The Fifth Vial

by Michael Palmer

  “When it’s appropriate, Doug and I will go to bat for you with one of the other surgical programs. I promise you that.”

  “But first I’ve got to come to peace with what I’ve done wrong in school, and what I did wrong in the Metro ER.” She held up her hand to keep him from reiterating that, in fact, if she had done nothing wrong she would still be in school. “I know, I know,” she said.

  “Used together like that, those are two of my least favorite words,” Millwood said.

  “I know.”

  “On your left!” a voice from behind called out.

  Two boys, wearing the purple and white of perennial track powerhouse St. Clement’s, flashed past them on the inside, forcing them to move to the right. Then, in unison, the youths glanced back, their expressions scornful condemnation of the policy that would allow just anyone onto their track.

  “Easy,” Millwood muttered. “They jail people for what you’re thinking of doing. You don’t have a weapon anyhow.”

  “Don’t be so sure.”

  “So, Doug tells me you’re spending quite a bit of time in the lab.”

  “What else do I have to do? The other techs want to kill me for making them look bad by being the first one in and the last one out, only they don’t appreciate that I don’t have anything else to do. They also don’t know that just on general principles, I want to kill them more.”

  “What time did you say your shrink appointment was today?”

  “You think I’m too angry?”

  “I wouldn’t be much of a friend if I just kept telling you that you were right all the time. You know I adore you, Nat, but I have to agree with what Goldenberg said about that hard edge of yours getting in the way.”

  “I am who I am. You of all people should appreciate that.”

  “You mean because I’m gay? That’s what I am. I wouldn’t want to change that even if I could—which I can’t. The kind of person I am is another story, and as wonderful as you are, you have a chip the size of Minnesota on your shoulder that’s getting in the way of—”

  “On your left!”

  Once again, the St. Clement’s runners rudely forced them to the right.

  “Hey, guys!” Natalie called.

  “I don’t think I want to see this,” Millwood muttered.

  Up ahead the boys stopped and turned. They were older than Natalie had first thought—probably juniors or seniors. One of them, curly blond hair, some residual acne, kept trotting effortlessly in place, while the other, swarthy and utterly self-assured, took a step back toward them, hands on hips, head cocked. Natalie had no doubt that this was hardly the first time the youths had asserted themselves this way with recreational joggers. She felt Millwood’s mute plea to forget the whole thing, but there was no chance. He was right that she didn’t have a gun to shoot them with, or a knife with which to carve them up, but she did have her legs.

  “Why didn’t you just go around us?” she asked.

  “Because we’re serious runners in training, and you’re joggers who could be running anyplace.”

  Wrong answer. Natalie saw Millwood step back, arms folded.

  “Is that so?” she said. “I’ll tell you what, serious runners, if either of you can beat this old, broken-down lady jogger back around to this spot, my friend and I will leave and go trot about someplace else. But if you can’t beat me in four hundred meters, we’ll keep our spot here, and you two can move way to the outside—or better still, go sit down on the grass and watch until we’re finished.”

  The youths exchanged looks and smiled knowingly. They were both good, Natalie realized, maybe very good. But hopefully not good enough. She was a distance runner, and a quarter mile was a sprint, but at that moment, she needed nothing more than to beat them. No, she needed to crush them.

  Natalie stepped out of her warm-ups as Millwood moved aside.

  “I’ll call the start,” he said, helpless to alter history in advance.

  As she lined up on the outside of the two teens, Natalie felt the familiar, fierce rush of competition course through her. You are not going to beat me…. You are not going to beat me…. You are not going to send that man out of the ER without a CT scan….

  “Ready…get set…go!”

  The youths were fast and arrogantly warm to the challenge of a race—especially against an older woman jogging on the track with a middle-aged man. Still, within the first twenty yards, Natalie knew that unless they each had rockets strapped to their legs in reserve, they were in for a rude surprise. The two of them seemed about equal, and ran that way—shoulder to shoulder. For a time, Natalie stayed back, drafting in the twin shadows. But a quarter of a mile was just that, and she was in no mood to nip these rivals at the finish. They both needed a profound attitude adjustment. Nothing close. The blond was Cliff Renfro, the darker one Sam Goldenberg.

  “Hey, fellas,” she called, “on your left!”

  The two looked back, clearly startled that she wasn’t far behind. It took only that instant for her to burst between them and accelerate away. Whether or not the teens could have run better had they known how fast she was didn’t really matter. In a hundred races they would lose to her a hundred times, only perhaps never again as badly as they did this day.

  Millwood had started the race halfway down one of the straightaways. Now he watched in some amusement as Natalie pounded around the final curve and sprinted in, not letting up until she had passed him. The St. Clement’s boys were just finishing that last turn. Without looking back, and battling not to show that she was even breathing hard, Natalie took her friend by the arm and led him down the track in a brisk jog.

  “Happy now?” Millwood asked.

  “Less miserable,” she said.

  It was early afternoon when Natalie finished dropping off groceries for Hermina and Jenny and at her own apartment, and arrived at the lab. Jenny, upbeat as always, had finished Wuthering Heights and started in on Oliver Twist. As far as Natalie was concerned, unless her niece suddenly leapt out of her wheelchair and ran to play with the other kids, God had some serious ground to make up.

