Perimeter

by M. A. Rothman

  “So,” Juan said. “I haven’t seen much of you around the campus. How goes it on the neurology research front? You’d told me about some big breakthroughs a few years back on your MS research—any new juicy details?”

  Steve hesitated. “Oh, it’s going pretty good. Believe it or not, I’ve taken on a bunch of oncology types to further my progress.”

  “Oncology? For MS research?”

  “Yeah, it’s not as crazy as it sounds. You know that MS is really all about the patient’s immune system having gone awry. The immune system gets confused about who the enemy is and starts attacking the myelin sheaths in the brain.” He tapped the side of his head and continued, “The process I came up with involves giving the patient a brief course of chemotherapy to stimulate stem cell production. We filter their blood, gather the stem cells, and then give the patient a heavy dose of chemo to kill off the malfunctioning immune system. Then we reintroduce their stem cells and reconstruct a new immune system, one that doesn’t have the same malfunctions and leaves the myelin around the neurons intact.”

  Juan nodded in understanding. “So, it’s like you’re rebooting their immune system.”

  “Exactly!” Steve’s blue eyes flashed with excitement. “It’s been really good at halting the progression in most cases of MS.”

  “That’s really cool.”

  An awkward silence fell over them. Juan hesitated as he struggled to come up with a way to change the subject. He wasn’t sure if he could lie to his friend about his work, and he already felt like a shit for not telling him that he was moving.

  Juan’s phone buzzed, and he glanced at the screen. An unrecognized number. “Probably one of those opinion surveys,” he said.

  “Yup, I get those all the time. So sick of them.”

  But when a short while later, Juan’s phone dinged to indicate he’d received a voicemail, he frowned. “Opinion surveys don’t normally leave messages. Do you mind if I—”

  Steve sipped his coffee. “Go ahead and check your message. I’ll just sit here and digest.”

  “Thanks.” He pressed the button to retrieve the phone mail and his speaker immediately played a message with a woman’s voice.

  “Juan, uh—Dr. Gutierrez? I know how lame it is for me to call you for this, but I’m sorry. I didn’t know who else to call. This is Kathy O’Reilly, you and I had dinner at the Mai Kai.”

  Juan’s heart leapt into his throat and he took the phone off speaker, putting it against his ear.

  “I know you’re an oncologist, and… well, my father’s been diagnosed with an advanced stage of cancer. Our doctors are only talking about hospice care, and I’m hoping there’s something more that’s possible. I know I’m probably just being difficult, but this is my father, and I was wondering if you might be able to give a recommendation for a second opinion or… maybe even any suggestions of your own. If you could let me know, I’d appreciate it. I’m home for winter break and calling from my parents’ phone. The cell phone signal is terrible, so if you can call my parents’ house and ask for me, I’d really, really appreciate it. Um… thanks.”

  Juan lowered the phone. He felt as though he’d been punched in the gut. The poor girl.

  Steve looked concerned. “Everything okay, Juan? Did someone die?”

  “No, but it sounds like they will. A student I got to know over in Georgetown, sounds like her father has a terminal case of cancer. The doctors are already suggesting hospice care, and she’s looking for a second opinion.”

  Steve frowned and used his spoon to swirl the melted remnants of his pistachio gelato. “Where’s her father live?”

  “She told me he has a ranch in Nevada. Why?”

  “That’s perfect! I happen to know about a phase-two clinical trial being administered through the Veterans Administration. They’re looking at treating certain types of metastatic cancer. And guess who knows the trial administrator?” Steve pointed both thumbs at himself.

  “Shit, Steve, that would be awesome. Is that part of what you’re working on?”

  Steve started to answer, then shook his head. “Let’s just say that I can’t say. But it looks promising.”

  Juan actually felt better that Steve couldn’t tell him. If they were both keeping secrets, then they were back on an even footing.

  Steve pulled out a pen and a scrap of paper. He scribbled something on it and slid it across the table.

  Juan glanced at the paper, smiled, picked up the phone and dialed the missed call.

  Kathy answered on the first ring. “Hello?”

