Side Effects

by Michael Palmer

  "Win, I have no response to what you just asked. You know that, don't you?"

  "Perhaps before too much longer you might. Let us eat. After our meal, there is a trip we must take."

  With a faint smile, Samuels nodded Kate toward the dining room and then took her elbow and guided her through the door. The IV nurse, a square-shouldered woman overweight by at least thirty pounds, rubbed alcohol on the back of Ellen Sandler's left hand, slapped the area a dozen times, and then swabbed it again. "Now, Ellen, " she said in the patronizing, demeaning tone Ellen had come to label hospitalese, "you've got to relax. Your veins are in spasm. If you don't relax, it will take all night for me to get this IV in."

  Relax? Ellen glared at the woman, who was hunched over her hand. Can't you tell I'm frightened? Can't you see I'm scared out of my wits by all that's happening to me? Take a minute, just a minute, and talk to me.

  Ask me, and I'll try to explain. I'll tell you how it feels to be seven years old I and to learn that your father, who entered the hospital for a "little operation, " has been taken to a funeral home in a long box with handles relax?

  Why not ask me to float off this bed? Or better still, just demand that I make the blood in my body start clotting, so you'll be spared the inconvenience of having to plunge that needle into the back of my hand.

  Relax?

  "I… I'm trying, " she said meekly. "Good. Now you're going to feel a little stick."

  Ellen grabbed the bedrail with her free hand as electric pain from the "little stick" shot up her arm. "Got it, " the nurse said excitedly.

  "Now don't move. Don't move until I get it taped down, okay? You know," she continued as she taped the plastic cathe er in place, "you've got the toughest veins I've seen in a long time."

  Ellen didn't answer. Instead, she stared at the ceiling, tasting the salt of the tears running over her cheeks and into the corners of her mouth, and wondering where it was all going to end. Apparently blood had begun appearing in her bowel movements. The intravenous line was, according to the resident who announced she was going to have it, merely a precaution. He had neglected to tell her what it was a precaution against. "Okay, Ellen, we're all set, " the nurse announced, stepping back to admire her handiwork. "Just don't use that hand too much. All right?

  Ellen pushed the tears off her cheeks with the back of her right hand.

  "Sure, " she said. The woman managed an uncomfortable smile and backed from the room. It isn't fair. With no little disgust, Ellen examined the IV dripping saline into her hand. Then she shut off the overhead light and lay in the semidarkness, listening to the sighs of her own breathing and the still alien sounds of the hospital at night. It isn't fair. Over and over her mind repeated the impotent protest until she was forced to laugh at it in spite of herself. Betsy, Eve, Darcy, Sandy, the business, her health. Why had she never appreciated how fragile it all was? Had she taken too much for granted? asked too few questions? Dammit, there were no answers, anyhow. What else could she do? What else could anyone do? Here she was, almost forty, lying in a hospital bed, possibly bleeding to death, with no real sense of why she had been alive, let alone why she should have been singled out to die. It just wasn't fair.

  A soft tap from the doorway intruded on her painful reveriestanding there, silhouetted by the light from the hall, was Sandyhe was holding his uniform hat in one hand and a huge bouquet in the other'permission to come aboard, " he said Ellen could feel, more than see or hear, his discomfiture. "Come on in, " she said. "Want the light on?"

  "I don't think so. On second thought, I'd like to see the flowers."

  Sandy flipped on the light and brought them to her. Then he bent over and kissed her on the forehead. Ellen stiffened for an instant and then relaxed to his gentle hug. "How're you doing? " he asked. "On which level?"

  "Any."

  "The flowers are beautiful. Thank you. If you set them over by the sink, I'll have the nurse get a vase for them later on."

  "Not so great, huh." He did as she asked with the bouquet, then pulled a green vinyl chair to the bedside and sat down. Ellen switched off the overhead light. "You look nice in your uniform. Have you been home yet?"

  "Just long enough to drop off my things and look in on the girls."

  "How do they seem to you?"

  "Concerned, confused, a little frightened maybe, but they're okay. I think it helped when your sister brought them up to see you yesterday.

  I've moved back into the house until you're better."

