Seizure

twenty-seven

7:42 P.M., Sunday, March 24, 2002

“Now, I do not mean to be a bother to you talented folks,” Ashley said, drawing out the words in his prototypal drawl. “And I do not mean to seem unappreciative of all your efforts. I apologize from the bottom of my heart if it distresses you, but there is no way I can stay here tonight.”

Ashley was sitting up in a hospital bed with the back cranked up as high as it would go. Gone was the hospital johnny, and in its place was his wacky tourist outfit. The only evidence of his recent surgery was a double-wide bandage on his forehead.

The room was one of the Wingate’s inpatient rooms, and it appeared more like a hotel than a hospital. The colors were all bright tropical hues, particularly the walls, which were peach, and the drapes, which were a combination of seafoam green and hot pink. Daniel was standing to Ashley’s immediate right in his efforts to dissuade the senator from leaving the clinic. Stephanie was standing at the foot of the bed. Carol Manning was ensconced in a purple club chair near the window with her shoes on the floor and her feet tucked in underneath her.

After the CAT scan, Ashley had been brought to the room and put in the bed to sleep off his sedation. Both Dr. Nawaz and Dr. Newhouse had left after they were certain Ashley was stable. Both had given Daniel cell phone numbers to be called if and when there was a problem, particularly a seizure recurrence. Dr. Newhouse had also left a vial of the fentanyl and diazepam combination that had been so effective, with the instructions that two cc’s should be given either intramuscularly or intravenously if the need arose.

Technically, Ashley was under the care of an impeccably groomed nurse by the name of Myron Hanna, who had been the Wingate Clinic’s recovery room nurse back in Massachusetts. But Daniel and Stephanie had stayed at the bedside, along with Carol Manning, for the four hours it had taken Ashley to wake up. Paul Saunders and Spencer Wingate had stayed for a while as well, but they had left after an hour with assurances that they too could be reached if needed.

“Senator, you are forgetting what I told you,” Daniel said with as much patience as he could muster. At times, it seemed that dealing with the senator was like dealing with a three-year-old.

“No, I understand there was a little problem during the procedure,” Ashley said, quieting Daniel by laying his hand on Daniel’s folded arms. “But I feel fine now. In fact, I feel like the spring chicken that I know I’m not, which is a tribute to your Aesculapian powers. You told me before the implantation that I might not notice much change for a few days, and even then it might be gradual, but that is clearly not the case. In comparison to how I felt this morning, I’m already cured. My tremor is almost gone, and I am moving with considerably more ease.”

“I’m glad you feel that way,” Daniel said with a shake of his head. “But it’s probably due more to your positive attitude or to the strong sedatives you were given than anything else. Senator, we believe you need more treatment, as I told you, and it is safer to remain here in the clinic, with all the medical resources at our fingertips. Remember, you had a seizure during the procedure, and while you were having the seizure, you acted like a completely different person.”

“How could I act like someone else? I have trouble enough being myself.” Ashley laughed, although no one else did. He looked around at the others. “What is wrong with you people? You all are behaving like this is a funeral rather than a celebration. Is it truly hard for you to believe how good I feel?”

Daniel had told Carol that the treatment cells had been placed inadvertently in an area slightly wide of where they were intended. Although he had downplayed the seriousness of the complication, he did tell her about the seizure episode and his worry that there might be more, and he admitted to the need for more treatment. Because of the presence of the restraints on Ashley’s wrists and ankles, he had even acknowledged the collective concern about what was going to happen when Ashley woke up. Luckily, such worries were proved to be unfounded, since Ashley awakened with his normal, histrionic personality as if nothing had happened. The first thing he did was insist the restraints be removed so he could get out of bed. Once that was accomplished and the slight dizziness went away, he demanded to put on his street clothes. At that point, he was ready to go back to the hotel.

Sensing he was losing the argument, Daniel glanced at Stephanie and then at Carol, but neither elected to come to his aid. Daniel looked back at Ashley. “How about we negotiate,” he said. “You stay here in the clinic for twenty-four hours, and then we’ll talk again.”

“Obviously you’ve had scant experience negotiating,” Ashley said with another laugh. “But I will not hold that against you. The fact of the matter is that you cannot keep me here against my will. It is my desire to go back to the hotel, as I informed you yesterday. Bring whatever kind of medication you think I might need, and we can always come back here if need be. Remember, you and the ravishing Dr. D’Agostino will be conveniently right down the hall.”

Daniel glanced up at the ceiling. “I tried,” he said with a sigh and a shrug.

“Indeed you did, Doctor,” Ashley admitted. “Carol, dear, I trust our limo driver is still outside, waiting for us?”

