Side Effects (1984)

by Palmer, Michael

  “Could you check her pressure?” Colangelo asked. He was a thin, minute man, but his hands were remarkable, especially in the fine, plastic work from which surgical legends were born. Kate was grateful beyond words that she had found him available. Still, she knew that the real danger lay not so much in what was happening as in why. Gruesome images of Beverly Vitale and Ginger Rittenhouse churned in her thoughts. At that moment, in the hematology lab, machines and technicians were measuring the clotting factors in a woman who was no more than a name and hospital number to them. Please …

  Colangelo’s assistant reported Ellen’s pressure at one-forty over sixty. No danger there. The jets of blood into the suction bottle seemed to be lessening, and for the first time Kate sensed a slight letup in the tension around the room.

  “Come to papa,” Colangelo cooed to the bleeding arteriole. “That’s the little fellow. Come to papa, now.”

  “What do you think?”

  Kate spun to her left.

  Tom Engleson had moved next to her. “Sorry,” he whispered. “I didn’t mean to startle you.” The concern she was feeling was mirrored in his face. His brown eyes, dulled somewhat by the continued pressures of his job, were nonetheless wonderfully expressive.

  “I think Pete is winning,” she said, “if that’s what you’re asking.”

  “It isn’t.”

  “In that case, I don’t have an answer. At least not yet. Not until the hematology report comes back.” She continued speaking, but turned her gaze back to the center of the room. “If her counts are normal, and you have the time, we can celebrate. I’ll buy you a coffee. If they’re low, I’d like to—wait, make that need to—talk with you anyhow. Besides Stan Willoughby, you are the only one who knows as much as I do, and I think these past two days Stan has been battered enough by his association with me.”

  “I’m free for the rest of the day,” Tom said. “If you like, maybe we could have dinner together.” The moment the words were out, he regretted saying them. Impetuous, inappropriate, tactless, dumb.

  Kate responded with a fractional look—far too little for him to get a fix on. “I think Pete’s done it,” she said, making no reference to his invitation.

  Moments later, Colangelo confirmed her impression. “We’ve got it, Mrs. Sandler. You just stay relaxed the way you have been, and we should be in good shape. You are a wonderful patient, believe me you are. I love caring for people who help me to do my best work.” He took a step back and waited, the reflected light from his head mirror illuminating the blood-smeared lower half of Ellen’s face. Then he turned to Kate, his lips parted in a hopeful half-smile.

  “Good job, Pete,” she whispered. “Damn good.”

  Colangelo nodded and then turned back to his patient. “Mrs. Sandler, I think it best for you to stay overnight here. There are some lab studies that haven’t come back yet, and I would also like to be sure that vessel stays cauterized.”

  “No,” Ellen said. “I mean, I can’t. I mean I don’t want to if I don’t have to. Kate, tell Dr. Colangelo all the things I have to do, and how responsible I am, and how I’ll do exactly what he tells me to do if I can go home. Please, Kate. No offense, but I hate hospitals. Hate them. I almost had Betsy in a roadside park because I wanted to wait until the last minute.”

  Kate crossed to her friend and wiped the dried blood from her face with damp gauze. “Let’s see,” she said finally. “As I see it, you want me to arbitrate a disagreement in medical philosophy between the chief of ENT surgery, who also happens to be a professor at Harvard, and the chief of E. Sandler Interior Designs, Inc.…”

  “Kate, please.”

  Ellen’s grip on Kate’s hand and the quaver in her voice reflected a fear far more primal than Kate had realized. Kate turned to the surgeon. “Pete?”

  Colangelo shrugged. “I get paid to do surgery and give advice,” he said. “If you’re asking me whether I think admission is one hundred percent necessary, the answer is no. However, as I said, I get paid to give advice, and observation in the hospital is my advice.”

  Before Kate could respond, a white-coated technician from the hematology service entered and handed her three lab slips, two pink and one pale green. She studied the numbers and felt a grinding fear and anger rise in her throat. “Lady,” she said, struggling to mask the tension in her voice, “I’m going to cast in with Dr. Colangelo. I think you ought to stay.”

