by Alan L. Moss
The doctor opened a medical folder sitting in the middle of his desk. Jack Flanagan listened intently, his left elbow resting on the arm of the couch and left hand rubbing his chin nervously. In his late forties, his long blond hair and blue eyes made him look more like an aging rock star then a computer genius. Kellie sat by his side, her left hand held by Jack’s right. Her five-foot frame, short black hair, and slim figure gave her a youthful appearance.
“Now, we knew coming in,” Forer said, “that Tim has Type 1, or juvenile diabetes. We also knew he has trouble stabilizing his blood sugar, even though he has been conscientious in measuring his glucose and taking the appropriate doses of insulin.
“What we learned from our testing is, although Tim is just twelve years old, we have been late in diagnosing his disease. We know this because we have detected the beginnings of diabetic retinopathy, nephropathy, and even cardiovascular damage. In other words, Tim’s body has already experienced damage to his eyes, kidneys, and blood vessels. It’s very unusual in a boy of his age, but I have seen it before.”
Tears started to fall from Kellie’s eyes and Jack handed her a handkerchief.
Forer closed the folder.
“The good news is now we know what’s going on. While he is a twelve-year-old, he is at a stage of the disease and shows deterioration usually associated with someone much older.”
Kellie’s heart dropped as she fought to maintain her composure. Forer continued.
“So, now that we know the situation, we must find a way to deal with it. First, we must fit Tim with an insulin pump. Given the ups and downs his body is going through, this is the only short-term way to keep things stable.”
Forer opened a desk drawer and produced an insulin pump that looked like a small portable radio with wires protruding from one end.
“The pump is computer-controlled. It’s usually worn on a belt or placed in a pocket. It delivers insulin into the body through this thin plastic tube that attaches to a very thin needle. The needle is inserted beneath the skin at an infusion site, usually in the abdomen. The pump delivers fast-acting insulin in precise amounts at pre-programmed times. It will give Tim much tighter control over his disease.
“Next, we need to investigate more fundamental ways of dealing with his situation. We must find a way to spare his young body from any more punishment.”
Jack interrupted.
“We know about the pump, but what kind of more fundamental alternatives are there?”
“Look,” Forer answered, his hands joined together as if in prayer, “you’re asking me if there’s a cure, right? The short answer is no, but we may have something close. A procedure called the Edmonton Protocol allows us to transplant pancreatic beta cells that produce insulin. A few hundred patients are testing this protocol to see if it can lead to a cure. The problem is you must subject the body to very powerful anti-rejection drugs and I don’t think Tim could handle them.”
Kellie, wiping the remaining tears away, brightened a little as the doctor continued.
“What we’re working toward is a stem cell cure in which rejection is not an issue. While I know of no human trials underway, my guess is we’re not too far from one. As soon as we identify that kind of test, we’ll do all we can to see that Tim is in the initial group.”
“Is there anything we can do to speed things along?” Jack asked.
Maintaining his monotone, the doctor continued.
“Well, let me suggest two courses of action. First, make every effort to become aware of new stem cell research that’s being conducted or planned. The best source of such information is the International Juvenile Diabetes Research Foundation. Get on their Web site and keep track of new research. If you can, speak to some of the scientists and see if any human trials are being considered. If you learn of a hopeful test before I do, let me know and I’ll do all I can to check it out and get Tim involved.
“Second, if you have the financial means, make some donations to help finance stem cell research. I’m not saying you can buy your way in, and in all honesty, I don’t think you’ll have to. Tim is a perfect candidate, but, becoming part of the community actively fighting this dreaded disease can't hurt."
After thanking Forer and making a follow-up appointment to introduce Tim to an insulin pump, the two parents, hand in hand, walked out to the Lexus coupe parked across from the doctor's office. As soon as they got in the car, Kellie broke down.
“You know, Jack, Dr. Forer was just being kind, trying to give us hope. They’ve been looking for a cure for diabetes forever and I just don’t know if Tim will be able to hold on. My God, isn’t there more we can do?”
“Forer is the best,” Jack responded, putting a positive spin on the results of their appointment. “We’ll just have to follow his advice and work as hard as we can to investigate stem cell research.
“I’ll meet with our financial advisers’ tomorrow morning and get a donation in the works. You need to start researching on the Internet to see what you can find out. Let’s use what we know, what I’ve developed, to help save our son.”
The couple didn’t utter another word on the ride home. They knew only a miracle could save their son.
***
Following their meeting with Dr. Forer, Jack and Kellie spent hours on the Internet searching for clues to promising stem cell research. When they located innovative work, Kellie would track down the principals and try to identify suitable trials. This strategy led nowhere.
However, as soon as they donated half a million dollars to one of the leading university research centers, things changed. They began receiving e-mails and letters informing them of related research, requesting support. Apparently, their gift landed them on several lists used by scientists looking for financial resources.
One afternoon, Jack received a call from a Dr. Jacobs, a renowned endocrinologist in Los Angeles. The doctor said he had heard of the Flanagan’s generosity and of Tim’s precarious condition. If Jack and Kellie were interested in a promising but unconventional approach, the doctor suggested they fly to Los Angeles to sit down with him. He insisted that their meeting not be discussed with anyone, including Tim’s physician.
