Fatal Cure

17

David and Angela were exhausted in the morning, but Nikki was well rested. She'd slept through the night without a nightmare and was eager to begin the day.

On Sundays the Wilsons got up early for church, followed by brunch at the Iron Horse Inn.

Attending church had been Angela's idea. Her motivation wasn't religious, it was social. She thought it would be a good way to join the Bartlet community. She'd settled on the Methodist church on the town green. It was far and away the most popular in town.

"Do we have to go?" David whined that morning. He was sitting on the side of the bed. He was trying to dress with clumsy fingers. He'd again awakened before dawn despite having gone to sleep so late. He'd lain awake for several hours. He'd just fallen back asleep when Nikki and Rusty had come bounding into the room.

"Nikki will be disappointed if we don't go," Angela called from the bathroom.

David finished dressing with resignation. A half hour later, the family climbed into the Volvo and drove into town. From past experience they knew to park in the Inn's parking lot and walk to the green. Parking near the church itself was always a disaster. The traffic on a Sunday was so bad it had to be supervised by one of the town's policemen.

That morning Wayne Robertson was on duty as traffic controller. A stainless-steel whistle protruded from his mouth.

"Isn't this handy," Angela said as soon as she spotted him. "You guys wait here."

Darting away before David could stop her, Angela went directly to the chief of police with the anonymous note in hand.

"Excuse me," Angela said. "I have something I'd like you to see. This was nailed to our door last night while we were in bed." She handed him the note, then rested her knuckles on her hips, her arms akimbo, waiting for his response.

Robertson allowed the whistle to drop from his mouth. It was attached by a cord around his neck. He glanced at the note, then handed it back. "I'd say it's a good suggestion. I recommend that you take the advice."

Angela chuckled. "I'm not asking your opinion as to the note's suggestion," she said. "I want you to find out who left it on our door."

"Well, now," he said slowly, scratching the back of his head, "it's not a lot to go on except for the fact that it was obviously typed on a nineteen fifty-two Smith Corona with a defective lowercase 'o.' "

For an instant, Angela began to reevaluate her estimation of Robertson's abilities. But then she realized he was making fun of her.

"I'm sure you'll do your best," Angela said with commensurate sarcasm, "but considering your attitude toward the Hodges murder case, I guess we can't expect miracles."

Honking horns and a few shouts from frustrated drivers forced Robertson's attention back to the traffic, which had quickly become a muddle. As he did his best to unsnarl the congestion, he said: "You and your little family are newcomers to Bartlet. Maybe you ought to think twice about interfering in matters that don't concern you. You'll only make trouble for yourself."

"So far I've only gotten trouble from you," Angela said. "And I understand that you happen to be one of the people who's not so sorry about Hodges' death. I understand you mistakenly blame him for your wife's death."

Robertson stopped directing traffic and turned to Angela. His chubby cheeks had become beet red. "What did you say?" he demanded.

Just then David slipped in between Angela and Robertson, forcing Angela away. He'd been eavesdropping on the conversation from a few feet away and he didn't like the direction it was taking.

Angela tried to repeat her statement, but David gave her arm a sharp tug. Through clenched teeth he whispered to her to shut up. When he got her far enough away he grabbed her shoulders. "What the hell has gotten into you?" he demanded. "You're taunting a man who's obviously got some kind of personality problem. I know you have a penchant for the dramatic but this is pushing it."

"He was ridiculing me," Angela complained.

"Stop it," David commanded. "You're sounding like a child."

"He's supposed to be protecting us," Angela snapped. "He's supposed to uphold the law. But he isn't any more interested in this threatening note than he is in finding out who murdered Hodges."

"Calm down!" David said. "You're making a scene."

Angela's eyes left David's and swept around the immediate area. A number of people had paused on their way into the church. They were all staring.

Self-consciously, Angela put the note away in her purse, smoothed her dress, and reached for Nikki's hand.

"Come on," she said. "Let's not be late for the service."

With Alice Doherty recruited to watch over Nikki and Caroline, David and Angela drove to the hospital. Nikki had met Caroline after the church service, and Caroline had accompanied them to the Iron Horse Inn for brunch.

