Robin Cook - Fatal Cure

"No, I don't think so," Walt said as he tried to think. "Toxicology came back and was negative except for the alcohol level which I told you about. That's about it. As I said, nobody's making this case much of a priority."

"I understand," Angela said. "Anything more on that carbon under the skin?"

"Haven't had a chance to even think about it again," Walt admitted.

After they wolfed down their sandwiches Angela said she had to get back to Bartlet; she told Walt she was on her lunch hour. Walt encouraged her to come back any time.

The drive back to Bartlet seemed even faster than the drive to Burlington. Calhoun dropped Angela off behind the library so she could get her own car.

"I'll be in touch," Calhoun said. "And remember, stay out of it."

"Don't worry," Angela said. She waved as she got in behind the wheel. It was almost one-thirty.

Back in her office, Angela put the copies of Hodges' papers in the top drawer of her desk. She wanted to remember to take them home that evening. While she was donning her white lab coat Wadley opened the connecting door without bothering to knock.

"I've been looking for you for almost twenty minutes," he said irritably.

"I was out of the hospital," Angela said.

"That much was obvious," Wadley said. "I had you paged several times."

"I'm sorry," Angela said. "I used my lunch hour to run an errand."

"You've been gone longer than an hour," Wadley said.

"That might be," Angela said, "but I plan to stay later than scheduled, which I normally do anyway. Plus, I spoke to Dr. Darnell to cover in case there were any emergencies."

"I don't like my pathologists disappearing in the middle of the day," Wadley said.

"I was not gone long," Angela said. "I'm fully aware of my responsibilities and carry them out to the letter. I was not responsible for surgical specimens which would have been the only true emergency. Besides, my errand involved a visit to the chief medical examiner."

"You saw Walt Dunsmore?" Wadley asked.

"You can call him if you doubt me," Angela said. She could tell that Wadley was partially mollified. She was suddenly glad she'd made the spur-of-the-moment visit.

"I'm too busy to be checking on your whereabouts," Wadley said. "The point is that I'm concerned about your behavior of late. I should remind you that you are still on probationary status. I can assure you that you will be terminated if you prove to be unreliable."

With that, Wadley stepped back through the connecting door and slammed it shut.

For a moment Angela stared at the door. She detested this open hostility with Wadley. Still, she preferred it to the previous sexual harassment. She wondered if they would ever be able to develop a normal professional relationship.

After the last office patient had been seen, David reluctantly headed over to the hospital to make his afternoon rounds. He was beginning to dread the experience for fear of what he might face.

Before seeing his own patients David went to the ICU to check on Caroline. The child was doing poorly and was clearly moribund. David found Dr. Pilsner sitting at the ICU desk in a hopeless vigil. The man was despondent. David could relate all too well.

Leaving the ICU, David started seeing his own patients. Each time he went into another room he felt anxious, only to be relieved when he discovered the patient was doing well. But when he went into Sandra's room the anxiety remained. Sandra's mental status had deteriorated.

David was appalled. The change was dramatic to him even though the nurses weren't impressed. When David had visited her early that morning she'd been bright and aware. Now she was apathetic to her surroundings and was drooling. Her eyes had lost their luster. Her temperature, which had fallen, had now crept back up over one hundred degrees.

When David tried to talk to her, she was vague. The only specific complaint he could elicit was abdominal cramps, a symptom that reminded him of other patients he'd been trying to forget. David felt his pulse quicken. He didn't think he could tolerate losing another patient.

Back at the nurses' station, David pored over Sandra's chart. The only new fact was that she'd apparently lost her appetite as evidenced by an entry in the nurses' notes that recorded she'd not eaten her lunch. David checked all the IV fluids she'd had; they were all appropriate. Then he went over all the laboratory tests; they were all normal. He was desperate for some clue to explain the change in her mental status, but there were no clues in the chart. The only idea that came to his mind was the possibility of early meningitis, or inflammation of the coverings of her brain. It was the fear of her developing meningitis that had moved him to admit her in the first place.

David re-examined her, and although he could not elicit any signs of meningitis, he went ahead with the definitive test. He did a lumbar puncture to obtain cerebrospinal fluid. He knew immediately the fluid was normal because of its clarity, but he sent it to the lab for a stat reading to be certain. The result was normal. So was a stat blood sugar.

The only thing Sandra wasn't apathetic about was pain when David palpated her abscess. Consequently, David added another antibiotic to her regimen. Beyond that he had no ideas. He felt lost. All he could do was hope.

Climbing on his bike, David cycled home. He knew he was depressed. He got no enjoyment from the ride. He felt heartsick about Caroline and concerned about Sandra. But as soon as he arrived he realized he could not wallow in self-pity. Nikki was slightly worse than she'd been at lunchtime when he'd brought home her oral antibiotic. Her congestion had increased and her temperature had reached one hundred degrees.

David phoned the ICU and got Dr. Pilsner on the line. David apologized for disturbing him but felt obliged to let him know the oral antibiotic wasn't helping.

"Let's up it," Dr. Pilsner said in a tired voice. "And I think we'd better use a mucolytic agent and a bronchodilator with her respiratory therapy."

"Any change with Caroline?" David asked.

"No change," Dr. Pilsner answered.

Angela didn't get home until almost seven o'clock. After she checked on Nikki, who was doing better after a respiratory therapy session with David, she went to take a shower. David followed her into the bathroom.

"Caroline is no better," David said as Angela stepped into the shower.

"I feel great compassion for the Helmsfords," Angela said. "They must be heartsick. I hope to heaven that Nikki doesn't come down with whatever Caroline got."

"I've got another patient-Sandra Hascher-who is scaring me the same way the others did."

Angela poked her head out of the shower. "What was her admitting diagnosis?"

"Abscessed tooth," David said. "It had responded nicely to antibiotics. Then this afternoon she suddenly had a mental status change."

"Disoriented?"

"Mostly just apathetic and vague," David said. "I know it doesn't sound like much, but to me it was dramatic."

"Meningitis?" Angela asked.

"That was the only thing I thought of," David said. "She hasn't had any headache or spiking fever. But I did a lumbar puncture just to be sure, and it was normal."

"What about a brain abscess?" Angela asked.

"Again, she's had little fever," David said. "But maybe I'll do an MRI tomorrow if she's not better. The problem is, she's reminding me of the other patients who died."

"I suppose you don't want to ask for any consults."

"Not unless I want to have her transferred to someone else," David said. "I might even get into trouble ordering the MRI."

"It's a lousy way to practice medicine," Angela said.

David didn't answer.

"The trip to Burlington went smoothly," Angela said.

"I'm glad," David replied without interest.