“As far as I know,” Carol said. “He was when I checked an hour ago, and I told him to stay until he heard from me.”

“Excellent,” Ashley said. He swung his legs over the side of the bed in a manner that surprised everyone, including himself. “Glory be! I do not think I could have done that this morning.” He stood up. “Well then, this country boy is ready to return to the pleasures of the Atlantis and the splendor of the Poseidon Suite.”

Fifteen minutes later in the parking area in front of the Wingate Clinic, a discussion ensued about the travel arrangements. Eventually, it was decided that Daniel would ride with Ashley and Carol in the limo while Stephanie would drive the rent-a-car. Carol had offered to ride with Stephanie, but Stephanie assured her she would be fine and actually preferred to be alone. Daniel had the vial of the sedative combination, several syringes, a handful of sealed individual alcohol pledgets, and a tourniquet in a small, black, zippered pouch compliments of Myron. Armed with the medication, Daniel felt it was imperative for him to remain in Ashley’s presence in case of a problem, at least until Ashley was safely in his suite.

Daniel sat in the seat facing the rear directly behind the glass shield separating the driver’s compartment from the passenger section. Ashley and Carol were sitting in the back, their faces intermittently illuminated by the flickering light of oncoming vehicles. With his procedure behind him, Ashley was ostensibly euphoric, carrying on an animated conversation with Carol about his political agenda after the Congressional recess. In reality, the discourse was more like a monologue, since Carol merely nodded or said yes at infrequent intervals.

As Ashley talked and carried on, Daniel began to relax from the tension engendered by his worry that Ashley was about to have a seizure and the associated concern of having to give a dose of the sedative. If the seizure was anything like what had occurred in the OR, Daniel knew the intravenous route would be close to impossible, and he’d be reduced to giving it intramuscularly. The problem with the IM route was that it took longer for the drugs to cause an effect, and any delay could be problematic if aggression was an issue, as Dr. Nawaz had strenuously warned. Considering Ashley’s size and surprising strength, Daniel knew that wrestling with him within the confines of the limo would be a nightmare.

The more relaxed Daniel became, the more his mind was able to go beyond the seizure concern. He became progressively amazed at the degree of mobility Ashley was displaying with his gestures and how normal his facial expressions and voice modulation were. He was a far cry from the semifrozen individual Daniel had seen that morning. Daniel was puzzled, since the treatment cells were not in their proper location, as was shown all too clearly on the CAT scan. But the effect he was observing could not be the result of the sedative or placebo, as he’d so blithely suggested earlier. There had to be some other explanation.

Like all scientists, Daniel was aware that science occasionally leapt ahead not by hard work alone but also by serendipity. He started to wonder if the errant site the treatment cells now occupied might prove to be particularly appropriate for dopamine-producing cells. It didn’t make sense, because Daniel knew that the area of the limbic system where the cells now resided was not a modulator of motion, but rather was involved with olfaction, autonomic behaviors like sex, and emotion. Yet there was a lot about the human brain and its function that was still a mystery, and at the moment Daniel was enjoying seeing such a positive result from his efforts.

When they arrived at the Atlantis, Ashley made it a point that he did not need assistance from the doormen as he climbed from the car. Although he had another bout of dizziness when he got to his feet, requiring him to hold on to Carol for a moment, it passed quickly, and he was able to walk reasonably normally into the lobby and to the elevators.

“Where is that gorgeous Dr. D’Agostino?” Ashley asked as they waited.

Daniel shrugged. “She either got here before us or will be here shortly. I’m not concerned. She’s a big girl.”

“Indeed!” Ashley agreed. “And smart as a whip.”

In the hallway of the thirty-second floor, Ashley walked ahead as if showing off his new capabilities. Although he was still hunched over to a degree, he was moving much more normally, including his arm swing, which had been almost negligent that morning.

Carol used her keycard when they got to the mermaid door. She opened it and stepped aside for Ashley to enter. As he did so, he turned on the lights. “Every time they make up the room, they close everything to make the place look like a root cellar,” he complained. He walked over to the wall switches and activated the curtains and the sliding-glass panels simultaneously.

At night, the view from inside the suite was nowhere near as dramatic as it was in the day, since the expanse of ocean was as dark as crude oil. But that was not the case from the balcony, where Ashley immediately went. He put his hands down on the cool stone balustrade, leaned forward, and surveyed the vast semicircular Atlantis water park splayed out in front of him. With its profusion of pools, waterfalls, walkways, and aquariums, all creatively illuminated, it was a feast for his eyes after the stress of the day.

