by G. H. Ephron
Now Emily was crying quietly. I put my arm around her.
“Was the car locked?” I asked.
Emily nodded.
Annie returned. “They’re on their way.”
“I already changed the locks twice,” Emily said. “I guess I’ll have to change them again. Shit. You wouldn’t believe what it costs. I can barely afford the payments as it is.”
When two police officers arrived—a man and a woman—they questioned Emily. It was damned frustrating to see them shrug it off with nothing more than the appropriate tut-tut sounds. Tracking down someone who liked to cut hearts out of women’s underwear wasn’t going to be their top priority. After all, no one had been hurt, no property had been damaged—unless you counted the bra and panties. At least they took the underwear as evidence.
“Want us to follow you home?” I asked.
“Thanks. The police offered to do that.” She gave me a hug, burying her face in my chest. I gave her a squeeze. I could feel her trembling as she kept holding on. “Sorry to be such a pain in the butt. You’ve been great.”
Annie was watching us, a speculative look on her face. Gently, I peeled Emily away.
Annie gave one last look around the garage. “You sure you don’t have any idea who…?” she began.
“That’s what the police kept asking me. Boyfriend? Ex-husband? Anyone I’d recently dumped? They even suggested that I might have done this to myself.” Emily looked up, her eyes pooling with tears. “That would be so pathetic.”
10
“IT’S SO hard seeing him suffer,” Annie said as she drove me back to the Pearce.
“I know.” I put my hand on her thigh. “I’m sorry—I should have realized how painful it would be for you to watch. When Emily told me about their new scanner and the research they were doing, I guess I got caught up in it and lost perspective.”
Annie turned off the radio, which had been forecasting overcast skies and rain.
“It’s not your fault,” she said. “Really, I’m grateful for everything you’re doing. Thanks for being there for me.”
Gratitude. I groaned inwardly. That implied obligation, which wasn’t what I wanted from Annie.
“My mother used to tell me how she hated to take me or my sister to the doctor because she couldn’t stand it when he gave one of us a shot. She’d a million times rather have taken it herself than see us hurt. Now I know what she meant.”
Annie was stopped at a light.
“You’re doing everything you can,” I said.
The light turned green and Annie accelerated. We drove the next few miles in silence.
“My elementary school was across the street from their apartment,” Annie said. “I used to love to go over to their house after school. Uncle Jack would take me to the park. Taught me how to throw like a guy.”
Now we were approaching the Stavros Diner. It was past lunch-time and neither of us had eaten.
I was about to ask Annie if she wanted to stop for a bite when she said, “You know she’s coming on to you, don’t you?” You could get whiplash talking to Annie.
“Who is?”
Annie shook her head. “Poor Peter. You can be so clueless at times. Emily Ryan. Don’t you think she seems a tad”—Annie bit on her lip—“I don’t know, manipulative maybe?” Annie swerved to avoid getting hit by a bus. “She’s got that knack for getting people to rescue her.”
“I just don’t like to see someone bullied and threatened.” I knew I sounded defensive.
“What is it, three times now?” Annie asked as she pulled onto the Pearce grounds.
I didn’t say anything.
“She gives you puppy-dog eyes.”
“She gives everyone puppy-dog eyes. Kwan. Even Gloria.”
“I noticed you holding that embrace an awfully long time.”
She was hugging me, I wanted to shout.
Annie drove slowly along the narrow winding lane through the grounds, up the hill to the Neuropsychiatric Unit. She cut the engine and we sat there, silence echoing around us.
I didn’t want to get out, but I did. How long it had been since Annie and I had gone out together or made love—nearly two weeks? “When will I see you?”
“I’ll be in to see Uncle Jack tomorrow.”
I shut the car door.
Annie hesitated. She began rolling down the passenger side window, then changed her mind and rolled it up again. She turned the car around and drove off.
When I finished banging my fist into my palm, I took a deep breath. Annie was wrong about one thing. I wasn’t “there” for her—she wasn’t letting me be.
