Authors: G. H. Ephron
She helped him get up on the table and lie back, his head pointing into the tube. He lay there, blinking up at the fluorescent light boxes, his head cradled in a foam pillow. The only hint of agitation was the way his hands wavered restlessly at his sides.
Emily overlapped the ends of Velcro straps across his forehead and pressed them in place. Then she took what looked like a plastic birdcage and set it over his head. She picked up a microphone from a side table and spoke into it.
“Can you hear me?” she asked. Uncle Jack jumped at the sound of her voice. “Good. I'll be asking you to do some things. Let's try a few.”
She asked Uncle Jack to open and close his eyes. Asked him to say his name. Tap his fingers. It was a simplified version of the protocol she'd run through with Mr. Black, minus the balls to squeeze and without the pictures. Uncle Jack managed to do most of what she asked.
“Now I'm going to slide you into the scanner,” she said. “Then I'll go into the room next door. Ready?”
She pressed a button and the table began to slide until Uncle Jack's head was in the center of the tube. His feet in paper slippers stuck out the end toward us.
“God, already I hate this,” Annie whispered to me.
Emily returned to the control room. Philbrick sat at the computer monitor alongside the window overlooking the scan room. He typed something and a dark window came up.
Emily picked up a microphone from alongside the control panel and began speaking into it. “Just relax, Mr. O'Neill. I'm right here. We're about to begin. When we turn on the machine it's going to be noisy. Don't worry, that's perfectly normal.”
Buzzing noises started and a gray, three-dimensional image took shape in a corner of the computer monitor. Philbrick clicked to enlarge it.
“That's your Uncle Jack's brain,” I told Annie.
Annie's mouth fell open. “Wow.”
I felt an unexpected surge of relief. I hadn't realized how much it mattered to me that Annie found this awe-inspiring.
Philbrick leaned forward and rubbed his cheek while he stared at the image. I noticed a bruise there, and the remains of blood at the corner of his eye. Looked as if he'd been in a fistfight. He hardly seemed like that kind of guy, but then neither did I. It had been a week since my run-in with Kyle, Emily's ex. All that remained was a yellowish smudge and a slight tenderness.
Annie put her elbows on the desk and watched intently. Now the machine began thumping.
“What's that?” Annie asked. Then the image went fuzzy for a moment. “What happened?” she asked, her voice taut with panic. She stood and pressed her face to the window into the next room.
“He just moved is all,” Philbrick said. “Here it comes.” The brain reappeared.
“You sure he's okay?” Annie asked.
“It's absolutely painless,” Philbrick said.
The brain shimmied again.
“Mr. O'Neill, please, try to hold your head still,” Emily said.
This was nothing like the baseline data I'd observed when Mr. Black had had his MRI. I could feel my heart starting to race as I watched the activity increase. There were little explosions of green and yellow, then flashes of orange and red behind the forehead in the frontal system, more at the center of the brain in the limbic system.
“He's having a panic attack,” I said, rising to my feet and overturning my chair.
“Please, try to hold still,” Emily said into the microphone. Now the image went out of focus again. “Mr. O'Neill!” Emily tried.
Uncle Jack's feet were flailing. One of the slippers had come off and was floating to the ground. I felt as if I were watching someone being tortured.
“Get him out of there,” Annie said, her voice strident. She reached for a panel of red buttons marked
EMERGENCY
. “How the hell do you shut this thing off?”
“Don't touch those!” Philbrick bellowed. Annie backed off. “Christ almighty, before you wreck the system, let me take care of this.”
Above the din of the machinery I could hear Uncle Jack's weak voice. “Help! Help!”
Philbrick pressed a button marked
STOP SCAN
and the machine fell silent. The thumping that we now heard was Uncle Jack inside the tube.
Annie and I started to follow Philbrick and Emily into the scan room but he stopped us. “Please, let us take care of this. It won't help to have the four us crowding around him.”
Annie and I watched through the window. It seemed to take forever for the table to slide out. “I'm not dead,” Uncle Jack said. He was whimpering.
Philbrick adjusted a lever and the table rolled away from the machine. He released the Velcro holding Uncle Jack's head in place.
“Coffin stop. Let me go!” Then a string of unintelligible syllables as Uncle Jack strained against the straps that were still holding him. He'd soiled himself and urine dripped off the table and onto the floor.
