Dr. Thea Sperelakis, diagnosed as a teen with Asperger’s syndrome, has always been an outsider. She has a brilliant medical mind, and a remarkable recall of details, but her difficulty in dealing with hidden agendas and interpersonal conflicts have led her to leave the complex, money-driven dynamics of the hospital, and to embrace working with the poor, embattled patients of Doctors Without Borders. Her father, Petros, is one of the most celebrated internal medicine specialists in the world, and the founder of the cutting-edge Sperelakis Center for Diagnostic Medicine at Boston’s sprawling, powerful Beaumont Clinic.
Thea’s rewarding life in Africa is turned upside-down when Petros is severely injured by a hit-and-run driver. He is in the Beaumont ICU, in a deep coma. No one thinks he will survive. Thea must return home. Two of Petros’ other children, both physicians, battle Thea and her eccentric brother, Dimitri, by demanding that treatment for their father be withheld.
As Thea uncovers the facts surrounding the disaster, it seems more and more to be no accident. Petros, himself, is the only witness. Who would want him dead? The answers are trapped in his brain . . . until he looks at Thea and begins slowly to blink a terrifying message.In The Second Opinion, Michael Palmer has created a cat-and-mouse game where one woman must confront a conspiracy of doctors to uncover an evil practice that touches every single person who ever has a medical test. With sympathetic characters and twists and betrayals that come from the most unlikely places, The Second Opinion will make you question…everything.
In this routine medical thriller from bestseller Palmer (The First Patient), Dr. Thea Sperelakis, an idealist who's been working for Doctors Without Borders in the Congo, rushes back to Boston after learning her physician father, Petros, an intimidating figure known as the Lion, is close to death, the victim of a hit-and-run. Thea faces one challenge after another, including having to resuscitate Petros when his heart stops beating. Her brilliant if socially challenged older brother, Dimitri, adds to her anxiety with his computer reconstruction of the accident, which indicates the driver struck Petros deliberately. When Thea manages to communicate haltingly with her father, she suspects he's stumbled on some medical fraud that's made him the target of those behind the fraud. Aided by the requisite hunky ex-cop turned hospital security guard, Thea doggedly seeks out the truth. Robin Cook fans have seen all this before and in more engaging form. (Feb.)
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St. Martin's Press
November 30, 2009
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Excerpt from The Second Opinion by Michael Palmer
"I'm afraid I have some bad news."
Hayley Long, just two weeks past her fi fty- fi rst birthday, heard her
physician's words as if they were being spoken through a long steel
I'm afraid I have some bad news. . . .
She wondered fl eetingly how many thousands of people heard the
same thing from their doctor every day? How many patients every
hour, maybe every minute, rode those words screeching through a
sudden right- angle turn in their lives.
I'm afraid . . .
Stephen Bibby, a graduate of Emory Med, had been her physician
since a bout of pneumonia twenty or so years ago. He was a man
Hayley respected, if for no other reason than that Bibby knew his
limitations and never hesitated to make a phone call and arrange a
specialist referral for a second opinion.
Hayley felt a wave of nausea sweep over her, and thought for a moment
she was going to have to excuse herself to go and get sick even
before she found out precisely what she was up against. She made a
largely unsuccessful attempt at a calming breath, and tried to maintain
an even gaze.
Hayley heard the word in her own voice, but couldn't believe she
had actually uttered it. Her thoughts wouldn't stay still.
Cancer . . . How could that be? . . . Oh, God, no.
Her initial symptom had been nothing more than an annoying sequence
of belly pain and gas. She almost hadn't even bothered to
mention them to her executive assistant. He was the one who had
talked her into calling Bibby. It was his fault.
The MRI Bibby had requested was of her abdomen.
The dizziness and nausea intensifi ed.
David didn't handle illness at all well, in himself or others, but at
some point she would have to tell him. Not yet, though. Not until all
the data were in. He was off skippering his boat in a round- the- world
race--his lifetime dream. He had lost his fi rst wife to a brain aneurysm,
and had waited more than ten years before marrying again.
