by Kōji Suzuki
But Hideyuki didn't flinch as he coolly chose the artificial anus. If you open me up and can't say with certainty that the cancer hasn’t spread that far, then I want you to cut it all out without hesitation, he'd volunteered. He intended to bet on the option with the best odds of survival.
Once again the summer found him back in the hospital for surgery. When they cut him open, the doctors found that the cancer hadn't invaded as far as they had feared; normally, in this situation, leaving the anus in would give at least even odds of success. But the surgeon in charge decided, in view of the patient's expressed wishes, to remove the sigmoid colon entirely.
Once again autumn found Hideyuki checking out of the hospital. For the next two years he'd lived in fear of signs of a relapse, as he strove to get used to life with a colostomy.
Exactly two years later there was another sign, this one a yellow light, as it were. Hideyuki became feverish and his body took on a yellowish cast, symptoms that got worse day by day. One look at his jaundiced condition told the doctors that the cancer was attacking his liver.
The doctors hung their heads. They thought they'd made sure, over the course of two previous surgeries, that the cancer hadn't spread to the liver or lymph nodes.
It was at this time that Kaoru began to suspect that what they were seeing was the emergence of some unknown illness, something that was indeed a kind of cancer, but one different from those previously known. His interest in basic medicine intensified. In the summer of his seventeenth year, having graduated from high school a year early, he entered the pre-med program in the same university that his father had attended.
The third time he lay down on the operating table, Hideyuki lost half his liver. He subsequently checked out of the hospital, but neither Kaoru nor Machiko could make themselves believe now that the battle with cancer was over. The family watched for enemy movements with bated breath, wondering where the cancer would invade next; the return of a peaceful, happy home life was something hardly to be hoped for.
That cancer won't rest until every organ in his body has been plucked out, Machiko insisted, and she wouldn't listen to any of Kaoru's medical knowledge. If she heard about a new vaccine, she'd scramble to get her hands on it even before it was fully tested. Hearing vitamin therapy was effective she tried that; she pressured the doctors into trying lymphocyte treatment; she even sought salvation in charismatic religion. She was willing to try anything-she couldn't swear she wouldn't sell her soul to the devil if it would save her husband's life. It depressed Kaoru to see his mother running around like a woman possessed. It was beginning to look like his father's death would also mean the collapse of his mother's psyche.
After that, Hideyuki spent most of his time in his hospital bed. He was still only forty-nine, but he looked like an old man of seventy. His hair had fallen out as a side-effect of the anti-cancer drugs, he was emaciated, his skin had lost its luster, and he was constantly running his fingers over his whole body and complaining of itchiness. But even so, he never lost his attachment to life. As his wife and son sat by his bedside he'd hold their hands and say, ''You listen to me, next year we're going to that desert in North America." And he'd force a smile. It wasn't exactly false cheer-he obviously fully intended to fight this illness so he could keep his promise. The sight was both reassuring and painful.
As long as his father showed such a positive attitude toward life, Kaoru never entertained thoughts of giving up. No matter how bad the cancer got, Kaoru believed his father would conquer his illness in the end.
At around this time, a type of cancer with the same progression as Hideyuki's began to be identified, first in Japan, then worldwide. At first the true cause of this new strain could not be identified, as if it lay wrapped under a veil. A few medical professionals supported a theory that it was the work of a new virus that turned cells cancerous, but they couldn't explain how this cancer virus differed from others, and besides, there had been no reports of such a virus being successfully isolated. But the vague suspicion spread.
It can take several years after a new disease has been identified to pinpoint the virus that causes it. The lag was especially understandable in the case of the cancer that had afflicted Hideyuki and millions of others, because at first it looked just like any other cancer: nobody realized they were dealing with a new disease. But gradually the world came to be gripped by fear that a terrible new virus had been unleashed.
Finally, one year ago, the new cancer virus had been successfully isolated in a laboratory at the medical school of Fukuzawa University. With that they had proof: a virus was the cause of this metastatic cancer.
The new virus was named the Metastatic Human Cancer Virus, and it was thought to have the following characteristics.
First, it was an RNA retrovirus that actually caused normal cells to become cancer cells. Thus, anyone infected with the virus ran the risk of developing cancer, regardless of whether or not they had been exposed to carcinogens. However, there was room for individual variation: there were confirmed cases, though only a few, of infected people who were mere carriers, never developing cancer themselves. It took on average three to five years from the time of infection for the cancer to grow large enough to be detected clinically, although the degree of individual variation in this was great.
Second, the cancer was contracted through the direct introduction of virally-infected lymphocytes into the body. That is, it was not spread through the air, but through sexual contact, blood transfusions, breastfeeding, and similar contact. Thus, it was not what would be called highly contagious. But there was no definitive evidence to say that it would not at some point in the future become transmissible through the air. This virus mutated with frightening speed.
