Michael Palmer - Side Effects

"Get up, dammit. Get up, get dressed, and get going."

With what seemed a major effort, she broke through the inertia of her spirit and the aching stiffness in her limbs, and stood up. The room, the house, the job, the girls-so much had changed, yet so little. She walked to the closet, wondering if perhaps something silkier and more feminine than what she usually wore to the office would buoy her. The burgundy dress she had bought for London caught her eye. Two men had made advances toward her the first day she wore it, and there had been any number of compliments on it since. As she crossed the room, Ellen felt the morning discomforts in her joints diminish-all, that is, except a throbbing in her left thigh that seemed to worsen with each step. She slipped off her housecoat, hung it up, and pulled her flannel nightgown off over her head. Covering much of the front of her thigh was the largest bruise she had ever seen.

Gingerly, she explored it with her fingers. It was somewhat tender, but not unbearably so. She did not know how she had gotten it. She had sustained no injury that she could remember. It must, she decided, have been the way she slept on it. She selected a blue, thin wool jumpsuit in place of the dress, which, it seemed, might not cover the bruise in every situation. She dressed, still unable to take her eyes off the grotesque discoloration. Her legs had always been one of her best features. Even after three children, she took pride that there were only a few threadlike veins visible behind her knees. Now this. For a moment, she thought about calling Kate for advice on whether or not to have a doctor check things out, but she decided that a bruise was a bruise.

Besides, she had simply too much else to do. A bit of makeup and some work on her hair, and Ellen felt as ready as she ever would to tackle the day. The face in her mirror, thin and fine featured, would probably turn some heads, but the eyes were still lifeless. She was leaving the room when she noticed the note tacked to the doorjamb. Each day it happened like this, and each day it was like seeing the note for the first time, despite the fact that she had tacked it there more than a year before. "Take Vit, " was all it said. Ellen went to the medicine cabinet, took the sheet of multivitamins plus iron from the shelf, punched one out, and swallowed it without water. Half consciously, she noticed that there was only a four-week supply remaining, and she made a mental note to set up an appointment with her physician at the Omnicenter. Although she was limping slightly as she left the house, Ellen found the tightness in her thigh bearable. In fact, compared to the other agonies in her life at the moment, the sensation was almost pleasant. The sign, a discreet bronze plate by the electronically controlled glass doors, said, "Metropolitan Hospital of Boston, Ashburton Women's Health Omnicenter, 1975." Kate had been one of the first patients to enroll and had never regretted her decision.

Gynecological care, hardly a pleasant experience, had become at least tolerable for her, as it had for the several thousand other women who were accepted before a waiting list was introduced. The inscription above the receptionist's desk said it all. "Complete Patient Care with Complete Caring Patience."

Kate stopped at the small coatroom to one side of the brightly lit foyer, and checked her parka with a blue-smocked volunteer. She could have used the tunnel from the main hospital, but she had been drawn outdoors by the prospect of a few minutes of fresh air and a fluffy western omelet sandwich, spetcialite' de la maison at Maury's Diner. The receptionist signaled Kate's arrival by telephone and then directed her to Dr. Zimmermann's office on the third floor. The directions were not necessary. Zimmermann had been Kate's Omnicenter physician for four years, since the accidental drowning death of Dr. Harold French, his predecessor and the first head of the Omnicenter. Although she saw Zimmermann infrequently-three times a year was mandatory for women on birth control pills-Kate had developed a comfortable patient-physician relationship with him, as well as an embryonic friendship. He was waiting by his office door as she stepped from the elevator.

Even after four years, the sight of the man triggered the same impresi sions as had their first meeting. He was dashing. Corny as the word was, Kate could think of no better one to describe him. In his late thirties or early forties Zimmermann had a classic, chiseled handsomeness, along with an urbanity and ease of motion that Kate had originally felt might be a liability to a physician in his medical specialty. Time and the man had proven her concerns groundless. He was polite and totally professional. In a hospital rife with rumors, few had ever been circulated regarding him. Those that had gone around dealt with the usual speculations about an attractive man of his age who was not married. Active on hospital and civic committees, giving of his time to his patients and of his knowledge to his students, William Zimmermann's was a star justifiably on the rise. "Dr. Kate." Zimmermann took both her hands in his and pumped them warmly. "Come in, come in. I have fresh coffee and… Have you had lunch? I could send out for something."

"I stopped at Maury's on the way over. I'm sorry for being so thoughtless. I should have brought you something."

"Nonsense. I only asked about lunch for your benefit. I have been skipping the meal altogether-part of a weight loss bet with my secretary."

Even if the bet were concocted on the spot, and considering the man's trim frame that was quite possible, his words were the perfect breeze to dispel Kate's embarrassment. Zimmermann's office was the den of a scholar. Texts and bound journals filled three walls of floor-to-ceiling bookcases, and opened or marked volumes covered much of a reading table at one end of the room. On the wall behind his desk, framed photographs of European castles were interspersed with elegantly matted sayings, quotations, and homilies. "The downfall of any magician is belief in his own magic."

"There are two tragedies in life, One is not to get your heart's desire, the other is to get it." And of course, "The Omnicenter, Complete patient care with complete caring patience." There were several others, most of which Kate had heard or read before. One, however, she could not recall having seen. Done in black Benedictine calligraphy, with a wonderfully ornate arabesque border, it said, "Monkey Work for the Monkeys."

Zimmermann followed her line of sight to the saying. "A gift from Carl,

" he explained. "His belief is that the energy of physicians and nurses should be directed as much as possible to areas utilizing their five senses and those properties unique to human beings-empathy, caring, and intuitiveness. The mechanics of our job, the paperwork, setting up of appointments, filling of prescriptions, and such, he calls 'monkey work.

His machines can do those jobs faster and more accurately than any of us ever could, and it seems Carl teaches them more almost every day."

"So, " said Kate, "he's named his computers… the Monkevs." Zimmermann said the last two words in unison with her. Kate sensed a letup in the uneasiness she had developed toward Carl Horner and began looking forward to meeting the man. "Now, " Zimmermann asked, "can you brief me on what you have found in these two patients of ours? I have reviewed their records and found little that might be of help to you."

In the concise, stylized method of case presentation ingrained in physicians from their earliest days in medical school, Kate gave a one minute capsule of each woman's history, physical exam, laboratory data, and hospital course. "I've brought sections from the ovaries of both patients. I think there's a decent microscope in the lab downstairs," she concluded. Zimmermann whistled softly. "And the only link to this point is that both were patients here? " Kate nodded. "Well, I can't add much. Miss Rittenhouse had been an Omnicenter patient since nineteen seventynine. Nothing but routine checkups since then, except that she was within one missed appointment of being asked to go elsewhere for her gynecologic care. The contract we have our patients sign gives us that option."