Life Support (11 page)

A new slide flashed onto the screen, a photograph of the Brant Hill common, with the swan pond in the foreground and the rolling hills of the golf course stretching into a soft shroud of mist.

"We know that the dream has nothing to do with a comfortable old age followed by a comfortable death. The dream has to do with life. With beginnings, not endings. That is what we offer our clients. We've made the dream a reality. And look how far we've come! Brant Hill, Newton, is expanding. Brant Hill, La Jolla, is sold out. Last month we started construction on our third development, in Naples, Florida, and already, seventy-five percent of those unbuilt units have been sold. And tonight, on the sixth anniversary of our first groundbreaking, I'm here to announce the most exciting news of all." He paused, and on the screen above him, the Brant Hill logo reappeared on a background of royal blue.

"At eight A.M. tomorrow," he said, "we will be making our initial public offering of stock. I think you all understand what that means."

Money, thought Brace as he heard the murmurs of excitement in the room.

A fortune for the initial investors. And for Brant Hill it self, it meant an infusion of cash that would spur construction of new developments in other states. No wonder there was champagne on the table, as of tomorrow morning, half the people in this room were going to be even more wealthy than they already were.

The audience burst out in applause.

Greta did not, which Robbie noted with some discomfort. The old stereotype about stubborn redheads held true for his wife. She was sitting with arms folded, her chin jutting out, the very picture of a pissed-off Socialist.

More slides appeared on-screen, reflecting a changing collage of colors on Greta's face. Photos of La Jolla's Brant Hill, designed as a cluster of Mediterranean-style villas overlooking the Pacific. A photo of the health club in Newton, where a dozen aging women in snazzy warm-up suits danced aerobics. A shot of Newton's fifth green, with two men posing beside their canopied golf cart. Then a photo of residents dining in the country club restaurant, a bottle of champagne chilling in a silver ice bucket.

Where the rich folk live.

Brace shifted in his chair, uncomfortably attuned to what Greta must be thinking of all this. Taking care of rich folk was not what he'd planned for his life's work when he'd been a medical student. But then, he hadn't anticipated the pressures of student loans or a home mortgage or saving for their kid's college fund. He hadn't imagined he would be forced to sell out.

Greta uncrossed her legs, and as her thigh brushed against his, he felt an unexpected dart of anger that she couldn't see his side of this. She was the wife, she could hang on to her principles. He was the one who had to keep their family fed and housed. And where was the sin in taking care of the rich? Like everyone else, the rich got sick, they needed doctors, they needed compassion.

They paid their bills.

He crossed his arms, withdrawing both physically and emotionally from Greta, and stared at the projector screen. So this was Ken Foley's real purpose for the dinner�to drum up excitement about the initial public offering, to fire up demand for the new stock. Foley's speech was intended for a far wider audience of investors than was now in this room. Already, Brant Hill must be showing up on radar screens of brokerage firms across the country. Every word he said tonight would be piped straight to the business media.

A new slide appeared, an artist's rendition of the new nursing home wing now under construction. Yesterday the concrete foundation had been poured, and next week excavation started on yet a second addition. They were building as fast as they could, yet the demand would only keep growing.

Foley had described the product, now he explained the market for it.

The next slide was a bar graph representing the growth of the elderly population in the United States, the surge of baby boomers progressing into old age like a pig swallowed and digested as it moves through a snake. The me-generation was graduating from skis to walkers. Here's our target population, Foley said, his laser pointer circling the statistical pig in the snake. Our future clients. By the year 2005, boomers will start retiring, and Brant Hill is just the sort of development they'll turn to. We're talking growth�and extraordinary returns on your investment. Boomers will be looking toward an exciting new phase in their lives. They don't want worries about sickness or infirmity. Many of them will have money saved up�a lot of it. They'll be getting old, but they don't want to feel old.

And who does? thought Brace. Which one of us doesn't look in the mirror and feel a sense of dismay that the face staring back is too old to be me?

Dessert and coffee finally arrived at their wilderness table. Greta, tasting artificial something-or-other in the whipped topping, didn't eat hers. Brace ate both their desserts in a depressing orgy of calories. He had his mouth full of whipped cream when he heard his name spoken over the microphone.

Greta gave him a nudge. "Stand up," she whispered. "They're introducing the new doctors."

Brace shot to his feet, accidentally flicking a glob of cream across the front of his suit. He stood for only a second, fumbling with a napkin as he waved to the audience, then quickly sank back into his chair. The other three new doctors rose to their feet, waving as they were introduced, no one else wearing whipped cream on their clothes, no one else tight-faced with embarrassment. I graduated second highest in my med school class, he thought. I was voted intern of theyear. I did it against all odds, and without a penny of help from my family. And I am siMng here feeling like a goddamn imbecile.

