“You can say ‘all he ended up with’ because it is not your wrist,” Elovitz remarked dryly.
“Why did the ER people ask for a cardiac consult?” Brian asked.
“Oh, partly because they just thought that anyone who fell on ten trillion volts ought to be checked over by us whether he conducted the electricity or not, and partly because he’s a Vasclear patient. One of the first, as a matter of fact.”
Brian’s interest perked up immediately.
“And you’re doing okay?” he asked.
“I don’t know about your okay,” Elovitz said, “but by my okay I’m okay. Now please. My wife is not well and she’s very worried about me. I’ve got to get home.”
Brian noted that the man took an extra breath or two during each sentence.
“Dyspnea?” he asked Phil.
“He’s in some early CHF,” Gianatasio replied, using the abbreviation for congestive heart failure—fluid building up in the lungs because of a weakened heart. “Listen, Bill. You’re a little short of breath. I don’t work in the Vasclear clinic anymore, but Dr. Holbrook does, and he would like to check you out. Could you call the clinic tomorrow and make an appointment to see him?”
Elovitz cocked his head and looked up at Brian.
“You’re a good doctor?” he asked.
“Pretty good,” Brian said. “Yes.”
“In that case, I’ll call. Thank you, Dr. Phil. Let’s go, dear.”
Before either physician could say a word, Mrs. Levine had wheeled her charge down the hall and around the corner.
“He’s cute,” Brian said. “How’s his ticker?”
“It needs some buffing up. I don’t do really good exams in the hallway on patients who are fully dressed and squirming to get out the door. That’s why I told him to arrange to see you. You might want to check with the Vasclear secretary in two days. If he hasn’t made an appointment, maybe we should call him. Now, let’s repair to the residents’ room. I want to know if Juicy Lucy came on to you or not.”
Twenty minutes later, Brian walked Phil out of the hospital and then returned to continue his orientation tour. Gianatasio was in no position to determine whether Wilhelm Elovitz was a treatment failure on Vasclear or whether his symptoms were due to factors other than hardening of the arteries. But he did make the point that Brian already knew well—while the drug had so far proved to be wildly successful by any standards, twenty-five percent of patients receiving it did not respond.
Brian wandered back to Boston Heart and made his way past the third-floor operating suite and the second-floor laboratories. Patient registration and the administrative offices were on the main floor, along with the regular cardiac clinic. The basement level housed the cardiac cath lab on one end and the animal maintenance facility on the other. In between them was a mechanized canteen. Brian suddenly realized he hadn’t eaten anything since breakfast except Phil’s cake.
He picked the stairs nearest the cath lab and descended to the basement. Tomorrow morning he would be taking the same stairway down to scrub in on a cath case for the first time in a year and a half, and with Carolyn Jessup no less. The cath lab and the film library next door to it were locked, and the basement corridor was totally deserted, although there were lights on beyond the twin glass doors of the animal facility. He was approaching the small canteen when a man emerged carrying a small cardboard box with two coffees and some sandwiches. He was Brian’s height, or even a bit taller, but with a linebacker’s broad shoulders and narrow waist; small, dark eyes; high cheekbones; and acne-scarred skin. He was wearing jeans and a blue button-down dress shirt, and was so startled at seeing Brian that he nearly dropped his food.
For the briefest moment, their eyes met. Brian saw only hostility and not a spark of intelligence. The man grunted a greeting, missed badly at an attempt to smile, and backed away several steps before turning. He then hesitated once more before entering the stairway across from the one Brian had used—the stairs down to the subbasement. Brian checked his map. The floors depicted on the sheet ended with the basement. He tried to place the man into some hospital niche based on his dress, impressive size, and connection with the subbasement. Maintenance? Security? Laundry? Heating plant?
A few moments later, Brian was microwaving a breaded chicken-breast sandwich and sipping from a paper cup of scalding coffee as bad as any he had ever tasted. The strange, moose-in-the-headlights expression on the man’s pockmarked face refused to fade from his thoughts. But what could the guy have been doing? Stealing food from the vending machines?
