Flashback

CHAPTER EIGHTEEN

Long before his wife had become pregnant, he had selected the names of his sons, and once suggested to her that, should the unimaginable come to pass, that they consider naming their daughter Ruth after Rutherford B. Hayes. Despite his pride in describing himself as "an emerging liberal" on the subject of women's rights, the Judge still had difficulty taking women seriously in any business dealings of substance.

And with no woman was that difficulty more intensely manifested than with Leigh Baron. Evening had settled in around the farm, bringing with it a persistent, windswept drizzle. The Judge sat with Leigh in his study, sharing coffee and some of Cinnie's apple pie and talking in only the vaguest terms about Ultramed and its plans for the future.

It was nearing eight o'clock. The conversation with the woman was, in his opinion, becoming somewhat tedious. In addition to Ultramed, they had touched on the stock market (her ideas were innovative, but charmingly naive, he thought), children (she and her husband, who spent most of his work week in New York, had decided not to have any!), criminal justice (her notions about the issues surrounding capital punishment were rather simplistic and poorly substantiated), and sports (she had the temerity to compare golf to croquet, and to state that she would consider taking up the game only after she was physically no longer able to play tennis!). "So, my dear, " the Judge said, completely ignoring a question from her about the differences between putting greens in various parts of the country, "I assume that the powers that be in Ultramed didn't send someone as bright and charming as you are just to pass the time with this old north woods war-horse."

"No, " she said, smiling at him curiously. "No, they didn't."

The Judge waited for her to continue. "Well, then, " he said finally, clearing his throat. "I suppose they wish you to lay some of the groundwork for tomorrow's board meeting."

"In a manner of speaking."

"Are you always this evasive and… and mysterious, Mrs. Baron?"

"Judge Iverson, " she said, "exactly who do you think I am?"

"That's a rather strange question, don't you think? I certainly know who you are."

"Do you?"

There was a firmness in Leigh Baron's voice-a steely brightness in her eyes that Clayton Iverson had not noticed before. Still, the ploy of asking questions rather than answering them was an amateurish tactic, and one she would have to improve upon if her aim was to control their conversation. "Okay, " he said after some thought, "I'll play. You're Leigh Baron, vice president of the Ultramed Hospitals Corporation. Your division is, correct me if I'm wrong, operations."

"Judge, I hope this doesn't come as too much of a shock, but I haven't been a vice president at Ultramed since, oh, just a few months after I negotiated our arrangement with Davis Regional. We were restructured by our parent company. My formal title now is Managing Director. That translates into CEO."

Startled, the Judge pulled from his briefcase the Ultramed organizational chart Guy Beaulieu had compiled. "Well, then, who'sum…

Blanton Richards?" Leigh smiled enigmatically. "Judge Iverson," she said, "Blanton Richards hasn't been part of Ultramed for several years.

I don't know who put that list together Dr. Beaulieu, I presume, he was always putting lists together-but whoever it was didn't do his homework.

I know how much you expect to be dealing with the good old boys on matters such as this, but I'm afraid that as far as Ultramed is concerned, I'm the good old boy."

"Now just a minute, young lady-"

"Young lady…" Leigh Baron's expression was not a little patronizing.

"Judge Iverson, I appreciate the compliment-really I do. But I think it will make things easier for both of us if you understand that my young lady days are well behind me. I'm thirty-seven years old. I was second in my MBA class at Stanford more than a decade ago, I spent two years studying economics at Oxford, and I managed several smaller operations for RIATA International before I was brought into Ultramed. My income last year-not counting bonuses and stock options — was slightly over half a million dollars. Now, if that little misunderstanding is taken care of to your satisfaction, I would suggest we get down to work. You and I have some important business to attend to."

"Yes, " he said, clearing his throat again. "Yes, I suppose we do. How about some more coffee first?"

The Judge suddenly felt edgy, and anxious to do something-anything-that would disrupt the woman's rhythm. What he had anticipated would be a preliminary sparring match with Ultramed had turned out to be the main event. "No, thank you, " she answered. "But go ahead if you want."

"I think I will."

