Flashback

THIS BOOK IS DEDICATED TO THE MEMORY OF MY MOTHER, ROSE GOSHGARIAN, AND MY AUNT, NEMZA “NANCY” MEGRICHIAN.

ACKNOWLEDGMENTS

For their contributions on various technical matters, I would like to thank the following people: James Stellar, Roy Freeman, Alice Janjigian, Karen Chase, Alice Gervasini, Tweedy Watkins, Deborah Copeland, Jack Reynolds, Karen Hutchinson, Karen Zoeller, Michael Ku, Richard Deth, Marjorie D’alba, Amy Sbordone, Peter Mollo, Michael Carvalho, Kate Flora, Kenneth Cohen, Charles O’Neill, and Malcolm Childers.

A special thanks to Dr. Daniel Press for his generous time and great help with medical matters. Also to Barbara Shapiro for her great advice and encouragement.

A very special thanks to my own special muse, Wanda Hunt, for her extraordinary assistance, her patience at the tape recorder, and her inspiration.

And, of course, my deep gratitude to my agent, Susan Crawford, my editor, Natalia Aponte, and my publisher, Tom Doherty, for their continuing support.

I’m also indebted to the books Alzheimer Solutions: A Personal Guide for Caregivers by Jim Knittweis and Judith Harch and The Story of My Father by Sue Miller.

So many dreams—it’s hard to pick out the right one.—E. B. WHITE, who died of Alzheimer’s disease

When I was young I could remember anything whether it happened or not; but my faculties are decaying now and soon I shall be so I cannot remember anything but the things that never happened.—MARK TWAIN

1

1

Homer’s Island, Massachusetts

FROM HIS PERCH ON SKULL ROCK, they looked like pale eggs sunny-side up moving just beneath the water’s surface. Some kind of jellyfish. Half a dozen, pulsating vigorously through the black surf like muscular parachutes.

Odd. Jack Koryan had spent several summers of his childhood out here and could remember only a few occasions seeing jellyfish in the cove, most of them washed ashore by the night tide-dinner-plate-sized slime bombs with frilly aprons and long fat tentacles. But these creatures were small round globs, translucent jelly bells with nothing visible in trail.

Maybe some tropical species that the warm water brought in, he thought.

Jack watched them pump by in formation, driven by primitive urgings and warm eddies. Somewhere he had read that jellyfish were ninety-five percent water—creatures with no brains, bones, or blood. What enabled them to react to the world around them was a network of nerves. What a lousy fate, Jack thought—to relate to the world only through nerve endings: a life devoid of thought, passion, or memory.

The cool, moist air had picked up, ruffling the water’s surface. The tide was coming in, and soon the rock would be covered.

Skull Rock.

It looked just as it had forever—a domed granite boulder rearing out of the surf about fifty yards offshore, it’s crown whitened by generations of barnacles, the base maned with sea grass, a necklace of shiny black mussels hugging the high-tide line like exotic pearls. When they were kids, he and his cousin George would fill a pail with the mollusks for his Aunt Nancy’s Armenian dishes or bouillabaisse.

It had been fifteen years since Jack had last swum out to the rock. Back then he’d spend hours there with his cousin and other summer kids. At low tide they’d pack as many as ten wriggling bodies on the crown, holding their perch by little more than the worn barnacles under their feet. He could almost hear the yowls of laughter as they lost balance or got elbowed off. First man in is a rotten skate.

Behind him a sea like liquid iron rolled off to the dark rain-sagged clouds swelling down from the north. Someplace out there Jack’s mother had died—August 20, 1975. She had paddled out to her small sailboat, moored just beyond Skull Rock—probably within fifty yards of where he was now standing. It must have been a nor’easter since the tender had washed up a half mile down the beach with lifejackets still in it. Her body was never recovered.

Today was the thirtieth anniversary of her death. Every few years he’d come out in quiet commemoration. He was not even two years old at the time she died. His Aunt Nancy and Uncle Kirk had raised him as their own.

Below, more jellyfish floated by—a skewed phalanx of them. Translucent bodies with intersecting purple rings at the centers just below the surface.

This was a special place, a caretaker’s cottage to Vita Nova, the large Sherman estate on the cliff above. His mother, Rose, had rented it decades ago for vacations, attracted to the unusually warm water, the results of complicated weather phenomena involving El Niño. Periodically, eddies from the Gulf Stream would bring into the area creatures from the tropics—sunfish, hawks-bill turtles, bonito, and smaller creatures that fascinated his mother. According to Aunt Nancy, Rose had a half-mystical yearning for the sea and would spend hours walking the beaches collecting odd critters. But Jack had no memory of her—only scraps of information from his aunt, who had died thirteen years ago. His father perished in a plane crash when Jack was only six months old. So he had no memory of him, either.

But Jack did remember getting stung once by a big orange lion’s mane jelly in shallow water. It had felt like a hot lash across his calf. As he choked back tears, Aunt Nancy calmly walked him into the house and flooded his skin with vinegar. “Never rub,” she had said, “that only makes it worse.” Then with the dull edge of a knife she had scraped off a small scrap of tentacle. An old Armenian remedy—something she learned from his mother, she had said. He wondered if that was true.

On shore, in the dimming light, Jack could make out his clothes where he had left them to swim out and, just up the beach, the dark silhouette of the cottage. The sandy beach that rimmed Buck’s Cove was completely empty, although lights burned in the Sherman mansion above. It was a private island, but on summer weekends the cove would draw boaters to its pristine beauty. Tonight the place was empty of life.

Lightning lit up the horizon. The storm would break soon.

From the rock the lightless cottage brooded in the shadows of the shore, yet it was a place incandescent with memories. After his mother had died, the Shermans continued to rent the place to his family for a summer week or two. He could still recall how he and his cousin charged down the sand and plunged into the water, inured to the chill that stopped adults dead at the knees.

From out of the gloom a seagull sliced low to catch something in the water then shot up with a squawk at the last second as if spooked. It came to rest on shore near Jack’s clothes, still protesting.

Jack felt a jab to his chest. Under the flashing sky, the half-dozen jellyfish had turned into a school. He looked at the water behind him.

“Jesus Christ!”

Not a school. He was standing in the middle of a damn jellyfish bloom. Hundreds of them were bobbing en masse by the rock. The cove was infested with them.

In the dimming light he could make out his clothes on shore, the legholes of his jeans beckoning him to slip back in and pull them up. They looked a mile away.

Where the hell did they come from?

What if these were stingers?

But aren’t there a hundred different jellyfish species, and only a handful that sting?

He thought about putting his foot in to test. That would be fine if he got no reaction. But if he got stung, then what? Wait out the storm so lightning could turn him into a charcoal briquette? Besides, in an hour, the rock would be underwater, and jellies would be streaming over his feet. Jesus!

He estimated the black expanse separating him from shore. His best high-tide time was one minute twenty seconds. But that was when he was eighteen years old. He was thirty-two, and at best he could reach shore in two minutes. Two little minutes, but the thought of swimming through water thick with jellies was repulsive. And if they were stingers, the trip could be nasty.

But they’re no bigger than a baseball and probably eat minnows.

True, but doesn’t their venom paralyze their prey like that?

But you’re not a minnow.

No, but a hundred hits could balance the books.

Sweet Jesus!

The sky lit up in a sickly green, then a high-metal crash exploded the air. With the incoming tide and the onshore wind, he could possibly make it in maybe a hundred adrenaline-driven seconds.

(His mind lit up with Aunt Nancy grinning on shore with a stopwatch. Three, two, one. Go! George was two years older, but Jack was the better swimmer.)

One hundred measly seconds.

The water was dark, but the jellies seemed to occupy the upper foot of surf. Jack could dive deep and swim half the distance just above the bottom, then he’d only have to stroke maybe another twenty feet to the shallows and go the rest of the way on foot.

He tried to tell himself that they were just harmless blobs whose mucus coating would slip by his body—that it would be like swimming through a tide of silicone gel bags.

Don’t think, just get your ass to shore. Three … two … one.

The sky exploded again, strobe-lighting the cove. His heart almost stopped: The water was flecked with jellies all the way out. He uttered a silent prayer, filled his lungs, and dived into the water.

But he was wrong. These jellies had three-foot-long invisible tentacles.

And they were stingers.

Jack kicked his way for maybe thirty feet, then shot to the surface.

In those first microseconds of awareness as he sucked for air, Jack could not determine the epicenter of the pain. The tentacles had slashed his arms, back, and legs and made a repulsive mucus mat of his head.

“Don’t rub.”

He brushed the things out of his hair, their spaghetti strands cutting across his face and ears. He screamed so loud that his throat nearly shattered. He was on fire, as if he had been caught in a hotwire mesh.

“Don’t rub. Don’t rub.”

In the chatter of lightning, he could make out a woman looking like Aunt Nancy waving to him from shore.

But it was too late, his hand was ablaze with poison. And his shoulders and back felt as if he’d been gashed with machetes. Jack had never known that pain could be so exquisite. He gasped in more air, closed his eyes, and kicked to get under the creatures. Pumping blindly, he could feel the blobs ripple by his face, cross-slashing his body.

He shot to the surface sucking for air, his mind screaming against the horror, fighting to focus on making it to shore no matter what, before the toxins began paralyzing his muscles.

On shore the woman had disappeared, and in her place a large white seabird pecked at his clothes.

Somewhere thunder crashed, but Jack did not register it. He did not register anything but the pain flashing across his body. It was like swimming through eddies of molten lava.

With a porpoise kick he shot ahead.

He was halfway there. On the hill above, the Sherman mansion glowed against the black sky. Even if he could find the voice to scream, it wouldn’t reach that far. And he could not summon the air. So he concentrated on pumping his legs and arms and keeping his face out of the water.

Your eyes. Close your eyes! his mind screamed.

Don’t want to go blind. Can take the skin burns, but, God, you don’t want to lose your eyes.

He pressed them shut. A tangle of tentacles made a partial noose under his right ear, searing his skin.

“Never rub.”

But in reflex he swiped them off, making it all the worse because that smeared the toxins into his ear and across his jaw and lips. God! The stuff was in his mouth, burning his tongue and throat as if he had swallowed hot water. He scraped his fingers on his bathing suit to remove the slime.

“NEVER RUB!”

Now both hands were on fire, like the rest of his body. And in that slender margin of sanity, he knew that his shoulders, back, and legs would be crosshatched with blistering welts—and that if he got out of this alive, he’d be a mess.

In the flickering light he made out the shore and the bird watching him. Maybe forty feet. He was in five feet of water. But he couldn’t wade in. So he pressed shut his eyes and kicked furiously, trailing his hands because they were useless balls of agony. He did all he could to keep his face up. But his eyes were beginning to burn. God, don’t let me go blind. Please.

As he kicked, he could feel jellies slip over his skin, the hot-poisoned strands streaming across his torso.

At maybe another twenty feet, he snapped open his eyes to see the waves crash on shore just a few body lengths ahead. Acid tears flooding his vision, but he could still make out the pile of clothes. And he locked his eyes on his shirt and pants which that bird picked at like some carrion vulture.

With every scintilla of muscular will he had left, Jack Koryan kicked.

Suddenly the burning began to fade.

Thank you, sweet God.

It was miraculous. His arms and legs were rapidly cooling. Maybe the toxins had worked their evil and were being neutralized by his body’s natural defenses. Or maybe he had somehow adjusted.

He tried to stand up to wade in, but he could not feel his feet touch ground. Nor could not even right himself up. He tried to continue swimming, but his legs did not obey the command.

God in heaven! His body was going numb, as if his blood were hardening wax.

He was maybe fifteen feet from shore, but he could not move. He was paralyzed in a dead man’s float, bobbing in the surf, staring at his running shoes and clothes, just this side of the finish line, some dumb seabird gawking at him, its milky eye flicking in the lightning.

Then coming down the sands from the cottage was that woman beckoning him with open arms. She was Aunt Nancy and she wasn’t Aunt Nancy.

My mind. My mind is going. The last delusions of a dying man.

He looked at the bird and felt a fog fill the sacs of his brain like a miasma.

The bird let out a long harsh cry.

This is my death.

In the surf, just a few feet from home. Three … two … one.

Those were Jack Koryan’s last thoughts before his brain went black.

2

BETH KORYAN WAS IN A DEEP sleep when the phone rang. Through the murk, the cable box clock read 12:22. Jack’s side of the bed was cold, so she rolled across it to catch the phone, thinking that he had probably stopped off at Vince’s to rehash out the menu for next month’s opening of Yesterdays, Jack’s dream restaurant that had sent them into huge debt.

Even though she and Jack didn’t have children, Beth could still hear her mother’s words about no good telephone call after midnight: “Pray it’s a wrong number.” Maybe there were problems with the water taxi; or maybe his car had broken down again and he needed to be picked up someplace. Just what she’d want to do at this hour—jump out of a warm bed and drive off. She’d warned him that the car might not make it to New Bedford and back, but no! He had to go out to that damn island—a little trip down Memory Lane.

Jack was strong-willed and fiercely independent, but he had nostalgic hankerings that could squelch his better judgment—like announcing his resignation from Carleton Prep’s English Department to open a place that served eclectic old-world cuisine—thus the name, Yesterdays.

Jack liked teaching and was popular, but he could not see himself committed for life—and after ten years he was growing weary of the budget cutbacks and increased class sizes to the point that education was losing out. So in a carpe diem mind-set, he decided to follow an old passion. From his Aunt Nancy he had developed a talent for cooking. And his old friend Vince Hammond had agreed to be his partner. The risks were high, of course, and in spite of Beth’s protests, Jack had broken the bank. But that was Jack: a can-do will propelled by mulish single-mindedness.

She was still furry with sleep as she caught the phone on the fourth ring. “Mrs. Koryan?”

“Yes?”

“Is Jack Koryan your husband?” and the man named their address.

A spike jabbed her chest. “Yes.”

“This is Dr. Omar Rouhana. I’m an ED physician at the Cape Cod Medical Center in Barnstable. Your husband is here. There’s been an accident and he’s seriously ill.”

“What?” Beth was now fully awake. ED. What’s ED? Emergency Department? “What happened?”

“We think it’s very important for you to come down to the hospital. Is someone with you—someone who can bring you in?”

“Is he alive? Is he alive?”

“Yes, he’s alive, ma’am, but it’s important for you to be here, and we’ll explain the details when you arrive. Do you have children?”

“What? No. Will you please tell me what happened? Was it a car accident?” There was a long pause during which Beth could hear her own breath come in sharp gasps.

“You husband was brought in by a Coast Guard rescue squad. He was found on a beach on Homer’s Island. What we’d like you to do is to come in so we can talk about this further. Can you get a ride?”

They were stonewalling her, refusing to give details. She did all she could to control herself. “Is he conscious? Can you please tell me if he’s conscious?”

“Well, I think it’s best—”

“Goddammit! Is he conscious?”

“No.” Then after a dreadful pause, the doctor added, “Would you be coming from Carleton, Massachusetts?”

“Yes.”

“Well, that’s about ninety miles away. Can somebody drive you, or would you like us to call the local police to bring you in?”

God! Was it that bad? She did not want to spend the next two hours riding in the back of a police car with a perfect stranger. Nor did she want to bother Vince or other friends. “I can drive myself.”

The man gave her directions that she scribbled down.

“What happened to him?”

Again the doctor disregarded the question. “And please bring any medications your husband’s been taking.”

IT WAS A LITTLE BEFORE THREE A.M. when Beth pulled into the lot of the CCMC. From the scant details, she guessed that Jack had probably blacked out while swimming, which meant he had suffered a lack of oxygen. As she entered the emergency entrance, she wished she had called Vince.

The ED lobby was a tableau in bleak fluorescence. Two people occupied the reception area—one man asleep across two chairs, and an elderly woman glaring blankly at a television monitor with the sound turned off. The woman at the reception desk had expected her, because when Beth identified herself she stabbed some numbers on the phone. “Mrs. Koryan is here.” In seconds a physician and a nurse emerged through the swinging doors. Their faces looked as if they had been chipped from stone. They introduced themselves, but Beth didn’t register their names and followed them to a small conference room off the lobby and closed the door.

“He’s dead, isn’t he?” Beth asked.

“No, he’s not dead, Mrs. Koryan,” the doctor said. “Please sit down. Please.”

Beth slid into a chair across from them. Their faces were grim. Their badges read Omar Rouhana, M.D., and Karen Chapman, R.N. “Mrs. Koryan, before we let you see him, we must first warn you that your husband experienced serious trauma. Besides nearly drowning, he suffered acute toxic burns on his body.”

“Burns?”

“He got caught in a school of jellyfish.”

It sounded like a bad joke. “Jellyfish?”

“We don’t know the details, but a coast guard officer at the scene reported a large school of them. Fortunately, he bagged a couple, and we’re in hotline contact with marine biologists at Woods Hole and Northeastern University’s marine labs at Nahant to assist with toxicology screening.”

“Wha-what are you saying?”

“That your husband got badly stung,” Nurse Chapman said. “And he’s not a pretty sight, I’m sorry to say.”

Beth nodded numbly. Then the nurse got up and took her arm and led her through the Emergency Department door and down a hall toward the curtained bays, an orchestra of electronic beeps and hums rising around them. They stopped by the third bay, and the nurse pulled back the curtain. The doctor and nurse had done their best to dull the shock, but they could never have prepared Beth for what her eyes took in.

The immediate impression was that this was not her husband but some hideous alien parody: Jack was spread-eagled on a stretcher. His eyes were patched with gauze, his genitals were draped with a white cloth, and his feet were balled in bandages. Tubes connected to monitors, machines, and drip bags from all parts of his body—mouth, head, arms, and privates. One had been surgically implanted under his collarbone and connected to drip bags. But what nearly made Beth faint was Jack’s body: It was bloated to twice its size, and his neck, chest, arms, thighs, legs, were crosshatched with oozing, angry red welts and glistening from head to foot with analgesic goo. He looked as if he had been brutally horsewhipped then pumped with fluid to the bursting point.

Instantly the air pressed out of Beth’s lungs in short staccato gasps, as she stood there stunned in horror while trying to process what had become of Jack—that beautiful man she had married with the thick black hair and star-burst green eyes that drove his female students to distraction. Beth’s own eyes fell on the small rose tattoo on his right arm in memory of the mother Jack never knew. Then she burst into tears.

The nurse put her arms around Beth. “I know, but the good news is that his heart rate is strong, and that his vital signs are good.”

“Wh-why’s he so bloated?”

“The toxin. It causes water to leak into the tissue and cavities of his body, which is why we’re hydrating him.”

“The tests won’t be back for a few days,” the doctor said, “but so far the lab work shows no major abnormalities in his blood.”

“What did this to him?”

The doctor took the question. “The marine-lab people think it’s some rare kind of creature found in the tropics. Until we get a tox screen, we’re treating him with steroids and antiseizure meds to keep him stable.” The doctor checked Jack’s chart. “Already his temperature is approaching normal.”

Jack’s eyes were wadded with dressing, and what little of his face she could see was a puffed mask of red and purple. His lips looked as if he had been beaten with fists—blue, swollen, bloody, painted with disinfectant, and an endotracheal tube jammed down his throat. Except for the tattoo, there was no reminder that this was the same man she had fought with just hours ago. Her heart twisted: Their last words had been contentious—about his going out to the island.

