He left the ground an improbable distance from the fence, his gloved left hand reaching, it seemed, beyond its limits, up to the top of the barrier and over it. For an instant, ball and glove disappeared beyond the fence. In the next instant, they were together, clutched to the chest of Bobby Geary as he tumbled down onto the dirt warning track to the roar of thirty thousand voices. It was a moment Kate would remember for the rest of her life. This, too, was such a moment. The body that had once held the spirit and abilities of Bobby Geary lay on the steel table before her, stripped of the indefinable force that had allowed it to sense and react so remarkably. To one side, in a shallow metal pan, was the athlete's heart, carefully sliced along several planes to expose the muscle of the two ventricles-the pumping chambers-and the three main coronary arteries-left, right, and circumflex. Images of that night at Fenway more than four years ago intruded on Kate's objectivity and brought with them a wistfulness that she knew had no place in this facet of her work. "Nothing in the heart at all? " she asked for the second time. Stan Willoughby, leprechaunish in green scrubs and a black rubber apron, shook his head. "Must a bin somethin' he et, " he said, by way of admitting that, anatomically at least, he had uncovered no explanation for the pulmonary edema, fluid that had filled Bobby Geary's lungs and, essentially, drowned him from within. Kate, clad identically to her chief, examined the heart under a highiotensity light. "Teenage heart in a thirty-six-year-old man. I remember reading somewhere that he intended to keep playing until he was fifty. This heart says he might have made it."
"This edema says no way, " Willoughby corrected. "I'm inclined to think dysrhythmia and cardiac arrest on that basis. Preliminary blood tests are all normal, so I think it possible we may never know the specific cause." There was disappointment in his voice. "Sometimes we just don't,
" Kate said. The words were Willoughby's, a lesson he had repeated many times to her over the years. Willoughby glared at her for a moment, then he laughed out loud. "You are a saucy pup, flipping my words back at me like that. Suppose you tell me what to say to the police lieutenant drinking coffee and dropping donut crumbs right now in my office, or to the gaggle of reporters in the lobby waiting for the ultimate word.
Ladies and gentlemen, the ultimate word from the crack pathology department you help support with your taxes is that we are absolutely certain we have no idea why Bobby Geary went into a pulmonary edema and died."
Kate did not answer. She had grabbed a magnifying glass and was intently examining Geary's feet, especially between his toes and along the inside of his ankles. "Stan, look, " she said. "All along here. Tiny puncture marks, almost invisible. There must be a dozen of them. No, wait, there are more."
Willoughby adjusted the light and took the magnifier from her. "Holy potato, " he said softly. "Bobby Geary an addict? " He stepped back from the table and looked at Kate, who could only shrug. "If he was, he was a bloomin' artist with a needle."
"A twenty-seven or twenty-nine gauge would make punctures about that size."
"And a narcotics or amphetamine overdose would explain the pulmonary edema." Kate nodded. "Holy potato, " Willoughby said again. "If it's true, there must be evidence somewhere in his house."
"Unless it happened with other people around and they brought him home and put him to bed. Why don't we send some blood for a drug screen and do levels on any substance we pick up?"
Willoughby glanced around the autopsy suite. The single technician on duty was too far away to have heard any of their conversation. "What do you say we label the tube Smith' or Schultz' or something. I'm no sports fan, but I know enough to see what's at stake here. The man was a hero."
"What about the policeman?"
"His name's Detective Finn, and he is a fan. I think he'd prefer some kind of story about a heart attack, even if the blood test is positive."
"Schultz sounds like as good a name as any, " Kate said. "Are these the tubes? Good. I'll have new labels made up."
"I'll send Finn over to the boy's place, and then I'll tell the newsnoses they will just have to wait until the microscopics are processed. Now, when can you give me a report on the goings on at the WMHT' "Well, beyond what I've already told you, there's not much to report. We've got some sort of ovarian microsclerosis in two women with profound deficiencies of both platelets and fibrinogen. At this point, we have no connections between the two, nothing even to tell us for sure that the ovarian and blood problems are related."
