Harmful Intent

Robin Cook - Harmful Intent

ACKNOWLEDGMENTS

As with all my projects, I have benefited significantly from the experience and expertise of friends, colleagues, and friends of friends for the writing of Harmful Intent. Since the story bridges two professions, it is understandable that professionals have been the primary source. Those whom I would particularly like to acknowledge are:

Physicians.- Tom Cook Chuck Karpas Stan Kessler

Attorneys.- Joe Cox Victoria Ho Leslie McClellan

Judge.- Tom Trettis

School-based therapist. Jean Reeds

All of them generously donated many hours of their valuable time.

Once again for Audrey Cook, my wonderful mother

"The first thing we do, let's kill all the lawyers." -Henry VI, Part II

PROLOGUE

SEPTEMBER 9, 1988

11:45 A.M.

BOSTON, MASSACHUSETTS

From the first twinges of cramps that began around nine-thirty that morning, Patty Owen was sure that this was it. She had been worried that when the time came she wouldn't be able to distinguish between the contractions that signaled the onset of labor and the little kicks and general discomfort of the final trimester of her pregnancy. But her apprehension proved groundless; the twisting and grinding pain she was experiencing was entirely different from anything she had ever felt. It was familiar only in the sense that it was so classically textbook in its nature and regularity. Every twenty minutes, like clockwork, Patty felt a steady stab of pain in her lower back. In the intervals between, the pain vanished only to flare again.

Despite the increasingly acute agony she was only beginning to endure, Patty couldn't repress a fleeting smile. She knew little Mark was on his way into the world.

Trying to remain calm, Patty searched through the scattered papers on the planning desk in the kitchen for the phone number of the hotel that Clark had given her the day before. He would have preferred to have skipped this business trip since Patty was so close to term, but the bank hadn't given him much choice. His boss had insisted that he follow through with the final round of negotiations that would close a deal he'd been working on for three months. As a compromise, the two men had agreed that no matter the state of the negotiations, Clark would be gone for only two days. He'd still hated to leave, but at least he'd be back a full week before Patty was due to deliver...

Patty found the hotel's number. She dialed and was put through to Clark's room by a friendly hotel operator. When he didn't pick up by the second ring, Patty knew Clark had already left for his meeting. Just to be sure, she let it ring five more times

in hopes that Clark was in the shower and would suddenly answer, out of breath. She was desperate to hear his reassuring voice.

While the phone rang, Patty shook her head, fighting back tears. For as happy as she'd been to be pregnant this, her first time, she had been troubled by a vague premonition from the start that something bad would happen. When Clark had come home with the news that he had to go out of town at such a critical juncture, Patty had seen her sense of foreboding confirmed. After all the Lamaze classes and exercises they'd done together, she would have to tough it out alone. Clark had assured her she was overly concerned, which was natural, and that he'd be back in plenty of time for the delivery.

The hotel operator came back on the line and asked if Patty wanted to leave a message. Patty told her that she wanted her husband to call her as soon as possible. She left the number for Boston Memorial Hospital. She knew that such a terse message was bound to upset Clark, but it served him right for going away at a time like this.

Next, Patty called Dr. Ralph Simarian's office. The doctor's booming, high-spirited voice momentarily quelled her fears. He told her to have

Clark take her over to the BM, as he humorously referred to the Boston

Memorial, and get her admitted. He'd see them there in a couple of hours.

He told her that twenty-minute intervals meant she had a lot of time.

"Dr. Simarian?" Patty said as the doctor was about to disconnect. "Clark is out of town on a business trip. I'll be coming in by myself."

"Great timing!" Dr. Simarian said with a laugh. "Just like a male. They like to have the fun, then disappear when there's a little work to be done."

"He thought there was another week," Patty explained, feeling like she had to defend Clark. She could be irritated at him but no one else could.

"Just joking," Dr. Simarian said. "I'm sure he will be crushed not to be involved. When he comes back, we'll have a little surprise for him. Now don't be a bit alarmed. Everything's going to be okay. Do you have a way of getting to the hospital?"

Patty said she had a neighbor who had agreed to drive her in case there were any surprises while Clark was away.

"Dr. Simarian," Patty added, hesitantly, "with my Lamaze partner gone, I think I really am too nervous to go through this.

I don't want to do anything to hurt the baby, but if you think I could be anesthetized the way we discussed..."

"No problem," Dr. Simarian said, without letting her finish. "Don't you worry your pretty little head about these details. I'll handle everything.

I'm going to call over there right this minute and tell them that you want the epidural, okay?"

Patty thanked Dr. Simarian and hung up the phone just in time to bite her lip as she felt the beginnings of another contraction.

There was no reason to worry, she told herself sternly. She still had plenty of time to make it to the hospital. Dr. Simarian had everything in hand. She knew her baby was healthy. She had insisted on ultrasound and amniocentesis, even though Dr. Simarian had advised it was unnecessary since Patty was only twenty-four years old. But between her ominous premonition and genuine concern, Patty's determination carried the day. The results of the tests were extremely encouraging: the child she was carrying was a healthy, normal boy. Within a week of receiving the results, Patty and Clark were painting the baby's room blue and deciding on names, ultimately settling on Mark.

All in all, there was no reason to expect anything but a normal delivery and a normal birth.

As Patty turned, intending to retrieve her packed overnight bag from the bedroom closet, she noticed the dramatic change in weather outside. The bright September sunlight which had been streaming through the bay window had been eclipsed by a dark cloud that had blown in suddenly from the west, plunging the family room into near darkness. A distant rumble of thunder sent a shiver down Patty's spine.

Not superstitious by nature, Patty refused to take this storm as an omen.

She edged over to the family room couch and sat down. She thought she'd call her neighbor as soon as this contraction was over. That way they'd almost be at the hospital by the time the next one began.

As the pain reached a crescendo, the confidence that Dr. Simarian had engendered disappeared. Anxiety swept through Patty's mind just as a sudden gust of wind raked across the backyard, bending the birches, and bringing the first droplets of rain. Patty shuddered. She wished it were all over.

She might not be superstitious, but she was frightened. All the timing-this storm, Clark's business trip, her going into labor a week earlyseemed off.

Tears rolled down Patty's cheeks as she waited to phone her neighbor. She only wished she weren't so afraid.

"Oh, wonderful," Dr. Jeffrey Rhodes said sarcastically as he glanced up at the main anesthesia scheduling board in the anesthesia office. A new case had appeared: Patty Owen, a delivery with a specific request for an epidural. Jeffrey shook his head, knowing full well that he was the only anesthesiologist currently available. Everyone else on the day shift was tied up on a case. Jeffrey called the delivery area to check on the patient's status and was told there wasn't any rush since the woman hadn't arrived from admitting yet.

"Any complications I should know about?" Jeffrey asked, almost afraid to hear. Things hadn't been going well for him on this particular day.

"Looks routine," the nurse said. "Primipara. Twenty-four. Healthy."

"Who's the attending?"

"Simarian," the nurse replied.

Jeffrey said he'd be over shortly and hung up the phone. Simarian, Jeffrey pondered, thinking it a wash. The guy was technically fine but Jeffrey found his patronizing manner toward patients a bit trying. Thank God it wasn't Braxton or Hicks. He wanted the case to go smoothly and hopefully quickly; if it had been either of the others, that wouldn't have been the case.

Leaving the anesthesia office, he headed down the main OR corridor, passing the scheduling desk and its attendant bustle of activity. The evening shift was due in a few minutes; the changing of the guard inevitably spelled momentary chaos.

Jeffrey pushed through the double swing doors of the surgical lounge and yanked off the mask which hung limply on his chest, dangling by its elastic. He tossed it into the waste receptacle with relief, he'd been breathing through the blasted thing for the last six hours.

The lounge was abuzz with staff members coming on shift. Jeffrey ignored them and passed through to the locker room, which was just as crowded. He paused in front of the mirror, curious to see if he looked as bad as he felt. He did. His eyes seemed to have receded, they appeared so sunken.

Below each was a dark indelible crescent-shaped smudge. Even Jeffrey's mustache seemed the worse for wear and tear, though what could he expect after having kept it under the wraps of the surgi-. cal mask for six solid hours.

Like most doctors resisting the chronic'hypochondriasis induced by medical school, Jeffrey often erred at the other ex-

treme: he denied or ignored every symptom of illness or sign of fatigue, until it threatened to overwhelm him. Today was no exception. From the moment he'd awakened that morning at six, he'd felt terrible. Although he'd been feeling run down for days, he first ascribed the light-headedness and chills to something he'd eaten the night before. When the waves of nausea came midmorning, Jeffrey was quick to attribute it to too much coffee. And when the headache and the diarrhea started in the early afternoon, he pinned it on the soup he'd had for lunch in the hospital cafeteria.

Only as he confronted his haggard reflection in the miffor of the surgical locker room did Jeffrey finally admit he was ill. He was probably coming down with the flu that had been going around the hospital for the last month. He put the flat of his wrist to his forehead for a rough check of his temperature. There was no doubt about it: it was hot.

Leaving the sink, Jeffrey went to his locker, grateful that the day was almost over. The idea of bed was the most appealing vision he could conjure.

Jeffrey sat on the bench, oblivious to the chatting crowd, and began to twirl his combination lock. He felt worse than ever. His stomach gurgled unpleasantly; his intestines were in agony. A passing cramp brought beads of perspiration to his brow. Unless someone could relieve him, he'd'still be on duty for another few hours.

Stopping at the final number, Jeffrey opened his locker. Reaching within the neatly arranged interior, he retrieved a bottle of paregoric, an old remedy his mother used to force on him when he was a child. His mother had consistently diagnosed him as suffering from either constipation or diarrhea. It wasn't until he got to high school that Jeffrey realized these diagnoses were just excuses to get him to take his mother's cherished cure-all. Over the years, Jeffrey had developed a confidence in paregoric, if not in his mother's diagnostic skills. He always kept a bottle on hand.

Unscrewing the cap, he tilted his head back and took a healthy swig. Wiping his mouth, he noticed an orderly sitting next to him watching his every move.

.'Want a swig?" Jeffrey asked, grinning, extending the bottle toward the man. "Great stuff."

The man gave him a disgusted look and got up and left.

Jeffrey shook his head at the man's lack of a sense of humor. From his reaction you'd have thought he'd offered him poison.

With uncharacteristic slowness, Jeffrey took off his scrubs. Briefly massaging his temples, he then pushed himself to his feet and went in to shower. After sudsing and rinsing, he stood under the rushing water five minutes before stepping out and drying himself briskly. Brushing his wavy, sandy-brown hair, Jeffrey dressed in clean scrubs, donned a new mask and a new hat. He felt considerably better now. Except for an occasional gurgle, even his colon seemed to be cooperating-at least for the moment.

Jeffrey retraced his steps through the surgical lounge and down the OR corridor and pushed through the connecting door that led to the delivery area. The decor there was a welcome antidote to the stark utilitarian tile of the OR. The individual delivery rooms may have been as sterile, but the delivery area and labor rooms were painted in pastels, with framed

Impressionist prints on the walls. The windows even had curtains. The feeling was more like a hotel than a major urban hospital.

Jeffrey went to the main desk and inquired about his patient.

"Patty Owen is in fifteen," a tall, handsome black woman said. Her name was

Monica Carver, and she was the nursing supervisor for the evening shift.

Jeffrey leaned over the desk, thankful for the momentary rest. "How's she doing?" he asked.

"Just fine," Monica said. "But it's going to be awhile. Her contractions aren't strong or frequent, and she's only dilated four centimeters."

Jeffrey nodded. He would have preferred to have things further along. It was standard practice to wait until the patient had dilated six centimeters to put in an epidural. Monica handed Jeffrey Patty's chart. He went through it quickly. There wasn't much there. The woman was obviously healthy. At least that was good.

"I'll have a chat with her," Jeffrey said, "then I'll be back in the OR. If something changes, give me a page."

"Sure thing," Monica said cheerfully.

Jeffrey started down toward room fifteen. About halfway down the hall he got another intestinal cramp. He had to stop and lean against the wall until it passed. What a nuisance, he thought. When he felt well enough, he continued to room fifteen and knocked. A pleasant voice told him to come in.

"I'm Dr. Jeffrey Rhodes," Jeffrey said, extending his hand. "I'll be your anesthesiologist."

Patty Owen grasped his outstretched hand. Her palm was

damp, her fingers cold. She appeared considerably younger than twenty-four.

Her hair was blond and her wide eyes looked like those of a vulnerable child. Jeffrey could tell the woman was frightened.

"Am I glad to see you!" Patty said, not willing to let go of Jeffrey's hand immediately. "I want to tell you straight off that I'm a coward. I'm really not very good with pain."

"I'm sure we can help you," Jeffrey said reassuringly.

"I want an epidural," Patty said. "My doctor said I could have it."

"I understand," Jeffrey said, "and have it you will. Everything is going to be fine. We have a lot of deliveries here at the Boston Memorial. We'll take good care of you and after all is said and done, you'll wonder why you were so apprehensive in the first place."

"Really?" Patty asked.

"If we didn't have so many happy customers, do you think so many women would be coming back a second, a third, or even fourth time?"

Patty smiled wanly.

Jeffrey spent another quarter hour with her, questioning her about her health and allergies. He sympathized with her when she told him her husband was out of town on a business trip. Her familiarity with epidural anesthesia surprised him. She confided that not only had she read about it, her sister had had it for her two deliveries. Jeffrey explained why he wouldn't be giving her the epidural immediately. When he told her that she could get some Demerol in the meantime if she wanted it, Patty relaxed.

Before leaving her, Jeffrey reminded her that any drugs she got, the baby got. Then he told her again there was no reason to worry; she was in good hands.

Coming out of Patty's labor room and suffering through another intestinal cramp, Jeffrey realized he would have to take more drastic steps against his own symptoms if he was to get through Patty's delivery. Despite the paregoric, he was feeling progressively worse.

Passing back through the connecting doors to the OR suite, Jeffrey returned to the anesthesia alcove next to the OR, where he'd spent most of the day.

The room was empty and probably wouldn't be used again until the following morning.