“What’s that on his head?” Jack’s hair had been roughly chopped to the scalp, and something had been implanted in his skull.

“An ICP gauge. We’re watching the intracranial pressure in his brain.” It looked like a tire pressure gauge buried in his head and had lines connecting it to an electronic monitor.

“As with some snakebites,” the doctor said, “toxins from marine organisms cause a rapid rise in blood pressure and cerebral hemorrhaging.”

On the wall was a light display and what looked like X-ray images of Jack’s brain. The nurse caught Beth’s eyes. “We had an MRI done to check on any edema … swelling and bleeding.”

“The good news is that we don’t think we’ll have to operate,” the doctor said. “The ICP trend has turned negative—no increase in intercranial pressure over the last two hours.”

“You mean there was bleeding in his brain?”

The doctor nodded. “But to what effect we can’t determine. We really don’t know how long he was unconscious. But we’re treating him with steroids to prevent brain inflammation and antiseizure medications hopefully to prevent seizures and keep him stable.”

Beth nodded as a hideous thought cut across her mind like the fin of a shark: Jack could be brain-damaged.

She scanned the various monitors with blinking blips and graphs and orange and red squiggles, quietly chittering away, the IV stands with drip bags, the ventilator chuffing in his throat, the catheter drainage bag, suction jars, and oxygen tanks along the side of the bed, tubes of urine connecting to some machine on the floor.

I’m going to lose him.

Her eye rested on the heart monitor. It was still pumping, that big stallion engine.

Jellyfish.

In a voice barely audible, Beth asked, “Is he going to make it?”

“We’re doing all we can,” the doctor said. “If he remains stabilized, we’ll move him to Massachusetts General where there are specialty neurologists and some of the best equipment in the world. And he’ll be closer to home.”

Nurse Chapman handed Beth a wad of tissue to absorb the tears that were now flowing freely down her face.

“His feet …” They were wrapped in dressing.

“Well, they were exposed to the water when he was washed up.”

And she imagined Jack’s feet marinating for hours in jellyfish toxin. Another nurse came in with a tray of medications. “Mrs. Koryan, we have to turn him over to dress his back, so it might be best if you waited in the waiting room. If you’re hungry, there’s a coffee machine and bunch of canteens down the hall.”

They wanted to spare her the sight of Jack’s back. Beth nodded. She wasn’t hungry, but she could use a coffee since she’d be up the rest of the night. They said to return in half an hour. As Beth started toward the door, her eyes fell on Jack’s hands. His fingers looked like purple sausages. His ring finger was bandaged. Then she noticed a small plastic Ziploc bag on the bed table. In it was a twisted piece of yellow metal. Like a Polaroid photo rapidly developing, she realized it was Jack’s wedding band. They had snipped it off his finger to prevent it from cutting off the blood flow.

“You may take it,” Nurse Chapman said, handing it to her.

But Beth shook her head and left.

3

EDDIE ZUCHOWSKY THOUGHT IT WOULD BE a bad day, but not like this.

First, he got stuck in traffic for half an hour on Route 3, no more than two miles from Cobbsville center, causing him to arrive at the store ten minutes before opening. Then two of his girls left messages that they were sick and wouldn’t be coming in—which really meant that they had gone to the Dave Matthews concert at UNH and got home at five A.M. And because it was Friday—always a busy day—Eddie would have to man the Hour Photo counter and still perform his other duties as assistant manager.

And now some old woman was at the Cover Girl shelf pocketing tubes of lipstick. He could see her on the security videos.

Good God, I don’t need this, Eddie told himself.

As he stared in disbelief at the monitor, he could swear he recognized the woman although he couldn’t quite place her. He adjusted the set, and then it came to him: Clara, one of the regular Seenies. That’s what some of the store staff had dubbed the residents from the Broadview Nursing Home up the street. Seenies, short for “Senile Citizens.”

Of course, that was a tad cruel—and as assistant manager of the Cobbsville CVS, he forbade any of his staff to use such insensitive language about customers. In fact, he once threatened to report a stock boy to the district manager when the kid announced to other staffers, “Here come the Alzies but Goodies.” (Eddie had to admit it was a funny line, although he reminded the kid that they could be us some day: “There but for fortune …”)

Their visit to the store was a common event, as they’d stop by on the way back from a field trip to a local baseball game or restaurant so that the nurse’s aides could pick up patient prescriptions. But instead of leaving them to sit restlessly in the vans, the aides would bring them into the store to wander around—in monitored groups, of course. As one aide dealt with the pharmacy, the other two would stay with the residents as they bumped up and down the aisles like sheep.

They’d never make any trouble or bother other customers. At times they could be a bit noisy. Once in a while one would yell something out of the blue—nothing that made sense—or if they got confused or frightened and started crying, the aides would hush them up or take them out to the van. Some of the bolder ones might speak to the customers, say harmless nothings—like retarded kids. A couple weeks ago one man asked Allison at the cash register if his daddy could move back in with them, apparently thinking he was a kid again and she was his mother who had ditched the old man. Allison, who’s pretty sharp, said, “Sure he can,” and the old guy grinned with joy.

Usually the nurse’s aides would let them select a little something—a picture book, a toy, a package of cookies, makeup—whatever caught their eye. If the items were inexpensive and appropriate, the aides would usually pay, then herd the patients out the door and into the van. (The patients each had small accounts back at the home, Eddie learned.) What amazed Eddie was that although Broadview was only three miles away, an excursion to the local CVS was a big deal to these folks—like a trip to Disneyland. The sad thing was some barely knew the difference.

But they seemed to enjoy these outings, and, frankly, it was good for business, because it let the community know that its local CVS was a good neighbor. Over the months, Eddie had gotten to know a few of the individual residents—like Clara, who was actually not a little old lady but a large blocky woman with a big flat face. She didn’t say much, just shuffled around sometimes holding the aide’s hand and studying the shelves. You’d say something to her and her only comment was “Yeah”—no matter what you said.

“Hi, Clara. Is everything okay?”

“Yeah.”

“You feeling good today?”

“Yeah.”

“You have a very pretty dress on.”

“Yeah.”

“Would you like to eat a bowl of maggots?”

“Yeah.”

Eddie left the photo counter and headed for aisle lA. But as soon as he rounded the corner he froze.

Clara was at the Cover Girl shelf. For a moment she appeared to be bleeding from the mouth. But as his eyes adjusted, Eddie realized that Clara had smeared her face with lipstick. She was also making awful moaning sounds, and scattered on the floor were shiny tubes and packages of bright-handled scissors—on special this week for $3.39. One big pink one sticking out of a hip pocket, the other, bulging with lipsticks.

“Clara, wha-what the heck you doing? Don’t do that!”

And where the hell were the damn nurses and aides? The woman’s nuts.

And she smells. And her feet and legs are all muddy, as if she’d spent the night in the woods. And she’s making a damn mess of the place.

But Clara was lost in smearing herself and groaning, her eyes rolling like she couldn’t get them to focus anywhere. God, this is horrible.

At the far end of the aisle Eddie spotted a young mother and her two young kids.

“Stop that, Clara!” Eddie shouted, thinking he’d have to page for the aides, get Allison or one of the older sales assistants to deal with her because this was out of hand, and he didn’t want to touch the woman. She was having some kind of loony fit.

Suddenly Clara noticed Eddie. Her eyes saucered and Eddie felt something jagged shoot out from them.

“Donny Doh, tsee-tsee go.”

“What’s that?”

“Donny Doh, tsee-tsee go,” she cawed again and again and again until she was screaming and her huge red face was contorted, and her bright raw mouth kept spitting at him: “Donny Doh, tsee-tsee go.”

Shit! I don’t need this. “Clara, stop. It’s okay. Everything’s going to be okay.”

The mother at the top of the aisle grabbed her kids and scurried off the other way.

Where the hell are the aides?

Hearing all the commotion, Audrey, one of the older customer assistants, came hustling down the aisle. “Oh, my god.”

“Donny Doh, Donny Doh, tsee-tsee go, tsee-tsee go.”

Clara paid no attention to Audrey coming up from behind. Her face was a huge red melon, and her eyes bulged so much Eddie was half certain they’d pop out of her skull. She looked positively possessed. “Clara, stop it!”

But Clara did not stop and began to rub herself, smearing lipstick on her dress and filling the aisle with those awful groans.

“Call 911,” Eddie barked to Audry. “Go!” Then to Clara: “Clara, stop it! Stop it!”

“Tsee-tsee go!”

Eddie reached his hand toward Clara in a desperate attempt to calm her down when he heard more shouting behind him—customers, other workers, maybe the nurse and aides, he thought.

As Eddie turned to check, he saw out of the corner of his eye a flash of pink as Clara lunged at him still screaming that refrain—that hideous screechy baby-talk phrase that he would take to his grave as she buried the pointy blade of the scissors in his neck.

There was yelling and commotion, but for a long gurgling moment Eddie tried to process that he had been spiked in the throat with a $3.39 pair of scissors with pink handles by a seventy-something-year-old Alzheimer’s patient with her face smeared with Cover Girl Rose Blush and screaming nonsense syllables at him.

Eddie slipped to his knees while faces swirled in his vision and shouting clogged his head. He pressed his hand to his neck and felt the scissors and sticky warm blood seeping through his fingers—and the last he remembered was being lowered to the floor and the overhead panels of cool fluorescent lights dimming into a soft furry blur as his life pulsed out of his jugular vein.

“Donny Doh, tsee-tsee go.”

4

JACK SLEPT THROUGH THE NEXT TWO nights and days without change.

Beth did not leave the Cape Cod Medical Center until they told her he had been stabilized and that he was ready to be moved to the intensive care unit of Boston’s Massachusetts General Hospital. Because she could not ride in the helicopter, Beth drove, stopping at home in Carleton to change and to update Vince Hammond. Once again he offered to accompany her, but she declined. Jack would not want anyone to see him in such a hideous state.

While they prepped Jack, Beth waited in the lobby of the ICU. Forty hours had passed since that awful call; yet she was still in a state of disbelief. Aimlessly she thumbed through the magazines and newspapers. The headlines of the Boston Globe were about the war in Iraq, another suicide bombing in Israel, a shooting in Dorchester. The usual horrors. But at the bottom of the front page her eye caught the headline, “Nursing Home Resident Arrested for Murder.” The story went on to say that yesterday a seventy-six-year-old woman had fatally attacked the floor manager of a local CVS with a pair of scissors. Witnesses reported that the woman had acted strangely; and when the store manager went to investigate, the woman plunged a scissors blade into his carotid artery. “It doesn’t make sense,” reported Captain Steven Menard of the Manchester Police Department. “Clara Devine was a docile old lady.”

Nothing makes sense, Beth thought, and put the newspaper down. After nearly an hour, Nurse Laura Maffeo came out to announce that she could go in now. “How is he?” Beth asked.

“He’s still asleep but stable.” The nurse led Beth to a room down the hall. Jack was suspended in a contraption that looked like a medieval torture device in chrome, his body sandwiched between two platforms that were attached to a large circular frame resembling a giant hamster wheel. One of the two nurses hit a button and the structure—what the nurse later called a Circo-electric bed—rotated Jack a few degrees so he was faceup.

“It’s so we can dress him front and back without moving him.”

Although Beth had last seen him only eighteen hours ago, his appearance this morning was nonetheless shocking—still bloated, lashed with fat red and purple welts, and basted all over his torso and limbs with a thick white ointment. His eyes were still taped and he was hooked up to half a dozen electronic monitors, drip bags, catheters, IVs, and an ICP plug taped to his skull. He was still on a ventilator, which snapped and hissed in persistent rhythm as his chest rose and fell, as if he were playing some strange wind instrument. But in a reverse illusion it appeared as if the machine were playing him—filling the bag of Jack as if he were some kind of inflatable Michelin Man.

“Most of his vital signs are stable,” the nurse said. “His heart is strong. His liver and kidneys are functioning well. We’ve given him medication to keep his blood pressure at an appropriate level.”

A woman in white entered the room and introduced herself as Dr. Vivian Heller, a neurologist. She was tall and lean with thick red hair pulled back and large dark eyes. “Mrs. Koryan, I’m very sorry about your husband’s condition, but we are monitoring him and thus far he’s fairly stable. The Woods Hole people have identified the jellyfish as a creature native to the Caribbean, and they’re on line with specialists in Jamaica. The tox screening is still ongoing, but they haven’t yet fully identified the agents, although they’re reporting unusual peaks on gas chromatography, and the lab is trying to isolate the chemical structure.”

Beth looked at her helplessly. “I don’t know what you’re telling me.”

“Just that there’s an odd neurotropic signature we’ve not seen before. But it’s conceivable that it will be out of his system by the time it’s identified. In the meantime, we’re monitoring his vital organs and assessing any damage.”

“Will he be … Does that mean there’s damage?” She could barely word her questions.

“He was without oxygen for some time, we think, but there’s no way to tell if there are any effects. There was initial cerebral bleeding, but that’s stopped, and the ICP is down to normal.”

All the technical jargon was fuzzing Beth’s mind. She looked down at Jack. “Why doesn’t he wake up?”

“Because he experienced major trauma to his neurological system. And we don’t know what the effects are. We just have to wait.”

“But how long?”

“It may take another few days before he comes out of it. But so far he’s not responded to commands or to stimuli. But that’s not unusual given the trauma.”

“How long will he have to have the ventilator?”

“Until we’re certain he can breathe on his own.”

The moment was interrupted by a call on the telephone, and Nurse Maffeo took it. “There’s a Vince Hammond who wants to visit.”

Beth nodded in relief. “He’s a friend.”

A minute later he walked into the room. Vince Hammond was a big man, about six-one with an athletic frame from years of working out at gyms with Jack. But as he laid eyes on Jack, he seemed to shrink in on himself. “Jesus!” he whispered, his eyes filling up. “What’s the prognosis?”

Dr. Heller repeated what she had told Beth. “In a few days the swelling will go down and the sores will begin to fade.”

Vince shook his head in disbelief that this was his old pal and partner who in less than a month was supposed to be popping champagne at the grand opening of Yesterdays. “How long do you expect him to remain unconscious?”

“As I explained to Mrs. Koryan, it’s hard to tell. With cases of coma caused by a near-drowning or toxic shock, there is a seventy-two-hour window in which we begin to see responses to stimuli. We’re keeping a close watch.” Heller checked her watch.

“Uh-huh,” Vince said, and put his arm around Beth’s shoulder.

Beth nodded in autoreflex to the doctor. But the word “coma” cracked through her mind like an electric arc.

THE CAFETERIA AT MASS GENERAL WAS located three floors below. It was midafternoon, and the place had only a few people scattered at the tables. Vince and Beth took a small table along the back wall.

“I’m scared,” Beth said, putting her hand out to Vince. He took it in both of his. And it occurred to her that the last time they had held hands like this was when Vince came to their house to announce that he and Veronica were separating. Now it was Jack near death.

“Of course you are. Me, too. What the hell was he doing out there?”

“The anniversary of his mother’s death. You believe that? Thirty years ago she gets lost in a boat accident, and he goes out there to commemorate it.” She shook her head. “He’s got this thing about his mother. He doesn’t even remember her, for God’s sake. It was stupid, going out there alone with a storm coming. Now he’s in a coma.”

“He could still wake up any time now. The doctor said so herself.”

“But what if he doesn’t? What am I going to do? And what about you and the restaurant? I don’t believe this is happening.” She began to cry again.

He squeezed her hand. “Come on, come on, hang in there.”

“It’s my fault he went. We had a fight, a dumb fight. Ever since I lost the baby, he convinced himself we weren’t going to have kids, that he’d never be a father. That got to him, because he wanted a big family. I don’t know.”

Vince nodded and let her continue.

“He wanted me to go out there with him, but I didn’t want to. So he got mad and went off in a huff.” She wiped her eyes. “Jellyfish. You believe it?”

“Did you talk about adoption?”

“He wasn’t interested. The thing is that we had other problems. Things weren’t right between us … I was thinking of leaving him.”

“Maybe we should change the subject.”

“I didn’t mean to make you uncomfortable. It’s just if he doesn’t make it, I never get to say I’m sorry.”

“He’s going to make it. And when he does, you can say you’re sorry all you want.”

She looked at Vince and nodded, struggling against dark sensations roiling just beneath the surface—sensations that she wanted so much to get out. But she couldn’t. Nor could she find the right words. And she hated herself. Besides, how could Vince understand when she herself didn’t—that when the doctors told her that Jack might not make it, her immediate reaction was relief?

5

IT WAS A LITTLE AFTER EIGHT on Saturday morning when the drilling ring of the doorbell startled René awake. Silky, her black-and-white cat, curled around her feet as René padded to the window. In her driveway was a Cobbsville, N.H., police car.

She threw on a bathrobe, made a fast gargle of mouthwash, and went down to the front door. A large man of about forty smiled and introduced himself as Officer Steven Menard of the Manchester P.D., Homicide Division. He was dressed in a navy blue sportcoat over a blue work shirt and chinos. “René Ballard?”

“Yes.”

He flashed his badge. “Sorry to bother you, but we’re investigating the murder of Edward Zuchowsky at the CVS yesterday. Are you familiar with the case?”

“No. What’s the name?”

“Edward Zuchowsky.”

“I’m sorry, but I’ve never heard of him.”

“Okay, but I’m wondering if I can come in to ask you a few questions.”

“Oh, of course.” René opened the door and Silky dashed out as the officer entered. She led him into the living room, where Menard settled on the couch.

From a folder he handed her an enlarged photograph of a man smiling and holding a pool stick in what looked like a basement rec room. “Edward Zuchowsky. He was assistant manager of the Cobbsville CVS.”

René studied the picture and shook her head. “Sorry, but I don’t recognize him.”

The officer nodded and returned the photo to the folder. “Okay, then does the name Clara Devine mean anything to you?”

“Clara Devine?” For the last two months René had been working as a consulting pharmacist who monitored the medication of nearly six hundred nursing home patients in facilities throughout southern New Hamsphire and eastern Massachusetts. At the present time most were still names attached to folders. The officer showed her the woman’s photograph—a wide-faced elderly woman with flat dark eyes.

He checked his clipboard. “She was living at the Broadview Nursing Home.”

“That’s one of my homes.” Clara Devine. The name did not register in René’s memory. “I’ll have to check my records. I’m still new at this.” She made a nervous smile, embarrassed that she couldn’t place a patient’s name. “Is there a problem?”

“She’s been arrested for Mr. Zuchowsky’s murder.”

“What?”

“She stabbed him in the neck with a pair of scissors at the CVS on Everett.”

“My God, that’s terrible. Are you sure it’s the same woman? I mean, nearly all of my patients are elderly and suffering from dementia.”

“There were several witnesses, plus, she was caught on security cameras.”

“That’s incredible.” René got up and got her laptop from the other room. In it were the medical records, bios, and pharmaceutical charts on her patients. She set the machine up on a table and began a search. “I’m very sorry about the young man, but I find it hard to believe that someone like her could have done this.” She scrolled her files.

“You’re not alone. So what’s your professional connection to Broadview?”

“I’m a consultant pharmacist for CommCare.”

“What’s that?”

