by Robin Cook
The master bedroom was at the very end of the hall, on the northeast side of the house. It had French doors giving out onto a balcony that had a commanding view of the lawn down to the sea. Next to the bedroom was a morning room facing east. On nice days the sun would stream through the windows. Between the two rooms was the master bath.
The only part of the house Cassi had redecorated was the bedroom suite. She’d salvaged and repaired the white wicker porch furniture that she had found ignominiously abandoned in the garage. She had chosen bright chintz fabrics for matching comforter, drapes, and seat cushions. The bedroom had been papered with a Victorian-style vertical print; the morning room painted a pale yellow. The combination was bright and cheerful, in sharp contrast with the dark and heavy tones of the rest of the house.
Cassi had essentially taken over the morning room as her study since Thomas had shown no inclination to share it. She’d found an old country-style desk in the basement, which she’d painted white, and had bought several simple pine bookcases, which she’d painted to match. One of the bookcases had a second role; it served to conceal a small refrigerator that contained Cassi’s medicines.
After testing her urine again, Cassi went to the refrigerator and removed a package of regular insulin and one of Lente insulin. Using the same syringe, she drew up a half cc of the U100 regular and then one-tenth cc of the U100 Lente. Knowing she had injected herself in her left thigh that morning, she chose a site on her right thigh. The whole procedure took less than five minutes.
After a quick shower, Cassi knocked on the door to Thomas’s study. When she entered she sensed that Thomas was more relaxed. He’d just finished buttoning a fresh shirt and ended up with more buttons than buttonholes when he got to the top.
“Some surgeon you must be,” teased Cassi, rapidly fixing the problem. “I met a medical resident whom you impressed last night. I’m glad he didn’t see you buttoning your shirt.” Cassi was eager for light conversation.
“Who was that?” asked Thomas.
“You helped him on a resuscitation attempt.”
“It wasn’t a very impressive effort. The man died.”
“I know,” said Cassi. “I watched the autopsy this morning.”
Thomas sat down on the sectional sofa, pulling on his loafers.
“Why on earth were you watching an autopsy?” he asked.
“Because it was a post-cardiac-surgical case where the cause of death was unclear.”
Thomas stood up and began to brush his wet hair. “Did the entire department of psychiatry go up to watch this event?” asked Thomas.
“Of course not,” said Cassi. “Robert called me and…”
Cassi paused. It wasn’t until she’d mentioned Robert’s name that she remembered the talk they had had in the car. Fortunately Thomas kept brushing his hair.
“He said that he thought there was another case for the SSD series. You remember. I’ve spoken to you about that before.”
“Sudden surgical death,” said Thomas as if he were reciting a lesson in school.
“And he was right,” said Cassi. “There was no obvious cause of death. The man had had a bypass operation by Dr. Ballantine…”
“I’d say that was a sufficient cause,” interrupted Thomas. “The old man probably put a suture right through the Bundle of His. It knocks out the heart’s conduction system, and it’s happened before.”
“Was that your impression when you tried to resuscitate him?” asked Cassi.
“It occurred to me,” said Thomas. “I assumed it was some sort of acute arrhythmia.”
“The nurses reported the patient was very cyanotic when they found him,” she said.
Thomas finished his hair and indicated he was ready for dinner. He gestured toward the hall while he spoke: “That doesn’t surprise me. The patient probably aspirated.”
Cassi preceded Thomas out into the hall. From the autopsy she already knew the patient’s lungs and bronchial tubes had been clear, meaning he had not aspirated anything. But she didn’t tell that to Thomas. His tone suggested he’d had enough of the subject.
“I would have thought that beginning a new residency would keep you busy,” said Thomas, starting down the stairs. “Even a residency in psychiatry. Aren’t they giving you enough work to do?”
“More than enough,” said Cassi. “I’ve never felt quite so incompetent. But Robert and I have been following this SSD series for a year. We were eventually going to publish our findings. Then, of course, I left pathology, but I truly think Robert is onto something. Anyway, when he called me this morning I took the time to go up and watch.”
“Surgery is serious business,” said Thomas. “Particularly cardiac surgery.”
“I know,” said Cassi, “but Robert has seventeen of these cases now, maybe eighteen if this new one checks out. Ten years ago SSD only seemed to occur in patients who were in coma. But lately there’s been a change. Patients who have come through surgery with flying colors are seemingly dying postop without cause.”
“When you consider the number of cardiac cases done at the Memorial,” said Thomas, “you must realize how insignificant a percentage you’re talking about. The Memorial’s death rate is not only well below the average, it’s equal to the best.”
“I also know that,” said Cassi. “But still it’s fascinating when you consider the trend.”
Thomas suddenly took Cassi’s arm. “Listen, it’s bad enough that you chose psychiatry as a specialty, but don’t try embarrassing the surgical department about our failures. We are aware of our mistakes. That’s why we have a death conference.”
“I never intended to cause you embarrassment,” said Cassi. “Besides, the SSD study is Robert’s. I told him today that he was going to have to carry on without me. I just think it’s fascinating.”
