Robin Cook

by Mortal Fear

  “Okay,” Carol said, gathering up her bags and umbrella. With a final smile she left the café.

  Glancing at her watch, Carol quickened her step. The impromptu meeting with Jason hadn’t figured in her tight schedule, and she didn’t want to be late for the meeting with her PhD adviser. She’d spent the late evening and early afternoon polishing the third chapter of her dissertation and she was eager to hear her professor’s response. Carol took the escalator down to the street level, thinking about her conversation with Dr. Howard.

  It had been a surprise to meet the man after hearing about him for so long. Alvin had told her that Jason had lost his wife and had reacted to the tragedy by completely changing his environment and submerging himself in his work. Carol had found the story fascinating because her thesis involved the psychology of grief. Dr. Jason Howard sounded like a perfect case study.

  The Weston Hotel doorman blew his whistle with a shriek that hurt Carol’s ears, making her wince. As the taxi lumbered toward her, she admitted that her response to Dr. Jason Howard went a bit further than pure professional interest. She’d found the man unusually attractive, and realized that her knowledge of his vulnerabilities contributed to his appeal. Even his social awkwardness had an endearing quality.

  “Harvard Square,” Carol said as she got into the cab. She found herself looking forward to brunch the following morning.

  Still seated in front of his cooling coffee, Jason admitted to being totally bowled over by Carol’s unexpected intelligence and charm. He’d expected an unsophisticated small-town girl who’d somehow been lured away from high school by money or drugs. Instead she was a lovely, mature woman quite capable of holding her own in any conversation. What a tragedy that a person with her obvious assets had become mixed up in the sordid world she inhabited….

  The insistent and jarring sound of his beeper snapped Jason back to reality. He switched it off and looked at the LCD display. The word “urgent” blinked twice, followed by a telephone number Jason did not recognize. After seeing his medical identification, the Au Bon Pain manager allowed Jason to use the phone behind the cash register.

  “Thank you for calling, Dr, Howard. This is Mrs. Farr. My husband, Gerald Farr, has developed terrible chest pains and he’s having trouble breathing.”

  “Call an ambulance,” Jason said. “Bring him to the GHP emergency. Is Mr. Farr a patient of mine?” Jason thought the name sounded familiar but he couldn’t place it.

  “Yes,” Mrs. Farr said. “You did a physical on him two weeks ago. He’s the senior vice president of the Boston Banking Company.”

  Oh. no, Jason thought as he hung up the receiver. It’s happening again. Deciding to leave his car on Beacon Street until he’d handled the emergency, he ran from the café, dashed over the pedestrian connection to the hotel side of the Copley Plaza complex, and leaped into a cab.

  Jason arrived at the GHP emergency room before the Farrs. He told Judith what he expected and even called anesthesia, pleased to learn Philip Barnes was on call.

  When he saw Gerald Farr, Jason knew immediately that his worst fears were realized. The man was in agonizing pain and was pale as skim milk, with crystalline beads of perspiration on his forehead.

  The initial EKG showed that a large area of the man’s heart had been damaged. It was not going to be an easy case. Morphine and oxygen helped to calm the patient, and lidocaine was given for prophylaxis against irregular heartbeats. But, despite everything, Farr wasn’t responding. Studying another EKG, Jason had the feeling that the infarcted area of the heart was expanding.

  In desperation, he tried everything. But it was all for naught. At five minutes to four, Gerald Farr’s eyes rolled up inside his head and his heart stopped.

  Unwilling as usual to give up, Jason commanded the resuscitative efforts. They got the heart to start several more times, but each time it would slip back into a deadly pattern and fail again.

  Farr never regained consciousness. At six-fifteen, Jason finally declared the patient dead.

  “Shit!” said Jason with disgust at himself and life in general. He was unaccustomed to swearing, and the effect of his doing so was not lost on Judith Reinhart. She leaned her forehead against Jason’s shoulder and put her arm around his neck.

  “Jason, you did the best you could,” she said softly. “You did the best anybody could. But our powers are limited.”

