Fever

Prologue

The poisonous molecules of benzene arrived in the bone marrow in a crescendo. The foreign chemical surged with the blood and was carried between the narrow spicules of supporting bone into the farthest reaches of the delicate tissue. It was like a frenzied horde of barbarians descending into Rome. And the result was equally as disastrous. The complicated nature of the marrow, designed to make most of the cellular content of the blood, succumbed to the invaders.

Every cell exposed to the benzene was assaulted. The nature of the chemical was such that it knifed through the cell membranes like steel through butter. Red cells or white, young or mature, it made no difference. Within some lucky cells where only a few molecules of benzene entered, enzymes were able to inactivate the chemical. In most others the destruction of the interior membranes was immediate.

Within minutes the concentration of the benzene had soared to the point that thousands of the poisonous molecules had reached the very heart of the marrow, the primitive, finely structured stem cells. These were the actively dividing units, serving as the source of the circulating blood cells, and their activity bore witness to hundreds of millions of years of evolution. Here, being played out moment by moment, was the incredible mystery of life, an organization more fantastic than the wildest scientific dream. The benzene molecules indiscriminately penetrated these busily reproducing cells, interrupting the orderly replication of the DNA molecules. Most of these cells either halted the life processes in a sudden agonal heave or, having been released from the mysterious central control, tumbled off in frenzied undirected activity like rabid animals until death intervened.

After the benzene molecules had been washed away by repeated surges of clean blood, the marrow could have recovered except for one stem cell. This cell had been busy for years turning out an impressive progeny of white blood cells whose function, ironically enough, was to help the body fight against foreign invaders. When the benzene penetrated this cell’s nucleus, it damaged a very specific part of the DNA but did not kill the cell. It would have been better if the cell had died because the benzene destroyed the fine balance between reproduction and maturation. The cell instantly divided and the resulting daughter cells had the same defect. No longer did they listen to the mysterious central control and mature into normal white blood cells. Instead they responded to an unfettered urge to reproduce their altered selves. Although they appeared to be relatively normal within the marrow, they were different from other young white blood cells. The usual surface stickiness was absent, and they absorbed nutrients at an alarmingly selfish rate. They had become parasites within their own house.

After only twenty divisions there were over one million of these lawless cells. By twenty-seven divisions there were over one billion; they then began to break free from the mass. First a trickle of sick cells entered the circulation, then a steady stream, finally a flood. These cells charged out into the body eager to establish fertile colonies. By forty divisions they numbered over a trillion.

It was the beginning of an aggressive, acute myeloblastic leukemia in the body of a pubescent girl, starting December 28, two days after her twelfth birthday. Her name was Michelle Martel and she had no idea except for a single symptom: she had a fever!