A Simple Cure
By
Lawrence W. Gold, M.D.
A Simple Cure 2013 © by Lawrence W. Gold, M.D.
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the publisher.
This book is a work of fiction. Characters names, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to any actual persons, living or dead, events, or locales is entirely coincidental.
A Grass Valley Publishing Production
Cover Art©2013 by Dawné Dominique
Dedication
To my wife, Dorlis, always supportive.
Acknowledgments
Donna Eastman of Parkeast Literary Agency who first encouraged me to write.
Donna Meares, a thoughtful and encouraging editor.
Joseph Barron, a true renaissance man and my writing buddy. Gone but not forgotten.
Dawné Dominique, a gifted artist and cover designer.
Writers groups on both coasts. WOW in Palm Coast, Florida and Sierra Writers Fiction Critique Group in Grass Valley, CA
There is no cure for birth and death save to enjoy the interval.
George Santayana
Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less in human beings of whom they know nothing.
Voltaire
He uses statistics as a drunken man uses lampposts—for support rather than illumination.
Andrew Lang
One of the first duties of the physician is to educate the masses not to take medicine.
Sir William Osler
Other Works
By
Lawrence W. Gold, M.D.
Fiction:
Brier Hospital Series:
First, Do No Harm
No Cure for Murder
The Sixth Sense
Tortured Memory
The Plague Within
Other Novels:
For the Love of God
Rage
Deadly Passage
Non-Fiction:
I Love My Doctor, But…, a lighthearted look at the doctor/patient relationship
All available in print and in Kindle.
Author’s Introduction
Malignant melanoma is the most dangerous form of skin cancer. Every year more than 50,000 people learn they have melanoma and more than 7,000 will die from the disease. The incidence rate has tripled in the last twenty years.
We can cure early stage melanoma, but once the disease has spread and progressed to advanced stages, the prognosis is grim.
Medical fiction, like science fiction, takes our best scientific evidence and extrapolates it into the future. Extrapolation isn’t scientific in biological systems. It’s speculative, and like speculation in general, it’s more often than not, wrong.
The use of BCG (Bacillus Calmette-Guérin, a weakened strain of bovine tuberculosis) in the treatment of cancer is not new, and has been a common practice in several malignancies.
Immunotherapy attempts to stimulate the immune system to search for and destroy cancer. The use of BCG in melanoma is a form of immunotherapy that has met with mixed results, and although promising, remains an unproven form of treatment.
Attempts at attacking malignant melanoma at a molecular level are ongoing and promising.
Prologue
Terri Powell stood alone in the elevator as it descended. As the elevator neared the parking garage, her pulse increased and she trembled.
She kept her head facing forward. Her eyes tracked the elevator’s blinking LEDs down to the final ‘P’ at the panel’s bottom.
Terri hated the garage. It reminded her of those ominous opening scenes of Law and Order, the gunshot—the blood—the dead body.
The elevator car jolted to a stop, and pinged as the doors slid open.
Terri hesitated a second, leaned forward, and stared both ways before stepping into the abyss. She tried, but couldn’t forgo the temptation to glance back over her shoulder.
Her four-inch heels clicked on the pavement and echoed off cement walls.
She stopped and took a step back as the elevator doors closed behind her.
Shit. This is ridiculous.
She walked toward her BMW parked in the row of cars, but the short echoes of screeching tires made her freeze.
Widely separated fluorescent fixtures left the cavernous garage dim and deeply shadowed. The air smelled of automobile exhaust.
In silence, Terri glanced first to the left, then to the right.
Nothing.
As she listened to her heels again, she heard something.
Terri stopped. Her heart raced.
Silence.
Thirty yards from her car, she heard it—leather shoes against pavement nearby.
She increased her pace.
The footsteps behind were closer now.
Too terrified to look back again, she bolted for her car.
Five yards from her BMW, the red tail lights of Volvo next to her car shined brightly as the older car backed out. Unable to stop, she smashed into the driver’s side door and bounced to the pavement.
The door opened. A middle-aged man in a blue suit got out and reached down for her arm.
“Are you okay?”
Terri scrambled to her feet and assumed the Tae Kwan Do ready position.
The man stepped back in fear, clutching his chest.
Terri quickly looked around.
Nothing.
She brushed her pleated skirt, straightened her silk blouse and took a deep breath. “Thank you. I’m fine.”
He studied her. “What happened? You looked like you were running from something. Should I call the police?”
“No thanks. I’m fine, just my overactive imagination.”
“Are you sure?”
“Yes. Thank you.” She looked at his car door. “Did I damage it?”
He studied the driver’s side door and shook his head. “This old thing is indestructible.”
“Thanks again.”
“I’ll wait until you get into your car.”
