Skin

By Paul Raffer

A doctor is diagnosed with an incurable skin cancer. As he faces his mortality, and attempts to avoid it, his life parallels a New York family immediately recognizable as having a common thread with him. The doctor was adopted and has no known siblings or relatives.

The doctor is offered an experimental stem cell transplant protocol and he matches someone from the international stem cell bank. The reader is led through the preparation for and the actual stem cell transplantation as seen through the eyes of an experienced physician, with detailed treatments and unexpected side effects. The reader will tour the cutting edge of cancer treatment at one of the worlds great institutions, and its effect on two families separated by 3000 miles.

Adoption and its psychological legacy color the emotional roller coaster of stem cell treatments. Its a story of two families, touched by and brought together by cancer.

• Language: English
• Publisher: Xlibris US
• Release date: Aug 26, 2014
• ISBN: 9781499053371

Paul Raffer

This is the first novel by Paul Raffer, MD, a Neurologist from Chula Vista, California, who like the protagonist in this book was adopted in New York City and grew up on a chicken farm on the Jersey shore. He attended Franklin and Marshall College where he played football and acted in the Green Room Theatre. He attended The New Jersey Medical School in Newark and received the Faculty Award at graduation for outstanding contributions to the school. He interned at Mt. Zion Hospital in San Francisco where he met and married his wife Donna, and they moved to San Diego for Neurology training at UCSD where he was Chief Resident. Paul had a solo private practice of neurology for 32 years until he got cancer and sold the practice. They have four daughters and three grandchildren, and he has returned to work part time as a Neurologist and medical-legal expert. He plays golf and tennis, and loves sports and music. He is especially fond of red wine and is known to sing at the Godfather Restaurant in San Diego after a few glasses.

Book preview

PROLOGUE

S kin. Pigskin, chicken skin, skinhead, skinflint, skinned, skinny, thin-skinned, balloon skin, earth’s skin, skintight, skin game, coonskin, potato skin, skin of one’s teeth, skinny-dip, goose skin. Who thinks about the organ that is 13% of body weight, the area of a king-size bedsheet, unless it’s cut, punctured, infected, burned, abraded, has a black spot or a lump, or it itches? A rash is officially called dermatitis and has innumerable causes. It is the dermatologist’s field day, always deserving of a shot of Kenalog or the newest topical steroid. Maybe something you touched or were allergic to, nothing serious. Don’t work in your tomato garden without gloves, take antihistamines, but they’ll make you sleepy. Try a non—sedating antihistamine. Don’t scr atch .

It doesn’t go away. In fact, it spreads and looks different. Back to the dermatologist. More tests, more useless steroids. It morphs into different patterns and places—the armpits, back, hands, and feet. Buy a good backscratcher, more steroids, and finally get a biopsy done, which is nonspecific. Still no diagnosis.

You know there has to be something wrong inside, so you visit your internist and get more blood tests and x-rays. Everything is normal. It’s just a rash, but just to be sure, he orders a whole-body CT scan, looking for a hidden tumor, but it is negative. No sign of cancer, no lymphoma, no autoimmune disorder, only a rash.

And the itching is keeping you awake at night. Skin flakes off like a blizzard when you remove your T-shirt. Doorjambs become your best friend, an easy way to scratch your back as you pass by.

Being a doctor, you expect your problem to be something weird. It happened fifteen years before, when they found a sarcoma in your scrotum, the seventeenth reported case in the world literature, the diagnosis finally determined by the folks at the Armed Forces Institute of Pathology. You were cured with surgery and radiation.

You have dinner with your friend the pathologist. As he had fifteen years before, he offers to review your biopsy with his own skin pathology specialist. You send them the slides, and you get a call a few days later that the specimen was not satisfactory and another biopsy is needed. You go and get a second biopsy. The results will take a week.

CHAPTER 1

New York City, 1946

S he first met John at the front door of her tenement apartment building. He was on his hands and knees and wore a sleeveless undershirt and a narrow-brimmed black fedora that was too small for his head. Reddish-brown hair curled around the narrow brim. He was sweating heavily on a humid, breezeless spring afternoon. She stepped around to avoid him as she entered the building. He looked up and whistled loudly.

That’s very rude, she said, but it had worked. She stopped to talk.

