Extreme Measures (28 page)

“If it doesn’t rot, it ain’t dead. I like it, Najarian. I like it. Although I can see how it could make for a bit of a space problem from time to time.”

“Seriously.”

“Seriously? Well, it seems to me that an M.D. degree and thirteen years of higher education qualify you to use
‘going
to rot’ as your standard.”

“But Reed Marshall used that, and Reed Marshall was wrong.”

“A fluke,” Subarsky said. “One in a billion.”

“I don’t think so, David. Because you see, I may have made the same mistake.”

Eric pulled out the EKG tracings and went over the two cases.

“And where is this John Doe now?” Subarsky asked.

“I don’t know. Do you have some time?”

“For you? All the time in the world.”

Piece by piece, Eric recounted his meeting with Laura, their visits to the Gates of Heaven and Thaddeus Bushnell, and their close call on the East Boston docks. Subarsky chewed on a pencil as he listened. When Eric finished, his friend whistled softly.

“You have been into some shit, my man. I’ll say that.”

“David, I have no idea what’s going on, but I think the derelict and Loretta Leone were poisoned.”

“How?”

“Accident. Product tampering. Psycho. Define
crazy
any way you want, and I’ll find you someone who fits the bill.”

“And you think you stopped too soon in resuscitating the guy who may have been your new flame’s brother?”

“It’s possible.”

“I don’t buy it.”

“I don’t expect you to, yet. That’s what I’m doing here.”

“And what have you come up with?”

“Lots of things. But what I keep coming up with is this.”

Eric slid his notes on tetrodotoxin across. Subarsky scanned them in a minute.

“So,” he said, “once again the zombi poison rears its ugly head.”

“You know about it?”

“Some. A few years ago there was a flurry of interest in it. Even a best-selling book. But after a while articles began popping up in the scientific literature refuting most of the methods and claims.”

“I know. I’ve read some of them.”

“And you still suspect the drug?”

“Either alone or in some kind of combination. Can a good toxicologist detect it?”

“Probably.”

“What about amanita and aconite?”

“Probably.”

“Well then, tomorrow I’m going to the pathology department to see if they can screen Loretta Leone’s blood. Then I think I’ll try to set up an appointment with Dr. Darden.”

“Ah, yes, White Memorial’s resident Haitian. Good idea.”

“If anyone around here would know about the tetrodotoxin myth, he would.”

“Agreed. But do you know if he’s ever been near Haiti since he came to the States?”

“Actually, I do,” Eric said. “There’s a clinic in Port-au-Prince that he helped set up. From time to time he takes a resident down with him.”

“In that case, he may well be the man who can put you straight.”

“What do you mean?”

“Well, I’m no expert in this particular area, but I can’t believe any drug could do the things you’re concerned about. As an Armenian, you have this overdeveloped, genetically inbred sense of responsibility. That’s what makes you such a terrific doctor. But along with it goes your equally inbred Armenian sense of guilt. And right now, that sense is saying that you might have been able to do something to prevent the death of your friend’s brother.”

“Well?”

“Well, I’ve known you for a long time, Eric, and I know that if something wasn’t right about that case, you would have spotted it.”

“Maybe so,” Eric said. “But right now, my inbred Armenian intuition is telling me that I’m onto something.”

“In that case, if you need my help in any way, just ask.” Subarsky scratched at his beard for a few seconds and then added, “However, I am willing to wager a pitcher of Heineken that you are orbiting Mars on this one.”

Eric gathered his notes.

“I’ll take the bet,” he said, “and believe me, I hope you win. Tomorrow I’ll hit Darden, the pathology department, and the Countway Library. I’ll keep you posted.”

“Do that,” Subarsky said. “Just let me know if I or my trusty computer can be of any assistance. And in the meantime, I’ll keep my telescope trained on Mars.”

The note was on Eric’s pillow when he arrived home, along with a volume of exquisite photographs entitled
Diving Off the Caymans
. He flipped through the pages, wondering what it might be like to live in such a place. For so long his life had been on automatic pilot, locked on a single unerring course. Now, there was only uncertainty—uncertainty and a woman.

He set the book aside and spent a few minutes flipping through his notes. He had expected to find
Laura waiting in the apartment, and now felt some relief to discover she was not. He had much to work through.

There remained little doubt that the man he had assumed was a derelict, the man he had pronounced dead and sent off to the Gates of Heaven Funeral Home, was Laura’s brother. Now there was reason—good reason—to believe he should have pressed on with his efforts that day, at least for a while longer. And although the
quality
of his patient’s life had been a major consideration, Eric knew that his order to stop the resuscitation had been based, at least in part, on his judgment of the
value
of that life as well. It was a judgment he, like Reed, would have to live with for the rest of his career.

