Cook,Robin - Mortal Fear.txt Page 3

  Also like Harring's, his stress EKG had been normal. Jason shook his

  head in dismay. Even more than the normal EKG, the stress EKG was

  supposed to pick up such potentially fatal conditions. It certainly

  suggested that the executive physical was an exercise in futility. Not

  only was the examination failing to pick up these serious problems, but

  it was giving the patients a false sense of security. With the results

  being normal, there wasn't motivation for the patients to change their

  unhealthy lifestyles. Briggs, like Harring, had been in his late

  fifties, was a heavy smoker, and never exercised.

  The second patient, Rupert Connoly, had died of a massive stroke. Again,

  it had been a short time after an executive-style physical, which in his

  case had also revealed no alarming abnormalities. In addition to a

  generally unhealthy lifestyle, Connoly had been a heavy drinker, though

  not an alcoholic. Jason was about to close the chart when he noticed

  something he had missed before. In the autopsy report the pathologist

  had recorded significant cataract development. Thinking that he'd not

  remembered the man's age correctly, Jason flipped to the information

  page. Connoly was only fifty-eight. Now cataracts were not entirely

  unknown at fifty-eight, but it was nonetheless rare. Turning to the

  physical, Jason checked to see if he'd noted cataracts. Embarrassingly

  he'd failed to include them, noting he described the "eyes, ears,

  nose, and throat" as being within normal limits.

  Jason wondered if he were getting sloppy in his "old" age. But then he

  noticed he described the retinas as appearing normal as well. In order

  to have visualized the retinas, Jason would have had to have sighted

  through a cataract. Not being an ophthalmologist, he knew his

  limitations in this regard. He wondered if certain kinds of cataracts

  impede the passage of light more than others. He added that question to

  his mental list of things to investigate.

  Jason stacked the charts. Three apparently healthy men had all died a

  month after their physicals. Jesus, he thought. People were often scared

  of going to hospitals. If this got out, they might stop getting

  checkups.

  Grabbing all three charts in his arms, Jason emerged from his office. He

  saw Sally stand up in the central desk area and look at him expectantly.

  Jason silently mouthed "two minutes" as he walked the length of the

  waiting area. He passed several patients whom he treated with nods and

  smiles. He slipped into the hall leading to Roger Wanamaker's office.

  Roger was an internist who specialized in cardiology and. whose opinion

  Jason held in high esteem. He found the man leaving one of the

  examination rooms. He was an obese man with a face like an old hound dog

  with wattles and lots of extra skin.

  "How about a sidewalk consult?" Jason asked.

  "It'll cost ya," Roger teased. "Whatcha got?"

  Jason followed the man into his disheveled office.

  "Unfortunately, some pretty embarrassing evidence." Jason opened the

  charts of his three late patients to the EKG sections and placed them in

  front of Roger. "I'm ashamed to even discuss this, but I've had three

  middle-aged men die right after their fancy executive physicals showed

  them in pretty good health. One was today. Cardiac rupture after a

  massive MI. I did the physical exam three weeks ago. This is the one.

  Even knowing what I do now, I can't find even a bit of trouble or any of

  the tracings. What do you think?"

  There was a moment of silence while Roger studied the EKGs. "Welcome to

  the club," he finally said.

  "Club?"

  It "These EKGs are fine , Roger said. "All of us have had the same

  experience.

  I've had four such cases over the last few months. Just about everybody

  who's willing to bring it up has had at least one or two."

  "How come it's not come up?"

  "You tell me," Roger said, with a wry smile. "You haven't exactly been

  advertising your experience, have you? It's dirty laundry. We'd all

  rather not call attention to it. But you're acting chief of service. Why

  don't you call a meeting?"

  Jason nodded glumly. Under the aegis of the GHP administration, which

  made all of the major organizational decisions, chief of service was not

  a desirable position. It was rotated on a yearly basis among all the

  internists, and had fallen onto Jason's shoulders two months previously.

  "I guess I should," Jason said, collecting his charts from Roger's desk.

  "If nothing else, the other doctors should know they're not alone if

  they've had the same experience."

  "Sounds good," Roger agreed. He heaved his considerable bulk to his

  feet.

  "But don't expect everybody to be quite as open as you are."

  Jason headed back to the central desk, motioning to Sally to ready the

  next patient. Sally took off like a sprinter. He then turned to Claudia.

  "Claudia, I need a favor. I want you to make a list of all the annual

  physicals I've done over the last year, pull their charts, and check on

  their state of health. I want to be sure none of the others have had

  serious medical problems. Apparently some of the other doctors have been

  having similar episodes. I think it's something we should look into."

