Of Flesh and Blood (3 page)

Hospital? More like a goddamned city, he thought. Why did I come back here of all places?

“Tyler!” a baritone voice called from somewhere to his right.

He stopped and scanned the landscape before he spotted the source of the voice emerging from the arched doorway of the redbrick building. Dr. William McGrath approached with the same purposeful stride that carried him everywhere. At seventy, the Alfredson’s president and CEO had a thin, wiry body and ramrod posture that defied age. As always, his graying brown hair was cropped short and he wore no tie under his navy jacket.

“You’re a long way from home,” William said good-naturedly, though his gray eyes brimmed with inquisitiveness.

“I had to review spinal fluid cytology with a pathologist,” Tyler said.

William squeezed his Cary Grant chin between his index finger and thumb. “Our paths hardly cross these days. Are you settling in okay?”

“
Settling in?
” Tyler frowned. “I’ve been here for over a year.”

“A year already? Amazing.”

Tyler shifted from foot to foot. “A patient and his family are waiting for me—”

“The spinal fluid?”

William’s dehumanizing habit of labeling patients by disease or procedure—remarks like “How did your Wilms’ tumor do in surgery?” or “Is your astrocytoma responding to chemo?”—riled Tyler, but he had no time to take issue. “He’s only eleven,” he said coolly.

William squinted at the younger doctor. “The news is not good, I take it.”

“Not what they want to hear.” Tyler shook his head. “Not what anyone would.”

“Of course,” William said without a glimmer of emotion. “Is Jill doing all right?”

The hair on Tyler’s neck bristled. “Busy. Fine. The usual.” Tyler began to edge away. “Dad, I can’t keep them waiting.”

“Go.” He flicked his hand and wrist in an away-with-you gesture. “Your sister would love it if you and Jill could make it to one of their Sunday family dinners.”

And you?
Tyler wondered without voicing it. “Not this Sunday, I’m on call. The week after, for sure,” he called out as he broke back into a run.

Tyler raced across the rest of the complex, wove through the main-floor
labyrinth of the Alfredson Children’s Hospital, and reached the oncology isolation ward—the sixth-floor unit, or SFU as it was referred to by most of the staff—in seven minutes. Normally, he appreciated the floor’s bright modern décor, its walls splashed with cheerful pastel murals and colorful ceramic plaques boasting the names of donors. But as Tyler stood scrubbing his hands at the stainless steel sink outside Nate Stafford’s room, the upbeat ambience struck him as cruelly deceptive by offering the illusion of hope to people like the Staffords who had practically none.

Tyler switched off the tap. He dried his hands, slipped his arms into a yellow gown, and donned a surgical mask and gloves. He took one slow breath and then, with hands held up safely away from other contact, backed through the double set of sealed doors that maintained positive pressure respiratory isolation inside the room. The precautions were meant to shut out the ubiquitous airborne viruses and bacteria that, while posing no threat to healthy people, represented potentially lethal infections to critically immunosup-pressed patients like Nate Stafford.

Inside the room, Nate’s gowned parents flanked his bed. His compact muscular father, Craig, swiveled his square head to stare over his mask at Tyler with a mix of concern and expectation. Nate’s mother, Laura, barely took her eyes off her son. She clutched his bare left hand in hers and mopped at his brow with the cloth she held in her other gloved hand. Wired to multiple lines and tubes, the eleven-year-old boy on the stretcher resembled a bald marionette. Skeletal and gray, he strained to lift his head off the bed and look over at Tyler. Nate was the only maskless person in the room. His dry fissured lips broke into a small grin that stirred Tyler’s sympathy.

Tyler joined Nate’s father by the bedside. “How’s my star ball player this morning?”

“I’m not ready to pitch yet, Dr. M,” Nate croaked.

“Your headache still bad?” Tyler asked.

Nate swallowed his confirmation.

Tyler rubbed the back of Nate’s hand. “Baseball season is still a while off yet.”

Craig leaned closer. “What did the spinal fluid show?” he demanded in a low growl.

Laura’s eyes widened and darted momentarily from Craig to Tyler. Her
son immediately picked up on the furtive warning. “C’mon, Mom, I want to hear it, too,” Nate said with a slight whine, sounding more like a kid demanding to see an R-rated movie with some friends than a patient waiting to hear if his cancer had spread to his brain.

