Fatal Cure

8

Days melted into weeks and weeks into months as summer advanced. The sweet white corn grew chest-high across the road from the Wilsons' house and could be heard rustling in the evening breeze from the front porch. Plump tomatoes ripened to a deep red in the garden by the terrace. Crab apples the size of golf balls began to drop from the tree next to the barn. Cicadas buzzed incessantly in the midmorning August heat.

David and Angela's work continued to be stimulating and rewarding as they settled into their jobs. Each day brought some new experience that they enthusiastically shared with each other as they lingered over quiet suppers.

Rusty's appetite remained undiminished and a source of wonder as he grew quickly and with great exuberance, catching up to the size of his feet. Yet despite his growth he maintained the same adorable quality he'd had as a tiny puppy. Everyone found it impossible to pass him without offering a pat on the head or a scratch behind a golden ear.

Nikki flourished in the new environment. Her respiratory status remained normal and her lungs stayed clear. She also made new friends. She was closest to Caroline Helmsford by far; Caroline was a petite child a year older than Nikki who also suffered from cystic fibrosis. Having had so many unique experiences in common, the girls formed a particularly strong bond.

They had met quite by accident. Although the Wilsons had been told about Caroline on their first visit to Bartlet, they'd made no attempt to contact her. The two girls had bumped into each other in the local grocery' store which Caroline's parents owned and ran.

Nikki also befriended the Yansen boy, Arni, who happened to be exactly Nikki's age. Their birthdays were only a week apart. Arni was like his father: short, squarely built, and aggressive. He and Nikki hit it off and spent hours in and out of the barn, never at a loss for things to do.

As much as they loved their work, the Wilsons delighted in their weekends. Saturday mornings David rose with the sun to make hospital rounds, then played three-on-three basketball in the high school gym with a group of physicians.

Saturday and Sunday afternoons David and Angela devoted to work on the house. While Angela worked on the interior, busying herself with curtains and stripping old furniture, David tackled outdoor projects like fixing the porch or replacing the drainpipes. David proved even less handy than Angela had feared. He was forever running off to Staley's Hardware Store for more advice. Fortunately, Mr. Staley took pity on David and gave him many lectures on fixing broken screens, leaky faucets, and burned-out electrical switches.

On Saturday, the twenty-first of August, David got up early as usual, made himself coffee, and left for the hospital. Rounds went quickly since he only had to see one patient, John Tarlow, the leukemia victim. Like David's other oncology patients, John had to be hospitalized frequently for a variety of problems. This latest hospitalization resulted from an abscess on his neck. Fortunately, he was doing fine. David anticipated discharging him in the next few days.

After completing his rounds, David biked over to the high school for basketball. Entering the gym he discovered that there were more people than usual waiting to play. When David finally got into the game he noticed that the competition was fiercer than usual. The reason was that no one wanted to lose because the losers had to sit out.

David responded to the heightened competition by playing more vigorously himself. Coming down from a rebound, his elbow collided solidly with Kevin Yansen's nose.

David stopped mid-stride, turning in time to see Kevin cradling his nose in both hands. Blood was dripping between his fingers.

"Kevin," David called in alarm. "Are you all right?"

"Chrissake," Kevin snarled through his cupped hands. "You ass!"

"I'm sorry," David said. He felt embarrassed at his own aggressiveness. "Let me see." David reached out and tried to ease Kevin's hands away from his face.

"Don't touch me," Kevin snapped.

"Come on, Mr. Aggressive," Trent Yarborough called from across the floor. Trent was a surgeon and one of the better ballplayers. He'd played at Yale. "Let's see the old schnozzola. Frankly, I'm glad to see you get a little of your own medicine."

"Screw you, Yarborough," Kevin said. He lowered his hands. His right nostril dripped blood. The bridge of his nose bent to the right.

Trent came over for a better look. "Looks like your beak's been broken."

"Shit!" Kevin said.

"Want me to straighten it?" Trent asked. "I won't charge much."

"Let's just hope your malpractice insurance is paid up," Kevin said. He tilted his head back and closed his eyes.

Trent grabbed Kevin's nose between his thumb and the knuckle of his index finger and snapped it back into position. The cracking sound that resulted made everyone-even the surgeon-wince.

Trent stepped back to admire his handiwork. "Looks better than the original," he said.

David asked if he could give Kevin a ride home, but Kevin told him he'd drive himself, still sounding angry.

A sub stepped into the game, taking Kevin's place. For a moment David stood and gazed at the door where Kevin had exited. Then he winced as someone slapped him on the back. David turned and looked into Trent's face.

