Second Opinion (2 page)

The eruption did not take long to begin. The first few molecules of the venom instantly began mobilizing mast cells from all over Fagone's body. The cells released huge amounts of histamine and other sensitivity chemicals. More venom, more mast cells, more histamine. In less than a minute, Fagone's tongue, cardinal red, had swollen to the size of a golf ball, and his lips to violet sausages. The muscles in the walls of his bronchial tubes went into vicious spasm. Seconds after that, his larynx, also in spasm, closed off altogether. His entire body became scarlet, and his fingers became nothing more than nubs protruding from softball-sized hands.

The team in the Terry unit acted quickly, bringing out a stretcher and hoisting the two-hundred-and-seventy-pound former teamster onto it, then wheeling him to an area that could be screened off from other patients.

But they were paddling against a medical tsunami.

The IV port was available, but the oncologist covering the unit, a young woman less than half Fagone's size, was not skilled in dealing with emergencies of this magnitude. By the time she got the right medications into the man, Fagone's blood pressure had been zero for nearly three minutes. By the time she gave up trying to force an endotracheal breathing tube past the massively swollen, distorted vocal cords, and began clumsily performing her first emergency tracheotomy while waiting for the ENT surgeon to answer his page, there had been no effective respirations for four minutes. She had just sliced a scalpel across her patient's massive throat when his heart stopped. The blood flowing from the gaping laceration was gentle.

When the oncologist, frustrated and utterly demoralized, called off the resuscitation at the ten-minute mark, a useful airway had still not been established.

Jeffrey Fagone, who years before had survived two assassination attempts during his rise to wealth and power in the Teamsters Union, had no chance of surviving this one.

Unlike the other attempts, however, there was no suspicion of anything sinister at work here. Fagone had been done in by a lethal allergic reaction to Waldenstrom's macroglobulinemia experimental drug #BW1745. No one present that day thought otherwise. There would be no analysis of the contents of the vial, and the perfunctory autopsy performed the next morning would disclose nothing out of the ordinary.

The treatment protocol for #BW1745 would be suspended indefinitely, but within just a few months, the principal investigator, supported by a hefty grant from one of the pharmaceutical giants, would roll out another experimental drug to meet the demand of referrals from all over the world.

The Susan and Clyde Terry Cancer Center closed for cleanup and staff support for an hour after the tragic event, but there were patients to treat, many of whom had come from even greater distances than Jeffrey Fagone.

Soon, like the surface of a pond disturbed by a jumping fish, the ripples had subsided, and the world's greatest hospital had gone back to being the world's greatest hospital.

CHAPTER 2

For another ten minutes, Thea stared down at her father, mentally cataloguing his injuries. It didn't take a Petros Sperelakis to discern that given the sort of excellent medical care practiced at the Beaumont, none of them was immediately life-threatening, except the hemorrhage in his midbrain. On the plus side of the ledger, she believed that at almost seventy, the man was in remarkable shape thanks to a disciplined diet, exercise, the right genetics, and the preservative effects of a daily shot glass or two of seven-star Metaxa.

Thea's eyes were X-ray probes, seeing through Petros's skull and visualizing the intricate folds and contours of his magnificent brain. According to Niko, the hemorrhage had occurred in the center of the middle portion of the brain stem, a tight bundle of nerves connecting the gray matter and the spinal cord and known technically as the mesencephalon. It had been a while since Thea had read a neuroanatomy textbook, several of them, in fact. But it had not been so long that she had forgotten very much. In fact, forgetting material she had read was something that essentially did not happen.

In just a few seconds, she connected with a vast amount of information concerning midbrain anatomy and function. Her mind's eye saw the information as integrations of a number of texts, but if she had to, she knew that she would be able to quote the actual passages virtually verbatim, with few or no mistakes, along with the page numbers on which they appeared.

There were curses connected with having the form of autism called Asperger syndrome, but her obsession with the details of what she saw, and her mastery over the printed word, had always been blessings—refuges in the often-confusing world of the neurotypicals. She flashed on Dimitri, never officially diagnosed, but undoubtedly afflicted with abnormal neurology that was similar to hers. The 'autism spectrum' was the label du jour for a series of conditions. Somewhere in the middle of the spectrum was the offshoot first described by Austrian pediatrician Hans Asperger in 1944.

