Careful not to dislodge the IV, Jeffrey lay back on the bed. His plan was to inject the huge dose of morphine and then open the stopcock on the solution containing the succinylcholine. The morphine would send him to never-never-land long before the succinylcholine concentration paralyzed his respiratory system. Without a ventilator, he would die. It was as simple as that.
Gently, Jeffrey inserted the needle of the syringe containing the morphine into the IV port of the infusion line going into the vein on the back of his hand. Just as he was beginning to inject the narcotic, there was a soft knock on his door.
Jeffrey rolled his eyes. What a time for Carol to interrupt. He held off the injection but didn't respond to her knock, hoping she'd go away if she thought he was still asleep. Instead, she knocked louder, then louder still. “Jeffrey!” she called. “Jeffrey! I've made dinner.”
There was a short silence that made Jeffrey think she'd given up. But then Jeffrey heard the knob turn and the door rattle against the jamb. “
Jeffreyâare you all right?
”
Jeffrey took a deep breath. He knew he had to say something or she might be concerned enough to force the door. The last thing he wanted was for her to come barging in and see the IV.
“I'm fine,” Jeffrey called out at last.
“Then why didn't you answer me?” Carol demanded.
“I was asleep.”
“Why is this door locked?” Carol asked.
“I guess I didn't want to be disturbed,” Jeffrey replied with pointed irony.
“I've made dinner,” Carol said.
“That's nice of you, but I'm still not hungry.”
“I made veal chops, your favorite. I think you should eat.”
“Please, Carol,” Jeffrey said with exasperation. “I'm not hungry.”
“Well, come eat for my sake. As a favor to me.”
Fuming, Jeffrey set the syringe with the morphine on the night table and pulled out the IV. He went to the door and yanked it open, but not so far that Carol could see in. “Listen!” he snapped. “I told you earlier that I wasn't hungry then and I'm telling you that I'm not hungry now. I don't want to eat and I don't like you trying to make me feel guilty about it, understand?”
“Jeffrey, come on. I don't think you should be alone. Now I've gone to the trouble to shop for you and cook. The least you can do is come try it.”
Jeffrey could see there would be no getting around her. When she'd made up her mind, she was not the type of person who could be easily dissuaded.
“All right,” he said heavily. “All right.”
“What's wrong with your hand?” Carol asked, noticing a drop of blood on the back of it.
“Nothing,” Jeffrey said. “Nothing at all.” He glanced at the back of his hand. Blood was oozing from the IV site. Frantically, he searched for an explanation.
“But it's bleeding.”
“A paper cut,” Jeffrey said. He was never good at fibbing. Then, with an irony only he could appreciate, he added, “I'll live. Believe me, I'll live. Look,” he said, “I'll be down in a minute.”
“Promise?” Carol said.
“I promise.”
With Carol gone and the door relocked, Jeffrey removed the quarter-liter IV bottles and stored them in the back of his closet in his leather doctor's bag. He threw the wrappers from the infusion kits and the scalp needle into the wastebasket in the bathroom.
Carol had some sense of timing, he thought ruefully. Only as he packed away the medical paraphernalia did he realize how close he had come. He told himself he shouldn't give in to despair, at least not until all legal avenues had been exhausted. Until this recent turn of events, Jeffrey had never seriously entertained thoughts of suicide. He was honestly baffled by the
suicides he knew of, though intellectually he could appreciate the depths of despair that might prompt it.
Oddly enough, or perhaps not so oddly, the only suicides he had known were other doctors who'd been pushed to the brink by motives not unlike Jeffrey's. He recalled one friend in particular: Chris Everson. He couldn't remember exactly when Chris had died, but it had been within the last two years.
Chris had been a fellow anesthesiologist. Years before, he and Jeffrey had been residents together. Chris would have remembered the days when gung-ho residents warded off flu symptoms with Ringer's Lactate. What made thinking about Chris suddenly so poignant was the realization that he'd been sued for malpractice because one of his patients had had a terrible reaction to a local anesthetic during epidural anesthesia.
