ACKNOWLEDGMENTS
I would like to thank Matthew Bankowski, Ph.D., for his patience and generosity in tolerating my questions about his arena of expertise, and for his willingness to read and comment upon the original manuscript of
I would also like to thank Phyllis Grann, my friend and editor, for her valuable input. I would also like to apologize for any deleterious effects the lateness of the manuscript of
Finally I would like to thank the basic science departments of the College of Physicians and Surgeons at Columbia University for providing me with the background that makes it possible for me to understand and appreciate the fast-paced developments in molecular biology.
Science without conscience is but the ruin of the soul.
—
PROLOGUE
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
