by Robin Cook
“It seems incredible that your mother would make something like that up?” Her tone was more a question than a statement, but Thomas took it as a statement.
Throwing down the medical journal, he leaped to his feet, nearly knocking Cassi to the floor. “Listen, I don’t care who you believe,” said Thomas. “My feet are fine, have always been fine, and I don’t want to hear anything more about a clubfoot.”
“All right, all right,” said Cassi soothingly. With a professional eye she watched her husband, noting that his equilibrium was slightly off in that he’d overshoot with simple motions that required him to make subtle readjustments. And that wasn’t all. His speech was slightly slurred as well. Cassandra had noticed similar episodes over the previous months but she’d ignored them. He had every right to indulge himself with alcohol now and then, and she knew he liked Scotch. What surprised her was how short a time had passed since he’d fled from the dinner table. He must have tossed off quite a few drinks, one after another.
More than anything, Cassi wanted Thomas to relax. If a discussion about a hypothetical clubfoot was going to upset him, she was perfectly willing to drop the subject forever if necessary. Sliding off the chair, she reached up to place her arm around his shoulder.
He fended her off, defiantly taking another sip of Scotch. He looked contentious and eager to quarrel. At close range Cassi noted his pupils were constricted to mere dots of black in his bright blue irises. Suppressing her own irritation at being rejected, Cassi said: “Thomas, you must be exhausted. You need a good night’s sleep.” She reached up again and this time he permitted her to put her arm around his neck. “Come to bed with me,” she said softly.
Thomas sighed but didn’t speak. He put down his half-finished drink and let Cassi lead him back down the hall to their bedroom. He started to unbutton his shirt, but Cassi pushed his hands away and did it for him. Slowly she undressed him, discarding his clothes in a careless heap on the floor. Once he was under the covers, she rapidly undressed herself, sliding in next to him. It was a delicious sensation to feel the coolness of the freshly laundered sheets, the comforting weight of the blankets, and the warmth of Thomas’s body. Outside the November wind howled and shook the Japanese wind chimes on the balcony.
Cassi began by rubbing his neck and shoulders. Then she slowly worked her way down his body. Beneath her fingers she could feel him relax and respond to her. He stirred and enveloped her in an embrace. She kissed him and gently reached down between his legs. He was flaccid.
The moment Thomas felt Cassi’s hand touch him, he sat up and pushed her away. “I don’t think it’s quite fair to expect that I’d be able to satisfy you tonight.”
“I was interested in your pleasure,” said Cassi softly, “not my own.”
“I’ll bet,” said Thomas viciously. “Don’t try any of your psychiatric bullshit on me.”
“Thomas, it doesn’t matter if we make love or not.”
Throwing his legs over the side of the bed, Thomas grabbed for his discarded clothes with jerky, uncoordinated motions. “I find that hard to believe.”
Thomas went into the hall, slamming the door behind him with such force that the storm windows rattled in their frames.
Cassi found herself engulfed in lonely darkness. The howling wind, which moments before had enhanced her sense of security, now did the opposite. The old fear of being abandoned haunted her. Despite the warmth of the blankets, Cassi shivered. What if Thomas left her? Desperately she tried to put the thought out of her mind because she could not bear the possibility. Maybe he had just been drunk. She recalled his lack of equilibrium and slurred speech. In the short time she’d spoken with Patricia, it didn’t seem possible that Thomas could have absorbed enough alcohol to cause such an effect, but when she thought about it, she had to admit that there had been several such episodes in the last three or four months.
Rolling onto her back, Cassi stared at the ceiling where an outdoor lamp shining through the leafless tree outside created a pattern like a gigantic spider web. Frightened by the image, she turned on her side only to confront the same scary shadow on the wall across from the window. Was Thomas taking some kind of drug? Having admitted the possibility, she recognized that she’d been denying the signs for months. It was further evidence that Thomas was unhappy with her, that their life had drastically changed, and that he had changed.