Under the table, Greta touched his knee. "The air's too rich in here," she whispered. "I think I'm choking on the gold dust."

"Do you want to leave?"

"Do you?"

He looked at the dais, where Foley was still talking about money.

Returns on investment, growth of the retiree market. There's gold in them thor old folks.

He threw his napkin on the table. "We're outta here."

Angus Parmenter was not feeling well, not feeling well at all. Since Thursday the trembling in his right hand had come and gone twice.

He found that if he concentrated, he could suppress it, but it took great effort, and it left his arm aching. Both times the twitching stopped of its own accord. For the last two days, it had not recurred at all, and he'd managed to convince himself the attacks meant nothing.

Too much coffee, perhaps. Or too much time at the Nautilus machine, overexerting those arm muscles. He had stopped using the Nautilus, and the movement had not returned, which was a good sign.

But now something else was wrong.

He had noticed it upon awakening from his afternoon nap. It was dark, and he had switched on the lamp and looked around at his bedroom.

All the furniture seemed tilted. When had that happened? Had he moved things around today? He couldn't recall. But there was the nightstand, way beyond arm's reach. It was tottering on its edge, ready to fall. He stared at it, trying to understand why it didn't topple over, why the glass of water set on top of it was not sliding to the floor.

He turned and looked at the window. It, too, had shifted position. It was now far in the distance, a receding square at the end of a long tunnel.

He stepped out of bed and immediately swayed. Was that an earthquake? The floor seemed to roll like swells on the open sea. He stumbled one way, then the other, and finally caught himself on the dresser. There he paused, clinging to the edge, trying to regain his sense of balance. He felt something dribble onto his foot. He looked down and saw that the carpet was wet, and he smelled the warm, sour odor of urine. Who the hell had peed in his bedroom?

He heard a chiming. The notes seemed to float around the room, like tiny black balloons. Church bells? A clock? No, someone was ringing the doorbell.

He staggered out of the bedroom, holding on to the walls, doorways, anything he could cling to. The hallway seemed to elongate, the door gliding away from his outstretched hand. Suddenly his fingers closed around the knob. With a grunt of triumph, he yanked open the door.

In astonishment he stared at the two midgets standing on his front porch.

"Go away," he said.

The midgets stared at him and made mewing sounds.

Angus started to swing the door shut but couldn't get it to close.

A woman had appeared and was holding it open.

"What are you doing, Dad? Why aren't you dressed?"

"Go. Get out of my house."

"Dad!" The woman was forcing her way in now.

"Get out!" said Angus. "Leave me alone!" He turned and staggered up the hall, trying to flee the woman and the two midgets. But they pursued him, the midgets whimpering, the woman yelling, "What's wrong? What's wrong with you?"

He tripped on the carpet. What happened next went by gracefully, like a slow dance underwater. He felt his body flying forward, gliding. Felt his arms stretching out like wings as he soared through liquid air.

He did not even feel the impact.

"Dad! Oh my God."

Those damn midgets were screeching and pawing at his head. Now the woman crouched over him. She turned him over on his back.

"Dad, are you hurt?"

"I can fly," he whispered.

She looked at the midgets. "Get the telephone. Call nine one one. Go!"

Angus moved his arm, flapping it like a wing.

"Hold still, Dad. We're getting an ambulance."

I canfly! He was floating. Gliding. I can fly.

"I've never seen him like this. He doesn't recognize me, and he doesn't seem to know his own grandchildren. I didn't know what else to do, so I called the ambulance." The woman shot an anxious glance into the exam room, where the nurses were trying to take Angus Parmenter's vital signs. "It's a stroke or something. Isn't it?"

"I'll be able to tell more after I examine him," said Toby.

"But does it sound like a stroke?"

"It's possible." Toby gave the woman's arm a squeeze. "Why don't you sit in the waiting room, Mrs. Lacy? I'll be out to talk to you as soon as I know more."

Edith Lacy nodded. Hugging herself, she went into the waiting area and sank onto the couch between her two daughters. The three of them hugged one another, arms forming a warm and compact universe.

Toby turned and entered the exam room.

Angus Parmenter was strapped down on the gurney in fourpoint restraints, babbling something about strangers in his house. For an eighty-two-year-old man, his limbs were taut and surprisingly muscular.

He was dressed only in his undershirt. That's the way his daughter had found him, naked from the waist down.