He walked to the kitchen, poured himself a cup, laced it with a stiff slug of brandy, and took a long sip. The warm, velvet rasp had a calming, reassuring effect, reminding him that, although Leigh Baron had him back on his heels, this was the sort of game he loved to play-the one in which he held all the trump cards. He was still the chairman of the board of the hospital. And in the end, regardless of who Leigh Baron was, how much she earned, or what she had to say, he was the one who controlled the votes. His next swallow drained the cup. He poured himself another before returning to the den. "Okay, Ms. Baron, " he said, with ever-so-slight emphasis, "what's your pitch?"

"No pitch, Judge. Simply put, I would like to know what your plans are for the meeting tomorrow."

He tried for a bemused expression, but sensed that he missed. He held all the cards. She knew that as well as he did. And yet she continued looking at him as if whatever he had to say really made no difference.

He sought another taste of his brandied coffee, but realized that he had once again drained his cup. "You have my letter, " he said. "In it, I stated that it was quite possible the board and Ultramed would be able to work things out."

"Judge, we have reason to believe that the situation up here, at least in your eyes, has changed since you wrote that. I'd like to know what's going on."

"Nothing's going on. I've done what I was supposed to do as chairman of the board here, and sent you a letter. The meeting's tomorrow. We expect you'll be there to represent Ultramed's interests. At the end of the meeting there'll be a vote. Cest tout."

He held his hands out, palms up. Leigh Baron rubbed at her eyes wearily.

"Judge, that list you just consulted, was that compiled by Dr. Beaulieu? "

"As a matter of fact, it was."

"Then I can assume that you have all the other material he had been scraping together against our company."

"You did try to drive him out of practice."

"That, Judge, is ridiculous. Ultramed has grown faster than any company of its size in the field. We know exactly what we are doing. So does our parent company. If we wanted somebody out, believe me, they'd be out.

Where did you get the idea that we would do such a thing?"

"Well, actually, it was from my-Actually, it's none of your business.

You can find out everything you want to know at tomorrow's meeting."

"Your son Zachary was a pall bearer at Dr. Beaulieu's funeral. Is he the one who's taken up Beaulieu's cause? "

"If he has, then like I said, you'll find out tomorrow."

"If he has, then he's wrong. If Guy Beaulieu was being driven from practice, it was not by us."

"Perhaps, " the Judge said, sensing a shift in control back toward himself. "If that's true, that should come out at the meeting also."

"Tell me something, Judge. You've already made up your mind, haven't you?"

"I wouldn't say that at all."

She flashed that same disquieting smile. "You don't have to, " she said.

"Judge, if your board does vote to repurchase Ultramed-Davis from us, what were you planning to do about Frank?"

"Do? Why, keep him on, of course. If-and mind you, I said, if-we do vote to return the hospital to the community, we'll need him. He's done a terrific job. You told me that yourself."

"And I meant it, too, " Leigh said, "with one slightly enormous exception… Here, Judge, I think you'd better look this over carefully."

She removed a thin folder from her briefcase and handed it to him.

"While you're doing that, " she went on, "if you could just point me toward your bathroom…"

"Huh? " He had already started scanning the material. "Oh, it's over there. Down that hallway and on the left "Thanks."

Clayton Iverson finished reading the first page. Written by a well established, highly respected Boston accounting firm, it was basically an explanation and summation of the material to follow. Before going on, he went again to the kitchen. This time, he poured brandy into his cup but did not bother adding coffee. By the time Leigh Baron returned to the study, he had reread the cover letter and begun to skim the lists of figures and transactions, all of which seemed to bear up the accountants' contention that almost three years before, Frank had embezzled nearly a quarter of a million dollars from the Ultramed accounts. Whether it was the hour or the brandy or the acid anger welling in his throat, the Judge was having increasing difficulty concentrating on the specific financial transfer maneuvers, which were characterized by the bookkeepers as "rather superficial efforts to obscure the missing funds, efforts which any reasonable audit would uncover, and therefore ones which suggest Mr. Iverson's intention of making good the shortfall at some near date."

"So," Leigh Baron said. "Suddenly this all becomes very serious business, wouldn't you agree?"

"Why haven't you done anything about this before now?"

"Oh, come now, Judge. It's unbecoming for you to ask a question with so obvious an answer. Besides, as we've both been saying, Frank's done a terrific job for us. It's apparent that he just got a little greedy back there three years ago. He does have a way of being headstrong sometimes.

