"Nothing." Duncan ground his teeth. The medical mountebank. Freezing off perfectly benign keratoses and billing for removal of precancerous lesions.
What a world. All a doctor had to do was practice straight, ethical medicine, and he was guaranteed a decent living. But that wasn't enough for the avaricious slugs who left a trail of slime across the profession. It drove him up the wall.
Congress had no exclusive on greed. There were doctors who deserved an implant as well.
Duncan's thoughts began to wander a new path, wondering if there might be a way . . .
He shook it off. No sense in letting matters get completely out of hand.
He scheduled Mrs. Jablonsky for surgery, then went on to the next patient. The chart sat in a pocket on the outside of the exam-room door.
He glanced at the intake sheet as he reached for the doorknob, and stopped. Hugh K. Marsden. Could it . . . ?
His gaze jumped a couple of lines down to the occupation box, U. S. senator.
Duncan leaned against the doorjamb. This was too much. The chairman himself?
Could it be . . . was someone on to him? Was he being set up?
But they'd never use a U. S. senator to try and trap him. Still . . . hard to believe Marsden's presence was mere chance.
Well, he'd pretend not to recognize Marsden and see how the consultation played out.
"Mr. Marsden, " he said, entering and extending his hand. "Dr. Lathram." Marsden's handshake was firm. And he didn't correct Duncan's failure to address him as Senator.
"Glad to meet you, Doctor. You come highly recommended."
"That's always good to hear." He pretended to glance through the medical history on the intake form he'd already perused outside the door.
"Looks like you've been in pretty good health. What can we do for you here?"
Marsden turned his head and touched the top of the auricle of his left ear. "I have it on good authority that this needs attending to."
Duncan stepped closer and saw the pink nodule in question He touched it, smooth, firm. He pulled an illuminated magnifying glass from a drawer and bent for a closer look. Fine capillaries crisscrossed the opalescent surface. A positive Tyndall effect with the light. He palpated it again, pressing around the edges. It was bigger than he'd initially thought.
"Your authority is a good one. You've got a basal cell carcinoma there. No risk of distant spread, but if left to its own devices it will continue to grow and eventuall ulcerate and bleed. My advice is to have it out now, while it's small."
"That's why I'm here."
Duncan placed the magnifier on the counter. "Sorry. I don't do therapeutic surgery, only cosmetic work. But I can recommend,"
"You were recommended."
"I won't argue with that, but I don't do what you need . . . done."
"But I do need a cosmetic repair. I don't want a notch out of my ear."
"I appreciate that, but,"
"Dr. Panzella told me you're the best."
"Gin? She sent you to me?" Why? he wondered, irritably. She should know better.
"Not really. It. seems we have something in common, she works for each of us. She spotted this thing on my ear, called it a lesion, and told me to have it looked at. Since many of my colleagues on the Hill speak highly of you, and since Gin seems devoted to you, I figure you're the man." Duncan's mind raced. He felt awkward. But this explained Marsden's presence, the Gin connection.
All right. Maybe it was time to stop playing completely dumb and move to slightly dumb.
"Marsden . . . " he said slowly. "Good Lord, you must be Senator Marsden. Forgive me for not making the connection. Of course. You're chairing the", he snapped his fingers, "the . . . "
"The Guidelines committee."
"Right! The Joint Committee on Medical Ethics and Practice Guidelines."
Marsden smiled. "You know the full title. So few people do."
"I read a lot. You're group has had some trouble recently, it seems."
"Yes. Poor Harold. He's quite ill, I'm afraid."
"Any idea as to if or when he'll be back?"
"No. No definite word yet." Marsden was playing it close to the vest. Not revealing anything. As he should do. Duncan was trying to sort out his feelings for this man. He had nothing personal against him. If he weren't chairing a committee that had no right to exist, he might even like him.
"A bit of bad luck, wouldn't you say?"
"Quite a lot more than a bit. It's almost as if some sort of curse was hanging over this committee."
