Silent Treatment

by Michael Palmer

  “Perchek has a place in Manhattan somewhere,” Harry said. “I think that’s where he keeps the disguises and ID badges, and the poisons he used. If we can find that place, maybe we’ll turn up the Aramine he used on Evie.”

  “Is this Perchek the man who killed the policeman in the elevator?” Dr. Zane asked.

  “And the nurse.”

  “No. Not the nurse. She spent most of the night in surgery, but she’s doing fairly well right now. I hear she’s going to be okay.”

  “God, that’s good news.”

  “They found a man floating directly beneath you in the power plant,” Zane said. “Was that him?”

  Harry nodded and smiled beneath his oxygen mask. He was thinking about Ray Santana.

  “I think we’d better let him rest for a while,” Zane said.

  She squeezed his hand reassuringly, adjusted his monitor leads, and then left the room.

  Maura lifted up the mask and kissed him on the lips.

  “Bamboo,” he said.

  “Bamboo,” she echoed. She stroked his forehead and kissed him again. “Hey,” she exclaimed. “Anybody ever tell you that you look like Gene Hackman?”

  ABOUT THE AUTHOR

  MICHAEL PALMER, M.D., is the author of The Patient, Miracle Cure, Critical Judgment, Silent Treatment, Natural Causes, Extreme Measures, Flashback, Side Effects, and The Sisterhood. His books have been translated into thirty languages. He trained in internal medicine at Boston City and Massachusetts General Hospitals, spent twenty years as a full-time practitioner of internal and emergency medicine, and is now an associate director of the Massachusetts Medical Society’s physician health program.

  Turn the page for an exciting preview of Michael Palmer’s newest medical thriller

  FATAL

  available soon in Bantam hardcover

  It was the second straight day of unremitting rain. Nikki Solari hated running in this kind of weather, but today she was considering doing it anyway. It had been more than a week since her roommate and close friend, Kathy Wilson, had stormed from their South Boston flat. A week without so much as a word—to her or to their mutual friends. The police had been surprisingly little help. Nikki had filled out the appropriate forms and brought in some photographs, but so far nothing.

  “Miss Solari, try to relax. I’m sure your friend will turn up.”

  “It’s Doctor Solari, and why are you so sure?”

  “That’s the way it is with cases like this. Everyone worries and the missing person just shows up.”

  “Well, this missing person is an incredibly talented musician who would never leave her band in the lurch, which she has. She is a wonderfully dependable friend who would never do anything to upset me, which she has. And she is an extremely compassionate and kind woman who would never say anything abusive to anyone, yet before she disappeared she had become abusive to everyone.”

  “Doctor Solari, tell me something honestly. Were you and Miss Wilson lovers?”

  “Oh, Christ …”

  Nikki desperately needed to wrest the worry from her brain, if only for a while, and the only ways she had ever been able to do so were running, making music, and performing autopsies.

  It was eleven in the morning. One more hour until lunch. She could go out and splash through a few miles then. She stood by the window of her office watching the cars creep down Albany Street past the modern building that was the headquarters of the chief medical examiner and his staff. This was her third year as an associate in ME Josef Keller’s office. She was fascinated by the work and absolutely adored the man. But the past week had been hell. She glanced over at her desk. There were reports to read, dictations to do, and several boxes of slides to review, but the concentration just wasn’t there.

  “Hey there, beautiful, you’ve got a case.”

  Without waiting for an invitation, Brad Cummings strode into the office. Divorced, with a couple of kids, Cummings was the deputy chief medical examiner. He was athletic, urbane, and, in the eyes of perhaps every woman in the city except Nikki, handsome. She found him smug, self-absorbed, and way too pretty—quite possibly the absolute antithesis of what she was looking for in a man.

  “Where’s Dr. Keller?” she asked.

  “Away until one. That means I’m the boss until then, so I get to say who gets what case, and you get this tubber.”

  “This what?”

