Terminal (A Medical Thriller)

January 4

Monday, 7:05 A.M.

Helen Cabot gradually awoke as dawn emerged from the winter darkness blanketing Boston, Massachusetts. Fingers of pale, anemic light pierced the darkness of the third-floor bedroom in her parents’ Louisburg Square home. At first she didn’t open her eyes, luxuriating under the down comforter of her canopied bed. Totally content, she was mercifully unaware of the terrible molecular events occurring deep inside her brain.

The holiday season had not been one of Helen’s most enjoyable. In order to avoid missing any classes at Princeton where she was enrolled as a junior, she’d scheduled an elective D&C between Christmas and New Year’s. The doctors had promised that removing the abnormally heavy endometrial tissue lining the uterus would eliminate the violently painful cramps that left her incapacitated each time she got her period. They’d also promised it would be routine. But it hadn’t been.

Turning her head, Helen gazed at the soft morning light diffusing through the lace curtains. She had no sensation of impending doom. In fact, she felt better than she had in days. Although the operation had gone smoothly with only mild post-operative discomfort, the third day after surgery she had developed an unbearable headache, followed by fever, dizziness, and most disturbing of all, slurred speech. Thankfully, the symptoms had cleared as quickly as they had appeared, but her parents still insisted she keep her scheduled appointment with the neurologist at the Massachusetts General Hospital.

Drifting back to sleep Helen heard the barely perceptible click of her father’s computer keyboard. His study was next to Helen’s bedroom. Opening her eyes just long enough to see the clock, she realized it was just past seven. It was amazing how hard her father worked. As the founder and chairman of the board of one of the most powerful software companies in the world, he could afford to rest on his laurels. But he didn’t. He was driven, and the family had become astoundingly wealthy and influential as a result.

Unfortunately the security that Helen enjoyed from her family circumstances did not take into account that nature does not respect temporal wealth and power. Nature works according to its own agenda. The events occurring in Helen’s brain, unknown to her, were being dictated by the DNA molecules that comprised her genes. And on that day in early January, four genes in several of her brain’s neurons were gearing up to produce certain encoded proteins. These neurons had not divided since Helen was an infant, which was normal. Yet now because of these four genes and their resultant proteins, the neurons would be forced to divide again, and to keep on dividing. A particularly malignant cancer was about to shatter Helen’s life. At age twenty-one, Helen Cabot was potentially “terminal,” and she had no idea.

January 4, 10:45 A.M.

Accompanied by a slight whirring noise, Howard Pace was slid out of the maw of the new MRI machine at the University Hospital in St. Louis. He’d never been more terrified in his life. He’d always been vaguely anxious about hospitals and doctors, but now that he was ill, his fears were full-fledged and overwhelming.

At age forty-seven Howard had been in perfect health until that fateful day in mid-October when he’d charged the net in the semifinals of the Belvedere Country Club’s annual tennis tournament. There’d been a slight popping noise, and he’d sprawled ignominiously as the unreturned ball sailed over his head. Howard’s anterior cruciate ligament had snapped inside his right knee.

That had been the beginning of it. Fixing the knee had been easy. Despite some mild problems his doctors ascribed to the aftereffects of general anesthesia, Howard had returned to work in just a few days. It had been important for him to get back quickly; running one of the nation’s largest airplane manufacturing firms was not easy in an era of sharply curtailed defense budgets.

With his head still stabilized in the vise-like apparatus for the MRI, Howard was unaware of the technician’s presence until the man spoke.

“You okay?” he asked as he began to release Howard’s head.

“Okay,” Howard managed to reply. He was lying. His heart was thumping in terror. He was afraid of what the test would reveal. Behind a glass divider he could discern a group of white-coated individuals studying a CRT screen. One of them was his doctor, Tom Folger. They were all pointing, gesturing, and, most disturbing of all, shaking their heads.

The trouble had begun the day before. Howard had awakened with a headache, a rare occurrence unless he’d “tied one on,” which he hadn’t. In fact, he’d not had anything to drink since New Year’s Eve. After taking a dose of aspirin and eating a bit of breakfast, the pain had abated. But later that morning in the middle of a board meeting, with no warning whatsoever, he’d vomited. It had been so violent and so unexpected, with no preceding nausea, that he’d not even been able to lean aside. To his utter mortification, his undigested breakfast had spewed over the boardroom table.

With his head now freed, Howard tried to sit up, but the movement caused his headache to return in full force. He sank back to the MRI table and closed his eyes until his doctor gently touched his shoulder. Tom had been the family internist for over twenty years. He and Tom had become good friends over the years, and they knew each other well. Howard did not like what he saw in Tom’s face.

“It’s bad, isn’t it?” Howard asked.

“I’ve always been straight with you, Howard…”

“So don’t change now,” Howard whispered. He didn’t want to hear the rest, but he had to.

“It doesn’t look good,” Tom admitted. He kept his hand on Howard’s shoulder. “There are multiple tumors. Three to be exact. At least that’s how many we can see.”

“Oh, God!” Howard moaned. “It’s terminal, isn’t it?”

“That’s not the way we should talk at this point,” Tom said.

“Christ it isn’t,” Howard snapped. “You just told me you’ve always been straight with me. I asked a simple question. I have a right to know.”

