Terminal (26 page)

Concerning therapy, Sean noted that it did not vary. The dosage and rate of administration of the coded medication was the same for all patients although it was adjusted for weight. All patients had experienced about a week of hospitalization and after discharge were followed in the outpatient clinic at intervals of two weeks, four weeks, two months, six months, then annually. Thirteen of the thirty-three patients had reached the annual-visit stage. Sequelae from the illness were minimal and were associated with mild neurological deficits secondary to the expanding tumor masses prior to treatment rather than to the treatment itself.

Sean was also impressed with the charts themselves. He knew he was looking at a wealth of material that would probably take him a week to digest.

Concentrating as deeply as he was, Sean was startled when the phone on his desk began to ring. It was the first time it
had ever rung. He picked it up, expecting a wrong number. To his surprise, it was Janet.

“I have the medicine,” she said tersely.

“Great!” Sean said.

“Can you meet me in the cafeteria?” she asked.

“Absolutely,” Sean said. He could tell something was wrong. Her voice sounded strained. “What’s the matter?”

“Everything,” Janet said. “I’ll tell you when I see you. Can you leave now?”

“I’ll be there in five minutes,” Sean said.

After hiding all the charts, Sean descended in the elevator and crossed over the pedestrian bridge to the hospital. He guessed he was being observed by camera and felt like waving to indicate as much, but resisted the temptation.

When he arrived in the cafeteria Janet was already there, sitting at a table with a cup of coffee in front of her. She didn’t look happy.

Sean slid into a chair across from her.

“What’s wrong?” he asked.

“One of my patients is in a coma,” Janet said. “I’d just started an IV on her. One minute she was fine, the next minute not breathing.”

“I’m sorry to hear that,” Sean said. He’d had some exposure to the emotional traumas of hospital life, so he could empathize to an extent.

“At least I got the medicine,” she said.

“Was it difficult?” Sean asked.

“Emotionally more than anything else,” Janet said.

“So where is it?”

“In my purse,” she said. She glanced around to make sure no one was watching them. “I’ll give the vials to you under the table.”

“You don’t have to make this so melodramatic,” Sean said. “Sneaking around draws more attention than just acting normal and handing them over.”

“Humor me,” Janet said. She fumbled with her purse.

Sean felt her hand hit his knee. He reached under the table and two vials dropped into his hand. Respecting Janet’s sensitivity
he slipped them into his pockets, one on each side. Then he scraped back his chair and stood up.

“Sean!” Janet complained.

“What?” he asked.

“Do you have to be so obvious? Can’t you wait five minutes like we’re having a conversation?”

He sat down. “People aren’t watching us,” he said. “When are you going to learn?”

“How can you be so sure?” she asked.

Sean started to say something, then thought better of it.

“Can we talk about something fun for a change?” Janet asked. “I’m completely stressed out.”

“What do you want to talk about?”

“What we can do come Sunday,” Janet said. “I need to get away from the hospital and all this tension. I want to do something relaxing and fun.”

“Okay, it’s a date,” Sean promised. “Meanwhile, I’m eager to get back to the lab with this medicine. Would it be so obvious if I were to leave now?”

“Go!” Janet commanded. “You’re impossible.”

“See you back at the beach apartment,” Sean said. He moved away quickly lest Janet say something about his not being invited. He looked back and waved as he left the cafeteria.

Hurrying over the bridge between the two buildings, he thrust his hands into his pockets and palmed the two vials. He couldn’t wait to get started. Thanks to Janet, he felt some of the investigative excitement he’d expected when he’d made the decision to come to the Forbes Cancer Center.

R
OBERT
H
ARRIS
carried the cardboard box of employee files into his small windowless office and set them on the floor next to his desk. Sitting down, he opened the top of the box and pulled out the first file.

After the conversation with Dr. Mason and Ms. Richmond, Harris had gone directly to personnel. With the help of Henry Falworth, the personnel manager, he’d compiled a list of non-professionals
who had access to patients. The list included food service personnel who distributed menus and took orders and those who delivered meals and picked up the trays. The list also included the janitorial and maintenance staffs who were occasionally called to patient rooms for odd jobs. Finally, the list ran to housekeeping: those who cleaned the rooms, the halls, and the lounges of the hospital.

