Robin Cook - Marker

"Thank you for your apology. Under normal circumstances, I wouldn't have reacted as I did. I'm afraid I'm not seeing much humor in things lately."

"Well, I didn't get a chance to tell you that Mulhausen was clean, just as you suspected. There was no pathology whatsoever on gross. And talking about Lou, you should know that I told him that I was coming around to your serial-killer idea and that his department might want to look into it."

"Really? And what did he say?"

"He wanted to know what the official OCME position was, and I told him."

"And?"

"He said under the circumstances, with neither the OCME or the hospital taking a stand and the mayor's office tangentially involved, his hands were, in a sense, tied."

"I'm going to try to change all that by coming up with a list of suspects."

"Actual suspects! Whoa! That would certainly alter the landscape. And strange that you should say that. I had a new thought along those lines."

"This should be interesting."

"Although the deaths in your series seem counterproductive to the actuarial interests of managed care, there are a couple of ways they could be related to the managed-care phenomenon."

"I'm listening."

"Managed care has had to be aggressive, taking over practices and hospitals in an often hostile way. Your serial killer could be someone as angry at AmeriCare as I am. I have to admit I'd harbored some murderous thoughts after AmeriCare gobbled up my practice. If it weren't for AmeriCare, I'd still be a conservative ophthalmologist back in the Midwest, walking around in a glen plaid suit and struggling to put a couple of girls through college."

"No matter how many times you tell me the story of your former life, I find it hard to picture. I'm sure I wouldn't recognize you."

"I wouldn't recognize myself!"

"But your point is well taken. A physician who has admitting privileges at Manhattan General and Saint Francis Hospital is one of the profiles that is being considered. What's your other idea?"

"Managed-care competition! It's a dog-eat-dog business world out there in the medical arena. As the two local giants in the industry, National Health and AmeriCare have bumped heads in the past with some strikingly underhanded machinations coming to light. I know National Health has generally conceded New York to AmeriCare, but they could have had a change of mind. Causing AmeriCare a major PR disaster, which your series will be sooner or later, would undoubtedly be a boon to National Health. And as long as I'm thinking in this vein, any individual or group who wanted AmeriCare stock to tumble could be involved, because once your series hits the media, investors are going to turn away in droves."

"Good points!" Laurie conceded. "I really hadn't thought of either one of those ideas. Thank you."

"Don't mention it."

Jack took a long pull on his beer, drinking it directly from the bottle. Laurie sipped her sparkling water. The restaurant was awakening from its daytime slumber. A few more patrons were seated. A bar crowd had materialized, raising the noise level with excited chatter and bursts of laughter.

Noticing the break in Jack and Laurie's conversation, the waiter came over to ask if they'd like to order appetizers. After Laurie and Jack exchanged glances to see if either objected, they both nodded, which keyed off an impressive performance on the waiter's part. He rattled off a long list of appetizer specials, explaining each in painstaking detail. Despite the enticing recital, Laurie ordered an arugula salad, and Jack settled on calamari. Both were from the regular menu.

After the waiter had gone and left them alone again, Jack eyed Laurie. She had her head down while busily repositioning her flatware that was already perfectly well positioned. Jack sensed that she was tense. After several more minutes went by, what had started out as a mere pause in the conversation seemed to Jack to become an awkward lull. He adjusted himself on the hard seat, and after a glance around the room to make sure they were being appropriately ignored, he broke the silence: "When would you like to talk about your important 'whatever' that involves you and me and no one else? Is it an appetizer subject, an entree subject, or a dessert subject?"

Laurie looked up. Jack tried to read her blue-green eyes, but he couldn't tell if she was angry or anguished. His speculation about what she was going to say ran the full gamut from her wanting to patch things up, as Lou had suggested, to telling him she was tying the knot with her French-sounding boyfriend. The fact that she was dragging the mystery out was starting to wear thin.

"If it's not too much to ask, I would like you to kindly avoid any attempts at sarcastic humor. I'm sure it is obvious I'm having a hard time with this, and you could at least show some respect."

Jack took a deep breath. It was a tall order for him to abandon his most potent psychological defense in a situation when he feared he needed it the most. "I'll try," he offered, "but I'm all over the map trying to figure what this is all about."

"First, let me say that I learned yesterday that I have the marker for BRCA1."

Jack stared at his former lover while myriad thoughts reverberated inside his head. Along with a rush of sympathy and concern was what he considered a less noble sense of relief. Selfishly, he knew he could personally deal with the BRCA1 problem a lot better than he could with the idea that she was getting married.

"Aren't you going to say anything?" Laurie asked after a pause.

"I'm sorry! The news has just caught me unawares. I'm truly sorry to hear that you have the marker. On the positive side, I still think it is better that you know than if you didn't know."

"At the moment, I'm not convinced."

"I am. There's not a shred of doubt in my mind. For now, it will merely mean you'll have to be that much more vigilant, perhaps with mammograms or MRIs on a yearly basis. Remember that although the marker means you have an increased risk of developing cancer before the age of eighty, your mother, whose mutation you undoubtedly share, didn't develop the problem until she was in her eighties."

"That's true," Laurie said, recognizing that Jack had a point. Her face visibly brightened. "And my maternal grandmother who'd had breast cancer didn't develop it until her eighties, either. And my aunts who are all in their latter seventies haven't gotten it-at least not yet."

"Well, there you go," Jack said. "It seems reasonably clear to me that your particular family mutation determines an octogenarian illness."

"Maybe," Laurie said, retracting some of her optimism. "But there's no test for such an assertion, and it doesn't take into account the increased risk of ovarian cancer."

"Has anyone in your family on either side ever had ovarian cancer?"

"Not that I know of."

"It seems to me that is all very positive information."

"I suppose," Laurie said, going back to tinkering with her flatware.

Jack took another gulp of his cold beer. He felt hot and wondered vaguely if his face reflected it. He stuck a finger into his collar and pulled it away from his perspiring neck. He was dying to take off his tie, but he didn't dare, with the chic way Laurie was dressed. What was bothering him was the way Laurie had introduced the BRCA1 issue. She'd said "first," which made Jack worry there was a "second."

At that moment, the salad and calamari arrived. The waiter served the food and then busily rearranged the table and scooped up the breadcrumbs before disappearing. He'd not pestered them about their entree order, which reminded Jack of one of the reasons he liked to eat at Elios. He'd never felt victimized by the inevitable bum's rush in an effort to turn the table, as he had at so many other "in" restaurants.