Having at least made a decision about one issue, Jeffrey felt slightly more in control. To make himself feel even more organized, he occupied himself by rearranging the contents of his briefcase. He stacked the money carefully, in the base, covering
it with the underwear. He then rearranged the contents of the accordion-style file area under the lid to make room for Chris Everson's notes. Turning his attention to the notes, he organized them according to size. Some of them were on Chris's notepaper, which had From the Desk of
Christopher Everson printed on top. Others were written on sheets of yellow legal paper.
Jeffrey began to scan the notes, almost without meaning to. He was glad for anything that took his mind away from his current predicament. Henry
Noble's case history was especially fascinating the second time around.
Once again, Jeffrey was struck by the similarities between Chris's unhappy experience with the man and his own with Patty Owen, particularly with respect to each patient's initial symptoms. The major difference between the two cases was that Patty's had been more fulminating and overwhelming.
Since Marcaine had been involved in both cases, the fact that the symptoms were similar was not surprising. What seemed extraordinary was that in both situations the initial symptoms were not what was expected in an adverse reaction to a local anesthetic.
Having been a practicing anesthesiologist for some years, Jeffrey was familiar with the kinds of symptoms that could occur when a patient had an adverse reaction to a local anesthetic. Trouble invariably arose due to an overdose reaching the bloodstream, where it could affect either the heart or the nervous system. Considering the nervous system, it was usually the central or the autonomic system that caused problems, either through stimulation or depression, or a combination of the two.
All this covered a lot of territory, but of all the reactions Jeffrey had studied, heard about, or witnessed, none had been anything like Patty
Owen's, not with the excessive salivation, the tearing, the sudden perspiration, the abdominal pain, and the constricted, or miotic, pupils.
Some of these responses might occur in an allergic reaction, but not from an overdose, and Jeffrey had reason to believe that Patty Owen had not been allergic to Marcaine.
Obviously, tojudge by his notes, Chris Everson had been comparably troubled. Chris noted that Henry Noble's symptoms were more muscarinic than anything else, meaning the kind that were expected when parts of the parasympathetic nervous system were stimulated. They were called muscarinic because they mirrored- the effect of a drug called muscarine, which came from a type of mushroom. But parasympathetic stimulation was not
expected with a local anesthetic like Marcaine. If not, then why the muscarine symptoms? It was puzzling.
Jeffrey closed his eyes. It was all very complicated, and, unfortunately, although he knew the basics, much of the physiological details were not fresh in his mind. But he remembered enough to know that the sympathetic division of the autonomic nervous system was the part affected by local anesthetics, not the parasympathetic part apparently affected in the Noble and Owen cases. There was no immediate explanation for it.
Jeffrey's deep concentration was interrupted by a thump against the wall, then some exaggerated moaning of feigned ecstasy coming from the neighboring room. He had an unwelcome image of the pimply-faced girl and the bald man. The moaning reached a crescendo of sorts and then diminished.
Jeffrey stepped over to the window to stretch. He was again bathed in the red neon light. A group of homeless people was milling around to the right of the Essex's stoop, presumably in front of the liquor store. Several young hookers were working the street. Off to the side were young toughs who seemed to take a proprietary interest in the goings-on of the area.
Whether they were pimps or drug dealers, Jeffrey couldn't say. What a neighborhood, he thought.
He turned away from the window. Jeffrey had seen enough. Chris's notes were sprawled across the bed. The moans from next door had stopped. Jeffrey tried to review the list of possibilities for the Noble and Owen mishaps.
Once more he focused on the notion that had so consumed Chris through the course of his last days: the possibility of a contaminant in the Marcaine.
Assuming that neither he nor Chris had made a gross medical error-in the
Owen case, for example, that he had not used the.75% Marcaine that had been found in his disposal-and in view of the fact that both patients had had unexpected parasympathetic symptoms without allergic or anaphylactic reactions, then Chris's theory of a contaminant had considerable validity.
Returning to the window, Jeffrey thought about the implications of a contaminant being in the Marcaine. If he could prove such a theory, it would go a long way toward absolving him from blame in the Owen case.
Culpability would fall to the pharmaceutical company that had manufactured it. Jeffrey wasn't sure about how the legal machinery would work once such a theory was proven. Given his recent brushes with the judicial system, he knew the gears would turn slowly, but turn they would. Maybe old Randolph would be able to figure a way to get the
wheels to turn faster. Jeffrey smiled at a wonderful thought: maybe his life and career could be salvaged. But how would he go about proving there had been a contaminant in a vial that had been used nine months earlier?
Suddenly, Jeffrey had a thought. He rushed back to Chris's notes to read
Henry Noble's case summary. Jeffrey was particularly interested in the initial sequence of events, when Chris was first administering the epidural anesthesia.
Chris had taken 2 cc's of Marcaine from a 30 cc ampule for his test dose, adding his own 1:200,000 epinephrine. It had been immediately after that test dose that Henry Noble's reaction began. With Patty Owen, Jeffrey had used a fresh 30 cc ampule of Marcaine in the OR. It was after this Marcaine was introduced into her system that her adverse reaction began. For the test dose, Jeffrey had used a separate 2 cc vial of spinal grade Marcaine, as was his custom. If a contaminant had been in the Marcaine, it had to have been in the 30 cc ampule in both situations. That would mean that
Patty had gotten a substantially larger dose than Henry Noble-a full therapeutic dose as opposed to a test dose of 2 cc's. That would explain why Patty's reaction was so much more severe than Henry Noble's and why
Noble had managed to live for a week.
For the first time in months, Jeffrey felt a glimmer of hope that his old life was still within reach. He could have it back again. During his defense, he'd never considered the possibility of a contaminant. Now, suddenly it seemed like a real possibility. But it would take time and some serious effort to investigate, much less prove. What was his first step?
First of all, he needed more information. That meant he'd have to bone up on the pharmakinetics of local anesthetics as well as the physiology of the autonomous nervous system. But that would be relatively easy. All he needed was books. The hard part would be looking into the idea of a contaminant.
He'd need access to the full pathology report on Patty Owen. He'd seen only parts of it during the discovery process. Plus, there was the question
Kelly had raised: what about an explanation for the.75% Marcaine vial found in the disposal container on the anesthesia machine? How could it have gotten there?
Investigating these issues would have been difficult under the best of circumstances. Now that he was a convict and a fugitive, it would be all but impossible. He would have to get into Boston Memorial. Could he do that?
Jeffrey went into the bathroom. Standing in front of the mirror, he evaluated his features in the raw fluorescent light. Could he change his appearance enough not to be recognized? He'd been associated with Boston
Memorial since his clinical clerkships in medical school. Hundreds of people knew him by sight.
Jeffrey put a hand to his forehead and slicked back his light brown hair.
He combed his hair to the side, parting it on the right. Holding it back made his forehead appear broader. He'd never worn glasses. Maybe he could get a pair now. And for most all of the years he'd been working at Boston
Memorial, he'd had a mustache. He could shave it off.
Caught up with this intriguing thought, Jeffrey went to the other room to retrieve his Dopp Kit. He went back
