Patient
Authors: Michael Palmer
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CRITICAL JUDGMENT
EXTREME MEASURES
FLASHBACK
MIRACLE CURE
NATURAL CAUSES
SIDE EFFECTS
SILENT TREATMENT
THE SISTERHOOD
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MIRACLE CURE
“A highly entertaining tale of greed and medicine
run amok.”—
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Associated Press
“A fast-paced lively thriller.”—
Boston Sunday Herald
CRITICAL JUDGMENT
“Wrenchingly scary ... Palmer is reaching the top of a
demanding craft.”—
Publishers Weekly
(starred review)
“This is a novel that manages to scare the socks off the
reader while still providing made-for-Hollywood
entertainment.”—
The Globe and Mail
, Toronto
“Palmer [brings] his fascinating ER procedural knowledge to
a fast-paced ... narrative.”—
San Francisco Chronicle
SILENT TREATMENT
“Guaranteed to terrify anyone who ... has reason to step
inside the doors of a hospital ... Dynamite plot ...
fast-paced and engrossing.”—
The Washington Post
“Terrifying ... highly entertaining ... [An] action-packed
tale that never lags.”—
Sun-Sentinel
, Fort Lauderdale
“Palmer owes this reviewer about three hours of sleep spent
reading this can’t-put-it-downer. You are cautioned ...
don’t start this one at 10 at night.”—
The Washington Times
ALSO BY MICHAEL PALMER
FROM BANTAM BOOKS
The Sisterhood
Side Effects
Flashback
Extreme Measures
Natural Causes
Silent Treatment
Critical Judgment
Miracle Cure
MICHAEL PALMER
THE PATIENT
BANTAM BOOKS
NEW YORK LONDON TORONTO SYDNEY AUCKLAND
This edition contains the complete text
of the original hardcover edition.
NOT ONE WORD HAS BEEN OMITTED.
This is a work of fiction. Names, characters, places, and incidents are
either the product of the author’s imagination or are used fictitiously.
Any resemblance to actual persons, living or dead, or locales,
is entirely coincidental.
THE PATIENT
A Bantam Book
PUBLISHING HISTORY
Bantam hardcover edition published April 2000
Bantam export edition / July 2000
For Beverly Lewis
All rights reserved.
Copyright © 2000 by Michael Palmer.
Cover art copyright © 2000 by Tom Hallman.
Library of Congress Catalog Card Number: 99-057838.
No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. For information address: Bantam Books.
ISBN: 0-553-84031-2
Published simultaneously in the United States and Canada
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PRINTED IN THE UNITED STATES OF AMERICA
OPM 10 9 8 7 6 5 4 3 2 1
For Beverly Lewis
Acknowledgments
The many, often lonely and uncertain hours spent here in front of my Mac have been much more bearable because of my friends and family. This page is one of the ways I get to express my appreciation to them.
At the Jane Rotrosen Agency, Jane Berkey, Don Cleary, Stephanie Tade, and Annelise Robey have made writing easier for me in many ways.
At Bantam Dell, Beverly Lewis, Christine Brooks, Irwyn Applebaum, Nita Taublib, Susan Corcoran, and Barb Burg have done the same.
Sam Dworkis, Mimi Santini-Rift, Sarah Elizabeth Hull, Dee Jae Jenkins, Matt Palmer, and Beverly Tricco have been invaluable as critical readers.
My deepest gratitude to Holly Isbister, Pamela Kelly, and the rest of the crew in the Brigham and Women’s Hospital magnetic resonance operating room for your hospitality, professionalism, and skill.
When blocks seemed insurmountable and another rewrite too daunting, Luke, Daniel, Matt, and Bekica have helped to keep everything in perspective, along with many friends of Bill W.
And finally, thanks beyond measure to my friends Linda Grey, who brought her genius as an editor to the final rewrites of this book, and Eben Alexander III, M.D., whose remarkable gifts as a physician, surgeon, and scientist made the whole project possible. Whenever I needed neurosurgical facts or techniques, Eben was always there. Any errors or oversights are mine, and are doubtless due to my neglecting to review them with him.
MSP
THE PATIENT
Contents
Prologue
SYLVAN MAYS, M.D., STOOD BY THE VAST WINDOW OF his fifth-floor office and gazed out at the countryside, where late afternoon shadows were lengthening across the Iowa River. At fifty, he had just gone over ten million in net worth and was one of the few physicians who had actually seen his income increase since the advent of managed care. The decision to remain in Iowa had certainly been the right one. For sure, he had his detractors. Success always brought those. He was too entrepreneurial, some said—a big fish in a small pond, too intent on building himself into a neurosurgical version of DeBakey or Menninger.
What’s so wrong with that?
he wondered. DeBakey and Menninger were world renowned and respected, doing good on a global scale. What was so wrong with wanting to emulate them?
The gleaming seven-story Mays Institute for Neurological Surgery had put Iowa City on the map and brought millions of dollars in research and industrial development grants to the university. Now, his robotics team was closing in on a real prize—the first microrobot to be approved by the FDA for use in neurosurgery. A preliminary application had already been submitted. Six months, maybe less, and the few remaining bugs in the system would be worked out. As it was, he was revered for cranking through more brain tumor cases than anyone else in the country. Now, with several researchers on the robotics project, and Sylvan Mays’ name on every scientific article the group generated, he was gaining recognition as a top researcher as well.
