“I’m sorry to catch you off guard,” I said. “I had a nice long chat with your secretary Tuesday, which is when she made the appointment. She sounded like she was right on top of things . . .”
I let my voice trail off briefly and gave him an eloquent look expressing my sympathies that he was at the mercy of someone incapable of so simple a task.
His smile was perplexed and his shrug didn’t amount to much. “I’m not sure what went wrong. She’s usually efficient.”
I said, “Ah, well. I know your time is limited so I’ll tell you why I’m here.”
“No rush. I have the morning free. What can I help you with?”
He seemed so relaxed and confident, I became curious what would happen when I mentioned Terrence Dace.
“I was hoping to talk about my cousin, who died week before last. I believe he was enrolled in a study you’re running, but I’m not sure if you’ll remember the name.”
“There are only forty participants in this phase of the study and I know most of them well,” he said. “If this is Terrence you’re referring to, I should tell you how sorry I was to lose him. Aaron Blumberg called as soon as he learned he’d been under my supervision.”
“I’m glad you spoke to Aaron. I was worried I’d have to start from scratch and explain everything. I know you can’t discuss my cousin’s health issues . . .”
“I don’t know why not. Aaron said he’d already gone over autopsy and lab reports with you, so you know about as much as I do at this point.”
“Well, I doubt that,” I said. “I have questions, but I don’t want to violate doctor-patient privilege.”
“I knew Terrence primarily in my role as researcher. I wasn’t actually his doctor if it comes right down to it. I can’t claim we had any long heart-to-heart talks, but I know he was a smart and talented man. Take a look at this.” He leaned to one side, opened his desk drawer, and removed a four-by-six-inch folio that bore Dace’s characteristic printing style, neat and uniform. He handed it across the desk.
“Roadside Plants of Southern California.” Like the other folios he’d done, the small hand-bound booklet was no more than sixteen pages. I smiled as I leafed through it. Some of the illustrations were done in pen and ink, and some in colored pencil; chokeberry bushes, wild cucumber, saltbush, and a plant called Nolina parryi identified by name. There were thirty or forty more. Each delicate drawing was accompanied by a brief description. “He gave you this?”
“I asked if I could borrow it. I don’t think he meant me to have it on permanent loan. You can take it if you like.”
“I would. Thanks. He left one of these to each of his children—different subjects, of course. I don’t know if you’re aware of this, but he was estranged from his family when he died. One of the reasons I came in was in hopes of taking away something that might soften the blow.”
“I knew his personal history through his group-therapy sessions. I think part of what motivated him was his deep shame at what went on in the past. I’m not sure how much of his struggle you were party to.”
“In all honesty, we never met. I found out we were related through a complicated set of circumstances, but he was gone by then.”
“He was a lost soul and I wish we’d done better by him.”
“When did he enroll in the study?”
“Might have been March. He was hospitalized for acute alcohol poisoning. The social worker referred him after he’d been through detox and rehab. This was meant as long-term support.”
“So you felt he would benefit?”
“That was the hope. Do you know anything about the study?”
I shook my head, not wanting to interrupt the flow. He was already more forthcoming than I’d had reason to hope.
“We’re looking at the use of three drugs in combination, one of which, Glucotace, we’re especially interested in. When Terrence came into the program, we explained we were running a random double-blind study and couldn’t guarantee which group he’d be assigned to. One group is given the drug. The control group receives a placebo.”
“That’s actually one of the questions I had for you,” I said. “He seemed to think the medication made him sick.”
Dr. Reed said, “So I was told. He was convinced he was on Glucotace. This was week one when we were barely under way. Fifty-fifty chance of it. Subjects aren’t told what medication they’re taking. Those of us conducting the study also operate in the dark. That’s what the term ‘double-blind’ refers to.”
“Really. You didn’t know what he was taking?”
“I do now. I’m not sure how familiar you are with research strategies. Since I designed the study and applied for the grant, I have a rooting interest in the outcome, as you might imagine. If we both knew he was on Glucotace, it might influence the questions I asked and the answers he gave. Even if I knew what he was taking and he didn’t, the outcome could be affected. We’re all suggestible in one way or another. A patient taking a placebo might actually get better because that’s the nature of the beast. What we believe affects our physiology. If we’re anxious, our heart rate goes up. If we feel safe, our respiration slows.”
“I’ve experienced that myself,” I said.
“In a clinical trial, our job is to render an unbiased account of test results. Some of this is based on blood work and other screening procedures, but some of what we track are the subjective reports from the patients themselves.”
“If he complained, would you have looked into it?”
“Of course. Absolutely. As you may know, Terrence did complain and we undertook a review. He was seen by three other clinic doctors, and all of us kept a close eye on his lab values and conducted regular physical examinations. If he’d suffered serious side effects, the symptoms would have surfaced.”
“So there weren’t any?”
“I wish I could reassure you, but he had a problem showing up for his appointments. Completely hit or miss.”
“Because of the medication?”