Brian’s reflections were cut short by his beeper. The number in the display was his home phone. He checked around for a phone, and then carried what remained of his sandwich and coffee down the glimmering linoleum to the lights at the end of the hall, where Animal Maintenance Facility was painted in gold across the first of two pairs of glass doors. It wasn’t until he was inside the outer set that Brian smelled and heard the animals. Through the inner doors, the odor and racket were a lot stronger.
“Help you?”
The man, his feet up on an old, scarred desk, was gaunt and ill-kempt. Brian took in the gray stubble, scraggly gray-black hair, jeans, and stained knee-length lab coat. An empty pen holder/nameplate on the desk identified him simply as Earl.
“My name’s Holbrook, Dr. Brian Holbrook. Today’s my first day at BHI, so I’m kind of orienting myself. I also wanted to use your phone if I could.”
“Phone’s all yours,” Earl said with an Appalachian twang. “I heard you was comin’ today. Gonna be helpin’ with the Vasclear study, right?”
Brian was surprised that this basement dweller knew of him. People may be talking about you, but so far, I haven’t heard anything. Isn’t that what Phil had just said?
The man’s teeth were nicotine-stained and in dreadful condition, and he was contributing, not insignificantly, to the odor of the place. But there was a smell other than filth that Brian detected coming off him as well—a smell he had become sensitized to over the last eighteen months—alcohol.
“That’s right,” Brian said. “I’ll be working on the ward and covering the Vasclear clinic some evenings. Were you involved in the animal studies?”
“’Course.”
Brian picked up the receiver, at the same time nonchalantly dropping his half-eaten sandwich into the trash. The man’s body odor, plus the alcohol fumes, had killed his appetite. Jack’s line was busy. Just a few hours ago, the visiting nurse had reported him stable and in decent spirits. Brian checked the coverage list. Sally was supposed to be there with him. It was most likely something minor, he decided.
“Busy,” he said. “Okay if I look around for a few minutes before I call again?”
“Suit yerself. I’ll be right here.”
“What animal did they use for the preliminary Vasclear studies?”
“Oh, a little of everything,” Earl replied. “That’s the way they usually do it. First the rats ’n rabbits, then a whole bunch of pigs, a few sheep, some dogs, an’ finally some monkeys. They like to work with them pig hearts most of the time. Somethin’ about them bein’ a lot like human hearts. Doesn’t surprise me none. I can show you a lot of humans who are just plain pigs.”
His mucousy laugh at his own humor terminated in a spasm of coughing. Brian glanced down at his newly placed TB skin test and made a mental note to have a follow-up done in a few months.
“Any problems arise with the testing?” he asked.
Earl looked at him queerly.
“Why no,” he said finally. “Why would you ask somethin’ like that?”
Brian grinned, trying to dispel the sudden change in mood.
“Just wantin’ to learn about the drug I’m going to be workin’ with is all,” he said, consciously adding the slight twang to his voice.
“Well, for your information, the animal testing was perfect.”
“That’s great to hear. I’ll be back in a minute to try that call again.”
Bri
an turned quickly and headed through the glass-paneled door to the right of Earl’s desk, and down one of the rows of cages.
Earl’s territory was actually quite large—and much better maintained than the man himself. From the left side of the facility to the right, the cages and the animals increased in size. Mice, hamsters, rats, rabbits, even some small dogs. Brian had never had pets when growing up and perhaps for that reason didn’t feel passionately against animal testing of pharmaceuticals, so long as the animals themselves were well cared for. But looking at them now, in row after row of cages, did affect him.
To the far right, separated from the rest of the facility by a glass wall, was a series of larger cages. Several of them were empty at the moment; two held sheep; two others large dogs; and eight of them housed primates—six wiry gibbons and two chimpanzees.
