The Society Page 13

  How about the catheter?

  “First the tube. Sorry. You want the nurses to give you something?”

  Just a little, Will wrote this time.

  “Five of morphine, Donna. Repeat it as needed.”

  Thanks.

  “Just bear with us, my friend,” Millstein said. “We’re going to get to the bottom of this.”

  With the help of the intravenous morphine, Will drifted in and out of a comfortable haze. At times he dreamed—a high-speed auto chase, a green-faced judge sentencing him to prison for something, swimming in perfectly blue Caribbean water alongside a woman who looked vaguely like Patty Moriarity. At one point, in the middle of a disturbing vignette in which his hands were about to be chopped off by someone, he awoke to see Gordo Cameron looming over him.

  “Greetings, lad,” he said. “You sure gave me and the gang in the OR one hell of a fright there. I’m glad you’re coming around.”

  How’d you do with the case?

  “He should make it through the next few hours, but that’s all I can say at the moment. Jim came to the rescue and assisted. We had to repair a couple of torn vessels, then we went ahead and did the Whipple. He lost a fair amount of blood and dropped his pressure a couple of times.”

  Did I tear the vessels?

  “Your head hit the incision like a bloody meteor. Some vessels were bound to rupture. But, really, it was manageable. Once we got the bleeding controlled, we irrigated everything like crazy. There’s bound to be infection, but that’s what we have antibiotics and infectious-disease specialists for. Plus you just don’t look like someone with a lot of devil germs on his face. What on earth do you think happened?”

  No idea.

  “Well, don’t use up your energy writing. We can talk after that tube comes out. Who’s takin’ care of you?”

  Millstein.

  “Good man, Millstein. A little scrawny by my standards, but sharp. Well, lad, I’m going to head on over to the recovery room to check on our boy.”

  Thanks, Gordo.

  “Just don’t ever do that again. My poor knickers had to be permanently retired.”

  Donna Lee appeared and pulled Cameron aside, beyond Will’s field of vision.

  “I don’t believe it!” Will heard Cameron say. “I don’t—”

  Will envisioned the nurse stopping Cameron short with a finger to her lips. He banged on the bed rail to get her attention.

  What’s up?

  “Nothing.” Donna’s tone was icy. “Dr. Millstein will be up to speak with you.”

  Tube very uncomfortable . . . could I have a little medication until he arrives?

  “He’ll be here before long. Just close your eyes and relax until he gets here. And don’t touch that tube.”

  The woman was gone before Will could write anything further. What could she have said that Gordo didn’t believe? Why was she refusing even a small amount of medication to help him deal with the tube? Why the sudden coldness? He shifted his position in bed and tried as best he could to ignore the discomfort in his throat and bladder.

  For a time he lay there, trying to divert himself with thoughts of Kurt Goshtigian. He had a decent enough patient–physician relationship with the man, but their history was not a long one. Even if Goshtigian fully recovered from his Whipple procedure, a lawyer could certainly make a good case for Will having caused the need for additional surgery and powerful, potentially life-threatening antibiotics, as well as prolonged time under anesthesia. Still, no judge or jury could find him negligent when clearly some medical problem beyond his control or knowledge had caused the incident in the OR. Will took pride in the fact that despite a high-risk specialty, he had never yet been sued, but he hardly took the fact for granted. As a surgeon, the specter of a malpractice action was always hovering not far away.

  Even without medication, Will began to drift off. Images of the OR floated about for a time, then gave way to a comforting darkness. Everything was going to be okay, he told himself. The diagnostic tests he would undergo over the days and weeks ahead would show no brain tumor, no vascular anomaly within his skull, no hemorrhage, and no irregular cardiac rhythm. The incident would be written off as a simple faint, caused by a virus, fatigue, dehydration, or factors never to be determined. Such a faint was known technically as vasovagal syncope, the sort of physiologic reaction that commonly accompanied stresses such as horrible news or a grisly sight. In such instances a sudden, powerful discharge of electricity along the large vagus nerve caused rapid dilation of the veins in the abdomen and legs and marked pooling of blood in those vessels. The resultant drop in blood pressure produced an instantaneous loss of consciousness. Fainting was the brain’s effort to protect its critical circulation by “insisting” that the body lie down.

