All the Ways the World Can End Page 5

  Dr. Ganesh took Dad’s temperature and checked his blood pressure. Then he had Dad lie down on the crinkly paper and massaged Dad’s belly slowly. He was humming the whole time and nodding his head. He talked to Dad in a low, soothing voice. I didn’t need to hear the words. The noise in my head—boy bands and spices and numbers colliding—started settling just watching these two men.

  Then Dr. Ganesh asked me to step into the hall while he did the “other part of the examination.” I could hear Linda packing up for the day. Muttering little reminders to herself, like “Gonna need to order printer paper soon,” and “Could just throw a can of tuna in with those noodles. Make a nice casserole.” She was totally unaffected by whatever catastrophe we’d just brought in—she saw this kind of suffering all the time. She left and went home and knew that day would follow night and she probably watched sitcoms with laugh tracks and ate processed cheese and trusted that life would go on. I listened to the swish of her pleated pants, hoping they could hypnotize me into trusting too.

  Dr. Ganesh came back out. “Ey-leah-nor,” he said with a gentle smile. “This is very good you came. I would like your father to stay overnight for some further testing.”

  “Why?”

  “His white count is up too high. There’s definitely infection.”

  “Why?” I said again. It was a word. Which was better than a wail.

  Dr. Ganesh put his hands together in a sort of prayer pose. He met my watery eyes. “Is there anyone who can be here for you?” he asked.

  I shrugged and shook my head and bit my tongue all at the same time. “You,” I said. Trying to laugh.

  “Okay,” he said. “Then me.”

  Nanotechnology

  Nanotechnology is the manipulation of matter on a teensy-tinesy, atomic, molecular, and supramolecular scale.

  That’s really small. For instance, this is a nanometer:

  (It’s too small to see without fancy microscopes.)

  25,400,000 nanometers = 1 inch

  This is how doctors have come up with the incredible treatments that pass through the blood-brain barrier.

  This is also how some sickos could design a poisonous aerosol and act like they’re just going to tag the big wall behind the high school football field with some cool avant-garde graffiti but then they’re actually releasing nerve gas or something that makes everyone turn into zombies before the halftime show. Or on a much larger scale, like anthrax pen pals and government-building air ducts.

  Probability:

  The FBI is concerned, so we should be too.

  Chapter 5

  WHO CAN TELL?

  “Why is he doing that?!” I yelled. “Make him stop!”

  Dad was writhing and quaking in his hospital bed. Arching his head back so far I thought his neck would snap in half.

  “Make him stop, please!” At least I had manners. Otherwise, it would be hard to tell the difference between a rabid bat and me. Flapping my arms and screeching around Dad’s bed. Luckily, everyone in the room chose to ignore me. There were two male nurses surrounding him—one pressing on Dad’s upper arms and the other doing some massagey thing to loosen Dad’s jaw. A female nurse was unraveling tubes connected to a hissing oxygen mask and then in a whirl of foresty-smelling faith, in came Dr. Ganesh, with a bag of clear fluid that he swiftly attached to the IV pole.

  “Hello, Jeremy. I’m going to give you a little oxygen now and we’re just going to breeeeaaaathe.” Dr. Ganesh’s voice was low and firm.

  “He just started shaking and I thought he was cold, but then his eyes rolled back and he was…” I didn’t know whom I was explaining this to. I just had to make sure my dad wasn’t dying. He couldn’t die without saying goodbye to my mom and sister and we had plans to do a road trip to the Jersey Shore in July and I think he even had library books out.

  “That’s it. Breeeaaaathe,” Dr. Ganesh said again. He got the oxygen mask on Dad’s face and directed one of the nurses with the IV needle. He put a heart-rate monitor on, too, and nodded at the electronic blips. “There we go,” he said. “You’re going to start feeling much better now. Muuuuuch better.”

  “He is?” I peeped.

