University Hospital, Boston
It ought to be raining, thought Luke Abramson. It ought to be gray and miserable, with a lousy cold rain pelting down.
Instead, the hospital room was bright, with mid-December sunshine slanting through the windows. In the bed lay eight-year-old Angela, Luke's granddaughter, frail and wasting, her eyes closed, her thinned blond hair spread across the pillow. Angela's parents, Luke's only daughter and his son-in-law, stood on the other side of the bed, together with Angela's attending physician. Luke stood alone.
He'd been playing tennis in the university's indoor court when the phone call from the hospital came. Or, rather, doggedly going through the motions of playing tennis. Nearly seventy-five, even doubles was getting beyond him. Although the younger men tried to take it easy on him, more than once Luke had gloomily suggested they start playing triples.
And then came the phone call. Angie was terminal. He had rushed to the hospital, bundling his bulky parka over his tennis shorts and T-shirt.
"Then there's nothing ...?" Luke's daughter, Lenore, couldn't finish the sentence. Her voice choked in sobs.
Norrie, Luke called to her silently, don't cry. I'll help you. I can cure Angie, I know I can. But he couldn't speak the words aloud. He watched Lenore sobbing quietly, her heart breaking.
And Luke remembered all the other times when his daughter had come to him in tears, her deep brown eyes brimming, her dear little form racked with sobs. I'll fix it, Norrie, he had always told her. I'll make it all better for you. Even when his wife died after all those painful years of battling cancer, Lenore came to her father for comfort, for protection against the terrible wrongs that life had thrown at them.
Now Lenore stood with her husband, who wrapped an arm protectively around her slim, trembling shoulders. Del towered over little Lenore, a tall, athletic figure standing firmly beside his diminutive, grief-stricken wife. He's being strong for her, Luke knew. But he could see the agony, the bitterness in his clenched jaw and bleak eyes.
The physician, Dr. Tamara Minteer, replied in a barely audible whisper, "We can make her as comfortable as possible. I'll contact Hospice and —"
"It's all right." Angela's tiny voice cut the doctor short. She had opened her eyes and was trying to smile. "It doesn't hurt. Not at all."
Lenore and Del leaned down over their daughter's prostrate body, both of them in tears. Dr. Minteer looked as if she wanted to cry, too, but she held herself stiffly erect and looked straight at Luke, standing on the other side of the bed.
I can cure her, Luke told her. He didn't have to say it aloud. He knew Minteer understood what was in his mind. She knew it. And she rejected the idea.
* * *
Glioblastoma multiforme is a particularly pernicious form of brain cancer. Stubbornly resistant to radiation and chemotherapy, it usually kills its victims in a matter of months. It rarely strikes children, but eight-year-old Angela Villanueva was one of those rare cases.
Luke Abramson was a cellular biologist at the end of his career. Approaching seventy-five, he had been under pressure for some years from the university's management to accept retirement gracefully and go away. Professor Abramson was well liked by his students and practically adored by his small laboratory staff, but his associates on the university's faculty found him cantankerous, stubborn, frequently scornful of his colleagues, and totally unwilling to go in any direction but his own. His retirement would be a blessing, they thought.
Cancer had been the curse of Luke's family. Both his parents had been cut down by cancers, his father's of the lungs and his mother's of the ovaries. His wife, good-natured and health conscious, had succumbed to bladder cancer despite a lifetime of carefully watching her diet and faithfully exercising to keep her weight down.
It was if some invisible supernatural monster haunted his family, Luke thought. An implacable enemy that took his loved ones from him, year after year.
Luke had anxiously watched over his only daughter, and was thankful to a deity he really didn't believe in when Lenore grew up cancer-free. But deep in his consciousness he knew that this was no victory. Cancer was out there, waiting to strike.
It devastated him when it struck, not his daughter, but her child, Angela. Glioblastoma multiforme. Inoperable brain cancer. Little Angie would be dead in six months or less. Unless Luke could prevent it.
* * *
Leaving angela with her grieving parents, Luke followed Dr. Minteer as she strode determinedly down the busy hospital corridor. The hallway bustled with people hurrying to and fro; it seemed to Luke more crowded than Grand Central Station.
He was puffing. First tennis and now a freaking foot race, he thought. We must look comical: a lean, bent old man with bad knees and what was left of his hair shaved down to a whitish fuzz, chasing after a slim, dark-haired oncologist. God, look at her go. Sleek and lithe as a prowling cheetah.
"Hey, Doc, slow up," he gasped.