Glancing up and down the OR corridor to make sure the coast was clear,

Jeffrey pulled the drape closed. Although bed finally

acknowledged being sick, he wasn't about to admit it to anyone else.

From the drawer of his Narcomed III anesthesia machine, Jeffrey got out a small-gauge intravenous scalp needle and an infusion setup. He pulled a bottle of Ringer's Lactate IV fluid down from the shelf and snapped off the cover over the rubber port. With a decisive shove, he pushed the IV tubing into the bottle and hung the bottle up on the IV stand over the anesthesia machine. He ran fluid through the tubing until it was free of air bubbles, then he closed the plastic stopcock.

Jeffrey had only started IVs on himself a couple of times, but he was practiced enough in the procedure to be adept. Using his teeth to hold one end of the tourniquet, he secured it around his bicep and watched as his veins began to distend.

What Jeffrey had in mind was a trick that he'd learned as a resident. Back then, he and his colleagues, especially the surgical residents, refused to take any sick time for fear they'd lose the competitive edge. If they got the flu or symptoms like the ones Jeffrey was now experiencing, they would simply take time out to run in a liter of IV fluid. The results were almost guaranteed, suggesting most flu symptoms were due to dehydration. With a liter of Ringer's Lactate coursing through your veins, it was hard not to feel better. It had been ages since Jeffrey had last resorted to an IV. He only hoped the efficacy would be as strong as it had been when he'd been a resident. Now forty-two, he found it hard to believe that last time he had been almost twenty years younger.

Jeffrey was about to push the needle in when the curtain to the alcove was pulled aside. Jeffrey looked up into the surprised face of Regina Vinson, one of the evening nurses.

"Oh!" Regina exclaimed. "Excuse me."

"No problem," Jeffrey started to say, but Regina was gone as quickly as she had appeared. As long as she'd inadvertently caught him in the act, Jeffrey had half a mind to ask her to lend a hand by attaching the IV to the scalp needle once he got it into the vein. Reaching out, he pulled back the curtain in hopes of catching her, but Regina was already far down the crowded hall. He let the curtain fall back into place. He was just as well off without her.

Once the IV tubing was attached, he opened the stopcock. Almost at once he felt the cool sensation of the fluid as it flowed rapidly into the arm. By the time most of the bottle had run in, Jeffrey's upper arm was cool to the touch. After he pulled out

the IV needle, he put an alcohol swab over the site and bent his elbow to hold it in place. He disposed of the IV paraphernalia in the wastebasket, then stood up. He waited for a moment to see how he felt. The light-headedness and headache were totally gone. So was the nausea. Pleased with the speedy results, Jeffrey pulled open the curtain and headed back to the locker room. Only his colon still troubled him.

The evening shift had now taken over and the day shift was in the process of leaving. The locker room was full of cheerful people. Most of the showers were occupied. First Jeffrey used the toilet. Then he got out his paregoric and took another hefty swig. He shuddered at the taste and wondered what made it so bitter. He tossed the now empty bottle into the wastebasket. Then he took a second shower and put on another set of clean scrub clothes.

When he walked out into the surgical lounge he almost felt human. He intended to sit down for a half hour or so and read the paper but before he had a chance his beeper went off. He recognized the number. It was delivery.

"Mrs. Owen is asking for you," Monica Carver told him when he phoned.

"How is she doing?" Jeffrey asked.

"Just fine," Monica said. "She's a little apprehensive, but she hasn't even asked for analgesia even though her contractions are now coming frequently.

She's somewhere between five and six centimeters."

"Perfect," Jeffrey said. He was pleased. "I'll be right over."

En route to the delivery area, Jeffrey stopped at the anesthesia office to glance at the big board to see about the evening assignments. As he expected, everyone was busy with ongoing cases. He took a piece of chalk and wrote that whenever someone was free he or she should come over to delivery and relieve him.

When Jeffrey arrived in labor room fifteen, Patty was in the middle of a contraction. An experienced LPN was with her and the two women were functioning like a practiced team. Beads of sweat dotted Patty's brow. Her eyes were shut tightly, and she was gripping the nurse's hands with both of hers. Strapped to her abdomen was the rubber monitor keeping track of the progress of the labor as well as the fetal heartbeat.

"Ah, my white knight in blue," Patty said as the pain abated and she opened her eyes to see Jeffrey standing at the foot of the bed. She smiled.

"How about that epidural?" Jeffrey suggested.

"How about it!" Patty echoed.

All the equipment Jeffrey needed was on a cart he had wheeled in with him upon his return. After putting a blood pressure cuff in place, Jeffrey removed the rubber monitor from Patty's abdomen and helped position her on her side. With gloved hands he prepped her back with an antiseptic solution.

"First I'm going to give you the local anesthetic we talked about," Jeffrey said as he prepared the injection. He made a small weal with the tiny needle midline in Patty's lower back. She was so relieved to be getting it, she didn't even flinch.

Next, he took a Touhey needle from the epidural tray and made sure the stylet was in place. Then, using both hands, he pushed the needle into Patty's back, advancing it slowly but de liberately until he was certain he had reached the ligamentous covering of the spinal canal. Withdrawing the stylet, he attached

I an empty glass syringe. Jeffrey put slight pressure on the sy ringe's plunger. Feeling resistance, he expertly returned to ad vancing the needle. Suddenly the resistance on the plunger disappeared. Jeffrey was pleased: he knew he was in the epidural space.

"Are you okay?" Jeffrey asked as he used a glass syringe to draw up a test dose of 2 cc's of sterile water containing a tiny amount of epinephrine.

"Are you flnished?" Patty asked.

"Not quite," Jeffrey said. "Just a few minutes more." He injected the test dose and immediately tested Patty's blood pressure and pulse. There was no change. If the needle had been in a blood vessel, Patty's heart rate would have increased immediately in response to the epinephrine.

Only then did Jeffrey seize the small epidural catheter. With practiced care, he threaded it up the Touhey needle.

"I feel something funny in my leg," Patty said nervously.

Jeffrey stopped pushing the catheter. It was only in about one centimeter beyond the tip of the needle. He asked Patty about the sensation, then explained that it was common for the epidural catheter to touch peripheral nerves as they traversed the epidural space. That could account for what she was feeling. When the paresthesia subsided, Jeffrey gingerly advanced the catheter another one and a half centimeters. Patty didn't complain.

Finally, Jeffrey pulled the Touhey needle out, leaving the small plastic catheter in place. Then he prepared a second test

dose of 2 cc's of.25% spinal-grade Marcaine with epinephrine. After injecting this second dose, he monitored Patty's blood pressure and her sense of touch on her lower extremities. When there were no changes even after several minutes, Jeffrey was absolutely sure that his catheter was in the proper place. Finally, he injected the therapeutic dose of anesthetic:

5 cc's of.25% Marcaine. Then he capped off the catheter.

"That's all there is to that," Jeffrey said as he put a sterile bandage over the puncture site. "But I want you to stay on your side for a while."

"But I don't feel anything," Patty complained.

"That's the idea," Jeffrey said with a smile.

"You're sure it's working?"

"Just wait until your next contraction," Jeffrey said with confidence.

Jeffrey conferred with the LPN to let her know how frequently he wanted

Patty's blood pressure taken. Then he helped her put the labor monitor back in place. He remained in the labor room through Patty's next contraction, using the time to complete his habitually meticulous anesthesia record.

Patty felt reassured. The discomfort she had been experiencing was much improved, and she thanked Jeffrey effusively.

After telling Monica Carver and the LPN where he would be, Jeffrey went into one of the darkened empty labor rooms to lie down. He was feeling better, but certainly not normal. Closing his eyes for what he thought would be just a few minutes and soothed by the sound of rain against the window, he surprised himself by falling fast asleep. He was dimly aware of the door being opened and closed several times as different people checked on him, but no one disturbed him until Monica came in and gently shook his shoulder.

"We've got a problem," Monica said.

Jeffrey swung his legs over the side of the bed and rubbed his eyes.

"What's wrong?"

"Simarian has decided to do a Caesarean on Patty Owen."

"So soon?" Jeffrey asked. He glanced at his watch. He blinked several times. The room seemed dimmer than before. Checking his watch, he was surprised to see that he'd been asleep for an hour and a half.

"The baby is an occiput posterior and hasn't been progressing," Monica explained. "But the main problem is that the baby's heart has been slow to return to a normal rate after each contraction."

"Time to do a Caesarean," Jeffrey agreed as he got unsteadily to his feet.

He waited a beat until his mild dizziness cleared.

"Are you all right?" Monica questioned.

"Just fine," Jeffrey said. He sat down on a chair to slip on his OR shoes.

"What's the time frame?"

"Simarian will be here in twenty minutes or so," Monica said, studying

Jeffrey's face.

"Is something wrong?" Jeffrey asked. He ran his fingers through his hair in fear it was standing on end.

.'You look pale," Monica said. "Maybe it's the lack of light in here."

Outside it was raining even harder.

"How's Patty doing?" Jeffrey asked, heading for the bathroom.

"She's apprehensive," Monica said from the door. "Painwise, she's fine, but you might consider giving her some kind of tranquilizer just to keep her calm."

Jeffrey nodded as he turned on the light in the bathroom. He wasn't wild about the idea of giving Patty a tranquilizer, but given the circumstances, he'd consider it. "Make sure she's on oxygen," he told Monica. "I'll be out in a second."

"She's on oxygen," Monica called over her shoulder as she left the room.

Jeffrey examined himself in the mirror. He did look pale. Then he noticed something else. His pupils were so contracted, they looked like twin pencil points. They were as small as he'd ever seen them. No wonder he'd had trouble seeing his watch in the other room.

Jeffrey splashed his face with cold water, then dried it roughly. At least that woke him up. He looked at his pupils again. They were still miotic. He took a deep breath and promised himself that as soon as he got through this delivery, he would make tracks for home and put himself to bed. After ad- justing his hair with his fingernails, he headed for labor room fifteen.

Monica had been right. Patty was embarrassed, scared, and nervous about the upcoming Caesarean. She was taking the failure of the labor personally.

Tears came to her eyes when she again voiced anger at her husband's absence. Jeffrey felt sorry for her and made a big effort at reassuring her that everything would be fine and that she certainly wasn't at fault. He also gave her 5 mg of diazepam IV, which he thought would have minimal effect if any on the unborn child. It had a rapid calming effect on Patty.

"I'll be asleep during the Caesarean?" Patty asked.

"You'll be very comfortable," Jeffrey replied, skirting the question. "One of the big benefits of continuous epidural anesthesia is that I can extend it now that we need a higher level, without disturbing Patty junior."

"It's a boy," Patty said. "His name is Mark." She smiled weakly. Her lids had become a little droopy. The tranquilizer was clearly taking effect.

, The transfer from the delivery area to the OR suite was accomplished without incident. Jeffrey kept Patty on oxygen by mask during the short trip.

The OR had been advised as to the decision to do a Caesarean. By the time

Patty was transferred, the room was almost set up for the procedure. The scrub nurse, already scrubbed, was busy laying out the instruments. The circulating nurse helped guide the gurney into the room and transfer Patty to the OR table. Patty still had the fetal monitor on, which was left in place for the time being.

Jeffrey wasn't as familiar with the evening personnel, and he hadn't met the circulating nurse before. Her name tag read: Sheila Dodenhoff.

"I'm going to need some.5% Marcaine," Jeffrey told Sheila as he changed

Patty from portable bottle oxygen to oxygen delivered through his Narcomed

III anesthesia machine. He then reapplied the blood pressure cuff to

Patty's left arm.

"Coming up," Sheila said cheerfully.

Jeffrey worked quickly but deliberately. He checked off every procedure in his anesthesia record once it had been performed. In sharp contrast to most other doctors, Jeffrey prided himself on his exquisitely legible handwriting.

After hooking up the EKG leads, he attached the pulse oximeter to Patty's left index finger. He was replacing Patty's IV with a more secure intracath when Sheila returned.

"Here you go," she said, handing Jeffrey a 30 cc glass vial of.5%

Marcaine. Jeffrey took the drug and, as he always did, checked the label.

He set the vial on top of his anesthesia machine. From the drawer, he took out a 2 cc ampule of spinal grade.5% Marcaine with epinephrine and drew it up into a syringe. Maneuvering Patty onto her right side, Jeffrey injected the 2 cc's into the epidural catheter.

"How's everything going?" a booming voice called out from the door.

Jeffrey turned to see Dr. Simarian holding a mask to his face while he held open the door.

"We'll be ready in a minute," Jeffrey said.

"How's the little one's ticker?" he asked.

"At the moment, fine," Jeffrey answered.

"I'll scrub up and we'll get this show on the road."

The door swung shut. Jeffrey gave Patty's shoulder a squeeze while he studied the EKG and the blood pressure readout. "You okay?" he asked her, moving the oxygen mask to the side.

"I think so," she said.

"I want you to tell me whatever you feel. Understand?" Jeffrey said. "Do your feet feel normal?"

Patty nodded. Jeffrey went around and tested her sensation. Coming back to the head of the table and checking the monitors again, he was sure that the epidural catheter had not moved and had not penetrated either the spinal canal or one of the pregnancy-dilated veins of Bateson.

Satisfied that all was in order, Jeffrey picked up the via] of Marcaine

Sheila had brought him. Using his thumb, he snapped off the top of the sealed glass container. Once again he checked the label, then drew up 12 cc's. He wanted anesthesia to extend at least to T6, and preferably to T4.

As he put the Marcaine down, his eyes caught Sheila's. She was standing off to the left, staring at Jeffrey.

"Is something wrong?" Jeffrey asked.

Sheila held his gaze for a beat, then spun on her heels and left the OR without speaking. Jeffrey turned to catch the eye of the scrub nurse, but she was still busy setting up. Jeffrey shrugged. Something was going on that he didn't know about.

Returning to Patty's side, he injected the Marcaine. Then he capped off the epidural catheter and returned to the head of the table. After putting down the syringe, he noted the time and the exact amount of the injection in the record. A slight quickening of the beep of the pulse brought his eyes up to the EKG monitor. If there was to be any change in the heart rate, Jeffrey expected a slight slowing from progressive sympathetic blockade. Instead, there was the opposite. Patty's pulse was speeding up. It was the first sip of the impending disaster.

