The Patient Read online

  RAVES FOR MICHAEL PALMER

  THE PATIENT

  “[Will] have you questioning the ethics of the medical biz—and praying that you don’t ever need a serious operation.”

  —New York Post

  “Deft plotting, sure characterization, and cutting-edge technology … A thriller that will extend the burning hours of your bedside reading lamp.”

  —Iowa City Gazette

  “Palmer’s novel has all of the ingredients to ensure … another engrossing drama by a master of the genre. Enthusiastically recommended.”

  —Library Journal

  “Keep[s] readers rooting for the home team through extortion and murder, medical mayhem, and medical miracle.”

  —Booklist

  “Twisting, suspenseful.”

  —Pittsburgh Post-Gazette

  “The Patient is wonderful … Palmer is a master at mixing the medical and terrorist thriller. The drama is tense and builds to a terrifying conclusion.”

  —Times Record News (Texas)

  “Suspense is maintained throughout, ending in a violent climax.”

  —Mystery News

  “Adrenaline-pumping action and cutting-edge medicine mesh seamlessly in The Patient, making it one of the most exciting medical thrillers.”

  —Morristown Daily Record

  “A top-notch thriller … filled with bits and pieces that only someone who has lived his or her life in the medical profession can convey.”

  —The Colony Times

  MIRACLE CURE

  “A highly entertaining tale of greed and medicine run amok.”

  —Chicago Tribune

  “Packs plenty of heart-stopping action.”

  —Associated Press

  “A fast-paced lively thriller.”

  —Boston Sunday Herald

  CRITICAL JUDGMENT

  “Wrenchingly scary … Palmer is reaching the top of a demanding craft.”

  —Publishers Weekly (starred review)

  “This is a novel that manages to scare the socks off the reader while still providing made-for-Hollywood entertainment.”

  —The Globe and Mail, Toronto

  “Palmer [brings] his fascinating ER procedural knowledge to a fast-paced … narrative.”

  —San Francisco Chronicle

  SILENT TREATMENT

  “Guaranteed to terrify anyone who … has reason to step inside the doors of a hospital … Dynamite plot … fast-paced and engrossing.”

  —The Washington Post

  “Terrifying … highly entertaining … [An] action-packed tale that never lags.”

  —Sun-Sentinel, Fort Lauderdale

  “Palmer owes this reviewer about three hours of sleep spent reading this can’t-put-it-downer. You are cautioned … don’t start this one at 10 at night.”

  —The Washington Times

  ALSO BY MICHAEL PALMER

  FROM BANTAM BOOKS

  The Sisterhood

  Side Effects

  Flashback

  Extreme Measures

  Natural Causes

  Silent Treatment

  Critical Judgment

  Miracle Cure

  NOT ONE WORD HAS BEEN OMITTED.

  This is a work of fiction. Names, places, characters, and incidents are either the product of the author’s imagination or are used fictitiously. Any resemblance to actual persons, living or dead, events or locales is entirely coincidental.

  THE PATIENT

  A Bantam Book

  PUBLISHING HISTORY

  Bantam hardcover edition published April 2000

  Bantam export edition published July 2000

  All rights reserved.

  Copyright © 2000 by Michael Palmer

  Library of Congress Catalog Card Number: 99-057838

  No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. For information address: Bantam Books.

  eISBN: 978-0-307-78125-3

  Bantam Books are published by Bantam Books, a division of Random House, Inc. Its trademark, consisting of the words “Bantam Books” and the portrayal of a rooster, is Registered in U.S. Patent and Trademark Office and in other countries. Marca Registrada. Bantam Books, 1540 Broadway, New York, New York 10036.

  v3.1

  For Beverly Lewis

  Contents

  Cover

  Other Books by This Author

  Title Page

  Copyright

  Dedication

  Acknowledgments

  Prologue

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Chapter 22

  Chapter 23

  Chapter 24

  Chapter 25

  Chapter 26

  Chapter 27

  Chapter 28

  Chapter 29

  Chapter 30

  Chapter 31

  Chapter 32

  Chapter 33

  Chapter 34

  Chapter 35

  Chapter 36

  Chapter 37

  Chapter 38

  Chapter 39

  Chapter 40

  Chapter 41

  Chapter 42

  Chapter 43

  Author’s Note

  About the Author

  ACKNOWLEDGMENTS

  The many, often lonely and uncertain hours spent here in front of my Mac have been much more bearable because of my friends and family. This page is one of the ways I get to express my appreciation to them.

  At the Jane Rotrosen Agency, Jane Berkey, Don Cleary, Stephanie Tade, and Annelise Robey have made writing easier for me in many ways.

  At Bantam Dell, Beverly Lewis, Christine Brooks, Irwyn Applebaum, Nita Taublib, Susan Corcoran, and Barb Burg have done the same.

