Blood Test (4 page)

“You’ll win the Nobel Prize,” I said.

“And it will all go for alimony!” He thought that
tremendously funny. When his laughter died down he said:

“I need a favor, Alex. There’s a family that’s giving
us some trouble—noncompliance problems—and I wondered if you could talk to
them.”

“I’m flattered but what about the regular staff?”

“The regular staff made a mess of it,” he said,
peeved. “Alex, you know the high regard I have for you—why you abandoned a
brilliant career I’ll never know, but that’s another issue. The people Social
Services are sending me are
amateurs
, my friend. Rank amateurs.
Starry-eyed caseworkers who see themselves as patient advocates—provocateurs.
The psych people will have nothing to do with us because Boorstin has a death
phobia and is terrified of the word cancer.”

“Progress, huh?”

“Alex, nothing’s changed in the last five years. If
anything it’s gotten worse. I’ve even started opening my ears to other offers.
Last week I was given the chance to run an entire hospital in Miami. Chief of
Staff. More money and a full professorship.”

“Considering it?”

“No. The research facilities were Mickey Mouse and I
suspect they want me more for my Spanish than my medical brilliance. Anyway,
what do you say about lending the department a hand—you’re still officially
listed as our consultant, you know.”

“To be honest, Raoul, I’m not taking on any therapy
cases.”

“Yes, yes, I’m aware of that,” he said impatiently, “but
this is not therapy. Short term liaison consultation. I don’t want to sound
melodramatic, but the life of a very sick little boy is at stake.”

“Exactly what kind of noncompliance are you talking
about?”

“It’s too complicated to explain over the phone, Alex.
I hate to be rude, but I must get over to the lab and see how Helen is doing.
We’re pacing an in vitro hepatoblastoma as it approaches pulmonary tissue. It’s
painstaking work and it requires constant vigilance. Let’s talk about it
tomorrow—nine, my office? I’ll have breakfast sent up, and voucher forms. We’re
prepared to pay for your time.”

“All right, Raoul. I’ll be there.”

“Excellent.” He hung up.

Being released from a conversation with Melendez-Lynch
was a jarring experience, a sudden shift into low gear. I put down the
receiver, regained my bearings, and reflected on the complexity of the manic
syndrome.

WESTERN P EDIATRIC Medical Center occupies a square
block of mid-Hollywood real estate in a neighborhood that was once grand but is
now the turf of junkies, hookers, drag queens, and fancy dancers of every
stripe. The working girls were up early this morning, halter-topped and
hot-panted, and as I cruised eastward on Sunset they stepped out from alleys
and shadowed doorways sashaying and hooting. The whores were as much a fixture
of Hollywood as the brass stars inlaid in the sidewalks, and I could swear I
recognized some of the same painted faces I’d seen there three years ago. The
streetwalkers seemed to fall into two categories: doughy-faced runaways from
Bakersfield, Fresno, and the surrounding farmlands, and lean, leggy, shopworn
black girls from South Central L.A. All of them raring to go at eight
forty-five in the morning. If the whole country ever got that industrious the
Japanese wouldn’t stand a chance.

The hospital loomed large, a compound of aged dark
stone buildings and one newer column of concrete and glass. I pulled the
Seville into the doctors’ lot and walked to Prinzley Pavilion, the contemporary
structure.

The Department of Oncology was situated on the fifth
floor. The doctors’ offices were cubicles arranged in a U around the
secretarial pool. As head of the department, Raoul got four times as much space
as any of the other oncologists, as well as privacy. His office was at the far
end of the corridor and cordoned off by double glass doors. I went through them
and walked into the reception area. Seeing no receptionist, I kept going and
entered his office through a door marked PRIVATE.