“CommunityCare. It’s a pharmacy that provides medications to patients at nursing homes and rehabilitation centers. It’s a federal regulation that a pharmacist reviews all patients’ charts. And that’s what I do—visit nursing homes once or twice a month to review charts and look for possible medication-related problems. If problems are seen, I’ll make recommendations for changes to the patient’s doctor.”

“Interesting. And what if the doctor doesn’t agree with your recommendations?”

“She or he has that right, but they’re obligated to respond to the recommendation in order to comply with federal regulations.”

“Uh-huh. So how well do you get to know the patients personally?”

“Well, I mostly get my information about them from their medical records and talking with the nursing home staff. But I’m getting to know some of them.”

“And when was the last time you visited Broadview?”

“I guess about three weeks ago.”

“And you’re saying you didn’t know the perpetrator.”

Perpetrator. It was hard to think of that elderly woman in the photo as a perpetrator—a term she associated with thuggy males in T-shirts. “I don’t know her.”

“But she’s one of your patients.” It sounded like an accusation.

“She’s on my list. Officer, you say this happened in the CVS. Where were the nurse and aides at the time? When patients go on outings, they’re heavily chaperoned.”

Menard looked up at her. “She was alone.”

“Alone? How could she be alone?”

“There were no staffers from the home with her.”

“But residents never leave the ward without staffers. How did she get there? How did she leave the home?”

“That’s what we’d like to know.”

René’s mouth made an O of comprehension. “You mean she eloped, she escaped?”

“Our guess.”

“But … that’s impossible.”

“Well, that’s what happened.” Menard flipped a few pages on the clipboard. “I’m wondering if you could check your records. According to the Broadview nursing staff, Mrs. Devine was not taking any antipsychotic medications. Is that your understanding?”

René scrolled through Clara Devine’s file. The woman had mild heart problems, high blood pressure, high cholesterol, and had been diagnosed with depression and moderate dementia. She had been admitted to Broadview by her sister a year ago at age seventy-two. The sister, Cassandra Gould from Dudley, N.H., was the listed sole survivor. Clara was also designated a ward of the state, which meant that her sister had not been willing to assume power of attorney. “As you know, without a search warrant I’m bound by patient confidentiality not to reveal details, including the medications she was on.”

“Of course, but that can be taken care of if something comes up.” And he gave her a look that said, Don’t play Polly Protocol, lady.

They both knew that he could have the records subpoenaed; but that would take time, and he wanted to know if the woman was on any medications that might have made her nutty. She scrolled down the list: Atorvastatin for high cholesterol, hydrochlorothiazide, Atenolol, Captopril, and a baby aspirin daily for her heart disease and high blood pressure; paroxetine for depression; donepezil for dementia. It was a pretty standard menu of medications for an elderly nursing home patient. And while some of the drugs had the potential to affect mental status, none could account for a volcanic urge to kill. According to her medication profile, Clara Devine had been on these same medications at the same doses for months, also decreasing the likelihood that any had caused her sudden homicidal behavior. “Looks like the standard laundry list for elderly patients.”

“No smoking gun?”

“No smoking gun.” Then she moved ahead toward the present. Suddenly René hit a blank. She went back and double-checked. “That’s odd,” she said.

“What’s odd?”

Clara Devine did not appear on René’s patient census for the last six months. And all of the woman’s medication orders were from last February or earlier. René felt Menard’s eyes scratch at her for an explanation. If she overreacted, he’d want to know how she could have a half-year hole in her records; then he’d go to Broadview to complain, and in no time her superiors at CommCare would wonder why they hired her. “A little computer glitch. Okay, here we are,” she pretended. “From what I can tell, she hadn’t been on any kinds of meds that would cause such behavior.”

“Any record of psychotic behavior on the ward or before?”

René checked the nurses’ notes to the six-month dead-end, feeling her face flush, and trying not to let on that she somehow had screwed up. “No. In fact, she was pretty well behaved.” Then some nurse’s notes made her smile. “Apparently she came out with some funny lyrics.” And she read: “‘Roses are red, violets are blue, look at my titties and say I do! ‘Had us laughing out loud,’ one nurse wrote. She also once announced that she was having a baby. Doesn’t sound like someone who’d attack a perfect stranger.”

“No, but she sounds delusional.”

“Many dementia patients are, but that doesn’t mean violent.”

Menard laid his pen hand on the clipboard. “So what do you think happened, Ms. Ballard?”

“I don’t have a clue.” But she’d go back to the home and double-check the master charts to see what she’d missed—and why there was a six-month blank in her files. She closed her laptop, feeling distracted that something was amiss. She had prided herself on keeping meticulous details, of being able to hold in her head the hundreds of unpronounceable syllables that made up drug indices, the technical details of complex chemical arrangements, their intended effects and side effects. And she had worked to attach names and faces to the reams of data. Yet here she was missing records of a patient who was the epicenter of a murder investigation. “So what happens to her now?”

“Well, she’s been sent to McLean’s for evaluation.”

McLean’s Hospital in Belmont, Massachusetts—part of Harvard Medical School—was one of the top psychiatric hospitals in the nation, and where dangerous patients were evaluated.

Menard got up and headed for the door, stopping by a table with an array of photographs. One of them was a shot of René in her cap and gown posing with her parents and Nick Mavros, her favorite professor at the New England School of Pharmacy. Beside it were pictures of her father, before he got sick. Also one of him as a little boy in a porch rocking chair—an image of him that she adored. Menard picked up a close-up portrait of Silky. “Is this the guy I met earlier?”

“Yes. Silky.” In the picture, the black longhaired tabby with the white nose patch looked like a mobster with a menacing wide-eyed gaze—the kind of photo you’d imagine hanging in a mouse post office stamped WANTED. At the moment he was out back thinking about chipmunks.

“For the record, are you living alone?”

The question sent a little ripple of unease through her. Until a few months ago, she had been living in Boston with Todd and planning a June marriage—June 26, to be exact. Then after nearly two years of cohabitation—bridal gown purchase, Mr. Tux reservations, seat upgrades on Delta flights to Maui, seaside view at the Kapalua Bay Hotel, honeymoon-special sunset-mai-tai-catamaran cruise, and one hundred and twenty unused “René and Todd” invitations—dear old Todd, in a last-moment panic, decided he couldn’t go through with it and moved back to New Jersey, where he took up with his high school girlfriend.

If the jilting hadn’t been so painful, it would’ve been comic. In her twenty-nine years, René had never met or heard of any woman or man actually being jilted. Todd’s announcement raised a lot of screaming and accusations, but he still left. And after three months of wound licking, René quit her job at the local pharmacy and with the help of Nick Mavros accepted an offer with CommCare that brought her here to Dover Falls where she now lived in a converted barn, stripped down to bare happiness. Since then, René had resolved that she didn’t need Todd—that she would embrace the split as an opportunity to find new traction in life and a chance to become a part of something good—something bigger than herself, the welfare of others. “Yes, I live alone.”

He thanked her and handed her his card. “Just in case you think of anything that might explain what set her off or how she escaped.”

“I’m sure you’ve already checked, but maybe the security door malfunctioned?”

“We checked. It’s working just fine.”

“And no family member signed her out.”

“Nothing like that. And she didn’t put a chair through the window.”

And there’s a bloody six-month hole I have to account for.

6

THE STORY WAS AT THE BOTTOM of the front page. “Elderly Nursing Home Patient Slays Cobbsville CVS Manager.” It didn’t make sense.

René bought the paper and headed to Broadview Nursing Home, an attractive complex nestled in a forest of oaks and resembling a tiny New England village. The Alzheimer’s disease unit was in the newly redone two-story wing at the rear. She parked her Honda and went inside where she waved hello to the receptionist. But instantly she sensed tension like the hush before a thunderstorm. Nurses and staff bounced off each other in trailing whispers around the lobby.

René made her way to the Alzheimer’s disease unit and with a strange apprehension entered the four-digit code on the keypad. To the sound of the electric bolt release, the door opened onto an intersection of two corridors. Along one corridor some patients sat in wheelchairs staring straight ahead. Others shuffled along the walls. Down the other she spotted Carter Lutz, Broadview’s medical director, talking to a tall black-haired man in a monogrammed sportcoat. When they spotted her, they peeled off the walls and into a small office and closed the door.

Unit Nurse Alice Gordon was at the desk. “Hey, hon, thought Saturday was your day off.”

“It was. The police just left my place.”

Alice’s smile played itself in reverse. “Then you heard,” she whispered. “They were all over here last night.”

“What happened?”

Alice just shrugged and looked away. “One of those things.”

Bonnie, an assistant nurse, came by rolling the meds cart. She looked at René knowingly and shook her head. A few patients milled about the halls. One man was pushing a woman in a wheelchair, a few others sat in chairs against the wall, some asleep, others chattering to the air. René ducked into the small files room. The large three-ring folder for Clara Devine was missing. “Where’s Clara’s folder?”

Something rippled across Alice’s face. “Well, actually it’s with Dr. Lutz.”

“So what do we know?”

“About what?”

“About how she got out and killed a guy at the CVS.”

Alice glanced at the newspaper René handed her and shook her head. “Unbelievable.” Then she turned her face to her paperwork again.

“What’s this ‘Donny Doh tsee-tsee go’ stuff the paper reported?”

“One of her rhymes, I guess. She had a thing for them.”

“Was this something you’ve heard before?”

Alice thought a moment. “I don’t know.” Then she flashed her a sharp look. “You playing Nancy Drew or something?”

“Just trying to get some answers. It’s not the kind of publicity the home needs.”

“I’ll say.” Alice dropped her eyes to her paperwork again.

“Alice, why do I have this feeling that something’s going on that I don’t know about?”

Alice straightened up. “Sorry, Sweetie. It’s that everybody’s pretty upset.”

“Six months of her records are missing from my files.”

“That right?” Alice said, frowning. “How did you do that?”

Christ! She was turning it on her. “Well, I’m not sure I did.”

Suddenly Alice checked her watch. “Oops. Mr. Martinetti needs his meds.”

“Alice, I double-checked my computer, and there are no entries for Clara Devine since February. And I didn’t delete anything because they’re not on my backup disks.”

“Beats me.”

René felt a blister of anger rise as Alice tried to shake her off. “Also, I don’t remember seeing her name, which makes me wonder if her name was on the monthly patient census lists I’d been given.”

Alice looked at her without expression. “What can I tell you?”

Just then, Bonnie came back down the hall with the drug cart. She looked at Alice, who held her glance long enough for René to sense something pass between them. Then she continued down the hall. Alice was useless, so René caught up to Bonnie. “Wait a second.” Bonnie stopped and René opened the file drawer containing each patient’s meds and files. René started going through them until she found Clara Devine’s name.

“Look, I’ve gotta go,” Bonnie said, and tried to move away.

Alice came over. “Is there a problem?”

René let Bonnie go but not before she caught the name of Clara’s physician. “Well, I’m really not sure. But according to my records Clara’s primary care doc is Barry Colette, but those med sheets were signed by a Dr. Jordan Carr.”

Alice’s face clouded over. “Well, he’s taken over for Dr. Colette.” She started away.

But before she did, René asked, “So who’s this Dr. Jordan Carr?”

Alice nodded toward the exit. “He just left.”

CARTER LUTZ’S OFFICE WAS ON THE first floor near the reception desk. Just as René rounded the corner, she spotted him leaving his office. “Dr. Lutz, can I speak with you for a moment?”

He looked at her, trying to place her face.

“René Ballard, with CommCare.”

“Oh, yes, of course. The new girl.”

“Yes.” The new girl. And in his tone she heard: The girl who doesn’t know any better.

Lutz sneered down at her for an explanation for why she was holding him up. He was a partridge-shaped man in his sixties with an ill-fitting toupee, a slick chocolate brown thing that hung on his brow in oily spikes but which barely covered the fuzzy gray growing around his ears. “Not right now.”

“Well, I’m very sorry, but it’s kind of important.”

His nostrils flared at her like a horse’s. “I’m in the middle of this police thing, which I’m sure you heard about.”

“Well, it’s about the police thing that I’d like to talk to you. Please, it’ll only take a minute.” He glared at her, then headed back into his office and closed the door. He checked his watch, then looked at her with sour impatience. Don’t let him rattle you, she told herself. Your job is on the line here, kiddo. “I believe that the medical records for Clara Devine are with you.”

“Is that a problem?”

“Well, as you know, my job is to check the record of each patient in the home, and I don’t have entries for Clara Devine.”

“Sounds more like your problem than ours.”

“Maybe, which is why I’d like to see her records.”

“I can assure you that nothing’s amiss.”

“But I don’t know that unless I see her folder.” And she forced a pleasant new-girl smile, hoping to soften his resolve.

“Miss Ballard, you’re an employee of the pharmacy, not this home or its corporation. I will not stand you interrogating me.”

“I’m sorry, Dr. Lutz, but I’m bound by federal regulations.” She tried to maintain a tone of politeness, but his dismissal of her was irritating. It was also unprofessional. And she wondered if he’d dismiss one of the older staffers or male doctors like this.

“Maybe you just neglected to copy them properly.”

“That’s entirely possible, but I won’t know that until I see her charts.”

He made a move to usher her out the door, but she didn’t budge. “Dr. Carvahlo is my supervisor at CommCare. I’m sure he would like to hear your explanation. May I use your telephone?”

“No, you may not. The charts are being photocopied in the event they’re subpoenaed by the police. You can see them when they’re returned.”

“Thank you. Oh, another thing: Somebody other than her primary care physician is signing off on her sheets.”

The skin of his face appeared to tighten. “Ms. Ballard, why at a time like this are you bothering me with trivial details?” And he pressed her outside the office and closed the door. “Dr. Carr is her primary care physician. Good day.”

She watched him clop out the front door and into the parking lot, thinking that maybe she was being trivial, maybe even petty, the kind of things that drove Todd away.

“You’re such a details person, so damn anal. I can’t even leave a fucking cup in the sink without you raising a flag.”

After recomposing herself, she returned to the reception desk and asked the operator to page Dr. Carr. Trivial be damned! she thought. Minutiae were what they paid her for. When the phone rang, the secretary said that Dr. Carr had left for the day. She jotted down his office number. “By the way, this is for you,” and she handed René a reminder about the groundbreaking ceremony on Monday at Morningside Manor, a nursing home in Smithfield. She stuffed the flyer into her bag, thinking it would be a good opportunity to network.

René left the building and headed for her car, where she called Dr. Carr’s number from her cell phone. With the answering service she left her name and number, identifying herself. Just as she started the car, something shot through her brain like a dark premonition.

SHE WENT BACK INSIDE AND INTO the AD unit again. Bonnie was alone at the desk and paid her no attention.

René began at the far end of the west corridor and moved toward the nurses’ station, then down the north corridor. Most of the doors were left open, and those that were closed she tapped first, then entered. She went upstairs and followed the same route. At the nurse’s station she bumped into Alice. “You’re back.” It sounded like a reprimand.

“Yes.” She didn’t explain her return, but she could feel Alice’s eyes bore through the back of her head as she cut into the activities room, where patients sat around tables doing puzzles or pasting pictures to colored paper. She stopped here and there to compliment some of them.

“You’re beautiful,” one woman said to her. And she stuck the tip of her tongue out between her teeth the way a child does. She was doing a puzzle of a kitten. “What’s your name?”

“My name is René. And you’re beautiful, too.” The woman’s face was soft and powdery, like risen bread dough. Her eyes were watery blue and she wore rimless glasses. She looked like an aged nun. Her hands were dappled with liver spots, but they worked the puzzle pieces with methodical care in search of their mates.

“I’m going to pray to the Virgin Mary for you.”

“Thank you,” René said. “And what’s your name so I can say a prayer for you?”

“Ma-ry Cur-ley,” she said in a singsong voice. Then she wrinkled her face and stuck her tongue out again like a child.

René felt a small shock. There was no Mary Curley on her census. This woman officially was not on the ward. “I’m sorry, what is your name?”

“Ma-ry Cur-ley, and I have a dog named Jello.”

“Jello. What a wonderful name.” René felt as if she had entered an alternate universe.

Mary took René’s hand and made an odd tongue-sucking sound. Then she said. “I have a dog named Jello. And he’s out back asleep in his house.”

“Well, I’ll be sure not to wake him.” And she patted Mary on the shoulder.

On the way out of the dayroom René passed a room with its door open. Inside was a male patient sitting by the window wearing a khaki U.S. army cap with insignia. She stepped inside. The man looked up at her blankly.

“Hi, my name is René.”

The man said nothing.

“I like your hat.” The man still did not respond, but he kept staring at her. “And what is your name?”

Still no answer. On the bureau behind him were several framed photographs with labels. One colored shot, presumably of his wife and daughter, was labeled “Marie and Christine.” Another showed the same woman Christine with a young boy named “Steven,” probably the man’s grandson. Beside them was a large blowup in black-and-white showing two young men posing in army fatigues and helmets. Each was holding a weapon. The label under the photo read: “Louis Martinetti and Sam Swenson, 187th Airborne Regimental Combat Team, Hill 329, Sukchon, Korea, October 1950.” A gold star was pasted under one young man—a black-haired slender kid with the same eyes as the elderly man she was addressing.

“Are you Louis Martinetti?”

He looked at her with shock. “You’re Fuzzy Swenson’s sister.”

“Who?”

“Fuzzy Swenson.”

René looked back at the black-and-white blowup. “There’s a Sam Swenson in the photograph of you. Is that who you mean?”

He squinted at her to sharpen his focus. “You his sister, um … Rita?”

René stepped closer so he could see her better. “No, my name is René Ballard. I’m the consulting pharmacist here.” She wasn’t sure he understood but she put out her hand.

He did not take her hand but stared at her until he was convinced that she was not who he thought. “Just as well … what they did to him.” He winced as something sharp passed through his mind.

She would have liked to talk, curious about Fuzzy Swenson and hoping to bring Louis out more. But Alice was standing in the doorway staring at her through hard eyes.

“Nice to meet you, Mr. Martinetti,” René said. As she turned to leave, she noticed that on the bed was an army uniform neatly pressed and still on hangers. She stepped out of the room and looked at Alice who just glared at her. René flashed her a smile and said, “Well, see you tomorrow.”

Alice did not respond, but René could still feel the press of her gaze as she made her way down the hall to the exit.

She passed down the stairs and out into the parking lot to her car. According to the road atlas, Dudley, New Hampshire, was about an hour north of here. She had the day off and it was a beautiful late August morning and maybe during the ride things might start making sense to her.

Especially why she had counted four more patients on the Alzheimer’s disease unit than were listed on her census.

7

“MRS. CASSANDRA GOULD? MY NAME IS RENÉ Ballard. I called you from the road.”

“Yes, yes, I remember,” the woman said through the screen door. “I’m not the one with dementia. At least not yet. Come in, please.”

René followed her into a living room, which was furnished in floral Queen Anne wing chairs and sofa.

“And it’s Cassie,” the woman demanded. “Who in their right mind would want to be named after a woman who prophesied doom while nobody listened.” She gestured for René to sit in a chair. “You’re here because of what my sister did, no doubt, so you’ll probably need a coffee, unless you prefer something stronger.”

“No, water would be fine, thank you.”

“Well, I’m having coffee. The only way to get my heart going in the morning. Still want the water?”

“I’ve already had three cups. Any more and I’ll need a straitjacket.”

