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PROLOGUE
“I’m afraid I have some bad news.”
Hayley Long, just two weeks past her fi fty- fi rst birthday, heard her
physician’s words as if they were being spoken through a long steel
tube.
I’m afraid I have some bad news. . . .
She wondered fl eetingly how many thousands of people heard the
same thing from their doctor every day? How many patients every
hour, maybe every minute, rode those words screeching through a
sudden right- angle turn in their lives.
I’m afraid . . .
Stephen Bibby, a graduate of Emory Med, had been her physician
since a bout of pneumonia twenty or so years ago. He was a man
Hayley respected, if for no other reason than that Bibby knew his
limitations and never hesitated to make a phone call and arrange a
specialist referral for a second opinion.
Hayley felt a wave of nausea sweep over her, and thought for a moment
she was going to have to excuse herself to go and get sick even
before she found out precisely what she was up against. She made a
largely unsuccessful attempt at a calming breath, and tried to maintain
an even gaze.
“It’s cancer?”
Hayley heard the word in her own voice, but couldn’t believe she
had actually uttered it. Her thoughts wouldn’t stay still.
Cancer . . . How could that be? . . . Oh, God, no.
Her initial symptom had been nothing more than an annoying sequence
of belly pain and gas. She almost hadn’t even bothered to
mention them to her executive assistant. He was the one who had
talked her into calling Bibby. It was his fault.
The MRI Bibby had requested was of herabdomen.
Cancer.
The dizziness and nausea intensifi ed.
David didn’t handle illness at all well, in himself or others, but at
some point she would have to tell him. Not yet, though. Not until all
the data were in. He was off skippering his boat in a round- the- world
race—his lifetime dream. He had lost his fi rst wife to a brain aneurysm,
and had waited more than ten years before marrying again.
Now this.
She had to tell him soon, but not yet.
Bibby, a Southern gentleman in his early sixties, looked toward
the door as if hoping that another doctor would march into the offi ce
and take over.
“I asked, is it cancer?”
Biting at his lip, the physician nodded.
“Operable?” she asked.
Come on, Stephen! Help me out here!
“I . . . I don’t know. It looks to have started in your pancreas.
That’s the organ which—”
“I know what the pancreas is. I hear Jimmy Carter talking about
pancreatic cancer every time I turn on the damn TV. Has it spread?”
“It’s . . . it appears to be in some places in your liver.”
Bibby turned on his computer with a click of his mouse and rotated
it so Hayley could see. A child could have picked out the cancer
in her MRI—an obscene white mass, dead center in her belly. Dead
center. How ironic that her mind’s default for something in the middle
would have been those words.
Please let this be a dream. Please let it be a fucking dream.
Hayley rubbed at her eyes as if trying to paw away the disbelief. At
fi fty, she had everything she could ever have wanted—marriage to a
wonderful, caring man; stepchildren who treated her like their birth
mother; more money and infl uence than most people could even
dream of; and a perspective on life that made everything make sense.
Now this.
Pancreatic cancer . . . Inoperable . . . God, don’t let it be, Hayley Long
thought desperately. Let it be a dream. . . . Let it be nothing but a
bad dream.
Petros Sperelakis’s awareness returned gradually and spasmodically.
The pain came fi rst—a dull throbbing in his groin and burning sensation
in his low back. He tried to move, to shift his position, but his
body did not respond.
Please, I don’t think I can move. Someone please help me. I’m Sperelakis,
Dr. Petros Sperelakis. I can’t see and I can’t move.
“Connie, why don’t you take a break. I’ll be here for another
hour.”
“Okay, thanks. Listen, Vernice, he could use some range- of- motion
work on his wrists and ankles.”
Connie? Vernice? I can hear you. I can hear you. Are you Beaumont nurses?
It’s me, Dr. Sperelakis. What do you mean, range of motion? Am I paralyzed?
What happened to me? An accident? A stroke? A tumor? Why can’t I see? Why
can’t I speak?
