Robin Cook - Fatal Cure

After the visit with Nikki, Angela left for the lab while David went to the nurses' station to pick up Marjorie's chart. He'd been considering discharging her until he walked into her room. Her response to his greeting told him something was wrong.

"Marjorie, what's the matter?" David asked as he felt his own pulse quicken. She was lethargic. He touched the back of his hand to her forehead and her arms. Her skin was warm to the touch. He guessed she had a fever.

Marjorie responded to David's persistent questioning with barely intelligible mumbling. She acted drugged although not in any apparent pain.

Noticing Marjorie's breathing was mildly labored, David listened carefully to her chest. He heard faint sounds of congestion. Next he checked the area of phlebitis and found it was all but resolved. With mounting anxiety David examined the rest of his patient. Finding nothing he hurried back to the nurses' station and ordered a barrage of stat laboratory tests.

The first thing to come back from the lab was her blood count, but it only added to David's puzzlement. Her white cell level, which had been appropriately falling with the resolution of the phlebitis, had continued to fall and was now in the lower percentile of normal.

David scratched his head. The low white count seemed contradictory to her clinical state, which suggested developing pneumonia. Getting up from the desk, David went back to Marjorie's room and listened to her chest again. The incipient congestion was real.

Returning to the nurses' station, David debated what to do. More lab tests came back, but they were all normal, even the portable chest X ray, and hence no help. David thought about calling in some consults, but after his poor utilization review the day before, he was reluctant. The problem was that the consults who might have been helpful were not part of the CMV organization.

Instead of requesting any consults, David took the Physicians' Desk Reference off the bookshelf. Since his main concern was that a gram-negative bacteria might have appeared as a super-infection, he looked up an antibiotic that was specific for such an eventuality. When he found one he felt confident it would take care of the problem.

After the appropriate orders were written, including a request to be called immediately if there was any change in Marjorie's status, David headed over to his office.

It was Angela's turn to handle the day's surgical frozen sections. She always found the task nerve-wracking since she knew that while she worked, the patient remained under anesthesia awaiting her verdict whether the biopsy was cancerous or benign.

The frozen sections were done in a small lab within the operating suite. The room was tucked off to the side and visited infrequently by the operating room staff. Angela worked with intense concentration, studying the patterns of cells in the specimen under the microscope.

She did not hear the door silently open behind her. She was unaware that anyone was in the room until he spoke.

"Well, honey, how's it going?"

Startled, Angela's head shot up as a bolus of adrenaline coursed through her body. With her pulse pounding in her temples, she found herself looking into Wadley's smiling face. She hated to be called "honey" by anyone, except maybe David. And she didn't appreciate being snuck up on.

"Any problems?" Wadley asked.

"No," Angela said sharply.

"Let me take a look," Wadley said, motioning toward the microscope. "What's the case?"

Angela gave Wadley her seat. Succinctly she gave the history. He glanced at the slide, then stood up.

For a moment they talked about the slide in pathological jargon. It was apparent they agreed the growth was benign, happy news for the anesthetized patient.

"I want to see you later in my office," Wadley said. He winked.

Angela nodded, ignoring the wink. She turned away and was about to sit down again when she felt Wadley's hand brush across her buttocks.

"Don't work too hard, honey!" he called out. And with that, he slipped out the door.

The episode had happened so fast that Angela had not been able to respond. But she knew it had not been inadvertent, and now she knew for certain that the thigh-touching the day before had not been an innocent oversight.

For a few minutes Angela sat in the tiny lab and trembled with indignation and confusion. She wondered what was encouraging this sudden boldness. She certainly had not changed her behavior over the last few days. And what should she do? She couldn't just idly sit by and allow it to go on. That would be an open invitation.

Angela decided she had two possibilities. She could confront Wadley directly or she could go to the medical director, Michael Caldwell. But then she thought about Dr. Cantor, the current chief of staff. Maybe she should go to him.

Angela sighed. Neither Caldwell nor Cantor struck her as ideal authorities to turn to in a case of sexual harassment. Both were macho types, and Angela remembered their responses when she'd first met them. Caldwell had seemed shocked that women were actually pathologists while Cantor had offered that ignorant remark about the few women in his medical school class being "dogs."

She thought again about confronting Wadley herself, but she didn't like that alternative any better.

The raucous buzz of static coming over the intercom shocked Angela back to reality. The static preceded the voice of the head nurse. "Dr. Wilson," she said. "They are waiting on the biopsy results down in OR three."

David found concentrating on his patients' problems harder that morning than the previous afternoon. Not only was he still upset about his review with Kelley, now he had Marjorie Kleber's worsening condition to worry about.

Midmorning, David saw another of his frequent visitors, John Tarlow, the leukemia patient. John didn't have an appointment; David had Susan squeeze him in as a semi-emergency after he'd called that morning. Only the day before David would have directed John to the ER, but feeling chastened by Kelley's lecture, he felt obliged to see the man himself.

John was feeling poorly. Following a meal of raw shellfish the night before, he'd developed severe GI problems with both vomiting and diarrhea. He was dehydrated and in acute discomfort with colicky abdominal pain.

Seeing how bad John was and remembering his leukemic history, David hospitalized him immediately. He ordered a number of tests to try to determine the cause of John's symptoms. He also started intravenous fluid to rehydrate him. For the moment he held off on antibiotics, preferring to wait until he had some idea of what he was dealing with. It could have been a bacterial infection or it could have been merely a response to toxins: food poisoning, in the vernacular.

Just before eleven in the morning Traynor was told the bad news by his secretary, Collette. She'd just been informed by phone that Jeb Wiggins had again carried the Board of Selectmen. The final vote on the hospital parking garage, which Traynor had managed once more to get on the agenda, had been thumbs down. Now there probably wasn't even a way to get it on the ballot again before spring.

"Goddamn it," Traynor raged. He pummeled the surface of his desk with both hands. Collette didn't flinch. She was accustomed to Traynor's outbursts. "I'd love to grab Wiggins around that fat neck of his and choke him until he turns blue."

Collette discreetly left the room. Traynor paced the area in front of his desk. The lack of support he had to deal with when it came to running the hospital galled him. He could not understand how the Board of Selectmen could be so shortsighted. It was obvious that the hospital was the most important enterprise in the entire town. It was equally obvious that the hospital needed the parking garage.

Unable to work, Traynor grabbed his raincoat, hat, and umbrella and stormed out of his office. Climbing into his car he drove up to the hospital. If there was to be no parking garage, he would at least personally inspect the lighting. He didn't want to risk any more rapes in the hospital parking lot.