Jeffrey closed his eyes and tried to remember the details of the case. As best as he could recall, Chris's patient's heart had arrested as soon as Chris put in the test dose of only 2 cc's. Although they had been able to get the heart beating again, the patient ended up quadriplegic and semicomatose. Within a week after the event, Chris had been sued along with Valley Hospital and everyone else even remotely associated with the episode. The “deep pockets” strategy yet again.
But Chris never went to court. He committed suicide even before the discovery period had been completed. And even though the anesthesia procedure had been characterized as having been impeccable, the decision ultimately rendered found for the plaintiff. At the time, the settlement had been the largest award for malpractice in Massachusetts' history. But in the ensuing months, Jeffrey could think of at least two awards that had topped it.
Jeffrey could distinctly remember his reaction when he'd heard of Chris's suicide. It had been one of complete disbelief. Back then, before Jeffrey's current involvement with the legal system, he'd had no idea what could have pushed Chris to do such an awful thing. Chris enjoyed a reputation as a superb anesthesiologist, a doctor's doctor, one of the best. He'd recently married a beautiful OR nurse who worked in Valley Hospital. He seemed to have everything going for him. And then the nightmare struck . . .
A soft knock brought Jeffrey back to the present. Carol was at the door again.
“Jeffrey!” she called. “Better come before it gets cold.”
“I'm on my way.”
Now that he knew too well what Chris had only begun to go through, Jeffrey wished he'd stayed in touch at the time. He could have been a better friend. And even after the man ended his life, all Jeffrey had done was attend the funeral. He had never even contacted Kelly, Chris's wife, even though at the funeral he'd promised himself he would do so.
Such behavior wasn't like Jeffrey, and he wondered why he'd acted so heartlessly. The only excuse he could think of was his need to repress the episode. The suicide of a colleague with whom Jeffrey could so easily identify was a fundamentally disturbing event. Perhaps facing it squarely would have been too great a challenge for him. It was the kind of personal examination that Jeffrey and doctors in general had been taught to avoid, labeling it “clinical detachment.”
What a terrible waste, he thought as he remembered Chris the last time he'd seen him, before all the tragedy struck. And if Carol hadn't interrupted, mightn't there be others thinking the same thoughts with respect to him?
No, Jeffrey thought vehemently, suicide wasn't an option. Certainly not yet. Jeffrey hated to sound mawkish, but where there was life, there was hope. And what had happened in the aftermath of Chris's suicide? With Chris dead, there was no one to defend or clear his name. For all his despair and developing depression, Jeffrey still was enraged by a system and process that had managed to convict him when he had honestly done no wrong. Could he really rest until he'd done his best to clear his name?
Jeffrey got angry just thinking about his case. To the lawyers involved, even Randolph, all this might be business as usual, but not so to Jeffrey. This was his life on the line. His career. Everything. The great irony was that the day of the Patty Owen tragedy, Jeffrey had done his utmost to do well by her. He'd only run the IV and taken the paregoric so he could perform the job for which he'd been trained. Dedication was what had motivated him, and this was how he'd been repaid.
If Jeffrey ever was able to return to medicine, he would be afraid of the long-lasting effects this case would have on any medical decisions he would ever make. What kind of care could people come to expect from doctors who were forced to work in the current malpractice milieu and who had to restrain their best instincts and second-guess their every step? How had such a system evolved? Jeffrey wondered. It certainly wasn't eliminating the few “bad” doctors, since they ironically rarely got sued.
What was happening was that a lot of good doctors were being destroyed.
As Jeffrey washed before descending to the kitchen, his mind dredged up another memory that he had unconsciously repressed. One of the best and most dedicated internists he'd ever met had killed himself five years ago on the same night he'd received a summons for malpractice. Shot himself through the mouth with a hunting rifle. He hadn't even waited for the discovery process to begin, much less the trial. At the time Jeffrey had been disturbingly mystified, since everyone knew the suit had been baseless. In fact the doctor had, ironically, saved the man's life. Jeffrey now had some idea of the source of the man's despair.
