by Robin Cook
“I still don’t understand why we don’t send him back to Boston,” Ms. Richmond said. “Then it’s over. Why take the risk of jeopardizing our relationship with Sushita?”
Sterling looked at Dr. Mason.
Dr. Mason cleared his throat. “From my perspective,” he said, “I don’t want to be rash. The kid is good at what he does. This morning I went down to where he’s working. He’s got a whole generation of mice accepting the glycoprotein. On top of that, he showed me some promising crystals that he’s been able to grow. He insists he’ll have better in a week. No one else has been able to get this far. My problem is I’m caught between a rock and a hard place. A more dire threat to our Sushita funding is the fact that we have yet to provide them with a single patentable product. They expected something by now.”
“In other words, you think we need this brat even with the risks,” Ms. Richmond said.
“That’s not the way I would phrase it,” Dr. Mason said.
“Then why don’t you call Sushita and explain it to them,” Ms. Richmond said.
“That would not be advisable,” Sterling said. “The Japanese prefer indirect communication so that confrontation can be avoided. They would not understand such a direct approach. Such a ploy would cause more anxiety than it would alleviate.”
“Besides, I already alluded to all this with Hiroshi,” Dr. Mason said. “And they still went ahead to investigate Mr. Murphy on their own.”
“The Japanese businessman has a great problem with uncertainty,” Sterling added.
“So what is your take on this kid?” Ms. Richmond asked. “Is he a spy? Is that why he’s here?”
“No,” Sterling said. “Not in any traditional sense. He’s obviously interested in your success with medulloblastoma, but it’s from an academic point of view, not a commercial one.”
“He was very open about his interests in the medulloblastoma work,” Dr. Mason said. “The first time I met him he was clearly disappointed when I informed him he would not be permitted to work on the project. If he’d been some kind of spy, I think he’d keep a lower profile. Rocking the boat only draws further scrutiny.”
“I agree,” Sterling said. “As a young man he’s still motivated by idealism and altruism. He has not yet been poisoned by the new commercialism of science in general and medical research in particular.”
“Yet he’s already started his own company,” Ms. Richmond pointed out. “That sounds pretty commercial to me.”
“But he and his partners were essentially selling their products at cost,” Sterling said. “The profit motive did not play a role until the company was bought out.”
“So what’s the solution?” Ms. Richmond asked.
“Sterling will monitor the situation,” Dr. Mason said. “He’ll keep us informed on a daily basis. He’ll protect Mr. Murphy from the Japanese as long as he is a help to us. If Sterling decides he is acting as a spy, he’ll let us know. Then we’ll send him back to Boston.”
“An expensive babysitter,” Ms. Richmond said.
Sterling smiled and nodded in agreement. “Miami in March is very agreeable,” he said. “Particularly at the Grand Bay Hotel.”
A short burst of static from Dr. Mason’s intercom preceded Patty’s voice: “Mr. Harris is here.”
Dr. Mason thanked Sterling, indicating the meeting was over. As he accompanied Sterling out of the office. Dr. Mason couldn’t help but agree with Ms. Richmond’s assessment: Sterling was an expensive babysitter. But Dr. Mason was convinced the money was well spent and, thanks to Howard Pace, readily available.
Harris was standing next to Patty’s desk, and for the sake of propriety, Dr. Mason introduced him to Sterling. As he did, he couldn’t help but feel each man was the other’s antithesis.
After sending Harris into his office. Dr. Mason thanked Sterling for all he’d done and implored him to keep them informed. Sterling assured him he would, and left. Dr. Mason then went back into his office to deal with the current crisis.
Dr. Mason closed the door behind him. He noticed Harris was standing stiffly in the center of the room; his patent leather visored hat with its gold trim was wedged under his left arm.
“Relax,” Dr. Mason said as he went around behind his desk and sat down.
“Yes, sir,” Harris said smartly. He didn’t move.
“For crissake, sit down!” Dr. Mason said when he noticed Harris was still standing.
