For once in her life, Cosima was early. She was up, showered, dressed and medicated before Delphine's alarm went off. At her girlfriend's insistence, she forced down a croissant and some fruit at a small cafe they passed on their way to DYAD. "I used to come here most mornings before work. Best croissants in Paris."
They turned a corner and suddenly they were there. Within these walls was her best shot at living. Probably her only shot. The early morning sun glistened off the dark windows and Cosima couldn't breathe. All these feelings and emotions she had been forcing back, not willing to think about nevermind deal with, forced themselves to the front of her brain. She fell to her knees, gasping for breath, blood flowing from her nose and lips, clinging to Delphine who looked on completely helpless, shouting something in French.
"I'm okay." Cosima waved off two big goon-looking guys in security uniforms. "I'm okay," she repeated, looking up at Delphine. After a moment, the Frenchwoman turned to the goons and said something that made them back up, but stay close enough in case their assistance was needed. Reaching into her bag she turned up the flow of oxygen and grabbed some tissues. With Delphine's help, and strength, she was cleaned up and ready.
If Duncan couldn't help this was it. They could keep pushing through for a gene therapy, but one was months away at best. Without a major push in the right direction, they were just poking at things with sticks.
It may have been years since she worked there, but Cosima noticed how Delphine walked right in, followed by the goon-guards from outside, and looked like she owned the place. Everyone still remembered her. Some wanted to stop for a chat, or the very European cheek kisses. Cosima had very little idea what they were saying. Her French was getting better, but she was still a beginner and French speakers spoke very fast. There was too much at stake for her to even pretend to be interested in what was being said anyway.
Delphine gripped her hand tighter and waved off an escort, saying something along the lines of remembering the way, from what Cosima could pick out. She took a deep breath and focused on her breathing.
In and out. In and out. In and out. I ou 8
"Hey"
Coming to a stop she looked up into the most beautiful hazel eyes she had ever seen. No matter what was going to happen, nothing would change the weight that lifted whenever she looked into those eyes. It made absolutely no sense. Nothing changed. Her problems didn't magically disappear, but with Delphine by her side, those problems didn't feel so drowning. When Delphine was near, Cosima actually felt that she could deal. Though if Dr. Duncan wasn't this saving grace they needed...
"I'm here for you. Always."
Cosima smiled, briefly brushing their lips together before a woman came and guided them to an office-a very cluttered and seemingly disorganized office, where a tall, thin, older man stood in front of a shelf with a file in his hands, mumbling to himself.
He didn't seem to notice them. "Dr. Duncan?" Delphine began.
The old man jumped, the file in his hands falling to the floor. "Ah, goodness me. My apologies." Delphine bent down to help him gather the various papers he dropped. "Dr. Cormier, I presume?"
Once stood up, he turned to Cosima with a warm smile on his face. Cosima knew how eccentric some scientists could be, but this office was a mess. Packed full of various books and journals and papers, and maybe a bird cage in the corner there. Duncan's clothes and lab coat were a wrinkled, dishevelled mess, but despite all of that, she trusted him. He had kind eyes and a soft handshake. "Miss Niehaus."
"Oh, please, it's just Cosima."
"Cosima." He nodded. "Then please call me Ethan. Let's work on getting you well, shall we?"
"When exposed to the serum, the cells all swelled. But then some of them immediately started degrading and folding in on themselves and some just burst." Cosima explained, focusing the microscope and stepping aside to show Duncan.
"Yes, yes." He agreed, looking down the microscope.
"But, we haven't been able to determine why. Why do some cells degrade and some explode?" And what would that do inside my body?
Duncan mumbled to himself as he shifted through the files and the papers spread out over the table. His notes and research combined with Cosima and Delphine's. The women quickly learned Duncan thought much like his office was organized. Messily, and with no clear or discernible pattern to an outsider. "Have you tried with fresh samples?"
"No." Delphine answered. "We ran out of your serum."
"I know there's a lot we need to test it on, but we need a better way to predict what it's going to do with these cells. We can't go injecting something into my body if half the masses are going to burst."
"Quite right." Duncan agreed, moving a new slide under the microscope and examining it as Delphine and Cosima looked at one another, wishing he would let them into his brain for just a moment. "And these samples were frozen?"
"Yes."
"Together?"
Cosima shrugged. "I don't know how they were storing them."
"Well, you are right. We do need fresh samples. The cells should all be doing the same thing if they have the same genetic make-up. I'll go and book a theater."
Cosima's blood ran cold. "A what?"