Cassie smiled. “A pharmacist with a sense of humor. Now there’s a rare duck.” And she left for the drinks.

Rare duck. C’est moi, she thought, the new girl, and now Ms. Popularity at your local nursing home. René strolled to the back wall, which consisted of built-in shelves full of books. Clearly Mrs. Gould was a well-read woman. Most of the books were hardback novels, including classics—Tolstoi, Steinbeck, Dickens, the Brontë sisters, Iris Murdoch—as well as Greek and Shakespearean plays.

On the small fireplace mantel were framed photos of children, perhaps grandchildren. One was a formal portrait of Cassie and a man, perhaps her husband. Also one of Cassie and, she guessed, Clara, from the resemblance, taken when they were much younger—probably in their twenties. Cassie was dressed in a high-fashion dress and hat and Clara in a skirt and polo shirt; Clara was holding a golf club. They were both strikingly handsome, Clara a bit shorter and less willowy than her sister, but with a round, elfin face that could barely disguise high spirits. She was caught midlaugh, as if somebody had just told a joke.

“She had just won a club tournament,” Cassie said, entering the room with a tray. “She was quite the sportswoman in her day.” She set the tray down and handed René a tall glass of ice water with a slice of lemon.

“That’s Walt, my third husband. Clara never married, but I made up for that. Buried three of them. Walt died six years ago, and that’s when the word got out I was a high-risk bride.” She smiled and sat opposite René. “Shortly after that my sister moved in. And now she’s up for murder.” She took a sip of coffee. “On second thought, maybe my parents had foresight when they named me.”

René smiled. The woman’s directness was refreshing. “So the police were here.”

“No, they called with the details. I’m sure they’ll be dropping by with a lot of questions. They tell me she’s being evaluated at McLean Hospital in Belmont, Massachusetts. But I can’t visit her for a while.”

Cassie was remarkably sharp of mind and still attractive for a woman of eighty—tall and broad-shouldered, although now rounded and padded by time. She had a regal face with wide cheekbones and arching, slightly supercilious dark brows that were enhanced by round, dark wire-framed glasses. Her brown eyes were large and heavily lidded and the skin around them was papery, but they held a person with a fierce intensity. Her hair was gray and pulled back in a bun. She wore no makeup. She was dressed in a red pullover, jeans, and white tennis shoes. Perhaps she was getting ready for a morning walk.

“On the phone you said you had some questions about what might have led up to her assault on that unfortunate young man.”

René handed her a photocopy of the murder story from the Manchester Union-Leader. “I take it you’ve not seen this?”

Cassie read the article, at one point wincing at something. When she finished, she laid the article on the table and looked at René without a word. René was sure the police had spelled out the details of the killing, but something in the woman’s manner set off uneasiness in her, as if the written words had confirmed the enormity of her sister’s act. “You no doubt know your sister better than anyone else. And I know you visited her at Broadview. I’m just wondering if you saw anything that might explain her behavior.”

“My sister was a high-energy woman—a fighter, as you can see,” and she nodded to a cabinet full of golfing trophies. “She had a temper and would lash out if she felt wronged. But my sister was not a violent woman or capable of murder.”

“And as far as you know Edward Zuchowsky was a perfect stranger to her.”

“Yes, besides, how could she know him, being stuck in the nursing home?”

“What’s baffling is that she wasn’t on any medications that would have led to such psychotic behavior.”

Cassie took a sip of her coffee. “But she was demented.”

“True, and demented people do have fits of violence, but there are always signs of that, and from her records Clara never harmed another patient or staff member.”

Cassie raised her cup to her face again, her eyes locked on René’s so intently that for a second René felt their heat. Then the woman looked down and the moment passed.

“Did you notice any changes in Clara while in the home—any alterations in her behavior from visit to visit?”

“Frankly, I’m embarrassed to admit it, but I haven’t visited my sister in several months. My eyesight is poor and I don’t trust myself on long drives. And to be honest, watching her bump down the staircase is very depressing, as you can imagine.”

Bump down the staircase. René nodded silently. Depressing doesn’t come close.

“As I said, she moved in with me after Walter died. And for a while it was fine. Then she began to have memory problems. We had her diagnosed, and within a year she began to get worse—confused, disoriented. She was forgetting things from one moment to the next. It was like watching her being peeled away like an onion. God, what a cruel disease.”

“Yes, it is.”

“When it became too much for me to handle, even with visiting nurses and day care, we found Broadview. I must confess that the early visits were stressful. I love my sister, but seeing her disappear like that took its toll. She would flicker in and out, asking me the same questions over and over again until I felt my own mind begin to go. Of course, the driving became an issue. So I stopped visiting her, which didn’t make any difference to her by then.”

“The last time you saw her, how did she seem in terms of mental abilities?”

“Half there. She’d sit around the activities table and try to fill in the blanks. The aide would read a familiar adage for patients to fill in the rest: ‘You can’t have your cake and …’ pause. Or’Nothing ventured, nothing …’ pause. ‘A stitch in time saves …’ et cetera.

“Clara would struggle to beat others to the answers. Sadly, she was a book person with a master’s in history and a doctorate in education. A former high school principal. Most of these books are hers. The last time I visited her she couldn’t read the name on the box of chocolates I’d brought.

“I have a good dozen ailments, not the least of which is degenerative arthritis of the lower back—which sounds much kinder in Latin. But I don’t know what happened in the genetic throw of the dice that caused her to start blanking out while I’m still festering with useless memories. There are times I envy her. You reach a certain point in life when even your recollections begin to feel made-up. I think Mark Twain said it best—something like, ‘I can’t remember anything but the things that never happened.’”

“I understand.”

Cassie took a sip of coffee. “No, you don’t understand.”

René wasn’t certain what she meant but felt as if she were engaged in some odd sparring match. “No, I can understand the anxiety of seeing her fade. It’s horrible, I know, and there’s nothing to feel guilty about.” René did all she could not to stumble on her words.

“It’s different. It’s part of your job.”

“My father died of Alzheimer’s.” The words jumped out before René could catch them.

Nothing to feel guilty about. Not true, René thought. She had felt guilty for getting angry with her father when he got confused or abusive; guilty for not being able to give him comfort against the awareness that he was demented and getting worse and that he would never go home again; guilty for losing her patience with him, for not knowing how to act when she visited the nursing home, for not knowing what to say when he wasn’t responding or was unaware of her presence, for hating the fog in his eyes and the slack-jawed mouth as he descended farther into the gloom. Guilty for breaking down in his presence after he’d confused her for his dead wife; when he begged her to remove his restraints and they wouldn’t let her; when in a fit of rage he swung at her cursing; when it got so bad she no longer wanted to visit him. She felt guilty for trying to get on with her life. For allowing the nursing home staff to avoid taking extraordinary measures when he would no longer eat. For letting him die.

The woman looked at her for a moment as if reading her thoughts. “Then I’m sorry for you. I suppose the only consolation is that the disease blots out the victim’s awareness of one’s offenses.”

“Yes.” It also has a shared effect on the caregiver: It eventually renders you numb and ineffectual. And you at last come to realize that nothing you can do will stop the deterioration. Yet, ironically, you can’t help but feel that you could have done more. That you failed. Yes, a cruel disease.

Cassie glanced at the newspaper story. “We had a fine sisterhood that lasted until we were old ladies. Certainly there was the usual sibling rivalry stuff, but there were enough years between us so that I was more the older sister and confidante than competitor. We would talk all night in bed, laughing, sharing stories, little truths, and secrets. And as trite as it sounds, I recall some of it as if it were yesterday.

“In many ways we were blessed with exceptional parents who were smart and loving and who provided us with a childhood full of laughter and beauty that should have lasted longer than it did, at least until the age when the world begins to dull and harden the child. Unfortunately, that happened much too much sooner than it should for my sister.”

The woman looked away for a moment. “Clara was raped by a neighbor when she was five years old.”

“Oh, how horrible.”

“By a drunken pig of a man who would sit on his back porch and drink beer out of large brown bottles and snort because he had some kind of sinus problem. One day he enticed Clara to come inside because he wanted to show her something. His name was Donald Dobretsky, the man my father lent the lawn mower to, the man whose wife was our mother’s shopping friend. The man we shared Christmas parties and barbecues with.

“He would encourage Clara to recite jingles, silly rhyming things she picked up from radio and TV like ‘You’ll wonder where the yellow went when you brush your teeth with Pepsodent’—way before your time—or ‘Mary, Mary, quite contrary’ or ‘Ding, dong, bell, pussy’s in the well.’

“Or ‘Donny Doh, Donny Doh, tsee-tsee go, tsee-tsee go.’ As clear as it was last evening, I remember her small, frightened voice cutting the warm night air of our room. Donny Doh was the name she had given Mr. Dobretsky. Just one of the many sweet names her magical little word box had created for people she knew.”

“And what’s ‘tsee-tsee go’?” René asked.

Cassie looked at her point-blank and said, “What he stuck in her mouth.”

“My god.”

“It took me a while, but she told me everything. She was still too innocent to know she was being sexually abused but old enough to know that what he made her do was bad. So she never told our parents, and I was too afraid. Besides, back then people didn’t talk about child abuse. The term wasn’t even part of the public lexicon. And if children were abused, nobody talked. And nobody believed kids even if they made such claims. Such things didn’t exist in our nice world of Barton Glen. Today, a little whisper can send a man to jail for life or close down a church.”

“Was it just that once?”

“No, no. And the SOB told her that our parents wouldn’t believe her if she said anything. He was clever not to rape her because that would leave torn tissue. But he left her so deeply scarred that for days she wouldn’t speak or eat and had nightmares. Our parents thought she had meningitis or some brain fever and put her under the care of the family doctor because she was wasting away. Of course, all the tests were negative because it was that monster’s filthy pleasure.”

She was shaking so much that her composure began to fracture. But she took a breath and found her center again. “I tell you this only to explain what’s beneath the layers—a wound that never, ever healed. Whatever it was, something in the encounter with poor Mr. Zuchowsky cut to the quick of that, and she exploded.”

Mrs. Gould closed her eyes for a moment. When she opened them, she seemed recomposed. “Besides, Clara’s nearly gone, so it doesn’t matter that I tell you.”

She suddenly looked very tired and old, as if she were staring into the narrowing corridor of her own last days. René got ready to leave. “What happened to this Donald Dobretsky?”

“Died of old age.”

“I’m sorry to hear that.”

“Me, too. And a perfect stranger paid with his life.”

8

DIED OF OLD AGE.

The phrase stuck in her mind like a thorn—all the way to Rose Hill Cemetery.

Well, my father didn’t die of old age. I let them pull the plug on him.

Rose Hill was located in Paxton, a small town outside of Peterborough, N.H. The place consisted of narrow tree-lined lanes like an arboretum. Since her father’s death, René had been coming here maybe once a month and on special days such as Memorial Day, Father’s Day, or Christmas. This day would have been his eighty-second birthday.

Her mother was also robbed of her golden years, dying of cancer three years before her father, two years after he was diagnosed with Alzheimer’s. She was buried beside him.

René had always been close to her father, but never so much as when he began to fade and especially after Diane died and his dependency fell full-weight on her, his only child. She had made regular visits each week to her parents’ home. She had arranged for visiting nurses, then hospice when her mother’s condition had begun to worsen. After her mother’s death, René moved her father into a long-term-care home, where he rapidly declined into the disease. She cleaned her mother’s headstone and laid down a pot of geraniums, then moved to her father’s.

“Hi, Dad.”

With paper towels she wiped the headstone, a black marble speckled slab that still glistened like glass in the sunshine. She removed some dead leaves and set down the second geranium pot.

THOMAS S. BALLARD BELOVED FATHER AND HUSBAND

She wished they had picked a less generic inscription. Three-quarters of the headstones had the same wording, just change the gender terms. She wished she had selected lyrics of one of his favorite songs—maybe a few bars of “As Time Goes By” or “Let Me Call You Sweetheart” or “Bridge Over Troubled Waters” or a hundred others. But the funeral director had talked her out of it, which made sense, since they’d probably have had to get copyright permission. And wouldn’t that look cute: a footnote with something like “© 1931 Warner Bros. Music Corporation, ASCAP, Music and Words by Herman Hupfeld.” Dad would have appreciated that.

“Well, eight weeks on the job, and I’m caught up in a murder investigation because one of my patients escaped from a locked ward and killed a guy. Half her records are incomplete, there are patients on the ward that shouldn’t be, and everybody’s stonewalling while my head’s on the block. Otherwise, it’s been a great week.”

She finished buffing the stone.

The end was in sight when he began to stop eating, something common with dementia patients. Most of his cognition was gone, but he had had no medical condition and was strong enough physically to shuffle about the ward on a walker or to sit up in a wheelchair. Hoping to stimulate his appetite, the nursing home staff treated him with antidepressants, which worked for a while. But eventually he refused food no matter how much they encouraged him. Sometimes he’d spit it out or he’d keep it in his mouth, not chewing. Or he’d chew it and not swallow, pocketing the mash in his cheeks. Because René was at pharmacy school fifty miles away, she couldn’t visit as often as she wanted—a fact that ate at her heart like acid. But when she did, his mood would perk up and he’d eat a little for her, sometimes recognizing her, sometimes just responding to a smiling face that encouraged him to cooperate. But without her, staff just could not get him to eat.

Eventually the options wore down to two: aggressive invasive measures—tube feeding and IVs—or letting him starve.

Because René was a pharmacy student her father had given her power of attorney. She had discussed the options with her father in the early days of his disease. Emphatically he said he did not want aggressive medical treatment. He did not want to simply hang on with tubes down his throat and wait to become riddled with infections. He did not want to put her through this.

“Promise me this,” he had said, taking her shoulders in his hands. “When I get really bad, you’ll let them do what has to be done to let me go out with dignity, okay? Promise? I don’t want to end up just some gaga thing attached to a diaper.”

She could barely get out a yes.

She told the nursing staff that she knew how her father viewed life and that he wanted it this way. So she signed the papers:

Do Not Resuscitate—DNR

Do Not Intubate—DNI

Do Not Hospitalize—DNH

Some days her recollection of her father was so vivid that she could not accept the fact of his death. And she could still recall that first day as if it were last week, when she realized that her father—former mechanical engineer, a man of extraordinary discipline, a book lover, a good-time piano player and crooner, an avid fisherman, a jokester, and a gentle, loving, fabulous parent—was beginning to bump down the staircase.

And in an instant René was in the backseat of his Lincoln Town Car, listening to him.

“You must remember this, a kiss is just a kiss, a case of do or die. The fundamental things in life as time goes by. Dah DAH dah DAH dah DAH …”

“Come on, Dad, you’re spoiling a great song. For old time’s sake.” It was his birthday, and she was home from college.

“Only if you lead.” He had pulled up to the stop sign at the top of their street.

“Yeah, like you don’t know the words. You could have written them, for God’s sake.” She was hoping he’d kick into an old sing-along as they did on long trips when she was a girl. But for some reason he wasn’t interested. And her mother sat in the passenger seat looking tense. “‘You must remember this, a kiss is just a kiss, a sigh is just a sigh …’”

“Oh, that version,” and he gave her a wink in the rearview mirror.

Her dad was still such a kidder. “You big goof.”

“What time are the reservations?” Diane had asked, her voice devoid of inflection.

Because of traffic, René had arrived late, which probably explained Diane’s mood. Her face was out the window and she dug in her handbag for a cigarette.

“Seven-fifteen.” René tried to ignore Diane’s grimness, especially on her father’s birthday. “Okay, from the top. ‘You must remember this, a kiss is just a kiss …’ Mom, feel free to join in. ‘A sigh is just a sigh …’”

Her father sang along haltingly, as if waiting for René’s prompting.

“‘No matter what the future brings …’ Dad, you’re punking out.”

“He doesn’t want to sing.”

“Yes, he does. Right, Dad?”

“Actually, I’m a little fuzzy on the lyrics,” he said to the mirror.

“How could it be fuzzy? It was your wedding song.” It was also part of their “repertoire”—old Sinatra, Bennett, and Johnny Mercer numbers.

He didn’t respond.

“Right,” Diane said under her breath.

His head jerked and he turned into the northbound lane of 6A. They were heading for the Red Goose, a favorite restaurant near their cottage in East Sandwich. It was a glorious midsummer’s evening with a soft, sultry sea breeze. In spite of a growing uneasiness, René persisted. “Then how about ‘I Remember You’?” She could hear the note of desperation not to let go of their old-time ritual.

“Sorry, Honey. My voice isn’t what it used to be.”

“You’ve got a great voice, Dad.”

Diane snapped her head around and hissed, “He doesn’t want to sing.”

It was as if she had stung René with venom. All she had done was try to lighten the air. Then she saw something in Diane’s eye just before she turned forward again. Something was wrong. Diane muttered under her breath to her father.

“What?”

“Next left.”

“You don’t have to tell me, for chrissake.”

“You passed the street.”

For a split second it occurred to René that her father was joking, that this was one of his elaborate charades to twist Diane’s tail—something he’d do when she was in a bad mood. It was slightly perverse but it always got her laughing. Like when he’d pretend that his leg had fallen asleep and that he’d have to limp to the movie or restaurant, stopping every so often to whack his thigh awake, then suddenly stop limping as if he were one of those miracles at Lourdes and look up to the sky in a gaze of beatific gratification. It would send both of them into laughing jags. Or the time he spent the entire evening speaking like Peter Sellers’s Inspector Clouseau because René was taking French lit. And the more Diane asked him to stop, the more he pretended he didn’t understand English until she cracked up. That was it: One of his routines—playing Daddy Dumb-Dumb.

“Christ!” He hissed and he slammed his hand on the wheel.

René felt her insides clutch. No, something else.

He pulled over to the side to let traffic pass. He had driven by the turnoff. For several seconds he stared through the windshield as silence filled the car like toxic gas.

“What’s wrong?” René could hear the fright in her voice. Ever since her arrival, she had detected a low-grade anxiety—her mother’s nervous distraction, her father’s forced cheer. A horrid thought slashed across her brain: Her mother’s cancer was back. During a regular check-up they had found a spot on her lung. And Dad was so distracted by worry that he got confused on a route he could navigate in his sleep.

“Everything’s fine,” her mother snapped.

“I’m just a little tired, Honey.” When the traffic cleared, he made a U-turn, approached the intersection again, then turned.

“Dad, it’s the other way!”

He slammed on the brakes and nearly collided with an oncoming car. Horns blared as they sat in the intersection, her father looking stunned. “Pull over. Pull over!” her mother shouted. He pulled over, the car facing the opposite way and on the wrong side of 6A. René’s chest was so tight she could barely breathe and her mother was crying. Her father sat staring straight ahead. “I don’t know what I’m doing.”

“What do you mean?”

“I’m getting senile. I forgot how to get there.”

“You’re not getting senile. You’re not.” But she could sense the ugly snout push its way up. “You just got a little confused, people blowing their horns like that. We don’t have to go, if you don’t want to.”

“We’re going,” her mother snarled. “You can turn now.”

Her father checked the road. “What happens when you get old.”

“You’re not old. Seventy-two is not old,” René insisted.

“Straight,” Diane said under her breath. “Straight.”

And her father pulled through the intersection up toward the restaurant.

And in the backseat René uttered a silent prayer. Please, God, no.

