Fever

Nine

Coming back from Beth Israel Hospital where she’d paid an unsuccessful visit to Marge Schonhauser, Cathryn felt she was being stretched to the limits of her endurance. She’d guessed that Marge must have been bad off or she wouldn’t have been hospitalized, but she was still not prepared for what she found. Apparently some vital thread had snapped in Marge’s brain when Tad had died, because she had sunk into an unresponsive torpor, refusing to eat or even sleep. Cathryn had sat with Marge in silence until a feeling of tension drove Cathryn away. It was as if Marge’s depression were infectious. Cathryn fled back to Pediatric Hospital, going from the casualty of one tragedy to the beginning of another.

Rising in the crowded elevator to Anderson 6, she wondered if what happened to Marge could happen to her or even to Charles. He was a physician and she would have guessed he’d be more capable of dealing with this kind of reality, yet his behavior was far from reassuring. As difficult as she found hospitals and illness, Cathryn tried to gird herself against the future.

The elevator arrived at Anderson 6 and Cathryn struggled to reach the front of the car before the doors closed. She was impatient to get back to Michelle, because the child had been very reluctant to let Cathryn leave. Cathryn had talked Michelle into letting her go after lunch by promising she’d be back in half an hour. Unfortunately it was now closer to an hour.

Michelle had clung to Cathryn earlier that morning after Charles had left, insisting that Charles was angry with her. No matter what Cathryn had said, she’d not been able to change Michelle’s mind.

Now Cathryn pushed open Michelle’s door, hoping the child might be napping. At first she thought perhaps she was, because Michelle didn’t move. But then Cathryn noticed the child had kicked off the covers and slid down in the bed with one leg tucked under her. From the doorway Cathryn could see that Michelle’s chest was heaving violently and worst of all, her face had an alarmingly bluish cast with deep maroon-colored lips.

Rushing to the bedside, Cathryn grasped Michelle by the shoulders.

“Michelle,” she cried, shaking the child. “What’s wrong?”

Michelle’s lips moved and her lids fluttered open but only whites showed; her eyes were rolled up in their sockets.

“Help!” cried Cathryn, running for the corridor. “Help!”

The charge nurse came from behind the nurses’ station followed by an LPN. From a room beyond Michelle’s came another RN. They all rapidly converged on Michelle’s room, pushing past the panic-stricken Cathryn. One went to either side of the bed, another to the foot.

“Call a code,” barked the charge nurse.

The nurse at the foot of the bed sped over to the intercom and yelled for the clerk at the nurses’ station to call a code.

Meanwhile the charge nurse could feel a rapid, thready pulse. “Feels like V-tack,” she said. “Her heart’s beating so fast it’s hard to feel individual beats.”

“I agree,” said the other nurse, putting the blood pressure cuff around Michelle’s arm.

“She’s breathing but cyanotic,” said the charge nurse. “Should I give her mouth-to-mouth?”

“I don’t know,” said the second nurse, pumping up the blood pressure cuff. “Maybe it would help the cyanosis.”

The third nurse came back to the bed and straightened out Michelle’s leg while the charge nurse bent over and, squeezing Michelle’s nose shut, placed her mouth over Michelle’s and blew.

“I can get a blood pressure,” said the second nurse. “Sixty over forty, but it’s variable.”

The charge nurse continued to breathe for Michelle but Michelle’s own rapid respiration made it difficult. The nurse straightened up. “I think I’m hindering her more than helping her. I’d better hold off.”

Cathryn remained pressed against the wall, terrorized by the scene in front of her, afraid to move lest she be in the way. She had no idea what was happening although she knew it was bad. Where was Charles!

A woman resident was the first doctor to arrive. She came through from the hallway so quickly that she had to grab the edge of the door to keep from falling on the polished vinyl floor. She ran directly to the bedside, grasping Michelle’s wrist for a pulse.

“I think she has V-tack,” said the charge nurse. “She’s a leukemic. Myeloblastic. Day two of attempted induction.”

“Any cardiac history?” demanded the woman resident, as she leaned over and elevated Michelle’s eyelids. “At least the pupils are down.”

The three nurses looked at each other. “We don’t think she has any cardiac history. Nothing was said at report,” said the charge nurse.

“Blood pressure?” asked the resident.

“Last time it was sixty over forty but variable,” said the second nurse.

“V-tack,” confirmed the woman resident. “Stand back a second.”

The woman resident made a fist and brought it down on Michelle’s narrow thorax with a resounding thump that made Cathryn wince.

An extremely young-looking chief resident arrived followed by two others pushing a cart filled with all sorts of medical paraphernalia and crowned with electronic instrumentation.

The woman resident gave a terse explanation of Michelle’s condition while the nurses rapidly attached EKG leads to Michelle’s extremities.

The charge nurse leaned over to one of the other nurses and told her to page Dr. Keitzman.

