by Robin Cook
Turning, Norma looked out the window at the intensely blue Miami sky, filled with massive bubbles of white cumulus clouds. Since her cancer had been diagnosed, she tried hard not to ask why me? When she’d first felt the lump she had hoped it would go away of its own accord, like so many lumps had done in the past. It wasn’t until several months had passed, and the skin over the lump had suddenly dimpled, that she’d forced herself to see a doctor, only to learn that her fears had been justified: the lump was malignant. So just before her thirty-third birthday she’d undergone a radical mastectomy. She hadn’t fully recovered from the surgery before the doctors began the chemotherapy.
Determined to end her self-pity, she was reaching for a novel when the door to her private room opened. She didn’t even look up. Staff at the Forbes Cancer Center was constantly in and out adjusting her IV, injecting her medicine. She had gotten so used to the constant comings and goings, they barely interrupted her reading anymore.
It was only after the door had closed again that she became aware she had been given some new drug. The effect was unique, causing the strength suddenly to drain from her body. Even the book she was holding fell from her hands. But what was more frightening was the effect on her breathing; it was as if she were being smothered. In agony she tried to get air, but she had progressive difficulty, and soon she was totally paralyzed except for her eyes. The image of her door being quietly opened was the last thing she knew.
1
February 26
Friday, 9:15 A.M.
“Oh, God, here she comes!” Sean Murphy said. Frantically he grabbed the charts stacked in front of him and ducked into the room behind the nurses’ station on the seventh floor of the Weber Building of the Boston Memorial Hospital.
Confused at this sudden interruption, Peter Colbert, a fellow third-year Harvard medical student, surveyed the scene. Nothing was out of the ordinary. It appeared like any busy internal medicine hospital ward. The nurses’ station was a beehive of activity with the floor clerk and four RN’s busy at work. There were also several orderlies pushing patients on gurneys. Organ music from the soundtrack of a daytime soap could be heard drifting out of the floor lounge. The only person approaching the nurses’ station who didn’t belong was an attractive female nurse who Peter felt was an eight or nine out of a possible ten. Her name was Janet Reardon. Peter knew about her. She was the daughter of one of the old Boston Brahmin families, aloof and untouchable.
Peter pushed back from the counter where he had been sitting next to the chart rack and shoved open the door to the back room. It was an all-purpose office with desk-high countertops, a computer terminal, and a small refrigerator. The nurses held their reports in there at the end of each shift, and those who brown-bagged it used it as a lunchroom. In the back was a lavatory.
“What the hell’s going on?” Peter demanded. He was curious to say the least. Sean was against the wall with his charts pressed to his chest.
“Shut the door!” Sean commanded.
Peter stepped into the room. “You’ve been making it with Reardon?” It was part question, part stunned realization. It had been almost two months ago at the outset of Peter’s and Sean’s rotation on third-year medicine that Sean had spotted Janet and had asked Peter about her.
“Who the hell is that?” Sean had demanded. His mouth had gone slack. In front of him was one of the most beautiful women he’d ever seen. She was climbing down from the counter after retrieving something from the inaccessible top shelf of a wall cabinet. He could tell she had a figure that could have graced any magazine.
“She’s not your type,” Peter had said. “So close your mouth. Compared to you she’s royalty. I know some guys who have tried to date her. It’s impossible.”
“Nothing is impossible,” Sean had said, watching Janet with stunned appreciation.
“A townie like you could never get to first base,” Peter had said. “Much less hit a home run.”
“Want to bet?” Sean had challenged. “Five bucks says you are wrong. I’ll have her thirsting for my body by the time we finish medicine.”
At the time, Peter had just laughed. Now he appraised his partner with renewed respect. He thought he’d gotten to know Sean over the last two months of grueling work, and yet here he was on the last day of medicine surprising him.
“Open the door a crack and see if she’s gone,” Sean said.
“This is ridiculous,” Peter said, but he opened the door several inches nonetheless. Janet was at the counter talking to Carta Valentine, the head nurse. Peter let the door shut.
“She’s right outside,” he said.
“Damn!” Sean exclaimed. “I don’t want to talk to her right now. I’ve got too much to do, and I don’t want a scene. She doesn’t know I’m leaving for Miami for that elective at the Forbes Cancer Center. I don’t want to tell her until Saturday night. I know she’s going to be pissed.”
“So you have been dating her?”
“Yeah, we’ve gotten pretty hot and heavy,” Sean said. “Which reminds me: you owe me five bucks. And let me tell you, it wasn’t easy. At first she’d barely talk to me. But eventually, utter charm and persistence paid off. My guess is that it was mostly the persistence.”
“Did you bag her?” Peter asked.
“Don’t be crude,” Sean said.
Peter laughed. “Me crude? That’s the best example of the pot calling the kettle black that I’ve ever heard.”
“The problem is she’s getting serious,” Sean said. “She thinks because we slept together a couple of times, it’s leading to something permanent.”
“Am I hearing marriage here?” Peter asked.
“Not from me,” Sean said. “But I think that’s what she has in mind. It’s insane, especially since her parents hate my guts. And hell, I’m only twenty-six.”
