Sensing Light (11 page)

XI

W
HILE WAITING FOR
K
EVIN
, Herb continued to craft text for their grant proposal. In such endeavors, he always used a number two wooden pencil capped with an oversized pink eraser and wrote on a yellow legal pad. He was holding the pencil by its point, bouncing the eraser up and down on his desk. A faint smile appeared as he thought about how obviously fundable the idea was, how the grant was writing itself. He hadn't shown any of this text to Kevin yet. He wanted Kevin to design the study with a minimum of assistance and feel ownership of the effort. He'd sneak in these paragraphs, articulating the rationale and larger significance of their proposal, later.

Herb's name would have to be listed as the principal investigator. His track record of publications was essential to getting them funded. Afterwards, he planned to recede into the background while Kevin ran the project and subsequently authored a paper describing the results. Herb was pleased by the personal closure his scheme entailed. He had become a wily mentor like the ones at the National Institutes of Health who had seduced him into a career of clinical research.

Herb had entered this pathway unintentionally. In 1968, after being deferred from military conscription for four years of medical school, three years of residency, and a year of pulmonary fellowship, he had run out of dodges. The army urgently needed doctors for its escalating war in Southeast Asia. Herb was newly married, and Cecilia wanted to get pregnant. He saw a flyer posted for a position at NIH, which was hiring young MDs to help conduct experimental treatment trials. Several perks came with the job—training in clinical research methods and another draft deferment. He applied immediately.

When Herb arrived in Washington DC, protests roiled the nation's capital. College students wearing army fatigues manned barricades and cursed
at police and National Guard troops. The kids were impassioned and cocky. They had just forced a sitting president to renounce his bid for re-election.

Cecilia was self-assured too—about her ability to handle the MBA program at Georgetown, pregnancy, and motherhood. Allison was born a few months after they arrived, an easy baby who slept through the night at six weeks and wasn't prone to crying spells. They could take her with them anywhere—restaurants, parties, movies. Herb carried Allison on his back in public places and received smiles from passers-by instead of furtive, xenophobic glances.

It was also in Washington that he started jogging again. Out Embassy Row, through Rock Creek Park, up Connecticut Avenue past the Zoo, or to the Lincoln Memorial, through the middle of the Mall, and on to Congress. The exercise calmed him, reinforced his own nascent self-confidence.

Kevin came into Herb's office holding a stapled, ten page document at arm's length, as though unsure of its odor.

“It can't be that bad,” Herb laughed.

“We'll see,” Kevin replied.

While Herb read the draft and made notes in the margins, Kevin thought of the question he hadn't asked yesterday.

Ten minutes later, Herb declared, “This is great! Besides a few typo corrections, all we need is to complete the analytic plan and justify the sample size. Then it'll be ready to plug into our grant application.”

“Do you really think it has a chance of being funded?”

“More than a chance. I'll be very, very surprised if it's rejected.”

Kevin wasn't convinced.

“There's always luck involved,” Herb admitted. “We don't know who will be on the study section panel or what their biases are. But even if it's not funded on the first round, I'm sure a resubmission can address any criticisms raised.”

“You've been lucky, haven't you?”

“Absolutely. My whole career was an accident. The only reason I went to NIH was to get out of the draft.”

“I don't want to go to NIH.”

“You don't have to go to NIH. There's plenty of opportunity right here.”

“But I'm not lucky.”

“Look, I know you had a bad experience with Flagler, but this is clinical research, not a laboratory experiment where every possible variable is under your control. It's about how patients react to a disease and respond to its treatment. Lots of uncertainty, many plausible interpretations of the data. You're the kind of person who's capable of dealing with the messiness and sorting it out.”

“So how did things work out so well for you?”

