First Thrills

The Dead Club by Michael Palmer and Daniel James Palmer

I’ve always loved Vegas. And not just in a “I love going there” kind of way, which I do. It’s really much more than that. Vegas is like a second home to me. In the same way some people turn all warm and tingly inside when they stroll into, say, a knitting shop, that’s how I feel as soon as I take my first footsteps onto the blood-red carpeting of a Vegas casino.

I’m home.

Funny thing is, I’m a doctor, a general practitioner, and a darn good one. So you’d think after seeing my fair share of emphysema cases and a battalion of concerned parents whose teenage kids have just started lighting up, that I’d despise the cigarette smoke that clings to the ceiling and the table felt. But you’d be wrong. I love it, despite having quit the nasty habit to win a bet some twenty years ago.

And who says gambling can be dangerous to your health?

The sounds of chips plinking against one another are like birdsongs to me. I love watching the waitresses work the room-the ones destined to seduce some high roller and those still strutting their stuff, despite being as well-worn as flea market furniture. I love the unending sea of lights and the symphony of the slots, praising the winners with their bells and chimes, while goading the losers into pointlessly dropping more down the hatch. But what I love most about Vegas is winning money and that’s something I’ve always been very good at doing.

Now, Lee Anne, she’s my wife, might be quick to disagree with that last claim, but she tends to focus on the negative. See, as any real gambler knows, you’ve got to take the bitter with the sweet and that means the losses with the wins. What Lee Anne can’t seem to grasp is that even with the expected dry spells over the years, if you add it all up, I’ve won more money than I’ve lost, which is more than most players could honestly claim.

Some folks who know me best, Lee Anne for one, might argue that I had no business attending the AMA symposium on osteoporosis, held at the Luxor in Vegas, but Lou (he would be the head of my group, and the one flipping the bill) didn’t seem to mind since I needed the continuing medical education credits.

“Bobby, do you really have to go for a whole week?” Lee Anne asked, while I was packing.

One thing to know about my wife, she only calls me Bobby if she’s really unhappy about something I’ve done. To my friends, I’m Bob and at work I’m Dr. Robert Tomlinson, but at home, at least lately, I’m far more Bobby than I am Bob. Over the years, I’ve come to use Bobby myself whenever my behavior veers a few degrees from the center.

Yeah, I told her, I had to go. But of course, that was white lie. I did have to go, but not for the CMEs. I mean, Vegas wouldn’t be Vegas without a little bit of sin thrown into the mix. You know, take the sweet with the bitter.

My first night in town, I skipped out on the Cardinal Healthcare- sponsored cocktail hour and rolled into the Bellagio’s vast casino. I wanted to wet my whistle with a little blackjack at the fifteen dollar table just to get the juices flowing. Since most of us docs were staying at the Luxor, I had no desire to bump into any of them out on the floor. See, I was harboring a wee bit of guilt about spending my practice’s hard earned money on the conference and not being the all-functions, all-the-time sort of guy. I figured, so long as I didn’t run into anybody who recognized me, I wouldn’t have to feel bad about having skipped out on the cocktail hour. Of course, even at the Bellagio I was spotted. But later I’d be glad because that was how I got introduced to The Dead Club.

The cocktail hour back at the Luxor was only half-cocked and already I was down three hundred on a string of hard-luck hands. The thing about strings, though, for good or bad, is that they’re destined to end. The MIT math wonks who claim that sort of thinking is nothing but a gambling fallacy are full of S-H-I-T, if you ask me. I can feel when a win streak is coming on. It starts in my toes and buzzes up my legs like electricity; I had that feeling now. The first two cards of my next hand were the six of clubs and four of spades. Naturally, I doubled down, intending to cut my current losses in half with a win. My next card was the jack of clubs. The dealer bust hitting on thirteen, and just like that, I heard that bad-luck streak snap like the string of an overplayed guitar.

That was when I met Grover.

He sat down on the empty stool to my left and placed a hundred dollar initial bet, which he proceeded to lose in seven seconds. His follow-up was an even two hundred smackers.

“Looks like you’ve soaked up all the good luck this table’s dishing out tonight,” he said to me.

