Extreme Measures (11 page)

With what seemed practiced precision, one of the youths jostled the woman, sending her off balance. The other boy, a step behind, snatched the woman’s purse as she was falling to the pavement, and then accelerated. Laura’s reaction was pure reflex. As he neared her, she pulled her shoulder bag free and swung it as hard as she could, catching the boy in the arm and sending the woman’s purse spinning across the sidewalk. The youth stumbled and whirled about.

“Don’t!” Laura barked, stepping between him and the purse.

The boy stopped short. His eyes locked with hers.

“Don’t do it,” she rasped, hoping that the determination in her own eyes held even a fraction of the fury in his. Behind him, she saw the other youth hesitate, and then turn and run. In continued slow motion, several male passersby began to close in on the confrontation. She saw a flicker of confusion replace the anger in the remaining youth’s eyes.

“Fuck you,” he spat. Then he bolted off, shoving his way between two startled businessmen.

Several people were mumbling praise and patting her on the shoulder as Laura, her pulse pounding in her ears, retrieved the purse. The old woman was being helped to her feet.

“Are you okay?” Laura asked.

“I … I think so,” she said, apparently unaware that she was talking to the woman who had helped her.

“Good. Here’s your bag.”

“Th-thank you, dear.”

The woman still seemed dazed. Laura stepped
closer to hand her the purse. Not ten feet away, a tall man dressed in a windbreaker and jeans ducked quickly into a doorway, out of her sight. Laura checked to be certain the old woman could walk. Then, barely aware of the smattering of applause, she headed off down Boylston.

A beat later, the man in jeans stepped out from the doorway and followed.

T
he pin was no bigger than Eric’s fingernail, but in its remarkable detail and craftsmanship it was a work of art. Set in black stone, the caduceus was hand-sculpted in gold, with fine enamel accents at the head of the staff and along the wings flaring out from just beneath it. The intertwining serpents below the wings were etched so meticulously that under a microscope, Eric could discern their scales, and even the facets in the flecks of ruby that highlighted their eyes.

We are Caduceus, your brothers and sisters in medicine. We care about the things you care about. We care about you
.

The words had echoed in Eric’s mind since the unexpected decision by the search committee to hold off for several weeks in making their selection. And although he had been unable to recall with exactitude all the phrases spoken by that eerie electronic voice, the sense of the message was clear. Some kind of secret work was going on at White Memorial, something arcane but important; something that he could
be a part of if he was willing to step beyond currently allowable medical therapies to administer an unusual treatment to a patient.

Joe Silver, Haven Darden, Sara Teagarden—they were the heaviest of the heavyweights at the hospital, and at least one of them, Eric felt certain, was part of Caduceus. At least one of them stood ready to assure his selection as associate director of emergency services.

Over the four days that had followed the search committee meeting, Eric had kept the caduceus pin in his desk. And although he had tried to ignore it, to approach his job in a business-as-usual fashion, rationalizations for pinning it on his clinic coat reverberated in his mind like distant ocean waves. He reflected on the physicians who made major breakthroughs by flying in the face of medical convention. He reasoned that in point of fact, by using the pericardial laser, he had already demonstrated to others, and to himself, his potential for similar vision and action. He argued that once he learned what Caduceus had in mind, he could always refuse to get involved.

But in the end, neither the promise of the promotion nor any amount of rationalization was persuasive enough. This was not the laser he had developed himself and knew so intimately. It was someone else’s work—someone else’s priorities. The struggle within him was constant, but again and again his inner voice kept at bay the urge to find out what Caduceus was up to. More than five years of study and total dedication to his work had proved, as far as he was concerned, that he was the better man for the E.R. job. And he continued to cling to the hope and the belief that ultimately that would be enough.

It was early evening. The emergency room, which had enjoyed a few hours of atypical quiet, had suddenly begun to pulse again. Eric had signed out to Reed Marshall, but an accident on the expressway had brought in two major casualties. Until things leveled
off, Eric had volunteered to man the minor medical desk, working with the triage nurse to screen walk-ins and treat those who did not need extensive evaluation. He had three examining rooms going at once, and several more patients waiting for laboratory results. Still, the pile of charts in the to-be-seen box on his desk continued to grow.

“Kristen, would you give me a quick moon check?” he asked, dashing off prescriptions and clinic referral forms for several patients at once.

“Full moon tomorrow,” the nurse said. “Can’t you tell?”

Eric glanced up at the waiting room, which was nearly packed.

“I can tell,” he said. “Señora Martinez,” he called out,
“traiga a su padre aquí, por favor.”

The woman, cradling an infant in one arm, helped her father limp over to the desk. Of all the courses Eric had ever taken—including all the biochemistry, biology, physics, and calculus—the one that seemed the most valuable to him as a physician was his four years of high-school Spanish.

“
Es
gout,
Señora. La gota”
he said, handing over two prescriptions and a referral slip. “
Es muy dolorosa, pero no es grave.”

The woman thanked him twice in Spanish, hesitated, and then squeezed his hand and kissed him on the cheek.

“That was very nice. Or should I say,
Fue muy simpático.”

Eric turned to find Dr. Haven Darden standing just to his right.

“Thanks,” Eric said. “I just wish I’d had enough foresight not to drop the language when I entered college. It sounds as if you didn’t make that mistake.”

The internist’s round face crinkled in a smile.

“We speak French in Haiti, remember?” he said. “Starting from there, the other romance languages aren’t too difficult to master.”

