Life Support (20 page)

"That's right."

"Did he have any surgery in the past five years? A corneal transplant, for instance?"

"I don't remember seeing anything like that in the record. I guess you could catch CJD that way."

"It's been reported." She paused. "There's another way it can be transmitted. By injections of human growth hormone."

"So?"

"You told me Brant Hill's doing studies on hormone injections in the elderly. You said your patients have shown improvement in muscle mass and strength. Is it possible you're injecting tainted growth hormone?"

"Growth hormone doesn't come from cadaver brains anymore. It's manufactured."

"What if Brant Hill is using an old supply? Growth hormone infected with CJD?"

"The old growth hormone's been off the market for a long time. And Wallenberg's been using this protocol for years, ever since he was at the Rosslyn Institute. I've never heard of a case of CJD in any of his patients."

"I'm not familiar with the Rosslyn Institute. What is that?"

"Center for geriatric research, in Connecticut. Wallenberg worked as a research fellow there for a few years, before he came to Brant Hill.

Check out the geriatric literature�you'll find a number of studies originating at Rosslyn. And half a dozen papers with Wallenberg's name as author. He's the guru of hormone replacement."

"I didn't know that."

"You'd have to be in geriatrics to know that." He rose from the chair, disappeared into an adjoining room, and came back out with some papers, which he set down on the coffee table in front of Toby. On top was a photocopied article fromJournal of the American Geriatrics Society, 1992. There were three authors listed, and the first name was Wallenberg's. The title of the article was, "Beyond the Hayflick Limit, Extending Longevity at the Cellular Level."

"It's research at its most basic," said Brace. "Taking a cell's maximum life span�the Hayflick Limit�and trying to prolong it with hormonal manipulation. If you accept the idea that our senescence and death is a cellular process, then you want to work toward prolonging cell life."

"But a certain amount of cell death is necessary for health."

"Sure. We shed dead cells all the time, in our mucous membranes and our skin. But we regenerate those. What we don't regenerate are cells like bone marrow and brain and other vital organs. They grow old and die. And we die as a result"

"And with this hormonal manipulation?"

"That's the point of the study. Which hormones�or combination of hormones�prolong cell life span? Wallenberg's been researching this since 1990. And he's finding some promising results. " She looked up at him. "That old man in the nursing home�the one who put up such a good fight?"

Brace nodded. "He probably has the muscle mass and strength of a much younger man. Unfortunately, Alzheimer's has messed up his brain.

Hormones can't help that."

"Which hormones are we talking about? You mentioned a combination."

"The accepted research shows promise for growth hormone, DHEA, melatonin, and testosterone. I think Wallenberg's current protocol involves various proportions of those hormones, plus maybe a few others."

"You're not certain?"

"I'm not involved with the protocol. I take care of only their nursing home patients. Hey, it's all pie in the sky right now. No one knows what works. All we know is, our pituitaries stop producing certain hormones as we get older. Maybe the fountain of youth is some pituitary hormone we haven't discovered yet."

"So Wallenberg's giving replacement injections." She laughed.

"Literally a shot in the dark."

"It might work. Seems to me Brant Hill's got some pretty healthylooking eighty-year-olds zipping around on that golf course."

"They're also wealthy, they exercise, and they live a carefree life."

"Yeah, well, who knows? Maybe the best predictor of longevity is a healthy bank account."

Toby flipped through the research article, then lay it on the coffee table. Once again she looked at the publication date. "He's been doing hormone injections since 1990, with no recorded case of CJD?"

"The protocol ran four years at Rosslyn. Then he came to Brant Hill and resumed the studies."

"Why did he leave Rosslyn?"

Brace laughed. "Why do you suppose?"

"Money."

"Hey, it's the reason I came to Brant Hill. Nice paycheck, no hassles with insurance companies. And patients who actually listen to my advice." He paused. "In Wallenberg's case, I hear there were other things going on. Last geriatrics conference I attended, there was some gossip circulating. About Wallenberg and a female research associate at Rosslyn."

"Oh. If it's not money, it's sex."

"What else is there?"

