A TEST OF SURVIVAL
C H A P T E R 1
Gretchen Judd’s
tumor arrived at San Francisco International Airport via
Federal Express priority overnight service. One-point-three
grams of tissue rested like a wedge of multicolored hamburger
on the curved bottom of a sterile vial, the vial hard
against a cold pack, both encased in a styrofoam mold,
and the whole transported in a white cardboard box wrapped
in plastic and red-letter labeled ‘Diagnostic Specimen’.
Two hours later, the Fed Ex driver turned into an industrial
park northeast of the city and followed a curving drive
to a two-story stucco building. He entered Receiving and
pressed the middle of three wall-mounted buzzers. It was
answered eventually by Danielle Ephraim, a slight woman
in a lab coat who shouldered through the door, rolling
thin rubber gloves off her hands and clasping a bundle
of slippery nine-by-twelve envelopes under one arm. She
sent him a shy smile, looking up tiny-eyed through thick
eyeglasses and a lank flop of butterscotch hair.
“Hey Dani,” the driver said. He turned a clipboard
for her signature. “Just the one this morning.”
She unclamped her elbow from her side and spilled envelopes
and paperwork on the counter, then swiveled the white
carton to read the sender address: Milwaukee Century Hospital.
“Ah,” she said, staring at it. “But
what a one.”
The driver paused at the tinge of doom in her voice. “Someone
you know?”
She picked up his pen and dipped her head over the clipboard.
“In a way,” she said, softly.
The Varden-Ephraim Cancer Testing Lab was licensed to
handle more than fifty hazardous chemotherapy agents.
Experimental drugs were acquired in small lots but the
majority were FDA-approved compounds purchased in volume
in powder or solution form, and periodically apportioned
into batches of bullet-shaped vials with brown tops. Bullets
containing chemo agents with names like thiotepa, cisplatin,
cyclophosphamide, fluorouracil. Bullets that would be
tested, or assayed, against cancer cells ‘ex vivo’
- outside the body - to tell physicians which chemotherapy
would most likely kill a particular patient’s cancer
and which cancers would resist the assault. Ex vivo’s
prime champions were Doctors Samuel Varden and Gus Ephraim.
Both were board-certified medical oncologists but Gus
Ephraim had given up clinical practice to perfect the
ex vivo assay and work full time as lab director, while
Varden continued a busy oncology practice and sent the
lab a third of its referrals for the chemo drug response
tests.
By afternoon of the Thursday the pancreatic specimen arrived,
two other jobs were in different stages of processing
in the lab. One medical technician, Francine, was spinning
a chop-wash slide for a lung cancer from Texas. A second
tech, Roberto, was preparing to plate the assay for an
esophageal cancer from Los Angeles.
Danielle Ephraim – senior medical technician and
Gus Ephraim’s wife – had been asked by her
husband to oversee the third job. She stood at the open
door to the freezer, pulling out frosted drug cartons,
matching their labels against the list of twenty-four
drugs Gus had prepared for this assay, placing them on
a wheeled cart. She had logged it in as #05X2231 but to
Dani, who years ago had ceased imagining the live donors
at the other end of these biopsied cancers, this was no
anonymous business-as-usual assay. One day earlier, the
pancreatic cancer from Milwaukee had been cut out of Gretchen
Judd, Gus’s ex-wife and the mother of his son. |
