Flashback

by Gary Braver

  The skin of Moy’s head flamed. “There is no connection, and there are no adverse drug reactions. These people were delusional psychotics suffering dementia. Christ, you see them all the time.”

  “I’m just raising the possibility.”

  Moy considered his words for a moment. His face suddenly lit up. “Then this is just the kind of thing we’d want you to monitor—making sure investigators look for contingencies, side effects, whatever. We need someone like you with uncompromising integrity. But, believe me, there’s no connection between the woman who stabbed the store guy and Memorine, and you can take that to the bank.”

  “Okay, but why do you want me when you have all these top people?”

  “Because I’d like you to direct the phase three clinical study, to be chief principal investigator—to coordinate all trial data for our FDA application. I want you at the top.”

  Nick did not see that coming. “Why not Pete Habib? He’s chief neurologist at South Shore and one of the best around. Or Jordan Carr?”

  “I said no bullshit: You’re senior neurologist at MGH and chief administrator of the imaging lab, and Peter Habib, Jordan Carr, and the rest aren’t. Having you in the lead would draw a lot of attention, not to mention investors.”

  “That’s quite an honor, but to do this right will require a large commitment.”

  “Of course, and you’ll be compensated handsomely.”

  “I’m talking time, not money. I’ll have to think about it and talk it over with Thalia.”

  “Of course.” Moy glanced at his watch. “How’s tomorrow by noon?” Nothing in Moy’s face said he was being humorous.

  “Next week.”

  “All right, next week.” Moy leaned into a huddle. “Okay, the ugly stuff: For your own patients, we’re offering you twice the standard trial rate—three thousand dollars per patient visit. We expect twelve to fifteen visits. You have a lot of AD patients and you can do the math. In addition, for all your expertise blah blah blah and the privilege of having you as clinical director blah blah blah … we’re offering you equity in the company in the form of stocks—the numbers to be worked out.

  “As you know, about five million people suffer Alzheimer’s in the States alone—a figure that’s going to double by 2020. The current market is twelve billion dollars for AD meds. We’ve created a special unit to market Memorine, lined up the third largest pharmaceutical company in the country to distribute, plus a sales force of seven hundred reps on a sales-based bonus system to promote it to practitioners. We’ve got a projection of three million prescriptions the first year on the shelves, twice that the next year, and multiples once our foreign subsidiaries kick in. Nick, this is a fifty-billion-dollar pill. And for the clinical director and the researchers associated with it, the benefits are incalculable.”

  Nick smiled. “At least you’re not turning up the pressure.”

  “Hell, I’m just winding up. Your imaging lab is a critical tool toward our end, and our board has authorized a ten-million-dollar grant for its application in the trials, which should cover overhead and salaries, blah blah blah. What do you say?”

  Nick was aware of the prestige of being part of the development of a potential miracle drug. But at his age he was not out for glory or the financial rewards—and he could do the math. Being a millionaire several times over did not move Nick. He and Thalia did not have extravagant tastes. They lived comfortably in Wellesley and drove a seven-year-old Saab. They vacationed in Fresno because Thalia had family there and Nick liked to hike the Sierras with his cameras. Because of ill health, Thalia no longer worked, nor did they miss her income now that their children were on their own. Money was never a motivating force in Nick’s life. And, like René, he harbored old-fashioned academic cynicism toward clinicians participating in studies with drug companies.

  But the majority of physicians conducted trials for higher ethical reasons: to benefit humankind. And Nick was one of them. As embarrassing as the financial benefits would be, Nick was hearing that he could be part of a team that might cure Alzheimer’s disease—a nemesis that he personally had confronted for most of his professional life—a disease more vicious than cancer since it robbed a victim first of selfhood, then of life.

  “You should know that I’ve been cutting back on my practice and research.”

  “Christ, you’re only sixty-two-too early to be retiring. Think of the hundreds, maybe thousands of people and patients you’ve watched waste away with dementia. Two or three years from now, when the world is singing ‘hallelujah’ because the scourge of the aging world has been defeated, where you going to be, huh?—on top of some mountain taking snaps of yellow-belly sapsuckers.”

