The Nagasaki Cluster: A Historical Novel of Medical Discovery

Copyright © 2013 BLAIR BEEBE.

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ISBN: 978-1-4808-0007-6 (sc)

ISBN: 978-1-4808-0008-3 (e)

Library of Congress Control Number: 2013901041

Archway Publishing rev. date: 2/1/2013

TABLE OF CONTENTS

PART ONE

CHAPTER 1 NAGASAKI

CHAPTER 2 JAKARTA

CHAPTER 3 WEWAK

CHAPTER 4 SUMBRINI

CHAPTER 5 THE SEPIK RIVER

CHAPTER 6 PORT MORESBY

CHAPTER 7 THE HYPOCENTER, NAGASAKI

CHAPTER 8 FUKUOKA

CHAPTER 9 THE SEA OF JAPAN

CHAPTER 10 AFTERMATH IN FUKUOKA

PART TWO

CHAPTER 11 WASHINGTON

CHAPTER 12 PAPUA NEW GUINEA

CHAPTER 13 BETHESDA

CHAPTER 14 RETURN TO FUKUOKA

CHAPTER 15 BACK TO JAKARTA

CHAPTER 16 SAN FRANCISCO

AFTERWORD

ABOUT THE AUTHOR

Also by Blair Beebe

NONFICTION

The Hundred-Year Diet: Guidelines and Recipes for a Long and Vigorous Life, 2008

ESSAYS

Doctor Tales, Sketches of the Transformation of American Medicine in the Twentieth Century, 2008

NOVELS

Doc Lucas USN, A Novel of the Vietnam War, 2010

SHORT STORIES

The Hero, 2009

Gathering Storm, 2012

For Sue

For every complex problem, there is an answer that is clear, simple, and wrong.

H. L. Mencken,

satirist, journalist, essayist, and author of The American Language

PART ONE

JUNE 1979

CHAPTER 1

NAGASAKI

Am I dying, Doctor?

Dr. Ichikawa’s silence and his downturned mouth answered her question. After a long pause, he said, The experimental drugs we’re using haven’t worked. We will try to make you as comfortable as we can.

May I see my children and my husband?

Since infection posed a great risk in advanced leukemia, hospital policy prohibited children from entering into rooms with immune-deficient patients.

We will move you to a private room where your children may visit.

Must my three-year-old daughter wear a mask when she comes in? the young woman asked. It scares her.

That won’t be necessary.

Dr. Ichikawa had watched too many patients die of acute T-cell leukemia, a disease unique to southwestern Japan. He was the director of the Atomic Bomb Disease Institute at Nagasaki University and had seen hundreds of leukemia patients in the thirty-four years since the end of World War II. As the years passed, the anguish he felt for his patients had only increased, and a deep melancholy enveloped him whenever a death was imminent. His appetite had gone, and his slender frame had begun to resemble the emaciated bodies of his patients.

When he had finished making rounds at the hospital, he walked with his umbrella in the light rain to his office nearby at the institute. Standing silently in front of the building were members of Soka Gakkai International, an organization of more than one million Buddhists who believed passionately in peace and the sanctity of life. They were holding wet placards that read Killers Not Welcome and Americans, Stay Home. The rain had smeared the red paint so that it resembled dripping blood.

One of the demonstrators recognized him and bowed respectfully. Good morning, Doctor.

Dr. Ichikawa stopped briefly and nodded in response, while the group parted to allow him entry into the building. He climbed the stairs to his third-floor laboratory, where he joined his colleagues, who were staring down at the demonstrators below. One of them asked, Why did we invite the American?

Dr. Ichikawa moved over to the windows and looked down with them. We didn’t invite him. He insisted on coming, and I didn’t want to seem impolite.

Researchers at the Atomic Bomb Disease Institute might conduct research on diseases from radiation fallout in Nagasaki, but not an American, whose visit had caused a stir in the local newspapers. Most Nagasaki residents deemed the dropping of the atomic bombs to be a heinous crime, one of the worst in human history. One Japanese journalist had even made an allusion to human experimentation carried out in Nazi concentration camps during the war.

Doesn’t he understand? Dr. Ichikawa’s colleague asked.

No, I think he doesn’t. Besides, we need the funding that the Americans can give us, and access to their research.

