by D. J. Palmer
Becky headed downstairs, her footsteps echoing in the cavernous home. It had been an extra lonely day for some reason, and not because Carl was off somewhere. These days, Becky did not even bother asking where he was going. They were an LLC, not a married couple. They were running a business, and the business was getting Meghan back. After that was done, well, maybe so were they. The marriage had nothing to give her. No support. No loving embrace. No tender kiss. Maybe that’s why Meghan’s absence felt so huge lately. Maybe that’s why Becky had spent a good hour under the covers of Meghan’s bed, inhaling her daughter’s fading scent, feeling the stiffness of the sheets that had not been slept on in ages.
Soon, she thought. When the biopsy is done, we’ll have all the proof we need, and then it will be over. Becky was confident they would have done the biopsy even if Meghan had not volunteered to undergo the procedure. White would not want an “oops” moment in denying a potentially life-saving treatment because they did not run a test that could help prove/disprove the condition. But there had been no urgency on the part of the hospital because the mito cocktail only inhibited disease progression slowly over time. Still, Becky wondered if she had pushed Meghan harder to have the test done sooner would that have helped avoid this entire ordeal altogether. Would that one test have been enough to reverse the charge of Munchausen syndrome by proxy? Maybe. Maybe not. But it certainly would not have hurt her cause.
Now, a treatment, as well as the clinical trial, was at risk, and the tragedy that had befallen Zach Fisher’s son was never far from Becky’s thoughts. At least Becky had Zach on her side, and she trusted him implicitly. She believed he’d find something, some root cause, but if not, she was prepared to keep looking. Because looking for the answer was her identity. More than Carl’s wife, or Sabrina’s sister, or even Meghan’s mother, Becky was the woman who hunted for a cure.
Opening the front door, Becky was once again surprised when Detectives Capshaw and Spence, dressed in near-matching blue blazers and red ties, greeted her on the front step. In his hand, Spence held an oversize clear plastic evidence bag with her computer inside.
“Sorry to drop in unannounced,” Capshaw said. “But we thought we might catch you at home. We wanted to bring this back to you in person.”
Becky took the computer but did not invite the detectives inside. She caught a hard-edged stare from Spence, the thinner of the pair, that made her feel uneasy.
“Thank you,” Becky said. “I appreciate that.”
“Is your husband at home?” Spence asked, leaning his body forward in an effort to peer inside.
“No, he’s out,” Becky said curtly. “Is there something else I can do for you, Detectives?”
“Mind if we ask you a few more questions?” Capshaw said.
“I’m a little busy at the moment,” Becky lied.
Capshaw pursed his lips and appeared to be chewing on a thought. “If you’ve seen cop shows before, then you’ll know this is the part where we tell you we could have that chat downtown,” Capshaw said with only the faintest of smiles.
Becky took a step to the side. “Please. Come in,” she said, motioning them inside.
The detectives stepped into the foyer and looked around as if expecting to find Carl at home. She got the feeling they did not trust much of what she had to say.
“Shall we go to the living room again?” Becky asked.
“Here’s fine,” Capshaw said. “We won’t be long.”
“What can I do for you, Detectives?” she asked, setting the computer down on an antique console table she and Carl had bought on a “get away from it all” drive to Vermont, made maybe a month or two after Sammy died.
Capshaw blew on his hands to warm them from the unseasonably cool spring afternoon. “Well, according to your browser bookmarks, you seem especially interested in … poisons.”
Her earlier nugget of worry grew into a knot. “Poisons?”
“Yeah, hemlock, popular with the ancient Greeks,” Spence said. “Aconite aka wolfsbane. Though that’s not what killed Levine, in case you were wondering, or at least we don’t think it is.”
“The medical examiner has to order specific tox screens for the more exotic poisons, so maybe if Levine had died of asphyxiation, then wolfsbane would have been on someone’s radar,” Capshaw tossed out. He was a little too nonchalant for Becky’s liking. It was as if they were two cats playing with a cornered mouse.
