He couldn’t have refused even if he wanted. Though he had been slapped in the face by fate, his mood soon improved. He was actually glad to not be alone in dealing with this disease. Nevertheless, the academic clock was ticking. He desperately needed funding, and a first-author publication would have been a foot in the door, giving him scientific credibility to grant review committees. He was back at square one.
Kevin’s pager buzzed again while he stood outside in the drizzle waiting for a shuttle bus. He saw Marco’s number, but there was no phone nearby. He couldn’t respond until he got to City Hospital.
Over the ocean, a dark curtain of rain was moving inland. Being exposed to inclement weather on the Hill, to forces beyond his control, evoked memories of his ward assignments in the university hospital across the street. He had hated those months, the arrogance of the attending physicians, the lack of resident autonomy, the ambience of social Darwinism. The approaching shuttle reminded him of the deliverance he had felt at moving on to rotations at the Veterans Administration and public hospitals where the mean-spirited competition that house staff exhibited on the Hill softened into collegiality. How strange life’s zigzags are, Kevin thought, as he compared those memories to his new appreciation of the Hill’s scientific resources.
He was still ahead of the storm sweeping across the city when he got off the shuttle. He walked toward his office in one of the original red-brick buildings constructed after the 1906 earthquake. Its bronze gargoyles, weathered green, were set against a blackening sky. He remembered he should check on his inpatients before meeting Herb at four-thirty. Kevin turned back and passed through motion-triggered, sliding-glass doors into the modern hospital. He had forgotten Marco’s page.
X
KEVIN WENT TO SEE Miller last. Flipping through the chart revealed nothing had changed since the morning. He consoled himself with the fact that at least the antifungal infusions hadn’t harmed Miller’s kidneys yet.
“Give me an order sheet from the chart.”
Dana stood before him, a hand outstretched, her lips pressed tight.
“Why the foul mood?”
“Well, Gail tapped him again this morning, and his pressure was still high. So neurology told us to keep hyperventilating him. Which means we have to continue sedating and paralyzing him so he won’t buck the ventilator. Which means we can’t assess whether his neurologic status is getting better or worse. Which means I have to say I don’t know to all the people who are asking about his prognosis.”
“Who’s asking?”
“The chief of medicine, the health department director, the hospital administrator, a nosy reporter I refused to talk to.”
“Wonderful,” Kevin groaned. “Any more city pols come by?”
“No,” said Dana, grinning mischievously. “What, you don’t like being a celebrity? The famous immune deficiency doctor?”
Kevin grimaced.
“Just kidding.”
Dana’s pager beeped. She looked irritated on seeing the number displayed and went to the nurse’s station to make a phone call. She returned ashen.
“My father’s in an ER back east with crushing chest pain and EKG changes. I need to get out of here.”
Ten minutes later, Gwen, the back-up resident for the month, came into the ICU. She had been paged by the chief resident who told her the bad news—she would have to drop her pulmonary elective and cover for Dana whose team also happened to be on call today. They had four new admissions so far, and two were unstable. Dana gave Gwen her set of index cards, to-do lists for each of her team’s patients.
As she walked out the door, Kevin gave a condolence frown to Gwen.
“It’s OK,” she said with a shrug.
Dana’s interns and student arrived, and Gwen spread Dana’s cards on the conference table. She sent one intern to the ER to take care of a sixty-five year old Salvadoran woman who had a dangerously rapid heart rhythm.
“Massage her carotid artery,” she instructed him. “If that doesn’t work dunk her face in a bucket of ice water. If she’s still in atrial fibrillation, push digoxin until her pulse slows down.”
She assigned the other intern to manage the admission with a bleeding stomach ulcer.
“Make sure he’s got two large bore IV’s running wide open,” Gwen advised. “If his blood pressure drops, grab the IV bag and squeeze it, hard. Draw a hematocrit every hour and spin it yourself. Dana ordered four units of packed cells half an hour ago. Ride herd on the blood bank if there aren’t at least two units already there when you get to the ICU.”
