Side Effects (1984)

by Palmer, Michael

  “It was,” Kate said, her thoughts swirling.

  “Pardon?”

  “I said it was put together by a computer.” Her eyes came up slowly and turned toward the window. Across the street, its glass and steel facade jewellike, was the pride of Metropolitan Hospital of Boston. “The pharmacy-dispensing computer of the Omnicenter. The Omnicenter where Ginger Rittenhouse never went.”

  “I don’t understand.”

  Kate rose. “Mrs. Tucker, you’ve been a tremendous help. I’ll call if we need any further information or if we learn something that might help explain your friend’s death. If you’ll excuse me, there are some phone calls I must make.”

  The woman took Kate’s hand. “Think nothing of it,” she said. “Oh, I felt uncomfortable at first, rifling through her drawers, but then I said to myself, ‘If you’re not going to do it, then …’ ”

  “Mrs. Tucker, thank you very much.” One hand still locked in Sandra Tucker’s, Kate used her other to take the woman by the elbow and guide her out the door.

  The tablets were a medium-strength estrogen-progesterone combination, a generic birth control pill. Kate wondered if Ginger Rittenhouse had been too shy to mention to her roommate that she took them. Computer printed along the top margin of the sheet were Ginger’s name, the date six weeks before when the prescription had been filled, and instructions to take one tablet daily. Also printed was advice on what to do if one dose was missed, as well as if two doses were missed. Common side effects were listed, with an asterisk beside those that should be reported immediately to Ginger’s Omnicenter physician. Perforations, vertical and horizontal, enabled the patient to tear off as many pills as might be needed for time away. The setup, like everything at the Omnicenter, was slick—thoughtfully designed, considerate, and practical—further showing why there was a long list of women from every economic level waiting to become patients of the facility.

  Kate ran through half a dozen possible explanations of why she had been told Ginger Rittenhouse was not a patient at the Omnicenter; then she accepted that there was only one way to find out. She answered, “Doctor Bennett,” when the Omnicenter operator asked who was calling, emphasizing ever so slightly her title. Immediately, she was patched through to Dr. William Zimmermann, the director.

  “Kate, this is a coincidence. I was just about to call you. How are you?” It was typical of the man, a dynamo sometimes called Rocket Bill, to forgo the redundancy of saying hello.

  “I’m fine, Bill, thanks. What do you mean ‘coincidence’?”

  “Well, I’ve got a note here from our statistician, Carl Horner, along with a file on someone named Rittenhouse. Carl says he originally sent word to you that we had no such patient.”

  “That’s right.”

  “Well, we do. Apparently there was a coding mistake or spelling mistake or something.”

  “Did he tell you why I wanted to know?”

  “Only that this woman had died.”

  “That’s right. Does your Carl Horner make mistakes often?” The idea of an error didn’t jibe with Marco Sebastian’s description of the man.

  “Once every century or so as far as I can tell. I’ve been here four years now, and this is the first time I’ve encountered any screwup by his machines. Do you want me to send this chart over to you?”

  “Can I pick it up in person, Bill? There are some other things I want to talk with you about.”

  “One o’clock okay with you?”

  “Fine. And Bill, could you order a printout of the record of a Beverly Vitale.”

  “The woman who bled out on the inpatient service?”

  “Yes.”

  “I’ve already reviewed it. A copy’s right here on my desk.”

  “Excellent. One last thing.”

  “Yes?”

  “I’d like to meet Carl Horner. Is that possible?”

  “Old Carl’s a bit cantankerous, but I suspect it would be okay.”

  “One o’clock, then?”

  “One o’clock.”

  Ellen Sandler clutched her housecoat about her and sat on the edge of her bed staring blankly at a disheveled blackbird foraging for a bit of food on the frozen snow beyond her window. She was expected at the office in less than an hour. The house was woefully low on staples. Betsy’s math teacher had set up a noontime conference to investigate her falling interest and grade in the subject. Eve needed help shopping for a dress for her piano recital. Darcy had come home an hour after weekday curfew, her clothes tinged with a musty odor that Ellen suspected was marijuana. So much to do. So much had changed, yet so little.

