Gray Matter

by Gary Braver

  31

  Fine gray drizzle was falling the morning that Martin and Rachel met with Dr. Malenko. The air was unseasonably cool, making the day feel more like a morning in October than late June.

  The appointment was set for noon. However, they did not meet at Nova Children’s Center. Instead they were directed to Malenko’s private office in Cobbsville, a small town just over the New Hampshire border, about a half hour drive from Hawthorne.

  Martin was quiet on the drive over, commenting perfunctorily on the rain and scenery. If he was nervous, it did not show. If he was incredulous, he didn’t let on. He had lapsed into a mode of slightly irritated neutrality—irritated because he had to cancel a meeting in Boston with an important client.

  Rachel disregarded Martin’s mood, too lost in her own vacillations between hopefulness and nagging anxiety. She had told Martin that she had consulted with Malenko last week, but didn’t go into details. All she said was that the doctor had agreed to meet with them both. About what she didn’t know.

  Number 724 Cabot Street turned out to be a small nondescript ranchlike house with pale green aluminum siding and black shutters behind a hedge of mulberry. Except for the cherry-red Porsche with the gold Bernardi dealer’s decal in the driveway, Rachel would have thought they had the wrong place. No M.D.’s shingle hung outside, no name above the bell.

  Malenko heard them pull up, because he opened the front door to greet them. He shook Martin’s hand. “Please come in.”

  A small reception area had been carved out of a front parlor on the left, but no receptionist. In fact, from what Rachel could tell, no one else was in the house.

  Malenko led them into a rear office furnished in leather and dark muted reds, greens, and gold. Bookcases lined two walls, full of medical tomes and technical journals. On a table beside some plants sat another elephant-god statue in tarnished brass.

  “You are your son’s father,” Malenko said. “The resemblance is striking.” A school photograph of Dylan was included in the folder.

  “Poor kid,” Martin joked.

  “On the contrary,” Malenko said, and took his seat behind the desk.

  The resemblance was uncanny, something everybody picked up on. It was as if Dylan were a miniclone of Martin, Rachel thought, his own Mini-Meas if she had passed nothing on to her son but a damaged brain.

  “Well, now,” Malenko began, glancing into the folder before him. “When you came in here last week, Mrs. Whitman, you expressed interest in the center finding a program that would best be suited for Dylan.”

  Rachel nodded, not knowing where this was going, but feeling her anxiety mount.

  “As you know, we had him assessed with an expectation of designing a program tailored to his talents and needs. Because of his language-processing problems and memory lapses, we conducted a body of tests, both neurological and behavioral, including an EKG and MRI scan.”

  Rachel felt her heart gulp as he pulled out a large envelope with MRI scans. She didn’t know if she could sit through another gruesome profile of her son’s disabilities.

  “The results show that there are region-specific language problems that are associated with the regional-specific deficits in Dylan’s brain, not unlike those we see in patients with dyslexia. As you well know, Dylan has a tendency to overregularize verbs—saying I singed, I goed, I knowed. He also has problems with the use of other morphemes such as possessives and verb agreements. Instead of the cat’s paw, he’ll say the cat paw. Or she talk instead of she talks.

  Rachel took a deep breath and swallowed it before it came out a groan.

  “He also has problems with certain reasoning aspects associated with language—the use of the passive voice, subjunctives, and if clauses. He was asked the classic test in the field: Who did the biting when he heard the statement ‘The lion was bitten by the tiger.’ His answer was the lion. He was not able to understand the causality. He heard ‘The lion bit the tiger.”’

  Rachel put her hand to her brow as Malenko went to the light board and pointed out the anatomical disparities in Dylan’s brain for Martin. Her heart raced, and she bit down, trying to keep herself from spinning out of control.

  “Jesus!” Martin said, as he listened. “The left looks smaller by a quarter.”

  “Yes, at least,” said Malenko.

  “But why?” Martin asked.

  Rachel stiffened. If Malenko even faintly intimated that she had brought this on with drugs, she knew that she would explode.

  “There are several possibilities,” Malenko began, “though none we can exactly determine. My best guess is that it’s a genetic aberration. Who knows? But that’s not the important thing. It’s what we can do for Dylan.”

  Rachel caught Malenko’s eye as he sat down again. He must have detected the insane heat in her eyes because he addressed Martin. “Your son will have to have a comprehensive individualized instruction program geared to improving his word recognition and comprehension, grammar, reading, and critical-thinking skills.”

  “How long a program are you talking about?”

  “Typically, from seventy-five to a hundred hours of instruction, and up to four hours of instruction per week. But given Dylan’s assessment, I’d say he would need instruction on a daily basis for a hundred to two hundred hours. Maybe more.”

  “God! It’s that bad?”

  Malenko leaned back in his chair and for a brief moment studied Martin’s reaction. “Mr. Whitman, I’m sure you’re aware that no test can exactly measure a person’s intellectual ability, including standard IQ tests. I mean, how can a test assign a number to creativity or artistic skills or leadership, curiosity, musical talent or physical prowess or social skills, emotional wellbeing, and so on? It’s impossible. However, the composite IQ score measures verbal and logical thinking, which is the best overall predictor we have of educational achievement and success.