  “Kathy, it’s Juan Gutierrez.”

  “Oh, thank God you returned my call!” She sounded like she was on the verge of tears. “I’m so sorry I didn’t call you before, I just—”

  “It’s fine. I’m really sorry to hear about your father and what your family is going through. I know how tough it can be.”

  “Thank you. And I know it’s really presumptuous of me to ask, but can you recommend anyone we could go to for a second opinion? My dad is really ornery about the doctors he’s seeing, and if nothing else, I don’t want to leave any stone unturned. You know what I mean?”

  “I do. Kathy, what kind of cancer does your father have?”

  “Osteosarcoma.”

  Juan mouthed the word osteosarcoma at Steve.

  Steve smiled and nodded.

  “And Kathy, I’m assuming that if the doctors you’re seeing are talking about hospice care, the cancer is metastatic? In other words, the cancer has spread?”

  “Yes. Metastatic osteosarcoma. Stage four if that helps.”

  Juan held up four fingers to Steve. “It does. Well, I suppose the good news, if there is any, is that I do have a bit more than just a name for you. I know about a clinical trial being administered at the VA in Las Vegas. Your father doesn’t have to be a veteran to take part. Do you think he’d be interested in looking into that?”

  “Are you kidding me?” Kathy’s voice quavered. “Yes! Yes, he’ll be very interested. Do you think he could get in? He is a vet. The only reason they didn’t go to the VA already is because they had some long waiting list.”

  “Hang on.” Juan cupped his hand over the phone and whispered to Steve. “She’s interested. What are the odds he gets into the trial?”

  “If he has stage-four osteosarcoma, he qualifies. And I’ll get him in.” Steve shot him a thumbs-up. “I’ll pull whatever strings I have to. After all you’ve done for me, it’s the least I can do.” Steve began scribbling some information on a scrap of paper.

  “Thanks, man. I appreciate it.” Juan took his hand off the phone’s mic. “I do think your dad can get in, but don’t get me wrong regarding this trial. I don’t know the full details of the clinical trial, since I was only recently made aware of it.” Juan winked at Steve. “I’ll be honest with you, Kathy: clinical trials can be a godsend or they can be next to useless.”

  “No, trust me, I understand.”

  “I just wanted to make sure you understood. And Kathy, if he were my father, I’d pull out all the stops, and that includes participating in a trial if it was available. Do you have a paper and pencil?”

  Kathy sniffed, cleared her throat, and said, “One sec.”

  Juan heard the rustling of paper in the background and a moment later she responded. “Yes, I’ve got paper and pen.”

  Juan picked up the paper Steve had scribbled on. “Okay, write this down. The clinical trial administrator is a man named Deidrick Müller. Your father will need to go there in the morning. He’ll probably be forced to read a whole bunch of disclosures and sign a bunch of papers. That’s how these trials work. Do you need the address to the VA?”

  “No, my parents have gone there before.” Kathy started to cry. “Juan, thank you so much. I know what the chances are, but just for them… for me to have some hope. I’m really grateful.”

  Juan’s throat tightened as Kathy’s emotion got to him. “Listen to me, Kathy.
You still have my business card, right?”

  “Yes,” Kathy said as she sniffed.

  “Please don’t hesitate to call me any time you want. If you have any medical questions, or even just need a shoulder to cry on. Okay?”

  “I hope you really mean that, because you might regret saying it.” She laughed, then sniffed again.

  Juan noticed that Steve was grinning and making a heart-shaped sign over his chest.

  Feeling the heat grow in his cheeks, Juan said. “I do mean it. Now go tell your folks.”

  “Mom, wait right there, I’ve got something to tell you. My mom just walked in. Thank you, Juan. Thank you so much. I promise I’ll call you one way or another.”

  “I look forward to it.”

  As Juan hung up, Steve said, “So, when do I get to meet this young lady who has you so smitten?”

  Apparently Juan’s emotions were written all over his face. He threw his cloth napkin at Steve and grumbled, “Shut up.”

