Harvest

CHAPTER NINE

"You're overreacting," said Mark, flipping through NinaVoss's SICU

chart. "There has to be a reasonable explanation for all of this."

"I'd like to know what it is," said Abby.

"It was a good excision. The heart came packed right, delivered right. And there were donor papers."

"Which now seem to be missing."

"The transplant coordinator will be in at nine. We can ask her about the papers then. I'm sure they're around somewhere."

"Mark, there's one more thing. I called the donor hospital. There's no surgeon named Leonard Mapes practising there. In fact there's no such surgeon practising in Burlington." She paused. Softly she said, "Do we really know where that heart came from?"

Mark said nothing. He seemed too dazed, too tired to be thinking straight. It was four-fifteen. After Abby's phone call, he'd dragged himself out of bed and driven to Bayside. Post-op fevers required immediate attention, and although he trusted Abby's findings, he had wanted to see the patient for himself. Now Mark sat in the gloom of the SICU, struggling to make sense of the paperwork in Nina Voss's chart. A bank of heart monitors faced him on the countertop, and three bright green lines traced across the reflection in his glasses. In the semidarkness nurses moved like shadows and spoke in hushed voices.

Mark closed the chart. Sighing, he pulled off his glasses and rubbed his eyes. "This fever. What the hell is causing the fever? That's what really concerns me."

"Could it be an infection passed from the donor?"

"Unlikely. I've never seen it happen with a heart."

"But we don't know anything about the donor. Or his medical history. We don't even know which hospital that heart came from."

"Abby, you're going off the deep end here. I know Archer spoke on the phone to the harvesting surgeon. I also know there were papers. They came in this brown envelope."

"I remember seeing it."

"All right. Then we saw the same thing."

"Where's the envelope now?"

"Hey, I was the one operating, OK? I'm up to my elbows in blood. I can't keep track of some goddamn envelope."

"Why is there all this secrecy about the donor, anyway?We don't have records. We don't know his name."

"That's standard procedure. Donor records are confidential. They're always kept separate from the recipient's chart. Otherwise you'd have families contacting each other. The donor side would expect undying gratitude, the recipient side would either resent it or feel guilty. It leads to one giant emotional mess." He sank back in his chair. "We're wasting time on this issue. It'll all be resolved in a few hours. So let's concentrate on the fever."

"All right. But if there's any question about this, New England Organ Bank wants to discuss it with you."

"How did NEOB get involved?"

"I called them. They have this twenty-four-hour line. I told them you or Archer would get back to them."

"Archer can handle it. He'll be here any minute."

"He's coming in?"

"He's worried about the fever. And we can't seem to get hold of Aaron. Have you paged him again?"

"Three times. No answer. Elaine told me he was driving in."

"Well, I know he got here. I just saw his car down in the parking lot. Maybe he got busy on the medical floor." Mark flipped through Nina Voss's chart to the order sheets. "I'm going to move on this without him."

Abby glanced towards NinaVoss's cubicle.The patient's eyes were closed, her chest rising and falling with the gentle rhythm of sleep. "I'm starting antibiotics," said Mark. "Broad spectrum."

"What infection are you treating?"

"I don't know. It's just a temporary bridge until the cultures come back. As immunosuppressed as she is, we can't take a chance she's infected somewhere." In frustration, Mark rose from the chair and walked over to the cubicle window. He stood there a moment, staring in at NinaVoss. The sight of her seemed to calm him. Abby came to stand beside him. They were very close, almost touching each other, and yet separated by the gulf of this crisis. On the other side of the window, Nina Voss slept peacefully.

"It could be a drug reaction," said Abby. "She's on so many things. Any one of them could cause a fever."

"That's a possibility. But not likely on steroids and cyclosporine."

"I couldn't find any source of infection. Anywhere."

"She's immunosuppressed. We miss something, she's dead." He turned to pick up the chart. "I'm starting the bug juice."

At 6 a.m. the first dose of IV Azactam was dripping into Nina's vein. A STAT infectious disease consult was requested, and at seven-fifteen the consultant, Dr. Moore, arrived. He concurred with Mark's decision. A fever in an immunosuppressed patient was too dangerous to go untreated.

At eight o'clock, a second antibiotic, Piperacillin, was infused. By then Abby was making morning SICU rounds, her wheeled cart piled six-deep with charts. It had been a bad call night — just one hour of sleep before that 2 a.m. phone call, and not a moment's rest since then. Fuelled by two cups of coffee and a view of the end in sight, she pushed her cart along the row of cubicles, thinking: Four hours and I'm out of here. Only four more hours until noon. She passed by Bed 15, and she glanced through the cubicle window.

Nina was awake. She saw Abby and weakly managed a beckoning wave.

Abby left her charts by the door, donned an isolation gown, and stepped into the cubicle.

"Good morning, Dr. DiMatteo," murmured Nina. "I'm afraid you didn't get much sleep because of me."

Abby smiled. "That's OK. I slept last week. How are you feeling?"

