Dr. Soames glanced at his watch and frowned. Hurriedly, he and his assistant now began laying out the reports and films at the bottom of Bill’s bed, in columns and rows, as in a game of solitaire. “Sagittal plane: 500 milliseconds TR, 13 milliseconds TE, field of view 24 centimeters, matrix size 128 × 256. Axial: 3900 milliseconds repetition time, 17 and 90 milliseconds TE, field of view 24 centimeters, matrix size 192 × 256.” Charts of blood and spinal fluid. Bill would have felt their fingers on the bedsheets, tracing the contours of curves, pointing to numbers, but he had no sensation in the lower part of his body. The Mayo specialist called for more light.
“I can find nothing definite,” Dr. Soames said to Dr. Petrov. “The Sed rates and RF look normal.” To Bill, it seemed that Petrov released a slight sigh of pleasure. Soames turned to his assistant, who nodded in agreement. “But … an ANA of 130 is suggestive. Yes, suggestive.” Soames began tucking his laptop away in its black carrying bag. He put on his jacket and went to the mirror over the sink. “We’ll need more blood work. I’d like to have tests for ACA, ssDNA, and another rheumatoid factor.” Soames’s assistant wrote down the orders on a slip of pink paper and handed them to Petrov. “And an autoimmune Western blot,” added Soames, straightening his tie and collar. “I’ll ask for additional tests later on. My opinion is that we may have some unusual autoimmune disease here. If so, the plasmapheresis may halt or even reverse the paralysis. We can follow with steroids.”
“I’ll be able to walk?” asked Bill, leaning forward in his bed. The specialist was probably lying, he felt, but he wanted to believe.
“Possibly.”
A nurse appeared at the door and announced that Dr. Soames’s taxi was waiting to take him to the airport.
Bill turned over again to face the wall. The needle in his arm entered just below a pink sliver of a scar left from long ago, diving off rocks at summer camp. If he held very still, he thought he could feel the blood move into him, a faint quivering. His eyes returned to the photograph of the nurses. Some were pretty. One had braided hair, a terribly sad smile. She was the only one who looked away from the camera.
After the plasmapheresis, Bill’s condition seemed to improve slightly. The new blood and the steroids, which caused his face to puff up, had restored a slender mobility, so that on some days he could take a step or two before falling. His dead fingers sometimes tingled. These uncertain gains, guardedly reported, were greeted with immediate e-mails from Dr. Petrov and Dr. Soames and another specialist of some kind from the Duke medical school in North Carolina. Such was the doctors’ interest, and even optimism to a degree, that Bill began to take seriously the hypothesis that he suffered from some autoimmune disorder, and he spent the morning hours at his terminal researching that condition. In the long afternoons, he often just lay on his bed, unable to nap, listening to the sounds of the house or dumbly staring at the ceiling. Sometimes he would summon the will to crawl across the floor and drag himself up to the window, braced against the wall, so that he might look down on the familiar neighborhood. Here he found a temporary peacefulness and pleasure in observing small things, the tiny splotches of white on the shingled roof, the way that the ribbon on the Cotters’ mailbox slowly fluttered and waltzed, the glint of chrome on automobiles as they passed down the street, fallen leaves cart-wheeling in a breeze, the red brick chimneys and the painted white chimneys, a kite caught in a tree, birds. After a time, however, a great sadness would sweep over him, a sensation that he was the only human on earth watching these things, and he could not bear to look through the window any longer. Then he would close his eyes and let his head drop against his raised arms until the impotent legs finally crumpled beneath him.
He stopped shaving, with the result that his swollen face became covered with a patchy growth of brown whiskers, white on the chin. Now, he hardly recognized the reflection of his face any more than the rest of his body. Day by day, his legs were visibly shrinking. His body was dwindling toward the nothingness he felt. He attempted to imagine the future. What would happen to his family? Melissa would have to get a money-earning job. Alex would have to go to a different school. They would have to move out of Lexington into a small house somewhere. It all seemed impossible, unimaginable. If only he could turn back the clock to the beginning of June, when he drove to the Alewife garage every morning, put in a full day of work at his company, ran sweaty and complaining on the treadmill in the Universe Health Club. It was not a bad life, it was a comfortable life, and he would give anything to have it again. As he sat with his limbs scattered on the divan, waiting for Melissa to bring him his tray, he pictured himself running on the Universe treadmill, his legs surging forward and down on the black rubber mat, forward and backward, as if he were a running machine, built for running, unable to do anything except run, run, run.