  The silence in the house was stifling. Gradually, she focused on a few ongoing sounds: the hum of the refrigerator, the drone of the blower on the heating and air conditioning system Sandy had installed to celebrate their last anniversary, the sigh that was her own breathing.

  “Get up,” she told herself. “Goddamn it, get up and do what you have to do.” Still, she did not move. The hurt, the oppressive, constricting ache in her chest seemed to make movement impossible. It wasn’t the loneliness that pained so, although certainly that was torture. It wasn’t the empty bed or the silent telephone or the lifeless eyes that stared at her from the mirror. It wasn’t even the other woman, whoever she was. It was the lies—the dozens upon dozens of lies from the one person in the world she needed to trust. It was the realization that while the anguish and hurt of the broken marriage might, in time, subside, the inability to trust would likely remain part of her forever.

  “Get up, dammit. Get up, get dressed, and get going.”

  With what seemed a major effort, she broke through the inertia of her spirit and the aching stiffness in her limbs, and stood up. The room, the house, the job, the girls—so much had changed, yet so little. She walked to the closet, wondering if perhaps something silkier and more feminine than what she usually wore to the office would buoy her. The burgundy dress she had bought for London caught her eye. Two men had made advances toward her the first day she wore it, and there had been any number of compliments on it since.

  As she crossed the room, Ellen felt the morning discomforts in her joints diminish—all, that is, except a throbbing in her left thigh that seemed to worsen with each step. She slipped off her housecoat, hung it up, and pulled her flannel nightgown off over her head. Covering much of the front of her thigh was the largest bruise she had ever seen. Gingerly, she explored it with her fingers. It was somewhat tender, but not unbearably so. She did not know how she had gotten it. She had sustained no injury that she could remember. It must, she decided, have been the way she slept on it.

  She selected a blue, thin wool jumpsuit in place of the dress, which, it seemed, might not cover the bruise in every situation. She dressed, still unable to take her eyes off the grotesque discoloration. Her legs had always been one of her best features. Even after three children, she took pride that there were only a few threadlike veins visible behind her knees. Now this. For a moment, she thought about calling Kate for advice on whether or not to have a doctor check things out, but she decided that a bruise was a bruise. Besides, she had simply too much else to do.

  A bit of makeup and some work on her hair, and Ellen felt as ready as she ever would to tackle the day. The face in her mirror, thin and fine featured, would probably turn some heads, but the eyes were still lifeless.

  She was leaving the room when she noticed the note tacked to the doorjamb. Each day it happened like this, and each day it was like seeing the note for the first time, despite the fact that she had tacked it there more than a year before.

  “Take Vit,” was all it said.

  Ellen went to the medicine cabinet, took the sheet of multivitamins plus iron from the shelf, punched one out, and swallowed it without water. Half consciously, she noticed that there was only a four-week supply remaining, and she made a mental note to set up an appointment with her physician at the Omnicenter.

  Although she was limping slightly as she left the house, Ellen found
the tightness in her thigh bearable. In fact, compared to the other agonies in her life at the moment, the sensation was almost pleasant.

  The sign, a discreet bronze plate by the electronically controlled glass doors, said, “Metropolitan Hospital of Boston; Ashburton Women’s Health Omnicenter, 1975.” Kate had been one of the first patients to enroll and had never regretted her decision. Gynecological care, hardly a pleasant experience, had become at least tolerable for her, as it had for the several thousand other women who were accepted before a waiting list was introduced. The inscription above the receptionist’s desk said it all. “Complete Patient Care with Complete Caring Patience.”

  Kate stopped at the small coatroom to one side of the brightly lit foyer, and checked her parka with a blue-smocked volunteer. She could have used the tunnel from the main hospital, but she had been drawn outdoors by the prospect of a few minutes of fresh air and a fluffy western omelet sandwich, spécialité de la maison at Maury’s Diner.

  The receptionist signaled Kate’s arrival by telephone and then directed her to Dr. Zimmermann’s office on the third floor. The directions were not necessary. Zimmermann had been Kate’s Omnicenter physician for four years, since the accidental drowning death of Dr. Harold French, his predecessor and the first head of the Omnicenter. Although she saw Zimmermann infrequently—three times a year was mandatory for women on birth control pills—Kate had developed a comfortable patient-physician relationship with him, as well as an embryonic friendship.

