_Tuesday, April 7
11:39 a.m.
_He had a high forehead and prominent cheekbones, just like in the
photo. And just as in his photo, there was a genuine dichotomy between
his face, which looked to be early forties and unwrinkled, and his gray
eyes, which were much older. That was it. That was what seemed odd. He
was different ages.
Underneath his white lab coat he was wearing a black suit and an open-
necked blue shirt. Ally noticed that his fingers were long and
delicate, like those of a concert pianist, and overall he had a kind of
ghostly presence, as though he were more spirit than man. Although he
looked exactly as he did in the photograph in the Gerex Corporation
brochure, in person there was an added dimension, a kind of raw
magnetism about him. It was more than simply a physician's bedside
manner, it was the allure of a pied piper. The first thing you wanted
to ask him was _How old are you, really?_ Maybe the next thing you'd
want to do was ask him to dinner.
What had she expected? Maybe a self-absorbed nerd researcher in
wrinkled stained lab attire, anxious to scurry back to his test tubes.
But in person Karl Van de Vliet was debonair and youthful, living proof
that his photo wasn't retouched and was recent. He had to be twenty
years older than she was, easily, but to look at him you'd guess he was
close to the same age. She was dying to ask him about that but she
couldn't think of a polite way to raise the subject.
She introduced herself. "We spoke yesterday." Then she introduced her
mother and Maria. "Mom and I talked last night about the clinical
trials, and she said she's interested. This morning, unfortunately, I'm
not sure she remembers what we discussed."
He placed a hand on Nina's shoulder and studied her face as he smiled
at her, embracing her with his eyes. "Well, we're going to see what we
can do about that aren't we, Mrs. Hampton?"
"I've got a question right up front" Ally said. "Have we already been
entered into the National Institutes of Health clinical trials?"
He seemed taken aback for a moment, caught off guard, but then he
stepped up to the question.
"As a matter of fact I did take the liberty of authorizing the
preliminary NIH paperwork for both of you. Of course it doesn't
obligate you in any way. The thing is, there's a lot of red tape, so if
you do decide to participate, the sooner we get that part started the
better. On the other hand, if you decide not to, we can just terminate
everything at this preliminary stage and you won't even be part of the
official record."
Well, Ally thought, that undoubtedly explains why Stone saw our names
on the NIH Web site. But why did Van de Vliet look so funny when I
brought it up?
He focused on Nina. "Mrs. Hampton, I'm Dr. Van de Vliet. You're a
pretty lady, and we've had some luck helping other ladies like you."
"Honey, if I had you in my bedroom, then maybe you could help me."
Oh my God, Ally thought, she's about to go ribald on us. But that's a
sign she's coming out of her funk.
But then she had another thought. Maybe Nina sensed he was older than
he looked. Like that paranormal perception that told her Grant was
involved in something evil. So far, however, that particular perception
hadn't panned out (though Grant clearly was up to something).
Maria was mortified. She blushed and made a disapproving animal noise
low in her throat and turned her face away, but Van de Vliet simply
smiled even more broadly.
"Mrs. Hampton, I don't think you should be talking that way in front of
your daughter." He gave her a wink. "What you and I do together is none
of these people's business. But I do think we should consider keeping
them informed if only a couple of hints."
Ally found herself wanting just to listen to his voice. There was an
intelligent warmth about it that reminded her of a kindly professor at
Columbia, a truly gifted architect who also could quote Keats and make
you cry. You wanted to give yourself to him. My God, she thought, how
am I going to stand up to this man?
"There're some issues you and I need to discuss," he said turning back
to Ally. "The first thing I need to do is take a look at Mrs. Hampton's
records. But whatever they say, it won't do any harm to run what we
call a 'mental state examination' for her, to establish a general
baseline of cognitive impairment as of now."
"How long will that take?"
"Actually, Ellen can start in just a few minutes," he said "Of course,
we'll need to hear about the usual danger signs everybody knows. Does
Mrs. Hampton have recent-memory loss? Does she get confused about
places and people? Does she have trouble handling money and paying her
bills?"
"The short answer is yes."
All of those things, Ally knew, had accelerated in the last six months.