She had to tell him soon, but not yet.
Bibby, a Southern gentleman in his early sixties, looked toward
the door as if hoping that another doctor would march into the offi ce
and take over.
"I asked, is it cancer?"
Biting at his lip, the physician nodded.
"Operable?" she asked.
Come on, Stephen! Help me out here!
"I . . . I don't know. It looks to have started in your pancreas.
That's the organ which--"
"I know what the pancreas is. I hear Jimmy Carter talking about
pancreatic cancer every time I turn on the damn TV. Has it spread?"
"It's . . . it appears to be in some places in your liver."
Bibby turned on his computer with a click of his mouse and rotated
it so Hayley could see. A child could have picked out the cancer
in her MRI--an obscene white mass, dead center in her belly. Dead
center. How ironic that her mind's default for something in the middle
would have been those words.
Please let this be a dream. Please let it be a fucking dream.
Hayley rubbed at her eyes as if trying to paw away the disbelief. At
fi fty, she had everything she could ever have wanted--marriage to a
wonderful, caring man; stepchildren who treated her like their birth
mother; more money and infl uence than most people could even
dream of; and a perspective on life that made everything make sense.
Pancreatic cancer . . . Inoperable . . . God, don't let it be, Hayley Long
thought desperately. Let it be a dream. . . . Let it be nothing but a
Petros Sperelakis's awareness returned gradually and spasmodically.
The pain came fi rst--a dull throbbing in his groin and burning sensation
in his low back. He tried to move, to shift his position, but his
body did not respond.
Please, I don't think I can move. Someone please help me. I'm Sperelakis,
Dr. Petros Sperelakis. I can't see and I can't move.
"Connie, why don't you take a break. I'll be here for another
"Okay, thanks. Listen, Vernice, he could use some range- of- motion
work on his wrists and ankles."
Connie? Vernice? I can hear you. I can hear you. Are you Beaumont nurses?
It's me, Dr. Sperelakis. What do you mean, range of motion? Am I paralyzed?
What happened to me? An accident? A stroke? A tumor? Why can't I see? Why
can't I speak?
The man many considered to be among the premier diagnostic
physicians in the world struggled to make sense of his own symptoms.
He knew he was having diffi culty holding on to a thought, and
that fact frightened him more than almost anything.
Why am I in such pain? Can someone please tell me what happened? What
happened to me? I can feel that, Vernice. I can feel you moving my ankle. Oh,
my God. . . .
Multiple contusions and abrasions . . . Fractured pelvis . . . Nondisplaced
fracture, proximal humerus . . . Pulmonary contusion and laceration secondary
to posterior displaced fractures of right seventh, eighth, and ninth
ribs . . .
With the grim litany ticking through her thoughts, Thea Sperelakis
approached Cubicle 4 in the medical ICU of the Beaumont
Transverse linear skull fracture . . . Extensive mid- brain stem hemorrhage . . .
Level I coma . . .
Thea hesitated, envisioning what her father would look like and
knowing that, as an internal medicine specialist herself, her projection
would not be far from on the mark. According to her brother
Niko, police estimated that the vehicle that struck their father at fi ve
thirty in the early morning eight days ago, then drove away, had to
have been traveling seventy, at least. It was a miracle he had survived
the impact, which threw him more than twenty- fi ve feet. But then,
for as long as Thea could remember, Petros Sperelakis was, to his
children, the Lion--aloof, powerful, and brilliant, often to the point
The absence of skid marks suggested that the driver never saw his
victim. Make that his or her victim, Thea edited, intent on enforcing
that sort of accuracy, even in her thoughts. The police still had no
clues and no witnesses.
Alcohol, she guessed. According to an article by Eileen Posnick in
a seven- year- old issue of the American Journal of Drug and Alcohol Abuse,
alcohol was involved in more than 90 percent of hit- and- run accidents
where the drivers were eventually apprehended.
