Harvest (20 page)

After she'd restarted Mary Allen's IV, Abby retreated to the on-call room and lay listlessly on the bed. Staring up at the ceiling, she wondered:What the hell is wrong with me? She'd never lost control like that before, never even come close to cursing at a patient or relative. I'm going crazy, she thought. The stress is finally breaking me. Maybe I'm not fit to be a doctor.

Her beeper went off. God, would they never leave her alone? What she'd give to go a whole day, a whole week, without being beeped or phoned or harassed. It was the hospital operator paging her. She picked up the phone and dialled "O'.

"Outside call for you, Doctor," said the operator. "Let me put it through." There were a few transfer clicks, then a woman said: "Dr. Abby DiMatteo?"

"Speaking."

"This is Helen Lewis at New England Organ Bank. You left a message last Saturday about a heart donor. We expected someone at Bayside to call back, but no one did. So I thought ! should check back."

"I'm sorry. I should have called you, but things have been crazy around here. It turns out it was just a misunderstanding."

"Well that makes it easy. Since I couldn't find the information anyway. If you have any other questions, just give me a--' "Excuse me," Abby cut in. 'what did you just say?"

"I couldn't find the information." 'why not?"

"The data you requested isn't in our system."

For a solid ten seconds Abby was silent. Then she asked, slowly, "Are you absolutely certain it's not there?"

"I've searched our computer files. On the date you gave for the harvest, we have no record of a heart donor. Anywhere in Vermont."

CHAPTER TWELVE

"Here it is," said Colin Wettig, laying open the Direcwry of Medical Specialists. "Timothy Nicholls. BA, University of Vermont. MDTufts. Residency, Massachusetts General. Speciality: Thoracic Surgery. Affiliated with Wilcox Memorial, Burlington, Vermont." He slid the book onto the conference table for anyone in the room to look at. "So there really is a thoracic surgeon named Tim Nicholls practising in Burlington. He's not some figment of Archer's imagination."

"When I spoke to him on Saturday," said Archer,"Nicholls claimed he was there at the harvest. And he said it took place at Wilcox Memorial. Unfortunately, I haven't been able to find anyone else who was in the OR with him. And now I can't get hold of Nicholls. His office staff tells me he's taken a prolonged leave of absence. I don't know what's going on, Jeremiah, but I sure as hell wish we'd had nothing to do with it. Because it's starting to smell pretty rotten."

Jeremiah Parr shifted uneasily in his chair and glanced at attorney Susan Casado. He didn't bother to look at Abby, who was sitting at the far end of the table, next to the transplant coordinator, Donna Toth. Maybe he didn't want to look at her. Abby, after all, was the one who had brought this mess to everyone's attention. The one who had initiated this meeting.

"What exactly is going on here?" Parr asked.

Archer said, "I thinkVictorVoss arranged to keep the donor out of the registry system. To shunt the heart directly to his wife." "Could he do that?"

"Given enough money - probably."

"And he certainly has the money," said Susan. "I just saw the latest list in Kiplinger's. The fifty wealthiest people in America. He's moved up to number fourteen."

"Maybe you'd better explain to me how donor assignments are supposed to work," said Parr. "Because I don't understand how this happened."

Archer looked at the transplant coordinator. "Donna usually handles it. Why don't we let her explain?"

Donna Toth nodded. "The system's pretty straightforward," she said. "We have both a regional and a national waiting list of patients needing organs. The national system's the United Network for Organ Sharing, or UNOS for short. The regional list is maintained by New England Organ Bank. Both systems rank patients in order of need. The list has nothing to do with wealth, race, or social status. Only how critical their conditions are." She opened a folder and took out a sheet of paper. She passed it to Parr. "That's what the latest regional list looks like. I had it faxed over from the NEOB office in Brookline. As you can see, it gives each patient's medical status, organ required, the nearest transplant centre, and the phone number to contact, which is usually the transplant coordinator's." "What're these other notations here?"

"Clinical information. Minimum and maximum height and weight acceptable for the donor. Whether the patient's had any previous transplants, which would make crossmatching more difficult because of antibodies."

"You said this list is in order of need?"

"That's right. The number one name is the most critical."

"Where was Mrs Voss?"

"On the day she received her transplant, she was number three on the AB blood type list."

