Marker

by Robin Cook

  After several other close calls with taxis along Central Park South, Jazz worked her way over to the East Side and then north on Madison to the Manhattan General Hospital. It was ten-fifteen when she pulled into the complex’s mammoth garage. One of the other benefits of working the graveyard shift was a plethora of parking spaces right near the garage’s entrance into the hospital on the second floor. Collecting her Blackberry and slipping it into her left coat pocket, Jazz crossed the pedestrian bridge and went into the hospital.

  As she had planned, she was a little early. She went directly to floor six, where she was assigned. It was a general surgical floor and always busy. After safely stashing her coat, she sat down at one of the computer terminals and casually typed in “Darlene Morgan.” The evening ward secretary ignored her, busy wrapping things up so she could leave.

  Jazz was pleased to learn that Darlene Morgan was in room 629 on Jazz’s floor, which made the mission that much easier. She could always go to other floors on her breaks and lunch hour, which she had done on previous missions, but there was always the mild concern about arousing attention.

  Leaving floor six, she took the elevator down to the first floor. There, she walked into the emergency room. As usual, it was pure pandemonium. Evening was its busiest time, and the waiting area was jammed with people and crying babies in all manner of illness and injury. It was the kind of chaos Jazz counted on. No one questioned when she walked into the storeroom where the parenteral or intravenous fluids were kept. Although she didn’t expect any interference, even if she was seen, she still looked around to make sure she wasn’t being observed. It was a reflex. When it was clear no one was watching her, she reached into the cardboard box containing the concentrated potassium chloride ampoules, took one out, and slipped it into her jacket pocket. As Mr. Bob had said, in the busy ER, it would never be missed.

  With the first part of her mission accomplished, Jazz returned upstairs to wait for the nursing report and for her evening shift to begin. More out of curiosity than anything else, she pulled Darlene Morgan’s chart to see if there was anything interesting or, for that matter, any explanation. Of course, she didn’t care whether there was or wasn’t.

  Mommy, I want you to come home tonight,” Stephen whined.

  Darlene Morgan patted the top of her eight-year-old’s head and exchanged a worried glance with her husband, Paul. Stephen was big for his age and at times could act reasonably mature, although that wasn’t the case at present. He was genuinely nervous about his mother being in the hospital and wouldn’t let go of her hand. Darlene had been surprised when Paul had showed up with the little guy in tow, since hospital rules dictated that visitors had to be twelve or older, and Stephen might have been big, but he didn’t look twelve. But Paul had explained that Stephen pleaded to come to the point that Paul was willing to gamble that enforcement of the twelve-and-over rule would be minimal and that the floor nurses would turn a blind eye.

  At first, Darlene had been glad to see Stephen, but now she was worried that there might be a tantrum if Paul inappropriately handled the departure issue. Paul had been trying to leave for half an hour and was understandably frustrated. With some difficulty, Darlene got her hand free and reached an arm around her son’s waist and pulled him over against the side of the bed.

  “Stephen,” she said softly. “You remember what we discussed yesterday. Mom had to have an operation.”

  “Why?”

  Darlene looked up at Paul, who rolled his eyes. Both knew that Stephen found the situation threatening, and he wasn’t going to make it easy. Darlene had explained everything to him over the weekend, but he obviously hadn’t comprehended.

  “I had to have my knee fixed,” Darlene said.

  “Why?”

  “You remember last summer when I hurt myself playing tennis? Well, I broke something in my knee called a ligament. The doctor had to make me a new one. Now I have to stay here overnight. Tomorrow night, I’ll be home, okay?”

  Stephen twirled the edge of the bedsheet in his fingers, avoiding his mother’s eyes.

  “Stephen, it’s way past your bedtime. You go home with Dad, and then when you wake up, it will be the day I come home.”

  “I want you home tonight!”

  “I know you do,” Darlene said. She leaned over and gave her son a hug. Then she winced and let out a little groan from having moved her operated leg more than she had planned. The leg was partially immobilized in a motorized apparatus that slowly but continuously flexed the joint.