“There were other poisons in your browsing history,” Spence said. “Belladonna, which means ‘beautiful woman’ in Italian—or in the case of the plant, a good option for a spear tip.”
“Plan on doing any hunting in the Amazon?” Capshaw inquired half-jokingly.
From the pocket of his sport jacket, Capshaw retrieved a piece of paper and read down a list.
“Polonium. Mercury. Cyanide. Arsenic.”
“Either you have a morbid fascination, or the BBC hired you to write for Sherlock. Which is it?” Spence folded his arms and eyed Becky.
“It’s my daughter,” Becky said assuredly. “Come up to my office. I’ll show you file drawers filled with research on all sorts of conditions. It’s what I do, Detectives. Since my daughter got sick, all I’ve done is research. I’m trying to find out what’s wrong with her. I assume that’s not a crime.”
Spence and Capshaw exchanged glances.
“No, of course not,” Spence said. “How is Meghan doing? She’s been all over the news.”
“That’s because she’s a prisoner at White. She’s a kidnap victim. Which, by the way, is the only crime I’m aware of that’s been committed here.”
“Point taken,” Capshaw said, shuffling his feet, heavy shoes threatening to mark up the softwood flooring underneath.
“Tomorrow is a big day for us, actually,” Becky said. “Meghan is having a muscle biopsy done, and we have high hopes that it’s going to clear up this whole mess by proving she has mitochondrial disease.”
“Not often you hope someone has a disease,” Spence said.
Becky broke eye contact. “I assume you made no progress in figuring out why Dr. Levine died so suddenly?” she asked.
“No, we haven’t,” Capshaw said.
“I just hope for your sake it wasn’t arsenic or belladonna that did him in,” Spence said. “Thanks for your time, Mrs. Gerard. We’ll leave you be.”
Capshaw nodded his head almost as if he were tipping his hat goodbye.
Becky called for their attention as they turned to go. “Detectives, did you get the DNA on that earring back yet?” she asked.
“Not yet,” Spence said with a sigh. “The lab is always backed up. Hopefully soon.”
Soon, thought Becky, trying her best not to bite her lip. While she was something of an expert at manipulating doctors, Becky could not parlay that particular skill to the police. These detectives could read body language. They’d know she was nervous about something. She needed that biopsy done now, and she needed those results to come back positive. She needed to get Meghan back home. Because soon, very soon, everything was going to get a lot more complicated.
CHAPTER 34
MEGHAN
I was trying not to scream. It’s minor surgery, I told myself. Minor. No big deal. So this procedure was no big deal, or NBD in my texting parlance. But it was a big deal. The only surgery that’s minor, my dad told me before getting his knee scoped for the third time, was surgery done on somebody else.
My breath quivered like I’d just exited the water after a chilly ocean swim.
You can do this, I tried encouraging myself. There is nothing to be afraid of. Think of what Mom’s been going through. Do it for her.
I gripped the thin sheet covering the surgical bed, balling the fabric up in my fists. I tried to clear my thoughts, but it was no use. All I could think about was Dr. Fisher sticking a needle the size of a spear into my right thigh. No, I said to myself. It’s not my right thigh. It’s the “vastus lateralis,” the largest muscle of the quadriceps group. Dr. Fishe
r had taught me that name. I don’t know why it helped me to think of the incision point in anatomical terms. Maybe because I thought of my thigh as belonging to me, but that vastus lateralis didn’t even sound like a body part. Whatever. I didn’t want to analyze that one too much, because it was working. We had talked about conscious sedation again, but I decided against it. I was worried about having to deal with two unknowns at the same time, and resigned myself to get through this experience without the added help.
There were no bright overhead lights in this small operating room, no specialized equipment. It was a simple procedure, after all. Minor surgery, right? There was a tray with some sterilized instruments on it, but I made sure not to look at the needles—or the scalpel, for that matter.
I had my mom with me, which was probably the only reason I wasn’t crying hysterically. I unclenched the bedsheet to hold her hand. I felt so stupid for being this afraid. It’s just a dumb needle, after all. You’d think after being pricked and prodded for two years straight, I’d become immune, but the brain gets what the brain wants, and mine wanted fear. I know there’s nothing to be afraid of. It’s a prick, and then it’s over. I should be over it. It’s childish and stupid. It’s pathetic. It’s weak.
