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"I'm breathing better," she says. Earlier, her lungs had filled with fluid, the result of other, possibly related, medical problems she must fight. "The cough is better, but when I do cough, I get a swelling."
The doctor nods, oblivious now to everything in the room but Linzner.
"I rarely use my oxygen," she continues.
"Are you eating well?" he asks suddenly.
"What are you taking now?"
"Well," Linzner says, "there's Coumadin [an anticoagulant that helps blood flow through an artery being constricted by her tumor], and of course there's the thyroid medicine. I take iron in the morning; you know I hate taking things. I took myself off the Prevacid [for intestinal problems, not prescribed by Abel]. And I'm dizzy a lot."
"Dizzy?" repeats Abel.
"Dizzy. You think it's from the chemo?"
"No, too long ago."
"You think I'm dizzy just because I'm dizzy?" she asks, almost coquettishly. More than 20 years ago, Linzner was a medical technician. She is not afraid to ask questions or to tease the doctor. "Could it be low blood pressure?"
The conversation goes on, questions and responses snapping like synapses on both sides. Working at it together, they narrow in on Linzner's current condition. Still, the doctor doesn't have enough information to know for sure if the Rituxan is working. They'll need to do a CAT scan of her tumor areas; the scan's thin, cross-sectional images, which can reveal even minuscule tumors, will help determine her next move. If the Rituxan has failed, her chances of surviving much longer are limited -- but she might become a candidate for the vaccine trials.
She'll have to live with the question for the next few days, awaiting the results of the CAT scan. Abel also gives her a tentative diagnosis of "excellent, just excellent."
"To understand what I mean," he explains to a visitor, "you have to know where she came from."
"A bad place," Linzner finishes.
"If the Rituxan doesn't work," she later comments quietly, riding the elevator down from Abel's office and nodding toward the cancer center, "at least I've lived long enough to benefit from that." Abel finishes his morning without a break. Today he will have to work through lunch at the hospital. He walks across the road from his medical building and into the Telesynergy Center for a midday meeting. On this day doctors will discuss four patients suffering from lung cancer. Because construction is under way, a door near the cancer center at Holy Cross has become the hospital's temporary main entrance. A host of people enter the hospital, but only a few turn into the cancer care center itself.
Abel passes through the sprawling waiting room, navigating among the familiar, seated forms of aging, somber cancer patients. He slips into a hospital corridor not open to the general public, turning into the Telesynergy Center, where a crowd gathers in a midday buzz of professional energy. This is the local half of the "Partners in Science" team of doctors in Bethesda and Fort Lauderdale. The doctors come from many disciplines: The team includes a pathologist, a pulmonologist, two radiation oncologists, a hematologist, a radiologist, and a surgeon. Nurses, technicians, a dietician, center administrator Maureen Mann, and a couple of psychologists round out the team, about 15 people.
Along one wall of the conference room is the technology that makes the vaccine trials possible at Holy Cross. Nine separate instruments together provide the "telesynergy." NCI literature trumpets this bit of technobabble to describe it: "A multi-media, medical imaging workstation to be used within an electronic imaging environment, utilizing an Asynchronous Transfer Mode (ATM) tele-medicine network designed to provide for the simultaneous high-resolution display of medical images from numerous modalities."
In plain English that means everybody in Fort Lauderdale and Bethesda can look at the patient and his or her tests at the same time using the equipment.
The workstation includes electronic view-boxes, a computer controlled by a main operator, a video monitor, and a remote-control microscope used for histopathology and cytogenetics -- the studies of microscopic changes in diseased tissue and cell formation and development respectively.
The workstation also includes a VCR that records the images doctors are studying, an x-rayfilm digitizer to present x-ray images on screens, and a hand-held camera that can be used to examine patients.
The equipment is poised and ready to go, but today the teleconferencing screens are blank. The Holy Cross team needs to settle on the first group of test subjects for vaccines. Some of the cases the team will discuss today are potential candidates for the trials, which are scheduled to begin in mid- to late October. Three of the four lung-cancer patients being considered today are Abel's.
"Patients should be categorized by their performance status," announces a doctor as the meeting gets under way. (Performance status is a euphemism for "chance of survival.")
The first patient has a performance status of one, out of a possible four. One is very good, if such a term can be used to describe a victim of lung cancer. But there is a peculiar problem. "This is a 74-year-old male who has smoked a pack a day since he was nine or ten years old," says the patient's doctor. Now the patient has a nodule in the middle lobe of his right lung.