Royal Pains

by D P Lyle

  “Some parents are too busy,” Jill said.

  Ashley munched on a green bean. “Maybe. But sporting and school events aren’t what I meant. I think they don’t respect Nicole. Like they don’t listen to anything she says and her opinions mean very little.” Her eyes glistened with moisture. “That’s just not right. Parents should listen.”

  Yes, they should. As disturbing as what Ashley said sounded, that was exactly my impression. I didn’t really know them and so couldn’t make a reliable judgment, but one thing about practicing medicine is that you see people of all types. I had seen couples like the Cromptons before. Okay parents in that they provided the basic needs, but extremely self-centered and inattentive to their children’s true needs. This dynamic could produce some really screwedup teenagers. To me, Nicole seemed well grounded and firmly centered. Maybe my view of her was skewed by the things I had heard from Ellie. No doubt the two had a special bond. I imagined that Nicole’s stability mostly came from Ellie. Nicole was more like her than she was her own mother.

  Some things skip a generation.

  Chapter 45

  The next morning, Divya and I made several house calls before we headed to the hospital. The first was to Ellie to make sure she was tolerating the stress of Nicole’s illness and the continued wedding preparations.

  “I’m doing fine,” Ellie said. “I’m just worried about Nicole. Is she going to be okay?”

  “She’s going to be fine,” I said. “We have a couple of stops to make and then we’ll head over to the hospital to check on her.”

  “Robert drove in from the city last night. He’s at the hospital now.”

  “I’ll give you a call after I talk with Dr. Gresham.”

  Ellie walked over to the window and looked out. “We almost have everything finished for the wedding.” She turned and looked at me. “If Nicole is able to attend her own wedding, that is.”

  “She will.”

  “Promise?”

  “Promise what?” Jackie walked into the room.

  “I was just asking Hank if Nicole will be able to show up for her wedding.”

  Jackie settled onto the sofa. “I went by early this morning. She was sitting up and eating breakfast. You couldn’t even tell anything had happened.”

  “That’s always a good sign,” Divya said.

  “To answer your question,” I said, “yes, Nicole will be here. Even if I have to roll her down the aisle in a hospital bed.”

  Even Jackie laughed at that one and then said, “She would be mortified.”

  “But she would be in white,” Divya said. “Though hospital white probably isn’t what she had in mind.”

  We left Westwood Manor and swung by to see Oscar and Maria Mendez. Oscar was back to earth. His brand of the earth anyway. Maria seemed comfortable with the move to assisted living, almost as if she were looking forward to it.

  I knew that Maria had shouldered the responsibility of caring for Oscar and their home for many years. That weight can wear you down over time, and though Maria had marched on like a good soldier, the time had come for her to lighten her load. She had apparently reconciled herself to that fact.

  Our last house call was to Nathan Zimmer. He and Todd were on the back patio, each with a laptop, each with a cell phone jammed to one ear. Once Nathan finished his call, he dropped the phone on the tabletop and looked up.

  “Did you come by to check on me? To make sure I wasn’t smoking?”

  “Absolutely,” I said.

  Nathan laughed. “I feel great. I haven’t touched a cigarette. I’ve been taking my medicines religiously. I’ve even been going to bed early.”

  Todd closed his phone and dropped it in his pocket. “That’s all true. He’s been a very good patient. Believe it or not.”

  “Remember,” Divya said, “not smoking is forever.”

  “Forever forever?” Nathan asked.

  Divya laughed. “Forever and ever.”

  Nathan’s phone buzzed. He answered.

  Back to work.

  We said our good-byes. Nathan waved as we left.

  A half hour later we walked into Nicole’s room. She was lying in bed, watching TV. Robert reclined in the chair next to her, reading a book. One of the Monk series by Lee Goldberg.

  “Dr. Lawson, Divya,” Robert said as he closed the book, laid it on the bedside table, and stood.

  “Ellie told us that you had driven out last night,” I said.

