The Perfect Treatment

‘Well…I was pretty tired all the time, much more so, I suspected, than was warranted by my age,’ he said, ‘although I lead a hectic life. I teach at the university—political science—and this is a busy time, coming up to the end of the academic year. Even so, I suspected that something was wrong with my health.’

‘I see,’ Abby said kindly, encouraging him to go on.

‘Also, my skin was very pale and I got breathless easily on the slightest exertion, whereas before I could walk for miles. I felt unwell for a lot of the time and I got several colds, as well as chest infections, which I couldn’t shake off.’

‘Do you smoke?’

‘No. Never have done.’

‘Anything else?’

‘I noticed that I bruised easily, and I couldn’t remember having injured myself in any way to cause the bruises,’ the patient went on. ‘Then my dentist noticed that my gums were bleeding more readily than usual, so when I told him my other symptoms he advised me to see my doctor right away. Then when I went to my GP for a check-up he found out I was very anemic…Then things progressed from there.’

‘He had some nausea as well, which indicates some involvement of the gastro-intestinal tract—either infection or bleeding, or both,’ Dr Contini said quietly.

‘I see.’ Abby nodded. ‘And what is the planned treatment?’

‘I’m getting on to that now,’ Dr Contini said. ‘What I’m going to do, Mr Simmons, is build up your general resistance before we start you on a course of chemotherapy. If you agree, that is. Since you’re very anemic, I’m going to give you a blood transfusion of packed cells, plus some fresh plasma which will help the clotting function of your blood, which gets out of whack with this disease.’

‘When am I going to get that?’ Mr Simmons asked.

‘We’ll start this afternoon. The hematology lab is getting you cross-matched. When we’ve done that, we’ll discuss the treatment further. If we decide on chemotherapy later, you get a combination of drugs over a period of five to ten days—that’s called the “induction therapy”.’

‘I’ve read something about that,’ Mr Simmons said ruefully. ‘It kills off all the abnormal cells. Right? Or almost all? I guess it makes you feel pretty awful, as well as making your hair fall out.’

Blake Contini nodded.

CHAPTER THREE

WHEN the consultation was over and the two doctors were out in the wide corridor again, divested of their protective clothing, Blake Contini drew Abby to one side, out of the way of the pedestrian traffic, and queried her about aspects of the disease.

‘How would you make the final diagnosis here, Dr Gibson?’ he asked, fixing her with an astute glance from those rather unnerving blue eyes.

Abby cleared her throat, feeling a little like a student taking an exam. At the same time, she was grateful to have this opportunity for learning—even if her feelings towards her teacher were a little mixed. There was no time now to dwell on that.

‘Well,’ she began, ‘there are abnormal cells in the blood and in the bone marrow—tests for those would be decisive. The cells in the bone marrow never mature beyond the myeloblast level.’ Abby met his glance squarely, warming to her subject. ‘And, of course, the proliferating leukemia cells accumulate in the bone marrow, eventually suppressing the production of normal blood cells and the normal bone-marrow elements.’

‘Yes.’

‘He would have evidence of abnormal blood-clotting function—an elevated prothrombin time and low fibrinogen levels, as well as the clinical findings,’ she added decisively.

‘Right.’

Mr Simmons had manifested two common clinical signs. Abby had felt those distinctly when she had examined him as well—an enlarged spleen and an enlarged liver. They were signs indicative of a blood disease. ‘He has hepatomegaly and splenomegaly,’ she said, ‘two other diagnostic signs.’

He nodded. ‘Quite right. After the transfusions that we’re going to give him, how would you proceed with treatment, Dr Gibson?’

‘Well…’ Abby took a deep breath. ‘I would give him the remission induction chemotherapy that you mentioned—provided we think he’s a good candidate. We hope to induce a complete remission. We would need to really build him up first, including, probably, the giving of broad spectrum antibiotics to try to get rid of residual infection, particularly if he has some gastrointestinal involvement.’

‘Yes…good. I can see that you know your stuff Dr Gibson,’ Blake Contini conceded, raising his dark eyebrows at her and giving her a small smile, a gesture that transformed his lean face.

