Obsessed (20 page)

I
WAS
cooling my heels in the waiting room at University Medical Imaging. I'd been dreading getting there. Now I wanted to get it over with. There were several other patients waiting. I picked up a newspaper and settled in. On a page inside the metro news section there was a short piece about Kyle being questioned and released.

Estelle Pullaski strode through. She barely acknowledged me, started through the door to the interior, then did a U-turn.

“Dr. Zak,” she said, coming at me with a smile I didn't know she had in her. Today she wore a well-tailored suit and open back shoes that showed off shapely ankles. There was a dark intensity about her.

I stood and took her outstretched hand. She gave my hand a firm shake.

“He keeping you waiting?”

“Actually, I'm a tad early.”

“Why don't you come in? There's usually coffee.”

Immediately my antennae went up. Coffee was always welcome, but I knew there had to be a reason she was chatting me up. She said something to the receptionist and ushered me inside.

“So,” she said as she poured coffee into two mugs and handed me one of them. The mug had
UNIVERSITY MEDICAL IMAGING
on it in red letters, and in deep blue
PROACTIVE HEALTH CHOICES
. Patriotism and health. “I understand the police have made an arrest. I'm so relieved.”

I took a sip. The coffee was mediocre but tasted good nevertheless. If she thought I knew the inside scoop she'd be disappointed. “Actually, today's
Globe
says he was released.”

“Released? But…the security guard tells me this young man was here just at the time of the accident. How could they have released him?”

She was still calling the event an “accident” even as she expressed relief over the police arresting a perpetrator. The best kind of perp, in fact. Not a disgruntled patient or family member. Someone with no formal connection to the lab.

“Come on, Peter,” she said. So she remembered my first name, too. “Don't you have connections to the DA's office, to the police? I've heard you do forensic work. Surely you have an opinion at least.”

“You probably know more than I do. Weren't you here that morning? You and Dr. Shands?”

“I…we…yes, of course,” she said, stumbling over her words. “We got here after the accident. We work here. What I want to know is what this man was doing here.” Now she'd regained her equilibrium. “Maybe it wasn't the first time. Is he going to be hanging around, hiding in the garage tonight when I go to get into my car? Are any of us safe?” Her eyes blazed. It occurred to me that any stalker who went after Estelle Pullaski would quickly discover he'd bitten off more than he could chew.

“He's—” I started. I honestly didn't know if Kyle was going to keep following Emily around like a lovesick puppy.

Dr. Pullaski's eyes widened. “You know this young man, don't you?”

“We've met. He's a friend of Dr. Ryan's.”

“He is, is he? I can't say I'm surprised.”

“He admits he was here. But says he didn't see anything,” I said, paraphrasing what I'd read in the paper. “He says he followed Emily here. Stayed until the police arrived.”

“Well, I certainly hope they find out what the hell is going on. We have important work to do, and I'm sure the last thing Leonard would have wanted is to have our research put on hold while the police dither about.”

Twin brains floated in fields of darkness—mine, and the one Shands kept referring to as a “normal brain.” I adjusted my glasses and leaned closer.

He was going back and forth between the two, pointing out what he claimed were differences, anomalies which I was either too dumb to appreciate or too much in denial to recognize. I felt my eyes glaze over as he went on and on about volumetric analysis and coefficients of permeability.

I snapped to when he said, “Bottom line, you're on the cusp. Lower end of the range for normal, upper end of the range for Lewy body dementia.” He fixed me with a grave look. “As I told you before, if I were you I'd start treatment as soon as possible.”

“Upper end for Lewy body dementia,” I said, repeating the words I hadn't quite absorbed. “On the cusp.”

“You understand, only a brain autopsy allows us to see for sure. Of course we could do what they used to do back in the eighties. Drill a hole in your skull and scoop out a little piece of your brain. Count the plaques and tangles and look for proto-Lewy bodies.” He watched me wince. It was probably the same look he gave worms he poured salt on when he was a kid. “Every once in a while it doesn't hurt to remind ourselves why magnetic resonance imaging was such a leap forward for medical research.”

He probably wanted me to kiss his feet, but at that moment I didn't feel much like groveling.

“So you're saying I might get it? And I should take medication every day to stave off this…potentiality?”

“Or you might call it an eventuality. You said both your father and uncle had it?”

“Maybe. It was never diagnosed.”

“Brothers. We know there can be a genetic component. In those cases, children have a fifty percent chance of inheriting.” I wouldn't have placed a bet on myself with those odds.

“How soon?” I asked.

“You know I can't tell you that. The onset of the symptoms is so variable. We do know that the medication has been well tested. Plenty of people have taken it to reduce their cholesterol.”

Was this what I was signing up for? Decades of popping a daily dose of pills I wasn't sure I needed? I could see from Shands's expression that he expected me to embrace this opportunity, to marvel at my good luck. Surely this was preferable to waking up one morning and finding that I'd lost my mind.

“Think about it. Here are the consent forms.” I watched my hand reach for the papers, as if those fingers belonged to someone else. “You're fortunate to have this opportunity.”

Yeah, lucky me. He stood. That was my cue to leave.

My legs felt like rubber. I rose and started out. When I reached the door I looked down at the papers I was holding, the words swimming into focus. I flipped to the back page.