I’m a sucker for beauty. He smiled broadly and got up from his knees, offering a mortar-speckled hand. I’m Johnny Prociero. His hand was rough-looking, but he was a handsome guy who towered over her when he stood. He was six feet tall, and she was five feet two. The hat was much too small for his head. She shook his hand, and they were face-to-face. I’m Laura Polamir.

He held her hand in his. A woman who’s not afraid to shake a working man’s hand, I like that. I’ll have this work done in no time. I was a bad boy for whistling. How about a drink at Patty’s when I’m done here? He let go of her hand.

She thought about meeting him. She had never been picked up in her life. Dates were arranged—a podiatry student with hands that smelled like sneakers, a short fat accountant with thick glasses, usually a disappointment. She noticed he had a tattoo, a red, white, and blue eagle.

I was rude, and I want to make it up to you. Meet me at Patty’s in an hour?

How do I know you won’t try to take advantage of me?

I’ll be as nice as pie.

Should I believe you?

I swear to Christ, I’ll be nice.

That doesn’t reassure me.

What do you mean?

Swearing to Christ, I mean. Not my religion.

Oh, I get it, you must be Jewish. I’ll just swear to God.

Much better. Say it.

Say what?

You swear to God you’ll be nice.

I will.

Say it.

I swear to God I’ll be nice. Okay?

Too late. Anyway, we just met, and I don’t know enough about you to meet you for a drink. It was hot, and she wanted to get upstairs.

Okay. What do you want to know? I’m Italian, in case you couldn’t tell.

I thought you might be Irish. Because of your red hair, I mean.

Pure Italian. My father’s from Apulia, mother’s from Sicily.

And you were in the army. She was looking at the eagle on his forearm.

Tell you all about it later. Let’s meet at Patty’s at six-thirty.

She thought about it and decided she would. Okay, I’ll see you at Patty’s at six-thirty. She had been picked up for the first time in her life.

She entered the atrium, and the heat was stifling. Her mail slot was empty, and she walked up to her flat. As she neared the door, she heard her father talking loudly in Yiddish. Despite being around it all her life, she had only a rudimentary understanding of Yiddish. Her parents used it like a code to exclude her from their conversations, although she generally understood their gist. She suspected that the argument was about money. It usually was.

She loudly inserted her key and loudly announced, Hi, I’m home. The Yiddish stopped, and her mother approached her and planted a kiss on her cheek. Her father gathered up some papers on the coffee table and put them in a sideboard. The windows were wide open, and the ceiling fan slowly moved heavy air. The apartment smelled of cabbage.

Zo, how vas was work today, Laura? asked her mother.

Nothing special, Mom. Kids from PS 129 spent the morning, and they were wild and noisy. I visited Grandma at lunch. She looks so weak and tired. Grandma Ellen, her mother’s mother, had recent surgery to remove a huge ovarian cyst. It was eight pounds and benign, but she lost a lot of blood during the surgery and was still very anemic. She was widowed and lived alone on the west side.

Doctor zay it take time, said her mother. Vas da apartment a mess?

Yes. I’ll go over Saturday and clean it up, said Laura. The icebox was really smelly. She announced she was going out for a while. I’m going out to meet a friend in a little while, at six-thirty.

Her father looked up. Which friend?

A friend. I’ll be home early.

We don’t know this friend? He was getting nosy as he always did.

No, you don’t, Daddy. It’s someone from work. You don’t know her.

He stared at her a few seconds, then picked up the newspaper and started reading.

Vant something before you go? asked her mother. Ve got borsch mit sour cream.

Thanks, Mom. She turned and went to her room to change. Her father wanted to know about everything she did socially. She was the only child of this arranged marriage between two Russian immigrants who were a generation apart in age; he was twenty years her mother’s senior. They were penny-pinchers, and recently, medical expenses had increased.

As soon as she left the room, her father started again in Yiddish. She could make out that it was about her school bills. Even though she went to City College with free tuition and worked part-time at the library, she needed additional financial help from them. Her father was a dispatcher for a painting company in Manhattan. He had been a painter, but arthritis had taken over his hands, and then a major heart attack last year had almost killed him. He had been a strong, healthy man in his younger years, but a fondness for fatty food had left him corpulent and coronary prone. He was lucky to still have a job. The bosses had felt sorry for him and given him the dispatcher job, but he was finding that it was harder and harder loading the trucks. He feared the job could end at any time, and they had no savings.

