"O.K., I'm glad it's not lupus," the middle-aged man said with a sad, rueful smile. He turned to look at the medical student who brought him the news of yet one more disease that it turned out he didn't have. For months now, he had a high fever off and on and low blood counts. His liver wasn't working well; he felt weaker every day, and yet none of his doctors could figure out why. Upendra Maddineni, a third-year medical student doing a rotation at the Memorial Sloan-Kettering hospital in New York, had the unenviable task of bringing the patient the near-daily reports of unrevealing test results. "I'm sure we'll find something soon," the student added, his voice fading to nearly a whisper.
The patient, who is 39, was healthy until a year earlier, when lymphoma, a cancer of the immune system, was diagnosed. But he received dose after dose of chemotherapy, and finally, six months later, his doctor told him that he was in remission. The cancer was gone. Indeed, when the fever first hit, he was packing for a weeklong "mission accomplished" vacation in Florida with his wife and 3-year-old daughter. Now it was unclear whether they would ever take that trip.
The fever frightened him. Why wasn't he healthy now that the cancer was gone? It worried the doctors as well. He spent almost a week in a hospital near his home in Pittsburgh, as his doctors looked for an infection they could not find. What they found instead were abnormally low levels of white blood cells and red blood cells. Was this because of the chemotherapy? Had his cancer made a comeback? Or was this something else? No one knew.
After several days of intravenous antibiotics, the fever resolved, and his cell counts seemed to be coming up, so he went home — relieved but without a diagnosis. Over the next two months, he was in the hospital four times. Each episode was the same — the fever, the low red- and white-blood-cell counts, the unrevealing work-up, the intravenous antibiotics. The last time the blood counts never rose, and he just stayed. After two more weeks, his doctors suggested he transfer to Sloan-Kettering. They worried that these fevers and low blood counts could represent a recurrence of his cancer.
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