Miracle Cure (6 page)

Once the catheters were in place, as verified by a squirt of X-ray dye, blood pressures would be measured in the various chambers and vessels. Next, the left-side catheter would be repositioned inside Jack’s right, then left, coronary arteries, the two main vessels that branched off the aorta to supply blood to the heart muscle. X-ray contrast material would be injected into the arteries while a video camera recorded the flow and simultaneously projected it onto the monitor screen. The arteries would then be viewed from eight different angles.

Grateful to be back in his milieu, if only as an outsider, Brian examined the mechanized table, the powerful X-ray camera, and the various types of catheters hanging in sterile cellophane packets from labeled hooks along one wall. He was looking over the crash cart when his father was wheeled into the room by the cath tech, a tall, rail-thin black man who introduced himself as Andrew.

“Dr. Jessup left word to expect you,” he said. “She’ll be down shortly. Welcome to the lab.”

“How about you put me down as a no-show and take me back to my room,” Jack said.

“Is your father always like this?” Andrew chided.

“Oh, no. Not at all. He’s probably this mellow because he’s been premedicated.”

The room, which seemed quite spacious when Brian wandered it alone, began filling rapidly. The console-room nurse arrived next, took her place behind the glass wall, and began readying her monitoring and recording equipment. Moments later, the scrub nurse entered from the women’s dressing room, gowned herself, then pulled on a pair of gloves and began preparing her instrument tray. Brian helped Andrew move Jack from the gurney to the mechanized fluoroscopy table.

“Jesus, Brian, this is like being set down on a slab of ice. There’s no reason they couldn’t put a little heating coil in these tables. None at all. A little cushioning, too. Don’t X rays go through cushioning? Hey, Andrew, how about a pillow. I can have a pillow, right?”

Brian knew that Jack’s machine-gun speech and litany of complaints meant only that he was scared stiff. Andrew, apparently appreciating the same thing, put his hand reassuringly on Jack’s shoulder. Brian knew his assessment was right when Jack made no attempt to move it away.

“Good morning, everyone.”

Carolyn Jessup entered from the women’s lounge and took command of the room instantly. She wore a paper hair-covering and mask, loose scrubs, and tennis sneakers, and looked as engaging in that outfit as she did in her lecture suit. Her first stop was at Jack’s side.

“Have you been behaving, Jack?” she asked.

“Complaining, but behaving. You look very mysterious, with just your eyes showing like that.”

Brian groaned inwardly. Suddenly, Black Jack Holbrook, the man whose glare set 270-pound linemen onto their bellies for twenty push-ups, was a puppy dog.

“All women look alluring and mysterious in this
getup,” Jessup said. “That’s why there’s such a clamor for jobs in the OR. Before we begin, do you have any questions?”

“None, except what am I doing here?”

“Without these pictures, we’re just about blindfolded in trying to figure out what to do to help you.”

“As long as one of the choices isn’t surgery.”

Brian had discussed with Jessup the aftermath of Jack’s catastrophic post-op course.

“He’d probably be willing to go along with just about anything,” Brian told her that first night, “except repeat bypass.”

The expression in Jessup’s eyes was knowing.

“We’ll see,” she said.

Now, she bent down to whisper a few words of encouragement and then crossed over to the scrub nurse, who helped her glove and gown.

Let the games begin
, Brian thought, noting how small and frail his father looked, sandwiched as he was between the table and the massive fluoroscopic camera.

Gloved, gowned, and masked, Carolyn approached the table, polled the console nurse and each person in the room with her eyes to ensure they were ready, and began. Her movements were economical and assured. Her skill at inserting the large-bore guide needles into the femoral artery and vein was unerring.

“Brian, I’ve sent for his old films from Suburban,” she said, threading the long catheters up without breaking tempo. “They should be here later today.”

“It’s been about four years since he was done last, so I’m not certain how much help the films will be. You know, I don’t think I’ve ever seen an arterial catheter quite like that.”

“That’s very observant of you. It’s a prototype from Ward-Dunlop, the surgical supply people. We’ve been
working on the development of this catheter with them for three years. Right now, we’re one of several institutions evaluating it. It’s all we use here.”

