Second Opinion (7 page)

CHAPTER 12

There was dedicated parking for Petros just outside the front doors of the Sperelakis Institute. Thea pulled his Volvo into the space wondering how her father must have felt at the moment of impact. It had to have happened too fast for him to think that he was about to take his last step, or that he had driven his car for the last time, or taken a nice, hot shower, or pondered a patient's perplexing diagnostic problem.

You never know,
she thought sadly as she headed to the unit.
You just never know.

Hospital CEO Sharon Karsten was standing in the deserted waiting area, talking on her cell phone. She motioned for Thea to wait before entering the unit, and quickly ended her call. Her fleeting expression looked strangely uncomfortable, giving Thea the impression that whoever was on the other end of the call was someone Thea knew.

'Hi, Thea,' Karsten said. 'They're working on him for a few more minutes. I was hoping I might bump into you before I had to run off for a meeting.'

Karsten, wearing a tan linen suit, was a trim, aristocratic woman in her midfifties, who, thanks to her taste in clothes, her hairdresser, and carefully applied makeup, looked younger than Thea knew she was. There was a time when Petros had held Karsten up as a potential role model for Thea, claiming that the woman was one of the brightest endocrinologists in the city. Not long after that, Karsten was chosen commander in chief of the Beaumont Clinic. It was under her guidance that the medical center's steady growth had skyrocketed, and an era of massive acquisition and expansion had begun.

'How does he look to you?' Thea asked.

'The same as he has,' Karsten replied, her distress apparent. 'Some of the bruising is going away. I heard about what happened last night. It sounds like you were quite a hero.'

'Niko is the one who did the pericardiocentesis.'

'Only kicking and screaming. I know that he and your sister feel strongly that Petros is unsalvageable.'

'They may be right.'

'But you don't feel that way.'

'It's not time to give up,' she said for what seemed like the thousandth time.

'Thea, do you have any idea how much your father is worth?'

'Not really. I do know he was pretty conservative and responsible with his money.'

Karsten glanced about to ensure no one had entered the waiting area.

'He's worth between fifteen and twenty million dollars—probably closer to twenty.'

'My goodness,' Thea said, realizing at the same instant that she had no real idea how much money twenty million dollars was, nor did she care.

'His will divides the money among the four of you, but not equally. Niko gets the largest portion because of his children. When—if— your father dies, Niko will go from being well-off to being quite rich. Your sister, with a high-paying, high-profile specialty, is already a millionaire, maybe several times over. Her inheritance will enable her to live the lifestyle she has chosen, but to live it at a level she and her partner have only dreamed of.'

Thea mulled over the CEO's revelation about her father and her family, and wasn't impressed one way or the other. Her own pay from Doctors Without Borders would not have been enough to keep her afloat in a city like Boston, but it was fine for her needs in Africa. She wondered briefly if this was another attempt to get her to stay at the Beaumont, but she couldn't see how.

'Sharon, do you mind if I ask you how you've come to know so much about my father's financial…'

'I can see that you've answered your own question,' Karsten said.

'Your father and I have been involved with each other for five years or so. He was—is—a very wonderful man and a marvelous doctor, but he was also very private. That's why our relationship wasn't more… commonly known, and also why it's so hard for me to see him in there like that. He was—is—such a dignified person. Still, I don't want him to die, Thea. I don't want him to die no matter what your brother and sister say.'

Thea was affected by the vehemence of the statement. She sensed some sort of commiseration was being asked for, but she didn't trust her words to come out right to a woman she knew only minimally, who had just admitted to a long-standing love affair with her father.

'I don't know what to say except that I think he's getting excellent care,' she managed.

At that moment, the unit nurse opened the glass doors and nodded that they were done.

'I'd better get going,' Karsten said after checking her watch. 'I'm glad you're home, Thea. And don't worry about that business yesterday. Your father's name carries a great deal of weight with donors to this hospital as well as those sending referrals. As chief development officer, Scott was merely seizing on the opportunity to have that name continue at the Beaumont.'

'I understand.'

Thea waited until the CEO had vanished down the corridor to the elevators, and then entered the ICU. The battered Lion lay peacefully on his back, eyes taped shut, machines whirring. The bed linen, pulled up to his shoulders, was crisp and very white. On the bedside table, surrounded by swabs, rolls of tape, and ointments, someone had left an
eikona
—a small framed picture in gold leaf of the Virgin Mary holding baby Jesus. Double protection along with Aunt Mary's
vaskania.
Greeks were nothing if not superstitious and religious. God first, but protection against the
mati
never far away.

Instinctively, Thea checked the monitor numbers, and found them all within normal range. Then she let the bedrails down, bent over, and kissed her father on the forehead.

'I love you, Dad,' she whispered, the first time she had said the words.

Then, as she had done once the day before, she removed the paper tape that secured his eyelids shut, and checked his pupils, which were mid-position as opposed to too constricted or dilated, and slightly reactive to light.

'I love you, Dad,' she said again.

A second later, Petros Sperelakis's left eye moved.

CHAPTER 13

Thea stared down at her father, her mind unwilling to accept fully what she had just seen.

