by Robin Cook
Pulling an Amstel Light from the refrigerator, Trent popped the top and took a long, satisfying gulp. He thought the beer might calm him down some. He was anxious and edgy from the hour of Miami Vice. Even reruns got him riled up enough to want to hit one of the local bars to see if he could scare up some trouble. He could usually find a homo or two along Cambridge Street to rough up.
Trent looked like a man who was looking for trouble. He also looked like he’d found it more than a couple of times. A stocky, muscular man of twenty-eight, Trent wore his bleach-blond hair in the severe, flat-topped hairstyle popularly known as a fade. His eyes were a piercing crystal blue. He had a scar below his left eye that ran back to his ear. He’d gotten it from being on the wrong end of a broken beer bottle in a barroom scuffle in San Diego. It had taken a few stitches but the other guy had had to have his entire face rearranged. The guy had made the mistake of telling Trent that he thought he had a cute ass. Trent still got hot every time he thought of the episode. What a creep, that goddamned fag.
Trent went back to his bedroom and set his beer down on top of the TV. He picked up the military-issue .45 pistol that he’d “cumshawed” from a Marine for amphetamines. It felt comfortable in his large hand. Gripping the pistol with both hands, Trent leveled the barrel straight at the TV screen with arms stiff and elbows locked. He spun around to point the gun out the open window.
Across the street a woman was opening her bedroom window. “Tough luck, baby,” Trent whispered. He aimed the pistol carefully, lowering the barrel until the front and rear sights lined up perfectly, targeting the woman’s torso. Slowly, deliberately, Trent pulled the cold steel of the trigger.
As the firing mechanism clicked, Trent called out “Pow!” as he pretended the gun kicked in the air from its recoil. He smiled. He could have drilled the woman if he’d put in the clip. In his mind’s eye he saw her hurled back into her apartment, a neat hole through her chest and blood squirting out.
Laying the pistol on the TV next to his beer bottle, Trent grabbed one of the vials of Marcaine from the bureau. Tossing it in the air, he caught it with his other hand behind his back. He calmly sauntered back to the kitchen to retrieve the necessary paraphernalia from its hiding place.
First he had to remove the glasses from the shelf of one of his kitchen cabinets next to the refrigerator. Then he gently lifted the plywood square that led to his secret cache: a small vault of space between the cabinet’s back and the exterior wall. Trent brought out a single vial filled with yellow fluid and an array of 18-gauge syringes. He’d picked up the vial from a Colombian in Miami. The syringes easily came into his possession through his hospital job. He carried both vials and the syringes back to his bedroom along with a propane torch he kept under the kitchen sink.
Trent reached for his bottle and took another swig of beer. He set the propane torch on a small tripod he kept folded under his bed. Taking a cigarette from the pack by the television set, he lit it with a match.
Trent took a long drag, then lit the propane torch with the cigarette. Next, he took one of the 18-gauge needles. After drawing up a tiny amount of the yellow fluid, he heated the tip of the needle until it glowed red hot. Keeping the needle in the flame, he picked up the vial of Marcaine and heated its top until it too started to become red. With deft, practiced moves, he pushed the hot needle through the molten glass and deposited a drop of the yellow fluid. Next was the trickiest part. After disposing of the needle, Trent began to twirl the vial, slipping it back into the hottest part of the flame. He kept it there for a few seconds, long enough for the puncture site to fuse closed.
He continued to twirl the vial even after he pulled it from the flame. He didn’t stop until the glass had cooled considerably.
“Shit!” Trent said as he watched the very end of the vial suddenly dimple into an unwanted depression. Though virtually unnoticeable, Trent couldn’t risk the blemish. If someone was careful enough to notice, they’d discard the vial as a defect. Or worse, someone on the ball might get suspicious. Disgusted, Trent tossed the vial into the trash.
“Dammit,” he thought as he grabbed another vial of Marcaine. He’d have to try again. As he repeated the process, he became more and more intense, angrily cursing when even the third attempt ended in failure. Finally, on the fourth try, the puncture site sealed properly; the curved tip maintained its smooth hemispherical contour.