Eric remembered reading in some magazine that the White Memorial chief of medicine had fluency in seven languages. He chose not to comment on the fact. Over his years at the hospital, he had spent some time training with Darden, but had never developed the closeness that he had with many other professors. In fact, Eric had been a bit uncomfortable around the man since the time when he and Reed Marshall were both rotating on Darden’s service. Marshall had, quite in passing, mentioned the Harvard connection, and had let slip that Darden had invited him and his wife over for dinner.

If a strong preference was held by anyone on the search committee for one candidate over the other, Eric believed, it had to be Darden’s partiality to Reed.

“Do you have a patient coming in?” Eric asked.

Darden, meticulously dressed beneath his knee-length clinic coat, nodded.

“A physician friend is bringing his fifteen-year-old daughter in with a high fever and a stiff neck.”

“Possible meningitis. I don’t blame him for being worried.”

“Exactly.”

“Well, if I can help, just let me know.”

Darden glanced out at the waiting room.

“At the moment, Eric, I would say that you are more the one in need of assistance. I’ll tell you what. Give me two or three minutes in private, and then I shall do what I can to help you wade through that crowd out there.”

“WMH rule number one,” Eric said. “Never refuse help. Just let me explain to the triage nurse, and have her do something to pacify that mob out there. We can go to my office.”

Haven Darden followed Eric back to the small chief resident’s office that he shared with Reed Marshall.

“Thank you for taking the time,” Darden said, closing the door. “I won’t keep you long. Eric, have
you spoken with any of the other committee members since the meeting last Monday?”

“Well, Joe Silver’s always around here, so we’ve spoken several times. Yesterday I ate lunch at the same table as Sara Teagarden. Why?”

“I’m curious if either of them said anything about what happened—why we told you both that we had made a decision, then announced that we needed more time?”

“Not a word. Typical of the hospital grapevine, though—everyone around here seems to know what transpired. I think the nurses have a betting pool going. From what I can tell, they seem to be split about fifty-fifty, so both Reed and I get encouragement, depending on which of them we’re working with.”

“Well,” Darden said. “This may be an impropriety, but I want you to know that had the committee made its decision, Dr. Marshall would have been chosen.” Eric felt a knot in his chest at the news. “Dr. Silver has seemed committed to him all along, and Dr. Teagarden had indicated she was leaning in his direction. Your use of that laser of yours did not sit well with them. You, however, are my choice. And that is why I am telling you this.”

“Thank you,” Eric muttered, as surprised that Darden would turn out to be a supporter of his as he was shaken by the news of how close he had already come to losing out. He tried to factor in the information with what he already knew. There was no way Darden could have been the caller—no way, even electronically, that he could have masked his clipped, distinctive English. That meant that one of the other two …

“I have no strong sentiment against Dr. Marshall,” Darden went on, “but I believe he lacks your commitment and dedication to medicine. I like the feel you have for your work—the flair, if you will. You have demonstrated a clinical aggressiveness—a willingness
to take chances, to do whatever it takes to get a patient through a crisis—that appeals to me.”

“Thank you again,” Eric said. “Can you say why Reed didn’t get chosen?”

“Not really. Joe Silver’s the one who suddenly pushed for an extension. You might not know it, but it was Joe who railroaded Craig Worrell into that post a few years ago, past a lot of strong objections around the hospital, and he took a fair amount of flak when the choice went sour. Maybe he got cold feet about backing another loser.”

“Maybe …” Eric said distantly.

“If we can sway either of those votes, you’re in. We’ve decided that a two-to-one vote will do it.”

“I appreciate your telling me all this,” Eric said. “Needless to say, Reed and I were both wondering what had gone on.”

“I wish I knew,” Darden said. “Eric, I don’t think White Memorial can easily afford to lose a physician with your skill and commitment. And speaking for myself, I would love to have another faculty member with a philosophy so much like my own. The votes at staff meetings are always perilously close between the conservatives and those of us who believe this hospital must move ahead to stay ahead. Do you remember that AIDS outreach program I proposed a year or so ago?”

“I heard about it, sure. I had planned to volunteer to help man the clinic when it was set up. In fact, I signed up on that list you sent around.”

“I know. It might not surprise you to learn that Reed Marshall did not. Well, regardless, what you may not know is that my proposal to the medical staff was defeated by just two votes.”

“That must have hurt, to come so close,” Eric said.

“No idea is ever dead until those who believe in it say it’s dead,” Darden replied. “Craig Worrell was one of the negative votes.”

“I see.”

“If I were you, and I wanted that position as much as you seem to, I would do whatever I could to sway the vote of either Dr. Silver or Dame Teagarden in my favor. Can you think of any way you might do that?”

“No,” Eric lied, glancing inadvertently at the drawer of his desk. “No, I can’t.”

“Well, then … I, um, I hope you understand that while I have great respect for Reed Marshall, if there is anything you know about him that would help influence either of my comrades on the committee …”

“No,” Eric said, unable to conceal how startled he was. “No I don’t.” He hesitated, and then added, “Dr. Darden, I think you should know that over our years of working together, Reed and I have developed a pretty deep respect for each other. Even if I did know something damaging about him, which truthfully I don’t, it’s doubtful I would be able to share that information with anyone—even if it meant losing out on the job.”

“Well said!” the chief exclaimed. “That’s precisely the response I wanted from you. And you have my apology for even bringing the subject up. Call it a final test if you want to, and consider yourself to have passed with flying colors. Just keep up your good work, Eric. I’ll do what politicking I can. Then we’ll cast our chips on the table and let them fall where they may.”

Before Eric could respond, there was an insistent knock on the office door.

“Eric, it’s Kristen.”

“Time to get to work,” Haven Darden said, opening the door. “We’ll talk again.”