by G. H. Ephron
Dr. Pullaski’s eyes widened. “You know this young man, don’t you?”
“We’ve met. He’s a friend of Dr. Ryan’s.”
“He is, is he? I can’t say I’m surprised.”
“He admits he was here. But says he didn’t see anything,” I said, paraphrasing what I’d read in the paper. “He says he followed Emily here. Stayed until the police arrived.”
“Well, I certainly hope they find out what the hell is going on. We have important work to do, and I’m sure the last thing Leonard would have wanted is to have our research put on hold while the police dither about.”
Twin brains floated in fields of darkness—mine, and the one Shands kept referring to as a “normal brain.” I adjusted my glasses and leaned closer.
He was going back and forth between the two, pointing out what he claimed were differences, anomalies which I was either too dumb to appreciate or too much in denial to recognize. I felt my eyes glaze over as he went on and on about volumetric analysis and coefficients of permeability.
I snapped to when he said, “Bottom line, you’re on the cusp. Lower end of the range for normal, upper end of the range for Lewy body dementia.” He fixed me with a grave look. “As I told you before, if I were you I’d start treatment as soon as possible.”
“Upper end for Lewy body dementia,” I said, repeating the words I hadn’t quite absorbed. “On the cusp.”
“You understand, only a brain autopsy allows us to see for sure. Of course we could do what they used to do back in the eighties. Drill a hole in your skull and scoop out a little piece of your brain. Count the plaques and tangles and look for proto-Lewy bodies.” He watched me wince. It was probably the same look he gave worms he poured salt on when he was a kid. “Every once in a while it doesn’t hurt to remind ourselves why magnetic resonance imaging was such a leap forward for medical research.”
He probably wanted me to kiss his feet, but at that moment I didn’t feel much like groveling.
“So you’re saying I might get it? And I should take medication every day to stave off this…potentiality?”
“Or you might call it an eventuality. You said both your father and uncle had it?”
“Maybe. It was never diagnosed.”
“Brothers. We know there can be a genetic component. In those cases, children have a fifty percent chance of inheriting.” I wouldn’t have placed a bet on myself with those odds.
“How soon?” I asked.
“You know I can’t tell you that. The onset of the symptoms is so variable. We do know that the medication has been well tested. Plenty of people have taken it to reduce their cholesterol.”
Was this what I was signing up for? Decades of popping a daily dose of pills I wasn’t sure I needed? I could see from Shands’s expression that he expected me to embrace this opportunity, to marvel at my good luck. Surely this was preferable to waking up one morning and finding that I’d lost my mind.
“Think about it. Here are the consent forms.” I watched my hand reach for the papers, as if those fingers belonged to someone else. “You’re fortunate to have this opportunity.”
Yeah, lucky me. He stood. That was my cue to leave.
My legs felt like rubber. I rose and started out. When I reached the door I looked down at the papers I was holding, the words swimming into focus. I flipped to the back page.
I turned around. Shands had gone back to examining my MRI. He was tracing something with his finger, then writing in a file folder.
“‘Consent for postmortem and retention of human material for diagnosis and research,” I read aloud. He blinked at me over his shoulder as if a chair had just spoken. “How come you don’t point this out to patients?”
In a disconnected part of my brain I wondered why on earth, after just having received what amounted to a death sentence, I was focusing on this extraneous detail.
I wanted to go up to Shands, poke my finger into his chest and say, “How come, huh? Why don’t you tell patients about this?” I was itching for a fight, even as I realized that what I wanted to fight him about was the news he’d just delivered.
Shands held up his hands. “Whoa! Take it easy. Peter, you’re not about to die.”
“Mr. O’Neill almost did. It came as an unpleasant surprise to his niece when they came to collect his corpse.”
“Unfortunate mixup,” Shands said, looking annoyed. “Hospital’s fault.”
“So why don’t you tell patients like me that we’re signing away our brains?”
