“Well, Lenny, the guy we’re about to meet is apparently some hot shit at Mass General. He’s an expert in something called transcranial magnetic stimulation.”
His father’s eyes stared straight ahead.
“I know,” Rick replied to his father’s silence. “That’s what I thought, too. But I figure it’s worth a shot.”
The director of the Laboratory for Neuromodulation was Dr. Raúl Girona, an associate professor of neurology at Harvard Medical School who had dark brown hair cut in high bangs and had a few days’ growth of beard that looked deliberate. He wore tortoiseshell glasses that looked Euro-stylish instead of nerdy, a navy suit and a bright green tie and a red Pebble smart watch. He couldn’t have been out of his thirties.
Meanwhile, in the next room, Lenny was being put through a battery of tests, all exams he’d no doubt been given years before, the greatest hits of stroke rehabilitation. He submitted to the tests docilely, as he did everything now, since he no longer had the ability to object.
“I should warn you,” Dr. Girona said as they shook hands. “Your father’s case is a difficult one.”
“Because of how long it’s been?”
Dr. Girona shrugged and sank back into his chair behind a small bare desk. “That concerns me less than the fact that your father does not speak at all. Most stroke victims are able to speak to some extent. They can make sounds, sometimes words or phrases. But your father’s chart indicates that he is unable to phonate at all, correct?” He was from Spain, according to his bio on the Mass General website, from Catalonia, but his English, though strongly accented, was remarkably fluent.
Rick nodded. “I’m not expecting miracles. I’m not expecting him to sit up one day and start talking about the Red Sox starting lineup with me. I just want to know what’s possible.”
“Well, your father has been categorized as a global aphasic. That means he can neither express himself nor comprehend when he’s spoken to. But I take it you think that diagnosis is incorrect.”
“I think there’s a good chance, yeah. Seems like he understands when I talk to him. He just doesn’t have a way of communicating what he wants to say.”
“What makes you think he understands?”
“He sometimes blinks rapidly, like he’s trying to tell me something. And when I asked him about something recently-something upsetting, I think-he grabbed my wrist.”
“With his right hand?”
“His left.”
“Ah, yes. His right side is immobilized. Well, perhaps so. More to the point, the question is, how much does he understand? And how can you know?”
“If he could write a note, maybe. Or type on a keyboard.”
Dr. Girona nodded. “I’m sure your father’s doctors and occupational therapists have tried all of the standard methods. The picture and symbol communication boards and so on. But the problem is, some aphasics don’t understand speech at all. At most, they recognize familiar names.”
“Can TMS help with that?”
“Perhaps. You know how a stroke affects the brain, yes?”
“Basically.”
Dr. Girona went on as if Rick hadn’t replied. “A stroke happens when something cuts off the flow of blood to your brain. The neurons in a certain area of the brain are starved of oxygen and they die. Now, the part of the brain where your father had a stroke was the left side, yes? And we know the left side of the brain not only controls the right side of the body but it’s also where the dominant language center is-the left inferior frontal gyrus, where speech is produced.”
“Okay.” Rick nodded.
“Now, when one side of the brain is damaged in a stroke, the other side takes over. As if to compensate. But we want to make the left side start to work again, right? To grow back, you might say. And the way we do that is to use magnetic pulses to rewire the brain itself. We run an electrical current through a wire in a coil to generate a magnetic field. Depending on what kind of magnetic field we generate, we can either activate the brain cells or inhibit them. Make them either more reactive or less. Are you following me so far?”
“I think so,” Rick said. “So you want to inhibit the right side to make the left side start doing work.”
“Exactly! We place the coil over the posterior inferior frontal gyrus. To inhibit the right side of his brain. Which we hope will make the left side, the language side, start to work again. And gradually the brain begins to rewire itself.”
“Will it hurt him?”
Dr. Girona shook his head. “At most, it may feel like a series of pinpricks.”
“How long will it take to see some results?”
“A few weeks, most probably. But you need to have realistic expectations.”
“What should I expect?”
“Expect nothing, and you won’t be disappointed.”
“I see. Well, anything would be an improvement.”
“One more thing. And perhaps I should have started with this. This is a costly procedure, and it’s not covered by any insurance.”
“How costly are we talking?”
“You’ll have to talk to our finance people.”
“Ballpark.”
“For a full course of treatment we’re talking probably over a hundred thousand dollars.”
Rick nodded, shrugged. “That won’t be a problem.”
28
Rick called Darren Overby, the editor in chief of Back Bay.
“Darren, how would you feel about a profile of Alex Pappas?”
“Alex Pappas… Remind me who he is again?”
“The Pappas Group. PR guy, fixer.”
“Oh, right. That would be great. But not a full profile, of course.”
“No, no. Nothing too serious. Just a Q &A, really.”
“Do it! But when am I going to see the Thomas Sculley piece?”
“Yeah, soon,” Rick said. Like never.
Then he called the Pappas Group, was connected to Pappas’s office, and left a message with one of his assistants, a woman with an appealingly raspy voice and a posh British accent.
It was a long shot, but worth a try.
To his surprise, an hour and a half later he received a call from the assistant agreeing to an interview the next morning.
The game was on.
He called Monica Kennedy and managed to keep her on the phone for six minutes while he questioned her about Alex Pappas. Though she claimed to have very little information on the man, she did know a few interesting things. She knew that his clients included a couple of former governors and mayors and senators. They also included a judge caught in a bribery scandal involving the construction of a huge parking garage. A football player for the New England Patriots, accused of murder, had hired Pappas to handle the public relations fallout, not legal representation. A House Speaker charged with corruption but who maintained his innocence had used Pappas’s services-again, not legal but in the realm of “reputation management.” Improving the Speaker’s image. A chemical company accused of contaminating the drinking water in a remote Massachusetts town, causing a sudden rise in leukemia cases among the children, had hired Pappas. The chemical company had had the charges dismissed, but that might have been the result of shrewd legal representation.
Alex Pappas specialized in crisis management, in “putting out fires,” Monica said. In making scandals go away.
The more Rick learned, the sketchier Pappas seemed to be. He seemed to have his fingers in a thousand pies.