To swing the purchase of the bungalow on a resident’s salary, she had taken Linda Grainger, another third year resident, in on the deal as a partner and housemate. Linda usually hit Huey’s for happy hour and dinner after work, but tonight, her red MR2 was already home.
Getting out of her car, Sarchi smelled the faint odor of Old Spice wafting in from the drum reclamation plant in the field behind the house. The realtor had pointed out that the plant made absolutely no noise, and with the rows of pines along the property line, couldn’t even be seen. So they hadn’t let its existence affect the deal. But shortly after moving in, they’d found that sometimes you could smell the contents of the containers the plant was reclaiming. In her troubled state, Sarchi saw this as just one more situation she’d mishandled.
Linda was in the kitchen watering Sarchi’s miniature rose on the shelf over the sink. Most of the plant’s leaves were in the pot, dried and curled.
“Thanks for the effort,” Sarchi said, “but I’m afraid even life support wouldn’t save it now.”
“That’s why I don’t have plants,” Linda said. “They always die. I hate that. I think just before they put them in stores, they change the soil so they’ll croak. Guess you saw we’re in for another three months of mud and noise on the opposite side of us.”
“At least they don’t work at night.”
Linda was about Sarchi’s height, also with dark hair that she, too, kept short. But that’s where the resemblance ended. Opting for low upkeep, Sarchi wore hers in a boyish cut, swept back on one side, carried gently down to her eyebrow on the other. Feeling that a man’s early impression of a woman was influenced at least as much by her hair as her breasts, Linda’s hair was always a carefully staged event. And she was a master at makeup, which she wore so skillfully she reminded Sarchi of a television commercial in which the sponsor’s product was in color, and the rest of the world was in black and white. In short, where Sarchi was viewed by most as merely homespun cute, Linda was generally thought to be a sloe-eyed flamboyant beauty. Tonight, in a form-fitting black dress and heels, pearls at her throat and ears, she certainly looked the part.
“Where are you going?” Sarchi asked.
“The Memphis Symphony ball.” She threw her head back and primped her hair. “Please don’t hate me because I’m popular.”
Actually, Sarchi couldn’t have handled being popular if it meant dressing like that. If L.L. Bean or Lands’ End didn’t sell it, Sarchi didn’t own it. Although she possessed legs that would make even a bishop want to sneak a look, she usually covered them with jeans, twills, or chinos. The rest of her closet was taken up by sweaters, knit pullovers, and simple oxford shirts. Any occasion requiring more than that was probably one that wouldn’t interest her. And pearls? Come on . . .
“Who’s the guy tonight?” she asked.
Linda wagged a finger at her. “Ah-ah . . . no prying.”
“I don’t know how you do it.”
“You live too closed a life. You have to get out, go places. You can’t catch fish in a toilet.”
“You think the hospital’s a toilet?”
“It’s a metaphor, hon. It means, to find a man, you have to move among them. Whatever happened to the guy you met last year on that caving trip? He should have been a natural for you. But you haven’t mentioned him in months.”
“On the trip he seemed fine, but later, his e-mails were so drenched in testosterone, I lost interest.”
“That doesn’t sound so bad.”
“Just because I love caves doesn’t mean I’m looking for a caveman.”
“There’s your problem. Your standards are too high. Are these pearls enough? Maybe a pin of some sort . . .”
“You look great.”
“. . . or a scarf instead of the necklace . . .”
While Linda went off to her room to fidget, Sarchi threw the rose in the wastebasket. She considered hanging around to get a look at Linda’s catch of the day but decided instead to head for the bathroom to wash her hair.
A few minutes later, her clean hair making her feel more centered, Sarchi went to her computer to check her e-mail. Her father lived alone in the family home in Johnson City, a small town in the northeast corner of the state. The death of her mother six years ago had affected his mind, so he had embarked on a grand plan to revisit every place in the world the two of them had ever been together, starting with Sarchi, Costa Rica, their first destination outside the United States and where they thought Sarchi had been conceived. His quest covered so much territory he still hadn’t completed the circuit. When Carolyn died barely a year after her mother, he began to spend much of his time between trips writing down, in minute detail, every memory he had of his two lost angels: what they wore on this occasion, what they said, and how they said it. It was practically all he talked about, and except for his trips, all he thought about. Whenever he found his memory about a particular point fuzzy, he turned to Sarchi for help. Which meant he sent her a lot of e-mails.
And sure enough, the first message listed was from him. Sarchi’s hobby was cave exploration. So she wasn’t surprised to see that the second e-mail was a caver’s digest. The third message was from a former medical school classmate, announcing her engagement. A month earlier, Sarchi had accepted an offer to join a team being put together to explore some new leads in Kentucky’s Flint Ridge Cave System the following February. Her regular workouts in the weight room were partly to ensure that she’d be physically up to the task. The last message was from the leader of that expedition, asking if she had any suggestions for replacing someone who had dropped out.
Too tired to deal with any of this, she turned off the computer, changed into her pajamas, and climbed into bed with a pediatric medicine text to see if she could get any new ideas about Drew’s condition. She read about six lines then fell asleep, still sitting up with the book in her lap.