  Vasovagal syncope, Will thought, as sleep enfolded him. Yes, that’s it. That’s what they’re going to conclude.

  “Will?”

  Ken Millstein stood by Will’s left hand. Standing beside Millstein, Anne Hajjar looked down at Will with the stony impassivity of a sphinx. On the right side of the bed was anesthesiologist Ramon Bustamante, also looking grim.

  Will opened his eyes and managed a weak thumbs-up, to which neither the nurse nor the physicians reacted.

  Something’s wrong, he thought. Something’s . . .

  “Will, Dr. Bustamante’s here to remove the tube; after that we’ll talk.”

  The Philippine anesthesiologist moved forward and used a syringe to deflate the balloon cuff that held the tube in place below Will’s vocal cords. The inflated cuff also prevented him from aspirating his stomach contents into his lungs.

  “Mrs. Hajjar, you have the backup tube ready?” Bustamante asked.

  “Right here.”

  “You tested the balloon?”

  “Yes.”

  “Suction?”

  “Ready.”

  “Okay, then, Doctor,” the anesthesiologist ordered unemotionally. “Cough when I say so . . . and . . . now!”

  Will coughed feebly and the redwood tree instantly vanished from his throat. He sputtered and gagged as the nurse suctioned his mouth and throat with a hard plastic tube. Then, eyes tearing, he sagged back against the pillow, sucking in drafts of sweet air. Bustamante listened to his chest, assured himself that neither lung had collapsed, then turned and left without a word. Anne Hajjar slipped oxygen prongs into Will’s nostrils, did a blood-pressure check, nodded to Millstein that it was satisfactory, and quickly followed the anesthesiologist out of the cubicle.

  For fifteen seconds, Millstein just stood there looking down at Will.

  “Feel able to talk?” he asked.

  Will cleared his throat as forcefully as he could manage.

  “Sure,” he rasped, nearly overcome now by apprehension.

  “Okay. I’ve gotten most of the lab work back, including a comprehensive panel I requested for drugs of abuse.”

  “That would be negative.”

  “Well, you can say so, Will, but it wasn’t.”

  Will felt his heart sink.

  “That’s impossible.”

  “You lit up for fentanyl, Will. Big time.”

  Fentanyl—one of the most powerful of all narcotics. It was used as a painkiller via a time-release patch and in an IV to put patients to sleep in the OR before they were intubated. It was highly addictive and too often an instrument of death in those anesthesiologists who chose to experiment with it by sequentially pushing up the dose they injected into themselves.

  “I tell you, that’s impossible. I’ve never taken any painkillers stronger than Tylenol.”

  “Two different samples,” Millstein said. “Fentanyl confirmed in both of them by emergency gas chromatography and mass spectrophotometry. Large amounts were in your blood when you passed out, Will. There is absolutely no doubt in anyone’s mind about that.”

  Will found the bed control and raised himself upright.

  “This is absolutely insane! I didn’t take anything.”

&n
bsp; “I don’t see how that can be true,” Millstein said evenly. “I can try and help you, Will, but only if you tell the truth.”

  The chilliness of the nurses and the anesthesiologist was certainly explained. Fear and anger tightened the muscles at the base of Will’s skull. A jet of bile rose in his throat.

  “You’ve known me for years, Ken. You’ve got to believe me.”

  Millstein shook his head slowly.

  “I don’t know what to make of this, Will. I’ve learned to repeat abnormal tests that don’t fit, and that’s just what I did here. But if I don’t trust our lab when a test is repeated with the same results, I might as well pack up and find another profession.”

  “It wasn’t my blood,” Will said desperately.

  Again Millstein shook his head. Will could see now the deep sadness in his eyes.

