Tarasoff shook his head. “This is hard to believe. If the heart didn’t come through UNOS or NEOB, where did it come from?”
“We think Voss paid to keep it out of the system. So it could go to his wife,” said Vivian.
“This is what we know so far,” said Abby. “Hours before Mrs. Voss’s transplant, Bayside’s transplant coordinator got a call from Wilcox Memorial in Burlington that they had a donor. The heart was harvested and flown to Boston. It arrived in our OR around one A.M., delivered by some doctor named Mapes. The donor papers came with it, but somehow they got misplaced. No one’s seen them since. I looked up the name Mapes in the Surgery section of the Directory of Medical Specialists. There’s no such surgeon.”
“Then who did the harvest?”
“We think it was a surgeon named Tim Nicholls. His name is listed in the Directory, so we know he does exist. According to his CV, he trained a few years at Mass Gen. Do you remember him?”
“Nicholls,” murmured Tarasoff. He shook his head. “When was he here?”
“Nineteen years ago.”
“I’d have to check the residency records.”
“We’re thinking this is what happened,” said Vivian. “Mrs. Voss needed a heart, and her husband had the money to pay for it. Somehow the word went out. Grapevine, underground, I don’t know how. Tim Nicholls happened to have a donor. So he funneled the heart directly to Bayside, bypassing NEOB. And various people got paid off. Including some of the Bayside staff.”
Tarasoff looked horrified. “It’s possible,” he said. “You’re right, it could happen that way.”
The lounge door suddenly swung open and two residents walked in, laughing, as they headed for the coffee pot. They seemed to take forever as they fussed with the cream and sugar. At last they left the room.
Tarasoff was still looking stunned. “I’ve referred patients to Bayside myself. We’re talking about one of the top transplant centers in the country. Why would they go outside the registry? Risk getting into trouble with NEOB and UNOS?”
“The answer’s obvious,” said Vivian. “Money.”
Again they fell silent when another surgeon walked into the lounge, his scrub top soaked with sweat. He gave a grunt of exhaustion and sank into one of the easy chairs. Leaning back, he closed his eyes.
Softly Abby said to Tarasoff: “We need you to look up the residency file on Tim Nicholls. Find out what you can about him. Tell us if he really did train here. Or if his CV’s a complete fabrication.”
“I’ll just call him myself. Put the questions to him directly.”
“No, don’t. We’re not sure yet how far this reaches.”
“Dr. DiMatteo, I believe in being blunt. If there’s a shadow organ procurement network out there, I want to know about it.”
“So do we. But we have to be very careful, Dr. Tarasoff.” Abby glanced uneasily at the dozing surgeon in the chair. She lowered her voice to a whisper. “In the last six years, three Bayside doctors have died. Two suicides and an accident. All of them were on our transplant team.”
She saw, from the look of shock on his face, that her warning had had its intended effect. “You’re trying to scare me,” he said. “Aren’t you?”
Abby nodded. “You should be scared. We all should.”
Outside, in the parking lot, Abby and Vivian stood together under a gray, drizzling sky. They had arrived in their separate cars, and now it was time to go their own ways. The days were growing so short now; only five o’clock, and already the light was fading. Shivering, Abby pulled her slicker tighter and glanced around the lot. No maroon vans.
“We don’t have enough,” said Vivian. “We can’t force an investigation yet. And if we tried, Victor Voss could just cover his tracks.”
“Nina Voss wasn’t the first one. I think Bayside’s done this before. Aaron died with three million dollars in his account. He must have been getting payoffs for some time.”
“You think he got second thoughts?”
“I know he was trying to get out of Bayside. Out of Boston. Maybe they wouldn’t let him go.”
“That could be what happened to Kunstler and Hennessy.”
Abby released a deep breath. Again she glanced around the lot, searching for the van. “I’m afraid that’s exactly what happened to them.”
“We need other names, other transplants. Or more donor information.”
