“You ever watch Breaking Bad?”
“Sure.” He and Holly had spent several steamy summer weekends binge-watching that TV show about a high school chemistry teacher who becomes a meth cook, addicted, a couple of zombies sprawled on the bed, the air-conditioning on high.
“Remember the old guy with the bell? The—”
“Sure. You mean, could I do something with that kind of letter board they used on the stroked-out old guy? It’s an idea, sure. But I’m not sure it would work. Years ago we tried that on him, but no luck.”
“Can’t hurt to try again.”
“I can’t get him to blink once for yes and twice for no, or whatever. He blinks, but I’m not sure what he’s responding to. I need to get him seen by a good neurologist.”
“You know what; I just did a remodeling job on this great old town house in Louisburg Square, belongs to the chief of neurology at Mass General. I could ask him.”
“You stay in touch with him?”
Jeff nodded. “He’s a great guy. He was happy with the work. It was pretty damned fine, if I say so myself. We did an awesome winding staircase on the main level.”
“You think you could get in touch?”
“Happy to. He was telling me about all this crazy-ass new shit they’ve been doing at MGH with, like, magnets on the brain or something. Really wild.”
“Like electroshock therapy?”
“Isn’t that where they hook your brain up to a car battery or whatever whatever? Nah, I mean, it’s literally like they put some kind of really strong magnet on your head.” He tapped the side of his skull. “It makes depressed people undepressed, he said, and they’re starting to use it on people with brain damage or stroke. It made me think about your dad.”
“Put me in touch with him,” Rick said. “I’ll try anything.”
27
Jeff put in a call to his former client, the chief of neurology at Mass General, Dr. Mortimer Epstein. Dr. Epstein had in turn called Rick and spent a good ten minutes on the phone asking about Lenny’s condition. A generous act by a busy man. Rick could hear traces of an old Brooklyn accent in Dr. Epstein’s speech, probably traces he’d tried to expunge, mostly successfully.
A few minutes into the conversation, Rick said, “So Jeff mentioned something about magnet therapy?”
“It’s called transcranial magnetic stimulation,” Dr. Epstein said. “TMS. It’s been quite successful in treating depression, and it’s shown some promising results in treating stroke victims as well.”
“So it’s a brand-new procedure?”
“There’s nothing new about it. TMS has been around for thirty years. The great thing is, there’s no downside. They basically place a magnetic coil on the patient’s head and run an electrical current through it, pulsing it on and off for half an hour. If it works, great. If it doesn’t—well, no harm, no foul.”
“How long does it take to work?”
“It can take weeks and it can take days.”
“Sounds a little sci-fi.”
“That’s what they said about anesthesia a hundred and fifty years ago. Anyway, look, TMS has become quite popular. There’s a long waiting list of patients desperate to try it.”
“How long a waiting list? I mean, are we talking months?”
Dr. Epstein let out a low chuckle. His Brooklyn accent came on strong. “Well, look, I’ll try to pull some strings, get you moved to the head of the line. But how long has it been since your dad’s stroke? I mean, not for nothing, but it’s been like twenty years, right? What’s the rush all of a sudden?”
Rick didn’t know how to answer. What’s the rush all of a sudden? The answer was simple and almost too ugly to admit.
A few weeks ago he didn’t care that his father couldn’t speak. The Lenny he’d grown up with was gone, replaced by a gaunt, spectral Lenny who bore no relation to his actual father.
So for the last twenty years he’d parked this replacement Lenny in a nursing home, just waiting for him to die a quiet and anticlimactic death.
Until it turned out that there was a lot of money at stake.
* * *
The next morning Rick showed up at the nursing home in an uberX car, a perfectly neat Mitsubishi. He’d brought a new set of clothes: a pair of khakis, a belt, and a blue button-down shirt. One of the attendants, a short, stocky Brazilian named Paulo, got Len out of his pajamas and into the new street clothes, which was a complicated operation. Also, the belt was too big; his father had lost a lot of weight over the years, largely muscle mass. Rick wheeled him out of the nursing home and into the wheelchair-accessible cab, with a lot of help from the taxi driver.
This was his father’s first time outside the walls of the nursing home in eighteen years, and Lenny stared out the window, wide-eyed. By shortly before noon, they’d passed through the gates of the Charlestown Navy Yard, the two-hundred-year-old shipyard now part residential, part commercial, part historical preserve. It was the site where the British landed just before the Battle of Bunker Hill. Now, Marine barracks and paint shops and forge shops had been turned into condos; warehouses and rope walks and officers’ clubs had been converted into outlying research facilities for Mass General Hospital. The cab pulled up to a brand-new-looking hospital building, the Sculley Pavilion, named for a rich benefactor, Thomas Sculley, the real estate magnate. Just seeing it gave Rick that unfinished-homework pang. The piece he’d been pretending to write.
When they got out, Rick could smell the tang of salt air and hear the cry of seagulls. They were just a few blocks from the Atlantic.
Getting his father out of the cab and into his wheelchair was an ordeal. Lenny’s head lolled to his left, a thread of drool escaping the left corner of his mouth. His eyes came open as the chair scraped against the ground.