  “We ran a urine, too. Straight from your catheter. Chain-of-custody handling. No breaks in the chain. It was positive, too. Strongly positive, I might add, and you know how rapidly fentanyl is cleared from the body. Will, with all that’s involved, this is way beyond me. I’ve reported everything to Sid Silverman, and he’s called the police. They’ll be here shortly if they’re not here already.”

  “Jesus,” Will said. Silverman, the president of the hospital, was in bed with several managed-care companies and had been openly critical of the Hippocrates Society and Will in particular. “I’m in no shape to deal with fucking Silverman or the police. Let me out of here, dammit! I’ll sign out AMA! Bring me the form.”

  He leaned forward, then just as quickly fell back as a spear of pain thrust itself through one eye and out the back of his skull.

  “Easy, Will.”

  “No! I’m out of here!”

  Mindless of the IV lines and catheter, Will battled through the headache, grabbed the side rails, and pulled himself forward again, scrambling toward the foot of the bed.

  “Hands!” Millstein cried out, restraining him with surprising strength.

  In seconds, the room was full of uniformed bodies, each trying to hold him down. A hand clutching a filled syringe moved into Will’s sight. Helplessly, he watched as the needle was slipped into a port of his IV and the syringe emptied.

  Moments later, a gentle, pleasant wave washed over him and he sank back into a dark, welcoming sea.

  CHAPTER 13

  “You’ve got to be kidding, Sergeant.”

  Benois Beane, seated in a well-worn leather easy chair in his office, stared across at Patty, shaking his head in utter disbelief.

  “It’s the truth. His body was loaded with a very powerful narcotic—one that doctors, but not most other people, would have easy access to.”

  From the moment they first shook hands, Patty liked the Open Hearth director. There was an engaging openness to him and an appealing wisdom in his face that she guessed was born of hard times. She had phoned him and driven over to the soup kitchen after a stop in the ICU at Fredrickston General.

  Shortly after she had been raked over the coals by Wayne Brasco and Jack Court for withholding the information about Will Grant from them, a call from her father alerted her to the latest bizarre twist in the managed-care case—the drug overdose of their only suspect. Sitting in on the tense meeting with Court and Brasco had been Sean Digby, a young, eager detective who had come on board about six months after Patty and been immediately accepted by the guys. This was the first time Digby had attended one of their skull sessions on this case, and Patty had no trouble figuring out why. He was clearly being groomed to take her place should she falter any more, and calling him in like this was a strident warning that she was skating on thin ice.

  Unwilling to make any moves without clearing them with both Brasco and Court, she called the two men together and asked permission to go out and check on the situation at Fredrickston General. Their response was predictable.

  “So, what is this?” Brasco exclaimed. “You called us in to tell us you want to go out and check on a guy in a coma? What’s next? You’ll call a meeting if you want to blow your nose?”

  “You know, Patty,” Court added, “you’ve got to show more independence in this thing. You don’t have to check with us for everything you learn or do—just the important things.”

  No surprise. She was damned if she involved the two of them and utterly damned if she didn’t. Was it that she was a woman? That she was her father’s daughter? That she had a master’s degree in criminal justice? That she had an independent streak? Probably all of the above and none of the above. And there was nothing she could do about it, absolutely nothing, except put one foot in front of the other and take the path that felt right. Quitting was not an option.

  Will was still sedated when Patty arrived at the ICU. The nurses she spoke with seemed shocked about what had happened in the OR and what had subsequently been discovered in his blood and urine, but they were also disappointed and angry. Will Grant certainly wasn’t the first physician they had grown to love and respect who turned out to have a hidden problem with alcohol or drugs, but he was the first one to have unveiled his shortcoming in such a spectacular way.

  “Must have just gone for a little more of a thrill and overshot,” Anne Hajjar said with a matter-of-factness that seemed blatantly forced.

  Patty did learn that absolutely none of the staff saw this one coming. If Will Grant had any faults as a doc, they were that he cared too much, often hurt too deeply when things didn’t go well, and spent way too much time in the hospital. Otherwise, as a physician and as a man, he was the total package.

