The Patient

by Michael Palmer

“I’ll … um … meet you in the conference room in just a minute,” he said. “I need to see what the cardiologist wants to do here.”

  Jessie went directly to the nurses’ station and had most of Emily’s home number dialed when she set the receiver down. If Em had checked in or returned home, her son Ted would have told her to call Jessie. He was that kind of kid. One more hour, she decided. If there was no word from her by then, it would be time to panic.

  The small conference room was located just to one end of the unit. Jessie waited there only a minute or two before Gilbride arrived. He had the look of a treed animal. To the outside world, he was still the king of robotic surgery, in demand at hospital conferences and on talk shows. But his immediate universe was coming unraveled. He perceived himself, not without justification, to be the brunt of cruel jokes throughout the hospital. He was in the process of having a very highly connected post-op patient die of surgical complications. And perhaps worst of all, the man holding the purse strings of a four-million-dollar grant had all but issued a vote of no confidence in him by choosing to be cared for by one of his junior faculty.

  “So,” he said brusquely, “what do you want?”

  “I … I want to talk to you about Orlis and Rolf Hermann,” Jessie said, wondering how she was going to pull this one off.

  “Go on.”

  “This may be hard for me to explain, and hard for you to accept, Carl, but I have reason to believe that Hermann may not be a count at all, and that both he and his wife may in fact be quite dangerous.”

  Gilbride’s anger gave way to absolute incredulity. Jessie could read his thoughts.

  Now what kind of goddamn trouble are you trying to cause me? Haven’t you done enough?

  “I don’t understand,” he said.

  Jessie tried as best she could to explain about Alex Bishop and his theories. She could tell by Gilbride’s expression and body language that he was simply not equipped for another assault on his academic fiefdom—especially one with no objective proof whatsoever.

  “This is insane,” he said when she had finished. “You think these are the people responsible for Sylvan Mays’ murder?”

  “It’s quite possible.”

  “And this man—this Bishop—he’s masquerading as a hospital guard but he’s actually CIA?”

  “That’s what he says, yes.”

  “But he hasn’t given you any concrete proof of that?”

  “He gave me a phone number of someone in Virginia that he said might vouch for him.”

  “But you haven’t called?”

  Jessie felt as if she were being cross-examined by a hostile attorney. She felt herself pulling in.

  “No,” she said. “I couldn’t see the point.”

  “So what do you want me to do about all this?”

  “I want you to be careful, Carl. Especially with things going so poorly for Hermann. I don’t want to cross Orlis in any way until Bishop has the chance to sort out what’s going on. And that includes your not going to New York tomorrow. I’ll help you talk to her right now about what’s going on with her husband. But let’s not do anything to rile her.”

  “She doesn’t frighten me one bit,” Gilbride said, clearly at the end of his tether. “And I don’t know who this Bishop is. But before I disrupt my service and go accusing anyone of anything, I want to see some proof. Until then, I’m still the chief of this department, and I’ll make any decisions that need making regarding our patients. Now, I would like you to accompany me into the family room to update Countess Hermann on this latest development.”

  Jessie followed Gilbride into the room, where Orlis Hermann was waiting, this time with all three of the Count’s offspring. The session lasted less than ten minutes, and was even more unpleasant than the last one, with Gilbride stumbling through yet another blame-anyone-but-himself explanation of another tragic Rolf Hermann outcome. The woman almost certain to be Hermann’s widow before too much longer received the news of her husband’s cardiac arrest stoically, but her chilling gaze, locked every moment on Gilbride, made Jessie shudder.

  “You will do everything you possibly can to save my husband’s life,” was all Orlis said when he had finished.

  Then she nodded toward her stepsons and stepdaughter, and the four of them stood in unison and marched out the door. The last of them had just left when Jessie’s beeper went off, directing her to an extension she didn’t recognize.

  “Em,” she said out loud, hurrying over to the phone.

  Her call was answered instead by the radiologist on duty. Jessie listened intently, then turned slowly to Gilbride.

  “That was Don Harkness in radiology,” she said. “He wants to review the findings on Eastman Tolliver’s films with us.”

