The Society

CHAPTER 19

It was just after eleven when Will entered the busy lobby of Fredrickston General Hospital. From what he could recall, not even his first visit back home after the separation from Maxine felt this strange. Less than two weeks ago he had entered the hospital as a widely respected surgeon prepared to perform a difficult case. By that day’s end, he had been vilified as a narcotic addict, signed himself out of the intensive-care unit against medical advice, and gone home with a warning from the hospital president not to return to the place until the allegations against him had been resolved. Now, here he was back at FGH again but, like the Monopoly square, just visiting.

Balanced against the uneasy tension of his return to the hospital were the feelings and sensations lingering from the night just past. He and Patty had made exquisite love, then slept and loved again, and finally dozed off until almost dawn. She was at once caring and patient, sensual and passionate. She was witty and quick, gentle and edgy, absolutely cynical yet surprisingly naive and vulnerable. And physically she was as pleasing, comfortable, and imaginative as he would ever need a woman to be.

Although Mark Davis was the one who had picked eleven as the time to meet at the ICU, Will knew the hour was about as good for him as it could be. Morning rounds were over for most of the docs, and many of those who weren’t in the OR were back in their offices. In addition to his partners, he certainly had friends on the staff whom he wouldn’t mind running into, but the majority he would be just as happy avoiding. Even with the favorable hour, his return to the corridors of FGH wasn’t pleasant. By the time he reached the unit, he had passed four physicians and three nurses. Although prior to the incident, he was cordial enough with all of them, none greeted him with any warmth or tried to extend their brief encounter into a conversation, and one of the docs pointedly ignored him. Will wasn’t surprised.

Over the years, beginning with a truncated med-school course on alcoholism and other addictions, he had been to half a dozen or more AA meetings. From the patterns of the stories shared at the meetings and the scientific studies discussed in the courses, he had no doubt that alcoholism, like addiction to other drugs, was a medical illness-a psychological, genetic, and biochemical disease, as opposed to the moral issue so many made it out to be. Unfortunately, many other caregivers did not share that opinion. Doctors and nurses caught in the nightmare of drug and alcohol dependence too often found themselves deprived in their colleagues’ minds of the right to be ill and the chance to recover, simply because they were health-care professionals and should have known better. The pervasive prejudice made Will terribly sad even before he himself became a victim of it.

Mark Davis, wearing a gray turtleneck and tweed sport coat, was waiting just outside the door to the unit. He was an angular, intense man, who sounded over the phone this morning as if he were still reserving judgment as to whether Will had or had not gone into the operating room stoned on narcotics.

“They just brought her back from getting an X-ray and they’re washing her up right now,” he said. “The nurse said it would be twenty minutes.”

“Fine. Do you know who her nurse is?”

“Anne something.”

“Hajjar. She’s excellent, one of the very best.”

“That’s good to know. Visiting Grace like this is very kind of you. We don’t have much family, and her mother is too frail to make the trip up from New York.”

“Nonsense. We do go back quite a ways. What she went through yesterday must have been absolutely terrifying. I’m anxious to see her and also to translate medicalspeak if you need me to. Mark, listen, there are a couple of things I’d like to do around the hospital while I have the chance. Why don’t I meet you back here in twenty minutes?”

“Is this connected in any way with what you are going through?”

Will studied the teacher’s expression and saw only concern. “As a matter of fact, it is, yes. I’m going to retrace some of my steps from that morning, to see if I can figure out who could have done this to me-and how.”

“I hope you find whatever it is you’re searching for,” Mark said. “You mean a great deal to Grace, and so you also mean a great deal to me.”

Will headed off, pausing for a moment to glance back at the fine man whom once filthy, intoxicated, angry Grace Peng would one day meet, beguile, and marry.

You never know, he thought, as much regarding his current plight as the one Grace had dealt with by finally letting go of her fears and immersing herself in recovery. You stay in the game when the going’s tough because you never know how it’s going to come out.

In the hopes that something, anything, would connect, Will headed back to the on-call room to re-create physically and in his mind the few hours between falling asleep that morning and stepping into the operating room. The idea of doing this had been his new attorney’s.

