Harmful Intent

by Robin Cook

  “I’m going to run to the store,” Kelly said. “You just stay put.”

  “I don’t want you going to any trouble,” Jeffrey said, making a motion as if to get up. But it wasn’t true. He loved the fact that Kelly was willing to make such an effort for him.

  “Nonsense,” Kelly said. “I’ll be back in a flash.”

  Jeffrey wasn’t sure if Kelly had said nonsense because she saw through his fib or because to her it was no trouble. She was gone in the blink of an eye. Jeffrey heard her start her car in the garage, pull out, and accelerate down the street.

  He glanced around at the comfortable family room and kitchen, pleased that he’d made the decision to call Kelly. Aside from deciding not to kill himself and not to fly away, in the last twenty-four hours it was the best decision he’d made.

  Settling back again, Jeffrey turned his attention to the summary of Chris’s anesthetic complication:

  Henry Noble, a fifty-seven-year-old white male, entered the Valley Hospital to undergo a total prostatectomy for cancer. The request from Dr. Wallenstern was for continuous epidural anesthesia. I visited the man the evening before his surgery. He was mildly apprehensive. His health was good. Cardiac status was normal with a normal EKG. Blood pressure was normal. Neurological exam was normal. He had no allergies. Specifically, he had no drug allergies. He’d had general anesthesia for a hernia operation in 1977 with no problems. He’d had local anesthesia for multiple dental procedures with no problems. Because of his apprehension I wrote an order for 10 mg of diazepam to be given by mouth one hour prior to coming to surgery. The following morning he arrived in good spirits. The diazepam had had good effect. The patient was mildly sleepy but could be roused. He was taken to the anesthesia room and placed in a right lateral position. An epidural puncture was made with an 18-gauge Touhey needle without problems. There was no reaction to 2 cc’s of Lidocaine utilized to facilitate the epidural stick. Confirmation of the epidural location was made with 2 cc’s of sterile water with epinephrine. A small-bore epidural catheter was threaded through the Touhey needle. The patient was returned to a supine position. A test dose of .5% Marcaine with a small amount of epinephrine was then prepared from a 30 ml vial. This test dose was injected. As soon as the test dose was injected the patient complained of what he described as dizziness, followed by severe intestinal cramping. The heart rate began to increase but not to the extent expected if the test dose had inadvertently been injected intravenously. Generalized muscular fasciculations then appeared, suggesting a hyperesthesia state. Massive salivation intervened, suggesting a parasympathetic reaction. Atropine was given intravenously. Miotic pupils were noted. The patient then had a grand mal seizure which was treated with succinylcholine and Valium intravenously. The patient was intubated and maintained on oxygen. The patient then had a cardiac arrest. The heart proved to be extremely resistant to drugs, but finally a sinus rhythm was achieved. The patient was stabilized but did not return to consciousness. The patient was moved to the surgical intensive care unit, where he remained comatose for one week, suffering multiple cardiac arrests. It was also documented that the patient had a total paralysis following his anesthetic complication that involved not only the spinal cord but cranial nerves as well. At the end of the week, the patient had a final cardiac arrest from which the heart could not be started.

  Jeffrey looked up from the notes. Reading Chris’s terse history of his complication recreated the terror that Jeffrey had felt when he’d desperately fought to save Patty Owen. The memory was so poignant that it brought perspiration to Jeffrey’s hands. What made it so poignant were the striking similarities in the two cases, and it wasn’t just the dramatic seizures and cardiac arrests. Jeffrey could remember with startling clarity the moment he’d seen salivation and lacrimation that Patty had had. And besides that there was the abdominal pain and the small pupils. None of these responses were usual side effects of local anesthetics, although local anesthetics were capable of causing an extraordinarily wide range of adverse neurological and cardiac effects in a few unfortunate individuals.

  Jeffrey studied the next page of the notes. There were a number of words printed in bold letters. Two of them were “muscarinic” and “nicotinic.” Jeffrey recognized them, mostly from his medical school days. They had to do with autonomic nervous system function. Then there was the phrase “irreversible high spinal blockade with cranial nerve involvement,” followed by a series of exclamation points.