Maudeen peeled off the blood pressure cuff and slid it neatly into the wall basket. "Vitals are fine. One thirty over seventy. Pulse is ninety-four and regular."

"Temp?"

"Thirty-eight degrees," said Val.

Toby stood by the man's head and tried to engage his attention. "Mr. Parmenter? Angus? I'm Dr. Harper."

". . . came right into my house . . . wouldn't leave me alone . . ."

"Angus, did you fall down? Did you hurt yourself?"

". . . goddamn midgets, came to steal my money. Everyone's after my money."

Maudeen shook her head. "I can't get a word of history out of him."

"The daughter says he's been healthy. No recent illnesses." Toby shone her penlight into the man's eyes. Both pupils constricted. "She spoke to him on the phone only two weeks ago and he sounded fine. Angus! Angus, what happened to you?"

". . . always trying to take my damn money . . ."

"We have a one-track mind," sighed Toby, flicking off the penlight. She continued her exam, searching first for evidence of head trauma, then moving on to her exam of the cranial nerves. She found no localizing signs, nothing to pinpoint the cause of the man's confusion.

The daughter had described a staggering gait. Had the man suffered a stroke of the cerebellum? That would affect coordination.

She unstrapped his right wrist. "Angus, can you touch my finger?"

She held her hand in front of his face. "Reach up and touch my finger."

"You're too far away," he said.

"It's right here, right in front of you. Come on, try and touch it."

He raised his arm. It wobbled in midair, like a dancing cobra.

The phone rang. Maudeen reached for the receiver.

Angus Parmenter's arm began to twitch, a violently rhythmic shaking that rattled the gurney.

"What's he doing?" said Val. "Is he having a seizure?"

"Angus!" Toby grasped the man's face and stared straight at him. He wasn't looking at her, he was gazing at his own arm.

"Can you talk, Angus?"

"There it goes again," he said.

"What? You mean the shaking?"

"That hand�whose hand is that?"

"It'syour hand."

The shaking suddenly ceased. The arm flopped down like a deadweight onto the gurney. Angus closed his eyes. "There now," he said. "All better."

"Toby?" It was Maudeen, turning from the telephone. "There's a Dr. Wallenberg on the line. He wants to talk to you."

Toby took the receiver. "Dr. Wallenberg? This is Toby Harper. I'm the ER doctor on duty tonight."

"You have my patient there."

"You mean Mr. Parmenter?"

"I just got beeped about the ambulance transfer. What happened?"

"He was found confused at home. Right now he's awake and the vitals are stable. But he's got atoxia, and he's disoriented times three. He doesn't even recognize his own daughter."

"How long has he been there?"

"The ambulance brought him in around nine."

Wallenberg was silent for a moment. In the background, Toby heard the sound of laughter and voices. A party.

"I'll be there in an hour. Just keep him stable till I arrive."

"Dr. Wallenberg�" The line had already gone dead.

She turned to the patient. He was lying very still, his eyes focused intently on the ceiling. Now his gaze shifted, first right, then left, as though he were watching a slow-motion tennis match.

"Let's get this man a STAT CT scan," said Toby. "And we'll need some bloods drawn."

Val pulled a fistful of glass tubes out of the drawer. "The usual? CBC and SMA?"

"Add a drug screen. He seems to be hallucinating."

"I'll call X-ray," said Maudeen, reaching once again for the phone.

"Ladies," said Toby. "One more thing."

Both nurses looked at her.

"Whatever happens tonight, we're not going to leave this guy alone, not for a second. Not till he's transferred out of our ER."

Val and Maudeen nodded.

Toby took hold of Angus Parmenter's unrestrained hand and tied it firmly to the gurney siderail.

"Here come the cuts," said the CT tech.

Toby stared at the computer screen as the pixels formed the first image, an oval with different shades of gray. She was looking at a cross section of Angus Parmenter's brain. Thousands of X-ray beams directed at his cranium had been analyzed by computer, and the different densities of bone and fluid and brain matter had produced this image. The skull appeared as a thick white rim, like the rind of a fruit. Inside the rind, the brain showed up as grayish pulp, indented by black wormlike sulci.

A succession of images materialized on the screen, each one a slightly different cut of the patient's cranium. She saw the anterior horns, two black ovals filled with cerebrospinal fluid. The caudate nuclei. The thalamus. There appeared to be no anatomical shifts, no asymmetry. No evidence of blood leakage into any part of the brain.

"I don't see anything acute," Toby said. "What do you think?"

Vince was not a physician, but he'd seen far more CT scans as an X-ray tech than Toby had. He frowned at the screen as a fresh cut appeared.

