by Robin Cook
Bellows emerged from Chandler’s cubicle with a strange feeling. He wasn’t surprised about hearing that he was being associated with Susan’s activities. He was already afraid of that. But the news about the drugs found in a locker to which he was assigned, that was a different story. His mind conjured up an image of Walters oozing around the OR area. He questioned why anyone would hoard drugs like that. Then there was the suggestion of association. Susan had used the words supernatural and sinister. Bellows wondered exactly what kind of drugs were stored in locker 338. He also wondered if he should tell Susan about the discovery.
Tuesday
February 24
2:30 P.M.
Susan allowed her eyes to wander around the Chief of Surgery’s office. It was spacious and exquisitely decorated. Large windows occupying most of two walls afforded a splendid view of Charlestown in one direction and a corner of Boston and the North End in the other. The Mystic River Bridge was partially concealed by gray snow clouds. The wind had shifted from the sea and was now blowing in from the northwest with arctic air.
Stark’s teak desk, with its white marble top, was situated catercorner in the northwest section of the office. The wall behind and to the right of the desk was mirrored from floor to ceiling. The fourth wall contained the door from the reception room and carefully constructed, recessed bookshelves. A section of the shelves was hinged; partly ajar, it revealed gleaming glasses, bottles, and a small refrigerator.
In the southeast corner, where the huge expanse of windows met the bookshelves, there was a low, glass-topped table surrounded by molded fiberglass chairs. Their leather cushions were made of bright colors ranging through the oranges and greens.
Stark himself was seated behind his massive desk. His image was recreated a hundred times in the mirror to the right thanks to the reflection from the tinted window glass to his left. The Chief of Surgery had his feet propped up on the corner of his desk so that daylight fell over his shoulder onto the paper he was reading.
He was impeccably dressed in a beige suit tailored to fit close to his lean body, accented by an orange silk scarf in his left breast pocket. His graying hair was moderately long and brushed back from his high forehead, just covering the tops of his ears. His face was aristocratic, with sharp features and a thin nose. He wore executive half-glasses framed in delicate reddish tortoiseshell. His green eyes rapidly scanned back and forth across the sheet of paper in his hand.
Susan would have been greatly intimidated by a combination of the impressive surroundings and Stark’s awe-inspiring reputation as a surgical genius had it not been for his initial smile and his seemingly incongruous posture. The fact that he had his feet up on the corner of the desk made Susan feel more comfortable, as if Stark really didn’t take his power position within the hospital too seriously. Susan correctly surmised that his skill as a surgeon and his ability as a medical administrator-businessman made it possible for Stark to ignore conventional executive posturing. Stark finished the paper and looked up at Susan sitting in front of him.
“That, young lady, is very interesting. Obviously I am totally aware of the surgical cases, but I had no idea a similar problem was occurring on the medical floors. Whether they are indeed related is uncertain but I must give you credit for coming up with the idea that they may be related. And these two recent respiratory arrests and deaths; associating them is . . . well, both far-out and brilliant at the same time. It gives food for thought. You have related them because you feel that depression of respiration is the common ground for all the cases. My first reaction to that—now, this is just my first reaction—is that it does not explain the anesthesia cases because in that circumstance, the respiratory pattern is being artificially maintained. You suggest some previous encephalitis or brain infection making people more susceptible to complications during anesthesia . . . let me see.”
Stark swung his feet from his desk and turned toward the window. Unconsciously he took his reading glasses from his nose and lightly chewed one of the earpieces. His eyes narrowed in concentration.
“Parkinsonism has now been related to previous unsuspected viral insult, so I suppose your theory is possible. But how could it be proved?”
Stark rotated around, facing Susan.
“And you must be assured that we investigated the anesthesia complication cases ad nauseam. Everything—and I mean everything—was studied with a fine-tooth comb by a host of people, anesthesiologists, epidemiologists, internists, surgeons . . . everybody we could think of. Except, of course, a medical student.”
