Death Benefit

10.

COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 2, 2011, 1:00 P.M.

Pia had quickly learned to feel at home in what Dr. Yamamoto liked to call the “bathroom,” the organ bath facility where the mouse kidneys, hearts, lungs, and pancreases were being nurtured. She had spent the morning in there, harvesting reams of data on the pH levels in the baths and using a handheld tablet to look at the histories of a few organs that had failed. They were later found to have very subtle variations in acidity or alkalinity from the rest of the samples. Pia’s task was to monitor the baths, and she tried to figure out how she might rig up some kind of electronic alarm to her cell phone like Rothman and Yamamoto had that would alert her when a bath developed a slight variation in pH.

Dr. Rothman had come and gone a couple of times. Pia knew from speaking with Dr. Yamamoto that the team was running complex and time-consuming studies concurrently, both here with the baths and in the biosafety level-3 lab on the other side of Rothman’s complex. Rothman’s work on salmonella had made his reputation, and he wasn’t about to abandon it, even if it meant working at superhuman levels of energy and concentration. He treasured his access to the highly virulent strains that NASA provided him with, and with the space shuttle program winding down, he didn’t know when he might get more.

Lesley and Will had left the room to find Dr. Yamamoto. It had been decided that in addition to helping Pia, they would initiate their own study of the effects of slight variations in the temperature of the baths. Unfortunately their study had reached a quick impasse, and they preferred to consult Dr. Rothman’s associate rather than the man himself.

Dr. Rothman entered the room, moving to the last row of baths.

“We seem to have a problem with number nineteen,” he said, apparently into thin air. Pia joined Rothman, who was fiddling with the monitoring unit under the bath.

“The blood flow is compromised. There’s a blockage, so we may have to section the organ to see if the problem is developmental or some kind of embolus. There are few journeys longer from in vitro to in vivo.”

“How long before you can start human trials?” Pia said.

Rothman flinched a little and looked around at Pia, apparently in surprise. Had he been talking to himself?

“We’re a little closer with the kidney than with the pancreas. The kidney is basically a filter. Quite simple. But the pancreas is very complicated. It’s fascinating to me that one gland would have so much to do, and such important tasks.”

“Hormones and enzymes,” Pia said.

“The islets of Langerhans. I always loved that name. They were discovered by a twenty-one-year-old German named Paul Langerhans in 1869. I remember when I was a teenager and first heard the term I thought they were named after some actual islands someplace.”

Pia had rarely heard Dr. Rothman sound so jovial. He seemed to revel in his lair. Pia thought it fitted his temperament to enjoy the name of the hormone-producing cells of the pancreas that pumped insulin and glucagon into the bloodstream to regulate sugar levels. Or at least, they were intended to.

“Of course it was necessary to locate the pancreas adjacent to the duodenum so it could inject its enzymes into the digestive system. The ampulla of Vater, another of my favorites.”

Rothman was referring to the junction of the bile duct and the pancreatic duct where food passing through the intestine was mixed with the agents necessary for its digestion and to control the level of acidity.

“But it’s so deeply buried in there. It’s very elusive. That’s why pancreatic cancer is so hard to detect and so lethal. The organ has such a large blood supply cancers tend to spread very quickly.”

Rothman’s mind was wandering. He seemed so uncharacteristically relaxed.

“Its organogenesis is very elusive too. All the hormone- and enzyme-producing cells have to be genetically coded to create the gland, and we’re just coming to grips with the process.”

Rothman had moved to a different bath.

“The mouse pancreas is remarkably similar to ours. We’re making strides here, but I want to speed things up.”

Some scientists were working on implanting glucose sensors and insulin pumps into patients. Others were examining gene therapy solutions, with patients ingesting a medication containing a virus to cause the production of insulin in the presence of glucose. Rothman was tackling the issue the only way he knew: by swinging for the fences. Pia loved that confidence and ambition. She felt some of it had rubbed off on her in the time she had spent with Rothman over the last three years. She also knew how other people saw him. They saw that confidence as arrogance of the worst kind, but it could be arrogance only if the conceit was deliberate. It wasn’t just that Rothman didn’t care what other people thought, he didn’t notice either.

“I wanted to thank you, Doctor,” Pia said.

“For what?”

“For offering to lend me money to pay the Sisters.”

“The Sisters helped you in the past, but the past is the past. You don’t need them anymore. You need to move beyond all the problems foster care caused you, just like I did.”

“I’m trying to,” she said, referring to rising above the legacy of her childhood experiences. But about not needing the Sisters anymore, she wasn’t so sure.

“My sons are not as healthy as I would like. I feel very guilty,” Rothman said out of the blue, shocking Pia. He rarely said anything personal, especially something so very personal. The only other time was when he’d admitted having Asperger’s.

“I’m so sorry,” Pia said. “I had no idea.”

“Nobody does,” Rothman said, uncharacteristically wistfully. “I never talk about it. But it’s a big part of my race with stem cells and stem cell science.”

Pia didn’t know what to say. What was suddenly clear was why Rothman had made such a deviation in his scientific pursuits after such success with his salmonella work.

Rothman continued to watch the tiny pancreas suspended in the bottom of the bath. Pia could only imagine what flight of hope his mind was taking him on now. She could see him almost physically shake it off. He took one more look at the figures on the monitor and wordlessly left Pia’s side. It was amazing and distressing how he could turn on and off.