Were you bitten by a tick? Yes. When? I left it blank.
When I finished I lay the clipboard in my lap, too tired to rise and give it to the receptionist.
Time blurred. I think I fell asleep. The next thing I knew a nurse was touching my shoulder. "Mrs. McNeil? The doctor's ready to see you now. Here, I'll take that." She held out her hand for the clipboard. "You need help getting up?"
"No. Thanks."
In slow procession she led me down a hallway and into an examining room. I eyed the paper-sheeted gurney and knew I wouldn't be able to balance upon it. "Sit here." The nurse motioned to a chair with arms.
I sat like a rag doll as she went through the typical nurse routine of blood pressure and temperature readings. "Okay, sit tight and the doctor will be right with you." The nurse left, closing the door behind her.
Sit tight. What else could I do? Now that the moment had come to see a bona fide Lyme-literate doctor, part of me wanted to flee the building. What if she said I didn't have Lyme? Any diagnosis would be better than not knowing. But I'd gone through so many tests for everything else. What was left?
A knock sounded on the door, jilting my nerves. It opened, and in walked a woman in her fifties, trim, with bobbed brown hair and large eyes. She couldn't have stood over five feet five, but an air of assurance and strength entered the room with her. No white coat. Just slacks and a blouse. She carried the clipboard with my telltale papers. "Hello." She gave me a sunny smile. "I'm Dr. Johannis."
I managed a weak smile in return. "Hi."
She surveyed me. "Boy, my nurse is right. You look really sick. I'm glad we were able to get you in so quickly."
A lump welled in my throat. Just to have a doctor admit I looked unhealthy. "Yeah."
"I understand you think you have Lyme." She sat in a chair opposite mine and plucked a pen from a pocket in her blouse. "I've looked through your symptom list here. You've certainly checked a lot of them."
I nodded.
"When did they start?"
"I don't . . . I need a calendar."
"Here you go." She pointed to a large one on the wall. I hadn't even noticed it. "You're not the first patient who's needed it. You need to look back a few months?"
"No, just . . ." My gaze faltered around on the calendar until I found today's date—Tuesday. That day I'd started to feel much worse—when I'd fallen in the kitchen—had to be weeks ago. It seemed like another lifetime. But I'd only been home a couple days from the hospital. And only been there a few days. I counted backwards, and my mouth fell open. It couldn't be. That had been just last Thursday. Five days ago.
Just six days ago I'd thought I had the flu? I'd had my hope to get better soon, a husband, a daughter. I couldn't grasp that. Surely I'd been through a time warp.
"Thursday I got worse. Last Thursday. I'd been s-sick for about three weeks before that. I just thought it was the . . . flu. Until Thursday."
"Okay." She jotted a note. "Your form says you were bitten by a tick. How long ago was that?"
"I don't know."
"You have any idea? One month? Two, three?"
I held her eyes, feeling the thump of my heart. Maybe I shouldn't have come. How could I go through this exam without telling her everything? I didn't know when I'd been bitten. Stalking Man said the ticks carried Lyme and three coinfections. Shouldn't I tell her that? But how could I?
My head shook.
Dr. Johannis made another note. "All right. Tell me what happened last Thursday."
In halting words I told her. My weakness and fatigue that day. Falling in the kitchen. My stay at the hospital. The slew of tests—all negative. Including the one for Lyme.
When I was done, Dr. Johannis shook her head. "You poor thing. Amazing they were able to run all those tests so quickly."
Not if you're Brock McNeil's wife. I shrugged.
She set down the clipboard. "Okay, let's take a look at you."
The doctor allowed me to stay in the chair as she gently examined my hands, wrists, and ankles. She poked around in my chest, stopping when I gasped. "That really hurts, huh?"
Oh, yeah.
She handed me my cane. "Can you stand up for me? I want to check your balance."
I fought to my feet, leaning on the cane. She motioned to it. "Can you stand without it?"
