Second Opinion (17 page)

CHAPTER 30

Thea crouched beneath the conference table on the plush Oriental rug in Lydia Thibideau's office, listening to the pounding of her own heart. Beside her were the two flashlights, the camera, the notebook, the two-way radio, and twenty-five or so patient records including Hayley's and Jack Kalishar's.

There were, by Thea's estimate, five hundred files altogether in the four drawers of Thibideau's cabinet, all of them, it seemed, patients with cancer of the pancreas, none of them, from what she could tell, any less recent than six years ago. They were arranged in alphabetical order, not by date. The patients' records dating back from six years were probably in cartons in some storage area. Given the mortality of pancreatic malignancy, few of them, if any, were likely to be alive today.

Earlier in the day, spurred by Julian Fang's remarkable pronouncement, Thea had researched the prevalence and lethalness of various types of cancers. The results relative to cancer of the pancreas were not encouraging. In the past year, 215,000 new cases of lung cancer had been reported in this country, and 160,000 patients were estimated to have died from the condition over the same period—74 percent. Bad disease. On the more sanguine side, the number of deaths from thyroid cancer (1,590) was 4 percent of the number of new cases diagnosed (37,300), down from 6 percent the year before. Conclusion: The number of thyroid cancer survivors was growing steadily.

The number of new cases each year of pancreatic cancer was almost identical to thyroid (37,700), but there had been 34,200 reported deaths (90 percent) over the same period, and 90 percent the year before. More data were needed to form any definitive conclusions, but the results implied that there had been little progress in the treatment of the disease.

Jack Kalishar had cancer of the pancreas. Of that there could be no doubt. From what Thea had learned of Hayley's disease, Kalishar's was quite a bit less far advanced at the time of diagnosis six years ago, but cancer of the pancreas was still cancer of the pancreas, and 90 percent was still 90 percent. Kalishar had been a healthy, robust man with a negative medical history, followed yearly in the Executive Health Evaluation program of the Beaumont. His MRI was difficult to read without using the four fluorescent view boxes fixed to a wall in Thibideau's office, so Thea decided to chance standing up and turning the box on for just a few seconds at a time.

Her father had made the diagnosis on Kalishar based on the MRI taken during a routine executive physical. The subsequent needle biopsy was reported as showing adenocarcinoma—the most common form of the cancer. It was Petros who had made the referral to Thi-bideau. It was she who had entered Kalishar in the treatment protocol evaluating the then new drug SU890. There were a few documents related to the study—mostly permissions signed by Kalishar validating that he was aware of the experimental nature of his treatment and knew the risks, but most of the paperwork was either in storage someplace or simply on the Internet.

There were no slides showing the pathology, and no further notes of interest, except one. It was a three-year-old thank-you to Kalishar from Director of Development Scott Hartnett—a straightforward and businesslike acknowledgement of a donation to the Beaumont Clinic in general and to the establishment of the Lydia Thibideau Gastroenterology Research Center in particular. The amount of the donation was not mentioned, but written on the side of the note in a feminine hand—perhaps Thibideau's, Thea thought—was the figure
$200,000,000.
Two hundred million dollars!

Thea checked the time and knew that she had to move faster, and in a more organized fashion. Sean Flowers had put a limit on her investigation of one hour. Longer, and they would be risking discovery even more than they already were. She decided to check records, starting with Hayley's, for half an hour, and then to begin taking photographs of anything that looked interesting. She realized now that she should have been better prepared, but it was too late for that.

Hayley Long's chart told of an MRI done in Atlanta for vague abdominal pain and showing pancreatic cancer just ten months after a similar MRI, done at the Beaumont, was normal. Crawling out from under the table, Thea snapped the two films side by side onto the view box. The initial film done as part of the Executive Health Evaluation program was normal—absolutely negative except for faint white calcium deposits in three abdominal lymph nodes, probably the result of some long-ago infection. The finding was so minuscule and unimportant that the radiologist who had read the film either had missed it altogether or hadn't bothered to mention it in his report. But Thea's life was all about details.

She was studying the extensive cancer in Hayley's more recent film, and wondering how Julian Fang could possibly say that such a cancer had been cured after less than two weeks of treatment, when her eyes were drawn back to the original film. The calcified nodes in that one were not present in the more recent MRI. Thea stepped back, then moved in close. There were a few even more minuscule differences in the two films—the shape of a vertebral wing here, the density of a rib cartilage there. Both subjects were women of about the same age, but they were not the same woman. Thea felt virtually certain of it.