Due to the similarity in the manner of its transmission, some scholars speculated that the new virus was the result of some sort of mutation in the AIDS virus. Perhaps the AIDS virus had sensed that it was about to be eliminated by vaccines, and so had colluded with an existing cancer virus, skilfully changing its appearance. And indeed, there was a nasty resemblance between the two viruses, not only in how they spread, but in the way they nested in cells in the human body.
When the Metastatic Human Cancer Virus, carrying reverse-transcription enzymes, merged with human cellular tissue, the RNA and reverse -transcription enzymes were released to synthesize the double helix of DNA.
Then, this synthesized DNA mingled with normal cellular DNA, turning the cell cancerous. Which was bad enough. But it didn't end there. The cell could now no longer tell the difference between its own DNA and the viral DNA, and so it kept manufacturing the cancer virus and releasing it outside the cell. The released virus made its way into the bloodstream and the lymph stream, where it deviously fought off attacking immune cells while awaiting the chance to move into a new host.
The third characteristic: when the cancer started, almost without exception it metastasized and spread throughout the body with frightful strength. This, of course, was why it was called the Metastatic Human Cancer Virus.
There are benign tumours and malignant ones, and the difference between them lies in the thorny questions of invasiveness and metastasis. A person may develop a tumour and still have no reason to fear, as long as it doesn't spread through the surrounding area, move into the blood and lymphatic vessels, and metastasize.
But this metastatic cancer spread through rapid reproduction and extreme invasiveness, and was highly resistant to the immune-system attacks it experienced as it circulated through the lymph and blood streams. It was much more likely than normal cancer to survive in the circulatory system.
As a result, anyone who came down with this cancer had to assume a 100% probability that it would metastasize. The question of whether or not one survives cancer can be restated in terms of whether or not one can prevent that cancer from metastasizing. With a 100% chance of metastasis, it was essentially impossible to hope for a complete recovery from MHC.
The fourth characteristic was that th
e cancer cells created by this virus were immortal-they would live forever if their host didn't die.
Normal human cells have a limit to the number of times they can divide over the course of their existence-just like humans themselves, they have a certain span of life allotted to them at birth. For example, by the time a person becomes an adult, his or her nerve cells have lost their ability to reproduce themselves, so that they are no longer replenished. It might be said that nerve cells have the same lifespan as humans do.
In this way, the aging and death of cells is intimately connected with the question of human lifespan. But these cancer cells, when removed from a host and sustained in a culture fluid, went on dividing infinitely-they would never die.
There were certain religionists who pointed to this and spoke of it in a prophetic vein, saying, If we could harness the power of these cancer cells and transfer it to normal cells, we would be able to achieve immortality-we’d never grow old.
But of course these were nothing but amateurish delusions. It was paradoxical that cells which had achieved immortality would then kill their human hosts, assuring that they themselves would die. But it was a paradox that, by and large, people managed to accept.
2
It was the rainy season, early summer of the year before Kaoru was to take his national examinations, and every day was a busy one for him. Visiting his dad and working a part-time job took up so much of his life that he barely had time to look after his mother's mental state-much less study.
If left to her own devices, his mother would try to get her hands on anything that claimed to be effective against cancer; Kaoru had to keep a constant watch so it didn't get out of control.
Hideyuki didn't approve of his son spending so much energy on his part-time job. He felt that his son should concentrate on studying, and that splitting his time between that and working was essentially a waste. The idea that Kaoru was doing it on account of his own illness irritated him even more: Hideyuki insisted that he could pay for Kaoru's school expenses, that they had enough money in savings. As far as talking big went, he was as healthy as ever; but the optimism in his words was Kaoru's salvation.
In reality, Kaoru was the one who held the family's finances in his hands, and he knew that they didn't have much to spare. He had to keep his job. But of course he wasn't about to complain to his father about their budgetary straits. There was nothing to be gained by letting his father know things were tight. So Kaoru lied to Hideyuki, telling him that he worked because he wanted more spending money.
When they were together, Kaoru wanted to set his father's mind as much at ease as possible. It wouldn't do to betray the fact that because his illness had decreased the family's income, Kaoru and his mother were having to squeeze by. Luckily, as a medical student Kaoru had no trouble hanging out his shingle as a tutor, and in fact he made quite a bit of money that way. The hospital connected to Kaoru's medical school had a lot of child patients whose parents didn't want them to fall behind in their studies when they went back to school; tutors were always in demand.
One day early in his summer vacation, Kaoru visited the hospital to tutor a junior high schooler in math and English, and then had a light lunch in the cafeteria. His father was a patient in this very hospital. Kaoru had just heard that there was a possibility that the cancer had spread to his father's lungs; his mood was black. His father had recently gone into his annual litany. This year, he said, we 're going to see those longevity zones in the North American desert. But the words had rung hollow. And then came-as if on cue-the indications that the cancer had spread.
Kaoru was sitting in the cafeteria, sighing over his father's illness and his family's future, when he saw Reiko Sugiura and her son Ryoji.
