Harmful Intent

by Robin Cook

  Trent looked up at the clock and watched the second hand sweep around its face. It was all going to happen in a matter of minutes. A shiver of pleasure swept down his spine. He loved the suspense!

  9

  THURSDAY,

  MAY 18, 1989

  7:52 A.M.

  With sirens blaring, the ambulance carrying Gail Shaffer turned into the emergency area of St. Joseph’s Hospital and backed to the unloading dock. The EMTs had called ahead on the mobile phone to alert the emergency room as to what kind of case was coming in, requesting cardiac and neurological backup.

  When the EMTs had initially reached Gail’s apartment, after responding to the call placed by her roommate, Annie Winthrop, they had quickly deduced what had happened. Gail Shaffer had suffered a grand mal seizure while in the shower. They believed she’d had some warning the seizure was coming on since her roommate had insisted that the water had been turned off. Unfortunately, Gail hadn’t been able to get out of the tub quickly enough, and she’d hit her head many times against the faucet and the tub. She had multiple scalp and facial wounds and a particularly deep gash high on her forehead at her hairline.

  The first thing the EMTs had done was to get Gail out of the bathtub. As they did, they had noticed a total lack of muscle tone, as if she were completely paralyzed. They’d also detected a marked abnormality of her heart rate. Its rhythm was totally irregular. They’d tried to stabilize her by starting an IV and giving her 100% oxygen.

  As soon as the ambulance doors were open, Gail was swiftly taken to one of the trauma units in the ER. Thanks to the EMTs’ call, a neurology resident and a cardiology resident were on hand when she arrived.

  The crew worked feverishly. Gail was clearly holding on to life by the thinnest of threads. The heart’s electrical conduction system, responsible for coordinating its beating, was severely impaired.

  The neurologist quickly corroborated the EMTs’ initial impression: Gail was suffering from an almost total flaccid paralysis, which included the cranial nerves. What was particularly strange about the paralysis was that a few muscle groups still elicited some reflexive behavior, but there seemed to be no governing pattern as to which still did. It was random.

  The consensus soon became that Gail had suffered a grand mal seizure secondary to an intracranial bleed and/or brain tumor. This was the provisional diagnosis despite the fact that the cerebrospinal fluid was clear. One of the internal medicine residents dissented. She thought the whole episode was due to some kind of acute drug intoxication. She insisted that a blood sample be drawn for an analysis of recreational drugs, particularly some of the newer synthetic types.

  One of the neurology residents also had reservations about the provisional diagnosis. It was his feeling that a central lesion couldn’t explain the paralytic problem. He sided with the internal medicine resident in suspecting an acute intoxication of some sort. But he wouldn’t speculate further until he reviewed the results of additional tests.

  Everyone agreed about the head trauma. The physical evidence was all too clear. A portal X-ray made everybody wince. The wound at the hairline had fractured into one of the frontal sinuses. But it was felt that not even such severe trauma was enough to explain Gail’s condition.

  Despite Gail’s precarious cardiac status, an emergency NMR was scheduled. The neurology resident had been able to cut through the bureaucratic red tape and smooth the way. With several residents in tow, Gail was taken to radiology and slid into the huge, doughnut-shaped machine. Everyone was a bit worried that the magnetic field might affect her unstable cardiac conduction system, but the urgency of settling on an intracranial diagnosis superseded all other concerns. Everyone involved in the case remained glued to the screen as the first images began to appear.

  Bill Doherty held the 5 cc glass syringe up to the light in the anesthesia alcove and gently tapped the edge. The few bubbles adhering to the sides floated to the surface. The syringe contained 2 cc’s of spinal-grade Marcaine with epinephrine.

  Dr. Doherty was far along in administering the continuous epidural on Karen Hodges. Everything was going smoothly and according to plan. The initial puncture had not given her the slightest pain. The Touhey needle had performed beautifully. He had demonstrated to his satisfaction that the Touhey needle was in the epidural space by the lack of resistance on the plunger of the small glass syringe when he pressed. A test dose he had administered had also confirmed it. And finally, the small catheter had slid into place with deceptive ease. All that remained was to confirm that the catheter was in the epidural space. Once he had, he could proceed with the therapeutic dose.