  “Sixty-six-year-old guy had a coronary getting into his Jacuzzi, smacked his head on the side, and went for the eternal swim. He’s just eight months post-bypass surgery. I spoke to his doctor, who said he was on mucho cardiac meds and undoubtedly had an MI. So he’s really just a “view,” You don’t have to cut on him at all. And that means we have time to go have lunch at that place on Newbury Street I’ve been telling you about.”

  “Brad, I don’t want to go out with you.”

  “But I thought you broke up with that drip you were dating.”

  “Correction, that drip broke up with me. And I’m not interested in starting up with another one.”

  “She digs me. I can tell.”

  In the best of times Nikki had precious little patience for the man.

  “Brad, you have more than enough scalps hanging on your lodgepole without mine. And I’m sure there are plenty more where those came from. We’ll keep getting along fine so long as you keep things on a business or collegial basis. But I promise you, Brad, call me beautiful again, or sweets, or honey, or babe, or anything other than Nikki or Dr. Solari, and I’ll write you up and hand it over to Dr. Keller. Clear?”

  “Hey, easy does it.”

  Nikki could tell that he stopped himself at the last possible instant from adding “Babe.”

  “I’m going to get started on the new case,” she said.

  “I told you, this is a straightforward view. No scalpel required, just eyeball him and sign off.”

  “If it’s all the same to you, I’ll make that decision after I’ve seen the guy.”

  Nikki didn’t add that there wasn’t a chance in the world she would pass on this case regardless of how open and shut it was. Here was the perfect opportunity to get her mind off Kathy for a few hours without getting soaked on the streets of Boston.

  “Suit yourself,” Cummings said. “Three days.”

  “What?”

  “Three days. That’s how long the dude’s been in the water. He’s a little, um, bloated. Sure you don’t want to just view and then skiddoo?”

  “Have a good lunch, Brad.”

  Nikki changed into scrubs and located the remains of Roger Belanger on the center of three stainless steel tables in Autopsy Suite 1. The daughter of an Italian and an Irishwoman, she could easily trace her thick, black hair and wide (some said sensuous) mouth to her father, and her fair skin, sea-green eyes, slender frame, and caustic wit to her mom. At her father’s urging, she had tried to follow his rather large footsteps into surgery. But after a year of residency, she switched to pathology, realizing that her desire to have a life outside of medicine was precluded by spending most of it in the OR or on rounds. Not once had she regretted her decision.

  Belanger was hardly the most unsightly corpse Nikki had ever examined, but neither was he at all pleasant to look at. Overweight and nearly egg bald, he was extremely bloated and discolored, with purplish marbling of his skin. His flaccid limbs were well past rigor mortis. The white scar from his bypass ran the length of his breastbone.

  Good-bye for now, Kath, she thought as she began to focus in on the details of the body, I’ll let you back in in two hours.

  “No matter how obvious a case is,” Joe Keller had reminded her on more than one occasion, “no matter how apparently open and shut, you must make no assumptions. Process is everything. If you stick to process, step by step, you will seldom have to explain having missed something.”

  Step one: Read over as much information as you can lay your hands on about the subject. Step two: Inspect every millimeter of the skin.

  Nikki use
d the foot-activated dictation system as she went.

  “There is a well-healed three-inch scar in the right lower abdominal quadrant, possibly from an appendectomy; a ten-inch scar less than a year old down the mid-anterior chest; a ten-inch scar of about the same age on the inner right thigh, probably from harvesting a vein for his bypass; and a well-healed two-inch scar just below the left patella, probably from the repair of a laceration many years ago.

  “There is a single contusion just above and behind the right ear, with discoloration and some swelling but no depression of the bone beneath. There is a nickel-size abrasion just beneath the right mandible that—”

  Nikki peered at the innocent-looking scrape. It was the only place on Belanger’s waterlogged body where skin was actually scraped off. She put on a pair of magnifying goggles and illuminated the area with a gooseneck lamp. The abrasion was actually a perfect hexagon. And in the center of the shape were ten tiny bruises perfectly forming the letter H. She photographed the area, then proceeded with her meticulous examination.

  Process is everything.