Harris took a seat, his hat remaining beneath his arm.
“I suppose you’ve heard another breast cancer patient has died,” Dr. Mason said. “At least for all practical purposes.”
“Yes, sir,” Harris said crisply.
Dr. Mason eyed his head of security with mild irritation. On the one hand he appreciated the professionalism of Robert Harris; on the other hand the militaristic playacting bothered him. It wasn’t appropriate for a medical institution. But he’d never complained because until these breast cancer deaths, security had never been a problem.
“As we told you in the past,” Dr. Mason said, “we believe some misguided demented individual is doing this. It’s becoming intolerable. It has to be stopped.
“I’ve asked you to make this your number-one priority. Have you been able to turn anything up?”
“I assure you, this problem has my undivided attention,” Harris said. “Following your advice I’ve done extensive background checks on most all of the professional staff. I’ve checked references by calling hundreds of institutions. No discrepancies have turned up so far. I’ll now be expanding the checks to other personnel who have access to patients. We tried to monitor some of the breast cancer patients, but there are too many to keep tabs on all the time. Perhaps we should consider putting security cameras in all the rooms.” Harris did not mention his suspicion of the possible connection between these cases and the death of a nurse and the attempted assault of another. After all, it was only a hunch.
“Maybe cameras in every breast cancer patient’s room is what we have to do,” Ms. Richmond said.
“It would be expensive,” Harris warned. “Not only the cost of the cameras and the installation, but also the additional personnel to watch the monitors.”
“Expense might be an academic concern,” Ms. Richmond said. “If this problem continues and the press gets hold of it, we might not have an institution.”
“I’ll look into it,” Harris promised.
“If you need additional manpower, let us know,” Dr. Mason said. “This has to be stopped.”
“I understand, sir,” Harris said. But he didn’t want help. He wanted to do this on his own. At this point it had become a matter of honor. No screwball psychotic was going to get the best of him.
“And what about this attack last night at the residence?” Ms. Richmond asked. “I have a hard enough time recruiting nursing personnel. We can’t have them attacked in the temporary housing we offer them.”
“It is the first time security has been a problem at the residence,” Harris said.
“Maybe we need security people there during the evening hours,” Ms. Richmond suggested.
“I’d be happy to put together a cost analysis,” Harris said.
“I think the patient issue is more important,” Dr. Mason said. “Don’t dilute your efforts at the present time.”
“Yes, sir,” Harris said.
Dr. Mason looked at Ms. Richmond. “Anything else?”
Ms. Richmond shook her head.
Dr. Mason glanced back at Harris. “We’re counting on you,” he said.
“Yes, sir,” Harris said as he got to his feet. By reflex he started to salute, but he caught himself in time.
“VERY IMPRESSIVE!” Sean said aloud. He was sitting by himself in the glass-enclosed office in the middle of his expansive lab. He was at an empty metal desk, and he had the copies of the thirty-three charts spread out in front of him. He’d chosen the office in case someone suddenly appeared. If they did he’d have enough time to sweep the charts into
one of the empty file drawers. Then he’d pull over the ledger featuring the protocol he’d developed to immunize the mice with the Forbes glycoprotein.
What Sean found so impressive were the statistics concerning the medulloblastoma cases. The Forbes Cancer Center had indeed achieved a one hundred percent remission rate over the last two years, which contrasted sharply with the one hundred percent fatality rate over the eight years prior to that. Through follow-up MRI studies, even large tumors were shown to have completely disappeared after successful treatment. As far as Sean was concerned, such consistent results were unheard of in the treatment of cancer except for the situation of cancer in situ, meaning extremely small, localized neoplasia that could be completely excised or otherwise eliminated.
For the first time since he’d arrived, Sean had had a reasonable morning. No one had bothered him; he hadn’t seen Hiroshi or any of the other researchers. He’d started the day by injecting more of the mice which had given him a chance to get the copies of the charts up to his office. Then he’d toyed with the crystallization problem, growing a few crystals that he thought would keep Dr. Mason content for a week or so. He’d even had the director come down to see some of the crystals. Sean knew he’d been impressed. At that point, reasonably confident he wouldn’t be disturbed, Sean had retired into the glass office to review the charts.
