Obsessed (11 page)

Since then Shands had been prolific. Nine or ten papers a year, plus a few book chapters. On most he was sole author; some were coauthored with others, including Leonard Philbrick and Estelle Pullaski. Now he was listed as professor of neurology. It was an impressive body of work, especially given the short period of time.

I brought up the
Boston Globe
archives, curious to see if there had been any news articles about him. The first hits were in 1984—an engagement announcement and an obituary. In March, Dr. Estelle Pullaski's parents had announced her engagement to James Shands, Ph.D. I wasn't surprised that their relationship had been personal as well as professional.

A month later was the obituary: “Dr. James Shands, cardiologist and researcher, died on April 10 in Beth Israel Hospital after a long illness. He was 65.” These days, that was awfully young to die. I skipped to the end. “Dr. Shands is survived by a son, James Shands, Jr., Ph.D.” The obituary was several inches long. The senior Shands had to have been a brilliant researcher—he'd been a primary author of the Amherst Cardiology Report, the first longitudinal heart study that provided us with virtually everything we know today about heart disease.

I wondered if his father's death had precipitated a breakup with Dr. Pullaski. I noticed, too, that the start of the gap in his research output lined up approximately with his father's death. Maybe that's what had propelled him into med school.

Then there was a 1991 article on the opening of the Cambridge Brain Bank. “Researchers in Cambridge today opened a state-of-the-art repository for human brain tissue.” I remembered the fanfare at the opening. I was finishing a post-doc at the Pearce at the time. Today, the Cambridge Brain Bank was still going strong.

I read on. “Dr. Estelle Pullaski, executive director, said the new brain bank is ‘indispensable to our efforts to relate what happens at the cellular and molecular level to behavior.'” There Dr. Pullaski was in a photograph of the dedication ceremony at the center of a group, with Shands at her side. The article went on to mention Shands as one of an esteemed staff of researchers.

I looked at the others in the group. Most I knew by reputation. There, with his head half-turned away from the camera, was Dr. Nelson Rofstein, my first mentor. According to the article, he'd been on their board of directors.

There were other articles. One covered the hoo-hah at the opening of University Medical Imaging Center years later. There were numerous pieces about aging and dementia in which Shands was quoted as
the
expert. He'd been keynote speaker at a national conference on the brain. No mention of unpleasantness or scandal.

There was no simple way to check on the lab's safety record. I could at least check that it was accredited by the American College of Radiology. I quickly discovered that while 4.5 tesla scanners could be used for research, they were not yet FDA-approved for clinical use. Nevertheless, University Medical Imaging had met the standards set for lower-strength devices.

While I was at the Web site, I found a list of reported accidents. I scrolled through, drilling down to look at details. There was the incident Annie told me about in Rochester, a gun pulled out of a police officer's hand, hitting a wall and going off. In another incident, a woman in Minneapolis was killed when a metal oxygen canister got sucked into the machine.

Two technicians and a patient had suffered frostbite and ruptured eardrums in a San Diego lab when a magnet quenched—rapidly lost its magnetic field and the liquid helium within the chamber boiled off into the scan room. That didn't sound like fun. I hoped Annie hadn't read about that incident. And if she had, I hoped she'd gotten to the part where it said that accidents like that were “extremely rare” and that MRI systems had an “exceptionally high safety record.”

No incidents had been reported at University Medical Imaging.

Finally, I hauled out my copy of the
Physician's Desk Reference
and looked up Cimvicor, the drug Shands was using to treat Lewy body dementia. The entry began, “Cimvicor is a synthetic, lipid-lowering agent…” I scanned the drug description and a lengthy section on how it worked. As I would have expected, its clinical trials had been for treatment of high cholesterol, not dementia. I read through the warnings, precautions, and finally adverse reactions. I looked through the symptoms of overdose. I could see nothing there that Shands hadn't disclosed, nothing that set off alarm bells.

I called Annie at work.

“What's wrong?” she said the minute she heard my voice.