"What happened to the first two names?"

"I checked with NEOB. Both names were reclassified as Code 8's a few days later. Permanently inactive and off the list."

"Meaning they died?" Susan Casado asked softly. Donna nodded. "They never got their transplants."

"Jesus," groaned Parr. "So MrsVoss got a heart that should have gone to someone else."

"That seems to be what happened. We don't know how it was arranged."

"How did we get notified of the donor?" asked Susan.

"A phone call," said Donna. "That's how it usually happens. The transplant coordinator at the donor hospital handles it. He or she will check the latest NEOB waiting list and call the contact number for the first patient on the list."

"So you were called by Wilcox Memorial's Transplant Coordinator?"

"Yes. I've spoken to him before on the phone, about other donors. So I had no reason to question this particular donation."

Archer shook his head. "I don't know how Voss managed this. Every step of the way, it looked legal and aboveboard to us. Someone at Wilcox obviously got paid off. My bet is, it's their transplant coordinator. So Voss's wife gets the heart. And Bayside gets suckered into a cash-for-organs arrangement. And we don't have any of the donor paperwork to double-check this."

"It's still missing?" asked Parr.

"I haven't been able to find it," said Donna. "The donor records aren't anywhere in my office."

VictorVoss, thought Abby. Somehow, he's made the papers disappear. "The worst part," said Wettig, 'is the kidneys." Parr frowned at the General. "What?"

"His wife didn't need the kidneys," said Wettig. "Or the pancreas or the liver. So what happened to those? If they never made it to the registry?"

"They must have gotten dumped," said Archer.

"Right. That's three, four lives that could have been saved. And got tossed instead."

There was a ballet of shaking heads, dismayed expressions. "What are we going to do about this?" said Abby. Her question was met with a momentary silence.

"I'm not sure what we should do," said Parr. He looked at the attorney. "Are we obligated to follow up on this?"

"Ethically, yes," said Susan. "However, there's a consequence, if we report this. I can think of several consequences, in fact. First, there's no way we can keep this from the press. A cash-for-organs deal, especially involving Victor Voss, is a juicy story. Second, we're going to be, in a sense, breaching patient confidentiality. That's not going to sit well with a certain segment of our patient population." Wetfig snorted. "Meaning the bloody rich ones."

"The ones who keep this hospital alive," corrected Parr. "Exactly." Susan continued. "If they hear that Bayside spurred the investigation of someone like Victor Voss, they're not going to trust us to keep their records private. We could lose all our private-pay transplant referrals. Finally, what if this somehow gets turned around? Made to look like we were part of the conspiracy? We'd lose our credibility as a transplant centre. If it turns out Voss really did keep that donor out of the registry system, we'll be tainted as well."

Abby glanced at Archer, who looked stunned by the possibility. This could destroy the Bayside transplant programme. It could destroy the team.

"How much of this has already gotten out?" asked Parr. He looked, at last, at Abby. "What did you tell NEOB about this, Dr. DiMatteo?"

"When I spoke to Helen Lewis, I wasn't sure what was going on. Neither of us were.We were just trying to figure out why the donor hadn't been entered in their system. That's how we left it. Unresolved. Immediately after the call, I told Archer and Dr. Wettig about it."

"And Hodell. You must have told Hodell."

"I haven't spoken to Mark yet. He's been in surgery all day."

Parr sighed with relief. "All right. So it's just in this room. And all Mrs Lewis knows is that you're not sure what happened."

"Correct."

Susan Casado shared Parr's look of relief. "We've still got a shot at damage control. I think what needs to be done now is, DrArcher should call NEOB. Reassure Mrs Lewis that we've cleared up the misunderstanding. Chances are, she'll leave it at that. We'll continue to make inquiries, but discreetly. We should try reaching Dr. Nicholls again. He might be able to clear things up."

"No one seems to know when Nicholls is coming back from his leave of absence," said Archer.

"What about the other surgeon?" asked Susan. "The guy from Texas?"

"Mapes? I haven't tried calling him yet."

"Someone should."

Parr cut in: "I disagree. I don't think we should be contacting anyone else about this."

"Your reason, Jeremiah?"

"The less we know about it, the less involved we'll be in this mess. We should stay miles away from it. Tell Helen Lewis that it was a directed donation. And that's why it never went through NEOB. Then let's just move on."

