Of Flesh and Blood (29 page)

“And you lived to tell?”

Despite his son’s attempt at levity, William picked up on his troubled eyes. Tyler had inherited those blue eyes, like so many of his other features, from his mother. At times, the resemblance was so strong, William found it painful to look at him. “What’s wrong?” he asked.

Tyler stared down at the desktop. “You remember that boy I told you about who had a leukemia recurrence?” he murmured.

“The spinal fluid?”

“Not ‘the spinal fluid,’ Dad. Nate Stafford.”

“Did Nate die?”

Tyler nodded.

“I’m sorry.”

All oncologists lost patients. It was inevitable. But William suspected something was different about this boy’s death. He sensed it would be best to let Tyler explain on his own terms, so he simply waited.

“Dad, he . . . um . . . died while I was treating him.”

“I assumed so.”

“No. I mean literally. In the middle of a procedure I was performing.”

“Oh.”

Tyler went on to summarize Nate’s doomed Vintazomab infusion. Nothing in his son’s description sounded beyond the realm of an unforeseen procedural complication, yet William felt extremely uneasy. “This treatment is largely unproven,” William said, trying to sound supportive. “You offered the family a last-ditch attempt to save their son’s life.”

Slouched even lower in his chair, Tyler merely shrugged.

“And you mentioned there were three deaths in the early trials of the drug.” William lowered his voice. “You did warn the family of the potential side effects?”

Tyler nodded slightly.

“Then what is it, Tyler?”

“Nate’s father is upset. Very upset.”

“Any father would be.”

“He blames me,” Tyler said.

“It’s not your fault.”

“He claims that I didn’t warn him of the real risks.”

“But you just told me—”

“Dad, I didn’t tell them that all three deaths in the previous trial occurred
only
in the subgroup who received Vintazomab directly into the spinal fluid.”

Ice ran through William’s veins. “You didn’t?”

“The parents were so anxious.” Tyler shrugged. “Every decision incapacitated them. Vintazomab was Nate’s very last hope. And the cancer was in the spinal fluid. I had to get the medicine to it. The boy had no time to wait for his parents to agonize over a decision.”

William wanted to accept his son’s explanation. He willed himself to say something reassuring, but he was already envisioning the potential legal consequences. “So you didn’t really get informed consent, did you?”

Tyler stiffened in his seat. “No. I guess not.”

“What are the parents planning to do?”

“Aside from suing me?” Tyler said. “The father is threatening to go to the press.”

“Damn it!” William slapped the desktop again. “Do you have any idea how lousy your timing is?”

“I’m sorry,” Tyler grunted. “I didn’t mean to inconvenience you. Next time, I’ll try to schedule my medical legal disasters better.”

Despite the back pain, William pushed himself up from his chair. “
Inconvenience me?
” He raised his voice to a near shout. “This hospital is teetering on the brink. And now you show up to give it a push at the moment it needs one least.”

Tyler jumped to his feet. “That’s all that worries you about what happened to Nate? How his death reflects on your precious fucking hospital?”

William shook his head angrily. “The hospital might mean nothing to you, but I have invested my life into it. And so did many others in our family.”

“Romanticize it all you want!” Tyler snapped. “It’s just bricks and stones. But Nate was a sweet kid with a whole life ahead of him.”

In William’s mind, all the crises suddenly melded into an insurmountable wall that was about to topple onto the Alfredson and erase a lifetime of work. In his heart, he knew he should try to console his son, but he felt so infuriated and helpless that he could not control himself. “Are you so pigheaded that you can’t see it, Tyler? The Alfredson represents hope to thousands of Nates.”

Tyler just glared back, unwavering.

“We provide them a level of care that almost no one else can. And we do so free of charge for families who couldn’t possibly afford it elsewhere.” William jabbed angrily at the window. “But if the board votes to sell the Alfredson to some private interest, it will become just another for-profit hospital. This country is teeming with those. What will happen to the other children like Nate then? Tell me that, Tyler!”

Without answering, his son slowly turned and walked for the door. Reaching the doorway, he looked over his shoulder at William. The bitterness had left Tyler’s features. His eyes were clouded with naked hurt. He opened his mouth as if to speak, but nothing came out. He stared helplessly at his father for a moment longer and then turned away.