Carol disappeared into her room while Daniel advanced to the balcony’s threshold. For a moment he watched Ashley as the senator closed his eyes and raised his head into the cool tropical breeze coming off the ocean. The wind rustled his hair and the sleeves of his Bahamian print shirt, but he was otherwise motionless. Daniel wondered if Ashley was praying or communicating with his God in some personal fashion now that he thought he had genes from Jesus Christ embedded in his brain.

A slight smile appeared on Daniel’s face. Suddenly he had more optimism about the outcome of treating Ashley than he had since the seizure in the operating room and more optimism than he thought possible after seeing the CAT scan. He began to think there was something of a miracle involved.

“Senator!” Daniel called after five minutes had passed and Ashley had not moved a muscle. “I don’t mean to bother you, but I think I will go to my own room.”

Ashley turned around and acted as if he was surprised to see Daniel standing there. “Why, Dr. Lowell!” he called out. “How nice to see you!” He pushed away from the balustrade and walked directly up to Daniel. Before Daniel knew what was happening, he was enveloped in a bear hug that kept his own arms pinned to his sides.

Self-consciously, Daniel allowed himself to be hugged, although he wondered if he had any choice in the matter. It was a testament to how much bigger and heavier the stocky Ashley was in comparison to Daniel’s spare and comparatively bony frame. The hugging continued beyond what Daniel thought reasonable, and just when he was about to voice impatience, Ashley let up and stepped back but kept one hand gripping Daniel’s shoulder.

“My dear, dear friend,” Ashley oozed. “I want to thank you for all you have done from the bottom of my heart. You are a tribute to your profession.”

“Well, thank you for saying so,” Daniel murmured. Feeling himself blush, he was embarrassed.

Carol reappeared from her bedroom and her presence rescued Daniel from Ashley’s clutches. “I’m on my way back to my room,” Daniel called out to her.

“You get a good rest!” Ashley ordered, as if he were the doctor. He gave Daniel a pat on the back, which was strong enough to cause Daniel to take a step forward to keep from losing his balance. Ashley then turned around to retreat back to his place at the balustrade, where he assumed the same meditative pose he’d struck earlier.

Carol accompanied Daniel to the door. “Is there anything I should know or do?” she asked.

“Not that I haven’t already told you,” Daniel said. “He seems to be doing okay, and certainly better than I expected.”

“You should be very proud.”

“Well, yeah, I suppose,” Daniel stammered. He wasn’t sure if she was referring to how Ashley was doing at the moment or sarcastically to the complication. Her tone, like her broad expressionless face, was hard to read.

“What exactly should I be watching for?” Carol asked.

“Any change in his health status or his behavior. I know you have no medical training, so you’ll just have to do the best you can. I would have preferred he stay in the clinic tonight so his vital signs could have been checked through the night, but that didn’t happen. He’s a strong-willed individual.”

“That is an understatement,” Carol said. “I’ll watch over him as I usually do. Am I supposed to wake him during the night? Anything like that?”

“No, I don’t think that is necessary, with him doing as well as he is. But if there is any problem whatsoever or you have any questions, call me, no matter what the time.”

Carol opened the door for Daniel and then closed it behind him without another word. For a moment, Daniel stared at the carved mermaids. Trained as a hard scientist, he knew psychology was far from his forte, and people like Carol Manning confirmed it. She confused him. One minute she seemed the perfect, dedicated assistant; the next she seemed as if she was mad about her subservient role. Daniel sighed. At least it wasn’t his problem, provided she watched the senator through the night.

On the short walk to the suite he shared with Stephanie, Daniel’s attention switched back to the shocking improvement in Ashley’s Parkinson’s. He was mystified on many counts but enormously pleased, and he couldn’t wait to share the news with Stephanie. He opened the door and was surprised not to see her, especially when she wasn’t in the bedroom either. Then he heard the shower going.

When Daniel entered the bathroom, he found himself enveloped in a fog as if Stephanie had been in there for a half hour. He put the toilet seat down and sat. With his line of sight at a lower level, he could now make out Stephanie’s form behind the frosted and fogged shower door. It appeared as if she weren’t moving beneath the full force of the spray.

“Are you all right in there?” Daniel yelled out.

“I’m better,” Stephanie answered.

“Better?” Daniel questioned silently. He had no idea what she meant, although it reminded him that she had been rather silent all afternoon. It also reminded him of her seemingly insensitive response to Carol’s offer to ride with her, although he admitted if the situation had been reversed, he would have responded similarly. The difference was, in contrast to him, Stephanie ordinarily concerned herself about other people’s feelings. Daniel didn’t consider himself base or even rude, but rather he just couldn’t be bothered. People had to understand that there were too many more important things for him to think about than social niceties.

Daniel debated with himself whether or not to go out to the minibar to get something to drink. In many ways, it had been one of the most stressful days of his life. Ultimately, he decided to stay put. He was eager to tell Stephanie about Ashley; the drink could wait. But Stephanie didn’t budge.