“This was a personality issue. We’re meticulous about outpatient monitoring, but we’re dependent on compliance. Without that, the numbers mean nothing.”
“Was he terminated or did he leave of his own accord?”
“We were forced to sever the relationship. We had no choice. I felt bad about it. He was a good man and we gave him every chance to straighten up. He couldn’t seem to manage it.”
“He had a friend named Charles Farmer.”
“I remember Charles. Same thing with him. He was another of those hard-core cases. Charles showed up for one of his exams so high, he could hardly stand. I have no idea what he was on, but I terminated him that day. Without reliable feedback, we might as well abandon ship. We can’t have patients taking meds we know nothing about. Even something as innocent as vitamins or nutritional supplements can skew results.”
“Were you alarmed that both men died within months of their enrollment?”
“Of course. That’s why I contacted the coroner’s office. I was concerned there was an underlying disease process hampering his recovery.”
“And was there?”
“Nothing any of us could pinpoint, including Dr. Palchek’s postmortem. Subjects aren’t always honest about their medical histories. A participant with unsuspected health issues could be at increased risk of an adverse event. We screen as rigorously as we can, but ultimately we can’t pick up every warning sign, especially if a patient is hiding something.”
“Earlier you talked about suggestibility. Are you saying that if Terrence was convinced he was on daily doses of Glucotace, the symptoms he experienced might have been, what . . . psychosomatic?”
“That’s not a term much in use these days. We’ve come to recognize that the effort to identify disorders as purely physical or purely mental is increasingly obsolete. Many physical illnesses have mental components that determine their onset, presentation, and susceptibility to treatment. Terrence Dace’s symptoms were real. The question under con
sideration has to do with their origin. That’s something I can’t help you with.”
“Understood,” I said. I realized I was fresh out of places to take the conversation and I was kicking myself for not bringing in a list.
“What else can I tell you?”
“I guess that’s about it.” I hadn’t pressed him on anything and it was clear I’d never make it as a hard-hitting investigative reporter. We’d covered the subjects superficially, but without anything specific in mind, I was reluctant to take up any more of his time. “Is there anything you want me to tell his daughter?”
“Convey my condolences. I can understand how devastating this must be.” He leaned back in his chair. “As long as I have you here, I hope you don’t mind if I ask you something.”
“Sure.”
“When Terrence left the program, he was asked to turn in any medications in his possession.”
“So I heard,” I said. At that very moment, I had the self-same vial of pills in my bag. My impulse was to avert my eyes, but I held his gaze, filling my head with innocent thoughts instead of the kind that were actually floating around in there.
“He’d just refilled a prescription. That’s one way we ensure conformity, insofar as we can do that with patients who aren’t under observation twenty-four hours day. According to the clinic pharmacist, he’d just picked up a week’s worth—fourteen pills. If you have any idea what he might have done with them, we’d love to know.”
My little lying self kicked in without missing a beat, an impulse predicated on the notion that it’s foolish to give up information that might prove useful at a later date. “No clue,” I said. “Do you know what the medication was?”
“I made a point of finding out. From a community-health perspective, it’s dangerous—worse than dangerous—it’s potentially fatal to have unidentified chemical compounds circulating among the homeless when so many are drug and alcohol addicted.”
I said, “I don’t know if you’re aware of this, but the morning he was found, someone walked off with everything he owned. Some of the items have turned up, but most of his personal belongings are gone. Maybe the pill bottle was in his cart.”
“I hope somebody had the presence of mind to toss it in the trash,” he said. “Addicts will knock back just about anything if there’s a chance of getting high, and most don’t worry about the hazards. If his medication turns up, would you let me know?”
“Of course,” I said. I glanced down at my shoulder bag and spotted the parking ticket from the lot outside. I pulled it out. “Could I ask you to validate this?”
“Certainly. Hang on a second.” He opened his pencil drawer and rooted around for a moment, finally coming up with a small booklet of stamps about the size of those the post office issues. I passed the ticket across the desk. He checked his watch and then tore out three small stamps that he pasted on the back. “These are fifteen minutes each, so you should be amply covered.”
“Thanks.”
He handed me the ticket. As I slid it back into my bag, I felt a quick jolt. I’d seen one just like it when I was pulling the crap out of Pete’s glove compartment. I looked sharply at Reed, but the phone rang just then.
He picked up. “This is Dr. Reed.” He listened for a moment and looked up at me. “Can I call you back on this? I have someone in my office.”
He listened. “Five minutes,” he said. As he hung up, he shot me an apologetic smile as though embarrassed to have to hurry me out the door.
I lifted a finger. “You’re the one who called me.”
“Come again?”
“June or July. Somebody called me looking for R. T. Dace. I don’t know how my number came to light, but I had a brief conversation with a doctor somebody. I didn’t catch the name at the time, but I recognized your voice just now.”
He shook his head. “Don’t think so. Not that I recall. I don’t believe we ever had a contact number for him. It might have been someone in the lab.”