“That isn’t necessary.”
He didn’t move, and then extended his hand. “Abe Cohen. I work in accounting. We’re on the second floor.”
“Thanks Mr. Cohen,” she said, starting toward her car.
Terri pushed the open button on the remote and heard the lock snap. She looked around once more and checked the back seat before she slid in.
She stopped her hands from shaking by gripping the steering wheel.
I can’t believe it. Is this what’s become of my life?
Chapter One
Emile Gigot watched the wispy St. Lawrence River fog pass over as he stood by the Rue Dalhousie Bridge. The gate was down as the lock into Port de Québec had opened to permit the passage of boats. Entry to the adjacent marina required the use of the lock unless its water level and the river’s were equal, at or they were near high tide.
When the last boat motored into the marina, the lock master lowered the bridge and lifted the gate. Emile walked over the bridge and turned left toward the back of the marina. He carried an insulated chest with the blazing orange international biohazard emblem on the sides and on top.
Earlier, Emile, a certified courier, had picked up the specimen from Laval University after he documented his identity three times and signed a stack of forms.
He was to deliver the chest to Aéroport de Québec for the 9 p.m. flight to San Francisco. Its final destination was Genentech Hall in Mission Bay, the University of Cal
ifornia’s major research facility.
A man and woman watched Laval. They had been waiting for their opportunity to grab the specimen, but security had been too tight. The message had come through this morning. The specimen would leave Laval late that afternoon.
They watched the pickup and followed the courier to the marina.
Emile had three hours to kill.
He phoned his wife to say he’d be in late, and then placed a call to his lover who lived in the marina on a spacious Grand Banks. He was so excited to see her that he failed to notice the couple following.
As Emile stood in front of the closed marina shops, a woman’s voice came from behind.
“Do you speak English?” asked the soft female voice with an American southern accent.
“But of course,” Emile said as he turned to face the couple. Emile tried not to stare at the stunning blond woman with the palest blue eyes he’d ever seen. He scarcely noticed her tall companion.
She smiled. “You know men...they won’t ask for directions.”
“Can’t find my way around this place,” the man said, “why don’t they have these damned signs in English?”
Stupid Americans, thought Emile. “Can I help you?”
The man unfolded a scrap of paper. “Sure can. Just point the way to Rue De L’estuaire.”
Emile turned toward the city and pointed. “That’s easy. It’s just on the other side...”
Emile’s head exploded with pain and he felt his body sag to the ground. Stunned, he shook his head, but couldn’t move. The woman picked up the chest while the man reached under Emile’s arm and pulled him upright. Emile was unable to support his weight, forcing the man to drag his limp body to the cement quay. The man looked both ways before throwing Emile into the marina’s icy waters.
Weakened, Emile struggled against the freezing water, but in his heavy clothes couldn’t swim.
No, not this way, Emile thought as he battled for his life. He felt his head sink below the water. He thrashed and fought for the surface. He tried to scream, but water flooded his throat and lungs as everything turned dark.
The blond flipped open her pink cell phone and pushed a speed-dial number.
“Do you have it?” a voice asked.
“Have we ever failed you?”
“Any problems?”
“None you need concern yourself about.”
“Meet me on the ferry to Lévis at ten.”
“We’ll be there.”
Chapter Two
The wipers slapped across the windshield, trying in vain to clear the hearse driver’s view as he followed the narrow cemetery road. He paused to wait for the sudden downpour to end, and then moved on slowly.
The thirty-car funeral procession drove onto the grounds of Rose Hill Cemetery in Lafayette and stopped near Richard Powell’s gravesite.
Terri Powell, his widow, watched as one umbrella after the next popped open as the respectfully dressed group exited the cars and limousines.
So many people
Her thoughts ran through the past few bewildering months.
Richard Powell had been an oncologist, a specialist in cancer, and had seen enough tragedy to make paranoia about health a personalized art form.
One morning just four months ago, he had joined Terri in the bathroom and pointed to his neck. “Check this mole out.”
Terri smiled. “You’re going to make me crazy, Richie.”
She had taken a quick look at the brown spot, a typical mole. “It looks okay to me, Richie. It’s uniform in color and has smooth edges. It’s just a mole. We have dozens of them.”
“Are you sure?”
“C’mon. Don’t do this to yourself.”
“It’s an occupational hazard. Let’s keep an eye on it.”
A month later, Richie sat on the side of the bed scratching his neck. “It itches. Take another look.”
He’s in the wrong business, she thought. He’d do better in a well-baby clinic.
Terri was a physician and a resident in infectious diseases. She turned to Abbie, their four-year-old daughter. “Why don’t you go to your room.”
