"Actually, I'm more a mid-afternoon person, " Zack replied. "Thanks for making the time to see me."
"No big deal. You want some coffee? There's a machine right down the hall."
"No. thanks, though."
Zack noticed a stained Mr. Coffee crammed to the side of one bookshelf, but saw no evidence of filters or coffee. "So, Iverson, what's on your mind?"
Pearl, sniffling every twenty or thirty seconds, stubbed out what was left of the smoldering cigarette as he was cuing up a fresh one. He was a man in constant motion, wiping his nose, smoking, or fiddling with the papers on his desk. He was also, Zack felt, somewhat effeminate. Though they had done one case together, and had spoken briefly after Suzanne's surgery, this was their first contact of any substance. The office, for all its disarray, was somehow barren and sterile.
There were no diplomas or certificates on the wall, no photographs or mementos on the shelves. Zack felt an instant, immense curiosity about the little man, but he had already abandoned any notion of small talkeven nonthreatening questions about his background. Nothing in Pearl's manner encouraged such an approach. "I need to discuss a case with you, " Zack began. "Okay, shoot."
"It's an eight-year-old boy named Toby Nelms. Jason Mainwaring repaired an incarcerated hernia in him almost a year ago. You did the anesthesia."
"No bells, " Pearl said. "Here's a Xerox of most of his chart."
Zack passed the copy across and waited as Pearl flipped through it.
"Seems pretty cut and dried to me." Pearl hesitated, and then looked up, his brow pinched in thought. "Cut and dried. That was sort of a joke, wasn't it? " He thought some more. "Pretty good joke, too, if I do say so myself. Pretty good."
His laugh was a cackle. Zack smiled, but otherwise made no attempt to join in. "Pentothal and isoflurane. Is that pretty routine for cases like Toby's?"
"Routine enough, " Pearl said. "Why?"
"Well…" Zack rubbed at his chin and silently counted to five. "I have reason to believe that the kid wasn't asleep during his surgery."
Pearl's listless eyes flashed. "That's ridiculous! " he snapped. "Maybe, but I think it's true. He remembers details of the operation that there's no reason for him to know. And to make matters even more interesting, for the past six months he's been reliving the whole thing."
Pearl was ashen. "What?"
"He's having flashbacks in which he reexperiences his surgery, only in a terrifying, distorted way. It's as if his preoperative fears have become fused with the actual procedure. Instead of having his hernia fixed, he has his testicles and his penis cut off, again and again. And each time, Jack, he feels the pain. Every bit of it."
"That's… that's insane."
"Is it?"
"Of course it is." Pearl took a nervous drag from his cigarette and then blew his nose. "He's lying, or… or he's been watching too much television."
"I don't think so, Jack. And neither do the boy's parents. They're this close to instituting some sort of action against the hospital, and, I assume, against you and Mainwaring as well."
"And you're encouraging them in this?
"
"Hell, no. The opposite."
"Well, thank God for that, " Pearl muttered. "But I'm determined to get to the bottom of things. That's why I'm here. The kid's very sick from what he's going through. Very sick. In fact, he may be dying."
Pearl whistled softly through his teeth. cc Well, " he said, "I can't help you much except to tell you that whatever is going on has nothing to do with his anesthesia. I've done thousands of cases with exactly the same stuff this boy got, and and nothing like this has ever happened.
Nothing."
"As far as you know, " Zack corrected. Pearl's expression was strange.
Zack tried to gauge the reaction against those he had anticipated.
Anger? Arrogance? Confusion?
Concern? Defensiveness? There was "I no real match. Something was going on, though. Of that he was almost certain. The man was… was what?
"Look, Iverson…" Pearl ground out his cigarette and folded his hands on the desk. His fidgeting stopped. His gaze became more direct."… I want to help you, I truly do. I want to help that kid. But there's really nothing I can say. He got routine anesthesia and had a routine operation. It's as simple as that. If you want to get to the bottom of whatever's going on, then you'll just have to head off in another direction, okay?"