“Why sue only Plymouth?” Bill retorted to Melissa late one night as they gazed at the television, unable to sleep.
“What are you saying? Is your brain going, too?”
“Sue all of them,” he said, trying not to jostle his head. “Especially the rows of dummies in Marbleworth’s Communications Room. Sue the motorists who clog up the highways, sue the fax machines and telephones. Sue the televisions.”
“Your brain is going.” She got up from the bed, her nightgown a glimmer of dead white in the light of the TV, and trudged to the bathroom.
————————————
>> MAIL 50.02.04 << From: Petrov at MGH.HARVARD.EDU
====> Received: from TAR.HARVARD.EDU by HARVARD.EDU with BFP
id AQ74078; Tues, 15 Sept 9:23:22 EDT
for [email protected]; Tues, 15 Sept 9:23:38 –0400
Press * for message
>>> MAIL 50.02.04 <<< From: Petrov at MGH.HARVARD.EDU
Dear Mr. Chalmers,
As you knnow, we have been consilting with Dr. Marjorie Stebbins at the Duke Medical School. Dr. Stebbins is an intenraltionaly known specialist in congenital neuropathies. I received the following E-mail from her over the weekend.
With good wishes, Armand Petrov, M.D.
Attached file:
———–
RE: Case MGH 384930
Dear Dr. Petrov,
I havae come to believe that we are not looing at an autoimmune disease here, but rather a rare kind of congential neuropathy. I will send you a list of recommended tests t pusrue this hyoethesis. Marjorie Stebbins, [email protected]
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THE ATTORNEYS
Late in September, when the summer heat had finally given way to a freshening of the air, Bill had his ninth session with Dr. Kripke. For a few moments, they sat silently in the psychiatrist’s cramped office. Kripke had just administered a Rorschach test, having reluctantly agreed that the last month of Paxil was failing to produce any positive effects.
“There’s plenty of anger here.”
“What?” Exhausted from staring at one inkblot after another, Bill could hardly understand human speech.
“The anger is building,” said the psychiatrist. “But it is too broad, unfocused and broad.” He scribbled a few lines in his notebook. “Generalized anger eats away at the mind and the body. It’s wasted.” The psychiatrist then offered some metaphor relating Bill’s anger to a Thoroughbred horse without any rider, such an absurd comparison that Bill found himself listening instead to the ripples from the noise machine on the wall. “In my experience,” Kripke continued, “it is best to channel anger, if possible, to give it a specific target. Action is a mode of adaptation.”
It was at this point that Bill realized he must sue Plymouth. How dare they treat him the way that they had, suddenly firing him as if he were temporary help. He had given Plymouth his lifeblood. Yes, he would sue the hell out of them, cut them off at the knees. And after that, he would sue his useless physicians, including Kripke.
“Do you see yourself as being in control of your life?” asked the psychiatrist, miles away.
Bill star
ed at the speckled pattern of light flowing through the single tiny window. “Control? I feel like I’m always being rushed. Rushed and pushed. I let myself be rushed and pushed.”
“Like a cork in the ocean?”
“You’re right!” Bill exploded. “You’re right. I’m going to sue those bastards.”
“That might be a healthy thing,” said the shrink, suddenly standing, for their hour had run out. “After you’ve succeeded in releasing your anger, we can begin seeking its cause.”
These last words Bill barely heard. Already he was banging into chairs and tables, wheeling himself as fast as he could toward the middle door, the one for exiting after a completed session.
