The Killing Harvest

by Don Donaldson

  They reached the front entrance and went outside, leaving the eavesdropper behind.

  “You haven’t answered my first question,” Marge said. “If the decision were yours and the insurance wasn’t a consideration, would you do it?”

  There were actually two issues here. One was money, and the other was getting Drew well. It was theoretically possible that somewhere in the world there were other doctors who understood Drew’s condition and had a safe and effective treatment that wasn’t so experimental. But who were they? Pierce hadn’t suggested a name, so he didn’t know of any. And he read everything. If they didn’t go with Latham, Drew would remain paralyzed while they followed other leads and took him to other clinics for evaluation, all of which would eat up money neither Marge nor Sarchi had. More important, the longer Drew remained the way he was, the greater the risk to his life. If only they could feel more secure about Latham. Then, Sarchi had an idea.

  “Look, we’ve got a couple of hours before we meet again with Latham. I’ve got a friend doing a residency at University Hospital here. Why don’t we call her and see if she’s heard anything about him or knows anyone who has.”

  “Let’s do that.”

  The Latham issue wasn’t the only reason Sarchi wanted to make the call. Before leaving Memphis, she’d sent Sharon McKinney, her best friend from med school, an e-mail saying she’d be in town today and, if there was time, she’d try to contact her.

  The most direct access to any doctor is through their pager. Fortunately, Sharon had given Sarchi the number of hers months ago. Sarchi punched the pager number into her cell phone, waited for instructions, then gave the pager her call-back number.

  Two minutes later, as Sarchi and Marge arrived at their rental car, Sharon returned the page.

  “Sharon, this is Sarchi.”

  “Are you in town?”

  “Across the river in Gretna . . . at the Westbank Medical Center.”

  “How long will you be here?”

  “I’m not sure, maybe just today,” Sarchi said.

  “Can you get free for a bit?”

  “Possibly, but listen, do you know anything about a neurosurgeon over here named Latham?”

  “I don’t, but there are a couple of people here with ties to Westbank. I could ask them.”

  “I’d appreciate that,” Sarchi said. “We’re under a time constraint, so could you do it quickly?”

  “Sure. Give me an hour, and then how about we meet at Cafe Dumond?”

  “Sounds perfect. See you there.”

  THE WEATHER IN New Orleans was much better than what they’d left in Memphis. The sky was cloudless, and the temperature was in the high sixties, minimizing the smell of the carriage horses that lined Decatur along Jackson Square. As usual, the area was barely contained pandemonium.

  In the few blocks from the parking lot beside the Jax Building to Cafe Dumond, Marge and Sarchi encountered three little kids keeping the art of tap dance alive, a living statue dressed like a 1920s flapper, and a talented musician playing “My Way” on a sax.

  Being the signature stop on most tourists’ visits, Cafe Dumond was hopping. They were fifteen minutes early, but Sarchi still scanned the throng looking for Sharon. Not finding her, she and Marge grabbed a table in back, just as the previous occupants were leaving.

  “You’ll like Sharon,” Sarchi said. “She’s a lot like you—tough, assertive, which didn’t always play well in med school. She’s real petite, and her fingers are short. So one day a group of us, including Sharon, are learning how to do proctology exams on a plastic model. But Sharon’s fingers couldn’t reach far enough into the model’s rectum to even touch the prostate. Well, the guy who was supervising this exercise, an evolutionary throwback about six-foot-six and thirty pounds overweight, who didn’t think women belonged in medicine, starts ridiculing her about it. I’ll never forget her reaction. She didn’t cry or get mad, she just looked this guy square in the eye and said, ‘Doctor, surely you have observed before this that, like assholes, fingers come in a variety of sizes.’

  “It was clear to all of us what she meant, but I don’t think he fully got it. Oh, he picked up on the tone, but to this day, I don’t believe he knows what she did. He put something in her file about being disrespectful, but she was so good at her work it didn’t matter. She finished third in a class of one seventy. Had an uncanny ability to predict what the exams would stress.”

