Robin Cook

by Mortal Fear

  Jason stacked the charts. Three apparently healthy men had all died a month after their physicals. Jesus, he thought. People were often scared of going to hospitals. If this got out, they might stop getting checkups.

  Grabbing all three charts in his arms, Jason emerged from his office. He saw Sally stand up in the central desk area and look at him expectantly. Jason silently mouthed “two minutes” as he walked the length of the waiting area. He passed several patients whom he treated with nods and smiles. He slipped into the hall leading to Roger Wanamaker’s office. Roger was an internist who specialized in cardiology and whose opinion Jason held in high esteem. He found the man leaving one of the examination rooms. He was an obese man with a face like an old hound dog with wattles and lots of extra skin.

  “How about a sidewalk consult?” Jason asked.

  “It’ll cost ya,” Roger teased. “Whatcha got?”

  Jason followed the man into his disheveled office.

  “Unfortunately, some pretty embarrassing evidence.” Jason opened the charts of his three late patients to the EKG sections and placed them in front of Roger. “I’m ashamed to even discuss this, but I’ve had three middle-aged men die right after their fancy executive physicals showed them in pretty good health. One was today. Cardiac rupture after a massive MI. I did the physical exam three weeks ago. This is the one. Even knowing what I do now, I can’t find even a bit of trouble or any of the tracings. What do you think?”

  There was a moment of silence while Roger studied the EKGs. “Welcome to the club,” he finally said.

  “Club?”

  “These EKGs are fine,” Roger said. “All of us have had the same experience. I’ve had four such cases over the last few months. Just about everybody who’s willing to bring it up has had at least one or two.”

  “How come it’s not come up?”

  “You tell me,” Roger said, with a wry smile. “You haven’t exactly been advertising your experience, have you? It’s dirty laundry. We’d all rather not call attention to it. But you’re acting chief of service. Why don’t you call a meeting?”

  Jason nodded glumly. Under the aegis of the GHP administration, which made all of the major organizational decisions, chief of service was not a desirable position. It was rotated on a yearly basis among all the internists, and had fallen onto Jason’s shoulders two months previously.

  “I guess I should,” Jason said, collecting his charts from Roger’s desk. “If nothing else, the other doctors should know they’re not alone if they’ve had the same experience.”

  “Sounds good,” Roger agreed. He heaved his considerable bulk to his feet. “But don’t expect everybody to be quite as open as you are.”

  Jason headed back to the central desk, motioning to Sally to ready the next patient. Sally took off like a sprinter. He then turned to Claudia.

  “Claudia, I need a favor. I want you to make a list of all the annual physicals I’ve done over the last year, pull their charts, and check on their state of health. I want to be sure none of the others have had serious medical problems. Apparently some of the other doctors have been having similar episodes. I think it’s something we should look into.”

  “It’s going to be a big list,” Claudia warned.

  Jason was aware of that. In its desire to promote what it called preventive medicine, GHP had been strongly advocating such physicals and had streamlined the process to take care of the maximum number of people. Jason knew that he did, on the average, between five and ten a week.

  For the next several hours, Jason devoted himself to his patients, who treated him to an endless stream of problems and complaints. Sally was relentless, filling examining rooms the moment the previous patient vacated. By skipping lunch, Jason was actually able to catch up.

  In the middle of the afternoon, as Jason was returning from one of the treatment rooms where he had done a sigmoidoscopy on a patient with recurrent ulcerative colitis, Claudia caught his attention and motioned for him to come over to the central desk. She was sporting a cocky smile as Jason approached. He knew something was brewing.

  “You have an honored visitor,” Claudia said with pursed lips, imitating a Lily Tomlin character.

  “Who?” Jason asked, reflexly scanning the adjacent waiting room area.

  “He’s in your office,” Claudia said.

  Jason shifted his eyes toward his office. The door was closed. It wasn’t like Claudia to put someone in there. He looked back at his secretary. “Claudia?” he questioned, extending her name out as if it were more than three syllables. “How come you allowed someone in my office?”

  “He insisted,” said Claudia, “and who am I to refuse?”

