Cluster: A potentially fatal disease, a tantalizing romance and international terrorism converge with explosive consequences in this medical thriller.

Copyright © 2023 Robert J. McCunney.

All rights reserved. No part of this book may be used or reproduced by any means,

graphic, electronic, or mechanical, including photocopying, recording, taping or by

any information storage retrieval system without the written permission of the author

except in the case of brief quotations embodied in critical articles and reviews.

This is a work of fiction. All of the characters, names, incidents,

organizations, and dialogue in this novel are either the products

of the author’s imagination or are used fictitiously.

Archway Publishing

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ISBN: 978-1-6657-4396-9 (sc)

ISBN: 978-1-6657-4397-6 (hc)

ISBN: 978-1-6657-4398-3 (e)

Library of Congress Control Number: 2023908896

Archway Publishing rev. date: 08/07/2023

Contents

Acknowledgements

Prologue

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

Chapter 25

Chapter 26

Chapter 27

Chapter 28

Chapter 29

Chapter 30

Chapter 31

Chapter 32

Chapter 33

Chapter 34

Chapter 35

Chapter 36

Chapter 37

Chapter 38

Chapter 39

Chapter 40

Chapter 41

Chapter 42

Chapter 43

Chapter 44

Chapter 45

Chapter 46

Chapter 47

Chapter 48

Chapter 49

Chapter 50

Chapter 51

Chapter 52

Chapter 53

Chapter 54

Chapter 55

Chapter 56

Chapter 57

Chapter 58

Chapter 59

Chapter 60

Chapter 61

Chapter 62

Chapter 63

Chapter 64

Chapter 65

Chapter 66

Chapter 67

About the Author

To my parents, who inspired in me at a

young age the love of reading and writing.

To them, I will be forever grateful.

Acknowledgements

W riting this book, in addition to considerable patience and persistence, has required the advice of numerous people, who have provided support, inspiration and encouragement. Attending writers’ workshops and participation in an invigorating creative writing course at Harvard, along with reading books too numerous to mention, have been instrumental in helping me understand the principles of developing plot and characters and the critical importance of researching topics in depth to make the story realistic and scientifically accu rate.

The following friends, family and colleagues have kindly reviewed various drafts: Dr. Phil Harber, Dr. Ken Donaldson, Dr. Jonathan Borak, Dr. Jon O’Neal, Jacqueline LaSalle, Ruthie Nelson, my brother Jim McCunney, Doreen O’Brien and Mary Beth Hardy. An earlier version of the book was also reviewed by my deceased father, an avid reader of novels. Dr. Ken Miller, a noted hematologist, provided me an on-site review of a Bone Marrow Transplant Unit and helped me understand the challenges of a bone marrow transplant and the corresponding risks of serious consequences. And finally, I’d like to add a special thanks to Ellie Eckhoff, my partner and love who provided support, guidance and motivation to complete the seemingly unending challenge in bringing the book to completion.

I wrote the book to both entertain and provide a glimpse into how to pursue the cause of a disease with no acknowledged cause. Too often in my medical career, I have tried to address the concerns of patients bewildered and frustrated about being told the cause of their disease was idiopathic-in medical parlance- of unknown cause. Hopefully, this book will offer readers a glimpse into one aspect of this challenge-evaluating a potential occupational and environmental cause of a disease.

Prologue

A s he departed the rooftop restaurant after lunch with an old college friend, Parker Barrows looked out the window and down onto the street activity he so often associated with the flavor of London. A few minutes later, he descended in the elevator and strolled through the hotel lobby en route to the Hyde Park station. A short ride on London’s Underground rail system brought him to Piccadilly Circus, where he took the elevator to street level. Crowds milled about and people hurried in all directions. He feared being knocked over in the flurry of activity but was able to successfully navigate his way to Trafalgar Sq uare.

