Fatal

by Michael Palmer

  “You okay?” he asked.

  “Jes get me back to the farm,” Lewis grunted. “An’ A’ll thank ya not ta take me fer no Sunday drives agin.”

  JUST MINUTES AFTER their arrival at the farm, Lewis’s brothers were in action. Kyle wheeled Matt’s motorcycle back to the barn, removed the first-aid kit from the saddlebag, and then concealed the bike beneath a tarp. Frank helped Matt bring Lewis to a tattered couch in the large, cluttered living room. Above them, a balustrade ran along the second-floor hallway, fronting several doors. Matt watched as Lyle opened a closet there and began removing all manner of rifles, shotguns, and even two semiautomatic weapons.

  “What’s he doing?” Matt asked.

  “Them mine people’s pretty crafty bastards,” Frank said matter-of-factly, gesturing up at the arsenal. “We don’ lak ta tek no chances.”

  Matt used a pair of shears to cut off Lewis’s blood-soaked shirts. Kyle returned and set the first-aid kit down by the sofa. Then he went to the kitchen and brought out an unlabeled jar half filled with some sort of thick, pungent, beige-colored goo. He rubbed the paste over Lewis’s face and wiped off the equally pungent black. Beneath his camouflage, Lewis was pale and tight-lipped. He looked at Matt and read his thoughts.

  “No hospital,” he rasped.

  Matt worked his stethoscope into place around his neck and knelt beside Lewis.

  “Please get me a pan of fairly warm water,” he said. “Put some soap in it if you have some—dishwashing soap would be best. A clean towel, too.”

  The bullet holes, not at all helped by the jarring ride out of the forest, were nearly clotted now, although blood was oozing from the edge of the exit wound. Matt set his hands on Lewis’s back and watched them as Lewis inhaled. The right side definitely moved more than the left. Listening with the scope confirmed what he suspected. A large portion of Lewis’s punctured lung had collapsed. He slipped a BP cuff around Lewis’s right arm and inflated it to occlude the brachial artery that ran beneath the crook of his elbow. Listening over the artery with his scope, he slowly deflated the cuff until he heard blood begin pulsing through the vessel. The sound marked the top number of Lewis’s blood pressure, which was 110, equivalent to the force needed to raise a column of mercury 110 millimeters. Could have been worse—much worse.

  “Lewis,” he said, “your lung has collapsed. The only way I can inflate it is by putting a tube into your chest. And the only place I can do that is the hospital.”

  Lewis shook his head grimly and looked away.

  “All right, all right,” Matt said. “I’ll do what I can. Frank, there’s a small room upstairs with a bed in it. I want that room cleaned out and I want the cleanest sheets you have put on the bed and also two pillows with clean covers on them. Got that?”

  “Gimme ten minutes,” Frank said.

  “There’s more. I’m going to need a pair of needle-nose pliers.”

  “Got one.”

  “And a plastic tube like the kind you use to siphon gas.”

  “Got thet, too.”

  “Good. And finally, I’m going to need a rubber glove from the first-aid kit.” He groaned. “Darn it, never mind. I took the gloves out and put them in my backpack. Listen, for what I want to put together, a condom would be even better. You know, a rubber. Can one of you hurry into town and get me a pack of three?”

  There was a momentary silence, then Lyle said simply, “I got a couple here.”

  Matt looked from brother to brother as Lyle went to their bedroom and returned with two Trojans. If the Slocumbs thought there was anything unusual about the revelation, their bland expressions hid it well. Smiling toothlessly, proudly, Lyle handed over the two condoms. The foil wrappers were crumpled but intact.

  “I don’t want to know,” Matt said to no one in particular. “I don’t want to know.”

  While Matt waited, he allowed Kyle to swab goo on his back.

  “Ouch, that stuff stings!”

  “Looks lak ya may be needin’ ta get ya a new razor, Doc,” Kyle said.

