“What’s that?” Nick replied. But Louis shook his head, then let out a howl and bolted back into his room, slamming the door.
“Louis! Louis!” Lucille called through the door. “What’s the matter? Everything’s okay.” She opened the door, but Louis shouted for her to leave the room.
“What’s his problem?” Moy asked.
Nick shook his head. “Something spooked him.”
“He was looking at us,” Jordan said.
“But who knows what he saw.” Nick moved to Louis’s door and tapped. “Louis, it’s Dr. Nick. May I come in?”
No answer.
“Louis, I think Margaret’s okay now, and you can take your nap. But you seem pretty upset. Maybe you can tell me what the problem is.” None of the patient rooms had locks, but instead of pushing his way in, Nick decided on giving Louis an option to open up and explain what had spooked him. Nick tapped again. “Louis, may I come in?”
Nothing.
Nick whispered to Lucille to get some meds, and he tapped once more. “Louis, I’m going to come in if that’s okay. Then we can talk about it.” He opened the door.
Louis’s single was empty. The windows were closed and still intact. The bed was flat. Nick opened the door to the toilet and pulled back the shower curtain. No Louis.
On the small bureau sat familiar photos of a younger Louis posed with other GIs in Korea. On the floor, probably tossed off when Louis got out of bed, were two CD cases,
The Real Johnnie Ray
—
Greatest Hits,
and Peggy Lee’s
Is That All There Is?
But nothing looked out of place.
“Louis, I know you’re here,” Nick said to the closed closet door. “There’s nothing to be upset about. Those gentlemen with me are my friends.” He tapped the door. “Louis, it’s Dr. Nick. I think it’s a good idea if you came out so we can talk about what’s bothering you.”
Nothing.
“Then I’m going to open the door.”
Nick opened the door. Louis was there all right, but he was crouched down among his slippers and shoes and a suitcase.
“Hi, Louis. It might be more comfortable if you came out into the room.”
Louis looked terrified. He mumbled something incoherent, but after a few moments Nick coaxed him into standing up.
But then Louis spotted Jordan, Moy, and the others behind Nick. His pupils dilated and he began to jabber nonsense syllables again, his voice rising in a ululating pitch. “I swear I don’t know nothing. Please.”
“I think it’s best if you waited outside,” Nick said to the others. Then to Louis, “It’s okay, Louis. Everything’s all right. No one’s going to hurt you. You can come out now.”
Jordan, Moy, and the rest began backing into the dayroom. But before they disappeared, Jordan looked back.
Louis Martinetti was standing in the closet dressed in army fatigues, combat boots, and fatigue cap. Although it was too small for him, his shirt was adorned with ribbons, a Bronze Star, and a Purple Heart. A set of metal dog tags hung around his neck. In his left hand he held a furled umbrella.
Louis muttered something to Nick.
“What did he say?” Moy asked.
“His name, rank, and serial number.”
“HE HAD A FLASHBACK.”
“A what?” asked Coleman.
Nick had filed several reports to GEM Tech scientists with cc’s to Gavin Moy about the seizures. But apparently Coleman had not been informed. “A flashback seizure,” Nick said after they had settled in the conference room. “It’s what I called you about. We have a problem.”
The nurses had given Louis Martinetti an injection of Haldol and put him back to bed. Nick put his hands on a stack of notebooks of cumulative data on the trials. “As we all know, the majority of test patients have experienced reversals of their pathology and are enjoying increased functionality and lucidity—a success level as defined by the company’s end-point objectives. But for some patients the turnaround works too well.”
Moy looked at him nonplussed. “What do you mean ‘too well’?”
“By stimulating the growth of new neuron formations in the hippocampus, memory functions are regained.”
“We know how it works,” Moy snapped.
“Of course, but over the last several weeks, we’ve noticed some disturbing side effects that we need to address. For a number of patients the compound dislodges them from the objective present and sends them into flashback modes. In short, they relive long-forgotten experiences.”
“That’s impossible,” Moy growled. “Our brains aren’t like some Blockbuster video collection, for God’s sake.”
“True, but Louis out there has been experiencing some kind of throwback to his Korean War days. In his mind he’s twenty years old and with his buddies in Korea.”
“That’s ridiculous,” Moy said. And his medical director nodded agreement.
“But that’s what we just witnessed,” Nick continued. “And it’s what I think happened with Mary Curley. From police reports, the woman was clearly delusional, thinking she was a child again looking for her puppy. And she crawled under the trolley. In her mind she was back six decades. Like Louis Martinetti, she was locked into continuous dissociative experiences.”
