Die Once Live Twice (31 page)

Rous shook his head. Jonathan was one of the brightest men he had ever met, and had this been anyone other than Marion, he knew Jonathan would be thinking more clearly. He knew when the sick person was your own wife, or your child, scientific medicine was meaningless if it provided no answers. “Here,” he said handing a slip to Jonathan. “Tell Spanezzi about Doctor Joe Megis in Boston. He’s just returned from Vienna, where he worked on a new debulking operation for pelvic cancer. He’s at Massachusetts General Hospital and the Pondville Cancer Hospital. I think he may be the best hope for Marion. I met him when I was in Europe right after my papers were published. He was one of the three that didn’t call me an idiot.” Rous chuckled heartily, hoping to lighten Jonathan’s mood, to no avail. Jonathan left without a word, wearing a dreadful vacant stare.

Phil spoke with Megis, who explained that the debulking operation was based on a rationale much like Halsted’s radical mastectomy—to remove all the affected tissues around the tumor. While debulking the pelvic tissues was risky, there was a longer survival rate among women in Europe who had this surgery compared to other choices. Jonathan remarked optimistically that his mother had lived six years after Halsted’s first mastectomy.

“Phil, if this gives me any chance for more time with my husband and son, I am willing to take the risk,” Marion said. “I know my motherin-law only by legend, but it seems the Sullivan women have a way of surviving all types of dangerous odds. How soon can we do this?” She looked Phil directly in the eye as she clenched Jonathan’s hand.

Marion now understood how and why Katherine came to her decision. The risk Katherine took had been the emblem of the life she lived and wished her children to follow. Personal sacrifices would be endured so medicine could progress. Marion knew she needed to show the same courage that Katherine had shown.
Neither she nor I will give up without a fight.

“Your mother would be proud of both of us today, wouldn’t she?” Marion smiled at Jonathan as they wheeled her down the corridor to the operating room. A feigned smile stretched across Jonathan’s tense face as he squeezed her hand.

“Remember all those years ago when we started Marion’s Clinic and you said you wanted to be part of the sacrifice I was making for medicine? How could we know that it would come to this?” She nodded and almost smiled. Kissing her ever so tenderly before she went through the doors, he whispered his love and devotion. “You are my life.” Too choked to speak, Marion wiped the tears from his face by rubbing her index finger across his cheeks.

Marion woke slowly in the recovery room. In her blurred vision, dull lights danced above her, helping to distract her from the pain washing through her body. A clock on the wall told her that she had been in surgery almost five hours, which meant Phil had indeed found cancer. The room began to tilt back and forth. Clinching her eyes tight to stop the swaying, she suddenly felt a sharp pain rip through her belly. Gasping in an effort to scream, she tried to rise, but was helpless when a faceless body dressed in white gently pushed her down in the bed. Another looked intently at a glass syringe. Phil and the nurses managed to medicate Marion back into fitful sleep.

Phil walked to the waiting area to speak with Jonathan, who was nearly drenched in nervous perspiration. Phil motioned him to walk down the hall to his small but elegantly decorated office, where he handed him a clean towel. “Jonathan, I am sorry. It was ovarian cancer. The surgery went as expected. I removed her uterus, fallopian tubes, and ovaries as planned. I did not find any other tumor in the peritoneal or retroperitoneal cavity, including the lymph nodes, which I removed. She can survive.” Jonathan looked at him hopefully while he continued.

“Now that I have removed the affected tissues, we should use penetrating radiation to her abdomen to kill any residual cancer cells. That is Marie Curie’s treatment. But we must wait until we know we have no infection. Radiation kills tissues, and you know how infection and dead tissues like each other. We are going to have to watch her very closely for the next few days.”

Some of the tension seemed to flow out of Jonathan’s body now that he knew what would happen. “Phil, I know about this new chemotherapeutic drug in Germany. It’s like Ehrlich’s Salvarsan. Are you using it?”

“No. We do not have anything like that available. You have the contacts in that arena, my friend. Find out what you can.”