She heard her mother’s response. Sam, is okay Sam. Vee help her mitt school. Vee agree that, Sam.

He switched to English and raised his voice, hoping his daughter would hear. At least she could be studying something useful, like becoming a secretary or a stenographer. But no, she has to study music. Where’s the future in that?

She could be music teacher, countered her mother.

She needs a husband.

At that point, Laura walked back into the room, ending their discussion. She had changed into a skirt with a white cardigan, and she sat at the kitchen table to have cold soup. Out of the corner of her eye, she saw that her father was looking at her.

What’s your friend’s name? he asked.

Laura didn’t look up and was annoyed. What does it matter, Daddy?

I’m just your father. Don’t forget that little music major. You should study something that would be useful, like stenography. You might meet a lawyer. Or become a nurse. You might meet a doctor.

Laura dropped her spoon and turned angrily. She began to raise her voice saying, Daddy, do we have to— but her mother broke in, Enaff, stop! Have your soup and go, Laura.

The borscht was cold and refreshing, and she had a few spoonfuls. She got up and announced she’d be home in a few hours.

What’s her name? asked her father as she was leaving. Laura ignored the question and slammed the door. She knew her parents were old-school immigrants who felt it was their duty to insert themselves in their children’s lives. There was never an expectation that a Jew would marry a non-Jew. World War II had made Sam Polomir even more rigid, certain that God had allowed the Holocaust to happen because the Jews had done something wrong, like the biblical flood of Noah’s Ark. Laura had the exact opposite take. If there were no religions, there would be no holy wars. People wouldn’t have been gassed because they were Jews. To Laura, the death camps argued for a universe without a God, for how could God have let this happen? She had become an atheist. This was heretical to her father. Her mother was less rigid, and Laura thought that if she met the right guy and he wasn’t Jewish, her mother would accept it. She knew her father never could.

Patty’s Bar was a three-block walk from her apartment. It was June and would be light until nine. It was a dry heat with no wind, like the doldrums, a city in irons. People were coming home from work, parking cars, balancing their packages, and fumbling with keys. Men sat on stoops sipping beer, and women fanned themselves in open windows. Laura sat down on a bench and lit up a cigarette. The Daily News lay on the bench, with a picture of Harry Truman on the front page. Cigarette smoke drifted straight up in a column. She was nervous. Why had she agreed to meet him? This wasn’t going to go anywhere. She snuffed her butt in the dirt and walked slowly toward the bar. There was still time to go back, but what would she tell her parents? As she neared the bar, loud big band music boomed from the jukebox. John was looking out the open window and came out to meet her.

Hi, Laura. Or should I say ciao, Laura? He had changed into a long-sleeved white shirt. He led her up to a seat he had saved at the bar, the little black hat sat on the barstool. The room was dark and smoky. Sinatra came on singing All or Nothing at All. John was smoking and offered her one of his.

I have my own, thanks. She pulled out her own pack of Camels, and he flicked his lighter and lit her smoke. He ordered a scotch on the rocks.

Single or double, Johnny? asked the bartender.

Make it a double.

The bartender turned to Laura. And what’ll you have, dear?

I’ll have one of those too.

John smiled broadly. A scotch drinker. This is getting even better. Hey, I’m really sorry about today. I mean, whistling at you and all that, but I couldn’t help myself. Italians get excited around beautiful women.

Don’t get too excited. Tell me about yourself.

Well, you already know I’m a mason, he started. I lay a mean stone.

I’ll decide.

Did you notice my fine work at your apartment?

No, I didn’t.

Take a look. It was just a small job, but I did it very well.

I’ll be the judge of that.

I object. You won’t be impartial.

Why do you say that?

I bet you’re a prejudiced person.

Prejudiced? About what?

I bet you discriminate against Italians like me.

I do not.

Then you’ll love my work. Well, you haven’t told me anything about yourself.

What do you want to know?

How old are you?

"I’m twenty. How old are you?

Twenty-four.

"Ever been married? she asked.

No. You?

