PROLOGUE“I’m afraid I have some bad news.”Hayley Long, just two weeks past her fi fty- fi rst birthday, heard herphysician’s words as if they were being spoken through a long steeltube.I’m afraid I have some bad news. . . .
She wondered fl eetingly how many thousands of people heard thesame thing from their doctor every day? How many patients everyhour, maybe every minute, rode those words screeching through asudden right- angle turn in their lives.I’m afraid . . .
Stephen Bibby, a graduate of Emory Med, had been her physiciansince a bout of pneumonia twenty or so years ago. He was a manHayley respected, if for no other reason than that Bibby knew hislimitations and never hesitated to make a phone call and arrange aspecialist referral for a second opinion.Hayley felt a wave of nausea sweep over her, and thought for a momentshe was going to have to excuse herself to go and get sick evenbefore she found out precisely what she was up against. She made alargely unsuccessful attempt at a calming breath, and tried to maintainan even gaze.“It’s cancer?”Hayley heard the word in her own voice, but couldn’t believe shehad actually uttered it. Her thoughts wouldn’t stay still.Cancer
. . . How could that be? . . . Oh, God, no.
Her initial symptom had been nothing more than an annoying sequenceof belly pain and gas. She almost hadn’t even bothered tomention them to her executive assistant. He was the one who hadtalked her into calling Bibby. It was his fault.The MRI Bibby had requested was of her abdomen.Cancer.
The dizziness and nausea intensifi ed.David didn’t handle illness at all well, in himself or others, but atsome point she would have to tell him. Not yet, though. Not until allthe data were in. He was off skippering his boat in a round- the- worldrace—his lifetime dream. He had lost his fi rst wife to a brain aneurysm,and had waited more than ten years before marrying again.Now this.She had to tell him soon, but not yet.Bibby, a Southern gentleman in his early sixties, looked towardthe door as if hoping that another doctor would march into the offi ceand take over.“I asked, is it cancer?”Biting at his lip, the physician nodded.“Operable?” she asked.Come on, Stephen! Help me out here!
“I . . . I don’t know. It looks to have started in your pancreas.That’s the organ which—”“I know what the pancreas is. I hear Jimmy Carter talking aboutpancreatic cancer every time I turn on the damn TV. Has it spread?”“It’s . . . it appears
to be in some places in your liver.”Bibby turned on his computer with a click of his mouse and rotatedit so Hayley could see. A child could have picked out the cancerin her MRI—an obscene white mass, dead center in her belly. Deadcenter
. How ironic that her mind’s default for something in the middlewould have been those words.Please let this be a dream. Please let it be a fucking dream
.Hayley rubbed at her eyes as if trying to paw away the disbelief. Atfi fty, she had everything she could ever have wanted—marriage to awonderful, caring man; stepchildren who treated her like their birthmother; more money and infl uence than most people could evendream of; and a perspective on life that made everything make sense.Now this.Pancreatic cancer . . . Inoperable . . . God, don’t let it be,
Hayley Longthought desperately. Let it be a dream. . . . Let it be nothing but abad dream.Petros Sperelakis’s awareness returned gradually and spasmodically.The pain came fi rst—a dull throbbing in his groin and burning sensationin his low back. He tried to move, to shift his position, but hisbody did not respond.Please, I don’t think I can move. Someone please help me. I’m Sperelakis,Dr. Petros Sperelakis. I can’t see and I can’t move.
“Connie, why don’t you take a break. I’ll be here for anotherhour.”“Okay, thanks. Listen, Vernice, he could use some range- of- motionwork on his wrists and ankles.”Connie? Vernice? I can hear you. I can hear you. Are you Beaumont nurses?It’s me, Dr. Sperelakis. What do you mean, range of motion? Am I paralyzed?What happened to me? An accident? A stroke? A tumor? Why can’t I see? Whycan’t I speak?
