“So you have learned something new about the cause.”
Eleanor gave a thin smile. “I promise, I’m not just being coy. I really can’t talk about that. Come back and ask me again in a few months.”
“All right. So then, officially at least, we still have no idea what’s causing it. Everyone thinks it’s a virus but–I know, you can’t comment on that. But we do know what it does. So what happens now? How do you see this situation developing?”
“That’s a multivariate question,” said Eleanor. She put down her toy, went to a bookcase, and started scanning titles. “It could develop a lot of ways, and will certainly develop differently in different places. For the U.S., the best case scenario is still that GDS turns out to be a curable condition.”
“So things could go back to normal?”
Eleanor laughed, a single sharp breath. “What do you mean by ‘normal’? If normal means how things were before GDS, not a chance. There’s a way for women to reproduce without men now, and thousands of people already have it. That genie isn’t going back in the bottle. Ah, here it is.” Eleanor pulled a thick oversized paperback off the shelf and brought it back to the desk. “But in the U.S., best case, we could have a new normal. One where individual women choose whether or not to be parthenogenetic. This raises a whole host of political questions, though. Should sexual reproduction be considered the default? Should girls born with GDS be compulsorily cured, or allowed to choose for themselves when they reach puberty? If we let them choose, what do we do in cases where girls begin ovulating before the age of informed consent? Put them on birth control? If we don’t, they’ll never experience what we consider a normal childhood, but handing out the pill to children is going to be controversial.” She wheeled her fingers in dismissive circles. “It just goes on. Even if we can cure it, things stay complicated. And that’s for our country. Look at this.”
Eleanor flipped through the book, found a chart, and turned it around for Tess to read. “This is Trends in Maternal Mortality. The World Health Organization publishes it every couple years. For every country they calculate the maternal mortality ratio, the number of maternal deaths per number of live births. In the developed world it’s negligible, but in places like Sub-Saharan Africa, giving birth is one of the most dangerous things a woman can do. If you’re a woman in Chad, your estimated lifetime risk of dying in childbirth, today, is one in fourteen. And that’s with only, on average, six children per woman. Call it…” Eleanor flipped the book back around and looked up something in an appendix. “Call it seven or eight pregnancies total. A girl born with GDS could naturally experience over thirty pregnancies during her reproductive years. At those rates, if you happen to be a woman in Chad, you might as well just expect to die during childbirth.”
Eleanor turned the book toward Tess again and went back to her chair. “Barring both a cure and a revolutionary change in the way we do foreign aid, the best-case scenario is that in thirty years the world’s undeveloped countries overflow with orphans. Picture NGOs setting up quonset huts packed with tiny bunk beds. Soup lines of just little girls. That sort of thing. The famine is going to be on a whole new scale.”
Tess pressed down the glossy page so she could look over the tables. Afghanistan, 1 in 11. Congo, 1 in 24. Haiti, 1 in 93. United States, 1 in 2,100. She copied down numbers and flipped to another page. “What’s the worst case?” she asked.
“In the undeveloped world? Short term, infanticide, maybe genocide of the infected. Long term, extinction of the male population and massive reduction in average life expectancy,” Eleanor said. “You can take that book if you want. They’ll be putting out a new one soon.”
Tess closed the book and put it in her bag. The followup article Lynette had proposed was already taking shape in her mind. “And in the developed world? What’s the worst case scenario here?”
“Ah. I wish I could answer that one. It’s something I think about a lot. But this is where I have to remember to wear my CDC hat,” said Eleanor. “The CDC is a federal agency, and I’ve got three grad students and a post-doc working on money from the NIH. The truth is that for a wealthy nation like us, what constitutes the worst case scenario is a policy question, not a science question. It’s important for me to stay nonpartisan or I could put my funding at risk.” She spread her hands in a mea culpa. “I think I’m more effective as a researcher than I would be as an advocate. I’m sorry. I know that’s an unsatisfying answer.”
“I understand,” said Tess. She scratched another dollar sign in her notebook, out of fidelity to her earlier impulse to case Eleanor as a kind of disease profiteer. But her heart wasn’t really in it anymore.
