Adrian tapped his fingers impatiently on the steering wheel of his silver SUV as he waited to get into event parking near the hospital. It was a surprise to him that a science-based event like this would have created such a jam. But then again, the topic was cutting edge and curiosity seekers should have probably been expected.
A half hour passed and he had scarcely moved an inch causing the cop in him. There had to be a problem he thought for which his assistance was needed. And so, he pulled the car to the side, locked the door, checked it four times, and went to see what exactly the issue was.
Walking down the streets of Boston with a stream of stopped cars between himself and the hospital reminded him very much of a time with his Natalie in which he, Natalie and Julie were returning from one of Julie's field hockey away games. Natalie had said that she thought it would be good for him to get out and see the game instead of hanging back in his apartment and cleaning all day. At the time, he thought she was only saying it because she knew that if he was left alone for the weekend, he would simply pester her with phone calls the whole time she was gone; and, she may have been right. Those were the days where he still felt unsure of his place or purpose in a world without Trudy. And, it was the day where things seemed to take a turn in his relationship with Natalie. There was a traffic jam. A murder. And a perp trying to get away. Natalie got caught up in the middle of it and Monk had risked his own life to save hers. That was when Natalie discovered there was more to the man and that it was, indeed, 'a two-way street.'
Arriving at the end of the line of cars, Monk was surprised to see a crowd of people standing around.
It must be some terrible accident if they haven't cleared it yet, he thought, as he plotted a way to get closer.
"Six feet people. Six feet. Social distancing, please. Let the police do their work." he said, squeezing through the crowd. "Six feet. Six feet. Excuse me…I'm an investigator. Please let me through so that I can investi…gate."
Monk reached the center of the crowd and instead of seeing the mangled wreckage or critically injured person that he expected, he ran directly into a ragtag band of individuals of different ages, races, genders and sizes. Some were holding signs, some standing, some sitting on the ground, a few arguing with officers who were trying to get them to disperse and some were chanting.
Nothing About Us, Without Us!
Nothing About Us, Without Us!
Nothing About Us, Without Us!
They shouted in unison using their voices and the amplification of a megaphone from somewhere within their midst. Monk immediately became uncomfortably anxious at the press of the crowd and moved closer to the group to talk to the first person he saw.
"Um…excuse me. Excuse me, what um…what's this all about." He stated, being jostled from behind. The individual appeared to ignore him, continuing to chant as a person at the other end of the group signaled a change of message.
No, No GMO!
No, No GMO!
No, No GMO!
Monk rolled his eyes and shouted a little louder. "Excuse me! Hey, listen to me. I'm a former police officer. What's this all about?" Getting no response, he began to step closer. "Excuse me…" Suddenly a very tall man, at least a foot and a half taller than him, stood in between him and the first man, crossing his arms in front of him.
"What do you want?" the man asked.
Monk looked nervously between the first man and the second as the first turned and looked up at the second then went back to his chant.
"I was just trying to ask him what this was all about."
"Can't you see? He's deaf." The tall man said.
Monk lowered his eyes. "Oh. I'm sorry, I didn't know. I was just…"
"It's a protest. Haven't you ever seen a protest before?"
Monk raised his chin a little. "As a matter of fact, I'm from San Francisco where we used to have them all the time. Can you take me to your leader?"
The man smirked. "What do you think we are, aliens?"
Monk looked around nervously then the man shook his head.
"She's over there. The one with the megaphone." He motioned with his head.
Monk nodded gratefully when he saw a lone person in the middle of the circle who was sitting in a wheelchair leading the chant, "No, No GMO!"
Reaching the woman, he gently tapped her on the shoulder. "Um, excuse me – Miss? Excuse me. Um, Miss?"
The woman in the wheelchair lowered the megaphone then spun her wheelchair around nearly knocking Monk to the ground in the process. He stumbled a bit then righted himself, tugging at his jacket as he looked at the woman who appeared to be about thirty years old.
"What?" she stated with irritation. "What is it?"
Monk straightened his jacket out and raised a single finger in the air. "Uh…hello. My name is Adrian, Adrian M-Monk. I used to be a former police officer who was trained in conflict resolution."
"Conflict resolution?" she replied, an amused look on her face. "What kind of conflicts?"
Monk folded his hands in front of him and looked around. "All kinds, really. Union disputes, domestic issues, hippies…"
"Oh, yeah?" She narrowed her eyes at him. "You tryin' to get into the conference?"
