Marker

by Robin Cook

  Lou shook his head. He was disgusted. “I can’t believe you’re saying all this. Hospitals for me have always been the place you go to be taken care of.”

  “Sorry,” Jack said. “Times are changing. The deciphering of the human genome has been a monumental event. It has briefly dropped off everyone’s radar, but it is coming back big-time. It is going to change everything we know about medicine in the not-too-distant future. Most changes are going to be for the good, but some are going to be for the bad. It’s always that way with technological advances. Maybe we shouldn’t label them ‘advances.’ Maybe a less value-laden word like ‘changes’ would be better.”

  Lou stared at Jack. Jack stared back. Jack thought the detective’s expression hovered somewhere between frustration and irritation.

  “Are you pulling my leg about all this?” Lou questioned.

  “No,” Jack said with a short laugh. “I’m being serious.”

  Lou meditated for a moment and then said moodily, “I don’t know if I want to live in your world. But screw it! Come on! Let’s make this ID on Rakoczi.”

  They entered the ER, which was already overflowing with patients. Several uniformed policemen were in evidence. Lou sought out the ER director, Dr. Robert Springer. Dr. Springer took Lou and Jack back to a trauma room, the door of which was closed. Inside, they found Jasmine Rakoczi. She was lying naked on an ER bed. An endotracheal tube had been inserted and then attached to a respirator. Her chest was intermittently rising and falling. Behind her, on a flat-screen monitor, blips recorded her pulse and blood pressure. The blood pressure was low, but the pulse was normal.

  “Well?” Lou asked. “Is this the lady you saw in Laurie’s room?”

  “It is,” Jack said. Then he looked at Dr. Springer. “Why are you respiring her?”

  “We want to keep her oxygenated,” Dr. Springer said while he adjusted the respirator’s rate.

  “Don’t you suspect her brainstem was destroyed?” Jack questioned. He was surprised that they were making such an effort in such a clearly moribund situation.

  “Without doubt,” Dr. Springer said, straightening up. “The organ people are trying to locate any next of kin. They want to salvage the internal organs.”

  Lou looked up at Jack. “Now that is going to be ironic,” he said. “She might save a handful of people.”

  “Ironic isn’t a strong enough word,” Jack replied. “I’d lean toward mordantly satirical.”

  To Dr. Springer’s surprise, the detective then cuffed the medical examiner on the head, accused him of being a pompous ass, and then the two walked out, laughing.

  epilogue

  6 WEEKS LATER

  DETECTIVE LIEUTENANT LOU SOLDANO nosed his departmental Chevy over to the curb next to a fire hydrant and tossed onto the dash the plastic-laminated card that spelled out who he was and who owned the vehicle. He then reached over, got out his breath spray from the glove compartment, and gave himself a few good squirts to hide the Marlboros he’d inhaled en route. Tipping his rearview mirror down, he looked as his reflection. He needed a shave, but he always needed a shave, especially at a quarter after eight in the evening. Since he couldn’t do anything about his stubble, he used his fingers to get his hair all going in the same direction. Satisfied with his appearance, he opened the door and stepped out onto the street.

  The air had the silky feel of a spring night. Thanks to daylight savings, the sky was a light rose color that faded to silvery violet to the east. Lou walked up Second Avenue with a spring to his step. He’d called Jack and Laurie that afternoon in the hope of meeting up with them to bring them up to speed on the AmeriCare case, and they had invited him to join them for dinner at their favorite restaurant, Elios.

  Lou had already had a few meals with Jack and Laurie at Elios—some good, some not so good. In the latter category was the evening Laurie announced that she was a marrying the twerp she had dragged along. Lucky for everyone, it was a false alarm and the memory of the evening brought a smile to Lou’s face. It was also lucky that he and Jack didn’t shoot themselves right there in the restaurant. They both had been devastated.

  Lou paused outside. Directly in front of the door was Jack’s mountain bike, secured to a parking meter with a panoply of locks. Lou shook his head. Neither he nor Laurie could talk Jack out of using the damn thing. Lou smiled wryly about Jack constantly ragging on him about his smoking being dangerous for his health, since the danger of riding a bike in the city, particularly the way Jack rode, was a thousand times greater.