With a few hours to spare until he met his wife of a year for dinner to celebrate their wedding anniversary, Barrows thought a few hours at the National Gallery of Art would be a welcome diversion. In the mood for reflection, he hoped that a leisurely stroll among the famous Dutch, French, and English masters of the past few centuries would smoothen the edge he’d acquired from the pressure and tension of his work for the British secret service.

After savoring his time at the art gallery, Barrows walked to Leicester Square and past the ticket office for the half-price theater. He continued to wander through the West End and passed through Covent Garden and Chinatown, en route to the restaurant where he planned to meet his wife, Susan. After years of being single, he had never imagined that he would fall in love in his late thirties.

A few blocks later, he entered the Albertina Restaurant and was met by the alluring smile of the woman who had helped make his life so much more interesting and stimulating than it had been before he’d met her.

Seated at a table by the window overlooking the chaotic street scene of West End London, she reached out to him with open arms.

How wonderful to see you, darling, Barrows said as he drew up a chair. Happy anniversary.

Susan kissed him on the lips in response, enhancing the mood with her smile, which Barrows considered magical.

A waiter approached and handed each of them a menu. Good evening. Can I offer you a drink? he asked.

Yes. Of course, Barrows replied. I’ll have a Glenfiddich, and my beautiful wife will have a glass of the best chardonnay you have.

How was your day? Barrows asked, his smile hinting at his love to even the most casual observer.

Crazy—and stressful. People are selling everything, answered Susan, a financial analyst for a major international investment firm.

Within minutes, the waiter obliged them with their drinks.

To us, they said in unison as they tapped their glasses together. Once they began to sip their drinks, a thunderous blast rocketed throughout the restaurant. Screams of frightened people filled the air. Chairs tumbled in the background, and breaking glass flew in all directions. Barrows and his wife were knocked to the floor and lost consciousness. Soon the wail of sirens from ambulances filled the air, along with the relentless and horrifying cries of the injured.

Momentarily, Barrows regained consciousness, but he was still dazed as he looked around. He began calling out in fear, Susan! Susan!

Hearing no reply, he tried to stand but fell over, looking down at his crushed right leg, which was bleeding profusely. He fought the urge to pass out and crawled in Susan’s direction. When he reached her, she was lying on her side, unresponsive, with blood covering her pale blue dress. Barrows cried in agony when he saw a large sliver of glass stuck in her neck with blood exiting without restraint. He frantically tried to stop the bleeding until he passed out again from the trauma and blood loss.

Faintly, Barrows heard the arrival of the emergency medical team, who lifted him onto a gurney for the ride to the hospital. The techs quickly wrapped his leg in a tourniquet to prevent further bleeding. Susan and Parker, along with other injured people, were promptly whisked away in ambulances to the hospital.

—

Barrows finally regained consciousness in the surgical intensive care unit. He looked over to a nurse and motioned to her to get her attention. What happened? he inquired, his mind still blurred from the anesthesia.

You needed emergency surgery, Mr. Barrows. I’m sorry to have to tell you this, but your leg was so crushed that it couldn’t be saved.

My God! he exclaimed, turning to his side in disbelief of the news. Where’s my wife? The fear in his voice was palpable as he expected a sad reply.

I’m sorry, sir, Susan didn’t make it. Her carotid artery was so damaged from the impaled glass that she hemorrhaged to death.

How did this happen? Barrows asked in a raised voice, anger and fear overwhelming him.

There was an explosion at the restaurant where you were eating.

Who’s responsible for this madness?

No one seems to know.

Chapter 1

P atrick Murphy was petrified. For the first time in his life, he actually thought he was going to die. The monitors, the IV bottles, and the steely silence of the hospital room amplified his fear.

Why was he drifting in and out of a dreamlike trance? He had never had a fever as high as 104°, the level it had reached last night, when his wife dragged him into the hospital.

It had been a few weeks since he felt well. Lost was his energetic zeal for activity, whether tending bar or working construction projects down at the pier. His work suffered. He didn’t want the overtime despite being paid a hundred dollars an hour for driving a truck.

