The Fifth Vial

by Michael Palmer

  “That’s certainly a fact. Most of our people have been here since we opened, three years ago. Funny, I haven’t heard anything at all about this.”

  “It’s only now being made public. I’m sure that after they narrow their choices down to this area, you’ll be brought in.”

  “I suspect you’re right,” she had said, and that was that.

  “So, Ben,” she said now, clearly taking pains to hold her shoulders back, her eyes locked tightly on his, and her head at just the right angle, “tell me about Chicago.”

  “Oh, it’s a great city,” he replied, wanting to bring the subject back to HLA typing, but not wanting to appear to ignore her. “Vibrant and very alive. Museums, symphony, great music, and of course, Lake Michigan.”

  “Sounds exciting.”

  “And romantic. I think you would love it.”

  “Oh, I definitely think I would, especially with the right guide.”

  “Perhaps that can be arranged.”

  “Well…perhaps you’d like a tour of beautiful downtown Soda Springs first. My daughter has cheerleading practice after school and won’t be home until six. I think I can get off early. Wait, what am I saying? I’m the boss. I know I can get off early.”

  “After I finish here I have some calls to make, so I can only say that I’d like a…um…tour very much, but we’ll have to see.”

  The implied promise brought her shoulders back another half inch.

  “So, Ben, tell me what I can do to help you learn about our operation. We’re doing half again as many tests as the hospital lab and as I said, we’ve only been open for about three years.”

  “Only three years. Impressive, very impressive. What do you do with your HLA typing now?”

  “To tell you the truth, we don’t get much call for it. Transplant candidates from here usually have been worked up in one of the university medical centers. What little we do get, we send out to Pocatello.”

  “Do you keep a record of those you tissue-type?”

  “Not specifically. We do have the capability in our quality control program to pull up a list of those who had a specific test drawn, including tissue-typing, but I’d have to think a bit about sharing our patients’ names. Oh, heck, I suppose if it’s really important to you, Ben, I could make an exception. I mean, you are about to become one of the Whitestone family, so to speak.”

  She favored him with intense eye contact and an expression that spoke of many long, lonely Idaho nights. He knew that given his imminent position with Whitestone, her willingness to share patient data with him wasn’t all that unprofessional, just desperate. She was asking him to take advantage of her. There was strong reason for his wanting to get a printout of those whose blood had been drawn for tissue-typing. Finding Lonnie Durkin on that list would mean that Marilyn Christiansen, for all of her kindly, concerned ways, would have some serious explaining to do. Still…

  “Listen, Shirley,” he heard his voice saying, “that’s really kind of you to offer, but I’ll be okay just taking a look around the lab. And about getting together later, I’d love to take you out for dinner and some conversation, but I need to tell you that I’ve just gotten into a relationship with someone back home that’s starting to get pretty serious, so conversation is all I can do.”

  All right, that’s it! If you’re going to succeed in this private detective business, no more Rockford reruns or Travis McGee books for you.

  Shirley Murphy’s expression reflected something other than disappointment. Oddly enough, Ben thought it might be relief.

  “Thank you, Ben,” she said. “Thank you for being honest with me. Come, let me show you the lab.”

  As he followed the director around the busy operation, a surprisingly vivid scenario began running through his mind. He was in an ornate courtroom of some sort, pacing back and forth as he cross-examined a fidgeting woman his mind’s eye could not see clearly. He felt certain, though, that the woman was Shirley.

  Let’s assume, he was saying, that Lonnie Durkin would never have been used as the donor in a bone marrow transplant unless his blood had been tissue-typed. And yet…and yet, we must start with the reality that such a transplant did, in fact, take place. Could blood have been drawn on Mr. Durkin without his understanding that it was being done? After all, the man has been acknowledged by his parents and his physician to have been somewhat slow. Perhaps someone drew his blood, then threatened to harm him or his parents if he told anyone it had been done. Does that make sense to you? It sure doesn’t to me. Why would they have chosen him in the first place? No, ma’am, it really couldn’t have happened that way. The only place it could have happened was right here in—

  Ben’s imagined rhetoric was cut off abruptly. He was standing behind Shirley as she was extolling the virtues of a new machine, whose name and function he had missed completely. Over her shoulder, he could see a young technician, slightly built, with a strawberry blond ponytail. She was removing a large number of tubes of blood from a freezer and gingerly placing them into racks in several Styrofoam shipping coolers filled with dry ice.

  “That’s a wonderful machine, Shirley,” he said, hoping she wouldn’t ask even the most elementary question about it. “Tell me, what percent of the tests that are ordered do you actually do here, and how much do you end up sending out?”

  “Good question. Actually, the equipment has gotten so sophisticated, accurate, and efficient that just a couple of techs can run virtually all the chemistries and hematology we get. We still send the more obscure and difficult-to-run tests out to the larger, more regional Whitestone labs, and also to specialty labs like yours. But on the whole, what we get in, we run here.”

  “Excellent. Those tubes that are being handled over there. Are they being sent out for a specific test?”

  Murphy laughed.

  “When I told you we send some things out, I wasn’t talking about that sort of volume.”