  "You may be there a long time."

  "That bad?"

  "Kate says no, but her eyes, and now this"-she held up her left hand-"say something else."

  "But they don't really know, do they?"

  "No. No, I guess not."

  "Well, then, you just gotta hang in there a day or an hour or if necessary a minute at a time and believe that everything's going to be all right. I've taken an LOA from the air line to be with the girls, so you don't have anything to worry about on that account. I'll see to it that they get up here every day."

  "Thanks. I… I'm grateful you're here."

  "Nonsense. We've been through a lot these nineteen years. We'll make it through this."

  Softly, Ellen began to cry. "Sandy, I feel like such a… a clod, an oaf. I know it's dumb, but that's how I feel. Not angry, not even sick, just helpless and clumsy."

  "Well, you're neither, and no one knows that better than I do. Hey, that's the second time you've yawned since I got here. Are you tired, or just bored?"

  She smiled weakly. "Not bored. A little tired, I guess. It turns out that lying in bed all day doing nothing is exhausting."

  "Then how about you don't pay any attention to me and just go to sleep.

  If it's okay with you, I'll sit here for a while."

  "Thanks, Sandy."

  "It's going to be okay, you know."

  "I know."

  He took her hand. "Kate's watching out for you, right?"

  "She's in twice a day, and she's doing everything she can to find out why I'm bleeding." Her voice drifted off. Her eyes closed. "Don't be afraid."

  "I'm not, " he said. "I'm not afraid… It's going to be okay." + The ride in Win Samuels's gray Seville took most of an hour along a network of dark country roads heading south and east from the city.

  They rode largely in silence, Samuels seeming to need total concentration to negotiate the narrow turns, and Kate staring out her window at dark pastures and even darker woods, at times wondering about the purpose of their journey and at times allowing disconnected thoughts to careen through her mind. Jared… Stan Willoughby… Bobby Geary … Roscoe… Ellen… Tom… even Ros'beekes, her elementary school principal-each made an appearance and then quickly faded and was replaced by the image of another. "We're here, " Samuels said at last, turning onto a gravel drive. "Stonefield School." Kate read the name from a discreet sign illuminated only by the headlights of their car.

  "What town is this?"

  "No town, really. We're either in southernmost Massachusetts or northwestern Rhode Island, depending on whose survey you use. The school has been here for nearly fifty years, but it was rebuilt about twenty-five years ago, primarily with money from a fund my firm established."

  The school was a low, plain brick structure with a small, well-kept lawn and a fenced-in play area to one side. To the other side, a wing of unadorned red brick stretched towards the woods. They entered the sparsely furnished lobby and were immediately met by a stout, matronly woman wearing a navy skirt, dull cardigan, and an excessive number of gold bracelets and rings. "Mr. Samuels, " she said, "it's good to see you again. Thank you for calling ahead." She turned to Kate. "Dr.

  Bennett, I'm Sally Bicknell, supervisor for the evening shift. Welcome to Stonefield."

  "Thank you, " Kate said uncertainly. "I'm not exactly sure where I am or why we're here, but thank you, anyway."

  Sally Bicknell smiled knowingly, took Kate by the arm, and led her down the hall to a large, blue velvet curtain.
"This is our playroom," she said, drawing the curtain with some flair to reveal the smoky glass of a one-way mirror. The room beyond was large, well lit, and carpeted. There were two tumbling mats, a number of inflatable vinyl punching dummies, and a stack of large building blocks. Mo one corner, her back toward them, a chunky girl with close-cropped sandy hair hunched over a row of large cloth dolls. "She's never in bed much before two or three in the morning," Sally Bicknell explained. "Kate, " Samuels said. "I brought you here because I thought that seeing this might help you understand some of my urgency as regards your moving forward with starting your family. Mrs. Bicknell."

  The evening shift supervisor rapped loudly on the glass three times, then three times again. The girl in the playroom cocked her head to one side and then slowly turned around. "Kate, meet your sister-in-law, Lindsey."

