Sinking into the chair behind his desk, Michael propped his head in his hands, then tunneled his fingers through his hair. It had been a long and frustrating day. Since his casualty patient this morning, he’d examined twenty pediatric patients, two men with malaria, and four pregnant women. All four of the women had borne other children; one had an even dozen waiting at home.
In each obstetrical case he had gently tried to explain the advantages of tubal ligation. Since most of his patients were Catholic in name if not in practice, discretionary methods of birth control were considered taboo. But in a country where women as young as thirteen began to bear children and most continued to produce babies until menopause, tubal ligation could be a quiet blessing.
His explanation—or Fortuna’s translation—must not have been effective, for all four of his pregnant patients merely smiled shyly and slid off the exam table, content to go home and continue bearing children. Performing the ligation would be simple if they came to the hospital to have their babies, but he knew he would see few of his maternity patients again. Tribal women had been delivering babies in riverside villages for generations; they only sent for the doctor when things went dramatically wrong.
Lowering his hands, Michael glanced at a bagful of drugs Fortuna had collected from his last patient. The man, who had been clearly suffering from malaria, had visited an Iquitos farmacia and walked out with a collection of medicines including cough syrup, worm pills, and a bottle of drops for “cerebral circulation”—whatever that was. None of the medicines had helped, so the man had then visited a nearby brujo, or shaman, who declared that evil had been visited upon the patient and he could provide the cure.
The blending of old and new cultures constantly amazed Michael. While as a physician he recognized illness as a clearly definable condition within a physical body, he could not ignore the prevailing culture’s view of sickness as the result of interactions between human bodies and spiritual forces. His patients thought nothing of visiting a brujo one day and a physician the next; what one did not cure, surely the other would. And their definition of illness surprised him—any upset, be it physical, mental, or emotional, caused dis-ease, so nearly as many patients consulted him for lovesickness as for parasites.
When faced with a lovesick patient, Michael frequently left the counsel and treatment to Fortuna, who knew far more about native spirits—and Peruvian marriage rites—than he did.
Peculiarities of the culture often frustrated Michael, yet one aspect of jungle customs pleased him—while in other societies a man might seek vengeance upon whomever had brought about an illness through spiritual means, the people with whom he worked made no effort to determine who the “bewitching” party might be. With surprising equanimity they accepted their illness and promptly sought cures from the brujo and physician.
Once he had asked Fortuna why this was so; she replied with a casual shrug. “There are too many people alive, too many dead, so how can you know who is responsible? You would go crazy if you tried to blame them all.”
Thus far Michael had encountered only one exception to this rule: Early in his Iquitos practice, a little boy’s father explained that his toddling lad’s persistent diarrhea resulted from his deceased mother’s efforts to persuade the boy to join her in the next world. After meeting the boy and the father’s new wife, Michael privately suspected the stepmother had more to do with the child’s illness than the spirit world, for the new wife had candidly told Fortuna she did not want to raise another woman’s child. Native women knew their plants; the stepmother could have been giving the boy tea from a vine in the forgetme-not family or overdosing him with any of the many plants used to kill worms; all acted as purgatives. Both Michael and the village brujo attempted to treat the sickly lad; over time, they both failed.
Resting his head on his hand, Michael blinked the troubling images of the past away. This morning’s fiasco in the casualty ward had vividly reminded him that superstition still thrived along the river. The orderly who fled at the sight of the tattooed patient never returned to the ward, and several of the nurses had shrunk from the sight of the unusuallooking native.
Michael glanced at his watch. That nameless patient was still fighting peritonitis and still losing the battle. His kidneys had begun to fail during the afternoon; death was only a few hours away. At midday, Fortuna had called for a priest to administer the last rites; she later reported that the patient resisted as the cleric approached, clearly wanting no part of the ritual. Michael had advised her to wait until later and then try again. While he doubted his patient was Catholic, Fortuna and the other nurses placed great emphasis on the ritual. The priest’s efforts might not be worth two pence to the patient, but at least the nurses would be comforted.
Looking around his desk, Michael’s eyes fell upon the Englishlanguage version of El Tiempo, Peru’s largest newspaper. He had subscribed to this digest version several weeks ago, but thus far he’d done nothing with the paper but clutter his desk. On a day like this, though, it might be nice to have a gander at the English language, to read a phrase or two that evoked a memory of old Blighty and civilization.
