The Second Opinion, page 18
Thea immediately envisioned herself riding up Loon Mountain on her first—and last—chairlift ride.
“I can handle it,” she said. “But what about the window?”
“That’s my job,” Flowers replied, patting his backpack.
The other thousand or so questions Thea had went unanswered. They turned onto the walkway that went between the Cannon Building and another modern building that seemed to have popped up in just the two years since Thea had last been at the clinic. There was a sawhorse at the entrance to the passageway, on which was nailed a sign that read closed.
A finger to his lips, Flowers led her around the sawhorse, checking behind and ahead of them continuously. There were no trees or electrical wires along the concrete walk, but there was a truck—an aerial boom truck—parked to the Cannon Building side, but taking up three- quarters of the passage. Thea scanned five stories up from the ground and sensed a churning in her gut. She leaned close to Flowers’s ear.
“Where did you get the truck?”
“I moved it from the other side of campus where they were doing some tree work,” he whispered back, seeming too proud of his ingenuity to keep silent. “In this world, all you ever have to do is look like you know what you’re doing, and nobody ever stops to question you unless they happen to be the person who’s supposed to be doing it. If that happens, it’s just plain lousy luck. I waited until the crew had left for the day, hot-wired the truck, put the ‘closed’ signs on the back, and drove it around to here simple as you please.”
Thea flashed on Dan possibly saving her father’s life by taking the time to check the average-looking orderly’s ID—an act he could just as easily have let pass. He must have been a terrific policeman.
“Have you ever worked one of these?” she asked.
“It’s just a few buttons and levers. I can do buttons and levers.”
Thea glanced at the small bucket, then upward again, and felt an involuntary chill.
“No, seriously,” she said.
“Okay, I tried it out.”
“And?”
“No sweat. Except that we have to keep the truck running in order to make the boom work. It’s a little on the noisy side, but at this hour I don’t think anyone’s in any of these labs. And even if they are, I doubt they’d think the truck was anything other than what it seems.”
“You enjoy doing this sort of thing?”
“When it all works, I do. In fact, sometimes I enjoy it even when it doesn’t work. I guess I’m just not cut out for Do you want fries with that, ma’am? Well, ready to go?”
He motioned to the bucket, then slipped into the cab of the flatbed truck and turned on the engine. Her heart pounding, Thea scrambled up next to the folded boom on the flatbed, then climbed into the bucket. Moments later, Flowers was standing beside her.
“Is there a weight limit?” she asked, battling back another wave of queasiness.
“I’m sure we’re not close to it. But there is one thing. With the boom fully extended, the bucket doesn’t quite reach the fifth floor.”
The wave grew large enough to surf on.
“That sounds like it could be a bit of a problem,” she said.
“I laugh at such problems. Seriously, don’t be worried. Once I’ve taken care of the window, you’ll have to stand up here on the edge of the bucket to get through. It should be easy.”
“You want fries with that?” Thea asked.
The rumbling engine noise reverberated between the walls of the two buildings as Flowers pushed a lever forward and the bucket glided up one floor, then another, with just enough bounce and sway to mentally propel Thea back to the chairlift on Loon Mountain.
“Just don’t look down,” Flowers said.
“I’ll try not to.”
Thea wasn’t sure until she heard her voice that she would be able to speak.
“There’s some sort of file cabinet inside, yes?”
“Yes,” she managed. “I know right where it is.”
“I’ll come in after you, then I’ll open the cabinet in a way that won’t leave any scratches and return to the truck so I can turn the engine off. You take care of business as quickly as you can, then call me on the radio and I’ll bring the bucket up.”
“Got it.”
They jounced up another floor. Inside the third-story window, Thea could make out the glassware and other equipment of a lab. Over her years with Doctors Without Borders she had been in many odd and often dangerous situations. But this . . . She risked a look at the specter who had taken control of her life. Even through the black greasepaint she could sense his exhilaration. A pull on the lever, and they advanced past the fourth- story windows up toward the fifth. Then, with a final bounce, they stopped. One of the huge plate-glass windows of Thibideau’s laboratory was still a foot or so above the top of the bucket.
