Blood Test

by Jonathan Kellerman

  “I didn’t know that.”

  He picked up another roll and hefted it.

  “Drinking your water?” he asked.

  “It’s all yours.”

  He drank it.

  “Tell me about the Swopes. What kind of noncompliance problems are you having?”

  “The worst kind, Alex. They’re refusing treatment. They want to take the boy home and subject him to God knows what.”

  “Do you think they’re holistic types?”

  He shrugged. “It’s possible. They’re rural people, come from La Vista, some little town near the Mexican border.”

  “I know the area. Agricultural.”

  “Yes, I believe so. But more important, close to Laetrile country. The father is some kind of farmer or grower. Crass man, always trying to impress. I gather he’d had some scientific training at one time or another—likes to throw around biological terms. Big heavyset fellow, in his early fifties.”

  “Old to have a five year old.”

  “Yes. The mother’s in her late forties—makes you wonder if the boy was an accident. Maybe it’s guilt that’s making them crazy. You know—blaming themselves for the cancer and all that.”

  “That wouldn’t be unusual,” I said. Few nightmares compare to finding out one’s child has cancer. And part of the nightmare is the guilt parents inflict upon themselves, searching for an answer to the unanswerable question: why me? It’s not a rational process. It occurs in doctors and biochemists and other people who should know better—the mental floggings, the I should haves and I could haves. Most parents get over it. The ones who don’t can be crippled ...

  “Of course in this case,” Raoul was hypothesizing, “there would be more of a basis for it, wouldn’t there? Aged ovaries, etc. Well, enough conjecture, let me go on. Where was I—ah, Mrs. Swope. Emma. A mouse. Obsequious even. The father’s the boss. One sibling, a sister, around nineteen or so.”

  “How long’s the boy been diagnosed?”

  “Officially just a couple of days. A local G.P. picked up the distended abdomen on exam. There’d been pain for a couple of weeks and fevers for the last five days. The G.P. had sneaking suspicions—not bad for a country doc—didn’t like the local facilities and sent them up here. We had to do an extensive eval—repeat physical, bloodwork, BUN, uric acid, bone marrows from two sites, immunodiagnostic markers—the non-Hodgkin’s protocol demands it. It wasn’t until a couple of days ago that we had it staged. Localized disease, no disseminated mets.

  “I had a diagnostic conference with the parents, told them the prognosis was good because the tumors hadn’t spread, they filled out informed consents, and we were ready to go. The boy has a recent history of multiple infections and there was pneumocystis swimming around in his blood so we put him in Laminar Flow, planned to keep him there for the first course of chemo, and then check how the immune system was working. It looked open and shut and then I got a call from Augie Valcroix, my clinical Fellow—I’ll get to him in a minute—and he told me the parents were having cold feet.”

  “No indication of problems when you first spoke to them?”

  “Not really, Alex. The father does all the talking in this family. She sat there and wept, I did my best to comfort her. He asked lots of picky questions—like I said, he was trying to impress—but it was all very friendly. They seemed like intelligent people, not flaky.”

  He shook his head in frustration.

  “After Valcroix’s call I went right over, talked to them, thinking it was momentary anxiety—you know sometimes parents hear about treatment and get the idea we’re out to torture their child. They start looking for something simple, like apricot pits. If the doctor takes the time to explain the value of chemo, they usually return to the fold. But not the Swopes. They had their minds made up.

  “I used a chalkboard. Drew out the survival graphs—that eighty-one percent stat I gave you was for localized disease. Once the tumors spread the figure drops to forty-six. It didn’t impress them. I told them speed was of the essence. I laid on the charm, cajoled, pleaded, shouted. They didn’t argue. Simply refused. They want to take him home.”

  He tore a roll to shreds and arranged the fragments in a semicircle on his plate.

  “I’m going to have eggs,” he announced.

  He beckoned the waitress back. She took the order and gave me a look behind his back that said I’m used to this.

  “Any theory as to what caused the turnaround?” I asked.

  “I have two. One, Augie Valcroix mucked it up. Two, those damned Touchers poisoned the parents’ minds.”

  “Who?”

  “Touchers. That’s what I call them. Members of some damned sect that has its headquarters near where the family lives. They worship this guru named Noble Matthias—that’s what the social worker told me—and call themselves the Touch.” Raoul’s voice filled with contempt. “Madre de Dios, Alex, California has become a sanctuary for the psychic refuse of the world!”

  “Are they holistic types?”

  “The social worker says yes—big surprise, no? Assholistic is more like it. Cure disease with carrots and bran and foul-smelling herbs thrown over the shoulder at midnight. The culmination of centuries of scientific progress—voluntary cultural regression!”

  “What did these Touch people do, exactly?”

  “Nothing I can prove. But all I know is things were going smoothly, the consents were signed, then two of them—a man and a woman—visited the parents and disaster!”