After glancing up to be sure his door was closed (Fortuna had a habit of promising his attention to anyone who asked for it, even on his dinner break), Michael picked up the paper and shook it open. The editors of El Tiempo routinely translated the week’s major stories, emphasizing those presumed to be of interest to travelers, students, or internationals.
A photograph on the front page immediately caught Michael’s attention. At first glance he thought he was looking at a starfish on a grainy beach, then he read the caption: “This platform canopy, designed by French researchers, will be employed for the next three months at a site on the Yarapa River. A multinational team of researchers will pursue several scientific investigations while visiting Peru.”
Reading the article, Michael learned that an international delegation had flown into Lima in late March. Many esteemed researchers would be staying at the Yarupapa Lodge and conducting various experiments throughout the months of April, May, and June.
“Among the American scientists are noted anthropologist Emma Whitmore and neurologist Alexandra Pace,” the reporter wrote. “And while Dr. Pace’s work is well known to medical researchers working in the field of brain diseases, few people realize why she has invested her life in this field of study.”
Michael tensed as the soft popping sounds of flip-flops broke his concentration. He stared at the doorknob, willing it to remain closed, then slowly released his breath as the passerby continued down the hallway.
He returned to his reading.
Alexandra Pace, one of the world’s leading neurologists, is employed by Horizon Biotherapies. She specializes in the quest for a cure or treatment for diseases caused by infectious proteins, more commonly known as prions. Few doctors have encountered prion diseases among their patients, but since the outbreak of mad cow disease in Europe, the threat of such illnesses hangs like a specter over mankind.
Prions—ordinary proteins that have somehow become misfolded— not only do not function properly in the body, but they cannot be eliminated or rendered harmless by enzymes. As they accumulate, they cause the patient to lose coordination, mental function, and speech. Often patients experience dementia or sleeplessness. Death usually occurs within two years after the onset of symptoms.
The quest for a cure brings Dr. Pace to Peru. When asked what she hopes to find within our country, the pretty American smiled and replied, “Nice people. Beautiful views. And hope.”
She went on to cite the recent rainforest discovery of a substance that enhances the action of adenosine, a brain chemical that reduces the effects of strokes and may help combat Alzheimer’s disease. She explains: “According to anthropologists, the Matses, a Peruvian tribe, use a particular frog to cure hunters of what we would call burnout. Whenever a weary hunter wishes to ‘take frog,’ another man finds the frog and harasses it, scrapes the defensively produced mucus off its skin, then burns the hunter with a hot twig. To the burn he then applies the frog mucus mixed with saliva. The hunter becomes violently ill for a few hours, but he awakens the next morning eager to hunt. And while I don’t know much about hunters or Peruvian natives, I am vitally interested in chemical compounds that affect brain function.”
When asked if she believes the frog mucus contains some bacteria or virus that will help her find a cure for prion diseases, she answers, “I have no idea, but at this point I’m open to any experiment. Researchers recently discovered a small molecule drug that can stop the misfolding of prions before they begin to malfunction. I’m looking for a molecule that can undo the damage caused by misfolded prions that result in brain disease. I am hoping to find that catalyst here in Peru.”
The American researcher, who lives in Atlanta and is employed by the company sponsoring the expedition, went on to cite several pertinent statistics: “Seventy percent of all prescription drugs in the United States come from plants found only in the rainforest. More than 90 percent of all the world’s plant and animal species live in the tropics. The rainforest contains the very biology of our planet, and if cures for our illnesses exist, I believe they can be found here.”
Michael gripped the edges of the newspaper as a slight coldness settled around his bones. He had never heard a local doctor speak of encephalopathies; few American physicians even knew what a prion was.
But his colleagues at London’s St. George’s Hospital knew all about prion-induced diseases. In their own wards they had treated variations of Creutzfeldt-Jakob disease, and under their microscopes they had peered at evidence of kuru and bovine spongiform encephalopathy, more commonly known as mad cow disease. BSE had frightened the country spitless in the late 1990s, resulting in the destruction of over half a million cattle . . . and the deaths of 107 people, including Michael’s wife.
The empty air around him seemed to vibrate, the silence filling with remembered dread. Slowly, he lowered the newspaper.
“If you find a cure for prion diseases, Dr. Pace, I’ll kiss your bloomin’ feet.”