by Kate Ledger
But it looked more wrenching than that. Jack had turned a faint shade of green. Tiny beads of sweat stood on his upper lip, which trembled. He looked afraid to breathe too deeply.
“Simon,” Emily whispered with a clenched jaw. “Do something.”
Gripped so completely by the pain, Jack was caught between standing and sitting again. Instead of reaching a safer position, he leaned sideways and threw up. Chairs reared backward as the people across the table jolted upward. A woman—the wife of one of the district executives—put her napkin over her nose and mouth and turned away.
Emily, always confident in moments of crisis, jumped to Jack’s elbow. “Help him get out of here,” she directed in a low voice that no one would dare to question.
Simon clenched Whitby beneath the armpit and steered him out of the ballroom as Emily followed. Whitby seemed to be recovering in the lobby, at least he seemed to be breathing. His face was ashen, and he remained silent. The wife held his hand and said to Simon, “He fell off a ladder at our house in the summer. He was cleaning out a gutter. He was fine—at least he said he was fine—but ever since then, he’s been having these episodes. We never know when they’re coming.”
“I need to go home,” Jack mouthed.
“That’ll be a trick and a half,” the wife answered, realizing the predicament they faced. “We came in your car. You know I don’t drive stick.”
“Simon’ll drive you,” Emily announced. She said to him, “Then you can take a cab home.”
His feelings about being excused were overcome by his delight at being useful. The valet brought around Jack’s car, and Simon eased Jack into the backseat. The wife squeezed in next to him, and Simon took the keys. “Where to?” he said, settling into the front seat, and the wife gave him directions toward Chevy Chase. “What’s he taking for this? Anything?” Simon had asked. “I’m a doctor, you know. I only sideline as a chauffeur.”
“I had a prescription,” Whitby said. It was the first utterance in a normal voice since he’d first let out that awful gasp. “But I’m out. Geez, what a night.”
Instead of steering to Chevy Chase, Simon headed for the D.C. Beltway. “I’m taking you home by way of my office,” he told them. “If you can just hang in there.”
But they didn’t have a choice. He drove all the way back to Baltimore, fifty minutes in the rather light traffic, and left the car running in the circular driveway as he dashed around the side of the house into the office to grab a prescription pad. “You can’t phone in the best painkillers,” he explained when he returned. “What were you taking?” He wrote a new prescription for OxyContin, handed it to the wife and then drove them all the way back to their home in Chevy Chase. He hadn’t heard from the Whitbys since then, but Emily had told him how appreciative they’d been of his efforts.
But now he had sulmenamine, something unique to propose, and he was sure Emily would be pleased that he could make a difference to one of her colleagues. He called Jack Whitby at work. When the secretary patched him through, Simon said, “It’s Dr. Bear.” There was an awkward pause that prompted Simon to supply his first name and then, “I’m Emily’s husband.”
“Of course. How are you?”
“I was wondering how you’re feeling.” There was another pause. “Remember? I drove you across state lines last Christmas.”
Jack coughed. “Mostly all right. From time to time, I have trouble. I try not to let it get in my way.”
“Good,” Simon said. “I mean, not good. I’m sorry for what you’re going through. I have a new treatment for patients with chronic pain. People like you who’ve suffered for a long time.”
“Oh?” Jack said, sounding like he had been called by a telemarketer and was about to insist on being taken off the phone list.
“It’s an injection,” Simon explained quickly. “A new substance. Well, it’s old actually, but new in the treatment of pain. Nonaddictive. Safe. No significant side effects. You’d have to come into the office. I’m conducting a clinical trial. There’d be no cost to you,” he added.
There was a pause on the other end that lasted so long, Simon asked, “Are you still there?”
“Yeah,” Whitby said finally. “Let me talk it over with my wife tonight. Can I call you back? And”—his voice dropped—“can I give you my cell number? I don’t like using the office line for personal kind of stuff.”
