The Fixer

27

Jeff put in a call to his former client, the chief of neurology at Mass General, Dr. Mortimer Epstein. Dr. Epstein had in turn called Rick and spent a good ten minutes on the phone asking about Lenny’s condition. A generous act by a busy man. Rick could hear traces of an old Brooklyn accent in Dr. Epstein’s speech, probably traces he’d tried to expunge, mostly successfully.

A few minutes into the conversation, Rick said, “So Jeff mentioned something about magnet therapy?”

“It’s called transcranial magnetic stimulation,” Dr. Epstein said. “TMS. It’s been quite successful in treating depression, and it’s shown some promising results in treating stroke victims as well.”

“So it’s a brand-new procedure?”

“There’s nothing new about it. TMS has been around for thirty years. The great thing is, there’s no downside. They basically place a magnetic coil on the patient’s head and run an electrical current through it, pulsing it on and off for half an hour. If it works, great. If it doesn’t-well, no harm, no foul.”

“How long does it take to work?”

“It can take weeks and it can take days.”

“Sounds a little sci-fi.”

“That’s what they said about anesthesia a hundred and fifty years ago. Anyway, look, TMS has become quite popular. There’s a long waiting list of patients desperate to try it.”

“How long a waiting list? I mean, are we talking months?”

Dr. Epstein let out a low chuckle. His Brooklyn accent came on strong. “Well, look, I’ll try to pull some strings, get you moved to the head of the line. But how long has it been since your dad’s stroke? I mean, not for nothing, but it’s been like twenty years, right? What’s the rush all of a sudden?”

Rick didn’t know how to answer. What’s the rush all of a sudden? The answer was simple and almost too ugly to admit.

A few weeks ago he didn’t care that his father couldn’t speak. The Lenny he’d grown up with was gone, replaced by a gaunt, spectral Lenny who bore no relation to his actual father.

So for the last twenty years he’d parked this replacement Lenny in a nursing home, just waiting for him to die a quiet and anticlimactic death.

Until it turned out that there was a lot of money at stake.

The next morning Rick showed up at the nursing home in an uberX car, a perfectly neat Mitsubishi. He’d brought a new set of clothes: a pair of khakis, a belt, and a blue button-down shirt. One of the attendants, a short, stocky Brazilian named Paulo, got Len out of his pajamas and into the new street clothes, which was a complicated operation. Also, the belt was too big; his father had lost a lot of weight over the years, largely muscle mass. Rick wheeled him out of the nursing home and into the wheelchair-accessible cab, with a lot of help from the taxi driver.

This was his father’s first time outside the walls of the nursing home in eighteen years, and Lenny stared out the window, wide-eyed. By shortly before noon, they’d passed through the gates of the Charlestown Navy Yard, the two-hundred-year-old shipyard now part residential, part commercial, part historical preserve. It was the site where the British landed just before the Battle of Bunker Hill. Now, Marine barracks and paint shops and forge shops had been turned into condos; warehouses and rope walks and officers’ clubs had been converted into outlying research facilities for Mass General Hospital. The cab pulled up to a brand-new-looking hospital building, the Sculley Pavilion, named for a rich benefactor, Thomas Sculley, the real estate magnate. Just seeing it gave Rick that unfinished-homework pang. The piece he’d been pretending to write.

When they got out, Rick could smell the tang of salt air and hear the cry of seagulls. They were just a few blocks from the Atlantic.

Getting his father out of the cab and into his wheelchair was an ordeal. Lenny’s head lolled to his left, a thread of drool escaping the left corner of his mouth. His eyes came open as the chair scraped against the ground.

“You doing okay, Dad?”

Rick hadn’t pushed a wheelchair for nearly twenty years. Gradually he got the hang of it as he searched for the wheelchair-accessible entrance. Even the simple process of wheeling his father up into the Sculley Pavilion and finding an elevator and getting him up to the second floor required reserves of patience Rick no longer had, if he ever did.

The elevator to the second floor required a building card-key-the research facility was security-protected-but people, he found, went out of their way to help. A woman in scrubs swiped the elevator keypad for him before taking the stairs herself. People passing by smiled at him as he wheeled his father out of the elevator and down the corridor. He was the good son taking care of his aged father. Everyone liked that.

“Well, Lenny, the guy we’re about to meet is apparently some hot shit at Mass General. He’s an expert in something called transcranial magnetic stimulation.”