  He reached over and took Nicole’s hand. “As soon as I heard what happened.”

  “What did happen?” Nicole asked. “I had more tests last night, but I haven’t heard the results yet. They put all those wires and glue stuff in my hair. Took me half an hour to wash it out this morning.”

  “An EEG,” Divya said. “That’s short for an electroencephalograph. It measures the brain’s electrical activity.”

  “I’ll be surprised if it finds any,” Nicole said. “Only someone brain-dead would fall for Julian Morelli’s BS.”

  I laughed. “Don’t be so hard on yourself. He’s a slick salesman.”

  “What’s going to happen to him?”

  “They should shoot him,” Robert said.

  “I doubt they will do that,” Divya said. “The medical examiner is involved, so I don’t think things will go well for him.”

  I heard the door behind me open and turned to see Dr. Martin Gresham come in. He had a smile on his face.

  “Here’s your doctor now,” I said.

  “I’ve got good news.” Gresham walked to the bedside. “We have a diagnosis.”

  “What’s wrong with me?” Nicole asked.

  “Don’t panic when I tell you this, because it’s not as bad as it sounds.”

  Nicole glanced at Robert. He squeezed her hand. She looked back at Gresham and said, “You’re not making me any calmer.”

  He smiled down at her and patted her shoulder. “You have a form of epilepsy. It’s the type we call temporal lobe epilepsy.”

  I saw Robert’s eyes widen; Nicole’s followed suit.

  “It’s a seizure disorder involving one of the smaller lobes of the brain,” Gresham said. “It’s not common, but it’s easily treated in most cases.”

  “So I’ll have to take medications for it?” Nicole asked.

  “I’m afraid so. But they will keep the seizures under control.”

  “For how long?”

  “Maybe forever. There’s ongoing research into various surgical procedures and even brain pacemakers to correct this problem. But for now, the answer is medications.”

  “That doesn’t sound very exciting.”

  Gresham nodded. “I know that at your young age the need to take medicines for the rest of your life seems daunting. But you’ll get used to it. It’ll just become part of your daily routine.”

  “What about my wedding this weekend? Will I be able to go?”

  “I don’t see any reason why not. I’ll start you on the medication today, and if you’re doing fine tomorrow morning, I’ll let you get out of here.” His beeper buzzed. He glanced at it and then said, “I’m afraid I have to run down to surgery.” He glanced at me. “They’re doing a mapping procedure on one of my patients and I need to be there.” He then said to Nicole, “I’ll come by this evening and we’ll talk more.” He left.

  “Medicine for the rest of my life?” Nicole shook her head. “Why does this have to happen to me? And why now?”

  I walked around to the left side of her bed. “Because you’re lucky.” I smiled. “Diabetics give themselves injections every day. At least yours are pills.”

  “Oh lucky me.”

  “Many people your age deal with much worse problems and they go on like nothing’s wrong,” Divya said. “You will, too.”

  “What is this thing that I have? It sounds awful.”

  I grabbed an empty chair from the corner, scooted up next to her bed, and sat down. I could see the fear in her face, her eyes more black than blue. She asked Robert for a
tissue. He pulled one from the box on the bedside table and handed it to her. She dabbed her eyes.

  “A seizure is where the electrical activity in the brain goes all haywire,” I said. “It’s like one of those plasma globes. You know how when you touch a finger to the glass and those electrical pulses dance all around?”

  She nodded. “Robert has one on his desk in his office.”

  “That’s what happens in the brain during a seizure. The electricity gets all wild and crazy. In a generalized seizure, like you had the other night, this happens all over the brain. Everything malfunctions. That’s why you passed out. That’s why you had those jerking motions. That’s why you lost control of your bladder.”

  “Is that going to happen again?”

  “Not once you get on the right medicines.”

  “That’s a relief. That was embarrassing.”

