1
It sounded like something was rattling the bars of an animal cage. Her frail, purple-veined hands were tightly wrapped around the slats of the safety rails, and she was working them with the full force of her emaciated frame. The racket made it down the empty hall to the nurses’ station.
The young nurse said, “She’s at it again.”
The ward supervisor didn’t look up from her paperwork.
“Are you sure we’re not allowed to restrain her?” the young nurse asked.
“She’s the only one on the ward. Who’s she going to bother?”
“Me?”
The supervisor told her that if she was so irritated, she could call Dr. Steadman and ask for a restraint order.
“I’m not calling him for that,” the young nurse said, horrified. “Can’t I page the fellow on call?”
“Steadman’s personally handling all her orders.”
“Well, I’m not calling him.”
“Fine.”
Then the high-pitched shouting started.
Shrieks. Rattles. Shrieks. Rattles.
The young nurse buried her face in her palms. “God, not that too. What’s she saying?”
“It’s Japanese. Do I look like I speak Japanese?”
“Can’t she speak English?”
“She did. She only remembers Japanese.”
Another nurse, this one older, emerged from the medication room and said, “I’m pretty sure she’s saying she’s hungry and wants rice.”
“How do you know?” the young nurse asked.
“Her daughter-in-law told me. It’s either that or she’s wet herself.”
“You don’t remember which?” the supervisor asked.
A shrug. “She cycles between them.”
“Would you check on her?” the supervisor asked.
The young nurse complained about having to gown up again. When she returned a few minutes later she said, “I guess she’s hungry.”
“Dry?” the supervisor asked.
“Bone dry. I just wasted twenty dollars of isolation garments to find out she wants rice half an hour after she had breakfast.”
“She forgets she’s eaten,” the older nurse said. “My father got that way.”
“What time is Steadman doing the deed?” the young nurse asked.
“Sometime this morning,” the supervisor said.
“Maybe by the time my shift starts tomorrow she’ll be using the call button and watching soaps.”
“Dream on.”
*
Roger Steadman arrived mid-morning, trailed by an entourage. He sailed down the corridor, his unbuttoned, long white coat billowing like the spinnaker of the beautiful Beneteau he kept at Baltimore’s inner harbor. His ruddy tan and fluid mobility gave him the appearance of a younger man, but he was not young. He was one of the gray-beards at the Baltimore Medical Center, a legendary figure in American neuroscience, his curriculum vitae as thick as a small-town phone book.
“Ruth?” he called out to the nursing supervisor. “Is my patient ready for her close-up?”
All three nurses stood. He was old-school. He liked them on their feet. “She is, Dr. Steadman.”
“Well, good. Get the syringe and come help me into my gear.”
“You’re going to dose her yourself?”
“I am. History’s being made today. Mark your calendars, boys and girls,” he said to the students. “Years from now, this day could be hailed as the day we began to effectively treat, maybe even cure Alzheimer’s disease. I couldn’t very well pass up the chance to administer the first dose to Patient One. Besides if it’s not me, then Dr. Pettigrew is the only other physician on my team who’s gone through virus screening. I need him to take the pictures. Tell me you brought the camera, Colin.”
His research fellow, Colin Pettigrew, raised the Nikon and said in a doleful English accent, “I’ve got it right here.”
“Remember, the left side’s my good side. The right side’s pretty awesome too.” At the awkward silence he added, “You students, it’s okay to laugh once in a while. Don’t go through life taking yourself too seriously.”
Medical students and residents congregated in the hall outside the gowning anteroom while the nursing supervisor and two doctors donned gowns, masks, booties, and gloves. Via the intercom, Steadman put on a show, thinly disguised as a Q&A session.
“Mrs. Noguchi is the first patient in this Phase One clinical trial of a novel gene therapy for Alzheimer’s,” he said. “This is for the students, not you residents: what is a Phase One study designed to detect? Anyone. Call it out.”
An eager student raised her hand. “Safety.”
“Correct. Safety. We treat a small number of people sequentially, in this case up to ten patients with severe disease, and we do extensive safety profiling along the way. If all goes well, and I’m quite sure it will, we’ll conduct a far larger Phase Two trial designed to look for efficacy. Of course, we may get an early Christmas or Hanukkah present in Phase One and see an efficacy signal. We’ll know because we’ll be doing daily mental status and memory tests. Now, as I’ve said, this is a gene therapy trial. What are the essential components of a gene therapy?”
Another student piped up, “A targeted therapeutic and a virus for delivering it.”
Steadman let the nurse fasten his gown behind his back. “Correct. A virus and a payload. In this case the payload is a novel transcription factor, NSF-4, the recently discovered neprilysin-stimulating factor that we found to have a profound boosting effect on the natural production of neprilysin. Does anyone know what neprilysin is?”
A bearded student smoothly answered. “It’s a protease that accelerates the degradation of beta-amyloid.”
“And what, pray tell, is beta-amyloid?” Steadman asked.
Several students tried to answer but the bearded one jumped the queue. “It’s the toxic substance that builds up in the brains of Alzheimer’s patients. The protein tangles that form are thought to produce the dementia.”
“Correct,” Steadman said. “And kudos for knowing about neprilysin. You’re the first student who’s been able to answer that.”
The bearded one kept on going. “I believe NSF-4 was discovered by Jamie Abbott at Harvard.”
Steadman hid his irritation behind the surgical mask. “How on earth did you know that?”
“I got a PhD in neuroscience before going to med school.”
“From where?”
“Harvard.”
“Well that explains Dr. Abbott. Jamie is a junior colleague of mine. My contribution to the discovery and elucidation of NSF-4 is well known, of course, and the construction of this gene therapy product was exclusively my work.”
Steadman wiggled thick fingers into sterile gloves.
“All right, almost ready,” he said. “The idea here is to get high concentrations of NSF-4 into the brain to chew up the beta-amyloid tangles and reverse the Alzheimer’s dementia. Before I do the procedure, who, other than our PhD friend knows why we just don’t administer neprilysin or NSF-4 directly instead of going through all the complexity of gene therapy?”