IT WAS PITCH-DARK outside the window of Anne Delaney’s office, but she was not heading home. She had a stack of incident reports to review before she started analyzing the results of the mortality rate study the Department of Health had suggested. If it was not past midnight by then, she would start researching how to protect test results for Huntington’s chorea from the prying eyes of insurance underwriters.
Her office microwave oven went ding! and Anne removed a steaming chicken pot pie, using tongs she had borrowed from the hospital lab. It was going to be another long evening, so she figured she might as well pop a second helping in right away. Anne walked across the hall to the employee lounge and fetched another pie from the frozen food compartment of the refrigerator, which was stocked primarily with her provisions.
Back in her office, she scrutinized the stacks of paper and books on her desk, each stack representing a distinct task. She mentally measured out her waking hours for the next week into corresponding allotments.
A visitor might have noticed that there were no pictures in Anne’s office. No children, no spouse, no boyfriend, no pets. Anne noticed it herself sometimes, and if the absence of such distractions in her life occasionally made her melancholy, the feeling quickly passed. She understood, with only slight regret, that somewhere along the line she had started taking her work so much to heart that it left time for little else. Every patient death that resulted from something the hospital should have done differently she suffered as a personal failure. Every baby who lived because of a safety measure that Anne had instituted was, in a way, hers.
Those incident reports were not merely papers to be shuffled. They were potential threats to people Anne felt responsible for, as she had for her six younger siblings when she was growing up—no, more responsible, because this was an obligation she had taken on voluntarily, as an adult. If others around her didn’t experience the onus of their jobs the same way, no matter. Anne had no choice.
Around half past ten, she pulled up on her computer screen the mortality data that the Medical Records Department had assembled. As she had requested, they compiled total admissions, discharges and deaths prior to discharge for every physician on the medical staff. She scrolled through the report carefully, taking twenty minutes to get to the letter T.
“Whoa,” she said.
One of her docs was off the charts on deaths.
CHAPTER
9
A week into June, Karen still had not found time to clean her office. The mess was worse, the coating of dust thicker, piles of paper everywhere, a little collection of Margaret’s chewing gum wrappers on the corner of the desk. Karen would make no progress on the cleanup today; she had a long to-do list. She might have to break down and violate her weekend.
Anne Delaney had been in earlier with her regular report. One medical staff member, a neurologist named Jeffrey Treacher, had dropped out on the mortality rate study. His death rate was three and a half times the norm for Shoreview Memorial, over five times the national norm for neurologists. Enough for Karen to suggest a chart review, which would require approval from the chief of the medical staff. Also, Anne had looked into protecting the results of genetic testing for Huntington’s chorea from disclosure to health insurers, and Karen had left a voice-mail message for Arthur Winslow to call to discuss his daughter’s dilemma.
Then Karen opened her mail and found Van Dyke ~ Eddington’s formal job offer. Apparently her interview with the name partners had gone better than she thought. The offer was more than twice her current salary. They were also offering flexible hours, health and dental coverage and a pension plan. She had to talk to Jake immediately, but for the first time since she had returned to work, he failed to answer their home phone. Prickling with anxiety, she tried the number of the cellular.
“Y-y-yello,” said Jake.
“Where are you?”
“Thought I’d get McKinley out for a little fresh air,” said Jake. “It’s a fine day.”
Karen could hear wind whistling, a rhythmic, metallic banging and a distant blatting motor.
“Where the hell are you, Jake?”
“I’m out fishing with my son,” he said, fatherly pride in his voice.
Karen identified the metallic banging. Waves beating against aluminum. Her stomach leaped. The canoe!
“Jake, you didn’t take the baby out on the flowage.”
“Did.”
“No! What if the canoe tips over?”
“It won’t. Besides, I’ve got him strapped to a self-righting flotation device, so if we capsize he’ll just bob around like a cork until I pick him up.”
“Come in right now!” said Karen, feeling something close to panic.
“But McKinley loves it out here. Notice he’s not crying. Must be the canoe rocking like a cradle.”
The image of her baby in a rocking canoe pushed Karen over the edge. “Right now. IN!”