At the hospital, David and Angela met Donald Schiller and his in-laws, the Josephsons, in the lobby. They sat on the benches to the right of the entrance to discuss the proposed autopsy.

"My husband has asked you for permission to do an autopsy," Angela said. "I'm here to tell you that I will be the one to do it if you agree. Since neither the hospital nor CMV will pay for this service, I'm offering to do it on my own time. It will be free. It also might provide some important information."

"That's very generous of you," Donald said. "We still weren't sure what to do this morning, but after talking to you, I think I feel okay about it." Donald looked at the Josephsons. They nodded. "I think Mary Ann would have wanted it too, if it could help other people."

"I think it might," Angela said.

David and Angela went down into the basement to retrieve Mary Ann's body from the morgue. They took it up to the lab and rolled it into the autopsy room. The room had not been used for autopsies for several years and had become a storeroom. They had to move boxes from the old stainless-steel autopsy table.

David had planned to assist, but it quickly became apparent to Angela that he was having a hard time dealing with the situation. He was not accustomed to autopsies, and this was the body of a patient he had been treating only the day before.

"Why don't you go see your patients?" Angela suggested when she was ready to begin.

"You sure you can manage?" David asked.

Angela nodded. "I'll page you when I'm done, and you can help me get her back downstairs."

"Thank you," David said. At the door he turned. "Remember, consider the possibility of an unknown viral disease. So be careful. And also, I want a full toxicological workup."

"Why the toxicology?" Angela asked.

"I want to cover all the bases," David said. "Humor me, okay?"

"You've got it," Angela said agreeably. "Now get out of here!" She picked up a scalpel and waved for David to leave.

David let the autopsy room doors close behind him before he took off the hood, gown, and mask he'd donned for the post mortem. He was relieved to have been excused. David left the lab and climbed up to the patient floor.

He fully intended to discharge Jonathan Eakins, especially after he he'd been told by the nursing staff that there'd been no abnormal heartbeats. But that was before he went into Jonathan's room to say hello. Instead of experiencing Jonathan's usual cheerfulness, David found the man depressed. Jonathan said he felt terrible.

Sensitized by recent events, David's mouth became instantly dry. He felt a rush of adrenaline shoot through his body. Afraid to hear the answer, he asked Jonathan what was wrong.

"Everything," Jonathan said. His face was slack and his eyes lusterless. A string of drool hung down from the corner of his mouth. "I started having cramps, then nausea and diarrhea. I've no appetite and I have to keep swallowing."

"What do you mean you have to keep swallowing?" David asked fearfully.

"My mouth keeps filling up with saliva," Jonathan said. "I have to swallow or spit it out."

David desperately tried to put these symptoms into some recognizable category. Salivation keyed off a memory from medical school. He remembered it was one of the symptoms of mercury poisoning.

"Did you eat anything strange last night?" David asked.

"No," Jonathan said.

"What about your IV?" David asked.

"That was removed yesterday on your orders," Jonathan said.

David was panicky. Except for the salivation, Jonathan's symptoms reminded him of the symptoms Marjorie, John, and Mary Ann had experienced prior to their rapid deterioration and deaths.

"What's wrong with me?" Jonathan asked, sensing David's anxiety. "This isn't something serious, is it?"

"I was hoping to send you home," David said, avoiding a direct answer. "But if you are feeling this bad, maybe we'd better keep you for a day or so."

"Whatever you say," Jonathan said. "But let's nip this in the bud; I've got a wedding anniversary coming up this weekend."

David hurried back to the nurses' station with his mind in an uproar. He kept telling himself that it couldn't happen again. It was impossible. The odds were too small.

David threw himself into a chair and took Jonathan's chart from the rack. He went over it carefully, re-reading everything, including all the nurses' notes. He noticed that Jonathan's temperature that morning had been one hundred degrees. Did that represent a fever? David didn't know; it was borderline.

Rushing back into Jonathan's room, David had him sit on the side of his bed so that he could listen to his chest. His lungs were perfectly clear.

