The Finder

22

She'd been enormously patient. She'd waited a few days before talking with Tom about what had happened at Martz's party, not that she hadn't kept going over the interaction, trying to understand what it meant for Tom. As soon as the old man had shaken her shitty fingers in front of Ann's face, she had gone cold inside-cold toward Tom, certainly cold toward Martz, whom she did not consider as a patient or worthy of her medical opinion. In fact, no medical opinion had been rendered directly to him. He had simply let go of her hand and then hoisted up his pants.

"I know I got a fucking prostate problem," he'd grumbled.

She'd pulled off her gloves inside out and thrown them in the trash.

"Come on," she snapped at him. "Turn around, face me. I dare you to look me in the face!"

But he had, and wheeled to confront Ann. "Your husband is in a lot of trouble, lady. Focus your attention on him." He cleared his throat. "So, by the way, what's your medical opinion?"

What an asshole, she thought. And I just put my fingers inside it. "My opinion is that you should fear chaos-in all its forms-cellular, psychological, interpersonal, and existential."

Martz, an old warrior, smiled thinly in disgust. "That's it?"

"That's all I'm saying to you."

He grunted, seemingly irritated with himself as much as with her, then left the room, leaving the door ajar. She heard the tinkle of silver ware and the murmur of party talk. She sat to collect herself, looked out the corner window. A beautiful view, the lights of Manhattan to the south and Jersey to the west. So high up she could see all the bridges and the Statue of Liberty. Money bought you a lot of sky.

Connie Martz hurried in. "He said you didn't tell him anything?"

Ann looked at Connie. How much did this woman know about her husband? How much did any woman know? And how much do I know about Tom? she thought.

"He seemed eager to get back to the party," she said diplomatically, her anger receding as she saw Connie's anxiety. "I'm supposed to tell him directly but I'm going to tell you."

"Please."

"Given the bit of history you gave me plus what I felt, I think he needs an immediate needle biopsy of the prostate, as well as a PSA test. I'm sure he's had one in the past, given his age. But the lobes of the prostate are lumpy, irregular, and show what we call differential firmness-hard here, soft there. Not good. This is very consistent with prostate cancer, though not proof of it. Only a needle biopsy can tell you for sure. But I would have this done tomorrow."

"Test for cancer tomorrow?"

"Once prostate cancer escapes the gland, treatment is much more difficult. The cancer seeds itself. Treatment is no longer confined to the organ but is systemic. From a theoretical basis, the escape of one cell is the tipping point into advanced prostate cancer. If you get it before that first cell escapes, then-"

"Yes, yes! I understand!" Connie's beautiful blue eyes became tearful, then she nodded in determination. "Thank you, Doctor."

Ann had found Tom when she rejoined the party and asked if they could go. He'd seemed relieved, but it took them fifteen minutes to extract themselves graciously. Connie noticed their exit, Martz did not. In the elevator, Tom asked her where she'd gone.

"I just gave your friend Martz a prostate exam."

"What? At a cocktail party?"

"His wife was very persistent."

"And?"

"He needs to have more tests," she said obliquely, somehow aware that this was not the time to violate doctor-patient confidentiality.

"He's not about to die or anything?"

"No," she answered tersely.

That had been two days ago, and she had watched Tom carefully since then.

Now, as they prepared for bed, she said, "That man Martz told me a few things the other night."

"What kind of things?" responded Tom, his voice calm.

Ann stood at the side of the bed, waiting for his full attention. "He said you were in a lot of trouble, Tom. That there were huge amounts of other people's money involved. He said you needed to give him some information. That you had lied to him! He's a very threatening person, even if he has prostate trouble. Maybe even because."

"He threatened you?"

"No, he threatened you, Tom. I'm just a doctor who pokes her finger into people. You're the corporate big shot throwing hundreds of millions of dollars around."

"All right, okay? I get it."

She watched him pull on his pajamas. Too much chub around the midsection; led to organ fat. We are now middle-aged, she thought. And no children. From a biological point of view, we've failed.

Tom swallowed an Ambien, as he did every night. "You said he might be threatening because of the prostate trouble?"

Ann sighed. This was Tom doing his bait and switch, stalling while he figured out what to say next. "There is a theory," she began, "just a theory, but a smart one, that when prostate cancer reaches a certain critical mass, it begins to affect the man's endocrine cycle. Messes with it. Prostate cancer cells like testosterone, live on it. This is why in advanced cases an orchidectomy is done, castration, in other words, or chemical castration is achieved through the administration of Lupron. Anyway, the prostate cancer cells may mess with a man's testosterone level. The disease itself stresses him, as perhaps does somatic awareness that he is ill-something I really believe happens, which is that we know we are sick before we really feel sick or are told we are sick-but in any case the level of free testosterone in his blood and hence in his brain fluctuates greatly. The system is sort of on the fritz. This can cause a bit of low-grade confusion, depression, and irritability. Or just sometimes inappropriate aggression, such as I witnessed. Sugar levels in the aged are also more volatile, and you get some interesting combination effects of sugar levels and endocrine levels. He'd probably had a drink or two, which both raises testosterone briefly and decreases inhibitions, of course. But I'd bet the other factors were at play. There's a lot of research on this being done. Decision making may be affected. It's subtle, especially because by the age of fifty the pathways of decision making in humans are highly determined. People largely think the way they always have, unless the general brain health begins to degrade, usually because of dendritic plaques and ministrokes."

