by Jake Wolff
When Sammy had asked me about my project and the soursop, I had told myself he was simply getting to know me and my work. I even took it as a sign, maybe, that he was falling deeper in love. But no. He had been steering me toward his elixir before I even knew it existed.
* * *
“Can I see his final journal entry?” Sadiq asked one evening during a snack break.
I wiped the cheddar cheese from a cracker off my lips. I’d offered Sadiq full access to the journals, but his relationship with them was so different from mine. I carried the hurt of being absent in those pages, of gaining no insight from them into Sammy’s true feelings for me. Sadiq carried the fear of Sammy’s true feelings, of discovering that their relationship, to Sammy, was a small and sunless thing. When Sadiq asked if he could see the final entry, what he meant was Should I see it? In some cases, I had to tell him no—you really shouldn’t.
“Sure,” I told him, in this case. “But it’s nothing.”
The final entry, and this seemed not an accident, was the only one, across twenty-two journals, that Sammy did not begin with the date.
Frustrating day. Sometimes the world makes so little sense that it feels like a conspiracy to confuse me.
It is a fact that 92% of Daily Doubles are located in the bottom three rows. The top two rows almost never contain Daily Doubles; the very top row, less than 1% of the time. It is a fact that most Daily Doubles are located in the fourth row from the top (38%). In Double Jeopardy!, the two Daily Doubles are never located in the same category. And yet, contestants who locate the first Daily Double generally do two things next, in sequence: (1) They finish the category in which the Daily Double was located, and (2) They start at the top of a new category. I can only guess that most contestants employ a suboptimal strategy because they don’t want to seem overly “cutthroat” in their methods of game-playing. But where does this come from, this inane desire to compete without appearing competitive?
My mom had an insult for basketball players whom she considered to be too friendly toward and too accommodating of their opponents. She would say, “He is not a basketball player.”
Good night.
* * *
We both felt it at once, Sadiq and I: the arrival of a crossroad. We’d run the tests available to us, done as much research as we could from a motel in southern Maine. I could see the gears of the elixir in motion, could understand, at least, the theories behind Sammy’s approach. But Sammy was dead, and nothing we’d accomplished had helped us understand what was missing or why we could expect the outcome for my father to be any different.
Surrounded by Sammy’s equipment, we had not much space to maneuver. It felt as if we were in the command room of a submarine, and I wondered if the feeling between us was not unlike that shared by the men and women who lived on such vessels: kinship, but also the claustrophobia of that closeness.
“The good news,” Sadiq said, “is that we understand the mechanisms of the tribal medicine. The bad news is that the Z. nesophila is a truly unique plant.”
I knew what he meant by this: to continue, we had to call Catherine.
Part of me did want to give up. When I slept, which was rarely, I dreamed of Sammy’s ravaged apartment, of a broken padlock, of a figure in the trees. I would dream of Sammy turning the same color as my father, turning mean like him—showing me I am not loved. Maybe I wasn’t. Sammy never said those words. But he’d given me these things, trusted me with them. He’d sent me a message, in his own infuriating way. He believed I could save my father.
“Okay,” I said. “We keep going.”
“The other benefit of reaching out to Catherine,” Sadiq said, as if trying to talk himself into it, “is that she may be able to provide more certainty on what exactly was in his system when he died.”
I wasn’t sure what he meant. Why would she know more than we did?
Sadiq rubbed his beard and looked at me with dull eyes. “Conrad, his parents are dead and he has no siblings. Where do you think his body went?”
“I don’t know. An aunt or something?”
“No. Not an aunt or something. It went to his next of kin.”
“But Catherine isn’t family.”
Sadiq’s mouth opened and closed. “Oh. There may have been things he didn’t tell you.”
I waited.
“When I say next of kin, I don’t mean Catherine. I mean her son. Sam’s son.”
CASE HISTORY
The Blood-Brain Barrier Is Discovered in Dogs
Freiburg, Germany, AD 1913
When Edward was a boy, his father said life is like the ripples of water from a cast stone skipped across the surface of a lake. There’s no end to a ripple—not really. There’s only an absorption, a subsumption, as the ripple rejoins the body of the whole. An individual life, his father said, only seems distinct from the sum total of all lives for the brief period in which it is visible.
That day by the lake, Edward had asked a simple question—“What is it like to die?”—but such had been his father’s way, choosing to interrogate the premise instead of answering. At the age of fifty-one, Edward owes much to the influence of his father. He has enjoyed a long career in the sciences: degrees from London and Breslau, an honorary professorship at Freiburg, a position as head of surgery at Deaconess. Still, in the case of that one, particular question, Edward wishes his father had answered more clearly. What is it like to die? The question has resurfaced, and the memory with it, because Edward has cancer and will soon be dead.
You will soon be dead, he tells himself. Edward will be dead.
But for now he is short, thin, and huddled over the body of a dog he killed earlier. It is noon on a Wednesday—lunchtime, if Edward could bring himself to eat. But the cancer is in his stomach, a tumor the size of a lemon, and there’s no room for food. At night, he dreams of Apfelstrudel and Rumkugeln, cooling in rows near an open window, and of anchors settling to the bottom of the ocean. During the day, he spends most of his time at the hospital, finishing as many projects as he can. His lab at Deaconess is long and narrow, like a train car, and he thinks of it that way now more than ever. He is only a passenger.
