The Future of Medicine
"They don't have a cure for asthma, but they do have a treatment. The mist reduces the swelling in the breathing passages — as best as I understand it. I'm no medical expert," Leslie said. "But we can look it up, if you want details."
Scrolling on her phone, Leslie almost walked into a passerby (who was also looking at his phone). Steve tugged her aside and prevented the collision. He suggested that they find somewhere to sit down, so they can safely look up information.
They went into a pastry shop. Steve studied the goodies in the case. "I don't know what to get," he confessed. There was a piece of cake with layers of chocolate and raspberry jam, but also a custard tart decorated with a mosaic of fruit.
"Get both," Leslie suggested. "You can use the calories. Get one of those fancy coffee drinks, too. Lots of milk and sugar."
Steve hesitated. Leslie poked him playfully. "I know you're hungry. It's been two hours since breakfast."
Steve batted her away with a grin. "OK. What will you have?" He got out his wallet to pay.
"I'll have a chocolate croissant and a plain black tea. I can't eat two calorie-laden treats. I don't burn calories like you do."
With their purchases in hand, they found a table, but the place was crowded. Leslie realized their conversation might be overheard.
"So, your professor wanted you to interview someone about medical advances they've seen during their lifetime?"
Steve was quick on the uptake. "That's right, Aunt Leslie."
"Better get out your notebook, then," she said.
Leslie pondered what diseases Steve would be interested in. She plunked for the ones that menaced her childhood and his.
"Let's see, we have vaccinations for most of the common childhood diseases — measles, mumps, German measles, whooping cough, chickenpox ..."
Steve nodded. "The whooping cough vaccine was invented in the 1930s," he said. "A little late for a lot of kids born in the 1920s," he said dryly. Leslie understood that meant he'd had the disease.
"Today we have a combined vaccine for measles, mumps and rubella, but all those came after my childhood. In my day, if one kid got measles, the typical move was to send all the other kids to be exposed, because all these diseases were considered much less dangerous for children than for adults. My sisters got mumps from a family we went on vacation with (not deliberate exposure), then Mom and I got the mumps from my sisters. I don't remember a lot, but I know she was more miserable than I was. I had measles and mumps before any vaccines existed, though they did have something called gamma globulin that was supposed to lessen the severity of the disease." Leslie looked up this term from her childhood. "I guess it was supposed to help boost the immune system.
"I think they came up with the rubella vaccine before I ever contracted German measles. I never had chickenpox either, despite being exposed at least twice, once as a child and once as an adult. They didn't come up with a vaccine for chickenpox until, like, the 1990s. I've never had chickenpox and I've never been vaccinated for it. These days there are a lot of commercials for a shingles vaccine for people my age. It's another condition caused by the chickenpox virus."
"What about polio?" Steve asked. "And smallpox?"
"As a child, I was vaccinated against smallpox. Today it's considered eradicated around the world. I remember my first polio vaccine. Mom and I stood in line at a park where they were giving out the vaccine. They put a drop on a sugar cube and you ate it. I don't remember what it tasted like, but I remember standing in a long line. One of my earliest memories."
"Has polio been eradicated?" Steve asked quietly. Anyone who might have been listening had tuned out this boring medical conversation. The tables next to them cleared out, meaning they could speak more openly as long as they kept their voices down.
"Not yet. There are still some places in the world where it's endemic, but we're a lot closer. Most of the threatening diseases of a 1920s childhood are curable or controllable these days."
"What about tuberculosis?"
"TB isn't a problem in most of the more developed world," Leslie said. She looked it up to be sure. "They have TB tests to check for it when you travel or when you apply for certain jobs. At least they did when I was younger. According to this ..." She gestured with her phone. "TB is curable with antibiotics, but it takes quite a bit of time." She looked Steve in the eye. "Today, your mother would have been vaccinated, because she worked with TB patients, and, if she got sick, would be cured. The scariest diseases from your childhood are mostly curable. Even leprosy is curable today. Over all, your preserum self would not be as sick today as in the 1920s and 30s."
