Second Opinion (13 page)

CHAPTER 22

'The step-down unit? How can you possibly transfer him there?'

'We… needed the bed—two beds, in fact—and your father was first on the list.'

The intensivist on duty, a doughy, baby-faced doc named Spiegel, withered before Thea's eruption.

'What list?' she demanded.

'Every day we make a list of who can be transferred out of here. Then we clear the name with their PCP. As soon as we need beds, we start at the top of the list. Because of the numbers at the Beaumont, the average patient stay here is not very long. Sometimes it's measured in hours. Your father's been here for many days.'

'But he had a pericardial drain in place.'

'It wasn't draining anything, so we pulled it. Same with the intracranial ventricular drain. I'm sorry, Dr. Sperelakis, but as I said, we're getting new patients all the time. We've got to keep them moving.'

'Who authorized this?'

'Well, the truth is no one has to authorize any transfer from the unit except the intensivist on duty, which, at the moment, is me. But because of who your father is, I consulted with Dr. Niko, who put in the drain, and also with Dr. Hartnett, his PCP. They both approved moving Dr. Sperelakis to the step-down unit on Eaton One.'

'I can't believe this.'

'The patient that took his place is very unstable. Go and see for yourself.'

'I can't believe this,' Thea said again. 'Do you know that just this morning someone tried to kill him?'

'Kill him?'

'The fight in the hall between a man dressed as an orderly and the security guard—that was about my father.'

'I wasn't told that.'

'Well, it's true… Listen, Dr. Spiegel. I'm sorry to snap at you. I know you just did what you thought was right. I just wish you had contacted me before moving him.'

'I spoke with Scott and your brother, and your sister is down there with him right now. He really is quite stable. Besides, anything we can monitor here, they can monitor on Eaton One.'

'But with less staffing than you have here.'

Thea apologized again and took the stairs back down to the tunnel. The Eaton Building, home to the cardiac cath lab and most of the powerful cardiology service, was so new that Thea had never been in it. Everything surrounding Petros in the step-down unit was as gleaming and sophisticated as in the ICU. The nursing coverage, Thea's benchmark for just how good a hospital was, seemed reasonably comprehensive.

In every way the Beaumont's worldwide reputation for excellence seemed well earned, except that something within its walls was wrong—very wrong—and the man connected to a ventilator and monitor screen in Step-Down 6 almost certainly knew what it was.

Reflexively, Thea scanned the numbers as she entered the private room. Nothing worrisome.

'Hey there, sis,' Selene said. 'One small step-down for a man, one giant leap for old Petros.'

'Do you think he's stable enough for this move?'

'What do I know? I'm only a dentist. At least according to what Dad believes about us hand surgeons, I am.'

Thea wanted to warn her to watch what she said, that in fact their father was in no coma whatsoever. But she had given her word, and even if she shouted the truth from the rooftops, Petros would give no sign that supported her. Still, even without any indication, someone believed her enough to have tried to silence him forever. Now, thanks to this transfer, he was again in danger.

Like everything else in the Beaumont, the fourteen-bed step-down unit was large and bustling and well staffed. But despite the excellent coverage, the nurses could not be expected to police SD 6 anything approaching 100 percent of the time. It wasn't a simple matter to kill someone on a ventilator and cardiac monitor, with nurses around who were skilled in resuscitation, but it could be done. One possibility was something as simple as a four-minute replacement of the oxygen driving the ventilator with something like nitrous oxide from a small, portable tank.

'Do you think we should get someone in here around the clock?' Thea asked.

Selene, wearing a perfectly tailored gray linen suit that might have come straight from a Paris design house, and enough gold bangles on each wrist to sink a lifeboat, looked at her queerly.

'The volunteer nurses that were helping out in the unit just sat around most of the time reading magazines.'

'I was thinking more in terms of security people, like off-duty policemen.'

'Do you have any idea how much that would cost?'

'No, but I have Dad's bankbook. Believe me, he can handle it.'

'Pardon me for asking, but what is this all about? That cartoon Dimitri has put together of the accident?'

'That and the incident with the bogus orderly.'

'You think they're connected?' Selene sounded incredulous.

'I do, actually,' Thea said, carefully measuring her words so as not to upset Petros, who she felt certain was listening. She also found herself wondering if whoever had sent the killer up to the ICU could have had anything to do with ordering or authorizing the transfer.

'Oh, honey, I know how badly you want to believe Dad is coming out of this,' Selene said, 'but logic and medical science say he isn't. He had an accident, his brain was damaged, he's in a deep coma, he's not going to wake up, and sooner or later, more likely sooner, pneumonia or heart failure is going to take him. And if he had a say in the matter, I believe Dad would insist on it.'