Stark smiled warmly and Susan found herself responding to the man’s renowned charisma.
“I believe,” said Susan, her confidence rallying, “the study should start with the central computer bank. The computer information I obtained was only for the past year and called up by an indirect method. I have no idea what data would emerge if the computer was asked directly for all cases over, say, the last five years of respiratory depression, coma, and unexplained death.
“Then with a complete list of the potentially related cases, the charts would have to be painstakingly reviewed to try to elicit any common denominators. The families of the involved patients would have to be interviewed to obtain the best possible record of previous viral illness and patterns of illnesses. The other task would be to obtain serum from all existing cases for antibody screens.”
Susan watched Stark’s face, intently preparing herself for an untoward response like that she had experienced with Nelson and then more dramatically with Harris. In contrast, Stark maintained an even expression, obviously in thought over Susan’s suggestions. It was apparent that he had an open, innovative mind. Finally he spoke.
“Shotgun-style antibody screening is not very productive; it is time-consuming and it is horribly expensive.”
“Counter-immunoelectrophoresis techniques have relieved some of these disadvantages,” offered Susan, encouraged by Stark’s response.
“Perhaps, but it still would represent an enormous outlay of capital with a very low probability of positive results. I’d have to have some specific evidence before I could justify that type of resource commitment. But maybe you should suggest this to Dr. Nelson, down in Medicine. Immunology is his special field.”
“I don’t think Dr. Nelson would be interested,” said Susan.
“Why is that?”
“I haven’t the faintest idea. To tell the truth, I already spoke with Dr. Nelson. So I already know he’s not interested. And he wasn’t the only one. I mentioned my ideas to another department head and I thought I was going to get swatted like some naughty child that needed chastising. Trying to incorporate that episode into the whole picture, I get a feeling that something else could be operating here.”
“And what is that?” asked Stark, glancing over the figures Susan had provided.
“Well, I don’t know what word to use . . . foul play . . . or something sinister.”
Susan stopped talking quite suddenly, expecting either laughter or anger. But Stark merely rotated in his chair, looking out over the city again.
“Foul play. You do have an imagination, Dr. Wheeler, no doubt about that.”
Stark turned back toward the room, rising up and walking around his desk.
“Foul play,” he repeated. “I must admit I’d never even considered that.” Stark had been briefed only that morning about Cowley’s discovery of the drugs in locker 338; that information had disturbed him. He leaned against his desk and looked down at Susan.
“If you think about foul play, motive becomes of paramount importance. And there just isn’t any motive for such a series of heartbreaking episodes. They are too dissimilar. And coma? You’d have to implicate some very clever psychopath operating on a premise that’s beyond rationality. But the biggest problem with the idea of foul play is that it would be impossible in the OR. There are too many people involved who are watching the patient too closely.
“Certainly investigative activities should b
e carried out with an open mind, but I don’t think foul play is possible in this instance. But, I must admit, I had not thought of it.”
“Actually,” said Susan, “I hadn’t planned on suggesting foul play to you, but I’m glad that I did so that I can forget it. But back to the problem itself. If antibody screening is too expensive, the chart review and interviews would be comparatively cheap. I could take that on myself, except I’d need a little help from you.”
“What kind of help?”
“First of all, I’d need to have authorization to use the computer. That’s number one. Secondly, I’d need authorization to get the charts. Thirdly, I may have run into a problem downstairs.”
“What kind of a problem?”
“Dr. Harris. He’s the one who blew his cool. I think he intends to have my surgical rotation here at the Memorial cut short. It seems that he is not fond of women in medicine, and perhaps I have served to underline that prejudice.”
