Side Effects

by Michael Palmer

  "All right, angina."

  "Do you suppose we could talk this over after we play? You're the one who was so worried about being late."

  Jared glanced at his watch and then restarted the engine. He turned to her. There was composure in the lines of his face, but an intensity perhaps even a fear-in his eyes. It was the same look Kate had seen in them when, before the election, he spoke of losing as "not the end of the world."

  "Sure, " he said. "Just answer me that one question. Do you really have a sense of what it would be like for you-for us-if you took over that department?"

  "I… I know it wouldn't be easy. But that's not what you're really asking, is it?"

  Jared shook his head and stared down at his clenched hands. Kate knew very well what he was asking. He was thirty-nine years old and an only child. His first marriage had ended in nightmarish fashion, with his wife running off to California with their baby daughter. Even Jared's father, senior partner of one of Boston's most prestigious law firms, with all the king's horses and all the king's men at his disposal, couldn't find them. Jared wanted children. For himself and for his father he wanted them. The agreement to wait until after the election was out of deference to the pressures of a political campaign and the newness of their marriage. Now neither was a factor. Oh, yes, she knew very well what he was asking. "The answer is, " she said finally, "that if I accepted the nomination and got the appointment I would need some time to do the job right. But that is the grossest kind of projection at this point. Norton Reese has hardly been my biggest supporter since I exposed the way he was using money budgeted for the forensic pathology unit to finance new cardiac surgery equipment. I think he would cut off an arm before he would have me as a department chief in a hospital he administrated."

  "How much time? " Jared's voice was chilly. "Please, honey. I'm begging you. Let's do this when we can sit down in our own living room and discuss all the possibilities."

  "How much?", I… I don't know. A year? Two?"

  Jared snapped the stick shift into first gear, sending a spray of ice and snow into the air before the rear tires gained purchase. "To be continued, " he said, as much to himself as to her. "Fine, " she said.

  Numbly, she sank back in her seat and stared unseeing out the window.

  Her thoughts drifted for a time and then began to focus on a face. Kate closed her eyes and tried to will the thoughts, the face, away. In moments, though, she could see Art's eyes, glazed and bloodshot, see them as clearly as she had that afternoon a. dozen years before when he had raped her. She could smell the whiskey on his breath and feel the weight of his fullback's body on top of hers. Though bundled in a down parka and warm-up suit, she began to shiver. Jared turned onto the narrow access drive to the club. To Kate's right, the metallic surface of the Atlantic glinted through a leafless hardwood forest. She took no notice of it. Please Art, don't, her mind begged. You're hurting me.

  Please let me up. All I did was take the test. I didn't say I was going to apply. "Look, there are the Carlisles up ahead of us. I guess we're not late after all."

  Jared's voice broke through the nightmare. Dampened by a cold sweat, she pushed herself upright. The assault had taken place the day after the second anniversary of her previous marriage, and only an hour after her husband, a failure first in a pro football tryout, then in graduate school, and finally in business, had learned that she had taken the Medical College Admission Test, and worse, that she had scored in the top five percent. His need to control her, never pleasant, had turned ugly. By the evening of that day she had moved out. "Jared, " she pleaded quietly, "we'll talk. Okay?"

  "Yeah, sure, " he answered. "We'll talk."

  The ball rainbowed off Jared's racquet with deceptive speed. A perfect topspin lob. From her spot by the net, Kate watched Jim and Patsy Carlisle skid to simultaneous stops and, amidst flailing arms, legs, and racquets, dash backward toward the baseline. The shot bounced six inches inside the line and then accelerated toward the screen, the Carlisles in frantic pursuit. "You fox," Kate whispered as Jared moved forward for the Uling shot they both knew would not be necessary. "That was absolutely beautiful."

  "Just keep looking sort of bland. Like we don't even know we're about to beat them for the first time ever."

  Across the net, Patsy Carlisle made a fruitless lunge that sent her tumbling into the indoor court's green nylon backdrop. Kate watched the minidrama of the woman, still seated on the court, glaring at her husband as he stalked away from her without even the offer of a hand up.

