Jonathan Kellerman - Blood Test

Being released from a conversation with Melendez-Lynch was a jarring experience, a sudden shift into low gear. I put down the receiver, regained my bearings, and reflected on the complexity of the manic syndrome.

Western Pediatric Medical Center occupies a square block of mid-Hollywood real estate in a neighborhood that was once grand but is now the turf of junkies, hookers, drag queens, and fancy dancers of every stripe. The working girls were up early this morning, halter-topped and hot-panted, and as I cruised eastward on Sunset they stepped out from alleys and shadowed doorways sashaying and hooting. The whores were as much a fixture of Hollywood as the brass stars inlaid in the sidewalks, and I could swear I recognized some of the same painted faces I’d seen there three years ago. The streetwalkers seemed to fall into two categories: doughy-faced runaways from Bakersfield, Fresno, and the surrounding farmlands, and lean, leggy, shopworn black girls from South Central L.A. All of them raring to go at eight forty-five in the morning. If the whole country ever got that industrious the Japanese wouldn’t stand a chance.

The hospital loomed large, a compound of aged dark stone buildings and one newer column of concrete and glass. I pulled the Seville into the doctors’ lot and walked to Prinzley Pavilion, the contemporary structure.

The Department of Oncology was situated on the fifth floor. The doctors’ offices were cubicles arranged in a U around the secretarial pool. As head of the department, Raoul got four times as much space as any of the other oncologists, as well as privacy. His office was at the far end of the corridor and cordoned off by double glass doors. I went through them and walked into the reception area. Seeing no receptionist, I kept going and entered his office through a door marked PRIVATE.

He could have had an executive suite but had chosen to use almost all the space for his lab, ending up with an office only ten by twelve. The room was as I remembered it, the desk piled high with correspondence, journals, and unanswered messages, all ordered and precisely stacked. There were too many books for the floor-to-ceiling bookcase and the overflow was similarly heaped on the floor. One shelf was filled with bottles of Maalox. Perpendicular to the desk, faded beige curtains concealed the office’s sole window as well as a view of the hills beyond.

I knew that view well, having spent a significant proportion of my time at Western Peds staring out at the crumbling letters of the HOLLYWOOD sign while waiting for Raoul to show up for meetings he had scheduled but inevitably forgot about, or cooling my heels during his interminable long-distance phone chats.

I searched for signs of habitation and found a Styrofoam cup half-filled with cold coffee and a cream-colored silk jacket draped neatly over the desk chair. Knocking on the door leading to the lab brought no response and the door was locked. I opened the curtains, waited a while, paged him and got no callback. My watch said ten after nine. Old feelings of impatience and resentment began to surface.

Fifteen minutes more, I told myself, and then I’ll leave. Enough is enough.

Ninety seconds before the deadline he blew in.

“Alex, Alex!” He shook my hand vigorously. “Thank you for coming!”

He’d aged. The paunch had grown sizably ovoid and it strained his shirt buttons. The last few strands of hair on his crown had vanished and the dark curls around the sides bordered a skull that was high, knobby, and shiny. The thick mustache, once ebony, was a variegated thatch of gray, black, and white. Only the coffee bean eyes, ever moving, ever alert, seemed agelessly charged and hinted at the fire within. He was a short man given to pudginess and though he dressed expensively, his wardrobe wasn’t selected with an eye toward camouflage. This morning he wore a pale pink shirt, a black tie with pink clocks, and cream-colored slacks that matched the jacket over the chair. His shoes were mirror-polished, sharptoed tan loafers of perforated leather. His long white coat was starched and immaculate but a size too large. A stethoscope was draped around his neck, and pens and documents stuffed the pockets of the coat, causing them to sag.

“Good morning, Raoul.”

“Have you had breakfast yet?” He turned his back to me and moved his thick fingers rapidly over the piles on the desk like a blind man speedreading Braille.

“No, you said you’d—”

“How about we go to the doctor’s dining room and the department will buy you some?”

“That would be fine,” I sighed.

“Great, great.” He patted his pockets, searched in them, and muttered a profanity in Spanish. “Just let me make a couple of calls and we’ll be off—”

“Raoul, I’m under some time pressure. I’d appreciate it if we could get going now.”

He turned and looked at me with great surprise.

“What? Oh, of course. Right now. Certainly.”

A last glance at the desk, a grab for the current copy of Blood , and we were off.

Though his legs were shorter than mine by a good four inches, I had to trot to keep up with him as we hurried across the glassed-in bridge that connected Prinzley with the main building. And since he talked as he walked, keeping up was essential.

“The family’s name is Swope.” He spelled it. “The boy is Heywood — Woody for short. Five years old. Non-Hodgkin’s lymphoma, localized. The initial site was in the G.I. tract with one regional node. The metastatic scan was beautiful — very clean. The histology is nonlymphoblastic, which is excellent, because the treatment protocol for nonlymphoblastics is well-established.”

We reached the elevator. He seemed out of breath, tugging at his shirt collar and loosening his tie. The doors slid open and we rode down in silence to the ground floor. Silence — but not serenity, because he couldn’t stand still: he tapped his fingers on the elevator wall, played with strands of his mustache, and clicked a ball-point pen open and shut repeatedly.

The ground floor corridor was a tunnel of noise, glutted with doctors, nurses, techs, and patients. He continued talking until I tapped his shoulder and shouted that I couldn’t hear him. His head gave a curt little nod and he picked up his pace. We zipped through the cafeteria and passed into the dimly lit elegance of the doctors’ dining room.

A group of surgeons and surgical residents sat eating and smoking around a circular table, dressed in greens, their caps hanging across their chests like bibs; otherwise the room was unoccupied.

Raoul ushered me to a corner table, motioned for service, and spread a linen napkin over his lap. He picked up a packet of artificial sweetener and turned it on its side, causing the powder within to shift with a dry whisper, like sand through an hourglass. He repeated the gesture half a dozen times and started talking again, stopping only when the waitress came and took our order.

“Do you remember the COMP protocol, Alex?”

“Vaguely. Cyclophosphamide, um — methotrexate and prednisone, right? I forget what the O stands for.”

“Very good. Oncovin. We’ve refined it for non-Hodgkin’s. It’s working wonders when we combine it with intrathecal methotrexate and radiation. Eighty-one percent of patients are achieving three-year, relapse-free survival. That’s a national statistic — the figures on my patients are even better — over ninety percent. I’m following a growing number of kids who are five, seven years and looking great. Think of that, Alex. A disease that killed virtually every child it got hold of a decade ago is potentially curable.”

The light behind his eyes picked up extra wattage.

“Fantastic,” I said.

“Perfect word — fantastic. The key is multimodal chemotherapy. More and better drugs in the right combinations.”