by Robin Cook
“Jennifer, I love you. The only reason I took those pills away is to protect our child.”
“I don’t care why you did it. I have to get away for a few days.” She picked up the phone and Adam listened while she called her father and made arrangements to take a cab to his office so he could drive her home.
“Jennifer, please don’t do this,” he begged as she went back to her packing, but she refused to look at him while she closed the case, picked up her purse, and stalked out of the apartment.
Alone, it took Adam a few minutes to believe she had actually gone. Dazed, he wandered into the living room and sat down at the computer. Turning it on, he connected with the Arolen mainframe and tried to call up Vandermer’s file. He intended to see if Dr. Vandermer’s prescribing habits had changed, but the screen remained blank save for the stark message: “Transferred to Julian Clinic.”
Shocked, Adam wondered if any other files had been erased from the computer. He pulled the printout McGuire had given him and then asked the machine to relist the doctors in his assigned territory. Not only had the computer dropped Vandermer’s file, but six other doctors had been taken off the list.
Frantically, Adam began calling up each of the expunged doctors’ names. None of them had files! Four had entries like Dr. Smyth’s—“Refresher course scheduled . . .”—suggesting that if a doctor went on an Arolen cruise, he didn’t have to be detailed any longer. Two had entries like Vandermer’s: “Transferred to Julian Clinic.” Adam wondered if the Cruise Conferences pitched the Julian Clinic as well as Arolen products.
More confused than ever, Adam asked the computer to list all the physicians on staff at the Julian Clinic. Dutifully the dot-matrix printer sprang to life and spewed out a sizable roster. Adam ran his eyes over the list of names and stopped short at an entry halfway down the sheet: Dr. Thayer Norton! What the hell was Norton doing at the Julian Clinic? He was chief of Internal Medicine at the university.
Slowly Adam typed Thayer Norton’s name into the computer and requested his file. All he got was “Transferred to Julian Clinic”!
The idea that the old battle-ax would give up his coveted medical chair at the university was unthinkable. Adam wondered if Norton had recently taken a Conference Cruise.
Going back to the computer, Adam tried to access statistical data about the Julian. He discovered that of the six doctors who had transferred, four were OB-GYN specialists. Maybe that proved something. For another half hour Adam fed questions into the computer, but most of his requests were returned with the message that his access code was not recognized for the material he was requesting. Switching tactics, he asked for the number of times amniocentesis was done at the Julian in the previous calendar year. He got the number: 7,112. When he asked how many had shown an abnormality in the fetus, the computer again refused his access code. Adam finally asked how many therapeutic abortions had been performed during that time period: 1,217.
Totally mystified, Adam turned off the computer and went to bed, where he spent the night confronting an outraged Jennifer in his dreams.
CHAPTER
10
The next morning Adam was so upset to wake up and find Jennifer’s side of the bed empty, that he left the apartment without even bothering to have a cup of coffee. By eight-thirty he was pacing restlessly outside GYN Associates, waiting for the office to open. The moment he saw Christine he began pressing the bell.
“Hello, Adam Schonberg.”
Adam thought it was propitious that she’d remembered his name. He adjusted his dark blue knit tie and said with the sincerest smile he could muster, “I was in the neighborhood so I thought I’d drop by and get an update on DJ’s batting average.”
“He’s doing terrific,” said Christine. “Better than even I anticipated. In fact, last Friday . . .”
Adam tuned out as he tried to organize his thoughts. When Christine paused for breath, he said, “What are the chances that you can get me in to see Dr. Vandermer?”
“Dr. Vandermer is at the Julian Clinic,” she said.
“He’s gone already?”
“Yup. The whole office is a disaster. Yesterday was his last day here, even though he has hundreds of patients scheduled for the next six months. I’ll be on the phone from now until Christmas.”
“So it wasn’t expected?” asked Adam.
“Hardly,” said Christine. “He came back from his cruise and told Dr. Stens and Dr. Baumgarten that he was leaving. He said he’d had it with private practice.”