  She took him gently by the arm and guided him over to the tech.

  “Sissy, this is Mr. Ben Callahan from Chicago. He owns a lab that does tissue-typing for transplants.”

  “Hazardous duty,” Sissy said, motioning to the bruises still enveloping his eyes.

  “Hey,” Ben replied with candor he hadn’t planned, “you should see the other guy.”

  “Sissy,” Shirley went on, “Mr. Callahan is interested in these vials you’re packing up.”

  “These? They’re backups.”

  “Backups?”

  “In case a sample gets contaminated or the results get questioned. Or in case we need to do a retest for any legal reason.”

  “As far as we know,” Murphy added proudly, “Whitestone is the only lab that takes such precautions. Perhaps that’s why we’re number one by such a wide margin. I’m sure it adds some to the expense of the tests, but from what I’ve been told, Whitestone covers that and doesn’t pass it on to the consumer or their insurance company.”

  Ben’s mind was whirling.

  “So every patient you draw has extra tubes of blood frozen and put in storage?”

  “Just a green top,” Murphy said. “We’ve been told that thanks to new technology, that’s all they need. We draw an average of four vials of blood on each of our clients—red tops, gray tops, purple tops, black tops. The colors of the rubber stoppers refer to the chemicals that are inside the vials. We refer to the green top as the fifth vial, even if we only draw two on a given patient.”

  “But you have to ship those green tops out?”

  “Oh, yes,” Sissy said. “We’d run out of room in no time if we didn’t. They’re flown to a storage facility in Texas.”

  “And kept there for a year,” Shirley added.

  “Amazing,” Ben muttered, wondering if it was even legal to draw such a tube without the patient’s knowledge, and deciding in the same moment that it probably was—so long as the blood was only used for quality control.

  Casually, he glanced down at the FedEx shipping label. Whitestone Laborato
ry, John Hamman Highway, Fadiman, Texas 79249. It was so simple, yet it fit the facts of the case so powerfully. At a lab, possibly in a place called Fadiman, Texas, Lonnie Durkin’s tissue type had been run and undoubtedly recorded. Ben wondered if a tube containing his own blood had also made the trip to Fadiman. If so, it seemed quite possible that his and Lonnie Durkin’s tissue types were two items in the same database—a very massive database at that.

  It took a while, and the promise of dinner on his next visit, for Ben to extricate himself from Shirley Murphy, but when he finally had, he hurried to a phone and called Alice Gustafson with a summary of the news from Soda Springs, and a single question.

  “What kind of vial is drawn to do a tissue-typing on someone?”

  Her reply, though made in a second, seemed to him to take an hour. “That would be a green top,” she said.

  Fourteen

  No physician, in so far as he is a physician, considers his own good in what he prescribes, but the good of his patient.

  —PLATO, The Republic, Book I

  “Unbelievable!”

  The physical therapist and pulmonary therapist stood back from the treadmill and watched in absolute amazement as Natalie passed thirty minutes of brisk uphill walking—4.5 miles per hour with an elevation of four.

  Gradually, Natalie had felt her breathing becoming more strained, and a burning beneath her sternum, but she was determined to hang on for another few minutes. It was little more than two weeks since her medevac return from Brazil, and little more than three since her right lung had been removed at Santa Teresa Hospital in Rio. She had spent the first three days out of the hospital at her mother’s, and might have stayed longer were it not for the pervasive odor of cigarettes—present even though, out of respect for her daughter, Hermina was limiting her smoking to the porch and bathroom.

  Jenny delighted in having her aunt around, and especially in having the chance to be the caregiver for a change. The two of them spent hours talking about life and standing tall against adversity, as well as about books (Jenny had reluctantly tried the first Harry Potter, and was now devouring the series), movie stars, opportunities in medicine, and even boys.

  “Aren’t you a little young to be interested in boys?”

  “Don’t worry, Auntie Nat, the boys are young, too.”

  Natalie’s progress and her attitude had astounded her physicians and rehab specialists. The scimitar scar on her right side was still sensitive, but there were no other outward signs of the massive operation she had undergone. And with each passing day—each passing hour—her left lung was accepting more and more of the responsibilities for gas exchange that once two lungs had shared.

  “Hey, Millwood,” she said, “I think tomorrow we should hit the track.”

  The surgeon, trotting briskly on the adjacent treadmill, looked over at her incredulously.

  “Just don’t hurt yourself,” he said. “You know, time is nature’s way of keeping everything from happening at once. You don’t have to totally rehabilitate in a single session.”

  “Before this is all over, I’m going to run a triathlon. That’s going to be my new sport.”

  “I think you should stop now, Nat,” the physical therapist said. “I promise we’ll add something tomorrow.”

  As Natalie started a cooldown, Millwood turned off his treadmill and hopped off.

  “Thank you, ladies, for allowing me to take up your machine like this, but I had to see for myself if the rumors about superwoman, here, were true.”

  “Are you a believer?” Natalie asked.

  “Believer, hell, I’m a disciple.”

  “In that case you can disciple me over to Friendly’s for a hot fudge sundae. If you can stand my grubbiness, I’ll wait and shower after I get home. I have to do a little grocery shopping for my mom anyhow, and Friendly’s is sort of on the way. We can meet there.”

