CHAPTER TWO: TAKING CARE OF BUSINESS
DOCTOR HEMPSTEAD’S BLONDE receptionist chomped her gum loudly as she stared blankly into Jonas’s eyes.
“Doctor Hempstead can see you . . . uh . . . like at 4:30,” she said in Valspeak, a distortion of English he associated with stupidity, ignorance, and being lower class. “It’s been, like, you know, basically a totally crazy day.”
Jonas looked at his Breitling. It was ten minutes past four. Earlier in the day he had bullied his way into getting an appointment at 4:15.
“I was told the doctor would see me at 4:15,” Jonas said firmly; it was a statement, not a question. “And I will be seen at 4:15 as promised.”
The girl looked scared. She was nineteen years old, the daughter of one of Stan Hempstead’s family friends, and had been working for only two weeks.
“I’ll, like, talk to the doctor,” she said.
Jonas suppressed a smile when he noticed her hands were shaking. He was always amazed by the reactions he could incite using only his words.
“Inform Doctor Hempstead that if I’m not standing in his office by 4:17, I will leave this insufferable place, and the next conversation he’ll have will be with my lawyer,” Jonas said icily.
The receptionist vanished into the nether regions of the office.
“He’s totally upset and threatening to leave,” he heard her say in a loud whisper. He strained his ears but couldn’t make out the muffled reply.
Jonas again checked his watch: 4:15 on the nose.
The girl returned to her desk, looking paler than when she’d left. She had stopped chomping her gum.
“The doctor will see you now,” she said.
Jonas didn’t say a word. He brushed past her and walked back into Dr. Hempstead’s domain.
“Jonas,” Dr. Hempstead said meekly from behind his desk. “I’m terribly sorry we have to meet this way. Wendy was a delightful woman, and I’ll miss seeing her.”
Jonas ignored the doctor’s outstretched hand. His mind raced—he had spent the past week locked in his office, arming himself for this conversation.
Doctor Hempstead rose. He was a fussy, paunchy man who looked like somebody who should have retired five years earlier. His tweed jacket and dual-colored bow tie scream 1970s Ivy League—undoubtedly when and where he completed his so-called training, Jonas thought.
“I reviewed the material my lawyer persuaded you to send,” Jonas said, as Dr. Hempstead collapsed back into his chair. “But if Wendy was suicidal—and obviously she was—then why didn’t you prescribe a drug that worked?”
Doctor Hempstead didn’t look as intimidated as Jonas would have liked. He had spent forty years dealing with ornery patients, and with the ornery husbands and wives of these patients.
“Your wife was suicidal because she was intensely unhappy in her marriage,” Dr. Hempstead said bluntly. “And she missed working at the university. It was her life, and you took that away from her.”
“That’s only your opinion,” Jonas said, a flash of anger in his eyes. “Now, what about that useless medicine you prescribed her?”
“I don’t know why the fluoxetine didn’t work,” Dr. Hempstead said. “People are different, and they react differently to different drugs.”
“Why didn’t you test her genotype?” Jonas asked. “Her genotype made it impossible for her to process the drug you prescribed.”
Hempstead looked genuinely surprised by Jonas’s question.
“We never test a person’s genotype,” he said. “The truth is, most people respond to treatment, and we change medications or dosages only when we see that a drug isn’t working.”
“Wendy wasn’t ‘most people,’” Jonas said.
“For most medications, it takes eight to twelve weeks before we see an effect,” Dr. Hempstead explained. “Psychiatric medicine relies heavily on clinical judgment, and there’s necessary trial and error needed when prescribing drugs and treating patients.”
“Trial and error sounds like a lazy person’s way out,” Jonas growled.
“I was hoping our therapy sessions mitigated your wife’s depression,” Dr. Hempstead said. “And for what it’s worth, insurance doesn’t pay for diagnostic genotyping. But, even if it did, I wouldn’t have changed my prescribing decision.”
“Your slipshod, trial-and-error approach cost my wife her life,” Jonas said, leaning across the desk so aggressively that Dr. Hempstead squared his fists. “You prescribed an antidepressant that requires a specific enzyme for processing for it to be effective.”
“I see you’ve been doing your homework,” he replied.
“You could have played it safe,” Jonas insisted, slamming his hand on top of a large psychiatry textbook. “You could have selected a drug that doesn’t require CYP2D6 to be activated. You could have prescribed escitalopram.”
