Suddenly terrified at what she might have done by trusting a man who was little more to her than a voice on the phone, she began to scramble to her feet.
Then, just as quickly, she dropped back down.
The boy was there, nestled between the physician’s legs, sharing the stick of the radio-control device.
“That’s it, fella,” she heard Zack cry over the noise. “A little more, a little more, and … now!”
The plane, which had begun a slow roll across the grass, shot forward and then up, climbing at a steep angle toward the treetops at the far end of the meadow.
“That’s it. You’ve got it. Now ease off. Ease off. Terrific! Hold her right there.”
Now well above the trees, the model banked smoothly to the south and began a lazy circle of the field.
“I did it! I did it!”
It took several seconds for Barbara Nelms to realize that the excited voice she had just heard was her son’s. With a joyful fullness in her throat and tears in her eyes, she slipped back out of sight and hurried down the hill.
Zack and Toby Nelms lay opposite one another on the warm grass, a few yards from the Fleet, chewing on stalks of wild barley and watching a red-tailed hawk glide in effortless loops atop high, midday thermale.
“Now, just who do you suppose is working the radio-control box for that model?” Zack asked. “Whoever it is has sure built one quiet engine.”
“That’s goofy,” Toby Nelms said.
“Of course it is. Anyone with half a brain could tell that’s just a kite. Now, if only I could see the string …”
Once the logjam of silence—of fear and mistrust—had been broken, the boy’s words had come with surprising ease, and even occasional spontaneity. Zack had been reluctant to test the progress they had made with any pointed questions, but now, with just a few minutes left in their two hours together, he felt comfortable enough to try.
“You know, kiddo,” he began, “a lot of people have been very worried about you these past few months.”
“I know.”
“But you still won’t talk to anyone?”
Toby shook his head.
“Not even your parents?”
The boy stared vacantly at the crucifix soaring overhead.
“They never help me,” he said suddenly. “I scream for them, and beg them to stop the … the man from hurting me. But they never come until it’s too late. They never stop him.”
“What man?” Zack asked, at once repulsed and fearful at the thought of the boy being molested. “Who’s been hurting you?”
Toby turned away.
“Hey, kiddo, I’m sorry. I didn’t mean to say anything to upset you or frighten you.”
For a few, anxious seconds, Zack feared he had pushed too hard and slammed the door he had, so gingerly, just opened.
“The man with the mask,” Toby said without turning back.
“Mask?”
The boy shifted restlessly, and then drew his knees and elbows in tightly to his body.
Zack decided he had gone far enough for one day. He reached in his pocket for a coin. One good thumb palm and they would call it quits.
“He … he cuts it off,” Toby said, in almost a whimper. “And … and then it grows back … and then he cuts it off again.”
“Cuts what off, Toby? … Look, I know it’s hard for you to talk about, but you’ve got to try.”
He moved to put his hand on the boy’s shoulder, but then thought better of it. He felt his heart pounding. Don’t stop now, kiddo. Don’t give up on me now.
“My … my peenie. And my balls, too.”
“Do you mean he touches you?”
“No, he cuts it off. He promises he won’t hurt me. He promises he’ll fix my lump, and then he cuts it off. And it hurts. It hurts and I scream at him, and he won’t stop. And I scream for my mommy and daddy, and they never come.”
The boy began to cry, his shoulders jerking spasmodically with each heavy sob.
Again, Zack moved to touch him, but before he could, the child spun and flung his arms around him.
“Please, Zack,” he cried softly. “Please don’t let him do it anymore.”
He promises he’ll fix my lump.… Suddenly, the child’s words registered.
“Toby,” Zack whispered, still holding the boy tightly, “the lump you’re talking about, is it your hernia? That place here you had fixed?”
The boy nodded, his body still racked with sobs.
“And the man with the mask … Is that the doctor?”
Again, a nod.
Zack eased him away, but continued to hold him by the shoulders.