She gave the other two admissions to the medical student and phoned Proctor, leaving a message for Rick that she wouldn’t be home until tomorrow night.
“Wow,” said Kevin, “Superwoman takes charge.”
Gwen wondered if she heard a gentle edge of mockery. She could never quite pin that down with Kevin, one of the many entertaining aspects of being his friend. It took her a moment to be sure it was there, an undercurrent in his admiration. Despite an effort to keep from smiling, the corners of her mouth rose.
“I can help with Miller,” Kevin offered.
“That’d be nice. Thanks.”
Kevin searched her face and asked, “You sure you’re OK?”
“I’m fine. It’s no big deal. Rick is used to this.”
“It must be hard on Eva.”
“You’ve got to be kidding. If I disappeared completely from her life, she’d be ecstatic.”
Kevin wrinkled his brow.
“Believe me, she is not longing for any more attention than she’s getting from me. And she’d be happier with less.”
“You really think she doesn’t mind all the time you’re away?”
“Did you want to spend time with either of your parents when you were twelve?”
Kevin tried to recall being twelve.
“Wrong question. You were a boy. Have to add two years. Did you want your parents interfering in your life when you were fourteen?”
“God, no.”
“See what I mean.”
That would be a major downside of having children, thought Kevin. They grow up and become difficult. He and Marco had talked of adopting. They were mutually relieved to discover the other had fantasized about the possibility and was nowhere close to considering it seriously yet.
“You think conflict with your child is inevitable?”
“Unfortunately, I’m afraid most of us do have to reject our parents in order to believe we’re individuals in charge of our own fate. Though maybe if I were more psychologically minded, more astute at parenting, I could avoid some of the nastier battles.”
“It sounds hard,” said Kevin.
“Not any harder than what we do here, once you know the ropes.”
“How so?”
“Understanding what motivates someone’s bad behavior, figuring out how not to take it personally. Sound familiar?”
“Yeah…but she’s your daughter. How could you not take it personally?”
“You’re a smart cookie, Kevin. That is precisely the problem. Most of the time I do take it personally.”
Holding the bell of his stethoscope to his mouth, Kevin imitated a newsreel reporter from the 1930s.
“Can you believe it folks? She can do all this and still be the mother of a teenage girl. Only her daughter’s kryptonite can stop this woman.”
Gwen laughed as Kevin headed off to find Miller’s chart.
She had never had a male friend like Kevin, adoring her in an utterly asexual way. I’ve always had pals at work I could be comfortable with, she thought, but no man, other than a lover, has ever shown me this much appreciation. Wrong, she corrected herself, except for my father.
The summer after Gwen’s brother joined the army, her father came out from New York. Her mother, now a dentist’s receptionist, had saved enough money for a week vacation at a desert spa. Children were not allowed. Gwen had no choice but to accompany her father on a fishing trip.
D
riving east through the empty desert, she was sullen while he remained doggedly cheerful. He let her pick radio stations and control the volume. She was surprised to find he didn’t mind listening to loud rock and roll. Turning north, they drove along the eastern slope of the Sierras, stopping at rustic, lakeside lodges to fish and stay the night. She hadn’t seen air this clear before. The sky’s rich blue color and the steep rock walls above tree line entranced her. Each day they cast lures from a rowboat beneath snow-capped peaks. Her father complimented her repeatedly on her skill at casting.
Gwen’s first two catches were too small to keep. Tossing the quivering, iridescent creatures back to freedom thrilled her. On the second day, she caught a trout big enough to eat. As her father was about to impale its jaw on a stringer, Gwen yelled, “Don’t!” She held out her hands, demanding the fish. He chuckled at her audacity and let her drop it in the water.