First he’d read through all the charts to gain an overall impression. Then he’d gone back, checking on epidemiological aspects. He’d noted that the patients represented a wide range of ages and races. They were also of varying sex. But the predominant group consisted of middle-aged white males, not the typical group seen with medulloblastoma. Sean guessed that the statistics were skewed due to economic considerations. The Forbes was not a cheap hospital. People needed adequate medical insurance or sizable savings accounts to be patients there. He also noted that the cases came from various major cities around the country in a truly national distribution.
But then, as if to show how dangerous generalizations were, he discovered a case from a small southwestern Florida town: Naples, Florida. Sean had seen the town on a map. It was the southernmost town on the west coast of Florida, just north of the Everglades. The patient’s name was Malcolm Betencourt, and he was nearing two years since the commencement of his treatment. Sean noted the man’s address and phone number. He thought he might want to talk with him.
As for the tumors themselves, Sean noted that most were multifocal rather than being a single lesion, which was more common. Since they were multifocal, the attending physicians in most cases had initially believed they were dealing with a metastatic tumor, one that had spread to the brain from some other organ like lung, kidney, or colon. In all these cases, the referring physicians had expressed surprise when the lesions turned out to be primary brain tumors arising from primitive neural elements. Sean also noted that the tumors were particularly aggressive and fast-growing. They would have undoubtedly led to rapid death had not therapy been instituted.
Concerning therapy, Sean noted that it did not vary. The dosage and rate of administration of the coded medication was the same for all patients although it was adjusted for weight. All patients had experienced about a week of hospitalization and after discharge were followed in the outpatient clinic at intervals of two weeks, four weeks, two months, six months, then annually. Thirteen of the thirty-three patients had reached the annual-visit stage. Sequelae from the illness were minimal and were associated with mild neurological deficits secondary to the expanding tumor masses prior to treatment rather than to the treatment itself.
Sean was also impressed with the charts themselves. He knew he was looking at a wealth of material that would probably take him a week to digest.
Concentrating as deeply as he was, Sean was startled when the phone on his desk began to ring. It was the first time it had ever rung. He picked it up, expecting a wrong number. To his surprise, it was Janet.
“I have the medicine,” she said tersely.
“Great!” Sean said.
“Can you meet me in the cafeteria?” she asked.
“Absolutely,” Sean said. He could tell something was wrong. Her voice sounded strained. “What’s the matter?”
“Everything,” Janet said. “I’ll tell you when I see you. Can you leave now?”
“I’ll be there in five minutes,” Sean said.
After hiding all the charts, Sean descended in the elevator and crossed over the pedestrian bridge to the hospital. He guessed he was being observed by camera and felt like waving to indicate as much, but resisted the temptation.
When he arrived in the cafeteria Janet was already there, sitting at a table with a cup of coffee in front of her. She didn’t look happy.
Sean slid into a chair across from her.
“What’s wrong?” he asked.
“One of my patients is in a coma,” Janet said. “I’d just started an IV on her. One minute she was fine, the next minute not breathing.”
“I’m sorry to hear that,” Sean said. He’d had some exposure to the emotional traumas of hospital life, so he could empathize to an extent.
“At least I got the medicine,” she said.
“Was it difficult?” Sean asked.
“Emotionally more than anything else,” Janet said.
“So where is it?”
“In my purse,” she said. She glanced around to make sure no one was watching them. “I’ll give the vials to you under the table.”
“You don’t have to make this so melodramatic,” Sean said. “Sneaking around draws more attention than just acting normal and handing them over.”
“Humor me,” Janet said. She fumbled with her purse.
Sean felt her hand hit his knee. He reached under the table and two vials dropped into his hand. Respecting Janet’s sensitivity he slipped them into his pockets, one on each side. Then he scraped back his chair and stood up.