It was a bit after ten, so Laura’s note left him an out—an excuse to delay sharing his conclusions until morning. But the more he thought about it, the more he wanted to get it over with, to tell her everything and to hope for her understanding. Both Scott and Loretta Leone had been somehow poisoned, either by a psycho or an inadvertent exposure to some toxin. Despite Dave Subarsky’s doubts, that much seemed clear to him now.

He hoped Laura would see that although he might have made essentially the same mistake as Reed, the deck had been stacked against them both.

He paced the apartment for a time, wondering if other patients in other settings had suffered fates similar to their two cases. Finally, he called the Carlisle. The phone rang half a dozen times before it was picked up. No one spoke.

“Hello?” he said. “Laura?”

Her sigh was audible.

“Oh, thank God,” she said. “Eric, I just got a call from some man who threatened me. All he kept saying was ‘It’s not over. We want the tape.’ I screamed at him that I didn’t know what he was talking about, but
he hung up. I don’t know what’s going on, but if his aim was to frighten me, he did a very good job.”

“I’ll be right over.”

“You don’t have to do that.”

“I want to. I was sort of surprised that you weren’t here.”

“I’m sorry. I thought it might be better if I spent some time alone. I … I just started feeling as if I was growing to depend on you too much.”

“Laura,” he said. “I’m depending on you too. Believe me I am. There’re some things I need to tell you about. When I do, I think you’ll see that in some ways I have as much at stake in getting to the bottom of all this as you do. I’d really like to come over now.”

“What things?”

“Face to face?”

She hesitated.

“I’ll be here,” she said finally.

Laura sat cross-legged on the bed and listened impassively as Eric recounted in detail his actions and thoughts on the morning the derelict was brought in.

“I knew,” she said, when he had finished. “That first night we were together, I could see a shadow cross your face every time you talked about that resuscitation.”

“For what it’s worth, I’m sorry. We see so many cardiac arrests—so many people brought in essentially dead after a coronary—that unless a case is strikingly different from all the others, we don’t have even the slightest suspicion that something other than natural causes might be involved.”

“Should you?”

“Well, I guess if we’re perfect we should.”

“I didn’t mean it like that, and you know it,” she snapped. “Eric, please. I just want to understand.”

He looked at her sheepishly.

“Sorry,” he said. “Let me think how to explain this.… Okay. There’s a concept in diagnostic medicine
called index of suspicion. Put in simplest terms, index of suspicion means, if you don’t think of it, you’ll never find it. The better a physician is, the more diagnostic possibilities he considers and sifts through in a given case. If you think every case of middle-aged cardiac arrest had a coronary occlusion, you’ll never diagnose a cocaine overdose in a fifty-five-year-old corporation president.”

“I see.”

“Believe it or not, the worst physician can usually do the right thing, or at least not do something harmful, ninety or even ninety-five percent of the time. It’s that other five or ten percent that separates great from run-of-the-mill in our business.”

“Most of us think of doctors so differently from that.”

“I know. And the misconceptions—the lofty expectations that the public has of us—are largely our own doing. For years physicians have fostered the notion that things are or aren’t, simply because we say so. And the public buys into it—or at least a large segment of it does—because people want the security of knowing that there’s someone they can turn to who has all the answers. But please don’t think I’m copping out or trying to make excuses for my actions last February. I’m just trying to help you understand what was going on in my head. I … I just didn’t have a high enough index of suspicion that something way out of the ordinary might be going on.”

Without responding, Laura walked to the window and looked out at the city. She could feel Eric’s anguish, and the part of her that was growing to love him wanted so much to hold him, to tell him that she understood. But she felt unable to get past the fact that the man whose life had been in his hands that winter morning was, in all likelihood, her brother.…

Suddenly she found herself thinking about a situation she had once been in with a diver whose skill and competence she had misjudged. The man had
ended up wedged in a narrow tunnel with his air supply all but used up. Luckily, she had sensed trouble and located him just a minute or two from disaster. She was able to buddy-breathe him up to the surface, but the outcome could easily have gone the other way.

She wondered how her life would have changed, how she would have responded had he not made it out of that tunnel alive. The manager of her club, people diving with her day after day—they had no more interest in seeing her as human, as fallible, than she did Eric.

When she finally turned back to him, tears glistened in her eyes.

“I wish you hadn’t stopped trying,” she said.

“I know. I wish like hell I could have that morning back. Believe me I do. And I know it doesn’t help Scott, but I’m determined never to make judgments on the value of anyone’s life again.”

“And never to ignore the possibility that what seems ordinary may not be at all?”

“That too.”

She put her arms around him and touched her lips to his ear.

“Fair enough,” she whispered.