by Robin Cook
“Well,” began Charles in as steady a voice as he could manage. “I hope you convey to the board of directors my thanks for this vote of confidence, but unfortunately I’m not in a position to take over the Canceran project. You see, my own work is progressing extremely well. They will have to find someone else.”
“I hope you’re joking,” said Morrison. His smile waned, then vanished.
“Not at all. With the progress I’m making, there is no way I can leave my current work. My assistant and I have been extremely successful and the pace is increasing.”
“But you have not published a single paper for several years. That’s hardly a rapid pace. Besides, funding for your work has come almost totally from the general operating funds of the institute; you have not been responsible for any major outside grants to the institute for a long, long time. I know that’s because you have insisted on remaining in the immunological field of cancer research and until now I have backed you all the way. But now your services are needed. As soon as you finish the Canceran project, you can go back to your own work. It’s as simple as that.” Morrison stood up and walked back behind his desk to signify that as far as he was concerned the meeting was over, the matter decided.
“But I can’t leave my work,” said Charles, feeling a sense of desperation. “Not now. Things are going too well. What about my development of the process of the hybridoma? That should count for something.”
“Ah, the hybridoma,” said Morrison. “A wonderful piece of work. Who would have thought that a sensitized lymphocyte could be fused with a cancer cell to make a kind of cellular antibody factory. Brilliant! There are only two problems. One: it was many years ago; and two: you failed to publish the discovery! We should have been able to capitalize on it. Instead, another institution got the credit. I wouldn’t count on the hybridoma development to ensure your position with the board of directors.”
“I didn’t stop to publish the hybridoma process because it was just a single step in my experiment protocol. I’ve never been eager to rush into print.”
“We all know that. In fact, it’s probably the major reason you’re where you are and not a department head.”
“I don’t want to be a department head,” yelled Charles, beginning to lose his patience. “I want to do research, not push around papers and go to benefits.”
“I suppose that’s meant as a personal insult,” said Morrison.
“You can take it as you will,” said Charles, who had abandoned his efforts at controlling his anger. He stood up, approached Morrison’s desk, and pointed an accusing finger at the man. “I’ll tell you the biggest reason I can’t take over the Canceran project. I don’t believe in it!”
“What the hell does that mean?” Morrison’s patience had also worn thin.
“It means that cellular poisons like Canceran are not the ultimate answer to cancer. The presumption is that they kill cancer cells faster than normal cells so that after the malignancy is stopped the patient will still have enough normal cells to live. But that’s only an interim approach. A real cure for cancer can only come from a better understanding of the cellular processes of life, particularly the chemical communication between cells.”
Charles began to pace the room, nervously running his fingers through his hair. Morrison, by contrast, didn’t move. He just followed Charles’s gyrations with his eyes.
“I tell you,” shouted Charles, “the whole attack on cancer is coming from the wrong perspective. Cancer cannot be considered a disease like an infection because it encourages the misconception that there will be a magic bullet cure like an antibiotic.” Charles stopped pacing and leaned over the desk toward Morrison. His voice was quieter, but more impassioned. “I’ve been giving this a lot of thought, Dr. Morrison. Cancer is not a disease in the traditional sense, but an unmasking of a more primitive life-form, like those that existed at the beginning of time when multicellular organisms were evolving. Think of it. At one time, eons ago, there were only single-celled creatures who selfishly ignored each other. But then, after a few million years, some of them teamed up because it was more efficient. They communicated chemically and this communication made multicellular organisms like us possible. Why does a liver cell only do what a liver cell does, or a heart cell, or a brain cell? The answer is chemical communication. But cancer cells are not responsive to this chemical communication. They have broken free, gone back to a more primitive stage, like those single-cell organisms that existed millions of years ago. Cancer is not a disease but rather a clue to the basic organization of life. And immunology is the study of this communication.”
Charles ended his monologue leaning forward on his hands over Morrison’s desk. There was an awkward silence. Morrison cleared his throat, pulled out his leather desk chair, and sat down.
