Blood Work

31

THE COORDINATOR’S OFFICE.”

“Glenn Leopold, please, this is Bonnie Fox calling.”

They were in Fox’s office with the door closed. Fox had the phone speaker on so McCaleb and Graciela could listen. They had waited for her a half hour before she had come in. Her demeanor was different. She was still going to help but McCaleb noticed that she was more agitated than she had appeared when they had gathered in the empty patient room in the north tower. They had gone over a plan McCaleb came up with while waiting, Fox had taken a couple of notes to refer to and then placed the call.

“Bonnie?”

“Hi, Glenn, how are you?”

“I’m fine. What can I do you for? I’ve got about ten minutes before a meeting.”

“This shouldn’t take long. I’ve got a slight problem here, Glenn, and I think you might be able to help me.”

“Tell me.”

“I performed a transplant here February ninth-it was BOPRA file number ninety-eight thirty-six-and a complication has come up. What I’d like to do is speak with the surgeons who performed transplants with the donor’s other organs.”

There was a brief silence before Leopold’s voice came up on the speaker again.

“Uh, let’s see… I mean, this is kind of unusual. What sort of complication are we talking about, Bonnie?”

“Well, I know you have your meeting. To make it as brief as possible, the recipient’s blood group was type AB with CMV negative. The organ we received through BOPRA matched that-according to the protocol. But now-what are we, nine weeks or so post-op-our recipient has developed CMV virus and we are showing rejection in the blood work from the latest biopsy. I am trying to isolate how this has happened.”

More silence.

“Well, I think it would have come up before now if it came in with the heart.”

“That’s true but we weren’t looking for it before. We assumed based on the protocol that there was no CMV. Don’t get me wrong, Glenn, I am not saying it came in with the heart. But I have to find out where it came from and I want to cover everything. Best place to start is with the heart.”

“Are you trying to isolate this, as you say, at the request of attorneys? Because if that’s what you are doing, then I think I need to get my-”

“No, no, Glenn, this is just me. I need to know if the virus came in with the organ or there was-is-a problem right here.”

“Well, what blood did you use?”

“That’s just it, we only used the patient’s own blood. I have the file right here. He stored eight units long before surgery. We only used six.”

“And you are sure you used his six?”

Leopold’s voice was now showing some agitation. Fox was looking at McCaleb as she answered and he saw how uncomfortable it was for her to be deceitful with the BOPRA organ coordinator.

“All I can say is that we followed procedures and I personally double-checked the bag labels before surgery. They were his labels. I have to assume it was his blood.”

“What do you want from us, Bonnie?”

“A list. What organ went to what patient, and the attending surgeon I can call.”

“I don’t know. I think maybe I should-”

“Glenn, listen, it is nothing personal, but my patient is having this problem and I need to check this out for myself. I have to be satisfied myself. I will keep it contained, if that’s what you are worried about. No one is talking about lawyers or malpractice. We just need to find out how this happened. For all we know, you are right, it’s a blood mix-up. But I am sure you would agree that the place to start with something like this is with the new tissue that’s been introduced to the patient.”

McCaleb held his breath. They were at the pivotal point. Fox needed to get the names herself. She couldn’t let Leopold say he would check it out himself and get back to her.

“I suppose…”

Leopold trailed off and Fox leaned forward, folded her arms on the desk and put her head down. In the silence McCaleb heard a sound from the phone that he identified as computer keys being tapped. He felt a slight charge as he realized that Leopold was probably calling up the file on his computer.

McCaleb stood up and leaned over the desk and gently tapped Fox on the elbow. She looked up at him and he made a circular motion with his hand, signaling her to keep going.

“Glenn?” she said. “What do you think?”

“I’m looking at it right now… Harvest occurred at Holy Cross… There is nothing here on the donor profile indicating CMV. Nothing. This person was a long-time blood donor. I think it would have come up before if she-”

“That’s probably true but I need to double-check. Even if just for my own peace of mind.”

