“Sir?” It was the doctor, his hand resting on Bigelow’s shoulder. “I’m sure you’ll be hearing from your friend soon. It sounds like he got called away.”
“But how can he have a family emergency?” Bigelow said softly.
“Maybe someone got sick. Someone died.”
“Phil doesn’t have a family.”
Dr. Brace was staring at him now. So were the women in the office. He could see them standing behind the glass window, like spectators gazing into a zoo enclosure.
“Something’s wrong here,” said Bigelow. “You’re not telling me, are you?”
“We can talk about it,” said the doctor.
“I want to see Dr. Wallenberg.”
“He’s at lunch. But you can talk to me, Mr.—”
“Bigelow. James Bigelow.”
Dr. Brace opened the door to the clinic hallway. “Why don’t we go to my office, Mr. Bigelow? You can tell me everything.”
Bigelow stared at the long white corridor that stretched beyond the doorway. “No,” he said, and he backed away. “No, never mind—”
He fled the building.
Robbie Brace knocked on the door and stepped into Carl Wallenberg’s office. The room, like the man, showed snooty good taste. Brace wasn’t up on fancy furniture brands, but even he could spot quality. The massive desk was made of some warm and exotically reddish wood he didn’t recognize. The art hanging on the walls was that fartsy-abstract stuff for which one usually paid a fortune. Through the window, behind Wallenberg’s back, was a view of the setting sun. The light glared in, forming a halo around the man’s head and shoulders. Jesus H. Wallenberg, thought Brace as he stood before the desk.
Wallenberg looked up from his papers. “Yes, Robbie?” Robbie. Not Dr. Brace. Guess we know who’s in charge here.
Brace said, “Do you remember a patient named Stan Mackie?”
Against the backlight, Wallenberg’s expression was unreadable. Slowly he leaned back in his chair, eliciting the rich creak of leather. “How did Stan Mackie’s name come up?”
“From one of your patients, James Bigelow. You do know Mr. Bigelow?”
“Yes, of course. He was one of the first patients on my panel here. One of the first to move into Brant Hill.”
“Well, Mr. Bigelow was over in the clinic this afternoon, very upset. I’m not sure I got a coherent story out of him. He kept ranting about all his friends getting sick, wondering whether he’d be next. He mentioned Mr. Mackie’s name.”
“That would be Dr. Mackie.”
“He was a physician?”
Wallenberg gestured to a chair. “Why don’t you have a seat, Robbie? It’s hard to discuss this with you when you’re towering over me.”
Brace sat down. He realized at once it was a tactical error; he had lost his advantage of height, and they were facing each other directly across the desk. Now Wallenberg held all the advantages. Seniority. Race. A better tailor.
“What was Mr. Bigelow talking about?” asked Brace. “He seemed terrified of getting sick.”
“I haven’t the faintest idea.”
“He mentioned some sort of procedure that he and his friends had.”
Wallenberg shook his head. “Maybe he meant the hormone protocol? The weekly injections?”
“I don’t know.”
“If he did, he’s worrying needlessly. There’s nothing revolutionary about our protocol. You know that.”
“So Mr. Bigelow and his friends were getting hormone injections?”
“Yes. It was one of the reasons they came to Brant Hill. For the benefits of our cutting-edge research.”
“Interesting you should use the term cutting edge. Mr. Bigelow didn’t say anything about injections. He specifically used the term procedure. Like some sort of surgery.”
“No, no. He hasn’t had any surgery. In fact, the only time I recall him needing a surgeon was to get a nasal polyp removed. It was benign, of course.”
“Well, what about that hormone protocol, then? Have there been any serious side effects?”
“None.”
“So there’s no chance it caused Angus Parmenter’s death?”
“The diagnosis hasn’t been determined yet.”
“It was Creutzfeldt-Jakob disease. That’s what Dr. Harper told me.”
Wallenberg went very still, and Brace suddenly realized he shouldn’t have mentioned Toby Harper’s name. Shouldn’t have revealed any contact with her.
