Michael Palmer - The Society

Even without medication, Will began to drift off. Images of the OR floated about for a time, then gave way to a comforting darkness. Everything was going to be okay, he told himself. The diagnostic tests he would undergo over the days and weeks ahead would show no brain tumor, no vascular anomaly within his skull, no hemorrhage, and no irregular cardiac rhythm. The incident would be written off as a simple faint, caused by a virus, fatigue, dehydration, or factors never to be determined. Such a faint was known technically as vasovagal syncope, the sort of physiologic reaction that commonly accompanied stresses such as horrible news or a grisly sight. In such instances a sudden, powerful discharge of electricity along the large vagus nerve caused rapid dilation of the veins in the abdomen and legs and marked pooling of blood in those vessels. The resultant drop in blood pressure produced an instantaneous loss of consciousness. Fainting was the brain’s effort to protect its critical circulation by “insisting” that the body lie down.

Vasovagal syncope , Will thought, as sleep enfolded him. Yes, that’s it. That’s what they’re going to conclude .

“Will?”

Ken Millstein stood by Will’s left hand. Standing beside Millstein, Anne Hajjar looked down at Will with the stony impassivity of a sphinx. On the right side of the bed was anesthesiologist Ramon Bustamante, also looking grim.

Will opened his eyes and managed a weak thumbs-up, to which neither the nurse nor the physicians reacted.

Something’s wrong, he thought. Something’s. .

“Will, Dr. Bustamante’s here to remove the tube; after that we’ll talk.”

The Philippine anesthesiologist moved forward and used a syringe to deflate the balloon cuff that held the tube in place below Will’s vocal cords. The inflated cuff also prevented him from aspirating his stomach contents into his lungs.

“Mrs. Hajjar, you have the backup tube ready?” Bustamante asked.

“Right here.”

“You tested the balloon?”

“Yes.”

“Suction?”

“Ready.”

“Okay, then, Doctor,” the anesthesiologist ordered unemotionally. “Cough when I say so. . and. . now!”

Will coughed feebly and the redwood tree instantly vanished from his throat. He sputtered and gagged as the nurse suctioned his mouth and throat with a hard plastic tube. Then, eyes tearing, he sagged back against the pillow, sucking in drafts of sweet air. Bustamante listened to his chest, assured himself that neither lung had collapsed, then turned and left without a word. Anne Hajjar slipped oxygen prongs into Will’s nostrils, did a blood-pressure check, nodded to Millstein that it was satisfactory, and quickly followed the anesthesiologist out of the cubicle.

For fifteen seconds, Millstein just stood there looking down at Will.

“Feel able to talk?” he asked.

Will cleared his throat as forcefully as he could manage.

“Sure,” he rasped, nearly overcome now by apprehension.

“Okay. I’ve gotten most of the lab work back, including a comprehensive panel I requested for drugs of abuse.”

“That would be negative.”

“Well, you can say so, Will, but it wasn’t.”

Will felt his heart sink.

“That’s impossible.”

“You lit up for fentanyl, Will. Big time.”

Fentanyl-one of the most powerful of all narcotics. It was used as a painkiller via a time-release patch and in an IV to put patients to sleep in the OR before they were intubated. It was highly addictive and too often an instrument of death in those anesthesiologists who chose to experiment with it by sequentially pushing up the dose they injected into themselves.

“I tell you, that’s impossible. I’ve never taken any painkillers stronger than Tylenol.”

“Two different samples,” Millstein said. “Fentanyl confirmed in both of them by emergency gas chromatography and mass spectrophotometry. Large amounts were in your blood when you passed out, Will. There is absolutely no doubt in anyone’s mind about that.”

Will found the bed control and raised himself upright.

“This is absolutely insane! I didn’t take anything.”

“I don’t see how that can be true,” Millstein said evenly. “I can try and help you, Will, but only if you tell the truth.”

The chilliness of the nurses and the anesthesiologist was certainly explained. Fear and anger tightened the muscles at the base of Will’s skull. A jet of bile rose in his throat.

“You’ve known me for years, Ken. You’ve got to believe me.”

Millstein shook his head slowly.

“I don’t know what to make of this, Will. I’ve learned to repeat abnormal tests that don’t fit, and that’s just what I did here. But if I don’t trust our lab when a test is repeated with the same results, I might as well pack up and find another profession.”

“It wasn’t my blood,” Will said desperately.

Again Millstein shook his head. Will could see now the deep sadness in his eyes.

“We ran a urine, too. Straight from your catheter. Chain-of-custody handling. No breaks in the chain. It was positive, too. Strongly positive, I might add, and you know how rapidly fentanyl is cleared from the body. Will, with all that’s involved, this is way beyond me. I’ve reported everything to Sid Silverman, and he’s called the police. They’ll be here shortly if they’re not here already.”

“Jesus,” Will said. Silverman, the president of the hospital, was in bed with several managed-care companies and had been openly critical of the Hippocrates Society and Will in particular. “I’m in no shape to deal with fucking Silverman or the police. Let me out of here, dammit! I’ll sign out AMA! Bring me the form.”

He leaned forward, then just as quickly fell back as a spear of pain thrust itself through one eye and out the back of his skull.

“Easy, Will.”

“No! I’m out of here!”

Mindless of the IV lines and catheter, Will battled through the headache, grabbed the side rails, and pulled himself forward again, scrambling toward the foot of the bed.

“Hands!” Millstein cried out, restraining him with surprising strength.

In seconds, the room was full of uniformed bodies, each trying to hold him down. A hand clutching a filled syringe moved into Will’s sight. Helplessly, he watched as the needle was slipped into a port of his IV and the syringe emptied.

Moments later, a gentle, pleasant wave washed over him and he sank back into a dark, welcoming sea.

“You’ve got to be kidding, Sergeant.”

Benois Beane, seated in a well-worn leather easy chair in his office, stared across at Patty, shaking his head in utter disbelief.

“It’s the truth. His body was loaded with a very powerful narcotic-one that doctors, but not most other people, would have easy access to.”

From the moment they first shook hands, Patty liked the Open Hearth director. There was an engaging openness to him and an appealing wisdom in his face that she guessed was born of hard times. She had phoned him and driven over to the soup kitchen after a stop in the ICU at Fredrickston General.

Shortly after she had been raked over the coals by Wayne Brasco and Jack Court for withholding the information about Will Grant from them, a call from her father alerted her to the latest bizarre twist in the managed-care case-the drug overdose of their only suspect. Sitting in on the tense meeting with Court and Brasco had been Sean Digby, a young, eager detective who had come on board about six months after Patty and been immediately accepted by the guys. This was the first time Digby had attended one of their skull sessions on this case, and Patty had no trouble figuring out why. He was clearly being groomed to take her place should she falter any more, and calling him in like this was a strident warning that she was skating on thin ice.