  Chapter Thirteen

  Kathy hopped out of the driver’s seat of the pickup, raced around to the passenger’s side, and held out her hand for Dad to grab ahold of. She’d been gone only three months, yet it seemed as if her father had aged ten years. He never complained, but she knew he was in serious pain; he winced any time he moved.

  “Come on, Dad, it’s just you and me. Let me help you.”

  Grudgingly, he took her hand to steady himself as he climbed down from the pickup. “I’m sorry you have to see me like this, pumpkin. It’s—”

  “Dad, please just stop torturing yourself. These people are going to help. I talked to the doctor running this program. They said that they’re having some really good luck with cases like yours.” Kathy slammed the pickup’s door shut and held her father’s hand as they walked to the VA’s entrance.

  “I really do appreciate whatever strings you pulled to get me in, but I heard what the previous docs said. Pumpkin, I just don’t want you and your mother’s hopes set too high on this.”

  “Dad, you need to be optimistic.” Kathy said it a bit too loudly; she took a deep breath. “I’ve read studies that show patients tend to have better results if they’re optimistic about their treatment. Just please, for me, try to not be so much like a—”

  “Like a jackass?” He squeezed her hand.

  Leaning her head against his shoulder, Kathy smiled. “I was going to say, ‘Try not to be so much like an O’Reilly.’”

  Dad chuckled. “Same thing.”

  The glass doors slid open as they approached the building, and a nurse walked briskly toward them with a wheelchair. “Mr. O’Reilly, you’re right on time.”

  Dad glared at the wheelchair. “Don’t take this the wrong way, but I’ll be damned if I’m getting in that contraption. I’m not a cripple.”

  “But sir—”

  “Please,” said Kathy, as politely as she knew how. “Can you just humor my father? He really doesn’t like those things.”

  The nurse paused, looking uncertain. But she then smiled and nodded. “Of course, Mr. O’Reilly.” She set aside the wheelchair and motioned for them to follow her. “I’ll take you to the waiting area we use for the trial patients.”

  Walking slowly with her father, Kathy winced every time he did. She prayed that this place could provide the miracle he needed.

  It took them a full five minutes to shuffle back to the lonely waiting room that seemed isolated from the main part of the facility.

  They sat down in the waiting area, and a blonde woman in her forties walked in holding a manila folder full of papers. “Hi, I’m Pamela Ravitz, Dr. Müller’s nurse.” She turned to Dad and asked, “Are you Franklin Christopher O’Reilly?”

  “Last I checked, that’s me,” Dad quipped.

  The nurse turned to Kathy. “And I take it you’re his daughter?”

  “Yes, I’m Kathy O’Reilly.”

  “Great, I’ve got some material here that you’ll both need to look over.” The nurse opened the folder she was carrying and handed each of them a relatively thick pamphlet. “This is the description of the clinical trial. It goes over the expectations of the patient, a summary of the trial itself, as well as the ongoing care that will be necessary. It’s a phase-two clinical trial, and we have one hundred and forty patients currently undergoing treatment for several types of metastatic cancer, including the osteosarcoma you’ve been diagnosed with. Four are actually here at this facility; the others are around the US, in South America, and in London.”

  “How is the treatment going?” Kathy asked as she looked up from the pamphlet.

  “I can’t say until all the data has been analyzed. I’ve only seen a few patients, and one person’s reaction to the treatment won’t be the same as another’s. That’s why we do these trials. With larger numbers, we can get more understanding of the overall effectiveness and study further why some people may react differently than others.”

  “Pamela, do you have a restroom here?” Dad asked.

  “Oh, of course.” Pam pointed. “Right down the hallway, past the first patient’s room on the right.”

  As Dad shuffled away, Kathy leaned forward and spoke softly. “What kind of results have you seen with the patients you’ve treated? I know it’s only a few, and not an official result, but… is it working at all?”

  The nurse hesitated. She scanned the empty waiting room, sat next to Kathy, and whispered, “Okay, I didn’t tell you this, but it’s like a miracle. I’ve been a registered nurse for twenty years, and I’ve never seen anything like it.”