But I guess you know that… Well, I had actually decided that once the sale of Davis to our company was a fait accompli, I would write off the $250, 000 as sort of a bonus for his good work. After all, anyone can make a mistake…"

"Sure, sure. And now you're saying that I would be making a mistake to vote against turning our hospital over to you."

"You won't have left us much choice, Judge, other than to press charges.

And believe me, the evidence against Frank is solid-absolutely rock solid."

In keeping with his overall outlook, Clayton Iverson had always reserved his strongest emotions-positive and negative-for men. But at that moment he hated the woman sitting across from him with more passion than he had ever hated anyone. "o in the hell did she think she was?

The question echoed impotently, over and over again in his mind. She looked like some sort of high fashion model, and discussed issues with the naivetd of a schoolgirl, and yet, there she sat, smiling quietly as she viciously blackmailed him. The life of his son and, by inference, the lives of his daughter-in-law and granddaughters, in exchange for a vote. He should have retired, he thought. He had clearly lost his edge.

He should have stepped down from such dealings long ago. His head was spinning. "I… I need time to think, " he said. "I understand…

Unfortunately, you have only until tomorrow."

"I was right in wanting your company out of our town, Mrs. Baron. You're a very callous and self-serving woman."

"Let's not lower ourselves to name-calling, Judge. It's so unprofessional." She stood. "So, then. Tomorrow at one minute after noon everything will be"-she shrugged-"exactly as it is right now. Only more permanent.

Yes?"

Clayton Iverson, his weathered face flushed, his eyes smoldering, could not respond. "Oh, and Judge, " she said, "there is one other thing. I would like to review that material Guy Beaulieu accumulated. I promise its return in a few days."

"You can't have it, " the Judge snapped. "Judge Iverson, I know I don't have to spell it all out for you, but let me do it anyway. If you go along with our request, your son will be exonerated from all he has done, and we will complete our purchase of the hospital. If you do not, your son will probably end up in prison, and his family will be disgraced. Your influence in Sterling will be greatly diminished, if not destroyed, and we shall almost certainly end up with Ultramed-Davis just the same."

"This is insane!"

"Perhaps, " Leigh Baron said. "Perhaps it is… That material, please?"

"Dammit "Judge Iverson, face it. It's going to happen. Our business arrangement is going to be consummated as it was laid out. Either easily and cleanly, or very, very messily. But it's going to happen. Now…"

Reluctantly, the Judge passed Beaulieu's folder across. Leigh Baron slipped it into her briefcase. "As I promised, " she said, "I'll return this in a few days. Don't bother to show me out. I know the way."

His face buried in his arm, Clayton Iverson sat alone in his study, listening to the soft spattering of night rain against the shutters. In all his business dealings, in all his years on the bench, never had he been manhandled so brutally or efficiently as he had by Leigh Baroin this night. Desperately, he struggled to keep his anger in check-anger directed as much at his son as at the Ultramed CEO. At this point, he reminded himself, he had only Leigh Baron's side of the story. Before he made another move, before he spoke to one more member of the board, he and Frank had to talk. If Frank could adequately explain why he took the money, how he lost it, how he was planning on replacing it, perhaps they could work something out. if not… Went to Frank's. Please don't worry. Clayton Iverson set the note for Cinnie on his desk and walked, somewhat shakily, to the Chrysler, wondering if perhaps he had had a bit too much to drink. His thoughts tumbled about as he tried to focus on what his options might be. He needed the fresh air of a drive as much as anything… needed to clear his head… needed to confront Frank…

He put the car in gear, turned around with more difficulty than usual, and sped down the winding drive. Frank would have an explanation, he thought. He would have an acceptable explanation for everything, and together they would find a reasonable way out. But if there was no explanation… if Frank had nothing to offer evcept greed… The Judge sped through the turn onto the Androscoggin access road. A station wagon speeding south swerved sharply, narrowly avoiding a collision. Clayton Iverson did not notice… Of all the ungrateful, inconsiderate things Frank had ever done, he was thinking, this was absolutely the worst…

Perhaps it was time he put his foot down… Prison or no prison, disgrace or no disgrace, perhaps it was time… His eyes open, but unseeing, Toby Nelms lay twitching on the cooling blanket, jerking one restrained hand from time to time in what might have been an attempt to get at the breathing tube Jack Pearl had inserted into his trachea. His core temperature, despite the blanket, intravenous cortisone, and several doses of rectally-administered lylenol, was still 103.