That was exactly what Percy had said about Foley, thought Adam, as Christine turned away to answer the phone.
“What a mess,” she said once she’d hung up. “And all the patients are mad at me.”
“Did Dr. Vandermer behave strangely when he got back from the cruise?” asked Adam.
“I’ll say,” laughed Christine. “Nothing we did was good enough for him. He drove us all crazy, though in some ways he was a lot more considerate. Before, he’d always been pretty abrupt.”
Remembering his own meeting with the doctor, Adam felt that “abrupt” was a generous description of the man’s manner.
“The strangest thing about the affair,” continued Christine, “is that Dr. Vandermer’s partner, Dr. Foley, did the very same thing. And at the time it made Dr. Vandermer furious. But it wasn’t so bad when Dr. Foley left because there were four doctors to take up the slack. Now there are only two because poor Dr. Smyth is still in the hospital with his weird disease.”
“What kind of disease?” asked Adam.
“I don’t know the name,” she said. “It’s some kind of trouble with his nerves. I remember when it started.” She lowered her voice as if what she was saying were a secret. “One moment he was normal, the next he was making strange faces. It was grotesque. And very embarrassing.”
A woman entered the office and came up to the reception desk, and Adam stepped out of the way, thinking that Smyth’s problem was similar to the case of tardive dyskinesia that he had discussed in his presentation at the medical school. In that case the cause was an unexpected reaction to tranquilizers.
“Do you know if Dr. Smyth had any psychiatric problems?” Adam asked once the patient was seated.
“I don’t think so,” said Christine. “He was one of the nicest young men. Looks a little bit like you. Dark, curly hair.”
“What hospital is he in?” asked Adam.
“He was admitted to University, but I heard one of the nurses say that he was going to be transferred to the Julian Clinic.”
The phone rang again, and Christine reached for it.
“One last question,” said Adam. “Did Foley or Smyth go on a Conference Cruise like Dr. Vandermer?”
“I think they both did,” said Christine, lifting the phone. “GYN Associates, could you please hold?” Turning back to Adam, she asked, “Would you like to see either Dr. Stens or Dr. Baumgarten?”
“Not today,” said Adam. “Another time, when things aren’t quite so hectic. Give my best to DJ.”
Christine gave Adam a thumbs-up sign and pushed the blinking button on the telephone.
Leaving the office, Adam felt he could no longer ignore the strange coincidences relating to the Julian Clinic. Why had so many doctors abruptly left their practices to work there? And why, after doing so, had Vandermer suddenly decided to prescribe pregdolen to Jennifer? As unpleasant as this last interview would be, Adam felt he had no choice but to confront the obstetrician. He had to convince him either to treat Jennifer without medication or to relinquish her as a patient. Adam knew he couldn’t persuade his wife to change physicians on his own.
As he approached the southern limits of Harlem, he saw the clinic towering over the surrounding tenements. Admiring its mirrored surface, Adam realized that it must have been designed by the same architects who had built Arolen headquarters. The office building was better suited to its surroundings. The clinic struck Adam as a twenty-first-century vision flung into a two-hundred-year-old setti
ng.
A half block away Adam found a parking spot and backed into it. Taking his briefcase in case he needed to disguise his visit as a sales call, he jogged up the broad steps to the clinic’s entrance.
The moment he walked inside his suspicions dissipated. He had intended to march through the lobby to the OB-GYN section as if he were a member of the staff. From his experience as a medical student he knew that if someone acted as if he belonged, he could go anywhere in a hospital. But the relaxed atmosphere of the Julian changed his mind. He walked directly up to the large information booth and said he wished to speak with Dr. Vandermer.
“Certainly,” said the receptionist. She picked up a phone and relayed Adam’s request. “The doctor is in,” she said, smiling broadly. “Do you know how to get to the GYN clinic?”
“Maybe I should ask the doctor if he has time to see me. I want to talk to him about my wife.”
“Of course he’ll see you,” she said, as if Adam had lost his senses. “Let me call one of the orderlies.” She pressed a small bell on the counter and a young man in blue shirt and white chino pants appeared. The receptionist gave him instructions.
