Darkest Fear

'But people must balk. I mean, most probably signed up the same way I did: They had a friend who was sick and ran a drive. For someone you know and care about, sure, you're willing to make a sacrifice. But for a stranger?'

Karen Singh's eyes found his and settled in hard. 'You are saving a life, Mr. Bolitar. Think about that. How many opportunities do you get to save a fellow human being's life?'

He had hit a nerve. Good. 'Are you saying people don't balk?'

'I'm not saying it never happens,' she said, 'but most people do the right thing.'

'Does the donor get to meet the person he or she is saving?'

'No. It's totally anonymous. Confidentiality is very important here. Everything is held in the utmost secrecy.'

They were getting to it now, and Myron could sense that her defenses were starting to slide back up like a car window. He decided to pull back again, let her resettle on comfy ground. 'What's the patient going through during all this?' he asked.

'At what point?'

'While the marrow is being harvested. How do you prep the patient?' Prep. Myron had said 'prep.' Like a real doctor. Who said watching St. Elsewhere was a waste of time?

'It depends on what you're treating,' Dr. Singh said. 'But for most diseases, the recipient goes through about a week's worth of chemotherapy.'

Chemotherapy. One of those words that hush a room like a nun's scowl. 'They get chemo before the transplant?'

'Yes.'

'I would think that would weaken them,' Myron said.

'To some degree, yes.'

'Why would you do it, then?'

'You have to. You're giving the recipient new bone marrow. Before you do that, you have to kill the old marrow. With leukemia, for example, the amount of chemo is high because you have to kill off all the living marrow. In the case of Fanconi anemia, you can be less aggressive because the marrow is already very weak.'

'So you kill off all the bone marrow?'

'Yes.'

'Isn't that dangerous?'

Dr. Singh gave him the steady eyes again. 'This is a dangerous procedure, Mr. Bolitar. You are in effect replacing a person's bone marrow.'

'And then?'

'And then the patient is infused with new marrow through an IV. He or she is kept isolated in a sterile environment for the first two weeks.'

'Quarantined?'

'In effect. Do you remember the old TV movie The Boy in the Plastic Bubble?'

'Who doesn't?'

Dr. Singh smiled.

'Is that what the patient lives in?' Myron asked.

'A bubble chamber of sorts, yes.'

'I had no idea,' Myron said. 'And this works?'

'Rejection is always a possibility, of course. But our success rate is quite high. In the case of Jeremy Downing, he can live a normal, active life with the transplant.'

'And without it?'

'We can keep treating him with male hormones and growth factors, but his premature death is inevitable.'

Silence. Except for that steady mechanical beep coming from down the hall.

Myron cleared his throat. 'When you said that everything involving the donor is confidential—'

'I meant totally.'

Enough wading. 'How does that sit with you, Dr. Singh?'

'What do you mean?'

'The national registry located a donor who matched Jeremy, didn't they?'

'I believe so, yes.'

'So what happened?'

She tapped her chin with her index finger. 'May I speak candidly?'

'Please.'

'I believe in the need for secrecy and confidentiality. Most people don't understand how easy, painless, and important it is to put their name in the registry. All they have to do is give a little blood. Just a little tube of the stuff, less than you would for any blood donation. Do that simple act — and you can save a life. Do you understand the significance of that?'

'I think so.'

'We in the medical community must do all we can to encourage people to join the bone marrow registry. Education, of course, is important. So, too, is confidentiality. It has to be honored. The donors have to trust us.'

She stopped, crossed her legs, leaned back on her hands. 'But in this case, something of a quandary has developed. The importance of confidentiality is bumping up against the welfare of my patient. For me, the quandary is easy to resolve. The Hippocratic oath trumps all. I'm not a lawyer or a priest. My priority must be to save the life, not protect confidences. My guess is that I'm not the only doctor that feels that way.

Perhaps that's why we have no contact with the donors. The blood center — in your case, the one in East Orange — does everything. They harvest the marrow and ship it to us.'

'Are you saying that you don't know who the donor is?'

'That's right.'

'Or if it's a he or she or where they live or anything?'

Karen Singh nodded. 'I can only tell you that the national registry found a match. They called and told me so. I later received a call telling me that the donor was no longer available.'

'What does that mean?'

'My question exactly.'

'Did they give you an answer?'

'No,' she said. 'And while I see things on the micro level, the national registry has to remain macro. I respect that.'

'You just gave up?'

She stiffened at his words. Her eyes went small and black. 'No, Mr. Bolitar, I did not give up. I raged against the machine. But the people at the national registry are not ogres. They understand that this is a life-or-death situation. If a donor backs out, they try their best to bring them back into the fold. They do everything I would do to convince the donor to go through with it.'

'But nothing worked here?'

'That seems to be the case.'

'The donor would be told that he's sentencing a thirteen-year-old boy to death?'

She didn't hesitate. 'Yes.'

Myron threw up his hands. 'So what do we conclude here, Doctor? That the donor is a selfish monster?'

Karen Singh chewed on that one for a moment. 'Perhaps,' she said. 'Or perhaps the answer is simpler.'

'For example?'

'For example,' she said, 'maybe the center can't find the donor.'

Hello. Myron sat up a bit. 'What do you mean, 'can't find'?'

'I don't know what happened here. The center won't tell me, and that's probably how it should be. I'm the patient's advocate. It's their job to deal with the donors. But I believe they were' — she stopped, searching for the right word—'perplexed.'

'What makes you say that?'