  As soon as the upstairs room was ready, Lewis was moved there. His breathing was more labored now, and his color was clearly duskier. Matt had read about the emergency chest tube insertion in a manual of field emergency measures that he kept on the tank in his bathroom. Most of the methods described by the former Vietnam corpsman were imaginative. Some, like the emergency thoracotomy tube insertion he was about to perform, were downright spectacular. The key to the procedure was the condom. Once it was unraveled and the tip was cut off, he would use tape to attach the base of it to the end of the siphon tube that protruded from the chest. The collapsed latex tube would then function as a perfect one-way valve, allowing air to escape from the lung cavity without allowing any to get in. Cutting the fingers off a rubber glove might have worked, but probably not as well, and not nearly as colorfully.

  The sheets on the upstairs bed—a faded floral print—were surprisingly clean and smelled that way. Ten minutes of boiling had removed the gasoline and any other contaminants from the six-foot-long, quarter-inch-wide siphon tube and the needle-nose pliers. The first-aid kit was a comprehensive one that included a magnifying visor, suture material, powerful injectable antibiotics, and the local anesthetic Xylocaine. Matt cleansed the bullet holes, packed them with antibiotic cream, and dressed them. Then he used Xylocaine to numb a spot just below and lateral to the exit wound.

  “Lewis,” he said, “I’m going to numb this the best I can, but it’s still going to hurt.”

  “More er less than bein’ shot?”

  “Good point.”

  Matt used a scalpel blade to stab a hole in the numbed skin, then he cut the tip of the siphon tube to a point.

  “Deep breath, Lewis, then hold it and get ready for me to push,” he said. “Okay, now!”

  Clamping the pointed end of the tube as tightly as he could in the needle-nose pliers, he jammed the pliers in until he felt them hit rib. Then he slid them beneath the rib, through the intercostal muscle, and drove them into the space created when the lung collapsed. Lewis, sweat dripping from his forehead, briefly cried out in pain, then lay still. Matt withdrew the pliers, leaving the tube in place. For several seconds all was quiet, then the condom began to flutter as air under some force rushed through it.

  Eyes closed, Lewis lay there, breathing evenly, utterly exhausted. Matt waited several silent minutes, then listened to his chest. The lung wasn’t fully reinflated yet, but there were breath sounds where none had been a short while ago. He wondered how many others had ever actually used one of the techniques from the field manual. Someday, provided Lewis and he made it through this ordeal alive, he was going to write a letter to the author.

  Once he had threaded ten inches of tubing into Lewis’s chest, Matt sutured the tube in place and dressed the opening. He listened again. More breath sounds, more expanded lung.

  “Well?” Frank asked.

  Matt gave Lewis a high-dose injection of antibiotic.

  “Well,” he replied, aware of the tinge of astonishment in his own voice, “the doggone thing appears to have worked, at least for the moment. I’ll sneak some oxygen and other stuff that I need out of the hospital and come back as soon as I can.”

  “Ya done good, Doc,” Frank said.

  Lewis’s color improved almost instantly. He opened his eyes.

  “Ah knowed we ’uz smart ta give ya thet money when ya come knockin’ on our door fer yer baseball team.”

  “We get you shot, we fix you up,” Matt said. “That’s our motto.”

  He was still overwhelmed that a technique he learned reading in the john had quite possibly saved a man’s life. What would the gang at Harvard have to say about this one?

  “Hey, Doc?” Lyle said.

  “Yes?”

  “If’n you ain’t gonna be usin’ thet other rubber, kin I have it back?”

  LYNETTE MARQUAND PRIDED herself on being, as she phrased it, precise, punctual, and predictable. In the appropriate company,
she would, with a wink, add passionate to the mix. Five days a week, when not on vacation, she was up at 4:30 A.M. and in her East Wing office at five. On Saturday, she slept until six, and on Sunday until seven unless her husband had need of her affection before breakfast and church. This predawn Wednesday morning, a rainy one in D.C., she had only one name written in her appointment book, Dr. Lara Bolton.

