Side Effects

by Michael Palmer

  Saturday 22 December

  "Mr. Samuels, I m here to take you up to your room.

  Mr. Samuels?"

  Jared's eyes opened from a dreamless sleep. He was on a litter, staring at the chipped, flaking ceiling of the emergency ward where a team of surgical residents had worked on his wounds. His last clear memory was of one of the doctors, a baby-faced woman with rheumy eyes behind horn-rimmed glasses, announcing that she was about to give him a "little something" so that his wounds could be explored, cleaned, and repaired.

  "I'm Cary Dunleavy, one of the nurses from Berenson Six, " the man's voice said from somewhere at the head of the litter. Jared tried to crane his neck toward the nurse, but was prevented by a thick felt cervical collar and a broad leather restraining belt across his chest.

  He ached in a dozen different places, and he sensed that he was seeing little or nothing through his left eye. Dunleavy took several seconds to appreciate his patient's predicament. Then he muttered an apology and moved to a spot by Jared's right hand. "Welcome to the land of the living, " he said. His voice was | kind, but his eyes were sunken and tired. "You've been out for quite a while. Apparently they overestimated how much analgesia to give you. "ii "It's swollen shut, " the nurse announced. "You look like you've been kicked by a mule. Jared felt his senses begin to focus, and he struggled to reconstruct the hazy events following the explosion in the Omnicenter. His first clear image was of William Zimmermann spinning wildly about, his clothes ablaze, the skin on one side of his face hideously scorched. That one was for you, Katey, he thought savagely. An I'm-sorry-for-not believing-you present from your husband. "What time is it? " he asked. "Almost four."

  "In the morning?"

  The nurse nodded. "According to the report I got from the ER nurses, you've been out for about three hours since they finished working on you. We've been too busy on the floor for anyone to come and get you until now. Sorry."

  "I need to get out of here, " Jared said, fumbling at the restraining strap with his left hand. His right hand, with an intravenous line taped in place, was secured to the railing of the litter. "Hey, partner, " the nurse said, setting a hand on his shoulder. "Easy does it."

  "I've got to see my wife. I've-" Suddenly, he remembered the notebook.

  "My things. Where are my things?"

  "We've got em, Mr. Samuels. They're put away safe awaiting the moment when we read a legitimate order from your doctor discharging you. Rounds are usually at seven. Until then, if you go, you go in a Johnny."

  Jared glared at the man. I'm a lawyer, he wanted to shout. I can sue you and this whole hospital for violating my civil rights, and win. Instead, he assessed his situation. In just three hours or so his physicians would make rounds and he could explain to them his need to leave. Three hours. Almost certainly, Kate would be sleeping through them anyhow, under the effects of her anesthesia. He sank back on the litter. "You win, " he said. The nurse said silent thanks with a skyward look and started maneuvering the litter out of the small examining room. "Just one thing, " Jared said. The man stopped short and again walked around to make eye contact. "I'll listen, but no promises." His tired voice was less good-natured than he intended. "I had a notebook. A black, looseleaf notebook. It should be in with my things. Get me that, and I promise to be a model patient."

  Cary Dunleavy hesitated, but then withdrew the notebook from the patient's belongings bag, which was stashed on the litter beneath Jared.

  I m taking you at your word, Mr. Samuels. Model patient. I'm nearing the end of a double. That's over sixteen straight hours of nursing on a floor that would fit right in at the Franklin Zoo. It's been one hell of a long night, and my usual overabundance of the milk of human kindness is just about dried up. So don't cross me."

  Jared smiled, made a feeble peace sign with his bandaged left hand, and tucked the notebook between his arm and his side. The exhausted nurse returned to the head of the litter and resumed the slow trek through the tunnels to the Berenson Building. The doors to one of the Berenson elevators opened as they approached, and a patient was wheeled out by two nurses. Jared saw the two bags of blood draining into two separate IVS, and a woman's tousled black hair, but little else, as Cary Dunleavy stopped and spoke to the nurses. "What gives? " Dunleavy asked. "GI bleeding. Getting worse. She's going to the OR for gastroscopy. The team's already up there waiting."

