The previous weekend, Gwen had cut her hair short. It had darkened to dusty brown in the last year. She expected it might turn gray by the time she turned forty. Since the prospect of coloring her hair was unappealing, she hoped a shorter length would make the transition less noticeable. Her face, creamy white all summer and fall, finally had a tan after three consecutive weekends in the sun.
These free weekends, once morning rounds ended, were the best part of being on a consult elective. Not that she was complaining. Residency wasn’t nearly as difficult as she had anticipated. Despite the long hours and sleep deprivation, it felt more like a booster shot than boot camp. Two weeks into her first ward rotation, managing medical problems she almost never saw in the Haight had become routine. Within months, her clinical judgment, acquired over years of outpatient practice, and her life experience of child-rearing and divorce had made her a sage among the other junior residents.
She watched pink seep into the western sky. Advancing shreds of stratus clouds absorbed the pigment. Turning seaward, she bumped into Rick. Eight inches taller than her and still thin with a faint ripple of muscle, he grabbed her to keep them both from tripping. Their eyes met. Rick brushed his lips against hers. He looked southward. They resumed walking.
How lovely, she thought. He can be present and not say anything. How unlike Daniel who always became ominously opaque whenever he did stop talking. Cut it out, she ordered herself. I’m over that marriage.
Eva, now as tall as Gwen, had been tiptoeing on an invisible, curving tightrope just beyond the tide’s reach. Skinny and angular, she high-stepped into the shallows, a black-wigged flamingo. Bored with that game, she ran to Rick and tagged him.
“You’re it,” she cried.
“Good thing I didn’t jog this morning,” he said to Gwen.
While Eva and Rick chased each other in and out of the tide, Gwen brooded over the nasty argument she had with her daughter the night before. Eva wanted her own telephone and her own private number. She had picked out the model—a Princess handset, the same one that came on the market when Gwen was her age. Eva had a precise color in mind to express her true persona—coral green. The idea of a pre-teen having her own phone made Gwen uncomfortable. She wouldn’t know how late Eva stayed up at night gossiping. The privilege might spoil her. Gwen certainly didn’t have her own phone as a teenager. Too late, after escalation, Gwen remembered the mantra her best friend, Nan, had told her to recite in such situations.
“She’s twelve, impulsive, passionate, unsure of herself—a toxic combination—but completely normal, age-appropriate behavior. She’s twelve, impulsive…..”
The tension had soon evaporated, like a passing thunderstorm. Still, Gwen worried this might be the harbinger of bigger trouble to come.
Eva came up to her, panting.
“You know, Mom,” she said, “It would be a lot more fun if you joined us. If that’s not too much for you.”
Gwen gritted her teeth and smiled congenially. Tag was not too much for her. She could still play three sets of tennis with a speed, skill, and ferocity few twelve year olds could match—surely not Eva who had neither the drive nor the athleticism requisite for competitive sports. Eva must be parroting some insufferable character from a television show. Her patronizing attitude made Gwen reconsider their lunch at the greasy spoon. She hadn’t tried to talk Eva into going elsewhere. She hadn’t even grumbled about it. Afterwards, Eva showed no gratitude. Gwen was luxuriating in the languid stroll, basking in unobstructed views of ocean and sky. She didn’t feel like running around.
“You know, Eva,” Gwen said, “I’d be more inclined to play if you asked me in a nicer way.”
Eva’s eyes narrowed to slits.
When Rick arrived, Eva said, “Mom doesn’t want to play with us. She has too many important things to think about.”
“I didn’t say that!” Gwen protested.
Eva was standing between Gwen and Rick. She turned to Gwen with a malicious grin then to Rick with doe-eyed innocence.
Rick kicked the sand and looked at his watch.
“Let’s turn around,” he said. “I think Billy and Laura will be at the fire pit by the time we get there, with their golden retrievers.”
Eva had forgotten what Rick’s friends were bringing to the bonfire picnic. She raced off, screaming, “Dogs!”
“Maybe I should get her a dog,” said Gwen. “Would that help?”