Asperger syndrome.

For her immeasurably brilliant brother, the gray matter once destined for learning such things as nonverbal communication, social grace, small talk, interpersonal pragmatics, group dynamics, and executive function had largely been usurped by an understanding at his mind's deepest levels of electronics and computer science. The groupings of neurons responsible for fine motor control and hand-eye coordination had yielded in large measure to the remarkable ability to focus for long periods of time on those things that interested him.

It didn't matter that he and Thea were probably different in as many ways as they were similar. If not the same, their diagnoses were certainly kissing cousins, layered on their unique personalities. Thea forced her focus from her brother back to their father. The injury to Petros's brain stem was indeed a frightening one.

The cerebral lobes and cerebellar hemispheres were the parts of the brain largely responsible for thinking, balance, and movement. Outgoing efferent nerve fibers from them coursed through the midbrain on their way to activate the muscles of the body. At the same time, incoming afferent fibers were skirting the central midbrain, carrying sensory information such as pain, light touch, and position up to the cerebrum and cerebellum for processing.

The hemorrhage in Petros's midbrain, as described by Niko, had probably effectively sliced across the efferent bundles like a blade, killing neurons and disconnecting the upper nervous system from the lower—thought from movement, intellect from physical ability, reason from function. The result: paralysis involving literally every muscle in the body.

Behind her, she sensed Niko and Selene, and the team from Beaumont standing patiently by the doorway. Dr. Sharon Karsten, a onetime endocrinologist, had been the president of the sprawling medical center for nearly as long as Thea could remember. Under her guidance, the hospital had enhanced its worldwide reputation as one of the places to go for second opinions, knotty diagnostic conundrums, and top-notch surgical specialists.

One of her most successful brainchildren was Medicon, Inc.— highly paid, highly trained physicians, who were scattered around the globe, networking and advising doctors to the wealthy, the influential, and the powerful. One product they were offering, in addition to their knowledge and experience, was the hospital's renowned five-day Executive Health Evaluation—a hundred thousand dollars' worth of the most sophisticated medical testing and specialist evaluation available anywhere. EHE was based in the luxurious Beaumont Inn and Spa, located on the grounds of the hospital.

With Karsten was Dr. Scott Hartnett, tall, handsome, and intellectual, the director of development for the Beaumont, and still a part-time practicing internal medicine physician at the Sperelakis Institute. Thea remembered her father once saying that if the government could generate money for the country the way Scott Hartnett could for the Beaumont, there would be no national debt.

And finally, there was chief of nursing, Amy Musgrave, five feet tall, if that, introduced to Thea as the glue that held the entire Beaumont system together—a system that now included three satellite hospitals in Boston, and expanding facilities in Washington, D.C., and Charlotte. Thea had never met Musgrave, but immediately took to her straightforward manner and powerful dedication to her nurses.

It was Musgrave who first stepped to Petros's bedside.

'Is there anything further you can think of that we should be doing, Doctor?'

Thea shook her head. 'It seems he's getting remarkable care,' she said.

'Your father was—
is
—a wonderful man. My nurses love him. He treats them as equals, and most of the time, at least, he seems to understand that the true measure of any medical facility is the minute-to-minute, hour-to-hour, day-to-day nursing care its patients receive. The more nurses, the better the care. It's as simple an equation as that.'

'I totally agree,' Thea said, wondering if Musgrave expected her to be more effusive.

'In fact, Vernice is one of several nurses who are volunteering time to work with him.'

'Thank you,' Thea said.

Musgrave continued without a pause. 'We have the highest nurse-to-patient ratio, and we're at or near the top of every listing of the best hospitals. I don't think that's a coincidence.'

Together, she and Musgrave returned to the others, and were ushered down the hall to a small sitting area, where the three hospital officials asked the three siblings to wait for a short while, and then walked off together. The moment they were gone, the twins each pulled out their cell phones, checked their messages, and made calls—three or four apiece. Thea smiled inwardly at the notion of when she had last made a cell phone call. It might have been two years—the last time she was back in Boston. It might have even been five, dating back to her first posting with Doctors Without Borders.

'Well, what do you think?' Niko asked, after completing the last of his calls.

