Just saying hi, old chap. Harumph pshaw. How’re the old CCC chumskys?
No answer.
Then he thought: What if something’s happened to him? Despite his outward robustness, Arthur was an old man. And the way he packed away alcohol and cholesterol . . .
Perhaps he’d had a heart attack and lay untended on the floor of his lab. Or worse.
Jeremy pictured the pathologist’s long frame stretched out, surrounded by jars of floating viscera, skeletal specimens, bodies in various states of dissection. Sterile tools laid out in preparation for human carpentry . . . laser scalpel? . . . an expensive gizmo. Would there be any reason for a pathologist to invest in one?
He hurried to the main wing, took the stairs down to the basement. Once again, Arthur’s office door was closed, and no one responded to Jeremy’s knock.
The morgue sat at the far end of the hall, and its door was open. The sleepy-looking attendant at the front desk was doing paperwork. No, he hadn’t seen Dr. Chess today, had no idea where he was.
“Was he here yesterday?”
“Uh, no, I don’t think so.”
Jeremy backtracked to the Pathology Office, on the opposite end and around a bend.
A chubby woman in her forties sat sentry.
“Hi,” she said. “Can I help you, Doctor?”
“I’m looking for Dr. Chess.”
“He’s out.”
“Is he okay?”
“Why wouldn’t he be?”
“I just wondered,” said Jeremy. “He wasn’t at Tumor Board, and I’ve never known him to miss one.”
“Well,” she said, “he’s as fine as he could possibly be. I believe he’s taken some time off.”
“Vacation?”
“It’s not like that,” said the receptionist.
Jeremy’s puzzled look made her smile. She said, “You don’t know him well, do you? How long have you been attending T.B.?”
“A year.”
“Ah,” she said. “Well, Dr. Chess isn’t really on staff, anymore. Not officially, anyway.” She cupped her hand around her mouth, and whispered, “He doesn’t get paid.”
“He’s volunteering his time?” said Jeremy.
“You could call it that, but that really doesn’t describe it.” She lowered her voice even further, forcing Jeremy to lean in close. “He doesn’t do autopsies anymore, or analyze specimens. Doesn’t do much at all, except Tumor Board. But he’s such a brilliant man, has given so much to this hospital, that they allow him to keep his office, do any research he wants to do. It’s not a secret, but we don’t publicize it either. For Dr. Chess’s sake. It’s not like he’s deadweight or anything. He’s a major asset to this department because of his reputation. In fact, I’ll have you know, he turned this department into what it is.”
Her voice had risen. Indignant. Protective.
“He’s brilliant,” Jeremy agreed, and that seemed to mollify her.
“That’s why we don’t talk about his . . . employment status. As far as everyone’s concerned, he’s a full-fledged member, welcome here whenever he wants. And his running T.B. is a big help. Everyone says he’s got an encyclopedic memory. And, of course, he’s available when the younger pathologists have questions for him. Which they frequently do. They have tremendous respect for him, everyone does. He’s a beacon in his field.”
“Yes, he is,” said Jeremy. “So . . . you’re saying he just decided not to come in.”
“It’s happened before. Why all the questions, Dr. . . . Carrier?”
“Dr. Chess and I had dinner a couple of nights ago. He seemed . . . a little shaky.”
The receptionist’s hand flew to her mouth. “Oh, my. I certainly hope he’s all right.”
“I probably overstated. He just seemed a little tired. Less energetic than what we’ve come to expect from him. That’s why, when he didn’t show up this morning for T.B., I got a little concerned.”
“Who ran Board this morning?”
“Dr. Singh.”
“Let me call him.” She punched her phone. “Dr. Singh? It’s Emily, sorry to disturb you, but I’ve got Dr. Carrier here asking about Dr. Chess . . . Carrier. From . . .” She inspected Jeremy’s badge. “Psychiatry. He had dinner with Dr. Chess last night, thought Dr. Chess looked a wee bit tired. He wants to make sure Dr. Chess is okay . . . what’s that? All right, I’ll tell him. Thanks, Dr. Singh.”
