Blood Test

3

Western Pediatric Medical Center occupies a square block of mid-Hollywood real estate in a neighborhood that was once grand but is now the turf of junkies, hookers, drag queens, and fancy dancers of every stripe. The working girls were up early this morning, halter-topped and hot-panted, and as I cruised eastward on Sunset they stepped out from alleys and shadowed doorways sashaying and hooting. The whores were as much a fixture of Hollywood as the brass stars inlaid in the sidewalks, and I could swear I recognized some of the same painted faces I’d seen there three years ago. The streetwalkers seemed to fall into two categories: doughy-faced runaways from Bakersfield, Fresno, and the surrounding farmlands, and lean, leggy, shopworn black girls from South Central L.A. All of them raring to go at eight forty-five in the morning. If the whole country ever got that industrious the Japanese wouldn’t stand a chance.

The hospital loomed large, a compound of aged dark stone buildings and one newer column of concrete and glass. I pulled the Seville into the doctors’ lot and walked to Prinzley Pavilion, the contemporary structure.

The Department of Oncology was situated on the fifth floor. The doctors’ offices were cubicles arranged in a U around the secretarial pool. As head of the department, Raoul got four times as much space as any of the other oncologists, as well as privacy. His office was at the far end of the corridor and cordoned off by double glass doors. I went through them and walked into the reception area. Seeing no receptionist, I kept going and entered his office through a door marked PRIVATE.

He could have had an executive suite but had chosen to use almost all the space for his lab, ending up with an office only ten by twelve. The room was as I remembered it, the desk piled high with correspondence, journals, and unanswered messages, all ordered and precisely stacked. There were too many books for the floor-to-ceiling bookcase and the overflow was similarly heaped on the floor. One shelf was filled with bottles of Maalox. Perpendicular to the desk, faded beige curtains concealed the office’s sole window as well as a view of the hills beyond.

I knew that view well, having spent a significant proportion of my time at Western Peds staring out at the crumbling letters of the HOLLYWOOD sign while waiting for Raoul to show up for meetings he had scheduled but inevitably forgot about, or cooling my heels during his interminable long-distance phone chats.

I searched for signs of habitation and found a Styrofoam cup half-filled with cold coffee and a cream-colored silk jacket draped neatly over the desk chair. Knocking on the door leading to the lab brought no response and the door was locked. I opened the curtains, waited a while, paged him and got no callback. My watch said ten after nine. Old feelings of impatience and resentment began to surface.

Fifteen minutes more, I told myself, and then I’ll leave. Enough is enough.

Ninety seconds before the deadline he blew in.

“Alex, Alex!” He shook my hand vigorously. “Thank you for coming!”

He’d aged. The paunch had grown sizably ovoid and it strained his shirt buttons. The last few strands of hair on his crown had vanished and the dark curls around the sides bordered a skull that was high, knobby, and shiny. The thick mustache, once ebony, was a variegated thatch of gray, black, and white. Only the coffee bean eyes, ever moving, ever alert, seemed agelessly charged and hinted at the fire within. He was a short man given to pudginess and though he dressed expensively, his wardrobe wasn’t selected with an eye toward camouflage. This morning he wore a pale pink shirt, a black tie with pink clocks, and cream-colored slacks that matched the jacket over the chair. His shoes were mirror-polished, sharptoed tan loafers of perforated leather. His long white coat was starched and immaculate but a size too large. A stethoscope was draped around his neck, and pens and documents stuffed the pockets of the coat, causing them to sag.

“Good morning, Raoul.”

“Have you had breakfast yet?” He turned his back to me and moved his thick fingers rapidly over the piles on the desk like a blind man speedreading Braille.

“No, you said you’d—”

“How about we go to the doctor’s dining room and the department will buy you some?”

“That would be fine,” I sighed.

“Great, great.” He patted his pockets, searched in them, and muttered a profanity in Spanish. “Just let me make a couple of calls and we’ll be off—”

“Raoul, I’m under some time pressure. I’d appreciate it if we could get going now.”

He turned and looked at me with great surprise.

“What? Oh, of course. Right now. Certainly.”

A last glance at the desk, a grab for the current copy of Blood, and we were off.

Though his legs were shorter than mine by a good four inches, I had to trot to keep up with him as we hurried across the glassed-in bridge that connected Prinzley with the main building. And since he talked as he walked, keeping up was essential.

“The family’s name is Swope.” He spelled it. “The boy is Heywood — Woody for short. Five years old. Non-Hodgkin’s lymphoma, localized. The initial site was in the G.I. tract with one regional node. The metastatic scan was beautiful — very clean. The histology is nonlymphoblastic, which is excellent, because the treatment protocol for nonlymphoblastics is well-established.”

