Harmful Intent (15 page)

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.

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 mirror. 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.

Clutching his briefcase, Jeffrey descended the Essex's front steps. He avoided stepping on the poor man who was still lolling on the pavement with his brown-bagged bottle. Jeffrey turned to the right. He planned to walk the five or six blocks to the Lafayette Center, which included a good hotel. There he'd find a cab.

Jeffrey was abreast of the liquor store when he spotted a police car heading in his direction. Without a moment's hesitation, he ducked into the store. The jangle of bells attached to the door wore on Jeffrey's nerves. As crazy as it seemed, he didn't know whom he was more afraid of, the street people or the police.

“Can I help you?” a bearded man asked from behind a counter. The police car slowed, then went past. Jeffrey took a breath. This wasn't going to be easy.

“Can I help you?” the clerk repeated.

Jeffrey bought a pint-sized bottle of vodka. If the police cruised back, he wanted his visit to the store to appear legitimate. But it wasn't necessary. When he emerged from the store, the police car was nowhere in sight. Relieved, Jeffrey turned to the right, intending to hurry. But he pulled up short, practically
colliding with one of the homeless men he'd seen earlier. Startled, Jeffrey raised his free hand to protect himself.

“Got any spare change, buddy?” the man asked unsteadily. He was obviously drunk. He had a fresh cut just by his temple. One of the lenses of his black-rimmed glasses was cracked.

Jeffrey recoiled from the man. He was about Jeffrey's height but with dark, almost black hair. His face was covered with a heavy stubble, suggesting he'd not shaved for a month. But what caught Jeffrey's attention was the man's clothes. He was dressed in a tattered suit complete with a button-down blue oxford shirt that was soiled and missing a few buttons. He had on a regimental striped tie that was loosened at the collar and spotted with green stains. Jeffrey's impression was that the man had dressed for work one day, then never gone home.

“What's the matter?” the man asked in a wavering, drunken voice. “Don't you speak English?”

Jeffrey dug into his trouser pocket for the change he'd received from his purchase of vodka. As he dropped the money in the man's palm, Jeffrey studied his face. His eyes, though glassy, looked kind. Jeffrey wondered what had driven the man to such desperate circumstances. He felt an odd kinship with this homeless person and his unknown plight. He shuddered to think of how fine a line separated him from a similar fate. The identification was made easier since the man appeared to be close to Jeffrey's age.

As he'd expected, Jeffrey hailed a taxi easily at the nearby luxury hotel. From there it took only fifteen minutes to get out to Harvard's medical area. It was just a little after eleven when Jeffrey walked into the Countway Medical Library.

Among the books and narrow study cubicles, Jeffrey felt at home. He used one of the computer terminals to get the call numbers for several books on the physiology of the autonomic nervous system and the pharmacology of local anesthetics. With these books in hand he went into one of the carrels facing the inner court and closed the door. Within minutes he was lost in the intricacies of nerve impulse conduction.

It wasn't long before Jeffrey understood why Chris had highlighted the word “nicotinic.” Although most people thought of nicotine as an active ingredient in cigarettes, it was actually a drug, more specifically a poison, which caused a stimulation and then blockade of autonomic ganglia. Many of the symptoms associated with nicotine were the same as those caused by muscarine: salivation, sweating, abdominal pain, and lacrimation—the
very same symptoms that had appeared in Patty Owen and Henry Noble. It even caused death in surprisingly low concentrations.

All this meant to Jeffrey that if he was thinking of a contaminant, it would have to have been a compound that mirrored local anesthetics to an extent, something like nicotine. But it couldn't have been nicotine, thought Jeffrey. The toxicology report on Henry Noble had been negative; something like nicotine would have shown up.

If there had been a contaminant it would also have to have been in an extremely small, nanomolar amount. Therefore it would have to have been something extraordinarily potent. As to what that could have been, Jeffrey hadn't a clue. But in his reading Jeffrey stumbled across something he'd remembered from medical school, but had not thought of since. Botulinum toxin, one of the most toxic substances known to man, mirrored local anesthetics in its ability to “freeze” neural cell membranes at the synapse. Yet Jeffrey knew he was not seeing botulinum poisoning. Its symptoms were totally different; muscarinic effects were blocked, not stimulated.

Never had time passed so quickly. Before Jeffrey knew it, the library was about to close for the night. Reluctantly, he gathered up Chris Everson's notes as well as his own that he'd just made. Carrying the books in one hand and his briefcase in the other, he descended to the first floor. He left the books on the counter to be reshelved and started for the door. He stopped abruptly.

Ahead people were being stopped by an attendant to open their parcels, knapsacks, and, of course, briefcases. It was standard practice to keep the loss of books to a minimum, but it was a practice Jeffrey had forgotten about. He hated to think what the reaction might be if the library guard got a look at his stacks of hundred-dollar bills. So much for staying low profile.

Jeffrey doubled back to the periodical section and ducked behind a shoulder-high display case. He opened his briefcase and began to jam the packets of paper money in his pockets. To make room, he pulled the pint of vodka from his jacket side pocket and packed it in the briefcase. Better to let the guard think he was a tippler than a drug dealer or thief.

Jeffrey was able to leave the library without incident. He felt a little conspicuous with all his pockets bulging, but there was nothing to be done about it just then.