  Natalie finished the short cooldown and performed a set of pulmonary function studies under the guidance of her pulmonary therapist.

  “The numbers are okay,” the woman said, “but your actual performance is much, much better. I honestly have never heard of anyone making this sort of progress after a total pneumonectomy.”

  “You just watch. If it can be done, I’m going to do it.”

  Natalie toweled off and changed into a floppy sweatshirt. Macabre and disastrous as losing an entire lung sounded, the recovery, at least to this point, had been nothing like the agonizing ordeal of rehabilitating her surgically repaired Achilles. She had bounced back from that, and she was determined to make it through this one.

  Her phenomenal recovery so far had been marred only by recurrent flashbacks to her attack, which were disrupting her sleep and sometimes even occurring during the day. They were almost identical to the ones she experienced at Santa Teresa’s—distorted, indistinct, and emotionally detached in some ways, utterly detailed and viscerally terrifying in others. One minute she was a frightened participant in the horrific cab ride from the airport, the next she was little more than an observer to her assault and subsequent shooting. She had discussed the phenomenon with her therapist, Dr. Fierstein, who spoke to her of the many faces of post-traumatic stress disorder.

  “Your mind chooses to remember what it can handle,” she had said. “Much of the rest is dummied down, if you will—put in a form that your emotions can deal with. It’s a matter of preservation and sanity, and when those defenses begin to break down, the true emotions connected with the precipitating event can be quite overwhelming. We would both do well to watch out for that.”

  For the time being, it was decided not to treat Natalie’s PTSD with any medications unless and until the symptoms began to interfere with her life. But except for some lost sleep, to this moment, at least, that was hardly the case. Fierstein’s belief was that Natalie was meeting the challenge of her rehabilitation so successfully because she functioned best when she had something to push against.

  Millwood met her in the parking lot of Friendly’s, a seventy-year-old chain throughout the Northeast that had survived inconsistent food and service largely because of their matchless ice cream.

  “I can’t totally explain what’s happened to me since I woke up from the operation,” she said to Millwood after they had settled into a booth and begun quickly replacing the calories they had burned off on the treadmill with hot fudge sundaes, “but something inside me has changed.” She grinned, pointed to her thoracotomy scar, and added, “I mean something besides the obvious.”

  “I’ve seen the changes in you,” Millwood said. “So has Doug. We expected to bring home a morose, self-pitying, bitter woman. And to tell you the truth, that wouldn’t have surprised us in the least. I suspect that if I were in your situation, that’s the way I would have responded.”

  “I did feel that way for a while, but then something started happening to me. It began after I moved back to my own place from my mom’s. I found myself thinking about how this whole business would never have happened if I hadn’t gotten suspended from school, and I would never have gotten suspended if I hadn’t decided that I needed to show Cliff Renfro what being a good, compassionate doctor was all about.”

  “You had a near-death experience,” Millwood said. “Different people react to that sort of trauma in different ways. Some enter a life of fear and hesitation. Others are absolutely liberated.”

  “Dr. Fierstein thinks I might just be in denial, but I don’t. It’s like what happened in Rio has begun opening my eyes about myself—my own intensity and the effect it has on people around me. You know, sometimes it’s possible to care too much about some things. Over the years, I’ve sort of been caring too much about everything. Passion is wonderful when it’s focused, but applied without any filter, it can be crazy-making for all concerned.”

  Millwood reached across the table and put his hand on hers.

  “I can’t believe I’m hearing this,” he said.

  Natalie made no attempt to wipe aside the tear that had br
oken free on a course down her cheek.

  “I’ve always taken such pride in being as tough as I was smart—especially in my belief that whomever I might be dealing with was lacking because they didn’t care with as much energy and commitment as I did. It’s always been, like, this is who I am. Take me or leave me, but don’t expect that I’m going to change. Now, at thirty-five, with one lung and every reason to pack it in, I don’t care anymore if I’m tough or not.”

  “Believe me, Nat, even at your most difficult, you still bring more to the table than almost anyone I know. Your friends love and respect your passion for things, although I’ll admit that sometimes we’re a little scared of you going off like a Roman candle.”

  “Well, I’m going to try like hell to be a little gentler on people. And if you catch me going off on anybody, you can rub the bridge of your nose or something to tell me to back off. Got that?”

  “Got it.”

  Millwood practiced the maneuver.

  “Perfect, thanks. Until I really get it down, you can be my Jiminy Cricket.”

  “Count on it.”

  “Speaking of consciences, Terry, you’ll never guess what I did the other day. I wrote letters of apology to Dean Goldenberg and also to Cliff Renfro. There was nothing in it for me, but I really wanted to do it—to go on the record that I finally know what I did wrong and why it was wrong. I also wanted to thank the dean for not kicking my butt out of school for good.”

  Millwood’s expression was enigmatic, but there was a spark in his eyes.

  “You said there was nothing in it for you to write those letters, but you did it anyway?”

  “That’s what I said, yes…. Why?”

  He leaned back in the booth, arms folded, his gaze fixed on her.