Some clinics are born out of need, some out of philanthropy—and others out of sheer desperation.
While the more medically sophisticated nations of the world continue to impose strict clinical protocols before ratifying experimental drugs for use on humans, the terminally ill refuse to wait. After failing to sway their own medical bureaucracy, they circumvent it by going to one of several special hospitals that have recently opened on tiny Caribbean islands previously known for their beaches and rum punch.
Many establishment physicians denigrate these operations as heartless and exploitative. While in certain cases this is a valid accusation, in others genuine cures are being realized. Numerous hopeless cases are alive today having acted as human guinea pigs beneath the swaying palms.
True, a large proportion of the “cures” offered by these institutions have been like Laetrile, an antitumor drug originally derived from apricot pits by two California doctors, which has produced little more than dashed hopes and large bills.
The dubious benefits of this remedy did not dissuade a stream of patients whom more traditional methods had not helped.
In other cases, for example under the Reagan and Bush administrations, while strict American legislation forbade the medical use of tissue from aborted fetuses, it became available in the islands. Brain surgeons were therefore able to try radical procedures that advanced the fight against such maladies as Parkinson’s disease and even Alzheimer’s.
Although they did not broadcast their presence, representatives of all the multinational drug companies made regular, if low profile, visits to these farflung enterprises, and even major universities turned a blind eye when distinguished senior members of their faculties dashed off to the Caribbean for what they euphemistically referred to as “working vacations.”
Now, Dmitri Avilov waited on the runway of the airport at St. Lucia, a lush and verdant paradise of volcanoes and valleys.
Though only the second largest of the Windward Archipelago, it held two special attractions for the former Soviet scientist: the ultramodern facilities of its private Clinique Ste Hélène, and the compelling coincidence that this tiny country—one-fifth the size of Rhode Island—had already produced two Nobel Prize winners, though none as yet in medicine.
Uncharacteristically sporty in his open short-sleeved shirt, Avilov scanned the cloudless skies for signs of the Piper Comanche ferrying the Zimmer family from Caracas, where they had flown in from Buenos Aires.
He was tense. For all his confidence before patients, he was deeply apprehensive about the new genetic therapy he was about to undertake.
While one of the ancillary advantages of risking experimental techniques in faraway places was the fact that doctors could quite literally bury their mistakes, he was still frightened that if he failed, albeit in so remote a place, somehow the word would get out. And while his formal academic job would not be imperiled, his international reputation might be irreparably damaged.
On the other hand, if he succeeded, his long-cultivated romance with the press would bring attention to the little island that had witnessed his major breakthrough.
A moment later the drone of the small plane became audible. In another instant it was visible, circled the field, and gracefully touched down. The pilot jumped energetically from the cockpit and hurried to open the passenger door. A dark-skinned nurse in a blue cotton pantsuit came quickly down the steps carrying a small satchel.
After scanning the various people waiting outside the terminal, she motioned to a white minibus. The orderlies who had been waiting in its air-conditioned comfort drove out onto the field and entered the plane. Then together they bore out Edmundo Zimmer, his face gray with impending death, placed him onto a stretcher, and carried him back to their vehicle.
The other passengers—Muriel, Francisco, and Dorotea—followed, shielding their eyes from the harsh Caribbean sun.
The local authorities insisted that the new arrivals go through an elaborate customs procedure that even the great professor could not circumvent.
Finally, Muriel and the Russian went in the minibus with Edmundo, while Francisco and Dorotea followed in a rickety taxi that bounced them dizzy.
When they regrouped at the Clinique Ste Hélène, Avilov proposed, “There’s no point in waiting. The actual ‘operation’ has already been performed on the samples I took from his bone marrow. We have merely to infuse the recombinant cells and set them to work transforming the murderous gene. I think we can get right on with that.”
“I agree,” Muriel responded, then cast a glance at Francisco and Dorotea, who both nodded concurrence.
“In that case,” the Russian continued, “I’ll see to it that he’s installed in a room and start the transfusion. Since there’ll be no immediate results, may I propose that the rest of you go to the hotel and unwind from the journey.”
“I want to stay with him,” Muriel insisted.
“So do I,” the two others echoed almost in unison.
“As you wish,” Avilov acceded. “But I would insist that you be present only one at a time.”