  Jeffrey heard Kelly’s car pull up the drive and enter the garage. He glanced at his watch. She was a fast shopper.

  The next item in Chris’s pile was an NMR—nuclear magnetic resonance—report on Henry Noble during the time he was paralyzed and comatose. The results recorded were normal.

  “Hi,” Kelly called brightly as she came through the door. “Miss me?” She laughed as she dumped a parcel on the kitchen countertop. Then she stepped up to the back of the couch and looked over Jeffrey’s shoulder. “What does all this stuff mean?” She pointed to the words and phrases Jeffrey had been reading.

  “I don’t know,” Jeffrey admitted. “But these notes are fascinating. There are so many similarities between Chris’s case and mine. I don’t know what to make of it.”

  “Well, I’m glad someone’s getting some use out of that stuff,” Kelly said as she went back into the kitchen. “It makes me feel less weird for having saved it all.”

  “I don’t think your saving it was weird at all,” Jeffrey said, turning to the next page. It was a typed summary of Henry Noble’s autopsy, which had been performed by the medical examiner. Chris had underlined the phrase “axonal degeneration seen on microscopic sections” and had followed it up with a series of question marks. Then he’d underlined the phrase “toxicology negative” and capped it off by an emphatic exclamation point. Jeffrey was mystified.

  The rest of the notes were outlines of articles taken mostly from the Goodman and Gillman book on pharmacology. A quick glance suggested to Jeffrey that they chiefly dealt with the function of the autonomic nervous system. He decided to look at the material later. He stacked the papers and set them on the table with the two medical volumes serving to anchor them.

  Jeffrey joined Kelly be the kitchen sink. “What can I do?” he asked her.

  “You’re supposed to be relaxing,” Kelly said as she rinsed the lettuce.

  “I’d prefer to help,” Jeffrey said.

  “Suit yourself. How about firing up the barbie on the back porch? The matches are in that drawer.” Kelly pointed with a lettuce leaf.

  Jeffrey grabbed a book of matches and went outside. The barbecue was one of those domed types powered by a cylinder of propane. He quickly figured out how the valve worked and lit it, then closed the dome.

  Before going back inside, Jeffrey looked around the untended yard. The tall grass was a fresh spring green. There had been a lot of rain that spring, so all the vegetation was particularly healthy and lush. Lacy fern fronds could be seen within the thicket of trees.

  Jeffrey shook his head in disbelief. It seemed almost inconceivable that only last night he had come so close to committing suicide. And only that afternoon he’d tried to flee to South America for good. And now here he was standing on a porch in Brookline getting ready to have a barbecue with an attractive, sensitive, disarmingly demonstrative woman. It almost seemed too good to be true. Then Jeffrey realized with a shock that it was; before too long he’d probably be confined to prison.

  Jeffrey took in a deep breath of the cool, late-afternoon air, enjoying its purity. He watched a robin yank a worm from the moist soil. Then he went back inside to see what else he could do to help.

  The dinner was delicious and a great success. In spite of the rather dire circumstances, Jeffrey managed to enjoy himself immensely. Conversation with Kelly was natural and easy. They dined on marinated tuna steaks, rice pilaf, and a mixed green salad. Kelly had a bottle of chardonnay hidden in the back of her refrigerator. It was cold and crisp. Jeffrey found himself
laughing for the first time in months. That in itself was a major accomplishment.

  With coffee and more of the frozen cheesecake, they retired to the gingham couch. Chris’s notes and the textbooks brought Jeffrey’s mind back to more serious thoughts.

  “I hate to revert to unpleasant subjects,” Jeffrey said after a pause in the conversation, “but what was the outcome of Chris’s malpractice case?”

  “The jury found for the plaintiff’s estate,” Kelly said. “Payment of the settlement was divided between the hospital, Chris, and the surgeon according to some complicated plan. I think that Chris’s insurance paid most of it, but I don’t know for sure. Fortunately this house was in my name only, so they couldn’t count that among his available assets.”

  “I read a summary that Chris had written,” Jeffrey said. “There certainly wasn’t any malpractice involved.”