The movement of Petros's left eye was a slight upward gaze of the globe, and with it a flick of his left upper lid. No movement whatsoever on the right.

'Dad, again,' she urged. 'Please try and move your eye again.'

After what seemed an eternity, the Lion repeated the movement— no more complicated, but no less.

Limited focal movement clearly in response to a command. For Thea the news her father could move at all was mixed—dreadfully mixed.

Locked-in syndrome, possibly the most nightmarish medical condition imaginable in a person.

In normal neuroanatomy, the cerebral hemispheres and cerebellums of the brain received and processed information from sensory receptors in the body, and then sent a response message back down to the muscles. In locked-in syndrome, injury due to a hemorrhagic brain stem stroke or, rarely, brain stem trauma, effectively severed the pathways from the brain to the muscles of the body while leaving intact the incoming nerve fibers. Pain, yes… sensation, yes… consciousness, total… ability to move, none.

A fully functioning, fully alert mind locked within an absolutely motionless, unresponsive body.

Could there be anything more horrible than that?

Ordinarily, it would be completely impossible to tell if a comatose patient was in fact, conscious and alert and immersed in locked-in syndrome. However, through a quirk of neuroanatomy, in a percentage of those with bleeding into a specific location of the pons region of the brain stem, one small set of muscles remained connected to the gray matter of the cerebral hemispheres: the muscles controlling a specific movement of one or sometimes both eyes.

Her heart pounding, Thea held her father's hand and asked him to repeat the movement of his left eye. Could this be anything other than locked-in syndrome? Perhaps, she began praying, it was the first step in a more generalized recovery.

'S'agapo, Mpampa.' I
love you, Daddy.

Again the movement—slight, but definite.

Thea cast about for someone to come in and validate what she was seeing, but neither her father's nurse nor the intensivist covering the unit were outside the room where she could see them, and Thea was reluctant to break the fragile connection with him.

For his part, the Lion looked unchanged, lying serenely supine, eyes closed, although it seemed to Thea as if he had been aged many years by the battering he had endured.

'Dad, can you open your eye? Can you open it just a little?'

Thea had not read a great deal about locked-in syndrome, although she planned on a long night in the hospital's extensive library as soon as this evolving situation had become stabilized. She had heard about the remarkable case of an editor of a French magazine who suffered a sudden brain stem hemorrhage while in his forties. As she recalled, he remained completely comatose with a tracheotomy and on a ventilator for some weeks, before awakening and discovering his gruesome condition. In his situation, communication was possible only through the elevation of his gaze. One eye? Both? Thea couldn't remember.

What she did remember was that the victim, through a scribe, developed the means to react as she was pointing to letters on an alphabet page. Together, painstakingly, they were able to record his story and his thoughts in a bittersweet memoir of a man's reaction to this most unimaginable of medical disasters. There was a book recording that memoir. Thea felt certain of it. And some time after that, there might actually have been a movie. As soon as possible, she vowed to read the man's memoir and to become an expert on the subject.

'Please, Dad. Just a little.'

The eyelid creased, then opened just the tiniest crack, then closed again. Thea separated the lids upper from lower and pleaded again for a response. Slowly, but definitely, the iris and pupil rotated upward a millimeter or two. Thea had little doubt that the movement had been purposeful and in response to her urging.

'Dad, can you squeeze my hand?'

Nothing.

She parted the lids again.

'Look up if you can hear me. Look up.'

Again, the eye rolled upward just enough for her to know for certain that the gesture was voluntary. Thea allowed herself to again focus on the possibility that this development might represent the first step on the path to neurological recovery. The elation was brief, giving way once again to the horrible sinking sensation that Petros was experiencing the pain and utter frustration that went with locked-in syndrome. One more confirmation that what she was witnessing wasn't merely in her head, and she would bring in the nurse or the intensivist and notify the twins and Dimitri, and maybe Sharon Karsten as well.

Was it possible Petros had been awake and alert when Niko and Selene were standing by the bedside, insisting that nothing be done to extend his life? How much of the discussion that preceded the resuscitation did he hear? How much of the closed-chest cardiac compressions did he feel?

'Dad,' she said, 'show me once more that you can hear me. Open your eye and look up at the ceiling… Dad?'

Thea again spread his lids. For a full minute there was no movement of the eye—no movement whatsoever. Then Petros looked upward—a gaze more pronounced than any preceding it. Excitedly, Thea hurried for the nurse, Tracy Gibbons, who had helped her run the code. She didn't mention locked-in syndrome, but instead said that her father had shown signs that he was awake and responsive.

'Oh, my God, that's wonderful,' the nurse exclaimed, hurrying with her to the bedside.

'Dad, I'm here with Tracy, your nurse. Can you open your eyes for her?'

No response.

'Dr. Sperelakis, it's me, Tracy. I'm so excited you're waking up!'

Thea waited for a minute, feeling increasingly edgy. She opened her father's lid as she had just successfully done. There was still no movement. She could feel the enthusiasm draining from the nurse beside her, and she imagined what the woman was thinking. Before them, Petros's eye stared unblinking at a point somewhere straight ahead.