On the afternoon of his appointment at the law offices of Thoreau and McCullough, Bill had worked himself into a healthy state of fury, which only intensified after Melissa had parked their car at a pricey garage at Beacon and School Street and begun pushing him up the sidewalk between the towering buildings of downtown Boston. Sue the bastards, Bill muttered to himself. The sidewalk teemed with people who scurried around Bill like ants dodging a crumpled leaf in their path. He imagined their eyes squirming upon him as they paused and stared, headsets protruding, then hurried on to their urgent appointments. How pathetic and helpless he must appear in his wheelchair. He scowled at each passerby.
Melissa gently placed her fingertips against his cheek. “Just tell the lawyers everything that’s happened,” she said softly. “And be decisive. These high-powered attorneys appreciate toughness.”
“Don’t tell me what to do,” snapped Bill. “Do you think I’m some cork on the ocean?”
They continued along Beacon, the crowds of pedestrians now laden with boxes and cartons and suit packs from their shopping expeditions on Newbury Street. It seemed to Bill that now, instead of staring at him, people avoided looking at him altogether. Which was worse? Was he not even worth staring at? Was he nobody at all? Plymouth had treated him like a nobody.
It was 3:15 when Bill and Melissa, heavily perspiring, disembarked from the elevator at the entrance to Thoreau and McCullough. Immediately Bill found himself squinting in the bright light. Looking up, he saw that the old plaster ceilings, with their elegant crown moldings and center medallions, had been completely covered over with fluorescent light tubes. Pale messengers squinted also as they boarded the elevator carrying armloads of documents. At the end of the hallway, Bill could discern a shining figure leaning over a desk. It was the receptionist, a sallow woman who appeared as if she hadn’t left the building in days. Her hair hung like spaghetti down the sides of her thin face, and her skin seemed to have permanently taken on the pale milky white of the fluorescent lights. Wearily, she looked up from her computer screen. “Mrs. Chalmers. Yes. Thank you. Mr. Baker will be with you shortly.” Then, with a wave of her hand, she gestured toward a waiting area, where one woman sat with her neck in a brace.
“Waiting, always waiting,” Bill muttered loud enough for the receptionist to hear him. He hated waiting, he was always waiting for people. He was on time, even now, even paralyzed and in a wheelchair. Why couldn’t the attorneys be on time? Bill angrily wheeled himself into the waiting area and wedged himself next to an antique commode bearing a porcelain lamp. A workman was installing a large acrylic painting on the wall.
“I’m sweating,” said Melissa. “I’m going to the rest room.”
“My husband wouldn’t come with me,” said the woman in the neck brace, carefully rotating her body to look at Bill. “But he wrote down a list of things for me to tell the lawyers.” She took some pages out of an envelope, tore them in two, and let the pieces drop to the floor. “I’m sorry for you,” she said and smiled sympathetically at Bill. “I hope you get something. I really hope you do.”
It was 3:25. Bill rolled himself back to the receptionist. “We have a three-fifteen appointment,” he shouted. “Look at me. Here. Look down. Do you see me now? Why do you keep people waiting?”
“I do apologize,” whispered the receptionist. She was about to say something more when her telephone began beeping in short frantic bursts. Then another instrument on the desk began humming. Glancing past the reception desk, Bill could see a maze of bright corridors, legs fluttering back and forth. Lawyers in gleaming white shirtsleeves hurried down the hallways, sputtering into their telephones or recorders, stopping now and then to interrogate one of the secretaries who sat in little booths along the way. In a room straight ahead, a conference of some kind was in progress. Through partly open white shutters, Bill could see a half-dozen people, leaping up and down at a table, slanted sections of moving torsos and heads.
Just then, a handsome, tallish man rounded a corner and strode to the reception desk. He was dressed in a beautiful herringbone suit and silk tie. His curly hair had turned prematurely silver and reflected the hues of his blue-gray eyes, which gazed calmly from behind the polished lenses of his glasses. Altogether, he gave the impression of a man in complete control of all things, so that it was surprising to see that he held a tissue against his dripping nose.
“It’s only a small cold,” he said at once, his voice thick and cottony. “I’m Thurston Baker. Forgive me for not shaking your hand. I’m afraid I don’t look well. But I feel much better than I look.” He gave a little laugh and smiled pleasantly, glancing down at Bill and fixing him with his eyes. “We’re going to try to help you, Mr. Chalmers.”
