Tuesday, November 22, 2016 — Hudson Valley
* * *
He drove to the cemetery on the Tuesday before Thanksgiving because the anniversary was Wednesday and Wednesday he’d be in the lab and the work wouldn’t stop for the dead.
The cemetery was in Rhinebeck — a small plot on the hill behind the Dutch Reformed Church, the stones old and tilted, the newer ones polished granite standing upright in rows that hadn’t existed when the church was built in 1730.
His parents were side by side in the new section, under a single piece of grey stone that read BRANDT and nothing else.
No first names, no dates, no inscriptions.
He’d chosen the stone himself at twenty and he’d chosen blankness because anything he wrote would have been insufficient and insufficient felt worse than nothing.
He stood at the foot of the graves in a grey wool coat and watched his breath cloud in the cold air and thought about his mother.
* * *
August 2000.
Rhinebeck.
He was fourteen.
She’d told him on the porch.
Not in the kitchen, not in the living room, not in the bedroom where the diagnosis had kept her awake for three nights — on the porch, where the view was the orchard and the valley and the Catskills blue in the distance, because she was a woman who believed that bad news should be delivered in beautiful places.
“The blood work came back,” she said.
She was sitting in the wooden rocker his father had built the summer they’d moved from Zürich.
She was wearing a white linen shirt and jeans and her feet were bare and her hair — dark blonde, thick, the hair he’d inherited — was loose around her shoulders.
She was forty-one and she looked thirty-five and she looked, in that moment, exactly like what she was: a woman who’d been healthy her entire life and was about to stop being healthy.
“Leukaemia,” she said.
“Acute myeloid.
The haematologist in Albany confirmed it this morning.”
He was sitting on the porch steps.
He was fourteen and he was tall for his age and he was wearing a t-shirt from the Rhinebeck science fair where he’d won first place with a project on epigenetic methylation patterns in Drosophila, and he didn’t understand the word acute in a medical context but he understood the word leukaemia because he’d read about it in a biology textbook his mother had given him for his thirteenth birthday.
“How bad,” he said.
“Bad.”
She didn’t elaborate.
She didn’t need to.
He looked at her face and saw the truth in the steadiness of it — not calm, not composed, but held, the way a woman holds her face when she’s decided that the person she’s talking to needs the information and not the fear.
His father was in the lab.
His father was always in the lab — the converted barn at the bottom of the hill where Erik Brandt, PhD, former chair of molecular biology at ETH Zürich, now independent researcher and occasional consultant for pharmaceutical companies that paid him well for work they didn’t understand, spent his days among centrifuges and spectrophotometers and the quiet hum of equipment he’d shipped from Switzerland when Lukas was six.
His mother had not told his father yet.
She’d told Lukas first because she understood, in the way she understood most things, that her son would process the information differently.
Erik would grieve.
Lukas would plan.
“What’s the treatment?” he asked.
“Chemotherapy.
Four cycles.
Possibly a stem-cell transplant after.”
“Survival rates.”
“Lukas.”
“Survival rates.”
She looked at him.
Her eyes were grey-green — the same grey-green he saw in the mirror every morning, the gene she’d given him along with the jaw and the height and the mind that moved faster than the world around it.
“Twenty to thirty per cent at five years,” she said.
“For my subtype.”
He didn’t say anything.
He looked at the orchard and the valley and the mountains going blue in the late-afternoon light and he processed the number — twenty to thirty per cent — the way he processed every number: as a boundary, not a verdict.
Boundaries could be moved.
Verdicts could not.
“There’s a trial at Memorial Sloan Kettering,” he said.
“A targeted therapy for AML with FLT3 mutations.
The results from the Phase II were published in Blood last month.
Median survival improved by fourteen months.”
She stared at him.
“You read Blood?”
“Dr Okafor’s subscription.
She lets me borrow the journals.”
“You’re fourteen.”
“The science isn’t complicated.”
She laughed.
The laugh broke something — the composure, the held face — and her eyes filled and she laughed again and the tears ran down her cheeks and she reached for his hand and held it the way you hold something you’re afraid of dropping.
* * *
The chemotherapy started in September.
Four cycles, three weeks each, administered at Albany Medical Centre because Memorial Sloan Kettering had a waiting list and time was the one thing the diagnosis hadn’t given them.
She lost her hair in week two.
She lost fifteen pounds by week four.
She lost the ability to climb the porch stairs by week six, and his father carried her — Erik, tall and lean and steady, carrying his wife up four wooden steps as though the steps were the problem and not the disease that was consuming her blood one cell at a time.
Lukas read everything.
He read the journals — Blood, The Lancet Oncology, Nature Medicine — not because a fourteen-year-old could treat leukaemia but because reading was the only form of control he had.
He read about blast percentages and cytogenetic risk groups and minimal residual disease, and he sat in his room at night with his mother’s lab results on the desk and his father’s textbooks on the shelf and he tried to find the thing that the oncologists had missed.
He didn’t find it.
There was nothing to find.
The disease was doing what acute myeloid leukaemia does — proliferating, crowding, replacing functional cells with dysfunctional ones, turning the bone marrow into a factory that produced nothing useful.
His mother’s body was being colonised by its own errors.
By December, the chemotherapy had failed.
The blast count was higher than before treatment.