“I’m not going to be feeding a dog and picking up its poop every day. Are you?”
“She’s old enough to take care of a pet.”
“I think you’ve got those developmental milestones confused.”
“OK, but if I gave her dog, then maybe she’d get it. I’m her mother, I love her unconditionally. We don’t need to be at war. And she’d grow into the responsibility.”
“That’s right, and while you’re harping, ‘Did you walk the dog? Did you feed the dog?’ she’ll be resenting all those helpful reminders.”
Gwen giggled.
Rick was relieved to see she wasn’t serious about the idea.
“Thanks,” she said and touched his cheek.
They held hands again and followed Eva.
As Rick watched the waves break, his mind wandered to surfing, his main avocation prior to running marathons, which led him to think about his younger sister. Years ago, he had bought her an airplane ticket to California as a college graduation gift and taught her how to surf.
Now she’s a partner in a Chicago law firm, he thought with a mix of irony and self-pity, while I’m four years older and still teaching middle school. Hold on, what’s with the “while” and “still” in that sentence? Like what I do isn’t as important as what she does?
Rick was proud of his little sister’s success in a world dominated by white men, though it had ceased to surprise him. He saw what was happening in his own classroom. The boys were so much more vulnerable and inept than the girls. Gwen had told him she’d been an aberration on graduating from medical school in 1969, but now fifty percent of new doctors were women. He had no doubt that in another generation a majority of the educated elite would be women.
Five minutes after the sun’s last ruby drop disappeared over the horizon, they were at a campfire being warmed by driftwood flames. A pair of golden retrievers looked expectantly at Eva. They leapt joyfully when she picked up a stick. Eva ran off with the dogs, and the adults flew into conversation about local ethnic restaurants and California nouvelle cuisine. Gwen wasn’t shy. She spoke more than Rick did.
He was proud of her charm and confidence. A bonus, he had told a friend, in a beautiful woman who already blows me away by loving passionately without being needy. If she wants, I’ll marry her. Yet Gwen had never brought up the subject. He guessed she had even less trust in the institution than he did. Rick had been in long-term relationships before. He had considered marriage once, ambivalently. But if Gwen were to push, he would commit in a second.
A bottle of brandy was circulating. Gwen took a sip and gave it to Rick. A drop remained on her lower lip. Rick leaned over to lick it off.
VI
MARCO HAD BEGUN RUNNING polyacrylamide gels as soon as Kevin left. He turned on an electrical current to separate the proteins in his experimental brews and prepared the equipment and reagents for his next steps. Two hours later, he switched off the current, peeled the slippery panels from their glass plates, bound them to nitrocellulose paper, and immersed the gels in electrophoresis trays. After another two hours, he bathed the blotted sheets in a series of monoclonal antibody solutions and washes. Six hours after starting, he was ready to add substrate for the final stain. Marco traversed the great laboratory, passing floor-to-ceiling windows, to a row of ventilated hoods. His only spectators were the redwood trees just outside, swaying in the breeze.
He envisaged blue bands about to emerge. Up to now he had been too subsumed with each step of the experiment—measuring reagents, manipulating gels, carefully timing each incubation an
d wash—to imagine how the blots would look. As he poured in substrate, the imminence of having evidence he could photograph and send to the journal editor thrilled him. He concentrated on the undulating sheets of paper, on where he wanted to see blue bands appear.
As he lifted each tray onto a rocker, he willed the bands to be in the locations he had predicted, visible proof of his hypothesis. Marco was on a roll. All the nitrocellulose sheets, so fragile they would crack like an egg shell if mishandled slightly, had peeled off the gels without a single tear. The photos would be impressive.
He saw the positive control columns first.
Perfecto, he thought, as a thick smudge flowered where his control protein ought to be. The negative control strip was pure white. Perfect again. Columns of blue bands appeared. Exactamente.
He was satisfied until he noticed the bands increased in size from left to right, not from right to left as he had expected.
“What? No! This can’t be. Unbelievable! Did I reverse the enzyme concentrations? Chíngame, que pendejo soy!”