It was the tragic, recognizable onset of the latter stages of
Alzheimer's. Already more than once Maria had said there were times
when she didn't think Nina recognized her. More and more she seemed to
be confused, unable some days to find her way around the apartment, and
she'd started repeating herself. She often had trouble finding the
right words, and she was increasingly paranoid and suspicious. Maria,
who had worked with other Alzheimer's patients, feared she might begin
hallucinating soon, seeing things that weren't there.
Ally turned to her. It felt obscene to talk about her when she was
sitting right there with them.
"Mom, sweetie, do you understand what Dr. Van de Vliet is asking? Do
you think you have trouble doing everyday things?"
She knew the answer but she was determined that her mother not be
treated like a potted plant.
"Ally, you know that half the time I can't remember a blessed thing.
I'm getting crazy as a bloody coot."
Then Nina turned and looked Van de Vliet in the eye.
"I don't want to lose my mind, Doctor. I don't want to see the shade
closing in. I can't do crosswords anymore. I used to do them all the
time. And all the music I used to know. It was my love and now . . .
now I can't tell Scriabin from Strauss half the time. It wasn't
supposed to happen that way. I thought my mind would go on forever."
"Mrs. Hampton, if you'll let me, what I want to do is try to work on
your recollection. I don't know how much I can help you with
crosswords, but then I've never been much good at them myself either.
Your memory of music should improve, though. There are no guarantees,
but--"
"Then I'm ready to try it, Doctor," she cut in. "You're all that stands
between me and losing the only thing I have left, my past" Next came a
burst of rationality. "Now, I hate to be a pest but could you explain
what exactly it is you're going to do. I want Ally to hear this too and
then maybe she can go over it with me later and help me understand it."
He smiled and reached over and stroked her slightly thinning hair. "I'd
be happy to try, Mrs. Hampton. It's actually pretty simple."
Then he turned to Ally. "We touched on some of this on the phone. Do
you want to hear it again?"
"Yes, I'm still trying to get it all into my simple mind."
"Well," he began, "to go back to the very beginning of my interest in
stem cells the focus of our research has been directed toward
challenging the notorious Hayflick limit. Back in the 1960s, Professor
Leonard Hayflick discovered that when tissue cells are taken from the
body and cultured in a laboratory dish, those cells grow and divide
about fifty times, give or take, and then they stop. They have reached
old age, senescence. The physical basis of the Hayflick limit is a
section of DNA known as telomere, which gets shorter each time the cell
divides. Eventually the telomeres become so short that all cell
division stops. It's like an internal clock telling them the game is
over. They've had their innings."
"And you're saying you've found a way to beat the clock, to stop the
telomeres from getting shorter?"
"All cells possess a gene known as the telomerase gene, which can
restore the telomeres to their youthful length. But in most cells the
gene is permanently repressed and inactive. It is only found in egg and
sperm cells, and in cancer cells." He gazed away for a moment as though
collecting his thoughts. Then he turned back. "However, we've found
that by isolating and inserting an active copy of the telomerase enzyme
into adult stem cells, which can be found in minute quantities
throughout the body, we can set their clock back to zero. We extract
cells, 'immortalize' them with telomerase, and then return them to the
body as a youthful infusion."
"And is that what you'd be doing for Mom?"
"There'd be a series of injections, but given what appears to be her
level of mental awareness right now, the procedure probably can be
accelerated." He patted Nina on the shoulder.
"All right," Ally said "but can you use the same procedure for
someone's heart?"
"Well, yes and no," he said. "Did you bring your medical records? I
should have a look at them before making any pronouncements."
To prepare for this moment, she'd printed off a copy of the medical
files she'd scanned into her computer.
"There're a lot of files," she said, opening her bag. "I've got copies
of my EKGs over the past eleven years. Dr. Ekelman, my cardiologist,
says my condition is getting progressively worse."
She took the folder out of her bag and handed it to him. He flipped
through the files with what seemed an absent manner, almost as though
he already knew what was in them and was just going through the
motions. Then he looked up.
"Well, your physical condition looks pretty good. You clearly exercise.
And I don't see anything here that would suggest a complication. As to
how your procedure might differ from your mother's, I guess the main
area of concern is simply the scale." He laid her files on the steel
table. "Your heart has reached the stage of aortic valve stenosis where
cardiac output no longer can keep up proportionately with vigorous
exercise. And that has put an even larger strain on an already weakened
condition. What we are about to undertake here corresponds to what
might almost be considered an aortic valve replacement, though it is
done at the cellular level. We call it regenerative medicine. Millions
of cells will be involved We'll attempt to reverse the calcification
and also to develop new blood vessels that supply the heart muscle."