Don’t look down.
There was no obvious way through the windows until Flowers opened his backpack and extracted a pair of heavy- duty disc-like clamps. With simian movement, he hopped up onto the top edge of the bucket, set the clamps on the window pane and, using some sort of implement taken from his pocket, quickly drew a rainbow arc, two feet high, beginning and ending at the sill. The next cut was across the sill itself. The whole maneuver, end- to- end, took less than a minute. Then, with a few well- placed taps from a cloth-covered mallet, the thick semicircle of glass came free.
Amazing, Thea thought, as Flowers lowered the glass to the floor inside and slithered face-first through the opening. According to Hayley, this sort of thing went on all over, every day, with an equally inventive industry devoted to preventing it. People got caught, people got arrested, people got away with what ever they were after, people kept trying. Absolutely amazing.
“Psst! Quick, through here. Don’t look down.”
The bucket was swaying with each movement. Once again, Thea began to feel ill.
Don’t look down. . . . Don’t look down. . . .
Chewing on her lower lip, she pulled herself up onto the edge of the bucket, bracing herself against what remained of the window. She passed her knapsack inside, put her hands on the sill, and dove, more than slithered, through the new opening. Her landing, assisted by Flowers, would have won few points from the judges, although the medical team standing by would have been pleased that he had moved the glass plate aside, and that none of her bones were broken.
Seconds later, they were standing in front of the locked door to Lydia Thibideau’s office, and seconds after that, thanks to some sort of strange- looking tool Flowers carried on his belt, they were inside. The lock on the file cabinet was no more of a challenge.
“That what you’re after?” Flowers asked, gesturing to a drawer completely full of perhaps a hundred yellow files. The drawer just below held an equal number.
Even before she slid one out, Thea knew that, as Hayley had promised, she was dealing with the dinosaurs of American medical care—paper printouts and actual X-ray photographs.
Nonelectronic medical records.
CHAPTER 30
Thea crouched beneath the conference table on the plush Oriental rug in Lydia Thibideau’s office, listening to the pounding of her own heart. Beside her were the two flashlights, the camera, the notebook, the two-way radio, and twenty-fi ve or so patient records including Hayley’s and Jack Kalishar’s.
There were, by Thea’s estimate, five hundred files altogether in the four drawers of Thibideau’s cabinet, all of them, it seemed, patients with cancer of the pancreas, none of them, from what she could tell, any less recent than six years ago. They were arranged in alphabetical order, not by date. The patients’ records dating back from six years were probably in cartons in some storage area. Given the mortality of pancreatic malignancy, few of them, if any, were likely to be alive today.
Earlier in the day, spurred by Julian Fang’s remarkable pronouncement, Thea had researched the prevalence and lethalness of various types of cancers. The results relative to cancer of the pancreas were not encouraging. In the past year, 215,000 new cases of lung cancer had been reported in this country, and 160,000 patients were estimated to have died from the condition over the same period—74 percent. Bad disease. On the more sanguine side, the number of deaths from thyroid cancer (1,590) was 4 percent of the number of new cases diagnosed (37,300), down from 6 percent the year before. Conclusion: The number of thyroid cancer survivors was growing steadily.
The number of new cases each year of pancreatic cancer was almost identical to thyroid (37,700), but there had been 34,200 reported deaths (90 percent) over the same period, and 90 percent the year before. More data were needed to form any definitive conclusions, but the results implied that there had been little progress in the treatment of the disease.
Jack Kalishar had cancer of the pancreas. Of that there could be no doubt. From what Thea had learned of Hayley’s disease, Kalishar’s was quite a bit less far advanced at the time of diagnosis six years ago, but cancer of the pancreas was still cancer of the pancreas, and 90 percent was still 90 percent. Kalishar had been a healthy, robust man with a negative medical history, followed yearly in the Executive Health Evaluation program of the Beaumont. His MRI was difficult to read without using the four fluorescent view boxes fixed to a wall in Thibideau’s office, so Thea decided to chance standing up and turning the box on for just a few seconds at a time.