"So what's next?"
"Next? Well, Tom Engleson, the resident who was involved with Beverly Vitale, is trying to get some information from the roommate of the WMH woman."
"And thou?"
Kate held her hands to either side, palms up. "No plan. I'm on surgicals this month, so I've got a few of those to read along with a frozen or two from the OR. After that I thought I'd talk to my friend Marco Sebastian and see if that computer of his can locate data on a woman named Ginger Rittenhouse."
"Sounds good," Willoughby said. "Keep me posted." He seemed reluctant to leave. "Is there anything else? " Kate asked finally. "Well, actually there is one small matter."
"All right, let me have it." Kate knew what was coming. "I… um… have a meeting scheduled with Norton Reese this afternoon. Several members of the search committee are supposed to be there and well… I sort of wondered if you'd had time to Willoughby allowed the rest of the thought to remain unspoken. Kate's eyes narrowed. He had promised her a week, and it had been only a few days. She wasn't at all ready to answer. There were other factors to consider besides merely "want to" or "don't want to." Willoughby had to understand that. "I've decided that if you really think I can do it, and you can get all those who have to agree to do so, then I'll take the position, " she heard her voice say.
The girl's name was Robyn Smithers. She was a high school junior, assigned by Roxbury Vocational to spend four hours each week working as an extern in the pathology department of Metropolitan Hospital. Her role was simply defined, do what she was told, and ask questions only when it was absolutely clear that she was interrupting no one. She was one of twelve such students negotiated for by Norton Reese and paid for by the Boston School Department. That these students learned little except how to run errands was of no concern to Reese, who had already purchased a new word processor for his office with the receipts from having them.
Robyn had made several passes by Sheila Pierce's open door before she stopped and knocked. "Yes, Robyn, what can I do for you?"
"Miss Pierce, I'm sorry for botherin' you. Really I am."
"It's fine, Robyn. I was beginning to wonder what you were up to walking back and forth out there."
"Well, ma'am, it's this blood. Doctor Bennett, you know, the lady doctor?"
"Yes, I know. What about her?"
"Well, Dr. Bennett gave me this here blood to take to she consulted a scrap of paper, "Special Chemistries, only I can't find where that is.
I'm sorry to bother you while you're working and all."
"Nonsense, child. Here, let me see what you've got."
Casually, Sheila glanced at the pale blue requisition form. The patient's name, John Schultz, meant nothing to her. That in itself was unusual. She made it her business to know the names of all those being autopsied in her department. However, she acknowledged, occasionally one was scheduled without her being notified. In the space marked "Patient's Hospital Number" the department's billing number was written. The request was for a screen for drugs of abuse. Penned along the margin of the
requisition was the order, "STAT, Phone results to Dr. K. Bennett ASAP."
"Curiouser and curiouser, " Sheila muttered. "Pardon, ma'am?"
"Oh, nothing, dear. Listen, you've been turning the wrong way at that corridor back there. Come, I'll show you." She handed back the vials and the requisition and then guided the girl to the door of her office.
"There, " she said sweetly. "Just turn right there and go all the way down until you see a cloudy-glass door like mine with Special Che
mistries written on it. Okay?"
"Yes. Thank you, ma'am."
Robyn Smithers raced down the corridor., Glad to help… you dumb little shit."
Sheila listened until she heard the door to Special Chemistries open and close, then she went to her phone and dialed the cubicle of Marvin Grimes. Grimes was the department's deiner, the preparer of bodies for autopsy. It was a position he had held for as long as anyone could remember. "Marvin, " Sheila asked, "could you tell me the names of the cases we autopsied today?"
"Jes' two, Ms. Pierce. The old lady Partridge n' the ball player."
"No one named Schultz? " Sheila pictured the bottle of Wild Irish Rose Grimes kept in the lower right-hand drawer of his desk, she wondered if by the end of the day the old man would even remember talking to her.
"No siree. No Schultz today."
"Yesterday?"
"Wait, now. Let me check. Nope, only Mcdonald, Lacey, Briggs, and Ca..
