Blood Test Read online

  “This is the roughest time, before the final decree. It can get better.”

  “They say that—the lawyer tol’ me too—but I don feel it. I feel shit on, y’know, shit on first class.”

  He paused and I didn’t fill it in.

  “Anyways, thanks for listenin’, and now you can talk to the judge and tell her I can see the kids, take ’em with me fishin’ for a week.”

  So much for optimism.

  “Richard, I’m glad you’re getting in touch with the situation but you’re not ready to care for your children.”

  “Whythefucknot?”

  “You need help to stabilize your moods. There are medications that are effective. And get someone to talk to, like you’re talking to me.”

  “Yeah?” he sneered, “If they’re assholes like you, goddamn money-chasing fuckers, talkin’ to them ain’t gonna do me no good. I’m telling you I’m gonna take care of the problems now don’t give me any shit, who the fuckareyou to tell me when I can see my kids.”

  “This conversation isn’t going anywhere—”

  “Hunnerd procent right, Headshrinker. You listen and you listen good, they’ll be hell to pay’f I’m not set up in my rightful place as daddy...”

  He emptied a bucket of verbal swill and after listening for several minutes I hung up to avoid being sullied.

  In the silence of the kitchen I became aware of the pounding of my heart and the sick feeling at the pit of my stomach. Maybe I’d lost the touch—the therapist’s ability to put distance between himself and the ones who suffered so as to avoid being battered by a psychological hailstorm.

  I looked down at the message pad. Raoul Melendez-Lynch. He probably wanted me to give a seminar to the residents on the psychological aspects of chronic disease or behavioral approaches to pain control. Something nice and academic that would let me hide behind slides and videotape and play professor again.

  At that moment it seemed an especially attractive prospect and I dialed his number.

  A young woman answered the phone, breathless.

  “Carcinogenesis lab.”

  “Dr. Melendez-Lynch, please.”

  “He’s not here.”

  “This is Dr. Delaware returning his call.”

  “I think he’s over at the hospital,” she said, sounding preoccupied.

  “Could you connect me to the page operator, please.”

  “I’m not sure how to do that—I’m not his secretary, Dr. Delray. I’m in the middle of an experiment and I really have to run. Okay?”

  “Okay.”

  I broke the connection, dialed the message desk at Western Peds, and had him paged. Five minutes later the operator came and told me he hadn’t answered. I left my name and number and hung up, thinking how little had changed over the years. Working with Raoul had been stimulating and challenging, but fraught with frustration. Trying to pin him down could be like sculpting with shaving cream.

  I went into the library and settled in my soft leather chair with a paperback thriller. Just when I’d decided the plot was forced and the dialogue too cute, the phone rang.

  “Hello.”

  “Hello, Alex!” His accent turned it into Ahleex. “So good of you to return my call.” As usual, he talked at a breakneck pace.

  “I tried to reach you at the lab but the girl who answered wasn’t too helpful.”

  “Girl? Ah yes, that would be Helen. My new post-doc. Brilliant young lady from Yale. She and I are collaborating on an N.I.H. study aimed at clarifying the metastatic process. She worked with Brewer at New Haven—construction of synthetic cell walls—and we’ve been examining the relative invasiveness of varying tumor forms on specific models.”

  “Sounds fascinating.”

  “It is.” He paused. “Anyway, how have you been, my friend?”

  “Fine. And you?”

  He chuckled.

  “It’s—nine forty-three and I haven’t yet finished charting. That tells you how I’ve been.”

  “Oh come on, Raoul, you love it.”

  “Ha! Yes I do. What did you call me years ago—the quintessential type A personality?”

  “A plus.”

  “I will die of a myocardial infarct but my paperwork will be completed.”

  It was only a partial jest. His father, dean of a medical school in pre-Castro Havana, had keeled over on the tennis court and died at forty-eight. Raoul was five years from that age and he’d inherited his sire’s lifestyle as well as some bad genes. I’d once thought him changeable but had long ago given up trying to slow him down. If four failed marriages hadn’t done the trick, nothing would.

  “You’ll win the Nobel Prize,” I said.

  “And it will all go for alimony!” He thought that tremendously funny. When his laughter died down he said:

  “I need a favor, Alex. There’s a family that’s giving us some trouble—noncompliance problems—and I wondered if you could talk to them.”

  “I’m flattered but what about the regular staff?”

  “The regular staff made a mess of it,” he said, peeved. “Alex, you know the high regard I have for you—why you abandoned a brilliant career I’ll never know, but that’s another issue. The people Social Services are sending me are amateurs, my friend. Rank amateurs. Starry-eyed caseworkers who see themselves as patient advocates—provocateurs. The psych people will have nothing to do with us because Boorstin has a death phobia and is terrified of the word cancer.”

  “Progress, huh?”

  “Alex, nothing’s changed in the last five years. If anything it’s gotten worse. I’ve even started opening my ears to other offers. Last week I was given the chance to run an entire hospital in Miami. Chief of Staff. More money and a full professorship.”