In the bathroom off his study, Thomas stared at his naked body in the mirror. Although he hated to admit it, he did look older. And more worrisome than that was his shriveled penis. To his own touch it felt almost numb, and the lack of sensation filled him with agonizing fear. What was wrong with his sexuality? When Cassi had been massaging him he’d felt the need for sexual release. But obviously his penis had had other ideas.
It must have been Cassi’s fault, he reasoned halfheartedly, as he returned to the study and got into his clothes. Rescuing his drink, he sat at his desk and opened the second drawer on the right. In the very back, hidden by his stationery, were a number of plastic bottles. If he was going to sleep, he needed one more pill. Just one! Deftly he flipped one of the small yellow tablets into his mouth, then chased it down with his Scotch. It was amazing how quickly he felt the calming effect.
Four
The next morning Cassi took her insulin and ate breakfast without any sign of Thomas. By eight she was concerned. Their usual schedule on Saturday was to leave by eight-fifteen so that Thomas could see his patients before Grand Rounds and Cassi could catch up on her own work.
Putting down the article she’d been reading at her desk and tightening the belt on her robe, Cassi walked from the morning room down the hall and listened outside Thomas’s door. There were no sounds whatsoever. She knocked softly and waited. Still nothing. She tried the door. It was unlocked. Thomas was sound asleep with his alarm clock gripped in his hand. Evidently he’d turned it off and fallen directly back to sleep.
Cassi walked over to him and shook him gently. There was no response. She shook him more forcibly and his heavy-lidded eyes opened, but he looked as if he didn’t recognize her.
“I’m sorry to wake you, but it’s already after eight. You do want to go to Grand Rounds, don’t you?”
“Grand Rounds?” answered Thomas with confusion. Then he seemed to understand. “Of course I want to go. I’ll be down for a bite in a few minutes. We’ll leave here in twenty at the most.”
“I’m not going to the hospital today,” said Cassi as brightly as she could. “I’m not expected in psychiatry, and I have an enormous amount to read. I brought home an entire bag full of reprints.”
“Suit yourself,” said Thomas, pushing himself up to a sitting position. “I’m on call tonight, so I’m not sure when I’ll be home. I’ll let you know later.”
Cassi went down to the kitchen to make something for Thomas to eat in the car.
Thomas sat on the edge of the bed while the room whirled around him. He waited until his vision cleared, feeling each pulse like a hammer in his head. He stumbled first to the desk where he got out one of his plastic containers. Then he made his way into the bathroom.
Avoiding his image in the mirror, Thomas tried to get one of the small, orange triangular pills out of the container. It was no easy task, and it wasn’t until he’d dropped several that he got one into his mouth and washed it down. Only then did he venture a glance at his face. It didn’t look as bad as he feared nor as bad as he felt. With a bit more agility he took another pill, stepped into the shower, and turned on the water full blast.
Cassi stood by the window in the living room watching as Thomas disappeared into the garage. Even through the glass she could hear the roar of the Porsche as it started. She wondered what it sounded like in Patricia’s apartment. The thought made her realize that she’d never visited Patricia; not once in the three years Cassi had been living there.
She watched until Thomas’s Porsche had accelerated down the driveway and disappeared into the damp morning fog that hung over th
e salt marsh. Even after the car was out of sight, its low-frequency roar could be heard as Thomas shifted gears. Finally the noise vanished and the stillness of the empty house enveloped Cassi.
Looking at her palms, Cassi noticed they were damp. Her first thought was that she was experiencing a mild insulin reaction. Then she realized it was nervousness. She was going to violate Thomas’s study. She’d always felt that trust and privacy were necessary parts of a close relationship, but she simply had to know if Thomas was taking tranquilizers or any other drugs. For months she’d been closing her eyes, hoping her marriage would improve. Now she knew she could not continue to wait passively any longer.
As she opened the door to Thomas’s study, she felt like a burglar: a very bad burglar. Each little sound in the house made her jump.
“My God,” said Cassi out loud. “You’re being an idiot!”
Her own voice had a calming effect. As Thomas’s wife she had the right to enter every room in the house. Yet in many ways she still felt like a visitor.