  Sam Dworkis, Mimi Santini-Ritt, Sarah Elizabeth Hull, Dee Jae Jenkins, Matt Palmer, and Beverly Tricco have been invaluable as critical readers.

  My deepest gratitude to Holly Isbister, Pamela Kelly, and the rest of the crew in the Brigham and Women’s Hospital magnetic resonance operating room for your hospitality, professionalism, and skill.

  When blocks seemed insurmountable and another rewrite too daunting, Luke, Daniel, Matt, and Bekica have helped to keep everything in perspective, along with many friends of Bill W.

  And finally, thanks beyond measure to my friends Linda Grey, who brought her genius as an editor to the final rewrites of this book, and Eben Alexander III, M.D., whose remarkable gifts as a physician, surgeon, and scientist made the whole project possible. Whenever I needed neurosurgical facts or techniques, Eben was always there. Any errors or oversights are mine, and are doubtless due to my neglecting to review them with him.

  MSP

  PROLOGUE

  SYLVAN MAYS, M.D., STOOD BY THE VAST WINDOW OF his fifth-floor office and gazed out at the countryside, where late afternoon shadows were lengthening across the Iowa River. At fifty, he had just gone over ten million in net worth and was one of the few physicians who had actually seen his income increase since the advent of managed care. The decision to remain in Iowa had certainly been the right one. For sure, he had his detractors. Success always brought those. He was t
oo entrepreneurial, some said—a big fish in a small pond, too intent on building himself into a neurosurgical version of DeBakey or Menninger.

  What’s so wrong with that? he wondered. DeBakey and Menninger were world renowned and respected, doing good on a global scale. What was so wrong with wanting to emulate them?

  The gleaming seven-story Mays Institute for Neurological Surgery had put Iowa City on the map and brought millions of dollars in research and industrial development grants to the university. Now, his robotics team was closing in on a real prize—the first microrobot to be approved by the FDA for use in neurosurgery. A preliminary application had already been submitted. Six months, maybe less, and the few remaining bugs in the system would be worked out. As it was, he was revered for cranking through more brain tumor cases than anyone else in the country. Now, with several researchers on the robotics project, and Sylvan Mays’ name on every scientific article the group generated, he was gaining recognition as a top researcher as well.

  He checked his watch. Five minutes or so before Frederick Wilson was due. As with his previous appointment, Wilson had insisted on being the very last patient of the day. At first, Mays had been put off by his prospective patient’s demands. But what a find he’d turned out to be! Wilson was eccentric as could be, yet ready to reward handsomely anyone who did him good service. A quarter of a million in cash just for evaluating his case. Four times that when the surgery was completed, plus a healthy donation to the Institute. Wilson was the patient of a surgeon’s dreams, except that his tumor was bad—as bad as any so-called benign tumor could be. A slow-growing subfrontal meningioma with some extension, steadily compressing normal brain tissue. Progressive neurologic difficulty had begun. Now, the only choices Wilson had were surgery or a stuttering, inexorable death.

  Mays was sure he would be able to get to the tumor, but not without doing some damage—maybe a lot of damage. Then there was the actual dissection. He had probably excised more tumors like this one than almost any other surgeon in the world; if he couldn’t do it, it was doubtful anyone could. But even for him, the dissection would be chancy. Wilson had come to him impressively well informed, and had asked specifically about the robotics system. Rather than risk losing him to some other surgeon, Mays had chosen to tell him that employing the robot in the OR was possible, but not definite. By no means definite. Hadn’t those been his exact words? The exaggeration had been necessary initially. Now, it was time to back off.

  The trick, as with all cases like this, was to hang crepe—to stress the dangers inherent in the surgery and lower the patient’s expectations to the point where even a marginally successful operation would be welcomed as the work of a genius. The man had seemed reasonably easygoing and understanding enough at their first meeting, yet he was sharp, too. That much was certain.

  But so was Sylvan Mays. Until Mays had the chance to study the MRIs, he had refused to talk in anything but generalities. Today, though, they would have to get down to business—to go over the specific anatomical challenges and potential surgical stumbling blocks inherent in Wilson’s case. First, it would be necessary to dispel Wilson’s belief that the only way to reach his tumor was by means of a robot.

  Mays wandered over to what he thought of as his wall of fame—dozens of photos and testimonials from world leaders and other celebrities. “Neurosurgeon to the Stars,” one publication had dubbed him. “Brain Tumor? Head for the Cornfields,” another had headlined. “Is This Heaven? … No, It’s Iowa—Unless You Need a Neurosurgeon.”

  “It damn well is heaven,” Mays said out loud.

  He paced to his desk and hit the intercom.

  “Yes, Syl?”

  Sandy had used his first name. The waiting room had to be empty.

  “Mr. Wilson arrive yet?” he asked, just in case.

  “Not yet. There’s no one here at all at the moment. No one at all.… Hint, hint.”

