The woman resident gave a terse explanation of Michelle’s condition while the nurses rapidly attached EKG leads to Michelle’s extremities.
The charge nurse leaned over to one of the other nurses and told her to page Dr. Keitzman.
The electronic box on the top of the cart began to spew forth an endless strip of narrow graph paper on which Cathryn could see the red squiggles of an EKG. The doctors grouped around the machine, momentarily forgetting Michelle.
“V-tack all right,” said the chief resident. “With the dyspnea and cyanosis she’s obviously hemodynamically compromised. What does that mean, George?”
One of the other residents looked up, startled. “Means we should cardiovert her immediately… I think.”
“You think right,” concurred the chief resident. “But let’s draw up some Lidocaine. Let’s see, the kid’s about fifty kilograms, no?”
“A little less,” said the woman resident.
“All right, fifty milligrams of Lidocaine. Also draw up a milligram of atropine in case she goes into bradycardia.”
The team functioned efficiently as one resident drew up the medications, another got out the electrode paddles, while the third helped position Michelle. One paddle went under Michelle’s back, the other anteriorly on her chest.
“All right, stand back,” said the chief resident. “We’ll use a fifty-watt second shock to start, programmed to be delivered at the R-wave. Here goes.”
He pressed a button and after a momentary delay Michelle’s body contracted, her arms and legs jumping off the surface of the bed.
Cathryn watched in horror as the doctors stayed bent over the machine, ignoring Michelle’s violent reaction. Cathryn could see the child’s eyes open in utter bewilderment and her head lift off the bed. Thankfully her color rapidly reverted to normal.
“Not bad!” yelled the chief resident, examining the EKG paper as it came out of the machine.
“John, you’re getting good at this stuff,” agreed the woman resident. “Maybe you should think about doing it for a living.”
All the doctors laughed and turned to Michelle.
Dr. Keitzman arrived breathless, hands jammed into the pockets of his long white coat. He went directly to the bed, his bespectacled eyes quickly scanning Michelle’s body. He snatched up her hand, feeling for a pulse.
“Are you okay, chicken?” he asked, getting out his stethoscope.
Michelle nodded but didn’t speak. She appeared dazed.
Cathryn watched as John, the chief resident, launched into a capsule summary of the event in what was to Cathryn incomprehensible medicalese.
Dr. Keitzman’s upper lip pulled back in a characteristic spasm as he bent over Michelle, listening to her chest. Satisfied, he checked a run of EKG paper offered by John. At that moment he caught sight of Cathryn pressed up against the wall. Keitzman glanced at the charge nurse with a questioning expression. The charge nurse, following his line of sight, shrugged.
“We didn’t know she was in here,” said the charge nurse defensively.
Dr. Keitzman walked over to Cathryn and put a hand on her shoulder.
“How about you, Mrs. Martel?” asked Dr. Keitzman. “Are you all right?”
Cathryn tried to talk but her voice wouldn’t cooperate, so she nodded like Michelle.
“I’m sorry you had to see this,” said Dr. Keitzman. “Michelle seems fine and she undoubtedly did not feel anything. But I know this kind of thing is shocking. Let’s go out in the hall for a moment. I’d like to talk to you.”
Cathryn strained upward to see Michelle over Dr. Keitzman’s shoulder.
“She’ll be okay for a moment,” assured Dr. Keitzman. Then, turning to the charge nurse, he said, “I’ll be just outside. I want a cardiac monitor in here, and I’d like a cardiac consult. See if Dr. Brubaker can see her right away.” Dr. Keitzman gently urged Cathryn out into the corridor. “Come down to the nurses’ station; we can talk there.”
Dr. Keitzman led Cathryn down the busy corridor to the chart room. There were Formica Parsons tables, chairs, two dictating telephones, and the massive chart racks. Dr. Keitzman pulled out a chair for Cathryn and she gratefully sat down.
“Can I get you something to drink?” suggested Dr. Keitzman. “Water?”
“No, thank you,” managed Cathryn nervously. Dr. Keitzman’s extremely serious manner was a source of new anxiety and she searched the man’s face for clues. It was hard to see his eyes through his thick glasses.
The charge nurse’s head came through the door. “Dr. Brubaker wants to know if he can see the patient in his office.”
Dr. Keitzman’s face contorted for a second while he pondered. “Tell him that she just had an episode of V-tack and I’d prefer he see her before she’s moved around.”
“Okay,” said the charge nurse.
Dr. Keitzman turned to Cathryn. He sighed. “Mrs. Martel, I feel I must talk frankly with you. Michelle is not doing well at all. And I’m not referring specifically to this latest episode.”
“What was this episode?” asked Cathryn, not liking the initial tone of the conversation.
“Her heart speeded up,” said Dr. Keitzman. “Usually it’s the upper part of the heart that initiates the beat.” Dr. Keitzman gestured awkwardly to try to illustrate what he was saying. “But for some reason, the lower part of Michelle’s heart took over. Why? We don’t know yet. In any case, her heart suddenly began to beat so fast that there wasn’t time for the heart to fill properly, so it pumped inefficiently. But that seems to be under control. What is worrying me is that she does not seem to be responding to the chemotherapy.”
“But she’s just started!” exclaimed Cathryn. The last thing that Cathryn wanted was for her hope to be undermined.
“That’s true,” agreed Dr. Keitzman. “However, Michelle’s type of leukemia usually responds in the first few days. On top of that Michelle has the most aggressive case that I’ve ever seen. Yesterday we gave her a very strong and very successful drug called Daunorubicin. This morning when we did her blood count, I was shocked to see that there was almost no effect on the leukemic cells. This is very unusual although it does happen occasionally. So I decided to try something a little different. Usually we give a second dose of this medicine on the fifth day. Instead I gave her another dose today along with the Thioguanine and Cytarabine.”
“Why are you telling me this?” asked Cathryn, certain that Dr. Keitzman knew she would not understand much of what he was saying.
“Because of your husband’s response yesterday,” said Dr. Keitzman. “And because of what Dr. Wiley and I said to you. I’m afraid your husband’s emotions will interfere and he’ll want to stop the medicines.”
“But if they’re not working, maybe they should be stopped,” said Cathryn.
“Mrs. Martel. Michelle is an extremely sick child. These medicines are her only chance for survival. Yes, it’s disappointing that as yet they have been ineffective. Your husband is right in saying her chances are slim. But without chemotherapy, she has no chance at all.”
Cathryn felt the stabbing pain of guilt; she should have brought Michelle to the hospital weeks ago.
Dr. Keitzman stood up. “I hope you understand what I’m saying. Michelle needs your strength. Now, I want you to call your husband and have him come over. He’s got to be told what’s happened.”
Even before the automatic radioactivity counter began to record the electrons emanating from the series of vials, Charles knew that the radioactive nucleotides had been absorbed and incorporated into the tissue culture of Michelle’s leukemic cells. He was now in the last stages of preparing a concentrated solution of a surface protein that differentiated Michelle’s leukemic cells from her normal cells. This protein was foreign to Michelle’s body but was not rejected because of the mysterious blocking factor that Charles knew was in Michelle’s system. It was this blocking factor that Charles had wanted to investigate. If only he knew something about the method of action of the blocking factor, perhaps it could be inhibited or eliminated. He was frustrated to be so close to a solution and have to stop. At the same time he realized that it was probably a five-year project with no guarantee of success.