Of Starlight and Plague

by Beth Hersant

  Mary Shelley, Frankenstein

  “Many parents who lose their child … experience post traumatic stress similar to that experienced by Veterans of war.”

  Cindy Dix, RN, “Depression After Losing a Child”

  Aaron Pickman stood, eyes closed, face tilted up to the sun. After a month-and-a-half of solid rain, it did feel good. The breeze was cool and the clear turquoise of the Caribbean stretched out before him. It reminded him of those rare summer days when Mary had coaxed him out of his study to come and sit by the pool. She would serve up daiquiris and plates of sliced watermelon and they’d lounge in the shade of the big umbrella and watch Rachel diving for rings in the shallow end.

  But it was that memory — the association of Rachel with water — that snapped him out of his reverie. By the end Rachel could not take a drink or even hear the word “water” without bursting into terrified, convulsive screams. So no, he did not have the time, nor the right, to stand here admiring the view. He had work to do. He turned on his heel and went back into the lab.

  It was patently awful. After the immaculate facilities he’d enjoyed at Massachusetts General and the EMMC, this place was a nightmare of rusting grey metal and cracked beige concrete. An old English air base traded to the American government as part of the 1940 Lend-Lease Agreement, its original purpose had been to protect a petroleum refinery on the tiny island of Cáscara. But in 1942 a German U-boat bombarded the coast destroying the aircraft hangar and the oil tank farm nearby. In the intervening years, nature had crept in to cover the worst signs of devastation, blanketing the craters and twisted wreckage with tree ferns, lobster claw heliconia and wild mamey fruit trees. Thick foliage pressed close to the remaining buildings and roots wormed their way through the old runways reducing the concrete to grit. All, however, was not lost. The barracks, mess hall and command center still stood and these Pickman had converted into labs, animal quarantine rooms and living quarters.

  While the outside of the facility was a ruin being reclaimed by the jungle, the interior was all diffuse fluorescent light, rusting cages and the stink of animals in the hot, close air. And the sound was like nothing of this earth. The dogs weren’t barking or howling — they were screaming. It was a wrenching croup-like yowl and the most eloquent expression of utter desolation Pickman had ever heard. As human beings we rely so much on language, but nothing expresses what it means to be hopeless and tortured and damned as effectively as a rabid dog. Aaron hastened into the lab and made a beeline for his noise-canceling headphones.

  How a prominent neurosurgeon could end up having to jerry-rig a research lab in the ass-end of nowhere is a saga in and of itself. It began in the spacious living room of the house he used to own in Maine. He’d sat there with the lights off and the curtains drawn, surrounded by flowers and sympathy cards and with a refrigerator full of casseroles from well-meaning friends and neighbors. And he wished he was dead. It was just too much. First he’d lost his wife Mary to a hit-and-run driver. He’d had to identify her body and you know, at first he wasn’t sure it was her. The left side of her face was a bloody pulp from the road rash. The coroner had attempted to mask the depressed fracture where the left side of her skull had caved in, but Pickman’s practiced eyes knew exactly what he was looking at. She hadn’t stood a chance.

  The right side of her face, however, was largely unscathed. It was his Mary and the room seemed to lurch to one side and he had felt cold and afraid. And so he hid. He topped a sixty-hour work week by devoting the lion’s share of his free time to writing his book: Case Histories in Neurosurgery, by Dr. Aaron Pickman. And he used that to blot out the image of Mary lying on a slab in the morgue.

  And when that didn’t work, he’d tell himself that at least her death was quick. She wouldn’t have suffered, the coroner said, and that was true. From Mary’s perspective it had probably seemed like someone had just come along and turned out the lights. No pain, no fear, no awareness. Just oblivion. But Rachel … he kept seeing her tiny body writhing on the bed as she screamed and screamed. And that was his fault; he had caused that. And how, exactly, was he supposed to know that and live? What was that line from the Robert Frost poem? Something about having no pride in the past and no hope for the future? Because that’s what the death of a child is: the negation of all future hopes. Wayne Loder, a man who has spoken movingly of his own loss, pointed out that children are supposed to be our legacy, our contribution to this world, a part of us that will survive after we’ve gone. Now there was nothing left. No family. His work — the grand distraction that enabled him to ignore the child — was tainted by her death. The house? That was just a beautiful memorial to the life he should have cherished. And there was no future. The world held nothing for him.