"I'm afraid I'll tip over."
She had me close my eyes—which caused me to sway, even with the cane. She watched me walk a few steps, then stopped the examination. Dr. Johannis shook her head. "I often do much more to check for balance and ability to move." Her voice lightened. "But obviously you're rather lacking in that department." She smiled again. "Come on next door into my office, and we'll talk." She pointed left. "There's a much more comfortable chair in there for you. You need help getting there, or is it too painful?"
Gratitude seeped through me. She understood that it hurt to be touched. She knew. "I'll do it, thanks."
Her lips pushed together. "Follow me in, then. Take your time." She strode out.
Heart fluttering, I pushed to my unsteady feet.
Chapter 34
I HOBBLED THROUGH THE DOOR OF DR. JOHANNIS'S EXAMINING room and around the corner into a surprisingly pretty office. Textured blue walls, a shiny oak desk. A large, healthy fern in one corner. Dr. Johannis took the chair behind her desk and motioned to one on my side. "Please."
With little grace I lowered myself into the seat. Hooked my cane over its arm.
Dr. Johannis pushed my papers aside and leaned forward, hands clasped. "Well, I certainly suspect you have Lyme. You present many common symptoms."
Lyme. The dreaded disease I'd read online. All those patients—sick for years. But just to hear a doctor say it. Not deny it.
"We'll test you for it, of course. After we're done here you can see my lab technician. He'll take your blood and send it out for testing."
"To that Lyme lab? Not the CDC . . . thing." All I needed was another negative result.
"Yes, to the Lyme lab. I don't find the CDC test nearly as reliable. They too often result in a false negative—perhaps what happened to you. Still, the Lyme lab tests aren't perfect either. Borrelia—the bacteria that cause Lyme—are very formidable creatures. They can change their outer coat to make themselves invisible to the body's immune system—and therefore to the tests. So a negative result on any test doesn't mean you don't have Lyme. In the end Lyme is a clinical diagnosis."
"Those doctors didn't think so. When the Lyme test said n-negative, they pushed it aside." As did Brock. Never had I heard him say Lyme is a clinical diagnosis—that symptoms outweighed test results.
"Yeah, well. That's the way it goes."
Clearly Dr. Johannis didn't want to talk against her colleagues.
I took a deep breath. My body felt so tired. But at the moment my brain was half working, and if I was prepared to go head-to-head against Stalking Man, I had much to learn. "The CDC Western blot tests sometimes are false negative because of the bands of antibodies they don't include, right? I read about it."
She nodded. "You'll see two results on your tests from the Lyme lab. One will be their results, the other will be what the CDC would say. Often with a positive from the lab, the CDC result reads negative. You'll be able to see the individual bands that are positive. One of the biggest problems is that numerous bands specific only to Lyme aren't included in CDC Western blot results. For example: band number thirty-one—which refers to an antibody for a protein on Borrelia's outer surface called OspA. This protein is so Lyme-specific it was used to make the Lyme vaccine back in the nineties. Yet the CDC doesn't include its antibody in determining test results."
Vaguely I remembered reading that detail. "Why?"
Dr. Johannis lifted a hand. "There are lots of unanswered whys in the Lyme world, I'm afraid."
I was beginning to see that.
"At any rate, I'll also order tests for coinfections. Many times Lyme isn't the only disease the tick was carrying. You may also have Erlichiosis, Babesiosis, and other coinfections. The problem is, each one needs to be treated differently. For example, Babesiosis isn't a bacteria, it's a parasite in the malaria family. Therefore it won't be killed off by antibiotic treatments for Lyme. Overall, if you treat for Lyme alone and ignore coinfections, you won't get better. So we have to look at the total package."
Relief washed through me. She'd test for everything. I wouldn't have to push her to do that.
Dr. Johannis leaned back in her chair. "Anything else you want to ask before we draw your blood?"