  Even with Berenger’s lab to go to, empty time was weighing heavily. The latest of what passed for a romantic relationship for her had ended quietly nearly three months ago, and in truth, she really hadn’t missed it—until now. Berenger and Millwood had promised to help her land another residency spot, but so far, what preliminary inquiries she had made had produced nothing. She had signed up for more time at the women’s shelter where she had volunteered since college, and had even enrolled in a knitting course at Boston Adult Ed. Still, having been forced to shift in an instant from fourth gear down to first, her life felt as if it were moving in slow motion.

  In addition to the track and the roads, the lab was a godsend—a place she could stay productive. She was one of a team of three, assigned by Berenger to a project examining the side effects of a new immunosuppressant drug still in the early phases of animal testing. If the evaluations were encouraging, somewhere down the line, the drug might replace or augment one of the toxic medications currently in use to reduce the frequency and severity of transplant rejection.

  Natalie changed into light blue scrubs and a lab coat, and took the elevator up to Berenger’s impressive research suite on the ninth floor of the Nichols Building. The two other members of the team, Spencer Green and Tonya Levitskaya, greeted her with their typical lack of enthusiasm. Given Berenger’s intellect, charisma, variety of interests, and superb surgical skill, it was a wonder to Natalie that either of them was still on the payroll.

  Green, a cadaverous, dour Ph.D. who had never mastered the knack of getting grants, had been with Berenger for ten years, and Levitskaya, a Russian-schooled resident on the transplant service, now doing a six-month research fellowship, seemed to have a deeply ingrained opinion on almost everything—usually negative. Married, in her late thirties, and absolutely humorless, Levitskaya almost certainly had a crush on their mentor, and so treated Natalie as a riv
al. Berenger, himself, seemed oblivious to the continuously smoldering acrimony among his research team.

  Entering the lab, Natalie checked to be sure that the small animal procedure room was available, then went to the holding area and returned with a cage of twelve specially bred white mice.

  “I’m using the animal room,” Levitskaya said, her dense accent vintage Count Dracula.

  Not already, Natalie sighed to herself. The little lift that remained from putting the St. Clement’s boys in their place vanished.

  “I just stopped by there, Tonya,” she said with artificial cheer. “The room’s empty.”

  “Well, I am about to use it.”

  “Tonya, I’ll be done in twenty minutes.”

  “Just do it later.”

  “Tonya, please don’t do this. I’m having a very tough time and—”

  “Or better still, do it tonight while you’re in here working until midnight and making the rest of us look lazy.”

  People skills, Natalie reminded herself. That’s what the dean and Terry had said she needed to work on. People skills.

  “Tonya,” she said, smiling sweetly, “if you don’t back off and stop giving me a hard time, I’m going to flatten your nose across your face.”

  There, how’s that for people skills?

  Levitskaya stepped forward. She was a stocky woman, a little taller than Natalie, and heavier by thirty pounds or more. Her crooked smile suggested she had faced challenges like this one before, and wasn’t even considering backing down.

  Damn, Natalie thought. Well, what’s the worst thing that can happen?

  The last time she had been in a fistfight had been in her junior year at the Newhouse School. She had come away with fractures of her nose and one knuckle, loudly claiming victory over the other girl, who was virtually unscathed. Would she ever learn to pick fights with people she actually had a chance against?

  “How about in the hallway where we can’t wreck anything?” she said, resigned to taking a pounding.

  “Ladies,” Spencer Green called out from across the lab, ignoring the conflict he couldn’t have helped but hear, “that was Doug on the phone. He says both of you are supposed to be in the follow-up clinic with him right now.”

  Levitskaya’s eyes narrowed as if she were calculating whether she could finish Natalie off and still make it to the clinic with minimal delay. Finally, with a shrug that said some other time, she headed out the door. Natalie debated staying with her mice, but then put them back and followed. Berenger clearly considered her part of his service regardless of her standing in the medical school—a gesture that was worth respecting.

  The clinic space, used by various services on different days, was four examining rooms, a consultation office, and a small waiting area on the sixth floor of the Hobbs Building. This afternoon was given to Berenger’s transplant patients, probably five or six of them. He was averaging about two transplants every three weeks, but the number would have been much higher had there been more donors. As things were, the number of people dying for want of a donor heart far exceeded the number saved by a transplant.

  By the time Natalie arrived at the clinic, Levitskaya was already in the consultation room mooning over Berenger. Natalie was surprised to note that the woman’s respiratory rate was normal, knowing she had to have sprinted over from the lab.

  Seated behind his desk, Berenger was every bit the med school professor of cardiac surgery, square-jawed and steely-eyed, with wonderful, long fingers. Respected by patients, students, and faculty alike, he was a world-renowned lecturer and researcher, yet most of the time as humble as such a man could be. Natalie had met his wife and teenage daughters on several occasions, and knew enough to believe that if Berenger cut any corners in his remarkably complex existence, it was with them.

  “So,” he said, “there was some misunderstanding in the lab?”

  Green.

  “We have straightened things out,” Levitskaya said quickly, smiling around nearly clenched teeth.