  Lynette had, at best, lukewarm feelings toward almost every one of her husband’s cabinet appointments, but Bolton was an exception. Six-foot-one and black, the Secretary of Health and Human Services had been depicted by more than one political cartoonist as a stork, and with her clipped Boston accent was an easy mark for the Saturday Night Live impressionists. But her brilliant mind and political savvy made her a frequent visitor to both Lynette’s office and the Oval Office in the West Wing.

  Bolton, as usual dressed in a crisp navy suit, knocked and entered Lynette’s office at precisely five-fifteen.

  “Well, Lara,” Lynette said after the Secretary had poured a cup of decaf from a carafe, “my staff is lighter by one.”

  “You did the right thing. Janine Brady has been in this game for a long time. She knows better than to assure you a vote will be unanimous without checking and rechecking.”

  “So, where do we stand now?”

  “Well, it appears Ellen Kroft does have serious misgivings about Omnivax.”

  “Damn.”

  “She’s the consumer representative on the panel, so there’s no way any of the pharmaceutical grant providers can put any pressure on her.”

  “Was one of my people consulted before she was appointed?”

  “I hate to say it, but it was Janine Brady. Wait, though, I was consulted, too, Lynette. Kroft seemed absolutely harmless—a token offered up by the people at PAVE. If she was more militant, we never would have approved her appointment. No one expected anything like this.”

  “So?”

  “Our man Poulos on the committee tells me he’s dealing with the problem. He’s optimistic something can be worked out.”

  “Is it worth my meeting with her?”

  “You can try, but I’ve learned that she contributed fifty dollars to Harrison’s campaign last election and upped it to seventy-five this time.”

  “Oh, that’s just terrific. We’re three points down in the latest polls. Jim is counting heavily on Omnivax to eliminate that. And here is a Harrison supporter threatening to screw up the whole thing.”

  “If Kroft remains on this path, we’re getting prepared to make the whole thing look political, being as she is a known Harrison backer.”

  “That isn’t going to give us back those three points.”

  “I know.”

  “What about our plans for the first inoculation?”

  “I think we’re there, Lynette. We have two women here in D.C. due to deliver at the right time, so that their babies will be four days old when we’re ready. Both attend the neighborhood health center in Anacostia, both are anxious to have their kids be the first to receive Omnivax.”

  “Uneventful pregnancies?”

  “No problems.”

  “Do we know the sex of the babies?”

  Bolton grinned. “Mrs. First Lady, you said you wanted a girl; whichever mama we choose, we got you a girl.”

  “It’ll be great theater, Lara. There’s three points in this, mark my words there are. Maybe more.”

  “Maybe more,” the Secretary echoed.

  CHAPTER 12

  NIKKI’S DRIVE FROM BOSTON TO BELINDA, WEST Virginia, was a somber, introspective one, filled with music—country-western, jazz, classical, and all manner of bluegrass. In addition to Kathy Wilson’s two albums, there were a number where she played as a studio musician, backing up star performers, several of whom were singing songs she had written. Kathy’s musicianship was transcendent on several instruments, but especially on mandolin, which she played as well as anyone Nikki had ever heard.

  A chief selling point for Nikki’s Saturn had been its sound system, which was surprisingly potent in all ranges. She drove most of the trip with the volume cranked up and the moon roof open. The backseat and trunk were packed with Kathy’s books, clothes, stereo, personal belongings, and instruments, including her most prized possession, a Gibson F-5 mandolin, built, she was proud to tell anyone who would listen, whether or not they knew mandolins, by Lloyd Loar.

  The day, like the one before, was sparkling and not too warm. Nikki had spent the night in a Best Western just outside of Harrisburg, Pennsylvania, and had left the motel early enough that morning to make Belinda with an hour or so to spare before the memorial service. Between the music and her reflections on the life and death of Kathy Wilson, hundreds of miles had passed virtually unnoticed.

  The autopsy Joe Keller had performed on Kathy revealed disappointingly little. Her brain, at least on gross examination, appeared normal. No tumors, no old strokes, no vascular malformations or occlusions, no scars—in short, no explanation for the pervasive psychological transformation that had ultimately taken her life. The microscopic sections of her brain would be ready to be read as soon as today or tomorrow, but Nikki wasn’t expecting anything from that or, in fact, from the detailed toxicology examination of her blood.

