Side Effects

by Michael Palmer

  "Well, between running the house and entertaining and taking the girls to one lesson or another and scouts and committees at our club and that business of hers, Ellen simply ran out of energy for me. In some areas, meals and such, she still goes through the motions, but without much spark."

  "How is Ellen handling all this? " Kate asked, checking Jared's face for a sign that she might be interloping with too many questions. The message she received was noncommittal. "She doesn't know yet."

  "What?"

  Her exclamation this time drew a be careful glare. "I just decided yesterday. But I've been thinking about it for weeks. Longer. I was hoping you two might have some suggestions as to how I should go about breaking the news to her."

  "Have you been to a counsellor or a shrink or something? " Jared asked the question. "It's too late."

  "What do you mean? You just said Ellen doesn't even know what you're planning to do." Jared sounded baffled. Across the table, Kate closed her eyes. She knew the explanation.

  "There's someone else, " Sandler said self-consciously. "A flight attendant. I… we've been seeing one another for some time." For Kate the words were like needle stabs. Jared was pressing to get a commitment from her to alter her life along pathways Ellen Sandler could negotiate blindfolded. Yet here was Sandy, like Jared in so many ways, rejecting the woman for not devoting enough energy to him. The image of Ellen sitting there while he announced his intentions made her first queasy and then frightened. The fear, as happened more often than not, mutated into anger before it could be expressed. "Ellen doesn't deserve this," she said, backing away from the table. We just lost one another. Sandy, don't you think that's sort of a sleazy explanation for what's really going on? How old is this woman?"

  "Twenty-six. But I don't see what her…"

  "I know you don't see. You don't see a lot of things."

  Jared stood up. "Now just one second, Kate."

  "And you don't see a lot of things either, dammit." There were tears streaming down her face. "You two boys work out how you're gonna break the news to Ellen that she did everything she goddamn well could in life-more than both of you put together, probably-but that it just wasn't enough. She's fired. Dismissed. Not flashy enough. Not showy enough. Her services are no longer required. Excuse me, I'm going to the bathroom to get sick. Then I'm going to my hospital. People there are grateful and appreciative for the things I do well. I like that. It helps me to get up in the morning."

  Fists clenched, she turned and raced from the room. Roscoe, who had settled himself under the table, padded to the center of the room and after a brief glance at the men, followed. Ginger Rittenhouse, a first-grade teacher, had just finished her run by the ice-covered Charles River when she began to die. Like the random victim of a crazed sniper, she did not hear the sound or see the muzzle flash of the weapon that killed her. In fact, the weapon was nothing more malevolent than the corner of her bureau drawer, the shot, an accidental bump less than twenty-four hours before to a spot just above her right eye. "That's one incredible lump! " her new roommate had exclaimed, forcing an icepack against the golfball-sized knot. The woman, a licensed practical nurse, had commented on the large bruise just below her right knee as well.

  Ginger was too self-conscious to mention the other, similar bruises on her lower back, buttocks, and upper arm. Her death began with a tic-an annoying electric sensation deep behind her right eye. The wall of her right middle cerebral artery was stretching. Bruised by the shock from the bureau drawer, the vessel, narrow as a piece of twine, had developed a tiny defect along the inner lining. The platelets and fibrinogen necessary to patch the defect were present, but in insufficient amounts to do the job. Blood had begun to work its way between the layers of the vessel wall. Squinting against the pain, she sat on a bench and looked across the river at the General Electric building in Cambridge. The outline of the building seemed blurred. From the rent in her right middle cerebral artery, blood had begun to ooze, a microdrop at a time, into the space between her skull and brain. Nerve fibers, exquisitely sensitive, detected the intrusion and began screaming their message of warning. Ginger, mindless of the huge lump over her ear, placed her hands on either side of her head and tried to squeeze the pain into submission. Powered by the beating of her own heart, the bleeding increased. Her thoughts became disconnected snatches. The low skyline of Cambridge began to fade. Behind her, runners jogged by. A pair of lovers passed close enough to read the dial on her watch. Ginger, now paralyzed by pain that was far more than pain, was beyond calling for help.