Dr. Edward Pinza from the NIH (National Institutes of Health) in the United States had contacted Dr. Ichikawa, who felt obligated to extend an invitation to the American to present his research. They were both studying leukemia, a cluster of which had erupted around Nagasaki and Hiroshima following the atomic bomb attacks in August 1945. The number of new cases had declined by the middle of the 1950s, but now doctors were observing a second surge. None of the demonstrators had any uncertainty about a connection between radiation fallout from the bombs and the recent increase in the number of leukemia victims.

Dr. Ichikawa counted only about thirty demonstrators in the group below. He grabbed his umbrella again and descended to the front door. Outside he said, You must be uncomfortable standing in this rain. If you will come inside to our conference room and be seated, I will listen to your concerns.

The drenched group filed in, each one making a short respectful bow before passing in front of the director. When they were seated, the demonstrator who had addressed him earlier acted as a spokesman. Each of us has a family member with leukemia, or one who has died from it. We all respect the work of the institute, but we don’t understand why you are allowing an American to come here.

Dr. Pinza had nothing to do with the atomic bomb, Dr. Ichikawa said, and he has resources from the American NIH that could aid our leukemia research.

What could he know about the effects from radiation fallout? You are the expert. Why should we share anything with the Americans?

Dr. Ichikawa frowned and lowered his head. You exaggerate my competence and my research. I am always willing to listen to anyone who might help to relieve the suffering that we face every day.

How can you trust the American? the spokesman said. The NIH is part of their government, isn’t it?

That’s true, Dr. Ichikawa said, but they control far more funding for research than we have.

We don’t want their blood money! a demonstrator shouted.

Research hasn’t helped my family, another added.

Dr. Ichikawa remained silent and did not attempt to rebut. It was true that his research had made no substantial difference to the thousands of victims who had suffered and died from Japan’s most sensitive open wound from World War II, but he didn’t see that objecting to help from an American scientist was rational. He knew the word leukemia struck terror into the residents of Nagasaki, who considered themselves innocent victims of the invisible assassin, and he was aware that they felt comfort in finding someone to blame.

Dr. Pinza will arrive today, Dr. Ichikawa said, but in the future, I shall keep in mind your distaste for American involvement in our research.

The demonstrators filed out slowly, some stopping to shake hands and thank Dr. Ichikawa, who stood frowning at the floor, with his mouth fixed in a grimace.

None of the demonstrators knew much about the technical differences among types of leukemia, and so they were unaware that the variety in the new outbreak was not the same as in the surge immediately following the war. Since the geographic distribution of the recent cluster overlapped with the radiation fallout area during World War II, the disease appeared to most people to be a recurrence of the same curse. Only a few people knew the dreaded term T-cell leukemia, which Japanese researchers had been using to distinguish the recent subtype, but many were aware that this new outbreak killed more rapidly than leukemia seen outside of southwestern Japan.

Dr. Pinza knew that most of the recent leukemia victims were born after the atomic bomb explosions—often many years later—and thus had never been exposed to high doses of radiation themselves. Some Japanese scientists had postulated that inheritance of mutant genes from parents exposed to radiation had perpetuated the disease, and Dr. Pinza wanted to understand the foundation for their premise.

Privately, Dr. Ichikawa did not believe the genetic hypothesis adequately explained the recent large number of leukemia cases in children and young adults in Nagasaki, but since he had no evidence for an alternative explanation, he was not willing to openly discuss his reservations. None of his colleagues were either, because some journalists and many activists forcefully opposed any suggestion that didn’t blame radiation fallout from the bombs. Dr. Ichikawa and his colleagues kept their misgivings to themselves.

In midafternoon, the bald, middle-aged American scientist arrived in a taxi at the institute. He towered over the small Japanese director, who stepped forward at the entrance to greet him with a bow. The two shook hands quickly, and Dr. Ichikawa introduced two of his colleagues. Then he offered to take the American’s coat and invited him into his office. They sat down, and Dr. Pinza said, I’m very pleased to have this opportunity to visit you and your institute.

We are honored that you have come to talk to us, Dr. Ichikawa answered in excellent English.

I hope that I may be of help.

Dr. Ichikawa ignored the comment and said, My colleagues and I have read some of your published work.

Dr. Pinza jumped straight to the point. In Bethesda, we’ve documented that radiation can induce cancer-causing gene mutations in mice, but we’ve never seen those abnormal genes pass on to future generations. It seems you have found children of atomic bomb victims with a rare form of leukemia.

Dr. Ichikawa sat stiffly with his lips pursed and did not respond immediately, but after a long pause, he said, Yes, that is so.

