Robin Cook 1982 - Harmful Intent Read online

  Jeffrey was abreast of the liquor store when he spotted a police car heading in his direction. Without a moment's hesitation, he ducked into the store. The jangle of bells attached to the door wore on Jeffrey's nerves.

  As crazy as it seemed, he didn't know whom he was more afraid of, the street people or the police.

  "Can I help you?" a bearded man asked from behind a counter. The police car slowed, then went past. Jeffrey took a breath. This wasn't going to be easy.

  "Can I help you?" the clerk repeated.

  Jeffrey bought a pint-sized bottle of vodka. If the police cruised back, he wanted his visit to the store to appear legitimate. But it wasn't necessary. When he emerged from the store, the police car was nowhere in sight. Relieved, Jeffrey turned to the right, intending to hurry. But he pulled up short, practically

  colliding with one of the homeless men he'd seen earlier. Startled, Jeffrey raised his free hand to protect himself.

  "Got any spare change, buddy?" the man asked unsteadily. He was obviously drunk. He had a fresh cut just by his temple. One of the lenses of his black-rimmed glasses was cracked.

  Jeffrey recoiled from the man. He was about Jeffrey's height but with dark, almost black hair. His face was covered with a heavy stubble, suggesting he'd not shaved for a month. But what caught Jeffrey's attention was the man's clothes. He was dressed in a tattered suit complete with a button-down blue oxford shirt that was soiled and missing a few buttons. He had on a regimental striped tie that was loosened at the collar and spotted with green stains. Jeffrey's impression was that the man had dressed for work one day, then never gone home.

  "What's the matter?" the man asked in a wavering, drunken voice. "Don't you speak English?"

  Jeffrey dug into his trouser pocket for the change he'd received from his purchase of vodka. As he dropped the money in the man's palm, Jeffrey studied his face. His eyes, though glassy, looked kind. Jeffrey wondered what had driven the man to such desperate circumstances. He felt an odd kinship with this homeless person and his unknown plight. He shuddered to think of how fine a line separated him from a similar fate. The identification was made easier since the man appeared to be close to

  Jeffrey's age.

  As he'd expected, Jeffrey hailed a taxi easily at the nearby luxury hotel.

  From there it took only fifteen minutes to get out to Harvard's medical area. It was just a little after eleven when Jeffrey walked into the

  Countway Medical Library.

  Among the books and narrow study cubicles, Jeffrey felt at home. He used one of the computer terminals to get the call numbers for several books on the physiology of the autonomic nervous system and the pharmacology of local anesthetics. With these books in hand he went into one of the carrels facing the inner court and closed the door. Within minutes he was lost in the intricacies of nerve impulse conduction.

  It wasn't long before Jeffrey understood why Chris had highlighted the word

  "nicotinic." Although most people thought of nicotine as an active ingredient in cigarettes, it was actually a drug, more specifically a poison, which caused a stimulation and then blockade of autonomic ganglia.

  Many of the symptoms associated with nicotine were the same as those caused by muscarine: salivation, sweating, abdominal pain, and lacrimation-the

  very same symptoms that had appeared in Patty Owen and Henry Noble. It even caused death in surprisingly low concentrations.

  All this meant to Jeffrey that if he was thinking of a contaminant, it would have to have been a compound that mirrored local anesthetics to an extent, something like nicotine. But it couldn't have been nicotine, thought Jeffrey. The toxicology report on Henry Noble had been negative; something like nicotine would have shown up.

  If there had been a contaminant it would also have to have been in an extremely small, nanomolar amount. Therefore it would have to have been something extraordinarily potent. As to what that could have been, Jeffrey hadn't a clue. But in his reading Jeffrey stumbled across something he'd remembered from medical school, but had not thought of since. Botulinum toxin, one of the most toxic substances known to man, mirrored local anesthetics in its ability to "freeze" neural cell membranes at the synapse. Yet Jeffrey knew he was not seeing botulinum poisoning. Its symptoms were totally different; muscarinic effects were blocked, not stimulated.

  Never had time passed so quickly. Before Jeffrey knew it, the library was about to close for the night. Reluctantly, he gathered up Chris Everson's notes as well as his own that he'd just made. Carrying the books in one hand and his briefcase in the other, he descended to the first floor. He left the books on the counter to be reshelved and started for the door. He stopped abruptly.

  Ahead people were being stopped by an attendant to open their parcels, knapsacks, and, of course, briefcases. It was standard practice to keep the loss of books to a minimum, but it was a practice Jeffrey had forgotten about. He hated to think what the reaction might be if the library guard got a look at his stacks of hundred-dollar bills. So much for staying low profile.

  Jeffrey doubled back to the periodical section and ducked behind a shoulder-high display case. He opened his briefcase and began tojam the packets of paper money in his pockets. To make room, he pulled the pint of vodka from his jacket side pocket and packed it in the briefcase. Better to let the guard think he was a tippler than a drug dealer or thief.

  Jeffrey was able to leave the library without incident. He felt a little conspicuous with all his pockets bulging, but there was nothing to be done about it just then.