"Treatment is around four w-weeks of antibiotics if you catch L-Lyme early enough, right? Are we catching it early enough for me?"
"Well, you look pretty sick. Your tests will show results in two different categories. Results labeled IgM show a positive or negative for Lyme introduced into the body in the last six months. The IgG category refers to six months or more. You could have a positive IgM and a negative IgG, meaning you've contracted in approximately the last six months. If so, you're not yet into the full chronic stage of Lyme. That stage is much harder to treat and takes far longer.
"However there are other factors that can make one patient's case harder to treat than another's. One, as I mentioned is coinfection. A second is the germ load in your body. Just how heavily infected are you? Another is simply each person's unique response to Lyme—where the spirochetes go in that particular body, the strength of the immune system, and other factors. You look to me like you could have had Lyme for over six months. On the other hand, not necessarily. You may just be a person it happens to hit very hard. Clearly once you started having symptoms they progressed quickly."
My eyes blinked a few times, my brain trying to process all she'd said. "Those patients that aren't diagnosed for years? They get r-really sick."
Dr. Johannis nodded. "Unfortunately, yes. They can get far more sick than you are. Those cases take a long time to treat. And some of those patients will get better, then relapse." She lifted a hand. "It's not easy science, treating Lyme. It's experience over the years, seeing what works, what doesn't. There's still so much we don't know about the disease."
Except for Brock. He seemed to know everything. Sitting there in Dr. Johannis's office, I could grasp more than ever the difference between her and my husband. He in his laboratory and classroom, she facing very ill patients who begged her to help them get well.
I wasn't being fair, keeping things from her like this. I was trusting her to tell me the truth. She was trusting me as her patient to do the same.
"Mrs. McNeil?" Dr. Johannis gave me a little smile. "Looked like you went off there for a minute. Something else on your mind?"
My veins heated. Why had she asked that?
Mentally I scrambled for some question to cover myself. A blurry memory surfaced—something Stalking Man had said about Brock's research. "I heard something about Lyme needing a . . . narrow definition in order for v-vaccines to sell. What does that mean?"
Dr. Johannis pulled in her mouth. "That could be another long discussion. I'll try for a short answer. We were just talking about how Lyme affects people differently—when it hits, how it hits. And also that it's a disease requiring a clinical diagnosis, since the tests don't always work. That makes Lyme a very nebulous sort of illness. Before you can create a vaccine you must do many things. One is to determine what part of the bacteria is infectious. I won't go into all of that right now. Another, as you say is to define the illness it's supposed to protect against. A more narrow definition, say one that calls for a specific set of symptoms, makes things easier." The doctor tilted her head. "That's a layman's answer and barely scratches the surface. But does that make sense?"
I focused on the desk, trying to process her words. "So . . . if someone is working on a v-vaccine, it would be better for that person to narrowly define Lyme."
"Well, the challenges in creating a vaccine are very convoluted. But looking back, some have wondered if the increasingly restrictive definition of Lyme was partly brought about by the development of the vaccine that was eventually taken off the market in 2002."
Restrictive definition . . .
Was Brock's research basically motivated by money, as Stalking Man suggested? The thought sickened me. For years I'd thought of Brock as caring for others. Had I been wrong all along about that, too? My eyes closed. What else about Brock didn't I know?
"Jannie, what is it? You look troubled."
"No, it's . . . I just . . ." I looked Dr. Johannis straight on. And then, just like that, the words leapt from my tongue. "I'm not who you think I am." My eyes widened. Why had I said that?
Confusion flicked across Dr. Johannis's face. "Your name's not Janessa McNeil?"
My body weighted to the chair. How to get out of this? "No. I mean, yes. I am. But . . ."
I should leave right now. Find another doctor. What I could not do was tell this woman my story—and watch her disbelieve me. I could take no more accusations. No more sneers.
The doctor's pen lowered. She placed it on her desk and leaned forward. "Mrs. McNeil?"