  “With that kind of emotionally charged case,” Kelly said, “whether there was actual malpractice or not isn’t all that important. A good plaintiff attorney can always get the jury to identify with the patient.”

  Jeffrey nodded. Unfortunately, it was true. “I have a favor to ask,” Jeffrey said after a pause. “Would you mind terribly if I borrowed these notes?” He patted the pile.

  “Heavens no,” Kelly said. “Be my guest. May I ask why you’re so interested in them?”

  “They remind me of questions I’d had about my own case,” Jeffrey said. “There were some mild inconsistencies that I could never explain. I’m surprised to see that the same inconsistencies appeared in Chris’s case. The thought of a contaminant hadn’t occurred to me. I’d like to go over his notes a few more times. It’s not immediately apparent what he was thinking. Besides,” Jeffrey added with a smile, “borrowing them will give me a good excuse for coming back.”

  “You hardly need an excuse,” Kelly said. “You’re welcome here anytime.”

  Jeffrey left soon after they finished their dessert. Kelly walked him out to his car. They had eaten so early that it was still daylight outside. Jeffrey thanked her effusively for her spontaneous hospitality. “You have no idea how much I’ve enjoyed this visit,” he said with sincerity.

  After Jeffrey had climbed into his car, along with his briefcase, which now contained Chris’s notes, Kelly stuck her head in through the open window. “Remember your promise!” she warned. “If you start thinking foolish thoughts, you have to get in touch with me.”

  “I’ll remember,” Jeffrey assured her. He drove home in quiet contentment. Spending a few hours with Kelly had done much to elevate his mood. Under the circumstances it amazed him that he’d been able to respond in such a normal fashion. But he knew it had more to do with Kelly’s psyche than his. Making the final turn onto his street, Jeffrey reached out to steady his briefcase, which threatened to fall from the seat. With his hand on it, he thought of its strange contents. Toiletries, underwear, $45,000 in cash, and a pile of notes written by a suicide victim.

  Although he didn’t expect to find anything absolving in the notes, just having them in his possession gave him a feeling of hope. Maybe he could learn something from Chris’s experience that he hadn’t been able to see himself.

  And although he’d been sorry to say good-bye to Kelly, Jeffrey was glad to be getting home so early. He planned to go through Chris’s notes more thoroughly and pull out a few books of his own for some serious reading.

  3

  TUESDAY,

  MAY 16, 1989

  7:49 P.M.

  Jeffrey stopped just short of the garage door, got out of the car, and stretched. He could smell the ocean. As a peninsula that jutted into the Atlantic Ocean, all of Marblehead was near to the water. Bending back into the car, Jeffrey dragged his briefcase toward him and hefted it into the air. He slammed the car door and started up the front steps.

  As he walked he noted the beauty that was all around him. Songbirds were going crazy in the evergreen tree in the front lawn and a sea gull shrieked in the distance. A bank of rhododendrons was in full bloom in a riot of color along the front of the house. Having been preoccupied by his problems during the last months, Jeffrey had completely missed the enchanting transition from bleak New England winter to glorious springtime. He was appreciating it now for the first time that year. The effect of having visited Kelly was still very much on his mind.

  Reaching the front door, Jeffrey remembered his suitcase. He hesitated a moment, then decided he could get it later. He put his key in the front door and went inside.

  Carol was standing in the entranceway, her hands on her hips. He could tell by her expression that she was angry. Welcome home, thought Jeffrey. And how was your day? He put his briefcase down.

  “It’s almost eight o’clock,” Carol said with undisguised impatience.

  “I’m quite aware of the time.”

  “Where have you been?”

  Jeffrey hung up his jacket. Carol’s inquisitional attitude irked him. Maybe he should have called. In the old days, he would have, but these weren’t normal times by any stretch of the imagination.

  “I don’t ask you where you’ve been,” Jeffrey said.

  “If I’m going to be delayed until almost eight at night I always call,” Carol said. “It’s just common courtesy.”

