At What Cost

by James L'Etoile

  “I had—I don’t know anything about that,” Zack said.

  John closed in on Zack. In spite of the chill in the room, small beads of moisture formed on the lab assistant’s upper lip. The man smelled of nervous sweat and cigarette smoke.

  “Sure you do, Zack. How often do you duck out into the stairwell for a smoke break?”

  Zack looked to Dr. Robinson for a lifeline.

  “Answer the man, Zack,” Robinson ordered.

  “Couple times a day,” Zack said. His head hung low and his toe scuffed an invisible smudge on the lab floor.

  “Let me see your cigarettes,” John said.

  “Back off! I know my rights. Get a warrant.” The little man put up a rickety front of belligerence.

  “I don’t need one,” Robinson said as he took Zack by surprise, lashed out, and snatched the cigarette package from the man’s lab coat. “The coat is hospital property.”

  Robinson handed the cigarettes to John. The package felt stiffer than a normal, thin paper container. John opened the top, folded back the flimsy foil layer, and tucked behind a half dozen cigarettes, John spotted a thick, plastic-laminated card. John dumped the contents onto the counter, and a hospital access card slipped out. Marsha Horn’s access card.

  “That’s no crime, using someone’s card,” Zack said quickly.

  “Maybe, maybe not. Depends on why you used it. Why did you take Dr. Anderson’s tissue sample?” John asked.

  “Who says I did? You’ve got no proof of anything.”

  John spun the man around, pressed his own body weight against the smaller man, and pinned him against the counter. As John ratcheted the handcuffs tight, he whispered in Zack’s ear, “You don’t have the balls to pull this off by yourself. Tell me who you’re working with.”

  “I don’t have to answer to you,” Zack said.

  John pulled Zack around and sat him on a stool at the workbench. “Why’s that?”

  “Because I’ve done nothing wrong, even according to your laws.” The little man looked smug, like he’d been waiting for this opportunity to boast. The scared lab geek transformed into someone with an edge.

  “Destroying evidence, conspiracy . . .”

  “Evidence of what? Conspiracy? The real conspiracy is the medical establishment and what they do to us,” Zack said. His voice deepened with the bravado of a true believer.

  John needed some conspiracy of his own, so he pulled out his cell and dialed.

  “Detective Newberry,” Paula said.

  “It’s me.”

  “How’s Tommy?”

  “Long story. Short version is the donated kidney was bad. It was from our ‘friend,’ and the hospital is compromised. We caught a break with a low-level hospital employee who destroyed evidence of the connection.”

  Zack’s brow winced at the “low-level employee” label.

  “I’ll be there in ten. Did some follow-up on the gun, too. I got the name of the last registered owner,” Paula said.

  “You were supposed to wait for me,” John said.

  “Yeah. I always do what I’m told. See you in ten.” She disconnected the call.

  John pointed at Zack Weber. “Sit, stay.”

  John motioned for Dr. Robinson. “Doc, your computer records showed when Marsha Horn’s access card was used in the lab. Can the system pull up any other access in the hospital systems?”

  “I think so, but what do you want me to look for?”

  “Did Marsha Horn access UNOS data?” John asked.

  Zack postured from his chair, smug and prideful. “You have no idea what you’re doing. You, of all people, Detective . . .”

  John wheeled around and faced Zack. “Why screw around with a kid’s life?”

  “I’ve committed no crime.”

  “No, you’ve done something far worse,” John said.

  TWENTY-TWO

  John arranged for a couple of uniforms to sit with Zack Weber while he checked on Tommy and Melissa. When he returned to his son’s room, the boy’s small chest barely rose with each breath. Melissa sat next to Tommy. She absently stroked Tommy’s arm, a mother’s touch, while she stared at the monitors attached to her boy, looking for any change in the blips, beeps, and lines that foretold Tommy’s future.

  Without glancing away from the monitor displays, Melissa said, “How could this happen?”

  John perched on the side of the chair, next to his wife. He leaned in and rested his head on hers. “We’ll get him through.”