  He was waiting by his office door as she stepped from the elevator. Even after four years, the sight of the man triggered the same impressions as had their first meeting. He was dashing. Corny as the word was, Kate could think of no better one to describe him. In his late thirties or early forties Zimmermann had a classic, chiseled handsomeness, along with an urbanity and ease of motion that Kate had originally felt might be a liability to a physician in his medical specialty. Time and the man had proven her concerns groundless. He was polite and totally professional. In a hospital rife with rumors, few had ever been circulated regarding him. Those that had gone around dealt with the usual speculations about an attractive man of his age who was not married. Active on hospital and civic committees, giving of his time to his patients and of his knowledge to his students, William Zimmermann’s was a star justifiably on the rise.

  “Dr. Kate.” Zimmermann took both her hands in his and pumped them warmly. “Come in, come in. I have fresh coffee and … Have you had lunch? I could send out for something.”

  “I stopped at Maury’s on the way over. I’m sorry for being so thoughtless. I should have brought you something.”

  “Nonsense. I only asked about lunch for your benefit. I have been skipping the meal altogether—part of a weight loss bet with my secretary.”

  Even if the bet were concocted on the spot, and considering the man’s trim frame that was quite possible, his words were the perfect breeze to dispel Kate’s embarrassment.

  Zimmermann’s office was the den of a scholar. Texts and bound journals filled three walls of floor-to-ceiling bookcases, and opened or marked volumes covered much of a reading table at one end of the room. On the wall behind his desk, framed photographs of European castles were interspersed with elegantly matted sayings, quotations, and homilies. “The downfall of any magician is belief in his own magic.” “There are two tragedies in life: One is not to get your heart’s desire; the other is to get it.” And of course, “The Omnicenter: Complete patient care with complete caring patience.” There were several others, most of which Kate had heard or read before. One, however, she could not recall having seen. Done in black Benedictine calligraphy, with a wonderfully ornate arabesque border, it said, “Monkey Work for the Monkeys.”

  Zimmermann followed her line of sight to the saying. “A gift from Carl,” he explained. “His belief is that the energy of physicians and nurses should be directed as much as possible to areas utilizing their five senses and those properties unique to human beings—empathy, caring, and intuitiveness. The mechanics of our job, the paperwork, setting up of appointments, filling of prescriptions, and such, he calls ‘monkey work.’ His machines can do those jobs faster and more accurately than any of us ever could, and it seems Carl teaches them more almost every day.”

  “So,” said Kate, “he’s named his computers … the Monkeys.” Zimmermann said the last two words in unison with her. Kate sensed a letup in the uneasiness she had developed toward Carl Horner and began looking forward to meeting the man.

  “Now,” Zimmermann asked, “can you brief me on what you have found in these two patients of ours? I have reviewed their records and found little that might be of help to you.”

  In the concise, stylized method of case presentation ingrained in physicians from their earliest days in medical school, Kate gave a one-minute capsule of each woman’s history, physical exam, laboratory data, and hospital course. “I’ve brought sections from the ovaries of both patients. I think there’s a decent microscope in the lab downstairs,” she concluded.

  Zimmermann whistled softly. “And the only link to this point is that both were patients here?” Kate nodded. “Well, I can’t add much. Miss Rittenhouse had been an Omnicenter patient since nineteen seventy-nine. Nothing but routine checkups since then, except that she was within one missed appointment of being asked to go elsewhere for her gynecologic care. The contract we have our patients sign gives us that option.”

  “I know. I signed one,” Kate said. The contract was another example of the patient-oriented philosophy of the Omnicenter. Fees were on a yearly basis, adjusted to a patient’s income. There was no profit to be made from insisting on compliance with periodic routine visits, yet insist they did. “What about Beverly Vitale?”

  Zimmermann shrugged. “Six years a patient. Abortion here five years ago by suction. Had a diaphragm. Never on birth control pills or hormones of any kind. Always somewhat anemic, hematocrits in the thirty-four to thirty-six range.”

