GRAY MATTER (19 page)
Authors: Gary Braver
G
reg met Joe Steiner at the Quarterdeck, a popular bar and restaurant in Falmouth center. Sitting with Joe was another man introduced as Lou Fournier, a neurologist from Cape Cod Medical Center.
reg met Joe Steiner at the Quarterdeck, a popular bar and restaurant in Falmouth center. Sitting with Joe was another man introduced as Lou Fournier, a neurologist from Cape Cod Medical Center.
“I think Lou might be able to give you a little more insight about your skull cases,” Joe had said. Greg didn’t have to be at work until seven, so they met at five-thirty. Joe knew Greg had been put on night shifts. He also was beginning to suspect that Greg might be on to something odd, although he didn’t know what. And that suspicion was why they were meeting.
Fournier was a man in his sixties with a round broad expressive face that made you think of Jonathan Winters. According to Joe, he had been chief neurologist in a hospital in Trenton, New Jersey, but had gone into semiretirement on the Cape. Joe had shown Fournier the photos of both sets of remains and the diagrams of the anonymous Essex Medical Center patient.
They ordered some beers. “I don’t know what I have,” Greg said. “It might all be a grand coincidence.”
“What does your instinct tell you?” Fournier asked.
“That the odds are against coincidence, that there’s some pattern, some connection.”
“I’m not sure, either,” Fournier said. “But I’d say your instinct is right on.” He laid the two skull photos side by side with the drawing of the Essex patient. “On the Sagamore Boy, you’ve got twenty-two holes all on the left side of the skull. On the Dixon boy, you’ve got nineteen holes on the left side of the skull. On this kid from the Essex Medical Center, his X rays show
eighteen holes on the left side. I think Dr. Budd is correct: The areas seem to map out interconnected circuits of the cerebral cortex that’s associated with intelligence and memory.”
eighteen holes on the left side. I think Dr. Budd is correct: The areas seem to map out interconnected circuits of the cerebral cortex that’s associated with intelligence and memory.”
Using his finger to illustrate, he continued. “This area here is the frontal lobe, or prefrontal cortex, and is important for planning behavior, attention, and memory. This other cluster is over the parietal lobe and is part of the ‘association cortex,’ known as Wernicke’s area.”
“Wernicke’s area?”
“Yes, the area of the brain associated with language and the complex functions of understanding. People with damage to this area suffer aphasia—they lose their ability to comprehend the meaning of words and can’t produce meaningful sentences.”
“What about these other holes?” Greg asked, pointing to seven around the ear area.
“That’s even more interesting,” Fournier said. “These cover what’s called Broca’s area, which is associated with the analysis of syntax and speech production. If someone experiences damage in the Broca’s area, they lose their ability to speak.”
“So you’re saying the holes cover the entire language center of the brain.”
“Yes, but it’s important to note that these same areas make important connections with many other areas of the brain involved with thinking abilities, conceptual skills, and memory.”
Greg nodded and sipped his beer.
“What do you know about this Essex patient?” Fournier asked Greg.
“Almost nothing—a male teenager from someplace on the North Shore, but that’s it.”
“Then you don’t know his handedness—whether he’s a righty or lefty.”
“No.”
“How about the Dixon boy?” He picked up the Dixon photo.
Greg thought for a moment. Grady’s first baseball glove. “Right-handed.”
Fournier nodded. “You’re sure?”
“Yeah. But why is that important?”
“I’m not sure, but more than ninety-five percent of right-handed males have language localization in the left hemisphere. Left-handers are bilateral, that is, they have language centers on both the right and left sides of the brain.”
“But the kid never had any kind of brain operation, his parents said. And I saw his medical records, and his pediatrician confirms.”
“I understand, but these holes are not random, so somebody did something to him. And these others.”
“Like what?”
Fournier took a sip of his beer. “These holes I’d say were made by stereotaxic drilling. It’s an alternative to removing large sections of the skull to reach target areas of the brain—a pinpoint-drilling procedure to remove lesions, abscesses, or tumorous tissue. Or to implant electrodes or radioactive seeds for killing tumors.
“The sheer number suggests mass intercranial lesions or multiple tumors—except the likelihood of survival for young kids is nil. Even with the most precise 3-D imaging, a surgeon can get lost trying to determine where a tumor ends and normal brain tissue begins. And in these areas, that means damage to important neurocircuitry, which could result in serious physical and emotional problems. So I’d rule out any orthodox neurological operation.