Patrick’s sense of monotony was broken by a woman in her early forties dressed in a white nursing uniform. How are you feeling today, Patrick? she inquired with a warmth that begged an optimistic reply.

Why am I so drenched? These sheets are disgusting.

Oh, don’t worry about things we can take care of. Your temperature is down to a hundred and one. The antibiotics are starting to work.

What’s wrong with me? His voice displayed the fear that he could no longer camouflage.

The nurse paused before responding, having no idea what to say. Dr. Allen will be in later. You should talk with him.

I don’t understand what the secret is. Why can’t I know?

Patrick, we don’t know yet.

When will you know?

You really should talk with Dr. Allen.

Leaving with a haste that mirrored her discomfort in continuing the conversation, the nurse fueled Pat’s fears about his fate. As he gazed up at the ceiling, the medication she had injected began to burn inside his arm, reminding him of high school when he broke his hip playing football. What is it about IV injections? he thought. It’s like battery acid running through your veins. Tempted to ask for more pain medication, he decided against it, hoping to be alert when Dr. Allen came. Already, the haziness from the fever was making him feel disconnected from his surroundings, a sensation he had not experienced since using PCP as a teenager at rock concerts. In the past two years, however, he had cleaned up his act—no drugs, and alcohol only rarely. Even his gambling habits seemed mostly under control. Now, he and his wife of a year were expecting their first child.

Pat shivered and pulled the blankets up to his neck. The fever must be coming back, he thought. What did the nurse say? My fever might spike again? He shook uncontrollably and felt the room whirling in all directions—clockwise, counterclockwise—so chaotically that his stomach churned, threatening to release its contents. Not again, he thought. There’s nothing left. Seconds later, he was leaning over his bed, directing what little remained in his stomach into a small blue bowl that the nurse euphemistically called an emesis basin. He wiped his face then put some ice chips in his mouth. Don’t drink anything, they had told him, not even water. But as he rinsed his mouth, he noticed blood in the basin. What now! He was afraid. What’s happening to me?!

He pressed a button to lower his bed, then turned off the television. He wanted to sleep, then awake with the nightmare over. Unfortunately, his problems were only beginning.

—

When Patrick next opened his eyes, he had no idea how long he had slept. It could have been fifteen minutes or three hours. The combined effects of the medication and his fever had caused him to lose perspective on time. His spirits were buoyed, however, when into his room came a physician dressed in a long white coat with a stethoscope draped around his neck, accompanied by a short young man in his late twenties, also in a white jacket. Probably an intern, Pat thought, recalling that his older brother once told him never to get sick in July, when medical students officially become interns. Dan, Pat’s brother, had completed his own internship four years earlier.

How are you feeling, Patrick? I’m Dr. Allen, the doctor said with confidence, extending his hand.

Lousy, Pat answered, the tension in his voice palpable.

Your chest x-ray was abnormal. It looks like pneumonia.

How would I get pneumonia?

Many different ways, Allen replied, as though about to embark on a short discourse designed to impress medical students. From people, usually, the way a cold is spread through coughing and sneezing, but there are other ways, such as from microbes that contaminate air-conditioning systems and cause Legionnaire’s disease.

What type do I have?

Pneumocystis.

What’s that mean? Pat asked, his deep frown telegraphing his apprehension.

It’s the name of the organism that causes the pneumonia.

Am I gonna be all right?

Allen hesitated before replying. We need to do more tests. But let me ask you a few questions first. How long have you been feeling ill?

About a month or two.

What has most troubled you?

I haven’t been myself. I have no energy.

Anything else unusual?

Just the tiredness. I don’t wanna do anything.

Tell me a little bit about your medical history. Have you ever had surgery or been hospitalized before?

In high school. I broke my hip playing football.

Were there any complications? Did you lose any blood? Allen methodically inquired without raising his head from the chart.