Behind her, Niko stepped out from the group that included his
twin, Selene, plus a trio of Beaumont Clinic dignitaries, and took
Thea's arm. He was swarthy and broad- shouldered, with their father's
strong nose and piercing dark eyes, but with features that were
somewhat softer. At forty, he was already an associate professor of
cardiac surgery at Harvard--a wunderkind, with several signifi cant
contributions to the fi eld. Selene, exotic, elegant, and totally selfassured,
was no less accomplished as a hand surgeon.
"You okay, Thea?" Niko asked softly.
As she had been taught to do, Thea searched her feelings before
responding. Her father, bigger than life itself, was in a deep coma
from which there was a 0.01 percent chance he would recover even
minimal function--at least according to the retrospective study of
traumatic midbrain hemorrhages published by Harkinson et al. in the
American Archives of Neurology, volume 117, page 158. One in ten thousand,
not counting the ribs and other fractures.
"I'm okay," she replied.
"Want to go in alone?"
Why would I want to do that? she wondered, shaking her head.
Would their father be any less comatose if she saw him by herself?
She shrugged that it made no diff erence, but sensed she could have
come up with a more acceptable response.
"Suit yourself," Niko said in a tone that was quite familiar to her.
Thea knew her brother cared about her--Selene, too. She also
knew that the twins had always thought she was odd, though certainly
not as odd as their oldest sibling, Dimitri. But their attitude, as
emphasized over and over by Thea's longtime therapist and mentor,
Dr. Paige Carpenter, was their problem.
One in ten thousand . . . Poor Dad.
Thea ran her fi ngers through her short chestnut hair, took a single
deep breath, and stepped through the doorway.
As anticipated, there were no surprises. Legendary Petros Sperelakis,
medical director of the Sperelakis Institute for Diagnostic
Medicine, lay motionless--the central fi gure in a tableau of medical
machines. Across the room, his private duty nurse (Haitian, Thea
guessed) rose and introduced herself as Vernice.
"I have heard a great deal about you, Dr. Thea," she said. "I hope
your fl ight was an easy one."
"I just read," Thea said, taking the husky woman's smooth, ample
I just read.
It was, Thea knew, the most resounding of understatements. During
the twenty- hour series of fl ights and layovers from the Democratic
Republic of the Congo to Boston, she had read Don Quixote, the
second edition of Deadman's A Manual of Acu punc ture (for the second
time), and Darwin's Voyage of the Beagle--more than sixteen hundred
pages in all. She would have made the trip home sooner, but she
was on a mission moving from refugee camp to camp in the bush
with a team of nutritionists, and simply couldn't be reached.
"There's been no change," Vernice said.
"I'd be most surprised if there were. He has taken a severe
beating--especially to his head."
Thea approached the bedside, instinctively checking the monitors
and intravenous infusions. Petros lay quite peacefully, connected via
a tracheotomy tube to a state- of- the- art ventilator. The various
Medecins Sans Fronti?res (Doctors Without Borders) hospitals to
which Thea had been assigned over the past fi ve years had been reasonably
well equipped, but nothing like this place.
The Beaumont, as nearly everyone referred to the institution, was
a sprawling campus, the size of a small university, consisting of what
had once been Boston Metropolitan Hospital, now augmented by
two dozen more buildings, varying widely in architectural style. The
buildings were linked by tree- lined sidewalks above, and an intricate
maze of tunnels below, some with moving walkways and others with
tarnished tile walls, leading in places to stairways that went down for
two or three damp stories, and dating back to Metro's earliest days
in the mid- nineteenth century.
Oxygen saturation . . . arterial blood pressure . . . cerebrospinal
fl uid pressure . . . central venous pressure . . . urine output . . .
chest tube drainage . . . cardiac rhythm and ECG pattern . . .
