DeShield heard the door to his waiting room open and close, and knew it was Ethan. He took a few final seconds to gaze out at the panorama from his twenty-third-story office--views of Alcatraz, the bay, and the Golden Gate--and then reviewed his notes.
Ethan Black was working as comptroller for some sort of family-owned company up in Patience. His psychiatric history dated back only a year or so. Following an automobile accident in which he sustained some head trauma and multiple minor lacerations, his passive, introspective personality underwent a radical change. After a number of fights, including one in which he'd bludgeoned a man with a baseball bat, he was referred to DeShield and placed in the Hempstead Institute just outside the city.
All neurologic tests and scans had been negative, and postconcussion syndrome seemed the obvious diagnosis. The prognosis for that condition was excellent. Just the way DeShield liked it.
In each of their previous sessions, DeShield had outlined what seemed to him to be a reasonable therapeutic program for Ethan to use in dealing with his aggression, hostility, and acting out--a program calling for the summoning forth of Ethan's inner child. Each time, it seemed, there was complete understanding between them. Each time Ethan left with the promise that he would employ his mental exercises and avoidance maneuvers before lashing out at anyone. Each time, when Black Ezra phoned to check on his son's progress, DeShield had given him a hopeful response. And each time Black's scion had gone right out and hurt someone. Money had been able to smooth over the damage so far. But Ezra Black clearly hated paying off anyone. And more and more DeShield sensed the man was blaming him for the failures.
Referring Ethan to another therapist was, of course, out of the question. Black Ezra had hired him because of his reputation as the best. How could there be anyone better?
With a sigh DeShield pushed himself back from his desk and opened the door to the waiting room. Ethan was there with his driver/bodyguard, smiling the same bland smile that the therapist had learned not to trust at all.
"Ethan, please, come in. Come in."
Black was five nine, but built like a wrestler. He had thick, curly dark hair, and a perpetual five o'clock shadow. In truth there was nothing about the man DeShield liked. His appearance and demeanor annoyed the doctor to distraction. His high-pitched voice sounded like a perpetual whine.
"I had more headaches," Black said.
"Tell me about it."
DeShield glanced at his desk clock and tried to will a faster sweep to the second hand.
"Well, you know those dreams? The ones where I lose an arm, then a leg, then the other arm and leg, and then my penis and my balls, and finally my head?"
"Yes, Ethan, I remember."
How could I not when you tell it to me every session?
"Well, I've been having them every night. Bloodier and more painful than ever. They're horrible. Really terrifying. I think what you've been telling me is true."
"What's that?"
"That the villain in the dreams--the one chopping my parts off--is me."
"Of course it is. But you can overcome that sense of low self-esteem by simply employing the positive-mental-attitude exercises I have taught you."
"PMA. I know. I've tried. Really, I have. Well, I think the dreams set me up again, because yesterday and again this morning the headaches hit."
"Tell me about them."
Tell me about them. Tell me about them. DeShield wondered how many more times he would have to say the words before the hour was over. He began thinking about Bebe Washington.
"The same as all the other times, only maybe worse. First there's the smell I told you about, sort of like rotten eggs. Sulfury. As soon as that hits, I know I'm in trouble. The smell gets worse and worse; then, after twenty or thirty minutes, my head explodes."
"Ethan, did you hurt anyone this time?"
"I ... um ... I got sick."
"But did you hurt anyone?"
"I think I hit a guard."
DeShield felt his stomach knot. Another ten or fifteen thousand in hush money from Black Ezra. Another black mark on Graham DeShield's scorecard.
"Ethan, Ethan," he said, summoning his strength for one more all-out attack. "Let's try some relaxation exercises."
"Sure."
"Okay. Now, close your eyes and concentrate on my voice. You must believe in me, Ethan. You must believe that I love you, that I believe in you."
"You believe in me," Ethan murmured.
"That's it. Okay, now picture yourself on a mountaintop. A beam of shimmering golden light is shining down on you from beyond the clouds, bathing you in its warm glow. Can you feel it?"
