Fever

by Robin Cook

  Charles searched for Cathryn in the press of women and children, but he didn’t see her. He worked his way over to the nurse who was being besieged by a covey of mothers demanding to know exactly when they would be seen. Charles tried to interrupt but soon realized he had to wait his turn. Eventually he got the woman’s attention and was impressed by her composure. If she was affected by the chaos around her, she did a superb job of not showing it.

  “I’m looking for my wife,” said Charles. He had to speak loudly to make himself heard.

  “What’s the name?” asked the nurse, her hands folded over a pile of charts.

  “Martel. Cathryn Martel.”

  “Just a moment.” As she rolled back in her chair and got to her feet, her face became serious. The women grouped around the desk eyed Charles with a mixture of respect and vexation. They were clearly jealous of the rapid response he’d elicited.

  The nurse returned almost immediately, followed by a woman of impressive dimensions who Charles thought would make an appropriate mate for the Michelin tire man. He noticed her name tag: Miss A. Hammersmith. She motioned to Charles, and he obediently stepped around the desk.

  “Please follow me,” said the nurse. Her mouth, suspended between two puckered cheeks, was the only part of her face that moved as she spoke.

  Charles did as he was told, finding himself hurrying down a hall behind the bulk of Miss Hammersmith who effectively blocked his view. They passed a series of what Charles imagined were examining rooms. At the end of the hall she opened a paneled door and moved aside for Charles to enter.

  “Excuse me,” said Charles, squeezing past her.

  “I guess we both could lose a few pounds,” said Miss Hammersmith.

  As Charles stepped into the room, Miss Hammersmith remained in the hall and softly closed the door behind him. Bookshelves lined one wall, filled with stacks of medical periodicals and some textbooks. In the center of the room was a round, blond oak table surrounded by a half dozen captain’s chairs. One of them abruptly scraped back as Cathryn stood up. She was breathing audibly; Charles could hear the air enter and exit from her nose. It wasn’t a smooth sound. It trembled.

  “What . . .” began Charles.

  Cathryn ran to him before he could speak and threw her arms around his neck. Charles put his hands on her waist and let her hold him for a few moments to regain her equilibrium. “Cathryn,” he said at last, beginning to experience the bitter taste of fear. Cathryn’s behavior was undermining his thought of appendicitis, of an operation, of something ordinary.

  A horrid, unwelcome memory forced itself into Charles’s mind: the day he’d learned of Elizabeth’s lymphoma. “Cathryn,” he said more sharply. “Cathryn! What is going on? What’s the matter with you?”

  “It’s my fault,” said Cathryn. As soon as she spoke she started to cry. Charles could feel her body shudder with the force of her tears. He waited, his eyes moving around the room, noticing the picture of Hippocrates on the wall opposite the bookshelves, the rich parquet floor, the Nelson’s textbook of pediatrics on the table.

  “Cathryn,” said Charles at length. “Please tell me what’s going on. What’s your fault?”

  “I should have brought Michelle in sooner. I know I should have.” Cathryn’s voice was broken by her sobs.

  “What’s wrong with Michelle?” asked Charles. He could feel panic tightening in his chest. There was a terrifying sense of déjà vu . . .

  Cathryn strengthened her grip on Charles’s neck as if he was her only salvation. All the control she’d marshaled before his arrival vanished.

  Using most of his strength, Charles managed to break Cathryn’s hold on his neck. Once he did so, she seemed to collapse. He helped her to a chair where she sank like a deflated balloon. Then he sat down beside her.

  “Cathryn, you must tell me what is going on.”

  His wife looked up with great effort, her teal-blue eyes awash with tears. She opened her mouth, but before she could speak the door opened. Dr. Jordan Wiley stepped into the room.

  Charles, his hands still resting on Cathryn’s shoulders, turned at the sound of the closing door. When he saw Dr. Wiley he stood up, searching the man’s face for a clue to what was happening. He had known Dr. Wiley for almost twenty years. It had been a professional rather than a social relationship, beginning while Charles was in medical school. Wiley had been his preceptor for third-year pediatrics and had impressed Charles with his knowledge, intelligence, and empathy. Later when Charles needed a pediatrician he’d called Jordan Wiley.

