Death Benefit

3.

COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 1, 2011, 7:30 A.M.

She knows the man’s important but she can’t remember his name. The girl is standing in front of a long desk, wearing a plain, very loose-fitting, institutional gray shift with her shoulders slumped forward and her hands clasped in front of her, elbows tucked into her sides. Even sitting down, the man is very large, enormous, in fact, and he’s leaning forward, talking to her, not looking her in the eye but right at her chest. She can’t make out what he’s saying. She’s been bad, she’s misbehaved, she’s going to need to be punished, that’s all she knows.

She can hear him now. He’s even bigger than he was before, telling her to stand up straight, to pull her shoulders back. Why is she wearing that shapeless garment? Pia remembers that she’s fifteen or at most sixteen and this is the head of her school, and it’s as if she’s at the back of the room, watching this girl who is her but not her. He pushes his chair back and stands up. Coming around the desk, he approaches her with a cruel, lustful smile. “Pia . . .” he orders. “Pia . . .”

“Pia . . . Pia . . . !” Pia sat up in bed and breathed a deep sigh of relief. Her T-shirt was sticking to the sweat on her back as she stretched forward, listening to George calling to her from the other side of the door. She let him in and hurried to get dressed, vowing that she’d remember to set the alarm that night. Her internal clock used to wake her up at six without fail but the last couple of weeks she’d had trouble sleeping, suffering from a number of recurrent nightmares. She felt exhausted. She’d not had nearly enough sleep. After visiting with the mother superior, she’d gone back to Rothman’s lab. By the time she’d gotten back to her dorm room and crawled into bed it had been 4:23 in the morning.

As she dressed, she found herself mulling over the meeting with the mother superior, and she shared some of it with George on the way to the medical center.

“I’m glad you went,” George said as they walked in the crisp morning sunshine. “I mean, you were never going to join the order, and I can’t see you in Africa doing whatever missionaries do nowadays. I’ve never known any nuns, but I can’t imagine you’re the nun type.” From one of their four lovemaking events, an erotic image of a satiated Pia naked in bed flashed through his mind. He noticed Pia shoot him a look, and he cringed. Could she read his mind? It wasn’t the first time George had this worry.

“I don’t think becoming a nun and taking the vows would have been a problem for me, George. I’m not even saying I’ll never do it. I’ve seen how life is at the convent, and it’s very peaceful. It’s different from the world out here. The sisters support each other. It’s safe.”

George immediately felt uncomfortable, like he was patronizing Pia. He couldn’t blame her for wanting some security in her life with the little he knew of her childhood. But becoming a nun? It seemed extreme. “I guess what I mean is that it seems like a way of avoiding life. There are other ways of being safe besides going and hiding out in a convent.”

“I don’t think of becoming a nun as hiding. It’s the opposite-they have to give all of themselves to the world they have chosen.” They don’t betray each other either, thought Pia to herself. They had reached the Black research building.

“Actually I think you’d be equivalently hiding if you end up spending your whole career working in there with Rothman,” George said, indicating the building with a tilt of his head. His concept of medicine involved helping people directly, one-on-one, having an effect on the lives of people he could see and touch. As far as he was concerned, research was too cold and abstract and populated with asocial martinets like Rothman who were as welcoming and warm as a file full of algorithms.

“So, what about lunch today?” George said, changing the subject and ever hopeful. As he had feared, they hadn’t met up for lunch the day before. In the three-plus years that George had known Pia, they’d never had an official lunch date. They had lunched together numerous times, but not as a planned event. During the first two years they had managed to have pretty much the same schedule so it just happened. But now that George was on a radiology elective and Pia was holed up in Rothman’s lab, he knew that the chances they’d run into each other by accident were slim. But why he was bothering to ask her he had no idea, since he knew it wasn’t going to happen. And why was he always so damned accommodating?

