BOOKS: White Male Infant
White male infant, health perf. 6 mo., hair blnd. Eyes bl., bidding ends 1/19, avail. 1/26
New York City
There is nothing stranger than a familiar place turned strange. Dr. Dooley McSweeney was in his accustomed place of work, which had been his home away from home five days a week for nine years, but today everything was changed. Dooley was a surgical pathologist at Beekman Hospital in Manhattan. Like most hospital surgical pathologists, he dealt primarily with tissue samples—chunks of necrotic tissue from patients in the emergency department, swabs of infected material, biopsy specimens, tissue taken from patients in operating rooms where the surgeon was looking for a tumor-free margin and wanted to know quickly whether there was any malignancy in the specimen, and hundreds of other pieces of flesh from living people where his analysis made a difference to their survival. Hospital pathologists generally didn't do lab tests—the chemical bench tests, hemocults, PSA levels, blood typings and so on. There were thousands of chemical analyses these days. Surgical pathologists didn't do analyses for the medical examiner. They also did not do exotic analyses, chemical or biological. These were sent to specialized labs around the country. What they did primarily was high-pressure work that had immediate life-or-death implications for real people present at that moment in the hospital.
Because Dooley had worked as a pathologist here for nine years, he had a lot of friends, a great deal of respect, intimate familiarity with the workings of the huge medical complex, and a certain amount of seniority.
Today, only the fact that he had friends was any help to him. He stood shifting from foot to foot in a minor surgery room in the pediatric wing. On the stainless steel table was his four-year old son Teddy, dressed in a blue and white surgical johnny. Dooley's wife Claudia had her arm around the little boy. Their pediatrician, Dr. Alison White, held Teddy's hand. A nurse and Dr. Felipe Fallot, the hematologist, busied themselves with a tray of instruments, which they had positioned behind Teddy, out of his sight.
Despite light sedation, Teddy sat rigidly upright, elbows close to his sides, hands in tight fists. He knew this wasn't going to be a good thing. Teddy looked tiny and vulnerable in the limp hospital gown. Dooley marveled at how much alike Teddy and Claudia were, an adult female and small male version of the same basic human form, with their curly red hair, pale skin and green eyes. Big, frightened green eyes.
Dooley saw the figures in the hospital room as if they were a teaching tableau, frozen in time and place, patient, nurse, doctor, worried relative. Back when he was in med school, and later going through his senior rotations, he had treated many thousands of patients. Now that he was a pathologist, he dealt with tissues, not the people the tissues had come from. He was much happier this way. He hated hurting people. He thought possibly he had gone into pathology because he found it so difficult to keep the necessary distance from patients so as to treat them objectively enough. You needed a certain blend of ruthlessness and empathy to do clinical work. Some patients had just stolen his heart, and his fear for them made it hard to do his job properly.
But it had never been as bad as this. This was his son.
Dr. Fallot had allowed Claudia and Dooley to stay here in the room. Their pediatrician, Alison, had told them that Fallot usually let parents stay with their children for what she called "minor procedures."
"He believes having mom and dad around consoles them."
"Do we have to do the aspiration?" Claudia asked nervously.
"Yes, Alison, do we have to?" Dooley asked. "You didn't find any leukemic blasts in the smear." A blood smear had been done a week before and repeated yesterday. Maybe he could stop this, even now.
Fallot answered instead of the pediatrician. "I'm sorry. You know why we have to. We couldn't get a reading. The WBC was too low." His slight French accent made the words sound pleasant.
Claudia leaned closer to Teddy. Their red curls mingled. Claudia's arm was tight around the child's shoulders. Everything about Claudia's posture screamed fear. Dooley thought her rigidity made Teddy even more frightened. There was nothing he could do about that, though, and in fact he was more scared than Claudia, because he knew what was coming next. She had no way to anticipate it, not really. Claudia was a lawyer, not a doctor.
Dooley had seen a lot of bone marrow aspirations.
Dr. Fallot asked Teddy to lie down. The nurse swabbed the child's hip with betadine and placed a sterile drape over it. Then Fallot swabbed the area too. "This is a topical anesthetic," he said, and Claudia looked relieved. Dooley wasn't. He knew that would be very little help. "This is more anesthetic." Fallot injected anesthetic next to the place they would go in for the bone sample. Teddy gulped and began to cry. "It'll be over soon, honey," Claudia said.
Dooley went to stand where Teddy could see him and be reassured. The nurse came closer to Teddy, too. She wasn't there to console. She was there to help hold the child down.
