The Second Opinion, page 2
From her early childhood, Thea had memories of the family talking about Dimitri’s aloofness and strange behaviors—his lack of friends, off beat humor, and often-inappropriate statements. Physical age, twelve years ahead of her. Emotional age, inconsistent and unpredictable.
“Dimitri, this is Robert, your new piano teacher.”
“Oh, hello. When’s the last time you went to the dentist?”
She would never know the bulk of what the family said to one another about her, but she also knew that the choices she had made, with Dr. Carpenter’s help, were the right ones for her, and ultimately, for her patients. Keeping her life as uncomplicated as possible, she had learned, was not only a pathway to happiness, it was her roadmap to survival. If there was any single word that did not apply to Petros Sperelakis, it was uncomplicated.
Born and raised in Athens until his late teens, Petros was strictly Old Country in his attitudes and philosophy—a brilliant physician as dedicated to his calling and his patients as he was hard on his family. Verbal chastisement and high expectations were his weapons, as well as his only means of expressing love. His wife, Eleni, had rebelled against him in one way and one way only, by continuing to smoke cigarettes despite his vehement edicts that she stop. The lung cancer that took her did nothing to soften Petros, and virtually every mention of her by him was followed by the impotent plea: “If she had only listened to me . . . If only she had listened.”
Thea reached between the tubes and brushed some damp, gray hair from her father’s brow. The sadness she was feeling at seeing him in such a state was, she knew, as much learned as it was deep-seated and visceral. But she also knew that it was still as real an emotion as those of her two “neurotypical” siblings.
From the beginning, Petros could never understand her shyness, or the severe reactions she had to certain noises—especially vacuum cleaners and hair dryers—as well as to certain foods, and different textures of clothing. When she was twelve, pressured by Eleni that she was seeming more and more like Dimitri in her lack of friends and her pathological obsessions, especially with books of all kinds, Petros consented to allow his wife to bring her to Dr. Carpenter. It was Carpenter who subsequently suggested that Thea was exhibiting many of the symptoms associated with the condition called Asperger syndrome.
The decision to allow his younger daughter to undergo neuropsychiatric testing and therapy did not come easily to Petros. In the lexicon of his life, there was no such word as can’t and no such concept as psychotherapy. If he had any weakness at all as a diagnostician, it was in the area of psychosomatic illness and the mind- body connection.
“I think he’s comfortable,” Vernice ventured from across the bed.
“I’m sure he is,” Thea replied, managing with some difficulty to swallow her belief that if Petros was feeling anything, then he was certainly not comfortable, and if he was feeling nothing at all, then trying to equate that void with comfort was a stretch.
“Your brother Dimitri said that if your father was in as deep a coma as he appears to be, it was a futile exercise to wonder if he was comfortable or not.”
“Sometimes, Dimitri says things just for the shock effect,” Thea replied, smiling inwardly at the number of times and situations in which her eccentric sibling had done just that. Vernice had gotten off relatively easily.
“Well,” the nurse said, “at least we have the comfort of knowing that Dr. S. is being taken care of in the greatest hospital in the world.”
“Yes,” Thea said, wondering where Vernice, and Newsweek, and the countless others who believed as she did about the Beaumont, could have gotten such quantification about something so unquantifiable.
At virtually the same instant, in the Susan and Clyde Terry Cancer Center, on the far side of the broad campus of the so-called greatest hospital in the world, the treatment nurse was doing her job, injecting a cutting-edge experimental drug into the central IV port of a burly man named Jeffrey Fagone.
Fagone, a trucking magnate from western Pennsylvania, had his rapid accumulation of wealth interrupted by an unusual variant of the blood cancer known as Waldenstrom’s macroglobulinemia. His presenting symptom had been lower-back pain. The referral by his primary care doctor had been to the expert in the disease at the Beaumont, where Fagone went yearly for his five-day spa pampering and executive medical checkup. Now, he was part of a cutting- edge treatment protocol—the sort of protocol that the doctors at the Beaumont were renowned for establishing.
Fagone flew up to the Terry Center weekly on his Gulfstream G500 corporate jet. Now he was about to receive the third in a series of ten treatments. The first two had been absolutely uneventful.
This injection, however, would be different.
The vial from which the medication was drawn had been skillfully switched during its journey from the research pharmacy to the cancer center. The new vial, with the same ID number as the old one, now contained enough concentrated bee venom to turn Fagone’s bee sting allergy, duly noted in his medical record, into an anaphylactic reaction—a fearsome medical emergency, equivalent to the Fourth of July fireworks on the Charles River Esplanade.
The eruption did not take long to begin. The first few molecules of the venom instantly began mobilizing mast cells from all over Fagone’s body. The cells released huge amounts of histamine and other sensitivity chemicals. More venom, more mast cells, more histamine. In less than a minute, Fagone’s tongue, cardinal red, had swollen to the size of a golf ball, and his lips to violet sausages. The muscles in the walls of his bronchial tubes went into vicious spasm. Seconds after that, his larynx, also in spasm, closed off altogether. His entire body became scarlet, and his fingers became nothing more than nubs protruding from softball-sized hands.