  "Good luck. Let me know how it goes."

  "Will do, " the nurse said. The stretchers glided past one another.

  "Sorry for the delay, Mrs. Sandler, " she continued. "We'll be there in just a minute or two."

  Mrs. Sandler. Several seconds passed before the name registered for Jared. "Ellen! " he called out, struggling once again against the leather strap. Dunleavy stopped. "Hey, what're you doing?"

  Jared forced himself to calm down. Ellen was on her way to the operating room, hemorrhaging. The option of waiting for seven o'clock rounds no longer existed. Kate had to see the notebook as quickly as possible.

  Even if the odds were one in a million against finding an answer for Ellen, she had to see it. "Dunleavy, I've got to talk to you, " he said with exaggerated reason. "Please."

  Wearily, the nurse again walked to where he could be seen. "Dunleavy, you care. I can see it in your face. You're tired and wasted, but you still care."

  "So?"

  "That woman who just went past here on the litter is Ellen Sandler, a friend of my wife's and mine. Dunleavy, she's bleeding-maybe bleeding to death. There's a chance the answer to her bleeding problem may be in this notebook, but it's written half in German and half in English, and it's technical as hell."

  "So?"

  "My wife is Kate Bennett, a pathologist here. Do you know her?"

  Dunleavy's acknowledging expression suggested that he might actually know too much. "Well, she speaks some German, and she knows what's been going on with that woman who just passed us. I've got to get this to her. She's a patient at Henderson Hospital in Essex."

  "Mr. Samuels, I can't-" v "Dunleavy, please. There's no time to fuck around. Undo this strap and help me get to a cab. I can move all my extremities, see? I'll be fine."

  "I-"

  "Dammit, man, look at me! That woman is dying and we might be able to help her. Get me an against-medical-advice paper and I'll sign it. I'll sign whatever the hell you want. But, please, do it now!"

  The nurse hesitated. "That woman needs us, my friend, " Jared said.

  "Right this minute she needs us both."

  Dunleavy reached down and undid the restraint. "It's my ass unless you come back and talk to the nursing office. Probably my ass anyway."

  "I'll speak to them. I promise. So will my wife."

  Dunleavy's eyes narrowed. "Please, Mr. Samuels, " he said. "Don't do me any favors."

  Even through the analgesic mist of Demerol and the distracting pain in her chest, Kate Bennett could sense the change in her husband. Bandaged, bruised, and needing a crutch to navigate, he had made a wonderful theatrical entrance into her room, sweeping through the doorway past a protesting night supervisor and announcing loudly, "The fucker's dead, Katey. Dead. He won't ever hurt you again." Then he had crossed to the bed, kissed her on the lips, and firmly but politely dismissed the supervisor and the special duty nurse. Now he sat on a low chair by her left hand, mindless of his own discomfort, watching intently as she opened the black notebook-the sole useful vestige of the fire, pain, and death in the Omnicenter. There was a strength about the man, an assuredness, she had never sensed before. The fucker's dead, Katey. He won't ever hurt you again. The words on the first page landed like hammer blows. Studies in Estronate 250, Volume III of III. Kate's heart sank. "Jared, " she said, swallowing at the sandpaper in her mouth and painfully adjusting the plastic tube that was draining bloody fluid from her chest, "have you looked at this?"

  "Just to flip through. Why? Too much German? We'll find someone to translate."

  "No. Actually, there's not that much… Honey, it says here volume three o
f three."

  "What? " He shifted forward and read the page. "Damn. I never saw any other books. There might have been others, but there was so much smoke.

  Everything was happening so fast… Paquette could have explained everything if he had made it."

  Kate searched her husband's face as he spoke. It was not an excuse, not an apology, but a statement of fact. Paquette had held the key to a E deadly mystery. But Paquette was dead. And Jared, battered, bruised, clearly in great pain, was alive. If she could unlock the answers, it would be because he had risked his life for her. "We'll do the best we can with what we have, " Kate said, turning to the first page of what appeared to be a series of clinical tests on a substance called Estronate 250. "I'm still foggy as hell from the anesthetic and that last shot, so bear with me."

