Kendall shoved aside the remains of Thomas’ breakfast, a discarded hospital gown, the call button, and a single shoe to plop down the palm-pross in the middle of the bedside table. He inserted the disc, adjusted his own Vox, and tugged the headphones off of Thomas Heaton. With a grand gesture, he tossed them aside and hit the Play key on the palm-pross.
For a moment, nothing happened. It abruptly occurred to Susan neither of them had actually listened to the disc. For all she knew, it might contain a grocery list or a Satanic sermon, or a series of swear words directed at their patient. Then, just as she felt certain it was entirely blank, she heard the tap of a baton on a podium and a hush, followed by the sweet sounds of a symphony orchestra playing a romantic piece Susan did not recognize. Every sound emerged crisp and true, an ancient wonder in an era of synthetic and simple music. The quadriphonic quality created by the palm-pross’s dual speakers and the individual Vox made the music seem to come from every direction at once.
The change in Thomas Heaton was gradual. The glaze melted from his eyes, granting them a new and lifelike glimmer. His head slowly lifted, dissolving what had seemed like a permanent double chin. His gestures, initially inhibited and jerky, smoothed as the first piece progressed so that by the end, they became noticeably fluent, strong strokes cleaving the air with sure precision.
Susan did not have to close her eyes to imagine the woodwinds blowing, fingers flying over the keys; the chirpier quality of the strings, bows dancing; the blaring of the brass, their horns gleaming golden in the subdued lights; and the intense focus of the percussionists keeping it all in proper rhythm. She could imagine this broken man in his prime, robust and professional, at the head of it all, lashing them into their finest performance.
As the final strains of the first piece trickled to silence, Kendall turned down the volume while Susan crouched in front of Thomas Heaton and chased his gaze until he had no choice but to physically cover his eyes or look at her. The latter required less energy, apparently, because the tired, dark eyes finally met hers. There was a glow this time she had not seen before, and she wanted to catch it before it disappeared again. “Maestro, please. Talk to us. We only want to help you.”
For an instant, nothing happened. Then broad shoulders heaved beneath the crimson-and-white bathrobe and a great sigh escaped him. It was a terrible noise, filled with the all the pain and wretchedness of the universe, yet it was also an enormous improvement from his previous near catatonia.
Susan glanced at Kendall, who continued the music at a lower volume and gestured for her to continue.
Susan did not know what else to do, so she took both of Thomas’ hands in hers. He had strong hands, lightly callused, larger and colder than her own. Brown lines etched deeply into his pale palms. She continued to hold his attention until it became more difficult to dodge her than to stare. “Maestro, please. We’re doctors, and we’ve seen everything. Whatever it is, we can help you.”
Thomas’ lips moved, but no words emerged.
Susan dropped to her haunches, wildly frustrated. She looked at Kendall again.
Kendall stepped to her side and crouched down beside her, also studying Thomas Heaton. When the conductor made no further attempt to speak, Kendall did what he always did best. “Mr. Heaton, do you know the difference between a bull and an orchestra?”
Susan froze and turned her head hurriedly toward Kendall. This sounded suspiciously like the opening to a bad joke, and, if not, then to a grave insult. Either way, she doubted it would help. “Kendall,” she started.
Thomas made a strangled noise. Then abruptly he let out a sudden bray that seemed to clear a long-plugged throat, followed by a rush of air.
Kendall carefully began the punch line. “A bull has the horns in the front…”
Thomas finished in a rusty tone, “And the asshole in the back.”
Both men laughed as if they had just collaborated on the most brilliant comedy ever written. It did not surprise Susan that Thomas knew the ending; likely he had heard every conductor joke in existence. What shocked her was both Kendall’s knowledge and the other man’s reaction. As the realization came to Susan that Thomas had just referred to himself as a nasty part of bovine anatomy, she chuckled along with them.
As the chortles died out, Susan worried Thomas Heaton might lapse back into the depths of his depression, into his stony and imprisoning silence.
