“Sudden shock less than an hour after his wires were pulled,” she said. “He’s essentially in EMD. You can see what we were getting prepared to do. Dr. Holbrook has some experience with the procedure, so we—”
Randa stopped her with a raised hand. He had heard and seen all he needed to.
“Chest tray,” he ordered. “Quickly, now. Quickly. If Mr. Wilansky appears to need it, give him some IV Demerol.”
He motioned Lewellen away from the bed with a shake of his head and, with a similar movement, ordered one of his cardiac surgical fellows to take the young physician’s place.
Without having to be asked, the nurse helped Randa slip a surgical gown over his street clothes, and stretched open a pair of gloves, into which he thrust his hands. His movements were rapid and smoothly precise.
“Scalpel,” he said. “Have the spreader ready.”
Without another word, the cardiac surgeon sliced through the paper tape and the incision with the same stroke. The sternum had been split down the middle for Wilansky’s surgery, after which the bone had been wired back together. Only the middle one of the three wires had broken during Lewellen’s closed-chest massage. Randa snipped the remaining two while his surgical fellow worked the spreader into place.
“Tamponade,” Randa said, speculating that they would find the heart constricted by hemorrhage.
The gush of blood from the cardiac cavity confirmed his prediction, as well as the diagnosis Carolyn had made. The pacemaker wire had caught on the vein graft and pulled it free of the aorta.
Except for his own commands, Randa worked in absolute silence. In less than a minute, the bleeding was stemmed. He slipped his left hand beneath Paul Wilansky’s heart to cradle it while he performed downward compressions from above with his right. Brian noted, without surprise, that Randa’s technique was perfect. The two-handed compressions would keep the surgeon from squeezing with one hand and inadvertently perforating the thin right atrial wall with his thumb.
“Good pulse,” Brian risked saying, his fingers pressing down over the femoral artery.
“We need an OR,” Randa said to the nurse, blatantly ignoring Brian.
“They’ll be ready for you by the time you get there,” she replied. “The pump team should be there by now.”
“Who ordered that?”
“Dr. Holbrook. We also have two units on the way and he ordered another six cross-matched.”
Randa continued his rhythmic massage. Then he turned to Mark Lewellen, who looked as if he were trying to melt into the wall.
“You nearly killed this man, Lewellen, by not recognizing EMD and its cause,” he said icily. “You have only these doctors to thank that he’s alive. I want you off my service immediately and I don’t want you back.”
“But—”
“Now!” Randa snapped the word like a whip.
Complete, painful silence accompanied the shattered young resident from the room. Brian managed a glance at Jessup, who looked furious, but she just shrugged and tightened her lips.
“So,” Randa said to his staff, “let’s unhook this man from the monitor and get him down to the OR. My hands are getting tired.”
Without another word, Randa and his entourage quickly maneuvered themselves out the door of the room and down the hall.
Brian, Carolyn, and the two remaining nurses stood silently amid the debris that was the typical aftermath of a Code 99, sharing exhaustion and lingering uncertainty, as well as dismay over the way Mark Lewellen had been expelled. The twenty minutes just past had been frantic, gut-wrenching, challenging, and up to now at least, triumphant. And during that time, members of the hastily formed team had been bound to one another in a way unique to a crisis in a hospital.
Finally, the nurses thanked the doctors for their help and assured them that their obligation to the surgical service did not extend to helping to clean up the room. Brian followed Jessup to the hallway.
“That was a really great pickup,” he said, “diagnosing a torn bypass graft that quickly.”
“Thank you, Brian. I was going to tell you how much confidence I have in you, having seen you in the cath-lab emergency and now here.”
“What a team.”
Brian held out his hand. Almost hesitantly, Jessup took it.
“A team,” she said softly. “Well, I’m late for an appointment.”
She turned quickly and headed down the hall.
“Dr. Jessup?” Brian called after her.
She stopped and turned slowly back to him.
“Yes?”
“You are really a terrific doc.”
Even at a distance of ten feet or so, Brian could see a dark sadness in her eyes.
“That’s nice to hear,” she said.
CHAPTER THIRTY-FOUR
THE SCENE WAS ALL TOO FAMILIAR FOR BRIAN AS HE stood on the observation floor above the cardiac surgical OR, watching Laj Randa and his team perform. Just ten days earlier it had been his father lying there on artificial life supports, living out the final minutes of his existence.
Before heading down to watch the surgery on Paul Wilansky, Brian had done a quick run-through of the patients on the ward, and then made another unsuccessful attempt to contact Phil Gianatasio. With each ring, he became more and more certain that something bad had happened to his friend. He had no luck in reaching Teri, either, and was beginning to worry about her as well. He left urgent messages on her voice mail and at her home, imploring her to page him as soon as she got in. Finally, he called the Reading police. A squad car had been sent to his home, he was told, but when nothing was seen through any of the windows, the patrolman elected not to break in.
How in hell had all this happened?
Brian felt as if he had stepped into quicksand and was now up to his chin, with no rope, no rescuer, in sight. He had gone up against a company with billions of dollars at stake and with the resources and depravity to do whatever was needed to protect their investment. Elovitz, MacLanahan, maybe Phil, and God only knew who else. Even the drunken animal keeper Earl and his poor chimp. None of their lives mattered to the pharmaceutical juggernaut.
Brian feared what was in store for him, but he was angry and frustrated as well—angry that there was no one he could safely turn to for help, and frustrated that there were still so many unanswered questions. From what he could tell, during Phase One trials, Vasclear worked well for a while in at least some of the patients, but soon their arteriosclerosis began recurring. Worse, although there was no solid proof in any one case, a number of those patients developed what looked like drug-induced pulmonary hypertension.
A drug with modest, short-lived benefits, complicated by a frequently occurring lethal side effect What combination could possibly have been worse? And yet, the scientists at Newbury had persevered, had modified the drug, and had ultimately emerged victorious. Brian had seen the clinical successes firsthand. Seventy-five-percent success. No significant side effects. A miracle cure. Why, then, were the Newbury powers still out to destroy the ants?
Brian felt a bit nervous about being alone in the dimly lit surgical-observation suite, but there was a security man on duty at the door, as there was whenever the operating theater was in action. And tucked in his lab coat pocket, beneath a washcloth he had taken from the on-call room, was the snub-nosed revolver. From what he could tell, the gun was strictly point-and-shoot—no safety, no special features. But he wasn’t certain. He had come close to wrapping it in the mattress in his room to try firing it, but feared the noise might attract someone’s attention, or else that he would do something wrong and blow off his own hand.
Brian stood back a bit from the Plexiglas canopy over OR 1. He had endured enough of Laj Randa’s pomposity for one day. Once it was clear Paul Wilansky was going to make it, he was out of there. Below him, the operation to repair the accountant’s bypass graft seemed to be progressing smoothly, although there was no way to tell what kind of intellect would emerge once the anesthesia was turned off. Wilansk
y’s blood pressure had been extremely low for some time, and he was on CPR for the better part of fifteen minutes before Randa opened his chest. Had they managed to keep his brain adequately perfused? The operation was a success, but—
“Nice of you to stop by, Dr. Holbrook,” Randa said suddenly.
As far as Brian could tell, the surgeon hadn’t once looked in his direction, nor was he looking up now.
“How’s it going?” Brian asked.
“Perfectly well.”
“How do you think he’ll do?”
“I have no reason to believe this man won’t make it intact.”
Unlike the one I killed, right? Brian thought.
“That’s great,” he said.
There was a prolonged silence during which Randa’s attention once again seemed focused on the motionless, artificially chilled heart before him.
“My nurse tells me you performed quite admirably during this man’s crisis,” he said suddenly. “You have my gratitude and at least some of the respect you lost by hanging your father’s life on the Vasclear thread.”
“That’s a cruel thing to say,” Brian managed.
“But it is true nonetheless.” Randa worked on as he talked. “You bought into the hype, Dr. Holbrook. Instead of waiting for the verdict of reason and scientific process, you chose to believe what you read in Time magazine and saw on TV.”
“That’s not true. I made inquiries. I read reports. I spoke with my colleagues, I examined patients. My father had nearly died after his bypass operation. For him, Vasclear was plainly the preferable option.”
“And I tell you, Dr. Holbrook, anything that seems to be too good to be true invariably is too good to be true. Mark my words on that. There is no Santa Claus. And you ultimately cost your father his life by believing there was.”
“Dr. Holbrook did nothing of the kind, Randa!”
Startled, Brian thrust his hand around the revolver and whirled, stumbling several steps backward in the process. Art Weber stood less than ten feet away, looking not at Brian, but at the scene below.
“Ah, if it isn’t the guru of Vasclear, himself,” Randa said. “Your man there helped save this patient’s life. I was just thanking him.”
“I heard what you were doing,” Weber shot back. “Randa, you’re just terrified of losing a huge chunk of your precious bypass empire. From the day you first realized that Vasclear was curing people, you’ve been on a mission to keep it from the public. Well, Laj, you’ve lost. Beginning Saturday, those kings and sultans who have been flying over here to pump up your already-bloated ego will be able to sit back on their thrones and get treated with nothing more invasive than an IV.”
“Get out!” Randa shouted. “Get out of my operating room!”
Brian was shocked to see the Sikh lose his composure, let alone be at a loss for a counterpunch. Even at a distance, swathed in his surgical garb, Randa seemed deflated. The only possible explanation, Brian realized, was that the surgeon sensed Weber was right. For all his railing against the way Vasclear had made an end run around the scientific community, Randa had no reason to believe there was any problem with the drug.
But Brian had more immediate concerns than Randa’s bruised ego. People were out to kill him. And as far as he could tell, the man at the heart of that threat was standing just two paces away. Brian kept his grip on the butt of the revolver and worked his finger through the trigger guard. If necessary, he could fire through his pocket. The muscles in his shoulders and neck were tense almost to spasm. He expected at any instant to have massive Leon come bursting through the door, gun blazing.
Instead, Art Weber reached over calmly and flicked off the microphone. Then he moved out of the sight line of the OR and motioned Brian to do the same.
“I ran into Carolyn,” Weber said. “She told me what a great job you did with Randa’s patient. She said that she thought you might be here in the observation suite following up on him.”
Brian inched backward, putting more distance between the two of them. Weber appeared relaxed, almost euphoric—the look of a man about to make medical history and come into several hundred million dollars at the same time.
“Where’s Phil?” Brian asked.
“Gianatasio?”
“Yes. Do you know what’s happened to him?”
“I had no idea anything had happened to him.”
Brian tried to see behind the man’s words. Nothing. But Weber was Vasclear. If Newbury Pharmaceuticals had anything to do with Phil’s disappearance, he had to know.
“He’s been missing all day,” Brian said. “We’ve all been worried about him.”
“Now I am, too. Have the police been called?”
“By Dr. Pickard, yes.”
Brian loosened his grip on the revolver, but kept his hand in his lab coat pocket. Even if Weber did know where Phil was, there was no way he was going to blink.
“Brian, I wanted to speak with you about Vasclear. I understand you’ve been making some inquiries about some of our Phase One patients. I believe their names are Elovitz and Ford.”
“Were,” Brian said.
“Pardon?”
“Were Elovitz and Ford. They’re both dead.”
Brian held back from saying anything about MacLanahan and Sylvia Vitorelli.
“I don’t think I knew that,” Weber said. “Well, I wanted to ask you to back off on any further investigation of our drug until the ceremony on Saturday is over. After that, you’re free, in fact you’re encouraged to pursue whatever investigations you wish.”
“I don’t understand. You want me to investigate Vasclear?”
Weber nodded.
“We’ve been very impressed with some of the things you’ve done around here, Brian. Your performance today is a case in point. Just because Vasclear is being approved for general use doesn’t mean our responsibilities are over. And frankly, I have a number of other projects that need my attention. I need a close associate to supervise the postmarketing evaluation of Vasclear and to troubleshoot should any problems arise. I think you could do that job, and do it well.”
Brian stared across the dim light at the man. Through the corner of his eye, he could see Laj Randa back away from the table as his fellows began closing Paul Wilansky’s chest. The operation was over.
“I … I’m not sure I believe what I’m hearing,” he said. “You’re offering me a job at Newbury?”
“The pay would start at, say, a hundred and fifty thousand. But after six months we can renegotiate.”
“A hundred and fifty thousand is … is very generous.”
“You don’t have to let me know right away, but I will have you put on the payroll as soon as you do. Of course you can stay at Boston Heart as long as Ernest needs you. For however long that is, you’ll actually be collecting two salaries.”
“I … don’t know what to say.”
“You don’t have to say anything right now, Brian. I would hope, though, to hear from you within the day. And of course, I would strongly urge you to hold up on any communication with the FDA. They are still quite jittery about speeding Vasclear into the world market. Any delay at this point would be extremely costly to Newbury and to thousands of needy patients.”
“You have my word.”
Art stepped forward and reached out his hand. Brian was reluctant to take his from his lab coat, but finally did.
“I’m looking forward to having you on our team,” Weber said. “I know the arrangement will be mutually beneficial for years to come.”
So, Brian thought, watching the man walk away, in one week he had learned what it felt like to be hunted, shot at, and now bribed. Art Weber and the folks at Newbury had given him an out—the chance to back off his crusade with honor and profit, and, of course, with his life. A hundred and fifty thousand for starters. Maybe it was worth it, he thought. He had nothing on Vasclear—less, even, than Weber might be fearing. A hundred and fifty thousand plus the forty-five or so he was earning at BHI. He closed
his eyes for a moment, somewhat giddy with thoughts of what nearly two hundred thousand dollars would do for him and the kids. But those thoughts were quickly replaced with another image, the image of Bill Elovitz slamming against the shelves in a Charlestown convenience store, his life gone even before he hit the floor.
Brian moved over to the Plexiglas and watched as Paul Wilansky, his heart working satisfactorily, was transferred to a gurney for the trip up to the recovery area in the surgical ICU. Randa, mask now down, was standing off to one side of the OR. Brian turned on the mike.
“How did he do?”
Randa looked up. For a moment, Brian thought he was simply going to ignore him.
“His pupils are down and reactive. It will be some time before we know if there has been brain damage, but I think he’ll be okay,” the surgeon replied.
“Excellent.”
“Your friend Weber is an insolent ass.”
“Perhaps. But you were attacking his life’s work.”
“The race is not always to the swift,” Randa replied. “In science, the ultimate victory always goes to the steady performer who walks the distance, rather than to the sprinter.”
Brian smiled inwardly at Randa’s analogy. Nellie Hennessey, the poster child for Vasclear, was a long-distance walker.
“I’ll keep that in mind,” he said.
Suddenly, Brian went so cold, it was as if he had been slammed with a blast of arctic air. But he knew that what he had really been hit with, finally, was understanding. Involuntarily, he shuddered. Randa had given him the answer. His hands gripped the brass railing that surrounded the canopy and squeezed until his knuckles were white. The explanation—the elusive answer to so many questions—had floated past him again and again, but never in a form concrete enough to grasp. And each time, he had missed it—he had missed it completely.
Now, suddenly, he knew. He knew the secret of Vasclear.
“Yes!” he said. “Oh, God, yes!”
He whirled around and charged back to the on-call room.
CHAPTER THIRTY-FIVE
VISITORS’ HOURS WERE JUST ENDING WHEN BRIAN bolted through the door to the clinical-research ward, startling an elderly couple on their way to the elevator.
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