He swiveled to face me, tilted his head and rubbed his chin.
“The autopsy is critical.”
“That’s not what I’m questioning. What happened to informed consent?”
“It’s there. We tell them to read—”
“Your patients and their families are under stress,” I said, cutting him off. “They’ve just received the worst possible news. And here you come, offering this one hope. But there’s a string attached. You should be telling them, up front, explicitly. Not waiting for them to interpret the jargon in the fine print.”
He sighed heavily. Go ahead, I thought, humor me.
“In the beginning we used to discuss this with patients. Explicitly. What we found was that it made them squeamish. Distracted them from where they should have been focusing—this opportunity to create new science. They’d delay enrolling in the treatment. The patient suffered unnecessarily. The research suffered.”
I folded my arms across my chest.
He went on. “We’re going to nail this disease, develop a definitive early diagnosis and effective treatment. Think of all the pain we’ll be able to avert. All the lives we’ll be able to save.”
I had to admit, that promise was pretty intoxicating. “Still,” I said, feeling my anger deflate, “seems like something you should be upfront about.”
Shands shrugged, like he was tired of having to explain. “Being a research subject isn’t like being a regular patient. Regular patients get tested and treated in order to get better. When you’re a research subject, sure you may benefit personally. But the bigger goal is to help humanity, make your own illness count, contribute in a significant way to our understanding of the pathology of the disease so others will be saved. That’s why people go into it willingly, knowing they may or may not get treatment. Knowing we’re going to want to autopsy their brain when it’s all over. Besides,” he added, “we need the family to give their consent once again after death. So where’s the harm?”
“Suppose a patient won’t sign this, won’t agree to donate his brain?”
“It’s a showstopper. No autopsy, no treatment.”
“Really?”
“Sure. If we were still under the thumb of the medical school I couldn’t make it conditional, but we have our own institutional review board and they understand the importance of this component.”
“But the family can rescind the decision after death?”
“They rarely do,” he said. I wanted to push in his smug face.
I walked back to the reception area feeling like I was watching myself from one of the fluorescent light boxes recessed into the ceiling. The receptionist nodded to me as I passed.
“Do you need to schedule a follow-up?” she asked.
“I’ll let you know,” I said.
In the lobby I pressed the elevator button. A voice in one ear scoffed, “Forget about it. It’s purely subjective. Herr Doktor sees what he wants to see because it confirms what he’s expecting.”
Where the hell was the elevator? I pressed the button again.
A voice in the other ear hectored, “You’ll be sorry if you don’t listen. Twenty years from now you’ll be hoarding wine that’s long since turned to vinegar. You’ll have bought so much Mission furniture it’ll be shoving you out the front door.”
Then a calm voice from deep within me took over. “Listen, twenty years from now, who knows what new cures there will be? They’ll probably be able to manipulate that gene you’ve got
, if you’ve got it. And that’s a big if.”
Finally the elevator came. I stepped in. The doors started to slide shut when I heard footsteps and then, “Wait!” I put out my hand to hold the door. It was Emily, holding a large envelope. She got into the elevator with me.
“I wanted to catch you and show you this.”
She pulled out a sheaf of newspaper clippings. “I found these—”
I meant to say This isn’t such a good time, can we talk later? But what came out was a sharp, “Not now.” Emily took a step backward. I knew a piece of this was displaced anger but I couldn’t stop myself. “There are other people, other problems in the world that aren’t about you.”
I got out at the parking garage and stomped over to my car.
“But I found these hidden in the back of one of the drawers in Lenny’s office,” she said, trailing behind.
I unlocked the car door and got in.
She looked at me hollow-eyed, wordlessly accusing me of abandoning her. “You asked if anyone at the lab collected obituaries, remember?”
