The Mutations Page 5

  This melancholy physician’s heart is as cold as his hands are sterile. The warmth of his patients may fail to stir him, but sometimes an exceptional tumor, a galloping cancer, a lone tiger, awakens his hunter’s instinct.

  Aldama picked up his phone and called Luis Ramírez, a pathologist at the National Cancer Institute. Two weeks earlier he had asked him, as a personal favor, to take a look at the samples from a sarcoma he’d just removed. Aldama wasn’t keen on Ramírez’s vulgar extroversion but had turned to him because he was a master at identifying enigmatic tissue and understanding what he referred to as “these fucking cellular idiosyncrasies.”

  “Did you do a biopsy on Godzilla or what?” asked Ramírez.

  “I thought it seemed remarkable right away. I’m very interested to know what you make of it.”

  “Well, when I first saw the samples, I thought those dipshits had gotten the plates mixed up, so I told them to set up some more, and I couldn’t believe my eyes. ‘I’ll be damned,’ I said to myself. ‘A pediatric alveolar sarcoma.’”

  “But didn’t you see the patient’s age?” Aldama interjected.

  “Damn right I did! ‘Holy shit,’ I said. ‘Not even a man-child like Chabelo could get something like this.’”

  “Everyone here was convinced it was a round-cell sarcoma.”

  “Look, send those little smart-asses from Harvard back to draw blood, that’s all they’re good for. This is a textbook alveolar rhabdomyosarcoma. I mean, it’s like the motherfucker’s two years old!”

  “But Luis, he’s fifty, and there’s no family history, and no mutagens, either. He’s a lawyer from Mexico City. I can’t explain it…”

  “Well, me neither. But if we figure it out you can bet they’ll give us a Lasker or a Nobel Prize.”

  “Well, I don’t know about that.”

  “Why not?” Ramírez replied with mock indignation. “When was the last time you laid eyes on something like this? An adult cell that acts like it’s in kindergarten! Do you have any idea what that means? We could be looking at the fountain of eternal youth, my friend.”

  “I have a hard time believing in that kind of thing.”

  “But you have to admit that it’s pretty weird. Is your patient a homo?”

  “He doesn’t have AIDS, if that’s what you mean.”

  “Maybe not,” said Ramírez, “but it looks like he’s been sucking some radioactive Superman dick!”

  Ramírez’s guffaws masked Aldama’s awkward silence. He found it disconcerting that such an eminent pathologist could be so crass.

  “I’d be interested to know,” Aldama continued when the pathologist had stopped laughing at his own joke, “if you think it’s appropriate to do a genetic profile to catalog the mutations involved.”

  “Damn straight. Those cells have got to be given a grilling. They have PAX7 and FOX1 fusions, shitloads of KRAS, NRAS, and FGFR4 translocations, and a whole bunch of other fucking tongue-twisters. I can tell you now, if there’s a glitch in the PAX3 gene—the PAX7, whatever—but in the PAX3, at least in childhood cases, that’s when the shit really hits the fan.”

  “I’m afraid the clinic makes it hard for me to stay up to date on oncogenetics,” said Aldama. “If you could give me a hand with this and help me chase up the relevant studies, I’d be very grateful.”

  “If you give me the green light,” said Ramírez, “I’ll talk to Juan Delgado. He’s a geneticist at the university and he’s really good at this stuff. I’ll tell him, Juan, this sarcoma we have here’s a tough motherfucker. We’ve got to cultivate this thing and study the shit out of it. It’s going to have a fuckload of abnormal oncogenes. We could be looking at a cover story in Cancer, my friend.”

  “Do you really think it’s that significant?” Aldama asked, incredulous at the pathologist’s enthusiasm.

  “They divide like crazy, but they’re disciplined little fuckers—they adapt and stimulate blood vessels without asphyxiating or blocking each other. It’s like a stampede. They’re crazy-ass bitches, but really disciplined Asian ones. And what’s nuts is how they raise so much hell without crashing into each other. Are you following me?”

  For the first time in his tedious career of diagnoses and routine treatments, Joaquín Aldama found himself faced with a mystery: How had such an aggressive childhood tumor appeared in the tongue of an adult male? It was as much of an aberration as finding mariachi rhythms in a Bach composition. What strange mutations were behind it? What risk factors had enabled it? He would have to design an aggressive adjuvant chemotherapy plan.