Seven years later they buried her father under that stone. By then he had forgotten he had once been a full human being.

René finished cleaning the headstone. “I’m doing better, Dad,” she said. “Making an effort to stay active. Even Nick is after me. ‘You’re too holed-up with your computer.’ ‘You have to end this self-exile,’ he says. ‘Meet a nice guy.’ Well, I’m going to a party tomorrow. Should be some interesting people there besides Nick.”

Birds fluttered overhead and changed direction with a flick. She watched them swirl around and return overhead, then blow away toward the west.

“Remember the time we went fishing off the pier at Scusset Beach? Caught a striper the size of my leg. Missed being a keeper by two inches, but you let me bring it home and scale it. You said they looked like quarters flying off it. Always had a way with words.” She touched the stone.

“I miss you, Dad.” I miss us.

9

RENÉ ARRIVED AT BROADVIEW AROUND NINE the next morning. The receptionist told her the old 3-2-1 security code had been replaced by 63082, which struck her as excessive given that the ward was for dementia patients, most of whom were bereft of short-term memory. She tapped the code on the keypad and the door to the AD unit clicked open. She passed through and the door closed and locked behind her as it was supposed to. Just as she started down the hall, her attention was arrested by something above her head—the ceiling security camera.

Even though it was Sunday, Alice was in her office. “Her records aren’t back, if that’s what you’re wondering. The police still have them. Sorry.” She looked away and began shuffling papers.

“Okay. Then maybe you can call me when they’re back,” she said, wondering why Alice was acting as if René were a giant botulism spore.

“No problem,” Alice said without looking up.

“Oh, one more thing,” René said, as Alice started away. “The patient census you gave me? There are forty-two names and forty-six patients on the ward.”

Alice looked at her blankly.

“Mary Curley, Louis Martinetti, Anthony Marsden, and Gloria Breed. According to my records, none of these people are residents.”

Alice gathered her things. “Well, they’re under Dr. Carr’s care.”

“Meaning what?”

“Meaning you should speak to him.” She began to move away from the desk.

“But you’re head nurse on the unit.”

“And Dr. Carr is head physician,” she snapped.

She tried to get away, but René stopped her, “Alice, are you telling me there are patients here whose medical records I don’t have access to?”

Alice took a deep breath, puffing up like a bird in defense. “Really, I have to go.”

“Sure, but maybe you can tell me about the security cameras.”

“What security cameras?” Alice’s voice skipped an octave.

“Outside the unit doors. Has anybody checked them?”

“Checked them?”

“To see who might have let Clara out of the ward?”

“Let her out? Nobody let her out.” Again she tried to get away.

But René took her arm. “Alice, I don’t know what’s going on here, but let me just say that if word got out to the state and federal regulatory boards that there are irregularities in the medical records of a patient arrested for murder, that there are more patients on the ward than listed, that critical pharmaceutical documentation is missing or locked away—there are going to be questions about patient neglect and patient abuse, and we could see a SWAT team of regulators come down on us like banshees demanding to know what other irregularities Broadview is up to, raising questions about patient security and wondering all sorts of things about the nursing staff and criminal negligence or, worse—that somebody here let Clara Devine out of the home, intent on murder. And since I’m professionally responsible for reporting irregularities in patients’ status, my job is on the line. So maybe somebody should tell me what’s going on or I’m calling the state.”

Alice stared at René for a long moment, her face rippling with expressions under the glare of René’s threat. Finally she sighed, and her body deflated like a balloon. She glanced down the hall to an aide. “Bonnie, I’ll be right back.” Then she nodded René inside a small back office and locked the door behind them. “They’ll probably have my head, but I’m sure you’ll find out anyway.”

“Find out what?”

“You know nothing about this,” she whispered, her eyes full of pleading.

The axes of the room felt as if they had shifted a few degrees. René nodded. “Okay.”

Alice unlocked a desk drawer and removed a videocassette. On a table behind them was a television monitor and VCR where they often viewed patient behavior or educational videos. Alice popped in the video, and after some flickering the screen filled with a grainy black-and-white ceiling shot of the unit’s security door from maybe ten feet back. For several seconds nothing moved, as if they were looking at a still. Then a figure appeared in the jerky time-lapsed motion of security cameras. Clara Devine.

She was alone and carrying a shopping bag. She looked about her, then, unbelievably, she went to the wall and with a finger she tapped the keypad and pushed her way through the door, which closed behind her. It happened so fast that René just said, “What?”

“Yeah, I know. She let herself out.”

René felt a flash of gooseflesh across her back. What she was seeing could not be—like witnessing a dog suddenly speaking English or seeing someone levitate. Dogs don’t talk, and Alzheimer’s patients don’t recover their short-term memory. The disease, like gravity, was a downward, persistent force.

“I don’t believe this.” René’s mind raced for a rational explanation: Clara had been misdiagnosed all along. She had faked her dementia. It was somebody else. None of the above.

“There’s more,” Alice said, her voice grim. She hit a few buttons and the tape switched to another venue. The main entrance outside. Again a shadowy figure, but with Clara’s face and body, and this time she was dressed in a rain poncho pulled over her head.

“We think she changed in the elevator and slipped by the front desk. It was raining out.”

On rare occasions, a patient managed to elope from a nursing home, usually because of understaffing. Two winters ago a man wandered outside and froze to death. As a result, Broadview had installed an elaborate security system. But no Alzheimer’s patient was capable of figuring out a pass code or remembering it even if she had heard it from one of the staffers. Nor were any of them capable of long-range planning of a disguise on a rainy night.

“My guess is she must have watched one of us use the keypad, and she memorized the combo.”

“Alice, she has middle-stage Alzheimer’s. She’s not capable of memorizing anything longer than a second, and you know that.”

Alice didn’t respond.

“Do the police know about this?”

“No. They never asked. Their job was to solve a murder. Broadview’s security is Broadview’s problem and not a police matter.”

“If they ask?”

“The system was down, the cameras weren’t working. Not my area.” Alice popped out the cassette and locked it in the drawer again. Then she got up and put her hand on the doorknob to leave.

Not my area.

“Alice, what the hell’s going on up here?”

“I think you’d better ask Dr. Carr. He’ll be in tomorrow.” And she hustled away.

10

MORNINGSIDE MANOR WAS A RED BRICK, three-story nursing home nestled among birches and evergreens and adjoining conservation land in Smithfield, just below the New Hampshire border. It was an adult long-term-care facility with a hundred and ten beds and was a cut above most of the homes and rehab centers that René regularly visited. It was Monday afternoon and she could not believe the number of cars in the parking lot including several limousines, all here for the groundbreaking of a new Alzheimer’s unit.

A large white tent had been pitched on the lawn, and waiters and waitresses were circulating through the crowd with champagne and fancy hors d’oeuvres. This was not the typical jug-wine-and-cheese-cube affair afforded by nursing home budgets.

René parked and made her way toward the tent, seeing no faces she recognized until she spotted Nick Mavros. He was standing with a small knot of people and waved her over.

“Now here’s a young woman for whom the expression ‘teacher’s pet’ was coined. Hello, beautiful,” he said, and gave her a hug and double-cheek air kisses, vestiges of a Peloponnesian birth some sixty years ago.

Nick had a strong face, thick bold features, and large eyes that lit up his face. “And now I’ve embarrassed her.”

“I’ll survive,” she said, and shook hands with another physician introduced as Peter Habib from Plymouth, a man about Nick’s age.

Nicholas Konstantinos Mavros had been her professor in pharmacy grad school and her thesis advisor for two years, during which time they had become more than student and professor. During her father’s decline, Nick had taken René under his wing, consoling her, bringing her to his home, giving her solace when she needed it the most. Over the three years since her father’s death, Nick had helped fill the void with warmth balanced by keen intelligence—traits which accounted for his position of respect in the community of neurophysicians. He was one of the few men whose mind never abandoned his heart, and René was grateful that there were people like Nick Mavros in the world.

Nick no longer had time to teach and was cutting back his private practice. He was senior neurologist at Mass General Hospital and chief collaborator at that institution’s MRI Imaging Center, where he and a team of physicists had pioneered new techniques for diagnostic imaging of the brain.

“They’ve got a tent the size of Fenway Park and half the medical community of the Northeast. What’s the big deal about a new nursing home wing?”

Nick made a happy grin and held up his glass. “Free champagne.” His eyes had that white-grape glow. He liked his wines and had a collection in his cellar.

“You have no shame,” René said.

“He’s a Greek. What do you expect?” Dr. Habib joked.

“Then they’re all Greeks here,” Nick said.

“Good stuff?” she asked, hinting that he’s probably had more than he should.

“Excellent, and brain cells be damned.” Then his eyes widened. “Uh-oh! There go another ten thousand.”

She laughed. “You can spare them.”

“Nice to meet you,” Habib said, excusing himself. “Something about the powers that do reckoning with the powers that be.” And he walked off.

“I love that guy,” Nick said through his champagne. “He knows how to live. He just bought himself a brand new Harley-Davidson for his semiretirement. Carpe diem.”

Habib had moved to a small group of people clustered around a large bald-headed man near the podium. “So what’s the big deal?” René asked. It was a crowd of at least a hundred and fifty and clearly was no shoestring celebration.

“It’s not Health Corp. who’s picking up the tab,” Nick said. Then he put his mouth to her ear. “The fella in the gray suit and bald head talking to Preston Van Dyke and Carter Lutz and now Peter. Gavin Moy.”

“Who?”

But just then Carter blew into the microphone. “May I have your attention, everybody?”

When the crowd quieted down, he introduced Preston Van Dyke, CEO of Health Corp., the parent company of the nursing homes that included Morningside and twenty-six other homes and rehab centers. Van Dyke began by thanking Carter Lutz and other dignitaries gathered there. “I’d like to say that this is a great day for Morningside as we break ground for our new long-term-care unit, which, as you may know, is to be constructed with another generous gift from GEM Tech.” And he motioned his hand toward Gavin Moy. When the applause died down, Van Dyke continued: “With your wonderful support, we will expand our already fine facilities and increase the quality of health care for years to come.”

Van Dyke continued briefly, and when he was finished, somebody handed him and Gavin Moy a chrome shovel with which they posed over a plot of dirt for a flurry of photographs and applause. The groundbreaking still didn’t explain the large crowd of suits, including someone she recognized from the FDA.

“Exciting, huh?” Nick said.

“Overwhelming,” René said, as they walked to a table of fancy snacks. Her mind was pulsing to tell him about the video of Clara Devine. “Do you know a neuro doc named Jordan Carr?”

“Yes. In fact, he’s here somewhere. Why?”

“I’ll catch him another time.” This was not the occasion for a confrontation.

“Well, if you change your mind, I’d be happy to—” But Nick was cut off.

“René Ballard?”

She turned to see a tall, good-looking man with shiny black hair.

“Speaking of the devil,” Nick said. “René Ballard, Jordan Carr.”

He held his hand out to her. “I understand you were looking for me.”

“Well, yes. I was.”

“Then I saved you the trouble.” His smile spread over a perfect set of upper teeth.

Nick grinned and took the invitation to depart. “If you’ll excuse me.”

“No, you don’t have to leave,” she said to Nick.

He held up his empty glass and nodded toward a waitress. “The champagne lady’s here and all’s right with the world,” he said with a wink. “Besides, there’s someone I have to say hello to.” And he headed off, grabbing another champagne from the waitress on the way to Gavin Moy.

“So,” Dr. Carr said, smiling down on her.

“We can do this at another time.”

“This is as good as any.”

He had a thin, boyish face with a high forehead and large, dark almond-shaped eyes that made him look Polynesian. His hair was perfectly black and parted on the side with optical precision. René stood five-five, maybe five-six in heels, and he was nearly a head taller than she was. “Okay. Then perhaps where we can have more privacy,” she said, and led him to an opening away from the crowd.

“My, my, this must be important,” he said, following her.

She couldn’t tell if he was being serious or condescending. It didn’t help that he spoke in a crisp English accent, which blurred the distinction. When they were on their own, she said, “I have some questions about Clara Devine.”

He kept his face in a neutral state of bemusement. “What about her?”

René was conscious of the professional divide between them—he a nationally recognized neurophysician probably on the board of a dozen important institutions and she a twenty-nine-year-old consulting pharmacist. She also reminded herself that a misstatement could get Alice Gordon and the other nurses in trouble. “I’m wondering how she managed to escape Broadview and get herself to the CVS and kill a complete stranger.”

“I’m familiar with the case, Ms. Ballard.” He smiled and sipped his wine, studying her with unblinking eyes.

She was not going to let his porcelain smugness derail her. “As you may know, I’m responsible for monitoring patients’ meds each month. When I went to check her folder, I discovered that several months’ worth of her charts were missing. Also, the order sheets were signed off by you rather than her primary care physician.”

“Because I’ve taken over for Dr. Colette.” His words had the honey-glaze patience of a teacher addressing a slow child.

“I see, but that still doesn’t explain Clara’s missing medical charts and those of four other patients under your care.”

If her discovery surprised him he did not let on. “They’re in Broadview’s computers.” His smile shaded into irritation, and he checked his watch.

“Then why was I told to consult you first when I asked to see them?”

“Just another firewall of patient confidentiality. Next question.”

Yeah. How did you get to be such an arrogant creep?

“Dr. Carr, I am licensed to have access to patient records—all patients’ records—not just some of them.”

“Then it’s an oversight to be corrected. Is that it?”

The feigned civility of Carr’s manner was annoying. Illegitimi non carborundum. Dad’s counsel. “No. The census sheets list forty-two patients, and a head count turned up forty-six.”

“Beg pardon?”

“There are four more residents in the AD unit than are registered. Four names I’ve not seen before, yet who have beds. And, frankly, Dr. Carr, I’d like an explanation because I’ve got to give one to my boss.”

Carr looked a bit nonplussed. “You’re very clever, Ms. Ballard. And may I call you René?”

“Dr. Carr, I’m responsible for the accuracy of all patients’ medical records on that ward as I am at all the homes I visit—”

Carr flapped his hand as if her words were gnats. “Yes, yes, of course.” Then he scanned the crowd, looking like a Serengeti gazelle testing the air for cheetahs. And while he did she noticed his outfit—tan hand-stitched boots that probably cost more than her Honda and a blue blazer with a breast-pocket shield of a black rearing stallion in a field of gold. Some designer’s logo she didn’t recognize.

“Ms. Ballard, I’m wondering if we might discuss this some other time.”

“Dr. Carr, I’ve been getting stonewalled on this since yesterday and possibly since I’ve been on the job. And given that this has become a police matter, I think I have a right to know what’s going on with residents in my homes.”

“Nobody is questioning your right to know. It’s just not the proper place.” He smiled widely and waved at someone in the crowd. “And now I’m being paged. Do you have a business card?”

She was being dismissed. She dug into her bag and pulled one out.

He produced a gold pen. “No, your home number and address, if you don’t mind.”

She looked up at him for an explanation.

“Chateau Dominique at eight tomorrow. Are you free?”

Christ, he’s making a damn date with me. “I guess,” she could hear the thinness of her voice. “But this is not a social matter.”

“No, but a much better venue.”

Go with it, she told herself, and wrote down her number and address.

“Is seven-thirty good?” But before she could file that away, Carr took her elbow. “Here’s someone I’d like you to meet,” he said, and took her to Gavin Moy.

Moy smiled and shook her hand. It was soft and warm, like a fine glove left in the sun. He had a weathered, tanned face that looked as if it had spent time on a yacht or a golf course. What was striking about his appearance was his brilliant green eyes, which made her wonder if he wore colored contacts. His head was a perfectly tanned dome with a mixture of white and auburn on the sides. “A pleasure to meet you, Ms. Blanchard.”

“Ballard.”

He nodded and scanned her up and down. “Nice pin,” he said looking at her lapel cat pin fashioned in black and white.

“It’s supposed to be my cat,” she said, feeling foolish.

Moy nodded and began searching the crowd. She could have announced that she had eaten the cat for breakfast and he could not have cared less. So why Dr. Carr’s insistence on their meeting?

“Nice to meet you,” he said, and pulled away with Carr.

Apparently Nick had taken in the scene, because he sauntered over with a fresh glass of champagne and took her arm. “Having a good time?”

“A blast.” She swallowed half her glass of wine. “Why do I feel like I’m stuck in a conspiracy movie and I’m the only one who doesn’t get it?”

“Maybe you are. What time is your date?”

“How do you know I have a date?”

“Because I know Jordan Carr. I also knew his ex-wife.”

“If first impressions mean anything, I’m on her side.”

Nick smiled broadly. “Well, maybe you should give him a chance. He’s a brilliant physician and someone who’s going places.”

“So, what should I know?”

“That you’re in for a lovely meal and some good wine.”

“Want to chaperone? Please?”

He laughed. “I’m sure you’ll be just fine.”

“What about the fifty questions I want answered?”

“I’m sure you’ll be satisfied.” He looked around for the waiter for a refill.

“And I think it’s time for Pellegrino.” And she plucked the fluted glass out of Nick’s hand and headed over to the bar feeling like Alice at the Mad Hatter’s jubilee.

When she returned Nick had removed from his jacket a magazine ad for a camera. “Not exactly a new Harley,” he said, and unfolded a photo of a large-format Mamiya camera. In what spare time he had, Nick liked to take nature photos and talked about taking time off to do a photo safari in the Canadian Rockies or the Grand Canyon someday. His office walls were covered with shots from Switzerland and Hawaii. “But it’s how I plan to enjoy the overrated golden years. And speaking of pictures, I’d like you to drop in at my office at the hospital. Got some interesting images you might like to see.”

“And, of course, you’re not going to tell me until then.”

“The next time you’re in Boston.” He checked his watch. “Thalia’s expecting me.” His wife of thirty-five years was suffering from Parkinson’s disease.

“Okay.”

“If he touches you I’ll kill him,” he whispered.

“You won’t have to.”

They double-cheek kissed and he headed for the parking lot. She watched him go, thinking how happy she was to have him in her life. Thinking that if he were a dog he’d be a graying black Lab—solid, strong, smart, loyal, and affectionate.

Across the crowd she spotted Jordan Carr holding forth to several admirers clustered around him. And you, a Doberman, she thought—sleek, angular, and a little dangerous.

11

“HIS EYES ARE MOVING.”

“That’s good, he’s dreaming. See those spikes? There’s activity.”

“Jack! It’s me, Beth. Wake up. Please.” Gently, she tapped his hip, one of the few places where he had not been stung.

“I think we’re ready to take him now,” the nurse said. “We’ll be back in an hour.”

They were preparing to take him to the Magnetic Resonance Center to record images of his brain for signs of strokes or other structural abnormalities. Also to check blood flow in the occipital and neotemporal lobes to be certain there were no occlusions. That was the nurse’s explanation to Beth.

And Jack could hear them.

They were on the other side of the door. Beth and the others … The door near the big window.

Don’t look out. Don’t look out.

Bad stuff …

“But he’s so agitated, he’s having a nightmare,” Beth pleaded. “Can’t you do something? Jack, wake up.”

That awful creature with the pointy head …

“They’ll give him some anesthesia so the images won’t blur. But his brain’s still active, and that’s what they want to capture.”

If this was a dream, he didn’t like it. Not dreaming. No way. This was too real. As real as those feet. Those horrible twitching feet. And the big brown mouse.