The man many considered to be among the premier diagnostic
physicians in the world struggled to make sense of his own symptoms.
He knew he was having diffi culty holding on to a thought, and
that fact frightened him more than almost anything.
Why am I in such pain? Can someone please tell me what happened? What
happened to me? I can feel that, Vernice. I can feel you moving my ankle. Oh,
my God. . . .
CHAPTER 1
Multiple contusions and abrasions . . . Fractured pelvis . . . Nondisplaced
fracture, proximal humerus . . . Pulmonary contusion and laceration secondary
to posterior displaced fractures of right seventh, eighth, and ninth
ribs . . .
With the grim litany ticking through her thoughts, Thea Sperelakis
approached Cubicle 4 in the medical ICU of the Beaumont
Clinic.
Transverse linear skull fracture . . . Extensive mid– brain stem hemorrhage . . .
Level I coma . . .
Thea hesitated, envisioning what her father would look like and
knowing that, as an internal medicine specialist herself, her projection
would not be far from on the mark. According to her brother
Niko, police estimated that the vehicle that struck their father at fi ve
thirty in the early morning eight days ago, then drove away, had to
have been traveling seventy, at least. It was a miracle he had survived
the impact, which threw him more than twenty- fi ve feet. But then,
for as long as Thea could remember, Petros Sperelakis was, to his
children, the Lion—aloof, powerful, and brilliant, often to the point
of majesty.
The Lion.
The absence of skid marks suggested that the driver never saw his
victim. Make that his or her victim, Thea edited, intent on enforcing
that sort of accuracy, even in her thoughts. The police still had no
clues and no witnesses.
Alcohol, she guessed. According to an article by Eileen Posnick in
a seven- year- old issue of the American Journal of Drug and Alcohol Abuse,
alcohol was involved in more than 90 percent of hit- and- run accidents
where the drivers were eventually apprehended.
Behind her, Niko stepped out from the group that included his
twin, Selene, plus a trio of Beaumont Clinic dignitaries, and took
Thea’s arm. He was swarthy and broad- shouldered, with their father’s
strong nose and piercing dark eyes, but with features that were
somewhat softer. At forty, he was already an associate professor of
cardiac surgery at Harvard—a wunderkind, with several signifi cant
contributions to the fi eld. Selene, exotic, elegant, and totally selfassured,
was no less accomplished as a hand surgeon.
“You okay, Thea?” Niko asked softly.
As she had been taught to do, Thea searched her feelings before
responding. Her father, bigger than life itself, was in a deep coma
from which there was a 0.01 percent chance he would recover even
minimal function—at least according to the retrospective study of
traumatic midbrain hemorrhages published by Harkinson et al. in the
American Archives of Neurology, volume 117, page 158. One in ten thousand,
not counting the ribs and other fractures.
Poor Dad.
“I’m okay,” she replied.
“Want to go in alone?”
Why would I want to do that? she wondered, shaking her head.
Would their father be any less comatose if she saw him by herself?
She shrugged that it made no diff erence, but sensed she could have
come up with a more acceptable response.
“Suit yourself,” Niko said in a tone that was quite familiar to her.
Thea knew her brother cared about her—Selene, too. She also
knew that the twins had always thought she was odd, though certainly
not as odd as their oldest sibling, Dimitri. But their attitude, as
emphasized over and over by Thea’s longtime therapist and mentor,
Dr. Paige Carpenter, was their problem.
One in ten thousand . . . Poor Dad.
Thea ran her fi ngers through her short chestnut hair, took a single
deep breath, and stepped through the doorway.
As anticipated, there were no surprises. Legendary Petros Sperelakis,
medical director of the Sperelakis Institute for Diagnostic
Medicine, lay motionless—the central fi gure in a tableau of medical
machines. Across the room, his private duty nurse (Haitian, Thea
guessed) rose and introduced herself as Vernice.
“I have heard a great deal about you, Dr. Thea,” she said. “I hope
your fl ight was an easy one.”
“I just read,” Thea said, taking the husky woman’s smooth, ample
hand.
