Chapter 54: Neither Best Nor Worst

June 5, 1983, Chicago, Illinois

"What did you think?" I asked when Teri and I got into my car after the concert at Chicago Stadium, having said 'goodbye' to Jack and Kristy.

"I liked it," she replied. "What's your favorite song they played?"

"It's between Just a Song Before I Go and Southern Cross. You?"

"Those two, or Wasted on the Way. Not that any of their songs are bad."

"True," I agreed. "Including the covers they performed. It's early enough to have the dessert that we skipped at dinner."

"Poppin Fresh Pies?" she suggested. "I could really go for a slice of Dutch apple, warmed up, a la mode."

"Where?"

"Harlem and Foster. The quickest way is probably the Kennedy to Harlem, rather than trying to take Harlem all the way north. About twenty minutes, I think."

"How late are they open?"

"10:00pm on Sundays. Now that I think about it, we'd be cutting it close."

"How about the diner by Circle? It's open twenty-four hours, and they have good pies, though I don't know if they have Dutch apple. What is that, by the way?"

"Apple pie but with a brown sugar- and cinnamon-flavored crumbled crust on top."

"That actually sounds really good, and I don't recall seeing that in their pie display case."

"It's OK. I'm sure they'll have something I like."

They didn't have Dutch apple, so Teri ordered peach cobbler instead, and I ordered a slice of pecan, which was my favorite. After our pie, I drove Teri home, where I walked her to the door.

"Would you like a goodnight kiss?" Teri asked.

"I would," I replied.

As we had the previous time she'd asked that question, we exchanged a soft French kiss, and she pressed her firm body against mine, and it did make me think about the 'coming attractions' she'd mentioned the previous time, but not enough that I was about to do something rash or foolish. The kiss lasted nearly a minute before she stepped back, said 'good night', and went into the house.

I returned to my car and headed home, where I quickly completed my bedtime routine and went to bed alone, given I planned to wake up early on Monday morning.

June 6, 1983, Chicago, Illinois

On Monday morning I was up very early, ate breakfast alone, then drove to the Hancock Center alone. I completed my usual morning routine, then at 8:30am, I placed a call to Detective Sergeant Bill Thomas in Overland Park. He wasn't at his desk, so I left a message with another detective, asking that Sergeant Thomas please return my call. Just before 11:00am, he did. He had no specific updates, but he did say he'd heard positive things and that I could expect an invitation to make a formal presentation before the end of the month.

As usual for a Monday, I ate lunch at my desk, then went to the gym to work out. After lunch, I placed a call to the Soviet Embassy and asked for the Office of the Trade Attaché. I was transferred, and a male voice answered, stating he was secretary to the Trade Attaché, Ivan Konstantinovich Voronin.

"My name is Jonathan Kane, and I'm a securities analyst with Spurgeon Capital in Chicago. I'm researching trade between the United States and the Soviet Union, and I'd like to gather some information about trade in general, but also specifically about Belarus Tractor in Milwaukee. I'd also like to speak to, or perhaps meet, the Trade Attaché.

"Minister Voronin is very busy, but I can provide you with some information. May I send you packet of information about trade and Soviet industry?"

"That would be good," I replied. "Thank you."

"What do you propose to do with information?"

"Part of my job is to understand international trade and currencies. I know very little about the Soviet Union, and not much was taught in school."

"American schools do not even teach importance of alliance with Soviet Union against fascists. You mentioned Belarus Tractor. Is very successful. You are in Chicago, so I could arrange visit, if you like, and you could speak to Managing Director, Viktor Bykov."

"Thank you. Let me give you my address, and once I read the packet of information, I'll be in touch."

I gave him the Spurgeon address, along with my name and phone number, and he promised to send the material right away. I thanked him and ended the call. I still wasn't sure what I was going to do with the information or if I could somehow parley it into even a tiny bit of insight into the Soviet Union. It was a long shot and might not pay off, but it wasn't costing me anything.

I left the office at 2:30pm and headed to Rush-Presbyterian so that I could be with Keiko when Doctor Morrison came to see her at 3:00pm. I arrived early, and he was a few minutes late. I greeted her, and I could tell she was feeling a bit better, even though overall, she was still suffering from the severe side effects of the chemo.

"I have your results, Keiko. Due to privacy rules, I'm required to ask if it's OK if Jonathan is in the room when we discuss them, even though he's been at every appointment so far."

"Of course," Keiko replied.

"Your blast count was reduced significantly," Doctor Morrison said, "but it wasn't eliminated. That's not the best outcome, but neither is it the worst. Most people still have some blast cells after induction and anything less than 5% is considered remission. In your case, your blast count is about 14%. That's a reduction of about 60%. On the very positive side, there are no signs of blasts in your spinal fluid.

"The bottom line is that the first round of chemo was successful, as it significantly reduced your blast count. What that means is we continue as we had planned. Once your blood chemistry is back to normal and you're not experiencing any serious side effects, we'll begin the consolidation phase, but without the intrathecal treatment. The goal is to further reduce the blast count to the point where you're in remission. I'm sure you have questions, so please ask."

