“Maybe I could.”
Teri checked her watch.
“Meanwhile, I’ll be pretty tied up with the pomp and ceremony. But I’ll be up again in five days. Let’s plan to speak every day until then. If we miss connections, I’ll page you. You can leave messages for me at home or at the office.”
Brian took her in his arms.
“I really loved last night,” he said. “And I hope it’s the start of something very special.”
“It is,” Teri whispered, her lips brushing his ear. “Believe me, Brian. I know now why I’ve been ignoring the phone and keeping to myself for so many months. I’ve been waiting for you.”
Brian ransomed the LeBaron from the airport parking garage and began the drive home to Reading. His thoughts were only of Teri Sennstrom—her voice, her poise, the scent of her hair, the feel of her waist, her body pressing against his. They had kissed good-bye in the bar, deciding it was still too chancy to walk together through the terminal to the security checkpoint. After Vasclear had been released to the world, there would be no problem in their going public. But for now, it was better for both of them to be discreet.
Teri was right, he thought, as he headed north on 1A. It was over. Despite his suspicions regarding Ford and Elovitz, Vasclear had proven to be incredibly effective and squeaky-clean in a reasonably sized, carefully controlled double-blind study. There was nothing he could do about Jack’s failure to respond to the drug. Of every million patients worldwide who would be treated once the Hippodome ceremony was over, two hundred and fifty thousand weren’t going to respond to Vasclear, either. Two hundred and fifty thousand total treatment failures. And at this point, from all anyone could determine, there was nothing more than the fickle finger of fate at work deciding who was going to be cured by the drug and who was not. A lethal combination of factors unknown plus plain old-fashioned lousy luck—that’s what had conspired to bring Jack Holbrook down. There was nothing more Brian could have done.
It was time to let the whole business rest. Phil had said it perfectly. They had nothing to gain and everything to lose by infuriating the powers that be at Boston Heart over this one.
Time to let the whole business rest. The words were still reverberating in Brian’s head when he reached Bell Circle, the rotary off of which one of the exits led to the highway home. Before he even fully realized what he was doing, he had sped past the turnoff, gone completely around the rotary, and was heading south on 1A, back toward the city—more specifically, back toward Boston City Hospital.
The secret of moving freely about a hospital was simple: Look and act like you belong wherever it is that you are. In a huge hospital like Boston City, with its many buildings, enormous international faculty, inner-city patient population, and chronically overworked staff, the task was easy.
Brian’s neat appearance, clinic coat, stethoscope, and plastic ID card got him into the record room, where he soon had the librarian helping in his search for the record of Kenneth Ford, deceased. It took considerably longer to get a security officer to come and lead him into the dusty bowels of the hospital to the locked storage room where the so-called inactive records were kept.
Not surprisingly, the carefully numbered cardboard file cartons, like the records inside them, seemed to be in no consistent order. After ten minutes of standing around, the guard became impatient and left, instructing Brian to lock up after himself when he was finished.
We Respect Patient Confidentiality. The signs were up in every elevator in every hospital Brian had ever known. Yet here he was, armed with only his clean-cut looks, a plastic ID from another hospital, and some of the accouterments of a physician, alone with thousands of medical records.
It took nearly forty-five minutes and half a dozen cartons to find the file on Kenneth Ford. And for a time, Brian had wondered if it would be among the missing, like the White Memorial labwork and chimp 4386.
Kenneth Ford had been admitted to Boston City Hospital on August 3, two years before, and had died on the sixth. Admission diagnosis: congestive heart failure, severe. Discharge diagnosis: same. His EKG showed changes consistent with both cardiac and pulmonary disease, and his chest X ray showed too much fluid in his lungs to make possible a diagnosis as subtle as pulmonary hypertension.
Brian felt a strangely pleasing tension as he turned to the hematology section of the lab reports.
