McCready wasn’t too sure he liked the way this was going. He had expected some bromides about how doctors were only human and were doing the best they could. He didn’t know what Bulmer was leading up to.
The doctor paused, then continued. “I really hate to bring it up before a committee such as this, but here goes: As doctors, we must—we need to—keep touching people, and by that I mean an actual laying on of hands, even when it’s not necessary. It’s letting that person know that there’s another human being among all this hardware.
“A simple example: A doctor can listen to a heart by standing to the patient’s right, grasping the head of the stethoscope with the fingers of his right hand, reaching over, and pressing it against the patient’s chest wall—only the diaphragm of the stethoscope touches the patient. Or he can lean close and steady the patient by placing his left hand on the patient’s bare back. He’s not hearing any better, but he’s in contact. It’s a very simple but very personal thing. And there are diagnostic bonuses that come with touching. You can often pick up little cues from the feel of the skin and tissues beneath. It’s not something you can get from a textbook, it’s something you can learn only by doing. It’s hands-on medicine, but too few doctors are doing it today. And those who are will be driven out by the Medical Guidelines bill.”
The committee room was silent. Even the reporters had stopped their chatter.
They like him. The senator decided he’d do better being gentle with Bulmer than trying to cut him up.
“Very well put, Dr. Bulmer. But why did you say you hesitated to bring it up before this committee?”
“Well…” Bulmer said slowly, obviously measuring his words. “The operating premise of this committee seems to be that you can actually lay out guidelines for good medical care. So I wouldn’t be surprised if my comments inspired a new federal guideline requiring every doctor to touch each patient for a predetermined number of minutes during each examination.”
A few titters, then a couple of guffaws, then the room erupted into laughter. Even some committee members broke into sheepish grins.
McCready was furious. He didn’t know if he had been set up or if Bulmer’s remark had been genuinely off the cuff. Either way, this pipsqueak doctor was ridiculing him and the committee. His words had been carefully padded with humor, but the sting was still there. McCready glanced at the other committee members. The looks on their faces sounded an alarm in him.
Until this moment he had harbored not the slightest doubt about his bill’s inclusion in the latest Medicare appropriations. These hearings had been mere formality. Now he experienced his first twinge of uncertainty. Bulmer had struck a nerve and the committee members were twitching.
Damn him!
This bill had to pass. The country needed it! He needed it! He had to put an end to the kind of medical oversights that had left him undiagnosed for so long. And if the medical establishment couldn’t or wouldn’t do it, then he’d goddamn well do it for them! But right now he had to act. Top priority was to get this doctor away from the microphone and off the floor immediately.
He leaned close to his own mike. “Thank you for your time and valuable input, Dr. Bulmer.”
And then the room was applauding and Congressman Switzer was clapping his pet doctor on the shoulder. McCready watched the pair from behind his dark lenses. He would have to do something about Switzer. And soon. And Dr. Bulmer…Dr. Alan Bulmer…
He would remember that name.
6
Alan
He made quick afternoon rounds at the hospital, then met Ginny back at the club for dinner. He was all set to spend a nice, quiet evening at home when the answering service patched through a call from Joe Barton, a longtime patient. He was coughing up blood. Alan told him to get right over to the emergency room and he’d meet him there.
Joe turned out to have a heavily consolidated lobar pneumonia. But because he was a smoker and there was the chance that something sinister might be lurking in the infiltrated area of lung, he scheduled him for a CT scan tomorrow.
As he approached the ER nursing desk, a voice called out from the corner gurney.
“You! Hey, you! You’re the one!”
The overhead light in the corner was out. Alan squinted into the dimness. A disheveled old man in shapeless clothes lay there, gesturing to him. Alan didn’t recognize him, but threw him a friendly wave in passing.
“Who’s in the corner cot?” he said to McClain when he reached the desk. “Anybody I know?”
“For your sake, I hope not,” she said. “He’s drunk as a skunk and doesn’t smell much better. Doesn’t even know his name.”
“What’s wrong with him?”
“Says he came here to die.”
“That’s encouraging.”
McClain snorted. “Not on my shift, it ain’t. Anyway, we’ve got lab and a chest X-ray cooking, and EKG is on the way.”
“Who’s on service?”
“Your old buddy, Alberts.”
McClain was one of the few nurses still around who would remember that Alan and Lou Alberts had been partners—how many years ago? Could it be seven years already since they’d split?
“I’m sure they’ll get along fine together,” he said with an evil grin.
McClain barked a laugh. “I’m sure!”
On his way back to say good night to Joe, the man in the corner cot called to him again.
“Hey, you! C’mere! S’time!”
Alan waved but kept walking. The man was in no distress, just drunk.
“Hey! S’time! C’mere. Please!”
The note of desperation in that last word made Alan stop and turn toward the corner. The man was motioning him over.
“C’mere.”
Alan walked to the side of the gurney, then backed up a step. It was the same bum who had banged on his car Tuesday night. And McClain hadn’t been kidding. He was filthy and absolutely foul smelling. Yet even the stench from his pavement-colored clothes and shoeless feet couldn’t quite cover the reek of cheap wine on the breath wheezing from his toothless mouth.