Nikki Salazar imagined she could feel the sunlight activating the vitamin D under her glistening skin. The hard rollerblading in the summerlike heat and brightness was what she needed after having spent so much time indoors, working overtime shifts. She didn’t need the extra income, but she had relied on the added work to distract her from her personal turmoil. Her fitful sleep and those extra shifts, with all that time spent on her feet, had only aggravated the throb of her collapsed vertebrae that had dogged her since the car accident. The anti-inflammatories weren’t touching the pain.

Two days before, after weeks of resisting, Nikki had dug out the last bottle of hydromorphone tablets from the back of her bathroom cupboard. She had hung on to the bottle “in case of emergency,” despite her Narcotics Anonymous sponsor’s repeated warnings of the foolishness of doing so.

After almost three sober years, Nikki was surprised by how easy it was to pop that first pink tablet. She swallowed it without regret or remorse, rationalizing that nothing else would touch her pain. And it did help. She attributed the dull sweet euphoria that followed to nothing more than a natural response to finally receiving some decent pain relief. Keen not to wait for the throb in her back to recur, Nikki popped two more pills within four hours of the first. By the time she headed out for her rollerblade, she was pain-free and had already consumed fourteen of those fifty pills.

Since the car accident, her vertebrae couldn’t bear the impact of jogging, which used to be her favorite exercise. Nikki had bought a mountain bike but, tired of the mud and the spills, soon gave up on trail riding. She stumbled onto rollerblading two years earlier only after being goaded into it by a blind date (her one and only) who wanted to establish how adventurous and fun he was. Though the date was a complete bust, Nikki was hooked
from the first strides. Rollerblading had since become her primary means of exercise and her best stress reliever.

She saw another advantage in skating, too; it was one of the few sports her former fiancé, Glen, had never pursued. Nikki didn’t need another activity that reminded her of his absence. The memories waxed and waned, but lately she had thought of Glen often. Especially after Nate Stafford’s death.

She found it strange that a little boy could remind her of a grown man, but the more she considered the association, the less odd it seemed. They were both baseball fanatics. They had both died far too young. And even at thirty-two, Glen had been just a little boy at heart. He could be so annoyingly immature—unreliable, overly spontaneous, and unself-conscious to the point of embarrassing—yet he had such a big heart. He could read her moods like no one else; without prompting, he knew when she needed an encouraging word or to be taken out dancing or to be just left alone. Nikki doubted she would ever again find anyone who loved her like Glen did.

And certainly not a man who is already married
, Nikki thought, still embarrassed at the memory of how she had thrown herself at Tyler McGrath that night at O’Doole’s Pub.

Before Tyler, Nikki had never felt the slightest spark for any of the young—or sometimes middle-aged or even older—doctors who had shown interest in her. In the first year of working with Tyler, she had resisted the effect of his blue eyes and disarming smile. Unlike several other SFU nurses, who gushed over and flirted with him as though they were still in the ninth grade, she had steadfastly maintained a professional distance. Nikki couldn’t help but admire his bedside manner, though. His patients and their parents routinely bonded with Tyler in a way she rarely saw with the other physicians. And while he was more serious in temperament than her happy-go-lucky former fiancé, sometimes even brooding, Tyler showed a few glimpses of Glen’s irreverent antiestablishment streak.

That night at O’Doole’s, the celebratory mood, nostalgic music, and warmth of their dance floor contact had all conspired to cloud her judgment. With their bodies pressed together and his sinewy arms wrapped around her, she had lost herself in a moment. It had gone way too far and ended too abruptly. At the time, she felt humiliated, confused, and hurt by his sudden departure. As those feelings abated, she realized he had made the right choice for both of them. An affair would have only led to more emotional upheaval
at work. And she had lived through enough of that during her days of painkiller addiction and pill theft.

Every time Nikki had seen Tyler since O’Doole’s, the awkwardness pooled anew and she hid behind a frosty aloof front, behaving as though she resented him for his actions. She wanted to let him know otherwise—to tell him how much she missed their friendship at work—but she hadn’t found the right moment or mustered the nerve yet.