  I guess it’s not a migraine, she wanted to add, but didn’t.

  In strained silence, the two of them took the elevator down to the basement and crossed through the tunnel to the MRI unit in the emergency ward. Don Harkness, a veteran radiologist, greeted them and then motioned toward the view box and Tolliver’s films.

  “Well, I’ll be …,” Jessie murmured.

  Gilbride and Jessie looked at each other in amazement. The tumor in Eastman Tolliver’s head was slightly smaller than Rolf Hermann’s, and a bit more to the left of center—not an identical twin, but certainly fraternal.

  “The man’s got problems,” Harkness said. “A subfrontal meningioma, I should think. Big ’un, too. Now, that’s one you don’t see every day.”

  CHAPTER 24

  ALTHOUGH SHE WASN’T ON CALL, JESSIE HAD chosen to spend the night in the hospital. Her closest friend had vanished. No note, no call, no signs of personal trouble, no hints of emotional instability, no evidence of an abduction—just a phone call to Emily at home … then she was gone. Jessie had been too worried to go home.

  It was not yet six-thirty in the morning when she awoke in one of the windowless on-call cubicles, momentarily disoriented in the pitch darkness, her mouth desert dry, her lungs burning from four hours of inhaling stale air. She switched on the bedside lamp and was grateful to see the cup of water she had left on the scarred table beside it. Wetting her fingertips, she rubbed some water on her eyelids, then drank the rest and sank back onto the pillow. Dreamlike, the highly charged events of the previous night drifted into focus.

  Eastman Tolliver had taken the unfortunate news of his MRI results about as Jessie had expected—a dismayed, softly uttered curse, followed by an attempt at a brave smile, and finally a resigned declaration that he would do whatever it took to beat the tumor. These were, Jessie knew, only baby steps in the process of coming to grips with the nearly unfathomable diagnosis of a brain tumor. The heavy work would take place over the few days remaining before surgery. And while the depth of the success of that work was unpredictable from patient to patient, it often had a major bearing on the outcome of the treatment.

  “Maybe it’s all the time I’ve been spending around the patients here,” Tolliver said, “but while they were wheeling me down here, I had this feeling it was going to be …”

  His voice drifted away, and for a brief while, he stared up at the ceiling. He then stated his decision to stay in Boston and have his surgery performed at EMMC. Gilbride made several hardly subtle efforts to insert himself as the physician of record, but Tolliver would have none of it.

  “I’ve made up my mind, Carl,” he said. “I know what happened to poor Count Hermann could have happened with any surgeon, but I’ve watched Dr. Copeland in the operating room, and I’ve spoken with her patients, and I have chosen Dr. Copeland to do it. It’s as simple as that. It says a good deal about you that you have a surgeon of her caliber on your staff.”

  “Whatever you say,” Gilbride managed, barely unclenching his jaws.

  “However, when I do go into the operating room,” Tolliver went on, “I’d like to know that you’ll be there as a consultant.”

  “Of course.”

  Jessie suggested an immediate admission to t
he neurosurgical service, and promised to schedule Tolliver’s operation as soon as possible. Tolliver convinced her instead to allow him to return to his room to gather some things and to call his wife, Kathleen. She would then fly in from California as soon as she could arrange for someone to take her place in caring for her mother, who was incapacitated by Alzheimer’s disease. However, Tolliver was quick to add, setting a time for surgery should not be predicated on his wife’s arrival. He wanted it done as quickly as possible.

  “Just get this thing out of my head,” he said.

  Two hours after his release from the emergency room, Eastman Tolliver had returned to EMMC and was admitted as a patient to Surgical Seven.

  Meanwhile, Jessie had left the hospital and driven over to the modest two-story house Emily shared with her husband, Ed, and their two sons. Jessie felt that Ed, a software engineer at a firm in Cambridge, responded to the crisis less emotionally and more analytically than Emily would have done had he been the one to have disappeared. But there was no misinterpreting his anxiousness. At Jessie’s urging, he called the Brookline police and an hour later an officer did stop by more out of courtesy than concern. The man had clearly encountered too many of these situations to get worked up about this one at this point.