Jeffrey's initial reaction was more of curiosity than concern. His analytical mind groped for a logical explanation for what he was witnessing. He glanced at the blood pressure readout and then the oximeter

LED. They were all fine. He looked back at the EKG. The pulse was still quickening, and even more disturb-

ing, there was an ectopic, irregular heartbeat. Under the circumstances, that was not a good sign.

Jeffrey swallowed hard as fear clutched at his throat. It had only been seconds since he'd injected the Marcaine. Could it have gone intravenous despite the test dose result? Jeffrey had had one other adverse reaction to local anesthetic in his professional career. The incident had been harrowing.

The ectopic beats were increasing in frequency. Why would the heart rate increase and why the irregular rhythm? If the anesthetic dose did go intravenously, why wasn't the blood pres:. sure falling? Jeffrey had no immediate answers to these questions, but his medical sixth sense, born of years of experience, set off alarm bells in his mind. Something abnormal was occurring. Something Jeffrey was at a loss to explain, much less understand.

"I don't feel good," Patty said, turning her head to talk out of the side of the mask.

Jeffrey looked down into Patty's face. He could see it was again clouded with fear. "What's the matter?" he asked, puzzled by these rapid events. He touched her shoulder.

"I feel funny," Patty said.

"How do you mean, funny?" Jeffrey's eyes went back to the monitors. There was always the fear of allergy to the local anesthetic, although developing allergy in the two hours since the first dose seemed a rather farfetched notion. He noticed the blood pressure had risen slightly.

"Ahhhhh!" Patty cried.

Jeffrey's eyes shot to her face. Patty's features were twisted in a horrible grimace.

"What is it, Patty?" Jeffrey demanded.

"I feel a pain in my stomach," Patty managed hoarsely through clenched teeth. "It's high up, under my ribs. It's different from the labor pain.

Please..." Her voice trailed off.

Patty began to writhe on the table, drawing up her legs. Sheila reappeared along with a muscular male nurse who lent a hand in attempting to restrain her.

The blood pressure that had risen slightly now began to fall. "I want a wedge under her right side," Jeffrey yelled as he got ephedrine from the drawer and prepared it for injection. Mentally he calculated how far he'd let the blood pressure drop before he'd inject the pressor agent. He still had no idea of what was happening, and he preferred not to act before he knew exactly what he was up against.

A gurgling sound brought his attention back to Patty's face. He pulled off her oxygen mask. To his surprise and horror she was salivating like a mad dog. At the same time she was lacrimating profusely; tears were streaming down her face. A wet cough suggested that she was also forming increasing amounts of tracheo-bronchial secretions.

Jeffrey remained the ultimate professional. He had been trained to deal with this type of emergency situation. His mind raced ahead, taking in all the information, making hypotheses, then ruling them out. Meanwhile, he dealt with the lifethreatening symptoms. First he suctioned Patty's nasopharynx, then he injected atropine intravenously, followed by ephedrine. He suctioned Patty again, then injected a second dose of the at- ropine. The secretions slowed, the blood pressure plateaued, the oxygenation stayed normal, but Jeffrey still did not know the cause. All he could think of was an allergic reaction to the Marcaine. He watched the

EKG, hoping that the atropine might have a positive effect on the irregular heartbeats. But they remained irregular. In fact, they became even more irregular as Patty's pulse quickened. Jeffrey prepared a 4 mg dose of pro- pranolol, but before he could inject it, he noticed the muscle fas- ciculations that distorted Patty's features in a series of seemingly uncontrolled twists and spasms. The fasciculations rapidly spread to other muscles until her body became wracked by clonic jerks.

"Hold her, Trent!" Sheila cried to the male nurse. "Get her legs!19

Jeffrey injected the propranolol as the EKG began to register further bizarre changes, intimating there was diffuse involvement of the heart's electrical conduction system.

Patty spewed up green bile which Jeffrey quickly suctioned away. He glanced at the oximeter readout. That was still holding. Then the fetal monitor alarm began to go off, the baby's heart was slowing. Before anyone could react, Patty suffered a grand mal seizure. Her limbs flailed madly in all directions, then her back arched in awkward hyperextension.

"What the hell is going on?" Simarian shouted as he came flying through the door.

"The Marcaine," Jeffrey shouted. "She's having some sort of overwhelming reaction." Jeffrey didn't have time to elaborate as he drew up 75 mg of succinylcholine.

"Jesus Christf" Simarian yelled, coming around the table to help hold Patty down.

Jeffrey injected the succiny1choline as well as an additional dose of diazepam. He was thankful that his compulsiveness had made him change the

IV to a more secure one. The audio portion of the oximeter readout began to fall in pitch as Patty's oxygenation decreased. Jeffrey again cleared her airway and tried to bag her with the 100% oxygen.

Patty's seizure movements slowed as succinylcholine-induced paralysis took effect. Jeffrey slipped in an endotracheal tube, checked its position, and ventilated her well with the oxygen. The sound of the oximeter immediately returned to its higher pitch. But the fetal monitor was still sending out its alarm. The baby's heart had slowed and was not speeding back up.

"We gotta get the baby!" Simarian yelled. He grabbed sterile gloves from one of the side tables and yanked them on.

Jeffrey was still watching the blood pressure, which had started to fall again. He gave Patty another dose of ephedrine. The blood pressure started back up. He glanced at the EKG; it had not improved with the propranolol.

Then to Jeffrey's horror, just as he was watching, the EKG disintegrated into senseless fibrillation. Patty's heart had stopped beating.

"She's arresting!" Jeffrey shouted. The blood pressure fell to zero. Both the EKG and the oximeter alarms began shrieking stridently.

"My God!" Simarian yelled. He had been.hastily draping the patient. He moved up to the table and started external cardiac massage by compressing

Patty's chest. Sheila put out the word to the OR desk. Help was on its way.

The crash cart arrived along with additional OR nurses. With lightning speed, they prepared the defibrillator. A nurse anesthetist also arrived.

She went directly to Jeffrey's side.

The oxygen content of Patty's blood went up slightly. "Countershock her!"

Jeffrey ordered.

Simarian took the defibrillator paddles from one of the nurses. He applied them to Patty's bare chest. Everyone stepped back from the OR table.

Simarian pressed the button. Since Patty was paralyzed with the succinylcholine, there was no apparent effect from the electric current except on the EKG screen. The fibrillation disappeared, but when the phosphorescent blip returned, it did not show a normal heartbeat. Instead, it traced a completely flat line with only a few minor squiggles.

"Restart massagel" Jeffrey ordered. He stared at the EKG. He couldn't believe there was no electrical activity. The muscu-

lar male nurse took over from Simarian and started compressing Patty's chest with good result.

The fetal monitor was still sounding. The child's heart rate was too slow.

"We gotta get the baby!" Simarian snapped again. He changed his gloves and hastily took additional drapes from the scrub nurse. He positioned them as best he could despite the cardiac massage. He grabbed a knife from the instrument table and went to work. Using a generous vertical incision, he sliced Patty's lower abdomen open. With the reduced blood pressure there was very little bleeding. A pediatrician arrived on the scene and prepared to take the baby.

Jeffrey's attention stayed with Patty. He suctioned her and was surprised at the amount of secretions even after the two doses of atropine. Checking

Patty's pupils, he was pleased they were not dilated. In fact, he was surprised to find them pinpoint. With oxygenation remaining up, Jeffrey decided to hold off introducing any more drugs into Patty's system until after the baby was delivered. Briefly, he explained what had happened to the nurse anesthetist.

"You think it's a reaction to the Marcaine?" she asked.

"That's all I can think of," Jeffrey admitted.

In the next minute a silent, blue, flaccid baby was pulled from Patty's abdomen. After the cord was severed, the child was quickly handed to the waiting pediatrician. He rushed the newborn to the infant care unit, where the baby was surrounded by his own resuscitation team. The nurse anesthetist joined that group.

"I don't like this flat EKG," Jeffrey said to himself as he injected a bolus of epinephrine. He watched the EKG. No response. He then tried another dose of atropine. Nothing. Exasperated, he drew an arterial blood sample and sent it off to the lab for a stat reading.

Ted Overstreet, one of the cardiac surgeons who had recently finished a bypass case, came in and stood next to Jeffrey. After Jeffrey explained the situation, Overstreet suggested opening her UP.

The nurse anesthetist came back to report that the baby was not in good shape. "The Apgar is only three," she said. "He's breathing and his heart is beating, but not well. And his muscle tone is not good. In fact, it's weird."

"How so?" Jeffrey asked, fighting a wave of depression.

"His left leg moves okay, but not his right. The right one is completely flaccid. With his arms it's just the opposite."

Jeffrey shook his head. Obviously the child had been oxygen deprived in utero and was now brain damaged. The realization was crushing, but there was no time to wallow in regret. Just then his chief concern was Patty and how to get her heart started.

The stat lab work came back. Patty's pH was 7.28. bnder the circumstances,

Jeffrey thought, that was pretty good. Next he injected a dose of calcium chloride. Minutes dragged like hours as everyone watched the EKG, waiting for some sign of life, some response to treatment. But the monitor traced a frustratingly flat line.

The male nurse continued the chest compressions and the ventilator kept

Patty's lungs Ned with pure oxygen. Her pupils remained miotic, suggesting her brain was getting enough oxygen, but her heart stayed electrically and mechanically still. Jeffrey repeated all the textbook procedures but to no avail. He even had Patty shocked again with the defibrillator set at 400 joules.

Once the pediatrician had the newborn stabilized, he had the entire infant care unit vacate the OR along with its attendant clutch of residents and nurses. Little Mark was on his way to the neonatal intensive care unit.

Jeffrey watched them go. He felt heartsick. Shaking his head in sorrow, he turned back to Patty. What to do?

Jeffrey looked up at Ted, who was still standing next to him. He asked Ted what he thought they should do. Jeffrey was desperate.

64 Like I said, I think we should open her up and work on the heart directly. There's not much to lose at this point."

Jeffrey watched the flat EKG for another moment. Then he sighed. "Okay.

Let's try it," he said reluctantly. He had no other ideas, and he didn't want to give up. As Ted pointed out, they had nothing to lose. It was worth a try.

Ted,gowned and gloved in less than ten minutes. Once he was prepared, he had the nurse stop compressing the chest so that he could rapidly drape and slice into it. Within seconds he was holding Patty's naked heart.

Ted massaged the heart with his gloved hand and even injected epinephrine directly into the left ventricle. When that failed to have an effect, he tried to pace the heart by attaching internal leads to the cardiac wall.

That resulted in a complex on the EKG, but the heart itself did not respond.

Ted recommenced the internal cardiac massage. "No pun intended," he said after a couple of minutes, "but my heart is no longer in this. I'm afraid the ballgame is over unless you guys have a heart transplant waiting around here. This one is long gone."

Jeffrey knew that Ted didn't mean to sound callous and that his apparently flip attitude was more of a defense mechanism than a true lack of compassion, yet it cut Jeffrey to the quick. He had to restrain himself from lashing out verbally.

For as much as he'd given up, Ted continued the internal cardiac massage.

The only sound in the OR came from the monitor recording the pacemaker's discharge and the low hum of the pulse oximeter as it responded to Ted's internal massage.

Simarian was the one who broke the silence. "I agree," he said simply. He snapped off his gloves.

Ted looked across the rapidly erected ether screen at Jeffrey. Jeffrey nodded. Ted stopped massaging the heart and pulled his hand from within

Patty's chest. "Sorry," he said.

Jeffrey nodded again. He took a deep breath, then turned the ventilator off. He looked back at the sorry sight of Patty Owen with her abdomen and chest rudely sliced open. It was a terrible sight, one that would stay with

Jeffrey for the rest of his life. The floor was littered with drug containers and wrappers.

Jeffrey felt crushed and numb. This was the nadir of his professional career. He'd witnessed other tragedies, but this was the worst, and most unexpected. His eyes drifted to his anesthesia machine. It too was covered with debris. Beneath the debris was the incomplete anesthesia record. He'd have to bring it up to date. In the fevered attempt to save Patty he'd had no time to do so. He looked for the half-empty vial of Marcaine, feeling an irrational antipathy toward it. Although it seemed unreasonable in light of the test dose results, he couldn't help but feel an allergic reaction to the drug was the root of this tragedy. He wanted to dash the vial against the wall, just to vent his frustration. Of course he knew he wouldn't actually throw the vial; he was too controlled for that. But he couldn't find it among the mess.

"Sheila," Jeffrey called to the circulating nurse who was starting the clean-up process, "what happened to the Marcaine vial?"

Sheila stopped what she was doing to glare at Jeffrey. "If you don't know where you put it, I certainly don't," she said angrily.

Jeffrey nodded and then turned his attention to unhooking

Patty from the monitors. He could understand Sheila's anger. He was angry too. Patty didn't deserve this kind of fate. What Jeffrey didn't realize was that Sheila wasn't angry at fate. She was angry at Jeffrey. In fact, she was furious.

MONDAY,

MAY 15, 1989

11:15 A.M.

A shaft of golden morning sunlight filtered through a window high on the wall to Jeffrey's left and knifed down through the courtroom, hitting the paneled wall behind the judge's bench like a spotlight. Millions of tiny motes of dust sparkled and swirled in the intense beam of light. Ever since the beginning of this trial, Jeffrey had been struck by the theatric quality of the justice system. But this was no TV daytime drama. Jeffrey's career-his whole life-was on the line.

Jeffrey closed his eyes and leaned forward at the defendant's table, cradling * his head in his hands. With his elbows splayed on the table, he roughly rubbed his eyes. The tension was about to drive him crazy.

Taking a deep breath, he opened his eyes, half hoping the scene before him would have magically disappeared and he would wake up from the worst nightmare of his life. But of course it wasn't a bad dream he was suffering. Jeffrey was involved in his second trial for Patty Owen's untimely death eight months previously. Just then he was sitting in a courtroom in the center of Boston, waiting to hear the jury deliver his fate on criminal charges.

Jeffrey glanced over his lawyer's head to scan the crowd. There was an excited, low-pitched babble of voices, a murmur of expectancy. Jeffrey averted his gaze, knowing that all the talk centered on him. He wished he could hide. He felt utterly humiliated by the public spectacle so rapidly unfolding. His entire life had unraveled and disintegrated. His career was going down the drain. He felt overwhelmed, yet oddly numb.

