Concealment

By Illya

New York Times reporter, Charles Platt, falls upon the story of a lifetime after being diagnosed as having an incurable brain tumor. His diagnosing doctor, Rachael Lord, has a less than stellar past. Five years priors, Charles himself, had written a front-page story about the Doctor, a dead geneticist and the Human Genome Project. The good Doctor was eventually cleared of all charges, but a mystery remained as to the whereabouts of the missing genetic map that was suppose to have been completed. Thus Charles journey begin, not only in the pursuit of his story, but ultimately for a lifesaving cure for himself.

• Language: English
• Publisher: Xlibris US
• Release date: Feb 12, 2001
• ISBN: 9781469121444

Illya

David Liebowitz is currently a Registered Critical Care Nurse in the Dialysis Unit of the Dartmouth-Hitchcock Medical Center in Hanover, NH. His formal training includes a Baccalaureate in Business Administration from Western New England College, in Springfield, Massachusetts, and an Associate degree in Nursing from Greenfield Community College, in Greenfield, Massachusetts. He currently lives the quite life with his seven-year-old daughter, Cathy, and enchanting wife, Susan in rural New Hampshire.

Book preview

CHAPTER 1

Mr. Charles Platt sat bolt upright on the paper-covered exam table as a thousand thoughts ran through his mind. It had only been four months since he felt his first pains, yet he could scarcely remember the events that had brought him to the Emergency Room. At the age of forty-two, he had always considered himself the picture of perfect health. He ate sanely, exercised regularly, and kept his stress down to a minimum. He had done all the right things, and still his body had betrayed him. At first he attributed his symptoms to just being rundown, but as time progressed the symptoms seemed to increase in their severity. He had morning headaches, afternoon nausea, and intermittent dizziness. The symptoms in themselves weren’t bad enough to seek out medical advice. The thing that had ultimately brought him to the Emergency Room was his vision changes. As a reporter for the New York Times, he needed 20/20 vision, or so he thought. After much hesitation on his part he had decided to check out one of the local eye doctors in the box franchises. His friends at the paper had recommended the one on West 48th Street. It was a national chain, and the doctor had seemed knowledgeable enough. After an extensive exam the doctor had given him a prescription for glasses, and a word of advice. He had told Charles that he had noted some papilledema. He didn’t think it was anything to worry about, but it was worth looking into, especially given his other symptoms. Charles ignored the advice, bought a pair of glasses and went on his merry way. Two weeks later Charles woke up semi-confused and weak. He vomited three times, took a shower, and headed straight for the Emergency Room. After a battery of tests the only remaining question was how deep was his body’s betrayal?

The door to the tiny exam room opened and a man in his early thirties walked in. Charles looked the young doctor up and down as he thought, ‘So it has come down to this. Forty years of trying to make a life for myself, and a kid is going to tell me my fate.’ Charles sighed. The doctor flipped through a number of pages on a clipboard as he said, Well, Mr. Platt, I have your test results. Charles immediately noticed the doctor’s lack of eye contact. He had interviewed enough people in his lifetime to know what that meant. The doctor was either afraid to tell him the news, or he feared the eye contact would somehow give him the disease.

Charles braced himself for the worst as he said, It’s alright Doc. Just tell me. The waiting will only make it worse.

The doctor looked up from his clipboard, and immediately regretted it. Charles and the doctor’s eyes met, it had only been for a split second, but it had been enough. Charles had expected life-changing news, the doctor’s eyes told him his life was over. The doctor scrambled back to the security of his clipboard. He cleared his throat, and said, I’m afraid the news isn’t very good. Charles didn’t say a word. He didn’t have to. His body had done all the talking. The doctor was just translating what it had said. Your visual field is decreased. Your Electroencephalography tracing is abnormal, and your MRI shows a lesion.

Charles closed his eyes, took a deep breath and asked, And all that means, what?

The doctor let the pages of the clipboard go, as he looked up. He knew he owed his patient that much. He wondered how he was supposed to tell a man so young that his life was over. He had gone into medicine with such high hopes. He wanted to ease the suffering, cure the afflicted, and make tons of money in the process. After six years of practicing he had learned the real truth. The cures were rare, the sufferings were many, and the money went into the coffer of the corporate bank accounts. Mainly that of the drug companies. Nevertheless, his job did have a purpose. He provided the hope, and he liked to think the time people needed. Through the magic of medicine he could buy his patients the time they needed to get their affairs in order.