Peter opened the door again. “She’s still there talking with one of the other nurses. She must be on break or something.”
“Great!” Sean said sarcastically. “I guess I can work in here. I’ve got to get these off-service notes written before I get another admission.”
“I’ll keep you company,” Peter said. He went out and returned with several of his own charts.
They worked in silence, using the three-by-five index cards they carried in their pockets bearing the latest laboratory work on each of their assigned patients. The idea was to summarize each case for the medical students rotating on service come March 1.
“This one has been my most interesting case,” Sean said after about half an hour. He held the massive chart aloft. “If it hadn’t been for her I wouldn’t even have heard about the Forbes Cancer Center.”
“You talking about Helen Cabot?” Peter asked.
“None other,” Sean said.
“You got all the interesting cases, you dog. And Helen’s a looker, too. Hell, on her case consults were pleading to be called.”
“Yeah, but this looker turned out to have multiple brain tumors,” Sean said. He opened the chart and glanced through some of its two hundred pages. “It’s sad. She’s only twenty-one and she’s obviously terminal. Her only hope is that she gets accepted by the Forbes. They have been having phenomenal luck with the kind of tumor she has.”
“Did her final pathology report come back?”
“Yesterday,” Sean said. “She’s got medulloblastoma. It’s fairly rare; only about two percent of all brain tumors are this type. I did some reading on it so I could shine on rounds this afternoon. It’s usually seen in young children.”
“So she’s an unfortunate exception,” Peter commented.
“Not really an exception,” Sean said. “Twenty percent of medulloblastomas are seen in patients over the age of twenty. What surprised everyone and why no one even came close to guessing the cell type was because she had multiple growths. Originally her attending thought she had metastatic cancer, probably from an ovary. But he was wrong. Now he’s planning an article for the New England Journal of Medicine.”
“Someone said she was not only beautiful but wealthy,” Peter said, lamenting anew he’d not gotten her as a patient.
“Her father is CEO of Software, Inc.,” Sean said. “Obviously the Cabots aren’t hurting. With all their money, they can certainly afford a place like the Forbes. I hope the people in Miami can do something for her. Besides being pretty, she’s a nice kid. I’ve spent quite a bit of time with her.”
“Remember, doctors are not supposed to fall in love with their patients,” Peter said.
“Helen Cabot could tempt a saint.”
JANET REARDON took the stairs back to pediatrics on the fifth floor. She’d used her fifteen-minute coffee break trying to find Sean. The nurses on seven said they’d just seen him, working on his off-service notes, but had no idea where he’d gone.
Janet was troubled. She hadn’t been sleeping well for several weeks, waking at four or five in the morning, way before her alarm. The problem was Sean and their relationship. When she’d first met him, she’d been turned off by his coarse, cocky attitude, even though she had been attracted by his appealing Mediterranean features, black hair, and strikingly blue eyes. Before she’d met Sean she hadn’t known what the term “Black Irish” meant.
When Sean had initially pursued her, Janet had resisted. She felt they had nothing in common, but he refused to take no for an answer. And his keen intelligence pricked her curiosity.
She finally went out with him thinking that one date would end the attraction. But it hadn’t. She soon discovered that his rebel’s attitude was a powerful aphrodisiac. In a surprising about-face, Janet decided that all her previous boyfriends had been too predictable, too much the Myopia Hunt Club crowd. All at once she realized that her sense of self had been tied to an expectation of a marriage similar to her parents’ with someone conventionally acceptable. It was then that Sean’s Charlestown rough appeal had taken a firm hold on her heart, and Janet had fallen in love.
Reaching the nurses’ station on the pediatric floor, Janet noticed she still had a few minutes left on her break. Pushing through the door to the back room, she headed for the communal coffee machine. She needed a jolt to get her through the rest of the day.
“You look like you just lost a patient,” a voice called.
Janet turned to see Dorothy MacPherson, a floor nurse with whom she’d become close, sitting with her stockinged feet propped upon the countertop.
“Maybe just as bad,” Janet said as she got her coffee. She only allowed herself half a cup. She went over and joined Dorothy. She sat heavily in one of the metal desk chairs. “Men!” she added with a sigh of frustration.
“A familiar lament,” Dorothy said.
“My relationship with Sean Murphy is not going anywhere,” Janet said at length. “It’s really bothering me, and I have to do something about it. Besides,” she added with a laugh, “the last thing I want to do is to be forced to admit to my mother that she’d been right about him all along.”
Dorothy smiled. “I can relate to that.”
“It’s gotten to the point that I think he’s avoiding me,” Janet said.
“Have you two talked?” Dorothy asked.
“I’ve been trying,” Janet said. “But talking about feelings is not one of his strong points.”
“Regardless,” Dorothy said. “Maybe you should take him out tonight and say what you’ve just said to me.”
“Ha!” Janet laughed scornfully. “It’s Friday night. We can’t.”
“Is he on call?” Dorothy asked.
“No,” Janet said. “Every Friday night he and his Charlestown buddies get together at a local bar. Girlfriends and wives are not invited. It’s the proverbial boys’ night out. And in his case, it’s some kind of Irish tradition, complete with brawls.”