The primate cages were four feet wide by eight feet deep—tall enough for a man to stand. Brian was pleased to see the swinging bars and children’s toys—touches of caring. Several of the monkeys seemed as curious about him as he was about them. Then, one of the chimps caught his eye. It was the smaller of the two, although it was still as large as a six-year-old child. It was slumped against the near corner of the cage, apparently asleep. But its breathing was sonorous and labored, and its abdomen seemed markedly distended. In addition, its hind paws were strikingly swollen.
To Brian’s eye, the somnolent animal seemed to be experiencing fairly severe fluid retention. Lungs, kidneys, liver, heart—instinctively, Brian thought through the various system failures that could be causing such a condition, acknowledging that certain hormonal imbalances could produce the same picture as well.
There was a mop resting against the wall nearby. Brian held it at the business end, slipped the pole between the steel mesh, and gently prodded the animal. Nothing. No reaction at all. He repeated the maneuver a little more firmly, touching the end of the pole against the side of the chimp’s distended belly. A rheumy eye opened and slowly looked down at the spot. But there was no reaction besides that. The animal was ill, almost moribund. Brian noted down the number in the card affixed to the cage—4386. Then he returned to the desk, where Earl was reading the comics in the Herald.
Before mentioning the animal, Brian called Jack once more. His father answered on the first ring.
“Brian?”
“Yeah, Pop. You okay?”
“Of course. I was just calling to see when you were coming home.”
Brian winced. Once one of the most fiercely self-reliant men he had ever known, his father was becoming more and more dependent as his illness progressed. Brian had encountered the syndrome in many of his patients, but Jack was only sixty-three. It was as if his natural aging was accelerating. And without any siblings, Brian knew there was nowhere for him to displace the consequences. The coach was rapidly becoming his third child.
“I was going to wait until the traffic let up some,” Brian replied. “Seven-thirty, eight, maybe. Can I bring you anything?”
“How about some ice cream?”
“You can’t eat ice cream, Jack.… Oh, hell. Listen, I’ll be home by eight, and I’ll bring you a cone from Schiller’s.”
“Hey, that would be great. That kind made out of cookies, okay?”
“Oreo, Pop. You’ve got it.”
Brian said good-bye and set the receiver down, wondering where it was all going to end.
“Thanks,” he said to Earl. “Thanks a lot. Say, listen, I was just watching one of those chimps back there, cage number four-three-eight-six, and I swear he’s sick.”
“Nonsense. Ol’ Jake is fat ’n lazy. But he ain’t no sicker ’n you or me.”
“Maybe so, but I think he’s got pretty severe fluid retention. Come on back and I’ll show you.”
“I ain’t goin’ no place except here. I’ll look in on him before I leave.”
There was clear irritation in his voice.
“Hey, easy does it,” Brian said, trying to remain cheerful, but sensing his own temper beginning to click in. “It won’t take a minute to come check him.” He gestured at the Herald. “That’ll be there when you get back.”
The moment he said it, Brian knew the facetious remark was a mistake.
Earl pushed unsteadily to his feet and confronted him, his face distorted and crimson. The alcohol odor was even heavier than Brian had at first appreciated.
“Look,” Earl said, “I told you I’d check Jake in my own time and tha’s what I’m gonna do. You’re a druggie, ain’t you. Everyone’s been sayin’ that. Well, you just watch your step, ’n watch who you’re orderin’ around.”
Brian was shocked. He warned himself to leave and just let the matter drop. But the quarterback in him wouldn’t allow it.
“Earl, I may be new, but I’m still a doctor on the faculty here, and I don’t think what I’m asking is so unusual. Look, just tell me what study the monkey’s involved in. I’ll speak to the researcher myself.”
“These are my animals. If they’s any reportin’ to do, I’ll do it myself.”
“Hey, I don’t know what’s with you, but you’ve been drinking—quite a bit, I think. I’m going to speak with Dr. Pickard about what’s going on down here.”
Earl jutted his chin out.
“You just go ahead,” he said. “Report me to anyone you fuckin’ want. My bet is you do that ’n you’ll find yourself on unemployment quicker than you can say junkie. Now get out of here.”