The man many considered to be among the premier diagnosticphysicians in the world struggled to make sense of his own symptoms.He knew he was having diffi culty holding on to a thought, andthat fact frightened him more than almost anything.Why am I in such pain? Can someone please tell me what happened? Whathappened to me? I can feel that, Vernice. I can feel you moving my ankle. Oh,my God. . . .
CHAPTER 1Multiple contusions and abrasions . . . Fractured pelvis . . . Nondisplacedfracture, proximal humerus . . . Pulmonary contusion and laceration secondaryto posterior displaced fractures of right seventh, eighth, and ninthribs . . .
With the grim litany ticking through her thoughts, Thea Sperelakisapproached Cubicle 4 in the medical ICU of the BeaumontClinic.Transverse linear skull fracture . . . Extensive mid– brain stem hemorrhage
. . .Level I coma . . .Thea hesitated, envisioning what her father would look like andknowing that, as an internal medicine specialist herself, her projectionwould not be far from on the mark. According to her brotherNiko, police estimated that the vehicle that struck their father at fi vethirty in the early morning eight days ago, then drove away, had tohave been traveling seventy, at least. It was a miracle he had survivedthe impact, which threw him more than twenty- fi ve feet. But then,for as long as Thea could remember, Petros Sperelakis was, to hischildren, the Lion—aloof, powerful, and brilliant, often to the pointof majesty.The Lion
.The absence of skid marks suggested that the driver never saw hisvictim. Make that his or her
victim, Thea edited, intent on enforcingthat sort of accuracy, even in her thoughts. The police still had noclues and no witnesses.Alcohol, she guessed. According to an article by Eileen Posnick ina seven- year- old issue of the American Journal of Drug and Alcohol Abuse,
alcohol was involved in more than 90 percent of hit- and- run accidentswhere the drivers were eventually apprehended.Behind her, Niko stepped out from the group that included histwin, Selene, plus a trio of Beaumont Clinic dignitaries, and tookThea’s arm. He was swarthy and broad- shouldered, with their father’sstrong nose and piercing dark eyes, but with features that weresomewhat softer. At forty, he was already an associate professor ofcardiac surgery at Harvard—a wunderkind, with several signifi cantcontributions to the fi eld. Selene, exotic, elegant, and totally selfassured,was no less accomplished as a hand surgeon.“You okay, Thea?” Niko asked softly.As she had been taught to do, Thea searched her feelings beforeresponding. Her father, bigger than life itself, was in a deep comafrom which there was a 0.01 percent chance he would recover evenminimal function—at least according to the retrospective study oftraumatic midbrain hemorrhages published by Harkinson et al. in theAmerican Archives of Neurology,
volume 117, page 158. One in ten thousand,not counting the ribs and other fractures.Poor Dad.
“I’m okay,” she replied.“Want to go in alone?”Why would I want to do that?
