Die Once Live Twice

by Lawrence Dorr

  He stepped closer to the painting, crying out loud to it, “Lord, why have you forsaken us? What have we done to deserve this wrath? Guns causing death in Europe and germs delivering misery everywhere. Our world is reeling in suffering. If you had the compassion to heal the sick in the temple, why not heal us? I cannot heal and I am your servant for healing. I beseech you, Lord, show mercy on us.”

  Jonathan’s faith in God was renewed when the armistice ending World War I was signed on November 11. That same week in Philadelphia there were no deaths from the flu. It was if God had indeed heard Jonathan’s plea. The Great Flu was finished in Philadelphia. The piles of bodies and the mass graves that could not be dug fast enough three weeks ago were a part of the history of Philadelphia now. Jonathan and Marion went from a state of helplessness to one of uselessness, for there were no new patients. The cause of its ending was as mysterious as its beginning, but Jonathan knew there was a medical explanation. Viruses were known to mutate, to change overnight. The virus might change from one which infects animals, like pigs or birds, to a human pathogen. The virus that caused the greatest human epidemic ever may have simply mutated into a harmless form. However, Jonathan preferred to believe God decided his children on earth had sustained enough war and shut down the guns and germs at the same time.

  Jonathan and Marion returned to their home in New York City for Thanksgiving. This year the meal was a true celebration, giving thanks for being alive. Everyone had friends and family who’d died. Jonathan and Marion hosted Phil Spanezzi and Danica, who were now married. Their priest, Father Padraig, came, as did Lucia and Angelo, who brought his fiancée, Maria. Audrey, the Russian-Jewish nurse, came alone. Rabbi Yassel Radulovic, who had converted his temple to a hospital, did not. He was a victim of the flu. Working with Audrey, he’d sometimes tended to the needs of patients twenty hours a day. Audrey felt one of the patients had coughed or sneezed into his beard, which was uncovered, and he likely inhaled the germs from his beard.

  Phil and Jonathan were engrossed in discussing the ravages the flu had wrought. “I am not sure the world will ever again see such a two-pronged attack,” Phil said. “A world war with guns and a world war with germs. The magnitude of this suffering is beyond anything I thought God would allow to unfold.”

  Jonathan had a long swallow of his wine. “I am not so sure I blame God. I did during the holocaust of September and October.” He told Phil of his plea to God in front of the painting of Christ healing the sick and the cessation of both the war and the epidemic three weeks later. “I rather thought I was a man with a direct line to the Throne,” he laughed.

  Jonathan went on, “Phil, we in medicine know the truth to be one-third fact, one-third faith, and one-third illusion. It is the illusion we constantly chase to solve disease. God does not let us see the truth in the midst of great suffering and certainly our faith is tested. But if we keep our faith during a failure of medicine of this scale, we will find the truth. Life is a hopeless journey without faith in something, even if it is not God. It may be faith in the force of Nature. This epidemic will compel us to find the illusive truth to identify viruses and bacteria. If we are to overcome Nature’s dominance, we need hard work and some brilliant men.”

  “With all the young men twenty to forty who died, we can only hope the next brilliant mind was not among them.”

  The evening’s toasts went on and on. Toasts to friendship, toasts to Marion’s instincts in saving Ward 19 from self-destruction, toasts to Lucia’s courage in saving Angelo, toasts to Angelo’s success and forthcoming marriage, and toasts to the meaningful life of Rabbi Rad. Jonathan and Marion pledged an endowment in his name for his temple’s support. Jonathan sat at the head of the table, both giving and listening to the toasts with deep gratitude for these people and how they had all shaped his life. But it was Marion who made this moment unforgettable. For when Marion rose to present her toast, she hailed her husband as one of the heroes of the Great Influenza disaster and then congratulated him as the father of the baby she was carrying.

  Silence first met her toast. Was she in that actress mode again? But the radiant smile on her face answered all the doubt of the guests. And of Jonathan. There was an outburst of cheers and clapping. Jonathan slowly rose, a stunned expression on his face, his eyes not focused. Two hands, with fingers spread, supported him as leaned into the table. A single tear trailed down his right cheek, then it was joined by one on the left. His head bowed and his shoulders heaved as he cried openly. Marion walked the length of the table and the embrace was a moment of union between two people that happens only when the deepest joy or sadness joins them. Thanksgiving 1918 was a day of joy.