The study was in partial disarray. The sofa bed was still open, the covers piled in a heap on the floor. Cassi eyed the desk but then saw the open bathroom door. She pulled open the medicine cabinet. Inside were shaving gear, the usual litter of patented medicines, several old tooth-brushes, and some out-dated Tetracycline antibiotics. She looked through all the packages and containers. There was nothing remotely suspicious.
As she was about to leave, her eye caught a flash of color on the white-tiled floor. Bending down, she found herself holding a small triangular orange pill stamped with SKF-E-19. It looked familiar, but she couldn’t place it. Back in Thomas’s study she scanned the bookshelves for a Physician’s Desk Reference. Not finding one, she walked back to the morning room and took out her own. Quickly she turned to the product identification section. It was Dexedrine!
Holding the pill in her hand, Cassi stared out at the sea. There was a lone sailboat about a quarter mile out moving slowly through the swells. Watching it for a moment helped her organize her thoughts. She felt a weird mixture of relief and increased anxiety. The anxiety came from confirming her fear that Thomas might be taking drugs. The relief stemmed from the nature of the pill that she’d found-Dexedrine. Cassi could easily imagine an achiever like Thomas taking an occasional “upper” in order to sustain his almost superhuman performance. Cassi was aware of how much surgery Thomas did. She could understand how he could fall into the trap of taking a pill to sharpen his attention when he was otherwise exhausted. For Cassi it seemed to be in keeping with his personality. But as much as she tried to calm herself, she was still afraid. She knew the dangers of abusing Dexedrine and wondered how much she was to blame for Thomas’s need for the drug, and how long he’d been taking it.
She put the innocent pill down on the desk and returned the PDR to the shelf. For a moment she was sorry she’d gone into Thomas’s study and found the pill. It would have been easier to ignore the situation. After all, it was most likely a temporary problem, and if she said something to Thomas, he would only get angry.
“You’ve got to do something,” said Cassi, trying to build her resolve. As ridiculous as it seemed, the only person who exerted any kind of authority over Thomas’s life was Patricia. Although Cassi was reluctant to discuss the issue with anyone, at least she could expect Patricia to keep Thomas’s best interests at heart. Briefly weighing the advantages and disadvantages, she decided to discuss the situation with her mother-in-law. If Thomas had been abusing Dexedrine for a long time, someone should intervene.
The first thing she had to do, Cassi decided, was to make herself presentable. Pulling off her terry robe and her nightgown, she went to the shower.
Thomas enjoyed presenting cases at Grand Rounds. The entire departments of internal medicine and surgery attended, including residents and medical students. Today the MacPherson amphitheater was so full people had even been forced to sit on the steps leading up from the central pit. Thomas always drew a crowd even when, as today, he split the schedule with George.
As Thomas finished his talk, which had been titled “Long-Term Follow-Up of Patients Undergoing Coronary Bypass,” the entire amphitheater broke into enthusiastic applause. The sheer volume of Thomas’s work was enough to impress anyone, and given his good results, the statistics seemed superhuman.
When he opened up the floor for questions, someone from the upper tier yelled out that he’d like to know what kind of diet Thomas ate that gave him so much energy. The audience laughed heartily, eager for a morsel of humor.
When the laughter died down, Thomas concluded by saying: “I believe from the statistics I’ve presented there can no longer be any residual doubt as to the efficacy of the coronary bypass procedure.”
He gathered his papers and took a chair at the table behind the podium next to Dr. George Sherman.
The topic of George’s presentation was “An Interesting Teaching Case.”
Thomas inwardly groaned and glanced longingly at the exit. He had a splitting headache that had gotten progressively more intense after his arrival at the hospital. What a ridiculous topic, Thomas thought. He watched with mounting irritation as George made his way over to the podium and blew into the microphone to make sure it was on. As if that weren’t enough, he tapped it with his ring. Satisfied, he began to speak.