'I don't think we should be talking about his condition at the bedside like this, just in case.'

'Whatever you say, baby.'

'I do have something I wanted to ask you about.'

'Shoot.'

'Do you know anything about Jack Kalishar?'

'The department store guy?'

'Yes. He was a patient of Dad's.'

'I didn't even know that. Dad took the confidentiality of his patients pretty seriously, just like he took everything else in life, except maybe parenting.'

Thea winced, but did not repeat her warning to keep remarks about him away from his bedside. She knew that she was asking about the billionaire as much to communicate with their father as with Selene.

'I've become friendly with a patient at the institute named Hayley Long,' she said. 'She has metastatic pancreatic CA. Jack Kalishar was treated here for the same thing, and according to Dr. Thibideau, is fine after five years.'

'I want
that
treatment.'

'Exactly. Selene, I assume you've heard that I've told Karsten I would take over Dad's practice for now.'

'She called and told me. You know that the two of them are an item, Dad and her, right?'

Please don't say anything nasty about her.

'Yes, she let me in on the secret. She's gotten me temporary privileges, but I don't have access yet to his patients' medical records. I have to go through Scott Hartnett for anything like that, at least until my staff privileges are expanded. I want to see Hayley's records and Kalishar's, too. Is there any way you can save me the hassle of going through Scott and just send them over to Dad's office?'

'Wish I could, but it isn't possible. Each patient has a number that restricts who on the staff has access to their electronic records. If your friend Hayley adds my code number to her records, I suppose I can get her chart over to Dad. I have no idea what his code is. Mine has like eight numbers and two letters in it. If I ever got caught giving it out, I'd be suspended.'

'Does Hayley have access to her own records?'

'Within a few months I think she will. Google and Microsoft are ahead of us in that regard.'

'Well, not to worry. I won't ever ask you to do anything compromising. First I'm going to check through Dad's desk and see if I can find his code. Then I'll let you and Hayley know if I need help with her record.'

'Just be careful.'

'What's that supposed to mean?'

'With this Thor system, things work both ways. Any request for information gets recorded someplace and transmitted to records security.'

'Brave new world,' Thea said.

'More like Kafka. For all I know there's a security team watching over that security team.'

Selene patted Petros on the cheek, her bangles clinking.

'Well, I've got to go, old shoe,' she said. 'I would think the least you could do was to wake up. You're not acting very grateful to this woman here for saving your life.' She turned to Thea. 'Take care, Princess Buttercup. Welcome to the staff of the Beaumont.'

Without waiting for a reply, Selene was gone. Thea ached for what their father was listening to, especially when the twins were at the bedside together. It was probably just as well that Dimitri wasn't among the man's regular daily visitors. She moistened a washcloth and mopped, then dried his forehead. Then she looked about, un-taped his eyes, added some lubricant, and bent low by his ear.

'Dad, did you hear all of that?' she asked. 'I need to get your records code so I can see exactly what was done with Jack Kalishar. Dr. Thibideau hasn't been very helpful. All she really told me is that he's still alive. Move your eye if you understand what I said.'

Thea gently moved his lids apart. Petros's pupils were mid-position—perhaps a bit smaller than usual.

'Dad, look up…'

He couldn't be sleeping, not after the conversation that had just gone on with Selene.

'Dad, please. Look up if you can hear me…'

There was no movement at all.

'Dad…?'

Nothing. Thea pulled back and stared down at the man. He wasn't hearing her. Not at all. She felt certain of it. There was no hint whatsoever that he was aware but locked-in. He wasn't aware at all. At this moment, Petros was as unconscious as everyone else believed he was.

CHAPTER 23

'You all right? You don't look so good.'

It was the patient with virtually incurable pancreatic cancer who was asking the question of the doctor.

'I was just going to say the same thing to you,' Thea replied.

'You'll get your chance,' Hayley said. 'In fact, I'm feeling bloated and a little uncomfortable up here in my stomach. I interpret every little ache, every little gas bubble as being another little cancer cell biting the dust. But you go first.'

Thea reviewed the developments surrounding her father and Jack Kalishar, the bizarre visit with Lydia Thibideau, and also the oddly truncated staff privileges conferred on her by Sharon Karsten and the credentials committee. Hayley, who had been reading Joyce Carol Oates in her usual spot near the doorway, had set her book aside and listened intently.

'So I think this Kalishar business might turn out to be a hopeful sign for you,' Thea said, unable to speak the name without wondering once again why her father had chosen it, of all the helpful words he could have given her. 'He was treated by the same physician in the same hospital as you, and he's a five-year survivor with no evidence of residual or recurrent disease.'