I tried to reason it away—won’t hurt, little pinch, I’ll have anesthetic, yada yada yada—but my anxiety was up in my throat. The room spun like I was inside a tumble dryer. Mom held my hand tighter. My dad was somewhere nearby. I didn’t want him with us, but he’d insisted on being there. I knew it had to have hurt him when I told him not to stand too close because it made me feel worse.
Good.
“You ready, Meghan?” Dr. Fisher asked.
Tears sprang out of my eyes. My body shook so badly that the line Dr. Fisher had drawn with marker on my vastus lateralis must have come out crooked.
“This is that first pinch we talked about. I’m going to infiltrate the incision point with a local anesthetic containing adrenaline. You’ll be fine. You’re doing great.”
I liked hearing Dr. Fisher’s voice. It was comforting. I could wrap myself in his sadness like an extra layer of protection. His hurt took away some of my own. I squeezed my mom’s hand harder.
The needle went in. I felt the pinch. Dr. Fisher didn’t warn me, or did he? I couldn’t remember. I screamed, that much I knew. I screamed because I knew I was that much closer to getting the giant needle.
My father came over to my bedside. “You did this to her,” he said to my mother.
“Not now, Carl,” Mom said. I could tell without looking that she was clenching her teeth.
“You’re doing great,” Dr. Fisher said again, which I knew was a lie.
He swabbed my leg with antiseptic solution and covered the area with a surgical cloth containing an oval-shaped cutout centered over the incision point.
“I’m going to test you first. Does that hurt?”
I lifted my head off the bed and could see Dr. Fisher’s hand dragging a scalpel across my leg like he was painting a line with a thin brush. I didn’t feel anything, but my mind told me it hurt like hell. I swear I could feel my skin being ripped apart.
It’s a trick … it’s all a trick. Your mind wants you to be afraid.
I thought of my mom. I wouldn’t let her down.
“No, it doesn’t hurt,” I managed.
And just like that, the pain went away.
I closed my eyes. I could feel pressure as Dr. Fisher cut, but couldn’t feel the clamps he used to keep my skin pulled apart. Dr. Fisher talked me through the next phase of the procedure.
“The first layer I’m going through is the subcutaneous fat, then we’ll get to the Scarpa’s fascia and then the subscarpal fat,” he said. “Okay. I can see your fascia. Looks great, Meghan. You’re doing great. I’m going to make a little more incision.”
A hornet the size of a small pony was buzzing around my head, its stinger dancing in front of my face. “Go away, go away,” I said.
“It’s okay, Meghan,” Dr. Fisher said. “Nobody is going anywhere.”
I knew I’d sound ridiculous if I confessed to imagining an oversize insect buzzing near my face. I didn’t need it getting back to Nash, who’d have yet another reason to think I was crazy. It was bad enough she couldn’t find any medical reason why I kept getting sick every time my parents came to visit.
Reason or not, every day my body felt like it was shutting down a little bit more. More switches inside me kept getting turned off. Everything I did—from showering to eating to talking with my therapists—felt like a series of impossible tasks, or what my English teacher would call a “Herculean effort.” Just opening my mouth to say “I’m fine” takes a lot out of me.
“I’ve incised the underlying fatty tissue,” Dr. Fisher said, “and I can see the muscle tissue underneath. No wonder you’re so good on the soccer field. That’s some great-looking muscle you have there. I’m now mobilizing a short section of your muscle and applying a stay suture to both ends so I can manipulate the area.”
I focused on Dr. Fisher’s voice, used it like a lighthouse beacon to guide me through the fog of fear.
“I’ve got the sample clasped in the forceps between the suture ties. I’m going to take it out now. You won’t feel a thing. Everything is going so well.”
My tears didn’t think it was going well.
Breathe … breathe … breathe …
“She’s terrified,” I heard my dad say, like he couldn’t believe how scared I was.