I’d won my fifth straight hand and he’d dropped his third.

“There’s more luck to be had,” I replied.

Now Grover was the sort of fellow you didn’t easily forget and I knew that I’d seen him earlier in the day at the symposium registration booth. He had a grizzly-bear frame, a thick Santa Claus head of snow-white hair, and a matching snowy goatee. I was pretty confident he didn’t recognize me.

“So what sort of doc are you?” he asked.

Guess I was wrong.

“GP,” I said. “You?”

“Orthopedist. Name’s Grover Theodore Marshall. Friends just call me Grove.”

Grove had a vise for a handshake and a deep Southern accent. I never bothered asking where he was from, or what hospital he worked at, and he never bothered to tell me.

“Look at that,” Grove said.

“What?”

“That woman over there.”

My eyes followed his finger until I spotted an attractive thirtysome-thing brunette at the craps table.

“What about her?” I asked.

“She keeps touching her hair with her left hand. Hundred bucks says the next time she does it, it’ll be with her right.”

“You serious?”

I let my attention wander and the dealer had to ask if I wanted to set down a bet. I hated passing on a deal when I was so hot, but there was something compelling about Grove. We left the table together.

On closer inspection, the woman was well into her forties, and wore too much makeup.

I reasoned that either Grove was lying to me and she had been touching her hair with her right hand all along, which made it a sucker bet, or he was thinking that I was thinking he was lying, in which case he’d expect me to double the stakes, but only if I got to bet the right hand-a wager he’d politely decline. Trusting my gut, I went with the left-hand touch. Three seconds later I was a hundred richer.

“Goddamit!” Grove said, slapping my back hard enough to rattle my lungs. “I was so sure she was going to go right.”

He slid a hundred from a thick wad and pressed the crisp bill into my palm.

“Just dumb luck,” I said.

“No way,” he said. “Hell, I got you pegged. You’re a player. I’ve gotta hang with you, man. You think you can teach this old dog a few Vegas tricks so I don’t get my clock cleaned all week?”

“Of course,” I said.

“Sorry, I didn’t catch your name,” Grove said.

“It’s Bobby,” I said. “Bobby Tomlinson.”

Grove and I spent the rest of the conference as inseparable gambling buddies. It helped that he shared my conferencing habits, which involved attending a morning session or two, skipping the afternoon sessions entirely to hit the tables, and breaking briefly for dinner, with more gambling until well past the witching hour. I shared all my trade secrets for blackjack (best odds for the player) and craps (a game I’ve affectionately renamed, “Lose All Your Money Fast”). By the week’s end, I was up over fifteen-hundred and Grove, good God, had socked away almost four grand thanks to his willingness to place bets that doubled mine.

We were drinking vodka tonics, lounging on a couple of cushy chairs, and watching an array of forty television sets broadcasting what seemed to be every sporting event taking place in the world at that moment. Of course, we could bet on all of them, which we did for some. Grove won five-hundred bucks when Baltimore returned a punt for a touchdown.

“Hey, G.P.,” he said, jabbing at my specialty, “didn’t your mama ever tell you that the real money’s in surgery?”

I guess I invited that taunt. All week long I had complained about not having deep pockets-the kind that would let me make the sort of bets Grove made without batting an eye.

“My wife is scared to death of the tables,” I said. “I thought it might be a good idea to stay married and see my two kids through college.” Each time I said something even half-funny, Grove laughed roundly and pounded my back.

“I like you, Bobby,” he said. “I wish we could keep playing.”

“Got to get back to reality.”

“You know,” Grove said. “You’re a really great player. A gamer’s gamer. You’re like a craftsman on those tables.”

“Hardly. I just helped educate you about some commonly held beliefs.”

I took an extra long sip of my vodka because I wanted Grove to think I was that casual about my skill.

“If you’re as good a doc as you are a gambler, you could make a killing in our club.”

He voiced the thought almost as an aside, but he got my attention.

“What club?”

“Huh? Oh, I’m sorry, I was thinking out loud.”

“Yeah? What club?”

Grove shifted his weight in his chair, glancing about as if the security cameras were as interested in his mysterious club as they were in the blackjack card counters.