'About Dad?'

'Yes, of course about Dad.'

Again the slightly annoyed edge that Thea had become used to over the years. Selene closed her phone and set it in her purse. Dressed in a striking beige designer pants suit, without a wisp of her sorrel hair out of place, her nails perfectly manicured, she might well have been taken for a bank president or movie studio head, or even a model, before anyone came close to guessing orthopedic surgeon. However, no one would ever even mention Selene's ostentatious style once they watched her reattach a severed finger or two, or create a functional replacement thumb—her true specialties.

Brother and sisters were in a small sitting area at the end of the sixth-floor corridor. Beside them, seven-foot windows overlooked a man-made pond with several fountains spraying gracefully. A flock of Canada geese pecked its way around the perfect emerald lawn.

'It doesn't look good,' Thea said. 'From the description of the MRI you gave me, according to Therrian et al. in the textbook
Traumatic Brainstem Injuries,
he has a sixteen percent chance of making it four months.'

'Not seventeen percent?'

'You know, it's okay
not
to make fun of me, Niko.'

From her earliest memory, Thea couldn't stand being teased.

'Hey, I'm sorry. I really am.'

'Okay, because I've never been very good at distinguishing good-natured from mean-spirited teasing. I just could never understand why someone would tease me to make me feel that I was one of the gang. And as far as me teasing someone else, when I try, it usually leads to unbelievably disastrous consequences.'

'I don't know if I'll ever get used to your… your, what would you call it, gift? Condition?'

'You don't have to call it anything, Niko. It's simply who I am, just like you have great coordination and a rock-steady hand, I couldn't hit a pitch if the thrower was using a beach ball, and I have to print so that people can read what I've written.'

'Sorry,' Niko muttered again.

'He doesn't mean anything hurtful, honey,' Selene added. 'You know that.'

'They had Dad here in less than an hour after the accident,' Thea said. 'Do you think they could have operated?'

'I spoke to Joe Rizzo, the neurosurgeon, and he said not a chance given where this hemorrhage is located.'

Thea shrugged and stared out the window, absently wondering if Dimitri had been told that she was flying in and had simply decided there would be too much commotion and he would see her back at the house.

'At least it was quick,' Selene said.

'It's not over,' Thea countered, 'at least not yet. This is mostly a ventral pontine hemorrhage. With the technology and rehab hospitals we have today, one reference I can recall reported five-year survival rates as high as fifteen percent.'

'At Dad's age and in that condition?' Selene sounded incredulous.

Thea shrugged impotently. 'Sorry.'

'He wouldn't want to live like this.'

Nobody would want to live like this,
Thea thought.
But how far b
ack can he come? That is the question.

She found herself integrating everything she knew of the man and his condition. Critical? Yes. Grave? Absolutely. But hopeless?

Thea tried wishing that Petros Sperelakis would simply stop breathing. No, he had to make it. He had to survive this. There remained unfinished business between them. The man had never, in all her memory, told her that he loved her, nor had she taken the initiative and told him. At the very least, she needed that exchange to happen between them before the end.

It was a mistake not to have told him before now. She had done so well in all of those role-playing therapy games. It was a mistake to have held back in real life—to believe they had time to work things out. She needed him to make it.

Then, she found herself wondering what the Lion himself would wish for.

CHAPTER 3

'What If You Knew the Exact Day and Time You Were Going to Die?'

The irony of that thought wasn't lost on Rev. Gideon Bohannan. The phrase was the title of his most beloved and requested sermon, and his personal favorite as well.

What if you knew the exact day and time you were going to die? The exact moment, my friends. What would you choose to do differently? Who would you tell that you loved them? To whom would you say you were sorry? How would you make your peace with the Lord?

Oh, hut that was one hell of a sermon.

The words ran through his mind like a stock exchange ticker as he fished behind the shoes on his closet shelf and brought out the .38 Smith and Wesson revolver he had virtually forgotten was there— until last Wednesday, that is. The bullets were in a small envelope beside the gun. There were six of them, but Bohannan expected to use only two—three at the most.

It was Friday. Caroline and the children had gone off to her mother's for the weekend. The thought of not seeing her ever again wasn't all that hard to take, but he surely would miss the girls. They would understand. The note he had left for them would see to that.