"Wait," he said. "That shot looks a little funny."

"What?"

"Right there." He pointed to a smudge at the center. "That's the sella turcica. See how it's not very clearly demarcated on this edge?"

"Could it be patient movement?"

"No, the rest of the shot's perfectly clean. He didn't move." Vince picked up the phone and dialed the radiologist at home. "Hi, Dr.

Ritter?

Are the cuts coming across okay on your computer' Great. Dr. Harper and I are looking at them right now. We're wondering about that last cut"�he typed on the keyboard, and the image reverted back to the previous screen�"that slice right there, see it? What do you think about the sella turcica?"

As Vince conferred with Dr. Ritter, Toby bent closer to the screen.

What Vince had spotted was a very subtle change�so subtle she herself would have missed it. The sella turcica was a tiny pocket of thin bone housing the pituitary gland at the base of the brain. The gland itself was vital, the hormones it produced controlled a wide variety of functions, from fertility to childhood growth to the daily sleep-wake cycle. Could that tiny erosion of the sella turcica be the cause of the patient's symptoms?

"Okay, I'll do the coronal thin slices," said Vince. "Anything else you want me to do?"

"Let me talk to Ritter," said Toby. She took the receiver. "Hi, George, this is Toby. What do you think about that sella?"

"Not much," said Ritter. She heard the squeak of his chair�probably leather. George Ritter liked his luxuries. She could imagine him ensconced in his study, surrounded by the latest in computer technology.

"In a man this age, pituitary adenomas aren't uncommon. Twenty percent of eighty-year-olds have them."

"Big enough to erode the sella?"

"Well, no. This one's gotten a little large. What's his endocrine status?"

"I haven't checked it. He just came in the ER with acute confusion.

Could this be the cause?"

"Not unless the adenoma's produced a secondary metabolic abnormality.

Have you checked the electrolytes?"

"They've been drawn. We're waiting for results."

"If those are normal, and the endocrine status is okay, I think you're going to have to look for some other reason for his confusion. This is too small a tumor to exert much anatomical pressure. I've asked Vince to do some thin-slice cuts on the coronal plane. That should define it a little better. You'll probably want to send the patient out for an MRI, too. Who's admitting him?"

"Dr. Wallenberg."

There was a silence. "This is a Brant Hill patient?"

"Yes."

Ritter gave an irritated sigh. "I wish you'd told me this earlier."

"Why? "

"I don't read X rays on Brant Hill patients. They use their own radiologist to interpret all their films. Which means I won't get paid for this."

"I'm sorry, I didn't know that. Since when did this arrangement start?"

"Springer signed a subcontract agreement with them a month ago. Their patients aren't supposed to go through the ER. The Brant Hill docs admit directly to the wards. How did this patient end up with you?"

"The daughter panicked and called nine one one. Wallenberg's on his way in now."

"Okay. Then let Wallenberg decide what to do about the coronal slices.

I'm going to bed."

Toby hung up and looked at Vince. "Why didn't you tell me Brant Hill had a closed referral system?"

Vince gave her a sheepish look. "You didn't tell me this was a Brant Hill patient."

"Don't they trust our radiology staff?"

"Our hospital techs shoot the films, but the Brant Hill radiologist interprets them. I guess they're trying to keep the professional fees within their group."

Hospital politics again, she thought. Everyone fighting for the same shrinking health care dollar.

She rose and looked through the viewing window into the CT scan room.

The patient was still lying on the table, his eyes closed, his lips moving silently. The twitching of his right hand had not recurred.

Nevertheless, he would need an EEG to rule out seizures. And probably a lumbar puncture. Wearily she leaned against the glass, trying to think of what she might have missed, what she could not afford to miss.

Ever since Harry Slotkin had vanished from her ER two weeks ago, she knew her performance was under scrutiny by the hospital board, and she had been even more compulsively thorough than usual. Every afternoon, she'd wake up wondering if this was the day they'd find Harry Slotkin's body, if this was the day her name would once again be thrust into the public eye. The initial news coverage had been painful enough. The week of Harry's disappearance, the tale of the missing patient had aired on all the local television stations. She'd managed to ride out that storm, and now it was old news, probably forgotten by the general public. But the minute they find Harry's body, she thought, it will once again be a hot story. And I'll be in the hot seat, battling both lawyers and reporters.

Behind her, a door opened and a voice said, "Is that my patient on the table?"

Toby turned and was startled to see a strikingly tall man in a tuxedo. He glanced at Vince, his gaze quickly taking in the CT tech, and just as quickly dismissing him. Then he strode to the viewing window and stared through the glass at Angus Parmenter. "I didn't ask for a CT. Who ordered it?"