“The competitive climate of medicine always makes other people’s mistakes fascinating,” said Thomas, gently propelling Cassi through the archway into the dining room, “whether they are legitimate mistakes or acts of God.”
Cassi felt a pang of guilt as she thought about the truth of Thomas’s last statement. She never considered it that way, but it was true.
As they entered the dining room, Harriet gave them a petulant glance and said that they were late.
Thomas’s mother was already seated at the table. “It’s about time you two showed up,” she said in her strong, raspy voice. “I’m an old woman. I can’t go this long before dinner.”
“Why didn’t you eat earlier?” said Thomas, taking his chair.
“I’ve been by myself for two days,” complained Patricia. “I need some human contact.”
“So I’m not human, am I?” said Harriet with annoyance. “The truth has finally come out.”
“You know what I mean, Harriet,” said Patricia with a wave of her hand.
Harriet rolled her eyes and began serving the casserole.
“Thomas, when are you going to get that hair of yours cut?” said Patricia.
“As soon as I have a little extra time,” said Thomas.
“And how many times do I have to tell you to put your napkin on your lap,” said Patricia.
Thomas pulled the napkin from the silver holder and threw it onto his lap.
Mrs. Kingsley placed a minute amount of food in her mouth and began chewing. Her bright blue eyes, similar to Thomas’s, ranged around the table, following Harriet’s progress, waiting for the slightest slip-up. Patricia was a pleasant-looking, white-haired lady with a will of iron. She had smoked Lucky Strikes for years and had deep creases running from her mouth like spokes on a wheel. She was obviously lonely, and Cassi continually wondered why the woman didn’t move to some place where she’d have friends her own age. Cassi knew the thought was motivated by her own interests. After more than three years of eating almost every evening meal with Patricia, Cassi longed for a more romantic end to the day. Despite Cassi’s strong feelings in this regard, she never said anything. The truth of the matter was that Ca
ssi had always been intimidated by this woman, and she’d been reluctant to offend her and thereby incur Thomas’s wrath.
Still and all, Cassi got along passingly well with Mrs. Kingsley, at least from Cassi’s perspective, and she did feel sorry for the woman, living in the middle of nowhere over her son’s garage.
After Harriet served, the dinner proceeded in silence, punctuated by silver clanking against china and whispered negatives to Harriet who tried to force seconds on everyone. It wasn’t until they were almost finished that Thomas broke the silence: “My surgeries went well today.”
“I don’t want to hear about death and disease,” said Mrs. Kingsley. Then she turned to Cassandra and said, “Thomas is just like his father, always wanting to discuss his business. Never could talk about anything important or cultural. Sometimes I think I would have been better off if I’d never married.”
“You can’t mean that,” said Cassi. “Otherwise you wouldn’t have such an extraordinary son.”
“Ha!” said Patricia with explosive suddenness. Her laugh echoed in the room, making the Waterford candelabra vibrate. “The only thing truly extraordinary about Thomas is how closely he resembles his father, even to having been born with a clubfoot.”
Cassi dropped her fork. Thomas had never mentioned this. The image of him as a tiny baby with a twisted foot triggered a wave of sympathy in Cassi, but it was clear from his expression that Thomas was furious with his mother’s revelation.
“He was a wonderful baby,” continued Patricia, oblivious to her son’s barely suppressed rage. “And a handsome, wonderful child. At least until puberty.”
“Mother,” said Thomas in a slow, even voice. “I think you’ve said enough.”
“Fiddlesticks, as they used to say,” returned Patricia. “It’s your turn to be quiet. I’ve been alone here, except for Harriet, for two days, and I should be able to talk.”
With a final glance of exasperation, Thomas bent over his food.
“Thomas,” called Patricia after a short silence. “Please remove your elbows from the table.”
Thomas pushed back his chair and stood up, his face flushed. Without a word, he threw down his napkin and left the room. Cassi heard him stomping upstairs. Then the door to his study slammed. The Waterford candelabra again tinkled gently.
Caught in the middle, as usual, Cassi hesitated, not knowing what was the best thing for her to do. After a moment of indecision she too stood up, planning on following Thomas.
“Cassandra,” said Patricia sharply. Then in a more plaintive voice she said, “Please sit down. Let the child be. Eat. I know people with diabetes have to eat.”
Flustered, Cassi sat down.
Thomas paced his study, mumbling out loud that it was unfair that he should have to weather such abuse at home after his frustrating day at the hospital. Angrily he wondered why Cassi had stayed with his mother instead of joining him. For a moment he considered returning to the hospital, fantasizing about Mr. Campbell’s daughter and the respect that she would be willing to show him. He remembered her comment about wishing there was something she could do for him.
But the cold rain beating on the window made the idea of returning to town seem like too much effort. Instead he picked up the journal from the top of his towering pile of reading and sprawled in the burgundy leather armchair next to the fireplace.
Trying to read, Thomas found his mind wandering. He wondered why his mother could still, after all these years, irritate him so easily. Then Thomas thought about Cassi and the SSD series that she’d been helping Robert Seibert with. There was no doubt in his mind that the kind of publicity that such a study would generate would be extraordinarily detrimental to the hospital. He also knew that Robert just wanted to get his name in print. He didn’t care who he hurt.
