TITLES BY ROBIN COOK
Charlatans
Host
Cell
Nano
Death Benefit
Cure
Intervention
Foreign Body
Critical
Crisis
Marker
Seizure
Shock
Abduction
Vector
Toxin
Invasion
Chromosome 6
Contagion
Acceptable Risk
Fatal Cure
Terminal
Blindsight
Vital Signs
Harmful Intent
Mutation
Mortal Fear
Outbreak
Mindbend
Godplayer
Fever
Brain
Sphinx
Coma
The Year of the Intern
G. P. PUTNAM’S SONS
Publishers Since 1838
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Copyright © 2017 by Robin Cook
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Library of Congress Cataloging-in-Publication Data
Names: Cook, Robin, author.
Title: Charlatans / Robin Cook.
Description: New York : G. P. Putnam’s Sons, 2017.
Identifiers: LCCN 2017018648 (print) | LCCN 2017018741 (ebook) | ISBN 9780735212497 (Ebook) | ISBN 9780735212480 (hardback)
Subjects: BISAC: FICTION / Suspense. | GSAFD: Medical novels. | Suspense fiction.
Classification: LCC PS3553.O5545 (ebook) | LCC PS3553.O5545 C46 2017 (print) | DDC 813/.54—dc23
LC record available at https://lccn.loc.gov/2017018648
p. cm.
This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, businesses, companies, events, or locales is entirely coincidental.
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CONTENTS
Titles by Robin Cook
Title Page
Copyright
Dedication
PROLOGUE
BOOK 1 Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
BOOK 2 Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
BOOK 3 Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
EPILOGUE
Author’s Note
Acknowledgments
Selected Bibliography
About the Author
To my extended family and friends
PROLOGUE
JUNE 27, BOSTON, MASSACHUSETTS
Due to the seasonal tilt of the earth’s axis, the dawn of June 27 came swiftly to Boston, Massachusetts, in sharp contrast to mornings in the dead of winter when the sun’s arc was low in the southern sky. Starting at 4:24 A.M., progressively bright summer light quickly filled the streets of the Italianate North End, the narrow byways of elegant Beacon Hill, and the broad boulevards of stately Back Bay. At exactly 5:09 A.M., the sun’s disc appeared at the horizon out over the Atlantic Ocean and began its steady rise into a cloudless early-morning sky.
Of the varying spires of the Boston Memorial Hospital, known as the BMH, the first to catch the golden rays was the very top of the central, twenty-one-story Stanhope Pavilion. This modern glass tower was the newest addition to the mishmash of structures comprising the famous tertiary-care Harvard teaching hospital that overlooked the Boston Harbor. Its clean silhouette was strikingly different from the older, low-rise, red-brick buildings dating back more than a hundred and fifty years.
The state-of-the-art Stanhope Pavilion had every modern hospital accoutrement, including a suite of twenty-four of the most up-to-date operating rooms, called “Hybrid ORs of the Future.” Each bristled with high tech and looked like it had been designed as a set for a Star Trek movie, far different from the old standard operating rooms. The entire suite was oriented in two radii of twelve rooms around two central command stations. Windows provided direct visual contact of each OR interior by OR supervisors to augment closed-circuit TV monitors.
Within each of these new hybrid ORs, capable of supporting a wide variety of surgical procedures, from brain surgery to complicated heart surgery to routine knee replacement, a number of large and exquisitely adjustable utility booms hung from the ceiling and supported various types of state-of-the-art medical technology. The suspension system allowed all the equipment to be instantly available yet kept the floor open to maximize movement of the personnel and speed up the transition between cases. One boom supported the anesthesia station, another included a heart-lung perfusion system, a third had an operating microscope, and a final C-shaped boom supported a biplane digital imaging and navigating system that used a combination of infrared light and X-rays to provide real-time three-dimensional images of internal human structure. Each OR also had multiple banks of high-definition video screens plugged into the hospital’s clinical information system so that patient data and medical images such as X-rays and sonograms could be displayed instantaneously by voice command.
The rationale for all this super-modern and inordinately expensive equipment was to increase the efficiency and efficacy of the surgery as well as enhance patient safety. Yet on this beautiful late-June day all this modern technological wizardry and rational design was not to be a guarantee against unintended consequence and human foibles. Despite the good intentions of all the dedicated personnel of the BMH surgical department, a human disaster was in the making in Stanhope’s hybrid operating room #8.