"An operating room." Delphine clarified, earning an eyeroll from her girlfriend. Cosima knew perfectly well what a theatre referred to in the medical sense. She was just hoping she heard wrong.
"Yes. We need to get fresh samples at once." Duncan explained, heading out of the room. "From the masses, lung tissue, blood. You will assist, Dr. Cormier."
"Wh..." Cosima slowly looked from the door closed behind Dr. Duncan to her girlfriend, eyes wide. "Seriously?"
Delphine's shoulders fell. Closing the distance between then, she gently cupped her girlfriend's face in her hands, bringing her in for a kiss. "We knew we would need fresh samples eventually." Cosima's eyes welled up with tears. Delphine made a promise to her. Promised to be there through everything. "I will be right there the entire time."
"No, I know." Cosima nodded. "It's just..."
"Everything is getting very real very quickly." Delphine finished, receiving a small smile and a "yeah" in response.
"But, yeah, let's do it." Cosima backhanded the salty tracks from her cheeks and nodded once. "I'll do anything."
"So will I."
"You're damn right you will." Cosima smirked. "Because after this I am going to need some serious TLC." Visions of her girlfriend in a lab coat and nothing else, well maybe that pair of boots she kept under their bed, brought a smile to her face.
"We will go in laproscopically," Delphine explained trying to assuage her tiny lover's fear, seeing right through her cheeky comment and smile. "Take a small sample. I am not sure how much Dr. Duncan will require, but it shouldn't be much."
Cosima listened to every word even though she knew perfectly well what to expect. This wasn't her first rodeo. There were so many procedures and biopsies she had been through already since her diagnosis. There probably wasn't anything that could be done to the human lungs that hadn't been done to her, but she listened nonetheless. The information coming from Delphine was different. It filled her with a sense of calm rather than trepidation.
It was inherently more invasive than a needle biopsy, but they needed a larger sample which required surgery rather than a simpler procedure. "If you're going to take a sample, why not just take an entire mass out? The more you take, the more we can test."
"I will ask Dr. Duncan what his plan is, but whereas we will already be...euh...in there, I don't see why we couldn't." A promise had been made for her to be Cosima's girlfriend first, but they had struck an unspoken truce. Cosima knew when it was necessary for Delphine to be her doctor. They were much closer since their fight and were both very happy with the adjustments they had made, but Delphine was having a harder time than ever separating the girlfriend from the doctor. Doctors weren't supposed to treat family members or loved ones for this exact reason. Soon they would be inside her girlfriend's chest cavity. That wasn't anything she wanted to see first hand. The images from the monthly tests they ran were quite enough, but at the same time she needed to be there. It wasn't that she doubted Dr. Duncan's abilities or any of the medical personnel who would be in the room, but this was Cosima. Her Cosima.
"Video-assisted?"
"Probably." Delphine answered. "Though if we are going to remove an entire mass, it may need to be open."
Cosima took a minute to digest the information. "And you'll be right there, right?" She looked at Delphine with fear in her eyes. Delphine wasn't a surgeon or a nurse so at most all she would do was hand over tools or take a sample, but Cosima needed to know she would be there.
Delphine looked deep into Cosima's eyes, trying to convey everything there weren't words for. Come hell or high water, as long as there was breath left in her body, she would be there. "Always."
Cosima woke some time later, the smile immediately returning to her face. "There was a farmer who had a dog and Delphine was her name-o!" She sung with a chuckle. "P-U-P-P-Y, P-U-P-P-Y, P-U-P-P-Y, 'cause Delphine is a pupp-y!"
"And that is quiet enough of that." Delphine shook her head as Cosima laughed beside her and took the PCA pump out of her hand.
"Aw, come on Delphiiiiiine! Don't kill my buzz, man."
Putting the pump out of the brunette's reach, Delphine sat down on the edge of the bed and lifted the gown Cosima was wearing to reveal two small incisions on the outside of her ribs under her left arm. Thankfully they had been able to do everything laproscopically with video assist and didn't have to open Cosima's chest. Lifting the bandages she was relieved to see no abnormal redness or discharge. Just normal swelling and a little bit of blood. The drainage from her chest tube had already slowed considerably which was another good sign. "How are you feeling?"
Cosima's smile widened as she looked up at her girlfriend. "Depends on what you're wearing under that lab coat, Doctor Cormier."
Looking at Cosima's exposed breast under the gown, Delphine replaced the bandages and covered the brunette back up. "Is sex all you ever think about?"
"Kinda." Cosima winked. "What am I on?"
"Morphine."
