“Sleepy and itchy. I feel like something’s crawling under my skin. Even scratching doesn’t make it any better.”
Rachel’s arms showed linear striations from scratching and a light pinkish rash. Jack lifted her hospital gown to examine her abdomen. The identical rash had small red areas looking like ruptured small vessels. Her eyes showed early signs of blood forming under the thin membrane covering the eyes, the conjunctiva.
Damnit, Jack thought. She can’t buy a break.
Jack returned to the nursing station. Carla handed him Rachel’s most recent laboratory data. When he skimmed through the list of tests and the results, the abnormal column showed five asterisks beside the blood platelet count. It had fallen dramatically. Low platelets increased the chance for bleeding; very low platelets guaranteed it and made the bleeding life threatening.
Jack asked Carla to bring Tom and Maxine back to Rachel’s bedside.
“We have a real problem here, Rachel. The rash, the itching, the bleeding in your skin and your eyes, and the falling blood platelet count means that you’re having an allergic reaction to CT1356. We need to stop it!”
Maxine glared at me. “Stop it! What are you, crazy?”
Jack counted to ten. “There’s no choice in the matter. I’m stopping the drug before it does any more damage.”
“Are you sure, Jack?” Tom asked.
Jack pulled Tom close to Rachel and lifted her gown to expose her abdomen. “Look at the redness and the bruising, and then look at your wife’s eyes. That’s all bleeding into her tissues. If we see it here, it’s everywhere throughout her body. Continuing the drug is too risky.”
“You didn’t want any part of this from the outset,” Maxine said. “I for one don’t trust you with this decision.”
Jack turned to Tom and Rachel. “You may wish to put up with this single-minded and ignorant approach to your illness, but I won’t be a part of it. Maxine may be willing to let you bleed to death, but I’m not.”
“Jack, please,” Rachel said, as her right eye began contracting spasmodically. Soon the entire right side of her face began twitching, then she threw her head back as her body convulsed, shaking the bed. Blood-tinged foam exuded from her mouth and nose.
“Get me some Valium, Carla, and get them the hell out of here.”
Jack placed a padded tongue depressor in Rachel’s mouth to protect her tongue and cheeks, then injected the Valium. Thirty seconds later Rachel lay still.
Jack rushed into the waiting room.
Maxine had her hands on her hips. “Who do you think you are? This is my daughter.”
Jack faced Tom. “We have to talk.”
“Don’t turn away from me, Doctor,” continued Maxine. “I’m talking to you.”
Jack was barely in control as he turned to Tom. “Get her out of here before I call security and have her thrown out.”
Tom turned toward Maxine. “Mother, you’re only making things more difficult.”
“You were always a weak little man.”
Jack turned to Carla. “Show Mrs. Clarke to the nurses’ lounge, please.”
Carla grasped Maxine by the arm. “Don’t you touch me,” Maxine said as she jerked her arm away violently, and then marched from the room.
Before he could say another word, Tom began to sob. “You told us. We refused to listen. We may be killing Rachel. What can we do?”
“With your permission, I’m getting CT scans of Rachel’s head and abdomen, and then we’re taking her to surgery.”
Chapter Fifteen
In spite of all his efforts and manipulations, Andre Keller couldn’t completely end his involvement in Archie Blake’s HIV research. He complained to the few who’d listen. “It’s a waste of my time. I have more important things to do.”
When Andre wasn’t in the lab, he’d go into his office or the library where he’d soak up each new piece of research data that appeared in journals or had been presented at scientific meetings. His wildly creative mind sought congruence with his own ideas for anti-aging and youth generating gene therapy. Andre wanted to find the Fountain of Youth, just like Ponce de Leon when he landed in St. Augustine in 1513.
He was particularly fascinated with studies using DNA viruses to carry growth-promoting genes directly into muscle fibers. He read and reread about the discovery of anti-aging enzymes called sirtuins that increased the lifespan of human cells in the laboratory, and studies on the molecular basis of human mitochondrial diseases. Mitochondria are the small organs in cells. They carry DNA inherited exclusively from the mother.
Elizabeth Brown became Andre’s sounding board. She’d listen to him and his stream-of-consciousness thoughts for hours. Although she was smart enough to have tough questions and at times stinging comments, she was no match for Andre who had his arguments ready. At times, she thought his responses went from glib to disingenuous.
There must be a scientific equivalent to the ideological thinker, she thought. If so, Andre would define it.
As she listened to Andre, she caressed his neck and ran her fingers through his hair. Something about Andre made him incredibly sexy, yet he had not acknowledged her messages. So much for subtlety, she thought. She’d had only two lovers in her life, but neither had worked. She tried to tone down her intelligence for the sake of their egos, but she couldn’t abide the dishonesty. She loved sex and the intimacy that it brought.
He pulled his head away from her touch. “I thought you liked me, Andre.”
“Of course I like you, Liz. What made you think otherwise?”
She smiled coyly. “Well, the closest physical contact we’ve had is hand holding. I need more.” She brought herself closer.
Andre pulled away. “I’ve been too busy with my research.”
