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A MARK ANGELOTTI NOVEL
By LYNNE RAIMONDO
Prometheus BooksCopyright © 2014 Lynne Raimondo
All rights reserved.
Melissa Singh was good at her job. In my dealings with her so far she had proved both mercilessly inquisitive and a shade less friendly than a Rottweiler. The interview was now in its second hour, and I was feeling the strain. Once I would have given my right testicle for this opportunity. Now I was having second thoughts.
"When did you first notice the symptoms?"
"Two years ago. In the fall."
It wasn't one I was likely to forget. "September sixth."
Melissa spoke in the clipped, efficient tones of a BB C newscaster, without a hint of her native Hindi. I figured she'd lost the accent while doing her postdoc at Cambridge. Nurse Ratched didn't square with the surname, so I'd conjured up something more Bollywood. Dark hair, kohl-lined eyes, combat boots peeking out from under her sari. Either way, I was sure she was scowling at me.
"In the morning, when I woke up."
She took this down, tapping rapidly on a tablet. "What were you seeing then?"
"When I looked out my left eye, there was a blurred area in the center. A scotoma, to use the technical term."
"And you'd never had a problem like it before?"
"Yet you didn't seek help immediately."
"It didn't seem all that serious at first."
"Really?" Melissa said. I imagined an arched eyebrow and pursed, plum-colored lips. "What happened to make you change your mind?"
"Later, that evening I, uh ... almost got into a traffic accident."
"Yes. It says in your application that you didn't notice a traffic light turning red."
"So that was your first red flag."
"Well, to be accurate, at the time I thought it was green."
She didn't seem to find this funny. "So the next day you went to see Dr. Turner."
I nodded and took a sip of water from the paper cup to my right. I'd been through this routine before, but always on Melissa's side of the table. I was starting to understand what it felt like to be a laboratory rat—except that rats didn't have to cough up their entire life stories. The night before, I'd listened once more to the information packet Melissa had sent me in the mail. The number of cheerily dispensed lies was breathtaking. Before being accepted into the study, you will be asked a number of questions. These questions are not meant to intrude upon your privacy. It depended on how you defined privacy. Their purpose is to provide you with the information you need to make an informed choice. Anyone who believed that should invest all their money in savings bonds.
"Doctor, are you listening?" Melissa asked impatiently.
I snapped back to attention. "Sorry. I was just remembering something I have to do today. Back at the office."
The hint was wasted on her. "I was asking about your vision at that point," she said.
"The right eye was still fine. The left was almost completely clouded over."
"That's an unusually rapid progression," Melissa observed.
Turner, my neuro-ophthalmologist, had thought so too. He'd acted like he couldn't wait to write me up in a journal article: "An Atypical Late Onset Case of Leber's Hereditary Optic Neuropathy (LHON)" featuring lurid color slides and a menu of nonexistent treatment options.
"All right then," Melissa continued. "It says here that Dr. Turner administered blood tests. Do you recall the results?"
"They revealed a homoplastic DNA mutation at G11778." In other words, a defective gene I'd inherited from my mother, one of several associated with a sudden shutdown of the nerves that channel information from the eye to the brain. When it strikes, which isn't always, it tends to afflict males in their twenties, though I had managed to pull off the feat at the ripe old age of forty-six.
"Did you question that finding?" Melissa asked.
"No, is there any reason I should have?"
"Only that when I spoke to him Dr. Turner thought you reacted rather strangely. According to him, you exhibited 'unnatural calm' upon hearing the results."
"I was in shock." That was true to a degree. I probably would have fainted dead away if I hadn't been busy concocting my own differential diagnosis, which assuredly did not include living out the rest of my days like Long John Silver's crewmate in Treasure Island.
"What did you do then?"
"I went home. To rest."
In fact, I'd gone straight to my usual watering hole, the Lucky Leprechaun, and gotten blind drunk, a warm-up I was to repeat many times over the following weeks. Luckily, the barkeep knew me well enough to sound the alarm, and my colleague, Josh Goldman, had come to collect me before I succeeded in passing out.