  “Considering it?”

  “No. The research facilities were Mickey Mouse and I suspect they want me more for my Spanish than my medical brilliance. Anyway, what do you say about lending the department a hand—you’re still officially listed as our consultant, you know.”

  “To be honest, Raoul, I’m not taking on any therapy cases.”

  “Yes, yes, I’m aware of that,” he said impatiently, “but this is not therapy. Short term liaison consultation. I don’t want to sound melodramatic, but the life of a very sick little boy is at stake.”

  “Exactly what kind of noncompliance are you talking about?”

  “It’s too complicated to explain over the phone, Alex. I hate to be rude, but I must get over to the lab and see how Helen is doing. We’re pacing an in vitro hepatoblastoma as it approaches pulmonary tissue. It’s painstaking work and it requires constant vigilance. Let’s talk about it tomorrow—nine, my office? I’ll have breakfast sent up, and voucher forms. We’re prepared to pay for your time.”

  “All right, Raoul. I’ll be there.”

  “Excellent.” He hung up.

  Being released from a conversation with Melendez-Lynch was a jarring experience, a sudden shift into low gear. I put down the receiver, regained my bearings, and reflected on the complexity of the manic syndrome.

  3

  WESTERN P EDIATRIC Medical Center occupies a square block of mid-Hollywood real estate in a neighborhood that was once grand but is now the turf of junkies, hookers, drag queens, and fancy dancers of every stripe. The working girls were up early this morning, halter-topped and hot-panted, and as I cruised eastward on Sunset they stepped out from alleys and shadowed doorways sashaying and hooting. The whores were as much a fixture of Hollywood as the brass stars inlaid in the sidewalks, and I could swear I recognized some of the same painted faces I’d seen there three years ago. The streetwalkers seemed to fall into two categories: doughy-faced runaways from Bakersfield, Fresno, and the surrounding farmlands, and lean, leggy, shopworn black girls from South Central L.A. All of them raring to go at eight forty-five in the morning. If the whole country ever got that industrious the Japanese wouldn’t stand a chance.

  The hospital loomed large, a compound of aged dark stone building
s and one newer column of concrete and glass. I pulled the Seville into the doctors’ lot and walked to Prinzley Pavilion, the contemporary structure.

  The Department of Oncology was situated on the fifth floor. The doctors’ offices were cubicles arranged in a U around the secretarial pool. As head of the department, Raoul got four times as much space as any of the other oncologists, as well as privacy. His office was at the far end of the corridor and cordoned off by double glass doors. I went through them and walked into the reception area. Seeing no receptionist, I kept going and entered his office through a door marked PRIVATE.

  He could have had an executive suite but had chosen to use almost all the space for his lab, ending up with an office only ten by twelve. The room was as I remembered it, the desk piled high with correspondence, journals, and unanswered messages, all ordered and precisely stacked. There were too many books for the floor-to-ceiling bookcase and the overflow was similarly heaped on the floor. One shelf was filled with bottles of Maalox. Perpendicular to the desk, faded beige curtains concealed the office’s sole window as well as a view of the hills beyond.

  I knew that view well, having spent a significant proportion of my time at Western Peds staring out at the crumbling letters of the HOLLYWOOD sign while waiting for Raoul to show up for meetings he had scheduled but inevitably forgot about, or cooling my heels during his interminable long-distance phone chats.

  I searched for signs of habitation and found a Styrofoam cup half-filled with cold coffee and a cream-colored silk jacket draped neatly over the desk chair. Knocking on the door leading to the lab brought no response and the door was locked. I opened the curtains, waited a while, paged him and got no callback. My watch said ten after nine. Old feelings of impatience and resentment began to surface.

  Fifteen minutes more, I told myself, and then I’ll leave. Enough is enough.

  Ninety seconds before the deadline he blew in.

  “Alex, Alex!” He shook my hand vigorously. “Thank you for coming!”

  He’d aged. The paunch had grown sizably ovoid and it strained his shirt buttons. The last few strands of hair on his crown had vanished and the dark curls around the sides bordered a skull that was high, knobby, and shiny. The thick mustache, once ebony, was a variegated thatch of gray, black, and white. Only the coffee bean eyes, ever moving, ever alert, seemed agelessly charged and hinted at the fire within. He was a short man given to pudginess and though he dressed expensively, his wardrobe wasn’t selected with an eye toward camouflage. This morning he wore a pale pink shirt, a black tie with pink clocks, and cream-colored slacks that matched the jacket over the chair. His shoes were mirror-polished, sharptoed tan loafers of perforated leather. His long white coat was starched and immaculate but a size too large. A stethoscope was draped around his neck, and pens and documents stuffed the pockets of the coat, causing them to sag.

  “Good morning, Raoul.”

  “Have you had breakfast yet?” He turned his back to me and moved his thick fingers rapidly over the piles on the desk like a blind man speedreading Braille.

  “No, you said you’d—”

  “How about we go to the doctor’s dining room and the department will buy you some?”

  “That would be fine,” I sighed.

