Marker

by Robin Cook

  “Then by all means,” Laurie said.

  For a few minutes, they both concentrated on eating. It was Laurie who broke the silence. “There’s something else important that I wanted to talk to you about.”

  “Oh?” Sue commented. She put down her teacup. “Fire away!”

  “I wanted to talk to you about SADS.”

  Sue’s face screwed up into an expression of complete confusion. “What the hell is SADS?”

  Laurie laughed. “I just made it up this second. You’ve heard of SIDS, sudden infant death syndrome.”

  “Of course! Who hasn’t?”

  “Well, I’ve coined SADS for sudden adult death syndrome, which is a good name for a problem that’s been occurring over here at the Manhattan General.”

  “Oh?” Sue questioned. “I think you’d better explain.”

  Laurie leaned forward. “Before I do, I have to say that it has to be in strictest confidence that the information I’m about to tell you came from me. I had suggested to our deputy chief that someone over here at the Manhattan General should be warned, but he blew his top, contending that it was all mere speculation with no proof, and as such, might hurt the hospital’s reputation. Yet I feel like the researcher caught in the bind of conducting a double-blind study on a life-saving procedure, which has quickly suggested its worth. Even though I’d be destroying the integrity of the study, which might keep the FDA from approving the treatment, I’ve got to leak the results so the people getting the placebo can be saved.”

  Laurie leaned back and laughed at herself. “Wow! Am I getting melodramatic or what? But it is true that I have no specific proof concerning what I’m about to tell you, mainly because I haven’t finished investigating the cases. I don’t even have copies of their hospital charts yet. I just feel it strongly, and someone has to know sooner rather than later. Anyway, this kind of medical politics drives me up the wall. It’s the one bad thing about my job.”

  “Now you’ve got my curiosity up. Way up! Come on! Spill the beans!”

  Leaning forward again and lowering her voice, Laurie proceeded to tell the story in the chronology it had unfolded by starting with McGillan, then adding the two cases posted by Kevin and George, and ending with her case that morning. She talked about the ventricular fibrillation and the fact that the autopsies had been completely clean. She then told Sue that she felt that with no pathology on gross or microscopically, the chances of four cases happening by chance was about the same as the sun not coming up the following morning.

  “What exactly are you saying?” Sue questioned dubiously.

  “Well . . .” Laurie said with hesitation. Knowing Sue as well as she did, she was aware that what she was about to say was the figurative equivalent of slapping her friend in the face. “Although I suppose there is still a minuscule chance the cause of these deaths was accidental in the form of a late anesthetic complication or maybe an unexpected side effect of a drug, I sincerely doubt it. And when I say minuscule, I mean infinitesimally small, because our toxicology screens have so far been negative. Anyway, the bottom line is this: I’m concerned about the possibility that these deaths are homicides.”

  For a few minutes, neither Laurie nor Sue said a word. Laurie was content to let the information sink into Sue’s brain. She knew Sue was enormously quick-witted and patriotic about the Manhattan General. She’d done all her residency training within its walls.

  Sue eventually cleared her throat. It was obvious that what Laurie had said had troubled her greatly. “Let me get this straight. You think we have some kind of a grim reaper wandering around our wards at night?”

  “In a way, yes. At least, that’s my worry. Before you dismiss the idea out of hand, just call to mind those cases in the news over the last couple of years, where deranged healthcare workers were dispatching patients under their care. You remember them, don’t you?”

  “Of course I remember them,” Sue said, seemingly taking offense at the comparison. She sat up straighter in her chair. “But we’re not out in the boonies here or operating a fly-by-night nursing home. This is a major medical center with layers of oversight. And these patients you’ve been describing weren’t bed-ridden or at death’s door.”

  Laurie shrugged. “It’s hard to argue with the facts that we have namely, no explanation for four deaths. And as I remember it, at least some of the institutions involved in those serial-murder cases were highly regarded. The double tragedy is that they went on for so long.”

  Sue took a deep breath and let her eyes wander around the room blankly.