“Well,” said Wallenberg quietly. “It does explain the patient’s symptoms.”
“What about Mr. Bigelow’s concerns? That his other friends had the same illness?”
Wallenberg shook his head. “You know, it’s hard for our patients to accept the fact they’ve reached the end of their life spans. Angus Parmenter was eighty-two. Senescence and death are what happen to all of us.”
“How did Dr. Mackie die?”
Wallenberg paused. “That was a particularly upsetting event. Dr. Mackie had a psychotic break. He jumped out of a window at Wicklin Hospital.”
“Jesus.”
“It stunned us all. He was a surgeon, and a very good one, too. Never retired from the OR, even at the age of seventy-four. He worked right up until the day of his . . . accident.”
“Was an autopsy done?”
“The cause was clearly from trauma.”
“Yes, but was an autopsy done?”
“I don’t know. He was under the care of surgeons at Wicklin. He died about a week after the fall.” He regarded Robbie with a thoughtful gaze. “You seem bothered by all this.”
“I guess it’s because Mr. Bigelow was so upset. There’s one more name he mentioned, another friend who’s fallen ill. A Phillip Dorr.”
“Mr. Dorr’s fine. He moved to Brant Hill West, in La Jolla. I just received his signed authorization to transfer his records.” He shuffled through the files on his desk and finally produced a sheet of paper. “Here’s his fax from California.”
Brace glanced at the sheet, and saw Phillip Dorr’s signature at the bottom. “So he’s not sick.”
“I saw Mr. Dorr in clinic a few days ago, for a routine checkup.”
“And?”
Wallenberg looked straight at him. “He was in perfect health.”
Back at his own desk, Brace finished up the day’s medical charts and dictations. At six-thirty, he finally shut off the microcassette recorder and looked down at his newly cleared desk. He found himself staring at the name he’d scrawled on the back of a lab report: Dr. Stanley Mackie. The incident that afternoon in the clinic still bothered him. He thought of the other names James Bigelow had mentioned: Angus Parmenter. Phillip Dorr. That two of those three men were now dead was not in itself alarming. All of them were elderly; all of them had reached their statistically apportioned life spans.
But old age was not in itself a cause of death.
Today he’d seen fear in James Bigelow’s eyes, real fear, and he could not quite shake off his uneasiness.
He picked up the phone and called Greta, telling her he’d be home late because he had to make a stop at Wicklin Hospital. Then he packed up his briefcase and left the office.
By now the clinic was deserted, the corridor lit by only one fluorescent panel at the end of the hall. As he walked beneath it, he heard a faint humming and looked up to see the shadow of an insect trapped behind the opaque plastic, wings fluttering against its own doom. He flipped off the wall switch. The hallway went dark, but he could still hear the humming overhead, the frantic thrashing of wings.
He walked out of the building, into a damp and windblown night.
His Toyota was the only car left in the clinic lot. Parked beneath the sulfurous glow of a security lamp, it looked more black than green, like the shiny carapace of a beetle. He paused to fish the car keys from his pocket. Then he gazed up at the lit windows of the nursing facility, at the unmoving silhouettes of patients in their rooms, the flicker of TV screens barely watched. He was gripped by a sudden
and profound depression. What he was seeing, in those windows, was the end of life. A shadowbox of his own future.
He slid into his car and drove out of the lot, but he could not leave behind that sense of depression. It clung to him like cold mist on his skin. I should have chosen pediatrics, he thought. Babies. Beginnings. Growing, not decaying flesh. But in medical school he’d been advised that the future of medical practice lay in geriatrics, with baby boomers gone gray, a vast army of them, marching toward senility, sucking up medical resources along the way. Ninety percent of the health care dollar was spent on sustaining a person’s last year of life. That’s where the money would flow; that’s where doctors would make their livings.
Robbie Brace, a practical man, had chosen a practical field.
Oh, but how it depressed him.
