Michael Palmer - Side Effects

"Well I'm living proof those don't cause any problems. I've taken them for a couple of years. Make frail pathologist strong like bull." Kate flexed her biceps. "Make pathologist excellent teacher, too."

"Why, thank you." Kate's green eyes sparkled. "Thank you very much, Tom." For a moment, she saw him blush. "How about we go say hello to Beverly. I'd like to make extra sure about one or two aspects of her history. Here, you can stick this salad in that refrigerator for later."

"Provided the bacteria who call that icebox home don't eat it first,"

Tom said. The two were heading down the hall toward the stairway when the overhead page snapped to life. "Code ninety-nine, Ashburton five-ohtwo, code ninety-nine, Ashburton five-oh-two."

"Oh, Jesus."

Tom was already racing toward the exit as he spoke. Kate was slower to react. She was almost to the stairway door before she realized that Ashburton 502 was Beverly Vitale's room. It had been a year, perhaps two, since Kate had last observed a cardiac arrest and resuscitation attempt. She was certified in advanced cardiac life support, but training and testing then had been on Resusciannie, a mannequin. Her practical experience had ended years ago, along with her internship. At the moment, however, none of those considerations mattered. What mattered was the life of a young woman who loved to make music. With an athlete's quickness, Kate bolted after Tom Engleson up the stairs from Ashburton Four to Ashburton Five. There were more than enough participants in the code. Residents, nurses, medical students, and technicians filled room 502 and overflowed into the hall. Kate worked her way to a spot by the door, from which she watched the nightmare of Beverly Vitale's final minutes of life. It was a gastric hemorrhage, almost certainly from an ulcer eroding into an artery. The woman's relentless exsanguination was being complicated by the aspiration of vomited blood. Cloaked in abysmal helplessness, Kate witnessed Tom Engleson, desperation etched on his face, issuing orders in a deceptively composed tone, the organized chaos of the white-clad code team, pumping, injecting, monitoring, reporting, respirating, suctioning, and through the milling bodies, the expressionless, blood-smeared face of Beverly Vitale. For nearly an hour the struggle continued, though there was never a pulse or even an encouraging electrocardiographic pattern. In the end, there was nothing but another lesson in the relative impotence of people and medicine when matched against the capriciousness of illness and death. Tom Engleson, his eyes dark and sunken, shook his head in utter futility. "It's over, " he said softly. "Thank you all. It's over."

Simultaneously with hearing the report from the WEEI traffic helicopter of a monumental backup stemming from the Mystic/Tobin Bridge, Kate became part of it. Commuting to the city from the North Shore was an experience that she suspected ranked in pleasantness somewhere between an IRS audit and root canal work. Although Tuesday was normally a low-volume day, this morning she had encountered rain, sleet, snow, and even a bizarre stretch of sunlight during her thirty-mile drive, far too much weather for even Boston drivers to attack. With a groan, she resigned herself to being half an hour late, perhaps more, for the appointment Stan Willoughby had arranged for her at White Memorial Hospital. The pathology chief's call had punctuated another confusing, bittersweet morning with Jared. It seemed as if the intensity and caring in their relationship was waxing and waning not only from day to day but from hour to hour or even from minute to minute. In one sentence the man was Jared Samuels, the funny, sensitive, often ingenuous fellow she had married and still loved deeply, in the next he was calculating and distant, a miniature of his father, intransigent on points they should have been working through as husband and wife. At last, after an awkward hour of lighting brush fires of dissension and then scurrying to stamp them out, Jared had suggested a week or ten days together in Aruba, away from the pressures and demands of their careers. "What do you say, Boots? " he had asked, calling on the pet name she favored most of the four or five he used. "Aruba you all over." The expression in his eyes-urgency? fear? — belied his levity. "Aruba you too, Jared, " she had said finally. "Then we go?"

"If Stan can give me the time off, and if you can stand the thought of trying to hang onto a woman swathe in Coppertone, we go."

