Critical Judgment (1996)

by Michael Palmer

  Abby was writing furiously.

  "Daddy took care of her, too?"

  "Of course."

  "Graham, you won't regret having done this."

  "I hope not, Abby. Just remember your promise to keep my name out of it, and be sure to give me a call to let me know what happens. Having Ezra Black bad-mouthing me from pillar to post is not going to be good for business."

  "One last thing."

  "Yes?"

  "Do you by any chance have the phone number at Feather Ridge?"

  "As a matter of fact, I do. Why?"

  "I don't think Ezra Black is likely to say yes to another operator with an emergency call from me."

  Despite a steady rain, the early evening was mild and quite bright. Driving to the hospital, Abby even caught a brief glimpse of the sun. There was still forty minutes before her meeting with Kelly. She couldn't wait to see Lew and share the two major developments of the day--her visit to Feather Ridge and Kelly's discovery of a secret staircase somewhere in Colstar.

  She felt buoyed by her success with Graham DeShield. The real trick would be to honor her promise to keep his name out of the conversation when she called Ezra Black. She had decided to hold off on that call until she had learned what Kelly had found. Even if it turned out to be nothing--and she strongly doubted that would be the case--there was still the information she now had about Ethan. Black would have to be devoid of a conscience not to take action against the company that had contributed to his son's death--even if that company was his own.

  As she pulled up the hospital drive, Abby mulled over the explanation she had given DeShield and Black for what had happened to Ethan and the four others, as well as to the 150 or so NIWWs. She strongly sensed--no, no, she knew--something was wrong with her reasoning. At first glance her logic held together reasonably well: a little cadmium exposure, especially when stimulated by an MRI, caused a variety of symptoms, depending on the patient; a heavy exposure, with or without the MRI, caused headaches, violent behavior, and eventual death. The theory certainly did what theories were supposed to do: integrated the facts. But each time she verbalized it--first to Lew, then to Black, and finally to DeShield--she felt uneasy.

  There was an ambulance parked at the receiving platform, but Abby's highly developed sixth sense told her that things inside were reasonably calm. In fact, there was very little going on. In bay one, two nurses were checking in the elderly man from the ambulance. The only other action was in bay four, where Lew was listening to a young boy's chest. He noticed Abby the moment she came through the door and motioned toward the on-call room. She nodded that she would see him there and made her way inconspicuously along the outside corridor. During the few minutes she was alone in the room, she dialed her answering machine to check for a message from Kelly, or perhaps even Josh. Nothing.

  She glanced about, wondering if, as Lew had warned, the room was bugged. Given the bogus autopsy report Joe Henderson had produced, a little electronic eavesdropping would hardly be a surprise. There was no reason she should have had any pangs about having to leave a hospital controlled by a corporation like Colstar and run by men like Henderson and George Oleander, but she did. She was angered beyond words at being squeezed out by lies and treachery. She was furious about having to leave a job that had taught her so much about herself and her capabilities. And she was upset about being forced to make decisions about her relationship with Lew Alvarez before she was ready.

  "Damn you, Henderson," she muttered, "damn you."

  At that moment the door opened and Lew stepped in. The instant the door clicked shut, her arms were around him, her lips pressed against his. He tensed with surprise. Then, with a soft sound of pleasure, he brought his hands up, buried them in her hair, and brought her mouth even more tightly against his. Even after she gently broke off their kiss, she held him against her.

  "I feel like I just won the lottery," he whispered.

  "Maybe you did."

  He sat down and guided her onto his lap. She buried her face in the curve of his neck and savored the taste of his skin and the feel of his hardness against her thigh.

  "Careful," he whispered. "Big Brother may be watching."

  "Let 'em."

  "Well said."

  "Lew, I can't stay long."

  He moved her away and kissed her lightly on the mouth.

  "Why did I know you were going to say that? Is everything all right with you?"

  "Better than all right, except that I haven't heard anything from Josh."

  "I've been saying prayers for him."

  "Thanks," she whispered. "Lew, do you think it's safe to talk in here?"

