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  He drifted back to the waiting room where Katie was looking bored and miserable. Josh was past fuming. He was exhausted, frustrated and ready to fight anything interfering with help for his daughter.

  At last, a nurse called them and led them down a hallway decorated with bright stencils of circus animals and child-sized furniture. “I don’t think a kid room is gonna work for you,” the nurse said over her shoulder. “Let’s use this one.” She ushered them into an examination room and closed the door.

  Seconds later, an impossibly young man with short dark hair breezed in carrying an oversize file. He wore a blue oxford shirt with the sleeves rolled up, a black plastic runner’s watch, khaki pants, and boat shoes. He ignored Josh, went straight to where Katie sat and knelt so that his face was level with hers and said, “Hi, Katie. I’m Doctor Pepper.”

  Katie grinned. Pepper thumbed the blue stitching on his white lab coat. “Seriously. Peter Pepper, M.D. Doctor Pepper—just like the soft drink they named after me.”

  Josh smiled. The guy was good with kids.

  Pepper continued, “Katie, we’re going to do some tests today to find out what’s going on with that leg. Your dad and I are going to talk for a few minutes then I’ll be right back. Okay?”

  Katie nodded.

  “Fingers crossed,” Josh whispered and instantly regretted it. How many times had he whispered the same thing to Sharon? Always whispered, for to voice such things aloud was to invite the notice of arbitrary and capricious forces. It was a fact that hospitals, beacons of scientific and technological progress, resurrected faith in the most primal fears and superstitions. ‘Fingers crossed’ had shown itself to be powerless. “Good luck,” he amended.

  Pepper led Josh to a brown-carpeted room where they sat at a small conference table. Josh noticed a book open face-down on a side table. It’s Time To Go: Preparing for the Death of Your Child. Josh scooted his chair closer to the doctor.

  “Mr. Gibbs,” Pepper said, “I’m sorry for the circumstances that have brought Katie here but I want you to know that I am optimistic.”

  “Good,” Josh answered cautiously. He felt himself relax.

  Pepper slipped on a pair of glasses and aged ten years. “When did Katie first start complaining of leg pain?”

  “Six week ago. I figured it was just something from soccer.”

  Pepper withdrew an x-ray film from a folder and snapped it onto a light box on the wall. “Yes, there it is.” Josh looked but had no idea what he was supposed to see and Pepper didn’t bother to explain. Pepper shoved the x-ray back in the file, fished out another film and slid it on to the box. “See that?” Pepper pointed to just below the knee.

  Josh couldn’t control his irritation. “Dr. Pepper, I didn’t see anything when I looked at these in Winston and I don’t see anything now. I am not here for an anatomy lesson. I am here to get some facts about what is wrong with my daughter.”

  Pepper raised his hand. “I’m sorry.” His face softened. “I’m not sure what Dr. Wright told you, but that isn’t at issue. My specialty is pediatric oncology. The orthopedic surgeons and I have looked at the x-rays and we agree. Your daughter has osteogenic sarcoma. It’s one of the most common bone cancers among children . . .”

  Chapter Nine

  The words fell on Josh like body blows and for a moment everything—the doctor, the room, time—stopped. Presently, he became aware of his thudding heart, his quickened breathing and the boy doctor saying, “ . . . it usually occurs in the long bones, just as it has in Katie’s leg.”

  Josh released his death grip on his chair arms. “I’m sorry . . . can you repeat that?”

  “I said osteogenic sarcoma in children generally presents in the long bones. Katie’s case is classic.”

  “How can you be so sure that’s what she has? Dr. Wright wasn’t sure.”

  “Dr. Wright was correct not to speculate before Katie was seen by a specialist. And there is always the chance that a biopsy will tell us our suspicions are in error. Believe me, no one wants to be wrong more than me.”

  “I think you most certainly are wrong.” Josh interrupted. He wasn’t going to sit idly by and accept what he was told. He was going to fight, starting with the diagnosis.

  “I have looked at a lot of x-rays and CT scans of this disease and I must tell you, I do not expect that outcome.”

  “If you’re sure, then why are we doing a biopsy?”

  “The primary purpose of the biopsy is to stage the disease—to see how much of the bone is affected and to determine if the cancer has spread to the other tissues.” Pepper spoke slowly and evenly. “The process is called metastasis.”

  Josh felt old wounds reopening, the sickness and poison oozing forth. “I’m all too familiar with the term, doctor. Now, tell me—”

  “The biopsy results dictate the details of treatment—what kind of chemotherapy and the nature of the surgery.”

  “It has to be chemo? Radiation won’t take care of it?”

  “We’ll know after we run some tests but typically I’d expect thirteen weeks of chemotherapy, followed by surgery to remove the affected bone and tissue, followed by thirteen more weeks of chemotherapy.”

  “That’s half a year.”

  “Could be less. Could be more. But that’s a good number to keep in your head. After that, there’ll be rehab, of course.”

  “Why ‘of course’?” Josh challenged.

