The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 123

Nat Rourke's office was in a solid old building behind the State House, comfortable but shabby. The lawyer himself reminded R.J. of pictures she had seen of Irving Berlin, a small man with sallow complexion and sharp features, nattily dressed in dark and subdued colors, very white shirt, a university tie whose symbol she didn't recognize. Penn, she found out later.

Rourke asked Tom to recount for him all the circ.u.mstances leading up to Elizabeth Sullivan's death. He watched Tom intently, a good listener, not interrupting, staying with the narrative until the end. Then he nodded, pursed his lips, leaned back in his chair with his hands folded on his vested belly, over the Phi Beta Kappa key.

"Did you kill her, Dr. Kendricks?"

"I didn't have to kill her. The cancer took care of that. She would have stopped breathing on her own, a matter of hours, a matter of days. She could never again be conscious, never again be Betts, without agony. I'd promised her she wouldn't suffer. She was already receiving very heavy dosages of morphine. I increased the dosage to make certain she wouldn't have further pain. If it brought death sooner rather than later, that was perfectly all right with me."

"The thirty milligrams that Mrs. Sullivan received by mouth twice a day. I would suppose it was a slow-acting form of morphine?" Rourke said.

"Yes."

"And the forty milligrams you gave her by needle, that was fast-acting morphine, in sufficient amount perhaps to inhibit her respiration."

"Yes."

"And if it inhibited her respiration sufficiently, that would cause death."

"Yes."

"Were you having an affair with Mrs. Sullivan?"

"No." They discussed Tom's early relationship with Elizabeth, and the lawyer seemed satisfied.

"Have you in any way benefited financially from Elizabeth Sullivan's death?"

"No." Tom told him the terms of Betts's will. "Is Wilhoit going to make something dirty of this?"

"Very possibly. He's an ambitious pol, interested in moving up in the world, lieutenant governor. A sensational trial would be a springboard. If he could get you convicted of murder in the first degree, sentenced to life imprisonment without parole, with big, black headlines, pats on his back, lots of splash, he'd be made. But first-degree murder isn't going to happen in this case. And Mr. Wilhoit is too shrewd a politician even to bring the case to the grand jury unless he has a good chance to convict. He'll wait for the hospital Medical Incidents Committee to give him direction."

"What's the worst thing that can happen to me in this case?"

"Bleakest scenario?"

"Yes. Worst."

"No guarantees that I'm right, of course. But I would guess your worst scenario would be conviction for manslaughter. The sentence would be incarceration. This kind of case, it's likely the judge would be sympathetic and give you what we call a 'Concord sentence.' He would sentence you to the Ma.s.sachusetts Correctional Inst.i.tution at Concord for twenty years, thus preserving his reputation as a judge who was tough on crime. But he'd be giving you easy time, because at Concord you would be eligible for parole after serving only twenty-four months of the sentence. So you could use the time to write a book, get famous, earn a potful of money."

"I would lose my license to practice medicine," Tom said levelly, and R.J. could almost forget that she had stopped loving him a long time ago.

"Keep in mind that we've been talking about the worst scenario. The best scenario would be that the case doesn't go to the grand jury. Accomplishing the best scenario is why I get paid the big money," Rourke said.

It was easy to move into a discussion of his fee. "Case like this, anything could happen, or nothing. Ordinarily, if the defendant were someone not terribly respectable, I would ask for an initial retainer, twenty thousand. But ... you are a professional man of high reputation and good character. I think your best bet would be to hire me on a time-spent basis. Two and a quarter an hour."

Tom nodded. "Sounds like a bargain to me," he said, and Rourke smiled.

They reached the high-rise courthouse at five minutes to five, ten minutes after Rourke had said they would get there. It was the end of the workday and people were pouring out of the building with the pleased energy of children released from school. "Take your time, we're in no hurry," Rourke said. "It'll do him good to meet us on our own schedule. That business of sending troopers to fetch you at the crack of dawn is strictly cheap intimidation, Dr. Kendricks. An invitation to the ball, you might say."

It was meant to tell them, R.J. knew with a chill, that the district attorney had gone to the trouble of learning Tom's timetable, not something he would do for a routine matter.

They had to sign in with the guard at the desk in the lobby, and then the elevator whisked them to the fifteenth floor.

Wilhoit was lean and tanned, a big-nosed man who smiled at them as cordially as an old friend. R.J. had looked him up. Harvard College, '72; Boston College Law School, '75; a.s.sistant D.A., '75-'78; state representative, '78 until elected district attorney in 1988.

"How are you, Mr. Rourke? A pleasure to see you again. Nice to meet you, Dr. Kendricks, Dr. Cole. Yes, sit down, sit down."

Then he was all business, cool eyes and quiet questions, most of which Tom already had answered for Rourke during the course of the afternoon.