“You doing okay, Dad?”
Rick hadn’t pushed a wheelchair for nearly twenty years. Gradually he got the hang of it as he searched for the wheelchair-accessible entrance. Even the simple process of wheeling his father up into the Sculley Pavilion and finding an elevator and getting him up to the second floor required reserves of patience Rick no longer had, if he ever did.
The elevator to the second floor required a building card-key—the research facility was security-protected—but people, he found, went out of their way to help. A woman in scrubs swiped the elevator keypad for him before taking the stairs herself. People passing by smiled at him as he wheeled his father out of the elevator and down the corridor. He was the good son taking care of his aged father. Everyone liked that.
“Well, Lenny, the guy we’re about to meet is apparently some hot shit at Mass General. He’s an expert in something called transcranial magnetic stimulation.”
His father’s eyes stared straight ahead.
“I know,” Rick replied to his father’s silence. “That’s what I thought, too. But I figure it’s worth a shot.”
The director of the Laboratory for Neuromodulation was Dr. Raúl Girona, an associate professor of neurology at Harvard Medical School who had dark brown hair cut in high bangs and had a few days’ growth of beard that looked deliberate. He wore tortoiseshell glasses that looked Euro-stylish instead of nerdy, a navy suit and a bright green tie and a red Pebble smart watch. He couldn’t have been out of his thirties.
Meanwhile, in the next room, Lenny was being put through a battery of tests, all exams he’d no doubt been given years before, the greatest hits of stroke rehabilitation. He submitted to the tests docilely, as he did everything now, since he no longer had the ability to object.
“I should warn you,” Dr. Girona said as they shook hands. “Your father’s case is a difficult one.”
“Because of how long it’s been?”
Dr. Girona shrugged and sank back into his chair behind a small bare desk. “That concerns me less than the fact that your father does not speak at all. Most stroke v
ictims are able to speak to some extent. They can make sounds, sometimes words or phrases. But your father’s chart indicates that he is unable to phonate at all, correct?” He was from Spain, according to his bio on the Mass General website, from Catalonia, but his English, though strongly accented, was remarkably fluent.
Rick nodded. “I’m not expecting miracles. I’m not expecting him to sit up one day and start talking about the Red Sox starting lineup with me. I just want to know what’s possible.”
“Well, your father has been categorized as a global aphasic. That means he can neither express himself nor comprehend when he’s spoken to. But I take it you think that diagnosis is incorrect.”
“I think there’s a good chance, yeah. Seems like he understands when I talk to him. He just doesn’t have a way of communicating what he wants to say.”
“What makes you think he understands?”
“He sometimes blinks rapidly, like he’s trying to tell me something. And when I asked him about something recently—something upsetting, I think—he grabbed my wrist.”
“With his right hand?”
“His left.”
“Ah, yes. His right side is immobilized. Well, perhaps so. More to the point, the question is, how much does he understand? And how can you know?”
“If he could write a note, maybe. Or type on a keyboard.”
Dr. Girona nodded. “I’m sure your father’s doctors and occupational therapists have tried all of the standard methods. The picture and symbol communication boards and so on. But the problem is, some aphasics don’t understand speech at all. At most, they recognize familiar names.”
“Can TMS help with that?”
“Perhaps. You know how a stroke affects the brain, yes?”
“Basically.”
Dr. Girona went on as if Rick hadn’t replied. “A stroke happens when something cuts off the flow of blood to your brain. The neurons in a certain area of the brain are starved of oxygen and they die. Now, the part of the brain where your father had a stroke was the left side, yes? And we know the left side of the brain not only controls the right side of the body but it’s also where the dominant language center is—the left inferior frontal gyrus, where speech is produced.”
“Okay.” Rick nodded.
“Now, when one side of the brain is damaged in a stroke, the other side takes over. As if to compensate. But we want to make the left side start to work again, right? To grow back, you might say. And the way we do that is to use magnetic pulses to rewire the brain itself. We run an electrical current through a wire in a coil to generate a magnetic field. Depending on what kind of magnetic field we generate, we can either activate the brain cells or inhibit them. Make them either more reactive or less. Are you following me so far?”
“I think so,” Rick said. “So you want to inhibit the right side to make the left side start doing work.”
“Exactly! We place the coil over the posterior inferior frontal gyrus. To inhibit the right side of his brain. Which we hope will make the left side, the language side, start to work again. And gradually the brain begins to rewire itself.”
“Will it hurt him?”
Dr. Girona shook his head. “At most, it may feel like a series of pinpricks.”
“How long will it take to see some results?”
“A few weeks, most probably. But you need to have realistic expectations.”
“What should I expect?”
“Expect nothing, and you won’t be disappointed.”
“I see. Well, anything would be an improvement.”
“One more thing. And perhaps I should have started with this. This is a costly procedure, and it’s not covered by any insurance.”
“How costly are we talking?”
“You’ll have to talk to our finance people.”
“Ballpark.”
“For a full course of treatment we’re talking probably over a hundred thousand dollars.”
Rick nodded, shrugged. “That won’t be a problem.”
