by Robin Cook
The woman resident gave a terse explanation of Michelle’s condition while the nurses rapidly attached EKG leads to Michelle’s extremities.
The charge nurse leaned over to one of the other nurses and told her to page Dr. Keitzman.
The electronic box on the top of the cart began to spew forth an endless strip of narrow graph paper on which Cathryn could see the red squiggles of an EKG. The doctors grouped around the machine, momentarily forgetting Michelle.
“V-tack all right,” said the chief resident. “With the dyspnea and cyanosis she’s obviously hemodynamically compromised. What does that mean, George?”
One of the other residents looked up, startled. “Means we should cardiovert her immediately . . . I think.”
“You think right,” concurred the chief resident. “But let’s draw up some Lidocaine. Let’s see, the kid’s about fifty kilograms, no?”
“A little less,” said the woman resident.
“All right, fifty milligrams of Lidocaine. Also draw up a milligram of atropine in case she goes into bradycardia.”
The team functioned efficiently as one resident drew up the medications, another got out the electrode paddles, while the third helped position Michelle. One paddle went under Michelle’s back, the other anteriorly on her chest.
“All right, stand back,” said the chief resident. “We’ll use a fifty-watt second shock to start, programmed to be delivered at the R-wave. Here goes.”
He pressed a button and after a momentary delay Michelle’s body contracted, her arms and legs jumping off the surface of the bed.
Cathryn watched in horror as the doctors stayed bent over the machine, ignoring Michelle’s violent reaction. Cathryn could see the child’s eyes open in utter bewilderment and her head lift off the bed. Thankfully her color rapidly reverted to normal.
“Not bad!” yelled the chief resident, examining the EKG paper as it came out of the machine.
“John, you’re getting good at this stuff,” agreed the woman resident. “Maybe you should think about doing it for a living.”
All the doctors laughed and turned to Michelle.
Dr. Keitzman arrived breathless, hands jammed into the pockets of his long white coat. He went directly to the bed, his bespectacled eyes quickly scanning Michelle’s body. He snatched up her hand, feeling for a pulse.
“Are you okay, chicken?” he asked, getting out his stethoscope.
Michelle nodded but didn’t speak. She appeared dazed.
Cathryn watched as John, the chief resident, launched into a capsule summary of the event in what was to Cathryn incomprehensible medicalese.
Dr. Keitzman’s upper lip pulled back in a characteristic spasm as he bent over Michelle, listening to her chest. Satisfied, he checked a run of EKG paper offered by John. At that moment he caught sight of Cathryn pressed up against the wall. Keitzman glanced at the charge nurse with a questioning expression. The charge nurse, following his line of sight, shrugged.
“We didn’t know she was in here,” said the charge nurse defensively.
Dr. Keitzman walked over to Cathryn and put a hand on her shoulder.
“How about you, Mrs. Martel?” asked Dr. Keitzman. “Are you all right?”
Cathryn tried to talk but her voice wouldn’t cooperate, so she nodded like Michelle.
“I’m sorry you had to see this,” said Dr. Keitzman. “Michelle seems fine and she undoubtedly did not feel anything. But I know this kind of thing is shocking. Let’s go out in the hall for a moment. I’d like to talk to you.”
Cathryn strained upward to see Michelle over Dr. Keitzman’s shoulder.
“She’ll be okay for a moment,” assured Dr. Keitzman. Then, turning to the charge nurse, he said, “I’ll be just outside. I want a cardiac monitor in here, and I’d like a cardiac consult. See if Dr. Brubaker can see her right away.” Dr. Keitzman gently urged Cathryn out into the corridor. “Come down to the nurses’ station; we can talk there.”
Dr. Keitzman led Cathryn down the busy corridor to the chart room. There were Formica Parsons tables, chairs, two dictating telephones, and the massive chart racks. Dr. Keitzman pulled out a chair for Cathryn and she gratefully sat down.
“Can I get you something to drink?” suggested Dr. Keitzman. “Water?”
