Authors: Harry Stein
“I’m a bit worried,” he continued. “I think something’s not right with her.”
“What do you mean, exactly?”
“Last night, in the middle of the night, she started vomiting. And she doesn’t look well.”
“Has the vomiting been continual?” The guy’s tone was so moderate, it was hard to believe anything could be seriously wrong.
“Continual? Yes, I would say so. Six or seven times. I don’t think there’s anything left to come out now.”
Jesus H
.
Christ! This woman should be in a hospital!
“She’s just exhausted, Doctor,” he continued, “and she’s also sweating a lot. She’s like a dishrag.”
“You were right to call. I think she should be looked at.”
These words of reassurance were all it took to crack Phil’s veneer of calm. “I knew it! It’s very bad, isn’t it?”
“I can’t tell you that, Phil,” he said. “Probably not.”
“But she was getting better! I thought she was well!”
“It’s probably nothing to worry about. Just a minor setback.”
“Should I take her to the hospital here?”
Where the hell were they?—somewhere in the New Jersey ’burbs! Chances are no one there would even begin to know what to look for!
“Look, if at all possible, I’d like to get her in here.” His mind was racing. “I have a thought—can I call you right back?”
A helicopter! That way she could be on site in little more than an hour. The ACF used them occasionally, but only for dire emergencies; and that required clearance by the director’s office.
In seconds, he had Shein on the line. Less than a minute after that, Shein called him back with formal authorization. “It’s being arranged through the New Jersey National Guard. Call your guy and tell him to sit tight.”
“Thank you, Dr. Shein.”
“Thank me if it pans out. Otherwise, keep me the hell away from it. We’re both spending a lot of capital here, Logan.”
It ended up being more like an hour and a half before the copter put down on the quad. Mrs. Dietz was hustled into the hospital on a stretcher.
Logan and Sabrina were waiting for her. Reston had declined an invitation to participate in the treatment.
One sight was all it took to assess the gravity of the patient’s condition. She was extremely pale and completely disoriented. Most worrisome, the whites of her eyes had a distinctly yellow cast, evidence that her liver was no longer functioning properly.
By prearrangement, Sabrina took charge of the patient’s care while Logan saw to her friend.
Phil, alone in the waiting room, wearing a Hawaiian shirt and pants of Day-Glo orange, was doubled over, head in hands. When Logan touched him gently on the shoulder, he was surprised to find he had not been weeping.
“Phil,” he said softly, “I’ve got to get back in there. I just want you to know we’re going to be running a few tests.”
“Tests?”
“We need to assess her overall condition. But I want you to know you haven’t been forgotten. If you feel you need to speak to me, tell a nurse.”
He nodded. “I understand. Thank you, Doctor.”
Sabrina, assisted by a nurse and an orderly, already had Mrs. Dietz hooked up to an IV line to counter her dehydration. The monitor over her head revealed that her heart was racing and she was hypotensive. But the greatest concern was the possibility, based on her obvious sense of confusion, that she was encephalopathic—yet another sign of liver failure.
Still, she appeared to be somewhat more alert now. Sabrina was leaning over her bed and talking soothingly. “Hello, Hannah. Do you recognize me?”
There came a smile on the old woman’s face. “How are you, Dr. Como?”
“Good, Excellent. Can you tell me how you are feeling, Hannah?”
“I’ve been better, thank you.” She paused, anxious eyes searching the room. “Where’s my Phil?”
“Right in the next room.”
“He’s fine, Hannah,” spoke up Logan, moving closer. “He’s just concerned about you. Like all of us.”
“He’s a good man, don’t you think?”
“I do,” agreed Sabrina. “You are a very lucky woman. Such a man is not easy to find.” She paused. “Now I am going to ask you to do something for me.”
“Yes?”
“Could you hold your arm out straight?” She demonstrated with her own.
It is the simplest possible test for hepatic encephalopathy. When a patient is suffering the condition, the hand will jerk back and forth spasmodically.
Which is precisely what Mrs. Dietz’s now began to do.
Sabrina looked to Logan and their eyes momentarily locked. There was no need for words.
“Can I put my arm down?”
“Yes, of course.” Sabrina managed a smile as she stroked her forehead. “See, nothing to it.”
