Robin Cook - Terminal

Ted reached the end of the room for the fiftieth time and turned. He looked through the glass at the giant MRI machine. He could just barely see his daughter. It was as if she were being swallowed by a technological whale. He hated being so helpless. All he could do was watch, and hope. He’d felt almost as vulnerable when she’d had her tonsils out a few months earlier.

“We’ve got something,” Dr. Buckley said.

Ted hurried over to the CRT screen.

“There’s a hyperintense circumscribed area in the right temporal lobe,” she said.

“What does it mean?” Ted demanded.

The doctors exchanged glances. It was not customary for the relative of a patient to be in the room during such a study.

“It’s probably a mass lesion,” Dr. Buckley said.

“Can you put that in lay terms?” Ted asked, trying to keep his voice even.

“She means a brain tumor,” Dr. Martinez said. “But we know very little at this point, and we should not jump to conclusions. The lesion might have been there for years.”

Ted swayed. His worst fears were materializing. Why couldn’t he be in that machine and not his daughter?

“Uh oh!” Dr. Buckley said, forgetting the effect such an exclamation would have on Ted. “Here’s another lesion.”

The doctors clustered around the screen, transfixed by the vertically unfolding images. For a few moments they forgot about Ted.

“You know it reminds me of the case I told you about in Boston,” said Dr. Rainey. “A young woman in her twenties with multiple intracranial tumors and negative metastatic workup. She was proved to have medulloblastoma.”

“I thought medulloblastoma occurs in the posterior fossa,” Dr. Martinez said.

“It usually does,” Dr. Rainey said. “It also usually occurs in younger kids. But twenty percent or so of the incidents are in patients over twenty, and it’s occasionally found in regions of the brain besides the cerebellum. Actually, it would be wonderful if it turns out to be medulloblastoma in this case.”

“Why?” Dr. Buckley asked. She was aware of the high mortality of the cancer.

“Because a group down in Miami has had remarkable success in getting remissions with that particular tumor.”

“What’s their name?” Ted demanded, clutching onto the first hopeful news he’d heard.

“The Forbes Cancer Center,” Dr. Rainey said. “They haven’t published yet but word of that kind of a result gets around.”

When Tom Widdicomb awoke at 6:15 to begin his workday, Sean Murphy had already been on the road for several hours, planning on reaching the Forbes Cancer Center by mid-morning. Tom did not know Sean, and had no idea he was expected. Had he known that their lives would soon intersect, his anxiety would have been even greater. Tom was always anxious when he decided to help a patient, and the night before he’d decided to help not one but two women. Sandra Blankenship on the second floor would be the first. She was in great pain and already receiving her chemotherapy by IV. The other patient, Gloria D’Amataglio, was on the fourth floor. That was a bit more worrisome since the last patient he’d helped, Norma Taylor, had also been on the fourth floor. Tom didn’t want any pattern to emerge.

His biggest problem was that he constantly worried about someone suspecting what he was doing, and on a day that he was going to act, his anxiety could be overwhelming. Still, sensitive to gossip on the wards, he’d heard nothing that suggested that anyone was suspicious. After all, he was dealing with women who were terminally ill. They were expected to die. Tom was merely saving everyone from additional suffering, especially the patient.

Tom showered, shaved, and dressed in his green uniform, then went into his mother’s kitchen. She always got up before he did, insistent every morning as far back as he could remember that he should eat a good breakfast since he wasn’t as strong as other boys. Tom and his mother, Alice, had lived together in their close, secret world from the time Tom’s dad died when Tom was four. That was when he and his mother had started sleeping together, and his mother had started calling him “her little man.”

“I’m going to help another woman today, Mom,” Tom said as he sat down to eat his eggs and bacon. He knew how proud his mother was of him. She had always praised him even when he’d been a lonely child with eye problems. His schoolmates had teased him mercilessly about his crossed eyes, chasing him home nearly every day.

“Don’t worry, my little man,” Alice would say when he’d arrive at the house in tears. “We’ll always have each other. We don’t need other people.”

And that was how things worked out. Tom had never felt any desire to leave home. For a while, he worked at a local veterinarian’s. Then at his mother’s suggestion, since she’d always been interested in medicine, he’d taken a course to be an EMT. After his training, he got a job with an ambulance company but had trouble getting along with the other workers. He decided he would be better off as an orderly. That way he wouldn’t have to relate to so many people. First he’d worked at Miami General Hospital but got into a fight with his shift supervisor. Then he worked at a funeral home before joining the Forbes housekeeping staff.

“The woman’s name is Sandra,” Tom told his mother as he ran his dish under the faucet at the sink. “She’s older than you. She’s in a lot of pain. The ‘problem’ has spread to her spine.”

When Tom spoke to his mother, he never used the word “cancer.” Early in her illness, they’d decided not to say the word. They preferred less emotionally charged words like “problem” or “difficulty.”

Tom had read about succinylcholine in a newspaper story about some doctor in New Jersey. His rudimentary medical training afforded an understanding of the physiologic principles. His freedom as a housekeeper allowed him contact with anesthesia carts. He’d never had any problem getting the drug. The problem had been where to hide it until it was needed. Then one day he found a convenient space above the wall cabinets in the housekeeping closet on the fourth floor. When he climbed up and looked into the area and saw the amount of accumulated dust, he knew his drug would never be disturbed.

“Don’t worry about anything, Mom,” Tom said as he prepared to leave. “I’ll be home just as soon as I can. I’ll miss you and I love you.” Tom had been saying that ever since he had gone to school, and just because he’d had to put his mother to sleep three years ago, he didn’t feel any need to change.

It was almost ten-thirty in the morning when Sean pulled his 4 x 4 into the parking area of the Forbes Cancer Center. It was a bright, clear, summer-like day. The temperature was somewhere around seventy, and after the freezing Boston rain Sean felt he was in heaven. He’d enjoyed the two-day drive, too. He could have made it faster, but the clinic wasn’t expecting him until late that day so there’d been no need. He spent his first night in a motel just off I95 in Rocky Mount, North Carolina.

The next day had taken him deep into Florida where the depth of spring seemed to increase with every passing mile. The second night had been spent in perfumed delight near Vero Beach, Florida. When he asked the motel clerk about the wonderful aroma in the air he was told it came from the nearby citrus groves.

The last lap of the journey turned out to be the most difficult. From West Palm Beach south, particularly near Fort Lauderdale and into Miami, he fought rush-hour traffic. To his surprise even eight-laned I95 coagulated into a stop-and-go mess.

Sean locked his car, stretched, and gazed up at the imposing twin bronzed, mirrored towers of the Forbes Cancer Center. A covered pedestrian bridge constructed of the same material connected the buildings. He noted from the signs that the research and administration center was on the left while the hospital was on the right.