by Robin Cook
Clad in a terrycloth lava-lava, which, unfortunately, emphasized the fifteen pounds he’d gained in the last ten years, Charles lathered his chin. He was trying to sort through the myriad facts associated with his current research project. The immunology of living forms involved a complexity which never failed to amaze and exhilarate him, especially now that he thought he was coming very close to some real answers about cancer. Charles had been excited before and wrong before. He knew that. But now his ideas were based on years of painstaking experimentation and supported by easily reproducible facts.
Charles began to chart the schedule for the day. He wanted to start work with the new HR7 strain of mice that carried hereditary mammary cancer. He hoped to make the animals “allergic” to their own tumors, a goal which Charles felt was coming closer and closer.
Cathryn opened the door and pushed past him. Pulling her gown over her head, she slipped into the shower. The water and steam billowed the shower curtain. After a moment she pulled back the curtain and called to Charles.
“I think I’ve got to take Michelle to see a real doctor,” she said before disappearing back behind the curtain.
Charles paused in his shaving, trying not to be annoyed by her sarcastic reference to a “real” doctor. It was a sensitive issue between them.
“I really thought that marrying a doctor would at least guarantee good medical attention for my family,” shouted Cathryn over the din of the shower. “Was I wrong!”
Charles busied himself, examining his half-shaved face, noticing in the process that his eyelids were a little puffy. He was trying to avoid a fight. The fact that the family’s “medical problems” spontaneously solved themselves within twenty-four hours was lost on Cathryn. Her newly awakened mother instincts demanded specialists for every sniffle, ache, or bout of diarrhea.
“Michelle still feeling lousy?” asked Charles. It was better to talk about specifics.
“I shouldn’t have to tell you. The child’s been feeling sick for some time.”
With exasperation, Charles reached out and pulled back the edge of the shower curtain. “Cathryn, I’m a cancer researcher, not a pediatrician.”
“Oh, excuse me,” said Cathryn, lifting her face to the water. “I thought you were a doctor.”
“I’m not going to let you bait me into an argument,” said Charles testily. “The flu has been going around. Michelle has a touch of it. People feel lousy for a week and then it’s over.”
Pulling her head from beneath the shower, Cathryn looked directly at Charles. “The point is, she’s been feeling lousy for four weeks.”
“Four weeks?” he asked. Time had a way of dissolving in the face of his work.
“Four weeks,” repeated Cathryn. “I don’t think I’m panicking at the first sign of a cold. I think I’d better take Michelle into Pediatric Hospital and see Dr. Wiley. Besides, I can visit the Schonhauser boy.”
“All right, I’ll take a look at Michelle,” agreed Charles, turning back to the sink. Four weeks was a long time to have the flu. Perhaps Cathryn was exaggerating, but he knew better than to question. In fact, it was better to change the subject. “What’s wrong with the Schonhauser boy?” The Schonhausers were neighbors who lived about a mile up the river. Henry Schonhauser was a chemist at M.I.T. and one of the few people with whom Charles enjoyed socializing. The Schonhauser boy, Tad, was a year older than Michelle, but because of the way their birthdays fell, they were in the same class.
Cathryn stepped out of the shower, pleased that her tactic to get Charles to look at Michelle had worked so perfectly. “Tad’s been in the hospital for three weeks. I hear he’s very sick but I haven’t spoken with Marge since he went in.”
“What’s the diagnosis?” Charles poised the razor below his left sideburn.
“Something I’ve never heard of before. Elastic anemia or something,” said Cathryn, toweling herself off.
“Aplastic anemia?” asked Charles with disbelief.
“Something like that.”
“My God,” said Charles, leaning on the sink. “That’s awful.”
“What is it?” Cathryn experienced a reflex jolt of panic.
“It’s a disease where the bone marrow stops producing blood cells.”
“Is it serious?”
“It’s always serious and often fatal.”
Cathryn’s arms hung limply at her sides, her wet hair like an unwrung mop. She could feel a mixture of sympathy and fear. “Is it catching?”