  There were, all told, one hundred and twenty carefully numbered pages.

  Paquette, or whoever had conducted this research, had been meticulous and precise. Stability studies, dosage modification studies, administration experiments in milk, in water, in solid food, investigation of side effects. Kate plodded through thirty years of terse German and English explanations and lengthy lists of test subjects, first from the state mental hospital at Wickford and in more recent years, from the Omnicenter. Thirty years. Arlen Paquette had not sounded that old over the phone, but perhaps he had taken over the Estronate research from someone else. Ten minutes passed, then twenty.

  Jared shifted anxiously in his seat, and stared outside at the sterile, gray dawn. "How long does a gastroscopy take? " he asked. Kate, unwilling to break her fragile concentration, glanced over at him momentarily. "That depends on what they find, and on what they choose to do about it. Jared, I'm close to figuring out some things. I need a few more minutes."

  "You look pretty washed out. Stop if you need to."

  "I'm okay."

  "Here. Here's some water."

  She took a sip and then moistened her cracked, bleeding lips, then she returned her attention to the notebook. Another ten minutes passed before she looked up. Despite the pain and the drugs, her eyes were sparkling. "Jared, " she said, "I think I understand. I think I know what Estronate Two-fifty is."

  "Well?"

  "This is amazing. Assuming he's the one who conducted this research-or at least completed it-the late Dr. Paquette was worth his weight in gold to Redding Pharmaceuticals. Estronate Two-fifty is an oral antifertility drug that causes irreversible sterilization. It can be given to a woman by pill or even secretly in a glass of milk."

  "Irreversible?"

  Kate nodded vigorously, wincing at the jab of pain from her side.

  "Exactly. Think of it. No more tubal ligations, fewer vasectomies, help for third-world countries battling overpopulation."

  "Then the scarred ovaries weren't a mistake?"

  "Hardly. If I'm right, the microsclerosis was the desired result, not a side effect."

  "But what about the bleeding? What about Ellen? " e I Kate motioned him to wait. She was scanning a column marked Nebenwirkung "Look, Jared," she said excitedly. "See this word? It means side effects All these women were apparently given this Estronate and monitored for side effects. Jesus, they're crazy. Paquette, Zimmermann Horner-all of them.

  Absolutely insane. They used hundreds of people as guinea pigs."

  "E. Sandler, " Jared said. "What?"

  "E. Sandler. There it is right at the bottom of the page."

  Kate groaned. "I may be even worse off than I think I am. Twice over the page and I missed it completely. Bless you, Jared."

  Ellen's name was next to last in a column of perhaps three dozen.

  Halfway down a similar list on the following page, Kate found the names B. Vitale and G. Rittenhouse. She pointed them out to Jared and then continued a careful line-by-line check of the rest of the column and yet another page of subjects. "I thought those were all the bleeding problems you know about," he said. "They are."

  "Well, whose name are you looking for?"

  She looked up and for a moment held his eyes with hers. "Mine," she said. She checked the pages once and then again before she felt certain.

  "I'm not here, Jared. I may be in some notebook marked anthranilic acid, but I'm not here."

  "Thank God, " he whispered. "At least volume three's given us that much."

  Kate did not respond. She was again immersed in the columns of data, turning from one page to another, and then back. From where he sat, Jared studied her face, the intensity in her eyes, the determination that had taken her through twelve years of the most demanding education and training. At that moment, more so than at any other time in their marriage, he felt pride in her-as a physician, as a person, as his "Jared, " she said breathlessly, her attention still focused on the notebook, "I think you did it. I think it's here."

  "Show me."

  "See these two words, Thrombocytopenie and Hypofibrinogenamie?

  Well, they mean low platelets and low fibrinogen. Just what Ellen is bleeding from. There's a notation here referring to Omnicenter Study Four B. Modification of Thrombocytopenie and Hypofibrinogenamie Using a Combination of Nicotinic Acid and Delta Amino Caproic Acid."

  "I've heard of nicotinic acid. Isn't that a vitamin?"

  "Exactly-another name for niacin. The other is a variant of a drug called epsilon amino caproic acid, which is used to reverse certain bleeding disorders. See, look here. All together, seven women on these n three pages developed problems with their blood. They were picked up early, on routine blood tests in the Omnicenter."