Monk smiled slightly and nodded. "Yes, I am already running a little late so if you and your compatriots don't mind, if you could just take your little protest to the side so we can at least park our cars. Then I can get someone over here to help resolve whatever dispute you have with the hospital."
"Oh, you want us to move, do you?"
"If you don't mind." He replied, rocking on his heels and checking his watch.
The woman pursed her lips and then motioned for him to bend over as if she wanted to say something to him. Monk bent over and as soon as he was within a short distance from her, from seemingly out of nowhere a super-sized plastic cup of ice water was thrown in his face.
"Hippie this! We ain't goin' nowhere!" she replied before spinning her wheelchair back around and moving it away from him, megaphone in hand.
While Monk stood there drenched and mortified, a group of officers swooped in and took hold of the woman's motorized chair, lifting it up off the ground and carrying her and it away from the parking lot.
"This is the third time we've told you and you know the consequences." One was heard saying. "Going to have to take you down to the precinct now."
"Heck no! I won't – go." she attempted to shout through megaphone before it was taken away and they carried her down to a waiting police van. The crowd dispersed almost immediately and Adrian took a handkerchief out of his pocket and wiped his face, looking up in time to see the woman in her chair looking directly at him through the van window with an intensity that definitely got his attention. He rolled his neck as the van pulled away.
Around fifteen minutes later, Monk retrieved his car from the street and parked it inside the confines of event parking then went directly inside the venue to the men's room to see if there was a hand dryer that he could use to get some of the dampness out of his shirt. Finding one, he stood under its flow for several minutes trying to avoid getting burnt as the air was very warm.
While he was there, a steady stream of men came in and out of the room which was something he was barely cognizant of, but when the air dryer suddenly quit working one of the men became very aware of him. While Adrian banged on the machine's button with his jacket-covered hand, looking up into its nozzle to see if the coils were warming, a man stepped out of a stall and smiled at him.
"Adrian! What are you doing there?" he said, moving over to him.
Monk stopped what he was doing and looked wide-eyed towards the man, nervously standing up straight and smoothing out his clothing even as he continually touched the button of the machine with his hand.
"D-Dr. Ianovsky! I just heard about the conference while visiting the hospital the other day and thought it sounded interesting. I wasn't expecting to see you here. Um, are you attending the conference?" he asked.
Ianovsky nodded. "Yes. Dr. Neal and I are part of a group presenting the findings of one of our presentations. What…what's going on here?" he asked, looking up and down over Adrian's wet clothing.
Monk looked down, embarrassed. "I, um. Well, I kinda got a glass of water thrown in my face."
Ianovsky raised his eyebrow. "Has happened to me several times. You should avoid upsetting the ladies." He joked.
"Well, I didn't mean to upset her." Adrian said. "I was just…"
"I know, Mr. Monk. I was just jesting with you. Come with me. I think I know where I can get you some dry and sterile clothes."
"Really?" Monk replied, looking hopeful.
"Yes. I'll have one of the interns bag your other clothes up. You'll fit right in."
Twenty minutes later, Monk exited Dr. Ianovsky's office dressed in green hospital scrubs and a white lab coat looking every bit the surgeon as he joined Ianovsky who was waiting just outside.
Smiling as he exited, Monk grasped the sides of the jacket and stepped up to the doctor. "These things are very comfortable. Can I have a stethoscope to go with them?" he asked as they began to walk.
Ianovsky smirked. "For you and Mrs. Monk?"
Adrian looked confused. "What would Natalie need with it?"
Zola chuckled. "Oh, Mr. Monk. You are a funny man. A very funny man. Come now. We can just make the three o'clock lecture."
Adrian nodded at an orderly who passed by. "What are they discussing at three?"
"Advances in Cancer Therapy." He replied.
"Sounds interesting." Monk said. "Dr. Ianovsky, I understand how genetics works in our system and have heard of CRISPR in passing, but really haven't delved into it in any detail. Will there be a summary of what this is all about, or did I already miss that by not making it here for the morning session?"
Ianovsky opened the door to the auditorium which was between sessions with professionals from various disciplines taking the time to stretch and network and informally discuss what they had seen thus far. "Well, I haven't seen the presentation. So, I really couldn't tell you. If you're interested in knowing more though, I or Dr. Neal could talk with you a little afterwards."
"I didn't know Dr. Neal was going to be here too. How fortunate. Yes, I'm interested in hearing more." He said.