(That’s one smart mouse.)

Nice mouse. Big mouse.

They lifted Jack onto the gurney and wheeled him down the hall to the elevator and up to the MRC.

And the noise. Don’t tell me that’s a goddam dream … explosions rattling the dishes in the hutch … and that sound …

That sickening terrible sound …

And don’t telling me to stop screaming …

“Jack, I’m right here. It’s going to be all right. They’re just going to take some pictures.”

He could hear her through the door … Beth …

“You won’t feel a thing.”

His body was a cross-patch of slashes from scalp to foot and covered with antibiotic ointment. But as if by the snap of a magician’s finger all that was gone … and his body was clean, whole, pain-free.

He grabbed the mouse and climbed out of the cage. The floor was cold and wet. Beth, it’s me.

“Almost there.”

I’m coming.

He padded toward the door by the big black window …

Don’t look out.

He could feel the night watching him, pulling him to climb up and take a peek. To see the bad stuff out there.

Don’t do it … The door. Go to the door. It’s Beth.

He made his way to the door feeling all the eyes scrape him as he passed, feeling the jelly stuff making his feet sticky.

He was scared. So scared that he was panting … making queer noises. So scared that he pissed himself.

Bad sounds. Bad sounds.

“Stop that screaming. Stop that screaming.”

The door. The brown paneled door with the little windows. He put his hand on the knob. It was cool and slick and he tried to turn it to let Beth inside, but it was frozen. God, please help me.

“Jack, we’re just going to give you a little something to keep you still, okay?”

Beth! Open the door. Please let me out of here before it come back in. Please. “You won’t feel a thing … just some noises …”

Beth, somebody, let me out, let me out. Please.

Pounding. He pounded for it to open, pounded so hard he thought he heard his hand bones crack.

Please, somebody.

God, make the door open.

His feet. He looked down at his feet and they were covered with sticky stuff that left prints when he walked, and it was seeping under the door …

And the room instantly flooded as thick glutinous fluid rose up around him, engulfing his body, blotting the light and pushing him backward, black dark thick water rushing him along … and the jellies—hundreds of pulsing blobs streaming by his face out of the gloom. He braced for the sting of the tendrils, yet he felt nothing. Maybe they were friendly. Or maybe he really was dreaming.

“You are my sunshine …”

He tried to swim, but nothing worked. His feet and arms were dead—as if his blood had turned to concrete. His brain screamed commands to his body, but nothing moved. Nothing. Couldn’t even lift his head.

And the voices beyond the door.

He was paralyzed.

“We’re all done, Jack. We’re taking you back now.”

The goddam fucking jellies had paralyzed him.

“Jack, you did good, real good.” Nurse Maffeo.

Movement. He felt himself being lifted and rolled away. He wiggled his fingers. Then his toes and feet. God, thank you. He could feel his body come back. He didn’t know how, but he was going to keep them purring before more vapor lock.

“He’s agitated.”

“The anesthetic’s wearing off.”

“Jack, it’s me. Wake up. Please.”

He grabbed the knob again and felt it turn a little.

“Push, Jack. Push.”

I’m trying, but it won’t budge. Whatever they did it locked the goddamn door … and everything’s turning black. Oh, shit!

“See the lines? Let me turn up the gain. He’s stable again. Just a bad dream. Happens with trauma cases.”

And the voices faded like muffled music.

12

AT SEVEN-THIRTY SHARP ON TUESDAY EVENING, Dr. Jordan Carr pulled up in a long, shiny red sports car. René met him at the door. She had on a black sundress and heels—her only dressy outfit, the rest being pants suits, long skirts, and button-down blouses, which were fine for nursing homes and the declared moratorium on her social life. And he stood there in a suede camel-colored sportcoat with the same logo as yesterday’s blazer.

He walked her to the car that in the house lights glowed like a piece of jewelry. “Yikes, what is it?”

“Ferrari Testarossa.” He said that with the aplomb of announcing that the stars were visible.

The vehicle had been polished to a wet ruby sheen. “Very pretty,” she said, taking in the long sinuous lines and sculpted vanes.

“Thank you.”

As he let her in, Silky meowed down to them from an upstairs window. “Good night, Silky.”

Carr got in, looking up at the cat. “Funny, but you seem more the dog types.”

“How’s that?”

“I guess I’m thinking of how pets reflect their owners. Maybe it’s silly, but how dogs are more aggressive than cats.”

“And?” She drew out the syllable to see where he was taking this.

“And, well, you impressed me as being aggressive and tenacious.”

“Tenacious, as in a pit bull who gets her jaws on something and won’t let go?”

“Something like that.”

“Would it make you feel better to know that Silky is actually a panther cub?” He looked at her to see if she was making mock of him. She smiled and changed the subject. “I’ve never been in a Ferrari.”

“Welcome aboard.” He turned the key, and the car growled to life.

The interior light lit up a medallion on the gearshift—a rearing black stallion on a field of gold. “That’s the logo on the blazer you wore yesterday.”

“Yes,” he said as he pulled away. “I used to have a few other models until a divorce lawyer entered the picture.”

For a moment she imagined that he had a whole wardrobe of Ferrari outfits—blazers, polo shirts, Windbreakers, hats—probably even had rearing stallion undies. “Sorry to hear that,” she said, but found it hard to feel sympathy for a guy who was down to his last Ferrari. “I collect Honda Civics.”

Carr turned his face toward her. “Is that supposed to be funny?”

“I guess not.” The guy seemed devoid of humor. Or maybe he wasn’t used to teasing from underlings. Whatever—she decided that this was not going to be a long and tedious night.

They came to a stoplight and Dr. Carr turned full-face toward her. “I think if we’re going to have a pleasant evening, it might be a good idea to clear the air.”

“Fine,” she said, feeling as if a valve had opened up. “Then maybe you can tell me what exactly is going on in Broadview Nursing Home, since that is what this is all about.”

Carr stared at her, no doubt offended that an inferior in the medical Great Chain of Being had spoken to him with such bluntness. “You are a feisty one, I’ll say.”

“And I think you’re playing coy with me, Dr. Carr.”

“Do you always say what’s on your mind?”

“I guess I do.”

He nodded. “Okay, fair enough, but over the wine. And it’s Jordan.”

Silence filled the car as they headed toward the restaurant, while René kept wondering what this was all about, why Chateau Dominique and escort service by this high-powered neurologist who collected Ferraris.

To break the tension, Jordan looked over at her. “So, how did you end up in a profession like yours? I mean, really, you’re an attractive, bright young woman, yet you chose to work with geriatrics and dementia patients.”

The question was as familiar as the answer was boring. “I like the elderly. And I guess it’s because I’ve always had an interest in caring for those who get overlooked or scorned by society. Before pharmacy school, I worked at a homeless shelter and then at a substance-abuse clinic. That put me in touch with what it feels like to be a social outcast.”

“And now it’s geriatric nursing home residents.”

“Yes. There are plenty of people in the medical professions who care for babies and the middle-class Americans with health insurance.”

“Thus you’ve chosen the underserved.”

“That or I’m suffering some kind of psychopathology. I’m also comfortable with the elderly. I grew up in a small Maine farm town that was impoverished and that didn’t have a lot of young people. All around me were older folks—grandparents, great-aunts and great-uncles, and neighbors who were surrogate grandparents to me. The only doctors I remember were those who cared for older people. In fact, I grew up thinking that all doctors were gerontologists. Besides, somebody has to take care of them, right?”

“That’s hardly psychopathology.”

She was silent for a moment. “Well, there’s a personal motive, I suppose. My father died of Alzheimer’s.”

“‘You must remember this, a kiss is just a kiss, a case of do or die …’”

“I see. So you’re trying to help others cope with the dragon.”

“Something like that.”

In the lights of the other cars she could sense him turn something over in his head that was making him grin slightly. “Was it bad—your father’s demise?”

“‘No matter what the future brings …’ Dad, you’re punking out.”

“Ever treat a good case of Alzheimer’s?”

“I meant, in the severity of the disease.”

“It was fast toward the end, and worse on us than him.”

Punking out.

“How old was he when he was diagnosed?”

“Seventy-two.”

“Not very old.”

“Only seventy-two, Dad. You’re not getting senile. You’re not! You’re not.”

“He died seven years later.”

“Listen to me, honey, no matter what happens to me, keep strong for your mother, okay?

“And don’t let the laughter go away. You’ll be my big hero, okay?”

She could still hear the gentle, consoling voice.

“We all have to go someday, and I had a wonderful life. I still do.”

“Well, I hope I didn’t upset you, but it’s what we’re trying to do something about.”

“I’m fine,” she said. “What about your becoming a doc?”

“Well, my father was a physician in Singapore. So I guess it’s in the blood. Also, it’s not a bad life.”

Ferrari Testarossa. No, not bad. “Singapore? Is that where you’re from?”

“Originally, yes. My mother was Chinese, my father Canadian, but originally from London.”

That explained his exotic appearance. Maybe even his aristocratic demeanor.

Jordan looked over at her when they approached the restaurant. “You’re very attractive. Just wondering why someone like you is unattached.”

“Thank you, but who says I am?”

“Well, you caught me. I was talking to Nick Mavros.”

Nick was a mentor, perhaps a father figure, and a friend, but there was a strain of village matchmaker in him. “I see. Well, I’m fairly busy. And frankly I’m downsizing.”

“Downsizing. Ahh, a recent parting of ways?”

“Something like that.”

“Clearly bad judgment on his part.”

“Thanks. And what about you?”

“Divorced, two children, and paying dearly because her attorney’s a velociraptor.”

They turned into the restaurant parking lot.

13

THE HOSTESS GREETED DR. CARR BY NAME and led them to a private candlelit table in a far corner.

While Carr read the wine menu, René studied his face. In the soft candlelight he was very handsome, with long-lashed quasi-Asian eyes, smooth fine features, hair that closed over his brow like a leather flap, and an absence of beard shadow. Adding to the effect was the silky voice and manner. And despite his obvious avoidance of the issue at the forefront of René’s mind, Jordan Carr was very charming—another lesson for her that people aren’t what they seem. He ordered a sixty-dollar merlot.

Awkward silence filled the air after the waiter left. René studied the menu just to fill the gap. Then she looked up. “So … ,” she said. “Clara Devine.”

Carr lit up. “Ahh, the wine.” And almost by magic the waiter appeared and filled the glasses. Jordan raised his glass. “To a better future through medicine.”

“Sounds more like a slogan than a toast.”

“Maybe a little of each.” And he took a sip and settled back in his chair. “So, what do you want to know?”

René leaned forward. “Okay. You are not Clara Devine’s primary physician.”

A bemused smile spread like an oil slick across Carr’s face. “Correct.”

“Why have her medical charts not come back to me?”

“I believe the police have impounded them.”

Maybe.

“Next question.”

“There are four more patients on the AD ward than in the census—which is highly irregular.”

He nodded. “They’re under special care with me.”

“Special care?”

“Yes,” but he did not elaborate.

“You know, of course, that I’m supposed to have total access to all patients’ records in order to determine the effect of their meds. If there’s a problem, I need documentation, nurses’ observations, et cetera.”

“Of course. And that’s all been documented. Next question.”

Stonewalling again, and with an irritating glint in his eyes that said he was savoring her annoyance. One call from her could get the state to review the practices at Broadview, but she pushed that to the back of her mind. “And where are they documented?”

“In the home computers.” He took another sip of wine. “Next.”

“Clara Devine is a seventy-six-year-old AD patient who mysteriously eloped from a locked unit and ended up the next morning three miles away in a CVS where she killed a guy. None of that is supposed to happen.”

“Do you know how she got out?”

She could not betray Alice. “Pardon me?”

His gaze hardened. “Do you know how she got out, how she eloped?”

Yes. “No.”

“Then how do you know she eloped and wasn’t let out?”

Shit! “I don’t. That’s probably what the police are wondering.”

“I know you saw the security videos.”

Her chest tightened. “Security videos?”

“It’s okay. In fact, we were eventually going to show them to you.” He leaned forward and lowered his voice. “Tell me exactly what you saw on those videos.”

René wondered if this was a trick to get the nurses in trouble. “I saw an elderly woman with Alzheimer’s tap a security code and let herself out, then emerge in disguise at the front of the building and disappear.”

“Yes. And how do you explain that? What are the possibilities?”

“That she’d been misdiagnosed. Or that somebody had instructed her how to do it. Or that it wasn’t Clara Devine.”

“And what does your gut tell you the most likely explanation is?”

“My gut tells me nothing.”

“Exactly.” Then he ticked them off on his fingers. “One, you know she was not misdiagnosed since you saw her admission profile: a seventyish woman with moderate AD. Two, she was too far gone to be trained to escape or recall the code. And, three, it was Clara Devine because that was her face on camera, correct?”

René’s heart kicked up a beat. Then out of some half-glimpsed premonition she heard him say, “What you witnessed was a medical miracle.”

“A medical miracle,” she said, as if taking an oath.

“Yes. For the last six months Clara Devine and other dementia patients have been part of a large clinical trial of a new compound for the treatment of Alzheimer’s disease. As I am sure you’re aware, the brains of patients with Alzheimer’s on autopsy and on MRI have been observed to have deposits of beta-amyloid protein, or plaques, which do not form on the brains of people without Alzheimer’s. So we know that these plaques are a major cause of dementia, though we’re learning there are other factors as well—a loss of key brain neurotransmitters such as acetylcholine, which is important in learning and memory functions.

“This new compound has been shown not only to dissolve the plaques but also to stimulate neuronal growth, all but reversing the degenerative effects of the disease. In short, patients are getting their memory and functionality back. And what you saw in that video is the result of that reversal.”

It was as if the speech centers of René’s brain had tilted out.

“The woman’s elopement was an unfortunate consequence of a recovered ability to function. My guess is that she overheard a staffer tell someone else the code, which she memorized. Then she escaped, put on a disguise, and walked out of the building. What you witnessed was a woman in the process of being cured of Alzheimer’s disease.” His face was beaming.

For a long moment René tried to process his words, running through her head the crude black-and-white video, trying to find cracks in his explanation against those images of the woman purposefully making good her elopement.

“Like I said, a miracle.”

René felt a fist grip her organs and it had nothing to do with protocol. “I’m having difficulty digesting all this. A cure for Alzheimer’s disease?”

“Exactly. And keep in mind that until a few years ago nobody thought it was possible for nerve cells to reproduce. Now we’ve learned that they divide even in adults, that we’re not born with all the brain cells we’ll ever have. And that’s what this stuff does—stimulates new cell growth in the hippocampus and with it memory functions.”

“But that’s impossible.”

“Only because you’re thinking of meds currently on the market—Aricept, Exelon, Reminyl—which, at best, only slow the progress of the disease. I am sure you know the pharmacology of those as well as I do, right? Why they only slow the progress of the dementia without curing the disease?”

René tried to concentrate on his question around the fist tightening on her internal organs. He was testing her, she told herself. Suddenly this was classroom. So she decided to humor him. “Aricept and the others are cholinesterase inhibitors. Cholinesterase is an enzyme that destroys the neurotransmitter acetylcholine, which, as you said, is crucial in learning and forming memory. By inhibiting the action of cholinesterase, acetylcholine is not destroyed as quickly. Yet the amount of new acetylcholine produced in the brain continues to decline. And these drugs keep the acetylcholine that’s produced around longer, but they don’t stop the continuing decline of acetylcholine production. So the dementia continues, but at a slower rate than without these medications.”

Carr’s eyes lit up. “Very good!”

Yeah, because I researched the pharmacology of every damn drug on the market to save my father.

“And, of course,” Carr continued, “the other reason is that the loss of acetylcholine isn’t the only cause of dementia. The big problem is the plaque deposits that spread throughout the brain, causing changes in the levels of other important neurotransmitters. And that may explain the different rates of disease progression seen in different patients—or why some dementia patients slowly become mute, docile, and isolative, while others become very agitated, combative, and aggressive. We don’t understand all the reasons for this, but so far we only have the cholinesterase inhibitors to help deal with the disease.”

She took a deep breath against the conflicting sensations. “So you’re saying you’ve developed a new approach.”

“More than that, a cure.”

And at the core of her body the fist tightened.

“And it’s a completely new drug entity. A proteolytic compound that actually degrades the beta-amyloid protein plaques that cause the dementia. I’m telling you it’s amazing: We’ve seen the plaques recede on MRI in these trials while patients regain functioning and memory. The stuff actually reverses previous damage, not simply slowing the progression. There’s also a mysterious secondary effect—the regeneration of nerve cells. Whatever, the compound’s been in the GEM Tech pipeline for years. And its trade name is Memorine.”

“Memorine.” All those fancy people under the tent yesterday. “GEM Tech.”

A cure.

“Yes, GEM Neurobiological Technologies. As in Gavin Edward Moy.”

The waiter arrived for their orders. René’s appetite had suddenly died, so she ordered an appetizer.

“That’s all you’re going to eat?”

“I’m not very hungry.”

Carr ordered a steak. “You don’t seem very impressed,” he said when the waiter left.

“I’m still trying to process it all.”

“Of course,” he smiled. “It is mind-boggling. But maybe this will help.” From his coat pocket he removed a Palm Pilot. He hit a few buttons, then turned the device for her to see. “You recognize Clara there in the blue sweatshirt.”

“Yes.” On the small screen was an interior shot of patients at a table.

“That was taken seven months ago.” The camera zoomed in on the Manchester Union Leader to confirm the date. Clara was at a table doing a picture puzzle of a puppy. She randomly picked up pieces and tried to fit them together, clearly having difficulty.

“Hi, Clara, how you doing today?” The feathery voice of Jordan Carr off camera.

“Fine,” Clara said, not looking up at the camera.

“Clara, look what I have here.”

Clara lowered her eyes into a shoebox. “See, a button, a hairbrush, and a lollypop.” She inspects them. “You can touch them. Go ahead.” She picks up each item, awkwardly running the brush through her hair. She inspects the button and puts it back, then picks up the lollypop and sniffs it. Carr puts the items back into the box and asks her about the puzzle she’s doing. For maybe a minute she picks up pieces and begins to try to find mates. She’s unsuccessful. Then the lidded shoebox appears. “Clara, remember this? This box?”

Clara looks at it blankly.

“Remember what’s inside?”

She continues to look at it blankly.

“What’s inside?”

“I don’t know,” she says and turns back to the puzzle.

“Remember the lollypop?”

“No,” she says, fingering the puzzle piece.

Carr pokes a few keys with a stylus. “Now this is Clara six months later.”

Clara is sitting at the same table. A wall clock behind her. Dr. Carr’s disembodied voice: “Good morning, Clara.”

“Good morning.” She smiles at the man beside the camera.

A shoebox slides into view. “I’m going to show you what’s inside, okay?”

“Okay.”

A hand opens the box and removes a spoon, a small Mr. Goodbar, and a pencil. Carr identifies each out loud, then puts them in the box and puts the lid back. “Now, do you remember what’s in the box, Clara?”

“Yes. A spoon, a Mr. Goodbar, a pencil.”

“Very good.” And Carr opens the box and removes each and replaces them. With the clock in constant view, he has her put together a child’s puzzle over the next fifteen minutes. She moves very slowly but manages to fit several pieces together. When time is up, the shoebox reappears. “Now, do you remember this shoebox?”