  “Didn’t you finish second?”

  “Well, yeah, but only with Sharon’s help.”

  “I doubt that.”

  A busboy came and cleaned away the debris from the previous occupants. He was followed by a waiter who was put on hold until Sharon arrived, which she did a few minutes later.

  Sarchi and Sharon hugged, then Sarchi introduced her two friends.

  Sharon was indeed a small women. She had long red hair with bangs and skin as smooth as Drew’s when he was an infant. Her eyes were large and expressive. A strong chin, however, upset the balance.

  “I’ve just been hearing of your exploits during the proctology exercise,” Marge said.

  Sharon rolled her eyes. “Sarchi always makes more of that than it deserves.”

  Marge was surprised at Sharon’s husky voice.

  Noticing that the remaining member of the party had arrived, the waiter returned, and they all ordered the traditional beignets and coffee.

  “Sarchi told me a little about why you’re here,” Sharon said to Marge. “I’m so sorry for your trouble.”

  Marge acknowledged Sharon’s expression of sympathy with a wan smile.

  “I guess Latham is your son’s doctor?”

  “Not quite yet,” Sarchi said. “We’re supposed to say ‘yes’ or ‘no’ in about two hours.”

  “I talked to the people I told you about,” Sharon said. “And I can tell you he’s Westbank’s prize pony. His service generates about twenty-five percent of the hospital’s billables.”

  “But is he any good?” Sarchi asked.

  “I wouldn’t think he’d be pulling those numbers if he wasn’t.” She opened her handbag and reached into it. “I stopped at the LSU library on my way here and looked him up in the specialty directory.” She unfolded a sheet of paper and handed it across the table to Sarchi.

  There were lots of bios on the page, but Sarchi was able to go right to Latham’s because Sharon had circled it. “At least he’s a board-certified neurosurgeon,” Sarchi said, seeing that first. “Good training—a five year residency at Albert Einstein, fellow in neurosurgery at University Hospital in Zurich . . .” Her eyes dropped to the abbreviations of his society memberships. “What’s AANS?”

  “American Academy of Neurologic Surgery,” Sharon said.

  “And CNS?”

  “Congress of Neurologic Surgery.”

  The waiter came and distributed mugs of coffee and hot beignets dusted with powdered sugar to the three women.

  “The smell in this place alone has doubled my triglyceride levels,” Sharon said, looking at her plate. “Do I really need this?”

  “You made that decision when you ordered,” Sarchi said.

  “Good point.” Sharon sampled one of her beignets and washed it down with coffee. “One of life’s simple pleasures,” she sighed.

  “Well, he looks good on paper,” Sarchi said. “But did anybody at your hospital comment directly on his skills?”

  “No. That’s the second time you’ve questioned his ability. Do you have reason to doubt him?”

  “He rubs her the wrong way,” Marge said.

  “If they got rid of every testosterone-driven jerk at University Hospital, the place would be practically deserted. It’s almost an axiom: If it’s a man, the better the doctor, the bigger the jerk.”

  “You and Steve have had another
fight?” Sarchi said.

  “Am I that transparent?”

  “Where’s the Windex?”

  “If you don’t mind, I’d rather not occupy a single neuron thinking about him. Did anybody directly say Latham was skilled? No. Did anybody say he wasn’t? Also no.” A certain look crossed Sharon’s face.

  “You’ve thought of something?” Sarchi asked.

  “The guy who runs our clinical labs, who’s actually kind of hunky, used to work in the lab at Westbank. He said Latham was always ordering PCR reactions on tissue from his patients. But what Latham was looking for was never there. Not once.”

  “What’s a PCR reaction?” Marge asked.

  “It’s a way to amplify tiny quantities of DNA,” Sarchi said. “To the sample you want to test, you add two primers that will bind to different regions of the DNA you’re looking for. You throw in the right enzymes and some raw materials, and if the DNA in question is there, the piece between the two primers will be made over and over from the raw materials.”