“Simply being in the right place at the right time, like you are now. When I showed up at NIH, the oncologists were investigating new chemotherapy regimens for children with leukemia, more toxic drug combinations than had ever been given before. The patients got so immune suppressed they were sitting ducks for opportunistic pneumonias like Pneumocystis. Serendipitously, the year I started, a company invented a flexible bronchoscope and wanted someone at NIH to try it out. There I was with the right training, the right patients, the right tool, and all these NIH microbiology and pathology labs happy to collaborate with me. A wide open road to success, and I took advantage of it. It wasn't hard to publish a dozen articles during the two years I was there, which made me marketable enough to be offered this job.”

“Sounds too good to be true.”

“Perhaps, but let's talk about how your stars are aligned. There are lots of GRID patients here, the disease isn't going away any time soon, and no one understands it. That is a huge opportunity for someone with your skills and training. Not only will this grant be funded, you'll be able to use the results to leverage bigger grants afterwards, which, by the way, should be more than enough to make the university change your academic appointment from temporary to permanent.
If
that's what you really want.”

Kevin disliked being probed. Impulsively, he turned the tables.

“Herb, why did you choose me? Why not one of your pulmonary fellows?”

Taken aback, Herb said, “What? Am I pushing you? Isn't this what you want? To figure out why people are dying from GRID and how to stop it?”

“Of course I do. But why choose me? Because I'm gay?”

Kevin tensed, expecting Herb to be defensive, if not hostile. Instead, Herb sighed, plopped his elbows on the desk, and rested his chin on intertwined fingers.

“I see,” Herb said, peering over his reading glasses. “Kevin, there are two reasons. One, it's obvious you're deeply disturbed by this disease. I can tell because I've been watching you since you were an intern. On the surface, you're a lot like me—a relatively calm person in this madhouse of high-strung prima donnas. Anyway, that first case—I'd never seen you so upset. You may not realize it yet, but you
need
to figure GRID out. It's going to haunt you until you do. And without that sort of passion, it's hard to accomplish much as a clinical researcher. The second reason is you have the smarts and drive to pull it off. There isn't anyone else here who has that combination of talent and motivation, which is why it has to be you.”

Kevin's cheeks burned. He tried to maintain a skeptical expression.

“I'm not selfless,” Herb added. “Getting grants funded is good for my career too.”

Herb offered his hand. Kevin tentatively clasped it.

XII

M
AKING GOOD ON HIS
promise, Kevin met Marco after work at a men's clothing store on Union Square. Two weeks earlier, scientists from a local biotech company interested in GRID had taken Kevin to dinner at an expensive restaurant. The next day, he swore to Marco's delight that he would never again go to such a place wearing frayed Rockports. Exploiting this window of opportunity, Marco hinted he might also have use for more than one tie.

Kevin was inspecting loafers when Marco arrived with opinions about color.

“A brown could match your eyes and hair,” said Marco, “if it's the
right
brown.”

Marco went through the store's entire inventory before settling on three pairs. While Kevin tried them on, Marco's eyes raced back and forth between the shoes and Kevin's face. He decided the first pair had too boxy a shape and the second made Kevin's skin look pasty. Kevin had been hoping he would pick the third pair, which had a matte finish. Shiny leather shoes seemed too pretentious to him.

Marco leaned against a mirror and gave Kevin a thumbs-up sign. Then he frowned.

“This is the tragedy of optics. You can only see your gorgeous green eyes in a mirror, which makes them twice as far away from you as they are from me.”

Kevin blew him a kiss.

Next they shopped for ties. Kevin followed as Marco led him through the racks and selected six candidates. Holding each one loosely knotted below Kevin's chin, he described the plusses and minuses of the color, pattern, and brightness, what it did to enhance Kevin's natural beauty. The last tie, yellow silk with diagonal, emerald stripes, particularly appealed to Kevin.

“You like it?”

“
Bello
,” said Marco, flaring his nostrils ever so slightly.

Kevin had never been inside a high-end men's clothing store before and was reluctant to leave. Now he wished he could afford a whole new wardrobe.

They grabbed a slice of pizza, and Marco went home, while Kevin drove to a meeting at the public health department. Marco was reading journals in bed when he returned.

“What was that about?” asked Marco.

“Bathhouses.”

“Bathhouses? They think saunas will cure GRID?”