  Husbands and wives mixed doubles, she thought, games within games within games. "Three match points, " she said. "Maybe we should squabble more often before we play." A took at Jared's eyes told her she should have let the matter lie. "Finish 'em with the ol' high hard one, " she urged as he walked back to the service line. Her enthusiasm, she knew, now sounded forced-an attempt at some kind of expiation. Jared nodded at her and winked. Kate crouched by the net. Eighteen feet in front of her, Jim Carlisle shifted the weight of his compact, perfectly conditioned body from one foot to another. A successful real estate developer, a yachtsman, and club champion several years running, he had never been one to take any kind of loss lightly. "You know, " he had said to her on the only attempt he had ever made to start an affair between them,

  "there are those like you-know-who, who are content to tiptoe along in Daddy's footsteps, and those who just grab life by the throat and do it. I'm a doer."

  The reference to Jared, even though prodded forth by far too many martinis, had left an aftertaste of anger that Kate knew would never totally disappear. When Carlisle sent the Samuels for Congress Committee a check for five hundred dollars, she had almost sent it back with a note telling him to go grab somebody's life by the throat. Instead, out of deference to her husband, she had invited the Carlisles over for dinner. Her hypocrisy, however honorable its purpose, continued to rankle her from time to time, especially when Carlisle, wearing his smugness like aftershave, was about to inflict yet another defeat on team Samuels/Bennett. At last she was beating the man. Not even a disagreement with her husband could dull the luster of the moment.

  Through the mirror of Jim Carlisle's stages of readiness to return serve, Kate pictured Jared's movements behind her. Feet planted, Jared had settled in at the line. Hunching over, knees bent, Jared was tapping ball against racquet, gaining his rhythm. Just before Carlisle began the quick bouncing which would signal the toss, she heard Jared's voice.

  "The ol' high hard one, " he said. Kate tensed, awaiting the familiar, sharp pok of Jared's serve and Carlisle's almost simultaneous move to return. Instead, she heard virtually nothing, and watched in horror as Carlisle, with the glee of a tomcat discovering a wounded sparrow, advanced to pounce on a woefully soft hit. The serve was deliberate-vintage Jared Samuels, his way of announcing that by no means had he forgotten their argument. "Jared, you bastard, " Kate screamed just as Carlisle exploded a shot straight at her chest from less than a dozen feet away. An instant after the ball left Carlisle's racquet, it was on Kate's, then ricocheting into a totally unguarded corner of the court. The shot was absolute reflex, absolute luck, but perfect all the same. "Match, " Kate said simply. She shook hands with each of their opponents, giving Jim's hand an extra pump. Then, without a backward glance, she walked off the court to the locker room. The Oceanside Racquet Club, three quarters of an acre of corrugated aluminum box, squatted gracelessly on a small rise above the Atlantic. "Facing Wimbledon, " was the way the club's overstuffed director liked to describe it. Keeping her hair dry and moving quickly enough to ensure that Jared would have to work to catch up with her, Kate showered and left the building. The rules of their game demanded a reaction of some sort for his behavior, and she had decided on taking the MG, perhaps stopping a mile or so down the road. As she crossed the half-filled parking lot, she began searching the pockets of her parka for her keys.

  Almost immediately, she remembered seeing them on the kitchen table.

  "Damn!
" The feeling was so familiar. She had, in the past, slept through several exams, required police assistance to locate her car in an airport parking garage, and forgotten where she had put the engagement ring Art had given her. Although she had come to accept the trait as a usually harmless annoyance, there was a time when visions of clamps left in abdomens concerned her enough to influence her decision to go into pathology rather than clinical medicine. This day, she felt no compassion whatsoever toward her shortcoming. Testily, she strode past their car and down the road. The move was a bluff. Jared would know that as well as she. It was an eight-mile walk to their home, and the temperature was near freezing. Still, some show of indignation was called for. But not this, she realized quickly. At the moment she accepted the absurdity of her gesture and decided to turn back, she heard the distinctive rev of the MG behind her. There could be no retreat now. It was a game between them, but not a game. Their scenarios were often carefully staged, but they were life all the same, actions and reactions, spontaneous or not, that provided the dynamics unique to their relationship. There had been no such dynamics in her first marriage. Put simply, Arthur Everett decreed and his dutiful wife Kathryn acquiesced. For two destructive years it had been that way. Her childhood programming offered no alternatives, and she had been too frightened, too insecure, to question. Even now there were times, though gradually fewer and farther between, when dreams of the farmhouse and the children, the well-stocked, sunlit kitchen and the pipe smoke wafting out from the study, dominated her thoughts. They were, she knew, nothing more than the vestiges-the reincarnations-of that childhood programming. Unfortunately, much of Jared's programming was continually being reinforced, thanks largely to a father who remained convinced that God's plan for women was quite different from His plan for men. "You have a wonderful behind, do you know that? " Jared's voice startled her.

