ch.3. breslow's depth
The next day he took Owen to a Chevy Chase mansion and began showing him around. "The Society will be headquartered here," Alvirez explained. "You see how close it is to your house. When members donate blood I'll be able to get it to you quickly."
Owen wandered from room to room. "How do you pay for this?" he asked.
"You can't break just one law," Alvirez answered.
[ Kyle, Lee. 'Chapter 9: Secret Society.' Let Me In 2. FanFiction Net (2011) ]
~oOo~ ~oOo~ ~oOo~ ~oOo~ ~oOo~
Tired, Lu lay face down on a thinly padded hospital examination table. Stan, standing at her side, held her hand. But with her head turned away she could not see him. Rather she was looking opposite, at a raised tray that straddled her shoulder. The tray's surface sat just above her eyesight and the only item she could clearly see on it was the raised chrome edges of a metal dish. The dish was labeled with her name, written in pen on masking tape. "Lucy DeRose." Yet from her viewing angle, her name appeared upside down.
She thought about the shapes that the letters of her name made as they hung inverted before her. The 'L' looked like a descending canine with the following letters forming a row of bicuspids and molars. A dog – sharp predator's teeth – would have a row of teeth that looked like that. Sharp, mean, tearing.
She'd been given a sedative about an hour ago and then a local anesthetic within the previous ten minutes. Voices came to her and she knew they were nearby but she could no longer figure out how many. She knew her husband was here; he was holding her hand. And an attendant, a sweet woman who kept bending over and checking on her, sometimes held her other hand. And she knew Dr. Bradley and one or two interns were somewhere nearby but not visible to her.
"Surgical excision" had been an unknown term to Lu until two nights ago.
First had come the surprise of finding Stan waiting for her when she brought the wee-vee in for the evening. The delight was short lived for next had come his ballooning concern about the mole located high on the back of her calf. She had been aware of it for a month, maybe two or three, and was surprised by his intense reaction.
"I'm taking you first thing tomorrow to have this looked at," he had said once they were back at her father's place in Fairfax. They had stood on opposite sides of the kitchen's central butcher block table. Her dad slept in his chair in the living room while a spring training report had played on the television.
"But I have an appointment at 10:00 to meet with a physical therapist. He might be able to assist dad."
"Okay, fine. But I'm serious, Lu. We're calling in the morning and getting this looked at."
He had then started in with terms that were foreign to her but second nature to him. Stan usually kept his professional side at work so she was not used to seeing the Doctor side of him.
"We went over this three years ago when I had the mellow-something taken off the back of my shoulder," she said with frustration.
"Melanoma. Mel-a-no-ma. It's a type of skin cancer."
"Is this one any different?" she had argued, "this was no problem at all last time." And it hadn't been. A spec of a mole had been found on her back. It was quickly removed. Her doctor had it examined and she was later told it was a melanoma. There had been no fuss, just a removal and life went on.
"Lu, this is most likely exactly that type of cancer. Again. If it is, we need to get it right away. I'm not saying it is another melanoma, but this needs to be looked at – right away."
"How can you know? It's … a brown mole. If this was 'not a problem' three years ago why is it a crisis now?"
"It's too large, Lu. There are qualities to all moles. This lesion has no symmetry. It has no good border. It's not uniform in color. Do you remember any of this?"
"No. This is your territory." Then noting his frustration with her disinterest she continued. "Something about basil. I remember the word because it's an herb."
"Basal cell carcinoma is what you're thinking of. This mole – it could be that. Basal cell presentations can look in many ways like this one." He was glad she remembered at least one of the terms. "But we can't be sure."
The next day, 2pm, they had been at her doctor's office. He too took an immediate dislike to the mole. To her dismay he and Stan were in agreement about a "surgical excision" and began making calls to schedule it. They found that a Dr. Bradley was available and as both men knew him, it was agreed to. Lu suppressed her anger that her schedule was being wiped away without their showing the least concern. The men's talk then turned to "sizing" and "margin measures," moving to a discussion about whether a skin graft would be needed. She ignored all this and worked instead on how to reconstruct her and dad's week.
The day had ended back in Fairfax with her and Stan having an argument about priorities. Somehow it came to include medical terminology, stuff she had no fathom line for figuring out. Angry and upset, it was then hard to sleep. She figured she got about three good hours before she had to get herself back up; her dad was an early riser and needed help as soon as he was awake. The "excision" was scheduled for 10:30 that morning.
The lights in the outpatient operating room flickered out. The attendant at her side made a joke about forgetting to pay the electric bill. When they came back on it was a relief. "Okay, let's not have that happen again," said Stan. Everyone agreed.
A couple minutes later Lu could tell by the pressures on her other leg that the excision had started. She was glad she could not feel anything. The medications were working. She continued to stare at the canine-shaped inverted 'L' of her name, written on the masking tape. She recalled she'd been nipped at by a few dogs once or twice over her forty years. She had seen dog bites in pictures but never in person. Could a dog, Lu wondered, really take a hunk out of your skin? What would that feel like, to lose a hunk of her leg, find it in a dog's jaws. Would it hurt?