"You don't know if any of your members went poking into a pharaoh's tomb, do you?"
Marsden's smile was wan. "You'd almost think so, wouldn't you?"
"Does that mean you're now out of the Guidelines business?"
"Only for a little while. I'm doing my damnedest to fill those empty seats. We should be rolling again in no time"
"Will you now?" Duncan said, feeling his jaw muscles bunch. "How interesting."
"But back to the matter at hand," Marsden said. "I'd like you to do the surgery. And the reason is, quite frankly, cosmetic. I understand you have a method that heals many times faster than regular surgery. I need that."
"Do you?"
"Yes. Depending on the president, the hearings could be up and running again in a matter of weeks. I don't want to be there on national TV with a cauliflower ear, or an ear that looks like someone took a bite out of it. You know the press. There'll be speculation about it, and once they find out, there'll be story after story on my skin cancer, then TV specials on the prevalence of skin cancer and how to avoid it."
"Nothing wrong with that."
"No. But I don't want the press to center on me and my minor skin disorder. They should focus on the Guidelines committee and what we're trying to do." Just what are you trying to do? Duncan wanted to ask.
Marsden continued, "With your reputed skill and accelerated healing methods, I believe you're just the man for the job."
Oh, I am, Senator, Duncan thought. I am that.
"Very well, Senator. Because of your connection with Dr. Panzella, who speaks very highly of you, by the way, I'll make an exception. But I will not make an exception about not dealing with any insurance company. You pay my outrageous fee up front. In return you will get the finest cosmetic surgery in the world, with absolute discretion. Ours is a doctor-patient relationship. It does not involve Medicate, Medicaid, Blue Cross, HMOs, PPOs, IPAs, or any of the rest of the alphabet soup. I do not fill out forms, talk to utilization committees or quality assurance coordinators or nurse-bureaucrats insisting on a second or third opinion. I speak to you, you speak to me. No other parties involved."
Marsden's expression reflected fascination rather than consternation. "I take it then that you're not a participant in any of the managed-care systems."
"You're looking at an endangered species, Senator."
"If you want, I can have you put on the Department of the Interior's protected list."
"Too late for that, I think."
"Well, the sale of my company left me with a bit of money. I can afford to spend some of it on my ear."
"Good. I'll turn you over to my secretary, who'll arrange all the releases. How does next week sound?"
"Thursday would be the best for me."
"I'll see what we can arrange. But if you want me to use the accelerated healing procedures, you'll have to watch a videotape and sign a stack of release forms. The implants I employ are still considered investigational at this point."
"Whatever you say."
"Excellent." As Duncan led him out into the hall, he spotted Gin passing by.
She glanced his way, then did a double take.
"Senator Marsden!" Something flickered across her face. Somewhere in the moment between her surprise of recognition and smile of greeting her features twisted with an odd expression. Was it fear, concern, or consternation?
Whatever, it was plain that Gin was anything but happy to see the senator here.
r /> Why?
She'd seen nothing but good results, excellent results, during her time here. Why on earth should she have the slightest concern about her senator's having surgery here?
Unless . . .
No. How could she suspect? How could she even guess? It had to be something else. Maybe he'd misinterpreted her expression.
But he didn't think so. Something there, something very much like fear.
Duncan tried to shrug off the feeling but it wouldn't let go. Why on earth should the sight of him with Senator Marsden strike terror into Gin?
Unsettling thoughts whirled through Gin's mind as she watched Senator Marsden sign the consent forms, thoughts about three members of Marsden's committee, all Lathram patients, all either dead, damaged, or demented . . .
She did her best to keep calm.
"What a surprise to see you here," she said after Duncan was gone.
He tapped the tip of his ear with his finger. "Well, it seems it's unanimous that this has got to go. And didn't you say he was the best?"
"Yes, but I never meant you should come here. . . I mean, he doesn't take cases like yours."
