Toxin

by Robin Cook

  “What happened?” Kim demanded.

  Kathleen came into the room behind Kim.

  “I don’t know,” Tracy wailed. “Becky and I were just talking when suddenly she cried out. She said she had a terrible pain in her stomach and her left shoulder. Then she had a shaking chill.”

  The nurse taking the blood pressure called out that it was ninety-five over sixty.

  Kathleen went around the left side of the bed and felt Becky’s pulse. “Has Dr. Stevens been called?” she asked.

  “Yes, immediately,” one of the nurses said.

  “Her temperature is one hundred and five,” the other nurse said with dismay. Her name was Lorraine Phillips. Her colleague was called Stephanie Gragoudos.

  Kim nudged Lorraine away from the right side of Becky’s bed. Kim was frantic. It was like being stabbed in the heart to see his daughter suffering.

  “Becky, what is it?” Kim demanded.

  “My stomach hurts me,” Becky managed amid groans. “It hurts me bad. Daddy, please!”

  Kim pulled down Becky’s blanket. He was shocked to see a swath of purplish subcutaneous bleeding on her chest. He raised his eyes to Kathleen. “Were you aware of this purpura?” he asked.

  Kathleen nodded. “Yes, I saw it earlier.”

  “It wasn’t there last night,” Kim said. Kim looked back at Becky. “Tell Daddy where it hurts.”

  Becky pointed to her lower abdomen slightly to the right of the midline. She was careful not to touch herself.

  Kim gently placed the tips of his index, middle, and ring fingers on Becky’s abdomen where she’d pointed. He pressed in enough to barely dimple the skin. Becky writhed.

  “Please don’t touch me, Daddy,” she pleaded.

  Kim pulled his hand back sharply. Becky’s eyes shot open and a cry of pain issued from her parched lips. Such a response was a sign Kim did not want to see. It was called rebound tenderness, and it was a strong indication of peritonitis, inflammation of the lining of the abdominal cavity. And there was only one thing that could cause such a catastrophe.

  Kim straightened up. “She’s got an acute abdomen,” he yelled. “She’s perforated!”

  Without a moment’s hesitation, Kim pushed up to the head of the bed and released the wheels. “Someone get the rear wheels,” he yelled. “We’ll use the bed for transport. We’ve got to get her to surgery.”

  “I think we should wait for Dr. Stevens,” Kathleen said calmly. She motioned for Stephanie to get away from the foot of the bed. Kathleen then stepped to the head next to Kim.

  “The hell with Dr. Stevens,” Kim snapped. “This is a surgical emergency. The hand-wringing is over. We have to act.”

  Kathleen put her hand on Kim’s arm, ignoring the wild look in his eyes. “Dr. Reggis, you are not in charge. You have to calm . . .”

  In his agitated frame of mind Kim perceived Kathleen as an obstacle, not a colleague. Determined to get Becky to surgery as soon as possible, he literally swept her aside. With his strength and Kathleen’s small stature, he inadvertently threw her against the bedside table.

  Kathleen grabbed the table in a vain attempt to keep her feet but only succeeded in knocking everything off its surface. Water pitcher, glass, flower vase, and thermometer all crashed to the floor beside her.

  Stephanie ran out into the hall to scream for help, while Lorraine tried to hold the bed in position. Despite the rear wheels being locked, Kim had managed to push it several feet toward the door.

  Tracy recovered from her initial shock to rush to Kim. She tugged on one of his arms to get him to release the bed. “Kim, stop it,” she sobbed. “Please!”

  Several other nurses arrived, including the head nurse and a brawny male nurse. Everyone converged on Kim, who initially remained intent on pushing the bed into the hall. Even Kathleen pulled herself up from the floor to lend a hand. Finally overwhelmed, Kim let go of the bed, but he wasn’t happy. He yelled that anyone who didn’t understand that Becky’s condition was a surgical emergency was incompetent.

  “How will they put me to sleep?” Becky asked, with a voice already thick with sleep.