she wondered, shaking her head.Would their father be any less comatose if she saw him by herself?She shrugged that it made no diff erence, but sensed she could havecome up with a more acceptable response.“Suit yourself,” Niko said in a tone that was quite familiar to her.Thea knew her brother cared about her—Selene, too. She alsoknew that the twins had always thought she was odd, though certainly
not as odd as their oldest sibling, Dimitri. But their attitude, asemphasized over and over by Thea’s longtime therapist and mentor,Dr. Paige Carpenter, was their problem.One in ten thousand . . . Poor Dad
.Thea ran her fi ngers through her short chestnut hair, took a singledeep breath, and stepped through the doorway.As anticipated, there were no surprises. Legendary Petros Sperelakis,medical director of the Sperelakis Institute for DiagnosticMedicine, lay motionless—the central fi gure in a tableau of medicalmachines. Across the room, his private duty nurse (Haitian, Theaguessed) rose and introduced herself as Vernice.“I have heard a great deal about you, Dr. Thea,” she said. “I hopeyour fl ight was an easy one.”“I just read,” Thea said, taking the husky woman’s smooth, amplehand.I just read
.It was, Thea knew, the most resounding of understatements. Duringthe twenty- hour series of fl ights and layovers from the DemocraticRepublic of the Congo to Boston, she had read Don Quixote,
thesecond edition of Deadman’s A Manual of Acu punc ture
(for the secondtime), and Darwin’s Voyage of the
Beagle—more than sixteen hundredpages in all. She would have made the trip home sooner, but shewas on a mission moving from refugee camp to camp in the bushwith a team of nutritionists, and simply couldn’t be reached.“There’s been no change,” Vernice said.“I’d be most surprised if there were. He has taken a severebeating—especially to his head.”Thea approached the bedside, instinctively checking the monitorsand intravenous infusions. Petros lay quite peacefully, connected viaa tracheotomy tube to a state- of- the- art ventilator. The variousMedecins Sans Frontières (Doctors Without Borders) hospitals towhich Thea had been assigned over the past fi ve years had been reasonablywell equipped, but nothing like this place.The Beaumont, as nearly everyone referred to the institution, wasa sprawling campus, the size of a small university, consisting of whathad once been Boston Metropolitan Hospital, now augmented bytwo dozen more buildings, varying widely in architectural style. Thebuildings were linked by tree- lined sidewalks above, and an intricatemaze of tunnels below, some with moving walkways and others withtarnished tile walls, leading in places to stairways that went down fortwo or three damp stories, and dating back to Metro’s earliest daysin the mid- nineteenth century.Oxygen saturation . . . arterial blood pressure . . . cerebrospinalfl uid pressure . . . central venous pressure . . . urine output . . .chest tube drainage . . . cardiac rhythm and ECG pattern . . .Thea took in the complex data and pro cessed them as if they werea grade- school primer. Steady. Everything was nice and steady. Atthe moment, the fi erce battle for the life of Petros Sperelakis was beingfought at a cellular and even subcellular level. And his youn gestoff spring, cursed by him when she made the decision to avoid academicmedicine and “give her ser vices away,” to third- world countries,pictured the microscopic confl ict clearly in her mind’s eye.At best it would probably be weeks before the man regained anyconsciousness. Along the way, his system would have to negotiate aminefi eld of infections, blood clots, kidney stones, embolisms, ce rebralswelling, chemical imbalance, intestinal obstructions, and cardiacevents. But in this setting, with this equipment, he would atleast have a fi ghting chance. Still, from what Thea knew of her father,if it were his choice, it was doubtful he would try very hard to steerclear of the mines.She took the man’s hand and held it for a time. It had been onlyeight days since the accident, but his muscle mass was already beginning
to waste away. In addition to the trach, he had a gastric feedingtube in place, two IVs, a urinary catheter, which was draining brisklyinto a collection bag, and a BOLT pressure manometer that passedthrough his skull and into the spinal fl uid–containing ventricle of hisbrain. His eyelids were paper- taped down to protect his corneasfrom drying out, and splints on his wrists and ankles were strappedin place to prevent joint contractures, against the remote possibilityof a return of function.Petros Sperelakis—an icon brought down by a driver who was eitherin an alcoholic blackout or was aware enough to try and get awaybefore anyone showed up. Never had Thea’s father looked even remotelyvulnerable to her. Now, he looked frail and pathetically infantile.Thea sensed that she was expected to stay at the bedside a bit longer,and she planned to be there as much as possible in the days tocome. But she had slept little if any on the planes, and the exhaustionof the fl ights was beginning to take hold. Fifteen minutes, she decided.Fifteen more minutes would be enough to stay at the bedsidewhether the others thought so or not.Niko had invited her to stay at his house, but three kids under ten,much as she loved them, provided more commotion than she couldhandle.Selene and her partner, a banker or businesswoman of some kind,lived in a designer high- rise condo by the harbor.The obvious choice was the spacious Wellesley home in which sheand the others had grown up, and where Petros still lived with theghost of their mother and with Dimitri who, many years before, hadmoved into the carriage house along with his computers, his monitors,his shortwave radio, his telescope, his machinery, his library ofmanga, graphic novels, and Dungeons and Dragons manuals, and hisvast collection of Coca- Cola and Star Wars memorabilia.It would be good to see her brother again for many reasons, notthe least of which was that of all those in her family, he was the oneshe related to the most—something of a mirror of what she mighthave been like had she not had the benefi t of early diagnosis, intervention,and extensive behavior modifi cation therapy.From her early childhood, Thea had memories of the family talkingabout Dimitri’s aloofness and strange behaviors—his lack offriends, off beat humor, and often- inappropriate statements. Physicalage, twelve years ahead of her. Emotional age, inconsistent and unpredictable.“Dimitri, this is Robert, your new piano teacher.”“Oh, hello. When’s the last time you went to the dentist?”
