Side Effects (1984)

by Palmer, Michael

  It had been some time since Kate had had reason to visit the pathology unit at White Memorial, and she was uncomfortably impressed with the improvements and expansion that had occurred. Equipment her department congratulated itself on acquiring, this unit possessed in duplicate or triplicate. Corridors and offices were brightly lit, with plants, paintings, and other touches that made the work environment less tedious and oppressive. Almost subconsciously, Kate found herself making mental lists of things she would press to accomplish as chief of pathology at Metro.

  Leon Olesky, a mild, Lincolnesque man, brushed off her apologies for her tardiness and after exchanging compliments about Stan Willoughby, left her alone in his office with the material from the autopsy of Ginger Rittenhouse. On a pink piece of paper by his elegant microscope were the data on the woman’s blood studies. Only two of many parameters measured were abnormal: fibrinogen and platelets. The levels of each were depressed enough to have been life threatening. Her hands trembling with anticipation, Kate took the first of the ovarian sections and slid it onto the stage of the microscope. A moment to flex tension from the muscles in her neck, and she leaned forward to begin another journey through the yellow-white light.

  Forty-five minutes later, the one had become three. Leon Olesky hunched over one set of oculars of the teaching microscope, controlling the focus with his right hand and moving the slide with his left. Across from him, in the seat Kate had occupied, was Tom Engleson.

  “You know,” Olesky said, “if Stan hadn’t called me about your case, the findings on our young woman would have slipped right past us. I mentioned the matter last night at our weekly department conference, but no one responded. An hour later, Dr. Hickman came to my office. Young Bruce is, perhaps, the brightest of our residents, but at times, I’m afraid, a bit too quick for his own good.”

  Kate sighed. Olesky’s observations described many of the so-called hotshot residents she had worked with over the years. “I’ll take methodical over genius any day of the week,” she said.

  “Both is best,” Olesky responded, “but that’s a rare combination, indeed. I might mention, though, that it is a combination your mentor feels he is lucky to have found in you.”

  “Methodical, yes,” Kate allowed, “but I’ve yet to receive a single membership application from Mensa.”

  “She’s only the best in the hospital,” Tom interjected somewhat impetuously.

  “Finish telling us about your resident.” Kate withheld reaction to Engleson’s enthusiasm, sensing that what she felt was, in equal parts, flattered and embarrassed.

  “Well, it seems our Dr. Hickman was uncertain about the pathology he was seeing in this woman’s ovaries. However, rather than think that the finding might be unique, he assumed, although he won’t say so in as many words, that the condition was one he should have known about, and hence one he would look foolish asking for help with. Since the cause of death was unrelated to the ovaries, he chose to describe his findings in the autopsy report and leave it at that.”

  “No harm done,” Kate said.

  “Quite the contrary, in fact. This event may be the pinprick Hickman’s ego needs so he can reach his full potential as a physician. It will make even more of an impression if, as Dr. Willoughby and now yours truly, suspect, this pathology turns out to be one never before described.”

  Kate and Tom exchanged excited glances. “How would you explain its showing up in two woman in the same city at about the same time?” she asked.

  The professor’s eyes, dark and deeply serious, met first Engleson’s and then Kate’s. “Considering the outcome of the illness in both individuals, I would suggest that we work diligently to find an answer to that question. At the moment, I have none.”

  “There must be a connection,” Engleson said.

  “I hope there is, young man.” Olesky rose from his stool. “And I hope the two of you will be able to find it. I have a class to teach right now at the medical school. This evening, I leave for meetings in San Diego, and from there, I go to the wedding of my son in New Mexico. My office and our department are at your disposal.”

  “Thank you,” they said.

  Olesky replaced his lab coat with a well-worn mackintosh. He shook hands first with Engleson and then with Kate. A final check of his desk and he shambled from the office.

  Kate waited for the door to click shut. “I’m glad you were able to get here so quickly,” she said. “Did you have any trouble getting the records people to let you take Beverly’s chart out of the hospital?”