  “Great, great.” He patted his pockets, searched in them, and muttered a profanity in Spanish. “Just let me make a couple of calls and we’ll be off—”

  “Raoul, I’m under some time pressure. I’d appreciate it if we could get going now.”

  He turned and looked at me with great surprise.

  “What? Oh, of course. Right now. Certainly.”

  A last glance at the desk, a grab for the current copy of Blood, and we were off.

  Though his legs were shorter than mine by a good four inches, I had to trot to keep up with him as we hurried across the glassed-in bridge that connected Prinzley with the main building. And since he talked as he walked, keeping up was essential.

  “The family’s name is Swope.” He spelled it. “The boy is Heywood—Woody for short. Five years old. Non-Hodgkin’s lymphoma, localized. The initial site was in the G.I. tract with one regional node. The metastatic scan was beautiful—very clean. The histology is nonlymphoblastic, which is excellent, because the treatment protocol for nonlymphoblastics is well-established.”

  We reached the elevator. He seemed out of breath, tugging at his shirt collar and loosening his tie. The doors slid open and we rode down in silence to the ground floor. Silence—but not serenity, because he couldn’t stand still: he tapped his fingers on the elevator wall, played with strands of his mustache, and clicked a ball-point pen open and shut repeatedly.

  The ground floor corridor was a tunnel of noise, glutted with doctors, nurses, techs, and patients. He continued talking until I tapped his shoulder and shouted that I couldn’t hear him. His head gave a curt little nod and he picked up his pace. We zipped through the cafeteria and passed into the dimly lit elegance of the doctors’ dining room.

  A group of surgeons and surgical residents sat eating and smoking around a circular table, dressed in greens, their caps hanging across their chests like bibs; otherwise the room was unoccupied.

  Raoul ushered me to a corner table, motioned for service, and spread a linen napkin over his lap. He picked up a packet of artificial sweetener and turned it on its side, causing the powder within to shift with a dry whisper, like sand through an hourglass. He repeated the gesture half a dozen times and started talking again, stopping only when the waitress came and took our order.

  “Do you remember the COMP protocol, Alex?”

  “Vaguely. Cyclophosphamide, um—methotrexate and prednisone, right? I forget what the O stands for.”

  “Very good. Oncovin. We’ve refined it for non-Hodgkin’s. It’s working wonders when we combine it with intrathecal methotrexate and radiation. Eighty-one percent of patients are achieving three-year, relapse-free survival. That’s a national statistic—the figures on my patients are even better—over ninety percent. I’m following a growing number of kids who are five, seven years and looking great. Think of that, Alex. A disease that killed virtually every child it got hold of a decade ago is potentially curable.”

  The light behind his eyes picked up extra wattage.

  “Fantastic,” I said.

  “Perfect word—fantastic. The key is multimodal chemotherapy. More and better drugs in the right combinations.”

  The food came. He put two rolls on his plate, cut them into tiny chunks, and systematically popped each piece in his mouth, finishing all of it before I’d downed half my bagel. The waitress poured coffee, which was inspected, creamed, stirred, and quickly swallowed. He dabbed his lips and picked imaginary crumbs out of his mustache.

  “Notice that I used the word curable. No timid talk of extended remission. We’ve beaten Wilm’s Tumor, we’ve beaten Hodgkin’s disease. Non-Hodgkin’s lymphoma is next. Mark my words, it will be cured in the near future.”

  A third roll was dissected and dispatched. He waved the waitress over for more coffee.

  When she’d gone he said, “This isn’t really coffee, my friend. It is a hot drink. My mother knew how to make coffee. Back in Cuba we had the pick of the coffee crop. One of the servants, an old black man named José, would grind the beans by hand with great finesse—the grind is essential—and we would have coffee!” He drank some more and pushed his cup away, taking a glass of water as a replacement and emptying it. “Come to my home and I’ll make you real coffee.”

  It occurred to me that though I’d worked with the man for three years and had known him twice that long, I’d never seen his living quarters.

  “I may take you up on that one day. Where do you live?”

  “Not far from here. Condo on Los Feliz. One bedroom—small but sufficient for my needs. When one lives alone it is best to keep things simple, don’t you agree?”

  “I suppose so.”

  “You do live alone, don’t you?”

  “I u
sed to. I’m living with a wonderful woman.”

  “Good, good.” The dark eyes seemed to cloud. “Women. They have enriched my life. And torn it apart. My last wife, Paula, has the big house in Flintridge. Another’s in Miami, and two others, God knows where. Jorgé—my second oldest, Nina’s boy—tells me his mother is in Paris, but she never stayed in one place very long.”

  His face drooped and he drummed on the table with his spoon. Then he thought of something that made him suddenly brighten.

  “Jorgé’s going to medical school next year at Hopkins.”

  “Congratulations.”

  “Thank you. Brilliant boy, always was. Summers he would visit me and work in the lab. I’m proud to have inspired him. The others are not so on the ball, who knows what they will do, but their mothers were not like Nina—she was a concert cellist.”