“No, thank you,” managed Cathryn nervously. Dr. Keitzman’s extremely serious manner was a source of new anxiety and she searched the man’s face for clues. It was hard to see his eyes through his thick glasses.
The charge nurse’s head came through the door. “Dr. Brubaker wants to know if he can see the patient in his office.”
Dr. Keitzman’s face contorted for a second while he pondered. “Tell him that she just had an episode of V-tack and I’d prefer he see her before she’s moved around.”
“Okay,” said the charge nurse.
Dr. Keitzman turned to Cathryn. He sighed. “Mrs. Martel, I feel I must talk frankly with you. Michelle is not doing well at all. And I’m not referring specifically to this latest episode.”
“What was this episode?” asked Cathryn, not liking the initial tone of the conversation.
“Her heart speeded up,” said Dr. Keitzman. “Usually it’s the upper part of the heart that initiates the beat.” Dr. Keitzman gestured awkwardly to try to illustrate what he was saying. “But for some reason, the lower part of Michelle’s heart took over. Why? We don’t know yet. In any case, her heart suddenly began to beat so fast that there wasn’t time for the heart to fill properly, so it pumped inefficiently. But that seems to be under control. What is worrying me is that she does not seem to be responding to the chemotherapy.”
“But she’s just started!” exclaimed Cathryn. The last thing that Cathryn wanted was for her hope to be undermined.
“That’s true,” agreed Dr. Keitzman. “However, Michelle’s type of leukemia usually responds in the first few days. On top of that Michelle has the most aggressive case that I’ve ever seen. Yesterday we gave her a very strong and very successful drug called Daunorubicin. This morning when we did her blood count, I was shocked to see that there was almost no effect on the leukemic cells. This is very unusual although it does happen occasionally. So I decided to try something a little different. Usually we give a second dose of this medicine on the fifth day. Instead I gave her another dose today along with the Thioguanine and Cytarabine.”
“Why are you telling me this?” asked Cathryn, certain that Dr. Keitzman knew she would not understand much of what he was saying.
“Because of your husband’s response yesterday,” said Dr. Keitzman. “And because of what Dr. Wiley and I said to you. I’m afraid your husband’s emotions will interfere and he’ll want to stop the medicines.”
“But if they’re not working, maybe they should be stopped,” said Cathryn.
“Mrs. Martel. Michelle is an extremely sick child. These medicines are her only chance for survival. Yes, it’s disappointing that as yet they have been ineffective. Your husband is right in saying her chances are slim. But without chemotherapy, she has no chance at all.”
Cathryn felt the stabbing pain of guilt; she should have brought Michelle to the hospital weeks ago.
Dr. Keitzman stood up. “I hope you understand what I’m saying. Michelle needs your strength. Now, I want you to call your husband and have him come over. He’s got to be told what’s happened.”
• • •
Even before the automatic radioactivity counter began to record the electrons emanating from the series of vials, Charles knew that the radioactive nucleotides had been absorbed and incorporated into the tissue culture of Michelle’s leukemic cells. He was now in the last stages of preparing a concentrated solution of a surface protein that differentiated Michelle’s leukemic cells from her normal cells. This protein was foreign to Michelle’s body but was not rejected because of the mysterious blocking factor that Charles knew was in Michelle’s system. It was this blocking factor that Charles had wanted to investigate. If only he knew something about
the method of action of the blocking factor, perhaps it could be inhibited or eliminated. He was frustrated to be so close to a solution and have to stop. At the same time he realized that it was probably a five-year project with no guarantee of success.
Closing the cover on the tissue culture incubator, he walked to his desk, vaguely wondering why Ellen had not appeared. He wanted to discuss the Canceran project with someone knowledgeable, and she was the only person he could trust.
He sat down, trying not to think about the recent humiliating meeting with Dr. Ibanez and the Weinburgers. Instead he recalled the frustrating visit to the EPA offices that didn’t make him feel much better. Yet he could laugh at his own naiveté in thinking that he could walk into a government agency and expect to accomplish something. He wondered if there would be any way that he could get some sort of photographic proof of Recycle’s dumping. It was doubtful, but he’d try.