Absolutely not, " Pearl was saying. "There's absolutely no way I am going to put a critically ill child under anesthesia for some off-the all theory."

"Jack, let me go over this again, " Zack pleaded, making no attempt to mask his exasperation. "What I'm proposing is not off the wall. Just because it isn't a widely used technique doesn't mean that it's wrong.

Hell, the problem hasn't been studied enough to be certain one way or the other. But there is the LSD article. Why do you think I drove all the way home to get it from my files for you?"

"No way, " Pearl said. Suzanne joined the two other physicians at the bedside. For more than an hour she had been battling one flurry of irregular cardiac rhythms after another in the boy. Now, for the moment at least, the situation seemed to have stabilized, but the dusky shadows enveloping her eyes were mute testimony to the tension of the struggle.

"So, where do we stand? " she asked, sipping tepid coffee. Throughout the crisis she had made no overt reference to Zack's theories regarding Mainwaring and Pearl, although several times her expression had warned-or begged-him against any confrontation with the anesthesiologist. "Well, " Zack said, "we're right where we were before the arrhythmias started. Cerebral edema. Nothing more. Could be caused by the fever, could be the cause of it, could be both."

"Well, for what it's worth, his arrhythmias seem to be under control."

"It's worth plenty. Nice going."

"Thanks. So, have you two decided? Are you going to put the boy back to sleep?"

The two men exchanged glances. Then Pearl looked away. "Well, Jack,"

Zack said, "go ahead and tell her. Tell her what wetell her what you have decided. Look down at that child there, think about what I've told you, what I've shown you, and tell her."

"Zack, please, " Suzanne said. She turned to the anesthesiologist.

"Sorry," he mumbled. "Jack? " she asked. "I refuse to do it, " Pearl said simply. "The evidence that this child's anesthesia had anything to do with his present condition is flimsy enough by itself. Used as justification for a highly questionable maneuver, such as Iverson here is proposing, is absurd. I positively refuse to do it."

"Do what?"

Frank Iverson appeared near the foot of the bed. He glanced from one physician to the next and then, with some discomfort, at the thrashing boy. "Do what, Jack? " he asked again. "Frank, " Pearl said, "earlier in the week I filed an official report and complaint about a visit I had from your brother, here. At that time, he accused me of any number of things, including improperly anesthe izing this child."

"Why, that's ridiculous, " Zack said. "I never-"

"Zack, will you please let him finish… Thank you. Go ahead, Jack."

"Well, now the boy's got cerebral edema-that's brain swelling from God knows what. Maybe some form of encephalitis or something. Your brother has this theory that if this is some nervous system reaction to the anesthesia he received, my putting him under again with the same drugs might reverse the effect."

"And? " Frank said. "And I won't do it." why?"

"Why! Well, because it… it won't work, Frank. That's why."

"Zack, has this been done before?"

"In analogous circumstances, yes. I brought in an article describing the theory behind it."

"Then, Jack, " Frank said calmly, "what harm would it do to put this boy to sleep again as Zack is suggesting? You put critically injured and ill patients under all the time, don't you? "

"Well yes, but-"

"Suzanne, do you think this child would be able to handle being put to sleep?"

"I… well, his cardiac problems seem to have quieted down, and he is already on a ventilator, so actually, I don't see why not."

"But-"

"No buts, Jack. I'm sorry I didn't get over here sooner to discuss all this, but I was tied up trying to reach some people in Akron. Now listen. We're in the business of helping people. That's why we're here.

If there's a chance that what Zack is suggesting will help this kid, I think you should try it. My brother's a pain in the neck sometimes, but he's hardly foolhardy. If he says he has evidence, then by God, He's got evidence."

Witnessing the bizarre exchange from his spot by the head of Toby's bed, Zack sensed an intense nonverbal interplay occurring between his brother and the anesthesiologist. he could also tell from Pearl's expression that the strange little man was no longer going to object to administering the drugs. "What were the anesthe ics again? " Suzanne asked. "Peiitothal and isoflurane, " Pearl said. gil", yes. "Are you going to do it? " Zack asked. "How long do you think we'll have to keep him under?"