“Just a couple more casts . . .”
“Now!”
“But sweetheart,” said Jake with a tone of sincere reverence, “the bass are spawning.”
“Oh they are, are they?” said Karen. “Well, if you wish to ever again enjoy the same privilege as the bass, you will get my baby off that water hazard this instant.”
“Aye, aye, Captain,” said Jake. “I just . . . hold on a minute.”
Karen heard a clunk followed by a clanging so loud she had to hold the receiver at arm’s length, at which distance she could still hear Jake yelling, “Daddy’s got one! Daddy’s got one!” After several minutes of shouting and banging, Jake got back on the line to announce he had stringered a five-pound largemouth.
“I’ll panfry it for dinner tonight,” he said, fisherman-proud now.
“So the place you’ll be staying has a kitchen?” asked Karen.
“We’ll be off the lake in ten seconds,” said Jake.
From her first date with Jake until the birth of their child twenty years later, Karen thought she had found the perfect man: kind, attentive, imaginative, strong. But each time she got another reminder of how lame Jake was at infant care it stung a little. As soon as he announced he was ashore, Karen had Jake agree to Inviolable Rule Number One: no leaving the house with the baby without prior notice. In the absence of notice, a failure to answer the home phone would be deemed an emergency.
Before Karen could tell Jake about her job offer, Margaret appeared in her doorway with a look of fidgety urgency about her. Margaret had been hyper all morning, ever since she got wind that her boyfriend, Ed, had landed the security job Matt Stoker had found posted on the hospital administration bulletin board. Margaret told Karen that Mr. Winslow was holding, so Karen bade Jake a quick adieu and asked Margaret to put the call through.
“Karen, I’ve done a terrible, terrible thing,” blurted Arthur, sounding as if he were in agony. Karen was caught off guard by Arthur’s utterance and his desperate tone, but she thought she knew what the terrible thing was. Her taste for juicy gossip and morbid curiosity notwithstanding, Karen decided it would be unwise for Arthur to discuss his marital crisis with her.
“Before you say anything, Arthur, have you talked about this with your wife or a counselor yet?”
“No. Perhaps I should,” said Arthur. “But you left me a voice-mail message to call you about genetic testing for my daughter.”
“That’s what you’re talking about?” said Karen.
“Sure. What did you think?”
Whoops. Karen paid for her assumption with a pang of embarrassment. She decided to blow right past her gaff, hoping Arthur hadn’t noticed.
“You said you’ve done a terrible thing. Does whatever you’ve done have to do with genetic testing?”
“Yes,” said Arthur. He sighed loudly, his sigh coming out as a low moan. He paused for several seconds. Whatever he was about to tell Karen appeared to be extremely hard for him to get out. “I’m sorry you and Anne wasted your time researching the subject,” he finally said. “We don’t need genetic
testing. Amy was adopted.”
Karen felt a surge of relief. Not only was she off the hook for discussing Arthur’s unsavory personal problems, this was actually good news. It spared the Winslows a wrenching decision. Arthur was being silly if he felt reticent about this. He needed reassurance.
“Why, that’s wonderful,” said Karen. “I know you’re very proud of Amy and you should be. So we did a little unnecessary research. You’ve done nothing terrible. But,” she added good-naturedly, “I am a little miffed you never told me.”
“We never told her, either,” said Arthur.
Now it was Karen who paused. “What? Are you serious?”
“It’s not an easy thing to do, Karen,” said Arthur. “At first, Lorraine and I decided to wait until Amy was old enough to understand. Then we started putting it off day by day, week by week, avoiding the pain and stress of it. She was doing well, but we didn’t ever feel she was secure enough, the time was never right. Months would go by, we wouldn’t even mention it to each other. Eventually, it started to dawn on us that we had waited too long. Amy would be angry we kept it from her all those years. She would never trust us again. Lorraine and I didn’t expressly agree to never tell Amy; at some point we just drifted into an implicit conspiracy of silence. Pretty despicable, huh?”
