by Robin Cook
Sean checked his watch. The agreement had been that he’d meet Janet at twelve-thirty. It was already twelve-thirty-five, and although a steady stream of hospital personnel continued to pour by, Janet had yet to appear. Sean began to fantasize about going down to the parking lot, getting into his Isuzu, and hitting the road. But then Janet came through the door, and just seeing her lightened his mood.
Although Janet was still pale by Florida standards, her few days in Miami had already given a distinctively rosy cast to her skin. Sean thought she’d never looked better. As he admiringly watched her sensuous movements as she weaved through the tables, he hoped that he’d be able to talk her out of whatever it was that was keeping her in her own apartment and out of his.
She took the seat across from him, barely saying hello. Under her arm she clutched an unfolded Miami newspaper. He could tell she was nervous, the way she continually scanned the room like some wary, vulnerable bird.
“Janet, we’re not in some spy movie,” Sean said. “Calm down!”
“But I feel like I am,” Janet said. “I’ve been sneaking around, going behind people’s backs, trying not to arouse suspicion. But I feel like everyone knows what I’m doing.”
Sean rolled his eyes. “What an amateur I have for an accomplice,” he joked. Then, more seriously, he added, “I don’t know whether this is going to work if you’re stressed out now, Janet. This is only the beginning. You haven’t even done anything yet compared to what’s coming. But, to tell you the truth, I’m jealous. At least you’re doing something. I, on the other hand, have spent a good part of the morning in the bowels of the earth injecting mice with the Forbes protein plus Freund’s adjuvant. There’s been no intrigue and certainly no excitement. This place is still driving me nuts.”
“What about your crystals?” Janet asked.
“I’m deliberately slowing down on that,” Sean said. “I was doing too well. I won’t let them know how far I’ve gotten. That way, when I need some time for some investigative work, I’ll take it and still be able to have results to show as a cover. So how’d you do?”
“Not great,” Janet admitted. “But I made a start. I copied one chart.”
“Just one?” Sean questioned with obvious disappointment. “You’re this nervous about one chart?”
“Don’t give me a hard time,” Janet warned. “This isn’t easy for me.”
“And I’d never say I told you so,” Sean quipped. “Never. Not me. That’s not my style.”
“Oh, shut up,” Janet said as she handed the newspaper to Sean under the table. “I’m doing the best I can.”
Sean lifted the newspaper and placed it on top of the table. He spread it out and opened it, exposing the copied pages which he immediately removed. He pushed the newspaper aside.
“Sean!” Janet gasped, as she furtively scanned the crowded room. “Can’t you be a little more subtle?”
“I’m tired of being subtle,” he said. He started going through the chart.
“Even for my benefit?” Janet asked. “There might be some people from my floor here. They might have seen me give these copies to you.”
“You give people too much credit,” Sean said distractedly. “People aren’t as observant as you might think.” Then, referring to the copies Janet had brought, he said, “Louis Martin’s chart is nothing but referral material from the Memorial. This history and physical is mine. That lazy ass on neurology just copied my workup.”
“How can you tell?” Janet asked.
“The wording,” Sean said. “Listen to this: the patient ‘suffered through’ a prostatectomy three months ago. I use expressions like ‘suffered through’ just to see who reads my workups and who doesn’t. It’s a little game I play with myself. No one else uses that kind of phraseology in a medical workup. You’re supposed to just give facts, not judgments.”
“Imitation is the highest form of flattery, so I guess you should be flattered,” Janet said.
“The only thing of interest here is in the orders,” Sean said. “He’s being given two coded drugs: MB300M and MB305M.”
“That code is comparable to the one I saw in Helen Cabot’s computer file,” Janet said. She handed him the paper on which she’d written the treatment information she’d gotten from the computer.
Sean glanced at the dosage and the administration rate.
“What do you think it is?” Janet asked.
“No idea,” Sean said. “Did you get any of it?”
