Side Effects

Tuesday 18 December

Soundlessly, Kate unlocked the heavy oak door and slipped out of her father-in-law's home into the gray glare of morning.

The deserted streets, sidewalks, and stone steps were covered with an immaculate dusting of white. Over the three days past, a blizzard had crushed the midwest and moved, unabated, into the midatlantic states.

Stepping gingerly down Beacon Hill toward Charles Street, Kate wondered if the feathery snow was, perhaps, the harbinger of that storm. She had slept far too little. Her eyes were dry and irritated, her temples constricted by the ache of exhaustion-an ache she had not experienced so acutely since her days as a medical student and intern. She thought about the surgicals scheduled to begin at ten o'clock and run through most of the rest of the day. With tensions thrusting at her life from one direction after another like the spears in some medieval torture, she debated asking one of the others to take over for her. No way, she decided quickly. As it was, the members of her department were stretched beyond their limits. Stan Willoughby's repeated requests for an additional pathologist had been laughed at. No, she was expected to do her part, and she would find whatever concentration it took to do it right. As she made her way toward the cab stand near White Memorial, Kate began her morning ritual of mentally ticking off the events and responsibilities of her day. The cab was halfway to Metro when she ended the ritual, as she inevitably did, by scrambling through her purse for her daily calendar, certain that she had forgotten something crucial.

Her schedule was abbreviated, due largely to a block of time marked simply "surgicals." Penciled in at the bottom was the one item she had forgotten, "Drinks with Tom." The three words triggered a surprising rush of feelings, beginning with the reflex notion to call and cancel, and ending with the sense of what her return home to an empty house would be like. Scattered in between were any number of images of the intense, gangly resident who had been her staunchest supporter during the difficult days that had followed the biopsy of Beverly Vitale. Tom Engleson was a man and a youth, enthusiastic at times even to exuberance, yet sensitive about people, about medicine, and especially about what her career involved and meant to her. The prospect of an hour or two together in the corner of some dark, leather and wood lounge might be just the carrot to get her through the day. "Dammit, Jared, " she muttered as the cab rolled to a stop in front of her hospital. "I need you."

She began her day as she had each of the last several working days, with a visit to Room 421 of the Berenson Building. Ellen was lying on her back, staring at the wall. Her breakfast was untouched on the formica stand by her bed. Suspended from a ceiling hook, a plastic bag drained saline into her arm. "Hi, " Kate said. "Hi, yourself." Ellen's eyes were shadowed. Her skin seemed lacking in color and turgor. Bruises, large and small, lined both arms. There was packing in one side of her nose.

Kate set the Cosmopolitan and morning Globe she had brought on the stand next to the breakfast tray. "Something new's been added, huh? " She nodded toward the IV. "Last night. A little while after you left."

Kate raised Ellen to a sitting position and then settled onto the bed by her knee. "They say why?"

"All they'll tell me is that it's a precautionary measure-"X "Have you had some new bleeding?"

"In my bowel movements, and I guess in my urine, too." She took a glass of orange juice from her tray and sipped at it absently that's probably why the IV, " Kate said. "In case they have to inject any X-ray dye or give you any blood." How much do you want to hear, El? Give me a sign.

Do you want to know about sudden massive hemorrhage? About circulatory collapse sudden and severe enough to make emergency insertion of an intravenous line extremely difficult? Do you want to know about Beverly Vitale. "Listen, Kate. As long as you're on top of what's going on, I'm satisfied."

"Good." Thank you, my friend. Thank you for making it a little easier.

"Sandy's back. He flew in late last night and then moved into the house to look after the girls."

Kate motioned to a vase of flowers by the window. "From him?"

"Uh-huh."

"So?"

Ellen shrugged. "No significance. He's still on his way out, I think."

"I hope not."

"Are you what?"

"On my way out."

"Jesus, Sandler, of course not."

Ellen took her hand. "Don't let me die, Katey, okay?"

"Count on it, " Kate said, having to work to keep from breaking down in front of her friend. Silently, she vowed to place her efforts on Ellen's behalf ahead of every other task, every other pressure in her life.