  Paul stepped forward, put his hands on his son’s shoulders, and urged him to step away. Stephen allowed himself to be backed up. He’d heard his mother’s moan.

  “Are you all right?” Paul asked his wife.

  “Yeah,” Darlene managed. She readjusted herself in the bed. “I just have to leave my leg still.” She closed her eyes and breathed deeply, and the pain lessened.

  “This is quite a setup,” Paul said, nodding toward the apparatus. “We should thank our lucky stars we got into AmeriCare this fall. Otherwise, all this would have broken the bank.”

  “You’re not suggesting I shouldn’t have had the surgery, are you?”

  “Not in the slightest! I’m just thinking our old insurance wouldn’t have covered everything. Remember all those complicated deductibles and all that nonsense every time we tried to put in a claim? Hey, I’m just pleased everything is covered.”

  The little episode with the pain seemed to have a big effect on Stephen. It scared him enough to convince him that his mother needed to be in the hospital. Just a few minutes later, when Paul repeated that they had to go, he went without complaint.

  All of a sudden, Darlene found herself alone. During the afternoon, there had been constant activity in the hallway, but now stillness reigned. No one passed her open door. What she didn’t know was that all the nurses and aides from the evening shift, as well as those from the night shift, were having their report. The only sound was the distant, barely audible beep coming from a cardiac monitor someplace down the corridor.

  Darlene’s eyes roamed around her room, taking in the simple hospital furniture, the cut flowers from Paul on the bureau, the celery-green paint, and the framed Monet print. She shuddered to think of the life-and-death struggles the walls had witnessed over the years, but then quickly tried to erase the thought from her mind. It wasn’t easy. She didn’t like hospitals, and except for childbirth, had never been in one as a patient. Childbirth had been different. There was sense of happiness and anticipation that permeated the ward. Here, it was different and far more intimidating.

  Turning her head and looking up, she watched the drops fall soundlessly from the IV bottle into an expanded portion of the IV line. Watching it was hypnotizing, and after a few minutes, it took a bit of effort to pull her eyes away. The reassuring part was that piggybacked to the IV line was a small pump containing morphine, which meant that to a controlled degree, she could medicate herself. So far she had done it only twice.

  A TV was suspended above the foot of her bed, and she turned it on, more for company than anything else. The local evening news was in progress. She turned down the sound, preferring only to watch, her mind addled from a combination of the morning’s anesthesia and the narcotic pain medication. The machine continued flexing her leg, but she was strangely detached from it, as if it were someone else’s leg.

  An hour passed effortlessly in a state midway between sleep and full consciousness. It was more like sleep when she remembered to lie still, and more like wakefulness if she happened to move her leg. She was vaguely aware that the local news had given way to the Letterman show.

  The next thing she knew, she was being shaken awake by a nurse’s aide. Darlene gritted her teeth because she’d inadvertently contracted her thigh muscle upon being disturbed.

  “Have you passed urine since your operation?” the aide asked. She was an overweight woman with stringy red hair.

  Darlene tried to think. In truth, she couldn’t
remember and said so.

  “I think you would have remembered if you had, so you’ve got to go now. I’ll get the bedpan.” The aide disappeared into the bathroom and returned with the stainless-steel container. She placed it on the edge of the bed, against Darlene’s hip.

  “I don’t have to go,” Darlene said. The last thing she wanted to do was move herself onto the bedpan. Even the thought made her wince. The surgeon had told her she might have some discomfort after the operation. What an understatement!

  “You have to,” the aide stated. She checked her watch, as if there was no time for discussion.

  A combination of the aide’s attitude and Darlene’s drugged state made Darlene’s dander rise. “Leave the bedpan; I’ll do it later.”

  “Honey, you’re doing it now. I got orders from above.”

  “Well you tell whoever is ‘above’ that I’m doing it later.”

  “I’m getting the nurse, and let me tell you, she doesn’t brook contrariness.”

  The aide disappeared again. Darlene shook her head. “Contrariness” was a word she associated with preschoolers. She moved the ice-cold bedpan away from her thigh.

