Shock

by Robin Cook

  Cynthia went through the preparations of starting the IV with a practiced economy of motion. At the same time she kept up a distracting stream of conversation about the weather, and before Joanna had a chance to work herself up into a dither, Cynthia was already putting a tourniquet around Joanna’s left arm just below the elbow.

  Joanna averted her face and grimaced as the needle broke the skin. The next instant the tourniquet was gone, and Cynthia was applying tape.

  “There, at least that’s done,” Cynthia said.

  Joanna turned. Her face reflected her surprise. “Is the IV in already?”

  “Yup,” Cynthia said cheerfully as she drew up medication in two syringes. “Here comes the fun part. But, just to be one-hundred-percent sure: You have no allergies to any medication, isn’t that right?”

  “That’s right,” Joanna said.

  Cynthia bent over the IV port and took the cap off the first syringe.

  “What am I getting?” Joanna asked.

  “You really want to know?” Cynthia asked. She finished with the first and started with the second.

  “Yes!”

  “Diazepam and fentanyl.”

  “How about in English?”

  “Valium and an opioid analgesic.”

  “I’ve heard of Valium. What’s the other stuff?”

  “It’s in the morphine family,” Cynthia said. The nurse quickly cleaned up the wrappers and other debris and threw it all into a special receptacle. While she made an entry onto the clipboard that she’d pulled from beneath the gurney’s pad, the door opened to the hallway and another patient walked in. She smiled at the women, went to the clothes rack for a set of the hospital patient clothes, then disappeared into one of the changing rooms.

  “Do you think she’s another donor?” Joanna asked.

  “I’ve no idea,” Deborah said.

  “That’s Dorothy Stevens,” Cynthia said in a hushed voice as she went around to the head of the gurney and unlocked the wheels. “She’s a Wingate client who’s here for yet another embryo transfer. The poor dear has suffered a lot of disappointment.”

  “Am I going already?” Joanna asked as the gurney began to move.

  “Yes, indeed,” Cynthia said. “I was told they were eagerly awaiting your arrival when I went out to get the IV material.”

  “Can I go along?” Deborah asked. She’d taken hold of Joanna’s hand.

  “I’m afraid not,” Cynthia said. “You stay and relax. You’ll be going up yourself before you know it.”

  “I’ll be all right,” Joanna said with a smile to Deborah. “I already feel that opioid stuff. It’s not half bad, either.”

  Deborah gave Joanna’s hand a final squeeze. Before the doors swung shut Deborah caught a glimpse of Joanna merrily waving to her over her shoulder.

  Deborah turned back to the room. She walked over to the couch and sat down heavily. She was hungry from not having eaten anything since before going to bed the night before. She picked up several magazines but found she could not concentrate, not with her stomach growling. Instead she tried to picture where they were taking Joanna in the huge, old, white elephant of a building. Tossing the magazines aside, she glanced around the room. There was the same jarring disjuncture between the elaborate crown molding and trim and the furniture as there had been out in the main waiting room. Joanna had been right: The Wingate was a place filled with contrasts that were vaguely unsettling. As much as Joanna, Deborah was looking forward to having the egg retrieval procedures behind them.

  One of the changing room doors opened and Dorothy Washburn emerged clutching her clothes. She smiled at Deborah before heading over to the lockers to store them. Deborah watched her and wondered what it was like to contend with continued infertility treatment and continual disappointment.

  Dorothy locked the locker, then came over to the sitting area while pinning the locker key to her johnny en route. She picked up a magazine, sat down, and began to flip through the pages. Apparently sensing Deborah’s stare, she raised her strikingly cerulean eyes. This time it was Deborah’s turn to smile. She then introduced herself, and Dorothy did the same. For a few minutes the two women indulged in light conversation. After a pause, Deborah asked Dorothy if she’d been a patient of the Wingate Clinic for some time.

  “Unfortunately, I have,” Dorothy said.

  “Has it been a pleasant experience?”