"In other words," said Wetfig, 'stick our goddamn heads in the sand."

"See no evil, hear no evil." Parr glanced around the table. He seemed to take the lack of response as a sign of general assent. "Needless to say, we don't talk about it outside this room."

Abby couldn't hold her silence. "The problem is," she said, 'the evil doesn't go away. Whether or not we hear about it or see it, it's still there."

"Bayside's the innocent party," said Parr. "We shouldn't have to suffer. And we certainly shouldn't expose ourselves to unfair scrutiny."

"What about the ethical obligations? This could happen again."

"I really doubt Mrs Voss will be needing another heart any time soon. It's an isolated incident, Dr. DiMatteo. A desperate husband bent the rules to save his wife. It's done with. We just need to install safeguards to ensure it doesn't happen again." Parr looked at Archer. "Can we do that?"

Archer nodded. "We're damn well going to have to."

"What happens to Victor Voss?" said Abby. By the silence that followed, she knew the answer: nothing would happen to him. Nothing ever happened to men like Victor Voss. He could beat the system and buy a heart, buy a surgeon, buy an entire hospital. And they could buy lawyers, too, a whole army of them, enough to turn a lowly surgical resident's dreams into scorched earth.

She said, "He's out to ruin me. I thought it would ease up after his wife's transplant, but it hasn't. He's dumped offal in my car. He's initiated two lawsuits, with more on the way, I'm sure of it. It's hard for me to see no evil, hear no evil, when he's resorting to tactics like those."

"Can you prove it's Voss doing these things?" asked Susan. 'who else would it be?"

"Dr. DiMatteo," said Parr, 'this hospital's reputation is on the line. We need everyone to be on the same team, everyone to pull together. Including you. This is your hospital too."

"What if it all comes out anyway?What if it hits the front page of the Globe? Bayside's going to be accused of a cover-up. And this'll blow up in all your faces."

"That's why it can't leave this room," said Parr.

"It could get out anyway." She lifted her chin. "It probably will." Parr and Susan exchanged nervous glances. Susan said: "That's a risk we'll have to take."

Abby stripped off her OR gown, tossed it in the laundry hamper, and pushed through the double doors. It was nearly midnight. The patient, a stabbing victim, was now in Recovery, the post-op orders were being written by the intern, and the ER had nothing coming down the pike. All was quiet in the trenches.

She wasn't sure she welcomed the lull. It gave her too much time to brood over what had been said at that afternoon meeting.

My one chance to fuck back, she thought, and I can't. Not if I'm going to be a team player. Not if I'm going to keep Bayside's interests at heart.

And her own interests as well. That she was still considered part of the team was a good sign. It meant she had a chance of staying on here, a chance of actually completing her residency. It came down to a deal with the devil. Keep her mouth shut, and hang onto the dream. IfVictorVoss would let her.

If her conscience would let her.

Several times that evening, she'd been on the verge of picking up the phone and calling Helen Lewis. That's all it would take, one phone call, to get NEB into the picture. One phone call to expose VictorVoss. Now, as she headed back to the on-call room, she was still mulling over what she should do. She unlocked the door and stepped inside.

It was the fragrance she noticed first, even before she turned on the lights. The perfume of roses and lilies. She switched on the lamp and stared in wonder at the vase of flowers on the desk.

A rustle of sheets drew her gaze to the bed. "Mark?" she said.

He came awake with a start. For a moment he seemed unsure of where he was. Then he saw her and smiled. "Happy Birthday."

"God. I completely forgot."

"I didn't," he said.

She went to the bed and sat down beside him. He'd fallen asleep in his surgical scrubs and when she bent down to kiss him, she could smell that familiar on-call scent of Betadine and fatigue.

"Ouch. You need a shave."

'! need another kiss."

She smiled and obliged him. "How long have you been here?"

"What time is it?"

"Midnight."

"Two hours."

"You've been waiting here since ten?"

"I didn't actually plan it this way. I guess I just fell asleep." He moved aside to make room for her on the narrow mattress. She pulled off her shoes and lay down beside him. At once she felt comforted by the warmth of the bed, and of the man. She thought of telling him about the meeting this afternoon, about the second lawsuit, but she didn't want to talk about any of it. All she wanted was to be held.