“Yes.”

“Do you remember what’s inside the box?”

Clara blinks at the box for a few seconds. She looks uncertain for a moment, then says, “Yes. Mr. Goodbar, a spoon, and a pencil.”

“Very good,” Carr says, and behind them the nursing staff cheers.

Carr laid the Palm Pilot on the table, the freeze frame of Clara smiling proudly.

The waiter delivered the food while René stared dumbly at the image of the woman smiling back at her. All she could think was, That could have been my father.

“SO WHAT DO YOU THINK?” Carr said, digging into his steak.

“Well, that’s incredible.” And for a second René wondered almost hopefully whether it had all been staged—that she wasn’t actually looking at Clara Devine but some imposter partaking in an elaborate conspiracy for whatever reasons—perhaps some security test gone awry.

“Even more remarkable, her cognitive test scores were double what she got before she was institutionalized and two to three times that of the placebo group—not to mention a five times response rate and enhanced ability to perform her activities of daily living. Six months before she took the drug, she could not dress herself or go to the bathroom alone. Now she’s undergone a clinical regeneration in twenty-four weeks at two ten-milligram dosages daily.”

“I’d very much like to see those results.”

“Of course.” Carr’s eyes beamed like a child sharing a secret.

“She was forgetting things from one moment to the next. It was like watching her being peeled away like an onion.” Cassandra Gould’s words buzzed in René’s brain.

And cutting across those her father’s plea: “Promise me … I don’t want to end up just some gaga thing attached to a diaper.”

Maybe Clara Devine was just some extraordinary anomaly. “Are there other test subjects?”

“Of course.”

“So why all the secrecy if it’s such a miracle drug?”

“It’s a blinded study to keep people unbiased.”

Clinical trials were blinded so that the people responsible for patients wouldn’t attribute any and every change to the drug being tested. And while in such studies the caregivers may not know which patients receive the active drug and which patients receive a placebo, they are made aware that patients are enrolled in a clinical study. “But why wasn’t I or my pharmacy informed?”

“Because technically the trial compound is not among the active meds supplied by CommCare, your pharmacy. The Memorine tablets came from GEM.”

“But these patients were on other meds that CommCare supplies.”

“Look, their medical charts were meticulously kept by the nursing staff.”

“You mean a separate and hidden set.”

“Yes, but the trial data wasn’t kept from those who need to know at the FDA.”

“That still doesn’t explain why there are no nurses’ reports of the trials in my records or the alleged improvement of patients’ behavior and functionality. Or why I wasn’t told.” Because her job centered mostly on paperwork, she had only minimal contact with nursing home residents—something she hoped to change as time passed. Therefore, she could not personally have witnessed any actual improvements in the behavior of these trial subjects. Nonetheless, nurses and other staffers at her homes often talked about patients’ health, behavior, affect, the funny things they may have said. Yet, remarkably, nobody had uttered a word about the extraordinary changes in Clara Devine or any other patients in these trials.

“Well, I’m telling you now.”

“But only because Clara Devine eloped and murdered someone.”

His face darkened. “That was unfortunate.”

“Doctor Carr, this isn’t a blinded study, it’s a concealed one.”

He stared at her for a moment, then shrugged. “If you wish.”

He was trying to disarm her with a concession because he knew that she could report him. As an employee of CommCare, she was an outsider to the nursing home and bound by state and FDA regulations. And they both knew that she could lose her job were she not to report a secret clinical trial. “Doctor, you’re not answering my question: Why was I kept in the dark?”

“It was nothing personal. Even the nursing staff didn’t know what the subjects were on, though they were aware they’d been enrolled in trial of a dementia drug.”

“That still doesn’t answer my question.”

He drained his wineglass. “Because GEM Tech did not want to risk the competition getting wind of what we have. Period.”

The we floated like a lazy feather in the air. “They’re really worried some other drug company’s going to whip up a me-too compound?”

“In a word, yes. They don’t want somebody else beating them to the market. You know what a rat race the pharmaceutical industry is. Somebody invents a Ford, and a Chevy is right on its bumper.” He lowered his voice to a conspiratorial whisper. “René, we’re talking about a supreme blockbuster drug here—a fifty-billion-dollar pill.”

The waiter arrived to clear their dishes. When he left, Carr said, “I know it’s premature, but the FDA is very excited about this, very. And I won’t be surprised if they fast-track its approval.”

That still didn’t justify burying data. But the more he talked about the miraculous results, the more she became self-conscious about raising niggling issues of policy regulations. Here was a celebrated senior neurologist sharing with her what might be the greatest breakthrough in medicine since penicillin, and two months on the job and little Polly Protocol was souring the air with fumes. “I can imagine.”

“In four months we’ll be submitting trial reports to the Institutional Review Board—all the data and documentation thus far, everything with all the Ts crossed and Is dotted as required by the FDA, to be followed by the necessary publications, which will no doubt make the press. This is going to be huge.”

“You’re talking as if you’re the principal investigator.”

“Actually, I’m one of them. A chief has yet to be named.”

The chief principal investigator on any clinical trial occupied a post heavy with responsibility and prestige, especially if the compound tested showed promise. That Jordan Carr was a prime candidate was evident. So was his yearning.

“So, what about Clara killing a man? How is that being explained?”

“That was unexpected, of course. And we’ll have to make the best of it. Thankfully, patient confidentiality protects us. Meanwhile, she’s at McLean for observation.”

She remembered Officier Menard’s question: Was she on any antipsychotic medication or other stuff that might have caused her violence? “So, what do we tell the police?”

“That there was a security breach and that it won’t happen again because new safeguards are in place.”

“I mean the murder.” He kept avoiding that fact.

“Simply that she was a woman suffering from dementia, that she just went berserk. And that’s not so far-fetched. These are crazy people, after all.”

René could hear her father’s voice. “Honey, I can feel it. I can feel the holes.”

The chilly touch of his words bothered her. “So you’re saying that Memoring—”

“Memorine,” he said, pronouncing it like a talisman. “Memorine—and file that away because it’s going to rock the world.”

“So you’re saying that Memorine did not cause her to attack the man.”

“That’s exactly what I’m saying.”

“But how do you know that if the drug’s been in its final phase of study for only six months?”

A smile spread across his face like a rainbow. “René, we’ve been running trials at Broadview and testing efficacy and safety for months, and there’ve been no adverse reactions whatsoever. The Clara Devine incident is an unrelated anomaly. Period.”

“She was sexually abused as a child.”

“Beg pardon?”

René did not want to violate the woman’s privacy, nor did she want to betray Cassandra Gould, but this was vital information. “A neighbor next door did things to her.” And she explained what she knew.

“How unfortunate, but what does that have to do with anything?”

She wasn’t sure if he was playing coy again or drawing her out. “Doctor, I’m saying that Clara Devine attacked the man because in her mind she was seeing her abuser. I’m just wondering if it had anything to do with this Memorine.”

Carr laid down his fork with a definitive snap. “Well, it didn’t.”

“But how can one be certain if the stuff’s improving memory?”

“Because half the people in your nursing homes are seeing dead people all the time. Their husbands are their baby brothers, their sisters are their kindergarten teachers. You spend your days on these wards, you should know that. Clara Devine was no different, except she’s had some kind of post-traumatic stress experience—which happens to people all the time. VA hospitals are full of them.”

“There’s also the matter of informed consent. Her sister had passed on power of attorney, which meant that Clara was a ward of the state. Essentially, nobody was watching out for her.”

Carr made another audible sigh. “And I suppose you’re going to quote the Nuremberg Code on the principles governing ethical experimentation on humans.”

“Actually, I was thinking of the Declaration of Helsinki.”

“Look, this is not some hideous conspiracy. We’re not conducting Josef Mengele experiments on the elderly, shooting them up with voodoo compounds. We’re bringing them back from a killer fog. You saw Clara Devine, and you’re going to see others in the next year. So, think of this as our apology for keeping you in the dark, as you said.”

She nodded, feeling as if she were being bought. “I’d like to know what other patients of mine are in these trials.”

“Of course, but you’ve got hundreds of patients, and I don’t know the overlap.”

“Dr. Carr, every clinical trial is bound by very detailed, very stringent protocols established well in advance. Were I to approach the Institutional Review Board and raise the question about their approval in advance of GEM Tech clinicians sequestering documentation of trial patients from the consulting pharmacist, what might be their reaction?”

For the first time that evening Jordan Carr’s face froze, his cheeks mottled with red as if he had been hit with a flash case of the hives. “Ms. Ballard, you’re very sharp and very responsible. I’ll make certain that you will have total access to all your patients enrolled, as soon as possible. But I ask that any indiscretion or irregularities you please overlook, okay? And I ask you because this is a turning point in the treatment of dementia, and any regulatory roadblock could be disastrous. Can’t you appreciate that?”

He was asking her to look the other way, and that made her very uncomfortable. And it wasn’t just being in complicity with regulatory violations. She didn’t like the power she suddenly possessed. One word from her and some very important people would end up on the proverbial red carpet and the trials of GEM Tech’s hot drug could be suspended. “Then I expect a full list of patients who are enrolled at Broadview and elsewhere.”

“Of course.”

“And full documentation of meds including Memorine, schedules, and nurses’ observations, et cetera.” If he proved as good as his word, she would not contact the IRB.

“Certainly. Absolutely.” The relief was clearly visible in his face.

The waiter came to clear the dishes. “Would you like to see the dessert tray?”

René shook her head.

Dr. Carr studied her face for a moment. “Irregularities aside, aren’t you impressed? A cure for Alzheimer’s?”

“If it’s the real thing, of course.” She could hear the forced brightness in her voice.

“Well, take my word for it, it’s the real thing.”

“And how long have these trials been going on?”

“The last phase for eight months. But we’ve known about the neurological benefits to dementia patients for years.”

She nodded, and felt something rip inside her heart.

14

JACK WAS AT THAT DOOR AGAIN.

The same brown stained wood-panel structure with the hanging herbs and tarnished brass knob. He had lost count how many times it had been. How many times he had grabbed the mouse and padded to the door through the sticky wet. Then how he had frozen again, knowing on some level that horrible things were happening out there, but also knowing he had to get out to Beth and the others.

Jack stared numbly at the doorknob as if something profound were about to occur. Then he heard a voice full of gravel: “Goddamn you, die.”

Then that horrible sound that pounded through his brain over and over again, every time he got here, every time he put his hand on the knob—a sound that set loose a flock of bats in his chest: The crack of iron against bonecap.

Somebody, please, I beg you. Make this stop.

He folded into the corner on the floor, still clutching the mouse, his eyes pressed shut, his own whimpers humming in his head.

“Jack, you’re having a dream. Can you open your eyes for me?”

He opened his eyes and the window at the top of the door flashed down at him with a blue-green light.

“He’s saying something.”

Safe. The thing with the big head has gone away.

Jack got up from the floor and put his hand on the doorknob. Cold metal. He turned it …

“Jack, wake up. Come on, you can do it. Just push.”

… and he pushed.

Instantly the wind sucked open the door with a bang. His heart nearly exploded. The thing with the pointy head stood before him, its arm raised, the shiny club glinting in the light.

“Close the goddamn door.”

He closed the door.

“What did he say? I didn’t catch it.”

“I think, ‘Nice Mookie’?”

“Who’s Mookie?”

“I haven’t got a clue.”

15

“DID YOU KNOW ABOUT THESE MEMORINE trials?”

Nick looked over his glasses at her. “Yes.”

“It seems as if everybody does but me.” She could barely disguise the emotion crackling in her words.

“Then someone should have told you, of course.”

“Dr. Carr was going on as if it was the medical breakthrough of the millennium.”

“From what I understand, the results are quite promising, but it’s too early to call a press conference.”

She nodded, feeling a swirl of hot emotions.

It was Thursday afternoon and they were sitting in the control room of the new MRI imaging suite at MGH. Glass windows separated the bank of computers from the huge scanner, the ring-shaped apparatus with an attached patient table, in the next room. Behind them were three technicians working at their own monitors. Nick was a regular here because he had helped pioneer new imaging techniques for studying Alzheimer’s—techniques that aimed at detecting the disease in the presymptomatic phase and diagnosing its progress.

“So, you had a pleasant evening with him?”

“It was interesting.” She knew how evasive that sounded.

“He’s a very bright and capable physician.”

“And very charming, and I’m not interested.” There was an awkward silence. Her relationship with Nick was warm and mutually gratifying. He was the older mentor-cum-father-figure and she the pretty former student who made him feel young and charming. She had always sensed that he regarded her with an admiration that exceeded the professor-and-student relationship. It was evident in the way he lit up when he looked upon her, or touched her arm when he was explaining something. He was also intent on seeing her find a boyfriend.

“Okay,” he said. “Did he show you the Palm Pilot images of Clara Devine’s tests? It’s all right, I’ve seen them. All these years and all the research, and this is the first time that anything out of a lab is showing promise of a cure. Quite remarkable, wouldn’t you say?”

“If it is, I was three years too late.” Tears filled her eyes.

Nick looked at her, and in a moment realization clicked in his eyes. “Ahh. You mean your father.” He took her hand. “Good God, woman, there was no way for you to know. How could you? Besides, he could not have lasted this long.”

“He was still strong.”

“Maybe physically, but there was nothing left of him inside, and you know that. I would have done the same thing if it were Thalia. I would have wanted the same thing if it were me.” He squeezed her hand with assurance.

“I did it for me.”

“No! You did it for him. It’s what he wanted.”

But if I had only waited …

“Listen to me. The first dementia patients were not enrolled in these trials until eight or nine months ago. That’s two and a half years after he died. You know as well as I what could have happened in that time. He would have continued to waste away, kept alive by machines and tubes and IV drips. Was that something you’d want? Of course not, and neither did he. And who’s to say this stuff would have worked for him? Or if he would have lived so long even full-coded. No, you did the right thing. So put it away for good.”

She nodded and gave Nick a hug. He was also the one person for whom she had unguarded respect and not a little affection. If it weren’t for him, she would have dropped out of pharmacy school and would probably be wiping counters at Starbucks. It was also Nick who had held her hand during her father’s demise.

Nick got up and poured her a cup of coffee from the small machine sitting on a back table. René took a few sips and let his consolation take effect.

“So, back to reality. You’re having some problems with administrative procedures, right?”

“I think I’ll feel better when I see Clara Devine’s records.”

“Dreadful story. I read the paper.”

“Nick, she was sexually abused as a young girl by some creep neighbor.” And she told him what Cassie Gould had said.

Nick’s face clouded over. “So, what are you saying?”

“I’m saying that in her head, Clara Devine may have been defending herself against the guy who raped her seventy years ago.”

“A flashback seizure.”

Flashback. The term lit up in her mind as if it were an established syndrome. “Yeah, exactly. A flashback.”

“It’s a Peter Habib term,” Nick said. “I guess it’s possible. We’re talking about axon connections rethreading the hippocampus. What does Dr. Carr say?”

“He says it’s the dementia, not an adverse drug reaction.”

“Because post-traumatic stress hallucinations can plague dementia victims. I suppose that will have to be determined. In the meantime, what are you thinking of doing?”

“Nick, for nearly two months I’ve been up against some clinical code of omertà while secret trials were going on right under my nose.”

“So you’re thinking of filing a formal complaint against the record-taking procedures of a senior clinician working on a potential cure for Alzheimer’s disease.”

“Not when you put it that way.”

“Then let it go. You’ll get the charts. Look through them, check the nurses’ reports, and if anything looks irregular, then write your letters. In the meantime, visit some of the trial patients. I think you may be impressed with what’s happening.”

“And what’s that?”

“Maybe medical history.”

“Wait a second. Are you part of this?”

“GEM’s made some recent inquiries.”

“How long have you known about the stuff?”

Nick must have heard her words skid because he narrowed his eyes. “I’m telling you it was not an option for your father. They hadn’t even begun phase one trials on animals yet. Nobody had any idea if it would work with AD patients. And had I known, you would have been the first to hear.”

She nodded. “I know.” She had scoured the journals and the Internet looking for every experimental drug in clinical trials, and nothing had held any promise for her father’s condition. Memorine was still deep in GEM’s pipeline.

“And in case you’re wondering, I haven’t committed myself.”

“Maybe you should. Given how they’ve been operating, they could use some ethical standards.”

“That’s very kind, but what do you think that’d do to my retirement plans?”

“You’re still young and energetic.”

“Kinder still. But Thalia has got her health problems, and I have a new grandchild, number three.”

“Okay. When I asked him why I was kept in the dark, Dr. Carr said that GEM wanted to guard against the competition. That seems rather paranoid to me.”

“Might also be good business. First of all, clinical trials are almost never done with geriatrics in nursing homes, as you know. So they wanted to keep things quiet for as long as possible. Secondly, GEM’s a small, tight drug company and nervous about some Goliath out there stealing its hot molecule. It’s happened before. I suppose if this compound turns out to be the real thing, the benefits will more than make up for minor irregularities.”

He, too, was saying to look the other way. “And what about Dr. Carr? I’m sure he’s doing well by GEM.”

“There’s nothing unethical or illegal in a physician’s getting a fee for enrolling patients in trials. It’s how research progresses.”

“That’s the one gray area that frankly bothers me. Doctors get paid thousands of dollars for each patient they enroll in a trial, plus research grants, equipment upgrades, staff support, travel perks, plus stock options in the company. With all those incentives, it’s hard to write up a negative report to the FDA.”

“Except actual scientific results don’t lie. And from what I hear, this Memorine is looking remarkable.” Nick fixed his glasses and rolled his chair. “Now, come here and look at this.” He inserted a CD into the computer and ran his fingers across the keyboard. In a matter of moments multicolored images of a brain filled the screen. He moved the mouse around and clicked a couple of times, and the colors began to change, pulsing in yellows and reds. “Thanks to the genius of imaging physicists and computer technicians, we now have the first quantitative, dynamic visualization of the destruction of cortical brain regions in people with dementia. What you’re seeing is a 3-D sequencing movie of a seventy-five-year-old male’s brain under the siege of plaque formation and neuron tangles over a thirteen-month period.”

As best she could, she tried to dissociate herself from thoughts of her father. “What do the colors represent?”

“The base image of the brain is blue. And in red is the beta-amyloid plaque.”

“God, it looks like a blight spreading across the brain.”

“And of the worst sort. What makes this technology very special is that we can directly monitor both the progressive damage as well as any therapeutic responses from Aricept and other treatments.” Nick ran the serial scan images several times.

“It’s moving right across the parietal and temporal lobes.”

“Exactly, the areas controlling language and major cognitive functions.”

“And obliterating memories, personalities—everything that made them who they were,” she said.

“His name is Louis Martinetti. He’s at Broadview. Maybe you’ve met him.”

“Yes. The Korean war vet.”

“And former POW. Well decorated—a Purple Heart, in fact. And a very sweet man.”

René felt a little sick as she watched the fast-forwarded sequence of his brain’s deterioration. Her father had been a Korean vet also. “What stage is he in?”

“Moderate, but it seems a particularly aggressive case.” The red blotches spread from frame to frame. “At this rate, the stuff will probably cover a good part of the frontal lobe within a year or so, rendering him incapable of speech and most memory.”