Kendall must have thought the same thing, because he pulled out another joke. “What do you do with a clarinetist who can’t play?” Kendall responded before the other man could. “Put him in the back, give him two sticks, and make him a percussionist.”
Susan wondered why Kendall had run over his own punch line without giving Thomas time to answer, but then Kendall continued.
“But what if he can’t do that right either?” This time, he waited for Thomas to reply.
A slight grin came to the corners of the man’s broad mouth, but he clearly had to figure out the answer. “Take away a stick, put him in the front, and call him the conductor.”
Again, the two men laughed. This time, Susan watched life trickle into the older man’s eyes. Responding appropriately to jokes demonstrated a command of memory, reason, and humor, all higher functions of the brain. Clearly, as they had suspected, the depression was the cause of his sudden slide into apparent dementia. It only remained to find the underlying cause, and Susan suspected it had something to do with the opaque spot on his MRI. She went back to her original thought: posterior cerebral artery stroke. “Maestro Heaton, are you having trouble with your vision?”
Heaton reluctantly pulled his gaze from Kendall to plant it on Susan.
Susan cringed, wishing she had not killed the mirth so quickly. Kendall had had a great idea that worked, one Susan would not have thought to try in this situation. “Do you find yourself startled by things that come upon you unexpectedly? Are you tripping or falling frequently?”
The conductor looked at Kendall, as if the male resident could explain the odd series of questions. There was a wariness to his manner, as if he might disappear back into his funk at any moment, irretrievable.
Susan tried the direct approach. “Maestro, please tell us what your symptoms are. We want to help you.”
It turned out to be exactly the wrong thing to say. Thomas buried his face in his palms. His body slumped into the chair.
Susan watched him for several moments, while Kendall cringed, head shaking. The conductor did not make a single motion. He did not even appear to breathe.
Susan released his hands and rose, scurrying to find a different approach before it was too late. “Maestro, I have some musical questions that have been bothering me for some time. I wonder if you could help me.”
Kendall froze in midmovement, head slightly cocked, as if he simultaneously suffered hope and fear for what Susan might say next. She wondered if he knew how many times she had worried for what might come out of his mouth.
Thomas’ head bobbed ever so slightly. Susan hoped she had not imagined the movement.
“My father and I have argued a long time over the correct pronunciation of”—she continued, letter by letter—“B-E-E-T-H-O-V-E-N.”
Thomas stiffened all over. Gradually, his head rose. “That’s Beethoven.”
“Ah.” Susan pretended to consider the response. “Dad insisted on pronouncing it ‘Beet Oven.’ I thought he was teasing, but he sounded so sure of himself.” She added, “And C-H-O-P-I-N?”
Thomas gave the name its proper French pronunciation. “Frédéric François Chopin.”
Susan nodded, as if taking mental notes. “So, not ‘Choppin.’”
Thomas managed a rusty laugh.
Susan tried one more. “B-A-C-H.”
Thomas accommodated that request as well. This time, Susan did not try to come up with a weird, phonetic response. She set down the palm-pross on a level surface, then retrieved a crumpled bit of paper and a pen from her pocket. “I’m going to look something up. I wond
ered if you’d save me some time by writing my grocery list while I’m doing it.”
It was a wretched attempt at casual behavior, but the conductor gamely smoothed out the paper and accepted the pen. While Susan did a quick search of the Net, she dictated: “Avocados, pecans, tomatoes…” She hesitated as the item she had sought came onto the screen, then continued. “…canned cat food, a round pan, a birthday cake, and”—she tried to think of an appropriate addition—“celery.”
Clutching the pen, Thomas turned Susan a thoughtful look. “Would you like me to pick up your laundry next?”
Susan chuckled, taking the pen and paper and placing it in her pocket absently. She turned the palm-pross to face the conductor. “What’s this, exactly?” The answer was clearly marked at the top of the screen in bold letters above a complicated musical score.
Thomas hummed the first several bars, one hand waving dramatically. He grinned suddenly. “That’s Bach’s Brandenburgische Konzerte, Number Three.”