After the child left, Terri grasped Richie’s head and tilted it to the right. “It’s too dark. These old Piedmont Houses don’t have enough light. Move over to the bedside table.”
Terri turned on the lamp and studied his neck.
At first, it looked like the ordinary 1/8 inch brown mole she’d seen before, but a closer examination made her pause.
“Wait a sec,” she said, standing and heading into their adjoining office.
“What did you see?”
Terri didn’t answer.
Twenty seconds later, she reappeared with a four-inch magnifying glass and sat next to him checking his neck.
“You’re making me nervous.”
She stared through the thick lens. The margins of the mole were irregular and the magnified image revealed its uneven color.
Terri felt her heart race. Sweat formed on her upper lip.
“I don’t like the looks of it, Richie. I’m calling Brenda Katz. I want you to see her today.”
He’d sought reassurance in her soft brown eyes, but found none. “Now you really have me nervous. A plastic surgeon and today. Are you sure?”
“I’m not sure of anything. Living with you is infectious—you have me worrying about everything.”
Later that day, Richie sat on Brenda’s examining table.
“You were right, Terri. I don’t like it either. Lie down, Richie. It’s small enough. Let’s get it out.”
“Now?”
“Right now.”
They waited twenty-four hours for the call.
Terri had placed two glasses of wine, brie, and crackers on the coffee table. They remained untouched.
When the phone rang, Richie jumped. “You take it. I can’t.”
Brenda’s words, “It’s a malignant melanoma,” sapped the strength from Terri’s legs as she sank onto the sofa.
Richie took one look at his wife and blanched.
The next two weeks were a blur for the Powells. Richie had a wider resection around the original mole and an exploration of his regional lymph nodes. They showed no cancer cells.
His scans were negative.
They felt a sense of relief as everything said they’d beaten this highly malignant tumor.
Although the odds were overwhelming that the surgery had cured Richie, they opted for treatment with interferon, just to be sure.
After the second month of treatment, Richie began to have headaches, nausea, and vomiting.
When the radiologist put Richie’s CT scan on the view box, Terri gasped and wept. The melanoma had spread to Richie’s brain and liver—terminal cancer.
“This can’t be true,” Richie cried. “I was cured. The odds were over 95 percent that surgery and the interferon destroyed the malignant cells.”
Terri sat by his side as Richie held his hands on his head. Looking at the floor, he said, “It’s impossible...it must be a mistake...a mistake.”
Richie knew many researchers involved in investigational drug trials for melanoma. He and Terri reviewed every experimental protocol for advanced metastatic melanoma. Finally, the National Institutes of Health accepted Richie into a Phase I trial, the newest experimental drugs.
Richie’s life was caught in the rapids and floated to the precipice, then tumbled over the waterfall to the rocks below.
Two months later, Richard Powell was dead.
The mourners had gathered under the canopy that had been erected by the cemetery’s staff.
The rain thrummed against the canvas and made it difficult to hear the heartfelt eulogies.
Terri’s mind was elsewhere. She hadn’t had time to prepare for any of this.
Can you ever prepare for such a thing?
Richie’s death left her in shock—numb to the external world, but exposed and tender inside.
Following the ceremony, Abbie clung to her moth
er’s side as each mourner expressed their condolences. She knew they were sincere, but their words sounded hollow, even as their closest friends embraced them in communion with their loss and pledged to help in any way they could.
Soon, only Terri and Abbie remained, standing with her mother and Richie’s parents.
They helped Terri into the limousine. As it departed, she looked back through the rain-blurred window at the life lost, then turned forward to an uncertain future.
Terri and her best friend, Eileen, sat on the porch two days after Richie’s funeral. “I don’t know how much Abbie understands,” Terri said.
“What does she say?”
“She wants to know when her Daddy’s coming home.”
“She probably understands more than we think. We need to give her time to adjust.”
“I know what to do. I’ve read all the articles about children and death, and I won’t substitute fantasy for reality.”
Eileen hugged Terri as both cried.
After several minutes, Terri wiped her eyes. “I’ve made a decision.”
“Don’t make decisions now, not so soon. Give yourself time.”
“No, Eileen. I’m leaving the infectious disease program for an oncology residency. If this is all we can offer victims of melanoma, it’s not enough—not enough by a mile.”
Eileen held Terri’s hands. “I’ll help you in any way I can.”
“I must do something that gives Richie’s death meaning.”
“There’s more, Terri. I can see it in your eyes. You never could hold anything back from me.”
Terri lowered her head and started to sob.
Eileen placed her arm around her friend’s shoulder. “What is it?”
Tears streamed down Terri’s cheeks.
Terri blew her nose. “It was my fault—my fault. I should never have let it happen. If it wasn’t for me, Richie would still be alive.”
A Simple Cure Page 1