Although one could only imagine the man’s cerebral cortex becoming clotted with plaque, this new technology let them witness the brutal unraveling of the man’s mind and memory. But if they could have looked inside Mr. Martinetti’s brain they would have seen the same landscape of destruction that a hundred years ago in Munich had startled the German physician who described the disease that bears his name. It was Alois Alzheimer whose investigation of what had been diagnosed as premature senility in a fifty-one-year-old woman led to his discovery of the disease’s gruesome signature: the brownish nodules of plaque and the dense tangle of neurofibers that eat away the upper layers of the cerebral cortex and destroy a person cell by cell. What had wasted her father.

Nick reran the sequence. “Now, imagine seeing this played backward—all that red turning blue again.” And in his eyes she saw a flicker of promise.

Three years too late.

René tried to deflect the voice and looked away. At a station nearby was another computer monitor showing another brain image. “Is this the same patient?”

“No, that’s the image of a patient of Dr. Heller, another neurologist here in the department.”

René welcomed the distraction.

“But it does look similar.” Nick rolled in his chair to the monitor. “And that’s rather interesting because he’s not an AD patient but a young fellow in a coma. He nearly drowned last week after being stung by jellyfish—some rare creature found in the Caribbean.”

“How did he end up here?”

“Actually, it happened up here. On very rare occasions tropical creatures get caught in the Gulf Stream. And when the waters are as warm as they’ve been, they get caught in eddies that bring them close to shore.”

“Where’d it happen?”

“Homer’s Island, a private island northwest of Martha’s Vineyard. The only place they’ve ever been reported in the northeast. The Coast Guard found him.”

“Lucky for him. What’s his prognosis?”

“Not good, though his unconscious mind is quite active.” Nick moved the mouse around and hit a few keys as new brain images filled the screen in quarters. Then with a pen he pointed to an area of the frontal lobe of his brain. “This is what interests me. See how the yellow area appears to be expanding. Unlike the other, this is a structural MRI that measures brain tissue volume. And if you look here, the active area is his hippocampus and frontal lobe.”

“Meaning what?”

“I’m not really sure, but if I didn’t know better, I’d say the tissue was getting denser.”

“Denser? You mean his brain is growing?”

“Unless I’m mistaken, there’s active cell growth. Unfortunately he’s in no condition to tell us what he’s experiencing. But if he wakes up, it might be interesting to interview him.”

“Meanwhile, he’s turning into a Conehead.”

Nick laughed. “Or someone with a pretty rich memory bank.”

When Nick looked away, René fingered open the folder with his name tab and that of the unit he was in. “Any way to tell how long he might be unconscious?”

Nick shook his head. “Could be a week, could be five years. Could be forever.”

“It must be very hard on his family.”

“I think it’s only his wife, and I hear she’s not doing too well. He has seizures but is settling deeper into his coma. The EEG measurement of his brain-wave activity is around three Herz, which is very low, nearly a third the activity of adults in normal sleep.”

“Which means he’ll probably be moved to a rehab center soon. I’m sure the caseworkers are probably already talking about that. Maybe I can suggest some possible facilities.”

“I think she’d appreciate that. Also, on the off chance that he wakes up, it might be useful to make contact. He’s experienced a unique restructuring in his brain, so he might be a treasure trove of data. And it would be good for his wife to have another arm of support.”

Jack Koryan. And she filed away the name.

16

JACK KORYAN.

It was later that evening, and René was back home and at her computer with a glass of chardonnay and Silky in his basket at her feet. Over the hours she had let Nick’s words help her come to terms with the reality that she had done the right thing by her father. That at the time there were no other options. “Promise me this …”

She typed the name in the Google search box, and instantly a community newspaper site came up with several hits of the same article:

MAN COMATOSE FROM JELLYFISH ATTACKA man was found washed up and unconscious on a beach on Homer’s Island. Jack Koryan of Carleton, Massachusetts, was barely alive after being stung by dozens of rare jellyfish while swimming.Koryan was taken by emergency helicopter to the Cape Cod Medical Center … .Scientists from Northeastern University and Woods Hole Institute said that Koryan had gotten caught in a large school of Solakandji jellyfish, which is only the size of a tennis ball but which has three-foot-long stinging tentacles. The highly venomous creature is a native of the waters of the Caribbean. Dr. Jason Marchi, a marine biologist from Woods Hole, said that the increased water temperature and the rise in nutrients from fertilizer runoff tend to support a rise in jellyfish populations … .Like other species of toxic jellyfish, the Solakandji tentacles have millions of stinging cells called nematocysts … .According to medical experts, there is currently no antivenom available for the Solakandji sting, which has caused deaths in Jamaica … .

She finished reading the story, then stretched out on the couch with her wine and Silky on her lap. She clicked on the television and lowered the volume just to decompress before getting ready for bed. On the news were the usual grim stories about the Iraq war and some local crime. She listened with half interest. Something was bothering her and she could not put her finger on it. Something to do with that Jack Koryan guy—something that sat under the upper layers of her mind and kept sending up little tremors.

After maybe fifteen minutes of distraction, she got up and went back to the computer and did a search for Solakandji, the species of jellyfish Nick had. Amazingly, she got over three hundred hits. And she spent the better part of the next hour clicking on different sites. Most were divided between news stories of attacks, treatment of the stings, general information about jellyfish, and a few scientific papers. Several of the technical sites had photos of a creature that looked like a translucent mushroom with four interior rings and spaghetti tendrils.

The Solakandji jellyfish (related to Irukandji jellyfish of Australia’s Great Barrier Reef) is found in warm waters of the Caribbean and southern Atlantic.

Minor envenomations cause pain, swelling, and localized numbness that often subsides within hours of onset. Serious envenomations are associated with a rapid progression of symptoms, including erythema, paralysis, respiratory arrest, cardiac failure, and death … .

Other sites offered information about how to treat stings with vinegar, news stories about how victims in the Bahamas and elsewhere suffered a rapid rise in blood pressure and a cerebral hemorrhage that led to their deaths. Her mind returned to poor Jack Koryan in a deep sleep, unfortunate victim to happenstance, his entire universe reduced to a bed and that bank of monitors and destined never to open his eyes again.

She clicked onto more technical sites intended for dedicated marine scientists and scrolled down until she came to a dead stop.

N. A. Sarkisian, Mavros, N. T., et al. Neurotoxic activity on the sensory nerves from toxin of the deadly Solakandji tropical jellyfish Chiropsalmus quadrigatus Mason. Chem Pharm Bull 17: 1086-8, 1971.

Mavros, N.T.

Nick. He had published a paper on the toxin thirty-five years ago. She read on.

The abstract described the Solakandji toxin as a novel proteolytic agent whose molecules functioned as an NMDA receptor antagonist. Furthermore, the substance was identified as a glutamate inhibitor affecting aspartate—an excitatory amino acid-transmitter in the brain, similar to glutamate.

“Glutamate inhibitor affecting aspartate.”

The words jumped out at her.

That was the same neurochemical function that Jordan Carr had described—the same neurotransmitter was linked to seizure activity and agitated behaviors of people with dementia. By inhibiting glutamate, demented patients were demonstrating better behaviors and enhanced cognitive capabilities.

My God! Jack Koryan was attacked by a jellyfish whose toxin was the chemical basis of Memorine. And Nick had helped pioneer the stuff.

2

17

“WHO THE HELL’S THIS COMMCARE WOMAN?”Gavin Moy’s eyes blazed down on Nick. He pulled a letter out of the folder. “René Ballard, Consulting Pharmacist. CommunityCare Pharmacy.” He handed the letter to Nick. “Isn’t she your friend?”

The letter was elegantly blunt, like a silver-plated bullet. “Yes, and former student,” Nick said.

“Well, your friend and former student says that medical records of some patients are missing—‘a violation of regulatory procedures,’ and she quotes the state and federal codes—blah, blah, blah—and she expects that all the records ‘complete and intact’ be returned immediately or she’s obligated to file a report with the IRB and request FDA review of our trial protocols. Jesus H. Christ!”

Nick had to repress the smile. “I believe she’s just doing her job.”

“Doing her job? She may be doing a job on friggin’ medical history.”

“Then maybe somebody should comply with her requests. Rumor has it that withholding nursing home records from consulting pharmacists is a violation of regulations.”

“Who the hell’s side you on?”

“Truth and beauty.” Nick smiled broadly.

Moy snickered. “Which is why I called you. But I must say, she has balls.”

“Because I taught her everything she knows.”

“Well, Jordan Carr says everything’s being returned, so tell her to wrap up.”

“What about the other nursing homes serving as research sites?”

“There, too. We want everything on the up-and-up.”

They were alone in Gavin Moy’s office at GEM Tech—a handsome, voluminous space with windows on two sides, one with a view of oak woodlands, the other commanding a view of the Boston skyline, shimmering in the distance.

On a table behind him were pictures of Moy’s wife, who had died five years ago. Moy had adjusted well to his widowerhood. Following her death he redirected his energy into his company, hiring the best and the brightest. And now he was consulting senior medical execs and leaders in hospitals and academic institutions to put together a Dream Team of clinicians. Likewise, his board members were major venture capitalists who would have eaten their own children to be part of GEM’s future. And who wouldn’t—since Gavin Moy might be sitting on the pharmaceutical equivalent of the Holy Grail: a cure for Alzheimer’s disease in an ever-aging world.

On the wall behind his desk hung framed patents with his name on them—each for a variation of the same parent compound, just to keep competing labs from making look-alike compounds—the first, now faded, was dated January 10, 1976, the latest, from eight years ago, represented the final molecular structure whose trials would eventually be presented to the FDA for market approval. Trademarked Memorine, the compound not only had enormous pharmaceutical and commercial potential, if successful Gavin Moy could find himself in Stockholm, Sweden, when they passed out Nobel Prizes.

“We’re going to make an announcement at the meeting of shareholders in a few weeks, so the word will officially be out instead of leaks and speculations.”

It was a risky plan, because formal announcements about the success of a drug are almost never made in the middle of trials. But given the early success, Moy’s strategy was to create a market for Memorine before the first pill hit the shelves.

“Until then, we’re playing mum.”

Gavin Moy was paranoid and for good reason. He had sunk millions of his own and hundreds of millions of investors’ dollars into Memorine against a history of adventures that had turned out to be duds, including development of a cure for a rare neurological disorder; it proved disastrous in the Phase III clinical trials, costing GEM eighty million dollars and nearly tanking the company. Another agent targeting Parkinson’s disease was beaten to market when a competing lab offered a disgruntled GEM science director an offer he couldn’t refuse—the results: a look-alike that became a blockbuster while GEM fumbled around in Phase III trials only to scrap the project and end up with huge go-nowhere litigation fees. Those fiascoes were why Gavin Moy had guarded Memorine as if it were the Manhattan Project.

It was also why Nick had played coy with René. Only when she called to ask if the jellyfish connection was true did he confess a minor role in its development, breaking ethical protocol. Since learning about Memorine René had been flagellating herself with guilt for having consented to let her father die instead of holding out for some breakthrough cure. So he reiterated the fact that the compound had not been targeted for clinical trials of dementia patients until two years after her father’s death. Even then Gavin Moy had sworn Nick and others to secrecy in face of the Darwinian competition for a cure and the fact that when the patent would run out in a few years generic knockoffs would fly. But before that eventuality, GEM hoped to establish a global franchise on Memorine.

“We’ve tried to keep a low profile, but we’re getting calls from physicians and AD organizations wanting to know if it’s true we’re working on a cure, can they volunteer patients. Christ, this is going to be the biggest thing since the Salk vaccine, maybe penicillin.”

“We can only hope.”

As Moy scanned Walden Woods out his window, Nick thought that he was like one of those reptiles with independent turretlike eyes constantly alert to opportunities and dangers. That was how he had been decades ago, and, perhaps, that was the secret of his successes and failures. On his desk was a brass plaque with the inscription: “It’s not over until you win.” Quintessential Gavin E. Moy.

Although Nick had seen Moy over the years at conferences and colloquia, they went back to a time before GEM Neurobiological Technologies existed. They were residents together at Mass General back in the late 1960s, when Gavin had started the forerunner of GEM Tech in the cramped basement behind MIT and where Nick helped in the research before finishing his residency. For years, some antecedent of Memorine had been in Moy’s pipeline, going through molecular reconfigurations and testing until the final form was developed. Today it was the flagship product for GEM Tech—and virtually their only product.

The promise began when it was discovered that the toxin from the Solakandji demonstrated an extraordinary neuronal property: it enhanced long-term memory. Fetal rodents injected with the compound learned to whip through complex mazes as if radar-directed while their untreated siblings stumbled along. Even more remarkable, mature rats demonstrated enhanced long-term recall, mastering maze problems that they hadn’t been exposed to since they were juveniles. The immediate thought, of course, was what it could do for people suffering memory loss—a speculation that raised hope against the scourge of Alzheimer’s disease.

The first breakthrough came when it was discovered that Memorine treatments had all but eliminated deposits of beta-amyloid peptides in mice genetically engineered to have an Alzheimer’s-like disease. Even more remarkable, new brain cell growth explained why treated mice had higher learning curves and functionality than untreated mice. In short, Memorine had converted memory-degenerating rodents into recall wizards. Last year it was tested on human subjects and medical history began to be rewritten.

“Nick, you’ve read the reports—the results are fabulous and you could share in its success. So don’t tell me ‘no’ again, because I’m asking you to come aboard.” Moy’s eyes were shooting fire.

“Gavin, I’m very flattered, really.”

“On the contrary, we’d be flattered. And all bullshit aside, we’d like to have a man with your prestige and reputation.” Moy handed Nick a few sheets of paper. “Some of the people you’d be working with. I think you’ll recognize a few.”

It was a long and impressive list of physicians already taking part in the trials—names of medical researchers and practitioners associated with the best of institutions: the Scripps Institute, Yale, Washington University Medical School, the National Institutes of Health, et cetera.

“Plus some acquaintances of yours—Peter Habib, Jordan Carr, and others. We’re expecting the FDA to fast-track the application so we can get it to market in eighteen months.” Moy spoke with serene conviction. “Word is the president might support clinical development as a pledge to older voters in his reelection campaign. The long and short is this is a revolution, and we want you to be part of it.”

“And you’re working out possible ADRs—adverse drug reactions.”

Moy’s face froze. “What adverse drug reactions?”

“That woman who killed the CVS manager. I’ve also heard rumors of patients experiencing some deep-past delusional spells.”

“Where the hell did you hear that?”

It was actually Pete Habib who had come up with the “flashback” label. “Where I heard it isn’t important. The story of the murder was in all the newspapers. But questions have been raised about whether there’s a connection to the drug.”

The skin of Moy’s head flamed. “There is no connection, and there are no adverse drug reactions. These people were delusional psychotics suffering dementia. Christ, you see them all the time.”

“I’m just raising the possibility.”

Moy considered his words for a moment. His face suddenly lit up. “Then this is just the kind of thing we’d want you to monitor—making sure investigators look for contingencies, side effects, whatever. We need someone like you with uncompromising integrity. But, believe me, there’s no connection between the woman who stabbed the store guy and Memorine, and you can take that to the bank.”

“Okay, but why do you want me when you have all these top people?”

“Because I’d like you to direct the phase three clinical study, to be chief principal investigator—to coordinate all trial data for our FDA application. I want you at the top.”

Nick did not see that coming. “Why not Pete Habib? He’s chief neurologist at South Shore and one of the best around. Or Jordan Carr?”

“I said no bullshit: You’re senior neurologist at MGH and chief administrator of the imaging lab, and Peter Habib, Jordan Carr, and the rest aren’t. Having you in the lead would draw a lot of attention, not to mention investors.”

“That’s quite an honor, but to do this right will require a large commitment.”

“Of course, and you’ll be compensated handsomely.”

“I’m talking time, not money. I’ll have to think about it and talk it over with Thalia.”

“Of course.” Moy glanced at his watch. “How’s tomorrow by noon?” Nothing in Moy’s face said he was being humorous.

“Next week.”

“All right, next week.” Moy leaned into a huddle. “Okay, the ugly stuff: For your own patients, we’re offering you twice the standard trial rate—three thousand dollars per patient visit. We expect twelve to fifteen visits. You have a lot of AD patients and you can do the math. In addition, for all your expertise blah blah blah and the privilege of having you as clinical director blah blah blah … we’re offering you equity in the company in the form of stocks—the numbers to be worked out.

“As you know, about five million people suffer Alzheimer’s in the States alone—a figure that’s going to double by 2020. The current market is twelve billion dollars for AD meds. We’ve created a special unit to market Memorine, lined up the third largest pharmaceutical company in the country to distribute, plus a sales force of seven hundred reps on a sales-based bonus system to promote it to practitioners. We’ve got a projection of three million prescriptions the first year on the shelves, twice that the next year, and multiples once our foreign subsidiaries kick in. Nick, this is a fifty-billion-dollar pill. And for the clinical director and the researchers associated with it, the benefits are incalculable.”

Nick smiled. “At least you’re not turning up the pressure.”

“Hell, I’m just winding up. Your imaging lab is a critical tool toward our end, and our board has authorized a ten-million-dollar grant for its application in the trials, which should cover overhead and salaries, blah blah blah. What do you say?”

Nick was aware of the prestige of being part of the development of a potential miracle drug. But at his age he was not out for glory or the financial rewards—and he could do the math. Being a millionaire several times over did not move Nick. He and Thalia did not have extravagant tastes. They lived comfortably in Wellesley and drove a seven-year-old Saab. They vacationed in Fresno because Thalia had family there and Nick liked to hike the Sierras with his cameras. Because of ill health, Thalia no longer worked, nor did they miss her income now that their children were on their own. Money was never a motivating force in Nick’s life. And, like René, he harbored old-fashioned academic cynicism toward clinicians participating in studies with drug companies.

But the majority of physicians conducted trials for higher ethical reasons: to benefit humankind. And Nick was one of them. As embarrassing as the financial benefits would be, Nick was hearing that he could be part of a team that might cure Alzheimer’s disease—a nemesis that he personally had confronted for most of his professional life—a disease more vicious than cancer since it robbed a victim first of selfhood, then of life.

“You should know that I’ve been cutting back on my practice and research.”

“Christ, you’re only sixty-two-too early to be retiring. Think of the hundreds, maybe thousands of people and patients you’ve watched waste away with dementia. Two or three years from now, when the world is singing ‘hallelujah’ because the scourge of the aging world has been defeated, where you going to be, huh?—on top of some mountain taking snaps of yellow-belly sapsuckers.”

Nick laughed. “All work and no play—”

“Bullshit! I want you on this, and so do you.”

“All right, all right, give me a chance to catch my breath.” Nick had seen Moy worked up before, but not like this. His face looked like a giant tomato.

“Catch your friggin’ breath and tell me yes, you’ll head this up.”

“If I agree, all proceedings will be according to protocol.”

“Goes without saying.”

“Fine.”

“Monday.”

Moy stood up and shook Nick’s hand. As Nick headed for the door, Gavin said, “Believe me, it’s the Holy Grail—what you’ve been chasing all your life. You deserve to share in the victory.”

GAVIN MOY’S WORDS ECHOED IN NICK’S mind as he took the elevator down to the lobby—a high-glassed interior and the main entrance to GEM’s state-of-the-art complex. Given the surrounding acreage, there was room for expansion to meet the anticipated demands of the drug for years to come.