He checked his watch. Five minutes or so before Frederick Wilson was due. As with his previous appointment, Wilson had insisted on being the very last patient of the day. At first, Mays had been put off by his prospective patient’s demands. But what a find he’d turned out to be! Wilson was eccentric as could be, yet ready to reward handsomely anyone who did him good service. A quarter of a million in cash just for evaluating his case. Four times that when the surgery was completed, plus a healthy donation to the Institute. Wilson was the patient of a surgeon’s dreams, except that his tumor was bad—as bad as any so-called benign tumor could be. A slow-growing subfrontal meningioma with some extension, steadily compressing normal brain tissue. Progressive neurologic difficulty had begun. Now, the only choices Wilson had were surgery or a stuttering, inexorable death.
Mays was sure he would be able to get to the tumor, but not without doing some damage—maybe a lot of damage. Then there was the actual dissection. He had probably excised more tumors like this one than almost any other surgeon in the world; if he couldn’t do it, it was doubtful anyone could. But even for him, the dissection would be chancy. Wilson had come to him impressively well informed, and had asked specifically about the robotics system. Rather than risk losing him to some other surgeon, Mays had chosen to tell him that employing the robot in the OR was possible, but not definite.
By no means definite
. Hadn’t those been his exact words? The exaggeration had been necessary initially. Now, it was time to back off.
The trick, as with all cases like this, was to hang crepe—to stress the dangers inherent in the surgery and lower the patient’s expectations to the point where even a marginally successful operation would be welcomed as the work of a genius. The man had seemed reasonably easygoing and understanding enough at their first meeting, yet he was sharp, too. That much was certain.
But so was Sylvan Mays. Until Mays had the chance to study the MRIs, he had refused to talk in anything but generalities. Today, though, they would have to get down to business—to go over the specific anatomical challenges and potential surgical stumbling blocks inherent in Wilson’s case. First, it would be necessary to dispel Wilson’s belief that the only way to reach his tumor was by means of a robot.
Mays wandered over to what he thought of as his wall of fame—dozens of photos and testimonials from world leaders and other celebrities. “Neurosurgeon to the Stars,” one publication had dubbed him. “Brain Tumor? Head for the Cornfields,” another had headlined. “Is This Heaven? ... No, It’s Iowa—Unless You Need a Neurosurgeon.”
“It damn well
is
heaven,” Mays said out loud.
He paced to his desk and hit the intercom.
“Yes, Syl?”
Sandy had used his first name. The waiting room had to be empty.
“Mr. Wilson arrive yet?” he asked, just in case.
“Not yet. There’s no one here at all at the moment. No one at all. ... Hint, hint.”
As always, Sandy Alter’s flirting over the intercom immediately turned Mays on. At thirty-one, she was a hell of a gal Friday, with an aerobics instructor’s body and a wicked imagination in bed. And even more exciting, after almost a year, she didn’t want anything from him other than a night or two a week, enough cocaine to elevate their lovemaking from great to sublime, and no talk about his wife or kids. Could life get any better?
“I wish we could do it right now,” he said. “Tonight can’t come soon enough for me.”
“Me either.”
The stiffness inside Mays’ slacks intensified. At that moment, through the intercom, he heard the outside office door open and close.
“Mr. Wilson,” Sandy said. “Nice to see you again.”
The intercom was switched off, then on again, and she announced Wilson’s arrival.
Mays positioned himself behind his desk, on which lay Wilson’s file, took a deep, calming breath, and asked Sandy to send him in.
Okay, Sylvan
, he thought.
It’s showtime
.
Frederick Wilson limped into the office, a cane in his right hand and an elegant black leather briefcase in his left. He set the briefcase down, shook Mays’ hand enthusiastically, and lowered himself into one of the two mahogany chairs on the patient’s side of the desk. He was dressed as he had been on his first visit to the office—dark suit, conservative tie, white shirt. His thick gray hair was brushed straight back, and his beard and mustache—equally gray—were neatly trimmed. His intelligent dark eyes were partially veiled by heavy-rimmed spectacles with lightly tinted glass.
As so often happened, Mays found himself seeing his patient with Superman-like X-ray vision, staring beyond Wilson’s face, eyes, and skull at the fleshy tumor that was infiltrating and displacing his brain.
Poor bastard
.
“You’ve verified the deposit?” Wilson asked in a modest accent that Mays had decided was probably German or Russian.
“Barclays Bank, Grand Cayman. In my name. Yes. Yes, I have.”
“There will be no tax problems that way ... for either of us.”
Eccentric. Mysterious. Clearly a man of wealth and breeding, yet with no health insurance. Electronic cash transfers only. When the time came, Wilson would speak to Bob Black, the hospital administrator, and transfer funds for his inpatient treatment. But first, Mays had had to pass muster in an interview that lasted most of an hour. His background ... his training ... his family ... his interests outside of medicine ... his specific experience with the kind of tumor Wilson had ... and finally, the status of his robotics research. Mays knew he had acquitted himself well, and was not in the least surprised when Wilson had called the next day to inform him about the money deposited in Grand Cayman and to formally accept him as his surgeon.