In that moment, Zack understood. His muscles tensed. The sensation was so familiar. It was being on the side of a steep drop, looking for the handholds and crevasses that would guide the traverse of a rock, and then suddenly seeing the perfect line across. Jack Pearl's attempt at sounding concerned and accommodating had missed badly. He was frightened-absolutely white with fear. The quieter and more composed he became, the more Zack knew he was squirming. Something was going on. His blade had hit a nerve. Now, it was time to give it a twist. "Jack, I'm interested in something, " he said. "Suzanne Cole was wide awake when she reached the recovery room. The nurse's notes in his chart say that Toby Nelms was, too. How do you do that?"
Pearl shrugged. "I just pay attention, that's all. I monitor vital signs more frequently than most anesthesiologists, so I can keep the level of anesthesia right on the edge. A rise in pulse or blood pressure, and I just turn up the gas a bit. It's a matter of experience and technique."
"But why is it that you only seem to use that technique and experience on Mainwaring's cases?"
The anesthesiologist's hand flickered toward the pack of cigarettes and then drew back. Where minutes before he had been in constant motion, now he was rigid. "That's nonsense, " he said. "The recovery room nurses don't think so. They tell me his cases always come out of the O. R. lighter than the rest of ours."
"Iverson, just what is it you're driving at?"
Easy, now, Zack warned himself. One step at a time. No slips. "Look, Jack, " he said. "I don't want to make trouble for anyone.
I just want to help this kid."
"Well, throwing darts at me isn't helping anyone. You're… you're barking up the wrong tree. And frankly, your innuendoes are starting to annoy me."
Zack sighed. "Listen, just give me a couple more minutes and I'll be out of your hair. All I want you to do is look this over and tell me what you make of it."
With what he hoped was just enough theatrical flair, Zack slid the notes he had just prepared from his folder and handed them across. Pearl scanned the sheet for only a few seconds before he snatched up his cigarettes. His hands were shaking and his heavy breathing blew out the match before it could ignite his smoke. "Just what in the hell is this supposed to be? " he asked. "You know what it is, Jack. It's a summary of nine of the gallbladder cases you've done the past two years. I have another twenty or so charts being pulled right now, and I suspect they'll confirm what this list already suggests."
Pearl looked ill. "Which is?"
"Which is, Jack, that despite having the same procedure, and receiving, at least according to your notes, exactly the same anesthesia, Jason Mainwaring's cases came out of the O. R. looking as if they had never been asleep, whereas Greg Ormesby's were normal. Look at the recovery room times. Mainwaring's cases were transferred out anywhere from one to six hours faster than Ormesby's… They didn't get the same anesthesia, Jack, did they."
It was a statement, not a question. "You're crazy, " Pearl said, thrusting the chart back at him. "Those patients got exactly what I said they got. Now why don't you just take this… this garbage, and get out of here."
"Okay, Jack. But you know I can't let this thing lie."
Pearl's hands were again folded tightly on his desk. "You do whatever you want, Iverson. I've got nothing to worry about because I haven't done anything."
For the first time since their session began, Zack began to have some doubts. A boy was dying. He had laid that on the table. Yet Jack Pearl, if he knew anything, had refused to budge. Could he have been that far off base about the anesthe ic? About the whole situa
tion? Or was the pallid little anesthesiologist some sort of monster?
Only minutes before, answers had seemed so close. Now… "Have it your way, Jack, " he said, rising. "You know how to reach me if you think of anything."
"I won't, " Pearl said. "So just take your witch-hunt somewhere else."
"He's eight, Jack. Eight years old."
"Get out."
CHAPTER FIFTEEN
Frank Iverson loved his Porsche 911 with a passion and intensity beyond that which he felt for any human being, including his children. The connection, he believed, was a spiritual one-man at his finest and man's finest machine, linked in style, flexibility, and speed. There were times, in fact, like this clear, windless Monday afternoon, when he felt certain the machine was actually sensing his mood and responding to it.