  Chapter Twenty-eight

  SUGAR TIME

  —1922—

  Jonathan and Marion, with their three-year-old son Jackson, were on a train from New York to Chicago. Jimmy Sullivan had called Jonathan desperate for help. “My mother is dying, Uncle Jonathan.” Jonathan was more than eager to help Jimmy, who had suffered so much.

  From the windows of the train, Marion saw the early spring flowers and tree buds of April. “Spring brings new life. Maybe that’s a good omen.”

  Jonathan nodded and thought back to the days when he had become close to Jimmy, when his nephew returned from World War I in December 1918. Jonathan, Marion, and Julianna had greeted Jimmy joyously in New York when he hobbled off the ship in a cast that covered him from his right ankle to his chest. Jimmy’s mother wrapped her arms around his neck and cried openly. The stress and the worry over a son in the teeth of war were expunged by those tears.

  “Did Father suffer much?” Jimmy asked Julianna as they hugged.

  Julianna tried to compose herself. “No. It was a powerful heart attack. He gasped a couple of times, then fell to the floor. I don’t know what I would have done if you too...” She began to cry once again, and Jimmy folded her in his arms.

  Jonathan was taken that Jimmy treated his mother so gently. While Jimmy and his mother were hugging, Jonathan leaned over to pick up Jimmy’s crutches which he had dropped to embrace Julianna. “You might need these,” Jonathan chuckled as Jimmy slipped them under his armpits.

  “Uncle Jonathan, can we go to your home for tonight?” Jimmy asked. “I don’t want to go straight to a hospital. I’ve been in jail over three months and on a troop ship two weeks. I need a beer.”

  “Great idea,” Marion said. “Besides, I’m a nurse and take orders from doctors like your mother and my husband. But if we’re in my home—there I give the orders. Let’s go, Jimmy!”

  That evening, Jimmy told everyone the whole story of his “crazy stunt,” as he called it, and the medicine that saved him. In the first attack by the Germans against his unit at the battle of the Marne, Jimmy and nine men were instructed to clear a church occupied by deadly snipers. As they gathered behind a stone wall to compose a strategy, a loud, high-pitched rifle sound reached the group milliseconds after one of the soldiers’ head burst apart. A second soldier bolted, only to be shot dead. The remaining eight immediately hit the ground, then crawled on their bellies around the corner of the stone wall to reconnoiter the small church. The German snipers had the high ground, firing from the church steeple and roof, but Jimmy’s athletic ability gave him courage. “I can clear this stone wall in one jump,” he whispered. “Then I’ll be behind that shed in the back of the church. From there I can climb onto the rooftop and take the snipers out.”

  Jimmy cleared the stone fence with a flying leap, and within moments he was on the church roof, firing his American Springfield rifle in a slow, steady rhythm. Two of the four snipers fell from the roof. As Jimmy continued to lay covering fire, three of the seven soldiers found the courage to race toward the church. They arrived just in time to catch Jimmy as he rolled off the church roof. He had killed the last two snipers, but not before one plugged two rounds into his thigh, the second one shattering his femur.

  A passing cavalry officer hitched a litter to his horse and collared a medic. The
y moved Jimmy onto the litter, the medic injecting Jimmy with morphine and tying a tourniquet high up on Jimmy’s thigh. Carefully avoiding the protruding bone, the medic packed the wound with clean gauze and wrapped it tight. In shock from loss of blood, Jimmy was dragged over the shell-pocked ground, bouncing and shaking, to a collection area for injured soldiers about half a mile away where the medics strapped his leg in a splint.

  Jimmy might easily have died from loss of blood if he had been driven to the field hospital in one of the horse-drawn carriages that usually carried the wounded. But luck was with him—one of the few motorized ambulances was available and he made it to the hospital in time. A blood transfusion reversed the shock and saved his life. When his blood pressure stabilized and his heart rate slowed, he was designated for the next opening on an ambulance to the American Hospital in Neuilly-Sur-Seine, just outside of Paris.

