DARKEST FEAR (6 page)

The elevator opened on the tenth floor. Directly in front of him, there was a rainbow-hued “Save the Rain Forest” mural, painted, according to the sign, by the “pediatric patients” of the hospital. Save the Rain Forest. Oh, like these kids didn’t have enough on their plate, right?

Myron asked a nurse where he might find Dr. Singh. The nurse pointed to a woman leading a dozen interns through the corridor. Myron was a little surprised to see that Dr. Singh was of the female persuasion, mostly because he had somehow imagined her being a man. Terribly sexist, but there you go.

Dr. Singh was, as her name strongly implied, Indian, from-India Indian as opposed to Native American Indian. Mid-thirties, he figured, her hair a lighter brown
than what he was used to seeing on India Indians. She wore a white doctor coat, of course. So did all the interns, most of them appearing to be about fourteen years of age, their white coats more like smocks, like they were about to finger-paint or maybe dissect a frog in a junior high biology class. Some wore grave expressions that were almost laughable on their cherubic faces, but most emanated that medical-intern exhaustion from too many nights on call.

Only two of the interns were men—boys really—both sporting blue jeans, colorful ties, and white sneakers like waiters at Bennigan’s. The women—to call them girls would use up Myron’s anti-PC quota for the week—favored hospital scrubs. So young. Babies taking care of babies.

Myron followed the group at a semi-discreet distance. Every once in a while he glanced in a room and immediately regretted it. The corridor walls were festive and brightly painted, jammed with Disney/Nick Junior/PBS kiddie images and collages and mobiles, but Myron only saw black. A floor filled with dying children. Bald little boys and girls in pain, their veins blackened by toxins and poisons. Most of the children looked so calm and unafraid and unnaturally brave. If you wanted to see the stark terror, you had to look in the eyes of the parents, as though Mom and Dad were sucking the horror toward them, taking it on so that their child wouldn’t have to.

“Mr. Bolitar?”

Dr. Singh met his eye and held out her hand. “I’m Karen Singh.”

Myron almost asked her how she did this, how she stayed on this floor day in and day out, watching children die. But he didn’t. They exchanged the usual pleasantries. Myron had expected an Indian accent, but the only thing he picked up was a little Bronx.

“We can talk in here,” she said.

She pushed open one of the superheavy, superwide doors endemic to hospitals and nursing homes, and they stepped into an empty room with stripped beds. The barrenness ignited Myron’s imagination. He could almost see a loved one rushing into the hospital, repeatedly pushing the elevator call button, diving inside, pushing more buttons, sprinting down the corridor into this silent room, the bed being stripped by a nurse, then the sudden cry of anguish ….

Myron shook his head. He watched too much TV.

Karen Singh sat on the corner of the mattress, and Myron studied her face for a moment. She had long sharp features. Everything pointed down—her nose, her chin, her eyebrows. Sort of harsh.

“You’re staring,” she said.

“I don’t mean to.”

She pointed to her forehead. “You were maybe expecting a dot?”

“Er, no.”

“Very good, then let’s get to it, shall we?”

“Okay.”

“Mrs. Downing wants me to tell you whatever you want to know.”

“I appreciate your taking the time.”

“Are you a private investigator?” she asked.

“More like a family friend.”

“Did you play basketball with Greg Downing?”

Myron was always surprised by the memory of the public. After all these years, people could still recall his big games, his big shots, sometimes with more clarity than Myron could. “You’re a fan?”

“Nope,” she said. “Can’t stand sports actually.”

“So how did you—”

“Just a deduction. You’re tall and about the right age and you said you were a family friend. So …” She shrugged.

“Nice deduction.”

“It’s what we do here when you think about it. Deduce. Some diagnoses are easy. Others must be deduced from the evidence. You ever read Sherlock Holmes?”

“Sure.”

“Sherlock said that you should never theorize before you have facts—because then you twist facts to suit theories rather than twisting theories to suit facts. If you see a misdiagnosis, nine times out of ten they ignored Sherlock’s axiom.”

“Did that happen with Jeremy Downing?”

“As a matter of fact,” she said, “it did.”