“Very interesting,” he said. “Unfortunately, we are not in a metaphysical business. And I must remind you that the immunological aspect of cancer has been worked on for more than a decade and contributed very little to the prolongation of the cancer victim’s life.”
“That’s the point,” interrupted Charles. “Immunology will give a cure, not just palliation.”
“Please,” said Morrison softly. “I listened to you, now listen to me. There is very little money available for immunology at the present time. That’s a fact. The Canceran project carries a huge grant from both the National Cancer Institute as well as the American Cancer Society. The Weinburger needs that money.”
Charles tried to interrupt, but Morrison cut him off. Charles slumped back into a chair. He could feel the weight of the institute’s bureaucracy surround him like a giant octopus.
Morrison ritually removed his glasses and placed them on his blotter. “You are a superb scientist, Charles. We all know that, and that’s why we need you at this moment. But you’re also a maverick and in that sense more tolerated than appreciated. You have enemies here, perhaps motivated by jealousy, perhaps by your self-righteousness. I have defended you in the past. But there are those who would just as soon see you go. I’m telling you this for your own good. At the meeting last night I mentioned that you might refuse taking over the Canceran project. It was decided that if you did, your position here would be terminated. It will be easy enough to get someone to take your place on a project like this.”
Terminated! The word echoed painfully in Charles’s mind. He tried to collect his thoughts.
“Can I say something now?” asked Charles.
“Of course,” said Morrison, “tell me that you’re going to take over the Canceran project. That’s what I want to hear.”
“I’ve been very busy downstairs,” said Charles, ignoring Morrison’s last comment, “and I’m moving very rapidly. I have been purposefully secretive but I believe that I am truly close to understanding cancer and possibly a cure.”
Morrison studied Charles’s face, trying to garner a hint as to his sincerity. Was this a trick? A delusion of grandeur? Morrison looked at Charles’s bright blue eyes, his high lined forehead. He knew all about Charles’s past, his wife’s death, his sudden move from clinical medicine into research. He knew that Charles was a brilliant worker, but a loner. He suspected that Charles’s idea of “truly close” might well constitute ten years.
“A cure for cancer,” said Morrison, not bothering to smooth the sarcastic edge to his voice. He kept his eyes on Charles’s face. “Wouldn’t that be nice. We’d all be very proud. But . . . it will have to wait until the Canceran study is done. Lesley Pharmaceuticals, who holds the patent, is eager to get production rolling. Now, Dr. Martel, if you’ll excuse me, I have work to do. The matter is closed. The Canceran lab books are available, so get cracking. Good luck. If you have any problems let me know.”
Charles stumbled out of Morrison’s office in a daze, crushed at the prospect of being forced away from his own research at such a critical time. Aware of the quizzical stare from Morrison’s prim secretary, Charles half ran to the fire stairs, banging open the door. He de
scended slowly, his mind reeling. Never in his life had anyone ever threatened to fire him. Although he felt confident he could get a job, the idea of being cast adrift even for a short time was devastating, especially with all his ongoing financial obligations. When he had given up his private practice, Charles had given up his status as moderately well-to-do. On his research salary, they barely made it, especially with Chuck in college.
Reaching the first floor, Charles turned down the hall, toward his lab. He needed some time to think.
THREE
It was their turn. A nurse who looked like she stepped out of a 1950s Doris Day movie called out Michelle’s name and held the door open. Michelle gripped her stepmother’s hand as they entered the inner office. Cathryn wasn’t sure which one of them was more tense.
Dr. Wiley looked up from a chart, peering over half glasses. Cathryn had never met Dr. Jordan Wiley, but all the children knew him. Michelle had told Cathryn that she remembered coming to him for the chicken pox four years ago when she was eight. Cathryn was immediately taken by the attractiveness of the man. He was in his late fifties and exuded that comfortably paternal air that people traditionally associate with doctors. He was a tall individual with closely cropped graying hair and a bushy gray mustache. He wore a small, hand-tied red bow tie which gave him a unique, energetic look. His hands were large but gentle as he placed the chart on his desk and leaned forward.