Finished in the bathroom, Jeffrey returned to his bedroom and changed into clean slacks and shirt. Opening his door, he smelled the food Carol had prepared. He still wasn't hungry, but he'd make an effort. Pausing at the top of the stairs, he vowed to fight the depressive thoughts he was bound to experience until this current episode had run its course. With that commitment in mind he started for the kitchen.
Jeffrey woke up with a start and was amazed at the time. He'd first awakened around five A.M., surprised to find himself sitting in the wing chair by the window. Stiffly, he had removed his clothes and gotten into bed, thinking he would never be able to fall back asleep. But obviously he had.
He took a quick shower. Emerging from his room, he looked for Carol. Having recovered to an extent from the depressive depths of the previous day, he wanted some human contact and a bit of sympathy. He hoped that Carol had not left for work without talking to him. He wanted to apologize for his lack of appreciation for her efforts the night before. It was a good thing, he now realized, that she'd interrupted him, and that she'd gotten him irritated. Unknowingly she'd saved him from committing suicide. For the first time in his life, getting angry had had a positive effect.
But Carol was long gone. A note was leaning against a shredded wheat box on the kitchen table. It said that she'd not wanted to disturb him since she was sure he needed rest. She had to get to work early. She hoped he'd understand.
Jeffrey filled a bowl with cereal and got the milk from the refrigerator. He envied Carol her job. He wished he had a job to go to. It would keep his mind occupied if nothing else. He would have liked to have made himself useful. It might have helped his self-esteem. He'd never realized quite how much his work defined his persona
Back in his room, Jeffrey disposed of the IV paraphernalia by wrapping it in old newspapers and carrying it out to the trash barrels in the garage. He didn't want Carol to find it. He felt strange handling the material. It gave him a tremendous uneasiness to have been knowingly and voluntarily so close to death.
The idea of suicide had occurred to Jeffrey in the past, but always in a metaphorical context, and usually more as a retribution fantasy to get back at someone who he believed had wronged him in some emotional way, like when his girlfriend in the eighth grade had capriciously switched her affections to Jeffrey's best friend. But last night it had been different, and to think that he'd come within a hair's breadth of doing it made his legs feel weak.
Returning to the house, Jeffrey considered what effects his suicide would have had on his friends and family. It probably would have come as a relief to Carol. She wouldn't have had to go through with the divorce. He wondered if anyone would have missed him. Probably not . . .
“For Pete's sake,” Jeffrey exclaimed, realizing the ridiculousness of this line of thought and remembering his vow to resist depressive thoughts. Would his thinking thrive on his low self-esteem for the rest of his days?
But the subject of suicide was hard to shake from his mind. He wondered again about Chris Everson. Had his suicide been the product of an acute depression that had struck like a sudden storm, like Jeffrey had felt the night before? Or had he planned it for some time? Either way, his death was a terrible loss for everyoneâhis family, the public, even the profession of medicine.
Jeffrey stopped en route to his room and stared out the livingroom window with unseeing eyes. His situation was no less a waste. From the point of view of his productivity, the loss of his medical license and his going to prison was no less a waste than if he'd succeeded in committing suicide. “Damn!” he shouted as he grabbed one of the pillows from the couch and punched it repeatedly with his fist. “Damn, damn, damn!”
Jeffrey quickly wore himself out and replaced the pillow. Then he sat himself down dejectedly with his knees jutting up in front of him. He interwound his fingers and rested his elbows on his knees and tried to think of himself in prison. It was a horrid thought. What a travesty of justice! The malpractice stuff had been more than enough to seriously disrupt and alter his life, but this criminal nonsense was a quantum leap worse, like throwing salt into a mortal wound.
Jeffrey thought about his colleagues at the hospital and other physician friends. They had all been supportive at first, at least until the criminal indictment had been handed down. Then they had avoided Jeffrey as if he'd had some kind of infectious
disease. Jeffrey felt isolated and alone. And more than anything, he felt angry.
“It's just not fair!” he said through clenched teeth.
Completely out of character, Jeffrey snatched up a piece of Carol's crystal bric-a-brac from a side table and in a moment of sheer frustration threw it with deadly accuracy at the glass-fronted sideboard that he could see through the arch leading to the dining room. There was a resounding shatter of glass that made him wince.