  “None. I just followed Engleson’s first law of chutzpah. The more one looks like he should be doing what he’s doing, the less anyone realizes that he shouldn’t. I’ll have to admit that the crooks with moving vans and uniforms who pick entire houses clean thought of the law before I did, but I was the first one I know to put it in words. Are you okay? I went to find you after the code was over yesterday, but you were gone. Before I could call, I was rushed to the OR to do an emergency C-section.”

  “I was okay.” She paused. “Actually, I wasn’t. It hurt like hell to see her lying there like that. I can’t remember the last time I felt so helpless.” At the thought, the mention of the word, Arthur Everett’s grotesque face flashed in her mind, his reddened eyes bulging with the effort of forcing himself inside her. Yes, I do, she thought. I do remember when. “How about you?” she asked.

  Engleson shrugged. “I think I’m still numb. It’s like I’m afraid that if I let down and acknowledge my feelings about her and what happened, I’ll never set foot in a hospital again.”

  Kate nodded her understanding. “You know, Tom, contrary to popular belief, being human doesn’t disqualify you from being a doctor. Are you married?” Engleson shook his head. “I think it’s hard to face some of the things we have to face and then have no one to talk them out with, to cry on, if necessary, when we get home.” She thought about the difficult morning with Jared and smiled inwardly at the irony of her words. “Had you known Beverly outside the hospital?”

  “No. I met her when she came into Metro. But I thought about trying to start up a relationship as soon as she …” His voice grew husky. He cleared his throat.

  “I understand,” Kate said. “Look, maybe we can talk about our work and our lives in medicine some day soon. Right now, we’ve got to start looking for some common threads between these women. I’m due back at Metro in,” she checked her watch, “—shoot, I’ve only got about twenty minutes.”

  Tom was thumbing through the thin sheaf of papers dealing with Ginger Rittenhouse. “It shouldn’t take long to check. They have next to no information here. Ginger Louise Rittenhouse, twenty-eight, elementary school teacher, lived and worked in Cambridge, but she was running along the Boston side of the river when she collapsed. Apparently she lived long enough to get an emergency CAT scan, but not long enough to get to the OR.”

  “Married?” Kate asked.

  “No. Single. That’s the second time you’ve asked that question about someone in the last two minutes.” He narrowed one eye and fingered his moustache. “You have, perhaps, a marriage fixation?”

  Kate smiled. “Let’s leave my fixations out of this. At least for the time being, okay? What about family? Place of birth? Next of kin? Did they document any prior medical history?”

  “Hey, slow down. We obstetricians are hardly famous for our swift reading ability. No known medical history. Next of kin is a brother in Seattle. Here’s his address. You know, world’s greatest hospital or not, they take a pretty skimpy history.”

  “It doesn’t look like they had time for much more,” Kate said solemnly. There had to be a connection, she was thinking. The two cases were at once too remarkable and too similar. Somewhere, the lives of a teacher from Cambridge and a cellist from a suburb on the far side of Boston had crossed.

  “Wait,” Engleson said. “She had a roommate. It says here on the accident floor sheet. Sandra Tucker. That must be how they found out about her family.”

>   Kate again checked her watch. “Tom, I’ve got to go. I promised Dr. Willoughby I’d help out with the post on Bobby Geary. Do you think you could try and get a hold of this Sandra Tucker? See if our woman has seen a doctor recently or had a blood test. Don’t teachers need yearly physicals or something?”

  “Not the ones I had. I think their average age was deceased.”

  “Are you going to call from here?” Engleson thought for a moment and then nodded. “Fine, give me a ring when you get back to Metro. And Tom? Thanks for the compliment you paid me before.” She reached out and shook his hand, firmly and in a businesslike manner. Then she left.

  With the pistol-shot crack of bat against ball, thirty thousand heads snapped in horror toward the fence in right center field.