“My, my,” said Dr. Wiley. “Miss Martel, you have become a lady. You look very beautiful, a little pale, but beautiful. Now introduce me to your new mother.”
“She’s not my new mother,” said Michelle indignantly. “She’s been my mother for over two years.”
Both Cathryn and Dr. Wiley laughed and after a moment’s indecision, Michelle joined them, although she was not sure she got the joke.
“Please, sit down,” said Dr. Wiley, motioning to the chairs facing his desk. As a consummate clinician, Dr. Wiley had started the examination the moment Michelle had entered his office. Besides her pallor, he’d noticed the girl’s tentative gait, her slumped posture, the glazed look to her blue eyes. Spreading open her chart, which he’d reviewed earlier, he picked up a pen. “Now then, what seems to be the trouble?”
Cathryn described Michelle’s illness with Michelle adding comments here and there. Cathryn said that it had started gradually with fever and general malaise. They’d thought she’d had the flu, but it would not go away. Some mornings she’d be fine; others she’d feel terrible. Cathryn concluded by saying that she’d decided it would be best to have Michelle checked in case she needed some antibiotics or something.
“Very well,” said Dr. Wiley. “Now I’d like some time alone with Michelle. If you don’t mind, Mrs. Martel.” He came around from behind his desk and opened the door to the waiting room.
Momentarily nonplussed, Cathryn got to her feet. She had expected to stay with Michelle.
Dr. Wiley smiled warmly and, as if reading her mind, said, “Michelle will be fine with me; we’re old friends.”
Giving Michelle’s shoulder a little squeeze, Cathryn started for the waiting room. At the door she paused. “How long will you be? Do I have time to visit a patient?”
“I think so,” said Dr. Wiley. “We’ll be about thirty minutes or so.”
“I’ll be back before that, Michelle,” called Cathryn. Michelle waved and the door closed.
Armed with some directions from the nurse, Cathryn retraced her steps back to the main lobby. It wasn’t until she entered the elevator that her old fear of hospitals returned. Staring at a sad little girl in a wheelchair, Cathryn realized that pediatric hospitals were particularly unnerving. The concept of a sick child made her feel weak. She tried to concentrate on the floor indicator above the doors, but a powerful, incomprehensible urge drew her eyes back to the sick child. When the doors opened on the fifth floor and she stepped off, her legs felt rubbery and her palms were sweaty.
Cathryn was heading for the Marshall Memorial isolation unit, but the fifth floor also contained the general intensive care unit and the surgical recovery room. In her emotionally sensitive state, Cathryn was subjected to all the sights and sounds associated with acute medical crisis. The beep of the cardiac monitors mixed with the cries of terrified children. Everywhere there was a profusion of tubes, bottles, and hissing machines. It was an alien world populated with a bustling staff who seemed, to Cathryn, to be unreasonably detached from the horror around them. The fact that these children were being helped in the long run was lost on Cathryn.
Pausing to catch her breath in a narrow hallway lined with windows, Cathryn realized that she was crossing from one building to another within the medical center. The hall was a peaceful bridge. She was alone for a moment until a man in a wheelchair with DISPATCHER written across the back motored past her. Glass test tubes and jars filled with all sorts of body fluid samples jangled in a metal rack. He smiled, and Cathryn smiled back. She felt better. Fortified, she continued on.
The Marshall Memorial isolation unit was easier for Cathryn to deal with. All the doors to the rooms were closed and there were no patients to be seen. Cathryn approached the nurses’ station which seemed more like a ticket counter at a modern airport than the nerve center for a hospital ward. It was a large square area with a bank of TV monitors. A clerk looked up and cheerfully asked if he could help her.
“I’m looking for the Schonhauser boy,” said Cathryn.
“Five twenty-one,” said the clerk pointing.
