Robin Cook - Harmful Intent

Holding the ampule up to the light, he inspected it carefully. It was close to perfect. He could still tell that the tube had been punctured, but he had to look carefully. He thought it might have been the best one he'd ever done. It gave him great satisfaction to have mastered such a difficult process. When he'd first thought of it a number of years ago, he'd had no idea if it would work. It used to take him hours to do what he could now do in minutes.

Once he had accomplished what he'd set out to do, Trent returned the vial of yellow fluid, the.45 pistol, and the remaining vials of Marcaine to the hiding place. He replaced the false back of the cabinet and put the glasses back.

Picking up the doctored Marcaine vial, he gave it a good shake. The drop of yellow fluid had long since dissolved. He turned the ampule upside down, checking to see if there was a leak. But the puncture site was as he expected it to be: airtight.

Trent gleefully considered the effect his vial would soon have in St.

Joseph's OR. He thought particularly about the high-andmighty doctors, the havoc he would wreak in that lofty quarter. In his wildest dreams, Trent couldn't have settled on a better career.

Trent hated doctors. They always acted as if they knew everything, when in reality many didn't know their ass from a hole in the wall, especially in the Navy. Most of the time Trent knew twice as much as the doctor did, yet he had to do their bidding. In particular, Trent loathed that true pig of a Navy doctor who'd turned him in for pocketing a few amphetamines. What a hypocrite. Everybody knew the doctors had been making off with drugs and instruments and all sorts of other loot for years. Then there was that real pervert doctor who complained to Trent's commanding officer about Trent's alleged homosexual behavior. That had been the straw that broke t he camel's back. Instead of going through some stupid court-martial or whatever the hell they were planning to do, Trent had resigned.

At least by the time he got out, he was properly trained. He

had no trouble getting nursing jobs. With nursing shortages widespread, he found he could work anywhere he pleased. Every hospital wanted him, especially since he liked working in the OR and had experience in that area from his stint in the Navy.

The only trouble with working in a civilian hospital, aside from the doctors, was the rest of the nursing staff. Some of them were as bad as the doctors, particularly the supervisors. They were always trying to tell him something he already knew. But Trent didn't find them as irritating as the doctors. After all, it was the doctors who conspired to limit the autonomy

Trent had had to practice routine medicine in the Navy.

Trent put the doctored ampule of Marcaine in the pocket of his white hospital coat, which hung in the front closet. Thinking about doctors reminded him of Dr. Doherty. He clenched his teeth at the thought of the man. But it wasn't enough. Trent couldn't contain himself. He slammed the closet door with such force it seemed to jar the whole building. Just that day, Doherty, one of the anesthesiologists, had had the nerve to criticize

Trent in front of several nurses. Doherty had chastised him for what he referred to as sloppy sterile technique. And this was coming from the moron who didn't put on his scrub hat or surgical mask properly! Half the time

Doherty didn't even have his nose covered. Trent was enraged.

"I hope Doherty gets the vial," Trent snarled. Unfortunately, there wasn't any way he could ensure Doherty's getting it. The chances were about one in twenty unless he waited until Doherty was scheduled for an epidural. "Ah, who cares," Trent said with a wave of dismissal. It would be entertaining no matter who got the vial.

Although Jeffrey's new fugitive status heightened his indecision and confusion, he no longer had the slightest inclination toward suicide. He didn't know if he was acting courageously or cow ardly, but he wasn't about to agonize further. Yet with all that had happened, he was understandably concerned about the pos sibility of a new round of depression. Thinking it better to throw temptation away, he t ' ook the step of getting the morphine vial from the briefcase, popping its lid, and flushing the contents down the toilet.

Having at least made a decision about one issue, Jeffrey felt slightly more in control. To make himself feel even more organized, he occupied himself by rearranging the contents of his briefcase. He stacked the money carefully, in the base, covering

it with the underwear. He then rearranged the contents of the accordion-style file area under the lid to make room for Chris Everson's notes. Turning his attention to the notes, he organized them according to size. Some of them were on Chris's notepaper, which had From the Desk of

Christopher Everson printed on top. Others were written on sheets of yellow legal paper.

Jeffrey began to scan the notes, almost without meaning to. He was glad for anything that took his mind away from his current predicament. Henry

Noble's case history was especially fascinating the second time around.

Once again, Jeffrey was struck by the similarities between Chris's unhappy experience with the man and his own with Patty Owen, particularly with respect to each patient's initial symptoms. The major difference between the two cases was that Patty's had been more fulminating and overwhelming.

Since Marcaine had been involved in both cases, the fact that the symptoms were similar was not surprising. What seemed extraordinary was that in both situations the initial symptoms were not what was expected in an adverse reaction to a local anesthetic.

Having been a practicing anesthesiologist for some years, Jeffrey was familiar with the kinds of symptoms that could occur when a patient had an adverse reaction to a local anesthetic. Trouble invariably arose due to an overdose reaching the bloodstream, where it could affect either the heart or the nervous system. Considering the nervous system, it was usually the central or the autonomic system that caused problems, either through stimulation or depression, or a combination of the two.

All this covered a lot of territory, but of all the reactions Jeffrey had studied, heard about, or witnessed, none had been anything like Patty

Owen's, not with the excessive salivation, the tearing, the sudden perspiration, the abdominal pain, and the constricted, or miotic, pupils.

Some of these responses might occur in an allergic reaction, but not from an overdose, and Jeffrey had reason to believe that Patty Owen had not been allergic to Marcaine.

Obviously, tojudge by his notes, Chris Everson had been comparably troubled. Chris noted that Henry Noble's symptoms were more muscarinic than anything else, meaning the kind that were expected when parts of the parasympathetic nervous system were stimulated. They were called muscarinic because they mirrored- the effect of a drug called muscarine, which came from a type of mushroom. But parasympathetic stimulation was not

expected with a local anesthetic like Marcaine. If not, then why the muscarine symptoms? It was puzzling.

Jeffrey closed his eyes. It was all very complicated, and, unfortunately, although he knew the basics, much of the physiological details were not fresh in his mind. But he remembered enough to know that the sympathetic division of the autonomic nervous system was the part affected by local anesthetics, not the parasympathetic part apparently affected in the Noble and Owen cases. There was no immediate explanation for it.

Jeffrey's deep concentration was interrupted by a thump against the wall, then some exaggerated moaning of feigned ecstasy coming from the neighboring room. He had an unwelcome image of the pimply-faced girl and the bald man. The moaning reached a crescendo of sorts and then diminished.