“Not yet,” Janet admitted. “But I finally located the supply. It’s kept in a special locker, and the shift supervisor has the only key.”
“This is interesting,” Sean said, still studying the chart. “From the date and time of the order they started treatment as soon as he got here.”
“Same with Helen Cabot.” Janet said. She told him what Marjorie had explained to her, namely that they started the humoral aspect of the treatment immediately whereas the cellular aspect didn’t begin until after the biopsy and T-cell harvesting.
“Starting treatment so soon seems odd,” Sean said. “Unless these drugs are merely lymphokines or some other general immunologic stimulant. It can’t be some new drug, like a new type of chemo agent.”
“Why not?” Janet asked.
“Because the FDA would have had to approve it,” Sean said. “It has to be a drug that’s already been approved. How come you only got Louis Martin’s chart? What about Helen Cabot’s?”
“I was lucky to get Martin’s,” Janet said. “Cabot is getting pheresed as we speak, and the other young woman, Kathleen Sharenburg, is being biopsied. Martin was a ‘to follow’ for his biopsy so his chart was available.”
“So these people are on the second floor right now?” Sean asked. “Right above us?”
“I believe so,” Janet said.
“Maybe I’ll skip lunch and take a walk up there,” Sean said. “With all the usual commotion in most diagnostic and treatment areas, the charts are usually just kicking around. I could probably get a look at them.”
“Better you than me,” Janet said. “I’m sure you’re better at this than I.”
“I’m not taking over your job,” Sean said. “I’ll still want copies of the other two charts as well as daily updates. Plus I want a list of all the patients they’ve treated to date who have had medulloblastoma. I’m particularly interested in their outcomes. Plus I want samples of the coded medicine. That should be your priority. I have to have that medicine; the sooner the better.”
“I’ll do my best,” Janet said. Knowing how much trouble it had been merely to copy Martin’s chart, she had misgivings about getting everything Sean wanted with the kind of speed he was implying. Not that she was about to voice those concerns to Sean. She was afraid he’d give up and leave for Boston.
Sean stood up. He gripped Janet’s shoulder. “I know this isn’t easy for you,” he said. “But remember, it was your idea.”
Janet put a hand on Sean’s. “We can do it,” she said.
“I’ll see you at the Cow Palace,” he said. “I suppose you’ll be there around four. I’ll try to get back about the same time.”
“See you then,” Janet said.
Sean left the cafeteria and used the stairs to get to the second floor. He emerged at the south end of the building. The second floor was a center of activity and as bustling as he’d expected. All the radiation therapy as well as diagnostic radiology was done there; so was all the surgery and any treatment that could not be done at the bedside.
With all the confusion Sean had to squeeze between gurneys carrying people to and from their procedures. A number of the gurneys with their human passengers were parked along the walls. Other patients sat on benches dressed in hospital robes.
Sean excused himself and pushed through the tumult, bumping into hospital personnel as well as ambulatory patients. With a modicum of difficulty he proceeded down the central corridor, checking each door as he went. Radiology and chemistry were on the left, treatment r
ooms, ICU, and the surgical suites were on the right. Knowing that the pheresis was a long procedure and not labor-intensive, Sean decided to try to find Helen Cabot. Besides looking at her chart, he wanted to say hello.
Spotting a hematology technician sporting rubber tourniquets attached to her belt loops, Sean asked her where pheresis was done. The woman guided Sean through a side corridor and pointed toward two rooms. Sean thanked her and checked the first. A male patient was on the gurney. Sean closed the door and opened the other. Even from the threshold he recognized the patient: it was Helen Cabot.
She was the only one there. Outflow and inflow lines were attached to her left arm as her blood was being passed through a machine that separated the elements, isolating the lymphocytes and returning the rest of the blood to her body.
Helen turned her bandaged head in Sean’s direction. She recognized him immediately and tried to smile. Instead, tears formed in her large green eyes.
From her color and general appearance Sean could see that her condition had dramatically worsened. The seizures she’d been suffering had been taking a heavy toll.