Perhaps if he were responsible for getting the evidence, he should sue Recycle directly rather than waiting for the EPA to do so. Charles knew very little about law, but he remembered there was a source of information open to him. The Weinburger Institute law firm on retainer.
The left lower drawer was Charles’s spot for miscellaneous pamphlets. Close to the bottom he found what he was looking for: a skinny red booklet entitled Welcome Aboard: This Is Your Weinburger Cancer Institute. In the back was a list of important phone numbers. Under services was Hubbert, Hubbert, Garachnik and Pearson, 1 State Street, followed by several phone numbers. He dialed the first.
Identifying himself, Charles was immediately switched to Mr. Garachnik’s office. His secretary was particularly cordial and within minutes, Charles found himself talking with Mr. Garachnik himself. Apparently the Weinburger was a valued customer.
“I need some information,” said Charles, “about suing a company dumping poisonous waste into a public river.”
“It would be best,” said Mr. Garachnik, “if we have one of our environmental law persons look into the matter. However, if your questions are general, perhaps I can help. Is the Weinburger Institute becoming interested in environmental pursuits?”
“No,” said Charles. “Unfortunately not. I’m interested in this personally.”
“I see,” said Mr. Garachnik, his tone becoming cool. “Hubbert, Hubbert, Garachnik and Pearson does not handle personal Weinburger employee legal problems unless special arrangement is made with the individual.”
“That could be arranged,” said Charles. “But as long as I’ve got you on the phone, why don’t you just give me an idea about the process.”
There was a pause. Mr. Garachnik wanted Charles to realize that he felt Charles’s inquiry beneath his stature as a senior partner. “It could be done as an individual or class action suit. If it were an individual suit, you’d need specific damages and if . . .”
“I’ve got damages!” interrupted Charles. “My daughter has come down with leukemia!”
“Dr. Martel,” said Mr. Garachnik with irritation. “As a physician you should know that establishing causation between the dumping and the leukemia would be extremely difficult. However, with a class action suit for the purpose of securing an injunction against the factory, you don’t need specific damages. What you do need is the participation of thirty to forty people. If you want to pursue this further, I suggest you contact Thomas Wilson, one of our new, younger lawyers. He has a particular interest in environmental matters.”
“Does it matter that the company is in New Hampshire?” asked Charles quickly.
“No, other than that it must be sued in a New Hampshire court,” said Mr. Garachnik, obviously eager to terminate the conversation.
“What if it’s owned by a corporation in New Jersey?”
“That might and might not compound the difficulties,” said Mr. Garachnik, suddenly more interested. “What factory in New Hampshire are you talking about?”
“A place called Recycle, Ltd. in Shaftesbury,” said Charles.
“Which is owned by Breur Chemicals of New Jersey,” added Mr. Garachnik quickly.
“That’s right,” said Charles, surprised. “How did you know?”
“Because on occasion we indirectly represent Breur Chemicals. In case you’re not aware, Breur Chemicals owns the Weinburger Institute even though it’s run as a nonprofit organization.”
Charles was stunned.
Mr. Garachnik continued: “Breur Chemicals founded the Weinburger Institute when they expanded into the drug industry by purchasing Lesley Pharmaceuticals. I was against it back then, but Weinburger, Sr. was committed to the idea. I was afraid of an antitrust action, but it never materialized because of the nonprofit cover. In any case, Dr. Martel, you essentially work for Breur Chemicals and in that capacity, you’d better think twice about suing anyone.”
Charles hung the phone up very slowly. He could not believe what he’d just heard. He’d never cared about the financial side of the institute except to the extent that the Weinburger could supply him with research space and equipment. But now he learned that he was working for a conglomerate which was ultimately responsible for dumping cancer-causing waste into a public river as well as running a research institute supposedly interested in curing cancer. As for Canceran, the parent company controlled both the drug firm holding the patents and the research firm chosen to ascertain its efficiency.
No wonder Weinburger was so interested in Canceran!
The phone jangled Charles’s taut nerves as it rang under his outstretched hand. As the source of the recent dreadful revelation, Charles debated answering it. Undoubtedly it was the administration calling, bent on harassing him with more pressure and more deceit.
