Second Opinion (12 page)

CHAPTER 20

The Lydia Thibideau Gastrointestinal Research Center occupied the entire fifth floor of the Cannon Building—a modern glass and steel structure built in tribute, the bronze plaque by the elevators read, to the skill and compassion of the physicians and nurses of the Beaumont Clinic. After checking to ensure that there would be restricted visitors and a guard on duty outside the ICU for at least until morning, Thea followed the directions the GI chief had given her and swiped her hospital security card to stop the elevator at Cannon 5. As Thibideau had promised, the main door to the center was unlocked, and the waiting area was now deserted.

Getting the card had taken most of a day. After numerous forms and a detailed interview with the head of hospital security, Thea had been granted Beta clearance, which she was told would get her into most common areas, her father's office and small laboratory, plus the hematology/blood chemistry lab, and the radiology suite. She was never given the explanation as to why those particular facilities were chosen, but Niko had, at some point, let slip that his clearance level was Delta. In fact, in order to access Petros's modest office, it was necessary not only to swipe her ID card, but to enter a password into the ten-digit keypad by his door. Not at all surprisingly, Petros's code, printed on a wallet-sized card given to Thea by the security head, was 2-8-4-3-6-7: ATHENS.

Security codes… ID cards… sign-ins… guards… electronic medical records… staggering malpractice insurance premiums… malpractice attorneys recruiting clients through television ads… other TV ads directed at having patients badger their doctors for various prescription medications… managed care companies dictating how much time a physician can devote to each patient.

The practice of medicine had evolved into something Alice would have encountered had she gotten ill on her trip through the looking glass.

Thea pictured the bustling jungle hospital near Katanga, DRC, where she had worked for almost two years now after transferring from a similarly vibrant facility in the Guidan Roumdji district of Niger. Sick and malnourished patients; skilled, devoted caregivers; miracle after miracle. It was an equation, a simple, straightforward system, she could understand. Her income of around twenty thousand dollars a year couldn't stand up to the hundreds of thousands Niko and Selene each made, but she was actually saving a reasonable portion of her salary.

Now she was trying to track down why, with only a single word available to him, her father had chosen the name of a man who had survived a brutal cancer, fatal to all but the very fortunate.

During her rotation through the Beaumont, Thea had met Lydia Thibideau once, and had attended several of her lectures. The woman never seemed particularly warm or open, but like many of the super-specialists at medical centers like this one, she was undeniably brilliant. As instructed, Thea took a seat in the empty waiting room. Twelve-hour workdays were the norm at her hospital, but she seldom felt stressed or too exhausted to go on. Now, though, she was feeling the strain of her father's devastating condition and the tension of dealing with the twins. Most of all, she was struggling with the terrible secret her father had imposed on her by allowing no one else to know that he was awake and alert.

In spite of herself, Thea's eyes closed. Her thoughts became disconnected fragments, many of them centering around Dan Cotton. In just the short time they had known each other, he had behaved nobly with the teen in the cafeteria and bravely with the assailant by the ICU. His rugged good looks were totally appealing to her, and although she was seldom consumed by sexual fantasies of a man, various images of them embracing and kissing and undressing each other began materializing. For a time, Dan galloped through her thoughts in full armor, carrying a lance and a shield. Moments later, he was lying next to her in the deep, rich grass of a meadow, slowly undoing the buttons of her blouse, unhooking her bra, touching her…

How could this be?
her mind asked over and over again.
How could this be?
… How—

'How do you do, Dr. Sperelakis?'

Thea's eyes snapped open, but took a few moments to focus. Imposing Lydia Thibideau, wearing a knee-length white lab coat, was standing less than five feet away, her arms folded tightly across her ample chest in a position, Thea sensed, that was typical of her. She had aged some since the photo in the
Bugle,
and perhaps gained some weight, but her stern expression was the same. Her hair, styled short, was more red than brown, and she wore no jewelry except for a plain gold band, partially buried at the base of her marriage finger.

'Oh, I think I fell asleep,' Thea said, not feeling the least embarrassed.

So it appears.

In improv class, Thea would have stood up, extended her hand, and asked, 'How do you do?'—a phrase she never completely understood. Now, although there was nothing in the professor's manner that encouraged her, she did so anyway.

'How do you do. I'm Thea,' she said, rising as the last wisp of her fantasy vanished.

'I… knew that,' Thibideau replied, her hand like a trout. 'I want to tell you how very sorry I am about your father. He was—
is
—a dear man and a dear friend.'

There was an all-too-familiar cadence to the woman's speech, and Thea stopped herself at the last second from asking if she, too, had Asperger's.

'He seems stable right now,' she said instead.