The electronic box on the top of the cart began to spew forth an endless strip of narrow graph paper on which Cathryn could see the red squiggles of an EKG. The doctors grouped around the machine, momentarily forgetting Michelle.

“V-tack all right,” said the chief resident. “With the dyspnea and cyanosis she’s obviously hemodynamically compromised. What does that mean, George?”

One of the other residents looked up, startled. “Means we should cardiovert her immediately… I think.”

“You think right,” concurred the chief resident. “But let’s draw up some Lidocaine. Let’s see, the kid’s about fifty kilograms, no?”

“A little less,” said the woman resident.

“All right, fifty milligrams of Lidocaine. Also draw up a milligram of atropine in case she goes into bradycardia.”

The team functioned efficiently as one resident drew up the medications, another got out the electrode paddles, while the third helped position Michelle. One paddle went under Michelle’s back, the other anteriorly on her chest.

“All right, stand back,” said the chief resident. “We’ll use a fifty-watt second shock to start, programmed to be delivered at the R-wave. Here goes.”

He pressed a button and after a momentary delay Michelle’s body contracted, her arms and legs jumping off the surface of the bed.

Cathryn watched in horror as the doctors stayed bent over the machine, ignoring Michelle’s violent reaction. Cathryn could see the child’s eyes open in utter bewilderment and her head lift off the bed. Thankfully her color rapidly reverted to normal.

“Not bad!” yelled the chief resident, examining the EKG paper as it came out of the machine.

“John, you’re getting good at this stuff,” agreed the woman resident. “Maybe you should think about doing it for a living.”

All the doctors laughed and turned to Michelle.

Dr. Keitzman arrived breathless, hands jammed into the pockets of his long white coat. He went directly to the bed, his bespectacled eyes quickly scanning Michelle’s body. He snatched up her hand, feeling for a pulse.

“Are you okay, chicken?” he asked, getting out his stethoscope.

Michelle nodded but didn’t speak. She appeared dazed.

Cathryn watched as John, the chief resident, launched into a capsule summary of the event in what was to Cathryn incomprehensible medicalese.

Dr. Keitzman’s upper lip pulled back in a characteristic spasm as he bent over Michelle, listening to her chest. Satisfied, he checked a run of EKG paper offered by John. At that moment he caught sight of Cathryn pressed up against the wall. Keitzman glanced at the charge nurse with a questioning expression. The charge nurse, following his line of sight, shrugged.

“We didn’t know she was in here,” said the charge nurse defensively.

Dr. Keitzman walked over to Cathryn and put a hand on her shoulder.

“How about you, Mrs. Martel?” asked Dr. Keitzman. “Are you all right?”

Cathryn tried to talk but her voice wouldn’t cooperate, so she nodded like Michelle.

“I’m sorry you had to see this,” said Dr. Keitzman. “Michelle seems fine and she undoubtedly did not feel anything. But I know this kind of thing is shocking. Let’s go out in the hall for a moment. I’d like to talk to you.”

Cathryn strained upward to see Michelle over Dr. Keitzman’s shoulder.

“She’ll be okay for a moment,” assured Dr. Keitzman. Then, turning to the charge nurse, he said, “I’ll be just outside. I want a cardiac monitor in here, and I’d like a cardiac consult. See if Dr. Brubaker can see her right away.” Dr. Keitzman gently urged Cathryn out into the corridor. “Come down to the nurses’ station; we can talk there.”

Dr. Keitzman led Cathryn down the busy corridor to the chart room. There were Formica Parsons tables, chairs, two dictating telephones, and the massive chart racks. Dr. Keitzman pulled out a chair for Cathryn and she gratefully sat down.

“Can I get you something to drink?” suggested Dr. Keitzman. “Water?”

“No, thank you,” managed Cathryn nervously. Dr. Keitzman’s extremely serious manner was a source of new anxiety and she searched the man’s face for clues. It was hard to see his eyes through his thick glasses.

The charge nurse’s head came through the door. “Dr. Brubaker wants to know if he can see the patient in his office.”

Dr. Keitzman’s face contorted for a second while he pondered. “Tell him that she just had an episode of V-tack and I’d prefer he see her before she’s moved around.”

“Okay,” said the charge nurse.

Dr. Keitzman turned to Cathryn. He sighed. “Mrs. Martel, I feel I must talk frankly with you. Michelle is not doing well at all. And I’m not referring specifically to this latest episode.”

“What was this episode?” asked Cathryn, not liking the initial tone of the conversation.

“Her heart speeded up,” said Dr. Keitzman. “Usually it’s the upper part of the heart that initiates the beat.” Dr. Keitzman gestured awkwardly to try to illustrate what he was saying. “But for some reason, the lower part of Michelle’s heart took over. Why? We don’t know yet. In any case, her heart suddenly began to beat so fast that there wasn’t time for the heart to fill properly, so it pumped inefficiently. But that seems to be under control. What is worrying me is that she does not seem to be responding to the chemotherapy.”

