Death of a Cure Read online

  Her look didn’t soften, but maybe one of the overworked facial muscles did relax. I’m sure it was more from some small measure of disappointment than from relief that she had not caught an actual trespasser. She contemplated what to do for about three seconds while her lips continued to press themselves into even smaller horizontal lines.

  “You have to leave this office immediately. You might have been associated with Doctor Briggs, but that doesn’t condone your presence in a private office. We can make a conference room available to you after we confirm your association with him, but you can’t stay here, and you can’t be rummaging about a society computer.”

  “Who are you?” I asked without showing the slightest sign of moving from the chair.

  “Not that it matters, but I am Margaret Townsend, executive vice president.”

  I ignored her momentarily and casually looked at the computer monitor as if she had never spoken. The email containing the backup was already showing as “sent.” I opened the “sent” folder and deleted the message.

  “STOP WHAT YOU ARE DOING THIS INSTANT!” she shouted, fully enraged.

  Leaning back in the chair, I put my feet up on the desk. “Are you planning to get any help or do you think you can toss me out all by yourself?” If I smoked I would have pulled one out and lit up.

  Her eyes all but bulged out of her head, and her mouth fell open. “Then I’ll call security,” she declared.

  “Are they armed?” I asked, stopping her retreat from the office.

  “What?” she stammered — confusion mounting.

  “Are they armed?”

  “I don’t know. What does that matter? They will arrest you for trespass.”

  “You’d better call the cops to help them out. Would you like me to call my friend Captain O’Dale, the commander of the 17th Precinct? I’m sure he’d be happy to send along a couple of uniforms to help you out. He seems very helpful,” I deadpanned.

  “Are you with the police?” she asked with a significant amount of caution creeping into her up until now demanding voice.

  “Worse,” I answered.

  “Worse?”

  “Yep. The military.”

  She stared at me, her confusion now complete.

  “Don’t sweat it, sweetheart,” I said as I rolled out of the chair and stood up. “I’ll go.”

  I walked the three steps across the office and looked down at her. She stepped back, fear replacing confusion. She was taller than most women and eye-to-eye with most men. My seventy-five inches, however, provided me with an elevation advantage. My eyes were unblinking and staring into her. She was used to having her height work for her as she dominated coworkers. This was unexpected.

  “As I see it, your considerate reception has just saved me a stack of greenbacks,” I said with a sarcastic tone and smile.

  She had moved from confusion to total bewilderment. I was enjoying this. “I have no idea what you mean,” she replied with a little of the huffiness returning with her retreat from the office.

  “Then let me explain. You’ve just insulted a multi-million dollar donor to this organization. I’ll let my chapter president know that because of you, Dr. Briggs’s brother, THE OTHER DOCTOR BRIGGS, has elected to redirect his family’s philanthropy. I’m sure she will make your blunder an agenda item at the next board meeting.”

  “Wait! Wait! I didn’t know you were his brother! You must understand!”

  “I understand well enough. The only thing I don’t understand is how Ron managed to tolerate you.”

  I stepped through the door, executed a heel-turn that would have made a Paris Island drill instructor proud, and headed for the elevator lobby. Leaving Townsend speechless — probably a first — and standing in the hallway, she was clenching her fists, looking quickly left and right, and generally not knowing what to do.

  I moved quickly by Suzie’s cubicle. The commotion had drawn an audience. She, along with about twenty others, had stood up to look over their dividers. Suzie looked at me with a worried expression. I winked back at her causing her to choke back a smile. She quickly dropped back into the security of the cube like a prairie dog that had come up, quickly sniffed danger, and tactically retreated. The other prairie dogs followed suit.

  Entering the elevator lobby, the receptionist was just getting off the phone with a pained look on her face.

  “Dr. Briggs! Can you please wait? Ms. Townsend just called, and she wants to meet with you in her office. Please don’t leave.” Her words were quick and her face worried.

  “She’s summoned me? That’s rich.”

  The receptionist was only partially successful at containing her amusement at my characterization. I didn’t think that Townsend had a lot of friends in the worker ranks.

  Before she could say anything else, I turned around and headed back from where I came. It would look like I was being a good boy and doing as told by the execu-bitch-in-charge-of-everything. As I rounded the corner, I was no longer under observation by the worried receptionist. Instead of continuing back to the executive offices, however, I opened the door to the stairwell, stepped through and moved quickly down the twenty-four flights to the lobby. At roughly five seconds per flight the descent was accomplished in two minutes. Pushing the lobby door open, I emerged next to the security area. Will was not at the desk, and his partner was engaged with someone else. I exited using the revolving door at the front of the lobby, turned right, and headed uptown. Confusion and frustration would again be a part of Margaret Townsend’s day. I hoped she wouldn’t beat up on the receptionist for not hog-tying me at the elevator. Don’t worry, Maggie. I’ll come back. Then you can really worry.

  I had stirred the pot. It felt right, but I didn’t know why.