Stunned, she sank down onto the rug, staring up at the films as if they were saucers from Mars, trying to make sense of what she was seeing, to sort out what she should do next. Five minutes passed. When she finally stood up, the approach she had been missing was clear to her.

She took the notebook and drew the rough outline of a pancreas on a dozen consecutive pages. Then she replaced all the records except Hayley's and Kalishar's, randomly chose patients from each of the four drawers in the filing cabinet, and went directly to the MRIs of each, quickly mapping their cancers. Half an hour later she had recorded twenty-five patients and had found nothing. With the twenty-sixth, she struck gold.

The patient's name was Samuel Blackman, a fifty-four-year-old computer wizard who had parlayed a software invention into a fortune. The pattern of the cancer in his MRI was an identical match for the cancer in another of Lydia Thibideau's patients, this one named Warren Grigsby. The two men, wildly successful, had both been patients of the Beaumont executive health program. Both were diagnosed with pancreatic cancer, only four years apart. The difference was that Grigsby never left the hospital alive. On his tenth day of treatment with the same drug as Hayley was receiving, SU990, he suffered a cardiac arrest and essentially died before the Code Blue team could be mobilized.

Blackman was a completely different story. Like Jack Kalishar, he had survived his devastating diagnosis, and like Kalishar he had the copy of a letter of gratitude from Scott Hartnett in his record. Again, there was no mention in Hartnett's letter of the amount donated other than to call it 'gracious,' but this time there was no note of the amount from Thibideau either.

What did it all mean? What had happened to Grigsby? At that moment, the questions defied answers. But Thea strongly suspected that if she had enough time and mapped enough charts, somewhere in there was at least one, and maybe even more than one cancer identically matching the cancer in Hayley's MRI.

The betting now was that Julian Fang's diagnosis was true. Hayley Long was cancer-free. But the reason for her fantastic cure was probably not her treatment or her genes or her powerful constitution or her
Qi.
The reason, in all likelihood, was that she had never had cancer in the first place.

But how could that be?

At that instant, Thea was startled by the two-way radio.

'Thea, get out, get out!' Flowers cried. 'They're here. They may not know where you are yet. Use the stairs! Use the stairs! Over!'

Thea raced through the lab to the window and, staying low, peered down. Three uniformed security people were closing in on the truck. Flowers had already climbed down from the cab. She watched as he hesitated, taking in the situation. Then he bolted down the walkway in the opposite direction from the guards. The three of them yelled something at him and took off in pursuit, but Flowers had a significant head start, and from what Thea knew, none of the hospital security force carried guns.

CHAPTER 31

Thea often described herself as a plodder, not a thoroughbred. Faced with a medical crisis, her reaction time and decision making were usually reasonable enough, but seldom extraordinary and never flashy. She almost always was able to move along at the pace demanded by the situation, but she was at her best when there was time to think such situations through. On the other hand, she was seldom prone to the mistakes of haste.

Now, with the urgent radio call from Sean Flowers, she was experiencing an emotion that was quite foreign to her. Panic. First, she was on her knees, stuffing all of her supplies into the knapsack. Then she was sweeping all the charts together like oversized playing cards, slipping X-rays back into their folders as fast as she could, and then trying, with little success, to replace the charts in the filing cabinet in alphabetical order. Twice she dropped records, mixing up the contents. Finally, she simply jammed the remaining charts into the drawer, paying no attention to where they had come from. Moments later, she inadvertently knocked a clamshell full of paper clips and coins off the corner of Thibideau's desk. In scrambling to pick them up, she slammed her head so hard that she had to stop and check for blood.

The stairs! Get to the stairs!

Thea surveyed Thibideau's office and could see nothing out of place. Of course, Flowers had cut away half of one of the windows in the laboratory—a reasonably strong clue that someone had been inside. Her mouth was desert dry. Her heart and her thoughts refused to slow.

What would happen if they caught her?… Surely she would be kicked off the staff even before she had begun… When word got out, would she have put herself in even more danger from whoever had attacked her?… What about Petros?… If she got caught, would he become a more urgent target?…

Hayley!

Thea was on her way out of Thibideau's inner office when she remembered that she had decided to take Hayley's MRIs with her. In her rush to straighten out the charts, she had put the films back. Did she have time to look?… Had they caught Flowers?… What was the penalty for breaking and entering?… She could never be locked up. Never!… She would leave the country first—forever… Would they even let her back in Doctors Without Borders if she was, running from this kind of trouble?… She had been living such a mellow, uncomplicated existence… How did this happen?

Thea braced against the file cabinet and willed herself to settle down.