  “Your son’s intelligence quotient falls in a range of seventy-nine to eighty-four which is the low side of the national average. He needs special attention.”

  “So it’s not just some attention-deficit thing that can be treated with medication?”

  “I’m afraid not.”

  “Jesus,” Martin said. “Maybe it was some lead paint he was exposed to. Or mercury or some other crap. I don’t get it. We’ve got lawyers and engineers on both sides of the family. How the hell …” And he tapered off.

  “How it happened isn’t the issue, Mr. Whitman. There are people with less intellectual talent than Dylan who are happy and productive members of our society.”

  “Yeah? Name me one.”

  Rachel shot a look at Martin.

  Martin turned to her. “What?”

  “Stop it!”

  “Stop what? He’s handicapped and I can’t accept that. Okay?”

  Rachel knew it was totally irrational, but all the outrage, despair, and vexation that was racking her soul converged like rays in a magnifying glass on Martin’s face. And at the moment she hated him. He was condemning their son to a life on the margins.

  Malenko cut in. “I can’t name names just like that. But you know what I mean—sports people, entertainers, actors, musicians, singers—people in the various trades, business people who surely would qualify.”

  Martin made a cynical grunt.

  “Mr. Whitman, your son is a charming and handsome little boy with a lovely voice, I understand. Who knows, he may grow up to be the next Luciano Pavarotti or Frank Sinatra.”

  “Hmm,” Martin said, feeling Rachel’s eyes burning him.

  To break the tension, Malenko said to Martin, “Let me ask you a question. You know something about the different programs we have, and you know your son’s potentials and limitations. Given all that, what exactly are your expectations for Dylan?”

  “My expectations? I don’t follow you.”

  “What would you like for Dylan?”

  “I would like him to have more of a head start on life.”

  “And you, Mrs
. Whitman? Do you feel the same way?”

  Rachel took another deep breath to steady herself. “I’m not sure I understand the question.” She could hear the deadness in her voice.

  “That you would like for Dylan to have more of a head start on life?”

  Still not certain she understood him, she said, “I suppose.” Tears began to fill her eyes. She felt as if she were dying inside. All she wanted to do was to go home.

  “Good, because that’s what we intend to give him—the chance to live up to his abilities.”

  “That’s not what I mean,” Martin said.

  “Then what do you mean, sir?”

  “Even if we sign him up for the best tutoring—”

  “Instruction,” Malenko insisted, cutting him off. “Not tutorial. There’s a big difference.”

  “Okay, instruction. Even with the best people you have, he’s got an eighty IQ. That wouldn’t be an issue if this were the eighteenth or nineteenth century. You didn’t have to be very bright to make it. But it’s the twenty-first century, and the brightest people occupy the highest-powered professions. Simple as that. The best instruction you can come up with won’t raise his capabilities.”

  “No, but we may get him to work at his best. What more can you ask for? Your son is not retarded or autistic.”

  “No, but he’s the low side of average. Just how far can that take him? It’s like asking him to run a race with a club foot.”

  There was a humming pause for a few seconds. Rachel began to cry.

  “Well, what exactly do you want of him?” she heard Malenko ask.

  “I want him to be smarter.”

  “But, surely, being smart isn’t the only measure of people.”

  “No, but it will get you places.”

  Rachel cried into her handkerchief while Martin’s and Malenko’s voices blurred like white noise. They seemed not to notice.

  “Like his mom and dad.”

  “What’s that supposed to mean?”

  “I’m just wondering whom you are here for, Mr. Whitman: Dylan or yourself. I seem to be hearing less about what we can do for Dylan and more about reducing your dissatisfaction with your child.”

  “I beg your pardon, Doctor, but I love my child very much.” Martin’s face was flushed.

  “Your love is not in question, Mr. Whitman. But what I’m hearing is that you don’t have the child you wish you had—a child who would grow to share your intellectual, cultural, and aesthetic interests. A child who will be your equal someday, not an inferior.”

  Martin’s eye twitched, and Rachel half-expected him to flash back at Malenko. But something in Malenko’s manner extinguished whatever impulse Martin felt. “I’m here for Dylan,” he said flatly. “I just wish he could have the opportunities other kids have.”

  “What other kids?”

  “Other kids in his school and play groups,” Martin said. “You know what I mean. Kids who aren’t intellectually handicapped. You’re saying that our son has a serious brain deficiency that’s crippled his verbal skills. We live in a heavily writing-dependent society, which means that he’ll be targeted as somebody who’s dumb.”

  Rachel got up.

  “What’s the matter?” Martin asked.

  “I’m leaving. You can stay, but I’m going.” She started toward the door.

  Malenko rose to his feet. “Please, please. Let’s all calm down.”

  “I am calm,” she said, barely able to disguise her emotions. She began to open the door when Malenko came over to her and took her arm.

  “Please, sit down. I’ll call Marie to bring in some coffee.”

  “I don’t want coffee,” Rachel said. “I want to go.”

  Something in Malenko’s expression gave her pause. “I think there’s more to discuss. Please.” And he beckoned for her to return to her seat.