Holding the ampule up to the light, he inspected it carefully. It was close to perfect. He could still tell that the tube had been punctured, but he had to look carefully. He thought it might have been the best one he’d ever done. It gave him great satisfaction to have mastered such a difficult process. When he’d first thought of it a number of years ago, he’d had no idea if it would work. It used to take him hours to do what he could now do in minutes.
Once he had accomplished what he’d set out to do, Trent returned the vial of yellow fluid, the .45 pistol, and the remaining vials of Marcaine to the hiding place. He replaced the false back of the cabinet and put the glasses back.
Picking up the doctored Marcaine vial, he gave it a good shake. The drop of yellow fluid had long since dissolved. He turned the ampule upside down, checking to see if there was a leak. But the puncture site was as he expected it to be: airtight.
Trent gleefully considered the effect his vial would soon have in St. Joseph’s OR. He thought particularly about the high-and-mighty doctors, the havoc he would wreak in that lofty quarter. In his wildest dreams, Trent couldn’t have settled on a better career.
Trent hated doctors. They always acted as if they knew everything, when in reality many didn’t know their ass from a hole in the wall, especially in the Navy. Most of the time Trent knew twice as much as the doctor did, yet he had to do their bidding. In particular, Trent loathed that true pig of a Navy doctor who’d turned him in for pocketing a few amphetamines. What a hypocrite. Everybody knew the doctors had been making off with drugs and instruments and all sorts of other loot for years. Then there was that real pervert doctor who complained to Trent’s commanding officer about Trent’s alleged homosexual behavior. That had been the straw that broke the camel’s back. Instead of going through some stupid court-martial or whatever the hell they were planning to do, Trent had resigned.
At least by the time he got out, he was properly trained. He had no trouble getting nursing jobs. With nursing shortages widespread, he found he could work anywhere he pleased. Every hospital wanted him, especially since he liked working in the OR and had experience in that area from his stint in the Navy.
The only trouble with working in a civilian hospital, aside from the doctors, was the rest of the nursing staff. Some of them were as bad as the doctors, particularly the supervisors. They were always trying to tell him something he already knew. But Trent didn’t find them as irritating as the doctors. After all, it was the doctors who conspired to limit the autonomy Trent had had to practice routine medicine in the Navy.
Trent put the doctored ampule of Marcaine in the pocket of his white hospital coat, which hung in the front closet. Thinking about doctors reminded him of Dr. Doherty. He clenched his teeth at the thought of the man. But it wasn’t enough. Trent couldn’t contain himself. He slammed the closet door with such force it seemed to jar the whole building. Just that day, Doherty, one of the anesthesiologists, had had the nerve to criticize Trent in front of several nurses. Doherty had chastised him for what he referred to as sloppy sterile technique. And this was coming from the moron who didn’t put on his scrub hat or surgical mask properly! Half the time Doherty didn’t even have his nose covered. Trent was enraged.
“I hope Doherty gets the vial,” Trent snarled. Unfortunately, there wasn’t any way he could ensure Doherty’s getting it. The chances were about one in twenty unless he waited until Doherty was scheduled for an epidural. “Ah, who cares,” Trent said with a wave of dismissal. It would be entertaining no matter who got the vial.
Although Jeffrey’s new fugitive status heightened his
indecision and confusion, he no longer had the slightest inclination toward suicide. He didn’t know if he was acting courageously or cowardly, but he wasn’t about to agonize further. Yet with all that had happened, he was understandably concerned about the possibility of a new round of depression. Thinking it better to throw temptation away, he took the step of getting the morphine vial from the briefcase, popping its lid, and flushing the contents down the toilet.
Having at least made a decision about one issue, Jeffrey felt slightly more in control. To make himself feel even more organized, he occupied himself by rearranging the contents of his briefcase. He stacked the money carefully, in the base, covering it with the underwear. He then rearranged the contents of the accordion-style file area under the lid to make room for Chris Everson’s notes. Turning his attention to the notes, he organized them according to size. Some of them were on Chris’s notepaper, which had From the Desk of Christopher Everson printed on top. Others were written on sheets of yellow legal paper.