While still avoiding eye contact, the doctor said, You have a stage four glioblastoma. A brain tumor. Charles felt his heart sink and his gut tighten. He knew the news was bad, but a tumor? The doctor had to be mistaken. The young doctor didn’t wait for Charles’ response. He continued, Judging by the size of the tumor, and the symptoms you’re feeling, my guess would be you’ve had this for quite some time. I’d like to admit you for a complete work up and an oncology consult.

Charles was stunned. He felt as though he was just run over by a Mack truck. He didn’t know what to say, or what to think. He had gone from having simple eye troubles to a brain tumor in the span of less then three weeks. The only thing he could manage to say was, I want a second opinion.

The doctor didn’t even look up, he simply replied, That’s your right. But I’m afraid the news isn’t going to get any better.

Charles half whispered, Just the same I want a second opinion.

The doctor replied, Sure, I’ll get my Attending. As the door closed behind the departing doctor Charles tried to digest what he had just been told. He had never known anyone with a brain tumor, although he did have a childhood friend that had leukemia. He didn’t remember the events too well, seeing how he was only ten at the time, but he did recall the funeral. He could almost hear the adults saying, ‘He was such a brave kid… Why did he have to get it, he was always the nicest of the boys… His poor parents… I thought they had a cure for that.’ Charles clung to his last recollection with all his might. He thought, ‘A cure. That’s it, there has to be a cure. For god sake, it’s nineteen ninety-nine. If we can keep AIDS at bay, why not cancer.’ The word cancer hung in Charles’ mind. The mere thought of the word seemed to make it a reality. The doctor hadn’t spoken it. He had used the words tumor and lesion. It was as though he was afraid to speak the word. Was he fearful of getting it himself, Charles wondered?

The door to the exam room opened and a young woman in her late thirties, early forties, walked in. Charles’ eyes couldn’t help but transverse her body. The woman was that beautiful. Her shoulder length brown hair, cobalt blue eyes, tan complexion, and sculptured features were enough to make any man weak in his knees. Even one that had just been told he had cancer. Charles’ eyes traveled up the woman’s blue jean encased legs. He paused at her waistline, not really aware of what he was doing, and stopped at the monogram on her lab coat. The script writing read, ‘Rachael Lord, MD.’

Rachael’s attire was simple, yet alluring. She wore New Balance running shoes, a pair of tight blue jeans, a silk white top, a thin gold rope necklace, and a knee length lab coat. The lab coat almost seemed out of place given the rest of her outfit. Her casual appearance practically said, ‘Don’t bother me, I’m trying to relax.’ But there was something about the way she held herself. Charles couldn’t quite put his finger on it. He was paid to size people up, however the woman before him remained a mystery. She had a confidence about her that seemed to stem from deep within her. Her stance showed command, knowledge and most of all a healthy respect for the uncontrollable. Charles knew he would like her even before she spoke.

Rachael held a clipboard in her hand, but she didn’t hide behind it. Instead, she looked directly at Charles’ face as she said, Hi, Mr. Platt. Rachael extended her arm. My name is Doctor Lord. I’m the Chief Attending of the Emergency Department. Charles took Rachael’s hand and shook it. Her skin felt remarkably smooth, and her touch was gentle. Rachael could feel a slight tremor in Charles’ grip. She wondered if it was the tumor’s doing, or the fear of what he had just been told. In either case, the source was the same. Rachael withdrew her hand and continued, I’ve been told you wanted a second opinion. Is that correct?

Ordinarily Charles would have felt as though he were being put on the spot, but for some reason Rachael didn’t make him feel that way. She didn’t sound accusatory. She sounded genuinely concerned. Besides, she had had the guts to look him in the eyes. He not only respected her for that, he trusted her. Charles replied, Yes, that’s correct. I’m afraid there’s been some kind of mistake. Rachael wanted to cut him off right there, given her workload, but she knew it was pointless. She had seen it many times before. The first reaction was almost always denial, and in a way she sympathized. Who would want to believe such a thing, especially from a complete stranger? Her work had backed up unbelievably, but she knew the man in front of her deserved her time just as much as the next guy despite his fatal prognosis. I think that other doctor must have gotten my test results screwed up. I feel as healthy as a horse. I mean I’ve had a headache or two, but who doesn’t? It doesn’t mean I have cancer. Charles laughed nervously before saying, Does it?