“Very funny. The health department thinks bathhouses are breeding the epidemic. They're planning an educational campaign to warn people to use condoms and not share drugs inside those places.”

Marco was drowsy and didn't want to hear a lecture. He asked about Kevin's meeting with Herb.

“I gave him a draft of the protocol today,” said Kevin.

Marco sat upright.

“And?”

“He liked it…a lot, actually.”

“
Fantástico
! This is the opportunity to get the academic credentials you need,
querido
.”

Opportunity to screw up, thought Kevin.

Kevin didn't want to talk about the grant. He asked if they were on for lunch tomorrow after Marco's symposium at the Hill. Kevin also had meetings there in the morning. They agreed on the cafeteria at noon. Marco mumbled something about gene splicing and fell asleep.

Kevin lay next to Marco, watching him at rest. He thought of Marco's self-assurance in generating and testing his own scientific ideas. Where did it come from? Was it from growing up with more money and parental love than he had received? Marco's father, an oil company executive, was a conservative, politically and socially. He may have been disappointed on finding out Marco was gay, but he was demonstratively fond of his son and civil to his son's lover. Was getting unconditional affection the key to having confidence?

Kevin had only experimented with mice, never with human subjects, sick people, dying people. It was easy to imagine the mistakes he might make—recruiting inappropriate patients, not following the protocol correctly, errors in his analysis of the data. And if he did it all flawlessly, in the end there still might be nothing of importance to show for the effort.

When Kevin first told Marco about Herb's suggestion they apply for NIH funding, Marco urged him to collaborate. Kevin was hesitant. He had already failed once at grant writing. A nasty argument ensued after Marco, whose view of academic reality was not sanguine, pointed out the facts of life.

“You won't last as a pure clinician,” Marco had said. “The university can always replace you with younger, cheaper doctors who are right out of training. How many faculty at City Hospital have you seen promoted on the basis of their clinical work alone? But if you're bringing in grant money, you become necessary. The university needs those overhead dollars.”

Kevin knew all this and didn't want to hear it from his lover. Since then, Marco had been circumspect whenever they discussed Kevin's career.

As he tried to fall asleep, Kevin soothed himself with a saving grace. At least he had a firmer grasp on how microbes killed humans than he ever had on how antibiotics killed microbes.

XIII

E
ARLY THE NEXT MORNING
, Kevin backed his 1969 Rambler sedan into the street, shifted into second gear, and let the engine brake his descent to Castro Street. The car had 120,000 miles on the odometer and numerous dents when Kevin bought it five years ago. Its smooth ride and excellent visibility were nice features, but Kevin had chosen the Rambler because of its reliable straight six, large engine compartment, and seven hundred dollar price tag. After stripping the air conditioner, unnecessary in San Francisco's climate, he had enough room to change the fan belt, clean the head, or replace the starter without having to jack the vehicle up and work underneath it on his back. He could make repairs without getting filthy or lacerating his hands. Space was the ultimate luxury for a mechanic.

Although the Rambler's squared-off frame and clunky, horizontal grille offended Marco's aesthetic sensibility, he had become reconciled to the car. It helped that Kevin didn't object to their exclusively using Marco's Alfa Romeo convertible when traveling together. Kevin wouldn't open the hood of the fragile Alfa unless there was an emergency. Marco frequently had to take it in to the local dealer for repairs. The 1969 Rambler had a track record of outstanding durability—its crowning merit from Kevin's perspective.

As a teenager, Kevin had no effeminate traits. However, his lack of pugnacity or enthusiasm for sports did make him suspect. His disinterest in girls' bodies might have sealed the verdict if not for the mechanic camouflage. Kevin knew his regular presence in the garage and competence with tools saved him from persecution. Yet he hated the charade and was repelled by car culture, which made the Rambler's uncoolness to automobile aficionados another virtue.