'Excellent. You said you wanted to speak to me about one of my patients. Shall we go into my office?'

'I would like that,' Thea replied.

The fifth floor was a spacious, gleaming laboratory behind a glass wall on one side of a corridor, and across from that, a conference room with ceiling-to-floor bookcases, original artwork, and a wall-sized whiteboard, as well as several examining rooms and a corner office overlooking an elegant duck pond, complete with two fountains. Aspie or not, whatever Lydia Thibideau had done in her professional life, she had done it right.

Thea flashed on the corner of a vast tent that she called her office, and barely suppressed a grin. Thibideau did not offer her anything, but simply motioned her to a chair next to the desk.

'I wish to warn you in advance, Dr. Sperelakis, that it is my policy not to share information about any of my patients, even to another doctor, without a signed release. And even then I may choose not to.'

'HIPAA, I know. Well, do the best you can.'

On something of a roll, Thea had thought through the lie she was about to tell, and even imagined the words she was going to use to tell it. Still, despite her previous success at it, manipulating and restructuring the facts felt foreign and uncomfortable.

'I've agreed to take over my father's practice until he is able to resume work himself.'

'Well, that's… very gracious of you. Weren't you practicing in the jungle somewhere?'

'The Congo, yes. I expect to go back there someday. Well, last night and today I've been going through some of my father's papers, and I came across a sheet with a name, a date, a diagnosis, and your name on it.'

'Can I see it?'

'See what?'

'The paper—the sheet of paper you found.'

'Oh… I… don't have it with me. I didn't stop back at the office after I called you.'

Thibideau rolled her eyes.

'What was the name?'

'The name was Kalishar. I wondered if he's the Kalishar from the department store.'

'And the diagnosis?'

'Pancreatic cancer.'

Thibideau sighed.

'Dr. Sperelakis,' she said wearily, 'I don't know you beyond having your father tell me in the past that you broke his heart by going away to the jungle as you did. I'm sorry, but I don't think you're being completely forthcoming with me. Now, exactly what is going on here?'

Thea felt the grip of panic. What was Thibideau talking about? Clearly, she had seen through the lie, but there was no way Thea could share any information about Petros's locked-in syndrome. What was she supposed to do now?

'I… I just need to know about Jack Kalishar,' she stammered.

'And you expect me to answer you without knowing why?'

Thea felt frozen, unable to respond. Twisting the truth had seemed so easy the last time she did it.

'I've been spending time late at night talking with Hayley Long,' she suddenly heard herself saying. 'We've been talking about… about her diagnosis.'

'I know.'

'You do?'

'Doctor, she's my patient. I don't know the medical customs in the jungle, but here in Boston we talk to our patients.'

Thea felt herself unraveling.

'I'm sorry,' she managed.

'Your visits have greatly buoyed Ms. Long's spirits. Now, I can't tell you much about Mr. Kalishar beyond that, as you surmised, he is my patient.'

'Then he's still alive?'

'That fact is constantly reported in the
Wall Street Journal.
Yes, he's still very much alive and in excellent health, I might add. We do manage to save some patients, you know.'

'I know,' Thea said, 'but the review article by Lawrence and Kelleher in the 2004 issue of the
American Journal of Gastroenterology
reports some pretty low survival rates.'

'So, you've been doing your homework.'

'My homework?'

Again, a queer look.

'Yes, research. You've been doing research on pancreatic cancer.'

'Oh. Yes, I've done a little. But the Kelleher article I read some time ago—right when it came out, as I recall.'

'I'm impressed you would remember such a thing.'

'Don't be. I remember lots of things I read. Most, in fact. The survival numbers weren't very encouraging back then. I don't think they've changed all that much since then. Can you tell me what Mr. Kalishar was treated with?'

Thibideau mulled the question for a time, then said, 'It was a developmental drug we labeled SU890. We developed it right here in our lab—well, in the lab that preceded this one.'

'Is that what Hayley is getting now?'

'No. Ms. Long is on a new investigational drug, SU990, the next generation of the drug Mr. Kalishar got. I believe he got some other chemotherapy as well.'

'But you said that Mr. Kalishar was completely disease-free after five years.'

Once more, Thibideau hesitated in replying.

'He is,' she said finally, 'but others… weren't as fortunate. There were some deaths. We… had to stop the study and withdraw the drug.'

'And go back to the drawing board.'

'Not all the way back.'

'I suppose with pancreatic cancer being such a lethal condition, the FDA has given you some breaks in that regard.'

'Tell me, Doctor, are you always so… direct?'

Thea nodded modestly. 'People have said that about me, yes. Some of them think it's refreshing. Some of them think that I'm a bit of a jerk.'

'My Lord. Is there anything else you'd like to know?'

