Side Effects

by Walter Jon Williams

1

Tolinal(R)

Prescribing information for this product, which appears on pages 788 and 789 of the PDR, has been revised as follows. Write “See Supplement B” alongside the product heading. Delete the first paragraph of the WARNINGS section and replace with the following:

Warnings: Hypomagnesemia, hypocalcemia, hypokalemia, and hypophosphatemia have been reported to occur in patients treated with Tolinal and are probably related to renal tubular damage. Tetany has occasionally been reported in those patients with hypocalcemia and hypomagnesemia. Generally normal serum electrolyte levels are restored by administering supplemental electrolytes and discontinuing Tolinal.

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2

Angel Hernandez was in his fifties, his hands were callused, and massive corded muscles enveloped his neck, evidence of a life of manual labor. Old blue tattoos on his forearms were only partially hidden by the rolled-up sleeves. There was a softness around his middle that suggested a fairly steady consumption of beer, but the rest of him was hard.

To come and speak to the doctor, he had worn a tie.

His wife, Filomena, was in her fifties. What had probably once been a voluptuous form had become heavy and shapeless, but her ankles were still delicate above the open-toed high heel sandals she’d worn even through the freezing East Coast spring. Her broad face was expressionless; her white hair was tied back. There were dark smudges beneath her eyes, and in spite of the plumpness of her face, heavy jowls were forming at the corners of her rosebud mouth. She sat in the chair, looking down at her polished toenails. Her husband did all the talking.

According to her records, she had carried seven living children in ten years. Incredible, Dr. Winkelstein thought. How can people live like this?

“The thing is,” Hernandez said. His voice was hesitant. “Is that she don’t mind most of it. All ladies gotta dry up, I guess. But, you know, it hurts. It hurts. her, I mean.”

It took Dr. Winkelstein a few seconds to realize what Hernandez was saying. Oh, Christ, he thought, suddenly understanding. How stupid can these people be? Carefully he assumed a grave and professional expression.

“Mr. Hernandez,” he said. Hernandez leaned forward to better hear his soft voice: Winkelstein often took care to speak in low tones, finding that it helped people to pay attention. “The decrease of vaginal secretions is a common side effect of menopause. But there are treatments that can relieve it. They’ve been available for years.” He swiveled his chair toward his desk and reached for his pen.

Hernandez looked at him with hopeless eyes. “How much these treatments gonna cost, Doctor?” he asked. “I been off unemployment for three months, and things are kinda bad right now.”

Winkelstein, his eyes on his desk, nodded and reached for the permission forms he kept in his drawer. “Under the new regulations,” he said, “the standard hormone cream won’t be covered by Medicaid. But don’t worry.”

He began filling out the form, copying carefully from Filomena Hernandez’s file in his strong hand. Kimberlee, he wondered. What am I going to say to Kimberlee when I get home? It would be her second abortion, and she was only seventeen. It wasn’t as if there weren’t birth control available, for chrissake; he’d prescribed it himself. And her grades were so awful he despaired of getting her into a good school. At least Norton Junior was shaping up well, in his third year of premed at Yale and getting excellent grades.

“I was just going to mention that there’s a new program just started,” Winkelstein said. “Tempel is making a new product available, and we can prescribe it to your wife. It won’t cost you anything.”

“We don’t have to pay?” Hernandez looked startled for a moment, then grinned. “That’s pretty good, Doc.”

“If your wife could fill out this form,” Winkelstein said. He turned toward them in his chair, a sheaf of white, blue, pink, and yellow flimsies in his hand. Hernandez scanned them with a baffled expression, then he knit his brows and began working his way through the print syllable by syllable. His lips moved as he read.

He looked up at Winkelstein with a surprised expression. “It says somethin’ about my wife being used for in-ves-tigational purposes,” he said, spelling it out slowly. “What’s that mean?”

“It means that since we’re dealing with a new product, I’m required to obtain the consent of Mrs. Hernandez before we can start,” he said. “Don’t worry. What it means is that Mrs Hernandez will have very good care while she’s in the program, including free monthly checkups.”

Doubt clouded Hernandez’s eyes, but he pursed his lips and began reading again. Winkelstein nodded thoughtfully to himself. He had long ago learned never to use the word experimental around a patient. For some reason they often took fright.

“Mrs. Hernandez,” he said softly. For the first time she looked up, her eyes docile, uncomprehending. “Do you have any other symptoms? Hot flashes, night sweats, dizziness, headaches? Perhaps we can help you with those.”

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3

TEMPEL PHARMACEUTICALS

GRANTS-IN-AID

STATEMENT OF AGREEMENT

Grant No. 89-T-002

I, Norton G. Winkelstein, M.D., agree to conduct a study of evaluating the efficacy of Tynadette as reliever of certain postmenopausal symptoms according to the attached protocol approved by the American Division of Tempel Pharmaceuticals, Inc., and me, dated March 22, 1983.

I understand that the total approved grant for this study is forty thousand dollars. The initial payment will be $10,000. Subsequent payments will be made according to the following schedule:

$10,000 upon completion of 1/2 of the case reports.

$10,000 upon completion of 2/3 of the case reports.

$10,000 upon completion of twenty-five (25) case reports…

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4

“Thanks, Doc,” Hernandez said, and stuck out his hand. Winkelstein looked down at it with antiseptic disapproval, then shook it. He looked over Hernandez’s shoulder at his wife’s submissive features.

“My girl will give you a card with your appointment time,” he said. “Put it somewhere where you can see it.” He had no confidence in Filomena Hernandez’s ability to remember appointment dates.

The woman nodded and flashed a smile — and for a moment, to Winkelstein’s surprise, a beautiful young lady shone through the wreckage. She must have been quite a catch when she was young.

In the end she had signed the Informed Consent Form twice; once for the Tynadette study, another for a study for The Baum Company’s Pharmacological Laboratories for a drug designed to suppress Mrs. Hernandez’s hot flashes and night sweats. It was against the study rules, though not the law, to give the same patient more than one experimental drug; but Winkelstein had never seen sense in that. He’d prescribe as he saw fit: and what Tempel and The Baum Company didn’t know, wouldn’t hurt them.

Winkelstein approved of the precision of the new drugs. Instead of a broadband treatment of the symptoms, the new drugs targeted each symptom individually. There would be fewer side effects that way, less interference with the metabolism.

He saw the Hernandezes on their way and then turned to wash his hands. They were his last case of the day. It was three o’clock, and on his Health Group days he always left early, hoping to get out of Brooklyn before the rush started. He hated traffic: there was a kind of squalid fervor to it that always upset him.

He took off his white coat, then stepped to the hall closet where he kept his jacket. He put it on, smoothing the lapels, and then walked to the mirror at the end of the hall to straighten his tie. He could hear the voice of Dr. Asad Ashraf through the transom above the examining room door.

“Why don’t you wash?” Ashraf asked. His clipped voice displayed annoyance.

“I’m bleeding,” came the answer. From the sound of her voice, the girl was in her teens.

“I don’t care. You should wash,” Ashraf said.