  As always, Sandy Alter’s flirting over the intercom immediately turned Mays on. At thirty-one, she was a hell of a gal Friday, with an aerobics instructor’s body and a wicked imagination in bed. And even more exciting, after almost a year, she didn’t want anything from him other than a night or two a week, enough cocaine to elevate their lovemaking from great to sublime, and no talk about his wife or kids. Could life get any better?

  “I wish we could do it right now,” he said. “Tonight can’t come soon enough for me.”

  “Me either.”

  The stiffness inside Mays’ slacks intensified. At that moment, through the intercom, he heard the outside office door open and close.

  “Mr. Wilson,” Sandy said. “Nice to see you again.”

  The intercom was switched off, then on again, and she announced Wilson’s arrival.

  Mays positioned himself behind his desk, on which lay Wilson’s file, took a deep, calming breath, and asked Sandy to send him in.

  Okay, Sylvan, he thought. It’s showtime.

  Frederick Wilson limped into the office, a cane in his right hand and an elegant black leather briefcase in his left. He set the briefcase down, shook Mays’ hand enthusiastically, and lowered himself into one of the two mahogany chairs on the patient’s side of the desk. He was dressed as he had been on his first visit to the office—dark suit, conservative tie, white shirt. His thick gray hair was brushed straight back, and his beard and mustache—equally gray—were neatly trimmed. His intelligent dark eyes were partially veiled by heavy-rimmed spectacles with lightly tinted glass.

  As so often happened, Mays found himself seeing his patient with Superman-like X-ray vision, staring beyond Wilson’s face, eyes, and skull at the fleshy tumor that was infiltrating and displacing his brain. Poor bastard.

  “You’ve verified the deposit?” Wilson asked in a modest accent that Mays had decided was probably German or Russian.

  “Barclays Bank, Grand Cayman. In my name. Yes. Yes, I have.”

  “There will be no tax problems that way … for either of us.”

  Eccentric. Mysterious. Clearly a man of wealth and breeding, yet with no health insurance. Electronic cash transfers only. When the time came, Wilson would speak to Bob Black, the hospital administrator, and transfer funds for his inpatient treatment. But first, Mays had had to pass muster in an interview that lasted most of an hour. His background … his training … his family … his interests outside of medicine … his specific experience with the kind of tumor Wilson had … and finally, the status of his robotics research. Mays knew he had acquitted himself well, and was not in the least surprised when Wilson had called the next day to inform him about the money deposited in Grand Cayman and to formally accept him as his surgeon.

  “So,” Wilson said now, “I have offered money for a service and you have agreed to provide it. I have given you a down payment for that service and you have accepted. We have set a fee to you and to this institute when the service is rendered that will total well in excess of a million dollars, tax free. It seems, then, we have entered into a business arrangement.”

  “I … I guess I never thought about what I do that way before, but yes, I suppose we have.”

  “Excellent. Let’s talk about expectations, then.”

  “Yes. I think at this point that’s quite appropriate.”

  Mays straightened himself in his chair, cleared his throat, and met Wilson’s gaze with an expression that he hoped was sufficiently grim. Now was the time to begin to paint the picture of guarded pessimism. But before the surgeon could say another word, Wilson began speaking.

  “Given the benign nature of my tumor, and the magnificent qualifications, experience, and skill you have described, I expect nothing less than a complete cure. I expect to be speaking as well as I am now, to be walking without a limp, and to have full use of my senses and my intellect.”

  “But—”

  “I also expect to have no evidence of residual tumor on a postoperative MRI study.”

  “But—”

  “Is that clear?”

  Mays fe
lt a sudden chill.

  “I … I expect an excellent result, of course, but I can’t make those sorts of promises. No surgeon can.”

  “You’ve told me you are the best in the world at this sort of surgery. You told me your robotics system was capable of bypassing the usual route from my skull to the tumor.”

  “I said it was potentially capable of that, yes. But I also said our robotics project was still in the experimental stage.”

  “And you accepted my money without hesitation.”

  “Yes, but—”

  “Then I expect full satisfaction.”

  “I understand. However—”

  “Dr. Mays. Close your mouth, please, and listen carefully. I have not paid you a quarter of a million dollars to debate this point. I expect you to perform the way you have promised me you can. To guarantee that I get your best work, my people are currently observing your wife and daughter. When the day of my surgery arrives, they will be entertaining your family at a place of my choosing until I am safely out of danger, and your radiologist as well as one of my choosing has reviewed my MRI films. When I know that I am safe, unharmed, and free of tumor, your wife and daughter will be returned to you. They will be treated well, I promise you that.”

  Mays felt as if he were being strangled. There was nothing in Wilson’s manner or expression that suggested flexibility. The man must be insane.

  “I … I can’t agree to this,” he finally managed. “No surgeon can.”

  “Our arrangement has been established. I have the right to expect complete satisfaction. I have the right to recourse if you fail.”