  “It’s good to see you again, Charles,” said Dr. Wiley, grasping Charles’s hand. “I’m sorry it’s under such trying circumstances.”

  “Perhaps you could tell me what these trying circumstances are,” said Charles, allowing annoyance to camouflage his fear.

  “You haven’t been told?” asked Dr. Wiley. Cathryn shook her head.

  “Maybe I should step outside for a few moments,” said Dr. Wiley.

  He started to turn toward the door, but Charles restrained him with a hand on his forearm. “I think you should tell me what this is all about,” he said.

  Dr. Wiley glanced at Cathryn, who nodded agreement. She was no longer sobbing but she knew she’d have difficulty speaking.

  “All right,” said Dr. Wiley, facing Charles once again. “It’s about Michelle.”

  “I gathered that,” said Charles.

  “Why don’t you sit down,” said Dr. Wiley.

  “Why don’t you you just tell me,” said Charles.

  Dr. Wiley scrutinized Charles’s anxious face. He saw that Charles had aged a lot since he was a student and was sorry that he had to be the messenger of more anguish and suffering; it was one of the few responsibilities of being a doctor that he detested.

  “Michelle has leukemia, Charles,” said Dr. Wiley.

  Charles’s mouth slowly dropped open. His blue eyes glazed as if he were in a trance. He didn’t move a muscle; he didn’t even breathe. It was as if Dr. Wiley’s news had released a flood of banished memories. Over and over Charles heard, “I’m sorry to inform you, Dr. Martel, but your wife, Elizabeth, has an aggressive lymphoma . . . I’m awfully sorry to report that your wife is not responding to treatment . . . Dr. Martel, I’m sorry to say, but your wife has entered a terminal leukemic crisis . . . Dr. Martel, I’m terribly sorry to have to tell you that your wife died a few moments ago.”

  “No! It’s not true. It’s impossible!” shouted Charles with such vehemence that both Dr. Wiley and Cathryn were startled.

  “Charles,” began Dr. Wiley as he reached out and placed a sympathetic arm on Charles’s shoulder.

  With a lightning movement, Charles knocked Dr. Wiley’s hand away. “Don’t you dare patronize me!”

  Despite her tears, Cathryn jumped up and caught Charles’s arm as Dr. Wiley stepped back in surprise.

  “Is this all some elaborate joke?” snapped Charles, shrugging off Cathryn’s hand.

  “It’s not a joke,” said Dr. Wiley. He spoke gently but firmly. “Charles, I know this is difficult for you, especially because of what happened to Elizabeth. But you have to get control of yourself. Michelle needs you.”

  Charles’s mind was a jumble of incomplete thoughts and emotions. He wrestled with himself, trying to anchor his thoughts. “What makes you think Michelle has leukemia?” He spoke slowly, with great effort. Cathryn sat back down.

  “The diagnosis in unequivocal,” said Dr. Wiley softly.

  “What kind of leukemia?” asked Charles, running his hand through his hair and looking out the window at the neighboring brick wall. “Lymphocytic?”

  “No,” said Dr. Wiley. “I’m sorry to say but it’s acute myeloblastic.”

  I’m sorry to say . . . I’m sorry to say . . . a stock medical phrase that doctors resorted to when they didn’t know what else to do and it echoed unpleasantly in Charles’s head. I’m sorry to say your wife died . . . It was like a knife plunging into the heart.

  “Circ
ulating leukemic cells?” asked Charles, forcing intelligence to struggle against memory.

  “I’m sorry to say, but there are,” said Dr. Wiley. “Her white count is over fifty thousand.”

  A deathly silence descended over the room.

  Abruptly Charles began to pace. He moved with quick steps, while his hands worked at each other as if they were enemies.

  “A diagnosis of leukemia isn’t certain until a bone marrow is done,” he said abruptly.

  “It’s been done,” said Dr. Wiley.

  “It couldn’t have,” snapped Charles. “I didn’t give permission.”

  “I did,” said Cathryn, her voice hesitant, fearful she’d done something wrong.

  Ignoring Cathryn, Charles continued to glower at Dr. Wiley.

  “I want to see the smears myself.”