“It’s sort of a private club for doctors,” Grove said, in a conspiratorial whisper. Then he added, “Doctors who like to gamble.”

“I’m a doctor and I like to gamble.”

“Yeah, well, we don’t bet on cards.”

“Yeah? What do you bet on, death?”

I laughed. Grove didn’t even break a smile.

“Holy shit,” I said. “Is that what you really do?”

Grove shifted his gaze down to his feet and spoke even softer.

“It’s not exactly what you think. It’s not even really illegal or anything. But ethically, well, it would be a bit awkward if word ever got out.”

“I think I want to know more.”

“Look, I’ll tell you,” Grove said, “but I need you to swear, Bobby, I mean swear to me, that you’ll never breathe a word of this to anybody. Heck, I might even be able to sponsor you if you want in. That’s how much I like you. We haven’t admitted a new member in over five years.”

“So what’s the club?”

“It’s called ‘The Dead Club.’ ”

“Sounds sinister. Tell me more.”

“Okay, here’s how it works. Each month you get an email with a link. The link is to a password protected website. You’ll have to download an application first before you can use the site. That way we can erase any record of the club on your computer in case of emergency.”

“By emergency I assume you mean detection. What’s on the site?”

“Each month there’s a new medical file for a terminally ill patient in some hospital somewhere in the world.”

“The world?”

“It’s sort of a global club.”

“And you’re all betting on terminally ill patients?”

“That’s right. We’re using our considerable doctoring skills to wager, based solely on the information in their medical records. Like I said, we bet on precisely when they’re going to die.”

“That’s a quite a new twist on the old line, ‘I’m sorry Mrs. Smith, but I regret to inform you you’ve only got six months to live.’ ”

Grove’s smile was far from his signature warm grin. This one was etched with profound mischievousness.

“See, that’s how the club started, Bobby,” he said. “A bet between two docs on just that and, well, it’s sort of grown from there.”

Right then and there I wished I had introduced myself as Robert, or at least Bob. But I kept thinking-How can I get in on this action?

“How many in the club?” I asked.

“I have no idea. Don’t even know how long the club has existed. Membership is on a trial basis and you have to be nominated by an existing member to be considered. Then you get vetted by a committee, all secret stuff, don’t ask me how they do it and if you make it past them, which apparently few do, your name goes before the board for approval.”

Grove was shockingly cavalier describing the club, given that it crossed fairly broad ethical lines.

“Where do the records come from?” I asked.

“Member-supplied. I have put up a few records myself. Of course you can’t bet on your own.”

I wanted to say something, but I was too stunned to speak. Grove continued.

“When you break the club down, there’s really nothing wrong with what we do. It’s all anonymous, supervised by the competition committee, which changes members every four months. We take pains to remove anything that could tie a record to the actual patient. No names, addresses, hospital, next of kin, exact birthday-none of it. All of that information is removed before it gets posted.”

“How much have you won?” I asked.

“Let’s just say if, like you say, you’re worried about college tuition, a few winning bets in The Dead Club could take care of all that-all four years, both kids.”

“Sounds intriguing,” I said. “But what if the patient dies of something else. A slip and fall, say.”

“Hey, in our world, dead is dead.”

Fast-forward now. Two months slip by since I met Grove and his twisted little club. I had sunk back into my life dominated by sore throats, snoring problems, unexplained and unexplainable chest pains, equally mysterious muscle and joint aches and of course, parents concerned about their teenagers’ smoking and pill-popping habits, refusing to look at their own.

Lee Anne and I fell back into step; that lost week in Vegas is now just a fuzzy memory, made even fuzzier by the routines of life-household duties and shuttling our children (Jake twelve and Max ten) to and from basketball practice, piano lessons, and the like. Then, on Christmas morning, no less, I get this email from tdc0529@aol.com. The message simply read: “YOU’RE IN” and there was a link for me to click. By this time, I had pushed Grove and his crazy betting pool to the back of my mind. I clicked the link anyway, and then panicked when it was clear some application was being installed on my computer. I was about to power off the machine when a Web browser popped open and the Web page that loaded read:

THE DEAD CLUB

Login:

Password:

First-time visitors, click here

When I clicked the first time visitor link, I was asked to enter my social security number, which to my surprise, I actually did. What’s even more astounding is that it recognized my social and then returned a username/password combo, which allowed me to log on to the site successfully. I guess Grove had nominated me and I had been vetted by some committee and approved for membership in The Dead Club.

