Fever

Four

Flipping the pages of an old issue of Time magazine, Cathryn wrestled with a resurgence of anxiety. At first Dr. Wiley’s waiting room had been a sanctuary from the horrors of the rest of the hospital, but as time passed uncertainty and foreboding began to reassert themselves. Glancing at her watch she saw that Michelle had been back in the examining area for over an hour. Something must be wrong!

She began to fidget, crossing and uncrossing her legs, checking her watch repeatedly. To her discomfort there was no conversation in the room and almost no movement except for the hands of a woman who was knitting and the erratic gestures of two toddlers playing with blocks. All at once Cathryn realized what was bothering her. Everything was too flat, without emotion. It was like a two-dimensional picture of a three-dimensional scene.

She stood up, unable to sit still for another moment. “Excuse me,” she said walking over to the nurse. “My little girl, Michelle Martel. Do you have any idea how much longer she’ll be?”

“The doctor hasn’t told us,” said the nurse politely. She sat with her back painfully straight so that her substantial buttocks protruded out the back of her chair.

“She’s been in there for a long time,” said Cathryn, searching for some reassurance.

“Dr. Wiley is very complete. I’m sure she’ll be out shortly.”

“Does he frequently take over an hour?” asked Cathryn. She felt superstitiously ambivalent about asking any questions at all, as if the asking would influence the ultimate outcome.

“Certainly,” said the nurse receptionist. “He takes whatever time he needs. He never rushes. He’s that kind of a doctor.”

But why does he need all that time, wondered Cathryn as she returned to her seat. The image of Tad with his plastic cell kept returning to Cathryn’s troubled mind. It was a horrifying shock to realize that children do get serious illnesses. She had believed that it was a rare occurrence that happened to someone else’s child, a child one didn’t know. But Tad was a neighbor, her daughter’s friend. Cathryn shuddered.

Picking up yet another magazine, Cathryn glanced at the advertisements; there were smiling, happy people, shining floors, buying new cars. She tried to decide what to fix for dinner but never completed the thought. Why was Michelle taking so long? Two more mothers arrived with pink swathed parcels that were obviously babies. Then came another mother and child: a small boy about two with a huge violaceous rash that covered half his face.

The waiting room was now packed and Cathryn began to have trouble breathing. Getting up to make room for the second mother carrying her infant, Cathryn tried to avoid seeing the two-year-old with the horribly disfiguring rash. Her fears mounted. It had been over an hour and twenty minutes since she’d left Michelle. She realized she was trembling.

Once again she approached the nurse and self-consciously stood before her desk until the woman acknowledged her presence.

“Can I help you?” she said in a painfully courteous manner. Cathryn wanted to reach over and shake this woman whose starched whiteness inflamed Cathryn’s precarious emotions. She didn’t need politeness, she needed warmth and understanding, an ounce of sensitivity.

“Do you think it could be possible,” asked Cathryn, “to find out what’s taking so long?”

Before the receptionist could respond, the door to her left opened and Dr. Wiley leaned into the room. He searched the waiting area until his eyes found Cathryn. “Mrs. Martel, can I speak to you for a moment?” His voice was noncommittal and he turned back inside, leaving the door ajar.

Cathryn hurried after him, nervously touching the flowered combs in her hair to be sure they were in place, and closed the door behind her carefully. Wiley had retreated to his desk but had not sat down in the chair. Instead he was half-sitting on the front edge, his arms folded across his chest.

Exquisitely sensitive to every nuance, Cathryn scrutinized Dr. Wiley’s broad face. His forehead was deeply lined, something Cathryn hadn’t noticed on her first encounter. The man didn’t smile.

“We need your permission for a test,” said Dr. Wiley.

“Is everything all right?” asked Cathryn. She tried to sound normal but her voice was too high.

“Everything is under control,” said Dr. Wiley. Unfolding his arms, he reached out for a paper on his desk. “But we need to do a specific diagnostic test. I’m going to need your signature on this form.” He handed the paper to Cathryn. She took it, her hand quivering.