Simon chafed at the response to his offer—what suffering person wouldn’t jump at the chance to end the torment, whatever the chances? He wrote on his list, Possible. Rita had provided him with two full pages of names to call, and as soon as he hung up with Whitby, he began at the top. They were patients who had depended on him for years. Some he still saw regularly. Some he hadn’t seen in quite some time and wasn’t even sure if they were still suffering with chronic pain. A few were interested. Maxi Bailey told him she’d do anything, and she was even willing to go off the other meds she was taking in order to give the trial a fair try. She intended to come in for the therapy in a week. The next morning, Jack Whitby called back, and two days later, he became the first patient in the clinical trial of sulmenamine for the treatment of chronic pain.
The wife, whom Whitby called Vally, came with him to the office, stroking his hand and clutching his forearm and all but mopping his brow with a kerchief. Simon thought he might have to pry the woman off Whitby in order to do a basic exam. But he appreciated their hopeful glances, the looks they cast at each other that were timid with anticipation, like two game show contestants presented with a triad of numbered doors.
“He’s been having an attack at least every other week,” Valerie said, running her palm against the back of her husband’s hand.
“That’s not true, Vally. They’re a lot less frequent,” Jack said.
Her oddly blond hair was pulled into a floppy twist behind her head. Whitby looked at her quickly as she protested, “Even if it’s not often. It’s getting to be too much—for him, I mean. He’s had every test under the sun. The last doctor we saw told him he was under too much stress.” She eyed the tray Simon had prepared with a vial of the watery substance and a sterile needle. “So, how does that stuff work?”
Simon snapped on a pair of latex gloves and then paused with his hands in the air as though he were standing in a sterile zone, waiting for an attendant. “The mechanism isn’t known. But that’s not an issue. We use medications all the time, even when we don’t know why they work. Take aspirin, for instance. People who wanted to reduce fever were chewing on willow bark for centuries, as far back as Hippocrates. It wasn’t until the 1960s that anyone was able to say, That stuff’s inhibiting an inflammatory hormone and that’s why it works as a fever reducer and an analgesic. What they think about this medication, in simple terms, is that it increases the positive molecules over the negative ones in exactly the appropriate regions of the brain. But I think there’s very good reason to believe that it works, based on the locale it targets.” He prepared the injection. “So,” he said, laying the needle against the vial, “you ready?”
His staff had been delighted, utterly supportive. Even Gabi, who had complaints about typical procedures and then complaints when the procedures changed, was enthusiastic to hear about the clinical trial that he was going to conduct with this new miraculous substance. She knew of a woman, also from Jamaica, who was a housekeeper who was all but crippled by her sciatica, and she was astounded that Simon could offer a promising treatment and not charge a penny for it. The gesture had all but reshaped her opinion of Americans. The staff had also been glad to hear that Julie was gone. (“Too young,” Rita agreed, when he announced that he’d made a decision to let her go. “Too angry,” he answered, and he hoped they did not suspect that unfortunate kiss, or anything else. It was done with.) His staff believed in him, they believed in his innovative vision in the service of his patients, and they were eager to see him succeed with a new treatment. Each of them could think of people with some form of chronic pain, and each of them
was eager to begin making calls.
Jack Whitby shifted in the paper gown, revealing knobby arms.
“Intramuscularly is what we need, so the deltoid is the best spot,” Simon said. “The shot itself won’t hurt. I’ll want you to sit here for half an hour, just to make sure you respond okay. Then you can go. Come back in a week, and we’ll see how you’re doing, but we’ll talk in the meantime.”
But before he even heard from the Whitbys at the end of a week, Simon had four additional patients interested in the treatment. Two were patients he’d called who were interested in trying it, but the other two were acquaintances of people on the list, who’d merely heard that something new had become available. All of them had run out of other options, but they hadn’t run out of hope. They were ready to try it, as long as it wasn’t addictive and didn’t constipate them worse than the narcotics. Is it herbal? they wanted to know. Is it Asian? Is it available at the pharmacy? Why haven’t we heard about it on the Internet? Can we get it from Canada if we need it? “What if it works?” one woman posed, as if the possibility of being released from her pain presented a range of other, untold threats.
He scheduled the four, and three had received the treatment by the time he reached Jack Whitby.
“I’ve been calling you for four days,” Simon accused.
