Second Opinion (10 page)

CHAPTER 18

The Stuart Drummond Memorial Medical Library occupied three refurbished stories of the Coldwater Building, one of the oldest on the campus. On her way to the expansive research center, Thea called Niko to report the ICU intruder and to formulate a strategy for protecting their father. Given her decision not to mention Petros's locked-in syndrome, she knew convincing her cynical brother to do anything of the sort would not be easy. It wasn't.

'Tell me again why you think this man was after Petros?' Niko asked.

'Dimitri is convinced that the hit-and-run was no accident.'

Niko groaned.

'You mean that animation of his? The damn thing looks like some sort of cave drawing.'

'The way he presented it made sense to me. Niko, call him anything you want, but don't call him dumb.'

'Oh, please. Nothing about Dimitri should make sense to anyone. He's one of those cases where he would have been better off without so much intelligence. Thea, I believe that you are grasping at straws. Petros was hit by a drunk driver or someone reaching for their cell phone, and has sustained massive, irreversible brain damage and a prognosis that is worse than hopeless. At the moment of impact he crossed the bridge of no return.'

'That's cruel.'

'No it's not, it's realistic. Thea, Scott Hartnett told me you tried to demonstrate to him that Dad was awake and alert.'

So much for limiting those who knew about that to Hartnett and Tracy Gibbons, Thea thought. It wouldn't be the first time she had been entangled in a hospital grapevine. It seemed as if she spent half of her residency there. One tells two, two tell four. Rumor at the speed of sound. Word of her behavior at her father's bedside, based on hopelessly naive wishes, was making its way across the vast hospital like ripples on a pond.

'That was a mistake,' she said.

'Now we're getting somewhere.'

'So I take it you don't think he needs a guard.'

'What he needs is benign neglect.'

'Are you coming by the ICU later today?'

'Petey has a soccer game. I missed the last two.'

'I hope I get to see him play.'

'We'll have you over for dinner next week on an evening when he's playing. I'll speak to Marie.'

'That would be great.'

'Thea, I know you think I'm being harsh about this, but we've both been doctors long enough to appreciate that Dad's situation is as hopeless as it is degrading. Deep down inside you must know that I'm right.'

Deep down inside I know that you're not,
Thea barely kept herself from saying.

A NUMBER
of the oak tables, carrels, and computer stations of the Drummond Library were occupied. Thea and the reference librarian, a lanky, bespectacled brunette named Rachel, were pleased to find a copy of Jean-Dominique Bauby's powerful memoir of his locked-in syndrome,
The Diving Bell and the Butterfly.

Thea took only forty minutes to read the 132 pages. It wasn't easy for her to comprehend why the once-powerful magazine editor would have chosen to write such a positive, life-affirming book when his condition was so abysmal and painful, but she dutifully took notes, and promised herself that she would spend more time thinking about what Bauby was trying to tell the world. Perhaps it was something she and Hayley could talk about.

She next moved to an available computer for more in-depth research and note-taking on the syndrome that only she and her father knew was holding his body hostage. According to Petros's longtime lover, Niko stood to inherit millions. Did Niko himself know that? If so, he would certainly have reason over and above his philosophical and medical beliefs to want the tragedy in the ICU to be over quickly.

As she worked, Thea's thoughts mulled over and over the questions raised by the Lion's refusal—not reluctance,
refusal
—to share with anyone else the fact that his mind was keen and totally alert to what was transpiring around him. Was it a manifestation of his well-established need to be in control? Was it fear? Pure petulance? It didn't really matter, she decided. At that moment, as helpless as he was, Petros was in control—unless, of course, someone other than Thea believed he had locked-in syndrome and was capable of communication. In that case he was not only
not
in control, he was in serious danger.

An hour of work on the Internet brought a mix of encouraging and frightening news. Locked-in syndrome, LIS, whether caused by hemorrhage, clot, or trauma, was rare, but common enough to have a number of outcome studies reported in the literature. One such study published in the
British Medical Journal,
hard for Thea to believe, alluded to an 80 percent ten-year survival. Another estimated the four-month mortality of LIS at 60 percent.