  Aldama fantasized about seeing his name in print in prestigious magazines, being invited to deliver keynotes and seminars in Boston, London, and Paris. He could already taste the fame of having elucidated the causes of a sarcoma even rarer than the one that dispatched Hugo Chávez, the malignant founding cell of the populist tumor choking Venezuela. Aldama’s classist convictions were based on a dubious physiological analogy: if there were no hierarchies within the body and all cells enjoyed the same privileges, humans wouldn’t be intelligent mammals but sea sponges. That was why unruly cells and mutinous flesh had to be removed, cast out from the organism’s social fabric. How to do so in such a difficult case? The tumor had been resected, along with the surrounding tissue, but the cells could easily still be lurking somewhere in the impenetrable barrios of the lymphatic system. If you were a metastatic sarcoma, where would you hide? The lymph nodes would be the obvious place, but apparently, no such luck. It might have decamped to the trachea, the eye sockets, or the commodious thyroid gland. But why the tongue, of all places? When the maxillofacial surgeon had removed it from the oral cavity and placed it on a steel tray, oozing an orange mixture of blood and saliva, Aldama had gazed in bafflement as if at a mollusk, an enormous slug, completely alien to human anatomy. The eye, the hand, the penis, and even the pancreas bear the mark of humanity, but the tongue is an eccentric, versatile organ; the tongue is an artist, a priest of flavor: gluttonous, vociferating, loquacious.

  During the patient’s fetal stage, a rhabdomyoblast had formed, but never matured. For almost half a century it lay dormant, inert in his tongue. What took it so long to flex its proletarian muscles? How did it manage this? And how many times did it divide before becoming a tumor cell? To find out, Aldama would have to brush up on oncogenetics, and collaborate for the first time with a team of biomedical scientists. Ramírez had convinced him they were going to make a highly unusual and valuable discovery, worthy of presentation before the international scientific community.

  Until that work began, though, Aldama would have to make sure that the patient lived long enough to be subjected to exhaustive DNA testing. As soon as he’d recovered from the glossectomy, Aldama planned to begin an aggressive adjuvant chemotherapy regime. He would approach Ramón’s treatment with the kind of dedication he had shown only in the case of Lorena Galván, a young woman of searing beauty who had appeared in his office twenty years earlier. Her dermatologist, a former classmate, had referred her to Aldama so he could examine a mole that had sprouted on her left ankle, whose outline bore more resemblance by the day to the shape of the state of Jalisco. Around that amorphous mark, the voluptuous continent of Lorena’s physique unfurled, where cells conspired in their trillions to paint a hyperrealist portrait of Parvati, the most sensual goddess of all mythologies. Her face was nocturnal and feline, her body a cocktail of amphetamines, and her voice a bewitching flame.

  * * *

  Aldama usually examined his patients with cold, firm hands, but they trembled as they approached those legs tanned by the tropical sun. If it hadn’t been for his loose white coat, his trousers would have betrayed a shameful bulge. After a lingering ascent up her legs, he detected something serious: swollen ganglion cysts in the inguinal fold. Aldama had to double his efforts to conceal his ardor and his suspicions: stage IV melanoma type 1b, with an extremely bleak prognosis.

  As he sat behind his desk and took the patient’s medical history, Aldama pe
ppered her with needless questions, posed with the sole purpose of keeping her in his office. With a warm, paternal demeanor, a far cry from his usual bedside manner, he ended the appointment with a prolonged caress of her shoulder and baseless words of reassurance.

  On her next visit, Lorena was accompanied by her fiancé, a dashing and pompous rich kid who jilted her two months later, claiming that he loved her too much to see her suffer. Lorena was devastated by the breakup. From that moment on, as her decline hastened, Aldama’s care became increasingly personalized. He went as far as making house calls to inject her with medications he could just as easily have prescribed as pills.

  His passion overrode his beliefs and principles. He went from being frank to furtive, from honesty to deceit, from distant examination to gratuitous fondling, from hatred of tattoos to rapt contemplation of the rose that flowered across Lorena’s back, the swallow that spread its wings at her waist, always half concealed by her lace-edged panties. Aldama longed to sip the rose’s nectar, capture the swallow, perch his bird in depravity’s nest. He was even aroused by his patient’s whimpers of pain. Overwhelmed by guilt and self-reproach, he considered referring her to a chaste colleague, preferably a blind, female oncologist who wouldn’t fall victim to the same perversions as him.