He led Adam down a long central hallway, past a flower shop, a bookstore, a pleasant-looking cafeteria.
“This is an impressive place,” said Adam.
“Yes,” said the young man mechanically.
Adam glanced at him as they walked. He had a broad, expressionless face. Looking more carefully, Adam thought he seemed drugged; he was probably a psychiatric case. A lot of the chronic patients worked in hospitals. It made them feel more confident.
The man left Adam in a lounge that resembled a private living room rather than a hospital waiting room. There was a couch, two chairs, and a small desk. Strange clinic, thought Adam as he walked to the window. The darkened glass gave a peculiar cast to the row houses across the street. He felt as if he were looking at an old photograph.
He wandered back to the couch and began leafing through one of the magazines. A few minutes later the door opened and Dr. Vandermer came in. Adam got hastily to his feet.
The man was imposing, especially in his starched white coat. But he seemed less hostile than at their first meeting.
“Adam Schonberg, welcome to the Julian,” he said.
“Thank you,” said Adam, relieved and at the same time taken aback by Vandermer’s cordiality. “I’m surprised to find you here. I thought you were very happy in your practice.”
“I was at one time,” said Dr. Vandermer. “But fee-for-service medicine is a thing of the past. Here we try to keep people well, instead of just trying to cure them when they are sick.”
Adam noticed that Vandermer’s voice had an oddly flat inflection, as if he were reciting from memory. “I wanted to talk about Jennifer,” he said.
“I assumed as much,” said Dr. Vandermer. “I asked the geneticist to come by.”
“Fine. But first I want to discuss the pregdolen.”
“Has it helped your wife’s nausea?” asked Dr. Vandermer.
“She thinks so,” said Adam. “But I suspect it is simply a placebo effect. What surprises me is that you gave it to her.”
“There are a number of drugs on the market,” said Dr. Vandermer, “but I think pregdolen is the best. Normally, I don’t like to use drugs for morning sickness, but your wife’s had gone on too long.”
“But why pregdolen?” said Adam tactfully. “Especially after the negative report in the New England Journal.”
“That was a poorly designed study,” said Dr. Vandermer. “They didn’t use the proper controls.”
Unwilling to confront Vandermer directly, Adam finally said, “But you told me the last time we spoke that pregdolen was dangerous. What’s made you change your mind?”
Dr. Vandermer shook his head, puzzled. “I’ve never said the drug was dangerous. I’ve been using it for years.”
“I distinctly remember . . .” began Adam as two other doctors entered the lounge. One was a tall, thin man with gray hair. He was introduced as Dr. Benjamin Starr, the Julian Clinic’s geneticist.
“Dr. Starr and I were just discussing your wife’s case this morning,” said Dr. Vandermer.
“Indeed,” said Dr. Starr, launching into a detailed description of the case. His voice had the same flat inflection as Vandermer’s, making Adam wonder if all the doctors at the Julian Clinic worked themselves to death.
Adam tried to understand what Starr was saying, but the man seemed to be speaking deliberately over Adam’s head. After trying to make sense out of the reasons given for Jennifer’s amniocentesis, Adam decided he was wasting his time. It was as if both Vandermer and Starr were trying to confuse him. As soon as he could, Adam said he had to leave. Dr. Vandermer offered to buy him lunch in the cafeteria, but Adam insisted he had to go.
Walking down the hall, he decided Jennifer was right. Dr. Vandermer was a changed man, and it made Adam nervous. In fact, the whole clinic struck a false note. Looking at the beautifully decorated rooms, he could understand why the Julian had such appeal. It seemed the ideal hospital environment. At the same time, it was almost too nice and, to Adam’s mind, slightly sinister.
Back in the car, Adam hesitated before turning on the ignition. There was no doubt in his mind that Vandermer had originally proclaimed pregdolen dangerous and all that super-scientific rhetoric about Jennifer needing amniocentesis alarmed him. With his wife sequestered at her parents’, his hands were tied. The only thing he was sure of was that he did not want Jennifer taking pregdolen, which meant that he didn’t want her to keep seeing Vandermer. The problem was that she obviously trusted Vandermer and didn’t want to change doctors.