  Melissa broke her trance away from the monitors, pulled back from her husband, and turned in the chair, facing him. “What have we done to our son?”

  John recoiled as if she had slapped him. “We didn’t—”

  “Stop. Stop right there. We are responsible. We allowed that monster in our lives, and he nearly took Tommy from us.”

  John got up from the side of the chair and walked to a window that looked out on a quiet, well-maintained residential neighborhood. Monsters lurked out there, hidden behind all that Norman Rockwell veneer, monsters who preyed on the innocent and the vulnerable.

  “You don’t deny it, do you? That case you’re working? He did this,” she said.

  John couldn’t face Melissa. He shoved his hands in his pockets, shoulders stooped.

  “What are you going to do about it?”

  “I’m sorry. I’ll get the case assigned to another detective,” he said.

  “The hell you will.”

  John turned.

  Melissa stood and took a step toward her husband. “You’ll do no such thing. Look at your son. Look what this creature made us do. You are not going to quit on Tommy. You find this son of a bitch and stop him.”

  Paula Newberry appeared at the doorway and cleared her throat.

  “How’s Tommy doing?”

  Melissa turned and greeted Paula with a hug. “The doctor says he’s going to take a while to bounce back. He still needs a transplant.”

  Paula handed a small, stuffed teddy bear, dressed in a soccer uniform, to Melissa. “I know he used to like to play, so until he feels better . . .”

  “Thanks. That’s very thoughtful. He’ll love it.” Melissa clutched the stuffed animal tight.

  “Let me have it,” a weak voice called out. Tommy reached an arm out toward the bear.

  “How are you, baby?” Melissa said, tucking the bear under his arms.

  “I’m not a baby.”

  “You’ll always be my baby. How are you feeling?” Melissa asked.

  “How come I don’t feel any different? I thought I was supposed to feel better. I feel the same, maybe worse. I’m sore.”

  John sat on the corner of the bed. “The doctor couldn’t finish the surgery, Tommy,” he said.

  “What happened? Was I bad?”

  John’s throat tightened. “No, Tommy, you weren’t bad. The kidney was bad, and the doctor didn’t want to give you a bad one.”

  “Oh.” Lines appeared on his small forehead. “But I still need one right?”

  John nodded.

  “So I have to wait some more?”

  “Afraid so,” John said.

  “Okay. Can I have some ice cream? Last time I was here they let me have ice cream.”

  “I’ll check,” John offered.

  The rattle of an equipment cart in the hallway stopped at their door. A young nurse came in with a tray laden with plastic-wrapped medical supplies and placed it on the table at Tommy’s bedside.

  “Hi, Tommy. I’m Katie. I need to hook you up with a new tube.” The nurse checked Tommy’s identification bracelet.

  “Another IV?” Melissa asked. “What’s wrong with the one he has?”

  “This isn’t for an IV. This is a shunt line for his dialysis treatment,” the nurse explained.

  “No one said anything about dialysis,” Melissa said.

  “Katie, could you excuse us for a moment? I need to speak with Mr. and Mrs. Penley,” Dr. Anderson said from the doorway.

  The nurse lef
t the tray on the table and walked out into the hallway beyond Dr. Anderson. John tensed when Anderson entered the room.

  “I’m sorry about that. I wanted to tell you myself,” the doctor said.

  “Tell us about what? Dialysis? That can’t be,” Melissa said.

  “I’m afraid that’s what we’re up against. The stress from the surgery strained his kidneys. Tommy’s blood work shows his GFR is below ten,” Dr. Anderson said, referring to the glomerular filtration rate. He spoke softly, with a glance at Tommy to make sure he wasn’t listening. “We are looking at levels that correspond with complete renal failure. We need to start him on dialysis while we search for a new kidney.”

  “Did the surgery cause this?” John asked.

  “The anesthesia and the surgery put additional strain on his system. Tommy’s renal function has been trending downward, but this event pushed him down a bit. I’m just grateful we didn’t go through with the transplant with that suspect organ.”

  “Grateful is not what I’m feeling,” John said.

