Excellent. Using that plane of yours was just a super idea.'
'Thank you, but-'
'You know, I'm no professional, but I've been trying to tell Barbara all along that this was all just a nasty phase, and that when that kid of ours was doggone good and ready he would get through it. It sounds like you two made quite a large step in that direction today.'
'Call it a baby step, ' Zack said. Despite the machismo in Bob Nelms's words and manner, one look in his eyes and Zack knew the man was whistling in the dark. As a supervisor at the mill, he was used to accepting the burden of difficult problems and solving them. His thin-shelled denial would require delicate handling and constant awareness that Toby's condition was no less baffling and frightening to Bob Nelms than his impotence in the face of it. As Zack followed the couple into the elevator, he wondered once again how much to share with them. It had never been his way to withhold information from his patients or, when the patient was comatose or a juvenile, from their families. But this was not information. It was the purest conjecture.
And even when he tested the explanation on himself, it sounded nothing short of phantasmagoric. Mr. and Mrs. Nelms, I don't know how to tell you this, but I believe that your son was not asleep during his hernia operation last year. He appeared to his surgeon and anesthesiologist to be fully anesthetized But somehow, at some level, he not only 'saw' his operation from within his body, but, it would seem, he jitlly experienced the pain of it as well Now, in some perverted, distorted way, he is reliving that surgery in terrifying flashbacks, much like those described in LSD users… No. I don't have any idea how that could happen… No, to the best o my knowledge, such a phenomenon has never been reported with the anesthetics he received… No, I don't have any hard evidence to back up what I say… No, I don't know what could possibly be causing the attacks… No, I don't have any idea…
I don't know… I don't know… I don't know…'
His suspicions were vague, fantastic, and virtually without proof.
Disclosure of them to the boy's parents would almost certainly precipitate premature action by them against Ultramed, the hospital, and the physicians involved in Toby's surgery-action Zack was in no position yet to support, and which could well lead to a coverup of the truth… whatever that was, 'Mr. and Mrs. Nelms,' he began once the couple was settled in across the desk from him. 'I'm afraid I don't have very much to tell you at this point. Toby did not share a great deal with me.
However, he did say enough for me to suspect that he is having very severe fright reactions, and that while these reactions are occurring he is completely unable to distinguish them from reality. In other words, in just a few seconds, apparently with very little warning, he is transported from wherever he happens to be into another reality-a very distorted, very terrifying reality.'
'Are you saying he becomes insane? ' Barbara Nelms asked. 'You've observed him, ' Zack responded, still feeling his way along. 'What do you think?'
'But… but insanity is a condition, isn't it? A state of being.
How can it possibly flick on and off like a light?'
'And what has the hospital got to do with it? ' Bob Nelms added. 'I don't know,' Zack said, wondering how many more times he would hear himself repeat that phrase. 'Well, what do you think?'
Zack tapped his fingers together, stalling for a few more seconds to sort his thoughts. As much as he hated deception, this simply was not the time to air his theory. 'I assume you are both somewhat familiar with epilepsy? ' he began. 'Well, most people think of epilepsy as an electrical disorder of the brain which causes periodic fits. The seizures we are most familiar with are motor seizures-that is, they involve the muscles and the extremities. But supposing the electrical explosion occurs in one or more Of the cognitive areas of the brain-the thinking areas. What would result would still be a seizure, but it would be a sensory seizure rather than a motor one.'
'Are you trying to tell us that Toby has petit mal or temporal-lobe CPILEPSY? ' Barbara asked. 'I've read everything I could get my hands on about both conditions, and quite frankly, Dr. Iverson, I don't think Toby's condition fits either one. He is aggressive like temporal-lobe epileptics, but only because he is absolutely terrified. And very little of his behavior resembles the detached, fugue reactions that I've read about in petit mal. And although the resting electroencephalogram is not that accurate in making either diagnosis, Toby's was normal the one time he had it done.'
Zack felt his cheeks flush and cautioned himself against any elaborate untruths, Barbara Nelms was too desperate and too bright. She was tired of getting the runaround from medical and mental health professionals, and she had done her homework well. 'I don't know what to say, Mrs.
Nelms, ' he countered, 'except to point out that if Toby's case were straightforward and typical, someone would have diagnosed it before now.'
'What about the hospital? ' Bob Nelms asked again. 'Didn't the boy say anything to you to explain why he seems so frightened?'
'Nothing specific, ' Zack lied. 'But since that's the main clue we have, I do feel that's the direction our investigation should go.'
Barbara Nelms slumped visibly. 'Dr. Iverson, investigations are fine, but you saw Toby. He's like a stick. His skin is getting infected. He gets bruises from almost nothing. He gets fevers with no evidence of infections. He's dying, Dr. Iverson. I swear, time is running out. Our son is dying.'
'Barbara, don't say that!'
Bob Nelms blurted. His outburst hit a raw nerve. 'Don't tell me what to say and what not to say, ' she snapped back. 'You're in that damn mill until seven every night. You don't see him.'
'Doggone it, Barbara, I'm doing everything I can. You're the one who hasn't paid a bit of attention to anything but Toby these past-'
'Please, ' Zack said. 'Please. I know this is hard on you both. But sniping at each other isn't helping anyone- least of all Toby.'
The couple stopped abruptly and exchanged sheepish looks. 'We're sorry,
' Barbara said. She reached over and squeezed her husband's hand. 'We never used to fight, even at home alone. But this has just got us all..
' She looked away. 'I understand, Mrs. Nelms. All I can ask is that you both just do your best to keep it together, and give me a little time to do some reading and talk to some people. I'll work as rapidly as I can.
I promise you that. And I'll plan on seeing Toby again next week. Same time. Same field.'
'Meanwhile?'
Zack shrugged. 'Meanwhile, I don't think any specific treatment is indicated. Especially since I don't really know yet what's going on. I will tell you that I don't take my responsibility for my patients lightly, and I'm fully aware that we don't have all the time in the world. I'll do my very best to get to the bottom of things quickly.'
He stood, hoping to bring the exchange to a merciful end before Barbara Nelms could hone in on the inadequacies in his explanation.
'Thank you, ' Bob said, standing as Zack did and shaking his hand.
Zack walked them to the outer door of his office and again promised to work as quickly as possible. 'Dr. Iverson, could you just tell me one thing? ' Barbara Nelms asked. 'Of course.'
'Are you holding anything at all back from us?'
Zack had to force himself to maintain contact with the woman's eyes. It was a technique at which, unlike Frank, he had never excelled. 'No, Mrs.
Nelms, ' he said flatly. 'No, I'm not.'
The woman hesitated, and for a moment seemed poised to challenge the denial. Then she reached out and shook his hand. 'That being the case, then, thank you, Doctor. You will keep us posted, yes. She took her husband's arm and walked away with him, down the darkened corridor. Zack watched until the elevator doors had closed behind them. He ached from his lies and from the graphic reminder of the power of illness over the lives of whole families. He also knew, from her parting look, that Barbara Nelms would never again allow him to hide behind evasions and half-truths. He would review Toby Nelms's record again, and then contact the National Institutes of Health library in Bethesda for a complete search of the reported adverse reactions to the anesthe ics he had received. Finally, he would meet with Jack Pearl and Jason Mainwaring.
Beyond those steps, there was nowhere to go-nowhere except another session with Toby himself and then the sharing of his suspicions with Frank. Something had happened to the boy during his hospitalization at Ultramed-Davis-something devastating. If nothing else panned out, Frank would have to realize that it was in everyone's best interests that he pursue the matter. He would cooperate, or face Barbara Nelms and her attorney.