The case was a twenty-eight-year-old man by the name of Jeoffry Washington who’d contracted acute rheumatic fever at age ten. He’d been a sick child at the time and hospitalized for an extended period. When the acute disease had run its course, the child had been left with a loud holosystolic heart murmur, indicating his mitral valve had been severely damaged. Over the years the problem gradually worsened to the point that an operation was needed to replace the damaged valve.
At that point Jeoffry Washington was wheeled in and presented to the audience. He was a slight, callow-appearing Negro with angular, precise features, bright eyes, and skin the color of blond oak. He held his head back and stared up into the multitude of faces that were looking down at him.
As Jeoffry was wheeled back out, Thomas’s and Jeoffry’s eyes happened to meet. Jeoffry nodded and smiled. Thomas returned the gesture. Thomas couldn’t help feeling sorry for the young man. Yet as tragic as his story was it was also quite common. Thomas had personally operated on hundreds of patients with similar histories.
With Jeoffry gone, George returned to the podium. “Mr. Washington has been scheduled to have a mitral valve replacement, but during the work-up an interesting fact was uncovered. Mr. Washington had an episode of pneumocystic carini pneumonia one year ago.”
An excited murmur rippled through the audience.
“I suppose,” called George over the babble of voices, “that it is not necessary to remind you that such an illness suggested AIDS, or Acquired Immune Deficiency Syndrome, which was indeed found in this patient. As it turns out, Jeoffry Washington’s sexual preferences have placed him in that group of homosexual men whose life-style has apparently led to immuno-suppression.”
Thomas now knew what George had meant by his comment in the surgical lounge the previous afternoon. He closed his eyes and tried to control his rising anger. Obviously Jeoffry Washington was an example of the kind of case that was taking OR slots and cardiac surgical beds away from Thomas’s patients. Thomas was not alone in his reservations concerning operating on Jeoffry. One of the internists raised his hand and George recognized him. “I would seriously question the rationale for elective heart surgery in light of the patient’s having AIDS,” said the internist.
“That’s a good point,” said George. “I can say that Mr. Washington’s immunological picture is not grossly abnormal at present. He’s scheduled for surgery next week, but we will be following his helper T-cell and cytotoxic T-cell populations for any sudden decline. Dr. Sorenson of the department of immunology does not think the AIDS is an absolute contraindication for surgery at this time.”
A number of hands popped up in the audience, and
George began to call on them. The animated discussion took the conference over its normal time, and even after it was officially over, groups of people stood in clumps to continue talking.
Thomas tried to leave immediately, but Ballantine had gotten up and blocked his way. “Good conference,” he beamed.
Thomas nodded. All he wanted to do was get away. His head felt as if it were in a vise.
George Sherman came up behind Thomas and clapped him on the back. “You and I really entertained them this morning. We should have charged admission.”
Thomas slowly turned to face George’s smiling, self-satisfied face. “To tell you the honest truth, I think the conference was a goddamn farce.”
There was an uncomfortable silence as the two men eyed one another in the midst of the crowd.
“Okay,” said George at length. “I suppose you are entitled to your opinion.”
“Tell me. Is this poor fellow, Jeoffry Washington, whom you paraded out here like some freak, occupying a cardiac surgical bed?”
“Of course,” said George, his own ire rising. “Where do you think he’d be, in the cafeteria?”
“All right, you two,” said Ballantine.
“I’ll tell you where he should be,” snapped Thomas while he jabbed George in the chest with his index finger. “He should be on the medical floor in case something can be done about his immunological problem. Having already had pneumocystic carini pneumonia there’s a good chance he’ll be dead before he ever gets into a life-threatening cardiac state.”
George knocked Thomas’s hand aside. “As I said, you’re entitled to your opinion. I happen to think Mr. Jeoffry Washington is a good teaching case.”
“Good teaching case,” scoffed Thomas. “The man is medically ill. He should not be taking up a scarce cardiac surgical bed. The bed is needed for others. Can’t you understand that? It’s for this kind of nonsense that I have to keep my patients waiting, patients with no medical problems, patients who will be making real contributions to society.”
