"And is that what you'd be doing for Mom?"
"There'd be a series of injections, but given what appears to be her level of mental awareness right now, the procedure probably can be accelerated." He patted Nina on the shoulder.
"All right," Ally said "but can you use the same procedure for someone's heart?"
"Well, yes and no," he said. "Did you bring your medical records? I should have a look at them before making any pronouncements."
To prepare for this moment, she'd printed off a copy of the medical files she'd scanned into her computer.
"There're a lot of files," she said, opening her bag. "I've got copies of my EKGs over the past eleven years. Dr. Ekelman, my cardiologist, says my condition is getting progressively worse."
She took the folder out of her bag and handed it to him. He flipped through the files with what seemed an absent manner, almost as though he already knew what was in them and was just going through the motions. Then he looked up.
"Well, your physical condition looks pretty good. You clearly exercise. And I don't see anything here that would suggest a complication. As to how your procedure might differ from your mother's, I guess the main area of concern is simply the scale." He laid her files on the steel table. "Your heart has reached the stage of aortic valve stenosis where cardiac output no longer can keep up proportionately with vigorous exercise. And that has put an even larger strain on an already weakened condition. What we are about to undertake here corresponds to what might almost be considered an aortic valve replacement, though it is done at the cellular level. We call it regenerative medicine. Millions of cells will be involved We'll attempt to reverse the calcification and also to develop new blood vessels that supply the heart muscle."
"You know, this is so risky. I remember that not long ago they tried to use fetal cell injections into the brain for treating Parkinson's disease. And it turned out that the side effects were horrendous. Why should I assume that this is any safer?"
He looked pained. "I assure you we don't do anything here that is remotely like that particular, unfortunate procedure."
She stared at the ceiling trying to grasp what he'd just said. "So how risky do you think this is?" she asked finally. "Truth time."
He looked away again and sighed. There was a long silence in which he seemed to be pondering some extremely troubling thoughts. Finally he turned back.
"In medicine there is always something that can go wrong. Even the most innocuous procedure can end up being lethal if that's what the gods want that day." He looked at her intently and seemed to try to measure his words. "But I wouldn't recommend we proceed if I didn't feel that the potential benefits far outweigh the risks."
She listened wondering. Something in his voice is sounding cagey. What is he leaving out?
"I still want to think about it"
"Of course, but we can make some preparations in the meantime," Van de Vliet said turning back to Nina. "Mrs. Hampton, do you understand anything of what I've said? Nothing is risk free."
"Young man, if you'd lived as long as I have, and then felt it all slipping away, you'd be willing to take a chance with anything."
"Mrs. Hampton, Alzheimer's is one of the more promising areas of stem cell research. We've already had successes here. I truly think we can help you. In fact, Ellen can start your preliminaries right now, if you like. A lot of it you may have done before. For example, there's a game where you have to memorize the names of three unrelated objects, and you have to count backwards from one hundred by sevens. Finally there's a test where you copy sentences and symbols." He chuckled and there was a warmth but also a distant sadness. "Some days I'm not sure I could even do it all myself. In any case, it's not something you pass or fail. But if we do enter you into the trials, you'll have to stay here for the duration. That's absolutely essential. We'd also like a caregiver to be here with you, as long as it's necessary."
Ally looked at Maria. "Do you think you want to stay here with Mom?"
Maria's eyes were very sad "I could stay for a day or two. But … maybe we should talk."
"We can arrange for someone," Van de Vliet interjected "We routinely provide caregivers from our staff when called for. And because we're still in clinical trials, there is no charge."
Ally watched Nina brighten and turn to Maria. "You can bring some things from my closet when you go back. I want to start right away. I just know he can help me. I've got a feeling and you know my feelings are always right."
Ellen reached and took Nina's hand. "Come, dear, we have a special office where we handle all the paperwork for admissions. We can do the tests there."
Ally leaned over and kissed her mother. "I love you, Mom. And I love your spirit. You taught me how to be a fighter a long time ago. And I guess you're still teaching me."
Tuesday, April 7
12:03p.m.
Karl Van de Vliet watched the three women leave. Now he was alone with Alexa.So far, so good, he thought.With her mother checked in, we're partway there.Now what is it going to take to get her with the program? I'm not sensing commitment. She's asking too damned many questions.
It looks like we may have to go to Plan B tomorrow. Too bad.
After the door was closed, he turned back.
"Your mother is quite an inspiration," he said with a smile. "I'll need those tests to create a baseline, but already I can tell she'll almost certainly respond to the treatment. She fits our success profile. I'd say the odds are heavily on her side." Then he darkened his look, for effect. Better let her know I don'thaveto do this, he reasoned.
"The truth is, we already have enough data on Alzheimer’s that I don't really need any further clinical trials. I know the parameters of what the procedure can do and what it can't. But when Grant told me about his mother's condition, I saw no reason not to work her into the trials. We're winding down now and we have some empty beds."