  The only antidote to his depraved fantasies was his passion for the works of Bach. No other composer had the power to distract him from Lorena. At home, he withdrew to his study and dosed himself with at least an hour of fugues, cantatas, and counterpoints. He gazed at his records as they spun on the turntable, hypnotized by the spiral orbit of the needle falling to the silent center of the musical galaxy.

  Despite his early conversion to atheism, Joaquín Aldama was possessed by spiritual demons. At his Catholic school the Marist Brothers had taught him that the flesh is weak, an enemy of the soul. It had to be fought somehow, with perseverance and privations, with drugs and the scalpel. Wasn’t his whole career a battle waged against the ravages of the flesh? He believed it was. Aldama felt an absence of something sacred; he yearned for it. He thirsted after ritual and transcendence, sacrifice and communion; music granted him solace and serenity.

  And what was the most powerful remedy for lust? The Art of Fugue, played on the harpsichord. Its old-fashioned timbre had a geometric air that swept him into a realm far away from himself, where form stripped down to incorporeal perfection. Side B of the third disc, “Contrapunctus XIV.” Aldama was entranced by the three subjects of this fugue. As the piece approached its 170th bar, a fleeting figure in the highest voice ravished him. His shudder could be likened only to orgasm, as intense as it was brief. The composer had left this counterpoint unfinished on his death. In bar 239, the music founders, the air is stilled, a bird flies into a transparent wall, again and again. That pause between music and sound, that ceaseless moment, was Bach’s masterpiece. Aldama had often heard the funereal song of an electrocardiogram connected to a dead chest, but death had never sounded this way. There it was.

  * * *

  One night, as he savored a Ravel concerto and a single-malt scotch, he received a call from Lorena’s father. Despite her narcotic-induced coma, Lorena was agitated and showing signs of pain. Aldama rushed to her house. A jolt of adrenaline cleared the fog from his intoxicated conscience.

  He found her in torment amid tangled sheets. He inspected her already purple fingernails and still-fleshy lips, administered a final dose of morphine, and left the room. He caressed each letter of her name with nostalgia as he inscribed it on the death certificate.

  Since that encounter, the taste of vinegar had never left his mouth. The years went by, bringing children, records and concerts, patients and disciples, lovers and grandchildren. He resigned himself to growing old, until the challenge of Ramón’s case shook him awake.

  “How’s the duck?” his wife asked him during an anniversary dinner at a high-end restaurant.

  Aldama was preoccupied, considering the possible consequences of including doxorubicin or cisplatin in Ramón’s chemotherapy. He wanted to add methotrexate, too, but he wasn’t sure how it would interact with the other drugs.

  “What?” he said.

  “How’s the duck?”

  “Very good,” he said, without conviction. He had just read a recent study about the application of high doses of interferon in children and teenagers with rhabdomyosarcoma, but he wasn’t familiar with that medication, and he was afraid it might be premature to use it at the adjuvant stage. “And your steak?”

  “Delicious,” she said enthusiastically. “As soft as butter.”

  They went on dining in silence.

  9

  After an expensive two-week stay in the hospital, Ramón went home to continue his convalescence. Elodia was in charge of his care. Carmela, who hadn’t practiced law in years, became interim director of Martínez and Associates, where she, two young paralegals, and a secretary trained back in the era of shorthand took on the task of resolving the few cases Ramón hadn’t passed on to other colleagues. These were disputes that presented no particular challenge: claims against defaulting tenants, the drafting of purchase agreements, protections from excessive sanctions.

  While Carmela updated herself on legal matters, Elodia took intensive nursing classes from a neighbor, a caregiver for elderly people with dementia. She learned to administer injections to a papaya, take blood pressure, and give abdominal massages for constipation. Her most important mission was to enforce the diet prescribed by Ramón’s nutritionist. For breakfast, she had to concoct an elaborate smoothie: two egg whites, a cup of milk, half a banana, three-fourths of an apple, four ounces of cooked oats, and two ounces of mango. She arranged the ingredients on the kitchen table, measured out the quantities with alchemical zeal, checked the proportions against the recipe while saying them aloud, then poured them one by one into the blender.

  “Señora,” she said to Carmela, “can I add some nopal? It’s good for the veins.”

