FOR A LONG TIME RENÉ SAT in the parlor looking out the window at the rustling leaves of the trees. All was calm again, and outside the slanting sun sent shafts of dancing light into the woods. She could not stop hearing Louis in distress and seeing his face contort and his eyes blaze like coals in the wind.
And suddenly she was at the sink in her parents’ kitchen doing the dinner dishes.
Her mother had passed away the year before, and he managed to function
well without her. The visiting nurse was gone for the day, and her father was in the basement at his workshop, from which René had removed all the dangerous tools. In a matter of months, she would move him into a nursing home. Over the years, he had built model cars from kits and had become an expert. Nearly every night after dinner he’d go down, turn on his tape player, and while oldies filled the cellar, he’d sit on his stool and work away like some crazed Gepetto. As a girl she had helped him put together several models.
He would sometimes wear a jeweler’s loupe for the fine detailing—fitting chrome trim and micro decals in place. He had even built a spray-paint station with sheets of plastic and glove holes. His handiwork was wonderful, and he was at his happiest when engaged in it. After twenty-five years, he had amassed an impressive collection of classic models, from Matchbox-size to over a foot long. And they sat on shelves arranged by size and years—all enameled in brilliant gloss colors and looking like jeweled artifacts from some pharaoh’s tomb. René’s favorite was a 1938 Packard, which looked like something Clark Gable would have driven. Her father’s favorite was the 1952 Studebaker Commander, the car her parents drove after his return from Korea.
“Someday all these will be yours,” he once said. “Imagine the yard sale.”
It was a little after seven and the slanting rays of the sun lit up the western wall of the house. Suddenly René heard banging below. She shot to the cellar door. “Dad, you all right?” she yelled down.
No response.
“Dad, is everything okay?” She could see that the orange pools of sunlight coming from the window wells mixing with the fluorescent lamp of his bench. “Dad?”
Silence. Then a sharp metallic crashing sound.
René dashed down the cellar stairs, half-expecting to find him sprawled out under one of the tables or machines. Instead he was standing in the middle of the floor and hurling model cars at the wall, pieces ricocheting around the room. “Dad, what are you doing?”
But he paid her no attention. His eyes were wild and he muttered oaths as he pulled car after car off the shelves and flung them at the far wall.
“Dad, stop it. Stop it!”
But he didn’t stop. He glanced wildly at René, then took a model fire engine and smashed it to the floor. And when it didn’t break, he dropped to his knees and pummeled it with a hammer.
“Dad. Please. Don’t,” she pleaded.
But he disregarded her and tore another off the shelf and smashed it.
“Dad, I made those with you. We did those together. Please, stop. Please,” she wailed.
He froze, the hammer still raised. He glowered at René, and for a hideous moment she thought he would come at her.
“Dad, it’s me. René, your daughter.”
“You’re not my daughter. Where’s my daughter? You’re a … fake.”
She moved closer to him and the overhead light. “Dad, it’s me. René. I’m right here.”
Then for an agonizing moment she watched his eyes soften as recollection registered in his poor beleaguered brain. He then let out a low groan as he surveyed the bright wreckage. The hammer slipped from his hand, and he began to cry. “I hate this,” he said as she embraced him.
“I know, I know,” she whispered. “I love you …”
“I hate this. I can feel the damn holes. I can feel them filling my head.” His voice dissolved.
“Don’t,” she begged, as she felt her heart tear. “I love you, Dad. I love you.”
And for a long moment they stood there silently embracing amongst the scatter of dimming light.
René could not bring back her father, nor could she have saved him from the slow and inevitable disintegration—this conclusion she had at last come to accept. But she would do anything to see Louis go home and resume his life with his mind again intact and his memories whole and good and not fraught with throwback traumas of the Red Tent.
NICK AND RENÉ WERE IN THE SMALL snack bar off the main lobby of Morningside when René heard the familiar high-compression growl out the window. It was Jordan Carr arriving for the eleven o’clock meeting that Nick had called. He had pulled in with a silver Ferrari Maranello he had just purchased.
When he came in, Nick smiled and said, “Did the other one get dirty?”
“Very funny,” Jordan said, and forced a smile.
But from the red blotching of his cheeks, he did not like the ribbing. Nor did he want to be reminded that his Italian sports car collection was growing, not from his practice, on which he had cut back, but from the trials. Gavin Moy had named him number-two point man.
Nick led them inside to the conference room. Although it was a regularly scheduled meeting for trial clinicians, Morningside administrators, and staffers, Nick had invited Peter Habib from Plymouth as well as two researchers from GEM Tech to review recent data—Kevin Maloney and a Hassan Vadali.
