“A good pickup,” George said while he pulled pensively at the skin at the edge of his jaw. He was obviously trying to relate these earlier symptoms to the current problem. “The fever is the curious part,” he said. “Did he say it was a high fever?”
“Moderate,” Sean said. “102 to 103. He said it was like having a cold or mild flu. Whatever it was, it went away completely.”
“It might be related,” George said. “At any rate this guy is a ‘sickie.’ The preliminary CAT scan showed two tumors. Remember Helen Cabot upstairs?”
“How can I forget?” Sean said. “She’s still my patient.”
“This guy’s tumors look very similar to hers,” George said.
The group of doctors around the CRT screen began talking excitedly. The first cuts were coming out. Sean and George stepped behind them and peered over their shoulders.
“Here they are again,” Harry said, pointing with the tip of his percussion hammer. “They’re definitely tumors. No doubt at all. And here’s another small one.”
Sean strained to see.
“Most likely metastases,” Harry said. “Multiple tumors like this have to come from someplace else. Was his prostate benign?”
“Completely,” Dr. Handlin said. “He’s been in good health all his life.”
“Smoke?” Harry asked.
“No,” Sean said. The people in front moved to give Sean a better view of the CRT screen.
“We’ll have to do a full metastatic workup,” Harry said.
Sean bent over close to the CRT screen. The areas of reduced uptake were apparent even to his inexperienced eye. But what really caught his attention was how much they resembled Helen Cabot’s tumors, as George had said. And like hers, they were all in the cerebrum. That had been a point of particular interest with Helen Cabot, since medulloblastomas generally occurred in the cerebellum, not the cerebrum.
“I know statistically you have to think of a metastasis from lung, colon, or prostate,” George said. “But what are the chances we’re seeing a tumor similar to Helen Cabot’s? In other words, multifocal primary brain cancer like medulloblastoma.”
Harry shook his head. “Remember, when you hear hoofbeats you should think of horses, not zebras. Helen Cabot’s case is unique even though there have been a couple of similar cases recently reported around the country. Nonetheless, I’ll be willing to wager anyone that we’re looking at metastatic tumors here.”
“What service do you think he should be on?” George asked.
“Six of one, half dozen of another,” Harry said. “If he’s on neurology, we’ll need an internal medicine consult for the metastatic workup. If he’s on internal medicine, he’ll need the neuro consult.”
“Since we took Cabot,” George suggested, “why don’t you guys take him. You interact better with neurosurgery anyway.”
“Fine by me,” Harry said.
Sean groaned inwardly. All his work doing the history and physical was for naught. Since the patient would be admitted to neurology, the medical student on neurology would get credit for it. But at least that meant Sean was free.
Sean motioned to George that he’d see him later on rounds, then slipped out of the CAT scan room. Although he was behind on his off-service notes, Sean took the time for a visit. Having been thinking and talking about Helen Cabot, he wanted to see her. Getting off the elevator on the seventh floor, he walked directly down to room 708 and knocked on the half-open door.
Despite her shaved head and a series of blue marker stains on her scalp, Helen Cabot still managed to look attractive. Her features were delicate, emphasizing her large, bright green eyes. Her skin had the translucent perfection of a model. Yet she was pale, and there was little doubt she was ill. Still, her face lit up when she saw Sean.
“My favorite doctor,” she said.
“Doctor-to-be,” Sean corrected her. He didn’t enjoy the charade of playing doctor like many medical students. Ever since he graduated from high school he’d felt like an imposter, play-acting first at the role of a Harvard undergraduate, then an MIT fellow, and now a Harvard medical student.
“Have you heard the good news?” Helen asked. She sat up despite her weakness from the many seizures she’d been having.
“Tell me,” Sean said.
“I’ve been accepted into the Forbes Cancer Center protocol,” Helen said.
“Fantastic!” Sean said. “Now I can tell you I’m heading there myself. I’ve been afraid to mention it until I heard you were going too.”
“What a marvelous coincidence!” Helen said. “Now I’ll have a friend there. I suppose you know that with my particular type of tumor they’ve had a one hundred percent remission.”
“I know,” Sean said. “Their results are unbelievable. But it’s no coincidence we’ll be down there together. It was your case that made me aware of the Forbes. As I’ve mentioned to you, my research involves the molecular basis of cancer. So discovering a clinic where they are having hundred-percent success treating a specific cancer is extraordinarily exciting for me. I’m amazed I hadn’t read about it in the medical literature. Anyway, I want to go down there and find out exactly what they’re doing.”
“Their treatment is still experimental,” Helen said. “My father emphasized that to me. We think the reason they’ve avoided publishing their results is that they first want to be absolutely sure of their claims. But whether they’ve published or not, I can’t wait to get there and start treatment. It’s the first ray of hope since this nightmare started.”
“When are you going?” Sean asked.
“Sometime next week,” Helen said. “And you?”
“I’ll be on the road the crack of dawn on Sunday. I should be there early Tuesday morning. I’ll be waiting for you.” Sean reached out and gripped Helen’s shoulder.
Helen smiled, placing her hand over Sean’s.
AFTER COMPLETING report, Janet returned to the seventh floor to look for Sean. Once again the nurses said he’d been there only moments earlier but apparently had disappeared. They suggested paging him, but Janet wanted to catch him off guard. Since it was now after four she thought the best place to find him would be Dr. Clifford Walsh’s lab. Dr. Walsh was Sean’s Ph.D. advisor.
To get there, Janet had to leave the hospital, brace herself against the winter wind, walk partway down Longfellow Avenue, cross the medical school quadrangle, and climb to the third floor. Even before she opened the door to the lab, she knew she’d guessed correctly. She recognized Sean’s figure through the frosted glass. It was mostly the way he moved that was so familiar. He had surprising grace for such a stocky, muscular frame. There was no wasted motion. He went about his tasks quickly and efficiently.
Entering the room, Janet closed the door behind her and hesitated. For a moment she enjoyed watching Sean. Besides Sean there were three other people busily working. A radio played classical music. There was no conversation.
It was a rather dated and cluttered lab with soapstone-topped benches. The newest equipment were the computers and a series of desk-sized analyzers. Sean had described the subject of his Ph.D. thesis on several occasions, but Janet still wasn’t a hundred percent certain she understood it all. He was searching for specialized genes called oncogenes that had the capability of encouraging a cell to become cancerous. Sean had explained that the origins of oncogenes seemed to be from normal “cellular control” genes that certain types of viruses called retroviruses had a tendency to capture in order to stimulate viral production in future host cells.
Janet had nodded at appropriate times during these explanations but had always found herself more interested by Sean’s enthusiasm than the subject matter. She also realized that she needed to do some more basic reading in the area of molecular genetics if she was to understand Sean’s particular area of research. Sean had a tendency to assume that she had more knowledge than she had, in a field where advances came at a dizzying pace.
As Janet watched Sean from just inside the door, appreciating the V that his broad shoulders and narrow waist formed, she became curious about what he was currently doing. In sharp contrast to many other visits she’d made over the last two months, he wasn’t preparing one of the analyzers to run. Instead he seemed to be putting