White Blood Cell Count 13,300/cu. mm (elevated)
Differential Cell Count:
Granulocytes: 45%
Bands: 3%
Lymphocytes: 33%
Monocytes: 5%
Eosinophils: 14% (elevated)
Basophils: 0%
Brian tore the page out and folded it in his pocket. He would leave Phil out of this from now on; it wasn’t fair to involve him. He would have to be extremely careful and tread softly. But Jack was dead, and directly or indirectly, Brian’s treatment choice of Vasclear had helped kill him. No matter what, there was no way he could let the matter rest until some gnawing questions were answered.
CHAPTER TWENTY-THREE
The Oprah Winfrey Show
Oprah: Do you believe in miracles? Today we’re devoting this program to people who have had their lives saved by so-called miracle cures. But before we begin with our very special miracle-cure guests, I would like to introduce to you Mr. Al Morgenfeld, a man with a history of two heart attacks and severe coronary artery disease, who is living life as what is known as a cardiac cripple. Also with Mr. Morgenfeld is his wife, Julia, and his cardiologist, Dr. Susan Norman, who has promised Mr. Morgenfeld he will be on the new wonder drug Vasclear the very day it is released for general use … which could be as soon as next week.
BRIAN STOOD AT THE REAR OF THE SMALL CROWD IN THE Vasclear-clinic waiting room and watched the initial portion of the TV program that everyone at the hospital had been anticipating. Patients and staff alike cheered and applauded at the mention of the drug that had brought them all together. Lucy Kendall, resplendent in pink cashmere, had positioned herself just to Brian’s left and a half-step behind him, and continued her assault on his arm and back with her breast.
“Isn’t it wonderful?” she said.
“It is that.”
“My only big concern is how long the clinic is going to remain open,” Lucy said.
“I never thought of that.”
It made sense that once the drug was in general use, the care of most Vasclear patients could be turned back over to their own doctors. Any physician with access to a pharmacy or a UPS truck would have access to Vasclear. Time, Newsweek, CNN, evening news programs, now Oprah.… How desperate everyone had been for a drug like this one. And how many hundreds of millions watched those shows and read those magazines? It would be a medical gold rush.
Brian flashed on what Laj Randa had told him about the cost of a course of treatment with the drug. One hundred dollars a dose, fifty or so doses in a full course. And what’s more, the managed-care people and insurance companies, the real controllers of cost in the country, would gladly pay. One quintuple bypass was the equivalent of how many doses of Vasclear? And, Brian reflected sourly, if the patient happened to be a nonresponder like Jack, and that patient was one of those who happened to die before he got into the OR, so much the better.
“Well, the drug still has to be given IV,” Brian said. “For all we know, Vasclear-administration clinics will become all the rage over the next few years, like surgicenters. And even if that doesn’t happen, you’re an excellent nurse, and I’m certain you won’t have any trouble landing something new.”
“Thank you for saying that. Are you okay, Brian?”
“What do you mean?”
“You just seem distracted. Distracted and sad.”
“I have a lot on my mind.”
“Your dad?”
“Yeah, him. Some other stuff.”
“Anything I can do?”
The question was punctuated with a less-than-subtle mammary nudge. Brian considered asking i
f she knew the names of the eighteen patients treated during the Phase One evaluation, but thought better of it. Just a word from her to Art Weber, and the fuse would be lit beneath one B. Holbrook.
“Thanks, Lucy,” he said, “but it’s stuff I’ve got to work through for myself.”
On the overhead TV, a barber named Al Morgenfeld from Moline, Illinois, was telling a hundred million people what it had been like to live with severe angina, knowing that each twinge in his chest or shoulder or jaw could be the start of what he called the Big One.
“Dr. Norman,” Oprah then asked, “tell me something. Why haven’t you sent Al for coronary artery bypass surgery like so many thousands of others have had?”
“Well, for one thing,” the doctor replied, “he already had bypass surgery once, seven years ago. Repeat surgery would be riskier. I got wind of Vasclear over a year ago and have been in constant touch with the people at Newbury Pharmaceuticals. We’ve been holding out for a nonsurgical cure of Al’s disease.”