  Obviously whoever it was had offended her. Jason knew her that well. And whoever it was certainly had some kind of stature at GHP. But Jason was tiring of the game. “Are you going to tell me who it is or am I supposed to be surprised?”

  “Dr. Alvin Hayes,” Claudia said. She batted her eyes and made a sneer. Agnes, the secretary who worked for Roger, snickered.

  Jason waved at them in disgust and headed for his office. A visit by Dr. Alvin Hayes was a unique occurrence. He was the GHP token and star researcher, hired by the Plan to promote its image. It had been a move reminiscent of the Humana Corporation’s hiring Dr. William DeVries, the surgeon of artificial-heart fame. GHP, as a health-maintenance organization (HMO), did not support research’ per se, yet it had hired Hayes at a prodigious salary in order to expand and augment its image, especially in the Boston academic community. After all, Dr. Alvin Hayes was a world-class molecular biologist who had been on the cover of Time magazine after having developed a method of making human growth hormone from recombinant DNA technology. The growth hormone he had made was exactly like the human variety. Earlier attempts had resulted in a hormone that was similar but not exactly the same. It had been considered an important breakthrough.

  Jason reached his office and opened the door. He could not fathom why Hayes would be paying him a visit. Hayes had all but ignored Jason from the day he had been hired over a year previously, despite the fact they’d been in the same Harvard Medical School class. After graduation they had gone their separate ways, but when Alvin Hayes had been hired by GHP, Jason had sought the man out and personally welcomed him. Hayes had been distant, obviously impressed by his own celebrity status and openly contemptuous of Jason’s decision to stay in clinical medicine. Except for a few chance meetings, they ignored each other. In fact, Hayes ignored everyone at the GHP, becoming more and more what people referred to as the mad scientist. He’d even gone to the extreme of letting his personal appearance suffer by wearing baggy, unpressed clothes and allowing his unkempt hair to grow long like a throwback to the turbulent sixties. Although people gossiped, and he had few friends, everyone respected him. Hayes worked long hours and produced an unbelievable number of papers and scientific articles.

  Alvin Hayes was sprawled in one of the chairs facing Jason’s antique desk. About Jason’s height, with pudgy, boyish features, Hayes’s unkempt hair hung about his face, which appeared more sallow than ever. He’d always had that peculiar academic pallor that characterizes scientists who spend all their time in their laboratories. But Jason’s clinical eye noted an increased yellowishness as well as a lax-ness that made Hayes look ill and overly exhausted. Jason wondered if this was a professional visit.

  “Sorry to bother you,” Hayes said, struggling to his feet. “I know you must be busy.”

  “Not at all,” Jason lied, skirting his desk and sitting down. He removed the stethoscope draped around his neck. “What can we do for you?” Hayes appeared nervous and fatigued, as if he hadn’t slept for several days.

  “I have to talk to you,” he said, lowering his voice and leaning forward in a conspiratorial fashion.

  Jason flinched back. Hayes’s breath was fetid and his eyes had a glassy, unfocused look that gave him a slightly crazed appearance. His white laboratory coat was wrinkled and stained. Both sleeves were p
ushed up above his elbows. His watch fitted so loosely that Jason wondered how he kept from losing it.

  “What’s on your mind?”

  Hayes leaned farther forward, knuckles resting on Jason’s blotter. He whispered, “Not here. I want to talk with you tonight. Outside of GHP.”

  There was a moment of strained silence. Hayes’s behavior was obviously abnormal, and Jason wondered if he should try to get the man to talk to his friend Patrick Quillan, thinking a psychiatrist might have more to offer him. If Hayes wanted to talk away from the hospital, it couldn’t be about his health.

  “It’s important,” Hayes added, striking Jason’s desk impatiently.

  “All right,” Jason said quickly, afraid Hayes might throw a tantrum if he hesitated any longer. “How about dinner?” He wanted to meet the man in a public place.

  “All right. Where?”

  “Doesn’t matter.” Jason shrugged. “How about the North End for some Italian food?”

  “Fine. When and where?”