“Toby, look at me. I think you’ve just been having nightmares. Bad, horrible dreams, but dreams that often go away as soon as you see them for what they are. The operation was perfect. All that’s left is a little scar. The lump is gone for good.”
“No,” the boy said angrily. “It isn’t. It grows back. So does my peenie, and my balls. But then he cuts them off again, and it hurts—worse each time.”
Inwardly, Zack sighed relief. The boy’s profound disturbance was rooted in a nightmare—the expression of pent-up fears surrounding a procedure now nearly a year in the past. Fascinating, but certainly neither difficult to understand nor as bad a situation as he had feared. At least Brookings would have something to work with.
“You don’t believe me, do you?” Toby said. “It’s not a dream. He cuts them off, and they grow back, and then he takes those Metzenbaums and cuts them off again.”
Zack felt a sudden, vicious chill.
“He takes what?” There was no hiding the incredulity in his voice.
“The Metzenbaums. He asks for them from the nurse, and then he sticks them into me right here, and it kills me. Then he just cuts and cuts.”
“Toby, think,” Zack said urgently. “Have you ever heard anyone else say that word?”
“What word?”
“Metzenbaums, Toby. Have you ever heard anyone except the doctor in your nightmare say that word?”
Toby Nelms shook his head.
Zack released the boy and sank back on his hands. Something was wrong. Something was terribly wrong. Metzenbaum scissors were commonly used in surgery, but rarely, if ever, until after the initial skin incision had been made. Toby Nelms would have been asleep at the time they were called for. Anesthetized. There was no way he could have heard that term, let alone so accurately understood what it meant. No way.
But somehow, he had.
17
By the time Zack had finished rounds and headed from the hospital to his office, evening had settled in over the valley. To the southwest, the silhouetted mountains were ebony cutouts against the deepening indigo sky. It was a quiet, awesome evening, perfect for a run by Schroon Lake or for a horseback ride into the foothills to watch the moonrise. It was an evening to celebrate the joy of living.
But for Zack, the magic of the evening was lost in reflection on the agonized struggles of an old surgeon and the desperate plea of the nurse who had condemned him; and in concern as to how much to tell the waiting parents of a child who was sinking deeper and deeper into a hell of dreams that were not dreams—dreams that cut and hurt and maimed.
As he crossed the parking lot, Zack noticed Frank’s Porsche, tucked in its reserved slot. Early mornings, late evenings, weekends—for whatever his shortcomings and the failings of his past, the man had become a demon of a worker.
Soon, Zack knew, the two of them would have to talk.
There were things Frank needed to learn of and to understand about Ultramed, about Guy Beaulieu … and now, especially, about Toby Nelms.
The boys condition was clearly on a downward spiral, and each passing day was a lost ally in the struggle to uncover the truth. With Frank’s help, the odds of finding answers in time to make a difference would be considerably shorter.
But would he listen?
Over the years, the two of them had drifted far apart in many ways. The
disagreement over Guy Beaulieu had only underscored their differences. Still, Zack reasoned, they were brothers, and they each had a significant stake in Ultramed-Davis and in Sterling.
He glanced back at the Porsche. At seven that morning, when he had arrived for work, it was already there. Now, after more than thirteen hours, Frank was still at it. What more testimony did he need? The man had hitched his wagon to the Ultramed-Davis star. If there was a threat to the integrity of the hospital, he would listen.
Zack felt sure, at least, of that much. But he also knew that all he had were theories—gut sensations plus a few million questions. His brother was a company man. If there were trouble in his paradise, it would take more than suspicions to enlist his help—much more.
Barbara Nelms and her husband were waiting on one of the stone benches that flanked the entrance to the Physicians and Surgeons Clinic. Bob Nelms, clean-cut, fit, and hardy, had clearly borne less of the day-to-day strain of Toby’s illness than had his wife. He greeted Zack with a firm hand.