Jeffrey sighed. Randolph Bingham, his lawyer, had urged him to appear calm and controlled. Easier said than done, especially now. After all the heartache, anxiety, and sleepless nights, it was

now down to the wire. The jury had reached its decision. The verdict was on its way.

Jeffrey studied Randolph's aristocratic profile. The man had become a father to him through these last eight harrowing months, even though he was only five years Jeffrey's senior. Sometimes Jeffrey had felt almost love for the man, other times something more akin to rage and hatred. But he'd always had confidence in his lawyer's skills, at least until this point.

Glancing at the prosecuting team, Jeffrey studied the district attorney. He had particular antipathy for this man, who seemed to have seized on the case as a vehicle for advancing his political career. Jeffrey could appreciate the man's native intelligence though he'd grown to despise him during the course of the fourday trial. But now, watching as the D.A. conversed animatedly with an assistant, Jeffrey realized he felt oddly devoid of emotion toward the man. For him, the whole business had been a job, no more, no less.

Jeffrey's eyes strayed beyond the district attorney toward the emptyjury box. During the trial the realization that these twelve strangers held his fate in their hands had paralyzed Jeffrey. Never before had he experienced such vulnerability. Up until this episode, Jeffrey had been living under the delusion that his fate was largely in his own hands. This trial showed him just how mistaken he was.

The jury had been deliberating for two anxious days and-for Jeffrey-two sleepless nights. Now they were waiting for the jury to return to the courtroom. Jeffrey again wondered if two days of deliberation was a good sip or a bad. Randolph, in his irritatingly conservative manner, would not speculate. Jeffrey felt the man could have lied just to give him a few hours of relative peace.

Despite his good intentions to refrain from fidgeting, Jeffrey began to stroke his mustache. When he realized what he was doing, he folded his hands and set them on the table in front of him.

He glanced over his left shoulder and caught sight of Carol, his soon io be ex-wife. Her head was down. She was reading. Jeffrey turned his gaze back to the judge's empty bench. He could have been irritated that she was relaxed enough to be able to read at this moment, but he wasn't. Instead,

Jeffrey felt thankful that she was there and that she'd shown as much support as she had. After all, even before this legal nightmare had

started, the two of them had come to the mutual conclusion that they had grown apart.

When they had first married eight years ago, it hadn't seemed important that Carol was extremely social and outgoing while he tended toward the opposite. It also hadn't bothered Jeffrey that Carol wanted to put off having a family while she advanced her career in banking, at least until

Jeffrey found out that her idea of postponement meant never. And now she wanted to head west, to Los Angeles. Jeffrey could have lived with the idea of moving to California, but he had trouble with the family issue. Over the years he'd come to want a child more and more. To see Carol's hopes and aspirations move in an entirely different direction saddened him, but he found he didn't hold it 4ainst her. Jeffrey had fought the idea of divorce at first, but had finally given in. Somehow, they just weren't meant to be.

But then, when Jeffrey's legal problems materialized, Carol had graciously offered to hold off on the domestic issue until Jeffrey's legal diffi- culties were resolved.

Jeffrey sighed again, more loudly than before. Randolph shot him a disapproving glare, but Jeffrey couldn't see that appearances mattered at this point. Whenever Jeffrey thought about the sequence of events, it had a dizzying effect on him. It had all happened so quickly. After the disastrous death of Patty Owen, the malpractice summons had arrived in short order. Under the current litigious climate, Jeffrey had not been sur- prised by the lawsuit, except perhaps by the speed.

From the start, Randolph had warned Jeffrey that it would be a tough case.

Jeffrey had had no idea how tough. That was right before Boston Memorial suspended him. At the time, such a move had seemed capricious and unreasonably vicious. It certainly wasn't the kind of support or vote of confidence Jeffrey had hoped for. Neither Jeffrey nor Randolph had had any inkling of the rationale for the suspension. Jeffrey had wanted to take action against Boston Memorial for this unwarranted act, but Randolph had advised him to sit tight. He thought that issue would be better resolved after the conclusion of the malpractice litigation.

But the suspension was only the harbinger of worse trouble to come. The malpractice plaintiff attorney was a young, aggressive fellow named Matthew

Davidson from a firm in St. Louis specializing in malpractice litigation.

He was also associated with a small general law firm in Massachusetts. He'd filed suit against Jeffrey, Simarian, Overstreet, the hospital, and even

Ar-

olen Pharmaceuticals, who'd manufactured the Marcaine. Jeffrey had never been the subject of a malpractice action before. Randolph had to explain that this was the "shotgun" approach. Litigators; sued everybody with "deep pockets" whether or not there was any evidence of direct involvement in the alleged incident of malpractice.

Being one among many had initially provided some solace to Jeffrey, but not for long. It quickly became clear that Jeffrey would stand alone. lie could remember the turning point as if it were yesterday. It had happened through the course of his own testimony in the early stages of the initial civil malpractice trial. He had been the first defendant to take the stand.

Davidson had been asking cursory background questions, when he suddenly became harder hitting.

"Doctor," Davidson said, turning his thin, handsome face toward Jeffrey and putting a pejorative cast to the title. He walked directly to the witness stand and placed his face within inches of Jeffrey's. He was dressed in an impeccably tailored, dark pinstriped suit with a light lavender shirt and a dark purple paisley tie. He smelled of expensive cologne. "Have you ever been addicted to any drug?"

"Objection!" Randolph called out, rising to his feet.

Jeffrey had felt as if he were watching a scene in some drama, not a chapter in his life. Randolph elaborated on his objection: "This question is immaterial to the issues at hand. The plaintiff attorney is trying to impugn my client."

"Not so," Davidson countered. "This issue is extremely germane to the current circumstances as will be brought out with the testimony of subsequent witnesses."

For a few moments silence reigned in the crowded courtroom. Publicity had brought notoriety to the case. People were standing along the back wall.

The judge was a heavyset black man named Wilson. He pushed his thick black-rimmed glasses higher on the bridge of his nose. Finally he cleared his throat. "If you're fooling with me, Mr. Davidson, there's going to be hell to pay."

"I certainly wouldn't choose to fool with you, Your Honor."

"Objection overruled," Judge Wilson said. He nodded toward Davidson. "You may proceed, Counselor."

"Thank you," Davidson said as he turned his attention back to Jeffrey.

"Would you like me to repeat the question, Doctor?" he asked.

"No," Jeffrey said. He remembered the question well enough.

He glanced at Randolph, but Randolph was busy writing on a yellow legal tablet. Jeffrey returned Davidson's steady glare. He had a premonition that trouble was ahead. "Yes, I had a mild drug problem once," he said in a subdued voice. This was an old secret that he'd never imagined would surface, especially not in a court of law. He had been reminded of it recently when he had to fill out the required form to renew his

Massachusetts medical license. Yet he thought that information was confiden- tial.

"Would you tell the jury what drug you were addicted to," Davidson asked, stepping away from Jeffrey as if he was too revolted to remain too close to him for any longer than necessary.

"Morphine," Jeffrey said with almost a defiant tone. "It was five years ago. I had trouble with back pain after a bad bicycle accident."

Out of the comer of his eye, Jeffrey saw Randolph scratching his right eyebrow. That was a previously arranged gesture to signal that he wanted

Jeffrey to confine himself to the question at hand and not offer any information. But Jeffrey ignored him. Jeffrey was angry that this irrelevant piece of his past was being dredged up. He felt the urge to explain and defend himself. He certainly wasn't a drug addict by any stretch of the imagination.

"How long were you addicted?" Davidson asked.

"Less than a month," Jeffrey snapped. "It was a situation where need and desire had imperceptibly merged."

"I see," Davidson said, lifting his eyebrows in a dramatic gesture of understanding. "That's how you explained it to yourself?"

"It was how my treatment counselor explained it to me," Jeffrey shot back.

He could see Randolph frantically scratching again, but Jeffrey continued to ignore him. "The bicycle accident occurred at a time of deepening domestic strain. I was prescribed the morphine by an orthopedic surgeon. I convinced myself that I needed it longer than I actually did. But I realized what was happening in a few weeks' time and I took sick leave from the hospital and volunteered for treatment. And also marriage counseling,

I might add."

"During those weeks, did you ever administer anesthesia while..."

Davidson paused as if he were trying to think how to word his question while you were under the influence?"

"Objection!" Randolph called. "This line of questioning is ab surd! It's nothing short,of calumny."

The judge bent his head down to look over the top of his

glasses, which had slid down his nose. "Mr. Davidson," he said patronizingly, "we're back to the same issue. I trust that you have some cogent reason for this apparent excursion."

"Absolutely, Your Honor," Davidson said. "We intend to show that this testimony has a direct bearing on the case at hand."

"Objection overruled," the judge said. "Proceed."

Davidson turned back to Jeffrey and repeated the question. He seemed to relish the phrase "under the influence."

Jeffrey glared back at the plaintiff attorney. The one thing in his life that he was absolutely sure of was his sense of professional responsibility, competence, and performance. The fact that this man was suggesting something else infuriated him. "I have never compromised a patient," Jeffrey snapped.

"That is not my question," Davidson said.

Randolph got to his feet and said, "Your Honor, I would like to approach the bench."

"As you wish," the judge said.

Both Randolph and Davidson went up to the judge. Randolph was obviously incensed. He began talking in a hoarse whisper. Even though Jeffrey was only ten feet away, he could not hear the conversation clearly although he did hear the word "recess" mentioned several times. Eventually, the judge leaned back and looked at him.

64 Dr. Rhodes," he said, "your counsel seems to think you need a rest. Is that true?"

"I don't need any rest," Jeffrey said angrily.

Randolph threw up his hands in frustration.

"Good," the judge said. "Then let's get on with this examination, Mr.

Davidson, so we can all get out for some lunch."

,.All right, Doctor," Davidson said. "Have you ever administered anesthesia under the influence of morphine?"

"There may have been one or two times..." Jeffrey began, "but--2'

"Yes or no, Doctor!" Davidson cut in. "A simple yes or no is all I want."

"Objection!" Randolph called. "The counselor is not letting the witness answer the question."

" Quite the contrary," Davidson said. "It's a simple question and I'm looking for a simple answer. Either yes or no."

"Overruled," the judge said. "The witness will have a chance to elaborate on cross-examination. Please answer the question, Dr. Rhodes."

"Yes," Jeffrey said. He could feel his blood boil. He wanted to reach out and strangle the plaintiff attorney.

"Since your treatment for your addiction to morphine..

Davidson began, walking away from Jeffrey. He emphasized the words

"addiction" and "morphine," then paused. He stopped near the jury box, turned, then added: have you ever taken morphine again?"

"No," Jeffrey said with forcefulness.

"Did you take morphine on the day you administered anesthesia to the unfortunate Patty Owen?"

"Absolutely not," Jeffrey said.

"Are you sure, Dr. Rhodes?"

"Yesl" Jeffrey shouted.

"No more questions," Davidson said, and he returned to his seat.

Randolph had done what he could on cross-examination, emphasizing that the addiction problem had been minor and shortlived, and that Jeffrey had never taken more than a therapeutic dose. Besides, Jeffrey had volunteered for treatment, had been certified "cured," and had not been subjected to any disciplinary action. But despite these assurances, Jeffrey and Randolph had both felt his case had been dealt a death blow.

Just then, Jeffrey was brought back to the present by the sudden appearance of a uniformed court officer at the door to the jury room. His pulse shot up. He thought the jury was about to be announced. But the court officer made his way over to the door to thejudge's chambers and disappeared.

Jeffrey's thoughts drifted back to the malpractice trial.

True to his word concerning its relevancy, Davidson brought the addiction issue back with further testimony that had been totally unexpected despite the discovery depositions. The first surprise came in the form of Regina

Vinson.

After the usual introductory questions, Davidson asked her if she had seen

Dr. Jeffrey Rhodes on the fateful day of Patty Owen's death.

"I did," Regina said, staring at Jeffrey.

Jeffrey knew Regina vaguely as one of the evening OR nurses. He didn't remember seeing her on the day that Patty died.

"Where was Dr. Rhodes when you saw him?" Davidson asked.

"He was in the anesthesia alcove for operating room eleven," Regina said, keeping her eyes directly on Jeffrey.

Again, Jeffrey had a premonition that something detrimental

to his case was c6ming, but he couldn't guess what it would be. He remembered working in room eleven for most of the day. Randolph leaned over and asked in a hushed voice, "What is she leading up to?"

"I haven't the foggiest," Jeffrey whispered, unable to break eye contact with the nurse. What disturbed him was that he could sense real hostility in the woman.

"Did Dr. Rhodes see you?" Davidson asked.

"Yes," Regina replied.

All at once, Jeffrey remembered. In his mind's eye he saw the image of her startled face as she pulled the drape aside. The fact that he was sick that fateful day was something besides his addiction problem that he had failed to tell Randolph. He'd considered it, but had been afraid to tell him. At the time he thought of his behavior as evidence of his dedication and self-sacrifice. After the fact, he'd not been so sure. So he'd never told anyone. He started to reach for Randolph's arm, but it was far too late.

Davidson was looking at the jurors, one after another, as he posed the next question: "Was there something strange about Dr. Rhodes being in the alcove of operating room eleven?"

"Yes," Regina answered. "The curtain was closed and operating room eleven was not in use."

Davidson kept his eyes on the jurors. Then he said, "Please tell the court what Dr. Rhodes was doing in the anesthesia alcove of the empty operating room with the drapes closed."

"He was shooting up," Regina said angrily. "He was injecting himself intravenously."

An excited murmur rippled through the courtroom. Randolph turned to Jeffrey with a shocked expression. Jeffrey shook his head guiltily. "I can explain," he said lamely.

Davidson went on. "What did you do after you saw Dr. Rhodes 'shooting up'T'

"I went to the supervisor, who called the chief of anesthesia," Regina said. "Unfortunately, the chief of anesthesia was not reached until after the tragedy."