  He was driving alongside her, studying her anatomy through a pair of binoculars. "Yes, I know that." She stiffened enough to be sure he could notice and walked on. Please don't get hurt, she thought. Put those silly binoculars down and watch where you're going. "And your face. Have I told you lately about your face?"

  "No, but go ahead if you must."

  "It is the blue ribbon, gold medal, face-of-the-decade face, that's what."

  "You tried to get me killed in there." Kate slowed, but did not stop.

  "It was childish."

  "And… I'll "And it was dumb." gcand… "And it didn't work."

  "Jared!"

  "And I'm sorry. I really am. The devil made me do it, but I went and let 'im."

  He opened the door. She stopped, hesitated the obligatory few seconds, and got in. The scenario was over, Through it, a dram of purulence had been drained from their marriage before it could fester. Energy no longer enmeshed in their anger would now be rechanneled, perhaps to a joint attack today on the pile of unsplit wood in the yard and later to a battle with the Times crossword puzzle. As likely as not, before the afternoon was through, they would make love. Eyes closed, Kate settled back in her seat, savoring what she had just heard. I'm sorry. He had actually said it. Apologizing has been bred out of Samuels men was yet another teaching from the philosophy of J. Winfield Samuels. Kate had suffered the pain of that one on more than one occasion. She thought about Jared's vehement reaction to the possibility of her taking over the chairmanship of her department. The morning, she had decided, had been a draw, Dad I. Wife I. "Now, Dr. Engleson, you may proceed with your report."

  Tom Engleson's groan was not as inaudible as he would have liked. "Your patient is still bleeding, sir. That's my report." During his year and a half of residency on the Ashburton Service at Metropolitan Hospital of Boston, Engleson had had enough dealings with D. K. Bartholomew to know that he would be lucky to escape with anything less than a fifteen-minute conversation. Dr. Donald K. Bartholomew held the receiver in his left hand, adjusted the notepad in front of him, and straightened his posture. "And what is her blood count?"

  "Twenty-five. Her crit is down to twenty-five from twenty-eight."

  Engleson pictured the numbers being shakily reproduced in black felt tip. "She has had a total of five units transfused in the last twenty-four hours, two of whole blood, one of packed cells, and two of fresh frozen plasma." He closed his eyes and awaited the inevitable string of questions. For a few seconds there was silence. "How many fresh frozen did you say?"

  "Two. The hematology people have been to see her again. Her blood is just not clotting normally." He had decided to keep the complicated explanation for Beverly Vitale's bleeding problem out of the conversation if at all possible. A single request from Bartholomew for specifics, and the phone call could drag on for another half hour. In fact, there was no good explanation even available. The hematologists knew what-two of the woman's key clotting factors were at critically low levels-but not why. It was a problem the surgeon should have at least identified before performing her D and C. "Have they further tests to run?"

  "No, sir. Not today, anyhow." Getting D. K. Bartholomew to come into the hospital on a Sunday morning was like getting a cat to hop into the tub.

  "They suggested loading her up with fresh clotting factors and perhaps doing another D and C. They're afraid she might bleed out otherwise."

  "How long will it take to give her the factors?"

  "We've already started, sir."

  There was another pause, "Well, then, " Bartholomew said at last.

  "I guess the patient and I have a date in the operating room."

  "Would you like me to assist? " Engleson closed his eyes and prayed for an affirmative response. "For a D and C? No, thank you, Doctor. It is a one-man procedure, and I am one man. I shall be in by twelve o'clock.

  Please put the OR team on notice."

  "Fine, " Engleson said wearily. He had already scheduled Beverly Vitale for the operating room. He hung up and checked the wall clock over the door of the cluttered resident's office. Only eight minutes. "A record, " he announced sardonically to the empty room. "I may have just set a record."