"Eight minutes. That's how long they did it in the article." Pearl glanced once again at Frank. "Okay, " he said unenthusiastically. "Give me a couple of minutes to get my equipment together."

"Good. I'll try and get this place set up." Zack leveled his gaze at the man. "Jack, whatever the kid got for that hernia of his, that's what he should get now. Understand?"

"He got Pentothal and isoflurane, " Pearl responded with exaggerated firmness. "Now, are we going to do this or not?"

"Suzanne?"

"No objections, " she said. "Okay, then. Let's go for it, " Zack said.

The eerie scene was one that nobody in the ICU that night would ever forget. Throughout the unit, all unnecessary lights were extinguished and every noncritical piece of equipment that produced a noise or vibration was shut off. Nurses sat silently and grimly beside their patients or by the nurses' station. In cubicle 7, the only lights were flashes of Zack's and Jack Pearl's small penlights and the shimmering monitor readouts of Toby Nelms's cardiac pattern and blood pressure.

Toby himself, anesthe ized first with Pentothal, and now with the gas, isoflurane, lay motionless and peaceful, his eyes patched and taped shut, his ears plugged with oil-soaked cotton and covered with bandages.

His feet were encased in lamb's wool. Two thin cotton blankets covered him on top, and the water-filled cooling blanket lay underneath him.

Zack had checked both the new, unopened vial of Pentothal and the label on the isoflurane tank before okaying their administration. Now, watch in hand, he sat to one side of the darkened cubicle, waiting. Jack Pearl's willingness to administer the two anesthe ics had dispelled some of his suspicions regarding an experimental drug, but doubt remained.

And even if this treatment was the right one, even if the anesthe ics were correct, even if Jack Pearl was as pure and honorable a physician as Galen, Zack knew they might have waited too long. Cerebral edema was, all too often, a one-way street. Five minutes, six… the time seemed endless… Blood pressure, ninety and holding, pulse 120… Seven minutes. Zack watched the last thirty seconds tick off, glancing over briefly at Suzanne, whose attention was riveted on the monitor screen.

"Okay, Jack, " he said. "That's it. Eight minutes."

He threw back the draperies to the room and motioned the nurse back in.

Her first move was to reinsert the rectal probe attached to the cooling blanket console. "It's 103, " she said. Slowly, Toby began to stir, as concentrated oxygen washed the isoflurane from his lungs and bloodstream. Zack bent over him and checked his pupils. They were, if anything, more sluggishly reactive than before. Otherwise, a top-to-bottom neurologic exam showed no change. "Anything? " Suzanne asked. "Nothing."

Zack left the cubicle and circled the counter to where she was stationed. "Satisfied? " she whispered. "Not really, but I guess there's nothing more I can do."

Across from them, Jack Pearl had removed Toby's eye patches and was conducting his own exam. "I really appreciated your restraint in dealing with Jack."

"It wasn't easy."

"I could tell."

"You still don't believe me about all this, do you?" She shook her head.

"As I said in your office, " she whispered, glancing first at the monitor and then at Pearl, "one other case, and I'll at least listen."

"I'm going to find it."

"You know, you are without a doubt the most headstrong man I've ever met."

"I'm the most headstrong man I've ever met, " he said. "It's my finest attribute."

She looked at him coolly. "Well, Zachary, that may be. But unfortunately, it's also your most frightening one."

She brushed past him and joined Pearl at the bedside. Zack stood alone at the nurses' station, fighting the hollowness in his chest, trying to cling to the notion that for the moment, at least, he had done all he could for Toby Nelms-he had done his best. "Dr. Iverson, " the ward clerk called to him from her desk. "The call on line two is for you.

It's Mr. Iverson."

"Zack, " Frank said breathlessly, "I'm down in the E. R. We've got trouble. Maybe big trouble."

"What?"

"Auto accident. Two cars. Both drivers injured."

"Bad?"

"Dunno about one of them-apparently they're still trying to cut him out of his pickup. Marshfield's in with the other one right now."

"Let me just wash my face and I'll be right down."

"Make it quick, Zack. The guy Marshfield's working on is the Judge."