"The future sounds awesome," Steve said with a grin.
"Of course, we haven't cured everything. Influenza is still a yearly concern. They make a vaccine every year, but some years it's not as effective as others. There are so many strains of flu, they have to guess which ones to include. And sometimes they guess wrong and we have a bad flu season. Flu can be serious, especially for kids and the elderly and people who are already ill, but it's not such a sweeping danger as in the days before antibiotics." Leslie rapped her knuckles on the wooden table. "Knock wood, because the flu is always mutating and health officials have not forgotten the deadly Spanish flu pandemic."
Leslie went on to talk about some today's threats: Ebola and other hemorrhagic fevers (hemorrhagic was a terrifying word all by itself, as far as she was concerned). She talked about AIDS, Alzheimer's, MS and ALS.
"I remember Lou Gehrig's speech," Steve said. "He was still a young man when he died."
"A brave man," Leslie agreed. "ALS is pretty much known as Lou Gehrig's Disease theses days."
Leslie talked a little about cancer, double-checking facts on her phone. "Cancer is when the body's cells run amok," she said. "It's a general term for a lot of different diseases where cells grow abnormally and for tumors. Surgery is often required to remove tumors. Some are treated with chemotherapy or radiation therapy. It depends on the kind of tumor and its position in the body. These days, regular checkups and tests can detect cancer early when the prognosis is good. Skin cancer is the most common and is usually spotted by a physical inspection from a dermatologist. Prostate cancer is Number 2 in men and is detected by a prostate exam and sometimes by a blood test. Breast cancer is Number 2 in women. Mammograms, which are X-rays of the breast, are used to detect abnormal growths that might be tumors." She sighed. "I've had two breast biopsies for lumps that turned out to be cysts, not tumors. About 40 percent of women have fibrous cysts." She raised her eyebrows. "Sorry, this says 50 to 60 percent of women have 'fibrocystic changes,' which is not a disease. Makes it hard to get an accurate mammogram, though, and I always have to go back for a ultrasound." Then she had to tell him about ultrasounds. Like an X-ray but using sonar," she said. Those were both familiar terms to Steve.
"Colonoscopies are interesting," she said, moving on to a new topic. "The doctor puts a tiny camera up your butt and actually examines your digestive tract from the inside."
Leslie laughed at the queasy expression on Steve's face.
"It doesn't hurt," she assured him. "The annoying part is the liquids you have to take to clear out your intestines so they're clean enough to see anything."
"Are you kidding me?" Steve asked doubtfully.
"No, sweetie, endoscopes are amazing. They have a camera on a long, flexible cable, like a plumber's snake. They can look inside and diagnose problems. Some are used for surgery."
She showed Steve the palm of her hand, pointing to a faint circular discoloration near the base of her palm and another on her wrist.
"I had carpal tunnel surgery. The tendons and the nerve in the wrist run through a narrow space called the carpal tunnel. Swelling put pressure on the nerve and it hurt constantly and tingled in my thumb and first two fingers. Filing my fingernails was like torture. The surgical treatment is to open up the space and give the nerve more room. Up until a couple of years ago, the surgeon would slit the wrist and leave a big scar. Now they make two little holes and open up the space from the inside. Arthroscopic surgery is amazing. They can even operate on a baby still in the womb."
"Wow! What caused your carpal tunnel?" Steve asked.
"Probably arthritis," Leslie said. "Repetitive motion, like doing lots of computer work, can lead to carpal tunnel syndrome, but I've been doing that work for years with no problem. I always take regular breaks. But as my arthritis developed, it probably narrowed the tunnel, the doctor thought. Arthritis is my curse," Leslie said. "It's degenerative and painful and there's no cure. You take anti-inflammatories to slow the progression. That's those big pills I take every morning and night. There are lots more treatments for it now than there used to be."
"Seems like medicine has made a lot of advances," Steve said.