“Hey, in there!” Daniel yelled at length. “Are you coming out or what?”

Stephanie cracked open the door, and steam billowed out. “I’m sorry. Are you waiting to get in here?”

Daniel waved the vapor away from his face. The bathroom had become a Turkish bath. “No, I’m waiting to talk to you.”

“Well, maybe you shouldn’t wait. I’m not sure I’m up to talking much.”

Daniel felt a wave of irritation course through him. Stephanie’s response was not what he wanted to hear. With the day’s events, he needed and deserved a bit of support, which he certainly did not believe was asking too much. Abruptly, he stood up, left the bathroom, and slammed the door. While he got himself a cold beer, he brooded. He didn’t need any more aggravation. He plopped himself down on the couch and concentrated on sipping his beer. By the time Stephanie appeared, wrapped in a towel, he had recovered.

“I can tell by the way you slammed the door you’re mad,” Stephanie said in a calm voice. She was standing in the doorway to the bedroom. “I just want to let you know I’m emotionally and physically exhausted. I need some sleep. We did wake up at five this morning to make sure everything was ready.”

“I’m tired too,” Daniel said. “I just wanted to tell you that Ashley is doing unbelievably. Most of his Parkinson’s symptoms have already mysteriously improved.”

“That’s nice,” Stephanie said. “Unfortunately, it does not alter the fact that the implantation went awry.”

“Maybe it didn’t go awry!” Daniel responded. “I’m telling you that you will be amazed. He’s a different man.”

“He certainly is a different man. We’ve inadvertently crammed a horde of aberrant dopamine-producing cells someplace into his temporal lobe. An experienced neurosurgeon strongly believes he’ll be saddled with the hell of temporal lobe epilepsy. For Ashley, that will be even worse than the Parkinsonism.”

“But he’s not had a seizure since the one in the OR. I’m telling you, he’s is doing marvelously.”

“He’s not had a seizure yet.”

“If he has a problem, we can deal with it the way I suggested to Dr. Nawaz.”

“You mean with the cytotoxic agent attached to the monoclonal antibody?”

“Exactly.”

“You can do that if you are so inclined and if you can talk Ashley into subjecting himself to such a foolhardy experiment, but it is not going to be ‘we.’ I’ll have no part of it. We haven’t even tried it in cell culture, much less animals, and as such, it is a quantum leap more unethical than what we have already done.”

Daniel stared at Stephanie. He could feel his irritation sweeping back over him. “Whose side are you on, anyway?” he demanded. “We decided on a goal to cure Ashley to save HTSR and CURE, and by God, we are going to get there.”

“I’d like to think that I am crossing over to the side less motivated by self-interest,” Stephanie said. “Today, when we realized the OR was not equipped with the necessary X ray, we should have stopped the procedure. We were gambling with someone else’s life for our own benefit.” Then she held up her hands as Daniel’s face flushed and his mouth opened to respond. “If you don’t mind, let’s cut it off right here,” she added. “I’m sorry, but this has become exactly the kind of discussion I did not feel capable of having tonight. I told you I’m drained. Maybe I’ll feel differently after a night’s sleep. Who knows?”

“Fine!” Daniel said sarcastically, with a wave of his hand. “Go to bed!”

“Are you coming?”

“Yeah, maybe,” Daniel said angrily. He got up and went to the minibar. He needed another beer.

Daniel wasn’t sure how many times the phone had rung since his exhausted mind had incorporated the jangle into the nightmare he was having. In his dream, he was a medical student again, and the phone was something to fear. Back then, it was often a call to an emergency he was untrained to handle.

By the time Daniel’s eyes popped open, the ringing had stopped. He sat up and looked over at the now silent phone on the side table and wondered if it had rung or if he’d just dreamed it. Then his eyes darted around the room to orient himself. He was in the living room, still in his clothes, with all the lights on. After two beers, he’d fallen fast asleep.

The door to the bedroom opened. Stephanie appeared in her silk shorty pajamas, squinting and blinking in the bright light. “Carol Manning is on the phone,” she said, in a voice thick with sleep. “She’s upset and needs to talk with you.”

“Oh, no!” Daniel said worrisomely. He swung his legs off the coffee table. He even still had his shoes on. Without standing up, he leaned across the length of the couch and picked up the phone. Stephanie stayed in the doorway to listen.

“Ashley is acting strangely,” Carol blurted into the phone after Daniel identified himself.

“What’s he doing?” Daniel asked. The old medical school fear of incompetence in the face of an emergency came flooding back. With as many years as Daniel had been away from clinical medicine, he had forgotten most of his doctoring skills.