I just read.
It was, Thea knew, the most resounding of understatements. During
the twenty- hour series of fl ights and layovers from the Democratic
Republic of the Congo to Boston, she had read Don Quixote, the
second edition of Deadman’s A Manual of Acu punc ture (for the second
time), and Darwin’s Voyage of the Beagle—more than sixteen hundred
pages in all. She would have made the trip home sooner, but she
was on a mission moving from refugee camp to camp in the bush
with a team of nutritionists, and simply couldn’t be reached.
“There’s been no change,” Vernice said.
“I’d be most surprised if there were. He has taken a severe
beating—especially to his head.”
Thea approached the bedside, instinctively checking the monitors
and intravenous infusions. Petros lay quite peacefully, connected via
a tracheotomy tube to a state- of- the- art ventilator. The various
Medecins Sans Frontières (Doctors Without Borders) hospitals to
which Thea had been assigned over the past fi ve years had been reasonably
well equipped, but nothing like this place.
The Beaumont, as nearly everyone referred to the institution, was
a sprawling campus, the size of a small university, consisting of what
had once been Boston Metropolitan Hospital, now augmented by
two dozen more buildings, varying widely in architectural style. The
buildings were linked by tree- lined sidewalks above, and an intricate
maze of tunnels below, some with moving walkways and others with
tarnished tile walls, leading in places to stairways that went down for
two or three damp stories, and dating back to Metro’s earliest days
in the mid- nineteenth century.
Oxygen saturation . . . arterial blood pressure . . . cerebrospinal
fl uid pressure . . . central venous pressure . . . urine output . . .
chest tube drainage . . . cardiac rhythm and ECG pattern . . .
Thea took in the complex data and pro cessed them as if they were
a grade- school primer. Steady. Everything was nice and steady. At
the moment, the fi erce battle for the life of Petros Sperelakis was being
fought at a cellular and even subcellular level. And his youn gest
off spring, cursed by him when she made the decision to avoid academic
medicine and “give her ser vices away,” to third- world countries,
pictured the microscopic confl ict clearly in her mind’s eye.
At best it would probably be weeks before the man regained any
consciousness. Along the way, his system would have to negotiate a
minefi eld of infections, blood clots, kidney stones, embolisms, ce rebral
swelling, chemical imbalance, intestinal obstructions, and cardiac
events. But in this setting, with this equipment, he would at
least have a fi ghting chance. Still, from what Thea knew of her father,
if it were his choice, it was doubtful he would try very hard to steer
clear of the mines.
She took the man’s hand and held it for a time. It had been only
eight days since the accident, but his muscle mass was already beginning
to waste away. In addition to the trach, he had a gastric feeding
tube in place, two IVs, a urinary catheter, which was draining briskly
into a collection bag, and a BOLT pressure manometer that passed
through his skull and into the spinal fl uid–containing ventricle of his
brain. His eyelids were paper- taped down to protect his corneas
from drying out, and splints on his wrists and ankles were strapped
in place to prevent joint contractures, against the remote possibility
of a return of function.
Petros Sperelakis—an icon brought down by a driver who was either
in an alcoholic blackout or was aware enough to try and get away
before anyone showed up. Never had Thea’s father looked even remotely
vulnerable to her. Now, he looked frail and pathetically infantile.
Thea sensed that she was expected to stay at the bedside a bit longer,
and she planned to be there as much as possible in the days to
come. But she had slept little if any on the planes, and the exhaustion
of the fl ights was beginning to take hold. Fifteen minutes, she decided.
Fifteen more minutes would be enough to stay at the bedside
whether the others thought so or not.
Niko had invited her to stay at his house, but three kids under ten,
much as she loved them, provided more commotion than she could
handle.
Selene and her partner, a banker or businesswoman of some kind,
lived in a designer high- rise condo by the harbor.