She would never know the bulk of what the family said to one anotherabout her, but she also knew that the choices she had made,with Dr. Carpenter’s help, were the right ones for her, and ultimately,for her patients. Keeping her life as uncomplicated as possible,she had learned, was not only a pathway to happiness, it washer roadmap to survival. If there was any single word that did not
applyto Petros Sperelakis, it was uncomplicated.Born and raised in Athens until his late teens, Petros was strictlyOld Country in his attitudes and philosophy—a brilliant physician asdedicated to his calling and his patients as he was hard on his family.Verbal chastisement and high expectations were his weapons, as wellas his only means of expressing love. His wife, Eleni, had rebelledagainst him in one way and one way only, by continuing to smokecigarettes despite his vehement edicts that she stop. The lung cancerthat took her did nothing to soften Petros, and virtually every mentionof her by him was followed by the impotent plea: “If she had onlylistened to me . . . If only she had listened.”Thea reached between the tubes and brushed some damp, grayhair from her father’s brow. The sadness she was feeling at seeinghim in such a state was, she knew, as much learned as it was deepseated
and visceral. But she also knew that it was still as real an emotionas those of her two “neurotypical” siblings.From the beginning, Petros could never understand her shyness,or the severe reactions she had to certain noises—especially vacuumcleaners and hair dryers—as well as to certain foods, and diff erenttextures of clothing. When she was twelve, pressured by Eleni thatshe was seeming more and more like Dimitri in her lack of friendsand her pathological obsessions, especially with books of all kinds,Petros consented to allow his wife to bring her to Dr. Carpenter. Itwas Carpenter who subsequently suggested that Thea was exhibitingmany of the symptoms associated with the condition called Aspergersyndrome.The decision to allow his younger daughter to undergo neuropsychiatrictesting and therapy did not come easily to Petros. In thelexicon of his life, there was no such word as can’t
and no such conceptas psychotherapy. If he had any weakness at all as a diagnostician,it was in the area of psychosomatic illness and the mind- bodyconnection.“I think he’s comfortable,” Vernice ventured from across the bed.“I’m sure he is,” Thea replied, managing with some diffi culty toswallow her belief that if Petros was feeling anything, then he wascertainly not comfortable, and if he was feeling nothing at all, thentrying to equate that void with comfort was a stretch.“Your brother Dimitri said that if your father was in as deep acoma as he appears to be, it was a futile exercise to wonder if he wascomfortable or not.”“Sometimes, Dimitri says things just for the shock eff ect,” Theareplied, smiling inwardly at the number of times and situations inwhich her eccentric sibling had done just that. Vernice had gotten offrelatively easily.“Well,” the nurse said, “at least we have the comfort of knowingthat Dr. S. is being taken care of in the greatest hospital in theworld.”“Yes,” Thea said, wondering where Vernice, and Newsweek,
and thecountless others who believed as she did about the Beaumont, couldhave gotten such quantifi cation about something so unquantifi able.at virtually the same instant, in the Susan and Clyde Terry CancerCenter, on the far side of the broad campus of the so- called greatesthospital in the world, the treatment nurse was doing her job,injecting a cutting- edge experimental drug into the central IV portof a burly man named Jeff rey Fagone.Fagone, a trucking magnate from western Pennsylvania, had hisrapid accumulation of wealth interrupted by an unusual variant ofthe blood cancer known as Waldenstrom’s macroglobulinemia. Hispresenting symptom had been lower-back pain. The referral by his primarycare doctor had been to the expert in