  “They’ll just put some medicine in your IV,” Kim said. “Don’t worry, you won’t feel it. The next thing you’ll know is that you’re awake and all better.”

  Becky was on a gurney in the anesthesia-holding area of the OR. A surgical cap covered her head. She’d been premedicated, so her pain and discomfort had abated, but she was anxious about facing surgery.

  Kim was standing next to her gurney in a clutch of other gurneys with patients waiting to be taken to their respective operating rooms. He was dressed in scrubs, with a hood on his head and booties covering his shoes. He’d recovered his senses after the scene in Becky’s room an hour and a half earlier. He’d apologized profusely to Kathleen. She’d graciously said she understood. Claire had arrived soon after and had immediately requested an emergency surgical consult.

  “Will I be all right, Daddy?” Becky asked.

  “What are you talking about?” Kim asked, trying to make it sound as if it were a ridiculous question. “Of course, you’ll be fine. They’re just going to open you up like a zipper, patch the little hole, and that will be it.”

  “Maybe I’m being punished for not signing up for the Nationals,” Becky said. “I’m sorry now that I didn’t. I know you wanted me to.”

  Kim choked on tears that threatened to erupt. For a moment he looked off to compose himself and try to think of a response. He found it difficult to tell his daughter about fate when he was grasping for an explanation himself. Only days before, she’d been the very epitome of youthful vigor; now she was poised at the edge of the abyss. Why? he pondered.

  “I’ll have Mom bring me in the application,” Becky added.

  “Don’t you worry about the Nationals,” Kim said. “I don’t care about them. I only care about you.”

  “Okay, Becky,” a cheerful voice called out. “Time to fix you up.”

  Kim raised his head. Both Jane Flanagan, the anesthesiologist, and James O’Donnel, the gastrointestinal surgeon, had appeared from the depths of the OR. They came over to Becky’s gurney. Jane went to the head and released the wheel locks.

  Becky gripped Kim’s hand with surprising strength, considering the amount of pre-op medication she’d had. “Will it hurt?” she asked Kim.

  “Not with Jane taking care of you,” James said playfully, overhearing the question. “She’s the best sand-woman in the business.”

  “We’ll even order you a good dream,” Jane joked.

  Kim knew and admired both these professionals. He had worked with Jane on numerous cases and had served with James on multiple hospital committees. James had been at Samaritan with Kim and had the reputation of being the best GI surgeon in the city. Kim had felt relieved when he agreed to drop everything that afternoon and come in to operate on Becky.

  James grasped the foot of Becky’s gurney. With Jane walking backward and James guiding, they maneuvered Becky toward the double swinging doors leading to the OR corridor.

  Kim walked along the side. Becky still had a grip on his hand. Jane used her rump to open the doors. As the gurney slid through, James reached out and grasped Kim’s arm to keep him from following. The doors closed behind Becky and Jane.

  Kim looked down at the hand clasped around his arm and then up into James’s face. James was not quite as tall as Kim but bulkier. He had a spattering of freckles across the bridge of his nose.

  “What are you doing?” Kim inquired. “Let go of my arm, James.”

  “I heard what happened downstairs,” James said. “I think it’s best you don’t come into the OR.”

  “But I want to come in,” Kim said.

  “Maybe so,” James said. “But you’re not.”

  “The hell I’m not,” Kim said. “This is my daughter, my only daughter.”

  “That’s the point,” James said. “You stay out in the lounge, or I’m not doing the case. It’s as simple as tha
t.”

  Kim’s face reddened. He felt panic about being cornered and confused as to what he should do. He desperately wanted James to do the surgery, but he was terrified to be apart from Becky.

  “You have to make up your mind,” James said. “The longer you agonize, the worse it is for Becky.”

  Kim angrily snatched his arm free, and, without saying another word, he broke off from staring at James. He strode away toward the surgical locker room.

  Kim didn’t look at the faces of the people in the surgical lounge as he passed through. He was too distraught. But he didn’t pass by unnoticed.

  In the locker room, Kim went directly to the sink and filled the bowl with cold water. He splashed it repeatedly onto his face before straightening up to regard himself in the mirror. Over his shoulder, he saw the pinched face of Forrester Biddle.