Brian held his temper in check, but just barely. The fallout of being involved in a major incident with an employee after only a few hours on the job wasn’t worth it. Fists clenched, he whirled and left.
CHAPTER EIGHT
BOSTON HERALD
General Release of Wonder
Heart Med Could Be Just
Weeks Away
Officials at South Boston’s Newbury Pharmaceuticals say that patient testing of their experimental heart drug, Vasclear, has demonstrated remarkable clearing of clogged coronary arteries in over seventy-five percent of cases. They have requested lifesaving-drug status for their discovery, which would enable it to become available to the general public without further testing.
BRIAN SLEPT LESS THAN TWO HOURS DURING THE NIGHT before his first full day on duty. It was hardly the way he wanted to prepare his mind or body for a morning in the cath lab and the afternoon covering the clinical service. But the emotional roller coaster of his orientation day had refused to slow down.
… Report me to anyone you fuckin’ want. My bet is you do that ’n you’ll find yourself on unemployment quicker than you can say junkie.…
Jesus! Gianatasio’s assessment of the situation notwithstanding, the word about him certainly was out. And it was clear that although he might be given responsibility for patient management, resuscitations, performing cardiac catheterizations, and running the Vasclear clinic, he was still very much the low man on the BHI totem pole. But he also felt the strength of his recovery had him ready to deal with whatever life in the hospital held in store.
The moment of truth for him had come nearly eighteen months ago, on his second day at the Fairweather Center. His counselor, Lois, herself a long-term recovering addict, had two small plaques tacked to the wall above her desk.
TIME IS NATURE’S WAY OF KEEPING
EVERYTHING FROM HAPPENING AT ONCE.
WHEN WE SPEAK OF TOMORROW,
THE GODS LAUGH.
Brian was staring up at the words without really comprehending either message when Lois suddenly snapped a ruler down on her desk.
“Okay, Dr. Holbrook,” she said, “it’s time for the sixty-four-thousand-dollar question. What are you willing to do to get out from under the shit that’s burying you right now?”
Brian, then just a week past the morning when two Drug Enforcement Agency officers had marched into his office with a computer printout of wholesale-drug-house Percocet orders, and a dozen or so prescriptions made out to various members of the Holbrook family, was too frightened, bewi
ldered, and depressed to respond to the woman right away. He had no way of knowing that there was only one totally acceptable answer to her question, and that he was about to give it. Finally, he looked up at her, his eyes glazed and reddened, his face unshaven.
“I’m willing to do anything,” he said. “Just tell me what to do.”
Where those words came from at that moment, he still didn’t know. And at the time, he certainly didn’t notice the glow that they brought to his counselor’s face. But they marked the beginning of the radical overhaul of his life.
The Fairweather Center specialized in helping alcoholic and chemically dependent health professionals. Many of the seventy or so who were residents there at the same time as Brian were physicians. And almost all of them, Brian included, had to overcome their own arrogance, drive, discipline, denial, and logic in order to free themselves from their addictions. They had to learn that what worked for them in courses like organic chemistry—intellect and sheer willpower—was not going to be enough to bring about lasting recovery, and in fact, was going to be an impediment in the early stages.
For Brian, the teachings of Lois and the rest were like a log floating past a drowning man. He grabbed on and held tight, with no idea where the current was taking him. For others at Fairweather, meetings and sponsors and surrender to a higher power made no sense whatsoever. And while they argued and rationalized and resisted, their log drifted on past. Some of those docs—physicians with so much training, so much intelligence, and so much to give—were already dead.
“For the past three months you’ve been leading a sheltered existence here at Fairweather,” Lois told him as she handed over his discharge plan. “But trust me, real life is waiting for you up there in Massachusetts, and real life can be pretty damn cruel at times, especially for an M.D. with your history. So, just remember, it’s a day at a time, an hour at a time, a minute at a time. Whatever it takes to get through a situation without resorting to pills again.”
Miracle Cure Page 9