"Like quite the centre of attention." Nina glanced up at the bottle of IV antibiotics hanging over the bed. "Is that the cure?"

"We hope so. You're getting a combination of Piperacillin and Azactam. Broad spectrum antibiotics. If you have an infection, that should take care of it."

"And if this isn't an infection?"

"Then the fever won't respond. And we'll try something else."

"So you don't really know what's causing this."

Abby paused. "No," she admitted. "We don't. It's more of an educated shot in the dark."

Nina nodded. "I thought you'd tell the truth. Dr. Archer wouldn't, you know. He was here this morning, and he kept telling me not to worry. That everything was taken care of. He never admitted he didn't know." Nina gave a soft laugh, as though the fever, the antibiotics, all these tubes and machines were part of some whimsical illusion.

"I'm sure he didn't want to worry you," said Abby.

"But the truth doesn't scare me. Really it doesn't. Doctors don't tell the truth often enough." She looked straight at Abby. "We both know that."

Abby found her gaze shifting automatically to the monitors. She saw that all the lines tracing across the screen were in the normal ranges. Pulse. Blood pressure. Right atrial pressure. It was pure habit, that focus on the numbers. Machines didn't pose difficult questions, didn't expect painfully truthful answers.

She heard Nina say, softly: "Victor."

Abby turned. Only then, as she faced the doorway, did she realize Victor Voss had just stepped into the cubicle.

"Get out," he said. "Get out of my wife's room."

"I was only checking on her."

"I said, get out!" He took a step towards her and grabbed a handful of the isolation gown.

Reflexively Abby resisted, pulling free. The cubicle was so tiny there was no more room to back away, no space to retreat to.

He lunged at her. This time he caught hold of her arm with a grip that was meant to hurt.

"Victor, don't!" said Nina.

Abby gave a cry of pain as she was wrenched forward. He thrust her out of the cubicle. The force of his shove sent her backwards against the wheeled cart. She felt herself falling as the cart slid away. She landed hard on her buttocks. The cart, still rolling, slammed against a counter and charts thudded to the floor. Abby, stunned by the impact, looked up to see Victor Voss standing over her. He was breathing hard, not from exertion but from fury.

"Don't you go near my wife again," he said. "Do you hear me, doctor? Do you hear me?" Voss turned his gaze to the shocked personnel standing around the SICU. "I don't want this woman near my wife. I want that written in the chart and posted on the door. I want it done now." He gave Abby one last look of disgust, then he walked into his wife's cubicle and yanked the curtain across the window.

Two of the nurses hurried over to help Abby to her feet.

"I'm OK," said Abby, waving them away. "I'm fine."

"He's crazy," one of the nurses whispered. "We should report him to security."

"No, don't," said Abby. "Let's not make things worse."

"But that was assault! You could press charges."

"I just want to forget about it, OK?" Abby went over to the cart. Her charts were on the floor, loose pages and lab slips scattered everywhere. Face burning, she gathered up all the papers and set them back on the cart. By then she was fighting to hold back tears.

I can't cry, she thought. Not here. I won't cry. She looked up. Everyone was watching her.

She left the cart right where it was and walked out of the SICU. Mark found her three hours later, in the cafeteria. She was sitting at a corner table, hunched over a cup of tea and a blueberry muffin. The muffin had only one bite taken out of it, and the teabag had been left soaking so long the water was black as coffee.

Mark pulled out a chair across from her and sat down. "Voss was the one who threw the tantrum, Abby. Not you."

"I'm just the one who landed on her butt in front of everyone."

"He shoved you. That's something you can use. Leverage against any more of those nutty lawsuits."

"You mean I charge him with assault?"

"Something like that."

She shook her head. "I don't want to think about Victor Voss. I don't want to have anything to do with him."

"There were half a dozen witnesses. They saw him push you."

"Mark, let's forget the whole thing." She picked up the muffin, took an unenthusiastic bite, and put it back down again. She sat staring at it, desperately wanting to change the subject.

Finally she said, "Did Aaron agree about starting antibiotics?" '! haven't seen Aaron all day."

She looked up, frowning. "I thought he was here."

"I beeped him but he never answered."

"Did you call his home?"

'! got the housekeeper. Elaine left for the weekend, visiting their kid at Dartmouth." Mark shrugged. "It's Saturday. This isn't Aaron's weekend to make rounds anyway. He probably decided to take a vacation from all of us."

"A vacation," Abby sighed and rubbed her face. "God, that's what I want. A beach and a few palm trees and a pifia colada."

"Sounds good to me, too." Reaching across the table, he took her hand. "Mind if! join you?"

"You don't even like pifia coladas."

"But I like beaches and palm trees. And you." He gave her hand a squeeze. That was just what she needed at that moment. His touch. It felt as solid and dependable as the man himself.

He leaned across the table. Right there, in the cafeteria, he kissed her. "Look at us. Creating another public spectacle," he whispered. "You'd better go home, before we get everyone's attention."