“Where is Michelle?” Cathryn’s eyes scanned the form. It was written in standard medicalese.

“She’s in one of the examining rooms. You can see her if you’d like although I’d rather go ahead with this test before you do. It’s called a bone marrow aspiration.”

“Bone marrow?” Cathryn’s head shot up. The words evoked the awesome image of Tad Schonhauser in his plastic tent.

“It’s nothing to be alarmed about,” said Dr. Wiley, noticing Cathryn’s shocked response. “It’s a simple test, very similar to taking a sample of blood.”

“Does Michelle have aplastic anemia?” blurted Cathryn.

“Absolutely not.” Dr. Wiley was perplexed at her response. “We want to do the test in order to try to make a diagnosis, but I can assure you Michelle does not have aplastic anemia. If you don’t mind my asking, what made you ask that?”

“Just a few minutes ago I visited our neighbor’s child who has aplastic anemia. When you said bone marrow, it…” Cathryn struggled to complete her own sentence.

“I understand,” said Dr. Wiley. “Don’t worry. I can assure you that aplastic anemia is not a possibility here. But we still want to do the test… just to be complete.”

“Do you think I should call Charles?” asked Cathryn. She was relieved that Michelle couldn’t have aplastic anemia and grateful to Dr. Wiley for eliminating it as a possibility. Although Charles had said aplastic anemia wasn’t infectious, its proximity was frightening.

“If you’d like to call Charles, by all means. But let me explain a little. Bone marrow aspiration is done with a needle similar to the one we use for drawing blood. We use a little local anesthesia so it’s practically painless, and it only takes a few moments. And once we have the results we’ll be done. It’s truly a simple procedure, and we do it often.”

Cathryn managed a smile and said they could go ahead with the test. She liked Dr. Wiley, and she felt a visceral confidence in the man, especially since Charles had undoubtedly picked him from a group of pediatricians he knew well, back when Chuck had been born. She signed the forms where Dr. Wiley pointed, then allowed herself to be escorted out of the office and back into the crowded waiting room.

Michelle lay very still on the examining table. Even with her head propped up on the pillow her view was mostly ceiling with frosted glass over fluorescent lighting. But she could see a little wallpaper, enough to make out images of laughing clowns, rocking horses, and children with balloons. There was a sink in the room, and although she couldn’t see it from where she was, she could hear the water dripping.

For Michelle the hospital had lived up to her fears. She’d been stuck with needles three times. Once in each arm and once in a finger. Each time she’d asked if it was the last but no one would say, so she was afraid it might happen again, especially if she moved too much, so she stayed very still.

She felt embarrassed to be dressed so scantily. She had on a nightie of sorts, but it was open in the back, and she could feel her skin on the paper which covered the table. By looking down, she could see the mounds made by her toes beneath the white sheet that covered her. Even her hands were under the cover, clasped together over her stomach. She’d been shivering a little but didn’t tell anyone. All she wanted was her clothes and to go home. Yet she knew the fever was back and she was afraid someone might notice and then want to stick her again. They had told her that the reason they needed her blood was to find out why she kept getting the fever.

There was a scraping sound, and the door to the examining room opened. It was the fat nurse, and she was backing into the room so that her form filled the doorway. She was pulling something, and Michelle heard the telltale sound of metal jangling against metal. Once clear of the door, the nurse swung around, pushing a small table on wheels. The table was covered with a blue towel. As far as Michelle was concerned, it didn’t look good.

“What’s that?” she asked anxiously.

“Some things for the doctor, sweetheart,” said Miss Hammersmith, as if she were talking about treats. Her name tag was pinned high on her shoulder like a battle ribbon, above the band of her bosom which went around her chest like an innertube. There seemed to be as much flesh in the back as the front.

“Is it going to hurt?” asked Michelle.

“Sweetheart, why do you ask that kind of question? We’re trying to help you.” Miss Hammersmith sounded offended.

“Everything the doctor does hurts,” said Michelle.

“Now that’s hardly true,” scoffed Miss Hammersmith.