That about summed up our relationship—I called and she immediately assumed the worst.

I told her Uncle Jack was up and about and had eaten lunch. “And I checked on the lab's safety record. It's clean.”

“At least that's something.”

“And Cimvicor, the treatment drug? I don't think there's a huge risk taking it, even at the higher dosage.”

“So you'd give this experimental treatment a green light?”

“I think it's worth a shot.”

“I talked to my mom this morning. That's what she says, too. Given the alternatives.”

There were no good alternatives. The brutal truth was we had no way to treat this disease, no way to cure it or even slow it down. All we had were medications for the grosser symptoms.

“What he has—it's basically a death sentence, isn't it?” Annie asked.

I wished I could have seen her face to gauge whether she wanted me to just say it outright or soften the blow. “I'm afraid so,” I said, my throat closing around the words. Knowing Annie, she probably wanted the facts. “A year, two at the outside. Even with the treatment we can give him, the visual and auditory hallucinations and the movement disorder will probably get worse.”

There was a long pause.

“He'd be living a nightmare,” she said, her voice calm and quiet. “I'll fax the consent forms over to the lab this afternoon. Though I have to tell you, I don't like that place. Do all research labs treat patients like crash-test dummies?”

It was the perfect image. Maybe it was inevitable. After all, researchers had to be dispassionate observers, and that required a certain sangfroid in the face of human suffering. They worked at the macro level looking for patterns—the occasional patient who beat the odds only muddied the picture.

“I'm glad you're not a researcher,” she added.

F
OR TWO
weeks Uncle Jack became my proverbial watched pot. I knew improvement, if any, would come in imperceptible increments. But even in this short time there did seem to be some. His gait was more stride than shuffle. He seemed a bit more coherent and the hallucinations less frequent. The nurses reported that he was doing better caring for himself, and was sleeping without nightmares.

I tried to curb my enthusiasm when I gave Annie progress reports. It could just be a bubble. I looked forward to those daily phone calls, even though all we talked about was Uncle Jack. Whenever I suggested that we get together, Annie put me off.

That morning Uncle Jack had gone to the imaging lab for a follow-up MRI. This time, he'd made the trip with a mental health worker. Philbrick had given me a curt “absolutely not” and cited safety concerns when I'd asked if I could observe.

I checked on Uncle Jack when he got back. He was in the common room watching TV. This time, the experience had left him somewhat subdued but otherwise unscathed.

I wondered if his test results would confirm the improvement, or if I was seeing what I wanted to see. It could be simply a result of the move to the Pearce, regular meals, combined with our trained staff and the meds we were giving him for the tremors and hallucinations. For all we knew, Uncle Jack could be getting the sugar pill.

“I finally got the analysis of Mr. Black's test results,” Emily told me during our weekly supervisory one-on-one that afternoon. Her stalker had been dormant since the incident in the garage. “Usually it only takes about a week. Guess this wasn't anybody's top priority but mine.” She reached for a tissue, discreetly removed the gum from her mouth, and threw it away.

“And?”

“Very disappointing. Differences left to right are pretty much the same for him as for the average person we've tested. If I'd been reporting results just based on observation, I'd have said for sure there was something there. I guess that's why research studies are always double-blind.”

“We see what we want to see,” I said. “Fortunately there's all that sophisticated equipment and data analysis to keep you honest. How's Mr. Black doing?”

“I've been thinking about what you said. That you never know what's right for your patient. Intellectually, I know you're right. I've heard it over and over—they drill it into you. But emotionally I can't quite wrap my arms around it.” She gave me a hard look.

I didn't say anything.

“I know, I know, as a therapist, I'm supposed to keep telling myself that I can only try to control what goes on within the confines of the therapy room. To believe otherwise is a sure recipe for disaster.”

I had to smile. “A sure recipe for disaster” had been one of the trademark phrases of Dr. Rofstein. That was how mentoring worked—hopefully we only bequeathed the good stuff.

