Elizabeth’s notes began with an overview of the research. She described the background, then the actual studies. Most drugs and devices in development are first studied in healthy volunteers, but not GBF-complex-coated screws. The FDA granted permission to skip that first step because the procedure for testing would require the insertion of metal screws into bone, and that’s something you can’t do to healthy volunteers. This meant, Barnes realized, that the file in front of him was likely the summary of everything Elizabeth and Shirley had been involved with, including maybe a review of results from other clinical trials throughout the country.
This was the type of information he’d been looking for. The file showed that Elizabeth had recruited patients for the early studies and had then reviewed much of the data from the later ones at other research centers. She’d coordinated the studies, but that didn’t mean the information in her files was complete. She would have received only summaries. Yet even if Barnes had every piece of relevant information, it probably didn’t matter. In all likelihood this project had nothing to do with her death.
He scrolled down and began reading a summary of results from a study in Minneapolis. Elizabeth had written: “The following pertains to results of a phase III trial in patients with GBF-complex-coated screws inserted for a minimum of one year. Demographic data is shown below in table I.” The table listed the age, sex, height, weight, body frame, and race for each of the patients enrolled in the study. The summary continued: “To date, two hundred forty-five of the two hundred sixty-three patients are being followed with no significant adverse events. Fifteen patients were lost to follow-up, and three died eleven, fourteen, and sixteen months after their surgery: one of an automobile accident, one of a gunshot wound to the head, and one following a bout of bacterial meningitis. The autopsies were unremarkable, suggesting the toxicity of the GBF-complex-coated screws was not significant and not different from patients who received plain screws.”
Barnes reread the end of the last sentence: “. . . the toxicity of the GBF-complex-coated screws was not significant and not different from patients who received plain screws.”
Elizabeth hadn’t written that sentence!
He read it again. Someone had altered the summary. Unlike her American colleagues, Elizabeth would never have written “different from.” She always said “different to.”
Maybe she’d had some sort of lapse, he thought. As she was becoming more Americanized, the word from could have slipped out. But he knew she proofread everything she wrote, and the likelihood that she would use that word in the first place and then not notice it in rereading was next to impossible.
This raised the possibility that one or more of the autopsies cited in the summary held clues to Elizabeth’s murder. Somehow he needed to get those reports. The three cases might have some abnormality in common. On the surface they appeared unrelated—an accident, a homicide or suicide, and an infectious disease—but one or more of them must have contained something that somebody wanted to hide. He just had to figure out what that something was.
He made a note to himself. Tomorrow, first thing, he would call around to get the reports. Elizabeth must have had them in her possession at one time, but like her computer disks, they had probably been altered, or stolen or discarded. He wondered what the reports contained that could be worth her life. Maybe something unrelated to her research, an incidental finding. If it was related to the GBF-complex-coated screws, she could have discovered a problem that jeopardized their clinical utility. But that seemed unlikely. If the screws weren’t holding properly, or if the bone around them was eroding, those findings would be readily apparent on X-rays of all the other patients enrolled in the study.
Nothing he could think of that related to the screws or the surrounding bone could be discovered on autopsy but not by routine examination of the other patients. Also, in a clinical trial involving such a large number of patients, certainly some of them would have had their screws removed, either because of complications like the shaft of a screw breaking or because some of the screws and bolts were meant to be only temporary. So a problem with the screws would more likely be noticed in the living volunteers than in those few who died. Now that he thought about it, the screws probably weren’t even examined on autopsy. After all, when someone dies of a gunshot wound to the head, a coroner doesn’t dig around his ankle or back or forearm to look at screws or rods or a metal plate. Medical examiners value their time as much as everyone else.
Most likely Elizabeth had uncovered something unrelated to the screws and her research. It could have involved the patient who’d died of the gunshot wound to the head. If the death had been ruled a suicide, she might have discovered evidence to the contrary.
Another thought occurred to Barnes: maybe she hadn’t uncovered anything at all. She could have been murdered simply because someone was afraid of what she might find. That meant that by pursuing this, he might risk becoming a victim himself. But at least that would eliminate him as a suspect.
Then he considered a more innocent explanation for the apparent alteration in the file: someone else could have written the summary, or at least part of it. After all, Elizabeth’s name wasn’t on it. Anyone involved in the study—even someone at another medical center or at Jarrell Pharmaceuticals—could have sent her the report on a disk.
The more he thought about it, the less the finding seemed to be any sort of breakthrough. Still, he would follow up on it. He wrote a separate note in French and taped it to the refrigerator.
The discovery could turn out to be nothing, but there was only one way to find out. And pursuing this might just lead to the break he’d been looking for.
He summarized his findings and lack of findings, then wrote a note of instructions to put on the mirror for the morning. Half-asleep, he got undressed and crawled under the covers. The bed felt large and empty without Elizabeth.
He lay there in the darkness. It seemed to fill not only the room but also his entire being. Soon he would fall asleep, and when morning arrived, he would have to relearn the terrible things that had happened to him and Elizabeth. Already he’d forgotten most of the day, remembering neither sunrise nor sunset, nor anything in between.