"Did you tell anyone about the diagnosis?"
"A friend." After I'd puked all over the interior of his new BMW 3 Series, it seemed only fair to let Josh in on the breaking story. It was the only time I'd seen him genuinely depressed.
"Is that all?"
"Well, naturally, my boss. I didn't think I'd be able to work for a while." Septimus Brennan, my department head, had listened unhappily but with the brass-tacks efficiency of a shrink in his fifth decade of practice. He wanted to hook me up immediately with a dozen specialists, but except for the obligatory second opinion, I turned down all of his proffered interventions. Too risky.
"No family members?" Melissa pressed.
"None that I'm close enough to," I said, fingers crossed.
It apparently worked. "Tell me about what was going on in your life immediately before," Melissa asked. "Were you eating and sleeping normally?"
"As normally as anyone in our line of work."
"Did you smoke?"
I shook my head.
"I consider myself a social drinker."
"Were you under any stress at home or at work?"
Remember that withholding facts from the research team can skew study results. "Not really."
"And the next event occurred when exactly?"
"About a month later." Twenty-one days, four hours, and fifty-seven minutes later, if she really needed to know.
"What did you do in the interim?"
What did I do? Good question. When I wasn't drowning myself in bourbon or trashing my small apartment, I made bucket lists—A Thousand Things to See before You Go Blind—that I knew were pure fantasy. There were places in the world I'd always meant to travel to, but the majority were in countries where I didn't trust the medical care (despite the fact that they were home to half the residents in my hospital) or my odds of getting home in one piece when—if—it happened. Bike trips were out for the same reason. With my luck, the lights would go out just as I was rounding a hairpin turn in the Rockies or in the middle of rush hour on the Golden Gate Bridge. If I were going to commit suicide, I could think of many less painful ways to do it. The Art Institute was only a short walk away, but I wasn't up to viewing bucolic scenes of French country life or catching a glimpse of The Old Guitarist. There was only one face that I needed to remember, and I handled his photo until it was ready to fall apart.
On the few days when I could stand to think about my future, I purchased a couple of the "top-ten products for independence" touted by a local blindness organization—a talking clock, a kitchen timer with raised dots, a set of powerful magnifiers (the last being entirely wishful thinking)—that I thought might help me get through the first few weeks. I even ordered a free white cane, though when it came in the mail and I checked it out in front of a mirror, I'd gone weak at the knees and hurriedly shoved it into the back of a closet. With hindsight, there was so much more that I should have done, would curse myself later for not doing, but I was still in the throes of magical thinking. And so, when the day of reckoning finally came, I was about as ready to play in the big leagues as a boy who's just hefted his first Louisville Slugger.
I didn't crack right away. There's a novelty element to losing one of your major senses that for a while had me simply wandering around my apartment, trying on the experience like a bespoke suit and allowing me to think it just might be manageable. The slippage started a few hours later, and by nightfall, I was a flat-out wreck, hugging my knees and weeping in a corner. I'd been on my own for most of my life but this ... I felt like Burgess Meredith venturing out into a postapocalyptic landscape, utterly alone and without even the solace of a good book to keep me company. If it hadn't been for the alternate reality I'd dreamed up in Turner's office, I probably would have ended it there and then.
I didn't tell any of this to Melissa, of course. Instead, I fed her some professional-sounding nonsense about loss and mourning, throwing in enough fabricated detail to make it seem like I was telling the truth. It must have succeeded, because when I was through she said, "I think we can move on now."
I breathed an enormous sigh of relief.
"I have to be frank," she continued in her prickly manner. "When you first contacted me I didn't think you'd be an appropriate candidate. Most of the success we've experienced overseas is with subjects who've only recently been diagnosed. The drug seems to work best as an early intervention, and your case is, well, rather past that."
"I know that," I said, trying not to sound too eager.