“Sorry, George, I can’t make plans,” she said. “Yesterday I had to spend the entire day and come back at night to work on one of Rothman’s journal articles, and it still isn’t done. On top of that I’ll be meeting with him sometime to find out what he has in store for me for the entire month. I seriously doubt I’ll even be getting lunch.”

Pia was unhappy to see that the pesky maintenance man was still in her office. He was up the stepladder again, only facing a different direction this time. The day before, as she had worked on Rothman’s paper on one of the benches out in the lab proper, she’d noticed that he’d left at twelve and didn’t come back for four hours. At that rate she worried about him being there pestering her and keeping her from her cubbyhole for a week. Her office was small, but it was hers and she could leave her stuff spread out on the countertops, something she couldn’t do in the main lab.

Pia made enough noise dropping her bag on her tool-littered desk to ensure Vance knew she was there and not particularly happy. “Hey, you up there,” she called out.

Vance pulled his head down into the room and, seeing Pia, climbed down, smiling, rubbing his hands on a rag. “Ah, Miss Grazdani! How are you today? I missed you yesterday when I left.”

“I noticed you took a four-hour lunch. You should have told me you’d be away so long. I could have been working here in my office. Anyway, yesterday you thought you’d be finished. What’s up? How long is this going to take?”

“The job is turning out to be more difficult than I had thought. All I can really say is that I’m trying my best. As soon as I figure out what the hell is wrong, I’ll knock it right out and be outa here.”

Pia merely sighed irritably and lifted her bag.

“Miss Pia, I’ve got a surprise for you. I made an extra sandwich today for lunch, one for me and one for you. How about joining me for a bite? I make a wicked pastrami sandwich on a ciabatta roll. What do you say?”

He was smiling again. Jesus, men were so predictable. Pia glowered: Was this guy suffering from delusions? She wasn’t staying to find out nor did she want to encourage the man.

“Just hurry the hell up with the job. Please!” she snapped. As far as the sandwich offer was concerned, she didn’t even want to acknowledge it.

Pia turned and stepped back into the main lab. She put her bag on the bench area where she’d worked the previous day. But instead of jumping right in, she walked back to Marsha’s desk to find out where their leader was that morning. To her surprise, she learned that Rothman was in his office and waiting for her. Pleased, Pia hurried in through the open door. Immediately she noticed he was dealing with the same maintenance inconvenience Overhead, a number of ceiling tiles were missing and spaghetti-like wires dangled from the holes. An assortment of tools dotted one of the countertops and a few were scattered on the floor. In the corner was a stepladder leaning against the wall and the security camera was missing from its mounting.

“Good morning, Dr. Rothman,” Pia chirped. She never knew what to expect mood-wise but hoped for the best. “Marsha said you were expecting me.”

“Miss Grazdani. How do you spell ‘catheter’?” Rothman demanded, not even bothering to look up from the sheet of paper he was holding. She could tell it was part of the Lancet manuscript she’d worked on.

“C-A-T-H-E-T-E-R. Why?”

“Well, it seems you know how to spell it, so I’m wondering why you felt the need to make up an alternative version for my paper?”

Pia had worked on Rothman’s article, making several suggestions for changes in structure and rewriting one whole section she found particularly opaque. Late last night she had been in a hurry to finish, and she hadn’t run a spell check.

“One wonders what they taught you at NYU, if anything. There were several spelling errors and two grammatical ones.”

From experience, Pia knew how Rothman worked. These jabs at her spelling and grammar almost certainly meant that he had accepted her structural changes. If you lived for compliments and praise, you’d starve to death working for Rothman. Rothman took good work for granted. If you weren’t good, you didn’t last long, so the only elements worth talking about were the minor faults. Rothman twisted in his seat to face his Mac and started pecking his way around the keyboard. Pia surmised he was adding her changes to the original manuscript. Pia took a seat without being asked. If she waited to be asked, she’d be standing all day.

