"The bridge?"
"Out there."
The window blinds were drawn down and closed tight. Springer went over and parted a couple of the flexible metal slats to peek out. It was a south view featuring the Queensboro Bridge. Floodlighted, the gray-painted intricacies of the span had a blue cast, a clean almost baby-boy blue. Twin reds of taillights were animate embellishments.
"Dad?"
"Hmm?" Springer returned to the bed.
"What are they going to do to me?"
Springer couldn't answer honestly, couldn't say he didn't know. "Nothing bad," he said. "But it's okay if you're afraid. Don't be ashamed of being afraid."
"If you say."
Springer took Jake's hand. It was fisted. He held it, enclosed it within both his hands, felt the shape and the bones of it. It was like he'd captured a little creature that he loved. "Maybe," he said, "you'd better be getting some sleep."
"Everything's Jake, right?"
"Yeah, everything's Jake."
Chapter 23
Early the following afternoon Springer leaned against a mail repository box on the comer of 67th Street while he kept an eye on the York Avenue entrance of Sloan-Kettering.
He didn't want to be in there, not anywhere within the walls of the hospital, when he got word. In there was where cancer concentrated, came to do battle, and he felt the news he awaited had a better chance of being good if it was brought out to him. It was, he realized, the sort of intuitive reasoning Audrey or Mattie might have used and that he would normally indulge.
Also, waiting outside alone allowed him to air his thoughts more clearly. The problems of yesterday, the robbery loss and all that, had been preempted. They were still sorry facts of life but were now far back in his line of concern. Diamonds and the perpetual scramble for them were inconsequential. He doubted that diamonds would ever again be as important to him as they had been. He was sure he was changed, humbled.
He'd waited an hour. It was another half hour before he saw Norman come out of the hospital. Norman paused, glanced upward as though to verify the sky. He armed out of his suit jacket, slung it by a hook of finger over his shoulder, and walked in Springer's direction.
From half a block away Springer tried to read Norman. Did Norman's slouch and unhurried pace signify that he was burdened with regrettable
information, or could it be taken as easygoingness because the findings had been favorable? Was that a glimmer of smile on Norman's face, or merely the squinting of his eyes against the day's brightness pulling up the comers of his mouth?
Although there was no traffic coming, Norman waited for the walk light before he crossed 67th Street. "Let's have a beer," he said.
From that Springer surmised the worst. But he had yet to hear it. It would come soon enough. No need asking for it.
They bought Heinekens from the cooler case of a nearby delicatessen. Went across York Avenue and down a block to the wide paved walkway situated between the FDR Drive and the East River. They sat on one of the benches and yanked the pull tabs from their beers.
"Osteogenic sarcoma," Norman said.
"For certain?"
"Positive. I saw the biopsy report, was even allowed a look at some of the tissue specimens. Anything I didn't understand Stimson explained to me."
"Tell me what you saw."
"Why?"
"I want to know. I don't want anything to be happening to Jake that I don't know about."
Not an unusual attitude, Norman knew from his doctoring. Often, seriously sick patients and, just as often, those closest to them wanted as much information as they could glean. He'd known people who had become lay experts from trying in this way to make up for their feelings of futility.
He told Springer, "I viewed several slides under a powerful microscope. They were sections—that is, very thin slices of tissue excised from in and around the tumored area of Jake's leg. Some of the sections were purposely taken from the edge of the tumor so they included normal tissue for comparison. Are you sure you want to hear all this?"
Springer nodded.
"What I saw was an average number of osteoblasts in the normal tissue and far too many of them in the tissue of the tumor. Those in the tumor were deformed one way or another, lopsided, missing membrane or something. They were also dark and angry-looking, and reproducing like sons of bitches. I could see them in various stages of replication: growing two nuclei, stretching out into spindle shapes, separating."
"What did you say they're called?"
"Osteoblasts."
"Cells . . ." Springer muttered vaguely.
