by Mark Davis
A year ago, Carmen had begun losing weight and suffering night sweats. She had been diagnosed at Stanford Hospital as having large granular lymphocytic leukemia, very rare for someone as young as she. With conventional treatment, Carmen could expect to live as many years as she had behind her. And along the way, the disease promised debilitation and pain.
There were, thankfully, new treatments coming into the labs that were anything but conventional. One of them involved a new Therapso experiment in CRISPR gene-editing that transformed ordinary white blood cells into microscopic superheroes. There were only so many slots at the experiment at the Stanford Medical School for test subjects. Sandra had made sure that Carmen was one of them and that she would not be in the control group. It was a violation of policy, perhaps even California and federal law, but Sandra had moved subtly, leaving no tracks. She had been careful not to order anyone to do anything. She had simply apprised them of the facts and left them to intuit the right course of action.
After the cake was passed around and her friends left, Carmen would need to rest for the remainder of the day. Sandra took a couple of bites of cake, sipped from a cold bottle of beer and talked with the other adults. She stayed just long enough to be polite.
When she was ready to leave, Alonso ushered her to the door.
“Thank you so much for coming, you have no idea how much Carmen looks up to you,” he said.
“Thank you Alonso.” She leaned in and whispered. “And how is she doing?”
Alonso looked around to make sure they were out of earshot.
“The T-cells are still aggressive, but the therapy has already saved her spleen. And she seems to have more energy.”
“We’re going to beat that bastard of a disease and that girl is going on to do great things,” Sandra said. “And when that particular therapy is validated, we’re going to give it away to the world.”
“Give it away, Sandra?”
“Why not? The PR value will be greater than the revenue on a therapy for such a rare disease. And besides, it’s not all about money, you know.”
“No, it isn’t,” Alonso said. “Sandra, thank you.”
TWENTY-FIVE
Sandra labored over her TED Talk. The speechwriter in Austin had done a serviceable job of capturing the conversational style of the format. He had expertly retold Sandra’s farm stories and memories of Nebraska, but he was off on a lot of the details and operational doctrines about Betsy. Sandra crossed out a line that seemed too crassly commercial in its meaning, scribbling “don’t go there.” She added in a few more lines at the end about the future of health and humanity.
Sandra had just set down her pen when Alonso entered her office. She remembered he had called the day before and asked to use the corporate jet to see her.
“You must have come straight from the airport,” Sandra said, smiling, not rising from behind her desk. Alonso stood almost perfectly still before her, gathering courage.
“I have some news and it isn’t good,” he said, his voice softer than usual.
Sandra steeled herself. She had heard that statement many times before in her career and she had always persevered. She nodded for him to continue.
“It’s not official, not yet, but our lobbyists caught word that the FDA will reject this round of testing,” he said. “They believe Empirca Labs cut some corners.”
The Food and Drug Administration requires any new test to be analyzed by the same exact methods and procedures as the regular testing for patient sampling. Empirca had to make some adjustments, but it was believed that the FDA would go along. They had said as much in back channel conversations.
“You know Empirca,” she said. “Is this just a minor compliance issue? Or is it something more serious? Do they see Betsy and the test labs as apples and oranges?”
“More like apples and baseballs,” Alonso replied.
“But how could it be otherwise?” Sandra asked, walking out from behind her desk. “This is a machine that prods atoms with a laser and sniffs molecules. It is not conventional laboratory bloodwork. What else could we compare ourselves to? Are they crazy?”
“They’re the government.”
“What about the other labs we used?”
“Same problem.”
“Is there any way to comply?”
“Yes, there is one way,” he said. “Siemens has sniffers that test for most of the same panels as Betsy, about a dozen machines in all. They’re not as good. But to keep the schedule from slipping any more than it has, we need to immediately task Empirca to purchase their sniffers and verify Betsy against Siemens, every one of their machines, line by line—”
“How much time will that take?”
“If we go all out, two more months.”
“And the cost?”
“Two million, maybe three.”
“Do it.”
Alonso nodded. They spoke some more of budget and personnel issues and then he was gone, racing back to the airport to begin the laborious process of designing a test that had never been attempted before.
Sandra paced on heavy carpet. The only sound in the room was the distant thrum of heavy engines starting. A credit card company had purchased her view—the Delaware forest she had looked out over for years—stripping it out for its new headquarters.
___________
Sandra entered Carmen’s hospital room slowly, an outward show of respect that was really the result of her natural trepidation around the ill. Alonso was standing over his niece, speaking softly to her with a smile that seemed to Sandra to be false.
The girl’s room in the Stanford Children’s Health Center looked more like a suite in a high-end hotel than a hospital room. The furniture was plush and comfortable. A flat wall screen flashed video images, but with the sound on mute.
Carmen noticed Sandra and smiled.
“Hello Carmen,” Sandra said.
“Hello.” The skin on her face was waxen, but her eyes were bright and her smile genuine.
“I heard about Stanford.”