  Melissa returned to Tommy’s bedside, her face brave, hiding a mother’s darkest fears.

  “The dialysis will keep his blood levels stable until the transplant.” The doctor ran his hand over his short-cropped hair. “I can’t understand what happened to that organ. The tissue damage I saw looked odd, like it was damaged by freezing temperature and improper perfusion.”

  “Perfusion? As in a perfusion pump?” John asked.

  The doctor nodded. “The pump extends viability of the transplant tissue. The perfusion fluid is chilled to preserve the tissue, and in this case, the tissue samples should indicate it was too cold. The solution turned to slush and caused damage to the cellular structure of the organ. The type of fluid used will also tell us where the process went off track.”

  “Like Euro-Collins solution?” John said.

  The doctor’s eyes narrowed at the mention of the solution. “Well, yes, but Euro-Collins is very stable at low temps. I can verify once the lab does their analysis.”

  “The tissue samples are gone.”

  “No. I sent them to the lab myself.”

  “A lab technician, Zack Weber, took them from the lab, and he’s not talking.”

  “Why would he do such a thing? Zack’s worked in the lab since he left medical school. He’s always proved reliable.”

  “Zack Weber went to medical school?” Paula interjected.

  “My partner, Detective Newberry,” John said, introducing her.

  “Yes, he did. Shame he got caught up in a cheating scandal in his last year. He threw away a potential career as a fine physician.”

  “What happened?” John asked.

  “Zack is a whiz when it comes to computer systems. I understand he hacked into the school’s servers, changed a few grades for a couple of colleagues, and posted the answers for an exam online. It was a black mark for the school. Everyone involved in the scandal was kicked out.”

  “How did he end up here with that kind of background?” Paula asked.

  “Good question,” John added.

  “It was a recommendation from the medical school. In spite of Zack’s many failings, the dean said that Zack’s superior clinical skills shouldn’t go to waste. He said Zack’s issues at the school were altruistic and misguided, but the young man had something to offer. The dean added that Zack didn’t change his own grades or benefit from the test answers he posted. He’d taken that course a year earlier.”

  “They make him sound like a medical-school Robin Hood,” Paula said.

  “It fits with something he said about the conspiracy within the medical establishment and how ‘our laws don’t apply,’” John observed.

  “Like he thinks he’s outside the system?” the doctor asked.

  “Exactly. Without the tissue sample, we have nothing to tie Weber to whoever is trafficking these organs,” John said.

  “What kind of tissue do you need?” Dr. Anderson asked.

  “The medical examiner wanted the kidney. Now that’s gone.”

  “What if I can give you the next best thing? I trimmed the renal artery to prep the organ for transplant. The cut from the harvest was irregular, kind of rough. I needed a uniform surface to graft the donated organ to . . .”

  “My son,” John said.

  Dr. Anderson bit his lower lip. “Sometimes when the harvest takes place, the tissue on the edge of the incision withdraws and shrinks back. In this case, it looked more torn than it usually does, so I cut a small section off.”

  “Are you saying that you have that tissue?”

  “I didn’t send that portion to the lab. I didn’t see the need.”

  “Where is it?”

  The doctor stuffed his hands into his lab coat. “It’s in a sealed biohazard container along with a vial with the perfusion fluid I drained from the kidney. The ME should be able to get somewhere with that.”

  “John, you stay with Tommy and Melissa while the doc takes me to get that sample,” Paula said. John started to protest, but Paula cut him off. “You can’t be in the chain of custody for a piece of a kidney that was supposed to go into your own kid. Besides, I think they need you.” She looked toward Tommy and Melissa.

  The boy clutched the stuffed animal under a frail arm. The sight made John’s chest tighten.

  Paula clasped John on his shoulder. “I’ve got this.” She turned to Dr. Anderson. “Doc, take me to the tissue sample,” she said before she left with him.

  Fifteen minutes later, Dr. Anderson returned. His face was tight, and John couldn’t recall the doctor looking as worn and worried as he did now. “I think I got your partner what she needed.” The doctor glanced at his tablet. “Tommy’s latest test results aren’t looking good. We need to get his dialysis started.”

