Malice by design, p.1
Malice by Design, page 1
MALICE BY DESIGN
An Authentic Medical Thriller
GARY BIRKEN, M.D.
Erupen Titles
Copyright © 2023 by Erupen titles
All rights reserved.
This is a work of fiction. Names, characters, places, and incidents are products of the author’s imagination or used fictitiously. Any resemblance to actual persons, living or dead, is purely coincidental. All products and brand names are registered trademarks of their respective holders/companies.
No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the author, except for the use of brief quotations in a book review.
Contents
Prologue
Part I
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Part II
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Part III
Chapter 57
Chapter 58
Chapter 59
Chapter 60
Chapter 61
Chapter 62
Part IV
Chapter 63
Chapter 64
Chapter 65
Chapter 66
Chapter 67
Chapter 68
Chapter 69
Chapter 70
Chapter 71
Chapter 72
Chapter 73
Chapter 74
Chapter 75
Chapter 76
Chapter 77
Chapter 78
Chapter 79
Chapter 80
Chapter 81
Chapter 82
Chapter 83
Epilogue
About Gary Birken, MD
Prologue
ITHACA, NEW YORK
JANUARY 2009
With each labored breath she drew, the muscles of Dr. Anna Hartmann’s barrel chest heaved and jerked as they struggled to force desperately needed oxygen into her failing lungs. With her condition rapidly deteriorating, she lay propped up against the hand-carved headboard of the four-poster bed that had been in her family for three generations.
“My appearance disturbs you,” she said to the gaunt man standing at the foot of her bed. “I’m an old woman, and my body has betrayed me, but I assure you, I’m still in full possession of my faculties.”
“I know you are, Doctor. Would it be okay if I asked you a question or two?” he inquired taking note of her patchy gray complexion and hollow eyes that had slipped back into their deep-set sockets. Though he struggled to ignore it, the stale scent of lingering illness that thickened the air churned his stomach.
“If you must,” she answered.
“It’s been many decades since you concluded your work. To your knowledge, has any other individual or group attempted to continue your medical research?”
“If you understood the mitigating circumstances—as I thought you did—you wouldn’t be asking that question. But since you did, the answer to your question is no.”
“You mentioned the first time we spoke that you were sure there are no other written accounts of your research except your own. I just wanted to make sure I understood you correctly.”
With a feeble hand, she gestured at the time-weary Victorian writing desk with tarnished brass handles that sat under the only window in the room. Uttering even a single sentence further weakened her ability to breathe.
“My journals are on the desk. I suggest you take a good look at them. They are without doubt the only recorded evidence of my discoveries.”
“I hope you understand that I intend no disrespect, but I have to remain extremely cautious regarding my possible involvement.”
“Young man, I’m not trying to sell you anything. If you don’t understand that I’m offering you the opportunity to lead one of the most important research initiatives in the last hundred years, then you’re a fool.”
“Dr. Hartmann, please understand that I didn’t mean to imply…”
“I pray I haven’t misjudged you. I thought you were a man of vision and inspiration.”
Deciding to say nothing, his pinched expression was his only response to her offensive comment. After a strained silence, he started across the room toward the desk where his eyes fell on three jade-colored leather journals that were scuffed and faded by time.
With a hand that quivered with anticipation, he ran his index finger along the gold-embossed border and coarse spine of the middle journal. Fearful of its fragility, he cautiously unknotted the black leather ties and gingerly opened it. He began by examining several pages from each of three divided sections. They were all marked by meticulous handwritten notes and flawless diagrams. When he was finished, he closed the journal and repeated the same process with the other two. After he’d scanned the final page, he felt reasonably assured he hadn’t traveled nearly five hundred miles on a fool’s errand.
“This appears to be magnificent work, Dr. Hartmann. You’re to be congratulated. If it’s still your wish, I’d be honored to continue the research where you were forced to stop.”
“Since I’d expect any scientist worth their salt to make the same offer, you’ll excuse me if I’m neither flattered nor overwhelmed by your words.”
“I’m sorry if I’ve said anything that has given you cause to regret inviting me here today.”