  “Jesus, Katey, it’s gone,” was all Jared could say.

  The ball, a white star, arced into the blue-black summer night sky. On the base paths, four runners dashed around toward home. There were two out in the inning, the ninth inning. The scoreboard at the base of the left-field wall in Fenway Park said that the Red Sox were ahead of the Yankees by three runs, but that lead, it appeared, had only seconds more to be.

  Kate, enthralled by the lights and the colors and the precision of her first live baseball game, stood frozen with the rest, her eyes fixed on the ball, now in a lazy descent toward a spot beyond the fence. Then into the corner of her field of vision he came, running with an antelope grace that made his movements seem almost slow motion. He left the ground an improbable distance from the fence, his gloved left hand reaching, it seemed, beyond its limits, up to the top of the barrier and over it. For an instant, ball and glove disappeared beyond the fence. In the next instant, they were together, clutched to the chest of Bobby Geary as he tumbled down onto the dirt warning track to the roar of thirty thousand voices. It was a moment Kate would remember for the rest of her life.

  This, too, was such a moment.

  The body that had once held the spirit and abilities of Bobby Geary lay on the steel table before her, stripped of the indefinable force that had allowed it to sense and react so remarkably. To one side, in a shallow metal pan, was the athlete’s heart, carefully sliced along several planes to expose the muscle of the two ventricles—the pumping chambers—and the three main coronary arteries—left, right, and circumflex. Images of that night at Fenway more than four years ago intruded on Kate’s objectivity and brought with them a wistfulness that she knew had no place in this facet of her work.

  “Nothing in the heart at all?” she asked for the second time.

  Stan Willoughby, leprechaunish in green scrubs and a black rubber apron, shook his head. “Must a’ bin somethin’ he et,” he said, by way of admitting that, anatomically at least, he had uncovered no explanation for the pulmonary edema, fluid that had filled Bobby Geary’s lungs and, essentially, drowned him from within.

  Kate, clad identically to her chief, examined the heart under a high-intensity light. “Teenage heart in a thirty-six-year-old man. I remember reading somewhere that he intended to keep playing until he was fifty. This heart says he might have made it.”

  “This edema says ‘no way,’ ” Willoughby corrected. “I’m inclined to think dysrhythmia and cardiac arrest on that basis. Preliminary blood tests are all normal, so I think it possible we may never know the specific cause.” There was disappointment in his voice.

  “Sometimes we just don’t,” Kate said. The words were Willoughby’s, a lesson he had repeated many times to her over the years.

  Willoughby glared at her for a moment; then he laughed out loud. “You are a saucy pup, flipping my words back at me like that. Suppose you tell me what to say to the police lieutenant drinking coffee and dropping donut crumbs right now in my office, or to the gaggle of reporters in the lobby waiting for the ultimate word. Ladies and gentlemen, the ultimate word from the crack pathology department you help support with your taxes is that we are absolutely certain we have no idea why Bobby Geary went into a pulmonary edema and died.”

  Kate did not answer. She had grabbed a magnifying glass and was intently examining Geary’s feet, especially between his toes and along the inside of his ankles. “Stan, look,” she said. “All along here. Tiny puncture marks, almost invisible. There must be a dozen of them. No, wait, there are more.”

  Willoughby adjusted the light and took the magnifier from her. “Holy potato,” he said softly. “Bobby Geary an addict?” He stepped back from the table and looked at Kate, who could only shrug. “If he was, he was a bloomin’ artist with a needle.”

  “A twenty-seven or twenty-nine gauge would make punctures about that size.”

  “And a narcotics or amphetamine overdose would explain the pulmonary edema.” Kate nodded. “Holy potato,” Willoughby said again. “If it’s true, there must be evidence somewhere in his house.”

  “Unless it happened with other people around and they brought him home and put him to bed. Why don’t we send some blood for a drug screen and do levels on any substance we pick up?”