I think they gave me some blood. I’m not sure though.

Have you been in the hospital any other time?

No, I’ve been pretty healthy.

The ER note says something about an eye injury.

Oh yeah! I forgot. I hurt my eye—I think they said it was the retina—playing basketball.

Does anyone in your family have any medical problems?

I think my mom has high blood pressure, but I’m not sure.

Any history of cancer, leukemia, or any blood disorders?

No.

Is your father living?

No.

How did he die?

He was shot.

I’m sorry, Allen replied with genuine sincerity. How’d it happen?

He was a police officer in Boston.

How about your mother?

Like I said, she’s got a problem with her blood pressure. What’s this have to do with me? Why do I feel this way?

It’s the pneumonia, but the blood tests will help us get a better idea.

What happened to all that blood they took last night?

The results aren’t back yet, Allen replied. Dr. Allen reviewed the chart as Patrick gazed at the television, watching the last quarter of the Patriots football game.

Would you talk with my brother, Doc?

I’ll try, but I have to make rounds on another twenty patients.

Look, my brother’s a doctor too, Pat said. I want you to talk to him.

Ask him to page me. Hopefully, the labs will be done by then even though it’s Sunday.

As Dr. Allen left the room, Pat turned back to the game, rubbing his hip and thinking back to high school. One simple dive into the end zone and his dreams of college football were gone. Despite the disappointment of his failed dream to play college football, Pat’s life wasn’t at risk from the bad hip. The outcome of his current illness was less clear.

Chapter 2

I t was almost eight o’clock at night when Dan Murphy heard his brother Pat’s message on his phone: Call me at Boston Hospital. I need to talk with you. Five years older than Pat, Dan had just returned from a weekend of skiing in New England, with the slopes lined with enough ice to force the most reckless to stay in control. After accepting an invitation from a nursing colleague to join friends for a weekend in Vermont, Dan was supposed to meet the woman of his dreams, the nurse’s cousin from New York. With the absence of any spark, Dan returned home disappointed, a common reaction since leaving Washington after his div orce.

Another message waited for him on his phone, this one from Pat’s wife, Maryann. Danny! Call me as soon as you get in. Patrick is in the hospital. He has some kind of pneumonia, and it’s serious. I’ll be at Mom’s all day.

Dan Murphy, the third of four children in an Irish Catholic family from South Boston, had recently returned to his hometown after spending four years in Washington, DC. Following medical school in Boston, he finished three years of an orthopedic surgery residency, which he left prematurely because he lost the drive, then worked for a year in an emergency department. The breakup of his marriage prompted his decision to leave town and start afresh, both socially and professionally. Although he loved medicine, he had lost heart for orthopedic surgery and was drawn to a preventive medicine specialty. He dialed the hospital.

Pat, this is Dan. What’s going on? What are you doing in the hospital?

Pat described the events that had led to his hospitalization the previous night.

Did they tell you what type of pneumonia you have?

Yeah, something called ‘new-mo-sistis,’ Pat replied.

You mean pneumocystis jiroveci?

That’s it.

Pneumocystis? Why would you have pneumocystis pneumonia?

That’s what the nurse told me. You know I’m not gay. And you know I don’t use drugs anymore.

Dan listened intently, aware that his younger brother had abused ecstasy and cocaine in his early twenties and lost a job because of a urine drug test coming back positive. Although reasonably confident that Pat never ventured into IV drug abuse with heroin, morphine, or amphetamines, Dan recognized that blood transfusions and illicit encounters with prostitutes could also lead to AIDS. Dan then recalled his brother’s hip surgery, during which Pat received three transfusions of whole blood. Although the risks were remote, Dan wondered whether his brother could have contracted HIV then and the disease was only appearing now. Or was it some other illness that had its own effect on the immune system leading to the pneumonia?

Did they do an HIV test? Dan asked.

Yeah. Would ya call this doctor and find out what’s going on so I can get outta here?