No. I live with my parents and go to City College. I am studying music.

A musician? he asked.

I sing, but I’m more interested in music history. I’m not the performing type.

I have a brother who is seventeen and has a great voice. He gets all the leads in his school plays. My parents keep telling him to forget music and learn a trade. Can you believe that? Italian parents telling their kid to forget about music! He doesn’t listen to them anyway. He can really sing. He’s got perfect pitch.

Do you live at home?

I live in an apartment with a friend.

What do you tell your brother about his music?

I tell him that he should follow his dream.

You know, I’m starting to like you.

There is plenty of me to like. He forced a silly smile and looked for a response, but she refused his bait.

You are very forward.

I learned that in the Army. Always forward, never retreat.

You were in Europe?

I was in the infantry. We landed at Messina and pushed north. Eventually, we got to Germany and liberated some camps. He pointed to the eagle tattoo on his forearm with the letter A below it. We were Eagle Group A. We liberated Auschwitz. His mood changed suddenly, and he looked down and away from her. I’ll never forget that place. He took a long drag on his cigarette, then a gulp of his scotch, and slowly exhaled a lung full of smoke. They were walking skeletons. We hydrated the people as best we could and saved quite a few lives, but we saw many more dead and dying. We just gave them water. We watered them. They were on the verge of death. We got medals for watering them. He was shaking his head.

Our family lost over thirty people to the Nazis, said Laura. Some died in the camps, but we heard other stories of them being machine-gunned down in their villages.

They incinerated the dead, but we saw mass graves as well, he said. Bodies were partially buried and rotting. The Germans ran when we got there. The smell … The bartender came by, and John ordered another drink. Laura was still sipping her first.

Let’s not talk about that, said Laura. Tell me more about your family.

"My father’s father came to New York from Apulia in Southern Italy, where the Crusaders embarked to the Holy Land. Maybe there is some Irish blood in me. They were very poor, and my father was eight when his family arrived in America with his two older brothers. My grandfather collected garbage. He got injured and received a pension. He died ten years ago and my grandma a year later.

My mother’s parents lived in Sicily. Her father died when she was seven, and she came to New York with her mother and an older sister. My parents met at church, and I already told you about my brother Louey.

I have no brothers or sisters, said Laura. My parents were Russian immigrants, my mother arriving via Argentina. They met in New York. My mother has no siblings, and my father has two older brothers whom we never see.

Why is that?

He envies them. He’s jealous of their success, a doctor and a lawyer. The doctor married his nurse, and the lawyer married his legal secretary. My father is a housepainter. My mother does seamstress work at home. She never really learned to write in English. Since my father had his heart attack, he’s moved to an inside job, dispatching paint and crews from a loading dock.

My dad was a laborer, said John, mainly maintenance in the subway system. He hasn’t worked since he was hurt on the job seven years ago. My mom never worked outside the house. Hey, you want to get something to eat? All this alcohol is going to my head. There’s a deli down the street.

Good idea, she said. The one drink had made her a little tipsy. She went to her purse to pay for the drink.

No way, Laura. My treat.

Okay, this time.

They walked out and down the street to the deli. It was still daylight. The deli was almost empty, and she ordered a corned beef sandwich with potato salad and paid for it before he could object. He had a salami sandwich and macaroni salad. They sat by the window, watching couples walking by arm in arm.

Can I see you again? he asked.

I’ll think about it.

This sounds like a relationship going nowhere.

That’s true. Where can it go? I’m Jewish, and you’re Catholic.

So we’re like water and oil? Unmixable?

I think.

Is that you or your parents talking, Laura?

She thought about that. And then she answered, I’ll see you again, John.

That makes me very happy, Laura.

They left the deli, and she took his arm. When they arrived as her apartment she looked down at the newly masoned stoop. I’ll give you an A for your work, John.

Let’s go to the movies this weekend, he suggested.

That sounded good to her. She nodded her head and said okay.

I’ll check out the shows and call you Saturday.

Call me at work at the New York Public Library. Call me on Saturday at noon, and tell me where and when.

It’s a deal. What’s the number?

It’s the central library, Murray Hill 7-6222. The operator will put you through to me.

He wrote the number down on a piece of paper in his pocket. I’ll call you Saturday at noon.