  He shrugged no idea and motioned her to the bathroom, where he turned on the sink and the shower.

  "I still think we ought to keep our voices down."

  "Okay. Lew, I think something's breaking at Colstar. Kelly Franklin's found a staircase that she thinks might lead to the underground caverns I told you about."

  "You really trust her?"

  "I do. I never thought she was hiding anything. Now she's angry as hell that they've kept the underground spaces and ventilation windows beneath Colstar secret from her. We both feel there's got to be a damn good reason why they did. I'm meeting her at a park near her house in twenty minutes to hear what she found."

  "And your visit to Ezra?"

  "Went poorly, but there's still hope. He wanted nothing to do with me, but I think it's because he doesn't want anyone to know his kid beat a man senseless with a baseball bat and broke a prostitute's arm. And those are just samples of his cadmium-induced violence. Once Ezra knows there's nothing left to hide, maybe he'll relent and at least order some sort of investigation."

  "Unless he already knows what Colstar is doing."

  "It's possible. I just can't get a decent read on the man."

  "I'll tell you one thing: if that company is responsible for those shootings in Las Vegas and the Wheaton woman's death, once the lawyers begin to gnaw at them, there's no way they're going to be able to stay in business. I'll be anxious to hear what Kelly finds."

  "Soon."

  Abby turned off the shower and sink and returned to the study for her jacket.

  "You know," she said, "the one thing that keeps bothering me is all those MRIs I told you about."

  "You don't think it's just some sort of agreement between the family docs and the radiology department to run up as many MRI charges as possible? It is a hell of an expensive test."

  "If that were the case, we'd be saying that it was a coincidence that something like ninety percent or more of the NIWWs have had one. I'm not much good at biostatistics, so I didn't even know if there was a formula that could be applied to all the data I gathered. But if there is, I bet it says all those MRIs done on our cases are statistically significant."

  "You may be right, but I certainly can't come up with an explanation that makes sense."

  "The MRI machine's an electromagnet, and cadmium's a heavy metal. It wouldn't be much of a stretch to imagine the two interacting in some way."

  "I guess."

  Abby slipped on her windbreaker.

  "Gotta go."

  "I'll be off by midnight. Maybe a little earlier," he said hopefully.

  "Hey, listen, I'll be back here as soon as I learn what Kelly's discovered."

  "Abby, for God's sake, be careful. Be very, very careful."

  Abby held his face in her hands and kissed him lightly.

  "In case you hadn't noticed," she said, "I'm not exactly the biggest risk taker in the world."

  The park Kelly had designated as their meeting spot was a rarity for public places in Patience--a space that was poorly maintained. It was a postage-stamp-sized play area at the end of a rather long drive. There were homes visible from the small gravel parking lot, but none that was close. The grass, much of which had yielded to weeds, was badly in need of cutting. And the swings, slide, and wooden seesaw were begging for repair. The playground was certainly private en
ough, but viewed in the rainy, late-evening gloom, it was also somewhat forbidding. To Abby it was something of a metaphor for the whole town.

  She arrived at the parking area several minutes early, cut her lights and windshield wipers, and slid in one of the three Beethoven-symphony tapes in her case. She listened to them frequently but had never concentrated on the music enough to be able to distinguish one symphony from another. There was a third of a Heath Bar resting in the compartment by the gear shift. The rest of the bar was all she had eaten since her trip back from Feather Ridge. Minimal exercise, lousy eating habits, even worse sleeping habits, unstable emotional life--what a wonderful example she was for the patients of the world. Someday, she told herself. Someday it would all settle down. She polished off the remaining Heath morsel and glanced in the direction of the drive. No one. It was just seven. The steady, fine rain continued, warm and cleansing. Abby glanced about once again and instinctively locked her doors. The windows began to fog. Beethoven filled the Mazda--his Eighth, she guessed, although for no particular reason. Her thoughts floated free for a time, then came to rest, once again, on the most irregular of the shapes she had been trying to force into the Colstar puzzle: the MRIs.

