Sensing Light

by Mark A. Jacobson

  Kevin disliked being probed. Impulsively, he turned the tables.

  “Herb, why did you choose me? Why not one of your pulmonary fellows?”

  Taken aback, Herb said, “What? Am I pushing you? Isn’t this what you want? To figure out why people are dying from GRID and how to stop it?”

  “Of course I do. But why choose me? Because I’m gay?”

  Kevin tensed, expecting Herb to be defensive, if not hostile. Instead, Herb sighed, plopped his elbows on the desk, and rested his chin on intertwined fingers.

  “I see,” Herb said, peering over his reading glasses. “Kevin, there are two reasons. One, it’s obvious you’re deeply disturbed by this disease. I can tell because I’ve been watching you since you were an intern. On the surface, you’re a lot like me—a relatively calm person in this madhouse of high-strung prima donnas. Anyway, that first case—I’d never seen you so upset. You may not realize it yet, but you need to figure GRID out. It’s going to haunt you until you do. And without that sort of passion, it’s hard to accomplish much as a clinical researcher. The second reason is you have the smarts and drive to pull it off. There isn’t anyone else here who has that combination of talent and motivation, which is why it has to be you.”

  Kevin’s cheeks burned. He tried to maintain a skeptical expression.

  “I’m not selfless,” Herb added. “Getting grants funded is good for my career too.”

  Herb offered his hand. Kevin tentatively clasped it.

  XII

  MAKING GOOD ON HIS promise, Kevin met Marco after work at a men’s clothing store on Union Square. Two weeks earlier, scientists from a local biotech company interested in GRID had taken Kevin to dinner at an expensive restaurant. The next day, he swore to Marco’s delight that he would never again go to such a place wearing frayed Rockports. Exploiting this window of opportunity, Marco hinted he might also have use for more than one tie.

  Kevin was inspecting loafers when Marco arrived with opinions about color.

  “A brown could match your eyes and hair,” said Marco, “if it’s the right brown.”

  Marco went through the store’s entire inventory before settling on three pairs. While Kevin tried them on, Marco’s eyes raced back and forth between the shoes and Kevin’s face. He decided the first pair had too boxy a shape and the second made Kevin’s skin look pasty. Kevin had been hoping he would pick the third pair, which had a matte finish. Shiny leather shoes seemed too pretentious to him.

  Marco leaned against a mirror and gave Kevin a thumbs-up sign. Then he frowned.

  “This is the tragedy of optics. You can only see your gorgeous green eyes in a mirror, which makes them twice as far away from you as they are from me.”

  Kevin blew him a kiss.

  Next they shopped for ties. Kevin followed as Marco led him through the racks and selected six candidates. Holding each one loosely knotted below Kevin’s chin, he described the plusses and minuses of the color, pattern, and brightness, what it did to enhance Kevin’s natural beauty. The last tie, yellow silk with diagonal, emerald stripes, particularly appealed to Kevin.

  “You like it?”

  “Bello,” said Marco, flaring his nostrils ever so slightly.

  Kevin had never been inside a high-end men’s clothing store before and was reluctant to leave. Now he wished he could afford a whole new wardrobe.

  They grabbed a slice of pizza, and Marco went home, while Kevin drove to a meeting at the public health department. Marco was reading journals in bed when he returned.

  “What was that about?” asked Marco.

  “Bathhouses.”

  “Bathhouses? They think saunas will cure GRID?”

  “Very funny. The health department thinks bathhouses are breeding the epidemic. They’re planning an educational campaign to warn people to use condoms and not share drugs inside those places.”

  Marco was drowsy and didn’t want to hear a lecture. He asked about Kevin’s meeting with Herb.

  “I gave him a draft of the protocol today,” said Kevin.

  Marco sat upright.

  “And?”

  “He liked it…a lot, actually.”

  “Fantástico! This is the opportunity to get the academic credentials you need, querido.”

  Opportunity to screw up, thought Kevin.