“Pleasure to meet you,” he said. “Barbara tells me you made some real progress with our boy. That’s excellent. Excellent. Using that plane of yours was just a super idea.”
“Thank you, but—”
“You know, I’m no professional, but I’ve been trying to tell Barbara all along that this was all just a nasty phase, and that when that kid of ours was doggone good and ready he would get through it. It sounds like you two made quite a large step in that direction today.”
“Call it a baby step,” Zack said.
Despite the machismo in Bob Nelms’s words and manner, one look in his eyes and Zack knew the man was whistling in the dark. As a supervisor at the mill, he was used to accepting the burden of difficult problems and solving them. His thin-shelled denial would require delicate handling and constant awareness that Toby’s condition was no less baffling and frightening to Bob Nelms than his impotence in the face of it.
As Zack followed the couple into the elevator, he wondered once again how much to share with them. It had never been his way to withhold information from his patients or, when the patient was comatose or a juvenile, from their families. But this was not information. It was the purest conjecture.
And even when he tested the explanation on himself, it sounded nothing short of phantasmagoric.
Mr. and Mrs. Nelms, I don’t know how to tell you this, but I believe that your son was not asleep during his hernia operation last year. He appeared to his surgeon and anesthesiologist to be fully anesthetized. But somehow, at some level, he not only “saw” his operation from within his body, but, it would seem, he fully experienced the pain of it as well.
Now, in some perverted, distorted way, he is reliving that surgery in terrifying flashbacks, much like those described in LSD users.… No. I don’t have any idea how that could happen.… No, to the best of my knowledge, such a phenomenon has never been reported with the anesthetics he received.… No, I don’t have any hard evidence to back up what I say.… No, I don’t know what could possibly be triggering the attacks.… No, I don’t have any idea.… I don’t know … I don’t know … I don’t know, …
His suspicions were vague, fantastic, and virtually without proof. Disclosure of them to the boys parents would almost certainly precipitate premature action by them against Ultramed, the hospital, and the physicians involved in Toby’s surgery—action Zack was in no position yet to support, and which could well lead to a coverup of the truth … whatever that was.
“Mr. and Mrs. Nelms,” he began once the couple was settled in across the desk from him, “I’m afraid I don’t have very much to tell you at this point. Toby did not share a great deal with me. However, he did say enough for me to suspect that he is having very severe fright reactions, and that while these reactions are occurring he is completely unable to distinguish them from reality. In other words, in just a few seconds, apparently with very little warning, he is transported from wherever he happens to be into another reality—a very distorted, very terrifying reality.”
“Are you saying he becomes insane?” Barbara Nelms asked.
“You’ve observed him,” Zack responded, still feeling his way along. “What do you think?”
“But … but insanity is a condition, isn’t it? A state of being. How can it possibly flick on and off like a light?”
“And what has the hospital got to do with it?” Bob Nelms added.
“I don’t know,” Zack said, wondering how many more times he would hear himself repeat that phrase.
“Well, what do you think?”
Zack tapped his fingers together, stalling for a few more seconds to sort his thoughts. As much as he hated deception, this simply was not the time to air his theory.
“I assume you are both somewhat familiar with epilepsy?” he began. “Well, most people think of epilepsy as an electrical disorder of the brain which causes periodic fits. The seizures we are most familiar with are motor seizures—that is, they involve the muscles and the extremities. But supposing the electrical explosion occurs in one or more of the cognitive areas of the brain—the thinking areas. What would result would still be a seizure, but it would be a sensory seizure lather than a motor one.”
“Are you trying to tell us that Toby has petit mal or temporal-lobe epilepsy?” Barbara asked. “I’ve read everything I could get my hands on about both conditions, and quite frankly, Dr. Iverson, I don’t think Toby’s condition fits either one. He is aggressive like temporal-lobe epileptics, but only because he is absolutely terrified. And very little of his behavior resembles the detached, fugue reactions that I’ve read about in petit mal. And although the resting electroencephalogram is not that accurate in making either diagnosis, Toby’s was normal the one time he had it done.”