"Don't let Kevin bother you," Trent said. "He's broken two other people's noses here that I know of. Kevin is not a particularly good sport, but otherwise he's okay."

Reluctantly, David resumed the game.

When David returned home, Nikki and Angela were ready for the day's outing. There were to be no projects that Saturday because they had been invited to a nearby lake for an overnight stay. An afternoon of swimming was to be followed by a cookout. The Yansens, the Yarboroughs, and the Youngs, the "three Y's" as they called themselves, had rented a lakeside cottage for the month. Steve Young was an obstetrician/gynecologist as well as one of the basketball regulars.

"Come on, Daddy," Nikki said impatiently. "We're already late."

David looked at the time. He'd played basketball longer than usual. Running upstairs, he jumped into the shower. A half hour later they were in the car and on their way.

The lake was an emerald green jewel nestled into a lushly wooded valley between two mountains. One of the mountains boasted a ski resort that David and Angela were told was one of the best in the area.

The cottage was charming. It was a rambling, multi-bedroomed structure built around a massive fieldstone fireplace. A spacious screened porch fronted the entire house and faced the lake. Extending out from the porch was a large deck. A flight of wooden steps connected the deck to a T-shaped dock that ran out fifty feet into the water.

Nikki immediately teamed up with Arni Yansen, and they ran off into the forest where Arni was eager to show her a treehouse. Angela went into the kitchen where Nancy Yansen, Claire Young, and Gayle Yarborough were happily involved in the food preparation. David joined the men who were nursing beers while casually watching a Red Sox game on a portable TV.

The afternoon passed languidly, interrupted only by the minor tragedies associated with eight active children who had the usual proclivities of tripping over rocks, skinning knees, and hurting each others' feelings. The Yansens had two children, the Youngs had one, and the Yarboroughs had three.

The only blip in the otherwise flawless day was Kevin's mood. He'd developed mildly black eyes from his broken nose. On more than one occasion he yelled at David for being clumsy and fouling him continuously. David finally took him aside, amazed that Kevin was making such an issue of the affair.

"I apologized," David said. "And I'll apologize again. I'm sorry. It was an accident. I certainly didn't mean it."

Kevin irritably eyed David, giving David the impression that Kevin was not going to forgive him. But then Kevin sighed. "All right," he said. "Let's have another beer."

After dinner the adults sat around the huge table while the children went out onto the dock to fish. The sky was still red in the west and the color reflected off the water. The tree frogs and crickets and other insects had long since started their incessant nightly chorus. Fireflies dotted the deep shadows under the trees.

At first the conversation dealt with the beauty of the surroundings and the inherent benefits of living in Vermont where most people only got to visit for short vacations. But then the conversation turned to medicine, to the chagrin of the other three wives.

"I'd almost rather hear sports trivia," Gayle Yarborough complained. Nancy Yansen and Claire Young heartily agreed.

"It's hard not to talk about medicine with all this so-called 'reform' going on," Trent said. Neither Trent nor Steve were CMV physicians. Although they had been trying to form a preferred provider organization with a large insurance company and Blue Shield, they were not having much luck. They were a little late. Most of the patient base had been snapped up by CMV because of the plan's aggressive, competitive marketing.

"The whole business has got me depressed," Steve said. "If I could think of some way of supporting myself and my family, I'd leave medicine in the blink of an eye."

"That would be a terrible waste of your skill," Angela said.

"I suppose," Steve said. "But it would be a hell of a lot better than blowing my brains out like you-know-who."

The reference to Dr. Portland intimidated everyone for a few moments. It was Angela who broke the silence. "We've never heard the story about Dr. Portland," she said. "I've been curious, I have to admit. I've seen his poor wife. She's obviously having enormous trouble dealing with his death."

"She blames herself," Gayle Yarborough said.

"All we heard was that he was depressed," David said. "Was it about something specific?"

"The last time he played basketball he was all uptight about one of his hip fracture patients dying," Trent said. "It was Sam Flemming, the artist. Then I think he lost a couple of others."

David felt a shiver pass down his spine. The memory of his own reaction as a junior resident to the deaths of several of his patients passed through him like an unwelcome chill.

"I'm not even sure he killed himself," Kevin said suddenly, shocking everyone. Other than complaining about David's clumsiness, Kevin had said very little that day. Even his wife Nancy looked at him as if he'd blasphemed.

"I think you'd better explain yourself," Trent said.