  Kevin didn’t want to talk about the grant. He asked if they were on for lunch tomorrow after Marco’s symposium at the Hill. Kevin also had meetings there in the morning. They agreed on the cafeteria at noon. Marco mumbled something about gene splicing and fell asleep.

  Kevin lay next to Marco, watching him at rest. He thought of Marco’s self-assurance in generating and testing his own scientific ideas. Where did it come from? Was it from growing up with more money and parental love than he had received? Marco’s father, an oil company executive, was a conservative, politically and socially. He may have been disappointed on finding out Marco was gay, but he was demonstratively fond of his son and civil to his son’s lover. Was getting unconditional affection the key to having confidence?

  Kevin had only experimented with mice, never with human subjects, sick people, dying people. It was easy to imagine the mistakes he might make—recruiting inappropriate patients, not following the protocol correctly, errors in his analysis of the data. And if he did it all flawlessly, in the end there still might be nothing of importance to show for the effort.

  When Kevin first told Marco about Herb’s suggestion they apply for NIH funding, Marco urged him to collaborate. Kevin was hesitant. He had already failed once at grant writing. A nasty argument ensued after Marco, whose view of academic reality was not sanguine, pointed out the facts of life.

  “You won’t last as a pure clinician,” Marco had said. “The university can always replace you with younger, cheaper doctors who are right out of training. How many faculty at City Hospital have you seen promoted on the basis of their clinical work alone? But if you’re bringing in grant money, you become necessary. The university needs those overhead dollars.”

  Kevin knew all this and didn’t want to hear it from his lover. Since then, Marco had been circumspect whenever they discussed Kevin’s career.

  As he tried to fall asleep, Kevin soothed himself with a saving grace. At least he had a firmer grasp on how microbes killed humans than he ever had on how antibiotics killed microbes.

  XIII

  EARLY THE NEXT MORNING, Kevin backed his 1969 Rambler sedan into the street, shifted into second gear, and let the engine brake his descent to Castro Street. The car had 120,000 miles on the odometer and numerous dents when Kevin bought it five years ago. Its smooth ride and excellent visibility were nice features, but Kevin had chosen the Rambler because of its reliable straight six, large engine compartment, and seven hundred dollar price tag. After stripping the air conditioner, unnecessary in San Francisco’s climate, he had enough room to change the fan belt, clean the head, or replace the starter without having to jack the vehicle up and work underneath it on his back. He could make repairs without getting filthy or lacerating his hands. Space was the ultimate luxury for a mechanic.

  Although the Rambler’s squared-off frame and clunky, horizontal grille offended Marco’s aesthetic sensibility, he had become reconciled to the car. It helped that Kevin didn’t object to their exclusively using Marco’s Alfa Romeo convertible when traveling together. Kevin wouldn’t open the hood of the fragile Alfa unless there was an emergency. Marco frequently had to take it in to the local dealer for repairs. The 1969 Rambler had a track record of outstanding durability—its crowning merit from Kevin’s perspective.

  As a teenager, Kevin had no effeminate traits. However, his lack of pugnacity or enthusiasm for sports did make him suspect. His disinterest in girls’ bodies might have sealed the verdict if not for the mechanic camouflage. Kevin knew his regular presence in the garage and competence with tools saved him from persecution. Yet he hated the charade and was repelled by car culture, which made the Rambler’s uncoolness to automobile a
ficionados another virtue.

  The sky had cleared. As Kevin rolled downhill, he saw the Marin headlands in the distance, a richer green after yesterday’s rain. He had some time before his appointments on the Hill and detoured into Buena Vista Park. Mothers were pushing strollers in the parking lot. No men were cruising for sex at this hour. Relieved there wouldn’t be any awkward encounters, Kevin trotted up a short footpath. At the crest, he saw the twin, cream spires of St. Ignatius Church rise from the valley below. Evergreen ridges in the Presidio formed a backdrop. Just beyond loomed the orange-vermillion towers of the Golden Gate Bridge.

  The ocean view through the glass walls on the twelfth floor of the Hill’s new medical science complex was also spectacular. Given his second chance in a week to see the Farallon Islands, Kevin didn’t mind waiting in the hallway.

