Obsessed (8 page)

“T
HE TREMORS
are somewhat better but he's still having hallucinations,” Gloria said. Uncle Jack had been with us on the unit for a couple of days. We were discussing his case at morning meeting. “He keeps picking things out of the air and talking to someone named Felicia.”

“That was his dead wife,” I said.

Kwan had Uncle Jack's file open. “Rapid onset, Parkinsonian symptoms, visual hallucinations…Hmm, what do we have here?” he said, looking at Emily.

“Dementia. Maybe Alzheimer's. Possibly Lewy body.”

“When do we ever get a definitive diagnosis?” Kwan asked.

“There's a new test,” Emily said. “They're doing research on it at University Medical Imaging where I'm a research fellow. Dr. Shands's whole focus is on Lewy body dementia.”

“James Shands?” Kwan said.

“You know him?” I asked.

Kwan pursed his lips. “By reputation.”

I'd known Kwan long enough to read his expression. He had reservations about the great Dr. Shands.

“If the test isn't going to change the treatment, why do it?” Kwan continued. “We've already got Mr. O'Neill on medication to mitigate the symptoms.”

“There's a research study that he might qualify for,” Emily said.

“Experimental protocol?” Kwan asked.

“Early results are promising. We're looking at whether increasing the permeability of cell membranes in the brain may counteract some of the effects of Lewy body dementia. We're using a cholesterol-lowering drug.”

“Not a whole lot on the risk side,” I said. “They do the tests on a new imaging system. Four point five tesla.”

Kwan's eyebrows went up a few microns. Now he seemed impressed. “Maybe it would be a good idea. If it works out, a closer connection with them wouldn't hurt. They provide the funding, we provide the patients. It's a win-win.”

I caught up with Kwan after the meeting. “So you know Dr. Shands?”

“Sure. He's the go-to guy on functional magnetic resonance imaging.”

“And…?”

Kwan sat there like the Buddha who knows all and tells squat.

“Listen, if there's anything off about him I don't want to be bringing our patients over there. We don't need a connection like that. There's plenty of other experts—”

“As an expert he's in a class by himself. You won't find anyone who knows more. Groundbreaking papers. Of course, he's a narcissist.”

So what else was new? Every researcher who did groundbreaking work had to have a healthy dose of narcissism or he'd never survive the skeptics and naysayers.

“And?”

“I've heard he's a rogue. A womanizer.”

Alpha male. Alpha geek. I remembered the argument I'd overheard between Shands and Dr. Estelle Pullaski. That level of anger rarely arose out of professional differences.

“Likes 'em young,” Kwan added.

“He's into his research assistants?”

“There may have been a few ugly situations in the past that got hushed up.”

My antennae went up. I was loath to swallow a rumor without questioning it first. Not too long ago, one manager's primary weapons for encouraging attrition at the Pearce were rumor and innuendo. I'd had a good friend, a psychiatrist, whose reputation got shredded by an ugly rumor campaign. When she was killed before she could defend herself, I did it for her.

I must have looked skeptical because Kwan put up his hands. “That's his reputation. I'm just telling you what I hear.” He cleared his throat and glanced about. No one was within hearing distance. “I have no idea if he and Dr. Ryan are, you know….”

I thought about Shands, that supernova presence of his that lit up a room. Had Emily been as seduced by the man's charisma as she'd been mesmerized by his intellectual brilliance? And what about Shands? What would he assume about Emily coming in one day wearing a suit jacket with nothing underneath? What about the way she touched him when she talked to him? Shands would probably assume
she
was coming on to
him
. It was his due, after all. He'd given her credit on a paper, something Philbrick confessed had taken him three years to achieve. Was that a bribe for future favors, or a reward for services rendered? It was entirely too easy for someone like Shands to take advantage of his position. Junior staff were ambitious, eager to please, and the power equation was stacked against them.

At first I thought Uncle Jack was playing with a piece of string, holding it in both hands, pulling it one way, then the other. Then I realized there was no string.

We'd put him in a sunny corner room and he'd made himself right at home. Magazine and newspaper clippings already littered the chair, the bed, and the bedside table. On the windowsill he'd started a collection of sugar packets. And that wasn't all. There was a silvery key ring with car keys on it, four Pearce Psychiatric Institute pens, and a pair of ladies' sunglasses. Apparently he was a magpie who helped himself to shiny things. I slipped the keys into my pocket, intending to bring them to our Lost and Found, and I made a mental note that we'd need to keep an eye on Uncle Jack.

“Good morning, Mr. O'Neill,” I said. My voice distracted him only for a moment. Now he held up the phantom string and examined it. At least the medication Kwan had put him on had calmed the tremors.

“What do you have there?” I asked. “Can I see?”

“At a theater near you,” he said, offering me his hands. “Felicia gorth fribbins.”

