Flashback

CHAPTER SEVENTEEN

The afternoon was oppressively warm and humid. Much to Judge Clayton Iverson's relief, several continuances and a no-show had led to the completion of the docket of the Clarion County Court far earlier than usual. Returning to his chambers, he slipped off his black robe and tossed it onto the brass coat rack near his desk. With two unanticipated free hours before Leigh Baron was due at the farm, he was rapidly becoming obsessed with thoughts of a shower and a cold drink or two. His white shirt was soaked through with perspiration, and his underwear felt as though it were glued to his body. Over the summer, BTU by BTU, the courthouse air-conditioning system had been dying. Even worse, the chances of getting it replaced before several more summers had come and gone were, the Judge knew, remote. There was a time when he would have laughed at such inconveniences. But now, he could barely keep his mind off his own discomfiture and concentrate on the cases at hand. Perhaps, he reasoned, in what had become a recurring internal dialogue, it was time to consider retiring. Despite frequent promises to his wife and to himself to cut back to travel more and work less-the pace of his life had, if anything, speeded up. Since buying the house in West Palm six years before, he and Cinnie had spent exactly two weeks there, and had finally leased it out. They had no real need for the rental income, but it had made no sense to leave the place vacant. The Judge knew that with her arthritis worsening, and her childhood roots in North Carolina, Cinnie would jump at the chance to sunbathe away at least some of the grueling New Hampshire winter. They had friends who had already made the move south and sounded ecstatic about their choice. And goodness knew, his golf game could always use some attention. Retirement… Such a soothing notion, he thought… such a frightening reality. It was one thing to consider leaving the bench. He had done about as much as he could do, seen about as much as he could see in that position. But it was quite another to pack up and move to the land of oversized tricycles and afternoon tea dances. The Judge sank into his chair and mopped at his brow with a towel. For the time being, at least, Cinnie and her arthritis would just have to make do. Bum air-conditioning or not, he had yet to reach the point where the liabilities of giving everything up and retiring to Florida were outweighed by a few less aches and pains for her and a few more rounds of golf for him. Besides, he reflected excitedly, for the foreseeable future he had business to attend to in Sterling-important business. In what could well become a landmark move in slowing the advancing juggernaut of r-orporate medicine, he had elected to spearhead the repurchase of Davis Regional Hospital from the Ultramed Hospitals Corporation, and then to supervise its reorganization and transition back to community control. Meetings… politicking… bargaining… rearranging… bending… standing firm… winning … losing… Clayton Iverson felt an almost sexual rush at the thoughts of what the months ahead held in store. It was an ironic harbinger of things to come that, even without knowing he had already made up his mind, Leigh Baron was making the four-hour drive from Boston "just to talk." It was also, he knew, probably not the last time Ultramed and RIATA corporate leaders would be dashing up to Sterling for a session with him. It would be interesting to see the ploys they chose to try-interesting and amusing, for whatever they were, he had absolutely no intention of changing his mind. Not that his decision to convince the board of trustees to annul the Davis sale had come easily.

In fact, it had been one of the most difficult he had ever had to make.

And the stickiest part of all was Frank. Engrossed in thoughts of his son, the Judge packed Guy Beaulieu's folder ap-d some related documents into his briefcase and left the courthouse for the drive home. Zack was right, he acknowledged, as he rolled down Main Street and then out of town along the Androscoggin road, toward the turnoff to the farm, Frank had done an excellent job as administrator of the hospital. It wasn't his fault he was working for a company whose policies were so self-serving that they could ultimately cause catastrophes such as Annie's. Nor was it his fault, at least according to Zack, that the corporation had set out deliberately to destroy Guy Beaulieu. Handling Frank just right through all of this would be a test… perhaps the hardest test of all. Still, the man was worth the effort. He had fallen on some hard times, true, made some bad decisions, but nevertheless…

The initial warning blast of the approaching tractor trailer entered Clayton Iverson's thoughts as nothing more intrusive than the familiar drone of a distant foghorn. He was driving by rote, looking without seeing. The second blast, far more desperate and insistent, startled him from his reverie with an ugly and terrifying suddenness. The left side of the Chrysler had drifted far across the two-lane road-so far, in fact, that the solid dividing line was streaking along underneath the very center of the car. The semi, a monstrous, red GMC was hurtling toward him, its air brakes screeching, its grillwork gaping down at him like the balleen of a whale. In the clamorous, surreal, frozen moments that followed, the Judge processed countless minute details of the scene before him, the high, Slavic cheekbones of the burly trucker, who was staring down at him in wide-eyed terror and fury… his green baseball cap-its gold brim… the sun, glinting off the truck's windshield… the white script Tenby's on the crimson wind deflector above the cab…

The horn… the air brakes… the face… the grill… the sun… the screeching tires… With no conscious realization of what he was doing, Clayton Iverson whipped the wheel of the Chrysler to the right, spinning into one ninety-degree turn and then another before skidding to a stop on the gravelly soft shoulder. Lurching and heaving from its efforts, the behemoth rig barreled past, shaking the Chrysler viciously in the vacuum of its wake. The Judge glanced in the rearview mirror in time to see the trailer stop its pitching and level out as the trucker gradually regained control. Gasping for breath, he continued staring at the mirror until the crimson reflection disappeared around a bend. Then he sat by the roadside, trembling mercilessly and waiting either for his heart and lungs to burst or for the adrenaline surging through his body to subside. He had had more than his share of close calls on the road before, although none much closer than this one. And after each one, as now, he silently thanked his Higher Power for giving him reflexes quick enough to compensate for being one of the most easily distracted drivers ever set behind the wheel of a car. He also paid brief tribute to his own foresightedness in purchasing one of the heavier models on the road.

