by Jim Lombardo
Hannah, Thank you so much for coming too see me, and thank you for trying too help me. Go with you too Fantavio someday. Love, Ellie
Hannah smiled touchingly. I’m going to get you all better, and then help you with the preposition ‘to’, my dear soulmate. She put the card next to her on the computer desk. She felt it was time for Cancer 101 now. Returning her attention to the screen, she downloaded a picture of a single magnified cancer cell and stared at it. The cell resembled a fuzzy purple tennis ball, or perhaps a harmless pompom stitched to the end of a winter stocking hat for decoration. But that is not what it was at all. In the dimly lit room the image projected onto the irises of Hannah’s eyes where it glowed for a full minute. This is what had taken her grandmother away, along with countless millions more. This was what was hurting Ellie.
Hannah learned that cancer occurred when abnormal cells grow out of control. Mummies that were thousands of years old showed evidence of it. In fact a tumor was found in the fossilized bone of a Neanderthal who lived 120,000 years ago. Efforts by man to understand, treat, and cure the disease dated back to the beginning of recorded human history. Hannah’s insistence on starting at the beginning of man’s approach to the disease took her to an ancient Egyptian scroll written around 1,500 B.C. known as the Edwin Smith Papyrus, which described cancer and reported, “There is no treatment.” Hippocrates, the Father of Medicine, who lived around 400 years B.C. described the crab-like appearance of the disease, which gave rise to its name, and suggested primitive treatments such as blood-letting. The child continued through history during periods where it was believed cancer was a poison that seeped insidiously through the body, as well as a time when there was the mistaken belief that it was contagious. The introduction of the microscope in the 1700s significantly improved man’s knowledge and understanding of the disease.
In the late 1700s one of the first causes of cancer was identified when it was discovered that an inordinately high percentage of men who had worked during their youth as chimney sweeps in England were coming down with a rare carcinoma. With the age of industrialization, more houses and buildings were being built with chimneys. Customary use of a fireplace resulted in a buildup of soot, known as creosote, on the inside walls of the chutes; this could eventually restrict airflow, and cause the chimney to spontaneously burst into flames. On a regular basis, chimney sweeps were hired to correct this problem. In order to ensure proper updraft, the widths of the flues had to be very narrow, as tight as 9 inches by 9 inches in some places. In congested urban settings, where apartments were being built higher and higher, sometimes flues were joined together, creating right angles a number of times before reaching the outside air above. In order to be able to squeeze through these constricted passageways, young boys, some only four years of age, were used to work as apprentices. These so-called “climbing boys” were usually orphans taken out of workhouses for this specific purpose. An adult “master sweep” would be given legal guardianship over the child until adulthood.
The boys would shimmy up the chimney holding a large flat brush and a scraper above their head to dislodge the creosote along the walls as they climbed through. The loosened ash would rain down over them into a pile at the bottom of the fireplace. If the master in charge of them felt the child was not working hard or fast enough, he might ignite some kindling ablaze underneath them as they worked, for motivation. It was not uncommon for climbing boys to get stuck within the confines of the flues and sometimes even suffocate to death.
After sliding back down, the youngsters would then have the job of bagging up the pile of soot and removing it. In order to toughen up the skin on their elbows and knees for this work, the master sweep would hold their cuts and scrapes perilously close to a burning fire and rub a salty solution into the wound with a bristle brush each evening until callouses had developed. At night, after a day spent cleaning about five chimneys, the young sweeps would sleep on a cellar floor using the soot-covered cloth bags as sheets. Some were permitted to bathe once a week, but others only a few times a year.
Later on, it was discovered that many of these climbing boys who had survived their labor succumbed to cancer during their teens and twenties. The cause ultimately was connected to the carcinogenic properties of the soot. Hannah paused for a long time reflecting on what she had just read. How poignant and tragic this historical account is, she thought. Every day these children would struggle valiantly towards the light at the top of the chimney. But upon reaching it, they would be forced to slide back down into a pile of filth. The mysterious illness that devoured their body would be the final abuse. Hannah lowered her head for a moment, then pushed onward, investigating man’s advances over the years.
During the 1800s, with improved hygienic techniques, and the availability of anesthesia, the primary treatment of tumors became surgical removal. By the end of that century, Marie and Pierre Curie had discovered radiation, and another effective means of battling the disease was born. During World War II there was the discovery that soldiers exposed to mustard gas during combat suffered from a suppression of cell growth within their bone marrow. This gave rise to the idea of using a chemical version of the gas as an effective weapon against certain types of cancer, by curbing its progress. This was the dawn of chemotherapy. During the mid-1900s advances in the study of the chemical structure of DNA, the basic component of genes, led to the understanding that cancer was a genetic problem. It was learned that when DNA within a cell was damaged, through such means as exposure to a carcinogen such as tobacco, or by being inherited, the faulty cell could begin to multiply, spawning an out-of-control growth of mutant cells, or cancer.