  There were practically no cabs on Huntington Avenue at that time of night.

  After he tried for ten minutes to no avail, the

  Green Line trolley came along. Jeffrey got on, feeling it was more prudent to keep moving.

  Jeffrey took one of the seats oriented parallel to the car and balanced the briefcase on his knees. He could feel all of the packets of money that were in his pants, particularly the ones he was sitting on. As the trolley lurched forward, Jeffrey allowed his eyes to roam around the car.

  Consistent with his experience on Boston subways, no one said a word.

  Everyone stared ahead expressionlessly as if in a trance. Jeffrey's eyes met those of the other travelers who were sitting across from him. The people who sullenly returned his state made him feel transparent. He was amazed at how many of them in his mind looked as if they were criminals.

  Closing his eyes, Jeffrey went over some of the material he'd just read, considering it in light of the experience he'd had with Patty Owen and

  Chris's with Henry Noble. He'd been surprised by one piece of information about local anesthetics. Under a section marked "adverse reactions," he'd read that occasionally miotic or constricted pupils were seen. That was new to Jeffrey. Except for Patty Owen and Henry Noble, he'd never seen it clin- ically or read it before. There was no explanation of the physiological mechanism, and Jeffrey couldn't explain it. Then in the same article it was written that usually mydriasis, or enlargement, of the pupils was seen. At that point Jeffrey gave up the issue of pupillary size. It all didn't make much sense to him and only added to his confusion.

  When the trolley suddenly plunged underground, the sound startled Jeffrey.

  He opened his eyes in terror and let out a little gasp. He hadn't realized how jumpy he was. He began to take deep, steady breaths in order to calm himself

  After a minute or two, Jeffrey's thoughts returned to the cases. He realized there was another similarity between the Noble and Owen cases that he'd not considered. Henry Noble had been paralyzed for the week he'd lived. It was as if he'd had total irreversible spinal anesthesia. Since

  Patty had died, Jeffrey had no idea if she would have suffered paralysis had she lived. But her baby had survived and did display marked residual paralysis. It had been assumed that the baby's paralysis stemmed from a lack of oxygen to his brain, but now Jeffrey wasn't so sure. The strange, asymmetric distribution had always troubled him. Maybe this paralysis was a
n additional clue, one that might be of use in identifying a contaminant.

  Jeffrey got off the subway at Park Street and climbed the

  stairs. Giving wide berth to several policemen, he hurried down Winter

  Street, leaving the crowded Park Street area behind. As he walked, he thought more seriously about getting back into Boston Memorial Hospital now that he'd done his reading.

  The idea of becoming part of the housekeeping staff had a lot of merit except for one problem: to apply for a job he'd need to provide some sort of identification as well as a valid social security number. In this day of computers, Jeffrey knew he couldn't expect to get by by making one up.

  He was wrestling with the problem of identification when he turned onto the street where the Essex Hotel stood. Half a block away from the liquor store, which was still open, he paused. A vision of the man in the tattered suit came back to him. The two of them had been about the same height and age.

  Crossing the street, Jeffrey approached the empty lot next to the liquor store. A strategically placed streetlamp threw a good deal of light into the area. About a quarter of the way into the lot there was a concrete overhang sticking out of one of the bordering buildings that looked like it could have been an old loading dock. Beneath it Jeffrey could make out a number of figures, some sitting, some passed out on the ground.

  Stopping and listening, Jeffrey could hear conversation. Overpowering any misgivings, he started toward the group. Stepping gingerly on a bed of broken bricks, Jeffrey approached the overhang. A fetid odor of unwashed humans assaulted his senses. The conversation stopped. A number of rheumy eyes regarded him suspiciously in the semidarkness.

  Jeffrey felt he was an intruder in another world. With rising anxiety, he searched for the man in the tattered suit, moving his eyes quickly from one dark figure to the next. What would he do if these men suddenly sprang at him?

  Jeffrey saw the man he was looking for. He was one of the men sitting in the semicircle. Forcing himself forward, Jeffrey approached closer. No one spoke. There was an electric charge of expectation in the air as if a spark could cause an explosion. Every eye was now following Jeffrey. Even some of the people who'd been lying down were now sitting up, staring at him.

  "Hello," Jeffrey said limply when he was in front of the man. The man didn't move. Nor did anyone else. "Remember me?" Jeffrey asked. He felt foolish, but he couldn't think of what else to say. "I gave you some change an hour or so ago. Back there, in front of the liquor store." Jeffrey pointed over his shoulder.

  The man didn't respond.

  "I thought maybe you could use a little more," Jeffrey said. He reached into his pocket, and pushing away the packet of hundred-dollar bills, pulled out some change and several smaller bills. He extended the change.

  The man reached forward and took the coins.

  "Thanks, buddy," he managed, trying to see the coins in the darkness.

  "I've got more," Jeffrey said. "In fact, I've got a five-dollar bill here, and I'm willing to bet that you're so drunk, you can't remember your social security number."