“No,” said Charles absently. He was trying to remember what he knew of the affliction. It was not a common illness.
“Michelle and Tad have spent quite a bit of time together,” said Cathryn. Her voice was hesitant.
Charles looked at her, realizing that she was pleading for reassurance. “Wait a minute. You’re not thinking that Michelle might have aplastic anemia, are you?”
“Could she?”
“No. My God, you’re like a med student. You hear of a new disease and five minutes later either you or the kids have it. Aplastic anemia is as rare as hell. It’s usually associated with some drug or chemical. It’s either a poisoning or an allergic reaction. Although most of the time the actual cause is never found. Anyway, it’s not catching; but that poor kid.”
“And to think I haven’t even called Marge,” said Cathryn. She leaned forward and looked at her face in the mirror. She tried to imagine the emotional strain Marge was under and decided she’d better go back to making lists like she did before getting married. There was no excuse for such thoughtlessness.
Charles shaved the left side of his face wondering if aplastic anemia was the kind of disease he should look into. Could it possibly shed some clue on the organization of life? Where was the control that shut the marrow down? That was a cogent question because, after all, it was the control issue which Charles felt was key to understanding cancer.
With the knuckle of his first finger, Charles knocked softly on Michelle’s door. Listening, he heard only the sound of the shower coming from the connecting bathroom. Quietly he opened the door. Michelle was lying in bed, facing away from him. Abruptly she turned over and their eyes met. A line of tears which sparkled in the morning light ran down her flushed cheeks. Charles’s heart melted.
Sitting on the edge of her eyelet-covered bed, he bent down and kissed her forehead. With his lips he could tell she had a fever. Straightening up, Charles looked at his little girl. He could so easily see Elizabeth, his first wife, in Michelle’s face. There was the same thick, black hair, the same high cheekbones and full lips, the same flawless olive skin. From Charles, Michelle had inherited intensely blue eyes, straight white teeth, and unfortunately a somewhat wide nose. Charles believed she was the most beautiful twelve-year-old in the world.
With the back of his hand he wiped the wetness from her cheeks.
“I’m sorry, Daddy,” said Michelle through her tears.
“What do you mean, sorry?” asked Charles softly.
“I’m sorry I’m sick again. I don’t like to be a bother.”
Charles hugged her. She felt fragile in his arms. “You’re not a bother. I don’t want to even hear you say such a thing. Let me look at you.”
Embarrassed by her tears, Michelle kept her face averted as Charles pulled away to examine her. He cradled her chin in the palm of his hand and lifted her face to his. “Tell me how you feel. What is bothering you?”
“I just feel a little weak, that’s all. I can go to school. Really I can.”
“Sore throat?”
“A little. Not much. Cathryn said I couldn’t go to school.”
“Anything else? Headache?”
“A little but it’s better.”
“Ears?”
“Fine.”
“Stomach?”
“Maybe a little sore.”
Charles depressed Michelle’s lower lids. The conjunctiva was pale. In fact, her whole face was pale. “Let me see your tongue.” Charles realized how long it had been since
he’d done clinical medicine. Michelle stuck out her tongue and watched her father’s eyes for the slightest sign of concern. Charles felt under the angle of her jaw and she pulled her tongue back in. “Tender?” asked Charles as his fingers felt some small lymph nodes.
“No,” said Michelle.
Charles had her sit on the edge of the bed, facing away from him, and he began to draw up her nightgown. Jean Paul’s head came into the room from the connecting bathroom to tell her the shower was free.
“Get out of here,” yelled Michelle. “Dad, tell Jean Paul to get out.”
“Out!” said Charles. Jean Paul disappeared. He could be heard laughing with Chuck.
Charles percussed Michelle’s back somewhat clumsily but well enough to be convinced that her lungs were clear. Then he had her lie back on her bed, and he drew her nightgown up to just below her nascent breasts. Her thin abdomen rose and fell rhythmically. She was thin enough for him to see the recoil of her heart after each beat. With his right hand, Charles began to palpate her abdomen. “Try to relax. If I hurt you, just say so.”