  Martin was on his feet looking at them both wide-eyed.

  Rachel felt herself consent. But with tears rolling down her cheeks, and her voice trembling, she said, “I don’t want to hear any more about how my son is intellectually handicapped. Okay? Or how he’s not going to make it in life.” She glared at Martin.

  “Yeah, sure,” Martin said feebly.

  She took a deep breath, and in as steady a voice as she could muster, she announced, “I want to discuss an instructional program for him. Period.”

  Malenko nodded, and led her back to her seat.

  An uncanny silence fell on the room, as he seemed to turn something over in his head. He then picked up the phone and called the secretary to bring in three coffees.

  They sat in an uneasy silence as the coffee was delivered.

  Rachel sipped from her cup and stared blankly at the floor. All the swirling eddies of emotions had receded to the rear of her mind leaving her at the moment feeling dead. She could register Martin’s presence beside her and Malenko’s behind his desk. But it was as if she were occupying that quasiconscious state in dreams.

  But the spell suddenly broke when Malenko clinked down his cup. “Mrs. Whitman, when you first came in here last week, you asked about special medical procedures to enhance your son’s IQ. At that time, I had said that there were no accepted strategies to accomplish that.”

  Rachel looked up.

  “I had assumed you were interested in standard medical practices, which to my knowledge do not exist. I had not assumed that you were interested in alternate procedures, thus, I mentioned none.”

  Rachel felt her heart jog. The room seemed to shift its coordinates. “Alternative procedures?”

  “Yes. There’s an experimental treatment that’s been known to have significant effects in lab animals. It appears to work by stimulating areas in the cortex and hypothalamus that affect memory and cognitive performance.”

  “Lab animals?”

  “Yes, maze tests with mice and more sophisticated problem-solving tasks for higher animals including monkeys. And the results are rather remarkable.”

  “Has it been tried on people?” Rachel asked.

  “Yes, and with remarkable results, but I must caution you that this is a purely experimental procedure akin to what’s used in the treatment of certain cerebral dysfunctions, including Parkinson’s disease. I’m talking about measures that are drastic and unconventional. Is this something you’d be interested in?”

  “You mean a brain operation?”

  “Yes, an invasive procedure.”

  Rachel wanted him to continue, but Martin cut him off. “And what are the results?”

  “They’re not always predictable, but the neuronal pathways in those areas associated with intelligence show marked blood flow and heightened electrical activity, including abnormally developed areas.”

  “Meaning what exactly?”

  “Meaning enhanced performance in language and analytical skills.”

  Sheila’s face flashed across Rachel’s mind—that look of burning import. Suddenly the line between hope and the emotional muck of grief, anger, and guilt had shifted.

  “That’s incredible,” Martin said.

  “But, once again, this is not orthodox methodology,” Malenko cautioned. “It’s an experimental alternative.”

  “And it’s been done on people? Children?” Rachel asked.

  “Yes.”

  Rachel’s mind was spinning in disbelief. “Is it safe?”

  “Like any operation, it has its risks, but it’s categorically safe.”

  Malenko’s manner was purposely guarded. Rachel was about to ask him to elaborate when Martin cut her off again. “What exactly is the science—some kind of genetic therapy?”

  “Before I continue, I must tell you that what we are discussing is strictly confidential. What we say in this room will not go beyond these walls. Do I make myself clear?” He looked from Martin to Rachel.

  “Yeah, sure,” Martin said.

  Rachel nodded, feeling a bit dazed at the new possibilities. It suddenly occurred to her that their previous discussion had been a test
—and that they had passed.

  “Good,” Malenko said. “The procedure involves the introduction of certain agents that stimulate neuronic connections and open new pathways.”

  “You mean like stem cells?” Martin asked.

  “Something like that. The target areas of the brain are infused with a cocktail of various substances including growth factors. Intelligence is a multifaceted phenomenon consisting of different potentials—mathematics, linguistic, logic, spatial, and so on—and each specialty has a field locus in the brain. Dylan’s musical talent has an associative field of activity in his cortex. However, there are underdeveloped areas where the field potential is low and where lateral support cannot be assumed by other specialized areas.”

  He opened a desk drawer and removed a diagram of a human brain.

  “I’m not saying it will work, but it might be possible to stimulate cell development in those language-deficient areas so that they’ll connect up to those specialty areas to make for more integrated brain dynamics.” He used a pen to demonstrate on the scans. “Essentially, it might be possible to compensate for the developmental deficiencies in utero.”

  “That’s incredible,” Martin said.

  “You said invasive. You mean an operation?” Rachel asked. “Cutting open our son’s head?”

  “Actually, it’s done by stereotaxic surgery—drilling tiny holes then implanting stimulants by use of needles.”

  Rachel let out an involuntary groan, and Malenko picked up on it. “Sorry to say that this can’t be done intravenally. But stereotaxic procedures are performed all the time, and it is very precise, of course, and monitored in three-dimension by CAT scans.”

  “And where do the stem cells come from?” Rachel asked.

  “There are donor banks.”

  “Who would be doing the procedure?” Rachel asked.

  “We have a surgical team.”

  “And your role is what?”