Lu tried to focus but knew the medications where calming her, putting her to sleep. There were moments where she could hear the group discussing the work. There were moments where she did nothing but stare at her inverted name. "Lucy DeRose." She thought about the dog her parents used to have. The doctors, she mused, were taking a hunk out of her leg. Would it hurt?
A gobbet. The word bubbled up in her mind. It was a vocabulary word she had given back in high school – so many years go. Gobbet: a hunk of flesh. The word had come up again in the acting she did following high school when she was at Seattle's Cornish College of the Arts. Shakespeare was a treasure trove of words! Somewhere in Henry VI was the line "into as many gobbets will I cut it," but which Part of that set of plays or by whom it was said she could not immediately recall.
She wanted to ask Stan if "surgical excision" was any different than being bitten by a dog. Was it just a euphemism for losing a gobbet of yourself? Doctor or dog – did it matter?
In her final moment of fading off to sleep she wondered how a dog felt about biting somebody's leg. Did the dog feel proud about biting through somebody's skin - sharp, mean, tearing?
She would never do that, she decided, even if she had razor sharp canines.
~oOo~
Stan stood by her side throughout the procedure. This was a surgery he had done in the past, although not that often. In recent years he had moved to research positions, working away from patients. Maybe that had been his loss.
He fretted about Lu while he watched the team perform the excision. First they marked out the area where they would perform the cut. Then they cleaned the area. Lu seemed completely indifferent, aloof, to the work. This was likely due to the local anesthetic, but it mirrored her overall attitude.
He had been alarmed to discover she had this melanoma, which is what he believed it to be. Once it was removed they would do an analysis on it. The depth of the lesion – the Breslow's depth - was one aspect of the biopsy. He was concerned about this. This was a recurrence of melanoma, he was certain, and it frightened him.
They had argued last night. Stan hadn't wanted that to happen, and he had likely taken it too far. In part it was due to the surprise of her condition and then her dismissive attitude. But it was also due to the secret he was keeping from her. The new job was something he couldn't discuss with her. For as much as he wanted to, he knew he couldn't. Once the door was open, she'd keep asking for more. And once she knew the truth, he would be facing her disapproval and eventually her anger. So the lid stayed on the secret. Yet the pressure remained.
He turned to check on her and was startled to see she was asleep.
~oOo~ April 4th ~oOo~
Thursday, Stan crashed into his first day at the Society. The mood seeing him off in Fairfax was cold. Lu, recuperating on the sofa, was glad to see him depart. Her calf was yet sore from the operation, and her mood, especially towards him, was not much better. The excision and now the recovery had become his fault. Only Henry seemed amused with the situation. He was being left to take on the odd role reversal: his having to take care of Lu for a day. The opportunity gave him a grin, the best Stan had seen on the old man for a long time. Yet the levity was lost on Lu.
After a stressful drive through D.C.'s rush hour traffic Stan arrived at the Society's offices, a remodeled mansion set off on a fairly quiet street in Chevy Chase. His senses warily rose as he entered. It was his acquaintance from several years back, Dr. Arun Samarth, who showed him around and made the introductions. Stan was careful to size up and examine the tensions exuded by each member. He had made a hobby of sizing up others, especially through first impressions. Here, the common thread was a sense of fiefdom. He found each member of the group held responsibility for a defined knowledge area and each seemed to want to guard that responsibility. Stan sensed this was intentional. Somebody had set up the system here to operate exactly in this manner. He himself had done the same in constructing the Self Monitoring Blood Glucose research team at the Atlanta pharmaceutical firm. It worked well in placing each contributor into a box – so to speak – where they could be managed.
"Dr. DeRose's background is in clinical pathology," Dr. Samarth was explaining to Dr. Johns. "He's going to be looking into Subject A's immune system attributes for us."
"Pleased to meet you," Dr. Johns said to Stan as they shook hands. "A background in hematology then?"
"Microbiology and clinical chemistry, actually," Stan replied.
"Interesting fit," Dr. Johns replied. "I'm curious to see what you're telling us in a week or two."
"I'm excited to get started," Stan replied, noting an undercurrent to Dr. Johns' delivery. There was a sense of challenge to it, as if to suggest he'd be measuring up Stan and that this was to put Stan on notice to that.
"Subject A is not ill, I hope?" Asked Dr. Johns to Dr. Samarth.
"Not ill at all, I'm told," Dr Samarth replied. "That's just the thing. Reportedly the subject is never ill. Remarkable." Then turning to Stan: "And here's our man for the job."
"Yes, I'm curious to see what you're telling us in a week or two," Dr. John repeated.
"Let's move along," said Dr. Samarth following the usual exchange of name dropping and revealed medical pedigrees – who had graduated from where, when, and under whose tutelage. Stan knew the drill. And he knew this was simply the first round of the sparring.