Winkelstein frowned and listened, but Ashraf began to mutter, and he could hear no more.

Good, Winkelstein thought. He didn’t want to have to speak to the man.

Winkelstein owned the Brooklyn Family Health Group in partnership with Dr. Irving Sussman. Winkelstein and Sussman had their regular practices on Long Island and only spent one day each week at the Health Group. The day-to-day work was done by young M.D.‘s fresh from school, trying to earn enough to pay off their school debts or buy into a practice somewhere. Here in New York, many of the young doctors were Indians, Pakistanis, or, like Ashraf, Iranians. They all worked hard, but many of them had odd, fastidious cultural notions with regard to basic feminine biological realities. It made Winkelstein wonder why they went into family practice in the first place.

Winkelstein picked up his briefcase and left the building by the back stair. He wanted to avoid the waiting room: it wasn’t any of his patients’ business when he left — and besides, he always felt a strange, reproachful, and unpleasant contrast when he saw many of his Health Group patients at once. Here in the Health Group, his patients were elderly or disadvantaged, single mothers and young girls without education, the unemployed, the mentally deficient, the foreign-born or hopeless or down-on-their-luck or alcoholic. There were a lot of blacks and Puerto Ricans. Their children were always with them, usually wandering unsupervised in the waiting room, getting in people’s way. The vast majority didn’t carry insurance. Winkelstein couldn’t understand how people could live like that.

Nevertheless, these people got sick, and it was possible to help them when they did. The state paid most of their bills, and it was often possible to get them on one program or another from one of the pharmaceutical companies. One thing about family practice was that there was always an enormous variety in terms of illness displayed, which the pharmaceutical companies loved because they were always producing a vast number of new chemicals that needed approval.

New birth control pills — Winkelstein did a lot of business in those. Other methods of birth control. Pills to relieve arthritic swelling. New methods of asthma relief. Pain relievers. Experimental antibiotics. New hormonal treatments. Interferon. An enormous flow of medicine to help treat heart conditions. Most had never been tested before, except supposedly on animals. The companies needed human subjects, and were willing to pay any qualified M.D. who provided them.

Filomena Hernandez was a good example. Winkelstein was being paid forty thousand dollars by Tempel Pharmaceuticals to produce twenty-five case studies complying with FDA formalities — which in this case were purely formalities, since Winkelstein happened to know that the FDA had given approval before receiving all the follow-up studies, and that Tempel was mass-marketing the drug within the next six months. All that Winkelstein’s study really meant was that Winkeistein would make sixteen hundred dollars from Mrs. Hernandez alone, and during that time all he had to do to earn the money was sign a few forms, hand out the drugs, and give a free pelvic exam once a month for the next six months.

On top of the Tempel study, Winkelstein was also getting $32,000 from The Baum Company for the second product Mrs. Hernandez was testing, which meant another $1,250 for the same patient, with no extra work except signing a few forms after having the clerical staff fill them out.

Mrs. Hernandez was typical. Winkelstein could usually get his patients onto more than one program, the heart patients in particular because there were so many new products jumping onto the market all the time. The Family Health Group was turning record profits.

Which was good, because though the profits from Winkelstein’s regular practice on Long Island were still higher than those of the Health Group, they were declining. There was no denying that people in general — those who could afford to take care of themselves, anyway — were healthier than they had been. Better diet, more exercise, more care about overwork…

It was too bad health was so bad for business.

––—

5

TEMPEL PHARMACEUTICALS, INC.

ANNUAL REPORT

PRETAX AND NET INCOME

FROM CONTINUING OPERATIONS

(Figures in millions of dollars)

1983* 1982 1981

Net sales 4,281.1 3,885.5 3,562.1

Pretax income 721.7 601.3 521.7

Taxes on income 327.6 299.7 245.2

Net income from 394.1 301.6 276.5

continuing operations

*Best estimate based on current growth rates.

––—

*6*

Dr. William Trilling looked down at the New York City streets through the glass wall of his office, hearing the gusty wind that blew flurries of rain against the pane. The streets were jammed with cars, none of which were moving. The people below, hunched beneath their umbrellas as they walked crabwise against the wind, looked like determined little blips on a video-game screen, dodging the cars and one another.

“Bleep, bleep,” said Dr. Trilling, providing the sound effects himself. “Bleep. Pow!” Then another thought struck him.

My God, he thought in dawning amazement. How can people live like that?

He worked hard at maintaining his optimism, but sometimes it was hard.

He returned to his desk and glanced at the paperwork that Natalia Latoni, his head girl, had put in his IN box earlier in the day. Realizing that his optimism was going to need a little help today, he carefully opened the upper drawer of his desk and glanced at the rows and rows of pills.

Working for the Experimental Drugs Division of Tempel Pharmaceuticals had its perks.

Dr. Trilling had no patients, no practice, and no phone calls summoning him to hospital bedsides at inconvenient hours: that was the advantage of being in research. His job was strictly supervisory; he and his colleagues oversaw the various field-testing programs of Tempel Pharmaceuticals throughout the world.

He took two Oronidol, which would serve to lengthen his attention span and create in him a kind of rapt fascination for his paperwork; and then he took a Calispeiron, a stimulant that would serve to counteract the Parankalon that he’d taken earlier in the day in order to numb his sensations during the long commute into town.

Dr. Trilling loved the new generation of psychotropic drugs. They selected the parts of the brain they wanted and left the others alone, a process that appealed to his sense of efficiency and economy. He found them invaluable in maintaining his basic optimism.

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7

Bennie Lovett opened his umbrella briefly and snorted his speedball in its shelter. He was going to need a little artificial motivation for this one, because the rain had been turning the ground to muck for weeks. This cemetery in Hempstead was going to be an awful, sloppy job, but he was out of money and this was one of the better ways he knew to raise cash in a hurry.

Quickly, he bent to the sodden turf and cut the sod neatly into squares, which he stacked to one side. Then he removed the headstone, got out his shovel, and began to dig. The walls of his trench kept liquefying, and he had to keep shoring it up, but after he stopped for another speedball, the work went quickly.

There was an art to grave robbing, Bennie Lovett had discovered. A grave with a high mound on it was too recent, and it meant that the skull would be hard to clean, with all the dead muscle and tissue still clinging to it. A grave with a depression over it meant the coffin underneath had collapsed and possibly crushed the skeleton under its weight. The best was a level grave, which meant it was just old enough for the cadaver’s muscle and tissue to fade, turn brittle, and lose its strength.

Bennie struck the coffin, cleared the rest of the soil out, and breathed a sigh of relief that at least it was a wooden coffin. The fucking bronze ones were a bitch. He got out his axe and chopped vigorously for a few moments, then peeled back the lid of the lead inner coffin and shone his flashlight on the cadaver. An old guy, apparently, in his best suit with a gold watch and chain. Benny pocketed the watch and chain, then hefted his axe and cut off the head with a well-placed blow.

He lifted the skull, examining it carefully in the light. It was perfect — just little bits of skin and sinew left, and a mild acid bath would soon get rid of those. He put the skull in his bag. He planned to raid two other graves before morning.