The site, itself, was a marvel. There were bets being tracked in real time from what I gauged to be nearing a hundred cases, some stretching back several years. The older cases were locked for any new action, but you could still track the current odds to win. To get into a betting pool, you had to bet on the current, active case, which for January was an eighty-eight-year-old man with stage-four pancreatic cancer, which, according to his biopsies, had spread to several adjacent organs, the most deadly of which was his liver. He was already showing signs of hepatic inflammation and obstruction.

My whole body started tingling with a mix of anticipation and excitement, but there was some revulsion, too. It was a feeling I knew well from Vegas, as though a thousand army ants had taken up residence underneath my skin and were now burrowing long tunnels alongside my veins and arteries. Grove was right, I thought, as I read through the anonymous record. There really wasn’t anything wrong with what the club was doing.

The poor patient had endured the usual barrage of treatments, including chemotherapy, radiation, and even biological therapy. I looked up the statistics. Rarely did survival for Stage IVA pancreatic cancer, even with aggressive treatment, exceed one year. I modified the rate of deterioration, taking into consideration the man’s medical history, general condition, and chemotherapy regimen that included Gemzar and Camptosar, both fairly recent. I weighed each factor, most importantly, his advanced age and thirty years of type-two diabetes. For this guy to make it six months would be a miracle.

Lee Anne popped her head inside my home office. I was so engrossed in reviewing the medical file that I didn’t even hear her calling my name.

“Bobby, are you going deaf?” she said. “Dinner’s on the table.”

I jumped at the sound of her voice and quickly hid the browser with a well-placed click of my mouse.

“Just give me a minute,” I said, without bothering to turn around.

My heart pounded in my chest. Lee Anne departed with my assurance that I’d follow, but I went back to the site as soon as she had left the room. The betting system for The Dead Club was even more ingenious than Grove had described. It was a kitty-based system, five-thousand-dollar uniform bet for all players wagering on an open case. Players were allowed to pick a time period from the options given, in this case, every two weeks for a year, and then every month. And just like The Price is Right, the winner had to be the closest without going over. There were already at least twenty doctors involved in this case, because the kitty was up to one hundred thousand dollars.

At risk was my five grand. If I won, I’d split with any doctor who picked the same time period as I did. Whoever was behind this operation possessed some serious computer chops to make the site so sophisticated, but still easy to use.

I had a bank account with ten grand in it that Lee Anne didn’t even know existed. I was planning to use it for a surprise mega-trip to Italy in celebration of our fifteenth wedding anniversary. My mouth went dry thinking about what we would do in Europe when I won this bet, and every nerve in my body told me I was going to. I never for a moment considered we might end up celebrating our anniversary at an Outback Steakhouse.

The Dead Club wasn’t luck, it was skill.

I imagined gondolas, floating down a river of champagne, with Lee Anne nestled in my arms, and then the two of us touring the lush English countryside in a rented Bentley. I felt a sudden rage at all those arrogant surgeons in The Dead Club with their gilded lives, looking down with disdain on my chosen specialty. But what they didn’t know was that I possessed skills to interpret medical records in ways the other docs simply could not. I decided then and there that I’d mail a bank check, as required, to the post- office-box address provided, to give myself a minimum kitty of five-thousand dollars to play with.

One measly bet couldn’t hurt.

I won.

John Doe died two months and twenty-five days from my first Dead Club bet. I wasn’t the only winner, though. Competition was tougher than I had anticipated. Fifteen of us split a hundred-fifty-thousand-dollar kitty. Just like that, I had doubled my money, and those army ants were now dancing the Lambada in my head, but at 75 r.p.m.

I hadn’t bet on another case since my inaugural John Doe play, but now I couldn’t wait for April the first to arrive, because that meant a new record would be posted for betting. The pool would be open again and I was ready and willing to take the plunge.

I won again.