  "It's going to be a big list," Claudia warned.

  Jason was aware of that. In its desire to promote what it called

  preventive medicine, GHP had been strongly advocating such physicals and

  had stream lined the process to take care of the maximum number of

  people. Jason knew that he did, on the average, between five and ten a

  week.

  For the next several hours, Jason devoted himself to his patients, who

  treated him to an endless stream of problems and complaints. Sally was

  re lentless, filling examining rooms the moment the previous patient

  vacated. By skipping lunch, Jason was actually able to catch up.

  in the middle of the afternoon, as Jason was returning from one of the

  treatment rooms where he had done a sigrnoidoscopy on a patient with

  recur rent ulcerative colitis, Claudia caught his attention and motioned

  for him to come over to the central desk. She was sporting a cocky smile

  as Jason approached. He knew something was brewing.

  "You have an honored visitor," Claudia said with pursed lips, imitating

  a Lily Tomlin character.

  "Who?" Jason asked, reflexly scanning the adjacent waiting room area.

  "He's in your office," Claudia said.

  Jason shifted his eyes toward his office. The door was closed. It wasn't

  like Claudia to put someone in there. He looked back at his secretary.

  "Claudia?" he questioned, extending her name out as if it were more than

  three syllables. "How come you allowed someone in my office?"

  "He insisted," said Claudia, "and who am I to refuse? PV

  Obviously whoever it was had offended her. Jason knew her that well. And

  whoever it was certainly had some kind of stature at GHP. But Jason was

  tiring of the game. "Are you going to tell me who it is or am I supposed

  to be surprised?"

  "Dr. Alvin Hayes," Claudia said. She batted her eyes and mad
e a sneer.

  Agnes, the secretary who worked for Roger, snickered.

  Jason waved at them in disgust and headed for his office. A visit by Dr.

  Alvin Hayes was a unique occurrence. He was the GHP token and star

  researcher, hired by the Plan to promote its image. It had been a move

  reminiscent of the Humana Corporation's hiring Dr. William Devries, the

  surgeon of artificialheart fame. GHP, as a health-maintenance

  organization (HMO), did not support research per se, yet it had hired

  Hayes at a prodigious salary in order to expand and augment its image,

  especially in the Boston academic community. After all, Dr. Alvin Hayes

  was a world-class molecular biologist who had been on the cover of Time

  magazine after having developed a method of making human growth hormone

  from recombinant DNA technology. The growth hormone he had made was

  exactly like the human variety. Earlier attempts had resulted in a

  hormone that was similar but not exactly the same. It had been

  considered an important breakthrough.

  Jason reached his office and opened the door. He could not fathom why

  Hayes would be paying him a visit. Hayes had all but ignored Jason from

  the day he had been hired over a year previously, despite the fact

  they'd been in the same Harvard Medical School class. After graduation

  they had gone their separate ways, but when Alvin Hayes had been hired

  by GHP, Jason had sought the man out and personally welcomed him. Hayes

  had been distant, obviously impressed by his own celebrity status and

  openly contemptuous of Jason's decision to stay in clinical medicine.

  Except for a few chance meetings, they ignored each other. In fact,

  Hayes ignored everyone at the GHP, becoming more and more what people

  referred to as the mad scientist. He'd even gone to the extreme of

  letting his personal appearance suffer by wearing baggy, unpressed

  clothes and allowing his unkempt hair to grow long like a throwback to

  the turbulent sixties. Although people gossiped, and he had few friends,

  everyone respected him. Hayes worked long hours and produced an

  unbelievable number of papers and scientific articles.

  Alvin Hayes was sprawled in one of the chairs facing Jason's antique

  desk.

  About Jason's height, with pudgy, boyish features, Hayes's unkempt hair

  hung about his face, which appeared more sallow than ever. He'd always

  had that peculiar academic pallor that characterizes scientists who

  spend all their time in their laboratories. But Jason's clinical eye

  noted an increased yellowishness -as well as a laxness that made Hayes

  look ill and overly exhausted. Jason wondered if this was a professional

  visit.

  "Sorry to bother you," Hayes said, struggling to his feet. "I know you

  must be busy."

  "Not at all, Jason lied, skirting his desk and sitting down. He removed

  the stethoscope draped around his neck. "What can we do for you?" Hayes

  appeared nervous and fatigued, as if he hadn't slept for several days.

  "I have to talk to you," he said, lowering his voice and leaning forward

  in a conspiratorial fashion.

  Jason flinched back. Hayes's breath was fetid and his eyes had a glassy,

  unfocused look that . gave him a slightly crazed appearance. His white

  laboratory coat was wrinkled and stained. Both sleeves were pushed up

  above his elbows. His watch fitted so loosely that Jason wondered how he

  kept from losing it.