Rachael let a soft but audible sigh out as she pulled up a stool that was on coasters. She sat down, gently placed her right hand on Charles’ knee and said, We can repeat the tests if you wish, but I’m afraid the outcome is going to be the same. Your headaches, nausea and vomiting, dizziness, vision changes, and papilledema are all symptoms of increased intracranial pressure. You haven’t received a blow to the head recently have you?

The corner of Charles’ lip curled up, as he meekly said, No.

Rachael stood up from her position and asked, Can I look into your eyes?

Charles shrugged his shoulders as he said, Sure, why not? What more could you possibly tell me.

Rachael retrieved an ophthalmofundoscope from her left pocket, snapped it on, and brought it up to Charles’ right eye. While holding the scope up to Charles’ eye she said, This will only take a minute. I know the light is a pain, just try to keep your eye open. Rachael turned the dial at the head of the scope as she leaned into Charles’ face. Rachael was so close Charles could feel her warm breath against his cheek. Without turning the light off, Rachael repeated the process to Charles’ left eye. She then clicked the light off and sat back down. Nope, I’m afraid there’s no mistake. Between your clinical presentation and test results I’d have to confirm the earlier diagnosis. Rachael put her hand back on Charles’ knee as she continued, I’m sorry. I wish we were wrong.

Charles still didn’t want to believe the diagnosis, but he knew he had to. He had heard good things about Beekman Hospital, and for some reason, Rachael’s last name seemed to strike a familiar cord. Charles looked down at Rachael as he said, OK, you’re the doctor. What’s my odds, and what’s my next move?

Rachael stood up, flipped through the pages on the clipboard, and said, I’ll be honest with you. You have a stage four astrocytoma. Which means it’s pretty advanced. Even when these tumors are detected early there’s a sixty percent mortality rate. Charles’ head sunk low into his chest. Upon seeing this Rachael said, I don’t want to give you false hope, but people do beat these things. With a combination of surgery, chemotherapy, and radiation therapy forty percent of the affected people return to a useful life. I’m not going to lie to you, it’s a tough road, and many people find the cure worse than the disease. The alternative, well, personally, if it were me, it wouldn’t be an option.

Charles heard every word Rachael had said, and he understood them. He trusted her diagnosis, her judgment, and in some mutual spiritual connection, her will to live. He lifted his head up with a newfound strength, and he half jokingly said, I take it there’s no miracle cure for this huh?

Rachael smiled before she said, No, I’m afraid not yet.

Charles replied, I didn’t think so. Alright, where do we begin?

Rachael patted Charles’ leg as if to reconfirm his decision before saying, I’d like to get you admitted to oncology and run a few more tests so we know exactly what we’re up against. We’ll need to do a spinal tap, a CT scan, and a cerebral arteriogram. We have to be absolutely certain that the tumor didn’t originate from somewhere else. I’m fairly sure it didn’t. Most cerebrum tumors tend to be localized, especially in our age group. Charles couldn’t help but smile when he heard Rachael include herself in the possible target group for the disease. It made her more human. He knew she saw him as a person, and not just a statistic.

OK, but I have a few things I need to take care of first. This is all happening so fast.

Rachael stood up, reached into her lab coat pocket, pulled out a prescription pad, and said, I understand, but we need to start on this as soon as we can. The faster we act, the better your odds of survival.

Charles was about to respond, but before he could there was a knock at the door and a nurse appeared. The nurse said, Doctor Lord, we need you right away in curtain three.

Rachael said, I’ll be there in a sec.

The nurse didn’t let up. No, Doctor Lord, we need you now. We have an eight year old with a blood sugar of eighteen hundred. She’s already had one seizure and I’m afraid we might lose her airway.