“It’s not so much what he is doing, it’s what he’s complaining about. Excuse my language, but he says he smells pig shit. You told me that if he smelled something strange, it might be important.”

Daniel felt his heart skip a beat and the optimism he’d felt earlier vanish. Immediately, there was not a modicum of doubt in his mind that Ashley was having an aura heralding the onset of another temporal lobe seizure. At the same time, the last vestiges of clinical confidence Daniel was holding on to crumbled as he acknowledged he was about to face handling an episode of what Dr. Nawaz predicted would be worse than the first. “Has he been aggressive or is he acting out in any way?” Daniel asked nervously. Frantically, he looked around the room for the black pouch containing the sedative and syringes. Thankfully, he spotted it on the table in the foyer.

“Acting out is a little strong, but he has been irritable. Then again, he’s been irritable for the last year.”

“Okay, be calm!” Daniel said, as much for his own benefit as for Carol’s. “I’ll be right down to the room.” He looked at his watch. It was two-thirty in the morning.

“We’re not in the room,” Carol said.

“Where the hell are you?”

“We’re in the casino,” Carol admitted. “Ashley insisted. There was nothing I could do, and I tried. I didn’t call you because I knew there was nothing you could do either. When he makes up his mind, that’s it. I mean, he’s a senator.”

“Good God!” Daniel complained. He slapped a hand to his forehead. “Did you try to get him to come back to the room when he smelled the pig poop?”

“I suggested it, but he told me to go out and jump in the shark tank.”

“Okay! Where in the casino are you?”

“We’re at a bank of slot machines on the ocean side of the room, beyond the roulette tables.”

“I’ll be right down. We’ve got to get him back to the room!”

Daniel got to his feet and glanced at Stephanie, but she had disappeared back into the bedroom. He dashed over and looked in. Stephanie was tearing off her pajamas and pulling on her clothes.

“Wait!” she called out. “I’ll come with you. If Ashley is going to have a seizure anything like what he had in the OR, you’ll need all the help you can get.”

“Okay,” Daniel said. “Where’s the cell phone?”

Stephanie nodded toward the bureau as she hastened to button her blouse.

“Bring it along! Where are the numbers for Newhouse and Nawaz?”

“I’ve got the numbers already,” Stephanie said, stepping into her pants. “They’re in my pocket.”

Daniel ran to the medical pouch. Just to be sure, he pulled open the zipper. He felt some reassurance after seeing the vial and the syringes. The trick was going to be getting the medicine into Ashley before all hell broke loose.

Stephanie appeared at the bedroom doorway, still struggling to get into her loafers and tuck in her blouse. By the time she got over to Daniel, he had the door to the hall open. Together, they flew toward the elevators.

After hitting the down button, Daniel took the cell phone from Stephanie, handed her the medical pouch, and dialed Dr. Nawaz’s number.

“Come on!” Daniel urged, as the phone rang and rang. Just as the elevator arrived, Dr. Nawaz answered sleepily.

“It’s Dr. Lowell,” Daniel said. “We might get cut off. I’m stepping into an elevator.” In response to Stephanie pressing the lobby button, the doors closed. “Can you still hear me?”

“Just barely,” Dr. Nawaz said. “What’s the problem?”

“Ashley is having an olfactory aura,” Daniel said. He was watching the floor indicator. It was supposed to be a high-speed elevator, but the numbers seemed to be decreasing agonizingly slowly.

“Who is Ashley?” Dr. Nawaz questioned.

“I mean Mr. Smith,” Daniel said. He glanced at Stephanie, who rolled her eyes. For her, it was another small episode in the continuously unfolding and unfunny comedy.

“It will take me about twenty minutes to get to the clinic. I advise you to call Dr. Newhouse. As I said earlier, I suspect this seizure might be worse than the first, especially considering where those cells are. We might as well have the same team.”

“I’ll call Dr. Newhouse, but we are not at the clinic.”

“Where are you?”

“We’re at the Atlantis resort on Paradise Island. At the moment, the patient is in the casino, but we are going to try to get him back to his room, which is registered under a Carol Manning. It’s called the Poseidon Suite.”

There was a silence that lasted for several floors.

“Are you still there?” Daniel said into the phone.

“I’m not certain I’m believing what I am hearing. This man had a craniotomy some twelve hours ago. What the hell is he doing in the casino?”

“It would take too long to explain.”

“What time is it?”

“It’s two-thirty-five. I know it sounds like a lame excuse, but we had no idea Mr. Smith would go to the casino when we brought him back here, but he is extremely strong-willed, with a mind of his own.”

“Has there been any progression beyond the aura?”

“I haven’t seen him yet, but I don’t think so.”