Michelle attempted to remain still but she squirmed beneath Charles’s cold hand. Then it hurt.
“Where?” asked Charles. Michelle pointed and Charles felt very carefully, determining that Michelle’s abdomen was tender at the midline. Putting his fingers just beneath the right ribs he asked her to breathe in. When she did, he could feel the blunt edge of her liver pass under his fingers. She said that hurt a little. Then with his left hand under her for support, he felt for her spleen. To his surprise he had no trouble palpating it. He’d always had trouble with that maneuver when he was in practice and he wondered if Michelle’s spleen wasn’t enlarged.
Standing up, he looked at Michelle. She seemed thin, but she’d always been slender. Charles started to run his hand down her legs to feel the muscle tone, then stopped, noticing a series of bruises. “Where’d you get all these black-and-blue marks?”
Michelle shrugged.
“Do your legs bother you?”
“A little. Mostly my knees and ankles after gym. But I don’t have to go to gym if I have a note.”
Straightening up again, Charles surveyed his daughter. She was pale, had minor aches and pains, a few lymph nodes, and a fever. That could be just about any minor viral illness. But four weeks! Maybe Cathryn was right. Maybe she should be seen by a “real” doctor.
“Please, Dad,” said Michelle. “I can’t miss any more school if I’m going to be a research doctor like you.”
Charles smiled. Michelle had always been a precocious child and this indirect flattery was a good example. “Missing a few days of school in the sixth grade is not going to hurt your career,” said Charles. “Cathryn is going to take you to Pediatric Hospital today to see Dr. Wiley.”
“He’s a baby doctor!” said Michelle defiantly.
“He’s a pediatrician and he sees patients up to eighteen, smarty pants.”
“I want you to take me.”
“I can’t, dear. I’ve got to go to the lab. Why don’t you get dressed and come down for some breakfast?”
“I’m not hungry.”
“Michelle, don’t be difficult.”
“I’m not being difficult. I’m just not hungry.”
“Then come down for some juice.” Charles lightly pinched Michelle’s cheek.
Michelle watched her father leave her room. Her tears welled up anew. She felt horrid and did not want to go to the hospital but worst of all, she felt lonely. She wanted her father to love her more than anything in the world and she knew that Charles was impatient when any of the kids got sick. She struggled up to a sitting position and braced herself against a wave of dizziness.
“My God, Chuck,” said Charles with disgust. “You look like a pig.”
Chuck ignored his father. He got some cold cereal, poured milk over it, then sat down to eat. The rule for breakfast was that everyone fended for themselves, except for the orange juice which Michelle usually made. Cathryn had made it this morning.
Chuck was wearing a stained sweater and dirty jeans, which he wore so long that he walked on the frayed bottoms. His hair was uncombed and the fact that he hadn’t shaved was painfully apparent.
“Do you really have to be so sloppy?” continued Charles. “I thought that the hippie look was passé now and that college kids were becoming respectable again.”
“You’re right. Hippie is out,” said Jean Paul, coming into the kitchen and pouring orange juice. “Punk is in now.”
“Punk?” questioned Charles. “Is Chuck punk?”
“No,” laughed Jean Paul. “Chuck is just Chuck.”
Chuck looked up from his cereal box to mouth some obscenities at his younger brother. Jean Paul ignored him and opened his physics book. It occurred to him that his father never noticed what he wore. It was always Chuck.
“Really, Chuck,” Charles was saying. “Do you honestly feel you have to look that bad?” Chuck ignored the question. Charles watched the boy eat with growing exasperation. “Chuck, I’m speaking to you.”
Cathryn reached over and put her hand on Charles’s arm. “Let’s not get into this discussion at breakfast. You know how college kids are. Leave him be.”
“I think I at least deserve an answer,” persisted Charles.
Taking in a deep breath and blowing it out noisily through his nose to punctuate his annoyance, Chuck looked into his father’s face. “I’m not a doctor,” he said. “I don’t have to adhere to a dress code.”