As sunlight filled the drop-off area for the Stanhope Pavilion at 5:30 A.M., cars and taxis began to line up at the entrance beneath the porte-cochere, their doors opening and passengers emerging with overnight bags. There was little conversation as these soon-to-be inpatients and their accompanying family members entered the hospital and took the
elevator up to “Day-Surgery Admitting” on the fourth floor. There had been a time in years past when people were admitted the day before their scheduled elective surgery, but that perk had mostly fallen by the wayside, thanks to health insurance company dictates. The extra night in the hospital was deemed too expensive.
The initial surge of patients represented the first cases of the day. Other patients scheduled as “to follow” cases were instructed to arrive two hours before the time their surgery was estimated to begin. Although the length of operations could be approximated to a reasonable degree, it was never certain. If there was to be an error on timing, it was always to the hospital’s benefit, not the patients’. Sometimes this caused the patients to have to wait for extended periods in holding areas. This could be a problem for some, as all patients were instructed to take nothing but a small amount of water by mouth starting at midnight the night before.
On this particular day, one of the “to follow” cases was an open right inguinal hernia repair on a strapping, healthy, intelligent, and gregarious forty-four-year-old man named Bruce Vincent. Since the operation had been estimated to begin at 10:15 A.M., he had been told to arrive at Surgical Admitting at 8:15. Unlike other patients scheduled that day, he wasn’t concerned about his upcoming procedure. His comparative nonchalance wasn’t just because of the relative simplicity of his procedure but had more to do with Bruce’s familiarity with the BMH. For Bruce, the hospital was not a mysterious, scary netherworld, because he’d been coming there most every day for twenty-six years. He had been hired by the BMH right out of Charlestown High School, where he had been a popular local sports celebrity, to join the hospital’s security department. It had been a legacy gesture: Bruce’s mother had been an LPN at the hospital for her entire career and his older sister was one of the hospital’s RNs.
But being an employee and thereby accustomed to the hospital environment was not the only reason for his comparative sangfroid that morning. What truly made him calm was that he had, over the twenty-six years of employment, befriended almost everyone, including doctors, nurses, administrators, and support staff. In the process, he had learned a lot about medicine, particularly hospital-based medicine, to the point that it was a common joke among the staff that he was a graduate of the nonexistent BMH medical school. Bruce could discuss surgical technique with orthopedic surgeons, malpractice concerns with administrators, and staffing problems with RNs, and he did all of this on a regular basis.
When Bruce had been told he was to have spinal anesthesia for his upcoming hernia repair that was going to take maybe an hour at most, he knew exactly what spinal anesthesia was and why it was safer than general anesthesia. For him there was no mystery involved. And on top of that, he was extremely confident of his surgeon, the legendary Dr. William Mason. Bruce was well aware that the mercurial Dr. Mason, who was known behind his back as “Wild Bill,” was one of the most famous surgeons at the hospital. Dr. Mason himself saw to it, making sure that it was common knowledge that patients came from around the world on a weekly basis to take advantage of his skilled hands and incredible statistics. Dr. Mason was a full Harvard professor of surgery, chief of the Department of Gastrointestinal Surgery, and one of the associate program directors of the hospital’s famed surgical residency program. His subspecialty was the very demanding surgery of the pancreas, an organ tucked away in the very back of the abdomen that was notoriously hard to operate on because of its peculiar consistency, digestive function, and location.
When Bruce told people that Dr. Mason was going to do his hernia repair, everyone was shocked. It was common knowledge that Dr. Mason hadn’t done a hernia repair since he had been a surgical resident more than thirty years ago. The professor prided himself on doing only the most complex and difficult cases involving the pancreas. Some had been mystified enough to ask Bruce how he had managed the impossible, getting Mason to do what he certainly considered a piddling operation fit for a surgical neophyte and well below his dignity. Bruce had been happy to explain.
Over the years, Bruce had enjoyed persistent advancement in the security department, thanks to his unabashed commitment to the hospital combined with his outgoing personality. He loved his work, and because of his attitude and the fact that he seemed to know everyone by name, everyone loved Bruce Vincent in return. They also liked that he was a family man who had married another outgoing and popular BMH employee from the food-service department. Together they had had four children, one of whom was an infant. Since the Vincent kids’ pictures continuously graced the cafeteria bulletin board, it seemed to the entire medical center community that they were the quintessential hospital family.