'Dad?' she tried, testing her own conviction that movement of the eye had actually happened. 'Please show Tracy and me that you can hear. Please move your eyes.'

'Maybe he's just tired out,' Tracy said in lieu, Thea knew, of saying
Maybe you just want this so much and are so jet-lagged and so emotionally involved after last night's resuscitation that you are trying to will this to happen.

'Maybe,' Thea said.

'Well…I've got a little more charting to do. Just give a yell if he moves his eye again.'

The nurse took two steps backwards, then turned and left the glass-enclosed room.

Thea stayed at the bedside, holding her father's hand and trying to sort out what could possibly have just transpired. Had she simply imagined the whole thing? No, she thought firmly. She didn't believe that at all. It wasn't like her. Petros had reacted to her and he had voluntarily moved. Could he have gotten worn out or slipped back into unconsciousness?

More likely,
she acknowledged.

Perhaps it was worth bringing Sharon Karsten up to speak with him. It had been ten years since Eleni Sperelakis's sad death. Karsten said she and Petros had been together for five years. For a Greek woman to become involved after five years of widowhood was a bit against tradition, but as in almost everything Greek, men had more leeway. Karsten had made it sound as if their relationship was quite serious. Thea remembered that the woman was divorced and wondered now if her marriage had ended before or after their involvement.

The situation was not one Thea was put together to handle very easily. She had seen what she had seen. Her father had opened his eye, and that was that. Furthermore, he had done it at her request. Why was he unable or unwilling to repeat the gesture?

More analytical and puzzled than frustrated, she bent over the bed once more and implored her father.

'Dad, please. I know you can hear me. Open your eyes so I know. It's very important that I know you understand me. Show me you can hear me and I'll help you to learn what is happening.'

Thirty seconds passed before Petros's left eye quivered and opened just a slit, then closed.

'Thank you, oh thank you,' she whispered.

She hurried to the nurse's station and returned with Tracy. Again, there was no response from the man. None at all. This time, Thea merely thanked the nurse and watched her leave. It was clear that the woman was trying to be polite, but it was equally clear that she didn't believe her deeply comatose patient had suddenly started responding to commands, only issued when he was alone with the daughter who was desperate for him to wake up. He was the invisible man, who was only invisible when there was no one around to see him.

Thea stepped back from the bed and peered down at her father's battered face. Petros was the one who imbued in her the notion that in diagnostic medicine there was always an explanation that fit the facts. A good physician's duty was to start with that assumption and to keep testing and examining until the wayward explanation became apparent.

In this case, the fact was that her father would signal to her and not the nurse. The most viable explanation, though there were certainly others, was that the only person he would respond to was her. The reason for that behavior would be another fact that needed explaining. But for now, what was clearly called for was another person Petros was likely to respond to—friend or family.

At that moment, as if on cue, Dr. Scott Hartnett knocked on the glass and entered the cubicle.

'I feel as if he might have just responded to me,' Thea said after she and Petros's friend and internist had exchanged greetings.

'Responded?'

'I think he opened his left eye a bit and looked upward.'

'Locked-in syndrome?'

'Hopefully not,' she replied.

She felt pleased at having picked up on the possible effect that hearing the grim diagnosis might have on her father. Until recently, it was not the sort of thing that her Asperger syndrome would have allowed her to consider.

Hartnett, whom she had always felt was a kind and intuitive physician, nodded that he understood her concern, then turned to his patient.

'Petros, my friend,' he said, his rich bass resonating throughout the cubicle, 'it's Scott. Squeeze my hand if you can hear me… Come on, old boy, you can do it… All right, then, how about opening your eyes? Just look up… Lookup and I'll write off your donation to this year's development fund… I don't know, Thea.'

'Try lifting his left lid.'

Hartnett gently did as she asked and repeated his request. The mid-position pupil stared blankly forward. Thea could only shake her head.

'I was so sure,' she said, still certain of what she had seen, but unwilling to push matters any more.

Her experiment had a result. Now she had to process the significance of the finding.

Hartnett patted her on the shoulder.

'Sometimes we want these things so badly…' His voice trailed off.

For a time, the two physicians stood silently by the bedrail.

'Have you spoken to the neurologist?' Thea asked finally.

'The neurologist, the neurosurgeon, the intensivist, the ortho-pod, the urologist because there was blood in his urine. Wait and see. That's all they have to tell us. Wait and see. Well, I'm going to make rounds. I may stop by again before I head home.' He guided Thea out the door, and added, 'The good news is that at least he doesn't appear to have locked-in syndrome.'

Thea smiled wanly and accepted a paternal hug. Then she returned to the bedside and gazed down at her father. She could almost see the steely set of his jaw. He was awake. Awake and alert, but stubbornly unwilling to share that fact with anyone except her.

'Dad, it's just me,' she said softly. 'Nobody else is here. Now open your eyes. Open your eyes if you can hear me.'

Twenty seconds went by before the Lion's upper and lower eyelids on the left separated a millimeter.

/
knew it!

'You don't want anyone but me to know you're awake. Is that it?'

Thirty motionless seconds passed before, with what seemed like a consummate effort, Petros opened his eye once more.