Under these circumstances, life didn’t seem worth living. But if that was the case, why hadn’t he already ended it? He knew the answer—Elizabeth.
Before turning out the lights, he had looked at the framed picture above her dresser, the black-and-white photo from their wedding. He pictured it in his mind. But then an image of Cheryl in Toronto flashed before him. How could he ever have cheated on Elizabeth?
She deserved better, he thought. But he took some solace in recognizing his shortcomings. Maybe that was a sign of improvement. He had never felt that way before. Remorse was an entirely foreign emotion to the old Christopher Barnes.
“I’ll make it up to you,” he said in the darkness. “I promise.”
Chapter 47
Barnes awoke to the sound of his alarm clock and slapped it off with a heavy hand. Exhaustion lingered like a hangover. How late had he stayed up? Looking at the clock through bleary eyes, he discerned a handwritten message taped to the front: “Read note on bathroom mirror.”
He suddenly noticed that Elizabeth wasn’t there, and an unsettling feeling came over him. He had no idea where she’d gone, and he had no recollection of the night before. Now that he thought about it, he couldn’t remember much of anything. The day of the week? The month? November, he guessed. He remembered sitting in a restaurant across from a blonde woman, a heaping plate of mussels in front of him. That had been November. It felt like a long time ago.
He lifted the note on the clock and looked at the time: 8:01. Why had the alarm been set so late? Didn’t he have surgery? Today must be Saturday, or Sunday. The morning paper would tell him.
He went to the mirror and read his message:
Don’t be alarmed. Your ability to form new memories has been severely damaged since you were poi
soned by mussels in Toronto in November. Today is December 18.
December. He had the feeling he’d read this before, but neither a note nor déjà vu was necessary to remind him of the poisoning: the fancy restaurant with obsequious waiters in black suits; the tables covered with white tablecloths, adorned with fine china; his blonde dinner companion and soon-to-be after-dinner companion; and most of all, the mussels—dark, ominous, steeped in brine.
He continued reading. The next paragraph described his coma and the protracted hospital stay. Then Elizabeth’s affair and her death.
Thoughts of Elizabeth came back to him, multiple images like photographs flung into the air: Elizabeth at home in front of the fireplace, reading a medical journal with Rex at her side; in a fondue restaurant, dripping chocolate onto the tablecloth; in the OR wearing bloody scrubs and replacing a hip; and in the Museum of Fine Arts posing between two Van Goghs. One memory in particular stayed with him, suspended in the air, while the others flitted away. It was the recollection of a picnic on a July weekend a year and a half ago, one of the hottest days of the summer. Early that afternoon Elizabeth had suggested—no, insisted—they have a picnic on the esplanade along the Charles River. Barnes remembered sitting on a blanket she had spread on the grass about ten feet from the water.
“It’s way too hot for this,” he’d complained.
She wore a straw hat, sandals, and a sky-blue sundress with little yellow sunflowers on it. Despite the oppressive heat, she looked comfortable, although tiny beads of sweat had formed on the tip of her nose.
“Christopher Barnes, the great cardiothoracic surgeon, can’t take the heat?”
“It’s hot as hell out here.”
“You just have to chill, no pun intended. Have some iced tea.” She’d brought iced tea, sandwiches, fruit, and Twiglets. Resembling straight pretzels in shape and consistency, Twiglets were junk food imported from England. They were coated with a yeast extract that most Americans, Barnes included, found foul tasting. Elizabeth loved them.
“There isn’t even a breeze out here,” Barnes complained. That was true. Only a couple of sailboats had ventured onto the water, and they didn’t appear to move much faster than the scattered clouds overhead.
Elizabeth blew in his face. “How’s that?”
“Don’t stop.”
She handed Barnes a cup of tea. “You didn’t dress properly. You shouldn’t have worn trainers.”
“Trainers?”
“Sneakers. You should have worn sandals instead. They’re much cooler.”
“I don’t wear sandals. Besides, they’re not going to cool off the rest of me. My clothes are practically dripping. Maybe you don’t have that problem with a dress, but doesn’t your underwear stick to you in weather like this?”
She smiled and squinted at him in the bright sunlight. “I’m not wearing any underwear.”
“Really?”
“Really.”
He wondered whether she was just saying that. “Show me.”
She shook her head like a child. “Show me yours first.”
“Show you my underwear?” He was wearing short pants.
“No. Show me what’s underneath.” She smiled mischievously.
“Are you trying to get me arrested?”
“No, but if you expect me to lift my dress, you should be prepared to drop your shorts.”
He thought about that. “You’re really not wearing anything underneath?”
She scooted on the blanket to face him and looked around to make sure no runners or bikers were passing by. Then, quickly, she lifted her dress.
He could see under the garment for less than a second, but with her sitting like that—knees apart—the sight left an indelible impression. “If you’re trying to arouse me, it’s working.”
She leaned forward, put her hand on his thigh, and slid her fingers upward, reaching under the leg of his shorts.
“Too bad you wore underpants,” she said, caressing him through the cloth. She withdrew her hand.