  Inside the restaurant, the evening’s festivities were in full swing. People were clustered about the bar to the point of impinging on the diners occupying the coveted front tables. Lou felt decidedly self-conscious, as he always did around such high rollers, particularly the glitterati who seemed to laugh and talk a bit louder than everybody else.

  After making his way through the bar crowd, Lou was faced with the jam-packed dining room. Slowly, his eyes made the circuit, looking for a familiar face. With relief, he spied Jack and Laurie at a table in the far right-hand corner.

  With as many tables and chairs packed into the room as humanly possible, it took Lou some time to worm his way over to his friends. En route he knocked one man’s arm, causing him to spill his wine. When Lou turned around to apologize, he dragged the belt of his raincoat, which was over his arm, through another person’s soup. Despite these travails, he eventually made it.

  “Sorry I’m late,” Lou said as he gave Laurie’s cheek a peck and shook hands with Jack across the table. He made sure he didn’t knock over their fluted glasses with his arm or his coat.

  “No matter,” Laurie said. She pulled a bottle of champagne from the ice bucket and filled the glass in front of Lou.

  Lou tried to drape his coat over the curved back of his chair, but his antics quickly brought an attentive waiter, who took the coat. Lou sat down and used his napkin to blot the line of perspiration that had appeared along his hairline. To him, it felt as though it was 90° inside the restaurant. He quickly undid the top button on his shirt, loosened his tie, and then fanned himself. “Next time, we’ll meet down in Little Italy with my people,” he said.

  “You’re on,” Laurie said cheerfully.

  After a few pleasantries, Jack said, “I’m really curious about the AmeriCare investigation. What’s the news?”

  “Me, too,” Laurie said.

  Lou eyed his friends. When he thought about their friendship, he was always a little amazed. He wasn’t even friendly with his own doctor, nor his kids’ doctor, for that matter. Most of Lou’s friends were other police officers, although there were a couple of firemen who he played cards with on a regular basis. But Jack and Laurie were different than the other doctors Lou had encountered. They didn’t look down on him for his education or what he did for a living. In fact, he felt it was just the opposite.

  “Okay,” Lou said. “Business before pleasure, but let’s see! Where shall I begin? First off, I have to say that what Jack told me the morning Jasmine Rakoczi got shot has turned out to be prophetic. Jack, my boy, you were on the money.”

  Jack smiled and gave Lou a thumbs-up sign.

  “However,” Lou continued. “The lion’s share of the kudos goes to Laurie for being persistent in the face of universal ignorance on everybody else’s part, including Jack’s, and for finding Rakoczi’s tissue under Stephen Lewis’s fingernails.”

  “I’ll drink to that,” Laurie said. She raised her flute and clicked glasses with the others.

  “Now,” Lou continued after putting his glass down. “Ballistics are back, and they indicate that Rakoczi’s gun killed both my captain’s sister-in-law and Roger Rousseau.” Lou reached over and gave Laurie’s forearm a squeeze. “Sorry to bring up a painful subject.”

  Laurie smiled and nodded acknowledgment of Lou’s sensitiveness.

  “Ballistics also indicate that David Rosenkrantz’s gun killed Rakoczi, so that gets Jack off the hook.”

  “Very fu
nny,” Jack said.

  “Now, I know you guys are familiar with Rousseau’s head and hands being found in Rakoczi’s refrigerator, since they were brought over to the OCME, so I won’t go into that.”

  “Please don’t,” Laurie said.

  “Since David Rosenkrantz was from out of state, the FBI jumped into the ring from day one, and lo and behold, there have been similar deaths in AmeriCare hospitals across the country. And now in each location, there is an ongoing investigation as to the perpetrator.”

  “Good grief!” Jack blurted. “When I suggested a conspiracy, I was thinking of one or two higher-ups and Rakoczi—certainly nothing on a national scale.”