  Ellen’s grip tightened. “Kate, what do the tests show? Is it bad?”

  “No, El. A couple of the numbers are off a bit and should be rechecked, but it’s not bad or dangerous at this point.” Silently, she prayed that her judgment of the woman’s strength was correct, and that she had done the right thing in not lying. Ellen studied her eyes.

  “Not bad or dangerous at this point, but it could be. Is that what you’re saying?” Kate hesitated and then nodded. Ellen sighed. “Then I guess I stay,” she said.

  “You shouldn’t be here long, and you’ll have the very best people taking care of you. I’ll help you make arrangements for the girls, and I’ll also let them know what’s going on.”

  “Thank you.”

  “I know it sounds foolish to say don’t worry, but try your best not to. We’ll keep an eye on your nose and recheck the blood tests in the morning. Most likely you’ll be home by the end of the weekend.” Kate fought to maintain an even eye contact, but somewhere inside she knew that her friend didn’t believe the hopeful statement any more than she did.

  “It’s the Omnicenter. Somehow I just know it is.”

  Kate grimaced at the coffee she had just brewed, and lightened it with half-and-half ferreted out from among the chemicals in her office refrigerator.

  “The Omnicenter is just that pile of glass and stone across the street. Every one of these reports is negative. Bacteriology, chemistry, epidemiology. All negative. Where’s the connection?” Tom Engleson flipped through a sheaf of reports from the studies Kate had ordered. There was nothing in any of them so far to implicate the outpatient center.

  “I don’t know,” Kate responded, settling in across the work bench from him. He was dressed in jeans and a bulky, ivory fisherman’s sweater. It was the first time she had seen the man wearing anything but resident’s whites. The change was a positive one. The marvelous Irish knit added a rugged edge to his asthenic good looks. “I think it’s a virus or some sort of toxin … or a contaminant in the pharmacy. Whatever it is is in there.” She jabbed a thumb in the general direction of the Omnicenter.

  “The pharmacy? These reports say that the analyses of Ginger Rittenhouse’s medications and of the ones Zimmermann sent you were all perfectly normal. Not a bad apple in the bunch.”

  “I know.”

  “So …?”

  “So, I don’t know. Look, my friend has whatever this thing is that has killed two women. Platelets seventy thousand, fibrinogen seventy-five percent of normal. You saw the report. Not as bad as either of the other two, at least not yet, but sure headed in the wrong direction.” Her words came faster and her voice grew more strident. “I don’t really need you to come down here and point out the obvious. For that I can go get Gus from the newsstand outside. I need some thoughts on what might be the explanation, not on what can’t be.” Suddenly she stopped. “Jesus, I’m sorry, Tom. I really am. Between political nonsense here at the hospital, the mess with Bobby Geary and his damn amphetamine addiction, two young women dying like ours did, the everyday tensions of just trying to do this job right, and now Ellen, I’m feeling like someone has plunked me inside a blender and thrown the switch. You don’t deserve this.”

  “It’s okay. I’m sorry for not being more helpful.” He was unable to completely expunge the hurt from his voice, and Kate reminded herself that while the five or so years difference in their ages meant little in most areas, hypersensitivity might not be one of them. “If you think it’s the pharmacy,” he said, “maybe you should call the FDA.”

  “One jot of evidence, and I would. I
’m the one who talked her into going to the Omnicenter in the first place.” Absently, she slipped her hands into her lab coat pockets. In the right one, folded back and again on itself, was the cardboard and plastic card containing what remained of Ellen’s Omnicenter vitamins plus iron. She set them on the bench. “No luck finding any of Beverly Vitale’s vitamins?” she asked.

  “None.”

  Kate crossed to her desk, returned with a medication card similar to Ellen’s, and slapped it down next to the other. “I think we should try one last time with our friends at the toxicology lab and their magic spectrophotometer. Ellen’s vitamins and these. If the reports come back negative, I shall put all my suspicions in the witch-hunt file and turn my attention to other pursuits—like trying to regain some of the respect that was snatched away in the Bobby Geary disaster.”

  “Don’t worry,” Tom said, “you still have respect, admiration, and caring in a lot of places … especially right here.” He tapped himself on the breastbone with one finger.