Somewhere down the hall, a machine started beeping. The sound hit the nerves like a police taser.

“So his first doctor screwed up?”

“I won’t get into that. But Fanconi anemia isn’t common. And because it looks like other things, it’s often misdiagnosed.”

“So tell me about Jeremy.”

“What’s to tell? He has it. Fanconi anemia, that is. In simple terms, his bone marrow is corrupted.”

“Corrupted?”

“In layman’s term, it’s shit. It makes him susceptible to a host of infections and even cancers. It commonly turns into AML.” She saw the puzzled look on his face and added, “That’s acute myelogenous leukemia.”

“But you can cure him?”

“ ‘Cure’ is an optimistic word,” she said. “But with a bone marrow transplant and treatments with a new flu-darabine compound, yes, I believe his prognosis is excellent.”

“Fluda-what?”

“Not important. We need a bone marrow donor that matches Jeremy. That’s what counts here.”

“And you don’t have one.”

Dr. Singh shifted on the mattress. “That’s correct.”

Myron felt the resistance. He decided to back off, test another flank. “Could you take me through the transplant process?”

“Step by step?”

“If it’s not too much trouble.”

She shrugged. “First step: find a donor.”

“How do you go about that?”

“You try family members, of course. Siblings have the best chance of matching. Then parents. Then people of similar background.”

“When you say people of similar background—”

“Blacks with blacks, Jews with Jews, Latino descent with Latino descent. You’ll see that quite often in marrow drives. If the patient is, for example, a Hasidic Jew, the donation drives will take place within their shuls. Mixed blood is usually the hardest to match.”

“And Jeremy’s blood or whatever you need to match—it’s fairly rare?”

“Yes.”

Emily and Greg were both of Irish descent. Myron’s family came from the usual potpourri of old Russia and Poland and even a little Palestine thrown in. Mixed blood. He thought about the paternity implications.

“So after you exhausted the family, how do you search for the match?”

“You go to the national registry.”

“Where are they located?”

“In Washington. You listed?”

Myron nodded.

“They keep computer records there. We search for a preliminary match in their banks.”

“Okay, now assuming you find a match in the computer—”

“A
preliminary
match,” she corrected. “The local center calls the potential donor and asks them to come in. They run a battery of tests. But the odds of matching are still fairly slim.”

Myron could see that Karen Singh was relaxing, comfortable with the familiar subject matter, which was exactly what he wanted. Interrogations are a funny thing. Sometimes you go for the full frontal attack,
and sometimes you sidle up, friendly-like, and sneak in the back. Win put it simpler: Sometimes you get more ants with honey, but you should always pack a can of Raid.

“Let’s suppose you find a full-fledged donor,” Myron said. “What then?”

“The center acquires the donor’s permission.”

“When you say ‘center,’ do you mean the national registry in Washington?”

“No, I mean the local center. Do you have your donor card in your wallet?”

“Yes.”

“Let me see it.”

Myron took out his wallet, flipped through about a dozen supermarket discount cards, three video club memberships, a couple of those buy-a-hundred-coffees-get-ten-cents-off-the-hundredth coupon, that sort of thing. He found the donor card and handed it to her.

“See here,” she said, pointing to the back. “Your local center is in East Orange, New Jersey.”

“So if I was a preliminary match, the East Orange center would call me?”

“Yes.”

“And if I ended up being a full match?”

“You’d sign some papers and donate marrow.”

“Is that like donating blood?”

Karen Singh handed the card back to him and shifted again. “Harvesting bone marrow is a more invasive procedure.”

Invasive. Every profession has its own buzzwords. “How so?”

“For one thing, you have to be put under.”

“Anesthesia?”

“Yes.”

“And then what do they do?”

“A doctor sticks a needle through the bone and sucks the marrow out with a syringe.”

Myron said, “Eeuw.”

“As I just explained, you’re not awake during the procedure.”

“Still,” Myron said, “it sounds much more complicated than giving blood.”

“It is,” she said. “But the procedure is safe and relatively painless.”

“But people must balk. I mean, most probably signed up the same way I did: They had a friend who was sick and ran a drive. For someone you know and care about, sure, you’re willing to make a sacrifice. But for a stranger?”