"The kind that form bone tissue. Osteoblasts aggregate within the matrix of a bone, where they become osteocytes, which in turn connect and harden into compact bone. Up until the time when the body has completed its growing—say, at about age twenty—there are lots of osteoblasts doing their constructive work throughout the skeletal system."
Springer grabbed that. "Jake's still growing."
"But in that one area on his femur too many of those cells are being reproduced. Remember, they're ugly tumor cells, enemy cells. I once saw a motion picture of such cells. It was astonishing how fast they multiplied, almost too fast for the eye. Like they had a vengeance."
Springer visualized the enemy.
"What happens is they multiply so fast there's not enough room for them. So they make room, pushing through whatever happens to be in their way: soft tissue, bone, blood vessels, nerves."
Springer wondered if Norman had brought out to him even a scintilla of hope. "What," he asked, "makes those cells behave like that?"
"The person who answers that will get a Nobel, will deserve a hundred Nobels. From what I understand, the theories are narrowing down and pointing more and more toward something genetic. Seems we all have the potential of cancer in us but about twenty-five percent of us are short on the genetic material that provides the necessary immunity. There seems to be little doubt that the immunological system is involved. Now that some of the taboos have been lifted from the field of genetic engineering, someone will probably hit on the one little thing that will do the trick."
Norman paused, swigged, got back to Jake. "This tumor he has is a nasty sort. It's unquestionably malignant. Left unchallenged much longer, its cells will get into his bloodstream and start doing their dirty work elsewhere in his body. It happens quickly."
"They can be stopped?"
"Slowed down, killed off to some extent with chemotherapy. The objective is to diminish the cancer, shrink it, and then cut it out. Hopefully all of it. It's not uncommon that in a case like Jake's it means having to amputate."
"So unless Jake gets chemotherapy he dies."
"Short of a miracle."
What Norman omitted was that even if everything went well with Jake's chemotherapy treatments and the operation, there were very likely to be morbid complications later on. Once malignant osteoblastic cells got into the system, they tended to clump and hide in some niche in the body for months or years. Then, suddenly, as though giving in to some whim of fury, they exploded into action, began replicating mercilessly, building bone tissue where it didn't belong. There would be little chance of stopping it. The five-year overall survival rate for what Jake had was only about 20 percent.
Springer sat forward on the bench. The river, he noticed, had a bilious look to it. The day was warm, the tide running out. The water smelled putrid. The river in any condition was usually a forgivable fact of the city. Today it was a personal affront. An incongruously clean seagull hovered for a handout. A Tropicana orange juice carton drifted by, and so did a filmy something that appeared to be a condom but could have been a plastic sandwich bag. Springer thought: Jake with a leg and a half was better than no Jake.
A car on the drive chose that moment to drop its muffler. There was a sharp, punctuating clang as the muffler struck the pavement, an instant before it smashed against the car behind and was slung by its speed at the windshield of another car driven by an elderly
man who overswerved reflex-ively. Then, not just one sound but a brief, full orchestration of screech and scrape and killing metallic impacts.
Springer and Norman heard the accident, but it was out of sight up the drive a way. In all lanes traffic backed up, stopped. Impeded drivers, irritated, glanced around for a way to go on.
Norman got up from the bench. He leaned on the fat iron railing, over it and out, as he would aboard a ship. That the rusted railing was staining the sleeves of his shirt didn't matter. A well-dressed green and black tug passed by, headed for the harbor. Norman's gaze didn't follow it. His eyes were fixed windows, and the tug merely something that traversed their frame. The wake of the tug sloshed against the river wall and, it seemed to Norman, against his thoughts.
Nothing had been the same for him since the President's crisis in Bethesda. He felt primitive, at times inept, and the bodies of his patients, geographies he'd believed familiar, had turned foreign. Listenings with stethoscope, observations of blood pressures, measurings of cholesterol levels, interpretations of electrocardiograms—all seemed little removed from the applying of leeches. What was medicine? He found himself asking himself at every tack of his professional routine.