Somewhere, there was an answer, and somehow she would find it. "Listen, I've got to go and get ready for some biopsies. I'll check on your lab tests and speak with you later this afternoon. Okay?"

"Okay." The word was spiritless. "Anything I can bring you?"

"A cure?" Kate smiled weakly. "Coming right up, " she said. The flowers, in a metallic gray box with a red bow, were on her desk when Kate returned from the Berenson Building. First a huge bouquet for Ellen from Sandy and now flowers from Jared. The former Dartmouth roommates had come through in the clutch. "I knew you guys must have learned something at that school besides how to tap a keg, " she said, excitedly opening the box. They were long-stem roses, eleven red and one yellow-the red for love and the yellow for friendship, she had once been told. She scurried about her office, opening and closing doors and drawers until she found a heavy, green-glass vase. It was not until the roses were arranged to her satisfaction and set on the corner of her desk that she remembered the card taped to the box. It would say something at once both witty and tender. That was Jared's style-his way. "To a not so unexceptional pathologist, from a not so secret admirer. Tom."

Kate groaned and sank to her desk chair, feeling angry and a little foolish. Try as she might, she could not dispel the irrational reaction that Jared had somehow let her down. Call Tom. She wrote the reminder on a scrap of paper and taped it in a high-visibility spot on the shade of her desk lamp. Still, she knew from experience that even a location only inches from her eyes gave her at best only a fifty-fifty chance of remembering. Perhaps now was the time to call. It was almost nine. If Tom wasn't in the OR, a page would reach him. Things were beginning to get out of hand, and at this point, meeting Tom for a drink hardly seemed fair. Kate was reaching for the phone when it rang. "Hello. Kate Bennett, " she said. "Dr. Bennett, how do you do? My name is Arlen Paquette, Doctor Arlen Paquette, if you count a Phd in chemistry. I'm the director of product safety for Redding Pharmaceuticals. If this is an inopportune time for you, please tell me. If it is not, I would like to speak with you for a few minutes about the report Dr. William Zimmermann phoned in to us yesterday."

"I have a few minutes, " Kate said, retaping the Tom note to her lampshade. "Fine. Thank you. Dr. Bennett, I spent a fair amount of time taking information from Dr. Zimmermann. However, since you seem to have done most of the legwork, as it were, I had hoped you might go over exactly what it was that led you to the conclusion there was a problem with one of our Redding generics."

"I'd be happy to, Dr. Paquette."

It was obvious from the few questions Paquette asked during her three-minute summary that Zimmermann's account to him had been a complete one and, further, that the director of product safety had studied the data well. "So, " the caller said when she had finished, "as I see it, your initial suspicions of trouble at the Omnicenter were based on a coincidence of symptoms in three patients of the thousands treated there. Correct?"

"Not exactly, " Kate said, suddenly perturbed by the tone of the man's voice. "Please, " he said, "bear with me a moment longer. You then decided to focus your investigation on the pharmaceuticals provided for the Omnicenter by my company, and…"

"Dr. Paquette, I don't think it's at all fair to suggest that I jumped to the conclusion that the drugs were at fault. Even now I am not at all sure that is the case. However, of all the factors I checked-sterilization techniques, microbiology, and all others common to my three patients — the contaminated vitamins were the only finding out of the ordinary."

"Ah, yes, " Paquette said. "The vitamins. Several dozen samples analyzed, yet only one containing a painkiller. Correct?"

"Dr. Paquette, " Kate said somewhat angrily, "I have a busy schedule today, and I've told you about all there is to tell. You are sounding more and more like a lawyer and less and less like a man concerned with correcting a problem in his company's product. Now, I don't know whether Dr. Zimmermann told you or not, but I feel that the need to get to the bottom of all this is urgent, critical. A woman who happens to be a dear friend of mine is in the hospital right now, with her life quite possibly at stake, and for all I know, there may be others. I shall give you two more days to come up with a satisfactory explanation. If you don't have one, I am going to get the chemist from the state toxicology lab, and together we will march straight down to the FDA."

"By chemist, I assume you mean Mr. Ian Toole?"

"Yes, that's exactly who I mean."