  Tongue-in-cheek medical wisdom had it that internists knew everything but did nothing; surgeons knew nothing but did everything; and pathologists knew everything, but a day too late. In Kathy’s case, the old saw couldn’t have been further from fact. What they would be left with, even after a most exhausting postmortem examination, were questions—questions with precious few answers.

  Even the striking neurofibromas had revealed little. Joe’s initial impression of the lumps that covered Kathy’s face and scalp was that they were fairly typical examples of the condition—cause unknown, except for the likelihood they were due to some sort of mutation or other genetic factor. He had assured Nikki that he wasn’t giving up and would be calling some other pathologists for advice, as well as trying some special staining techniques. But for the moment at least, the questions that remained unanswered were like unfulfilled promises.

  Nikki rolled the window down halfway and breathed in the fragrant Appalachian air. She had traveled some in the U.S.—a rafting trip down the Colorado through the Grand Canyon, mountain-bike tours of Bryce, Zion, and Yosemite National Parks, plus a week here and there in places like New Orleans, San Francisco, and Chicago. But this was her first time in West Virginia. Even viewed from the highway, it was a stunningly wild and beautiful place. The forests were dense and lush, and largely unspoiled. Countless streams and broader rivers wound under the roadway, roiling off through prolonged stretches of whitewater or meandering through the intensely deep green canopy, toward distant, dusky mountains. Waterfalls that would have been a major attraction in many places were simply . . . there. Driving through this country, it was easy for her to understand the passion for the natural earth in much of Kathy’s music.

  The sign on Route 29 read BELINDA, 20 MILES. As planned, she would be there an hour or so before the service. She could have flown and rented a car as the band had done. But even though she would have to turn around and drive right back to Boston in order to avoid unnecessarily taking vacation time and, worse, being indebted to Brad Cummings for coverage, she wanted the extended time alone to listen to the music and reflect on the choices she had made in her own life.

  Her decision to attend medical school, while it seemed to be proving the right one for her, was based on nothing more profound than the desire to emulate her father. Likewise, the decision to become a surgeon. If there was a single turning point in her life and her sense of herself, it was leaving surgery for pathology. At last she was no longer choosing paths merely because others were urging her to travel that way. Breaking her engagement to Joe DiMare—a man everyone, including her parents and many friends, deemed the perfect catch and perfect for her—underscored her evolution. It happened a year after completing her pathology residency. A year or so
after that, she was dropping out of chamber-music groups and begging Kathy Wilson to teach her bluegrass.

  At its most placid, her existence, like almost everyone else’s, was unpredictable and frangible. Illness, accident, errors in judgment, errors in choices—they were all out there like boulders in a rapidly flowing river, along with the challenges of love, work, and relationships. The most she could do, she was finally learning, was to keep searching her own soul for who she was and what she wanted, to be fearless in making decisions, and to try to make every day matter.

  The prim, white Baptist church was filling up when Nikki arrived. She was wearing a black linen pants suit with a sleeveless, silver silk blouse. But the day was already nearing eighty, and the crowd was dressed informally enough so that she carried the jacket over her arm.

  Kathy’s band greeted her warmly, as did Kathy’s parents—Sam, a dairy farmer, and Kit, who made and sold quilts. They were severe, taciturn country people, their faces weary from the hardness of their lives, and even more so now from the death of their only child. Kathy had spoken of them with love and admiration, despite the differences in temperament and philosophy that had strained their relationship over the years.

  Nikki was surprised when Kit asked her to walk with them along a dirt road that led past the church and through a broad, untended field. When she had called them after the postmortem exam, beyond some indirect questions as to whether or not Kathy was drinking or taking drugs when she was killed, neither parent seemed interested in any of the details of her health or the findings of the autopsy. Maybe the shock was too much for any clear thinking, but Nikki still saw no reason to answer questions they hadn’t asked. They quickly made up their minds in favor of cremation and a memorial service, and that was that.