"Can't we give him a general?" Dooley whispered to Fallot.
"You know better than that, Dooley. Every general anesthetic carries some risk. It wouldn't be ethical for such a brief procedure." He reached for the punch biopsy bone tool. With it he would drill out a piece of Teddy's bone marrow.
Not brief enough, Dooley said in his head.
Claudia didn't know what Dooley was so upset about. She understood when Teddy started to scream.
"Mommy! Make them stop! Help me, Mommy! Mommy! Mommy! Mommy! Mommy!"
"Dooley, do something!" Claudia had shouted, making Teddy even more frantic. The thick needle ground into the bone like a drill.
"Please!" Claudia begged. "Dooley! Help him!"
Dooley wanted to close his eyes. Instead he did what he had to; he held Teddy—held him down so that it would be as quick as possible, saying, "It's almost over, pal. Hang on Teddy, hang on there, kiddo."
"Daddy! Make them stoooooop!" And then he just shrieked and shrieked and shrieked and Dooley whispered words in his ear, thinking all the time that, if Teddy did have leukemia, there would be many, many bone marrow aspirations ahead for him.
The path lab was a long, bright room, with a lot of space for bench tests and high-tech equipment around the perimeter, in addition to the old standbys like microtomes and fluid baths to float sliced sections onto slides.
On a working day, Dooley might use most of these himself. Today he wouldn't be allowed near them.
"Go sit someplace, Dooley," Tony Groenington said.
Dooley sat at a binocular microscope station and stared at the bench top.
Felipe had allowed Dooley to come with them to the lab, on his promise to stay out of the way. Alison had come too. Dooley thought she had trailed along just to make sure he was all right, since as a pediatrician she would be no help to the lab techs or the hematologist.
Felipe Fallot carried the tray, covered with the sterile paper sheet, and under that bland sheet, the precious biopsy specimens. Dooley's colleague, staff pathologist Dr. Tony Groenington, had been waiting for them here in the lab.
Dr. Alison White said, "I've got a feeling it's going to be all right."
"Then we shouldn't have put him through this," Dooley said.
It was a stupid remark, born of frustration and fear. Alison didn't even try to answer.
Dooley's whole body buzzed with tension, so much so that he could hardly see or feel anything outside himself.
He knew Alison meant well. She was a fine doctor. He knew she had to do what she was doing. She had to push him and Claudia, knowing they would have said, "Let Teddy alone. We'll wait and see what happens. Let him be a happy child." Of course she had had to push them. Acute leukemia had to be treated right away. The sooner you started therapy the more likely the child would survive.
The other docs would never ordinarily have allowed the father of a patient to accompany them to the lab. Not even Dooley, though this was his lab. Fallot, Groenington, and White must have been aware of how they would have felt in his shoes. Alison had a new baby daughter, chubby and perfect. Tony had two older children, healthy active boys aged eleven and fourteen. Dr. Fallot had no children, yet he had a perfect manner for kids, both forthright and sympathetic; he was one of the most caring doctors Dooley had ever met. The fact that the three doctors didn't manufacture consoling phrases made it clear they understood how he felt—they knew no words would have helped if the patient were their child.
Fallot had overheard Dooley's remarks. "It's done now, Dooley," he said. "We'll know in a few minutes."
A few minutes was an exaggeration. They'd be lucky to take less than an hour at this, even though Tony would hurry preparing the slides. The favorite question of pathologists, who were often rushed by surgeons holding patients under anesthesia in operating rooms, was, "Do you want it fast or do you want it right?"
Dooley wanted it fast and right.
Tony immediately began to prepare the bone both as sections for cellularity and touch preparations for cytology. His assistant, who was following Tony's instructions, simultaneously ran up smears with less usual stains, Sudan Black B, myeloperoxidase, para-aminosalicylic acid and nonspecific esterase histochemical. Many hands make light work.
Fallot touched Dooley's shoulder. Dooley nodded his head to acknowledge the encouraging gesture, but he couldn't utter a word.
Teddy's fevers and weakness had gone on too long.
When Teddy first started feeling sick, Dooley had thought it was just a virus. An FUO, he told Claudia, nothing to worry about, just one of the ubiquitous fevers of unknown origin, caused by one of the hundreds or thousands of viruses out there. In a few days it would go away.
But it didn't go away. Their little boy kept running the fever and his throat hurt and his lymph nodes were enlarged and still Dooley kept saying it couldn't be serious. Finally, they took him to his pediatrician, Alison White.