Her father had made the diagnosis on Kalishar based on the MRI taken during a routine executive physical. The subsequent needle biopsy was reported as showing adenocarcinoma—the most common form of the cancer. It was Petros who had made the referral to Thibideau. It was she who had entered Kalishar in the treatment protocol evaluating the then new drug SU890. There were a few documents related to the study—mostly permissions signed by Kalishar validating that he was aware of the experimental nature of his treatment and knew the risks, but most of the paperwork was either in storage someplace or simply on the Internet.
There were no slides showing the pathology, and no further notes of interest, except one. It was a three- year- old thank-you to Kalishar from Director of Development Scott Hartnett—a straightforward and businesslike acknowledgement of a donation to the Beaumont Clinic in general and to the establishment of the Lydia Thibideau Gastroenterology Research Center in particular. The amount of the donation was not mentioned, but written on the side of the note in a feminine hand—perhaps Thibideau’s, Thea thought—was the figure $200,000,000. Two hundred million dollars!
Thea checked the time and knew that she had to move faster, and in a more organized fashion. Sean Flowers had put a limit on her investigation of one hour. Longer, and they would be risking discovery even more than they already were. She decided to check records, starting with Hayley’s, for half an hour, and then to begin taking photographs of anything that looked interesting. She realized now that she should have been better prepared, but it was too late for that.
Hayley Long’s chart told of an MRI done in Atlanta for vague abdominal pain and showing pancreatic cancer just ten months after a similar MRI, done at the Beaumont, was normal. Crawling out from under the table, Thea snapped the two films side by side onto the view box. The initial film done as part of the Executive Health Evaluation program was normal—absolutely negative except for faint white calcium deposits in three abdominal lymph nodes, probably the result of some long- ago infection. The finding was so minuscule and unimportant that the radiologist who had read the film either had missed it altogether or hadn’t bothered to mention it in his report. But Thea’s life was all about details.
She was studying the extensive cancer in Hayley’s more recent film, and wondering how Julian Fang could possibly say that such a cancer had been cured after less than two weeks of treatment, when her eyes were drawn back to the original film. The calcified nodes in that one were not present in the more recent MRI. Thea stepped back, then moved in close. There were a few even more minuscule differences in the two films—the shape of a vertebral wing here, the density of a rib cartilage there. Both subjects were women of about the same age, but they were not the same woman. Thea felt virtually certain of it.
Stunned, she sank down onto the rug, staring up at the films as if they were saucers from Mars, trying to make sense of what she was seeing, to sort out what she should do next. Five minutes passed. When she finally stood up, the approach she had been missing was clear to her.
She took the notebook and drew the rough outline of a pancreas on a dozen consecutive pages. Then she replaced all the records except Hayley’s and Kalishar’s, randomly chose patients from each of the four drawers in the filing cabinet, and went directly to the MRIs of each, quickly mapping their cancers. Half an hour later she had recorded twenty- five patients and had found nothing. With the twenty-sixth, she struck gold.
The patient’s name was Samuel Blackman, a fifty-four-year- old computer wizard who had parlayed a software invention into a fortune. The pattern of the cancer in his MRI was an identical match for the cancer in another of Lydia Thibideau’s patients, this one named Warren Grigsby. The two men, wildly successful, had both been patients of the Beaumont executive health program. Both were diagnosed with pancreatic cancer, only four years apart. The difference was that Grigsby never left the hospital alive. On his tenth day of treatment with the same drug as Hayley was receiving, SU990, he suffered a cardiac arrest and essentially died before the Code Blue team could be mobilized.
Blackman was a completely different story. Like Jack Kalishar, he had survived his devastating diagnosis, and like Kalishar he had the copy of a letter of gratitude from Scott Hartnett in his record. Again, there was no mention in Hartnett’s letter of the amount donated other than to call it “gracious,” but this time there was no note of the amount from Thibideau either.