You can be so clueless sometimes. I couldn’t just write off what Annie was suggesting. After all, she was trained to see what other people miss.
I knew Emily Ryan was attached to me, infatuated in the way that post-docs can become with a mentor. Sure I’d been flattered, but I thought I had it diagnosed it for what it was and set it aside. That’s what I was trained to do.
When I got back on the unit I wasn’t hungry. I checked on Uncle Jack. He was lying on his bed asleep, his breathing regular but still a little wheezy. Insufficient oxygen getting to the brain would only worsen his dementia. I made a mental note to mention it to Kwan.
The pages Uncle Jack had torn out of the waiting-room magazines were on the bedside table. I looked through them. Golf vacations, cell phones, and Viagra. All of life’s essentials.
I went up to my office and returned calls. Then I read the day’s accumulated e-mail messages. After that, I found myself sitting, staring at my computer screen, unable to concentrate on work. I picked up the phone, wanting to call Annie. I hung up before dialing.
I went back down and walked the unit. Usually that helps get my mind back on track. Not today. I still felt only half plugged in, my mind churning. I could hear Emily Ryan’s scream. The tires screech. Manipulative. That was Annie’s take on her.
I felt claustrophobic, unable to think. I needed to get the hell out of there and out on the river. Rowing usually helped blow the dust balls from my brain and drain away tension. Not as well as sex, but that option wasn’t on the table at the moment.
There was nothing on the afternoon’s calendar that I couldn’t skip. I checked in with Gloria and then I left.
The day had turned gray and drizzly. When I slammed the car door the speaker grill fell into my lap. Again. I felt a cold trickle down the back of my neck. The sunroof was leaking. Still. Goddamned car was a Crackerjack toy. Car of the year, schmar of the year, as my mother would have said. Meaningless award, anyway—after all, the Pinto and the Escort had both been proud recipients. At least the radio worked. I turned it on and was immediately calmed to hear guitar virtuoso Richard Thompson playing.
I revved the engine, backed out of the parking spot, and took off. I crossed into Cambridge and headed for the river. There were parking spots near the boathouse. Small wonder. Only a fool would be out jogging or rowing in what had now turned into a steady rain. Didn’t matter—my shirt was already soaked from the sunroof leak.
The new BU boathouse faintly echoed the original boathouse, a hundred-year-old structure that had been torn down a few years ago. I missed the scooped out steps, the ancient timbers and creaky boards. But for once, change had been in the right direction. The new boathouse was a showpiece with its gables, blue-green copper roof, and balcony overlooking the river. The high, barrel-vaulted ceiling and band of windows all around made it as light and airy on the inside as the old boathouse had been dark and dank.
I went into the locker room and changed. Then I trotted down the wide central stairway to dock level. Two of the double-doors were flung open to the river. The rain had stopped and with the clouds beginning to lift, sun slanted in from one side. Felt like a good omen.
I got a pair of oars and set them on the edge of the dock. From the overhead sling I lowered the single that belonged to my friend Rudi. He’d been letting me borrow it since mine got demolished by a speedboat that
was aiming for me. When I got around to replacing mine, I’d get one like this. The Levator, its sleek carbon-fiber shell long and thin like a razor clam, looked as if it were made of a rich mahogany. I held it over my head and carried it out onto the dock.
Sunlight sparkled off the water. Soon I was stroking upriver. The water was mirror-smooth, only my puddles marring the surface, the air cool and clean-smelling from the rain.
Rowing requires complete concentration and exquisite precision, dipping the oars, then pushing off with the legs to propel the boat forward. I tried to relax, imagining that the oars were fixed and I was using them to lever the boat through the water. I checked over my shoulder every few strokes. Ripples feathered from the prow as the boat cut through the water.
As I approached the Weeks footbridge I broke a sweat. I ignored the growing ache in my legs, knowing that soon the endorphins would kick in and it would be just me and the rhythm of the river.