  Willoughby glanced around the autopsy suite. The single technician on duty was too far away to have heard any of their conversation. “What do you say we label the tube ‘Smith’ or ‘Schultz’ or something. I’m no sports fan, but I know enough to see what’s at stake here. The man was a hero.”

  “What about the policeman?”

  “His name’s Detective Finn, and he is a fan. I think he’d prefer some kind of story about a heart attack, even if the blood test is positive.”

  “Schultz sounds like as good a name as any,” Kate said. “Are these the tubes? Good. I’ll have new labels made up.”

  “I’ll send Finn over to the boy’s place, and then I’ll tell the newsnoses they will just have to wait until the microscopics are processed. Now, when can you give me a report on the goings on at the WMH?”

  “Well, beyond what I’ve already told you, there’s not much to report. We’ve got some sort of ovarian microsclerosis in two women with profound deficiencies of both platelets and fibrinogen. At this point, we have no connections between the two, nothing even to tell us for sure that the ovarian and blood problems are related.”

  “So what’s next?”

  “Next? Well, Tom Engleson, the resident who was involved with Beverly Vitale, is trying to get some information from the roommate of the WMH woman.”

  “And thou?”

  Kate held her hands to either side, palms up. “No plan. I’m on surgicals this month, so I’ve got a few of those to read along with a frozen or two from the OR. After that I thought I’d talk to my friend Marco Sebastian and see if that computer of his can locate data on a woman named Ginger Rittenhouse.”

  “Sounds good,” Willoughby said. “Keep me posted.” He seemed reluctant to leave.

  “Is there anything else?” Kate asked finally.

  “Well, actually there is one small matter.”

  “All right, let me have it.” Kate knew what was coming.

  “I … um … have a meeting scheduled with Norton Reese this afternoon. Several members of the search committee are supposed to be there and well … I sort of wondered if you’d had time to …” Willoughby allowed the rest of the thought to remain unspoken.

  Kate’s eyes narrowed. He had promised her a week, and it had been only a few days. She wasn’t at all ready to answer. There were other factors to consider besides merely “want to” or “don’t want to.” Willoughby had to understand that. “I’ve decided that if you really think I can do it, and you can get all those who have to agree to do so, then I’ll take the position,” she heard her voice say.

  The girl’s name was Robyn Smithers. She was a high school junior, assigned by Roxbury Vocational to spend four hours each week working as an extern in the pathology department of Metropolitan Hospital. Her role was simply defined: do what she was told, and ask questions only when it was absolutely clear that she was interrupting no one. She was one of twelve such students negotiated for by Norton Reese and paid fo
r by the Boston School Department. That these students learned little except how to run errands was of no concern to Reese, who had already purchased a new word processor for his office with the receipts from having them.

  Robyn had made several passes by Sheila Pierce’s open door before she stopped and knocked.

  “Yes, Robyn, what can I do for you?”

  “Miss Pierce, I’m sorry for botherin’ you. Really I am.”

  “It’s fine, Robyn. I was beginning to wonder what you were up to walking back and forth out there.”

  “Well, ma’am, it’s this blood. Doctor Bennett, you know, the lady doctor?”

  “Yes, I know. What about her?”

  “Well, Dr. Bennett gave me this here blood to take to …” she consulted a scrap of paper, “Special Chemistries, only I can’t find where that is. I’m sorry to bother you while you’re working and all.”

  “Nonsense, child. Here, let me see what you’ve got.”

  Casually, Sheila glanced at the pale blue requisition form. The patient’s name, John Schultz, meant nothing to her. That in itself was unusual. She made it her business to know the names of all those being autopsied in her department. However, she acknowledged, occasionally one was scheduled without her being notified. In the space marked “Patient’s Hospital Number” the department’s billing number was written. The request was for a screen for drugs of abuse. Penned along the margin of the requisition was the order, “STAT: Phone results to Dr. K. Bennett ASAP.”