Jack and Kellie flew to California the next day and met with the doctor. He told them about an international firm specializing in stem cell research which developed a new technique to cure Type 1 diabetes. Although the doctor was well informed about the process and believed it worked, he cautioned that no results from long-term tests were available.
However, given their son’s condition, Dr. Jacobs wanted to provide the opportunity to have Tim participate in the initial trials. The two requirements for participation were a six million dollar donation that would be put in escrow until full pancreatic function was restored, and complete silence, regardless of results.
After researching Dr. Jacobs’ credentials and observing the failure of Tim’s insulin pump to ease his symptoms, the Flanagans leaned toward taking the chance, but they weren’t sure.
CHAPTER 30
PANIC
June 3, 2001
Boston, Massachusetts
Now, Jack focused on the event that pushed them over the edge.
A few days after their meeting with Dr. Jacobs, the telephone rang in the middle of the night. Kellie Flanagan glanced at the clock, rolled over, and picked up the receiver. Given the hour, she was confident it was a wrong number. With Jack still dead to the world, she whispered, “Hello?”
“Kellie, get over here right now and get Tim to a doctor.”
Not fully awake, Kellie struggled to make sense of the call. The voice was Joan Fletcher, the mother of one of Tim’s best friends, Charlie. The boys played on the same baseball team. They were having a sleepover at Charlie’s that night and intended to spend the next day practicing at the ballpark just a few blocks from his house.
Kellie snapped into consciousness.
“What are you talking about?” she shouted.
“Just get over here
. Tim is burning up and his right foot looks like he’s been in a terrible accident.”
Kellie hung up the phone and saw Jack awakened, sitting up in bed.
“What’s going on?” Jack asked, trying to maintain a sense of calm.
“I don’t know. It was Joan Fletcher. She said Tim is burning up and has been in an accident.”
Shaking, Kellie yanked her nightgown off and put on a pair of jeans and a blouse. Jack dressed quickly and said he’d bring the car around and meet her at the front door.
Within a few minutes they were speeding down Lowell Avenue. Jack pulled the car into the Fletcher’s driveway.
Joan and her husband, Mark, met them at the front door and they ran upstairs to Charlie’s room. Charlie sat on the edge of his bed, ashen, looking at his friend.
Tim’s face was flushed and he was unresponsive. Jack pulled down the sheet and looked at his son’s left foot. A deep, raw sore stretched from his big toe to the ball of his foot.
“No accident,” Jack said. “That’s a foot ulcer that diabetics can get. We need to call Dr. Forer and rush Tim to Patriot Hospital.”
Carefully, Jack picked Tim up from the bed, carried him downstairs, and laid him on the back seat of the car. Kellie pulled out Dr. Forer’s card from her wallet and dialed the emergency number on her cell phone as Jack sped away.
She heard a click at the doctor’s end and a voice began.
“For the next week, Dr. Forer is attending a workshop of the American Diabetics Association in Palm Beach, Florida. If this is an emergency, please dial nine-one-one. To obtain assistance during normal office hours, Dr. Leonard Fraser will be acting in place of Dr. Forer.”
“It’s a tape,” Kellie cried. “Dr. Forer is out of town for the week.”
“Don’t worry,” Jack said, not saying any more about foot ulcers.
Tim moaned as the car turned a corner and his foot rubbed against the seat.
“Hurry, Jack,” Kellie pleaded.
Finally, Patriot Hospital appeared and Jack spotted a sign for emergency parking and registration.
“You wait here and I’ll get the doctor,” Jack said, as he opened the car door and disappeared into the hospital.
Kellie turned to look at her son and was surprised to see him with open eyes.
“Don’t tell Dad,” Tim said in a barely audible voice. “I’ve been wearing my cleats.”
Each player had received a pair of baseball shoes, along with a uniform, before their initial game. Tim complained that the shoes irritated the inside of his left foot. Jack told him to discard the shoes for sneakers. With Jack and Kellie unable to attend the past few games, Tim, wanting to be like the other kids, wore the cleats anyway. He didn’t understand the consequences.
“Don’t worry, sweetie, we just need to get you better,” Kellie whispered.
With tears running down her face, she turned away and saw two men approaching the car with a gurney.
“We’ll take it from here, ma’am,” one of the men said. “Your husband needs you at the information desk.”
When the men lifted Tim onto the gurney with confidence, Kellie rushed into the hospital and saw Jack at the registration desk.
“There’s an endocrinologist in residence here and he’ll meet us in ER bay A-110, pediatric triage.”
“Okay, Mr. and Mrs. Flanagan, I have all your insurance information and if we need anything else, someone will call you later,” the receptionist said. “I hope Tim will be all right.”
The couple followed the signs to A-110. Tim had been wheeled in and transferred to an examining table. An emergency room nurse, a husky African-American woman, entered as two emergency medical technicians worked to clean the wound and establish an intravenous line.