“Oh. Well, maybe so. It stuck in my mind, but I guess it could have been anyone.”
I got up and slung the strap of my bag over my shoulder. “I better let you get back to work. Thanks for your time.”
“I’m not sure how much comfort I’ve provided. If the family have any other questions, I’d encourage them to get in touch. For peace of mind if nothing else.” He stood and we shook hands across the desk. This time his grip was ice cold and his palm was damp. “Again, my condolences. I liked him.”
“I appreciate your saying so,” I replied. I held up the booklet. “Thanks for this.”
“My pleasure.”
He smiled and resumed his seat, probably already thinking about the call he’d be returning as soon as I was out of earshot.
It wasn’t until I reached the door that I hesitated. “One more question if you wouldn’t mind. I know this is out of line and if you can’t or don’t want to answer, please say so.”
He watched me and then made a little gesture, indicating his willingness.
“You said you checked on his medications. Was he taking Glucotace or the placebo?”
There was a silence during which he regarded me without expression. I didn’t think he’d answer and I could see him weigh the issue in his mind. Finally, he said, “I don’t see any harm in telling you. The placebo.”
In the corridor, I paused for a short debate. Instead of heading for the exit, I returned to the clinic office. No sign of Greta. I reached over and picked up the appointment book, leafing back through the weeks as though I had every right. August: nothing. Tuesday, July 12: Pete’s name was penned into the 1:00 P.M. slot.
Walking back to the parking lot, I gave careful consideration to the exchange. Dace had signed himself out of St. Terry’s in June, after which he’d fled to Los Angeles. Dr. Reed had called me in hopes of finding him. Now he dismissed the incident. Plausible deniability is the term, I believe. Covering his ass was my take on it. What he couldn’t disguise was the shift from a warm to an icy hand. Slick as he was, he couldn’t control the physiology of fear.
• • •
I gave Ruthie’s front bell a twist and waited. She came to the door in a sweatshirt and jeans with a scarf knotted around her head. She had a dust rag in hand. “Woo. Come in. I could use a break.”
She stepped back and I moved into the foyer, saying, “I see you’re getting life in order.”
She closed the door behind me and I followed her down the hall. “I don’t know about that. I have two closets emptied, which I consider a triumph. I don’t suppose you have any use for forty-six neckties. I gave him every one of those and he wore the same two all the time.”
“No neckties. Sorry ’bout that.”
“Too bad. Some are nice. You got my message.”
“I was off to an appointment or I’d have picked up right then.”
“I hope I didn’t sound too cryptic.”
“I was properly intrigued.”
We’d reached the kitchen by then, which was much as it had been when I’d seen it last. Stacks of boxes, brown paper bags, and plastic bags filled to capacity, the counter littered with odds and ends.
She picked up the sack of birdseed I’d dropped off the day before. She held it in her right hand as though to illustrate a point. “So here’s how this went. I decided I’d fill the bird feeder. That was always Pete’s job, but I thought what the heck. Poor little things must be starving to death. I had a chickadee bang into the window glass yesterday and it about knocked itself out. Anyway, I get into the bag of birdseed and come up with this.”
She pulled her left hand from behind her back and held up a thick stack of bills folded in half and secured with a silver clip. The outermost denomination was a one. “He keeps small bills on the outside,” she said when she saw my look.
“How much?”
“I didn’t count. I figured if he robbed a bank, the cops would want to dust for prints.”
“You don’t really think he robbed a bank.”
“I don’t know what to think.”
“Didn’t he say he was setting money aside for a cruise?”
“He said whatever sounded good. He never had this much money in his life.”
I stared at her and then stared at the wad of bills.
Sheepishly, she said, “Okay, I did peek just a little bit. The bills on the inside are hundreds. Lots of them.”
She handed me the money clip. I sat down at the table and riffled the corners of the bills. “I’d say two or three thousand dollars.”
“That’s my guess.”
She took out saucers and coffee cups and filled both from a thermos. She put a small pitcher of milk on the table and set the sugar bowl close by. Then she sat down. “You know what bugs me? The bill collectors were hounding him. And I mean, hounding him. A lot of it was nickel-and-dime stuff. I’m not saying the bills weren’t overdue, but some were in the two- to three-hundred-dollar range. There wasn’t anything major, except maybe his back rent. It burns my ass to think how many debts he could have paid off with money like that.”
“You know how he was. I’m sure in his mind, paying bills wasn’t any fun. That’s why he avoided it. I’m sure he felt better saving for a trip, which was at least something positive.”
“Oh, right, and thanks a bunch, pal. I don’t know what I’m supposed to do with that plan.”
“If it’s any comfort, he probably hadn’t booked anything.”
“Be thankful for small favors.”
I put the clip of money on the table between us. “What are you thinking the source for this is?”
“You go first.”
“No, you first. You were married to him.”
“I think he was extorting money from someone. Mid-July, he told me business was looking up. He had some kind of job he thought might net him a paycheck. I think ‘a handsome chunk of change’ is the phrase he used.”