“What you mean to say is that you’ve been holding out for a miracle.”
“Exactly. And I think we’ve got one.”
Brian turned and headed off toward the physician’s office.
“Hey, I almost forgot,” Lucy called after him. “Your girlfriend is in room two.”
“Girlfriend?”
“Nellie—the woman who was willing to turn her daughter over to you”—she ran up and whispered the rest of the sentence in his ear—“as your sex slave.”
“Oh,” Brian said with far less enthusiasm in his voice or expression than he had intended, “thanks.”
He went back to the office, purposely avoiding room 2. It wasn’t Nellie who had him upset. She was a delight. It was what she represented—a Vasclear cure—that upset him.
Why not Jack? he asked himself for the millionth time. Why not my father?
Finally, after a few minutes of shuffling papers, he headed in to see her. Nellie seemed, if anything, even more full of life than when he had last seen her at the cake cutting. But she was also very upset.
“Dr. Holbrook, the nurse just told me about your father’s death,” she said. “I’m so sad for you.”
“Thank you.”
“Was it his heart?”
“It was, yes.”
“That must have been very frustrating for you as a cardiologist. I’m so sorry.”
Impressed as before with her intuitiveness, Brian thanked her again, then conducted a fairly brief physical exam, which showed a normal heart and excellent arteries.
“How old were your parents when they died?” he asked.
“Parent,” she said. “My mother is ninety-three and still bright as a penny and living by herself, thank you very much.” It was clearly a question she enjoyed answering. “My father died three years ago at eighty-nine. Believe it or not, he fell off a ladder and broke his hip. The operation did him in. A blood clot in the lungs, they said.”
A pulmonary embolus, Brian translated to himself—an avoidable complication of not mobilizing the man early and often enough, and inadequately thinning his blood post-op. To all intents, Nellie’s father hadn’t even died of natural causes. Her parents had essentially both lived into their nineties! Usually the most common predictor of cardiovascular disease—positive and negative—was family history. What had happened to Nellie?
“Well, Nellie, the nurse will be in to hook you up,” he said. “Afterward, you can see the secretary about next month’s appointment.”
“Wait, I almost forgot.” She fumbled in her purse and handed him an unsealed envelope with Dr. Holbrook printed on the front.
It was a neatly typed letter announcing a twenty-mile charity walk for the homeless and requesting sponsorship for each mile. An attached page summarized a number of similar events in which she’d participated.
“This is wonderful,” Brian said, scanning the list, wondering what his father would have been like with a clean set of arteries. “I’ll be happy to sponsor you.”
He wrote in a pledge, tore off that portion of the letter and gave it to her, then dropped the rest of the announcement into his briefcase. For a decade or more, the battered case had served as his combination medical bag, library, portable desk, and even closet. He would next see Nellie’s papers when he cleaned the thing out, as he was forced to do every week or two.
“Will I see you before I leave?” Nellie asked.
“Only if the secretary has a problem making your appointment. Otherwise, she has all the schedules, and you can just pick a date.”
She has all the schedules. The image sent Brian suddenly hurrying to the front desk, where the receptionist, Mary Leander, was filling out an appointment slip for a patient.
“Can I help you, Dr. Holbrook?” she asked.
“Ah … yes. Yes, you can.” Brian realized that he should have taken a minute or two to prepare for this performance. “I was asking Mrs. Hennessey when it was that she shifted from receiving treatments every two weeks to every four and she couldn’t remember. I was thinking the answer might be in the clinic appointment book, but I didn’t know how far back they go.”
Brian hoped his explanation made sense to Mrs. Leander, because it made absolutely none to him.
“Well, I don’t know,” she said. “I think we get a fresh book each year. I have no idea where the old ones are kept, or even if they’re kept at all. Maybe somewhere in the office here.”