"Good shit, dude. Way better than pot. Think you can get me some of this back home too?"
Delphine's face fell. How much pain was Cosima hiding behind cheeky comments and bright smiles? "If you need it, yes."
Cosima's smile faded. This was the best she had felt in months. When you live in chronic pain you just sort of accept some level as your baseline even though it never really goes away, but right now she didn't feel so much as a twinge anywhere. It wouldn't last long, she knew. Now that she was awake they would wean her off, but it was nice while it lasted. A much better high than pot. And no cotton mouth or subsequent munchies which was a plus. Though honestly she could use the munchies. Her appetite wasn't good and she was losing weight fast.
As some of the fog cleared, she looked down and saw the tube hanging out of her chest and her good mood quickly deflated. There was no avoiding any of this now; couldn't avoid thinking about the reality of her situation or dealing with it now. It was here whether or not she was prepared. Maybe it was better that she didn't know they would be doing any of this today so she didn't have time to think about it. They enjoyed a nice few days in France, with a few bumps in the road, but how much of that would have been ruined if she had been worrying about this?
"We removed a couple of the larger masses from your lungs. Took samples of healthy lung tissue as well. We shouldn't have to do this again." Delphine said with a smile, leaning down to gently kiss her girlfriend.
"Unless after Duncan's treatment you have to go back in and take more out to see if it's working." Cosima knew Delphine wasn't the one physically going into her chest cavity and removing masses and tissue. It was more of a general you.
"Let's take it one step at a time."
Cosima nodded and Delphine updated her on what was going on. They had cells from each of the masses they removed, the lung tissue and blood currently marinating in Duncan's mystery serum. He still refused to tell them what it was made of. Part of Cosima believed he didn't even remember at this point. Delphine pulled out a tablet and pulled up the live video feeds from the cameras the samples were all under. A recent addition Delphine assured her would already be in their lab by the time they returned home. There were no changes to any of the cells yet, but it was still early. The cultures had only just been prepared.
"We injected the serum into one of the whole masses as well." The blonde explained. When there was no response she looked over to see Cosima had fallen asleep. "Sleep well mon amour."
Two days later, sans chest tube, Cosima was back in the lab and none too happy. The serum worked on each of the samples from the masses they tested it on. On the cellular level, it broke each individual cell down. It sort of made the cell look like it was melting as it shrunk. There was no more bursting, not that they could explain why some of the tests they did back in Toronto showed that. Most likely explanation was the samples were improperly stored which resulted in the cells becoming unstable.
According to Duncan's research and their simulations, models and tests, the serum needed to be injected into each of the masses individually. They completely submerged one mass in the serum, and tried every different method other than injection they could think of, dividing the masses into sections to test each method – no change. The only way the mass broke down was by direct injection. They set up a lung-like cavity with 'veins' and 'tissue' with Cosima's own blood cycling through and, if the stakes hadn't been so high Cosima would have stepped back and marveled at how absolutely amazing it was to be able to do something like that, injected the serum into one of said 'veins' and in spots on the 'tissue,' but by the time it filtered down into the mass it did very little. The only method that did what they needed it to was direct injection.
Unfortunately, the serum didn't seem to break down every cell either. If even one cell survived, which their tests were showing to be the case, the mass would re-grow. And it took time for the mass to break down. It wasn't instantaneous.
"We don't have that kind of time," Cosima exclaimed. "There are literally hundreds of them! And what about the ones in my trachea, my diaphragm? We can't possible inject this stuff into each and every mass. It's just not realistic. What about new ones?"
"We will still work on a gene therapy," Delphine offered. "We clear out the current growths with Duncan's treatment and continue working on a permanent cure."
"So I'm looking at a future with dozens of surgeries."
"Every other month or so I am afraid based on the data. You could stretch it to every three, but I would recommend doing it sooner than that." Duncan said, apologetically. "I am so sorry Cosima. I should have kept pushing, but when my subject died I was moved to another project."
The room fell into silence until Duncan left an hour later. "It's something." Delphine began quickly before Cosima could open her mouth. "And it works."
"It's major surgery every few months Delphine! Do you have any idea how long it takes to heal from lung surgery?" It wouldn't be possible to do this as a procedure with a local anesthetic. There were too many masses for them to be shoving a needle through her skin, muscle and tissue for each and every mass.