I slid through a band of darkness under the Anderson Bridge and continued toward Watertown Square. The landscape turned pastoral, the riverbanks wide. I could convince myself that I’d stepped back a century into a Thomas Eakins painting, long before anyone had conceived of highways or ten-wheelers. A great blue heron stood regal in tall grass not far from where a good-sized rat foraged along the edge of the bank. No other boats were on the water.
After about forty minutes, I’d reached the Newton Yacht Club. I stopped and hung there, oars out like dragonfly wings, looking upriver where the water met the sky, savoring the peace and solitude. Reluctantly, I spun the boat and headed back.
Rowing with the current was easier and my mind started to wander. Did I have feelings for Emily Ryan that were clouding my judgment? Was I being manipulated by her? And if so, why was I allowing it to happen? Why did I feel so protective toward her?
If I’d been my own therapist, I might have pointed out that it probably had more than a little to do with guilt over my wife’s murder. Repetition compulsion. With Emily, here was a chance to get it right.
I had no trouble sizing up Emily’s rose-colored version of Shands. A bad case of hero worship, probably combined with a powerful dose of physical attraction. Maybe he’d seduced her. Was she wearing those same rose-colored glasses when she looked at me?
And what about Annie’s misgivings about University Medical Imaging? Based on little more than Emily’s say-so, I’d allowed Annie’s uncle to be evaluated there. I hadn’t bothered to check the place out other than asking Kwan and then ignoring his reservations about Dr. Shands.
Had the accident with the test magnet been a one-off, or was it part of a pattern of lax safety procedures? And what about Cimvicor? Was taking it in such high doses as straightforward as Shands insisted?
A little due diligence was in order. When I got back, I’d check out the lab’s safety record. I’d also find out more about the risks of taking Cimvicor.
I arrived back at the boathouse feeling my equilibrium somewhat restored. I had research to do, some psychic distance to install between myself and Emily, and more than a little sorting-out to do with Annie.
Back in the office I logged into the medical school library system, where virtually every piece of medical research from the late eighties onward was online. I typed in “James Shands.” There were dozens of hits.
The oldest record was from a paper published in 1981. “Functional Mapping of the Human Visual Cortex by Magnetic Resonance Imaging.” Apparently Dr. Pullaski had outshone Shands early on, because she was listed as the paper’s principal author. “James Shands, Jr., Ph.D., Assistant Professor of Neuroanatomy” was one of three coauthors. He must have started as a researcher and gotten the M.D. later.
Shands had coauthored several more papers that year with Dr. Pullaski as lead author. I read the abstracts. Lots about functional brain mapping. Nothing about Lewy body dementia.
There was a six-year gap. Then there was a paper, “Dementia with Lewy Bodies: Cognition, Neuropathology, and Cell Permeability” by James Shands—now with an M.D. and a Ph.D. In the preceding years he’d evidently finished a medical degree. No coauthors were listed.
The paper reported on functional MRIs and subsequent examinations of the brains of patients who had been diagnosed with Lewy body dementia. This must have been his breakthrough. Probably included the patient whose brain scan and cortical brain cells were proudly displayed on his office wall, the way a shopkeeper displays his first dollar bill.
Since then Shands had been prolific. Nine or ten papers a year, plus a few book chapters. On most he was sole author; some were coauthored with others, including Leonard Philbrick and Estelle Pullaski. Now he was listed as professor of neurology. It was an impressive body of work, especially given the short period of time.
I brought up the Boston Globe archives, curious to see if there had been any news articles about him. The first hits were in 1984—an engagement announcement and an obituary. In March, Dr. Estelle Pullaski’s parents had announced her engagement to James Shands, Ph.D. I wasn’t surprised that their relationship had been personal as well as professional.
A month later was the obituary: “Dr. James Shands, cardiologist and researcher, died on April 10 in Beth Israel Hospital after a long illness. He was 65.” These days, that was awfully young to die. I skipped to the end. “Dr. Shands is survived by a son, James Shands, Jr., Ph.D.” The obituary was several inches long. The senior Shands had to have been a brilliant researcher—he’d been a primary author of the Amherst Cardiology Report, the first longitudinal heart study that provided us with virtually everything we know today about heart disease.