"He said he'd make an exception in my case." Gin felt a cold lump form in her stomach. Duncan never made exceptions.
"Really. I'm surprised."
"Maybe you should be flattered. He said it was because of you." He clapped her on the upper arm. "See. I knew I'd be glad I hired you."
I hope so, Senator, she thought. She made what she hoped was a graceful exit and hurried away. She had someplace to go.
She sat in the periodicals section of the D. C. Public Library's main branch on G Street. She'd remembered something Oliver had said about the Guidelines committee . . . shortly after Duncan had exploded at the news that she was looking for a post on the committee. . . . years ago he had a bit of trouble . . .
Trouble with the Guidelines committee? How many years? Oliver wasn't talking. Maybe the microfilm would.
She ran a search of the Washington Post the year of Lisa's death, looking for Duncan.
The earliest was dated May 7th, about a week before the first anti-Duncan article in the Alexandria Banner. Front page, lower right corner.
Gin's stomach lurched as she read the heading, "Committee Decries Gross Overcharging by Surgeon." She scanned the article until she spotted his name, then backtracked.
From his seat beside the committee chairman, ranking member Senator Harold Vincent said his staff had uncovered a case of "flagrant abuse of the current system, right here in our own backyard." He went on to excoriate Dr. Duncan Lathram, a vascular surgeon in Alexandria, for collecting over a million dollars from Medicate last year. "This sort of gouging is a prime example of a profession running wild, lining their pockets with millions of taxpayers' hard-earned money. If ever there was a doubt that the medical profession needs guidelines imposed on it, that doubt should be banished by the likes of Dr. Lathram." Gin sat rigid in her seat before the microfilm screen, shocked not only by the words, but by their speaker. Senator Vincent . . . Duncan had operated on him just a few weeks ago, they'd been bantering in the committee hearing room moments before his seizures. And though he'd attacked Duncan in public five years before, neither had ever mentioned it. Had they both forgotten?
No. Not Duncan. Vincent, maybe. In a quarter century on the Hill, this was simply another in an endless series of remarks prepared by one of his aides and tossed away after they were read into the record.
But Duncan . . . those words no doubt were branded on his brain. He'd never forget something like this. Nor would he forgive.
She went back and read the article from the beginning. Vincent had attacked Duncan from his seat on the Committee for Medical Practice Guidelines, the original Guidelines committee under Senator McCready.
The article listed the other members of that first committee. Besides Vincent and McCready, it named Lane, Allard, and Schulz.
Schulz! Schulz had been on the original committee. Gin hadn't known that.
'"Oh . . . my . . . God, " she whispered. That was the connection between the four dead or injured legislators, all had been members of the McCready committee.
She found another mention of Duncan, deeper in the paper, a week later.
This time it was Congressman Allard pillorying this price-gouging surgeon and calling him "the tip of the iceberg." Something must be done on the federal level. He demanded a Medicate audit of Duncan's officer and hospital records.
Gin leaned back. So this was where Duncan's hell had begun, ignited by a spark from the original Guidelines committee. He must hate these men . . . yet he'd done cosmetic surgery on four of them.
And now those four were either dead or hospitalized.
It was all circumstantial, all four cases were different, and she couldn't see how any grand jury could indict on the available evidence . . . yet only a fool could deny the obvious and terrifying pattern.
But where was the connection to Lisa?
And did it matter?
At the moment, no. What did matter was that Senator Marsden was going under Duncan's knife next week.
She remembered him signing the surgical consent forms a few hours ago.
Wasn't there an expression about signing your life away?
21
GINA
GINA DIDN'T WAKE UP SATURDAY MORNING. SHE DIDN’T have to. She never got to sleep.
A night of endless tossing and turning. She'd tried everything short of a sleeping pill. She didn't have one around and it probably wouldn't have worked anyway. Her racing mind was stuck in overdrive and refused to downshift.
Something's going to happen Jo Senator Marsden.