  “Don’t improvise. Just do exactly as the recipe says.”

  “And where am I going to get mangoes?”

  “Aren’t there any at the market?”

  “They don’t bring them till April, and that’s if it rains.”

  “The supermarket always has them. Put them down on my list.”

  The main injunction was for Ramón to gain weight before beginning his chemotherapy. “Shall I bring you another smoothie?” Elodia would ask him compulsively. “Have you finished your yogurt?”

  It was also vital to shield him from infection. Elodia doubled down on her efforts to keep the house clean. She scoured the pots and pans furiously, laundered the towels twice over, brutalized the floors with bleach and the carpets with the vacuum cleaner. Ramón took refuge in the bathrooms, which reeked of chlorine, to escape the electric racket sucking up the dead skin from the rugs, the dirt carried in from the street on people’s shoes, and the negligible sprinkling of dust continually shed by the plaster walls.

  Just as Elodia’s workload tripled, her wages were cut. The Martínezes became increasingly indebted to her, and she accepted their partial payment every Friday without complaint. On the contrary, she worked far more contentedly now that Ramón spent his days recuperating at home, at the mercy of her constant chatter.

  “Now that you can eat more,” she began to say as she vigorously dusted the bookshelves in the study, “I’ll make you some mashed chilaquiles. You just soak the chips in the salsa, and they soften up all by themselves. You won’t believe how good they are.” It hadn’t occurred to Elodia that Ramón had lost his sense of taste as a result of the glossectomy. “And you know what? They say that chili has healing powers. An aunt of mine had the same thing as you, but in her uterus. They started the injections and it put her right off her food. Then someone told her to put some chili powder on her belly near the tumor, to sweat it out. I’m not kidding. In three months, she was like new. One time I put some chili and garlic on a wart on my elbow. A miracle cure.”

  Elo
dia’s monologues lulled him to sleep like soft background music. Ramón took long siestas that led to nights of tossing and turning, his insomnia compounded by his oral discomfort and financial woes. To distract himself, he would go down to the study to see what the satellite dish was picking up at that hour: ancient reruns, soft porn, evangelical sermons, and infomercials, nearly all dubbed into Spanish.

  What he most enjoyed from among those dismal TV offerings was an infomercial for a case of Japanese Takemitsu knives. It was a multicultural tour de force, featuring a Chinese man dressed up as a samurai and a peroxide blonde whose apron looked like something you’d buy in a sex shop. To demonstrate the knives’ power and versatility, the Chinese man sliced through, among other things, a tennis ball, a multivolume encyclopedia, and a frozen turkey.

  “That’s incredible, John Li,” the woman exclaimed, with a smile so stiff she looked like a ventriloquist. “I never dreamed that a knife could do that! But … you know what? Whenever I try to slice a pineapple, the knife gets jammed or slips. Once, I almost chopped my finger off! Whatever can I do, John? Do you think these Japanese high-tech Takemitsu knives could help me?”

  Next came Ramón’s favorite part: the Chinese samurai asked the blonde to take a pineapple and toss it to him like an American football.

  “Are you serious, John?”

  The Chinese man responded by brandishing the chef’s knife like a baseball bat. The blonde tossed the pineapple daintily and John Li sliced it lengthwise in midair. Then the camera zoomed in on one of the perfect halves as it fell to the floor. Ramón was thrilled by this feat and thought it more than worthy of the fake applause on the infomercial.

  Had he called in the next five minutes, in addition to a set of fifteen professional-grade knives they would have thrown in an ergonomic potato slicer and a Japanese cookbook. Despite his utter helplessness in the kitchen and his hatred of Japanese food, he wanted to purchase the Takemitsu knives so he could use them in tasks as absurd as those performed in the infomercial. He pictured himself sauntering through the house with the roast beef knife, carving things up for his own amusement. He would have butchered at least half of the decorative throw pillows Carmela had piled onto the living room armchairs, making it impossible to sit anywhere comfortably. He’d have slashed the canvases decorating the dining room, bucolic landscapes that had hung at his in-laws’ house—symbols of a bourgeoisie whose version of paradise was off-limits to brown people like him. With the seafood knife, he would have given his brother a nasty fright, a little nick just over his jugular vein. On his most recent visit, Ernesto had suggested that Ramón sell his house and move to an apartment to reduce his expenses, crudely pressuring his brother to pay back the loan as soon as possible.