Thea took in the complex data and pro cessed them as if they were
a grade- school primer. Steady. Everything was nice and steady. At
the moment, the fi erce battle for the life of Petros Sperelakis was being
fought at a cellular and even subcellular level. And his youn gest
off spring, cursed by him when she made the decision to avoid academic
medicine and "give her ser vices away," to third- world countries,
pictured the microscopic confl ict clearly in her mind's eye.
At best it would probably be weeks before the man regained any
consciousness. Along the way, his system would have to negotiate a
minefi eld of infections, blood clots, kidney stones, embolisms, ce rebral
swelling, chemical imbalance, intestinal obstructions, and cardiac
events. But in this setting, with this equipment, he would at
least have a fi ghting chance. Still, from what Thea knew of her father,
if it were his choice, it was doubtful he would try very hard to steer
clear of the mines.
She took the man's hand and held it for a time. It had been only
eight days since the accident, but his muscle mass was already beginning
to waste away. In addition to the trach, he had a gastric feeding
tube in place, two IVs, a urinary catheter, which was draining briskly
into a collection bag, and a BOLT pressure manometer that passed
through his skull and into the spinal fl uid-containing ventricle of his
brain. His eyelids were paper- taped down to protect his corneas
from drying out, and splints on his wrists and ankles were strapped
in place to prevent joint contractures, against the remote possibility
of a return of function.
Petros Sperelakis--an icon brought down by a driver who was either
in an alcoholic blackout or was aware enough to try and get away
before anyone showed up. Never had Thea's father looked even remotely
vulnerable to her. Now, he looked frail and pathetically infantile.
Thea sensed that she was expected to stay at the bedside a bit longer,
and she planned to be there as much as possible in the days to
come. But she had slept little if any on the planes, and the exhaustion
of the fl ights was beginning to take hold. Fifteen minutes, she decided.
Fifteen more minutes would be enough to stay at the bedside
whether the others thought so or not.
Niko had invited her to stay at his house, but three kids under ten,
much as she loved them, provided more commotion than she could
Selene and her partner, a banker or businesswoman of some kind,
lived in a designer high- rise condo by the harbor.
The obvious choice was the spacious Wellesley home in which she
and the others had grown up, and where Petros still lived with the
ghost of their mother and with Dimitri who, many years before, had
moved into the carriage house along with his computers, his monitors,
his shortwave radio, his telescope, his machinery, his library of
manga, graphic novels, and Dungeons and Dragons manuals, and his
vast collection of Coca- Cola and Star Wars memorabilia.
It would be good to see her brother again for many reasons, not
the least of which was that of all those in her family, he was the one
she related to the most--something of a mirror of what she might
have been like had she not had the benefi t of early diagnosis, intervention,
and extensive behavior modifi cation therapy.
From her early childhood, Thea had memories of the family talking
about Dimitri's aloofness and strange behaviors--his lack of
friends, off beat humor, and often- inappropriate statements. Physical
age, twelve years ahead of her. Emotional age, inconsistent and unpredictable.
"Dimitri, this is Robert, your new piano teacher."
"Oh, hello. When's the last time you went to the dentist?"
She would never know the bulk of what the family said to one another
about her, but she also knew that the choices she had made,
with Dr. Carpenter's help, were the right ones for her, and ultimately,
for her patients. Keeping her life as uncomplicated as possible,
she had learned, was not only a pathway to happiness, it was
her roadmap to survival. If there was any single word that did not apply
to Petros Sperelakis, it was uncomplicated.
Born and raised in Athens until his late teens, Petros was strictly
Old Country in his attitudes and philosophy--a brilliant physician as
dedicated to his calling and his patients as he was hard on his family.
Verbal chastisement and high expectations were his weapons, as well
as his only means of expressing love. His wife, Eleni, had rebelled
against him in one way and one way only, by continuing to smoke
cigarettes despite his vehement edicts that she stop. The lung cancer
that took her did nothing to soften Petros, and virtually every mention
of her by him was followed by the impotent plea: "If she had only
listened to me . . . If only she had listened."
Thea reached between the tubes and brushed some damp, gray