Side Effects

by Michael Palmer

  Paquette set the report aside and tried to remember what Norton Reese had been graded on Redding's scale. An eight? And what about himself?

  "A ten, " he muttered. "Move over Bo Derek. Here comes Arlen Paquette, an absolute ten." He poured a second drink, this one pure Dewar's, and buried it. In minutes, the amber softness had calmed him enough for him to begin some assessment of the situation. Bennett had sent specialists to the Omnicenter to take cultures. No problem. If they were negative, as he suspected they would be, the clinic had gotten a free, comprehensive microbiology check. If they were positive, investigation would move away from the pharmacy anyhow. She had asked for, and received, samples of the pharmaceuticals dispensed by Horner's Monkeys.

  No problem. The samples would prove to be clean. Horner had seen to that. Would she press her investigation further? Stein's report and what he knew of the woman said yes. However, that was before she had become mired down in the baseball player mess. The more he thought about the situation, the more convinced Paquette became that there was no avenue through which Kate Bennett could penetrate the secret of the Omnicenter, especially since all product testing had been suspended. Tenacity or no tenacity, the woman could not keep him away from home for more than a few days. As he mixed another drink, Paquette realized that there was, in fact, a way. It was a twisting, rocky footpath rather than an avenue, but it was a way nonetheless. After a moment of hesitation, he placed a call to the 202 area.

  "Good afternoon. Ashburton Foundation."

  "Estelle?"

  "Yes."

  "It's Dr. Thompson."

  "Oh. Hi, Doctor. Long time no hear."

  "Only a week, Estelle. Everything okay?"

  "Fine."

  "Any calls?"

  "Just this one. I almost jumped out of my skin when the phone rang. I mean days of doing nothing but my nails, I…"

  "Any mail?"

  "Just the two pieces from Denver I forwarded to you a while ago."

  "I got them. Listen, if any calls come in, I don't want you to wait until I check in. Call me through the numbers on the sheet in the desk.

  The message will get to me, and I'll call you immediately."

  "Okay, but…"

  "Thank you, Estelle. Have a good day."

  "Good-bye, Dr. Thompson."

  To Kate Bennett the scene in Room 6 of the Metropolitan Hospital emergency ward was surreal. Off to one side, two earnest hematology fellows were making blood smears and chatting in inappropriately loud tones. To the other side, Tom Engleson leaned against the wall in grim silence, flanked by a nurse and a junior resident. Kate stood alone by the doorway, alternating her gaze from the crimson-spattered suction bottle on the wall to the activity beneath the bright overhead light in the center of the room. Pete Colangelo, chief of otorhinolaryngology, hunched in front of Ellen Sandler, peering through the center hole of his head mirror at a hyperilluminated spot far within her left nostril. "It's high. Oh, yes, it's high, " he murmured to himself as he strove to cauterize the hemorrhaging vessel that because of its location, was dripping blood out of Ellen's nose and down the back of her throat.

  Kate looked at her friend's sheet-covered legs and thought about the bruise, the enormous bruise, which had been a harbinger of troubles to come. Don't let it be serious. Please, if you are anything like a God, please don't let her tests come back abnormal. In the special operating chair, Ellen sat motionless as marble, but her hands, Kate observed, were whitened from her grip on the armrest. Please… "Could you check her pressure? " Colangelo asked. He was a thin, minute man, but his hands were remarkable, especially in the fine, plastic work from which surgical legends were born. Kate was grateful beyond words that she had found him available. Still, she knew that the real danger lay not so much in what was happening as in why. Gruesome images of Beverly Vitale and Ginger Rittenhouse churned in her thoughts. At that moment, in the hematology lab, machines and technicians were measuring the clotting factors in a woman who was no more than a name and hospital number to them. Please… Colangelo's assistant reported Ellen's pressure at one-forty over sixty. No danger there. The jets of blood into the suction bottle seemed to be lessening, and for the first time Kate sensed a slight letup in the tension around the room. "Come to papa,"

  Colangelo cooed to the bleeding arteriole. "That's the little fellow.

  Come to papa, now."

  "What do you think?"