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8

The baby’s heart sounded strong and clear. Winkelstein disengaged the stethoscope from his ears and fit them carefully on the head of the mother-to-be. He watched her eyes widen in joy as she heard the heartbeat.

“Wow,” she said, and then grinned. “It’s fast,” she said.

“A hundred forty beats per minute, give or take,” Winkelstein said. He gave a smile and returned to his desk. “You’ve had an exceptional pregnancy, Mrs. Lasley, for a woman your age,” he said. “Remarkably free of any difficulties. We have every reason to expect an uncomplicated birth and a healthy child.”

Isadora Lasley, her eyes dreamy as she listened to the baby’s heartbeat, nodded abstractedly. She was thirty-eight, owned a pair of expensive boutiques, and was married to a wealthy contractor. This would be her first delivery. She’d opted for natural childbirth without anesthetics, a choice Winkelstein wasn’t exactly overjoyed with but one he was willing to concede as being in the realm of her choice — though he knew some anesthetists who were livid about these things. Not that it mattered in this case: Winkelstein would have an anesthetist standing by anyway.

His nurse helped Mrs. Lasley to the dressing room. He went to his office and waited for her to reappear.

She had spared no expense in regard to her child, going through about every expensive prenatal test ever devised. She had cats, so he’d tested for toxoplasmosis; she’d had amniocentesis early on to look for possible birth defects, and there had been ultrasound checks to make certain it wasn’t a tubal pregnancy. She’d tested for herpes and cytomegalic and a handful of other unlikely possibilities. She had been careful about her weight and diet, had reduced her social drinking, and given up smoking. Winkelstein and his wife saw the Lasleys socially at least a half a dozen times each year. The contrast with his Health Group patients was heartwarming.

Winkelstein picked up his pen. “I’d like to do another B-scan in a couple of weeks or so to make sure the baby’s in the right position for delivery. Every indication so far shows the baby will be making its appearance on schedule. I suppose we should think about making reservations at the hospital.”

Isadora’s eyes slowly lost their cloudy look. She frowned as she looked at Winkelstein. “I’ve been meaning to talk to you about that, Norton,” she said slowly. “I think I want to have the baby at home.”

Winkelstein returned the pen to its stand with careful precision and gazed at Isadora with unblinking brown eyes. “I don’t do home deliveries, Mrs. Lasley,” he said. “I don’t regard them as safe. Especially not in the case of a woman your age.” She looked as if she were about to say something, and he spoke quickly and firmly. “If you hemorrhage, Mrs. Lasley, you can bleed to death in minutes. There’s nothing I can do about it outside a hospital. If the baby doesn’t breathe right, I’d have to be able to have treatment available on the spot, otherwise there could be brain damage or worse.”

“You said we’d be fine!”

“I said the chances were, you and the baby would be fine. But there’s always the chance you won’t be.”

Isadora gazed stubbornly at nothing in particular for a moment. Winkelstein spoke on. “And just in case, I’d like to keep you monitored and have an anesthetist standing by. You might change your mind about anesthesia, you know. It’s been done.” Winkelstein sensed her resistance eroding, and he hastened to his final argument.

“On top of all that, Mrs. Lasley, you might be in labor for hours and hours, and in a home-birth situation, I’d have to be right there all the time — maybe for an entire twenty-four hour period, maybe longer. In a hospital they have nurses to take care of you during that time. But my being absent for all that time — it just isn’t fair to my other patients. I can’t afford to be away from them for a full day or more.”

He saw her blink slowly and thought he’d convinced her. That argument usually worked well: don’t do it for me, do it for my other patients.

Isadora spoke uncomfortably, her gaze moving rapidly about the room, never lighting on Winkelstein. “Well. You see, my husband has a niece. Whose name is Alice. Who’s just become a midwife. She could take care of me till it’s time for you to come.”

“I see.” Well, so that’s where the ideas were coming from: he hadn’t seen Isadora as the sort to pick up this kind of trendy medical chic on her own. Winkelstein frowned at her and picked his words carefully. “I don’t want to speak against your husband’s relatives, Mrs. Lasley,” he said. “Midwives were all very well and good in the eighteenth century, I suppose, but they’re not needed now, and a lot of their attitudes are … well, I suppose unprofessional is the only way to describe them.”

“I’ll have to think about it,” said Isadora. There was a stubborn firmness in her eyes.

“We can talk about it again at your B-scan,” Winkelstein said. “But remember, I won’t do home deliveries. It’s a firm principle with me. And, as I said, it’s not fair to my other patients.”

“Alice knows a doctor who will,” said Isadora.

A wave of red fury rose in Winkelstein and stayed with him for the rest of Isadora’s visit. So the new brand of holier-than-thou, the holistic medical doctor — no doubt with a forty-dollar haircut and fresh-cut flowers on his desk — had no objection to poaching on another doctor’s preserves, did he? Or was it she? And with palpably unsafe techniques to boot. What about professional courtesy? What about medical ethics?

Winkelstein had been as ambitious as any when he was young, but he’d never gone in for poaching.

He saw Isadora to the door and spent the next few minutes drumming angry fingers on his desk top. Another one gone, he thought. Next he’d have some woman who wanted to deliver her kid underwater … he’d heard that was getting to be quite a fashion these days.

Who the hell could understand them? The same woman who’d gone to the barricades in defense of abortion worried her head off about birth trauma.

Ah, well. At least he still had the Health Group. People there didn’t have the financial wherewithal to root around among treatments for the most fashionable. They took what he gave them and were glad to get it.

His eyes slid to his desk, to the framed photographs of his family. There they were, smiling in frozen perfection against a powder-blue backdrop, each surrounded by a kind of glowing artful halo. Winkelstein, his wife, Norton Junior, and Kimberlee. Taken three years ago now. Before the vice-principal found pot in Kimberlee’s locker at school, and before she’d had her first abortion.

The second had been last week. He’d tried to talk to Kimberlee since, but he’d always had to shout at her over an aural wall composed of Joe Voss and the Vidiots, and he’d given up.

The girl simply hadn’t any basis for making decisions, he thought. She’d been brought up in affluence and didn’t know what she was throwing away.

Too bad she’d never worked at the Health Group, he thought savagely. Give her a dose of reality she’d never forget.

An idea descended upon Winkelstein like a warm fuzzy blue blanket. Why the hell not? he thought. He needed clerical help at the moment in order to process all the forms for Tempel and The Baum Company and the rest. He pictured his darling little princess among the losers and diseased in the Health Group office, and began to smile.

His intercom buzzed.

“Dr. Winkelstein, one of the reps from Tempel is here. Are you available?”

Not what he needed. His next half-hour was free, and he wanted some room to think without cluttering up his mind with complimentary pens and bits of pharmaceutical literature.

“Tell him I have only a few minutes,” he said grudgingly.

A long, close-cropped head thrust sideways through the door. “Hi, Dr. Winkelstein,” said Homer Bernstein. “Just thought I’d drop off some pens and some literature.” He walked into the room, fished into his pocket, and brought out a handful of Tempel Pharmaceuticals, Inc., ballpoint pens. Then he opened his case and brought out an armful of glossy, highly colored folders, advertisements for new Tempel products.