Dr. Hempstead didn’t flinch at the sound of Jonas’s thump. “I start all my patients on fluoxetine,” he replied calmly. “It’s the best studied and most understood antidepressant. It’s also relatively mild, so there aren’t any horrendous side effects. Some of the newer antidepressants cause weight gain, sexual dysfunction, seizures, and a smorgasbord of other effects.”
“I have money,” Jonas insisted. “Lots and lots of money. I don’t care about the cost. Why wouldn’t you test her? Wendy is a CYP2D6 hyper-metabolizer who could never have had any benefit from that drug to save her life.”
Dr. Hempstead wondered for the first time if Jonas was carrying a gun.
“You gave my Wendy the equivalent of a goddamn placebo,” Jonas continued, once again pounding the cover of the textbook.
“We never test patients,” Dr. Hempstead said for the second time. “And we never do pretreatment diagnostic testing because we have to assume that a patient will respond to the medication.”
“A philosophy out of the dark ages,” Jonas said.
“Psychiatry isn’t simple,” Dr. Hempstead said. “I am very sorry that Wendy is no longer with us . . . but the truth is that in my medical opinion, I doubt that even a different drug would have prevented her suicide.”
Doctor Hempstead could tell Jonas didn’t believe a word he was saying.
“Your wife was extremely depressed,” Dr. Hempstead added. “She even thought about divorce . . .”
“Nonsense,” Jonas declared, his rising blood pressure pounding like a jackhammer through his temples. “Ignorance isn’t a legal defense in this country. Stupidity and dogma are inadequate reasons to put a person’s life at risk.”
Dr. Hempstead rose for the second time. “Jonas, I think you should leave now,” he said. “Nobody and nothing could have saved Wendy.”
“You could not be more wrong,” Jonas said, “you incompetent, ignorant, ugly anachronism.”
“Sticks and stones,” Dr. Hempstead said, guessing that if Jonas did have a gun, he was likely a dead man.
“Furthermore, you are a vile murderer with a license to kill,” Jonas said. “You’ll regret that you didn’t test my wife. You and your entire psychiatrist brethren.”
Dr. Hempstead’s pupils dilated. Jonas sensed actual fear in his eyes. Convinced nothing more was to be gained, Jonas wheeled on his heels and stormed out of the office.
“Have a nice afternoon, Mister von Gelden,” the blonde receptionist called to him.
Jonas ignored her and everybody in the waiting room, striding out and slamming the door behind him.
THE NEXT AFTERNOON, JONAS called the vice president of Sierra Santé and informed him he wouldn’t be coming into the office until further notice, because of a family emergency back in France.
There was no family emergency back in France. Instead, Jonas hung up the phone and walked out to his car—today, he had depressingly dubbed “shopping day.” He hated shopping more than any other activity on Earth, but today it was a necessary evil. He drove slowly and somberly to the dreaded strip mall, buying all the supplies he would need for the next two weeks—food, whiteboards, pens, a new computer and printer, and several reams of paper.
Jonas arrived home at six thirty, exhausted but exhilarated. He unpacked his groceries, organized his supplies, set up his computer and printer, then collapsed into bed with a massive headache and his body overflowing with rage and adrenalin.
The next weeks are going to be the beginning of something transformational, Jonas thought, as sleep overcame him.
Awful, terrifying, and horrific . . . but also satisfying.
JONAS’S FIRST ORDER OF business was to investigate the current state of personalized medicine. He’d discovered in his online searches that everything Anne had told him was true. His most important discovery was PubMed, a website where he could search for medical articles. On a lark, he researched how long it took for the field of medicine to accept changes in a treatment protocol. To his horror, he learned it took an average of seventeen years for translational research to move into clinical practice. For example, the importance of liver enzymes in drug metabolism and human variation had been discussed as far back as 1994. Diagnostic tests followed soon thereafter.
Jonas’s challenge was defined. He wasn’t going to wait for medicine to catch up with the literature. He was going to accelerate the long overdue transition himself. Personally.
Next, he set out to learn everything he could about antidepressants. He confirmed that fluoxetine was an SSRI, and he already knew this was a class of drugs that increased the level of serotonin in the brain. As he had learned the day he found her pills, it was used to combat depression and anxiety, as well as obsessive-compulsive, eating, and premenstrual dysphoric disorders.