“Dr. Harris can be difficult to get along with. He’s an emotional type. But at the same time he’s probably the best mind in anesthesiology in the country. So don’t damn him until you see his other side. I believe he has specific personal reasons for his attitude toward women in medicine. It’s not admirable, perhaps, but it is potentially understandable. Anyway, I’ll see what I can do for you. At the same time I must tell you that you have picked a very touchy subject to become involved in. You have undoubtedly considered the malpractice implication, the potential bad publicity for the hospital and even the Boston medical community. Tread lightly, young lady, if you choose to tread at all. You’ll make no friends on the course you are embarking on, and it’s my opinion you should drop the whole affair. If you choose to go on, I’ll try to help you, although I can guarantee nothing. If you do turn up any information, I will be happy to offer an opinion. Obviously the more information you have, the easier it will be for me to get you what you need.”
Stark moved toward the door from his office, opening it.
“Give me a call later this afternoon and I’ll let you know if I’ve had any luck with your requests.”
“Thank you for your time, Dr. Stark.” Susan hesitated in the doorway, looking at Stark. “It is reassuring that you have not lived up to your reputation of being a man-, or should I say, woman-eater.”
“Perhaps you will agree with the others when you find time to come on teaching rounds,” said Stark, with a laugh.
Susan said goodbye and left. Stark returned to his desk and spoke into his intercom, talking to his secretary.
“Call Dr. Chandler and see if he has talked with Dr. Bellows yet. Tell him that I want to get to the bottom of those drugs in the locker room as soon as possible.”
Stark turned and looked out over the complex of buildings that made up the Memorial. His life was so closely linked to the hospital that at certain points they merged. As Bellows had told Susan, Stark had personally raised an enormous amount of the money it had taken to revitalize the hospital and build its seven new buildings. It was partly due to his fund-raising abilities that he was Chief of Surgery at the Memorial.
The more he thought about the drugs in 338 and their possible implications, the angrier he got. It was just another glaring example of how people in general could not be trusted to think in terms of the long-run effects.
“Christ,” he said out loud, his eyes mesmerized by the swirling snow clouds. Fools could undermine all his efforts at ensuring the Memorial’s position as the number one hospital in the country. Years of work could go down the drain. It underscored his belief that he had to attend to everything if he wanted it done right.
Tuesday
February 24
7:20 P.M.
The gloom of the winter Boston night had long since invaded the city when Susan alighted from the Harvard line train at the open-air Charles Street MBTA station. The wind, still blowing in from the Arctic, whistled in the river end of the station and traversed the length of the platform in short turbulent gusts. Susan bent over as she headed toward the stairs. The train lunged and slid out of the station, passing her on her right, its wheels screeching as it turned into the tunnel.
Susan used the pedestrian overpass to cross the intersection of Charles Street and Cambridge Street. Underneath, the traffic had dissipated to a minor dribble of cars, but the noxious odor of exhaust gases still fouled the night air. Susan descended to Charles Street. In front of the all-night drugstore there was the usual collection of wayward individuals, either drunk or stoned. Several of them reached toward Susan, asking for spare change. She responded by quickening her step. Then she collided with a seedy, bearded fellow who had deliberately stepped into her way.
“Real Paper or Phoenix, beautiful?” asked the bearded fellow with seborrheic eyelids. He held several newspapers in his right hand.
Susan recoiled, then pressed on, ignoring the lurid jibes and laughter of the night people. She passed down Charles Street and presently the surroundings changed. A few antique shop windows beckoned for her to dally, but the cold night wind urged her on. At Mount Vernon Street she turned up to the left and began to ascend Beacon Hill. From the numbers on the doors she knew she had a way to go. She passed Louisburg Square. The orange glow from the mullioned windows cast warm rays in the cold night. The houses gave a sense of peace and security behind their solid brick facades.
Bellows’s apartment was in a building on the left, about a hundred yards beyond Louisburg Square. The buildings along here sat back behind small lawns and towering elms. Susan pushed open a squeaking metal gate and went up the stone steps to the heavy paneled door. In the foyer she blew on her blue fingers while walking in place to encourage circulation in her feet. She always had cold feet and hands from November to March. While she blew and stamped she scanned the names next to the buzzer. Bellows was number five. She pushed the button hard, and was rewarded with a raucous buzz.