She thought of Carl Wallenberg in his tuxedo, the young lion with amber eyes, and she could easily imagine him being the object of female desire. "So he had an affair with a research associate," she said.

"That's not particularly shocking."

"It is if there are three people involved."

"Wallenberg, the woman, and who else?"

"Another M.D. at Rosslyn, a man. I understand things got pretty tense between them, and all three of them resigned. Wallenberg came to Brant Hill and resumed his research. Anyway, that makes it a full six years heXs been injecting hormones, with no catastrophic side effects."

"And no cases of CJD."

"None reported. Try again, Dr. Harper."

"Okay, let's look at other ways these two men might've gotten infected.

A surgical procedure. Something relatively minor, like a l corneal transplant. You might have overlooked that history in their outpatient charts."

Brace made an exasperated sound. "Why are you hung up on this, anyway?

Patients die on me all the time, and I don't obsess over it."

Sighing, she sank back on the couch. "I know it doesn't change things.

I know Harry's probably dead. But if he did have Creutzfeldt-Jakob, then he was already dying when I saw him. And nothing I did could have saved him." She looked at Brace. "Maybe I wouldn't feel so responsible for his death."

"So it's guilt, is it?"

She nodded. "And a certain amount of self-interest. The lawyer representing Harry's son is already taking depositions from the ER staff. I don't think there's any way I can avoid a lawsuit. But if I could prove Harry already had a fatal illness when I saw him�"

"Then the damages wouldn't seem so severe in court."

She nodded. And felt ashamed. Your dad was already dying, Mr. Slotkin.

What's the big deal?

"We don't know Harry's dead," said Brace.

"He's been missing for a month. What else would he be? It's just a matter of finding his body."

Upstairs, the crying had stopped, the battle finally won. The silence only accentuated their uneasy lapse in conversation. Footsteps creaked down the stairs, and a woman appeared. She was a redhead, so fair-skinned her face seemed translucent in the glow of the living room lamp.

"My wife, Greta," said Brace. "And this is Dr. Toby Harper. Toby just dropped by for some shop talk."

"I'm sorry about all the screaming," said Greta. "It's our daily tantrum. Tell me again, Robbie. Why did we have a kid?"

"To pass on the gift of our superior DNA. Trouble is, babe, she got your temper. " Greta sat down on the armrest next to her husband. "That's called determination. Not temper."

"Yeah, well, whatever you call it, it's hard on the ears." He patted his wife on the knee. "Toby's an ER doc over at Springer Hospital. She's the one who stitched up my face."

"Oh." Greta nodded in appreciation. "You did a very nice job. He'll hardly have a scar." She suddenly frowned at the coffee table. gRobbie, I hope you offered our guest something to drink. Shall I put on some tea?"

aNa, babe, that's all right," said Robbie. "We're all finished here."

I guess that's my signal to leave, thought Toby. Reluctantly she stood up.

So did Robbie. He gave his wife a quick kiss and said, "This won't take long. I'm just running over to the clinic." Then he turned to Toby, who was looking at him in surprise. "You want to see those outpatient records, don't you?" he asked.

aYes. Of course."

aThen I'll meet you there. Brant Hill."

I knew you were gonna keep bugging me about this," said Robbie as he unlocked the front door to the Brant Hill Clinic building.

"Check this out, check that out. Man, I figured I'd just let you see the damn charts for yourself, so you'd know I wasn't holding out on you." They walked into the building and the front door slammed shut behind them, setting off echoes down the empty hallway. He turned right, and unlocked a door labeled, MEDICAL RECORDS .

Toby flipped on the lights and blinked in surprise at six aisles of filing cabinets. "Alphabetical?" she asked.

"Yeah. As are that way, Zs the other way. I'll find Slotkin's chart, you find Parmenter."

Toby headed toward the Ps. "I can't believe how many records you have.

Does Brant Hill really have this many patients?"

"No. This is central records storage for all of Orcutt Health's nursing homes."

"Is that like a conglomerate?"

"Yeah. We're their flagship facility."

"So how many nursing homes do they run?"

