“I know the area. Agricultural.”
“Yes, I believe so. But more important, close to
Laetrile country. The father is some kind of farmer or grower. Crass man,
always trying to impress. I gather he’d had some scientific training at one
time or another—likes to throw around biological terms. Big heavyset fellow, in
his early fifties.”
“Old to have a five year old.”
“Yes. The mother’s in her late forties—makes you
wonder if the boy was an accident. Maybe it’s guilt that’s making them crazy.
You know—blaming themselves for the cancer and all that.”
“That wouldn’t be unusual,” I said. Few nightmares
compare to finding out one’s child has cancer. And part of the nightmare is the
guilt parents inflict upon themselves, searching for an answer to the
unanswerable question:
why me?
It’s not a rational process. It occurs in
doctors and biochemists and other people who should know better—the mental
floggings, the I should haves and I could haves. Most parents get over it. The
ones who don’t can be crippled …
“Of course in this case,” Raoul was hypothesizing, “there
would be more of a basis for it, wouldn’t there? Aged ovaries, etc. Well,
enough conjecture, let me go on. Where was I—ah, Mrs. Swope. Emma. A mouse.
Obsequious even. The father’s the boss. One sibling, a sister, around nineteen
or so.”
“How long’s the boy been diagnosed?”
“Officially just a couple of days. A local G.P. picked
up the distended abdomen on exam. There’d been pain for a couple of weeks and
fevers for the last five days. The G.P. had sneaking suspicions—not bad for a
country doc—didn’t like the local facilities and sent them up here. We had to
do an extensive eval—repeat physical, bloodwork, BUN, uric acid, bone marrows
from two sites, immunodiagnostic markers—the non-Hodgkin’s protocol demands it.
It wasn’t until a couple of days ago that we had it staged. Localized disease,
no disseminated mets.
“I had a diagnostic conference with the parents, told
them the prognosis was good because the tumors hadn’t spread, they filled out
informed consents, and we were ready to go. The boy has a recent history of
multiple infections and there was pneumocystis swimming around in his blood so
we put him in Laminar Flow, planned to keep him there for the first course of chemo,
and then check how the immune system was working. It looked open and shut and
then I got a call from Augie Valcroix, my clinical Fellow—I’ll get to him in a
minute—and he told me the parents were having cold feet.”
“No indication of problems when you first spoke to
them?”
“Not really, Alex. The father does all the talking in
this family. She sat there and wept, I did my best to comfort her. He asked
lots of picky questions—like I said, he was trying to impress—but it was all
very friendly. They seemed like intelligent people, not flaky.”
He shook his head in frustration.
“After Valcroix’s call I went right over, talked to
them, thinking it was momentary anxiety—you know sometimes parents hear about
treatment and get the idea we’re out to torture their child. They start looking
for something simple, like apricot pits. If the doctor takes the time to
explain the value of chemo, they usually return to the fold. But not the
Swopes. They had their minds made up.
“I used a chalkboard. Drew out the survival graphs—that
eighty-one percent stat I gave you was for localized disease. Once the tumors
spread the figure drops to forty-six. It didn’t impress them. I told them speed
was of the essence. I laid on the charm, cajoled, pleaded, shouted. They didn’t
argue. Simply refused. They want to take him home.”
He tore a roll to shreds and arranged the fragments in
a semicircle on his plate.
“I’m going to have eggs,” he announced.
He beckoned the waitress back. She took the order and
gave me a look behind his back that said
I’m used to this.
“Any theory as to what caused the turnaround?” I
asked.
“I have two. One, Augie Valcroix mucked it up. Two,
those damned Touchers poisoned the parents’ minds.”
“Who?”
“Touchers.
That’s what I call them. Members of some damned sect that has its headquarters
near where the family lives. They worship this guru named Noble Matthias—that’s
what the social worker told me—and call themselves the Touch.” Raoul’s voice
filled with contempt.
“Madre de Dios
, Alex, California has become a
sanctuary for the psychic refuse of the world!”
“Are
they
holistic types?”
“The social worker says yes—big surprise, no?
Assholistic is more like it. Cure disease with carrots and bran and
foul-smelling herbs thrown over the shoulder at midnight. The culmination of
centuries of scientific progress—
voluntary
cultural regression!”
“What did these Touch people do, exactly?”
“Nothing I can prove. But all I know is things were
going smoothly, the consents were signed, then two of them—a man and a woman—visited
the parents and
disaster!”
A plate heaped with scrambled eggs arrived along with
a dish of yellow sauce. I remembered his affection for hollandaise. He poured
the sauce on the eggs and used his fork to divide the mound into three
sections. The middle segment was consumed first, followed by the one on his
right, and finally the left third disappeared. More dabbing, more imaginary
crumb disposal.
“What does your Fellow have to do with it?”
“Valcroix? Probably plenty. Let me tell you about this
character. On paper he looked great—M.D. from McGill—he’s a French-Canadian—internship
and residency at Mayo, a year of research at Michigan. He’s close to forty,
older than most applicants, so I thought he’d be mature. Ha! When I interviewed
him I talked to a well-groomed, intelligent man. What showed up six months
later was an aging flower child.
“The man is bright but he’s unprofessional. He talks
and dresses like an adolescent, tries to get down to the patients’ level. The
parents can’t relate to him and eventually the kids see through it, too. There
are other problems, as well. He’s slept with at least one mother of a patient
that I know about and I suspect there’ve been several others. I chewed him out
and he looked at me as if I were crazy to be worried about it.”
“A little loose in the ethics department?”
“He has no ethics. Sometimes I’m convinced he’s drunk
or on something, but I can’t trip him up on rounds. He’s prepared, always has
the right answer. But he’s still no doctor, just a hippie with a lot of
education.”