THE NEXT TWO days were awful. Twelve hours after Gilbert Klyce completed the regimen of antibiotics he was being given for the pneumonia that had initially brought him to the hospital, he spiked a fever. The cause couldn’t be his Staph infection kicking up because he was still receiving vancomycin. While waiting for results from the blood and urine cultures, his neutrophil count tripled. Then they got the bad news: His cultures came back positive for yeast. Now he had a damn Candida infection, which probably meant six more weeks in the hospital while he was treated for that.
Drew didn’t get any worse, but the blood and spinal fluid cultures grew nothing, and no botulism organisms were found in a stool sample. His blood chemistry and differential leucocyte count remained normal, and a series of nerve conduction studies indicated that his peripheral nerves were functioning properly.
On the fourth day after Drew’s admittance, Mel Pierce, the reigning neurology guru on staff discovered that Drew had developed a bilateral Babinski sign, a splaying and elevation of the toes when the sole of the foot is stroked. This classic indicator of a lesion in the major motor pathways of the central nervous system prompted Pierce, in part, to schedule a PET scan, an additional noninvasive way of looking at the brain. Because it can show by different colors which parts of the brain are metabolically abnormal, everyone hoped this scan would finally provide the clue that had so far eluded them.
It didn’t. Nor did Pierce contribute anything to justify his reputation. The case quickly became a cause célèbre in the hospital, and a steady procession of residents and attendings made their way past Drew’s bed. But no one had a decent explanation for Drew’s condition.
In her years of caving, sitting hundreds of feet underground in huge limestone chambers with her carbide lamp creating ghostly shadows on the alien landscape, Sarchi had often felt her mind expand. More than once in such surroundings, she had seen the answer to some perplexing personal problem. Unable to figure out what was wrong with Drew, she had even tried sitting in
her darkened bedroom with only a small lamp illuminating her huge poster of the candelabra room in Lechuguilla, the fabulously beautiful cave in New Mexico. But nothing came of it.
Late on the seventh day, when Sarchi returned to Drew’s room after an hour spent on the asthma ward, Marge stood and said, “I heard from my insurance company today. They won’t pay to keep Drew here any longer. He has to go to a clinic in New Orleans that’s had a lot of success with cases like this.”
Sarchi was embarrassed at her performance on the case and was relieved that the spotlight was about to shift off her, especially if it meant Drew would get help.
“I wonder if . . .” Marge faltered.
“What?”
“I know it’s a lot to ask, but would you . . . Could you go to New Orleans with me . . . to the clinic and be there while I talk to the doctors? I’d feel much more comfortable with you next to me.”
Considering how badly she’d let Drew and Marge down, there was only one answer Sarchi could give. “Of course I’ll go.”
8
“THE DOCTOR IS available now,” the nurse said.
Sarchi followed Marge through the door off the waiting room, down a hall, and into a well-furnished office where a white-coated man with coarse features stood as they entered.
Drew had left Memphis for the clinic in New Orleans by medical transport the previous day. Marge had wanted to follow in her car, but Sarchi had convinced her to fly the next day, pointing out that it would take at least eight hours for Drew to reach the clinic, and he would have to be evaluated before there could be any discussion about his treatment. As an inducement to this rational course of action, Sarchi had offered Marge one of the frequent flyer tickets she’d accumulated from her father, who sent them regularly in hopes she’d use one to come home for a visit. To get free, Sarchi had convinced another resident to cover for her.
“I’m Doctor Latham,” the man behind the desk said, offering his hand.
Marge shook it and introduced herself. “And this is Doctor Seminoux. She’s Drew’s aunt and was also his physician in Memphis.”
“A pleasure, Doctor,” Latham said, taking Sarchi’s hand.
He tried to make his face match the cordial tone of his greeting, but Sarchi sensed that he was not pleased to have her there. That wasn’t surprising. Considering all the big egos in medicine, he probably believed she was angry at having Drew’s case taken from her. Boy, was he mistaken.
Latham waited until they were seated before returning to his chair. “Mrs. Harrison, I’ll get right to the point. We’ve evaluated your son’s condition, and I’m pleased to say I think we can help him.”
Relief spread across Marge’s face. Her pent-up anxiety came out in a long sigh, and she lowered her face into her hands. “Thank God.” She looked up. “What’s wrong with him?”
Latham leaned back in his chair and brought his hands together, steepling his fingers. “It’s a condition caused by the malfunction of a small cluster of neurons deep in his brain. They are sending erroneous messages to their many relays, ultimately affecting the motor cortex, the cells where voluntary movement originates.”
“What causes it?” Marge asked.
“We don’t know.”
“How is it treated?”
“We send a small instrument into the brain and sever the outflow fibers from those cells.”