“You’d better get him out of that casino. Otherwise, there could be one hell of a scene.”

“We’re on our way down to the casino as we speak.”

“I’ll be there as soon as I can. I’ll check the casino first. If you’re not there, I’ll assume you are in the room.”

Daniel ended the call and then dialed Newhouse’s number. Like with Dr. Nawaz, the phone had to ring multiple times before it was picked up. But in contrast to Dr. Nawaz, Dr. Newhouse sounded chipper, as if he’d been awake.

“Sorry to bother you,” Daniel said, as the elevator doors opened on the lobby level.

“No bother. As an anesthesiologist frequently on call, I’m accustomed to calls in the middle of the night. What’s the problem?”

Daniel explained the situation as he jogged down the main hall toward the casino, which was centrally located in the huge complex. Dr. Newhouse’s reaction mirrored Dr. Nawaz’s in all respects, and he too said he would be there imminently. After disconnecting, Daniel exchanged the phone for the black medical pouch.

Upon reaching the casino, Daniel and Stephanie slowed to a fast walk. The facility was in full swing and significantly more crowded than either anticipated, despite the hour. It was a colorful sight with its rich, red-and-black carpet, huge crystal chandeliers, and snappily dressed croupiers. Daniel and Stephanie made a beeline through the clutter of activity and past the roulette tables grouped in the middle of the spacious room. It didn’t take them long to find the bank of slot machines Carol had described and, once there, even less time to find Ashley. Carol was standing right behind him and was ostensibly glad to see help arrive.

Ashley was sitting in front of one of the slot machines with a considerable pile of coins on the counter. He was still dressed in his laughable tourist outfit. His bandage was still in place on his forehead. His paleness wasn’t as apparent with the red glow reflecting off the carpet. There was no one at the machines immediately neighboring his.

Ashley was relentlessly feeding his machine in a manner he clearly wouldn’t have been able to do the day before. The instant the inner wheels stopped, another coin dropped into the slot and the arm was pulled. Ashley appeared mesmerized by the blurred images of fruit.

Without a moment’s hesitation, Daniel went directly up to Ashley and pulled him around with a hand on his left shoulder. “Senator! How nice to see you!”

Ashley squinted up into Daniel’s face. His eyes were unblinking, his pupils dilated. His normally carefully combed hair was tousled as if someone had deliberately messed it up, giving him a wild appearance.

“Take your hands off me, you skinny shit,” Ashley growled, without a trace of his normal accent.

Daniel obeyed instantly, shocked and terrified by Ashley’s uncharacteristic profanity, which recalled a similar outburst in the operating room. The last thing he wanted to do was provoke the man and thereby incite a more rapid progression of the seizure symptoms. He stared into Ashley’s eyes, which reflected a kind of disconnect, since Ashley evidenced no signs of recognition. For a beat, neither moved as Daniel rapidly debated whether to attempt to medicate him on the spot. He decided against it, for fear he’d be unsuccessful and make things worse in the process.

“Carol tells me you smelled a disagreeable odor,” Daniel remarked, unsure of what to say or how to proceed.

Ashley gave a wave of dismissal before nodding his head. “I think it was that whore over there in the sexy red dress. That’s why I moved to this machine.”

Daniel glanced down the row of slot machines. There was a young woman in a red dress showing significant cleavage, especially when she worked the slot machine’s arm. Daniel redirected his attention to Ashley, who had gone back to feeding the machine in front of him.

“So you don’t smell the odor any longer?”

“Just a little, now that I moved away from that bitch.”

“Well, good,” Daniel said, allowing himself a ray of hope that the aura might resolve without progression. Regardless, he wanted Ashley back in the Poseidon Suite. If there were a scene in the casino, undoubtedly the whole affair would unravel in the media.

“Senator, I have something I want to show you up in your room.”

“Piss off, I’m busy.”

Daniel swallowed nervously. His nascent ray of hope began to fade as he acknowledged that Ashley’s mood and behavior were obviously already significantly abnormal, even if not yet outrageous. Frantically he tried to think of something to get Ashley up to his suite, but nothing came to mind.

All at once, Carol gave Daniel’s shirtsleeve a tug and whispered in his ear. Daniel shrugged. He was willing to try anything, no matter how ridiculous. “Senator. There’s a full case of bourbon in your room.”

With encouraging rapidity, Ashley let go of the slot machine’s arm, turned, and looked up at Daniel. “Why, Doctor, fancy seeing you down here,” he said, with his accent returning.

“Good to see you as well, sir. I came down to tell you about the case of bourbon that arrived in your room. You have to come up and sign for it.”