“But she’s just started!” exclaimed Cathryn. The last thing that Cathryn wanted was for her hope to be undermined.

“That’s true,” agreed Dr. Keitzman. “However, Michelle’s type of leukemia usually responds in the first few days. On top of that Michelle has the most aggressive case that I’ve ever seen. Yesterday we gave her a very strong and very successful drug called Daunorubicin. This morning when we did her blood count, I was shocked to see that there was almost no effect on the leukemic cells. This is very unusual although it does happen occasionally. So I decided to try something a little different. Usually we give a second dose of this medicine on the fifth day. Instead I gave her another dose today along with the Thioguanine and Cytarabine.”

“Why are you telling me this?” asked Cathryn, certain that Dr. Keitzman knew she would not understand much of what he was saying.

“Because of your husband’s response yesterday,” said Dr. Keitzman. “And because of what Dr. Wiley and I said to you. I’m afraid your husband’s emotions will interfere and he’ll want to stop the medicines.”

“But if they’re not working, maybe they should be stopped,” said Cathryn.

“Mrs. Martel. Michelle is an extremely sick child. These medicines are her only chance for survival. Yes, it’s disappointing that as yet they have been ineffective. Your husband is right in saying her chances are slim. But without chemotherapy, she has no chance at all.”

Cathryn felt the stabbing pain of guilt; she should have brought Michelle to the hospital weeks ago.

Dr. Keitzman stood up. “I hope you understand what I’m saying. Michelle needs your strength. Now, I want you to call your husband and have him come over. He’s got to be told what’s happened.”

Even before the automatic radioactivity counter began to record the electrons emanating from the series of vials, Charles knew that the radioactive nucleotides had been absorbed and incorporated into the tissue culture of Michelle’s leukemic cells. He was now in the last stages of preparing a concentrated solution of a surface protein that differentiated Michelle’s leukemic cells from her normal cells. This protein was foreign to Michelle’s body but was not rejected because of the mysterious blocking factor that Charles knew was in Michelle’s system. It was this blocking factor that Charles had wanted to investigate. If only he knew something about the method of action of the blocking factor, perhaps it could be inhibited or eliminated. He was frustrated to be so close to a solution and have to stop. At the same time he realized that it was probably a five-year project with no guarantee of success.

Closing the cover on the tissue culture incubator, he walked to his desk, vaguely wondering why Ellen had not appeared. He wanted to discuss the Canceran project with someone knowledgeable, and she was the only person he could trust.

He sat down, trying not to think about the recent humiliating meeting with Dr. Ibanez and the Weinburgers. Instead he recalled the frustrating visit to the EPA offices that didn’t make him feel much better. Yet he could laugh at his own naiveté in thinking that he could walk into a government agency and expect to accomplish something. He wondered if there would be any way that he could get some sort of photographic proof of Recycle’s dumping. It was doubtful, but he’d try.

Perhaps if he were responsible for getting the evidence, he should sue Recycle directly rather than waiting for the EPA to do so. Charles knew very little about law, but he remembered there was a source of information open to him. The Weinburger Institute law firm on retainer.

The left lower drawer was Charles’s spot for miscellaneous pamphlets. Close to the bottom he found what he was looking for: a skinny red booklet entitled Welcome Aboard: This Is Your Weinburger Cancer Institute. In the back was a list of important phone numbers. Under services was Hubbert, Hubbert, Garachnik and Pearson, 1 State Street, followed by several phone numbers. He dialed the first.

Identifying himself, Charles was immediately switched to Mr. Garachnik’s office. His secretary was particularly cordial and within minutes, Charles found himself talking with Mr. Garachnik himself. Apparently the Weinburger was a valued customer.

“I need some information,” said Charles, “about suing a company dumping poisonous waste into a public river.”

“It would be best,” said Mr. Garachnik, “if we have one of our environmental law persons look into the matter. However, if your questions are general, perhaps I can help. Is the Weinburger Institute becoming interested in environmental pursuits?”

“No,” said Charles. “Unfortunately not. I’m interested in this personally.”

“I see,” said Mr. Garachnik, his tone becoming cool. “Hubbert, Hubbert, Garachnik and Pearson does not handle personal Weinburger employee legal problems unless special arrangement is made with the individual.”

“That could be arranged,” said Charles. “But as long as I’ve got you on the phone, why don’t you just give me an idea about the process.”

There was a pause. Mr. Garachnik wanted Charles to realize that he felt Charles’s inquiry beneath his stature as a senior partner. “It could be done as an individual or class action suit. If it were an individual suit, you’d need specific damages and if…”

“I’ve got damages!” interrupted Charles. “My daughter has come down with leukemia!”