Philbrick stooped so his face was level with Uncle Jack's. He placed his hand on the old man's heaving chest. “Mr. O'Neill, it's all right,” his voice came through the speaker. “Take it easy. Try to relax.”
Annie was breathing in time with Uncle Jack's labored breathing, and she had her hand clamped on my arm.
Philbrick loosened the straps as he continued talking in a soothing voice. “It's going to be okay. I'm right here with you.”
I was dumbfounded. Philbrick was acting nothing like the slightly prissy fellow who'd spoken in jargon and avoided eye contact. I'd never have guessed it, but clearly his bedside manner was as useful to Shands as his technical expertise.
Now Uncle Jack's breath was coming in wheezes. Emily went around to the other side of the table and held one of his hands, which had been fluttering like a moth caught between window-panes.
“Don't bury me yet,” he said, his voice weak and quavery.
Not a shred of word salad. A strong emotional shock can do that sometimes, clear the synapses like a good sneeze.
“Call Dr. Shands.” Philbrick flung the order at Emily. Then he turned his attention back to Uncle Jack. He helped him to a seated position. Uncle Jack looked down into his lap and moaned.
It was Dr. Pullaski who steamed in moments later. Uncle Jack drew back as she scrutinized his face. Gently she picked up his wrist and took his pulse.
“We should have sedated him beforehand, but we had no idea he was so volatile,” she said.
“Mr. O'Neill hasn't been volatile,” Emily said. “Not until just now.”
Dr. Pullaski barely acknowledged that Emily had spoken. She'd taken out a hypodermic syringe. Efficiently she pushed up the arm of Uncle Jack's gown, swabbed the flesh, and jabbed. Slowly she depressed the plunger. In moments, Uncle Jack's shoulders and face had relaxed as any residual agitation smoothed over.
Dr. Pullaski put a stethoscope to Uncle Jack's chest and listened. She sent Emily off for oxygen.
Philbrick crossed to the sink and ran water into a basin. He snapped on some latex gloves. Gently, he washed Uncle Jack's legs and in between with a sponge, then took a towel and dried. He helped Uncle Jack into a fresh hospital gown. While he was wiping the table Emily returned pushing a handcart holding a cylinder of oxygen.
“This will help you breathe,” Philbrick said, showing Uncle Jack the face mask. Uncle Jack recoiled. Philbrick held the mask an inch from his own mouth and breathed, showing Uncle Jack how it worked. Then gently, he held the mask over Uncle Jack's mouth.
“Just breathe and try to relax,” he said. “That's right, deep breaths.” Philbrick strapped the mask around Uncle Jack's head.
Dr. Pullaski and Philbrick talked quietly. They both looked toward the window at Annie and me. Then they left Emily with Uncle Jack and came through into the control room.
“Dr. Zak, isn't this your patient?” Dr. Pullaski asked. “You should have warned us. I'm sure I don't have to tell you how much better it is when we can anticipate these things.”
It had been a judgment call. Kwan and I had discussed it, and we both felt sedation unnecessary. Plus, a sedative might have made Uncle Jack less responsive to the test protocol. Though I didn't like to admit it, Annie's aversion to Uncle Jack being sedated had weighed in. With twenty-twenty hindsight, it was clear that I'd made an error.
“We're ready to try again,” Philbrick said.
“You're kidding,” Annie said, looking incredulous.
“With the sedation your uncle will be fine,” Dr. Pullaski said.
“Are you nuts?” Annie said.
Uncle Jack's head jerked around. Philbrick put his hand over the microphone.
I knew it was standard operating procedure
not
to let family observe these kinds of procedures for this very reason. It hadn't gone smoothly, and now Annie's concern for her uncle was swamping her judgment about what was best for him.
Philbrick gave me a look that said,
This was your idea. Now fix it
. “Annie, think about why you're here,” I said. “This machine is the only one that can do this kind of testing. We may get a diagnosis. Maybe even a treatment.”
“And what if he has a heart attack or a stroke in there?”
“We'll be monitoring him. If he becomes upset again, we'll stop,” Philbrick said.
“It'll be over before you know it,” I added.
“Butâ” Annie started, tears building behind her wall of anger.
