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A Scientist’s Reckoning with the Cruelty of Chance

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A Scientist’s Reckoning with the Cruelty of Chance

On a leaden afternoon at the end of last August, six months before the pandemic took hold of the country, I found myself in an I.C.U. near Washington, D.C., breathing by way of a ventilator. I was fully conscious, having lost too much blood to risk sedation. I remember gripping the button on the morphine drip. When a nurse changed the position of my bed, my neck wrenched to the side, and saliva began to pool in my throat. With my index finger, I spelled “C-H-O-K-I-N-G” over and over again on my husband’s hand, until the nurse returned with a suction bulb. For that terror-filled night and into the next day, the machine drew my breaths in and out.

I had always imagined that if I died young, it would be in some empty part of our world. I figured I’d get swept off by katabatic winds, lose my way in a desert, or inch too close to a volcano. As a planetary-science professor, I have spent my career doing field work in far-off places, trying to understand how life survives on Earth, and, ultimately, whether it might exist on Mars. I have pulled molecular fossils from the salt-crusted sediments of the Australian outback and sequenced the red sands of the Atacama. I have helicoptered to the shorelines of ancient lakes in the Antarctic Dry Valleys and belly-crawled through the darkness of basaltic-lava tubes. Out in these extreme environments, there are known risks, and I’m always aware that, if I’m not careful, I could abruptly run up against some mortal limit of my own. But I never thought my life might end like this: a Monday morning, a medical accident.

If time could be unspooled, I would go back to the beginning—or what I thought was the beginning. Springtime in our apartment in D.C., flowers everywhere, an easy warmth that promised real heat to come. I took a pregnancy test and marvelled as the faintest of pink lines appeared. I was thirty-nine years old. This would be our third child.

A couple weeks into the summer, I dropped by my obstetrician’s office for some quick prenatal blood work. I went alone, not expecting an ultrasound, but one of the office’s soon-to-be-replaced machines was sitting idly outside the door, so she wheeled it in. As she traced her wand over my belly, a murky shape appeared, and then, out of nowhere, another. “Twins!” she exclaimed, the sound of double heartbeats filling the small room. I’d had two of these ultrasounds already—one at eight weeks and one at ten—and no one had noticed a second baby. When I called my husband with the news, he had to duck out of an important meeting. He was quiet for a second, and then he began to laugh.

More detailed imaging that afternoon revealed that the babies were identical, much to the delight of our young son and daughter. Two lives, sprung from the very same template. What were the chances? It seemed like a twist on the enigma of creation—unexpected and completely enchanting, like discovering life in an ice-sealed lake or a mile beneath the surface of the Earth. I couldn’t help but smile as I thought about all the arbitrary miracles of existence, and how this one had happened to me.

I turned down a research opportunity in Mauna Loa, and my husband started coming to the lab to help me lift heavy dewars of liquid nitrogen. After I passed into the second trimester, I started shopping for tiny matching outfits online. I lost myself in reviews of all the ingenious contraptions that had been invented: the Twingaroo baby carrier, the Twin Z nursing pillow, the Twin City bassinet. As the summer progressed, the pregnancy went from feeling exceptional, almost inexplicable, to reassuringly commonplace. In some ways, it felt like settling into an expedition at the edge of the Earth. After a while, every grand adventure begins to feel normal, just part of a life’s work.

Like most women pregnant with twins, I was scheduled for frequent checkups. One morning, right before the start of the fall semester, the babies appeared as usual—waving and dancing. But then the ultrasound technician picked up some anomalous blood flow in the placenta. A bit worried, our obstetrician sent my husband and me for a follow-up consult at another doctor’s office. We arrived just two hours later, but, when the next ultrasound came into focus, one of our babies was floating deathly still, like a child who had fallen into a swimming pool.

The next few seconds stretched into minutes that stretched into hours, all a taffy of numbness. A team of doctors quickly mobilized; if we were going to save our other baby, we needed a fetal blood transfusion. When, after hours of anxious waiting, it finally arrived—a lavish pint, when all we needed was a few millilitres—a doctor plunged a long, thin needle into my womb. She nodded encouragingly as she did real-time tests: things were going well. Then, at the very end of the procedure, the umbilical-cord vessels inexplicably began to coagulate. The room went quiet. If the flow of blood was strangled, our baby would asphyxiate. As the minutes passed, nothing changed—nothing worsened, but nothing improved. Eventually, we were told that there was nothing to do but wait. The next morning, we were back at the hospital, in front of the same screen, desperate for some piece of news. As soon as we saw our baby moving, I burst into tears. Our doctor did, too. She told us that the heartbeat was strong, and all the blood was flowing in the right direction. She told us that our baby could recover.