  Kathy’s heart beat loudly in her chest, her eyes misted and she blinked away the unshed tears that blurred her vision. “Is there a control group? You know, are some patients getting placebos in this trial?”

  Pam nodded. “Yes, I’m afraid there has to be. And I’m not allowed to know who’s in which group. That’s all handled by the company sponsor.” She pointed at the pamphlet. “It’s all in there. Your father will need to have blood drawn before we get started, and a physical workup.”

  “But he’s already done all sorts of tests at the other hospital. Can’t you use those?”

  “I’m afraid not.” The nurse shook her head. “The trial requires a fresh set of tests, all done by the staff here. Note that the first part of the trial requires inpatient monitoring of the trial participant, so he’ll be staying here with us for roughly seven days.”

  “Inpatient?” Kathy felt a pang of anxiety. “I doubt our insurance would cover this. Do you know what the cost is? I have tuition money saved that—”

  “There’s no cost.” Pamela smiled. “Any person accepted for this trial has all of their costs covered by the trial sponsor, AgriMed. That includes the testing, hospital stays, drugs, et cetera. We’ll even pay eighty dollars for every mandatory office visit you have to come to.”

  “You’re kidding.” Kathy stared at the woman with her mouth agape, unbidden tears dribbling down her cheeks. “But, how’s that possible?”

  “The sponsor is funding the research on this trial, and they’re covering all of the expenses,” the nurse said matter-of-factly. “That’s pretty standard practice for these types of trials.”

  Dad came back, saw Kathy’s tear-streaked face, and said, “What in God’s name?”

  “Dad, you’re doing this or I’m disowning you.”

  Her father cocked one brow. “I’m not sure that’s the way these things work, young lady.”

  The nurse pointed at the pamphlet her father had left on the table in the middle of the waiting room. “Mr. O’Reilly, you’ll need to read this all the way through before we can even really begin. I’m required to get informed consent, so that means going through everything twice. Once on your own, the second time with me talking and talking and talking some more.”

  Dad picked up the pamphlet and grumbled good-naturedly, “Darn women telling me what to do. It’s the story of my life.”

  ###

&nbs
p; It was early in the morning, not much after nine a.m., but Kathy had already been up for hours. The smell of roast beef permeated the house while Kathy was busy peeling potatoes.

  Mom retrieved a carving knife from one of the kitchen drawers and uncovered the roast that had been resting on the countertop. “Kathy, after you get those potatoes peeled, please try to dice them evenly this time. And check them! I don’t want any mushy or raw potatoes in the potato salad. It’s your father’s favorite.”

  Ignoring her mother’s nagging, Kathy glanced at Jasper, who sat patiently underneath Mom’s cutting board. Mom began thinly slicing the roast beef for sandwiches, and Jasper stared up at every move she made. Every once in a while, when Mom didn’t like how she’d cut a slice, she’d drop it to the floor and Jasper would snatch it out of midair and down it with a gulp. “Mom, you know he’s going to get fat if you keep feeding him like that.”

  “Your father needs to put on some weight anyway.”

  Kathy laughed. “I was talking about Jasper.”

  Mom glanced down at the large dog and blew him a kiss. “Your father’s got four more days at the hospital and he’s dropped more than enough hints about how terrible the food is over there. The least I can do is prepare some roast beef sandwiches and potato salad for him while he’s there.”

  Tires crunched on gravel outside, and Kathy looked out the window. A taxi pulled into the driveway and as soon as it stopped, one of the rear doors flung open. Dad struggled out of the car. She dropped her potato peeler and got up from her chair. “Oh no.”

  She rushed to the door and opened it just as her father struggled up the steps to the porch, his arms full. His face held a determined expression.

  “Dad! What in hell’s name are you doing here?”

  He walked in and dropped a bag of clothes down on the floor. He then set a large box-like contraption on the dining room table and said, “I’m not staying in that place another second.”

  Mom gaped at him as she wiped her hands on her apron. “Franklin Christopher O’Reilly, what are you thinking?”