After some pleasantries, Nick got down to business. “The good news is that test results are improving markedly in test residents.” And he named several patients, including Louis Martinetti, who had shown higher scores on the Mini-Mentals as compared to scores of those patients receiving placebos. “Similar results have been recorded at other sites. Of course, we are very pleased, as the progress demonstrates the efficacy of Memorine.”
A summary of the report that René had helped put together had been sent to everybody in the room.
“But what concerns me are the mounting reports of flashbacks,” Nick continued. “We’re seeing regressive behavior in a number of patients here and at other sites.” Nick named several.
“I’ve had a few also,” Peter Habib added. “One particularly troublesome case you may recall was that of William Zett several weeks back. According to his brother and sister-in-law, he got completely lost in a deep-past flashback, talking to kids from his childhood. He went down a slide backward and broke his neck. Nobody knows what was going on in his head, but, according
to his brother and sister-in-law, before the accident he appeared frightened, traumatized, as if reliving some disturbing experience. And these are the kinds of things that concern me.”
Nick nodded. “The problem is that almost none of these patients experienced flashback seizures before they were enrolled in the trials.”
“How many patients have you seen with these so-called flashbacks?” Vadali asked.
The question was disingenuous because René knew that the number was headlined in the report. “About thirty percent. And that could be a problem for a fast-track FDA approval.”
It was the first time Nick had raised this warning. Perhaps they had seen it coming, because the GEM Tech representatives looked unfazed.
“And how are these so-called flashbacks characterized?” Maloney asked. “You seem to view these as discrete neuropsychological phenomena.”
Nick deferred the question to René, who could feel the pressure from Maloney’s expression. “Well, in their reports nurses describe them as elaborate delusional episodes in which residents manifest regressive behavior.”
“Such as?”
“Such as talking like children, singing nursery rhymes and Christmas carols, spending hours playing with toys or flipping through children’s books. They appear to be locked in some past recollections.”
Maloney nodded. “And you think these delusions are the result of Memorine.”
Either he was playing dumb or he had not read the regular reports René had forwarded to GEM’s R&D people. Or they never took them seriously. “I’m saying that there are indications of a patterned correlation,” she said.
“I’m also seeing a frequency correlation between the flashbacks and increased neurological repair in MRIs,” Habib added. “It’s rudimentary, but there might be something to it, which means an added diagnostic tool for screening.”
“That sounds like yes,” Vadali said.
“Then yes—they’re the result of Memorine,” Habib said.
“And what do you think, Dr. Mavros?” Vidali asked.
“I’m being more open-minded, although the correlation is troublesome.”
“It’s more than troublesome,” Habib said. “I frankly think the drug is flawed, and we have to address that.”
Flawed.
The word fluttered in the air like a bat.
“I don’t believe that for a moment,” Maloney said. “But even if that were
true, these anomalies are more than compensated for by the patients’ extraordinary progress in cognition and daily functionality.”
Vadali and others in the room nodded in agreement.
René felt a battle line cut across the table like a seismic fault: GEM Tech reps and home administrators on one side; she, Peter Habib, one nurse, and Nick on the other. Jordan Carr had thus far not responded.
“The problem is that when patients get stuck in past experiences and become disruptive, they have to be medicated with antiseizures, antipsychotics, and sedatives that impede their mental recovery.” René looked toward the unit nurse, who concurred.
“How so?” Maloney asked.
“They’re doped down.”
“Our strategy here and at other sites,” Nick said, “is to try to come up with just the right dosages and combination of agents.”
Maloney kept his eyes on René, but she disregarded their heat. “My suggestion is that instead of simply addressing the events with antipsychotics and other meds, it might make sense to determine the nature of the connection, because I believe these flashback seizures are adverse reactions to the use of Memorine.”
Jordan cleared his voice. “If I may, and with all due respect, Peter, in patients with moderate-to-severe dementia, delusions that are related to post-traumatic stress disorders are not uncommon. And that’s what I believe we’re seeing here, since all these so-called flashback victims are patients within that population. Furthermore, according to nurses’ reports, since Mr. Martinetti was first treated with antipsychotic drugs he hasn’t had any sustained flashbacks.”
“That’s not exactly true,” René said. “He was lost in a closed loop, reexperiencing some horrible episode when he was a POW.”
An uneasy silence filled the room as she described the earlier episode.
René continued: “What bothers me is that according to his wife and daughter, Louis never suffered PTSD flashbacks before, and now he’s getting trapped in them.” She didn’t need to remind them that this flew in the face of the public perception of Memorine as a miracle cure and Louis as poster boy for GEM’s half-billion-dollar marketing campaign.