  “Well, let me get to the juicy part,” Lou said. He pulled his chair closer to the table and leaned forward. “Our saving that dirtbag Rosenkrantz has turned out to be key. He’s copped a plea and has cooperated by implicating his immediate boss, Robert Hawthorne. Hawthorne has turned out to be one interesting dude, and the lynchpin of the whole operation. He’s a retired Army Special Forces officer and maintains contact with the military through a network of buddies. He’s had an ongoing interest in dissatisfied military medical personnel. Whether he was recruited or had just cleverly created a niche for himself, we don’t know. What we do know is that he has been acting like an independent contractor secretly in the employ of a big Saint Louis law firm, which specializes in plaintiff malpractice work. This firm is extremely active, carrying on simultaneous cases all over the country. As near as can be determined, Hawthorne recruited and ran a group of mostly disgruntled nurses, some of whom had been in the military, who were paid to communicate episodes of adverse outcomes from their respective hospitals, and who got bonuses if the case went to trial.”

  “I’ve heard about that,” Jack said.

  “Me, too,” Laurie said. “It’s mostly OB and anesthesia cases. It’s the modern equivalent of the ambulance chasers of old.”

  “Well, I don’t know about those details,” Lou said. “But here comes the most interesting part. Over the last few years, there has been movement to make managed-care companies liable for malpractice, which, as an aside, seems reasonable to me.”

  “What’s reasonable and what isn’t has little to do with decisions about healthcare in this country,” Jack interjected. “Everything is decided according to vested interests.”

  “By a strange twist of fate,” Lou continued, “managed-care companies and malpractice plaintiff attorneys suddenly found themselves in the same bed in their desire to keep any malpractice-reform legislation from happening. I mean, the goals were slightly different in that the managed-care companies didn’t want things changed so they could be sued, and the malpractice attorneys didn’t want changes that would cap pain-and-suffering awards or eliminate contingency fees, among other things. Both groups employed lobbyists to make sure malpractice law did not change, which brought them together. So, essentially, their waking up in the same bed spawned a weird marriage between the two groups. How it happened is anybody’s guess, but someone in AmeriCare must have realized they could use the shady services of Robert Hawthorne, since at least some of his contacts were . . . what should we say? Psychopaths or sociopaths capable of murder without pangs of conscience.”

  “The newest term is ‘antisocial disorder,’ ” Laurie chimed in.

  “Okay, whatever,” Lou said. “Anyway, some AmeriCare bureaucrat—or bureaucrats, as the case may be—became interested in tapping into the law firm’s cast of unsavory medical insiders, which the law firm had formed to drum up business, in order to set up an elimination scheme for high-risk subscribers. These were the subscribers who they knew would be costing them millions of dollars in specialized care and thereby put upward pressure on premium rates. I mean, it makes some sort of sick sense.”

  “Good grief!” Jack reiterated. “This is close to what I feared, but on a larger scale.”

  “Let me finish!” Lou said after making sure no one was overhearing. “Whether there was any further cooperation in the works, such that the malpractice lawyers would then take advantage of the deaths by appealing to the next of kin to sue the doctors involved, we don’t know. So far, we are only aware of one suit involving a doctor at Saint Francis Hospital.”

  “But that suit will surely be dropped now that homicide is suspected,” Jack said.

  “Maybe so,” Lou said, “But I wouldn’t count on it, since the perpetrator was in the hospital’s employ.”

  “So, what’s the state of the investigation at this point?” Laurie asked.

  “There’s a very active hunt for the Jasmine Rakoczis at these other institutions where a similar pattern of deaths has occurred. The hope is to nab one and have that individual turn state’s evidence. If that happens, maybe the whole house of cards will tumble down.”

  “Have there been any indictments so far from the hit man’s testimony?” Laurie asked.

  “Only Robert Hawthorne, who isn’t talking and is in fact out on sizable bail,” Lou said. “Unfortunately, the hit man was not really apprised of the whole operation. All he knew was that his boss, Robert, was a frequent visitor to the law firm. He didn’t know whom he saw or what was ever talked about.”