  Five minutes later, the nurse burst into the room with the aide in tow, causing Darlene to start. In contrast to the aide, the nurse was tall and lean with exotic eyes. With her hands on her hips, she leaned over Darlene. “The aide tells me you refuse to urinate.”

  “I didn’t refuse. I said I would do it later.”

  “You’re doing it now or we’ll cath you. I trust you know what that means.”

  Darlene had an idea, and it wasn’t appealing in the slightest. The aide went around to the other side of the bed. Darlene felt surrounded.

  “It’s your call, sister,” the nurse added when Darlene didn’t respond. “My advice to you is to get that butt of yours in the air.”

  “You could be a little more empathetic,” Darlene suggested as she prepared to raise her backside by putting her two palms against the bed.

  “I got too many sick patients to be empathetic about passing a little urine,” the nurse said. She checked the IV line while the aide got the bedpan into place.

  Darlene breathed a sigh of relief. Getting on the bedpan hadn’t been as bad as she had imagined, although the cold metal was shocking. Urinating was another matter. It took her a few minutes of concentration before she could start. Meanwhile, the nurse and the aide had left. She passed more urine than she thought she could, which made her recognize that the ordeal was necessary. At the same time, it made her remember why she didn’t like hospitals.

  Once she was finished, she had to wait. She could move her pelvis up and down without discomfort, but to get the bedpan out from under her, she’d have to lift one of her hands off the bed. That meant tensing muscles that hurt her knee, so she was stuck. After five minutes, her back started to complain, so she gritted her teeth and managed to move the bedpan to the side. Almost on cue, both the nurse and the aide reappeared.

  While the aide dealt with the bedpan, the nurse offered Darlene a sleeping pill and a small paper cup of water.

  “I don’t think I need it,” Darlene said. With all the drugs she’d had during the day, she felt like she was floating.

  “Take it,” the nurse enjoined. “It’s been ordered by your doctor.”

  Darlene looked up into the nurse’s face. She couldn’t tell if her expression was brazen or bored or disdainful. Whatever it was, it seemed inappropriate. It made Darlene wonder why the woman had gone into nursing. Darlene took the pill, swallowed it, and chased it with the water. She gave the cup back to the nurse. “You could be a little more personable,” she suggested.

  “People get what they deserve,” the nurse said, taking the cup and crushing it in her hand. “I’ll be back to see you later.”

  Don’t bother, Darlene thought but didn’t say. Instead, she merely nodded as the nurse and the aide left. Recognizing her neediness and vulnerability, she didn’t want to cut off her nose to spite her face. With her leg bound up in the flexing machine and with as much pain as she got when she moved her knee, she was totally dependent on the nursing staff.

  Darlene gave herself a dose of her pain medication to dull her toothache-like discomfort after the bedpan ordeal. She soon felt calm and detached. The emotions evoked by the run-in with the nurse and the aide faded into insignificance. The important thing was that the surgery was over. The anxiety she’d felt the night before was a thing of the past. She was now on the road to recovery, and, according to the doctor, she could look forward to playing tennis in six months or so.

  Without being aware of the transition, Darlene fell into a deep, dreamless, drugged slumber. She was unaware of the passage of time until she was rudely yanked back to consciousness by a searing pain racing up her left arm. A moan escaped from her lips as her eyes shot open. The TV was off, and the room was dim with only a single low-wattage nightlight down near the floor. For an instant, Darlene was disoriented, but she quickly recovered. With the pain now spreading into her shoulder, she lunged for the call button. But she didn’t get to it. Instead, she felt a hand grab her wrist. Raising her eyes, she saw a white figure standing at the bedside, the face lost in shadow. Darlene opened her mouth to talk, but the words caught in her throat. The room dimmed and began to spin before Darlene felt herself falling from the light into darkness.

  six

  SHELLY, WATCH OUT!” LAURIE yelled. “Stop!” To her utter horror, her brother was running full tilt toward a stagnant lake, the shore of which was ringed with deadly mud capable of swallowing an elephant. She couldn’t believe it. She’d warned him of the danger, but he wouldn’t listen. “Shelly, stop!” she repeated as loud as she could.