Jonathan visited Peyton Rous again. “Peyton, Marion is in danger of a postoperative infection. Do you know Doctor Gerhard Domagk in Germany?”

“In Vienna I heard about him. A research scientist with Bayer Laboratories. He recently reported he had a chemotherapeutic agent that worked. The bacteria he studied was hemolytic streptococci. The drug, Prontosil, is a dye that turns fabric a golden red color. They said it turns the patient red too, but it works.”

“Peyton, do you know how I can get it? I don’t have time to go to Germany.” Jonathan was desperate.

“Give me a few hours. I will call around. Do you know anybody in Germany?”

“No—no, but I have a friend who does. I’ll make that call.”

Jonathan quickly called Frederick Specht’s office in Iowa City. He was in surgery so Jonathan begged the secretary to pass an urgent message to Frederick. Jonathan then called Helene and informed her of Marion’s danger and the German discovery. Could she think of anyone to call?

“I will call Lorenz Böhler in Vienna, Jonathan. I will notify Arthur Steindler, too.”

Jonathan waited in Marion’s room, poised to pick up the receiver. Time stood still. He had lost control of his life. Marion’s temperature was rising The drainage from her wound was no longer pure blood. It was cloudy
. My wife could die and I cannot do anything to stop it. God, it’s the same feeling I had during the Flu. I hate these damn germs.

As the hours passed, Jonathan knew the bacteria were multiplying with little constraint by Marion’s compromised immune system. Jackson had arrived from Harvard and slept in the bed next to his mother. Jonathan jumped at the first phone call, which was from Frederick. “I cannot be more sorry for you, Jonathan. I’ll wire Böhler in Vienna immediately. With the time difference it may be a few hours before a response.” Then Peyton Rous called to say that researchers in France were now certain the active ingredient in Prontosil was sulphanilamide and DuPont in Delaware had a small amount of it. But no one could confirm the French finding or had any idea of dosage. Jonathan knew the director of research at DuPont, but could not reach him until morning.

He sat up all night waiting for light to show through the window, fearing that time was running out. Marion’s infection had caused her abdomen to distend. Pus was draining from her abdominal wound and the vaginal repair. Spiking fevers kept her hair drenched. Ice was packed around her neck, in her armpits, and her groin. She was in and out of delirious dreams. Jonathan knew she had septicemia. The bacteria were in her blood and could land in any organ.
Please God, bring me morning. Bring me this drug
.

At first light, Jonathan got his first glimmer of hope. Frederick Specht called to say he had spoken with Böhler, who called Gerhard Domagk, who confirmed that sulphanilamide was the active ingredient. Domagk had been using the drug since 1932, so he was certain of its efficacy and safety. Frederick gave the dosages to Jonathan.

Jonathan reached the research director at Dupont by phone, and he agreed to provide the drug. Then Jonathan called Jimmy, who flew to Delaware and brought the drug back.

The morning of the fourth postoperative day sulfa was administered both intravenously and topically on the wounds. When Marion did not turn red, Jonathan became certain the drug was not working and his hope plunged into despair. But then he remembered that the color change happened with Prontosil.
Maybe it doesn’t happen with the derivative sulphanilamide.
Jonathan and Jackson sat together, silently praying for a miracle.

Phil spent hours with Jonathan at Marion’s bedside, worrying about the pus still draining from her vagina and her fever. “This bloody pus is the Devil’s blood. I despise it.” Phil was almost praying as he spoke to Jonathan. Marion’s fever kept spiking. “If this drug overcomes this infection it will be God’s victory over the Devil.”

“It would be the Christian victory at Jaffa. The clincher to opening up Jerusalem,” Jonathan said almost absent-mindedly.

Phil looked at him blankly. “What are you talking about?”

“Same thing you are—just a historical metaphor that my mother used.”