Feeling surreal, distant from himself, Bohannan drew the huge motorized drapes spanning the south wall of their home—the wall that overlooked the interior of the vast All Praise the Lord Sanctuary.

Far below, the 7,500 seats of the sanctuary, beneath an enormous geodesic dome, stretched off in perfect symmetry. The design had been his, and the remarkable golden dome a dream of his from the day he'd visited the Royal Bank of Canada building in Toronto, with its 27,000 gold reflective-glass windows. This was his vision, his golden sanctuary.

In just an hour the whole goddamn thing would belong to Glenn Lovering—the prick.
Lovering.
Even the thought of not existing anymore wasn't as difficult to take as that one.

If Bohannan felt there was even a 1 percent chance he could survive the scandal of being diagnosed with AIDS, let alone the exposure of his homosexual affair, he would try to stick it out—if for no other reason than to keep his slimy assistant pastor from taking over his hundred-million-a-year baby. But there wasn't a 1 percent chance. There was no chance. Bohannan's hard-line conservative stance had seen to that.

The public had forgiven Swaggart and Bakker and any number of sinning evangelicals, but there would be no warmth in their hearts for Gideon Bohannan. And even if there were, the doctors at the Beaumont Clinic gave him a chance at remission from the virus, but virtually no chance at recovery.

Word would get out. He had managed to keep his affair with Race DuPre under wraps, but now Race had let him down by sleeping around. Word would get out and after being booted out of his church and his home, Gideon Bohannan would progressively sicken and die, shriveling away alone and disgraced.

Bohannan slipped the revolver into the pocket of his sports coat.

What if you knew
…?

The midday desert heat was already bearing down, and Bohannan, twenty-five pounds overweight, was sweating by the time he reached the garage and his Mercedes. Race would beg, Bohannan was thinking,

but it wouldn't do any good. Maybe while he was pleading for his life, the bastard would share who it was who had passed the virus on to
him
—who had gotten DuPre so hot that he threw caution to the wind and had unprotected sex.

Stupid
… just stupid.

DuPre, a bass player with a jazz combo that played the club scene throughout the area, had been a wonderful lover and friend.

Parked in the driveway of the man's modest ranch-style house at 10 Briarcliff Road, Rev. Gideon Bohannan was in a near fugue state as he flipped open the cylinder of his gun and checked that he had loaded it properly. Then he slipped it back in his pocket and used a key to enter the back door, just as he had done for over five years.

What if you knew the exact day and time you were going to die?

As expected, Race denied cheating—and convincingly so.

Even after seeing the lab reports and the repeat lab reports from the hospital in New England, he denied cheating. Bohannan felt himself weakening.

'Even if you have it, we'll still be together,' DuPre said. 'People do it all the time. They're just careful. I love you, Bo. I really do. We can beat this. Together we can beat this.'

Bohannan lowered his gun. Visions of Swaggart, Bakker, and others filled his thoughts. Maybe they
could
get through this.

The kitchen door opened and closed. There were footsteps across the tiled floor. Before Bohannan could react, there was a man in the room—jet-black hair; olive skin; cold, dark eyes. He wore thin black gloves. The pistol he held looked as if it had never left his hand.

'The gun,' he barked. 'Set it on the table, there. Now!'

Startled and bewildered, Bohannan did as he was ordered.

The intruder hefted it for a moment, and then, without another word, shot Race DuPre in the center of the throat. In a second, he grabbed Bohannan with one hand around the back of the neck, his grip so powerful that the man dropped immediately and soundlessly to his knees. The first shot went through Bohannan's head, temple-to-temple. The second one, with the now-deceased minister's hand around the gun, hit precisely between DuPre's brows.

A minute and twenty seconds after he picked the back door lock at 10 Briarcliff Road, Gerald Prevoir walked out again. Five minutes after that, he picked up a Diet Coke and grilled chicken sandwich, no mayo, at a McDonald's drive-through on the highway. He was eating at the far end of the parking lot when he called his employer.

'I had to be of some assistance to the good reverend,' he said, between bites, 'but in the end, he performed admirably. They both did. Give my best to Rev. Lovering, and congratulate him on his new position.'