Most striking in one of the articles was the fact that most long-term survivors with locked-in syndrome chose to return home in hopes that the interaction with loved ones would enhance their desire to live. Improved communications technology such as infrared eye movement sensors and computer voice prosthetics, coupled with a plain old alphabet board, had actually made it possible for a lawyer with LIS to return to his profession.

With time, Thea vowed, she would begin to educate her father in what she was learning about his condition. Only then, only when they knew everything there was to know about LIS, along with the amount of neurological function the Lion was going to regain, would it be fair to sign any health proxies.

The afternoon light had begun to thin by the time Thea set aside her notes on LIS and turned her attention to the next item on her list—billionaire businessman Jack Kalishar.

First the basics,
she wrote on her yellow legal pad.
John (Jack) Joseph Kalishar, age
57…
Occupation: businessman. President and CEO of K-Group, corporate raider. Born: Indianapolis, IN. Current residence: Boca Raton, EL. Married, two children
—
24 (m-Mark), 22 (J-Marcy). Estimated worth: 1.7 billion
… Pilot, speedboat ocean racer… art collector.

His photos—there were dozens on Google Image—were of a lean, tanned man with an aquiline nose and narrow, dark eyes. His looks weren't that appealing to Thea, although she suspected that many women would find him attractive. Why would he be so important that of all the words, of all the names her father could have chosen, he had picked
Kalishar
?

Why????

Thea scribbled down the word and ornamented it with flowers, then continued clawing through item after item on the Internet searching for a clue—any clue.

Why?

When the clue finally appeared, it almost passed her by. It was in a
Wall Street Journal
article on philanthropic giving in which Jack Kalishar's name was mentioned exactly once.

Reginald Pickard's World Vaccine program is just one of a number of health-related philanthropies established by this group of businessmen. Following his close call with cancer, Jack Kalishar of Kalishar Investments has formed the Breath of Life Foundation to fill needs in the areas of medical research, medical student education, and the upgrading of health care facilities.

Cancer,
Thea wrote after copying down the segment verbatim.

What kind of cancer?

Was K treated here?

Connection to Dad?

Another hour added little except for the address and a phone number for the Breath of Life Foundation. The information about Kalishar's cancer she could get from his medical record. She was gathering her notes together with plans to visit Hayley Long, when her father's cell phone began to vibrate. Thea hurried to an empty glassed-in carrel to one side of the main floor, built along with two others for cell phone use or for answering pages.

'Hello, this is Thea Sperelakis,' she said, precisely as she had done until it came naturally in role-playing pragmatics improv class.

'Thea, it's Sharon Karsten here.'

Perfect timing,
Thea thought.

'Yes, how are you?'

'A little perturbed, and I guess a little embarrassed, too. Thea, there are some members of the credentialing committee who resent my efforts to circumvent what has been established as standard procedure. Out of respect for your father they are willing to cut some corners, but they are steadfast against giving you unrestricted privileges without the usual check of your references and employment history. The application forms will be in your new mailbox in the mail room outside the library. The best I've been able to do is to get you provisional staff privileges that will require Dr. Hartnett to sign off on all your patient notes.'

'Including admission notes?'

'We have hospitalists who will do that for you if you decide to write any admission notes in addition to theirs. I'm talking about office patients and notes you write as a consultant.'

'That doesn't make a lot of sense. Neither does just accepting the hospitalist's admission note when it's
my
patient. I'll write my own admission history and physical if that's okay, but I'll be happy to have one of the hospitalists or Scott sign off on anything, even though it seems like I'll just be making more work for them.'

'He's grateful to have you. He has been handling referrals to your father from around the country, and indeed around the world. We have a force of physicians out there recruiting patients to be sent to our most renowned specialists, including the great Petros Spe-relakis.'

