You Be the Giant (1)
Today I had come out for a meal. Alice had offered to treat me, saying there was something she wanted to see. As expected, it turned out to be fish-related again. Alice looked at me.
“Isn’t this fascinating? A sushi restaurant serving swordfish sashimi right near the hospital……”
I nodded. She really loved fish that much. And did it matter to her whether the fish had been alive? This was one of Palo Alto’s many upscale sushi spots. As usual, it was a dimly lit, high-end restaurant. Some might wonder whether Japanese-style sushi restaurants even existed in 1970s California. They did, and they were quite popular among the American elite at the time. There would be plenty in the modern era too. California rolls had originated in this era, after all.
The menu Alice chose was swordfish sashimi. It was obvious she would like it……. She was clearly a Dagon worshipper. As long as she looked happy, that was enough. Alice was awkwardly holding her chopsticks, trying to eat the swordfish sashimi. Soon she gave up and simply speared it with a fork.
“Have you ever tried swordfish sashimi?”
“No.”
“I was sure you had.”
She tilted her head. That was island culture from nearby. Not every white person ate sardine pie with mint chocolate ice cream, after all. The difference was that swordfish sashimi actually tasted good. The flavor was similar to tuna.
Alice ate the swordfish sashimi while sipping from a glass of watered-down Japanese sake. It had been a while since we had gone out to eat together. A plum fragrance rose from the sake.
“Whew, I thought I’d die from being so busy at the end of the year. So many people overeat around the holidays and end up in the ER vomiting blood……”
“Must have been a headache.”
“You were stuck at the hospital on Christmas Day and the day after, weren’t you? That must have been rough.”
Alice clicked her tongue. She continued with everyday talk. Whenever the ward nurses gathered, they only talked about you. They said incidents never stopped happening around you. This time they had even given you the nickname “Christmas Angel.” If a disease was rare enough to study, did that mean you didn’t have to pay the hospital bill? Alice laughed as she spoke.
After a short wait, the restaurant’s chef, who had been preparing our course meal, brought something red to our table. It smelled exactly like the sashimi. We stopped talking. The chef set the plate down in front of us and looked at us as though he had something to boast about.
“Today’s special.”
He seemed to be waiting for us to ask what it was. So I did.
“What is this?”
“It’s the heart of a swordfish……. Among Japanese sailors, eating the heart of a swordfish or a large tuna is considered something of a coming-of-age ritual. Of course, you already know that.”
How would I know that? I scratched my head.
“Thank you.”
“It’s incredibly delicious. Personally, I think it’s the tastiest part of a tuna. I hope you enjoy it……”
The chef bowed and left. A tuna heart had only two chambers—one atrium, one ventricle. I hadn’t immediately recognized it as a heart because a human heart has four. Still, it was a curious sight. I flipped the heart over with my chopsticks. The swordfish heart had been cut in half for the two of us. Suddenly, something stirred deep in my mind.
Cutting the heart in half? It felt like there was something I should remember……. While I was pondering, Alice poked me in the side with a mischievous look.
“What, did you think of something else to research?”
“Yeah.”
It came to me.
***
Professor Norman Shumway. He was a world-renowned authority on organ transplantation and the thoracic surgeon who had first performed heart surgery. He was staring at the record of a coronary intervention. An Asian resident had repaired a coronary artery using experimental equipment……? With a machine no one had seen before, logically speaking. The internists had called it the Christmas miracle. But…… well.
The phrase “Christmas miracle” held little meaning for America’s most prestigious thoracic surgeon. He was a man who solved problems directly with scalpel and needle. Miracles were what internists hoped for when they prescribed drugs and waited. There had to be something to learn here, something he was missing.
Knock, knock.
Professor Shumway, lost in thought, looked up at the sound from the door. Had he been expecting a visitor today?
“Come in.”
The Asian doctor entered the office. The very genius resident he had just been thinking about. What had brought him here?