We reached the elevator. He seemed out of breath, tugging at his shirt collar and loosening his tie. The doors slid open and we rode down in silence to the ground floor. Silence — but not serenity, because he couldn’t stand still: he tapped his fingers on the elevator wall, played with strands of his mustache, and clicked a ball-point pen open and shut repeatedly.

The ground floor corridor was a tunnel of noise, glutted with doctors, nurses, techs, and patients. He continued talking until I tapped his shoulder and shouted that I couldn’t hear him. His head gave a curt little nod and he picked up his pace. We zipped through the cafeteria and passed into the dimly lit elegance of the doctors’ dining room.

A group of surgeons and surgical residents sat eating and smoking around a circular table, dressed in greens, their caps hanging across their chests like bibs; otherwise the room was unoccupied.

Raoul ushered me to a corner table, motioned for service, and spread a linen napkin over his lap. He picked up a packet of artificial sweetener and turned it on its side, causing the powder within to shift with a dry whisper, like sand through an hourglass. He repeated the gesture half a dozen times and started talking again, stopping only when the waitress came and took our order.

“Do you remember the COMP protocol, Alex?”

“Vaguely. Cyclophosphamide, um — methotrexate and prednisone, right? I forget what the O stands for.”

“Very good. Oncovin. We’ve refined it for non-Hodgkin’s. It’s working wonders when we combine it with intrathecal methotrexate and radiation. Eighty-one percent of patients are achieving three-year, relapse-free survival. That’s a national statistic — the figures on my patients are even better — over ninety percent. I’m following a growing number of kids who are five, seven years and looking great. Think of that, Alex. A disease that killed virtually every child it got hold of a decade ago is potentially curable.”

The light behind his eyes picked up extra wattage.

“Fantastic,” I said.

“Perfect word — fantastic. The key is multimodal chemotherapy. More and better drugs in the right combinations.”

The food came. He put two rolls on his plate, cut them into tiny chunks, and systematically popped each piece in his mouth, finishing all of it before I’d downed half my bagel. The waitress poured coffee, which was inspected, creamed, stirred, and quickly swallowed. He dabbed his lips and picked imaginary crumbs out of his mustache.

“Notice that I used the word curable. No timid talk of extended remission. We’ve beaten Wilm’s Tumor, we’ve beaten Hodgkin’s disease. Non-Hodgkin’s lymphoma is next. Mark my words, it will be cured in the near future.”

A third roll was dissected and dispatched. He waved the waitress over for more coffee.

When she’d gone he said, “This isn’t really coffee, my friend. It is a hot drink. My mother knew how to make coffee. Back in Cuba we had the pick of the coffee crop. One of the servants, an old black man named José, would grind the beans by hand with great finesse — the grind is essential — and we would have coffee!” He drank some more and pushed his cup away, taking a glass of water as a replacement and emptying it. “Come to my home and I’ll make you real coffee.”

It occurred to me that though I’d worked with the man for three years and had known him twice that long, I’d never seen his living quarters.

“I may take you up on that one day. Where do you live?”

“Not far from here. Condo on Los Feliz. One bedroom — small but sufficient for my needs. When one lives alone it is best to keep things simple, don’t you agree?”

“I suppose so.”

“You do live alone, don’t you?”

“I used to. I’m living with a wonderful woman.”

“Good, good.” The dark eyes seemed to cloud. “Women. They have enriched my life. And torn it apart. My last wife, Paula, has the big house in Flintridge. Another’s in Miami, and two others, God knows where. Jorgé—my second oldest, Nina’s boy — tells me his mother is in Paris, but she never stayed in one place very long.”

His face drooped and he drummed on the table with his spoon. Then he thought of something that made him suddenly brighten.

“Jorgé’s going to medical school next year at Hopkins.”

“Congratulations.”

“Thank you. Brilliant boy, always was. Summers he would visit me and work in the lab. I’m proud to have inspired him. The others are not so on the ball, who knows what they will do, but their mothers were not like Nina — she was a concert cellist.”

“I didn’t know that.”

He picked up another roll and hefted it.

“Drinking your water?” he asked.

“It’s all yours.”

He drank it.

“Tell me about the Swopes. What kind of noncompliance problems are you having?”

“The worst kind, Alex. They’re refusing treatment. They want to take the boy home and subject him to God knows what.”

“Do you think they’re holistic types?”

He shrugged. “It’s possible. They’re rural people, come from La Vista, some little town near the Mexican border.”

“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.”