According to Duncan's limited research into the disease before he was moved onto a new project, the serum had a short span of time it was effective. It only stayed in the body for about a month to a month and a half and then whatever remained of the masses would start to re-grow. Cosima's masses, despite causing a vast host of issues, were more plentiful rather than large, so in that month they should all be gone, visibly. But, the serum was, in a way, incomplete. It lacked that final one-two knock-out punch needed to completely eradicate the disease. It left infected cells deep within the lung tissue that would enable each mass to grow back thus requiring future surgeries. It would be better to do the future surgeries when the masses were still small. The serum stayed in the body for about month so the smaller the masses, the more of a chance the serum would get those last stubborn cells.
Every other month made the most sense. Inject the masses, the serum continued to work for that first month, then another month for the masses to re-grow. That would give them enough time to be large enough to be visible, even if just barely, and thus injectable, and hopefully wipe out every last cell.
"We can do it laparoscopically. Three incisions, one needle, guided by a thoracoscope." Delphine assured. "It would be a long procedure and you would need to be under anesthesia, but it would be minimally invasive."
"It's still surgery. Every other month." I'm already so weak.. She sighed. "It's a treatment-"
"It is our best shot."
"I'm not physically strong enough for it Delphine!" Cosima exclaimed with a bloody cough into the crook of her elbow and radiating pain from her healing incisions.
"Duncan said we can stretch it to every three months." Delphine began gently, taking her girlfriend's hands in her own. Her shaky hands, Delphine noted. A surgery like this would be a lot on her already extremely weakened body. The one two days ago wasn't as involved as it would need to be with Duncan's serum and it took a lot out of Cosima. Her chest tube was able to be removed easily and the incisions were healing well and quickly, but she couldn't stand up for more than a couple minutes and it was harder for her to breathe, though that should fade as the pain did, and Delphine was concerned that she hadn't stopped shaking yet. Her test results showed no significant decline, but physically Cosima was suffering.
Every three months wasn't ideal, but the masses were slow growing. It was a year since her time in the hospital that had wiped them out that they were causing issue, so in the grand scheme of things an extra month shouldn't be that big of a deal. Only Delphine was hyper aware that Cosima's doctor had given her two years and that two years was up in nine months and every month they added got them that much closer to that date. But, if they managed to get rid of the masses did that timeline still apply? There was still so much they didn't know.
"I will be there every step of the way mon amour." A cheap trick, using French to sway Cosima, but Delphine told Cosima she would do anything, she meant it. "We use Duncan's treatment and keep pushing through for a gene therapy with Duncan's notes."
They weren't getting anywhere with a gene therapy. They were pursuing a few different avenues and though some looked promising, they were slow moving. There was still Delphine's project with the spiny mice where they were trying to switch on that same gene in Cosima's biology that allowed the mice to shed skin and fur. If they could somehow edit that gene to view the masses the same the gene in the mice viewed skin, hair and tissue, it could enable those masses to be shed. There was also a new study in the U.S. approved for one specific strain of childhood leukemia. The patient's T-cells were taken out of their blood, edited in a lab to attack cancer cells then put back into the patient's body. It was promising. Of course the treatment had been developed by DYAD and Delphine already had the team that developed it working to see if it could be used on Cosima, but that was a stretch.
However both of those were still merely treatments, but as long as it wasn't a treatment that required invasive surgeries and procedures, Cosima was willing. Scott was still trying to find the genetic reason for the disease. If they could find the cause, they could fix it. None of what they were looking into would do any good at curing this disease unless they could find the source.
Their best bet now was to continue off of Duncan's research. Find a way to get the serum into the faulty cells via a viral vector once they found a way to adjust it to not only break down the cells of the masses, but to cure each and every cell in her lung tissue so none of the defective cells survived to be able to re-grow.
"It is less than we hoped," Delphine admitted softly, sadly. As much as she was trying to put on a brave face and be positive for Cosima, her heart hurt too. Everything had been hanging on this. It was their only hope. It was far from a dead end, but how helpful would it be, really? They had Duncan now. His notes and research, but there was still a massive mountain to get over to turn it into a curative gene therapy. They were still just poking at things with sticks.
"But it is something. And it works." The doctor didn't need to say how much it would be putting Cosima's body through. Or all the pain it would lead her love straight into, all the pain she was asking Cosima to go through. They both knew. "Cosima, this is your only way forward. You can do this."
Cosima heard the unspoken. You don't have a choice.
The subject was dropped with them calling it a night and returning to the hotel. Cosima needed to process. She had been through all of this before. If she knew there was a light at the end of the tunnel, she would do it no question, but who knew if and when they would find a gene therapy that would work and she would require surgery every other month until they did. She needed to think if this was really what she wanted. She couldn't do this for Delphine or her sisters or her mother. It had to be for herself.