  “Like stamping out a truckload of gaskets from one mold,” Sharon said.

  “With PCR you can detect as little as one copy in the original sample,” Sarchi said. “The guy who invented the technique won the Nobel prize.”

  “And revolutionized biological science,” Sharon added.

  “Did your friend say what they were trying to amplify?” Sarchi asked.

  “He doesn’t know. Latham just gave him the primers and told him the size of the product that would be detected if there was a hit. Considering what you’ve told me about the kinds of cases he handles, I’d guess it’s probably a screen for encephalitis virus or something like that, to rule out an infection.”

  They chatted for a while longer, then Sharon got a page that called her back to work.

  As Sharon made her way out of the restaurant, Marge said, “Well, what do we tell Latham?”

  “I guess we say yes.”

  “I don’t want to leave Drew alone here. Maybe I’ll stay at a motel near the hospital.”

  “I’m having the same feelings, but I’ve got to go home. And you might as well come, too. You didn’t bring any clothes.”

  “I could buy a few things.”

  “Latham said we couldn’t see Drew, so what’s the point of staying? You’d have nothing to do but worry. At least if you were home, you’d have your work to think about. And it’s really not such a long time.”

  “I suppose you’re right.”

  “So you’ll be coming back to Memphis with me?”

  “I guess so.”

  “Then I need to see if there’s a late plane we can take today.”

  Using the Internet connection on her phone, she managed to get them on an eight o’clock flight. They spent the next hour distractedly hitting the antique shops on Royal Street, then returned to the Westbank Medical Center.

  LATHAM TOOK THE surgical release form from Marge. “I realize being separated from your son will be difficult,” he said. “But you can be sure he’ll get the best care possible. And when you next see him, I think you’ll be very happy.” He pressed a button on his intercom. “Julia, will you come in here please?”

  “If you’ll go with Julia, she has a few more papers for you to sign.”

  A nurse who smelled heavily of lavender appeared in the doorway, and Latham gave her the surgical release form for Drew. Sarchi and Marge then followed her to another room.

  Across the hall from Latham’s office, where the billing was handled, the woman who had eavesdropped on Marge and Sarchi’s discussion earlier on their way to the car, and who had overheard both conversations through the thin office door when they’d met with Latham, stepped into the hall and watched them leave. Both attractive women, she thought. Everywhere there were attractive women. But not her . . . oh no, not Lee-Ann.

  9

  REACHING HOME AFTER the flight from New Orleans, Sarchi grabbed her neuroanatomy text and read about the ansa lenticularis, the fiber bundle Latham was going to sever to treat Drew. The neural connections involved were so diffuse and complex she didn’t learn much.

  She woke the next morning to the sound of hammers and the tearing of wood. Looking out the window, she saw a work crew attacking the house next door.

  This poor start to the day continued. Upon arriving at work, she discovered that Gilbert Klyce’s creatinine levels had gone from .3 to 1.2, meaning that the antifungal drug he was being given for his yeast infection, in combination with the vancomycin he was receiving to combat the MRSA, was damaging his kidneys.

  Welcome home.

  She responded by cutting the antifungal dose in half and ordering a new set of blood, urine, and tracheal cultures. At the first opportunity she located Mel Pierce, the neurologist Kate had called in on Drew’s case, and questioned him about the ansa lenticularis. He patiently explained what it was then went on to say he didn’t see how cutting those fibers could have any effect on Drew’s condition. This made Sarchi even more apprehensive about Latham.

  There had been no equivocation in Latham’s statement that Drew’s treatment would be complete in five days. So after making sure she could take the time off, Sarchi dipped again into her cache of frequent flyer tickets and scheduled Marge and herself on a flight back to New Orleans the following Wednesday. For the return, she put all her pessimism aside and reserved three seats.