Returning to the nurses' station David leaned his elbows on the counter and covered his face with his hands. He had to think. He didn't know what to do, yet he felt he had to do something.

Impulsively David reached for the phone. He already knew the response he could expect from Kelley and CMV, but he didn't care. He called Dr. Mieslich, the oncologist, and Dr. Hasselbaum, the infectious disease specialist, and asked them both to come in immediately. David told them he believed he had a patient who was in the very early stages of the same condition that had proved mortal three times in as many days.

While David was waiting for the consults to arrive, he ordered a barrage of tests. There was always the chance that Jonathan would wake up the next day feeling fine, but David didn't think he could risk his patient's going the route of Marjorie, John, and Mary Ann. His sixth sense was telling him that Jonathan was already locked in a mortal struggle, and lately David's intuition had not been wrong.

The infectious disease specialist was first to arrive. After a quick chat with David, he went in to see the patient. Dr. Mieslich came in next. He brought with him his records of Jonathan's treatment when he had been his patient. Dr. Mieslich and David went over the record page by page. By then Dr. Hasselbaum was finished examining Jonathan. He joined David and Dr. Mieslich at the nurses' station.

The three men had just begun to discuss the case when David became aware that the two doctors were looking over his shoulder. David turned to see Kelley looming above him.

"Dr. Wilson," Kelly said, "may I have a word with you in the patients' lounge?"

"I'm too busy right now," David said. He turned back to his consults.

"I'm afraid I must insist," Kelley said. He tapped David on the shoulder. David brushed his hand off. He did not like Kelley touching him.

"This will give me a chance to examine the patient," Dr. Mieslich said. He stood up and left the nurses' station.

"I'll use the time to write up my consult," Dr. Hasselbaum said. He took his pen from his jacket pocket and reached for Jonathan's chart.

"All right," David said, standing up. "Lead on, Mr. Kelley."

Kelley walked across the corridor and stepped into the patient lounge. After David entered the room Kelley closed the door.

"I presume you know Ms. Helen Beaton, the hospital president," Kelley said, "and Mr. Michael Caldwell, the medical director." He gestured toward both people, who were sitting on the couch.

"Yes, of course," David said. He remembered Caldwell from Angela's interviews, and he'd met Beaton at several hospital functions. David reached out and shook hands with each. Neither bothered to stand up.

Kelley sat down. David did likewise.

David anxiously glanced around at the faces arrayed around him. He expected trouble from Kelley, thinking this meeting had to do with the autopsy on Mary Ann Schiller. He guessed that was why the hospital people were there. He hoped this didn't spell trouble for Angela.

"I suppose I should be forthright," Kelley said. "You probably wonder how we've responded so quickly to your handling of Jonathan Eakins."

David was flabbergasted: how could these three be here to talk to him about Jonathan when he'd only just started investigating the man's symptoms?

"We were called by the nursing utilization coordinator," Kelley explained. "She had been alerted by the floor nurses according to previous instructions. Utilization control is vital. We feel the need to intervene. As I've told you before, you are using far too many consults, especially outside the CMV family."

"And far too many laboratory tests," Beaton said.

"Too many diagnostic tests as well," Caldwell said.

David stared at the three administrators in disbelief. Each returned his stare with impunity. They were a tribunal sitting in judgment. It was like the Inquisition. He was being tried for economic medical heresy, and not one of his inquisitors was a physician.

"We want to remind you that you are dealing with a patient who has been treated for metastatic prostate cancer," Kelley said.

"We're afraid you've already been too lavish and wasteful with your orders," Beaton said.

"You have a history of excessive use of resources on three previous patients who were clearly terminal," Caldwell said.

David struggled with his emotions. Since he'd already been questioning his competence as a result of the three successive deaths, he was vulnerable to the administrators' criticism. "My allegiance is to the patient," David said meekly. "Not to an organization or an institution."

"We can appreciate your philosophy," Beaton said. "But such a philosophy has led to the economic crisis in medical care. You must expand your horizons. We have an allegiance to the entire community of patients. Everything cannot be done to everybody. Judgment is needed in the rational use of limited resources."