“Sounds disgusting,” Dorothy said.
“After four years at Harvard, a year of molecular biology at MIT, and now three years of medical school, you’d think he’d have outgrown it. Instead, these Friday nights seem to be more important to him than ever.”
“I wouldn’t stand for it,” Dorothy said. “I used to think my husband’s golf fetish was bad, but it’s nothing compared to what you’re talking about. Are there women involved in these Friday night escapades?”
“Sometimes they go up to Revere. There’s a strip joint there. But mostly it’s just Sean and the boys, drinking beer, telling jokes, and watching sports on a big-screen TV. At least that’s how he’s described it. Obviously I’ve never been there.”
“Maybe you should ask yourself why you’re involved with this man,” Dorothy said.
“I have,” Janet said. “Particularly lately, and especially since we’ve had so little communication. It’s hard even to find time to talk with him. Not only does he have all the work associated with med school, but he has his research too. He’s in an M.D.-Ph.D. program at Harvard.”
“He must be intelligent,” Dorothy offered.
“It’s his only saving grace,” Janet said. “That and his body.”
Dorothy laughed. “At least there’s a couple of things to justify your anguish. But I wouldn’t let my husband get away with that juvenile Friday night stuff. Hell, I’d march right in and embarrass the heck out of him. Men will be boys, but there have to be some limits.”
“I don’t know if I could do that,” Janet said. But as she took a sip from her coffee, she gave the idea some thought. The problem was that she’d always been so passive in her life, letting things happen, then reacting after the fact. Maybe that’s how she got herself into this kind of trouble. Maybe she needed to encourage herself to be more assertive.
“DAMN IT, MARCIE!” Louis Martin shouted. “Where the hell are those projections? I told you I wanted them on my desk.” To emphasize his displeasure, Louis slapped his hand on his leather-bound blotter, sending a flurry of papers wafting off into the air. He had been feeling irritable ever since he’d awakened at four-thirty that morning with a dull headache. While in the bathroom searching for aspirin, he’d vomited into the sink. The episode had shocked him. His retching had come with no warning and no accompanying nausea.
Marcie Delgado scurried into her boss’s office. He’d been yelling at her and criticizing her all morning. Meekly she reached across the desk and pushed a stack of papers bound with a metal clip directly in front of the man. In block letters on the front cover was: PROJECTIONS FOR BOARD MEETING FEBRUARY 26.
Without even an acknowledgment, much less an apology, Louis snatched up the documents and stormed out of the office. But he didn’t get far. After half a dozen steps, he couldn’t recall where he was going. When he finally remembered he was headed for the boardroom, he wasn’t sure which door it was.
“Good afternoon, Louis,” one of the directors said, coming up behind him and opening the door on the right.
Louis stepped into the room feeling disoriented. He hazarded a furtive glance at the people sitting around the long conference table. To his consternation, he was unable to recognize a single face. Lowering his eyes to stare at the packet of papers he’d carried in with him, he let them slip from his grasp. His hands were shaking.
Louis Martin stood for another moment while the babble of voices in the room quieted. All eyes were drawn to his face, which had turned ghostly pale. Then Louis’s eyes rolled up inside his head, and his back arched. He fell backward, his head striking the carpeted floor with a dull thump. Simultaneous with the impact on the floor, Louis’s body began to tremble before being overwhelmed by wild tonic and clonic muscular contractions.
None of Louis’s board of directors had ever seen a grand mal seizure, and for a moment they were all stunned. Finally, one man overcame his shock and rushed to the side of his stricken chairman. Only then did others respond by racing off to nearby telephones to call for help.
By the time the ambulance crew arrived, the seizure had passed. Except for a residual headache and lethargy, Louis felt relatively normal. He was no longer disoriented. In fact, he was dismayed t
o be told he’d had a seizure. As far as he was concerned, he’d only fainted.
The first person to see Louis in the emergency room at the Boston Memorial Hospital was a medical resident who introduced himself as George Carver. George seemed harried but thorough. After conducting a preliminary examination he told Louis that he would have to be admitted even though Louis’s private internist, Clarence Handlin, had not yet been consulted.
“Is a seizure serious?” Louis asked. After his prostate operation two months earlier, Louis was not happy about the prospect of being hospitalized.
“We’ll get a neurology consult,” George said.
“But what’s your opinion?” Louis asked.
“Seizures with sudden onset in an adult suggests structural brain disease,” George said.
“How about talking English,” Louis said. He hated medical jargon.
The resident fidgeted. “Structural means exactly that,” he said evasively. “Something abnormal with the brain itself, not just its function.”
“You mean like a brain tumor?” Louis asked.
“It could be a tumor,” George said reluctantly.
“Good Lord!” Louis said. He felt himself break out in a cold sweat.
After calming the patient the best he could, George went into the “pit,” as the center of the emergency room was called by those that worked there. First he checked to see if Louis’s private physician had called in yet. He hadn’t. Then he paged a neurology resident stat. He also told the ER clerk to call the medical student who was up for the next admission.
“By the way,” George said to the clerk as he was returning to the cubicle where Louis Martin was waiting. “What’s the name of the medical student?”
