The Second Opinion, page 13
The little warmth that had been radiating from Lydia Thibideau vanished.
“Doctor, are you trying to undercut me in some way?”
“No, no. All I wanted to do was help.”
“Well, you’re not helping me. I have no truck with acupuncture or herbalism or reflexology or chiropractic or any of those other quacks. You seem to have inherited not only your father’s intelligence, but his penchant for getting in people’s way.”
Thea was stunned.
“Wh-what’s that supposed to mean?” she managed.
“It means that if your acupuncturist so much as touches my patient with a needle, I will have you brought before the executive committee so fast it will make your head spin.”
CHAPTER 21
The more Thea thought about her session with Lydia Thibideau, the less sense it made. One moment she was saying how much she respected Petros, another she was disrespectfully calling him a meddler. What did that mean?
As she walked through the tunnels to grab some dinner at the cafeteria before heading to Hayley’s room, she tried sorting out what she had learned regarding Jack Kalishar. The man, because of his meta-static pancreatic cancer, had been referred by her father to Thibideau, one of the foremost specialists in that disease in the world. She had designated him for inclusion in a clinical trial, one of a number of such trials she was continuously running on various chemotherapeutic agents, developed in her lab or in conjunction with one of the big drug houses. In Kalishar’s case, it was a drug named SU890.
The investigational drug accomplished something that was almost impossible to believe. It cured Kalishar—cured him of a cancer with an average five-year survival of 4 percent. Cured him of a cancer where the survival from the most aggressive treatment—surgery, radiation, and chemo in combination—in the most localized disease, averaged seventeen months.
Seventeen months in a best- case scenario.
Jack Kalishar was a miracle, and SU890 was the maker of the miracle.
There was just one problem. Other patients receiving the miracle drug had died. Exactly how many, what percent of those in the SU890 treatment group, Thibideau would not say.
Thea wondered how many deaths it would take to offset a miracle like Jack Kalishar.
Four-percent five-year survival. That was the starting point. Extending that statistic to eight percent, or ten, or even fifteen would be miraculous in its own right, but a cure . . .
What about Hayley? Did SU990 have any track record yet? Had she and her husband made the right decision in choosing to forgo treatment with the other established anticancer drugs to concentrate on this one?
Four percent survival. Not a heck of a lot to hope for.
Thibideau had been hardly forthcoming about her research. At times in their brief conversation she seemed unpleasantly patronizing. Then there was the attack on Petros. Thea tried to understand why, but got nowhere. Was it just the woman’s personality? Was she unusually paranoid about her data, or was this simply the way world-renowned scientists acted? It would seem that Petros Sperelakis’s physician-daughter might have deserved more respect. Perhaps the gastroenterologist had learned about her Asperger’s from Petros or one of the twins. Perhaps, in addition to her loathing for all those alternative healers, she just couldn’t take seriously someone who’d worked in Africa.
It was half past seven and Thea was famished. Once she got settled in with a salad and what ever pasta they were serving, she would call Dan to see how he was doing, and if he might be free tomorrow to spend some time with Dimitri. She also wanted at least to leave a message for Professor Julian Fang at the Eastern Massachusetts School of Acupuncture to see if he could stop by at the hospital to evaluate Hayley. Just no needles—isn’t that what Thibideau had said?
A year after her graduation from medical school, weighed down by the stress of too many patients and not nearly enough sleep, Thea had taken a basic acupuncture course taught by Fang, and had embraced both the philosophy and the man. She took another course in which she clearly demonstrated an aptitude for alternative medicine, and then, later in the year, used most of her vacation to go on a retreat with Fang and some of his most promising students.
For some time after that, Thea gave serious consideration to switching from Western to Eastern medicine. Fang had spent several hours discussing change with her—not the specific change she was considering, but the nature of change in general, and the difficulty she often had around flexibility and dealing with the unexpected. Ultimately, although it would have meant another student for his school, and a favorite of his at that, Fang recommended that she wait until her training was over before considering such a radical alteration of her life.
Eventually, Thea decided on a commitment to Doctors Without Borders. But she continued her study of acupuncture and herbal medicine, as well as her contact with Julian Fang.
Dan answered her call and sounded excited to hear from her, but he was locked in a game of chess with his son while they waited for the boy’s mother to pick him up.
“I can call you back right after I get beaten,” he said. “Make that get beaten again. Between Josh and the orderly with the fancy fast feet, I’m on quite a roll today.”
Thea imagined a comfortable den with thick leather furniture, and put Dan Cotton in a huge chocolate- colored leather easy chair. There were pictures of sports heroes on the wall, and trophies on the mantel for baseball and football and . . . and weight lifting.
“That was a sneak attack in the hospital,” she said, “just like Pearl Harbor.”
“Well, I don’t intend to go through a world war and an atomic blast before I get even.”
“I’ll help.”
“I’m counting on that.”
“Dan, listen. I know you have to get back to Josh, but I just want you to know that I’m really sorry you got hurt and I really want to see you again as soon as possible.”
