Isolation Ward

by Joshua Spanogle

  Eventually, traffic began to move and my speed got well into the teens. The road passed under train tracks, then rose again to meet The Farm.

  Whatever my feelings about the university where I’d spent four grinding years of medical and scientific training, I had to admit it: I love the grandeur of the place. It isn’t grandeur in the East Coast sense; it lacks the Gothic and Georgian gravitas of Yale or Harvard. But it is grand nevertheless. The entrance to the university grounds—which are, by sheer acreage, the largest of any university in the country—is marked by two large sandstone arches that give way to a half-mile-long thoroughfare lined with palm trees. The trees, the gift of some rich alumnus with an eye for spectacle, rise like massive pillars with broad green Corinthian capitals. Rumor has it the trees were thirty thousand a pop.

  The medical school itself was barely recognizable. Two massive science buildings bulged from where there had only been patches of green years before. The buildings were impressive and impassive, hewn from what looked like solid blocks of buff-colored sandstone. My entrance made me think of a quote I once read by a famous art historian: Coming into New York City through Grand Central Station, “one entered the city like a god”; coming in via Penn Station, “one scuttled in like a rat.” Well, if sandstone arches and palm-lined boulevards make you feel like a god, giant medical buildings make you feel like a rat. Especially if you’re the rat they kicked out years before.

  Anyway, I suppose there was more here at play than an architecture-induced inferiority complex. There was, too, that feeling that institutions do not change; they remain the same as when you’d left them. Especially true for schools and colleges. So it’s jarring when you find that the doorway where you pissed after that party is now a security door with a security guard behind it; the bushes where you got that dynamite blow job after the fall formal is now a student center. Universities do not remember their children. And this university definitely did not remember me. At least that’s what I hoped.

  Fifteen minutes before the appointment with Dr. Tobel. Figuring I might as well face my demons, I locked the car, pumped the meter with quarters, and walked toward the school.

  Once inside, I recognized exactly nothing. Gone were the banks of beige lockers in which we’d stashed books and stethoscopes. Gone was the refrigerator in which lunches sat for weeks and which smelled like a landfill. Gone were the cramped, ammoniac bathrooms.

  I stopped a girl who looked to be about thirteen and asked her where the med school was.

  “It’s over there”—she pointed through the wall—“near the admin buildings.”

  So they finally gave the students the long-promised new classrooms. I had a pang of nostalgia for the old place, but my reverie was cut short by a screechy voice behind me.

  “Nathaniel? Nathaniel McCormick?” I turned my head to see a short, dark-haired woman in a long white coat, the pockets filled with stethoscope, pens, pocket charts. Oh, God, I thought, not now. Not ever.

  My stomach churned and I ratcheted through the faces of every white woman I knew from my early years.

  “Jenna Nathanson,” she said, sticking out her hand, saving me from having to stumble through a conversation in which I never once said her name. On the downside, if I remembered Jenna Nathanson correctly, this was going to be a less-than-pleasant tête-à-tête. I wondered why the hell I hadn’t stayed in the car.

  “Hi, Jenna,” I said. “Long time.”

  “It sure has been. Wow. It really has been a long time. What have you been up to? Why are you back here?”

  I told her about working for CDC, about being here for a job and wanting to visit the old school.

  “Great. That’s great. It’s good to see you’re finally back on your feet after such a rough time.” The good old backhanded compliment, I thought. “You got an MPH, then?” she asked. Evidently, she didn’t think I could get back into an MD program and had opted for a master of public health. All things considered, it wasn’t a bad assumption.

  “No. MD.”

  “That’s awesome. Where?”

  The conversation was killing me. “At the University of Maryland,” I said.

  “Fine school,” she said disingenuously. “Well, I stuck around here for neurosurgery. They asked me to stay on for faculty. I’m an assistant professor now.”

  Jenna seemed not to have noticed I didn’t ask. “Good for you,” I said.