"It has. These are just some of my personal observations. You can read up on more if you like. But you're the most amazing advance, in medicine ever," Leslie said. "No one's ever been able to duplicate you."
Steve ducked his head shyly. "I'm not perfect," he pointed out. "I still want to punch things."
"Yes, we'd better get going and find you a punching bag," Leslie agreed.
They balled up their trash and left the building.
When they found the address, they descended two concrete steps from the sidewalk. The double doors had glass panels framed in peeling green-painted wood. The glass was protected by wrought iron security bars. "Boxing Club" was stenciled in gold letters on the right side door with "Est. 1927" in small letters below. A hand-printed sign indicated the operating hours on the left side. The club should be closed, but the right hand door was slightly ajar and showed a Post It Note reading "Members Entrance."
Steve reached for the door handle.
"On TV, it's always a bad sign when the door is ajar," Leslie joked. "The cops usually find a body inside."
Steve grinned at her. "Director Fury said they'd leave it open for us," he said. "But you can stay behind me if you're scared," he teased.
She made a face at him. "Not scared. Just sensible."
They entered the dimly lit room. It spread out over most of a city block with multiple boxing rings, heavy bags, speed bags and all the other accouterments. The wood floor was scarred but gleamed with polish. Wood fixtures were well worn and the brass was polished. The place was well used, but clean.
Steve took a deep breath and relaxed in the familiar atmosphere.
"Miz Leslie, as I live and breathe!" said a quavering voice with a faint Southern accent.
An elderly black man approached, tilting his head with birdlike curiosity. His white hair and beard contrasted strongly with his dark skin. He was thin but wiry, wearing worn work pants and leaning on a broom.
Leslie surprised Steve by bursting out laughing. "Abraham Lincoln Brown. Still up to your old tricks."
The old man cackled. Leslie gave him A Look and he began to guffaw in a deeper, less feeble voice that somehow had lost its Southern accent. "I've missed you, little girl."
He held his arms wide and Leslie walked into the hug. "You old fraud. It hasn't been three months since you invaded my office and ate all the maple bacon doughnuts."
"I take it this is a friend of yours," Steve said.
The man wobbled his hand back and forth. Leslie punched him. "We used to work together, until he retired."
"There's no one in the building right now, but let's go up to my office to talk anyway. It's more private," Brown suggested. He led the way to some wooden stairs that went up to an office that overlooked the entire facility. He carried the broom with him, touching it down for balance because he limped heavily on his left leg.
"That knee replacement didn't work out?" Leslie asked.
"Knee replacement?" Steve asked, then clapped his mouth shut, realizing he'd shown odd ignorance in front of a stranger.
Leslie patted his arm. "We've been talking about modern medicine," she answered Brown's questioning look. To Steve, she said, "Doctors can replace some damaged joints with artificial ones. Knees and hips are very common. Some others are possible."
"Fingers," Brown said.
"Really?" Leslie asked.
He nodded. "I know a guy."
"Fingers, ankles and shoulders," Leslie said, after studying her phone. "There seems to be a lot of debate about artificial ankles vs. ankle fusion. And I don't see anything about wrists or elbows."
"But lots of people get hip or knee replacements," Brown said. "Including me. I'm still working through my PT. I'll be dancing on the tables soon."
"Eh, I've seen it. Doesn't bear repeating," Leslie teased.
The trio entered his office and Brown turned the old-fashioned door latch, then pressed a series of buttons on a modern keypad. Little lights lit up momentarily, then settled to a steady green glow. "I sweep for bugs — listening devices — every other day, but no one's interested in a has-been spy," Brown said in amusement.
To Steve, Leslie said, "He's got a higher security clearance than I do. He was Fury's training officer years ago."
"Nicky told me who you are, captain," Brown said, extending his hand. "I'm very pleased to meet you. Gabe Jones always spoke highly of you."
A/N: So, Brown is based on a character in the Steve Rogers deleted scene from the Avengers DVD. The character manning a desk in the boxing club has no lines, but now he has a whole background in my story.