Chapter 20
Low Earth Orbit, International Space Station
Friday
6:30 p.m. Eastern Time
“Well, Natalie, I hope you have a very happy birthday!” Major Allison Simms told her niece through the video link to Earth. The little girl was turning six and sat excitedly in her father’s lap and beside her mother, Abigail, Allison’s sister. From the noise and activity in the background, it was clear there was a party happening. There was the noise, sure. But there was also the fact that the little girl was wearing a party hat, a princess dress, and a ribbon across her chest that said BIRTHDAY GIRL. “Did you get the present I sent you?”
“Yes, Aunt Allie, I love it!” Natalie exclaimed while holding up the little astronaut-suited stuffed tiger. “Did you really take him to space with you?”
“Yes, I did! In fact, I kept him with me the entire time I stayed on the International Space Station on my last mission. He floated about all over. I’ve had a really difficult time getting to sleep up here this time without him to take care of me.” Allison acted tired and faked a yawn.
“I promise to keep him with me all the time!” Natalie could barely contain herself. “Can I go show the others, Mommy?” she asked.
“Sure, and don’t give him any cake.” The little girl jumped out of her father’s lap energetically with the little stuffed astronaut tiger clutched in her left hand.
“Hey guys…look what my Aunt Allie sent me from space!”
“Haha! Reminds me of you,” Allison told her sister, Abigail. “All that energy.”
“Thanks for calling her, Allie. I think it made her day. Especially with her grandpa not being able to keep his promise that he’d be here,” her sister’s husband, Daniel, added with a solemn look on his face. He exhaled slowly and started to rise out of the chair hesitantly. Then he put on a smile that was both a façade from sadness and real from joy at the same time. “I’d better go and keep an eye on them or they’ll tear down the house. Stay safe up there.”
“Thank you, Daniel. You stay safe in there with those screaming girls!” Allison laughed. “I’m much more afraid for you than me!”
“Big Sis, when are you going to be home?” Abigail turned serious now that her daughter was in the other room playing with her friends. Allison could tell by how somber Daniel had looked and now Abigail’s abrupt facial expression change that the news coming was not going to be happy news.
“Right now, Abby, if things stay the way they are, I’ll be back on the next resupply. That is in three weeks,” Allison told her sister. “So…the elephant in the room?”
“Dad isn’t getting any better. And the prognosis…well…they don’t give him three weeks. His lungs have filled up again and the pneumonia from the inflammation has returned.” Abby looked as if she were holding back tears. “Mom is a basket case.”
“The chemo didn’t work, then,” Allison said. She was disappointed. They’d all had high hopes that the new chemotherapy treatment could stop the cancer in her dad’s lungs from getting worse, but that appeared not to have been the case. “What do they plan to do next?”
“Not sure. There was talk of monoclonal antibody treatment, but I dunno if insurance will cover it and…it’s very expensive.” Abigail shrugged and nodded her head left and right with a frown on her face. “They said, um, let me think, it was something like soo-gee-molley-mub or something. I have trouble understanding the doctor’s Pakistani accent.”
“Okay, if you have any details, email them to me. I’ll try to get time to research it sometime later today.” Allison looked at the timer on the screen for her call. She was approaching her bandwidth limit for the call.
“I don’t think he’s—” her sister started but Allison wouldn’t let her finish.
“We’ve been this close before. Tell Dad I said to fight!” Allison blinked tears back. “I’ll tell him myself in three weeks!”
“I’ll see him in the morning. I’ll tell him.”
“I’ll make a video and email it to you tonight,” Allison said.
“I’ll play it for him.” The two of them fell silent for a brief second or two. Both of them aware that their father could pass before Allison could return home to see him. Allison couldn’t handle being overwhelmed by negative emotions. She fought them back and focused on something positive. That’s how she’d always been. Stay positive, she thought.
“Abby, smile, your little girl is six!” she said.
“I know, she’s growing so fast,” her sister agreed while wiping the tears away. A thin smile made its way across her face. “She’s growing up fast…”
“It will be…” Allison couldn’t finish the sentiment and had to choke back the tears herself.