“I’m seeing the same thing,” Peter Habib said. “Patients getting caught in some dark past-time traumas. And nothing in their medical history shows they had suffered PTSD disorders.”
“But nothing in the reports in the earlier phases point to any such efficacy
problem,” Maloney said. “So I think Dr. Carr is correct. But that’s not to say we shouldn’t continue monitoring patients’ behavior problems, et cetera.” And he offered a conciliatory smile.
“Well, that’s our intention.” And Nick outlined a plan to measure cognitive progress while trying to determine a medical, demographic, or even genetic cause to any flashback seizures.
As he and the others continued, René receded and took notes. She had already created for herself a reputation as some self-appointed Ralph Nader watchdog. Besides, Nick was in charge and laying out a sensible strategy.
As she sat there, she tried to remind herself that everybody in this room—GEM Tech reps, nurses, physicians—were decent, well-intentioned professionals dedicated to the relief of patients suffering from dementia. Yet she could not help thinking that corporate agendas were at least as important as medicine—that decisions made in this room had as much to do the stock portfolios of GEM Tech investors as with science.
WHEN THE MEETING WAS OVER, Jordan Carr pulled her aside. “I think we’ve mapped out a good strategy. And maybe to an extent you’re right.”
“I think it makes sense.”
“And if there’s something to these episodes, we’ll deal with them.” And he patted her on the shoulder.
She nodded.
He lowered his glasses. “So how come you don’t seem pleased?”
“Because what I felt in there was just more pressure to downplay problems.”
“What pressure? What are you talking about?”
She opened her briefcase and pulled out a set of pearl earrings, two complimentary tickets to a Celtics game, more tickets to Boston Symphony Orchestra and Boston Pops concerts, and a year’s membership to Kingsbury Club, an upscale fitness center on the South shore. “And I’m not alone. Nurses, aides, and other home staffers are being flooded with GEM gifts including trips to Bermuda and Jamaica.”
“Complimentary gestures for working on the trials.”
“You mean standard practice in the industry.”
“In any industry, and nothing’s wrong with that.” Then he picked up the BSO tickets. “Not exactly payola.”
“No, but this is,” and she held up a letter. “From a Tanner Walker, chief financial officer at GEM—an offer of stock options.” She did not cite the
specifics, but the letter, which had just arrived, said that in recognition of her services to the company and to victims of Alzheimer’s disease she was being granted options to purchase five thousand shares in GEM Tech for five dollars each. And that she had three years to exercise her option.
“Well, congratulations.”
“Congratulations?”
“Yes, you could be a wealthy woman in a few years.”
He was right. If Memorine was approved by the FDA, her own Memorine-driven stocks would in a year wipe out all her loans and still leave her with more money than she had ever dreamed of having. But that bothered her. For as long as she could remember, René had viewed health care workers, especially physicians, as good and trustworthy by nature. But while working on these trials she was witnessing bold-faced avarice—like that growing collection of Ferraris out the window.
As if picking up her thoughts, Carr said, “Look, don’t get me wrong. I’m not like that Michael Douglas character from
Wall Street
—you know, ‘Greed is good.’ But anyone who says they’re not interested in money is a liar.” Then he added, “And nothing wrong with doing well by doing good.”
“Jordan, this isn’t an incentive, it’s bribery.”
“Bribery? That’s ridiculous.”
“Then tell me what I’m missing. First they intimidate us to silence about the Zuchowsky murder. Now they’re buying us off to underplay the flashbacks.”
“Nobody is buying anybody off. All that’s simply encouragement to do your best work—what you call employee incentives.”
“But I’m not an employee of GEM.” And she wanted to add that neither was he, or the fact that, under the guise of “incentives,” drug companies lined the pockets of doctors, showering them with fancy gifts to spouses and free trips to flossy ski slopes and tropical resorts in order to get them to write prescriptions for their products. And how nobody protested. Nobody raised the conflict-of-interest flag. And the reason was that drug companies had bottomless coffers to buy the best legal defense teams.
“This is about making sure we’re all insiders so we put the best possible light on the trials without appearing to cross the ethics line.”
“Nobody is asking anybody to cross the ethics line. And just keep in mind that if it weren’t for pharmaceutical companies, you wouldn’t have a job.” Then, as if an afterthought: “Or me, for that matter.”
“True, but it just doesn’t feel right.”
“Well, René, if you’re not comfortable with the stock options, then don’t
exercise them.” And before he walked away, he added, “This is a fast-moving train coming down the tracks, and jumping in front won’t stop it.”
She watched him walk away, thinking that he seemed more interested in his silver bullet outside than Louis Martinetti’s private war with Colonel Chop Chop.