  By the next morning, Gilbert’s creatinine had improved to .9, and his cultures, miraculously, were negative. Fortunately, this was his last day on vancomycin. Over the next three days, his creatinine inched back to normal, and repeat cultures stayed negative. The swelling in his pharynx also subsided to where they were able to remove his trach tube. After consulting with Kate, Sarchi substituted an oral antifungal for the one Gilbert had been receiving intravenously, and she shipped the boy back to Brunswick.

  A win for the good guys—or at least a draw.

  Marge contacted Latham’s clinic daily to check on Drew, then called Sarchi. And every day the message was the same: “Drew is doing well, and everything is proceeding as expected.” On Tuesday, the clinic reminded Marge to bring Drew some clothes when she came to pick him up.

  The next day Sarchi and Marge left Memphis on an eleven o’clock flight and by one o’clock were walking through the Westbank Medical Center’s main entrance.

  “I am so scared, I’m shaking,” Marge said.

  “They’ve had plenty of opportunity to tell us if anything was wrong and have said nothing. So let’s go get him.”

  Despite her expressed bravado, Sarchi’s insides felt like cold dishwater. As instructed, they took the clothes to Latham’s waiting room and gave them to Julia, the nurse who smelled of lavender. She smiled and told them it would be a few minutes before Latham could see them. She gave Drew’s clothes to another minion in white, who went out the waiting room door carrying them.

  Sarchi took a seat to wait, but Marge paced. After a few minutes of that she came over and sat as well.

  Sarchi took Marge’s hand in hers.

  “My palms are sweating,” Marge said.

  “It’s natural.”

  “Yours aren’t.”

  “I’m a hardened professional.”

  As they waited, it struck Sarchi that there were no other patients in the room. Considering what Sharon had said about the money Latham was bringing in, the place should have been jammed. Maybe there was another waiting room. Or possibly Latham was making so much on each case, he didn’t need volume.

  After what seemed like an hour, but was actually a much shorter time, the waiting room door opened, and the woman who had taken Drew’s clothes returned—with Drew.

  And he was walking—no, running—toward his mother.

  “Momma, I’m better.”

  Marge caught Drew in her arms and hugged him
so tight he complained. “I can’t breathe.”

  Marge held him up and covered his face with kisses. Sarchi’s eyes grew watery, and she fought to keep from crying openly. “Don’t I get a hug?” she said.

  Marge handed Drew to her, and she kissed him on the cheek and then gently on the small scabs above each eyebrow. Drew pulled his head back and gave Sarchi a serious look. “That’s enough kissing for now.”

  It was one of the most exciting days of Sarchi’s life. Drew was cured. All Sarchi’s reservations about Latham were gone, washed away in this stunning demonstration of his competence.

  “Well, what do you think?” Latham said from the doorway leading to the back.

  Latham walked over to Drew and gently rubbed his knuckles against the boy’s shoulder. “Hello there, young man. Are you happy to be going home?”

  “Are you coming too?” Drew asked.

  “No. I have to stay here and work.”

  “Nuts. We could play with my trains.”

  Sarchi offered Latham her hand. “Doctor, I’m awed.”

  “Don’t be,” Latham said, taking her hand. “I’m sure you do as much for your patients. May I?” He held his arms out for Drew, and Sarchi handed him over.

  Latham then turned to Marge. “Mrs. Harrison, these little scabs above each of Drew’s eyebrows are where the device we used to guide our instrument into Drew’s brain was screwed to his head. I know it sounds terrible, but it really isn’t. Those scabs will quickly fall off. Up here”—he gently touched a spot in Drew’s hair—”there are two places with metal clips in the skin, where the incisions were made for entry of the instrument.”

  “There was more than one incision?” Marge asked.

  “The brain is bilateral. There was one affected area on each side. Hence two incisions. Some surgeons shave the entire head, but the hair takes so long to grow back I thought you’d prefer this way. The clips should be removed in a week. I’m sure Doctor Seminoux would be happy to take them out. He hasn’t been having any headaches, but that wouldn’t be unusual. If he begins to have some”—Latham reached in the pocket of his white coat and took out a prescription which he handed to Marge—”have this filled.”