“Dr. Martel,” said Mr. Garachnik with irritation. “As a physician you should know that establishing causation between the dumping and the leukemia would be extremely difficult. However, with a class action suit for the purpose of securing an injunction against the factory, you don’t need specific damages. What you do need is the participation of thirty to forty people. If you want to pursue this further, I suggest you contact Thomas Wilson, one of our new, younger lawyers. He has a particular interest in environmental matters.”

“Does it matter that the company is in New Hampshire?” asked Charles quickly.

“No, other than that it must be sued in a New Hampshire court,” said Mr. Garachnik, obviously eager to terminate the conversation.

“What if it’s owned by a corporation in New Jersey?”

“That might and might not compound the difficulties,” said Mr. Garachnik, suddenly more interested. “What factory in New Hampshire are you talking about?”

“A place called Recycle, Ltd. in Shaftesbury,” said Charles.

“Which is owned by Breur Chemicals of New Jersey,” added Mr. Garachnik quickly.

“That’s right,” said Charles, surprised. “How did you know?”

“Because on occasion we indirectly represent Breur Chemicals. In case you’re not aware, Breur Chemicals owns the Weinburger Institute even though it’s run as a nonprofit organization.”

Charles was stunned.

Mr. Garachnik continued: “Breur Chemicals founded the Weinburger Institute when they expanded into the drug industry by purchasing Lesley Pharmaceuticals. I was against it back then, but Weinburger, Sr. was committed to the idea. I was afraid of an antitrust action, but it never materialized because of the nonprofit cover. In any case, Dr. Martel, you essentially work for Breur Chemicals and in that capacity, you’d better think twice about suing anyone.”

Charles hung the phone up very slowly. He could not believe what he’d just heard. He’d never cared about the financial side of the institute except to the extent that the Weinburger could supply him with research space and equipment. But now he learned that he was working for a conglomerate which was ultimately responsible for dumping cancer-causing waste into a public river as well as running a research institute supposedly interested in curing cancer. As for Canceran, the parent company controlled both the drug firm holding the patents and the research firm chosen to ascertain its efficiency.

No wonder Weinburger was so interested in Canceran!

The phone jangled Charles’s taut nerves as it rang under his outstretched hand. As the source of the recent dreadful revelation, Charles debated answering it. Undoubtedly it was the administration calling, bent on harassing him with more pressure and more deceit.

Abruptly Charles’s mind switched to Michelle. The call could be about his daughter. He snatched the receiver from the cradle and pressed it to his ear.

He was right. It was Cathryn and her voice had the same stiff quality it had the day before. His heart jumped into his throat.

“Is everything okay?”

“Michelle is not doing so well. There’s been a complication. You’d better come over.”

Charles grabbed his coat and ran out of his lab. At the front entrance, he knocked on the massive glass door, impatient for it to open.

“All right, all right!” said Miss Andrews, pressing the door release under her desk.

Charles squeezed out before the door was fully opened and disappeared from sight.

“What’s the matter with him?” asked Miss Andrews, pressing the close switch. “Is he crazy or something?”

Roy adjusted his worn holster and shrugged.

Charles concentrated on hurrying to keep from guessing what had happened to Michelle. But after crossing the Charles, he got bogged down in traffic on Massachusetts Avenue. As he inched forward, he couldn’t help worrying about what he was going to find when he got to Pediatric Hospital. Cathryn’s words kept echoing in his head: “Michelle is not doing so well. There’s been a complication.” Charles felt panic tighten his stomach into a painful knot.

When he reached the hospital, he rushed inside and forced his way onto a full elevator. Maddeningly the car stopped at every floor. Eventually it reached the sixth, and Charles pushed his way off and hurried down to Michelle’s room. The door was almost closed. He entered without knocking.

An elegant blond-haired woman straightened up from leaning over Michelle. She’d been listening to the girl’s heart before Charles’s entry. On the opposite side of the bed was a young resident dressed in hospital whites.

Charles gave the woman a cursory glance and looked down at his daughter with empathy submerging all other emotions. He wanted to grab her and shield her, but he was afraid she had become too fragile. His trained eyes inspected her rapidly and could detect a worsening in her condition since that morning. There was a greenish cast to her face, a change Charles had associated during his medical training with ensuing death. Her cheeks had become hollow with the skin taut over her facial bones. Despite an intravenous line attached to both arms, she looked dehydrated from the vomiting and high fever.

Michelle, lying flat on her back, looked up at her father with tired eyes. Despite her discomfort she managed a weak smile and for a brief moment her eyes shone with the incredible luster that Charles remembered.

“Michelle,” said Charles softly, bending down so his face was close to hers. “How do you feel?” He didn’t know what else to say.

Michelle’s eyes clouded and she began to cry. “I want to go home, Daddy.” She was reluctant to admit how bad she felt.

Biting his lip Charles glanced up at the woman next to him, embarrassed by his overwhelming emotion. Looking back down at Michelle, he put his hand on her forehead and smoothed back her thick black hair. Her forehead was hot and damp. Her fever had risen. Michelle reached up and grasped his hand.