Maybe bacterial, Dr. White said. She took a throat culture, but she couldn't isolate any specific bacterium. "Maybe infectious mononucleosis," she said. "These symptoms are pretty typical."
Claudia, already worried, asked, "Isn't mono something only teenagers get? The kissing bug?"
"Actually, no, not only teenagers, even though it's called the kissing bug a lot. Mono is an Epstein-Barr virus infection. We think half the children in the U.S. have had it by age five. Most of the time, it doesn't cause enough symptoms for anybody to notice."
Teddy was four.
His fever would go up in the afternoon, down in the morning.
"Well, then test him for Epstein-Barr," Claudia said. Dooley knew this wouldn't help. Claudia, of course, was not a doctor, and anyway by now he'd been reassuring too often, so she didn't really believe what Dooley told her. He let Alison explain.
Alison said, "So many people carry the virus, Claudia, that finding it won't tell us whether it's the organism causing his symptoms. Although," she added cautiously, "if the test turned up negative, we'd know it had to be something else." If there were no Epstein-Barr antibodies, they'd know it wasn't mono. Something else like what? Alison said "Let's wait and see."
It would leave them with more serious possibilities, maybe leukemia.
Alison ordered the test and the test discovered the antibodies. Dooley breathed a sigh of relief. Up until then, no one had actually uttered the word leukemia aloud, and since the test told them it might be mono, they could still feel hopeful.
But Teddy didn't get any better.
Three days ago, in a conference with Dooley and Claudia, Alison said, "We haven't nailed this down. We've got to go ahead with other blood work."
They did. Teddy's white cells were abnormal. He had mild leukocytosis. He had atypical lymphocytes—white blood cells—and some of them were bizarre. Alison called in the hematologist. Dr. Felipe Fallot tried to be reassuring to Claudia and Dooley.
"This is pretty close to the textbook picture of mononucleosis," he said, in his precise French-accented speech.
Claudia said, "But—?"
"But not exactly. I would like to aspirate some bone marrow."
"Dr. Fallot, what do you really think?" she asked desperately.
"I think it's mononucleosis."
Claudia was panicking. "If you really knew it was, you wouldn't ask for any more tests."
Fallot had just bowed his head.
Here in the lab, they were at the moment of truth. Dooley heard Tony and Felipe mumbling about the fixing and staining. They were making quick decisions, talking it through with the assistant and a pathology resident. At first Dooley strained to overhear them; even one word of optimism would have diminished the peculiar numb ache in his head and chest. Then he swung to the opposite extreme. Too frightened to let himself hear anything at all, he moved farther away. They were just talking about mechanisms anyhow. He was grateful that Alison let him alone in his silence for these moments, said nothing, just followed him, to be nearby in case he wanted to talk. Which he didn't. One more word of consolation would have made him frantic.
He still heard Teddy's screams echoing in his ears.
Dooley wondered whether Alison or Tony or Felipe gave a thought to the fact that Teddy was adopted. He knew some people believed you didn't care quite as much about an adopted child. Those people were so stupid. If anything, it was the opposite. An adopted child was such a wondrous gift.
Suddenly, his mood swung again. He needed speech, maybe he wanted to talk so he couldn't hear what the others were saying. He turned to Alison and whispered, "When we first got Teddy, it was like the sun coming out. We wanted a baby more than anything else in life. We'd tried so hard. Claudia had gone through every infertility treatment there was. The treatments were debilitating. She felt sick all the time. And time after time, they simply didn't work. She was utterly discouraged."
"She felt worthless. Like she couldn't do something that almost every other woman could do. She didn't just want a baby; she needed a baby."
"Then, when we started the adoption process, it was horrible. Months went by. Years. Six years! It seemed like there were no babies in the whole United States. Claudia wanted a baby that looked like her. Well, like us, I suppose," he put his hand to his red hair, "except that it didn't matter to me at all whether the baby looked like me. It mattered to Claudia. Red hair, green eyes, and that pale Irish skin—"
Alison nodded. "I understand. Some of my patients' parents, people who've adopted, felt the same way."
"It sounds like ego. To want your child to look like you. Still, I guess maybe she didn't want it to be obvious everyplace we went that our child was adopted. I don't mean we'd hide the facts, but ? whatever. It made me uncomfortable because I knew there were thousands of African-American babies in this country in foster care who desperately wanted a family. It's one of the nasty things about adoption that white babies get adopted more than black babies. It's not right."
"And also children who aren't 'perfect.'"
"Right. If they have a physical defect, people don't want them. Or mental disability. It's wrong."