  Dr. Ganesh turned around to face me. “Ey-leah-nor!” He smiled. “Yes, of course. Here.” He pulled off one of his latex gloves and held out a hand, ushering me forward. “Come see for yourself. He won’t bite.” He took my right hand and placed it on my dad’s shoulder, which was slowly sinking into the bed, giving off little twitches as it relaxed. The combination of all of us touching made me feel like I was overheating and turning to ice at the same time. There was a small brown cloud of dried blood on Dad’s pillow next to his ear. I shuddered.

  “He’s just breathing, right? I mean, sleeping?”

  Dr. Ganesh nodded. Then he thanked each nurse personally for doing a fine job. The woman who’d been unraveling Dad’s tubing looked at me with huge, kind eyes and said, “You did great, honey. I know this must be hard.” Her lavender scrubs were so serene they made me weepy. She was a gorgeous woman with hundreds of tiny braids woven into a bun on top of her head. Her name tag read SAFFI.

  Dad stayed asleep while everyone cleaned up around him. I hoped he would sleep for a while now. At least until I got some answers. Dr. Ganesh looked like he was heading out the door with the team of superhero nurses, so I rushed over to say, “Can I just ask … what was that?”

  “Yes, this is a good question, Ey-leah-nor,” Dr. Ganesh said. He gave me a fist bump, maybe as a prize for boldness. “Come with me, we will talk more in the hall.”

  We started walking toward the elevators. I thought maybe he was taking me to a lab or conference room to chat, but we kept roaming around the tenth floor without a word between us. We did three laps around the Island of Unanswerable Questions in the middle. That was the semicircle of desks that held all the secrets of life and death. Test results, urine samples, take-out menus, a misplaced vial of morphine—every answer would ultimately be pulled out of this mysterious island. As we walked by I heard nurses and doctors entering data on computers and comparing notes about leukocytes and parking tickets and medically induced comas and anyone doing something fun this weekend? all in the same breath.

  I couldn’t wait any longer. I turned to Dr. Ganesh so abruptly that a motion-activated hand sanitizer spurted out a dollop of foam. “Can I just ask you a couple of questions?” I said. “Or more like a thousand?”

  “Ha! Yes. Let us just start with one,” Dr. Ganesh replied.

  “Did I just kill my dad?”

  “I do not think so. Your father is very much alive in room 428, yes?”

  “Okay, but then what was that? Did he just have a heart attack or…?”

  “Right. Okay, what I think happened is your father’s temperature elevated so rapidly that he experienced what we call a febrile seizure. This is actually fairly common, but we see it mostly in young children. So now we have to get this fever down, have him rest, and then determine how it is related to the infection and where the infection is exactly.”

  “It’s right here,” I said, poking my chest. “Where I tried to clean out his port.”

  “Yes, well, this is one theory. But a fever of one hundred five degrees indicates something more systemic.”

  “I could’ve given him something systemic, though. I was the one who flushed his catheter port and then he was in so much discomfort and the fever. I mean, I washed my hands a bunch of times and I wore the gloves but we’ve been fostering this rodent named TinyGinsberg and I changed her water bowl last night, which must be a cesspool of all kinds of bacteriosis.”

  Dr. Ganesh smiled. “This is good. I did not know you were studying medicine,” he said.

  “That’s a joke, right? Because I’m not.”

  “Yes, I joke. Ey-leah-nor, you are asking what? What gave him this infection? Your father is in a very immunosuppressed state, so many things can elicit a strong reaction. At this point, really, who can tell?”

  “You can!”
>
  That one came out a lot louder and angrier than I meant it to. Dr. Ganesh nodded slightly and kept walking. We were almost up to the tenth-floor lounge at the end of the hall.

  “Sorry,” I said in a calmer voice. “I just know there are a gazillion germs on the tip of a single fingernail and I wore the gloves but then I usually have antibacterial spray too but I read something yucky about propylene glycol, which I’d also like to ask you about, and mostly I’m just really worried that I caused all this.”

  Dr. Ganesh stopped walking and turned to face me. Which was lovely and terrifying. “Ey-leah-nor, we really don’t know with any certainty what causes this infection. But we treat it and bring his fever down and then we see.” He tapped his right pointer finger in the air, just a millimeter away from my left nostril. I pretended not to notice, even though he could probably feel every one of my nose hairs stand to attention.