"Don't think I'm not grateful," she said, "even though I may ask a lot of questions."
She got the message, he thought. Good.
"Alexa, I'm now going to tell you something I've never told anyone else," he went on, feeling a tinge of sadness arise in his chest. He hadn't planned to say this, but for some reason he now wanted to. Perhaps because it was true. "My late wife, Camille, was a brilliant medical researcher. We worked together for many years, first at Johns Hopkins and then at Harvard. What took her from me was a heart condition very similar to your own. That was over a decade ago and I vowed I would dedicate my work to her. I wanted the final clinical trial in this program to be on a young person with advanced valvular stenosis, but I could never find a patient who matched that profile. But you would be perfect." He looked carefully at her. It was all so true, which made this whole scene especially poignant.
"I'm sorry about your wife," Ally said. "I read in your-"
"You see, if I can succeed with you, it would almost seem as though I'd had a second chance to save her life. You bear such a striking likeness to her in several ways. You look something like her, but more importantly I sense that you share her indomitable will."
"So I'm not just another statistic to you?" She seemed to be trying to gauge the depth of his sincerity.
"No one here is a statistic, but you would definitely be someone special."
"I see," she said still sounding noncommittal.
Am I getting anywhere?he wondered Just press on. You've got to make this happen.
"All right, whatever you decide, we need to get some preliminaries out of the way. For one thing, we must have a complete new cardiology exam. Nothing in the file you brought presents an obvious red flag, but still, it's essential that we have an up-to-the-minute stress test. Toward that end I've taken the liberty of arranging for a checkup at the New York University Faculty Practice Radiology on East Thirty-fourth Street. Among other things, they can run a high-speed computed tomography screening using ultrafast X rays. Also, I'd like to see a phonocardiogram. A sonic analysis of 'murmurs' can tell us a lot abo
ut valve abnormalities. Regardless of what you decide to do here, it's a good idea for you to have this done regularly anyway."
"You've already scheduled tests?" Her tone of voice told him she was mildly taken aback at the presumption.
"It's just that the NYU Faculty Practice is sometimes difficult to get into on short notice. They can be booked for weeks in advance. But a cardiologist I know there, Lev Amram, has agreed to make room for you this afternoon. It's a professional courtesy. There'll be no charge. After that, and assuming you want to proceed, you should get a good night's rest and then come back here as early as possible tomorrow morning. You should pack for a three-week stay, though we'll provide you with pretty much everything you'll need here."
Just get her here.
"You know," she said, "I was actually hoping we could do this on an outpatient basis. I know you like to have your patients here for constant observation, but I run a business that needs me there every day."
"Alexa," he said, putting every last ounce of authority he had into his voice, "this is not a conventional procedure, and it's possible you might suddenly need special care of some kind. This is an experimental clinical trial, so we don't know what can happen. That's why I really must insist that you be here twenty-four hours a day." He looked at her with great tenderness. "We're talking about the possibility of completely repairing your heart. Surely you don't expect just to drop by now and then for that."
"All right, point taken," she said, "but-if we go forward with this-I'll need to hire at least one temp to be at the office while I'm gone. Somebody to at least handle the phone. That could take time."
"Surely someone there could manage to handle that," he said. She's getting resistant again, he told himself. Don't let that happen. "And there's also the matter of your mother. I think it would be wise for you to be nearby during the early stages of her procedure. When her mind starts climbing out of the abyss, it's important for a close family member to be there to provide a visual and emotional anchor. It truly can make all the difference. I fully expect that her functions of attention and recall will return to those normal for a woman her age, or quite possibly even better, but it will happen a lot quicker if you're here to help her, to remind her of things."
"This is a lot to digest." Ally turned and sat down in a chair. "All right, I might as well get the exam. It doesn't mean I've agreed to anything here."
He heard the ambivalence and knew he had no choice but to do what he was going to have to do tomorrow.
"I will proceed on the assumption that you'll be entering the program. Truthfully, if you don't, a week from now your mother is going to be asking you why." He smiled. "In any case, we need to have those tests done in the city. Also some blood work here. We're affiliated with a lab. I want to check your T-cells and certain other markers, like C-reactive protein and homocystine. It's something you should do regularly anyway."
"All right, then," she said finally. "But after that, let me go see how Mom's doing. Then I'll arrange things with Maria somehow and drive back to the city."
"By the way, before I forget, we have to complete a formal application for your mother to admit her into the clinical trials, and we also need a signed liability waiver. I assume you have power of attorney for her by now. If you don't, then we may not legally be able to proceed."
"I have it."
"Then let's get started" he declared almost certain he had her.
Chapter 14
Tuesday, April 7
11:35a.m.
Stone Aimes was in his cubicle, staring at the phone when it rang.
