by Linda Nagata
This was news to Everett. It put a whole new spin on Ellen’s own refusal. Like maybe it was some weird kind of loyalty thing to her mom. He didn’t understand it, but he didn’t have to.
“I’ll love you always,” he said. “No matter what. They can rip everything apart, till there’s nothing left, and I’ll love that.”
“Don’t be morbid.”
“I’m just saying.”
“I know. And thank you. I’ll remind you later you said that.”
He kissed her on the ear, then the neck. “You won’t have to remind me. I won’t forget.”
She swallowed a lump in her throat.
He kissed her breast.
She felt a tingle, a stirring, in her belly.
“Again?” he asked.
They did it again and afterward conked out. Everett woke midway through the night. Ellen was turned away from him, her arms clutched tightly across her chest, crying softly in her sleep. It pained him deeply, and he wrapped his arms around her, hugging and holding her from behind, until eventually her sobbing ceased. The next morning he rose early and closeted himself in the study. By the time Ellen was up, showered, and dressed, he had what he wanted and had uploaded it to his pad. He brought it to Ellen, who put her own pad down and looked at his.
“I found this yesterday,” he told her.
“Twenty-Two and You?”
“It’s a start-up. They’re, like, an hour away.”
She scanned the page.
“You believe this?” she asked.
“I don’t disbelieve it.”
“It seems like a joke.”
“What? Gene therapy? Hardly.”
“This therapy. They claim they can rewrite any gene you have. You’d think something like that would be in the news.”
“It was in the news. It is. But they’re new. They don’t have much of a track record. It’s an evolving story.”
Evolving? she thought. Try outrageous. Still, it was something. Maybe. But first things first.
They ordered the genome kit that same morning. Like an arrow waiting to be launched, it came the very next day. Ellen unwrapped the package with some excitement, which surprised her. She worked up a nice glob of spit, full, she hoped, of cheek cells, emptied it into the vial, sealed the vial, and sent it off. Six weeks later the results arrived online.
Earlier that week, she’d gotten a call from her mother. These were calls that she dreaded, but this time the news was good. Amazingly so. The cancer was in retreat. It was shrinking. Who knew why? A delayed effect of the drugs? The visualization? Both? Neither?
“It’s a reprieve,” said her mother cautiously.
Ellen was thinking more along the lines of a miracle. But either would do. She wasn’t going to quibble. She felt like shouting for joy.
The news carried her until the day her own results arrived. Let there be a miracle now, she thought, staring at the company’s screen before logging on, heart pounding, hope battling dread.
This is what she found out:
1. She had a low risk for diabetes.
2. She carried something called rs 1805007, which explained her strawberry-blonde hair.
3. She was hypersensitive to a drug used to thin the blood.
4. Her ancestors roamed the forests of Eastern Europe. They had interbred with tribes to the south. They had also interbred with Neanderthals.
5. She had sticky earwax. This she already knew. Now, though, she no longer had to feel guilty when her ears got clogged. It wasn’t her fault. It was in her genes.
6. She carried the Triggering Endocrine Stutter Sequence gene, TESS 233, the one her mother had, but with a twist. She had another gene, probably from her father. A hormone-sensitive promoter gene. It was part of the constellation they had feared. Were she to get pregnant, her chance of getting cancer of the breast and ovary was near certain.
Twenty-Two and You, the company Everett had found, was named after the number of chromosome pairs minus one, the one, according to their upbeat, breezy website, being You. You were the wild card. You were the one in charge, who decided what needed to change. You were the supplier of that critical information, the orchestrator of your personal future, the Author with a capital A of your own destiny. This was their guarantee. Their promise: to unzip, repair, and rezip whatever gene needed fixing, then send you on your way. Their motto: Put the ever-after forever-after in your hands.
The company was housed in a spanking new box off the freeway. Ellen and Everett visited it the week after she got her test results. Their appointment was the last of the day.