It was astonishing, for sure, but was it despicable? Karen and Jake had tried unsuccessfully for years to make a baby before Karen got pregnant with McKinley. She had thought about adoption many times, but not about how or when adoptive parents would tell their child about her origin. Nor were the Winslows the only parents Karen knew who tried to keep a big secret from their child. Karen’s older sister, Pamela, had grown up believing she was a New Year’s baby, until at the age of twenty-five she needed a certified copy of her birth certificate in order to get a passport for her honeymoon. What a surprise it was to learn her birthday was actually October 5. Her parents had concocted the fake birth date to conceal from their families that Pamela was conceived out of wedlock. Yet Karen did not consider her parents to be at all despicable, just a little weak.
“You have to tell Amy, now,” said Karen.
“I know,” said Arthur.
“Talk to one of our psychiatrists first,” said Karen. “Dr. Moyer is very good. He’ll have some ideas on how to present it.”
“Thanks, I’ll do that. Boy, this summer is starting out lousy. It can’t get any worse. I’d say I’m due for some good luck, wouldn’t you?”
Karen did not respond. She was distracted by Gary Wick-wire, a personal injury attorney whom she knew to be a real bottom-feeder, skulking outside her door.
“THE SHIT’S IN the fan, sweets,” said Duane Billick. “You might wanna haul ass outa here for the rest of the day. My new lawyer Gary’s gonna spring for lunch at a fancy restaurant.”
This was the first time Duane had ever bothered to visit Shari at work. It was also the first time in years she had seen him in a shirt with a collar and a necktie. With his stringy hair and scraggly beard, he looked like some public defender had done a halfhearted job of cleaning him up for a court appearance.
“I can’t just leave, Duane. I’ve got work to do.”
“Yeah,” said Duane, “Your big runner job. What can’t you blow off until tomorrow?”
“I have to deliver these patient charts to the floor right away,” she said, gesturing to the manila folders in her metal cart. “Then at noon I have to help deliver meals to patient rooms. This stuff can’t wait.”
“Oh yeah? Let’s see what’s so important.”
“Duane, don’t,” said Shari.
Ignoring her, Duane flipped through the folders in the cart. “Hey, what a coincidence. You got one here with the name Winslow on it. Gary’s dropping off a claim right now with the name Winslow on it.”
“Put that back, Duane. So you’re starting the lawsuit.”
“Not yet. Might not have to. Gary says we start by showing them a draft of a complaint, try to shake out a settlement without filing. Gives the hospital and Winslow a little extra goose, ’cause if they settle before we file, there’s no publicity. What’s the matter?”
Shari was covering her eyes with her hand. Her face, ears and neck were magenta.
“I don’t feel so good.”
“Oh yeah? So it’s okay you miss the fancy lunch. I’ll bring home a doggie bag.”
ARTHUR WINSLOW FIDDLED with the remote control on his titanium blinds and stared out the window at the parking lot. For a moment, he looked as if he was about to slip into catatonia. Then he rotated his chair to face Karen Hayes, belligerence in his eyes.
“It’s all bullshit,” he said. “There’s not a goddamn word of truth in it.” He slammed the remote control against the desk with a loud clack that echoed in the cavernous office. “Bring Stoker in on this immediately. We’ll shove this right back up Wickwire’s ass.”
Karen had never heard Arthur use profanity before, let alone lose his temper. He suddenly seemed big and scary-looking. She wanted to leave but she had to get through this.
“What about the allegation that you arranged her removal from the front desk? There’ll be a record of that.”
“Yes, I did put that through,” said Arthur. He pointed a finger at Karen. “But not for the reason they say. She asked me to do that, as a personal favor.”
Ah, he was admitting to doing a personal favor for her, acknowledging some relationship with the claimant. “Are you and Shari Billick friends?”
“Yes, well, not really, no.” He twisted in his chair. “Sort of.”
“Did you ever,” Karen looked down at the draft complaint in her lap, “meet with her privately for cocktails at a nightclub?”
“Of course not,” said Arthur.
Thanks to Jake’s report after his gig at the Caledonia Club, Karen knew Arthur was lying. Another disappointing first. It hurt her feelings, but more importantly it was going to be a lot harder to defend this claim if she could not trust Arthur to give her the truth.