The government insiders had mistaken his preoccupation for modesty and made his quandary all the worse. Their covert kudos, the hushed, private gratitudes from the highest level had to be endured. He hated the dissemblance. Every thank-you he'd said in return for congratulations had been like a hook torn from his mouth. He'd succeeded in not allowing it to affect his daily efficiency, but he felt he was a changed man, a changed doctor. The nuclei in him were as surely divided as those he'd looked at in the cells of Jake.
"Chemotherapy," he said to the situation, drawing the word out and losing part of it to the sound of a siren.
Springer said, "What?"
"Maybe Jake shouldn't be given chemotherapy."
"What the hell are you talking about? You just got through telling me he'd die without it."
"And what I'm telling you now is go another route."
"I'm open to whatever's best for Jake."
"Then use the stone."
It was so far from Springer's thoughts it took a while to register.
"The stone you brought down to Washington for my opinion," Norman reminded.
"And that you said was nothing more than an ordinary pebble."
"I intended to tell you different. At the time I couldn't. I was . . . anesthetized, dazzled beyond belief. I didn't know whether I'd been tricked or privileged, whether I'd experienced something I should fend off or embrace. Even now I don't have a single clear excuse."
"Why?"
Norman ran it down for him. The entire Bethesda scenario, all its inexplicable medical aspects and his personal reactions. He said it was the first he'd spoken to anyone about it. Evidently his telling to close acquaintance, patient, and Assistant Secretary of State Thomas Longmire was forgotten on the other side of drunkenness.
Springer heard Norman out and then put it to him pointedly. "Do you believe that stone was the reason Janet got well?" He looked Norman squarely in the eyes, saw reluctance but no doubt.
"Yes," Norman replied.
Springer added it up: His sister Janet's remarkable recovery, the transformation of Libby's hands, the miraculously healed heart of the President. He asked himself. Was it only now, desperate, that he was vulnerable to believing such things? Outweighing that possibility was Norman's conviction. Norman was the most practical-minded man Springer had ever known, always looking ahead to where his next step should be placed, never venturing out on a limb that was even slightly shaky. If one word described Norman, it was judicious.
Again a siren sent its red blade of sound into the atmosphere. The exhausts of the idling cars on the drive were a collaborative contamination.
If he had stone 588 at that moment, Springer knew, he would run with it up to that fifth-floor hospital room and clasp it for as long as was needed in Jake's hand.
But he didn't have it.
Chapter 24
For the next couple of days, Springer and Audrey spent most of their time at Sloan-Kettering with Jake. Springer's mother and sister were down from Connecticut, staying at the family apartment on East 72nd, so at times there was only standing room around Jake's bed. Janet, Springer observed, was still a newborn adult, rational, light of heart, and glowing. Not a sign of her old seesaw mental illness. Springer was now certain her abrupt recovery came from stone 588.
"Have you found out anything new about that stone of Father's?" Janet asked, while she and Springer were out in the hospital corridor.
"It's everything you thought it was," he told her, and when he saw her eyes moisten, he was glad he'd chosen not to mention that the stone had been stolen.
"Perhaps it might do Jake some good," she said.
Springer agreed and Janet took that to mean he intended to give it a try.
When they went back into the room they found Mattie and Audrey doing some healing, standing on opposite sides of the bed with their hands extended above Jake's malignant thigh. Their hands were flat, palms down, layered one above the other like a metaphysical stack of pancakes. Their eyes were closed to enhance their connection to whatever power they were drawing from. Jake remained tolerantly still. Springer stood off to the side and watched, alert for any discemable change in the atmosphere. After ten minutes Mattie and Audrey broke their healing trances. Both shook and snapped their hands vigorously, as though ridding them of a filthy substance.
"Surround yourself with healing white light . . ." Mattie advised Jake. "The God light." She also told him that his name was at that very moment in thousands of prayer baskets all over the world.
