February 20, 1997: Professor Richard King

“So I think we should start radiation right away.  The chemotherapy can wait a few weeks, I think.  You’ll want time to prepare for that.”

“You didn’t really answer my question.  I asked you what kind of cancer this is.  What kind of tumor I have.”

The oncologist hemmed and hawed.  “It’s difficult to say, Richard.  The cells I’ve biopsied are odd.  They have an odd appearance, I mean.  They’ve mutated in a way that makes it difficult to identify the source organ.  They look like nothing else so much as stem cells.  If I had to make a guess as to what they are, I’d say they were embryonic stem cells that failed to differentiate during your embryonic growth, and have been floating around in your bloodstream since they formed.  But I should be able to find out more from the culture.”

King considered the many times he’d found lumps in his arms and legs—lipomas, inflamed lymph nodes—and never acted on them.  He had to know whether that weird cyst in his left foot, removed a year ago in a drunken fit of self-surgery, had done this to him.  He did not have any samples of that tissue left to show the oncologist or his regular physician, who had referred him to this guy after finding something weird in his bloodstream.

“Is it possible that breaking a cyst wall might introduce tumor cells, or stem cells, into the bloodstream?  If I, for instance, received a deep puncture that punched through one?”

“Why, have you?  I don’t know, Richard, but I don’t think so.  Depending on the kind of cyst, and how long it had been there, any cells walled off inside it should be dead.  Most dermoid cysts are entirely benign, and I don’t believe I’ve encountered any instances of, say, a sebaceous cyst including cancerous cells.  At least living cancerous cells.  Now, we know some tumors have a viral cause, so if there were any cancer-causing viruses or infected cells in that cyst, then they might have gotten into your system, yes.  Is there a particular cyst you’re worried about?”

“There’s one on my foot.  What’s left of one, anyway.  Could you maybe take a biopsy from there, too?”

“Sure, we could do that.  How long ago did the cyst…er, get punctured?”

“About a year, I think.”

“Hmm.  A virus doesn’t sound very plausible in that case.  I would expect much longer-term exposure, with a dormant period in which the virus remained latent, in unassembled form, within cells, where they could interfere with genetic transcription and duplication.  That's how you make cancer.  It's not from the disease itself, because it doesn't emerge from cells that are killed by the virus replicating itself.  It emerges from the cells that survive the infection, and they survive the infection by assimilating the virus' DNA without expressing any of its cell-damaging features.  Since the virus' shell proteins aren't manufactured by the cell, or are manufactured incompletely, then the virus won't burst out of the cell, and the cell may survive long enough to divide.  If it does, and the virus has been incorporated into its nuclear DNA, then each division will carry the same insertion mutations to both daughter cells.  If any of the inserted DNA masks important nuclear genes, or interferes with the production of vital enzymes, the cell will not operate correctly, may be prone to higher energy consumption in order to overcome that inefficiency and survive, and may not be properly inhibited in reproducing.  Anyway, I'm over-explaining.  The point is that any virus that could spread pervasively enough to cause tumors within a year’s time would probably have made you very sick in the process.  More likely, we're dealing with something that you've had a long time and simply came to regard as an aspect of your health, rather than an illness.  You say you’ve felt fine this entire time?”

He’d been fit as a fiddle, for an old man, for well over a year.  Except for those unpleasant lumps now and then.  “I haven’t been sick a day since.”  Since excising an unidentifiable foreign growth from his skin.  “What about fungi?”

The doc shrugged.  “Wouldn’t be unheard-of, I guess.  You might be a candidate for candidiasis.”  He seemed pleased with this verbal juxtaposition.  “We can do an antibody test for that.  Why this sudden interest, though?  Had somebody suggested this possibility to you before?  Or are you just agonizing over what you might have done to bring your illness about?”

King stood up, regarding the consult as finished.  “You know how it is, Doc.  A smoker with lung cancer can blame his habit.  An IV drug user with AIDS can blame his habit.  All I’ve got to blame is Act of God, and if God could do this to me, I might not be able to expect Him to stand by me while I face it.”

The doc’s pleased expression gave way to blankness, and this pleased King.  Never pass on an opportunity to share one’s inner blackness, he thought.  But if he were going to die of cancer, it wouldn’t be God he held responsible for it.  But the guilty would be just as difficult as God to hold accountable for this.  Gods they might as well be.