“We’ve been out, I guess.”
“Well, that’s good! So? How is it? How do you feel?”
“Okay, I think.”
“Any spasms?”
“I haven’t had any—but it’s only been a few days and they can be infrequent. Hard to tell.”
“And what about otherwise? Are you feeling—um—good?”
“I feel fine. I don’t know. About the same, I guess.”
“But better, you said,” he urged.
“I don’t know.”
“Probably you should come in for another shot, just to make sure the spasms don’t recur.”
“I think—I’m not sure about this treatment. I mean, there’s no literature on this stuff at all. I did a search.”
“But if it seems to work,” Simon reasoned.
“I just don’t know,” Jack sighed. “Maybe I could do another round. I’ll talk to Valerie.”
Simon was incredulous. “But if you haven’t had spasms.”
“It might be the drug. I’ve been changing my diet and doing yoga, so who knows.”
But Simon knew better. Even if Whitby didn’t want to credit sulmenamine with his improved state, Simon was convinced the drug had played a role. The following week, Maxi Bailey left the office with a hopeful face, her doleful eyes watery and her hands wringing a Kleenex. He called her a day later, just to check up, and she said, yes, it was hard to describe, but she thought she was feeling better. The pain in her back was a little less sharp, maybe, a little muted. It was still too soon to tell whether it was working, but she was going to try to go out for a little while, heading to the mall with her son. The Jamaican woman, Gabi’s friend with sciatica, seemed to know the minute she hobbled into the office that the treatment, whatever it was, would do wonders. He didn’t have to call her; she called him to say he was a miracle worker. But he was most hopeful about Whitby, particularly because he seemed most skeptical. And Whitby hadn’t said he felt worse. Simon called Ted Ebberly, who listened patiently.
“I mean, I could be imagining it,” Simon acknowledged. “But conceivably, couldn’t there be something molecular—couldn’t you imagine this as a plausible mechanism?”
“Sure, w-why not?” Ted said.
“No, I mean in the way of proof—could you run some kind of biochemical tests? In your lab? The company did fMRI studies. Something’s happening in the brain. Can’t you figure out what receptors are involved?”
“W-we’d have to grind up brain tissue—m-mice obviously—run it through a ligand binding test.”
“Could that be done? Could you do it?” He knew he sounded too desperate, and he knew what Ted’s answer would be.
“N-nope. D-don’t have the manpower or the resources. Or the right m-mice. Got a lot of projects going on right now. But that’s a fascinating finding, and I hope it works out. Aristotle postulated that pain was not a s-sensation but actually an emotion that’s the opposite of pleasure. Maybe it’ll turn out that they’re directly linked through neurotransmitters. An erectile dysfunction drug would be a billion-dollar coup, but to have something for pain? Can you imagine? Hey, b-by the way, are we on for September? La Bohème?”
A laboratory study would have given him an ace in the hole, and he couldn’t help feeling annoyed with Ted, who hadn’t even entertained the notion of what it could mean to conduct experiments. The early results of his very small clinical study were promising but not quite as conclusive as he’d hoped. The Jamaican housekeeper with sciatica, a garrulous woman named Yolanda McBride, seemed delighted with her treatment and was insistent that her legs and back felt better than they had in months. Maxi Bailey said she felt “lighter” overall, and she would come in again and do another round. But there were others who wanted to go back on their regular meds. Simon kept telling patients that the nuances of individual pain were an order of magnitude simpler than the complexities of individual treatment. In medicine, he told them, even success has a range of meanings.
The question remained: What to do about the big picture? He considered the possibility of calling Boeker, not Greg but maybe one of the researchers. Perhaps he could interest someone in the industry in doing the work to prove the drug’s efficacy as an analgesic. He knew a scientist in Boston who did computer modeling of molecules, but he wasn’t sure how long a model of sulmenamine might take to create, and would it answer the question of what the treatment did to create feeling? Through the Groves, he knew of a researcher at an institute in Philadelphia who’d been reprimanded for giving brain injuries to chimps. Perhaps animal studies would help. But every time he listed the possibilities, he returned to the conviction that he couldn’t wait for studies to take shape. It would take months and months just to plan them, not to mention get funding. He was convinced about the drug’s potential, and he didn’t feel he could keep it from his patients.
