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. 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 boy's 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 jitlly 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 o 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 causing 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 boy's 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 rather than a motor one."
"Are you trying to tell us that Toby has petit mal or temporal-lobe CPILEPSY? " 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 husband's 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 since 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 anesthe ics 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. "Frank, don't move, honey, please. You feel so good. I want to do a little while you're still inside me. Just a line. Okay? " I Frank's secretary, the blond one, was named Annette Dolan. She had moved with her child to live with her mother in Sterling, and had been working as a hostess in the Mountain Laurel Restaurant when Frank first spotted her and offered her a job. Her qualification for the position was, quite plainly, that she looked better in a sweater than any woman he had ever seen. She was a mediocre receptionist, and a far-worse-than-that secretary, but she was sweet and polite to everyone, and had proved a wonderful, undemanding diversion, especially on those occasions when he was able to indulge her passion for cocaine. "Go ahead, baby, " he said, running his thumbs over her nipples. "But hustle. I don't have much time left."
For more than an hour, first on the oriental rug in his office, and then on the couch, Annette had screwed him as only she could-purely and passionately, without any of the head games he tolerated but hated in brighter women. He cradled her breasts in his hands as she slipped one end of a straw into her nose and lowered the other onto the mirror that she had rested on his chest. "That's it, " he whispered as she inhaled the dust. "Get it all, baby. Get it all."
He glanced across at the Lucite clock on his bookshelf. Twenty after eight. Less than an hour until Mainwaring was due. Less than an hour until the beginning of the end. Annette had been the perfect appetizer for that session. Now, however, it was time to pack her up and ship her home. Frank waited until she had wiped the last grains of powder off the mirror and onto her gums. Then he skimmed the mirror across the room and pulled her magnificent, glistening body close to his. Slowly, he toppled off the couch and on top of her on the rug. She was beautiful to the eye and to the touch, but after an hour and a hundred dollars worth of cocaine, she held little excitement for him. All that remained was the mechanical need to climax. He grabbed her corn-silk hair tightly in his fists, buried his chest against her breasts, and rammed himself into her again and again until, in less than a minute, it was over. If only Lisette knew how much he needed this sort of uncomplicated, unquestioning sex, everything would be much better for them, he thought.
Much better. He took a minute to stroke the woman's clit, her tight, flat stomach, and finally her perfect ass. Then he moved to the chair behind his desk and watched as she dressed. Once every week or two was perfect-just enough to keep the adventure fresh and the woman from becoming tiresome. Absently, he thumbed through the papers on his desk-papers that included the application of the surgeon who would be Mainwaring's replacement. The whole business had gone down like clockwork, Frank mused, just as he had promised it would. He and Mainwaring had estimated two years, and precisely two years it had been.
Now, there was less than an hour until the final phase of their project would start. Less than an hour until the beginning of the end, until the beginning of everything good for him. Frank wrapped up what was left of the cocaine and flipped the plastic bag across to the woman. "Here you go, baby, " he said. "Enjoy."
"You promised you would try some with me sometime, Frank. Remember?"
"Sometime, maybe. For now, you just get on home and enjoy it, " he answered. "I don't have much use for that shit. There are enough other things I get off on. Like you."
And, he was thinking, like a million dollars. Frank showered in the bathroom off his office, dressed, and cleaned up the last vestiges of his session with Annette Dolan. Then he settled in before the computer terminal on his desk. There were still twenty minutes before Mainwaring was due-just enough time to check in with Mother. And, Frank noted, it was especially fitting that he should. For at a time when his back was to the wall, when the absence of $250, 000 he had borrowed from the hospital accounts and then lost in that foolish land deal stared at him every day like a gaping, black hole of doom, Mother had provided him with the answer. Mother was Ultr'ma, the Ultramed mainframe computer housed in the home office in Boston. She was the fiber that held the expanding Ultramed empire together, providing it with consistency, rapid exchange of information, and a seemingly endless pool of physicians. And in Frank's darkest, most desperate hour, Mother had served up both Jack Pearl and Jason Mainwaring. Frank activated the terminal, dialed the network number, and flipped the toggle switch on his phone. In seconds, Good evening, welcome to Ultr'maplease enter access code appeared
on the screen. Frank typed in the code and then, when requested, his own password. In a week or so his regional director would receive a printout of Ultr'nla users and would note on the appropriate evaluation form that at nine o'clock in the evening of that day, Frank had been hard at work in his office. Good evening, Mr. Iverson. We trust all is well in Sterling, New Hampshire. Do you wish to see your menu?
Frank typed Y. Immediately, ADMINISTRATOR'S MENU flashed on, followed by a list, 1. Changes in procedures and policies manual 2. Ultramed current staff physicians and salaries (your hospital only) 3. Ultramed current staff physicians and salaries (your region only) 4. Available physicians (by specialty) 5. Promotions, reassignments, terminations (past 30 days) 6. National health news of note 7. Regional health news of note 8.
Preferred suppliers and services (your region only) 9. Performance ratings (region) 10. Performance ratings (nation) 11. Golden Circle Administrators As he invariably did when communicating with Mother, Frank began by affirming his membership in the Golden Circle and his position as the leading administrator in the northest region. Leading administrator. Golden Circle. It was laughable now to think of how close he had come to not even applying for the Ultramed-Davis job. But with his electronics firm going down the tubes, the Judge refusing to help him out, and Leigh Baron insisting that he would get serious consideration in the search process despite his lack of hospital experience, he really had nothing to lose. It had been a mild shock when he was finally offered the position. And although there could be no arguing his remarkable success with the corporation, it remained something of a mystery to him why Leigh had picked him over many more experienced candidates. Frank scanned the regional and national rankings and then returned to the Administrator's Menu and summoned up item four.
The physicians of possible interest to the Ultramed system were listed by specialty and subspecialty, along with a detailed but straightforward summary of their education and work experience. However, item four was hardly a typical employment bulletin board.
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