Robin Cook: Harmful Intent

Jeffrey stepped over to the window to stretch. He was again bathed in the red neon light. A group of homeless people was milling around to the right of the Essex's stoop, presumably in front of the liquor store. Several young hookers were working the street. Off to the side were young toughs who seemed to take a proprietary interest in the goings-on of the area.

Whether they were pimps or drug dealers, Jeffrey couldn't say. What a neighborhood, he thought.

He turned away from the window. Jeffrey had seen enough. Chris's notes were sprawled across the bed. The moans from next door had stopped. Jeffrey tried to review the list of possibilities for the Noble and Owen mishaps.

Once more he focused on the notion that had so consumed Chris through the course of his last days: the possibility of a contaminant in the Marcaine.

Assuming that neither he nor Chris had made a gross medical error-in the

Owen case, for example, that he had not used the.75% Marcaine that had been found in his disposal-and in view of the fact that both patients had had unexpected parasympathetic symptoms without allergic or anaphylactic reactions, then Chris's theory of a contaminant had considerable validity.

Returning to the window, Jeffrey thought about the implications of a contaminant being in the Marcaine. If he could prove such a theory, it would go a long way toward absolving him from blame in the Owen case.

Culpability would fall to the pharmaceutical company that had manufactured it. Jeffrey wasn't sure about how the legal machinery would work once such a theory was proven. Given his recent brushes with the judicial system, he knew the gears would turn slowly, but turn they would. Maybe old Randolph would be able to figure a way to get the

wheels to turn faster. Jeffrey smiled at a wonderful thought: maybe his life and career could be salvaged. But how would he go about proving there had been a contaminant in a vial that had been used nine months earlier?

Suddenly, Jeffrey had a thought. He rushed back to Chris's notes to read

Henry Noble's case summary. Jeffrey was particularly interested in the initial sequence of events, when Chris was first administering the epidural anesthesia.

Chris had taken 2 cc's of Marcaine from a 30 cc ampule for his test dose, adding his own 1:200,000 epinephrine. It had been immediately after that test dose that Henry Noble's reaction began. With Patty Owen, Jeffrey had used a fresh 30 cc ampule of Marcaine in the OR. It was after this Marcaine was introduced into her system that her adverse reaction began. For the test dose, Jeffrey had used a separate 2 cc vial of spinal grade Marcaine, as was his custom. If a contaminant had been in the Marcaine, it had to have been in the 30 cc ampule in both situations. That would mean that

Patty had gotten a substantially larger dose than Henry Noble-a full therapeutic dose as opposed to a test dose of 2 cc's. That would explain why Patty's reaction was so much more severe than Henry Noble's and why

Noble had managed to live for a week.

For the first time in months, Jeffrey felt a glimmer of hope that his old life was still within reach. He could have it back again. During his defense, he'd never considered the possibility of a contaminant. Now, suddenly it seemed like a real possibility. But it would take time and some serious effort to investigate, much less prove. What was his first step?

First of all, he needed more information. That meant he'd have to bone up on the pharmakinetics of local anesthetics as well as the physiology of the autonomous nervous system. But that would be relatively easy. All he needed was books. The hard part would be looking into the idea of a contaminant.

He'd need access to the full pathology report on Patty Owen. He'd seen only parts of it during the discovery process. Plus, there was the question

Kelly had raised: what about an explanation for the.75% Marcaine vial found in the disposal container on the anesthesia machine? How could it have gotten there?

Investigating these issues would have been difficult under the best of circumstances. Now that he was a convict and a fugitive, it would be all but impossible. He would have to get into Boston Memorial. Could he do that?

Jeffrey went into the bathroom. Standing in front of the mirror, he evaluated his features in the raw fluorescent light. Could he change his appearance enough not to be recognized? He'd been associated with Boston

Memorial since his clinical clerkships in medical school. Hundreds of people knew him by sight.

Jeffrey put a hand to his forehead and slicked back his light brown hair.

He combed his hair to the side, parting it on the right. Holding it back made his forehead appear broader. He'd never worn glasses. Maybe he could get a pair now. And for most all of the years he'd been working at Boston

Memorial, he'd had a mustache. He could shave it off.

Caught up with this intriguing thought, Jeffrey went to the other room to retrieve his Dopp Kit. He went back to the bathroom miffor. Soaping up, he quickly shaved off his mustache. It felt strange to run his tongue across a bare upper lip. Wetting his hair, he combed it straight back from his forehead. He was encouraged; already he was beginning to look like a new man.

Next, Jeffrey shaved off his moderate sideburns. The difference wasn't much but he figured everything helped. Could he pass for another M.D.? He had the know-how; what he needed was an ID. Security at Boston Memorial had been beefed up considerably, a sign of the times. If he was challenged and couldn't produce an ID, he would be caught. Yet he needed the access, and it was the doctors who had access to all areas of the hospital.

Jeffrey kept thinking. He wouldn't despair. There was another group in the hospital that had wide access: housekeeping. No one questioned housekeeping. Having spent many nights on call in the hospital, Jeffrey could recall seeing housekeeping staff everywhere. No one ever wondered about them. He also knew there was a housekeeping graveyard shift from eleven P.m. to seven A.M., which they always had a hard time filling. The graveyard shift would be perfect, Jeffrey figured. He'd be less likely to bump into people who knew him. For the past few years, he'd worked mainly during the day.

Energized by this new crusade, Jeffrey yearned to start immediately. That meant a trip to the library. If he left right away, he would have about an hour before closing. Before he had time for second thoughts, he slipped

Chris's notes into the spot he'd prepared for them in his briefcase and closed and latched the lid.

For what it was worth, Jeffrey locked the door behind him. As he made his way down the stairs, he hesitated. The musty,

sour smell reminded him of Devlin. Jeffrey had gotten a whiff of his breath when Devlin nabbed him at the airport.

In considering his plan of action, Jeffrey neglected to factor in Devlin.

Jeffrey knew something about bounty hunters, and that's what Devlin undoubtedly was. Jeffrey harbored no illusions of what would happen if

Devlin caught him again, especially after the episode at the airport. After a moment's indecision, Jeffrey resignedly continued down the stairs. If he wanted to do any investigating, he'd have to take some chances, but it still behooved him to remain constantly alert. In addition, he'd have to think ahead so that if he was unlucky enough to confront Devlin, he'd have some sort of plan. Downstairs, the man with the magazine was gone, but the clerk was still watching the Red Sox game. Jeffrey slipped out without being noticed. A good sign, he joked to himself His first try at not being seen was a success. At least he still had a sense of humor.

Any lightheartedness that Jeffrey had been able to call up faded as he surveyed the street scene in front of him. He felt a wave of acute paranoia as he reminded himself of the double reality of being a fugitive and carrying around $45,000 in cash. Directly across from Jeffrey, in the shadows of a doorway of a deserted building, the two men he'd seen from the window were smoking crack.