  “You are the hero of this story too, yes?” he continued. “You knew enough to bring your father in. This makes you a responsible young lady.”

  “I’m eighty-nine. It’s all Botox,” I said. He laughed loud enough for a couple in the lounge to look up. That felt great. Then we started walking again, and I just kept blabbing, because it was the first pocket of unterrified space I’d found in so long. “No, seriously. I’m not that young. Emotionally, at least. How old are you? If you want to tell me. Which you don’t have to. Or … never mind.”

  “This is a fun question,” Dr. Ganesh said. “I will have thirty-six years on May twentieth.” He bought a bottle of water from one of the lounge vending machines while I did some fast calculations.

  Yes, he was almost twenty years older than me, but his birthday was in May and mine was November 18, which meant we were really nineteen and a half years apart—almost to the day. Also, eighteen minus eleven (for November) was seven, and five plus two plus zero (the digits in his birthdate) equaled seven. And seven was prime, which meant we couldn’t be divided.

  “Now, I have a question for you,” Dr. Ganesh said after taking a sip of water.

  “Okay.”

  “I met your mother a few weeks ago and I assumed you all live together. Is this fair what I assumed?”

  “Yes,” I said. “She’s just crazy.” Dr. Ganesh scrunched his eyebrows. He didn’t know how to respond to that. “Not crazy,” I clarified. “I just mean she’s always super busy at work and maybe in denial about this situation but fully functional. Overly functional, really. She’s just at work now. She’ll be here later. Or, I guess I need to tell her where we are, but then she’ll be here. Wait, what did you ask me? Oh yeah, if we live together. Yes, we live together.”

  Dr. Ganesh looked concerned. “You must call and leave this message so she can come.”

  “Yes, I will,” I told him. I didn’t like that he used the word must. But he did have a good point.

  He nodded slightly and whispered, “Thank you so much.”

  I sensed he was about to leave so I blurted, “Wait! Where are you going? I mean, can I just ask you one more question?”

  “Shoot it,” he said, fist bumping the air.

  “Did you always know you wanted to do this? I mean, saving people’s lives…”

  Dr. Ganesh’s smile dimmed. “Did I always know?” he repeated. “This is a yes and a no answer.”

  “What do you mean?” I pressed.

  He took another swig of water, as if he needed to gear up for the rest of his explanation. Then he fixed a button on his lab coat that had come undone. “I do not say this to patients usually, but I tell you because I think you can hear it, right? Are we keepin’ it real?” he asked.

  “Definitely,” I answered.

  “When I was a little boy, I was growing up in an area of India called Pondicherry, and I wanted to be a singer. Just like this man, Bruce Springsteen. You know him?”

  “Not personally, but yes.” I tried not to giggle, but the thought of him singing “Born in the USA” made me really happy.

  He continued. “I had a sister, born at the same time.”

  “Twin.”

  “Yes, twin. And she contracted leukemia.” He paused. I could feel the dot, dot, dot drooping off the end of his words. That was cancer-speak for “she didn’t make it.”

  “I’m sorry.”

  “Yes. I was not old enough to know her really, but I feel her loss in my body, you know? And I see the sadness in my parents. And I see this and I know I have to change this. I have to do this work.”

  “I’m so, so sorry.” I hated that phrase but it really was the only thing I could think to say.

  “Thank you. It is okay. I am very blessed to do this. I get to attend one of the top research universities. And there is much cross-pollination of these ideas between Eastern and Western treatment. So now there are many great possibilities with new forms of immunotherapy!” His voice was rising again.

  “Wow, well I’m glad you’re so hopeful.”

  “Oh yes! For this example, there is a drug we have in trial right now called Nivolumab. It is a full human monoclonal antibody that binds to a molecule called PD-1. We are looking at each individual molecule, which is quite astounding! There is so much more available to us through the use of this nanotechnology.”

  I wanted to tell him I knew a little about this stuff too, but he was too busy waving his arms excitedly and pressing his fingers together to show me how small a molecule could be. He went on, “… which augments the human immune response, instead of the traditional cytotoxic agents. Now, cytotoxins have proven enormously effective in stopping rapid replication, so we cannot ignore that method completely, but in combination we could resolve this on a physical and philosophical plane.” He tried to catch his breath and started laughing. “Agh! Ey-leah-nor! You have to tell me to stop before I am so majorly boring, right?”