After several minutes, his pulse had slowed and his shaking had let up enough for him to swing back onto the roadway. The rest of the drive, he promised, would be made at fifteen, twenty at the most. The trucker, whoever he was, had earned a pass to heaven with his masterful driving … and masterful it was, too, he thought… He fished a handleerchief from the dashboard pocket and wiped the drenching sweat from his face and hands… absolutely masterfur… He savored a deep breath, then another. His pulse returned to normal. Now, he thought, where was he? … Ah, yes, Frank… It had been a joy to hear from both Whitey Bourque and Bill Crook of their dinner session with him. One hell of a guy. Those had been Bourque's exact words. Smart, well prepared, and persuasive as the Dickens… It was almost like the old days-the reporters, the TV people, the calls from friends every week… Judge, that's one hell of a kid you've got there… One hell of a kid…

Judge, can we get a shot of the two of you together? … "at were you thinking when your boy took off and headed for the end zone like that?… As far as the Judge was concerned, the moment Annie Doucette had tumbled off the end of her bed, the fate of the Ultramed Hospitals Corporation in Sterling had been sealed. But speaking to Bourque had helped him see that although the company had to go, there was no reason Frank had to go with it. A few calls to select trustees had convinced him that the board would go along with him in keeping Frank on as administrator. Now, he had only to convince Frank… The Judge had sped a hundred or so yards beyond the oversized silver mailbox marking the dirt drive to his farm before he realized that he had missed it. "Damn you, Iverson, " he cursed out loud. He slowed, giving momentary thought to a U-turn or to backing up. Then, before he could talk himself into chancing either maneuver, he accelerated over the five hundred additional yards to the next driveway.

Twice, trying turnarounds on that stretch of narrow road, he had backed into the drainage ditch.

The last thing he needed at that moment was to spend a sweltering hour perched on the split-rail fence, waiting for Pierre Rousseau and his damn tow truck. He had a date with a shower and a gin-and-tonic, and then with a' lovely businesswoman who would try, unsuccessfully, to get him to reconsider his decision. Leigh Baron wasn't all that tough, but she was bright and certainly diverting. And she would surely provide a decent warm-up for the encounters to come with the real heavy hitters.

Once again, he felt the scintillation-the rush-at the prospect of what lay ahead. It was hardly difficult for him to understand why generals gave up their commands so reluctantly. Retirement?… Nonsense, he thought. The game was on, and Clayton Iverson was right in the middle of it. As he eased the Chrysler to a stop by his barn, stepped out, and surveyed his land and the mountains beyond, the Judge made a mental note to send a renewal off to their Florida tenant before Cinnie realized that the man's lease had run out. The atmosphere in the intensive care unit was somber and extremely tense. A child was in trouble-serious trouble. The nurses moved from one patient cubicle to another efficiently, but more quietly than usual, stopping from time to time at the doorway to number 7 to see if the nurse working on Toby Nelms needed any assistance. Behind the nurses station, next to the bank of monitors, Zack checked over the latest set of laboratory figures with the boy's pediatrician, Owen Walsh, a soft-spoken man in his late fifties with close cropped, graying hair, and deep crow's feet at the corners of his eyes which gave him a perpetually cheerful expression. Across from them, in cubicle 7, Toby lay thrashing on a cooling blanket, totally unresponsive to his environment. His core temperature, despite aggressive measures, remained well above 104. The fire/rescue squad had broken into the Nelms's bathroom and found the boy draped over the side of the tub, barely conscious, with multiple, self-inflicted slices and stab wounds on his arms, abdomen, and legs. Barbara Nelms, conscious but in shock, lay in the bedroom, blood still oozing from the gashes in her arm. Zack had arrived at the house in time to help with the first aid and the insertion of intravenous lines in both mother and child. Then he had accompanied the ambulance to the hospital and had turned Barbara Nelms, whose blood pressure had responded nicely to a fluid push, over to the general surgeon, Greg Ormesby. Finally, after getting Toby up to the ICU and onto the cooling blanket, Zack had begun to repair his wounds, none of which involved tendons or vital structures. And, frightening as the lacerations appeared, Zack knew that they were of little importance compared to the fever and the deterioration of the boy's central nervous and cardiovascular systems-a constellation of signs that were almost certainly a reflection of brain swelling. "Do you think Boston? " Owen Walsh asked. Like many community pediatricians, especially older ones, Walsh was far more comfortable dealing with patients in his office than in the hospital, and was not comfortable at all with a critically ill child in the intensive care unit. "At this point, I'm not even sure he could make it, " Zack said. "Although I guess that's what we should be shooting for."