  The coffee table in front of him was littered with pamphlets that a nurse at the hospital had given him. They had titles like: “Be Gentle With Yourself While Grieving” and offered advice about looking after your health and nurturing your soul. But that was all beyond the point. First of all, he didn’t deserve to get over his grief because he was the cause of all this hell. If he suffered, surely that was natural justice and any pain he felt did not hold a candle to what Rachel had endured. And let’s, just for the sake of argument, suppose that he could heal through the liberal application of prozac and counseling and kumbaya moments in the local church — then what? He was done.

  How do you even continue to live in a world in which random disaster lands on you out of nowhere? Rabies? Are you fucking kidding me? This isn’t medieval Europe or deepest Africa or India where packs of wild dogs prowl. This is peaceful, orderly Bangor, Maine. But that doesn’t matter, does it? The world is a fucking war zone and you get to wonder when the bullet with your name on it is going to nail you.

  Rabies. Until Rachel, he’d never seen a case of it. He didn’t really know that much about it. He rose from the couch and retrieved the laptop from his study. He wanted to see this prick. Soon he found an image of the disease: tiny, bullet-shaped (of course it was), with fine cilia covering its body. So that was the culprit. He began to read. He read how rabies, known in medical circles as the lyssavirus, eludes the immune system by bypassing the blood stream and traveling directly along the peripheral nerves. Of course, if Rachel had had the vaccine during that interval (when the virus was still in transit), she’d be alive. But once the disease reaches the brain, it’s game over. Hence rabies kills 55,000 people a year.

  That can’t be right. He read on. In India the mortality rate is nearly 21,000 deaths per annum — that is a third of all cases reported worldwide. And do you know how much a course of the rabies vaccine costs in India? 1800 rupees. That’s $27.12. He would have paid more for Rachel’s jabs — the American health system would have bled him for about $400, but it was still a small price to pay to prevent all this. He would have given every penny he had. He continued to scroll through the articles…

  … The vast majority of victims are children…

  …The incubation period varies depending on the distance from the bite to the brain…

  …The virus is heavily present in the victim’s saliva. The inflammation of the throat, the inability to swallow, the victim’s fear of water — all allowed the virus to maximize its concentration in the animal’s spit. When Rufus bit Rachel, it was certain that he’d pass on the disease. And the dog had no choice but to bite because the virus ramps up aggression. This is hailed as an excellent example of how a pathogen can modify its host’s behavior in order to reproduce…

  …Throughout history rabies has been a symbol of madness, excessive violence and unstoppable plague…

  … Spanish neurologist, Juan Gómez-Alonso, has theorized that rabies is actually the origin of the vampire myth — that the idea of a bite that could steal your soul and make you prey upon your loved ones is founded in mankind’s experience of the disease…

  …Only twenty-five percent of all human victims actually bite another
person. People make really poor vectors for the disease; therefore, scientists now believe that we are not the virus’s primary target. We constitute the collateral damage — the unintended victims of a pathogen that is targeting dogs, foxes, skunks and bats as the means to spread quickly. Human deaths are just a needless side-effect…

  …And it is never going to stop. Having gained a foothold in wild animal populations, rabies can never be eradicated from the earth. Furthermore, they are not even working on a cure for patients like Rachel. The vaccine that halts the disease before it reaches the brain is deemed to be good enough. Why? Because every year 8.2 million people die of cancer; 1.2 million succumb to TB; 719,551 will be killed by malaria; and 230,615 women will die in childbirth. The rabies mortality rate of 55,000 a year isn’t high enough to warrant further investment of time and money into a cure for patients in the final stages of the illness — not when those resources are needed so urgently elsewhere. Charles Rupprecht, head of the CDC’s rabies unit, cited this as an example of the “cycle of neglected diseases”…

  And if, hypothetically, the money were to become available, is a cure even possible? He read on through the night.