“Edward,” says a woman’s voice. “Are you awake?”
Edward stirs. “Yes. Were my eyes closed?”
“Briefly.” She is Marie, his lab assistant. She has the pale hair and wide blue eyes typical of the women of Germany, including his own wife. Edward was born in South Africa, but Germany is his home. He will be buried here.
“Could I trouble you for some coffee?” he asks her. Marie’s work is research, and it is not her job to fetch him drinks, but she says yes, of course. She is half his age and very smart, and he thinks of her like a daughter. He has already secured a position for her after his death.
When Marie is gone, Edward returns his gaze to the dead dog, a beagle, whose little brain is the size of a newborn’s fist. Earlier, Edward carved a window into the dog’s skull, like the porthole of a ship, so he can see the shoulderlike curve of the cerebral cortex. Other than its size, the dog’s brain is similar in shape to that of a human’s, and there is either comfort or unease in this similarity, depending on your opinion of dogs. Edward maneuvers his scalpel into the porthole and uses the blade to carve a biopsy sample from the brain. He balances the specimen on the flat edge of the scalpel and rolls his chair to the microscope, where he plates the sample and examines it. Through the lens of the eyepiece, the cells of the brain are blue.
Edward returns to the beagle’s body, holds it flat against the lab table, and digs a larger scalpel into the back of its neck. Under all that fur, a dog’s skin is thin and dry, much less stubborn against the blade than a man’s. Edward cuts until he has exposed the cervical vertebrae, and the cells of these, too, are blue under the microscope—the color of Marie’s eyes, and his wife’s eyes, and the sky in June.
He flips the body over and cuts into the stomach. There is the squish and stench of a belly exposed, the warm, hot smell of
innards. He plunges his hand into this opening and removes the organs as he finds them, cutting deeper as he needs to, and places their samples under the lens. The liver: not blue. The kidneys: not blue. The heart: not blue. Nothing is blue but the brain and the spine, and this is good. The experiment was a success.
When you’re dying, memories are like teenagers: they come and go as they please. So there was no reason, several months prior, for Edward to have remembered a minor experiment conducted by a former mentor at Breslau. In the experiment the mentor injected blue dye into the blood of a dog, killed the dog, and examined which organs had been stained. The liver: blue. The kidneys: blue. The heart: blue. He worked his way up the body, finding blue wherever blood travels, until he reached the central nervous system. The brain and spine were untouched.
Edward’s mentor hypothesized that by the time it reached the cranium, the dye was too diluted to turn the brain blue. He further speculated that the chemical properties of the dye made it less adherent to the tissues of the brain and vertebrae; the blue coloring slid off those organs the way raindrops run off a pane of glass.
Only many years later, when he could pinpoint the month he would die, did Edward consider an alternative theory. In his own practice, he had noticed the difficulty faced by himself and his colleagues when trying to deliver drugs to the brain. What if, he wondered, some sort of protective membrane, an invisible barrier, separated the central nervous system from the rest of the body?
Once he had the question, finding the answer was simple. He reversed his mentor’s process. Rather than injecting the dye into the bloodstream, he inserted it directly into the cerebrospinal fluid of the brain. If the dye still couldn’t stain the brain cells, then the hypothesis about adherence to tissue was correct. If the dye stained the brain cells and every other organ, then the theory of the dye becoming too diluted proved true and his mentor was right. But if the dye stained only the brain and spinal column, then Edward could prove that the central nervous system shielded itself with an invisible fence heretofore unknown to science.
Edward’s nose detects the bitter, burnt smell of coffee, and then Marie appears, holding two mugs. She joins him at the microscope, and he moves aside for her to see. She bends at the waist and presses one eye to the eyepiece, her mug of coffee still steaming in her hand. Edward sips his own, just enough to get the taste of it, to wet his tongue. His fingers around the handle are the fingers of a stranger, skeletal and sallow. He used to be a man of substance, but now, as Marie pulls back from the microscope and blows cool breath onto her coffee, he thinks she could breathe him right out of the room.
“Oh, Edward. You did it.”
Who is he, and what has he done? What can possibly be accomplished in a life so short?
“It seems so.”
She laughs at his modesty and places a hand on his shoulder. “You are one of a kind.”
It is Edward’s turn to laugh, and here is the joke: Edward’s specialty is the removal of cancerous tumors. If Edward were some other person, some layperson—a bricklayer, perhaps, or a butcher—he would have gone to see his family doctor. He would have said, “Doctor, I have no appetite, and there is blood in my stool.” And the doctor would have said, “I will make you an appointment with Dr. Edward Goldmann at Deaconess.”
