"A set of twins."
"How's Beverly Vitale?"
"Her blood count's down this morning. Twenty-five. She's due for a recheck in an hour or two. Any further drop, and we'll give her more blood."
"Her GI tract?
" Kate asked, speculating on the site of blood loss. "Probably. There's been some blood in every stool we've checked. She's on steroids, you know."
"I do know. Withhold steroids, and her antibodies run wild, destroying her own clotting factors, use them, and she risks developing bleeding ulcers. It's one of those situations that makes me grateful I decided on pathology. Stan Willoughby and I reviewed the ovary sections this morning. His impression is that the findings are unique. He's doing some special stains now and has sent slides to a colleague of his at Johns Hopkins, whom he says is as good as anyone in the business at diagnosing ovarian disorders. He also is calling around town to see if anything like this has turned up in another department."
"Etiology?"
"No clues, Tom. Virus, toxin, med reaction. All of the above, none of the above, A and B but not C. She told you she wasn't on any meds, right?"
"None except vitamins. The multivitamin plus iron we dispense through the Omnicenter."
"Well I'm living proof those don't cause any problems. I've taken them for a couple of years. Make frail pathologist strong like bull." Kate flexed her biceps. "Make pathologist excellent teacher, too."
"Why, thank you." Kate's green eyes sparkled. "Thank you very much, Tom." For a moment, she saw him blush. "How about we go say hello to Beverly. I'd like to make extra sure about one or two aspects of her history. Here, you can stick this salad in that refrigerator for later."
"Provided the bacteria who call that icebox home don't eat it first,"
Tom said. The two were heading down the hall toward the stairway when the overhead page snapped to life. "Code ninety-nine, Ashburton five-ohtwo, code ninety-nine, Ashburton five-oh-two."
"Oh, Jesus."
Tom was already racing toward the exit as he spoke. Kate was slower to react. She was almost to the stairway door before she realized that Ashburton 502 was Beverly Vitale's room. It had been a year, perhaps two, since Kate had last observed a cardiac arrest and resuscitation attempt. She was certified in advanced cardiac life support, but training and testing then had been on Resusciannie, a mannequin. Her practical experience had ended years ago, along with her internship. At the moment, however, none of those considerations mattered. What mattered was the life of a young woman who loved to make music. With an athlete's quickness, Kate bolted after Tom Engleson up the stairs from Ashburton Four to Ashburton Five. There were more than enough participants in the code. Residents, nurses, medical students, and technicians filled room 502 and overflowed into the hall. Kate worked her way to a spot by the door, from which she watched the nightmare of Beverly Vitale's final minutes of life. It was a gastric hemorrhage, almost certainly from an ulcer eroding into an artery. The woman's relentless exsanguination was being complicated by the aspiration of vomited blood. Cloaked in abysmal helplessness, Kate witnessed Tom Engleson, desperation etched on his face, issuing orders in a deceptively composed tone, the organized chaos of the white-clad code team, pumping, injecting, monitoring, reporting, respirating, suctioning, and through the milling bodies, the expressionless, blood-smeared face of Beverly Vitale. For nearly an hour the struggle continued, though there was never a pulse or even an encouraging electrocardiographic pattern. In the end, there was nothing but another lesson in the relative impotence of people and medicine when matched against the capriciousness of illness and death. Tom Engleson, his eyes dark and sunken, shook his head in utter futility. "It's over, " he said softly. "Thank you all. It's over."
Simultaneously with hearing the report from the WEEI traffic helicopter of a monumental backup stemming from the Mystic/Tobin Bridge, Kate became part of it. Commuting to the city from the North Shore was an experience that she suspected ranked in pleasantness somewhere between an IRS audit and root canal work. Although Tuesday was normally a low-volume day, this morning she had encountered rain, sleet, snow, and even a bizarre stretch of sunlight during her thirty-mile drive, far too much weather for even Boston drivers to attack. With a groan, she resigned herself to being half an hour late, perhaps more, for the appointment Stan Willoughby had arranged for her at White Memorial Hospital. The pathology chief's call had punctuated another confusing, bittersweet morning with Jared. It seemed as if the intensity and caring in their relationship was waxing and waning not only from day to day but from hour to hour or even from minute to minute. In one sentence the man was Jared Samuels, the funny, sensitive, often ingenuous fellow she had married and still loved deeply, in the next he was calculating and distant, a miniature of his father, intransigent on points they should have been working through as husband and wife. At last, after an awkward hour of lighting brush fires of dissension and then scurrying to stamp them out, Jared had suggested a week or ten days together in Aruba, away from the pressures and demands of their careers. "What do you say, Boots? " he had asked, calling on the pet name she favored most of the four or five he used. "Aruba you all over." The expression in his eyes-urgency? fear? — belied his levity. "Aruba you too, Jared, " she had said finally. "Then we go?"
"If Stan can give me the time off, and if you can stand the thought of trying to hang onto a woman swathe in Coppertone, we go."
At that moment, Jared looked reborn. "Grumper-to-grumper, stall-and-crawl traffic headed in a snail trail toward the bridge, thanks to a fender bender in the left-hand lane." The Eye-in-the-Sky was sparing none of his cliches in describing the mess on Route 1 south.
Kate inched her Volvo between cars, but gained little ground. Finally, resigned to the situation, she settled back, turned up the volume on the all-news station, and concentrated on ignoring the would-be Lothario who was winking and waving at her from the Trans-Am in the next lane. The news, like Stan Willoughby's call, dealt with the sudden death of Red Sox hero Bobby Geary, a homegrown boy who had played his sandlot ball in South Boston, not a mile from the luxurious condominium where he was found by his mother following an apparent heart attack. Stan's name was mentioned several times as the medical examiner assigned to autopsy the man who had given away thousands of free tickets and had added an entire floor to Children's and Infants' Hospital in the name of "the kids of Boston."
"Kate, " Willoughby had begun, "I hope I'm not interrupting anything."
"No, no. Just getting ready for work, " she had said, smiling at Jared, who was nude by the bathroom door dancing a coarse hula and beckoning her to the shower with a long-handled scrub brush. "Well, I don't want you to come to work."
"What?"
"I want you to go to White Memorial. You have an appointment in the pathology department there at eight-thirty. Leon Olesky will be waiting for you. Do you know him?"
"Only by name."
"Well, I called around town trying to see if anyone had seen a case similar to our Miss Vitale's. Initially there was nothing, but late last night Leon called me at home. From what he described, the two cases — his and ours-sound identical. I told him you'd be over to study his material."
"How old was the woman? " Kate had asked excitedly. "I don't remember what he said. Twenty-eight, I think."
I)m "Cause of death?"
"Ah ha! I thought you'd never ask. Cerebral hemorrhage, secondary to minor head trauma."
"Platelets?
Fibrinogen? " Her hand was white around the receiver. "Leon didn't know.