"I can feel it. I can feel it."
Ethan stood up. Arms spread, eyes still closed, he turned slowly, basking in the golden light.
From behind his desk, feeling vaguely nauseous, DeShield watched him, thinking about how absolutely ridiculous he looked--the pirouetting hippo in Fantasia.
"That's it, Ethan. Feel the warmth. Feel your inner child take over."
Ethan continued his slow spin.
"The inner child, Ethan. Listen to your inner child and do as he says."
"Okay," Ethan said.
He stopped, hands on hips.
"Okay what?"
"I hear my inner child. I know what he's telling me to do."
"Wonderful. That's wonderful."
Ethan's expression seemed more animated. His body posture more confident. Hang in there with me, Black Ezra, DeShield thought. Maybe this really was a breakthrough.
"Dr. DeShield?"
"Yes, Ethan."
"Tell my father you tried."
With two strong steps Ethan hurled his stocky body upward against the huge picture window. The glass shattered almost noiselessly as he hurtled through it. He fell without uttering a sound. In an instant, there was only silence--silence and the rush of warm summer air into the air-conditioned office.
Numbly, Graham DeShield moved to the window. He had always suffered from vertigo when looking down from any height, and he had to hang on to the wall to peer at what remained of his patient. His phone had rung several times before he noticed it.
"H-hello?" he heard himself say.
"Dr. DeShield, Ezra Black here. I'm sorry to disturb your session, but I need to speak with my son."
Abby's alarm went off at seven P.M. Her next shift at work wasn't for two days, but after an all-nighter, her body needed to be eased back into normal-world time. Sleeping some during the day, then getting up and staying awake until midnight, usually did the trick. Her shades were up--another trick of the trade--so that the early-evening light could help her get oriented. She rolled out of bed, aware that the house was very quiet. Josh was either passed out in his room, or he had pulled himself together and gone into work.
For a few minutes she sat on the small chair by her window, gazing at the mountains as she sorted out her emotions. She was uncomfortable with the coldness that had worked its way into her heart. But, in truth, there was nothing she could do about it. The look in Josh's eyes as he grabbed her shoulders would never be erased from her memory, regardless of what became of their relationship.
Stretching, she walked to the living room. Even before she saw the note on the dining-room table, she knew that he was gone. The computer and printer that were his lifeline were missing as well.
Abby-
I've made a terrible mess of things. I never wanted to leave San Francisco. I never wanted to come here. But what could I do? They offered me so much money and so much respect. You were paying for everything and trying to act like it didn't matter to you. Well, it did to me. Now, I just don't know what's going on except that I put my hands on you in anger and came close to striking you. Maybe I'm going crazy. Maybe there's something wrong with my brain. Maybe it's just the pressure at work, and the adjustment I haven't made to living here. It isn't my feelings for you, which are as strong as ever.
I've taken some time off from work to do some hiking and some thin
king. When I return, it won't be to the house. Until I straighten myself out, I just don't want to be around you. I've spoken to a realtor and rented a place west of the valley. I'll call soon and arrange to pick up some more of my stuff. I'll go to those doctors. I promise I will. Meanwhile, at least I won't be doing any more damage.
Take care, and forgive me for wrecking everything. I'll be in touch.
I love you,
Josh
Abby sank down onto the sofa and reread the note. After so many recent arguments and so much verbal abuse, she knew that her overriding feeling at that moment was relief--relief that there would be some space between them; relief that Josh had agreed to get help; and, finally, relief that her conflict about attending the Alliance meeting had been resolved.
CHAPTER ELEVEN
It was seven-thirty in the evening when Abby smoothed out Lew's map on the passenger seat of the Mazda and headed across the valley. Dense clouds made headlights helpful, and a drop in the temperature suggested rain might be on the way. Just over twenty-four hours had passed since she had read Josh's note. There had been no word from him since. Nor had she tried to find out where he had gone. As isolated as she was feeling, as apprehensive as she was about the future, she knew that separating was the best thing they could have done. There might not be healing yet, but at least the bleeding had stopped. She had called Garrett Owen, the neurologist, and learned that Josh had scheduled an appointment several weeks away for an evaluation of headaches.