***
Cutting the heart……. The surgeon who had invented heart transplant surgery, whom I had seen not long ago, came to mind. Back then I had come to observe whether emergency heart surgery would be necessary. Professor Shumway looked at me with an intrigued expression. He still didn’t seem to know why I was here.
“Good afternoon, Professor.”
“Have a seat. What brings you here?”
I sat down in front of Professor Shumway’s desk. The reason I had come to see him today was simple. Professor Shumway was the surgeon who had invented heart transplant surgery. There was something I wanted to research with him, something connected to the work I had done before.
“A new paper has been published. It says a new drug called Cyclosporine shows selective immunosuppression on T-lymphocytes.”
“That’s rather advanced. I didn’t realize our residents were interested in such topics.”
That was something I had discovered. I scratched my head. Professor Shumway still didn’t seem to know who I was.
“Professor, do you remember which paper earned me the Lasker Award this year?”
“I don’t.”
“No……. The topic of the Lasker paper I wrote as an undergraduate was exactly that. It dealt with the process by which macrophages present antigens to lymphocytes. The major histocompatibility complex.”
“Ah. So that was you?”
Professor Shumway glanced briefly at the ceiling as though witnessing the heavens split open, then pressed his temple and met my eyes again.
“Yes.”
I suppressed a chuckle. It was a story from years ago. Surgeons, people who operated, naturally weren’t very interested in others. Even while reading the paper, he apparently hadn’t realized I had written it. The professor’s face had gone somewhat pale.
“I see……. I failed to recognize a great man.”
Shumway was a physician who had spent his entire life studying organ transplantation. Since I had discovered, together with Professor McDevitt, the principle of T-lymphocyte immunity—the main cause of rejection in organ transplants—he could not have avoided my paper. I had provided the clue to solving the problem that had tormented him all his life. And today I had brought the solution as well. The veteran physician’s gaze changed.
“Yes. The most important problem in organ transplantation is graft-versus-host disease, isn’t it? And the main mediator of graft-versus-host disease is—”
“Probably T-lymphocytes. Ah!”
Professor Shumway exclaimed in admiration. It was as though I could hear the word “Eureka!” added, like Archimedes leaping from the bath.
“Yes. While the current mainstay of immunosuppressive therapy after organ transplantation is still broad immunosuppression using steroids and the like, there may be a way to selectively suppress the immune mechanisms that cause organ rejection.”
The professor let out a sigh.
“You really are……”
Norman Shumway. He was a world-renowned scholar who had developed groundbreaking treatments, yet he could find no answer to what I had just said and pondered for a long time. He seemed to have searched for a rebuttal but ultimately found none.
“Yes.”
“How did you come up with that idea?”
“Because it’s the paper I wrote. Ever since I first discovered the major histocompatibility complex, I had been thinking about its clinical implications. It was research I had originally conducted with transplantation in mind……”
“So. Does this mean the newly developed drug called Cyclosporine can solve the rejection problem in organ transplantation?”
I nodded.
“The immunosuppressive treatments we use now have quite severe side effects. Applying immunosuppression selectively would be better.”
After some thought, Professor Shumway agreed.
“Your reasoning seems correct. Certainly……. After all, you’re the one who essentially elucidated the immune process of those T-lymphocytes.”
Professor Shumway pulled out a bundle of papers from his study. It was the very paper I had written as an undergraduate in Professor McDevitt’s laboratory.
“Professor McDevitt collaborated on the research.”
“You’re the expert. The idea of using Cyclosporine for organ transplantation wasn’t Professor McDevitt’s—it was yours.”
Professor Shumway sighed again.
“You flatter me.”
“I’ve spent my life studying heart transplantation. This might be the final piece……. The one that takes organ transplantation out of the realm of experimental treatment.”
“It certainly will.”
“Today, you be the giant.”
Professor Shumway stood up, gave my shoulder a couple of pats, and hurried off somewhere. He probably meant for me to follow.