  “The type of seizure you had we call grand mal because it involves the entire brain. Other seizures are localized and only affect part of the brain. A seizure that occurs in the area that controls the left arm will make it jerk while the rest of the body remains normal. The person usually doesn’t pass out or any of the other things.”

  She rolled her eyes. “Like wetting your pants.” She looked at Robert. “I’m glad you weren’t there.”

  “I can handle it.”

  She smiled and squeezed his hand.

  “Do you understand what I’ve said so far?” I asked.

  “I think so. The brain can have a seizure in just one part or it can involve the entire brain. And whatever part of the brain acts up will determine what happens to the body. Is that right?”

  “I couldn’t’ve said it better. Sometimes a local seizure can spread across the brain and become a generalized seizure. That’s what happened to you.”

  “Sort of breaks containment?” Robert asked.

  “Exactly,” Divya said.

  “The temporal lobe seizures you have are a special type of localized seizure.”

  “I knew you were special,” Robert said.

  “Maybe special needs,” Nicole laughed.

  “The temporal lobes lie on either side of the brain just above and behind the ears. About here.” I touched the side of her head. “These areas don’t move arms or legs or any other part of the body, so a seizure in these areas doesn’t cause any abnormal movements. Instead the temporal lobes control emotions, memories, and certain feelings. A seizure in this area can make you feel happy, or sad, or giddy. You might have a déjà vu or an out-of-body experience. Alterations in taste or sound or one of the other senses can occur. They can also trigger fugue states. That’s what’s been happening to you.”

  “I thought a fugue was a type of music?” Robert said.

  “It is,” Divya said. “This is a little different.”

  “When someone has a fugue episode, their personality changes,” I said. “They become someone else. Might not know who they are or recognize people they know. They appear completely normal but often do things that they wouldn’t normally do and not remember any of it. It’s as if those few minutes or few hours of their life isn’t recorded on their brain’s hard drive.”

  “That’s exactly how I felt every time one of these happened.”

  “It can be scary,” I said.

  “Tell me about it,” Nicole said. “One time I apparently walked out in the middle of a seminar. This was a year or so ago. I remember sitting in the conference room but not leaving. The next thing I knew, I was on the subway down in the financial district.” She shook her head. “Totally freaked me out.”

  “That’s what happened the other night,” Divya said. “When you left the restaurant and we had to come find you.”

  “What?” Robert asked. “You didn’t tell me about that.”

  “I will. Later.”

  “So that’s basically what the problem is,” I said. “With proper medication, the seizures will stop, and these episodes will disappear.”

  Nicole dropped her head back against the pillow and looked up at the ceiling. I could see the tears welling in her eyes. “I’m such a freak.”

  Robert bent over and kissed her cheek. “But you’re my freak.”

  She laughed and threw one arm around him, pulling him down until their cheeks were mashed together. “I love you so much.”

  “You’re not a freak,” I said. “This type of seizure is not common, but it’s not rare either. In many cases it probably goes unrecognized.”

  “So there are other freaks like me,” Nicole said. She laughed as she dabbed tears from her eyes again.

  “You’re in good company. You know who Agatha Christie was, don’t you?”

  “Sure. I read her books when I was in high school.”

  “I don’t know whether she had this form of epilepsy or not, but she did apparently have fugue states. I remember reading that she once disappeared for eleven days before showing up at a hotel. She had no memory of what had happened.”

  “Eleven days? That makes my few hours here and there seem small.”

  “That’s the attitude I want you to take. This is simply an aggravation and not something that will alter your life unless you let it. Take your medicines and everything will be okay.”

  “I won’t be Jekyll and Hyde anymore?”

  “Wouldn’t it be more like Jacqueline and Heidi?” I asked.

  Nicole laughed. “I don’t want to be them either.”

  Chapter 46

  The Suffolk County medical examiner’s office sat just north of I-495 in Smithtown, a nine iron from the medical society’s office. It was just after noon when Divya, Jill, and I were ushered into Dr. James Hawkins’s office by his secretary. He had called earlier and asked if we would come by.

