Robin Cook - Fever

Cathryn strengthened her grip on Charles’s neck as if he was her only salvation. All the control she’d marshaled before his arrival vanished.

Using most of his strength, Charles managed to break Cathryn’s hold on his neck. Once he did so, she seemed to collapse. He helped her to a chair where she sank like a deflated balloon. Then he sat down beside her.

“Cathryn, you must tell me what is going on.”

His wife looked up with great effort, her teal-blue eyes awash with tears. She opened her mouth, but before she could speak the door opened. Dr. Jordan Wiley stepped into the room.

Charles, his hands still resting on Cathryn’s shoulders, turned at the sound of the closing door. When he saw Dr. Wiley he stood up, searching the man’s face for a clue to what was happening. He had known Dr. Wiley for almost twenty years. It had been a professional rather than a social relationship, beginning while Charles was in medical school. Wiley had been his preceptor for third-year pediatrics and had impressed Charles with his knowledge, intelligence, and empathy. Later when Charles needed a pediatrician he’d called Jordan Wiley.

“It’s good to see you again, Charles,” said Dr. Wiley, grasping Charles’s hand. “I’m sorry it’s under such trying circumstances.”

“Perhaps you could tell me what these trying circumstances are,” said Charles, allowing annoyance to camouflage his fear.

“You haven’t been told?” asked Dr. Wiley. Cathryn shook her head.

“Maybe I should step outside for a few moments,” said Dr. Wiley.

He started to turn toward the door, but Charles restrained him with a hand on his forearm. “I think you should tell me what this is all about,” he said.

Dr. Wiley glanced at Cathryn, who nodded agreement. She was no longer sobbing but she knew she’d have difficulty speaking.

“All right,” said Dr. Wiley, facing Charles once again. “It’s about Michelle.”

“I gathered that,” said Charles.

“Why don’t you sit down,” said Dr. Wiley.

“Why don’t you you just tell me,” said Charles.

Dr. Wiley scrutinized Charles’s anxious face. He saw that Charles had aged a lot since he was a student and was sorry that he had to be the messenger of more anguish and suffering; it was one of the few responsibilities of being a doctor that he detested.

“Michelle has leukemia, Charles,” said Dr. Wiley.

Charles’s mouth slowly dropped open. His blue eyes glazed as if he were in a trance. He didn’t move a muscle; he didn’t even breathe. It was as if Dr. Wiley’s news had released a flood of banished memories. Over and over Charles heard, “I’m sorry to inform you, Dr. Martel, but your wife, Elizabeth, has an aggressive lymphoma… I’m awfully sorry to report that your wife is not responding to treatment… Dr. Martel, I’m sorry to say, but your wife has entered a terminal leukemic crisis… Dr. Martel, I’m terribly sorry to have to tell you that your wife died a few moments ago.”

“No! It’s not true. It’s impossible!” shouted Charles with such vehemence that both Dr. Wiley and Cathryn were startled.

“Charles,” began Dr. Wiley as he reached out and placed a sympathetic arm on Charles’s shoulder.

With a lightning movement, Charles knocked Dr. Wiley’s hand away. “Don’t you dare patronize me!”

Despite her tears, Cathryn jumped up and caught Charles’s arm as Dr. Wiley stepped back in surprise.

“Is this all some elaborate joke?” snapped Charles, shrugging off Cathryn’s hand.

“It’s not a joke,” said Dr. Wiley. He spoke gently but firmly. “Charles, I know this is difficult for you, especially because of what happened to Elizabeth. But you have to get control of yourself. Michelle needs you.”

Charles’s mind was a jumble of incomplete thoughts and emotions. He wrestled with himself, trying to anchor his thoughts. “What makes you think Michelle has leukemia?” He spoke slowly, with great effort. Cathryn sat back down.

“The diagnosis in unequivocal,” said Dr. Wiley softly.

“What kind of leukemia?” asked Charles, running his hand through his hair and looking out the window at the neighboring brick wall. “Lymphocytic?”

“No,” said Dr. Wiley. “I’m sorry to say but it’s acute myeloblastic.”

I’m sorry to say… I’m sorry to say… a stock medical phrase that doctors resorted to when they didn’t know what else to do and it echoed unpleasantly in Charles’s head. I’m sorry to say your wife died… It was like a knife plunging into the heart.

“Circulating leukemic cells?” asked Charles, forcing intelligence to struggle against memory.

“I’m sorry to say, but there are,” said Dr. Wiley. “Her white count is over fifty thousand.”

A deathly silence descended over the room.

Abruptly Charles began to pace. He moved with quick steps, while his hands worked at each other as if they were enemies.

“A diagnosis of leukemia isn’t certain until a bone marrow is done,” he said abruptly.

“It’s been done,” said Dr. Wiley.

“It couldn’t have,” snapped Charles. “I didn’t give permission.”

“I did,” said Cathryn, her voice hesitant, fearful she’d done something wrong.

Ignoring Cathryn, Charles continued to glower at Dr. Wiley.

“I want to see the smears myself.”

“I’ve already had the slides reviewed by a hematologist,” said Dr. Wiley.

“I don’t care,” said Charles angrily. “I want to see them.”

“As you wish,” said Dr. Wiley. He remembered Charles as a rash but thorough student. Apparently he hadn’t changed. Although Dr. Wiley knew that it was important for Charles to substantiate the diagnosis, at that moment he would have preferred to talk about Michelle’s extended care.

“Follow me,” he said finally and led Charles out of the conference room and down the hall. Once the conference room door opened a cacophony of crying babies could be heard. Cathryn, initially unsure of what to do, hurried after the men.

At the opposite end of the corridor they entered a narrow room which served as a small clinical lab. There was just enough space for a counter and a row of high stools. Racks of urine samples gave the room a slightly fishy aroma. A pimply faced girl in a soiled white coat deferentially slid off the nearest stool. She’d been busy doing the routine urinalysis.

“Over here, Charles,” said Dr. Wiley, motioning to a shrouded microscope. He plucked off the plastic cover. It was a binocular Zeiss. Charles sat down, adjusted the eyepieces, and snapped on the light. Dr. Wiley opened up a nearby drawer and pulled out a cardboard slide holder. Gently he lifted one of the slides out, being careful to touch only the edges. As he extended it toward Charles, their eyes met. To Dr. Wiley, Charles looked like a cornered animal.

Using his left hand, Charles took the slide between his thumb and first finger. In the center of the slide was a cover glass over what appeared to be an innocuous smudge. On the ground glass portion of the slide was written:

Charles’s hand trembled as he placed the slide on the mechanical stage and put a drop of oil on the cover glass. Watching from the side he lowered the oil immersion lens until it just touched the slide and entered the oil.

Taking a deep breath, Charles put his eyes to the oculars and tensely began to raise the barrel of the scope. All at once a multitude of pale blue cells leaped out of the blur, choking off his breath, and forcing the blood to pound in his temples. A shiver of fear as real as if he were looking at his own death warrant blew through his soul. Instead of the usual population of cells in all stages of maturation, Michelle’s marrow had been all but replaced by large, undifferentiated cells with correspondingly large irregular nuclei, containing multiple nucleoli. He was gripped by a sense of utter panic.