  “Yeah. Brain surgery’s tough, though.”

  “Well, it’s not rocket science.” I smiled; Jenna didn’t.

  “But it’s brain surgery.”

  “Yes, it is,” I said. How did I get ambushed into this conversation again?

  “The work’s not too bad, but being a woman . . . it’s hard.”

  About ten quips came to mind, but I steered toward safer shores. “I imagine it is.”

  “Anyway, somebody has to crack the boys’ club,” she said, giving me the weird feeling that I wasn’t even there, that she was talking to a wall or a shrink. But then she touched my arm. “How is it being back after—well, you know?”

  That was my cue. I looked at my watch. “Gosh, Jenna, I’m going to be late for a meeting. Congratulations on everything. Sounds like things are really falling in place for you.”

  I backed up as I spoke, not allowing opportunity for a coffee invitation or other social trap Jenna Nathanson might spring on me.

  Outside, I walked a good distance from the old building before looking around to make sure Jenna was gone. All was clear, and I sat on a bench. Only when I looked up did I realize I was sitting across from the Heilmann Building, where Harriet Tobel had her lab. Unlike everything else here, it looked the same as it always had: a blasted sandstone structure where I had spent many hours, where I had broken down in front of Dr. Tobel and asked—begged—her to help me. I looked to my right and saw the gray Dunner Building, the place that housed the lab in which I did my PhD work. In the corner, third floor, that’s where I’d been cocky, happy, ambitious, feeling like a Master of the Universe, where I’d flamed out. “Flamed out.” That’s what my classmates called it. I began to sweat.

  CHAPTER 43

  My flameout. In the career of an MD-PhD, the first two years of education are spent with the normal MD students, twenty months dedicated to basic science, the so-called preclinical classes: anatomy, biochemistry, physiology. But when the normal med students went off to the clinics to learn how to be doctors, the MD-PhDs went to the labs to learn how to be scientists. One’s choice of labs was excruciatingly important. Not only were you choosing your environment for the next four years, you were choosing a mentor and a field that would—it was hoped—produce for you a surfeit of publications, grant money, and contacts. Choose well and do good work and the world was your oyster. Choose poorly and, well, you could always be a doctor.

  In short, you wanted clout and respect, which shed like a virus from your respected and powerful principal investigator, your PI, and infected you. The end goal for most of us was the same, that grail of grails: your own faculty appointment and your own lab.

  After a year of searching, I settled on the cancer biology lab of Mark Jurgen, a transplant from Germany who was interested in the effects of viruses on human DNA. Dr. Jurgen worked with human papillomavirus, which causes warts and, in a subset of unlucky women, cervical cancer. Specifically, Jurgen was looking at the role of the virus in cell signaling. How, he wondered, did the virus cause the cells to divide crazily in some people? Though he worked with HPV, there was no reason to stop at warts. The idea of infectious causes for cancer was in vogue then, and Jurgen’s work was thought to apply across the board. I was hooked.

  The Jurgen Lab had the reputation as a pressure cooker. Jurgen expected results, and he expected his team to know how to get them. There wasn’t a lot of hand-holding, and his lab meetings were famous for sending people away in tears. But the man got results, and published them in the choice places: Nature, Cell, Science, Cancer, basically the A-list of scientific journals. A
nd though the whole endeavor was young—Jurgen had been around for only eight years—his doctoral students and postdocs were going on to places like Duke, Penn, Harvard. It was the place to be for young, smart, self-directed grinds like me. With my advisor Harriet Tobel’s blessing, I hitched myself to Jurgen’s coattails. And it went wonderfully. For a while.

  I carved out a niche working with the hepatitis C virus, which can cause liver cancer in some people. Hepatitis B and liver cancer had been getting a lot of attention then, but hep C was relatively untouched in this regard. My work with the virus was a big switch for the lab, though, since the papillomavirus is double-stranded DNA and hep C is single-stranded RNA. Anyway, enough of the nitty-gritty science. Suffice it to say that my work was new for the lab and no one there truly understood what I was doing. This gave me a lot of freedom, which, at the time, seemed great. In the end, though, it let me slide deeper into a scientific grave.