“What I can tell you,” said Eleanor, “is that our limiting factor won’t be poverty. It’ll be consensus. We have hospitals and access to hormonal birth control. However things end up, it’s going to be the result of a series of collective decisions about values. So our job–I’m talking yours and mine now–is to try and make sure those decisions are as informed as possible.”
Tess raised her pen and swirled it between her fingertips. “Working on it.”
“And of course, there’s nothing stopping you from advocacy, is there? I’m looking forward to seeing what you write. I promise not to call it terrible.” Eleanor grinned, then shook a large rubber watch down her wrist and checked the time. “Do you have any more questions? I have a meeting, but I can go a few minutes more if you need.”
“I think I’ve got enough here.” Tess stopped the recorder and put it back in her bag. “I can get back in touch with you if I need to?”
“Oh, sure.” They got up, and Eleanor shoved Tess’s chair back against the wall. “Are you parked in the lot off Clifton?” she asked. “My meeting’s across the street. I’ll walk down with you.” Eleanor grabbed a small backpack and slung it over one shoulder. “Who else do you have on your dance card while you’re in town?”
“Tomorrow I sit down with Donald Noyce of AABB,” Tess said. “Then I spend a week in D.C. Talking with people who can go on the record about policy.”
“I know Don a little. He’s a good guy. A good guy with a bit of a talent for rubbing people the wrong way. But he knows his stuff.”
“I’ve heard good things.”
At the end of the hall Eleanor turned toward the stairwell. Tess paused by the elevators. It took a moment for Eleanor to notice.
“Wait, what am I thinking. We’ll take the elevator.” She came back and pressed the button. “Habit. Sorry.”
“It’s okay.”
“So when are you due?” Eleanor asked.
“October twenty-second,” said Tess.
“A little Libra. Unless he shows up late. Do you know what you’re going to name him?”
The elevator chimed and the doors slid open. “My partner and I have been calling it Decaf. We don’t know the sex yet. I’m scheduled to get a sonogram when I get back from this trip.”
“Oh,” said Eleanor. “Sorry. From what you said earlier, I just assumed you already knew.”
“Not yet. Not for a bit. I think I’d be fine with not knowing, but my partner. She couldn’t handle it.”
The elevator counted down the floors with soft beeps. Neither of them said anything more, the first time Eleanor had stopped talking all afternoon. Tess leaned against the wall, letting the steel handrail press comfortingly into her lower back, until the elevator spat them out at ground level.
As they walked outside into the Georgia sunshine, Eleanor asked, “So did you use a known donor?”
Oh. “No. No, it was an unknown donor. It’s much safer. Legally safer, I mean. There’s no risk that years later the guy decides he wants to try being your kid’s father.”
“Right. Of course.” Eleanor nodded. “That makes sense.”
Eleanor visored her hand over her glasses and scanned the sky. Then she caught Tess’s eyes again.
“Okay, this is none of my business, but given what you said before…I mean, you’re going to tal
k to Don about the blood banks, so you’ve probably thought of it already. But you do know there’s a chance the sperm banks are going to be a problem too, right? That’s another thing we might have to deal with.”
Did she know about the sperm banks? Of course she knew. She and Judy had argued for weeks. It was almost certain that the sperm banks were contaminated to some degree. For Tess, at least at first, how great that degree was didn’t matter. Any chance was too much. The amount of time you’ve spent researching this has you paranoid, Judy had countered. Every medical procedure has some risk. We’re in a state hostile to gays. The most important thing is to protect our family. In the end Tess had conceded. Judy was right that, of all the dangers associated with pregnancy, GDS would be the most minor. She was right that their legal risks as same-sex parents dwarfed their medical ones. She was right that they could, if Tess was worried, reduce the chances even further by selecting sperm that had been frozen for several years. And she was so invincibly certain when she said whatever happens, we can handle it, that she was probably right about that too. But still.
“Do you have any statistics?” Tess asked.
“On sperm banks?” said Eleanor.
“Or demographic data. Anything unpublished. If it’s out there, I’d have seen it already. I’ve looked.”
