Of Flesh and Blood (23 page)

“Nikki, you okay?”

She instinctively touched the bags under her eyes with a finger and thumb. “I missed my Botox refresher. When that happens, I’m like Cinderella at ten past midnight. It ain’t pretty.”

“Botox,
right
.” Tyler chuckled. “Did you get any sleep last night?”

She shook her head. “You?”

“I slept. Almost wished I hadn’t.”

“Nightmares?”

“Yeah,” he said. “Well, not exactly. I dreamed Nate was still alive. I told
him I wanted to try him on a new treatment, but he refused. Said he was sick of the hospital, and he was going to leave to go pitch a Little League game.”

“If only,” she said with a slight shake of her head.

Tyler smiled. “You were always his favorite, Nikki.”

Her neck bobbed as she swallowed hard. “Tyler, do you think . . .” She stopped.

“That the Vintazomab caused his death?”

She nodded.

“Yes, I do.”

“Me, too.” Her face fell. “I don’t understand. I double-checked all the bags from the pharmacy. I didn’t confuse any of the infusion rates on the pump. I don’t—”

He grabbed her by the shoulders. “Christ, Nikki, it was nothing you did!”

She frowned, not looking the least consoled. “It’s supposed to be a harmless drug. So if we didn’t do anything wrong, then how—”

Tyler squeezed her shoulders once before releasing his grip. “There were three deaths in the early drug trials involving Vintazomab. They all came in the group that had spinal infusions.” He felt his face heating. “I chose not to tell his parents that ‘small’ detail, because I thought it might spook them.”

“And it would have! You know Laura and Craig. It would have paralyzed them with indecision. And Nate needed desperate measures to stand
any
chance.”

“Maybe too desperate,” Tyler said. “I didn’t even do a CAT scan before I started the drug. Nate could have had dangerously elevated intracranial pressure when I ran that extra fluid in around his brain. That might well have been what pushed him over the edge.”

Nikki’s fingers wrapped around his elbow. Her kind smile exuded encouragement. “Tyler, I’ve worked with you long enough to know that your judgment is impeccable,” she said. “But imagine for a moment that Laura and Craig had known about the added risk and chosen to proceed anyway, which we both know they would have in the end. The sense of responsibility would have destroyed them. Believe me, it’s almost better it happened this way.”

For that brief moment, Tyler did.

His phone rang. He would have ignored it, but Nikki let go of his arm
and said, “Go ahead, take it. I’ve got a dose of chemo to administer.” She turned and hurried from the nursing station.

Tyler dug his phone out of his pocket.

“It’s me, Ty!” Jill’s voice bubbled. “Catch you at a bad time?”

“No. Not at all.” But he felt oddly sheepish hearing her voice with Nikki so nearby. “What’s up?”

“The data, Tyler! From my stem cell study!” Her words tumbled out in a rush as she told him about the early data demonstrating a marked improvement in the functional ability of the MS patients who received stem cell implants.

“Congratulations, hon,” he said with heartfelt pride. “The timing isn’t so shabby, either, huh?”

“Ah, yeah.” She laughed. “This is going to save my lab!”

“Might mean a lot more than that.”

“You think?” she asked giddily.

“Aside from bone marrow transplants, has any other stem cell treatment ever been proven to show clinical benefits so far?”

“Not that I know of. No.”

Tyler knew Jill must have gone over the implications multiple times but still probably wanted to hear his validation. He was more than willing to indulge her. “Exactly!” he said. “This is going to be earthshaking stuff when you publish. For you and the Alfredson.”

“Let’s hope,” Jill said with another giggle. “You think your father will be pleased?”

“I think Dad will be over the moon,” he said. “Sounds like the Alfredson is under siege, politically, these days. This news could be a huge help. The timing couldn’t be better.”

“Would be nice if one of my studies actually helped William out, instead of causing him more headaches.”

“It might even save you some Christmas shopping this year.”

“No more unappreciated scarves,” Jill joked, referring to her last Christmas present that William had neither worn nor acknowledged. “I think I’m done with my grant reapplication. Maybe tonight we could go out to celebrate? After all, we didn’t ever get that birthday drink the other night.”

“Yeah, I’d like that,” Tyler said as he hung up. But despite how pleased he was for her, celebrating was the last thing on his mind.