“We’ll talk about it,” said Charles, his lips quivering.

“Excuse me,” said the woman. “You must be Dr. Martel. I’m Dr. Brubaker. Dr. Keitzman asked me to see Michelle. I’m a cardiologist. This is Dr. John Hershing, our chief resident.”

Charles made no effort to respond to the introductions. “What happened?”

“She had an acute episode of ventricular tachycardia,” said Dr. Hershing. “We cardioverted her immediately, and she’s been very stable.”

Charles looked at Dr. Brubaker. She was a tall, handsome woman with sharp features. Her blond hair was piled on top of her head in a loose chignon.

“What caused the arrhythmia?” asked Charles, still holding Michelle’s hand.

“We don’t know yet,” said Dr. Brubaker. “My first thoughts are either an idiosyncratic reaction to the double dose of Daunorubicin, or a manifestation of her basic problem: some kind of infiltrative myopathy. But I’d like to finish my exam, if I may. Dr. Keitzman and your wife are in the chart room at the nurses’ station. I understand they are waiting for you.”

Charles lowered his eyes to Michelle. “I’ll be right back, sweetheart.”

“Don’t go, Daddy,” pleaded Michelle. “Stay with me.”

“I won’t go far,” said Charles, gently loosing Michelle’s grip. He was preoccupied by Dr. Brubaker’s statement that Michelle had received a double dose of Daunorubicin. That sounded irregular.

Cathryn saw Charles before he saw her and leaped to her feet, throwing her arms around his neck.

“Charles, I’m so glad you’re here.” She buried her face in his neck. “This is so difficult for me to handle.”

Holding Cathryn, Charles glanced around the small chart room. Dr. Wiley was leaning against the table, his eyes on the floor. Dr. Keitzman was sitting opposite from him, his legs crossed, and his hands clasped together over his knee. He appeared to be examining the fabric of his slacks. No one spoke, but Charles felt nervous, his eyes darting from one doctor to the other. The scene seemed too artificial, too staged. Something was coming and Charles hated the theatrics.

“All right,” said Charles challengingly. “What’s happening?”

Dr. Wiley and Dr. Keitzman started to speak simultaneously, then stopped.

“It’s about Michelle,” said Dr. Keitzman finally.

“I assumed as much,” said Charles. The vise on his stomach turned another notch tighter.

“She’s not doing as we would have hoped,” said Dr. Keitzman with a sigh, looking up into Charles’s face for the first time. “Doctors’ families are always the most difficult. I think I’ll call it Keitzman’s law.”

Charles was in no mood for humor. He stared at the oncologist, watching the man’s face twist into one of its characteristic spasms. “What’s this about a double dose of Daunorubicin?”

Dr. Keitzman swallowed. “We gave her the first dose yesterday but she did not respond. We gave her another today. We’ve got to knock down her circulatory leukemic cells.”

“That’s not the usual protocol, is it?” snapped Charles.

“No,” Dr. Keitzman replied hesitantly, “but Michelle is not a usual case. I wanted to try…”

“Try!” shouted Charles. “Listen, Dr. Keitzman,” Charles snapped, pointing a finger in Dr. Keitzman’s face. “My daughter isn’t here for you to try things on. What you’re really saying is that her chances of remission are so poor that you’re ready to experiment.”

“Charles!” said Cathryn. “That’s not fair.”

Charles ignored Cathryn. “The fact of the matter, Dr. Keitzman, is that you are so certain she’s terminal you abandoned orthodox chemotherapy. Well, I’m not sure your experimentation isn’t lessening her chances. What about this cardiac problem. She’s never had any trouble with her heart. Doesn’t Daunorubicin cause cardiac problems?”

“Yes,” agreed Dr. Keitzman, “but not usually this fast. I don’t know what to think about this complication and that’s why I asked for a cardiac consult.”

“Well, I think it’s the medicine,” said Charles. “I agreed to chemotherapy, but I assumed you would be using the standard doses. I’m not sure I agree with doubling the usual treatment.”

“If that’s the case, then perhaps you should retain another oncologist,” said Dr. Keitzman wearily, standing up and gathering his things. “Or just handle the case yourself.”

“No! Please!” said Cathryn, letting go of Charles and clutching Dr. Keitzman’s arm. “Please. Charles is just upset. Please don’t leave us.” Cathryn turned frantically to Charles. “Charles, the medicine is Michelle’s only chance.” She turned back to Dr. Keitzman, “Isn’t that right?”

“That is true,” said Dr. Keitzman. “Increasing the chemotherapy, even if it is an unusual approach, is the only hope for a remission, and a remission has to be obtained quickly if Michelle is going to survive this acute episode.”

“What are you proposing, Charles?” said Dr. Wiley. “To do nothing?”

“She’s not going to go into remission,” said Charles angrily.