The cafeteria was on the third floor of the hospital, surrounding a courtyard on three sides; the walls facing the courtyard were of glass. There was a fountain in the courtyard, and sitting at a table in the cafeteria one was eye level with the top of its spray. The cafeteria was so carefully decorated, and its food so pleasant to the taste, that it felt more like a stylish outdoor cafe than part of a hospital. Gazing at the water from the fountain had a truly relaxing effect.
Kaoru's eyes were drawn naturally toward the beautiful woman being shown to an empty table.
Her tanned body was sheathed in a summery beige dress, and her face was so nicely formed that it was eye-catching even without the aid of cosmetics. If it weren't for the child at her side, she could have passed for ten years younger than what Kaoru guessed she had to be.
The woman and boy sat at the table the waiter indicated, which happened to be diagonally adjacent to Kaoru's. Kaoru watched them seat themselves, and, after that too, he found his attention drawn to the woman, his eyes riveted to the legs stretching out from beneath her mini dress.
He realized this was the same mother and child he'd seen at the hotel pool two weeks ago. One of his students' grades had gone up so much that the kid's parents had given Kaoru an all-summer free pass to that pool. On the first day he'd gone to swim there he'd encountered this pair, sitting poolside in deck chairs.
From the first moment he'd laid eyes on the woman in the green bathing suit, he was sure he'd seen her somewhere before, but when and where he couldn't say. Kaoru was normally confident in his powers of recall, but poke about as he might in the recesses of his memory he couldn't place the woman. The experience left him with an unpleasant aftertaste that wouldn't go away. A woman as beautiful as this he wouldn't expect to forget, and yet evidently he had. At the time, he'd tried to put her out of his mind, telling himself he was mistaken, but then something about her finally triggered memories of the star of a soap opera he'd watched as a child. He wondered if it was the same woman.
The boy made an odd impression, particularly his physique. The blue swim cap that he wore pushed back on his head, the goggles, the check-pattern shorts that Kaoru could tell at a glance weren't for swimming in, his skinny bowed legs, and most of all his abnormally white skin. He resembled an "alien corpse" Kaoru had seen on some fake TV show a long time ago. Everything about the boy looked strangely off-kilter. The pair stuck in Kaoru's memory: this woman he'd seen somewhere before and this weird-looking boy.
And now they were sitting at the next table over. Kaoru, sitting by the window so he could gaze down at the fountain, found he could catch their reflection faintly in the glass. He observed this instead of staring at them directly.
After a few moments, Kaoru figured out why his first impression of the boy had been of unbalance. It was his hair, or rather his lack of it. When Kaoru had first seen the boy poolside, his swim cap had been missing the bulge that would normally have told of a full head of hair.
Today, too, the boy was wearing a hat when he sat down at the table, but after a few moments he took it off, revealing his head to be perfectly devoid of hair.
Kaoru realized what that meant. The boy was here to be treated for cancer. He'd assumed mother and child were both here to visit a patient, but now it turned out that the mother was accompanying her son to chemotherapy. Hideyuki was undergoing chemotherapy, and his hair too had fallen out, but somehow seeing a child suffer that side effect was even more heart-rending. Kaoru thought about that day at the pool, that swim cap hugging the boy's bare scalp directly-no wonder he'd left such a peculiar impression.
Kaoru rested his head on his hand and watched the beautiful thirty-something woman and her son, who was probably a fifth or sixth grader, eat their lunches without talking. Without being conscious of it, he was comparing them to his father, hospitalized here. His father was forty-nine, while this boy had to be eleven or twelve. Both were taking anti-cancer medication.
The mother in her airy beige dress looked too bright and cheerful for a hospital. Once in a while she raised her head and glanced out the window. She didn't look like she was tasting what she ate-she was just eating to eat, looking at no one in particular with an expression that could have been a smile or the equivalent of a sigh.
She paused with her spoon in the air, then returned it to the plate, then started to bring it to her mouth again, and then suddenly shot a glance in Kaoru's direction. At first her gaze was sharp, as if to ask, What are you looking at? But as her eyes met Kaoru's her gaze softened. Kaoru found himself unable to look away.
It seemed she recognized him from the pool. She looked like she wanted to say something. Kaoru bowed his head slightly, and she answered with the same gesture.
And then her attention was taken up by her son, who chose that moment to toss aside his chopsticks and spoon and throw a tantrum. The sight of Kaoru fled her mind.
Even then Kaoru continued to watch the two. He was powerless to resist-it was as if his consciousness had been uprooted and physically carried to where they were.
Several days later, in the courtyard this time, Kaoru had the opportunity to speak to this mother and her child. By some lucky chance they ended up sitting side by side on the same bench, making it possible for a conversation to start naturally without either one making the first move.
The mother introduced herself as Reiko Sugiura and her son as Ryoji. Ryoji's cancer, which had first appeared in his lungs, now looked like it had spread to his brain, and his days were filled with tests preparatory to radiation and chemotherapy.
Not only that, but it seemed that the agent that had turned his cells cancerous was none other than the recently isolated Metastatic Human Cancer Virus-the progress of the illness, from first appearance through subsequent metastasis, was nearly identical to Kaoru's father's case.