  “I don’t think pleasant is the right word,” Dorothy said. “It’s not been an easy road by any stretch of the imagination. But to the Wingate’s credit, they did warn me. Anyway, my husband and I are not about to give up, at least not yet or at least not until we’ve used up all our credit.”

  “You’re having an embryo transfer today?” Deborah asked. She was reluctant to admit she already knew.

  “My ninth,” Dorothy said. She sighed and then held up crossed fingers.

  “Good luck,” Deborah said sincerely.

  “I could use some.”

  Deborah imitated the crossed-fingers gesture.

  “Is this your first time to the Wingate?” Dorothy asked.

  “It is,” Deborah admitted. “For both myself and my roommate.”

  “I’m sure you’ll be satisfied with your choice,” Dorothy said. “Are you both doing in vitro?”

  “No,” Deborah said. “We’re egg donors. We responded to an ad in the Harvard Crimson.”

  “That’s wonderful,” Dorothy said with unabashed admiration. “What a loving gesture. You are going to give hope to some desperate couples. I applaud your generosity.”

  Deborah suddenly felt uncomfortably venal. She hoped to change the subject before her true motive for donating was revealed. Luckily she was saved by Cynthia’s abrupt return. The nurse burst through the swinging doors without warning.

  “Okay, Dorothy!” Cynthia called out with great enthusiasm. “You’re on! Get yourself down there to the transfer room. They’re all ready for you.”

  Dorothy stood, took a deep breath, and then headed out the door.

  “She’s quite a soldier,” Cynthia remarked as the door swung shut. “I sure hope this turns out to be a successful cycle. If anyone deserves it, she does.”

  “How much does a cycle cost?” Deborah asked. Concern about her venality had brought the issue of economics to the fore.

  “It varies quite a bit depending on what procedures are involved,” Cynthia said. “But on average it’s around eight to ten thousand dollars.”

  “Oh, my goodness,” Deborah commented. “That means Dorothy and her husband have spent nearly ninety thousand dollars!”

  “Probably more,” Cynthia said. “That doesn’t include the initial infertility workup or any ancillary treatments that might have been indicated. Infertility is an expensive undertaking for couples, especially since insurance doesn’t usually cover it. Most couples have to come up with the cash somehow.”

  Two more patients entered, and Cynthia’s full attention immediately turned to them. She took the women’s paperwork, glanced at it briefly, got them apparel, and directed them into changing rooms. Deborah was surprised at the apparent age of one of them. She couldn’t be sure, but she thought the woman looked old, like she was in her middle to late fifties.

  Feeling restless, Deborah got to her feet. “Excuse me, Cynthia,” Deborah said. The nurse was reading the patients’ paperwork more thoroughly. “Dr. Donaldson mentioned that I could have a tour of the laboratory. Who should I see about it?”

  “That’s a request I haven’t had before,” Cynthia said. She thought for a moment. “I guess you could try Claire Harlow in public relations. She gives tours to prospective patients, although I don’t know if that includes the lab or not. If you don’t mind walking around in your robe, you can go out to the receptionist in the main waiting room and have her page Miss Harlow. You don’t have a lot of time so I wouldn’t go far. I imagine they’ll be calling for you in another fifteen minutes or so.”

  Despite the warning about time, Deborah ha
d to do something. Following Cynthia’s suggestion, she retraced her steps out to the main waiting room and had the public relations person paged. While she waited for the page to be returned, she noticed that quite a few patients had arrived since she and Joanna had passed through. There was not much conversation. Most of the women were reading the magazines. A few were blankly staring ahead.

  Claire Harlow was a soft-spoken, gentle, accommodating woman who seemed pleased to take Deborah up a floor and show her the main lab. As Dr. Donaldson had suggested, it was huge, extending along the back of the building for almost the entire wing occupied by the Wingate.

  Deborah was duly impressed. Having spent many hours in biology labs, she knew, for the most part, what she was looking at. The equipment was the newest and best available and included surprising things like automated DNA sequencers. The other surprise was how few people were in the mammoth room.

  “Where is everybody?” Deborah asked.

  “The doctors are all doing various clinical procedures at the moment,” Claire answered.

