The Valeditztorian

by Alli Curran

  She smiles, shaking her curly hair.

  “Thanks, but no, I’ve always hated running. It’s so boring.”

  She almost sounds like Aimee talking about math.

  “What do you do for exercise, then?”

  “When my husband was healthy, we played a lot of tennis. Lately I just work out by myself at the gym. Some days I lift weights, and other days I ride the stationary bike or use the ellipticals. I really miss the tennis.”

  By the time she’s done speaking, we’ve arrived at the lab, where Joan is still rushing around, looking more frantic than ever.

  “Hi, Joan,” I say.

  The poor woman jumps about a foot in the air.

  “Oh, Emma…sorry. You scared me. Who’ve you brought with you?”

  “Joan, this is Mrs. Santos. Her husband is the patient I was telling you about, the one upstairs who has melanoma. Mrs. Santos, this is Dr. Joan Riley. She runs the lab here.”

  “Nice to meet you, Dr. Riley,” says Mrs. Santos, and the two women shake hands. “My first name is Carla. Emma, you should call me Carla, too.”

  “And both of you can call me Joan. I’m sorry to hear about your husband’s illness. Did you stop by to talk about our melanoma study?”

  “Actually, we’re looking for my daughter, though I’d love to hear more details about the study, once we find her.”

  Joan looks puzzled.

  I jump in, “You remember, the little girl with the braids, who almost crashed into the tech?”

  “Oh. That was your daughter?” says Joan.

  Joan glances at Carla, still looking confused.

  “I think she followed me here,” I say.

  “I’d love to help you find her,” says Joan, “but I don’t think there’s much I can do, since I haven’t seen her. In fact, I could use a little help finding something myself.”

  “What are you looking for?” I ask.

  “A few minutes ago, I walked out to use the bathroom. When I came back inside, I started closing up for the night. Then I noticed I’d left the door to the fridge open. When I checked inside, I couldn’t find the syringe from the pharmaceutical company. Emma,” she says, scratching her face vigorously, “after I showed it to you earlier, do you remember where I put that syringe?”

  Joan continues opening and shutting various refrigerators, cabinets, and drawers.

  “I must’ve put it around here somewhere,” she says.

  To my horror, understanding descends upon my frazzled brain like a pile of falling bricks.

  “Oh, I’m pretty sure I know where it is,” I say.

  For a moment the two women stare at me.

  “Room 509.”

  “You didn’t take it there, did you Emma?” asks Joan, looking baffled.

  “No, Joan. I didn’t take it anywhere.”

  “Umm, exactly what was in that syringe?” asks Carla.

  “The melanoma drug,” I reply.

  Carla slaps her palm to her forehead.

  “Oh, no. She didn’t, did she?”

  Carla stares at me beseechingly.

  I shrug, saying, “Would she even know what to do with it?”

  “A few months ago, a visiting nurse taught Aimee how to inject her father with his pain medication,” says Carla.

  Without saying another word, the three of us dash into the stairwell.

  Sure enough, upon entering room 509, we find Aimee lying in bed next to her father, one of her arms wrapped protectively around his scaphoid abdomen (talk about looking like a concentration camp victim). A mostly empty syringe dangles from the IV tubing leading into his subcutaneous portacath, not far from where Aimee’s head rests upon his bony chest wall. One or two drops of purple fluid are still visible within the barrel of the syringe.

  For a few seconds, Carla Santos stands frozen in the middle of the room, staring at her daughter with a mixture of anger, disbelief, and pride on her face. Then she shakes her head, smiles, and walks over to the bed, kissing first Aimee’s forehead and then her husband’s.

  Joan and I just stand inside the doorway, watching the scene unfold.

  Eventually the oncologist turns to me and says, “So much for the IRB approval.”

  I nod in agreement, but what I’m really thinking is…thank God that kid stole the syringe before I did! She probably just saved my medical career.

  Chapter Twenty

  Shocking Developments

  Now that GrR is irreversibly coursing through Roberto Santos’s veins, Joan and I spend a few minutes outside the room, discussing potential pitfalls.

  “What if the receptor in human cells is structurally different than the one in mice?” I ask.