Jill had not asked him about Nate, but Tyler didn’t blame her. She had worked so hard for this breakthrough. With blood, sweat, and tears, she had climbed the academic ladder, one painful rung at a time. Now she was poised to hit the scientific equivalent of a grand slam. Tyler would not expect her to dwell on his problems at that moment.

Walking down the hallway, lost in his thoughts, he almost ran into Maya Berry where she stood in front of the long mural. Her husband was nowhere to be seen. Before she spoke a word, Tyler noticed a difference in the generously proportioned woman—the serene calm she had miraculously maintained throughout her daughter’s ordeal had vanished, replaced by an expression bordering on panic. “Dr. McGrath, thank God you’re here!”

“What is it, Maya?”

“Keisha’s not right.” She shook her head gravely. “She’s complaining of a headache. She won’t touch her breakfast. The child is not even interested in her coloring book.”

Keisha and her sketchbook had been inseparable in Tyler’s memory. But he was not surprised to hear that her condition had deteriorated. He had seen her blood work and the MRI of her brain. It was inevitable that she started to show symptoms sooner than later. “I am coming to see Keisha right now.”

“Oh, that’s good. I’m relieved.” Maya turned for her daughter’s room.

Tyler stood where he was. “Maya, the cancer in Keisha’s spinal fluid must be causing the headache and lethargy.”

Maya stopped and turned back to him. “So she needs that targeted therapy we discussed, right?” she exclaimed. “The Vintazomab. You’re going to start it right away, aren’t you?”

Tyler’s chest began to flutter. “Well, it’s an experimental drug,” he hedged. “We still need approval from the team.”

“
Approval?
” Maya grimaced. “You never mentioned anything about that before.”

Tyler had not raised the issue because it was generally a rubber-stamp process. According to hospital policy, all experimental treatment protocols had to be discussed with the entire oncology medical staff at the twice-a-week rounds where the complicated cases were reviewed by Tyler and his peers. Normally, no doctor would impede his colleague from starting a treatment deemed potentially life-saving. However, as a result of Nate’s sudden death, the department head, Dr. Alice Wright, would likely suspend the use
of Vintazomab until a full mortality review was conducted. Tyler knew in his heart that such a formality would never have stopped him before, but he was suffering his first professional instance of cold feet. And he could not bring himself to tell Maya about Nate.

“I am sorry, Maya,” he said. “I still need to get the go-ahead from my colleagues.”

“When will that happen?” she asked, her hands flapping in agitation.

“We have rounds the morning after next. I should have the green light by the end of that meeting.”

Maya’s expression crumpled. “What do we do in the meantime, Dr. McGrath?” she croaked.

“I’m going to start Keisha on steroids, now,” Tyler said. “That should help with the headaches.”

“But steroids won’t get rid of my child’s cancer!”

Tyler shook his head. “They will buy us time to start the treatment that might,” he said, realizing how hollow his reassurance must have sounded.

“I pray to God you can start Keisha on that Vintazomab soon, Dr. McGrath.”

For the first time since he had met her, Tyler saw recognition in Maya’s eyes that faith alone would not be enough to guarantee her daughter’s survival.

Wordlessly, they walked together into Keisha’s room. Inside, Tyler realized Maya had not exaggerated. In little over a day, the girl had withered. Her cheeks had lost color. The lovable missing-toothed smile was nowhere to be seen. Even her sketchbook lay neglected on the nightstand beside her. Eyes half open, she stared at the TV above her bed without much interest. Holding her neck bone-straight and her head in neutral, Keisha was clearly uncomfortable. But she still managed a slight grin for Tyler.

“How bad is the headache, Keisha?” he asked.

Keisha started to nod but the pain stopped her. “It hurts, Dr. M. Even my neck. Like when Jimmy Adams squeezed me in that headlock for too long.”

Tyler bared his teeth and punched his fist against his palm. “I’d love to have a talk with that Jimmy.”

Keisha laughed weakly. “Have to be long-distance. He still lives in Alabama.”

“Good thing for Jimmy.” Tyler winked. “Keisha, we’re going to give you some medicine to take away that headache.”

Her eyelids lowered to half shut. “That Vintazo stuff you told us about?”

“Not yet, Keisha.” He explained to her about the steroids, stressing they were pills and could be crushed into juice or applesauce. Though subdued, Keisha accepted all of it in her usual stride.