"Not much to explain except Randy didn't have a gun," Kevin said. "It's one of those nagging details that no one has been able to explain. Where'd he get it? No one has stepped forward to say that he'd borrowed it from him. He didn't go out of town. What did he do, find it along the road?" Kevin laughed hollowly. "Think about it."

"Come on," Steve said. "He must have had it, just no one knew."

"Arlene said she didn't know anything about it," Kevin persisted. "Plus he was shot directly through the front of the head and angled downward. That's why it was his cerebellum that was splattered against the wall. I've personally never heard of anyone shooting himself like that. People usually put the barrel in their mouths if they want to be sure not to mess it up. Other people shoot themselves in the side of the head. It's hard to shoot yourself from the front, especially with a long-barreled magnum." Kevin made a pistol with his hand as he'd done on David's first day of work. This time when he tried to point the gun straight into his forehead, he made the gesture look particularly awkward.

Gayle shivered through fleeting nausea. Even though she was married to a doctor, talk of blood and guts made her ill.

"Are you trying to suggest he was murdered?" Steve said.

"All I'm saying is I'm personally not sure he killed himself," Kevin repeated. "Beyond that, everybody can make his own assessment."

The sounds of crickets and tree frogs dominated the night as everyone pondered Kevin's disturbing comments. "Well, I think it's all poppycock," Gayle Yarborough said finally. "I think it was cowardly suicide, and my heart goes out to Arlene and her two boys."

"I agree," Claire Young said.

Another uncomfortable silence followed until Steve broke it: "What about you two?" he asked, looking across the table at Angela and David. "How are you finding Bartlet? Are you enjoying yourselves?"

David and Angela exchanged glances. David spoke first: "I'm enjoying it immensely," he said. "I love the town, and since I'm already part of CMV I don't have to worry about medical politics. I walked into a big practice, maybe a little too big. I've got more oncology patients than I'd anticipated and more than I'd like."

"What's oncology?" Nancy Yansen asked.

Kevin gave his wife an irritated look of disbelief. "Cancer," he said disdainfully. "Jesus, Nance, you know that."

"Sorry," Nancy said with equal irritation.

"How many oncology patients do you have?" Steve asked.

David closed his eyes and thought for a moment. "Let's see," he said. "I've got John Tarlow with leukemia. He's in the hospital right now. I've got Mary Ann Schiller with ovarian cancer. I've got Jonathan Eakins with prostatic cancer. I've got Donald Anderson who they thought had pancreatic cancer but who ended up with a benign adenoma."

"I recognize that name," Trent said. "That patient had a Whipple procedure."

"Thanks for telling us," Gayle said sarcastically.

"That's only four patients," Steve said.

"There's more," David said. "I've also got Sandra Hascher with melanoma and Marjorie Kleber with breast cancer."

"I'm impressed you've committed them all to memory," Claire Young said.

"It's easy," David said. "I remember them because I've befriended them all. I see them on a regular basis because they have a lot of medical problems, which is hardly surprising considering the amount of treatment they've undergone."

"Well, what's the problem?" Claire asked.

"The problem is that now that I've befriended them and accepted responsibility for their care, I'm worried they'll die of their illness and I'll feel responsible."

"I know exactly what he means," Steve said. "I don't understand how anybody can go into oncology. God bless them. Half the reason I went into OB was because it's generally a happy specialty."

"Ditto for ophthalmology," Kevin said.

"I disagree," Angela said. "I can understand very well why people go into oncology. It has to be rewarding because people with potentially terminal illnesses have great needs. With a lot of other specialties you never truly know if you have helped your patients or not. There's never a question with oncology."

"I know Marjorie Kleber quite well," Gayle Yarborough said. "Both TJ and my middle, Chandler, had her as their teacher. She's a marvelous woman. She had this creative way to get the kids interested in spelling with tiny plastic airplanes moving across a wall chart."

"I enjoy seeing her every time she conies in for an appointment," David admitted.

"How's your job?" Nancy Yansen asked Angela.

"Couldn't be better," Angela said. "Dr. Wadley, the chief of the department, has become a true mentor. The equipment is state-of-the-art. We're busy but not buried. We're doing between five hundred and a thousand biopsies a month, which is respectable. We see interesting pathology because Bartlet Hospital is acting as a tertiary care center. We even have a viral lab which I didn't expect. So all in all it's quite challenging."

"Have you had any run-ins with Charles Kelley yet?" Kevin asked David.

"Not at all," David said with surprise. "We've gotten along fine. In fact just this week I met with Kelley and the CMV quality management director from Burlington. They were both complimentary about the responses patients had given on forms asking them to evaluate care and satisfaction."

