Extreme Measures

by Michael Palmer

  They showered and then shared juice and coffee on the balcony, neither anxious to break the mood by speaking of the day just past.

  Finally Laura stood and leaned against the railing, gazing across the rooftops at Cambridge.

  "Do you have a plan for the day?" Eric asked.

  "Not really. I think it's worth going to the police and at least seeing what they're willing to do about Donald Devine."

  "I agree. But after yesterday morning I'm not sure I like the idea of your wandering around the city alone.

  I'm off tomorrow if you can wait."

  "I'll see."

  "At least wait until noon. I'll call before then."

  The phone began ringing. Eric hesitated, not anxious to deal with Caduceus again. Finally he pulled himself up and reentered the apartment. A minute later he was back.

  "I've got to go," he said. "Something's happened at the hospital-something pretty bad. Reed Marshall's resigned."

  "Resigned?"

  "That was my boss, Joe Silver. Apparently, Reed pronounced a woman dead and sent her to the hospital morgue. Late yesterday, they autopsied her and found her heart was still beating."

  "No! Is that possible?"

  "I really can't imagine it, but according to Silver, it happened.

  We kid about such things all the time, and there are always stories, but this is the first time I've heard of its actually happening to anybody I know.

  Just the notion of it gives me a sick feeling in my gut.

  Reed called in this morning and quit. It sounds like he's in a pretty bad way."

  Laura followed him into the apartment and sat on the side of the bed as he dressed.

  "Eric, how can that be? How could a doctor with all that equipment make such a mistake?"

  "I don't know. As I've told you, Reed's about as good as there is."

  "Will you call and let me know what happened?"

  "I'll call," he said. "But I'm not sure we'll ever know what happened."

  From the moment the doors of a hospital open for the first time and the first patient is treated, the facility acquires a pulse and begins to develop a personality as unique asany individual's. It fumbles and grows, learning from its mistakes. It stretches and explores, reaching out more and more to the world around it.

  Its organs decay and need repair or replacement. Its moods-the collective moods of its patients and employees-grow more distinctive.

  Within minutes of arriving at the emergency room that morning, Eric could feel the uneasiness pervading White Memorial. It was the reflection of a great hospital confronting its own fallibility.

  The autopsy of Loretta Leone had taken place late the, previous afternoon. The hospital grapevine, while by no means always accurate, was as swift as any communications system yet devised. Within hours everyone at every level in the institution had a version of the tragedy.

  Joe Silver, looking even more frazzled than usual, met Eric at the triage desk.

  "I just got a call from the goddam Herald," he said. "This sucks. It really does."

  They walked back to Eric's office, where the E.R. chief told him what he knew.

  "Marshall blew it," Silver concluded. "He just blew it."

  "Nonsense. I refuse to believe that," Eric said.

  "Reed's damn good at what we do, and you know it."

  Anger prickled at the base of his neck and then began to burn.

  "Joe, it doesn't seem to me that you're showing a hell of a lot of loyalty to someone who's worked so hard for you for five years. The least you can do is give him the benefit of the doubt until you know the full story."

  Silver glared at him.

  "Benefit of the doubt? A medical examiner named Corcoran wants to have my department nailed to the wall, some asshole from the Herald is bringing up that Worrell business again and calling me and my staff incompetent, a woman got pronounced dead who wasn't, and you're calling me disloyal? You've got some goddam nerve, Nan." His sallow complexion was nearly scarlet. "You just get out there and do your job and keep your mouth shut to any reporters," he spat.

  "No wonder people don't want you in a position of authority around here.

  You're just too damn arrogant.

  Marshall was overtired from working too many shifts in a row. If you had been on duty yesterday the way you were supposed to be, this would never have happened."

  "Now just one minute," Eric started to say.

  But Silver had already stalked from the office.

  Eric sank to his chair, nearly as furious with himself for not holding his feelings in check as he was with Silver. But what he had said to Silver was true.

  Reed had his weaknesses, but he was a hell of a doctor.