What’s his name?

Dr. Allen. Mark Allen.

I’ll track him down and let you know. Talk to you later, Pat. Hang in there.

Dan Murphy tracked down a fatigued Dr. Allen later that night.

Dr. Allen, I’m Dan Murphy, the brother of your patient Pat Murphy. I don’t mean to intrude, especially so late, but he’s asked me to talk with you. I’m an occupational physician at South Boston General.

I understand, Allen said. I know how physicians often serve as intermediaries between their families and the medical profession. Your brother has pneumocystis pneumonia—at least according to the sputum stain. We’re still waiting for the blood cultures.

Do you think he has AIDS?

I’m not sure. There are some peculiarities to your brother’s case.

What do you mean? Dan asked.

Well, for one, he doesn’t have an elevated white count, which is hard to fathom in light of how sick he was last night.

How about the rest of the results?

It looks like a bone marrow disorder, especially if the HIV test is negative.

Why?

The combination of his symptoms and lab results. He’s shown evidence of bleeding, both in his gums and in his eye. That eye injury from basketball that bled so much is probably a result of his low platelet count. He’s also anemic.

How’s he doing today? Dan queried.

Improving, but I think we should pursue the heme problem, Allen answered, indicating his concern about the abnormal blood studies. If the HIV test is negative, we should ask Marty Novich from hematology to look at him. A bone marrow biopsy may be helpful.

Dan paused before responding. Thanks. If you don’t mind, I’d like to keep in touch.

No problem. Call me tomorrow. I’ll let you know how things are going.

Patrick lay on his side, covered with sheets and blankets, as a nurse brought both encouraging and disheartening news. His HIV test had come back negative—again—but the blood studies suggested a serious problem with his bone marrow.

What’s the bone marrow? Patrick asked the nurse who had advised him of the probable diagnosis.

It’s here. She pointed to her breastbone and then to her hip. And here.

What’s it do?

It makes all your blood cells—the ones that fight infection, control bleeding, and carry oxygen, she answered, her pleasure in educating patients obvious to the casual observer.

How do you know I have a problem with my bone marrow?

The test results. Your blood count is down in all categories.

What are they going to do?

I’m not sure, but you’ll need a bone marrow biopsy.

What’s that?

They put a needle into your hip for a sample. It’s not too bad.

That’s easy for you to say.

Just then, Dr. Novich, a physician whose practice focused on all sorts of blood disorders, entered the room. After brief introductions, the hematologist casually walked over to a metal tray on which a variety of medical instruments had been placed. Without any hesitation, in the event that Pat might refuse to undergo the procedure, he said, Don’t worry, it only causes minor discomfort.

I don’t believe it, Pat quipped. Discomfort—that’s what you doctors tell everybody. ‘It’ll cause some discomfort.’

It’ll be over before you know it, Dr. Novich replied matter-of-factly.

I want to talk with my brother about this, Pat said with an air of authority.

At the end of his bed stood his wife, Maryann. Bright, alert, and smartly dressed in a blue dress, she looked to her husband. Pat, I’ve talked with Danny. He says it’s OK.

When did you talk with him?

This morning. He talked with Dr. Novich. She nodded toward the physician, who was now anxious to obtain Pat’s signature on the consent form.

The hematologist looked through his black-rimmed glasses at Patrick. We’re only going to take a piece of the marrow. It may cause some discomfort, but we’ll give you a local anesthetic to help numb the pain.

Discomfort! I’d like to give discomfort to some of you doctors.

Novich, without acknowledging Pat’s worry about the pain, responded, We’ll take the sample, then look at it under the microscope.

Maryann, whose expanded girth from the pregnancy had rounded her customarily trim physique, said, Pat, you can handle this. Come on now!

Dr. Novich, dressed in green surgical garb and outfitted with two pairs of latex gloves, nodded in agreement. We should get going.