“I don’t know how long it will take me to get used to being around someone who actually says what they mean. Let me try. Alethea Sperelakis, I really want to see you again, too. Let’s talk later.”
“Let’s talk later, Dan Cotton.”
Thea slipped her father’s cell phone into her pocket and did some people-watching as she ate. She also continued to try and sort out the meaning and significance of her strange, tightly controlled exchange with Lydia Thibideau. Was there any sense in trying to set up another meeting to get any more information from the woman? Doubtful. Was there anyone else she could speak to about Jack Kalishar and the other patients who had been treated with SU890? At the moment, there was only one she could think of—her father. But unless he brightened considerably in terms of his processing speed and ability to respond to the sort of code that enabled Jean- Dominique Bauby to dictate his memoirs, it was going to be next to impossible. For now, the key to moving forward had to rest not with the man himself, but with the man’s office, and his cluttered study at home.
Across the expansive cafeteria, a security guard wandered along the sandwich counter making his choice. He was quite a bit shorter than Dan, though, and didn’t look nearly as handsome in his uniform. In seconds, the trigger of seeing the man had her fantasizing again about making love with Dan—this time in the den she had conjured up for him, and even more passionately than what she had envisioned in Thibideau’s waiting room.
Sitting there in the still busy cafeteria, eyes half-closed, she wondered if anyone else in the crowded place was having a fantasy as rich and as enjoyable as was hers.
Aspies were defined in part by their concreteness and lack of latitude in their thinking. Yet many of them were involved in role-playing games that required the ability to transport themselves into alternative worlds, and to live in those wild, unpredictable worlds for hours on end. It was an ability that actually separated many with Asperger syndrome from the majority of neurotypicals. Did this ability carry over into other aspects of their fantasy life? Were their virtual sex lives richer, more passionate, and more quickly engaged than those of the typicals, even as their realities were more tightly bound?
Thea made a mental note to ask Dan. It would be as much fun to see his expression at the question as to hear his answer.
Before leaving for the ICU, she left a message for Julian Fang asking if he would be available to render an opinion about the extent and potential for treatment of Hayley’s cancer. Thea had never responded sanguinely to being pushed or told what to do. Her many clashes over the years with her father attested to that. If the acupuncturist put even a single needle into Hayley. That’s what she had said, almost word for word. Fortunately, Thibideau had said nothing of checking Hayley’s acupuncture pulses—a skill at which Julian was profoundly adept.
Wondering if she might run into either of the twins, Thea set her tray on the conveyor belt and headed for the unit. If there were no visitors and no volunteer nurses in Petros’s cubicle, she might try another question for him—one carefully formulated to determine where she would be most likely to hit paydirt in her search for more information about Jack Kalishar. Hopefully the Lion would have brightened enough to be ready for some yes-or-no exchange.
The woman at the security desk in front of the unit had been replaced by a husky man with tattoos on the backs of both hands, whose name tag read officer william saunders. He dutifully checked her ID badge and watched as she signed in.
“Leave something behind?” he asked.
Distracted, she barely heard the question.
“Huh?” she replied. “Oh, no. No, I didn’t leave anything.”
What an odd question, she was thinking as the glass doors glided apart and she strode into the unit, anxious to see who might be visiting. She was actually inside her father’s cubicle before she realized that the figure in his bed, partially obscured by machines and tubes, being tended to by a nurse she had never seen with Petros, was an elderly woman.
CHAPTER 22
“The step-down unit? How can you possibly transfer him there?”
“We . . . needed the bed—two beds, in fact—and your father was first on the list.”
The intensivist on duty, a doughy, baby-faced doc named Spiegel, withered before Thea’s eruption.
“What list?” she demanded.
“Every day we make a list of who can be transferred out of here. Then we clear the name with their PCP. As soon as we need beds, we start at the top of the list. Because of the numbers at the Beaumont, the average patient stay here is not very long. Sometimes it’s measured in hours. Your father’s been here for many days.”
“But he had a pericardial drain in place.”
“It wasn’t draining anything, so we pulled it. Same with the in-tracranial ventricular drain. I’m sorry, Dr. Sperelakis, but as I said, we’re getting new patients all the time. We’ve got to keep them moving.”
“Who authorized this?”
“Well, the truth is no one has to authorize any transfer from the unit except the intensivist on duty, which, at the moment, is me. But because of who your father is, I consulted with Dr. Niko, who put in the drain, and also with Dr. Hartnett, his PCP. They both approved moving Dr. Sperelakis to the step-down unit on Eaton One.”
“I can’t believe this.”
“The patient that took his place is very unstable. Go and see for yourself.”
“I can’t believe this,” Thea said again. “Do you know that just this morning someone tried to kill him?”
“Kill him?”
“The fight in the hall between a man dressed as an orderly and the security guard—that was about my father.”
“I wasn’t told that.”
“Well, it’s true. . . . Listen, Dr. Spiegel. I’m sorry to snap at you. I know you just did what you thought was right. I just wish you had contacted me before moving him.”
“I spoke with Scott and your brother, and your sister is down there with him right now. He really is quite stable. Besides, anything we can monitor here, they can monitor on Eaton One.”