"If he had told my nurse that it was an emergency," Owen told her, "she would have spoken to me, and I would have found a spot to squeeze him in."
Abby was about to ask Owen to do just that but stopped herself. It was Josh's game now, and he could call the shots.
The route on Lew's map took her past the cutoff to Ives's trail, then along the base of the northern hills. Finally, about a mile west of town, she found the dirt road labeled on the map "my driveway." At the base of the road was a crudely cut and painted arrow that read, The Meadows--Alvarez.
The stony dirt drive sloped steeply upward for half a mile. It was hard to imagine Lew getting home at all when it snowed. At the crest of the hill was his farm, an unpretentious patchwork of wooden-fenced meadows, stretching out around a rambling whitewashed two-story house, a large old barn, and two garage-sized outbuildings. The spectacular vista, south and east, spanned the entire town and included a long-distance view of the Colstar cliff and the mountains beyond. There were several cows grazing nearby. Farther out, in a field of wildflowers, a pair of horses moved slowly toward one another.
She had no idea how many members of the Alliance would be there and was somewhat dismayed to see just two cars, one of which she assumed to be Lew's. Alvarez greeted her warmly at the door. He was wearing worn jeans, a plaid denim work shirt, and scuffed cowboy boots. The outfit looked as natural on him as did blue scrubs and a clinic coat.
"This place is lovely," she said as he led her through a fireplaced kitchen that looked as if it had been designed by someone who had a passion for cooking.
"I knew you'd like it."
They passed through a short paneled hallway to a spacious den. The walls of both were covered with framed photographs. Most of them seemed to be taken in a foreign country, and a number of them featured a woman--a slender, dark-haired beauty with a luminous smile. Abby asked where the pictures had been taken.
"Paraguay. That's where I was born, and where I chose to practice after I finished my training here. The woman in the pictures is ... was ... my wife. She's dead."
"I'm sorry."
His sadness was palpable.
"Thank you. So am I," he said.
The den was set up with a wet bar, some dishes of pretzels and chips, and a slide projector and screen. The only other person there was a stout, middle-aged woman named Barbara Torres, the associate director of the Patience Valley Region Visiting Nurse Association.
"I'm very pleased you've come," she said. "We've been hearing so many good things about you."
Abby thanked the woman and accepted a Perrier and lime from Lew.
"Are you expecting many people tonight?" she asked.
Lew and Torres exchanged brief glances.
"Gil Brant, who owns the pharmacy in town, should be here shortly," Lew said. He paused, searching for the right words. "The Alliance used to number several dozen, but for now, at least, I'm afraid we're it."
... Very few. They're harmless because no one takes them very seriously.
Lyle Quinn certainly seemed to have his facts in order.
Lew motioned her to an easy chair positioned to get a good view of the screen.
"Perhaps while we're waiting for Gil," Lew went on, "Barbara and I could fill you in on our group's history and goals."
"Please."
"I was the last ER physician to come here before you. By the time I arrived, David Brooks, who'd been here for a couple of years, had been noticing a disturbing number of the sort of cases you refer to as NIWWs."
"NIWWs?" Torres asked.
"Abby's abbreviation for 'no idea what's wrong,' " Lew said. Barbara's smile suggested that, like him, she appreciated the irony in the label. "Well," Lew continued, "over the months after I started here, David and I began talking about these cases--the strange rashes, chronic fatigue, adult asthma, headaches, and the like. We became convinced that some sort of environmental exposure had to be at the root of them all. And, of course, the most likely source was up there on the cliff."
The doorbell rang. Lew left and returned with Gil Brant, a tall man with a cheerful, ruddy face.
"Let me congratulate you on your handwriting and the accuracy of your prescriptions," Brant said after their introduction. "And let me also thank you for your commitment to see this cause of ours through."