He prayed this was the call he'd been waiting for. As a gamble, a long shot, he'd requested that Jane Tully, his former live-in lover and theSentinel's part-time corporate counsel, do him a small favor. After he hacked the NIH Web site, he'd asked her to pass along just one question concerning Gerex to Winston Bartlett's corporate attorneys: Why had a patient been abruptly and mysteriously terminated, without explanation, from the clinical trials now under way by the Gerex Corporation? If that wouldn't get a rise out of Bartlett, he didn't know what would. It was the only part of the corporation's encrypted NIH file that seemed irregular. But would Bartlett take the bait?
He reached for the phone.
"Aimes here." Around him came the clatter of computer keys and muted laughter from the direction of the water cooler. Everybody had watched a Tivo of the latest Sunday night and they were still critiquing the shows. Mondays were everybody's day off, so Tuesdays were the first chance to catch up. The staff was also starting to rev up again for the coming week's edition, everybody with the hope that their particular assignment would have legs and make its author a household name. Stone, however, felt like this was either the first day of the rest of his life or the last day of a career built on dealing to inside straights.This cannot go on much longer, he kept telling himself; it was an unstable condition. His soul was already over the fence, keeping company with that wild, free ox he liked to muse about.
"Stone," came a husky female voice, strained and yet strong. Just as he'd hoped, it was Jane, whose office was down on the third floor. "Can you come down? Right now."
"Did you hear back from-"
"Stone," she admonished her voice growing urgent, "just come down. Do itnow, all right?"
"Sure." He paused a moment, wondering. Why did she sound so upset? Had his plan somehow backfired? "I'm on my way."
He glanced up at the fluorescent light over his head like a pitiless hovering spaceship, and wondered if this was going to be the break he had been praying for. There was a nervousness in Jane's voice that indicated something major was afoot.Somethingwas about to change.
He switched off his Compaq laptop and reached for his brown corduroy jacket, which was hanging from a hook on the side of the glass-walled cubicle. He straightened his brown knit tie as he stepped on the elevator, and for some reason he found himself thinking of his daughter, Amy.
He mimed a toast.Here's looking at you, kid.
She was in the fifth grade and lived with her mother, Joyce, in a small condominium nestled in the hills near El Cerrito, where his ex-wife grew up. Joyce was a television producer who had left him to go back out there, where she got work as a garden designer. When he got over the shock, he finally concluded she loved California more than she loved him. Maybe not an unreasonable choice. But then she got custody of Amy, based solely on the fact that his income was inadequate to send her to private school in New York and the public schools were out of the question. But Joyce had agreed that if he ever had the money, she could live with him some of the time. This book, he hoped, would make that happen.
He still didn't know why he and Joyce couldn't have made a go of it. It had occurred to him that there was the real possibility she had fallen in love with the idea of a dashing investigative reporter, not the grueling reality. These days she had Amy all the time except for three weeks in July, and he had so many things to regret he scarcely knew where to start.
He kept a year-old photograph of Amy on his desk, in a frame far too expensive for a snapshot of a young girl on a black horse named Zena. But it was Zena that his $1,500 a month in child support had helped to pay for, and he felt it somehow bonded them.
Hi, Dad, from me and Zena, went the inscription.
Why was he thinking about her now? he wondered. The answer was, because he wanted her world to be different from the one he had known as a child. He hadn't had a father around, and that had left him with a lot of anger. He didn't want the same fate for her.
Amy's world, he knew, was going to be very different, no matter what he did. To be young like her and starting out was a daunting prospect these days. He wanted to make everything easier for her, but the only thing he could give her now was a measly $1,500 every month and his unshakable love.
Even so, that was more than his mother, Karen, got for child support-from a natural father he had never actually seen in the flesh until he was eleven. And that was a chance encounter. ..
she'd said she wanted to do, though he wasn't sure where he would keep Zena.
But all in good time. Now everything depended on the book. ..
The elevator door opened and he stepped out on the third floor. The receptionist, Rhonda, a dark-haired resident of Avenue A who usually tried to flirt, looked at him as though he'd just been convicted of a crime and nodded with her head toward the corridor leading to Jane's office.
"Stone, you'vereallyscrewed up this time. You'll never guess who's in there and after your scalp. What onearthdid you do?"
"You mean-"
"This is a guy I've only seen in newspaper pictures, though, needless to say, not in this upstanding rag." In her dismay, she unthinkingly reached for the pack of Virginia Slims lying next to the phone, momentarily forgetting that smoking had long-since been forbidden in the building. "You'd better get your ass in there. Jesus, he came in with a bunch of lawyers, but then he told them to split. 'I'm going to handle the fucker myself.' Quote, unquote. Right here by my desk."
Stone didn't know, with absolute certainty, who she was talking about, but surely it had to be …My God, he thought with a thrill,maybe it worked. Maybe I've smoked him out.
"Truth tellers have nothing to fear, Rhonda." He winked at her. "I'm protected by the sword of the Lord. 'He is my rod and my staff. He leadeth me beside still waters.'"
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