“What can I do for you?” Alan said.
“Take my hand.” He held out a filthy paw with cracked skin and blackened, ragged fingernails.
“Gee, I don’t know,” Alan said, trying to keep the mood light. “We haven’t even been introduced.”
“Please take it.”
Alan took a breath. Why hadn’t he just walked on by like everybody else?
He shrugged and reached out his right hand. The poor guy did look like he was dying, and this seemed important to him. Besides, he’d had his hands in worse places.
As soon as his fingers neared the derelict’s, the filthy hand leaped up and grabbed him in an iron grip. Pain blossomed in his fingers and palm, but from more than pressure. Light blazed around him as a jolt like high-voltage electricity coursed up his arm, convulsing his muscles, causing him to thrash uncontrollably like a fish on a hook. Dark spots flared in his vision, coalescing, blotting out the derelict, the emergency room, everything.
And then the grip was broken and he was reeling backward, off balance, his hands reaching for something, anything to keep him from falling. He felt fabric against his left hand, grabbed it, realizing it was a privacy curtain as he heard its fasteners snap free of the ceiling track under his weight. But at least it slowed his fall, lessening the blow to the back of his head as it struck the nearby utility table. His vision blurred, then cleared to reveal McClain’s shocked expression as she leaned over him.
“What happened? You okay?”
Alan rubbed his right hand with his left. The electric shock sensation was gone, but the flesh still tingled all the way down to the bone.
“I think so. What the hell did he do to me?”
McClain glanced at the corner gurney. “Him?” She straightened up and gave the derelict a closer look. “Oh, shit!” She darted out toward the desk and came back pushing the crash cart.
From the overhead
speaker the operator’s voice blared, “Code Blue—ER! Code Blue—ER!”
Nurses and orderlies appeared from every direction. Dr. Lo, the ER physician for the night, ran in from the doctors’ lounge and took charge of the resuscitation, giving Alan a puzzled look as he darted by.
Alan tried to stand, intending to help with the CPR, but found his knees wobbly and his right arm numb. By the time he felt steady enough to help, Lo had called the resuscitation to a halt. Despite all their efforts, the heart had refused to start up again. The monitor showed only a wavering line when McClain finally turned it off.
“Great!” she said. “Just great! Don’t even know his name! A coroner’s case for sure! I’ll be filling out forms for days!”
Lo came over to Alan, a half smile on his Asian face.
“For a second there, when I saw you on the floor, I thought we’d be working on you. What happened? He hit you?”
Alan didn’t know how to explain what had happened, so he just nodded. “Yeah. Must have been some sort of Stokes-Adams attack or something as he arrested.”
Alan went over to the corner cot, stepped inside the drawn curtains, and pulled down the covering sheet. The old man’s head was half turned toward Alan, his mouth slack, his eyes half open and glazed. Alan gently pushed the lids closed.
He cradled his right arm in his left. It still felt strange.
What the hell did you do to me?
He could think of no explanation for the shock that had run up his arm. It had come from the derelict, of that he was sure. But where had he got it? Alan had no answer, and the dead man wasn’t going to tell him, so he pulled the sheet back over the face and walked away.
7
Sylvia
“No hurry, Ba,” Sylvia said from her seat in the rear of the Graham. “Take your time.”
She was not particularly anxious to hear what Sara Chase had to say today. She had resigned herself to the fact that it was not going to be good.
Fighting the melancholia that clung like a shroud, she ran her hand over the polished mahogany that framed the tinted side windows, sliding it down to the plush upholstery. Usually she took such pleasure in the interior refurbishing job she’d commissioned on this old 1938 sedan, transforming it from a rusting derelict into a warm, safe place, a bright red home away from home. A passenger had once remarked that it reminded him of a luxury stateroom on the QE2. Today it left her cold.
She hadn’t gone into this with her eyes closed. She’d known from the beginning that raising a child like Jeffy wasn’t going to be easy. She had expected and had been prepared for trouble, aggravation, and frustration. She hadn’t counted on heartbreak.
But the heartbreak was there. For months now, Jeffy receded from her a little bit each day, and each tiny increment of withdrawal was a stab of pain.
She wondered if she had known from the start that things would turn out this way—slow progress over more than four years, teasing her into a false hope, only to see those hopes dashed in the space of a few months—would she have adopted Jeffy?
A difficult question, but she knew only one answer: yes.
She clearly remembered how she had lost her heart to that little boy from the moment she opened the Monroe Express five years ago and saw his picture. The three-year-old had been left on the steps of the Stanton School for Special Education, secured to the front door by a leash fastened to the dog collar around his neck, with a note saying “Please take care of Jeffy I cant do it no more” pinned to his shirt. The picture had been published in an attempt to identify him and locate his parents.
It had accomplished neither. But it did capture Sylvia. Jeffy reached through that grainy black-and-white photo and touched a spot in Sylvia’s heart that refused to let her rest until she brought him home.