“Here’s a nice little booklet on use of Interferon,” Bernstein said. “And another on using the new-generation psychotropic drugs to help treat the elderly.” Winkelstein nodded politely. Then Bernstein reached into his case and flashed Winkelstein a devilish grin.

“You’re not gonna believe the new promotion,” he said. He brought his hand out of his case. In it was a human skull.

“Beats the hell out of pens, huh?” he said, and placed the skull carefully on Winkelstein’s desk. “For one of our best customers,” he said. “Careful. The jaw is loose.”

Winkelstein picked up the skull and looked at it in amazement. It grinned at him whitely. “Where do you get them?” he asked.

Bernstein shrugged. “Medical schools, I guess,” he said.

“Huh,” said Winkelstein. He set the skull down on his desk, then opened a drawer and put it inside. “Well, thanks,” he said. “But I think I’ll take it home with me tonight. Wouldn’t want the patients to see it.”

Bernstein gave a laugh as Winkelstein put the skull into his drawer. “Yeah,” he said. “Wouldn’t want them to think this is one of your case studies, would you?”

––—

9

Dr. Trilling, signing his authorizations, was humming in his office high above the world. Dr. Winkelstein gets his initial ten grand for the Tynadette study. Dr. Amardas Singh of Chamba gets his initial three grand for his birth control study. Wherever Chamba is, Trilling thought, they probably need birth control. Dr. Jose Martin Rodriguez y Saavedra in Buenos Aires gets four grand on completion of his new serum study. Good boy, Jose.

Third World doctors, Trilling thought, seem to come cheaper, but there were always certain risks. All the studies in Salvador had been canceled.

His intercom lit up and buzzed imperiously. He regretted leaving his signing of the vouchers — ever since he’d taken the Oronidol, he found it fascinating to think of all the strange places he was sending Tempel’s money to — but he recognized the sound of duty when he heard it.

“Buzz buzz buzz,” he said absently, and then picked up the phone. He cleared his throat to make his voice seem deep and grave.

“Trilling here,” he said.

“Dr. Trilling, this is Jeanie.” Trilling spent a long moment trying to remember who Jeanie might be. Ah, yes, his new secretary, just sent from the temporary agency. Tempel used a lot of temporaries, since that meant they didn’t have to pay the unemployment, insurance, or benefits. Which, of course, meant more money floating around the world for the important things.

This one was about thirty. Kind of bony and flat-chested, to his way of thinking, big cornflower-blue eyes under thick glasses. She spoke with a western accent that Trilling, without any evidence, assumed was Texan. Her brown hair was in a style that had become popular with a lot of white girls these days, long strands down the nape of her neck but short and brushy everywhere else. When she’d been introduced to him, she’d worn three sets of leg warmers under her skirt. She’d been wearing cowboy boots when she came into the office, before switching to the heels she wore at her desk. Trilling was glad that thin, tall heels had come back into style. Her legs were good.

“What is it, Jeanie?” His telephone voice was good, he thought. It was a voice that belonged to a kindly and responsible doctor.

“The mail’s just come in. There’s a letter here I’m not sure I know what to do with. It’s from the FDA.”

Trilling felt a very active centipede crawl madly up and down his spine. “Why don’t you ask Natalia about it?” he said.

“She’s on her lunch break.”

“Oh,” he said. “Is it lunchtime already?” Good old Oronidol.

But the FDA — oh, damn. He wasn’t in shape to deal with the FDA today. “Better bring it in,” he said.

Jeanie was wearing her leg warmers pulled over her bare feet and was carrying a cup of coffee in her free hand. She put the letter on his desk. “It’s about some kind of heart medication called TriPhiloden,” she said. “They say it’s been mass-marketed by Tempel since 1977, and we still haven’t submitted our twenty-five follow-up case reports to qualify for full approval. The FDA is wondering where the reports are.”

TriPhiloden? Trilling’s memory trundled vaguely over his internal index. “Oh,” he said. “I remember that stuff now. Isn’t there a file?”

Jeanie was patient. “I don’t know where the file is. I’ll ask Natalia when she comes back.”

“I don’t think we have the case studies up here,” Trilling said. “I think all the follow-up reports are in another department, or two other departments, or somewhere. Word processing and the TriPhiloden consultants should have them. I suppose the failures have held up the processing.”

“Failures?” Jeanie asked.

“Yes. Patient failures. We have a lot of delays when they keep dying like that.”

In the sudden thunderous silence, Trilling had the suspicion that perhaps he’d said something wrong. Panic thrashed in him like a floundering eel. He looked up into Jeanie’s wide blue eyes. “It happens all the time,” he said. “Heart patients, you know. They’re not well people.”

“I guess not.” Then: “Failure?”

“The FDA,” Trilling mused. “Look. If they call, I’m not in. I have to think about this.”

Jeanie nodded briskly. Dr. Trilling realized he was overreacting to the whole situation and cursed the Oronidol he’d taken. It was good for plodding through a lot of detail work, but it was hopeless in dealing with a crisis.

Dicryptomine, he thought. It would stimulate production of acetylcholine and other neurotransmitters and help him think. But it tended to put a nasty edge to reality, so he’d take some Shacocacine to help smooth things out and let him suppress his panic reaction.

“Oh,” said Jeanie. “Would you like some?” It took Dr. Trilling some seconds to realize that he’d been staring abstractedly at Jeanie’s coffee cup, and that she’d misinterpreted.

“Oh, no,” he said. “Thanks anyway. I don’t use caffeine. I think it’s bad for me.” He frowned down at her hose-covered toes peeking from the bulky layered leg warmers that obscured the shape of her calves. “You have good legs,” he said. “Why do you wear those things?”

“Because it’s cold out in my office. There are a lot of drafts blowing around this glass box. And because it’s cold outside, especially on the subway platforms.”

“Oh. Subways. Right.” Funny, he’d almost forgotten the subways existed. He always took taxis or a company car, and sometimes — not often enough — the Tempel limo.

“Well, thank you, Jeanie,” he said. “Uh, I think you should call these people I’m checking off in the directory. First find out where the follow-ups are, then find out how soon they’ll be ready. Tell them it’s a rush and to hire however many people they need to finish in a reasonable amount of time. And when you’ve found out where the reports are, tell me and I’ll call them myself, sort of let them know Daddy cares.”

She walked out of the office in a blaze of warm colors. Trilling thought about the FDA and their annoying insistence that he read hundreds of boring follow-ups, and then with an angry motion, he opened his drawer. With the blind petulance of the inanimate, it parted company from the desk and spilled the hundreds of little pills and capsules all over his carpet.

“Ooohh…” Trilling moaned softly. He got down on his knees and began methodically to put them back in their little plastic bottles. The red pills and the white pills and the blue pills, all the patriot colors … they could sort of look like a flag if he moved them around and put this red one here and the blue one over there…

It was very hard to stay optimistic under these conditions, he thought. No choice but to soldier on.