  Jason ran down the list of restaurants he knew in the North End section of Boston, a warren of crooked streets that made you feel you’d been mystically transplanted to southern Italy. “How about Carbonara?” he suggested. “It’s on Rachel Revere Square, across from Paul Revere House.”

  “I know it,” Hayes said. “What time?”

  “Eight?”

  “That’s fine.” Hayes turned and walked somewhat unsteadily toward the door. “And don’t invite anyone else. I want to talk with you alone.” Without waiting for a reply, he left, pulling the door shut behind him.

  Jason shook his head in amazement and went back to his patients.

  Within a few minutes, he was again absorbed in his work, and the bizarre episode with Hayes slipped into his unconscious. The afternoon drifted on without unwelcome surprises. At least Jason’s outpatients seemed to be doing well and responding to the various regimens he’d ordered. That gave a needed boost to his confidence that the Harring affair had undermined. With only two more patients to be seen, Jason crossed the waiting room after having done a minor surgical procedure in one of the treatment rooms. Just before he disappeared into his office to dictate the procedure, he caught sight of Shirley Montgomery leaning on the central desk and chatting with the secretaries. Within the clinical environment, Shirley stood out like Cinderella at the ball. In contrast to the other women, who were dressed in white skirts and blouses or white pants suits, Shirley wore a conservative silk dress that tried but failed to hide her attractive figure. Although few people could guess when seeing her, Shirley was the chief executive officer of the entire Good Health Plan organization. She was as attractive as any model, and she had a PhD in hospital administration from Columbia and a master’s degree from the Harvard Business School.

  With her physical and mental attributes, Shirley could have been intimidating, but she wasn’t. She was outgoing and sensitive and as a result she got along with everyone: maintenance people, secretaries, nurses, and even the surgeons. Shirley Montgomery could take personal credit for providing a good portion of the glue that held GHP together and made it work so smoothly.

  When she spotted Jason, she excused herself from the secretaries. She moved toward him with the ease and grace of a dancer. Her thick brown hair was swept back from her forehead and layered along the side into a heavy mane. Her makeup was applied so expertly that she didn’t seem to be wearing any. Her large blue eyes shone with intelligence.

  “Excuse me. Dr. Howard,” she said formally. At the very comers of her mouth there was the faint hint of a smile. Unknown to the staff, Shirley and Jason had been seeing each other on a social basis for several months. It had started during one of the semiannual staff meetings when they had met each other over cocktails. When Jason learned that her husband had recently died of cancer, he felt an immediate bond.

  During the dinner that followed, she told Jason that one morning three years ago her husband had awakened with a severe headache. Within months he was dead from a brain tumor that had been unresponsive to any treatment. At the time they had both been working at the Humana Hospital Corporation. Afterward, like Jason, she had felt compelled to move and had come to Boston. When she told Jason the story, it had affected him so deeply that he’d broken his own wall of silence. That same evening he shared his own anguish concerning his wife’s accident and death.

  Fueled by this extraordinary commonality of emotional experience, Jason and Shirley began a relationship that hovered somewhere between friendship and romance. Each knew the other was too emotionally raw to move too quickly.

  Jason was perplexed. She had never sought him out in such a fashion. As usual, he had only the vaguest notion of what was going on inside her expansive mind. In so many ways she was the most complicated woman he’d ever met. “Can I be of assistance?” he asked, watching for some hint of her intent.

  “I know you must be busy,” she was saying now, “but I was wondering if you were free tonight.” She lowered her voice, turning her back on Claudia’s unwavering stare. “I’m having an impromptu dinner party tonight with several Harvard Business School acquaintances. I’d like you to join us. How about it?”

  Jason immediately regretted having made plans to eat with Alvin Hayes. If only he’d agreed to see the man for drinks.

  “I know it’s short notice,” Shirley added, sensing Jason’s hesitation.

  “That’s not the problem. The trouble is that I promised to have dinner with Alvin Hayes.”

  “Our Dr. Hayes?” Shirley said with obvious surprise.

  “None other. I know it sounds peculiar, but he seemed almost distraught. And though he’s hardly been friendly, I felt sorry for the man. Dinner was my suggestion.”

