The Killing Harvest

by Don Donaldson

  IF TWO KIDS have the same disorder, and one can be cured by a lesion in the ansa lenticularis, it follows that the other would require a lesion in the same place. So why were Stephanie’s scalp wounds farther back than Drew’s were? Sarchi said nothing to the Stanhills about this, mostly because she didn’t know what it meant. Their location, however, reaffirmed a decision she’d made when she’d talked to Pierce about Stephanie before leaving Memphis.

  “Doctor, do you need Stephanie anymore?” Raymond asked.

  “Perhaps later.”

  “Stephie, go to your room now and play,” Raymond said.

  “Do I have to?”

  “Stephanie . . .” The tone in which he said her name sent her scurrying. When she was gone, Raymond said, “What do you think, Doctor? Will that odd movement in her arm ever go away?”

  The arrival of this moment had posed a problem from the time Sarchi had told Raymond she was coming. He thought she’d bring answers, but all she carried were questions. It didn’t feel good to be so deceitful, but the circumstances had left her with little choice. For now though, she didn’t have to admit anything.

  “It’s too soon to say. I’d like to get her an MRI—it’s something like an X-ray . . .”

  “We know what it is,” Raymond said. “God knows, she’s had enough of them. Why do you want that?”

  “Just to see what things look like in her brain now that some time has passed since the operation.”

  Thankfully, that answer seemed to satisfy him.

  “We won’t have to get permission from your insurance company. There’s a neurologist in Memphis who has a large program to study movement disorders in children, and he’s agreed to let us charge the study to his grant.”

  “So after you see the MRI results, you’ll know better what Stephanie’s prognosis will be?” Regina asked.

  “I hope so.”

  “We won’t have to take her to Memphis, will we?” Raymond asked.

  “We can do it here, at whatever hospital did them before. I’d also like copies of the scans that were done before she was treated. Would you release those to me?”

  “Of course. When do you want to schedule the new ones?”

  “I’d like to get them done today if possible. Otherwise, you’ll have to send them to me. If you’ll give me the phone number of the hospital, I’ll set it up.”

  “It’s in my study.”

  Raymond rose to get the number, but Sarchi stopped him.

  “Before we do that, there are a couple of things I’d like to discuss.” She certainly wasn’t going to tell them about her anonymous e-mail message, but the last admonition on it—”Don’t ignore the beginning of it all”—was on her mind. “I’d like to hear how Stephanie’s paralysis began.”

  “It was a Wednesday,” Regina said. “I remember because it was the last day I had to get out a marketing survey I was working on, and I was afraid I’d be late picking Stephie up at her day care. They’re very strict about pick-up time. For every minute past five thirty, they charge you ten dollars, and you have to pay right then. But I made it with about two minutes to spare.”

  “When you picked her up, did she seem normal?”

  “Perfectly—talkative, energetic, just my usual Stephie. I stopped at our favorite bakery, picked up some French bread, and drove home. Ray got in about seven as usual—he works in New York City—and we had dinner.”

  “You all ate the same things?”

  “Yes, fish and a spinach casserole. We had some wine, but of course Stephie didn’t.”

  “And there were still no signs of weakness or difficulty standing?”

  “She was completely normal. She even helped me set the table. After dinner, Ray and I watched TV awhile, and Stephie played with her dolls. Then, just before bedtime, I read her a story. I was sitting in the rocker in her room, and she was in my lap.” Regina’s eyes misted again.

  “She was pointing at the pictures in the book, and we were discussing the story. By the time I’d finished, she’d apparently nodded off, except she wasn’t asleep, she was . . .”

  Sarchi’s brow furrowed. Regina’s story was much like the one Marge told about Drew when he got sick—both kids normal all evening, both suddenly falling ill while being read to.

  “Did anyone ask the day care if Stephanie had hit her head or fallen down or had anything unusual happen to her either the day before or during the day she became ill?”

  “That same afternoon, a bratty kid visiting the playground with his mother squirted her in the face with a water gun,” Regina said.

  “Nothing else?”

  “We questioned them pretty hard, but that’s all we got.”

  “How do you think she acquired this thing?” Raymond asked.

  “I’d love to know the answer, but I’m afraid it’s still a mystery.”

  Then Raymond finally took the conversation in the direction Sarchi had been hoping to avoid. “When you first called us, you mentioned that Dr. Latham had also treated a patient of yours . . . a boy, you said. How’s he doing?”

  “He has a residual problem too.”

  “But different from Stephie’s . . .”

  “Yes.”

  “Why is that?”

  “At this point I’m not sure.” At least that was the truth.

  “Have you done a postoperative MRI on him?”

  “We just completed it.”

  “What did it show?”

  This was getting tough. Hoping she didn’t look as nervous as she felt, Sarchi said, “We’re still evaluating the results. Being able to compare his with Stephanie’s will help us understand both sets better.” Sarchi moved quickly to a remaining issue she needed to bring up about their daughter.

  “In order for Stephanie’s new MRI to be useful to the neurologist in Memphis, he asked me to bring him a video of her from which he can see for himself the nature of her disorder. Would that be all right? I can do it with my phone.”

