Although Jeffrey’s new fugitive status heightened his indecision and confusion, he no longer had the slightest inclination toward suicide. He didn’t know if he was acting courageously or cow ardly, but he wasn’t about to agonize further. Yet with all that had happened, he was understandably concerned about the pos sibility of a new round of depression. Thinking it better to throw temptation away, he t ‘ ook the step of getting the morphine vial from the briefcase, popping its lid, and flushing the contents down the toilet.
Having at least made a decision about one issue, Jeffrey felt slightly more in control. To make himself feel even more organized, he occupied himself by rearranging the contents of his briefcase. He stacked the money carefully, in the base, covering
it with the underwear. He then rearranged the contents of the accordion-style file area under the lid to make room for Chris Everson’s notes. Turning his attention to the notes, he organized them according to size. Some of them were on Chris’s notepaper, which had From the Desk of
Christopher Everson printed on top. Others were written on sheets of yellow legal paper.
Jeffrey began to scan the notes, almost without meaning to. He was glad for anything that took his mind away from his current predicament. Henry
Noble’s case history was especially fascinating the second time around.
Once again, Jeffrey was struck by the similarities between Chris’s unhappy experience with the man and his own with Patty Owen, particularly with respect to each patient’s initial symptoms. The major difference between the two cases was that Patty’s had been more fulminating and overwhelming.
Since Marcaine had been involved in both cases, the fact that the symptoms were similar was not surprising. What seemed extraordinary was that in both situations the initial symptoms were not what was expected in an adverse reaction to a local anesthetic.
Having been a practicing anesthesiologist for some years, Jeffrey was familiar with the kinds of symptoms that could occur when a patient had an adverse reaction to a local anesthetic. Trouble invariably arose due to an overdose reaching the bloodstream, where it could affect either the heart or the nervous system. Considering the nervous system, it was usually the central or the autonomic system that caused problems, either through stimulation or depression, or a combination of the two.
All this covered a lot of territory, but of all the reactions Jeffrey had studied, heard about, or witnessed, none had been anything like Patty
Owen’s, not with the excessive salivation, the tearing, the sudden perspiration, the abdominal pain, and the constricted, or miotic, pupils.
Some of these responses might occur in an allergic reaction, but not from an overdose, and Jeffrey had reason to believe that Patty Owen had not been allergic to Marcaine.
Obviously, tojudge by his notes, Chris Everson had been comparably troubled. Chris noted that Henry Noble’s symptoms were more muscarinic than anything else, meaning the kind that were expected when parts of the parasympathetic nervous system were stimulated. They were called muscarinic because they mirrored- the effect of a drug called muscarine, which came from a type of mushroom. But parasympathetic stimulation was not
expected with a local anesthetic like Marcaine. If not, then why the muscarine symptoms? It was puzzling.
Jeffrey closed his eyes. It was all very complicated, and, unfortunately, although he knew the basics, much of the physiological details were not fresh in his mind. But he remembered enough to know that the sympathetic division of the autonomic nervous system was the part affected by local anesthetics, not the parasympathetic part apparently affected in the Noble and Owen cases. There was no immediate explanation for it.
Jeffrey’s deep concentration was interrupted by a thump against the wall, then some exaggerated moaning of feigned ecstasy coming from the neighboring room. He had an unwelcome image of the pimply-faced girl and the bald man. The moaning reached a crescendo of sorts and then diminished.
Jeffrey stepped over to the window to stretch. He was again bathed in the red neon light. A group of homeless people was milling around to the right of the Essex’s stoop, presumably in front of the liquor store. Several young hookers were working the street. Off to the side were young toughs who seemed to take a proprietary interest in the goings-on of the area.