  “Nobody in the AmeriCare hierarchy has been indicted?” Jack asked plaintively.

  “Not yet,” Lou admitted. “But we have our fingers crossed.”

  “What a nightmare,” Laurie said with a shudder, remembering something of her ordeal in the hospital.

  “Hey!” Lou said, eyeing the bubbles rising in the flute next to his water glass as if it were the first time he’d seen them. “This is champagne.” He reached out and lifted the bottle from the ice bucket. “I don’t know why I’m looking at this. I wouldn’t know one brand from the next.” He nestled the bottle back into the ice. “What is this, some kind of celebration?”

  “Sort of,” Laurie said with a smile. She looked at Jack, who raised his eyebrows as if there was a secret.

  “Okay, out with it!” Lou commanded. He looked from one to the other.

  “Well, it’s not that big a deal,” Laurie said. “I had a medical test today, which wasn’t very pleasant I must say, but the result was reassuring. Apparently, the reason I had an ectopic pregnancy was because I had an abnormal or damaged oviduct. The test I had today showed my remaining oviduct is perfectly normal.”

  “That’s great!” Lou said. He nodded a few times. He again looked back and forth between his two friends, both of whom were avoiding eye contact by looking down and swirling their drinks. “Well,” Lou added. “Does this favorable result mean you two are planning to put this oviduct to the real test?”

  Laurie looked up at Jack and said, “Unfortunately, at the moment, it just means it could be put to the real test.”

  “Too bad,” Lou commented. “Well, if you need any volunteers to test that duct, I’m available.”

  Jack laughed and looked up at Lou and then Laurie. “Why do I have the feeling you two are ganging up on me?”

  “Hey, I’m just trying to be a good friend,” Lou said while raising both hands to profess his innocence.

  “Well, good friend,” Jack said, putting his arm around Laurie. “In the oviduct-testing business, I think Laurie and I can manage just fine.”

  “I’ll drink to that,” Lou said, raising his glass.

  “Me, too,” Laurie said.

  AUTHOR’S NOTE

  The announcement of the completion of the first draft of the human genome’s 3.2 billion base pairs was made with great fanfare in June of 2000, and included the participation of two heads of state, President Bill Clinton and Prime Minister Tony Blair. Although the media’s excitement could be measured by coverage on both the network evening news as well as prominent front-page space in all the major newspapers on the following day, the public greeted the event with vague interest, a touch of bewilderment, and varying degrees of ennui, then quickly forgot about it. Despite glowing promises of future benefits, the subject apparently was too esoteric. P
erhaps because of the public’s reaction, the mass media soon forgot about it as well, except for a few follow-up articles on the colorful personalities of the leading scientists of the two competing organizations that carried out the painstaking work and the almost soap opera–like race to the finish.

  The public’s disregard for this landmark achievement has continued, even though the involved science and technology have been charging ahead, and reporting startling discoveries, such as the surprising fact that we humans have only about twenty-five thousand or so genes—a far cry from the hundred thousand experts had predicted not too long ago—and not that many more than an organism as comparatively simple as a roundworm! (This discovery is a blow to humanity’s hubris equivalent to the Copernican revelation that the earth revolved around the sun, instead of vice versa.) In short, the decipherment of the human genome and the avalanche of research cascading from it has disappeared from most everyone’s radar except for those working in the two new and related endeavors of Genomics and Bioinformatics. Genomics, in simple terms, is the study of the flow of information in a cell, while Bioinformatics is the application of computers to make sense of the enormous amount of data coming from Genomics.

  In my mind, this lack of interest or apathy or whatever it might be called is startling; I believe the decipherment of the human genome might be the most important milestone in the history of medical science to date. After all, it gives us all the letters of the “book of life” in the right order, despite our having, as of yet, imperfect understanding of the language or the punctuation. In other words, in a cryptic form that is now being decoded with gathering speed, we have access to all the information nature has amassed to make and run a human being! As a consequence, the knowledge of the human genome will change just about everything we know about medicine, and some of the changes are going to happen sooner rather than later.