“Miss Squires,” Dr. Pullaski said gently, “Dr. Shands and I have been doing this work for more than a decade. We test patients like your uncle every day of the week. This is very routine. Your uncle is going to be fine. Just let us do our jobs.”
We had her surroundedâthree against one. It wasn't fair, but it was the right thing to do. Finally she agreed.
Philbrick went back into the scan room and listened to Uncle Jack's chest. He removed the oxygen mask and Emily wheeled away the tank. Uncle Jack's color was approaching normal and his back had straightened. Now he was smiling and scooping nonexistent dust balls off the floor.
This time Philbrick took charge. We watched as he helped Uncle Jack up onto the table. The computer monitor was flickering salt and pepper where Uncle Jack's brain had been. I glanced at the red panel where Annie had almost pushed a button. Could she really have wrecked the system by pressing one? Another good reason not to have visitors.
Philbrick placed the plastic cage in place over Uncle Jack's head, then slid the table into the tube.
“Peter, you're sure this is going to help my uncle?” Annie said under her breath. “Tell me this isn't a stupid useless procedure.”
“It's not.” I squeezed her hand and hoped to hell I was right.
Through the rest of the testing Annie sat with her hands gripping the chair arms, her jaw locked. She hadn't relaxed, even after Uncle Jack was back in his street clothes and on his way to the Pearce and we were waiting in the control room for Shands to see us.
We could see Philbrick wiping down the MRI system and the table again as Emily backed into the room. She was carrying a mop and pail of water. She turned around, her eyes wide and her mouth open in protest. The front of her lab coat was pulling away from her as if some creature in the pocket were fighting to escape. She dropped the bucket and water spilled all over the floor as she strained to pull back.
“Watch out!” Emily cried as the pocket ripped and something blasted across the room and crashed into the MRI scanner less than a foot from Philbrick.
He recoiled, arms over his head. Then he turned slowly and stared at itâthe big magnet that Emily had used to check me out was now stuck to the side of the scanner. Emily must have used it to test the metal pail and then, without thinking, stashed it in the pocket of her lab coat. Philbrick seemed to grow larger, his anger filling the room as he glowered at Emily.
“What in the hell is wrong with you? The scanner is a magnet. A great
big
magnet. Right? We don't bring magnetic objects into this because, repeatâ¦afterâ¦me,” he thundered at Emily, “the magnetic field is never off!”
“I'm sorry,” Emily squeaked.
“Say it!”
“The magnetic field is never off.”
I squirmed as I felt Annie looking at me. I knew what she was thinking.
And you trust these people
?
W
E SAT
around a small table in a small meeting room with Shands. Philbrick was pointedly turned away from Emily. He'd ignored her repeated attempts to apologize. Annie was too tense and anxious to notice.
Shands said he'd taken a look at Uncle Jack's MRI. “Preliminarily, I'd say Mr. O'Neill has those changes in his brain that we look for. They're the early markers we've identified for Lewy body dementia.” He said this as if he were delivering a weather report.
A fine day, a few high cloudsâ¦
“I'm confident that analysis will confirm.”
I wanted to kick the asshole. He was completely oblivious to the impact of this news on Annie. She'd gone pale and her jaw was quivering.
“We'd like to sign yourâ” Shands paused, looking through a file folder.
“Uncle.” Annie shot the word at him.
He looked up, momentarily stung. “Yes, we'd like to sign your uncle up for our study.” Shands gave Annie an understanding smile. “As I'm sure Peter has told you, we're testing a new treatment for Lewy body dementia. Results so far are promising, though of course there's never any guarantee. And even we won't know if your uncle is getting the treatment or the placebo.”
Annie was looking at him but I wasn't sure she was processing his words.
“It's a clinical trial,” I said. “They assign half the patients to treatment, half get a sugar-pill. Even the doctors here won't know what Uncle Jack is getting.”
“And if he gets nothing?”
I swallowed. “He'll still be getting other treatmentâsomething for the tremors, something for hallucinations.”
Shands leaned back in his chair and tented his fingers. “There's evidence that the treatment increases brain-cell membrane permeability,” he said, talking to his fingertips.
“Meaning what exactly?” Annie asked.
Couldn't he just say it in English? I thought I caught the shadow of a smile on Philbrick's face.