They had moved well away from the door of room six to discuss their patient, yet Abby glanced at it, feeling a familiar sense of pity. ‘I expect he was generally a very fit man before this,’ she said. ‘He doesn’t smoke, has always exercised regularly.’

‘Yes,’ he agreed. ‘We’ll see what the packed cells and the plasma do for him over the next day or two. I try to be as hopeful as I can with these patients. After all, what’s the point of trying to play God when each case is somewhat different from the next. We can only talk in probabilities. Do you agree?’

‘Yes.’

‘There’s nothing to stop him from getting hold of a medical book, of course, and reading about probabilities for himself,’ he commented dryly.

‘No, he’s obviously done some reading.’

‘Do you think he’s a candidate for a bone marrow transplant?’ he asked, looking at her quizzically again.

Abby shrugged, indicating her uncertainty. ‘Statistically speaking…I’m not sure,’ she said slowly. ‘His age is not on his side.’ She considered how well Mr Simmons would stand up to the effects of the toxic drugs that would be required prior to a transplant of bone marrow. ‘But I…I wouldn’t want to rule it out.’

‘Quite right, on both counts,’ he said crisply, ‘so I don’t think that’s an undisputed option. We’ll see. Before we start chemo, we need to do another liver function test and make sure his kidneys are in good working order.’

A small silence ensued, while other staff moved busily past them in both directions.

‘Well…’ Abby said, thinking of her outpatient clinic yet oddly reluctant to bring this teaching session to an end, ‘thank you for the time you’ve taken to go over this case with me, Dr Contini. I guess I ought to be getting back…’

Dr Contini looked at his wrist watch. ‘That’s the least I could do since you missed the presentation because of Will Ryles. A quick cup of coffee is in order, I think, don’t you?’

‘Definitely,’ she agreed.

‘Come to my office,’ he said lightly, ‘then I can quiz you about your attitudes and biases, Dr Gibson.’ The smile he gave her surprised her once again, as did his almost playful propensity to goad her in a gentle way, just out of the blue. Although he would not suffer fools gladly, she suspected, he would also be quick to burst any bubble of pomposity wherever he found it…and there was certainly plenty of pomposity in a hospital setting. For this reason, she found herself warming to him even more.

As she gave him a quick sideways glance, Abby reconfirmed her convictions about the false veracity of first impressions; she didn’t know what to think about Dr Contini. Two things were certain—he was an unusually attractive man, and knowing him was going to be a challenge, both personally and professionally.

‘You said you were good at other things, as well as taking histories,’ he said. It seemed that he was determined to shake off the slightly sombre mood that had been engendered by Mr Simmons’s condition. ‘Tell me what some of those other things are.’ His hand lightly under her elbow indicated that they should walk and talk at the same time.

‘Well…’ Enjoying his touch, she walked slowly. ‘I’m pretty good in a crisis.’ Looking at him sideways again, she challenged him to contradict her, her full lips curving up at the corners in an involuntary smile.

‘I expect you are,’ he conceded thoughtfully, his voice husky.

‘Even though you think I’m a bit klutzy?’ Her smile broadened.

‘You said that—I didn’t,’ he reminded her. ‘I would have come up with a word that was more complimentary.’

‘I’m not sure I believe that,’ she said.

As he led the way to a quiet side corridor off the main second-floor corridor, where the department of internal medicine offices were situated, Abby considered, a little nervously, what he might query her about, and she began to think that maybe she should have declined the offer of coffee.

‘Dr Wharton will be wondering what’s taking me so long,’ she ventured, as he led the way into his cosy office.

‘I spoke to Dr Wharton. It’s all right,’ her colleague informed her. ‘This is a teaching hospital after all. You haven’t told me what else you’re good at…outside work. I like to know who—and what—I’m dealing with in my new colleagues.’

‘Well…’ Abby racked her brains. ‘I’m good at gardening, and I make a pretty mean rum baba when I’m in the mood for it.’