Hayley sighed.

'Doc, I got where I am today by being able to read people—many of them extremely oblique and difficult in that regard. You, my dear woman, are neither. It's great that you're trying to be upbeat and cheerful around me, but we'll get a lot farther a lot faster if you just take the things that are bothering you one at a time.'

'Sorry. I'll try.'

'Do we know if Kalishar and I are part of the same study?'

'Actually, we know that you're not. According to Thibideau, the drug you're getting is an improvement over the one he got.'

'Bad side effects?'

'Enough to modify the original drug. But Thibideau says this new version is showing great promise. You sleeping any better?'

Hayley took her hand.

'I'll assume that the wonderful, unselfish, caring physician in you wants to reach out to me,' she said, 'and to do what you can to make me feel better. We'll get to me later. I promise. Now, number one on the list of things that are weighing on you is…'

Thea sighed and stared down at their hands. Over the years, she had improved a thousand percent in the art of making direct eye contact when speaking with someone, but the improvement still left her well below the average neurotypical in that regard. Hayley either didn't notice the tendency, or more likely, chose not to comment on it.

'Well, number one is my father,' Thea said finally. 'I told you he was communicating with me, but refused to communicate with my brother Niko or my sister Selene. She's—'

'Niko's twin. I have this terrible shortcoming in that I pay attention to what people say to me—especially people I care about. What about Dimitri?'

'I don't know. He hasn't been here very much. I think Petros has chosen me and only me. Unfortunately, I didn't realize that at first, and told one of the nurses and Dr. Hartnett that he was awake and had communicated with me.'

'But they didn't believe you when he didn't respond to them.'

'Exactly.'

'Go on, please. I'll try not to interrupt. Interrupting is another one of my shortcomings.'

'Well, even though they might not have believed he had regained consciousness, one or both of them said something about it to other people. Now I have no idea who knows my father might be awake, and who doesn't. Not long after I failed to demonstrate Petros's ability to communicate, a man disguised as an orderly almost got into the ICU. I think he was trying to kill him.'

'But you're not certain of that.'

Thea shook her head.

'Earlier today, without my knowledge or opportunity to object, Petros was transferred from the ICU to the step-down unit. A little while ago, I was alone with him and tried to communicate. He's been very slow at give-and-take, but I thought he might be improving. This time, he didn't respond. Not at all.'

'Has he slipped back into a coma?'

'I don't know. They took the pressure monitor out of his head, so there's no easy way to tell if there's a new blockage.'

'If the chief of the institute is treated that way, what can / expect?'

'You're doing fine, and from all I can tell, you're getting great care. You know, it's possible my father is just being petulant. Thinking he was in a coma, Selene said some pretty harsh things about him at the bedside. If he heard her, maybe he just stopped talking.'

'Or maybe she knew he was awake… I'm sorry, sweetheart. That was the cynical broad from the land of Trust No One speaking.'

'That may be better than the land of Trust Everyone, where I come from. Now, tell me what's going on with you.'

'In a minute. First, tell me a little more about Jack Kalishar.'

'Do you know him?'

'No, but I know people who do. We billionaires are a pretty close bunch, you know, bound by the spirit of competition, plus an unbreakable creed of dislike, envy, and mistrust. Oops, there I go again. The wicked witch of the Southeast.'

'I think you're wonderful.'

'Kalishar.'

'Okay. From what I can tell, my father believes that the hit-and-run that nearly killed him was no accident. I have the sense that he knew something he shouldn't know, or saw something he shouldn't have seen, and then maybe he told the wrong person about it. After he allowed me in on the secret that he had regained consciousness and had the ability to communicate, I convinced him to summon all his energy and let me walk him through the alphabet searching for one word—just one word—to help me understand what might be going on.'

'And he gave you
Kalishar.
I like the clothes they carry in his stores. The Kalishar's Department Store chain is just the tip of his empire, though. The man's got his thumb in more pies than Little Jack Horner.'

'Any of it dishonest?' Thea asked, a hopeful note in her voice. 'Something that my father might have learned about him?'

'Not that I've heard. People like us don't get to where we are without stepping on a toe or two or reinterpreting a law here or there. Dr. Thibideau wasn't very helpful?'

'Typically, I just couldn't tell if she was holding back from me, but she certainly wasn't forthcoming either. You and I have talked about HIPAA. She only told me things she was certain I already knew or could find out by reading the papers.'

'Tell me something, Thea. While you were there, did Thibideau refer to anything in a yellow file folder?'

Thea shook her head.