“I understand.”

More sounds of the computer keyboard being played.

“Let’s see, transportation was… by MedicAir… The liver was transplanted right there with the heart at Cedars. Do you know Dr. Spivak? Daniel Spivak?”

“No.”

McCaleb grabbed a legal pad from his bag and started writing.

“Well, he did that one. Let’s see, the lungs-”

“I’ll call Spivak,” Fox interrupted. “What’s the patient’s name?”

“Um… I’m really going to have to ask you to keep all of this in the strictest confidence, Bonnie.”

“Absolutely.”

“It was a male. J. B. Dickey.”

McCaleb wrote it down.

“Okay,” Fox said. “You were on to the lungs.”

“Uh, yes, lungs. No takers without the heart. Your patient got the heart.”

“Right. What about bone marrow transfer?”

“You want everything, I guess. The marrow… uh, the marrow we did not do well with. We missed the window. The tissue was flown to San Francisco but by the time MedicAir got up there, they had a weather delay. They were redirected to San Jose but with the delay and the ground traffic and everything, it took too long getting up to St. Joseph ’s. We missed the chance. From what I understand, the patient later expired. As you know, this blood group is tough. That was probably our one chance on that one.”

That brought another measure of silence. McCaleb looked at Graciela. Her eyes were downcast and he couldn’t read her. For the first time he considered what she was going through. They were talking about her sister and the people she had helped save. But it was all said in such a clinical manner. Graciela was a nurse and was used to such discussions about patients. But not her sister.

McCaleb wrote “bone marrow” on the page and then drew a line through the words. He then made the keep-it-rolling hand motion to Fox again.

“What about kidneys?” she asked.

“The kidneys… The kidneys were split. Let’s see what we’ve got on the kidneys…”

Over the next four minutes Leopold went down the list of items mined from the body of Gloria Torres and redistributed to living patients. McCaleb wrote it all down, now keeping his eyes on the legal pad and not wanting to look at Graciela again to see how she was handling having to listen to such a grim inventory.

“That’s it,” Leopold finally said.

McCaleb, energized by getting the names but exhausted by the cliff walk it took in getting them, blew his breath out loudly. Too loudly.

“Bonnie?” Leopold said quietly. “Are you alone? You didn’t tell me you were with-”

“No, it’s just me, Glenn. I’m alone.”

Silence. Fox threw an angry look at McCaleb, then closed her eyes tightly and waited.

“Well, okay,” Leopold finally said. “I thought I heard someone else there, that’s all, and I have to reiterate that this information is highly confidential in-”

“I know that, Glenn.”

“-nature. I’ve broken my own rules by giving it to you.”

“I understand.” Fox opened her eyes. “I will make my inquiries discreetly, Glenn, and… I’ll let you know what I find.”

“Perfect.”

After a few more exchanges of small talk, the call was ended. Fox pushed the phone’s disconnect button and brought her head back down on her folded arms.

“God… I can’t believe what I just did. I… lied to this man. Lied to a colleague. When he finds out, he’s…”

She didn’t finish. She just shook her head on the cradle of her arms.

“Doctor,” McCaleb tried. “You did the right thing. There is no harm to him and he’ll probably never know what was done with the information. Tomorrow you can call him and say you isolated the CMV problem and it wasn’t from the donor. Tell him you destroyed the notes on the other recipients.”

Fox brought her head up and looked at him.

“It doesn’t matter. I was deceitful. I hate having to be deceitful. If he finds out, he’ll never trust me again.”

McCaleb just looked at her. He had no answer to that.

“You have to promise me one thing,” Fox said. “That if your theory proves out, that if you are right, then you get whoever did this. That will be the only way I’ll be able to accept this. It will be my only defense.”

McCaleb nodded. He came around the desk and leaned down and hugged Fox.

“Thank you,” Graciela said softly. “You did good.”

Fox smiled weakly at her and nodded.

“One last thing,” McCaleb said. “Do you have a copying machine?”