  “Thank you for saying that.”

  “Whose pills are those other ones?” he asked.

  “Huh?”

  “The other card of pills, whose are they?”

  “Oh. They’re mine.”

  7

  Friday 14 December

  There was an air of excitement and anticipation throughout the usually staid medical suite of Vernon Drexler, MD. The matronly receptionist bustled about the empty waiting room, straightening the magazines and taking pains to see that the six-month-old issue of Practical Medical Science with Drexler’s picture on the cover was displayed prominently enough to be impossible for Cyrus Redding to miss, even if he were ushered directly into the doctor’s office.

  In the small laboratory, the young technician replaced the spool of paper in the cardiograph machine and realigned the tubes, needle, and plastic sleeve she would use to draw blood from the arm of the man Drexler had described as one of the most influential if not one of the wealthiest in the country.

  Behind her desk, Lurleen Fiske, the intense, severe office manager, phoned the last of their patients and rescheduled him for another day. She had been with Drexler in 1967, when Cyrus Redding had made his first trip up from Kentucky. Nineteen sixty-seven. Fiske smiled wistfully. Their office in the Back Bay section of Boston had been little more than two large closets then, one for the doctor and one for herself. Now, Drexler owned the entire building.

  It was twelve-thirty. Redding’s private 727 had probably touched down at Logan already. In precisely an hour, the woman knew, his limousine would glide to a stop in front of their brownstone. Redding, on foot if he could manage it, in his wheelchair if he could not, would be helped up the walk and before entering the building, would squint up at their office window, smile, and wave. His aide, for the last five or six years a silent, hard-looking man named Nunes, would be carrying a leather tote bag containing Redding’s medicines and, invariably, a special, personal gift for each of those working in the office. On Redding’s last visit, nearly a year before, his gift to her had been the diamond pendant—almost half a carat—now resting proudly on her chest. Of course, she realized, this day could prove an exception. Some sort of pressing situation had arisen requiring Redding to fly to Boston. He had called the office late on the previous afternoon inquiring as to whether, as long as he had to be in the city, he might be able to work in his annual checkup.

  “Mrs. Fiske,” Drexler called from his office, “I can’t remember. Did you say Dr. Ferguson would be coming in with Mr. Redding, or did you say he wouldn’t be?”

  “I said ‘might,’ Doctor. Mr. Redding wasn’t sure.” The woman smiled lovingly and shook her head. Vernon Drexler may have been a renowned endocrinologist, and a leading expert on the neuromuscular disease myasthenia gravis, but for matters other than medicine, his mind was a sieve. She and his wife had spent many amusing evenings over the years imagining the Keystone Comedy that would result were they not available to orchestrate his movements from appointment to appointment, lecture to lecture.

  The thought of Dr. Ferguson sent the office manager hurrying to the small, fire-resistant room housing their medical records; she returned to her desk with the man’s file. John Ferguson, MD, afflicted, as was Cyrus Redding, with myasthenia, was a close friend of the tycoon. The two men usually arranged to have their checkups on the same day, and then for an hour or so they would meet with Dr. Drexler. Lurleen Fiske suspected, though Drexler had never made her party to their business, that the two men were in some way supporting his myasthenia research laboratory at the medical school.

  “Mrs. Fiske,” Drexler called out again, “perhaps you’d better get Dr. Ferguson’s chart just in case.”

  “Yes, Doctor, I’ll get it right away,” she said, already flipping through the lengthy record to ensure that the laboratory reports and notes from his last visit were in place. Drexler was nervous. She could tell from his voice. He was conducting himself with proper decorum and professional detachment, but she could tell nonetheless. Once, years before, he had been ferried by helicopter to Onassis’s yacht for a consultation on the man’s already lost battle against myasthenia. That morning, he had calmly bid the office staff good day and then had strode out minus his medical bag, journal articles, and sport coat.

  Redding’s limousine, slowed by the snow-covered streets, arrived five minutes late. Lurleen Fiske joined the two other employees at the window. Across the room, Drexler, a tall, gaunt man in his midfifties, watched his staff pridefully.