Abby felt her cheeks redden. Lew spoke up quickly.
"Gil, Abby has made it clear that she's not committed to any cause. She's come to hear what we have to say and to see if there's a unifying explanation for the strange cases she's been seeing in the ER. That's all."
"Yes, yes, I see. Well, then, why don't we have at it?"
"Barbara, why don't you show Abby what we have?" Lew said.
Torres took a computer printout from her briefcase and handed it over.
"This is a list of one hundred seventy-five patients who have been seen in the emergency ward by Dr. Alvarez, Dr. Brooks, bless his soul, and by some of us at the VNA. The ages and diagnoses are beside each name. Some of them may have had definite diagnoses made by their private doctors by now, but we have no way of knowing."
Abby scanned the printout. The patients she had seen during her own brief experience at PRH were a microcosm of this group.
"I could probably add an additional twenty or so patients myself," she said. "What about enlisting some of the other doctors in town?"
"When David first confirmed my sense that there was a pattern," Lew said, "just as I did when you told me about your strange cases, we decided to do just that. Without even suggesting that Colstar was at fault, we sent out flyers announcing an organizational meeting of a group we named Alliance for a Healthy Patience and describing the symptoms we'd seen. About fifty people attended that meeting, including at least fifteen doctors from the hospital staff."
"Well, what happened?"
Lew turned to the pharmacist.
"Gil?"
"Well, the people at Colstar got wind of what we were doing and started a campaign to discredit us almost immediately. Attendance at our meetings dropped each time. Then, when we tried and failed to prove our theory about what was going on, we began to be looked on as ... as--"
"Go ahead, Gil, say it. As quacks."
"Well, what was your theory?" Abby asked.
Brant looked to Lew, who nodded that it was fine for him to go on.
"Cadmium," he said. "This Colstar plant, in addition to being the company headquarters and research center, manufactures all of their rechargeable batteries. Cadmium i
s one of the main components. Colstar has it shipped in by the ton. Our theory right from the beginning has been that all of the varied symptoms we've been seeing have been caused by cadmium poisoning either through the air or the water."
Abby strained to remember what little she knew of the adverse effects of the heavy metal.
"Toxicity somewhat like mercury, yes?"
"Exactly," Brant said. "It's in the same column as mercury in the periodic table of elements. You know your chemistry."
Lew lowered the lights with a dimmer and flicked on the slide projector. The first slide, expertly prepared, was headed, "Symptoms and Signs of Cadmium Toxicity." The list was extensive.
"These slides were put together for presentations to both OSHA and EPA," he explained. "Obviously, they didn't make much of an impression, or we wouldn't be here tonight."
The list included all of the symptoms and findings Abby and the others had been seeing, plus a number of additional ones. Kidney failure, which Abby had not encountered in the ER, was the most serious common manifestation, along with severe respiratory disease. But everything from headaches to skin eruptions to gingivitis and even sterility was listed as well.
"So," Abby said, "don't keep me in suspense. What were the blood levels?"
Again, the three Alliance members exchanged glances.
"We managed to get fourteen or fifteen samples sent off on various patients," Lew responded. "They were all negative."
"Done at the hospital or sent out?"
"Mostly here. The hospital lab has a contract with employee health at Colstar to monitor nickel, cadmium, lithium, and the other potential toxins used at the plant. So they have all the equipment and expertise."
"We think the hospital lab is under instructions to keep any positive test under the tightest wraps," Torres added.
"Another possibility is that someone in the lab replaces all blood sent in for cadmium levels with blood they know will be negative," Brant chimed in.
"But why?"
"The usual reason," Lew said. "Money. It would cost millions for Colstar to close for any length of time, locate the source of contamination, and do whatever is necessary to correct it. In addition, Colstar competes with a number of other companies for very lucrative government contracts. Anything that forces them to retool would also make them ineligible or unable to stay in the game. Did you know that Senator Corman is from Patience?"
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