28
Rick called Darren Overby, the editor in chief of Back Bay.
“Darren, how would you feel about a profile of Alex Pappas?”
“Alex Pappas . . . Remind me who he is again?”
“The Pappas Group. PR guy, fixer.”
“Oh, right. That would be great. But not a full profile, of course.”
“No, no. Nothing too serious. Just a Q&A, really.”
“Do it! But when am I going to see the Thomas Sculley piece?”
“Yeah, soon,” Rick said. Like never.
Then he called the Pappas Group, was connected to Pappas’s office, and left a message with one of his assistants, a woman with an appealingly raspy voice and a posh British accent.
It was a long shot, but worth a try.
To his surprise, an hour and a half later he received a call from the assistant agreeing to an interview the next morning.
The game was on.
* * *
He called Monica Kennedy and managed to keep her on the phone for six minutes while he questioned her about Alex Pappas. Though she claimed to have very little information on the man, she did know a few interesting things. She knew that his clients included a couple of former governors and mayors and senators. They also included a judge caught in a bribery scandal involving the construction of a huge parking garage. A football player for the New England Patriots, accused of murder, had hired Pappas to handle the public relations fallout, not legal representation. A House Speaker charged with corruption but who maintained his innocence had used Pappas’s services—again, not legal but in the realm of “reputation management.” Improving the Speaker’s image. A chemical company accused of contaminating the drinking water in a remote Massachusetts town, causing a sudden rise in leukemia cases among the children, had hired Pappas. The chemical company had had the charges dismissed, but that might have been the result of shrewd legal representation.
Alex Pappas specialized in crisis management, in “putting out fires,” Monica said. In making scandals go away.
The more Rick learned, the sketchier Pappas seemed to be. He seemed to have his fingers in a thousand pies.
* * *
In the morning, after too many cups of coffee, Rick arrived at Pappas’s offices, on the forty-second floor of the Prudential Tower in the Back Bay. He was apprehensive for some reason, probably because he didn’t know what to expect. He had to keep reminding himself that he was ostensibly there to conduct an interview. A puff piece. That was the cover story, anyway.
On one side of the bank of elevators was a law firm. On the other side, behind glass doors, was the Pappas Group. The reception area was hushed and sterile. Dove-gray wall-to-wall carpet, low flat coffee tables perched in front of low white leather couches. A receptionist sat at a long mahogany desk. Rick gave his name and prepared to wait. Some interview subjects liked to keep their interviewers waiting, just to show them who’s boss. The more reluctant the subject, the longer the wait, Rick had always found. The receptionist, a dark-haired Asian beauty in her midtwenties, offered him coffee or water. Rick took a bottle of spring water and sat down on one of the sofas. He took out his iPhone, switched off the ringer, and pocketed it again.
Arrayed on the coffee table were the local newspapers, the Globe and the Herald, as well as The New York Times, The Wall Street Journal, and the salmon-colored Financial Times. Rick was reaching for the Journal just as someone said, “You must be Rick Hoffman.”
He looked up and saw a lean middle-aged man bounding across the reception area. The man had silver hair and thick horn-rimmed glasses and was dressed in a perfectly cut gray suit.
Rick rose. “Mr. Pappas,” he said, offering his hand.
“Alex. Please.” He had a pleasant baritone voice.
“Rick. Nice to meet you.”
Pappas had a sha
rp, prominent nose like a hawk’s beak, a deeply creased, tanned face, and a dazzling smile. His teeth were a shade of white not found in nature. He was a few inches shorter than Rick, a tightly coiled man, fit and trim and radiating energy. “Come,” Pappas said, placing a hand on Rick’s shoulder and guiding him across the reception area, down a hallway and into a big corner office. Here Pappas didn’t seem a recluse at all. The walls of his office were lined with photographs of himself with the rich and powerful and famous, governors and senators and businessmen and TV stars. He obviously wanted visitors to his office to admire his proximity to the famous, even if he didn’t like to talk about it to reporters.
They sat at a couple of chairs off to one side of his desk, a glass coffee table between them. The chairs were high-backed, overstuffed, comfortable. The whole office was arranged as carefully, as ceremonially, as the Oval Office. Rick placed his small black leather-bound reporter’s notebook on the table. He considered taking out his iPhone and switching it to Record mode but decided to hold off. A running tape recorder—actually, most journalists by now used their phones to record—was a quick way to get an interview subject to clam up. And he wanted Pappas to let down his guard, unlikely though that might be. But for now, that was Rick’s best hope. He’d prepared a set of questions for Pappas, all of them predictable, none probing or provocative. The sort of questions that would enable Pappas to spout boilerplate answers by the yard, the sort of questions that might get the man to lower his defenses. This wasn’t going to be an interrogation. The point was to lull him into complacency.
“I’m sorry Back Bay stopped publishing the print edition,” Pappas said. “It was a handsome magazine.”
“Me, too.”
“Well, that seems to be the future. Everything digital, everything online, no more paper.”
“Seems that way.”
“They laid off a lot of the staff. And yet here you are.”
“Thanks for seeing me. I know you don’t often talk to the media.”
The Fixer Page 15