  “It’s almost always some sort of misunderstanding,” he said, in a clumsy and totally ineffective attempt to calm everyone. “A meeting or an appointment that Mrs. DelGreco’s certain she told you about, but didn’t—something like that.”

  Jessie rolled her eyes. Emily was as meticulously organized as anyone she knew, and considerate to a fault.

  The policeman then pulled Ed and Jessie away from the boys and asked them about the possibility that Emily was seeing someone else.

  “I suppose anything’s possible,” Ed replied clinically.

  “Nonsense!” Jessie exclaimed. “Emily tells me when a movie star is attractive to her. If she was involved with someone else I guarantee you I’d know about it. I suspect it’s police procedure to wait a certain amount of time before considering a person actually missing, but in this case you shouldn’t waste time waiting, Officer. Emily is an incredibly responsible woman. She would never disappear like this without telling anyone—unless she didn’t have the chance.”

  The policeman had responded with patronizing reassurance that they would do whatever was necessary as soon as it was clear Emily had been missing at least twenty-four hours.

  Jessie finished the last of the water from the bedside table, and forced herself to use the narrow, molded-plastic shower.

  What in the hell happened to Emily?

  The question overrode all her other thoughts. She searched with little success for an explanation that worked with all she knew of the woman. Finally, she began ticking through a list of scenarios that didn’t jibe with what she knew. Maybe there was another man. Ed DelGreco was a decent-looking guy, and certainly bright, but he was dry as toast. It wasn’t an impossible stretch to believe that Em could have left Ed and run off with someone. But it was inconceivable that she could have done it to her boys. No, something bad had happened to her. Jessie felt almost certain of it.

  Was it possible that Emily’s disappearance had something to do with the Count and Orlis Hermann? Had she seen or heard something she shouldn’t have? Jessie pondered those questions for a time, then toweled off, pulled on a fresh set of scrubs, and fished out the number Alex had given her.

  “Four-two-six-nine-four-four-four,” a woman’s sterile voice said.

  “Alex Bishop, please.”

  “You may leave a message.”

  “Can you get it to him?”

  “You may leave a message.”

  “Okay, okay. Ask Mr. Bishop to page Dr. Copeland, please.” Jessie hesitated, then added, “Tell him it’s important.”

  Em, where in the hell are you?

  Jessie joined the breakfast bunch in the cafeteria, but found it impossible this day to tolerate their humor. Making rounds on Surgical Seven was the only thing she felt she could handle. With the exception of Ben Rasheed, who would remain a ticking bomb until his surgery later that day, her service—nine patients right now—was in excellent shape. Making rounds on the group would have to be a boost to her spirits, and starting early would give her some extra time to talk with each of them.

  As always since Sara’s surgery, Jessie started her rounds in NICU room 6. Although it was only seven-thirty, she was not that surprised to find Lisa Brandon at work, using lotion to massage Sara’s back.

  “So, how’s my patient?”

  “Just … good,” Sara said.

  Lisa helped her onto her back and cranked up the bed.

  “I’m going to see if the nurses have anything for me to do,” she said. “See you later, Dr. Copeland.”

  “Thank you, Lisa.”

  Sara’s neurologic exam showed signs, albeit not striking ones, of continuing improvement in many areas. Voluntary movement present in all extremities with some decent leg strength.… Cognition good.… Speech somewhat disjointed but largely discernible.… All twelve pairs of cranial nerves intact. Clearly, Sara was nearing the edge of the woods. She was certainly ready to be moved out of the unit and, barring a major complication, could be in a rehab facility within a week.

  One friend a virtual miracle, one friend missing.… Patrons with heart conditions should refrain from taking this ride.

  The two women talked for a time, although Jessie carried most of the conversation. They spoke about the weather and movies, Sara’s kids and Jessie’s personal life, and even what it was like to be operated on while awake. And finally, Sara drifted into an exhausted sleep. Jessie pushed herself up from the edge of the bed and was heading out of the room when she noticed a thin volume on the bedside table, folded open, with a passage circled in pencil. It was Shakespeare’s Richard III. The marked passage was probably one Barry Devereau had read to his wife—perhaps many times.

