by Harlan Coben
"Did that happen with Jeremy Downing?"
"As a matter of fact," she said, "it did."
Somewhere down the hall, a machine started beeping. The sound hit the nerves like a police taser.
"So his first doctor screwed up?"
"I won't get into that. But Fanconi anemia isn't common. And because it looks like other things, it's often misdiagnosed."
"So tell me about Jeremy."
"What's to tell? He has it. Fanconi anemia, that is. In simple terms, his bone marrow is corrupted."
"Corrupted?"
"In layman's term, it's shit. It makes him susceptible to a host of infections and even cancers. It commonly turns into AML." She saw the puzzled look on his face and added, "That's acute myelogenous leukemia."
"But you can cure him?"
" 'Cure' is an optimistic word," she said. "But with a bone marrow transplant and treatments with a new flu-darabine compound, yes, I believe his prognosis is excellent."
"Fluda-what?"
"Not important. We need a bone marrow donor that matches Jeremy. That's what counts here."
"And you don't have one."
Dr. Singh shifted on the mattress. "That's correct."
Myron felt the resistance. He decided to back off, test another flank. "Could you take me through the transplant process?"
"Step by step?"
"If it's not too much trouble."
She shrugged. "First step: find a donor."
"How do you go about that?"
"You try family members, of course. Siblings have the best chance of matching. Then parents. Then people of similar background."
"When you say people of similar background--"
"Blacks with blacks, Jews with Jews, Latino descent with Latino descent. You'll see that quite often in marrow drives. If the patient is, for example, a Hasidic Jew, the donation drives will take place within their shuls. Mixed blood is usually the hardest to match."
"And Jeremy's blood or whatever you need to match--it's fairly rare?"
"Yes."
Emily and Greg were both of Irish descent. Myron's family came from the usual potpourri of old Russia and Poland and even a little Palestine thrown in. Mixed blood. He thought about the paternity implications.
"So after you exhausted the family, how do you search for the match?"
"You go to the national registry."
"Where are they located?"
"In Washington. You listed?"
Myron nodded.
"They keep computer records there. We search for a preliminary match in their banks."
"Okay, now assuming you find a match in the computer--"
"A preliminary match," she corrected. "The local center calls the potential donor and asks them to come in. They run a battery of tests. But the odds of matching are still fairly slim."
Myron could see that Karen Singh was relaxing, comfortable with the familiar subject matter, which was exactly what he wanted. Interrogations are a funny thing. Sometimes you go for the full frontal attack, and sometimes you sidle up, friendly-like, and sneak in the back. Win put it simpler: Sometimes you get more ants with honey, but you should always pack a can of Raid.
"Let's suppose you find a full-fledged donor," Myron said. "What then?"
"The center acquires the donor's permission."
"When you say 'center,' do you mean the national registry in Washington?"
"No, I mean the local center. Do you have your donor card in your wallet?"
"Yes."
"Let me see it."
Myron took out his wallet, flipped through about a dozen supermarket discount cards, three video club memberships, a couple of those buy-a-hundred-coffees-get-ten-cents-off-the-hundredth coupon, that sort of thing. He found the donor card and handed it to her.
"See here," she said, pointing to the back. "Your local center is in East Orange, New Jersey."
"So if I was a preliminary match, the East Orange center would call me?"
"Yes."
"And if I ended up being a full match?"
"You'd sign some papers and donate marrow."
"Is that like donating blood?"
Karen Singh handed the card back to him and shifted again. "Harvesting bone marrow is a more invasive procedure."
Invasive. Every profession has its own buzzwords. "How so?"
"For one thing, you have to be put under."
"Anesthesia?"
"Yes."
"And then what do they do?"
"A doctor sticks a needle through the bone and sucks the marrow out with a syringe."
Myron said, "Eeuw."
"As I just explained, you're not awake during the procedure."
"Still," Myron said, "it sounds much more complicated than giving blood."
"It is," she said. "But the procedure is safe and relatively painless."
"But people must balk. I mean, most probably signed up the same way I did: They had a friend who was sick and ran a drive. For someone you know and care about, sure, you're willing to make a sacrifice. But for a stranger?"
Karen Singh's eyes found his and settled in hard. "You are saving a life, Mr. Bolitar. Think about that. How many opportunities do you get to save a fellow human being's life?"
He had hit a nerve. Good. "Are you saying people don't balk?"
"I'm not saying it never happens," she said, "but most people do the right thing."
"Does the donor get to meet the person he or she is saving?"
"No. It's totally anonymous. Confidentiality is very important here. Everything is held in the utmost secrecy."
They were getting to it now, and Myron could sense that her defenses were starting to slide back up like a car window. He decided to pull back again, let her resettle on comfy ground. "What's the patient going through during all this?" he asked.
"At what point?"
"While the marrow is being harvested. How do you prep the patient?" Prep. Myron had said "prep." Like a real doctor. Who said watching St. Elsewhere was a waste of time?
"It depends on what you're treating," Dr. Singh said. "But for most diseases, the recipient goes through about a week's worth of chemotherapy."
Chemotherapy. One of those words that hush a room like a nun's scowl. "They get chemo before the transplant?"