Tamara Minteer stopped altogether and turned to face him. Slightly taller than Luke, she wasn't exactly beautiful, he thought: Her nose was a trifle too sharp, her lips on the thin side. But she was elegant. That was the word for her: elegant. She moved like a cat, supple and graceful. Almond-shaped green eyes set above high cheekbones. Glossy raven-black shoulder-length hair. At the moment, though, her lean, taut face was set grimly, her brilliant emerald eyes snapping.
"I know what you're going to say, Professor, and —"
"Luke," he wheezed. "My name is Luke."
"It's no good, Professor," Minteer continued, her voice low, throaty. "You can't wave a magic wand and cure your granddaughter."
Don't lose your freaking temper, Luke commanded himself. You need her. Don't turn her off.
He sucked in a breath. "It's not a magic wand and you know it. It's manipulating the telomeres, and I've got solid experimental evidence for its efficacy."
"In lab mice." Minteer resumed walking along the corridor, but at a slower pace.
"And chimps," Luke said, hurrying to keep up with her.
That stopped her. Minteer looked surprised. "I hadn't heard about chimpanzee experiments."
"One chimp. NIH won't let us have any more, something about the mother-loving animal rights activists. As if we were hurting them."
"You got positive results in a chimpanzee?"
Luke waggled a hand. "Sort of. We haven't published yet."
Minteer shook her head and started along the corridor once again. "I can't let you use your granddaughter as a guinea pig."
"She's going to die, for God's sake!" Luke barked. Several people in the corridor turned to stare at him.
Minteer kept walking, her soft-soled shoes squeaking on the tiled floor. She reached her office door and yanked it open, Luke two steps behind her.
He followed her into the office and closed the door tightly, then leaned against it, puffing. "You ought to be in the Olympics, Doc," he said, breathless.
"And you should be retired," Minteer snapped as she headed for her desk, her body as rigid as a steel bar.
It was a small office, windowless, efficiently lit by glareless light panels in the ceiling. Everything in its place, except for a bilious green spider plant that had overflowed its pot and spread halfway across the bookcase in one corner of the room.
"Let me try to save her," Luke pleaded. "She's my only grandchild, for God's sake."
"It's a totally unproven therapy. How can I let you experiment on an eight-year-old child?"
"So you're going to let her die? Is that what you call practicing medicine?"
"Don't tell me what I should be doing," Minteer snapped.
"Somebody's got to!"
Glaring at him, she said, "You know I can't approve it."
"Yes you could."
"I don't have the authority."
"But you could recommend it."
"How can I recommend a therapy I don't believe in?"
"What freaking difference does it make? Angie's going to die unless you let me help her!"
"You can't help her. We've tried targeted bacterial vectors and immunotherapy. Nothing's worked. She's going to die, whatever you do."
"And you'll be killing her mother, too. This'll kill Lenore."
That hit home. He could see it in her face.
"I'm no good at begging," Luke said, hating the whine in his voice. "But please. For God's sake, please!"
Her rigid stance softened a little. She looked away from him, then slowly sank into her swivel chair. Luke remained standing in front of the desk.
"Recommend it to the executive committee," he urged again. "Please. It's Angie's only chance."
Minteer locked her eyes on Luke's. For an eternally long moment she said nothing, just stared at him. At last she nodded slowly and said, "I can't recommend your therapy, Professor. It's just a lab experiment."
Before he could protest, she added, "But I can ask the committee to hear you out."
"Thanks! Thanks a lot," said Luke. Then he abruptly turned and left Dr. Minteer's office. He desperately needed to find the nearest men's room.
Executive Committee Meeting
This is a waste of time, Luke realized.
It had taken two days for the executive committee to agree to hear him out. Two days taken from Angela's lifetime. Luke watched them as they came into the conference room and took their seats along the table. They've already made up their minds. He could see it in their faces. They resent being here. They won't listen to anything I say.
Twelve men and women, like a jury. Senior members of the hospital staff and the university faculty. They were all younger than Luke; four of them had been students of his, at one time. But they had stopped being active research scientists years ago. They were administrators now, paper shufflers, decision makers — who had already made their decision.
All right, he told himself. You've got to change their stupid hidebound minds. Stay cool. Don't get angry with them. Don't let them see what you really think of them.
He went through his presentation carefully, using his best lecture manners. No jokes, of course. Totally serious. Life or death. His slides flicked across the screen at the head of the room. His words bounced off the walls. The committee members shifted in their chairs, waiting for the end.
At last Luke showed his final slide. "As you can see," he said, working his laser pointer down the list of test results, "by activating the controlling gene set we increase the body's production of telomeres, which rejuvenates the subjects and alleviates the symptoms of aging."
He thumbed the button on his remote that turned off the projector and turned on the ceiling lights.