  “Sue, I’m not expecting you to do anything about this personally,” Laurie said. “Nor should you feel defensive about the Manhattan General. I know it is a fine institution, and I’m certainly not trying to sully its reputation. What I was hoping is that you would know whom you or I should inform to try to keep it from happening in the future. Seriously, I’ll be happy to tell this individual exactly what I told you, provided my identity can stay out of the picture, at least until the OCME officially gets involved.”

  Sue visibly relaxed. She gave a quick, mirthless laugh. “Sorry! I guess I take any criticism of the place to heart. Silly me!”

  “Do you know someone like I described: someone on a clinical administrative level? Or what about the head of anesthesia? Maybe I should talk to him.”

  “No, no, no!” Sue repeated for emphasis. “Ronald Havermeyer has an ego as big as a tectonic plate, with the usual associated volcanic eruptions. He should have been a surgeon. Don’t talk to him! He’d definitely take it personally and want to take revenge on the messenger. I know because I’ve sat with him on several hospital committees.”

  “What about the hospital president? What’s his name again?”

  “Charles Kelly. But he’d be as bad as Havermeyer, and maybe worse. He’s not even a doctor, and he clearly thinks of this whole operation as a business. There’s no way in hell he’d be sensitive to your situation, and he’d be looking for a scapegoat immediately. No, it has to be someone with a bit of finesse. Maybe a member of the mortality/morbidity committee.”

  “Why do you say that?”

  “Simply because dealing with something like this is their mandate, and they meet once a week to keep tabs on what is going on.”

  “Who serves on it?”

  “I served on it for six months. Someone from the clinical side serves on a rotating basis. The permanent members are the risk management officer, the quality-control chief, the chief counsel for the hospital, the president of the hospital, the nursing supervisor, and the chief of the medical staff. Wait a second!”

  Sue lunged across the table and grasped Laurie’s forearm so quickly that Laurie jumped. Laurie’s eyes darted around the room, as if she expected an imminent physical threat.

  “The chief of the medical staff!” Sue repeated with enthusiasm. She let go of Laurie’s arm and gestured widely with her hands. “Why didn’t I think of him before? Oh my gosh, he’s perfect!”

  “How so?” Laurie questioned, having recovered from her momentary fright.

  It was now Sue’s turn to lean forward and lower her voice in a conspiratorial tone. “He’s in his late forties, single, and he’s a doll. He’s only been here for three or four months. All the single nurses are gaga over him, and if I weren’t happily and irrevocably married, I would be, too. He’s tall and lean and has this smile that melts ice. He does have a rather big snout, but you don’t even notice it. Best of all, he’s got an IQ in the stratosphere and a personality to go with it.”

  Laurie couldn’t help but wryly smile. “He sounds charming, but that’s not what I’m looking for. I need someone in a position of power who can be discreet. It’s that simple.”

  “I told you, he’s the chief of the medical staff. What more power can you ask for? And as far as being discreet is concerned, he’s the definition of the word. I tell you, you have to pry personal information out of him with a crowbar. It took me a quarter of an hour at the Christmas party
just to find out that before coming here, he’d been with Médecins Sans Frontières, which took him all over the world. I had to bite my tongue when Gloria Perkins, the head nurse in the OR, butted in and asked him to dance.”

  “Sue, I think you are telling me more than you need to. I don’t need to know the guy’s history. All I want to know is if you’re reasonably confident he’ll listen to what I have to say, act on it, and leave my name out of it until there’s official word from the OCME. Is that your take?”

  “I told you he’s the picture of discretion. And personally, I think you two will hit it off famously. And all I ask in return is that you name your firstborn after me. I’m joking, of course. Now, let’s see if he’s here.” Sue pushed back her chair, stood up, and started scanning the crowd.

  Aghast at suddenly comprehending Sue’s romantic intentions, Laurie reached out and tugged insistently on her white coat. “Hold on! This is not the time or place to try to fix me up.”

  “Hush, girl!” Sue said, batting Laurie’s hand away while continuing to search the room. “You dared me to find somebody suitable, and this dude fills the bill. Now, where in tarnation is he? He’s always here with women around him like he’s dressed in flypaper. Ah, there he is, and no wonder I couldn’t see him. He’s holding court at the far table.”