Karen Singh’s eyes found his and settled in hard. “You are saving a life, Mr. Bolitar. Think about that. How many opportunities do you get to save a fellow human being’s life?”

He had hit a nerve. Good. “Are you saying people don’t balk?”

“I’m not saying it never happens,” she said, “but most people do the right thing.”

“Does the donor get to meet the person he or she is saving?”

“No. It’s totally anonymous. Confidentiality is very important here. Everything is held in the utmost secrecy.”

They were getting to it now, and Myron could sense that her defenses were starting to slide back up like a car window. He decided to pull back again, let her resettle on comfy ground. “What’s the patient going through during all this?” he asked.

“At what point?”

“While the marrow is being harvested. How do you prep the patient?” Prep. Myron had said “prep.” Like a real doctor. Who said watching
St. Elsewhere
was a waste of time?

“It depends on what you’re treating,” Dr. Singh said. “But for most diseases, the recipient goes through about a week’s worth of chemotherapy.”

Chemotherapy. One of those words that hush a
room like a nun’s scowl. “They get chemo before the transplant?”

“Yes.”

“I would think that would weaken them,” Myron said.

“To some degree, yes.”

“Why would you do it, then?”

“You have to. You’re giving the recipient new bone marrow. Before you do that, you have to kill the old marrow. With leukemia, for example, the amount of chemo is high because you have to kill off all the living marrow. In the case of Fanconi anemia, you can be less aggressive because the marrow is already very weak.”

“So you kill off all the bone marrow?”

“Yes.”

“Isn’t that dangerous?”

Dr. Singh gave him the steady eyes again. “This is a dangerous procedure, Mr. Bolitar. You are in effect replacing a person’s bone marrow.”

“And then?”

“And then the patient is infused with new marrow through an IV. He or she is kept isolated in a sterile environment for the first two weeks.”

“Quarantined?”

“In effect. Do you remember the old TV movie
The Boy in the Plastic Bubble
?”

“Who doesn’t?”

Dr. Singh smiled.

“Is that what the patient lives in?” Myron asked.

“A bubble chamber of sorts, yes.”

“I had no idea,” Myron said. “And this works?”

“Rejection is always a possibility, of course. But our success rate is quite high. In the case of Jeremy Downing, he can live a normal, active life with the transplant.”

“And without it?”

“We can keep treating him with male hormones and growth factors, but his premature death is inevitable.”

Silence. Except for that steady mechanical beep coming from down the hall.

Myron cleared his throat. “When you said that everything involving the donor is confidential—”

“I meant totally.”

Enough wading. “How does that sit with you, Dr. Singh?”

“What do you mean?”

“The national registry located a donor who matched Jeremy, didn’t they?”

“I believe so, yes.”

“So what happened?”

She tapped her chin with her index finger. “May I speak candidly?”

“Please.”

“I believe in the need for secrecy and confidentiality. Most people don’t understand how easy, painless, and important it is to put their name in the registry. All they have to do is give a little blood. Just a little tube of the stuff, less than you would for any blood donation. Do that simple act—and you can save a life. Do you understand the significance of that?”

“I think so.”

“We in the medical community must do all we can to encourage people to join the bone marrow registry. Education, of course, is important. So, too, is confidentiality. It has to be honored. The donors have to trust us.”

She stopped, crossed her legs, leaned back on her hands. “But in this case, something of a quandary has developed. The importance of confidentiality is bumping up against the welfare of my patient. For me, the quandary is easy to resolve. The Hippocratic oath trumps all. I’m not a lawyer or a priest. My priority must be to save the life, not protect confidences. My guess is that I’m not the only doctor that feels that way.

Perhaps that’s why we have no contact with the donors. The blood center—in your case, the one in East Orange—does everything. They harvest the marrow and ship it to us.”

“Are you saying that you don’t know who the donor is?”

“That’s right.”

“Or if it’s a he or she or where they live or anything?”

Karen Singh nodded. “I can only tell you that the national registry found a match. They called and told me so. I later received a call telling me that the donor was no longer available.”