Fallout

by Mark Ethridge

  “I know a guy who got radioactive seeds for prostate cancer,” Josh pointed out. “He was told to avoid children and pregnant women.”

  “Probably he was told to avoid close contact with them,” Allison suggested. “That’s a rare caution and very conservative. But no question, some of the stuff can be deadly if it’s mishandled.”

  “What are the chances of that happening?”

  “Unlikely. But it’s worth checking out sometime.”

  The meeting with the hospital’s vice president of external affairs and Dr. Pepper went as Allison expected. Everyone blamed the insurance company. Josh’s appeal for a reduced rate was listened to politely but she heard clearly that such requests were rarely granted, particularly to someone with the resources to own a business. Allison’s impression was that the man was an unthinking bureaucrat, not someone inclined to go out of his way to help them. But she said nothing. She didn’t want to discourage Josh.

  She was, however, happy for the opportunity to meet Pepper. She gave him a printout of clinical trials for which Katie might qualify and was encouraged when he did not make her feel like she was infringing. She raised the possibility of appealing to the Sarcoma Foundation and to the Sparrow Foundation for assistance. Before they left, Allison obtained the name of the hospital’s radiation safety officer, explaining that she wanted to consult on issues that came up at her clinic from time to time.

  They returned to the Volvo. Josh was buckling up when Allison asked, “Any reason you need to get back right away?”

  Josh shrugged. “Nothing except work.”

  “I was thinking we could touch base with the radiation safety officer now. Maybe get a few questions answered. At least narrow the possibilities. That way, we don’t have to make another trip, especially with River Days starting.”

  “Sure.”

  Allison rummaged through her physicians bag, pulled out an old, inactive pager and tossed it to him. “Clip this to your belt. Congratulations. You’re a doctor.”

  Josh smiled. He opened the glove box and removed a nylon strap and a laminated pass from a long-ago soccer tournament. “Just the thing.” He slipped the strap over his head and dropped the pass in his front shirt pocket, gambling that no one would check his ID. If they did, he’d simply laugh and say that he’d picked up the wrong lanyard.

  “Good, but add this.” Allison unclipped an engraved plastic nametag—Horace Wright, M.D. Winston Medical Clinic—from the lining of her bag. “It reminds me that whatever else he was, Horace was a pretty fair country doctor.” She handed it to Josh.

  Allison put on her white coat, checking her reflection in the passenger window to ensure that her own nametag from The Winston Medical Clinic showed prominently.

  Seconds later they hurried through a cloud of tobacco smoke rising from the knot of smokers huddled by the main hospital’s front door. Josh held his breath—partly to avoid the smoke, partly to ward off the hospital’s hated antiseptic smell that engulfed them when the automatic doors slid open.

  Given the hour, Josh was surprised at the level of activity. Orderlies and attendants in green scrubs and quiet athletic shoes streamed purposefully across the marble and carpet floor, reminding him of the travelers headed to their gates at Hartsfield. Clusters of visitors carrying flowers and stuffed bears herded toward a massive bank of elevators, a scattering of bobbing helium balloons marking their progress. Two men with stethoscopes protruding from their jacket pockets walked along oblivious to anything except their own animated conversation. In a small sitting area, visitors chatted with bath-robed patients in wheelchairs. Josh noticed some of the patients were hooked to IVs.

  It never ceased to amaze Josh how easy it was to avoid security at hospitals. He’d first seen it as a reporter where he’d learned that by walking around like he owned the place, he could pretty much get to wherever he wanted. During Sharon’s illness, during the endless hours of waiting for this test and that treatment and, ultimately, for the end to come, he and Katie had found themselves able to roam the halls without challenge.

  But this was different. This time, not only would people need to assume he was a doctor or an otherwise authorized person, he would also have to impersonate one. He wondered if doing so was a crime.

  He was relieved when the guard with whom he had grown familiar wasn’t on duty. With Allison trailing, he veered confidently into a long corridor, took a left down a hallway and pushed through doors marked “Cancer Center.”