“The other possibility is radioactive seeding. But that’s not likely, either.” Fournier picked up the schematic of the Essex patient again. “This is what throws me the most. If this kid underwent extensive stereotaxic surgery, he’s either a walking miracle or he’s walking brain-dead.”
“The nurse said that he looked perfectly healthy and that he has a remarkable memory,” Greg said.
“Then something else is going on.”
“Like what?”
Fournier shook his head. “Some kind of exotic experiment, but nothing I’ve seen before,” Fournier said. Then he added, “But if these two kids are dead, and this one is walking around, you might want to look him up, because he’s making medical history.”
F
ine gray drizzle was falling the morning that Martin and Rachel met with Dr. Malenko. The air was unseasonably cool, making the day feel more like a morning in October than late June.
ine gray drizzle was falling the morning that Martin and Rachel met with Dr. Malenko. The air was unseasonably cool, making the day feel more like a morning in October than late June.
The appointment was set for noon. However, they did not meet at Nova Children’s Center. Instead they were directed to Malenko’s private office in Cobbsville, a small town just over the New Hampshire border, about a half hour drive from Hawthorne.
Martin was quiet on the drive over, commenting perfunctorily on the rain and scenery. If he was nervous, it did not show. If he was incredulous, he didn’t let on. He had lapsed into a mode of slightly irritated neutrality—irritated because he had to cancel a meeting in Boston with an important client.
Rachel disregarded Martin’s mood, too lost in her own vacillations between hopefulness and nagging anxiety. She had told Martin that she had consulted with Malenko last week, but didn’t go into details. All she said was that the doctor had agreed to meet with them both. About what she didn’t know.
Number 724 Cabot Street turned out to be a small nondescript ranchlike house with pale green aluminum siding and black shutters behind a hedge of mulberry. Except for the cherry-red Porsche with the gold Bernardi dealer’s decal in the driveway, Rachel would have thought they had the wrong place. No M.D.’s shingle hung outside, no name above the bell.
Malenko heard them pull up, because he opened the front door to greet them. He shook Martin’s hand. “Please come in.”
A small reception area had been carved out of a front parlor on the left, but no receptionist. In fact, from what Rachel could tell, no one else was in the house.
Malenko led them into a rear office furnished in leather and dark muted reds, greens, and gold. Bookcases lined two walls, full of medical tomes and technical journals. On a table beside some plants sat another elephant-god statue in tarnished brass.
“You
are
your son’s father,” Malenko said. “The resemblance is striking.” A school photograph of Dylan was included in the folder.
are
your son’s father,” Malenko said. “The resemblance is striking.” A school photograph of Dylan was included in the folder.
“Poor kid,” Martin joked.
“On the contrary,” Malenko said, and took his seat behind the desk.
The resemblance
was
uncanny, something everybody picked up on. It was as if Dylan were a miniclone of Martin, Rachel thought, his own Mini-Meas if she had passed nothing on to her son but a damaged brain.
was
uncanny, something everybody picked up on. It was as if Dylan were a miniclone of Martin, Rachel thought, his own Mini-Meas if she had passed nothing on to her son but a damaged brain.
“Well, now,” Malenko began, glancing into the folder before him. “When you came in here last week, Mrs. Whitman, you expressed interest in the center finding a program that would best be suited for Dylan.”
Rachel nodded, not knowing where this was going, but feeling her anxiety mount.
“As you know, we had him assessed with an expectation of designing a program tailored to his talents and needs. Because of his language-processing problems and memory lapses, we conducted a body of tests, both neurological and behavioral, including an EKG and MRI scan.”
Rachel felt her heart gulp as he pulled out a large envelope with MRI scans. She didn’t know if she could sit through another gruesome profile of her son’s disabilities.
“The results show that there are region-specific language problems that are associated with the regional-specific deficits in Dylan’s brain, not unlike those we see in patients with dyslexia. As you well know, Dylan has a tendency to overregularize verbs—saying
I singed, I
goed,
I knowed.
He also has problems with the use of other morphemes such as possessives and verb agreements. Instead of
the
cat’s paw,
he’ll say
the
cat
paw
. Or
she talk
instead of
she talks.
