Terminal (16 page)

March 4
Thursday, 6:30 A.M.

J
anet was up, dressed in her white uniform, and out of the apartment early since her shift ran from seven to three. At that time of the morning there was very little traffic on 195, especially northbound. She and Sean had discussed driving together but in the end decided it would be better if each had their own wheels.

Janet felt a little queasy entering the Forbes Hospital that morning. Her anxiety went beyond the usual nervousness associated with starting a new job. The prospect of breaking rules was what had her on edge and tense. She already felt guilty to a degree; it was guilt by intent.

Janet made it to the fourth floor with time to spare. She poured herself a cup of coffee and proceeded to familiarize herself with the locations of the charts, the pharmacy locker, and the supply closet: areas she would need to be familiar with to carry out her job as a floor nurse. By the time she sat down for report with the night shift going off duty and the day shift coming on, she was significantly calmer than she had been when she first arrived. Marjorie’s cheerful presence no doubt helped put her at ease.

Report was routine except for Helen Cabot’s deteriorating condition. The poor woman had had several seizures during the night, and the doctors said that her intracranial pressure was rising.

“Do they think the problem is related to the CAT scan–driven
biopsy yesterday?” Marjorie asked.

“No,” Juanita Montgomery, the night shift supervisor, said. “Dr. Mason was in at three
A.M.
when she seized again, and he said the problem was probably related to the treatment.”

“She’s started treatment already?” Janet asked.

“Absolutely,” Juanita said. “Her treatment started Tuesday, the night she got here.”

“But she just had her biopsy yesterday,” Janet said.

“That’s for the cellular aspect of her treatment,” Marjorie chimed in. “She’ll be pheresed today to harvest T lymphocytes which will be grown and sensitized to her tumor. But the humoral aspect of her treatment was started immediately.”

“They used mannitol to bring down her intracranial pressure,” Juanita added. “It seemed to work. She hasn’t seized again. They want to avoid steroids and a shunt if possible. At any rate, she’s got to be monitored carefully, especially with the pheresis.”

As soon as report was over and the bleary-eyed night shift had departed, the day’s work began in earnest. Janet found herself extremely busy. There were a lot of sick patients on the floor, representing a wide range of cancers, and each was on an individual treatment protocol. The most heartrending for Janet was an angelic boy of nine who was on reverse precautions while they waited for a bone marrow transplant to re-populate his marrow with blood-forming cells. He’d been given a strong dose of chemotherapy and radiation to wipe out completely his own leukemic marrow. At the moment he was completely vulnerable to any microorganisms, even those normally not pathogenic for humans.

By mid-morning, Janet finally had a chance to catch her breath. Most of the nurses took their coffee breaks in the utility room off the nurses’ station where they could put up their tired feet. Janet decided to take advantage of the time to have Tim Katzenburg show her how to access the Forbes computer. Every patient had a traditional chart and a computer file. Janet wasn’t intimidated by computers, having minored in computer science in college. But it still helped to have someone familiar with the Forbes system get her started.

When Tim was distracted for a moment by a phone call from the lab, Janet called up Helen Cabot’s file. Since Helen had been there less than forty-eight hours, the file was not extensive. There was a computer graphic showing which of her three tumors they had biopsied and the location of the trephination of the skull just above the right ear. The biopsy specimen was grossly described as firm, white, and of an adequate amount. It said that the specimen had been immediately packed in ice and sent to Basic Diagnostics. In the treatment section it said that she’d begun on MB-300C and MB-303C at a dosage of 100mg/Kg/day of body weight administered at 0.05 ml/Kg/minute.

Janet glanced over at Tim who was still busy on the phone. On a scrap of paper, she wrote down the treatment information. She also wrote down the alpha numeric designator, T-9872, that was listed as the diagnosis along with the descriptive term: medulloblastoma, multiple.

Using the diagnostic designator, Janet next called up the names of the patients with medulloblastoma who were currently in the hospital. There were a total of five including the three on the fourth floor. The other two were Margaret Demars on the third floor, and Luke Kinsman, an eight-year-old, in the pediatric wings of the fifth floor. Janet wrote down the names.