  CIRCUMVENIO INFRACTUS

  DEMYELINATION

  It is an engineering marvel. Nothing in the known universe is as complex, as capable of carrying out so many chemical and physical processes in such a small yet mobile package. It is the assemblage of ten generalized systems that function together as one harmonious unit. It is self-healing, fragile, and yet highly adaptable over generational time. To most, the inner workings are a mystery. We each have one. We tend to take it for granted. The human body, ubiquitous, yet each one unique.

  My understanding of the human body, while considerable when compared to most people not involved in medicine or health science, was still in my estimation primitive. There is so much left to learn. There are so many areas of medicine where we are just getting started.

  Medical researchers today have determined that chronic disease often has a basis in genetics. Missing chromosomes, extra chromosomes, chromosomes with pieces damaged or duplicated or even swapped between chromosomes are the stuff of inherited disorders. Genes are also the tempering factors standing between you and environmental factors, good or bad.

  The problem with learning about chromosomes and genes is that it involves the study of Deoxyribonucleic Acid, or DNA. Most of us have seen the pretty pictures of the interlaced, double helix. We may have further learned that the body’s master program directing our development, appearance, and resistance to disease is laid out in the 3 million pairs of amino acids that contain our exact representation of the human genome. This all sounds highly organized with a very precise structure. Unfortunately, it’s nothing like this. Immediately under the covers is chaos. There never seemed to me to be any organizational structure to DNA’s contents. You will not find similar program subroutines gathered together based on function. The genes that regulate this or that are scattered about haphazardly, making any logical flow of program instructions impossible. A computer programmer looking at what is in a DNA strand would find neither an object-oriented approach nor a functional decomposition based upon a program’s objectives. Calling it spaghetti-code was way too generous. As important as genetics is to medicine, and even though I made myself learn all that I could stand in order to be the best doc that I could, I was never going to like it. Give me a broken par
t to fix – that’s a stand up fight I can win. Way too many of the gene boys remind me way too much of the sleazy intel operatives that we have to deal with. Nothing concrete, nothing you can ever depend upon, and a lot of excuses about the subtle complexity of their domain and how brilliant they are as the sleuths in this mystical world. I used to hear the frustration in my brother’s voice when he would tell me about the difficulty in pinning down the actual science allegedly underlying some researcher’s claim. He had the patience for it. I didn’t.

  I needed to find out the current state of research into finding a cure for CID. Due to the abbreviated stop at the CID Society headquarters, there was some extra time in the morning schedule. I walked back to the condo across midtown and around the bottom end of Central Park. Passing the towering buildings and by the perceived serenity of the park, I planned my next moves. Marilena was not due in for almost five hours. There was time to hit the gym and then do some research. My breakfast would hold me over; lunch was not a priority.

  I changed at the condo and walked less than two blocks to the gym where we had a membership. The hour of exercise was divided into equal parts of cardio and weight training and made me feel human again. As I dressed in the locker room, I noticed that my cell phone had received numerous calls from the same number. It was the three-digit prefix for Ron’s office. No surprise that someone at the CID Society was trying very hard to talk to me. The message-waiting indicator blinked ineffectively. I smiled and let it continue to blink.

  After returning to the condo, I fired up Ron’s home computer. I doubted that anyone would try to stop me this time. Launching his Internet browser allowed me to log into various medical sites that I use when I am in the field. In those cases, I am typically trying to learn more about a pathogen or a surgical technique to help me do my job. Today, I was going to look at a broader body of material.

  CID had been a familiar part of my life even though no one in the family had it. We were not a high-risk group due to our lineage and resulting genetics. I had studied it briefly in medical school, again during my neurology rotation as a resident, and had learned much more from my discussions with Ron about his work. If there was a connection between Ron’s death and his involvement at the society, I needed to know specifically what he was working on and whom he was working with. I began with a quick CID refresher just to set the stage. To do this, I turned off my surgeon-doctor thought process and replaced it with my lesser-developed clinician-doctor thought process.

  To begin with, the human body is protected by a highly sophisticated immune system. The immune system interacts with all of the other systems in the body. It is our last line of defense and comes into play when something bad penetrates the derma or is unintentionally infused along with the air we breathe, the water we drink, or the food we eat. The immune system senses invasion and musters the defenders. I couldn’t help myself. I always thought of the immune system in military terms — my own personal army, excuse me, Marine Corps. In my mind there are recon teams detecting and reporting incursion by enemy units into friendly territory. A command, control and communication system takes in the information and determines an appropriate response. Orders are sent out to build antibodies and white blood cells. The body’s infrastructure cranks the troops out, puts them on the blood vessel transport system where they hook on and parachute into the battlefield. The speed of the response and the industry demonstrated by the immune system would make any Pentagon logistics planner envious. Landing at the front, the troops are fearless and launch themselves at the invaders with kamikaze-like commitment to the cause — defense of the homeland. The system was anything but simple, and incredibly effective.