  Suddenly, a brilliant white light replaced the agony. The heat from the light bathe the inside of her eyes. Her random thoughts coalesced about woods and a stream. It was the Dingle, the secret hiding place of her childhood. She knew every tree, every rock. Home and safe at last, Ginger Rittenhouse surrendered to the light, and gently toppled forward onto the sooty snow.

  Monday 10 December

  .

  First there was the intense, yellow white light-the sunlight of another world. Then, subtly, colors began to appear, reds and pinks, purples and blues. Kate felt herself drifting downward, Alice drawn by her own curiosity over the edge and down the rabbit's hole. How many times had she focused her microscope in on a slide? Tens of thousands, perhaps even hundreds of thousands.

  Still, every journey through the yellow-white light began with the same sense of anticipation as had her first. The colors darkened and coalesced into a mosaic of cells, the cells of Beverly Vitale's left ovary, chemically fixed to prevent decay, then embedded in a block of paraffin, cut thin as a slick of oil, and finally stained with dyes specific for coloring one or another structure within the cell. Pink for the cytoplasm, mottled violet for the nuclei, red for the cell walls.

  With a deep breath calculated at once to relax herself and to heighten her concentration, she focused the lenses and her thoughts on the cells, now magnified a thousand times. Her efforts were less successful than usual. Thoughts of Sandy and Ellen, of Jared and the 26-S discussion they had had following her return from the hospital the previous night, continued to intrude. She had come home late, almost eleven, after meeting with Tom Engleson, interviewing Beverly Vitale, examining the frozen section of her ovary, and finally spending an hour in the hospital library. Her expectations had been to find the former roommates in the den, comatose or nearly so, with the essence of a half a case of Lowenbrdu permeating the room. Instead, she had found only a somber and perfectly sober Jared. "Hi, " he said simply. "Hi, yourself." She kissed him on the forehead and then settled onto the ottoman by his chair.

  "When did Sandy leave?"

  "A couple of hours ago. Did you get done whatever it is you wanted to?"

  Kate nodded. His expression was as flat and as drained as his words. No surprise, she realized. First his wife stalks out of the house with no real explanation, then he has to listen to the agonies of the breakup of his best friend's marriage. "I… I guess I owe you an apology for the way I acted earlier. Some sort of explanation." Jared shrugged. "I'll take the apology. The explanation's optional."

  "I'm sorry for leaving the way I did."

  "I'm sorry you left the way you did, too. I could have used some help-at least some moral support."

  "Sorry again." The three feet separating them might as well have been a canyon. "Anything decided?"

  "He went home to tell Ellen and to move out, I guess. It got awful quiet here after you left. Neither of us was able to open up very well. We each seemed to be wrapped up in our own bundle of problems."

  "Three I'm sorries. That's my limit." She unsnapped her barrette, shook her hair free, and combed it out with her fingers. The gesture was natural enough, but at some level she knew she had done it because it was one Jared liked. "After what happened this morning-in the car, I mean-I couldn't listen to Sandy just brush off Ellen and their marriage the way he did. I mean, here I am, scrambling to do a decent job with my career and to be a reasonably satisfying friend and wife to you, and there's
Ellen able to do both of those so easily and raise three beautiful, talented children to boot, and…"

  "It's not right what you're doing, Kate."

  "What's that?"

  "You're comparing your insides to Ellen's outsides, that's what. She looks good. I'll give you that. But don't go and cast Sandy as the heavy just because he's the one moving out. There are things that are missing from that relationship. Maybe things too big to overcome. What's that got to do with our discussion this morning, anyway?"

  "Jared, you know perfectly well what it has to do. Having children is a major responsibility. As it is, I feel like a one-armed juggler half the time. Our lives, our jobs, the things we do on our own and together…

  Toss in a baby at this point, and what guarantee is there I won't start dropping things?"

  "What do you want me to say? I'm almost forty years old. I'm married. I want to have children. My wife said she wanted to have children, too.