Back at home, after twenty-four sleepless hours, I tried to rest. I thought about the baby who had already died, who I would carry with me until the end of the pregnancy, who would be mummified into a fetus papyraceus. Grief was punctuated by consolation, or my attempts at consolation: we had lost a baby, but we still had a baby, and that baby was a carbon copy of the one we’d lost. Sort of, but of course not at all.

Just two days later, my belly started to tighten. We rushed back to the hospital. Yet another ultrasound, our anxiety both painfully new and terribly familiar. We strained to hear the sounds of an unborn heart and searched the doctors’ faces for the news that they were about to break. They switched off the display. I’m not sure if they ever even said the words. Eventually, I stood up, carrying two lifeless bodies with me.

When the surgery to remove the fetuses was scheduled, I looked forward to it. It would speed past at least some of the pain and put an end to the unreality that I had been living. I would fall asleep and wake up and it would all be over. Instead, what had seemed like the last chapter of one bad story became the first of another. I have no memory of the accident: an unseen artery, inadvertently punctured. What I remember, as the anesthesia wore off in the recovery room, is a rising chorus of beeps, a sense that people were gathering around me. I told myself to take a deep breath. By the time they rushed me back to the O.R., two litres of blood had escaped the punctured vessel and pooled inside my abdominal cavity.

I spent several days in the I.C.U. Even after I was removed from the ventilator, I was pierced with tubes, unrecognizable to myself and friends and family. I was eventually transferred to a hospital ward, and then released. But the day after I arrived home I was overcome by a rapidly spreading infection at the site of an I.V. In the weeks that followed, I shuttled back and forth between home and the emergency room. Septic thrombophlebitis, deep-vein thrombosis. Scans for brain bleeds, scans for clots in my lungs. Our apartment was crowded by then: my husband, my children, my mother, my father, my sister. Each time we would leave for the E.R., my four-year-old daughter clutched my leg and sobbed. My son, who had just turned seven, stared blankly ahead, sometimes sinking his teeth into his arm. It seemed that the more I fought to recover, the more the complications came, a riptide I couldn’t escape.

When the time came, when I was finally well, I wasn’t really. My body was still covered in scars—numb cables of skin, flanked by eyelet holes where staples had been. Some nights, I didn’t sleep at all, and when I did I had unnerving dreams, in which I suffocated by every means possible: my tongue swelled in my mouth; a tsunami collapsed on top of me. I’d wake up right before I died, my chest like a cage of scared birds.

I had always thought of life as an expression of resilience. The kinds of organisms that I study can survive—can thrive—in the most unimaginable conditions. They can endure breathtaking pressures, boiling-hot and freezing-cold temperatures. They can make a home out of bare rock. If life ever took hold on Mars, I reasoned, traces of it were likely still there, for the more we learn about what life can endure, the more impossible it seems that it could ever be wholly extinguished from a planet. Even my small children had struck me, from the moment they were born, as strong and vital, as irrepressible beings. But now, in the days and weeks that followed my surgeries, they seemed intent on cataloguing hazards: where was the nearest volcano, they needed to know, the closest asteroid. I tried to assure them that everything was O.K., that the world was no teacup. I promised them that there were happy times ahead.

One morning at the end of October, we buried the babies in a quiet ravine. It had taken weeks to make the arrangements. We’d skipped calls from the hospital morgue, then calls from the funeral home, until finally we decided that we were ready. We covered the graves with flower clippings sent from friends all over the country. It seemed we had finally reached the bottom of our loss.

The next day, my father collapsed on a bathroom floor. As he lost consciousness, blood splashed from his nose onto the vinyl tile—the result, we would learn, of a pulmonary embolism. We rushed the kids to the car and broke highway speed limits getting to the West Virginia hospital where he had been taken. The next night, I took my mother’s place, on an air mattress beside my father’s bed. Trying to sleep, I fought off a panic attack. I was back in a hospital ward, the fluorescent lights, the anonymous alarm of nurses rushing in the halls.

A few days later, my father was diagnosed with advanced metastatic cancer. The doctors said that he’d probably had it for less than six months. They could slow it down but not cure it. For the two months that he’d been away from home, helping to take care of me and my family, my father had avoided complaining about his pain; he thought it was just from sleeping on an uncomfortable couch.

