"But complications there were."
"Four separate operations, all of them indicated and due to unforeseeable circumstances, as far as I can tell, but four nonetheless.
Then there was a protracted stay in the Sterling Nursing Home. In fact, Yvette never did return home before she died."
"And, of course, there were more bills for that. I get the picture."
"Actually, " Beaulieu said gravely, "you haven't gotten the picture at all… yet. You see, Ultramed Corporation not only owns our hospital, it now owns both nursing homes in town as well. Did you know that?"
"No, " Zack said. "No, I didn't."
"The corporate name is the Leeward Company. They own nursing homes and rehabilitation centers all over the east and midwest, and about three years ago they purchased the two here in Sterling. But what not so many people know, including me until just a few months ago, is that Leeward is a division of Ultramed, bought out by them precisely four years ago.
The bills for all three institutions-Ultramed-Davis and the two nursing homes-are actually spit out of the same computer. I'm not going to tell you who's in charge of that computer, but you can guess if you wish."
"I don't have to, " Zack said, wondering why Frank had never mentioned the purchase of the nursing homes to him. "Coulombe's story is a very sad one, especially with the unfortunate outcome for his wife. But I see nothing evil or even immoral in it."
"That is because you are missing a piece of the puzzle, " Beaulieu said.
"A crucial piece. And remember, " he added, "what I am about to reveal to you is just the tip of the iceberg."
"Go on, " Zack said, wishing now that the man would not. Beaulieu pulled a folded typed sheet from his jacket pocket, smoothed it out on the table, and slid it across to Zack. "As I mentioned before, " he said, "I do not have too many allies in my little crusade. But I do have some.
One of them has spent nearly six months traveling from place to place, trying to gather information for me. Just last week he came up with this. It's a list of the boards of directors of two companies."
Zack scanned the parallel lists of names, headed simply R and EPSS. Five of the ten names on each list were identical. "What do these letters stand for? " he asked. The fire in Guy Beaulieu's eyes intensified. "The R stands for RIATA of Boston, the megaglomerate that owns Ultramed. In a sense, they are our bosses, Zachary. Yours, mine, and every other doctor's in town."
"And the other?"
"The other, my friend, stands for Eagle Pharmaceuticals and Surgical Supplies-the corporation that bought out Richard Coulombe. Their boards of directors interlock."
Beaulieu illustrated his point by sliding the fingers of one hand between the fingers of the other. Before he could respond, Zack saw movement at the corner of his eye. He slid the paper onto his lap at the instant a shadow fell across the table. He and Beaulieu looked up.
Frank, smiling benignly, stood not five feet away from them, holding a tray of food. "Are you gentlemen having a heart-to-heart? " he asked.
"Or do you have room at the table for one more?"
Carefully, Zack folded the sheet of paper and slid it into his pocket, although he sensed the move was a fruitless one. Frank had heard at least part of their conversation. Of that, he was almost certain.
A Bach fugue was playing on the small cassette deck by the sink. Barbara Nelms, staring glumly at the bathroom mirror, ran a finger over the furrows in her forehead and the crow's feet at the corners of her eyes.
The creases had, it seemed, appeared overnight. Instinctively, she reached for her makeup kit. Then, just as quickly, she snapped off the tape, turned and walked from the bathroom. If she was bone-tired, if she was stressed close to the breaking point, if frustration and fear had aged her six years in six months, why in the hell should she try to hide it anymore?
The product of a perfectly uncomplicated unbringing in Dayton, Ohio, and four idyllic years as a business and marketing major at tiny St. Mary's College in Missouri, she had always prided herself on being a model parent, wife, citizen, and member of society. She was a registered Democrat, a voting Republican, an officer in the PTO three years running, a scout leader, a reader at church, a better than average pianist and tennis player, and, at least according to her husband, the best lover a man could ever want. But now, after six months of haggard guidance counselors and harried school resource workers, of evasive, pompous behavioral psychologists and bewildered pediatricians, none of that mattered.
She had dropped off all committees, hadn't picked up a tennis racket in weeks, and couldn't remember the last time she and Jim had had sex.