"I did," said Toby.

Now Wallenberg focused on her, as though finally realizing she was worth his attention. He was no older than forty, yet he regarded her with an expression of clear superiority. Perhaps it was the tuxedo, a man who looked as if he'd stepped off the pages of GQ had every reason to feel superior. He reminded Toby of a young lion, his brown hair perfectly clipped and swept back like a mane, his eyes like amber, alert and not particularly friendly. "Are you Dr. Harper?"

"Yes. I wanted to save you some time on the workup. I thought I'd order the CT."

"Next time, let me order my own tests."

"But it seemed more efficient to get it done now."

The amber eyes narrowed. He seemed about to make a retort, then thought better of it. Instead he simply nodded and turned to Vince. "Please get my patient back on the gurney. He's being admitted to the third floor, medical wing." He started to leave the room.

"Dr. Wallenberg," said Toby. "Did you want to hear the results of your patient's CT scan?"

"Was there anything to report?"

"A small erosion of the sella turcica. It appears he has a pituitary adenoma growing."

"Was there anything else?"

"No, but you'll probably want to order thin-slice tomography. Since he's already lying on the CT table�"

"It won't be necessary. Just get him upstairs and I'll write the admitting orders."

"What about the lesion? I know the adenoma's not an emergency, but it may require surgical removal."

With a sigh of impatience he turned to face her. "I am fully aware of the adenoma, Dr. Harper. I've been following it for two years now. Thin-slice tomography would be a waste of money. But thank you for your suggestion." He walked out of the room.

"Geez," muttered Vince. "Who shoved the pole up his ass?"

Toby looked through the viewing window at Angus Parmenter, who was still babbling quietly to himself. She didn't agree with Wallenberg, she thought further X-ray studies were indicated. But the patient was no longer her responsibility.

She looked at Vince. "Come on. Let's get him on the gurney."

1.

The sign on the door was stenciled in soft blue on grdy, PRENATAL COUNSELING. Molly could hear the sound of a telephone ringing in the room beyond, and she hesitated in the hallway, her hand clutching the knob as she listened to the faint murmur of a woman's voice beyond the closed door.

She took a breath and walked in.

The receptionist didn't see her at first, she was too busy talking on the phone. Afraid to interrupt this very busy woman, Molly stood on the other side of the desk, waiting to be noticed. At last the receptionist hung up and looked at her. "Can I help you?"

"Urn, I'm supposed to talk to someone . . ."

"Are you Molly Picker?"

"Yeah." Molly gave a relieved nod. They were expecting her. "That's me."

The receptionist smiled, the sort of smile that starts off at the mouth, but then gets no further. "I'm l.indo. We spoke on the phone. Why don't we go in the other room?"

Molly glanced around the reception area. "Am I gonna see a nurse or something? Cause maybe I'm s'posed to pee first."

"No, today we're just going to talk, Molly. The rest room's out in the hall if you need to use it right away."

"I guess I can wait."

She followed the woman into the adjoining room. It was a small office with a desk and two chairs. On one wall was a giant poster of a pregnant woman's belly, drawn as if that belly were sliced right down the middle, so you could see the baby resting inside, its chubby little arms and legs curled up, its eyes closed in sleep. On the desk was a plastic model of a pregnant womb, a 3-D puzzle that could be taken apart layer by layer, belly, womb, and then baby. There was also a big picture book open to a drawing of an empty baby stroller, which seemed like a strange image to display.

"Why don't you have a seat?" Linda said. "Would you like a cup of tea?

A glass of apple juice?"

"No, Ma'am."

"Are you sure? It's really no trouble."

"I'm not thirsty, thank you, Ma'am."

Linda sat down across from Molly so that the two of them were looking directly at each other. The woman's smile had changed to an expression of concern. She had light blue eyes that, with a little makeup, might have been pretty were they not staring from a face that was so bland and humorless. Nothing about this woman�not her suburban housewife perm or her high-necked dress or her tight little mouth�set Molly at ease. She might as well be from another planet, for all the ways they were different. She knew the other woman sensed that difference as well, could see it by the way Linda sat behind her desk, her shoulders squared, her bony hands folded before her. Molly suddenly felt the need to tug down the hem of her skirt, to cross her arms over her chest. And she felt a twinge of something she hadn't felt in a long time.

She felt ashamed.

"Now," said Linda. "Tell me about your situation, Molly."

"My, uh, situation?"

"You said on the phone you're pregnant. Are you having symptoms?"

"Yes, Ma'am. I think so."