  Kate spun to her left. Tom Engleson had moved next to her. "Sorry, " he whispered. "I didn't mean to startle you." The concern she was feeling was mirrored in his face. His brown eyes, dulled somewhat by the continued pressures of his job, were nonetheless wonderfully expressive.

  "I think Pete is winning, " she said, "if that's what you're asking."

  "It isn't."

  "In that case, I don't have an answer. At least not yet. Not until the hematology report comes back." She continued speaking, but turned her gaze back to the center of the room. "If her counts are normal, and you have the time, we can celebrate. I'll buy you a coffee. If they're low, I'd like to-wait, make that need to-talk with you anyhow. Besides Stan Willoughby, you are the only one who knows as much as I do, and I think these past two days Stan has been battered enough by his association with me."

  "I'm free for the rest of the day, " Tom said. "If you like, maybe we could have dinner together." The moment the words were out, he regretted saying them. Impetuous, inappropriate, tactless, dumb. Kate responded with a fractional look-far too little for him to get a fix on. "I think Pete's done it, " she said, making no reference to his invitation.

  Moments later, Colangelo confirmed her impression. "We've got it, Mrs.

  Sandler. You just stay relaxed the way you have been, and we should be in good shape. You are a wonderful patient, believe me you are. I love caring for people who help me to do my best work." He took a step back and waited, the reflected light from his head mirror illuminating the blood-smeared lower half of Ellen's face. Then he turned to Kate, his lips parted in a hopeful half-smile. "Good job, Pete, " she whispered.

  "Damn good."

  Colangelo nodded and then turned back to his patient. "Mrs. Sandler, I think it best for you to stay overnight here. There are some lab studies that haven't come back yet, and I would also like to be sure that vessel stays cauterized."

  "No, " Ellen said. "I mean, I can't. I mean I don't want to if I don't have to. Kate, tell Dr. Colangelo all the things I have to do, and how responsible I am, and how I'll do exactly what he tells me to do if I can go home. Please, Kate. No offense, but I hate hospitals. Hate them.

  I almost had Betsy in a roadside park because I wanted to wait until the last minute."

  Kate crossed to her friend and wiped the dried blood from her face with damp gauze. "Let's see, " she said finally. "As I see it, you want me to arbitrate a disagreement in medical philosophy between the chief of ENT surgery, who also happens to be a professor at Harvard, and the chief of E. Sandler Interior Designs, Inc…"

  "Kate, please."

  Ellen's grip on Kate's hand and the quaver in her voice reflected a fear far more primal than Kate had realized. Kate turned to the surgeon.

  "Pete?"

  Colangelo shrugged. "I get paid to do surgery and give advice," he said.

  "If you're asking me whether I think admission is one hundred percent necessary, the answer is no. However, as I said, I get paid to give advice, and observation in the hospital is my advice."

  Before Kate could respond, a white-coated technician from the hematology service entered and handed her three lab slips, two pink and one pale green. She studied the numbers and felt a grinding fear and anger rise in her throat. "Lady, " she said, struggling to mask the tension in her voice, I'm going to cast in with Dr. Colangelo. I think you ought to stay."

  Ellen's grip tightened. "Kate, what do the tests show? Is it bad?"

  "No, El. A couple of the numbers are off a bit and should be rechecked, but it's not bad or dangerous at this point."

  Sile
ntly, she prayed that her judgment of the woman's strength was correct, and that she had done the right thing in not lying. Ellen studied her eyes.

  "Not bad or dangerous at this point, but it could be. Is that what you're saying? " Kate hesitated and then nodded. Ellen sighed. "Then I guess I stay, " she said. "You shouldn't be here long, and you'll have the very best people taking care of you. I'll help you make arrangements for the girls, and I'll also let them know what's going on."

  "Thank you."

  "I know it sounds foolish to say don't worry, but try your best not to.

  We'll keep an eye on your nose and recheck the blood tests in the morning. Most likely you'll be home by the end of the weekend."

  Kate fought to maintain an even eye contact, but somewhere inside she knew that her friend didn't believe the hopeful statement any more than she did. "It's the Omnicenter. Somehow I just know it is."