“I can see why. It looks like a definite improvement over the one that we were using.”

“It is. In another year or so, we expect every cath lab in the country to be using them. Hey, Jack, are you still with me?”

“I’m with you.… But I’d rather be with you in Hawaii.”

Jack’s speech had slowed and thickened. His eyes were closed. The pre-op medication had kicked in right on schedule.

“Good,” Jessup said. “If anything hurts or bothers you, just shout out.”

“I will.”

“Now, Jack, I want you to know that I’ve asked another doctor to stop by and look at these arteries of yours with me.”

“Fine by me. Whatever you say.”

“His name is Dr. Randa. He’s the chief of the surgical unit here at BHI.”

“No surgery,” Jack managed.

“I understand that’s how you feel, Jack,” she said with, it seemed to Brian, a hint of flirtatiousness in her voice, “and right now I’m not suggesting anything. Just a consult. He’s just going to look at the films and say hello. Okay?”

“If … you … say … so.”

Brian was pleased to hear his father capitulate so easily, although he was well aware of the role sedation was playing in Jessup’s small victory. He was also elated that Laj Randa was being called in on the case, even though he had once heard the surgeon described as two velvet hands on a 130-pound asshole.

As Jessup advanced the catheters into Jack’s heart, she checked their position by shooting in a small burst of X-ray opaque dye and turning on the X-ray camera for short exposures using a toe pedal on the floor. Brian was not surprised that she checked much less frequently than most operators. She performed the pressure measurements and brief injections of the chambers on the right side of the heart, then turned her attention to the more important left side, and Jack’s coronary arteries in particular.

“Okay,” she said. “Let’s start with the right coronary. Left anterior oblique view, please, Andrew.”

The tech adjusted the position of the huge camera to the first of what would be eight different views, and Carolyn Jessup did the first injection of dye. In between glances at the EKG monitor and at his father, Brian studied Jack’s coronary arteries on the video display. With each injection, the arterial tree lit up bright white against the pulsating gray of the heart itself. Although the main vessels followed a similar pathway from patient to patient, the overall pattern of the arteries was actually as unique and individual as fingerprints.

Jack’s vessels were as bad as Brian had feared. There were arteriosclerotic plaques blocking portions of nearly every artery that mattered. Two of the grafts from his previous surgery appeared to have closed. For three decades of marriage, Jack and Shirley Holbrook had drunk and smoked to excess. After her death from alcohol-induced jaundice and kidney failure, Jack had stopped drinking altogether. He stopped smoking a year or two after that, but much cigarette-related damage had already been done.

After the final injection of the left coronary—the so-called Widowmaker Artery, Brian whistled softly through his teeth and looked away. Jessup turned from the table to face him.

“Not a pretty picture,” she said softly.

Jessup was withdrawing the catheters when the door to the men’s locker room burst open, and Laj Randa strode into the cath lab, followed at a respectful distance by two of his fellows. The surgical chief was no more than five feet four, with café-au-lait skin, a short black beard, and piercing dark eyes. He wore a royal blue silk turban and had a steel bracelet on his right wrist.
A Sikh
, Brian thought.
Mystical, deeply religious, persecuted in the Punjab of northern India for centuries
. He had trained with a Sikh during his fellowship. The man was as determined, as opinionated and intense, as anyone he had ever known. If Randa was equally fervent, the hair beneath his turban had never been cut, and most of his beard was actually rolled up tightly beneath his chin.

“So, Carolyn,” Randa said, breezing past Brian, “this man is how old?”

His accent was a mix of British and Indian.

“Sixty-three. He—”

“And who did his previous surgery?”

“Steve Clarkin at Suburban did a quintuple bypass six years ago,” Brian said.

Randa stopped short and turned slowly to Brian, who towered over him.

“And you are?”

“Jack’s son, Brian Holbrook. I’m a—”

Randa had already turned away.

“Carolyn, could you have your nurse run the film for me.”

Jessup nodded to the control-room nurse, who could hear everything they were saying. Surely Randa knew that, too, Brian thought. He could have simply asked the nurse himself.
A 130-pound asshole
. Whoever had made that assessment obviously knew what he was talking about.

