Michael Palmer - Flashback

Judge, can we get a shot of the two of you together? … "at were you thinking when your boy took off and headed for the end zone like that?… As far as the Judge was concerned, the moment Annie Doucette had tumbled off the end of her bed, the fate of the Ultramed Hospitals Corporation in Sterling had been sealed. But speaking to Bourque had helped him see that although the company had to go, there was no reason Frank had to go with it. A few calls to select trustees had convinced him that the board would go along with him in keeping Frank on as administrator. Now, he had only to convince Frank… The Judge had sped a hundred or so yards beyond the oversized silver mailbox marking the dirt drive to his farm before he realized that he had missed it. "Damn you, Iverson, " he cursed out loud. He slowed, giving momentary thought to a U-turn or to backing up. Then, before he could talk himself into chancing either maneuver, he accelerated over the five hundred additional yards to the next driveway.

Twice, trying turnarounds on that stretch of narrow road, he had backed into the drainage ditch.

The last thing he needed at that moment was to spend a sweltering hour perched on the split-rail fence, waiting for Pierre Rousseau and his damn tow truck. He had a date with a shower and a gin-and-tonic, and then with a' lovely businesswoman who would try, unsuccessfully, to get him to reconsider his decision. Leigh Baron wasn't all that tough, but she was bright and certainly diverting. And she would surely provide a decent warm-up for the encounters to come with the real heavy hitters.

Once again, he felt the scintillation-the rush-at the prospect of what lay ahead. It was hardly difficult for him to understand why generals gave up their commands so reluctantly. Retirement?… Nonsense, he thought. The game was on, and Clayton Iverson was right in the middle of it. As he eased the Chrysler to a stop by his barn, stepped out, and surveyed his land and the mountains beyond, the Judge made a mental note to send a renewal off to their Florida tenant before Cinnie realized that the man's lease had run out. The atmosphere in the intensive care unit was somber and extremely tense. A child was in trouble-serious trouble. The nurses moved from one patient cubicle to another efficiently, but more quietly than usual, stopping from time to time at the doorway to number 7 to see if the nurse working on Toby Nelms needed any assistance. Behind the nurses station, next to the bank of monitors, Zack checked over the latest set of laboratory figures with the boy's pediatrician, Owen Walsh, a soft-spoken man in his late fifties with close cropped, graying hair, and deep crow's feet at the corners of his eyes which gave him a perpetually cheerful expression. Across from them, in cubicle 7, Toby lay thrashing on a cooling blanket, totally unresponsive to his environment. His core temperature, despite aggressive measures, remained well above 104. The fire/rescue squad had broken into the Nelms's bathroom and found the boy draped over the side of the tub, barely conscious, with multiple, self-inflicted slices and stab wounds on his arms, abdomen, and legs. Barbara Nelms, conscious but in shock, lay in the bedroom, blood still oozing from the gashes in her arm. Zack had arrived at the house in time to help with the first aid and the insertion of intravenous lines in both mother and child. Then he had accompanied the ambulance to the hospital and had turned Barbara Nelms, whose blood pressure had responded nicely to a fluid push, over to the general surgeon, Greg Ormesby. Finally, after getting Toby up to the ICU and onto the cooling blanket, Zack had begun to repair his wounds, none of which involved tendons or vital structures. And, frightening as the lacerations appeared, Zack knew that they were of little importance compared to the fever and the deterioration of the boy's central nervous and cardiovascular systems-a constellation of signs that were almost certainly a reflection of brain swelling. "Do you think Boston? " Owen Walsh asked. Like many community pediatricians, especially older ones, Walsh was far more comfortable dealing with patients in his office than in the hospital, and was not comfortable at all with a critically ill child in the intensive care unit. "At this point, I'm not even sure he could make it, " Zack said. "Although I guess that's what we should be shooting for."

"He's been a patient there in the past, you know."

"I know, Owen, I know. And I know you're nervous about having him here.

The truth is, I'm not so comfortable with it myself. But believe me, as someone who a month ago might have been called in to see this kid after his transfer to Boston, our fluids are just as good as theirs. So're our cooling blanket and our Tylenol and our steroids. And we've got a hell of a cardiologist in Suzanne Cole. So it's not like we're doing nothing.

I think we should alert the people down there about what's happening and put one of the chopper teams on standby. But there's something we ought to attend to first."

"The anesthe ic?"

"Exactly-, Zack had shared Toby's history with the pediatrician, withholding only his suspicion that some sort of secret anesthe ic might have been used during his hernia operation. "Can you explain it to me again? " Walsh asked. "Sure. In a second."

Zack stood and peered across at Toby. Swathe in bandages, surrounded by the monitor, the clipboards, the intravenous, gastric, and oxygen tubings, and the large cooling blanket console, the child looked terribly frail and vulnerable. "Any change?"

Zack called out to the nurse attending him. "Temp's down to 104, Doctor,

" she said. "No other change."

"Pupils?"

"Still equal and reactive, but sluggish."

"Thank you…"

He glanced at the monitor in time to catch several ominous, premature heartbeats. "See if you can locate Dr. Cole, please, " he said to the unit secretary. "Ask her if she can come down here."

He turned back to the pediatrician. "Okay, Owen. Now, if what we're seeing is some sort of central, toxic reaction to an anesthe ic, then as far as I'm concerned, the actual molecules of the drug, or at least their chemical imprints, are still there in Toby's brain, clogging up neuro pathways and periodically firing off messages without any warning or control from him."

"The seizures."

"Or flashbacks, or whatever you want to call them. Somehow, the messages these molecules are transmitting are violent ones-ones related to the surgery."

But why? Zack found himself asking for perhaps the millionth time.

"Y do they happen when they do? Why not to every patient, or at least to more of them? The answer, he felt certain, had to be some sort of neuroactivator-a trigger, or more likely, given the rarity of the condition, a specific sequence of triggers. No other explanation made sense… "Zack, you were saying? " Owen Walsh was looking at him curiously. "Oh, sorry." Zack made a mental note to go over with Barbara Nelms the minute details of the events preceding Toby's attacks. He would also write down his best recollection of the minutes preceding and following Suzanne's bizarre episode. "Do you follow all this?"

"So far, " Walsh said. 71 Okay… Zack drew a sketch of several nerve endings on a piece of scratch paper, and used the diagram to illustrate his theory. "So, what we might consider doing, is putting Toby back under again in a perfectly controlled, sensory-deprived situation.

One of those isolation tanks would be ideal, but I understand that's just not possible with him being so sick. Anyhow, we just make things as dark and as quiet as we can, and we administer the same anesthe ic he received originally."

"And what we'd be trying to do, " Walsh said, "would be literally to wash out the molecules that are sending violent sensory messages, and replace them with molecules transmitting-what, blanks?"