"Well, Doctor, I'm a little confused. You see, I have in front of me a notarized letter, copies of which I have just put in the mail to you and Dr. Zimmermann. It is a letter from Mr. Ian Toole stating categorically that in none of his investigations on your behalf did he find any contamination in any product dispensed at the Omnicenter."

"What? " Kate's incredulity was almost instantly replaced by a numbing fear. "That's not true, " she said weakly. "Shall I read you the letter?"

"You bought him off."

"I beg your pardon."

"I gave you the courtesy of reporting this to your comapny instead of going to the FDA, and you bought off my chemist."

"Dr. Bennett, I would caution you against carelessly tossing accusations about, " Paquette said. "The statement in front of me is, as I have said, notarized."

"We'll see about that, " she said with little force. The vitamins she had sent to Toole were all she had. In a corner of her mind, she wondered if Arlen Paquette knew that. "I would like to confirm my company's sincere desire to correct any shortcomings in its products, and to thank you for allowing us to investigate the situation at your hospital." Paquette sounded as if he was reading the statement from a card. "You may think this is the end of things, Dr. Paquette, " Kate said, "but you don't know me. Please be prepared to hear from the FDA."

"We each must do what we must do, Doctor."

Kate had begun to seethe. "Furthermore, you had better hope that whatever you paid Ian Toole was enough, because that man is going to be made to visit a certain hospital bed to see first hand the woman he may be helping to kill." She slammed the receiver to its cradle. + Seated in his suite at the Ritz, Arlen Paquette hung up gently. He was shaking.

You don't know me. Paquette snorted at the irony of Kate Bennett's words, splashed some scotch over two ice cubes, drank it before it had begun to chill, and then set the glass down on the photographs of the woman he had just helped nail to a cross of incompetence, mental imbalance, and dishonesty. Cyrus Redding had decreed that she be discredited, and discredited she would be. Kate Bennett had only herself and a few shaky allies. Cyrus Redding had an unlimited supply of Norton Reeses, Winfield Samuelses, Ian Tooles, and, yes, Arlen Paquettes. He glanced down at the pad where he had written the words he had rehearsed and then used when talking to the woman, and he wondered if he could have come off so self-assured in a face-to-face confrontation. Doubtful, he acknowledged. Extremely doubtful. Their conversation had lasted just a few minutes, with all of the surprises coming from his end. Yet here he was, soaked with sweat and still trembling. He'd take a dozen in-person encounters with Norton Reese over the one phone call he had just finished. Water. That was it, he needed some water. No more goddamn scotch. He snatched his empty glass from the coffee table. Beneath it was one of the five-by-seven blowups of Kate Bennett, this one of her bundled in a sweatsuit, scarf, and watch cap, jogging with her dog along a snowbanked road. Paquette turned and unsteadily made his way to the bathroom. "You bastard, " he said to the thin, drawn face staring at him from the mirror. "You weak little fucking bastard."

He hurled the glass with all his strength, shattering it and the mirror.

Then he dropped to his knees amidst the shards and, clutching the ornate toilet, retched until he felt his insides were tearing in two. "Don't you see, Bill? Someone at Redding Pharmaceuticals, maybe this… this Paquette, bought off Ian Toole. Damn, I knew I was right not to trust them. I knew it. I knew it." Kate, still breathless from her run across the snowy street and up three flights of stairs, screamed at herself to calm down. William Zimmermann, as relaxed as Kate was intense, rose from behind his desk and crossed to the automatic coffee maker on a low table by his office door. His knee-length clinic coat was perfectly creased and spotless, his demeanor as immaculate as his dress. "How about a few deep breaths and a cup of coffee?"

"Coffee's about the last thing I need in my state, thanks, but I will try the deep breaths. Vacation. Can you believe it? One day the man is at his little spectrophotometer running tests, and the next he's off on vacation and nobody knows when he'll be back. Now if that isn't a payoff, I don't know what is. Next thing you know, Ian Toole's name will be on a lab door somewhere in Redding Pharmaceuticals."

"The deep breaths? " Zimmermann asked, returning to his desk. "Oh, yes.

I'm sorry, Bill. But you don't blame me, do you?"

"No, I don't blame you." He paused, obviously searching for words.