“Sean!” Janet complained.
“What?” he asked.
“Do you have to be so obvious? Can’t you wait five minutes like we’re having a conversation?”
He sat down. “People aren’t watching us,” he said. “When are you going to learn?”
“How can you be so sure?” she asked.
Sean started to say something, then thought better of it.
“Can we talk about something fun for a change?” Janet asked. “I’m completely stressed out.”
“What do you want to talk about?”
“What we can do come Sunday,” Janet said. “I need to get away from the hospital and all this tension. I want to do something relaxing and fun.”
“Okay, it’s a date,” Sean promised. “Meanwhile, I’m eager to get back to the lab with this medicine. Would it be so obvious if I were to leave now?”
“Go!” Janet commanded. “You’re impossible.”
“See you back at the beach apartment,” Sean said. He moved away quickly lest Janet say something about his not being invited. He looked back and waved as he left the cafeteria.
Hurrying over the bridge between the two buildings, he thrust his hands into his pockets and palmed the two vials. He couldn’t wait to get started. Thanks to Janet, he felt some of the investigative excitement he’d expected when he’d made the decision to come to the Forbes Cancer Center.
ROBERT HARRIS carried the cardboard box of employee files into his small windowless office and set them on the floor next to his desk. Sitting down, he opened the top of the box and pulled out the first file.
After the conversation with Dr. Mason and Ms. Richmond, Harris had gone directly to personnel. With the help of Henry Falworth, the personnel manager, he’d compiled a list of non-professionals who had access to patients. The list included food service personnel who distributed menus and took orders and those who delivered meals and picked up the trays. The list also included the janitorial and maintenance staffs who were occasionally called to patient rooms for odd jobs. Finally, the list ran to housekeeping: those who clean
ed the rooms, the halls, and the lounges of the hospital.
All in all, the number of people on the list was formidable. Unfortunately he had no other ideas to pursue save for the camera surveillance, and he knew such an operation would prove too costly. He would investigate prices and put together a proposal, but he knew Dr. Mason would find the price unacceptable.
Harris’s plan was to go through the fifty or so files rather quickly to see if anything caught his attention, anything that might seem unlikely or strange. If he found something that was questionable, he’d put the file in a group to investigate first. Harris wasn’t a psychologist any more than he was a doctor, but he thought that whoever was crazy enough to be killing patients would have to have something weird on his record.
The first file belonged to Ramon Concepcion, a food service employee. Concepcion was a thirty-five-year-old man of Cuban extraction who’d worked a number of food service jobs in hotels and restaurants since he was sixteen. Harris read through his employment application and looked at the references. He even glanced at his health care utilization. Nothing jumped out at him. He tossed the file on the floor.
One by one, Harris worked through the box of files. Nothing caught his eye until he came to Gary Wanamaker, another food service employee. Under the heading experience Gary had listed five years’ work in the kitchen at Rikers Island Prison in New York. In the employment photo the man had brown hair. Harris put that file on the corner of his desk.
It was only five files later that Harris came across another file that caught his eye. Tom Widdicomb worked in housekeeping. What got Harris’s attention was the fact that the man had trained as an emergency medical technician. Even though he’d had a series of housekeeping jobs subsequent to his EMT training, including a stint at Miami General Hospital, the thought of a guy with emergency medical training working housekeeping seemed odd. Harris looked at the employment photo. The man had brown hair. Harris put Widdicomb’s file on top of Wanamaker’s.
A few files later, Harris came across another file that tweaked his curiosity. Ralph Seaver worked for the maintenance department. This man had served time for rape in Indiana. There it was right in the file! Included was even a phone number of the man’s former probation officer in Indiana. Harris shook his head. He’d not expected to find such fertile material. The professional staff files had been boring in comparison. Except for a few substance abuse problems and one child molestation allegation, he’d not found anything. But with this group, he’d only gone through a quarter of the files and had already yanked three that he thought deserved a closer look.