Something was wrong, terribly wrong, with her son. And not only could none of the so-called specialists they had seen diagnose the boy's problem, but each seemed bound and determined to convince her that it fell in someone else's bailiwick. The violent episodes, occurring at first monthly, but now almost once a week, had enveloped Toby in a pall of melancholy and fear so dense that he no longer smiled or played or even spoke, except for occasional monosyllables in answer to direct questions-and then only at home. Situational depression, delayed autism, childhood schizophrenia, developmental arrest with paranoid ideation, acting out for secondary gain, the labels and explanations for Toby's condition were as varied-and as unacceptable-as the educators and clinical specialists who had applied them. The boy was sick, and he was getting sicker. He had lost nearly ten pounds from a frame that had not an ounce of fat to begin with. He had stopped growing. He had failed to satisfy the requirements for promotion to the fourth grade. He avoided interacting with other children. He had been given vitamins, antidepressants, Thorazine, Ritalin, special diets. She had taken him to Concord, and then to Boston, where he had been hospitalized for four days. Nothing. Not a single objective clue. If anything, he had returned from the medical mecca even more uncommunicative than before. Now, as she prepared to drag her son to yet another specialist-this one a young psychiatrist, new in town, named Brookings-Barbara Nelms felt the icy, all-too-familiar fingers of hopelessness begin to take hold. Toby's episodes at first seemed like horrible nightmares. Several times she had actually witnessed them happen-watched helplessly as her son's eyes widened and grew glassy, as he withdrew into a corner, drifting into a terrifying world he would share with no one. She had listened to his cries and had tried to hold him, to comfort him, only to be battered about the head and face by his fists. In the end, there was nothing she could do but stay close, try her best to see that he didn't hurt himself, and wait. Sometimes the episodes would last only half an hour, sometimes much longer than that. ' 518 Always they would end with her son mute, cowering, and totally drained. Perhaps this will be the day, she said to herself. Perhaps this man, Brookings, the first full-time psychiatrist in the valley, would have the answer. But even as she focused on this optimistic thought, even as she buttoned her blouse and smoothed the wrinkles she should have ironed from her skirt, even as she went to her son's room to fetch him for yet another evaluation at yet another specialist's office, Barbara Nelms knew that nothing would come of it. Nothing, perhaps, except another label. And time, she also knew, was running out. The drive from their house to the Ultramed-Davis Physicians and Surgeons Clinic took fifteen minutes. For most of the ride, Barbara Nelms kept up a determined conversation with her son-a conversation that was essentially a monologue. "This doctor's name is Brookings, Toby. He's new in town, and he specializes in helping people with attacks like yours… We're going to get to the bottom of this, honey. We're going to find out what's wrong, and we're going to fix it.
Do you understand?"
Toby sat placidly, hands folded in his lap, and stared out the window.
"It would make it easier for Dr. Brookings to do his job if you would talk to him-tell him what it is you see and feel when you have the attacks. Do you think you can try and do that?… Toby, please, answer me. Will you try and talk to Dr. Brookings?"
Almost imperceptibly, the boy nodded. "That's good, honey. That's wonde
rful. We all just want to help.
No one's going to hurt you."
Barbara Nelms thought she saw her son shudder at those words. She swung her station wagon into one of the few spaces left in the crowded parking lot, locked her door, and then walked around the car to let Toby out. It was a promising sign that he had unbuckled his safety belt himself.
Instantly, hope resurfaced. Perhaps this would be the day. The only other time she and Toby had been in the Ultramed-Davis Physicians and Surgeons Clinic was for a brief follow-up visit with Dr. Mainwaring.
Toby's pediatrician worked out of an old Victorian house on the north side of Sterling. A directory, framed by two large ficus trees in the gleaming, tiled lobby, listed two dozen or so doctors, along with their specialties. Phillip R. Brookings, MD, Child and Adult Psychiatry was on the second of the three floors. "Toby, do you want to take the stairs or the elevator?… Honey, I promise you, Dr. Brookings just wants to talk. Now, which will it be?… Okay, we'll take the stairs, then."