I wondered if his father’s death had precipitated a breakup with Dr. Pullaski. I noticed, too, that the start of the gap in his research output lined up approximately with his father’s death. Maybe that’s what had propelled him into med school.
Then there was a 1991 article on the opening of the Cambridge Brain Bank. “Researchers in Cambridge today opened a state-of-the-art repository for human brain tissue.” I remembered the fanfare at the opening. I was finishing a post-doc at the Pearce at the time. Today, the Cambridge Brain Bank was still going strong.
I read on. “Dr. Estelle Pullaski, executive director, said the new brain bank is ‘indispensable to our efforts to relate what happens at the cellular and molecular level to behavior.’” There Dr. Pullaski was in a photograph of the dedication ceremony at the center of a group, with Shands at her side. The article went on to mention Shands as one of an esteemed staff of researchers.
I looked at the others in the group. Most I knew by reputation. There, with his head half-turned away from the camera, was Dr. Nelson Rofstein, my first mentor. According to the article, he’d been on their board of directors.
There were other articles. One covered the hoo-hah at the opening of University Medical Imaging Center years later. There were numerous pieces about aging and dementia in which Shands was quoted as the expert. He’d been keynote speaker at a national conference on the brain. No mention of unpleasantness or scandal.
There was no simple way to check on the lab’s safety record. I could at least check that it was accredited by the American College of Radiology. I quickly discovered that while 4.5 tesla scanners could be used for research, they were not yet FDA-approved for clinical use. Nevertheless, University Medical Imaging had met the standards set for lower-strength devices.
While I was at the Web site, I found a list of reported accidents. I scrolled through, drilling down to look at details. There was the incident Annie told me about in Rochester, a gun pulled out of a police officer’s hand, hitting a wall and going off. In another incident, a woman in Minneapolis was killed when a metal oxygen canister got sucked into the machine.
Two technicians and a patient had suffered frostbite and ruptured eardrums in a San Diego lab when a magnet quenched—rapidly lost its magnetic field and the liquid helium within the chamber boiled off into the scan room. That didn’t sound like fun. I hoped Annie hadn’t read about
that incident. And if she had, I hoped she’d gotten to the part where it said that accidents like that were “extremely rare” and that MRI systems had an “exceptionally high safety record.”
No incidents had been reported at University Medical Imaging.
Finally, I hauled out my copy of the Physician’s Desk Reference and looked up Cimvicor, the drug Shands was using to treat Lewy body dementia. The entry began, “Cimvicor is a synthetic, lipid-lowering agent…” I scanned the drug description and a lengthy section on how it worked. As I would have expected, its clinical trials had been for treatment of high cholesterol, not dementia. I read through the warnings, precautions, and finally adverse reactions. I looked through the symptoms of overdose. I could see nothing there that Shands hadn’t disclosed, nothing that set off alarm bells.
I called Annie at work.
“What’s wrong?” she said the minute she heard my voice.
That about summed up our relationship—I called and she immediately assumed the worst.
I told her Uncle Jack was up and about and had eaten lunch. “And I checked on the lab’s safety record. It’s clean.”
“At least that’s something.”
“And Cimvicor, the treatment drug? I don’t think there’s a huge risk taking it, even at the higher dosage.”
“So you’d give this experimental treatment a green light?”
“I think it’s worth a shot.”
“I talked to my mom this morning. That’s what she says, too. Given the alternatives.”
There were no good alternatives. The brutal truth was we had no way to treat this disease, no way to cure it or even slow it down. All we had were medications for the grosser symptoms.
“What he has—it’s basically a death sentence, isn’t it?” Annie asked.
I wished I could have seen her face to gauge whether she wanted me to just say it outright or soften the blow. “I’m afraid so,” I said, my throat closing around the words. Knowing Annie, she probably wanted the facts. “A year, two at the outside. Even with the treatment we can give him, the visual and auditory hallucinations and the movement disorder will probably get worse.”