"Great." Ianovsky replied. "He's right over there talking to Professor Brigham of U. Mass. Shall we?"
Ianovsky brought Monk over to Professor Charles Brigham and Monk's own primary doctor while in the hospital, Dr. Sebastian Neal, and introduced him.
An amused Neal looked him up and down and said "I didn't even realize you were interested in becoming a doctor."
Monk chuckled. "Actually, I am just borrowing the uniform while my clothes dry out."
"Oh? Is it raining out?"
"No, Neal." Zola replied. "Mr. Monk had the unfortunate experience of being doused in water by one of our local miscreants."
"Them again?" Neal replied, rolling his eyes.
"Every day this week. Seems the local constable can't keep them away." Ianovsky replied.
"So, they're out there often?" Monk asked.
"Yes." Neal replied. "Each and every time we hold an event like this. Boggles the mind that they can't see that this research benefits them as much as it does us."
Brigham shook his head. "Poor miserable creatures."
Monk furrowed his brow in displeasure as he listened, but remained silent.
A few minutes later the lights were dimmed signaling the next lecture was to begin. A woman in a bright blue business suit walked out and introduced the speaker, Dr. Lisa Chen, Director of Research for a Taiwanese Genetics Laboratory, Biosynthetica in Taipei. Ms. Chen took to the stage, her presence exuded poise and determination.
"Good Afternoon." She began. "The history of humanity has been one of change and adaptation. Small changes made over time have carried humanity along in its development in steady yet often imperceptible ways. But in recent centuries, the growth of human knowledge has been at an exponential pace. According to one theory, until 1900 knowledge doubled about once every hundred years. By World War Two it was once every 25 years. And since that time, we have seen space travel and medical marvels, the birth of the internet and all sorts of amazing inventions to where by the year 2000 it was said to have doubled once a year. Today, with artificial intelligence and supercomputers and all of the amazing technology which rules our word – it is said that our knowledge as a species doubles daily. With Quantum computers, this will only continue to increase until soon we will be in the age where the knowledge of our computers outpaces our own and computers will become smarter than humanity – a time that Google's director of Engineering, Ray Kurzweil, calls The Singularity.
But that is not what we are here today to discuss. In the realm of purely human knowledge, much of what we come to know is not necessarily consequential or even lasting. However, every so often a discovery comes around that is so significant, so life-altering that one can only describe it as revolutionary. Such is the case of the discovery of the CRISPR-CAS9 gene-editing technology by Berkeley biochemist Jennifer Doudna and her colleague Emmanuelle Charpentier of Umeå University in Sweden in 2012.
Most of you are well aware of the scope of this finding, but for those of you who are new to it, I will give you a brief history. In the 1950s, when DNA was first discovered, we realized that we had come upon a blueprint of human life. In the 60s and 70s the code that made up our DNA was discovered and sequenced to where we then became able to read our own DNA structure. With that effort, in the 80s and 90s, we sequenced the entirety of our genome and were able to pinpoint precisely which areas within it were the cause of many of the diseases and disorders which plague us today. We discovered Huntington's Disease and its relationship with Chromosome 4, Down Syndrome's relationship with Chromosome 21, Klinefelter's Syndrome's relationship with X & Y, and so on. We now had the ability to diagnose the root cause of certain disorders and illnesses – yet, we did not have the ability to fix the error which caused them with any sort of precision – until CRISPR-CAS9.
CRISPR is an acronym which stands for Clustered Regularly Interspaced Short Palindromic Repeats. This is a fancy way to describe the adaptive mechanism that bacteria have in fighting off viral attacks. Viruses called bacteriophages attack bacteria just like they attack us. They do so by attempting to infect and reproduce themselves within the bacterium itself. When this occurs, the bacterium which survives has an immunological response in which it uses enzymes to cut up the attacking virus, destroying it. However, what we have discovered is that when this happens, the bacteria actually stores a record of the virus's DNA within its own system so that the next time that virus appears, the system recognizes it and destroys it more quickly. This library of information within a person's DNA is what we call CRISPR, which is simply sequences of DNA which read the same forward and backward and which have within them certain spacer segments in which the viral record is stored.
One of the enzymes that the body uses to go after these invading viruses is CAS9. CAS9 acts as a pair of scissors, cutting up the virus so that the body's immune system cannot only be rid of the threat but set up a mechanism whereby should it return, it will immediately recognize its presence and be able to fight it off. Pretty cool? Huh? It gets better.