“If you force me to answer, I’d have to say yes; it could be terminal. But we don’t know for sure. For the present we’ve got a lot of work to do. First thing we have to do is find out where it’s come from. Being multifocal suggests it’s spread from someplace else.”

“Then let’s get on with it,” Howard said. “If there’s a chance, I want to beat this thing.”

January 4, 1:25 P.M.

When Louis Martin first awoke in the recovery room, he felt as if his throat had been scorched with an acetylene torch. He’d had sore throats before, but nothing had even come close to the pain he’d felt as he tried to swallow after his surgery. To make matters worse, his mouth had been as dry as the central Sahara.

The nurse who had materialized at his bedside seemingly out of nowhere had explained that his discomfort was due to the endotracheal tube the anesthesiologist had inserted prior to his operation. She gave him a damp washcloth to suck on and the pain had abated.

By the time he was wheeled back to his room, a different pain had started, located somewhere between his legs and radiating into the small of his back. Louis knew the cause of that discomfort. It was the site of his surgery to reduce an enlarged prostate gland. The damn thing had been forcing him to get up to urinate four or five times each night. He’d scheduled the surgery for the day after New Year’s. Traditionally that was a slow time for the computer giant he ran north of Boston.

Just as the pain was getting the best of him, another nurse gave him a bolus of Demerol through the IV which was still attached to his left hand. A bottle of fluid hung on a T-shaped pole protruding from the head of his bed.

The Demerol put him back into a drugged sleep. He wasn’t sure how much time had passed when he became aware of a presence next to his head. It took all his strength to open his eyes; his eyelids felt like lead. At the head of his bed was a nurse fumbling with plastic tubing coming from the IV bottle. In her right hand was a syringe.

“What’s that?” Louis mumbled. He sounded inebriated.

The nurse smiled at him.

“Sounds as if you’d had one too many,” she said.

Louis blinked as he tried to focus on the woman’s swarthy face. In his drugged state, the nurse was a blur. Yet she was correct about how he sounded.

“I don’t need any more pain medicine,” Louis managed to say. He struggled to a half-sitting position, leaning on an elbow.

“It’s not pain medicine,” the nurse said.

“Oh,” Louis said. While the nurse completed the injection, Louis slowly realized he still didn’t know what he was being given. “What kind of medicine is it?” Louis asked.

“A wonder drug,” the nurse said, quickly capping the syringe.

Louis laughed in spite of himself. He was about to ask another question, but the nurse satisfied his curiosity.

“It’s an antibiotic,” she said. She gave Louis’s shoulder a reassuring squeeze. “Now you close your eyes and rest.”

Louis flopped back onto his bed. He chuckled. He liked people with a sense of humor. In his mind he repeated what the nurse had said: a wonder drug. Well, antibiotics were wonder drugs, there was no doubt. He recalled that Dr. Handlin had told him he might be put on antibiotics as a precaution after his operation. Louis vaguely wondered what it had been like to be in a hospital before antibiotics had been discovered. He felt thankful that he was living when he was.

Closing his eyes, Louis followed the nurse’s suggestion and let his body relax. The pain was still present, but because of the narcotic, it didn’t bother him. Narcotics were wonder drugs as well, and so were the anesthetic agents. Louis was the first to admit he was a coward when it came to pain. He could never have tolerated surgery back when none of the “wonder drugs” were available.

As Louis drifted off to sleep, he wondered what kind of drugs the future would bring. He decided he’d have to ask Dr. Handlin’s opinion.

January 4, 2:53 P.M.

Norma Kaylor watched the drops fall into the millipore chamber hanging below her IV bottle. The IV ran through a large-bore catheter into her left arm. She had such mixed feelings about the medicine she was getting. She hoped the powerful chemotherapeutic agents would cure her breast cancer which, she’d been told, had spread into her liver and lungs. At the same time she knew the medicines were cellular poisons, capable of wreaking havoc on her body as well as on her tumor. Dr. Clarence had warned her about so many dreadful side effects that she’d made a conscious effort to screen out his voice. She’d heard enough. She’d signed the consent form with a feeling of numbed detachment.

Turning, Norma looked out the window at the intensely blue Miami sky, filled with massive bubbles of white cumulus clouds. Since her cancer had been diagnosed, she tried hard not to ask why me? When she’d first felt the lump she had hoped it would go away of its own accord, like so many lumps had done in the past. It wasn’t until several months had passed, and the skin over the lump had suddenly dimpled, that she’d forced herself to see a doctor, only to learn that her fears had been justified: the lump was malignant. So just before her thirty-third birthday she’d undergone a radical mastectomy. She hadn’t fully recovered from the surgery before the doctors began the chemotherapy.

Determined to end her self-pity, she was reaching for a novel when the door to her private room opened. She didn’t even look up. Staff at the Forbes Cancer Center was constantly in and out adjusting her IV, injecting her medicine. She had gotten so used to the constant comings and goings, they barely interrupted her reading anymore.

It was only after the door had closed again that she became aware she had been given some new drug. The effect was unique, causing the strength suddenly to drain from her body. Even the book she was holding fell from her hands. But what was more frightening was the effect on her breathing; it was as if she were being smothered. In agony she tried to get air, but she had progressive difficulty, and soon she was totally paralyzed except for her eyes. The image of her door being quietly opened was the last thing she knew.