“We’ve got to start somewhere,” Micelli had said when Will called and agreed to pay a modest retainer to seal their relationship, “and I suggest the beginning. For the time being, I can handle the cops and the courts, but sooner or later, preferably sooner, we’ve got to come up with some answers. Before you tell me anything more, retrace your steps and cement every movement of that morning in your mind. We’ll talk later in the day.”

Ignoring the whispers and the stares, Will went to the surgical on-call room and unlocked the door using the keypad. It had been just after two when he went there for the first time that early morning. He then slept uninterrupted until the wake-up call he had put in for at five-fifteen. Could he have been called out of the room for something and simply not remembered? Impossible. Could he somehow have been drugged earlier in the night and then injected with fentanyl while he slept? Not impossible, but far out, and the powerful narcotic, rapidly absorbed, would have had to be in a time-release form-a mode of delivery that existed only in a skin patch. Being both superstitious and a creature of habit, it was not difficult to retrace his movements and actions from that morning.

When he reached the staff lounge in the ER, two of the nurses actually went out of their way to come in and ask how he was doing-bright spots in an otherwise gray homecoming. He fought back the urge to plug in the “I didn’t willingly take any drugs” tape and simply thanked them for being nonjudgmental. One of the women, a mother of two in her early thirties named Bobbi Hamill, checked the calendar and confirmed that the day he was drugged was her day to bring in the customary dozen doughnuts. Will and she had been quite friendly over the years, and there was no way he could imagine her purposely trying to ruin him. But then again, there was no way he could imagine anyone purposely trying to ruin him. The coffee they drank every morning in the ER was from a pot prepared in the room and replenished by whoever finished off the dregs. Neither of the nurses could remember someone pouring a cup for Will.

The OJ they drank came in individual cartons. Will wondered to himself whether someone might have injected one of those cartons with fentanyl, then set it aside until it was the right moment to hand it to him. The possibility didn’t seem that ridiculous, but he had no recollection at all of who had passed the carton over to him. Finally, he used Bobbi’s memory and the staffing chart from that day to make a list of all those who were or might have been in the room. The only person who stood out at all was Gordo.

Gordo.

As Will retraced the path he would have taken from the ER to the surgeons’ lounge, he wondered about the man who had been his partner and friend for so many years. He wouldn’t be the first to work closely with someone and even see him socially but not really know him. Everyone had a dark side. He tried to dismiss the possibility that Gordo was the one, but couldn’t. Somebody had done this to him. That much was certain.

The lounge was deserted. Will opened his locker using a key. Empty. No surprise there. His stuff-soap, shampoo, deodorant, watch, journals, change of socks and underwear-was undoubtedly packed in an evidence box at the Fredrickston police station. Mentally, he retraced the steps he would have followed when dressing for the OR. Nothing unusual. The hair covers, shoe covers, and paper masks were all in boxes by the door to the scrub room. Gordo was already in the OR when Will was dressing. Could he have tampered with a paper mask or hair cover knowing that Will was likely to be the next person to take one? Again, far out but remotely possible.

With several scenarios playing in his brain, each one of them seriously flawed, Will headed back to the ICU. Anne Hajjar, the nurse he had felt closest to over the years, was standing just inside the glass doors.

“Welcome back,” she said. “We’ve been worried about you.”

Another kindness. Will’s battered faith began, ever so slowly, to return.

“It’s been hell,” he said, “but I’m still out there turning over stones to find out how this could have happened to me.”

“You just make sure you’re okay as far as drugs go,” she said, her almond eyes fixed on him, “because if you’re not, if you’re fooling yourself, nothing will be okay.”

“I appreciate that,” Will said, and he did. “Grace Davis’s husband around?”

“He’s in with her.”

“She okay?”

“She’s alive. Given what she went through, that’s okay. The kid who did the trach had never done one before.”

“What a brave thing to do.”

“You said it. He had a horrible decision to make and went with what he believed. We’ve done everything we can to make sure Grace and her husband understand that. Unfortunately, while he definitely saved her life, the guy made a bit of a mess of things. The ENT people are going to have to repair the damage to her trachea. But before they can do that, she’s aspirated some blood and now has a bit of a pneumonia.”

“Just make sure she gets you taking care of her until she’s out of here.”

“That’s very kind. No problem. I’ll stay close to her. Speaking of getting out of here, it looks as if your patient Kurt Goshtigian is going to make it.”