"Yes."
"I would think that would weaken them," Myron said.
"To some degree, yes."
"Why would you do it, then?"
"You have to. You're giving the recipient new bone marrow. Before you do that, you have to kill the old marrow. With leukemia, for example, the amount of chemo is high because you have to kill off all the living marrow. In the case of Fanconi anemia, you can be less aggressive because the marrow is already very weak."
"So you kill off all the bone marrow?"
"Yes."
"Isn't that dangerous?"
Dr. Singh gave him the steady eyes again. "This is a dangerous procedure, Mr. Bolitar. You are in effect replacing a person's bone marrow."
"And then?"
"And then the patient is infused with new marrow through an IV. He or she is kept isolated in a sterile environment for the first two weeks."
"Quarantined?"
"In effect. Do you remember the old TV movie The Boy in the Plastic Bubble?"
"Who doesn't?"
Dr. Singh smiled.
"Is that what the patient lives in?" Myron asked.
"A bubble chamber of sorts, yes."
"I had no idea," Myron said. "And this works?"
"Rejection is always a possibility, of course. But our success rate is quite high. In the case of Jeremy Downing, he can live a normal, active life with the transplant."
"And without it?"
"We can keep treating him with male hormones and growth factors, but his premature death is inevitable."
Silence. Except for that steady mechanical beep coming from down the hall.
Myron cleared his throat. "When you said that everything involving the
donor is confidential--"
"I meant totally."
Enough wading. "How does that sit with you, Dr. Singh?"
"What do you mean?"
"The national registry located a donor who matched Jeremy, didn't they?"
"I believe so, yes."
"So what happened?"
She tapped her chin with her index finger. "May I speak candidly?"
"Please."
"I believe in the need for secrecy and confidentiality. Most people don't understand how easy, painless, and important it is to put their name in the registry. All they have to do is give a little blood. Just a little tube of the stuff, less than you would for any blood donation. Do that simple act--and you can save a life. Do you understand the significance of that?"
"I think so."
"We in the medical community must do all we can to encourage people to join the bone marrow registry. Education, of course, is important. So, too, is confidentiality. It has to be honored. The donors have to trust us."
She stopped, crossed her legs, leaned back on her hands. "But in this case, something of a quandary has developed. The importance of confidentiality is bumping up against the welfare of my patient. For me, the quandary is easy to resolve. The Hippocratic oath trumps all. I'm not a lawyer or a priest. My priority must be to save the life, not protect confidences. My guess is that I'm not the only doctor that feels that way.
Perhaps that's why we have no contact with the donors. The blood center--in your case, the one in East Orange--does everything. They harvest the marrow and ship it to us."
"Are you saying that you don't know who the donor is?"
"That's right."
"Or if it's a he or she or where they live or anything?"
Karen Singh nodded. "I can only tell you that the national registry found a match. They called and told me so. I later received a call telling me that the donor was no longer available."
"What does that mean?"
"My question exactly."
"Did they give you an answer?"
"No," she said. "And while I see things on the micro level, the national registry has to remain macro. I respect that."
"You just gave up?"
She stiffened at his words. Her eyes went small and black. "No, Mr. Bolitar, I did not give up. I raged against the machine. But the people at the national registry are not ogres. They understand that this is a life-or-death situation. If a donor backs out, they try their best to bring them back into the fold. They do everything I would do to convince the donor to go through with it."
"But nothing worked here?"
"That seems to be the case."
"The donor would be told that he's sentencing a thirteen-year-old boy to death?"
She didn't hesitate. "Yes."
Myron threw up his hands. "So what do we conclude here, Doctor? That the donor is a selfish monster?"
Karen Singh chewed on that one for a moment. "Perhaps," she said. "Or perhaps the answer is simpler."
"For example?"
"For example," she said, "maybe the center can't find the donor."
Hello. Myron sat up a bit. "What do you mean, 'can't find'?"
"I don't know what happened here. The center won't tell me, and that's probably how it should be. I'm the patient's advocate. It's their job to deal with the donors. But I believe they were"--she stopped, searching for the right word--"perplexed."
"What makes you say that?"
"Nothing concrete. Just a feeling that this might be more than a donor with cold feet."
"How do we find out?"
"I don't know."
"How do we find the donor's name?"
"We can't."
"There has to be a way," Myron said. "Play pretend with me. How could I do it?"
She shrugged. "Break into the computer system. That's the only way I know."
"The computer in Washington?"
"They network with the local centers. But you'd have to know codes and passwords. Maybe a good hacker could get through, I don't know."
Hackers, Myron knew, worked better in the movies than in real life. A few years ago, maybe--but most computer systems nowadays were secure against such invasions.
"How long do we have here, Doctor?"
"There's no way of telling. Jeremy is reacting well to the hormones and growth factors. But it's only a question of time."
"So we have to find a donor."
"Yes." Karen Singh stopped, looked at Myron, looked away.
"Is there something else?" Myron asked.
She did not face him. "There is one other remote possibility," she said.
"What?" Myron asked.