"Kate, " he said finally, "I want to be as tactful as possible in what I have to ask, and if I'm not, please excuse me, but…"

"Go on."

"Well, since you brought the subject up at our dinner the other night, I feel I must ask. Just how badly do you have it in for the pharmaceutical industry?"

The question startled her. Then she understood. "What you're saying is that without Ian Toole, it becomes a matter of my word against theirs.

Is that it?"

"If I'm out of line, Kate, I'm sorry. But remember, there is a lot at stake here-for me and my clinic, and as far as I know, this whole matter was between you and your Mr. Toole. I mean I called in the report because it was our facility, but the hard data are strictly…"

"Wait, " Kate interrupted excitedly. "There is someone else. I just remembered."

"Who?"

"Her name's Millicent. She's Toole's assistant, and I remember him telling me she was put out about having to work late on the stuff I sent him."

"Do you have a last name?"

"No, but how many Millicents can there be at the State Toxicology Lab?"

She was already reaching for the phone and her address book.

"You don't know me, Dr. Paquette, " she murmured as she dialed. "Oh, no, you don't know me at all."

The call lasted less than a minute. "Millicent Hall is no longer in the employ of the state lab, " Kate said as she hung up, her expression and tone an equal mix of embarrassment, dejection, and anger. "They wouldn't give out any further information."

This time it was Zimmermann who took a deep breath. "First the baseball player and now this, " he said. "You certainly aren't having a very easy time of it."

Kate's eyes narrowed. An emptiness began to build inside her. "You're having trouble believing me, aren't you?"

Zimmermann met her gaze and held it. "Kate, what I can say in all honesty is that at this moment I believe that you believe." He saw her about to protest, and held up his hands. "And at this moment," he added reassuringly, "that is enough. There is too much at stake for me to make any hasty moves. I shall await Redding's formal response to my report, meanwhile keeping our pharmacy on backup. No Redding generics until then. However, if there have been no further cases or further developments in, say, a week, I plan to reinstate our automated system."

"With Redding products?"

"We have a contract."

"But they…"

"Facts, Kate. We need substantiated facts."

Kate sighed and sank back in her seat, deflated. It was nearly ten and she had done nothing to prepare for the day's surgicals. "Have you started working on that list of patients who might be willing to allow me to have their medications analyzed?"

Zimmermann smiled patiently. "You can see how that might be a bit tricky to explain to a patient, can't you? " He handed her a brief list and five Omnicenter medication cards. "These belong to long-term patients of mine, who agreed to exchange them as part of what I said was a routine quality-control check."

"It is, " Kate said. "Thanks, Bill. I know this isn't easy for you and I'm grateful."

"I'll try and get you some more today."

"Thanks. You're being more than fair. I know I'm right, and sooner or later I'm going to prove it." She stood to go. "You know, " Zimmermann said, "even if you find there was a manufacturing error at Redding, you have no way of tying it in with the cases you are following."

The faces of three women-two dead and one her friend-flashed in her thoughts. "I know, " she said grimly. "But it's all I… it's all we have. Say, before I forget. Have you got the purchase invoices for the Redding generics that I asked you about?"

Zimmermann opened his file cabinet. "Carl Horner does the ordering. He gave me these and asked that I convey his desire to cooperate with you as fully as possible. He also asked that you return these as soon as you're done."

"Of course, " Kate said, glancing at the pile of yellow invoice carbons.

Redding Pharmaceuticals, Inc., Darlington, Kentucky. The words sputtered and sparked in her mind. Then they exploded. "Kate, are you all right? " Zimmermann asked. "Huh? Oh, yes, I'm fine. Bill, something very strange is going on here. I mean very strange." Zimmermann looked at her quizzically. "I don't know how long ago they moved, but at one time, the Ashburton Foundation was located in Darlington, Kentucky."

"How do you know?"

"I found their old address in my father-in-law's Rolodex."

"So?"

Kate held up an invoice for him to see. "Darlington. That's where Redding Pharmaceuticals is headquartered."

For the first time, William Zimmermann seemed perturbed. "I still don't see what point you're trying to make."