  “Then it’s not going to work,” she answers.

  “Could it do any harm?”

  “Possibly. GrR induces apoptosis by binding to a specific receptor on the melanoma cells. If GrR can bind to a similar receptor on healthy human cells, then he’ll die pretty quickly. Of course the cancer’s killing him anyway, so perhaps the risks and benefits are adequately balanced.”

  “How long before we know what’s going to happen?”

  “I have no idea. This drug is completely untested in humans. I don’t know whether it’s going to save him, kill him, or turn his hair as purple as yours. We’re just going to have to wait and see.”

  “I think I’m not going to be able to sleep tonight.”

  “Me, neither,” says Joan. “You know, Emma, even though I’ve been an oncologist for many years, I still lose sleep over my patients. Sometimes I get so attached to them, it feels like they’re family. Speaking of which, how are you related to them?”

  She gestures inside the room.

  “Oh, umm…that is a very long, complicated story and I’m not really sure that this is a good time to….”

  Before I can finish the sentence, a piercing wail issues from inside the room. Aimee is screaming like a banshee.

  Joan and I dash inside to find Aimee sitting on top of her father’s unconscious form, shaking his shoulders like a rag doll.

  “What’s wrong?” I ask.

  “I was lying next to him, listening to his heart. For a few seconds it got really fast, and then it stopped. His heart stopped beating! Please help me wake him up!”

  “Quickly, now,” says Joan, assuming the role of top doctor in the room, “we need to start CPR. Carla, get her off the bed, immediately.”

  Carla rushes to grab Aimee, who is stuck to her father like a barnacle. Thank goodness Carla has been doing all of that weight lifting, as a heroic effort is required to pry the child off Roberto’s body. Though her daughter continues kicking and screaming, Carla manages to wrestle Aimee down to the couch.

  Simultaneously, Joan grabs the intercom, announcing, “Code blue, room 509…code blue, room 509.”

  Then she runs behind the bed, grabbing a ventilation bag and mask.

  “Until the team gets here, I’ll bag, and you do chest compressions, okay Emma? You know how to do them, right?”

  I nod. I hope I remember everything I learned in my ACLS class. I hope the team gets here soon. Baruch Atah Adonoi Eloheinu Melech Haolam, etc. Please, God, don’t let him die.

  Then I’m rhythmically compressing Roberto’s chest, as Joan chants the numbers like a prayer.

  “One, two, three—a little deeper Emma—four, five—a little faster, but let the chest recoil fully—six, seven, eight, nine, ten—good—eleven, twelve, thirteen, fourteen, fifteen.”

  When she pauses to administer two breaths from the mask, I watch Roberto’s chest rise and fall. His skin is gray, completely drained of color.

  A moment later, about 10 other doctors and nurses rush into the room, sweeping me backward, out of the action. Soon I find myself sitting on the couch, next to Aimee and Carla. Aimee is sobbing, her face buried in her mother’s chest. Every so often she peeks at the activity around the bed, quickly hiding her eyes between glances.

  “Is this my fault?” she asks miserably. “Did I do this to
him?”

  “No, sweetheart,” says Carla. “You did your best to help him.”

  “She’s right, Aimee.” I say. “If you hadn’t given him the medicine, I would’ve done it instead.”

  She looks up at me, sniffling, her eyes wet with tears.

  “Really? You’re not lying about that, just to make me feel better?”

  “No, Aimee. I’m not lying. I really mean it.”

  “But why would you do that?” she asks.

  “Giving your father the medicine was the right thing to do. It was the only thing that had any chance of saving his life.”

  Aimee nods and takes a deep breath. Looking exhausted, she leans her head against her mother’s shoulder.

  Carla turns to me and silently mouths the words, “Thank you.”

  Now that Aimee has calmed down, I direct my full attention to the code. A young, female resident is bagging Mr. Santos while Joan continues shouting instructions.

  “Alright, everyone. He’s in ventricular fibrillation, and we need to shock him. Lisa, have you finished pushing the calcium chloride?”

  “Done!” shouts a nurse.

  “Everyone except Michael step away from the bed. Ready?”