  Anyway, I thought I’d hit on a novel way the viruses spurred tumor growth, and I set about designing experiments to prove it. And, after two short years, I did prove it, and my results would have added significantly to the body of knowledge. With Jurgen salivating over the results, I readied the papers to be sent to top journals. I was a rising star in the lab, the medical school, and—dare I say it?—the field of cancer biology. There was only one problem: my results weren’t exactly valid.

  Let me flesh out the scene a bit more: compared to academic medicine, Wall Street and Hollywood are for candy-asses. If you want real pressure—and the promise of riches of the mind as well as of the world, the envy of your colleagues—try working in a powerful lab with a brilliant and driven principal investigator. With all due respect to Jenna Nathanson, it is brain surgery. Hell, scratch that; it’s a lot harder than brain surgery. Neurosurgery is for mechanics; neuroscience and cancer biology and molecular biology are for geniuses. As for money . . . the biotech revolution was seeing that the top dogs got paid and got paid well.

  Let me also flesh out my culpability here: I didn’t start by fudging data. My initial results were promising. So promising, in fact, that Jurgen was offering me the world. I was his golden boy and I basked in the sunshine of his admiration. When things began to go south, when the data I knew should say one thing said another, I started to massage the numbers a bit. I was right and I knew I was right; I just couldn’t get the goddamned numbers to fall in line. There it was: my path to fame and glory, threatened by a few stupid digits. I massaged and massaged until there was no way in hell I would ever be able to go back.

  My strategy wasn’t as misguided, naïve, or malicious as it sounds. Science is often a race, and I was running against a number of other labs working on similar problems. To the victor, all spoils. To the losers, years of work lost. Literally. I mean, you might be able to publish something in a third-tier journal, but even that might be a stretch. Feeling the heat, I wanted to take advantage of a quality in the submissions game. The time course of publication is a long one. I had every intention of running my experiments again while the papers wended their way through the submission and editorial process. I told myself that if, God forbid, the results didn’t pan out, I would pull the papers. And I believe, to this day, I would have. But it never got to that.

  A month or so before I was to submit the papers, Jurgen called me into his office. He’d been at a conference earlier in the year and had been chilly toward me since his return. I chalked it up to his peripatetic Aryan nature. Anyway, I was in the middle of writing the methods section of my paper and I asked him to wait.

  “Now, Nathaniel,” he rasped. From his tone, I knew something was up. I went into the small office ten paces from my lab bench.

  Jurgen folded his long Teutonic frame behind his desk and leaned back in his seven-hundred-dollar office chair. “Close the door.” I did. He said, “What’s going on?”

  I felt myself begin to flush. “What do you mean?”

  He tented his fingers and leaned forward. He spoke each word distinctly. “What is going on with your work?”

  Sweat prickled in my scalp. “It’s going fine. I’m just—”

  “You’re blushing.”

  “I know.”

  “And you’re sweating.”

  A good scientist never misses anything.

  “I know,” I said.

  He cleared his throat. “At the conference, I ran into Don Applegate.” Applegate was a researcher at the University of Chicago whose lab had been working on the same problem I was. “We talked about the research. He seemed surprised that we’d gotten the data we did.”

  I didn’t say anything; Jurgen continued. “Very surprised. So surprised, in fact, that he told others at the conference, and they, too, were surprised.”

  So, more than for the sin of fabricating data, I was being crucified for the sin of embarrassing my PI. Of course, Jurgen would never say this.

  “Since the conference, I have had the opportunity to monitor a few discussion boards. It seems as though there is much doubt about what we’ve been doing. I imagine after the paper is published, there will be others who will try to replicate the experiments.”