“I can’t discuss unpublished — ”
“Off the record. Please.”
Eleanor probed at a pebble of asphalt with the toe of her boot and wiped sweat from the back of her neck. “Census data isn’t granular enough, is the problem. There’s a longitudinal study underway. Where are you from?”
“South Texas. Houston.”
“The birth rate bump in Texas has been slightly higher among Hispanics. Probably that’s attributable to the Catholic distaste for condoms. But to do any meaningful risk analysis, you’d need to account for selection bias. What cross section of men choose to donate, and what, if anything, do the banks disproportionately screen for? I’m not sure we have that data.”
“Yeah,” said Tess, “I didn’t think it was out there.”
“The chances are really low. Honestly, almost all pathogens are taken care of by the sperm washing process. Usually sexually transmitted infections are due to exposure to semen, not sperm. With this one, though…” Eleanor seemed lost for what to do with her hands, and pushed them down into her back pockets. “I just wanted to make sure you were aware.”
Tess sighed. “I think I know about as much as anyone does.”
Eleanor nodded, and paused again. Tess was ready for goodbyes, but then Eleanor said, “‘Off the record’ means you absolutely can’t publish it? Under any circumstances?”
“Yeah. Don’t worry, I won’t write up any of this.”
“It’s not a virus.”
“What?”
“GDS. It isn’t a virus. It’s a massively drug resistant bacterium. An obligate intracellular parasite. Like chlamydia,” said Eleanor.
“Chlamydia?”
“It’s not chlamydia, that’s just another organism with a similar life cycle. Kind of like a bacterium that wants to be a virus. It lives in the cytoplasm of the host cell and reproduces there. So if sperm washing doesn’t work, that’ll be the reason why. That’s all I can say for now, but we’re figuring this thing out. Seriously, come back and talk to me in a few months. I’ll have things to tell you. Ones you can publish.”
Tess reached out for a handshake. “Thanks for sitting down with me,” she said.
“Good luck with your article.” Eleanor lingered a moment. “And on the rest of it. Good luck.” She let go of Tess’s hand and headed off.
Tess went to her car. She thought about her trip to the sperm bank with Judy. The two of them had looked through the database and decided on an unknown Anglo donor. (Anglo so that their child would share an ethnic heritage with both of its parents. Though the scrubs-wearing teenager who handled their paperwork at the clinic had helpfully informed them that “mixed-race sperm” was available, in case Tess wanted her baby to look just like her. Ha.) They’d settled on a five-year-old sample, the oldest the clinic could provide. They’d taken every reasonable precaution. And maybe, in a few months, Eleanor would tell her that it wasn’t a problem anymore. A shot for her, a shot for Decaf. Perhaps a shot for Judy, too, if it was even necessary. There was just no way to be sure.
Tess got out her phone to map the way off the campus and found a text from Judy, a stale response from their earlier conversation: That’s what I always tell you.
She put the phone away.
There was some event going on in the school’s auditorium, and Tess ended up in a long, creeping line of cars, most of them turning one by one into a parking structure. The single-file inching reminded her of the giant worker ants in the airport. She wondered if there was any way to tell, as they swarmed the building in their statue stillness, whether they were supposed to be taking the place apart or putting it together.
DONALD NOYCE IS a 40-year veteran of the blood industry. He has been a phlebotomist, worked for the American Red Cross, and now works for AABB, a non-profit that promotes safety standards for blood-based medicine. He says there are two words being whispered behind closed doors in his field: profiling and speciation.
“The real question we are struggling with is, when are we going to bifurcate the blood banks? I can tell you, we’re going to have to sooner or later.”
The first cases of GDS to get widespread attention from the medical community were the result of blood transfusions. One might expect, then, that donations and transfusions would be a primary areas of focus as our healthcare institutions adapted to this new reality. That turns out not to be the case. In the nearly two years that the medical community has been aware of the problem, there have been no changes to national policy on blood collection and distribution.