“We’ve been waiting for that,” said Bill.
Before further introductions could be made, a disheveled secretary ran up to Mr. Baker with a sheath of fax pages and thrust them into his hands. “Is this really so urgent, Olivia?” he said, holding out the pages at arm’s length as if Olivia would take them back.
“They’re from Mr. Davidson-Chamberlain, and Mr. Kelleher,” said the secretary, out of breath. “Mr. Davidson-Chamberlain just called and insisted that you respond to him today, by four-thirty. He said he’ll take whatever you’ve got.” She glanced helplessly at the receptionist and adjusted a tired-looking purple scarf on her shoulders.
Mr. Baker began coughing. It now struck Bill that almost everyone he had seen on the premises appeared ill. He could hear other coughing and sneezing coming from the hallways. Baker glanced at his watch. “Shall we go to my office?” he muttered through his tissue. “Where’s Mrs. Chalmers?”
As they started down a bright corridor, ancient oak floors creaked under their feet. Lawyers and their assistants hurried by, each tossing a “Good afternoon, Thurston” to Baker as they flew past. Some of the office doors were open, and Bill could see people in shirtsleeves at great desks, typing at their terminals or talking on the phones.
Then they were in Baker’s office, which smelled of old wood and new electronic equipment. On the wall were autographed photos of baseball players, glinting in the light from a large bay window. The attorney withdrew a fresh tissue from a box on his cluttered desk. “So you live in Lexington,” he said and took off his jacket. Reaching forward, he moved the computer terminal a few inches so that he could clearly see Bill. “There you are.” An odd expression moved over his face. “You look familiar to me, Mr. Chalmers. Have we met somewhere before?”
“I don’t believe so,” said Bill. Then the horrifying thought came to him that Baker could have been on the subway that fateful morning when he had made a fool of himself. In a flood of repressed memory, he recalled his panic at the unfamiliar subway signs, the vomiting on his tie and shirt, the stickiness and the smell and the disgusted stares of other passengers. Could Baker have been in that train? Or in the church, when Bill was on stage in the cash booth? Little by little, as imperceptibly as possible, Bill rolled his chair to one side so that the computer terminal again came between his face and Baker’s.
“I must be mistaken,” said the attorney, a slight note of doubt remaining in his voice.
“Yes,” said Bill. Quietly, he slid down in his chair, further distancing himself from Baker’s direct view.
“Well, then,” said the
attorney, “let’s get the discussion of the billing out of the way.” His charges were $300 an hour, he explained, with billing in five-minute units. Associate attorneys received $150 per hour and were used to as great an extent as possible to keep costs down for the client.
“How much time have we been billed for so far?” blurted Melissa.
Mr. Baker smiled. “As of yet, not a single second, Mrs. Chalmers.” He began to say something else, possibly some further assurance that his new clients would not be excessively charged, when there was a knock on the door. A smartly dressed young woman entered, clutching a pad of yellow paper and faintly annoyed.
“This is Alice Stevenson,” said Baker. “Alice is an associate in the firm and will be joining us in our meeting.” Instead of taking one of the chairs, Ms. Stevenson installed herself on the windowsill, dangling her legs like a schoolgirl.
Although Bill could not see Baker’s face, he imagined that it must be registering disapproval. Why did the senior attorney tolerate this kind of behavior from a subordinate? Baker stirred behind his computer terminal and called attention to the clock on the wall. It read 3:44.
Bill found himself staring in silence at the floor. He could think of nothing except the figure of $300 an hour. Plus $150 for Ms. Stevenson’s services, which had been left in a cloud of uncertainty. Whatever her function, he had never asked for Ms. Stevenson. Thinking about her now, he grew angry. Shouldn’t he have been consulted about bringing Ms. Stevenson in on the case? These attorneys did what they wanted. So now it was $450 an hour. He should speak up this minute and say that he didn’t want Ms. Stevenson. That’s what he should do. Why couldn’t he speak up? So it was $450 an hour. His face contorted in mathematical calculations as he strained to compute the cost of each five-minute “unit.” Unconsciously, he made a grunting noise as he thought.
Diagnosis Page 25