God! A coma had punched a hole in the fourth decade of his life.
He missed Beth. He missed the way it was years ago. He missed their old life together. He wished they could heal the wounds and go back. While the monitors beeped like birds, he stared at the perforated ceiling.
Then he closed his eyes and pressed back into sleep.
42
NICK AND RENE WERE IN THE SMALL snack bar off the main lobby of Morningside when Rene heard the familiar high-compression growl out the window. It was Jordan Carr arriving for the eleven o’clock meeting that Nick had called. He had pulled in with a silver Ferrari Maranello he had just purchased.
When he came in, Nick smiled and said, “Did the other one get dirty?”
“Very funny,” Jordan said, and forced a smile.
But from the red blotching of his cheeks, he did not like the ribbing. Nor did he want to be reminded that his Italian sports car collection was growing, not from his practice, on which he had cut back, but from the trials. Gavin Moy had named him number-two point man.
Nick led them inside to the conference room. Although it was a regularly scheduled meeting for trial clinicians, Morningside administrators, and staffers, Nick had invited Peter Habib from Plymouth as well as two researchers from GEM Tech to review recent data—Kevin Maloney and a Hassan Vadali.
After some pleasantries, Nick got down to business. “The good news is that test results are improving markedly in test residents.” And he named several patients, including Louis Martinetti, who had shown higher scores on the Mini-Mentals as compared to scores of those patients receiving placebos. “Similar results have been recorded at other sites. Of course, we are very pleased, as the progress demonstrates the efficacy of Memorine.”
A summary of the report that Rene had helped put together had been sent to everybody in the room.
“But what concerns me are the mounting reports of flashbacks,” Nick continued. “We’re seeing regressive behavior in a number of patients here and at other sites.” Nick named several.
“I’ve had a few also,” Peter Habib added. “One particularly troublesome case you may recall was that of William Zett several weeks back. According to his brother and sister-in-law, he got completely lost in a deep-past flashback, talking to kids from his childhood. He went down a slide backward and broke his neck. Nobody knows what was going on in his head, but, according to his brother and sister-in-law, before the accident he appeared frightened, traumatized, as if reliving some disturbing experience. And these are the kinds of things that concern me.”
Nick nodded. “The problem is that almost none of these patients experienced flashback seizures before they were enrolled in the trials.”
“How many patients have you seen with these so-called flashbacks?” Vadali asked.
The question was disingenuous because Rene knew that the number was headlined in the report. “About thirty percent. And that could be a problem for a fast-track FDA approval.”
It was the first time Nick had raised this warning. Perhaps they had seen it coming, because the GEM Tech representatives looked unfazed.
“And how are these so-called flashbacks characterized?” Maloney asked. “You seem to view these as discrete neuropsychological phenomena.”
Nick deferred the question to Rene, who could feel the pressure from Maloney’s expression. “Well, in their reports nurses describe them as elaborate delusional episodes in which residents manifest regressive behavior.”
“Such as?”
“Such as talking like children, singing nursery rhymes and Christmas carols, spending hours playing with toys or flipping through children’s books. They appear to be locked in some past recollections.”
Maloney nodded. “And you think these delusions are the result of Memorine.”
Either he was playing dumb or he had not read the regular reports Rene had forwarded to GEM’s R&D people. Or they never took them seriously. “I’m saying that there are indications of a patterned correlation,” she said.
“I’m also seeing a frequency correlation between the flashbacks and increased neurological repair in MRIs,” Habib added. “It’s rudimentary, but there might be something to it, which means an added diagnostic tool for screening.”
“That sounds like yes,” Vadali said.
“Then yes—they’re the result of Memorine,” Habib said.
“And what do you think, Dr. Mavros?” Vidali asked.
“I’m being more open-minded, although the correlation is troublesome.”
“It’s more than troublesome,” Habib said. “I frankly think the drug is flawed, and we have to address that.”
“I don’t believe that for a moment,” Maloney said. “But even if that were true, these anomalies are more than compensated for by the patients’ extraordinary progress in cognition and daily functionality.”
Vadali and others in the room nodded in agreement.
Rene felt a battle line cut across the table like a seismic fault: GEM Tech reps and home administrators on one side; she, Peter Habib, one nurse, and Nick on the other. Jordan Carr had thus far not responded.
“The problem is that when patients get stuck in past experiences and become disruptive, they have to be medicated with antiseizures, antipsychotics, and sedatives that impede their mental recovery.” Rene looked toward the unit nurse, who concurred.
“How so?” Maloney asked.
“They’re doped down.”
“Our strategy here and at other sites,” Nick said, “is to try to come up with just the right dosages and combination of agents.”
Maloney kept his eyes on Rene, but she disregarded their heat. “My suggestion is that instead of simply addressing the events with antipsychotics and other meds, it might make sense to determine the nature of the connection, because I believe these flashback seizures are adverse reactions to the use of Memorine.”
Jordan cleared his voice. “If I may, and with all due respect, Peter, in patients with moderate-to-severe dementia, delusions that are related to post-traumatic stress disorders are not uncommon. And that’s what I believe we’re seeing here, since all these so-called flashback victims are patients within that population. Furthermore, according to nurses’ reports, since Mr. Martinetti was first treated with antipsychotic drugs he hasn’t had any sustained flashbacks.”
“That’s not exactly true,” Rene said. “He was lost in a closed loop, reexperiencing some horrible episode when he was a POW.”
An uneasy silence filled the room as she described the earlier episode.
Rene continued: “What bothers me is that according to his wife and daughter, Louis never suffered PTSD flashbacks before, and now he’s getting trapped in them.” She didn’t need to remind them that this flew in the face of the public perception of Memorine as a miracle cure and Louis as poster boy for GEM’s half-billion-dollar marketing campaign.
“I’m seeing the same thing,” Peter Habib said. “Patients getting caught in some dark past-time traumas. And nothing in their medical history shows they had suffered PTSD disorders.”
“But nothing in the reports in the earlier phases point to any such efficacy problem,” Maloney said. “So I think Dr. Carr is correct. But that’s not to say we shouldn’t continue monitoring patients’ behavior problems, et cetera.” And he offered a conciliatory smile.
“Well, that’s our intention.” And Nick outlined a plan to measure cognitive progress while trying to determine a medical, demographic, or even genetic cause to any flashback seizures.