  Now, all of a sudden, having children is a threat to our marriage."

  "Christ, Jared, that's not what I mean… and you know it. I didn't say I won't have children. I didn't say it's a threat to our marriage. All I'm trying to say is there's a lot to think about-especially with the opportunities that have arisen at the hospital. It's not the idea I'm having trouble with so much as the timing. A mistake here and it's a bitter, unfulfilled woman, or a neurotic, insecure kid, or… or a twenty-six-year-old stewardess. Can you understand that?"

  "I understand that somewhere inside you there are some issues you're not facing up to. Issues surrounding me or having children or both."

  "And you've got it all together, right? " Kate struggled to stop the tears that seemed to be welling from deep within her chest. "I know what I want."

  "Well, I don't. Okay?

  And I'm the one who's going to have to pass up a chairmanship and go through a pregnancy and change my life so that I don't make the same horrible mistakes with our child that my mother made with us. I…

  Jared, I'm frightened." It was, she realized, the first time she had truly recognized it. "Hi, Frightened. I'm Perplexed. How do you do?"

  "You know, you could use a little better sense of timing yourself."

  "Okay, folks, here we go. It's time once again to play let's-jump-all over-everything-Jared-says. Well, please, before you get rolling, count me out. I'm going to bed."

  "I'll be in in a while."

  "Don't wake me."

  The section from Beverly Vitale's left ovary was unlike any pathology Kate had ever encountered. The stroma-cells providing support and, according to theory, critical feminizing hormones-were perfectly normal in appearance. But the follicles-the pockets of nutrient cells surrounding the ova-were selectively and completely destroyed, replaced by the spindle-shaped, deep pink cells of sclerosis-scarring. Assumin'g the pattern held true throughout both ovaries-and there was no reeison to assume otherwise-Beverly Vitale's reproductive potential was as close to zero as estimate would allow. For nearly an hour, Kate sat there, scanning section after section, taking notes on a yellow legal pad. Why couldn't Jared understand what it all really meant to her? Why couldn't he see what a godsend medicine had been to a life marked by aimlessness and a self-doubt bordering on self-loathing. "My God, woman, if I didn't know better, I'd swear you were a model the Zeiss Company had hired to plug their latest line of microscopes."

  "Aha, " Kate said melodramatically, her eyes still fixed on the microscope, "a closet male chauvinist pig. I expected as much all. along, Dr. Willoughby." She swung around and, as always, felt a warm jet of affection at the sight of her department head. In his early sixties, Stan Willoughby was egg bald save for a pure white monk's fringe. The pencil-thin moustache partially obscured by his bulbous nose was a similar shade. His eyes sparkled from beneath brows resembling endstage dandelions. In all, Jared's likening him to the wise imp Yoda was, though inappropriate, not inaccurate. Willoughby packed his pipe and straddled the stool across the table from Kate. "The young lady on Ashburton Five? " he asked. Kate nodded. "This a good time for me to take a look-see?"

  Although Willoughby's primary area of interest was histochemistry, thirty-five years of experience had made him an expert in almost every phase of pathology. Every phase, that is, except how to administer a department. Willoughby was simply too passive, too nice for the dogmaim-dog world of hospital politics, especially the free-for-all for an adequate portion of a limited pool of funds. "Stan, I swear I've never seen, or even heard of, anything like this."

  The chief peered into the student eyepieces on the teaching microscope-a setup enabling two people to view the same specimen at the same time.

  "All right if I focus? " Kate nodded. Ritualistically, he went from low power magnification to intermediate, to high, and finally to thousand-fold oil-immersion, punctuating each maneuver with a "hmm" or an "uh huh." Through the other set of oculars, Kate followed. They looked so innocent, those cells, so deceptively innocent, detached from their source and set out for viewing. They were in one sense a work of art, a delicate, geometrically perfect montage that was the antithesis of the huge, cluttered metal sculptures Kate had built and displayed during her troubled Mount Holyoke years. The irony in that thought was immense. Form follows function. The essential law of structural design.