Jeffrey began to scan the notes, almost without meaning to. He was glad for anything that took his mind away from his current predicament. Henry Noble’s case history was especially fascinating the second time around. Once again, Jeffrey was struck by the similarities between Chris’s unhappy experience with the man and his own with Patty Owen, particularly with respect to each patient’s initial symptoms. The major difference between the two cases was that Patty’s had been more fulminating and overwhelming. Since Marcaine had been involved in both cases, the fact that the symptoms were similar was not surprising. What seemed extraordinary was that in both situations the initial symptoms were not what was expected in an adverse reaction to a local anesthetic.
Having been a practicing anesthesiologist for some years, Jeffrey was familiar with the kinds of symptoms that could occur when a patient had an adverse reaction to a local anesthetic. Trouble invariably arose due to an overdose reaching the bloodstream, where it could affect either the heart or the nervous system. Considering the nervous system, it was usually the central or the autonomic system that caused problems, either through stimulation or depression, or a combination of the two.
All this covered a lot of territory, but of all the reactions Jeffrey had studied, heard about, or witnessed, none had been anything like Patty Owen’s, not with the excessive salivation, the tearing, the sudden perspiration, the abdominal pain, and the constricted, or miotic, pupils. Some of these responses might occur in an allergic reaction, but not from an overdose, and Jeffrey had reason to believe that Patty Owen had not been allergic to Marcaine.
Obviously, to judge by his notes, Chris Everson had been comparably troubled. Chris noted that Henry Noble’s symptoms were more muscarinic than anything else, meaning the kind that were expected when parts of the parasympathetic nervous system were stimulated. They were called muscarinic because they mirrored the effect of a drug called muscarine, which came from a type of mushroom. But parasympathetic stimulation was not expected with a local anesthetic like Marcaine. If not, then why the muscarine symptoms? It was puzzling.
Jeffrey closed his eyes. It was all very complicated, and, unfortunately, although he knew the basics, much of the physiological details were not fresh in his mind. But he remembered enough to know that the sympathetic division of the autonomic nervous system was the part affected by local anesthetics, not the parasympathetic part apparently affected in the Noble and Owen cases. There was no immediate explanation for it.
Jeffrey’s deep concentration was interrupted by a thump against the wall, then some exaggerated moaning of feigned ecstasy coming from the neighboring room. He had an unwelcome image of the pimply-faced girl and the bald man. The moaning reached a crescendo of sorts and then diminished.
Jeffrey stepped over to the window to stretch. He was again bathed in the red neon light. A group of homeless people was milling around to the right of the Essex’s stoop, presumably in front of the liquor store. Several young hookers were working the street. Off to the side were young toughs who seemed to take a proprietary interest in the goings-on of the area. Whether they were pimps or drug dealers, Jeffrey couldn’t say. What a neighborhood, he thought.
He turned away from the window. Jeffrey had seen enough. Chris’s notes were sprawled across the bed. The moans from next door had stopped. Jeffrey tried to review the list of possibilities for the Noble and Owen mishaps. Once more he focused on the notion that had so consumed Chris through the course of his last days: the possibility of a contaminant in the Marcaine. Assuming that neither he nor Chris had made a gross medical error—in the Owen case, for example, that he had not used the .75% Marcaine that had been found in his disposal—and in view of the fact that both patients had had unexpected parasympathetic symptoms without allergic or anaphylactic reactions, then Chris’s theory of a contaminant had considerable validity.
Returning to the window, Jeffrey thought about the implications of a contaminant being in the Marcaine. If he could prove such a theory, it would go a long way toward absolving him from blame in the Owen case. Culpability would fall to the pharmaceutical company that had manufactured it. Jeffrey wasn’t sure about how the legal machinery would work once such a theory was proven. Given his recent brushes with the judicial system, he knew the gears would turn slowly, but turn they would. Maybe old Randolph would be able to figure a way to get the wheels to turn faster. Jeffrey smiled at a wonderful thought: maybe his life and career could be salvaged. But how would he go about proving there had been a contaminant in a vial that had been used nine months earlier?