  Nick laughed. “All work and no play—”

  “Bullshit! I want you on this, and so do you.”

  “All right, all right, give me a chance to catch my breath.” Nick had seen Moy worked up before, but not like this. His face looked like a giant tomato.

  “Catch your friggin’ breath and tell me yes, you’ll head this up.”

  “If I agree, all proceedings will be according to protocol.”

  “Goes without saying.”

  “Fine.”

  “Monday.”

  Moy stood up and shook Nick’s hand. As Nick headed for the door, Gavin said, “Believe me, it’s the Holy Grail—what you’ve been chasing all your life. You deserve to share in the victory.”

  GAVIN MOY’S WORDS ECHOED IN NICK’S mind as he took the elevator down to the lobby—a high-glassed interior and the main entrance to GEM’s state-of-the-art complex. Given the surrounding acreage, there was room for expansion to meet the anticipated demands of the drug for years to come.

  Nick crossed the lobby, which was appointed in marble and brass, red oriental rugs, and gold leather sofas and chairs. As was characteristic, Gavin himself had worked with designers. Basically it was a Gavin Moy decor. So was the large aquarium in the middle of the floor, its brightly colored sea life looking like Christmas ornaments floating in the air.

  Nick’s heels clicked on the marble as he walked to the structure that sat like a fairyland column of coral, anemones, sea fans, long diaphanous grasses, and a bewildering variety of polychrome tropical fish. It was GEM’s showpiece, which Gavin Moy had specially designed and which cost a small fortune. According to him, this was one of the few Kreisel nonpublic aquariums. And what distinguished the setup were its unique water inlets and outlets—essential so that its special residents were suspended in the middle of the tank and didn’t get sucked into the filters. To add to the complicated filtration and fluid dynamics, sophisticated monitors maintained the proper temperature as well as delicate chemical and biological levels. In addition to the special filter system and chilling unit, a separate breeder tank provided brine shrimp as a substitute for plankton, the creatures’ natural diet. This was not your average pet shop fish tank.

  Nor were those pulsing bulbs with the meter-long tentacles your average fish tank denizen. These creatures were the real celebrities of this bottled reef and the secret source of the endless blue skies above, the iconic genus of GEM Neurobiological Technologies—the elusive Solakandji.

  The fifty-billion-dollar jellyfish.

  18

  RENÉ FOUND JACK KORYAN IN THE intensive care unit of Mass General Hospital.

  Sitting with him was his wife, Beth, a slender, attractive woman with thick dark shoulder-length hair that was streaked blond. Her complexion was pale, as if she were getting over the flu. Her brown eyes were bloodshot—probably from a lack of sleep—giving her a muddy glance.

  René introduced herself and explained that she was the consulting pharmacist and an associate of Dr. Nicholas Mavros. “I just wanted to come by to see how he was doing.” And to put a face to the brain images.

  The woman didn’t seem to care who she was or why she was there. “This is Jack.” Her voice was flat.

  On the windowsill sat a double frame containing two color photographs of Jack—one
of him standing with a male friend, the other a close-up solo that made René aware of how handsome he was—a man with black curly hair, a disarming smile, and lively exotic eyes. He was dressed in a black T-shirt that showed a well-built upper body. It was difficult to believe it was the same man in the bed. What struck her about the close-up photo were Jack Koryan’s eyes. They looked like shards of peridots and vaguely familiar.

  “That’s his friend Vince Hammond,” Beth explained, watching René examining the photos. “They were business partners, or would have been.” Then Beth muttered “Shit!” under her breath and looked away.