  At the American Hospital Jimmy was put in traction, just like his grandfather Patrick in the Civil War. But in contrast, Jimmy’s wound was surgically cleaned in a sterile operating room with surgeons dressed in sterile gowns and masks using sterile instruments. The traction weights were attached to a metal pin drilled through the femur bone, which allowed the bone to be straightened and pulled to length, so that Jimmy would heal with a straight leg of correct length. He remained in traction for three months, like Patrick, and then was wrapped in a spica body cast that extended from his ankle to his chest for the trip to the United States in a troop ship.

  With a full body spica he could not sit, so Marion propped pillows behind Jimmy on the couch. Dinner was lavish and well-lubricated. After four beers Jimmy rolled off the couch onto the floor and lay on his back, unable to get himself up again. Everyone howled. “I think he’s a turtle!” Marion yelled out, almost doubled over with laughter. Jonathan took a knife and fork and began to beat on the cast as if he were playing a drum.

  The next day Jonathan delivered Jimmy to Phil Spanezzi, who x-rayed Jimmy’s femur and pronounced his fracture healing well. “There’s solid callus there. Come back in a month and I’ll get you out of that thing.”

  Over the next month, Jonathan and Jimmy spent a great deal of time together as Jimmy tried to become accustomed to the absence of his father. With Jackson on the way, Jonathan was delighted to become Jimmy’s surrogate father for a time. They were days that he remembered with deep fondness.

  He was roused from his reveries by Marion. “Jonathan, are you sleeping? Jackson is hungry. Let’s walk to the dining car. He needs to run a little. He is making me restless.”

  Jonathan’s mind quickly shifted to the present. “Okay, honey. Lead the way.”

  When Jonathan and Marion arrived in Chicago and Jonathan saw Julianna for the first time in three years, he was shocked. “Julianna,” he said, “I’m so glad you asked us to come.”

  Julianna did not stand up from her chair—it took too much energy—but a wry smile broke across her mouth and eyes. “So that a famous researcher of infections can save me?” Jonathan could only laugh.

  Julianna, a strong, plain-spoken Dutch woman, did not mince words. “Jonathan, I am dying from diabetes. For two years I’ve been on a carbohydrate-free diet so my dead pancreas cells don’t kill me.” Paul Langerhans had shown in 1869 that insulin was made in cells of the pancreas, now called Islets of Langerhans. The cells didn’t function, or functioned poorly, in patients with diabetes.

  “Yes,” Jonathan agreed. “Without pancreas cells, you can’t produce insulin, so the glucose from your blood can’t get to your cells.” Langerhans had injected pancreatic extract into animals, but it had no effect on blood sugar.

  “I eat boring food and very little of it,” Julianna said grimly. “I used to weigh 150 pounds. Now, a hundred on a good day.” Julianna’s voice became soft. “I’m just afraid there is no help for me. I think diabetic coma is looking better and better.”

  “Julianna, maybe there is help.” Jonathan proceeded to tell Julianna and Jimmy why he had come to Chicago. There were reports that in Toronto there were scientists who had isolated insulin. If they truly had, it could be injected and blood sugar modulated. “You could eat carbohydrates and more food. You could eliminate your starvation diet.”

  “Jonathan. Are you serious?” Julianna’s eyes brightened.

  “Uncle Jonathan, is this a new drug?”

  “Not exactly. It’s a natural substance, but we—we doctors—could never isolate it to help patients with diabetes. Now that’s been done.”

  “Jonathan, how did you find out about this?”

  Jonathan explained that he had learned of a breakthrough in diabetes research at the University of Toronto. A young doctor named Frederick Banting and a medical student, Charles Best, had discovered a technique to isolate insulin and effectively treat humans. In January, three months ago, a fourteen-year-old boy whose diabetes was completely out of control was saved. Jonathan had telephoned Banting. “What did you do that Langerhans missed?”

  “We learned that enzymes in the blood destroyed the injected whole pancreas extract,” Banting explained. “We isolated the Islet cells and injected just those into dogs. The blood sugar dropped!”