At that moment, Jared looked reborn. "Grumper-to-grumper, stall-and-crawl traffic headed in a snail trail toward the bridge, thanks to a fender bender in the left-hand lane." The Eye-in-the-Sky was sparing none of his cliches in describing the mess on Route 1 south.

Kate inched her Volvo between cars, but gained little ground. Finally, resigned to the situation, she settled back, turned up the volume on the all-news station, and concentrated on ignoring the would-be Lothario who was winking and waving at her from the Trans-Am in the next lane. The news, like Stan Willoughby's call, dealt with the sudden death of Red Sox hero Bobby Geary, a homegrown boy who had played his sandlot ball in South Boston, not a mile from the luxurious condominium where he was found by his mother following an apparent heart attack. Stan's name was mentioned several times as the medical examiner assigned to autopsy the man who had given away thousands of free tickets and had added an entire floor to Children's and Infants' Hospital in the name of "the kids of Boston."

"Kate, " Willoughby had begun, "I hope I'm not interrupting anything."

"No, no. Just getting ready for work, " she had said, smiling at Jared, who was nude by the bathroom door dancing a coarse hula and beckoning her to the shower with a long-handled scrub brush. "Well, I don't want you to come to work."

"What?"

"I want you to go to White Memorial. You have an appointment in the pathology department there at eight-thirty. Leon Olesky will be waiting for you. Do you know him?"

"Only by name."

"Well, I called around town trying to see if anyone had seen a case similar to our Miss Vitale's. Initially there was nothing, but late last night Leon called me at home. From what he described, the two cases — his and ours-sound identical. I told him you'd be over to study his material."

"How old was the woman? " Kate had asked excitedly. "I don't remember what he said. Twenty-eight, I think."

I)m "Cause of death?"

"Ah ha! I thought you'd never ask. Cerebral hemorrhage, secondary to minor head trauma."

"Platelets?

Fibrinogen? " Her hand was white around the receiver. "Leon didn't know.

The case was handled by one of his underlings. He said he'd try to find out by the time you got there."

"Can't you come?"

"Hell, no. Haven't you heard the news about Bobby Geary?"

"The ball player?"

"Heart attack late last night. Found dead in bed. I'm posting him at ten-thirty. In fact, I'd like you back here before I finish, just in case I need your help."

"You've got it. You know, you are a pretty terrific chief, Stanley. Are you sure you want to retire?"

"Yesterday, if I could arrange it, Katey-girl. You hurry on back to Metro after you see Olesky, now. No telling what this shriveled brain of mine might miss."

White Memorial Hospital, an architectural polyglot of more than a score of buildings, was the flagship of the fleet of Harvard Medical School affiliated hospitals. Overlooking the Charles River near the North End, WMH had more research facilities, professors, grants, and administrative expertise than any hospital in the area, if not the world. Metropolitan Hospital had once held sway, reportedly supplying ninety percent of all the professors of medicine at all the medical schools in the country, but that time had long since been buried beneath an avalanche of incompetent administrators, unfavorable publicity, and corrupt city politicians. Although Metro had made a resurgence of sorts under the guidance of Norton Reese, there was little likelihood of its ever recapturing the prestige, endowments, and fierce patient loyalty of the glory days, when at least one man was known to have had "Take Me To Metro" tattooed across his chest. It had been some time since Kate had had reason to visit the pathology unit at White Memorial, and she was uncomfortably impressed with the improvements and expansion that had occurred. Equipment her department congratulated itself on acquiring, this unit possessed in duplicate or triplicate. Corridors and offices were brightly lit, with plants, paintings, and other touches that made the work environment less tedious and oppressive. Almost subconsciously, Kate found herself making mental lists of things she would press to accomplish as chief — of pathology at Metro. Leon Olesky, a mild, Lincolnesque man, brushed off her apologies for her tardiness and after exchanging compliments about Stan Willoughby, left her alone in his office with the material from the autopsy of Ginger Rittenhouse. On a pink piece of paper by his elegant microscope were the data on the woman's blood studies. Only two of many parameters measured were abnormal, fibrinogen and platelets. The levels of each were depressed enough to have been life threatening.