Abruptly Charles’s mind switched to Michelle. The call could be about his daughter. He snatched the receiver from the cradle and pressed it to his ear.
He was right. It was Cathryn and her voice had the same stiff quality it had the day before. His heart jumped into his throat.
“Is everything okay?”
“Michelle is not doing so well. There’s been a complication. You’d better come over.”
Charles grabbed his coat and ran out of his lab. At the front entrance, he knocked on the massive glass door, impatient for it to open.
“All right, all right!” said Miss Andrews, pressing the door release under her desk.
Charles squeezed out before the door was fully opened and disappeared from sight.
“What’s the matter with him?” asked Miss Andrews, pressing the close switch. “Is he crazy or something?”
Roy adjusted his worn holster and shrugged.
Charles concentrated on hurrying to keep from guessing what had happened to Michelle. But after crossing the Charles, he got bogged down in traffic on Massachusetts Avenue. As he inched forward, he couldn’t help worrying about what he was going to find when he got to Pediatric Hospital. Cathryn’s words kept echoing in his head: “Michelle is not doing so well. There’s been a complication.” Charles felt panic tighten his stomach into a painful knot.
When he reached the hospital, he rushed inside and forced his way onto a full elevator. Maddeningly the car stopped at every floor. Eventually it reached the sixth, and Charles pushed his way off and hurried down to Michelle’s room. The door was almost closed. He entered without knocking.
An elegant blond-haired woman straightened up from leaning over Michelle. She’d been listening to the girl’s heart before Charles’s entry. On the opposite side of the bed was a young resident dressed in hospital whites.
Charles gave the woman a cursory glance and looked down at his daughter with empathy submerging all other emotions. He wanted to grab her and shield her, but he was afraid she had become too fragile. His trained eyes inspected her rapidly and could detect a worsening in her condition since that morning. There was a greenish cast to her face, a change Charles had associated during his medical training with ensuing death. Her cheeks had become hollow with the skin taut over her facial bones. Despite an intravenous
line attached to both arms, she looked dehydrated from the vomiting and high fever.
Michelle, lying flat on her back, looked up at her father with tired eyes. Despite her discomfort she managed a weak smile and for a brief moment her eyes shone with the incredible luster that Charles remembered.
“Michelle,” said Charles softly, bending down so his face was close to hers. “How do you feel?” He didn’t know what else to say.
Michelle’s eyes clouded and she began to cry. “I want to go home, Daddy.” She was reluctant to admit how bad she felt.
Biting his lip Charles glanced up at the woman next to him, embarrassed by his overwhelming emotion. Looking back down at Michelle, he put his hand on her forehead and smoothed back her thick black hair. Her forehead was hot and damp. Her fever had risen. Michelle reached up and grasped his hand.
“We’ll talk about it,” said Charles, his lips quivering.
“Excuse me,” said the woman. “You must be Dr. Martel. I’m Dr. Brubaker. Dr. Keitzman asked me to see Michelle. I’m a cardiologist. This is Dr. John Hershing, our chief resident.”
Charles made no effort to respond to the introductions. “What happened?”
“She had an acute episode of ventricular tachycardia,” said Dr. Hershing. “We cardioverted her immediately, and she’s been very stable.”
Charles looked at Dr. Brubaker. She was a tall, handsome woman with sharp features. Her blond hair was piled on top of her head in a loose chignon.
“What caused the arrhythmia?” asked Charles, still holding Michelle’s hand.
“We don’t know yet,” said Dr. Brubaker. “My first thoughts are either an idiosyncratic reaction to the double dose of Daunorubicin, or a manifestation of her basic problem: some kind of infiltrative myopathy. But I’d like to finish my exam, if I may. Dr. Keitzman and your wife are in the chart room at the nurses’ station. I understand they are waiting for you.”
Charles lowered his eyes to Michelle. “I’ll be right back, sweetheart.”
“Don’t go, Daddy,” pleaded Michelle. “Stay with me.”