His father’s eyes stared straight ahead.

“I know,” Rick replied to his father’s silence. “That’s what I thought, too. But I figure it’s worth a shot.”

The director of the Laboratory for Neuromodulation was Dr. Raúl Girona, an associate professor of neurology at Harvard Medical School who had dark brown hair cut in high bangs and had a few days’ growth of beard that looked deliberate. He wore tortoiseshell glasses that looked Euro-stylish instead of nerdy, a navy suit and a bright green tie and a red Pebble smart watch. He couldn’t have been out of his thirties.

Meanwhile, in the next room, Lenny was being put through a battery of tests, all exams he’d no doubt been given years before, the greatest hits of stroke rehabilitation. He submitted to the tests docilely, as he did everything now, since he no longer had the ability to object.

“I should warn you,” Dr. Girona said as they shook hands. “Your father’s case is a difficult one.”

“Because of how long it’s been?”

Dr. Girona shrugged and sank back into his chair behind a small bare desk. “That concerns me less than the fact that your father does not speak at all. Most stroke victims are able to speak to some extent. They can make sounds, sometimes words or phrases. But your father’s chart indicates that he is unable to phonate at all, correct?” He was from Spain, according to his bio on the Mass General website, from Catalonia, but his English, though strongly accented, was remarkably fluent.

Rick nodded. “I’m not expecting miracles. I’m not expecting him to sit up one day and start talking about the Red Sox starting lineup with me. I just want to know what’s possible.”

“Well, your father has been categorized as a global aphasic. That means he can neither express himself nor comprehend when he’s spoken to. But I take it you think that diagnosis is incorrect.”

“I think there’s a good chance, yeah. Seems like he understands when I talk to him. He just doesn’t have a way of communicating what he wants to say.”

“What makes you think he understands?”

“He sometimes blinks rapidly, like he’s trying to tell me something. And when I asked him about something recently-something upsetting, I think-he grabbed my wrist.”

“With his right hand?”

“His left.”

“Ah, yes. His right side is immobilized. Well, perhaps so. More to the point, the question is, how much does he understand? And how can you know?”

“If he could write a note, maybe. Or type on a keyboard.”

Dr. Girona nodded. “I’m sure your father’s doctors and occupational therapists have tried all of the standard methods. The picture and symbol communication boards and so on. But the problem is, some aphasics don’t understand speech at all. At most, they recognize familiar names.”

“Can TMS help with that?”

“Perhaps. You know how a stroke affects the brain, yes?”

“Basically.”

Dr. Girona went on as if Rick hadn’t replied. “A stroke happens when something cuts off the flow of blood to your brain. The neurons in a certain area of the brain are starved of oxygen and they die. Now, the part of the brain where your father had a stroke was the left side, yes? And we know the left side of the brain not only controls the right side of the body but it’s also where the dominant language center is-the left inferior frontal gyrus, where speech is produced.”

“Okay.” Rick nodded.

“Now, when one side of the brain is damaged in a stroke, the other side takes over. As if to compensate. But we want to make the left side start to work again, right? To grow back, you might say. And the way we do that is to use magnetic pulses to rewire the brain itself. We run an electrical current through a wire in a coil to generate a magnetic field. Depending on what kind of magnetic field we generate, we can either activate the brain cells or inhibit them. Make them either more reactive or less. Are you following me so far?”

“I think so,” Rick said. “So you want to inhibit the right side to make the left side start doing work.”

“Exactly! We place the coil over the posterior inferior frontal gyrus. To inhibit the right side of his brain. Which we hope will make the left side, the language side, start to work again. And gradually the brain begins to rewire itself.”

“Will it hurt him?”

Dr. Girona shook his head. “At most, it may feel like a series of pinpricks.”

“How long will it take to see some results?”

“A few weeks, most probably. But you need to have realistic expectations.”

“What should I expect?”

“Expect nothing, and you won’t be disappointed.”

“I see. Well, anything would be an improvement.”

“One more thing. And perhaps I should have started with this. This is a costly procedure, and it’s not covered by any insurance.”

“How costly are we talking?”

“You’ll have to talk to our finance people.”

“Ballpark.”

“For a full course of treatment we’re talking probably over a hundred thousand dollars.”

Rick nodded, shrugged. “That won’t be a problem.”