  Raymond Johnson, an overweight, bald man in his fifties, was twenty minutes late. The immunologist sported a silver goatee and square-rimmed, tortoise shell glasses. Johnson apologized, but he neither smiled nor shook Kevin’s hand. He hastily ushered his visitor through a high-ceilinged laboratory into his office.

  Kevin knew Johnson’s academic niche was investigating rare, inherited immune deficiency syndromes and that one of the instruments he caught a glimpse of could count helper T lymphocytes in blood. Kevin’s acquaintances at UCLA had used a similar device in their study about to be published in the New England Journal of Medicine. Johnson had the only laboratory on the Hill capable of measuring these unique cells.

  The meeting had been Kevin’s idea. He called Johnson and proposed they talk about some common interests. Kevin hoped once Johnson heard details of the UCLA report and understood Kevin had a cohort of GRID patients willing to donate a little blood, the immunologist would be thrilled to collaborate. Johnson was well-funded. He could cover the salary of a research assistant for Kevin if he wanted.

  Johnson sat in a black leather armchair and directed Kevin to a small plastic seat across from his desk. He leaned back and opened his hands. Kevin took the cue to explain GRID, tossing in the UCLA group’s results along with the fact that their paper had been accepted by a prestigious journal. He described his patients at City Hospital then waited for immunologist’s eager response.

  “I’m surprised the Journal accepted the manuscript. As a reviewer, I was unimpressed—such a small sample size. Apparently, the other reviewers were more indulgent. It is an interesting observation, although not very illuminating. The money question is what’s driving the loss of T helper cells. Are they destroyed, or is there a failure of production? And what’s the underlying cause—a toxin, virus, occult malignancy, or some new pathogen no one has ever seen before?”

  “I … I’m not sure,” said Kevin, flummoxed. “I don’t have a hypothesis yet.”

  Johnson smiled tightly.

  “That would be a good place to start, wouldn’t it?” he said.

  As Johnson rose to escort Kevin out, he added, “My plate is full right now. Let’s discuss this in six months or a year when you have a clearer idea of what you’re looking for.”

  Kevin’s next appointment was in the basement of the medical center’s oldest building. This meeting had not been initiated by Kevin. A PhD in the oncology division, Rajiv Singh, had called him requesting blood specimens from GRID patients. Kevin queried oncologists at City Hospital but only learned Singh was studying a rare virus that caused leukemia in cats.

  Kevin entered a tiny laboratory and found a short, wiry man sitting erect on a stool, writing numbers in a bound notebook. On seeing Kevin, he jumped up, pumped Kevin’s hand, and began explaining what the various pieces of equipment measured. The instrument Singh was most proud of could detect reverse transcriptase—a signature enzyme uniquely present in a class of organisms called retroviruses.

  “Do you think GRID might be caused by a retrovirus?” Kevin asked.

  “It’s a reasonable hypothesis. Maybe a retrovirus infects helper T lymphocytes and destroys them. You know what? I could look for reverse transcriptase in the lymphocytes of your patients.”

  “I can get you blood samples,” said Kevin, “But there’s going to be a problem. GRID patients have very few T cells.”

  “Then I’ll need a lot of blood,” said Singh with a wide grin.

  Although Kevin doubted the plausibility of Singh’s hypothesis, he had no other opportunities on the horizon for partnering with a basic scientist. He volunteered to submit an institutional review board application, which would permit him to collect blood from his patients and allow Singh to assay the specimens.

  “That’s exactly what I was hoping to hear you say,” said Singh, patting Kevin on the back.

  XIV

  KEVIN WAS STILL DEJECTED when he met Marco in the university hospital cafeteria and told him about his meetings with Johnson and Singh.

  “So you’re batting five hundred, yes?” said Marco.

  “I guess so. But it’s more like my team acquired a walk-on and lost a top draft choice.”

  “Oh, I thought you didn’t know anything about baseball?”

  “Unfortunately, I do. I just don’t like talking about it—except when I’m angry.”