Zack felt his cheeks flush and cautioned himself against any elaborate untruths. Barbara Nelms was too desperate and too bright. She was tired of getting the runaround from medical and mental health professionals, and she had done her homework well.
“I don’t know what to say, Mrs. Nelms,” he countered, “except to point out that if Toby’s case were straightforward and typical, someone would have diagnosed it before now.”
“What about the hospital?” Bob Nelms asked again. “Didn’t the boy say anything to you to explain why he seems so frightened?”
“Nothing specific,” Zack lied. “But since that’s the main clue we have, I do feel that’s the direction our investigation should go.
Barbara Nelms slumped visibly.
“Dr. Iverson, investigations are fine, but you saw Toby. He’s like a stick. His skin is getting infected. He gets bruises from almost nothing. He gets fevers with no evidence of infections. He’s dying, Dr. Iverson. I swear, time is running out. Our son is dying.”
“Barbara, don’t say that!” Bob Nelms blurted.
His outburst hit a raw nerve.
“Don’t tell me what to say and what not to say,” she snapped back. “You’re in that damn mill until seven every night. You don’t see him.”
“Doggone it, Barbara, I’m doing everything I can. You’re the one who hasn’t paid a bit of attention to anything but Toby these past—”
“Please,” Zack said. “Please. I know this is hard on you both. But sniping at each other isn’t helping anyone—least of all Toby.”
The couple stopped abruptly and exchanged sheepish looks.
“We’re sorry,” Barbara said. She reached over and squeezed her husbands hand. “We never used to fight, even at home alone. But this has just got us all …” She looked away.
“I understand, Mrs. Nelms. All I can ask is that you both just do your best to keep it together, and give me a little time to do some reading and talk to some people. I’ll work as rapidly as I can. I promise you that. And I’ll plan on seeing Toby again next week. Same time. Same field.”
“Meanwhile?”
Zack shrugged.
“Meanwhile, I don’t think any specific treatment is indicated. Especially sinc
e I don’t really know yet what’s going on. I will tell you that I don’t take my responsibility for my patients lightly, and I’m fully aware that we don’t have all the time in the world. I’ll do my very best to get to the bottom of things quickly.”
He stood, hoping to bring the exchange to a merciful end before Barbara Nelms could hone in on the inadequacies in his explanation.
“Thank you,” Bob said, standing as Zack did and shaking his hand.
Zack walked them to the outer door of his office and again promised to work as quickly as possible.
“Dr. Iverson, could you just tell me one thing?” Barbara Nelms asked.
“Of course.”
“Are you holding anything at all back from us?”
Zack had to force himself to maintain contact with the woman’s eyes. It was a technique at which, unlike Frank, he had never excelled.
“No, Mrs. Nelms,” he said flatly. “No, I’m not.”
The woman hesitated, and for a moment seemed poised to challenge the denial. Then she reached out and shook his hand.
“That being the case, then, thank you, Doctor. You will keep us posted, yes?”
She took her husband’s arm and walked away with him, down the darkened corridor.
Zack watched until the elevator doors had closed behind them. He ached from his lies and from the graphic reminder of the power of illness over the lives of whole families. He also knew, from her parting look, that Barbara Nelms would never again allow him to hide behind evasions and half-truths.
He would review Toby Nelms’s record again, and then contact the National Institutes of Health library in Bethesda for a complete search of the reported adverse reactions to the anesthetics he had received. Finally, he would meet with Jack Pearl and Jason Mainwaring.
Beyond those steps, there was nowhere to go—nowhere except another session with Toby himself and then the sharing of his suspicions with Frank. Something had happened to the boy during his hospitalization at Ultramed-Davis—something devastating. If nothing else panned out, Frank would have to realize that it was in everyone’s best interests that he pursue the matter. He would cooperate, or face Barbara Nelms and her attorney.
Flashback (1988) Page 19