They’d warned her. Right from the start, the people at the Stanton School—Dr. Chase the most vocal among them—had told her that he was profoundly autistic and would be a tremendous financial, psychological, and emotional burden. The entire range of Jeffy’s behavior consisted of rocking back and forth, humming tunelessly, eating, sleeping, urinating, and defecating. He never even looked at another person, directing his gaze always just to the right or left of anyone facing him, as if they were an inanimate object obstructing his view. The most rudimentary rewards of motherhood, such as the simple return of love and affection showered on a child, would be denied her.
But Sylvia hadn’t listened. She’d known she could reach Jeffy.
And she had.
While waiting for all the legal machinery to process Jeffy and clear him for adoption, Sylvia had taken him into her home as a foster child. She immersed herself in his care, spending her nights reading every available reference on autism, her days structuring his environment and using the theories she was studying. Operant behavior-modification techniques worked best with Jeffy.
The operant sessions had been grueling at first. Endless repetitions, positively reinforcing each tiny fragment of a desired response, building a repertoire of behavior, increment by increment, from nothing—a seemingly impossible task. But Sylvia’s efforts had paid off. She smiled now, reliving a hint of the joy she’d felt as, bit by bit, Jeffy began to come around, began to respond. Dr. Chase and the staff at the Stanton School had been amazed. Sylvia and Jeffy became celebrities of sorts there.
The dream of the little boy with open arms running toward her across the lawn had looked like it would come true. Until last winter.
She felt her lips tighten as her smile withered.
Jeffy had never come near to being a “normal child”—whatever that was—but he had begun responding to people to the extent that he would look up when someone came into the room, something he had not been doing when found. He responded to animals and inanimate objects much more readily, going so far as to play with Mess and Phemus, and even say a few words to the air. He never spoke a word to another human being, but at least he proved he had the capacity for speech. Sylvia had felt they were on the verge of a breakthrough when Jeffy inexplicably began to regress.
It had been so subtle at first that Sylvia had refused to even acknowledge it was happening. Finally, reluctantly, she was forced to admit that Jeffy was losing ground. She’d fervently hoped that she was wrong, but Dr. Chase had begun to notice it, too. The results of her behavioral evaluation of Jeffy were due today.
“I’m afraid the results aren’t good,” Sara Chase said without preamble as Sylvia seated herself in the chair beside the desk.
A pleasant-looking woman of about fifty, Sara had ruddy cheeks and wispy brown hair. She never wore makeup and was perhaps twenty pounds overweight. She’d long ago told Sylvia to stop calling her “Doctor.”
Sylvia sank deeper into the chair. She bit her lip to keep it from quivering. She wanted to cry. “I’ve done everything. Everything.”
“I know you have. The progress he made with you is incredible. But…”
“But I didn’t do enough, right?”
“Wrong!” Sara said sternly as she leaned forward on her desk. “I won’t have you blaming yourself. Autism is a developmental disorder that follows a bell curve of severity and can confound you at every turn. I don’t have to tell you this. You know almost as much about it as I do.”
Sylvia sighed. She knew she had done all that could be done for Jeffy, but it hadn’t been enough.
“And Jeffy’s on the wrong end of the curve, is that it?”
She nodded.
Sylvia pounded her fist against the arm of the chair. “There’s a beautiful little boy in there and he can’t get out! It’s not fair!”
“Oh,” Sara said in a placating tone, “I don’t know if any of us knows what Jeffy’s really like.”
“I do! I can feel him in there, trapped. He’s been locked away so long he doesn’t even know he’s a prisoner. But he’s in there. I know it! Last summer I saw him pick a monarch butterfly out of a puddle, dry off its wings with his shirt, and let it fly away. He’s kind, he’s gent
le, he’s—”
There was sympathy in Sara’s eyes as she sat and watched Sylvia in silence.
Sylvia knew what the psychologist was thinking—that she was romanticizing Jeffy’s condition.
“No new medication?” she asked.
Sara shook her head. “We’ve tried them all and he’s refractory.
“We could arrange another trial—”
“No.” She sighed as depression settled on her like a mantle. “They only made him jittery or put him to sleep.”
“Keep working with him, then. Keep using the operant techniques. Maybe you can slow his slide. Maybe it will turn around by itself. Who can say?”
A few moments later Sylvia walked out into the crystalline daylight.
The sun shouldn’t be shining, she thought. Dark and rainy were more in tune with her mood.
8
Alan
It began late Friday morning.
The only incident of note before that was the call from Fred Larkin.
Connie buzzed back with the word that Dr. Larkin was calling.
“Dr. Larkin himself, or his secretary?”
Alan already knew the answer. Fred Larkin was the local glamorboy orthopedist who took in something like $750,000 a year, owned three homes, a forty-two-foot cabin cruiser, and traveled the 35 mile-an-hour roads from his home to the hospital in a 200-mile-an-hour, $90,000 Maserati with license plates that read FRED MD. Alan never referred patients to him, but one of his regulars had somehow landed under Larkin’s care in January. He had been expecting this call.
The Touch Page 6