“You can’t say that,” said Dr. Wiley.

Charles backed up, watching the others in the room as if they were going to force him into submission.

“How do you think she should be treated?” asked Dr. Wiley.

“We can’t do nothing, Charles,” pleaded Cathryn.

Charles’s mind screamed for him to get away. Within the hospital, close to Michelle, he could not think rationally. The idea of causing Michelle additional suffering was a torture, yet the concept of just allowing her to die without a fight was equally abhorrent. There were no alternatives open to him. Dr. Keitzman was making sense if there was a chance they could get a remission. But if a remission was impossible, then they were merely torturing the dying child. God!

Abruptly Charles turned and strode from the room. Cathryn ran after him. “Charles. Where are you going? Charles, don’t go! Please. Don’t leave me.”

At the stair he finally turned, gripping Cathryn’s shoulders. “I can’t think here. I don’t know what’s right. Each alternative is as bad as another. I’ve been through this before. Familiarity doesn’t make it easier. I’ve got to pull myself together. I’m sorry.”

With a feeling of helplessness Cathryn watched him go through the door and disappear. She was alone in the busy corridor. She knew that if she had to, she could handle the situation even if Charles couldn’t. She had to, for Michelle’s sake. She walked back to the chart room.

“The strange thing,” said Cathryn with a tremulous voice, “is that you two anticipated all this.”

“Unfortunately we’ve had some experience with families of physicians,” said Dr. Keitzman. “It’s always difficult.”

“But it’s usually not this difficult,” added Dr. Wiley.

“We were talking while you were gone,” said Dr. Keitzman. “We feel that something must be done to ensure continuity of Michelle’s care.”

“Some kind of guarantee,” said Dr. Wiley.

“It’s mostly because time is so important,” said Dr. Keitzman. “Even if the treatment were stopped for a day or two, it could mean the difference between success and failure.”

“We’re not suggesting that Charles’s concerns are unfounded,” assured Dr. Wiley.

“Absolutely not,” agreed Dr. Keitzman. “In Michelle’s case, with circulating leukemic cells unresponsive to the Daunorubicin, the outlook is not the best. But I think she deserves a chance no matter what the odds. Don’t you agree, Mrs. Martel?”

Cathryn looked at the two doctors. They were trying to suggest something but she had no idea what it was. “Of course,” said Cathryn. How could she disagree? Of course Michelle deserved every chance.

“There are ways of making sure that Charles cannot arbitrarily stop Michelle’s treatment,” said Dr. Wiley.

“The powers need only be evoked if they are needed,” said Dr. Keitzman. “But it’s good to have them just in case.”

There was a pause.

Cathryn had the distinct impression that the doctors expected her to respond, but she had no idea what they were talking about.

“Let me give you an example,” said Dr. Wiley, leaning forward in his chair. “Suppose a child desperately needs a transfusion. If the transfusion is not given, then the child will die. And further, suppose that one of the parents is a Jehovah’s Witness. Then there is a conflict between the parents as to the proper treatment of the child. The doctors, of course, recognize the need for the transfusion to save the child. What do they do? They have the court award guardianship to the consenting parent. The court is willing to do this to guarantee the rights of the child. It’s not that they disrespect the beliefs of the nonconsenting parent. It’s just that they feel it’s unfair for one individual to deprive another of lifesaving treatment.”

Cathryn stared at Dr. Wiley in consternation. “You want me to assume guardianship of Michelle behind Charles’s back?”

“Only for the specific purpose of maintaining treatment,” said Dr. Keitzman. “It might save the child’s life. Please understand, Mrs. Martel, we could do it without your help. We would ask the court to appoint a guardian, which is what we do when both parents resist established medical treatment. But it would be much simpler if you participate.”

“But you’re not giving Michelle standard treatment anymore,” said Cathryn, remembering Charles’s words.

“Well, it’s not that unusual,” said Keitzman. “In fact I’ve been working on a paper about increased chemotherapeutic doses in cases as recalcitrant as your daughter’s.”

“And you must admit that Charles has been acting bizarrely,” added Dr. Wiley. “The strain of this may be too great. He may be incapable of making sensible decisions. In fact, I’d feel much better if we could also get Charles to seek some professional help.”

“You mean see a psychiatrist?” asked Cathryn.

“I think it would be a good idea,” said Dr. Wiley.

“Please understand us, Mrs. Martel,” said Dr. Keitzman, “we’re trying to do our best, and as Michelle’s doctors our primary concern is her well-being. We feel we must do everything in our power.”

“I appreciate your efforts,” said Cathryn, “but…”

“We know it sounds drastic,” said Dr. Keitzman, “but once the legal papers are obtained, guardianship doesn’t have to be evoked unless the situation calls for it. But then if Charles tried to take Michelle off treatment or even out of the hospital, we’d be in a position to do something about it.”

“An ounce of prevention is worth a pound of cure,” said Dr. Wiley.