Patrick hastily signed the consent form, then passed it to the nurse, who prepared a table with a local anesthetic, sterile gauze pads, sutures, and a biopsy needle. She then arranged some small glass jars designed to house the marrow for its trip to the pathology lab.

Patrick, roll over on your side, please, the nurse requested, her youth belying her self-confidence.

Pat did as instructed, then the nurse draped green cotton sheets over his lower back and upper legs. After marking an area over his left hip, she said, Patrick, don’t touch the drapes. They’re sterile. I’m going to prepare an area for Dr. Novich to do the biopsy.

After methodically attending to his task of the biopsy, Novich removed his surgical gloves, then said to the nurse, Send some tissue for culture as well. She nodded in agreement, then prepared the specimens and the inevitable paperwork designed to ensure that the biopsy made it to the right lab and was analyzed properly.

What’s your date of birth? she asked Patrick.

March 17, 1975, Saint Patrick’s Day, he said. My father said any Irish son born on Saint Patrick’s Day had to be called Patrick.

Chapter 3

F reezing rain made Dan Murphy’s drive through Boston’s rush -h our traffic more arduous than customary. En route to Harvard’s Countway Library, a medical library, Murphy navigated through absentminded pedestrians, randomly stopping cabs, and cars running red lights. Traffic had become much more exasperating since he had left Boston four years ago. Now, he thought, if you stop at a yellow light, you risk getting hit in the rear. Drivers used their directional signals so infrequently before switching lanes or turning that when any of them did use their signals, he wondered if the driver’s electrical system was working properly. The early dusk associated with mid -D ecember added to the driving challenge as he patiently made his way to one of the world’s best medical libra ries.

Murphy pulled into a metered spot on Huntington Avenue, the lower end of Harvard’s medical area, which also included the medical school and its major teaching hospitals. After dodging a streetcar, he climbed the steps to the Countway Library, where as a member of the Massachusetts Medical Society he had privileges. None of Dan’s medical training had focused on aplastic anemia, the illness from which Pat was suffering. Late that afternoon, a pathologist had called him: the bone marrow was hypocellular, typical of a disease known as aplastic anemia. The results reflected a deficiency in Pat’s bone marrow, which explained why all his blood cell counts had shown a decrease.

Having never treated a patient with aplastic anemia, and not terribly knowledgeable about an illness first described in 1888, Murphy decided to conduct a literature search of medical articles written on the topic. After reaching the library, he went to the computer bank on the lower level to access the National Library of Medicine’s database.

He entered the keywords aplastic anemia, treatment, and prognosis. Numerous articles appeared on the screen, some of which motivated Dan to review their abstracts. He continued his review of the references in the hopes of finding additional studies related to the cause of aplastic anemia. Then, armed with his list, he ambled through stacks of journals to retrieve the articles that were not readily available online without paying a fee.

After reading half a dozen reports, he realized that his brother’s condition was more serious than he imagined and that the disease could actually kill him within months, if not sooner. Only half the people with aplastic anemia lived more than two years after being diagnosed.

The cause of aplastic anemia, Murphy learned, was often difficult to determine, although drugs, toxins, and radiation were accountable at times. In fact, the author of one article claimed that searching for drug or toxin exposure was probably the most appropriate action to take in finding the cause. Could Pat’s work as a truck driver have anything to do with this? Dan wondered.

Dan spent the rest of the evening poring over medical articles related to aplastic anemia. The stress he felt because of his brother’s illness, however, intruded on a restful night’s sleep. He reflected on how Pat had recovered from drug abuse and a gambling habit that had kept him constantly in debt. During that time, he and his younger brother had become closer. Pat had finally allowed an opening in his tough-guy exterior to permit Dan and Maryann, Pat’s future wife, access. Still drawing a substantial part of his self-image from his life as a jock, Pat found it difficult to display what he and his buddies might consider to be any sign of weakness, such as seeing a counselor for help. As was the case for most people trapped in the whirlwind of dysfunctional behavior, a crisis had forced him to change. In Pat Murphy’s case, being arrested for driving while intoxicated, followed by falling in love, is what had prompted the alteration in his lifestyle.