"A dozen, I think. We all share billing and referral services."

Toby found the cabinet for the Ps and thumbed through the charts. "I can't find it," she said.

"I found Slotkin's."

"Well where's Parmenter?"

Brace reappeared in her aisle. "Oh, I forgot. He's deceased, so they probably moved that file to the inactives." He walked to a set of cabinets at the back of the room. A moment later he closed the drawer.

"Must've been culled. I can't find it. Why don't you just concentrate on Harry's chart? Look it over to your heart's content and prove to yourself I haven't missed anything."

She sat down at an empty desk and opened Harry Slotkin's file. It was organized in a problem-oriented format, with Current Illnesses listed on the first page. She saw nothing surprising here, benign prostatic hypertrophy. Chronic back pain. Mild hearing loss secondary to otosclerosis. All the expected ravages of old age.

She flipped to the past medical history. Again, it was a typical list, Appendectomy, age thirty-five. Transurethral resection of the prostate, age sixty-eight. Cataract surgery, age seventy. Harry Slotkin had been, for the most part, a healthy man.

She turned to the clinic visits record, which contained the doctors' notes. Most were routine checkups, signed by Dr. Wallenberg, with an occasional subspecialist note by Dr. Bartell, a urologist. Toby turned the pages until she paused over an entry dated two years before. She could barely decipher the doctor's name.

"Who wrote this?" she asked. "The signature looks like a Y something."

Brace squinted at the illegible handwriting. "Beats me."

"You don't recognize the name?"

He shook his head. "Occasionally we get outside docs coming in for specialty clinics. What's the visit for?"

"I think it says deviated nasal septum." Must be ENT."

"There's anENT specialist named Greeley here in Newton. That signature must be a G, not a Y."

She knew the name. Greeley occasionally consulted in the Springer ER.

She turned to the lab section, where Harry's most recent blood counts and chemistries were recorded on a computer printout. All were in the normal ranges.

"Pretty good hemoglobin for a guy his age," she noted. "Fifteen's better than mine." She turned to the next page and paused, frowning at a printout with the letterhead, Newton Diagnostics. "Wow, you guys don't believe in cost control, do you? Look at all these labs.

Radioimmunoassays for thyroid hormone, growth hormone, prolactin, melatonin, ACTH. The list goes on and on." She flipped to the next page.

"And on. The panel was done a year ago, and three months ago as well.

Some lab in Newton is raking it in."

"That's the panel Wallenberg orders on all his hormone-injection patients."

"But the hormone protocol's not mentioned anywhere in this chart."

Brace fell silent for a moment. "It does seem strange, doesn't it? To be ordering all these tests if Harry wasn't on the protocol."

"Maybe Brant Hill's padding the pockets of Newton Diagnostics. This patient's endocrine panel probably cost a few thousand dollars."

"Did Wallenberg order it?"

"Doesn't say on the lab report."

"Look at the order sheets. Cross-check the dates."

She flipped to the section labeled, Physician's Orders. The sheets were carbon copies of the doctors' handwritten orders, each signed and dated.

"Okay, the first endocrine panel was ordered by Wallenberg. The second panel was ordered by that guy with the bad handwriting. Dr. Greeley�if that's who this is."

"Why would anENT order an endocrine panel?"

She scanned the rest of the order sheets. "Here's that signature again, dated almost two years ago. He ordered preop Valium and six A.M. van transport to Howarth Surgical Associates in Wellesley."

"Preop for what?"

"I think this says Deviated nasal septum." " Sighing, she closed the chart. "That wasn't very helpful, was it?"

"So can we get out of here? Greta's probably getting pissed at me about now."

Ruefully she handed back the chart. "Sorry for dragging you out here tonight."

"Yeah, well, I can't believe I went along with it. You don't really need to look at Parmenter's record, do you?"

"If you can find it for me."

He stuffed Harry Slotkin's chart in the cabinet and slid the drawer shut with a bang. "To tell you the truth, Harper, it's not high on my list of priorities."