Every evening, he had a single beer, which made Gwen wary, though its only discernible effect was to make him more agreeable. By the end of the trip, it was difficult for her to be angry with him. Still, on principle, she refused to kiss him good-bye. He was disappointed but not put off. He asked her if she’d like to see New York. Unable to hide her excitement, Gwen said yes.
The following summer, she rode east in an air-conditioned bus, studying her transcontinental highway map and calculating distances when not engrossed in the new landscapes. On a moonless night, the coach crossed the eastern Colorado plains. Gwen saw a carpet of stars falling to the horizon—a sixty mile radius away in all directions, the driver told her. The only terrestrial light was from a lone, distant farm house.
She imagined a family with a girl her age living there. She worried the isolation might make them lonely. No, she decided, they were contented, humble people, grateful to live at the center of such a peaceful world. But the girl would need to leave home soon to seek her fortune in a great metropolis.
Her father’s apartment was on the thirty-eighth floor of a building in mid-town Manhattan. He let Gwen have his bedroom and slept on the couch. He bought her a subway pass and urged her to see the city while he was at work. She spent the first two weeks exploring neighborhoods from the Battery to Washington Heights and the rest of the trip inside museums.
At the Metropolitan Museum of Art, Gwen was drawn to the ancient marble sculptures. Her favorites were Jupiter astride an eagle and a nude Aphrodite. Perfect human forms carved over two thousand years ago, they defied life’s impermanence. She was equally intrigued by the Cloisters, a castle filled with medieval art perched on a bluff above the Hudson River. She went there for the ambience, not the tapestries or sculptures, and pretended to be a princess in fifteenth century France, safe behind the parapets while wars raged below.
On her last evening in New York, her father took her out to a fancy Italian restaurant. He drank two cocktails before dinner and turned gloomy.
“I’m going to miss you,” he said.
Gwen flushed. She fended off her own conflicting emotions and tried to understand what he meant. His sentiment sounded genuine, but she wondered if he had some other agenda. Was he hoping she would take care of him when he became old and feeble?
“Are you lonely?” she asked.
That question flustered him.
“Sometimes,” he acknowledged.
“Why don’t you get married again?”
“I don’t think so. One alimony is enough.”
“Huh?”
“Honey,” he explained sadly, “All the women I’ve met here are just like your mother. They want a man to take care of them. That’s ultimately a no-win proposition. They end up resenting their dependence. It’s a vicious circle.”
Gwen was offended. He had no right to insult her mother. Nevertheless, she recognized the truth in what he said.
“You’re strong, Gwen, and smart enough to make your own way in the world. You’ll go to college, won’t you? I’ll give you all the help I can. I promise.”
“College,” she said softly, exhilarated by his confidence in her potential.
“You could do it, Gwen. Finish college and get a good job before you settle down with someone. It’s best to have an exit strategy.”
On the ride back to California, she was on the lookout for lone farmhouses, especially at sunset. She didn’t find one that had moved her, though in Utah a crow perched atop a dying fir caught her attention. Its glassy black eyes tracked her bus for miles. Gwen felt its steely tenacity stirring inside her.
XI
WHILE WAITING FOR KEVIN, Herb continued to craft text for their grant proposal. In such endeavors, he always used a number two wooden pencil capped with an oversized pink eraser and wrote on a yellow legal pad. He was holding the pencil by its point, bouncing the eraser up and down on his desk. A faint smile appeared as he thought about how obviously fundable the idea was, how the grant was writing itself. He hadn’t shown any of this text to Kevin yet. He wanted Kevin to design the study with a minimum of assistance and feel ownership of the effort. He’d sneak in these paragraphs, articulating the rationale and larger significance of their proposal, later.
Herb’s name would have to be listed as the principal investigator. His track record of publications was essential to getting them funded. Afterwards, he planned to recede into the background while Kevin ran the project and subsequently authored a paper describing the results. Herb was pleased by the personal closure his scheme entailed. He had become a wily mentor like the ones at the National Institutes of Health who had seduced him into a career of clinical research.