“All the information about donors is locked up in the transplant coordinator’s office. I’d have to break in and steal it. If it’s even there. Remember how they misplaced the donor papers on Nina Voss?”
“Okay, so we go at it from the recipient side.”
“Medical Records?”
Vivian nodded. “Let’s find out the names of who got transplanted. And where they were on the waiting list when it happened.”
“We’ll need NEOB’s help.”
“Right. But first we need names and dates.”
Abby nodded. “I can do that.”
“I’d help you out, but Bayside won’t let me in its doors anymore. They think I’m their worst nightmare.”
“You and me both.”
Vivian grinned, as if it was something to be proud of. She seemed small, almost childlike in her oversize raincoat. Such a fragile-looking ally. But while her size didn’t inspire much confidence, her gaze did. It was direct and uncompromising. And it saw too much.
“Okay, Abby,” sighed Vivian. “Now tell me about Mark. And why we’re keeping this from him.”
Abby released a deep breath. The answer spilled out in a rush of anguish. “I think he’s part of it.”
“Mark?”
Abby nodded. And looked up at the drizzling sky. “He wants out of Bayside. He’s been talking about sailing away. Escape. Just like Aaron did before he died.”
“You think Mark’s been taking payoffs?”
“A few days ago, he bought a boat. I don’t mean just a boat. A yacht.”
“He’s always been crazy about boats.”
“This one cost half a million dollars.”
Vivian said nothing.
“Here’s the worst part,” whispered Abby. “He paid in cash.”
17
The Medical Records file room was in the hospital basement, just down the hall from Pathology and the morgue. It was a department well known to every physician at Bayside. This was where doctors signed off on charts, dictated discharge summaries, and initialed lab reports and verbal orders. The room was furnished with comfortable chairs and tables, and to accommodate the often erratic work hours of its physicians, the department stayed open until nine P.M. every night.
It was six that evening when Abby walked into Medical Records. As she’d expected, the room was nearly deserted for the dinner hour. The only other physician was a haggard-looking intern, his desk piled high with delinquent charts.
Heart pounding, Abby approached the clerk’s desk and smiled. “I’m compiling statistics for Dr. Wettig. He’s doing a study on heart transplant morbidity. Could you pull up a list on your computer? The names and record numbers of all heart transplants done here in the last two years.”
“For a records search like that, we need a request form from the department.”
“They’ve all gone home by now. Could I get that form to you some other time? I’d like to have this ready for him by the morning. You know how the General is.”
The clerk laughed. Yes, she knew exactly how the General was. She sat down at her keyboard and called up the Search screen. Under Diagnosis, she typed in Cardiac Transplant, then the years to be searched. She hit the Enter button.
One by one, a list of names and record numbers began to appear. Abby watched, mesmerized by what she saw scrolling down the screen. The clerk hit Print. Seconds later, the list rolled out of the printer. She handed the page to Abby.
There were twenty-nine names on the list. The last one was Nina Voss.
“Could I have the first ten charts?” Abby asked. “I might as well start wo
rking on this tonight.”
The clerk vanished into the file room. A moment later she reemerged hugging a bulky armful of files. “These are only the first two. I’ll get you the rest.”
Abby lugged the charts to a desk. They landed with a heavy thud. Every heart transplant patient generated reams and reams of documentation, and these two were no different. She opened the first folder to the patient information sheet.
The name was Gerald Luray, age fifty-four. Source of payment was private insurance. Home address was in Worcester, Massachusetts. She didn’t know how relevant any of this information was, so she copied it all down onto a yellow legal pad. She also copied the date and time of transplant and the names of the doctors in attendance. She recognized all the names: Aaron Levi, Bill Archer, Frank Zwick, Rajiv Mohandas. And Mark. As expected, there was no donor information anywhere in the chart That was always kept separate from recipient records. However, among the nurses’ notes, she found written: “0830—Harvest reported complete. Donor heart now enroute from Norwalk, Connecticut. Patient wheeled to OR for prep . . .”