The team in the Terry unit acted quickly, bringing out a stretcher and hoisting the two-hundred- and- seventy-pound former teamster onto it, then wheeling him to an area that could be screened off from other patients.
But they were paddling against a medical tsunami.
The IV port was available, but the oncologist covering the unit, a young woman less than half Fagone’s size, was not skilled in dealing with emergencies of this magnitude. By the time she got the right medications into the man, Fagone’s blood pressure had been zero for nearly three minutes. By the time she gave up trying to force an endotracheal breathing tube past the massively swollen, distorted vocal cords, and began clumsily performing her first emergency tracheotomy while waiting for the ENT surgeon to answer his page, there had been no effective respirations for four minutes. She had just sliced a scalpel across her patient’s massive throat when his heart stopped. The blood flowing from the gaping laceration was gentian.
When the oncologist, frustrated and utterly demoralized, called off the resuscitation at the ten-minute mark, a useful airway had still not been established.
Jeffrey Fagone, who years before had survived two assassination attempts during his rise to wealth and power in the Teamsters Union, had no chance of surviving this one.
Unlike the other attempts, however, there was no suspicion of anything sinister at work here. Fagone had been done in by a lethal allergic reaction to Waldenstrom’s macroglobulinemia experimental drug #BW1745. No one present that day thought otherwise. There would be no analysis of the contents of the vial, and the perfunctory autopsy performed the next morning would disclose nothing out of the ordinary.
The treatment protocol for #BW1745 would be suspended indefinitely, but within just a few months, the principal investigator, supported by a hefty grant from one of the pharmaceutical giants, would roll out another experimental drug to meet the demand of referrals from all over the world.
The Susan and Clyde Terry Cancer Center closed for cleanup and staff support for an hour after the tragic event, but there were patients to treat, many of whom had come from even greater distances than Jeffrey Fagone.
Soon, like the surface of a pond disturbed by a jumping fish, the ripples had subsided, and the world’s greatest hospital had gone back to being the world’s greatest hospital.
CHAPTER 2
For another ten minutes, Thea stared down at her father, mentally cataloguing his injuries. It didn’t take a Petros Sperelakis to discern that given the sort of excellent medical care practiced at the Beaumont, none of them was immediately life-threatening, except the hemorrhage in his midbrain. On the plus side of the ledger, she believed that at almost seventy, the man was in remarkable shape thanks to a disciplined diet, exercise, the right gene tics, and the preservative effects of a daily shot glass or two of seven-star Metaxa.
Thea’s eyes were X-ray probes, seeing through Petros’s skull and visualizing the intricate folds and contours of his magnificent brain. According to Niko, the hemorrhage had occurred in the center of the middle portion of the brain stem, a tight bundle of nerves connecting the gray matter and the spinal cord and known technically as the mesencephalon. It had been a while since Thea had read a neuroanatomy textbook, several of them, in fact. But it had not been so long that she had forgotten very much. In fact, forgetting material she had read was something that essentially did not happen.
In just a few seconds, she connected with a vast amount of information concerning midbrain anatomy and function. Her mind’s eye saw the information as integrations of a number of texts, but if she had to, she knew that she would be able to quote the actual passages virtually verbatim, with few or no mistakes, along with the page numbers on which they appeared.
There were curses connected with having the form of autism called Asperger syndrome, but her obsession with the details of what she saw, and her mastery over the printed word, had always been blessings—refuges in the often-confusing world of the neurotypicals. She flashed on Dimitri, never officially diagnosed, but undoubtedly afflicted with abnormal neurology that was similar to hers. The “autism spectrum” was the label du jour for a series of conditions. Somewhere in the middle of the spectrum was the off shoot first described by Austrian pediatrician Hans Asperger in 1944.
Asperger syndrome.
For her immeasurably brilliant brother, the gray matter once destined for learning such things as nonverbal communication, social grace, small talk, interpersonal pragmatics, group dynamics, and executive function had largely been usurped by an understanding at his mind’s deepest levels of electronics and computer science. The groupings of neurons responsible for fine motor control and hand- eye coordination had yielded in large measure to the remarkable ability to focus for long periods of time on those things that interested him.
It didn’t matter that he and Thea were probably different in as many ways as they were similar. If not the same, their diagnoses were certainly kissing cousins, layered on their unique personalities. Thea forced her focus from her brother back to their father. The injury to Petros’s brain stem was indeed a frightening one.
The cerebral lobes and cerebellar hemispheres were the parts of the brain largely responsible for thinking, balance, and movement. Outgoing efferent nerve fibers from them coursed through the midbrain on their way to activate the muscles of the body. At the same time, incoming afferent fibers were skirting the central midbrain, carrying sensory information such as pain, light touch, and position up to the cerebrum and cerebellum for processing.
The hemorrhage in Petros’s midbrain, as described by Niko, had probably effectively sliced across the efferent bundles like a blade, killing neurons and disconnecting the upper nervous system from the lower—thought from movement, intellect from physical ability, reason from function. The result: paralysis involving literally every muscle in the body.