"Did this change the prognosis?" Keiko asked.

"I can't say one way or the other at this point," Doctor Morrison replied. "We'll continue to monitor your blood chemistry while you recover from the chemo and watch the progression very carefully."

"Do you have a rough idea of when the next round would start?" she asked.

"I would say, based on experience, anywhere from four to six weeks. The consolidation phase consists of five days of treatment, every four weeks, for three to four months."

"Will I have to be in the hospital?"

"More than likely, yes, at least for the first round, given the amount of remaining blast cells. That said, a five-day course of the single drug, rather than the double cocktail, should not have the same severity of side effects. After that first round, we'll reevaluate."

"Where is this on the scale of typical results?" I asked.

"For someone Keiko's age, slightly more than half the patients enter partial remission, that is, having a blast count ratio under 5%. Those have the best prognoses. About 20% see reductions of less than 50% or continue to show signs in their spinal fluid. Those are the ones with the worst prognoses. Please remember, a reduction of more than 50% is considered a success, even if it's not the best possible outcome. Keiko's reduction was 60%."

"What are the criteria for her coming home?" I asked.

"A platelet count of greater than 100,000, five days past the last transfusion of platelets and packed red blood cells, and an absolute neutrophil count, which is a type of white blood cell, greater than 1000. We'll do a CBC every day, and as soon as the numbers are good, I'll sign her discharge papers. She can complete her recovery at home at that point, though she'll need weekly blood tests and bi-weekly bone marrow biopsies. Do either of you have any further questions?"

"What limits the blood transfusions? You mentioned that at one point."

"The equivalent of an allergic reaction; I could go into detail if you wanted."

"Thanks, but detail isn't necessary," I replied. "If I wanted to research Keiko's illness, where would I start?"

"With an undergrad degree in biochemistry, four years in medical school, an MD, and a Residency in oncology. I'm not being flip, because to understand the kind of material you're asking for requires quite a bit of specialized knowledge. And to be honest, we don't fully understand the causes nor the pathophysiology. The research that is being done on things like AML is cutting edge, and the people doing that research often have PhDs in biochemistry to go along with their MD. Is there something specific you want to know?"

"I suppose the short answer is everything and anything that might help Keiko."

"I promise what we're doing follows the current best practice, and, as strange as this sounds, Keiko is not sick enough to even consider an experimental procedure or drug trial. There is, at the moment, literally nothing better, even experimentally. And this is extremely important — there are all manner of snake oil answers that, on the surface, sound good but have exactly zero scientific backing.

"If it's a matter of trust, I'm happy to bring in a colleague from the University of Chicago who completed his Residency at Johns Hopkins, which is a renowned research and teaching hospital which created the standard by which physicians are trained. I also have a colleague who is a cancer researcher at Stanford University Hospital who could consult, most likely by telephone. It won't offend me if Keiko requests a second opinion, as I'm confident both my colleagues will confirm everything I've said."

"I don't think it's necessary," Keiko said. "Jonathan is a financial research analyst, and his solution to every challenge or problem is research and analysis."

"That's not a bad thing," Doctor Morrison observed. "And I'm positive he understands my point about specialized knowledge, as I'm sure he could teach me a lot about stocks and bonds. The thing is, I have my role, and he has his. I'd go to him for advice and guidance in his specialization, just as you've come to me for my specialization. As far as I'm aware, nothing is more specialized than medicine and medical research. I'm an oncologist, and you wouldn't ask me to deliver a baby or perform open heart surgery! Anything else?"

Neither Keiko nor I had anything else, so Doctor Morrison left the room.

"What do you think?" Keiko asked.

"That we have to trust Doctor Morrison knows his stuff," I replied. "I believe he does."

"Me, too. Do you think I should get a second opinion?"

"It couldn't hurt, but that said, I think Doctor Morrison is telling the truth about what they're doing is the best they can do. The most positive thing he said, in my mind, is that you aren't sick enough for a trial or experimental medication."

"How so?"

"I believe you'd have to be dying or very likely to die to qualify; you don't, therefore you're not. He did also say that a reduction in cancer cells by more than 50% is considered a success, so there's that, too."

"You seem very positive," Keiko said.

"I think it's my nature, but it's also the case that things could be significantly worse."

"That is you, isn't it? Always looking for the positive."

"I see no point in focusing on the negatives. Yes, I look for them, but only insofar as knowing what they are so they can be avoided. They can't be your focus, no matter what, because that way leads to despair and depression. One thing I learned from my mom was to always focus on the positives and deal with the negatives as they come along."

"That's a very good way to look at life, and it's my grandfather's philosophy. Despite your ethnic differences, you have very much in common."

"We do seem to agree on many, if not most, things."

"If it's OK to change topics, how was the concert?"

"I enjoyed it, though they only played for about ninety minutes total, but that was eighteen songs, so even if I had paid for the tickets, I wouldn't have been disappointed. Teri, Jack, and Kristy enjoyed it as well."

"Have you been to concerts before?"

"Never. That was the first one. I've been to a club once, but never a concert."