What did it all mean? What had happened to Grigsby? At that moment, the questions defied answers. But Thea strongly suspected that if she had enough time and mapped enough charts, somewhere in there was at least one, and maybe even more than one cancer identically matching the cancer in Hayley’s MRI.
The betting now was that Julian Fang’s diagnosis was true. Hayley Long was cancer-free. But the reason for her fantastic cure was probably not her treatment or her genes or her powerful constitution or her Qi. The reason, in all likelihood, was that she had never had cancer in the first place.
But how could that be?
At that instant, Thea was startled by the two-way radio.
“Thea, get out, get out!” Flowers cried. “They’re here. They may not know where you are yet. Use the stairs! Use the stairs! Over!”
Thea raced through the lab to the window and, staying low, peered down. Three uniformed security people were closing in on the truck. Flowers had already climbed down from the cab. She watched as he hesitated, taking in the situation. Then he bolted down the walkway in the opposite direction from the guards. The three of them yelled something at him and took off in pursuit, but Flowers had a significant head start, and from what Thea knew, none of the hospital security force carried guns.
CHAPTER 31
Thea often described herself as a plodder, not a thoroughbred. Faced with a medical crisis, her reaction time and decision making were usually reasonable enough, but seldom extraordinary and never flashy. She almost always was able to move along at the pace demanded by the situation, but she was at her best when there was time to think such situations through. On the other hand, she was seldom prone to the mistakes of haste.
Now, with the urgent radio call from Sean Flowers, she was experiencing an emotion that was quite foreign to her. Panic. First, she was on her knees, stuffing all of her supplies into the knapsack. Then she was sweeping all the charts together like oversized playing cards, slipping X-rays back into their folders as fast as she could, and then trying, with little success, to replace the charts in the filing cabinet in alphabetical order. Twice she dropped records, mixing up the contents. Finally, she simply jammed the remaining charts into the drawer, paying no attention to where they had come from. Moments later, she inadvertently knocked a clamshell full of paper clips and coins off the corner of Thibideau’s desk. In scrambling to pick them up, she slammed her head so hard that she had to stop and check for blood.
The stairs! Get to the stairs!
Thea surveyed Thibideau’s office and could see nothing out of place. Of course, Flowers had cut away half of one of the windows in the laboratory—a reasonably strong clue that someone had been inside. Her mouth was desert dry. Her heart and her thoughts refused to slow.
What would happen if they caught her? . . . Surely she would be kicked off the staff even before she had begun. . . . When word got out, would she have put herself in even more danger from whoever had attacked her? . . . What about Petros? . . . If she got caught, would he become a more urgent target? . . .
Hayley!
Thea was on her way out of Thibideau’s inner office when she remembered that she had decided to take Hayley’s MRIs with her. In her rush to straighten out the charts, she had put the films back. Did she have time to look? . . . Had they caught Flowers? . . . What was the penalty for breaking and entering? . . . She could never be locked up. Never! . . . She would leave the country first—forever. . . . Would they even let her back in Doctors Without Borders if she was running from this kind of trouble? . . . She had been living such a mellow, uncomplicated existence. . . . How did this happen?
Thea braced against the file cabinet and willed herself to settle down.
Where did I put Hayley’s record? Breathe in . . . breathe out. . . . Easy does it. . . . Easy . . . Come on! You know how to do this. . . . Get a hold of yourself. . . .
After a minute or two she was able to focus enough to make a decent guess. The record was one of those she had put back in some degree of alphabetical order in the second drawer down.
Yes!
She snatched the two films from Hayley’s file. Each one was about nine inches by twelve. Carrying them loosely rolled in one hand, she rushed down the glassed-in corridor separating the clinical area from the laboratory. She had entered the tastefully appointed waiting room, where not that long ago she had enjoyed such vivid fantasies of Dan, when she heard men’s voices from just outside the door.