The eyes of the father and the older son met. Chuck said to himself: “Take that, you smart-ass son-of-a-bitch, just because you got good grades in chemistry you think you know everything, but you don’t.” Charles examined the face of this son of his, marveling how much arrogance the boy could manufacture with so little basis. He was intelligent enough but hopelessly lazy. His performance in high school had been such that Harvard had rejected him, and Charles had a feeling that he wasn’t doing well at Northeastern. Charles wondered where he, as a father, might have gone wrong. But such musing was made difficult by the personality of Jean Paul. Charles glanced at his other son: neat, easygoing, studious. It was hard to believe that both boys had sprung from the same genetic pool and grown up together. Charles’s attention returned to Chuck. The boy’s defiance had not altered, but Charles felt his interest in the issue wane. He had more important things to think about.
“I hope,” said Charles evenly, “your appearance and your grades have nothing in common. I trust you are doing all right at college. We haven’t heard much about that.”
“I’m doing all right,” said Chuck, finally dropping his eyes back to his cereal. Standing up to his father was something new for Chuck. Before he’d gone to college, he had avoided any confrontation. Now he looked forward to it. Chuck was sure that Cathryn noticed and approved. After all, Charles was a tyrant with Cathryn as well.
“If I’m going to drive the station wagon into Boston, I’m going to need some extra cash,” said Cathryn, hoping to change the subject. “And speaking of money, the oil people called and said they won’t deliver until the account is settled.”
“Remind me tonight,” said Charles quickly. He didn’t want to discuss money.
“Also my semester tuition has never been paid,” said Chuck.
Cathryn looked up from her food and glanced at Charles, hoping he would refute Chuck’s allegation. Semester tuition amounted to a lot of money.
“I got a note yesterday,” said Chuck, “saying that the tuition was way overdue and that I wouldn’t get credits for my courses if it weren’t paid.”
“But the money was taken out of the account,” said Cathryn.
“I used the money in the lab,” explained Charles.
“What?” Cathryn was aghast.
“We’ll get it back. I needed a new strain of mice and there was no more grant money until March.”
“You bought rats with Chuck’s tuition money?” asked Cathryn.
“Mice
,” corrected Charles.
With a delicious sense of voyeurism Chuck watched the discussion unfold. He’d been getting notes from the bursar for months, but he’d not brought them home, hoping for a time when he could bring it up without his performance being at issue. It couldn’t have worked out better.
“That’s just wonderful,” said Cathryn. “And how do you expect we are to eat from now until March after Chuck’s bill is paid?”
“I’ll take care of it,” Charles snapped. His defensiveness was coming out as anger.
“I think maybe I should get a job,” said Cathryn. “Do they need extra typing at the institute?”
“For Christ’s sake. It’s not a crisis!” said Charles. “Everything’s under control. What you should do is finish that Ph.D. thesis of yours so that you can get a job that uses your training.” Cathryn had been trying to finish her thesis in literature for almost three years.
“So now it’s because I haven’t gotten my Ph.D. that Chuck’s tuition isn’t paid,” said Cathryn sarcastically.
Michelle stepped into the kitchen. Both Cathryn and Charles looked up, their conversation momentarily forgotten. She’d dressed herself in a pink monogrammed sweater over a white cotton turtleneck, making her look older than her twelve years. Her face, framed by her jet-black hair, seemed extraordinarily pale. She went over to the counter and poured herself some orange juice. “Ugh,” said Michelle, taking a taste. “I hate it when the juice is filled with bubbles.”
“Well, well,” said Jean Paul. “If it isn’t the little princess playing sick to stay home from school.”
“Don’t tease your sister,” commanded Charles.
Suddenly, Michelle’s head snapped forward with a violent sneeze, sloshing juice from her glass to the floor. She felt a surge of liquid come from her nose and she automatically leaned forward, catching the stream in an open palm. To her horror, it was blood. “Dad!” she cried, as the blood filled her cupped hand and splattered to the floor.
In unison, Charles and Cathryn jumped up. Cathryn snatched a dish towel while Charles picked Michelle up and carried her into the living room.