Robert Sawyer - The Terminal Experiment

Peter chuckled. “Still the same old guy,” he said. “It’s good to hear your voice, Becky.”

“And yours, too.”

Peter felt his throat go dry. “Would you — would you be free for lunch today?”

“Oh, I’d love that. I’ve got to go by the bank this morning — in fact I was just on my way out to do that — but I could meet you, oh, gee, is eleven-thirty too soon?”

Not at all. “That would be great. Where?”

“Do you know Carlo’s on the Sparks Street Mall?”

“I can find it.”

“I’ll see you there at eleven-thirty, then.”

“Great,” said Peter. “I’m looking forward to it.”

Becky’s voice was full of warmth. “Me, too. Bye!”

“Bye.”

Peter left the little office and asked the receptionist if she knew Carlo’s. “Oh, yes,” she said, smiling mischievously. “It’s quite a singles spot in the evening.”

“I’m going there for lunch,” said Peter, feeling a need to explain himself.

“Ah, well, it’s a lot more quiet then. Good tortellini, though.”

“Can you tell me how to get there?”

“Sure. Are you driving?”

“I’ll walk if it’s not too far.”

“It’ll take about half an hour.”

“That’s no problem,” said Peter.

“I’ll draw you a little map,” she said, and proceeded to do so. Peter thanked her, took the elevator down to the lobby, and exited onto the street. The walk actually only took him twenty minutes; Peter was famous for his brisk walking speed. That meant he still had close to half an hour to kill. He found an on-demand newspaper box, fed three loonies into the machine, and waited the twenty seconds it took to print off a hardcopy of today’s Ottawa Citizen. He then made his way back to Carlo’s. It was deserted.

He asked for a table for two, was seated, and ordered black coffee. He looked around the place, trying to imagine it hopping with sweaty flesh in the evenings. He wondered if the receptionist had been pulling his leg. Still, there was a familiar face across the room: the same Molson’s cutie who adorned the wall next to the pay phones at The Bent Bishop. Peter settled into reading the paper, trying to contain his nervousness.

Heather Miller was a general practitioner with an office in the lower floor of her house. She was about forty-five, short and wide, with chestnut hair cut in a bob. Her desk was made out of a thick glass sheet supported by marble blocks. When Sandra Philo came in, Miller waved a hand, indicating she should sit in a green leather chair facing the desk. “As I said on the phone, Detective, I’m severely constrained in what I can say because of physician-patient confidentiality.”

Sandra nodded. It was the usual dance, the establishing of turf. “I understand, Doctor. The patient I wish to discuss is Rod Churchill.”

Miller waited.

“I don’t know if you’ve heard yet, but Mr. Churchill died last week.”

The doctor’s jaw dropped open. “I hadn’t heard.”

“I’m sorry to be the bearer of bad news,” said Sandra. “He was found dead in his dining room. The medical examiner said it had likely been an aneurysm. I visited his house and found that you’d been treating him with Nardil, which, according to the label, means he had to watch what he ate. And yet he’d been eating take-out food before he died.”

“Damn. Damn.” She spread her arms. “I told him to be careful about what he ate, because of the phenelzine.”

“Phenelzine?”

“Nardil is a brand name of phenelzine, Detective. It’s an antidepressant.”

Sandra’s eyebrows went up. Bunny Churchill had thought both her husband’s prescriptions were for his heart condition. “An antidepressant?”

“Yes,” said Miller. “But it’s also a monoamine oxi-dase inhibitor.”

“Which means?”

“Well, the bottom line is if you’re taking phenelzine,. you have to avoid foods high in tyramine. Otherwise your blood pressure will go through the roof — a hypertensive crisis. See, when you’re taking phenelzine, tyramine builds up; it’s not metabolized. That causes vasoconstriction — a pressor effect.”

“Which means?” said Sandra again. She just loved talking to doctors.

“Well, that kind of thing could conceivably kill even a healthy young person. For someone like Rod, who had a history of cardiovascular problems, it could very likely be fatal — causing a massive stroke, a heart attack, a neurological event, or, as your medical examiner suggested, a burst aneurysm. I assume he ate the wrong thing. But I warned him about that.”

Sandra tilted her head. Malpractice was always a possibility. “Did you?”

“Yes, of course.” Miller’s eyes narrowed. “That’s not the sort of mistake I make, Detective. In fact — ” She pushed a button on her desk intercom. “David, bring in the file on Mr. Churchill, please.” Miller looked at Sandra. “Whenever a drug involves substantial risks, my insurance company makes me get the patient’s signature on an information sheet. The sheets for each drug come in duplicate snap-sets. The patient signs them, I keep the duplicate, and he or she takes away the original — with all the warnings spelled out in plain English. So — ah.” The office door opened and a young man walked in holding a file folder. He handed it to Miller, then left. She opened the thin file, pulled out a yellow sheet, and passed it to Sandra.

Sandra glanced at it, then handed it back. “Why use phenelzine if it has so many risks associated with it?”

“These days we mostly use reversible MAO inhibitors, but Rod didn’t respond to them. Phenelzine used to be the gold standard in its class, and by checking MedBase, I found that one of his relatives had been successfully treated for the same sort of depression with it, so it seemed worth a try.”

“And what exactly are the risks? Suppose he ate the wrong food? What would happen?”

“He would start by having occipital headaches and retro-orbital pain.” The doctor raised a hand. “Excuse me — that’s headaches at the back of the head and pain behind the eye sockets. He’d also have had palpitations, flushing, nausea, and sweating. Then, if he didn’t get immediate treatment, intracerebral bleeding, a stroke, a burst aneurysm, or whatever, to finish him off.”

“It doesn’t sound like a pleasant way to go,” said Sandra.

“No,” said Miller, shaking her head sadly. “If he’d gotten to a hospital, five milligrams of phentolamine would have saved him. But if he’d been alone, he could easily have blacked out.”

“Had Churchill been your patient long?”

Miller frowned. “About a year. See, Rod was in his sixties. As often happens, his original doctor had been older than him, and he died last year. Rod finally got around to finding a new doctor because he needed his Cardizone prescription renewed.”

“But you said you were treating him for depression. He hadn’t come to see you specifically for that?”

“No — but I recognized the signs. He said he’d had insomnia for years and when we got to talking about things, it seemed clear that he was depressed.”

“What was he sad about?”

“Clinical depression is a lot more than just being sad, Detective. It’s an illness. The patient is physically and psychologically unable to concentrate and he or she feels dejection and hopelessness.”

“And you treated his depression with drugs?”

Miller sighed, picking up the implied criticism in Sandra’s tone. “We’re not stringing these people out, Detective; we’re trying to get their body chemistry back to what it should be. When it works, the patient describes the treatment as being like a curtain drawing away from a window and letting the sun in for the first time in years.” Miller paused, as if considering whether to go on. “In fact, I give Rod a lot of credit. He’d probably been suffering from depression for decades — possibly since he was a teenager. His old doctor had simply failed to recognize the signs. Lots of older people are afraid of having their depression treated, but not Rod. He wanted to be helped.”