"I think that number of songs is pretty typical, but I don't know for sure. Are you ready for your final?"

"Yes. And I'm confident I'll do well."

We were interrupted by a nurse coming into the room to check Keiko's vital signs and remove the empty IV bag but didn't put on a new one, explaining that Keiko was able to eat and didn't need the fluids. The nurse encouraged Keiko to get up and walk, and Keiko agreed. After Keiko put on a mask, I helped her from bed, helped her into her robe, then allowed her to take my arm and we walked out into the corridor.

We walked for about ten minutes, which was a huge improvement from the end of the previous week, though Keiko was clearly exhausted when we returned to her room. She wanted to sleep, so I squeezed her hand in lieu of a kiss, then left the hospital. It was too early to go to Violet's, as she wouldn't be home from work until 4:45pm, so I drove to her house, parked the car, then walked to Lily's house to see if she was home.

"Jonathan?!" she asked in surprise when she opened the door. "What are you doing here?"

"I was visiting Keiko and had some time to kill before dinner with Violet, so I thought I'd stop by and see you."

"Come in!"

I stepped into the house, closed the door behind me, and then followed Lily to the kitchen.

"Coke? I'd offer a Lily sundae, but I don't think Jim would approve."

"A Coke would be fine, thanks. And you know I'm not one to get involved in cheating."

"How is Keiko?" she asked as she got the bottle of Coke from the fridge and opened it."

"She finished her first round of chemo and will have her second in about a month."

"How many rounds?"

"Well, there are three phases, and she's finished the first phase. The second phase has four rounds, about four weeks apart. I don't know about the third phase yet. The chemo seriously reduced the amount of cancer cells, which the doctor says is a success. But she's not out of the woods just yet."

"Can she be cured?"

"Yes, though she has to be free of cancer cells, called 'blasts', for five years to be declared cured. Otherwise, she's in remission."

"You have your exam tonight, right?" Lily asked.

"Yes. How did your exams go today?"

"Fine. I should have all A's this semester.

"That's good. How is your mom doing?"

"She went on a date on Saturday evening," Lily said. "I'm not sure what to think about that!"

"Take it from someone who knows — it's a good thing. I was happy my mom started dating, though it wasn't until after I left home."

"Are you having a Fourth of July party?"

"I think we're going to go to a Cubs double-header. Violet is checking on tickets, and we'll take the entire gang and sit in the bleachers. My treat."

"That sounds like fun. Grant Park for fireworks?"

"That's what we were thinking."

"We're in, for sure! When will you know?"

"When I see Violet in about twenty minutes. We'll start letting everyone know as soon as we're sure we can get the block of tickets."

"Cool. How are things going at work?"

"I closed a nice deal, and I have another one in progress. Things are going very well."

"That's awesome! Congratulations."

"Thanks."

I finished my Coke, thanked Lily, received a chaste hug, then headed to Violet's house for dinner. She greeted me with a tight hug and a kiss on the cheek, and I followed her to the kitchen. She asked about Keiko, and I gave her more details than I'd given Lily, given Violet had been to visit Keiko and would visit her again.

"Did you find out about the tickets for the Fourth?"

"Yes. I have to go through a ticket broker, but we can get them, and they're only $3.25 over face."

"OK. Write down the details for me, please, and I'll call tomorrow to buy them."

"Great!" Violet replied.

She wrote down the information, and I pocketed it, then helped her finish making dinner. We ate, then went to class, and I had no trouble at all with my final exam. When I finished, I went to the diner to meet Violet, and we had pie and coffee, though neither of us had homework to do. When we finished, I walked her to her house, received a tight hug and a kiss on the cheek, then headed home.

June 7, 1983, Chicago, Illinois

On Tuesday, I kept my normal schedule, having agreed with Keiko that I'd visit her right after work. At 9:00am, I placed a call to Beth at the tailor shop and let her know I was available for dinner, if she was free, and we made a date for our usual place, though I'd pick her up on my way from the hospital. Once I finished that call, I made the call to the ticket broker and arranged to purchase a block of thirty tickets in the bleachers for the Fourth of July doubleheader.

Just before lunch, Compliance notified me that they had approved all the new clients and had sent everything to New Accounts to initiate the transfer of securities and cash from their current brokerage accounts. I expected at least one of their brokers to attempt to retain them, but I was confident those attempts would be futile. I'd looked at their returns the previous years, and Spurgeon had returned nearly double compared to the best of their previous brokers and advisors.

I ate my lunch outside in the small park, and after lunch, I spent some time researching the leadership of the Soviet Union, finding very little in the way of analysis in any of the publications to which I had access. That didn't surprise me, and it reinforced the idea that Americans, in general, were in the dark about the workings of Soviet politics. For the most part, it had very little impact on my analysis, as most Western countries had trade restrictions or embargoes in place against exports to Russia, and Russia had very little to export to the West.

What I did discover was that Russia had significant natural resources, especially petroleum and timber, which they could export if they got their act together. Articles I read indicated that soil in the Ukraine was every bit as good as that in the Great Plains, and, once again, if the Soviets got their house in order, they could easily become a significant exporter of grain.