“The idea doesn’t make me feel comfortable,” said Cathryn. “But Charles has been very strange. I can’t believe he left like he did just now.”

“I can understand it,” said Dr. Keitzman. “I can sense that Charles is a man of action, and the fact that he cannot do anything for Michelle must drive him mad. He’s under a terrible emotional burden, and that’s why I think he could benefit from professional help.”

“You don’t think he could have a nervous breakdown, do you?” asked Cathryn with increasing anxiety.

Dr. Keitzman looked at Dr. Wiley to see if he wanted to answer, then he spoke: “I don’t feel qualified to say. Certainly the strain is there. It’s a matter of how strong his defenses are.”

“I think it’s a possibility,” said Dr. Wiley. “In fact, I think he’s showing certain symptoms. He doesn’t seem to be in command of his emotions and I think his anger has been inappropriate.”

Cathryn was swept by a turmoil of emotion. The idea that she was capable of going between Charles, the man she loved, and his daughter, whom she’d learned to love, was unthinkable. And yet if the strain was too much for Charles, and he interrupted Michelle’s treatment, she would have to share the blame for not having the courage to help the child’s doctors.

“If I were to do as you ask,” said Cathryn, “what would be the procedure?”

“Hold on,” said Dr. Keitzman, reaching for the phone. “I think the hospital attorney could answer that better than I.”

Almost before Cathryn knew what was happening, the meeting with the hospital attorney was over, and Cathryn was hurrying after the man in the Boston courthouse. His name was Patrick Murphy. He had freckled skin and indeterminate light brown hair that could have been red at one time. But by far his most distinguishing characteristic was his personality. He was one of those rare people whom everyone instantly liked, and Cathryn was no exception. Even in her distraught state, she had been charmed by his gentle and forthright manner and engaging smile.

Cathryn was not sure when the conversation with the attorney had changed from discussing a hypothetical situation to discussing an actual one. Making the decision to petition for legal guardianship for Michelle behind Charles’s back was so difficult that Cathryn had welcomed its accomplishment by default. Patrick had assured Cathryn, as had Dr. Keitzman, that the legal powers would not be used except in the unlikely instance that Charles tried to stop Michelle’s treatment.

Still Cathryn felt very uneasy about the whole affair, especially since she had not had time to see Michelle in the rush to get to the court before the 4 P.M. deadline.

“This way if you will,” said Patrick, pointing to a narrow stairwell. Cathryn had never been in a courthouse before, and it was nothing like she’d imagined. She’d thought it would be grand in some symbolic way, standing as it did for the concept of justice. Yet the Boston courthouse, which was actually over one hundred years old, was dirty and depressing, especially since, for security reasons, the public was forced to enter through the basement.

After ascending the narrow steel stairs, which Cathryn could not believe served as the sole public entrance to the court, they reached the old main hall. Here there was at least a shadow of former grandness with an arched two-story ceiling; marble pilasters and marble floors. But the plaster was chipped and cracked, and the elaborate moldings gave the appearance they were about to break free and fall to the floor below.

Cathryn had to run a few steps to catch up with Patrick as he turned into the Probate Court. It was a long, narrow room with a heavy, dusty appearance, especially with the hundreds of aged ledgers sitting sideways on their low shelves to the right. On the left was a long scuffed and pitted counter where a coterie of court employees seemed suddenly roused from their diurnal slumber at the prospect of quitting time.

As Cathryn surveyed the room she did not feel the confidence and reassurance she’d hoped. Instead its shabbiness evoked images of being snared in a quagmire of red tape. Yet Patrick did not allow Cathryn to stop. He pulled her over to a smaller counter at the end of the room.

“I’d like to speak to one of the Assistant Registers of Probate,” said Patrick to one of the bored clerks. She had a cigarette in the corner of her mouth, making her cock her head to the side to keep the smoke from stinging her eyes. She pointed to a man facing away from them.

Hearing the request, the man turned; he was on the phone but put up a finger for them to wait. After finishing his conversation, he came over to Cathryn and Patrick. He was tremendously overweight, a middle-aged man with a thick, flaccid layer of fat that shook when he walked. His face was all jowls, wattles, and deep creases.

“We have an emergency,” explained Patrick. “We’d like to see one of the judges.”

“Hospital guardianship case, Mr. Murphy?” questioned the Assistant Register knowingly.

“That’s correct,” said Patrick. “All the forms are filled out.”

“Must say, you fellows are getting efficient,” said the man. He looked up at the face of the institutional clock. “My God, you’re cutting it close. It’s almost four. I’d better check to be sure Judge Pelligrino is still here.”

He waddled through a nearby doorway, his arms swinging almost perpendicularly to his body.

“Glandular problem,” whispered Patrick. He put his briefcase on the counter and snapped it open.