"David, the fact of the matter is that your use of ancillary services far exceeds norms developed by your fellow physicians," Kelley told him.

There was a pause. David wasn't sure what to say. "My worry in these particular cases is that I'm seeing an unknown infectious disease. If that is the case, it would be disastrous not to diagnose it."

The three medical administrators looked at each other to see who would speak. Beaton shrugged and said: "That's out of my expertise; I'm the first to admit it."

"Mine too," Caldwell said.

"But we happen to have an independent infectious disease consult here at the moment," Kelley said. "Since CMV is already paying him, let's ask him his opinion."

Kelley went out and returned with both Dr. Martin Hasselbaum and Dr. Clark Mieslich. Introductions were made. Dr. Hasselbaum was asked if he thought that David's three deceased patients and Mr. Eakins might have been afflicted by an unknown infectious disease.

"I sincerely doubt it," Dr. Hasselbaum said. "There's no evidence whatsoever that they had an infectious disease. All three had pneumonia, but I feel the pneumonia was caused by generalized debility. In all three cases the agent was a recognized pathogen."

Kelley then asked both consults what form of treatment they thought should be given to Jonathan Eakins.

"Purely symptomatic," Dr. Mieslich said. He looked at Dr. Hasselbaum.

"That would be my recommendation as well," Dr. Hasselbaum said.

"You both have also seen the long list of diagnostic tests that have been ordered by Dr. Wilson," Kelley said. "Do you think any of these tests are crucial at this time?"

Dr. Mieslich and Dr. Hasselbaum exchanged glances. Dr. Hasselbaum was first to speak: "If it were my case I'd hold off and see what happened. The patient could be normal by morning."

"I agree," Dr. Mieslich said.

"Well then," Kelley said, "I think we all agree. What do you say, Dr. Wilson?"

The meeting broke up amid smiles, handshakes, and apparent amity. But David felt confused and humiliated, even depressed. He walked back to the nurses' station and canceled most of the orders he had written for Jonathan. Then he went in to see Jonathan himself.

"Thanks for having so many people come and examine me," Jonathan said.

"How do you feel?" David asked.

"I don't know," Jonathan said. "Maybe a little better."

When David got back to the autopsy room, Angela was just cleaning up. David's timing had been good. He helped return Mary Ann's body to the morgue. David noticed that Angela wasn't eager to talk about her findings. He practically had to grill her for answers.

"I didn't find much," Angela admitted.

"Nothing in the brain?" David asked.

"It was clean grossly," Angela said. "But we'll have to see what the microscopic shows."

"Any tumor?" David asked.

"I think there was a tiny bit in the abdomen," Angela said. "Again, I'll have to wait for the microscopic to be sure."

"So nothing jumped out at you as a cause of death?" David asked.

"She did have pneumonia," Angela said.

David nodded. He already knew that.

"I'm sorry I didn't find more," Angela said.

"I appreciate that you tried," David said.

As they drove home, Angela could tell that David was depressed. He'd only been answering questions in monosyllables.

"I suppose you're upset because I didn't find much on the autopsy," Angela said, pausing before she got out of the car.

David sighed. "That's just part of it," he said.

"David, you are a wonderful, talented doctor," Angela said. "Please stop being so hard on yourself."

David then told her about being hauled before the tribunal by Kelley. Angela was livid. "The nerve," she said. "Hospital administrators should not become involved in treatment."

"I don't know," David said with a sigh. "In some ways they're right. The cost of medical care is a problem. But it's so confusing when you get down to specifics with an individual patient. But the consults did side with the administrators."

At dinner, David discovered he wasn't hungry; he merely pushed his food around the plate. To make matters worse, Nikki complained that she didn't feel well.

By eight o'clock, Nikki started to sound congested and Angela took her upstairs for her respiratory therapy. When it was over, Angela found David sitting in the family room. The television was on but David wasn't watching; he was staring into the fire.

"It might be best to keep Nikki home from school tomorrow," Angela said. David didn't answer. Angela studied his face. For the moment she didn't know who she was more concerned about: Nikki or David.