“So how is this different from a patient who's suicidal?” Emily continued. “I'm not supposed to just sit there and nod and say, ‘How interesting. Tell me more about how you're going to kill yourself.'” Today she wore a white blouse under her suit jacket, and there were no flashes of bare skin as she leaned forward. “Don't I have an obligation to act?”

“If you think a patient is serious about killing himself, then yes, you have an obligation to act. If he tells you he's going to hurt someone else, then by law you have to warn that person.”

“So here's a man who says he's going to cut off his arm? What can I do to stop him?”

“If he's psychotic or demented, you can commit him. Do you think he is?”

“He's not.”

“Do you think he's suicidal?”

“No. But he's got this obsession—”

“You can't hospitalize him unless what he's doing is life-threatening. We're talking self-mutilation. That's not necessarily even about wanting to die. It can be just the opposite. Some people crave pain in order to feel connected to the real world. While we all might have opinions about what Mr. Black should or shouldn't do, as his therapist you have to accept the fact that you can't control his actions.”

“It's so frustrating,” Emily said, her fists clenched. “So I just sit back and watch, engage in some intellectualized bullshit when a person is in desperate need of a kind of help that I'm not allowed to give?”

I admired her passion, her determination to help, but she was dead wrong. “It's not intellectualized bullshit.”

Emily stared out the window. “Well, I can't do nothing. Can't I at least tell him that as an outside observer, I don't think this is such a good idea?”

“Sure you can, but what would be the consequences? Suppose you say, ‘I don't think you should cut your arm off,' but that's what he wants to do? Why would he come back to you? By offering your opinion you run the risk of ruining the therapeutic relationship.”

“So what
do
I do?”

“Think about it this way. It's like penicillin. If a patient has an infection, then the key to treating him is to make sure he takes the penicillin.”

“So”—Emily paused, sitting up straighter—“you're saying that the key is to keep Mr. Black working in therapy before he takes action. Make sure he keeps working at understanding where this need comes from.”

“Right,” I said. “Explore other ways of dealing with these urges.”

“So I was on the right track when I tried to help him understand the downside of doing this?” Now she didn't need to look to me for approbation. It was one of those “aha” moments that make supervision so gratifying.

“You could go even further,” I said. “Encourage him to get the data he needs to make an informed decision.”

“Data…” Emily murmured. She frowned and thought for a few moments. “So I could suggest that he talk to people who are amputees.”

“Sure. That's the kind of thing that would give him a chance to experience vicariously before he acts.”

Just then my phone rang.

“I wonder—” Emily said, her brows coming together over her eyes. The phone rang again. “Go ahead, take the call.” She stood. “I gotta run anyway. Mr. Black is probably waiting for me and I've just had a brainstorm.”

I picked up the phone. It was Gloria. “I thought you'd want to know,” she said as Emily shut the door. “Mr. O'Neill isn't feeling well. Started vomiting after lunch. Now he's wheezing and feverish. We called his niece and let her know.”

As if to underline Gloria's concern, the red message light on my phone had begun to blink. I ignored it. Whoever it was would beep me if it was important.

“But I was down there just a couple of hours ago and he was fine.”

“Hey, I'm just the messenger. Could be a stomach bug. We're keeping an eye on him.”

I checked my watch. My last patient of the day wasn't due for fifteen minutes. I hurried down to the unit. Uncle Jack's bed was cranked nearly vertical and an oxygen mask was strapped over his face. He looked pale but comfortable, his chest rising and falling with each breath. At the end of each exhale, I could hear a little whistle from his lungs. His eyelids fluttered when I touched his shoulder.

“How you feeling?” I asked, pulling up a chair and pushing the mask aside.

“Been better,” he said.

“Heard you had another MRI this morning,” I said.

He muttered something that sounded like “fool thing.” Then his eyes drifted and he was focusing on a space over my right shoulder, a faint smile on his lips. I wondered if Felicia's ghost was back.

I turned around. Annie had come into the room. She must have had to testify in court today because she was wearing a dark suit and had her hair pinned up. She looked worried. I knew this wasn't the time or the place to notice her legs, but I couldn't help it. Uncle Jack blinked at her. She took his hand.

