The fifth vial

CHAPTER 21

Natalie, you're supposed to be starting back on your surgical rotation next week."

Dean Goldenberg held up the stack of paperwork that had been generated in order to get her back on track at school.

"I know."

"And you say that physically you think you can handle such a trip?"

"From the moment I finished making all those calls to Brazil, I've been spending three hours a day or more in rehab. My pulmonary function studies have improved nearly twenty-five percent since the first time they were measured after the fire. I'm even able to jog."

"But now you want to take more time off."

"I feel that I have to."

Goldenberg's office looked the same as when Natalie had been suspended from school, except that everything had changed. The people there this time, in addition to Natalie and the dean, were Doug Berenger and Terry Millwood. Veronica had offered to come along for moral support, but Natalie saw no reason for her to take time from her obstetrics rotation.

After her initial flurry of calls to various departments at Santa Teresa Hospital, Natalie had spoken to several police stations around the city of Rio. To the best that she could tell, there was a law requiring hospitals to report all gunshot wounds, and no such report had been filed on her, nor did the police themselves have a record of responding to her being shot.

First thing the next morning, she had brought her mother over for another try. The results were all the same, with one additional failure — the failure to find any Dr. Xavier Santoro on the staff of Santa Teresa's or, in fact, in the entire city. Within an hour of her mother's last call — this one to the Rio de Janeiro State Medical Board, where there was no record of any Dr. Xavier Santoro — Natalie was at the gym, dragging herself through a series of aerobic and anaerobic exercises. The next morning she called her pulmonary therapist with an apology and a request for more time — much more time.

"Terry, you have a note from Natalie's pulmonologist'" Goldenberg asked.

"I do. Rachel French dropped it off with me because she couldn't make it this morning."

Millwood passed the sheet over, and the dean scanned it, nodding that the conclusions were clear.

"Natalie, you are behind on your schedule if you wish to graduate with your class," he said. "And you, yourself, said that this whole business in Brazil is probably a misunderstanding due to language barriers and the difficulty in negotiating through a hospital system that is half a world away."

"If I get there and discover that the hospital and the police do have records of me, I'll be home on the next available flight. I won't even try and find out who and where Dr. Santoro is."

"Doug, you spoke with this Dr. Santoro?"

"Once," Berenger replied. "According to Nat, the man said he knew who I was, although I had never heard of him. Mostly I spoke with a surgical nurse, whose name I just don't remember."

Goldenberg looked nonplussed.

"Natalie," he said, "as you know, with your permission, I spoke to Dr. Fierstein, your therapist. She does not think it is in your best interest for you to go. Apparently you have been having some sort of serious flashbacks surrounding the evening you were shot."

"I started having them when I was still in the hospital in Rio. Dr. Fierstein is calling them a manifestation of PTSD."

"I know. She is worried that your return to the scene of your trauma might have disastrous consequences."

"Dr. Goldenberg," Natalie said, "Terry knows about what I am going to tell you, but aside from him, no one else does, not even my therapist. At the time of the call from my health insurance company, I was seriously contemplating killing myself. I felt my situation was hopeless and that I would live my life either crippled from my pulmonary condition, or debilitated from the anti-rejection drugs necessary for a transplant. I'm still frightened of both of those possibilities, but from the moment I finished with the first round of calls to Brazil, I have been consumed with the need to find answers to the questions of why there is no record of the crime that changed my life so radically. If I have to give up my scholarship and a year of medical school, then that's what I'm going to do."

The three physicians exchanged looks.

"Okay then," Goldenberg said finally, "here is the best I can do. I'll give you two weeks and take it off one of your electives. Half of the students don't do any work on their electives anyway. OB in San Francisco, dermatology in London. You all think we don't know, but the truth is that when we were students we all did the same thing."

The three others smiled.

"So Nat," Millwood asked, "when are you going?"

"As soon as I can get a ticket."

"Sam, thank you," Berenger said, standing and shaking the dean's hand. "For what it's worth, I think you're doing the right and fair thing."

He guided Natalie out of the office into the reception area, and then waited until Millwood had gone before extracting an envelope from his jacket pocket.

"Nat, the moment you told me what was going on, I knew you were headed back to Brazil. I knew because I know you. Since I sent you there in the first place, I thought that helping you get back to Rio to straighten matters out would be the least I can do."

"Tickets!" Natalie exclaimed without even opening the envelope.

"First-class tickets," Berenger corrected.

Natalie hugged him unabashedly as Goldenberg's secretary looked on, amused.

"When are they for?" Natalie asked, fumbling open the envelope.

"When do you think? Remember, I have no more patience than you do. Besides, as I'm sure you recall, my wife owns a travel agency."

Natalie took a minute to find the departure date on the ticket.

"Tomorrow!"

"Now it's your turn," Berenger said. "I hope this circle gets closed quickly."

Me, too.

"And I hope one other thing as well."

"What's that?"

"I hope you take a bus into the city instead of a cab."

The physician known among the Guardians as Laertes paced across the study of his seacoast estate, overlooking the mouth of the Thames. He was a professor of surgery at St. George's in London, and a world-renowned lecturer on his specialty, cardiac transplantation. He was also one of the original members of the Guardians. For the past six months he had been serving his rotation as the PK, the Philosopher King of the society — providing day-to-day leadership and, in rare instances, the final word on any controversial decisions.

"Glaucon, tell us again," he said, addressing the speakerphone on his Louis Quatorze desk.

"The patient is W, number eighty-one on your list," replied Glaucon, a brilliant young renal transplant urologist from Sydney. "As you can see, he is an industrialist, and one of the most economically and politically powerful men in Australia — fifty-eight years old, and conservatively worth four billion dollars, a significant portion of which he is ready to transfer to us in exchange for our services. His cardiac situation has gone from stable to critical, and he will die within the next few weeks without a transplant."

"It says here that he is a heavy smoker."

"Yes, but he has promised he will stop."

"But there is a problem."

"Yes. His antibody pattern is quite unusual."

"The best our database has been able to do?"

"An eight out of twelve, which would require him to be treated aggressively with immunosuppressive drugs, and would, of course, greatly increase the possibility of organ rejection."

"However," Laertes said, "we have located a perfect twelve-point match for him in the state of Mississippi."

"So what's the problem?" Thermistocles asked.

"The donor is eleven years old."

"I see. Weight?"

"That's the good part. He's chunky. Our man estimates he weighs one hundred and twenty pounds. That's fifty-four kilos."

"And the recipient?"

"One hundred seventy pounds. Seventy-seven kilos."

"That's a thirty percent difference. Is that going to work?"

"Twenty percent difference or less would be ideal, but W has an excellent cardiologist. With enforced rest and medication, the transplant might serve for a while, giving us time to search for something more compatible."

"How long?"

"Maybe a month, maybe less, maybe somewhat longer."

"Profile of the donor?"

"Nothing significant. One of four children. Father drinks too much, mother works in a clothes cleaners."

"Our facility in New Guinea is ready, and I am willing to make the flight as soon as the donor has been procured and transferred there."

"So, I ask you again," Themistocles said, "what's the problem?"