A light was burning in the living room. As Toby pulled into the driveway next to Jane Nolan's Saab, she saw the warm glow through the curtains, saw the silhouette of a woman standing in the window. It was a reassuring sight, that vigilant figure peering out at the darkness. It told her someone was home, someone was keeping watch.

Toby let herself in the front door and walked into the living room.

"I'm back."

Jane Nolan had turned from the window to gather up her magazines. On the sofa, a National Enquirer lay open to a spread on "Shocking Psychic Predictions." Quickly Jane scooped it up and turned to Toby with an embarrassed smile. "My intellectual stimulation for the night.

I know I'm supposed to be improving my mind with serious reading. But honestly"�she held up the tabloid�"I can't resist anything with Daniel Day-Lewis on the cover."

"Neither can I," admitted Toby. They both laughed, a comfortable acknowledgment that among women, some fantasies are universal.

"How did the evening go?" asked Toby.

"Very well." Jane turned and quickly straightened the sofa cushions.

"We had dinner at seven, and she pretty much devoured everything. Then I gave her a bubble bath. I guess I shouldn't have, though,> she added ruefully.

"Why? What happened?" "She had such a good time she refused to get out. I had to drain the tub first."

"I don't think I've ever given Mom a bubble bath."

"Oh, it's really funny to watch! She puts the foam on her head and blows it all over. You should've seen the mess on the floor. It's like watching a kid play. Which, in a way, she is."

Toby sighed. "And the kid is getting younger every day."

"But she's such a nice kid. I've worked with so many Alzheimer's patients who aren't nice. Who just get mean as they get older. I don't think your mother will."

"No, she won't." Toby smiled. "She never was."

Jane picked up the rest of her magazines, and Daniel Day-Lewis disappeared into her backpack. There was a Modern Bride in the stack as well. The magazine of dreamers, thought Toby. According to Jane's resume, she was single. At thirty-five, Jane seemed like so many other women Toby knew, unattached but hopeful. Anxious but not yet desperate.

Women for whom images of dark-haired movie idols would have to suffice until a flesh-and-blood man came into their lives. If one appeared at all.

They walked to the front door.

"So you think everything went well," said Toby.

"Oh, yes. Ellen and I will get along just fine." Jane opened the door and stopped. "I almost forgot. Your sister called. And there was a call from some man at the ME's office. He said he'd call back."

"Dr. Dvorak? Did he say what he wanted?"

"No. I told him you'd be home later." She smiled and gave a wave. "Good night."

Toby latched the front door and went to the bedroom to call her sister.

"I thought it was your night off," said Vickie.

"It is."

"I was surprised when Jane answered."

"I asked her to watch Mom for a few hours. You know, I do enjoy having one night out every six months."

Vickie sighed. "You're pissed at me again. Aren't you?"

"No, I'm not."

L _ "Yes you are. Toby, I know you're getting stuck with Mom. I know it doesn't seem fair. But what am I supposed to do? I've got these kids driving me crazy. I have a job, and I still end up with most of the housework. I feel like I'm barely treading water."

"Vickie, is this a contest? Who's suffering the most?"

"You have no idea what it's like trying to deal with kids."

"No, I guess I don't."

There was a long pause. And Toby thought, I *ave no idea because I never got the chance. But she couldn't blame that on Vickie. It was ambition that had kept Toby focused so squarely on her career. Four years of medical school, three years of residency. There'd been no time for romance. And then Ellen's memory had deteriorated, and Toby had gradually assumed responsibility for her mother's affairs. It had not been planned. It was not a path she'd deliberately chosen. It was simply the way her life had turned out.

She had no right to be angry at her sister.

ULook, can you come for dinner on Sunday?" asked Vickie.

"I'm working that night."

"I can never keep your schedule straight. Is it still four nights on, three nights off?"

"Most of the time. I'll be off Monday and Tuesday next week."

"Oh, God. Neither of those nights will work for us. Monday's open house at school. And Tuesday is Hannah's piano recital."

Toby said nothing, merely waited for Vickie to finish her usual litany of how full her calendar was, how difficult to coordinate the schedules of four different people. Hannah and Gabe were so busy these days, like all kids, filling up every spare moment of their childhoods with music lessons, gymnastics, swimming, computer classes. It was drive them here, drive them there, and by the end of the day, Vickie didnwt know which end was up.