  Moments later, he called the operating suite. "Denise, it's Tom Engleson. You know the D and C I scheduled for Dr. Bartholomew?…

  Vitale. That's right. Well, I was wondering if you could switch it to the observation OR. I want to watch… I know you're not supposed to use that room on a weekend. That's why I'm asking in such a groveling tone of voice… Bartholomew doesn't want anyone assisting him, but he can't keep me from watching through the overhead… I owe you one, Denise. Thanks."

  Looking down from behind the thick glass observation window into the operating room, Tim Engleson exchanged worried looks with the scrub nurse assisting Dr. Donald K. Bartholomew. The dilatation of Beverly Vitale's cervix and subsequent curettage-scrapidg-of the idner surface of her uterus was not going well. She had gone to the emergency ward three days before because of vaginal bleeding that started with her period but would not let up. For several years, she had been receiving routine gynecologic care through the Omnicenter-the outpatient facility of the Ashburton Women's Health Service of Metropolitan Hospital. As her Omnicenter physician, D. K. Bartholomew had been called in immediately.

  In his admission physical, Bartholomew had noted a number of bruises on the woman's arms and legs, but elected nevertheless to proceed with a D and C-commonly done for excessive bleeding. He did not order blood clotting studies until after his patient's bleeding worsened postoperatively. Now, with the woman loaded with fresh clotting factors, Bartholomew was repeating the curettage. Beverly Vitale, a thin, delicate young cellist with straight jet hair and fine, artist's hands lay supine on the operating table with her eyes taped shut and her head turned ninety degrees to one side. A polystyrene tube placed through her mouth into her trachea connected her with the anesthesia machine. Her legs, draped in sterile sheets, were held aloft by cloth stirrups hooked beneath each heel. Overhead, in the observation gallery Tom Engleson watched and waited. He was dressed in standard operating room whites, with hair and shoe cover
s, but no mask. As he watched the level of suctioned blood rise in the vacuum bottle on the wall, Engleson wondered if D. K. Batholomew was considering removing the woman's uterus altogether. He cursed himself for not throwing protocol to the winds and inviting himself into the OR. The prospect of the old surgeon moving ahead with a hysterectomy brought a ball of anger to the resident's throat. Much of his reaction, he knew, had to do with Beverly Vitale.

  Though he had only spoken with her a few times, Engleson had begun fantasizing about her and had become determined to see her when she was released from the hospital. Now his thoughts added, if she was released from the hospital. He glanced again at the vacuum bottle and then at Bartholomew. There was a flicker of confusion and uncertainty in the man's eyes. "Her pressure is dropping a bit."

  Engleson heard the anesthesiologist's voice crackle through a barely functional speaker on the wall behind him. "Young lady, get me the freshest unit of blood we have, and see if the blood bank can send us up ten units of platelets."

  "Yes, sir, " the nurse said. "Dr. Bartholomew, blood loss so far is four hundred and fifty cc's."

  Bartholomew did not respond immediately. He stood motionless, staring at the steady flow of crimson from Beverly Vitale's cervix.

  "Let's try some pitocin. Maybe her uterus will clamp down, " he said finally. "Dr. Bartholomew, " the anesthesiologist said, an even tenseness in his voice, "you've already ordered pitocin. She's been getting it. Maximum doses."

  Engleson strained to see the older surgeon's face. If he rushed into the OR and the man did not need assistance, a formal complaint was' sure to … Before he could complete the thought, the bellboy hanging from his waistband emitted the abrasive tone signaling a transmission. "Dr.

  Engleson, call two eight three stat. Dr. Engleson, two eight three stat, please."

  An anxious check of the scene below, and the resident rushed to the nearest phone. It was a rule of the Ashburton Service that all stat pages were to be answered within sixty seconds. Telephones had even been installed in the residents' bathrooms for such purposes. The call concerned a postop patient whose temperature had risen to 103, not a life-or-death situation. By the time Engleson had listened to the nurse's report, given orders for evaluating the patient's fever and returned to the observation window, Bartholomew had begun swabbing antiseptic over Beverly Vitale's lower abdomen. Engleson switched on the microphone by his right hand. "What's going on? " he asked. Below, no one reacted to his voice. "Can you hear me? " Again no response. Through the door to the scrub area, Engleson saw Carol Nixon, a surgical intern rotating through the Ashburton Service, beginning to scrub. Apparently Bartholomew had called her in to assist, perhaps when Engleson could not be found.