  "What's on your mind?"

  Hayes leaned farther forward, knuckles resting on Jason's blotter. He

  whispered, "Not here. I want to talk with you tonight. Outside of GHP."

  There was a moment of strained silence. Hayes's behavior was obviously

  abnormal, and Jason wondered if he should try to get the man to talk to

  his friend Patrick Quillan, thinking a psychiatrist might have more to

  offer him. If Hayes wanted to talk away from the hospital, it couldn't

  be about his health.

  f'It's important," Hayes added, striking Jason's desk impatiently.

  "All right," Jason said quickly, afraid Hayes might throw a tantrum if

  he hesitated any longer. "How about dinner?" He wanted to meet the man

  in a public place.

  "All right. Where?"

  "Doesn't matter." Jason shrugged. "How about the North End for some

  Italian food?"

  "Fine. When and where?"

  Jason ran down the list of restaurants he knew in the North End section

  of Boston, a warren of crooked streets that made you feel you'd been

  mystically transplanted to southern Italy. "How about Carbonara?" he

  suggested.

  "It's on Rachel Revere Square, across from Paul Revere House."

  "I know it," Hayes said. "What time?"

  10 Eight?"

  "That's fine." Hayes turned and walked somewhat unsteadily toward the

  door.

  "And don't invite anyone else. I want to talk with you alone." Without

  waiting for a reply, he left, pulling the door shut behind him.

  Jason shook his head in amazement and went back to his patients.

  Within a few minutes, he was again absorbed in 'his work, and the

  bizarre episode with Hayes slipped into his unconscious. The afternoon

  drifted on without unwelcome surprises. At least Jason's outpatients

  seemed to be doing well and responding to the various regimens he'd

  ordered. That gave a needed boost to his confidence that the Harring

  affair had undermined.

  With only two more patients to be seen, Jason crossed the waiting room

  after having done a minor surgical procedure in one of the treatment

  rooms.

  Just before he disappeared into his office to dictate the procedure, he

  caught sight of Shirley Montgomery leaning on the central desk and

  chatting with the secretaries. Within the clinical environment, Shirley

  stood out like Cinderella at the ball. In contrast to the other women,

  who were dressed in white skirts and blouses or white pants suits,

  Shirley wore a conservative silk dress that tried but failed to hide her

  attractive figure. Although few people could guess when seeing her,

  Shirley was the chief executive officer of the entire Good Health Plan

  organization. She was as attractive as any model, and she had a Phd in

  hospital administration from Columbia and a master's degree from the

  Harvard Business School.

  With her physical and mental attributes, Shirley could have been

  intimidating, but she wasn't. She was outgoing and sensitive and as a

  result she got along with everyone: maintenance people, secretaries,

  nurses, and even the surgeons. Shirley Montgomery could take personal

  credit for providing a good portion of the glue that held GHP together

  and made it work so smoothly.

  When she spotted Jason, she excused herself from the secretaries. She

  moved toward him with the ease and grace of a dancer. Her thick brown

  hair was swept back from her forehead and layered along the side into a

  heavy mane.

  Her makeup was applied so expertly that she didn't seem to be wearing

  any.

  Her large blue eyes i&one with intelligence.

  "Excuse me, Dr. Howard," she said formally. At the very comers of her

  mouth there was the faint hint of
a'smile. Unknown to the staff, Shirley

  and Jason had been seeing each other on a social basis for several

  months. It had started during one of the semiannual staff meetings when

  they had met each other over cocktails. When Jason learned that her

  husband had recently died of cancer, he felt an immediate bond.

  During the dinner that followed, she told Jason that one morning three

  years ago her husband had awakened with a severe headache. Within months

  he was dead from a brain tumor that had been unresponsive to any

  treatment. At the time they had both been working at the Humana Hospital

  Corporation.

  Afterward, like Jason, she had felt compelled to move and had come to

  Boston. When she told Jason the story, it had affected him so deeply

  that he'd broken his own wall of silence. That same evening he shared

  his own anguish concerning his wife's accident and death.

  Fueled by this extraordinary commonality of emotional experience, Jason

  and Shirley began a relationship that hovered somewhere between

  friendship and romance. Each knew the other was too emotionally raw to

  move too quickly.

  Jason was perplexed. She had never sought him out in such a fashion. As

  usual, he had only the vaguest notion of what was going on inside her expansive mind. In so many ways she was the most' complicated woman he'd

  ever met. "Can I be of assistance?" he asked, watching for some hint of

  her intent.

  "I know you must be busy," she was saying now, "but I was wondering if