With a four-hundred-dollar Minuet radar detector scanning the road, and a mental map of favorite State Police hiding spots, he swept down route 16 toward the Massachusetts state line and Leigh Baron, nudging the Porsche through eighty-mile-an-hour turns with his fingertips. The Ultramed managing director's call to meet her at the Yankee Seaside Inn, just over the border, had come this morning, only minutes after Frank had learned from Mother of his two-place leap in the national standings.
Almost certainly, a promotion of some sort-probably to regional director-was in the offing. The place for their meeting, a good hour north of Boston, had been chosen to accommodate Leigh, who would be attending a management seminar there-or so she had said. There were, Frank acknowledged excitedly, other possibilities. Time and again, over the four years of their association, the spectacular redhead had hinted at an attraction for him. Perhaps now, with his stature rising in the company like a rocket, she was ready. And what an incredible prize she would be. Looks in a league with Annette Dolan's, money, power, and a brain to boot-the ultimate perk for the new Ultramed regional director.
Regional director. Frank beamed. The timing couldn't have been better.
With Mainwaring's money as good as in the bank, and the nightmarish chore of juggling the hospital accounts to hide that quartermillion-dollar deficit nearly behind him, he would need the flexibility of offices in New Hampshire and Boston to set up some of the deals he had in mind. Although the northeast region wasn't Ultramed's most lucrative, it was the fastest izrowin. He would be functioning in the center of the corporate spotlight. The company had set its sights on the prestige that involvement with established medical schools would bring, and there were ten of the world's most respected institutions in New England alone. In fact, only a year before, Ultramed had narrowly missed purchasing a major university psychiatric facility. Success in getting the company's foot in that door, and he could pretty much write his own ticket. And, Frank pledged, as he cruised around the Portsmouth rotary and south toward Newburyport, the first piece of business he would attend to with his newly acquired clout would be the removal from Ultramed of one Zachary Iverson. Since being taken to the cleaners in that disastrous land deal, he hadn't made too many mistakes in life. But allowing the Judge and Leigh Baron to pressure him into bringing Zack back to Sterling was easily the worst. Frank screeched through a ninety-degree turn onto the o'cean road. It might, he mused, even be worth making Zack's dismissal the condition of his accepting the new appointment. Leigh would agree or risk losing him. Making such a demand was certainly worth considering-if not now, then soon. In a matter of months, when his involvement with Ultramed amounted to little more than icing on his cake, he would have that kind of leverage anyhow. And as the Judge loved to say, over and over again, leverage was the name of the game. The Yankee Seaside, a two-story hotel laid out in a wide V above the rugged coast, was opulent but not garish. Frank stopped in the lobby men's room for a final check in the mirror-just in case-and then mounted the wide, circular staircase to the second floor. The notion that Leigh Baron's call might have been social began to dissolve the moment she opened the door. Suite 200 was a meeting room-richly appointed, with a fireplace and conversation area at one end, and an oval conference table with seating for ten nestled in the V. Huge plate-glass windows revealed a breathtaking vista of the North Atlantic., Leigh herself was dressed for business in a lightweight burgundy suit and plain silk blouse. Her wonderful titian hair was pulled back in a tight bun, and she was wearing the tortoiseshell glasses that were sometimes replaced by contact lenses. Still, there was no hairstyle nor manner of dress that could obscure her spectacular good looks. And there was no way, Frank promised himself, that they would not become lovers.
If not that day, then before too long. "Frank, welcome, " she said, shaking his hand firmly, and warning him with her eyes against any other contact. "I'm pleased you could make it down on such short notice."
At, perhaps, five-foot-seven, she was shorter than he was by more than half a foot, but her bearing and manner neutralized that difference.
Frank felt off balance and edgy with the coolness of her greeting. "You call, I come, " he said, taking a seat in the conversation area, across a low marble coffee table from her. He gestured to the room. "Nice place."