the disease at the Beaumont,where Fagone went yearly for his fi ve- day spa pampering andexecutive medical checkup. Now, he was part of a cutting- edge treatmentprotocol—the sort of protocol that the doctors at the Beaumontwere renowned for establishing.Fagone fl ew up to the Terry Center weekly on his GulfstreamG500 corporate jet. Now he was about to receive the third in a seriesof ten treatments. The fi rst two had been absolutely uneventful.This injection, however, would be diff erent.The vial from which the medication was drawn had been skillfullyswitched during its journey from the research pharmacy to the cancercenter. The new vial, with the same ID number as the old one, nowcontained enough concentrated bee venom to turn Fagone’s bee stingallergy, duly noted in his medical record, into an anaphylacticreaction—a fearsome medical emergency, equivalent to the Fourth
of July fi reworks on the Charles River Esplanade.The eruption did not take long to begin. The fi rst few molecules ofthe venom instantly began mobilizing mast cells from all overFagone’s body. The cells released huge amounts of histamine andother sensitivity chemicals. More venom, more mast cells, more histamine.In less than a minute, Fagone’s tongue, cardinal red, hadswollen to the size of a golf ball, and his lips to violet sausages. Themuscles in the walls of his bronchial tubes went into vicious spasm.Seconds after that, his larynx, also in spasm, closed off altogether.His entire body became scarlet, and his fi ngers became nothing morethan nubs protruding from softball- sized hands.The team in the Terry unit acted quickly, bringing out a stretcherand hoisting the two- hundred- and- seventy- pound former teamsteronto it, then wheeling him to an area that could be screened off fromother patients.But they were paddling against a medical tsunami.The IV port was available, but the oncologist covering the unit, ayoung woman less than half Fagone’s size, was not skilled in dealingwith emergencies of this magnitude. By the time she got the rightmedications into the man, Fagone’s blood pressure had been zerofor nearly three minutes. By the time she gave up trying to force anendotracheal breathing tube past the massively swollen, distortedvocal cords, and began clumsily performing her fi rst emergency tracheotomywhile waiting for the ENT surgeon to answer his page,there had been no eff ective respirations for four minutes. She hadjust sliced a scalpel across her patient’s massive throat when hisheart stopped. The blood fl owing from the gaping laceration wasgentian.When the oncologist, frustrated and utterly demoralized, calledoff the resuscitation at the ten- minute mark, a useful airway had stillnot been established.Jeff rey Fagone, who years before had survived two assassinationattempts during his rise to wealth and power in the TeamstersUnion, had no chance of surviving this one.Unlike the other attempts, however, there was no suspicion ofanything sinister at work here. Fagone had been done in by a lethalallergic reaction to Waldenstrom’s macroglobulinemia experimentaldrug #BW1745. No one present that day thought otherwise. Therewould be no analysis of the contents of the vial, and the perfunctoryautopsy performed the next morning would disclose nothing out ofthe ordinary.The treatment protocol for #BW1745 would be suspended indefi -nitely, but within just a few months, the principal investigator, supportedby a hefty grant from one of the pharmaceutical giants, wouldroll out another experimental drug to meet the demand of referralsfrom all over the world.The Susan and Clyde Terry Cancer Center closed for cleanup andstaff support for an hour after the tragic event, but there were patientsto treat, many of whom had come from even greater distancesthan Jeff rey Fagone.Soon, like the surface of a pond disturbed by a jumping fish, theripples had subsided, and the world’s greatest hospital had gone backto being the world’s greatest hospital.