  “She was on iron.”

  “Yes. Dr. Bartholomew has had her on daily supplements since the day of her first exam.”

  “Who was Ginger Rittenhouse’s doctor?” Kate was grasping for any connection, however remote.

  “Actually, she was cared for by the residents, with the help of a faculty advisor. In this woman’s case, it was me. However, there was never any need for me to be consulted. She became a patient just after I arrived. I saw her once, and she has had no trouble since.” He grimaced at what he considered an inappropriate remark. “Excluding the obvious,” he added.

  DEAD END. Kate’s mind’s eye saw the words as she had written them. She glanced at her watch. There would be a surgical specimen processed as a frozen section in half an hour. Her reading would determine whether the patient underwent a limited or extensive procedure. Still, she felt reluctant to let go of the one common factor she had found. “I’m due back for a frozen in a short while, Bill. Do you think you could take me by to meet Carl Horner and his trained Monkeys?”

  “Certainly,” Zimmermann said. “He’s expecting us. By the way, I understand congratulations are in order.”

  “For what?”

  “Well, word has it that you are to be the next chief of pathology.”

  Kate laughed ruefully. “Welcome to the new game show, I’ve Got No Secrets. Actually, I don’t even think my name has formally been presented for consideration yet, so you can hold the congratulations. Besides, with the financial mess the department is in, I’m not sure condolences wouldn’t be a better response. You don’t suppose that Ashburton Foundation of yours has a few extra hundred thousand lying around, do you?”

  “I have no idea, Kate. Norton Reese handles that end of things. I am just one of the barge toters and bale lifters. You might talk to him, though. The foundation certainly has taken good care of us.”

  Kate stepped into the carpeted, brightly lit corridor. “I’ll say they have,” she said. The chance that Norton Reese would put himself out on behalf o
f her department was less than none.

  “Monkey Work for the Monkeys.” The message was displayed throughout Carl Horner’s computer facility, which occupied an area at the rear of the first floor several times the size of Marco Sebastian’s unit. Ensconced in the midst of millions of dollars in sophisticated electronics, Carl Horner looked to be something of an anachronism. Beneath his knee-length lab coat, he was wearing a plaid work shirt and a pair of farmer’s overalls. His battered work boots might just as well have received their breaking in on a rock pile as in the climate-controlled, ultramodern suite.

  Horner greeted Kate with an energetic handshake, though she could feel the bulbous changes of arthritis in every joint. Still the man, stoop shouldered and silver haired, had an ageless quality about him. It emanated, she decided, not only from his dress, but also from his eyes, which were a remarkably luminescent blue.

  “Dr. Bennett, I owe you my deepest apology. The error regarding the Rittenhouse file was nothing more—nor less—than a spelling mistake on my part.”

  Kate smiled. “Apology accepted. Incident forgotten.”

  “Have you found the explanations you were looking for?”

  “No. No, we haven’t. Mr. Horner, could you show me around a bit? I’m especially interested in how the machines work in the pharmacy.”

  “Carl,” Zimmermann said, “if you and Dr. Bennett don’t mind, I’m going to get back to work. Kate, I plan to review those slides later tonight and to do some reading. Together, I promise that we shall get to the bottom of all this. Meanwhile, enjoy your tour. We’re certainly proud of Carl and his Monkeys.”

  Patiently, the old man took Kate through the filling of a prescription.

  “These cards are preprinted with the patient’s name and code number and included with the patient’s chart when she has her appointment. The doctors tear ’em up if they’re not needed. As you can see, there are twenty-five separate medications already listed here, along with the codes for dosage, amount, and instructions. The machines dispense only these medications, and then only in the form of a generic—as good as any brand-name pharmaceutical, but only a fraction of the cost. The machines automatically review the patient’s record for allergies to the medication prescribed, as well as any interaction with medications she might already be taking.” Horner’s presentation had all the pride of a grandmother holding court at a bridge party. “If there’s any problem at all, the prescription is not filled and the patient is referred to our pharmacist, who handles the matter personally.”