Kevin arrived to find him crouched over a lab bench, head in hands.
“Uh-oh. What happened?”
“I don’t know. It’s all wrong, and I can’t figure out why. I remember exactly what I did yesterday when I loaded the gels. The tubes are still in the correct order. How I could have made a mistake?”
“What’s the problem?”
“The replicates with more enzyme shows less protein on the blot, not more.”
Kevin gave him a sympathetic pat.
“What did I do wrong?” Marco implored.
“You’re asking me?”
“Even a contaminant can’t explain these results. Maybe, if the enzyme I used acted on another molecule in the cell…which could have blocked the reaction…No, that’s ridiculous.”
Kevin had no idea what enzyme or blocking molecule Marco was talking about but felt he had to say something.
“Why’s it ridiculous?”
Marco gave him a dismissive frown. Then his eyes opened wide.
“Sangre de Cristo!” he shouted. “Of course, the new pathway the Cambridge people just found, it must be here, too. That’s the only possible explanation. You’re a genius, Kevin!”
Baffled and delighted, Kevin asked, “Can you tell me what we just discovered?”
In a cozy French restaurant on Russian Hill, Marco was elaborating, for the second time that evening, on what a breakthrough this was. His research focused on stem cells obtained from the earliest stage of a developing mouse embryo. A stem cell could proliferate indefinitely, and its progeny could mature into all the different kinds of cells that constitute an adult mouse—gut, brain, bone, skin, muscle, and more. In theory, a living, reproducing mouse could be grown from a single stem cell after Marco and his colleagues had altered its DNA. If feasible, such a technique could advance at warp speed the understanding of how genetics and disease interact.
Marco’s unexpected results suggested a new way for scientists to stimulate stem cell growth. He knew precisely what molecules to look for now in order to explain his findings. Before the entrees were served, he had envisioned a set of experiments to confirm his new hypothesis as well as assure his paper’s acceptance by the journal. Although Kevin was excited and amused, the terminology of cutting-edge cellular biology was hard to follow. Keeping up his end of the conversation was becoming tedious. He was glad to see Marco turn his attention from science to food.
Marco made quick work of his scallops. As a waitress emptied the rest of a Napa Valley chardonnay into his glass, he reached under her arm to pick at Kevin’s cassoulet. Kevin thought ruefully about Marco’s daily six mile run—the obvious reason he could eat voraciously and not gain weight. Kevin carefully watched his own diet, rarely had more than one drink, consistently took in fewer calories than Marco, yet still was twenty pounds overweight. Marco had been urging him for months to run with him, promising that he’d slow down to an easy jog. But Kevin hated exercise as much as he hated professional sports. Both were associated with his father’s auto repair shop—the heavy engine blocks and transmissions he had lugged around, the radio station always tuned to a game, the frozen bolts and scraped knuckles, the omnipresent black grease.
“I’m…what’s the term? I know, thunderstruck,” said Marco. “That’s an English word? It sounds German. I’m thunderstruck you can get food this good in America. And it’s not even expensive.”
“This isn’t cheap,” Kevin remonstrated.
“Don’t worry, sweetheart. My treat. It’s the least we can do for ourselves after our vacation day was so abruptly interrupted. See what I mean. That sounds German too.”
“I’m sorry, baby.”
“Don’t be sorry. You were a hero today. Didn’t Herb say how much it will help the cause?”
Marco pumped his fist and leaned back to study Kevin. He held up his wineglass.
“I’m so proud of you.”
Kevin laughed self-consciously.
He caressed Marco’s thigh under the table and asked, “Is this what…what being in love is?”
“Oh yes,” Marco answered, his eyes sparkling, “I think so. De veras, I do.”
VII
ON WEDNESDAYS, KEVIN HAD a morning clinic and came to work early to look in on his hospitalized patients beforehand. Today would be Mr. Miller’s fourth day in the ICU, and Kevin wasn’t hopeful about his recovery. He decided to see Miller last, after checking on two ward patients who had Pneumocystis pneumonia.
