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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31815c0840
Reflections of an ID Specialist

The Last Ray of Hope

Louie, Ted MD

Free Access

In April of 1996, I was finishing up my fellowship in infectious diseases at the University of Maryland. The venerable but dowdy old hospital had gotten a spanking new face-lift. Patients were now ushered into the spectacular revolving door by fully liveried security men. And the Homer Gudelsky tower had been completed, all sleek chrome and glass. On each floor, there was a security person seated at a beautiful dark wooden module, ready to efficiently direct visitors to the appropriate corridor. The tremendous upgrade had no doubt been expensive, perhaps exorbitant, but we were in absolute awe of the new building and dreamed of all the wonderful state-of-the-art procedures that could now be done in this most proper of settings.

Spring was certainly in the air. A warm breeze wafted through the hospital parking garage, and you only had to look out toward Camden Yards and hear the radios from the local bars blasting Jon Miller's mellifluous voice, and you knew baseball was in the air, too.

Baseball in Baltimore was wonderful. It was a small, closely knit town, and everyone-man, woman, and child alike-loved their Orioles. Over the years, the team had won many championships, but none since 1983. Even so, the crowds had continued to pack the beautiful stadium every year, loyally backing up their team and every year living through more disappointment. But the word was that this team was going to be different. After 12 years of wallowing in mediocrity, this team was going to be good. The owner, Peter Angelos, had poured money into the team, and there was a new manager and some expensive free agent acquisitions. This 1996 edition, like the University Hospital, had been completely overhauled. Anything, it seemed, was possible.

That April, I was doing a rotation in the Cancer Center. One Saturday, the director of the Cancer Center stopped me and asked if I wanted a couple of spare tickets to the Orioles' afternoon game. Without hesitation I replied in the affirmative, and of course, I said I would take Ray along.

Ray was 19 years old, a tall, gangling youth with an angular face and a quiet but direct manner. He was intelligent and polite, and everyone in the Cancer Center knew and liked him. Unfortunately, he spent more time in the hospital than outside it: for he was afflicted with acute leukemia.

Over several stints through the Cancer Center, I recalled rounding on him. Often he was febrile and neutropenic, and I would examine him, and he would tell me what I needed to do: order blood cultures times two, urine culture, and a chest film. Perhaps he would suggest starting ceftazidime. He was not sarcastic nor bitter, nor was he depressed. He remained outwardly calm, almost in a Zen-like state. The only concession he made to his illness was to hide his chemotherapy-induced alopecia with a baseball cap.

Most of the cancer patients had frequent visitors, yet I never saw anyone stop by Ray's room. Later, he told me, quite matter-of-factly and without a trace of self-pity, that he had come from a broken home. His mother had apparently taken off several years ago to some other county, whereabouts unknown. He seemed a bit wistful and uncertain of her motives, yet did not seem embittered.

On this fine April afternoon, Ray grabbed his windbreaker and quickly obtained a pass for a few hours to leave the hospital grounds. With his baseball cap on, he looked like any other teenager on an outing. We quickly walked away from the long shadow of the hospital, past the small neighborhood bars with open porches, and ascended the elevators into Camden Yards. Soon we found our seats in the bleachers, enjoying the warm air and the broad emerald-green vistas of the baseball field. I watched as Ray looked around him, taking in all the happy fans munching on their hot dogs and popcorn. He hunched over in his seat, intently watching the baseball players as they warmed up: Cal Ripken flawlessly fielding grounders at shortstop, newcomer Roberto Alomar working his magic at second base, and swift center-fielder Brady Anderson, much admired by the ladies of Maryland, playing catch in the outfield. Ray and I chatted easily about baseball and nary a word about his health. We were seated next to a gastroenterology attending and his wife, who kept complaining about the fat kid in front who stood up every time a ball was hit to the outfield. I introduced Ray simply as "Ray," and I don't think the others ever caught on that he was a leukemia patient with a port in his chest and chronic pancytopenia, on leave for just a few hours in the only peaceful haven he had left.

The Orioles won easily that afternoon, and Ray remarked with great satisfaction, "I'm eleven and two at these games. I'm their good luck charm."

"You should go to more games, Ray," I laughed. "You definitely should. The Orioles need you. They can't win without you."

Later that month, the oncologist told me that Ray's leukemia had not responded to chemotherapy and that he really needed a bone marrow transplant. For some reason, Ray was a tough match. They had looked high and low for a match, and none was close enough. He told me perhaps the only chance left was if Ray could locate his mother and see if her bone marrow was a close enough match. Maybe, just maybe, there was a single ray of hope left. But time was swiftly running out.

In June of that year, I completed my fellowship and moved to New Jersey to join a group practice. Still enamored of the Orioles, I discovered to my delight that by carefully positioning my radio with the antenna pointing due south, I could pick up Jon Miller's radio broadcasts from downtown Baltimore.

The Orioles had started out fast that spring, winning many games in April. By May and June, they had slowed down considerably, and by the All-Star break, things did not look at all promising. The team, it seemed, was dead in the water.

Yet, sometime during the dog days of August, when the Maryland air is at its hottest and most stifling, the Orioles started mounting an unlikely comeback. The team rallied and started winning. And when summer gave way to early autumn, and the evenings became cool and brisk, the team refused to die and continued to fight and claw their way until they just barely managed to make the playoffs.

The Orioles had fooled most everyone and managed to survive the regular season, but now they had to face the formidable Yankees. The first team to win 4 games would advance to the next round. Of course, the Yankees were heavy favorites, but the axiom in baseball is that anything can happen in the playoffs. Were we about to see a minor miracle happen?

The Orioles, however, looked fatigued and overmatched. They quickly dropped 3 of the first 4 games. On a sun-drenched afternoon in mid-October, they took the field for their last stand.

Two hours and 57 minutes into the game, their battle-scarred veteran Cal Ripken stood at the plate. The early evening shadows began to lengthen across the field, leaving areas in purple darkness. The warmth of the afternoon had given way to an autumn chill. Struggling to calm himself, Ripken windmilled the bat around. For one final time, he swung as hard as he could. The sharp grounder went right to Jeter at shortstop. Churning his legs hard, Ripken strained to make it to first, but Jeter's throw disappeared into the first baseman's glove for the last out of the game.

The Orioles had lost their last ray of hope. It was all over.

Perhaps this was inevitable, for there was a single empty seat in the stands where their good luck charm should have sat, with his baseball cap pulled tight over his eyes, hunched over and taking in the ball game: for Ray had never found his mother.

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