  Knowing a little about the immune system helps you understand many chronic diseases that afflict humans. There are hundreds of these disorders, from allergies to Lupus, some mild, some terrible, that cause the body’s normally well-intended immune system to run amuck. The immune systems of patients afflicted with one of these diseases have decided that some healthy part of the body that is supposed to be there is really an invader with evil intentions. The immune system attacks that body part as if it were the enemy. Using my military analogy, headquarters receives bad intel and friendly fire starts taking out the good guys. With a chronic disease, the intel never gets corrected, and the self-inflicted damage goes on and on.

  Some examples of autoimmune diseases that many people have heard of include Lupus, Rheumatoid Arthritis, Crohn’s Disease, also known as chronic inflammatory bowel disease, Multiple Sclerosis or MS, Cirrhosis and Circumvenio Infractus Demyelination, better known as CID. Curiously to many people, HIV is not an autoimmune disease. In the case of AIDs, a virus infects the body, hides, mutates, and replicates as part of the host’s DNA, and then attacks the immune system eventually reducing it to the extent where it becomes completely ineffective. The difference is simple: autoimmune diseases cause the immune system to attack an otherwise healthy body, the HIV virus attacks the immune system with the symptoms presenting themselves as an acquired immune deficiency.

  The discovery of CID was made by a Greek physician whose name escapes me. He stayed close to his roots by giving the disease a Greek-language derived name. Circumvenio translates to “surround,” Infractus means, “broken” or “impaired.” Demyelination was his reference to the impairment mechanism that affects the nervous system. In other words, that which surrounds the nerves is broken due to demyelination.

  The stuff that surrounds the nerves in our body is very important. When people talk about their brain, they sometimes refer to it as the “grey matter.” Surrounding the “grey matter” is the “white matter.” The “white matter” is called myelin. It is a fat-based material that insulates our nerves keeping them from firing off or short circuiting indiscriminately and not just when specifically ordered to do so. Demyelination is the loss of this important insulating material. Loss of myelin is also the cause of MS and believed to play a role in fibromyalgia. Unlike MS, CID affects both the central and peripheral nervous system — to my knowledge, it is the only neurological disease to do so. Further, it is strongly believed that CID has a genetic basis, but the onset requires some still to be determined trigger, either some other disease or an environmental factor yet to be discovered. It strikes only in the teenage years afflicting both males and females equally, but only those kids having some eastern European ancestry within the last eight to ten generations. The patients will live another ten to thirty years having symptoms not unlike MS before they die.

  I was contemplating breaking into the society’s network from the outside. After this morning, I was sure that any attempt from Ron’s office would not be possible. Having highbrow friends in low places, this would not be a major problem. In the meantime, I would look around on the outside. I searched Ron’s name and was amazed, and more than a little proud, at how many references there were to him and his accomplishments. Most of the publications, events, and awards were news to me. I wish he had told me about them.

  It appeared that Ron had recently been collaborating with a research team in Boston at a prestigious institution. His principal collaborator was Caroline Little, Ph.D., M.D. and most of the rest of the alphabet. A recently published paper described the search for genetic markers shared by the patient and both parents. Real progress was being made. The paper hinted at the fact that the net result of this work would be the determination of the gene or genes causing susceptibility to CID. They would not have made this statement unless behind the scenes they were actually closing in on the genetic facts. Dr. Little’s name was new to me. Ron had never mentioned her. He did, however, recently tell me on the phone that he had been having a hard time with a senior-level woman whose “ego was bigger than all outdoors!” Maybe he was referring to her. I decided that a visit to Dr. Little was in my future.

  After poking around for almost two hours, I had to head to LaGuardia. Marilena was certainly capable of getting to the condo on her own — somewhere in all of that advanced FB
I training, there must have been a section on high-risk, urban taxicab transport. Nevertheless, I had promised her that I would appear in person and planned to do just that. A part of me was also excited to see her as soon as possible and not wait for her arrival in town. That was the part that bothered me. I needed to have a firm talk with that part. I wrapped up my research for the time being and headed downstairs. As I bounced down the stairwell, I thought of CID, Ron’s enemy, and his passion to end it.

  CID is a tragedy for any family. The financial burden of the disease management and treatment is immense, the emotional toll on parents and child immeasurable. Ron was going to end this. He believed a cure was inevitable. He told me many times that in ten years, twenty at most, CID would become like polio: A part of history, not a part of anyone’s future. With Ron’s death, the odds of that outcome had diminished.

  A LITTLE HELP

  FROM MY FRIEND

  Antonio, the ever-friendly doorman, had arranged a car service for my trip to LaGuardia and back. He swore to me that the driver, conveniently his Uncle Ricardo, was “the only guy in New York City you can trust behind the wheel” and that “I was as safe as if I was in a church.” I elected not to tell him that once in Bosnia, I got shot at while in a church. The shooter had missed, and no one on my team had been injured. The church didn’t stop him from shooting. I don’t think he missed because we were in a church. My response prevented him from ever shooting at anyone, anywhere, ever again.

  At 2 PM, I was in front of the condo and boarding the limo for the promised quick trip to LGA. My driver, “the only guy in New York City that you can trust behind the wheel,” looked to be about ninety years old. This did not bode well. However, looks can be deceiving, and in this case they were. For a guy thirty years into social security, he was spry and had a bounce to his step.