  Kate grimaced at the coffee she had just brewed, and lightened it with half-and-half ferreted out from among the chemicals in her office refrigerator. "The Omnicenter is just that pile of glass and stone across the street. Every one of these reports is negative. Bacteriology, chemistry, epidemiology. All negative. Where's the connection? " Tom Engleson flipped through a sheaf of reports from the studies Kate had ordered. There was nothing in any of them so far to implicate the outpatient center. "I don't know, " Kate responded, settling in across the work bench from him. He was dressed in jeans and a bulky, ivory fisherman's sweater. It was the first time she had seen the man wearing anything but resident's whites. The change was a positive one. The marvelous Irish knit added a rugged edge to his asthenic good looks. "I think it's a virus or some sort of toxin… or a contaminant in the pharmacy. Whatever it is is in there." She jabbed a thumb in the general direction of the Omnicenter. "The pharmacy? These reports say that the analyses of Ginger Rittenhouse's medications and of the ones Zimmermann sent you were all perfectly normal. Not a bad apple in the bunch."

  "I know."

  "So…?"

  "So, I don't know. Look, my friend has whatever this thing is that has killed two women. Platelets seventy thousand, fibrinogen seventy-five percent of normal. You saw the report. Not as bad as either of the other two, at least not yet, but sure headed in the wrong direction." Her words came faster and her voice grew more strident. "I don't really need you to come down here and point out the obvious. For that I can go get Gus from the newsstand outside. I need some thoughts on what might be the explanation, not on what can't be." Suddenly she stopped. "Jesus, I'm sorry, Tom. I really am. Between political nonsense here at the hospital, the mess with Bobby Geary and his damn amphetamine addiction, two young women dying like ours did, the everyday tensions of just trying to do this job right, and now Ellen, I'm feeling like someone has plunked me inside a blender and thrown the switch.

  You don't deserve this."

  "It's okay. I'm sorry for not being more helpful." He was unable to completely expunge the hurt from his voice, and Kate reminded herself that while the five or so years difference in their ages meant little in most areas, hypersensitivity might not be one of them. "If you think it's the pharmacy, " he said, "maybe you should call the FDA."

  "One jot of evidence, and I would. I'm the one who talked her into going to the Omnicenter in the first place." Absently, she slipped her hands into her lab coat pockets. In the right one, folded back and again on itself, was the cardboard and plastic card containing what remained of Ellen's Omnicenter vitamins plus iron. She set them on the bench. "No luck finding any of Beverly Vitale's vitamins? " she asked. "None."

  Kate crossed to her desk, returned with a medication card similar to Ellen's, and slapped it down next to the other. "I think we should try one last time with our friends at the toxicology lab and their magic spectrophotometer. Ellen's vitamins and these. If the reports come back negative, I shall put all my suspicions in the witch hunt file and turn my attention to other pursuits-like trying to regain some of the respect that was snatched away in the Bobby Geary disaster."

  "Don't worry, " Tom said, "you still have respect, admiration, and caring in a lot of places… especially right here." He tapped himself on the breastbone with one finger. "Thank you for saying that."

  "Whose pills are those other ones? " he asked. "Huh?"

  "The other card of pills, whose are they?"

  "Oh. They're mine."

  Friday 14 December

  There was an air of excitement and anticipation throughout the usually staid medical suite of Vernon Drexler, MD. The matronly receptionist bustled about the empty waiting room, straightening the magazines and taking pains to see that the six-month old issue of Practical Medical Science with Drexler's picture on the cover was displayed prominently enough to be impossible for Cyrus Redding to miss, even if he were ushered directly into the doctor's office. In the small laboratory, the young technician replaced the spool of paper in the cardiograph machine and realigned the tubes, needle, and plastic sleeve she would use to draw blood from the arm of the man Drexler had described as one of the most influential if not one of the wealthiest in the country. Behind her desk, Lurleen Fiske, the intense, severe office manager, phoned the last of their patients and rescheduled him for another day. She had been with Drexler in 1967, when Cyrus Redding had made his first trip up from Kentucky. Nineteen sixty-seven.