  “Look, look. There he is,” the receptionist twittered.

  “Is he walking?” Drexler wanted to see for himself, but was reluctant to disrupt the ritual that had developed over the years.

  Lurleen Fiske craned her neck. “His wheelchair is out,” she said, “but yes … yes, he’s taking a few steps on his own. Another year, Dr. Drexler. You’ve done it again.” There was no mistaking the reverence in her voice.

  In spite of himself, Drexler, too, was impressed. In sixty-seven he had predicted three years for Redding, four at the most. Now, after more than fifteen, the man was as strong as he had been at the start, if not stronger. You’ve done it again. Mrs. Fiske’s praise echoed painfully in his thoughts. Myasthenia gravis, a progressive deterioration of the neuromuscular system. Cause: unknown. Prognosis: progressive weakness—especially with exertion—fatigue, difficulty in chewing, difficulty in breathing, and eventually, death from infection or respiratory failure. Treatment: stopgap even at its most sophisticated. Yet here were two men, Redding and John Ferguson, who had, in essence, arrested or at least markedly slowed the progress of their disease. And they had performed the minor miracles on their own. Though his staff thought otherwise, and neither patient would ever suggest so, they had received only peripheral, supportive help from him. They were certainly a pair of triumphs, but triumphs that continually underscored the futility of his own life’s work.

  From the hallway, Drexler heard the elevator clank open. For years, his two prize patients had been treating themselves with upwards of a dozen medications at once, most of them still untested outside the laboratory. For years he had dedicated his work to trying to ascertain which drug or combination of drugs was responsible for their remarkable results. The answer would likely provide a breakthrough of historic proportions. Perhaps this would be his year.

  Redding, seated in an unmotorized wheelchair, waved his aide on ahead and then wheeled himself to the doorway. Using the man’s arm for some support, he pulled himself upright and took several rickety steps into the office.

  “Thank you for seeing me on such short notice, Vernon,” he said, extending his hand to give Drexler’s a single, vigorous pump. “Mr. Nunes?” The aide, a sullen, swarthy man with the physique of an Olympic oarsman, slid the wheelchair into place for Redding to sit back down. Across the waiting room, Lurleen Fiske and the two other women beamed like proud grandmothers.

  “You look wonderful, Cyrus,” Drexler said. “Absolutely wonderful. Come
on into my office.”

  “In a moment. First, I should like to wish your staff an early Merry Christmas. Mr. Nunes?”

  The expressionless Nunes produced three gifts of varying sizes from the leather bag slung over his shoulder, and Redding presented them, one at a time, to the women, who shook his hand self-consciously. Lurleen Fiske squeezed his shoulders and kissed him on the cheek.

  “My limousine will go for Dr. Ferguson,” Redding said, as he was wheeled into Drexler’s office. “He will be here to share notes with the two of us, but not to be examined. He would rather keep the appointment he has for next month, if that is agreeable to you.”

  “Fine, fine,” Drexler said.

  The two men, Ferguson and Redding, had met perhaps a dozen years before in his waiting room and had developed an instant rapport. By their next appointment, Redding had asked that a half day be set aside for just the two of them. The request, supported as it was by the promise of substantial research funds, was, of course, granted.

  Redding’s bodyguard wheeled him into Drexler’s office, set the bag of medications on the desk, and left to accompany the limousine to John Ferguson’s house. Carefully, Redding arranged the vials and plastic containers on the blotter before Drexler. There were, all told, thirteen different preparations.

  “Well, Doctor,” he said, “here they are. Most of them you already know we have been taking. A couple of them you don’t.”

  “Dr. Ferguson continues to follow exactly the same regimen as you?”

  “As far as I know.”

  The endocrinologist made notes concerning each medication. There were two highly experimental drugs—still far from human testing—that he himself had only learned of in the past six or seven months. He bit back the urge, once again, to warn against the dangers of taking pharmaceuticals before they could be properly investigated, and simply recorded the chemical names and dosages. Somehow, the two men were screening the drugs for side effects. They had let him know that much and no more. As far as Vernon Drexler, MD, was concerned, with a goodly proportion of his own research at stake, there was no point in pushing the matter.