The obvious choice was the spacious Wellesley home in which she
and the others had grown up, and where Petros still lived with the
ghost of their mother and with Dimitri who, many years before, had
moved into the carriage house along with his computers, his monitors,
his shortwave radio, his telescope, his machinery, his library of
manga, graphic novels, and Dungeons and Dragons manuals, and his
vast collection of Coca- Cola and Star Wars memorabilia.
It would be good to see her brother again for many reasons, not
the least of which was that of all those in her family, he was the one
she related to the most—something of a mirror of what she might
have been like had she not had the benefi t of early diagnosis, intervention,
and extensive behavior modifi cation therapy.
From her early childhood, Thea had memories of the family talking
about Dimitri’s aloofness and strange behaviors—his lack of
friends, off beat humor, and often- inappropriate statements. Physical
age, twelve years ahead of her. Emotional age, inconsistent and unpredictable.
“Dimitri, this is Robert, your new piano teacher.”
“Oh, hello. When’s the last time you went to the dentist?”
She would never know the bulk of what the family said to one another
about her, but she also knew that the choices she had made,
with Dr. Carpenter’s help, were the right ones for her, and ultimately,
for her patients. Keeping her life as uncomplicated as possible,
she had learned, was not only a pathway to happiness, it was
her roadmap to survival. If there was any single word that did not apply
to Petros Sperelakis, it was uncomplicated.
Born and raised in Athens until his late teens, Petros was strictly
Old Country in his attitudes and philosophy—a brilliant physician as
dedicated to his calling and his patients as he was hard on his family.
Verbal chastisement and high expectations were his weapons, as well
as his only means of expressing love. His wife, Eleni, had rebelled
against him in one way and one way only, by continuing to smoke
cigarettes despite his vehement edicts that she stop. The lung cancer
that took her did nothing to soften Petros, and virtually every mention
of her by him was followed by the impotent plea: “If she had only
listened to me . . . If only she had listened.”
Thea reached between the tubes and brushed some damp, gray
hair from her father’s brow. The sadness she was feeling at seeing
him in such a state was, she knew, as much learned as it was deepseated
and visceral. But she also knew that it was still as real an emotion
as those of her two “neurotypical” siblings.
From the beginning, Petros could never understand her shyness,
or the severe reactions she had to certain noises—especially vacuum
cleaners and hair dryers—as well as to certain foods, and diff erent
textures of clothing. When she was twelve, pressured by Eleni that
she was seeming more and more like Dimitri in her lack of friends
and her pathological obsessions, especially with books of all kinds,
Petros consented to allow his wife to bring her to Dr. Carpenter. It
was Carpenter who subsequently suggested that Thea was exhibiting
many of the symptoms associated with the condition called Asperger
syndrome.
The decision to allow his younger daughter to undergo neuropsychiatric
testing and therapy did not come easily to Petros. In the
lexicon of his life, there was no such word as can’t and no such concept
as psychotherapy. If he had any weakness at all as a diagnostician,
it was in the area of psychosomatic illness and the mind- body
connection.
“I think he’s comfortable,” Vernice ventured from across the bed.
“I’m sure he is,” Thea replied, managing with some diffi culty to
swallow her belief that if Petros was feeling anything, then he was
certainly not comfortable, and if he was feeling nothing at all, then
trying to equate that void with comfort was a stretch.
“Your brother Dimitri said that if your father was in as deep a
coma as he appears to be, it was a futile exercise to wonder if he was
comfortable or not.”
“Sometimes, Dimitri says things just for the shock eff ect,” Thea
replied, smiling inwardly at the number of times and situations in
which her eccentric sibling had done just that. Vernice had gotten off
relatively easily.
“Well,” the nurse said, “at least we have the comfort of knowing
that Dr. S. is being taken care of in the greatest hospital in the
world.”
“Yes,” Thea said, wondering where Vernice, and Newsweek, and the
countless others who believed as she did about the Beaumont, could
have gotten such quantifi cation about something so unquantifi able.
at virtually the same instant, in the Susan and Clyde Terry Cancer
Center, on the far side of the broad campus of the so- called greatest
hospital in the world, the treatment nurse was doing her job,
injecting a cutting- edge experimental drug into the central IV port
of a burly man named Jeff rey Fagone.