  True hope is swift, and flies with swallow’s wings;

  Kings it makes gods, and meaner creatures kings.

  “Hang in there, Sara,” Jessie whispered. She headed into the hallway, then added, “Em, you hang in there, too.”

  “Dr. Copeland, there’s trouble in two,” a nurse called out.

  Jessie hurried to Rolf Hermann’s bedside. His daughter was asleep in the guest chair, a pillow bunched beneath her head. A cardiac pacemaker wire, inserted after the code 99, had been added to Hermann’s array of tubes and monitor cables. It was a temporary wire, inserted through a blind stick into the subclavian vein beneath the Count’s right collarbone and threaded down until it made contact with the inner lining of his heart. The pacer control box to which the wire was connected was taped to his upper arm.

  Pacemaker, IV, breathing tube, mechanical ventilation, catheter, feeding tube, eyes taped shut. Rolf Hermann or Claude Malloche—whoever he was—was more dead than alive. The code 99 had been a success, but the underlying cause of his cardiac degeneration, which was most likely a disruption of the nerve pathways from the brain regulating his heart rhythm, remained unchanged. And now, another grave situation was developing. His blood pressure, as displayed on the monitor screen from the cannula in his radial artery, was 75/30 … and dropping.

  A normal heartbeat pattern on the monitor with a falling blood pressure. Cardiac pump failure—the sort of circulatory collapse that not even a pacemaker could help. Rolf Hermann was on the barge, as the residents often put it—on the barge and about to cross the river of no return.

  “Hang a dopamine infusion, please,” Jessie said to the nurse. “Then call the cardiology fellow, the neurosurgical resident, and Dr. Gilbride.”

  Hermann’s daughter woke up with a start, and appeared lost and alarmed. She was in her early to mid-twenties, lithe, with short, straight brown hair and an aquiline nose that dominated her face. Jessie patted her shoulder to calm her, then led her out into the hall and turned her over to one of the nurses, with instructions to go find Orlis and to bring th
e whole group to the family room. Rolf Hermann’s heartbeat hadn’t stopped yet, but it was going to.

  Jessie sighed and turned to the unit secretary. There was no sense in just sitting around waiting for the inevitable.

  “Code ninety-nine, NICU two,” she said. “Please call it in.”

  CHAPTER 25

  AFTER THE MEDICAL NIGHTMARE COUNT ROLF Hermann had been through, his death would be almost anticlimactic. With his ventilator-driven respirations, the cardiac meds, and the pacemaker, he was essentially being continuously resuscitated. He could go on indefinitely this way so long as his heart continued to circulate blood with enough force to perfuse his organs. But the drop in blood pressure was a signal that his pump was failing. Speeding up his heart rate with the pacemaker might help for a while, Jessie thought—long enough at least for the room to fill up once again with the usual crush of combatants and onlookers. But the ultimate negative outcome was approaching rapidly.

  The cardiology fellow, Joe Milano, was still on call, and in fact had been on his way up to check on Hermann and his pacemaker when the code 99 was broadcast. He rushed into the room, checked the monitor screen, then slid into place beside Jessie.

  “I had the pacer set to take over if he dropped below seventy,” he said. “Now he’s pacing at one-twenty.”

  “His pressure had dropped to seventy-five,” Jessie replied. “We’ve hung some dopamine, and since there’s no fluid in his chest that I can hear, we’re pushing fluid to increase his circulating volume. But I thought that increasing his rate with the pacemaker might drive up his pressure some.”

  “And look, it has,” Milano said, gesturing to the pressure readout of 79. “That was a heck of a good move—especially for a neurosurgeon.”

  “I was a doctor once, remember? Any other ideas?”

  Milano checked the clear plastic urine collector hanging from the bed frame.

  “There’s not much pee. Has this been emptied recently?”

  “Three hours ago,” a nurse responded. “There wasn’t much output then either.”