  In all likelyhood, whatever happened to him could have happened to any of them. Eric snatched up the phone and dialed Reed's home. On the tenth ring Carolyn Marshall answered.

  "I'm sorry, Eric," she said. "Reed's in bed. He's not talking to anyone."

  "Just tell him it's me and see if he'll speak with me for a minute."

  She set the receiver down. In the background Eric could hear a baby crying. He glanced down the corridor at the triage area. The faces of the E.R. staff looked gray and drawn. Not one of them, he guessed, wanted to be at work that day.

  "Hey, whaddaya say, pal?"

  Marshall's speech was thick and awkward.

  "Reed, have you been drinking?"

  "Not since I threw up that blood a few hours ago, I haven't.

  Besides, Valium's so much mellower."

  "Jesus- Reed, You've got to stop that shit."

  "why? I'm still conscious."

  "Can you tell me what happened?"

  "I fucked up. That's what happened."

  "We all fuck up, all the time," Eric said. "That's the nature of this job, and you know it as well, as I do.

  If we had all night to sit and debate and hold court, we could do the right thing every time. But the people we deal with are sick, and we have to make decisions.

  That's just the way things are."

  "Well said, mr. amigo. Well said."

  "Dammit, Reed, I mean it. Now please, just tell me what happened."

  "The woman had a rhythm and I ignored it. I fucked up. it's as simple as that."

  Eric felt a sudden tightness in this throat.

  "What kind of a rhythm?" he asked.

  "Eight, ten beats a minute. Broad complexes.

  Looked useless at the time. But I guess they were enough to generate a contraction, 'cause that's what the M. E. said was happening'. Now, if that isn't fucking up, I don't know-"

  "Re did you stick the tracings in her chart?"

  Eric's pulse was beginning to race.

  "Course I did. Mr. Thorough, that's me."

  "well, listen. Get rid of that goddam Valium and don't give up on yourself, okay?"

  "Whatever you say, Doc. Well, thanks for callin'.

  See you around, ol' buddy."

  "Reed, put Carolyn on for a minute, will you?"

  Eric heard him fumble with the phone and then knock something over.

  Moments later his wife came on.

  "Listen," Eric said, "Reed's got Valium someplace.

  "He does?"

  "Find it and throw it out, okay?"

  "O-okay. Eric, do you understand what happened?"

  "Nothing that should have caused all this trouble.

  Carolyn, we pronounce people like this woman all the time-believe me we do. I've done it plenty."

  The admission brought a sudden chill. All Eric could think about was the need to review Loretta Leone's chart.

  "You're not just saying that, are you?" Carolyn asked.

  "No way. Joe Silver nearly fired me just now for sticking up for Reed.

  I meant what I said to him and I'm not lying to you."

  "Thank you," she said. "Will you keep in touch?"

  "Of course I will. But for now, just get all the booze and tranquilizers out of the house. Reed once mentioned he was
seeing a therapist. Is he still?"

  "Why, yes. Yes, he is."

  "Well, call him. I think Reed might need to be hospitalized. At least let his doctor decide."

  By the time Eric hung up, he was damp with sweat.

  It took nearly half an hour to track down Loretta Leone's hospital record. It was in Joe Silver's office, but at first the E.R. chief refused to allow him to see it. Eric persisted. Finally the man relented, extracting the promise that it would go no further than Eric's office-and be-discussed with no one. unable to wait, Eric flipped open the chart in the hallway. From what he remembered, the E.K.G complexes were identical to those of the derelict he had pronounced dead. Not similar-identical. He spent an hour getting through the mounting backlog of patients, and then sent to the record room for the derelict's chart. He was right. The man's cardiogram and Loretta Leone's were interchangeable.

  Was the man who might have been Laura's brother still alive when his monitor was shut off.

  Given what evidence he had, Eric knew there was little reason to believe otherwise. The prospect sickened him. Trying desperately to make sense of things, he wandered from the triage area to the deserted residents' lounge and dropped into a battered easy chair.