Tyler left Keisha and her mother to go write the orders for steroids and painkillers. Uncharacteristically, he double-checked his calculation on the steroid dosage based on her weight. The unnecessary step bothered him. He wasn’t used to second-guessing himself like that.

Tyler slogged through the rest of his hospital rounds on autopilot. Fortunately, his inpatient load was light; he had only eight other children admitted under his care. Though they all appeared to be relatively stable, they were cancer patients and deserved his absolute focus. But he could not stop his thoughts from wandering back to what went wrong with Nate Stafford and what might happen to Keisha if he were to start her on the same treatment.
What other option does the girl have?

Tyler arrived at the children’s outpatient clinic at noon. The three-year-old sleek glass building was as large as the neighboring children’s hospital and connected to it via a second-floor glass walkway. Parents from all over the country and around the world brought their children to the center for second and even third opinions. Not only cancer victims. The Alfredson’s world-class areas of pediatric care ranged from muscular dystrophy to cystic fibrosis. The only common denominator was the life-threatening nature of the illnesses.

As soon as Tyler walked into the front office of the oncology clinic, the young redheaded receptionist, Lela, with a row of studs along her left earlobe, rushed up to him anxiously. “Dr. McGrath, I’m so sorry,” she sputtered. “He wouldn’t take no for an answer.”

“Who wouldn’t?”

“Craig Stafford,” Lela said. “He insisted on seeing you now. He was real pushy about it.”

Tyler’s veins ran cold. “Where is Mr. Stafford?” he asked.

She thumbed behind her. “Waiting in the first exam room for you.” She clicked her studded tongue and frowned. “I’m sorry, Dr. McGrath.”

“Don’t worry, Lela, you did the right thing.” He headed toward the exam room, dread rising with each step. At the door, he gathered himself before turning the handle and stepping inside.

In jeans and a black T-shirt, with his back to Tyler, Craig Stafford stood absolutely still as Tyler approached. “Craig?” Tyler stopped, close enough to pick up on the stale smell of body odor.

Craig turned slowly to face him. He was unshaven, and his wavy black hair was matted on one side and stuck out in untamed spears on the other. Eyes sunken and cheeks hollow, Craig looked just as lousy as Tyler had expected.

Struggling for the right remark, all Tyler came up with was, “How is today?”

Craig’s eyes narrowed. “Today isn’t so great,” he said throatily. “Laura hasn’t said ten words since Nate . . .” He rubbed his eyes. “She can’t get out of bed. I had to take Brittany over to my parents in Redmond. Brit can’t stop crying. Says she doesn’t believe her big brother’s really gone.”

Sensing Craig did not want his sympathy, Tyler simply nodded.

“You don’t have any kids, do you, Dr. McGrath?”

“No.”

“I didn’t even think I wanted to be a dad,” Craig said, his tone remote and his gaze far away. “I was only twenty when Laura got pregnant. It all seemed like way too much responsibility to me. Then this colicky baby comes along who cries all the time for the first four months. I’m holding two jobs and not sleeping in between, thanks to little Nate.” He grunted. “Something weird happened in that first year. Never even really saw it coming. But one day, I suddenly can’t imagine life without the little guy around.”

They lapsed into a long silence that Craig finally broke. “I wanted to ask you something, Dr. McGrath.”

“All right.”

Craig dug in his pocket and pulled out a crumpled sheet of paper. He held it, still folded in his hand, without even glancing at it. “This Vintazomab drug. You told us serious side effects were rare, didn’t you?”

Tyler held steady eye contact. He knew now for certain where Craig was heading, and he wasn’t surprised. Even before the man showed up at the clinic, Tyler had expected he would have to hold this conversation with
Craig at some point. The loss of a child often elicited unpredictable reactions in parents, but not in Craig’s case. At every setback, Nate’s father had lashed out with anger. The more helpless he felt, the greater his fury. And Tyler knew he was facing a volcano moments from eruption. “Craig, I said that serious side effects were uncommon, not rare.”

“There’s a difference?”

Tyler nodded. “To doctors, ‘uncommon’ usually means less than one in a hundred, whereas ‘rare’ would be more like one in a thousand or less.”

“Maybe I was too emotional to understand you right.” Craig slowly unfolded the paper in his hand. “Your memory is obviously better than mine. Did you happen to tell us, too, that deaths from this Vintazomab only happened in kids who got the drug through spinal needles?”