The modern era introduced a number of ingenious approaches to cancer treatment. Man’s understanding of hormones and how they affect cancer led to effective hormonal therapies. Immunotherapy involved using the body’s own immune system to target and attack unique receptors on the surface molecules of cancer cells. Growth factor receptor inhibitors were developed. These special drugs impeded a cancer cell’s ability to bind with substances that the cell needed to grow. Angiogenesis inhibitors, substances that hinder the formation of new blood vessels, were being used effectively to starve a malignant tumor of its blood supply. Gene transfer therapy was a process of inserting specially engineered genes into a cancer cell to destroy it, or slow its growth. Hannah was keenly interested in a website that offered the results of a competition at a renowned university in the United States where doctoral students were able to present their futuristic ideas on how to cure cancer.
Along with these treatments, Hannah also carefully studied the many causes of cancer, and ways of preventing or reducing risk. Tobacco leaves increased the danger, whereas lettuce leaves reduced it. Physical exercise had a protective effect. Exposure to the sun’s ultraviolet rays was a hazard, which was why people were advised to wear sunscreen, stay in the shade, and cover skin with clothes, preferably darker colors, which the dangerous energy waves couldn’t penetrate as easily. She read that certain viruses could cause cancer too, and that scientists had developed immunizations to safeguard people from some of them. Being aware of family medical history was useful, because just as a family’s gene pool could help predict a baby’s chances of having dimples or freckles, it could also indicate increased vulnerability to cancer.
In addition to Boston General’s extensive library of online textbooks, Hannah was also able to gain access to a worldwide repository where cancer-related scholarly articles, doctoral dissertations, research results, discoveries and theories, including the most recent ones, were shared freely. “That’s brilliant, Dr. Zhuyuan Zhang. You’re spot on madam!” she cried out at one point. Sometimes she was less flattering. “A noble effort, Mr. Hogan, but ummm, that dog won’t hunt.”
As she zipped along this titanic technological highway, her brain became a library of its own. She stored all of the information she garnered into distinct categories in her personal and eminently sophistic
ated biological tracking system. In her brain the material was three-dimensional, allowing overlap of related data, where multiple interwoven parcels of information could be reviewed and considered simultaneously. But there were obstacles. One problem Hannah had to manage was that not all of the information she was absorbing was consistent. There were contradictions, where specific research study postulates were shown to be proven by scientific results, while other studies would refute these findings. There were also basic errors, such as the molecular structures of specific organic chemicals appearing differently amongst various resources, where at least one had to be wrong. Some of these inconsistencies were explained simply by man’s improving knowledge over time, whereas others were merely typographical errors. Hannah had to consider the date of the information, the quality of the resource, the preponderance of one version amongst numerous resources, and at times, her own adjudication to settle these discrepancies.
Moving into her fifth day of research, Hannah decided to shake things up to give her intellectual wings their maximum lift. She left the comforts and confines of her home and was whisked late at night into the city, where she was given after-hours admittance into the Boston Public Library. Joined only by one of her tutors and a sparse crew reshelving the stacks and polishing the elegant marble floors, the place was essentially hers.
Entering the building, she paused momentarily to admire the magnificent vaulted ceiling arching high above her, a sight that seemed to magically amplify her brain power. She deeply inhaled the distinctive, musty aroma of aging books. This scent was truly life itself, the organic compounds released from the breakdown of super-strong building materials such as cellulose and lignin found in the cell walls of wood, so sturdy that they could support the giant sequoia tree. However in this case, simply used to produce pages, the paper plate for words.
And what of books themselves? Hannah viewed them as the extravagant, fossilized remains of mankind. Excavated by simply flipping a cover, they captured the trials and triumphs of this Earth-dwelling species. Though silent, books were still able to speak to the reader, for as long as the legion of little ink squiggles lingered on the page. Science publications were obelisks, each one a stone block, industriously laid down, allowing apprentices to step up and build new layers, reaching higher and higher towards the final truth.
Hannah used the library’s public computers to identify the areas she wanted to explore, then skipped merrily along through the labyrinth of rooms and aisles, with her assistant in tow, trying to keep up. She climbed up and down rolling stepladders, meticulously mining for golden nuggets amongst the myriad of books, and handing off the ones she wanted to borrow. Looking down at her tutor struggling with the expanding load conjured up the old image she had of the monkey trying to hold on to too many bananas. She was pleased to finally offer him some happy news.
“Okay, tootie, I’m good.”
Though cancer was a quandary, Hannah found that one aspect of it was clear. Man’s efforts against the disease had been nothing less than heroic. In all the areas of prevention, research, diagnostics, treatment and care, publicity campaigns, fundraising and charitable gift giving, men and women were fighting nobly, brilliantly, and courageously. Every single day, mankind was striving on behalf of their fellow man to succeed against it. They were winning many battles. They were saving human lives. But unfortunately the war was not yet won.
During the seventh day of her studies, the phone rang in the Blakes’ home. A few minutes later there was a gentle knock on the door of the room where Hannah was toiling.
“Come on in,” she called out while continuing to scroll the report she was industriously pouring over.
The door slowly swung open. It was Monica.
“Hannah, sorry to bother you, but I just got some very sad news.”
The child greeted her mother and saw the pained expression on her face.