“You know what?” Will said. “I’ve been so wrapped up in my own deal that I completely forgot to check on him. Of course, that may also have something to do with the fact that he and his family are suing me for like a gazillion dollars.”

“Maybe they’ll back off once he’s home. He really has had a tough go of it. I lost the pool when he made it through last Sunday. His family’s in there with him now, so you may want to steer clear of room one.”

“Thanks for the warning.”

“I think you’ll remember the room Grace is in,” Anne said with a wry grin. “It was yours.”

Will paused at the doorway to Grace’s cubicle and tried to imagine what he looked like when he was transferred there from the ER on a vent. Grace looked surprisingly good. She was pale and extremely weak, but awake and alert, communicating with her husband by hand signals, some carefully mouthed words, and the clipboard and blank progress notepaper Will knew only too well. She had oxygen running into her lungs through the tracheotomy that had saved her life. On the wall to the right side of the room, her latest chest X-rays were displayed on an illuminated view box-two views, one shot from her back through her front and one taken from side to side. At a brief glance, Will could easily make out the fluffy white density in her left lung that represented the pneumonia he had been told about.

“Greetings,” he said.

Grace managed a weak smile and a wave. In addition to her pallor, her respirations were slightly rapid and shallower than normal. So long as her condition remained like this, the ICU was exactly the place she should be.

You OK? she wrote.

“Define okay. I feel as though I’ve been hit by an invisible bus. I’m trying to fight back at whoever nearly killed me, but nobody seems to notice. How about you?”

Grace made a so-so sign.

“She seems a little more worn out than she was earlier this morning,” her husband observed. “Maybe they shouldn’t have taken her down to radiology for those X-rays.”

“We wheel patients down there if we can because they’re better quality than the films done by the portable machine,” Will replied. “Here’s one of the reasons she’s not feeling better, this white stuff right back here. A pneumonia.”

He pointed to the area on himself. At that moment, another finding in the films caught his eye. There was a small density inside the wall of Grace’s right chest, just below her third rib, perfectly round and much whiter even than the bone, which suggested that the object was metallic. The lateral view confirmed the object’s presence and located it toward the front and fairly deep. Almost certainly, it was a BB.

“Look at this,” he said.

Grace smiled.

BB, she wrote. Brother shot me.

“How old were you?”

12.

“On purpose?”

Who knows?

“I never even knew about this,” Mark said. “My wife, shot. What a mysterious, exotic woman you are, Grace. Having met the man, though, I don’t have to stretch my imagination too far to see him doing it and it not be an accident.”

Grace waved him off, but her expression suggested she agreed.

“Did your parents take you to a doctor?” Will asked.

Grace nodded.

“I imagine he said trying to get it out was more trouble than it was worth, and that it would either work itself out or stay there for the rest of your life.”

Another nod.

“Obviously, he was right, because there it is.”

There it is, she wrote.

“And there it will stay.”

Keep your spirits up.

“I appreciate that. Listen, don’t worry about me. Somehow I’ll come out of this okay. And don’t worry about what’s going to happen with your chemo.”

I know.

“There are alternatives. Right now you should just concern yourself with getting better. Well, I think I should leave you to rest.”

Thanx.

“I’m just grateful you made it. What a thing to go through.”

You, too.

Will smiled, kissed her on the cheek, shook Mark’s hand, and turned toward the door.

“Dr. Grant?” Mark said.

Will turned back. Mark had moved closer to the X-ray view boxes and was peering at Grace’s films.

“Yes?”

“If this BB is here on her chest films, then wouldn’t you expect it to be on her mammograms, as well?”

“Some of the views, yes, of course.”

“Well, it wasn’t there.”

“Pardon?”

“It wasn’t there.”

“Are you sure?”

“As you can probably tell, Dr. Grant, I am a very meticulous man-not obnoxious about it, I hope, but I am a stickler for details. There was no BB on Grace’s breast films-not any of them. Did you see it there, hon?”

She shook her head tentatively.

Never thought about it, she wrote.