Thanks for the drink. She opened the door and walked inside. He stood there until she disappeared into the building.

She could still hear fans running and the clatter of dinner plates. The halls smelled sour, like boiled meat and cabbage. It was nearly nine and still muggy when she walked into the apartment. Her father had retired, and loud snoring came from his bedroom. Her mother was sewing at the kitchen table.

Vas nice evening, Laura?

Very nice, Mother. I’m going to get in bed and read. I’ll see you in the morning.

Do you vork tomorrow?

Yes, then not again until Saturday.

Your father vants go to the Catskills Friday. Ve haven’t decided yet. Vant to go?

No, I have things I want to get done this weekend. She certainly couldn’t mention her date. Plus, I’m going to clean out Nanna’s refrigerator this weekend. Go, Mother. Get away from the heat. It will be nice in the mountains. Daddy loves the mountains.

Lots of eligible men come up on weekends, her mother added.

All with mothers who look at you with eagle eyes, like at a market she answered.

Laura, ve also vud look very closely at any man who took an interest in you.

Laura thought about what they would think about the guy who she had just had a drink with. It frightened her to think about her father’s reaction. She kissed her mother and turned for her room.

Her mother smelled the scotch. Vere ver you tonight?

I met a friend from work. We had a drink.

I gotta a nose.

John called the library at noon on Saturday. Laura Polamir, please.

I’ll put you through.

Hello, answered Laura.

"Hi, Laura, Johnny here. Let’s see The Postman Always Rings Twice. It’s playing at the Bijou at 7:00 p.m. Let’s meet at the theater at six and eat first."

See you there, she answered.

She left the library at 4:30 p.m. There were dark clouds, and it had cooled down. She got off the bus a block from her apartment. The rain was starting, and there were flashes of lightning and thunder. She ran and made it home just as it started to pour. She smelled ozone. As she climbed the stairs, she wondered if it was raining in the Catskills.

Laura would ask him over after the movie if everything went well. The last time her parents were away and she had done that, it with was an accountant, and it had gone badly. He was a virgin, and after fumbling to put on his Trojan, the sex lasted about five seconds. There were several other similarly disappointing dates. Maybe it was Jewish men. They seemed to think it was all about them.

She took a cab to the theater. The rain had stopped, but she wore a raincoat and put a rain hat in the pocket just in case. The setting sun was trying to creep through. He wore a black raincoat and that little Italian hat. A cafeteria was next to the movie theater, and they had sandwiches and milk shakes before the show. As the movie started, he took her hand in his. His hands were rough, but she didn’t mind. It was a murder mystery, and they were engrossed. The time went fast.

When they walked out, it was dusk, and it had started to rain again.

I’ll bring the car around. You stay here, he said.

You didn’t tell me you had a car.

There’s a lot you don’t know about me. I’ll be right back.

He ran through the drizzle around the corner to get the car. It was foggy, and the streetlights glowed yellow. He wiped the inside window with a cloth and turned on the defroster. He pulled up in front of the theater and ran around to open the door for her.

Where to? she asked.

How about Patty’s for a drink?

That’s becoming our place, she said.

It’s about ten minutes from here, unless there’s traffic. They drove down the Grand Concourse as rain came down harder.

I like your car.

It’s a Henry J.

It looks like the car in the movie tonight, she said.

Yes, it does. That car was a Kaiser. Willis Motors, same maker, so they look alike.

She wanted to talk about the movie. Do you think they got what they deserved?

What do you mean? He had been concentrating on getting around a car that had blocked him in. The defroster wasn’t working, and the windows fogged up again. He wiped the driver’s window off again.

"In the movie, I mean.

I believe in fate, he said. People get what they deserve, he answered, "although the old man didn’t deserve to be murdered. On the other hand the relationship wasn’t right. He was too old for her. It was fate that her lover was punished for killing her when it was really an accident that caused her death. He would have gotten away with murder, otherwise.

Some women marry older men out of necessity. My mother did that.

Why did she do that?

It was an arranged marriage, the way they did it in the old country.

Would you, Laura?

Would I what?

Would you marry an older man?

How much older?

About four years.

"I don’t consider that older. Older is twenty years older, like my father is to my mother. I wouldn’t marry someone