He could have had an executive suite but had chosen to
use almost all the space for his lab, ending up with an office only ten by
twelve. The room was as I remembered it, the desk piled high with
correspondence, journals, and unanswered messages, all ordered and precisely
stacked. There were too many books for the floor-to-ceiling bookcase and the
overflow was similarly heaped on the floor. One shelf was filled with bottles
of Maalox. Perpendicular to the desk, faded beige curtains concealed the office’s
sole window as well as a view of the hills beyond.

I knew that view well, having spent a significant
proportion of my time at Western Peds staring out at the crumbling letters of
the HOLLYWOOD sign while waiting for Raoul to show up for meetings he had
scheduled but inevitably forgot about, or cooling my heels during his
interminable long-distance phone chats.

I searched for signs of habitation and found a
Styrofoam cup half-filled with cold coffee and a cream-colored silk jacket
draped neatly over the desk chair. Knocking on the door leading to the lab brought
no response and the door was locked. I opened the curtains, waited a while,
paged him and got no callback. My watch said ten after nine. Old feelings of
impatience and resentment began to surface.

Fifteen minutes more, I told myself, and then I’ll leave.
Enough is enough.

Ninety seconds before the deadline he blew in.

“Alex, Alex!” He shook my hand vigorously. “Thank you
for coming!”

He’d aged. The paunch had grown sizably ovoid and it
strained his shirt buttons. The last few strands of hair on his crown had
vanished and the dark curls around the sides bordered a skull that was high,
knobby, and shiny. The thick mustache, once ebony, was a variegated thatch of
gray, black, and white. Only the coffee bean eyes, ever moving, ever alert,
seemed agelessly charged and hinted at the fire within. He was a short man
given to pudginess and though he dressed expensively, his wardrobe wasn’t
selected with an eye toward camouflage. This morning he wore a pale pink shirt,
a black tie with pink clocks, and cream-colored slacks that matched the jacket
over the chair. His shoes were mirror-polished, sharptoed tan loafers of
perforated leather. His long white coat was starched and immaculate but a size
too large. A stethoscope was draped around his neck, and pens and documents
stuffed the pockets of the coat, causing them to sag.

“Good morning, Raoul.”

“Have you had breakfast yet?” He turned his back to me
and moved his thick fingers rapidly over the piles on the desk like a blind man
speedreading Braille.

“No, you said you’d—”

“How about we go to the doctor’s dining room and the
department will buy you some?”

“That would be fine,” I sighed.

“Great, great.” He patted his pockets, searched in
them, and muttered a profanity in Spanish. “Just let me make a couple of calls
and we’ll be off—”

“Raoul, I’m under some time pressure. I’d appreciate
it if we could get going now.”

He turned and looked at me with great surprise.

“What? Oh, of course. Right now. Certainly.”

A last glance at the desk, a grab for the current copy
of
Blood
, and we were off.

Though his legs were shorter than mine by a good four
inches, I had to trot to keep up with him as we hurried across the glassed-in
bridge that connected Prinzley with the main building. And since he talked as
he walked, keeping up was essential.

“The family’s name is Swope.” He spelled it. “The boy
is Heywood—Woody for short. Five years old. Non-Hodgkin’s lymphoma, localized.
The initial site was in the G.I. tract with one regional node. The metastatic
scan was beautiful—very clean. The histology is nonlymphoblastic, which is
excellent, because the treatment protocol for nonlymphoblastics is
well-established.”

We reached the elevator. He seemed out of breath,
tugging at his shirt collar and loosening his tie. The doors slid open and we
rode down in silence to the ground floor. Silence—but not serenity, because he
couldn’t stand still: he tapped his fingers on the elevator wall, played with
strands of his mustache, and clicked a ball-point pen open and shut repeatedly.

The ground floor corridor was a tunnel of noise,
glutted with doctors, nurses, techs, and patients. He continued talking until I
tapped his shoulder and shouted that I couldn’t hear him. His head gave a curt
little nod and he picked up his pace. We zipped through the cafeteria and
passed into the dimly lit elegance of the doctors’ dining room.