“We’re all still waiting for an assay,” says Noyce, meaning a blood test that can identify GDS. “Once we know what the bug looks like, things will be a lot easier. But you can’t just put transfusions on hold while the science gets done. And if you can’t screen blood directly, the only ethical choice is profiling. Now that’s a dirty word, right there. But it’s a lesser of two evils thing. It’s more important that you don’t get sick when you need blood than it is that everyone who wants to can donate.”
The profiling Noyce refers to is the practice of barring members of statistically high-risk groups from giving blood. During the early years of the AIDS epidemic, that meant deferring intravenous drug users and homosexual men. Noyce worked for the Red Cross at the time, but was driven to resign by what he saw as the organization’s inability to react in a timeframe necessary to save lives.
The non-profit Red Cross didn’t start deferring homosexuals until several years after the for-profit companies that buy blood and process it into expensive medications. “And then,” says Noyce, “they forgot to ever switch back after we had a blood test, but that’s a whole ‘nother kettle.”
Today the high-risk populations would be women who have given birth to daughters in the last six years and fathers of those daughters. (Girls younger than six would technically be on the list, too, and will have to be added if there still isn’t a blood test when they are old enough to donate.) The more daughters a woman has recently had, the higher risk she is. Companies in compliance with AABB recommendations are now deferring women with three or more daughters under the age of six. There are no mechanisms currently in place to defer potential male carriers.
“It’s not a perfect solution,” Noyce admits, and runs a hand over his bald scalp. “Profiling is just a stopgap, anyway. We’ll get an assay eventually. But when we do, we can’t just throw away the positive blood. There are going to be a lot of these people. Eventually we’re going to have to store their blood just to keep up with the population boom. But we can’t get started on updating our infrastructure because of the [expletive] FDA.”
The Blood Products Advisory Committee of the Food and Drug Adminis
tration is responsible for setting the guidelines that publicly funded collection agencies are required to follow. They commissioned a white paper on GDS, which ended up recommending precisely what Donald Noyce wants to see happen: the establishment of a dedicated infrastructure for collecting and storing GDS-infected blood. The recommendation became controversial, due to what Noyce identifies as an impolitic choice by the paper’s authors.
“The poor bastard who wrote it never realized the trouble he was causing. His heart was in the right place, really. You read the report. The projections in there are sound, the timeframe is perfectly reasonable. It was just the words he used.”
Enter “speciation.” The white paper used this term to describe why it was necessary to double the number of categories in the blood industry, implying that, due to their different reproductive strategy, women with GDS should be considered a different species than men and women without. The debate over the accuracy of that assessment has incapacitated the FDA.
“No one wants to pull the trigger now. They’re all [expletive] terrified of being the person who officially splits the human race down the middle.” Noyce has several unpublishable alternatives for what the letters of the organization stand for. On the subject of speciation, though, he is agnostic. “I’m happy to leave that one to folks who have a better idea of what a species is than me. What I think about is that, whatever they are, they’re people. And there’s bound to be a lot of them. And they’re going to need blood.”
No one disputes that there will be a lot of them, but not everyone agrees that those who have GDS are people. While the FDA is paralyzed by fear of endorsing the idea that those with GDS constitute a different species, in other branches of government there are already attempts underway to enshrine the notion in law.
TESS WAS DAUNTED by the access afforded her in D.C. as a reporter for American Moment. As she sent her bag through the x-ray machine at the Hart Senate Office Building and spread her arms for the wand-wielding security guard, she felt the familiar, irrational queasiness that all the eyes and sensors would peer through her credentials and spot an impostor. No matter her rituals of reassurance, the anxiety had only mounted during her time in the city, through all the meetings she’d already taken. She’d interviewed three representatives involved in GDS legislation and had an appointment with a fourth. There were lobbyists seeking her out, fighting each other for face time. And now she was about to sit down with Bailey Rogers, senior senator from Texas, who had unexpectedly found a free quarter-hour in her schedule. Members of her own family were harder to get ahold of than the politicians she wanted to see. After years of “could not be reached for comment,” it made Tess feel as though she’d tricked her way into a sudden, fragile celebrity. But just as all the others had, the security guard waved her through without incident.
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