The oncologist at Albany — a kind man with tired eyes and a voice calibrated for delivering information that ended lives — used the words refractory and salvage protocol and comfort measures in the same sentence, and Lukas watched his father’s face collapse in a way that tall, steady men’s faces are not supposed to collapse.
His mother died on January 3, 2001.
At home.
In the bed his father had built from cherry wood that came from the orchard.
She was forty-one.
She gave him the ring the day before.
* * *
He’d been sitting with her.
His father was asleep in the chair by the window — Erik, who hadn’t slept in the bed since she’d stopped being able to leave it, who slept upright in a wooden chair every night with his hand on the edge of the mattress so he’d feel her move.
“Lukas.” Her voice was a whisper.
The morphine had taken the pain but it had taken the volume with it.
“The drawer.
My side.”
He opened it.
Inside, among a passport and a watch and a folded letter, was a ring.
Grey metal, no markings, no stones — a plain band that looked like it had been cast from something he couldn’t identify.
It was cold to the touch and heavier than it should have been.
“It was my mother’s,” she said.
“And her mother’s.
A long time before that.
Sardinia — the old family, the one we don’t talk about.”
He held the ring.
It weighed nothing and it weighed everything.
“Put it on.”
He did.
Left hand, ring finger.
It was too large for a fourteen-year-old’s hand — it slid and sat loose at the base of his finger, the metal cold against his skin.
“It’ll fit,” she said.
“When you’re ready.”
“Ready for what?”
She didn’t answer.
She was looking at the ceiling, or past it, at something that the morphine or the dying or the thing she’d inherited from her own mother let her see.
“Don’t let your father disappear,” she said.
“He’ll want to.
When I’m gone, he’ll go into the lab and he won’t come out.
Make him come out.”
“I will.”
“Promise me.”
“I promise.”
She closed her eyes.
Her breathing slowed.
He sat with her until his father woke at dawn and took over and she died that afternoon with Erik’s hand on the mattress and Lukas at the foot of the bed and the ring on his finger and the orchard bare outside the window.
* * *
He couldn’t make Erik come out.
He tried.
For three years — fourteen to seventeen — he tried.
He cooked meals and left them at the barn door.
He mowed the lawn and maintained the house and did his schoolwork and applied to MIT and got in and deferred because his father was a man sitting alone in a converted barn surrounded by equipment from a life that had ended when his wife died and Lukas couldn’t leave him.
Erik didn’t drink.
Erik didn’t rage.
Erik worked.
He worked with the same quiet, methodical focus he’d always had, except the work had no direction.
He ran experiments that led nowhere.
He read papers he’d already read.
He maintained equipment that no longer needed maintaining.
The lab became a mausoleum with centrifuges — a space where a grieving man went every morning because the alternative was the house where his wife had died, and the house was unbearable, and the barn was merely empty.
The cancer came for Erik in 2005.
Pancreatic.
The diagnosis was late — Erik had ignored symptoms for months because symptoms required attention and attention required caring about the body he lived in and Erik had stopped caring the day the body he cared about had stopped breathing in a cherry-wood bed.
Stage IV.
No treatment.
Comfort measures.
Lukas was nineteen.
He’d deferred MIT twice.
He came home from a week in Cambridge — where he’d gone to sit in on a genetics lecture and feel, for seven days, what it was like to be a young man with a future instead of a young man with a father who was dying — and found Erik in the barn, on the floor, unconscious.
The ambulance took thirty-seven minutes.
Rhinebeck.
Rural.
Distance.
Erik died three months later.
At home.
In the bedroom, in the cherry-wood bed, because Lukas moved him there in the last week over Erik’s weak protests, because the bed was where his wife had died and Lukas understood — with the clarity of a nineteen-year-old who’d spent five years watching disease take everything — that his father wanted to die where she had.
Not because he was sentimental.
Because he was still, after four years and a cancer that was eating him from the inside, following her.
* * *
November 22, 2016.
Lukas stood at the foot of the two graves and the wind came off the valley and the sky was the colour of old pewter and the trees were stripped bare and the stone said BRANDT and nothing else.
He thought about his mother’s blood turning against her.
He thought about his father’s pancreas producing cells that consumed him.
He thought about the ring — the ring that had been too large for his fourteen-year-old finger and that had fitted perfectly by the time he was seventeen, as though the metal had contracted or his hands had grown to meet it.
The ring that had sat dormant for sixteen years until the MRI in April 2016, and that had opened, and that had shown him what he could build.
He could heal the body.
He was doing it — five products, six weeks, one woman whose skin was glass and whose breasts defied time and whose hair shone with a lustre that no salon could replicate.
He was healing her body, and he would heal others, and the products would become treatments and the treatments would become cures and the cures would reach the diseases that had taken his mother and his father — leukaemia, pancreatic cancer, the failures of biology that medicine couldn’t fix because medicine didn’t have the tools and he did.
Two graves.
Two diseases.
Two parents who’d been brilliant and kind and devoted and who’d died because the twentieth century’s best science wasn’t good enough.
The twenty-first century’s wouldn’t be either.
Not from anyone else’s lab.
From his.
He placed a hand on the stone.
The ring was warm against the cold granite.
“I’m close,” he said.
The wind answered.
The valley was silent.
The dead were silent.
He drove back to the lab.
Worked until midnight.
The deficit warning pulsed amber in the dark and he let it pulse.