As he drove toward Wicklin Hospital, he considered what his life would be like had he chosen pediatrics. He thought of his own daughter, and remembered his joy at looking into her wrinkled newborn face as she’d wailed in fury in the delivery room. He remembered the exhaustion of 2 A.M. feedings, the smell of talcum powder and sour milk, the silky baby skin in a warm bath. In so many ways, infants were like very old people. They needed to be bathed and fed and dressed. They needed their diapers changed. They could neither walk nor talk. They lived only at the mercy of people who cared about them.
It was seven-thirty when he reached Wicklin, a small community hospital just inside the Boston City limits. He pulled on his white coat, made sure his name tag with ROBERT BRACE, M.D. was clipped on, and walked into the building. He didn’t have hospital privileges here, nor did he have the authority to request any of their medical charts; he was gambling that no one would bother to question him.
In the medical records department, he filled out a request form for Stanley Mackie’s chart and handed the slip to the clerk, a petite blond. She glanced at his name tag and hesitated, no doubt realizing he was not on their staff.
“I’m from Brant Hill Clinic,” he said. “This patient was one of ours.”
She brought him the chart, and he carried it to an empty desk and sat down. Across the chart cover was written in black marker: Deceased. He opened the file and looked at the first page, listing the identifying data: name, birth date, Social Security number. The address caught his eye at once: 101 Titwillow Lane, Newton, MA.
It was a Brant Hill address.
He turned to the next page. The record covered only a single hospitalization—the one in which Stanley Mackie had died. With a growing sense of dismay he read the admitting surgeon’s dictated history and physical, dated March ninth.
74-year-old previously healthy white male physician admitted with massive head trauma via ER after falling from fourth-floor window. Just prior to accident, patient had been scrubbed and gowned and was performing a routine appendectomy. According to OR nurses, Dr. Mackie displayed marked tremors of both hands. Without explanation, he proceeded to resect several feet of normal-appearing small bowel, resulting in massive hemorrhage and death. When the OR staff attempted to pull him away from the table, he slashed the anesthesiologist’s jugular vein, then fled the OR.
Witnesses in the hallway saw him dive headfirst through window. He was found in the parking lot, unresponsive and bleeding from multiple lacerations.
After being intubated and stabilized in the ER, patient was admitted to trauma service with multiple skull fractures as well as probable spinal compression fractures. . . .
The physical exam had been recorded in typically terse surgical style, a rapid rundown of the patient’s injuries and neurologic findings. Lacerated scalp and face. Open fractures of the parietal and coronal bones with extrusion of gray matter. A blown pupil on the right. No spontaneous respirations, no response to painful stimuli. The patient’s injuries, thought Brace, were consistent with a headfirst landing in the parking lot.
Flipping further, he saw the surgeon’s note: “X-ray report: spinal compression fractures C6, C7, T8.” That, too, indicated a headfirst landing with the force of the fall transmitted straight down the spinal column.
Stanley Mackie’s hospital course was a weeklong deterioration of multiple organ systems. Comatose and on a ventilator, he never reawakened. First his kidneys shut down, probably due to the shock of his injuries. Then he developed pneumonia and his BP dropped out twice, causing a bowel infarct. Finally, seven days after his plunge through the fourth-story window, his heart went into arrest.
He flipped to the back of the chart, where the lab results were filed. There were seven days’ worth of computer printouts, a running log of electrolytes and blood chemistries, cell counts, and urinalyses. He kept turning pages, scanning thousands of dollars’ worth of lab tests done on a man whose death had been, from the very first day, inevitable.
He paused at a lab report marked: Pathology.
Liver (postmortem):
Gross appearance: Weight: 1600 gm., pale, pinpoint surface areas of acute hemorrhage. No evidence chronic fibrotic changes.
Microscopic: On H and E stain, there are scattered areas of poorly stained mummified hepatocytes. This is consistent with focal coagulative necrosis, probably secondary to ischemia.
Brace turned the page and found a blood count report, out of sequence. He turned another page, and found himself staring at the back cover. There were no pages left.