“Ah, my favorite patient,” said Dr. Wiley, opening the door with his shoulder. Coming into the room he kept his hands away from his body because they were wet and dripping onto the floor. Miss Hammersmith broke open a paper package, and Dr. Wiley carefully pulled out a sterile towel with his thumb and forefinger. Most alarming to Michelle, he was wearing a surgical mask.

“What are you going to do?” she asked, her eyes opened to their physical limits. She forgot her resolve about staying still and pushed herself up on one elbow.

“Well, I’m afraid I’ve got good and bad news,” said Dr. Wiley. “I’m afraid you have to have one more little needle stick but the good news is that it will be the last for a while. What do you say?”

Dr. Wiley tossed the towel onto the counter by the sink and plucked out a pair of rubber gloves from a package Miss Hammersmith held open for him.

With growing dismay, Michelle watched him pull the gloves onto each hand, snapping the wrist portion into place and tugging on each finger in turn.

“I don’t want any more needles,” said Michelle, her eyes filling with tears. “I just want to go home.” She tried not to cry but the harder she tried, the less successful she was.

“Now, now,” soothed Miss Hammersmith as she began stroking Michelle’s hair.

Michelle parried Miss Hammersmith’s hand and tried to sit up, but she was restrained by a cinch about her waist. “Please,” she managed.

“Michelle!” called Dr. Wiley sharply, then his voice softened. “I know you don’t feel well, and I know this is hard for you, but we have to do it. It will be over in a moment if you help us.”

“No!” said Michelle defiantly. “I want my father.”

Dr. Wiley gestured to Miss Hammersmith: “Maybe Mrs. Levy could come in here for a moment and give us a hand.”

Miss Hammersmith lumbered out of the room.

“Okay, Michelle, just lie back and relax for a moment,” said Dr. Wiley. “I’m sure your dad will be real proud of you when I tell him how courageous you were. This is only going to take a moment. I promise.”

Michelle lay back and closed her eyes, feeling the tears run down the side of her face. Intuitively she knew that Charles would be disappointed if he heard that she’d acted like a baby. After all, it was going to be the last stick. But both her arms had been punctured and she wondered where they would do it.

The door opened again and Michelle propped herself up to see who it was. Miss Hammersmith came in followed by two other nurses, one of whom carried some leather straps.

“We won’t need restraints, I don’t think,” said Dr. Wiley. “Okay, Michelle, now just lie back quietly for a moment.”

“Come on, sweetheart,” cajoled Miss Hammersmith, coming up alongside Michelle. One of the other nurses went around to the opposite side while the nurse who had been carrying leather straps went down to the foot of the table. “Dr. Wiley is the best doctor in the world and you should be so thankful he’s taking care of you,” said Miss Hammersmith as she pulled Michelle’s sheet down over the child’s legs. Keeping her arms stiffly against her side, Michelle half-heartedly tried to resist when Miss Hammersmith pulled up the nightie to expose the child’s body from her nipples to her bony knees.

She watched while the nurse whisked the towel from the table with the wheels. Dr. Wiley busied himself with the instruments on it, his back to her. She could hear the tinkle of glass and the sound of fluid. When the doctor turned, he had a wet piece of cotton in each hand. “I’m just going to clean your skin a little,” he explained as he began scrubbing Michelle’s hipbone.

The water felt alarmingly cold to Michelle as it ran down her hip and pooled beneath her buttocks. This was a new experience, not like the previous needles. She strained to see what was happening, but the doctor gently urged her to lie back.

“It will be over in just a moment,” said Miss Hammersmith.

Michelle looked at the faces of the nurses. They were all smiling but they were fake smiles. Michelle began to feel panic. “Where are you going to stick me?” she shouted, trying again to sit up.

As soon as she moved, she felt strong arms grip her and force her back. Even her ankles were locked in an iron grasp. She was pressed firmly back onto the table, and the restriction inflamed her panic. She tried to struggle but felt the hold on her limbs tighten. “No!” cried Michelle.