Immediately after Regina's damaging testimony, Randolph had been able to get a recess. When he was alone with Jeffrey he demanded to know about this

"shooting-up" episode. Jeffrey confessed to having been ill that fateful day, and said that no one but he had been available for the delivery. He explained everything he'd done in order to keep working, including giving himself the IV and taking paregoric.

"What else haven't you told me?" Randolph demanded angrily.

"That's all," Jeffrey said.

"Why didn't you tell me this before?" Randolph snapped.

Jeffrey shook his head. In truth, he wasn't completely sure himself. "I don't know," he said. "I have never liked admitting when I'm sick even to myself, much less anyone else. Most doctors are like that. Maybe it's part of our defense about being around illness. We like to think we're invulnerable."

"I'm not asking for an editorial," Randolph practically shouted. "Save it for the New England Journal of Medicine. I want to know why you couldn't tell me, your lawyer, that you were seen 'shooting up' on the morning in question."

"I guess I was afraid to tell you," Jeffrey admitted. "I did everything possible for Patty Owen. Anyone can read the record and attest to that. The last thing I wanted to admit was that there could be a question of my having been in top form. Maybe I was afraid you wouldn't defend me with the same intensity if you thought I was even remotely culpable."

"Jesus Christl" Randolph exclaimed.

Later, back in the courtroom, during the cross-examination, Randolph did as much damage control as he could. He brought out the fact that Regina did not know if Jeffrey was injecting himself with a drug or merely starting an

IV to rehydrate himself.

But Davidson was not done yet. He brought Sheila Dodenhoff to the stand.

And just like Regina, she glared at Jeffrey while she testified.

"Miss Dodenhoff," Davidson intoned, "as the circulating nurse during Mrs.

Owen's tragedy, did you ever notice anything strange about the defendant,

Dr. Rhodes?"

"Yes, I did," Sheila said triumphantly.

"Would you please tell the court what you noticed," Davidson said, obviously relishing the moment.

"I noticed his pupils were pinpoint," Sheila said. "I noticed it because his eyes are so blue. In fact, I could barely see his pupils at all."

Davidson's next witness was a world-famous ophthalmologist from New York who'd written an exhaustive tome on the function of the pupil. After establishing his eminent credentials, Davidson asked the doctor to name the most common drug to cause pupils to contract to pinpoints-miosis, as the doctor preferred to call the condition.

"You mean a systemic drug or an eye drop?" the ophthalmologist asked.

:'A systemic drug," Davidson said.

'Morphine," the ophthalmologist said confidently. He then commenced an incomprehensible lecture about the EdingerWestphal nucleus, but Davidson cut him off and turned the witness over to Randolph.

As the trial dragged on, Randolph had tried to rectify the damage, proposing that Jeffrey had taken paregoric for diarrhea. Since paregoric is compounded with tincture of opium, and since opium contains morphine, he proposed that the paregoric had caused Jeffrey's constricted pupils. He also explained that Jeffrey had given himself an IV to treat flu symptoms, which are frequently caused by dehydration. But it was apparent that the jury did not buy these explanations, especially after Davidson brought a well-known and respected internist to the stand.

-Tell me, Doctor," Davidson said unctuously, "is it common for doctors to give themselves IVs as it has been suggested that Dr. Rhodes had done?"

"No," the internist said. "I've heard some scuttlebutt about gung-ho surgical residents doing such a thing, but even if such reports are true, it's certainly not a common practice."

The final blow in the trial came when Davidson called Marvin Hickleman to the stand. He was one of the OR orderlies.

"Mr. Hickleman," Davidson said. "Did you clean OR fifteen after the Patty

Owen case?"

'Yes, I did," Marvin said.

'I understand you found something in the biohazard disposal container on the side of the anesthesia machine. Could you tell the court what you found?"

Marvin cleared his throat. "I found an empty vial of Marcaine."

"What concentration was the vial?" Davidson asked.

.,It was.75%," Marvin said.

Jeffrey had leaned over and whispered to Randolph, "I used.5%. I'm sure of it."

As if he'd overheard, Davidson then asked Hickleman: "Did you find any.5% vials?"

"No," Marvin said, "I did not."

On cross-examination, Randolph tried to discredit Marvin's testimony, but only made things worse. "Mr. Hickleman, do you always go through the trash when you clean an operating room and check the concentration of the various drug containers?"

"Nopel"

"But you did on this particular case."

.,Yup!"

"Can you tell us why?"

"The nursing supervisor asked me to."

The final coup de grace was delivered by Dr. Leonard Simon from New York, a renowned anesthesiologist whim even Jeffrey recognized. Davidson got right to the point.

"Dr. Simon. Is.75% Marcaine recommended for obstetric epidural anesthesia?"

"Absolutely not," Dr. Simon said. "In fact it is contraindicated. The warning is clearly labeled in the package insert and in the PDR. Every anesthesiologist knows that."

"Can you tell us why it is contraindicated in obstetrics?"

"It was found to cause occasional serious reactions."

"What kind of reactions, Doctor?"

"Central nervous system toxicity."

"Does that mean seizures, Doctor?"

"Yes, it has been known to cause seizures."

"What else?"

"Cardiac toxicity."

"Meaning... T'

"Arrhythmias, cardiac arrest."

"And these reactions were occasionally fatal?"

"That's correct," Dr. Simon said, pounding in the final nail of Jeffrey's coffin.

The result had been that Jeffrey and Jeffrey alone was found guilty of malpractice. Simarian, Overstreet, the hospital, and the pharmaceutical company had been exonerated. The jury awarded the Patty Owen estate eleven million dollars: nine million more than Jeffrey's malpractice coverage.

At the end of the trial, Davidson had been openly disappointed that he'd done such a good job destroying Jeffrey. Since the other defendants and their deep pockets had been exculpated, there was little chance of collecting much above and beyond Jeffrey's insurance coverage even if

Jeffrey's income was attached for the rest of his life.

For Jeffrey, the result was devastating, personally no less than professionally. His whole image of himself and his self-worth had been predicated on his sense of dedication, commitment, and sacrifice. The trial and the finding by thejury destroyed that. He even came to doubt himself.

Maybe he had used the.75% Marcaine by accident.

Jeffrey could have become depressed, but he didn't have time to submit to depression. Between the widespread news reports of Jeffrey's having

"operated under the influence" and the fierce antidrug sentiment of the times, the district attorney had felt compelled to file criminal charges.

To Jeffrey's total disbelief, he now found himself charged with murder in the second degree. It was on this charge that Jeffrey was now awaiting the jury's verdict.

Jeffrey's musings were again interrupted by the uniformed court officer as he reappeared from the judge's chamber and slipped back into the jury room.

Why were they drawing it out like this? It was torture for Jeffrey. He was plagued by an allioo-real sense of d6jA vu, since the four-day criminal trial had not gone much differently than the previous civil trial. Only this time the stakes were higher.

Losing money, even if he didn't have it, was one thing. The specter of a criminal conviction and mandatory prison term was something else entirely.

Jeffrey truly did not think he could withstand life behind bars. Whether it was due to a rational fear or an irrational phobia, he didn't know.

Regardless, he'd told Carol he'd spend the rest of his life in another country rather than face a prison term.

Jeffrey raised his eyes to the empty judge's bench. Two days previously, the judge had charged the jury before they'd retired for their deliberations. Some of the judge's words reverberated in Jeffrey's mind and fanned his fears.

7

"Members of the jury," Judge Janice Maloney had said, "before you can find the defendant, Dr. Jeffrey Rhodes, guilty of second-degree murder, the

Commonwealth must have proved beyond a reasonable doubt that Patty Owen's death was caused by an act of the defendant which was imminently dangerous to another person and evinced a depraved mind, indifferent to human life.

An act is 'imminently dangerous' and 'evinces a depraved mind' if it is an act that a person of ordinary judgment would know is reasonably certain to kill or do serious bodily injury to another. It is also such an act if it comes from ill will, hatred, or harmful intent."

It seemed to Jeffrey that the outcome of the case hinged on whether the jury believed he had taken morphine or not. If they believed he had, then they would find he had acted with harmful intent. At least that was how

Jeffrey would find if he were one of the jurors. After all, giving anesthesia was always imminently

dangerous. The only thing that distinguished it from criminal battery was the informed consent.

But the judge's words to the jury that had most threatened Jeffrey involved the part about punishment. The judge had informed the jury that even a conviction of the lesser charge of manslaughter would require her to sentence Jeffrey to a minimum of three years in prison.

Three years! Jeffrey began to perspire and feel cold at the same moment. He wiped his brow and his fingers came away damp.

"All rise!" the court officer called out, having just stepped out of the jury room. Then he stood aside. Everyone in the courtroom scrambled to his feet. Many craned their necks, hoping to get a glimmer of the verdict from the jurors' expressions when they appeared.

Preoccupied with his thoughts, Jeffrey was caught off guard by the court officer's terse announcement. He overreacted, leaping to his feet. He felt momentarily dizzy and had to lean on the defendant's table a moment for support.

As the jurors filed in, none of them made eye contact with Jeffrey. Was that a good or bad sign? Jeffrey wanted to ask Randolph but he was afraid to.

"The Honorable Judge Janice Maloney," the court officer called out as the judge appeared from her chambers and took her seat at the bench. She arranged things on the desk in front of her, moving the water pitcher to the side. She was a thin woman with intense eyes.

"You may be seated," the court officer called. "Members of the jury, please remain standing."

Jeffrey took his seat, still watching the jury. Not one of them would look at him, a fact that progressively disturbed him. Jeffrey focused on the white-haired grandmotherly figure who stood on the far left in the front row. During the trial she had frequently looked in his direction. It had been Jeffrey's intuition she'd felt some special warmth toward him. But not now. Her hands were clasped in front of her, her eyes downcast.

The clerk of the court adjusted his glasses. He was sitting at a desk just below the bench and to the right. The court recorder was directly in front of him.

"Will the defendant please stand and face the jury," the clerk said.

Jeffrey stood up again. This time he did it slowly. Now all the jurors were staring at him. Still, their faces remained stony. Jeffrey felt his pulse hammering in his ears.

"Madam Foreperson," the clerk called out. The foreperson was a handsome woman in her late thirties who looked professional. "Has the jury agreed upon a verdict?"

:'Yes," the foreperson said.

'Bailiff, please get the verdict from the foreperson," the clerk directed.

The court officer stepped over to her and took a seemingly plain sheet of paper from her hands. Then he handed the sheet to the judge.

The judge read the note, tilting her head back to read through her bifocals. She took her time, nodded, then handed the paper to the clerk who had stood to receive it.

The clerk seemed to take his time, too. Jeffrey felt intense irritation at all this unnecessary delay as he stood facing the expressionless jurors.

The court was taunting him, mocking him with its archaic protocol. His heart was beating faster now, and his palms were sweating. There was a burning in his chest.

After clearing his throat, the clerk turned to face the jury. "What say you, Madam Foreperson, is the defendant guilty or not guilty of the alleged complaint of second-degree murder?"

Jeffrey felt his legs tremble. His left hand leaned on the edge of the defendant's table. He wasn't specifically religious, but he found himself praying: Please, God...

"Guilty!" the foreperson called out with a clear, resonant voice.

Jeffrey felt his legs sway as the image of the courtroom momentarily swam before him. He grappled for the table with his right hand to steady himself. He felt Randolph grip his right arm.

"This is only the first round," Randolph whispered in his ear. "We'll appeal, just like we did the malpractice judgment."

The clerk looked over toward Jeffrey and Randolph reprovingly, then turned back to the jury and said: "Madam Foreperson and members of the jury, harken to your verdict as recorded by the court. The jurors upon their oath do say that the defendant is guilty as charged in said complaint. So say you, Madam FoTeperson?"

:'Yes," the forelady said.

'So say you, members of the jury?" the clerk asked.

"Yes," the jurors replied in unison.

The clerk turned his attention back to his books while the judge began to discharge the jury. She thanked them for their

time and consideration of the case, praising their role in upholding a two-hundred-year tradition of justice.

Jeffrey sat down heavily, feeling numb and cold. Randolph was talking to him, reminding him that thejudge of the malpractice case should never have allowed the question of his drug problem to stand.

"Besides," Randolph said, bending down and looking Jeffrey directly in the eye, "all the evidence is circumstantial. There was not one piece of definitive evidence that you had taken morphine. Not one!"

But Jeffrey was not listening. The ramifications of this verdict were too overwhelming to consider. Deep down he realized that for all his fears, he'd really never believed he'd be convictedsimply because he was not guilty. He'd never been involved in the legal system before, and he'd always trusted that "truth would out" if he ever was wrongly accused. But that belief had been false. Now he'd be going to prison.

Prison! As if to underscore his fate, the court officer came over to handcuff him. Jeffrey could only look on, incredulous. He stared at the polished surface of the handcuffs. It was as if the manacles had transformed him into a criminal, a convict, even more than the jury's verdict.

Randolph was murmuring encouragement. The judge was still discharging the jury. Jeffrey heard none of it. He felt depression descend like a leaden blanket. Competing with the depression was a sense of panic from imminent claustrophobia. The idea of being locked in a small room evoked scary images of being caught beneath the blankets when he was a young child by his older brother, filling him with a fear of being smothered.

"Your Honor," the district attorney said as soon as the jury had filed out.

He got to his feet. "The Commonwealth moves for sentencing."

"Denied," the judge said. "The court will schedule penalty proceedings after a presentencing; investigation by the probation department. When is an appropriate time, Mr. Lewis?"

The clerk flipped through the scheduling book. "July 7 looks good. 19

"July 7 it is," the judge said.

"The Commonwealth respectfully requests denying bail or a significant increase in bail," the district attorney said. "It is the Commonwealth's position that at a minimum,- the bail should be raised from $50,000 to

$500,000."

"All right, Mr. District Attorney," the judge said, "let's hear your argument."

The district attorney stepped from behind the prosecution tablc to face the judge. "The serious nature of the complaint combined with the verdict demands a significant bail, more in keeping with the severity of the crime of which he has been convicted. There also have been rumors that Dr.

Jeffrey Rhodes would prefer to flee rather than face the punishment of the court."

