ELEVEN

Monk was slicing a banana over his bowl of Kellogg’s Mini-Wheats when the phone rang the next morning. He dropped the remaining banana into the cereal and grabbed the phone. His eyes widened when he heard who was calling. Dr. John Gordon, his primary-care physician at Georgetown University Medical Center.

“Yes, Doctor.”

“I just spoke with the radiologist about your MRI films. Do you have time to come by for a few minutes this morning?”

Monk felt a tingle climb up the back of his neck. “What’s the problem?”

“I have an opening at eight-forty-five.”

“What did you find?”

“I’ll see you at a quarter to nine.”

Dr. Gordon’s office was a small one, lit by a single large window behind the doctor’s plain wooden desk. The right wall was covered with books, the left with framed diplomas and certificates. Dr. Gordon went around the desk and sat. Monk took the upholstered armchair in front of the desk. The doctor was young—couldn’t have been much over forty—and that was one of the things Monk liked about him, that and the fact that he looked like a nerd. In his white lab coat, with his receding hairline and thick glasses, Gordon didn’t seem like the type to have messed around in medical school, and that was just fine with Monk.

This morning, however, he couldn’t help noticing that the doctor looked even more serious than usual as he gestured toward a large yellow envelope on his desk. Monk glanced at it, saw his name in black lettering, below his name the letters MRI in red. Monk looked at the doctor’s face, but Gordon wouldn’t meet his gaze. Monk felt a tightening at the top of his shoulders.

“What did you come up with?” he asked.

“Not enough, I’m afraid.”

Monk stared at him. His shoulders grew even tighter.

“The radiologist concentrated on the parietal and temporal lobes,” Doctor Gordon said. “Where we would expect early evidence of dementia … for pathology that might explain the symptoms you’ve reported. The good news is the films show no evidence of stroke or tumors.”

“And the bad news?”

“The radiologist did notice something that concerns him.”

Monk looked past the doctor, out the window at the tops of hemlock trees moving with the unusual morning breeze that was holding off the heat of the day. Is this how it happens? he wondered. Is this the way you get such news as this? Somehow—sitting in this drab little office with this drab little doctor—it didn’t seem nearly dramatic enough.

“New York University did a study,” the doctor said, “of markers for early detection of Alzheimer’s. They claim they can predict to a ninety percent accuracy rate which patients are at risk.”

“And I’m one of them.”

“Not necessarily. I only mention the study as a lead-in to what the radiologist wants to explore further.”

“What did he see?”

“The brains of patients with mental decline show a shrinkage of the medial-temporal lobe. About seven-tenths of one percent of its volume each year.”

“But this was my first brain scan. You don’t have a baseline to use for comparison.”

“That’s why we need to take the next step.” The doctor paused. “The films show that your medial-temporal lobe is undersized. Microscopically so, but given the symptoms you claim are getting worse—increasing forgetfulness, problems with concentration and everyday functions like remembering passwords and common vocabulary for your written reports—we think a PET scan is the way to go.” He paused again. “If for no other reason, to ease your mind.”

Monk sat forward in his chair. “Amyloid plaque. That’s what you’d be looking for, right?” He’d spent more than an hour on Google last night.

Dr. Gordon nodded. “The standard MRI you took can’t show it. To find the amyloid plaque, the radiologist has to use PBI, a dye he’ll inject, then watch as it circulates through your brain.”

“It sticks to the plaque. Highlights the plaque.”

“Exactly.”

Monk glanced at the diplomas on the doctor’s wall, then out the window again for a moment, before turning back to the doctor. “I’m only forty-five years old.”

“Your father died of complications from Alzheimer’s. How old was he at the onset of dementia?”

“Late fifties, I think, but I can’t be certain. We didn’t have much of a relationship.”

“You told me last time you were here, but refresh my memory. How long has it been since he died?”

“A couple of months, maybe three.”

The doctor glanced at Monk’s chart on his desk, at his notes from the last visit. “Almost seven months, actually.” He paused. “I have no training in psychiatry, but have you considered that your symptoms might be part of a reaction to his death?”

“Maybe for a few weeks. Not this long.”

“Perhaps not. And you’re considerably younger than he was when his symptoms started. You can look at the PET scan as a way to put your concern behind you.”

“What if I don’t take it at all?” Monk hesitated. “There’s no cure. What good would it do me to know?”

“Your medial-temporal anomaly could be congenital, could be indicative of nothing … You wouldn’t have to give it another thought. And even if we do measure further shrinkage, researchers are coming up with new discoveries every day. A cure could be found tomorrow. And you would have dodged a bullet.”

Monk studied his hands on the arm of his chair for a moment, before looking at the doctor again. “Would you do it? If you were me, would you do it?”

“As a doctor I’d like to think I’d trust the science.”

“I’m not a doctor.”

“I’d still do it. It might be a gamble, but I’d still do it.”

Monk chewed the inside of his cheek. A gamble. Ordinarily that would be all he needed to hear, but now? With this? No matter the payoff, some wagers were just too scary. This one sounded way too spooky. He opened his mouth to tell the doctor as much, but something else came out instead.

“When?” he asked. “How soon can I get an appointment?”

Even before he reached the Saab in the medical center parking lot, Monk knew the PET scan wouldn’t be enough. To prove to himself he wasn’t losing his mind to the disease that killed his father, he had to have something more than an examination of his brain. No matter how the test came out, he still had to make a living, and he couldn’t do it in a state of fear. The only way to beat the fear was to run headlong at it, to tackle it directly between the numbers, to dare it to kill him or leave him alone. And to do that required a massive test of his abilities, every one of his abilities. A wager bigger than anything a casino would ever allow him to make. He thought about such a wager. About what losing would do to him … and winning. Winning would literally make him well, would do more for him than any poker pot he’d ever raked across the table to his stack. As he thought about it, Monk’s stomach began to churn. The vibration seemed to expand in every direction at the same time, until he was giddy with it. But over the euphoria, an insistent voice in the back of his mind fought to be heard.

You’re actually considering working for NSA without telling your bosses? the voice was saying. Then why bother with the PET scan? Going after Sung Kim on your own is all the proof you need that you’re completely crazy!

Monk allowed the small voice to rattle on, but at the Saab he snatched the door open and reached for his phone. Philip Carter’s offer was good until noon, but there was no reason to wait any longer to get started.