  “I suppose I’m not a courteous person,” Jeffrey said. He was too tired to argue the point. He picked up his briefcase, intending to go directly to his room. He wasn’t interested in fighting with Carol. But then he stopped. A large man had appeared, leaning casually against the doorjamb leading into the kitchen. Jeffrey’s eyes immediately took in the ponytail, the denim clothes, the cowboy boots, and the tattoos. He had a gold earring in one ear and was holding a bottle of Kronenbourg in his hand.

  Jeffrey gave Carol a questioning look.

  “While you are out doing God knows what,” Carol snapped, “I’ve been here putting up with this pig of a man. And all because of you. Where have you been?”

  Jeffrey’s eyes went from Carol to the stranger and back again. He had no idea what was going on. The stranger winked and smiled at Carol’s unflattering reference as if it had been a compliment.

  “I’d also like to know where you’ve been, sport,” the thug said. “I already know where you haven’t been.” He took a pull on the beer and smiled. He acted as if he were enjoying himself.

  “Who is this man?” Jeffrey asked Carol.

  “Devlin O’Shea,” the stranger offered. He pushed off the doorjamb and stepped beside Carol. “Me and the cute little missus here have been waiting for you for hours.” He reached out to pinch Carol’s cheek, but she batted his hand away. “Feisty little thing.” He laughed.

  “I want to know what’s going on here,” Jeffrey demanded.

  “Mr. O’Shea is the charming emissary of Mr. Michael Mosconi,” Carol said angrily.

  “Emissary?” Devlin questioned. “Ooh, I like that. Sounds sexy.”

  “Did you go to the bank to see Dudley?” Carol demanded, ignoring Devlin.

  “Of course,” Jeffrey said. Suddenly he realized why Devlin was there.

  “And what happened?” Carol demanded.

  “Yeah, what happened?” Devlin chimed in. “Our sources report that there was no deposit like was promised. That’s unfortunate.”

  “There was a problem . . .” Jeffrey stammered. He’d not been prepared for this interrogation.

  “What kind of a problem?” Devlin asked, stepping forward and poking Jeffrey repeatedly in the chest with his index finger, keeping the pressure on. He felt Jeffrey wasn’t coming clean.

  “Paperwork,” Jeffrey said, trying to fend off Devlin’s jabs. “The kind of red tape you always get at a bank.”

  “What if I don’t believe you?” Devlin said. He smacked Jeffrey on the side of the head with an open palm.

  Jeffrey’s hand went to his ear. The blow stung him and startled him. His ear was ringing.

  “You can’t come in here and push me around,” Jeffrey said, trying to be authoritati
ve.

  “Oh, no?” Devlin said in an artificially high voice. He switched the beer to his right hand and then with his left he smacked Jeffrey on the other side of the head. His movement was so swift, Jeffrey had no time to react. He stumbled back against the wall, cowering in front of this behemoth.

  “Let me remind you of something,” Devlin said, staring down at Jeffrey. “You are a convicted felon, my friend, and the only reason you’re not rotting in prison at this moment is because of the generosity of Mr. Mosconi.”

  “Carol!” Jeffrey yelled. He felt a mixture of terror and anger. “Call the police!”

  “Ha!” Devlin laughed, throwing his head back. “ ‘Call the police!’ You’re too much, Doc. You really are. I’m the one with the law behind me—not you. I’m just here as an . . .” Devlin paused, then looked back at Carol. “Hey, dearie, what was that you called me?”

  “An emissary,” Carol said, hoping to appease the man. She was appalled at this scene but had no idea what to do.

  “Like she said, I’m an emissary,” Devlin repeated, turning back to Jeffrey. “I’m an emissary to remind you about your deal with Mr. Mosconi. He was a little disappointed this afternoon when he called the bank. What happened to the money that was supposed to be in your checking account?”

  “It was the bank’s fault,” Jeffrey repeated. He hoped to God this giant didn’t look in his briefcase, which he was still holding. If he saw the cash, he’d guess that Jeffrey had been planning to flee. “It was some minor bureaucratic holdup, but the money will be in the account in the morning. All the paperwork is done.”

  “You wouldn’t be jerking me around, would you?” Devlin asked. He flicked the end of Jeffrey’s nose with the nail of his index finger. Jeffrey winced. His nose felt like it had been stung by a bee.