“You’re a very kind girl, do you know that? Very loving.”
“Thank you. From you, I consider this a great compliment.”
Dietz opened her gray eyes a little wider. “I’m going to die now.”
For an instant, Sabrina thought to protest.
But, no, Mrs. Dietz wasn’t looking for reassurance. It was a declaration.
Though it sounds like myth, many doctors who’ve done serious time in hospitals believe it: when a patient tells you they’re dying, even in apparent contradiction of the facts, they usually are.
Neither of the doctors doubted now it was true.
As she drifted off to sleep, Sabrina remained perched on the side of the bed, watching the beautiful old face.
She touched Logan’s hand. “You should get Phil.”
He was there a few minutes later when she fell into a hepatic coma; and still there early that evening when she peacefully died.
The initial autopsy report came in two days later. As he read through it, Logan physically shuddered.
A congested and grossly distended liver. Fulminent hepatic necrosis. Holy shit! It was almost identical to the one on the damn rabbits!
T
he speed of the improvement startled her. Three days after she started radiation therapy, the pain in her back had begun to subside; within a week, she no longer felt it at all.
“I’d forgotten what it was like not being constantly aware of it,” she delightedly told her husband that night. “I feel like the Tin Man in
The Wizard of Oz
—like someone took an oil can to me and made all the stiffness disappear.”
Her husband, the President, took her in his arms. “That’s so wonderful, darling. Maybe the worst is over.”
“I hope so. They say so much of it is attitude. Well I’m going to test that theory—because no one’s going to top my attitude!”
Gregory Stillman knew not to be fooled, of course. They’d killed only a single, localized tumor—just a symptom, not the disease itself. Now it was a crap shoot. The distinctive cancer cells, born in the breast, could resurface almost anywhere, anytime: in thirty years, thirty months, or thirty days.
And this last was by far the most likely. By every indication, this was an exceptionally aggressive tumor.
Still, for the time being, there was no reason to disabuse the patient of her optimism—especially this patient. “Obviously, things are looking pretty good right now,” Stillman told her when the ten days of radiation were over. “The treatment’s done everything I hoped it would and more.”
“And now?”
“I’m going to want to keep a close eye on you, of course. There’s still disease there.”
“Isn’t that what we should be doing now, rooting out what remains of the disease?”
“It’s not that simple.” He opened his briefcase and withdrew a book—a copy of his own
Basic Principles of Breast Malignancy
. “Read this, I’d be pleased to discuss any questions you have then.”
She looked at him, incredulous. If he hadn’t just pulled off what she regarded as a minor miracle, she’d have been tempted to fire him on the spot.
“I would suggest an examination every two weeks,” he continued. “But, please, call me if you experience unusual physical symptoms of any kind.”
The first three exams were uneventful. When she arrived for the fourth, she once again reported nothing unusual. But it was impossible not to notice her cough.
“How long have you had that?” asked Stillman.
“Just a few days. I’ve always gotten a lot of colds.”
But there were no other cold symptoms evident. The cough was dry and rasping.
This was not necessarily cause for concern. Coughs are wildly nonspecific, they can be caused by a thousand things, nine hundred and ninety-eight of which are meaningless. And, in fact, when he took a chest X ray, it was clean.
Five days later, he reached her at the White House. “Just checking on that cough.”
Before she could respond, he heard it. “It’s no big deal,” she insisted. “Aside from that, I’m feeling strong as a horse.”
“How you’re feeling otherwise doesn’t interest me. I’d like you to come in tomorrow.”
“No!” Tomorrow truly was impossible. She had meetings all day and, with the Irish prime minister in town, a formal dinner scheduled for the evening. But more than that, she resented his peremptory manner. “It will just have to wait until next week. And frankly, Doctor, if we’re going to continue, I’d appreciate a bit more courtesy.”
That was the right button to push; like most bullies, he
responded well to threats. “I’m sorry, Mrs. Rivers,” he instantly backed off, “I didn’t mean it as it sounded. My only concern is your health.”
“Believe me, Doctor, it concerns me also. But surely this can wait a few more days. Till next week.”
“Of course.”
The cough was still there the following week, perhaps even a bit stronger. But she resisted his suggestion of another X ray. “Look, I just had one last week. I
know
that’s not healthy.”