The thought had ricocheted off the walls of her brain like a racquetball. She'd countered it with every explanation she could dredge up. It all came down to the fact that despite a seemingly obvious pattern, all the evidence was circumstantial. Yes, the committee had initiated a series of events that had ruined Duncan's practice, but it would take more than that to set him on a murderous vendetta.
Yet every time she thought she'd laid the fear to rest, some dark, formless dread from her hindbrain, that ancestral home of primal instincts, would rear up and slam it into wild, random motion again.
So now she sat in her bay window and looked down on the Saturday-morning quiet of Kalorama Road. God, what was she going to do?
She'd have to do something.
Stop the surgery? How? What reason could she give? No, she'd have to find a way to ease her mind so she wouldn't go crazy waiting for something to happen.
But anything bad that happens to Marsden after the surgery, even if he gets hit by a meteor while raking leaves in his front yard, I'm going to blame on Duncan.
Gin could handle just about every question except the one about Duncan's desk drawer.
She had seen the vial and the oversized trocar. And she couldn't explain them.
What was in that vial? What was a trocar doing in there?
Only one way to find out. Did she dare?
She headed for the bedroom to throw on some clothes.
Gin let herself into the surgicenter through the private rear entrance and coded off the alarm. She felt more than a little guilty about this.
After all, Duncan had entrusted her with a set of keys and here she was sneaking in to snoop through his desk.
It's not as if I'm going to steal anything, she thought. I'm just going to borrow a little reassurance.
She locked the door behind her, then set up her excuse for being here.
Not much chance that anyone else would be in on a Saturday, and her car was in the rear lot, hidden from the street, but you never knew. So, first thing, she trotted down to the records room and left her Senate ID badge on the floor under the dictation desk. Should anybody ask, that was why she was here, looking for her lost badge.
Back upstairs, she let herself into Duncan's officer. She noticed her hands were sweaty. What if Duncan popped in and caught her here? Not l
ikely. He couldn't wait to get out of here weekday afternoons, so why would he show up on a Saturday? Oliver was a different story. But he'd mentioned a trip to Virginia Beach for the weekend, so it was unlikely he'd show up. Through the picture window she saw that the rock garden was half in shadow. The shrubbery shielded her from anyone outside, but also blocked her view of the rear parking lot, so she left the office door open to hear anyone unlocking the private entrance.
She moved to Duncan's desk, praying she'd find the top right drawer sitting open.
No such luck.
Okay, another prayer that he'd forgotten to lock it. She pulled on the handle. The drawer wiggled but wouldn't slide.
Damn! She slapped her palm against the drawer. She wanted this over with. She couldn't stand it.
She slumped into Duncan's chair and stared at the drawer. The putting-to-bed, or God forbid, confirmation, of all her distress lay on the far side of half an inch of wood. She stared at the brass face of the lock. She'd seen Duncan's key ring hanging from that lock, which meant the drawer key went wherever he went. But maybe there was a spare around.
She went through each of the remaining drawers carefully and did find two keys, but neither fit the lock. She tried prying it open with a letter opener but was getting nowhere, and she was afraid to exert too much leverage for fear of scratching the wood.
If only she knew how to pick a lock . . . or knew someone who did.
.
They made love first.
Gerry arrived a few minutes early and, as much as Gin wanted to learn how to pick a lock, the sight of him standing inside her door swept away thoughts of locked drawers. After about three words they were in each other's arms and leaving a trail of clothing between the front door and the bedroom. Nicer making love on a bed instead of a couch, and this time Gerry took charge, running his lips around her nipples, then between her breasts, down along her scar to her navel, circling that, and continuing downward. She whimpered with delight and thrust herself against his probing tongue.
Afterward, they lay breathless and sweaty in each other's arms. Gin fought the urge to fall into a contented doze. She got up, threw on a robe, and opened a bottle of merlot. They snuggled together on the couch, sipping their wine.