  Nearly every one of the NIWW patients had had the test done. In many, if not all of them, the date of the MRI actually preceded the onset of the symptoms that placed the patients in the NIWW group. Her theory was that these patients had already been exposed to cadmium, and that somehow the combination of the heavy-metal poisoning and magnetic resonance imaging triggered the rashes, fatigue, susceptibility to infection, headaches, and other complaints.

  Combination. That was the key, the most disturbing word. First the cadmium exposure, then the MRI. That combination was the concept she was having trouble with--the square peg that kept refusing to be jammed into the round hole. Her explanation required a pairing of events in 150 or so patients--what amounted to 150 coincidences. It simply didn't wash.

  She glanced at her watch. Seven-ten.

  Come on, Kelly. Where the hell are you?

  The windows of the Mazda were fogged too much to see outside. She opened the front ones an inch, started the motor, and turned on the defogger. Then she ejected Beethoven and listened to the deep silence, broken only by the brush of rain on the hood and roof.

  Something had gone wrong.

  Five more minutes, she decided. No, ten. She'd give her until seven-twenty, and then go looking--first at Kelly's house, then at Colstar.

  Dammit, where are you?

  A car's headlights at the end of the drive flickered off the trees, and for the briefest second Abby felt a flood of relief. Then the lights swung away and continued down the road.

  She tried to make the minutes pass by focusing, once again, on the possible significance of all the MRIs. Never postulate two diagnoses to explain a patient's symptoms when one will suffice. The maxim was at the very heart of sound medical case synthesis, right next to the venerable adage warning young doctors, fascinated with the obscure, that when they hear hoofbeats on the plains of Arizona, they would do well not to look for zebras. Never two diagnoses when one will do. Abby wrote Cd in the condensation on the left side of her window and MRI on the right. Then she fingered a circle around each one. Cadmium exposure alone might explain each and every symptom in the NIWWs. But it would not explain the MRIs. Never two when one will do.

  There was only one other option she could think of--that the NIWWs were not cadmium toxic but were somehow actually getting sick from the MRI test itself. Did that make any sense at all? Not from anything she had ever learned about the procedure. And what about the high levels in Willie Cardoza?

  Perhaps the machine was defective in some way. But how would that explain the hundreds of MRI cases who weren't among the NIWWs? Her mind was tying itself in knots.

  The ten minutes were up. She turned on the high beams and swung back so they shone down the drive. Nothing. Kelly's map was on the seat beside her. Abby checked it to get her bearings and drove to the house, just three blocks away. The rain continued--steady, gentle. The house was a prim stucco ranch with a neat shrub-lined lawn and an attached garage. Several lights were on inside. Abby snapped her windbreaker, then felt around the rear floor until she located her Giants baseball cap and pulled it on. She walked up the flagstone path to the kitchen door and peered in the window. Nothing seemed out of place. To her right was half a small barrel, planted with a yucca, some geraniums, and ferns.

  Abby lifted the planter on edge with both hands, braced it against her leg, and was about to reach underneath for the key when she heard the dull rumble of an automobile engine. She lowered the planter back down and listened. The street was deserted. Suddenly, she knew. Her heart in her throat, she raced around to the garage and pulled up the door. A dense haze of automobile exhaust billowed out. Abby stepped back and turned to get a lungful of fresh air, then pulled her shirt up over her nose and mouth and charged into the lethal fog. Kelly was lying motionless across the front seat of a small white convertible.

  Abby snatched open the door, shut off the key, pulled her out by the waist, and dragged her out of the garage into the rain by her wrists. She didn't stop pulling until they were halfway down the drive. Then she sank down on one knee, gasping. Her breath was visible in the cool, rainy air. Kelly had a reasonable pulse although there were several skipped beats, but her breathing was exceedingly shallow. Abby slapped her face once, then again, and called her name. There was no reaction. She gave her several effective mouth-to-mouth breaths and repeated the attempts to rouse her. Then she checked her pupils, fearing the worst--fixed and dilated. Instead, she was able to make out that they were pinpoint small--the pupils of a narcotics overdose.