  An hour later she had accomplished two major things. She had in fact managed temporarily to drive her concerns for Kathy Wilson from her mind, and she had come within one final step of proving that Roger Belanger had been murdered. She stripped off her gloves, grabbed the Boston Yellow Pages, and made a call. Minutes later she paged Brad Cummings.

  “Jesus,” he said, the dishes clinking in the background, “this pager goes off so infrequently, it scared the heck out of me.”

  “You almost done?”

  “We were just waiting for our flans.”

  Nikki didn’t want to go anywhere near who “we” was.

  “I need you to pick something up for me and come back to the office, Brad.”

  “But—”

  “No buts, no flans. Just go to Mulvaney’s Pool and Patio on Route nine, right after the mall. You know where that is?”

  “Yes.”

  “They’ll have a package waiting in your name. Eleven ninety-five plus tax. I’ll pay you back. Hurry.”

  For the next forty-five minutes Nikki finished collecting her specimens and waited. Inexorably her concerns for her friend reemerged. The two of them had met almost three years ago at a folk club in Cambridge. Nikki had been a classical violinist from age three, when her father enrolled her in a Suzuki method class. She played in chamber music groups right through college and medical school when time allowed, and was reasonably satisfied with what she got from her music—that was, until she heard Kathy Wilson and the Lost Bluegrass Ramblers play. Kathy sang lead and played strings—mandolin, guitar, and bass—with astounding deftness and heart.

  Nikki had heard bluegrass before, but in truth she had never paid much attention to it. That night the Ramblers, and Kathy in particular, brought her an exhilaration that had long ago vanished from the music she played and listened to. After the performance she waited by the dressing room door.

  “I don’t collect autographs,” she said once Kathy had emerged, “but I wanted to tell you that I love your voice and your energy.”

  “Jes’ doin’ what comes naturally. You play the fiddle professionally?”

  “Hardly. How did you—”

  “You’ve got a fiddler’s mark right there under your jaw.”

  Nikki knew the reddish-brown mark and the small lump beneath it caused by long-term pressure from her violin’s chin rest.

  “It became permanent sometime during college,” she said. “I play mostly chamber music.”

  “Eyes and necks, that’s how I judge a person. Eyes and necks. An’ yours tell me you care a lot about people an’ about music.”

  Half an hour later Nikki was drinking beer with the band and sharing intimate details with Kathy of her laughable lack of judgment when it came to choosing men. A week after that, Kathy gave her a lesson in bluegrass. Over the two years that followed, Nikki developed into a reasonably proficient bluegrass musician, good enough to sit in with the group when they weren’t touring.

  “Girl, you’re capable of hittin’ on all cylinders when you put your mind and soul to it,” Kathy said. “But you gotta learn how to shut out the extraneous—especially all them folks who want a piece of you. Do that an’ you’ll feel your feet start floatin’ off the ground when you play.”

  From day one, being around Kathy was an adventure in spontaneity. Nikki had friends—close, good friends—from college and before, and two from medical school. But from their earliest times together, often talking and giggling from the end of a show until breakfast* Kathy and she were sisters.

  “I’ve had it with men,” Kathy moaned after she and her bassist boyfriend had broken up for the third and last time. “Pass the beer nuts is all they’re about.”

  “That and apologizing for leaving the toilet seat up again.”

  “But only after you’ve gone for another unexpected dip.”

  The night of that conversation, a year ago, they decided Kathy would move into Nikki’s second-floor flat in South Boston. The deal was one quarter rent and utilities for Kathy plus weekly lessons for Nikki. Kathy had been religious about giving them, too, when she and the band weren’t on tour. She was a treasure, absolutely irrepressible and in love with life in general and her music in particular. Not at all shy about grading every man Nikki dated, she once told a lawyer he simply wasn’t interested enough in anything but himself and his BMW to have designs on her friend. They were in a gritty club, one of Kathy and Nikki’s favorites, and the man was fidgeting uncomfortably as if battling the desire to wash down the furniture and probably some of the patrons as well. Often outspoken when she was sober, Kathy had consumed, perhaps, a beer or so too many.