Capez… Capezio. No one named… what did you say the name was?"
"Never mind, Marvin. Don't worry about it."
As she replaced the receiver, Sheila tried to estimate the time it would take the technicians in Special Chemistries to complete a stat screen for drugs of abuse. "Curiouser and curiouser and curiouser, " she said.
The dozen or so buildings at Metropolitan Hospital were connected by a series of tunnels, so tortuous and poorly lit that the hospital had recommended that its employees avoid them if walking alone. Several assaults and the crash of a laundry train into a patient's stretcher only enhanced the grisly reputation of the tunnel, as did the now classic Harvard Medical School senior show, Rats. Kate, unmindful of the legends and tales, had used the tunnels freely since her medical student days, and except for once coming upon the hours-old corpse of a drunk, nestled peacefully in a small concrete alcove by his half-empty bottle of Thunderbird, she had encountered little to add to the lore. The single greatest threat she faced each time she traveled underground from one building to another was that of getting lost by forgetting a twist or a turn or by missing the crack shaped like Italy that signaled to her the turnoff to the administration building. At various times over the years, she had headed for the surgical building and ended up in the massive boiler room, or headed for a conference in the amphitheater, only to dead end at the huge steam pressers of the laundry building.
Concentrating on not overlooking the landmarks and grimedimmed signs, Kate made her way through the beige-painted maze toward the computer suite and Marco Sebastian. Nurses in twos and threes passed by in each direction, heralding the approach of the three o'clock change in shift.
Kate wondered how many thousands of nurses had over the years walked these tunnels on the way to their charges. The Metro tradition, nurses, professors of surgery, medical school deans, country practitioners, even Nobel laureates. Now, in her own way and through her own abilities, she was becoming part of that tradition. Jared had to know how important that was to her. She had shared with him the ugly secrets of her prior marriage and stifling, often futile life. Surely he knew what all this meant. In typically efficient Metro fashion, the computer facilities were situated on the top floor of the pediatrics building, as far as possible from the administrative offices that used them the most. Kate paused by the elevator and thought about tackling the six flights of stairs instead. The day, not yet nearly over, had her feeling at once exhausted and exhilarated. Three difficult surgical cases had followed the Geary autopsy. Just as she was completing the last of them, a Special Chemistries technician had dropped off the results of Geary's blood test. The Amphetamine level in his body was enormous, quite enough to have thrown him into pulmonary edema. Before she could call Stan Willoughby with the results, she was summoned to his office. The meeting there, with Willoughby and the detective, Martin Finn, had been brief.
Evidence found on a careful search of Bobby Geary's condominium had yielded strong evidence that the man was a heavy amphetamine user. It was information known only to the three of them. Finn — was adamant-barring any findings suggesting that Geary's death was not an accidental overdose, there seemed little to be gained and much to be lost by making the revelation public. The official story would be of a heart attack, secondary to an anomaly of one coronary artery. The elevator arrived at the moment Kate had decided on the stairs. ISM She changed her mind in time to slip between the closing doors. Marco Sebastian, expansive in his white lab coat and as jovial as ever, met her with a bear hug. She had been a favorite of his since their first meeting, nearly seven years before. In fact, he and his wife had once made a concerted effort to fix her up with his brother-in-law, a caterer from East Boston. After a rapid-fire series of questions to bring himself up to date on Jared, the job, Willoughby, and the results of their collaborative study, the engineer led her into his office and sat her down next to him, facing the terminal display screen on his desk.
"Now then, Dr. Bennett, " he said in a voice with the deep smoothness of an operatic baritone, "what tidbits can I resurrect for you this time from the depths of our electronic jungle? Do you wish the hat size of our first chief of medicine? We have it. The number of syringes syringed in the last calendar year? Can do. The number of warts on the derriere of our esteemed administrator? You have merely to ask."
"Actually, Marco, I wasn't after anything nearly so exotic. Just a name."
"The first baby born here was He punched a set of keys and then another.
Jessica Peerless, February eighteenth, eighteen forty-three."