  "Help!" she screamed as loud as she could. "Someone help!"

  Her voice was swallowed by the dense night.

  The house across the street had lights on, and Abby could actually see someone inside. She bent over one more time and gave Kelly three deep breaths. Next she stripped off her own windbreaker and bunched it beneath Kelly's neck to keep her airway straight.

  "Hang in there, Kelly," she said.

  Then she whirled and sprinted down the rain-slicked drive.

  CHAPTER THIRTY-FOUR

  By the time the rescue squad arrived, Abby and the man across the street had lifted Kelly, carried her into his house, and placed her on the living-room rug. She remained unconscious. Her pupils were pinpoint and her respiratory rate still depressed. Neither of those were classic signs of carbon-monoxide poisoning. Almost certainly Kelly had been drugged before being placed in her garage.

  Tears mixed with the rainwater on Abby's face as she did what little she could to help Kelly get air into her lungs. The rescue squad was just five minutes away. Carbon-monoxide poisoning--even a mild exposure--was one of the most challenging crises in emergency medicine. The monoxide literally forced oxygen off the hemoglobin molecules that normally carried it to the tissues of the body. The effect of the poisoning was extremely difficult to reverse, and the newly formed carboxyhemoglobin prevented vital structures, especially the brain and heart, from getting enough oxygen. In addition, the monoxide caused a dangerous buildup of acids in the blood, and a drop in blood pH, making the heart dangerously prone to life-threatening arrhythmias.

  There were half a dozen neighbors standing around the living room. None of them had seen anything unusual around Kelly's house. In fact, none of them had even seen her come home. There was going to be no way to fix the length of exposure. Abby knew they all expected her to do something heroic. But without oxygen and some way to deliver it in high concentrations, there wasn't much she could do except continually monitor Kelly's pulse and be prepared to institute CPR at the first sign of a loss of blood pressure. She did have the presence of mind to send one of the men over to Kelly's car and house to look for pills.

  "Open the car door carefully and don't touch anything except with a cloth," she warned.

  "You mean you don't think this
was an attempted suicide?" he asked.

  "I don't know," she lied. "But let's not assume anything."

  Abby wiped the rain from her cheeks with the back of her hand. Thank God it was Lew waiting there in the ER and not McCabe or Jill Anderson. Together they would do what they could do. She looked down at Kelly, who was laboring to breathe once again, and adjusted the jacket beneath her neck. The woman was a few years older than Abby, but without her tortoiseshell glasses it was easy to appreciate her youthful skin and fine, somehow innocent, little-girl's face.

  You shouldn't have done it, Kelly, Abby was thinking. You shouldn't have gone down there alone.

  Abby forced herself to stay focused. She was angry, shocked, and frightened, but determined not to be distracted by any emotion. This was the time to do things precisely right.

  The immediate goal would be to get a breathing tube in and get Kelly onto a cardiac monitor. Next would be to deliver 100 percent oxygen and treat any cardiac irregularities. Once in the ER, they would measure the amount of circulating carboxyhemoglobin, as well as Kelly's blood pH. The low pH could be corrected, but the dissociation of oxygen from hemoglobin was another story. The oxygen concentration of room air was about 20 percent. In a hospital setting they could deliver pure oxygen--100 percent. Unfortunately, even pure oxygen was often not enough to break apart the carboxyhemoglobin in time to prevent serious brain damage. There was, however, a way to deliver more than 100 percent, and that was by giving 100 percent oxygen under increased atmospheric pressure. Hypersaturation, it was called. The technique would require transporting Kelly to a hyperbaric decompression chamber. Somebody at the hospital would know where the nearest ones were. There she would undergo a series of what amounted to deep dives into a sea of pure oxygen. The carboxyhemoglobin would yield to the technique much more quickly than it would to oxygen delivered at sea-level pressures, or worse, at the atmospheric pressure in Patience, which was located several hundred feet above sea level.