Then, amid all his reasoning, he picked up the phone and dialed his father. He wondered if he could get some corroboration. He hadn’t spoken to Charles since he’d left Florida. His mother’s voice, when she answered, was airy, like a person hosting a party.
“How is he?” she repeated in singsong tones. “No change. Nothing to report.”
“So that’s good.” There was a brief silence. “We’re fine here, too,” he said.
Simon wanted to bring up the drug. He wondered what had precipitated Charles’s involvement in the study—had Charles gone to someone looking for treatment to maintain his verility? too terrible to think of it—or was he the victim of someone else’s greed? Either way, Simon found himself unwilling to ask his mother about it. He got off the phone without answers.
The only thing to do, Simon realized, was to recruit more patients, and to find out whether he had stumbled upon a cure. No time to be wasted if he intended to be of help. He went to the list that Rita and the staff had compiled. Lewis Gimlet was a longtime patient who’d been crushed by a tall book cart he’d been wheeling through a library and who continued to suffer a pain he described as liquid heat. There was Evelyn Janers, whose problems had begun long before she’d found her way to Simon, with inexplicable pain in her pelvis during intercourse. With a gynecologist, she’d undergone investigative endoscopy through a tiny dime-sized port in her lower abdomen and was found to have minor patches of abnormal uterine tissue growing in the pelvic cavity. The gyn had gone in surgically to remove the endometriosis, but the consequences of that invasive procedure had been unbearable—damage to some nerve process that left Evelyn Janers so pained she could barely stand up straight. Simon had been helping her get by—just barely—with prescriptions of narcotics. There was Sandy Undrsoll, a former pro football player who had suffered knee pain tw
enty years earlier after a tackle, and even after total knee replacement surgery had continued to suffer, as though his old knee would not be forgotten. There was Florence Rudolph, who had trigeminal nerve pain, mysterious, sudden lightning-like bolts of pain that shot across her face and made it almost impossible for her even to wear glasses. There were others, too. Simon phoned them all, and they responded. They were enthusiastic, and they marveled that the doctor remembered them. They were touched to be called at home. Some were skeptical, but others were eager to schedule an appointment.
“How soon can I start?” the former football player, Sandy Undrsoll, asked. “I’ll come over there now. It’s only nine p.m.”
Simon was stunned, but he agreed, and Sandy drove up to the house in the dark. Simon met him in the waiting room, flipping on the lights in the clinic. He gave Sandy the shot and then sat with him for the requisite twenty minutes to make sure the still-burly former athlete didn’t have an allergic reaction to pine bark before driving back home.
All of this was happening—the patients, the anecdotal instances linking one to the next, all evolving into a possible solution to a horrific problem, and he wanted to tell Emily. She’d been distant since he’d returned from Florida, and busy with conferences.
Climbing into bed after Sandy Undrsoll’s injection, he looked at his wife. Her arms were splayed over her head, the eerie mask covering her eyes. He dozed fitfully, with longing and with fragments of unfinished sentences. In disconnected sequences of dream, pained patients were roving outside the waiting room door, howling like wolves. One by one he let them in, reaching out to touch them, patting their shoulders with reassurance. It works with enzymes in the brain, he was explaining in the clinic. It works with the body’s natural capabilities for pain relief. When they looked at him quizzically, he continued, Long-term pain produces alterations in nerves, rearranges their normal activity and establishes new connections. You can’t just step in and interfere with the process. That’s like trying to put your finger on a bead of mercury. Just keeps breaking into more and more pieces and slithering away. You have to increase the body’s ability to do its own job. You’re not just subverting signals or trying to redirect them. You’re enhancing the brain’s ability to overcome pain at the highest level. In his fingers, he held a syringe that glowed gold, and he was worried that he might drop it. Julie McKinley was standing next to him, naked to the waist, one hand on her wretched bony hip. Her breasts were the shape of the bell on the counter of a motel and they looked as hard. “A lot of good it did,” she said. “Your being a doctor.”
