Marker

by Robin Cook

  “I’m amazed you can find humor in this,” Roger said.

  “I feel better after talking to you.”

  “I’m so sorry about all this,” Roger said with a voice that suggested utter sincerity. “What are you going to do? What’s the next step?”

  “As soon as I leave here, I’m supposed to head over to the clinic to see Sue Passero. She’s offered to help arrange an appointment in the near future with an oncologist.”

  She gave Roger a pat on the thigh and started to stand up.

  “Hold on,” Roger said, reaching out and pressing down on her shoulder to keep her in her seat. “Not so fast! Since the social worker didn’t have a chance, let me ask you how you feel. I imagine it’s something like finding out your best friend is your mortal enemy.”

  Laurie peered into the depths of Roger’s dark brown eyes. She found herself wondering if he was asking the question as a close friend or as a doctor. If it was the former, was his interest truly sincere? He seemed to have a knack for saying the right thing, but what was his motivation? Then she chided herself for questioning, but after the marriage and children flap, she wasn’t sure of anything.

  “I guess I haven’t had time to feel much of anything,” Laurie said after a pause. She was tempted to say something about her newly recognized ability to compartmentalize her thoughts to the point of just not thinking about anything she didn’t want to. But then she decided it was too long a story, since she wanted to get over to the Kaufman Clinic building to see Sue. In the long run, it was the oncologist who was going to be key, and the sooner the appointment was scheduled, the better she would feel.

  “There must be something you can share with me,” Roger persisted. He still had his hand resting on her shoulder. “You can’t learn something as disturbing as this without having some specific fears.”

  “I suppose you are right,” Laurie admitted reluctantly. “For me, some of the suggested prophylactic measures and their side effects are the scariest. For instance, the idea of electively losing my fertility by having my ovaries removed is . . .”

  Laurie stopped in mid-sentence. For her, the thought that suddenly raced through her mind like a tornado was the equivalent of being rudely slapped in the face. It brought an instantaneous adrenaline rush that caused her pulse to race and the ends of her fingers to tingle. For a moment, she even felt dizzy, such that she had to grasp the edge of her chair to keep from toppling over.

  Luckily, the dizziness passed as quickly as it had appeared. She could tell Roger was talking, but for the moment, she couldn’t hear him, as the idea that had occurred to her kept reverberating in her mind with an effect akin to claps of thunder. The old adage “Be careful what you wish for because it might come to pass” again flashed into her consciousness.

  Laurie stood up abruptly, effectively pulling Roger to his feet as well, since he still had his hand on her shoulder. All at once, she wanted to be by herself.

  “Laurie!” Roger demanded. Using his two hands, he gave her shoulders a shake. “What’s wrong? You didn’t finish your sentence.”

  “I’m sorry,” Laurie said in a voice that was calmer than she felt. She peeled Roger’s reluctant hands from her shoulders. “I have to go.”

  “I can’t let you go like this. What are you thinking about? Are you depressed?”

  “No, I’m not depressed. Not yet, anyway. I have to go, Roger. I’ll call you later.”

  Laurie turned to leave, but Roger grabbed her arm. “I have to be sure you won’t hurt yourself in any way.”

  Catching Roger’s drift, Laurie shook her head. “Rest assured, I’m not going to hurt myself. I just need to be alone for a while.” She extracted her arm from Roger’s grasp.

  “You’ll call me.”

  “Yes, I’ll call you,” Laurie said as she opened the door.

  “Am I going to see you tonight?”

  Laurie hesitated in the doorway and then turned around. “Tonight’s not going to work. But I’ll be in touch.”