“Hey big guy, what's this about you getting sick?”

Uncle Jack managed a chuckle.

Later, in the hall, Annie asked me, “You don't think this has anything to do with that test he had today? I mean, both times he gets an MRI he ends up wheezing.”

“MRIs don't cause breathing problems,” I said. I didn't add that this time it was more than breathing problems. He couldn't keep food down and his temperature had spiked to over a hundred.

“But he was in that tube. Maybe the person in there before him was sick. Coughed all over the place. They don't bother to wipe it down—”

I didn't bother to point out that in fact they did. “Most bugs that make you sick like this have an incubation period that's more than a couple of hours.”

Annie was having no part of it. “People pick up all kinds of infections in hospitals that they wouldn't if they just stayed home,” she said. “Didn't I read about flesh-eating bacteria that some guy got after he was operated on for a hangnail?”

“Flesh-eating bacteria?”

“I'm not making this up.”

“Annie, your uncle's probably got the flu, not a hangnail. It's the kind of thing he could have picked up anywhere. At least he's here, where can monitor him closely.”

Annie was pacing up and back now in short rapid strides.

“Maybe I should take him out of here. Right now. He was fine at home.”

“Annie!” I stopped her and put my hands on her shoulders. “You know as well as I do that he was not fine.”

“But he wasn't sick like this.” A tear started at the corner of her eye.

“I know, I know,” I said gently, taking her in my arms. “But he is now.” I rested my cheek against her and inhaled her fruity scent. “And he needs to be monitored. It could be a virus of some kind.”

“Just flu?” She sounded hopeful.

With someone Uncle Jack's age it was never “just flu.” Flu and pneumonia were among the leading causes of death in older people.

“We'll watch him round the clock. If there's any problem we'll get him admitted to the medical hospital immediately.”

“Hospital?” Annie pulled back and gave me a horrified look.

It had been a long day. Administrative meetings had lasted until seven. After that I checked in again on Uncle Jack. The oxygen mask was on the table and he seemed to be breathing easily. He had the covers pulled up to his chin but seemed chilled. I got an extra blanket and tucked it around him.

I went up to my office, hauled my briefcase from under the desk and slid in some notes I'd taken. I was feeling tired and achy myself and wanted to get home. I reached for the phone, intending to give Annie a quick update before taking off. The red message light was still going.

I groaned, and considered leaving it until morning. I swallowed my impatience and dialed voicemail.

“You have four new messages….”

I sank into my chair and scrounged for a pencil and a scrap of paper.

“Dr. Zak? This is Leonard Philbrick calling.” I recognized his high-pitched voice. “I wanted to”—there was a pause, like he wasn't sure why he'd called—“I wanted to check on how Mr. O'Neill was doing. The procedure went smoothly this time, but he did have some breathing difficulty. I was concerned about…” His voice trailed off. “I wonder if you could give me a call. I'm at the lab.” I made a note of the number and deleted the message.

The next one had come in at three. It began with a stretch of silence. At first I thought it was one of those automatic-dial phone solicitations. Then, “Damn.” Sounded like Philbrick again. The third message came in at 3:26. It was my mother, wondering if I wanted to join her and her friend Mr. Kuppel for a seven o'clock screening of
The Collector
at the Brattle. Too late for that. Too bad, too. I remembered the film—a dweebie bank clerk adds a girl he's lusted after from afar to his meticulously catalogued collection of butterflies. It was a world-class creepy performance.

The last message. Six-twenty. I waited. The caller cleared his throat. “This is Dr. Philbrick again. Please give me a call this evening? I should be home after nine.” He left his number.

He hadn't called all that long ago. Maybe he was still at the lab. I called. Their answering system picked up. I punched in Philbrick's extension. Six rings, then his voicemail. I left a message that I'd call him at home.

There was no answer at home either. Later that night I tried again after the ten o'clock news. Still nothing.