“Quiet,” my mother growled.
I heard a high-pitched whine followed by a zapping sound, as if my imaginary hornet had flown into a plus-size bug trap.
“That’s just electrocauterization,” Dr. Fisher said, sensing my distress. “It lets me seal off blood vessels that are bleeding. Nothing to worry about. And I’ve put some extra freezing in the fascia. You probably didn’t even realize I used a needle on you, did you?”
I hadn’t.
“All right, Meghan, we’re almost done. But now I’ve got to get the sample with the biopsy needle. There aren’t many nerves in the muscle, so it won’t hurt, but it won’t feel like nothing, either. Okay?”
Jagged energy shook my body.
“Okay,” I said, trying to sound brave while failing miserably. The only saving grace was that I couldn’t see the needle.
“Here it comes.”
A darkly ominous voice spoke up in my head: It’s gonna hurt. It’s gonna hurt soooooo much, Meghan. You’re going to scream your head off. Get ready. Get ready to bleed!
I knew the voice wasn’t there, but that’s what you get with irrational fear. I took in breaths like Mom always reminded me to: through my nose, then out my mouth, slowly and deeply.
I braced myself. There was an uncomfortable tugging sensation, like a hand pulling at something that did not want to let go. Pain followed. It was sharp, dull, and burning all at once, an indescribable sensation, unlike anything I’d ever felt before.
I cried out.
I cried.
I thought, Thank God, thank God Almighty that I’ll never have to experience that again.
CHAPTER 35
ZACH
Dr. Lucy Abruzzo, head pathologist at White Memorial, put a rush on Meghan Gerard’s biopsy, both to accommodate Zach and to address Knox Singer’s concerns. Singer had made it quite clear he wanted anything pertaining to that particular patient at the top of the “get it done” list. The relentless bombardment from an insatiable media had turned White into a nightly news item, and Knox into a target for relentless criticism. This did not bode well for Zach’s future at the hospital, but he had other, more pressing issues to address.
“It’s the wrong stain,” Dr. Abruzzo said matter-of-factly to Zach. “That’s the issue.”
When Dr. Abruzzo first broke the news over the phone to Zach, he understood what using the wrong stain meant for Meghan, but he felt compelled to see the ruined biopsy sample for himself.
They were alone together in her pat
h lab. Zach had limited experience with Dr. Abruzzo. She was a bit of a mystery around White—an extremely fastidious, committed, dedicated physician who was much better at working with tissue samples and dead people than with the living.
An avid marathoner, Dr. Abruzzo brought the kind of focus it took to train for races to her lab. Everything about her was precise and intense, which was why this mistake was so uncharacteristic, not to mention inopportune.
The lab was a big, open, airy space hidden in the subbasement of White. It was well stocked with the best equipment, including the microscope Zach was looking through. He adjusted the coarse focus to get a clearer picture of the stained sample on the microscope stage.
“It’s a regular H and E stain,” Lucy said, sounding frustrated. “If we’d known we were looking for a specific diagnostic condition, we’d have stained it differently. I’m so sorry, Zach.”
A routine H&E stain on this muscle-tissue biopsy was fine for showing the histological anatomy, the cells, and the nuclei, but that’s not what Zach had requested.
“How did this happen?” Zach produced a copy of the order sheet for the lab test. He thought he’d been extremely clear: he wanted a Gömöri trichrome stain that looked specifically for ragged red fibers as a marker of mitochondrial disease. The diseased muscle fibers stand out a bright red, making it obvious when the result came back positive.
“I know it’s not done routinely,” continued Zach, “but I specifically ordered it. And now the specimen’s lost, and all we’ve got is this routine everyday stain that doesn’t give me a hint of what may be going on metabolically within the muscle.”
“Data entry error, I suppose,” Lucy said. “It used to be that we’d do all the stains regardless, to cut down on errors like this, but you know how Singer is with his budget. He sucks out more fat than a plastic surgeon. So now, unless it’s for a very specific reason, we do the minimum required, which in this case is a basic H and E stain.”