  “I’ve already had the slides reviewed by a hematologist,” said Dr. Wiley.

  “I don’t care,” said Charles angrily. “I want to see them.”

  “As you wish,” said Dr. Wiley. He remembered Charles as a rash but thorough student. Apparently he hadn’t changed. Although Dr. Wiley knew that it was important for Charles to substantiate the diagnosis, at that moment he would have preferred to talk about Michelle’s extended care.

  “Follow me,” he said finally and led Charles out of the conference room and down the hall. Once the conference room door opened a cacophony of crying babies could be heard. Cathryn, initially unsure of what to do, hurried after the men.

  At the opposite end of the corridor they entered a narrow room which served as a small clinical lab. There was just enough space for a counter and a row of high stools. Racks of urine samples gave the room a slightly fishy aroma. A pimply faced girl in a soiled white coat deferentially slid off the nearest stool. She’d been busy doing the routine urinalysis.

  “Over here, Charles,” said Dr. Wiley, motioning to a shrouded microscope. He plucked off the plastic cover. It was a binocular Zeiss. Charles sat down, adjusted the eyepieces, and snapped on the light. Dr. Wiley opened up a nearby drawer and pulled out a cardboard slide holder. Gently he lifted one of the slides out, being careful to touch only the edges. As he extended it toward Charles, their eyes met. To Dr. Wiley, Charles looked like a cornered animal.

  Using his left hand, Charles took the slide between his thumb and first finger. In the center of the slide was a cover glass over what appeared to be an innocuous smudge. On the ground glass portion of the slide was written: MICHELLE MAR- TEL #882673 BONE MARROW. Charles’s hand trembled as he placed the slide on the mechanical stage and put a drop of oil on the cover glass. Watching from the side he lowered the oil immersion lens until it just touched the slide and entered the oil.

  Taking a deep breath, Charles put his eyes to the oculars and tensely began to raise the barrel of the scope. All at once a multitude of pale blue cells leaped out of the blur, choking off his breath, and forcing the blood to pound in his temples. A shiver of fear as real as if he were looking at his own death warrant blew through his soul. Instead of the usual population of cells in all stages of maturation, Michelle’s marrow had been all but replaced by large, undifferentiated cells with correspondingly large irregular nuclei, containing multiple nucleoli. He was gripped by a sense of utter panic.

  “I think you’ll agree it’s rather conclusive,” said Dr. Wiley gently.

  With a crash, Charles leaped to his feet, knocking his stool over backwards. An uncontrollable anger, anger pent up from the exasperating morning and now fired by Michelle’s illness, blinded him. “Why?” he screamed at Dr. Wiley, as if the pediatrician were part of an encircling conspiracy. He grabbed a fistful of the man’s shirt and shook him violently.

  Cathryn leaped between the two men, throwing her arms around her husband. “Charles, stop!” she shouted, terrified of alienating the one person she knew they needed to help them. “It’s not Dr. Wiley’s fault. If anyone’s to blame, it’s us.”

  As if waking from a dream, Charles embarrassingly let go of Dr. Wiley’s shirt, leaving the surprised pediatrician’s bow tie at an acute angle. He bent down and righted the stool, then stood back up, covering his face with his hands.

  “Blame is not the issue,” said Dr. Wiley, fumbling nervously with his tie. “Caring for the child is the issue.”

  “Where is Michelle?” asked Charles. Cathryn did not let go of his arm.

  “She’s already been admitted to the hospital,” said Dr. Wiley. “She’s on Anderson 6, a floor with a wonderful group of nurses.”

  “I want to see her,” said Charles, his voice weak.

  “I’m sure you do,” said Dr. Wiley. “But I think we have to discuss her care first. Listen, Charles.” Dr. Wiley reached out a comforting hand, but thought better of it. Charles’s fury had unnerved him. Instead he put his hands in his pockets. “We have here at Pediatric one of the world’s authorities on childhood leukemia, Dr. Stephen Keitzman, and with Cathryn’s permission I’ve already contacted him. Michelle is a very sick little girl, and the sooner a pediatric oncologist is on the case the better. He agreed to meet with us as soon as you arrived. I think we should talk to him, then see Michelle.”