“If you don’t like me in that way, I’ll understand.”
“No, it’s nothing like that. It’s just that I’ve never been the affectionate type.”
“Some men are that way. Everyone has his own needs and his own preferences.”
Andre reddened instantly. “What are you talking about? Preferences?”
“I’m just telling you that I care for you and want more from our relationship.”
“There’s nothing wrong with me, Liz.”
“Who said anything was wrong?”
Andre stood and paced the room. “I don’t want you to get the wrong idea about me.”
“What kind of wrong idea? I don’t know what you’re talking about.”
“Just drop it.”
In the last thirty-six months, Andre had achieved a level of success that surprised even his ego-driven conception of his own abilities.
Elizabeth sat with Andre in his office. Piles of thick research folders, stacks of data printouts and graphs sat on his desk. Research journals, bound scientific proceedings of symposia, and reference books of every variety filled his bookshelves. On the wall behind his desk, he’d consolidated his diplomas, awards, and newspaper articles about his work.
Andre thumbed through a thick data logbook. He opened to a page midway through, and turned to Elizabeth. “We’ve been working with the Ames dwarf mouse, a strain that was particularly sensitive to the oxidative stresses seen in aging. First, we had to modify an adenovirus similar to the one that causes the common cold. I picked it because of its proven ability to infect cells and carry in the modified human DNA. After we modified the DNA fragments, we injected them into the experimental group of mice.”
He thumbed further and then opened a page for Elizabeth. “Take a look at this data,” he said excitedly. “We had a similar number of controls. Incredibly, the infected mice showed a highly significant change in life expectancy from 800 days to 1300 days and the animal’s sirtuin levels increased. In addition, Raymond Ames, my chief laboratory technician and I, on a lark, gave the virus to mice approaching 600 days. Amazingly, the few we’d injected showed reversal of aging.”
“I’m fascinated with the research into the use of stem cells, especially embry
onic stem cells in gene therapy. These cells have the potential to grow into almost any type of tissue. Just think about the projected benefits of growing new brain, heart, and pancreas cells for strokes, Parkinson’s Disease, heart attacks, and diabetes. These possibilities have become widespread in the scientific literature and the popular media. Science fiction, is becoming fact.”
Elizabeth grasped Andre’s hand. “You’re incredible. You’re making history.”
Andre gave her a small smile. “Using our existing techniques, I can alter the genes within a stem cell and control what it will become. That eliminates a major problem we have with the viruses, targeting the cells we want to treat. Stem cells eliminate this problem because they’ll be that specific cell type before we administer them.”
“My God,” Elizabeth said, “think of the implications of both these approaches!”
Andre directed her into the laboratory. “Let me show you something we’ve been playing with.”
In a corner of the stacked cages, he brought down one and placed it on the table. It contained five mice and each was a different color; white, gray, blue, yellow, and incredibly, one was bright pink.
“Why have you dyed their hair?”
“No dye used here. The white mouse is the normal. The others have had their coats subjected to a solution of liposomes, artificial tiny globules of fat surrounding a central core where I placed specific genes that determine hair color. Someday, if this all works out, anyone will be blonde, redhead, or whatever is the popular color of the day, and grey hair will exist only if you want it.”
Elizabeth stared at the mice. “Unbelievable.”
“We’re just killing time with this. We have so many really important things on our plates.”
These successes and Andre’s desire to first extrapolate, then move these results rapidly into primates, and then into humans, put him on a collision course with Archie Blake and the university.
Andre could not wait for the regularly scheduled monthly progress report meeting. He dialed Archie Blake’s extension.
“Dr. Blake’s office. Mildred speaking. How can I assist you?”
“Millie, it’s Andre. I must see Archie today. It’s urgent.”
“It’s Mildred please, Dr. Keller. Dr. Blake’s booked up this morning and he’s giving a seminar this afternoon. If it’s important, let me talk with him and see if we can arrange something.”
“Thanks Mildred, it is important.”
“I’ll call you back in a few minutes.”
His appointment was for five that afternoon.
Andre sat in Archie’s office waiting for him to return. The walls of the office and even the small amount of wall space below the window contained thick textbooks, research journals, and thick data files. Beautifully framed diplomas, awards, and letters of appreciation covered the little space available. Archie’s large west-facing window looked down on the campus quad.
Archie arrived at 5:15. He put his slides and laser pointer into his top drawer.
“These graduate students are getting smarter every day. It’s all I can do to keep up with them.”
The setting sun shone through the window, leaving Archie in silhouette and glaring into Andre’s eyes.
“Let me pull the shades. So what’s so urgent?”
Andre spewed out the details of his experiments and his results, including the effect on the older mice, and the next steps he planned for his research. He added his more recent interest in approaching embryonic stem cells with his techniques, and the research and clinical potential.
Archie studied the graphs and the statistical tables while Andre fidgeted expectantly.
“This is incredible data, Andre, so promising. I can’t wait until you flesh it out.”
“Flesh it out?”
“Of course. Slow down for a moment and think past your enthusiasm.”
Andre remained silent.