  Could the similarity between the tracings be Coincidence?

  Once, in medical school, when confronted with a confusing set of findings in a patient, he had suggested to a favorite professor that the explanation might be coincidence. The woman patiently allowed him to braid his own noose before turning to the class.

  "Your cohort Mr. Najarian has chosen coincidence as his solution to this problem," she said. "I suggest to you all that while coincidence might from time to time exist in diagnostic medicine, the concept is in the main God's way of placating the intellectually lazy.

  Eric managed a thin smile at the memory. Never since that day-had he accepted coincidence as an explanation for anything without one hell of a fight.

  He took the two charts to his office and locked them in his desk.

  As soon as he could break from the E.R he would head for the library to begin the process of becoming an expert on metabolic poisons and deathlike states.

  Somewhere there existed an explanation for the findings in the derelict and Loretta Leone- And until there was not a source left in Boston he hadn't tapped, Eric vowed that there was no way he would settle for anything even remotely like coincidence.

  Soon after Eric had left for the hospital, Laura floated back to sleep.

  She awoke after nine, bewildered and confused to find herself not in her cabana on Little Cayman. Across the room, Verdi was scuffing about beneath his cage cover.

  Laura set the cover aside and spent a fruitless five minutes endeavoring to coax the bird into a t'good e bed, morning." Finally, she sat on the edge of the bed, trying to map out some sort of plan for the day ahead.

  For the first time since leaving the island she felt restless and ill at ease.

  Gradually she began to see that meeting Ericgrowing to care for him and to have him care for her seemed somehow to have blunted her sense of urgency in finding Scott.

  Was her commitment that fragile? it frightened and angered her to think that it might not be fear for her brother that had been driving her so, but fear of losing the only real connection she had kept to life beyond the island.

  Had her life grown that thin?

  She got dressed and walked downtown to the Carisle- the day was cloudless and a little overcast begging for the relief that rain would bring. Several times during her walk she tried without success to spot anyone following her.

  Just the notion that somone might constantly be watching was sickening.

  The Iranian desk clerk had no new messages.

  Laura went up to her room, turned on some talk show, and lay down.

  Almost immediately she could feel herself begin to drift off again.

  The search for Scott was so much easier with Eric along to help, she reasoned. She could catch up on some sleep, do some shopping, and wait.until tomorrow to see the police.

  The thought of another encounter with another bored, condescending officer was not at all appealing. Besides, there was little chance of their helping anyway.

  Her eyes closed. and it is our belief as antivivisectionisis," one of the program's guests was saying, "that the medical researchers and animal providers have a lobby going in Washington that is as strong and well-funded as any special interest group…

  Laura- forced her eyes open, pushed herself up, and stared at the screen. The speaker droned on, castigating the loss of perspective in the medical world.

  "First mice and hamsters, then dogs, then primates, then so-called volunteer prisoners," she was saying. "And where do you suppose all this is heading?

  Laura snatched up the phone, dialed Information, and got the number of the anatomy department at the medical school. She was connected with a man named Bishoff, the administrator of the department.

  "Mr. Bishoff, thanks for speaking with me," Laura said. "My name is Laura Scott. I'm doing some research for a novel, and I need some information on how med-school anatomy departments acquire the bodies they use for students to dissect."

  "You a mystery writer?" The man sounded intrigued.

  "That's right."

  "Published?"

  "No, not yet."

  "Oh." Laura could sense the man's interest begin to wane.

  "But I'm under contract," she said eagerly.

  "Well, then, in that case congratulations are in order. Your first sold novel. You know, I've been planmng, a book myself. A medical mystery.

  I haven't quite gotten to the actual writing yet, but I do have a title:

  Take Two Aspirins and Call Me in the Morgue.

  Catchy, don't you think?"

  Laura wished she had decided on some other ploy. "It… has potential," she said.

  "Glad you think so. Now then, author to author, what do you want to know?"

  "well, Mr. Bishoff, where do you get your bodies?"