  “The man’s only. fifty-eight,” said Jason, choking back tears of frustration.

  Judith cleared the room of the other nurses and residents. Coming back to Jason, she put her hand on his shoulder, “Look at me, Jason!” she said.

  Reluctantly, Jason turned his face toward the nurse. A single tear had run down from the corner of his eye, along the crease of his nose. Softly but firmly she told Jason that he could not take these episodes so personally. “I know that two in one day is an awful burden,” she added. “But it’s not your fault.”

  Jason knew intellectually that she was right, but emotionally it was another story. Besides, Judith had no idea how badly his inpatients were doing, especially Matthew Cowen, and Jason was embarrassed to tell her. For the first time, he seriously contemplated giving up medicine. Unfortunately, he had no idea of what else he could do. He wasn’t trained for anything else.

  After promising Judith that he was okay, Jason went out to face Mrs. Farr, steeling himself against the expected anger. But Mrs. Farr, in the depths of her grief, had decided to take the burden of guilt on herself. She said her husband had been complaining of feeling ill for a week, but that she’d ignored his complaints because, frankly, he’d always been a bit of a. hypochondriac. Jason tried to comfort the woman as Judith had tried to comfort him. He was about equally successful.

  Confident that the medical examiner would take the case, Jason didn’t burden Mrs. Farr with an autopsy request. By law, the ME didn’t need authorization to do a postmortem in cases of questionable death. But to be sure, he called Margaret Danforth. The response was as expected: she indeed wanted the case, and while she had Jason on the phone, she spoke to him about Holly Jennings.

  “I take back that snide comment I made this morning,” Margaret said. “You people are just having bad luck. The Jennings woman was as bad off as Cedric Harring. All her vessels looked terrible, not just the heart.”

  “That’s not a lot of consolation,” Jason said. “I had just given her a physical showing everything was fine. I did a follow-up EKG on Thursday, but that showed only minimal changes.”

  “No kidding? Wait till you see the sections. Grossly the coronary vessels looked ninety percent occluded, and it was disseminated, not focal. Surgery wouldn’t have done a damn thing. Oh, by the way, I checked and it’s okay for us to give you small specimens from Jennings’s case. But I should have a formal request in writing.”

  “No problem,” Jason said. “Same with Farr?”

  “Sure thing.”

  Jason took a cab back to his car and drove home. Despite the fog and rain, when he got home, he went for a jog. Getting mud-spattered and soaked had a mild cathartic effect, and after a shower he felt some relief from his burdensome emotions and depressive feelings. Just when he was starting to think about food, Shirley called and asked him over for dinner. Jason’s first response was to say no. But then he recognized he felt too depressed to be alone, so he accepted. After changing into more reasonable clothes, he went down to his car and headed west toward Brookline.

  Eastern’s flight #409, nonstop from Miami to Boston, banked sharply before lining up for the final approach. It touched down at seven thirty-seven as Juan Dfaz closed his magazine and looked out at the fog-shrouded Boston skyline. It was his second trip to Boston and he wasn’t all that pleased. He wondered why anyone would choose to live in such predictably bad weather. It had rained on his previous trip just a few days ago. Looking down on the tarmac, he saw the wind and rain in the puddles and thought nostalgically of Miami, where late fall had finally put an end to the searing summer heat. Getting
his bag from under the seat in front of him, Juan wondered how long he’d be in Boston. He remembered that on the previous trip he’d been there only two days, and he hadn’t had to do a thing. He wondered if he’d have the same good fortune. After all, he got his five thousand no matter what.

  The plane taxied toward the terminal. Juan looked around the compartment with a sense of pride. He wished his family back in Cuba could see him now. Would they be surprised! There he was, flying first class. After being sentenced to life in prison by the Castro government, he’d been released after only eight months and sent first to Mariel and then, to his astonishment, to the USA. That was to be his punishment for having been convicted of multiple murder and rape—being sent to the USA! It was so much easier to do his type of work in the United States. Juan felt that the one person in the world whose hand he’d most like to shake was a peanut farmer someplace in Georgia.