Pia had enjoyed laboring over the Lancet piece. Scientific writing was something she enjoyed and seemed to have a facility for. Over the previous three years, Pia had collaborated with Rothman on his salmonella studies and had even got credit as one of the authors on several. It had been exciting work. Rothman was continuing his award-winning, landmark research that he had accomplished concerning salmonella virulence, a subject for which he’d won his Nobel and Lasker prizes. Virulence was the microorganism’s ability to invade and kill its host cells, something salmonella was particularly good at. Over the years Rothman had found, classified, and defined the five pathogenicity “islands,” or areas, in the salmonella genome that encoded for various virulence-related factors such as specific toxins and antibiotic resistance, both of which had contributed to salmonella being by far the largest cause of human food-borne illness in the world. Every year salmonella caused the mortality and morbidity of countless millions of people. Every year typhoid fever alone still killed upwards of half a million people, a situation Rothman had his sights on rectifying and was coming closer to each year.

Initially when Pia first joined Rothman’s lab, she had been more interested in his newer area of research, namely stem cells, and had hoped to work with them. But he had had other ideas and wanted her to cut her teeth with his continuing salmonella work. As time passed she’d become as committed as he in the microbiological arena, fascinated by bacteria and viruses in general and salmonella in particular and the microscopic realm they inhabited. Soon she found herself reveling in the involved science while enjoying the thrill of working with one of the greatest minds on the subject. On a daily basis Pia had come to relish refining her knowledge of genetics so that she could one day make her own contribution to basic research. Gradually she had come to realize how exciting research could be and how well it fit with her personality.

Pia watched Rothman type away in front of her. The level of his concentration was truly remarkable. One minute he’d been talking with her, the next he was totally absorbed, as if she were no longer in his presence. Pia did not take any aspect of his behavior personally. After he’d confided about his Asperger’s, she’d read about the syndrome and guessed that many aspects of his personality were dictated by it, even ignoring her as he was doing at that moment. Instead of being annoyed, she thought about the content of the article she’d rewritten. It was about studies that Rothman had been doing involving salmonella typhi grown in outer space on the orbiting International Space Station. Rothman had found that growing the bacteria in a zero-gravity environment made it enormously more virulent than control bacteria grown back on earth. It was Rothman’s belief that the conditions in space somehow mimicked to a marked extent those present in the human ileum, triggering the bacteria to turn on the genes in the pathogenicity islands to produce effector proteins. Pia was one of the few people who knew that at that moment in the refrigerated storage facility inside the biosafety unit there were three strains of these enormously virulent, space-grown salmonella. She also knew that what Rothman wanted to do was to figure out how zero gravity caused these changes with the hope of learning how to turn them off, not only in space but in the human ileum as well.

Although Pia had learned to be patient in Rothman’s presence, she had her limits. After a few minutes had gone by Pia coughed lightly. She’d found by experience that coughing seemed to penetrate Rothman’s concentration more than anything else. Almost immediately he peered around the screen of his Mac and pushed a box of tissues in her direction. He had a phobia about people coughing in his presence. He was, after all, a firm believer in the “germ” theory. Pia took one of the obligatory tissues.

“Right. Miss Grazdani, for this month’s assignment . . .” He disappeared from her sight again. He resumed his two-finger typing but at least kept talking. She couldn’t see his face but she preferred it that way, which he did too as both had trouble maintaining eye contact not only with each other but with everyone else as well. “I want to move you over into our induced stem cell work. You’ve done a knockout job with salmonella, but it’s time you started in the other arena.”

A smile of anticipation appeared on Pia’s face. Rothman’s words were music to her ears.

“We’ve been making breakthrough discoveries of late involving organogenesis.”

Pia’s heart picked up speed. It was the first time Rothman had talked to her about his stem cell work. She knew what organogenesis meant as the word was self-explanatory. It was now the cutting edge of stem cell research. It was the last hurdle before creating organs that could be transplanted into patients-organs like hearts, lungs, and kidneys. It thrilled her to think that Rothman was making enormous leaps forward. And the idea that she would become part of the effort gave her chills down her spine.

