Side Effects (9 page)

"So, how's Kate?" The older Samuels was still looking out the window when he spoke.

"She's okay. A little harried at work, but okay." It was unwise, Jared had learned over the years, to offer his father any more information than asked for. At seventy, the man was still as sharp as anyone in the game. What he wanted to know, he would ask.

"And how are the negotiations coming with the union people at Granfield?"

"Fine. Almost over, I think. We're meeting with them this afternoon. If that idiot shop steward can understand the pension package we've put together, the whole mess should get resolved with no more work stoppage."

"I knew you could do it. I told Toby Granfield you could do it."

"Well, like I said, it's not over yet."

,-. %^

"But it will be." The words were an order, not a question.

"Yes," Jared said. "It will be."

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"Excellent, excellent. How about a little vacation for you and Kate when everything is signed and sealed. Goodness knows you deserve it. Those union thugs are slow, but they're tough. Bert Hodges says his place in Aruba is available the week after next. Suppose we book it for you."

"I don't ... what I mean is I'll have to talk with Kate. She's got quite a bit going on at the hospital."

"I know." Win Samuels swung around slowly to face his son. At six feet, he was nearly as tall as Jared and no more than five pounds heavier. His rimless spectacles and discreetly darkened hair neutralized the aging effects of deep crow's feet and a slightly sallow complexion.

"What?"

"I said that I knew she was having a busy time of it at the hospital." Samuels paused, perhaps for dramatic effect.

"Norton Reese called me this morning."

"Oh?" The statement was upsetting. For five years, Jared had handled all of Boston Metro's legal affairs. There was no reason for Norton Reese to be dealing directly with his father, even allowing that the two of them had known each other for years.

"He tells me the head of pathology is retiring." Jared nodded that the information was not news. "He also said that this head pathologist, Willoughby, wants Kate to take over for him."

"She mentioned that to me," Jared understated.

"Did she now? Good. I'm glad you two communicate about such minor goings on." The facetiousness in Samuels's voice was hardly subtle.

Kate's independence had been a source of discussion between them on more than one occasion. Somewhere in the drawer of that Louis Quatorze desk was a computer printout showing that while he had received forty-nine percent of the total vote cast in the congressional race, he had garnered only forty-two percent of the women's vote.

To Win Samuels, the numbers meant that if Mrs. Jared Samuels had been out stumping for her husband instead of mucking about elbow deep in a bunch of cadavers, Jared would be packing to leave for Washington. Self-serving, contrary, disloyal, thoughtless--the adjectives had, from time to time, flown hot and heavy from the old man, though never in Kate's presence. Toward her, he had always been as cordial and charming as could be.

"Look, Dad," Jared said, "I've still got some preparation to do for that session at Granfield. Do you think

..." "Donna," Samuels said through the intercom, "could you bring in another tea for me and another coffee for my son, please?"

Jared sank back in his seat and stared helplessly at the far wall, a wall covered with photographs of politicians, athletes and other celebrities, arm in arm or hand in hand with his father. A few of them were similar shots featuring his grandfather, and one of them was an eight by ten of Jared and the President, taken at a three-minute meeting arranged by his father for just that purpose. With a discreet knock, Samuels's sensuous receptionist entered and set their beverages and a basket of croissants on a mahogany stand near the desk. Her smile in response to Jared's

"Thank you" was vacant--a subtle message that her allegiance was to the man on the power side of the Louis Quatorze.

"So," Samuels said, settling down with a mug of tea in one hand and his Havana in the other, "what do you think of this business at Metro?"

"I haven't given it much thought," Jared lied. "As far as I know, nothing formal has been done yet."

"Well, I'd suggest you start thinking about it."

"What?"

"Norton Reese doesn't want Kate to have that position and, frankly, neither do I. He thinks she's too young and too inexperienced. He tells me that if she gets the appointment, which incidentally is doubtful anyhow, she'll run herself ragged, burn out, and finally get chewed to ribbons by the politicians and the other department heads.

