Robin Cook: Fatal Cure

"Thank you," Angela said.

"Frankly, I didn't expect a woman pathologist," Caldwell said. "Subsequently I've learned it's a field that is appealing to more and more women."

"The hours tend to be more predictable," Angela said. "It makes the practice of medicine and having a family more compatible." She studied the man. His comment made her slightly uncomfortable, but she was willing to withhold judgment.

"From your letters of recommendation I have the feeling that the department of pathology at the Boston City Hospital thinks you have been one of their brightest residents."

Angela smiled. "I've tried to do my best."

"And your transcript from Columbia 's medical school is equally impressive," Caldwell said. "Consequently, we would like to have you here at Bartlet Community Hospital. It's as simple as that. But perhaps you have some questions for me."

"David has also applied for a job in Bartlet," Angela said. "It's with one of the major health maintenance organizations in the area: Comprehensive Medical Vermont."

"We call it CMV," Caldwell said. "And it's the only HMO in the area."

"I indicated in my letter that my availability is contingent on his acceptance," Angela said. "And vice versa."

"I'm well aware of that," Caldwell said. "In fact I took the liberty of contacting CMV and talking about David's application with the regional manager, Charles Kelley. CMV's regional office is right here in our professional building. Of course I cannot speak for them officially, but it is my understanding there is no problem whatsoever."

"I'm to meet with Mr. Kelley as soon as we're through here," David said.

"Perfect," Caldwell said. "So, Dr. Wilson, the hospital would like to offer you a position as associate pathologist. You'll join two other full-time pathologists. Your first year's compensation will be eighty-two thousand dollars."

When Caldwell looked down at the folder on his desk, Angela looked David's way. Eighty-two thousand dollars sounded like a fortune after so many years of burdensome debt and meager income. David flashed her a conspiratorial smile in return, obviously sharing her thoughts.

"I also have some information in response to your query letter," Caldwell said. He hesitated, then added: "Perhaps this is something we should talk about privately."

"It's not necessary," Angela said. "I assume you are referring to Nikki's cystic fibrosis. She's an active participant in her care, so there are no secrets."

"Very well," Caldwell said. He smiled meekly at Nikki before continuing. "I found out that there is a patient with that condition here in Bartlet. Her name is Caroline Helmsford. She's nine years old. I've arranged for you to meet with her doctor, Dr. Bertrand Pilsner. He's one of CMV's pediatricians."

"Thank you for making such an effort," Angela said.

"No problem," Caldwell said. "Obviously we want you folks to come here to our delightful town. But I must confess that I didn't read up on the condition when I made the inquiries. Perhaps there is something I should know in order to be of more assistance."

Angela looked at Nikki. "Why don't you explain to Mr. Caldwell what cystic fibrosis is."

"Cystic fibrosis is an inherited problem," Nikki said in a serious and practiced tone. "When both parents are carriers there is a twenty-five percent chance a child will have the condition. About one in every two thousand babies is affected."

Caldwell nodded and tried to maintain his smile. There was something unnerving about getting a lecture from an eight-year-old.

"The main problem is with the respiratory system," Nikki continued. "The mucus in the lungs is thicker than in the lungs of normal people. The lungs have difficulty clearing the thicker mucus which leads to congestion and infection. Chronic bronchitis and pneumonia are the big worries. The condition is quite variable: some people are severely affected; others, like me, just have to be careful not to catch colds and do our respiratory therapy."

"Very interesting," Caldwell said. "You certainly sound professional. Maybe you should be a doctor when you grow up."

"I intend to," Nikki said. "I'm going to study respiratory medicine."

Caldwell got up and gestured toward the door. "How about you doctors and doctor-to-be going over to the medical office building to meet Dr. Pilsner."

It was only a short walk from the hospital's administrative area in the old central building to the newer professional building. In just a few minutes they passed through a fire door, and the corridor covering changed from vinyl tile to posh carpet.

Dr. Pilsner was in the middle of his afternoon office hours but graciously took time to meet the Wilsons. His thick white beard made him look a bit like Kris Kringle. Nikki took to him immediately when he bent down and shook her hand, treating her more like an adult than a child.

"We've got a great respiratory therapist here at the hospital," Dr. Pilsner said to the Wilsons. "And the hospital is well equipped for respiratory care. On top of that I took a fellowship in respiratory medicine at Children's in Boston. So I think we can take care of Nikki just fine."

"Wow!" Angela said, obviously impressed, and relieved. "This is certainly comforting. Ever since Nikki's diagnosis we take her special needs into consideration in all our decision-making."

"And indeed you should," Dr. Pilsner said. "Bartlet would be a good choice with its low pollution and clean, crisp air. Provided she has no tree or grass allergies, I think it would be a healthy environment for your daughter."

Caldwell escorted the Wilsons to CMV's regional headquarters. Before he left he made them promise to return to his office after David's interview.

The CMV receptionist directed the Wilsons to a small waiting area. The three of them barely had time to pick up magazines before Charles Kelley emerged from his private office.

Kelley was a big man who towered eight inches over David as they shook hands. His face was tanned and his sandy-colored hair had pure blond streaks running through it. He was dressed in a meticulously tailored suit. His manner was outgoing and ebullient, more like a high-powered super-salesman than a health care administrator.

Like Caldwell, Kelley invited the whole Wilson family into his office. He was also equally complimentary.

"Frankly, we want you, David," Kelley said, tapping a closed fist on his desk. "We need you as part of our team. We're pleased that you've taken an internal medicine residency, especially at a place like the Boston City Hospital. As more of the city moves to the country, we're finding we need your kind of expertise. You'll be an enormous addition to our primary care/gatekeeper crew, no doubt about it."

"I'm pleased you're pleased," David said with an embarrassed shrug.

"CMV is expanding rapidly in this area of Vermont, especially in Bartlet itself," Kelley boasted. "We've signed up the coat-hanger mill, the college, and the computer software company, as well as all the state and municipal employees."

"Sounds like a monopoly," David joked.

"We'd rather think it has to do with our dedication to quality care and cost control," Kelley said.

"Of course," David agreed.

"Your compensation will be forty-one thousand the first year," Kelley said.

David nodded. He knew he'd be in for some teasing from Angela even though they'd known all along that her earnings would be significantly larger than his. On the other hand, they hadn't expected hers would be double his.

"Why don't I show you your prospective office," Kelley said eagerly. "It will give you a better feeling for our operation and what it will be like working here."

David looked at Angela. Kelley's approach was certainly a harder sell than was Caldwell 's.

To David's mind the office was dream-like. The view south over the Green Mountains was so picture-perfect, it looked like a painting.