“Is it, now?” Susan said, as if the screen bore no label. She punched a few more buttons. “How about this one?”
Again, Thomas hummed several bars, waving grandly, before declaring it Franz Liszt’s Orpheus.
Susan tried another tack. She brought up an image on the computer. “Do you happen to know who this is?”
Thomas glanced at the picture and answered almost instantly. “That’s Leonard Bernstein.”
“Is it, now?” Susan examined the picture more closely. “Looks like my Uncle Justin.” She found another online portrait. “Who’s this, then?”
Thomas had no difficulty naming the obscure composer. “That’s Francesco Malipiero.”
Susan turned the palm-pross around to examine the screen and made a thoughtful noise. “So it is.” She touched a few more buttons. “I have one more identification for you.” She brought up an image and turned it back to Thomas Heaton.
The conductor laughed. “That would be me.”
“I knew that,” Susan said, as if admitting a secret. “But I’m wondering what you’re doing there.”
Thomas studied the picture, the smile plastered in place, as if forgotten. “I’m clearly conducting the Manhattan Symphony Orchestra.” He leaned in closer. “That’s the score from Mozart’s Fourteenth, which means that picture was taken in 2029.”
“How do you know you’re conducting?”
Thomas Heaton turned Susan a look of withering disdain. “First, that’s what I do. Second, why else would I have a baton in my hand and an audience at my back?”
Susan turned the screen around to look at it. “Baton? You mean that pink-and-green stick in your hand?”
“Pink and green?” Thomas grabbed the edge of the palm-pross and pulled it back around. He gave Susan another queer look. “Are you color-blind, Doc? It’s clearly white with a bit of red at the tip. One of my favorites at the time, if I remember correctly.”
Susan accepted the palm-pross back. “Why, so it is. White with red at the tip. Maybe the illusion of movement made me see pink, but green? Where’d I get that from?” She put her hand in her pocket, trying to make the gesture look absentminded. “Well, we need to be going now, Maestro. Is there anything we can get you to make your stay more comfortable? I’ll add it to my list.”
“Thank you, but that’s not necessary.”
Susan pulled her empty hand from her pocket. “Darn it, I seem to have lost the list.” She drew out the pen but left the paper in place. “You don’t happen to remember what I had on it, do you?”
Thomas considered. “I recall avocados, pecans, birthday cake…” He thought a moment longer. “…and celery. There were a couple of other things, but I’m blanking on them.”
Susan glanced at Kendall with a slight head shake, concerned he might jog the older man’s memory, but the other resident had taken a seat on the only other chair and seemed content to watch Susan work.
Susan feigned discovering the list deeper in her pocket. “Ah, here it is.” She scanned the list, written in small, neat print. “I’m sorry, I can’t make this one out. Can you tell me what this says?”
Susan placed the list over the palm-pross keypad and pointed to the words “canned cat food” that Thomas Heaton had previously written.
The effect was dramatic. His smile wilted into a deeply scored frown of irritation. All humor left the conductor’s features, his body language grew tight and tense, and his gentle stare became a solid and angry glare. “I thought you had to leave, Doctors.”
Susan acted as if she had not heard him. She pointed to the word “celery.” “Also this word, if you please. I can’t quite read your writing.”
Thomas’ head sank back into his palms. His body seemed to shrink before her eyes. “Get out,” he said feebly. “Leave me alone.”
Susan had all the information she needed. “Good day, Maestro,” she said, then scurried from the room. She waited until Kendall exited behind her before shutting the door. Without speaking, they fast-walked to the staffing area, where Kendall collapsed into a chair, laughing. “What the hell was that, Calvin? Some bizarre sort of surreptitious mini mental-status exam?”
“Bingo.” Susan dropped the palm-pross to the table. “The posterior cerebral artery version.”
“Sounds like a computer game.”
“It wouldn’t be the most boring one I’ve ever played.” Susan explained in more detail. “Remember Diesel Moore?” The case was a year old, but she felt certain Kendall would remember the boy.