"Keep in mind what I said before. I'm the patient's advocate. It's my job to explore every possible avenue to save him."
Her voice was funny now.
"I'm listening," Myron said.
Karen Singh rubbed her palms on her pant legs. "If Jeremy's biological parents were to conceive again, there is a twenty-five percent chance that the offspring would be a match."
She looked at Myron.
"I don't think that's a possibility," he said.
"Even if it's the only way to save Jeremy's life?"
Myron had no reply. An orderly walked by, looked in the room, mumbled an apology, left. Myron stood and thanked her.
"I'll show you to the elevator," Dr. Singh said.
"Thank you."
"There's a lab on the first floor in the Harkness Pavilion." She handed him a slip of paper. Myron looked at it. It was an order form. "I understand you might want to take a certain confidential blood test."
Neither of them said anything else as they walked toward the elevators. There were several children being wheeled through the corridor. Dr. Singh smiled at them, the pointed features softening into something almost celestial. Again the children looked unafraid. Myron wondered if the calmness spawned from ignorance or acceptance. He wondered if the children did not understand the gravity of what was happening to them or if they possessed a quiet clarity their parents would never know. Such philosophical queries, Myron knew, were best left to those more learned. But maybe the answer was simpler than he imagined: The children's suffering would be relatively short; their parents' would be eternal.
When they reached the elevator, Myron said, "How do you do it?"
She knew what he meant. "I could say something fancy about finding solace in helping, but the truth is, I block and I compartmentalize. It's the only way."
The elevator door opened, but before Myron could move he heard a familiar voice say, "What the hell are you doing here?"
Greg Downing stepped toward him.
7
Too much history. Again. The last time the two men had been in the same room, Myron was straddled over Greg's chest, trying to kill him, punching him repeatedly in the face until Win--Win of all people--pulled him off. Three years ago. Myron hadn't seen him since, except on highlight films during the evening news.
Greg Downing glared at Myron, then at Karen Singh, then back at Myron as though he expected him to have evaporated by then.
"What the hell are you doing here?" he asked again.
Greg was clad in a flannel shirt over some waffle knit you'd buy at Baby Gap, faded jeans, and preternaturally scuffed work boots. The Suburban Lumberjack.
Something sparked hot in Myron's chest, ignited, took flight.
From the day they first battled for a rebound in the sixth grade, Greg and Myron were the pure definition of cross-town rivals. In high school, where their competitive cup truly runneth over, Greg and Myron met up eight times, splitting the games evenly. Rumor had it that there was bad blood between the budding superstars, but that was just standard sports hyperbole. The truth was, Myron barely knew Greg off the court. They were killer competitors, sure, willing to do just about anything to win, but once the final buzzer sounded, the two boys shook hands and the rivalry hibernated until the next opening tap.
Or so Myron had always thought.
When he accepted a scholarship at Duke and Greg chose the University of North Carolina, basketball fans rejoiced. Their seemingly innocent rivalry was ready for ACC prime time. Myron and Greg did not disappoint. The Duke-UNC matchups drew fantastic television ratings, no game decided by more than three points. Both had spectacular college careers. Both were named first-team All-Americans. Both were on covers of Sports Illustrated, once even sharing it. But the rivalry stayed on the court. They would do battle until bloody, but the competition never overlapped into their personal arenas.
Until Emily.
Before the start of senior year, Myron broached the subject of marriage with Emily. The next day she came to him, held his hands, looked into his eyes, and said, "I'm not sure I love you." Bam, like that. He still wondered what happened. Too much too soon, he guessed. A need to spread the proverbial wings a bit, play the proverbial field, what have you. Time passed. Three months, by Myron's count. Then Emily took up with Greg. Myron publicly shrugged it off--even when Greg and Emily got engaged just before graduation. The NBA draft took place right about then too. Both went in the first round, though Greg was surprisingly picked before Myron.
That was when it all unraveled.
The end result?
Almost a decade and a half later, Greg Downing was winding down an All-Star pro basketball career. People cheered him. He made millions and was famous. He played the game he loved. For Myron, his lifelong dream had ended before it had begun. During his first preseason game with the Celtics, Big Burt Wesson had slammed into him, sandwiching Myron's knee between himself and another player. There was a snap, crackle, pop--and then a hot, ripping pain, as though metal talons were shredding his kneecap into thin strips.
His knee never recovered.
A freak accident. Or so everyone thought. Including Myron. For more than ten years, he'd believed that the injury was merely a fluke, the fickle work of the Fates. But now he knew better. Now he knew the man who stood in front of him had been the cause. Now he knew that their seemingly innocent childhood rivalry had grown monstrous, had feasted upon his dream, had slaughtered Greg and Emily's marriage, and had in all probability led to the birth of Jeremy Downing.
He felt his hands tighten into fists. "I was just leaving."
Greg put a hand on Myron's chest. "I asked you a question."
Myron stared at the hand. "One good thing," he said.
"What?"
"No transportation time," Myron said. "We're already at the hospital."
Greg sneered. "You sucker-punched me last time."
"You want to go again?"
"Pardon me," Karen Singh said. "But are you guys for real?"
Greg kept glaring at Myron.