“But with less staffing than you have here.”
Thea apologized again and took the stairs back down to the tunnel. The Eaton Building, home to the cardiac cath lab and most of the powerful cardiology service, was so new that Thea had never been in it. Everything surrounding Petros in the step-down unit was as gleaming and sophisticated as in the ICU. The nursing coverage, Thea’s benchmark for just how good a hospital was, seemed reasonably comprehensive.
In every way the Beaumont’s worldwide reputation for excellence seemed well earned, except that something within its walls was wrong—very wrong—and the man connected to a ventilator and monitor screen in Step-Down 6 almost certainly knew what it was.
Reflexively, Thea scanned the numbers as she entered the private room. Nothing worrisome.
“Hey there, sis,” Selene said. “One small step-down for a man, one giant leap for old Petros.”
“Do you think he’s stable enough for this move?”
“What do I know? I’m only a dentist. At least according to what Dad believes about us hand surgeons, I am.”
Thea wanted to warn her to watch what she said, that in fact their father was in no coma whatsoever. But she had given her word, and even if she shouted the truth from the rooftops, Petros would give no sign that supported her. Still, even without any indication, someone believed her enough to have tried to silence him forever. Now, thanks to this transfer, he was again in danger.
Like everything else in the Beaumont, the fourteen- bed step-down unit was large and bustling and well staffed. But despite the excellent coverage, the nurses could not be expected to police SD 6 anything approaching 100 percent of the time. It wasn’t a simple matter to kill someone on a ventilator and cardiac monitor, with nurses around who were skilled in resuscitation, but it could be done. One possibility was something as simple as a four-minute replacement of the oxygen driving the ventilator with something like nitrous oxide from a small, portable tank.
“Do you think we should get someone in here around the clock?” Thea asked.
Selene, wearing a perfectly tailored gray linen suit that might have come straight from a Paris design house, and enough gold bangles on each wrist to sink a lifeboat, looked at her queerly.
“The volunteer nurses that were helping out in the unit just sat around most of the time reading magazines.”
“I was thinking more in terms of security people, like off- duty policemen.”
“Do you have any idea how much that would cost?”
“No, but I have Dad’s bankbook. Believe me, he can handle it.”
“Pardon me for asking, but what is this all about? That cartoon Dimitri has put together of the accident?”
“That and the incident with the bogus orderly.”
“You think they’re connected?” Selene sounded incredulous.
“I do, actually,” Thea said, carefully measuring her words so as not to upset Petros, who she felt certain was listening. She also found herself wondering if whoever had sent the killer up to the ICU could have had anything to do with ordering or authorizing the transfer.
“Oh, honey, I know how badly you want to believe Dad is coming out of this,” Selene said, “but logic and medical science say he isn’t. He had an accident, his brain was damaged, he’s in a deep coma, he’s not going to wake up, and sooner or later, more likely sooner, pneumonia or heart failure is going to take him. And if he had a say in the matter, I believe Dad would insist on it.”
“I don’t think we should be talking about his condition at the bedside like this, just in case.”
“What ever you say, baby.”
“I do have something I wanted to ask you about.”
“Shoot.”
“Do you know anything about Jack Kalishar?”
“The department store guy?”
“Yes. He was a patient of Dad’s.”
“I didn’t even know that. Dad took the confidentiality of his patients pretty seriously, just like he took everything else in life, except maybe parenting.”
Thea winced, but did not repeat her warning to keep remarks about him away from his bedside. She knew that she was asking about the billionaire as much to communicate with their father as with Selene.
“I’ve become friendly with a patient at the institute named Hayley Long,” she said. “She has metastatic pancreatic CA. Jack Kalishar was treated here for the same thing, and according to Dr. Thibideau, is fine after five years.”
“I want that treatment.”
“Exactly. Selene, I assume you’ve heard that I’ve told Karsten I would take over Dad’s practice for now.”
“She called and told me. You know that the two of them are an item, Dad and her, right?”
Please don’t say anything nasty about her.
“Yes, she let me in on the secret. She’s gotten me temporary privileges, but I don’t have access yet to his patients’ medical records. I have to go through Scott Hartnett for anything like that, at least until my staff privileges are expanded. I want to see Hayley’s records and Kalishar’s, too. Is there any way you can save me the hassle of going through Scott and just send them over to Dad’s office?”
“Wish I could, but it isn’t possible. Each patient has a number that restricts who on the staff has access to their electronic records. If your friend Hayley adds my code number to her records, I suppose I can get her chart over to Dad. I have no idea what his code is. Mine has like eight numbers and two letters in it. If I ever got caught giving it out, I’d be suspended.”
“Does Hayley have access to her own records?”
“Within a few months I think she will. Google and Microsoft are ahead of us in that regard.”
“Well, not to worry. I won’t ever ask you to do anything compromising. First I’m going to check through Dad’s desk and see if I can find his code. Then I’ll let you and Hayley know if I need help with her record.”
“Just be careful.”
“What’s that supposed to mean?”
“With this Thor system, things work both ways. Any request for information gets recorded someplace and transmitted to records security.”
