Die Once Live Twice (22 page)

Across the table, Jonathan stood, banging on a water glass with his spoon. “Happy birthday to my wife, Nurse Marion, the twin sister of Jesus. Both were born on Christmas day.”

“Oh, Jonathan, you are blasphemous!” Marion shouted. “You know I never graduated from nursing school.” She sat and winked at Jonathan while laughter filled the room and the guests sang a boisterous chorus of the birthday song.

Welch leaned over to her. “Is it true you have entirely given up your Broadway career to work in the tenements?”

“Yes.”

“Do you miss the adulation and applause? You obviously still have the knack for timing!”

Marion paused before answering. “It’s a different reward. I’m a local hero. Not in the newspapers, not with any national acclaim. But Doctor Welch, it is a thrill to do work that makes someone’s life better every day. Sometimes we even save their life.”

By Christmas Marion had taken charge of Ward 19. Mothers believed her when she told them to use clean water and to boil milk. More babies were surviving, so Marion became a beacon to the families.

“I am glad that you have medicines to save children. That is because Jonathan’s mother supported laboratory medicine and we were able to build a flagship medical school at Johns Hopkins.”

“And your outstanding Rockefeller Institute.”

Welch looked a little confused. “Well, of course, the funding for that came from Mr. Rockefeller.”

“Oh yes, of course you’re right, but what’s important,” she said, raising her voice, “is that they’re studying infantile paralysis. Don’t you think infantile paralysis is the most important problem of our age? We’re seeing it at the clinic all the time now.”

The guest sitting on Welch’s other side turned to look at Marion. Simon Flexner, the chief of the Rockefeller Institute, never saw patients and didn’t believe any disease could be understood by any method except in the laboratory. Marion looked expectantly at him, and then at Doctor Welch.

“Oh, excuse me,” Welch stammered. “Simon Flexner, have you been introduced to our hostess, Marion Sullivan? Marion, Doctor Flexner is the head of our research into infantile paralysis.”

“Yes, I do know that,” Marion said brightly, and smiled at Flexner, whose expression changed not at all. “Doctor Flexner, we need to talk.”

Flexner frowned. He sat in haughty silence waiting for the next sentence.

“We’ve been keeping records on our infantile paralysis patients at my clinic and I think your theory about the germ entering directly through the nose to the nervous system is wrong.” The table conversation quieted and Jonathan shook his head
no
to his wife. Flexner was a small man, shorter than Marion, and slightly built. “He’s got a short man syndrome,” Jonathan had told her.

“My dear Mrs. Sullivan, I’m afraid that simply cannot be.” The effort to be polite was obvious. “I am studying it in monkeys in the laboratory every day. I can only make these germs grow in nervous tissue culture.”

“That’s not how it grows in the kids in Ward 19. When this disease is in season there are lots of kids with flu-like sickness. They don’t get paralyzed. Just sick. We’ve kept records.”

“With all due respect, Mrs. Sullivan, your records are not as accurate as my laboratory work. I have tried to infect monkeys by feeding them infected infantile paralysis tissue and they never get paralyzed.”

“It must be the species of the monkey you used,” Marion continued, raising her index finger. “Lucia, one of my Italian mothers who works as an aide, thinks it has to do with cleaning up the water. She thinks the old water had
soldati
in it.” Flexner’s frown deepened, making Marion think she should explain. “That is her name for antibodies in the blood.”

The muscles in Flexner’s jaw clenched. “It’s nonsense that an Italian mother in the tenements could know anything about polio. It doesn’t come in through the stomach. I’ve proved that.” His conversation with Marion was finished. He turned his back to her and spoke to the doctor on his left.

Marion was quiet. “You won’t change his mind, Marion,” Welch whispered to her. “He is brilliant, but pugnacious. Always sure he is right.”

“Well, he’s wrong,” and the index finger stood straight up in front of Welch’s nose. “The secret is in the water. That’s why it affects rich people more than my tenement kids. The kids still live in filth and the new immigrants do not get infantile paralysis.”

“This virus is so hard to culture, Marion. It will take a while for us to know if you or Simon is correct.”

“Don’t bet against me, Doctor Welch. Patients are the ultimate lab. It is not a disease of filth and it starts with clean water.”