  Without a second’s hesitation, and oblivious to Laurie’s appeals to the contrary, Sue strode off. Laurie watched her wend her way among the crowded tables. Almost fifty feet away she tapped a medium-brown-haired man on the shoulder. He stood up, and being a head taller than Sue, Laurie guessed he was close to Jack’s height. For a moment Sue talked with him, utilizing lavish hand gestures capped off with her finger pointing in Laurie’s direction. Laurie felt herself blush, and she looked down at her tray. The last time she had experienced this kind of social humiliation was in middle school, and although that episode turned out reasonably well, she didn’t feel confident now.

  The next few minutes crawled by. Laurie redirected her eyes out the window at the empty fountain, wondering if she should flee. The next thing she knew, Sue was tapping her shoulder and calling her name. With a sense of resignation, Laurie turned and found herself looking up into the rugged, smiling face of an attractive and vigorous-appearing man standing next to her friend. He could have been a sailor or someone who had spent a good deal of time in the sun. He was carefully groomed, dressed in a dark blue suit with a white shirt and colorful tie. Over his clothes, he had on a clean, highly starched white coat similar to Sue’s. All in all, he exuded an urbane, refined, even elegant aura that stood out markedly from the other mostly frumpy doctors. As far as the nose was considered, Laurie felt it fit in just fine.

  “I want you to meet Dr. Roger Rousseau,” Sue said. Her hand gripped his shoulder.

  Laurie scrambled to her feet and shook the hand that was extended toward her. It was warm and forceful. Looking into his eyes she was surprised to find them a pale blue. After stumbling over saying she was glad to meet him, Laurie winced internally. She felt like she was acting as she had back in middle school, during that previous awkward introduction.

  “Please call me Roger,” the man said warmly.

  “And me Laurie,” Laurie added, regaining her composure. She noticed the man’s smile that Sue had described and found it appealing.

  “Sue mentioned that you had some confidential information that you were willing to share with me.”

  “I do,” Laurie said simply. “I assume she also mentioned it has to stay anonymous. A leak could put my job in jeopardy. Unfortunately, I’ve had some bad experiences in the past.”

  “I have no problem with your need for secrecy. I give you my word.” He glanced around the busy cafeteria. “This isn’t the best place for a confidential conversation. May I invite you up to my modest but at least private office? We won’t have to shout, and we surely won’t be overheard.”

  “That would be fine,” Laurie said. She glanced at Sue, who winked, smirked, and waved good-bye all at the same time. When Laurie started to pick up her tray Sue motioned for her to leave it, saying she’d take care of it.

  Laurie followed Roger as he threaded his way out through the cafeteria entrance, which was now even more crowded than when Laurie first arrived. Just beyond the throng, Roger stopped and waited for Laurie to catch up. “It’s only one flight up. I usually take the stairs. Do you mind?”

  “Heavens, no,” Laurie said. She was surprised he’d even thought to ask.

  “Sue told me you were part of the Médecins Sans Frontières,” Laurie said as they climbed.

  “I was indeed,” Roger said. “For about twenty years.”

  “I’m impressed,” Laurie said, knowing something of the good works carried out by the organization, for which it had received a Nobel Prize. Out of the corner of her eye, she noticed that Roger was taking the stairs by twos. “How did you happen to join that organization?”

  “When I finished my residency in infectious diseases in the mid-eighties, I was looking for some adventure. I was also an idealistic, far-left liberal who wanted to change the world. It seemed like a good fit.”

  “Did you find adventure?”

  “Most assuredly, as well as training in hospital administration. But I found some disillusionment as well. The need for even the most basic medical care in so much of the world is staggering. But don’t get me started.”

  “Where were you located?”

  “The South Pacific first, then Asia, and finally Africa. I made sure I made the rounds.”

  Laurie remembered her trip to West Africa with Jack and tried to imagine what it would be like to work there. Before she could mention her experience, Roger sprinted ahead and opened the door at the top of the stairs.