  Marco laughed and stroked Kevin’s cheek.

  “We’ll change the subject. You want to hear about my symposium?”

  “Absolutely!”

  “I know how science gets you aroused,” Marco whispered conspiratorially. “Are you sure you want to discuss it in public?”

  Kevin finally smiled.

  Marco’s symposium was a gathering of two groups with converging interests, his own laboratory at Berkeley, run by the cell biologist Isaac Goldstein, and the Wilmer laboratory on the Hill, which specialized in gene splicing—excising natural genes from a cell and inserting modified ones. In collaboration, the two groups might be the first to create a gene-knockout mouse by removing a normal gene from a mouse stem cell, replacing it with a gene that couldn’t function, and growing the altered stem cell into a mature adult mouse in which every cell had the faulty gene.

  “Wilmer’s lab is in the same boat we are. They’re getting scooped by people at Oxford just like we were last month by the Cambridge group that published their paper in Cell on the same day Goldstein submitted our paper to Nature.”

  “So the Brits are your common enemy?”

  “Exactamente! Which is why Goldstein and Wilmer are ready to trust each other enough to join forces.”

  “So, how did it go?”

  “Querido, you would have loved it. When I get there, all the Wilmer people are sitting on one side of the room and our people are on the other. Nobody is talking. Complete silence.”

  “Sounds unpleasant.”

  “Right. So I sit down right in the middle of the Wilmer group who give me these uncomfortable social smiles. Then the data presentation begins. All the post-docs are edgy, trying to figure out what information is OK to give. They don’t want to reveal too much. It was like, how you say, a strip show. Then Goldstein takes the big leap. He puts some very hot, unpublished data on the overhead projector. The Wilmer people’s eyes get big. They lick their lips. I’m surprised nobody makes a wolf whistle. Then the anti-Brit jokes begin. After that, everybody is good buddies, sharing all their data.”

  Kevin laughed.

  “The best thing was that nobody picked at details, like whether enough replicate experiments had been done or the controls were adequate. People asked about what the data meant, which showed they really respected each other’s work. In no time, we came up with a consensus research plan.”

  “And you promised you’d be faithful to me.”

  “Aha! I knew that story would cheer you up.”

  Well aware of what this collaboration implied for Marco, Kevin exclaimed, “What a fabulous opportunity for you!”

  Marco beamed, and Kevin tipped his own coffee cup against Marco’s in a celebratory toast.

  XV

  ALL THE CITY HOSPITAL medicine house staff and faculty had been inv
ited to a party on Saturday night at the home of their newly recruited chief, Ray Hernandez. While riding in the passenger seat as the Alpha Romeo swerved on a narrow, winding road in the East Bay hills, Kevin told Marco the little he knew about Ray. The new chief had grown up in Fresno, the child of Mexican immigrants and, like Kevin, was the first person in his family to go to college.

  “So what do you think of him so far?” asked Marco.

  “I’ve only met him once. Mostly, he praised the work I’m doing.”

  “That’s good.”

  “I don’t know. Herb says he’s very ambitious, and not just for himself. He’s gung ho on academic success for everybody in the department. I wonder if he’s softening us up for painful changes.”

  “Has Gwen met him?”

  “Yeah. She likes him. He runs morning report with the residents. She says he doesn’t teach by intimidation. That’s an anomaly for a chief of medicine.”

  “Then don’t be pessimistic. If I were you, I’d enjoy it while you can. Maybe he’s taken one of those new management courses in team building and wants to inspire loyalty instead of fear.”

  “Right,” said Kevin dismissively.

  They found the address in a wooded dell. Long shadows and waning sunlight filtered by fir needles fell upon a rambling house with a redwood-shingled roof and cedar-plank walls. At the stairway leading down to the chief’s front door, they ran into Rick and Gwen.

  Kevin and Marco took turns pecking cheeks with Gwen. Kevin shook hands with Rick, but Rick and Marco gave each other daffy grins. Rick wet his lips and aimed them at Marco’s cheek. He missed, planting a kiss on Marco’s ear. Both erupted in laughter.