Robin Cook - Fatal Cure

The stat blood count came back showing very little cellular response to the developing pneumonia, a situation reminiscent of both Tarlow and Kleber. The portable chest film confirmed his fear: extensive pneumonia developing in both lungs.

At a loss, David called Dr. Mieslich, the oncologist, to confer by phone. After all the trouble with Kelley he was reluctant to ask for a formal consult even though that would have been far better.

Without having seen the patient, Dr. Mieslich could offer little help. He did confirm that the last time he had seen Mary Ann in his office there had been no evidence of her ovarian cancer. At the same time he told David that her cancer had been extensive prior to treatment and that he fully expected a recurrence.

While David was on the phone with the oncologist, a nurse appeared in front of the nurses' station and yelled that Mary Ann was convulsing.

David slammed down the phone and raced to the bedside. Mary Ann was indeed in the throes of a grand mal seizure. Her back was arched and her legs and arms were rhythmically thrashing against the bed. Fortunately, her IV had not become dislodged, and David was able to control the seizure quickly with intravenous medication. Nevertheless, in the wake of the seizure, Mary Ann remained comatose.

Returning to the nurses' station, David put in a stat call to the CMV neurologist, Dr. Alan Prichard. Since he was in the hospital making his own rounds, he called immediately. After David told him about the seizure along with a capsule history, Dr. Prichard told David to order either a CAT scan or an MRI, whichever machine was available. He said he'd be over to see the patient as soon as he could.

David sent Mary Ann to the Imaging Center for her MRI accompanied by a nurse in case she seized again. Then he called the oncologist back, explained what had happened, and asked for a formal consult. As he'd done with Kleber and Tarlow, he also called Dr. Hasselbaum, the infectious disease specialist.

David couldn't help but worry about Kelley's reaction to these non-CMV consults, but David felt he had little choice. He could not allow concern about Kelley to influence his decision making in light of the grand mal seizure. The gravity of Mary Ann's condition was apparent.

As soon as David was alerted that the MRI study was available, he dashed over to the Imaging Center. He met the neurologist in the viewing room as the first images were being processed. Along with Dr. Cantor they silently watched the cuts appear. When the study was complete David was shocked that there was no sign of a metastatic tumor. He would have sworn such a tumor was responsible for the seizure.

"At this point I cannot say why she had a seizure," Dr. Prichard said. "It could have been some micro emboli, but I'm only speculating."

The oncologist was equally surprised about the MRI result. "Maybe the lesion is too small for the MRI to pick up," he suggested.

"This machine has fantastic resolution," Dr. Cantor said. "If the tumor was too small for this baby to pick up, then the chances it could have caused a grand mal seizure are even smaller."

The infectious disease consult was the only one with anything specific to add, but his news wasn't good. He confirmed David's diagnosis of extensive pneumonia. He also demonstrated that the bacteria involved was a gram-negative type organism similar but not identical to the bacteria that had caused Kleber's and Tarlow's pneumonia. Worse still, he suggested that Mary Ann was already in septic shock.

From the Imaging Center David sent Mary Ann to the ICU where he insisted on the most aggressive therapy available. He allowed the infectious disease consult to handle the antibiotic regimen. The respiratory care he turned over to an anesthesiologist. By then Mary Ann's breathing was so labored she needed a respirator.

When everything that could be done for Mary Ann had been done and after all the consults had departed, David felt dazed. His group of oncology patients had become far more emotionally draining than he'd originally feared. Finally he left the ICU, and just to be reassured, he stopped in again to see Jonathan. Thankfully Jonathan was doing marvelously.

"I only have one complaint," Jonathan said. "This bed has a mind of its own. Sometimes when I press the button nothing happens. Neither the head nor the foot rises."

"I'll take care of it," David assured him.

Thankful for a problem that had an easy solution, David went back to the nurses' station and mentioned the problem to the evening head nurse, Dora Maxfield.

"Not his too," Dora said. "Some of these old beds break down a little too often. But thanks for telling us. I'll have maintenance take care of it right away."

David left the hospital and got on his bike. The temperature had dropped as soon as the sun had dipped below the horizon, but he felt the cold was somehow therapeutic.

Arriving home David found a bedlam of activity. Nikki had both Caroline and Arni over, and they were racing around the downstairs with Rusty in hot pursuit. David joined the melee, enjoying being pummeled and trampled by three active children. The laughter alone was worth the punishment. For a few minutes he forgot about the hospital.

When it was almost seven Angela asked David if he would take Caroline and Arni home. David was happy to do it, and Nikki came along. After the two children had been dropped off, David was glad for the moments alone with his daughter. First they talked about school and her new teacher. Then he asked her if she thought much about the body discovered in the basement.

"Some," Nikki said.

"How does it make you feel?" David asked.

"Like I don't want to ever go in the basement again."

"I can understand that," David said. "Last night when I was getting firewood I felt a little scared."

"You did?"

"Yup," David said. "But I have a little plan that might be fun and it might help. Are you interested?"

"Yeah!" Nikki said with enthusiasm. "What?"

"You can't tell anybody," David said.

"Okay," Nikki promised.

David outlined his plan as they continued home. "What do you say?" he asked once he had finished.

"I think it's cool," Nikki said.

"Remember, it's a secret," David said.

"Cross my heart."

As soon as David got into the house, he called the ICU to check on Mary Ann. He had been distressed that the floor nurses had missed the worsening condition of his two patients who had died. At the same time he recognized that his patients' vital signs had shown little change as their clinical states markedly deteriorated.

"There has been no alteration in Mrs. Schiller's status," the ICU nurse told him over the phone. She then gave him a lengthy review of Mrs. Schiller's vital signs, lab values, and even the settings on her respirator. The nurse's professionalism bolstered David's confidence that Mary Ann was receiving the best care possible.

Intentionally avoiding the kitchen table after the previous night's revelation, Angela served dinner in the dining room. It seemed huge with just three people and their skimpy dining-room furniture. But Angela tried to make it cozy with a fire in the fireplace and candles on the table. Nikki complained it was so dark she could hardly see her food.

After they had finished eating, Nikki excused herself to watch her half-hour allotment of television. David and Angela lingered at the table.

"Don't you want to ask me how my afternoon went?" Angela asked.

"Of course," David said. "How was it?"

"Interesting," Angela said. She told him about her conversations with Paul Darnell and Barton Sherwood concerning Dennis Hodges. She conceded that David might have been right when he suggested that some people in town knew who did it.

"Thanks for giving me credit," David said, "but I'm not happy about your asking questions about Hodges."