It had not been the best week of her life. She’d had nightmares every night, terrible things fraught with images of disfigurement and loss. More than once she woke like a bolt in the darkness, drenched in sweat and gasping for air. Her waking hours were hardly better. She hated what was inside of her. She dreaded what lay ahead. Everett had high hopes about this company, but that was Everett. She did not share his optimism. The whole thing seemed too good to be true. Too simple. Too easy. How could they perform these miracles? The answer: they couldn’t. It was hype. In the end she would have the surgeries and be a husk of a woman, a non-woman, for what remained of her sad, barren life.
The reception room was full. Men, women, and children of every age. Her eyes glided over the men, lingering on the women and most especially the children. Such beautiful things. What, she wondered, had brought them? What terrible condition did they have? How thin the line between a normal life and this. She felt a wave of tenderness and sadness for them. She felt pity too, for them and for herself.
By ones and twos and threes the room emptied, until they were the only ones left. It was five o’clock, an hour later than their scheduled appointment. Everett was restless and annoyed; Ellen, surprisingly blasé. The world of cancer was not the same as the rest of the world. She had learned this with her mother. It had its own set of rules, its own pace, and its own clock. You couldn’t get worked up about these differences. It was humiliating enough simply to have the disease.
“You don’t have the disease,” Everett reminded her, not for the first time. “You have a chance for the disease. That’s why we’re here. To remove that chance. Reverse the odds.”
She imagined someone tossing a pair of dice, which seemed an iffy way to decide one’s future. She knew it was irrational thinking. This was science, not a crapshoot. Science and Everett, her soul mate, her heartthrob, her love. Everett, trying to raise her spirits; Everett, caring for her; Everett, keeping the flame of hope alive.
She owed him, if not cheer, then at least a measure of kindness.
“You’re right,” she said, lacing her fingers through his. “I’m sorry for being such a bitch.”
“You have every reason. And besides, you’re not.”
“You lie.”
“I never lie,” he said, squeezing her hand.
His wedding ring pressed against the inside of her little finger. From the finger to her heart. From her heart back to his. The true ring.
A nurse came out and called her name, breaking the reverie. They followed her through a door, where they were placed in another, smaller room. They waited longer, and eventually a man appeared. He was tall and broad-shouldered. He had slate-blue eyes and a sweep of lank, wheat-colored hair that all but covered his forehead. His nose was large, his cheeks wide, his lips a boisterous red. His name was Rudolf Stanovic. Dr. Rudolf Stanovic. He had trained jointly as a researcher and a clinician, had spent time at the bench but now worked solely as a practitioner. He treated patients, and this was work he loved.
He was passionate about his profession. He believed in its power to heal and transform. He believed in his company, Twenty-Two and You, as the guiding hand of this transformation. He believed in himself. He was a doctor, and his job was nothing more or less than helping those in need.
He knew Ellen’s story before he entered the room. He had read the history she had provided. With minor variations it was the same h
istory and story of every patient who came to Twenty-Two and You. A bad gene, or genes; an uncertain future. He had no need to hear it again, yet hear it again he did, sitting in a chair opposite her, folding his hands in his lap, meeting her eyes and listening patiently without interrupting as she laid it out for him.
When she was done, he asked some simple questions designed to draw her out further, to allow her to express and unravel, at least a little, the complex knot of her feelings. She hadn’t expected this, had assumed he wanted it cut and dried and to the point, and was taken by surprise. Her feelings? What manner of doctor was this?
“It’s late,” she said. “Are you sure you want to know? Do you have time?”
It was an honest question but also a warning, disguised as a little joke. It could get messy, she was telling him. Emotions could fly. Much was bottled up inside. Was he prepared for what might happen when the bottle was uncorked? More to the point, could she trust him enough to let down her guard?
He glanced at his watch, then slipped it off his wrist and into a drawer. Then he settled back in his chair.
“We’ll talk. First you, then me. We’ll put our cards on the table. We’ll make time.”