To Daniel’s relief, Ashley immediately slid off the stool attached to the floor in front of the slot machine and stood. He must have had a wave of dizziness, because he tottered for a moment before grasping the edge of the counter. Daniel grabbed his arm just above his elbow for additional support. Ashley blinked, looked at Daniel, and for the first time smiled.

“Let’s proceed, young man,” Ashley said. “Signing for a case of bourbon sounds like a worthy cause to this old country boy. Carol, dear, see to my loot, if you please!”

With his hand still gripping Ashley’s upper arm, Daniel guided the man away from the slot machines. In appreciation of Carol’s suggestion, which he never would have thought of on his own, Daniel winked at her as their eyes briefly met. While Carol quickly gathered up Ashley’s coins, Daniel and Stephanie accompanied the senator across the floor and through the milling crowd of gamblers.

The journey went smoothly until they got to the elevators, where they had to wait briefly. Like a cloud passing in front of the sun, Ashley’s smile suddenly disappeared and was replaced by a scowl. Having been watching his face and seeing the transition, Daniel was tempted to ask the senator what he was thinking. But he didn’t, for fear of undermining the status quo. Daniel’s intuition told him that a mere tendril of reality was maintaining Ashley’s control of his mind.

Unfortunately, two couples that Ashley had spotted over Daniel’s shoulder boarded the same elevator behind them. One of them pressed the button for the thirtieth floor. Daniel swore under his breath. He had hoped to have the car to themselves, and the tension of worrying about an explosion of Ashley’s behavior in the presence of strangers caused his pulse to race and perspiration to appear on his forehead. For a split second he looked at Stephanie, who appeared as terrified as he. Returning his attention to Ashley, he could tell the senator was glaring at the couples who were tipsy and carrying on in a boisterous and provocative manner.

Daniel unzipped the medical pouch. He looked in at the vial and syringes, and considered whether he should fill one of the syringes. The problem was that the strangers would see what he was doing and might become alarmed.

“What’s the matter, Papa?” one of the women questioned teasingly after noticing Ashley’s truculent, unblinking stare. “Are you jealous, old man? You need a little action?”

“Screw you, bitch!” Ashley snapped.

“Hey, that’s no way to talk to a lady,” the woman’s companion blurted. He pushed the woman to the side and stepped forward to confront Ashley.

Without thinking of the consequences, Daniel sandwiched himself between the two. He could smell the man’s garlic-and-alcohol breath and feel Ashley’s stare on the back of his head.

“I apologize for my patient,” Daniel said. “I’m a doctor, and the gentleman is ill.”

“He’s going to be a lot sicker if he doesn’t apologize to my wife,” the man threatened. “And what’s he ill with, loss of marbles?” The man laughed mockingly as he tried to peer around Daniel for a better look at Ashley.

“Something like that,” Daniel agreed.

“Whore!” Ashley shouted, while making a lewd gesture toward the woman.

“Oh, that’s it!” the man snapped. He reached out and tried to move Daniel aside while making a fist with his other hand.

Stephanie grabbed the man’s arm. “The doctor is telling the truth,” she asserted. “The gentleman is not acting like himself. We’re taking him back to his room to give him some medication.”

The elevator stopped at the thirtieth floor, and the doors opened.

“Maybe you’d better give him a new brain,” the man said, as his laughing companions pulled him off the elevator. He yanked his arms free and stood, glaring in at Ashley, until the doors closed in front of him.

Daniel and Stephanie exchanged a nervous glance. A potential disaster had been averted. Daniel looked at Ashley, who was smacking his lips as if tasting something disagreeable. The elevator doors opened on the thirty-second floor.

With Carol on one arm and Daniel on the other, they managed to get Ashley off the elevator and down the hall. He did not resist but rather walked like an automaton. At the mermaid door, Carol let go of Ashley long enough to get out her keycard and hand it to Stephanie, who got the door open. As Daniel and Carol started to urge Ashley forward, he shook off their hands and walked in freely.

“Thank heavens,” Stephanie said, as she closed the door behind the group.

The chandelier in the foyer was turned on, as was a lamp on the desk in the great room. Otherwise, the suite was lost in shadow. The drapes were pulled to the side, along with the glass panels. Beyond the balcony, a star-strewn sky arched over a dark sea. Freshly cut flowers rustled softly on the coffee table from the night breeze.

Ashley continued walking until he reached a point a few steps away from the coffee table. There he stopped and remained motionless while staring out at the balcony. Carol turned on more lights to fill the room with illumination, then went to Ashley to see if she could get him to sit down.

Daniel dumped the contents of the medical pouch on one of the small matching console tables in the foyer. He fumbled, trying to tear open a syringe packet, while Stephanie removed the cap covering the rubber stopper on the parenteral medication vial.

“How are you going to do this if he resists?” Stephanie whispered.