  Fiske smiled wistfully. Their office in the Back Bay section of Boston had been little more than two large closets then, one for the doctor and one for herself. Now, Drexler owned the entire building. It was twelve-thirty. Redding's private 727 had probably touched down at Logan already. In precisely an hour, the woman knew, his limousine would glide to a stop in front of their brownstone. Redding, on foot if he could manage it, in his wheelchair if he could not, would be helped up the walk and before entering the building, would squint up at their office window, smile, and wave. His aide, for the last five or six years a silent, hard-looking man named Nunes, would be carrying a leather tote bag containing Redding's medicines and, invariably, a special, personal gift for each of those working in the office. On Redding's last visit, nearly a year before, his gift to her had been the diamond pendant-almost half a carat-now resting proudly on her chest. Of course, she realized, this day could prove an exception. Some sort of pressing situation had arisen requiring Redding to fly to Boston. He had called the office late on the previous afternoon inquiring as to whether, as long as he had to be in the city, he might be able to work in his annual checkup. "Mrs. Fiske, " Drexler called from his office, "I can't remember.

  Did you say Dr. Ferguson would be coming in with Mr. Redding, or did you say he wouldn't be?"

  "I said might, Doctor. Mr. Redding wasn't sure." The woman smiled lovingly and shook her head. Vernon Drexler may have been a renowned endocrinologist, and a leading expert on the neuromuscular disease myasthenia gravis, but for matters other than medicine, his mind was a sieve. She and his wife had spent many amusing evenings over the years imagining the Keystone Comedy that would result were they not available to orchestrate his movements from appointment to appointment, lecture to lecture. The thought of Dr. Ferguson sent the office manager hurrying to the small, fire-resistant room housing their medical records, she returned to her desk with the man's file. John Ferguson, MD, afflicted, as was Cyrus Redding, with myasthenia, was a close friend of the tycoon.

  The two men usually arranged to have their checkups on the sameday, and then for an hour or so they would meet with Dr. Drexler. Lurleen Fiske suspected, though Drexler had never made her party to their business, that the two men were in some way supporting his myasthenia research laboratory at the medical school. "Mrs. Fiske, " Drexler called out again, "perhaps you'd better get Dr. Ferguson's chart just in case."

  "Yes, Doctor, I'll get it right away, " she said, already flipping through the lengthy record to ensure that the laboratory reports and notes from his last visit were in place. Drexler was nervous. She could tell from his voice. He was conducting himself with proper decorum!.. and profes
sional detachment, but she could tell nonetheless. Once, years before, he had been ferried by helicopter to Onassis's yatch for a consultation on the man's already lost battle against myasthenia. That morning, he had calmly bid the office staff good day and then had strode out minus his medical bag, journal articles, and sport coat. Redding's limousine, slowed by the snow-covered streets, arrived five minutes late. Lurleen Fiske joined the two other employees at the window. Across the room, Drexler, a tall, gaunt man in his midfifties, watched his staff pridefully. "Look, look. There he is, " the receptionist twittered. "Is he walking? " Drexler wanted to see for himself, but was reluctant to disrupt the ritual that had developed over the years.

  Lurleen Fiske craned her neck. "His wheelchair is out, " she said "but yes… yes, he's taking a few steps on his own. Another year, Dr.

  Drexler. You've done it again." There was no mistaking the reverence in her voice. In spite of himself, Drexler, too, was impressed. In sixty-seven he had predicted three years for Redding, four at the most.

  Now, after more than fifteen, the man was as strong as he had been at the start, if not stronger. You've done it again. Mrs. Fiske's praise echoed painfully in his thoughts. Myasthenia gravis, a progressive deterioration of the neuromuscular system. Cause, unknown. Prognosis, progressive weakness especially with exertion-fatigue, difficulty in chewing, difficulty in breathing, and eventually, death from infection or respiratory failure. Treatment, stopgap even at its most sophisticated. Yet here were two men, Redding and John Ferguson, who had, in essence, arrested or at least markedly slowed the progress of their disease. And they had performed the minor miracles on their own.