Behind her, she sensed Niko and Selene, and the team from Beaumont standing patiently by the doorway. Dr. Sharon Karsten, a onetime endocrinologist, had been the president of the sprawling medical center for nearly as long as Thea could remember. Under her guidance, the hospital had enhanced its worldwide reputation as one of the places to go for second opinions, knotty diagnostic conundrums, and top- notch surgical specialists.
One of her most successful brainchildren was Medicon, Inc.—highly paid, highly trained physicians, who were scattered around the globe, networking and advising doctors to the wealthy, the influential, and the powerful. One product they were offering, in addition to their knowledge and experience, was the hospital’s renowned five-day Executive Health Evaluation—a hundred thousand dollars’ worth of the most sophisticated medical testing and specialist evaluation available anywhere. EHE was based in the luxurious Beaumont Inn and Spa, located on the grounds of the hospital.
With Karsten was Dr. Scott Hartnett, tall, handsome, and intellectual, the director of development for the Beaumont, and still a part-time practicing internal medicine physician at the Sperelakis Institute. Thea remembered her father once saying that if the government could generate money for the country the way Scott Hart-nett could for the Beaumont, there would be no national debt.
And finally, there was chief of nursing, Amy Musgrave, five feet tall, if that, introduced to Thea as the glue that held the entire Beaumont system together—a system that now included three satellite hospitals in Boston, and expanding facilities in Washington, D.C., and Charlotte. Thea had never met Musgrave, but immediately took to her straightforward manner and powerful dedication to her nurses.
It was Musgrave who first stepped to Petros’s bedside.
“Is there anything further you can think of that we should be doing, Doctor?”
Thea shook her head. “It seems he’s getting remarkable care,” she said.
“Your father was—is—a wonderful man. My nurses love him. He treats them as equals, and most of the time, at least, he seems to understand that the true measure of any medical facility is the minute- to-minute, hour-to- hour, day- to- day nursing care its patients receive. The more nurses, the better the care. It’s as simple an equation as that.”
“I totally agree,” Thea said, wondering if Musgrave expected her to be more effusive.
“In fact, Vernice is one of several nurses who are volunteering time to work with him.”
“Thank you,” Thea said.
Musgrave continued without a pause. “We have the highest nurse- to- patient ratio, and we’re at or near the top of every listing of the best hospitals. I don’t think that’s a coincidence.”
Together, she and Musgrave returned to the others, and were ushered down the hall to a small sitting area, where the three hospital officials asked the three siblings to wait for a short while, and then walked off together. The moment they were gone, the twins each pulled out their cell phones, checked their messages, and made calls—three or four apiece. Thea smiled inwardly at the notion of when she had last made a cell phone call. It might have been two years—the last time she was back in Boston. It might have even been five, dating back to her first posting with Doctors Without Borders.
“Well, what do you think?” Niko asked, after completing the last of his calls.
“About Dad?”
“Yes, of course about Dad.”
Again the slightly annoyed edge that Thea had become used to over the years. Selene closed her phone and set it in her purse. Dressed in a striking beige designer pants suit, without a wisp of her sorrel hair out of place, her nails perfectly manicured, she might well have been taken for a bank president or movie studio head, or even a model, before anyone came close to guessing orthopedic surgeon. However, no one would ever even mention Selene’s ostentatious style once they watched her reattach a severed finger or two, or create a functional replacement thumb—her true specialties.
Brother and sisters were in a small sitting area at the end of the sixth-floor corridor. Beside them, seven-foot windows overlooked a man-made pond with several fountains spraying gracefully. A flock of Canada geese pecked its way around the perfect emerald lawn.
“It doesn’t look good,” Thea said. “From the description of the MRI you gave me, according to Therrian et al. in the textbook Traumatic Brainstem Injuries, he has a sixteen percent chance of making it four months.”
“Not seventeen percent?”
“You know, it’s okay not to make fun of me, Niko.”
From her earliest memory, Thea couldn’t stand being teased.
“Hey, I’m sorry. I really am.”
“Okay, because I’ve never been very good at distinguishing good-natured from mean-spirited teasing. I just could never u nderstand why someone would tease me to make me feel that I was one of the gang. And as far as me teasing someone else, when I try, it usually leads to unbelievably disastrous consequences.”
“I don’t know if I’ll ever get used to your . . . your, what would you call it, gift? Condition?”
“You don’t have to call it anything, Niko. It’s simply who I am, just like you have great coordination and a rock-steady hand, I couldn’t hit a pitch if the thrower was using a beach ball, and I have to print so that people can read what I’ve written.”
“Sorry,” Niko muttered again.
“He doesn’t mean anything hurtful, honey,” Selene added. “You know that.”
“They had Dad here in less than an hour after the accident,” Thea said. “Do you think they could have operated?”
“I spoke to Joe Rizzo, the neurosurgeon, and he said not a chance given where this hemorrhage is located.”
Thea shrugged and stared out the window, absently wondering if Dimitri had been told that she was flying in and had simply decided there would be too much commotion and he would see her back at the house.
“At least it was quick,” Selene said.
“It’s not over,” Thea countered, “at least not yet. This is mostly a ventral pontine hemorrhage. With the technology and rehab hospitals we have today, one reference I can recall reported five-year survival rates as high as fifteen percent.”