"You know, this is so risky. I remember that not long ago they tried to
use fetal cell injections into the brain for treating Parkinson's
disease. And it turned out that the side effects were horrendous. Why
should I assume that this is any safer?"
He looked pained. "I assure you we don't do anything here that is
remotely like that particular, unfortunate procedure."
She stared at the ceiling trying to grasp what he'd just said. "So how
risky do you think this is?" she asked finally. "Truth time."
He looked away again and sighed. There was a long silence in which he
seemed to be pondering some extremely troubling thoughts. Finally he
turned back.
"In medicine there Is always something that can go wrong. Even the most
innocuous procedure can end up being lethal if that's what the gods
want that day." He looked at her intently and seemed to try to measure
his words. "But I wouldn't recommend we proceed if I didn't feel that
the potential benefits far outweigh the risks."
She listened wondering. Something in his voice is sounding cagey. What
is he leaving out?
"I still want to think about it"
"Of course, but we can make some preparations in the meantime," Van de
Vliet said turning back to Nina. "Mrs. Hampton, do you understand
anything of what I've said? Nothing is risk free."
"Young man, if you'd lived as long as I have, and then felt it all
slipping away, you'd be willing to take a chance with anything."
"Mrs. Hampton, Alzheimer's is one of the more promising areas of stem
cell research. We've already had successes here. I truly think we can
help you. In fact, Ellen can start your preliminaries right now, if you
like. A lot of it you may have done before. For example, there's a game
where you have to memorize the names of three unrelated objects, and
you have to count backwards from one hundred by sevens. Finally there's
a test where you copy sentences and symbols." He chuckled and there was
a warmth but also a distant sadness. "Some days I'm not sure I could
even do it all myself. In any case, it's not something you pass or
fail. But if we do enter you into the trials, you'll have to stay here
for the duration. That's absolutely essential. We'd also like a
caregiver to be here with you, as long as it's necessary."
Ally looked at Maria. "Do you think you want to stay here with Mom?"
Maria's eyes were very sad "I could stay for a day or two. But ...
maybe we should talk."
"We can arrange for someone," Van de Vliet interjected "We routinely
provide caregivers from our staff when called for. And because we're
still in clinical trials, there is no charge."
Ally watched Nina brighten and turn to Maria. "You can bring some
things from my closet when you go back. I want to start right away. I
just know he can help me. I've got a feeling and you know my feelings
are always right."
Ellen reached and took Nina's hand. "Come, dear, we have a special
office where we handle all the paperwork for admissions. We can do the
tests there."
Ally leaned over and kissed her mother. "I love you, Mom. And I love
your spirit. You taught me how to be a fighter a long time ago. And I
guess you're still teaching me."_
Tuesday, April 7
12:03 P.M.
_
Karl Van de Vliet watched the three women leave. Now he was alone with
Alexa. So far, so good, he thought. With her mother checked in, we're
partway there. Now what is it going to take to get her with the
program? I'm not sensing commitment. She's asking too damned many
questions.
It looks like we may have to go to Plan B tomorrow. Too bad.
After the door was closed, he turned back.
"Your mother is quite an inspiration," he said with a smile. "I'll need
those tests to create a baseline, but already I can tell she'll almost
certainly respond to the treatment. She fits our success profile. I'd
say the odds are heavily on her side." Then he darkened his look, for
effect. Better let her know I don't have to do this, he reasoned.
"The truth is, we already have enough data on Alzheimers that I don't
really need any further clinical trials. I know the parameters of what
the procedure can do and what it can't. But when Grant told me about
his mother's condition, I saw no reason not to work her into the
trials. We're winding down now and we have some empty beds."
"Don't think I'm not grateful," she said, "even though I may ask a lot
of questions."
She got the message, he thought. Good.
"Alexa, I'm now going to tell you something I've never told anyone
else," he went on, feeling a tinge of sadness arise in his chest. He
hadn't planned to say this, but for some reason he now wanted to.