“What is it?”
“Come and sit.” Monica went to the guest bed and patted the mattress for her daughter to sit next to her. She then took hold of one of her tiny hands.
“It’s about your friend, Ellie. I’m afraid she’s passed away, sweetheart. I’m so sorry.”
Hannah straightened up rigidly. “She died?”
“Yes. Her mother was kind enough to call and let us know. She said she died peacefully in her sleep. The doctors just couldn’t get the disease under control, and her body finally gave out.”
Hannah sat motionless and speechless.
“Her mom said to let you know how much your visit meant to her. She said Ellie never stopped talking about you.” Monica’s voice trailed off at the end.
Hannah suddenly felt a strange sensation deep within her mind and body. It was similar to the feeling just before a sneeze, a laugh, or a yawn where there is an increasing tide mounting within that demands an outlet of some kind. She had never cried before, but now her eyes were inundated with water, and she noticed her vision became blurry because of it.
“Is there something in my eyes?” the child asked.
Monica checked Hannah’s eyes, which seemed normal except tears were welling up in them.
“No, I think you’re just feeling sad, and are getting tears from that.”
Hannah went back to thinking about Ellie. Her makeup and crescent earrings. Her jazzy nails, and those wisps of remaining hair clinging tenuously to her scalp, stubbornly refusing to relinquish their intended purpose. She thought about that unpleasant antiseptic smell of the hospital and then, Fantavio.
For the first time in her life, tears of sadness began to flow from Hannah’s eyes. At first this felt peculiar to her, as if her body was in control of something that her mind was not. But it was natural, and it had to happen, so she simply surrendered. She put her head on Monica’s shoulder and began sobbing.
“It’s okay, it’s okay. Let it out. Just let it out.”
After many tissues, Hannah’s crying subsided and she politely asked her mother for privacy. The door closed and she sat idly for a minute, just thinking and dabbing at her eyes. Then she rose to her feet and made a beeline back to the computer and climbed into her seat. She downloaded that same purple image of the cancer cell again. Leaning forward, she gritted her teeth and sneered at it. “Hey, cancer cell. Guess what? I’ve got 100 trillion healthy cells, and we’re all coming after you.”
Hannah then put her elbows on the desk, lowered her head into her hands, closed her eyes, and squeezed her cranium like a vise. Her brain whirred within her skull. She expelled emotion from the equation because she knew that would be counterproductive. It was time to concentrate only on the facts. The bottom line was that cancer cells were doing something every cell strives to do. They were trying to live. Nature had programmed cells to create flowers, trees, starfish, and babies. Somehow she needed to find a way for nature to stop creating cancer cells.
There was a meager rain falling outside. The child listened to the pitter-pattering on the windows of the room as cars loudly sloshed by below. Her mind drifted back to those windshield wipers during her drive to meet Dr. Lally. That had been a week ago, but seemed like so much longer. “Come on, Hannah,” she prodded herself. “Find a better wiper, girl.”
Chapter Thirty-Seven
The Key to Success
Hannah knew that if eradicating cancer cells was the only objective, that part of the problem was already solved. That was not the hard part. Cancer cells could easily be destroyed by removal, chemicals, radiation, and other agents. The tricky task was doing away with harmful cells while sparing the healthy ones that people needed. Many times the bad cells were inextricably intermingled with the good cells. She considered how a lawn overtaken by weeds could be treated by using a backhoe to remove the entire lawn, planting new soil and seeds, and starting over from scratch. This strategy was not always an option for treating human beings with cancer. What was needed in many cases, using the lawn analog
y, was a weed killer, which would destroy the unwanted growth while letting the healthy grass thrive.
Hannah had learned that cancer cells were distinct from healthy cells in a variety of ways, one of which was that their surface molecules were unique. She knew that most cancer cells derived from a single mutant cell that passed along an exact replication of itself to its progeny, so the surfaces of these cells for each individual cancer must all be the same. Could that be the Achilles’ heel of cancer? This was the direction she found herself gravitating towards.
On the 11th day of Hannah’s work, Monica gently knocked on the door for one of her regular check-ins.
“I have your lunch, sweetie.”
“Thanks, Mom, come on in.”
The doorknob jiggled a bit, but the door didn’t open.
“Do you have this locked?”
“No, Mom, I didn’t touch the lock.”
Monica shook the doorknob again a few times more vigorously.
“It’s not opening. I’ll get your dad.”
The pair tried to open the door without success. Hannah tried from inside as well.
“Stupid old thing,” said Brian, “it’s a spring latch and the doorknob’s broken away from the cylinder. We need the key, or I’m gonna have to take it apart.”
“I don’t think we’ve ever used the key. It could be anywhere,” said Monica.
“Okay, I’ll get my toolbox. Hang on, Hannah, I’ll bust you out in a few minutes. After you cure cancer, can you invent a new lock and key?”
Hannah sat down on the bed thinking for a minute, then moved to the computer and started researching how keys work. By the time Brian had unscrewed the knob and forced open the door, the child had swiveled her chair around to face her parents, and now had a request.