  “How are you doing?” Dr. Doherty asked Karen. Karen was on her right side, turned away from him. He would turn her supine after administering the anesthesia.

  “I guess I’m doing all right,” Karen said. “Are you finished? I still don’t feel anything.”

  “You’re not supposed to feel anything yet,” Dr. Doherty said.

  He injected the test dose, then blew up the blood pressure cuff. The pressure didn’t change, nor did the pulse. While he waited, he made a small bandage to fit around the catheter. After several minutes he tried the blood pressure again. It hadn’t changed. He tested the sensation in her lower legs. There was no anesthesia, meaning that the catheter was surely not in the space where spinal anesthesia was given. He was pleased. The catheter had to be in the epidural space. All was ready for the main injection.

  “My legs feel totally normal,” Karen complained. She was still worried the anesthesia would not work on her.

  “Your legs are not supposed to feel different at this point,” Dr. Doherty assured her. “Remember what I told you when we started.” He’d been careful to tell Karen what to expect. But he wasn’t surprised that she’d forgotten. He was patient with her and knew she was apprehensive.

  “How are we all doing?”

  Dr. Doherty looked up. It was Dr. Silvan, dressed in scrubs.

  “We’ll be ready in ten minutes,” Dr. Doherty said. He turned back to his stainless-steel table, picked up the 30 cc ampule of Marcaine, and checked the label again. “I’m just about to inject the epidural,” he added.

  “Good timing,” Dr. Silvan said. “I’ll scrub up and we’ll get started. The sooner we do, the sooner we’ll be finished.” He patted Karen’s arm, careful not to disturb the sterile drape Dr. Doherty had set up. “You relax, you hear?” he said to Karen.

  Dr. Doherty broke the top off the ampule. He drew the Marcaine up with a syringe. From force of habit he tapped the edges of this larger syringe to remove any air bubbles, even though putting air into the epidural space would not cause a problem. The motion was more from force of habit.

  Bending slightly, Dr. Doherty connected the syringe with the epidural catheter. He began a steady injection. The narrow gauge of the catheter provided some resistance, so he pushed firmly against the plunger. He had just emptied the syringe when Karen suddenly moved.

  “Don’t move yet!” Dr. Doherty scolded.

  “I have a terrible cramp,” Karen cried.

  “Where?” Dr. Doherty asked. “In your legs?”

  “No, my stomach,” Karen said. She moaned and straightened out her legs.

  Dr. Doherty reached for her hip to steady her. A nurse who’d been standing by for assistance reached over and grasped Karen’s ankles.

  Despite Dr. Doherty’s attempts to restrain her with his free hand, Karen rolled over onto her back. She pushed herself up on one elbow and looked at Dr. Doherty. Her eyes were wide with terror.

  “Help me,” she cried desperately.

  Dr. Doherty was confused. He had no idea what was going wrong. His first thought was that Karen had simply panicked. He let go of the syringe. With both hands, he grabbed Karen by the shoulders and tried to force her back down onto the gurney. At her end, the nurse tightened her grip on Karen’s ankles.

  Dr. Doherty decided to give Karen a dose of IV diazepam, but before he could get it, Karen’s face became
distorted by undulating fasciculations of her facial muscles. At the same time, saliva bubbled out of her mouth and tears flowed from her eyes. Her skin was instantly wet with perspiration. Her breathing became stertorous and phlegmy.

  Dr. Doherty went for the atropine. As he was administering it, Karen’s back arched. Her body went rigid, then exploded in a series of convulsing fits. The nurse rushed to Karen’s side to prevent the woman from throwing herself to the floor. Hearing the commotion, Dr. Silvan came in from the scrub sink to try to help.

  Dr. Doherty got out some succinylcholine and injected it into the intravenous line. He then injected diazepam. He turned on the flow of oxygen and held the mask over Karen’s face. The EKG began to register irregularities of conduction.