"Thanks. We own it."
"Ultramed?"
"A subsidiary-Whiteside Travel Services."
"Whiteside Travel? I didn't know that was Ultramed."
"Not many people do."
There was a door across from the one Frank had entered, and in spite of himself, his mind kept flicking to the possibility that it led to a bedroom. It would fit her style, he was thinking, a stiff, businesslike greeting, followed by mention of his recent rise in the Ultramed rankings, then word of his promotion. Suddenly, just as it seemed they were through for the day, she would reach up casually and shake free her hair. "So, Frank, " she began, crossing her phenomenal legs and then consciously adjusting her skirt, "you're looking well. How are things going?"
"I'm doing all right," he answered cautiously. "My brother's been a bit of a pain, but it's nothing I can't handle as long as you and Ultramed back me up."
"We always back up our administrators, especially those with the sort of track record you have. I assume you saw the new figures we just posted in Mother?"
Frank smiled. Step two of the scenario was unfolding. "I told you I'd make it, " he said, feeling a surge of confidence. "No, Frank," she corrected. "I told you. Remember? I want you to know how pleased we all are with the job you've done. Especially me, since I'm the one who first saw your potential and pushed for your appointment. Your success makes me look good."
And my promotion will make you look even better, he thought. The scent of her, even at a distance, had begun to fill his head, making it hard to concentrate. He would be the best-the very best she ever had. "Now," she said, "what's this about your brother? "
"Oh, nothing." He wished he had not brought up Zack until their business was concluded. "He just doesn't have, I don't know, the team attitude, I guess, to make it with Ultramed. He's been nothing but a disruption since he arrived in Sterling."
"What sort of disruption?"
Oh, Christ, never mind him. Just get on with it. A hundred miles from Sterling, and his brother was getting in the goddamn way. "Hey, it's no big deal, Leigh. Like I said, I can handle it."
"Tell me, please." Frank sighed. "Okay, " he said. "It's your dime.
Zack's been constantly clashing with other doctors. He goes out of his way to undermine my authority, and he won't listen to anyone's reason. I tried to tell you he was going to be trouble."
"Yes, I remember."
"He always has been. I'll take care of it, though. Just as soon as we finish our business here, I'll take care of it." He gestured about the room again. "You know, this place sort of reminds me of a great little inn in Provincetown. I think you'd love it." Her eyes hardened. "Frank,
" she said, "I want you to listen to me, and listen carefully. At this particular moment, as far as you're concerned, I'm Ultramed. You work for me. If you want to continue working for me, you'll stop mentally undressing me and pay attention to what this m
eeting's all about."
"It's not going to happen, Frank. Get that through your head. I have a husband I'm perfectly happy with. Understand?"
Numbly, Frank nodded. "Good." She reached across and squeezed his hand.
"Now just settle back and let's get down to business, because I'm afraid you have a problem to take care of."
Her voice was grim. Frank sensed a dreadful sinking in his gut. "What sort of problem? " he asked. "This letter arrived early this morning by messenger, " she said. "I assume, since you haven't mentioned it yet, that it will come as a surprise. 9@ The moment Frank recognized the Judge's letterhead, an annoying whine began building in his head. By the time he had finished reading, the noise was a screech. He scanned the document, and then read it again more slowly. It was, as Leigh had surmised, a total surprise. An audit… When?… It was crazy. Frank squeezed his temples, trying to quiet the noise as he struggled to concentrate, to understand what was happening, and why. The whole thing was crazy… fucking crazy… The buy back threat he could deal with.
The Judge was a bastard, but he was still only one vote. The board could be had. A member at a time, the board could be had. But until Mainwaring came through, an audit was out of the question. Absolutely out! "Frank?
"… It was Zack again. It was that goddamn scene with Nortnan that had pushed the Judge over… Frank's teeth were clenched so tightly that his jaw ached… "o in the hell did they think they were dealing with?
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