He flipped toward the front of the record, searching for other postmortem reports, but could find only the page describing the liver. This didn’t make sense. Why would Pathology do a postmortem on a single organ? Where were the reports for lungs, the heart, the brain?
He asked at the desk if there were more files for Stanley Mackie.
“That’s the only one,” said the clerk.
“But some of the Pathology reports are missing.”
“You can check directly with Path. They keep copies of all their reports.”
The Pathology Department, located in the basement, was a low-ceilinged warren of rooms, the walls painted white and decorated with lushly photographed travel posters. Mist over the Serengeti. A rainbow arching above Kauai. An island of mangroves in a turquoise sea. A radio was playing soft rock music. The lone technician at work in that room seemed absurdly cheerful, considering the nature of her job. She herself was another bright splash of color, with rouged cheeks and eyelids powdered a sparkly green.
“I’m trying to locate an autopsy report done back in March,” said Brace. “It’s not in the patient’s file. Medical Records suggested I check with you.”
“What was the patient’s name?”
“Stanley Mackie.”
The technician shook her head as she crossed to a filing cabinet. “He was such a nice man. We all felt awful about that.”
“You knew him?”
“The surgeons always come down to check Path reports on their patients. We got to know Dr. Mackie pretty well.” She pulled open a drawer and began thumbing through files. “He bought us our department coffeemaker for Christmas. We call it the Mackie Memorial Mr. Coffee.” She straightened and stood frowning at the open drawer. “That’s frustrating.”
“What?”
“I can’t find it.” She closed the drawer. “I’m sure an autopsy was done on Dr. Mackie.”
“Could it be misfiled? Under S for Stanley?”
She opened a different drawer, searched the files, then closed it again. She turned as another technician entered the lab. “Hey, Tim, have you seen the autopsy report for Dr. Mackie?”
“Wasn’t that done way back?”
“It was early this year.”
“Then it should still be in the files.” He set a tray of slides on the countertop. “Try checking Herman.”
“Why didn’t I think of Herman?” she sighed, and crossed the lab into one of the offices.
Brace followed her. “Who’s Herman?”
“He’s not a who but a what.” She flipped on the lights, revealing a desk with a personal computer. “That’s Herman. It’s Dr. Seiber
t’s pet project.”
“What does Herman do?”
“He—it—is supposed to make retrospective studies a snap. Say you want to know how many perinatal deaths involved mothers who smoked. You type in the keywords smoker and perinatal and you’ll get a list of relevant patients who’ve been autopsied.”
“So all your autopsy data’s in there?”
“Some of it. Dr. Seibert started inputting our data only two months ago. He’s a long way from finishing.” She sat down at the keyboard, typed in the name Mackie, Stanley, and clicked on Search.
A new screen appeared with identifying data. It was Stanley Mackie’s autopsy report.
The technician vacated the seat. “It’s all yours.”
Brace sat down in front of the computer. According to the data on the screen, this report had been input six weeks ago; the actual file must have been lost since then. He hit Page Down and began to read.
The report described the body’s gross appearance at postmortem: the multiple IV lines, the shaved head, the incision marks on the scalp left by the neurosurgeon’s blade. The report continued with a description of the internal organs. The lungs were congested and swollen with inflammation. The heart showed a fresh infarct. The brain had multiple areas of hemorrhage. The findings at gross examination were consistent with the surgeons’ diagnosis: massive head trauma with bilateral pneumonia. The fresh myocardial infarct had probably been the terminal event.
He clicked to the microscopic reports and found a summary of the same page he’d seen in the medical record, describing the liver. In addition there were reports that had not appeared in the medical record—microscopics of the liver, the heart, the lungs. No surprises, he thought. The man fell headfirst onto the pavement, he crushed his skull, and the neurologic trauma led to multiple organ failure.
He clicked to the microscopic report on the brain, and his eyes suddenly focused on a sentence buried within the description of traumatic injuries:
“. . . variable vacuolation in the background neuropil. Some neuronal loss and reactive astrocytosis with kuru plaques, Congo-red positive, as seen in cerebellar sections.”
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