Pulling out into the street, Adam realized that Jennifer was right on two counts: he wasn’t a doctor and he knew nothing about obstetrics. He realized that if he hoped to change Jennifer’s mind, he’d better study up on the subject.
There were no parking places within blocks of the university hospital, so Adam pulled the Buick into the hospital parking garage. After he’d found a space, he went down to the medical center. The Irish fellow at the information booth recognized him and lent him a white jacket.
In the library, he selected several recent textbooks on obstetrics and began looking up both morning sickness and amniocentesis. When he was finished, he turned to a chapter on fetoscopy—the visualization of the fetus within the uterus—and stared in wonder at the photos of what his child must look like at this stage in its development.
Returning the books to the desk, Adam made his way to the hospital. After the soft carpets and gleaming paint at the Julian, the university medical center looked like a set for Dante’s Inferno. It was uniformly drab with peeling paint and stained floors. The nurses and staff appeared rushed, and their expressions indicated that their patients’ psychological well-being was not high priority.
Adam took the main elevator to Neurology on the tenth floor. Pretending that he was still a student, he marched to the nurses’ station and positioned himself squarely in front of the chart rack. There were three nurses, two ward clerks, and a resident standing about talking, but none of them so much as looked at Adam.
Dr. Stuart Smyth’s chart was in the slot for room 1066. After a furtive glance at the nurses, Adam grasped the metal-backed record, pulled it out of the rack, and stepped back into the relative quiet of the chart room. There was a doctor there, but he was on the phone making a tennis date. Adam sat down at the desk.
Curiously, Smyth was diagnosed as having tardive dyskinesia. Reading over the history, Adam learned that Dr. Smyth had no past record of psychotropic drugs. The cause of his illness was still listed as unknown, and most of the workup involved sophisticated attempts to isolate a virus.
The only positive test Adam found was the EEG, but the resident had written that the results, though slightly abnormal, were nonspecific. In short, Dr. Smyth had been poked, prodded, and bled for a myriad of tests, yet the source of his troubles still had not been discovered.
He’d been in and out of the hospital for two and a half months. On a happier note, he had started to improve, though no one knew why.
Adam returned the chart and walked down the hall to room 1066. Unlike the other rooms, the door was shut. Adam knocked. After hearing what sounded like “Come in,” he pushed open the door and stepped into the room.
Stuart Smyth was seated near the window, surrounded by books and periodicals. As Adam entered, he looked up and adjusted rimless glasses.
Adam immediately saw that Christine’s observation that he and Smyth looked alike was true, and it pleased Adam because Stuart was a handsome man.
Adam introduced himself as a medical student, and Smyth, whose face was periodically contorted by a grimace, asked Adam to sit down and explained that he was making the best of his confinement by reviewing the entire field of OB-GYN. His speech was difficult to understand because his lips and tongue were also affected by distorting spasms.
Despite his impediment, Dr. Smyth was eager for company and not at all shy about his illness. Adam waited patiently as he slowly recounted the details, most of which Adam had already gleaned from the chart. He did not mention the Arolen cruise, and Adam got around to the subject by first mentioning that Dr. Vandermer was taking care of Jennifer.
“Vandermer is a great obstetrician,” said Dr. Smyth.
“He was recommended by one of the OB residents,” said Adam. “Apparently he handles a lot of the house staff.”
Dr. Smyth nodded.
“I suppose you’ve heard that he’s just returned from an Arolen cruise?”
Dr. Smyth nodded as his face bunched in a spasm.
“Did you ever go on one of the cruises?” asked Adam.
The book Smyth had been reading slid from his lap and thumped on the floor. He reached down and picked it up, but when he started to answer, his tongue wouldn’t cooperate and he ended up just nodding his head.
Adam was afraid of tiring Smyth with more questions, but when he stood to go the doctor waved him back to his seat, making it clear that he wanted to talk.