Jonas discovered that some people who took SSRIs suffered cardiac issues, sexual dysfunction, and suicidal thoughts. And, as he’d learned from that miserable Dr. Hempstead, Prozac was the most studied and first approved SSRI in the United States. Jonas was surprised that its chemistry lineage could be traced back to the antihistamine Benadryl. Digging deeper into the scientific literature, he discovered it was a Swedish psychiatrist, Anna Åberg-Wistedt, who first observed low serotonin levels in the brains of those who commit violent suicides. Sweden, the birthplace of his mother and the origin of his name. The association triggered memories.
While searching the internet, he realized that anonymity could be important. He investigated and signed up with a virtual private network provider. With his computer identity masked, Jonas clicked on link after link . . . which led to more links, which led to more links. While he searched and read, he printed—his new laser printer spewed out paper by the ream.
At the end of the fourth day, Jonas pushed himself back from his desk, bleary-eyed, and stared with satisfaction at the five large stacks of paper on his glass coffee table. Each stack was labeled with a meticulously printed green index card.
Fluoxetine (SSRIs)
Serotonin Syndrome
Other Antidepressants
Chemical Characteristics
Options
Jonas poured himself a glass of red wine to celebrate, eyeing the mounds of paper while sipping his drink.
The tedious medical research portion of his “emergency” was over. It was time to move on to the part he was most looking forward to.
Revenge.
JONAS SPENT THE NEXT WEEK trying to figure out the best way to avenge Wendy’s death. He searched phrases like mass murder and making homemade explosives. He joined chat rooms and online forums, the existence of which, before Wendy’s death, would have horrified him. He cleverly—and anonymously—broached the subject of how to kill large numbers of people randomly without getting caught.
Jonas was pleased to discover that instead of judging him—or reporting him to the FBI—his fellow cyber-comrades egged him on, even giving him helpful suggestions and links to possible resources. When Jonas justified his thoughts by talking about the horrors of nonpersonalized medicine, he found even more empathetic ears. Some suggested times when retribution is justified and offered Timothy McVeigh as an example.
McVeigh had been horrified by the deaths of seventy-four men, women, and children during the stand-off between the Branch Davidians and the Bureau of Alcohol, Tobacco, and Firearms. He justified his bombing of the Federal Building in Oklahoma in 1995 as redress against an out-of-control government and saw himself as heroically defending the Constitution “against all enemies, foreign and domestic.” The 168 people killed, including nineteen children in a daycare center, were collateral damage sacrificed to achieve a greater good.
After two weeks, Jonas knew, with refreshing clarity, what his mission was: to personalize death through medicine—exactly what had happened to Wendy, only the reciprocal. It was impersonalized medicine that killed Wendy, and personalized vengeance would right this wrong.
IT COST JONAS LESS THAN $300 and took only twenty minutes to set up his dummy corporation online. He chose CT as his registered agent, the same agent who worked for Google, Coca-Cola, and General Motors, to ensure compliance with state and federal laws. For his contact information he named the illustrious C. Spencer Callow. Jonas knew that if the authorities came snooping down the road, he would be protected by attorney–client privilege.
His next call was to C. Spencer Callow himself. Jonas told his lawyer he wanted to set up multiple layers of subsidiaries, just in case.
“You’re not doing anything illegal, are you?” C. Spencer Callow asked. He considered Jonas to be upstanding and by the book but liked to joke that underneath his stoic European exterior beat the heart of a criminal.
“There’s nothing criminal about it,” Jonas said. “I’ve just been stricken with some unsettling bouts of paranoia regarding my sizeable portfolio.”
“Tell you what we’re going to do, Jonas,” C. Spencer Callow said. “First thing we’re going to do is create a subsidiary in Nevada—because nothing sordid has ever happened in Nevada, and what happens in Carson City stays in Carson City. The next layer down we’re going to drift over to the Caribbean—I’m thinking Nevis, Panama, maybe even Antigua. When I’m done, your corporation is going to be nine layers deep, impossible to find by anybody. For good measure, though, I’m going to create another company in Guam—in case you ever need to dance with US Customs.”
Jonas began to sweat—he felt like C. Spencer Callow was reading his mind.
“And my name will not appear anywhere on these documents?” he said.
“The only person who will know it’s you is me,” C. Spencer Callow said. “And they don’t call me ‘The Black Hole’ for nothing.”
What an unlikeable man, Jonas thought as he hung up the phone.
Unlikeable . . . but useful.