  Laurie left Roger’s office, rounded the nearest secretary’s desk, and walked deliberately down the hallway, resisting the inclination to run. She could feel Roger’s eyes on her back, but she didn’t turn around. Passing through the doorway that separated the administrative area from the rest of the hospital, she slipped into the crowd. Once again, the anonymity was comforting. Instead of dashing out of the building, which was her initial intention, she regained her seat opposite the information booth and spent the next quarter of an hour thinking of the consequences of her disturbing notion.

  eleven

  THE THURSDAY-AFTERNOON conference at the Office of the Chief Medical Examiner was a command performance, according to the dictates of the chief, Harold Bingham. Although he frequently did not attend himself, citing pressing administrative duties, everyone else under his command in the five boroughs of New York had to attend. The rule was strictly enforced by the deputy chief, Calvin Washington, unless prior dispensation had been granted, which required deathbed illness or the equivalent. Consequently, the forensic pathologists from the branch offices in Brooklyn, Queens, and Staten Island all had to make the weekly hajj to Mecca for the questionable enlightenment that the conferences offered. For those medical examiners assigned to the home office serving Manhattan and the Bronx, the onus was far less of an imposition, since all they had to do was take the elevator from the fifth floor down to the first.

  Laurie generally found the conferences entertaining to a degree, particularly the informal social period prior to the meeting. It was during this time that the examiners traded war stories of the week’s more intellectually challenging or plainly bizarre cases. Laurie rarely contributed to these “sidewalk” discussions but enjoyed listening. Unfortunately, enjoyment was not the situation on this particular Thursday. After learning that she was positive for the BRCA1 marker and then having the disturbing worry emerge in Roger’s office, she felt shell-shocked, almost numb, and certainly didn’t feel social in the slightest. Coming into the room, she didn’t join the group around the coffee and donuts, but rather had taken a seat near the door to the hall in hopes of possibly slipping away at some convenient and unobtrusive time.

  The conference room was of moderate size, and its décor had a particularly tired look that suggested it was much older than its purported forty-four years. To the left, where a door communicated directly into Bingham’s office, stood a scarred and scratched lectern with its own little picture lamp that no longer worked and a goosenecked microphone that did. Arrayed in front of the podium were four rows of equally battered seats fixed to the floor and outfitted with hinged writing surfaces. The seats gave the room the appearance of a small lecture hall and allowed it to fulfill its major function: Bingham’s news conferences. In the back of the room stood a library table that presently supported the refreshments, and around which were grouped the city’s medical examiners: everyone except the two higher-ups and Jack. A babble of voices interspersed with laughter floated around the room.

  Unlike Laurie, Jack did not like anything about the Thursday conferences. Jack had had a run-in with one of the medical examiners from the Brooklyn office over the sister of one of Jack’s basketball buddies and refused to even socialize with the man. The same feelings were extended to the branch chief when he supported his underling in the dispute. Even though Jack denied that it was deliberate, he always arrived late, to Calvin’s irritation.

  The door to Bingham’s office opened, and Calvin’s massive body appeared. He was clutching a folder, which he opened on the lectern. His dark eyes scanned the room, briefly connecting with Laurie’s before moving on. He was obviously taking attendance.

  “All right!” Calvin bellowed when no one paid him any heed. Thanks to the microphone, his voice reverberated around the room like a kettledrum. “Let’s get under way here.”

  Calvin kept his head bent down while he organized his papers on the lectern’s slanted surface. The medical examiners quickly broke off from their conversat
ions and filed into the rows of chairs to take their seats. Calvin began the meeting the way Bingham used to, back when the chief regularly attended. First, he launched into a summary of the previous week’s statistics.

  As Calvin’s voice droned on, Laurie’s mind wandered. Although she was usually good at slipping into her professional persona on command and leaving her personal problems for another time, she couldn’t do it presently. Her new worry kept popping back unpleasantly into her consciousness, such that it even trumped the BRCA1 concern. The problem was that she had no idea what she would do if her fears were realized.

  The hall door immediately to Laurie’s left opened, and Jack walked in. Calvin stopped his presentation, glared at Jack, and said sarcastically, “I’m so glad you were able to grace us with your presence, Dr. Stapleton.”