The judge turned toward Randolph. Randolph stood up. "Your Honor," he began, "I would like to emphasize to the court that my client has significant ties to the community. He has always demonstrated responsible behavior. He has no previous criminal record. In fact, he has been an exemplary member of society, productive and law-abiding. He has every intention of appearing for sentencing. I feel that $50,000 is more than enough bail; $500,000 would be excessive."

..Has your client ever expressed an intention of avoiding punishment?" the judge asked, looking over the top of her glasses.

Randolph shot a glance at Jeffrey. Jeffrey's gaze fell to his hands.

Turning back to the judge, Randolph said: "I do not believe my client would think or say such a thing."

The judge looked slowly back and forth between Randolph and the district attorney. Finally she said, "Bail set at $500,000 cash surety." Then, looking directly at Jeffrey, she said, "Dr. Rhodes, as a convicted felon you are not to leave the Commonwealth of Massachusetts. Is that clear?"

Jeffrey meekly nodded.

"Your Honor... !" Randolph protested.

But the judge only pounded her gavel once and stood up, clearly dismissive.

"All rise!" the court officer barked.

With swirling robes like a dervish, Judge Janice Maloney swept from her court and disappeared into her chambers. The courtroom erupted in conversation.

"This way, Dr. Rhodes," the court officer standing next to Jeffrey said, motioning toward a side door. Jeffrey stood and stumbled forward. He cast a quick glance in Carol's direction. She was looking at him sadly.

Jeffrey's panic grew as he was taken to a holding room furnished with a plain table and spartan wooden chairs. He sat in the chair Randolph steered him to. Although he did his best to

maintain his composure, he couldn't keep his hands from trembling. He felt short of breath.

I Randolph did his best to calm him. He was indignant about the verdict and optimistic about the appeal. Just then, Carol was escorted into the narrow room. Randolph patted her on the back and said, "You talk to him. I'll go call the bail bondsman."

Carol nodded and looked down at Jeffrey. "I'm sorry," she said after

Randolph had left the room.

Jeffrey nodded. She had been good to stand by him. His eyes welled with tears. He bit his lip to keep from crying.

"It's so unfair," Carol said, sitting down next to him.

"I can't go to prison," was all Jeffrey could say. He shook his head. "I still can't believe this is happening."

"Randolph will appeal," Carol said. "It's not over yet."

"Appeal," Jeffrey said with disgust. "It will be just more of the same.

I've lost two cases..."

"It's not the same," Carol said. "Only experienced judges will be looking at the evidence, not an emotional jury."

Randolph came back from the phone to say that Michael Mosconi, the bail bondsman, was on his way over. Randolph and Carol began an animated conversation about the process of appeal. Jeffrey put his elbows on the table and despite the handcuffs, rested his head in his hands. He was thinking about his medical license, wondering what would happen to it as a consequence of the verdict. Unfortunately, he had a pretty good idea.

Michael Mosconi arrived in short order with his briefcase. His office was only a few steps from the courthouse, in the curved building facing

Government Center. He was not a big man, but his head was large and almost bald. What hair he had grew in a dark crescent that stretched around the back of his head from ear to ear. Some of the strands of dark hair were combed directly over the bald dome in a vain effort to provide a minimum of cover. He had intensely dark eyes that appeared to be all pupil. He was oddly dressed in a dark blue polyester suit with a black shirt and a white tie.

Mosconi set his briefcase on the table, snapped open the latches, and removed a file folder labeled with Jeffrey's name.

"Okay," he said, taking a seat at the table and opening the file. "How much is the increase in bail?" He had already put up the initial $50,000 bail, having collected $5,000 for his services.

"It's $450,000," Randolph said.

Mosconi whistled through his teeth, pausing in setting out the

papers. "Who do they think they got here, Public Enemy Number One?" Neither

Randolph nor Jeffrey felt they owed him the courtesy of an answer.

Mosconi's attention returned to his paperwork, unconcerned by his client's lack of response. He'd already done an O&E, an ownership and encumbrance check, on Jeffrey and Carol's Marblehead house when bail had initially been set, securing the first bond with a lien of $50,000 on the home. The house had a documented value of $800,000 with an existing mortgage ofjust over

$300,000. "Well, isn't that convenient," he said. "I'll be able to post bond with an additional $450,000 lien against your little castle in

Marblehead. How's that?"

Jeffrey nodded. Carol shrugged.

As Mosconi began filling out the papers, he said: "Then, of course, there is the little matter of my fee, which in this case will be $45,000. I'll want that in cash."

"I don't have that kind of cash," Jeffrey said.

Mosconi held up from completing the form.

"But I'm sure you can raise it," Randolph put in.

"I suppose," Jeffrey said. Depression was setting in.

"Either yes or no," Mosconi said. "I don't do this stuff for recreation."

"I'll raise it," Jeffrey said.

"Normally I require the fee up front," Mosconi added. "But since you are a doctor..." He laughed. "Let's just say I'm accustomed to dealing with a slightly different clientele. But for you, I'll take a check. But only if you can raise the money and have it in your account by, let's say, this time tomorrow. Is that possible?"

"I don't know," Jeffrey said.

"If you don't know, then you'll have to stay in custody until you got the money," Mosconi said.

"I'll raise it," Jeffrey said. The thought of even a few nights in jail was intolerable.

"Do you have a check with you?" Mos6oni asked.

Jeffrey nodded.

Mosconi went back to filling out the form. "I hope you understand, Doctor," he said, "that I'm doing you a big favor by taking a check. My company would take a dim view, so let's just keep it between us. Now you'll have that money in your account in twenty-four hours?"

"I'll take care of it this afternoon," Jeffrey said.

"Wonderful," Mosconi said. He pushed the papers toward

Jeffrey. "Now if you two will sign this note, I'll run down to the clerk's office and settle the score."

Jeffrey signed without reading what he was signing. Carol read it carefully, then signed. Carol got Jeffrey's checkbook out of his jacket pocket and held it while Jeffrey made out a check for $45,000. Mosconi took the check and put it in his briefcase. Then he got up and sauntered to the door. "I'll be back," he said with a sly smile.

"Charming fellow," Jeffrey said. "Does he have to dress that way?"

"He is doing you a favor," Randolph said. "But it's true, you're hardly one of the lowlifes he's accustomed to dealing with. Before he gets back, I think we should talk about the presentencing investigation and what it entails."

"When do we file the appeal?" Jeffrey asked.

"Immediately," Randolph said.

"And I'm on bail until the appeal is heard?"

"Most likely," Randolph said evasively.

"Thank God for small favors," Jeffrey said.

Randolph then explained the presentencing investigation and what Jeffrey might expect from the penalty proceedings. He didn't want to see Jeffrey any more demoralized than he already was, so he was careful to emphasize the more promising aspects of the appeal. But Jeffrey's spirits remained low.-

"I have to admit I don't have a lot of faith left in this legal system,"

Jeffrey said.

"You've got to think positively," Carol said.

Jeffrey looked at his wife and began to appreciate how angry he was. Carol telling him he should think positively under the circumstances was eminently annoying. Suddenly Jeffrey realized he was angry at the system, angry at fate, angry at Carol, even angry at his attorney. At least anger was probably healthier than being depressed.

"All is in order," Mosconi said as he slipped in the door. He was waving an official-looking document. "If you would?" he said, motioning for the court officer to unhandcuff Jeffrey.

Jeffrey rubbed his wrists with relief when they were free from the shackles. What he wanted most was to get out of the courthouse. He stood up.

"I'm sure I don't have to remind you about the $45,000," Mosconi said.

"Just remember, I'm putting my ass on the line for you."

"I appreciate it," Jeffrey said, trying to sound thankful.

They left the holding room together although Michael Mosconi hurried off in the opposite direction when they got to the hall.

Jeffrey had never been so consciously appreciative of the fresh, ocean-scented air as when he stepped from the courthouse onto the brick-paved plaza. It was a bright, midspring afternoon with puffy little white clouds scudding across a faraway blue sky. The sun was warm but the air crisp. It was amazing how the threat of prison had sharpened Jeffrey's perceptions.

Randolph took his leave on the wide plaza in front of the garishly modem

Boston City Hall. "I'm sorry it turned out like this. I tried my best."

"I know," Jeffrey said. "I also know I was a lousy client and made it extra hard for you."

"We'll get right on the appeal. I'll be talking with you in the morning.

Good-bye, Carol."

Carol waved, then she and Jeffrey watched Randolph stride off toward State

Street, where he and his partners occupied an entire floor of one of the newer Boston office towers. "I don't know whether to love him or hate him,"

Jeffrey said. "I don't even know if he did a good job or not, especially since I got convicted."

"I personally don't think he was forceful enough," Carol said. She started toward the parking garage.

"Aren't you going back to work?" Jeffrey called after her. Carol worked for an investment banking firm located in the financial area. That was in the opposite direction.

"I took the day off," she said over her shoulder. She stopped when she saw that Jeffrey wasn't walking after her. "I didn't know how long rendering the verdict would take. Come on, you can give me a ride to my car."

Jeffrey caught up to her and they walked together, skirting City Hall. "How are you going to raise $45,000 in twenty-four hours?" Carol'asked, tossing her head in her characteristic way. She had fine, straight, dirty-blond hair that she wore in a fashion that caused it to constantly blow in her face.

Jeffrey felt his irritation surface again. Finances had been one of the trouble points in their marriage. Carol liked to spend money, Jeffrey liked to save it. When they'd married, Jeffrey's salary was larger by far, so it was Jeffrey's salary Carol made it her business to spend. When Carol's salary began to climb, it all went into her investment portfolio while

Jeffrey's salary was still used to pay all the expenses. Carol's rationale had been

that if she didn't work, then they would be using Jeffrey's salary for all the expenses anyway.

Jeffrey didn't answer Carol's question immediately. He realized that in this instance his anger was misdirected. He wasn't angry with her. All their old financial disputes were water under the bridge, and wondering where $45,000 in cash was to come from was a legitimate concern. What angered him was the legal system and the lawyers who ran it. How could lawyers like the district attorney or the plaintiff attorney live with themselves when they lied so much? From the depositions Jeffrey knew they did not believe their own prosecution ploys. Each of Jeffrey's trials had been an amoral process in which the opposing attorneys had allowed ends to justify dishonest means.

Jeffrey got in behind the wheel of his car. He took a deep breath to control his anger, then turned to Carol. "I plan to increase the mortgage on the Marblehead house. In fact, we should stop at the bank on the way home."

"With the lien we just signed, I don't think the bank will up the mortgage," Carol said. She was something of an authority on the subject; this was her area of expertise.

"That's why I want to go right now," Jeffrey said. He started the car and drove out of the garage. "No one will be the wiser. It will take a day or two before that lien finds its way into their computers."

"Do you think you ought to do that?"

"Do you have any other ideas of how I can raise $45,000 by tomorrow afternoon?" Jeffrey asked.

"I guess not. "

Jeffrey knew she had that kind of money in her investment portfolio, but he'd be damned if he'd ask her for it.

"See you at the bank," Carol said as she got out in front of the garage where her car was parked.

As Jeffrey drove north over the Tobin Bridge, exhaustion settled over him.

It seemed that he had to make a conscious effort to breathe. He began to wonder why he was bothering with all this rigmarole. It wasn't worth it.

Especially now that he was sure to lose his medical license. Other than medicine, in fact other than anesthesia, he didn't know much about anything. Except for a menial job like bagging at a grocery store, he couldn't think of anything else he was qualified to do. He was a convicted, worthless forty-two-year-old, an unemployable middle-aged nothing.

When Jeffrey arrived at the bank, he parked but didn't get

out of the car. He slumped forward and let his forehead rest on the steering wheel. Maybe he should just forget everything, go home, and sleep.

When the passenger-side door opened, Jeffrey didn't even bother to look up.

"Are you all right?" Carol asked.

"I'm a little depressed," Jeffrey said.

"Well, that's understandable," Carol said. "But before you get too immobile, let's get this bank stuff out of the way."

"You're so understanding," Jeffrey said irritably.

"One of us has to be practical," Carol said. "And I don't want to see you going to jail. If you don't get that money in your checking account, that's where you'll end up."

"I have a terrible premonition that that's where I'm going to end up no matter what I do." With supreme effort, he got out of the car. He faced

Carol over the roof of the car. "The one thing I find interesting," he added, "is that I'm going to prison and you're going to L.A., but I don't know who's worse off."

"Very funny," Carol said, relieved that he was at least making a joke, even if she failed to find it amusing.

Dudley Farnsworth was the manager of the Marblehead branch of Jeffrey's bank. Years before, he'd happened to be the junior bank officer in the

Boston branch of the bank that had handled Jeffrey's first real estate purchase. Jeffrey had been a resident in anesthesia at the time. Fourteen years previously, Jeffrey had bought a Cambridge three-decker and Dudley had arranged the financing.

Dudley saw them as soon as he could, taking them back to his private office and seating them in leather chairs facing his desk.

"What can I do for you?" Dudley said pleasantly. He was Jeffrey's age but looked older with his silver-white hair.

"We'd like to increase the mortgage on our house," Jeffrey said.

"I'm sure that won't be a problem," Dudley said. He went to a file drawer and pulled out a folder. "What kind of money are you looking for?"

"Forty-five thousand dollars," Jeffrey said.

Dudley sat down and opened the folder. "No problem," he said, looking at the figures. "You could take even more if you wish."

"Forty-five thousand will be enough," Jeffrey said. "But I need it by tomorrow."

"Ouchl" Dudley said. "That's going to be tough."

"Perhaps you could arrange a home equity loan," Carol suggested. "Then when the mortgage comes through, you can use that to pay off the loan."

Dudley nodded with eyebrows arched. "That's an idea. But I tell you what, let's go ahead and fill out the forms for the mortgage. I'll see what I can do. If the mortgage doesn't come through, then I'll take Carol's suggestion. Can you come in tomorrow morning?"

"If I can get out of bed," Jeffrey said with a sigh.

Dudley shot a glance at Jeffrey. He intuited that something was wrong, but he was too much of a gentleman to inquire.

After the bank business was concluded, Jeffrey and Carol walked out to their cars.

"Why don't I stop at the store and get something good for dinner?" Carol suggested. "What would you like tonight? How about your favorite: grilled veal chops."

"I'm not hungry," Jeffrey said.