My throat heaved in a swallow. "I'm Brock McNeil's wife."
The news rippled across her features. She sat up straighter, her mouth pulling in. The doctor stared at her desk, as if wondering which question to ask first. She spread her hands. "Is this a set-up?"
"No. I'm really sick. Wish I wasn't."
She nodded slowly. "I can see that. Does your husband know you're here?"
I pictured Brock's scoffing at the mere mention of her name. "Yes."
"But he doesn't approve."
"No. He thinks I'm faking."
"Why would you be faking?"
My eyes burned. I wiped a weak hand across my forehead. "You have to believe me. I just w-want someone to believe me."
"I do believe you. I'm listening."
Maybe it was the compassion on her face, maybe it was just that I felt so exhausted and alone. Maybe at that point I simply didn't know how to back out. For whatever reason—I told her. Everything. Once I got started, I couldn't stop. The phone calls, all I remembered that Stalking Man had told me. Brock's affair, and his leaving. The vial with the tick inside. The detective's request—almost a pleading—for evidence he could use. I tripped over words, sometimes forgot them altogether. Dr. Johannis didn't rush me. She just let me talk until my brain shuttered and my tongue lay thick in my mouth.
Finally I sat back, a worn and begging supplicant.
Dr. Johannis's gaze drifted across the office. Her eyebrows rose, and I saw a slight shake of her head, as if she couldn't fathom my tale. Moments passed. For the first time I heard the ticking of a clock on her wall.
She drew a breath and looked at me, empathy softening her mouth. "First of all, I believe you."
My eyes welled. I felt stupid for crying. Seemed I'd cried more in the last few days than the past decade. But I was too tired to fight the tears. "Thank you."
Dr. Johannis laced her hands together. "I hardly know where to begin." She tapped a finger against her desk. "I find myself trying to think like this man who's been calling you. Just to try to understand him. I suppose, in his perverted logic, he is helping the Lyme community. And I can see where he'd get the idea." She rubbed her temple. "You hear about the legislation regarding Lyme that passed in Connecticut in 2009?"
I shook my head.
"It was a bill—passed unanimously—that allows doctors in that state to treat Lyme long term without repercussions from the medical board. California also has a law that allows doctors to treat Lyme as they see fit. But Connecticut"— she shook her head—"that's the ground zero state for Lyme. Amazing how long it took for
that state to come around. Anyway, it happened because two state representatives came face-to-face with Lyme through illnesses of their family members. One representative's mom got it, and the other's husband fought a life-threatening case. Seeing loved ones go through such a difficult disease—that tends to diffuse the notion that it's 'hard to get and easy to cure.'" She raised her hands. "So I can see where this guy would expect your husband to come around in the same way."
A shiver ran down my back. Stalking Man was insane but smart. Bad combination.
"And the fact that he contacted you this month. Did you know May is Lyme Awareness Month?"
"No."
"It is. Every year the Lyme community gets more media in May. You'll hear public service announcements about the disease, that sort of thing. There are rallies, people speaking out."
I raised my chin in a nod. What little energy I had was trickling away.
Dr. Johannis seemed to pick up on that fact. "Okay, so let's get down to what to do next. I didn't hear you say you called the detective after that last phone call."
Had I? My gaze roved back to the fern. I'd meant to. But I couldn't remember . . .
"No. Don't think I did."
"Well, that's critical. You should do it. Matter of fact, I should call the detective for you right now."
"But—"
"Let me back up a minute. The Lyme lab can take a week or even longer to get blood test results back to me. And they don't hurry for anybody. But your case is different—you've got police involved and an alleged crime. If we have a detective hand-carry your blood to the lab and ask for a rush, they'll listen."
"But I don't want them to know who I am. I mean—that I'm Brock's wife."
Dr. Johannis shook her head. "McNeil's a fairly common name. That in itself isn't going to give you away. And I'm certainly not going to tell them. Now, how did you get here? Surely you didn't drive."
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