On the way home from rollerblading, she felt a new twinge in her back and the growing desire for another hydromorphone tablet. Suspecting she would need more than her remaining pills, Nikki considered how best to extract a prescription from her doctor, who was well aware of her addiction history. She considered trying the local walk-in clinic instead.

Once home, Nikki polished off an entire carton of orange juice, drinking it straight from the container—her one habit that used to infuriate Glen. She permitted herself one more tablet of hydromorphone before work. She registered a hint of alarm at how frantically she grabbed for the bottle and dug out a pill.

She ran a hot bath and soaked in the tub until she felt the narcotic kick in and her worries drain away. She toweled off and slipped into a set of mauve scrubs that complemented her improved mood.

Nikki arrived on the sixth-floor unit twenty minutes early for her afternoon shift. She had hoped to catch up on her charting, but before reaching the nursing station, she bumped into Keisha Berry’s parents standing hand in hand in the hallway outside their daughter’s room.

“Keisha’s gone for a chest X-ray,” Jonah explained.

“That’s routine, isn’t it?” Maya asked anxiously.

“Very.” Nikki laid a hand on Maya’s shoulder and squeezed reassuringly. “You know us, Maya, we always think the roof will cave in if we stop running tests on our patients for even one second.”

Maya nodded, though the worry clung to her features.

“How’s Keisha today?” Nikki asked.

“She’s doing better,” Jonah said. “The headache is almost gone with those steroid medicines. And she’s getting her appetite back.”

“She’s even drawing again,” Maya added.

“That’s a good sign. And good news for me. She’s promised to draw me a tiger and a puppy.” Nikki winked. “I hope she puts a fence between ’em.”

Maya’s face creased deeper. “But the steroids are only making her feel better. They’re not really fighting off her cancer, are they?”

“They’re shrinking the swelling,” Nikki said, while evading the question. “That’s important.”

Nikki had noticed a marked change in Maya over the past days. The helpless anxiety that was so common among the parents of children on the SFU now flamed in her eyes, too. At first, Nikki had assumed Keisha’s clinical deterioration had ignited her anxiety, but the day before Maya had made it clear that Nate Stafford’s death was responsible. “That poor boy had the same type of cancer as our Keisha, didn’t he?” she had said.

Nikki tried to release Maya’s shoulder, but the woman reached out and grabbed her hand so that all three of them were physically linked. “Nikki?”

“Yes, Maya?”

“I don’t understand this . . . um . . . delay.”

Nikki frowned. “What delay?”

“Well, we signed all those consent forms days ago for the experimental treatment protocol. Dr. McGrath seemed to be in such a hurry to get Keisha going on this Vintazomab. And now . . . well, it’s like he’s changed his mind or something.”

Still holding his wife’s hand, Jonah shot her a cautioning look. “Now, Maya, Dr. McGrath knows what he’s up to. He already explained why he had to wait to start treatment. He needs to get all the right approval first.”

“It’s just that he was so eager before,” Maya said.

Nikki understood exactly what explained Tyler’s reticence, but she kept it to herself. “I know the wait is so frustrating,” she soothed. “Dr. McGrath has to follow the hospital protocol.”

“That’s right, baby,” Jonah said.

“I just hope he gets it soon,” Maya muttered.

Nikki freed her hand and, with a promise to visit Keisha within the hour, continued on to the nursing station. Inside the enclosure, she spotted Tyler sitting at the back desk reviewing lab work on a computer screen. She sat down in the chair beside his.

At the sound, he spun in his seat to face her. “Hey.” He showed her a tired grin.

“Hey, yourself.” She felt a sudden pang of sympathy for Tyler and
decided against adding to his worries by telling him about his sister’s apparent migraine and evasive attitude in the courtyard. “How’s it going?”

“Busy.” He shrugged. “I’m on call, and we have three new admissions to the ward today.”

She nodded. “I just ran into Keisha’s parents.”

“Oh?”

“Maya was asking me about the Vintazomab protocol.”

“She’s anxious to get Keisha going on it, huh?” he sighed.

“As in yesterday.”

Tyler rubbed his eyes. “Nikki, I’m supposed to run all experimental protocols past my colleagues at our clinical rounds to get their approval before proceeding.”