“Easy now,” said Dr. Wiley as he floated a gun-metal colored drape with a hole in the center over Michelle’s pelvis and positioned it on her hipbone. Turning back to the small table, Dr. Wiley busied himself. When he reappeared in Michelle’s view he was holding a huge syringe with three stainless steel finger rings.

“No!” cried Michelle and with all her might she tried to break from the grasp of the nurses. Instantly she felt the crushing weight of Miss Hammersmith settle on her chest, making breathing difficult. Then she felt the sharp pain of a needle pierce her skin over her hipbone followed by a burning sensation.

Charles bit off the corner of his pastrami on white, catching a stray piece of meat with his fingers before it fell to the desktop. It was a mammoth sandwich, the only good thing put out by the institute cafeteria. Ellen had brought it back to the lab since Charles did not want to see anyone and, except for his brief foray to the First National Bank, he’d stayed at his desk poring over the Canceran experimental protocol. He’d been through all the lab books, and to his surprise, he found them well-organized. He began to feel optimistic that completing the study would not be as difficult as he had initially imagined; maybe they could get it done in six months. He swallowed what he had in his mouth and chased it down with a slug of lukewarm coffee.

“The one good thing about this project,” said Charles, wiping his mouth with the back of his hand, “is the size of the grants. For the first time we’ve got money to burn. I’ll bet we can get that new automatic counter we’ve wanted as well as a new ultra centrifuge.”

“I think we should get a new chromatography unit,” said Ellen.

“Why not?” said Charles. “Having been railroaded into this project, we owe it to ourselves.” He put the sandwich back down on the paper plate and picked up his pencil. “Here’s the way we’ll handle this thing. We’ll start out with a dose of 1/16 of the LD50.”

“Wait,” said Ellen. “Being in immunology, it’s been a while since I’ve done this kind of thing. Refresh me. The LD50 is the dose of a drug that causes 50 percent death in a large population of test animals. Right?”

“Right,” said Charles. “We have the LD50 for mice, rats, rabbits, and monkeys from the toxicity studies done on Canceran before they started the efficacy studies. Let’s start out with the mice. We’ll use the RX7 strain bred for mammary tumors because Brighton ordered them and they’re here.”

With his pencil, Charles began to make a flow diagram of the project. While he wrote, he spoke, explaining to Ellen each step, particularly how they would increase the dosage of the drug and how they would expand the study to include rats and rabbits as soon as they got some preliminary data from the mice. Because the monkeys were so expensive they would not be used until the very end when the information from the other animals could be extrapolated and applied to a statistically significant group. Then, assuming positive results, a method of randomization would be worked out with each species to ensure suitable controls. These fresh animals would then be treated with the optimum dosage level of Canceran determined from the first part of the study. This portion of the project would be carried out so that neither Charles nor Ellen would know which animals had been treated until after each had been sacrificed and studied and recorded.

“Whew,” sighed Ellen as she stretched her arms back. “I guess I didn’t know what was involved.”

“Unfortunately there’s more,” said Charles. “Each animal, after they’re autopsied, has to be studied not only microscopically, but also with the electron microscope. And…”

“All right already!” said Ellen. “I get the picture. But what about our own work? What are we going to do?”

“I’m not sure,” said Charles. He put down his pencil. “I guess that’s up to both of us.”

“I think it’s more up to you,” said Ellen. She was sitting on a high stool with her back against the slate-topped workbench. She was wearing a white laboratory coat which was unbuttoned, revealing a beige sweater and a single strand of small, natural pearls. Her soft hands were folded together and lay still in her lap.

“Did you mean what you said about working nights?” asked Charles. In his mind he tried to estimate the feasibility of continuing the work on the mysterious blocking factor while they labored with Canceran. It would be possible, although they’d have to put in long hours and slow down considerably. But even if they were able to isolate a single protein in a single animal which functioned as a blocking agent, they’d have something. Even if only one mouse became immunized to its tumor, it would be spectacular. Charles was well aware that success with a single case was hardly a reason to generalize, but he felt that a single cure would provide the basis for convincing the institute to back his work.