I’d asked her no such thing, I thought as I jammed the key into the ignition. But I didn’t start the engine. Grudgingly I had to admit that Philbrick was the most likely person to have collected obituaries, the one who’d care enough to note the death of a patient as more than a clinical finding. I remembered those three phone calls Philbrick made to me right before he was killed. That had been the same night Uncle Jack became critically ill after having an MRI. If these were obituaries that Philbrick collected and kept hidden, I owed it to him to at least consider the implications. On top of that, I could see Annie waving the two obituaries in my face. This is what I think it’s about.
I rolled down the window. “Sorry. Yes, of course I’d like to see those. Okay if I take them?”
Emily gave a grateful nod and passed me the envelope.
20
ANNIE AND I had the obituaries and death notices spread out on her kitchen table. She’d pushed away a pair of mismatched oak pressed-back chairs. An empty pizza box was on the counter.
In about twenty more years, Annie’s kitchen would be considered vintage. There were Sears metal cabinets on the wall and the gas stove was avocado-green. The only modern anything was a microwave.
Annie had sorted the clippings in chronological order. Columbo leaped up, settled himself on the pile in front of Annie, and began to purr. He gave a complaining squeal when Annie scooped him up and dropped him unceremoniously on the floor. Undeterred, he rubbed up against her leg. She scratched him between the ears.
“Let’s suppose for a moment that Dr. Philbrick was collecting obituaries and death notices for all the patients of the lab who died. Does this seem like a lot?” Annie asked.
“Over three years? Not really. The lab treats a lot of sick elderly patients. And I think it’s fair to assume that most of these had Lewy body dementia.”
“If that’s what killed them.”
“‘Died after a lengthy illness,’” I said, pointing to one of the early ones.
“‘Died of a blood infection at Brookline Hospital,’” Annie read, indicating one that was a few months old. “Or how about this one? ‘Died suddenly at his home.’”
“‘Loved ballroom dancing,’” I said, reading from another. “Doesn’t give a cause of death, or even where.”
A lot of them were like that.
“Just because it isn’t listed as the cause of death doesn’t mean dementia isn’t what killed them,” I said. “There’s a stigma. People feel reluctant to admit that their husband or mother had dementia. They’d rather put ‘heart failure,’ which is what kills most of us in the end anyway.”
Annie folded her arms across her chest. “I don’t see a whole lot of heart failures.” I could feel her digging in her heels.
“Annie, I know you want there to be something sinister going on here, but are you sure you’re being objective?”
She looked me in the eye. “You think I’m burned because Uncle Jack returned from the MRI lab and came down with an infection which Gloria says he couldn’t have picked up at the Pearce. And I admit, maybe I am looking for someone to blame for the fact that Uncle Jack almost died. And yes, it’s true that I’m more than a little miffed because five minutes after he’s supposed to be dead they send around a team of ghouls to collect his brains.
“Call me paranoid if you like, but I’m just wondering if Mr. Martin Drogan”—she put her finger on one of the obituaries, a longtime clerk at the Middlesex courthouse who, according to the article, played hockey in his youth and continued to skate well into his seventies—“died of a bacterial infection.” The obituary gave pneumonia as the cause of death. “What harm would it do if I checked into some of these?”
“We don’t even know if these guys were all patients at the imaging lab,” I said.
“We’ll find out,” Annie said, giving me an exasperated look. “Surely that’s something Emily Ryan can find out for us.”
“Okay, okay,” I said, sighing. “Got any paper?”
Annie opened a drawer and pulled out a pad of yellow lined paper.
“If we’re going to do this, at least let’s be methodical about it.” I ruled off some columns and put a heading at the top of the first three: name; date of death; cause.
Annie read me the names, one by one, and whatever other information was provided. A half hour later we stood back. There were six obituaries from three years ago. Ten in the last year. A dozen already this year and the year was only half up.
“Plus the two that your Uncle Jack snitched,” I pointed out. Made a grand total of thirty.
“Pneumonia. Blood infection. After a short illness. Pneumonia again.” Her finger hopscotched down the page.
I had to agree, it was decidedly odd.