“I start in September,” the girl said. “Can’t wait.”
“I’m sure you can’t.”
Carmen suddenly looked serious.
“I’ve been meaning to ask you, do you think I should take organic chemistry in my first year? I’d like to get it out of the way early and, you know, actually enjoy my college experience, but I’d be lying if I told you I wasn’t a little intimidated.”
“You’d be a fool not to be,” Sandra said. “I got an ‘A’ in organic chemistry, but I had to cut sleep and skate by in my other classes. Needless to say, weekends were for catching up. So I waited until I was a sophomore and took the second class as a junior.”
“Thanks,” Carmen said. “So will I.”
After a long silence, Sandra said, “This is a nice room.” It was all she could think to say.
“Even a nice hospital stay is still a hospital stay,” Carmen said. “I get out tomorrow. Uncle Al is taking the weekend off and we’re driving up to Tahoe.”
“That should do you wonders.”
They talked for a good half hour about school, biomedicine, Carmen’s possible future as a biomedical scientist, maybe an entrepreneur. When it was time to leave, Alonso excused himself from Carmen and walked Sandra toward the elevator.
When they were out of earshot of Carmen’s room, Sandra asked about the girl’s prognosis.
“Small cell tests came back not so good,” Alonso said. “But we start the second round next week. We’re really hopeful about that. All the prelims show that you usually need to get to the second round to start seeing results, so we’ve got that in our corner.”
“Yes,” Sandra said.
“Along the way, we need to make sure that there will be no obstacles or questions about our participation for a second round.”
“There will not be, I will see to that personally,” Sandra said. “A few years from now, you and I will b
e attending Carmen’s graduation party.”
Alonso stared at her.
“Thank you Sandra.”
“Now, if we can talk a moment about Betsy.”
He swallowed hard and struggled to compose his features.
“Of course. Yes. The news is still not good. Empirca is having trouble getting the Siemens machines to reproduce our results.”
“That simply means they are not as good.”
“Even so, we still have a compliance issue with the testing.”
They had come to the elevator.
“Alonso, can you get inside Empirca?”
“What do you mean?”
She asked Alonso how well he knew the head of the team dedicated to Therapso and Betsy. She already knew the answer. Alonso had a long-time friend, Jim Achenbach, at Empirca who had worked on several start-ups with him.
“I’ve been over to Jim’s house a few times for dinner in the last year,” he said.
“I know him only by reputation,” Sandra says. “He sounds like he would be quite a catch for Therapso. Let him know that in two years’ time our head of research will be retiring. Salary alone is two mil, with annual stock options that are multiples of that. We could add a signing bonus as well.”
Alonso stared at her, at first not sure what she was saying.
“I just want you to talk with your friend. And then the two of you could do a code by code comparison, perform some reverse engineering and make sure that the comparison tests reflect all the real-world attributes of Betsy.”
Alonso looked down at his shoes.
“Can you do that for me?”
Alonso answered her with a shrug.
“In the meanwhile, I will be moving heaven and earth to secure that second round for Carmen.”
Alonso finally looked up at her.
The elevator chimed and the door opened.
“To rig the test,” he whispered.
“To make sure that this great technology ticks all the bureaucratic boxes of the FDA so it can save lives.”
Alonso said nothing in response. He searched Sandra’s eyes, looking for validation that he had heard her correctly.
“If you do that, I will do my part, and we shall all come through this passage better than ever—you, me, Carmen, Betsy. Do we understand each other?”
Alonso nodded.
The door closed.
___________
Sandra waved away an assistant bringing her another short glass of warm water. She took a few deep breaths and thought of a beloved family cow, a gentle Brown Swiss named Betsy, the one that had helped win her first 4-H ribbon.
This was just another test, no different than the first, just another milestone in her rise. There would be other milestones at Davos, at the New York Economic Club, and eventually Stockholm. Then she could cash out her stock, retire and maybe run for the Senate in Delaware or take a Cabinet post. How far could Sandra Armstrong go with a Nobel Prize behind her?
The assistant checked the lavalier mike clipped to Sandra’s shirt. Sandra cleared her throat while the music swelled. She stepped out on to the stage to sharp applause that made her feel as if she were about to address a stadium.
The venue was in fact an old theater near Carnegie-Mellon in Pittsburgh with only about 150 people. But they were all seated close for the cameras, making it look like a vast attendance. The lights were too bright to see anything more than just the suggestion of an audience, which was just fine by Sandra. Behind her was an enormous video screen with a depiction of a massive cell against a background of fluid pulses of dark and light red.
“Blood,” she said.
Sandra walked toward the audience at a slow, thoughtful pace, hands interlaced in front of her chest, two fingers pointing toward the ceiling.
“The ocean of life within us.”
She continued to pace forward until she hit her mark. She spoke her lines conversationally, addressing the silhouettes before her. Many in the audience were, she knew, Therapso investors and Wall Streeters looking for the Next Big Thing. So this was a twofer—selling Sandra as a public intellectual while boosting Betsy and the share price.