“Look,” said Ellen. “I know how much this work of yours means to you, and I know you think you’re close to some sort of a conclusion. I don’t know whether it’s going to be positive or negative in the final analysis but that doesn’t matter. You need to know. And you will. You’re the most stubborn person I ever met.”

Charles examined Ellen’s face. What did she mean, stubborn? He didn’t know whether it was a compliment or an insult, and he had no idea how the conversation had switched to his personality. But Ellen’s expression was neutral, her unfathomable eyes unwavering.

Noticing Charles’s stare, Ellen smiled, then said: “Don’t look so surprised. If you’re willing to work nights, so am I. In fact, I can bring in some things to eat on the days we work evenings so we can have supper right here.”

“I’m not sure you realize how tough it will be,” said Charles. “We’d be practically living here.”

“The lab is bigger than my apartment,” said Ellen with a laugh, “and my cats take care of themselves.”

Charles turned his gaze back to his recently concocted flow diagram. But he wasn’t thinking about Canceran. He was wrestling with the advisability of working evenings with Ellen. “You understand that I have no idea whether I can get Morrison to pay you overtime?” he said.

“I don’t…” began Ellen, but she didn’t finish. The phone interrupted them.

“You answer it,” said Charles. “I don’t want to talk with anyone.”

Ellen slid off her stool and, leaning on Charles’s shoulder, reached across his desk for the receiver. Her hand rested on Charles as she said hello, but it was quickly removed. Abruptly she dumped the receiver in his lap and walked away. “It’s your wife.”

Charles fumbled for the phone as it slid between his legs, retrieving it by pulling on the coiled cord. Of all the times for Cathryn to be calling, he thought.

“What is it?” he asked impatiently.

“I want you to come over here to Dr. Wiley’s office,” said Cathryn in a stiffly controlled voice.

“What’s going on?”

“I don’t want to discuss it over the phone.”

“Cathryn, this hasn’t been a good morning for me. Give me an idea of what’s happening.”

“Charles, just come over here!”

“Cathryn, the roof has fallen in on top of me this morning. I can’t leave now.”

“I’ll be waiting for you,” said Cathryn. Then she hung up.

“Fuck!” shouted Charles as he slammed down the receiver. He swung around in his chair and saw that Ellen had retreated behind her desk. “On top of everything, Cathryn wants me over at the pediatrician’s office but won’t tell me what it’s about. God! What else can happen today?”

“That’s what you get for marrying a typist.”

“What?” asked Charles. He’d heard but the comment seemed out of context.

“Cathryn doesn’t understand what we are doing. I don’t think she can comprehend the pressures you feel.”

Charles peered quizzically at Ellen, then shrugged. “You’re probably right. Obviously she thinks I can just drop everything and run over there. Maybe I should call Wiley and find out what’s going on.” Charles snapped the phone off the hook and started dialing, but midway he stopped. Slowly he replaced the receiver. The thought of Michelle planted a seed of concern under his irritation. Vividly he remembered the morning’s nosebleed. “I’d better run over there. It won’t take very long.”

“But what about our schedule?” asked Ellen.

“We’ll talk more when I get back. Meanwhile why don’t you prepare the dilution of Canceran for the mice. We’ll inject the first batch as soon as I return.” Charles went over to the metal locker near the door and pulled out his coat. “Have the mice brought up here to our own animal room. It will make it a lot easier.”

Ellen watched the door close behind Charles. No matter what she resolved outside of the lab, whenever she was face to face with him, it seemed that her feelings were hurt. Ellen knew it was absurd but she couldn’t protect herself. And now she felt such a mixture of disappointment and anger that she could have cried. She had allowed the idea of working together at night to excite her. But it was stupid, adolescent. She knew deep down that it would not lead to anything and ultimately cause her more heartache.

Thankful for something specific to do, Ellen forced herself over to the counter where the sterile bottles of Canceran had been left. It was a white powder, like confectioner’s sugar waiting for the introduction of sterile water. It wasn’t as stable in solution as it was in solid form so it had to be reconstituted before it was used. She got out the sterile water, then used the desktop computer to work out the optimum dilution.