Suddenly his eyes opened wide and he reared back as if someone had struck him in the face. He let out a holler and his shoulders twitched. Then he stood there wide-eyed and gasping, the breath knocked out of him. There were benign hallucinations with which you could play cat's cradle, and then there was this other kind that knocked the stuffing out of you.

I called Annie and told her about the troubling hallucinations. “Still, overall, he's adjusting well. Even seems to like the food. As soon as we get a more definitive diagnosis, we'll have a better idea about the best treatment. We're trying to get him scheduled for a functional MRI.”

“You're going to slide him into one of those contraptions? Won't that upset him?”

“It might. But hopefully it will give us a diagnosis. We can always sedate him—”

“Sedate him?” Annie sounded horrified.

“Something short-acting. There wouldn't be any lasting effects.”

There was silence on the other end. Then, “Can I be there, at least.”

“I'll ask.” Already I was marshaling my arguments for getting around their “no visitors” policy. “How's it going with the apartment?”

“We're making progress. Slowly. We're talking years of accumulation. How did this get so bad without us knowing?”

“You told me your uncle was a little obsessive to begin with. He was always collecting things, right?”

“Sure, but not like this.”

“When you begin to dement, often you try to hang on by focusing all your remaining energy on a single thing that you can still control. Psychologists have a fancy word for it: hypercathexis. Collecting turns into hoarding, and pretty soon you're reluctant to throw out anything because hey, you never know when you're going to need it. It's all about trying to keep your internal world from spiraling out of control.”

Annie gave a weak laugh. “Is he ever going to be upset when he gets home and finds the place cleaned out.”

She wasn't ready to hear it, but it wasn't likely that Uncle Jack would be returning home.

There was hardly an empty seat in the waiting room. There'd been a cancellation and Emily had been able to slip Uncle Jack in for a nine o'clock appointment. I'd ridden over in the ambulance with Uncle Jack. Annie had convinced her mother not to postpone her trip to Ireland, and had delivered her to Logan before dawn. Emily had helped me convince Dr. Shands to let me and Annie observe.

Uncle Jack wore new sneakers and creased khaki pants that looked freshly laundered. His face was clean shaven, the skin nearly translucent. Comb marks lined his hair. Now he was poring over an article titled “Golf Mania.” He tore a page from the magazine, then another. Carefully he folded the two and stuffed them into his pants pocket. Now he tore out a discount coupon for eighteen holes at a country club in Myrtle Beach and added that to his stash.

By the time the receptionist came for him, Uncle Jack's pocket was bulging. She told us they'd be doing a brief physical exam. When Uncle Jack had been prepped, someone would come get us.

Annie stood as Uncle Jack shuffled off. “He's okay in there alone?”

“They deal with dementia patients all the time. It's like a hospital,” I said.

Annie looked at the door through which Uncle Jack had disappeared, as if some force were tugging her. With a sigh, she went over to a table of magazines and picked up
Time
. She sat and riffled through the pages, then set it open on her lap and gazed off into space.

She leaned over and whispered into my ear, “Did you know that an MRI magnet is four times as powerful as the ones they use to lift cars in junkyards? In Rochester a while back, an MRI magnet yanked a .45-caliber gun out of a police officer's hand. The gun discharged a round that ended up in the wall.”

“You don't say? I had no idea,” I said, suppressing a smile. It was a relief to find some of the old Annie in there. “I gather you decided not to pack a pistol?”

“Thought I'd err on the side of caution.”

“Wise move.”

When Leonard Philbrick came out to get us, he had on what looked like the same rumpled lab coat. Today the inner office hummed with activity. A man and two women in white coats with plastic name tags clipped to the pockets were working at the counter in the central area. A man with a stethoscope around his neck strode through, carrying a large file folder. A nurse darted down one of the corridors. Phones were ringing, and in a corner the wall lit up as the receptionist used a copier.

Annie left her leather backpack and the folding knife she kept in her pocket at the desk. I emptied my pockets.

Philbrick took us to the control room. Annie looked through the window into the scan room next door where Emily was showing Uncle Jack the machine. He was dressed in a white-and-blue hospital gown and looked even more frail and uncertain.

“Mr. O'Neill,” Emily said, bringing her face near his. Her voice sounded slightly distorted and tinny as it broadcast through the speaker. “We're going to ask you to get up onto this table”—she put Uncle Jack's hand on the cushioned platform—“and then we'll raise the table and slide you in there.” Uncle Jack gazed at the hole in the massive white metal cube.

She continued with a simple explanation of the procedure. “There will be a lot of noise, but that's perfectly normal.” She showed Uncle Jack a pair of shiny black earphones. She put them on Uncle Jack's head and adjusted them. Now Uncle Jack looked like an insect with enormous compound eyes on either side of his head.