What Doudna and Charpentier discovered was that this same mechanism could be leveraged in such a manner that CAS9 could be programmed to go where we want it to go – which basically means that they discovered a way that one could take the CAS9 scissors and direct them towards a faulty section of our own DNA, cut out the faulty section so that it could then be replaced by a corrected section or one that has been further engineered within a lab. It's been likened to a word processor. If you suspect you've made a mistake in typing, you can use the 'find' function within the computer to find the error, highlight and delete that error and replace it with the correction. Same with CRISPR-CAS9. CRISPR is the document that stores the information. Guide RNA is used to find and highlight errors and CAS9 comes along and cuts and deletes the erroneous data.
Now, as I mentioned before, the discovery of this mechanism was so important that it can only be described as revolutionary. And, while we are still in an early phase of discovering what all can be accomplished using CRISPR, what we have been able to achieve thus far has been nothing short of remarkable. In the hands of scientists, CRISPR has been able to target sickle cell disease and make it so that the effects of the disease have all be disappeared in its victims. We've been able to make malaria-resistant mosquitos which has the potential of saving hundreds of thousands of lives every year. We've been able to turn off certain human infecting viruses in pigs making possible the ability in the future to grow a limitless supply of organs within pigs that can be later used in humans. We've eliminated HIV-1 from human cells making those cells no longer vulnerable to infection. We have fixed the genetic disease, Duchenne muscular dystrophy within mice in the laboratory and now, we are going after cancer."
As Chen continued to talk Monk's mind became distracted as he considered the possibilities. He wanted to know, of course, whether or not this could cure his child of Down's Syndrome but it didn't stop there. Would it be possible through the use of gene editing that traits that he received from his mother, such as her anxiety disorder and obsessiveness, traits that he appeared to have passed on to his eldest son, could be 'fixed'? And what about Natalie's Hashimotos? Might there be a cure in a needle waiting for her so that she wouldn't have to suffer? The more he considered these things, the more excited about the technology he became. Perhaps, there was a way that he could undo the damage that he had done to his family and allow them to live the happy childhood that he himself lacked. Perhaps, he could eliminate the risk of them entering adulthood feeling some of the same inadequacies that he himself felt. If he could do this for them, he thought, it would be the most important thing he had ever done.
After the lecture, the conference attendees were given a break and Monk called Neal and Ianovsky to the side. Excusing themselves from a colleague, they walked over to a corner where he began to pepper them with questions.
"This conference, it's amazing!" he said.
"It is very informative." Neal replied. "Glad you are enjoying it."
"Oh, I am. I just had a few questions – how accessible is this technology to the average person today? I mean, is it a treatment that the hospital offers?"
Ianovsky shook his head. "Not yet. Currently, our research is confined mostly to laboratories and mice – although we have begun some clinical trials in humans on a limited scale."
"And how are the trials going?" Monk asked.
"So far, things look very promising." Ianovsky replied. "Why do you ask?"
Monk looked around, considering how he would answer. "Um, well…you see…I have this friend. His child has a birth defect, a couple actually, and I was wondering if perhaps this therapy might help."
Ianovsky looked over at Neal and nodded.
"Well, Mr. Monk, depending upon what we are talking about here it is entirely possible that a therapy could be developed that would help the child's condition or improve it altogether. Do you know what the defects are?"
Monk took a deep breath and his heart began to race. "The baby has a heart defect that is secondary to Down Syndrome."
Ianovsky raised his eyebrows. "I have heard of work being done on Down's, though that isn't something that we've gotten into ourselves."
"But you are using CRISPR?" Monk asked.
Neal nodded. "Yes. Zola and I have been working on certain genetic experiments since 2018. Our current focus is Myeloma."
The lights dimmed off and on signaling to conference participants that it was time to take their seats and Ianovsky reached out and touched Monk's arm. "I'll tell you what. Things are too busy today, but when the conference ends tomorrow afternoon, perhaps I can take you back to the lab and show you exactly what we've been working on and then we could perhaps discuss how we might help your friend. Would you like that?"
"Most definitely." Monk said, with a smile. "Thank you, Dr. Ianovky. I appreciate this more than you know."
Monk and the doctors returned to their seats unaware of the older gentleman of African descent who had been standing within feet of them listening in on their conversation taking notes. When the party returned to their seats, the man spoke into his wrist watch and then received his directions through an earpiece hidden inside his ear. Then, he quietly returned to his seat as the conference continued to completion.