Luke's legs ached, and he desperately wanted to urinate, but he remained standing at the front of the conference room. The committee members glanced back and forth at each other. No one spoke.
Finally, one of his former students, now head of the university's grant committee, cleared his throat noisily. "Luke, your work with telomerase is very interesting, but I don't see how it could possibly apply to Angela Villanueva's case."
A better reaction than he had expected. Luke made a smile as he replied, "Glioblastoma multiforme is a form of cancer."
"A very dangerous form," said one of the women, halfway along the table. She was plump and gray-haired, wearing a stylish slate gray dress and a pearl choker beneath her double chin.
Nodding, Luke went on. "Cancer cells multiply wildly, they don't stop proliferating. But if we can inhibit their production of telomerase, we can kill them."
"Wait a minute, back up a bit," said the committee's chairman, Odom Wexler, a small, roundish black money manager with a fringe of silvery beard and wire-rimmed tinted eyeglasses. Frowning puzzledly, he asked, "Inhibiting their telomerase will kill the cancer cells? How's that work?"
Christ, Luke snarled silently, didn't you listen to anything I told you?
Patiently, he explained. "All normal cells reproduce a certain number of times, then they stop reproducing."
"The Hayflick Limit. I understand that."
"Cancer cells don't have a Hayflick Limit. They just go on reproducing, making more of themselves, building tumors that just grow and grow."
"Unless we intervene with radiation or chemotherapy," said the dean of the psychiatry department, a handsome man dressed in a navy blue three-piece suit. He had a leonine mane of silvery hair and a smile that had reassured countless wealthy wives.
"There's also surgery," added the surgeon seated down at the foot of the conference table.
"Surgery, of course," the psychiatrist muttered.
"All of those interventions have serious side effects," Luke said. "In Angela's case, surgery is impossible, and both radiation and chemo have been ineffective."
"And your intervention doesn't have serious side effects?"
Ignoring the snide tone of the question, Luke continued explaining. "Telomeres control the cells' reproduction rate. Each time a cell reproduces, the telomeres at the ends of the chromosomes shrink a little."
"Telomeres are sort of like aglets at the end of a shoelace, aren't they?" asked a balding man seated across the table from the chairman. He was a financial guy, a glorified accountant, neither a physician nor a scientist.
"Like aglets, right," said Luke. "Telomeres protect the ends of the chromosome strings, keep them from unraveling. But they shrink every time the cell reproduces."
"And when they get small enough the cell stops reproducing," said one of Luke's former students. "Everybody knows that."
You always were a smug little prick, Luke said to himself. Aloud, he replied, "And when your cells stop reproducing, you begin to get the symptoms of aging. Your skin wrinkles. Your eyesight fades. Your muscles weaken. When enough of your cells stop reproducing, you die."
His former student, almost smirking, said, "Telomeres were a hot subject for a while, back in the nineties. The cure for aging, they thought."
"They were right," Luke snapped.
"Inject telomerase into the body," the younger man continued, "and you regrow the cells' telomeres. The fountain of youth."
"It works," Luke insisted.
"It works on genes that mice and human beings have in common. It will work on humans. I'm sure of it!"
Before the back-and-forth could grow into a really bitter argument, Chairman Wexler interrupted. "But what's all this got to do with Angela Villanueva's case?"
"As I explained before," Luke said, trying to hold on to his temper, "by inhibiting her telomerase production we can kill the cancer cells."
"But what about the other cells of her body?" asked the gray-haired woman.
"We'll be inhibiting their telomerase production, too, of course. But the cancer cells will die long before her somatic cells become endangered."
"How do you know that?"
"I showed you my experimental evidence —"
"But that's with lab mice!" said one of the younger men. "You can't expect us to approve a human trial with nothing more than mouse experiments to go on. The FDA would shut us down in two seconds flat!"
Luke stared at him. He wasn't much more than forty, and he'd made his way through the political jungles of academia by smilingly agreeing with almost everyone but then going ahead ruthlessly with his own ideas. He never stuck his neck out, though. He always had underlings do his dirty work, and he had no compunctions about chopping their heads off when he had to.
"If you told the FDA that you approved the therapy and wanted to do a clinical test —"
"No, no, no," said Wexler, wagging his bearded head back and forth. "Luke, you know as well as I do that it takes years to get FDA approval for any new procedure. Then there's the state medical board and at least three other federal agencies to get through."
"There's an eight-year-old girl dying!"
"That's regrettable, but we can't put this hospital in jeopardy by going ahead with an unapproved therapy."
Luke exploded. "Then you pea-brained idiots might just as well put a gun to my granddaughter's head and blow her freaking brains out!"
He strode angrily down the length of the table, past the stunned committee members, and stormed out of the room.