All in all, the number of people on the list was formidable. Unfortunately he had no other ideas to pursue save for the camera surveillance, and he knew such an operation would prove too costly. He would investigate prices and put together a proposal, but he knew Dr. Mason would find the price unacceptable.

Harris’s plan was to go through the fifty or so files rather quickly to see if anything caught his attention, anything that might seem unlikely or strange. If he found something that was questionable, he’d put the file in a group to investigate first. Harris wasn’t a psychologist any more than he was a doctor, but he thought that whoever was crazy enough to be killing patients would have to have something weird on his record.

The first file belonged to Ramon Concepcion, a food service employee. Concepcion was a thirty-five-year-old man of Cuban extraction who’d worked a number of food service jobs in hotels and restaurants since he was sixteen. Harris read through his employment application and looked at the references. He even glanced at his health care utilization. Nothing jumped out at him. He tossed the file on the floor.

One by one, Harris worked through the box of files. Nothing caught his eye until he came to Gary Wanamaker, another food service employee. Under the heading experience Gary had listed five years’ work in the kitchen at Rikers Island Prison in New York. In the employment photo the man had brown hair. Harris put that file on the corner of his desk.

It was only five files later that Harris came across another file that caught his eye. Tom Widdicomb worked in housekeeping. What got Harris’s attention was the fact that the man had trained as an emergency medical technician. Even though
he’d had a series of housekeeping jobs subsequent to his EMT training, including a stint at Miami General Hospital, the thought of a guy with emergency medical training working housekeeping seemed odd. Harris looked at the employment photo. The man had brown hair. Harris put Widdicomb’s file on top of Wanamaker’s.

A few files later, Harris came across another file that tweaked his curiosity. Ralph Seaver worked for the maintenance department. This man had served time for rape in Indiana. There it was right in the file! Included was even a phone number of the man’s former probation officer in Indiana. Harris shook his head. He’d not expected to find such fertile material. The professional staff files had been boring in comparison. Except for a few substance abuse problems and one child molestation allegation, he’d not found anything. But with this group, he’d only gone through a quarter of the files and had already yanked three that he thought deserved a closer look.

I
NSTEAD OF
sitting down and having coffee on her afternoon coffee break, Janet took the elevator to the second floor and visited the intensive care unit. She had a lot of respect for the nurses who worked there. She never understood how they could take the constant strain. Janet had tried the ICU after graduation. She found the work intellectually stimulating, but after a few weeks decided it wasn’t for her. There was too much tension, and too little patient interaction. Most of the patients were in no position to relate on any level; many of them were unconscious.

Janet went over to Gloria’s bed and looked down at her. She was still in a coma and had not improved although she was still breathing without mechanical assistance. Her widely dilated pupils had not constricted, nor did they react to light. Most disturbing of all, an EEG showed very little brain activity.

A visitor was gently stroking Gloria’s forehead. She was about thirty years old with coloring and features similar to
Gloria’s. As Janet raised her head, their eyes met.

“Are you one of Gloria’s nurses?” the visitor asked.

Janet nodded. She could tell the woman had been crying.

“I’m Marie.” she said. “Gloria’s older sister.”

“I’m very sorry this happened,” Janet said.

“Well,” Marie said with a sigh, “maybe it’s for the best. This way she won’t have to suffer.”

Janet agreed for Marie’s benefit, although in her own heart she felt differently. Gloria had still had a shot at beating breast cancer, especially with her positive, upbeat attitude. Janet had seen people with even more advanced disease go into remission.

Fighting tears of her own, Janet returned to the fourth floor. Again, she threw herself into her work. It was the easiest way to avoid thoughts that would only leave her cursing the unfairness of it all. Unfortunately the ruse was only partly successful, and she kept seeing the image of Gloria’s face as she thanked Janet for starting her IV. But men suddenly the ruse was no longer needed. A new tragedy intervened that matched Gloria’s and overwhelmed Janet.