Kate heard the irritation in the man's voice and, recalling his oblique reference to the Bobby Geary letter, cautioned herself to tread gently.

Her supporters, even skeptical ones, were few and far between. "I… I guess I overreacted a little, " she said with a sheepishness she was not really feeling. "Ellen's being in the middle of all this has me grasping at straws, I guess." She glanced at her watch. "Look, I've got to get over to the OR. Thanks for these. If I come up with any facts," she corrected herself with a raised finger, "make that substantiated facts, I'll give you a call."

"Fine, " Zimmermann said. "Let me know if there's any further way I can help."

Kate hurried outside and across the street, mindless of the wind and snow. Ashburton and Redding-once both in Darlington, and now both at the Omnicenter. A coincidence? Not likely, she thought. No, not likely at all. The lobby clock read two minutes to ten as she sped toward the surgical suite and the small frozen-section lab. The room was dark.

Taped to the door was a carefully printed note.

OR CRYOSTAT INOPERATIVE. BRING BIOPSY SPECS TO PATH DEPARTMENT CRYOSTAT FOR PROCESSING

"Ten seconds to ignition. Nine. Eight. Seven. Six. Five. Four. Three. Two. One. Ignition." Tom Engleson struck the wooden match against the edge of an iron trivet and touched the brandy-soaked mound of French vanilla ice cream. "Voila! " he cried. "Bravo! " Kate cheered. Tom filled two shallow dishes and set Kate's in front of her with a flourish. The evening had been a low-key delight, drinks at the Hole in the Wall Pub, dinner at the Moon Villa, in Chinatown, and finally dessert in Tom's apartment, twenty stories above Boston Harbor. She had forgotten to break their date, and for once her poor memory had proven an asset.

Twenty minutes into their conversation at the Hole in the Wall, Kate had given up trying to sort out what she wanted from the evening and the man and had begun to relax and enjoy both. Still, she knew, thoughts of Jared were never far from the surface, nor were thoughts of Redding Pharmaceuticals and the Ashburton Foundation. "Okay, " Tom said as he poured two cups of coffee and settled into the chair next to her, "now that my brain is through crying for food and drink and such, it's ready to try again to understand. There is no Ashburton Foundation?"

"No, there's something called the Ashburton Foundation, but I'm not at all certain it's anything other than a laundry for money."

"Pharmaceutical company money."

"Right. I called the number I got from my father-in-law's Rolodex and got a receptionist of some sort. She referred every question, even what street they were located on in DC, to someone named Dr. Thompson, apparently the director of the so-called foundation."

"But Dr. Thompson was out of the office and never called you back."

"Exactly. I tried calling the receptionist again, and this time she said that Thompson was gone for the day and would contact me in the morning.

It was weird, I tell you, weird. The woman, supposedly working for this big foundation, didn't have the vaguest idea of how to handle my call."

"Did you ask Reese about all this?"

"He was gone for the day by the time I called, but tomorrow after I see Ellen, I intend to camp out on his doorstep."

"But why? What does Redding Pharmaceuticals get out of funneling all this money into our hospital?"

Kate shrugged. "That, Thomas, is the sixty-four dollar question.

At the moment, every shred of woman's intuition in my body is screaming that the tie-in has something to do with the contaminated vitamins our friend Dr. Paquette has gone to such lengths to cover up."

"Incredible."

"Incredible, maybe. Impossible? " She took a folded copy of an article from her purse and passed it over. "I came across this yesterday during one of my sessions in the library. It's part of a whole book about a drug called MER/29, originally developed and marketed by Merrell Pharmacouticals."

"That's a big company, " Tom said, flipping through the pages. "Not as big as Redding, but big enough. This MER/29 was supposed to lower cholesterol and thereby prevent heart disease. Only trouble was that other companies were racing to complete work on other products designed to do the same thing. The good folks at Merrell estimated a potential yearly profit in the billions at just one twenty cent capsule a day for each person over thirty-five. However, they also knew that the lion's share of that profit would go to the first company whose product could get cleared by the FDA and launched into the marketplace."

"I'm not going to want to hear the rest of this, am I, " Tom said.