They had obtained and studied Elizabeth Sullivan's medical file, Wilhoit told them. "It says that by order of Dr. Howard Fisher, the patient in Room 208 of the Middles.e.x Memorial Hospital had been receiving an oral morphine medication known as Contin, thirty milligrams twice a day.

"Let's see now. ... At two-ten a.m., the night in question, Dr. Thomas A. Kendricks entered into the patient's record a written order for forty milligrams of morphine sulphate to be injected intravenously. According to the medications nurse, Miss Beverly Martin, the doctor told her he'd give the needle himself. Martin said that half an hour later, when she entered Room 208 to check the patient's temperature and blood pressure, Mrs. Sullivan was dead. Dr. Kendricks was seated next to her bedside, holding her hand." He looked at Tom. "Are those facts essentially correct as I have presented them, Dr. Kendricks?"

"Yes, I would say they are accurate, Mr. Wilhoit."

"Did you kill Elizabeth Sullivan, Dr. Kendricks?"

Tom looked at Rourke. Rourke's eyes were guarded, but he nodded, signifying that Tom should answer.

"No, sir. Cancer killed Elizabeth Sullivan," Tom said.

Wilhoit nodded, too. He thanked them politely for coming, and he indicated that the interview was at an end.

6.

THE CONTENDER.

There was no further word from the district attorney, no story in the newspapers. R.J. knew silence could be ominous. Wilhoit's people were at work, talking to nurses and doctors at Middles.e.x, a.s.sessing whether they had a case, whether it would help or hurt the district attorney's career if he tried to crush Dr. Thomas A. Kendricks.

R.J. concentrated on her work. She posted notices in the hospital and at the medical school announcing the formation of the publications committee. When the first meeting was held, on a snowy Tuesday evening, fourteen people showed up. She had expected the committee to attract residents and young doctors, the unpublished. But several senior physicians attended, too. It shouldn't have surprised her. She knew at least one man who had become a medical school dean without having learned how to write acceptable English.

She set up a monthly schedule of lectures by medical journal editors, and several of the doctors volunteered to read their own papers-in-progress at the next meeting so they could be critiqued. She had to admit that Sidney Ringgold had antic.i.p.ated a need.

Boris Lattimore, an elderly physician on the hospital's visiting staff, pulled R.J. aside in the cafeteria and whispered that he had news for her. Sidney had told him the next a.s.sociate chief of medicine would be either R.J. or Allen Greenstein. Greenstein was a hotshot researcher who had developed a much-publicized program for the genetic screening of newborns. R.J. hoped the rumor was wrong; Greenstein was daunting compet.i.tion.

The new committee responsibility wasn't difficult; it added to her schedule and nibbled away at her precious free time, but she was never tempted to sacrifice her Thursdays. She was aware that without sanitary, modern clinics many women would die trying to end pregnancies themselves. The poorest women, those without medical insurance, money, or enough sophistication to find out where help was available, still tried to end their own pregnancies. They drank turpentine, ammonia, and detergent, and poked things into their cervixes-coat hangers, knitting needles, kitchen tools, any instrument that promised to bring on a miscarriage. R.J. worked at Family Planning because she felt it was essential for a woman to have adequate services available if she needed them. But it was becoming harder and harder for the medical staff at Family Planning. Driving home after a busy Wednesday at the hospital, R.J. heard on the car radio that a bomb had exploded at an abortion clinic in Bridgeport, Connecticut, knocking out a portion of the building, blinding a guard, and injuring a staff secretary and two patients.

The next morning at the clinic, Gwen Gabler told R.J. she was resigning, moving away.

"You can't," R.J. said.

She, Gwen, and Samantha Potter had been close friends since medical school. Samantha was a fixture on the faculty of the University of Ma.s.sachusetts medical school in Worcester, her anatomy cla.s.s already a legend, and R.J. didn't get to see her as frequently as they would like. But she and Gwen had spent time together regularly and often for eighteen years.

It was Gwen who had made it possible for her to continue to work at Family Planning, bolstering her when things became difficult. R.J. was not brave. She thought of Gwen as her courage.

Gwen smiled at her miserably. "I'm gonna miss the h.e.l.l out of you."

"So don't leave."

"I have to go. Phil and the boys come first." Mortgage rates had soared and the bottom had dropped out of the real estate market. Phil Gabler had had a disastrous business year, and the Gablers were moving west, to Moscow, Idaho. Phil was going to teach real estate courses at the university and Gwen was negotiating for a job as a gynecologist-obstetrician with a Health Maintenance Organization. "Phil loves to teach. And HMOs are where it's at. We've got to do something to change the system, R.J. Before long, we're all going to be working for HMOs." She and the Idaho HMO already had completed initial arrangements by phone.

They held hands tightly, and R.J. wondered how she would get along without her.

After Grand Rounds on Friday morning, Sidney Ringgold broke away from the gaggle of white coats and crossed the hospital lobby to where R.J. waited at the elevator.