  “Give it up, councillor,” she said suddenly as Nikki sat watching in stunned silence. “I know this woman here’s beautiful, an’ I know she’s smart, an’ I know she’d look great at your office Christmas party, to say nothin’ of in your bed. But I am the guardian of her chastity, and I’m tellin’ you what she’s too damn nice to say: There ain’t no set of car keys you can produce is gonna get her to where you want her to be.”

  Not highly educated in any traditional book sense, Kathy was a patient listener, wildly funny when she wanted to be, and always philosophical in an earthy, homespun way. The perfect roommate—at least until the mood swings began.

  It might have been four or five months ago that the sleeplessness started. Two, three, four in the morning, she would be pacing the apartment or walking the streets. Then a day or two or even three would go by without her coming back to the apartment at all. Soon after, her meltdowns began at home and with the band—rages that could be neither predicted nor controlled. Nikki begged her to see a doctor and even arranged for several appointments, none of which Kathy kept.

  Finally, maybe six or seven weeks ago, odd lumps began appearing on Kathy’s face—the first two just above her eyebrows, then one by her ear and another on her cheek. She wouldn’t let Nikki touch them or even talk about them, until ten days ago. In a rare, totally lucid moment, she sank onto a chair in the kitchen, buried her face in her hands, and sobbed.

  “Nikki, what’s happening to me?… where has my mind gone?… Where has my music gone?… Why are they doing this to me?”

  Her sobbing became uncontrollable. Nikki held her tightly and felt the fear and confusion in her body. Beneath her hair she could feel more lumps—solid rather than cystic, slightly movable, not tender that she could tell. Lymph nodes? Some weird kind of firm cyst? Neurofibromas? It was impossible to tell. Nikki begged her to come with her to the ER. Finally Kathy agreed to see Nikki’s doctor the next day. But at the appointment time she was nowhere to be found. She came back to the apartment once more that Nikki knew of, then vanished again.

  “Nikki, how are you doing?”

  Dr. Josef Keller had entered the autopsy suite and now stood beside the bloated corpse of Roger Belanger. Nikki had covered the open thoracic and abdominal cavities with moist towels. Ke
ller, a German Jew whose family had fled the Holocaust, was a year or two from retirement but still vibrant, curious, and energetic. Still, the strain of overseeing a department responsible for the evaluation of more than 50,000 deaths statewide each year was taking its toll. He limped from arthritis in his hip and had a back condition that made it painful to bend over the cadavers for long.

  “I’m glad you’re here,” Nikki said. “This is an interesting case.”

  “I thought this man had a coronary,” Keller replied, with still the hint of an accent.

  “Well, I think he was murdered.”

  “Murdered? Have you been watching reruns of that pathologist show—um, what was his name?”

  “Quincy. Nope. I may be wrong, but here, look at this.”

  First Nikki showed him the bizarre abrasion beneath Belanger’s chin.

  “A ring?” Keller asked, immediately on top of things as usual.

  “I think so.”

  “With diamond studs forming the initial.”

  “Exactly. There’s more.”

  Nikki handed over the otoscope—the tool used by physicians to examine the ear canal and drum. More often than not, she had found residents and even board-certified pathologists omitting this part of the postmortem exam. Process.

  Keller took his time, murmuring to himself as he examined Belanger’s ears by turning the large, violet head from one side to the other and back and inserting the otoscope into the external ear canal.

  “Ruptured, with flakes of dried blood,” he said finally. “Both eardrums were ruptured shortly before his death.”

  “I haven’t been to see his Jacuzzi,” Nikki said, “but I would bet it isn’t at least five feet deep.”

  Five feet—the minimum depth where the pressure on the drums, if not equalized, could cause rupture.

  “You are postulating that this man did not drown in his tub?”

  “I am. I think he drowned all right, but I think someone he was swimming with—someone with the initial H on his ring in diamond studs—dragged him underwater by the throat, maybe to the bottom of a pool, and then brought him home and put him in the tub.”