“Ten-year-old with Prader-Willi syndrome.”
“Not exactly.” Susan had been following the child in her outpatient clinic, so she had more recent updates. “He appeared to have Prader-Willi syndrome, but the test was negative. He actually had the syndrome of optic nerve hypoplasia. It just presented like PWS because he had normal vision coupled with the hypothalamic problems that often accompany hypoplastic optic nerves.”
“Yeah.” Kendall sprawled across his chair, one arm thrown over its back. “So?”
“So, that case made me realize any disease process presents as a constellation of symptoms that can vary between individuals.”
Kendall raised his brows. “That’s the first time you realized it? Isn’t that elementary pathology?”
Susan sighed. “Of course, Kendall. But my point is, we naturally shortcut the symptoms to those displayed by the greatest number of people with the particular illness.” She used a more straightforward example. “When I was on Pediatrics as a student, we had a toddler present with intractable seizures accompanied by clouding of the cornea and excessive tearing.”
Each of those features, in and of itself, was rare and interesting. Kendall sat up. “Injured the eyes during one of the seizures?”
Susan bit her lower lip. “That was assumed. It took a week before anyone suspected glaucoma.”
Kendall snapped his fingers. “Glaucoma.” Taking the next appropriate step, he asked, “And what did the child ultimately turn out to have?”
“Sturge-Weber syndrome.”
Kendall slumped in the chair and gave Susan a searing look. “Well, anyone could have made that diagnosis, if you hadn’t left out the most significant detail. Why didn’t you mention the gigantic reddish-purplish splotch across the face?”
“Because,” Susan emphasized, “she didn’t have the classic port wine stain.”
“Okay, what made this particular port wine stain so hard to see?”
“It didn’t exist, Kendall. She didn’t have a port wine stain.”
“But I thought all—”
“Ninety-eight percent of infants with Sturge-Weber syndrome have the port wine stain, which leaves two percent to the whims of diagnostic suspicion. A hundred percent have leptomeningeal angiomata, which she did turn out to have. Eighty-three percent have seizures.” Susan winced at the memory. “Because of the delay in diagnosis, this little girl wound up blind. Had doctors diagnosed the glaucoma earlier, she might have had a chance for at least some vision.”
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br /> “Might,” Kendall emphasized. “But doctors aren’t perfect, and when the disease presents without its primary feature…” He trailed off as understanding struck him. “What’s the percentage of people who suffer a posterior cerebral artery stroke who develop homonymous hemianopsia?”
“Not sure,” Susan said. “It’s the classical symptom, so we all look for it. When someone presents without it, or any obvious motor dysfunction, or even apparent memory impairment, we overlook it.”
“We,” Kendall repeated smugly, “meaning anyone but you.”
Susan dismissed words Kendall probably meant as a compliment. “I, and you, have the benefit of hindsight.”
“Do we?” Kendall planted his feet firmly on the floor. “Most physicians would have accepted the previous doctor’s diagnosis, that Thomas Heaton had developed dementia, and he would have become lodged here for the rest of his life, albeit short.”
Susan merely shrugged.
But Kendall had not finished. “Calvin, I’m tired of you couching your successes in terms suggesting anyone could have figured it out. Everyone could not have figured it out, or someone else would have done so.”
The conversation discomfited Susan for reasons she could not wholly explain. “Fine, I’m brilliant. I’m the smartest woman in the world. Does that make you happy?”
“No,” Kendall admitted. “Mostly because you’re being sarcastic while I’m trying to…”
“Butter me up?” Susan tried.
“No.” Kendall’s face assumed an exaggerated leer. “Although the image is somewhat satisfying.” His tone dripped with innuendo. “I could lick off the butter—”
“Enough!” Susan stopped him before he could say anything lewd, thus wholly changing their association in an instant. Apparently, he had given upgrading their relationship at least as much thought as she had. “I have one talent: a knack for taking handfuls of facts and putting them together in the proper order.” She added carefully, “And a good grasp of human nature and behavior.”
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