'Have you treated enough patients with this new generation of drug to have an idea how it's doing?'

'The results to this point are rather promising. Dr. Sperelakis— Thea—I'm sorry I said what I did about you breaking your father's heart.'

'I know that I did. But Dr. Carpenter—Paige Carpenter, she's my

therapist—helped me learn that sometimes a person has to do what they have to do.'

'Yes… Well, I wish you luck in your new practice. If you are just a fraction as talented as your father, you are sure to be a success.'

'I can't be as good as he is. I can only be as good as I can be.'

'Dr. Carpenter, too?'

'Why, yes. Good guess.'

'You are a very unusual woman, Dr. Sperelakis.'

'Unusual. I think I like being that.'

'If there's anything further I can do for you, you may at least ask.'

'Well,' Thea said, 'there is one thing.'

'Yes?'

'I'd like to bring an acupuncturist by to see Hayley.'

'A what?'

'A revered acupuncture instructor from the school I used to study at. I was hoping he might give us some idea as to how Hayley is responding to her treatment.'

The little warmth that had been radiating from Lydia Thibideau vanished.

'Doctor, are you trying to undercut me in some way?'

'No, no. All I wanted to do was help.'

'Well, you're not helping me. I have no truck with acupuncture or herbalism or reflexology or chiropractic or any of those other quacks. You seem to have inherited not only your father's intelligence, but his penchant for getting in people's way.'

Thea was stunned.

'Wh-what's that supposed to mean?' she managed.

'It means that if your acupuncturist so much as touches my patient with a needle, I will have you brought before the executive committee so fast it will make your head spin.'

CHAPTER 21

The more Thea thought about her session with Lydia Thibideau, the less sense it made. One moment she was saying how much she respected Petros, another she was disrespectfully calling him a meddler. What did that mean?

As she walked through the tunnels to grab some dinner at the cafeteria before heading to Hayley's room, she tried sorting out what she had learned regarding Jack Kalishar. The man, because of his metastatic pancreatic cancer, had been referred by her father to Thibideau, one of the foremost specialists in that disease in the world. She had designated him for inclusion in a clinical trial, one of a number of such trials she was continuously running on various chemotherapeutic agents, developed in her lab or in conjunction with one of the big drug houses. In Kalishar's case, it was a drug named SU890.

The investigational drug accomplished something that was almost impossible to believe. It cured Kalishar—cured him of a cancer with an average five-year survival of 4 percent. Cured him of a cancer where the survival from the most aggressive treatment—surgery, radiation, and chemo in combination—in the most localized disease, averaged seventeen months.

Seventeen months in a best-case scenario.

Jack Kalishar was a miracle, and SU890 was the maker of the miracle.

There was just one problem. Other patients receiving the miracle drug had died. Exactly how many, what percent of those in the SU890 treatment group, Thibideau would not say.

Thea wondered how many deaths it would take to offset a miracle like Jack Kalishar.

Four-percent five-year survival. That was the starting point. Extending that statistic to eight percent, or ten, or even fifteen would be miraculous in its own right, but a cure…

What about Hayley? Did SU990 have any track record yet? Had she and her husband made the right decision in choosing to forgo treatment with the other established anticancer drugs to concentrate on this one?

Four percent survival. Not a heck of a lot to hope for.

Thibideau had been hardly forthcoming about her research. At times in their brief conversation she seemed unpleasantly patronizing. Then there was the attack on Petros. Thea tried to understand why, but got nowhere. Was it just the woman's personality? Was she unusually paranoid about her data, or was this simply the way world-renowned scientists acted? It would seem that Petros Sperelakis's physician-daughter might have deserved more respect. Perhaps the gastroenterologist had learned about her Asperger's from Petros or one of the twins. Perhaps, in addition to her loathing for all those alternative healers, she just couldn't take seriously someone who'd worked in Africa.

It was half past seven and Thea was famished. Once she got settled in with a salad and whatever pasta they were serving, she would call Dan to see how he was doing, and if he might be free tomorrow to spend some time with Dimitri. She also wanted at least to leave a message for Professor Julian Fang at the Eastern Massachusetts School of Acupuncture to see if he could stop by at the hospital to evaluate Hayley. Just no needles—isn't that what Thibideau had said?

A year after her graduation from medical school, weighed down by the stress of too many patients and not nearly enough sleep, Thea had taken a basic acupuncture course taught by Fang, and had embraced both the philosophy and the man. She took another course in which she clearly demonstrated an aptitude for alternative medicine, and then, later in the year, used most of her vacation to go on a retreat with Fang and some of his most promising students.