That night, Marion worried to Jonathan, “I think I care too much. How do I keep from being a mother to every child?”

“You can’t, but you don’t need to. You are the essence of medicine, you are Hope. It is all we can offer most patients. We pray to God to let their suffering pass. We prescribe compassion. It is so frustrating. We need more scientific answers.”

“Well, that Flexner is not going to provide them. Self-important booby.”

Jonathan took Marion in his arms. “I think we can be quite sure that he’s not going to provide them to you.”

Chapter Twenty-two

—1911—

J
onathan was hunched over a microscope, his laboratory lights dimmed so he could better see what was on the slide. He dialed the eyepieces so the focus was clear and watched a white blood cell engulf a bacteria. “Having your favorite lunch, boy?” He smiled.

Research was Jonathan’s passion, both because of his obsession to rise to Katherine’s challenge and because he knew that revolutionary changes in medicine originated in the laboratory. Despite the success of vaccines against infections and the improvements in public health medicine, the magic bullet was still out there. The Holy Grail that would save lives was still to be discovered and he meant to be the one to find it.

While Jonathan watched the dynamics of phagocytosis under his microscope, he thought how clearly it confirmed the Science of Self theory, which proposed that body cells recognized and accepted each other, but attacked foreigners. When a foreign cell invaded the body, host cells circulating in the blood identified it as not of the self and engulfed it, as well as signaling the immune system to form antibodies to fight it. Antibodies were the “circulating factor” in blood that biologists had posited for at least three hundred years, but had been identified by Pasteur only fifty years prior. That idea had led doctors to believe that bleeding patients when they were sick would drain out the disease, which they called bad humors.

Jonathan and his colleagues had reconciled the two views of cells and circulating factor, showing that circulating antibodies and white blood cells worked in concert to defend the body. When this system was strong, patients had a better chance of overcoming an infection. All that medicine could do to support the body was serotherapy—vaccines to stimulate more antibody formation. Or antitoxins, which injected antibodies that had been created in another body.

Jonathan was convinced that the Science of Self was true for all cellular organisms and that he could use it to find a chemical produced by one organism that would kill another. Pasteur already had shown that a bacterium would not flourish if it were in competition with another microorganism, even a less virulent one. Jonathan believed that the microorganism was releasing a chemical, a toxin, that inhibited the rival bacterium. He slaved daily in his laboratory to find a universal toxin that could be safely injected into patients to augment their host defense. This discovery would revolutionize treatment of infections, a step far beyond serotherapy. The Holy Grail—survival against infection.

In Germany, Doctor Paul Ehrlich had taken the first step. Ehrlich made the brilliant assumption that since dyes stained bacteria, perhaps a dye could be a chemotherapeutic drug toxic to bacteria. After long efforts, he found a dye that was not toxic to humans and killed spirochetes, a complex bacteria that caused syphilis.

Jonathan was studying bacillus pyocyaneus, a bacterium whose toxin, pyocyanase, was being commercially produced and used as a topical antiseptic on infected wounds. Jonathan figured if it worked on skin wounds, why not inside the body? But he also knew that a chemical may be safe on a skin wound but poison to the inner organs. To study its toxicity, Jonathan was mixing pyocyanase with human tissue in test tubes. So far his results were not promising. Since Pasteur first developed the concept of vaccination by using an anthrax vaccine in sheep, he had begun with studying pyocyanase against anthrax, and it had been effective against that bacilli in the test tube. Whether it would be usable in people was another question. Pasteur’s vaccine was solely veterinary and there were no successes of a vaccine against anthrax in humans.

The drudgery and frustration of laboratory work made Jonathan’s weekly clinic day a welcome relief. Working with patients was far more satisfying and immediate than staring through a microscope or inspecting test tubes for months or years. Besides, he was able to spend the day with Marion. On this Friday, while he and Marion ate a bowl of borscht and a meat pie that Audrey, the Russian-Jewish nurse, had made in Marion’s kitchen-office, Rabbi Radulovic came in carrying a young child, looking very serious. “Her mother brought her to the temple. They are here from Russia only a few days. What is wrong, Jonathan?”

Jonathan knew it was an infection by the girl’s appearance, febrile and listless. “What’s the history, Rabbi? Where is the mother?”