“Don’t stop.”
“Later. Have a sandwich. If you finish your lunch, you can have me for dessert.”
She teased him for more than an hour before they headed back. When they arrived home, they made love before Elizabeth even took off her straw hat. On the living room floor. She sat on top of Barnes, having pulled his shorts around his ankles. He could still picture her looking down at him.
He and Elizabeth would never have another picnic, never make love again. Yet he mustn’t allow himself to dwell on that. Right now he needed to finish reading the note on the mirror, to find out what else was happening in his life.
Your number one priority today is to obtain the autopsy reports from the three people who died after receiving GBF-complex-coated screws. See the note on the refrigerator for details. One or more of these cases may be connected with Elizabeth’s murder.
Your next priority is to investigate Claire’s lover, Judge Darcia Parker—the jealous type. Find out about her relationship or interactions with Elizabeth.
He needed a cigarette. Not just to calm his nerves but to sharpen his focus, to help him try to remember any details from the past day or two.
Then he read he’d quit smoking. The rest of the letter contained other unexpected news: lunch plans with Nate Billings, dinner with Shirley Collins. What turn of events had led to this?
He tried to remember the day before. Certainly something memorable must have happened to result in lunch and dinner with Nate and Shirley. Had Nate assisted him in surgery? And what about Shirley? He’d slept with her. Yet he could conjure up no memory of that, not even an image of her in his house.
How had he managed to do so much when he could remember so little? At least it meant he wasn’t just sitting around moping. And it gave him an incentive to do more. Already he might have made significant headway in solving Elizabeth’s murder. Focusing on that would be paramount.
After getting dressed, he fixed himself a cup of coffee, took out the garbage—it was trash-pickup day—and then started making phone calls.
His first task was to figure out the names of the people who had died in the clinical trial with GBF-complex-coated screws. The patients hadn’t been identified by name but rather by their initials and an assigned number, to maintain their privacy. To get the names, he called the orthopedics departments at the participating hospitals and asked to speak to the investigators conducting the studies. He identified himself as Elizabeth’s husband and a medical doctor, and the clinical investigators at two of the three sites revealed the information necessary for him to obtain autopsy reports. The third site was in California, three time zones away, and he would have to wait at least two hours before calling them. From the other two sites, he obtained autopsies of a twenty-nine-year-old black man who’d died in an automobile accident and a fifty-four-year-old Caucasian who’d died of a gunshot wound to the head. Both were faxed to him in his home office. He looked at the gunshot victim first.
Leslie Martin Dobson, subject LMD-019. Dobson had undergone surgery to have a plate with a bolt and six screws placed in his right ankle, according to Elizabeth’s case summary. The autopsy report didn’t even mention it except in the general findings, in which the coroner had described a well-healed scar from a surgical incision along the lateral aspect of the lower left leg. The gunshot wound was determined to be self-inflicted from a 9mm handgun fired into his mouth. The bullet had passed through the base of the brain, and the cause of death was ruled to be the destruction of the respiratory center in his brain stem.
Barnes read and reread the report of the examination of the various organs, but he found no abnormalities that he could attribute to GBF-complex-coated screws. The patient had an obstruction of three major coronary arteries and moderate emphysema, probably from cigarette smoking. The liver was entirely normal—no congestion or necrosis or other pathology. This was significant because if substances produce toxins, they often damage the liver as it tries to break them down. Bu
t the liver in the autopsy had no abnormalities.
From what Barnes could tell, the screws in this man’s ankle had no bearing on his death or any other medical problems. He moved on to the next case.
Melvin Carl Brooks, subject MCB-031, appeared to have been in good health until the time of his death. He hadn’t been wearing a seatbelt and had suffered multiple rib fractures, one of which perforated his left lung. The cause of death had been ruled massive hemorrhage from a ruptured spleen.
Barnes read through both autopsies a second time but found no additional information. Maybe the remaining report from California—the patient who’d died from bacterial meningitis—would be more useful. Elizabeth had most likely uncovered something. He just needed to figure out what it was. If she’d found it, eventually he would, too.
As Barnes studied the autopsy reports, a large van rolled up to the curb in front of his house. Two gloved men stepped from the rear.
Garbage cans lined the street for refuse collection, and Barnes had set out two tall cans along with several boxes full of letters and other papers. The men hurriedly loaded the boxes into the van and dumped the contents of the trash cans into a bin. After setting the empty cans beside the curb, the men hopped back into the rear of the vehicle, and it pulled away from the curb.
Chapter 48
Barnes stayed home all morning. According to his notes, Billings didn’t have any surgeries scheduled and Houston wouldn’t let him assist in the OR. Going to work would be pointless. At least Billings had let him assist with cases during the previous two days. That was hard to believe, but perhaps not as hard to believe as some of the other things in his notes, like sleeping with Shirley. Apparently Billings and he worked well together, and maybe they even liked each other. Otherwise, why would Nate have asked him to lunch? Life seemed to be taking a series of unusual turns, but that was okay. All he needed to do was to trust his notes.
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