Sarchi stiffened in her seat, reminded of the ill-conceived notion popular years ago that prefrontal lobotomies were an acceptable way of treating certain personality disorders. In those, too, they’d simply cut fibers, often producing effects worse than the original condition. But Latham’s work had obviously passed scrutiny by the bean counters at Marge’s HMO. He must be getting patients back on their feet in a functional state. But, of course, a lot of the people working for HMOs were morons.
“Sever . . . you’ll be cutting on my son’s brain?”
“In a very precise way and in only a tiny area.”
“Is this a complete cure?”
Latham leaned forward and folded his hands on the desk. “The odds for significant improvement are very high. Some of the cases we’ve treated have shown complete recovery within weeks after treatment. Others show some residual deficits that improve over time, often resolving completely. In a small percentage, minor deficits persist.”
“Is there any way to predict what will happen with Drew?” Marge asked.
“Unfortunately, no.”
Sarchi had planned to keep quiet during this session, but she now found it impossible. Latham was treating a disease no one at her home hospital could even diagnose. This was something she needed to know more about. “Forgive me for interrupting, Doctor, but to further my own education, could you tell me exactly what cells are malfunctioning?”
That look again—veiled and brief, but unmistakable. He didn’t welcome the question.
“Doctor Seminoux . . . is it?”
Sarchi nodded.
“You seem young to be a practicing pediatrician.”
“I’m a third-year resident.”
Latham smiled. “I see, still in the fold.”
Sarchi felt he was stalling. She half expected him to ignore her question, but then he said, “The cells in question are those that form the ansa lenticularis.”
It was a term she vaguely remembered hearing in neuroanatomy a lifetime ago, but she couldn’t recall any of the details. And this certainly wasn’t the time or place to admit that. Instead, she took a different course. “I’d love to read more about this. Have you written up any of your work?”
“No. There are several papers in draft form, but I’ve just been too busy to get them out. Now, if you’ll pardon me for saying this, we’re not here to fill the gaps in your education. We’re here to make a little boy better.”
Sarchi felt her face flush.
Latham turned his attention to Marge. “The way we work is this: you leave Drew with us for five days, during which we allow no visitation—”
“I couldn’t do that,” Marge said. “Can’t I stay with him?”
“I’m sorry, no. Children are very good at picking up on the anxiety their condition creates in their parents. They do much better emotionally when left entirely in our care. Of course, you may call whenever you like and check on the boy. I’ll give you the number. If you leave Drew here today, he’ll go home next Wednesday, in all probability very much like he was before this difficulty arose.”
He reached in a drawer and brought out a sheet of paper. “We’ll need your signature on this surgical release form. There is a clause in there I should call to your attention. By signing, you waive your right to any litigation that might arise from our treatment of your son.”
“You mean I could never sue for malpractice?”
“It’s an ugly subject to bring up at this point, but we are such a litigious society, we have to protect ourselves. As Doctor Seminoux pointed out by her question, this is a relatively new treatment, and for us to be able to offer it requires the immunity that clause provides.
“In any event, you need time to think. But I already have a great many obligations scheduled in the next few months, so if you do decide to proceed, I must have your decision before the end of the day. Now, why don’t you and Doctor Seminoux discuss this and let me know. I don’t mean in the next few minutes. In fact . . .” He looked at his watch.
“I have a meeting coming up that will occupy the better part of the next three hours. If it’s agreeable with you, let’s get together again right here at four thirty and see where we are. Don’t stay in the hospital. It’s such a fine day, you should get out to talk.”
BEFORE THEY MET with Latham, Sarchi and Marge had visited with Drew in his room at the clinic to reassure him about what was happening. They stopped by his room again briefly, then took Latham’s ad
vice and headed for the front entrance.
“What do you think?” Marge asked, stepping off the elevator on the first floor, unaware that someone from Latham’s office was now tagging along close enough to overhear Sarchi’s answer.
“Do we really have any choice? Latham’s is the only treatment your insurance company will pay for. He has to know that, which means, this time he gave us to discuss it is an empty gesture.”
“Forget the insurance. If we had complete freedom to choose, would you put Drew in Latham’s care?”
“I sure don’t like the guy.”
“Because of the remark he made about your education?”
“Not just that. This three hours to talk is manipulative.”
“Does liking him really matter?”
“No.”
“What else?”
“There’s nothing to read about his treatment.”
“He explained that.”
“But only in a very sketchy way. Where are the case reports?”
“You heard what he said. He’s been too busy to write them up. Isn’t that possible?”
“Absolutely.”
“Well?”
“I’ve never heard of this disease and neither has anyone at my hospital, so his treatment of it has to be experimental. Even long-accepted protocols sometimes turn out to have problems. Take Thorotrast, for instance. For years, doctors gave people Thorotrast to increase the detail that could be seen in X-rays. Completely harmless, they said. Now, we know a lot of it ends up in the liver where it remains for the rest of your life and is a factor in liver cancer.”
“But this isn’t like that. He’s not giving Drew any chemicals, and he’s done enough of these cases to know what the results are.”
“How many has he done? We don’t know. And how long has he been treating these cases? I’ll bet he only knows the short-term results. What about ten to fifteen years from now?”
The Killing Harvest Page 6