  At first Cathryn wasn’t sure about Dr. Stephen Keitzman. Outwardly he was the opposite of Dr. Wiley. He was a small, young-looking man with a large head and thick dark, curly hair. He wore rimless glasses on a skinny nose whose pores were boldly evident. His manner was abrupt, his gestures nervous, and he had a peculiar tic that he displayed during pauses in his speech. All at once he’d curl his upper lip in a sneer that momentarily bared his capped teeth and flared his nostrils. It lasted only an instant but it had a disquieting effect on people who were meeting him for the first time. But he was sure of himself and spoke with an authority that made Cathryn feel confidence in the man.

  Certain that she would forget what was being told to them, she pulled out a small notebook and ballpoint pen. It confused her that Charles didn’t seem to be listening. Instead he was staring out the window, seemingly watching the traffic inching along Longwood Avenue. The northeast wind had brought arctic air into Boston and the mixture of light rain and snow had turned to a heavy snow. Cathryn was relieved that Charles was there to take control because she felt incapable. Yet he was acting strangely: angry one minute, detached the next.

  “In other words,” summed up Dr. Keitzman, “the diagnosis of acute myeloblastic leukemia is established beyond any doubt.”

  Swinging his head around, Charles surveyed the room. He knew that he had a precarious hold on his emotions, and it made it difficult to concentrate on what Keitzman had to say. Angrily he felt he’d spent the whole morning watching people undermine his security, dislocate his life, destroy his family, rob him of his newly found happiness. Rationally he knew there was a big difference between Morrison and Ibanez on the one hand and Wiley and Keitzman on the other, but at the moment they all triggered the same unreasoning fury. Charles had great difficulty believing that Michelle had leukemia, particularly the worst possible type, the most deadly kind. He had already been through that kind of disaster; it was someone else’s turn.

  Listening half-heartedly, Charles examined Dr. Stephen Keitzman, who had assumed that typical condescending air of the physician in charge, doling out bits and pieces of information as if he were lecturing. Obviously Keitzman had experienced this scene many times before and his stock phrases like “I’m sorry to say” had an overused, insincere ring. Charles had the uncomfortable feeling that the man was enjoying himself, not in the same manner he’d enjoy a movie or a good meal, but in a more subtle, self-satisfied way: he was the center of attention in a crisis. This attitude abraded Charles’s already frayed emotions, especially since he was more than familiar with the general material Dr. Keitzman was covering. Charles forced himself to remain silent while his mind’s eye conjured up kaleidoscopic images of Michelle as she grew up.

  “In order to allay the inevitable sense of guilt,” continued Keitzman as he bared his upper teeth in one o
f his nervous grimaces, “I want to emphasize that the cause and date of onset of leukemia like Michelle’s is unknown. Parents should not try to blame specific events for initiating the disease. The goal will be to treat the condition and bring about a remission. I’m pleased to be able to report that we have very favorable results with acute myeloblastic leukemia; something we didn’t have ten years ago. Now we are able to engineer a remission in about eighty percent of cases.”

  “That’s wonderful,” said Charles, speaking for the first time. “But unlike the five-year cures you’ve been achieving with other forms of leukemia, can you tell us how long the remission lasts in Michelle’s form of the disease.” It was as if Charles had to goad Keitzman into revealing the worst news at once.

  Keitzman pushed back his glasses and cleared his throat. “Dr. Martel, I am aware you know more about your daughter’s disease than other parents I deal with. But since your field is not specifically childhood leukemia, I don’t have any idea what you know and what you don’t know. Therefore, I felt it best to have this discussion as if you knew nothing. And even if you are already familiar with these facts, perhaps they are helpful to Mrs. Martel.”

  “Why don’t you answer my question?” said Charles.

  “I think it is a more fruitful approach if we concentrate on obtaining a remission,” said Dr. Keitzman. His nervous tic became more frequent. “My experience has shown that with the advances in chemotherapy, leukemia should be approached on a day-to-day basis. We have seen some spectacular remissions.”

  “Except in Michelle’s type,” snarled Charles. “Come on, tell us what the probability is of a five-year survival with acute myeloblastic leukemia.”