Holmes is excited to discover a new pattern to the angel's behavior: he talks to his victims at length, getting to know them, before killing them. He insists on re-examining the hospital's records, elated that his first instinct was proven right.
Taking this to heart, Watson goes back to Dr. Dwyer and insists that she perform a more invasive, but conclusive, test for endocarditis in Morgan. Dwyer is hostile and defensive about her own patient, but Watson pleads.
The next morning, Watson returns to the police station and finds Holmes in a state of high excitement: the second victim was a Ukrainian national, who spoke so little English that she needed a bilingual nurse's help to fill out the consent form for her surgery. If the angel's pattern is to converse with his victims before he kills them, then he would have had to speak Ukrainian. Holmes has already checked and confirmed that there are no doctors or nurses currently on the hospital's staff who speak Ukrainian - but, as Holmes points out with a smile, "doctors do not always stay doctors."
At the station, Holmes and Gregson interrogate Danilo Gura, the janitor, who, contrary to appearances, is a native of Ukraine and was trained as a doctor there. A search warrant of his apartment has turned up detailed logs on all nine of the angel's victims. Caught, Gura admits that he "freed" these patients. After confirming that they were not going to recover, and had nothing to look forward to except an agonizing death, he helped them die painlessly. Holmes angrily asks whether that excuses what he did to Samantha Cropsey, who was not terminal. Gura is aghast, saying that people do not recover from metastatized cardiac cancer, and accuses Holmes and Gregson of making up lies to suit their version of events.
As Gura is arrested, Gregson congratulates Holmes enthusiastically, but Holmes is not satisfied. Gura truly believed that Samantha Cropsey was terminal, which means there is something more going on at the hospital.
Holmes is seated on the floor of the living room, reading Gura's "patient log" on Samantha Cropsey. He insists to Watson that Gura is highly intelligent, methodical, and detail-oriented, yet how could he make such a glaring mistake as to believe that Samantha's bypass surgery revealed the presence of cardiac cancer which she didn't have?
They are interrupted by the doorbell ringing. Carrie Dwyer, shamefaced, admits that Watson was right: an anonymous "someone" wrote on Morgan's chart, ordering the additional test, which showed positive for endocarditis, which could have led to her dying during surgery. Dwyer is shaken at how close she came to losing her patient, and Watson empathizes, telling Dwyer she knows how it feels to make such a mistake. Dwyer replies that Watson was always a good friend, but she is a better doctor, and hopes that soon she will come back to medicine.
After Watson sees Dwyer out, Holmes congratulates Watson on her actions, and also thanks her for giving him an idea as to why Danilo Gura killed Samantha Cropsey.
Dr. Baldwin is called in for questioning. Holmes has realized that, after two of Baldwin's patients died suddenly, Baldwin realized the existence of an "angel" at the hospital. Ordinarily, Baldwin would have reported it, but at the same time, he realized he'd made a third surgical mistake: operating on Samantha Cropsey's heart, he left a surgical clamp inside her arteries. The mistake could have been easily corrected, but Baldwin's "third strike" would have ended his medical career. Instead, he decided to manipulate the "angel" into making his problem go away. He altered Samantha's surgical charts, making it seem to an observant, knowledgeable person that she had developed terminal cardiac cancer. He also reduced Samantha's pain medication, causing her intense agony and making it difficult to communicate with the "angel" when he tried to talk with her.
Baldwin says there is no proof, and Gregson informs him that, with the consent of Samantha's family, her remains have been exhumed and autopsied, and they found the surgical clamp inside her. Baldwin says that may be proof of his third and final mistake, but there is no proof that he altered records or killed anyone. Holmes says, very true - which is why he and Watson visited Gura the previous evening. From the beginning, Holmes was struck by the detail of Gura's private patient log - they were so detailed it was as if Gura was copying them from the originals, but that wouldn't make any sense, since a janitor couldn't do such a thing without drawing attention to himself. Then it hit him: Gura was photographing the original charts. After Holmes and Watson explained to him how he had been manipulated into killing Samantha Cropsey, he produced the originals of the photos, including a report, signed by Dr. Baldwin, diagnosing Samantha with cardiac cancer.
Baldwin shakes his head, saying he could save thousands of lives on his operating table, and they will accomplish nothing by putting him in jail. Holmes coldly says that that sort of thinking must have made it easy for Baldwin to decide that Samantha's life was of no value. Gregson informs him that the District Attorney has already agreed to indict Baldwin for second-degree murder.
At home, Holmes watches the news coverage of Baldwin's arrest, remarking that the most satisfying moment is when the killer crumples under the realization that he has been caught, "like a turtle retreating into its shell." Holmes also remarks that catching a glimpse of Watson in her former element was quite enlightening, and perhaps she will return to it one day.
In her room, Watson browses through photos on her tablet of herself and her friends from her old hospital days. Then she selects all of them for deletion. When the computer prompts, "are you sure?", Watson's fingers hover over the keys for a few seconds, then she presses, "Yes."
- Norah Jones - Travelin' On plays at episode end.
- This episode was loosely based on a real Angel of Death named Kristen Gilbert. She was a nurse who was convicted for murder of patients admitted for care at the Veterans Affairs Medical Center (VAMC) in Northampton, Massachusetts. She killed her patients by injecting them with epinephrine, causing them to have heart attacks.
- The opening scene where Holmes is choking a corpse, was inspired by a reference in Arthur Conan Doyle's A Study in Scarlet where Holmes hit corpses with riding crops to study post-mortem bruising.
- Titled "Todesengel" (Angel of Death) in German.
|Elementary Season One Episodes|
|Pilot • While You Were Sleeping • Child Predator • The Rat Race • Lesser Evils • Flight Risk • One Way to Get Off • The Long Fuse • You Do It to Yourself • The Leviathan • Dirty Laundry • M. • The Red Team • The Deductionist • A Giant Gun, Filled with Drugs • Details • Possibility Two • Déjà Vu All Over Again • Snow Angels • Dead Man's Switch • A Landmark Story • Risk Management • The Woman • Heroine|
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