“How’d he get along with the Swopes?” I asked.
“Maybe too well. He was very chummy with the mother
and seemed to relate to the father as well as anyone could.” He looked into his
empty coffee cup. “I wouldn’t be surprised if he wanted to sleep with the
sister—she’s a looker. But that’s not what’s bothering me right now.”
He narrowed his eyes.
“I think Dr. August Valcroix has a soft spot in his
heart for quacks. He’s spoken up at staff meetings about how we should be more
tolerant of what he calls
alternative health care approaches.
He spent
some time on an Indian reservation and was impressed with the medicine men. The
rest of us are discussing the
New England Journal
and he’s going on
about shamans and snake powders. Unbelievable.”
He grimaced in disgust.
“When he told me they were pulling the boy out of
treatment I couldn’t help but feel he was gloating.”
“Do you think he actually sabotaged you?”
“The enemy from within?” He considered it. “No, not
overtly. I just don’t think he supported the treatment plan the way he should
have. Dammit, Alex, this isn’t some abstract philosophy seminar. There’s a sick
boy with a nasty disease that I can treat and cure and they want to prevent
that treatment. It’s—
murder!”
“You could,” I suggested, “go to court on it.”
He nodded sadly.
“I’ve already broached the subject with the hospital
attorney and he thinks we’d win. But it would be a Pyrrhic victory. You
remember the Chad Green case—the child had leukemia, the parents pulled him out
of Boston Children’s and ran away to Mexico for Laetrile. It turned into a
media circus. The parents became heroes, the doctors and the hospital, big bad
wolves. In the end, with all the court orders, the boy never got treated and
died.”
He placed an index finger against each temple and
pressed. A pulse quivered under each fingertip. He winced.
“Migraine?”
“Just started. I can handle it.” He sucked in his
breath. The paunch rippled.
“I may have to take them to court. But I want to avoid
it. Which is why I called you, my friend.”
He leaned forward and placed his hand over mine. His
skin was unusually warm and just a bit moist.
“Talk to them, Alex. Use any tricks you’ve got up your
sleeve. Empathy, sympathy, whatever. Try to get them to see the consequences of
what they’re doing.”
“It’s a tall order.”
He withdrew his hand and smiled.
“The only kind we have around here.”
THE W ALLS of the ward were covered with sunny yellow
paper patterned with dancing teddy bears and grinning rag dolls. But the
hospital smells that I’d grown used to when I worked there—disinfectant, body
odor, wilting flowers—assaulted my nostrils and reminded me I was a stranger.
Though I’d walked this same corridor a thousand times, I was gripped with the
chilling uneasiness that hospitals inevitably evoke.
The Laminar Airflow Unit was at the east end of the
ward behind a windowless gray door. As we approached, the door swung open and a
young woman stepped into the hallway. She lit up a cigarette and began to walk
away, but Raoul hailed her and she stopped, turned, bent a knee and froze the
pose, one hand on the cigarette, the other on her hip.
“The sister,” he whispered.
He’d called her a looker but it was an understatement.
The girl was stunning.
She was tall, five eight or nine, with a body that
managed to be both womanly and boyish. Her legs were long, coltish, and firm,
her breasts high and small. She had a swan’s neck and delicate, slender hands
ending in crimson lacquered nails. She wore a white dress made of T-shirt
material and had cinched it with a silver cord that showed off a tiny waist and
flat belly. The soft fabric molded to every angle and curve and ended midthigh.
Her face was oval with a strong cleft chin. She had
prominent cheekbones and a clean jawline leading to lobeless ears. Each ear was
pierced with two threadlike hoops of hammered gold. Her lips were straight and
full, her mouth a generous red slash.
But it was her coloring that was most striking.
Her hair was long, lustrous, combed straight back from
her high smooth forehead, and coppery red. But unlike most redheads she had no
freckles and lacked the buttermilk complexion. Her skin was blemishless and
burnished a deep California tan. Her eyes were wide-set, thick-lashed, and inky
black. She’d used a bit too much makeup but had left her eyebrows alone. They
were full and dark, with a natural arch that gave her a skeptical look. She was
a girl anyone would notice, with a strange combination of simplicity and flash,
almost overwhelmingly physical without trying to be.
“Hello,” said Raoul.
She shifted her weight and looked both of us over.
“Hi.” She spoke sullenly and regarded us with with
boredom. As if to underscore her apathy, she gazed past us and sucked on her
cigarette.
“Nona, this is Dr. Delaware.”
She nodded, unimpressed.
“He’s a psychologist, an expert in the care of
children with cancer. He used to work here, in Laminar Flow.”
“Hello,” she said, dutifully. Her voice was soft,
almost whispery, the inflection flat. “If you want him to talk to my parents,
they’re not here.”
“Uh, yes, that is what I wanted. When will they be
back?”
The girl shrugged and flicked ashes onto the floor.
“They didn’t tell me. They slept here so they probably
went back to the motel to clean up. Maybe tonight, maybe tomorrow.”
“I see. And how have you been doing?”
“Fine.” She looked up at the ceiling and tapped her
foot.
Raoul raised his hand to offer the classic physician’s
pat on the back, but the look in her eyes stopped him and he immediately
lowered it.
Tough kid, I thought, but then, this was no day at the
beach for her.
“How’s Woody?” he asked.
The question infuriated her. Her lean body tensed, she
dropped the cigarette and ground it under her heel. Tears collected in the
inner corners of the midnight eyes.
“You’re the damned doctor! Why don’t you tell
me!”
She tightened her face, turned, and ran away.
Raoul avoided eye contact. He picked up the crushed
butt and deposited it in an ashtray. Covering his forehead with one hand he
took a deep breath and gave a migraine grimace. The pain must have been
excruciating.