  “No, I love hearing you talk!” I said. “About this,” I added, looking out the window and pretending to be fascinated by the traffic patterns on the East River Drive. I felt like this was the most informative, encouraging, slightly intimate talk I’d had in forever. I also felt guilty because I was forcing back a smile and meanwhile I didn’t know if my dad was dying down the hall.

  “So, in terms of my dad…” I said.

  “Yes,” Dr. Ganesh said. “All we can do now is wait for the fever to come down.” The word we lit up in neon behind my eyes.

  “The first forty-eight hours are very critical and I will not introduce any new treatments until the white blood count comes down. After that, however, I do think your father could be a fine candidate for this trial I mention involving Nivolumab, possibly in conjunction with Varlilumab. Of course, ultimately this will be Dr. Lowenstein’s decision, because your father is his patient.”

  “Dr. Ganesh? Dr. Ganesh!” Saffi was rushing toward us, lithe and lovely, but her lavender scrubs looked a little wrinkled. “I know you’re not officially on, but can you help out with room 453? The patient pulled out her monitor. She just had gamma ray done and we were told to keep her immobilized but she says she has to get up and walk.”

  “Walk! Yes!” Dr. Ganesh said. “Can I get a walk walk?” He turned to me sharply. “Ey-leah-nor, are you good so I can go in and speak with this patient? I think we have a plan. You are going to call your mother and then chillax and let your father’s fever come down. We will check in again in a little while, yes?”

  I put my hand up for one last fist bump, trying to savor that skin-to-skin jolt of courage before he and Saffi took off.

  I stared out the lounge window for another ten minutes or so. If I closed my eyes halfway, the cars below looked like a glowing red worm. It would take Mom at least two hours to get in with this traffic on a Friday night. I knew I should call her, but I also felt like she didn’t deserve to know anything after being out of touch all day.

  When I did try her number, I got her voice mail again anyway. I omitted the part about pushing the needle into Dad’s chest too hard and possibly causing a lethal infection. I actuall
y left no details besides “fever” and Dad’s hospital room number, ending with a smug, “Oh, this is your youngest daughter, Eleanor.”

  Then I turned off my phone and went back to Dad’s room to watch him sleep some more. My new favorite thing about oxygen masks (besides saving people’s lives) was that they made a wheezing sound when he took in air and filled up with a little white cloud to let me know he had breathed out again.

  Then I could breathe out too.

  Pandemics

  Perhaps

  After the

  Next outbreak of

  Deadly and/or debilitating

  Ebola, influenza, or hoof-and-mouth disease, we can

  Meet for

  Iced tea and

  Chat about the lessons we’ve learned since the

  Spanish flu wiped out fifty million people?

  Chapter 6

  THE UTTERANCE OF COSMIC REALITY

  I could feel the floor vibrating the second Mom got off the elevator (at 8:36 p.m.—almost three and a half hours after I’d gotten there with Dad). She was a parade of Sorrys and Thank yous and I can’t believe thises. I snuck behind a few empty gurneys in the hall so I could spy on her. Mom rushed over to the nurses’ island and told them how grateful she was for this incredible staff. She’d brought a big thing of doughnuts and knew everybody’s favorite flavor: “Nadia, you’re chocolate frosted. Mariel—cinnamon spice. Saffi, I thought you might like this sconewich. Dr. Ganesh! The man of the hour!”

  Even though I didn’t want to give her credit, Mom had put in her time in these halls. She’d walked every inch of this scratched linoleum and knew every nurse’s story. That was the thing with Mom—she drew everyone into her orbit. When she was there, she was really there. I watched her as she listened to Dr. Ganesh. She was crying and laughing and running through every human reaction in the space of a minute. Then I slipped back into Dad’s room and waited. And here’s something evil and ugly and true: I started stroking his head just so she could walk in and see me in that Florence Nightingale pose.