Abby wrote: 0830. Harvest in Norwalk, Conn.
The records clerk wheeled a cart to Abby’s desk, deposited five more charts, and went back for more.
Abby worked straight through the supper hour. She didn’t stop to eat, didn’t allow herself even a break, except to call Mark to tell him she’d be home late.
By closing time, she was starving.
She stopped at a McDonald’s on the way home and ordered a Big Mac and giant fries and a vanilla shake. Cholesterol to feed the brain. She ate it all while sitting in a corner booth, keeping an eye on the dining room. At that hour, the other patrons were mostly the postmovie crowd, teenagers on dates, and here and there a few depressed-looking bachelors. No one even seemed to notice she was there. She finished every last french fry, then left.
Before she started the car, she made a quick survey of the parking lot. No van.
At ten-fifteen, she arrived home to find that Mark was already in bed and the lights were out. She was relieved that she would not have to answer any questions. She undressed in the dark and climbed under the covers, but she didn’t touch him. She was almost afraid to touch him.
When he suddenly stirred and reached out to her, she felt her whole body go rigid.
“I missed you tonight,” he murmured. He turned her face to his and gave her a long and intimate kiss. His hand slid down to her waist and caressed her hip. Stroked along her thigh. She didn’t move; she felt as frozen as a mannequin, unable to respond or resist. She lay with her eyes closed, her pulse roaring in her ears, as he pulled her into his arms. As he slid inside her.
Who am I making love to? she wondered as he thrust again and again, their hips colliding with brutish force.
Then it was over, and he was sliding out of her.
“I love you,” he whispered.
It was a long time later, after he’d fallen asleep, that she whispered her answer.
“I love you too.”
At seven-forty A.M. she was back in Medical Records. Several of the desks were now occupied by physicians cleaning up paperwork before making their morning rounds. Abby requested five more charts. Quickly she took notes, gave the charts back to the clerk, and left.
She spent the morning in the medical library, looking up more articles for Dr. Wettig. It wasn’t until late that afternoon when she returned to Medical Records.
She requested ten more charts.
* * *
Vivian finished off the last slice of pizza. It was her fourth slice, and where she put it all was a mystery to Abby. That elfin body consumed calories like a fat-burning furnace. Since they’d sat down in the booth at Gianelli’s, Abby had eaten only a few bites, and even those were an effort.
Vivian wiped her hands on a napkin. “So Mark still doesn’t know?”
“I haven’t said a thing to him. I guess I’m afraid to.”
“How can you stand it? Living in the same house and not talking?”
“We talk. We just don’t talk about this.” Abby touched the sheaf of notes on the table—the notes she’d been carrying around all day. She’d been careful to keep them where Mark wouldn’t find them. Last night, when she’d returned home after McDonald’s, she had hidden the notes under the couch. Lately it seemed she’d been hiding so many things from him, and she didn’t know how long she could keep it up.
“Abby, you’ve got to talk to him about this eventually.”
“Not yet. Not until I know.”
“You’re not afraid of Mark, are you?”
“I’m afraid he’ll deny everything. And I’ll have no way of knowing if he’s telling the truth.” She ran her hands through her hair. “God, it’s like reality’s completely shifted on me. I used to think I was standing on such solid ground. If I wanted something badly enough, I just worked like hell for it. Now I can’t decide what to do, which move to make. All the things I counted on aren’t there for me anymore.”
“Meaning Mark.”
Wearily, Abby rubbed her face. “Especially Mark.”
“You look awful, Abby.”
“I haven’t been sleeping very well. I’ve got so many things to think about. Not just Mark. But also that business with Mary Allen. I keep waiting for Detective Katzka to show up on my doorstep with his handcuffs.”
“You think he suspects you?”
“I think he’s too bright not to.”
“You haven’t heard anything from him. Maybe he’ll let it slide. Maybe you’re giving him too much credit.”
