Robin Cook - Fatal Cure

The weather was not much better the next morning. The rain had stopped, but it was misting so heavily that it might as well have been raining. There was no break in the heavy cloud cover and it seemed even chillier than it had the day before.

While Nikki was doing her postural drainage the phone rang. David snatched it up. Considering the early morning hour, he was afraid the call was about John Tarlow. But it wasn't. It was the state's attorney's office requesting permission to send over an assistant to look at the crime scene.

"When would you like to come?" David asked.

"Would it be too inconvenient now?" the caller said. "We have someone in your immediate area."

"We'll be here for about an hour," David said.

"No problem," the caller replied.

True to their word, an assistant from the state's attorney's office arrived within fifteen minutes. She was a pleasant woman with fiery red hair. She was dressed conservatively in a dark blue suit.

"Sorry to bother you so early," the woman said. She introduced herself as Elaine Sullivan.

"No trouble at all," David said, holding the door open for her.

David led her down the cellar steps and turned on the floor lamp to illuminate the now empty tomb. She took out a camera and snapped a few pictures. Then she bent down and stuck a fingernail into the dirt of the tomb's floor. Angela came down the stairs and looked over David's shoulder.

"I understand that the town police were here last night," Elaine said.

"The town police and a district medical examiner," David said.

"I think I'll recommend that the state police crime-scene investigators be called," she said. "I hope it won't be a bother."

"I welcome the idea," Angela said. "I don't think the town police are all that accustomed to a homicide investigation."

Elaine nodded, diplomatically avoiding comment.

"Do we have to be here when the crime-scene people come?" David asked.

"That's up to you," Elaine said. "An investigator may want to talk with you at some point. But as far as the crime-scene people are concerned, they can just come in and do their thing."

"Will they come today?" Angela asked.

"They'll be here as soon as possible," Elaine said. "Probably this morning."

"I'll arrange for Alice to be here," Angela said. David nodded.

Shortly after the state's attorney's assistant had left, the Wilsons were off themselves. This was to be Nikki's first day back to school since she got out of the hospital. She was beside herself with excitement and had changed her clothes twice.

As they took her to school, Nikki couldn't talk about anything besides the body. When they dropped her off, Angela suggested that she refrain from talking about the incident, but Angela knew her request was futile: Nikki had already told Caroline and Arni, and they'd undoubtedly passed the story on.

David put the car in gear, and they started for the hospital.

"I'm concerned about how my patient will be this morning," he said. "Even though I haven't gotten any calls I'm still worried."

"And I'm worried about facing Wadley," Angela said. "I don't know if Cantor has spoken to him or not, but either way it won't be pleasant."

With a kiss for luck, David and Angela headed for their respective days.

David went directly to check on John Tarlow. Stepping into the room he immediately noticed that John's breathing was labored. That was not a good sign. David pulled out his stethoscope and gave John's shoulder a shake. David wanted him to sit up. John barely responded.

Panic gripped David. It was as if his worst fears were coming to pass. Rapidly David examined his patient and immediately discovered that John was developing extensive pneumonia.

Leaving the room, David raced down to the nurses' station, barking orders that John should be transferred to the ICU immediately. The nurses were in the middle of their report; the day shift was taking over from the night shift.

"Can it wait until we finish report?" Janet Colburn asked.

"Hell, no!" David snapped. "I want him switched immediately. And I'd like to know why I haven't been called. Mr. Tarlow has developed bilateral pneumonia."

"He was sleeping comfortably the last time we took his temperature," the night nurse said. "We were supposed to call if his temperature went up or if his GI symptoms got worse. Neither of those things happened."

David grabbed the chart and flipped it open to the temperature graph. The temperature had edged up a little, but not the way David would have expected having heard the man's chest.

"Let's just get him to the ICU," David said. "Plus I want some stat blood work and a chest film."

With commendable efficiency John Tarlow was transferred into the ICU. While it was being done, David called the oncologist, Dr. Clark Mieslich, and the infectious disease specialist, Dr. Martin Hasselbaum, to ask them to come in immediately.

The lab responded quickly to lab work requested for the ICU, and David was soon looking at John's results. His white count, which had been low, was even lower, indicating that John's system was overwhelmed by the developing pneumonia. It was the kind of lack of response one might expect from a patient undergoing chemotherapy, but David knew that John hadn't been on chemo for months. Most ominous of all was the chest X ray: it confirmed extensive, bilateral pneumonia.

The consults arrived in short order to examine the patient and go over the chart. When they were finished they moved away from the bed. Dr. Mieslich confirmed that John was not on any chemotherapy and hadn't been for a long time.

"What do you make of the low white count?" David asked.

"I can't say," Dr. Mieslich admitted. "I suppose it is related to his leukemia. We'd have to do a bone marrow sample to find out, but I don't recommend it now. Not with the infection he's developing. Besides, it's academic. I'm afraid he's moribund."

This was the last thing David wanted to hear although he had begun to expect it. He couldn't believe he was about to lose a second patient in his brief Bartlet career.

David turned to Dr. Hasselbaum.

Dr. Hasselbaum was equally blunt and pessimistic. He thought that John was developing massive pneumonia with a particularly deadly type of bacteria and that, secondarily, he was suffering from shock. He pointed to the fact that John's blood pressure was low and that his kidneys were failing. "It doesn't look good. Mr. Tarlow seems to have very poor physiological defenses, undoubtedly due to his leukemia. If we treat, we'll have to treat massively. I have access to some experimental agents created to help combat this type of endotoxin shock. What do you think?"

"Let's do it," David said.

"These drugs are expensive," Dr. Hasselbaum said.

"A man's life hangs in the balance," David said.

An hour and fifteen minutes later, when John's treatment had been instituted and there was nothing else to be done, David hurried to his office. Once again, every seat in the waiting room was occupied. Some patients were standing in the hall. Everyone was upset, even the receptionist.

David took a deep breath and plunged into his appointments. In between patients he called the ICU repeatedly to check on John's status. Each time he was told there had been no change.

In addition to his regularly scheduled patients, a number of semi-emergencies added to the confusion by having to be squeezed in. David would have sent these cases to the emergency room if it hadn't been for Kelley's lecture. Two of these patients seemed like old friends: Mary Ann Schiller and Jonathan Eakins.

Although he was somewhat spooked by the way Marjorie Kleber's and now John Tarlow's cases had progressed, David felt compelled to hospitalize both Mary Ann and Jonathan. David just didn't feel comfortable treating them as outpatients. Mary Ann had an extremely severe case of sinusitis and Jonathan had a disturbing cardiac arrhythmia. Providing them with admitting orders, David sent them both over to the hospital.