Barbara took his hand and led him up the stairs, half wishing he would react, make some attempt to pull away. He was plastic, emotionless.
Still, she could tell he was completely aware of what they were doing. A small plaque by the door to room 202 read P. R. BROOKINGS, MD, RING BELL ONCE AND ENTER. The waiting room was small and windowless, with textured wallpaper, an array of black-and-white photographs of mountain scenes, and seating for only four. At one side was a small children's play area, consisting primarily of dog-eared Highlights magazines, multicolored building blocks, and puzzles, none of which, Barbara knew, Toby would be interested in. She ached at the image of her son before it all began, huddled on the floor with his father, pouring excitedly over his Erector Set. No, Daddy, this way… turn it this way… See?
At precisely three o'clock, Phillip Brookings emerged from the inner office, introduced himself stiffly to her with a handshake and to Toby with a nod. He looked even younger than she had anticipated-no more than thirty-two or — three, she guessed, although his thick moustache made it hard to tell. As so often had happened over the preceding months, Barbara found herself wondering if she had aged so much, or if doctors were actually getting younger. "So, " he said, taking one of the two remaining empty chairs, "welcome to my office. Toby, I appreciate your coming to see me, and I hope we can help you to feel better."
He wore a button-down shirt and tie, but no jacket, and Barbara's initial impression, despite his youth, was positive. If nothing else, he had started off on the right foot by not talking down to the boy. She glanced over at Toby, who sat gazing impassively at the photos on the wall. "Here's the medical history form you sent us, Dr. Brookings," she said, passing the paper over. "You have the other reports I sent you?"
Brookings nodded and briefly scanned the sheet. "I think, " he said,
"that if it is all right with Toby, I would like to speak with him alone in my office. What do you say, Toby?… We can keep the door open if you want, okay?"
He stood up and stepped back to the doorway of his inner office. "Are you coming?"
"Go ahead, honey, " Barbara urged. "I'll be right here. Remember what I said. There's nothing to be afraid of."
Slowly, Toby rose from his chair. "Wonderful, " Brookings said. "Come in. Come in."
Silently, but with every fiber, Barbara Nelms cheered her son on.
He was being more cooperative, more open to this man than he had been to anyone she had taken him to in some time. Perhaps, at last, he was ready. Perhaps… She watched as Brookings disappeared into his office.
From where she sat, directly opposite the doorway, she could see a roomy, comfortably furnished office with a large picture window, and plants arranged on the floor and hanging from the ceiling. Go on, darling Go ahead in. It's okay. It's okay. After a brief hesitation, Toby followed Brookings in. Then, after a single, tentative step inside the door, he stopped, his gaze riveted on the broad picture window across from him. "Come in, Toby, " Barbara heard Brookings say. "I'm not going to hurt you."
Barbara could see Toby's body stiffen. His hands, which had been hanging lifeless at his side, began to twitch. Dear God, she thought, he's going to have an attack. Right here.
Right now. "Toby, are you all right? " Brookings asked. Toby took several backward steps into the waiting room, his face chalk white, his eyes still fixed on the window. "Honey, what's wrong? " Barbara felt her muscles tense. No one but she and her husband had ever witnessed one of the attacks before. Frightened as she was, she sensed a part of her was actually grateful for what was about to happen. At least someone else would know what they had been going through all these months.
Instinctively, she glanced about for any objects on which Toby might hurt himself. Then, suddenly, the boy turned, threw open the outer office door, and raced out into the hall. "Toby! " Barbara and Brookings, who had come out of his office, called out in unison. The psychiatrist was across the waiting room and out the door before she had left her seat. Barbara reached the corridor just as he disappeared through the stairway door. Her pumps were almost impossible to run in.
At the head of the stairs she kicked them off and skidded down to the first floor, falling the last three steps and skinning her shin. As she limped into the lobby, Barbara heard the horrible screech of an automobile's tires and froze, anticipating the sickening thump of the car hitting her son. There was none. Instead, through the glass doorway, she saw him weaving through the parking lot, running as she had not seen him do in many months. Phillip Brookings was a dozen yards behind and closing. Barbara raced across the drive, narrowly avoiding being hit by a car herself. "Toby, stop! Please stop!"