A little after two, Janet gave an intramuscular injection to a patient whose room was at the far end of the corridor. On her way back to the nurses’ station, she decided to check in on Helen Cabot.

Earlier that morning and about an hour after Janet had added the coded medication to Helen’s IV and adjusted the rate, Helen complained of a headache. Concerned about her condition, Janet had called Dr. Mason and informed him of this development. He’d recommended treating the headache minimally and asked to be called back if it got worse.

Although the headache had not gone away after the administration of an oral analgesic, it had not grown worse. Nevertheless, Janet had checked on Helen frequently at first, then every hour or so throughout the day. With the headache unchanged and her vital signs and level of consciousness remaining normal, Janet’s concern had lessened.

Now, almost 2:15, as Janet came through the door, she was alarmed to discover that Helen’s head had lolled to the side
and off the pillow. Approaching the bed, she noticed something even more disturbing: the woman’s breathing was irregular. It was waxing and waning in a pattern that suggested a serious neurological dysfunction. Janet phoned the nurses’ station and told Tim she had to speak with Marjorie immediately.

“Helen Cabot is Cheyne-Stoking,” Janet said when Marjorie came on the line, referring to Helen’s breathing.

“Oh no!” Marjorie exclaimed. “I’ll call the neurologist and Dr. Mason.”

Janet took the pillow away and straightened Helen’s head. Then she took a small flashlight she always carried and shined it in each of Helen’s pupils. They weren’t equal. One was dilated and unresponsive to the light. Janet shuddered. This was something she’d read about. She guessed that the pressure had built up inside Helen’s head to the point that part of her brain was herniating from the upper compartment into the lower, a life-threatening development.

Reaching up, Janet slowed Helen’s IV to a “keep open” rate. For the moment that was all she could do.

Soon other people started to arrive. First it was Marjorie and other nurses. Then the neurologist, Dr. Burt Atherton, and an anesthesiologist, Dr. Carl Seibert, rushed in. The doctors began barking orders in an attempt to lower the pressure inside Helen’s head. Then Dr. Mason arrived, winded by his run from the research building.

Janet had never met Dr. Mason, although she’d spoken with him on the phone. He was titularly in charge of Helen’s case, but in this neurological crisis he deferred to Dr. Atherton.

Unfortunately, none of the emergency measures worked, and Helen’s condition deteriorated further. It was decided that emergency brain surgery was needed. To Janet’s dismay, arrangements were made to transfer Helen to Miami General Hospital.

“Why is she being transferred?” Janet asked Marjorie when she had a moment.

“We’re a specialty hospital,” Marjorie explained. “We don’t have a neurosurgical service.”

Janet was shocked. The kind of emergency surgery Helen
needed required speed. It did not require an entire neurosurgical service, just an operating room and someone who knew how to make a hole in the skull. Obviously with the biopsies they’d been doing, that expertise was available at the Forbes.

With frantic preparations, Helen was readied to leave. She was moved from her bed onto a gurney. Janet aided in the transfer, moving Helen’s feet, then running alongside holding the IV bottle aloft as the gurney was rushed to the elevator.

In the elevator Helen took a turn for the worse. Her breathing, which had been irregular when Janet had entered her room, now stopped altogether. Helen’s pale face quickly began to turn blue.

For the second time that day, Janet started mouth-to-mouth resuscitation while the anesthesiologist yelled for someone to get an endotracheal tube and an Ambu bag as soon as they got to the first floor.

When the elevator stopped and the doors opened, one of the fourth-floor nurses rushed out. Another kept the doors from closing. Janet continued her efforts until Dr. Seibert nudged her aside and deftly slipped in an endotracheal tube. After connecting the Ambu bag, he began to inflate Helen’s lungs to near capacity. The blue cast to Helen’s face transformed into a translucent alabaster.

“Okay, let’s go,” Dr. Seibert yelled.

The tightly packed group rushed Helen out to the ambulance receiving dock, collapsed the gurney, and pushed it inside the waiting vehicle. Dr. Seibert boarded with Helen, maintaining her respiration. The doors were slammed shut and secured.