“Having trouble?” Tim asked over Janet’s shoulder.

“Not at all,” Janet said. She quickly cleared the screen so that Tim wouldn’t see what she’d been up to. She couldn’t afford to arouse suspicion on her very first day.

“I’ve got to enter these lab values,” Tim told her. “It will only take a sec.”

While Tim was absorbed with the computer terminal, Janet scanned the chart rack for Cabot, Martin, or Sharenburg. To her chagrin, none of those charts was there.

Marjorie breezed into the station to get some narcotics from the pharmacy locker. “You’re supposed to be on your coffee break,” she called to Janet.

“I am,” Janet said, holding up her plastic foam cup. She
mentally made a note to bring a mug into work. Everyone else had his or her own.

“I’m already impressed with you,” Marjorie teased from inside the pharmacy. “You needn’t work through your break. Kick back, girl, and take a load off your feet.”

Janet smiled and said that she’d be taking that kind of break after she was fully acclimated to the ward’s routine. When Tim was finished with the computer terminal, Janet asked him about the missing charts.

“They’re all down on the second floor,” Tim said. “Cabot’s getting pheresed while Martin and Scharenburg are being biopsied. Naturally the charts are with them.”

“Naturally,” Janet repeated. It seemed tough luck that not one of those charts could have been there when she had the chance to look at them. She began to suspect that the clinical espionage she’d committed herself to might not be quite as easy as she’d thought when she suggested her plan to Sean.

Giving up on the charts for the moment, Janet waited for one of the other shift nurses, Dolores Hodges, to finish up in the pharmacy closet. Once Dolores had headed down the hall, Janet made sure no one was watching before slipping into the tiny room. Each patient had an assigned cubbyhole containing his or her prescribed medications. The drugs had come up from the central pharmacy on the first floor.

Finding Helen’s cubbyhole, Janet quickly scanned the plethora of vials, bottles, and tubes that contained anti-seizure medication, general tranquilizers, anti-nausea pills, and non-narcotic pain pills. There were no containers designated MB300C or MB303C. On the chance that these medications were secured with the narcotics, Janet checked the narcotics locker, but she found only narcotics there.

Next Janet located Louis Martin’s cubbyhole. His was a low one, close to the floor. Janet had to squat down to search through it, but first she had to close the lower half of the Dutch door to make room. As with Helen’s cubby, Janet could find no drug containers with special MB code designations on the label.

“My goodness, you startled me,” Dolores exclaimed. She
had returned in haste and had practically tripped headlong over Janet crouched before Louis Martin’s cubbyhole. “I’m so sorry,” Dolores said. “I didn’t think anyone was in here.”

“My fault,” Janet said, feeling herself blush. She was instantly afraid she was giving herself away and that Dolores would wonder what she’d been up to. Yet Dolores showed no signs of being suspicious. Instead, once Janet stepped back and out of the way, she came in to get what she needed. In a moment she was gone.

Janet left the pharmacy closet visibly trembling. This was only her first day and though nothing terrible had happened, she wasn’t sure she had the nerves for the furtive behavior espionage demanded.

When Janet reached Helen Cabot’s room, she paused. The door was propped open by a rubber stopper. Stepping inside, Janet gazed around. She didn’t expect to find any drugs there, but she wanted to check just the same. As she’d expected, there weren’t any.

Having recovered her composure, Janet headed back toward the nurses’ station, passing Gloria D’Amataglio’s room on the way. Taking a moment, Janet stuck her head through the open door. Gloria was sitting up in her armchair with a stainless steel kidney dish clutched in her hand. Her IV was still running.

When they’d chatted the day before Janet had learned that Gloria had gone to Wellesley College just as she herself had. Janet had been in the class a year ahead. After thinking about it overnight, Janet had decided to ask Gloria if she’d known a friend of hers who’d been in Gloria’s class. Getting Gloria’s attention, she posed her question.

“You knew Laura Lowell!” Gloria said with forced enthusiasm. “Amazing! I was great friends with her. I loved her parents.” It was painfully obvious to Janet that Gloria was making an effort to be sociable. Her chemotherapy was no doubt leaving her nauseous.

