Michael Palmer - Critical Judgment

A CKNOWLEDGMENTS

In the process of getting a novel written, there is no substitute for long hours alone and in doubt. For helping me keep the isolation and uncertainty in perspective, my deepest thanks go to my agents, Jane Rotrosen Berkey, Stephanie Tade, and Don Cleary; my editor, Beverly Lewis; associate editor Katie Hall; my publisher, Irwyn Applebaum; my publicist, Stuart Applebaum; many friends of Bill W; and, of course, my family.

In addition, I have imposed on a number of friends to help me as critical readers or technical consultants. Steve Shapiro and Ellen Rosenthal, Dr. Steve Defossez, Dr. Donna Harkness, Kim Kelly, Dolly Fenton, Bunny Webb, Kelly Corbet, Ethan, Daniel, Matt, and Dad have each had an imprint on this book.

M.S.P.

A LSO BY M ICHAEL P ALMER

From Bantam Books

The Sisterhood
Side Effects
Flashback
Extreme Measures
Natural Causes
Silent Treatment
Miracle Cure

And coming soon
The Patient

A BOUT THE A UTHOR

M ICHAEL P ALMER , M.D., is the author of Miracle Cure, Critical Judgment, Silent Treatment, Natural Causes, Extreme Measures, Flashback, Side Effects, and The Sisterhood. His books have been translated into thirty languages. He trained in internal medicine at Boston City and Massachusetts General Hospitals, spent twenty years as a full-time practitioner of internal and emergency medicine, and is now an associate director of the Massachusetts Medical Societys physician health program.

Turn the page for an exciting preview of
Michael Palmers new medical thriller

MIRACLE CURE

coming in hardcover
March 1998
from Bantam Books

It took every bit of her strength, but Sylvia Vitorelli managed to force a third pillow under her back. She was nearly upright in bed now. Yet she still felt queasy and hungry for air. It was the dampness and the mold, she told herself. If she had been in her apartment in Boston rather than her sons farmhouse in rural upstate New York, this would not be happening. Not that her breathing had been all that great in Boston, either. For months her ankles had been badly puffed and her fingers swollen. And over the past few weeks she had been experiencing increasing trouble catching her breath, especially when she lay down.

Sylvia cursed softly. She should never have agreed to make this trip to Fulbrook. She should have told Ricky that she just wasnt up to it. But she had desperately wanted to come. The ghost of her husband, Angelo, had made living in their apartment a constant sadness. And the dust and noise surrounding construction of Bostons central artery tunnel had made living in their part of the North End most unpleasant. Besides, her daughter-in-law, who had always acted as if her visits were an inconvenience, had actually made the call inviting her to spend almost two weeks away from the city. The kids ask for you all the time, Mama, she had said. And autumn is so beautiful up here.

Sylvia checked the time. Ricky, Stacey, and the children would be at church for another half hour or so, and then they were going to stop by a friends. She had begged off going with them, citing a headache. The truth was, she didnt feel she had the strength to get dressed. She should try to get up, maybe make something to eat, watch Mass on TV; but when she tried to move, she suddenly was seized by a violent, racking spasm of coughing, accompanied by a horrible liquidy sound in her chest.

For the first time she began to feel panic. The dreadful gurgling in her lungs persisted. Now she was gasping for breath. Sweat began to pour from her forehead, stinging her eyes. Her purse was right beside her, on the bedside table. She fumbled through it for her pills, with no clear idea of what she would do once she found them. Her fingers were stiff, obscene sausages, bluish and mottled.

The air in the musty room seemed heavy and thick. An extra diuretic pill might help, she thought. Perhaps one of the nitroglycerins too. Desperately, she emptied her purse out onto the bed. Alongside several vials of pills was an appointment card from the clinic at Boston Heart Institute. Drops of perspiration fell from her face onto the ink. Her next appointment was a week from tomorrow. In order to fly to Rickys, she had had to skip a Vasclear treatmentthe first one she had missed in almost six months. But the missed medication couldnt possibly be the reason she was having so much trouble breathing now. She was down to only one treatment every two weeks, and was due to drop to once a month before much longer. Besides, her cardiologist had told her when she called that it was perfectly okay for her to go.

Oh my God, she thought, as she frantically gulped down one pill from each of the medication vials. Oh my God, whats happening to me? Suddenly she remembered that the nitroglycerin, which she had not had to take since the early days of her Vasclear treatment, was supposed to be dissolved under her tongue, not swallowed. She tried to get a tablet into place under her tongue, but her hands were shaking so badly, she spilled the tiny pills all over the bed and onto the floor.

Her left ring finger was beginning to throb now. The gold band she had worn for over fifty years was completely buried in her flesh. The finger itself looked dark and violet, almost black in color. Oh please, God, help me. Help me!

Drowning now, she struggled to force air through the bubbling in her chest. A boring, squeezing pain had begun to mushroom outward from beneath her breastbone and up into her neckangina, just like before she began the treatments. She had to try and call Ricky. Or was it better to call 911? She had to do something. Her nightgown was soaked with sweat now. She was breathing and coughing at the same time, getting precious little air into her lungs. There was no telephone in the guest room.

Gamely, she pushed herself off the side of the bed and lurched across to the bureau. Her feet were like water bottles, her toes little more than nubs above the swelling. Another spasm of coughing took away what little breath remained. She clutched the corner of the bureau, barely able to keep herself upright. The cough was merciless now, unremitting. Perspiration was cascading off her. Her head came up just enough for her to see that the mirror was spattered with blood. Behind the scarlet spray was her ashen face. She was a terrifying apparition. Her hair was matted with sweat. Bloody froth covered her lips and chin.

Seized by fear unlike any she had ever known, Sylvia turned away from her reflection, stumbled, and fell heavily to the floor. As she hit, she heard as much as felt the snapping of the bone in her left hip. Sudden, blinding pain exploded from that spot. Her consciousness wavered, then started to fade. The agony in her hip and chest began to let up. Ricky Barbara Maria Johnny One by one her childrens faces flashed through her thoughts. The last face she saw was her Angelos. He was smiling beckoning to her.

Two years later

Brian Holbrook squeezed into the ambulance for the short ride from the Back Bay to White Memorial. His fathers chest pain was down to a two or three from a ten by the time they left the Towne Deli. Still, throughout the ride, Brian kept a watchful eye on the monitor. The absence of extra beats was a good sign, but the shape of the cardiogram wave pattern strongly suggested an acute coronary.

Jacks cardiologist at Suburban was Gary Gold, one of Brians former partnersthe only one of the four partners who had suggested that Brians recovery from addiction was the same as recovering from an illness and that he should be readmitted to the practice as soon as he was ready. Silently, Brian cursed himself for not insisting that Gary be more aggressive with Jack in pushing for a repeat cardiac catheterization and surgical evaluation. But then again, with Jack so adamantly against repeat surgery, what was there to do?