Tom was listening closely now. Like his life depended on it. "Wait, take it back to Martz."

"Fine. I think you're in some kind of trouble, Tom, and you haven't told me about it!"

He was silent.

"And, based on my clinical experience, and a brief interaction, the man you are in trouble with cannot be depended upon to be highly rational! Or kind and decent! I don't care how much money he has! He's an animal under stress! He's got high cortisol levels, increased blood pressure, who knows what. He's also clearly an aggressor, given how much wealth he's accumulated. In fact, extreme wealth accumulation is, according to some people, an indication of pathological obsession, personality disorder, inappropriate aggression syndrome, grandiosity, nice things like that."

"What do you suggest, Dr. Wife?"

"I suggest you get yourself out of whatever goddamn mess you are in! Come on, Tom! What the hell else do you want me to say?"

He was deciding to tell her, she could see. "Tom? What is it? You can't tell me?"

He made a little biting motion. "It's a business thing."

"You won't tell me? You're actually not going to tell me?"

"It's-I just don't want to go into it, okay?"

He looked at her, plaintively, she thought, so far buried in the structures and agendas of Good Pharma that he was more or less inextricable from it. She turned off the light, settled into bed, her mind wide awake now, even after a long day of work. Tom, she knew, was the company, the company was him. He was not the Tom Reilly she'd married. That man had disappeared at least ten years ago. That man used to be good in bed, be fun to spend time with. God help her for even having the thought, but the plain fact was that Tom had become, what, a human information processor inside the information structure that was the company. Good Pharma manufactured pills and other medical goods, but those were the endpoint results. The company didn't even make the pills, actually. They were jobbed out to for-hire pharmaceutical factories, usually in Puerto Rico or India, increasingly with proprietary manufacturing contracts. The company was a huge matrix of human information processors both running and being run by the information technology. The levels of abstraction, from the chemical composition of the pills themselves, to the research protocols, up through the organization of each division, to the management of the company as a whole, to its interaction with the health-care market on the one hand, governmental regulation on the second, and the financial markets on the third, required people like Tom, supersmart human processors who could carry around enormous levels of abstraction, segue among them and choose the proper inputs of information to each and derive the correct output information from each. You had to have a highly compartmentalized mind yet the ability to reach from one compartment to another for a piece of information that was relevant. Tom was like that and had become more so in the years she'd known him, the overall functioning of his brain becoming, arguably, more specialized in the exact manner the company required. Classic nature-nurture feedback. Environment switching on and off genes in real time, which researchers were starting to understand was possible. Her proof? Highly subjective, admittedly. But she was his wife, after all. He'd lost his playfulness. His sense of humor was far less subtle, more brutal and dark. He read faster; she could see it in the morning with the newspaper. Certain of his mental functions were more highly de veloped. He retained numbers well, perhaps because they had deeper significance. He could articulate better in social settings. He was, in fact, very good with the social aspect of the job, glad-handing prospective investors, showing them a good time, negotiating when the time came. She'd heard him on the phone from home, listened to his voice, and been impressed with the instant affability, the somber tones of judgment-whatever the situation demanded. But these were not authentic responses, she'd come to see. They were mannered-no, that was not the right word-they were algorithmic. Most of the people Tom dealt with were coming to him from a position he understood. He knew more or less what they wanted and why they were talking to him. Under these circumstances, an algorithm of interaction was called for. It was conversation, yes, but not exactly spontaneous human contact filled with discovery and intimacy. Ann herself understood this, for it was how she dealt with patients. You tell someone she has high blood pressure a few hundred times, you start to do it the same way. So she understood that. But in Tom's case most of the conversation involved abstractions that were answered with abstractions. The people on the other end of the conversation were working within an algorithm, too. This meant that Tom had very few real conversations. He spoke to dozens of people a day but always within his corporate persona and within the appropriate algorithm. He was trapped. The man he'd been once was either buried under all of this behavior or even, perhaps, gone. Irrecoverably. We change in only one direction. We don't ever change back. She still loved Tom, she supposed, at least out of a kind of habit; her mind was trapped within its own algorithms, too, of course.

But in this overall perception about her husband, who was now brushing his teeth in their bathroom, came another one. Tom had made an error. A big human error. He had misjudged a human being. Maybe it was Martz, maybe it was someone else. The misjudgment was a serious one, full of huge personal and professional risk. This led her to another thought.

Tom was stalling because he didn't have an algorithm.

He'd never seen the problem before.

He didn't know what to do.