“Though you’d think if all these deaths were suspicious, someone would have blown the whistle on them long ago,” I pointed out. “When a healthy patient goes in for a medical test and then drops dead, you can be sure the authorities are going to hear about it. Lawsuits, complaints to the regulators.”
“Maybe,” Annie admitted. “But what happens when that patient is mentally unbalanced, draining away family energy and resources? When that person isn’t that person anymore, sudden death can be the answer to a prayer.” Annie’s eyes pooled with angry tears. “They don’t sue. They say, ‘Such a shame. Oh well, it was for the best.’”
I couldn’t argue with her logic.
“So when did each of these people have their last appointment at the MRI lab?” I said, writing a heading over the next empty column: last appointment at UMI. “Emily can find that out for us, too.”
“And I’ll look up death certificates for these people and get the missing causes of death,” Annie said.
Over the next-to-last column I wrote: death certificate?
“I’ll verify the causes given. Then we’ll see what we have.” She sat back. “Wish I could talk to them, ask them…” She looked up at me. “I’m going to find some of these families. See if I can figure out exactly what caused these deaths.”
She took the pencil from me and wrote a heading over the last column: family?
From her look, I knew it was useless to try talking her out of it.
“You need to be discreet,” I said. “We don’t want to end up getting sued by the lab for defamation.”
“I’m always discreet,” Annie said, batting her eyes at me and giving me the biggest, wettest, most obscene kiss ever. “God, it feels great to be doing something instead of sitting around on my butt cursing the fates. I feel like dessert.” She opened the freezer. “Let’s see, what have we here? How about some Toscanini’s?”
I came up behind her and put my arms around her. “Are you sure it’s ice cream that you want for dessert?” I kissed her neck and inhaled her sweet fruity scent.
She’d reached in and pulled out a quart of vanilla. “Mmm. My favorite. And I wonder—” Annie opened the refrigerator. There in the door w
as a cardboard container of fudge sauce. “Ah. Just the thing.”
She put the fudge sauce in the microwave and set the timer. I went back to nibbling on her neck. The microwave dinged. Annie got out a spoon and stirred the hot fudge and offered me the spoon. I took a lick. Warm, intense. Perfect.
Annie had the ice cream container open. She gouged out some ice cream. “Hard as a rock,” she said.
The ice cream wasn’t the only thing that was hard.
Annie put the spoon in her mouth and drew it out slowly, leaving some of the ice cream in the spoon. Then she fed me what was left. “You’re in charge of the hot fudge,” she said.
We took turns feeding and being fed spoonfuls of ice cream and spoonfuls of hot fudge sauce.
“Wait a minute,” I said. “You’ve got some fudge over here.” I licked a little bit from the corner of her mouth. “And here.” I put down the fudge and gave her a long, lingering kiss. Annie slid her hands inside my shirt and ran her fingers up and down my back.
“You think there might be some more fudge sauce down there?” Annie asked as I unbuttoned her shirt.
“You never can tell. Gotta check to be sure.”
Late the next afternoon, I was waiting in my office for Emily to show up for our regular conference. I was glad I hadn’t acted on suspicion and suspended her from working with patients. After Annie and I had finished analyzing the obituaries and death notices, I’d found myself agreeing with Annie that maybe Leonard Philbrick’s death wasn’t an accident, and maybe it had nothing to do with Emily being stalked. At the very least I was feeling a reasonable doubt.
What I kept wondering was, Why had Leonard Philbrick saved all those obituaries and death notices? My first thought had been that he’d cared, and in some small way wanted to memorialize them. But I had to consider the possibility that Philbrick himself was the one responsible. Maybe collecting obituaries of those who’d died was the equivalent of carving notches in his belt. And it would explain why he kept them hidden. Following that line of reasoning, maybe someone had taken revenge for the untimely death of a loved one. Thirty potential victims, thirty sets of friends and family. It was possible that someone among them had the know-how to set up the MRI accident.