Thomas threw the unread journal to the side and went into the bathroom off the study. Staring into the mirror, he looked at his eyes. He’d always thought he looked young for his age, but now he was not quite so sure. There were dark circles under his eyes, and the lids seemed red and swollen.
Returning to his study, he sat at his desk and opened the second drawer on the right, removing a plastic bottle. He popped a yellow pill into his mouth and, after a brief hesitation, another. Over at the bar he poured himself a single-malt whiskey and sat down in the leather armchair that had been his father’s. He already felt a lessening of his tension. Reaching over to the side table, he picked up the journal again and tried to read.
But he couldn’t concentrate. He still felt too much anger. His mind went back to his first week as the chief cardiac surgery resident when he’d been faced with a full intensive care unit and two senior attendings who were demanding space. Without empty available beds, the whole surgical schedule came to a halt.
Thomas remembered how he had gone into the intensive care unit and carefully checked over each patient to see if any could be moved out. In the end he chose two “gorks,” patients in irreversible coma. It was true they needed round-the-clock special nursing that could only be given in the ICU, but it was also true they were beyond any hope of recovery. Yet when Thomas ordered them moved, their physicians were livid and the nursing staff refused the order. Thomas could still remember the humiliation he experienced when the nursing staff prevailed and the brain-dead patients stayed in the ICU. Not only hadn’t the problem been solved, but Thomas had made additional enemies. It was as if no one understood that surgery, that life-giving process, as well as the costly intensive care unit, were intended for patients who would recover, not the living dead.
Back at the bar, Thomas refreshed his drink. The ice had diluted the Scotch and blunted its taste. Looking back at the burgundy leather chair, Thomas remembered his father, the businessman, and Thomas wondered what the old man would have thought of him had he lived. Thomas had no idea because, like Patricia, Mr. Kingsley had never been particularly appreciative or supportive of Thomas, always more willing to criticize than commend. Would he have approved of Cassi? Thomas guessed that his father probably would not have thought much of a girl with diabetes.
Cassi felt anxious after Thomas had left the table. Since he’d already been in a bad mood prior to coming down for dinner, she was afraid he was upstairs seething. Desperately she hunted for conversation but could only elicit “yes” or “no” from Patricia, who acted as if she were pleased she’d driven Thomas away.
“Did Thomas have a bad clubfoot?” Cassi finally asked, hoping to break the silence.
“Terrible. Just like his father, who was crippled for life.”
“I had no idea. I never would have guessed.”
“Of course not. In contrast to his father, he got treated.”
“Thank goodness,” said Cassi sincerely. She tried to imagine Thomas with a limp. It was hard for Cassi even to think of Thomas being crippled as a young baby.
“We had to lock the boy in foot braces at night,” said Patricia, “which was a strain because he screamed and carried on as if I were torturing him.” Patricia dabbed at her lips with her napkin.
Cassi pictured Thomas as an infant, strapped into his confining foot braces. Undoubtedly it had been a type of torture.
“Well,” began Patricia, abruptly standing up. “Why don’t you go up to him? Obviously he needs someone. He’s not such a strong boy despite his aggressive manner. I’d go, but he’s obviously chosen you. Men are all the same. You give them everything and they abandon you. Good night, Cassandra.”
Dumbfounded by Patricia’s rude exit, Cassi sat by herself for a moment. She heard Patricia talking with Harriet, then the front door slammed. The house was quiet except for the squeak of the porch swing as gusts of wind blew it back and forth.
She got up and began to mount the stairs, smiling suddenly at the thought that she and Thomas had shared a point in common while growing up; they both had had childhood afflictions. Knocking on the study door, Cassi wondered what kind of mood Thomas would be in. After the way he’d behaved in the car, combined
with Patricia’s pestering, she expected the worst. But when she entered the room, she was immediately relieved. Thomas was sitting sideways with his legs draped over one arm of his chair, drink in one hand, medical journal in the other. He looked relaxed and handsome. And more important, he was smiling.
“I trust you and Mother remained cordial,” he said, raising his eyebrows as if there were a chance that the opposite had occurred. “I’m sorry for my abrupt departure, but the old woman was about to drive me mad. I didn’t quite feel up to a scene.” Thomas winked.
“You’re so predictably unpredictable,” said Cassi, smiling. “Your mother and I had a most interesting conversation. Thomas, I never knew about your clubfoot. Why didn’t you tell me?”
She sat down on the arm of his chair, forcing him to swing around into a normal position. He didn’t answer, concentrating on his drink.
“It’s not important,” said Cassi, “but I’m an expert on childhood afflictions. I find it reassuring that we shared such an experience. I think it gives us a special degree of understanding.”
“I can’t remember anything about a clubfoot,” said Thomas. “As far as I know I never had one. The whole thing is some elaborate delusion of my mother’s. She wants you to be impressed by how she suffered bringing me up. Look at my feet: Do they look deformed?”
Thomas took off his shoes and raised his feet.
Looking down, Cassi had to admit both feet looked entirely normal. She knew Thomas had no problem walking and had been something of a college athlete. But she still wasn’t sure who had been telling the truth.