“To be frank, you haven’t convinced me you fully grasp the immense responsibility that comes with building upon my work.” Between disjointed breaths, she went on. “My journals will take you to a hilltop from which you can make one of the greatest medical breakthroughs in modern history.”
Before he could respond, a hefty woman with mousy gray hair walked into the room. After casting a displeased glance the man’s way, she went to her mother’s bedside.
“Don’t try to speak any more, Mom. You’re obviously exhausted.” Elise Hartmann was her mother’s only child and sole caretaker. For the past few years, she had devoted herself mind and body to the task. For most, it would have been a trying existence, but Elise was a kindhearted woman who accepted her dreary life without bitterness, almost as if it were her calling.
“Stop fussing over me. I’m…I’m fine.”
“I know you are,” she said, tucking the lavish down comforter snugly under her mother’s feet. Without turning toward the man, she stated, “My mother’s in no condition to continue her conversation with you. I’m afraid you’ll have to leave now. I’ll meet you downstairs in a few minutes. If it’s still her wish, I’ll bring the journals to you.”
“Of course,” he responded, relieved he wouldn’t be placed in the awkward position of having to conclude the meeting himself. Just as he was about to step out into the hall, he turned back to the woman in the bed. “It was a distinct pleasure meeting you, Dr. Hartmann. If you allow me to advance your work, you have my word of honor the results will reflect proudly on you.”
“Unfortunately, that’s something I’ll never know.”
As soon as he was out of the room, Elise said, “Mother, you have to calm down. You promised me.”
“I’ve accomplished a great deal in my life, but there were grave mistakes along the way.” Her words faded into silence for a few seconds. “Perhaps this man will be the one to make the world understand that. In spite of regrettable appearances, my hands and mind were always guided by the highest purpose.”
“Nobody will ever question your intentions or the importance of your work.”
With Elise’s assistance, Anna used what little energy she could muster to lean forward. The skin of her arms was parched and stretched over her fluid-filled elbows. Elise placed a crystal tumbler to her mouth. With barely parted, cyanotic lips, Anna found the tip of the straw and drew two sips of ice water into her mouth.
Tears brimming in her eyes, Anna said, “I pray I haven’t made a catastrophic mistake. May God forgive me if I have.”
“Get some rest. I love you.”
Elise leaned down and kissed her mother’s forehead. She then moved to the desk, collected the journals, and slipped out of the room. She advanced along the dimly
“Miss Hartmann, I have some concerns I’d like to—”
“Your concerns don’t interest me in the slightest, sir.”
“But you must understand, I have to—”
“Actually, the only thing that matters is what you understand,” she told him, gesturing toward his leather computer case. “Either take the journals or leave without them. It’s a matter of complete indifference to me. I assure you, my mother’s second choice to carry on her work is a phone call away.”
It was the look of sheer resolve in her eyes that guided his choice. He was a man who didn’t normally tolerate insubordination, nor did he allow anybody to instruct him, but he was also savvy enough to appreciate who had the leverage in a negotiation.
He raised an apologetic hand. “I’m sorry. I certainly didn’t mean to imply that I wouldn’t be honored to further advance your mother’s work.” He extended his hand and accepted the journals from Elise.
As he slipped them into his computer bag, she said, “What you carry in your case is the legacy of a great woman. I warn you sir. We’ve taken you at your word. Don’t ever forget the pledge you made never to disclose my mother’s identity to anybody. I promise you, if you break your word it will be a tragic mistake.”
“My oath to her is forever and unconditional. Nobody will ever learn of her involvement in any of this.” He buttoned his coat and stepped out onto the porch. “I only regret your mother won’t be here to see her dream come to fruition.”
“As per our agreement, don’t ever contact my mother or me again.”
The sound of the door pounding closed prevented any hope he had of responding.
By the time he reached the end of the driveway, he was chilled to the depth of his core by a gusty wind laced with frozen rain. Hunching his shoulders, he made his way down the slippery sidewalk to his rental car. He struggled to remain cautiously optimistic but his elation was mounting. Every particle of his being was telling him the contents of Anna Hartmann’s journals would be a shining beacon guiding him to a medical triumph that would be forever attributed to him, and him alone.
