Michael Palmer - Side Effects

"I know. I signed one, " Kate said. The contract was another example of the patient-oriented philosophy of the Omnicenter. Fees were on a yearly basis, adjusted to a patient's income. There was no profit to be made from insisting on compliance with periodic routine visits, yet insist they did. "What about Beverly Vitale?"

Zimmermann shrugged. "Six years a patient. Abortion here five years ago by suction. Had a diaphragm. Never on birth control pills or hormones of any kind. Always somewhat anemic, hematocrits in the thirty-four to thirty-six range."

"She was on iron."

"Yes. Dr. Bartholomew has had her on daily supplements since the day of her first exam."

"Who was Ginger Rittenhouse's doctor? " Kate was grasping for any connection, however remote. "Actually, she was cared for by the residents, with the help of a faculty advisor. In this woman's case, it was me. However, there was never any need for me to be consulted. She became a patient just after I arrived. I saw her once, and she has had no trouble since." He grimaced at what he considered an inappropriate remark. "Excluding the obvious, " he added. DEAD END. Kate's mind's eye saw the words as she had written them. She glanced at her watch. There would be a surgical specimen processed as a frozen section in half an hour. Her reading would determine whether the patient underwent a limited or extensive procedure. Still, she felt reluctant to let go of the one common factor she had found. "I'm due back for a frozen in a short while, Bill. Do you think Voll could take me by to meet Carl Horner and his trained Monkeys?

"Certainly, " Zimmermann said. "He's expecting us. By the way, I understand congratulations are in order."

"For what?"

"Well, word has it that you are to be the next chief of pathology."

Kate laughed ruefully. "Welcome to the new game show, I've Got No Secrets. Actually, I don't even think my name has formally been presented for consideration yet, so you can hold the congrattllations.

Besides, with the financial mess the department is in, I'm not sure condolences wouldn't be a better response. You don't suppose that Ashburton Foundation of yours has a few extra hundred thousand lying around, do you?"

"I have no idea, Kate. Norton Reese handles that end of things. I am just one of the barge toters and bale lifters. You might talk to him, though. The foundation certainly has taken good care of us."

Kate stepped into the carpeted, brightly lit corridor. "I'll say they have, " she said. The chance that Norton Reese would put himself out on behalf of her department was less than none. "Monkey Work for the Monkeys." The message was displayed throughout Carl Horner's computer facility, which occupied an area at the rear of the first floor several times the size of Marco Sebastian's unit. Ensconced in the midst of millions of dollars in sophisticated electronics, Carl Horner looked to be something of an anachronism.

Beneath his knee-length lab coat, he was wearing a plaid work shirt and a pair of farmer's overalls. His battered work boots might just as well have received their breaking in on a rock pile as in the climate-controlled, ultramodern suite. Horner greeted Kate with an energetic handshake, thotlgh she could feel the bulbous changes of arthritis in every joint. Still the man, stoop shouldered and silver haired, had an ageless quality about him. It emanated, she decided, not only from his dress, but also from his eyes, which were a remarkably luminescent blue. "Dr. Bennett, I owe you my deepest apology. The error regarding the Rittenhouse file was nothing more-nor less-than a spelling mistake on my part."

Kate smiled. "Apology accepted. Incident forgotten."

"Have you found the explanations you were looking for?"

"No. No, we haven't. Mr. Horner, could you show me around a bit?

I'm especially interested in how the machines work in the pharmacy."

"Carl, " Zimmermann said, "if you and Dr. Bennett don't mind, I'm going to get back to work. Kate, I plan to review those slides later tonight and to do some reading. Together, I promise that we shall get to the bottom of all this. Meanwhile, enjoy your tour. We're certainly proud of Carl and his Monkeys."

Patiently, the old man took Kate through the filling of a prescription.

"These cards are preprinted with the patient's name and code number and included with the patient's chart when she has her appointment.

The doctors tear em up if they're not needed. As you can see, there are twenty-five separate medications already listed here, along with the codes for dosage, amount, and instructions. The machines dispense only these medications, and then only in the form of a generic — as good as any brand-name pharmaceutical, but only a fraction of the cost. The machines automatically review the patient's record for allergies to the medication prescribed, as well as any interaction with medications she might already be taking." Horner's presentation had all the pride of a grandmother holding court at a bridge party. "If there's any problem at all, the prescription is not filled and the patient is referred to our pharmacist, who handles the matter personally."

"What if the physician wants to prescribe a medication other than the twenty-five on the card? " Kate asked. "Our pharmacy is fully stocked.

However, because of the Monkeys, we need only one pharmacist on duty, and he or she has more time to deal with problems such as drug interaction and side effects."

"Amazing, " Kate said softly. "Have the Monkeys ever made an error?"

Horner's smile was for the first time somewhat patronizing. "Computers cannot make errors. There are programs backing up programs to guarantee that. Of course, human beings are a different story."

"So I've learned." Kate's cattiness was reflex. There was something about Horner's limitless confidence in the wires, chips, discs, and other paraphernalia surrounding them that she found disquieting. "Tell me, where do the generics come from that the machines dispense?"

"One of the drug houses. We hold a closed-bid auction each year, and the lowest bidder gets the contract."

"Which one has it now? " Horner's answer had been somewhat evasive, hardly in character with the man. She watched his eyes. Was there a flicker of heightened emotion in them? She couldn't tell. "Now? Redding has it. Redding Pharmaceuticals."

"Ah, the best and the brightest." Kate was not being facetious. In an industry with a checkered past that included thalidomide and many other destroyers of human life, Redding stood alone in its reputation for product safety and the development of orphan drugs for conditions too rare for the drugs to be profitable. "Well, Mr. Horner, I thank you.

Your Monkeys are truly incredible."

"My pleasure. If there's anything else I can do, let me know."

Kate turned to go, but then turned back. "Do you have a list of the companies that have held the contract in years past?"

"Since the Omnicenter opened?"

"Yes." For the second time, Kate sensed a change in the man's eyes.

"Well, it won't be much of a list. Redding's the only one."

"Eight auctions and eight Reddings, huh?"

"No bids have even been close to theirs."

"Well, thanks for your help."

"No problem."

Horner's parting handshake and smile seemed somehow more forced than had his greeting. Kate watched as he ambled off, feeling vaguely uneasy about the man, but uncertain why. She glanced at her watch. The frozen section was due in ten minutes, and the patient would be kept under anesthesia until her diagnosis was made. Aside from alerting Bill Zimmermann as to what was going on, her Omnicenter visit had accomplished essentially nothing. Still, the clinic remained the only factor common to two dead women. As she walked through the lobby to retrieve her coat, Kate ran through the possible routes by which the ovarian and blood disorders might have been acquired. Finally, with time running short, she stopped at the reception desk, and wrote a note to Zimmermann. Dear Bill-Thanks for the talk and the tour. No answers, but perhaps together we can find some. Meanwhile, I'm sending over some microbiology people to take cultures, viral and bacterial, if that's okay with you. They will also check on techniques of instrument sterilization-perhaps a toxin has been introduced that way. Let me know if you come up with anything. Also, check your calendar for a night you could come north and have dinner with my husband and me. I'd enjoy the chance to know you better. Kate She sealed the note in an envelope and passed it over to the receptionist. "Could you see to it that Dr. Zimmermann gets this?