  The plane gave a final lurch, then was still. Juan rose to his feet and stretched. Taking his carry-on bag, he headed for baggage. After retrieving his suitcase, he caught a cab to the Royal Sonesta Hotel, where he registered as Carlos Hernández from Los Angeles. He even had a credit card in that name, with a legitimate number. He knew the number was good, since he’d taken it off a receipt he’d found at the Bal Harbour shopping plaza in Miami.

  Once he was comfortably relaxed in his room, with his second silk suit hanging in the closet, Juan sat at the desk and called a number he’d been given in Miami. When the phone was answered, he told the person he needed a gun, preferably a .22 caliber. With that business taken care of, he got out the name and address of the hit and looked up the location on the map supplied by the hotel. It wasn’t far away.

  The evening with Shirley was a great success. They dined on roast chicken, artichokes, and wild rice. Afterward they had Grand Marnier in front of the fire in the living room and talked. Jason learned that Shirley’s father had been a doctor and that back in college she’d entertained the idea of following in his footsteps.

  “But my father talked me out of it,” Shirley said. “He said that medicine was changing.”

  “He was right about that.”

  “He told me that it would be taken over by big business and that someone who cared about the profession should go into management. So I switched to business courses, and I believe I made the right choice.”

  “I’m sure you did, too,” Jason agreed, thinking about the explosion of paperwork and the malpractice dilemma. Medicine had indeed changed. The fact that he now worked for a salary for a corporation stood as testament to that change. When he’d been in medical school he’d always imagined he’d work for himself. That had been part of the appeal.

  At the end of the evening, there was a bit of awkwardness. Jason said he’d best be going, but Shirley encouraged him to stay.

  “You think that would be a good idea?” Jason asked.

  She nodded.

  Jason wasn’t so sure, saying he’d have to get up early for rounds and wouldn’t want to disturb her. Shirley insisted she was up at seven-thirty as a matter of course, Sundays included.

  They stared at each other for a time, the firelight making Shirley’s face glow.

  “There’s no obligation,” Shirley said softly. “I know we both have to be slow about this. Let’s just be together. We’ve both been under stress.”

  “Okay,” Jason said, recognizing he did not have the strength to resist. Besides, he was flattered that Shirley was so insistent. He was becoming more open to the idea that not only could he care about another person but another person could care about him.

  But Jason did not get to sleep the whole night through. At three-thirty he felt a hand on his shoulder, and he sat up, momentarily confused as to his whereabouts. In the half light, he could just make out Shirley’s face.

  “I’m sorry to have to bother you,” she said gently, “but I’m afraid the phone is for you.” She handed him the receiver from the nightstand.

  Jason took the phone and thanked her. He hadn’t even heard the phone ring. Propping himself on one elbow, he put the receiver to his ear. He was certain it would be bad news, and he was right. Matthew Cowen had been found dead in his bed, apparently having suffered a final, massive stroke.

  “Has the family been notified?” Jason asked.

  “Yes,” said the nurse. “They live in Minneapolis. They said they’d come in the morning.”

  “Thanks,” Jason said, absently giving the phone back to Shirley.

  “Trouble?” Shirley asked. She set the receiver back in the cradle.

  Jason nodded. Trouble had become his middle name. “A young patient died. Thirty-five or so. He had rheumatic heart disease. He was in for evaluation for surgery.”

  “How bad was his heart disease?” asked Shirley.

  “It was bad,” Jason said, seeing Matthew’s face, remembering him as he’d been when he entered the hospital. “Three of his four valves were affected. They would have had to replace all of them.”

  “So there were no guarantees,” Shirley said.

  “No guarantees,” Jason agreed. “Three valve replacements can be tricky. He’s had congestive heart failure for a long time, undoubtedly affecting his heart, lungs, kidneys and liver. There would have been problems, but he had age on his side.”

  “Maybe it was for the best,” Shirley suggested. “Maybe he’s been spared from a lot of suffering. Sounds like he would have been in and out of the hospital for the rest of his life.”