  “I want to talk with you,” Forrester said in his clipped voice.

  “Talk,” Kim said. He took a towel and briskly dried his face. He didn’t turn around.

  “After imploring you not to go to the media with your opinions, I was appalled to hear Kelly Anderson again quote you on the eleven o’clock news.”

  Kim let out a short, mirthless laugh. “That’s curious, considering that I had refused to talk with her.”

  “She said it was your feeling that AmeriCare closed the Samaritan ER to cut costs and increase profits by forcing everyone to use the overburdened ER here at the University Med Center.”

  “I didn’t say that,” Kim responded. “She did.”

  “She quoted you,” Forrester said.

  “A curious situation,” Kim said casually. In his current agitated state of mind he was getting perverse pleasure out of Forrester’s self-righteous anger. Consequently Kim was not inclined to defend himself, although the incident strengthened his resolve never to talk to the TV journalist again.

  “I’m warning you again,” Forrester announced. “The administration and myself only have so much forbearance.”

  “Fine,” Kim said. “Consider me warned again.”

  For a moment Forrester’s tight mouth became a grim line without lips. “You can be galling,” he spat. “I should remind you that just because you ran the department over at the Samaritan, you should not expect special treatment over here.”

  “That’s apparent,” Kim said. He threw the towel into the hamper and walked out, without giving Forrester another glance.

  Using the phone in one of the dictation booths to avoid Forrester, Kim called Ginger to tell her that he’d not be coming back to the office. She told him that she’d assumed as much and had sent all the patients home.

  “Were they upset?” Kim asked.

  “Do you really have to ask?” Ginger said. “Of course they were upset, but they understood when I said it was an emergency. I hope you don’t mind that I said it involved your daughter. I knew they’d empathize.”

  “I suppose that’s all right,” Kim said, although mixing his private life and professional life bothered him.

  “How is Becky?” Ginger asked.

  Kim explained what had happened and that Becky was in surgery at that moment.

  “I’m so sorry,” Ginger said. “Is there anything I can do?”

  “I can’t think of anything,” Kim said.

  “Call me,” Ginger said. “After aerobics I’ll be at home.”

  “Fine,” Kim said. He hung up.

  Knowing himself well enough that he could not just sit and wait while Becky was in surgery, Kim went to the hospital library. He had a lot of reading to do. He had to learn what he could about E. coli O157:H7 and HUS.

  Kim glanced at his watch. It was almost midnight. He looked back at Becky and shuddered. Her image was distorted by a clear plastic tube that snaked out of one of her nostrils and was attached to low suction. Becky’s dark hair framed her otherwise angelic, pale face with soft waves. Tracy had combed it for almost an hour. It was something Becky had always liked, and it had done the trick. Becky was fast asleep and appeared for the moment the picture of tranquillity.

  Kim was standing next to Becky’s bed. The room was awash with the gentle glow of the reflected night-light, just as it had been early that morning. Kim was exhausted mentally and physically.

  Tracy was on the other side of the bed, leaning back in one of the two vinyl-covered chairs in the room. She had her eyes closed, but Kim knew she was not asleep.

  The door opened on silent hinges. Janet Emery, the corpulent night nurse, pushed through the door. Her permed blond hair glowed in the half light. She didn’t speak. She moved to the side of the bed opposite from Kim. Her shoes were soled in a soft crepe so her footfalls were inaudible. Using a small flashlight, she took Becky’s blood pressure, pulse, and temperature. Becky stirred but immediately fell back asleep.

  “Everything staying nice and normal,” Janet said in a low voice.

  Kim nodded.

  “Maybe you folks should think about going home,” Janet added. “I’ll be keeping a sharp eye on your little angel here.”

  “Thanks but I prefer to stay,” Kim said.

  “Seems to me you could use some rest yourselves,” Janet said. “It’s been a long day.”

  “Just do your job,” Kim grumbled.

  “No question about that,” Janet said cheerfully. She went to the door and silently disappeared.

