“You see, she filled out her form as Single and gave her sister as person to be notified. So we didn’t know—”
“She was living with me. Right. Where’s—”
“And Dr. Hufman likes to have both parties present when…”
“When what?”
“Well, I, ah, only wanted to apologize. We, I would have asked Miss Ascencio to come with you if we had—”
“Mr. Walmsley. Come in.”
Dr. Hufman was an unremarkable man in an ill-fitting brown jacket, no tie, large cushioned shoes. His black hair thinned at the temples, showing a marble-white scalp. He turned and walked back into his office without waiting to see if Nigel would follow.
The office differed in detail but not general theme from every other doctor’s office Nigel had ever seen. There were old-fashioned books with real bindings, some of them leather or a convincing synthetic. Long lines of medical journals, mostly out of date, marched across the shelves on one wall, punctuated by a model ship here and there. On the desk and a side table were collections of stubby African dolls. Nigel wondered if physicians were given a course in med school in interior decorating, with special emphasis on patient-soothing bric-a-brac, restful paintings and humanizing oddments.
He began to sit down in the chair Hufman offered when a door opened to his left and Alexandria stepped in. She hesitated when she saw Nigel and then closed the door softly. Her hands seemed bony and white. There was in her manner something Nigel had never seen before.
“Thank you, dear, for coming so quickly.”
Nigel nodded. She sat in another chair and both turned toward Hufman, who was sitting behind a vast mahogany desk, peering into a file folder. He looked up and seemed to compose himself.
“I’ve asked that you come over, Mr. Walmsley, because I have some rather bad news for Miss Ascencio.” He spoke almost matter-of-factly, but Nigel sensed a balanced weight behind the words.
“Briefly, she has systemic lupus erythematosus.” “Which is?” Nigel said.
“Sorry, I thought you might have heard of it.”
“I have,” Alexandria said quietly. “It’s the second most common cause of death now, isn’t it?”
Nigel looked at her questioningly. It seemed an unlikely sort of thing for Alexandria to know, unless—unless she’d guessed.
“Yes, cancer of all sorts is still first. Lupus has increased rapidly in the last two decades.”
“Because it comes from pollution,” she said. Hufman leaned back in his chair and regarded her. “That is a common opinion. It is very difficult to verify, of course, because of the difficulty in isolating influences.”
“I think I’ve heard of it,” Nigel murmured. “But…” “Oh. A disease of the connective tissue, Mr. Walmsley. It strikes primarily the skin, joints, kidneys, heart, the fibrous tissue that provides internal support for the organs.”
“Her sprained wrists—”
“Exactly, yes. We can expect further inflammation, though not so much as to create a deformity. That is only one symptom, not the total disease, however.”
“What else is there?”
“We don’t know. It’s an insidious process. It could reside in the joints or it could spread to the organs. We have very little diagnostic capability. We simply treat it—”
“How?”
“Aspirin,” Alexandria said mildly with a wan smile. “That’s absurd!” Nigel said. “Fixing up a disease with—”
“No, Miss Ascencio is correct, as far as she goes. That is the recommended course for the mild stages. I’m afraid she is beyond that now, though.”
“What’ll you give her?”
“Corticosteroid hormones. Perhaps chloroquine. I want to stress that these are not cures. They offer only symptomatic relief.”
“What does cure it?”
“Nothing.”
“Well, hell! There’s got to be—”
“No, Nigel,” she said. “There doesn’t have to be anything.”
“Mr. Walmsley, we are dealing with a potentially fatal disease here. Some specialists attribute the rise of lupus to specific pollutants such as lead or sulfur or nitrogen compounds in auto exhausts, but we truly do not know its cause. Or cure.”
Nigel noticed that he was clenching the chair arms. He sat back and put his hands in his lap. “Very well.”
“Miss Ascencio’s condition is not acute. I must warn you, however, that the subacute or chronic stage of this disease has been getting shorter and shorter as its frequency among the population increases. There are cases in which the disease persists but is not ultimately fatal.”
“And—?” she said.
“Other cases sometimes go to completion within a year. But that is not an average. The course of the illness is totally unpredictable.” He leaned forward earnestly to emphasize the point.
“Simply take the drugs and wait, is that what you advise?” Alexandria said.
“We will keep close track of your progress,” Hufman said, glancing at Nigel. “I assure you of that. Any flareup we can probably control with more powerful agents.”
“What is it that kills people, then?” she said. “Spread to the organs. Or worse, interception of the connective tissue in the nervous system.”