"I wanted to tell you, I'm getting lots of positive feedback about the publications committee," he said.

R.J. was suspicious. Sidney Ringgold didn't usually go out of his way to deliver back pats.

"How's Tom doing these days?" he said casually. "I heard something about a complaint to the Medical Incidents Committee at Middles.e.x. Is it apt to give him any real trouble?"

Sidney had raised a lot of money for the hospital, and he had an exaggerated fear of bad publicity, even the kind that rubbed off on a spouse.

All her life she had intensely disliked the role of job candidate. She didn't give in to temptation, didn't tell him: You can take the appointment and stuff it. "No, no real trouble, Sidney. Tom says it's just a nuisance, nothing to worry about."

He leaned toward her. "I don't think you have anything to worry about, either. No promises, mind, but things look good. They look very good indeed."

His encouragement filled her with inexplicable gloom. "You know what I wish, Sidney?" she said impulsively. "I wish you and I were working to set up a family practice residency and clinic for Lemuel Grace Hospital, so the uninsured of Boston would have a place to get really top-flight medical care."

"The uninsured already have a place to go. We have a drop-in clinic that scores high numbers." Sidney's annoyance showed. He didn't like conversations about the medical inadequacies of his service.

"People come to the drop-in clinic only when they absolutely have to. They get a different doctor every time they come, so there's no continuity of care. They're treated for the illness or injury of the moment, and no preventive medicine is practiced. Sidney, we could start something if we turned out family pract.i.tioners. They're the doctors who are really needed."

His smile was forced now. "None of the Boston hospitals has a family practice residency."

"Isn't that a wonderful reason to start one?"

He shook his head. "I'm tired. I think I've done well as chief of medicine, and I have less than three years before retirement. I'm not interested in leading the kind of battle that would be necessary to set up a program like that. You can't come to me with any more crusades, R.J. If you want to make changes in the system, the way to do it is to earn your own place in the power structure. Then you can fight your own battles."

That Thursday, her secret backyard route into the Family Planning building was uncovered. The police detail that kept demonstrators pushed away from the clinic was late that morning. R.J. had parked in Ralph Aiello's yard and was going through the gate in the fence when she became aware of people pouring around both sides of the clinic building.

Lots of people, carrying signs, shouting, and pointing their fingers at her.

She didn't know what to do.

She knew there would be violence, what she had always been afraid of. She steeled herself to walk through them in silence, without visibly trembling. Pa.s.sive resistance. Think of Gandhi, she told herself, but instead she thought of doctors who had been attacked, clinic staff who had been killed or maimed. Crazy people.

Some of them ran past her, went through the gate and into the Aiello yard.

An aloof dignity. Think peace. Think of Martin Luther King. Walk through them. Walk through them.

She looked back and saw that they were taking pictures of the red BMW, crowding around it. Oh, the paint job. She turned around and pushed back through the gate. Someone punched her in the back.

"Touch that car and I'll break your arm!" she yelled.

The man with the camera turned and shoved it toward her face. The strobe lamp flickered again and again and again, nails of light piercing her eyes, screams like spikes driven into her ears, a kind of crucifixion.

7.

VOICES.

She called Nat Rourke right away and told him about the confrontation at the clinic.

"I thought you should know, so it wouldn't be a surprise in case they tried to use my activities against Tom."

"Yes. Thank you so very much, Dr. Cole," he said. He had a very courtly manner. R.J. couldn't tell what he was really thinking.

That evening, Tom came back to the house on Brattle Street early. She was seated at the kitchen table doing paperwork, and he came in and took a beer from the refrigerator. "Want one?"

"No, thanks."

He sat down opposite her. She had an urge to reach out and touch him. He looked tired, and in the old days she'd have gone around and ma.s.saged his neck. At one time they were very touchy. He had ma.s.saged her often. Lately they had tended to demonize one another, but she couldn't escape the fact that he had had many sweet traits.

"Rourke called me," Tom said, "and told me about what happened in Jamaica Plain."

"Oh?"

"Yeah. He, uh ... asked me about our marriage. And I was frank and truthful in my answer."

She looked at him and smiled. Then was then, she thought; this was now. "Always the best way."

"Yes. Rourke said if we're going to be divorced, proceedings should be inst.i.tuted at once, so that any controversy about your work at Family Planning won't prejudice my defense."

R.J. nodded. "It makes sense to me. Our marriage has been over for a long time, Tom."

"Yes. Yes, it has, R.J." He smiled at her. "Now would you like that beer?"

"No, thanks," she said, and went back to her paperwork.

Tom took some of his things and moved out at once, so easily she was convinced he had somebody's place to move right into.

At first she could detect no change in the house on Brattle Street, because she was accustomed to being alone there. She returned each night to the same empty house, but now there was a sense of peace, an absence of the signs of him that used to annoy and aggravate. A pleasing expansion of her personal s.p.a.ce.

Eight nights after he left, however, she began to receive telephone calls.