  Tracy opened her eyes and glanced over at Kim. He looked wretched under the strain. His hair was a mess and his face covered with stubble. The single night-light near the floor accentuated the gauntness of his cheeks and made his eye sockets look like dark hollows.

  “Kim!” Tracy said. “Can’t you control yourself? It’s not helping anyone not even yourself.”

  Tracy waited for a response, but it didn’t come. Kim appeared like a sculpture depicting anguished frenzy.

  Tracy sighed and stretched. “How’s Becky doing?”

  “She’s holding her own,” Kim said. “At least the surgery handled the immediate crisis.”

  The surgery had gone quickly. In fact, James had reported to Kim that what had taken the most time was a painstaking irrigation of Becky’s abdomen to lessen the chances of infection. Following the surgery, Becky had spent a short time in the recovery room before being brought back to the floor. Kim had requested the ICU but again he’d been overruled.

  “Tell me again about her colostomy,” Tracy asked. “You said it can be closed in a couple of weeks.”

  “Something like that,” Kim said tiredly. “If all goes well.”

  “It was a major shock for Becky,” Tracy said. “As was the tube in her nose. She’s having a hard time coping. What’s made it worse is she feels betrayed because no one told her these things might happen.”

  “It couldn’t be helped,” Kim snapped.

  Kim backed up and sank into a chair similar to Tracy’s. With his elbows on the hard wooden arms, he buried his face in his hands.

  Now all Tracy could see was the top of Kim’s head over Becky’s bed. He didn’t move. The sculpture of anguished frenzy had assumed another, even more expressive pose.

  Looking at Kim’s dejected posture forced her to think about the situation from Kim’s point of view. Drawing on her experience as a therapist, she could appreciate how hard it had to be for him, considering not only his surgical training but, more important, his narcissism. All at once her anger toward him melted.

  “Kim,” Tracy called. “Maybe you should go home. I think you need some distance as well as rest. Besides, you have to see patients tomorrow. I can stay. I’ll just be skipping class.”

  “I wouldn’t be able to sleep even if I did go home,” Kim said, without lifting his face from his hands. “Now I know too much.”

  During the entire time Becky had been in surgery, Kim had researched HUS in the hospital library. What he’d learned had been frighteningly overwhelming. Everything Kathleen had said had been true. HUS could be a horrible illness, and now all he could hope was Becky had something else. The
problem was that everything was pointing in the direction of HUS.

  “You know, I’m beginning to appreciate how difficult this is for you, above and beyond your medical training,” Tracy said sincerely.

  Kim lifted his face from his hands and looked over at Tracy. “Please don’t patronize me with any of your psychological bullshit. Not now!”

  “Call it what you like,” Tracy said. “But I’m realizing this is probably the first time in your life that you’ve been faced with a major problem that your force of will or expertise cannot alter. I think that must make this especially hard for you.”

  “Yeah, and I suppose all this isn’t affecting you at all.”

  “Quite the contrary,” Tracy said. “It’s affecting me terribly. But it’s different for you. I think you’re having to deal with a lot more than Becky’s condition. You’re having to take a hard look at new limits, new constraints that are impeding your ability to act on Becky’s behalf. It’s taking a toll.”

  Kim blinked. He always hated his former wife’s psychological theorizing, but at the moment he had to admit she was making a certain amount of sense.

  TEN

  Thursday, January 22nd

  Kim ended up going home, but as he expected he had not been able to sleep much, and the sleep he did get was marred by disturbing dreams. Several of the dreams he found incomprehensible; they were about being ridiculed for poor performance on tests in college. By far the most horrible nightmare had been about Becky, and it was easy for him to understand. In the dream she had fallen from a jetty into a surging sea. Although Kim was on the jetty, he couldn’t reach Becky no matter what he did. When he had awakened, he had been covered with perspiration.

  Despite getting little rest, Kim’s going home did afford him an opportunity to shower and shave. With at least an improved appearance, he was back in his car just after five in the morning. He drove on mostly deserted streets slick with a dusting of wet snow.