According to him, Kate just doesn't understand the way the game is played--that there are some toes that are simply not to be stepped on."

"Like his," Jared snapped.

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"Jared, you told me the two of you were planning on starting your family. Does Kate think she can do that and run a department, too? What about her obligation to you and your career? It's bad enough she's married to you and doesn't even have your name. Christ, her looks alone would be worth thousands of votes to you if she'd just plunk her face in front of a camera a few times. Add a little baby to that, and I swear you could make a run for the Senate and win."

"Kate's business is Kate's business," Jared said with neither enthusiasm nor conviction.

"Take her to the Caribbean. Have a talk with her," Sam uels reasoned calmly. "Help her see that marriage is a series of ... compromises. Give and take."

"Okay, I'll try."

"Good. Kate should see where her obligations and her loyalties lie. Ross Mattingly may be on a downhill slide, but he still managed to hang on and win the election.

Don't think he's going to roll over and play dead next time. The fewer liabilities we have the better. And frankly, the way things stand, Kate is a minus. Have I made my thoughts clear?"

"Clear." Jared felt totally depleted.

"Fine. Let me know when the Granfield business is done, and also let me know the date you two decide on, so I can tell Bert Hodges." With a nod, Winfield Samuels signaled the meeting over. In his sea-green scrub suit and knee-length white coat, Tom Engleson might have been the earnest young resident on a daytime soap opera, loving his way through the nurses one moment, stamping out disease the next.

But his eyes gave him away. Kate saw the immense fatigue in them the moment she entered the resident's office on the fourth floor of the building renovated by the Ashburton Foundation and renamed in memory of Sylvia Ashburton. It was a fatigue that went deeper than the circles of gray enveloping them, deeper than the fine streaks of red throughout their sclerae.

"Been to sleep at all?" Kate asked, glancing at the clock as she set two tinfoil pans of salad on the coffee table. It was twenty minutes of two.

Engleson merely shook his head and began to work off the plastic cover of his salad with a dexterity that was obviously far from what it had been when he had started his shift thirty and a half hours before. Studying the man's face, Kate wondered how residency programs could justify the ridiculous hours they required, especially of surgical trainees. It was as if one generation of doctors was saying to the next,

"We had to do it this way and we came out all right, didn't we?" Meanwhile, year after year, a cardiogram was misread here, an operation fumbled there; never a rash of problems, just isolated incidents at one hospital then another, one program then another--incidents of no lasting consequence, except, of course, to the patients and families involved.

"I hope you like blue cheese," Kate said. "Gianetti's has great vinaigrette, too. I just guessed."

"It's fine, perfect, Dr. Samuels," Engleson said between bites. "I've missed a meal or two since this Vitale thing started yesterday morning."

"Eat away. You can have some of mine if you want.

I'm not too hungry. And it's 'Kate.' We pathologists have a little trouble with formality." Engleson, his mouth engaged with another forkful of salad, nodded his acknowledgment.

"Sorry I missed you when I was here last evening.

The nurse said you were in the delivery room."

"A set of twins."

"How's Beverly Vitale?"

"Her blood count's down this morning. Twenty-five.

She's due for a recheck in an hour or two. Any further drop, and we'll give her more blood."

"Her GI tract?" Kate asked, speculating on the site of blood loss.

"Probably. There's been some blood in every stool we've checked. She's on steroids, you know."

"I do know. Withhold steroids, and her antibodies run wild, destroying her own clotting factors; use them, and she risks developing bleeding ulcers. It's one of those situations that makes me grateful I decided on pathology.

Stan Willoughby and I reviewed the ovary sections this morning. His impression is that the findings are
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unique.

He's doing some special stains now and has sent slides to a colleague of his at Johns Hopkins, whom he says is as good as anyone in the business at diagnosing ovarian disorders. He also is calling around town to see if anything like this has turned up in another department."

"Etiology?"