Will tried to remember the distinctive density in Grace Davis’s mammograms, but he couldn’t. It would only have been on a couple of the views-perhaps two or three out of ten-but from what he could tell, it definitely should have been on some. He did sense that, just as with these films, had there been a BB on the mammograms he would not only have noticed but commented on it. Instantly, a meteor shower of questions flashed across his mind. Could the camera angles of the mammograms possibly have cut out the BB? Possible but not likely. Could he, Grace, and Mark Davis all have missed the BB in the other set of films? Again, possible but not likely. Did he ever read the radiologist’s dictated report? Doubtful. There wasn’t any question about the cancer that was there, so what the radiologist had to say really didn’t matter to him. Could Grace’s mammograms have been accidentally switched with another woman’s? Ugh. The possibility was sickening but not really feasible, because the cancer in the X-ray had been biopsied and confirmed by a pathologist.

Nevertheless, it appeared quite possible that some sort of mix-up had occurred.

Over two decades of working in hospitals, Will had encountered almost every imaginable permutation of error. Working under enormous time pressures, with massive volumes of patients and procedures, handicapped by human frailties, imperfections, miscommunications, and personality disorders, to say nothing of fatigue, mechanical failure, and the vagaries of biology, caregivers made mistakes. Many of those mistakes passed by totally unnoticed or caused no inconvenience of any great magnitude. Some of them altered lives, and some either devastated lives or, sadly, ended them.

Will knew he had enough problems of his own to work out without trying to track down the source of this odd conflict. Still, he also knew there was no way he wouldn’t do it.

“Guys, listen,” he said, “I don’t have a good explanation for this, but I’m sure there is one-at least I think there is one. I’ll check with someone in radiology here, and then I’ll speak to the person at the cancer center who did those mammograms.”

It was only then that he recalled his unpleasant encounter over the phone with radiologist Charles Newcomber. That time he had gone over Newcomber’s head and prevailed, but it would be a pleasure to put the pompous prig on the hot seat once again.

“Please keep us posted,” Mark said.

“Oh, don’t worry,” Will replied, knowing that this time the encounter with Newcomber would occur in person, and that this time he would have the hospital X-rays tucked under his arm. “I will.”

Alone in his office, Augie Micelli sipped on a brandy, stared across the room at a spider plying its trade in the corner, and scratched boxes around words on a yellow legal pad-his way since college of working through problems. From the portable CD player on the floor by his desk, Gene Ammons’s soulful tenor sax was playing “Willow Weep for Me.” A drug addict, Ammons was known as Jug, perhaps for the way he drank, Micelli thought fondly, or maybe for the stretches he did in the jug before, at forty-nine, he died.

Although Micelli had been there at his desk for several hours with a drink close at hand, he was still far more sober than not. There was significant work to do, so he had been treading the delicate line between maintaining a clear head and keeping the shakes in check. It was a case that, when all was said and done, might not even pay the electric bill. But if Will Grant was telling the truth, if he had been framed and was now being purged from medicine much as Micelli, himself, had been, taking the case had been the right thing to do. Now the trick was seeing to it that Grant never made it anywhere near a courtroom, and that meant figuring out how he could have been railroaded so smoothly.

Spread out across the desk and on the floor around him were articles, xeroxed book pages, and printouts from the Internet, all dealing with the narcotic fentanyl. Usual dose; onset of action; route of administration; duration of action; pharmacologic effects; side effects; symptoms of overdose; chemical formula; metabolites. Gene Ammons had moved on to “I Remember You,” Micelli’s favorite on the album, which was to say the one that made him feel most blue.

“Not good,” he muttered as he considered the case, “not good at all.”

The only explanation that fit all the facts was that Will Grant was both an addict and a liar. Micelli bounced the eraser of his pencil on an article dealing with the pharmacokinetics of sufentanil, ten times more powerful than fentanyl, eight hundred times more powerful than morphine, and of carfentanil, which was nearly fifteen times more powerful even than that. He found himself thinking about a statement from one of his law-school professors, and wrote it in block letters at the bottom of the yellow sheet.

IF YOUR BELIEFS DON’T FIT WITH THE FACTS, THEN JUST POUND THE HELL OUT OF THE FACTS UNTIL THEY DO.

He snatched up the phone and dialed. Will Grant answered on the first ring.

“Okay, Doctor,” Micelli said, making a series of boxes around the words, “take me through that day again.”