"Not if you have much trust in the pharmaceutical industry. Remember, the FDA doesn't evaluate products, the pharmaceutical companies do. The FDA only evaluates the evaluations. In its haste to get MER/29 into the bodies of the pharmaceutical-buying public, Merrell cut corner after corner in their laboratory and clinical testing. But since none of the shortcuts was evident in the massive reports they submitted to the FDA, in 1961, MER/29 was approved by the FDA and launched by Merrell. Two years later, almost by accident, the FDA discovered what the company had done and ordered the drug removed. By that time, a large number of people had gone blind or developed hideous, irreversible skin conditions or lost all their hair."

Tom whistled. "Kids with no arms because their mothers took a sleeping pill called thalidomide. Kids with irreparably yellow teeth because tetracycline was rushed into the marketplace before all its side effects were known. The list goes on and on."

"You sound a little angry, " Tom said, taking her hand and guiding her to the couch across the room. "They paid off my chemist, Tom, " she said. "They've made me look like a fool, or worse, a liar. You're damn right I'm angry."

She sighed and leaned back, still holding his hand. "Forgive me for popping off like that, but I guess I needed to."

Tom slipped his free arm around her shoulders and drew her close.

Together they sat, watching fat, wind-whipped flakes of snow tumble about over the harbor and melt against the huge picture window. "Thank you, " she whispered. "Thank you for understanding."

Again and again they kissed. First her blouse, then her bra, then Tom's shirt dropped to the carpet, as he bore her gently down on the couch.

His lips, brushing across the hollow of her neck and over the rise of her breasts, felt wonderful. His hand, caressing the smooth inside of her thigh was warm and knowing and patient. She felt as excited, as frightened, as she had during her earliest teenage encounters. But even as she sensed her body respond to his hunger, even as her nipples grew hard against his darting tongue, she sensed her mind begin to pull back.

"Kate. Oh, Kate, " Tom whispered, the words vibrating gently against the skin of her breast. "Tom? " The word was a soft plea, almost a whimper.

"Hold me, Kate. Please don't stop."

She took his face in her hands. "Tom, " she said huskily. "I… just can't."

Her emotions swirling like the snow on the interstate, Kate took most of an hour and a half to make the drive from Boston to Essex. Tom had been hurt and frustrated by her sudden change in attitude, but in the end he had done his best to understand and accept. "I only hope Jared knows how goddamn lucky he is, " he had snapped as she was dressing. Later, he had insisted on driving her back to Metro and her car, where they had shared a quasi-platonic good-bye kiss. The phone was ringing as she opened the door from the garage to her house. Roscoe, who had spent most of the past two days at a sleepover with neighbors and their golden retriever, bounded down the hall, accepted a quick greeting, and then followed her to the den. It was Jared. "Hi, " he said. "I called the house at three A. M. and no one was home. Are you okay?"

"I'm fine, Jared. I spent the night at your father's. Didn't he tell you he had invited me?"

"No." There was no mistaking the curiosity in Jared's voice. "Did you get my letter?"

Kate thumbed through the pile of bills and throwaway journals she had carried in with her. Jared's letter was sandwiched between the magazines Aches and Pains and Pathologist on the Go. "I just brought it in, " she said. "If you want to wait, I'll read it right now."

"No need, Kate. I've got it memorized." Kate opened the letter and read along as he said the words. "It says I love you, I miss you, and I don't want to not live with you anymore. Jared."

Kate's heart was pounding so much she could barely respond. "I love you too, Jared. Very, very much. When are you coming home? "

"Day after tomorrow, unless you want me to hitch home now."

"Thursday's fine, honey. Just fine. I'll pick you up at the airport."

"Seven P. M. United."

"Perfect. I have a lot to tell you about. Maybe we'll take a ride in the country. There's someone you should visit."

"Who?"

"You'll see. Let me leave it at that until Thursday. Okay?"

"Okay, but…"

"I love you."

"I love you, Boots. Sometimes I don't know who the heck you are or where Jared Samuels is on your list of priorities, but I love you and I want to ride it all out with you as long as I can hang on."

"We'll do just fine, honey. Everything is going to be all right." As she hung up, Kate realized that for the first time in weeks she believed that.