It was around this same time, on the other side of the world, that a tiny entity—an entity not even truly alive—was finding its way into a human body. Only a hundred and twenty-five nanometres across, smaller than the wavelength of light, it slipped into the ribosomes of its host and began replicating. As the coronavirus quietly began to spread in Wuhan, passing from husband to wife to child to teacher to traveller, my father began a gauntlet of cancer treatments that would lessen his pain. In between meeting with his new doctors, I met with my own array of specialists. The earliest cases of the COVID-19 in D.C. were documented in early March. The visits with my hematologist, cardiologist, primary-care doctor, and trauma therapist, and with my father’s oncologists, all shifted to a screen.

On one Zoom appointment, conducted from my kitchen, I learned the results of a battery of genetic tests: I had inherited a blood-clotting disorder. It was caused by a point mutation. Of the three billion nucleotide pairs that make up my chromosomes, there was one mistake. But that one tiny error created a much bigger problem, twisting a protein into the wrong shape, setting off a cascade of other changes in my blood chemistry, and leading to thrombophilia, the propensity to develop clots. The kind of clot that could lodge inside a placenta, or block the blood flow in the lungs of a man with cancer.

I took the news hard, not because the outlook was dire—the condition is easily treated—but because it made the recent catena of misfortune seem so avoidable. I couldn’t stop thinking about the what-ifs, the many small nudges that could have brought about a different, happier ending. If only there had been a little guanine base where it belonged. If only I had known about the mutation, and taken some daily low-dose aspirin during the pregnancy. If only I’d sat or slept differently, or if the ultrasound had been a day earlier. If only I’d seen my father’s aching for what it was, before the first cancerous cell migrated into his bloodstream. The same kind of thinking was irresistible in the early days of the pandemic, and remains tempting today: if only we’d started testing sooner, or wearing masks earlier; if only that hundred-and-twenty-five-nanometre virus had been carried away by the wind.

I sometimes find comfort in thinking that recent events, in my own life and across the globe, are just rare departures from the normal way of things, the result of unfathomably bad luck. In a way, the thought gives me a sense of hope, as if there is a predestined positive outcome that will come to pass in our lives, so long as we can avoid things going wrong. But I know that the world doesn’t work that way. A wheel of fortune is deeply embedded in life itself—from a cellular to a planetary level. My twins were formed when a blastocyst collapsed in on itself—but then, instead of dying, doubled. The DNA fused in their tiny genes was the result of an almost impossible string of events, beginning with the birth of a star billions of years ago. Their cells carried echoes of the origins of life, of multicellularity, of consciousness—the fingerprints of mass extinctions and annihilating pandemics, of thousands of generations of opportune human meetings and human pairings. All of that led to two tiny bodies, unrepeatable, full of boundless potential.

The other day, my son tentatively curled into my lap and asked me about cause and effect, the subject of a lesson he had watched online during quarantine. I told him that the ideas he was learning about were the foundation of my work as a scientist, that they provided the answer to the essential question I was always asking, the one he and his sister asked, too: why? He looked at me, puzzled. Cause and effect, I said, were tools that could unlock the universe. The more we can learn and grasp and comprehend, the better we will be able to function in the world, and the better we can cope with our fears. “Like the corona,” he said.

I explained how we now can read every letter of life’s genetic instructions; how we can peer through human bodies to find out why someone is sick, where they are bleeding, what has happened to them; how we can target the rogue cells in his grandfather’s body and leave the healthy ones alone; how we can limn the crowns of a virus and trace its spread across the world. I assured my son that these were reasons for hope, and they are. We are now pulling COVID-19 antibodies from the plasma of survivors, developing new treatments for those still battling the disease, and deploying rapid new tests in hot spots. And, one day, we will formulate a vaccine.

In our conversation, I emphasized that there is rhyme and reason to the universe, and that our challenge is to understand it. I didn’t mention that, lately, it has been harder for me to face this challenge. But I know this is a lesson he’ll learn in time: that causality exists in a constant, essential tension with randomness—that the universe is also driven by the dragon of chance. As my family, like countless others, finds its way forward in these uncertain times, I remember the moment in the I.C.U. when, after all the emergency procedures, after the intubation, after two CT scans, after a dozen transfusions had been sluiced into my neck, my blood pressure still wouldn’t stabilize. It was too dangerous to open me back up, so my bed was ferried to a lower floor of the hospital, for a radiation-guided angiogram. I lay on the cold radiographic table. On the screen, my veins were a terrifying white, as if they’d been filled with snow. Then a tiny probe designed by brilliant human beings, using a kind of light we cannot see, threaded its way into my body. It found the rupture and stemmed the breach. An almost impossible procedure, with an almost impossible result. It might just as easily have gone the other way.

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