"He's been a patient there in the past, you know."

"I know, Owen, I know. And I know you're nervous about having him here.

The truth is, I'm not so comfortable with it myself. But believe me, as someone who a month ago might have been called in to see this kid after his transfer to Boston, our fluids are just as good as theirs. So're our cooling blanket and our Tylenol and our steroids. And we've got a hell of a cardiologist in Suzanne Cole. So it's not like we're doing nothing.

I think we should alert the people down there about what's happening and put one of the chopper teams on standby. But there's something we ought to attend to first."

"The anesthe ic?"

"Exactly-, Zack had shared Toby's history with the pediatrician, withholding only his suspicion that some sort of secret anesthe ic might have been used during his hernia operation. "Can you explain it to me again? " Walsh asked. "Sure. In a second."

Zack stood and peered across at Toby. Swathe in bandages, surrounded by the monitor, the clipboards, the intravenous, gastric, and oxygen tubings, and the large cooling blanket console, the child looked terribly frail and vulnerable. "Any change?"

Zack called out to the nurse attending him. "Temp's down to 104, Doctor,

" she said. "No other change."

"Pupils?"

"Still equal and reactive, but sluggish."

"Thank you…"

He glanced at the monitor in time to catch several ominous, premature heartbeats. "See if you can locate Dr. Cole, please, " he said to the unit secretary. "Ask her if she can come down here."

He turned back to the pediatrician. "Okay, Owen. Now, if what we're seeing is some sort of central, toxic reaction to an anesthe ic, then as far as I'm concerned, the actual molecules of the drug, or at least their chemical imprints, are still there in Toby's brain, clogging up neuro pathways and periodically firing off messages without any warning or control from him."

"The seizures."

"Or flashbacks, or whatever you want to call them. Somehow, the messages these molecules are transmitting are violent ones-ones related to the surgery."

But why? Zack found himself asking for perhaps the millionth time.

"Y do they happen when they do? Why not to every patient, or at least to more of them? The answer, he felt certain, had to be some sort of neuroactivator-a trigger, or more likely, given the rarity of the condition, a specific sequence of triggers. No other explanation made sense… "Zack, you were saying? " Owen Walsh was looking at him curiously. "Oh, sorry." Zack made a mental note to go over with Barbara Nelms the minute details of the events preceding Toby's attacks. He would also write down his best recollection of the minutes preceding and following Suzanne's bizarre episode. "Do you follow all this?"

"So far, " Walsh said. 71 Okay… Zack drew a sketch of several nerve endings on a piece of scratch paper, and used the diagram to illustrate his theory. "So, what we might consider doing, is putting Toby back under again in a perfectly controlled, sensory-deprived situation.

One of those isolation tanks would be ideal, but I understand that's just not possible with him being so sick. Anyhow, we just make things as dark and as quiet as we can, and we administer the same anesthe ic he received originally."

"And what we'd be trying to do, " Walsh said, "would be literally to wash out the molecules that are sending violent sensory messages, and replace them with molecules transmitting-what, blanks?"

"Precisely-" 6"You just thought of this?"

"Actually, " Zack said, "there was some work done in the late sixties and early seventies using the isolation tank technique on patients who had become psychotic from recurring LSD flashbacks."

"You mean they treated LSD psychoses with LSDT' Zack nodded. "A neurologist in Europe. Scotland, I think."

"Successfully?"

"Successfully enough to be encouraging." This time, it was Walsh who stood and gazed in at their patient. The crow's feet by his eyes deepened with what he saw. "Dangers? " he asked. "Given the disaster you're observing in there, " Zack said, "I don't see how giving the child some anesthesia can do much harm, as long as the anesthesiologist is standing by to intubate him if necessary."

"Will Jack Pearl go along with it?"

"That, my friend, may well turn out to be the sixty-four-dollar question. He and I haven't exactly seen eye to eye on this anesthesia business."

Owen Walsh nibbled at the edge of one fingernail. "Perhaps we should present this to the boy's parents, and get their consent, " he said. "I can do that, provided his mother is still stable."

"And maybe your brother ought to know what's going on, too. He's a good man, and an excellent administrator, but he doesn't like surprises."

Zack felt the prickle of irritation and impatience. He reminded himself that one of the reasons he had opted to become a surgeon, while others, like Walsh, had chosen pediatrics or internal medicine, was the speed with which they went about making decisions. More often than not, the primary care people and the surgeons ended up at the same spot. They simply arrived there by different routes. He motioned toward Toby's cubicle. "Owen, " he said, "we don't exactly have a lot of time to play around with this thing. I can understand your reluctance, but we either do this or we don't." Again, the man hesitated. "Okay, Zack, " he said finally. "You deal with Pearl and Barbara Nelms, and I'll take care of alerting Boston, getting the helicopter people on standby, and notifying your brother. We'll meet back here at, say, six-thirty."

"Six-thirty it is. And, Owen?"

"Yes?"

"It's the right decision."