Chapter 14

Rob knew the hospital's legend for lab results highlighted was red: panic and yellow: abnormal. He saw from the display he was in serious trouble.

Dr. Angell returned the page and called Dr. Kournikova. She answered and said, "Rob Jenkins is in my lab. His rbc is 3.0, his wbc is 2200, his platelet count is 754, his absolute retic count is 579.4, his blast count is 12 and his creatinine is 6.4. I suggest an immediate bone marrow biopsy, and then a PET scan. I've admitted him overnight to the room off my lab."

Dr. Angell said, "I recall you have a priority on one of the PET scanners. Use it. After the scan, we should get him a couple of units of blood. We have to deal with the anemia. Who have you called for an oncology consult?'

She answered, "John Gerber."

He said, "Very good. We'll probably end up referring him to McDevitt at Sloan-Kettering. This looks like AML(acute myeloid leukemia), but we can hope it is MPD (myeloproliferative disorder)."

Dr. Gerber came in and looked at the lab results. "I'll do the bone marrow biopsy before any scans and before he has been influenced by too much lab attention. He needs fluids before his kidneys shut down. Begin a saline IV now."

Leon came back and said, "Fifty units of A-positive whole blood will be here in three hours. Dr. Johnson is supervising gathering blood at Summerdale and Barin. They are sending Rob's banked blood and what's available. They have mass blood collection equipment for disasters, and they have on record blood types for all personnel at Summerdale and Barin. All have been screened. We can further type the blood when it gets here. A special missions jet is coming from nearby at Hurlburt to bring the blood to Kennedy. The Marshall Service will have a helicopter pickup the blood at Kennedy and fly it here. The flights have special priority clearance to speed landing."

Dr. Kournikova had a sophisticated lab, but it was a couple of orders of magnitude less sophisticated than Dr. Sharapova's in San Francisco. Dr. Sharapova'a lab was involved in a number of highly classified government projects. Dr. Gerber looked at the bone marrow biopsy under one of Dr. Kournikova's electron microscopes. He said, "A lot of irregular cells, I count twenty blasts. That agrees with the preliminary diagnosis of AML. We should be preparing him for a bone marrow transplant as soon as possible."

One of Rob's security men accompanied Pris to Dr. Kournikova's office. Dr. Angell greeted her. "We are seeing that Rob is getting the best care possible. We are going to do a PET scan to see if there are any tumors or injuries that explain the drop in Rob's red blood cell count. He has some irregularities in his bone marrow, but we need to eliminate other reasons."

Dr. Kournikova called Dr. Sharapova in San Francisco. "Maria, I faxed you Rob Jenkins' blood work. I sent you a sample of the bone marrow biopsy by special courier. I suspect chromosome splits. He doesn't appear to have any problems related to the hormone treatment or the accelerant we gave him that he had the reaction to a few years back. We won't know about chromosome damage until after your analysis. We need to get him clearance to use your machines, especially if a bone marrow transplant is necessary. He will need advanced stem cell equipment. I think he is owed that. He more than did what we asked and never caused a problem for us or the agency."

Maria said, "I agree. I'll check on what we can do. As soon as I get the biopsy analyzed, I'll come to New York."

The PET scan came back negative for tumors or bone cancer. Rob was admitted to Presbyterian for an overnight stay. He stayed in a special room off Anna's lab. He was on constant saline IV to flush his kidneys. When they got the blood from Alabama, Rob was given two units. Unexpectedly, his red blood cell count didn't increase. Bone marrow cancer interferes with regular red blood cell development, but it doesn't destroy red blood cells already in the blood. It was an anomaly that bothered all the doctors. They did more scans and looked more extensively for tumors. Dr. Angell admitted him to medicine so if necessary, he could be moved to a regular floor.

Dr. Kournikova had the most sophisticated blood replacement equipment in the City. They replaced as much of Rob's blood with the blood from Alabama as they could. The goal was to lessen the impact to other organs.

Dr. Sharapova called back in a short time. "We have authorization to setup the duplicates we have of our four advanced machines. That could help in attempts to replace irradiated bone marrow. We could drop ship the four machines tonight and have people ready to set them up and train staff to use the machines. We have the authorization, but the cost would be about thirty million. Does Rob want to fund it and where do you want ithe machinery sent?"

Dr. Kournikova said, "I'm sure he will fund it. As much as I would like the equipment, they should go to Sloan-Kettering or Johns Hopkins. Both have strong pediatric transplant research units."

Rob had the same opinion of fund raising pimps as welfare pimps. The Sloan Kettering development head stood to profit on any gift made to fund the purchase of the machines for Sloan Kettering.

Rob instructed Thornton to negotiate with Sloan Kettering for a fifty million dollar gift, but only if the slick development man, who offended Rob, was replaced. Otherwise, Rob and his donation were going to Johns Hopkins.

Sloan Kettering terminated the man's employment. Rob hadn't been the only person to dislike the man and Sloan Kettering had fifty million reasons to make an immediate change. His replacement, who Rob liked, promised all the funds would go for leukemia research. Rob and Pris made the pledge. They donated an additional ten million for a building to house the equipment and a clinic. Sloan Kettering prepared a place for the equipment and people to operate them immediately.

In the middle of February, Rob was transferred to Sloan Kettering. His kidney function was elevated but near normal. He remained anemic but out of the panic range.

Sloan Kettering was collecting stem cell tissue, primarily from aborted fetuses, and from placenta birth tissue. The new lab equipment helped sort the best stem cells to use. Rob's strength had improved as much as they expected it would, but Rob wanted to wait for two things: Pris' delivery and his opportunity to hold his child and Rob wanted to dispose of some of his assets.

He and Pris discussed both issues. Rob adamantly opposed anything that would potentially harm Pris or the child and he required Pris' approval before his disposition of his assets. As he and Pris discussed the disposition, they decided to make the gifts effective immediately, not in a revocable trust that would spring only if Rob didn't survive.

One of the things Rob liked about Dr. Kournikova and Dr. Sharapova was they always told it like they saw it. They told Rob that he had about a twenty percent chance of surviving the bone marrow transplant at the state of the art of medicine at the time and he should get his affairs in order. The process was in four stages: