Harmful Intent

by Robin Cook

  “Sure, I can talk to him,” Devlin said.

  “Be nice,” Michael said. “Just be persuasive. Remember, he’s a doctor. I just don’t want him to forget about me.”

  “I’m always nice,” Devlin said. “Considerate, well-groomed, well-mannered. That’s my charm.”

  Devlin left the office, glad to have something to do. He hated just sitting around. The only problem was that he wished the task was a bit more lucrative. But he looked forward to the ride out to Marblehead. Maybe he’d hit that Italian restaurant up there and then go and have a few beers at his favorite harbor bar.

  Kelly’s house was a charming two-story colonial with mullioned windows. It was painted white with black shutters. The two chimneys on either end were surfaced with old brick. A two-car garage was to the right of the house, a screened porch off the left.

  Jeffrey stopped in the street across from the house and pulled up to the curb. He studied the house through the car window, hoping to nerve up enough to cross the street and ring the bell. He was surprised to see so many trees so close to downtown Boston. The house was nestled in a cozy stand of maples, oaks, and birches.

  As he sat there, Jeffrey tried to think of what he would say. Never before had he gone to someone’s house looking for “sympathy and understanding.” And there was always the concern of rejection despite her warmth on the phone. If he didn’t know she was waiting for him, he wouldn’t have been able to go through with it.

  Marshaling his courage, he put the car in gear and turned into Kelly’s driveway. He went up to the front door, briefcase in hand. He felt ridiculous holding it—as a doctor, he wasn’t even used to carrying one—but he was afraid to leave so much cash in the car.

  Kelly opened the door before he had a chance to ring the bell. She was dressed in black tights with a pink leotard and pink headband and warm-up leggings. “I go to an aerobics class most afternoons,” she explained, blushing slightly. Then she gave Jeffrey a big hug. Tears almost came to his eyes when he realized he couldn’t remember the last time someone had hugged him. It took him a moment to catch his balance and hug her back.

  Still holding his arms, she leaned back so she could look up into his eyes. Jeffrey was a good six inches taller than she was. “I’m so glad you came over,” she said. She held his gaze for a beat, then added: “Come in, come in!” She took him by the hand and led him inside, giving the door a kick closed with her stockinged foot.

  Jeffrey found himself in a wide foyer with archways into a dining room on the right and a living room on the left. There was a small table supporting a silver tea service. At the end of the foyer, toward the back of the house, an elegant staircase curved up to the second floor.

  “How about some tea?” Kelly offered.

  “I don’t want to be a bother,” Jeffrey said.

  Kelly clucked her tongue. “What do you mean, bother?” She led him, still holding his hand, through the dining room and into the kitchen. Extending off the back of the house and open to the kitchen was a comfortable family room. It seemed to be part of an addition. There was a garden outside the broad bow window. The garden appeared as if it could use a little attention. Inside, the house was spotless.

  Kelly sat Jeffrey on a gingham couch. Jeffrey put down his briefcase.

  “What’s with the briefcase?” Kelly asked as she went over to put some water on to boil. “I thought doctors carried little black bags when they made house calls. It makes you look more like an insurance salesman.” She laughed a crystalline laugh as she went to the refrigerator and pulled a cheesecake from the freezer.

  “If I showed you what was in this briefcase you wouldn’t believe it,” Jeffrey said.

  “What makes you say that?”

  Jeffrey didn’t answer, but she graciously let it pass. She pulled a knife from a rack above the sink and cut two pieces of cheesecake.

  “I’m glad you decided to come over,” she said, licking the knife. “I only bring out the cheesecake when I have company.” She put a large tea bag in the teapot and got out cups.

  The kettle began to whistle fiercely. Kelly pulled it off the range and poured the boiling water into the teapot. She put everything on a tray and carried it to a coffee table in front of the family room couch.

  “There!” she said, setting it down. “Did I forget anything?” Kelly surveyed the tray. “Napkins!” she cried, and returned to the kitchen area. When she returned, she sat down. She smiled at Jeffrey. “Really,” she said, pouring the tea. “I’m glad you came over, and not just because of the cheesecake.”

  Jeffrey realized he’d not eaten since the shredded wheat that morning. The cheesecake was a delight.

  “Was there something in particular that you wanted to talk about?” Kelly asked, setting her teacup down.

  Jeffrey admired her frankness. It made it easier for him.

  “For starters, I guess I want to apologize for not having been much of a friend to Chris,” Jeffrey said. “After what I’ve been through in the past few months, I have an appreciation of what Chris went through. At the time, I had no idea.”

  “I guess no one did,” Kelly said sadly. “Even I didn’t.”

  “I don’t mean to dredge up painful memories for you,” Jeffrey said when he saw the change in Kelly’s expression.

  “Don’t worry. I’ve finally come to terms with it,” she said. “But that’s all the more reason I should have called you. How are you holding up?”

  Jeffrey hadn’t expected the conversation to shift to his troubles so quickly. How was he holding up? In the last twenty-four hours he’d attempted suicide and, failing that, had tried to leave the country. “It’s been difficult,” was all he managed.

  Kelly reached over and squeezed his hand. “I don’t think people have any idea of the toll malpractice takes and I’m not talking about money.”

  “You know better than most,” Jeffrey said. “You and Chris paid the highest price.”

  “Is it true you are going to prison?” Kelly asked.

  Jeffrey sighed. “It looks that way.”

  “That’s absurd!” Kelly said with a vehemence that surprised Jeffrey.

  “We’re filing an appeal,” he said, “but I don’t have much faith in the process. Not anymore.”

  “How did you become the scapegoat?” Kelly asked. “What happened to the other doctors and the hospital? Weren’t they sued?”

  “They were all dropped from the case,” Jeffrey explained. “I had a brief problem with morphine a few years back. Standard story: it was prescribed for a back injury I suffered in a bike accident. During the trial, they suggested that I’d mainlined some morphine shortly before I came on the case. Then someone found an empty vial of .75% Marcaine in the disposal of the anesthesia machine I was using—.75% Marcaine is contraindicated for obstetric anesthesia. No one found the .5% vial.”

  “But you didn’t use .75%, did you?” Kelly asked.

  “I always check the label of any medication,” Jeffrey said. “But it’s that type of reflex behavior that’s hard to specifically remember. I can’t believe I used .75%. But what can I say? They found what they found.”

  “Hey,” Kelly said. “Don’t start to doubt yourself. That’s what Chris started to do.”

  “Easier said than done.”

  “What is .75% Marcaine used for?” Kelly asked.

  “Quite a few things,” Jeffrey said. “Whenever you want a particularly long-acting block with little volume. It’s used a lot in eye surgery.”

  “Had there been any eye cases in the OR where your accident occurred or any operations that might have required .75% Marcaine?”

  Jeffrey thought for a moment. He shook his head. “I don’t think so, but I don’t know for sure.”

  “It might be worth looking into,” Kelly said. “It wouldn’t have much legal import, but if you could explain the .75% Marcaine, at least to yourself, it would go a long way in helping rebuild your confidence. I really think that where malpractice is concerned, doctors
need to be as diligent in guarding their self-esteem as they are in preparing their court cases.”

  “You’re right about that,” Jeffrey said, but he was still thinking about Kelly’s questions regarding the .75% Marcaine. He couldn’t believe that no one had thought to ask about cases prior to Patty Owen’s in the same OR. He sure hadn’t thought of it. He wondered how he’d go about inquiring now that he didn’t enjoy the access to the hospital he once had.

  “Speaking of self-esteem, how’s yours?” Kelly smiled, but Jeffrey could tell that despite her apparent lightheartedness, she was dead serious.

  “I have the feeling I’m talking to an expert,” Jeffrey said. “Have you been reading a bit of psychiatry on the side?”

  “Hardly,” Kelly said. “Unfortunately, I learned about the importance of self-esteem the hard way, by experience.” She took a sip of tea. For a moment she was lost in her own sorrowful reverie, staring out the bay window at the overgrown garden. Then, just as abruptly, she snapped out of her momentary trance. She looked at Jeffrey, without her smile. “I’m convinced it was through low self-esteem that Chris committed suicide. He couldn’t have done what he did if he felt better about himself. I just know it. It wasn’t the fact of the tragedy that pushed him over the edge. It certainly wasn’t guilt. Chris was like you, in that he had nothing to feel guilty about. It was the sudden erosion of confidence, the damage done to how he thought about himself, that made Chris take his life. People have no idea how sensitive even the most accomplished doctors are to the impact of being sued. In fact, the better the doctor the more it hurts. The fact that the suit is baseless has nothing to do with it.”

  “You’re so right,” Jeffrey said. “Back when I heard that Chris had killed himself, I was astounded. I knew what kind of man he was, what kind of doctor he was. Now his suicide doesn’t astound me at all. In fact, from where I sit now, I’m surprised more doctors sued for malpractice aren’t drawn to it. In fact, I tried it last night.”

  “Tried what?” Kelly asked sharply. She knew what Jeffrey meant but she didn’t want to believe it.

  Jeffrey sighed. He couldn’t look at her. “Last night I tried to commit suicide,” he said simply. “I came within an inch of doing the same thing that Chris did. You know, the succinylcholine and morphine trick. I had the IV running and everything.”

  Kelly dropped her cup of tea. She lunged forward and, grabbing Jeffrey by his shoulders, she shook him. The move startled him. She caught him completely unaware.

  “Don’t you dare do such a thing. Don’t even think about it!”

  Kelly was glaring at him, still clutching his shoulders. Finally Jeffrey mumbled that she needn’t worry, since he’d lacked the courage to go through with it.

  Kelly shook him again, reacting to his comments.

  Jeffrey didn’t know what to do, much less say.

  Kelly kept shaking him, her passions inflamed. “Suicide is not courageous,” she said angrily. “It is the opposite. It’s the cowardly thing to do. And it’s selfish. It hurts everyone you leave behind, everyone who loves you. I want you to promise me that if you ever have thoughts of suicide again, you’ll call me immediately, no matter what time of day or night. Think of your wife. Chris’s suicide filled me with such guilt, you have no idea. I was crushed. I felt that somehow I had failed him. I know that’s not true now, but his death is something I’ll probably never get over completely.”

  “Carol and I are getting a divorce,” Jeffrey blurted.

  Kelly’s expression softened. “Because of the malpractice suit?”

  Jeffrey shook his head. “We’d planned it before all this started. Carol was just nice enough to put it off for the time being.”

  “You poor man,” Kelly said. “I can’t imagine trying to deal with being sued for malpractice and a breakup of a marriage at the same time.”

  “My marital problems are the least of my worries,” Jeffrey said.

  “I’m serious about your promising me you’ll call before you do anything foolish,” Kelly said.

  “I’m not thinking . . .”

  “Promise!” Kelly insisted.

  “All right, I promise,” Jeffrey said.

  Satisfied, Kelly got up and cleaned up the mess that she’d made when she’d dropped her teacup. As she picked up the pieces of broken china, she said: “I wish more than anything that I’d had the slightest indication of what Chris had been planning. One minute it seemed that he’d been full of fight, talking about the anesthetic complication being secondary to a contaminant in the local, the next minute he was dead.”

  Jeffrey watched Kelly as she threw the shards of china away. It took a few moments for her last words to sink in. When she returned and took her seat again, Jeffrey asked, “What made Chris think of a contaminant in the local anesthetic?”

  Kelly shrugged. “I haven’t the faintest idea. But he seemed to be genuinely excited about the possibility. I encouraged him. Just before that he’d been depressed. Very depressed. The idea of a contaminant gave him a real boost. He spent several days poring over pharmacology and physiology textbooks. He made lots of notes. He was working on it the night he . . . I’d gone to bed. I found him the next morning with an IV in place, the bottle empty.”

  “How awful,” Jeffrey said.

  “It was the worst experience of my life,” Kelly admitted.

  For an instant, Jeffrey envied Chris, not because he’d succeeded where Jeffrey had failed, but because he’d left behind someone who obviously loved him so deeply. If Jeffrey had followed through, would anyone be that sorry about it? Jeffrey tried to shake the thought. Instead, he considered the notion of a contaminant in the local anesthetic. It was a curious thought.

  “What kind of contaminant was Chris thinking about?” Jeffrey asked.

  “I really don’t know,” Kelly answered. “It was two years ago, and Chris never did go into much detail about it. At least not with me.”

  “Did you mention his theory to anybody at the time?”

  “I told the lawyers. Why?”

  “It’s an intriguing idea,” Jeffrey said.

  “I still have Chris’s notes,” Kelly said. “You’re welcome to see them if you’d like.”

  “I would,” Jeffrey said.

  Kelly stood up and led Jeffrey back through the kitchen and dining room, across the foyer and through the living room. She stopped at a closed door.

  “I think I’d better explain,” she said. “This was Chris’s study. I know it probably wasn’t all that healthy, but after Chris’s death I just closed the door to this room and left everything the way it was. Don’t ask me why. At the time it made me feel better, as if some part of him was still here. So be prepared. It might be a little on the dusty side.” She opened the door and stepped aside.

  Jeffrey walked into the study. In contrast to the rest of the house, it was disheveled and musty. A thick layer of dust coated everything. There were even a few cobwebs hanging from the ceiling. The blinds were closed tight. On one wall was a floor-to-ceiling bookcase filled with volumes that Jeffrey recognized immediately. Most of them were standard texts for anesthesia. The others dealt with more general medical topics.

  In the center of the room stood an old partners’ desk, heaped with papers and books. In the corner of the room was an Eames chair upholstered in black leather that had dried and cracked. Next to the chair was a tall stack of books.

  Kelly was leaning against the doorjamb with her arms folded as if she was reluctant to enter. “Quite a mess,” she said.

  “You don’t mind if I look around?” Jeffrey asked. He felt a certain kinship with his dead colleague but did not want to trespass on Kelly’s feelings.

  “Be my guest,” she said. “As I told you, I’ve finally come to terms with Chris’s passing. I’ve been meaning to clean this room for some time. I just haven’t gotten around to it.”

  Jeffrey circled the desk. There was a lamp on it, which he turned on. He wasn’t superstitious; he did not believe in the s
upernatural. Yet somehow he felt Chris was trying to tell him something.

  Open on the desk’s blotter was a familiar textbook: Goodman and Gillman’s Pharmacological Basis of Therapeutics. Next to it was Clinical Toxicology. Beside both books was a pile of handwritten notes. Bending over the desk, Jeffrey noted that the Goodman and Gillman was open to the section on Marcaine. The potential adverse side effects were heavily underlined.

  “Did Chris’s case involve Marcaine as well?” Jeffrey asked.

  “Yes,” Kelly said. “I thought you knew that.”

  “Not really,” Jeffrey said. He’d not heard which of the local anesthetics Chris had used. Occasional complications were seen with all of them.

  Jeffrey picked up the stack of notes. Almost immediately he felt a tickle in his nose. He sneezed.

  Kelly put the back of her hand to her lips to hide her smile. “I warned you it might be dusty.”

  Jeffrey sneezed again.

  “Why don’t you get what you want and we can retreat to the family room,” Kelly suggested.

  Through watery eyes, Jeffrey picked up the pharmacology and toxicology books, along with the notes, and carried them out with him. He sneezed a third time before Kelly shut the study door.

  When they got back to the kitchen, Kelly offered a suggestion. “Why don’t you stay for an early dinner? I can whip us up something. It won’t be gourmet, but it’ll be healthy.”

  “I thought you were off to an aerobics class,” Jeffrey said. He was delighted by her offer, but didn’t want to inconvenience her any more than he already had.

  “I can work out any day,” Kelly said. “Besides, I think you need a little TLC.”

  “Well, if it wouldn’t be a bother,” Jeffrey said. He was amazed by her kindness.

  “I’ll enjoy it,” Kelly said. “Now you make yourself comfortable on the couch. Take your shoes off if you like.”

  Jeffrey took her at her word. He sat down and laid the books on the coffee table. He watched her for a moment as she bustled about the kitchen, looking in the refrigerator and various cabinets. Then he kicked off his shoes and settled back to shuffle through Chris’s notes. The first thing he came across was a handwritten summary of the anesthetic complication in Chris’s tragic case.