  But I knew then, as Jurgen did, that the paper would never be published. My face burned.

  “I have been spending the past few weeks with your data. A lot of time, Nathaniel. And I am having some trouble understanding how you came up with it.”

  “I explained it all to you. And it’s all in the methods. You have access to my lab notebook—”

  “And I have seen you have blacked-out some numbers.”

  Lab notebooks are the crumb trails of scientists. They record everything, or at least that’s how it’s supposed to be. You never erase or blacken something. You just cross it out. I should have known that, but I was sloppy. What I did was akin to shooting a man and leaving the gun with fingerprints at the scene.

  “I—”

  “Don’t speak.” His tic was to clear his throat. He did it again. “Last month, I had Karen run some of the assays—”

  “Last month? You had her run the experiment without telling me? You don’t trust—?”

  “No. Not now I don’t. But I want you to be quiet now, and then I want you to tell me I am wrong. If I am.” The guttural throat clearing again. “Karen ran the assays and did not get your results. She ran them again. She still did not.”

  I said nothing, just stood in his office and burned.

  “So, I ask you the question: Did you fabricate your data, Nathaniel?”

  My options blazed through my head. I had known from the beginning this was a possibility, but as the months and years went by, the possibility seemed more and more remote.

  I started slowly. “I may have rounded some numbers—”

  “Goddamn it!” he shouted. “Thank God I caught this. Goddamn it. This, I can’t believe.”

  “I can explain.”

  “Explain what, exactly? What can you explain?”

  “I just need more time. I’m right, Mark. I’ll run the assays again and—”

  “You can’t do that. Not now. You can’t do that.”

  “But I—”

  “Get the hell out of here. Leave now. Do not stop at your bench. I will send someone to you with your belongings.” He stood and cleared his throat. “Someone from the academic affairs office will contact you.”

  Later that day, in fact, someone from the academic affairs office did contact me. At the hearing, I was asked to leave the PhD program. After a year’s probation, they would let me finish out my MD, with the restriction that I conduct no more research—in the basic sciences or the clinical sciences—while at the university. I agreed to all the demands, including attending a two-day conference on research ethics. I also agreed to meet with members of Jurgen’s lab and walk them through my work for the previous two years.

  It is famously hard to get kicked out of medical school, the theory being that it is so difficult to get in, everyone admitted should have the chance to be a doctor. On a more c
ynical note, there is such an investment in making a doctor that no school wants to lose out on that investment. Anyway, as hard as it is to get kicked out, I managed it.

  During my probationary year, I volunteered at a local clinic. If I wasn’t going to be a physician-scientist, I’d take a shot at being a good doctor. For two months, I took histories and blood pressures and temperatures. I became adept, I was part of the team, I had the admiration of the staff. I was also bored out of my skull. Since I hadn’t been to the clinics as a medical student, and since I’d spent the past two years in a lab, I wasn’t permitted to practice much medicine. So it was blood pressure and history, day after day. My fantasy time was split between wishing that I’d never fabricated the data and wishing that I’d fabricated better. By the end of eight long weeks, I was getting more than bored; I was getting bitter. So I quit.

  To make some money, I got a job at the coffee shop on campus. That’s when the love trouble began. No longer the promising young MD-PhD student, my relationship with the beautiful Alaine Chen was rotting away before my eyes. I struggled to keep it—man, did I struggle—but no bright, young, superficial woman wants to be with a sullen barista if she can help it. And she could help it. So she left.

  In the tradition of my father and my father’s father, I began to drink. A few nips to get to sleep at night turned into a few nips before work and half a bottle of bourbon to get to sleep. After a month with no Alaine, I managed to finagle a fellow coffeehouse peon—an undergrad majoring in religious studies—to sleep with me a few times. This took some of the sting out of my desperation, but she dropped me after a particularly inebriated evening during which I pounded on her dorm door loud and long enough to draw the police.