Thea remembered Hayley speaking about the doctor, sort of a salesman, who had convinced her physician in Atlanta to begin sending her to the executive health program at the Beaumont, and subsequently to Petros and to Lydia Thibideau.

'Well, I'll do whatever I have to,' she said.

'Excellent. Scott will be so relieved to turn Petros's appointment book over to you. Most of the referrals in there are quite ill, but there are many chronic problems as well.'

Thea felt edgy. Just a few days ago they were begging her to step in and take over her father's practice. Now that she had agreed to do so, they weren't ready to give her unrestricted staff privileges.

'What about medical records?' she asked. 'Will I have access to them?'

'Actually, Scott will retrieve them electronically and forward them to you. The credentials committee has been adamant about protecting our system and our patients' records from anyone without full staff privileges.'

'So, there's no way I can just read through any of my father's patients' records—see how he did things?'

'Why would you be wanting to do that?' the CEO asked.

Danger!

Suddenly Thea felt out of her element. Karsten's query had been made in an offhanded way, but there were layers beneath it, Thea could tell that much. This was the sort of complex business that had driven her away from hospital politics and intrigues in the first place.

'I… I've been reading some patient notes Dad has on file in his office, and I just wanted to learn about them in more detail. That's all.'

The lie took just a few seconds to materialize, and it probably could have come out smoother, Thea supposed. But considering that she couldn't remember the last time she had told one, she had conjured it up quickly and told it quite well. Still, lying bothered her. No guile. That was how Dr. Goldman had described Aspies to her— people incapable of telling a decent lie. Now, after just a short time back in civilization, one had simply rolled out.

Welcome home.

There was little left to the conversation with Karsten. Thea rang off and sat on the edge of the small desk, trying to make sense of why they had begged her to come on board the medical staff, and then were suddenly making it difficult for her to do so. Scott Hartnett, from all she could tell, was a fine doctor and a good person. Still, the last thing she wanted was for anyone to be looking over her shoulder. If Dimitri's and Daniel's suspicions were right, someone had twice tried to kill her father. If restricted staff privileges were the best she could get from the credentials committee, she would find a way to work around them.

The strength of her intellect was in logic and concreteness. This situation was, to this point at least, neither logical nor concrete. Bewildered, she returned to the computer station and was packing her notes when the tall reference librarian, Rachel, approached.

'Dr. Sperelakis,' the woman said, 'I haven't got very much for you on John or Jack Kalishar, but I did find this article in the
Beaumont
Bugle. That's our bimonthly newsletter here at the clinic. The article's on microfiche and it's almost exactly three years old. Here, I printed it out for you.'

Thea took the single sheet and settled into the high-tech computer chair. Basically, the short article, with a photo of Kalishar posing with six or seven hospital dignitaries, was about the businessman/ philanthropist's attendance at a black-tie dinner honoring the hospital's researcher of the year, Dr. Lydia Thibideau. The name registered instantly—Hayley Long's oncologist, the world-renowned specialist on cancer of the pancreas. Thea focused back on the photo. Thibideau, shorter by half a foot than Kalishar, stood directly to his right. She was a stocky, jowly woman with a determined, bulldog look. Directly to Kalishar's left, looking positively dashing in his tuxedo, was the Lion himself.

Why would Kalishar be attending such a dinner?

Thea read the caption beneath the photograph, which identified each dignitary by degree or academic title.

Petros Sperelakis, Davis and Edwina Hart Professor of Medicine, Director,

Sperelakis Institute f
or Diagnostic Medicine…Jack Kalishar, benefactor, the Lydia Thibideau Gastroenterology Research Center…

Thea checked her notes once more, and next to where she had questioned what kind of cancer Jack Kalishar might have survived, she wrote
pancreatic.
It wasn't that surprising that Kalishar had the same cancer as Hayley Long, or that he had been treated by the same oncologist. Lydia Thibideau was famous and undoubtedly had patient referrals from all over the world. What was surprising and interesting was that Kalishar was still alive.