  “Ready,” says Michael. “Charging to two hundred joules. All clear. Delivering the first shock.”

  Michael discharges the defibrillator. The corpse shudders, momentarily contracting beneath Michael’s paddles.

  “Still in v-fib. Next shock,” shouts Joan.

  “Increasing to three hundred sixty joules. Ready. All clear.”

  Roberto’s body contracts again, and this time Joan shouts, “Okay, everyone. We’ve got a pulse. He’s back in sinus rhythm. Victoria, keep bagging until he’s breathing effectively on his own. Michael, call the ICU and let them know we’re coming.”

  “What’s happening?” asks Carla, who’s still holding Aimee in her arms as she rushes after the bed, which is now being pushed by the residents toward the doorway.

  “Your husband’s heart stopped beating,” says Joan, “but we were able to restart it with the defibrillator. Because we began CPR so quickly, I doubt that he suffered any brain damage. For the moment, we’re taking him to the ICU for closer monitoring.”

  “But why did this happen?” Carla asks, as we chase the bed down the hallway. “Is he dying? My husband didn’t want to be resuscitated or put on a ventilator if there was no real chance of saving his life. Did the medicine do this?”

  “I know you’ve got a lot of questions,” says Joan, “and frankly, so do I. At the moment, we don’t have time to discuss everything, so I’ll try to focus on what’s most important.”

  Zipping down the hallway toward the ICU, Joan is clearly back in road runner mode.

  “As to why this happened,” she says, “I’m not exactly sure, but I suspect the problem is tumor lysis syndrome.”

  “Tumor lysis—what’s that?” asks Carla.

  Still carrying Aimee, Carla is doing a remarkably good job keeping up with the entourage.

  “When a person with cancer receives chemotherapy, the tumor cells sometimes burst open, releasing their toxins into the blood stream. At high enough levels, the toxins can cause the heart to stop beating.”

  “So you’re saying his tumor cells are bursting open? Does that mean he’s getting worse?”

  “Just the opposite, in fact. The tumor cells could be rupturing because they’re selectively dying. At this point we need to control the side effects, and we’ll do that more effectively in the ICU.”

  “I want to make sure I understand this,” says Carla. “You’re telling me that you just had to shock my husband’s heart because he’s getting better?”

  Aimee suddenly wiggles down from her mother’s arms, forcing Carla to halt.

  “Weren’t you listening, Mommy?” she says, grabbing Carla’s hand. “That’s exactly what she said.”

  “I can see that you’re a very smart young lady,” says Joan, pausing to study Aimee as the residents move ahead with her father.

  “Now, I want you—and your mom—to listen very carefully. I said he might be getting better. We’ll need to do some blood work to know for sure. If we confirm that he is in tumor lysis, the next few days are still going to be very rough. From what I understand, your father’s tumor burden was quite large, which means that all of those dying cancer cells are potentially going to cause a lot of trouble, at least until he stabilizes.”

  Though remarkably stable up until this point, Carla’s hard shell is clearly starting to crack. As the tears roll down Carla’s cheeks, Aimee turns to comfort her.

  “He’s going to be okay,” she says, wrapping her arms around her mother’s waist.

  “I know, sweetheart,” she replies, bending down to return the hug.

  Carla then looks up at Joan.

  “Thank you for everything you’re doing,” she says through her tears, “and please take good care of him.”

  “I can’t make any promises regarding the outcome,” says Joan, “but we’ll certainly do our best to help your husband.”

  Just before heading to the ICU, Joan pulls me aside and whispers, “You know, if you had stolen that syringe, Emma, I would’ve understood.”

  After flashing a quick smile, Joan races away, leaving me standing in the hallway with Carla and Aimee.

  Unsure of what to do next, the three of us walk slowly back to room 509. Aimee and her mother immediately sink into the couch in the otherwise empty room, leaning against one another. Both of them look tired, but peaceful.

  “Do you want us to walk you home, Emma?” Carla asks.

  “No thanks. I’ll be fine. Do you mind if I stop by next week, to see how things are going?”

  “You can stop by whenever you want. You’re welcome here anytime.”