One was nearing the end of treatment, able to stomach medication by mouth and being weaned from nasal oxygen. He could likely go home tomorrow. A thirty-five year old investment banker with a private doctor in Pacific Heights, he had never been to City Hospital before collapsing in his office downtown and being brought to the ER by ambulance.
The banker was staring at the wall, expressionless, when Kevin peeked into the room.
“How’s it going?” said Kevin as he entered.
“How much time do I have?” asked the man in a monotone. “A few months? A year?”
Kevin sat down on the edge of the bed. He had learned by trial and error it was better to listen first, get a handle on a patient’s understanding of his disease and what he feared, then discuss prognosis. But this man’s replies to open-ended questions had been “I don’t know” up to now. He had shown no curiosity about his condition. Kevin presumed he was reacting to his diagnosis with disbelief and numbness—it can’t be happening to me. Clearly, he had moved to the next stage, depression. No, Kevin reconsidered, anger and bargaining are supposed to occur before depression.
The banker was mute, waiting for him to speak. Kevin couldn’t deflect the question and maintain credibility. He had to take a stab at it.
“Maybe longer, if you’re monitored closely, if we get on top of infections like this one sooner.”
“That’s pathetic! You don’t even know what’s causing the disease, do you? All you can do is try to treat the complications of having a crippled immune system, right? And mine has already been destroyed, hasn’t it? It’s not going to get better, so it’s just a matter of time. And not much time. And most of it spent feeling shitty, right?”
Kevin was at a loss. The banker had moved the wrong way, from depression to anger, in a blink. These stages of grief weren’t as orderly as one would think from reading the literature on death and dying. And patients like this were the most difficult, the ones with penetrating, merciless intellects that turned on themselves and their physicians. The best he could do now was to apologize.
“I’m sorry…I can promise we’ll do whatever we can to help you. There is research going on. We might have answers soon.”
Still refusing to look at him, the banker screamed, “I am fucked. Fucked!”
He lay down, covered his head with a pillow, and asked Kevin to leave.
Across the hall was a patient Kevin knew well, Danny, a fifty-two-year-old denizen of the South of Market bondage-and-discipline sce
ne. Underneath the metal spikes and chains was a puckish, sweet-tempered man reconciled to the inevitable. Danny had been admitted the previous night with his third episode of Pneumocystis, a severe one. What little was left of his lungs was full of frothy fluid that blocked oxygen from diffusing into his blood. The pulmonologist on call had told Kevin it was futile to put him on a ventilator. Kevin hadn’t argued. Danny would die in a few days no matter what they did.
He stood in the doorway watching Danny’s labored breathing. Though he saw morphine dripping into Danny’s vein and knew his patient wasn’t conscious, Kevin couldn’t help but imagine being frantic with air hunger, the desperate compulsion to expel smothering liquid inside his lungs, the clawing need to inhale more air, the inability to gratify either urge. He left the ward trying to erase the intrusive picture in his mind of an abandoned car being crushed by a metal compactor.
In the ICU, Kevin found Dana looking at a printout of Miller’s blood test results. He glanced at the numbers, which indicated no further deterioration, and began lecturing her on how important it was they stay aggressive in lowering the pressure squeezing the patient’s brain. He stopped when her medical student, Gail, walked past carrying a long spinal needle.
Dana changed the subject.
“So what do you think?” she asked. “Is the culprit behind GRID a toxin, a virus, or an autoimmune disease?”
Dana had worked in an immunology laboratory between college and medical school and planned to do an oncology fellowship. Her interest in GRID had been piqued when Kevin informed her that scientists at UCLA had discovered a subset of lymphocytes called helper T cells were greatly diminished in the blood of GRID patients. This deficit was almost certainly the proximate reason for their vulnerability to opportunistic infections like Pneumocystis pneumonia or cryptococcal meningitis—infections caused by microbes unable to invade people with intact immune systems.
“I don’t know,” Kevin answered. “Those are the major suspects. Most epidemiologists think some kind of virus is knocking off helper T cells. But the jury’s out.”
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