This is one of a collection of stories that are like “Final Destination” meets “The Monkey’s Paw” (W. W. Jacobs, 1902). As such, they are tragedies more than either mysteries or horror, and would appeal most to readers who enjoy the inexorable pull of a story arc that leads to doom. In each story, a protagonist makes a wish that comes true with fatal results for someone, often the person making the wish. Nothing supernatural, but just how things work out. (Or is it?) The technical details surrounding the fatal (or near-fatal) event are drawn from real cases in the US OSHA incident report database or similar sources and are therefore entirely realistic, even if seemingly outlandish. The plots draw lightly from cultural beliefs around actions such as pointing at someone with a stick or knife, wishing in front of a mirror, or stepping on a crack.
Death came for Leonard at a leisurely pace, with no rush, no fuss, and very little mess. It all started with a mess, though, and Leonard had ample time for later regret.
As a student, Leonard had earned pocket money from a variety of part-time or seasonal jobs. His favorite was at a roller rink, but the best paid was doing tedious work at the college biomedical lab. His DJ job at the roller rink involved setting up a music playlist and controlling the sound system, lights, and an ancient smoke machine. He also did a roaring trade in party drugs that operated just below the owner’s awareness and the local police attention.
One of his best sellers was “hash oil,” which he made by extracting some active principles from cannabis plant bricks that he made, and that’s where his job at the lab came in. Besides a reasonably good hourly rate, it gave him access to knowhow and equipment that enabled him to make, among other things, a high-concentrate cannabis oil.
Leonard had copied equipment and techniques he saw at the lab, sometimes clarifying ideas by asking innocent-sounding questions of some of the younger and friendlier lab technicians. It was from Liza that he figured out how to use a low-pressure vessel to increase infusion without having to heat the solution and risk denaturing some of the more sensitive compounds. Leonard had fashioned his own low-pressure extraction process out of some bits lifted from the lab storeroom, plus odds and ends he had built or bought from DIY stores. The negative pressure incubator glove box had given him many practical ideas that he parlayed into improved products.
Making side money growing weed, and making oils and other products, was becoming a steady source of funding to pay for music equipment, extra lessons, recording studio time, and college fees. In short, Leonard had developed a dependency on his drug revenue. One issue plagued him, though—he didn’t have access to the right cold filtration equipment. Using sieves, filter paper, or distillation was slow, tedious, messy, and often wasteful. High-pressure filtration seemed like an option, but nothing at the lab used that technology, and he was out of ideas for the moment. Leonard was chatting with Liza one day when she mentioned her work separating blood products. She described how the red cells separated as a pellet, leaving a supernatant liquid that could be drained off. It dawned on him that a centrifuge may be just the thing he needed to do the bulk of the work of getting unwanted solids out of his oils. He figured that a final filtering would be a lot easier if most material was removed by centrifuge, so Leonard inveigled himself into doing some of the weekend after-hours centrifuge work. He would be unsupervised, the lab would be mostly empty, and he would have plenty time to test out the idea.
That weekend had gone mostly according to plan. He was alone, he successfully sneaked some cannabis oil products into the lab, and he placed two tubes into the swinging bucket centrifuge along with the routine blood samples he was meant to be processing. There was a part of Liza’s instructions that he had misunderstood, though. When he added his tubes, he had not placed the additional tubes diagonal to each other and evenly spaced from the blood samples. As he craned over to watch them spinning up, there was a brief shuddering as the imbalanced load accelerated, and then the tubes rapidly disintegrated.
Leonard’s head and shoulders were enveloped in a cloud of cannabis oils, blood, and glass fragments. The cuts on his face and neck weren’t serious, but he had oil and blood everywhere. It was in his ears, up his nose, and in his eyes. The mixture of blood and oil in his mouth made him retch, and he had to blindly fumble his way to the restroom. The cleanup took him the rest of Saturday, and on Monday, the lab director tore a strip off Liza for allowing an untrained helping hand to work with blood products.
That laid to rest most of his experimentation at the lab, and from then on, he was only asked to clean things or pack boxes.
Leonard completed his musicology degree and moved on to manage a small recording studio in another state. His forays into drug manufacture had tapered off, but he was still a heavy recreational user, especially when doing DJ work at the local night clubs. Along with manning a booth at music festivals, and joining New Age and Alternative Health groups, Leonard still hoped to eventually be a musician in his own right. The years ebbed along, and Leonard had acquired a life partner whose blue hair, piercings, and vivacious outlook had kept him youthful in spirit, even though his thirties had melted away and he barely noticed that he had entered into his forties. Topaz was not just a kindred spirit; she was also the most gorgeous being he had ever set eyes on.
It was after a heavy night of laughing, playing, and toking that Leonard woke up at 3 AM with excruciating pain in his belly. When his nausea shifted to bouts of vomiting, Topaz broke with their antipathy towards doctors, and they hurtled in their minivan to the nearest emergency department.
Dr. Ryan Marino was the chief emergency medicine physician on night shift, and his team had been able to control Leonard’s pain and subdue the nausea and vomiting. Ryan ran through some history with Leonard and the most likely cause of his upper abdominal pain seemed to be cannabinoid hyperemesis syndrome. It matched the symptoms well and tied in with Leonard’s frequent use of cannabis, including his recent heavy evening. “One thing I would like you to be checked for is hepatitis,” the doctor said. “The same symptoms might emerge from that. A simple blood screen could show one way or the other.”