She glanced at her watch. It was twelve o'clock, and a Saturday. The weekend, at last, had begun.

He walked her out of the cafeteria and across the hospital lobby. As they pushed through the front doors he said, "I almost forgot to tell you. Archer called Wilcox Memorial and spoke to some thoracic surgeon named Tim Nicholls. Turns out Nicholls assisted on the harvest. He confirmed the patient was theirs. And that Dr. Mapes did the excision."

"Then why isn't Mapes listed on the Wilcox staff?."

"Because Mapes was flown in by private jet from Houston. We knew nothing about it. Apparently, Mr Voss didn't trust just any Yankee surgeon to do the job. So he had a specialist flown in."

"All the way from Texas?"

"With his money, Voss could've flown in the whole Baylor team."

"So the harvest was done at Wilcox Memorial."

"Nicholls says he was there. Whatever nurse you spoke to last night must've been looking at the wrong log sheet. If you'd like me to call and confirm it again-'

"No, just forget it. It all seems so stupid now. I don't know what I was thinking." She sighed and looked across at her car, parked in its usual spot at the far end of the lot. Outer Siberia, the residents called their assigned parking area. Then again, slave labour was lucky to get assigned parking at all. "I'll see you at home," she said. "If I'm still awake."

He put his arms around her, tipped her head back, and kissed her, one tired body clinging to another. "Careful driving home," he whispered. "I love you."

She walked across the lot, dazed by fatigue and by the sound of those three words still echoing in her head.

I love you.

She stopped and looked back to wave at him, but he had already vanished through the lobby doors.

"I love you too," she said, and smiled.

She turned to her car, her keys already out of her purse. Only then did she notice that the lock button was up. Jesus, what an idiot. She'd left the car unlocked all night.

She opened the door.

At the first foul whiff of air, she backed away, gagging on the stench. And repulsed by the sight of what lay on the front seat.

Loops of rotting intestine were coiled around the gear shift and one end hung like a grotesque streamer from the bottom of the steering wheel. A hacked-up mass of unidentifiable tissue was smeared across the passenger seat. And on the driver's side, propped up against the cushion, was a single bloody organ. A heart.

The address was in Dorchester, a rundown neighbourhood in southeast Boston. He parked across the street and eyed the boxy house, the weedy lawn. There was a kid of about twelve bouncing a basketball in the driveway, every so often flinging it at a hoop over the garage, and missing every time. No athletic scholarship for that one. Judging by the junker of a car parked in the garage, and the general shabbiness of the home, a scholarship would certainly come in handy.

He got out of his car and crossed the street. As he walked up the driveway, the boy suddenly fell still. Hugging the ball to his chest, he eyed the visitor with obvious suspicion. "I'm looking for the Flynt residence."

"Yeah," said the boy. "This is it."

"Are your parents at home?"

"My dad is. Why?"

"Maybe you could let him know he has a visitor."

"Who are you?"

He handed the boy his business card. The boy read it with only vague interest, then tried to hand it back. "No, keep it. Show it to your father."

"You mean right now?"

"If he's not busy."

"Yeah. OK."The boy went into the house, the screen door slapping shut behind him.

A moment later a man came to the door, big-bellied, unsmiling. "You looking for me?"

"Mr Flynt, my name is Stewart Sussman. I'm with the law firm of Hawkes, Craig, and Sussman."

"Yeah?"

"I understand you were a patient at Bayside Medical Centre six months ago."

'! was in an accident. Other guy's fault."

"You had your spleen removed. Is that correct?"

"How do you know all this?"

"I'm here in your best interests, Mr Flynt.You had major surgery, did you not?"

"They said I coulda died. I guess that makes it major."

"Was one of your doctors a woman resident named Abigail DiMatteo?"

"Yeah. She saw me every day. Real nice lady."

"Did she or any of the other doctors tell you the consequences of having your spleen removed?"

"They said I could have bad infections if I'm not careful."

"Fatal infections. Did they say that?"

"Uh… maybe."

"Did they mention anything about an accidental nick during surgery?"

"What?"

"A scalpel slipping, cutting the spleen. Causing a lot of bleeding."

"No." The man was leaning towards him now, with a look of intense worry. "Did something like that happen to me?"

"We'd like to confirm the facts. All we need is your consent to obtain your medical record."

"Why?"

"It would be in your interest, Mr Flynt, to know if the loss of your spleen was, in fact, due to surgical error. If a mistake was made, then you've suffered unnecessary damage. And you should be compensated."

Mr Flynt said nothing. He looked at the boy, who was listening to the conversation. Probably understanding none of it. Then he looked at the pen that was being offered to him.

"By compensation, Mr Flynt," said the attorney, "I was referring to money."

The man took the pen and signed his name.

Back in his car, Sussman slipped the signed records request form in his briefcase and reached once again for the list. There were four more names, four more signatures to obtain. He should have no problem. Greed and retribution were a powerful combination.

He crossed off the name Flynt, Harold, and started the car.