"It's all right," Toby finally interrupted. "Why don't we try for another day?"

"I really did want you to come over."

"Yes, I know. I'm off the second weekend of November."

"Oh, I'll put that down. First let me make sure it's okay with the troopS IXll call you back next week, okay?"

"Fine. Good night, Vickie." Toby hung up and wearily ran her hand through her hair. Too busy, too busy. We can't even find the time to mend our bridges. She went down the hall to her mother's room and peeked in the door.

By the soft glow of the night-light, Toby could see that Ellen was asleep. She looked childlike in her bed, her lips slightly parted, her face smooth and unworried. There were times, like this one, when Toby glimpsed the ghost of the little girl that once was Ellen, when she could picture the child with Ellen's face and Ellen's fears. What became of that child? Did she retreat, to become entombed in all the numbing layers of adulthood? Was she reemerging amy now, at the end of life, as those same layers peeled away?

She touched her mother's forehead, brushing aside her tendrils of gray hair. Stirring, Ellen opened her eyes and regarded Toby with a look of confusion.

"It's just me, Mom," said Toby. "Go back to sleep."

"Is the stove turned off?"

"Yes, Mom. And the doors are locked. Good night." She gave Ellen a kiss and left the room.

She decided not to go to bed yet. No sense confusing her circadian rhythm�in another twenty-four hours she'd be back on the night shift.

She poured herself a glass of brandy and carried it into the living room. She turned on the stereo and slipped in a Mendelssohn CD.

A single violin sang out, pure and mournful. It was Ellen's favorite concerto, and now it was Toby's as well.

At the peak of a crescendo, the phone rang. She turned down the music and reached for the receiver.

It was Dvorak. "I'm sorry to call so late," he said.

"It's all right. I just got home a little while ago." She settled back on the sofa cushions, the brandy glass in hand. "I heard you tried to reach me earlier."

"I spoke to your housekeeper." He paused. In the background, she could hear opera music playing on his end. Don Giovanni. Here we are, she thought, two unattached people, each of us sitting at home, keeping company with our stereos. He said, "You were going to check the history on those Brant Hill patients. I was wondering if you'd learned anything more."

"I saw Harry Slotkin's chart. There was no surgical exposure to Creutzfeldt-Jakob ."

"And the hormone injections?"

"None. I don't think he was on the protocol. At least, it wasn't mentioned in his chart."

"What about Parmenter?"

"We couldn't locate his record. So I don't know about surgical exposure. You might ask Dr. Wallenberg tomorrow."

He said nothing. She realized that Don Giovanni was no longer playing, that Dvorak was sitting in silence.

"I wish I could tell you more," she said. "This waiting around for a diagnosis must be awful."

"I've had more enjoyable evenings," he admitted. "I've discovered that life insurance policies make very dull reading."

"Oh, no. That's not how you spent your evening, was it?"

"The bottle of wine helped."

She gave a sympathetic murmur. "Brandy is what I generally recommend after a bad day. In fact, I'm holding a glass of it right now." She paused, and added recklessly, "You know, I'll be awake all night. I always am. You're welcome to come over and have a glass with me."

When he didn't answer right away, she closed her eyes, thinking, God, why did I say that? Why do I sound so desperate for company?

"Thank you, but I wouldn't be much fun tonight," he said. "Another time, maybe."

"Yes. Another time. Good night." As she hung up, she thought, And what was I expecting? That he'd drive right over, that they'd spend the night together gazing into each other's eyes?

She sighed and restarted the Mendelssohn concerto. As the violin played, she sipped her brandy and counted the hours until dawn.

James Bigelow was tired of funerals. He had attended so many of them in the last few years, and lately they had become more and more frequent, like an accelerating drumbeat marking the passage of time. That so many of his friends had died was to be expected, at seventy-six years old, he had already outlived most of them. Now death was catching up with him as well. He could sense its stalking footsteps, could envision, quite clearly, his own stiff form lying in the open coffin, face powdered, hair combed, gray woolen suit neatly pressed and buttoned. This very same crowd filing by, silently paying their last respects. The fact it was Angus Parmenter and not Bigelow lying in the coffin was merely a matter of timing. Another month, another year, and it would be his coffin on display in this funeral parlor. The journey comes to an end for all of us.