“She wanted Dad to be here so badly.” Abby sobbed softly and then sniffled and wiped at her eyes.
“I have to go now. You tell everyone I’ll be home as soon as I can be. Give my niece a big hug for me. And tell everyone…” Allison paused to regain her composure. “And tell them I love them.”
“Be safe up there, sis.”
“Always. Love you, little sister.”
“Love you.”
Allison closed the window and terminated the connection. She felt large singular tears building at the corners of both eyes. With no gravity to pull them down her cheeks the tears continued to grow into balls that washed over her eyes, blurring her vision to the point that she couldn’t see. She blinked and wiped her eyes with her thumb and forefinger of her right hand and then wiped the moisture away into her jumpsuit. The tears were accompanied by several slight sniffles and unstoppable sobs. She took in a couple of deep breaths doing her best to regain control.
“Everything…uh…okay, comrade?” Dr. Solmonov stuck his head around the corner of her private area. “I thought I heard someone being sad over here.”
“Eavesdropping, cowboy?” Allison straightened herself and made certain her eyes were wiped clear. Then she wasn’t sure if her eavesdropping insinuation was hurtful or not. She hadn’t meant it to be. She decided to soften it with a more back to business comment. “I’m fine. What’s up?”
“Up? Down? Left? Right? Which way is that here?” He raised an eyebrow at her, trying to lighten her mood. “Space confuses me.”
“Perhaps I should have asked, what’s happening, then?”
“Aha! Happening. Lots of things and lots of nothing. There are checklists and schedules and timelines and on and on.”
“Life in space…lots of everything and lots of nothing.” She wiped her eyes again.
“I’m about to grab something to eat from the galley and wondered if you cared to join me?” Solmonov asked. The two of them had spent a lot of time together over the last couple of years training and flying and being in space. They had become very close friends. Solmonov was about the age of her father. Allison wasn’t certain if she was looking at him that way or if there was something else happening between them. Training had made them so busy neither of them had been able to make the time to find out.
“Sure. I could eat.”
* * *
“Allison, you know Raheem.” Solmonov floated next to the European astronaut. “I asked him to join us for a moment or two.”
“Dr. Fahid,” Allison greeted him, wondering what the Russian cowboy was up to. “Nice to meet you…for the millionth time.”
“Yes, indeed, Major Simms,” Dr. Fahid replied. He was drinking some bright red fluid from a squeeze bottle and nibbling at something that was a freeze-dried chunk of brown stuff. Allison had no idea what he was eating.
“You two are so formal!” Solmonov slapped Allision on the shoulder, causing himself to spin slight. He grabbed a handhold to stabilize his motion. “Relax. Raheem, tell her what you told me.”
“Ah, yes, about the protein dendrites?”
“Yes, that, my friend.”
“Dr. Solmonov—” He was interrupted by a grunt from the Russian. “Eh, Peter, said that your father was battling stage four lung cancer?”
“Yes, he’s in pretty bad shape.” Allison glared at Solmonov, not certain why he would be talking about that with the crew. Just the thought of it forced her to hold back the sobs and tears.
“Do you know what type of lung cancer?”
“Uh, what do you mean?” Allison wasn’t sure she understood. It was “lung cancer.”
“Is it small cell or non-small cell?”
“Oh, yeah. I know that. It is non-small-cell carcinoma.”
“What treatments have they done?” Fahid asked.
“Radiation, didn’t work.” She ticked off on her fingers. “Surgery, didn’t work. And they just did a round of chemo that didn’t seem to help.”
“Pneumonia?”
“Yes. The inflammation and fluid in his lungs are apparently very bad.” Allison did her best not to cry again. She was distracted by Solmonov handing her a squeeze bottle. She accepted it and took a swig. It was sweet, like some fruit-based syrup with a strong taste of ethanol. She shot a quick glance at the Russian to acknowledge he wasn’t supposed to have that up there. She took another squeeze before handing it back.
“You keep it. I have my own.” Solmonov manifested another squeeze bottle from within a pocket somewhere on his jumpsuit. “Cheers, comrade.”