With Tim unconscious again, the nurse took his temperature with an ear thermometer, cancelled the reading, and took it again. Then, she surveyed his wound.
“What can you tell me?” she asked, looking at Jack.
“Tim has an unusually volatile case of Type 1 diabetes. He’s under the care of Dr. Forer in Boston, but the doctor is in Palm Beach this week. Tim was sleeping over at a friend’s house when the parents discovered he was sick. They called us about thirty minutes ago.”
“I saw his pump,” the nurse responded, now taking Tim’s pulse. “His foot ulcer must have been there for several days. I’m surprised you didn’t catch it earlier, before it got so deep.”
Feeling as though they were being cross-examined, Kellie responded.
“Tim regained consciousness in the car and told me he’s been wearing the team-issued baseball shoes which are too tight for his feet. We told him he had to wear sneakers but I guess he couldn’t resist the cleats. He hid the sore from us, thinking it would get him in trouble.”
“Kids … aren’t they great?” the nurse asked sarcastically. “Well, Dr. Korashi will be in to look at Tim and provide a diagnosis and recommendation for treatment.”
With the nurse gone, Kellie asked Jack if he knew anything about Dr. Korashi.
“This hospital is excellent,” Jack answered. “If he didn’t have good credentials, he wouldn’t be here. We’re lucky they have an endocrinologist on duty this time of night.”
A minute later Dr. Korashi walked into the room, reading the chart started by the nurse.
“Now, I don’t want to alarm you, but we need to move with some speed,” cautioned the doctor as he began to examine Tim.
Jack and Kellie figured Korashi was either Indian or Pakistani, countries that exported some of their best medical talent to the United States. The doctor moved with grace and precision, addressing the Flanagans after several minutes.
“Let me tell you what we’re facing. First, Tim is running a temperature of close to one-hundred and five degrees. If we don’t rectify this situation soon, he will go into convulsions and we could lose him on that score.
“Second, this foot ulcer is down to the bone and we will not be able to heal it in time. It’s badly infected and pumping deadly toxins into Tim’s bloodstream. If we don’t stop that flow right away, some of Tim’s vital organs, already weakened by his diabetes, will begin to shut down. This could have fatal results.”
Feeling weak but forcing himself to think, Jack asked the doctor about alternative treatments.
“I’m afraid there are no alternatives. To save his life, we will administer powerful antibiotics through his IV and hope his temperature comes down some. Then, as soon as we can assemble a team, we’ll have to remove that foot.”
Kellie’s knees buckled. Somehow she made her way to a vacant bed for support.
“Oh my God,” she screamed, “you’re going to amputate his foot, my little boy’s foot! Jack, you can’t let them do it! No, no, no,” she yelled, falling back on the bed, her arms flailing.
“Please, Mrs. Flanagan,” pleaded the doctor. “We have to save his life.”
***
The next few hours were a blur. In what seemed like moments, Kellie found herself sitting in the operating room theater. Below, she saw Tim covered in white with a black mask over his face and an anesthesiologist sitting on a stool. A team of three doctors and two nurses crowded around the operating table.
A nurse wheeled a tray over to one of the doctors and he uncovered two large saws used to sever limbs. He picked up one of the saws and moved toward Tim’s infected foot.
Tim sat up, removed the mask, and cried hysterically for his mother.
“No, Mommy, no! Stop them, stop them! Don’t let them take my foot!”
***
“Kellie, Kellie, wake up,” Jack begged. “You’re having another nightmare. Wake up!”
“Oh my God, Jack, I can’t even tell you about this one,” Kellie mumbled through tears, still half-asleep.
“I have to see Tim,” she said, regaining her composure.
The couple rose and Jack flipped on their bedroom light.
“My God, Kellie, you look horrible,” Jack said, taking her hand and leading her into
Tim’s room.
Tim was fast asleep.
Kellie opened his closet door and saw the pair of baseball shoes on the floor. She picked them up and started out of the room.
“I’ll give them back once we know he’s been cured,” she said. “Tomorrow, you’re calling Dr. Jacobs and telling him we’re in.”
***
Shortly thereafter, Tim and his parents went to Los Angeles to allow Dr. Jacobs to conduct the necessary tests. Then, they returned to Boston.
As soon as the trial was ready, probably in late June or early July, they would be asked to return. The results of the procedure would be known in one or two weeks.
***
After the bank’s vice president confirmed that the escrow deposit was made, Jack sought solace in the crowded streets of downtown Boston. After two hours of aimless wandering, he realized his son’s life, and possibly his marriage, depended on the outcome of an untested procedure he was prohibited from discussing with the outside world.
With his car in sight, he saw an emaciated old man being pushed in a wheelchair. Jack flashed back to his last conversation with his father before he succumbed to liver cancer in 1981. As delicately as he could, Jack questioned the wisdom of his father flying to Mexico for a radical procedure that offered hope to those near death.
“Son, desperate men make desperate decisions,” counseled his father. Now, he knew what his dad meant.
CHAPTER 31
THE GAMBLING DEBT
June 4, 2001
Pago Pago, American Samoa