As the professor had predicted, nothing dramatic happened for several days. Avilov had returned temporarily to Boston to attend to other matters and other patients. When the rest of them weren’t visiting the hospital, they relaxed on the beach.
One night at dinner Dorotea confided, “I’ve spoken to several doctors, and all of them seem to concur that Avilov is on the right track. I asked if—since we’re in a ‘rule-free’ zone—he would try the therapy on me as well. And he agreed.”
“Isn’t that taking a big risk?” Muriel asked.
“No,” the younger woman replied, her voice revealing both anger and fear. “I can’t live waiting to be sick. If he can’t cure me, I’d rather die immediately.”
Francisco tried to dissuade his sister, but she was adamant.
On his return, the Russian was delighted. “A very wise decision,” he trumpeted. “There’s still time for you to be a happy mother of children—healthy children.”
He was so effusive that it almost seemed as if he was willing to help get her pregnant also.
There was little to do on this distant paradise. The newspapers were all three days old. In her room, Muriel found a pamphlet with a brief history of the island, which mentioned as one of its tourist attractions a seventeenth-century cemetery whose residents provided a historical panoply of the various waves of emigrants to this island—thence to the North American colonies. According to the brochure, there was even a fellow with the exotic name of “Uriel Da Costa.”
“Do you think he might be a relative?” Francisco asked.
“I doubt it. But it would give us something to fill the afternoon.”
“Okay, vamos.”
It turned out to be a mixed blessing.
Francisco was able to translate the epitaphs, which were all in Spanish or Portuguese. And yet, amid the worn and beaten gray stone slabs, they discovered three perceptibly newer ones.
Upon investigation, they were staggered to see that this trio of graves dated not only from the twentieth century, but from the past five years. And the deceased were neither Portuguese nor Spanish. One headstone read, “Mary Donovan, 1935–1989.”
Francisco, who read Muriel’s thoughts, immediately approached the caretaker and asked who these people were. The old man shrugged, and mumbled a few words.
Francisco was furious when he returned, and Muriel asked anxiously, “What did he say?”
Her stepson imitated the man’s French accent, “ ‘Zey ill—zey die—I bury.’ ”
“Were you able to ask him what they died of?”
“He said just two words—‘La Clinique.’ ”
They were both alarmed and incensed, but during the interim had agreed not to impart this information to Dorotea. They were waiting on the runway to confront Avilov when his chartered plane from Boston touched down.
He seemed offended by their attitude.
“I do not wish to discuss such matters in public. Let me first get this vital genetic material to the hospital and then we will talk.”
When they were finally back in the acceptable privacy of the doctor’s office, Francisco exploded. “Why didn’t you come clean with us about your failure rate?”
“Because I have none,” he insisted coolly. “Don’t forget, there are doctors performing other procedures on this island.”
Muriel fixed him with an intense gaze and demanded, “Was Mary Donovan a patient of yours?”
The Russian fidgeted uneasily. “I regard that question as unethical,” he mumbled.
“It doesn’t matter,” Muriel responded. “You’ve just answered it.”
Avilov suddenly panicked. “But you don’t understand, Mrs. Zimmer,” he babbled. “The woman was practically dead when she got here. It was too late. But the treatment did her no harm—”
“I would have believed that more readily had you told me in Boston.”
“If I had, would you still have come?”
“I don’t know.” Muriel shook her head. “I certainly would have thought twice.”
“Have you told Dorotea?” he inquired.
“No,” her brother answered. “Not yet.”
“Then at least give me a week’s grace. I’ll keep her retrovirus in cold storage, and you can see for yourself if Edmundo makes any progress.”
Muriel could not help wondering how many other human guinea pigs he had treated. And whether, in clinics on other islands, there had been more Mary Donovans. No doubt she would have to wait till his data was published. And yet her instinct told her that the Russian would be emphasizing the positive results and might even succumb to some selective amnesia when it came to patients who had been too sick to be helped.
It took merely five days to discover that Dorotea’s fate would be reversed. Indeed, Avilov’s success was proof that even the devil himself could work miracles.
Whatever his motivation, he was a superb scientist. With each passing day it became apparent that Edmundo had become a unique medical phenomenon: a victim of Huntington’s in remission.
It was a momentous achievement.
Perhaps even worthy of a Nobel Prize.