  The girl was, physically, a monster. Her eyes were low set and narrow, her facial features thick and coarse, with heavy lips and twisted yellow teeth. What little there was of her neck forced her head to the right at an unnatural angle. Her barrel chest merged with her abdomen, and her legs were piteously bowed. "That can't be, " Kate said softly, her attention transfixed by the grotesquery. "Jared's sister Lindsey…"

  "Died when she was a child, " Samuels finished the sentence for her.

  "I'm afraid his mother and I chose not to tell him the truth. It seemed like the best idea at the time, considering that we were assured Lindsey would live only a few years. She has Hunter's Syndrome. You are familiar with that, yes? " Kate nodded. "Severe mental retardation and any number of other defects. Her mother, my wife, was nearly forty when she gave birth."

  Kate continued staring through the glass as the gargoylelike child-no, woman, for she had to be in her thirties-lumbered aimlessly about the playroom. Reflected in the window, Kate saw the faces of Sally Bicknell and her father-in-law, watching for her reaction. You are the monster, Win Samuels, not that poor thing, her thoughts screamed. What do you think I am, a piece worker in a factory? Did you think this… this demonstration would frighten me? Do you think I know nothing of amniocentesis and prenatal diagnosis and counseling?

  Did you think I would just brush off the enormous lie you have been telling my husband for the past thirty years? Why? Why have you brought me here? Why haven't you included Jared?

  "Take me home, " she ordered softly. "Take me home now." The antique clock on Win Samuels's huge desk said two-fifty. It had been nearly two hours since Kate had abandoned her efforts to sleep and wandered into the study searching for reading matter distracting enough to close her mind to the events of the evening. Something was wrong. Something did not sit right in the bizarre scenario to which her father-in-law had treated her. But what?

  On the ride home from Stonefield, Samuels had quietly assailed her with statistics relating maternal age to infertility, fetal death, chromosome abnormalities, genetic mutation, spontaneous abortions, and mental retardation. He had, over many years apparently, done his homework well.

  The few arguments she had managed to give him on the accuracy of intrauterine diagnosis were countered with more facts and more statistics. Still, nothing the man said could dispel her gut feeling that something was not right. At one time during his presentation-for that is what it was-she came close to crying out that their whole discussion was quite possibly a futile exercise, because a production error at Redding Pharmaceuticals might have already cost her any chance of seeing her forties, let alone conceiving in them. From the direction of Samuels's room on the second floor, she heard a door open and then close softly. Seconds later, the sound was repeated further down the hall. Jocelyn Trent had returned to her room. The study, now divested of its fire, was chilly and damp. Kate shuddered and tightened the robe Jocelyn had given her. It was only around midnight in San Diego. Jared wouldn't mind a call, she thought, before realizing that she had forgotten to ask Win at which hotel he was staying. As she reached for a pad and pen to write herself a reminder, she noticed Samuels's Rolodex file. She spun it to "A." The man was right about having a card for the Ashburton Foundation. On it were an address and a number that had been crossed out. A second, apparently newer, address and number were written in below. Kate copied the new address and added a note to check in the morning on Jared's hotel. She glanced at the clock. Three-fifteen. How many surgicals were scheduled for the day? Five? Six? Too many.

  Desperate for sleep, she took her note and an anthology of Emily Dickinson and padded up two flights of stairs to her room. Forty-five minutes of reading were necessary before Kate trusted the heaviness in her eyes and the impotence in her concentration enough to flip off the light. The realization that her drowsiness was continuing to deepen brought a relieved, contented smile. Then, in her final moments of consciousness, she sensed a troublesome notion. It appeared, then vanished, then appeared again like a faint neon sign. It was not the trip or the school or even the girl. No, it was the address-the address of the Ashburton Foundation, not the newer Washington, DC, address, but the one that was crossed out. With each flash, the neon grew dimmer, the thoughts less distinct. There was something, she thought at the moment of darkness, something special about Darlington, Kentucky. Something…

  Tuesday 18 December

  Soundlessly, Kate unlocked the heavy oak door and slipped out of her father-in-law's home into the gray glare of morning.

  The deserted streets, sidewalks, and stone steps were covered with an immaculate dusting of white. Over the three days past, a blizzard had crushed the midwest and moved, unabated, into the midatlantic states.