"Maybe you're not hungry now, but you will be later." I doubt it," Jeffrey said.

"I know you and you'll be hungry. I'm going to stop at the grocery for food for tonight. So what'll it be?"

"Get whatever you want," Jeffrey said. He climbed into his car. "With the way I feel, I can't imagine I'm going to want to eat.$'

When Jeffrey reached home, he pulled into the garage, then went directly to his room. He and Carol had been occupying separate rooms for the past year.

It had been Carol's idea, but Jeffrey. surprised himself by warming to the idea right away. That had been one of the first clear signs that their marriage was not all it should be.

Jeffrey closed the door behind him and locked it. His eyes wandered to his books and periodicals carefully shelved according to height. He wasn't going to need them for a while. He 'walked over to the bookcase and pulled out Bromage's Epidural Analgesia and threw it against the wall. It poked a small hole in the plaster, then crashed to the floor. The gesture didn't make him feel any better. In fact it made him feel guilty, and the effort exhausted him even more. He picked up the book, smoothed out a few of the bent pages, then slipped it back into its designated spot. By habit, he lined the spine up with the other volumes.

Sitting down heavily in the wing chair by the window, Jeffrey vacantly stared out at the dogwood, whose wilting spring blos-

soms were past their prime. He was gripped by overwhelming sadness. He knew he had to shake this self-pity if he was to accomplish anything. He heard

Carol's car pull up, then the door slam. A few minutes later there was a quiet knock at his door. He ignored it, thinking she'd guess he was asleep.

He wanted to be alone.

Jeffrey struggled with his deepening sense of guilt. Perhaps that was the worst part of having been convicted. By undermining his confidence, he again worried that maybe he had erred in administering the anesthesia that fateful day. Maybe he had used the wrong concentration. Maybe Patty Owen's death was his fault.

Hours slipped by as Jeffrey's preoccupied mind wrestled with a growing sense of his worthlessness. Everything that he'd ever done seemed stupid and pointless. He'd failed at everything from being an anesthesiologist to being a husband. He couldn't think of one thing that he'd succeeded at.

He'd even failed at making the basketball team in junior high school.

When the sun sagged down in the western sky and touched the horizon,

Jeffrey had the sense it was setting on his life. He thought that few people could realize the tremendous toll malpractice litigation took on a practicing physician's emotional and professional life, especially when there was no malpractice involved. Even if Jeffrey had won the case, he knew that his life would have been changed forever. The fact that he lost was that much more devastating. And it had nothing to do with money.

Jeffrey watched the sky change from warm reds to cold purple and silver, while the light ebbed and the day died. As he sat there in the gathering gloom, he suddenly had an idea. It wasn't entirely true that he was helpless. There was something he could do to affect his destiny. With the first sense of purpose in weeks, Jeffrey pushed himself out of the wing chair and went to the closet. From it he pulled his large black doctor's bag and put it on the bureau.

From the doctor's bag he retrieved two small bottles of Ringer's Lactate intravenous fluid as well as two infusion kits and one small scalp needle.

Then he took out two vials, one of succinyleholine, the other of morphine.

Using a syringe, he drew up 75 mg of the succinylcholine and squirted it into one of the Ringer's Lactate bottles. Then he drew up 75 mg of morphine, a walloping dose.

One of the benefits of being an anesthesiologist was that Jeffrey knew the most efficient way to commit suicide. Other doc-

tors didn't, though they tended to be more successful in their attempts than the general public. Some shot themselves, a messy method which, surprisingly enough, was not always effective. Others took overdoses, another method that often didn't yield the desired result. Too often the would-be suicides were caught in time to have their stomachs pumped. Other times the drugs injected were enough to bring on a coma but not death. Jeffrey shuddered at the haphazard consequences.

Jeffrey felt his depression lift slightly as he worked. It was heartening to have a goal. He took the painting that hung over the head of the bed down to use the hook to hang both IV bottles. He then sat down on the side of the bed and started the IV on the back of his left hand with the bottle containing only the Ringer's Lactate solution. He piggy-backed the bottle containing the succiny1choline onto the other, with only the thin blue stopcock separating him from its lethal contents.

Careful not to dislodge the IV, Jeffrey lay back on the bed. His plan was to inject the huge dose of morphine and then open the stopcock on the solution containing the succiny1choline. The morphine would send him to never-never-land long before the succiny1choline concentration paralyzed his respiratory system. Without a ventilator, he would die. It was as simple as that.

Gently, Jeffrey inserted the needle of the syringe containing the morphine into the IV port of the infusion line going into the vein on the back of his hand. Just as he was beginning to inject the narcotic, there was a soft knock on his door.

Jeffrey rolled his eyes. What a time for Carol to interrupt. He held off the injection but didn't respond to her knock, hoping she'd go away if she thought he was still asleep. Instead, she knocked louder, then louder still. "Jeffrey!" she called. "Jeffreyl I've made dinner."

There was a short silence that made Jeffrey think she'd given up. But then

Jeffrey heard the knob turn and the door rattle against the jamb.

"Jeffrey-are you all right?"

Jeffrey took a deep breath. He knew he had to say something or she might be concerned enough to force the door. The last thing he wanted was for her to come barging in and see the IV.

"I'm fine," Jeffrey called out at last.

"Then why didn't you answer me?" Carol demanded.

"I was asleep."

"Why is this door locked?" Carol asked.

"I guess I didn't want to be disturbed," Jeffrey replied with pointed irony.

"I've made dinner," Carol said.

"That's nice of you, but I'm still not hungry."

"I made veal chops, your favorite. I think you should eat."

"Please, Carol," Jeffrey said with exasperation. "I'm not hungry. 11

"Well, come eat for my sake. As a favor to me."

Fuming, Jeffrey set the syringe with the morphine on the night table and pulled out the IV. He went to the door and yanked it open, but not so far that Carol could see in. "Listen!" he snapped. "I told you earlier that I wasn't hungry then and I'm telling you that I'm not hungry now. I don't want to eat and I don't like you trying to make me feel guilty about it, understand?"

"Jeffrey, come on. I don't think you should be alone. Now I've gone to the trouble to shop for you and cook. The least you can do is come try it."

Jeffrey could see there would be no getting around her. When she'd made up her mind, she was not the type of person who could be easily dissuaded.

"All right," he said heavily. "All right."

"What's wrong with your hand?" Carol asked, noticing a drop of blood on the back of it.

"Nothing," Jeffrey said. "Nothing at all." He glanced at the back of his hand. Blood was oozing from the IV site. Frantically, he searched for an explanation.

"But it's bleeding."

"A paper cut," Jeffrey said. He was never good at fibbing. Then, with an irony only he could appreciate, he added, "I'll live. Believe me, I'll live. Look," he said, "I'll be down in a minute."

"Promise?" Carol said.

"I promise."

With Carol gone and the door relocked, Jeffrey removed the quarter-liter IV bottles and stored them in the back of his closet in his leather doctor's bag. He threw the wrappers from the infusion kits and the scalp needle into the wastebasket in the bathroom.

Carol had some sense of timing, he thought ruefully. Only as he packed away the medical paraphernalia did he realize how close he had come. He told himself he shouldn't give in to despair, at least not until all legal avenues had been exhausted. Until this recent turn of events, Jeffrey had never seriously enter tained thoughts of suicide. He was honestly baffled by the sui-

cides he knew of, though intellectually he could appreciate the depths of despair that might prompt it.

Oddly enough, or perhaps not so oddly, the only suicides he had known were other doctors who'd been pushed to the brink by motives not unlike

Jeffrey's. He recalled one friend in particular: Chris Everson. He couldn't remember exactly when Chris had died, but it had been within the last two years.

Chris had been a fellow anesthesiologist. Years before, he and Jeffrey had been residents together. Chris would have remembered the days when gung-ho residents warded off flu symptoms with Ringer's Lactate. What made thinking about Chris suddenly so poignant was the realization that he'd been sued for malpractice because one of his patients had had a terrible reaction to a local anesthetic during epidural anesthesia.

Jeffrey closed his eyes and tried to remember the details of the case. As best as he could recall, Chris's patient's heart had arrested as soon as

Chris put in the test dose of only 2 cc's. Although they had been able to get the heart beating again, the patient ended up quadriplegic and semicomatose. Within a week after the event, Chris had been sued along with

Valley Hospital and everyone else even remotely associated with the episode. The "deep pockets" strategy yet again.

But Chris never went to court. He committed suicide even before the discovery period had been completed. And even though the anesthesia procedure had been characterized as having been impeccable, the decision ultimately rendered found for the plaintiff. At the time, the settlement had been the largest award for malpractice in Massachusetts' history. But in the ensuing months, Jeffrey could think of -at least two awards that had topped it.

Jeffrey could distinctly remember his reaction when he'd heard of Chris's suicide. It had been one of complete disbelief. Back then, before Jeffrey's current involvement with the legal system, he'd had no idea what could have pushed Chris to do such an awful thing. Chris enjoyed a reputation as a superb anesthesiologist, a doctoes doctor, one of the best. He'd recently married a beautiful OR nurse who worked in Valley Hospital. He seemed to have everything going for him. And then the nightmare struck...

A soft knock brought Jeffrey back to the present. Carol was at the door again.

"Jeffrey!" she called. "Better come before it gets cold."

"I'm on my way."

Now that he knew too well what Chris had only begun to go through, Jeffrey wished he'd stayed in touch at the time. He could have been a better friend. And even after the man ended his life, all Jeffrey had done was attend the funeral. He had never even contacted Kelly, Chris's wife, even though at the funeral he'd promised himself he would do so.

Such behavior wasn't like Jeffrey, and he wondered why he'd acted so heartlessly. The only excuse he could think of was his need to repress the episode. The suicide of a colleague with whom Jeffrey could so easily identify was a fundamentally disturbing event. Perhaps facing it squarely would have been too great a challenge for him. It was the kind of personal examination that Jeffrey and doctors in general had been taught to avoid, labeling it "clinical detachment."

What a terrible waste, he thought as he remembered Chris the last time he'd seen him, before all the tragedy struck. And if Carol hadn't interrupted, mightn't there be others thinking the same thoughts with respect to him?

No, Jeffrey thought vehemently, suicide wasn't an option. Certainly not yet. Jeffrey hated to sound mawkish, but where there was life, there was hope. And what had happened in the aftermath of Chris's suicide? With Chris dead, there was no one to defend or clear his name. For all his despair and developing depression, Jeffrey still was enraged by a system and process that had managed to convict him when he had honestly done no wrong. Could he really rest until he'd done his best to clear his name?

Jeffrey got angry just thinking about his case. To the lawyers involved, even Randolph, all this might be business as usual, but not so to Jeffrey.

This was his life on the line. His career. Everything. The great irony was that the day of the Patty Owen tragedy, Jeffrey had done his utmost to do well by her. He'd only run the IV and taken the paregoric so he could perform the job for which he'd been trained. Dedication was what had motivated him, and this was how he'd been repaid.

If Jeffrey ever was able to return to medicine, he would be afraid of the long-lasting effects this case would have on any medical decisions he would ever make. What kind of care could people come to expect from doctors who were forced to work in the current malpractice milieu and who had to restrain their best instincts and second-guess their every step? How had such a system evolved? Jeffrey wondered. It certainly wasn't eliminating the few "bad" doctors, since they ironically rarely got sued.

What was happening was that a lot of good doctors were being destroyed.

As Jeffrey washed before descending to the kitchen, his mind dredged up another memory that he had unconsciously repressed. One of the best and most dedicated internists he'd ever met had killed himself five years ago on the same night he'd received a summons for malpractice. Shot himself through the mouth with a hunting rifle. He hadn't even waited for the discovery process to begin, much less the trial. At the time Jeffrey had been disturbingly mystified, since everyone, knew the suit had been baseless. In fact the doctor had, ironically, saved the man's life. Jeffrey now had some idea of the source of the man's despair.

Finished in the bathroom, Jeffrey returned to his bedroom and changed into clean slacks and shirt. Opening his door, he smelled the food Carol had prepared. He still wasn't hungry, but he'd make an effort. Pausing at the top of the stairs, he vowed to fight the depressive thoughts he was bound to experience until this current episode had run its course. With that commitment in mind he started for the kitchen.

TUESDAY,

MAY 16,1989

9:12 A.M.

Jeffrey woke up with a start and was amazed at the time. He'd first awakened around five A.M., surprised to find himself sitting in the wing chair by the window. Stiffly, he had removed his clothes and gotten into bed, thinking he would never be able to fall back asleep. But obviously he had.

He took a quick shower. Emerging from his room, he looked for Carol. Having recovered to an extent from the depressive depths of the previous day, he wanted some h1iman contact and a bit of sympathy. He hoped that Carol had not left for work without talking to him. He wanted to apologize for his lack of appreciation for her efforts the night before. It was a good thing, he now realized, that she'd interrupted him, and that she'd gotten him irritated. Unknowingly she'd saved him from committing suicide. For the first time in his life, getting angry had had a positive effect.

But Carol was long gone. A note was leaning against a shredded wheat box on the kitchen table. It said that she'd not wanted to disturb him since she was sure he needed rest. She had to get to work early. She hoped he'd understand.

Jeffrey filled a bowl with cereal and got the milk from the refrigerator.

He envied Carol her job. He wished he had a job to go to. It would keep his mind occupied if nothing else. He would have liked to have made himself useful. It might have helped his self-esteem. He'd never realized quite how much his work defined his persona.

Back in his room, Jeffrey disposed of the IV paraphernalia by wrapping it in old newspapers and carrying it out to the trash barrels in the garage.

He didn't want Carol to find it. He felt strange handling the material. It gave him a tremendous uneasiness to have been knowingly and voluntarily so close to death.

The idea of suicide had occurred to Jeffrey in the past, but always in a metaphorical context, and usually more as a retribution fantasy to get back at someone who he believed had wronged him in some emotional way, like when his girlfriend in the eighth grade had capriciously switched her affections to Jeffrey's best friend. But last night it had been different, and to think that he'd come within a hair's breadth of doing it made his legs feel weak.

Returning to the house, Jeffrey considered what effects his suicide would have had on his friends and family. It probably would have come as a relief to Carol. She wouldn't have had to go through with the divorce. He wondered if anyone would have missed him. Probably not...