“It’s good to see you,” Sean said as he bent down to bring his face close to hers. He resisted an urge to hold and comfort her. “How are you doing?”
“It’s been difficult,” Helen managed to say. “I had another biopsy yesterday. It wasn’t fun. They also warned me I might get worse when they started the treatment, and I have. They told me I was not to lose faith. But it’s been hard. My headaches have been unbearable. It even hurts to talk.”
“You have to hold on,” Sean said. “Keep remembering that they have put every medulloblastoma patient into remission.”
“That’s what I keep reminding myself,” Helen said.
“I’ll try to come to see you every day,” Sean said. “Meanwhile, where’s your chart?”
“I think it’s out in the waiting room,” Helen said, pointing with her free hand toward a second door.
Sean gave her a warm smile. He squeezed her shoulder, then stepped into the small waiting room that connected to the corridor. On a counter was what he was searching for: Helen’s chart.
Sean picked it up and flipped to the order sheets. Drugs similar to those he’d seen in Martin’s chart were duly noted: MB300C and MB303C. He then turned to the beginning of the chart and saw a copy of his own workup which had been sent as part of the referral package.
Flipping the pages quickly, Sean came to the progress note section, and he read the entry for the biopsy that had been taken the day before, indicating they had gone in over the right ear. The note went on to say that the patient had tolerated the procedure well.
Sean had just begun to scan for the laboratory section to see if a frozen section had been done when he was interrupted. The door to the hallway crashed open and slammed against the wall with such force that the doorknob dented the plaster.
The sudden crash startled Sean. He dropped the chart onto the plastic laminate countertop. In front of him and filling the entire doorway was the formidable figure of Margaret Richmond. Sean recognized her immediately as the nursing director who’d burst into Dr. Mason’s office. Apparently the woman made a habit of such dramatic entries.
“What are you doing in here?” she demanded. “And what are you doing with that chart?” Her broad, round face was distorted with outrage.
Sean toyed with the idea of giving her a flip answer, but he thought better of it.
“I’m looking in on a friend,” Sean said. “Miss Cabot was a patient of mine in Boston.”
“You have no right to her chart,” Ms. Richmond blustered. “Patients’ charts are confidential documents, available only to the patient and his doctors. We view our responsibility in this regard very seriously.”
“I’m confident the patient would be willing to give me access,” Sean said. “Perhaps we should step into the next room and ask her.”
“You are not here as a clinical fellow,” Ms. Richmond shouted, ignoring Sean’s suggestion. “You are here in a research capacity only. Your arrogance in thinking that you have a right to invade this hospital is inexcusable.”
Sean saw a familiar face appear over Ms. Richmond’s intimidating shoulder. It was the puffy, smug countenance of the frustrated Marine, Robert Harris. Sean suddenly guessed what had happened. Undoubtedly he’d been picked up by one of the surveillance cameras, probably one in the second-floor corridor. Harris had called Richmond and then had come over to watch the slaughter.
Knowing that Robert Harris was involved, Sean could no longer resist the urge to lash back, particularly since Ms. Richmond wasn’t responding to his attempts to be reasonable.
“Since you people aren’t in the mood to discuss this like adults,” Sean said, “I think I’ll wander back to the research building.”
“Your impertinence only makes matters worse,” Ms. Richmond sputtered. “You’re trespassing, invading privacy, and showing no remorse. I’m surprised the governors of Harvard University would let someone like you into their institution.”
“I’ll let you in on a secret,” Sean said. “They weren’t all that impressed with my manners. They liked my facility with a puck. Now, I’d really like to stay and chat with you people, but I’ve got to get back to my murine friends who, by the way, have more pleasant personalities than most of the staff here at Forbes.”
Sean watched as Ms. Richmond’s face empurpled. This was just one more of a series of ridiculous episodes that had him fed up. Consequently he derived perverse pleasure out of goading and angering this woman who could easily have played linebacker for the Miami Dolphins.
