“DID YOU KNOW ABOUT THESE MEMORINE trials?”
Nick looked over his glasses at her. “Yes.”
“It seems as if everybody does but me.” She could barely disguise the emotion crackling in her words.
“Then someone should have told you, of course.”
“Dr. Carr was going on as if it was the medical breakthrough of the millennium.”
“From what I understand, the results are quite promising, but it’s too early to call a press conference.”
She nodded, feeling a swirl of hot emotions.
It was Thursday afternoon and they were sitting in the control room of the new MRI imaging suite at MGH. Glass windows separated the bank of computers from the huge scanner, the ring-shaped apparatus with an attached patient table, in the next room. Behind them were three technicians working at their own monitors. Nick was a regular here because he had helped pioneer new imaging techniques for studying Alzheimer’s—techniques that aimed at detecting the disease in the presymptomatic phase and diagnosing its progress.
“So, you had a pleasant evening with him?”
“It was interesting.” She knew how evasive that sounded.
“He’s a very bright and capable physician.”
“And very charming, and I’m not interested.” There was an awkward silence. Her relationship with Nick was warm and mutually gratifying. He was the older mentor-cum-father-figure and she the pretty former student who made him feel young and charming. She had always sensed that he regarded her with an admiration that exceeded the professor-and-student relationship. It was evident in the way he lit up when he looked upon her, or touched her arm when he was explaining something. He was also intent on seeing her find a boyfriend.
“Okay,” he said. “Did he show you the Palm Pilot images of Clara Devine’s tests? It’s all right, I’ve seen them. All these years and all the research, and
this is the first time that anything out of a lab is showing promise of a cure. Quite remarkable, wouldn’t you say?”
“If it is, I was three years too late.” Tears filled her eyes.
Nick looked at her, and in a moment realization clicked in his eyes. “Ahh. You mean your father.” He took her hand. “Good God, woman, there was no way for you to know. How could you? Besides, he could not have lasted this long.”
“He was still strong.”
“Maybe physically, but there was nothing left of him inside, and you know that. I would have done the same thing if it were Thalia. I would have wanted the same thing if it were me.” He squeezed her hand with assurance.
“I did it for me.”
“No! You did it for him. It’s what he wanted.”
But if I had only waited …
“Listen to me. The first dementia patients were not enrolled in these trials until eight or nine months ago. That’s two and a half years after he died. You know as well as I what could have happened in that time. He would have continued to waste away, kept alive by machines and tubes and IV drips. Was that something you’d want? Of course not, and neither did he. And who’s to say this stuff would have worked for him? Or if he would have lived so long even full-coded. No, you did the right thing. So put it away for good.”
She nodded and gave Nick a hug. He was also the one person for whom she had unguarded respect and not a little affection. If it weren’t for him, she would have dropped out of pharmacy school and would probably be wiping counters at Starbucks. It was also Nick who had held her hand during her father’s demise.
Nick got up and poured her a cup of coffee from the small machine sitting on a back table. René took a few sips and let his consolation take effect.
“So, back to reality. You’re having some problems with administrative procedures, right?”
“I think I’ll feel better when I see Clara Devine’s records.”
“Dreadful story. I read the paper.”
“Nick, she was sexually abused as a young girl by some creep neighbor.” And she told him what Cassie Gould had said.
Nick’s face clouded over. “So, what are you saying?”
“I’m saying that in her head, Clara Devine may have been defending herself against the guy who raped her seventy years ago.”
“A flashback seizure.”
Flashback.
The term lit up in her mind as if it were an established syndrome. “Yeah, exactly. A flashback.”
“It’s a Peter Habib term,” Nick said. “I guess it’s possible. We’re talking about axon connections rethreading the hippocampus. What does Dr. Carr say?”
“He says it’s the dementia, not an adverse drug reaction.”
“Because post-traumatic stress hallucinations can plague dementia victims. I suppose that will have to be determined. In the meantime, what are you thinking of doing?”
“Nick, for nearly two months I’ve been up against some clinical code of
omertà
while secret trials were going on right under my nose.”
“So you’re thinking of filing a formal complaint against the record-taking procedures of a senior clinician working on a potential cure for Alzheimer’s disease.”
“Not when you put it that way.”
“Then let it go. You’ll get the charts. Look through them, check the nurses’ reports, and if anything looks irregular, then write your letters. In the meantime, visit some of the trial patients. I think you may be impressed with what’s happening.”
“And what’s that?”
“Maybe medical history.”
“Wait a second. Are you part of this?”
“GEM’s made some recent inquiries.”
“How long have you known about the stuff?”
Nick must have heard her words skid because he narrowed his eyes. “I’m telling you it was not an option for your father. They hadn’t even begun phase one trials on animals yet. Nobody had any idea if it would work with AD patients. And had I known, you would have been the first to hear.”
She nodded. “I know.” She had scoured the journals and the Internet looking for every experimental drug in clinical trials, and nothing had held any promise for her father’s condition. Memorine was still deep in GEM’s pipeline.
“And in case you’re wondering, I haven’t committed myself.”
“Maybe you should. Given how they’ve been operating, they could use some ethical standards.”
“That’s very kind, but what do you think that’d do to my retirement plans?”
“You’re still young and energetic.”
“Kinder still. But Thalia has got her health problems, and I have a new grandchild, number three.”