“Blood bathes the cells of our bodies in nutrients. It carries oxygen to our brains and delivers carbon dioxide to our lungs for us to exhale. And it contains within it multitudes of organisms … parts of ourselves we barely know exist … armies of white blood cells with specialized spotters ready to detect an alien bacteria or rogue cell turning cancerous … suicide soldiers ready to dig into these errant cells and explode them … and platelets ready to come to the scene of any injury, our first-responders who seal our wounds with coagulants.”
Sandra was on a semi-circular stage set just high enough so she could glance down at the words of her speech scrolling on screens inset in the floor, while appearing to be merely looking straight down to make eye contact with her audience. But Sandra did not need to read her lines. She had rehearsed them so well the words poured out of her.
Her Austin speechwriter had told her that when a speaker focuses on merely getting the words out, the result seems predictably forced. But when a speaker dwells on the rich meaning of her words, she invites her listeners to dwell on those meanings with her.
Sandra was good at this, so good that the format’s chin-stroking asides and flashes of revelatory insights seemed to flow naturally from her.
“The handiwork of billions of years of evolution in our blood is majestic, a thing of wonder,” she said. “But it isn’t perfect. We are not perfect. We are vulnerable to diabetes. Cancers. Immune disorders. Anemia. Alzheimer’s.”
Sandra repeated statistics about early death from these scourges of mankind.
There are tests and markers, she said, for each of these scourges. But not one practical, affordable universal assay for all diseases detectable in the human blood … until now.
Sandra spoke of how one day she was sitting at her desk, pouring over statistics about how many people died for lack of early detection, when she looked beyond the numbers to think with fondness and sadness of a young woman she had known for years … the niece of a friend … a bright and clever young lady Sandra had mentored … who had been accepted to Stanford and started working on a degree in biochemistry … only to be forced to withdraw from school just a month in her first quarter … This young lady, her name was Carmen, soon lost her life to one of the very diseases she had hoped to one day cure.
A commotion in the audience. Someone speaking loudly. Sandra ignored it, like a good actress should and continued.
“That was when I determined that I would dedicate whatever number of years I have left on this earth to saving the Carmens of the future.”
“Cunt.”
Sandra paused. Whatever it was, security would take care of it. With a flurry of fright, she realized she had lost her place, but remembered the screens. She glanced down and found her place. They could edit out the interruption.
“The tragedy is that most diseases are easily cured with early detection. But we can’t go to the clinic every week to have every little imperfection checked and double-checked. What was needed was a way to read a record of the body in one glance … in one drop of blood. What was needed was … Betsy.”
“Liar.”
The silhouettes were moving. There was a scuffle, someone being grabbed by the arm and pulled back.
“Tell them Sandra, tell them about our little deal.”
Sandra put it out of her mind. He was being taken care of … being ushered out. She had to get on with it. She had to tell the story of how she had devised this new technology and then close strong.
___________
“It was Alonso, of course. I had not been able to keep up my part of the bargain. Believe me, I tried. We had Jim at Empirca Labs on board. But a stubborn faculty physician blocked Carmen at the last minute, indignant about compromising the purity of the leukemia test. He was right, of course. But what w
ould it have hurt to have at least added Carmen to the test and scrubbed out of her data later? After all I’ve given to that school …”
The skin around her eyes looked bruised. Sandra looked older, her eyelids pinched.
“They escorted Alonso out of the auditorium without arresting him. If they had, the story would have spilled out right then and there. TED told me that my presentation was spoiled by the interruption. I asked them if they could edit it out, but they said that was against the rules.
“Several days later, the FBI paid me a little visit. The FDA suspended Betsy. The board fired me but made it look like a retirement. So I sat at home, talking with lawyers, preparing myself for the story to break and the subpoenas to arrive. After that would come trial and retrial, testimony, getting yelled at by congressmen, scandal. Then this …”
Sandra picked up the report from her desk.
“While I was steeling myself to weather this storm, I found that I was having trouble concentrating, thinking clearly. Not surprising, given all I was going through. But I took a vacation to Italy and realized it was not just stress. It was something else, something that felt different inside me. So I went in for testing and was diagnosed with early onset Alzheimer’s.”
Sandra set down the report. She took a sip from a cocktail glass, for a long time the only sound the tinkling of ice.
She put the drink down.
“So Betsy couldn’t even get that right.”
Her lips fluttered and eyes welled over with tears. Sandra composed herself and looked straight into the computer camera.
“So that’s it. That’s the end of me. This is where I wind up. As I traveled around the world striking items off my bucket list—there weren’t many left—I heard about Freyja. I got in touch. Freyja and I had some useful conversations, though I don’t buy her bullshit for one minute. I do detect someone very clever and intuitive. A week ago, when I received her invitation, I instantly accepted. So I am going to go to Norway. I will probably not do it with the others, at least not that way. If I don’t put an end to myself then, no one will see this little confessional of mine.