  Deborah strolled along a long countertop supporting more dissecting microscopes than she’d seen in any one place before. They were also more powerful than the microscopes Deborah had had the pleasure of using.

  “An army could work in here,” Deborah said.

  “We’re always looking for qualified people,” Claire said.

  Deborah came to the end of the lab bench and glanced out the window. It faced out the back of the building and offered an impressive view. It was particularly expansive because the building sat on the spine of a hill, with lawn sloping away in both the front and the back. Northward through a tangle of orange oaks and red maples Deborah could make out stone buildings similar to the gatehouse but with white trim.

  “Are those buildings part of the farm?” Deborah asked.“No, those are some of the living quarters,” Claire explained. Pointing off to the right in a southeastern direction to where the property sloped down even more dramatically than elsewhere, she directed Deborah’s attention to a shimmering of light just visible through old-growth pines. “That sparkle is sun reflecting off the surface of the mill pond. The farm buildings are grouped around it.”

  “What’s the story with the brick chimney spewing smoke?” Deborah questioned, gesturing toward a smokestack rearing up above the trees even farther to the right. “Is that part of Wingate complex as well?” The smoke was white as it left the chimney but faded to a dark purplish-gray as it trailed off in the distance toward the east.

  “It certainly is,” Claire said. “That’s the old power plant for heat and hot water. It’s a rather interesting structure. It was also the crematorium for the Cabot Institution.”

  “Crematorium?” Deborah sputtered. “Why on earth did they have a crematorium out here?”

  “Out of necessity, I guess,” Claire said. “Back in the olden days I think a lot of the patients were essentially abandoned by their families.”

  Deborah cringed at the thought of an isolated mental hospital with its own crematorium, but before she could ask another question, Claire’s pager went off. The woman checked the LCD window. “That’s for you, Miss Cochrane. They’re ready for your procedure.”

  Deborah was pleased. She was eager to get it over with so she and Joanna could be on their way.

  OCTOBER 15, 1999

  9:05 A.M.

  THERE WAS NO TRANSITION

  period. One minute Joanna was fast asleep, and the next she was fully awake. She found herself staring up at a high, unfamiliar, embossed-tin ceiling.

  “Well, well, the sleeping beauty has awakened,” a voice said.

  Joanna turned in the direction of the voice and found herself looking up into an equally unfamiliar face. At the exact instant she was going to ask where she was, her momentary confusion was replaced by full comprehension of her situation.

  “Let’s get your blood pressure,” the nurse said as he took his stethoscope from around his neck and put the earpieces into his ears. He was an impeccably groomed individual, close to Joanna’s age, dressed in surgical scrubs. His name tag said MYRON HANNA. He began inflating a blood pressure cuff already present around Joanna’s left upper arm.

  Joanna watched the man’s face. His eyes were glued to the pressure gauge while he pressed the stethoscope’s bell against the crook of her elbow. As the cuff deflated she felt her pulse surge through her arm. The man smiled and removed the apparatus.

  “Your blood pressure is fine,” he said. He then reached for her wrist to time her pulse.

  Joanna waited until he was through. “What about my procedure?” she asked.

  “Your procedure is all done,” Myron said as he recorded his findings on a clipboard.

  “You’re joking,” Joanna said. She had no appreciation of the passage of time.

  “Nope, you’re all done,” Myron repeated. “And it was successful, I assume. Dr. Saunders must be pleased.”

  “I can’t believe it,” Joanna said. “My roommate told me when you wake up from anesthesia, you’re sick to your stomach.”

  “That’s rare nowadays,” Myron said. “Not with propofol. Isn’t it great stuff?”

  “Is that what I had?”

  “Yup!”

  “What time is it?”

  “A little after nine.”

  “Do you know if my roommate, Deborah Cochrane, has had her procedure?”

  “She’s having it as we speak,” Myron said. “How about sitting up for me on the side of the bed?”

  Joanna did as she was told. Her mobility was limited by the IV still attached to her right arm.

  “How do you feel?” Myron asked. “Any dizziness? Any discomfort?”