Abby thought of Bernard Katzka’s calm gray eyes. And she said, “He’s a hard man to read. But I think Katzka’s not only smart, he’s persistent. I’m scared of him. And weirdly enough, fascinated by him too.”
Vivian sat back. “Interesting. The prey intrigued by her hunter.”
“Sometimes I just want to call Katzka and blurt out everything. Get it all over with.” Abby dropped her head in her hands. “I’m so tired, I wish I could run away somewhere. Sleep for a whole week.”
“Maybe you should move out of Mark’s house. I’ve got an extra bedroom. And my grandmother’s leaving.”
“I thought she was a permanent houseguest.”
“She makes the rounds of all her grandkids. Right now I’ve got a cousin in Concord who’s bracing herself for the visit.”
Abby shook her head. “I don’t know what to do. The thing is, I love Mark. I don’t trust him anymore, but I love him. At the same time, I know that what we’re doing could ruin him.”
“It could also save his life.”
Abby looked miserably at Vivian. “I save his life. But I destroy his career. He may not thank me much for that.”
“Aaron would have thanked you. Kunstler would have. Certainly Hennessy’s wife and baby would have thanked you.”
Abby said nothing.
“How certain are you that Mark’s involved?”
“I’m not certain. That’s what makes this so hard. Wanting to believe in him. And not having any evidence to tell me one way or the other.” She touched her notes. “I’ve looked at twenty-five files so far. Some of the transplants go back to two years ago. Mark’s name is on every one of them.”
“So is Archer’s. And Aaron’s. That doesn’t tell us anything. What else have you learned?”
“All the records look pretty much the same. Nothing to distinguish one from any other.”
“Okay, what about the donors?”
“That’s where things get a little interesting.” Abby glanced around the restaurant. Then she leaned toward Vivian. “Not all of the charts mention which city the donor organ comes from. But a number of them do. And there seems to be a cluster. Four of them came from Burlington, Vermont.”
“Wilcox Memorial?”
“I don’t know. The hospital was never specified in the nurses’ notes. But I find it interesting that a relatively small town like Burlington ends up with so many brain-dead people.”
&nb
sp; Vivian’s gaze met hers in a stunned look. “There’s something really wrong here. We were hypothesizing nothing more than a shadow referral network. Donors who are simply kept out of the registry system. But that doesn’t explain a cluster of donors in one town. Unless . . .”
“Unless donors are being generated.”
They fell silent.
Burlington is a university town, thought Abby. Full of young, healthy college students. With young, healthy hearts.
“Can I have the dates on those four Burlington harvests?” said Vivian.
“I have them right here. Why?”
“I’m going to check them against the Burlington obituaries. Find out who died on those dates. Maybe we can identify the names of the four donors. And find out how they ended up brain-dead.”
“Not all obits list the cause of death.”
“Then we may have to go to the death certificates. Which means a trip to Burlington for one of us. A place I’ve been dying to visit. Not.” Vivian’s tone of voice was almost breezy. That warrior woman bravado again; she had the act down pat. But this time it wasn’t enough to hide the note of apprehension.
“Are you sure you want to do this?” said Abby.
“If we don’t, then Victor Voss wins. And the losers are going to be people like Josh O’Day.” She paused. And asked, quietly: “Is this what you want to do, Abby?”
Abby dropped her head in her hands. “I don’t think I have a choice any longer.”
Mark’s car was in the driveway.
Abby pulled up behind it and turned off her engine. For a long time she simply sat there, scraping up the energy to get out of the car, to walk into the house. To face him.
At last she stepped out of the car and walked in the front door.
He was in the living room, watching the late night news. As soon as she came in, he clicked off the TV. “How is Vivian doing these days?” he asked.
“She’s fine. Landed right back on her feet. She’s buying into a practice in Wakefield.” Abby hung up her coat in the closet. “And how was your day?”
“We got a dissecting aorta. He bled out sixteen units just like that. I didn’t get out till seven.”
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