I turned around. Shands had gone back to examining my MRI. He was tracing something with his finger, then writing in a file folder.

“‘Consent for postmortem and retention of human material for diagnosis and research,” I read aloud. He blinked at me over his shoulder as if a chair had just spoken. “How come you don't point this out to patients?”

In a disconnected part of my brain I wondered why on earth, after just having received what amounted to a death sentence, I was focusing on this extraneous detail.

I wanted to go up to Shands, poke my finger into his chest and say, “How come, huh? Why don't you tell patients about this?” I was itching for a fight, even as I realized that what I wanted to fight him about was the news he'd just delivered.

Shands held up his hands. “Whoa! Take it easy. Peter, you're not about to die.”

“Mr. O'Neill almost did. It came as an unpleasant surprise to his niece when they came to collect his corpse.”

“Unfortunate mixup,” Shands said, looking annoyed. “Hospital's fault.”

“So why don't you tell patients like me that we're signing away our brains?”

He swiveled to face me, tilted his head and rubbed his chin.

“The autopsy is critical.”

“That's not what I'm questioning. What happened to
informed
consent?”

“It's there. We tell them to read—”

“Your patients and their families are under stress,” I said, cutting him off. “They've just received the worst possible news. And here you come, offering this one hope. But there's a string attached. You should be telling them, up front, explicitly. Not waiting for them to interpret the jargon in the fine print.”

He sighed heavily.
Go ahead,
I thought,
humor me.

“In the beginning we used to discuss this with patients. Explicitly. What we found was that it made them squeamish. Distracted them from where they should have been focusing—this opportunity to create new science. They'd delay enrolling in the treatment. The patient suffered unnecessarily. The research suffered.”

I folded my arms across my chest.

He went on. “We're going to nail this disease, develop a definitive early diagnosis and effective treatment. Think of all the pain we'll be able to avert. All the lives we'll be able to save.”

I had to admit, that promise was pretty intoxicating. “Still,” I said, feeling my anger deflate, “seems like something you should be upfront about.”

Shands shrugged, like he was tired of having to explain. “Being a research subject isn't like being a regular patient. Regular patients get tested and treated in order to get better. When you're a research subject, sure you may benefit personally. But the bigger goal is to help humanity, make your own illness count, contribute in a significant way to our understanding of the pathology of the disease so others will be saved. That's why people go into it willingly, knowing they may or may not get treatment. Knowing we're going to want to autopsy their brain when it's all over. Besides,” he added, “we need the family to give their consent once again after death. So where's the harm?”

“Suppose a patient won't sign this, won't agree to donate his brain?”

“It's a showstopper. No autopsy, no treatment.”

“Really?”

“Sure. If we were still under the thumb of the medical school I couldn't make it conditional, but we have our own institutional review board and they understand the importance of this component.”

“But the family can rescind the decision after death?”

“They rarely do,” he said. I wanted to push in his smug face.

I walked back to the reception area feeling like I was watching myself from one of the fluorescent light boxes recessed into the ceiling. The receptionist nodded to me as I passed.

“Do you need to schedule a follow-up?” she asked.

“I'll let you know,” I said.

In the lobby I pressed the elevator button. A voice in one ear scoffed, “Forget about it. It's purely subjective. Herr Doktor sees what he wants to see because it confirms what he's expecting.”

Where the hell was the elevator? I pressed the button again.

A voice in the other ear hectored, “You'll be sorry if you don't listen. Twenty years from now you'll be hoarding wine that's long since turned to vinegar. You'll have bought so much Mission furniture it'll be shoving you out the front door.”

Then a calm voice from deep within me took over. “Listen, twenty years from now, who knows what new cures there will be? They'll probably be able to manipulate that gene you've got,
if
you've got it. And that's a big if.”

Finally the elevator came. I stepped in. The doors started to slide shut when I heard footsteps and then, “Wait!” I put out my hand to hold the door. It was Emily, holding a large envelope. She got into the elevator with me.

“I wanted to catch you and show you this.”

She pulled out a sheaf of newspaper clippings. “I found these—”

I meant to say
This isn't such a good time, can we talk later?
But what came out was a sharp, “Not now.” Emily took a step backward. I knew a piece of this was displaced anger but I couldn't stop myself. “There are other people, other problems in the world that aren't about you.”

I got out at the parking garage and stomped over to my car.

“But I found these hidden in the back of one of the drawers in Lenny's office,” she said, trailing behind.

I unlocked the car door and got in.

She looked at me hollow-eyed, wordlessly accusing me of abandoning her. “You
asked
if anyone at the lab collected obituaries, remember?”

I'd asked her no such thing, I thought as I jammed the key into the ignition. But I didn't start the engine. Grudgingly I had to admit that Philbrick was the most likely person to have collected obituaries, the one who'd care enough to note the death of a patient as more than a clinical finding. I remembered those three phone calls Philbrick made to me right before he was killed. That had been the same night Uncle Jack became critically ill after having an MRI. If these were obituaries that Philbrick collected and kept hidden, I owed it to him to at least consider the implications. On top of that, I could see Annie waving the two obituaries in my face.
This is what I think it's about
.