Finding it difficult to fall asleep, Dan Murphy surfed the TV channels while paging through weekly newsmagazines, neither of which distracted him from the spiral of insomnia. Surrendering to his tension, he got out of bed and read the remaining articles, learning that the immune system plays a major role in the development of aplastic anemia. Amid the dismal reading material were hopeful remarks referring to spontaneous recoveries from a disease whose outcome depends upon the extent of bone marrow failure.

Murphy’s thoughts bounced randomly about in both uncertainty and hope. Could the official reading of the bone marrow biopsy be more encouraging than the aspirate that the pathologist interpreted? Perhaps his brother’s results were confused with those of someone else.

Chapter 4

A s Pat’s wife, Maryann, finished the interminable hospital paperwork, an ambulance awaited them for the transfer to Boston Medical Center. Only a week earlier, they had been house -h unting in South Boston. Now, Pat was en route to a major teaching hospital for a bone marrow transplant. He wondered how he could have become ill so quickly and whether a bone marrow transplant would cure him.

As the ambulance made its way through traffic, Pat turned to the side and closed his eyes. Maryann reflected on comments made by the hematologist who had performed the bone marrow biopsy. Her husband probably had developed aplastic anemia a few weeks ago but was just beginning to feel ill, the physician told her. When the marrow is injured, he advised, it takes a few weeks thereafter before serious symptoms occur.

Shortly, the ambulance pulled up to the emergency department at Boston Medical Center. With military efficiency, two attendants welcomed the driver, then moved Pat from the gurney to a wheelchair. Within minutes, he was wheeled onto an elevator that took him to the Hematology Unit and his isolation room.

Pat, look. Maryann pointed to her waist as Pat lay in bed with a thermometer perched in his mouth. How’s the temperature? she asked the nurse.

It’s been down since last night. It’s a good sign.

Maryann smiled hopefully, just as a bearded physician of average height confidently entered the room and reached for the chart.

Moments later, Pat’s brother, Dan Murphy, appeared.

Danny, Maryann said, rising from her chair to greet him.

Hi, Dan replied. How are you making out?

A lot better. I’m so glad you’re here.

The bearded physician approached the side of Pat’s bed and spoke with the assurance of a man well versed in his own discipline. Patrick, I’m Dr. Harrington. I’m the physician to whom Dr. Novich referred you. I direct the Bone Marrow Transplant Unit here. We treat all sorts of blood-related disorders such as leukemia and the illness you have.

Pat nodded. While you’re here, you’ll have some more tests. We’ll take another look at the slides from your biopsy and recommend the best option for you.

A transplant? Pat asked.

Most likely, but we want to look at other alternatives too.

What do you mean?

Well, a medication has been effective for certain types of patients.

Do you mean ATG? Dan asked, fresh from his review of the articles. His younger brother looked on approvingly.

Yes, as a matter of fact. But first, we should do some genetic tests on your family members.

What do they have to do? Maryann asked.

Not much, Harrington replied. Just a blood test.

They can handle it, Pat said, looking over at Maryann as though she were a candidate.

No, actually only direct family members can be bone marrow donors, Harrington added.

Not wives? Maryann asked.

No. Not even aunts, uncles, or cousins.

What do you think the chances are of finding a match? Dan asked.

The usual odds are one in four, Harrington answered. But many factors are involved. Transplant rejection rates are down considerably.

What happens if there’s no match? Pat asked.

Well, there are other alternatives. For example, there are about half a million people in the country who have been HLA tested.

What’s that mean? Pat asked.

They’ve had their genetic blueprints determined. And they’ve volunteered to be bone marrow donors.

That’s marvelous, Maryann said. "What are the chances of Pat getting a