"Marco, that wasn't the name I had in mind."
"How about the two hundredth appendectomy?"
"Nope. "The twenty-eight past directors of nursing?"
"Uh-uh. I'm sorry, Marco."
"All this data, and nobody wants any of it." The man was genuinely crestfallen. "I keep telling our beloved administrator that we are being under-used, but I don't think he has the imagination to know what questions to ask. Periodically, I send him tables showing that the cafeteria is overspending on pasta or that ten percent of our patients have ninety percent of our serious diseases, just to pique his interest, remind him that we're still here."
"My name?"
"Oh, yes. I'm sorry. It's been a little slow here. I guess you can tell that."
"It's Rittenhouse, Ginger Rittenhouse. Here's her address, birthplace, and birthdate. That's all I have. I need to know if she's ever been a patient of this hospital, in or out." 64 Keep your eyes on the screen,"
Sebastian said dramatically. Thirty seconds later, he shook his head.
"Nada. A Shirley Rittenhouse in nineteen fifty-six, but no others."
"Are you sure?
" Sebastian gave her a look that might have been anticipated from a judge who had been asked, "Do you really think your decision is fair?"
"Sorry, " she said. "Of course, she still could have been a patient of the Omnicenter."
Kate stiffened. "What do you mean?"
"Well, the Omnicenter is sort of a separate entity from the rest of Metro. This system here handles records and billing for the Ashburton inpatient service, but the Omnicenter is totally self-contained. Has been since the day they put the units in-what is it? — nine, ten years ago."
"Isn't that strange?"
"Strange is normal around this place, " Sebastian said. "Can't you even plug this system into the one over there?"
"Nope. Don't know the access codes. Carl Horner, the engineer who runs the electronics there, plays things pretty close to the vest.
You know Horner?"
"No, I don't think so." Kate tried to remember if, during any of her visits to the Omnicenter as a patient, she had even seen the man. "Why do you suppose they're so secretive? "
"Not secretive so much as careful. I play around with numbers here, Horner and the Omnicenter people live and die by them. Every bit of that place is computerized, records, appointments, billing, even the prescriptions."
"I know. I go there for my own care."
"Then you can i
magine what would happen if even a small fly got dropped into their ointment. Homer is a genius, let me tell you, but he is a bit eccentric. He was writing advanced programs when the rest of us were still trying to spell IBM. From what I've heard, complete independence from the rest of the system is one of the conditions he insisted upon before taking the Omnicenter job in the first place.", So how do I find out if Ginger Rittenhouse has ever been a patient there? It's important, Marco. Maybe very important."
"Well, Paleolithic as it may sound, we call and ask."
"The phone?"
Marco Sebastian shrugged sheepishly and nodded. DEAD END. Alone in her office, Kate doodled the words on a yellow legal pad, first in block print, then in script, and finally in a variety of calligraphies, learned through one of several "self-enrichment" courses she had taken during her two years with Art. According to Carl Horner, Marco Sebastian's counterpart at the Omnicenter, Ginger Rittenhouse had never been a patient there. Tom Engleson had succeeded in contacting the woman's roommate, but her acquaintance and living arrangement with Giilger were recent ones. Aside from a prior address, Engleson had gleaned no new information. Connections thus far between the woman and Beverly Vitale, zero. Outside, the daylong dusting of snow had given way to thick, wet flakes that were beginning to cover. The homeward commute was going to be a bear. Kate tried to ignore the prospect and reflect instead on what her next move might be in evaluating the microsclerosis cases, perhaps an attempt to find a friend or family member who knew Ginger Rittenhouse better than her new roommate. She might present the two women's pathologies at a regional conference of some sort, hoping to luck into yet a third case. She looked at the uncompleted work on her desk. Face it, she realized, with the amount of spare time she had to run around playing epidemiologist, the mystery of the ovarian microsclerosis seemed destined to remain just that. For a time, her dread of the drive home did battle with the need to get there in order to grocery shop and set out some sort of dinner for the two of them.
Side Effects Page 8