'No,' she said. 'There was nothing about that.'

'Well, they exist—at least for me one exists, and I'm pretty sure I caught sight of a lot more of them. They're in a walnut or oak file cabinet behind her desk.'

'Four drawers tall. I saw it,' Thea said, closing her eyes to bring the image of Thibideau's office into shaper focus. 'Brass handles and a little statue of… of a ballerina on top.'

'Aren't you something.'

'I remember thinking that Dr. Thibideau was one of the least ballerina-like women I have ever met. I almost asked her about it.'

'Probably just as well that you battled that particular impulse back, kiddo. Your Asperger's therapist would be proud.'

Thea managed a thin smile.

'So Dr. Thibideau was using a folder and not an electronic record?'

'Actually, she had her computer going, too, but mostly she paid attention to me and referred to the yellow folder.'

'So, do you think she has a folder for Jack Kalishar?'

'I wouldn't be surprised.'

'Maybe I could talk to her about that.'

Hayley smiled at her patiently.

'If she didn't pull Kalishar's file out when you were there in her office, do you think she'd do it just because you went back there and asked?'

'Just a thought.'

'And a very excellent thought, too… But I might have a better one.

'What?'

Flowers.

'But what would giving her flowers accomplish?'

Hayley laughed out loud.

'Not those kind of flowers, Dr. Thea.
Sean
Flowers. He works for me.

Thea didn't understand why Hayley had found that miscommuni-cation so funny.

'How can this Flowers help us with Dr. Thibideau?' she asked.

Hayley sighed and cast about as if searching for guidance in picking her words.

'There are times in various aspects of my business enterprises,' she began, 'where a rival company might have hidden away information that would help our company make important decisions.'

Thea looked at her blankly.

'Such as?'

'Such as whether that company plans to release a product that we have only recently begun to research at the cost of tens of millions of dollars. It would be worth a great deal to us to have that information. Sometimes, the secret to getting it is Sean Flowers.'

'I think I'm beginning to understand.'

'Good. Sean is an expert at getting ahold of information. Other companies have their version of Sean also.'

'You mean like industrial spies.'

'Well, I suppose that's one way to put it.'

'Is there another?'

There was admiration in Hayley's expression.

'No,' she said. 'No, I don't suppose there is.'

'So you want to have this Mr. Sean Flowers of yours break into Dr. Thibideau's office.'

'He does have that ability. Yes.'

'And he would know what he was looking for?'

'Well, Thea, that depends on precisely what we want. It may be that you would have to go in there with him and review the charts right there.'

'I wonder how many of them there are.'

'Altogether? Hundreds, I would bet. I mean, pancreatic cancer is one of the most common, and she is one of the most referred-to experts in the field. The cases come rolling in to her. You think you could learn stuff from studying charts other than mine and Jack Kalishar's?'

'Quite possibly. I wish I knew exactly what I'd be looking for.'

'I think when you see it, you'll know. Somewhere in that locked-in brain of his, I think your father feels the same way.'

'Maybe. Maybe so.'

'Okay, then,' Hayley said, 'we're on?'

Thea thought for a few moments, then shook her head.

'I don't think so,' she said. 'Earlier today, I told the president of the hospital a lie about why I wanted staff privileges here. I don't remember the last time I lied to someone like that. Then, just a little while later, I lied to her again. It wasn't as hard the second time.'

'I promise you, Thea, companies do this sort of thing all the time, even companies like ours that have a reputation for high standards and ethical practices. The last thing I want is for you to think badly of me and the way I do business, but getting this information seemed important to you, and in case you forgot, it might turn out to be sort of important to me as well.'

'You have a point there.' so are we a go.'

Thea considered the question again.

'There are a lot of aspects of my Asperger syndrome that I wish I didn't have,' she said finally, 'but on the other hand, there are a lot of aspects I like having. It's hard to explain.'

'I think I understand.'

'Then you understand why at this point at least, I don't feel comfortable breaking into Dr. Thibideau's office.'

Hayley stared down at her hands as she picked at a cuticle.

'We'll see if we can find another way,' she said at last. 'Now, when are you bringing this acupuncturist of yours over to see me?'

'Tomorrow evening. Not a word to Dr. Thibideau if you can help it.'

'Not a word.'

'Do you think that omission is a form of lying?'

'I think you're a really terrific person, Thea. That's what I think.'

'Professor Fang and I will be here right after dinner, I think.'

'I'll be right here. And don't worry, darling, I'm not the least bit disappointed in you for choosing not to involve Sean Flowers in this.'

'Actually,' Thea said, 'I hadn't even considered that you would be.'