  “I wouldn’t miss it for the world,” Jack answered, causing Laurie to wince. With her fear of authority figures, she couldn’t understand how Jack could be so transparently brazen with Calvin. She thought it was a kind of masochism on Jack’s part.

  Jack looked down at Laurie with an exaggerated questioning expression. She was sitting in the seat he always preferred, and for the same reason Laurie had taken it. He gave her shoulder a squeeze before taking the aisle seat directly in front of her. With Jack’s head in the line of her vision, she found it even harder to concentrate on what Calvin was saying. It was a visual reminder that, one way or the other, she was going to have to have a serious conversation with him.

  After giving the statistics, Calvin launched into his usual discussion of cogent administrative issues that usually involved some decrease in city funding, and this week’s conference was no different. Instead of listening, Laurie watched Jack. Although he had just sat down, his head started the telltale bobbing that suggested that he had already begun falling asleep, causing her to worry that Calvin was going to notice and fly into a rage. When authority figures got angry, even if it wasn’t directed at her, it still made her feel uncomfortable.

  Either Calvin didn’t notice or he just elected to ignore the disrespect, because he concluded his remarks without making a scene and introduced the chief of the Brooklyn office, Dr. Jim Bennett.

  Each one of the chiefs from the respective borough offices stood up to give their presentations. When Dick Katzenburg from Queens got behind the microphone and started speaking, Laurie had a flashback to her cocaine conspiracy twelve years earlier. It was at a Thursday-afternoon conference that she had the idea of discussing her overdoses with the group, and the ensuing discussion had been helpful, thanks to Dick. She wondered why the idea of doing the same with the Manhattan General cases hadn’t occurred to her, and she thought about bringing it up. But then she changed her mind. She was too stressed-out to deal with the anxiety of talking in front of the group. But then she waffled again when she reminded herself that Calvin seemed to be in a reasonably tolerant mood.

  At the end of Margaret Hauptman’s presentation of the Staten Island statistics, Calvin reclaimed the podium and asked if anyone else wanted the microphone for any other business. It was a pro forma offer that was rarely accepted, since people were eager to leave. After a moment of painful indecision, Laurie tentatively raised her hand. Any chance of changing her mind was dashed when Calvin quickly but reluctantly recognized her. Jack twisted around in his seat in front of her and gave her an exasperated questioning expression that implied: Why are you extending this agony?

  Laurie walked unsteadily up to the podium. She felt a jolt of adrenaline, since speaking in front of groups always intimidated her. As she adjusted the microphone, she berated herself for getting into such a situation. She certainly didn’t need any more stress.

  “First, let me apologize,” Laurie began. “I hadn’t prepared for this, but it just occurred to me that I would like to get some general response from everyone about a current series of mine.”

  Laurie looked down at Calvin and could tell that his eyes had narrowed. She sensed that he knew what was coming and didn’t approve. She glanced back at Jack, and as soon as her eyes connected with his, he positioned his fingers like a gun and pretended to shoot himself in the head.

  With such negative vibes, Laurie felt even more insecure. To collect her thoughts, she looked down at the lectern’s defaced wooden surface with its myriad initials and doodles encased with ballpoint-pen marks. Vowing to avoid making eye contact with either Calvin or Jack, she raised her eyes and launched into a short description of her Sudden Adult Death Syndrome, or SADS, a term she admitted she’d coined when talking with a professional colleague five weeks ago, about four totally unexpected, hospital-based cardiac arrests that had resisted resuscitation. She said she now had six cases spanning a six-week period, all of which had similar demographics: young, healthy, and within twenty-four hours of elective surgery. She went on to say that there was no pathology on gross or microscopic, although on the last two cases, she had yet to do the microscopic, since they had been posted that very morning. She concluded by saying that despite toxicology failing to come up with any possible arrhythmic agent, she suspected that the manner of death in these cases was not natural or accidental.