  After we were seated, he handed me a piece of paper. Lab results on his testing of the pills Julian Morelli had been spreading around the county.

  “Ms. Casey, our lab confirmed everything your lab found. An ephedrine-like amphetamine, furosemide, desiccated thyroid, and digitalis leaf.”

  “That’s a relief,” Jill said. “Last night I tossed and turned, worrying that the lab might be wrong.”

  Jill stayed over last night. I didn’t remember her tossing and turning. I gave her a look. She got it. Fought the smile I saw nipping at the corner of her mouth.

  “You’ve got nothing to worry about on that front,” Hawkins said.

  “Morelli threatened to file a lawsuit,” Jill said. “This might change his mind.”

  “We’ll get to Dr. Morelli in a minute.” Hawkins settled his glasses in place and shuffled through some papers until he found the one he was looking for. “We also repeated the blood tests you had done. Again confirming your findings.” He handed me the lab report.

  I looked it over before passing it to Divya. “This looks like strong evidence. Is it enough?”

  Hawkins nodded. “More than enough. These findings suggest we have a true public health issue here.” He slipped off his glasses and pinched the bridge of his nose for a second. “I spoke with Bernard Bernstein a little while ago. President of the county medical society.”

  “I bet that went well,” I said.

  He gave me a quizzical look.

  “Before you got involved,” I said, “I brought this up with Dr. Bernstein. I thought he might help, but he wasn’t very receptive. I know that he and Julian Morelli are friends.”

  Hawkins nodded and a slight smile appeared. “Maybe not anymore.”

  “Really?” Jill asked.

  “He started down that path with me, too. Until I presented him with all the evidence you’ve just seen. He backpedaled.”

  “So he’s jumping off the Julian Morelli bandwagon?” I asked.

  “He didn’t really have much choice.”

  “What’s your next step?”

  “A warrant for Morelli’s arrest was signed an hour ago. A search warrant and a cease-and-desist order for StellarCare, too. The police should be making the arrest and shutting the place do
wn about now.”

  “That quickly,” Divya asked. “I’m impressed.”

  “This is a public health issue,” Hawkins said. “We don’t know how many people out there are taking these drugs. Once we dig through StellarCare’s records, we can identify and warn them.”

  I wondered exactly how many people Julian had given these little poison packets to. Twenty? A hundred? Several hundred? The worst-case scenario was frightening.

  “We’ve sent the word out,” Jill said. “We passed along the information we had to every emergency room on Long Island. Gave them a heads-up on our findings so they will do the proper testing if any similar patients show up in their facilities.”

  “Excellent,” Hawkins said. “Forewarned is forearmed.”

  Evan lay inside the oxygen chamber, eyes closed, listening to the piped-in music. Cindy had put him in there just five minutes earlier and already he felt both relaxed and energized. He wondered if he was becoming addicted to oxygen. Could that happen? Was there an Oxygen Anonymous?

  He remembered reading somewhere about oxygen bars being big on the West Coast a few years earlier. At the time, he had thought it was silly. Something that could happen only in California. Why would anyone pay to sit in a bar and breathe oxygen? To him it was like paying for gourmet water. Water is water. Oxygen is oxygen. There’s plenty of both free for the taking.

  He still didn’t understand the water part, but paying for oxygen made perfect sense now. He wondered what the home version of one of these would cost.

  The cushion was soft, the music soothing, and the oxygen-rich air cool against his face. He felt as if he were floating on air and didn’t realize that he had dozed off. Until a sharp knock on the side of the cylinder yanked him awake.

  Cindy’s face appeared in the window above him. Behind her was another face. A stern face. One that didn’t look happy. When Cindy cracked open the chamber and lifted the lid, he saw that the other face belonged to a uniformed police officer.

  Evan rolled out of the chamber and stood. “Evan R. Lawson. CFO of HankMed.” He extended his hand toward the officer.