“At this stage our biggest problem is that tissue culture techniques and fluids have not kept up with the breakthroughs that we’re making. Current tissue culture techniques were developed for sheets of cells, not solid organs. I’m sure you can gather what I mean. It relates to oxygenation and removing metabolic waste while maintaining acid base balance within extremely narrow parameters. It’s been basically a combination of pushing the limits of biochemistry and engineering. We have come up with some impressive hardware breakthroughs, but the involved fluids have not kept pace. The problem that is now holding us back is the acid base balance. My guess is that the pH is varying too much. We can’t figure out why. What I want you to do is to become a tissue culture fluid expert and figure out why we’re having this pH problem. Got it?”

“I think so,” Pia managed. She had learned that it was never a good ploy to question any of Rothman’s directives. Anything and everything could be discussed again, but not on the spur of the moment.

“Good! Get to it! And when I finish making these changes in the manuscript, I’ll see that Marsha gets you a copy for your final review. Now get out of here!”

Rothman’s typing picked up pace, a few keystrokes followed by several frantic deletions. Pia kept her seat despite Rothman’s final comment. She sensed that this was all the information she was going to get about her month’s elective at the moment, and it wasn’t much. Inwardly, she shuddered a little. She had expected to be working on some aspect of Rothman’s salmonella research as she’d done in the past. Tissue culture was a new discipline for her and what she was being tasked to do sounded like an entire Ph.D. project, not a month’s assignment. She was going to need a lot of help from Rothman and from the other technicians, especially Nina Brockhurst, whose job it was to take care of the physical plant of Rothman’s organ-growing experiments, which would include the baths. In the past Nina had openly resented Pia, claiming Rothman played favorites with her. Pia had taken the situation in stride as she knew there was always intrigue when people were forced to work together, especially when the boss’s signals were so hard to read.

But whatever the workload and her colleague’s demeanor, Pia knew she was going to find the month fascinating. Even if the fluid bath assignment wasn’t, on the face of it, very exciting in and of itself, it was still vital experience she would be gaining, learning the basic techniques for taking care of newly created organs, a key steppingstone in the journey from studying organogenesis in mice to studying it in people. Most important, the work was in the stem cell arena: the place she believed she really wanted to be.

Pia coughed again, this time into the tissue that she had in her hand. Rothman’s face reappeared around the side of his Mac. His expression was one of surprise that Pia was still there.

“I went to see the mother superior at the convent last night,” she said. “I told her about my not wanting to go to Africa.”

“Good,” Rothman said simply. His face disappeared. The typing recommenced.

“She was nice about it, but I could tell she was not happy.”

“That’s her problem, not yours. You’ll be doing a lot more of God’s work here in my lab than going to any godforsaken part of Africa.”

“She said she did not want to be repaid.”

“Good for her. So don’t.”

“I think I should. Are you still willing to cosign for a fifty-thousand-dollar loan?”

“I am, but I think you’re crazy. She doesn’t want to be repaid, or so she says. Save your money.”

“She used the word ‘betrayal,’ ” Pia said. She knew she was distorting the reason the mother superior had chosen to use the word, but the fact that she had used it at all still bothered Pia.

Rothman gave a short, mocking laugh. “Betrayal! She’s just trying to foist some Catholic guilt on you, Pia. For chrissake, pay her the money if you need to and be done with it. I’ll have Marsha take care of it with my bank. As a fourth-year medical student, I’m sure your credit is adequate. Remember, it’s your life, not the mother superior’s. Now, get out of here and get to work.”

Pia got up and left Rothman to his typing. Passing Marsha, she thought about hitting the library. Her initial plan was to read everything on tissue engineering that she could get her hands on. She had no doubt it was going to be an overwhelming amount of information.