  “Maybe so,” Jason said without conviction. He knew what Shirley was doing: she was trying to make him feel better. Jason appreciated her effort. He patted the thigh through the thin cover of her robe. “Thanks for your support.”

  The night seemed awfully cold when Jason ran out to his car. It was still raining, in fact, harder than before. Turning up the heat, he rubbed his thighs to get his circulation going. At least there was no traffic. At four A.M., Sunday morning, the city was deserted. Shirley had tried to get him to stay, arguing that there was nothing for Jason to do if the man had died and the family was not available. As true as this was, Jason felt an obligation to his patient that he could not dismiss. Besides, he knew he’d not be able to get back to sleep. Not with yet another death on his conscience.

  The GHP parking lot was mostly empty. Jason was able to park close to the hospital entrance rather than under the outpatient building where he usually parked. As he stepped out of his car, preoccupied with thoughts of Matthew Cowen, he didn’t notice a darkened figure hunched over at the side of the hospital door. Rounding the front of his car, the figure lunged at Jason. Caught completely unaware, Jason screamed. But the figure turned out to be one of the drunken street people who frequented the GHP emergency room, asking for spare change. With a shaking hand, Jason gave him a dollar, hoping he’d at least buy himself a little food.

  Shirley had been right. There was nothing for Jason to do but write a final note in Matthew Cowen’s chart. He went in and viewed his body. At least Matthew’s face looked calm, and as Shirley suggested, he was now spared further suffering. Silently. Jason apologized to the dead man.

  Paging the resident on call, Jason instructed him to ask the family for an autopsy. Jason explained he might not be immediately available. Then, feeling as ineffectual as ever, after these deaths, he left the hospital and returned to his apartment. He lay for some time, staring at the ceiling, unable to sleep. He wondered what kind of job he could get in the pharmaceutical industry.

  9.

  Cedric Harring, Brian Lennox, Holly Jennings, Gerald Farr, and now Matthew Cowen. Jason had never lost so many patients in such a short period of time. All night the parade of their faces had interrupted his dreams, and when he awakened about eleven he was as exhausted as though he’d never slept at all. He forced himself to do his regular Sunday six miles, then showered and dressed carefully in a pale yellow shirt with white collar and cuffs, dark brown pants, and a muted brown plaid jacket of linen and silk. He was glad he had the me
eting with Carol to distract him.

  The Hampshire House was on Beacon Street, overlooking the Boston Public Gardens. In contrast to Saturday’s rain, the sky was filled with bright sunshine and scudding clouds. The American flag flying over the Hampshire entrance snapped in the late autumn breeze. Jason arrived early and asked for a table in the front room on the first floor. A fire crackled comfortably and a piano player kept up a stream of old favorites.

  Jason regarded the people around him. They were all respectably dressed and were engaged in lively conversation, obviously unaware of whatever new medical horror was sweeping their city…. Then Jason warned himself not to let his imagination run wild. Half a dozen deaths didn’t mean an epidemic. Besides, he wasn’t even sure it was infectious. Still, he couldn’t get the fatalities out of his mind.

  Carol arrived at five minutes after two. Jason stood up, waving to get her attention. She was appealingly dressed in a white silk blouse with black wool pants. Her fresh, young innocent appearance away from the club always amazed Jason. Noticing him, she smiled broadly and made her way over to the table. She acted mildly out of breath.

  “Sorry I’m late,” she said, arranging her things, which included a suede jacket, a canvas bag full of papers, and a shoulder handbag. As she did so, she glanced frequently at the entrance.

  “Are you expecting someone?” Jason asked.

  “I certainly hope not. But I have this crazy boss who insists on being overprotective. Especially since Alvin died. He’s keeping someone with me most of the time, supposedly for my protection. At night I don’t mind, but during the day I don’t like it. Mr. Muscle showed up this morning, but I sent him on his way. He may have followed me anyway.”

  Jason wondered if he should mention he’d met Bruno, but decided against it. It was only after they had been served without glimpsing Bruno’s hulk that they both began to relax a bit.