  As word went out, help started to arrive. They wheeled Karen into the OR to have more room. The succinylcholine stopped her seizure. Dr. Doherty intubated her. He checked her blood pressure and found that it was falling. Her pulse was irregular.

  Dr. Doherty injected more atropine. He’d never seen such salivation and lacrimation. He attached a pulse oximeter. Then Karen’s heart stopped.

  A code was called and more hospital staff descended on room twelve to offer assistance. After the number attending swelled to more than twenty, there were too many to notice out in the alcove when a hand reached for the half-full vial of Marcaine, dumped the contents down a nearby drain, and spirited away the empty vial.

  Kelly put down the phone in the intensive care unit. The call left her feeling acutely distressed. She’d just been informed they were getting an admission from the emergency room. But that wasn’t what had upset her. What bothered her was that the patient was Gail Shaffer, one of the OR nurses. A friend.

  Kelly had known Gail for some time. Gail had dated one of the residents in anesthesia at Valley Hospital who’d been a student of Chris’s. Gail had even been over to the Eversons’ home for the annual dinner Kelly threw for the anesthesia residents. When Kelly had made the switch to St. Joe’s, Gail had been nice enough to introduce her to a number of people there.

  Kelly tried not to let her personal feelings get in the way. It was vital she remain professional. She called out to one of the other nurses who would help with the admission, telling her to get bed three ready for a new occupant.

  A team of people brought Gail into the intensive care unit and helped get her set up with a monitor and a respirator. Her own breathing efforts were not satisfactory to keep her blood gases in a normal range. As they were working, Kelly was brought up to date.

  There still was no diagnosis, which made Gail that much tougher to treat. The NMR had been negative except for the fracture into the frontal sinus. This ruled out a tumor and/or an intracranial bleed. Gail had not regained consciousness, and her paralytic state had deepened rather than resolved. The gravest, most immediate threat to Gail’s condition was her unstable cardiac status. Even that had worsened. In radiology she’d scared everyone with runs of ventricular tachycardia that made people fear she was about to arrest. It was almost a miracle she had not.

  By the time Gail was fully set up in the ICU the results of the cocaine test came back. It was negative. A broader screen for recreational drugs was pending, but Kelly was quite sure that Gail did not use drugs.

  The team who’d brought Gail to the ICU was still there when Gail arrested. A countershock to her heart eliminated the fibrillation but resulted in asystole, meaning there was no electrical activity or beat whatsoever. A pacemaker threaded into her heart from a cutdown in her groin restored a heartbeat of sorts, but the prognosis was not good.

  “I’ve faced a lot in this line of work,” Devlin said angrily. “Guns, knives, a lead pipe. But I wasn’t expecting to get shot in the ass with some Amazonian arrow poison. From a guy who was handcuffed, no less.”

  Michael Mosconi could only shake his head. Devlin was the most efficient bounty hunter he knew of. He’d brought in drug pushers, hit men, Mafioso dons, and petty thieves. How he could be having so much trouble with this piss-ant doctor was beyond Mosconi. Maybe Devlin was losing his touch.

  “Let me get this straight,” Mosconi said. “You had him in your car, handcuffed?” It sounded crazy.

  “I’m telling you, he injected me with some stuff that paralyzed me. One minute I was fine, the next I couldn’t move a muscle. There wasn’t anything I could do about it. The guy’s got modern medicine working for him.”

  “Makes me wonder about you,” Mosconi muttered with irritation. He ran a nervous hand through his thinning hair. “Maybe you should think about changing your line of work. What about becoming a truant officer?”

  “Very funny,” Devlin said, but he clearly was not amused.

  “How do you think you’re going to be able to handle a real criminal if you can’t bring in a skinny anesthesiologist?” Michael said. “I mean, this is a major screwup. Every time the phone rings I have palpitations that it’s the court, saying they’re forfeiting the bond. Do you understand the seriousness of all this? Now, I don’t want any more excuses—I want you to get this guy.”