She gestured behind her at the ceiling-to-floor shelves of forms, ledgers, procedure manuals, papers, and the like—far more than Brian had time to sift through at the moment. But if there was an appointment ledger from the first year of the clinic’s existence, then maybe he could find the names of the other sixteen patients from the Phase One trials.
“Thank you, Mrs. Leander,” he said. “I’ll check some other time when I have the chance.”
That evening, Brian’s first night duty since before Jack’s death, was blessedly quiet. He had decided to wait until eleven before searching for the first Vasclear-clinic appointment book. At exactly five of, he checked on the two sickest patients on the ward, reassuring himself that they were reasonably stable. Then he told the charge nurse he’d be on-beeper, left the floor, and slipped into the clinic through the same door Jessup and Weber had used to bring in Walter Louderman.
The place, as before, was eerily dark. Brian decided to keep it that way. He used his penlight to negotiate the long corridor to the receptionist’s office, wondering if, perhaps, the glass-fronted room might be locked.
Despite being alone, Brian moved cautiously. If the door was locked, the game was over and he would return to the ward. But he could see immediately that it wasn’t even completely closed. He slipped inside, hesitated, then flicked on the overhead lights. In the nearly total darkness, the sudden fluorescence was blinding. He allowed his eyes to adjust, then explored the drawers of the metal desk behind the receptionist’s station. Nothing. Next he turned to the bank of shelves.
It took just a few minutes to find them—two thin volumes, leather-bound, obviously purchased from the same stationer, identical to the one lying closed on the receptionist’s desk. Each had a year embossed in gold on the cover. Brian pulled the first one out and settled down on the receptionist’s chair. The appointments were widely scattered at first, but then rapidly filled in. Brian reasoned that what he was seeing was the transition between Phase One patients, who may have been seen initially in their cardiologists’ offices, and the larger double-blind study, Phase Two, which soon grew to over six hundred cases. The clinic, itself, seemed to have been opened two and a half years ago, about halfway through Phase One.
He found early appointments for both Bill Elovitz and Kenneth Ford. Using them as a marker, he began to scratch down names and follow them through the ledger, searching for those who did not have the two weeks of almost-daily treatments demanded by Phase Two. After twenty minutes the list, counting Elovitz and Ford, had grown to ten. Brian felt reasonably certain that mos
t, if not all, of the ten were Phase One patients. Then, he heard the tones of a keypad being punched, followed moments later by a door opening. A faint shaft of light pierced the darkness in the hall.
On a sudden adrenaline rush, Brian cut the lights in the office, thrust the list of names into his pocket, dropped to his knees, and crawled as quickly as he could out through the darkness to the waiting room. The lights in the hallway flared on. Brian inched toward the patients’ entrance, then ducked behind a sofa as he sensed the intruder approaching the reception area.
Only now did Brian curse himself for overreacting. He had dived for cover like a prowler about to be caught in the act. He was on the faculty of the institute and on duty that night. He also possessed the keypad access code to the clinic and a perfectly legitimate reason for being there—a reason he had established earlier in the day during a conversation with the receptionist, Mrs. Leander. Now, however, it was too late.
The piece of furniture he had flattened himself behind—wooden arms and frame with loose cushions on top—offered some, but not total, cover. Brian lay on the floor looking under the furniture and wondering if all of his seventy-five inches was hidden. He reached down slowly and shut off his pager. But he decided against disabling the code-call beeper. If there was a cardiac arrest somewhere in the hospital, however, his own might follow close behind.
The door to the waiting room was maybe six feet away, but there was no way he could chance going for it. The noise of opening it would probably get him caught, and there was also the possibility it was locked. He pressed the side of his face onto the heavy-duty carpet and breathed silently.
Suddenly the fluorescents flickered on in the waiting room. Beneath the furniture, Brian could make out the pants legs and sneakers of a man standing across the room. Sneakers? He wondered whether hospital security allowed such dress. The sneakers turned one way then another as the man scanned the room. Then, after an unending two or three minutes, the overheads went off.
Miracle Cure Page 22