  “Before this happened,” Hajjar said, “we all thought Dr. Grant was the catch of the year, even though it seemed he never left the hospital long enough to date.”

  “I expect he’ll have a good bit of free time now,” Donna Lee added. “I just hope he uses it to get some help.”

  More confused about Will Grant than ever, Patty had left the hospital and driven over to keep her appointment with Benois Beane, whom she tracked down after discovering Will had won an unsung hero award from the Boston Celtics for the work he did at the Open Hearth. Following her session with Will in his office, it was easy for her to believe he had no involvement in the managed-care slayings. Now, however, there could be no way around the fact that he had taken a potent narcotic and then attempted to perform surgery.

  Would the real Will Grant please stand up?

  “Sergeant Moriarity,” Benois Beane was saying, “we have twenty-eight people who work here and a couple of hundred who volunteer regularly and probably know Will Grant. I’d wager not one of them would believe he knowingly took drugs and went into the OR.”

  Let alone killed three people, Patty almost added, but didn’t.

  “I just don’t get it, then,” she said. “The drug was in his blood. That’s a given.”

  “I don’t care. If it was in his body, someone put it there.”

  “Tell me how.”

  “I can’t, but I can sort of prove he doesn’t take narcotics.”

  “Go on.”

  “A few months ago, maybe three, one of our regulars, Sophie Rennet, died after a long battle with cancer. Will was her surgeon and did his best, but the cancer had gone too far from the start. It just so happened that one night when Will was working here, Sophie’s family called to say that she had passed on. Will and I both went over to her place to pay our respects and for Will to pronounce her dead so the mortuary could come and get her. As we were leaving, her son handed us a box containing her medications, saying he hoped maybe someone else could use them. Inside were bottles and bottles and vials and vials of narcotics—all kinds of narcotics. Once we got back here, Will took a hammer to each of the vials and flushed the pills down the toilet. I saw him do it.”

  “But he could have just as easily told you he was taking the medicine back to his office.”

  “Exactly. I have known a lot of addicts in my day, a lot of addicts, and not one of them would have thrown away such a stash. I would think that’s got t
o prove something.”

  Patty thought of several rebuttals to Beane’s logic, but she knew in her heart that none of them carried much clout.

  “Are you sure he’s awake?”

  “It doesn’t matter. He’s got to wake up sometime.”

  Hospital president Sid Silverman’s distinctive tenor worked its way into the darkness. The other voice, irritated and sardonic, was Donna Lee’s. The veteran nurse and Silverman, once an endocrinologist on the staff of FGH, had known each other for years. Now they had something else in common—a clear distaste for one Will Grant. Will tested his arms and legs and found that the wrist restraints were back in place. Shit.

  “I just came from the recovery room,” Silverman was saying. “The guy looks bad, real bad. His blood pressure won’t stay up. There’s talk about bringing him back into the OR to open him up again and see if something’s bleeding.”

  “That’s terrible,” Donna said.

  “You’re damn right it is. If he doesn’t make it, his family could end up owning this place.”

  “I doubt they’d want it. Well, go on in there. We haven’t given him anything for a while, so he should be pretty light.”

  Will kept his eyes closed but sensed Silverman approaching his bed. He pictured the man glaring down at him, his paunch stretching the vest of his trademark three-piece suit.

  “Welcome to the ICU, Sid,” he said keeping his eyes shut for a few more seconds, then slowly opening them. “I don’t suppose it matters to you, but I didn’t take any fentanyl.”

  “It was in your blood and in your urine,” Silverman said flatly. “Do you have any explanation that I can give to the executive committee when they meet in an hour?”

  “I didn’t take anything. Listen, can you crank me up halfway? I don’t like lying flat like this. I feel like I’m on a slab getting ready to be sacrificed.”

  Silverman hesitated, then raised the head of the bed.

  “And while you’re at it, Sid, could you please tell the nurses to take these restraints off? I’m not going to cause any trouble. Promise.”

  “I’ll send the nurses in when I’m finished,” Silverman said. “I asked if you had any explanation for how the fentanyl got into your body.”