  Filled with the agonizing frustration of powerlessness in the face of imminent disaster, Laurie began running. Although she knew she would be helpless when Shelly blundered into the mud, she couldn’t stand there and let the tragedy unfold without trying to do something. As she ran, she frantically looked for a long stick or a log that she could extend to her brother once he was caught in the muck, but the surrounding landscape was barren, with nothing but bare rock.

  Then, suddenly, Shelly stopped about ten feet from the quicksand-like muddy border of the lake. He turned and faced Laurie. He was smiling in the same taunting fashion as he had when they were children.

  Relieved, Laurie came to a halt. Panting, she didn’t know if she should be thankful or angry. Then, before she could say anything, Shelly turned around again and recommenced his mad dash toward calamity.

  “No!” Laurie shouted. But this time, Shelly reached the lake and ran out as far as he could go before his legs became hopelessly mired. Again, he looked back, only now his smile was gone. In its place was a look of terror. He reached toward Laurie, who’d run to the very edge of the dry land. Again, she looked for something to use to reach out to him, but there was nothing. Rapidly and relentlessly, her brother sank into the muck, with his pleading eyes riveted to Laurie’s until they disappeared into the filth. All that was left was a hand vainly grasping at the air, but it, too, soon disappeared from view, swallowed by the enveloping mud.

  “No! No! No!” Laurie shouted, but her voice was drowned out by a jarring jangle that pulled her from the depths of sleep. Quickly, she stretched out and quieted her ancient windup alarm clock. She flopped back onto the bed and stared up at the ceiling. She was perspiring and breathing heavily. It was an old nightmare that, mercifully, she’d not had for several years.

  Laurie sat up and put her feet over the side of her bed. She felt terrible. The night before, she’d stayed up too late, compulsively cleaning her dirty apartment despite her exhaustion. She knew it had been a stupid thing to do, but it had been symbolically therapeutic. The literal and figurative cobwebs had to be cleaned.

  She couldn’t believe how much her life had changed in forty-eight hours. Although she was confident that her friendship with Jack would remain strong, her intimate relationship with him was probably over
. She had to be realistic about her needs and his reality. On top of that were the concerns about her mother, as well as the worry about her own health.

  Getting to her feet, Laurie went into her tiny bathroom and started her morning routine of showering, washing and drying her hair, and putting on the small amount of makeup she’d become accustomed to using. It was restricted to a touch of coral blush, a bit of eyeliner, and a natural-color lipstick. When she was finished, she looked at herself in the mirror. She wasn’t pleased. She appeared tired and stressed, despite her attempts to hide it, and even with additional blush and a few dabs of concealer, she didn’t look any better.

  Laurie had always been a healthy person, and had taken health for granted except during a brush with bulimia in high school. Suddenly, the threat of carrying the marker for a BRCA1 mutation changed that dramatically. It was a scary, disturbing idea that a genetic conspiracy might be covertly residing inside every one of her trillion cells. Although she had hoped the previous evening’s research would have been reassuring, it hadn’t been. She now knew a lot more about the BRCA1 problem from an academic point of view; namely, that the normal gene functioned as a tumor-suppressor gene but that in its mutated form, it acted the opposite.

  Unfortunately, bookish information was not a lot of help when she thought about the issue personally, particularly when she coupled what she had learned with her desire to have children. Prophylactically losing her breasts was bad enough, but losing her ovaries was much worse: It was castration. To her horror, she’d learned that if she had the marker for BRCA1, she not only had an increased chance of developing breast cancer before age eighty but also an increased chance of ovarian cancer! In other words, her biological clock was ticking even louder and faster than she had thought.

  It was all very depressing, especially combined with her exhaustion from lack of sleep. The question was: Should she be tested for the BRCA marker? She didn’t know. She certainly would not consent to having her ovaries removed, at least not until she had had a child. And her breasts? She didn’t think she’d consent to that, either, so what would be the rationale for having the test? In her mind, such a quandary was the current problem with modern genetic testing: Either there was no cure for the illness in question, or the cure was too horrific.