Critical Judgment (1996) (30 page)

Love, marriage, kids, a reasonably interesting job, a nice place to live. Her goals in moving to Patience had always seemed perfectly straightforward—never farfetched or self-serving. And it had all started out so right, so innocent.
How in the hell had all this happened?

Ironically, Claire Buchanan had been placed in the
same cubicle Willie Cardoza had occupied. She still had the lifesaving NT tube in place, but Abby noted through the glass wall that the tube was now attached to moisturized oxygen, not to a ventilator. A very good sign. There was a beefy man in a turtleneck and sports coat seated next to her stroking her hand. Dennis Buchanan, the man who could sell iceboxes to Eskimos, the man who had rescued Claire from the Rockettes. Watching his gentle, concerned attentiveness brought a bittersweet fullness to Abby’s throat. Once upon a time Josh had cared for her like that. And knowing that he did had made almost every problem in life bearable.

She shook off her melancholy as best she could and moved closer to the glass. Claire’s lips were much less swollen already, and her eyes, though still puffy, were open. The terrible inflammation in her skin had also begun to ebb. With any luck she would have the tube removed before long. Abby saw no sense in trying to speak with her at this point, especially while her husband was there. But later tonight she would stop by again. Even if the tube was still in, Claire would probably be alert and strong enough to communicate in writing. And there were a number of questions Abby wanted answered, the most pressing being: What happened?

Abby started out of the unit. Then, bothered by the persistent gnawing feeling that she was missing something, she suddenly turned and went to the nurses’ station. Claire’s old hospital record was in a slot just below the loose-leaf-bound current record. The old record wasn’t large. There were no inpatient stays before this one, except for the delivery of a healthy baby girl sixteen years before, and only five emergency-room visits: the two in which Abby had been her doctor, a sprained ankle, removal of a piece of glass from her foot, and an episode of upper-abdominal pain that was believed to be gastritis.

Gastritis
. Claire had said something about that, something that Abby thought was unusual at the time.
She flipped through the laboratory and X-ray reports. Blood counts had been done on the evening Claire had come into the ER with belly pain. Then, a day later, she’d had an MRI, which was normal. That was it. That was what had seemed so weird when Claire had first mentioned it.

An MRI, appropriate when a doctor suspected a condition not easily visualized by conventional X rays, seemed an odd and extravagantly expensive choice in view of Claire’s symptoms. And for someone with claustrophobia, like Claire, it was bound to be an ordeal. In addition, the time required to run each study meant that there was often a long waiting period to get one done. Yet George Oleander had ordered an MRI without first going to an upper GI series, or even, from what Abby could tell, a trial course of treatment. Why?

And why had he ordered a second MRI today?

Abby left the unit and returned to the MRI suite. It occurred to her for the first time how unusual it was for a hospital the size of Patience Regional to have its own MRI machine at all. Granted, the facility served a fairly large geographic area. But as far as she knew, most hospitals this size referred patients to a freestanding MRI center that served several hospitals. And some facilities actually contracted with a mobile unit that was built inside a tractor trailer and hauled from hospital to hospital. Yet here was PRH with not only an MRI, but a very up-to-date CT scanner as well. And there was a great deal of crossover in the diagnostic capabilities of the two techniques.

The room housing the gleaming MRI unit showed no hint of the drama that had unfolded there just two hours before. The floor was polished and the machine was already in operation again. Del Marshall sat outside the room at a console, checking the remarkably precise images as the machine produced them. Inside, the sheet-covered feet of the patient could be seen just inside the cylinder.

“Hi,” Abby said. “How’re you doing?”

Marshall looked up at her and smiled warmly. He was a lean, fatherly man, with Ben Franklin glasses and razor-cut gray hair.

“I didn’t have a coronary in there, if that’s what you mean.”

“You actually seemed to be handling yourself pretty well.”

“That’s kind of you to say, but I know better. It’s one thing to take all those courses in CPR and advanced CPR. It’s quite another to be confronted with a flesh-and-blood patient who’s stopped breathing—especially when it happens in your MRI machine. I can understand my being a basket case, but I confess I was a little surprised Jill Anderson wasn’t more up to the task. I don’t know what would have become of that poor Buchanan woman if you hadn’t been there.”