  Allison had been thinking about whether her plan involved a punishable violation of the rules of medical ethics or whether it was merely dishonest. She decided on the latter.

  She approached the Cancer Center reception desk. “I’m Dr. Wright from The Winston Medical Clinic.” She waved at Josh who lingered behind. “My colleague and I have an appointment with the RSO.”

  The receptionist consulted a clipboard. “The radiation safety officer is gone for the day.”

  “We had an appointment,” Allison said firmly.

  Josh stepped forward. “Dr. Pepper set it up,” he volunteered, hoping detail would add to their credibility. “Peter Pepper. Pediatric oncology. I’ll call him.” He unclicked a cell phone from his belt and started punching keys as if Pepper’s number was top-of-mind.

  “I hope this isn’t some bureaucratic screw-up,” Allison said. “Pepper’s got a temper.”

  “Maybe I could find you someone else,” the receptionist said quickly.

  Josh looked at Allison and shrugged. Allison nodded. Josh snapped his phone shut.

  The receptionist punched a pager number into the phone. “You guys married?” she asked as they waited. Josh saw she was staring at his nametag.

  “A year, Tuesday,” Allison replied

  “Congratulations.”

  “You don’t look like a Horace,” said the receptionist.

  “Neither did the Roman poet,” Josh said. “‘Dum loquimor, fugerit invida aetas.’”

  The receptionist looked at him like he was crazy.

  “Even as we speak, the summer flees unseen.”

  The Radiation Safety Assistant who answered the receptionist’s page wore jeans, a blue polo shirt and black shoes with rubber soles that squeaked as he led Allison and Josh down a series of corridors. Black, thick-framed glasses accented his spiky blond hair. A phone hung from his belt, right next to a dosimeter the size of a credit card. Allison was sure he couldn’t be more than a year or two out of college.

  The assistant ushered them into a small office marked with a maroon tri-foil on a yellow background, the international symbol of radiation. “How’d you end up in this field?” Allison asked.

  “I liked pharmacology and, dude, this stuff is like that, only cutting edge. You say you were supposed to be set up with the RSO?”

  “We talked to Pepper and Dr. Havranek in radiology, both,” Josh answered, impulsively deciding to mention Sharon’s radiologist.

  Allison said, “Our clinic is looking at ways of handling radiopharmaceuticals and sealed sources of radioactivity.”

  White lie number two, Allison thought, but so far nothing punishable—at least by earthly authorities like the medical board.

  “Nothing really to look at in Havranek’s area,” the assistant said. “The radiology guys use liquid stuff delivered daily by an outside vendor. It decays to nothing in a few hours so they just toss it or incinerate it. The other stuff is here, in the cobalt room.”

  The assistant approached a blue door with a metal keypad built into a stainless steel doorknob, similar to the kind Josh had seen airline workers use to access jetways. “What’s the date? The thirteenth?” He punched 0-6-1-3 into the keypad and opened the door.

  Josh and Allison followed the assistant into a small, L-shaped room where a two-foot-square safe sat on a waist-high Formica counter behind a wall of stacked lead bricks. A gooseneck lamp hung over
the safe along with a clear shield of thick glass.

  “There’s cobalt in here?” Allison asked.

  “Not anymore. The place was originally designed for cobalt radiation protection years ago and the name stuck.” He thudded his hand into the wall. “Lined in lead.” The assistant took a set of keys that hung above the safe and opened it. He withdrew a gray cylinder about five inches high and five inches across, carefully unscrewed the top and, keeping the cylinder behind the lead brick wall, tilted it toward Allison and Josh. “Cesium-137. Nasty chemical. Deadly for decades before it decays and poisonous even in its non-radioactive state.”

  The contents reminded Josh of a quiver of tiny black darts—several dozen as best he could tell.

  “Used mostly for gynecological cancers in this form,” Allison noted.