  Wow. Precisely the words I’m longing to hear from my own mother. At that exact moment, like a ray of sunshine piercing through the clouds, inspiration hits me. For the first time in forever, I’m finally able to visualize a path toward winning my mother’s forgiveness.

  “Am I still fired?” I ask.

  “Yes—but only because Aimee is going to do her homework from now on. Right, Aimee?”

  “I’ll do it if you give me candy, like Emma does.”

  Oops. Kids have such big mouths. I’ll have to remember that in the future.

  Mrs. Santos raises her eyebrows at me, laughs, and wraps Aimee up in a gigantic hug.

  “My darling daughter, life is short. If it’s candy you want, then it’s candy you’ll get…so long as you eat your broccoli first.”

  I’m not sure whether the two of them are laughing or crying as I leave the room to go home.

  Chapter Twenty-one

  Outcomes

  Over the next few days, life starts settling down. On Sunday I successfully dye my hair back to a boring shade of brown, mimicking my natural color. Studying my head in the mirror, I almost miss the purple…almost, but not quite.

  That afternoon I receive an e-mail from Grace.

  Subject: Life in Salvador

  Dear Emma,

  It was great to hear from you, and good for you! I know you made the right decision about Thomas. Incidentally, I broke up with BJ last week. When I first confronted him about Helen, we tried to work things out, but then I realized that I didn’t trust him anymore. I ended up leaving him over the phone, and I’m still feeling pretty sad about it.

  Since you left, dealing with Alvin has actually gotten much easier. He stopped asking me to make the hospital deliveries, and he hasn’t been nearly as critical. Initially, when you told him I was depressed and homesick, I was pretty annoyed at you, but now I’m thinking it probably helped. Either way, I’m really looking forward to coming home.

  I miss you, too.

  Love,

  Grace

  P.S. Thanks for the can opener. I ate canned string beans yesterday for the first time in nine months.

  P.P.S. Paula says, “Oi” and “Obrigada.” She wan
ted me to tell you that she recovered completely and is feeling just fine.

  Monday and Tuesday are spent hanging out in Connie’s lab, entering data on pediatric tuberculosis patients. Though the work is mundane, I’m overjoyed to be sitting calmly in front of a computer, typing away at a keyboard, instead of performing chest compressions. Thankfully no one goes into cardiac arrest, and my own blood pressure slowly returns to normal.

  By Wednesday afternoon, I’m ready to return to Memorial. Arriving at the ICU, the first thing I notice is a large group of senior-looking doctors crowded behind Roberto’s bed, passing around sheets of paper and talking excitedly to one another. Given the intense activity level I nearly bolt, but in my moment of hesitation, Joan Riley pulls me into the mix.

  “Emma, hey, Emma,” she shouts, “come over here for a minute.”

  Walking closer, I notice Carla sitting near the head of the bed, holding a very self-satisfied looking Aimee on her lap. Roberto, I’m thrilled to see, is sitting up, smiling, and drinking what looks like a cup of coffee. With cheeks as pink as the cherry blossoms outside, his color looks absolutely wonderful. Catching my eye, Carla smiles and waves over the crowd of doctors, and I do the same.

  “What happened?” I ask Joan, who’s moved a few feet away from everyone to reach me.

  “The last three days were very difficult,” she says. “Roberto had one of the worst cases of tumor lysis that I’ve ever seen. Initially he went into renal failure and needed dialysis, but fortunately his kidneys are now recovering.”

  “Why did he get so sick?” I ask.

  “He had an enormous tumor burden, which probably would’ve killed someone with a weaker constitution.”

  “Did you say he ‘had’ a large tumor burden?”

  “Indeed,” says Joan.

  “What do you mean?”

  “That’s what all of this excitement is about,” she says, gesturing toward the other doctors, who collectively appear to be scratching their heads.

  “Roberto just went for a PET scan, which showed that his tumor is gone.”

  “Gone?” I ask.

  “That’s right. His tumor hasn’t just regressed. It’s disappeared—like it never existed. At this point we’re unable to detect any cancer cells or biochemical tumor markers in his body. He appears to be cured.”