“Uh-oh!” Jeffrey said as he realized what he'd done. He got up and went for the dustpan and broom. By the time he'd picked up the mess, he'd come to a momentous conclusion: he wasn't going to prison! No way. Screw the appeal process. He had as much confidence in the legal system as he did in fairy tales.
The decision was made with a suddenness and resolve that left Jeffrey feeling exhilarated. He checked his watch. The bank would be open soon. Excitedly he went to his room and found his passport. He was lucky the court hadn't made him surrender it at the same time they'd increased his bail. Then he called Pan Am. He learned that he could shuttle to New York, bus to Kennedy, and then fly on to Rio. Considering all the carriers serving the market, he had a wide range of flights from which to choose, including one that left at 11:45
P
.
M
. and made a few stops in exotic locations.
With his pulse racing in anticipation, Jeffrey called the bank and got Dudley on the line. He did his best to sound controlled. He asked about the progress on the loan.
“No problem,” Dudley said proudly. “Pulling a few strings, I got it approved like that.” Jeffrey could hear the man snap his fingers for his benefit. “When will you be coming in?” Dudley continued. “I'd like to be sure I'm here.”
“I'll be in shortly,” Jeffrey said, planning his schedule. Timing would be key. “I have one other request. I'd like to have the money in cash.”
“You're joking,” Dudley said.
“I'm serious,” Jeffrey insisted.
“It's a bit irregular,” Dudley said hesitantly.
Jeffrey hadn't given this issue much thought, and he could sense Dudley's hesitance. He realized he'd have to explain if he hoped to get the money, and he definitely needed the money. He couldn't leave for South America with only pocket change.
“Dudley,” Jeffrey began, “I'm in some unfortunate trouble.”
“I don't like the sound of this,” Dudley said.
“It's not what you're thinking. It's not gambling or anything like that. The fact is, I have to pay it to a bail bondsman. Haven't you read about my troubles in the papers?”
“No, I haven't,” Dudley said, warming up again.
“I got sued for malpractice and then indicted over a tragic anesthesia case. I won't burden you with the details at the moment. The problem is, I need the $45,000 to pay a bail bondsman who posted my bail. He said he wanted it in cash.”
“I'm sure a cashier's check would be acceptable.”
“Listen, Dudley,” Jeffrey said. “The man told me cash. I promised him cash. What can I say? Do me this one favor. Don't make it any harder on me than it already is.”
There was a pause. Jeffrey thought he heard Dudley sigh.
“Are hundred-dollar bills okay?”
“Fine,” Jeffrey said. “Hundreds would be perfect.” He was wondering how much space four hundred and fifty hundred-dollar bills would take.
“I'll have it ready,” Dudley said. “I just hope you're not planning on carrying this around for any length of time.”
“Just into Boston,” Jeffrey said.
Jeffrey hung up the phone. He hoped that Dudley wouldn't call the police or try to check his story. Not that anything wouldn't have jibed. Jeffrey felt the fewer people thinking about him and asking questions, the better, at least until he was on the plane out of New York.
Sitting down with a writing tablet, Jeffrey started a note to Carol, telling her he was taking the $45,000 but that she could have everything else. But the letter sounded awkward. Besides, as he wrote he realized he didn't want to leave any evidence of his intentions in case he was delayed for some reason. He crumpled the paper, set a match to it, and tossed it in the fireplace. Instead of writing, he decided to call Carol from some foreign location and talk to her directly. It would be more personal than a letter. It would be safer, too.
The next issue was what he should take with him. He didn't want to be burdened with a lot of luggage. He settled on a small suitcase, which he loaded with basic casual clothes. He didn't imagine South America would be very formal. By the time he had packed everything he wanted, he had to sit on the suitcase to get it closed. Then he put some things in his briefcase, including his toiletries and clean underwear.
He was about to leave his closet when he eyed his doctor's bag. He hesitated for a moment, wondering what he would do
if something went horribly wrong. To be on the safe side, he opened the doctor's bag and took out an IV setup, a few syringes, a quarter liter of IV fluid, and a vial each of succinylcholine and morphine and packed them in his briefcase beneath the underwear. He didn't like to think he was still entertaining thoughts of suicide, so he told himself that the drugs were like an insurance policy. He hoped he wouldn't need them, but they were there just in case . . .