"I'll show you the facilities," Dr. Samarth continued. "The lab systems we're assembling are in the basement." He led Stan across the room and halls of the ground floor to a locked stairwell. Its position within the house and its solid modern construction jarred with the house's original 1920's style. A card reader protected the door, the same type Stan had seen coming into use at the NIH before his departure last spring to Atlanta. "We have a card for you," said Dr. Samarth as he opened it and led the way down. "The card is up in my office. Don't let me forget to give it to you."
"The equipment is not always the best, but it was what could be afforded." They walked through a set of sterile lab room, replete with centrifuges, storage systems, equipment racks and work stations.
At the far end, Dr. Samarth waved Stan into a partitioned area containing several small semi-private offices. The one pointed out by Arun was for Stan. It contained very little: a desk and a partially assembled IBM PC XT. "This will be your work area. Dr. Phil is putting together the computer systems. I will make sure yours is not neglected."
"Thanks," said Stan. Then he decided to throw in a hook. It was easy to see how each of the doctors that made up the group had been posturing so as not to reveal any weakness. So, it might be a nice softening to reel in Dr. Samarth with the opposite approach. "I hardly know how to work the things," he confessed.
"Don't worry," replied Dr. Samarth, taking the bait. "None of us do. But we hope to build a means of using them to pool the results of our work."
"I hope you don't mind if I stick with clipboards and filing cabinets for the most part."
"You'll probably find that a good idea," agreed Dr. Samarth.
~oOo~
They ventured upstairs to the second floor. Here Dr. Samarth and Dr. Mecklenburg had their offices next to one marked "C. Alvirez". This got Stan's attention as it was the only nameplate in the building where the surname was not preceded by the honorific "Dr."
They bypassed Arun and Alvirez' offces only to find the "Dr. Mecklenburg" door shut and locked. A knock at the door brought no answer. Turning back towards the stairs the two entered through the "Alvirez" door and settled into the chairs of a well-appointed office.
"So you understand," said Alvirez once the formalities were passed through, "we are playing this very close to the vest. None of us are to discuss any of this with anyone. As far as the world knows, we're an adjunct research outfit benefiting NIH."
"We're one quiet family," said Stan as he realized this was the one pulling the strings. Alvirez was somehow the one running this show… an FBI man.
"For the time being, we are working with blood samples from a person whom we are referring to only as 'Subject A.' We're taking care to properly long-term store much of the samples as they arrive, which occurs on a weekly basis. You will be allotted an amount of the remainder each week for your work. All work, of course, is being done here and here alone. Nothing is to leave the offices. Whenever you need something, let Dr. Samarth or Dr. Mecklenburg know."
"As I was saying to Dr. Johns, whom I met downstairs, I'm excited to get going on this."
"I understand from Dr. Samarth that you've returned to this area, specifically for this opportunity," Alveriz continued.
"Right. We own a house over in Arnold, along the Chesapeake. Rented it out, starting last summer while I took on a position in Atlanta." Stan was hoping not to have to get into anything specific about his work there. "Yet, when Dr. Samarth contacted me last month, this sounded like something I didn't want to pass up. So coming back's not a problem."
"You have a wife, right? And a daughter?"
"And both are, honestly, delighted to be returning home," Stan said.
"Yet your house is still rented, correct?" Stan got the feeling Alvirez knew the answers to these questions. Plus that Alvirez wanted Stan to know that he already knew.
"Right, right," he replied with a nod. "We're staying in Fairfax with my wife's father. His place is good enough until June. At that point we have the place – the house in Arnold - back to ourselves."
Alvirez pursed his lips and then flexed his hands and fingers. "Let's do this," he said, opening his desk drawer and pulling out a check ledger. He signed and tore off a check and handed it to Stan. Stan noted it had already been made out to him. "Take this. I'm putting this down as defrayment of your moving costs."
"Oh," Stan began to object. Their moving costs were barely worth thinking about.
"Apply liberally to your renters. See that they make an early departure. I want you to be settled."
"Very well. Will do." Stan said. The position in Atlanta had had its own under the table dealings, but nothing as outright as this. Plus a sum that made him sit up straight: $10,000.00. "This'll do the trick."
Dr. Samarth, Stan realized, hadn't said even one word the entire time. Several points were made in quick order. First, all this had been rehearsed or planned. Alvirez and Dr. Samarth, at least, had made this arrangement ahead of his arrival. Second, Alvirez was clearly the one in command. While Arun had paved the way for his being here, hired, Stan would need to work more on how Alvirez worked. Arun would be a resource but not a strong one.
He packed the offered check into the inner pocket of this sport jacket. At that moment, Stan realized he had been bought. This adventure, willingly taken on was a cancer unto itself. Question was, what would its depth be?
# # #
[A/N: Thank you to the American Cancer Society and the Skin Cancer Foundation for the information concerning melanoma symptoms and treatment that they make available on their websites.]