The joke isn’t funny—not because it’s morbid, but because it’s much, much too familiar. A joke told every day loses its punch line, and the history of medicine is filled with jokes like these. For instance: the dye Edward used in his experiment is called trypan blue. It was developed by an American biologist who was searching for a drug to treat a particularly nasty brain parasite called African Trypanosoma. At the turn of the century, an epidemic of these little critters killed more than a quarter of a million people. They enter the brain through the bite of the tsetse fly, and once there, it’s impossible to remove them. The American hoped the trypan could infiltrate the brain and wipe out the infection, allowing him to save countless lives. But the trypan didn’t work. The drugs couldn’t reach the parasites—they were somehow protected.
That somehow was the invisible barrier Edward just proved. In trying and failing to solve one problem, the American created the substance that would be used, in another decade, on another continent, to explain his failure.
It is only the beginning. Edward has proved the existence of the barrier, but what does the barrier look like and how does it work? He will never know. He will never get to see it. He is aware of a man, a fellow German, who has begun to experiment with focused electron beams, and these may allow for microscopic views of incredible detail, turning the invisible visible. Then, he supposes, the dye itself will become obsolete, replaced perhaps by radioactive atoms that operate with such precision that Edward’s work will appear clumsy and crude. People will read the brain the way they read a city map, and these maps will prove his own knowledge laughably incomplete.
He can only glimpse the contours of these things; he can’t even imagine them so much as he can imagine someone else imagining them. There’s too much he doesn’t know! What is the exact relationship between the brain tissue and the invisible barrier? When will cancer of the stomach be nonfatal? When will anyone be able to say, definitively, that Edward’s work mattered?
For now, imagine the surface of a lake. Edward’s father said life is like the ripples on the water—diffusing, suffusing. There is no end. Soon, Edward will see his father, and he’ll tell him, Father, you were wrong. Life is not the ripples. Life is simply the throwing of the stone. By the time it touches water, you’re gone.
17
My Husband’s Radiation
A few weeks after my husband’s diagnosis, I sat next to my mother-in-law in the waiting room at Northern Maine Medical Center, Department of Radiation Oncology. Her name was Kimberly, and she hated me. She felt that I had been selfish to bring my husband up here to “the arctic,” as she called it, away from his family and his friends and the life he’d built in New York. She was right to think so. My husband lived a good life in the city. We lived a good life. At some point, and I don’t know when, that goodness stopped working for me. My roommate in college had been an army brat, and I remember asking him, of the ten different places he’d lived, which one he considered home. He told me what his father had told him, that he wouldn’t know until he was older, until wherever he was, whatever he was doing, one of those ten places called to him. One day I was lying in bed, awake, my future husband asleep beside me, and I knew I had to listen to the voice I’d been ignoring. I knew it was time to go home to Winterville.
I’d said to my husband, “I’m hoping that you’ll come with me. Also that you’ll marry me.”
“You’re proposing,” he said, not a question.
“Yes.”
“Winterville.” He took out his phone. “Let me find it on a map.”
* * *
Kimberly pulled her jacket tight around her little body. She was in her late seventies but had the body of a much older woman, the frailty. “It’s too cold in here,” she said. “It can’t be good for him.”
A nurse and her patient emerged from behind the heavy doors. I tried to picture my husband at the end of this long road, after radiation round one, radiation round two, and the inevitable surgery.
Kimberly’s mind was in a similar place. “Will his hair fall out?”
“Yes and no.” That was only the start of my answer, but she turned back to her reading, either satisfied or determined to remain unsatisfied.
After our first visit with the doctor, we entered my husband’s treatment plan into his medical chip, and it responded with his odds of survival: 93 percent. Such a high number! We toasted to 93 percent. We joked about it (“There’s a better chance I’ll kill you”). We made love in the glow of it. The number was so high it seemed almost vulgar. Some people in the world were truly suffering, and here we were, worrying ourselves over 93 percent. Then we woke up one morning, scanned the chip as usual, and the odds of survival were
92.5 percent.
We called our doctor in a panic and asked him what had changed.
“Nothing’s changed,” he said. “Time is passing.”
The thought of that morning upset me. I turned to Kimberly. “He’s going to be fine.” I hoped that if I gave her some comfort, she might respond with some for me. What better opportunity for us to bond, at last, than this? But I was wrong to think Kimberly’s heart could be thawed. She was a sheet of ice, and behind that was another sheet of ice, and behind that, another. “He’s going to be fine,” I said again, into the emptiness of the waiting room.
Kimberly looked at me sideways. “God willing. My doctor said he’s never heard of your doctor.”
I studied the etched lettering on the door by the reception desk: ONCOLOGY. From the Greek onkos, for “mass,” the Latin onco-, for “tumor.” The study of. I allowed myself a moment of anger at Kimberly’s doctor, who would feed her neuroses and give her ammunition against me. But most likely she had tricked him into it, asked him a seemingly harmless, offhand question, “Do you know Dr. So-and-So?” And he’d answered honestly, no, never heard of him.
The doors opened, and they rolled my husband into the room. They had told him to dress comfortably, so he’d worn sweatpants, a flannel shirt. He looked like a lumberjack after a bad fall. I went to him and touched his face, which was cool, clammy. He gazed up dreamily, happy to see me but not quite himself. Kimberly nudged me aside and kissed him on the cheek.
My husband touched the thick spokes of the wheelchair. “I feel like Bruce Banner.”