Marion seemed to rally in the afternoon. Her fever stopped spiking. She recognized Jonathan and Jackson and the three of them were able to talk of hope of recovery. Seventeen-year-old Jackson, a sophomore at Harvard, was exceptionally bright. During the hour he sat talking with his mother about his classes, his football season last fall, and his plans to go to medical school after one more year of college.

Then Marion’s fever rose again. It was as if the sulfa had blocked the bacteria for a while, but eventually the germs broke through and the infection had its way with Marion’s body. Shaking uncontrollably at times, she jabbered meaningless and sometimes unintelligible words. Phil knew the drug had failed to save her. Jonathan had not yet given up hope. Jonathan, Jimmy and Jackson maintained the vigil in her room, taking turns napping. Jackson’s pain was the worst as he had not yet experienced death and was watching his mother’s agony. He questioned his decision of a career in medicine. Did he have the resolve to watch patients go through this?

Jonathan was startled awake by a nurse tapping him on his shoulder. His brain registered the morning light in the window. “Doctor Sullivan, your wife’s breathing is erratic. I believe she is near death. You may want to say good-bye.”

Jackson was already draped across his mother, crying. Jonathan sat on the edge of the bed next to Marion. Wrapping his arm around his son’s shoulders, which lay across Marion’s chest, he leaned over her sleeping face. He kissed her lips and as her eyelids fluttered he smoothed her hair. She woke, momentarily lucid. “The two loves of my life. Why are you crying? God just asked me to sing lead soprano in his choir.” There was a smile on her lips as she exhaled.

Chapter Thirty-one

J
onathan opened one door to a small anteroom, pulled on a white coverall made of a fabric thick enough to prevent a mosquito from biting through it, and then a hood and gloves. When he rang the doorbell, Doctor Wilbur Sawyer admitted him to the yellow fever virology laboratory, which was housed on the top floor of the Rockefeller Institute.

Besides Sawyer and Max Theiler, who would win the Nobel Prize for yellow fever vaccine, only two lab technicians and Jonathan were allowed in the room. Sawyer had lost too many lab people who became infected and died after being bitten. Sawyer himself had been bitten, but survived. Doors opened only from the inside out and the double-door entry prevented an infected monkey from getting loose if it escaped from its cage. That had happened once and the monkey was captured in the lobby of a neighboring bank.

For the first year after Marion died, work at the Institute was all that kept Jonathan from incapacitating depression. He had never forgotten his promise to William Gorgas that he would find a vaccine for yellow fever, and that goal was nearing reality in Sawyer’s lab. Yellow fever was controlled in cities like Havana by mosquito eradication, but in rural areas, military camps, and in war the threat remained high. This research was his only relief from his despair. He had no energy to pursue his dream of bringing bacterial antagonism to clinical reality.

His loneliness at night was sometimes numbing, but visits by Spanezzi and other friends, or Jimmy, who flew in periodically, gave him some joy. After attending a speech on healthcare by FDR given in New Jersey in 1936, Jimmy reported, “FDR said the Federal Administration contemplates action only in the interests of doctors and nurses and that all attempts to put medicine into politics have and always will fail. Socialized medicine while FDR is president is dead.”

“I am not so concerned with that as I was before, Jimmy,” Jonathan ruminated. “I’ve lost interest in many issues. I only have one focus remaining in my final years. I want to see this yellow fever vaccine become reality. It will be my last project.”

“I hope you do. We all do. But I think government involvement in health care will be important for medical discoveries in my lifetime, Jonathan. That is why I care about avoiding socialized medicine. Time will tell.”

It was almost a year before Jonathan ventured out in society. In February, 1937, Spanezzi convinced him to meet for an evening in the Oak Room bar, his favorite haunt. Snow was falling and the large window framed a winter wonderland scene of Central Park. Few people were in the streets, but those passing by lowered their faces against the wind, huddled in the warmth of overcoats, scarves, hats, and gloves sprinkled white with snow.
What a wonderful winter evening,
Jonathan thought as he waited for Phil.
I wonder if Phil will have Danica with him tonight?
Phil and Danica had three children and she seldom left them.