  "Whaddya mean?" the man mumbled as he struggled to his feet. Two of the other men followed suit. The man Jeffrey was interested in swayed as if he were about to fall, but caught himself. He appeared drunker than he'd been earlier. "It's 139-321560. That's my social security number."

  "Oh, sure!" Jeffrey said with a wave of dismissal. "You just made that up."

  "The hell I did!" the man said indignantly. With a sweeping gesture that almost knocked him off his feet, he reached for his wallet. He staggered again, struggling to lift the wallet from his trouser pocket. After he got it out, he fumbled to remove not a Social Security card, but his driver's license. He dropped the wallet in the process. Jeffrey bent down to pick it up. He noticed there was no money in it.

  "Lookit right here!" the man said. "Just like I said."

  Jeffrey handed him the wallet and took the license. He couldn't see the number but that wasn't the point. "My word, I guess you were right," he said after he pretended to study it. He handed over the five-dollar bill, which the man grabbed eagerly. But one of the other men grabbed it out of his hand.

  "Gimme that back!" the man yelled.

  Another of the men had advanced behind Jeffrey. Jeffrey reached into his pocket and pulled out more coins. "There's some for everybody," he said as he tossed them on the ground. They clinked against the broken brick. There was a rush as everyone but Jeffrey dropped to his hands and knees in the darkness. Jeffrey took advantage of the diversion to turn and run as quickly as he dared across the rubble-strewn lot toward the street.

  Back in his hotel room, he propped the license up on the edge of the sink and compared his image to that of the photo on the license. The nose was completely different. Nothing could be done about that. Yet if he darkened his hair and combed it

  straight back with some gel the way he'd thought he would, and if he added some black-framed glasses, maybe it would work. But at the very least, he had a valid social security number associated with a real name and address: Frank Amendola, of 1617 Sparrow Lane, Framingham, Massachusetts.

  WEDNESDAY,

  MAY 17, 1989

  6:15 A.M.

  Trent Harding wasn't due to start work until seven, but at sixfifteen he was already pulling off his street clothes in the locker room off the surgical lounge of St. Joseph's Hospital. From where he was standing, he had a straight shot to the sinks and he could see himself in the over-the-basin mirrors. He flexed his arm and neck muscles so that they bulged. He hunched over slightly to check their definition. Trent liked what he saw.

  Trent went to his health club at least four times a week to use the

  Nautilus equipment to the point of exhaustion. His body was like a piece of sculpture. People noticed and admired it, Trent was sure. Yet he wasn't satisfied. He thought he could stand to beef up his biceps a bit more. On his legs, his quads could use tightening. He planned to concentrate on both in the coming weeks.

  Trent was in the habit of arriving early, but on this particular morning, he was earlier than usual. In his excitement he'd awakened before his alarm and could not go back to sleep, so he'd decided to get to work early.

  Besides, he liked to take his time. There was something unbelievably exhilarating about placing one of his doctored Marcaine ampules in the

  Marcaine supply. It gave him shivers of pleasure-like planting a time bomb.

  He was the only one who knew about the imminent danger. He was the one who controlled it.

  After he'd gotten into his scrub outfit, Trent glanced around him. A few people who were going off shift had come into the locker room. One was in the shower singing a Stevie Wonder tune; another was in one of the toilet stalls; and a third was at his locker well out of sight.

  Trent reached into the pocket of his white hospital jacket and pulled out the doctored ampule of Marcaine. Palming it in case

  someone unexpectedly appeared, Trent slipped it into his briefs. It felt cold and uncomfortable at first; he grimaced as he adjusted it. Then he closed his locker and started walking toward the lounge area.

  In the surgical lounge, fresh coffee was softly perking, filling the room with its pleasant aroma. Nurses, nurse anesthetists, a few doctors, and orderlies were gathered there. Soon they'd be going off shift. There were no emergency cases in progress, and all the preparations for the day's schedule for which the night shift was responsible were complete. The room rang with happy conversation.

  No one acknowledged Trent, nor did he try to say hello to anyone. Most of the staff didn't recognize him since he was not a member of the night shift. Trent passed through the lounge and entered the OR area itself. No one was at the main scheduling desk. The huge blackboard was already chalked with the upcoming day's schedule. Trent paused briefly, scanning the big board for two things: to see which room he was assigned to for the day and to see if there were any spinal or epidural cases scheduled. To his delight there was a handful. Another shiver
of excitement went down his spine. Having a number of such cases meant there was a good chance his

  Marcaine would be used that very day.

  Trent continued down the main OR corridor and turned into Central Supply, which was conveniently located in the middle of the OR area. The operating room complex at St. Joe's was shaped like the letter U with the ORs lining the outside of the U and Central Supply occupying the interior.

  Moving with a sense of purpose, as if he were heading into Central Supply to get a setup pack for one of the ORs, Trent took a loop around the whole area. As usual, no one was there. There was always a hiatus between six-fifteen and six forty-five when Central Supply was unoccupied.

  Satisfied, Trent went directly into the section that housed the IV fluids and the nonnarcotic and uncontrolled drugs. He did not have to search for the local anesthetics. He'd scouted them out long ago.