Tyler squeezed Nate’s hand and felt only bones. “It’s not completely gone, Nate.”

Laura gasped involuntarily and then tried to cover the noise with a cough. Craig squinted hard at Tyler, his intense eyes ablaze. Nate simply stared at Tyler with a look of brave determination. “So what do we do now, Dr. M?”

“You know me, Nate.” Tyler winked. “I always have a backup plan up my sleeve.”

Nate nodded dully. “More chemo?” His hoarse voice quavered slightly.

“In a way, yeah.”

“What the hell does that mean?” Craig snapped.

Tyler didn’t take his eyes off Nate. “Targeted therapy.”

“What’s that?” Nate asked nervously.

“Remember, Nate, when I explained how leukemia is a disease of your immune system?”

Nate nodded slowly. “You said something goes wrong with the cells that fight off infection and stuff. Some of them go crazy and multiply out of control. Then they take over the bone marrow like a rebel army attacking from the inside.”

“I forgot how smart you were for a jock,” Tyler said, impressed by the boy’s military analogy. “The usual chemotherapy we give attacks all living cells in your body. We hope it poisons the bad cells—the cancer cells—worse than the others. But with targeted therapy, we use specially designed drugs that are immune active.”

“What’s that mean?” Nate asked.

“These drugs are designed by scientists to seek out and destroy only the defective cancer cells by recognizing what we call ‘tumor markers’ on the outside of those cells.” Tyler struggled for a concrete comparison. “It’s kind of like guerrilla warfare.”

“More like counterterrorism commandos working in hostile civilian country,” Nate said.

Tyler chuckled. “I stand corrected.”

Nate shrugged modestly. “I play a lot of video war games.”

Tyler patted the boy’s arm. “We haven’t used targeted therapy much with the kind of leukemia you have, but we have seen some good results with other types.”

Nate shifted in his bed. “Will it hurt?” he murmured sheepishly.

Tyler heard Laura’s choppy breathing as she fought back sobs. He felt Craig’s stare burning into him. But he didn’t take his eyes off the boy’s stoic face. “No.” Tyler shook his head. “You have my word on that, Nate.”

The sealed door hissed open. All eyes in the room were drawn to the slim, black-haired nurse who carried a pill cup in one gloved hand and a syringe in the other. Even if her entire face had been covered by her surgical mask, Tyler still would have recognized Nikki Salazar from the effortless way she swept across the floor, moving like the dancer she had once trained to be. He turned back to Nate without making eye contact with Nikki, but her proximity brought a familiar bittersweet rush.

Nikki nodded to the parents—holding Laura’s gaze for one empathetic moment—and then turned to Nate. “Time for painkillers and antibiotics,” she groaned in an exaggerated way, as if offering cod-liver oil. She waved the pills in the small paper cup at him. “If we get this over with fast, then maybe we can get the controllers out and I can whip your butt in football again.”

Nate huffed a laugh. “As if!” The worry drained from his face, and even his color seemed to improve as he forced himself up a little higher in his bed. He slipped his hand out of his mother’s. “I got to teach Nikki
another
lesson, Mom,” he said almost apologetically as he pulled farther away from Laura.

Tyler decided to capitalize on the distraction. “Come on, Mom and Dad, let’s leave it to the pros.” He turned for the door. Craig followed right on his heels, but Laura stood by the bedside, reluctant to move.

“It’s okay, Mom,” Nate said. “Go have one of your boring grown-up conversations outside.”

Nikki’s presence always affected Nate, filling him with prepubescent bravado, but Tyler knew that the kid was also giving his mother permission to take a break from her relentless vigil.

Laura took a step, wavered a moment, and then followed Tyler and Craig out the door. Without exchanging a word, they walked together down the
bright hallway. The parents had been through this enough to know they were heading to the same conference room where all the news—most of it bad—had been broken before. By the time they stepped into the daylight-flooded room, tears were flowing freely down Laura’s cheeks. She rushed over to the nearest rolling chair and collapsed onto it.

As soon as Tyler shut the door, Craig turned on him. Though almost six inches shorter than Tyler, he seemed to rise to the same height. Craig’s chest swelled and his right fist curled at his waist, looking as if it might strike at any second. “What the fuck was that in there?” he said in a low-pitched tone that came across angrier than a yell.