He had an easy manner and spoke with an accent. Eastern European . . . Balkan maybe. Something that from other lips could have come out guttural and harsh. From his, almost embarrassingly gentle.
She drew a breath, then began. A fistful of wadded-up, tear-soaked tissues later she wiped her nose, heaved a sigh and was done. She hadn’t meant to cry. Doctors were either uncomfortable with tears or else they treated you like a child. But there it was. He’d asked for it.
Everett sat beside her. Midway through her unburdening he’d taken her hand and continued to grip it tightly. She was grateful for his presence. She could have done it alone, but he was a rock. Together, they waited for the doctor’s response.
He began by thanking her for being open and candid with him. Anger, fear, frustration, and all the rest were natural. Hope was natural, too. Not that she’d mentioned it, but he knew it was there. Why else would she be sitting in this room?
“Now I’ll be candid with you. There is hope. More than hope. We’ll fix this gene. If you like, we’ll turn around your future.”
“I like,” she said.
He held up a hand. “Please. You need to understand the full picture.
“This gene of yours is part of a constellation of genes. Like stars, but close to each other. Like a family. They live together in a big neighborhood. A shtetl. You know what a shtetl is? Like that. This family, they visit each other. They work together. They separate, then come together again. Maybe they actually join and make a new family. Maybe they have offspring. Whatever happens, everybody knows about it. Big family, small town, word gets around. If one member makes a change, the news travels fast. Some in the family could care less. They go about their business. Other members—now we’ll say genes—they change, too.
“Change makes change. You fix a tire, your car runs better. You fix TESS 233, you run better. Cancer-free is always better. But maybe you run differently. Maybe you experience another change.”
“Like what?”
“Maybe you do, maybe you don’t. Change creates a ripple, a ripple creates change. You see what I’m saying? A ball in a box is a ball. You take the ball out and kick it, or throw it, you put it in motion. This motion starts a chain of events. Your ball takes on a life of its own.”
“You’re saying there’s a risk,” said Everett.
“There’s always a risk. With any treatment.”
“She could end up not cured?”
“This is unlikely. We have an outstanding rate of success. Close to one hundred percent. We’ll fix this gene of yours. We’ll break it apart and sew it back together like new.” His eyes swung back to Ellen. “You’ll have a healthy gene. You’ll be a healthy person. You can have all the little ones you like. They’ll be healthy, too. Free of TESS 233. We’ll eliminate that from the picture. We’ll make another picture. A valentine for you. Health. Happiness. Family. Your heart’s desire. We’ll put ourselves out of business.”
He smiled. “I joke. It’s an old joke. A doctor’s joke. We do our job well, we’ll never see you again. For us, this is not a problem. We have plenty of work. For other doctors—oncologists, rheumatologists—the future is not so rosy. We engineer genes, we engineer their demise. It’s sad to say, but what can you do? Progress is a god. A great god. God of the impossible. But not a god of mercy.”
“You said I’d change,” said Ellen. “How? Please be specific.”
“I said maybe. The chance is roughly fifty-fifty.”
It was a substantial risk. He watched her closely to see how she’d react, then swiveled in his chair, opened a drawer in the desk, and pulled out an eight-by-eleven-inch laminated card. On it was a busy diagram with an oblong shape in the center surrounded by similar but smaller shapes connected to it and to each other by bidirectional arrows. The large shape was labeled TESS 233. The other shapes, he explained, represented genes and gene products that interacted with it. Each could have been at the center of its own diagram. Start anywhere, and you could get anywhere else. From the smallest gene to the largest, from a single molecule to an entire cell. All paths were joined. In the end there was only one path, and that was the body.
He called her attention to one of the small oblong shapes colored a royal blue and labeled DMTF, 18p5.7. The 18, he said, referred to the chromosome number. The p, to its short, petit, arm. The 5.7, to the gene’s location on that arm. DMTF stood for Dynamic Memory Transcription Factor, DYMETRA for short.