The line moved forward, so did Bigelow. He came to a stop beside the coffin and gazed down at his friend. Even you were not immortal, Angus.

He moved past, headed up the center aisle, and took a seat in the I _ fourth row. From there he watched the procession of familiar faces from Brant Hill. There was Angus's neighbor Anna Valentine, who had recklessly pursued him with phone calls and casseroles. There were golfing buddies from the club, and couples from the winetasting circle, and musicians from the Brant Hill amateur band.

Where was Phil Dorr?

Bigelow scanned the room, looking for Phil, knowing he should be here.

Only three days ago, they had shared a few drinks at the club, had spoken in hushed tones about their old poker buddies, Angus and Harry and Stan Mackie. All three of them gone now, and only Phil and Bigelow remaining. A game of poker with just two of them didn't seem worth the effort, Phil had said. He'd been planning to slip a deck of cards into Angus's coffin, a sort of going-away gift for the great poker table in the sky. Would the family mind? he'd wondered. Would they think it undignified to have such a cheap token tucked in with the satin lining?

They'd shared a sad laugh about that, another round of tonic water.

Hell, Phil had said, he'd do it anyway, Angus would appreciate the gesture.

But Phil had not shown up today with his deck of cards.

Anna Valentine edged into his row and sat down in the chair next to him. Her face was thickly powdered, grotesquely so, every fine wrinkle emphasized by the attempt to camouflage her age. Another hungry widow, he was surrounded by them. Normally he would have avoided striking up a conversation with her, for fear of stirring up mistaken notions of affection in her one-track mind, but at the moment there was no one else close enough to talk to.

Leaning toward her, he murmured, "Where's Phil?"

She looked at him, as though surprised he'd spoken to her. UWhat?"

"Phil Dorr. He was supposed to be here."

UI think he's not feeling well."

"What's wrong with him?"

"I don't know. He begged off the theater trip two nights ago. Said his eyes were bothering him."

UHe didn't tell me."

"He only noticed it last week. He was going to see the doctor about it." She gave a deep sigh and gazed straight ahead, at the coffin . "It's terrible, isn't it, how everything's falling apart. Our eyes, our hips, our hearing. I realized today that my voice has changed. I hadn't noticed. I saw the videotape of our trip to Faneuil Hall, and I couldn't believe how old I sounded. I don't feel old, Jimmy. I don't recognize myself in the mirror anymore...." Again she sighed. A tear slid down her cheek, carving a trail through that dusting of face powder. She wiped it away, leaving a chalky smear.

Phil's eyes were hot*ering him.

Bigelow sat thinking about this as the line of mourners filed past the coffin, as chairs creaked and voices murmured around him, "Remember when Angus . . ."

"Can't believe he's gone . . ."

"Said it was some kind of stroke . . ."

"No, that's not what I heard . . . " Abruptly Bigelow rose to his feet.

"Aren't you staying for the service?" asked Anna.

"I�I have to go talk to someone," he said and squeezed past her, into the aisle. He thought he heard her calling after him, but he didn't glance back, he headed straight out the front door.

He drove first to Phil's cottage, which was only a few houses away from his. The door was locked, no one answered the bell. Bigelow stood on the porch peering in through the window, but all he could see was the foyer with the little cherry wood table and the brass umbrella holder. There was a single shoe lying on the floor�that struck him as odd. Wrong. Phil was so persnickety about orderliness.

Walking back out through the garden gate, he noticed the mailbox was full. That, too, was unlike Phil.

His eyes were bothering him.

Bigelow climbed back in his car and drove the winding half mile to the Brant Hill Clinic. By the time he walked up to the receptionist's window, his palms were sweating, his pulse hammering.

The woman didn't notice he was there�she was too busy yammering on the phone.