Perhaps because it was true. "My late wife, Camille, was a brilliant
medical researcher. We worked together for many years, first at Johns
Hopkins and then at Harvard. What took her from me was a heart
condition very similar to your own. That was over a decade ago and I
vowed I would dedicate my work to her. I wanted the final clinical
trial in this program to be on a young person with advanced valvular
stenosis, but I could never find a patient who matched that profile.
But you would be perfect." He looked carefully at her. It was all so
true, which made this whole scene especially poignant.
"I'm sorry about your wife," Ally said. "I read in your--"
"You see, if I can succeed with you, it would almost seem as though I'd
had a second chance to save her life. You bear such a striking likeness
to her in several ways. You look something like her, but more
importantly I sense that you share her indomitable will."
"So I'm not just another statistic to you?" She seemed to be trying to
gauge the depth of his sincerity.
"No one here is a statistic, but you would definitely be someone
special."
"I see," she said still sounding noncommittal.
Am I getting anywhere? he wondered Just press on. You've got to make
this happen.
"All right, whatever you decide, we need to get some preliminaries out
of the way. For one thing, we must have a complete new cardiology exam.
Nothing in the file you brought presents an obvious red flag, but
still, it's essential that we have an up-to-the-minute stress test.
Toward that end I've taken the liberty of arranging for a checkup at
the New York University Faculty Practice Radiology on East Thirty-
fourth Street. Among other things, they can run a high-speed computed
tomography screening using ultrafast X rays. Also, I'd like to see a
phonocardiogram. A sonic analysis of 'murmurs' can tell us a lot about
valve abnormalities. Regardless of what you decide to do here, it's a
good idea for you to have this done regularly anyway."
"You've already scheduled tests?" Her tone of voice told him she was
mildly taken aback at the presumption.
"It's just that the NYU Faculty Practice is sometimes difficult to get
into on short notice. They can be booked for weeks in advance. But a
cardiologist I know there, Lev Amram, has agreed to make room for you
this afternoon. It's a professional courtesy. There'll be no charge.
After that, and assuming you want to proceed, you should get a good
night's rest and then come back here as early as possible tomorrow
morning. You should pack for a three-week stay, though we'll provide
you with pretty much everything you'll need here."
Just get her here.
"You know," she said, "I was actually hoping we could do this on an
outpatient basis. I know you like to have your patients here for
constant observation, but I run a business that needs me there every
day."
"Alexa," he said, putting every last ounce of authority he had into his
voice, "this is not a conventional procedure, and it's possible you
might suddenly need special care of some kind. This is an experimental
clinical trial, so we don't know what can happen. That's why I really
must insist that you be here twenty-four hours a day." He looked at her
with great tenderness. "We're talking about the possibility of
completely repairing your heart. Surely you don't expect just to drop
by now and then for that."
"All right, point taken," she said, "but--if we go forward with this--
I'll need to hire at least one temp to be at the office while I'm gone.
Somebody to at least handle the phone. That could take time."
"Surely someone there could manage to handle that," he said. She's
getting resistant again, he told himself. Don't let that happen. "And
there's also the matter of your mother. I think it would be wise for
you to be nearby during the early stages of her procedure. When her
mind starts climbing out of the abyss, it's important for a close
family member to be there to provide a visual and emotional anchor. It
truly can make all the difference. I fully expect that her functions of
attention and recall will return to those normal for a woman her age,
or quite possibly even better, but it will happen a lot quicker if
you're here to help her, to remind her of things."
"This is a lot to digest." Ally turned and sat down in a chair. "All
right, I might as well get the exam. It doesn't mean I've agreed to
anything here."
He heard the ambivalence and knew he had no choice but to do what he
was going to have to do tomorrow.
"I will proceed on the assumption that you'll be entering the program.
Truthfully, if you don't, a week from now your mother is going to be
asking you why." He smiled. "In any case, we need to have those tests
done in the city. Also some blood work here. We're affiliated with a
lab. I want to check your T-cells and certain other markers, like C-
reactive protein and homocystine. It's something you should do
regularly anyway."
"All right, then," she said finally. "But after that, let me go see how
Mom's doing. Then I'll arrange things with Maria somehow and drive back
to the city."
"By the way, before I forget, we have to complete a formal application
for your mother to admit her into the clinical trials, and we also need
a signed liability waiver. I assume you have power of attorney for her
by now. If you don't, then we may not legally be able to proceed."
"I have it."
"Then let's get started" he declared almost certain he had her.