A TEST OF SURVIVAL (continued)

C H A P T E R 3
Dr. Gus Ephraim had fashioned a ritual out of interpreting slides for his ex vivo assay. Others might describe it as lending focus to a demanding task; he saw it as minimizing the signal-to-noise ratio in his head. Office door, closed. Snack food, in the drawer. Window blinds, tipped forty-five degrees. Slide folder, to the left of the microscope. Phone ringer, off. Beethoven’s Missa Solemnis into the tape deck, the first strains of the Kyrie announcing emergency-only interruptions to Dani and the staff.

And finally, stand for half a minute in front of the grainy blown-up photograph hung behind his desk. It dated back to the year he had married Dani and moved to California with her and Jenna, her three-year-old. Dani had climbed across slick boulders toward the beach, Jenna clinging to her back. A satiny evening in April, the sun like a peeled apricot. A giant wave exploded at their feet. Jenna squealed and threw up her arms as Gus snapped the shutter. They were a dark silhouette in a halo of ocean and sunset; they were every mother and daughter, every parent and child.

He seated himself in front of the microscope, inserted the control slide, and bent forward. What he hoped to see could so easily taint the assay. In the back of his mind the coaching voice chanted: Forget this is Gretchen’s life. Expect nothing. Be empty. Be open.

In the space of ten seconds, Gus Ephraim’s attention was perfectly calibrated on slides of a cultured pancreatic cancer. He began to count.

The med techs’ slide preparation amounted to concentrating and isolating the tumor cells, and keeping them alive and happy until they met up with the panel of chemo drugs. That was the business they were in: staging dress rehearsals in the test tube, where killer cells were attacked by different platoons of drugs, followed by Gus Ephraim’s visual sweep of the microscopic field. If enough cells were killed, that was the platoon to send in for the real fight inside the patient’s body.

Gus’s slide reading – the demanding task of distinguishing between cell types and counting the dead ones – would not forgive gaps of concentration. Every patient’s cancer was unique, every slide different.

When he completed slide twelve of Gretchen Judd’s assay, Gus pushed back from the microscope for a short break. He needed to shake off his disappointment, to regain focus on what he saw and not what he wished to see. What he wished to see was many fewer intact nuclei and cell membranes. He twisted his torso from side to side and pressed his palms against his eyes. He talked to himself – “Okay. It is what it is. Okay.” – and then reached for slide thirteen.

A stranger peering in the window would see a man in his forties slouched in apparent casual attitude over his work, an unlined face under a shaggy head of polar bear hair. He looked like an affable maintenance man stopping off in the boss’s office to play scientist. His age showed in his eyes, wide-set and hazel with a history of perpetual sleep deprivation in the bruised pouches beneath. He favored cheap white cotton shirts. He had bought a batch of them at Penney’s back in Wisconsin and would be wearing them still were it not for his love of chips, sweets, and burritos.