"How about in Paris?" Jake asked.
"Even in Paris," Mattie said unequivocally.
Springer suspected she was fibbing but he loved her for it. Since he'd accepted the efficacy of stone 588 he was seeing Mattie differently. He no longer loved her despite her eccentricities. He loved her more because of them. He understood now the plain generosity of her nature and was a bit ashamed of how narrow-minded he'd been. He rightfully blamed some of that on 47th Street. Its ways had compressed him, intensified his dubiousness with its cold, mean realities.
While Mattie and disciple Audrey did their spiritual best for Jake, Springer comforted him on less abstract levels. He lugged a new nineteen-inch Sony television to Jake's room. Also a Sony video recorder. Jake's having mentioned there being no cable TV at the hospital had created for Springer the opportunity to please. He phoned around and located a store on Third Avenue near 96th that had an extensive selection of video cassettes. Springer bought a whole day's worth of rock videos. Twelve cassettes, two hours each. Stints by Van Halen, Sting, Foreigner, Springsteen, and a lot of Jake's other favorites. From his own collection Springer brought a cassette of the 1984 Olympic Gold Medal volleyball match between Brazil and the United States. He hooked up everything, including earphones, so Jake could listen anytime, even in the middle of the night, as loud as he wished.
Jake could use all the support and distraction he could get. On Wednesday, the very next day after his biopsy surgery (which was not all that minor, considering an incision had been made all the way to the bone and even a "window" of the bone excised), Jake was put through a battery of tests to evaluate his condition for chemotherapy. A technetium-99 bone scan and a CT scan of his chest determined that the tumor had not yet spread. A trispiral tomograph further verified this with a dimensional "sound picture" of his chest. Other tests measured the function of his liver and kidneys.
The hurry to have these evaluations done was not arbitrary. Whenever a tumor such as Jake's was cut into, the malignant cells took advantage, ran rampantly into the bloodstream. They had to be chased down with chemotherapy as soon as possible.
Thursday would be Jake's day for that.
First, because it was essential that his system be alkaline, he was given intravenously 50cc of sodium bicarbonate solut
ion. Then, over a period of four hours, 10 grams of methotrexate in a 5 percent glucose and sodium bicarbonate solution was dripped into his veins. Methotrexate, a synthesized chemical substance, is a very potent poison, 10 grams of it enough to kill a dozen men. Methotrexate literally tricks the body. Its molecular makeup resembles folic acid, one of the vitamins in the B-complex needed for healthy cell division. The resemblance of fatally poisonous methotrexate to harmless folic acid is, in fact, so close that the body misidentilies it and readily admits it into the system.
Jake also received injections of three other aggressive chemotherapeutic agents: bleomycin, cyclophosphamide, and dactinomycin.
At six o'clock Thursday morning he was "rescued" from deadly methotrexate by being given calcium leucovorin. Thus he was poisoned one day and given the antidote the next.
He had to drink a lot of water.
He had to have intravenous fluid going into him constantly.
He had to take allopurinal pills to prevent the cells that were being killed by the chemotherapy from creating uric acid and causing him to have gout.
He had to remain alkaline, have every pee litmused.
By Thursday noon Jake was just about out of cooperation and courage. Springer, who was more sensitively in tune with Jake's feelings at this time, detected as much when a laboratory specialist came to draw blood and Jake begrudgingly stuck out an arm already badly discolored from previous punctures. Springer remembered he'd promised Jake that nothing bad was going to be done to him. He hoped Jake didn't feel betrayed.
When not at the hospital. Springer spent some time at the office. The box of rough from the sight he'd attended while in London required going over. It consisted of an average number of pieces of average quality goods, indicative of The System's merely average opinion of him.
He tried to give the new rough the scrutiny he would ordinarily give it, but his spirit wasn't in it. He handed the task to Linda. She would sort and classify the stones and see that they were sent off with instructions to the cutter in Antwerp.
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