“You’re still young and energetic.”
“Kinder still. But Thalia has got her health problems, and I have a new grandchild, number three.”
“Okay. When I asked him why I was kept in the dark, Dr. Carr said that GEM wanted to guard against the competition. That seems rather paranoid to me.”
“Might also be good business. First of all, clinical trials are almost never done with geriatrics in nursing homes, as you know. So they wanted to keep things quiet for as long as possible. Secondly, GEM’s a small, tight drug company and nervous about some Goliath out there stealing its hot molecule. It’s happened before. I suppose if this compound turns out to be the real thing, the benefits will more than make up for minor irregularities.”
He, too, was saying to look the other way. “And what about Dr. Carr? I’m sure he’s doing well by GEM.”
“There’s nothing unethical or illegal in a physician’s getting a fee for enrolling patients in trials. It’s how research progresses.”
“That’s the one gray area that frankly bothers me. Doctors get paid thousands of dollars for each patient they enroll in a trial, plus research grants, equipment upgrades, staff support, travel perks, plus stock options in the company. With all those incentives, it’s hard to write up a negative report to the FDA.”
“Except actual scientific results don’t lie. And from what I hear, this Memorine is looking remarkable.” Nick fixed his glasses and rolled his chair. “Now, come here and look at this.” He inserted a CD into the computer and ran his fingers across the keyboard. In a matter of moments multicolored images of a brain filled the screen. He moved the mouse around and clicked a couple of times, and the colors began to change, pulsing in yellows and reds. “Thanks to the genius of imaging physicists and computer technicians, we now have the first quantitative, dynamic visualization of the destruction of cortical brain regions in people with dementia. What you’re seeing is a 3-D sequencing movie of a seventy-five-year-old male’s brain under the siege of plaque formation and neuron tangles over a thirteen-month period.”
As best she could, she tried to dissociate herself from thoughts of her father. “What do the colors represent?”
“The base image of the brain is blue. And in red is the beta-amyloid plaque.”
“God, it looks like a blight spreading across the brain.”
“And of the worst sort. What makes this technology very special is that we can directly monitor both the progressive damage as well as any therapeutic responses from Aricept and other treatments.” Nick ran the serial scan images several times.
“It’s moving right across the parietal and temporal lobes.”
“Exactly, the areas controlling language and major cognitive functions.”
“And obliterating memories, personalities—everything that made them who they were,” she said.
“His name is Louis Martinetti. He’s at Broadview. Maybe you’ve met him.”
“Yes. The Korean war vet.”
“And former POW. Well decorated—a Purple Heart, in fact. And a very sweet man.”
René felt a little sick as she watched the fast-forwarded sequence of his brain’s deterioration. Her father had been a Korean vet also. “What stage is he in?”
“Moderate, but it seems a particularly aggressive case.” The red blotches spread from frame to frame. “At this rate, the stuff will probably cover a good part of the frontal lobe within a year or so, rendering him incapable of speech and most memory.”
Although one could only imagine the man’s cerebral cortex becoming clotted with plaque, this new technology let them witness the brutal unraveling of the man’s mind and memory. But if they could have looked inside Mr. Martinetti’s brain they would have seen the same landscape of destruction that a hundred years ago in Munich had startled the German physician who described the disease that bears his name. It was Alois Alzheimer whose investigation of what had been diagnosed as premature senility in a fifty-one-year-old woman led to his discovery of the disease’s gruesome signature: the brownish nodules of plaque and the dense tangle of neurofibers that eat away the upper layers of the cerebral cortex and destroy a person cell by cell. What had wasted her father.
Nick reran the sequence. “Now, imagine seeing this played backward—all that red turning blue again.” And in his eyes she saw a flicker of promise.
Three years too late.
René tried to deflect the voice and looked away. At a station nearby was another computer monitor showing another brain image. “Is this the same patient?”
“No, that’s the image of a patient of Dr. Heller, another neurologist here in the department.”
René welcomed the distraction.
“But it does look similar.” Nick rolled in his chair to the monitor. “And that’s rather interesting because he’s not an AD patient but a young fellow in a coma. He nearly drowned last week after being stung by jellyfish—some rare creature found in the Caribbean.”
“How did he end up here?”
“Actually, it happened up here. On very rare occasions tropical creatures get caught in the Gulf Stream. And when the waters are as warm as they’ve been, they get caught in eddies that bring them close to shore.”
“Where’d it happen?”
“Homer’s Island, a private island northwest of Martha’s Vineyard. The only place they’ve ever been reported in the northeast. The Coast Guard found him.”
“Lucky for him. What’s his prognosis?”
“Not good, though his unconscious mind is quite active.” Nick moved the mouse around and hit a few keys as new brain images filled the screen in quarters. Then with a pen he pointed to an area of the frontal lobe of his brain. “This is what interests me. See how the yellow area appears to be expanding. Unlike the other, this is a structural MRI that measures brain tissue volume. And if you look here, the active area is his hippocampus and frontal lobe.”
“Meaning what?”
“I’m not really sure, but if I didn’t know better, I’d say the tissue was getting denser.”
“Denser? You mean his brain is growing?”
“Unless I’m mistaken, there’s active cell growth. Unfortunately he’s in no condition to tell us what he’s experiencing. But if he wakes up, it might be interesting to interview him.”
“Meanwhile, he’s turning into a Conehead.”
Nick laughed. “Or someone with a pretty rich memory bank.”
When Nick looked away, René fingered open the folder with his name tab and that of the unit he was in. “Any way to tell how long he might be unconscious?”
Nick shook his head. “Could be a week, could be five years. Could be forever.”
“It must be very hard on his family.”
“I think it’s only his wife, and I hear she’s not doing too well. He has seizures but is settling deeper into his coma. The EEG measurement of his brain-wave activity is around three Herz, which is very low, nearly a third the activity of adults in normal sleep.”
“Which means he’ll probably be moved to a rehab center soon. I’m sure the caseworkers are probably already talking about that. Maybe I can suggest some possible facilities.”
“I think she’d appreciate that. Also, on the off chance that he wakes up, it might be useful to make contact. He’s experienced a unique restructuring in his brain, so he might be a treasure trove of data. And it would be good for his wife to have another arm of support.”
Jack Koryan. And she filed away the name.
16
JACK KORYAN.
It was later that evening, and René was back home and at her computer with a glass of chardonnay and Silky in his basket at her feet. Over the hours she had let Nick’s words help her come to terms with the reality that she had done the right thing by her father. That at the time there were no other options. “Promise me this …”