  “As long as the video is only used for medical purposes, and Stephie’s identity is withheld from everyone but the neurologist,” Raymond said.

  “I’m sure he’ll agree,” Sarchi said.

  “Would you like to do it now?”

  “If it’s convenient.”

  Regina got out of her chair. “I’ll get her.”

  THE HOSPITAL COULDN’T do Stephanie’s new MRI until the following day. Nor could Sarchi obtain the pre-Latham scan file in the time available. She therefore had to leave New York without either set. As it happened, Pierce was traveling the next day and wouldn’t have been around to help read them anyway. CDs of both scan sets arrived by Federal Express a little after four p.m. the day after her return. Hoping Pierce was back from wherever he’d been, she paged him on a house phone. He returned the call almost immediately, and they agreed to meet ten minutes later in her office. Wanting to get a quick look at the scans before Pierce did, Sarchi sat at her desktop computer and went through them while waiting for his arrival.

  During the month since Stephanie’s surgery, the tracks of Latham’s lesioning instrument had slowly faded, making the new scans more difficult to interpret than Drew’s, so when Pierce showed up a few minutes into her attempts to read them, she was more than ready to turn the job over to him.

  “How’d you like New York?” he asked.

  “I could have done without the blizzard.”

  “Let’s see what you’ve got.”

  “What do you want first, the video of her movement disorder, or the scans?”

  “The video.”

  Sarchi got up and went to her laptop, which was open on top of a short bookcase behind her desk. “She has constant shoulder movement on her right side, and about every twenty minutes she flings her right arm out. I was only able to get one
instance of the large movement, but I’ve got the video set up to loop, so you can see it more than once.”

  Sarchi started the video.

  Pierce watched it cycle a couple of times, then turned to Sarchi. “Looks like ballismus to me. Let’s see the scans.”

  Sarchi gestured to the computer on her desk. “The post op scans are already open. That CD right there contains the pre-op files.”

  Pierce sat down and began his study.

  Sarchi found another chair, dropped into it, and waited breathlessly for his analysis. Even though he hadn’t done so when he’d looked at Drew’s scans, she hoped he’d comment on each one as he viewed it. But again, he worked silently, looking at one and moving to the next, occasionally going back to recheck some feature, his hand pulling at his earlobe.

  Sitting there, watching him work at a maddeningly slow pace, the suspense was unbearable. In an attempt to pry some conversation out of him, Sarchi said, “There should be something of interest here, because—” Pierce silenced her with a raised finger.

  Eventually, he swapped CDs.

  After a relatively quick inspection of the pre-op images, he went back to the post-op scans. Finally, he turned and faced her. “The new scans are bizarre. Admittedly, the tracks are fading, but I see no evidence of any attempt to lesion the ansa. Instead . . .” He looked at the computer and moved back two images. “See this light area and this one?” He pointed to a pair of spots Sarchi had also noticed when she’d first looked at the scans. “They weren’t there before the operation.”

  “Meaning?”

  “There’s no doubt in my mind Latham damaged the substantia nigra on both sides.”

  This was bad news for Stephanie. The area Pierce was talking about was the one involved in Parkinson’s disease, a disorder in which the afflicted have difficulty initiating voluntary movements and exhibit a characteristic “pill rolling” tremor in their hands. Because all the nigra’s work can be done by as few as five percent of its cells, Parkinson’s disease ordinarily shows up late in life, only after decades of cell death. Presently, Stephanie showed no such symptoms, probably because the damage there had left her with enough cells to function normally. But since nerve cells cannot replenish their numbers, she now had a much smaller safety margin.

  “So the girl may have Parkinson’s disease in her future?” Sarchi asked.

  “It’s not likely to be a problem anytime soon, but after she’s grown, her risk will certainly be greater than normal.”

  “Is there any rationale for lesioning the substantia nigra to treat a paralytic disorder?”

  “I can’t think of any. In fact, as I mentioned once before, I don’t see how lesioning the ansa lenticularis could have had any beneficial effect in these cases.”

  “I’m sure that’s what he said he was doing.”

  “Makes no sense to me. But he is getting results.”

  “Aren’t you curious about his treatment?”

  “Immensely.”

  “Why not call him and discuss it?”

  “Anecdotal conversations on the phone aren’t useful. When he publishes, we’ll see what he’s got.”

  “Do those lesions explain Stephanie’s tic?”

  “Not as well as something else I found.” He turned back to the scans and pointed at another light spot Sarchi too had noticed before he’d arrived. “On this side he also hit the subthalamus. That’s the area usually damaged when someone shows the kind of symptoms the girl exhibits.”

  “Then what’s this?” Sarchi pointed to yet another light spot.

  “A lesion in the ventrolateral nucleus of the thalamus.”

  “Christ, he was all over her brain.”

  “Interestingly, this last one is in an area sometimes intentionally lesioned to alleviate ballismus.”

  Pierce was leading up to something, but Sarchi couldn’t see what. “I’m sorry, you’ll have to help me.”