  A plate heaped with scrambled eggs arrived along with a dish of yellow sauce. I remembered his affection for hollandaise. He poured the sauce on the eggs and used his fork to divide the mound into three sections. The middle segment was consumed first, followed by the one on his right, and finally the left third disappeared. More dabbing, more imaginary crumb disposal.

  “What does your Fellow have to do with it?”

  “Valcroix? Probably plenty. Let me tell you about this character. On paper he looked great—M.D. from McGill—he’s a French-Canadian—internship and residency at Mayo, a year of research at Michigan. He’s close to forty, older than most applicants, so I thought he’d be mature. Ha! When I interviewed him I talked to a well-groomed, intelligent man. What showed up six months later was an aging flower child.

  “The man is bright but he’s unprofessional. He talks and dresses like an adolescent, tries to get down to the patients’ level. The parents can’t relate to him and eventually the kids see through it, too. There are other problems, as well. He’s slept with at least one mother of a patient that I know about and I suspect there’ve been several others. I chewed him out and he looked at me as if I were crazy to be worried about it.”

  “A little loose in the ethics department?”

  “He has no ethics. Sometimes I’m convinced he’s drunk or on something, but I can’t trip him up on rounds. He’s prepared, always has the right answer. But he’s still no doctor, just a hippie with a lot of education.”

  “How’d he get along with the Swopes?” I asked.

  “Maybe too well. He was very chummy with the mother and seemed to relate to the father as well as anyone could.” He looked into his empty coffee cup. “I wouldn’t be surprised if he wanted to sleep with the sister—she’s a looker. But that’s not what’s bothering me right now.”

  He narrowed his eyes.

  “I think Dr. August Valcroix has a soft spot in his heart for quacks. He’s spoken up at staff meetings about how we should be more tolerant of what he calls alternative health care approaches. He spent some time on an Indian reservation and was impressed with the medicine men. The rest of us are discussing the New England Journal and he’s going on about shamans and snake powders. Unbelievable.”

  He grimaced in disgust.

  “When he told me they were pulling the boy out of treatment I couldn’t help but feel he was gloating.”

  “Do you think he actually sabotaged you?”

  “The enemy from within?” H
e considered it. “No, not overtly. I just don’t think he supported the treatment plan the way he should have. Dammit, Alex, this isn’t some abstract philosophy seminar. There’s a sick boy with a nasty disease that I can treat and cure and they want to prevent that treatment. It’s—murder!”

  “You could,” I suggested, “go to court on it.”

  He nodded sadly.

  “I’ve already broached the subject with the hospital attorney and he thinks we’d win. But it would be a Pyrrhic victory. You remember the Chad Green case—the child had leukemia, the parents pulled him out of Boston Children’s and ran away to Mexico for Laetrile. It turned into a media circus. The parents became heroes, the doctors and the hospital, big bad wolves. In the end, with all the court orders, the boy never got treated and died.”

  He placed an index finger against each temple and pressed. A pulse quivered under each fingertip. He winced.

  “Migraine?”

  “Just started. I can handle it.” He sucked in his breath. The paunch rippled.

  “I may have to take them to court. But I want to avoid it. Which is why I called you, my friend.”

  He leaned forward and placed his hand over mine. His skin was unusually warm and just a bit moist.

  “Talk to them, Alex. Use any tricks you’ve got up your sleeve. Empathy, sympathy, whatever. Try to get them to see the consequences of what they’re doing.”

  “It’s a tall order.”

  He withdrew his hand and smiled.

  “The only kind we have around here.”

  4

  THE W ALLS of the ward were covered with sunny yellow paper patterned with dancing teddy bears and grinning rag dolls. But the hospital smells that I’d grown used to when I worked there—disinfectant, body odor, wilting flowers—assaulted my nostrils and reminded me I was a stranger. Though I’d walked this same corridor a thousand times, I was gripped with the chilling uneasiness that hospitals inevitably evoke.

  The Laminar Airflow Unit was at the east end of the ward behind a windowless gray door. As we approached, the door swung open and a young woman stepped into the hallway. She lit up a cigarette and began to walk away, but Raoul hailed her and she stopped, turned, bent a knee and froze the pose, one hand on the cigarette, the other on her hip.

  “The sister,” he whispered.

  He’d called her a looker but it was an understatement.

  The girl was stunning.

  She was tall, five eight or nine, with a body that managed to be both womanly and boyish. Her legs were long, coltish, and firm, her breasts high and small. She had a swan’s neck and delicate, slender hands ending in crimson lacquered nails. She wore a white dress made of T-shirt material and had cinched it with a silver cord that showed off a tiny waist and flat belly. The soft fabric molded to every angle and curve and ended midthigh.