The boy had made it beyond the parking lot and was sprinting across a stretch of thirty-or-so yards of lawn, toward the dense woods beyond.
Brookings was now no more than a few steps behind him. With only a yard or two to go before the forest, the psychiatrist launched himself in a flying tackle, catching Toby at the waist and hauling him down heavily.
"Thank God, " Barbara panted, hurrying across the parking lot. This was the first time, in all of his attacks, that Toby had done anything like this. Even at a distance she could tell that, although he was pinned beneath the physician, Toby was struggling. As she neared she could see his efforts lessen. "Toby, stop that, " she heard Brookings saying firmly, but gently. "Stop fighting me and I'll let go."
Barbara approached cautiously, expecting to see the familiar lost, glassy terror in her son's eyes. What she saw, instead, was a fierce, hot mix of anger and fear. It was almost as if he were snarling at the man. Carefully, Brookings pushed himself away, although he still maintained a grip on the boy's belt. As Barbara knelt beside her son, she realized that this was not one of his attacks after all-at least not a typical one. He was awake and alert. Whatever had set him off was in this world, not in the world locked within his mind. "Toby, are you all right? " she asked. "What happened? What frightened you so?"
The boy did not answer. "I'm going to let you go, Toby, " Brookings said. "Promise me you won't run?"
Again, there was no response. Slowly, Brookings released his grip on Toby's belt. The boy, still breathing heavily, did not move. "What was it? " Barbara asked. "Pardon? " Brookings's shirt and the knees of his tan trousers were stained with grass, and he, too, had not yet caught his breath. "Dr. Brookings, Toby saw something out your window-something that frightened him. This wasn't one of his attacks."
She turned to her son. "It wasn't, was it, honey?"
Tears glistening in his eyes, Toby stared up at her. Then he shook his head. "Can you tell us what it was?"
This time there was no answer. Phillip Brookings rubbed at his chin.
"Mrs. Nelms, I don't know what to say. I saw Toby staring out my window, and I followed his line of sight. But there was no one there, nothing."
"Nothing?"
Brookings shook his head. "Just a big oak tree, a parking lot, and beyond it the emergency ward of the hospital. Nothing else. I'm sure of it.
"
The emergency ward. Barbara Nelms saw her son stiffen at the words.
"Toby, was that it? Was it the emergency ward?"
The boy remained mute. "Dr. Brookings, what would you suggest? " she asked. "Can you help us?"
The psychiatrist looked down at Toby. "Perhaps, " he said. "Perhaps with time I can. But I would like to insist on something before I begin."
"Anything."
"I want Toby to have a CT scan and a clean bill of health from a neurologist. As near as I can tell from reviewing the material you sent me, he has had neither. Correct?"
"I… I guess so."
"Well, if his attacks are some sort of seizure disorder, I think a neurologist should be involved, don't you?"
"Doctor, I told you when I first called, we're willing to do anything.
Absolutely anything. Is there someone you can recommend?"
Brookings nodded. "There's a new man in town. Yale Med. Trained at Harvard hospitals. He's a neurosurgeon, actually, but he's doing neurology as well. His name's Iverson. Zachary Iverson. I'll give him a call and then get back to you."
Barbara stroked her son's forehead. There was nothing in his expression to suggest he had followed any of their conversation. For a moment, studying the sunken hollows around his eyes and the tense, waxy skin over his cheeks, she felt as if she were looking at a corpse. "Please, Doctor, " she said, "just one thing."
"Yes?"
"Do it quickly."
Brookings nodded, and then rose and returned to his office. Barbara took her son by the hand and led him back to their car. Desperately, she searched her thoughts for any unpleasantness or difficulty he had encountered at Ultramed-Davis or in any other emergency ward. There was none. Nothing but a gashed chin when he was five and, of course, the incarcerated hernia operation last year. But Barbara Nelms knew-as the surgeon, Dr. Mainwaring, had told her-that the whole hernia affair had been as routine as routine could be.
CHAPTER FIVE
Flashback Page 7