“Thanks. Del, do you have any idea what happened in there?”

“No, no idea at all,” he responded with knee-jerk quickness. “One moment she was perfectly peaceful, the next she was thrashing about violently, kicking the inside of the tube. We pulled her out, and she was already swelling up and turning beet-red.”

“Well, I just stopped by the unit, and she seems to be making a nice recovery. I was wondering if you would happen to have Mrs. Buchanan’s request sheet in there. I just want to get some data for my dictation.”

Abby phrased the question carefully. She had no idea how connected the radiologist was to Henderson or to George Oleander. And the last thing she wanted was for either of them to know she was poking around for more information.

Marshall called up Claire’s sheet on one of the screens. The specific line Abby was looking for was
Provisional Diagnosis
. According to it, Oleander had requested the study for
recurrent hives, possible occult malignancy
.

The diagnosis of possible occult malignancy was reasonable enough. Hives sometimes
were
the outward manifestation of serious internal disease. But this MRI, like Claire’s previous one, seemed to have been ordered prematurely. Of course, there could have been any number of diagnostic studies done through Oleander’s office of which Abby would have been unaware. But she sensed that was not the case. Oleander had a strange predilection for ordering MRIs, as did the other physicians with NIWW patients. But there was something else about the MRIs—something that seemed to be floating just beyond her grasp.

There was just enough time before her ER shift to go home and review the data she had managed to gather so far—focusing this time on the MRIs. The PuPu Platter would have to wait for another day.

Abby thanked the radiologist and left the hospital trying to sort out what she was discovering, and what pieces were missing. Pending the results of the assay of Willie Cardoza’s blood, she would try assuming for the moment that all of the NIWWs, including Cardoza, Claire Buchanan, and even Josh, were cadmium toxic to one degree or another. How could that possibly tie in with the inappropriate, excessively ordered MRIs?

Unlike standard X rays or even CT scans, which were a computerized integration of hundreds of individual X rays, magnetic resonance imaging involved placing the patient in a magnetic field and then bombarding that person with radio waves. The billions of hydrogen ions in the body, mostly located in water, would vibrate under the influence of the magnet in such a way that their density could be measured and then converted to incredibly detailed slices through the body. The slices were used to create three-dimensional pictures of any organ. The science behind an MRI was straight out of
Star Trek
, and for years many distinguished scholars had derided the believers. But scholars had laughed at Newton, too.

As far as Abby knew, no adverse effects of any real
consequence had been attributed to magnetic resonance imaging. At a lecture on the technique sometime in the past year, she had learned that there was a slight but significant rise in body temperature in patients undergoing the test, possibly caused by the intense radio-wave bombardment. With time and a massive volume of cases it seemed possible something else would show up. But for the time being the temperature rise was it—except, of course, for the psychological trauma of lying in a metal tube for most of an hour, unable to move at all, surrounded by the echoing pings, hums, and clangs of the charging and discharging electromagnet.

The problem, as Abby saw it, was coming up with a workable explanation for how the MRIs fit in with the varied clinical presentations of the NIWWs. The understanding of the biochemistry of the brain was still in its infancy. Perhaps, she reasoned, the radio waves, the magnetic field, or even the claustrophobic effects of being slid into the narrow tube set off some sort of chemical discharge. And perhaps, in the presence of cadmium, that chemical discharge short-circuited the brain.
Perhaps. Perhaps. Perhaps
.

The truth was, the explanations she was conjuring up didn’t make much sense. Some cases fit, some didn’t. There simply wasn’t any consistent pattern. Willie Cardoza had an MRI after his head injury. Josh had never been ill before coming to Patience, and had never had an MRI. Claire Buchanan seemed to be having trouble with her immune system—especially the immune chemicals in the skin. Other NIWW patients had nothing more than persistent fatigue, and still others, a chronic cough that was unresponsive to antibiotics.

By the time Abby arrived home, the best theory she had come up with was that she had stumbled by accident on a scam to raise revenues for the hospital or justify its MRI unit by ordering an excessive number of tests. What did the scam have to do with the NIWWs? Probably nothing.