“I haven’t the slightest idea,” Daniel admitted. “Hopefully, Dr. Nawaz and Dr. Newhouse will be here to lend a hand.” He had to use his teeth on the cellophane.

“The senator is grimacing like he did when he smelled the pig excrement,” Carol called from the other room.

“Try to get him to sit down,” Daniel yelled back. He finally got the syringe out of its packaging and threw the wrapper to the side.

“I already tried,” Carol said. “He refuses.”

A loud crash of furniture in the other room snapped Daniel and Stephanie’s heads around. Carol was picking herself up from the floor after having been shoved into one of the end tables, knocking its lamp over. The ceramic lamp had shattered into a thousand pieces. Ashley was tearing off his clothes and throwing them around the room.

“Oh God!” Daniel cried. “The senator is going off the deep end.” Daniel grabbed one of the alcohol pledgets and tore it open, but the moment he got the pledget itself out, he dropped it. He grabbed another.

“Can I help?” Stephanie asked.

“I’m all thumbs,” Daniel admitted. He got another pledget out and swabbed the rubber stopper of the medication vial. But before he could insert the needle, Ashley let out a shriek. In a panic, Daniel thrust the vial and the syringe into Stephanie’s hands before dashing into the room to see what was happening. Carol was standing behind one of the couches with her hands clasped alongside her face. Ashley was still in the same place but naked save for calf-length black socks. He was slightly hunched over and staring at his hands, which he had cupped close to his face.

“What’s the trouble?” Daniel cried, as he came around to look at Ashley.

“My palms are bleeding,” Ashley said with horror. He was shaking. Slowly, he lowered his trembling hands palm-up, spreading his fingers widely.

Daniel looked at Ashley’s hands and back up into his face. “Your hands are fine, Senator. You have to calm yourself. Everything is going to be all right. Why don’t you sit down? We have some medicine for you, which will make you feel relaxed.”

“I am sorry for you that you cannot see the wounds on my hands,” Ashley snapped. “Perhaps you can see them on my feet.”

Daniel looked down and then back up at Ashley. “You’re wearing socks, but your feet look fine. Let’s sit you down on the couch.” Daniel reached out to take Ashley’s arm, but before he could, Ashley slapped his hands against Daniel’s chest and viciously shoved him away. Completely caught off guard, Daniel stumbled into the coffee table, falling over backward onto it and smashing the flower vase in the process. Water and cut flowers splayed out in an arc on the thick carpet. Daniel rolled off the table face-first, falling between it and one of the couches. Carol screamed.

Mindless of the havoc he’d caused, Ashley skirted around the other side of the coffee table and ran toward the balcony. He stopped abruptly just over the threshold and lifted his hands horizontally with his palms facing forward. The night breeze off the ocean fluttered his disheveled hair.

“Good grief! He’s out on the balcony!” Stephanie yelled. She was clutching the syringe, alcohol pledget, and vial to her chest.

Wincing from the pain in his back from the collision with the flower vase, Daniel struggled to his feet. He ran out onto the balcony, skirting Ashley, to put himself between Ashley and the balustrade.

“Senator!” Daniel yelled, holding up his hands. “Get back in the room!”

Ashley did not move. His eyes were closed, and a look of serenity had replaced the earlier horror.

Daniel snapped his fingers to get Stephanie’s attention. She had stopped just inside the room with a look of dismay on her face. “Is the syringe filled?” he asked, without taking his eyes off Ashley.

“No!”

“Fill it fast!”

“How much?”

“Two cc’s. Quick!”

Stephanie drew up the fluid, pocketed the vial, and snapped the syringe with the nail of her index finger to get rid of any bubbles. She dashed out onto the balcony and handed the syringe to Daniel. She looked into Ashley’s placid face. The man was like a statue. He didn’t move. He didn’t even seem to be breathing.

“It’s like he is frozen,” Stephanie said.

“I don’t know whether to try to give this IV or just settle for IM,” Daniel debated. He took a step forward, still not having decided what he was going to do, when Ashley’s eyes popped open. Without the slightest warning, Ashley bolted forward. Daniel reacted by throwing his arms around Ashley’s chest while trying to brace himself against the floor tiles. But it was like trying to hold back a charging bull. Daniel’s shoes slid easily across the ceramic floor, and when the two men collided with the balustrade, Ashley’s momentum caused them to flip over the top and out into the night.

Stephanie screamed “No!” as she raced to the railing and looked down. To her utter horror, Ashley and Daniel were locked in a slow-motion, tumbling embrace, like two lovers falling into the abyss. In the next instant, Stephanie averted her gaze, and with a sick feeling, she slumped down with her back against the cold stone balustrade.