  Pepper looked at him like it was something he already ought to know. “For a long time the standard treatment for this disease has been chemotherapy and amputation. Removing the entire extremity offers the best chance of excising all the cancerous tissue. More recently, we’ve developed techniques using bone grafts or artificial implants that allow us to save the leg in those cases where we can safely do so. In either case, Katie will require significant rehabilitation.”

  “But she’s a soccer player,” Josh protested, as if that would change things.

  “I wouldn’t think of that as a realistic expectation going forward.”

  Josh chafed that Pepper said it with such finality, offering no hope, as though this was an everyday setback, not the end of a way of life. “Doctor, you brought me in here and told me you were optimistic about Katie. Now you’re telling me she definitely has cancer, that you may have to cut off her leg, that we’re looking at a half year of chemotherapy—”

  “That’s just—”

  “A helluva lot of time in the goddam hospital, not to mention rehabilitation.” Josh felt the heat wash through him. “So what in almighty hell are you optimistic about?”

  Pepper set his jaw. “Mr. Gibbs, this is a first-class hospital. I have confidence in my training and ability. What I am optimistic about is that the orthopedic surgeons and I can save the life of your daughter. That is the priority here. My plan is to admit Katie this afternoon, have one of the orthopedic guys perform a needle biopsy to confirm the cancer and do a couple of scans. If it has spread, we start treatment right away. Those cancer cells are bad actors and once they start to metastasize, they’re a ticking time bomb. If the rest of the body is clear, within a week or so the surgeon will perform an open biopsy so we’ll know if we have a chance to save the leg. If there’s no chance, he amputates. If there is, she’ll get her first round of chemotherapy. Then, we’ll be fighting this thing.”

  Thoughts tumbled into Josh’s brain in no helpful order and spiraled away before he could get hold of them. To think forty-eight hours ago his chief worry had been that Katie might miss camp!

  These doctors—so unshakably confident of their diagnoses and their hospital and their training and their abilities—made his blood boil. In the end, all their promises and protocols, their degrees and high-tech gadgetry amounted to nothing more than voodoo witchcraft. Sharon had died. And now this pint-size Dr. Pepper was taking him down the same old path, pushing him. And they weren’t even
sure Katie had cancer. Nothing had been proven. “You won’t be doing that,” he said.

  Pepper’s expression froze somewhere between agog and aghast. “What do you mean?”

  “Doctor”—Josh was past being polite—“I don’t have to tell you crap. But since you ask, I’m not sure you have a clue what you’re doing. If your medical skills are as good as your communication skills, you suck!”

  “She’s my patient! This is a nasty, aggressive cancer. It metastasizes exceedingly rapidly. Time is of the essence! You can’t just—”

  “No, Josh shouted, “You can’t. That’s not just another case in the room back there. That’s my daughter. Got it? Mine. So I make the decisions. Not you. Me.”

  But for a knock on the conference room door, Josh might have slugged him. A nurse poked her head in. She looked first at Josh, then the doctor. “Everything okay?”

  “Fine,” Josh croaked. No wonder the nurse had come running. He must have been shouting to high heaven.

  “No problem,” said Pepper.

  The nurse left. Pepper slumped in his chair. After a minute, he said, “I shouldn’t have yelled. I apologize. Sometimes I forget that when a kid is sick, the parents are patients, too.” He pushed his glasses to the top of his head, and sighed. “How’s your wife doing with all this?”

  “She’s dead. She doesn’t feel a thing. Two years ago. Breast cancer.”

  “Oh Christ.” It emerged as a single word. “I’m so sorry for . . . everything. I didn’t know you had a history.”

  “Of defeat.”

  “I have faith we can make this one turn out differently.”

  Josh remembered how it had been with Sharon—the constant worry, the clinging even to the faintest hope, and the endless rounds of chemo followed by sickness and suffering. And finally death. Since then, faith was something he’d done without. Facts were what counted, answers what he needed. “I need to make a phone call,” he said.

  “Of course. Have the nurse find me when you’re done.”

  Pepper was barely out of the room before Josh was on the phone to Allison. “This guy’s screwed up,” he said, pacing. “I don’t think he knows what he’s doing.”

  “His reputation is one of the best in the business.”

  “Then I’d hate to see the worst. We haven’t done any tests but he’s pushing me to admit Katie today.”

  “If she’s sick, the clock is ticking.”

  “Her soccer camp starts Saturday.”

  “Let’s cross one bridge at a time. Have them do an MRI and bone scan. They’re relatively fast, painless and I predict it’ll tell us that whatever’s in the leg hasn’t spread. Follow that up with a core needle biopsy. It’s going to hurt some but she won’t have to be admitted and it’ll tell us if it’s cancer and what kind. They’ll have the results in a few days. We’ll figure out soccer camp from there.”

  “Will do.” Josh hung up, called the nurse and sat at the conference table. Pepper arrived a minute later.

  “You have a remarkable daughter. She’s very mature for her age, very grounded.”

  “She hasn’t had much of a chance to be a kid.” Seated, Josh felt like he was begging. He stood so the two men looked eye-to-eye. “Pepper, here’s the deal. Do an MRI, a bone scan and a needle biopsy. If there’s no cancer or if it hasn’t spread, she goes to camp. If there is cancer, I’ll bring her directly here at the end of camp.”