Ryan looked at the tattooed, pierced, and obviously still floating Leonard and knew in his heart that this patient was going to ignore advice. Leonard agreed to have a screening done, but dismissed the idea as soon as he was discharged. “No way, babe. No more needles for me and they ain’t going to be sucking no blood outta this guy!” Leonard had ignored the reminder letter, and the follow-up phone messages, and wished they would leave him alone. “I’m not going to end my life in some hospital,” he had said emphatically to Topaz. Leonard’s life returned to much the same as before, but he did scale back on weed and booze, and since fatty foods made him queasy, he cut down on those, too. Topaz had been trying to get him to cut meat for ages, so he reduced his red meat habit, and grew to like the occasional veggie burger instead of beef.
It seemed odd to him, though. Looking back, it was like the more he cut weed, booze, and fatty food, the less he was able to tolerate them. Topaz had also noticed that a day or so before he felt bilious, his eyes would be bloodshot. Actually, he reflected, they weren’t red like when he smoked a lot, but more yellow than bloodshot. It was weird what freaked his belly out and what didn’t.
Coffee was fine.
Potato vodka made by a buddy was hell.
Candy was painful, but dark chocolate was OK.
Sodas were out; tomato juice seemed OK.
Steamed greens were great, but onion rings were not.
Some of his herbal supplements were a nightmare.
What put him in the ED again was a handful of acetaminophen tabs. He had been working all day spray painting a reconditioned minivan he was kitting out as a sort of mobile DJ booth for outdoor shows. The paint fumes had left him with a pounding headache, and although he avoided medicines, a friend had offered him a bottle of acetaminophen. Within an hour of swallowing three tabs, he was curled up in pain. Topaz helped him into the back of their van and Leonard headed to the ED for the second time in his life.
This time, the screening got done, and so did an MRI. Expecting just another lecture on weed again, Leonard and Topaz were not prepared for what came next. Topaz was a very intuitive person, and she had seen two of the doctors talking in the hallway. One had glanced in Leonard’s direction and then they were joined by a third doctor. This doctor had an expression on her face that Topaz read like a book: pain, sadness, regret. The body language in the two ED doctors sagged, grew heavier, darker, and the three doctors turned and walked toward Leonard and Topaz.
There was bad news, and then there was worse news. Leonard had cirrhosis of the liver, which explained the constant feeling of fullness, the tenderness when he bent over or lay on his belly, and why booze and oily foods had been so rough. It explained the eyes. The problem was why his liver was conked out.
“You have cancer—specifically primary liver cancer.” Dr. Eiko Brown, the oncologist, walked them through some major points. Using an information sheet donated by a liver cancer charity, she led them through the damage caused by the hepatitis virus that had been eating away at his liver for many years. Leonard was flabbergasted and wanted to know how he had been sick so long without knowing, how he had been infected. Dr. Brown explained how the symptoms would be absent early on, and then very vague and nonspecific later, ” … which is why screening is so important.” Topaz suddenly recalled the ED visit a couple of years back, and the importance of the screening that Leonard had turned down loomed in her memory. They covered vaccinations and Leonard had been glum. “I don’t believe in jabs,” he had said. “My immune system has always taken care of things.”
With their discussion turning to causes, Leonard had been able to dismiss IV drug use, but was less sure about unprotected sex when he was still a student. Then he remembered an incident: A face full of blood, glass fragments everywhere, the nauseating taste of blood and hemp oil in his mouth. “Yes, that could do it,” Dr. Brown had agreed. The discussion turned to staging and the worse news just kept getting even bleaker. He had unknowingly blown past stages one, two, and three. His cancer was at stage four, it had spread, and the options were slim. Surgery was no longer going to be of much use, radiation could only address some areas of the spread, and chemo could reduce, but not eliminate, the cancer. Transplantation was no longer an option.
By the time they got to the end of treatment options, Topaz had run out of her own tissues and was using more from a box held out by the oncologist. Dr. Brown outlined the few remaining but bleak options. Curative care was possible, but the odds were low. There were some clinical trials of two new drugs, but they were still experimental. The care team could buy some time by surgically removing some of the worst metastases, and radiation therapy of these and a few other spots could shrink them a bit. In that time, maybe one of the experimental drugs might be effective. But it was a long shot.
Talk switched to palliative care, supportive drugs, and less extreme surgery. “The trade off with palliative care is that your time will likely be shorter, but your quality of life in that time will be higher.” Dr. Brown described options that would focus on comfort and limiting pain, noting that Leonard would be cared for by a team whose specialty was terminal care. At the phrase “terminal care,” Topaz reached for more tissues. They both agreed to meet the palliative care doctor.
A few minutes later, they were joined by someone who could have easily been Topaz’s soul twin, who radiated calm and warmth. The feeling of rushing through alarm and bad news subsided, and the pace slowed, mellowed, and took on an almost restful sense.
“Hi, I’m Leanne, and I run the palliative care team. Let’s talk about your priorities.”
The time left to Leonard and Topaz was far shorter than they had expected, and was not without fear and pain, but it was good time. Leonard was able to stay at home and be with Topaz, his music, and his friends for another 80 days, and in relative comfort. When his care needs grew beyond what Topaz could provide, and he was too frail to go to the bathroom unaided, he was admitted to hospice. Leonard was gone in a week, surrounded at the end by friendly faces, holding Topaz’s hand, and, as he had wished, not in a hospital.
The Blue Faery Liver Cancer Association provides free patient information for those with hepatocellular carcinoma (HCC) and an annual research grant for work in HCC.
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