  “I feel fine,” Joanna said. “Perfectly normal.” She was surprised, especially by the lack of pain.

  “Why don’t you sit there for a few minutes,” Myron suggested. “Then, if you are okay, we’ll yank the IV and send you downstairs to change back into your street clothes.”

  “Fine by me,” Joanna said. As Myron recorded her blood pressure and pulse, she glanced around at her surroundings. There were three other beds besides hers. None was occupied. The room was antiquated; it had clearly missed whatever facelift other parts of the Institute had received. Old tile lined the walls and floors, the windows looked old, and the sinks were made of soapstone.

  The ersatz recovery room reminded her of the archaic operating theater where she’d had her procedure, and the thought gave her a shudder. It was the kind of OR in which she could imagine lobotomies being performed against vulnerable patients’ wishes. When she’d first been wheeled in, the setting had reminded her of a gruesome, several-hundred-year-old painting she’d seen once of an anatomy lesson. In the painting the tiers of seats disappearing up into the darkness were occupied by leering men gazing down at a skinned, ghastly pale corpse.

  The door to the recovery room opened. Joanna turned and spotted a short man with a shock of dark hair. His pale complexion made her think again of the old anatomy lesson painting. She saw he’d stopped short, and his surprised expression quickly changed to irritation. He was attired in a long doctor’s white coat over green surgical scrubs.

  “Hello, Dr. Saunders,” Myron said, looking up from the desk.

  “Mr. Hanna, I thought you told me the patient was still asleep,” Dr. Paul Saunders snapped. His eyes stayed glued to Joanna’s.

  “She was, sir, when we spoke,” Myron said. “She just woke up, and everything is fine.”

  Joanna felt acutely uncomfortable under the man’s unblinking gaze. Joanna had reflexive, visceral reaction to authority figures thanks in part to her emotionally distant, staunchly disciplinarian, oil-company-CEO father.

  “Blood pressure and pulse are all normal,” Myron said. He stood up and started forward but stopped when Dr. Saunders held up his hand.

  The doctor advanced toward Joanna with his mouth set. His nose had a wide base that gave the false impression of closely spaced eyes. But by far his most dist
inguishing characteristics were irises of slightly different colors and a minute widow’s peak of white hair that quickly lost itself in the rest of his mildly unruly coiffure.

  “How do you feel, Miss Meissner?” Paul asked.

  Joanna noticed his tone was devoid of emotion, similar to the tone her father had used to ask her how her day had been back when she was in elementary school. “Okay,” she answered, unsure if the man cared particularly or even wanted her to respond. Marshaling her courage, she asked: “Are you the doctor who did my egg retrieval?” She’d been put to sleep before Paul’s arrival into the operating room.

  “Yes,” Paul replied in a manner which discouraged further questions. “Would you mind if I had a look at your abdomen?”

  “I suppose not,” Joanna said. She glanced at Myron, who immediately came around the other side of the bed. He encouraged her to lie back supine and then pulled the sheet up to her waist to cover her legs.

  Paul gently pulled up the johnny, being careful to keep the sheet covering Joanna’s lower half in place, and gazed down at Joanna’s exposed midriff. Joanna lifted her head to look herself. There were three Band-Aids. One was directly below her navel, and the other two were in the lower quadrants forming an equilateral triangle.

  “No sign of any bleeding,” Myron said, “and the gas has been absorbed.”

  Paul nodded. He pulled the johnny back to cover Joanna’s abdomen and turned to leave.

  “Dr. Saunders,” Joanna called out impulsively.

  Paul stopped and turned back.

  “How many eggs did you get?”

  “I can’t remember exactly,” Paul said. “Five or six.”

  “Is that good?”

  “It’s perfectly adequate,” Paul said. A faint smile graced his heretofore grim expression. Then he left.

  “He’s not much of a conversationalist,” Joanna commented.

  “He’s a busy man,” Myron said. He pulled the sheet back to expose her legs. “Why don’t you stand up and see how that feels. I think you’re about ready to have that IV taken out.”