"No clues, Tom. Virus, toxin, med reaction. All of the above, none of the above, A and B but not C. She told you she wasn't on any meds, right?"

"None except vitamins. The multivitamin plus iron we dispense through the Omnicenter."

"Well I'm living proof those don't cause any problems.

I've taken them for a couple of years. Make frail pathologist strong like bull." Kate flexed her biceps.

"Make pathologist excellent teacher, too."

"Why, thank you." Kate's green eyes sparkled. "Thank you very much, Tom." For a moment, she saw him blush.

"How about we go say hello to Beverly. I'd like to make extra sure about one or two aspects of her history. Here, you can stick this salad in that refrigerator for later."

"Provided the bacteria who call that icebox home don't eat it first," Tom said. The two were heading down the hall toward the stairway when the overhead page snapped to life. "Code ninety-nine, Ashburton five-oh-two; code ninety-nine, Ash burton five-oh-two."

"Oh, Jesus." Tom was already racing toward the exit as he spoke. Kate was slower to react. She was almost to the stairway door before she realized that Ashburton 502 was Beverly Vitale's room. It had been a year, perhaps two, since Kate had last observed a cardiac arrest and resuscitation attempt. She was certified in advanced cardiac life support, but training and testing then had been on Resusci-Annie, a mannequin.

Her practical experience had ended years ago, along with her internship. At the moment, however, none of those considerations mattered. What mattered was the life of a young woman who loved to make music. With an athlete's quickness, Kate bolted after Tom Engleson up the stairs from Ashburton Four to Ashburton Five.

There were more than enough participants in the code. Residents, nurses, medical students, and technicians filled room 502 and overflowed into the hall. Kate worked her way to a spot by the door, from which she watched the nightmare of Beverly Vitale's final minutes of life. It was a gastric hemorrhage, almost certainly from an ulcer eroding into an artery. The woman's relentless exsanguination was being complicated by the aspiration of vomited blood. Cloaked in abysmal helplessness, Kate witnessed Tom Engleson, desperation etched on his face, issuing orders in a deceptively composed tone; the organized chaos of the white-clad code team, pumping, injecting, monitoring, reporting, respirating, suctioning; and through the milling bodies, the expressionless, blood-smeared face of Beverly Vitale.

For nearly an hour the struggle continued, though there was never a pulse or even an encouraging electrocardiographic pattern. In the end, there was nothing but another lesson in the relative impotence of people and medicine when matched against the capriciousness of illness and death. Tom Engleson, his eyes dark and sunken, shook his head in utter futility.

"It's over," he said softly. "Thank you all. It's over." V

Tuesday 11 December

Simultaneously with hearing the report from the WEEI traffic helicopter of a monumental backup stemming from the Mystic/Tobin Bridge, Kate became part of it. Commuting to the city from the North Shore was an experience that she suspected ranked in pleasantness somewhere between an IRS audit and root canal work. Although Tuesday was normally a low-volume day, this morning she had encountered rain, sleet, snow, and even a bizarre stretch of sunlight during her thirty-mile drive, far too much weather for even Boston drivers to attack. With a groan, she resigned herself to being half an hour late, perhaps more, for the appointment Stan Willoughby had arranged for her at White Memorial Hospital.

The pathology chiefs call had punctuated another confusing, bittersweet morning with Jared. It seemed as
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if the intensity and caring in their relationship was waxing and waning not only from day to day but from hour to hour or even from minute to minute. In one sentence the man was Jared Samuels, the funny, sensitive, often ingenuous fellow she had married and still loved deeply; in the next he was calculating and distant, a miniature of his father, intransigent on points they should have been working through as husband and wife. At last, after an awkward hour of lighting brush fires of dissension and then scurrying to stamp them out, Jared had suggested a week or ten days together in Aruba, away from the pressures and demands of their careers.

"What do you say, Boots?" he had asked, calling on the pet name she favored most of the four or five he used.