  "But Ellen and the other two aren't listed as having problems with their blood. There's nothing written next to their names in the side effects column."

  She nodded excitedly. "That's the point, Jared. That's the key. Ellen and the two women who died were never diagnosed. Maybe they just didn't have Omnicenter appointments at the right time."

  "The others were treated?"

  Kate nodded. "That's what this Study Four B is all about. They got high doses of nicotinic acid and the other drug, and all of them apparently recovered. Their follow-up blood counts are listed right here. I think you did it. I think this is the answer. I just hope it's not too late and that somebody at Metro can get hold of the delta form of this medication. If not, maybe they can try the epsilon."

  Jared handed her the receiver of the bedside telephone. "Just tell me what to dial, " he said. Kate's hand was shaking visibly as she set the receiver down. "Ellen's still in the operating room. Nearly three hours now."

  "Who was that you were talking to?"

  "Tom Engleson. He's a resident on the Ashburton Service. In fact, he's the one who called-Never mind. That's not important. Anyhow, he's been up to the operating room several times to check how it's going. The gastroscopist has found a bleeding ulcer. They've tried a number of different tricks to get it to stop, but so far no dice. They've had to call in a surgical team."

  "They're going to operate?"

  Kate shook her head. "Not if they can't do something with her clotting disorder."

  "And?"

  "Tom's gone to round up the hematologist on call and the hospital pharmacist. I'm sure they can come up with the nicotinic acid. It's that delta version of the EACA I'm not sure of. Goddamn Redding Pharmaceuticals. I'm going to nail them, Jared. If it's the last thing I do, I'm going to nail them for what they've done."

  "I know a pretty sharp lawyer who's anxious to help, " he said. "I'm afraid even you may not be that sharp, honey."

  "What do you mean?"

  "Well, we've got this notebook and your word that it belongs to Paquette, but beyond that all we have is me, and I'm afraid my word isn't worth too much right now."

  "It will be when they see this."

  "Maybe."

  "Either way, we're going to try. I mean somebody's going to have to come up with a logical explanation for all this that doesn't involve Redding Pharmaceuticals, and I really don't think that's possible.

  Do you?"

  "I hope not."r />
  "How long do you think it will take before we hear from this resident-what's his name?"

  Kate suddenly recalled a gentle, snowy evening high above Boston Harbor and felt herself blush. "Tom. Tom Engleson." Did her voice break as she said his name? "I don't know. It shouldn't be long." It had better not be, she thought. They waited in silence. Finally, Jared adjusted his cervical collar and rubbed at his open eye with the back of his hand.

  "Kate, there's something else, something I have to tell you, " he said.

  "It has a good deal to do with what you were saying before about your word not being worth too much."

  She looked at him queerly. He held her hand tightly in his. "Kate, yesterday morning I spoke to Lisa."

  Kate sat in the still light of dawn, stroking Jared's forehead and feeling little joy in the realization that, in his eyes at least, she had been vindicated. Nearly fourteen years that he might have shared in some way with his daughter had been stolen. Fourteen years. His hatred of Win Samuels was almost palpable. To her, the man was pitiful-not worth hating. She had tried her best to make Jared see that and to convince him that whatever the circumstances, no matter how much time had gone by, he had a right to be a father to his daughter. He had listened, but it was clear to her that his pain and anger were too acute for any rational planning. There would be time, she had said, as much to herself as to him. If nothing else, there would be time. The telephone rang, startling Jared from a near sleep. Kate had the receiver in her hand well before the first ring was complete. For several minutes, she listened, nodding understanding and speaking only as needed to encourage the caller to continue. Jared searched her expression for a clue to Ellen's status, but saw only intense concentration. Finally, she hung up and turned to him. "That was the hematologist, " she said. "They've started her on the drugs."

  "Both of them?"

  Kate nodded. "Reluctantly. They wanted more of a biologic rationale than Tom was able to give them, but in the end, her condition had deteriorated so much that they abandoned the mental gymnastics. They have her on high doses of both."