  “What made you leave the organization?” Laurie asked as they descended the busy main corridor en route to the administration area. As Roger was a relatively new employee she was impressed by how many people greeted him by name as they passed.

  “Partly the disillusionment of not being able to change the world, and partly because I felt the need to come home and settle down and have a family. I’d always seen myself as a family man, but it wasn’t going to happen in Chad or Outer Mongolia.”

  “That’s romantic,” Laurie said. “So love brought you back from the wilds of Africa.”

  “Not quite,” Roger said as he held open the door that lead into the carpeted, peaceful realm of the administrative offices. “There was no one here waiting for me. I’m like a migratory bird instinctively flying back to the nesting site where I began as a chick, hoping to find a mate.” He laughed as he waved to the secretaries who were not at lunch.

  “So you’re from New York,” Laurie commented.

  “Queens, to be exact.”

  “Where did you go to medical school?”

  “Columbia College of Physicians and Surgeons,” Roger said.

  “Really! What a coincidence! So did I. What year did you graduate?”

  “Nineteen eighty-one.”

  “I was eighty-six. Did you happen to know a Jack Stapleton in your class?”

  “I did. He was one of the best basketball players in Bard Hall. Do you know him?”

  “I do,” Laurie said without elaborating. She felt strangely uncomfortable, like she was cheating on her relationship with Jack just by bringing up his name. “He’s a colleague of mine over at the OCME,” she added lamely.

  They entered Roger’s office, which was, as he had said, modest. It was situated on the inside area of the administration wing and accordingly had no windows. Instead, the walls were covered with framed photos of numerous places around the world where he had worked. There was a number of himself with either local dignitaries or patients. Laurie couldn’t help but notice that in all of them, Roger was smiling as if each photo had recorded a celebratory event. It was particularly noticeable, since the other people were expressionless or actually frowning.

  “Please, sit down!” Roger suggested. He angled a small stra
ight-back chair toward the desk. After closing the door to the hall, Roger sat at the desk, leaned back, and folded his arms. “Now then, tell me what’s on your mind.”

  Laurie again emphasized the need to keep her name out of the situation, and Roger assured her that she had nothing to fear. Reasonably confident, Laurie told the story as she had told it to Sue. This time, she used the term “serial killer.” When she was finished she reached over and put a three-by-five index card with the four names directly in front of him.

  Roger had been silent throughout Laurie’s monologue, staring at her with increasing intensity. “I can’t believe you are telling me this,” he said finally. “And I am enormously appreciative of your making this effort.”

  “My conscience dictated that someone should know,” Laurie explained. “Perhaps after I get copies of the charts or if toxicology comes up with something surprising, I’ll have to eat my words. That would be fine, and no one would be happier than I. But until then, I’m worried something weird is going on.”

  “The reason I’m so surprised and appreciative is because I have been the scorned gadfly here like you have been over at the OCME, and for the same reasons. I’ve brought up each of these cases at the morbidity/mortality meeting. In fact, the last time was this morning with Darlene Morgan. And every time, I’ve been met with denial, even anger, particularly from the president himself. Of course, I haven’t had the added benefit of the autopsy results, since we haven’t gotten them yet.”

  “None of the cases have been signed out,” Laurie explained.

  “Whatever,” Roger said. “These cases had me worried right from the first one, Mr. Moskowitz. But the president has put a gag order on our even discussing them, lest something leak out to the media and put the efficacy of our CPR program in question. The on-call docs were unable to get even a rudimentary heartbeat going on any of these cases.”

  “Has there been any investigation of any sort?”

  “Nothing, which flies in the face of my strenuous recommendations. I mean, I’ve personally looked into it to a degree, but my hands are tied. The problem is, our mortality is very low, below two-point-two percent. The President said we’d do something when it gets to three percent, the usual level of concern. The rest of the committee agrees, particularly the quality-control person, the risk-management person, and the damn lawyer. They are all convinced beyond a shadow of doubt these episodes are merely unfortunate and unavoidable complications in the inherently risky environment of a tertiary-care center. In other words, they are within statistical predictions. But I don’t buy it. For me, they’re sticking their heads in the sand.”