“Get out of here before I call the police,” Ms. Richmond yelled.
Sean thought that calling the police would be interesting. He could just imagine some poor uniformed rookie trying to figure out how to categorize Sean’s offense. Sean could see it in the paper: Harvard extern actually looks into his patient’s chart!
Sean stepped forward, literally eye to eye with Ms. Richmond. He smiled, pouring on his old charm. “I know you’ll miss me,” he said, “but I really must go.”
Born Ms. Richmond and Harris followed him all the way to the pedestrian bridge that spanned the gulf between the hospital and the research building. The whole time they maintained a loud dialogue about the degeneracy of current-day youth. Sean had the feeling he was being run out of town.
As Sean walked across the bridge he recognized how much he would have to depend on Janet for clinical material pertaining to the medulloblastoma study, provided, of course, he stayed.
Returning to his fifth-floor lab, Sean tried to lose himself in his work to repress the anger and frustration he felt toward the ridiculous situation he found himself in. Like the empty room upstairs, Helen’s chart didn’t have anything in it to get upset about. But as he cooled down, Sean was able to acknowledge that Ms. Richmond did have a point. As much as he hated to admit it, the Forbes was a private hospital. It wasn’t a teaching hospital like the Boston Memorial, where teaching and patient care went hand in hand. Here, Helen’s chart was confidential. Yet even if it was, Ms. Richmond’s fury was hardly appropriate for his infraction.
In spite of himself, within an hour Sean became engrossed in his crystal-growing attempts. Then, as he held a flask up against the overhead light, he caught a bit of movement out of the corner of his eye. It was a rerun of the incident on his first day. Once again the movement had come from the direction of the stairwell.
Without so much as looking in the direction of the stairwell, Sean calmly got off his stool and walked into the storeroom as if he needed some supplies. Since the storeroom was connected to the central corridor, Sean was able to dash the length of the building to the stairwell opposite the one where he’d seen the movement.
Racing down a flight, he ran the length of the fourth floor to enter the opposite stairwell. Moving as silently as possible, he climbed the stairs until the fifth-floor landing came into view. As he’d suspected, Hiroshi was there furtiv
ely looking through the glass of the door, obviously baffled as to why Sean had not returned from the storeroom.
Sean tiptoed up the remaining stairs until he was standing directly behind Hiroshi. Then he screamed as loud as he was able. Within the confines of the stairwell, Sean was impressed with the amount of noise he was capable of generating.
Having seen a few Chuck Norris martial arts movies, Sean had been a little concerned that Hiroshi might turn into a karate demon by reflex. But instead Hiroshi practically collapsed. Conveniently he’d had one hand on the door handle. It was that support which kept him standing.
When Hiroshi recovered enough to comprehend what had happened, he stepped away from the door and started to mumble an explanation. But he was backing up at the same time, and when his foot hit the riser of the first stair, he turned and fled up, disappearing from view.
Disgusted, Sean followed, not to pursue Hiroshi, but rather to seek out Deborah Levy. Sean had had enough of Hiroshi’s spying. He thought Dr. Levy would be the best person to discuss the matter with since she ran the lab.
Going directly to the seventh floor, Sean walked down to Dr. Levy’s office. The door was ajar. He looked in. The office was empty.
The pool secretaries did not have any idea of her whereabouts but suggested Sean have her paged. Instead, Sean went down to the sixth floor and sought out Mark Halpern, who was dressed as nattily as ever in his spotless white apron. Sean guessed he washed and ironed the apron every day.
“I’m looking for Dr. Levy,” Sean said irritably.
“She’s not here today,” Mark said. “Is there something I can help you with?”
“Will she be here later?” Sean asked.
“Not today,” Mark said. “She had to go to Atlanta. She travels a lot for work.”
“When will she be back?”
“I’m not sure,” Mark said. “Probably tomorrow late. She said something about going to our Key West facility on her way back.”
“Does she spend much time there?” Sean asked.