  “Correct. But probably the biggest use of cesium-137 is in the machines that sterilize blood. Every decent-sized hospital in the United States has a blood irradiator.”

  Josh found a notepad emblazoned with the Viagra logo in his lab coat pocket and made notes. Allison was about to fire off the first of a dozen questions she had when the assistant closed the canister, returned it to the safe and said, “We’ve been in here long enough.”

  “I thought the room was extra safe,” Josh said when they returned to the assistant’s office. “Lead lining and all that.”

  “The lead walls protect people in the hospital. But the biggest danger is to the people in the cobalt room. The canister is lead. And the safe is lead. And there’s a lead brick shield so you can open the safe and the canister. But you definitely get some radiation. Not enough to hurt you. But I work here every day. I have a limit.” He patted the radiation dosimeter on his belt.

  Allison noticed several devices she assumed to be hand-held Geiger counters perched on the cabinets. “Have you ever had an accident here, any kind of accidental release of radiation?”

  “Not in my two years and not that I’ve heard of.”

  “How do the cesium implants get to the hospital and what happens to them when they’re removed?” she asked.

  “The manufacturer ships them here by UPS or Airborne in those canisters. FedEx won’t do it. They get used and reused and then they’re shipped back. Lots of record-keeping.” He motioned toward a row of file cabinets. “In fact, that’s ninety percent of my job. The state radiation protection division tracks the whereabouts of all nuclear sources used in medicine and once in a great while, we get audited.”

  “What about the nuclear material in sterilizers, radiotherapy machines, etcetera?”

  “It’s fully shielded and contained, but the problem for us comes when the machines need to be replaced. The feds require that they be disposed of at an approved site because the cesium is still deadly. But there is no approved site for most states, including any in the east, like Ohio. And since they shut down the last burial site in South Carolina, there’s not even a place to dispose of mid-level radioactive waste like contaminated gloves and instruments.”

  “So what happens to it?”

  “We have five sterilizers alone waiting for the federal government to tell us what to do with them. That decision is years, maybe decades away. And believe me, storage is expensive. They’re heavy. They take space. They need to be inventoried and the paperwork was pretty random at some of these backwoods clinics that our medical center has been buying. There’s been a lot of catch-up.”

  Allison felt a flush rise up her neck. In the same way that mothers warn their children about ending up in the hospital and being discovered with unclean underwear, her father had demanded she not end her clinic day before her paperwork was complete, lest she die and be labeled a sloppy physician. The assistant’s comment reminded her that someone inspecting her clinic now might well describe aspects of her paperwork as “random.”

  “A blood sterilizer is one of the pieces of equipment we’ve been thinking about,” Allison said. “Maybe we could look at one of the old ones?”

  The attendant escorted Josh and Allison to a service elevator and punched the button for the basement. When they emerged, he led them past an iron dumpster brimming with scrap—metal piping, ducts, cartons of dented stainless steel trays and pans—to a large caged area filled with heavy machinery, office equipment and medical devices. Allison recognized X-ray machines, centrifuges, medical file cabinets, and computer printers among the massive inventory. The printers were newer than what she worked with every day.

  “This is where we store old equipment,” the assistant said. “Most of it gets recycled. But not the sterilizers and the radiotherapy machines. They just sit there.”

  Allison followed the attendant’s finger to three devices that looked like blue and cream refrigerators. She noticed their red emergency cut-off buttons, a hand-written sign on one that alerted users to lengthen the standard irradiation time every sixty days due to the cesium source’s decay, the small logo of the manufacturer, the skull and crossbones of the radiation warning sign, the green shield and a stylized rings and sphere logo of the hospital’s Department of Nuclear Medicine. To her, the shield, spheres and rings looked like a representation of the rudimentary observations of the ancients. To the marketers, she supposed, the logo suggested something cosmic, eternal, scientific—the solar system, or perhaps an atom, in keeping with the department’s focus.

  Allison asked about the status of the federal government’s hoped-for, high-level waste repository in Nevada. (Stalled.) Josh asked about the price of blood sterilizers (About $200,000 for a Nordion Raycell.)