…and the black pills and the blue pills with the yellow stripes and the other yellow pills…

––—

10

Replace the first paragraph in the ADVERSE REACTIONS section with the following:

The following adverse reactions have been reported since the drug was marketed. A probability has been shown to exist between Riderophan and these adverse reactions. The adverse reactions that have been observed encompass observations for 2,722 patients, including 381 observed for at least 52 weeks…

––—

11

Dr. Winkelstein peered with frowning attention into Mrs. Kane’s private parts. “Oh Jesus, oh Jesus,” Mrs. Kane moaned. “Oh fuck, oh Jesus.” She was thrashing around considerably, and Winkelstein found it hard to concentrate. Shut up, you silly woman, he thought, and jabbed her very precisely with his curette. Mrs. Kane gave a sudden strangled yelp.

“Try not to move so much, Mrs. Kane,” he said. “You might hurt yourself.”

“Careful now,” the nurse said automatically. She was frowning at her nails. “It’ll be over soon.”

“Sonofabitch shit oh fuck,” said Norma Kane. But she stopped thrashing.

Winkelstein finished cutting his tissue sample from Mrs. Kane’s uterus and dropped the bloody tidbit of flesh into his clear plastic specimen container that his nurse had labeled. He put the cap on it, left the room, gave it to the lab assistant, and then returned to Mrs. Kane.

“You’re doing fine, Mrs. Kane,” he said.

“Jesus God Almighty,” she said. Her forehead was spangled with sweat.

He removed the speculum, trying not to pay attention to his patient’s occasional groans. Norma Kane, he knew, was a perfect subject for the Tynadette study. She was a fifty-eight-year-old black woman with graying hair and good health. Two grown children, one in the navy and the other in school somewhere in Tennessee. Menopause confirmed for at least three years, but still subject to hot flashes as well as vaginal atrophy: she was thus good for both the Baum study and the Tempel group. She was a widow who lived on a small pension and had a hard time meeting her medical bills. It hadn’t been hard to find her: he’d just had the office staff look through his records and call anyone who was currently employing his prescription for hormones.

Winkelstein thought he’d give her the new pills right away; if anything contraindicative came up from the lab, he’d call her and tell her to cancel.

He straightened and took off his gloves. “There,” he said. “That wasn’t so hard, was it?”

“That sin of Eve must have been some sin,” breathed Mrs. Kane as she sat up.

“I guess,” Winkelstein answered remotely. His mind was already on his next patient, Mae Nare. She was white, poor, married to a husband who was in prison for theft, had four teenaged kids, and lived on welfare.

Another perfect subject for his study.

––—

12

Well, thought Jeanie McGovern. So this is how some people live.

It was National Secretaries’ Week, which meant that all the secretaries received nice bowls of flowers for their desks and got a free lunch from Tempel in the Executive Club that occupied the top floor of the Tempel International Building in Manhattan. The booths were padded with tooled red leather, and the glass-and-chrome tables gleamed with white tablecloths. Quite a change from the employees’ cafeteria on the second floor. It was nice of Trilling — or more likely Natalia — to see that she was included.

Free food, Jeanie thought, has no calories. She ordered lobster and a margarita.

“And coffee,” she said. “With lots of cream.”

Trilling ordered mineral water and a cottage cheese salad. He had taken Dicryptomine and Paradol for the combined effects of lunch table wit and a sunny personality, but unfortunately, Paradol had as its major side effect the suppression of appetite.

“They have a gym on the floor below,” he said. “I have an appointment with Dr. Kaplan to work out and then play squash every night after work. That gives time for the rush hour to end before I head back home.”

“Where’s that?” Jeanie said.

“Hempstead. It’s a long commute,” he said.

“Your wife must never see you.”

“We play tennis on weekends,” Trilling said. The waiter came with Jeanie’s coffee.

“Just leave the pot,” she said. He lowered it expressionlessly to the table.

“Your margarita will be right up, miss,” he said.

“You drink a lot of coffee, don’t you?” Trilling said.

“I have to keep alive somehow. Margaritas help, too.”

“I like white wine sometimes,” Trilling said. “I don’t drink much alcohol.”

“You,” said Jeanie, “don’t need to.”

Trilling pondered the implications of this remark for a moment. The margarita made its appearance: Jeanie smiled gratefully and drank about a third of it at a gulp.

Temporaries were so different from regular employees, Trilling thought. They were outside the structure of the corporate authority, and as a result were free of the usual office games. Sometimes it made them interesting.

The rest of the time they were simply annoying.

Jeanie sat back in the padded booth and smiled. She had a broad mouth and a lot of white teeth. “I’m a dancer,” she said. “That’s why I’m working temp. My company folded, since we were new, and after the cutbacks all the art money is going to the rich, established groups — you know, the ones who already have money. I still take class every night.”

“You’re doing a very good job here,” said Trilling. “You’ve picked up Tempel’s way of doing things remarkably well.” He wondered how long a thirty-year-old dancer had left.

“Thank you. I try.”

“Where do you live?”

“Downtown. Lower East Side,” said Jeanie. She gulped some more margarita.

“Oh. Isn’t that dangerous?” Trilling’s views of the Lower East Side came mainly from the eleven o’clock news, lots of dying people lying in alleys, all in the hard, lurid colors of night video.

Jeanie shrugged. “It’s kind of like range war,” she said. “There are a lot of rich people moving in now, taking over from the ethnics and the junkies and winos and artists. I’m kind of hoping the winos hang on — it’s the only part of Manhattan where I can afford to live.” She gave a low laugh. “I can protect myself, though,” she said.

With a sudden grin, she unbuttoned the blue jacket she was wearing and showed him the gleaming butt of an automatic pistol tucked snugly in her armpit. The leather holster seemed to be approximately the size of the state of Colorado, and it was polished with use. Dr. Trilling felt sudden terror bleating shrilly in the hollows of his chest.

“Please put that away,” he said. She closed her jacket, finished her margarita, and looked for the waiter.

“Don’t worry. I got a permit after my apartment was broken into for the fifth time,” Jeanie said. She never understood why New Yorkers, who were so often tough-minded people, felt so terrified of guns. Damned if she was going to be one of those herd animals, always bleating about their problems to an authority that never cared.

By the time a Montana girl got out of high school, she knew how to take care of herself.

“Isn’t that thing a little big for you?” Trilling asked. Maybe he’d order a margarita himself.

“No. The only problem is learning how to correct your aim after the recoil. It’s my daddy’s .45, and it jumps like crazy unless you know how to control it. He added a custom grip and competition sights, and when I can afford the ammunition I go down to the gun club and practice my quick draw.” She patted the thing under her armpit. “I keep my jacket unbuttoned all the time when I’m outside in the weather. You never know.”

You sure as hell don’t, thought Trilling. If he had known this, he would have taken Shacocacine.

My God, he thought, how can people live like this?

––—

13

Bennie Lovett hawked and spat into the sink, his phlegm having that lovely speedball aftertaste that promised cool excitement in his brain. He turned to look at the skulls sitting in the acid bath in his tub and grinned. More money tomorrow. This little sideline was turning out all right.

