Robin Cook - Terminal

“It went south to Basic Diagnostics,” Dr. Friedburg said. “You’ll have to call there if you want any information on it. That sort of thing doesn’t come through this lab at all.”

“Who should I ask for?” Sean asked.

“Dr. Levy,” Dr. Friedburg said. “Ever since Paul and Roger left, she’s been running the show down there. I don’t know who she has reading the specimens now, but it’s not us.”

Sean hung up the phone. Nothing about Forbes seemed to be easy. He certainly wasn’t about to ask Dr. Levy about Helen Cabot. She’d know what he was up to in a flash, especially after she heard from Ms. Richmond about his looking at Helen’s chart.

Sean sighed as he looked down at the work he was doing trying to grow crystals with the Forbes protein. He felt like throwing it all into the sink.

For Janet, the afternoon seemed to pass quickly. With patients coming and going for therapy and diagnostic tests, there was the constant tactical problem of organizing it all. In addition, there were complicated treatment protocols that required precise timing and dosage. But during this feverish activity Janet was able to observe the way patients were divided among the staff. Without much finagling she was able to arrange to be the nurse assigned to take care of Helen Cabot, Louis Martin, and Kathleen Sharenburg the following day.

Although she didn’t handle them herself, she did get to see the containers the coded drugs came in when the nurses in charge of the medulloblastoma patients for the day got the vials from Marjorie. Once they’d received them, the nurses took them into the pharmacy closet to load the respective syringes. The MB300 drug was in a 10cc injectable bottle while the MB303 was in a smaller 5cc bottle. There was nothing special about these containers. They were the same containers many other injectable drugs were packaged in.

It was customary for everyone to have a mid-afternoon as well as a mid-morning break. Janet used hers to go back down to medical records. Once there she used the same ploy she’d used with Tim. She told one of the librarians, a young woman by the name of Melanie Brock, that she was new on the staff and that she was interested in learning the Forbes system. She said she was familiar with computers, but she could use some help. The librarian was impressed with Janet’s interest and was more than happy to show her their filing format, using the medical records’ access code.

Left on her own after Melanie’s introduction, Janet called up all patients with the T-9872 designator which she’d used to pull up current medulloblastoma cases on the ward’s work station. This time, Janet got a different list. Here there were thirty-eight cases on record over the last ten years. This list did not include the five cases currently in the hospital.

Sensing a recent increase, Janet asked the computer to graph the number of cases against the years. In a graph form, the results were rather striking.

Looking at the graph, Janet noted that over the first eight years there had been five medulloblastoma cases, whereas during the last two years there had been thirty-three. She found the increase curious until she remembered that it had been in the last two years that the Forbes had had such success with its treatment. Success sparked referrals. Surely that accounted for the influx.

Curious about the demographics, Janet called up a breakdown by age and sex. Sex showed a preponderance of males in the last thirty-three cases: twenty-six males and seven females. In the earlier five cases there had been three females and two males.

When she looked at ages, Janet noted that in the first five cases there was one twenty-year-old. The other four were below the age of ten. Among the recent thirty-three cases Janet saw that seven cases were below the age of ten, two between the ages of ten and twenty, and the remaining twenty-four were over twenty years of age.

Concerning outcome, Janet noted that all of the original five had died within two years of diagnosis. Three had died within months. In the most recent thirty-three, the impact of the new therapy was dramatically apparent. All thirty-three patients were currently alive, although only three of them were nearing two years after diagnosis.

Hastily, Janet wrote all this information down to give to Sean.

Next Janet randomly picked out a name from the list. The name was Donald Maxwell. She called up his file. As she went through the information, she saw that it was rather abbreviated. She even found a notation that said: Consult physical chart if further information is needed .

Janet had become so absorbed in her investigative work, she was shocked when she glanced at her watch. She’d used up her coffee break and then some, just as she had that morning.

Quickly she had the computer print out a list of the thirty-eight cases with their ages, sexes, and hospital numbers. Nervously, she went over to the laser printer as the sheet emerged. Turning from the printer, she half expected to find someone standing behind her, demanding an explanation. But no one seemed to have taken notice of her activities.

Before heading back to her floor, Janet sought out Melanie for one quick and final question. She found her at the copy machine.

“How do I go about getting the hospital chart of a discharged patient?” Janet asked.

“You ask one of us,” Melanie said. “All you have to do is provide us with a copy of your authorization, which in your case would come from the nursing department. Then it takes about ten minutes. We keep the charts in the basement in a storage vault that runs beneath both buildings. It’s an efficient system. We need access to them for patient care purposes, like when the patients come for outpatient care. Over in administration they need access to them for billing and actuarial purposes. The charts come up on dumbwaiters.” Melanie pointed to the small glass-fronted elevator set into the wall.

Janet thanked Melanie, then hurried out to the elevator. She was disappointed about the authorization issue. She couldn’t imagine how she would arrange that without completely giving herself away. She hoped Sean would have an idea.

As she pressed the elevator button impatiently, Janet wondered if she would have to apologize for again extending her break. She knew she couldn’t keep doing it. It wasn’t fair, and Marjorie was bound to complain.

Sterling was extremely pleased with the way the day was proceeding. He had to smile to himself as he rose up in the paneled elevator of the Franklin Bank’s home office on Federal Street in Boston. It had been a sublime day with minimal effort and maximum gain. And the fact that he was being handsomely compensated for enjoying himself made it all that much more rewarding.

The luncheon at the Ritz had been heavenly, especially since the maître d’ had been accommodating enough to bring a white Meursault down from the main dining room wine cellar. Sitting as close as he had to Tanaka and his guest, Sterling had been able to hear most of their conversation from behind his Wall Street Journal .

Tanaka’s guest was a personnel executive from Immunotherapy. Since the buyout, Genentech had left the company largely intact. Sterling did not know how much money was in the plain white envelope that Tanaka had placed on the table, but he did notice that the personnel executive had slipped it into his jacket in the blink of an eye.

The information Sterling overheard was interesting. Sean and the other founding partners had sold Immunotherapy in order to raise capital for a totally new venture. Tanaka’s informer wasn’t one hundred percent certain, but it was his understanding that the new company would also be a biotechnology firm. He couldn’t tell Tanaka its name or its proposed product line.