Where did I put Hayley's record? Breathe in
… breathe out… Easy does it… Easy… Come on! You know how to do this… Get ahold of yourself…

After a minute or two she was able to focus enough to make a decent guess. The record was one of those she had put back in some degree of alphabetical order in the second drawer down.

Yes!

She snatched the two films from Hayley's file. Each one was about nine inches by twelve. Carrying them loosely rolled in one hand, she rushed down the glassed-in corridor separating the clinical area from the laboratory. She had entered the tastefully appointed waiting room, where not that long ago she had enjoyed such vivid fantasies of Dan, when she heard men's voices from just outside the door.

'Is this the floor where the window is out?'

'That's what Kim said. Fifth floor, Dr. Thibideau's office and lab.'

'She going to call the police?'

'I think she already did.'

Thea stumbled backward into the hallway, casting about from one side to the other for someplace to hide. The exam rooms were small, and the conference rooms and Thibideau's office offered nothing. It had to be the laboratory—a large area, covering two-thirds of the entire floor, busy with the workbenches, glassware, and complex electronic equipment of basic science research. She could duck behind a counter and wait for the right moment to bolt—or perhaps sneak—down the hallway and through the waiting area to the stairs. She had never been a very fast runner, but the notion of what was in store should she get caught was flooding her body with adrenaline.

Keeping low, she entered the research center and prowled from one row of workstations to the next, searching for one that looked more inconspicuous than the others.

One that looked more inconspicuous than the others
… Thea almost laughed out loud at the absurd notion. She heard the voices enter the office and ducked down where she was, as far toward the rear of the lab as possible. Somehow, there had to be a moment when she could move forward along the cluttered workbenches back toward the waiting room.

The voices grew louder. Three people, maybe four, including one woman. Thea knew that surprise was the only element in her favor. She crawled ten feet in the direction of the waiting room. There was no choice but to make a dash for the staircase—at least to try—and soon. Realistically, though, she knew there was still too great a distance to the door and the stairs.

She glanced down at her knapsack and the two MRIs. It was going to be even more difficult trying to make it out of the lab carrying them. Perhaps her best chance was to leave them behind inside one of the cabinets, and to come back for them later on. Even if she got caught and was arrested, the twins would help her get a good lawyer, and she would get out of jail before too long. It wasn't as if she had hurt or killed anyone. If nobody needed anything from the cabinet she chose, there was no telling how long the knapsack and films might stay there undisturbed.

The voices were getting louder, and Thea felt certain at least one person had entered the lab area. Slowly, fearing the hinges were going to squeal, she eased open the door beneath the slate-covered workbench next to her. There was no sound, the movement of the door was quite smooth, and in fact, she realized, the construction smelled new. But even more interesting to Thea was that the cabinet was empty—completely empty. In fact, peering in she could see that the space next to it was empty, too.

There was some electronic equipment on top of the workbench, but it looked as if no scientist had been assigned to this area. If that were so, not only could the knapsack remain there undiscovered, but with a little maneuvering, perhaps she could as well. There wasn't much space—if she were five ten instead of five seven, or overweight, there might not have been enough room, but the option felt smarter than trying to run.

'Someone go through the lab and try to find the window where they got in.'

There was no more time. Terrified of scraping against the wood, or inadvertently kicking the door, Thea set the knapsack aside and eased herself feetfirst into the cabinet and onto her right side. Her knees could bend just a little. When she tried extending her legs, her feet just touched some glassware. The faint clink it made, given the circumstances, sounded like a church bell.

With a band of tension tightening around her chest, she drew her knees up an inch or two and pulled the knapsack and films into the curvature formed by her belly. Then she reached her fingers around the cabinet door and closed it soundlessly. The moment before her hiding place was plunged into utter darkness, she thought she saw that one of the films wasn't completely inside. There was no way she could be sure if part of it was sticking out, and no way she could move off her arm to pull it in farther.

Her position was terribly uncomfortable, especially her right elbow, which was pinned beneath her, and the bony medial condyles of her knees, which were pressing against each other, left on right. The knapsack made it extremely difficult to change position.

Outside the cabinet she heard the shuffling of feet as someone walked slowly down her row. Suddenly, directly beside where she was lying, the shuffling stopped. Something solid, a nightstick, she imagined, was laid on the counter top above her. Half a minute passed before Hayley's MRI film lying beneath her began to move as it was pulled out under the door.

She pressed her arched back tightly against the rear wall of the cabinet. Moments later, the door swung open, flooding the space with fluorescent light. She caught a glimpse of a dark blue uniform just before a powerful flashlight beam struck her in the eyes. The nearly blinding light stayed locked in place as the security guard knelt down behind it, peering in at her.

'Thea?' Dan Cotton said. 'What the—?'