“So,” Wilson said now, “I have offered money for a service and you have agreed to provide it. I have given you a down payment for that service and you have accepted. We have set a fee to you and to this institute when the service is rendered that will total well in excess of a million dollars, tax free. It seems, then, we have entered into a business arrangement.”
“I ... I guess I never thought about what I do that way before, but yes, I suppose we have.”
“Excellent. Let’s talk about expectations, then.”
“Yes. I think at this point that’s quite appropriate.”
Mays straightened himself in his chair, cleared his throat, and met Wilson’s gaze with an expression that he hoped was sufficiently grim. Now was the time to begin to paint the picture of guarded pessimism. But before the surgeon could say another word, Wilson began speaking.
“Given the benign nature of my tumor, and the magnificent qualifications, experience, and skill you have described, I expect nothing less than a complete cure. I expect to be speaking as well as I am now, to be walking without a limp, and to have full use of my senses and my intellect.”
“But—”
“I also expect to have no evidence of residual tumor on a postoperative MRI study.”
“But—”
“Is that clear?”
Mays felt a sudden chill.
“I ... I expect an excellent result, of course, but I can’t make those sorts of promises. No surgeon can.”
“You’ve told me you are the best in the world at this sort of surgery. You told me your robotics system was capable of bypassing the usual route from my skull to the tumor.”
“I said it was
potentially
capable of that, yes. But I also said our robotics project was still in the experimental stage.”
“And you accepted my money without hesitation.”
“Yes, but—”
“Then I expect full satisfaction.”
“I understand. However—”
“Dr. Mays. Close your mouth, please, and listen carefully. I have not paid you a quarter of a million dollars to debate this point. I expect you to perform the way you have promised me you can. To guarantee that I get your best work, my people are currently observing your wife and daughter. When the day of my surgery arrives, they will be entertaining your family at a place of my choosing until I am safely out of danger, and your radiologist as well as one of my choosing has reviewed my MRI films. When I know that I am safe, unharmed, and free of tumor, your wife and daughter will be returned to you. They will be treated well, I promise you that.”
Mays felt as if he were being strangled. There was nothing in Wilson’s manner or expression that suggested flexibility. The man must be insane.
“I ... I can’t agree to this,” he finally managed. “No surgeon can.”
“Our arrangement has been established. I have the right to expect complete satisfaction. I have the right to recourse if you fail.”
“You’re not buying a used car from me, Mr. Wilson. This is neurosurgery.”
“Precisely why I have sought out the very best, which you assure me you are. The terms are nonnegotiable, Dr. Mays.”
The shirt beneath Mays’ armpits was soaked. He felt as if his bowels might let loose at any moment.
“I refuse,” he managed, with forced bluster. “I refuse to be bullied and threatened, and I refuse to operate on you under these circumstances. Go find yourself another surgeon. There are plenty of them as qualified as I am.”
“That is not what you told me at our first meeting.”
“All right, all right, there are only a few. But that makes no difference. I will not operate.”
“Dr. Mays, I am very disappointed in you.”
“I don’t give a damn that you’re disappointed, Wilson. I won’t be pushed like this. Be reasonable, man. This is brain surgery we’re talking about. Nothing is certain in brain surgery. Christ, man, nothing is certain anyplace.”
Wilson sighed.
“That is where you are wrong, Doctor. One thing is very certain.”
He calmly opened his briefcase and extracted a heavy pistol with a long silencer on it. Without waiting for another word, he aimed from his chest and fired.
Mays saw the muzzle flash, and actually heard the spit of the shot. But he would never appreciate the perfect placement of the bullet hole, exactly equidistant between the bridge of his nose and his hairline. An expression of amazement froze on his face, and his head jerked backward, then slowly drifted forward until it slammed onto the desk.
Frederick Wilson took his file and every piece of paper with any reference to him, and placed them all in his briefcase. Then he carefully wiped the arms of his chair. He stopped by the door to ensure that he had overlooked nothing, then stepped out into the reception area. The receptionist smiled up at him.
“Well, that didn’t take long,” she said. “Did Dr. Mays want to see you in the office again?”
“No,” Wilson replied, without the hint of an accent. “He didn’t say a word about that.”
He removed the silenced pistol from behind his briefcase and, from ten feet away, firing almost nonchalantly from his hip, put a shot in precisely the same spot on Sandy’s forehead as he had on Mays’. Then he placed all potentially incriminating files and papers in his case, hooked his cane over a chair, and, without any sign of a limp, strolled back into Mays’ office. He was upset by the disappointing session with the surgeon, although not with his decision to terminate the relationship. The man was a pompous ass. A few thousand to the bank manager in Cayman would transfer the quarter million back into his account. And that would be that for his dealings with Sylvan Mays.
After a final check to ensure he had removed all trace of his ever having been at the Institute, he retrieved his cane, reacquired his limp, locked the outer office door behind him, and hobbled off down the hall.