  They thanked the Radiation Safety Assistant for pinch-hitting for the RSO and headed for home.

  “I do okay?” Josh asked as they drove.

  “You’d make a terrific physician.”

  “I meant in the meeting about Katie.”

  “You did fine. Hopefully, they’ll feel some pressure to cut you a break.”

  “They ain’t seen nothing yet.”

  Chapter Thirty-Two

  Having the extra telephone line installed in the study of his Georgetown house, Harry Dorn often reflected, was one of the smartest political moves he had ever made. He seldom spoke on it and he rarely picked up when it rang, instead letting the answering machine kick in. But the phone allowed him to create the illusion of providing special access for key supporters because he could hand them a card with a number and say, truthfully, “This rings in my den. Call anytime.” His wife had christened it the “nut line.”

  The only downside had been when the number had somehow gotten out on the Internet. He’d been deluged by all manner of crank calls—an amazing number of them obscene—and it really had been the nut line until he’d had the number changed. When the phone’s ringing woke him from a deep, dreamless sleep Friday morning and the clock radio at his bedside told him it was 2:30 a.m., his immediate thought was that the same problem was happening again.

  “I’ll unplug it,” he mumbled to the unmoving lump beside him, his wife.

  He stumbled to the den, silently cursing technology and hoping he’d be able to get back to sleep. He hadn’t had much recently and, if the last few days were any indication, there wouldn’t be much opportunity for it down the road.

  It had been a whirlwind of a week, nonstop since before dawn on Monday when his window-tinted, gasified coal-powered Suburban—a reminder of his commitment to personal, as opposed to governmental, environmental responsibility—had rolled away from the peace of his beloved retreat at Possum Island and crawled through the fog along the river all the way up to Winston. He’d given a thousand speeches and the one at the plant that morning had gotten the job done.

  But he’d felt enormous stress as well as exhilaration. Who wouldn’t? The cameras staring at him from every angle were unblinking reminders that he was defining himself for the crucial first television commercial of his campaign for the U.S. Senate. He regarded it as ridiculous yet unque
stionable that his prospects to be the leader of the free world hung on this performance.

  The speech had been followed by an easy meeting with the local newspaper which had been followed by what—even in the massive Suburban—had been a brutal ride behind gear-grinding coal trucks on winding, two-lane roads up to Fairmont. There, at the annual convention of the West Virginia Medical Society, he had been presented with an award for his years of public service which, he well knew, had come to the attention of the state’s doctors after he supported tort reform legislation limiting payouts for “pain and suffering” lawsuits to $250,000. Of course, the pressing need for tort reform had come to his attention only after the society quietly arranged for his campaign to receive $1,000 from each of one hundred of the state’s doctors, creating a deliciously symmetrical total of $100,000. It had taken him some mental gymnastics to figure out how tort reform was compatible with the Liberty Agenda, which supported individual rights over government restrictions but he had done it and he believed it. The Liberty Agenda supported not just individual rights but individual responsibilities. “We will not let society’s freeloaders use pain and suffering awards to suckle at the breasts of medical caregivers,” he had told the cheering physicians.

  Following the speech, Dorn had made good on a promise to spend the night at the home of a long-time supporter in Marion County. The guest room mattress had been lumpy. The supporter’s wife’s snoring had resonated through the house like a chainsaw. Still jacked from two speeches, he had slept little and envied Richey who had stayed at the convention hotel in a comfortable room, presumably with a mini bar and, likely, with a young woman in a miniskirt. How Richey found them so consistently was a marvel. Were they getting younger or was he just getting older?

  They had arrived back in DC before 10 a.m. Tuesday so Dorn could participate in an important appropriations committee hearing. He was well-known as a congressman who respected his legislative duties. As always, he made a particular effort to look engaged when the Associated Press photographer was taking pictures of the panel. Her photos, after all, were the ones that would go to papers nationwide.