"If we include you it will be for two reasons. First, because the affected population is so small. And second, in order to test whether mild improvement is possible even in LHON sufferers who have been blind for several years. You shouldn't expect much, if anything, to come of it."
I nodded. What she was leaving out was that nearly a quarter of the subjects like me achieved enough visual acuity by the end of the trial to read a few letters off an eye chart.
This is as good a place as any to explain that what I'd ended up with, while not as bad as it could have been, was on the low end of the VI spectrum. Depending on my surroundings and the time of day, I could make out bright light and shadow, the fuzzy presence of large objects, and the occasional hint of color—the last primarily from the corner of my right eye, where I retained a sliver of peripheral vision. When forced to offer details, I told people it was like looking at the world through a sheet of wax paper. Under the circumstances, I'd consider it a victory just to be able to see an eye chart.
"And, of course, the study will be double-blind, meaning neither you nor I will know whether you are receiving the drug or a placebo."
"I can live with that," I assured her.
"Can you? For some the stress of not knowing one way or the other takes a heavy toll. And if you're in the placebo group, there could be a huge let-down at the end. I see from your application that you've been consulting a psychiatrist."
"Yes, but not because of anything having to do with this." I gestured at my eyes. "I can live with what I have. I'd just like to have a little more."
"I see." I took this to mean she wasn't convinced, so I poured on the sincerity.
"Listen, Melissa—I mean, Doctor Singh—I know you take your job seriously, and that you're concerned about all aspects of my well-being. I would be too if I were in your boots—I mean, shoes. But I'm well-adjusted to my condition and a psychiatrist besides. I'm sure I'll be able to manage the uncertainty, and if it becomes too much I'll know where to go for help."
"That's comforting," she said, as though I'd just offered her a discount on aluminum siding. "But I still have to be concerned about data loss. The manufacturer is anxious to obtain FDA approval with this trial."
I understood what she was getting at. Withdrawal from a clinical trial—either because of side effects, unpleasant study procedures, or simply because a participant doesn't feel any better—is a major headache for medical researchers. Dropouts produce biased comparisons that can drastically alter the outcome of a study or reduce its statistical significance. I assumed this was the reason for the grilling Melissa had put me through: she was trying to decide whether I had the guts to stick out the program.
"You don't have to worry about me copping out," I said. "I'll be your guinea pig for as long as you want me. If nothing else, I'd feel a responsibility to my fellow LHON sufferers—as you call them—to complete the treatment."
I was beginning to sound like a Boy Scout.
"Very well, then. I'll be meeting with the sponsors later today and should be in a position to tell you soon whether you've been accepted. Given some of the heavyweights lobbying for your inclusion"—I visualized more scowling—"I'm not anticipating a negative response. We'll have to meet again to go over informed consent, but assuming all goes according to schedule"—shedyule—"we should be able to commence treatment on the fifteenth."
September 15. Less than one week away.
* * *
When I left Melissa's office it was half-past noon and I hadn't eaten all day. I had an hour to spare, so I walked over to a pizza joint on Rush that serves the real stuff, not the Chicago version that comes in soggy three-inch squares and tastes like cheese curds. I was a regular, so as soon as the manager saw me he put in an order for a Margherita and steered me to a table in a corner where I could more easily stow my cane. I loosened my collar and tie, sipped at my water, and felt some of the tension ease out of me.
I can live with what I have. It was true up to a point. On a good day I barely gave a thought to what I was missing and had few excuses for feeling sorry for myself. I wasn't in a black hole. I could still see something, and my former photographic memory made up for a lot of the boredom that otherwise goes hand in hand with vision loss. Stepping off a curb no longer felt like bungee jumping in the Grand Canyon. Thanks to all the geek brains volunteering to solve my problems, I was more independent than ever. My new smartphone had apps for detecting the value of paper currency, for reading items off a menu, even for telling me when my socks were mismatched. Hell, the way the technology was headed, it wasn't crazy to think that one day I'd be behind a wheel again.