  Her face was oval with a strong cleft chin. She had prominent cheekbones and a clean jawline leading to lobeless ears. Each ear was pierced with two threadlike hoops of hammered gold. Her lips were straight and full, her mouth a generous red slash.

  But it was her coloring that was most striking.

  Her hair was long, lustrous, combed straight back from her high smooth forehead, and coppery red. But unlike most redheads she had no freckles and lacked the buttermilk complexion. Her skin was blemishless and burnished a deep California tan. Her eyes were wide-set, thick-lashed, and inky black. She’d used a bit too much makeup but had left her eyebrows alone. They were full and dark, with a natural arch that gave her a skeptical look. She was a girl anyone would notice, with a strange combination of simplicity and flash, almost overwhelmingly physical without trying to be.

  “Hello,” said Raoul.

  She shifted her weight and looked both of us over.

  “Hi.” She spoke sullenly and regarded us with with boredom. As if to underscore her apathy, she gazed past us and sucked on her cigarette.

  “Nona, this is Dr. Delaware.”

  She nodded, unimpressed.

  “He’s a psychologist, an expert in the care of children with cancer. He used to work here, in Laminar Flow.”

  “Hello,” she said, dutifully. Her voice was soft, almost whispery, the inflection flat. “If you want him to talk to my parents, they’re not here.”

  “Uh, yes, that is what I wanted. When will they be back?”

  The girl shrugged and flicked ashes onto the floor.

  “They didn’t tell me. They slept here so they probably went back to the motel to clean up. Maybe tonight, maybe tomorrow.”

  “I see. And how have you been doing?”

  “Fine.” She looked up at the ceiling and tapped her foot.

  Raoul raised his hand to offer the classic physician’s pat on the back, but the look in her eyes stopped him and he immediately lowered it.

  Tough kid, I thought, but then, this was no day at the beach for her.

  “How’s Woody?” he asked.

  The question infuriated her. Her lean body tensed, she dropped the cigarette and ground it under her heel. Tears collected in the inner corners of the midnight eyes.

  “You’re the damned doctor! Why don’t you tell me!” She tightened her face, turned, and ran away.

  Raoul avoided eye contact. He picked up the crushed butt and deposited it in an ashtray. Covering his forehead with one hand he took a deep breath and gave a migraine grimace. The pain must have been excruciating.

  “Come on,” he said. “Let’s go in.”

  A hand-scrawled sign in the nurses’ office said “Welcome to Space Age Medasin.”

  The bulletin board was tacked with layers of paper—shift schedules, cartoons cut out of magazines, chemotherapy dosage charts, and an autographed picture of a famous Dodger with a young bald boy in a wheelchair. The child held a bat with both hands and gazed up at the baseball player, who looked slightly ill at ease among the I.V. lines.

  Raoul picked a medical chart out of a bin and flipped through it. He grunted and pushed a button on a panel above the desk. Seconds later a heavyset woman dressed in white stuck her head in.

  “Yes—oh, hi, Doctor Melendez.” She saw me and gave a nod with a question mark stuck to the end of it.

  Raoul introduced me to the nurse, whose name was Ellen Beck-with.

  “Good,” she said, “we could use you around here.”

  “Dr. Delaware used to coordinate psychosocial care on this unit. He’s an international expert on the psychological effects of reverse isolation.”

  “Oh. Great. Pleased to meet you.”

  I took the proferred fleshy hand.

  “Ellen,” said Raoul, “when are Mr. and Mrs. Swope due back on the unit?”

  “Gee, I dunno, Doctor. They were here all last night and then they left. They usually come in every day, so they should be around sometime.”

  He clenched his teeth.

  “That’s very helpful, Ellen,” he said sharply.

  The nurse grew flustered and her meaty face took on the look of an animal corralled in an unfamiliar pen. “I’m sorry, Doctor, it’s just that they’re not required to tell us—”

  “Never mind. Is there anything new with the boy that hasn’t been charted?”

  “No sir, we’re just waiting for—” she saw the look on his face and stopped herself. “Uh, I was just going to change the linens in unit three, Doctor, so if you have nothing more—”

  “Go. But first get Beverly Lucas over here.”

  She glanced at a chalkboard across the room.

  “She’s signed out to page, sir.”

  Raoul looked up and stroked his mustache. The only evidence of his agony was the slight tremble beneath the bristly hairs.

  “Then page her, for God’s sake.”

  She hurried off.

  “And they want to be professionals,” he said. “Working hand in hand with the doctor as equal partners. Ludicrous.”

  “Do you use anything for the pain?” I asked.

  The question threw him.

  “
What—oh, it’s not so bad,” he lied, and forced a smile. “Once in a while I take something.”

  “Ever tried biofeedback or hypnosis?”

  He shook his head.

  “You should. It works. You can learn to vaso-dilate and constrict at will.”

  “No time to learn.”

  “It doesn’t take long if the patient’s motivated.”