The acid was making a mess out of the chipped porcelain of the bathtub, not to mention the iron underneath it, but Bennie didn’t much care. The tub was propped up on two-by-fours to keep it from crashing through the floor into the apartment below — the building was rent-controlled, and the landlord never bothered to maintain it. If he had to replace the bathtub, serve him right. Bennie hadn’t taken a bath in weeks anyway.

––—

14

Write “See Supplement B” alongside the product heading.

Warning: Serious and fatal blood dyscrasias are known to occur after the administration of Moxalinophene. These include thrombocytopenia and aplastic anemia. Blood dyscrasias have been known to occur after both short-term and prolonged use of the drug.

––—

15

Angel Hernandez stepped into his kitchen, patted Filomena affectionately on her behind, and put five-sixths of his Rolling Rock in the shaky refrigerator. He opened the other sixth and took a swallow. Filomena was listening to the radio — it had to be one of the college stations since it was playing Latin music — and dancing as she moved about the kitchen. He grinned.

“You feel better?” he asked.

“I don’t feel that arthritis in my hips,” she said. “Not since Mass on Sunday.”

Angel put his arms around her. “Mi senyora, you’re looking better, too.” He began to dance with her to the salsa coming from WKCR.

She was looking better. The darkness under her eyes was fading, and her skin seemed much fresher. Her ass wasn’t so soft, either.

“It’s having you around the house,” she said, “and you being so good to me.”

He felt a short throb of sadness at the reminder of his unemployed status, and he kissed her carefully on her forehead. “Hey,” he said in wonder, running his hand through her hair. “Your hair’s coming in black again.”

––—

16

Static was joining the Vidiots in her left ear. Kimberlee Winkelstein tapped the earpiece of her Walkman, bone conduction producing a strange sound. The static continued. She looked up, frowning, through the reception room window at the motley group of patients in the Health Group waiting area, and then turned to her typewriter. She was losing interest in the Vidiots anyway — who could retain respect for a band that played the Bottom Line and whose lead was becoming a movie star? They were getting old…

She was spending the summer doing the paperwork for her father’s programs in Experimental Drugs. It had sounded interesting at first, but the whole experience had turned out to be awful. The job was in Brooklyn, for God’s sake, not even in the city. And since she’d started working, she hadn’t seen anything but sick people. Several pairs of eyes looked dully back at her. How could people live like that?

Oh, well. She would be working only until they went to Maine on vacation in August.

Patient failed 5-1-83, she typed carefully. Physician attending reported there was no connection between patient’s failure and Simulene.

She detached the defective phones from her ears and looked up at Martha, the middle-aged black woman who ran the clerical staff of the Health Group. “What does it mean when it says that the patient failed?” she asked.

“It means they dead,” said Martha.

“Oh. Thanks.” Everything here was depressing. Maybe tomorrow she’d bring some of her father’s vodka in her pocketbook and try to make things better.

––—

17

Dr. Trilling’s relaxed voice sounded in Jeanie’s ear as she typed. “Make sure you stamp CONFIDENTIAL on this,” he said for the second time. She took her foot off the Dictaphone pedal, adjusted her earphones, took a sip of coffee, and wondered for a moment why Dr. Trilling always seemed so anxious about things. Then she lit a cigarette and went back to her work.

“Recently,” Trilling said, “I have received several inquiries about bleeding associated with use of the fourth-generation cephalosporins. Until now we’ve assumed that all bleeding that did occur was related to hypoprothrombinemia secondary to depletion of vitamin K. This seems to be in error.”

Jeanie’s fingers followed Trilling’s words nimbly over the keyboard. “Recent reports, however, demonstrate bleeding due to alteration of prothrombin time. These reports usually involve elderly or debilitated profiles with deficient stores of vitamin K. Marked reversal of hypoprothrombinemia is demonstrated by prompt administration of vitamin K.”

Jeanie had heard of vitamin K — dancers know a lot about vitamins — but hypoprothrombinemia was new. She decided to look it up in the medical encyclopedia when she got time, after she typed a new version of her resume. There was nothing like a new job to increase one’s knowledge.

––—

18

Norma Kane balanced her bags of groceries carefully against the wall, took her keys out of her pocketbook, and unlocked the three locks on her door. She maneuvered herself and her bags inside, closed the door with a nudge of her foot, and put the bags on the sideboard.

She dusted her hands and turned back to the door to lock it. A few months ago, she would have been out of breath after that three-flight climb. She seemed to be feeling better lately, and the friends she met for regular games of bid whist were complimenting her on her looks. Her hair was even coming in black again.

There was a bid whist party again tonight at Serene’s apartment, and Norma began washing potatoes so that she could bring some potato salad. Even the wrinkles around her knuckles were smoothing out. “You have the hands of a babychild, Norma,” old Carey had said the other night.

The odd thing was, she didn’t used to have.

She put the potatoes on to boil and walked to the toilet. “Oh, lord,” she said softly, discovering that the source of the slight feeling of abdominal pressure wasn’t from her bladder.

Damned if it wasn’t the Curse of Eve. It was the first time in almost two years, and she’d thought she’d long been done with it. She sighed and began to wonder if she had any sanitary napkins left.

Strange, though, that it had come so easy. A few years ago, the cramps would have driven her half-crazy. Well. Another strange miracle.

She heard the potatoes boiling in the kitchen. It was time to turn the gas down so they wouldn’t boil over.

She began to wonder seriously about the sanitary napkin supply.

––—

19

“I’m sorry, Mrs. Nare,” Winkelstein said. “It turns out you’re right.”

“God damn it, I knew it,” said Mae Nare. She was a thin and perpetually angry woman of fifty-five, and when Winkelstein had first enrolled her in the Tempel and Baum Company studies, she had worn a ton of makeup and a blond wig. Now the cosmetic layer was thinner, revealing a smoother complexion, and the hair was short but genuinely blond and abundant. Heavy copper earrings brushed her shoulders when she turned her head. As she looked at Winkelstein, her thin lips became thinner.

“Look,” she said. “You’ve got to do something about it. When my husband gets out of prison, he’ll kill me.”

“We’ll arrange an abortion,” Winkelstein said. This sometimes happened with the birth control studies; it was an unfortunate but necessary expense. “At no cost to you. The program will pay for it.”

“It damn well better,” said Mrs. Nare. She gave a short bark of a laugh. “Hey,” she said. “I ain’t even had my period for a year. Who’d of thought this would happen?”

“We’ll switch your medication,” Winkelstein said. “I’ll write you a new prescription.”

Abortions, he thought. Arranging them seemed to be half his life.

It occurred to him that once upon a time, when he was young and in medical school, he hadn’t even believed in them, had supported the laws that made them criminal. He remembered making a speech to a friend about the value of continence and self-discipline.

He had, of course, been a virgin then.