“I thought you might,” Janet said. “Everybody knew Laura.”

Janet was about to excuse herself and allow Gloria to rest
when she heard a rattle behind her. She turned in time to see the housekeeping man appear at the door, then immediately disappear. Fearing her presence had interrupted his schedule, Janet told Gloria she’d stop by later and went out into the hall to tell the housekeeper the room was all his. But the man had disappeared. She looked up and down the corridor. She even checked a couple of the neighboring rooms. It was as if he’d simply vanished into thin air.

Janet headed back to the nurses’ station. Noticing she still had a bit of break time left, she took the elevator down to the second floor in hopes of getting a glimpse at one or more of the missing charts. Helen Cabot was still undergoing pheresis and would be for some time. Her chart was unavailable. Kathleen Sharenburg was undergoing a biopsy at that moment, and her chart was in the radiology office. With Louis Martin, Janet lucked out. His biopsy was scheduled to follow Kathleen Sharenburg’s. Janet discovered him on a gurney in the hallway. He was heavily tranquilized and soundly sleeping. His chart was tucked under the gurney pad.

After checking with a technician and learning that Louis would not be biopsied for at least an hour, Janet took a chance and pulled out his chart. Walking quickly as if leaving the scene of a crime with the evidence in hand, she carried the chart into medical records. It was all she could do not to break into a full sprint. Janet admitted to herself that she was probably the worst person in the world to be involved in this kind of thing. The anxiety she’d felt in the pharmacy locker came back in a flash.

“Of course you can use the copy machine,” one of the medical record librarians told her when she asked. “That’s what it’s here for. Just indicate nursing on the log.”

Janet wondered if this librarian was the mother of the woman in public relations who’d been in Sean’s apartment on the night of her arrival. She’d have to be careful. As she walked over to the copy machine, she glanced over her shoulder. The woman had gone back to the task she’d been doing when Janet had entered, paying no attention to Janet whatsoever.

Janet quickly copied Louis’s entire chart. There were more pages than she would have expected, particularly since he had only been hospitalized for one day. Glancing at some of them, Janet could tell that most of the chart consisted of referral material that had come from Boston Memorial.

Finished at last, Janet hurried the chart back to the gurney. She was relieved to see that Louis had not been moved. Janet slipped the chart under the pad, positioning it exactly as she’d found it. Louis didn’t stir.

Returning to the fourth floor, Janet panicked. She hadn’t given any thought to what she would do with the copy of the chart. It was too big to fit into her purse, and she couldn’t leave it lying about. She had to find a temporary hiding place, somewhere the other nurses and nursing assistants would not be likely to go.

With no break time left, Janet had to think fast. The last thing she wanted to do on her first day of work was take more time off than she was due. Frantically, Janet tried to think. She considered the patient lounge, but it was currently occupied. She thought of one of the lower cabinets in the pharmacy closet, but dismissed that idea as too risky. Finally she thought of the housekeeping closet.

Janet looked up and down the corridor. There were plenty of people around, but they all seemed absorbed by what they were doing. She saw the housekeeper’s cart parked outside a nearby patient room, suggesting the man was busy cleaning within. Taking a breath, Janet slipped into the closet. The door with its automatic closer shut behind her instantly, plunging her into darkness. She groped for the light switch and turned it on.

The tiny room was dominated by a generous slop sink. On the wall opposite was a countertop with undercounter cabinets, a bank of shallow overcounter wall cabinets, and a broom closet. She opened the broom closet. There were a few shelves above the compartment that held the brooms and mops, but they were too exposed. Then she looked at the overcounter cabinets and her eyes kept rising.

Placing a foot on the edge of the slop sink, she climbed up
atop the counter. Reaching up, she groped the area above the wall cabinets. As she’d guessed, there was a narrow depressed space between the top of the cabinets and the ceiling. Confident she’d found what she’d been looking for, she slipped the chart copy over the front lip and let it drop down. A bit of dust rose up in a cloud.

Satisfied, Janet climbed down, rinsed her hands in the sink, then emerged into the hall. If anybody had wondered what she’d been up to, they didn’t give any indication. One of the other nurses passed her and smiled cheerfully.