  Stepping gingerly down Beacon Hill toward Charles Street, Kate wondered if the feathery snow was, perhaps, the harbinger of that storm. She had slept far too little. Her eyes were dry and irritated, her temples constricted by the ache of exhaustion-an ache she had not experienced so acutely since her days as a medical student and intern. She thought about the surgicals scheduled to begin at ten o'clock and run through most of the rest of the day. With tensions thrusting at her life from one direction after another like the spears in some medieval torture, she debated asking one of the others to take over for her. No way, she decided quickly. As it was, the members of her department were stretched beyond their limits. Stan Willoughby's repeated requests for an additional pathologist had been laughed at. No, she was expected to do her part, and she would find whatever concentration it took to do it right. As she made her way toward the cab stand near White Memorial, Kate began her morning ritual of mentally ticking off the events and responsibilities of her day. The cab was halfway to Metro when she ended the ritual, as she inevitably did, by scrambling through her purse for her daily calendar, certain that she had forgotten something crucial.

  Her schedule was abbreviated, due largely to a block of time marked simply "surgicals." Penciled in at the bottom was the one item she had forgotten, "Drinks with Tom." The three words triggered a surprising rush of feelings, beginning with the reflex notion to call and cancel, and ending with the sense of what her return home to an empty house would be like. Scattered in between were any number of images of the intense, gangly resident who had been her staunchest supporter during the difficult days that had followed the biopsy of Beverly Vitale. Tom Engleson was a man and a youth, enthusiastic at times even to exuberance, yet sensitive about people, about medicine, and especially about what her career involved and meant to her. The prospect of an hour or two together in the corner of some dark, leather and wood lounge might be just the carrot to get her through the day. "Dammit, Jared, " she muttered as the cab rolled to a stop in front of her hospital. "I need you."

  She began her day as she had each of the last several working days, with a visit to Room 421 of the Berenson Building. Ellen was lying on her back, staring at the wall. Her breakfast was untouched on the formica stand by her bed. Suspended from a ceiling hook, a plastic bag drained saline into her arm. "Hi, " Kate said. "Hi, yourself." Ellen's eyes were shadowed. Her skin seemed lacking in color and turgor. Bruises, large and small, lined
both arms. There was packing in one side of her nose.

  Kate set the Cosmopolitan and morning Globe she had brought on the stand next to the breakfast tray. "Something new's been added, huh? " She nodded toward the IV. "Last night. A little while after you left."

  Kate raised Ellen to a sitting position and then settled onto the bed by her knee. "They say why?"

  "All they'll tell me is that it's a precautionary measure-"X "Have you had some new bleeding?"

  "In my bowel movements, and I guess in my urine, too." She took a glass of orange juice from her tray and sipped at it absently that's probably why the IV, " Kate said. "In case they have to inject any X-ray dye or give you any blood." How much do you want to hear, El? Give me a sign.

  Do you want to know about sudden massive hemorrhage? About circulatory collapse sudden and severe enough to make emergency insertion of an intravenous line extremely difficult? Do you want to know about Beverly Vitale. "Listen, Kate. As long as you're on top of what's going on, I'm satisfied."

  "Good." Thank you, my friend. Thank you for making it a little easier.

  "Sandy's back. He flew in late last night and then moved into the house to look after the girls."

  Kate motioned to a vase of flowers by the window. "From him?"

  "Uh-huh."

  "So?"

  Ellen shrugged. "No significance. He's still on his way out, I think."

  "I hope not."

  "Are you what?"

  "On my way out."

  "Jesus, Sandler, of course not."

  Ellen took her hand. "Don't let me die, Katey, okay?"

  "Count on it, " Kate said, having to work to keep from breaking down in front of her friend. Silently, she vowed to place her efforts on Ellen's behalf ahead of every other task, every other pressure in her life.

  Somewhere, there was an answer, and somehow she would find it. "Listen, I've got to go and get ready for some biopsies. I'll check on your lab tests and speak with you later this afternoon. Okay?"

  "Okay." The word was spiritless. "Anything I can bring you?"