“What’s the next treatment planned?” Dr. Fahid made no expression to indicate whether or not he had seen the surprise on her face from the contraband. Allison recalled what her sister had told her earlier on the video chat.
“There is some monoclonal antibody thing, but I don’t know if our insurance will cover it.”
“Which one?”
“Which one what?” Allison asked.
“Which monoclonal antibody?” Fahid asked in return.
“Oh, um, I haven’t looked it up or even have the right pronunciation. My sister said it sounded like soo-gee-molley-mub maybe?”
“Sugemalimab. Yes. That was just approved for use recently and is an anti-PD1-L1 inhibitor.” Fahid nodded knowingly. “That just means the antibody is designed to attach to the Programmed Cell Death-1 Ligand-1 checkpoint of the cancer cell.”
“Not sure what all that means, Doc,” Allison said.
“Cancer cells are mean and sneaky. If your father’s doctor is using this, and he knows why he is using it, and he is using it correctly, it suggests to me that your father’s cancer cells are growing unchecked. You see, the PD1-L1 turns off your immune system to these cells. It’s like a cloaking system to keep it hidden and growing unchecked. The anti-PD1-L1 inhibitors are designed to attach to the bad cells and send out a signal saying ‘here is the bad cell, come and get it.’”
“A target designator,” Solmonov added.
“Yes, Peter. Of sorts.”
“But will it work, my friend?” Peter asked.
“Well, there has been success with it. I’d honestly suggest combining it with brentuximab vedotin and pembrolizumab, but insurance will only let them do one at a time,” Fahid said. “This is one of the reasons I left being a clinician and went to pure research. The damned treatment protocols are dictated by the insurance companies not the physicians.”
“So, um, what are you saying, Dr. Fahid?” Allison wasn’t certain what exactly the point of this conversation was turning out to be. On the other hand, she knew her friend. She trusted that he had some intention behind all this. “It isn’t the right medicine?”
“Oh no, my dear Major. It might be just enough.” Allison could hear an unsaid “but” in the end of that sentence.
“But…?” she asked.
“But, this being stage four and the patient being hospitalized, I’d prefer much more aggressive. Time is critical here.” Fahid paused, realizing that he might have been insensitive. “I’m sorry, Major. I don’t mean to suggest there isn’t hope, nor to discourage.”
“No, no. If you have data, or a suggestion, I want it. I agree. Time is extremely short,” she said, fighting the tear buildup again. She wiped at her eyes and then took another squeeze from the bottle Solmonov had given her.
“Well, if you are amenable to it, I am running a current trial as we speak for Schwab Medical Industries. There is, actually, highly likely, the best treatment for your father here in the refrigerator. I would be more than happy to have your father brought into the trial,” Fahid told her.
“Thank you very much, Dr. Fahid, but I fear that might be too late. I couldn’t get him anything from up here for almost a month from now.”
“Yes, I realize this.” Fahid waved a hand at her as if he were annoyed by the interruption. “I will have my team go tomorrow morning and start him on an aggressive treatment to help him until we can get to him. The first thing is to get the cytokine storm in his lungs under control.”
“You would do that?” Allison asked. “How expensive would that be?”
“I would do that. And there is no expense. This is a trial, you see. It is part of my research and I need volunteers.”
“What would you need from me?”
“Just terrestrial points of contact information and I can have them make calls first thing tomorrow,” he said. “And drift through the protein growth experiment in the morning and I will prepare a sample for you to take to your father on your return.”
“That is amazing. Thank you.”
“You are quite welcome. But really, thank you. I honestly need more candidates for my research. And, of course, while I’ve had great success thus far with this particular protein, you must realize there are no certainties, yes?”
“Yes. I understand. At this point, I would try anything.”
“I’m certain you would,” Dr. Fahid said softly. “I did the same when my daughter passed. But that is another story for a different time.”
“Thank you,” Allison told him.
“Major, you are very welcome even though you are doing me a favor too.”
“Thank you, Raheem.” Solmonov turned to Allison and tossed her a pouch filled with what appeared to be freeze-dried chili. She reached out and grabbed it before it floated past. Then he held the squeeze bottle up in front of his face. “Sometimes, comrades, it pays to have dinner.”