As she was getting out the syringes, Dr. Morrison came into the lab.

“Dr. Martel isn’t here,” said Ellen.

“I know,” said Morrison. “I saw him leave the building. I wasn’t looking for him. I wanted to talk to you for a moment.”

Putting the syringe down, Ellen thrust her hands into her jacket pockets and came around the end of the counter to face the man. It was not usual for the head of the department of physiology to seek her out, especially behind Charles’s back. Yet with everything else that had happened that morning, she wasn’t all that surprised. Besides, Morrison’s face had such a Machiavellian look that such intrigue seemed appropriate.

Coming over to her, Morrison produced a slim, gold cigarette case, snapped the case open, and extended it toward Ellen. When she shook her head, Morrison withdrew a cigarette. “May I smoke in here?” he asked.

Ellen shrugged. Charles didn’t allow it but not because of danger. He just hated the smell. Ellen felt a stab of rebellious joy as she tacitly acquiesced.

Morrison produced a gold lighter that matched his cigarette case from his vest pocket and made an elaborate ritual out of lighting his cigarette. It was a staged gesture, designed to keep Ellen waiting.

“I suppose you know what has happened today concerning the Brighton case,” said Morrison at length.

“A little bit,” agreed Ellen.

“And you know that Charles has been selected to continue the Canceran study?”

Ellen nodded.

Morrison paused and blew smoke out in successive rings. “It’s extremely important for the institute that this study be concluded… successfully.”

“Dr. Martel has already started on it,” said Ellen.

“Good. Good,” said Morrison.

Another pause.

“I don’t know exactly how to put this,” said Morrison. “But I’m concerned about Charles messing up this experiment.”

“I don’t think you have anything to worry about,” said Ellen. “If there’s one thing you can count on with Charles, it is scientific integrity.”

“It’s not his intellectual capabilities that concern me,” said Morrison. “It’s his emotional stability. To be perfectly candid, he seems a bit impulsive. He’s hypercritical of everyone else’s work and seems to feel he has a corner on the scientific method.”

Impulsive? The word hit a familiar chord in Ellen’s memory. As if it were yesterday she could remember the last evening she’d spent with Charles. They’d had dinner at the Harvest Restaurant, gone back to her apartment on Prescott Street, and made love. It had been a warm and tender night, but as usual Charles had not stayed over. He’d said he had to be home when the children woke up. The next day at work he had behaved as he always did, but they never went out again and Charles never offered a word of explanation. Then he’d married the temporary typist. It seemed like one day Ellen heard he’d been seeing this girl, and the next he was marrying her. Ellen agreed that impulsive was a good description of Charles; impulsive and stubborn.

“What do you want me to say?” said Ellen, struggling to bring her mind to the present.

“I guess I want you to reassure me,” said Morrison.

“Well,” said Ellen. “I agree that Charles is temperamental, but I don’t think it will influence his work. I think you can count on him to do the Canceran study.”

Morrison relaxed and smiled, his small teeth visible behind thin lips. “Thank you, Miss Sheldon. That’s exactly what I wanted to hear.” Reaching into the sink, he ran water on his half-smoked cigarette and dropped it into the wastebasket. “One other thing. I was wondering if you would do me and the institute a big favor. I’d like you to report any abnormal behavior on Charles’s part in relation to the Canceran project. I know this is an awkward request, but the entire board of directors will be grateful for your cooperation.”

“All right,” said Ellen quickly, not sure how she really felt about it. At the same time she thought that Charles deserved it. She’d put forth a lot of effort for the man and he’d not appreciated it. “I’ll do it with the proviso that anything I say remains anonymous.”

“Absolutely,” agreed Morrison. “That goes without saying. And, of course, you will report to me directly.”

At the door, Morrison paused. “It’s been nice talking with you, Miss Sheldon. I’ve been meaning to do it for some time. If you need anything, my office is always open.”

“Thank you,” said Ellen.

“Maybe we could even have dinner sometime.”

“Maybe,” said Ellen.

She watched the door close. He was a strange-looking man but he was decisive and powerful.