This time, I split the kitty with only two other docs who agreed with me that the woman, halfway into her fourth year with ALS, or Lou Gehrig’s disease, would be gone in four months. The safe bet would have been eight months, given that the average life expectancy for ALS sufferers was between three and five years. But this Jane Doe had a subtle abnormality on her cardiogram and an elevation in her serum calcium that I decided was worth at least a deduction of six weeks.

It was a tough bet, given that 10 percent of ALS patients live ten years or longer. Still, there were enough indicators that, like me, two other skilled docs had calculated death would soon be knocking on her door. Her demise netted me sixty-three thousand dollars. Forget gondolas. Now, it was the Riviera that was flooded with champagne.

But winning streaks, even a streak of two, run the risk of ending and mine came to a crashing halt that August. I lost four in a row. Four! Two Jane Does and two John Does. It would have been a twenty-five-thousand-dollar loss, five thousand dollars per bet. But I didn’t bet five thousand dollars. The Dead Club also had a high rollers game with a thirty-thousand- dollar minimum ante and my winnings qualified me for that club membership as well. For a man of my income and means, the rush of placing a thirty-thousand- dollar bet was indescribable. I was sure my winning ways were going to continue. I never would have started playing the thirty-thousand-dollar kitty game otherwise. Never has being wrong about a hunch hurt so much.

A mere twelve months after placing my initial wager on the stage IVA John Doe, I had blown not only my winnings, but a second mortgage on my house and a chunk of my kids’ college fund. Lee Anne hadn’t found out just yet, but she was suspicious, that’s for sure.

Confessing to her my involvement with The Dead Club would be akin to signing my divorce papers. Just when I thought my luck had officially run out, I saw the January bet.

The unimaginable had happened.

I couldn’t believe what I was seeing. The name of a consulting neurologist for a terribly ill man had been left in at the bottom of his note. Ivan Dworsky, a neurologist I knew well. Barring an incredible coincidence, the case was a patient at my hospital! All I had to do was determine and confirm the identity, and that I was quickly able to do. The gondolas were floating again.

Richard Generoso-sixty-seven years old with invasive glioblastoma multiforme, a grade-four malignant brain tumor.

I had only three days to place my bet. This was like betting blackjack while seeing the dealer’s hand. It was one thing trying to predict the outcome by reading a medical record, but another thing entirely to have access to the actual patient. I could review his CT scans with the best radiologists around.

It was no problem tracking Generoso down. I was standing by his bed when in came my second pot of gold. His doctor, whom I happened to have played racquetball with on a few occasions, entered the room with his patient’s latest lab results. I explained that Generoso and I were acquaintances. The invasive radiologists had just performed a spinal tap, I was told, and the results were bad-very bad. Cancer cells were filling the spinal canal-a quick ticket to heaven. The news was as good as gold, because it was fresh and not something included in the medical records the rest of The Dead Club had reviewed. It was better than seeing the dealer’s cards. This was knowing I had blackjack on my next hand.

Three weeks, that’s what I gave him-no more than twenty-one days to live. The cancer itself wasn’t that large, and sure enough, I was the only one to bet his end would come so soon. I took out a third mortgage on my house, forged Lee Anne’s signatures, and put the money in the kitty. If I lost, I’d be over a hundred grand in the hole. But I had no intention on losing this one.

Fast-forward nineteen days. Richard Generoso is beginning to fail, but not that rapidly. He has finally been readmitted, but he is hanging on and still conscious most of the time. I’ve checked on him enough so that he thinks I’m his new physician and his doc thinks that he’s my long- lost uncle.

“How’re you feeling today, Richard?” I asked. It was less than forty hours before I was going permanently under water if he didn’t die.

“Feeling okay,” he replied dreamily. “My daughter is looking into hospice care.”

Richard’s eyes were rheumy with memory.

He knew he was going to die and I knew he was going to die, but for him to pointlessly pass away three days or a week or a month from now in hospice care would have thrown my life into an unrecoverable tailspin. The money was already gone, and trying to find The Dead Club, let alone trying to blow the whistle on them, was fruitless.

The next day, with less than twelve hours remaining on my bet-make that life as I knew it-Richard was still alert most of the time.

It simply wasn’t going to happen.