The sky had cleared. As Kevin rolled downhill, he saw the Marin headlands in the distance, a richer green after yesterday's rain. He had some time
before his appointments on the Hill and detoured into Buena Vista Park. Mothers were pushing strollers in the parking lot. No men were cruising for sex at this hour. Relieved there wouldn't be any awkward encounters, Kevin trotted up a short footpath. At the crest, he saw the twin, cream spires of St. Ignatius Church rise from the valley below. Evergreen ridges in the Presidio formed a backdrop. Just beyond loomed the orange-vermillion towers of the Golden Gate Bridge.

The ocean view through the glass walls on the twelfth floor of the Hill's new medical science complex was also spectacular. Given his second chance in a week to see the Farallon Islands, Kevin didn't mind waiting in the hallway.

Raymond Johnson, an overweight, bald man in his fifties, was twenty minutes late. The immunologist sported a silver goatee and square-rimmed, tortoise shell glasses. Johnson apologized, but he neither smiled nor shook Kevin's hand. He hastily ushered his visitor through a high-ceilinged laboratory into his office.

Kevin knew Johnson's academic niche was investigating rare, inherited immune deficiency syndromes and that one of the instruments he caught a glimpse of could count helper T lymphocytes in blood. Kevin's acquaintances at UCLA had used a similar device in their study about to be published in the
New England Journal of Medicine
. Johnson had the only laboratory on the Hill capable of measuring these unique cells.

The meeting had been Kevin's idea. He called Johnson and proposed they talk about some common interests. Kevin hoped once Johnson heard details of the UCLA report and understood Kevin had a cohort of GRID patients willing to donate a little blood, the immunologist would be thrilled to collaborate. Johnson was well-funded. He could cover the salary of a research assistant for Kevin if he wanted.

Johnson sat in a black leather armchair and directed Kevin to a small plastic seat across from his desk. He leaned back and opened his hands. Kevin took the cue to explain GRID, tossing in the UCLA group's results along with the fact that their paper had been accepted by a prestigious journal. He described his patients at City Hospital then waited for immunologist's eager response.

“I'm surprised the
Journal
accepted the manuscript. As a reviewer, I was unimpressed—such a small sample size. Apparently, the other reviewers were more indulgent. It is an interesting observation, although not very illuminating. The money question is what's driving the loss of T helper cells. Are they destroyed, or is there a failure of production? And what's the underlying cause—a toxin, virus, occult malignancy, or some new pathogen no one has ever seen before?”

“I … I'm not sure,” said Kevin, flummoxed. “I don't have a hypothesis yet.”

Johnson smiled tightly.

“That would be a good place to start, wouldn't it?” he said.

As Johnson rose to escort Kevin out, he added, “My plate is full right now. Let's discuss this in six months or a year when you have a clearer idea of what you're looking for.”

Kevin's next appointment was in the basement of the medical center's oldest building. This meeting had not been initiated by Kevin. A PhD in the oncology division, Rajiv Singh, had called him requesting blood specimens from GRID patients. Kevin queried oncologists at City Hospital but only learned Singh was studying a rare virus that caused leukemia in cats.

Kevin entered a tiny laboratory and found a short, wiry man sitting erect on a stool, writing numbers in a bound notebook. On seeing Kevin, he jumped up, pumped Kevin's hand, and began explaining what the various pieces of equipment measured. The instrument Singh was most proud of could detect reverse transcriptase—a signature enzyme uniquely present in a class of organisms called retroviruses.

“Do you think GRID might be caused by a retrovirus?” Kevin asked.

“It's a reasonable hypothesis. Maybe a retrovirus infects helper T lymphocytes and destroys them. You know what? I could look for reverse transcriptase in the lymphocytes of your patients.”

“I can get you blood samples,” said Kevin, “But there's going to be a problem. GRID patients have very few T cells.”

“Then I'll need a lot of blood,” said Singh with a wide grin.

Although Kevin doubted the plausibility of Singh's hypothesis, he had no other opportunities on the horizon for partnering with a basic scientist. He volunteered to submit an institutional review board application, which would permit him to collect blood from his patients and allow Singh to assay the specimens.

“That's exactly what I was hoping to hear you say,” said Singh, patting Kevin on the back.