Shands laced his fingers. “It may slow the progress of the disease, ameliorate the symptomsâ¦perhaps more. Taken early enough, it may even provide a cure,” Shands explained, talking more slowly now. “That's the hope. Of course, your uncle is already showing clear symptoms of dementia.” Annie flinched at the words. He plowed on. “The trials are designed to help us find out exactly what the treatment effects are.”
I doubted Shands was making the impression on Annie that he usually made on patients' family members. “And the drug he'd be taking?” she asked.
“Cimvicor,” Shands said. “It's already FDA-approved for treatment of high cholesterol. Generally well tolerated. We're administering it at a somewhat higher dosage. Of course, there may be side effects. In some, it can cause adverse reactions.”
He handed Annie a piece of paper. I read over her shoulder. Though the risk of most of these nightmares was low, the list was daunting. Starting with dyspepsia and ringing of the ears, it moved on to photosensitivity, impaired vision, muscle weakness, and liver dysfunction. Doctors were required to disclose worst-case whenever discussing treatment. But even for me, it was impossible to know what to make of this laundry list of afflictions. Basically it was a big fat CYA, just in case anyone decided to sue.
“We'd like to put him on the treatment regimen and see how he responds. With permission of course. Then retest him every few weeks,” Shands said.
“More MRIs?” Annie groaned.
“It's important to monitor his progress.”
“If it was me, I wouldn't want to come back here. That's for sure,” Annie said.
“He'll probably have forgotten all about it by lunch time,” Shands said complacently.
It wasn't the right thing to say. “
I
won't have forgotten,” Annie said, her voice cold.
Shands recoiled, blinked. “I'm sorry,” he said. For the first time, he seemed to really look at Annie and to take a moment to think before he spoke. “I realize that sometimes I sound insensitive. I don't mean to. Maybe if I explain.” Now he lowered his voice and spoke as if he and Annie were the only ones in the room. “Medicine has been wonderful in helping people live their full allotment of years, but sadly deficient in attending to the quality of life during those last years. Over four million Americans suffer from dementia. We're at the edge of a major breakthrough here.” There was a passion in his voice and his eyes were alive. “And while it's true, your uncle only has a fifty percent chance of getting our new treatment, he has a one hundred percent chance of helping save countless others from this devastation, not to mention saving families from going through what you're going through now.”
Annie sat back, mollified. He slid some more papers across the table. “This is just the paperwork we need to start the process. Unfortunately, research entails a lot of bureaucracy.”
Annie fingered the pages but she wasn't reading. The shock of the diagnosis. The uncertainties of treatment. I knew what it was like. Shands held out a pen and Annie stared at it.
“She doesn't have to decide this minute,” I said. Annie gave me a grateful look.
“Of course not. This is an awful lot to digest,” Shands said, sliding the pen back into his own pocket. “I really couldn't let you sign the consent forms now. Take them with you. Think it over. There are only a few slots left in the research protocol. If not this study, I'm sure there will be another one at a later date. But keep in mind, the earlier we get started, the better the chances are that treatment will be effective.”
Annie and I walked with Emily to the elevator in the lobby. Annie seemed exhausted, wrung out.
“I know Dr. Shands seems a bit aloof,” Emily said. That was just the beginning as far as I was concerned. A windbag, a narcissist, a guy with the sensitivity of sandpaper. Still, I had to admire his intensity and single-mindednessâclearly a man who believed in his own work.
“He's a brilliant researcher,” she went on. “His work is light-years ahead of anyone else.”
Under her breath so only I could hear, Annie said, “Wouldn't be the first time the genius is a jerk.”
Sometimes they went hand in hand. Here was the golden boy who'd gotten in early on a new technology and run with it. At least he was self-aware enough to know his own weaknesses. He'd surrounded himself with people who could shore him up. He had Philbrick with his technical know-how and gentle touch with patients, Dr. Pullaski the efficient manager who seemed in charge of day-to-day operations. Apparently he'd attracted a string of bright, eager young researchers who, like Emily, stroked his ego and wrote up his results.
“Dr. Philbrick was wonderful with Uncle Jack,” Annie said.
“Yeah, Lenny is something else,” Emily said. “Great with patients, perhaps less good with people. And he doesn't tolerate fools. I'm afraid now he thinks I'm one. Can't believe I did something so stupid in there. I've been drilled over and over again on safety procedures.”