I went to my office and returned with just fifteen minutes left, as panicked as I had ever been about anything.

Generoso’s doctor and nurse had just left. I walked nonchalantly down the hall and into his room, closing the door behind me.

I don’t really remember injecting the Diprivan into his IV port. In less than two minutes, his eyes closed. Moments later, his breathing stopped. His face turned waxy and pale. I notified the nurses and they called the attending physician. There was no resuscitation. I watched as the time of death was logged.

11:58 P.M.

Two minutes later and I would have killed the man for nothing.

Grove sat across from me.

“You look well,” he said.

“I’ve been better.”

“I can imagine,” he said.

I hadn’t seen Grove since that week in Vegas, but somehow his hair looked even whiter, the goatee fuller; same for his belly.

For a few awkward minutes, we didn’t say anything to each other; then he broke the silence.

“I came here to thank you,” he said.

“For what? I tried to shut down The Dead Club. But I never could find you.”

“Yeah, well, our application makes it easy to erase all information about the club from a member’s computer. And Grover Marshall isn’t my real name.”

“Figured that. So what are you here thanking me for?”

“Well, you made me a lot of money.”

“Yeah? How’s that?”

I asked the question, but I already had a knot forming in my stomach. I knew what his answer would be.

“You deserve to know that you were never in The Dead Club, Bobby.”

I swallowed hard. My throat was tightening, but I still managed a slight, near-imperceptible nod.

“You were The Dead Club, Bobby.”

I caught a devilish gleam in his eyes and it made me shiver.

“You were betting on me?” I croaked.

Grove didn’t budge, but he did jump in his seat when I smacked my hand hard against the reinforced Plexiglas that separated us.

“Hands off the glass, Tomlinson!” A guard’s voice boomed from a crackly PA system.

I glanced down the long hallway, past the row of other prisoners on my side of the glass, toward the guard’s station. I waved my hands in the air, the well-understood signal that I promised no further breech of prison protocol.

“I wouldn’t tell you this if they recorded our conversation,” Grove said, smiling again. “But I thought you’d appreciate knowing that a lot of members were betting you wouldn’t go through with it. I mean, they really didn’t think you could. But I gambled with you in Vegas, Bobby. I guess I had the inside skinny. I doubled down and bet half a million that you’d kill that guy to win the bet. I really owe you for coming through.”

“My win streak, the neurologist in Generoso’s hospital record not being blanked out, all part of the set up to suck me in?”

Grove nodded, real slow and deliberate.

“I also bet a bundle that you’d get caught,” he said. “Gotta hand it to you, Bobby. You don’t disappoint.”

“This isn’t over, Grove, or what ever your name is. Not by a long shot. Five years from now I’m up for parole. When I’m out, I’m going to track you down and make sure you’re either sitting on my side of the glass, or lying somewhere six feet underground. You hear me? That’s what’s going to happen.”

Grove laughed in a jolly, warm guffaw that reminded me of the week we met in Vegas.

“You’re not going to do anything of the sort, Bobby. And don’t count on making parole either.”

“Oh yeah?” I replied.

My eyes narrowed on Grove as I balled my hands into tight fists.

“Yeah,” Grove said.

“You want to bet?” I said.

Massachusetts native DR. MICHAEL PALMER is the author of fourteen novels of medical suspense, all international bestsellers. His books have millions of copies in print worldwide, and have been translated into thirty- eight languages. Palmer was educated at Wesleyan University and Case Western Reserve School of Medicine. His most recent novel is The Last Surgeon, dealing with Post Traumatic Stress Disorder. His novel Extreme Measures was made into the hit film of the same name starring Hugh Grant, Gene Hackman, and Sarah Jessica Parker. Palmer also works as an associate director of the Massachusetts Medical Society’s Physician Health Services, helping doctors with physical and mental illness, as well as drug dependence, including alcoholism. He has three sons, two cats, and some fish.

DANIEL JAMES PALMER holds a master’s degree in communications from Boston University, and is a musician, songwriter, and software professional. His debut thriller novel, Delirious, is scheduled to be published by Kensington Publishing in early 2011, part of a three-book contract with the publisher. He lives with his wife and two children in one of those sleepy New England towns.