  Chapter Two

  Meaning

  “If this most ancient of viruses can never be eradicated from animals, molecular biologists have hit upon the next best outcome: they are harnessing its uniquely diabolical properties in an attempt to resolve one of our thorniest medical problems. Rabies still knows how to infect us, but at the molecular level we have learned how to infect it.”

  Bill Wasik and Monica Murphy, Rabid

  “…take something designed by nature and reprogram it to make it work for the body rather than against it.”

  Dr. Alice Krippin, 2007 film, I Am Legend

  It turns out that the current research being done on rabies focuses not on finding a cure, but on using the virus to treat other ailments. The human brain is protected by the blood-brain barrier, 400 miles of capillaries that supply the organ with oxygenated blood. These threadlike capillaries are so densely packed around the brain that they form a sort of helmet that keeps out many infections. Unfortunately if a virus or bacterium does get into the brain, it is effectively inside the fortress, protected by the very walls that were meant to keep it out. It can then wreak havoc at will. Our immune systems and our medicines cannot reach it to fight it off. That is, in fact, why we can’t do a damn thing about rabies once neurological symptoms present.

  But innovators like Priti Kumar of Yale Medical School are working on an interesting idea. Rabies is very adept at slipping past the barrier and entering the brain. So why not turn this deadly trait to our advantage? Why not genetically alter the virus, essentially removing its harmful content while retaining its structure? Pickman imagined the result as an empty bullet casing designed to hit a target that used to be out of reach. That empty shell could be used to deliver a payload of our own design — gene therapies, medicines, you name it. As Dorothy Crawford suggests in Invisible Enemy: A Natural History of Viruses, “Why not use a ready-made parasite with generations of experience in penetrating cells [as a] ‘magic bullet’ approach … to treat killer diseases?” So here is the question: could rabies be used to cure rabies? Could the hollowed-out virus be used to deliver a remedy to an infected brain?

  Dr. Aaron Pickman puzzled over the logistics of that question for the next month and the epiphany, when it came, was like that scene in Young Frankenstein when Gene Wilder declares, “It. Could. WORK!” He had found it: the thing he could do with his blighted life. He had a mission. It’s not all that surprising, really. Many people cope with tragedy by taking up a crusade. It is a way of proclaiming: ‘See! Something good can come out of this!’ It allows us to take all that anger and pain and despair that might otherwise destroy us and funnel it into something positive. Doris Tate, mother of murdered daughter Sharon, founded COVER (the Coalition on Victims’ Equal Rights). Candace Lightner, whose thirteen-year-old daughter was killed by a drunk driver, started Mothers Against Drunk Driving. Whether we start movements or establish scholarships and memorial funds, we all try to find some silver lining in that grief-laden cloud. “In some ways,” Viktor E. Frankl wrote, “suffering ceases to be suffering at the moment it finds a meaning.” Pickman, surrounded by printouts and hastily scribbled notes, sat back and took a long, deep breath. Just think of all the thousands of lives that could be saved — all because Rachel had brought him to this fight.

  When Shakespeare wrote “The course of true love never did run smooth,” he did not know that it is a frolicking jaunt in a meadow compared to obtaining funding for most research projects. Pickman first approached the Eastern Maine Medical Center about the possibility of conducting clinical research there. His colleagues nodded along to his proposal, but as he spoke he began to feel distracted and flustered. They weren’t listening, not really. And he began to wonder what was going through their minds at that moment. They felt sorry for him — that was clear from the sideways cock of their heads and the somber earnestness of their expressions. But there was something else: a reticence or a judgment? Before them stood a brilliant, highly educated doctor whose daughter had died a wholly preventable death. That placed a question mark over any professional assertion he made. And now, here he stood trying to make it all better by grasping at straws.