“Okay. When I asked him why I was kept in the dark, Dr. Carr said that GEM wanted to guard against the competition. That seems rather paranoid to me.”
“Might also be good business. First of all, clinical trials are almost never done with geriatrics in nursing homes, as you know. So they wanted to keep things quiet for as long as possible. Secondly, GEM’s a small, tight drug company and nervous about some Goliath out there stealing its hot molecule. It’s happened before. I suppose if this compound turns out to be the real thing, the benefits will more than make up for minor irregularities.”
He, too, was saying to look the other way. “And what about Dr. Carr? I’m sure he’s doing well by GEM.”
“There’s nothing unethical or illegal in a physician’s getting a fee for enrolling patients in trials. It’s how research progresses.”
“That’s the one gray area that frankly bothers me. Doctors get paid thousands of dollars for each patient they enroll in a trial, plus research grants, equipment upgrades, staff support, travel perks, plus stock options in the company. With all those incentives, it’s hard to write up a negative report to the FDA.”
“Except actual scientific results don’t lie. And from what I hear, this Memorine is looking remarkable.” Nick fixed his glasses and rolled his chair. “Now, come here and look at this.” He inserted a CD into the computer and ran his fingers across the keyboard. In a matter of moments multicolored images of a brain filled the screen. He moved the mouse around and clicked a couple of times, and the colors began to change, pulsing in yellows and reds. “Thanks to the genius of imaging physicists and computer technicians, we now have the first quantitative, dynamic visualization of the destruction of cortical brain regions in people with dementia. What you’re seeing is a 3-D sequencing movie of a seventy-five-year-old male’s brain under the siege of plaque formation and neuron tangles over a thirteen-month period.”
As best she could, she tried to dissociate herself from thoughts of her father. “What do the colors represent?”
“The base image of the brain is blue. And in red is the beta-amyloid plaque.”
“God, it looks like a blight spreading across the brain.”
“And of the worst sort. What makes this technology very special is that we
can directly monitor both the progressive damage as well as any therapeutic responses from Aricept and other treatments.” Nick ran the serial scan images several times.
“It’s moving right across the parietal and temporal lobes.”
“Exactly, the areas controlling language and major cognitive functions.”
“And obliterating memories, personalities—everything that made them who they were,” she said.
“His name is Louis Martinetti. He’s at Broadview. Maybe you’ve met him.”
“Yes. The Korean war vet.”
“And former POW. Well decorated—a Purple Heart, in fact. And a very sweet man.”
René felt a little sick as she watched the fast-forwarded sequence of his brain’s deterioration. Her father had been a Korean vet also. “What stage is he in?”
“Moderate, but it seems a particularly aggressive case.” The red blotches spread from frame to frame. “At this rate, the stuff will probably cover a good part of the frontal lobe within a year or so, rendering him incapable of speech and most memory.”
Although one could only imagine the man’s cerebral cortex becoming clotted with plaque, this new technology let them witness the brutal unraveling of the man’s mind and memory. But if they could have looked inside Mr. Martinetti’s brain they would have seen the same landscape of destruction that a hundred years ago in Munich had startled the German physician who described the disease that bears his name. It was Alois Alzheimer whose investigation of what had been diagnosed as premature senility in a fifty-one-year-old woman led to his discovery of the disease’s gruesome signature: the brownish nodules of plaque and the dense tangle of neurofibers that eat away the upper layers of the cerebral cortex and destroy a person cell by cell. What had wasted her father.
Nick reran the sequence. “Now, imagine seeing this played backward—all that red turning blue again.” And in his eyes she saw a flicker of promise.
Three years too late.
René tried to deflect the voice and looked away. At a station nearby was another computer monitor showing another brain image. “Is this the same patient?”
“No, that’s the image of a patient of Dr. Heller, another neurologist here in the department.”
René welcomed the distraction.
“But it does look similar.” Nick rolled in his chair to the monitor. “And that’s rather interesting because he’s not an AD patient but a young fellow in a coma. He nearly drowned last week after being stung by jellyfish—some rare creature found in the Caribbean.”
“How did he end up here?”
“Actually, it happened up here. On very rare occasions tropical creatures get caught in the Gulf Stream. And when the waters are as warm as they’ve been, they get caught in eddies that bring them close to shore.”
“Where’d it happen?”
“Homer’s Island, a private island northwest of Martha’s Vineyard. The only place they’ve ever been reported in the northeast. The Coast Guard found him.”
“Lucky for him. What’s his prognosis?”
“Not good, though his unconscious mind is quite active.” Nick moved the mouse around and hit a few keys as new brain images filled the screen in quarters. Then with a pen he pointed to an area of the frontal lobe of his brain. “This is what interests me. See how the yellow area appears to be expanding. Unlike the other, this is a structural MRI that measures brain tissue volume. And if you look here, the active area is his hippocampus and frontal lobe.”
“Meaning what?”
“I’m not really sure, but if I didn’t know better, I’d say the tissue was getting denser.”
“Denser? You mean his brain is growing?”
“Unless I’m mistaken, there’s active cell growth. Unfortunately he’s in no condition to tell us what he’s experiencing. But if he wakes up, it might be interesting to interview him.”
“Meanwhile, he’s turning into a Conehead.”
Nick laughed. “Or someone with a pretty rich memory bank.”
When Nick looked away, René fingered open the folder with his name tab and that of the unit he was in. “Any way to tell how long he might be unconscious?”