It’s possible that by working together, we might be able to prove whether an inherited mutant gene exists. As you know, we at the NIH don’t see this type of leukemia very often and have little opportunity to study it.

No, I suppose you don’t see this disease in America. Dr. Pinza flinched at the irony.

Little time remained before Dr. Pinza’s scheduled talk, so they made their way to an auditorium at the university. Because of the controversy, a large percentage of the medical students and faculty members at the university medical school wanted to attend Dr. Pinza’s presentation. A packed audience had already gathered, curious about both Dr. Pinza’s research and his boldness in appearing as a representative of an American government agency just five hundred meters from ground zero. The audience became hushed as the two scientists entered the room.

After Dr. Ichikawa’s brief introduction, Dr. Pinza began his presentation by using a few Japanese phrases that he had learned, thanking the audience for attending. He supplemented his talk with slides in Japanese prepared for him in Bethesda, and an interpreter translated his comments.

At the end, Dr. Ichikawa thanked Dr. Pinza in both English and Japanese. The audience remained silent and then filed out slowly, duplicating the same short bow of the demonstrators a few hours before.

Using a translator is difficult, Dr. Pinza said. I hope they understood my presentation.

I’m sure they did, Dr. Ichikawa replied.

Now, I am most anxious to see what you’ve found, Dr. Pinza said.

Dr. Ichikawa bowed formally and said, My colleagues and I look forward to talking with you over the next few days.

That evening, Dr. Ichikawa and two of his colleagues arranged a traditional dinner at an intimate restaurant, where Dr. Pinza suggested the possibility of collaboration. Dr. Ichikawa remained mostly quiet. They all planned to meet again the following morning at the institute and left the restaurant in good humor. The misty rain was still falling, but since the restaurant was only a short distance from his hotel, Dr. Pinza chose to walk.

The next morning, Dr. Ichikawa and several of his associates were waiting in a small conference room for the arrival of Dr. Pinza. One of them grumbled, Americans are rude. They can’t even come to a meeting on time.

Dr. Ichikawa began pacing and looking at his watch. He’s extremely late, even for an American, he said.

After a few more minutes, he stopped and picked up the phone to call the hotel manager, who said he would check into it and call back. While the manager was investigating, the three Japanese scientists sat around the conference table and silently stared at the telephone. They all jumped when it rang. Dr. Ichikawa picked it up.

He’s not here, the manager said. "A maid found his copy of the International Herald Tribune still lying in front of the door to his room."

Did she enter the room?

Yes. No one answered her knock, so she unlocked the door and went in. He wasn’t there, the manager said.

Had he checked out?

No. His clothes were hanging in the closet, and his briefcase was on the floor next to the desk.

After a short pause, Dr. Ichikawa asked, Did he sleep there last night?

The bed had not been slept in, the manager said.

Dr. Ichikawa gripped the telephone tighter and grimaced. After several seconds, he said in a low voice, I’m going to call the police. The two other scientists at the table turned and looked at each other silently.

The police sergeant who answered the phone found no entries in his log that might have involved an American and transferred Dr. Ichikawa’s call to the chief inspector.

What does the American scientist look like? the chief inspector asked.

He’s very tall and bald—about fifty years of age—and he has a mustache and bushy eyebrows. He’s moderately overweight, like most Americans, and he was wearing a dark brown suit that did not fit well.

The inspector grunted and said, I’ll have the description sent to all of our stations.

Next, Dr. Ichikawa called the emergency department and admissions office of Nagasaki University Hospital. They had no entry for anyone named Pinza or for anyone fitting his description. Dr. Ichikawa’s secretary called all the other hospitals in the city, while he telephoned the nearest American consulate in Fukuoka, about one hundred kilometers from Nagasaki. They assured him that they would notify Dr. Pinza’s wife, the FBI, and the National Institutes of Health in Bethesda.

The chief inspector came to see Dr. Ichikawa the next day and said they had expanded their search to all of the surrounding cities, but still had no information about Dr. Pinza’s disappearance. They had found his airline tickets in his room and had examined the contents of his briefcase. Have you heard anything? the inspector asked.

No. I’ve checked the hospitals again and called the American consulate myself. Dr. Pinza’s wife and colleagues have heard nothing from him.

We will continue our search, the chief inspector said.

Dr. Ichikawa lowered his head. This is very embarrassing for me and for the institute.

I am sorry, Doctor.