She placed the phone in its cradle. “Dr. Singh says Dr. Chess called him last night to inform him he’d be taking additional time off and wouldn’t be making Board. Dr. Singh said he sounded fine.”
“Great, that’s good to know. Thanks.” Jeremy turned to leave.
“It’s so nice,” she said. “The way he does that.”
“Does what?”
“Dr. Chess. The way he gets people to care about him. The dear.”
Her phone rang and she picked it up and got involved in a conversation with someone named Janine who’d just had a baby and wasn’t that great, and she was sure he was cute, just the cutest, when could she stop by with the baby gift she’d bought thecutestlittlebootieandjammy set.
21
The psychiatry secretary phoned Jeremy, and said, “You’re requested on Six West.”
It was Wednesday, well past his late-night supper with the old eccentrics and but for occasional surreal remembrances, the experience had been expunged from his head. Arthur Chess was out of his head, as well. He couldn’t believe he’d actually cared about the old man’s well-being.
Over the past few days, he’d seen Angela once—half an hour for coffee and hand-holding before she rushed off. During that time she talked more about her lung cancer patient, who was not doing well, and said, “For the rest of my chest rotation, I’ll be shifting from lung to heart. That should be good.”
“Absence makes the lungs grow fonder?”
“Ouch,” she said.
“Sorry.”
“No, I like it. Another side of you.”
“What side is that?”
“Regular. Not so . . . composed.”
“Happens all the time,” he said.
“Well, I haven’t seen it before. I like it.”
She squeezed his hand, left to talk to dying people.
He said, “Who requested me?”
The psych secretary said, “Dr. Dirgrove.”
“Don’t know him.”
“Well, that’s what it says, here. ‘Dirgrove.’ He’s a surgeon.” A redundancy; Six was a surgical ward. “He wants you to evaluate a preop patient.”
“For what?”
“That’s all I’ve got, Dr. Carrier.”
“He asked for me personally?”
“Sure did. Guess you’re famous.”
He found Dirgrove in scrubs, charting in the Six West physicians’ room.
The pale, blond man he’d seen demonstrating some sort of technique in the dining room to Mandel the cardiologist and the dark, mustachioed surgeon.
The trio Jeremy had believed Arthur to be observing, only to have Arthur shift his attention to the daily paper. And ask Jeremy to supper.
Seated, Dirgrove had appeared tall. On his feet, he was of medium height, no larger than Jeremy and ten pounds lighter. One of those rangy men who seems to be moving even while standing still. He greeted Jeremy with a warm smile and a hearty handshake. “Dr. Carrier. Great to meet you. Thanks so much for coming, I’m Ted.”
The photo on his badge was a good likeness—a rarity. A thumbnail shot of Dirgrove smiling just as he was now.
T.M. DIRGROVE, M.D. ATTENDING, CARDIAC SURGERY.
“Jeremy. What can I do for you?”
Dirgrove put the chart aside, leaned against the desk, rubbed one paper slipper against the other. His eyes were deep blue, thatched with laugh lines, clear, earnest, tired. Faint yellow-gray stubble dotted his angular face. Hands pinkened by frequent washing fluttered restlessly. His surgical scrubs were wine red. Jeremy found himself thinking: The better to hide the blood.
“I’m slated to operate on a young woman with a ventricular septal defect. On the face of it, routine.” Dirgrove smiled. “You know what they say: Routine is when it’s happening to someone else. Anyway, this girl worries me. She’s highly anxious. We cutters generally don’t pay much attention to that kind of thing, but I’ve learned to be a bit more careful.”
“Careful about anxiety?” said Jeremy.
“About the whole mind-body connection.” Dirgove tented his spidery fingers. He’d indulged in a beautiful manicure, but the rest of him seemed put together casually: short, spiky, uneven haircut, and the scrubs were wrinkled. Careless shaving had left a grid of longer, pale hairs at the juncture of his jaw and neck. “A guy like me can do all the right things technically, but if the mind’s not cooperating, it can be a problem.”
“You’re concerned about an anxiety attack during surgery?”