––—

20

A disc jockey made a joke in stereo about a sweet strawberry-flavored drink spiked with vodka, and Kimberlee wondered if he’d been paid to mention the stuff and remembered it was okay, sort of like a watery milkshake that got you high, but she preferred her vodka straight.

Patient gravida, she wrote, left study 7-8-83.

She wondered briefly what “gravida” meant. She seemed to be writing that word a lot lately.

––—

21

Write “See Supplement B” alongside product heading. Delete the first paragraph of the WARNINGS section and replace with the following:

Warning: The prolonged administration of Simulene often leads to the development of a positive antinuclear antibody (ANA) test. If a positive ANA titer develops, the benefit/risk ratio related to continued Simulene therapy should be assessed.

––—

22

There was a liquid sadness in Angel Hernandez’s eyes. Filomena looked down at her little feet with their bright red toenails. She was withdrawn again. Recently, during her monthly examinations, she had been livelier, more conversational, and Winkelstein had noticed she’d been losing weight steadily and picking up body and skin tone as if she were exercising regularly.

“I’m afraid I’ve bad news,” Winkelstein said. He spoke to the husband; he was the only one who seemed to be taking an interest. “Mrs. Hernandez is pregnant. Five, six weeks.”

“Doc,” he said. “How can that happen?”

The usual way, of course, Winkelstein thought, but didn’t say it. Things were going sadly awry with the Tynadette patients and The Baum Company study groups. Of the eighteen women who overlapped in the two studies, Mrs. Hernandez was the seventh to have become pregnant. In each case, menopause had been well advanced, and pregnancy was not to be suspected.

Which of the drugs was causing it? Winkelstein wondered. Now he didn’t have his twenty-five usable case studies for either drug. He was seriously considering cutting his losses and withdrawing from both programs.

“Any treatment Mrs. Hernandez requires will continue to be without charge, Mr. Hernandez,” Winkelstein said. “I think it would be best if we can arrange an abortion sometime soon.”

“Dr. Winkelstein, we’re Catholics,” said Filomena Hernandez. It was the first time she’d spoken; the hoarse wail was forced up from deep inside her. Winkelstein steepled his fingertips and spoke quickly.

“Mrs. Hernandez is over fifty,” he said. “She’s overweight, and her last pregnancies had complications. I think it could be dangerous for her to bring a pregnancy to term, and in the case of danger to the mother, the church will sanction the termination of the pregnancy. I can give you the name of a priest who will speak to you about it, if you like. I don’t think the church will give us any objections.”

As long, Winkelstein thought, as she talks to a priest from my neighborhood. Bigoted old priests who got stuck in poor parishes might well be another matter. In these things, as in everything else, much depended on whom you knew.

There was no hope in Angel Hernandez’s solemn eyes; he had clearly resigned himself to Winkelstein, the church, and fate. “Do what you can, Doc,” he said.

––—

23

Jeanie McGovern pulled on her cigarette and frowned at the collection of Form 1639 Drug Experimental Reports filed by Dr. Winkelstein. They were badly typed and featured a lot of correction fluid, but their impact was clear. Of the thirty women in the Tynadette study, all of whom had confirmed menopause, seven had become pregnant. There was something strange going on here; she’d been working on and off for Trilling for some time now, and there’d never been a case like this before. There was something about it she couldn’t put her finger on.

She picked up the telephone and buzzed Trilling’s number. He was a long time picking up.

“I’ve been reviewing the Tynadette file,” she said. “I think I’ve found something strange.” His pause before acknowledging was a long one, and she used the time to stub out her cigarette.

“Yes,” he said finally. There was a halfhearted question in his tone.

“Seven women out of thirty have become pregnant,” Jeanie said. “After using a drug supposed to relieve vaginal atrophy following menopause.”

There was another thoughtful pause. “I suppose I’d better see the profiles,” he said.

She gathered the forms from her desk, put them back in the folder, and entered his office. Trilling was staring with an uninterested expression at the office building opposite his window. Outside, the forty-story glass cube across the street was reflecting the frantic lights of a blocked fire engine. There was no sound: high in the Tempel Building, they were insulated from the siren.

“Do you suppose,” Jeanie said, “that Tynadette could be used as a fertility drug?”

Trilling pursed his lip, his eyes never wavering from the window. “Tempel has fertility drugs already,” he said. The red reflection slowly flashed away, the traffic flow suddenly unclogged. “I don’t understand this. I suppose I should call Winkelstein and see if he had them on any other kind of medication. Maybe he misinterpreted the profile.”

“I should think,” Jeanie said, “that Tempel would want to discover the cause of this. Something that makes menopausal women fertile could be useful. This might help a new line of research.”

Trilling gave her an irritated glance. “What this is is a pain,” he said suddenly. He straightened in his chair and reached for the telephone. “What it is is a messed-up study and letters from the FDA and great big WARNING boxes in the PDR.” And having unpleasant conversations that interfere with a man’s optimism, he almost added.

“Let me know what you find out,” Jeanie said. “I’m interested.”

Trilling gave a savage nod, and she knew she was dismissed. She wanted to ask him to discover how many of the other women in the study were suddenly fertile, but he gave her another annoyed look as he began flipping through his Rolodex. He had put on a doctor-knows-best face, and she knew it wasn’t the time.

Later, she thought. It would give her time to think about it, and the papers would cross her desk anyway.

––—

24

Should it become necessary to terminate the project prior to completion, the following financial arrangement is hereby agreed upon: Investigator receives payment prorated according to completed case reports:

$1,200 for each completed evaluable case.

$300 for each completed nonevaluable.

––—

25

Jeanie had taken class, and the whirlpool and sauna at a health club afterward — one of her friends had given her a guest pass — had left her with a pleasant, warm feeling oozing over her limbs. She hadn’t met any hustlers or crazy people on the way home, and that was cause for celebration, too. She thought it would be nice to crawl into bed and drink a few margaritas while reading the new Crumley; but she couldn’t afford margarita fixings and so decided to settle for killing half the bottle of California red that was sitting in the refrigerator.

She unlocked her apartment building street door and saw, slumped in the doorway, the present girlfriend of Joe Voss, the Vidiot who lived upstairs. Her name, Jeanie thought, was Angela. She looked up at Jeanie. “The club where I dance fired me ‘cause I got all skinned up in a fight. And now he’s thrown me out.” She pointed with her bruised chin upstairs. “He’s taking back his wife ‘cause she got her old job back. Well, maybe she’ll get beat up again and I can come back.”

Well. One pleasant, dreamy mood smashed to hell. Jeanie made some consoling remarks about men in general and then climbed the two flights of stairs to get to her apartment. She opened the three locks on her door, pushed it open, and saw a ruin.

Part of the ceiling had caved in, and something vast and white had fallen onto her bathtub and broken the welds that held it together, shattering it. There was foul-smelling water all over the place, and her belongings, including a lot of books she had piled up on the floor, were slowly soaking the stuff up.

Anger blew through her like Krakatoa saying hello to the record books. She leaped across her small kitchen to the refrigerator, behind which she’d hidden her gun, and reached back to seize the weapon. She didn’t wear the holster in the summertime, or to class ever; and she had been afraid the gun would have been stolen. It was her only remaining valuable possession.