  John nodded. The test results explained the doctor’s worried expression.

  The doctor leaned into the hallway and whispered for the nurse. She reappeared in seconds and entered Tommy’s room, her ponytail flipping side to side as she walked.

  She grabbed a fresh set of latex gloves from a wall-mounted dispenser and approached the bedside.

  “Okay now, Tommy, you don’t like getting needles stuck in you all the time, do you?”

  The boy shook his head but remained silent.

  “How about if I gave you a special one that made sure that you didn’t need another one while you’re here? No more poking you every time we need a blood sample.”

  “That’s good, I guess,” Tommy said.

  The nurse unwrapped a sterile dialysis shunt and found a vein in the boy’s arm. With a gentle motion, she inserted the line. Tommy winced but didn’t make a sound when the needle pierced his skin.

  “Great job, Tommy. No more needles for you,” she said.

  “Promise?”

  “Anybody tries to stick you, you tell them I said no.”

  The nurse finished up with Tommy and said to Melissa and John, “Let’s give him some time to rest, then we’ll take him down to the dialysis unit. That takes about three hours.”

  “Can we be with him?” Melissa asked.

  “Sure, there’s a place for family to sit while he gets his dialysis. Make sure you get rest too. This is a race, but it’s a marathon, not a sprint.”

  Dr. Anderson reentered the room, leaned close to John, and said quietly, “Can I speak to you—privately?” The doctor motioned toward the hallway.

  John tensed. “What’s wrong?”

  Dr. Anderson saw the concern etched into the father’s face. “Nothing’s wrong. We’ll get Tommy back on track. What I wanted to talk to you about is this whole situation with the transplant tissue. We have procedures to ensure that can’t happen.”

  “Are you saying the procedures weren’t followed?” John asked as he followed the doctor into the hallway.

  “On paper, everything checks out. I’ve pored over every document and computer entry, and everything says that the donated kidney was perfectly viable. We both know that w
asn’t the case.”

  “The documents were falsified?” John asked.

  “I can’t see any other possibility. You mentioned Zack Weber and the lab computers. He could have altered the documents in our system, but he wouldn’t have access to the UNOS registry. That system requires a higher level of clearance than Zack had.”

  “Did Marsha Horn access UNOS?”

  “Marsha? No, she didn’t have approval for the system. When I handed what was left of the tissue sample to Detective Newberry, she asked for a list of our personnel authorized to enter and change data in the UNOS registry.”

  “Tricia Woods was already supposed to be gathering that report for us,” John said.

  “She is, but I told Detective Newberry I could do you both one better. We have a security camera in the area where the UNOS terminals are located. Once we know when our phony entry was made, we will have a record of which terminal was used.”

  “And the camera will show us who made that entry,” John added.

  “And it will prove to you that it wasn’t me. I gave all the camera footage to Detective Newberry, for what it’s worth.”

  A blue-smocked nurse came from down the hallway and interrupted the conversation. “Dr. Anderson, we have an opening in dialysis, and your orders were to get the Penley boy in as a priority. Has he recovered enough from his surgical anesthesia?”

  “He should be fine to go. See if you can get him some water, nothing solid yet,” the doctor directed.

  She nodded and entered Tommy’s room.

  “Thanks for making Tommy a priority,” John said.

  The nurse unplugged monitors from the electric outlets, made sure the IV tubing was up away from the wheels, and rolled Tommy’s gurney out the doorway as he clutched on to the stuffed animal. The boy searched over his shoulder to ensure that his mom followed close behind.

  “Someone will be up in a moment to take him downstairs to dialysis,” the nurse said.

  John parked alongside the gurney when Melissa grabbed him gently and tugged him aside.

  “I’ve got this, John. You go stop the son of a bitch who did this to our son.”

  The sight of his son, strapped down in the hospital gurney, made John’s stomach fill with acid. Tommy glanced back. “It’s okay, Dad,” he said.