ONE
Advance Genetics Lab
Walters, New York
A VOLCANO ERUPTING IN the open jaw of a shark.
As Lydia Susi leaned into the monitor, one half of her brain identified the image for what it was, a PET-CT scan of the chest of a twenty-nine-year-old male with extensive stage small-cell lung cancer. The cross section, which cut the patient’s rib cage in horizontal slices, showed the tumors in the right lung, which seemed bigger to her, and two new masses on the left side. Given that this was both positron emission tomography with F-fluorodeoxyglucose in conjunction with computed tomography, the growths were well visualized, but also appearing as hot spots given the highly metabolically active abnormal cells.
It was a very clear and helpful diagnostic picture of a dying man’s respiratory landscape, and yet, her Ph.D. in biology aside—as well as forgetting about the last six months of looking at similar images—she was nonetheless struggling to stay connected to what she was looking at and what it all meant: i.e., that the traditional immunotherapy, just like the chemotherapy, hadn’t worked.
“Daniel…” she whispered as the doctor beside her cued up the next cut and continued to drone on.
Instead of properly processing any of the information, her brain continued to treat the slideshow as a Rorschach test of avoidance, her thoughts skipping away from the grim news to pull random pictures out of the oblong frame of red-tinted shadows and yellow-and-orange clouds. It wasn’t stage four cancer run amok, no, absolutely not. It was a first-generation video game, where you could drop a crudely pixelated soldier onto an alien planet and use the boulders of tumor growth to take cover behind while blocky monsters chunked around and tried to eat you. No, wait, it was a plate in a psychedelic buffet line, with only the baby new potatoes part of the Grateful Dead entrée having been spooned on. How about Jackson Pollock, in his little-known oncology period? Sofa slipcover pattern? Bowl of fruit.
The visual extrapolation that finally stuck was that of a volcano, her mental cracked-up-Krakatoa seated where the spine formed a little triangular notch on the bottom of the chest cavity’s slice, the ghostly point of the vertebra seeming to launch an eruption that was tinted with that angry Kool-Aid red and the comic strip yellow and the autumn hearth orange, the whole of it contained within an outline that reminded her of that scene in Jaws, when Chief Brody goes to Quint’s to hire the contractor to kill the shark.
All those boiled, open jawbones hanging around, their graceful contours like the shape of the rib cage.
Here’s to swimmin’ with bowlegged women.
“I beg your pardon?”
Lydia looked over at the white-coated doctor who’d been talking at her. Given that the man was staring over in surprise, she’d clearly shared that little ditty about genu varum out loud—and what do you know. She hadn’t properly processed him, either. Trying to remember his name, she failed, and if she had to describe him ten minutes from now, she knew she’d suck at that, too. Then again, he had anonymous looks, his thinning brown hair side parted, his unremarkable eyes myopic behind rimless glasses, his facial features functional rather than attractive. With his surgical scrubs hanging loose on a thin, nonathletic body, it was like his IQ was so high, his brain co-opted all of the available nutrients and calories out of his digestive tract before they ever got a chance to fill him out.
The one thing she did know about him, and that she would never forget, was that he was a brilliant oncologist.
“Sorry,” she mumbled. “Please continue.”
He pointed to the screen with the tip of his Montblanc pen, the little white star on the top making the rounds of the tumor growth like a fly trying to decide where to land. “As you can see here, the primary site has increased by—”
“Yeah, yeah, she knows that already.”
As the booming voice cut through the narrative, Lydia thought, Thank God.
Turning away from the monitor, she clung to the eyes of the man who marched up to them. Augustus St. Claire was unlike every other researcher and clinician. Standing well over six feet tall, with an Afro and a wardrobe that consisted solely of t-shirts from the sixties, he looked like someone who belonged in Jimi Hendrix’s band. Instead, he was the leader of this privately financed facility that was exploring medical advances well under the radar of the Food and Drug Administration.
Today Gus was wearing a well-washed H. R. Pufnstuf number, the pattern seafoam green, the background mustard yellow, the name done in those trippy, melt-y sixties letters.
“I’ll take care of this,” he said. “Thanks.”
The other doctor opened his mouth to argue the dismissal. No doubt he was the type who had succeeded at everything academic and professional in his life and was more used to people welcoming him into discussions, especially if they were about life-and-death medical issues. But when Gus stared him down, he clipped that black pen with its icy bathing cap back into the pocket protector on his white coat and ambulated himself out of the boardroom.
The glass-and-chrome door eased shut, and for a moment, Lydia looked through the bank of floor-to-ceiling panes that ran down the front of the space. The underground laboratory on the far side was so vast, she couldn’t see the end of the facility, all the workstations and equipment in shades of gray and white, all the people who bent over microscopes, and put liquid into tubes, and frowned into the screens of laptops, in bright blue and white blocks of scrubs and doctor coats.
“How long’s he got, Gus.”
Even though she knew. Still, some stupid desperation on her part tossed the question out into the air, the fishing expedition for some kind of hope, any kind, guaranteed to come up with an empty hook.
Guess she had internalized these new scans, after all.
Gus went around the long black table with its stable of leather chairs. There were projector screens at both ends of the room, and she imagined the scans being reviewed here by the senior staff. They were not going to be surprised. Small-cell lung cancer, especially in its late stages, was an absolute bitch.
“You want something to drink?” Gus said.
Down the long wall of the room, a layout of sodas, sparkling waters, and fruit juices had been arranged on a credenza, everything from the labels on the branded bottles and cans, to the crystal glassware, to the ice cubes in their refrigerated dispenser, lined up with OCD precision, a platoon of libations reporting for duty in the war against dehydration.
“So do you want anything?”
“No, thanks,” she replied.
Gus helped himself to a room-temperature Coke, popping the top of a can and pouring the Real Thing down his throat like he was dousing a fire in his abdomen.
Lydia waited until he took a break halfway through to catch his breath. “I want to know how much time. And enough with the I-don’t-answer-questions-like-that and every-patient-is-different bullshit. We’re way past that point now, and you know it.”
She turned back to the view out into the laboratory. All those brilliant minds working around the clock, trying to create a future that wasn’t going to come fast enough. At least not for the person she cared about.
As Gus came across to her, she braced herself, but all he did was glance over his shoulder at all the drinks like he desperately wanted to bring something to her.
Crossing her arms, she nodded at the laptop on the table. “FYI, I will launch this thing at you if you try to offer me an orange juice.”