“About any significant sympathetic nervous system reaction. Even with the premedication, I’ve seen it happen. Patients who are ostensibly out and you cut them open and for some reason their adrenaline kicks in and their S.N.S. spikes and their blood pressure goes through the roof. When the anesthesiologist has his hands full, I can’t do my job optimally. That’s why I play mellow music in my O.R., and everyone shuts up. My instinct on this girl is she needs calming down. I’ve heard you’re the man for that, so if you don’t mind, could you see her? The family’s got good insurance.”
“What can you tell me about her?”
Dirgrove rummaged in a pile of charts, found one, flipped it open, passed it to Jeremy, and crossed to the door. “Everything you need to know is in here. Thanks. And I’d appreciate if you’d do it ASAP. We’re scheduled for tomorrow, first thing, in the A.M., so if you think we need a delay, try to let me know by 5 P.M.”
A brief wink, and he was off.
Merilee Saunders. The chart had lots to say about her congenital heart defect and her family’s ability to pay (excellent private insurance, indeed) but nothing about her psyche. None of the nurses had recorded any untoward anxiety, and Dirgrove’s only assertion to that effect was a neatly printed addendum to yesterday’s notes: Poss hi anx. Call psych.
Jeremy went to see her.
Dirgrove hadn’t told her about the consult.
She was a chubby young woman with grainy skin and unruly dark hair tied up in a knot. Her hospital gown had bunched around her shoulders, and she lay propped uncomfortably. Coal-nugget eyes aimed at Jeremy the moment he entered the room, and she glared but said nothing. Cheap silver rings banded eight of her fingers. Three pierces in one ear, four in the other. A tiny rosy dot above her left nostril said she’d changed her mind about the nose stud.
The chart said she was twenty years old, but the reading material on her bed table was all teen zines.
Jeremy introduced himself, and she frowned.
“A shrink? You’re kidding. What, someone thinks I’m crazy?”
“Not at all. Dr. Dirgrove would like you to be as calm as possible before the surgery, and he thought I might be able to help you with that.”
“If he wants me to be calm, he shouldn’t cut me up.”
Jeremy pulled a chair up to her bed. “May I?”
“Do I have a choice?”
“Sure.”
Merilee Saunders rolled her eyes. “What the hay. Park.”
“So,” he said, “surgery wasn’t in your game plan.”
She turned sharply, regarded him as if his skull had split open and his brain had tumbled out. “Sure,” she said. “It’s a fun thing for me, I can’t wait to be sliced. What a rush.”
“Has the reason for the surgery been explained to—”
“Blah-blah, blah-blah, blah-blah, blah-blah. Yeah, Freaky Dirgrove told me the facts.”
“Freaky,” said Jeremy.
“He’s a stiff. Roboticon. Except when he wants to turn on the charm. My mom loves him.”
The chart said the Saunders family was intact.
“What about your dad?” said Jeremy.
“What about him?”
“Does he like Dr. Dirgrove?”
“Sure, why not.” Merilee Saunders looked over at the TV suspended from the wall. “The channels here suck. Home shopping and Spanish crap and other crap.”
“True,” said Jeremy. “We’re a bit behind the times.”
The young woman shifted position under her covers. “Dirgrove tell you I’m nuts?”
“Not in the least. He just wants to make sure you’re in peak shape for—”
“Maybe I am,” she said. “Nuts. So what? And what does that have to do with getting my heart sliced open? And why now? All these years I’ve been fine and all of a sudden . . . I’m twenty, I don’t have to do something I don’t want to do.”
“If you have doubts about the—”
“Look, I’ve had this”—she patted her left breast—“since I was born. They tell me it’s a hole in my heart, but I don’t feel any different from anyone else. Not until some docko slips me the old steth and he hears it and everyone starts freaking out.”
“You feel fine, so why should you—”
“It just doesn’t feel right, know what I mean? I come into this shithole all okay and they poke me and jam crap in me and give me X rays and CAT scans and all kinds of crap and now tomorrow I’m gonna wake up feeling like I got run over by a truck. It doesn’t make sense, but try telling Mom that. She’s only out for my best interests.”