“She is at the temple. She wouldn’t leave. This is in God’s hands, she is sure, so she is begging him for salvation.”

Jonathan examined the girl, who was coughing with a mild wheeze, and could find no bites, neither lice nor animal, and no evidence of trauma.
She must be three or four years old. Probably has never had any vaccinations. Her fever could cause the listlessness
. His mind sorted through all the possible infections. He always told his students that being a good doctor meant being a superb detective. A successful diagnosis was the process of putting clues together to solve the mystery.

The rabbi said, “Her mother says she’s been sick for a few days, complaining of aches, and she had fever. Today she got worse. Her mother sent this blanket to cover her. The girl is attached to it ever since a man on the ship gave it to her when she was cold.”

Jonathan looked at the woolen blanket that the rabbi was giving to Marion. Suddenly, he knew the answer and he rose to grab Marion’s arm. “Marion! Do not take that blanket. Rabbi,” Jonathan said urgently, “do not touch anything and come with me.”

Jonathan donned rubber gloves and led the rabbi through the kitchen to the fireplace outdoors. “Drop the blanket in the fireplace. Now go take a bath with your robes on. Then remove them and scrub all your skin with soap.” Jonathan set the blanket on fire. He then went inside and gathered the rabbi’s robes and added them to the flaming blanket. The rabbi dressed in clothes from the clinic and wore rubber gloves. When he returned to Marion, who was watching the child lying on a cot, she commented, “My goodness, Rabbi. You look like us!” Marion and Audrey, the Russian-Jewish nurse, had also put on gloves.

Jonathan was all business. “Marion, hand me the girl’s clothes and the bedding she was on. Do not let them touch your skin. Take the girl and scrub her clean. Don’t let her skin touch your skin.” Jonathan burned the girl’s clothes and the bedding while Marion took the girl to the shower.

The nurses and Audrey were transfixed by the flurry of activity. They never had seen this reaction to a sick child. Were they all exposed to a disease that would kill them? “Doctor, what is it?” Audrey asked, fear in her voice.

“Anthrax. She got anthrax from the wool blanket. You are all safe. You can’t catch it from her breath. It passes by direct contact through the skin. Touch her only with gloves and burn all her excrement, even urine.”

He turned to the Rabbi. “Get the mother to bring all the family’s clothing here and burn it. The clothes can have spores living on them.” He dug into his pocket and pulled out some money. “Here’s twenty dollars. Buy the family new clothes and make them all bathe. By the way, what is her name?”

“Anna.”

“Audrey, use ice to keep Anna’s temperature low. I will be back in an hour. Rabbi, can your driver take me to my lab to get medicine?” The rabbi nodded. “I must treat her immediately or she will be dead. Every second counts.” Jonathan knew once respiratory symptoms appeared the chance to save a patient from anthrax was slipping away.

Anthrax was unusual in New York City, even in the United States, but occurred in Europe and in Russia. It was caused by bacteria in the soil and infected people through animal hide products, because its spore would attach to the animal and survive when the animal died. It was most common among those who worked with wool products.

At his lab Jonathan counted out ten test tubes with pyocynsase toxin incubating in them. He had decided to take a risk because anthrax was invariably lethal. He had nothing to lose. If he did nothing, Anna was dead. Her only chance was what was in these test tubes.

Using a pipette he drew up the chemical from each tube. He had no idea how much volume he needed for an
in vivo
effect in Anna. When he had ten ccs of pyocyanase he transferred it to a sterile syringe, attached a sterile needle and slipped them into a sterile glove. “Hell, this is life or death,” he said aloud, as if arguing with someone in the room. “This is one chance. I will not just watch this girl die when there is any chance.”

As he re-entered the clinic he felt his breathing and heart rate increase. Rabbi Rad had brought Anna’s mother from the temple. At first she had thought she could not watch her daughter suffering, but the rabbi convinced her to be with Anna and now she would not leave her. Jonathan did his best to sound encouraging, but his gut tightened.
In ten minutes this girl could be dead from my injection
. He knew that, at least, he would not give her another infection. His experience managing the production of sterile antitoxin in the horses served him well in producing injections that were not contaminated. But there could be an allergic reaction to the toxin in pyocyanase. Jonathan was shaking inside.