Jeffrey felt strange and a little sad glancing around the house for what was probably the last time, knowing he might never lay eyes on it again. But walking from room to room, he was surprised not to be more upset. There was so much to remind him of past events, both good and bad. But more than anything else, Jeffrey realized that he associated the place with his failed marriage. And just like his malpractice case, he'd be better off leaving it behind. He felt energized for the first time in months. It felt like the first day of a new life.
With the suitcase in the trunk and his briefcase on the passenger seat beside him, Jeffrey drove out of the garage, beeped the door shut, and was on his way. He didn't look back. The first stop was the bank, and as he got closer, he began to get anxious. His new life was starting out in a unique fashion: he was deliberately planning to break the law by defying the court. He wondered if he would get away with it.
By the time he pulled into the bank's parking lot, he was very nervous. His mouth had gone dry. What if Dudley had called the police about his requesting the bail money in cash? It wouldn't take the intelligence of a rocket scientist to figure that Jeffrey might be planning on doing something else with the money rather than turn it over to the bail bondsman.
After sitting in his parked car for a moment to summon his courage, Jeffrey grabbed his briefcase and forced himself into the bank. In some respects he felt like a bank robber, even though the money he was seeking technically belonged to him. Taking a deep breath to steady himself, he went to the service desk and asked for Dudley.
Dudley came to meet him with smiles and small talk. He led Jeffrey back to his office and motioned to a chair. To judge by his demeanor, he didn't hold Jeffrey suspect. But Jeffrey's anxiety stayed razor sharp. He was trembling.
“Some coffee or a soft drink?” Dudley offered. Jeffrey decided he'd be better off without caffeine. He told Dudley some juice would be fine. He thought it best to give his hands something
to do. Dudley smiled and said, “Sure thing.” The man was being so cordial, Jeffrey was afraid it was a trap.
“I'll be right back with the cash,” Dudley said after handing Jeffrey a glass of orange juice. He returned in a few minutes carrying a soiled canvas money bag. He dumped the contents onto his desk. There were nine packets of hundred-dollar bills, each containing fifty bills. Jeffrey had never seen so much money in one place. He felt increasingly uneasy.
“It took us a little doing to get this together so quickly,” Dudley told him.
“I appreciate your effort,” Jeffrey said.
“I suppose you'll want to count it,” Dudley said, but Jeffrey declined.
Dudley had Jeffrey sign a receipt for the cash. “Are you sure you don't want a cashier's check?” Dudley asked as he took the signed paper from Jeffrey. “It's not safe carrying this kind of cash around. You could call your bail bondsman and have him pick it up here. And you know, a cashier's check is as good as cash. He could then go into one of our Boston offices and get cash if that's what he's after. It would make it safer for you.”
“He said cash, so I'm giving him cash,” Jeffrey said. He was actually touched by Dudley's concern. “His office isn't far,” he explained.
“And you're sure you don't want to count it?”
Jeffrey's tension was beginning to evoke irritation, but he forced a smile. “No time. I was supposed to have this money in town before noon. I'm already late. Besides, I've been doing business long enough with you.” He packed the money into his briefcase and stood up.
“If I'd known you weren't going to count it, I would have taken a few bills from each packet.” Dudley laughed.
Jeffrey hurried out to the car, tossed in the briefcase, and drove out of the parking lot with extra care. All he needed was a speeding ticket! He checked the rearview mirror to make sure he wasn't being followed. So far so good.
Jeffrey drove directly to the airport and parked on the roof of the central parking building. He left the parking stub in the car's ashtray. When he called Carol from wherever, he'd tell her to pick the car up.
With the briefcase in one hand and the suitcase in the other, Jeffrey walked to the Pan Am ticket counter. He tried to behave like any businessman going off on a trip, but his nerves were shot; his stomach was in agony. If anyone recognized him,
they'd know he was jumping bail. He'd been specifically told not to leave the state of Massachusetts.