"For Pete's sake," Jeffrey exclaimed, realizing the ridiculousness of this line of thought and remembering his vow to resist depressive thoughts.

Would his thinking thrive on his low selfesteem for the rest of his days?

But the subject of suicide was hard to shake from his mind. He wondered again about Chris Everson. Had his suicide been the product of an acute depression that had struck like a sudden storm, like Jeffrey had felt the night before? Or had he planned it for some time? Either way, his death was a terrible loss for everyone-his family, the public, even the profession of medicine.

Jeffrey stopped en route to his room and stared out the livingroom window with unseeing eyes. His situation was no less a waste. From the point of view of his productivity, the loss of his medical license and his going to prison was no less a waste than if he'd succeeded in committing suicide.

"Damn!" he shouted as he grabbed one of the pillows from the couch and punched it repeatedly with his fist. "Damn, damn, damn!"

Jeffrey quickly wore himself out and replaced the pillow. Then he sat himself down dejectedly with his knees jutting up in front of him. He interwound his fingers and rested his elbows on his knees and tried to think of himself in prison. It was a horrid thought. What a travesty of justice! The malpractice stuff had been more than enough to seriously disrupt and alter his life, but this criminal nonsense was a quantum leap worse, like throwing salt into a mortal wound.

Jeffrey thought about his colleagues at the hospital and other physician friends. They had all been supportive at first, at least until the criminal indictment had been handed down. Then they had avoided Jeffrey as if he'd had some kind of infectious dis-

ease. Jeffrey felt isolated and alone. And more than anything, he felt angry.

..It's just not fair!" he said through clenched teeth.

Completely out of character, Jeffrey snatched up a piece of Carol's crystal bric-a-brac from a side table and in a moment of sheer frustration threw it with deadly accuracy at the glassfronted sideboard that he could see through- the arch leading to the dining room. There was a resounding shatter of glass that made him wince.

'~Uh-ohl" Jeffrey said as he realized what he'd done. He got up and went for the dustpan and broom. By the time he'd picked up the mess, he'd come to a momentous conclusion: he wasn't going to prisonl No way. Screw the appeal process. He had as much confidence in the legal system as he did in fairy tales.

The decision was made with a suddenness and resolve that left Jeffrey feeling exhilarated. He checked his watch. The bank would be open soon.

Excitedly he went to his room and found his passport. He was lucky the court hadn't made him surrender it at the same time they'd increased his bail. Then he called Pan Am. He learned that he could shuttle to New York, bus to Kennedy, and then fly on to Rio. Considering all the carriers serving the market, he had a wide range of flights from which to choose, including one that left at 11:45 P.m. and made a few stops in exotic locations.

With his pulse racing in anticipation, Jeffrey called the bank and got

Dudley on the line. He did his best to sound controlled. He asked about the progress on the loan.

"No problem," Dudley said proudly. "Pulling a few strings, I got it approved like that." Jeffrey could hear the man snap his fingers for his benefit. "When will you be coming in?" Dudley continued. "I'd like to be sure I'm here."

"I'll be in shortly," Jeffrey said, planning his schedule. Timing would be key. "I have one other request. I'd like to have the money in cash."

"You're joking," Dudley said.

"I'm serious," Jeffrey insisted.

"It's a bit irregular," Dudley said hesitantly.

Jeffrey hadn't given this issue much thought, and he could sense Dudley's hesitance. He realized he'd have to explain if he hoped to get the money, and he definitely needed the money. He couldn't leave for South America with only pocket change.

"Dudley," Jeffrey began, "I'm in some unfortunate trouble."

"I don't like the sound of this," Dudley said.

"It's not what you're thinking. It's not gambling or anything like that.

The fact is, I have to pay it to a bail bondsman. Haven't you read about my troubles in the papers?"

"No, I haven't," Dudley said, warming up again.

"I got sued for malpractice and then indicted over a tragic anesthesia case. I won't burden you with the details at the moment. The problem is, I need the $45,000 to pay a bail bondsman who posted my bail. He said he wanted it in cash."

"I'm sure a cashier's check would be acceptable."

"Listen, Dudley," Jeffrey said. "The man told me cash. I promised him cash.

What can I say? Do me this one favor. Don't make it any harder on me than it already is."

There was a pause. Jeffrey thought he heard Dudley sigh.

"Are hundred-dollar bills okay?"

"Fine," Jeffrey said. "Hundreds would be perfect." He was wondering how much space four hundred and fifty hundreddollar bills would take.

"I'll have it ready," Dudley said. "I just hope you're not planning on carrying this around for any length of time."

"Just into Boston," Jeffrey said.

Jeffrey hung up the phone. He hoped that Dudley wouldn't call the police or try to check his story. Not that anything wouldn't have jibed. Jeffrey felt the fewer people thinking about him and asking questions, the better, at least until he was on the plane out of New York.

Sitting down with a writing tablet, Jeffrey started a note to Carol, telling her he was taking the $45,000 but that she could have everything else. But the letter sounded awkward. Besides, as he wrote he realized he didn't want to leave any evidence of his intentions in case he was delayed for some reason. He crumpled the paper, set a match to it, and tossed it in the fireplace. Instead of writing, he decided to call Carol from some foreign location and talk to her directly. It would be more personal than a letter. It would be safer, too.

The next issue was what he should take with him. He didn't want to be burdened with a lot of luggage. He settled on a small suitcase, which he loaded with basic casual clothes. He didn't imagine South America would be very formal. By the time he had packed everything he wanted, he had to sit on the suitcase to get it closed. Then he put some things in his briefcase, including his toiletries and clean underwear.

He was about to leave his closet when he eyed his doctor's bag. He hesitated for a moment, wondering what he would do

if something went horribly wrong. To be on the safe side, he opened the doctor's bag and took out an IV setup, a few syringes, a quarter liter of IV fluid, and a vial each of succiny1choline and morphine and packed them in his briefcase beneath the underwear. He didn't like to think he was still entertaining thoughts of suicide, so he told himself that the drugs were like an insurance policy. He hoped he wouldn't need them, but they were there just in case...

Jeffrey felt strange and a little sad glancing around the house for what was probably the last time, knowing he might never lay eyes on it again.

But walking from room to room, he was surprised not to be more upset. There was so much to remind him of past events, both good and bad. But more than anything else, Jeffrey realized that he associated the place with his failed marriage. And just like his malpractice case, he'd be better off leaving it behind. He felt energized for the first time in months. It felt like the first day of a new life.

With the suitcase in the trunk and his briefcase on the passenger seat beside him, Jeffrey drove out of the garage, beeped the door shut, and was on his way. He didn't look back. The first stop was the bank, and as he got closer, he began to get anxious. His new life was starting out in a unique fashion: he was deliberately planning to break the law by defying the court. He wondered if he would get away with it.

By the time he pulled into the bank's parking lot, he was very nervous. His mouth had gone dry. What if Dudley had called the police about his requesting the bail money in cash? It wouldn't take the intelligence of a rocket scientist to figure that Jeffrey might be planning on doing something else with the money rather than turn it over to the bail bondsman.

After sitting in his parked car for a moment to summon his courage, Jeffrey grabbed his briefcase and forced himself into the bank. In some respects he felt like a bank robber, even though the money he was seeking technically belonged to him. Taking a deep breath to steady himself, he went to the service desk and asked for Dudley.

Dudley came to meet him with smiles and small talk. He led Jeffrey back to his office and motioned to a chair. To judge by his demeanor, he didn't hold Jeffrey suspect. But Jeffrey's anxiety stayed razor sharp. He was trembling.

"Some coffee or a soft drink?" Dudley offered. Jeffrey decided he'd be better off without caffeine. He told Dudley some juice would be fine. He thought it best to give his hands something

to do. Dudley smiled and said, "Sure thing." The man was being so cordial,

Jeffrey was afraid it was a trap.

"I'll be right back with the cash," Dudley said after handing Jeffrey a glass of orange juice. He returned in a few minutes carrying a soiled canvas money bag. He dumped the contents onto his desk. There were nine packets of hundred-dollar bills, each containing fifty bills. Jeffrey had never seen so much money in one place. He felt increasingly uneasy.

"It took us a little doing to get this together so quickly," Dudley told him.

"I appreciate your effort," Jeffrey said.

"I suppose you'll want to count it," Dudley said, but Jeffrey declined.

Dudley had Jeffrey sign a receipt for the cash. "Are you sure you don't want a cashier's check?" Dudley asked as he took the signed paper from

Jeffrey. "It's not safe carrying this kind of cash around. You could call your bail bondsman and have him pick it up here. And you know, a cashier's check is as good as cash. He could then go into one of our Boston offices and get cash if that's what he's after. It would make it safer for you."

"He said cash, so I'm giving him cash," Jeffrey said. He was actually touched by Dudley's concern. "His office isn't far," he explained.

"And you're sure you don't want to count it?"

Jeffrey's tension was beginning to evoke irritation, but he forced a smile.

"No time. I was supposed to have this money in town before noon. I'm already late. Besides, I've been doing business long enougk with you." He packed the money into his briefcase and stood up.

"If I'd known you weren't going to count it, I would have taken a few bills from each packet." Dudley laughed.

Jeffrey hurried out to the car, tossed in the briefcase, and drove out of the parking lot with extra care. All he needed was a speeding ticket! He checked the rearview mirror to make sure he wasn't being followed. So far so good.

Jeffrey drove directly to the airport and parked on the roof of the central parking building. He left the parking stub in the car's ashtray. When he called Carol from wherever, he'd tell her to pick the car up.

With the briefcase in one hand and the suitcase in the other, Jeffrey walked to the Pan Am ticket counter. He tried to behave like any businessman going off on a trip, but his nerves were shot; his stomach was in agony. If anyone recognized him,

they'd know he was jumping bail. He'd been specifically told not to leave the state of Massachusetts.

Jeffrey's anxiety went up a notch every minute he waited in the ticket line. When his turn finally came, he bought a ticket for the New York to

Rio flight as well as one for the 1:30 P.m. shuttle. The agent tried to convince him it would be far easier to take one of their late afternoon flights directly to Kennedy. That way Jeffrey wouldn't have to take the bus from LaGuardia to Kennedy. But Jeffrey wanted to go on the shuttle. He felt the sooner he got out of Boston, the better he would feel.

Leaving the ticket area, Jeffrey approached security's X-ray machine. There was a uniformed state police officer casually lounging just beyond it. It was all Jeffrey could do not to turn around and run.

Right after he hoisted his briefcase and then the suitcase onto the conveyer belt and watched them disappear into the machine, Jeffrey had a sudden fright. What about the syringes and the ampule of morphine? What if they showed up on the X-ray, and he had to open the briefcase? Then they'd discover the stacks of moneyl What would they think of all that cash?

Jeffrey thought about trying to reach into the X-ray machine to yank his briefcase back, but it was too late. He glanced at the woman studying the screen. Her face was illuminated eerily by the light, but her eyes were glazed with boredom. Jeffrey felt himself being subtly urged on by the people waiting behind. He stepped through the metal detector, eyes on the policeman the whole time. The policeman caught his eye and smiled; Jeffrey managed a crooked smile in return. Jeffrey looked back at the woman studying the screen. Her blank face looked suddenly puzzled by something.

She had stopped the conveyor belt and was motioning for another woman to look at the screen.

Jeffrey's heart sank. The two were examining the contents of his briefcase as it appeared on the screen. The policeman hadn't noticed yet. Jeffrey caught him yawning.

Then the conveyor belt started again. The briefcase came out, but the second of the two women stepped over and put her hand on it.

"Is this yours?" she asked Jeffrey-

Jeffrey hesitated, but there was no denying it was his. His passport was in it.

:'Yes," he said weakly.

'Do you have a Dopp Kit in there with a small pair of scissors?"

Jeffrey nodded.

"Okay," she said, giving the briefcase a push toward him.

Stunned but relieved, Jeffrey quickly took his belongings to a far comer of the waiting area and sat down. He picked up a discarded newspaper and hid behind it. If he hadn't felt like a criminal when the jury handed down its verdict, he felt like one now.

As soon as his flight was called, Jeffrey pressed to get on. He couldn't wait to get on the plane. Once he was on, he couldn't wait to take his seat.

Jeffrey was in an aisle seat fairly close to the front of the plane. With his suitcase secured in the overhead compartment and his briefcase tucked under his feet, Jeffrey leaned back and closed his eyes. His heart was still racing but at least he could now try to relax. He had just about made it.

But it was difficult to calm down. Sitting there in that plane, the seriousness and irreversibility of what he was about to do finally began to sink in. So far, he hadn't broken any law. But as soon as the plane crossed from Massachusetts into another state, he would have. And there would be no turning back.

Jeffrey checked his watch. He began to perspire. It was one twenty-seven.

Only three minutes to go before the door would be sealed. Then takeoff. Was he doing the right thing? For the first time since he'd come to this decision that morning, Jeffrey felt real doubt. The experience of a lifetime argued against it. He'd always followed the law and respected authority.

Jeffrey began to shake all over. He'd never experienced such agonizing indecision and confusion. He looked at his watch again. It was twenty-nine after the hour. The cabin attendants were busy slamming all the overhead compartments, and the crashing noise threatened to drive him mad. The door to the cockpit was closed with a resounding click. A gate agent came onto the plane and gave a final manifest. All the passengers were in their seats. In a way he was ending the life he had always known, as surely as if he'd released the stopcock the night before.

He wondered how running away would affect his appeal. Wouldn't it make him appear the guiltier? And if be was ever brought to justice, would he have to serve extra time for fleeing? Just what did he plan to do in South

America? He didn't even speak Spanish or Portuguese. In a flash, the full horror of his action hit home. He just couldn't go through with it.

"Waitf" Jeffrey shouted as he heard the sounds of the plane's

door closing. All eyes turned on him. "Wait! I have to get off!" He undid the seat belt, then tried to pull his briefcase from under the seat. It opened and some of the contents, including a stack of hundred-dollar bills, fell out. Hastily, he jammed the things back inside, then got his suitcase from the overhead compartment. No one spoke. Everyone was watching Jeffrey's panic with stunned curiosity.