  Undeterred, he submitted his proposal to his alma mater, Harvard Medical School. After an interminably long wait he received their response…

  Dear Dr. Pickman,

  Thank you for your interest in conducting your research with us. As you know, Harvard Medical School has a reputation for producing groundbreaking research in a variety of medical fields and your proposal to broaden the scope of Priti Kumar’s work is intriguing … Blah blah blah.

  He scanned through all the formalities, certain that he would soon be moving back to Boston, until he encountered the word “unfortunately.” Unfortunately, they could not sanction his work at the school. They had grave concerns about his proposed methodology. Apparently it relied too heavily upon animal testing. The letter reminded him that Harvard maintains full AAALAC International accreditation for excellence in its treatment of laboratory animals and its commitment to the three “R’s”:

  1.Reduce the number of animals used for testing,

  2.Refine procedures to minimize distress to the animals, and

  3.Replace live test subjects with computer simulations wherever possible.

  His proposal would, frankly, burn through a large number of rhesus macaques, standing in direct violation of the Animal Welfare Act. The letter thanked him again for his interest and invited him to enquire again in the future if the parameters of his research changed … blah, blah, blah.

  He sat there stunned. Couldn’t they see the importance of what he was trying to do? Children all over the world were dying in agony. How could they so glibly ignore that fact? But then they hadn’t sat in that room with Rachel and watched… He took a deep breath. No, they hadn’t. They could not understand the full rip-your-guts-out horror of watching a child die of rabies. And so he could excuse their ignorance and short-sightedness. He’d simply find somewhere else to go.

  He applied to another university — Tufts, thinking they might be a little more tolerant of his methods. Online, he’d found a 2016 article entitled “Modern Day Frankenstein” by Yasmin Jeffery. It outlined the work of a Dr. Levin, who apparently had created a range of monstrosities at Tufts including six-legged frogs and tadpoles with eyes on their backs. As grotesque as that may seem, Levin insisted these experiments were merely steps on the way to the primary goal: “to one day be able to restore the function of damaged or missing sensory structures” — lost eyes, damaged ears. Pickman received another letter and another lecture on the “3R’s” as well as a reminder that Dr. Levin’s work was on tadpoles and not non-human primates. They further asserted that Pickman’s procedures did not conform to the Tufts Refine
ment Initiative, which sought to protect the welfare of test animals and implement non-harmful alternatives wherever possible.

  He got the same response again and again. So he cast his net further afield. The Caribbean Primate Research Center (CPRC) had a Laboratory of Virology conducting research into new vaccines. But any proposal to them required approval by the Institutional Animal Care and Use Committee — which adheres to the Animal Welfare Act and around we go again. The bottom line was that the proposed experiment stood in violation of every law and ethical guideline that regulated medical research. No reputable lab would touch it and the National Institutes of Health would not fund the project. Even the shoestring labs that ignored the law in favor of profits weren’t biting because, frankly, animal testing was unlikely to produce a marketable (FDA-approved) drug. Cure cancer in mice all you want, it doesn’t mean that that product will ever be effective on human beings or available on your prescription plan. Simply put, they couldn’t see any money in it.

  He began to look at poorer countries with different laws and even that proved problematic. Bioquark had just had its “ReAnima” project booted out of India when the local government halted its research on the reanimation of dead human brain tissue. They would be moving their operation to “an unidentified country in Latin America.” That’s what it boiled down to. Controversial research had to go underground. It had to be self-funded and hence, it was going to be conducted in some jerry-rigged “lab” in the middle of nowhere.

  Pickman’s frustration mounted. People were so stupid, so short-sighted. We fight wars over land and politics and religion, but shed a little blood to actually save lives and you’re Attila the Hun. But that’s ok. He’d manage it on his own. He’d find the answer he sought and Rachel’s death would not be in vain.