“Your mother—”
“My mother loves doctors,” said Merilee. “Especially the cute ones. She thinks Dirgrove’s cute. I don’t. I think he’s a stiff. And since you’re obviously going to ask about my dad, let’s just say he works like eight hundred hours a week, pays the bills, goes with the flow.”
“You’re right,” said Jeremy. “You’re an adult, and it’s your body we’re talking about. So if you have serious reservations—”
“Nah. I’ll go with the flow, too. Why not? What’s the worse that can happen, I die?” She laughed.
Jeremy started to speak, but she waved him off. “Don’t think I’m gonna talk shrinky, to hell with that. Even if I am nuts, so what? It’s not my brain we’re talking about, it’s my heart.”
“Sometimes there are things we can do to make the experience easier,” he said. “Relaxation exercises.”
“I hate exercise.”
“This is more like meditation—hypnosis.”
She regarded Jeremy through slitted eyes. “What, you want to put me asleep and tell me my heart’s okay and the hole closed up by itself? If you can pull that off, sure, let’s party.”
“Sorry,” said Jeremy. “That’s a bit beyond my abilities.”
“Then who the hell needs you?” said Merilee Saunders, shaking her fingers as if discarding flecks of filth. “Leave me alone, I’m tired.”
Pt. More angry than anx. Understands need for surgery intellec.
but not emot. More discussion of procedure from Dr. Dirgrove
recommended. Pt. Refuses relax.trng.
J. Carrier, Ph.D.
Not one of his triumphs.
But later that day, he picked up his voice-mail messages and the third of a dozen said: “Jeremy, this is Ted Dirgrove. You were a great help. Thanks.”
22
Another envelope arrived in the interoffice mail. Same source: Otolaryngology. Once again, an unnamed recipient, but it had ended up in Jeremy’s stack.
This one was copied from a five-year-old gynecology journal. Laser hysterectomy technique in the treatment of uterine lieomyomata, endometriosis, and pelvic adhesive inflammation.
Optimally, the patient should be positioned in the dorsal lithotomy posture with low stirrups, prepped and draped . . .
Another team of authors, physicians, and biomedical engineers. Americans, working at a West Coast university hospital.
Construction of a bladder flap . . . endoscopic kittner . . . dissection of the broad ligaments.
Jeremy slipped the
article back in the envelope, walked over to the Psychiatry Department, and asked Laura, the secretary who disbursed the mail if she had any idea who had delivered the envelope.
“It all comes in a batch from the mail room, Dr. Carrier.” Laura was barely twenty, just out of junior college. Still sufficiently green to hold the professional staff in awe.
“This wasn’t addressed to me.” He showed her. “So it had to be dropped off in person. Any idea how it got in my pile?”
“Uh-uh. Sorry.”
“When the batch gets here, where’s it stored?”
“Right here.” She pointed to a bin on the counter, just to her left. “I go through it, divide it by staff member, and tie up each stack with a rubber band and a Post-it with your name on it. Then someone—me or a clerk or a volunteer—brings it around to each office. Yours we do last because you’re on a different floor.”
“So once the batch is divided, anyone could insert another envelope into any pile.”
“I guess so—is something wrong, Dr. Carrier?”
“No, just curious.”
“Oh,” she said, looking frightened. “Have a nice day.”
He barged in on the ENT receptionist. A young man, beautifully dressed and groomed, whose fingers flew over a computer keyboard.
“May I help you?” he said, without looking up. Same voice Jeremy had spoken to when he’d inquired about the first envelope.
Jeremy said, “I have a question about this.”
The young man stopped typing, and Jeremy handed him the envelope.
“Didn’t you call me about this before?”
“That was the first, this is the second. So I don’t think it’s an accident. I’ve obviously been confused with someone else.”
The young man inspected the photocopied article. “Hmm . . . well, I didn’t send it. These envelopes get reused all the time.”
“I guess someone’s stockpiling ENT envelopes.”
The young man grinned. “That’s because we’re so charming.” He tried to hand the article back.
“All yours,” said Jeremy.
The Conspiracy Club Page 10