Now he couldn't stop talking. He was just so tense—"I told Claudia all this and she sort of what I call 'went lawyer' on me. She argued that women all over the world give birth to babies that look like them. A Japanese woman expects a Japanese baby. An Ethiopian woman expects an Ethiopian baby. For that matter, when they adopt, that's what they adopt, too. Why should she be different? Then we heard there was a chance of adopting an orphan from Russia, that they were finally letting some of their babies be adopted out of the country, and some of the babies looked like the child Claudia wanted—we—we wanted. And then of course Claudia argued that a baby from Russia might die in an institution. Which is true. She said wasn't that better than adopting an American child who at least had a foster family and enough food and a house to live in. She had heard about this wonderful agency that was doing a marvelous job of finding babies for people. It was as if somebody had given us the gift of life. We went over there, to Russia. A man from the agency, a spotter, had heard a rumor about a red-haired baby boy in an orphanage. He thought he could find him and we might be able to adopt him. He took us to several orphanages, five, I think. It was like a treasure hunt, but very frightening in a way, because Russia is so chaotic now. You just don't know whether you're breaking a law or not. There are police and soldiers everywhere."
"I've heard that."
"In one of the biggest orphanages he took us to, finally, there he was. He was so delicate and wonderful-looking. Five months old. Very thin, but otherwise healthy. The orphanage was hideous. The babies had almost no care. And no love at all. It was pitiful. They were lying in their own waste. All of them had terrible diaper rash, actual bleeding sores. The staff changed their diapers just twice a day, morning and evening. The babies got no attention, no medicine, no sunlight, no stimulation, no cuddling or mothering. Not enough food. I felt like we ought to take them all. We couldn't, of course. I felt so bad, leaving the others. We were glad to get him out of there while he was still little and hadn't been—stunted."
"You've been blessed, Dooley. And so has Teddy."
He looked to where Tony and Felipe were working over the slides. "I hope so," he said.
"I believe Teddy will be well. Even if it's bad news, if it's leukemia, leukemia's not a death sentence any more. You're a doctor. You know that."
"Yes. Yes, I do." It wasn't a death sentence every time.
"We're curing seventy-five per cent these days."
Seventy-five per cent go through hell—bone marrow aspirations, spinal taps, chemotherapy, and come out alive. Twenty-five per cent die. Was he about to hear that his child had one chance in four of dying?
By now Tony had made up slides from the marrow of the trabecular bone, the spongy interior tissue. There were some minute discarded pieces of the cortical bone, the hard outside shell, lying in the Petri dish, and a few slides that hadn't come out right, that had too much cortical bone and not enough trabecular, or were improperly stained. Dooley idly pushed the Petri dish with his finger.
"My child's bone," he said. "It's so cruel to do this to him."
Alison said, "It's awful, Dooley."
He picked up the Petri dish and studied the minuscule white and pink scraps. With a magnifying glass, he examined all the little pieces.
"Dooley," Alison said, "you can't tell anything that way."
"I know. I don't even want to. I'm trying to distract myself."
By now, the slides mostly completed, Tony and Felipe were working at two different microscopes, double-teaming to get the answer sooner.
Dooley slid the Petri dish under the photographic equipment, but he wasn't intending to take a picture. He tipped it back and forth. "What sort of God made a world in which you have to drill bone marrow out of little children? Or leave thousands of babies wasting away without parents or love?"
He stuck the slide into the dark pocket under the fluorescing microscope, then drew it back out. Fidgeting, he ran it under again, then took it out and set it on the lab bench.
He was so absorbed that he didn't hear Tony at first.
He jumped, nearly upsetting the dish and the camera setup nearby.
Dooley, cold and too fearful to speak, just looked at Tony. And he saw the smile on his face.
Felipe was smiling, too. "Mononucleosis," he said.
"Oh, god, oh, god, really?"
"Are you sure?"
Tony said, "You can take him home. Just don't let him bump his spleen for a few weeks."
Dooley threw his arms around Felipe, then Alison, then Tony. "We have to tell Claudia!"
Tony gestured to his resident to fill out the paperwork and clean up. He said "Store the slides," to the assistant. Tony, Felipe, Dooley, and Alison bolted out the door.
But in the elevator, even while happy tears ran down his cheeks, Dooley asked himself why that small fragment of bone had fluoresced yellow-green. Fluorescence was characteristic of bone in patients who had been treated with the antibiotic tetracycline. Teddy had never been treated with tetracycline in his whole life in the United States. And there were no such medicines available to Russian orphans.
© Barbara D'Amato. Photo of Barb by David Lasker.