I singed, I
goed,
I knowed.
He also has problems with the use of other morphemes such as possessives and verb agreements. Instead of
the
cat’s paw,
he’ll say
the
cat
paw
. Or
she talk
instead of
she talks.
Rachel took a deep breath and swallowed it before it came out a groan.
“He also has problems with certain reasoning aspects associated with language—the use of the passive voice, subjunctives, and
if
clauses. He was asked the classic test in the field: Who did the biting when he heard the
statement
‘The
lion was bitten by the tiger.
’ His answer was the lion. He was not able to understand the causality. He heard
‘The
lion bit the
tiger.”’
if
clauses. He was asked the classic test in the field: Who did the biting when he heard the
statement
‘The
lion was bitten by the tiger.
’ His answer was the lion. He was not able to understand the causality. He heard
‘The
lion bit the
tiger.”’
Rachel put her hand to her brow as Malenko went to the light board and pointed out the anatomical disparities in Dylan’s brain for Martin. Her heart raced, and she bit down, trying to keep herself from spinning out of control.
“Jesus!” Martin said, as he listened. “The left looks smaller by a quarter.”
“Yes, at least,” said Malenko.
“But why?” Martin asked.
Rachel stiffened. If Malenko even faintly intimated that she had brought this on with drugs, she knew that she would explode.
“There are several possibilities,” Malenko began, “though none we can exactly determine. My best guess is that it’s a genetic aberration. Who knows? But that’s not the important thing. It’s what we can do for Dylan.”
Rachel caught Malenko’s eye as he sat down again. He must have detected the insane heat in her eyes because he addressed Martin. “Your son will have to have a comprehensive individualized instruction program geared to improving his word recognition and comprehension, grammar, reading, and critical-thinking skills.”
“How long a program are you talking about?”
“Typically, from seventy-five to a hundred hours of instruction, and up to four hours of instruction per week. But given Dylan’s assessment, I’d say he would need instruction on a daily basis for a hundred to two hundred hours. Maybe more.”
“God! It’s that bad?”
Malenko leaned back in his chair and for a brief moment studied Martin’s reaction. “Mr. Whitman, I’m sure you’re aware that no test can exactly measure a person’s intellectual ability, including standard IQ tests. I mean, how can a test assign a number to creativity or artistic skills or leadership, curiosity, musical talent or physical prowess or social skills, emotional wellbeing, and so on? It’s impossible. However, the composite IQ score measures verbal and logical thinking, which is the best overall predictor we have of educational achievement and success.
“Your son’s intelligence quotient falls in a range of seventy-nine to eighty-four which is the low side of the national average. He needs special attention.”
“So it’s not just some attention-deficit thing that can be treated with medication?”
“I’m afraid not.”
“Jesus,” Martin said. “Maybe it was some lead paint he was exposed to. Or mercury or some other crap. I don’t get it. We’ve got lawyers and engineers on both sides of the family. How the hell …” And he tapered off.
“How it happened isn’t the issue, Mr. Whitman. There are people with less intellectual talent than Dylan who are happy and productive members of our society.”
“Yeah? Name me one.”
Rachel shot a look at Martin.
Martin turned to her. “What?”
“Stop
it!
”
it!
”
“Stop what? He’s handicapped and I can’t accept that. Okay?”
Rachel knew it was totally irrational, but all the outrage, despair, and vexation that was racking her soul converged like rays in a magnifying glass on Martin’s face. And at the moment she hated him. He was condemning their son to a life on the margins.
Malenko cut in. “I can’t name names just like that. But you know what I mean—sports people, entertainers, actors, musicians, singers—people in the various trades, business people who surely would qualify.”
Martin made a cynical grunt.
“Mr. Whitman, your son is a charming and handsome little boy with a lovely voice, I understand. Who knows, he may grow up to be the next Luciano Pavarotti or Frank Sinatra.”
“Hmm,” Martin said, feeling Rachel’s eyes burning him.
To break the tension, Malenko said to Martin, “Let me ask you a question. You know something about the different programs we have, and you know your son’s potentials and limitations. Given all that, what exactly are your expectations for Dylan?”
“My expectations? I don’t follow you.”
“What would you like for Dylan?”
“I would like him to have more of a head start on life.”