Although Bruce’s popularity ratings had been high from day one, they soared when he had been elevated to take over the hospital’s problematic parking division. Due to his efforts, the seemingly intractable difficulties had melted away, especially after he convinced the hospital board to build a third multistory garage specifically for doctors and nurses as part of the Stanhope project. On top of that, Bruce was never one to hide out in his “parking czar” cubicle. Instead, he was always available in the trenches, anticipating problems from the crack of dawn to late afternoon with a smile and personalized comment. By his example, all the other parking employees were similarly dedicated and personable. And it was in this capacity as a hands-on supervisor that Bruce had managed to befriend the otherwise rather aloof Dr. William Mason.
The whole hospital knew when Dr. Mason got his red Ferrari four years ago. There were some jokes behind his back about a mid-life crisis, because along with the flashy sports car he had become overtly flirtatious with several of the OR department’s younger and attractive women, mostly nurses, but also one of the female surgical residents. Bruce heard the buzz about Dr. Mason’s behavior and off-color comments but dismissed them as envy. And as far as the Ferrari was concerned, instead of thinking of it as inappropriate and out of place among the tamer and more conservative Volvos, Lexuses, BMWs, and Mercedes, Bruce lavished it with praise and even offered daily to personally park the car in a special protected place to avoid door dings. So when Bruce learned from his Charlestown GP that he had to have his hernia repaired, a problem he had had for some time but which was now giving him mild intermittent problems, particularly with his digestive system, he simply asked Dr. Mason if he would do it. Bruce popped the question on the spur of the moment one morning when he took the Ferrari’s keys. To everyone’s surprise—even Bruce’s, as he later confided—Dr. Mason agreed on the spot, promising to squeeze Bruce into his jam-packed schedule of celebrities, business mavens, European aristocrats, and Arab sheiks whenever Bruce wanted.
Despite being scheduled for surgery that very morning, Bruce had still appeared at his parking office at five as if it were a normal day. And just as he had done for years, he greeted the staff as they arrived. He even parked Dr. Mason’s Ferrari. Dr. Mason was a bit taken aback to see him and said as much, wondering if his own memory was failing him.
“I’m a to-follow case, so I don’t have to be at Surgical Admitting until eight fifteen” was Bruce’s simple explanation.
Yet Bruce’s dedication to his job wasn’t without consequence on this particular morning. After handling a problem generated by an employee who had failed to show up or call, Bruce was late getting to Surgical Admitting on Stanhope 4.
“Bruce, you are almost forty minutes late,” Martha Stanley said anxiously. She was head of Day-Surgery Admitting. She didn’t usually do intakes herself, but she had been waiting for Bruce to show up. “You were supposed to be here at eight fifteen. We’ve already heard from the OR, wondering where the hell you were.”
“Sorry, Miss Stanley,” Bruce said sheepishly. “I got held up by a staff problem in the garage.”
“Maybe you shouldn’t have worked this morning,” Martha said with a disapproving shake of her head. She had been surprised to see him in his usual uniform when she pulled into the garage early that
day, as she was aware he was scheduled for an inguinal repair. She opened the folder and riffled through its contents, checking that the history and physical were there, along with the most recent blood work and an ECG. She turned her attention to the computer screen to be sure all the same material was there. “In case you don’t know, Dr. Mason is a bear about waiting, and he has two other big VIP pancreatic cancer cases this morning.”
Bruce flashed a remorseful, almost pained expression. “Sorry! I’m sure he hates to wait. Maybe we can speed this admitting process up a bit. My operation is no big deal. It’s just a hernia repair.”
“Every case is important and has to be done by the book,” Martha mumbled as she made an entry into the EMR, the electronic medical record, “but we do have to get you up there sooner rather than later. You haven’t eaten anything, have you?”
“I’m having spinal anesthesia,” Bruce said. “Dr. Mason’s fellow, Dr. Kolganov, told me I was to have spinal when he did the history and physical.”
“It doesn’t matter what kind of anesthesia you’re scheduled to have. Have you eaten anything? You were told not to eat after midnight. That is the same for everyone.”
“No, I’m fine. Let’s get the show on the road.” Bruce glanced at his watch as his heart skipped a beat. A sudden fear swept over him that Dr. Mason might change his mind and refuse to operate on him. That was the last thing Bruce wanted.
“Okay,” Martha said with a touch of reluctance. “You have a negative history and physical by Dr. Mason’s fellow, so maybe we can leapfrog the junior surgical resident going over it and adding his two cents. There has been a kind of rush here over the last half hour, so I know he’s got his hands full, meaning it would take quite a while for him to get to you. Which side is to be operated on?”
“Right side,” Bruce said.
“Do you have any allergies?”
“No. None.”
“Have you ever had anesthesia?”
“No. I’ve never been a hospital patient.”