Suddenly, Jeffrey had a thought. He rushed back to Chris’s notes to read Henry Noble’s case summary. Jeffrey was particularly interested in the initial sequence of events, when Chris was first administering the epidural anesthesia.
Chris had taken 2 cc’s of Marcaine from a 30 cc ampule for his test dose, adding his own 1:200,000 epinephrine. It had been immediately after that test dose that Henry Noble’s reaction began. With Patty Owen, Jeffrey had used a fresh 30 cc ampule of Marcaine in the OR. It was after this Marcaine was introduced into her system that her adverse reaction began. For the test dose, Jeffrey had used a separate 2 cc vial of spinal grade Marcaine, as was his custom. If a contaminant had been in the Marcaine, it had to have been in the 30 cc ampule in both situations. That would mean that Patty had gotten a substantially larger dose than Henry Noble—a full therapeutic dose as opposed to a test dose of 2 cc’s. That would explain why Patty’s reaction was so much more severe than Henry Noble’s and why Noble had managed to live for a week.
For the first time in months, Jeffrey felt a glimmer of hope that his old life was still within reach. He could have it back again. During his defense, he’d never considered the possibility of a contaminant. Now, suddenly it seemed like a real possibility. But it would take time and some serious effort to investigate, much less prove. What was his first step?
First of all, he needed more information. That meant he’d have to bone up on the pharmakinetics of local anesthetics as well as the physiology of the autonomous nervous system. But that would be relatively easy. All he needed was books. The hard part would be looking into the idea of a contaminant. He’d need access to the full pathology report on Patty Owen. He’d seen only parts of it during the discovery process. Plus, there was the question Kelly had raised: what about an explanation for the .75% Marcaine vial found in the disposal container on the anesthesia machine? How could it have gotten there?
Investigating these issues would have been difficult under the best of circumstances. Now that he was a convict and a fugitive, it would be all but impossible. He would have to get into Boston Memorial. Could he do that?
Jeffrey went into the bathroom. Standing in front of the mirror, he evaluated his features in the raw fluorescent light. Could he change his appearance enough not to be recognized? He’d been associated with Boston Memorial since his clinical clerkships in medical school. Hundreds of people knew him by sight.
Jeffrey put a hand t
o his forehead and slicked back his light brown hair. He combed his hair to the side, parting it on the right. Holding it back made his forehead appear broader. He’d never worn glasses. Maybe he could get a pair now. And for most all of the years he’d been working at Boston Memorial, he’d had a mustache. He could shave it off.
Caught up with this intriguing thought, Jeffrey went to the other room to retrieve his Dopp Kit. He went back to the bathroom mirror. Soaping up, he quickly shaved off his mustache. It felt strange to run his tongue across a bare upper lip. Wetting his hair, he combed it straight back from his forehead. He was encouraged; already he was beginning to look like a new man.
Next, Jeffrey shaved off his moderate sideburns. The difference wasn’t much but he figured everything helped. Could he pass for another M.D. ? He had the know-how; what he needed was an ID. Security at Boston Memorial had been beefed up considerably, a sign of the times. If he was challenged and couldn’t produce an ID, he would be caught. Yet he needed the access, and it was the doctors who had access to all areas of the hospital.
Jeffrey kept thinking. He wouldn’t despair. There was another group in the hospital that had wide access: housekeeping. No one questioned housekeeping. Having spent many nights on call in the hospital, Jeffrey could recall seeing housekeeping staff everywhere. No one ever wondered about them. He also knew there was a housekeeping graveyard shift from eleven P.M. to seven A.M., which they always had a hard time filling. The graveyard shift would be perfect, Jeffrey figured. He’d be less likely to bump into people who knew him. For the past few years, he’d worked mainly during the day.
Energized by this new crusade, Jeffrey yearned to start immediately. That meant a trip to the library. If he left right away, he would have about an hour before closing. Before he had time for second thoughts, he slipped Chris’s notes into the spot he’d prepared for them in his briefcase and closed and latched the lid.