Nick glanced at Jordan, whose face looked like red camouflage. The episode with Louis Martinetti had clearly upset him. Or maybe it was the way Moy was glaring at him. Jordan knew about these problems, of course. He had experienced similar episodes at his own trial site. So had the other investigators. “Luckily, nobody raised the question of a connection between Memorine and Mary’s suicide.”
“And there isn’t one,” Moy said.
The party line.
Nick opened a file folder. “And they’re not just anomalies here. Maurico Rucci, who’s PI at the Providence trial site, reports similar problems. So does Peter Habib in Plymouth. He’s got a resident who refuses to change out of a party dress she’s worn around the clock for several days, and she becomes violent when aides try to make her. Apparently the dress was like one she had worn to her high school prom. And every time she has it on, she would hold full conversations with old classmates. It’s bizarre.”
“I don’t believe it,” Moy declared. And the others nodded.
“Another patient in the study from Schenectady was caught at the last minute trying to drown his three-year-old grandson in a sink.”
“What?”
“The mother stopped him in time. Later he said he thought the little boy was a fox. Then we learned he was raised on a chicken farm. He was trying to appease his dead abusive father, he said. This was not a violent person. Nor was Mary Curley suicidal.”
“Dr. Mavros, how do you know these anomalies weren’t the results of neuropsychiatric problems?”
“Because none of the placebo patients have flashback seizures. Look, I’m telling you that what we are seeing are intrinsically significant side effects that must be addressed.”
Thompson asked, “Any idea what these flashbacks are rooted in, Doctor?”
“No, but my guess is abnormal brain plasticity. Some people might be genetically susceptible to psychomotor seizures. Or it could be demographic. Whatever, we need to make a thorough dose-response profile of the population, since the numbers are high.”
“How high?”
“Thirty percent, maybe more.”
Throughout the exchange, Jordan remained quiet. But now he seemed to rise in his chair. “I beg to differ,” he said. “I’ve seen several reports, and these flashbacks are simply isolated cases that are clearly the result of the prior dementia and not Memorine.”
Nick nodded. “That was my suspicion, too, but when I withdrew patients from the drugs, the episodes disappeared. Unfortunately, that presents an even worse problem, as you know. Withdraw them too long, and the plaque returns.”
“So what are you recommending?” Moy asked.
“That we try to create a demographic profile while determining proper dosages and treatments. But we’ll need more time—maybe a year or two.”
Gavin’s face looked as if it had turned to brick. “We don’t have a year or two. The first weekend in June you, I, and every GEM Tech trial clinician are scheduled to meet at Bryce Canyon, Utah, to work out the final details of the application to the FDA. It has to be submitted by midmonth for a year-end market release. And you know that.”
Jordan cut in. “Nick, we’re talking about people who’ve suffered years of brain deterioration. And we all know that connections of the different areas lose control and get repatterned, resulting in different behavioral aberrations. With all due respect, dementia patients have adverse episodes—flashbacks, if you wish—but they’re caused by the rerepatterning from the original damage. In short, it’s the pathology, not the pill.”
“Then that’s something we better determine before we rush to the FDA.”
“Any idea what sets off these flashbacks?” Thompson asked.
“From what I’ve observed, external stimuli—odors, loud sounds, something somebody says, flashing lights. Almost anything can bring them on, in fact. Depending on the flashbacks, the experiences can be traumatic or delightful. Mr. Martinetti had clearly experienced trauma. So did Clara Devine and others, including one of Peter Habib’s patients, a Rodney Blake, who bled to death after he castrated himself for God knows what reason. Mary Hurley’s was just the opposite, and it killed her horribly.”
“And what do you do to stop them?”
“Dilantin, some of the other antiseizure medications. Heavy doses of antianxiety and antipsychotic drugs have been necessary also.”
“And how would you characterize the majority of these flashbacks?”
“For the most part pleasurable.”
“Is that a problem?”
“It is if they’re addicted.”
Thompson’s face screwed up. “Pardon me?”
“Many
want
to go back to their past,” Nick continued. “For them the present is a dull reality—like Dorothy returning from Oz to black-and-white Kansas. And they know that it’s Memorine that will get them to return.”
“You’re talking dependency.”
“Big time. And if they can’t get their flashback fix, some of them will try to bring themselves back by whatever means.”
“Such as what?”
“For Mary Curley, it was returning to a place where her parents had taken her—the Museum of Fine Arts. When her daughter brought her home, she somehow managed to make her way. But this was not your typical aimless dementia wandering. This was marked by purpose and destination. Others employ queer little rituals to trigger the flashbacks—like what you saw out there with Louis’s hand movements.”
“You mean hitting himself in the head?”
“He wasn’t hitting himself. He was saluting.”
“Saluting?”
“Yes, but on some weird fast-forward. It’s how he induces a flashback.”