Two days later, the fully clothed body of a bald Caucasian man washed ashore on a beach at an island off Fukuoka. A wallet the police found in the pocket of the dead man’s pants contained Japanese yen, American dollars, and a Maryland driver’s license that identified the deceased as Dr. Edward Pinza. Dr. Ichikawa took a train the short distance to Fukuoka to identify the body. An autopsy showed the cause of death to be drowning.

The police began a homicide investigation and listed vengeance as the probable motive, but they had only one lead: the murderer was probably a Buddhist, because they rarely killed anyone directly with their own hands. A Buddhist might have reasoned that the victim shared the blame for his death by his inability to swim to shore.

The chief inspector telephoned Dr. Ichikawa one more time and said, We would like to examine your family charts of leukemia victims.

Why so? answered Dr. Ichikawa.

I suspect that one of your leukemia patients, or a distraught relative, may have attempted to assuage his grief by murdering the American scientist.

Dr. Ichikawa closed his eyes and slowly lowered his head once again. I see, he said. After a long moment, he added, We will cooperate with your investigation.

CHAPTER 2

JAKARTA

At about the same time that Dr. Pinza’s body was washing ashore in Japan, Lynn Lucas was sitting at her husband’s desk at the US Naval Medical Research Unit in Jakarta reading a report on the incidence of new malaria cases for the island of Java since the beginning of the rainy season. A rebellious streak during childhood had induced her to seek more structure in her life and had led her to apply for a commission in the navy. She had been a tomboy in junior high, and unknown to her parents, she had attended a self-defense class before she was twelve years old. Although she was now a lieutenant in the Medical Service Corps of the United States Navy, she wore a plain white blouse and khaki pants while working in the lab. She and her husband, Luke, had always played down showing the flag, because they were guests of the Indonesian government, but for Lynn, wearing civilian clothes was especially appealing because it was against the rules.

Lynn had become bored with laboratory work for the routine surveillance of malaria and dengue, but she enjoyed trekking around the backwater areas of Indonesia finding localized outbreaks of rare tropical diseases. The high physical demands of her job kept her slim and trim so that she looked like a teenager, an impression that her passion for surfing reinforced. She had grown up near Ocean Beach in San Francisco and had gone surfing much of her life, usually without permission and often by cutting class. Surfing was macho and territorial, and so she had learned early how to take care of herself in a tough crowd. With her agility and small size, she had been able to speed along the face of a wave faster than other surfers and frequently had drawn a crowd of young men admiring the daring and skill of this unusually attractive young woman. After coming to the research lab in Jakarta, she had discovered that Indonesia had more coastline than any other country in the world, and she had found beautiful beaches that no other surfer knew existed.

Lynn and Luke had both entered the navy right out of their training at about the same time, he as a physician and she as a microbiologist, and after their marriage a year later, they had obtained duty assignments together to study the prevention and treatment of infectious diseases in Southeast Asia. The marines in Vietnam had suffered high casualty rates from both malaria and dengue, and so the navy commissioned the Naval Medical Research Unit in Jakarta to study tropical diseases in order to be better prepared in case another conflict arose in the western Pacific. After the end of the Vietnam War, the Indonesian government had invited the navy to stay, with the understanding that the research unit would support the needs of the Indonesian Ministry of Health, and the partnership had worked well.

By helping to reduce the incidence of common scourges like malaria, Luke and Lynn had maintained their welcome in Indonesia and had gained some minor recognition by the World Health Organization. Luke had arranged for navy Seabees to install drainage systems in the area where President Suharto and other government officials lived, and the project had eliminated much of the standing water from the heavy rains, reducing the swarms of mosquitoes. Luke was now the director of the research unit and had flown to Switzerland for a WHO meeting to present their mosquito abating results, and he wouldn’t return for almost a week.

The phone ringing on the desk broke Lynn’s concentration. She recognized the high-pitched voice of Dr. Kumbini, the minister of health for Indonesia. I need your advice. Doctors in New Guinea have called us about some unusual cases.

Lynn could hear the anxiety in Dr. Kumbini’s voice, more rapid than usual and in a higher pitch that made her English even less intelligible.

I’ll be glad to help if I can, Lynn said. What can you tell me?

It looks like an outbreak of hemorrhagic fever.

Lynn sighed and leaned back in her chair while staring blankly at the map of Indonesia on the wall of the small office. We see a lot of dengue. It sometimes causes bleeding and fever.

The doctors and nurses would recognize dengue, Dr. Kumbini said. They think it’s something else. They’re worried.

Everyone in Indonesia knew about dengue. It was second only to malaria as the most common