  “Damn!” Shirley said. “You’d have enjoyed this group. Well, next time …”

  “I’ll take a rain check,” Jason said. She was about to leave when he remembered his conversation with Roger Wanamaker. “I probably should tell you I’m going to call a staff meeting. A number of patients have died of coronary disease which our physicals have missed. As acting chief of service I thought I should look into it. Dropping dead within a month of receiving a clean bill of health from us doesn’t make for good PR.”

  “Dear God,” Shirley said. “Don’t go spreading rumors like that!”

  “Well, it’s a bit unnerving when someone you’ve examined with all your resources and declared essentially healthy comes back to the hospital with a catastrophic condition and dies. Avoiding such an event is the whole purpose of the executive physical. I think we should try to increase the sensitivity of our stress testing.”

  “An admirable goal,” Shirley agreed. “All I ask is that you keep it low key. Our executive physicals play a major role in our campaign to lure some of the larger corporate clients in the area. Let’s keep this an in-house issue.”

  “Absolutely,” said Jason. “Sorry about tonight.”

  “Me too,” Shirley said, lowering her voice. “I didn’t think Dr. Hayes socialized much. What’s up with him?”

  “It’s a mystery to me,” Jason admitted, “but I’ll let you know.”

  “Please,” Shirley said. “I’m one of the main reasons GHP hired the man. I feel responsible. Talk to you soon.” She moved off, smiling to nearby patients.

  Jason watched her for a moment, then caught Claudia’s stare. She guiltily looked down at her work. Jason wondered if the secret was out. With a shrug he went back to his last two patients.

  2.

  Late fall in Boston was an exhilarating season for Jason despite the bleak winter it heralded. Dressed in his Indiana Jones-style fedora and his “lived-in” Burberry trench coat, he was adequately protected from the chilly October night.

  Gusts of wind blew the yellowed remains of the elm leaves around Jason’s feet as he trudged up Mt. Vernon Street and passed through the columned passageway under the State House. Crossing the Government Center promenade, he skirted the Faneuil Hall Marketplace with its street performer
s and entered the North End, Boston’s Little Italy. People were everywhere: men standing on street corners and talking with animated gestures; women leaning out the windows gossiping with their friends on the opposite side of the street. The air was filled with the smell of ground coffee and almond-flavored baked goods. Like Italy itself, the neighborhood was a delight to the senses.

  Two blocks down Hanover Street, Jason turned right and quickly found himself in sight of Paul Revere‘s modest wood clapboard house. The cobblestoned square was defined by a heavy black nautical chain looped between metal stanchions. Directly across from Paul Revere’s house was Carbonara, one of Jason’s favorite restaurants. There were two other restaurants in the square but neither was as good as the Carbonara. He mounted the front steps and was greeted by the maitre d’, who led him to his table by the front window, affording him a view of the quaint square. Like many Boston locations the scene had an unreal quality, as though it were the set for some theme park.

  Jason ordered a bottle of Gavi white wine and munched on a dish of antipasto while waiting for Hayes to appear. Within ten minutes, a cab pulled up and Hayes got out. For a few moments after the cab had left, he just stood on the sidewalk and peered back up North Street from the direction he had come. Jason watched, wondering what the man was waiting for. Eventually, he turned and entered the restaurant.

  As the maître d’ escorted him to the table, Jason noted how out of place Hayes seemed in the elegant decor and among the fashionably dressed diners. In place of his stained lab coat, Hayes was wearing a baggy tweed jacket with a torn elbow patch. He seemed to be having trouble walking, and Jason wondered if the man had been drinking.

  Without acknowledging Jason’s presence, Hayes threw himself into the empty seat and stared out the window, again looking up North Street. A couple had appeared, strolling arm in arm. Hayes watched them until they disappeared from view down Prince Street. His eyes still appeared glassy, and Jason noted that a web of new, red capillaries had spread out over his nose like a sea fan. His skin was pale as ivory, not too dissimilar to Harring’s when Jason had seen him in the CCU. It seemed certain that Hayes was not well.