“First, the numbers are too small, and although you’ve achieved statistical significance, you’re going to need bigger numbers before we present or publish the data. The older mice didn’t even have a control group.”
Andre stood and paced. “Look, Archie, we both know the hoops we must jump through with this kind of study, especially a study of this sort which may have wide clinical implications. What I’d like is your support and advice on the best way to expedite the process.”
“Considering all we need to do, it would surprise me if we even got into primate subjects in less than three to five years. And human trials—who knows, six or seven years from now.”
Andre shook his experiment data in Archie’s face. “You must be kidding. You’ve seen the data. You see the potential. Delay like this is insane!”
“Excuse me, Andre, but where the hell have you been in the last ten years? Don’t you know what’s happened in clinical trials and the resultant limitations placed on research by the government? The newspapers and television were overflowing with coverage over the Jesse Gelsinger fiasco. That teenager died three days after receiving a dose of adenovirus vectors, just like the one’s you’re proposing to use. He had multiple organ failures and they took him off life support on the fourth day.”
“But, Archie, research of this type is inherently risky, but the benefits far outweigh the risks.”
“Tell that to the Gelsinger family or to your congressman or senator. I don’t like it, and I know you hate it, but this is the world in which we live. We’ve no choice but to play the game by its rules.”
“Look at gene therapy’s promising results in treatment of immune system deficiencies, Archie.”
Archie shook his head at Andre’s obtuseness. “That’s great and it is promising, but it can’t undo the visuals of a coffin carrying an eighteen-year-old to his grave.”
Andre had in a few minutes moved from exhilaration and hope to depression and despair.
Archie stood and moved to the bookshelf immediately to his right. He pulled five, two to three-inch thick volumes, and two soft-cover bound books, one a copy of Federal Guidelines for Gene Therapy, the other, The Report of the National Bioethics Commission. “Here’s some light reading for you, Andre. Read these and you’ll understand what we’re up against.”
“This is impossible. We must find a better way, some other venue in which to work,” Andre said, refusing the books.
“Even private industry has to live with much of these limitations. You could go to a foreign country like China where ethical concerns are secondary. Oh, and speaking of limitations, we’re recipients of federal grant money, so although I agree with you about the potential in embryonic stem cell research, the government has limited this area of research.”
I’ll find a better way, Andre vowed.
Chapter Sixteen
Harmony Lane was fortunate to find office space in Ben Davidson’s building. Unlike his three thousand sq. ft office suite, hers was about a third its size. The consolidation of medical practices in the face of reduced physician incomes left enough vacant office space in the building that the owners made her an attractive proposal on rent including a generous build-out allowance for her office space. Deeply in debt from medical school and training, she bit-the-bullet and asked for financial assistance from her parents.
In contrast to her male colleagues, Harmony spent a great deal of time furnishing and designing her office. The result was a beautifully decorated, elegantly furnished suite. She’d chosen a light-blue color for its serenity and hung antique art on the walls. The totality reflected a woman’s touch designed to please herself and her mostly female clientele. Harmony abandoned the stiff, flimsy paper examination gowns for monogrammed robes. Patients, especially females, loved that.
She’d obtained a mailing list from the Alameda County Medical Association and sent new practice announcements to its membership. Harmony placed ads in the local papers stressing her particular interest in women’s health issues. Her announcement and the large framed sign on the door of her office said, WOMEN TAKE CAR
E OF EVERYTHING...EXCEPT THEMSELVES.
These approaches proved effective, and when the public discovered her special interest in fibromyalgia and chronic fatigue syndrome, she needed to extend her office hours to four full days per week and take on an assistant, Shelley Stillwell.
Shelley had worked as a ward nurse until she had the first of her four children. Gradually, over the years, she’d returned to the workplace, first in home health, and then later, after completing three more years of training, as a nurse practitioner. She was an imposing black woman, nearly six feet tall and large-boned, yet her soft brown eyes reflected a truly empathic soul.
“If it keeps up at this pace, Harmony,” Shelly said, “We’ll have to beat them off with a stick.”
Harmony smiled. “No reflection on our male colleagues, Shelly, but many women are more comfortable with a female physician.”
One of the first to call for an appointment to see Harmony was Zoe Sims, an old close friend.
When Harmony returned to California, the first person she had called was Zoe. They’d been like sisters through elementary and high school, but had grown apart when Harmony went to USC and then to medical school in Illinois. They corresponded and saw each other on holidays and summer vacation, a poor substitute for the intimacy they’d shared. Harmony had few close friends, and never had a friendship she cherished more than the one she shared with Zoe.
Harmony’s parents loved Zoe. They saw in her, the free spirit they missed in their own daughter. Zoe and Harmony often laughed about switching parents.
Their busy lives kept them apart, though they’d managed to get together for the symphony or the opera in San Francisco, and a few ill-fated, good-intentioned blind dates.
When Zoe developed the first signs of lupus, Harmony suggested that she see a lupus specialist at Stanford, reasonably close to her home in Scott’s Valley. Zoe had recently moved into San Francisco and asked Harmony to take over her care. Harmony agreed at once.
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