  “It looks to me like this guy intentionally went after the substantia nigra, but on one side he accidentally hit the subthalamus. I don’t know whether he knew it when he did it or found out later when the girl showed symptoms of ballismus, but I’ll bet that lesion in the ventrolateral nucleus was an attempt at damage control.”

  “Why did he lesion the nigra?”

  “I’m a neurologist, not a fortune-teller.”

  “He’s dangerous, isn’t he, this guy?”

  Pierce shrugged. “It appears he’s not as careful as he could be.”

  “Shouldn’t somebody do something about that?”

  “There you go again, making me nervous.”

  “What’s the prognosis for this girl’s ballismus? Can you say with certainty it’ll go away?”

  “No.”

  “And she’s now faced with an increased risk for Parkinson’s. How can we ignore that?”

  “It’ll take a little willpower, but I believe I’m up to it. It helps to look at the balance sheet. A girl comes in paralyzed, no one else can do anything for her, and Latham sends her home walking and talking. Occasionally, to accomplish the greater good, surgeons have to cause damage. In removing a malignant tumor, it may be necessary to cause some degree of paralysis.”

  “But this isn’t like that. The damage he did to cause the girl’s problems wasn’t necessary. Isn’t that correct? And likewise, he didn’t have to damage Drew Harrison’s caudate. In my view, his knowledge about this paralytic disease would be better placed in more competent hands. He needs to let the world in on what he knows, then step back and let more careful surgeons handle things.”

  “That’s not gonna happen.”

  “Not if we turn our heads.”

  “Instead, you’d rather we put them on the block.”

  “You’re established. You can’t be hurt.”

  “No? Say a close friend of Latham’s is the primary reviewer of my next grant renewal. Latham drops a word in his shell-like ear, and I get hammered at study section.”

  “One biased opinion could put your funding at risk?”

  “The word is politics. Become familiar with it.”

  “What do I tell Stephanie’s parents? They’re expecting a report from me.”

  “There’s nothing to be gained by telling them the truth. The girl may never develop Parkinson’s, so why compound their problems by raising the issue?”

  “Give me some estimate of the chances her ballismus will go away.”

  “She’s young. Her brain may adapt and find pathways around the lesion.”

  “What are the odds?”

  “Some people do much better than you expect, some do worse. I can’t give you the odds.”

  Seeing no point in continuing the conversation, Sarchi left the hospital and took the long way home, wondering what she was going to say to the Stanhills. By the time she walked into her living room, she still hadn’t decided. Finally, she accepted Pierce’s position. As distasteful as it was, she’d be noncommittal and vague and get off the line quick.

  She made the call at five thirty, six thirty New York time, hoping she’d get Regina.

  “Hello.”

  Nuts . . . it was Raymond. She considered hanging up without answering, but that seemed so childish she decided to push on and get it over with. “This is Doctor Seminoux.”

  “Yes, Doctor. What news do you have for us?”

  “I’m afraid the scans were inconclusive. I’m so sorry to have put you through all that for nothing.”

  There was silence on Raymond’s end.

  “Mr. Stanhill?”

  “I don’t believe you. I saw your face when you looked at the shaved spots on my daughter’s head. You were surprised then, and I think you found something on those scans you’re not telling me.”

  Sarchi was so surprised by his resp
onse she was caught speechless. “I . . . I’m . . .” And this was making it worse. Say something. “I’m sorry you feel that way. I wish you all the best and hope Stephanie’s problem clears up soon.” She hung up without giving Raymond the chance to reply.

  Lying was bad, but being caught at it was worse. Her heart was thudding against her blouse, and her palms were slick with sweat. She took a couple of deep breaths to calm down, then went into the bathroom and splashed cold water on her face, which was on fire. Obviously, she didn’t have the constitution to be a con woman.

  There was a knock at the door. “Sarchi, you want to grab a bite to eat at that Vietnamese place?”

  It was her housemate, Linda. She went to the door and opened it. “Sure, give me a minute.”

  Linda’s almond-shaped eyes widened. “Jesus, are you trying a chemical peel or something? Your face is the color of my favorite lipstick.”

  “I just told a lie to someone on the phone.”

  “You need more practice.”

  “And I got caught.”

  “With you amateurs that’s always a danger. I’ll drive with the windows down so you can cool off.”

  On the way to the restaurant, Linda angled for details about the lie, but Sarchi didn’t want to talk about it. The food at Min Chou’s was ordinarily a delight, but tonight it could not compete with the bitter aftertaste of her conversation with Raymond Stanhill.

  During dinner, they chatted about hospital politics, Sarchi’s chances of being named chief resident, and whether Linda should sleep with her latest boyfriend. After they ate, Linda talked Sarchi into doing some mall window-shopping. Despite all the distractions there, Sarchi’s thoughts kept bouncing between the lie she’d told and what, if anything, she should do about the Latham clinic. Both Kate McDaniels and Mel Pierce had advised her to tread lightly. And they were senior staff. Maybe she was wrong to pursue this.

  In the center of the mall, where the various wings met, was a large carousel that filled the place with calliope music. Sarchi stopped and watched it turn, the horses going up and down, the bright lights spinning past, kids laughing with delight. She turned to Linda. “Come on, let’s ride.”

  “On that? You’re kidding.”