C. SPENCER CALLOW WORKED his magic as promised and created Airstream Pharmaceuticals, an untraceable new biotech company with an address at a lawyer’s office in Reno, Nevada.
It was time for a test.
Jonas—or, more specifically, Airstream Pharmaceuticals—placed his first order from China. He effortlessly ordered two hundred grams each of three different chemicals.
It took four weeks for the vials of powder to travel the world—from China, to Guam, to Delaware (via Nevis Island), to Nevada, then to their final destination in Napa.
The process was excruciatingly slow, but as a ghastly tribute to his wife Wendy, Jonas was willing to take all the time in the world and to spend whatever was needed.
JONAS’S BASEMENT WAS SMALLER than the footprint of the house. At the back, where the hill sloped under the foundation, was his wine cellar. He unlocked the creaky old door then turned on the light. With satisfaction, he looked at his prize possession—a wooden crate of the 1945 Romanée-Conti, the last burgundy produced by this legendary vineyard using the original pre-phylloxera French vines. The $500 he’d paid for each bottle had appreciated by two orders of magnitude. It was one of his best investments. It was also too good and too risky to waste on someone who would never appreciate it. Plus, there was the possibility it had turned to vinegar. He needed something drinkable and a size that one person could drink.
In a corner of the room, he found exactly what he wanted. He dusted the top of the green box, breaking the seal to open it. He cradled it like a newborn up to the kitchen, making certain not to disturb the wine. It was the perfect choice.
WHEN HE ARRIVED AT DR. HEMPSTEAD’S office, the blonde receptionist was just leaving.
“Do you have an appointment?” she asked tentatively as she backed away from Jonas.
“No, I don’t need an appointment,” he said almost sweetly. “I want to give him a special gift.”
She turned and went into the back of the office. Jonas overheard her whispering to Hempstead.
“That awful man is here again. He says he has something for you.”
“Jonas von Gelden?” There was a pause. “Is he angry?”
“No, he seems okay.”
She returned to the waiting room and gave a brief nod as she left.
A few minutes later, Dr. Hempstead emerged.
“Jonas, what can I do for you?”
“I wanted to apologize for my behavior last month. I was distraught. I took my anger out on you. I know you tried to help Wendy. You would never do anything to harm her. I hope that you’ll accept this extraordinary port from my cellar as a peace offering. It’s from the year of The Great Comet.”
Jonas handed the green cardboard box to Hempstead.
“Which one? Halley’s Comet? Hale-Bopp? Shoemaker-Levy?”
Jonas shook his head no after each name and said, “The Great Comet was also called Napoleon’s Comet. It was visible for 260 days in 1811.”
Dr. Hempstead looked at Jonas in disbelief. He accepted the box, placing it on the receptionist’s counter. He lifted the cardboard lid and gingerly took out the walnut case. He took a deep breath and opened the box. The almost black-purple wine was resting in a crystal decanter swaddled tightly in the box. He pulled out the passport-sized document labeled “Scion” from the lid and began to leaf through it.
“The vintage of 1811 was spectacular,” Jonas continued. “This port was barreled in oak for over fifteen decades in the Douro Valley. It is from the cellar of an aristocratic family whose last scion died in 2008. Taylor Fladgate purchased the barrel and bottled it. It is among the rarest and most unique wines in the world. I’ve savored its magical complexity. I could think of no better peace offering.”
“Jonas, I am honored.” Hempstead started to pick up the decanter.
“Don’t disturb it until you are ready to open and drink the wine,” Jonas cautioned. “If I were you, I’d drink it soon, as wine doesn’t age as gracefully in the bottle as it does in the barrel. I also suggest it be consumed in a single sitting as it may not withstand the stress of oxidation. Breathing works well for young wines but not for old wines. Enjoy and savor it. It’s a once-in-a lifetime experience.”
“Thank you. I have always valued our friendship, probably more than you know. I did my best for Wendy, and I miss her too. Will you join me for a drink?”
“Thank you, but no. It is best savored solo. At least that has been my experience.”
Jonas turned and walked toward the door. He stopped briefly and looked at Hempstead as if memorizing the scene.
“Adieu.”
TWO WEEKS LATER, A HEADLINE in the back pages of the Napa Valley Register caught Jonas’s attention:
“Stanley Hempstead, Psychiatrist, Dies at 68.”
The article said the cause of death was stroke. His death was sudden and unexpected. He was survived by his wife and children.
Jonas closed the paper and put it in his recycling bin.