Herb had entered this pathway unintentionally. In 1968, after being deferred from military conscription for four years of medical school, three years of residency, and a year of pulmonary fellowship, he had run out of dodges. The army urgently needed doctors for its escalating war in Southeast Asia. Herb was newly married, and Cecilia wanted to get pregnant. He saw a flyer posted for a position at NIH, which was hiring young MDs to help conduct experimental treatment trials. Several perks came with the job—training in clinical research methods and another draft deferment. He applied immediately.
When Herb arrived in Washington DC, protests roiled the nation’s capital. College students wearing army fatigues manned barricades and cursed at police and National Guard troops. The kids were impassioned and cocky. They had just forced a sitting president to renounce his bid for re-election.
Cecilia was self-assured too—about her ability to handle the MBA program at Georgetown, pregnancy, and motherhood. Allison was born a few months after they arrived, an easy baby who slept through the night at six weeks and wasn’t prone to crying spells. They could take her with them anywhere—restaurants, parties, movies. Herb carried Allison on his back in public places and received smiles from passers-by instead of furtive, xenophobic glances.
It was also in Washington that he started jogging again. Out Embassy Row, through Rock Creek Park, up Connecticut Avenue past the Zoo, or to the Lincoln Memorial, through the middle of the Mall, and on to Congress. The exercise calmed him, reinforced his own nascent self-confidence.
Kevin came into Herb’s office holding a stapled, ten page document at arm’s length, as though unsure of its odor.
“It can’t be that bad,” Herb laughed.
“We’ll see,” Kevin replied.
While Herb read the draft and made notes in the margins, Kevin thought of the question he hadn’t asked yesterday.
Ten minutes later, Herb declared, “This is great! Besides a few typo corrections, all we need is to complete the analytic plan and justify the sample size. Then it’ll be ready to plug into our grant application.”
“Do you really think it has a chance of being funded?”
“More than a chance. I’ll be very, very surprised if it’s rejected.”
Kevin wasn’t convinced.
“There’s always luck involved,” Herb admitted. “We don’t know who will be on the study section panel or what their biases are. But even if it’s not
funded on the first round, I’m sure a resubmission can address any criticisms raised.”
“You’ve been lucky, haven’t you?”
“Absolutely. My whole career was an accident. The only reason I went to NIH was to get out of the draft.”
“I don’t want to go to NIH.”
“You don’t have to go to NIH. There’s plenty of opportunity right here.”
“But I’m not lucky.”
“Look, I know you had a bad experience with Flagler, but this is clinical research, not a laboratory experiment where every possible variable is under your control. It’s about how patients react to a disease and respond to its treatment. Lots of uncertainty, many plausible interpretations of the data. You’re the kind of person who’s capable of dealing with the messiness and sorting it out.”
“So how did things work out so well for you?”
“Simply being in the right place at the right time, like you are now. When I showed up at NIH, the oncologists were investigating new chemotherapy regimens for children with leukemia, more toxic drug combinations than had ever been given before. The patients got so immune suppressed they were sitting ducks for opportunistic pneumonias like Pneumocystis. Serendipitously, the year I started, a company invented a flexible bronchoscope and wanted someone at NIH to try it out. There I was with the right training, the right patients, the right tool, and all these NIH microbiology and pathology labs happy to collaborate with me. A wide open road to success, and I took advantage of it. It wasn’t hard to publish a dozen articles during the two years I was there, which made me marketable enough to be offered this job.”
“Sounds too good to be true.”
“Perhaps, but let’s talk about how your stars are aligned. There are lots of GRID patients here, the disease isn’t going away any time soon, and no one understands it. That is a huge opportunity for someone with your skills and training. Not only will this grant be funded, you’ll be able to use the results to leverage bigger grants afterwards, which, by the way, should be more than enough to make the university change your academic appointment from temporary to permanent. If that’s what you really want.”
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