  “No,” Pepper said. “She goes to camp only if she’s clear.”

  Josh decided to let the matter drop. With any luck, it wouldn’t be an issue. He paced in the waiting room while Katie, dressed in a hospital gown adorned with the children’s hospital mascot giraffe, was pushed off for her MRI in a wheelchair. He caught his next glimpse of her through an open door ninety minutes later as she rolled by on a gurney, covered to her neck by a green sheet. A tube ran from a plastic bag suspended over the gurney to a needle in her left arm. A nurse walked alongside.

  Josh sprinted into the hallway and caught up. The gurney kept moving. Josh kept pace. He took Katie’s hand. “Hey, sweetheart. How’s it going?”

  “Fine. The hardest thing was staying still. But they gave me headphones so I could listen to music.”

  Josh caught the nurse’s eye and nodded to the bag. “What’s that?”

  “Technetium ninety-nine. It’s a tracer that accumulates in damaged bone so it shows up on the gamma camera scan.”

  “It’s radioactive,” Katie volunteered from the gurney.

  “It is,” the nurse confirmed. “Perfectly harmless. Half life of about four minutes. Got to keep moving.”

  Josh dropped back as the gurney picked up steam.

  He insisted on being present during the needle biopsy. Katie lay on the gurney, only her face exposed. A nurse pulled back the green sheet, swabbed the leg with Betadine and secured it with a Velcro strap. Josh took Katie’s hand. An orthopedic surgeon appeared, selected a syringe from a tray, palpated the area just below Katie’s knee, and gently inserted the needle. Josh winced. Katie looked the other way. The surgeon removed the needle a few seconds later.

  “That’s it?” Josh said hopefully.

  “That’s lidocaine. We’ll let it freeze this knee and be in and out in a flash.” The surgeon began to hum “Frosty the Snowman.”

  He reached for another needle, this one much larger than the first. “Fourteen gauge should do it,” he mused. He slid the needle into the flesh just below Katie’s knee.

  Katie cried out, “Dad, you’re hurting me!”

  Josh realized he had Katie’s hand in a death grip.

  The surgeon withdrew the needle. Josh heard a click. The surgeon plunged the needle in again.

  Chapter Ten

  “Pfizer man’s here.”

  Allison marked her place in the Atlas of Dermatology. Coretha stood in her door. “Skip the Viagra samples but get as much of the Lipitor as you can.”

  “You told him last time you’d eat lunch with him.”

  Allison groaned. Drug company sales people made a practice of providing lunch to busy physicians and their office staffs just to get a few moments to talk with them about the latest wonder drug and to leave samples. In many offices, it was a tradition—the Pfizer man on Mondays, the Merck woman on Wednesdays and so on. The Winston Medical Clinic had few pharma callers and Allison couldn’t have cared less about the ones who did show up. But samples allowed her to provide medicines to her many patients who could not afford them. Lunch with the drug rep came with the territory.

  At the moment, however, she couldn’t even think about eating. She’d almost vomited when she removed the sock of fifty-eight-year-old Wanda Faggart, her first patient Monday morning. The putrid smell of the black, oozing, gangrenous fourth toe on her right foot still clung to her nostrils. On top of that, the call from Josh in Columbus had left her stomach churning.

  “Apologize to him for me. And don’t forget to get the Lipitor.” Allison returned to the medical text and found a section dealing with what she had observed in Faggart: a large necrotic ulcer with overlying exudate and surrounding erythema, edema, and eschar formation.

  But what had caused the death of the tissue? She turned to her computer and searched her medical sites for causes. There were plenty, from vasculitis to streptococcal infections to a dozen different syndromes and phenomena. But occurrences were extremely rare. In all her prior practice, she’d never seen a single case where the cause wasn’t immediately apparent. Now, within days, she’d seen three cases of tissue death in otherwise healthy people. Scruggs’s nipple ring involved a piercing. He had done it himself. Streptococcal bacteria on the instrument was the presumed cause. In the case of Faggart’s toe and the woman with the infected ear—Audrey Pringle, according to the file she’d retrieved—dirty instruments could not be blamed. Still, she couldn’t shake the feeling that the incidents were related.
But how?

  She remembered another patient, the woman with the tongue piercing. She buzzed Coretha. “Bring me the file of that that woman whose boyfriend beat her up last week. Sugar something.”

  “Candi. Candi Cloninger.”

  “Right. The one with the black hole on the x-rays.”

  Allison reread her notes. Cloninger had shown swelling and blood near the tongue piercing. Allison had attributed it to the beating. Maybe it was something else. An early stage of what she was seeing in her other patients? She withdrew an x-ray of Cloninger’s skull with the black void in the middle as if there were no bone in the way. “What’s the word from the company about checking the machine?” she asked.

  “They can’t get a tech here until Wednesday.”

  “Wednesday? We need to know before then.”

  “Is there a way we could do our own test?”

  Allison thought about it. “Can’t hurt, I guess.”

  “Start with a fresh box of film in case there was something wrong with the last one.”

  A new box was lying on the counter. Allison opened it and took three views of Coretha’s wrist and hand.