Part I
Chapter 1
OSTER CHILDREN’S HOSPITAL
DEFIANCE, OHIO
THIRTEEN YEARS LATER
Consumed by a brand of misery that penetrated to the cavernous recesses of his marrow, Dr. Hayden Kubicek walked out of his younger brother’s hospital room. He made his way down the broad corridor that ended in an expansive glass atrium, still struggling to believe that five minutes earlier he’d been holding Max’s hand when he drew his final breath.
Unable to hold a clear thought in his mind, Hayden stared without purpose at a densely wooded area behind the hospital that stretched, untouched by human hands, as far as the eye could see. Even though he wasn’t a particularly spiritual person, he couldn’t fathom what divine force would see the need to seize the life from a vibrant teenager who had everything to live for.
At twenty-eight years of age and a second-year family practice resident at Fowler Hospital in Toledo, Hayden had an encyclopedic mind for medical detail that had distinguished him as one of the most talented residents the program had ever recruited. He was tall, with wide-set porcine eyes and a jutting chin that overhung an ample neck. He had a slight crook to his nose, a constant reminder of the three fractures he had suffered during a praiseworthy four-year high school wrestling career.
Two years earlier, his world and that of his parents was thrown into turmoil when Max was diagnosed with leukemia. In spite of the poor prognosis, he’d battled his way to remission through several intensive courses of chemotherapy. But all that changed five days earlier when he was suddenly stricken by an overwhelming illness. For no apparent reason, he’d developed extreme leg pain and difficulty walking from severe muscle spasms. The next day, he’d suffered uncontrollable seizures and bizarre changes in his behavior that ended in a profound coma.
In spite of an Olympian effort on the part of his physicians, Max showed no signs of improving. Eventually, the only intervention left to them was to place him on full life support. The next morning, Max’s treatment team met with Hayden and his parents to inform them that Max’s passing was imminent. In addition to being devoted parents, Nina and Peter Kubicek were intelligent and realistic people who were already painfully aware their son was close to the end. Maintaining dignity in both life and death was a guiding spiritual principle they shared, prompting them to sign the necessary documents that forbade the doctors from employing any heroic means to preserve Max’s life. As soon as the meeting was over, Nina and Peter went to his bedside, tearfully said their goodbyes, and returned to Toledo to wait for the inevitable phone call.
Hayden continued to gaze out on the woodland. With the stark realization that Max was gone, a chilling mixture of sorrow and denial numbed him with disbelief. Even though he had said his final goodbye to his brother, he suddenly felt compelled to see him one last time. Doing whatever he could to gather himself, he exited the atrium and followed the corridor back to Max’s room.
When he came through the door, he was surprised to see a man standing next to Max’s bed making entries in a small spiral notebook. Hayden didn’t recognize him but was quick to notice his sky-blue, knee-length lab coat, which differed from the gray coats that were customarily worn by the attending physicians.
Hayden took a few paces forward. The man crooked his head and locked his eyes on him. Just as quickly, he averted his gaze and slipped the note pad into his top pocket. Hayden moved toward the opposite side of the bed to speak with him, but to his surprise, he hurried toward the door without uttering a word. Hayden craned his neck but was unable to read his identification badge. More than a little stunned, he considered following him into the hall, but after a few moments of reflection, he assumed there must be a logical explanation and dismissed the notion.
Hayden shifted his attention to Max and allowed a lungful of air to escape through narrowly parted lips. His face had taken on the appearance of an ethereal death mask. His lifeless cheeks and lips were as vaporous as an early morning ground fog. Standing there motionless like a child playing freeze tag, Hayden fought back a new stream of tears.
When a few minutes had passed, he reached for the black and yellow American Legion baseball cap that Max always kept on his nightstand. He claimed it was good luck. With the softness of a watchmaker’s touch, Hayden brushed the cap’s visor with his fingertips. His lips parted into a hint of a smile as he remembered how he and Max had always shared a fist pump and a high-five when their visit came to an end.
Easing forward a step, he leaned over and lightly stroked Max’s cool hand. With his throat drawn taut from unmitigated heartache, he set the hat on the pillow and kissed his beloved brother’s forehead for the last time.