  “So you isolated insulin?”

  “Yes. But we still had to find a source of cells from which to extract the insulin. Adult cows are perfect. They have a large pancreas and humans do not react to the bovine insulin. The only problem is that we don’t yet know the appropriate dosage.”

  Jonathan had described Julianna’s situation and asked if he could bring her to Toronto for an experimental trial of Banting’s insulin. “She is dying, to be blunt about it. Whatever risk she is running in terms of dosage can’t be any worse than that.” Banting agreed.

  When Jonathan finished recounting his conversation with Banting, Jimmy jumped up. “Let’s go. I’ll fly up and meet you, Mom.” Jimmy was flying airplanes. He had a plane which he flew out of the Grant Park Airstrip, which had a single cinder runway.

  “No, you aren’t, Jimmy boy. I’m not going to Toronto to gamble on living while you gamble on dying!” Jonathan rented a railcar for the family to ride from Chicago to Toronto. Jimmy rode the train.

  At the University of Toronto Hospital, Julianna underwent a flurry of tests: chest x-ray, EKG, an eye exam, urine tests. She weighed 92 pounds. Charles Best was interested in whether her body organs were already in the process of destruction. “Your tissues have remained well vascularized, Doctor Sullivan,” he told her. He explained their uncertainty about dosage. “Too much insulin and you could become severely hypo-glycemic.”

  “With the risk of heart attack and coma,” Julianna said.

  Best nodded. “So we will keep an IV hooked to you in case you get too large a dose. Then we can give you glucose to counteract the effect of the insulin. We’ll also monitor your urine, of course.”

  The next day Jonathan and Jimmy accompanied Julianna to the beginning of the tests while Marion remained in the hotel caring for Jackson. After Julianna ate her usual breakfast—one poached egg and a small slice of ham—a small test dose of insulin was given through the IV to determine if she would have a bad reaction to it and if her sugar levels would drop. There were taut faces in her room as Jimmy and Jonathan waited.

  “Did you brush your teeth this morning?” Jonathan squinted at Jimmy’s mouth.

  “Yes, but...why?”

  “Oh, just wondering how healthy you are. An ad in the Toronto paper said brushing teeth and using Listerine for halitosis will prolong your life by killing germs!” He laughed. “The business of medicine makes more money than doctors now. Listerine is an $8 million product.”

  “Do you know the greatest danger to humans since World War I, Uncle Jonathan?”

  Jonathan laughed again. “Yes. The fly! Lucia put screen doors on the clinic to keep out flies. They all carry disease, so say the radio ads. Lucia is covering all her food with this new cellophane, too!”

  Best walked into the room with a big smile. “Your result is just what I wa
nted to see. Now, we will do the real test with insulin.”

  First, there were more tests that morning—more blood chemistries, an EKG, and even an ophthalmoscopic exam of Julianna’s retinal vessels. When her midday meal arrived, Julianna exclaimed, “My goodness!” The plastic tray held a potato, bread with butter and jam, even a small piece of apple pie. “This is my favorite restaurant.”

  Her fork was shaking as she picked it up to begin eating. This meal could be her last if the insulin failed to lower the high blood sugar this food would cause.

  “La Hospitalia. World famous cuisine,” young Best joked. “I’ll stay here with you. We’ll measure your blood sugar in thirty minutes and then administer the dose of insulin we think appropriate. A positive result will be evident by thirty minutes after that.”

  Jonathan stood. “Julianna, I’ll return in an hour. I’m going to take a walk.”

  Needing to work off his nervous energy, Jonathan walked around the hospital ten times. The implications of success for Julianna were simple: life or death. If insulin controlled her blood sugar she could live many years. If not, she died. The implications of success for medicine were more complex. All the previous cures and effective treatments discovered were for infections, especially those that affected children. Diabetes was not an infection, though it certainly was a prominent cause of death among adults. This would be medicine’s first victory over a fatal disease acquired in adulthood. Success would stimulate every research laboratory, too, confirming the belief of researchers that their work could lead to the ultimate clinical success. Instead of a patient dying, they could give patients a second chance at living.