  "Why, they're donated."

  "By whom?"

  "By the only person authorized to do so-the deceased."

  "Pe-People sign their bodies over in their wills?"

  "That's right. They are required to notify us of their desire when they are sound of mind, and to sign a notarized form in triplicate. A copy goes to their records, a copy goes to us, and a copy goes on their will."

  "Do the police ever supply you with bodies?"

  "Never."

  "And you get enough that way?"

  "More than enough, actually. We keep them on ice. Say, wouldn't it be great to have a big chase scene that ends up in a body freezer?"

  "It would be, Mr. Bishoff, been done already." but I think it may have "Oh, "Tell me," she said, "do you Pay for them?"

  "The bodies? Hell no. Only burial fees if the family Wants to use the county's boot hill up on the North Shore."

  "You never pay for a body?"

  "Absolutely not. We can't make budget as it is.

  Does that wreck your plot?"

  "It may."

  "In that case, I'm sorry."

  "One last time, just so I can be sure: There is no way someone can profit from selling bodies to medical schools?"

  "Absolutely none."

  "Thank you, Mr. Bishoff. You've been very helpfull."

  "My pleasure. Now I have one question for you.

  "Yes?"

  "Do you think I should get an agent before or after I write my book?"

  Laura smiled. "I think after might be better, Mr. Bishoff," she said.

  She hung up and then dialed the number of the medical examiner Thaddeus Bushnell. A recording told her that the line was out of order.

  Ten minutes later she was in a cab headed toward his lower Beacon Hill town house, hoping that in midday she Might find him a bit more sober and easier to talk to.

  At the Turn onto Bushnell's street, she spotted the wooden barriers on the sidewalk in front of his pl
ace.

  The building itself was gutted-a burned-out shell.

  The stench of smoke and charred wood hung heavy in the air.

  She asked the cabbie to wait and walked to the barriers. A uniformed fire inspector was standing beside what remained of the front doorway.

  "What happened?" she asked.

  The man stared at her.

  "The house burned down," he said, his tone asking: What do you think happened?

  "What about Dr. Bushnell?"

  Laura sensed ominously that she needn't have bothered asking the question.

  "You a friend?"

  "I… I knew him."

  The man softened. "I'm sorry," he said. "The old guy never made it out."

  "I knew he would do this to himself," Laura said.

  "Pardon?"

  "Dr. Bushnell. I saw him the other night, and he was drinking too much and smoking. I was frightened that something like this might happen to him."

  The inspector looked back at the house, and then at Laura.

  "You a reporter?" he asked.

  "No, why?"

  "Who are you?"

  "I'm… I'm visiting from the South. Why?"

  "Because I'm not supposed to talk to anyone until we've checked on a few more things."

  "Please," Laura said, suddenly apprehensive.

  "Please tell me what happened. It… it's very important." The man sized her up for a few moments and then said simply, "The fire was set.

  Professional job from the looks of it, but not the best. The old guy was on the second floor. The thing was put together in such a Way that he probably couldn't have gotten out even if he wanted to…

  Miss? You look a little pale."

  Laura pictured the frail little man, wrapped in his blanket, speaking of events long past as if they had happened yesterday.

  "I'm feeling a little pale," she said. "There are some terrible things going on around here."

  The man gazed again at the shell that was once Thaddeus Bushnell's home.

  "Yes. Yes, I suppose there are." He put his hand out and peered overhead. "Rain's startin'," he said.

  Except for the elegant county Medical Library on Huntington Avenue, the Hoffman Medical Library at White Memorial was the largest in the city.

  Eric planned to start his research there with a screening of basic textbooks in the areas of toxicology, metabolism, and cardiOlOgy- He would pay special attention to the bibliographies at the end of each pertinent chapter, and set up a card file of the journal articles that would form phase two of his project. His operating thesis was that somehow the two patients had encountered the same Poison or environmental Pollutant-a toxin powerful enough to cause cardiovascular collapse and profound metabolic slowing.