“You’ve got to be kidding,” Moy said.
“I’m not kidding. Some subjects set off events by stimulating different sensory zones—rubbing parts of their bodies, pacing, bouncing on one foot. Or they play nursery rhymes and Christmas carols on their CD players. Whatever sends them back.”
“But Gavin’s right,” Thompson said. “Past experiences aren’t stored intact in the brain.”
“Yes. True memory is a matter of flashbulb recollections. With these patients, there are just more flashbulbs and a strong autosuggestive component, allowing them to create the illusion of being back when.”
“That guy was acting normal one minute, then he snapped.”
“Yes, and something set him off.”
“I am not happy about this,” Moy growled. “We’ve spent hundreds of millions of dollars in years of studies examining the efficacy and tolerability of Memorine with two dozen test groups and hundreds of patients, and consistently across all the damn scales the drug improved cognition—in some cases a hundred percent compared to placebos—and with no deterioration in global functioning and behavior. And now we have these goddamn flashbacks or whatever the Christ they are.”
Nick was aware that GEM’s marketing plan was to send scores of sales reps to physicians and health care people across the country to encourage use of Memorine once it hit the markets. According to Gavin Moy, that program alone was costing the company forty million dollars. Adding to the rush was the fact that FDA director George Orman-Witt was retiring at the end of the
year, and his replacement might not be as sympathetic with flashback reports and could ask for a complete review. So they were playing Beat the Clock.
Mort Coleman, GEM’s legal counsel, turned to Nick. “So, what do you suggest?”
“I suggest that we do an internal review of all clinical data and try to determine the correlation between these flashbacks and patient profiles—demographics, ethnicity, environment, genetic markers, medical profiles, and any other possible parameters. If something comes out of it, perhaps we can determine if certain patients should be excluded from use of the drug.”
“That could take months, maybe years.”
Nick heard the edge of panic in Coleman’s voice. “It may also save lives and beat lawsuits. We rush this to market before it’s ready and we could end up with the greatest medical flop since thalidomide.”
“And if we don’t, it might be the greatest medical crime against humanity,” Thompson declared.
“Then maybe you should speak to some family members,” Nick said.
“What does
that
mean?” Moy asked.
“At Webster Smith Rehab in Maine,” Nick explained, “an eighty-two-year-old male lies in his bed all night talking to kids at the YMCA camp he went to as boy—I mean full, coherent conversations about canoeing, rope swinging, et cetera to people who aren’t there. He had his wife bring in mosquito netting, and he’s got it draped over his bed like he’s back camping. Most of the time he doesn’t acknowledge her presence and it’s driving her crazy because Memorine has brought back a son instead of a husband.”
“He’s suffering other problems.”
“You saw what happened to Louis Martinetti out there.”
“I saw a demented patient banging himself in the head.”
“Even if there are these flashbacks,” Thompson said, “what’s the problem with patients reliving parts of their childhood every so often? It’s better than sitting in front of a television like a turnip.”
“Then maybe you should come with me.” Nick opened the door and led them down the hall to another room. “We’re still waiting for the family to claim her belongings, so the place hasn’t been changed over yet. But this is the single that Mary Curley occupied for the last year.” Nick swung open the door.
The interior was a mausoleum to little girlhood. The walls were draped with posters of kittens and puppies and cartoon decals. The bed was covered with applique floral bedspread patches in pinks and yellows, and the pillow was stacked with stuffed animals and Raggedy Ann and Andy dolls. Pasted on
the headboard were large floral letters in pink spelling out “Mary.” Beside the bed was a nightstand with a pink lamp whose shade had cartoon figures of bees and bluebirds and a framed black-and-white photograph of a puppy with a label “Jello.” On the bureau were ceramic figurines of ballerinas and puppies as well as a grouping of the Cowardly Lion, Tin Man, and Scarecrow. Beside the bed was a pink rocking chair whose back was a carved heart with the hand-painted inscription: “Time out to think about the things you do!” In the corner was a large plastic pumpkin structured as an armoire with shelves lined with small dolls.
“Jesus!” Moy muttered.
“She wanted to be a little girl again,” Nick said, “And in her mind she was.”
“Where did all this stuff come from?” Coleman asked.
“Family members. As she became more functional, she began to demand mementos from her childhood. But since most of them were long gone, relatives brought all this stuff, which made her want more. The problem was that she’d sit in here for hours playing.”
From a bureau drawer Nick removed a small black-and-white photo of a little girl beside a man in a suit. They were standing in front of a statue of an Indian seated bareback on a horse with arms extended. “According to relatives, the MFA was a favorite place her parents took her to as a child. She liked the mummies.”