  “Ready to go,” Natalie added with exaggerated cheer. “I appreciate being included.”

  “You both know this is all about teamwork, right?”

  “Right,” the two women answered in unison.

  “Well, Mr. Culver is in the next room. He’s three months post-op. Tonya, you know this man, so brief Natalie and bring her in to observe your evaluation. Natalie, let’s talk afterward.”

  The cardiac surgical resident led Natalie to the hall, then gave a thirty-second, totally unenthusiastic presentation of a forty-seven-year-old truck driver who had developed cardiomyopathy—heart swelling of unknown cause—and managed to get a life-saving transplant after two years of progressive cardiac failure with profound shortness of breath and massive fluid retention. Medically, he had done quite well since the surgery.

  Culver, first name Carl, was a husky, swarthy man with thick brows, a wide pancake face, and disconcertingly small eyes. But there was something even more unappealing than his appearance—he reeked of cigarettes. In her presentation, Levitskaya had made a point of saying that he was once a heavy smoker, but had kicked the habit as his breathing deteriorated and he was made to see that his continued smoking would all but eliminate him from the transplant list. Clearly, he had fallen off the abstinence wagon.

  Without so much as a greeting or a handshake, the Russian exploded.

  “Goddamn it, Carl,” she said in a near shout, “you stink of cigarettes!”

  “Well, I got laid off and my daughter got sick, so—”

  “No excuses. Do you have any idea how many hours and how much money went into putting that new heart into your chest, to say nothing of the poor man who gave it to you or the many, many others who did not get a chance at it? And here you are, smoking like a chimney, doing your best to destroy it.”

  “But—”

  “No buts. I am going to see if Dr. Berenger even wants to speak with you. If not, then I want you to get out and only come back when you have stopped smoking again. What a waste this is of a heart that could keep a nonsmoker alive for years.”

  She brushed past Natalie and stormed from the room, leaving Carl Culver bewildered, frustrated, and angry.

  “I’m sorry about your job, Mr. Culver,” Natalie said.

  “Thanks. I’m sorry about the cigarettes, Doc, I really am. But it’s hard, especially when things aren’t going well.”

  “Is your daughter very ill?”

  “She had a seizure. They thought she might have a brain tumor, but it turned out to be migraines. Honest, Doc, I’ll try to stop, I really will.”

  “You really need to keep trying,” Natalie said, moving forward and putting her hand on his shoulder. “Your daughter needs you more than ever now. I know it’s hard, but you’ve really got to keep trying.”

  At that moment, the door opened and Berenger entered, followed by a still crimson-faced Levitskaya. Over the ten minutes that followed, Natalie’s mentor put on an instructional clinic on how to be a doctor, making constant, honest eye contact with his patient, reasoning, not chastising, asking about his family and his situation at home, calming him down, touching him reassuringly on the arm, yet all the while counseling him on the dangers of continued smoking. Quiet, stern, concerned, empathetic, understanding, unwavering.

  “I hear some wheezes, Carl,” he said after examining the trucker. “That’s bad—very bad. Now it’s time for you to go to work on this problem. I’m going to refer you to our SSN program—that’s Stop Smoking Now. But the doctors and social workers there can only go so far. You’ve got to do the rest.”

  “I will, Dr. Berenger. I promise I will.”

  “You need to exercise more. Do you have a Y near you?”

  “I…I think so.”

  “I want you to stop at cardiac rehab on your way out of the hospital. I’ll call and have them go over your exercise program again. If there is a Y, they’ll call the people there and sign you up. If money is a problem, talk to the SSN people. They have
some funds available. Now I did a beautiful job on you. No more messing it up.”

  “Thanks, Doc. I’ll do better. I promise.”

  “Your family needs you.”

  The two men shook hands warmly, and then Berenger left Culver in the room as he made calls and wrote out referrals. Finally, he sent Levitskaya back with the paperwork and instructions to move to the next patient when she was finished.

  “Tonya’s a very good surgeon,” he said when he and Natalie were alone.

  “I believe she is.”

  “Did you really threaten to flatten her nose across her face?”

  “I wasn’t using my people skills. Sorry. This isn’t the time for me to act smart. It was my fault. I was feeling angry at the world and sorry for myself, and I goaded Tonya into fighting.”

  “I see. Well, you’re both too valuable to my work to have you duking it out. I’m paying you to do battle with the mysteries of science, not with each other. No more incidents.”

  “No more incidents,” Natalie echoed.

  “Besides, I suspect ol’ Tonya would be a real brawler.”

  Natalie grinned.

  “I was thinking the same thing.”

  “So, how would you like to get away from all this for a while?”

  “Excuse me?”

  “Away.”

  “But not away as in I’m fired?”

  “You’re going to have to do a heck of a lot worse than threaten Tonya to get me to fire you. How’s your Portuguese?”

  “Third grade, maybe. Possibly fourth. I’m half Cape Verdean, but I was infamous for never doing anything that might have pleased my mother, and she desperately wanted me to speak the language.”

  “You probably won’t need it anyhow. There’s an international transplant meeting next week in Brazil—Rio to be exact. Have you been there?”