  Nearly two weeks had lapsed since the accident and, according to the nurse, the news was good. Jack Koryan was off the ventilator. But he was still a shocking sight. His body was slightly bloated, and the silver nitrate for his open sores had turned his skin black. The blisters across his torso and legs had eventually dried up and had to be surgically debrided—the dead skin being cut away, leaving red patches against the yellow. He looked as if he had been painted for camouflaging. His scalp and ears were scabbed, and his lips were gray. His feet and fingers had been freshly dressed against lesions. His arms were connected to IVs, and a percutaneous gastrostomy tube had been surgically inserted through the wall of his stomach so he could feed—standard for unconscious patients. Machines monitored his vital functions including his brain waves. It was hard to believe he had survived the attack.

  “The nurse says that the brain swelling has subsided and he’s responsive to sensory stimulation—which is good news.”

  Beth nodded glumly. “His EEG is only four Herz; six to eight is for normal sleep. He’s still unconscious. How’s that good news?”

  René let the jab pass. “Well, every brain injury is unique; so is the rate of recovery. He could just pop awake.”

  “I don’t believe that.” Then she placed her hand on his arm. “Jack, it’s Beth. Please wake up. You’ve got a visitor. What did you say your name is?”

  René told her again and studied Jack while Beth spoke to him in a flat, neutral voice. But there was no sign of response—not a twitch of an eyelid or a finger, not a hitch in his breathing.

  “The doctors call it a persistent vegetative state.” She made an audible humpf. “More like he’s dead.”

  Mercifully, her father had never passed into a coma, at least not technically. Toward the end he was conscious and unconscious at the same time. He could sit up in bed or in a wheelchair, move his eyes and hands. But inside he was nearly blanked out. And that’s what René could not take: the loss of recognition that animated the face, the vacant stare, the sudden spike of fright, the reduction of his mind to brain-stem reflexes, his strong voice and articulate words reduced to grunts, his bright eyes to blown fuses. A gaga thing attached to a diaper.

  Thank God he had made her promise to let him die. He knew what was coming. It was his final gift to her.

  “His vital signs look good,” René said, nodding at the steady beat of the monitors.

  “I don’t know,” Beth said. “He’s had some kind of seizures and bad dreams that make him agitated and get that thing jumping all over the place.”

  “But that means there’s activity in the frontal and occipital lobes, so his memory and vision sectors are functioning. And there’s no indication from the MRIs that he’d suffered a stroke.”

  As René watched the persistent pulse on the monitors, she wondered what if anything was going on inside Jack’s mind. Was he dreaming or aware of his condition, or just suspended in a profound void? His brain had been saturated with the chemistry of Memorine. God knows what he might remember were he to even wake up.

  “He never should have been out there. It’s got an undertow and all those damn poisonous fish and things. But no! And now he’s locked inside himself.” Then she looked at René in exasperation. “He could go on forever like this, right? Jesus!” she said in exasperation.

  René could hear anger and resentment coiling around Beth Koryan’s words as if Jack had done this to her. The more Beth talked, the more it became clear that their marriage had not been a healthy, solid one—a suspicion that explained Beth’s chilly manner and the fact that there were no happy photographs of the two together.

  “Who found him?”

  “The Coast Guard. He was supposed to catch the water taxi back by seven, and when he didn’t show up by nine and didn’t answer his cell phone, the rental guy called.”

  “It’s lucky they got to him in time.” The woman was not easily consoled, and this was the best René could come up with.

  “Is it?”

  The question squirmed between them. “Of course.”

  Beth shrugged. “The thing is, he loved the sea. Look at that, I’m talking in the past tense already, like he’s dead. But he did—It’s in his blood, like his mother, which is kind of ironic, his getting himself poisoned, kind of like the ocean betrayed him. Those goddamn things show up something like three times in the last fifty years. He was in the wrong place at the wrong time.”

  René noticed that the woman’s fingernails had been bitten to the quick.

  “He could go on like this for years. Just lie there with these fucking tubes and wires and just shrivel up.”

  “And he could still wake up any time.”

  But it was as if Beth didn’t hear her, locked in some long-running narrative. “It’s all my fault. I shouldn’t have let him go alone. We had a fight, nothing new, and … now this is what we’ve got to live with.”

