Excerpt from 1st To Die by James Patterson, plus links to reviews, author biography & more

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1st To Die

by James Patterson

1st To Die by James Patterson
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  • First Published:
    Mar 2001, 432 pages
    Paperback:
    Feb 2002, 480 pages

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"I want to show you something," Orenthaler began. He held a slide up against a light.

He pointed to splotches of tiny ghostlike spheres in a current of smaller pellets. "This is a blowup of the blood smear we took from you. The larger globules are erythrocytes. Red blood cells."

"They seem happy," I joked nervously.

"They are, Lindsay," the doctor said without a trace of a smile.

"Problem is, you don't have many." I fixed on his eyes, hoping they would relax and that we'd move on to something trivial like, You better start cutting down those long hours, Lindsay.

"There's a condition, Lindsay," Orenthaler went on. "Negli's aplastic anemia. It's rare. Basically, the body no longer manufactures red blood cells." He held up a photo. "This is what a normal blood workup looks like."

On this one, the dark background looked like the inter-section of Market and Powell at 5:00 P.M., a virtual traffic jam of compressed, energetic spheres. Speedy messengers, all carrying oxygen to parts of someone else's body.

In contrast, mine looked about as densely packed as a political headquarters two hours after the candidate has conceded.

"This is treatable, right?" I asked him. More like I was telling him.

"It's treatable, Lindsay," Orenthaler said, after a pause. "But it's serious."

A week ago, I had come in simply because my eyes were runny and blotchy and I'd discovered some blood in my panties and every day by three I was suddenly feeling like some iron-deficient gnome was inside me siphoning off my energy. Me, of the regular double shifts and fourteen-hour days. Six weeks' accrued vacation.

"How serious are we talking about?" I asked, my voice catching.

"Red blood cells are vital to the body's process of oxygenation," Orenthaler began to explain. "Hemopoiesis, the formation of blood cells in the bone marrow."

"Dr. Roy, this isn't a medical conference. How serious are we talking about?"

"What is it you want to hear, Lindsay? Diagnosis or possibility?"

"I want to hear the truth."

Orenthaler nodded. He got up and came around the desk and took my hand. "Then here's the truth, Lindsay. What you have is life threatening."

"Life threatening?" My heart stopped. My throat was as dry as parchment.

"Fatal, Lindsay."

THE COLD, BLUNT SOUND of the word hit me like a hollow-point shell between the eyes.

Fatal, Lindsay.

I waited for Dr. Roy to tell me this was all some kind of sick joke. That he had my tests mixed up with someone else's.

"I want to send you to a hematologist, Lindsay," Orenthaler went on.

"Like a lot of diseases, there are stages. Stage one is when there's a mild depletion of cells. It can be treated with monthly transfusions. Stage two is when there's a systemic shortage of red cells.

"Stage three would require hospitalization. A bone marrow transplant. Potentially, the removal of your spleen."

"So where am I?" I asked, sucking in a cramped lungful of air.

"Your erythrocytic count is barely two hundred per cc of raw blood. That puts you on the cusp."

"The cusp?"

"The cusp," the doctor said, "between stages two and three."

There comes a point in everybody's life when you realize the stakes have suddenly changed. The carefree ride of your life slams into a stone wall; all those years of merely bouncing along, life taking you where you want to go, abruptly end. In my job, I see this moment forced on people all the time.

Welcome to mine.

"So what does this mean?" I asked weakly. The room was spinning a little now.

"What it means, Lindsay, is that you're going to have to undergo a prolonged regimen of intensive treatment."

Copyright © 2001 by James Patterson.

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