Upon her hurried return home from the computer room at the community-college bookstore, Abby had searched for a spot to hide the loose-leaf notebook containing her data sheets. She thought there was a good chance that someone, probably Lyle Quinn, would try to find and destroy them. Finally she had settled on a hollowed-out area just behind the furnace in the basement. The spot would probably yield to a careful search, but the searcher would have to wade through a hell of a lot of junk first.

She carried the notebook upstairs to the dining-room table and brought out a blank sheet of paper. This time she would concentrate on just the MRIs. She jotted down the dates when the tests had been done, the doctor, the diagnosis, the results. Nothing. The only finding that looked like a pattern was that in most cases the study was negative. She rubbed at her eyes and paced around the house. Something was there. She felt certain of it. Maybe she needed more cases. But more likely she was approaching her work with a burden of preconceived notions. If she could only clear her mind of expectations …

She was still pacing when her beeper went off. The return number was not local, but still in the 916 area. Lew answered on the first ring. Abby had never heard him so excited.

“I’m at the state hospital in Caledonia,” he said. “And one of the patients we have here right now is Angela Cristoforo. Do you know who that is?”

“Yes, the girl who cuts herself.”

“Exactly. Well, this is the second time she’s been here since that incident at the Colstar picnic. This time her mother found her burning herself with a curling iron. Apparently she had set her bed on fire as well.”

Abby flashed on the scene at Colstar Park—Angela screaming at Lyle Quinn, with Willie Cardoza approaching her, ever so carefully, from behind.

“…  Let me die! I deserve to die!”

“Poor baby,” she said.

“Poor baby, maybe,” Lew said, “but she’s also the break we’ve been waiting for. And you did it.”

“I don’t understand.”

“Her eyes. I finished doing an intake exam on her, and then I started thinking about the rings you found in Willie Cardoza. Angela Cristoforo
has
them, Abby! The same ones you described. Invisible under regular light, glowing like fire under a black light. Both of them are poisoned, both of them are violently insane, and both of them worked for you-know-who. Have you heard anything from your friend in San Francisco?”

“Not yet. Soon, I think. In fact, I thought this page from you might be Sandy. Have you drawn blood on Angela?”

“I’m about to. Abby, we’re going to
get
them. I knew we would. As soon as you mentioned those NIWWs of yours, I knew we’d get them. All we need now is a little more time—just a little more time to get everything organized and put our findings together.”

A little more time may be all I have left around here
.

“Lew, that’s great news. You’ve worked very hard for this these past years. You deserve a breakthrough.”

“You were the breakthrough, Abby. You did it. Will you page me as soon as you hear about Cardoza’s blood?”

“Of course. Where are you now?”

“In the on-call room. But I have to see some patients. It’s a full moon.”

“Lord. That bodes ill for my shift in the ER tonight.”

Abby decided against telling him anything about her meeting with Joe Henderson or the fabricated autopsy report. This was Lew’s moment. There was no reason to spoil it.

“Abby, I can’t wait to see you again. How about tomorrow? We can have lunch at my place.”

“Sure. That would be fine.”

“You don’t sound that enthused.”

“Oh, I am, Lew. I just have a lot on my mind. Remember, Colstar has been your fight for several years. I’m just trying to keep my head above water here.”

“I understand. I’m sorry—I keep making the same dumb assumption about you and the Alliance over and over again.”

“It’s all right. I’m on your side. You know that.”

“Are you headed into the hospital now?”

“Yes. There’s a patient in the unit whose eyes I want to check.”

“Just keep me posted.”

Abby set the receiver down, replaced the notebook behind the furnace, and gathered her things for work. Lew was right. She had sounded lukewarm about having lunch with him. And he didn’t deserve that. She was justifiably upset over what had happened with Henderson and
un
justifiably angry at Lew for not being around to help her come up with the appropriate response. Little Abby Dolan, feeling sorry for herself. That was it in a nutshell. Lew was off now seeing patients. But as soon as there was a chance later on, she would call and apologize. She was down to one ally she could really count on in Patience. Now she was trying to drive him off.