  Laurie let her voice trail off. Her mouth was bone-dry. She would have loved a drink of water, but she stayed where she was. The implication of her monologue was immediately clear to the group, and for a few seconds, silence reigned in the conference room. Then a hand shot up, and Laurie called on the individual.

  “What about electrolytes: sodium, potassium, and particularly calcium?”

  “The lab reported all electrolytes from all the usual sample sources to be entirely normal,” Laurie responded. She then called on another person who raised his hand.

  “Are the patients related in any way other than all being young, healthy, and having just had surgery?”

  “Not that is apparent. I’ve made it a point to search for commonalities, but I haven’t found any other than what I have mentioned. The cases involve mostly different doctors, different procedures, different anesthetic agents, and, for the most part, different medications, even for postoperative pain.”

  “Where have they occurred?”

  “All six have been at the same hospital: the Manhattan General.”

  “Which has an extremely low death rate,” Calvin snapped. He’d had enough. He stood up, approached the podium, and used his bulk to nudge Laurie aside. He bent the microphone up, and a harsh squeal emanated from the speakers as if in protest. “Calling these disparate cases at this stage ‘a series’ is misleading and prejudicial because, as Dr. Montgomery has admitted, they are not related. I’ve told Dr. Montgomery this before, and I’m telling her again. I’m also telling this august assemblage that this is an in-house discussion that doesn’t leave this room. OCME is not going to tarnish the reputation of one of the city’s premier tertiary-care centers with unsubstantiated innuendo.”

  “Six is rather a lot for a coincidence,” Jack said. He had revived when Laurie got up to speak. Although he was not asleep, he was slouched back in his seat with his legs draped over the seat in front of him.

  “Would you kindly show some respect, Dr. Stapleton,” Calvin growled.

  Jack put his feet down on the floor and sat up. “Four was borderline, but six is too many when they are all at the same hospital. Still, I’m going to vote for accidental. Something in the hospital is affecting these patients’ conduction systems.”

  Dick Katzenburg raised his hand. Calvin motioned with his head for him to speak.

  “My colleague at the Queens office just reminded me that we saw some similar cases,” Dick said. “It’s our recollection that the demographics were quite similar: all relatively young and supposedly healthy. The last case was at least a few months ago, and we haven’t had one since.”

  “How many overall?” Laurie asked.

  Dick leaned toward Bob Novak, his deputy, and listened for a moment, then straightened up. “We think it was also six. But it was spread over a period of several
months with a number of examiners. Just when we began to be a bit curious about them, they stopped, and as a consequence, they have sort of dropped off our radar. It’s my recollection that all were eventually signed out as natural, even though no significant pathology was found. I know for certain that toxicology was negative on all of them, because that would have certainly been brought to my attention.”

  “Were they postoperative?” Laurie asked. She was taken aback, excited, and pleased. It would be déjà vu if her series were to double from having brought up the issue at a Thursday conference. And if it did double, the profile of these cases would surely be even more of a mental diversion than it had been to date.

  “I believe so,” Dick said. “Sorry that I can’t be more definitive.”

  “I understand,” Laurie said. “Where did these deaths occur?”

  “At Saint Francis Hospital.”

  “Ah, the plot thickens,” Jack commented. “Isn’t St. Francis another AmeriCare hospital?”

  “Dr. Stapleton!” Calvin snapped. “Kindly maintain a modicum of decorum! Allow yourself to be recognized if you wish to contribute to the conversation.”

  “It is an AmeriCare institution,” Dick said, turning toward Jack and ignoring Calvin.

  “How soon can I get their names and accession numbers?” Laurie asked.

  “I’ll e-mail them to you as soon as I get back to the Queens office,” Dick said. “Or we can just call my secretary. I think she could find the list.”

  “I’d like them as soon as possible,” Laurie said. “I’d like to get their hospital charts, and the sooner I get the accession numbers to one of our investigators, the better.”