  Yet here were cells perfect in form, produced by a biologic cataclysm tantamount to a volcano. A virus? A toxin? An antibody suddenly transformed?

  The art of pathology demanded that the cells and tissues, though fixed and stained, never be viewed as static. "Did you send sections over to the electron microscopy unit? " Willoughby asked. "Not yet, but I will."

  "And the young woman is bleeding as well? "

  "Platelets thirty thousand. Fibrinogen fifteen percent of normal." 7. all "Ouch!"

  "Yes, ouch. I spoke with her at some length last night. No significant family history, no serious diseases, nonsmoker, social drinker, no meds …"

  "None?"

  "Vitamins and iron, but that's all. No operations except an abortion at the Omnicenter about five years ago." The two continued to study the cells as they talked. "She's a cellist with the Pops."

  "Travel history?"

  "Europe, China, Japan. None to third world spots. I told her how envious I was of people who could play music, and she just smiled this wistful smile and said that every time she picked up her cello, she felt as rich and fulfilled as she could ever want to feel. I only talked to her for half an hour or so, Stan, but I came away feeling like we were… I don't know, like we were friends." Spend a day here sometime, Jared.

  Come to work with me and see what I do, how I do it. "The hematology people are talking autoimmune phenomenon. They think the ovarian problem is long-standing, a coincidental finding at this point."

  "Never postulate two diseases when one will explain things." Willoughby restated the maxim he had long since engrained upon her. "I suppose they're pouring in steroids."

  "Stan, she's in trouble. Real trouble."

  "Ah, yes. Forgive me. Sometimes I forget that there's more to this medicine business than just making a correct diagnosis. Thanks for not letting me get away with that kind of talk. Well, Doctor, I think you may really have something here. I have never encountered anything quite like it either."

  "Neither had Dr. Bartholomew."

  "That fossil? He probably has trouble recognizing his own shoes in the morning. Talk about a menace. AJI by himself he's an epidemic."

  "No comment."

  "Good. I have enough comments for both of us. Listen, Kate. Do you mind if I try a couple of my new silver stains on this material? The technique seems perfect for this type of pathology."

  "I was about to ask if you would."

  Willoughby engaged the intercom on the speaker-phone system one of the few innovations he had managed to bring into the department. "Sheila, is that you?"

  "No, Doctor Willoughby, it's Jane Fonda.

  Of course it's me. You buzzed my office."

  "Co
uld you come into Dr. Bennett's office, please? " There was no response. "Sheila, are you still there?"

  "It's not what it sounds like, Dr. Willoughby," she said finally. "Not what what sounds like?"

  "Sheila, " Kate cut in firmly, "it's me. We're calling because we have a specimen we'd like to try the silver stain on."

  For a few moments there was silence. "I… I'll be over shortly, " the technician said. Willoughby turned to Kate, his thick brows presaging his question.

  "Now what was that little ditty all about?"

  "Nothing, really-, "Nothing? Kate, that woman has worked for me for fifteen years. Maybe more. She's cynical, impertinent, abrasive, aggressive, and at times as bossy as my wife, but she's also the best and brightest technician I've ever known. If there's trouble between the two of you, perhaps I'd best know about it. Is it that study of the department I commissioned you and your eomputer friend, Sebastian, to do?"

  "It's nothing, Stan. I mean it. Like most people who are very good at what they do, Sheila has a lot of pride. Especially when it comes to her boss of fifteen years. I know it's not my place to decide, but if it's okay, I'd like the chance to work through our differences without involving you. Okay?"

  Willoughby hesitated and then shrugged and nodded. "Thanks, " she said.

  "If I were ever to take over the chairmanship of the department, I'd like to know I had a solid relationship with my chief technician-especially if she were someone as invaluable as Sheila Pierce."

  "Invaluable is right. I keep giving her raises and bonuses even though she puts a knot in my ninny just about every time she opens her mouth.

  Say, did I hear you just give me the green light to submit your name to Reese?"

  "I said if and you know it."

  Willoughby grinned mischievously. "Your voice said if, but your eyes…"