Robin Cook - Fatal Cure

At first the conversation dealt with the beauty of the surroundings and the inherent benefits of living in Vermont where most people only got to visit for short vacations. But then the conversation turned to medicine, to the chagrin of the other three wives.

"I'd almost rather hear sports trivia," Gayle Yarborough complained. Nancy Yansen and Claire Young heartily agreed.

"It's hard not to talk about medicine with all this so-called 'reform' going on," Trent said. Neither Trent nor Steve were CMV physicians. Although they had been trying to form a preferred provider organization with a large insurance company and Blue Shield, they were not having much luck. They were a little late. Most of the patient base had been snapped up by CMV because of the plan's aggressive, competitive marketing.

"The whole business has got me depressed," Steve said. "If I could think of some way of supporting myself and my family, I'd leave medicine in the blink of an eye."

"That would be a terrible waste of your skill," Angela said.

"I suppose," Steve said. "But it would be a hell of a lot better than blowing my brains out like you-know-who."

The reference to Dr. Portland intimidated everyone for a few moments. It was Angela who broke the silence. "We've never heard the story about Dr. Portland," she said. "I've been curious, I have to admit. I've seen his poor wife. She's obviously having enormous trouble dealing with his death."

"She blames herself," Gayle Yarborough said.

"All we heard was that he was depressed," David said. "Was it about something specific?"

"The last time he played basketball he was all uptight about one of his hip fracture patients dying," Trent said. "It was Sam Flemming, the artist. Then I think he lost a couple of others."

David felt a shiver pass down his spine. The memory of his own reaction as a junior resident to the deaths of several of his patients passed through him like an unwelcome chill.

"I'm not even sure he killed himself," Kevin said suddenly, shocking everyone. Other than complaining about David's clumsiness, Kevin had said very little that day. Even his wife Nancy looked at him as if he'd blasphemed.

"I think you'd better explain yourself," Trent said.

"Not much to explain except Randy didn't have a gun," Kevin said. "It's one of those nagging details that no one has been able to explain. Where'd he get it? No one has stepped forward to say that he'd borrowed it from him. He didn't go out of town. What did he do, find it along the road?" Kevin laughed hollowly. "Think about it."

"Come on," Steve said. "He must have had it, just no one knew."

"Arlene said she didn't know anything about it," Kevin persisted. "Plus he was shot directly through the front of the head and angled downward. That's why it was his cerebellum that was splattered against the wall. I've personally never heard of anyone shooting himself like that. People usually put the barrel in their mouths if they want to be sure not to mess it up. Other people shoot themselves in the side of the head. It's hard to shoot yourself from the front, especially with a long-barreled magnum." Kevin made a pistol with his hand as he'd done on David's first day of work. This time when he tried to point the gun straight into his forehead, he made the gesture look particularly awkward.

Gayle shivered through fleeting nausea. Even though she was married to a doctor, talk of blood and guts made her ill.

"Are you trying to suggest he was murdered?" Steve said.

"All I'm saying is I'm personally not sure he killed himself," Kevin repeated. "Beyond that, everybody can make his own assessment."

The sounds of crickets and tree frogs dominated the night as everyone pondered Kevin's disturbing comments. "Well, I think it's all poppycock," Gayle Yarborough said finally. "I think it was cowardly suicide, and my heart goes out to Arlene and her two boys."

"I agree," Claire Young said.

Another uncomfortable silence followed until Steve broke it: "What about you two?" he asked, looking across the table at Angela and David. "How are you finding Bartlet? Are you enjoying yourselves?"

David and Angela exchanged glances. David spoke first: "I'm enjoying it immensely," he said. "I love the town, and since I'm already part of CMV I don't have to worry about medical politics. I walked into a big practice, maybe a little too big. I've got more oncology patients than I'd anticipated and more than I'd like."

"What's oncology?" Nancy Yansen asked.

Kevin gave his wife an irritated look of disbelief. "Cancer," he said disdainfully. "Jesus, Nance, you know that."

"Sorry," Nancy said with equal irritation.

"How many oncology patients do you have?" Steve asked.

David closed his eyes and thought for a moment. "Let's see," he said. "I've got John Tarlow with leukemia. He's in the hospital right now. I've got Mary Ann Schiller with ovarian cancer. I've got Jonathan Eakins with prostatic cancer. I've got Donald Anderson who they thought had pancreatic cancer but who ended up with a benign adenoma."

"I recognize that name," Trent said. "That patient had a Whipple procedure."

"Thanks for telling us," Gayle said sarcastically.

"That's only four patients," Steve said.

"There's more," David said. "I've also got Sandra Hascher with melanoma and Marjorie Kleber with breast cancer."

"I'm impressed you've committed them all to memory," Claire Young said.

"It's easy," David said. "I remember them because I've befriended them all. I see them on a regular basis because they have a lot of medical problems, which is hardly surprising considering the amount of treatment they've undergone."

"Well, what's the problem?" Claire asked.

"The problem is that now that I've befriended them and accepted responsibility for their care, I'm worried they'll die of their illness and I'll feel responsible."

"I know exactly what he means," Steve said. "I don't understand how anybody can go into oncology. God bless them. Half the reason I went into OB was because it's generally a happy specialty."

"Ditto for ophthalmology," Kevin said.

"I disagree," Angela said. "I can understand very well why people go into oncology. It has to be rewarding because people with potentially terminal illnesses have great needs. With a lot of other specialties you never truly know if you have helped your patients or not. There's never a question with oncology."

"I know Marjorie Kleber quite well," Gayle Yarborough said. "Both TJ and my middle, Chandler, had her as their teacher. She's a marvelous woman. She had this creative way to get the kids interested in spelling with tiny plastic airplanes moving across a wall chart."

"I enjoy seeing her every time she conies in for an appointment," David admitted.

"How's your job?" Nancy Yansen asked Angela.

"Couldn't be better," Angela said. "Dr. Wadley, the chief of the department, has become a true mentor. The equipment is state-of-the-art. We're busy but not buried. We're doing between five hundred and a thousand biopsies a month, which is respectable. We see interesting pathology because Bartlet Hospital is acting as a tertiary care center. We even have a viral lab which I didn't expect. So all in all it's quite challenging."

"Have you had any run-ins with Charles Kelley yet?" Kevin asked David.

"Not at all," David said with surprise. "We've gotten along fine. In fact just this week I met with Kelley and the CMV quality management director from Burlington. They were both complimentary about the responses patients had given on forms asking them to evaluate care and satisfaction."

"Ha!" Kevin laughed scornfully. "Quality management is a piece of cake. Wait until you have your utilization review. It usually takes two or three months. Let me know what you think of Charles Kelley then."