We got to the elevator and I pushed the button.
“Thanks for walking me to my car,” Emily said.
Annie gave Emily an appraising look. “I hope you don't mindâPeter told me about you being threatened. I'm an investigator. I've had some experience with stalkers.”
The elevator arrived. Emily glanced over her shoulder before she stepped inside. “I didn't think it was getting to me, but it is.”
“Have you thought about who might be doing this?” Annie asked as we rode down. “Most likely it's someone you know. That's how it usually works.”
“Is it? I had something like this happen a few years ago and it turned out to be someone I'd never met before.”
We got out at the parking level.
“You had this happen before?” Annie asked. She was probably thinking what I wasâthat it was usually celebrities that got stalked by people they didn't know. Being the victim of two stalkers made Emily still more unusual. I wondered if she'd done somethingâ¦then I stopped myself. That was the insidious thing about stalkingâor any kind of abuse, for that matter. It was easy to blame the victim. So much less frightening when we can tell ourselves, she must've done something to deserve it.
“It happened back when I was in college. But it couldn't be him now. That guy died in a car accident. I have no idea who it is this time. The only thing I know for sure is that it's not Dr. Zak. He saved me from him.” We'd reached her car. Emily stared down at her feet. “I'm not sure I thanked you properly for that.”
“Don't worry about it,” I said.
“Have there been any more incidents since Peter”âAnnie paused and shot me a sideways lookâ“saved you? Wasn't that about a week ago?”
“A week and a half,” Emily said. “Nothing since then. Maybe he got scared off.”
“Maybe,” Annie said. She didn't sound convinced.
“I don't know, though. I feel like he's still out there watching me.”
Emily opened her car trunk and put her briefcase inside. I looked at my watch.
“See you at the Pearce,” I said.
Annie and I walked to Annie's car. We got in and Annie started the engine.
“Stalking doesn't usually turn off like a faucet,” Annie said. She backed out of the space and started to accelerate. “And don't you find it oddâ”
Just then Emily darted out in front of us. Annie smashed down on the brakes and the car bucked to a halt just in time. Emily's scream echoed off the garage walls.
I tumbled out of the car on one side, Annie on the other. “What's the matter? Are you all right?”
Emily was holding her arms around herself, her face twisted in horror. “In my car,” she managed to gasp between incoherent sobs.
Annie was looking in through the open door of the Miata, her face stony. I went over and peered in. Someone had put a white bra over the seat back and laid out a pair of white lace panties on the seat, making it look as if the seat was wearing Emily's underwear. That was disturbing enough, but the bra had heart-shaped holes cut in it, the dark seat back showing through at the center on each side. A heart had been cut from the crotch of the panties, too. I looked away. It felt obscene.
“Great. A stalker with a sense of humor,” Annie muttered. “I'm calling the police.”
This time Emily didn't protest.
Annie got out her cell phone out and punched in numbers. She waited, phone to her ear. Then looked at the readout. “Damn. There's never any signal when you need it.” She went over to use the pay phone by the elevator.
Now Emily was crying quietly. I put my arm around her.
“Was the car locked?” I asked.
Emily nodded.
Annie returned. “They're on their way.”
“I already changed the locks twice,” Emily said. “I guess I'll have to change them again. Shit. You wouldn't believe what it costs. I can barely afford the payments as it is.”
When two police officers arrivedâa man and a womanâthey questioned Emily. It was damned frustrating to see them shrug it off with nothing more than the appropriate
tut-tut
sounds. Tracking down someone who liked to cut hearts out of women's underwear wasn't going to be their top priority. After all, no one had been hurt, no property had been damagedâunless you counted the bra and panties. At least they took the underwear as evidence.
“Want us to follow you home?” I asked.
“Thanks. The police offered to do that.” She gave me a hug, burying her face in my chest. I gave her a squeeze. I could feel her trembling as she kept holding on. “Sorry to be such a pain in the butt. You've been great.”
Annie was watching us, a speculative look on her face. Gently, I peeled Emily away.
Annie gave one last look around the garage. “You sure you don't have any idea whoâ¦?” she began.
“That's what the police kept asking me. Boyfriend? Ex-husband? Anyone I'd recently dumped? They even suggested that I might have done this to myself.” Emily looked up, her eyes pooling with tears. “That would be so pathetic.”