At 8:45 that evening, Monk arrived home somewhat exhausted but still excited over his day. He couldn't wait to tell Natalie the news. Walking into the house, however, he found that his wife was in tears. Seeing him come through the door, she jumped up from her seat and ran to him wrapping her arms around him.
"I was so afraid! I called your cell phone and when you didn't answer, I called Leland's around six. He said he hadn't seen or talked to you. Where were you?" she said.
Monk looked down at his phone in confusion. "I was at a conference at the hospital and had my phone turned off. I texted you to let you know, but it looks like there was an error and it never sent. I'm sorry, sweetheart."
She embraced him again and began to cry. "I'm just so glad you're okay. Oh, Adrian, if something had happened…"
He kissed the top of her head and held her. "Darling, nothing is going to happen. And, I'm okay. I didn't mean to worry you. Come. Let's go into the living room for a few minutes and sit down. There are some things I learned today that I'm really excited about and I'd like to share them with you."
Monk sat with Natalie on the couch and told her all about what the scientists were doing. He told her about CRISPR and how it was palindromic in its sequence, something that uniquely excited him. He explained to her how they were able to pinpoint abnormalities with precision and correct them in the lab. He told her of how they had now begun moving to clinical trials and how Drs. Ianovsky and Neal were involved in the research. He shared that they were going to talk to him the next day about its application for Down's and it was clear he was very excited about it all.
But, even though he felt excited, Natalie was unsure and even a little wary. The very idea that their child could be used as a lab experiment just felt wrong to her. Still, she tried to keep an open mind.
"Do we know that this CRISPR stuff is safe?" she asked.
Monk shrugged. "They haven't gotten much into that yet. But think of the possibilities, Natalie! Our little boy could have a normal life! He could grow up just like the other kids and not have to worry about being made fun of or being rejected or struggling to get ahead in life like…"
"Like you did." She replied.
Monk nodded. "Yeah, like me."
Natalie leaned against him and thought. "Can I ask you a serious question?"
"Sure. Anything." He responded.
"Why do you not want to tell people that our baby has Down's? And why is it that you are so excited about 'fixing' his condition?"
Monk thought about her questions for a while then rested his cheek against her head. "I guess its just that fear. When I think of Down's Syndrome, I think of what Petey went through and I think of what I went through and I don't want that for our boy. I'm afraid that he's gotten some defective gene from me and I want to make that right. He doesn't deserve to start life with those kinds of disadvantages. Life is hard enough. Nat, I haven't even met our son but I'd already give my life for him. I just want things to be right for him, you know, when I'm no longer here."
The last words spoken cut Natalie to her core but she pushed past the pain that the eventuality brought to mind. "I think that's what all of us ever want for our kids. But why do you not want to tell people that he has Down's?"
Monk lowered his head. "I was thinking about that myself and I think I get it. I'm afraid they will reject him."
"Him, or us?" she asked.
"A little bit of both, I suppose." He replied. "Right now, everyone is excited that he is soon going to be here with us. They're all out buying gifts for showers and looking forward to holding him and watching him do his baby things. But, I've seen it before. When people find out that there is something not right in a pregnancy, it gets awkward and strange. They withdraw. They don't know what to say. And, they look at the birth of the child not as a happy event but as something to be wary about.
I watched a world, including my younger self to a degree, reject Petey for who he was. I can't deal with the thought of them rejecting our son as well. Nor, do I really want to deal with us having to feel that awkward silence where our friends will start treating us differently because our son is special needs."
"But our friends aren't like that." Natalie said. "They love us and they are going to love our son."
"I believe that." Monk replied. "But I guess right now I'm still trying to make sense of it all myself – so until I know what we're dealing with I'd prefer to not deal with it to others. If, by some modern miracle this CRISPR system has a cure, then maybe we won't have much to explain. If they could just fix that extra chromosome where it exists."
"But in Mosaicism, they don't know where the extra chromosome will show up. Maybe they won't be able to do anything with. And, truthfully honey, I am very wary of the idea that our son could be used as a guinea pig. If there is any hint of this being unsafe, we simply cannot do it. Do you agree?"
Monk looked toward her solemnly. "Natalie, I would never do something, knowingly, that I thought might harm you or one of our children. If there is any question as to safety, it's off the table, I promise."