For some time after that, Thea gave serious consideration to switching from Western to Eastern medicine. Fang had spent several hours discussing change with her—not the specific change she was considering, but the nature of change in general, and the difficulty she often had around flexibility and dealing with the unexpected. Ultimately, although it would have meant another student for his school, and a favorite of his at that, Fang recommended that she wait until her training was over before considering such a radical alteration of her life.

Eventually, Thea decided on a commitment to Doctors Without Borders. But she continued her study of acupuncture and herbal medicine, as well as her contact with Julian Fang.

Dan answered her call and sounded excited to hear from her, but he was locked in a game of chess with his son while they waited for the boy's mother to pick him up.

'I can call you back right after I get beaten,' he said. 'Make that get beaten
again.
Between Josh and the orderly with the fancy fast feet, I'm on quite a roll today.'

Thea imagined a comfortable den with thick leather furniture, and put Dan Cotton in a huge chocolate-colored leather easy chair. There were pictures of sports heroes on the wall, and trophies on the mantel for baseball and football and… and weight lifting.

'That was a sneak attack in the hospital,' she said, 'just like Pearl Harbor.'

'Well, I don't intend to go through a world war and an atomic blast before I get even.'

'I'll help.'

'I'm counting on that.'

'Dan, listen. I know you have to get back to Josh, but I just want you to know that I'm really sorry you got hurt and I really want to see you again as soon as possible.'

'I don't know how long it will take me to get used to being around someone who actually says what they mean. Let me try. Alethea Sperelakis, I really want to see you again, too. Let's talk later.'

'Let's talk later, Dan Cotton.'

Thea slipped her father's cell phone into her pocket and did some people-watching as she ate. She also continued to try and sort out the meaning and significance of her strange, tightly controlled exchange with Lydia Thibideau. Was there any sense in trying to set up another meeting to get any more information from the woman? Doubtful. Was there anyone else she could speak to about Jack Kalishar and the other patients who had been treated with SU890? At the moment, there was only one she could think of—her father. But unless he brightened considerably in terms of his processing speed and ability to respond to the sort of code that enabled Jean-Dominique Bauby to dictate his memoirs, it was going to be next to impossible. For now, the key to moving forward had to rest not with the man himself, but with the man's office, and his cluttered study at home.

Across the expansive cafeteria, a security guard wandered along the sandwich counter making his choice. He was quite a bit shorter than Dan, though, and didn't look nearly as handsome in his uniform. In seconds, the trigger of seeing the man had her fantasizing again about making love with Dan—this time in the den she had conjured up for him, and even more passionately than what she had envisioned in Thibideau's waiting room.

Sitting there in the still busy cafeteria, eyes half-closed, she wondered if anyone else in the crowded place was having a fantasy as rich and as enjoyable as was hers.

Aspies were defined in part by their concreteness and lack of latitude in their thinking. Yet many of them were involved in role-playing games that required the ability to transport themselves into alternative worlds, and to live in those wild, unpredictable worlds for hours on end. It was an ability that actually separated many with Asperger syndrome from the majority of neurotypicals. Did this ability carry over into other aspects of their fantasy life? Were their virtual sex lives richer, more passionate, and more quickly engaged than those of the typicals, even as their realities were more tightly bound?

Thea made a mental note to ask Dan. It would be as much fun to see his expression at the question as to hear his answer.

Before leaving for the ICU, she left a message for Julian Fang asking if he would be available to render an opinion about the extent and potential for treatment of Hayley's cancer. Thea had never responded sanguinely to being pushed or told what to do. Her many clashes over the years with her father attested to that. If the acupuncturist put even a single needle into Hayley. That's what she had said, almost word for word. Fortunately, Thibideau had said nothing of checking Hayley's acupuncture pulses—a skill at which Julian was profoundly adept.

Wondering if she might run into either of the twins, Thea set her tray on the conveyor belt and headed for the unit. If there were no visitors and no volunteer nurses in Petros's cubicle, she might try another question for him—one carefully formulated to determine where she would be most likely to hit paydirt in her search for more information about Jack Kalishar. Hopefully the Lion would have brightened enough to be ready for some yes-or-no exchange.

The woman at the security desk in front of the unit had been

replaced by a husky man with tattoos on the backs of both hands, whose name tag read
OFFICER WILLIAM SAUNDERS.
He dutifully checked her ID badge and watched as she signed in.

'Leave something behind?' he asked.

Distracted, she barely heard the question.

'Huh?' she replied. 'Oh, no. No, I didn't leave anything.'

What an odd question,
she was thinking as the glass doors glided apart and she strode into the unit, anxious to see who might be visiting. She was actually inside her father's cubicle before she realized that the figure in his bed, partially obscured by machines and tubes, being tended to by a nurse she had never seen with Petros, was an elderly woman.