A group of surgeons and surgical residents sat eating
and smoking around a circular table, dressed in greens, their caps hanging
across their chests like bibs; otherwise the room was unoccupied.

Raoul ushered me to a corner table, motioned for
service, and spread a linen napkin over his lap. He picked up a packet of
artificial sweetener and turned it on its side, causing the powder within to
shift with a dry whisper, like sand through an hourglass. He repeated the
gesture half a dozen times and started talking again, stopping only when the
waitress came and took our order.

“Do you remember the COMP protocol, Alex?”

“Vaguely. Cyclophosphamide, um—methotrexate and prednisone,
right? I forget what the O stands for.”

“Very good. Oncovin. We’ve refined it for non-Hodgkin’s.
It’s working wonders when we combine it with intrathecal methotrexate and
radiation. Eighty-one percent of patients are achieving three-year, relapse-free
survival. That’s a national statistic—the figures on my patients are even
better—over ninety percent. I’m following a growing number of kids who are
five, seven years and looking great. Think of that, Alex. A disease that killed
virtually every child it got hold of a decade ago is potentially curable.”

The light behind his eyes picked up extra wattage.

“Fantastic,” I said.

“Perfect word—fantastic. The key is
multimodal
chemotherapy.
More and better drugs in the right combinations.”

The food came. He put two rolls on his plate, cut them
into tiny chunks, and systematically popped each piece in his mouth, finishing
all of it before I’d downed half my bagel. The waitress poured coffee, which
was inspected, creamed, stirred, and quickly swallowed. He dabbed his lips and
picked imaginary crumbs out of his mustache.

“Notice that I used the word curable. No timid talk of
extended remission. We’ve beaten Wilm’s Tumor, we’ve beaten Hodgkin’s disease.
Non-Hodgkin’s lymphoma is next. Mark my words, it will be cured in the near
future.”

A third roll was dissected and dispatched. He waved
the waitress over for more coffee.

When she’d gone he said, “This isn’t really coffee, my
friend. It is a hot drink. My mother knew how to make coffee. Back in Cuba we
had the pick of the coffee crop. One of the servants, an old black man named
José, would grind the beans by hand with great finesse—the grind is essential—and
we would have
coffee!”
He drank some more and pushed his cup away,
taking a glass of water as a replacement and emptying it. “Come to my home and
I’ll make you real coffee.”

It occurred to me that though I’d worked with the man
for three years and had known him twice that long, I’d never seen his living
quarters.

“I may take you up on that one day. Where do you live?”

“Not far from here. Condo on Los Feliz. One bedroom—small
but sufficient for my needs. When one lives alone it is best to keep things
simple, don’t you agree?”

“I suppose so.”

“You do live alone, don’t you?”

“I used to. I’m living with a wonderful woman.”

“Good, good.” The dark eyes seemed to cloud. “Women.
They have enriched my life. And torn it apart. My last wife, Paula, has the big
house in Flintridge. Another’s in Miami, and two others, God knows where. Jorgé—my
second oldest, Nina’s boy—tells me his mother is in Paris, but she never stayed
in one place very long.”

His face drooped and he drummed on the table with his
spoon. Then he thought of something that made him suddenly brighten.

“Jorgé’s going to medical school next year at Hopkins.”

“Congratulations.”

“Thank you. Brilliant boy, always was. Summers he
would visit me and work in the lab. I’m proud to have inspired him. The others
are not so on the ball, who knows what they will do, but their mothers were not
like Nina—she was a concert cellist.”

“I didn’t know that.”

He picked up another roll and hefted it.

“Drinking your water?” he asked.

“It’s all yours.”

He drank it.

“Tell me about the Swopes. What kind of noncompliance
problems are you having?”

“The worst kind, Alex. They’re refusing treatment.
They want to take the boy home and subject him to God knows what.”

“Do you think they’re holistic types?”

He shrugged. “It’s possible. They’re rural people,
come from La Vista, some little town near the Mexican border.”