Cathryn looked at the attractive young lawyer. He was dressed in the typical attorney fashion with a boxy, Ivy League, pin-striped suit. The slacks were slightly rumpled, particularly behind the knees, and they were about two inches too short, exposing black-socked ankles. With great attentiveness, he arranged the forms which Cathryn had signed.

“Do you really think I should do this?” asked Cathryn abruptly.

“Absolutely,” said Patrick, giving her one of his warm, spontaneous smiles. “It’s for the child.”

Five minutes later they were in the judge’s chamber, and it was too late to turn back.

As different as the Boston courthouse was from Cathryn’s imagination, so was Judge Louis Pelligrino. Instead of an older, gowned, Socratic figure, Cathryn found herself sitting across from a disturbingly handsome man wearing a well-tailored designer’s suit. After donning stylish reading glasses, he accepted the papers from Patrick saying, “Jesus Christ, Mr. Murphy. Why is it you always show up at four o’clock?”

“Medical emergencies, your honor, adhere to a biological rather than a probate clock.”

Judge Pelligrino peered at Patrick sharply over his half-glasses, apparently trying to decide if Patrick’s retort was clever or presumptuously brazen. A slow smile appeared as he decided on the former. “Very good, Mr. Murphy. I’ll accept that. Now, why don’t you fill me in on these petitions.”

As Patrick skillfully outlined the circumstances surrounding Michelle’s illness and treatment as well as Charles’s behavior, Judge Pelligrino examined the forms, seemingly not paying attention to the young lawyer. But when Patrick made an insignificant grammatical error, the judge’s head shot up, and he corrected him.

“Where are the affidavits by Doctors Wiley and Keitzman?” asked Judge Pelligrino as Patrick finished.

The lawyer leaned forward and anxiously thumbed through the papers in the judge’s hands. He snapped open his briefcase, and with great relief found the two documents and handed them over with an apology.

The judge read them in detail.

“And this is the adopted mother, I presume,” said Judge Pelligrino, capturing Cathryn’s attention.

“Indeed it is,” said Patrick, “and she is understandably concerned about maintaining the proper treatment for the young girl.”

Judge Pelligrino scrutinized Cathryn’s face, and she felt herself blush defensively.

“I think it’s important to emphasize,” added Patrick, “that there is no marital discord between Charles and Cathryn Martel. The only issue is the wish to maintain the established method of treatment advocated by the appropriate medical authorities.”

“I understand that,” said Judge Pelligrino. “What I don’t understand or like is the fact that the biological father is not here to be cross-examined.”

“But that’s precisely why Mrs. Martel is asking for emergency temporary guardianship,” said Patrick. “Just a few hours ago, Charles Martel rushed away from a meeting with Mrs. Martel and Michelle’s doctors. Mr. Martel expressed the belief that Michelle’s treatment, which is her only chance at survival, be stopped, then left the conference. And, off the record, the attending physicians are concerned about his mental stability.”

“That sounds like something that should be part of the record,” said the judge.

“I agree,” said Patrick, “but unfortunately that would require Mr. Martel seeing a psychiatrist. Perhaps it could be arranged for the full hearing.”

“Would you like to add anything, Mrs. Martel?” asked the judge, turning to Cathryn.

Cathryn declined in a barely audible voice.

The judge arranged the papers on his desk, obviously thinking. He cleared his throat before he spoke: “I will allow the emergency temporary guardianship for the sole purpose of maintaining the recognized and established medical treatment.” With a flourish he signed the form. “I will also appoint a guardian ad litim on the petition for guardianship to serve until the full hearing on the merits, which I want scheduled in three weeks.”

“That will be difficult,” said the Assistant Register, speaking for the first time. “Your schedule is fully booked.”

“The hell with the schedule,” said Judge Pelligrino, signing the second document.

“It will be difficult to prepare for a hearing in just three weeks,” protested Patrick. “We’ll need to obtain expert medical testimony. And there is legal research to be done. We need more time.”

“That’s your problem,” said the judge without sympathy. “You’re going to be busy anyway with the preliminary hearing on the temporary guardianship. By statute that must be in three days. So you’d best get cracking. Also I want the father apprised of these proceedings as soon as possible. I want him served no later than tomorrow with a citation either at the hospital or at his place of work.”

Cathryn sat bolt upright, stunned. “You’re going to tell Charles about this meeting?”

“Absolutely,” said the judge, rising. “I hardly think it fair to deprive a parent of his guardianship rights without telling him. Now if you’ll excuse me.”

“But…” blurted Cathryn. She didn’t finish her statement. Patrick thanked the judge and hurried Cathryn out of the judge’s lobby, back into the main room of the Probate Court.

Cathryn was distraught. “But you said we wouldn’t use this unless Charles actually stopped treatment.”

“That’s correct,” said Patrick, confused at Cathryn’s reaction.

“But Charles is going to find out what I’ve done,” cried Cathryn. “You didn’t tell me that. My God!”