  “I’ll get him,” Devlin said. “I have someone tailing the wife. But more importantly, I put a bug on her telephone. He’s got to call sometime.”

  “You have to do more than that,” Michael said. “I’m scared the police might be losing interest in keeping him from getting out of the city. Devlin, I can’t afford to lose this guy. We can’t let him slip away.”

  “I don’t think he’ll be going anyplace.”

  “Oh?” Michael questioned. “Is this some new intuitive power you’ve developed, or is it wishful thinking?”

  Devlin studied Michael from his seat on Michael’s uncomfortable couch. Michael’s sarcasm was beginning to get on his nerves. But he didn’t say anything. Instead he leaned forward to get at his back pocket. He pulled out a bunch of papers. Putting them on the desk, he unfolded them and smoothed them out.

  “The doc left this stuff behind in his hotel room,” he said, pushing them toward Michael. “I don’t think he’s going anyplace. In fact, I think he’s up to something. Something that’s keeping him here. What do you make of these papers?”

  Michael picked up a page of Chris Everson’s notes. “It’s a bunch of scientific mumbo-jumbo. I don’t make anything of it.”

  “Some of it’s in the doc’s handwriting,” Devlin said. “But most of it isn’t. I assume it was written by this Christopher Everson, whoever he is. His name is on some of the papers; does the name mean anything to you?”

  “Nope,” Michael said.

  “Let me have the phone directory,” Devlin said.

  Michael handed it over. Devlin turned to the page where Eversons were listed. There was a handful, but no Chris. The closest was a K. C. Everson in Brookline.

  “The man’s not in the directory,” Devlin said. “I suppose that would have been too easy.”

  “Maybe he’s a doctor too,” Michael suggested. “His number could be unlisted.”

  Devlin nodded. That was a good possibility. He opened the directory to the Yellow Pages and looked under Physicians. There were no Eversons. He closed the book.

  “The point is,” Devlin said, “the doctor is working on this scientific stuff while he’s on the lam and holed up in a fleabag hotel. It doesn’t make a whole lot of sense. He’s up to something, but I don’t know what. I think I’ll find this Chris Everson and ask him.”

  “Yeah,” Mosconi said, losing his patience. “Just don’t take four years to go to medical school. I want results. If you can’t deliver, just say the word. I’ll get someone else.”

  Devlin got to his feet. He put the phone book down on Michael’s desk and picked up Jeffrey’s and Chris’s notes. “Don’t worry,” he said. “I’ll find him. It’s getting to be sorta a personal thing at this point.”

  Leaving Michael’s office, Devlin descended to the street. It was raining harder now than it had been when he’d arrived. Fortunately he’d parked close to an arcade, so he had only a shor
t dash in the open to get to his car. He’d parked in a loading zone on Cambridge Street. One of the perks he enjoyed from having been on the police force was that he could park anywhere. Traffic cops turned a blind eye. It was a professional courtesy.

  Getting into his car, Devlin worked his way around the State House to get on Beacon Street. The route was convoluted and complicated, as most Boston driving was. He turned left on Exeter and parked by the closest hydrant he could find to the Boston Public Library. Getting out of his car, he bolted for the entrance.

  In the reference section he used city directories for Boston and all the outlying towns. There were plenty of Eversons but no Christopher Everson. He made a list of the Eversons he found.

  Going to the nearest pay phone, he dialed the K. C. Everson in Brookline first. Although he figured the initials meant it was a female, he thought he’d give it a try anyway. At first he was encouraged: a sleepy male voice answered the phone.

  “Is this Christopher Everson?” Devlin asked.

  There was a pause. “No,” said the voice. “Would you like to speak with Kelly? She’s—”

  Devlin hung up the phone. He’d been right. K. C. Everson was a woman.

  Scanning his list of Eversons, he wondered which one was the next most promising. It was tough to say. There weren’t even any others with a middle initial C. That meant he’d have to start making house calls. It would be a time-consuming process, but he couldn’t think of what else to do. One of the Eversons was bound to know this Christopher Everson. Devlin still had a hunch that this was his best lead.