Moments later, Jack’s catheterization began to replay on the monitor.

“See,” Randa said to his sycophants, “only three grafts are left open and one of them is nearly closed. Typical result for Clarkin.”

The remark was inappropriate under any circumstances, but doubly so in the presence of Clarkin’s patient. Jessup, obviously used to the surgeon, seemed unfazed.

“So,” Randa said as soon as the screen went dark, “are you planning on treating this man with your magic juicer?”

“Laj, let’s not get into this here.”

“I read an article about your drug in the
Boston Herald
. The
Herald!
Why not the
National Enquirer?”

“I don’t know where the lay press is getting its information about Vasclear,” Jessup said patiently.

“Obviously someone is feeding it to them. I don’t like getting my medical information through the tabloids. From the beginning of science, methods have evolved to inform the scientific community of a new discovery. They do not include the
Boston Herald.”

“I’ve got half a dozen academic papers on the drug accepted or already published in very prestigious journals. The FDA has thousands of pages of our research documentation and dozens of our angiograms. Now please, Laj. Let’s discuss this someplace else. As for your question about this patient, our double-blind research protocol bars anyone from Vasclear treatment who has had bypass surgery, so Mr. Holbrook doesn’t qualify.”

“Whatever you say.”

Randa walked past her to the table. Brian could see Jack’s eyes open, then close. He was awake and very much aware.

“I am Dr. Randa,” the surgical chief said, not bothering to shake Jack’s hand or even to ensure that he was
awake. “Your arteriograms show a great deal of arteriosclerotic blockage throughout the arteries of your heart. You would benefit from bypass surgery as soon as possible. Dr. Jessup will go over the details with you and set up a time. I would suggest if there is an opening in my schedule, that you have the procedure done before you go home. Otherwise, you should be at bed rest until something can be arranged. One of my fellows will be up to see you later today. Good day, Carolyn.”

“Thanks for coming down,” she said as he was heading out the door.

Brian went immediately to his father.

“You okay?” he asked.

“No surgery,” Jack said.

“We’ll do our best. But listen, Pop, I don’t want to lose you, and the girls would be devastated. I’ll do my best to protect you from surgery, but whatever it takes, I’m going to recommend, including a repeat bypass. I need your promise that you’ll go along with that. Jack?”

There was a prolonged silence.

“I don’t like that guy,” Jack said finally.

“You don’t have to like him, Jack,” Jessup said. “You just have to believe us that he’s one of the very best in the world at what he does.”

She motioned Brian across the room and out of Jack’s earshot.

“Randa’s an absolute boor, I know,” she said. “But trust me, he really is a wizard in the OR. Lately, he’s even more unbearable than usual because of our research. I can’t believe he isn’t feeling very threatened by the Vasclear results we’ve been getting.”

“If what I’ve been hearing is correct, I understand why. He’d be like a blacksmith watching a Model T Ford rumbling up the road. Dr. Jessup, about putting Jack on Vasclear—”

The cardiologist shook her head.

“I’m sorry, Brian. In almost three years of research we haven’t broken protocol once. Not once. The only thing I can promise you is that I’ll mention the situation to Dr. Art Weber, the project director from Newbury Pharmaceuticals. But you know, even if he said yes, which is doubtful, Jack would have to be randomized into the study like every other patient. That gives him only a thirty-three percent chance of getting into the maximum-treatment group and an equal chance of getting placebo.”

“I understand, but please, do what you can. If we really push, there’s a possibility we could talk Jack into surgery. He’s taken to you like no other doctor he’s ever had. But if we can manage him with medications alone, we really owe it to him to try that.”

“Well, we might be able to buy some time by juggling his meds. I have a few ideas that might help the situation, especially after seeing his pressures on this cath. And I will speak with Dr. Weber, I promise you that. But I’d have to say that as things stand, surgery is my recommendation.”

“Okay. I’m not arguing. But I need time to think and to discuss this with Jack. I haven’t seen many patients go through the hell he did after surgery. We nearly lost him.”

“I know.”

“Well, thank you. There’s no need for you to wait around here. I’ll stay with my dad until he gets back upstairs.”