Rachael turned towards Charles as she headed for the door. Charles raised his hand, as if to say, ‘No words needed.’ Rachael nodded her head in acknowledgment, and walked out the door. As the door closed, Charles wondered where he had heard his new doctor’s name before. It was at the tip of his memory, just out of his reach. He couldn’t help but think it was the tumor’s fault.

Rachael reached the bedside of curtain three just in time to see the eight year old girl open her eyes. She was soaked in sweat, her muscles twitched, and her eyeballs looked sunken. She had the classic signs of DKA, diabetic ketoacidosis. The only problem was the girl shouldn’t have been awake. With a blood sugar of eighteen hundred, she should have been in a nonketotic coma, but she wasn’t. Doctor Arden Bowers was in charge of the case, the same doctor that had done the initial work-up on Mr. Platt. Rachael knew Bowers’ work well. As Chief Attending she served as his mentor. He wasn’t a great doctor, but he wasn’t bad either. He did things by the book, a little too by the book in Rachael’s opinion, but nevertheless he performed his job well. When Doctor Bowers saw Rachael’s appearance he started his case summary, but Rachael didn’t hear a word of it. A heavyset Hispanic woman that stood to the right of the girl’s head was screaming hysterically. Rachael’s Spanish was a little rusty, so she was only able to pick out bits and pieces of what the woman was saying. She said something about pills and it being her fault. After that Rachael was at a loss.

Rachael motioned for the nurse that had pulled her away from Mr. Platt and whispered, See if you can guide our friend here to the waiting room. Then find a translator so we can find out what the hell happened. It’s obvious she’s not the girl’s mother.

The nurse looked down at the girl on the stretcher. The girl was clearly from a rich family. Her hair and nails were professionally done, and her uniform practically shouted out private school. The nurse was sure she had seen the uniform’s design before, despite the fact that the private schools in the area tended to have their own infirmaries. She made a mental note to check the local phone book.

As the nurse guided the not so calm caretaker to the waiting room Doctor Bowers spoke. Wow, pretty wild huh? That’s one lady you don’t want to mess with.

Rachael ignored Bowers comments as she said, So what do we have?

Doctor Bowers reeled himself in and said, It’s the darndest thing. A private limousine driver brought in the girl. She was completely unresponsive and her breath smelled of ketones. I started an IV of normal saline and drew some labs. I knew her sugar was high, I just didn’t know how high. I give her twenty units of regular insulin and had the nurse mix up an insulin drip. Then all hell broke lose. That woman came screaming into the room. She slapped my hands and pulled me away. I didn’t know what she was saying, well, you heard her. Anyway, before I had a chance to move back to the stretcher the woman slipped something into the girl’s mouth. A minute later the girl opened her eyes. I immediately did another glucose test and the result came back 250mg/dl. I know it sounds crazy, but it happened.

Rachael’s tone remained neutral as she asked, Are you certain the first labs were correct?

Bowers knew Rachael well enough to know that she wasn’t accusing him of anything. In fact, if the roles were reversed he would have asked the same question. Yes, the results were double checked. Both times. Bowers looked at the girl on the stretcher. She was stirring more. He then asked, Could it have been the twenty units of regular?

Rachael thought about the question for a moment. She knew twenty units of regular insulin was like a drop in the bucket for a sugar level of that magnitude. She personally would have given an initial dose of forty units, but then again, twenty units seemed to have worked. The results went against everything she knew. Either something was amiss, or the girl had received some insulin before she had arrived. But even still, the girl’s change in status had occurred too rapidly. Rachael’s mind kept slipping back to Bowers comment about the Hispanic woman. He had said, ‘before I had a chance to move back to the stretcher the woman slipped something into the girl’s mouth.’ Rachael wondered what that something was.

The girl on the stretcher shifted her position and tearfully said, Mommy, mommy. I want my mommy.

Rachael stroked the girl’s hair as she said, It’s OK. We’re going to get your mommy for you.

The girl calmed some and Bowers said, It’s OK, I can handle it from here.

Rachael had a thousand and one things to do so she said, Alright, but keep me advised if there’s any changes.

Bowers replied, Will do.

Rachael felt the prescription pad in her hand and walked back to the exam room where she had left Mr. Platt. There was a nagging