"Ha!" Kevin laughed scornfully. "Quality management is a piece of cake. Wait until you have your utilization review. It usually takes two or three months. Let me know what you think of Charles Kelley then."

"I'm not concerned," David said. "I'm practicing good, careful medicine. I don't give a hoot about the bonus program concerning hospitalization and I'm certainly not in the running for one of the grand prize trips to the Bahamas."

"I wouldn't mind," Kevin said. "I think it's a good program. Why not think twice before hospitalizing someone? Patients around here follow your orders. People are better off home than in the hospital. If the hospital wants to send Nance and me to the Bahamas, I'm not going to complain."

"It's a bit different for ophthalmology than for internal medicine," David said.

"Enough of this medical talk," Gayle Yarborough said. "I was just thinking we should have brought the movie The Big Chill. It's a great movie to watch with a group like this."

"Now that would stimulate some discussion," Nancy Yansen said. "And it would be a lot more stimulating than this medical drivel."

"I don't need the movie to think about whether I would be willing to let my husband make love to one of my friends so she could have a baby," Claire Young said. "No way, period!"

"Oh, come on," Steve said, sitting up from his slouch. "I wouldn't mind, especially if it were Gayle." He reached over and gave Gayle a hug. Gayle was sitting next to him. She giggled and pretended to squirm in his arms.

Trent poured a bit of beer over the top of Steve's head. Steve tried to catch it with his tongue.

"It would have to be a desperate situation," Nancy Yansen said. "Besides, there's always the turkey baster."

For the next several minutes everyone except David and Angela doubled up with laughter. Then followed a series of off-color jokes and sexual innuendoes. David and Angela maintained half smiles and nodded at punch lines, but they didn't participate.

"Wait a minute, everybody," Nancy Yansen said amid laughter after a particularly salacious doctor's joke. She struggled to contain herself. "I think we should get the kids off to bed so we can have ourselves a skinny dip. What do you say?"

"I say let's do it," Trent said as he clicked beer bottles with Steve.

David and Angela eyed each other, wondering if the suggestion was another joke. Everyone else stood up and started calling for their children who were still down on the dock fishing in the darkness.

Later in their room as Angela washed her face at the wall sink she complained to David that she thought the group had suddenly regressed to some early, adolescent stage. As she spoke they both could hear the rest of the adults leaping from the dock amid giggles, shouts, and splashing.

"It does smack of college fraternity behavior," David agreed. "But I don't think there's any harm. We shouldn't be judgmental,"

"I'm not so sure," Angela said. "What worries me is feeling that we're in a John Updike novel about suburbia. All that loose sexual talk and now this acting out makes me uncomfortable. I think it could be a reflection of boredom. Maybe Bartlet isn't the Eden we think it is."

"Oh, please!" David said with amazement. "I think you're being overly critical and cynical. I think they just have an exuberant, fun-loving, youthful attitude toward life. Maybe we're the ones with hang-ups."

Angela turned from the sink to face David. Her expression was one of surprise, as if David were a stranger. "You're entirely welcome to go out there naked and join the Bacchanalia if you so desire," she said. "Don't let me stop you!"

"Don't get all bent out of shape," David said. "I don't want to participate. But at the same time I don't see it in such black and white terms as you apparently do. Maybe it's some of your Catholic baggage."

"I refuse to be provoked," Angela said, turning back to the sink. "And I specifically refuse to be baited into one of our pointless religious discussions."

"Fine by me," David said agreeably.

Later when they had gotten into bed and turned out the light the sounds of merriment from the dock had been replaced by the frogs and insects. It was so quiet they could hear the water lapping against the shore.

"Do you think they're still out there?" Angela whispered.

"I haven't the faintest idea," David said. "Moreover I don't care."

"What did you think of Kevin's comments about Dr. Portland?" Angela asked.

"I don't know what to think," David said. "To be truthful, Kevin has become somewhat of a mystery to me. He's a weird duck. I've never seen anyone carry on so much about getting bumped in the nose in a pickup basketball game."

"I found his comments unsettling to say the least," Angela said. "Thinking about murder in Bartlet even for a second leaves me strangely cold. I'm beginning to have this uncomfortable nagging feeling that something bad is going to happen, maybe because we're too happy."

"It's that hysterical personality of yours," David said, half in jest. "You're always looking for the dramatic. It makes you pessimistic. I think we're happy because we made the right decision."

"I hope you are right," Angela said as she snuggled into the crook of David's arm.