In a minor panic she reached for the doorknob, scraping her knuckle on the metallic guard on the doorframe as the door swung open. A small amount of blood oozed from her knuckle, and she lifted her hand to her mouth. In front of her was a staircase twisting up to the left. A shining brass chandelier hovered above, and a gilded frame mirror served to make the hall seem more spacious. By reflex she checked her hair in the mirror, pressing it down at her temples. As she climbed she noticed attractively framed Brueghel prints on every landing.
Exaggerating her exhaustion, she reached the top flight and paused, gripping the banister. Down the stairwell she could see to the tiled floor of the foyer, five stories below. Bellows opened his door before Susan knocked.
“There’s an oxygen bottle in here if you need it, Grandma,” he said, smiling.
“God, the air is thin up here. Maybe I should sit here on the steps and recuperate for a few moments.”
“A glass of Bordeaux will fix you up perfectly. Give me your hand.”
Susan allowed Mark to help her into his apartment. Then she took off her coat, her eyes wandering around the room. Mark disappeared into the kitchen, returning with two glasses of ruby red wine.
Susan threw her coat over a straight-back chair near the door and pulled off her high boots. Distracted, she took the wine and sipped it. Her attention had been captured by the room she found herself in.
“Pretty tastefully decorated for a surgeon,” said Susan, walking into the center of the room.
It was about twenty by forty feet. At each end was a large old-fashioned fireplace, and in each glowed a cheerful fire. The beamed cathedral ceiling was very high, perhaps twenty feet at the peak, slanting down toward both fireplaces. The far wall was an enormous complex of geometric shapes, some housing bookshelves, others objets d’art and a large stereo, TV, and tape system. The near wall was of exposed brick and covered with paintings, lithographs, and medieval sheet music, attractively framed. An antique Howard clock ticked unobtrusively over the fireplace to the right, a ship model adorned the mantelpiece to the left. Through the windows, on either
side of both fireplaces, a myriad of crooked chimneys was silhouetted against the night sky.
The furnishings were of a minimum; Bellows had relied on a collection of thick scatter rugs, dominated by a blue and cream Bukhara in the center of the room. On it was a low onyx coffee table, surrounded by a large number of sizable pillows covered in shocking shades of corduroy.
“This is beautiful,” said Susan twisting around in the center of the room and then collapsing on an armful of cushions. “I never expected anything like this.”
“What did you expect?” Mark sat down on the other side of the low table.
“An apartment. You know, tables, chairs, couch, the usual.”
They both laughed, aware that they really did not know each other very well. Conversation remained on a frivolous level as they enjoyed the wine. Susan hopefully pointed her stocking feet toward the fire, to warm her toes.
“More wine, Susan?”
“For sure. It tastes wonderful.”
Mark disappeared into the kitchen for the bottle. He poured each of them another glass.
“No one would ever believe the day I’ve had today, incredible,” said Susan, holding the glass of wine between her eye and the fire and appreciating its deep luscious red glow.
“If you haven’t abandoned your suicidal crusade, I believe anything. Did you go and see Stark?”
“You bet your ass, and contrary to your fears, he was very reasonable . . . more than I can say about Harris or even Nelson, for that matter.”
“Be careful, that’s all I can say. Stark is like an emotional chameleon. I usually get along with him extremely well. Yet today, out of the blue, I found out he’s furious at me because of some nut putting half-used medicine in a locker that I had used for a while. He doesn’t come to me and ask me about it the way a normal human being would. Instead he sics poor old Chandler, the chief resident, onto me, and Chandler cancels a case of mine to ask me about it. Then later he calls me out of rounds to tell me Stark wants me to get to the bottom of it. You’d think I had nothing to do.”