Then, still shaking with fury, she surveyed the damage. The damned rotten ceiling had collapsed, dropping the bathtub that belonged to the junkie upstairs onto her own. Fortunately the bathtub, like hers, was not directly connected to any plumbing except the drain, which had torn out, dripping some awful slime down her walls. No heavy water damage, anyway.

Rotten floors made rotten ceilings, and it all made for a rotten life. The hell with this city, anyway. But what was making that awful smell? She moved closer to the bathtub and peered inside it. Three skulls, still dripping flesh and hair, grinned back at her.

There was the sound of a footstep behind her, and she turned and fired.

The skinny junkie from upstairs had just come out of her bathroom, where he’d evidently been washing another skull. He looked dazed, hardly able to keep his eyes open. He carried the dripping skull in his hand.

Screaming, Jeanie unzipped him with four neatly spaced shots between larynx and sternum. In the sudden silence broken only by the sound of her brass rolling on the floor, Jeanie thought with surprising clarity. She’d tell the police that he had stolen her gun, that he’d threatened her with it and grabbed for her, and she’d wrestled the gun away from him and fired. He sure as hell would have grabbed her sooner or later, anyway.

She went to the phone, dialed 911, and told the cops to come. There were a dozen neighbors clustered in her doorway, including Joe Voss and his once and future lover, both staring at the mess with dull junkie eyes. Jeanie tried and failed to chase them away. That was a comforting thing about poor neighborhoods, she thought: everything was everyone else’s business. In a newly gentrified neighborhood, her fellow tenants would probably have made sure their doors were locked and then put pillows over their ears.

She went into her bedroom alcove and lay down, drawing up her booted feet on the bed, and waited. She wondered what a ranch girl from Montana was doing in this crazy place anyway, and she thought hard about the long valleys filled with sagebrush scrub and the timbered highlands that gave a view of the wine-dark Rockies all far away. Tears stung her eyes. Damn, she thought, how could people live like this?

The first cop stepped into the apartment, treading cautiously as if walking on ice. She looked up from her pillow and answered her own question. “Gotta dance,” she said. The policeman gave no indication he thought her remark was odd.

––—

26

It took a couple of days for Trilling to get accustomed to the idea of a killer working in his office. He’d seen Bennie toes-up on the eleven o’clock news, with a bloody sheet over him all in mute hideous color, and a morbid closeup of a cardboard box full of skulls. The tabloids had been featuring vast headlines, all screaming adjectives, about the East Side Addict Grave Robber, and Trilling had been forced to stare at them as they were upheld by other passengers on the long commute to Hempstead. It was all nightmarish.

Jeanie had been out for several days following the incident, though, and by the time she got back, Trilling had got used to the idea. He took some Pandrocene for a kind of calm gravity and ordered an extravagant bouquet of flowers for her desk. He wanted to be on hand when she arrived. She seemed a little pale, and he gave her a paternal hug.

“I’d rather not talk about it,” she said.

He nodded. “Of course you don’t,” he said. He began fumbling in his pocket for one of his pill bottles. Perhaps she’d like a capsule or two.

Jeanie looked at her desk and saw the flowers. “Oh,” she said. “They’re pretty, aren’t they?”

Trilling nodded and tried to smile in an encouraging way. “Thank you,” said Jeanie, and sat down at her desk.

Well, Trilling thought. Things back to normal so quickly. Repressing the impulse to dust off his hands, he gave everyone in the office a sunny smile and returned to his desk.

Jeanie went straight to work, trying to ignore the solemn, inadvertent stares of her fellow workers as they walked past her alcove. She really didn’t want to talk about it. It seemed that talk was all she’d done for days.

She’d spent the first night in jail, until her phone calls had got through to a lawyer she had once worked for. He’d come down and got her out, but that wasn’t the end of it.

There was a very good chance she’d end up charged with murder. She had listened in amazement as her lawyer explained the facts.

“You were supposed to find out his intentions, Jeanie,” he’d said. “You were supposed to ask him what he was doing in your apartment. If he was there to rob you, you should have let him. If he was there to rape you, you were justified in holding him at gunpoint or subduing him, but never shooting to kill. Only if he had expressed his intention to murder you were you justified in killing him. And even then the precedents aren’t unanimous.”

“But he had a gun,” Jeanie had told him. “And a skull.”

“Doesn’t make any difference,” the attorney said. “You’ve been watching too many Charles Bronson movies. Bronson never gets booked for murder, but that’s just Hollywood. Here in reality, things are different.”

And so the police investigation was continuing. Her friends and the personnel at the gun club were being interviewed by detectives. Even if no charges were eventually laid — and that was up to the district attorney, not the cops — there would be depositions to be given and appearances to be made, and for all of that she’d need a lawyer who was charging her five hundred an hour. Reporters from the tabloids were staking out her apartment in hopes she’d let something slip, and on top of everything, someone had broken into her apartment when she was in jail and cleaned everything out.

Even if she wanted to leave the city, she couldn’t: the police had told her to stay in their jurisdiction, and besides, she couldn’t afford to move. She’d had to return to Tempel, if only to pay her bills.

How can people live this way? she thought.

Late the next day, Jeanie was on the Dictaphone and realized that the letter she was typing canceled the Tynadette study. She took her foot off the pedal, pulled off her earphones, and lit a cigarette, trying to understand what was gnawing at her mind. Whatever it was, it wouldn’t come.

Hell, she decided. I’ve got my own problems.

She put her foot down on the pedal and began to type.

––—

27

Kimberlee Winkelstein typed her father’s name and office address across the Tempel Request for Check form. Program terminated, she typed, 9-12-84. She had to go to the correction fluid and retype the correct year. She’d had a little too much vodka during the break.

It was the second program termination in a week. The first had been the Baum Company study. Her father had been upset about it, but he’d now received approval to test new medications for both companies, different medications that were supposed to do the same thing without the side effects that had snarled up the programs. So he’d get his money anyway.

She’d forgotten her Walkman today, and glanced up in annoyance at the sounds of the children jumping up and down on the waiting room seats. Old people and young mothers and children, all sick with something. She wished she could cover up the noise with her bootleg cassette of the Headlickers. There were beginning to replace the Vidiots in her affections.

––—

28

PARANOID DISORDERS (Definitions for basis of treatment):

1. Paranoia

2. Shared paranoia (folie a deux)

3. Acute paranoid disorder

4. Atypical paranoid disorder

––—

29

Angel Hernandez sipped on his fourth beer of the afternoon and watched the television without interest as it showed an Argentine soap opera. Filomena moved slowly about the living room, picking up the children’s toys. Since the abortion she’d been a lot less lively, and in the past few days, she’d been complaining that her arthritis was coming back. She came to the sports section of yesterday’s Post and held it up mutely.

“I picked my horses,” he said. “You can throw it away. How about a kiss?”

She gave a faint smile and bent over him for a peck. She seemed out of breath with the exertion, and in the instant before she straightened, he noticed sadly that her hair was coming in white again.

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