Cathryn thanked him and walked over to the closed door. She knocked softly. “Just go right in,” called the clerk. “But don’t forget your gown.”
Cathryn tried the door. It opened and she found herself in a small anteroom with shelving for linen and other supplies, a medicine locker, a sink, and a large soiled-laundry hamper. Beyond the hamper was another closed door containing a small glass window. Before Cathryn could move, the inner door opened and a gowned, masked figure stepped into the room. With rapid movements the individual discarded the paper mask and hood in the trash. It was a young nurse with red hair and freckles.
“Hi,” she said. The gloves went into the trash, the gown into the hamper. “You going in to see Tad?”
“I was hoping to,” said Cathryn. “Is Mrs. Schonhauser in there, too?”
“Yup, she’s here every day, poor woman. Don’t forget your gown. Very strict reverse precautions.”
“I . . .” started Cathryn, but the harried nurse was already through the door.
Cathryn searched through the shelves until she found the hoods and the masks. She put them on, feeling ridiculous. The gown was next but she put it on like a coat. The rubber gloves were more difficult and she never got the left one all the way on. With the half-empty fingers dangling from her hand, she opened the inner door.
The first thing she saw was a large plastic enclosure like a cage surrounding the bed. Although the plastic fragmented the image, Cathryn was able to make out Tad Schonhauser’s form. In the raw fluorescent light the boy was a pale, slightly greenish color. There was a low hiss of oxygen. Marge Schonhauser was seated to the left of the bed, reading by the window.
“Marge,” whispered Cathryn.
The masked and gowned woman looked up. “Yes?” she said.
“It’s Cathryn.”
“Cathryn?”
“Cathryn Martel.”
“For goodness sake,” said Marge when she was able to associate the name. She got up and put her book down. Taking Cathryn’s hand, she led her back into the anteroom. Before the door closed behind them Cathryn looked back at Tad. The boy had not moved although his eyes were open.
“Thank you for coming,” said Marge. “I really appreciate it.”
“How is he?” asked Cathryn. The strange room, the gowning . . . it wasn’t encouraging.
“Very bad,” said Marge. She pulled off her mask. Her face was drawn and tense; her eyes red and swollen. “He had a marrow transplant twice from Lisa but it hasn’t worked. Not at al
l.”
“I spoke to Nancy this morning,” said Cathryn. “I had no idea he was this sick.” Cathryn could sense the emotion within Marge. It was just beneath the surface like a volcano, ready to erupt.
“I’d never even heard of aplastic anemia,” said Marge, trying to laugh. But the tears came instead. Cathryn found herself crying in sympathy, and the two women stood there for several minutes weeping on each other’s shoulder. Finally Marge sighed, pulled back slightly, and looked at Cathryn’s face. “Oh, it is good of you to come. You don’t know how much I appreciate it. One of the difficult things about serious illness is that people ignore you.”
“But I had no idea,” repeated Cathryn remorsefully.
“I’m not blaming you,” said Marge. “I just mean people in general. I suppose they just don’t know what to say or maybe they are afraid of the unknown, but it happens when you need people the most.”
“I’m terribly sorry,” said Cathryn, at a loss for something to say. She wished she’d called weeks ago. Marge was older than she, closer to Charles’s age. But they got along well, and Marge had been gracious and helpful when Cathryn had first come to Shaftesbury. The other New Englanders had been very cold.
“I don’t mean to take it out on you,” said Marge, “but I feel so upset. The doctors told me this morning that Tad might be terminal. They’re trying to prepare me. I don’t want him to suffer, but I don’t want him to die.”
Cathryn was stunned. Terminal? Die? These were words that referred to old people, not to a young boy who just a few weeks ago was in their kitchen bursting with life and energy. With difficulty she resisted an urge to run back downstairs. Instead she hugged Marge.
“I just can’t help but ask why,” sobbed Marge, struggling to control herself and allowing Cathryn to hold her. “They say the good Lord has His reasons, but I’d like to know why. He was such a good boy. It seems so unfair.”