  It seemed as if the woman had already consigned Jack to permanent unconsciousness and herself a life of bedside wife. And what René was hearing was blame and resentment.

  Suddenly one of the machines made a double chirp. And on the screen the green little sawteeth made a series of ugly spikes.

  “Shit! Another seizure,” Beth said, and got up. “Jack, calm down.”

  He let out a high-pitched whine at the same time his eyes snapped open—so open that René half-expected his eyeballs to explode from their sockets.

  “Amaaaaa!”

  The sound cut through René like shrapnel. His voice must have carried, or somebody at the head desk was checking the monitors, because two nurses dashed into the room. Jack was thrashing and pulling against the lines connected to him. The nurses worked to restrain him since Jack was trying to rise from the bed to follow his cries, his eyes huge and staring at something that was terrifying him.

  “Jesus, what’s happening to him?” Beth cried.

  Jack continued babbling nonsense syllables.

  “It doesn’t even sound like him. His voice. That isn’t his voice. It sounds like … a child.”

  It did. And nobody said anything as the nurses tried to hold him down because Jack was pulling against his dressing and the tubes, his eyes bulging and focused on nothing across the room, but something awful swirling behind them.

  “Ahamman maideek amaaa …,” Jack continued babbling.

  “What’s he saying?” Beth asked.

  “Maideek.”

  “It sounds like ‘mighty’ something.”

  Jack muttered more syllables. “Ammama …”

  “I think he’s saying ‘Mama,’” René said.

  “That’s not unusual,” one of the nurse replied. “Patients under stress even in comas call for their mothers.”

  “That happens a lot,” the other nurse added. “We hear it all the time.”

  “Except Jack didn’t have a mother.”

  René looked at Beth. “What?”

  “She died when he was a baby, and he was brought up by his aunt and uncle. He never called anyone mama.”

  Jack started thrashing again, and to calm him down the smaller nurse produced a syringe of Valium and emptied it into Jack’s IV. In a minute or so, Jack gasped and deflated against his pillow, his eyes pulsing against closing lids until he slipped back to sleep with a solitary sigh rising from his lungs.

  But before that happened, his eyes shot open again and he looked dir
ectly at René. And through his crusted mouth still glistening with analgesic ointment he formed the syllables: “Mama.”

  “MAMA”

  Jack Koryan was at the door again. He could hear the wind outside, but that was all. He was safe to go out and the knob wasn’t frozen again, so he turned until he heard the latch come free.

  Instantly the door sucked open and in the flare he saw the large pointed creature standing over the big mouse, its feet twitching as the club came cracking down on it.

  Then the door slammed shut and Jack was back in the cage.

  And outside the night raged and flared.

  Then all began to fade like distant thunder as black air mercifully closed around him.

  19

  Hartford, Connecticut

  “SURE, I REMEMBER HOW TO GET there,” said William Zett, sitting in the passenger seat of his sister’s car.

  Greg Lainas drove while his wife MaryAnn sat in the back seat. It was late Sunday morning, a beautiful early September day with a big blue sky filled with sudsy white puffs of clouds. One of those days that reminded you of childhood.

  “Yeah, turn up here,” William said. Then it came to him. “South Street.”

  “Son of a gun,” Greg said. “You’ve got the memory of an elephant.”

  “Told you,” William said proudly. “Then you take a … let’s see … a left onto Campfield Ave.” The name then opened up in his head like a flower. “Goodwin Park.”

  “Heck, maybe you can get Dr. Habib to get some of those magic pills for me, too.”

  “Yeah, ask him for the both of us,” MaryAnn said with a chuckle. Then she turned toward Greg in a voice loud enough that William could hear. “Do you know the other day he started reciting one of his physics lectures. Come on, tell him, William. You know, the Heisenberger something-or-other principle, or whatever.”

  “Heisenberg uncertainty principle.”

  “Yeah, that’s it. Come on, let Greg hear it.”