“This plays a crucial role in the brain,” he explained. “It’s the hub of memory maintenance. I think of it as the jealous sister in the family. She’s used to being center stage. If TESS gets a facelift, DYMETRA’s going to know about it. Half the time she lets things be and goes about her business. But half the time she makes a fuss. Floods the brain with her transcript. Shows how important she is.”
“What happens then?”
“The brain is a plastic organ. Memory is the most plastic of all. It’s like rubber. DYMETRA recruits other genes in the family. Some turn on, some off. Memory gets reshaped. It’s a small change usually. A small effect. Most of the time it’s barely noticeable. Sometimes not noticeable at all.”
“Like what?” asked Ellen. “Give me an example.”
“Maybe you forget a face. Or forget something you said. Or where you put something. Things like that.”
“Is it permanent?”
“How do you mean?”
“Do you ever get the memory back? Or do you get it but keep forgetting over and over? Does the process stop?”
“We’ve only been offering this treatment for two years. We don’t have long-term results. In the short-term, sometimes yes, sometimes no.”
“It doesn’t sound so bad,” said Everett. “Hell, I’m forgetful now. We could handle it, El.”
“It sounds like Alzheimer’s,” she said.
Stanovic shook his head. “No. Alzheimer’s is a different beast.”
She imagined how it might be, forgetting things. It was always annoying when it happened. Frustrating at times. She could see how it could get embarrassing if it happened a lot. But life-altering? It would depend on the degree.
She asked him about that. “You said the effect is usually small. Have you seen a large effect? How often does that happen? What’s it look like?”
“One time,” he said, raising his index finger as though it required emphasis. “A patient of ours, a man, forgot his wife. It was a difficult situation. Very troubling for all concerned.”
“What do you mean, he forgot her?” she asked. “Like what? Completely?”
Stanovic nodded.
“How awful.”
“We tried many different things to help. Called in experts. Hired consultants. Sent counselors to their home. We took it very seriously, I assure you.”
“And?”
“After six months his wife moved out. There was nothing we could do.”
“She deserted him?”
“She was a young woman. And extremely unhappy.”
“That’s horrible,” said Ellen. “How could someone completely abandon someone they love like that?”
Stanovic did not point out the obvious, that the wife had been abandoned as well, and first. “It was very sad.”
“It’s not going to happen,” said Everett.
She turned to him. She was shaken. “What? I won’t forget you, or you won’t move out?”
“Neither.”
She stared at him.
He stared back, then left his chair and crouched in front of her.
“Take my hands,” he said. “Now look at me. Now tell me: do you think you can forget me? Do you possibly believe you ever would?”
He had the most beautiful eyes. In every way he was a beautiful and memorable person. What could she do but shake her head?
“Now tell me: do you think I’d ever leave you? Ever?”
A slightly harder question, only because you could never know someone else’s mind as well as your own. Except maybe in this one case.
“No,” she whispered.
He turned to Stanovic. “How many times has something this extreme happened? Remind us. Out of how many treatments?”
“One time. Only one. Out of twenty-three treatments. As I explained, small effects are much more common. But listen. There’s more to the story. A new development. Do you have time? Would you like to hear?”
“Yes,” said Everett, then glanced at Ellen, who wasn’t so sure. But curiosity got the better of her, and she nodded.
Stanovic leaned back in his chair. He was pushing the envelope a little of what it meant to be a doctor. Stories of other patients weren’t usually told in such detail, though this one could easily be justified from the point of view of full disclosure of risk. And he had to admit, he enjoyed telling it.
“The wife moves out. Time goes by, and he forgets her again. He loses her memory, as it were. He goes back to work. He’s living alone, a young man, and he wants to meet women. He goes to a bar one night and sees someone he likes. Pretty face, nice figure. She’s talking to the bartender and doesn’t notice him. The room is crowded, and he pushes his way toward her. The closer he gets, the more he likes what he sees. He feels something inside. Chemistry? Would that be the word?”