He smiled benignly, his mind brimming with contempt:
This fucking moron’s just gotten dosed with three thousand rads and now she’s worrying about a twelth of a rad more!
“Mrs. Rivers,” he said, in his best, concerned manner, “I really think this is pretty important. Knowing how you feel, I certainly wouldn’t suggest it otherwise.”
The new X ray showed it clearly: a streaky density, like a cirrus cloud, in the left lung. Studying it in his office while she waited in an adjoining room, he assumed the worst. The tumor was growing within the walls of the lymph vessels inside the lung. Radiation had taken them as far as it could. If this proved out, he’d have to begin a course of chemotherapy—and soon.
“Mrs. Rivers, I’m going to suggest you have a bronchoscopy. Just as a precautionary measure.”
“What’s that?”
“Well …” There was no way to make it sound anything other than gruesome, snaking a tube down the trachea and up into the lungs to take a look—but he tried. “I really think it’s something that must be done.”
“I’d like to discuss this with Dr. Burke. I value his opinion.”
“Absolutely. Of course.” He was coming to truly dislike this woman.
He
was the expert, Burke was a nothing! “If you can possibly arrange it, I’d like to schedule it for the day after tomorrow.”
“All right,” she suddenly relented, pain in her eyes, “since you seem to feel it can’t wait.”
This was a very sick woman. He knew it—and now she knew it too.
For the time being, at least, he suspected she wouldn’t be giving him much trouble.
F
or the first few days after Hannah Dietz’s death, Logan found reason for hope, if not optimism. Several of his colleagues expressed dismay at the shocking turn of events; wanting to know what he thought had gone wrong and, more to the point, what it would do to a protocol that had seemed so promising.
“I only know what they tell me,” he stiff-upper-lipped it. “As far as I can tell, we’re still viable. Patients are still coming in to be dosed. And we still have three success stories on our hands.”
But, in fact, he was honest enough to recognize that things had begun to change almost before Hannah was cold. His very first act, after spending a quarter hour trying to comfort a sobbing Phil, had been to call Shein’s office. Logan needed some bucking up himself. He didn’t expect sympathy from this quarter, but hoped for some realistic counsel.
Typically, Shein was already on top of things: he’d gotten a blow-by-blow account of Hannah Dietz’s last hours from the head nurse on duty.
“Sorry,” he told Logan. “Tough luck.”
But his voice was so flat, he might have been a stranger.
“Look,” said Logan, “I’d really like to get together—all of us—to talk about the impact this might have on the protocol.”
“Yeah, yeah. Of course.”
“Good. Thank you. Is there a good time tomorrow?”
“I don’t know.” He hesitated. “Why don’t you call the office?”
After he hung up, it was Shein’s detachment that
lingered. Logan would have been far more reassured by a barrage of put-downs.
When Logan reached him the next day, Shein no longer saw any reason for such a meeting. “Look,” he said, at least sounding like himself. “What the hell am I gonna tell you? Nothing to do now but tough it out.”
“I was just wondering if, from a political perspective, there’s anything we might do to—”
“Yeah, bring her back to life.” He laughed mirthlessly. “Just, whatever you do, don’t use a helicopter again. You know how much that cost us? Six grand!”
Logan had no idea how to respond to this.
Under the circumstances, six thousand
—
half the price of a third-rate car
—
seemed like pocket change
.
But of course it was really something else he was hearing. It wasn’t the money that irked Shein—it was that he’d let himself be persuaded to put through the request to the director’s office. And
that
was Logan’s doing.
“Look,” said Logan, “things were moving pretty fast. I thought we should get her down here as fast as possible.”
“Yeah, well, I guess you were wrong.” He suddenly coughed. “And look now, I’m comin’ down with a damn cold. Good-bye, Logan, I got no time for you this morning.”
Only with Sabrina was there relief from the sense of impending disaster. That night, in bed, they held each other tight for two hours without even a thought of making love. She told him about the summers she’d spent as a child in Lugano, and her long-ago best friend Marissa, and her first wild crush on the pop star Joe Dassin. He talked about his undergraduate days at Princeton and, coming cleaner than he ever had before, the assorted peculiarities of his family.