“You never met her at a motel for sexual relations?”
“Absolutely not.” Arthur fiddled with the remote control and glanced off to the side. Karen thought he looked like a defendant whose lawyer had failed to coach him on how to look innocent on the stand. The pink in his ears and beads of moisture at his hairline didn’t help, either.
“You never threatened to have her demoted when she tried to end your romantic relationship?”
Arthur gaped at her. “Jesus Christ, Karen. What do you think I am?”
Karen did not reply.
CHAPTER
10
Late Friday night, ten days later. The first symptoms were subtle, like a sense of déjà vu. A queasiness more mental than physical, a vague sense that all was not right. Then a gurgling in the bowels, followed by a dull ache in the abdomen that passed quickly and returned just as quickly, but not as dull. A wave of nausea, then nothing. Nothing for so long that the patient thought she was okay, that whatever it was had passed without consequence. When the pain in her gut came back, it was sharp, hard and accompanied by a cold sweat that saturated her hospital gown. Then dizziness and nausea that rose rapidly and with urgency. She hopped out of bed and stumbled to the toilet.
Lorraine Winslow was in the hospital for the third time in a month, this time for her neurologist and her psychiatrist to adjust the multiple medications she was on for depression and other symptoms of Huntington’s chorea, and for additional testing. By the time the nurse came to check on her, Lorraine had been through several cycles of vomiting and diarrhea.
“Mrs. Winslow! You poor thing. Why didn’t you ring for me?”
Lorraine was seated on the floor of the bathroom, leaning against the tile wall, panting and pale. “I don’t know what’s the matter with me,” she said, her eyes goggling about, her hands trembling. “Is this the Huntington’s?”
“No, no, Mrs. Winslow,” said the nurse, a slender African American in her late twenties. “You’ve come down with somet
hing.” The nurse glanced into the toilet bowl and immediately interpreted the contents as signaling a medical emergency. She dampened a washcloth with cool water, knelt down and mopped Lorraine’s face. “Let’s get you cleaned up and back in bed. I’ll get you a bedpan. Then I need to call the doctor.”
“Will Dr. Treacher come?” asked Lorraine, sounding frail and childlike.
“No, I don’t think he’s here at the hospital this late, but we have an internal medicine resident on call.”
THE RESIDENT SOUNDED like he had just been awakened from a deep sleep.
“Did you get a temp?”
“It’s 102 degrees,” said the nurse.
“Blood pressure?”
“Elevated at 190 over 130.”
“Did you get a look at her stool?”
“Yes. There’s blood in it.”
“Like coffee grounds or bright red?”
“Red.”
“Okay, I’ll be there in ten minutes,” he said, yawning. “It’s acute gastroenteritis, probably severe food poisoning. Get a stool sample down to the lab. Get an IV in her, push fluids.With fever and blood in the stool, we’d better start antibiotics.Add enrofloxacin to the IV and get some oral Septra ready.Give her an injection of diphenoxylate for the vomiting.Where’s her last food tray?”
“Gone.”
“Ay, caramba,” grumbled the resident. “I had dinner at the cafeteria myself today! Call the infection control officer. We need to close down the food service. Where’d you eat today?”
“At home.”
“Lucky you.”
Twenty minutes later, the resident had finished examining Lorraine.
“You ate something that didn’t agree with you,” he said.
“Will I be better tomorrow?” she asked plaintively.
“Maybe not tomorrow,” he said, “but if you take your medicine and stay hydrated, you’ll be good as new in a couple of days.”
IT WAS A CLOUDLESS night, and Arthur had a clear view of the winding road ahead, and of the Milky Way glittering through his moon roof, but the dense woods on both sides formed solid walls of blackness that not even the halogen headlamps of his Lexus could penetrate. Arthur had always derived great satisfaction from the location of his property, a peninsula on the Weyawega flowage that was buffered from the rest of Jefferson by state forest land. To be surrounded by water and near wilderness, a mere fifteen minutes from town, seemed an exquisite luxury. Tonight, however, the dark woods seemed threatening and full of reproach, imposing on him an awareness of how small and alone he was and of how little he had done to earn his vaunted estate.
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