Робин Кук - Mortal Fear

After leaving word that he should be called after the cardiology consult on Brian Lennox and after one more masochistic glance at the sheet-wrapped corpse of Cedric Harring, Jason left the coronary care unit and took the elevator down to the second floor, which connected the hospital with the outpatient building. The GHP Medical Center was the impressive central facility of the large prepaid health plan. It incorporated a four-hundred-bed hospital with an ambulatory surgery center, separate outpatient department, a small research wing, and a floor of administrative offices. The main building, originally designed as a Sears office building, had an art deco flair. It had been gutted and totally renovated to incorporate the hospital and the administrative offices. The outpatient and research building was new, but it had been built to match the old structure, with the same careful details. It was built on pillars over a parking lot. Jason’s office was on the third floor, along with the rest of the department of internal medicine.

There were sixteen internists at the GHP Center. Most were specialists, though a few like Jason maintained a generalized practice. Jason had always felt that the whole panoply of human illness interested him, not just specific organs or systems.

The doctors’ offices were spread around the perimeter, with a central desk surrounded by a waiting area with comfortable seating. Examining rooms were clustered between the offices. At one end were small treatment rooms. There was a pool of support personnel who were supposed to rotate positions, but in actual fact the nurses and secretaries tended to work for one or another of the doctors. Such a situation promoted efficiency since there could be some adaptation to each doctor’s eccentricities. A nurse by the name of Sally Baunan and a secretary by the name of Claudia Mockelberg had aligned themselves with Jason. He got along well with both women, but particularly Claudia, who took an almost motherly interest in Jason’s well-being. She had lost her only son in Vietnam and contended that Jason looked just like him despite the age difference.

Both women saw Jason coming and followed him to his office. Sally had an armload of charts of waiting patients. She was the compulsive one, and Jason’s absence had disturbed her carefully planned routine. She was eager to “get the show on the road,” but Claudia restrained her and sent her out of the room.

“Was it as bad as you look?” Claudia asked.

“Is it that obvious?” Jason said as he washed his hands at the sink in the comer of the room.

She nodded. “You look like you’ve been run over by an emotional train.”

“Cedric Harring died,” he said. “Do you remember him?”

“Vaguely,” Claudia admitted. “After you got called to the emergency room, I pulled his chart. It’s on your desk.”

Jason glanced down and saw it. Claudia’s efficiency was sometimes unnerving.

“Why don’t you sit down for a few moments,” Claudia suggested. More than anyone else at GHP, Claudia knew Jason’s reaction to death. She was one of only two people at the Center in whom Jason had confided about his wife’s fatal accident.

“We must be really behind schedule,” Jason said. “Sally will get her nose bent out of shape.”

“Oh, screw Sally.” Claudia came around Jason’s desk and pushed him gently into the seat. “Sally can hold her water for a few minutes.”

Jason smiled in spite of himself. Leaning forward, he fingered Cedric Harring’s chart. “Do you remember last month the two others who died just after their physicals?”

“Briggs and Connoly,” Claudia said without hesitation.

“How about pulling their charts? I don’t like this trend.”

“Only if you promise me you’re not going to let yourself” — Claudia paused, struggling for a word — “get into a dither over this. People die. Unfortunately it happens. It’s the nature of the business. You understand? Why don’t you just have a cup of coffee.”

“The charts,” Jason repeated.

“Okay, okay,” Claudia said, going out.

Jason opened Cedric Harring’s chart, glancing through the history and physical. Except for his unhealthy living habits, there was nothing remarkable. Turning to the EKG and the stress EKG, Jason scanned the tracing, looking for some sign of the impending disaster. Even armed as he was with hindsight, he could find nothing.

Claudia came back and opened the door without knocking. Jason could hear Sally whine, “Claudia...” but Claudia shut the door on her and came over to Jason’s desk. She plopped down Briggs’s and Connoly’s charts in front of him.

“The natives are getting restless,” she said, then left.

Jason opened the two charts. Briggs had died of a massive heart attack probably similar to Harring’s. Autopsy had shown extensive occlusion of all of the coronary vessels despite the EKG done during his physical four weeks prior to his death being as normal-looking as Harring’s. Also like Harring’s, his stress EKG had been normal. Jason shook his head in dismay. Even more than the normal EKG, the stress EKG was supposed to pick up such potentially fatal conditions. It certainly suggested that the executive physical was an exercise in futility. Not only was the examination failing to pick up these serious problems, but it was giving the patients a false sense of security. With the results being normal, there wasn’t motivation for the patients to change their unhealthy lifestyles. Briggs, like Harring, had been in his late fifties, was a heavy smoker, and never exercised.

The second patient, Rupert Connoly, had died of a massive stroke. Again, it had been a short time after an executive-style physical, which in his case had also revealed no alarming abnormalities. In addition to a generally unhealthy lifestyle, Connoly had been a heavy drinker, though not an alcoholic. Jason was about to close the chart when he noticed something he had missed before. In the autopsy report the pathologist had recorded significant cataract development. Thinking that he’d not remembered the man’s age correctly, Jason flipped to the information page. Connoly was only fifty-eight. Now cataracts were not entirely unknown at fifty-eight, but it was nonetheless rare. Turning to the physical, Jason checked to see if he’d noted cataracts. Embarrassingly he’d failed to include them, noting he described the “eyes, ears, nose, and throat” as being within normal limits. Jason wondered if he were getting sloppy in his “old” age. But then he noticed he described the retinas as appearing normal as well. In order to have visualized the retinas, Jason would have had to have sighted through a cataract. Not being an ophthalmologist, he knew his limitations in this regard. He wondered if certain kinds of cataracts impede the passage of light more than others. He added that question to his mental list of things to investigate.

Jason stacked the charts. Three apparently healthy men had all died a month after their physicals. Jesus, he thought. People were often scared of going to hospitals. If this got out, they might stop getting checkups.

Grabbing all three charts in his arms, Jason emerged from his office. He saw Sally stand up in the central desk area and look at him expectantly. Jason silently mouthed “two minutes” as he walked the length of the waiting area. He passed several patients whom he treated with nods and smiles. He slipped into the hall leading to Roger Wanamaker’s office. Roger was an internist who specialized in cardiology and whose opinion Jason held in high esteem. He found the man leaving one of the examination rooms. He was an obese man with a face like an old hound dog with wattles and lots of extra skin.

“How about a sidewalk consult?” Jason asked.