“And you, Mrs. Whitman? Do you feel the same way?”
Rachel took another deep breath to steady herself. “I’m not sure I understand the question.” She could hear the deadness in her voice.
“That you would like for Dylan to have more of a head start on life?”
Still not certain she understood him, she said, “I suppose.” Tears began to fill her eyes. She felt as if she were dying inside. All she wanted to do was to go home.
“Good, because that’s what we intend to give him—the chance to live up to his abilities.”
“That’s not what I mean,” Martin said.
“Then what do you mean, sir?”
“Even if we sign him up for the best tutoring—”
“Instruction,” Malenko insisted, cutting him off. “Not tutorial. There’s a big difference.”
“Okay, instruction. Even with the best people you have, he’s got an eighty IQ. That wouldn’t be an issue if this were the eighteenth or nineteenth century. You didn’t have to be very bright to make it. But it’s the twenty-first century, and the brightest people occupy the highest-powered professions. Simple as that. The best instruction you can come up with won’t raise his capabilities.”
“No, but we may get him to work at his best. What more can you ask for? Your son is not retarded or autistic.”
“No, but he’s the low side of average. Just how far can that take him? It’s like asking him to run a race with a club foot.”
There was a humming pause for a few seconds. Rachel began to cry.
“Well, what exactly do you want of him?” she heard Malenko ask.
“I want him to be smarter.”
“But, surely, being smart isn’t the only measure of people.”
“No, but it will get you places.”
Rachel cried into her handkerchief while Martin’s and Malenko’s voices blurred like white noise. They seemed not to notice.
“Like his mom and dad.”
“What’s that supposed to mean?”
“I’m just wondering whom you are here for, Mr. Whitman: Dylan or yourself. I seem to be hearing less about what we can do for Dylan and more about reducing your dissatisfaction with your child.”
“I beg your pardon, Doctor, but I love my child very much.” Martin’s face was flushed.
“Your love is not in question, Mr. Whitman. But what I’m hearing is that you don’t have the child you wish you had—a child who would grow to
share your intellectual, cultural, and aesthetic interests. A child who will be your equal someday, not an inferior.”
share your intellectual, cultural, and aesthetic interests. A child who will be your equal someday, not an inferior.”
Martin’s eye twitched, and Rachel half-expected him to flash back at Malenko. But something in Malenko’s manner extinguished whatever impulse Martin felt. “I’m here for Dylan,” he said flatly. “I just wish he could have the opportunities other kids have.”
“What other kids?”
“Other kids in his school and play groups,” Martin said. “You know what I mean. Kids who aren’t intellectually handicapped. You’re saying that our son has a serious brain deficiency that’s crippled his verbal skills. We live in a heavily writing-dependent society, which means that he’ll be targeted as somebody who’s dumb.”
Rachel got up.
“What’s the matter?” Martin asked.
“I’m leaving. You can stay, but I’m going.” She started toward the door.
Malenko rose to his feet. “Please, please. Let’s all calm down.”
“I am calm,” she said, barely able to disguise her emotions. She began to open the door when Malenko came over to her and took her arm.
“Please, sit down. I’ll call Marie to bring in some coffee.”
“I don’t want coffee,” Rachel said. “I want to go.”
Something in Malenko’s expression gave her pause. “I think there’s more to discuss. Please.” And he beckoned for her to return to her seat.
Martin was on his feet looking at them both wide-eyed.
Rachel felt herself consent. But with tears rolling down her cheeks, and her voice trembling, she said, “I don’t want to hear any more about how my son is intellectually handicapped. Okay? Or how he’s not going to make it in life.” She glared at Martin.
“Yeah, sure,” Martin said feebly.
She took a deep breath, and in as steady a voice as she could muster, she announced, “I want to discuss an instructional program for him. Period.”
Malenko nodded, and led her back to her seat.
An uncanny silence fell on the room, as he seemed to turn something over in his head. He then picked up the phone and called the secretary to bring in three coffees.
They sat in an uneasy silence as the coffee was delivered.
Rachel sipped from her cup and stared blankly at the floor. All the swirling eddies of emotions had receded to the rear of her mind leaving her at the moment feeling dead. She could register Martin’s presence beside her and Malenko’s behind his desk. But it was as if she were occupying that quasiconscious state in dreams.
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