Fagone, a trucking magnate from western Pennsylvania, had his
rapid accumulation of wealth interrupted by an unusual variant of
the blood cancer known as Waldenstrom’s macroglobulinemia. His
presenting symptom had been lower-back pain. The referral by his primary
care doctor had been to the expert in the disease at the Beaumont,
where Fagone went yearly for his fi ve- day spa pampering and
executive medical checkup. Now, he was part of a cutting- edge treatment
protocol—the sort of protocol that the doctors at the Beaumont
were renowned for establishing.
Fagone fl ew up to the Terry Center weekly on his Gulfstream
G500 corporate jet. Now he was about to receive the third in a series
of ten treatments. The fi rst two had been absolutely uneventful.
This injection, however, would be diff erent.
The vial from which the medication was drawn had been skillfully
switched during its journey from the research pharmacy to the cancer
center. The new vial, with the same ID number as the old one, now
contained enough concentrated bee venom to turn Fagone’s bee sting
allergy, duly noted in his medical record, into an anaphylactic
reaction—a fearsome medical emergency, equivalent to the Fourth
of July fi reworks on the Charles River Esplanade.
The eruption did not take long to begin. The fi rst few molecules of
the venom instantly began mobilizing mast cells from all over
Fagone’s body. The cells released huge amounts of histamine and
other sensitivity chemicals. More venom, more mast cells, more histamine.
In less than a minute, Fagone’s tongue, cardinal red, had
swollen to the size of a golf ball, and his lips to violet sausages. The
muscles in the walls of his bronchial tubes went into vicious spasm.
Seconds after that, his larynx, also in spasm, closed off altogether.
His entire body became scarlet, and his fi ngers became nothing more
than nubs protruding from softball- sized hands.
The team in the Terry unit acted quickly, bringing out a stretcher
and hoisting the two- hundred- and- seventy- pound former teamster
onto it, then wheeling him to an area that could be screened off from
other patients.
But they were paddling against a medical tsunami.
The IV port was available, but the oncologist covering the unit, a
young woman less than half Fagone’s size, was not skilled in dealing
with emergencies of this magnitude. By the time she got the right
medications into the man, Fagone’s blood pressure had been zero
for nearly three minutes. By the time she gave up trying to force an
endotracheal breathing tube past the massively swollen, distorted
vocal cords, and began clumsily performing her fi rst emergency tracheotomy
while waiting for the ENT surgeon to answer his page,
there had been no eff ective respirations for four minutes. She had
just sliced a scalpel across her patient’s massive throat when his
heart stopped. The blood fl owing from the gaping laceration was
gentian.
When the oncologist, frustrated and utterly demoralized, called
off the resuscitation at the ten- minute mark, a useful airway had still
not been established.
Jeff rey Fagone, who years before had survived two assassination
attempts during his rise to wealth and power in the Teamsters
Union, had no chance of surviving this one.
Unlike the other attempts, however, there was no suspicion of
anything sinister at work here. Fagone had been done in by a lethal
allergic reaction to Waldenstrom’s macroglobulinemia experimental
drug #BW1745. No one present that day thought otherwise. There
would be no analysis of the contents of the vial, and the perfunctory
autopsy performed the next morning would disclose nothing out of
the ordinary.
The treatment protocol for #BW1745 would be suspended indefi -
nitely, but within just a few months, the principal investigator, supported
by a hefty grant from one of the pharmaceutical giants, would
roll out another experimental drug to meet the demand of referrals
from all over the world.
The Susan and Clyde Terry Cancer Center closed for cleanup and
staff support for an hour after the tragic event, but there were patients
to treat, many of whom had come from even greater distances
than Jeff rey Fagone.
Soon, like the surface of a pond disturbed by a jumping fish, the
ripples had subsided, and the world’s greatest hospital had gone back
to being the world’s greatest hospital.
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