Tyler did not move. “He had a right to know, Craig.”

Craig’s lip curled into a sneer. “And we had the right to know before him. To be fucking prepared.” He nodded toward his wife. “She almost dissolved in front of the boy.”

Tyler shook his head. “I only found out a few minutes ago.”

“You know our goddamn cell number!” Craig said, unmoved. “I thought you were better than that amateur shit back there.”

Tyler lowered his eyes and nodded. He knew Craig desperately needed somewhere to vent his rage and helplessness at the disease ravaging his only son. And Tyler was more than willing to play the scapegoat. At least, it was
something
he could offer them.

After a long simmering glare, Craig pivoted, stomped over to the table, and sat down beside Laura. He wrapped his thick arm around her. Tyler noticed that the hand gripping his wife’s shoulder trembled slightly. He gave them a private moment, walking slowly around the far side of the table before sitting down across from them.

Laura gaped at Tyler. He was accustomed to seeing those eyes bloodshot and teary more often than dry, but now they were clouded with even more defeat than usual. “That last round of chemo . . .,” she said. “I don’t know why, but I was sure he was going to respond.”

“I know,” Tyler said.

“God, he’s been through so much. The endless chemo. All that radiation. The bone marrow transplant.” Laura sniffed several times. “But I’ve never seen him look so weak, Dr. McGrath. So gray. He doesn’t have any immune system left, does he?”

“Not much of one, no.”

“And now the cancer is back again around his brain. . . .” Her words petered out.

Craig pulled his wife closer into his side, as though sheltering her from a blizzard. “What about this targeted therapy thing?” he grunted. “Were you just blowing smoke up our asses?”

Tyler paused to consider his response, aware how fragile the moment was. Craig and Laura were too experienced to be taken in by false promises—which Tyler would never stoop to—but the wrong word or phrase might drain the last of their reserve. And no one had the right to steal a parent’s last drop of hope. Tyler was particularly concerned how Craig would digest the news. Despite appearances, inwardly Laura was stronger than her husband.

“Look, this field is evolving all the time. Every year the outcomes improve,” Tyler said without overstating the case for optimism. “In certain adult forms of leukemia, targeted immune therapy has replaced chemotherapy altogether. With excellent results. I think it’s the long-term direction for all types of blood cancers.” He paused. “Granted, we have not yet seen as good results in the leukemia like Nate’s. But we have brand-new experimental drugs. One in particular I would like to try on him.”

Craig let go of his wife’s shoulder. He leaned forward and pushed his hands against the table, rising out of his chair. “Have you used it before?”

Tyler shook his head.

The veins at Craig’s temples pounded visibly. “Has anyone?” he choked.

“At St. Jude’s, in Tennessee, they have run a few small trials.”

“Small,” Craig scoffed. “That doesn’t sound encouraging.”

“I know the principal investigator—the woman running the trials. She’s one of the very best in the world. And she believes in this drug.”

Craig stared at him, unappeased. “So what’s involved?”

“Another intravenous. And like with the chemo, we’re going to have to do a lumbar puncture and put the drug directly in Nate’s spinal fluid because it won’t otherwise cross the blood-brain barrier and get to the cancer cells in the fluid around his brain.”

Laura shuddered in her chair, and Tyler hurried to add, “But it’s not as toxic as the standard chemotherapy. Less nausea and vomiting. No increased risk of infection. Nate’s such a trooper. He’ll probably tolerate it even better than previous treatments.”

Craig slammed a fist onto the table. “And if he doesn’t?”

Laura put a hand up to her husband’s chest and gently pushed him back in his seat. “Dr. McGrath, you told us before that if the cancer came back after Nate’s bone marrow transplant, the prognosis was poor. . . .”

Tyler silently cursed as he listened to his own words come back to haunt him. It was unavoidable, though. With limitless Internet information and, even worse,
misinformation
available with a few keystrokes, he had to warn his patients and their families about possible adverse outcomes. “Poor is not the same as hopeless,” Tyler insisted. “As I said, every day we’re making strides—”

“What do the statistics say?” Craig demanded.

“Statistics only apply to groups of patients,” Tyler said. “They don’t take into consideration each individual case and new experimental treatments.”

“You’ve given us numbers before,” Craig said. “Be honest with us now.”