But there were also bad days. Days when I had to ransack my home to find where I'd left my keys, or been hijacked by one of the Good Samaritans lurking at crosswalks, or had to answer one too many dumb questions. ("How do you know when you're awake?") On bad days even the small frustrations—walking into a closed door, knocking over a drink—multiplied until getting out of bed the next morning seemed as pointless as scrubbing the bathroom tiles with a toothbrush or walking back and forth over hot coals. How much of this had to do with blindness, as opposed to all the other things on my plate, I couldn't tell you. But it made the possibility of even a small uptick in my fortunes all the more appealing.
Still, I wasn't naive about my state of mind. Hope is a powerful stimulant, and when the e-mail came announcing the US trial of a new drug that had shown promising results in the Netherlands, I was on the phone before I even reached the end of the subject line. To say I bullied my way into Melissa's study was putting it mildly. I called in every favor I was owed, including a major arm-twisting campaign by my boss, Sep, who played golf with half the hospital directors in the city. He wasn't wholeheartedly in favor, but couldn't say no after getting me involved in a case that had almost cost me my life. My friend Josh was even more downbeat, concerned it would undo all of the progress I'd made over the last year.
"Aren't you going to feel like shit if it doesn't work out?" he'd said to me recently on one of our Sunday forays to Jewel, the supermarket being one of the few places where I capitulated to the advantages of being guided. "You're better these days than I've seen you in a long while. You've got a great kid and an ex who's talking to you again. You have more work than you can handle, especially with all the lawyers knocking at your door. Why take a chance?" He pushed our grocery cart forward.
"You do realize that we're talking about something that might let me see again?"
Excerpted from DANTE'S POISON by LYNNE RAIMONDO. Copyright © 2014 Lynne Raimondo. Excerpted by permission of Prometheus Books.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Most Helpful Customer Reviews
4.25 stars-DANTE’S POISON is the second instalment in Lynne Raimondo’s contemporary, mystery Mark Angelotti suspense series focusing on sight impaired Chicago psychiatrist and amateur investigator Mark Angelotti. Although this is the second book in the series, each book focuses on a different investigation and case with some of the characters over lapping between the stories. The premise follows Mark as he investigates the murder of the Chicago Sun Times sleaze ball reporter Rory Gallagher and his connections to a controversial antipsychotic drug known as Lucitrol. When power attorney Jane Barrett (and Rory’s lover) is fingered and charged with the murder, Mark’s path of clues will find him the subject of an attack that will leave his friend Hallie in a coma and Mark setting his sights on a billion dollar drug company with too many secrets to hide. Add unethical and questionable sales reps and, Mark will soon discover that he is closer to the truth than he had ever surmised. Our hero Mark Angelotti is a man who is mired in guilt-struggling with the demise of his marriage, a son he barely knows, the loss of his eye sight and a guilt so dark he will never be able to forgive or forget. Lynne Raimondo pulls the reader into a storyline that is richly detailed in psychiatric and medical terminology-from bio medical ethics to prescription side effects; from diagnostics to treatment DANTE’S POISON is a storyline that focuses on corporate greed, big pharma, psychotic killers, jilted lovers, betrayal and revenge. The Windy City of Chicago is not one to play second fiddle and positions itself-front and center-in a storyline that will find our intrepid sleuth making his way through the sights and sounds of a city where he loves to live. The secondary characters are an eclectic mix of friends from both the medical and legal fields. The world building finds Mark taking small steps towards a potential future all the while focusing on what he has lost and why. DANTE’S POISON is a remarkable storyline that looks at the controversial side of prescription medications and medical ethics; an imaginative tale about a sociopathic mind and the lengths one will go to to avenge the past; and an intimate look at a man whose own past is darker than the world in which he now lives.
I read and loved the first book in this series, Dante's Wood. Dante's Poison is a fine follow-up---twisty, turny, complex until all the threads come together. I would still recommend reading DW first to have the full story of Mark's blindness and family regrets, but this book made Mark more real to me. He's less angry, more human. I can see rooting for this character for a long time, through many books.