[RADIOLAB INTRO]

LOU GARCIA: What we have over the criminal is the criminal actually thinks he's destroyed all the evidence. It's never all destroyed. Ever, ever, ever, never.

ROBERT: This is Lou Garcia.

LOU GARCIA: I recently retired from New York City Fire Department as the chief fire marshal. So I've spent 25 years of my life looking at fires and investigating the causes of fires.

SOREN WHEELER: How many fires do you think you've seen?

LOU GARCIA: Oh, tens of thousands of fires.

ROBERT: You've seen tens of ...

LOU GARCIA: Yes, absolutely.

ROBERT: You, you, you? You yourself?

LOU GARCIA: Yeah.

ROBERT: When he tells me a story ...

LOU GARCIA: There was—this is a true story. I'm not gonna get too many details about it, but there was a fire in an area of New York City.

ROBERT: It was in an apartment building in the South Bronx.

LOU GARCIA: As I pulled up to this building ...

ROBERT: The fire was already over when Lou got to it.

LOU GARCIA: ... there were people in the street, and we're questioning people.

ROBERT: People are saying, "Well, in the apartment where the fire was, there was this brave guy. Somehow he'd gotten in there, and he was pouring water ..."

LOU GARCIA: Pouring water on the fire.

ROBERT: ... trying to get the fire out. This guy was really something!

LOU GARCIA: You know, and he's a hero right now. Everybody's telling me what a hero he is. Everything they were saying in the street about this man was wrong.

ROBERT: So he walks into the apartment. He looks around, and he knows right away ...

LOU GARCIA: Where the fire started.

ROBERT: How?

LOU GARCIA: Well, you just look at the fire patterns.

ROBERT: And he could tell that the fire started, first of all, in the bedroom with a mattress.

LOU GARCIA: The mattress. The mattress. Now mattresses go up if you put a match to it.

ROBERT: Really?

LOU GARCIA: Yeah.

ROBERT: Don't you have to put gasoline on the mattress?

LOU GARCIA: No, no, no.

ROBERT: You can just put a match onto a mattress and it will catch ...

LOU GARCIA: Fire, yes. If you hold it there long enough, yeah.

ROBERT: And he also knew that the mattress had been placed upright against the wall.

LOU GARCIA: You could tell by the fire pattern that it was standing on end.

JAD ABUMRAD: Wow, he can even know what position the mattress was in?

LOU GARCIA: Yes, absolutely. Believe me.

ROBERT: So he meets the woman whose apartment this is.

LOU GARCIA: She shows up.

ROBERT: And he says to her, "So do you know this fellow who was putting out the fire?" She says, "Yes, as a matter of fact, I do."

LOU GARCIA: It just so happens that ...

ROBERT: "He used to live with me, but I kicked him out."

LOU GARCIA: And he still had a key, by the way. And ...

ROBERT: She now says, "I have a new boyfriend." So Garcia naturally goes and finds the hero.

LOU GARCIA: So now I'm questioning this fellow. I said, "By the way, did you buy that mattress?" And he said, "Yes, I did." "And you weren't sleeping on it anymore. Was someone else sleeping in the mattress in your place?" And he says, "Yeah, well, she had a boyfriend." I said, "Boy, I'd be pissed. How much did it cost you? Like $400, 500?" He said, "No, more than that. It was like $800"

LOU GARCIA: I said, "So now she is screwing somebody else on the mattress you bought? I would be pissed." I said, "You know, if it was me, if I were in your place, I would want this mattress to burn. I would probably stand it on end, I would take matches—matches—and I would put it to the mattress. That's what I would do. And in fact, I'm an expert on fires, and I know that's what you did. You really did do that, didn't you? You can talk about it. I don't blame you. I mean, at least you tried to put it out. That'll work in your favor in court."

LOU GARCIA: And he looks at me, and he said, "Well, you're not so smart." I said, "Why?" He goes, "I used a lighter." [laughs] I said, "Oh, you're right. I'm not that smart." Then they put the cuffs on him.

JAD: Okay, so that was an easy one. We're gonna have some harder ones coming up.

ROBERT: Yep. The point is, the whole hour, we're going to be addressing the same problem. We'll walk into one situation after another and discover that something is not right here.

JAD: That's right. Something's not right with my son. What do I do? Something's not right with my pancreas. What do I do? Something's not right with the very phrase "Something's not right," because it presumes that I know what's right, and maybe I don't. Have we confused you enough?

ROBERT: Well, there's a whole lot of abnormal things coming your way. This is Radiolab.

JAD: I'm Jad Abumrad.

ROBERT: And I'm Robert Krulwich.

JAD: Stay with us. Okay, so this first story is about delivering a diagnosis. Comes to us from producer Lu Olkowski . It's about two doctors who start with that phrase, "Something's not right here," and end up going on a crazy adventure after a cure for a deadly disease.

ROBERT: Which is that?

JAD: Pancreatic cancer.

ROBERT: Oh, that's not good.

LU OLKOWSKI: It is the most deadly cancer. This is the one that people have nightmares about.

JAD: Why? It's deadly how?

LU: Well, it's rare but it's deadly. It's the one where, you know, something's wrong, you go to the doctor, and they say you have six months to live.

JAD: Wow, is it that fast?

LU: It usually is that fast.

JAD: And how did you find this out?

LU: I found this out because my friend Amy said, "I've got a friend named Doctor Teri Brentnall. She made a big scientific discovery, and you should go to her press conference. This will be amazing. Like, go." And I go to the press conference.

[ARCHIVE CLIP, Teri Brentnall: It's just a tremendous pleasure to be here today.]

LU: And, like, press conferences are kind of never amazing.

JAD: [laughs]

[ARCHIVE CLIP, Teri Brentnall: And I hope to unfold a story for you. I hope it will capture your attention.]

LU: But ...

[ARCHIVE CLIP, Teri Brentnall: It's a fascinating story.]

LU: But then I heard this incredible story.

[ARCHIVE CLIP, Teri Brentnall: About 10 years ago ...]

LU: One morning ...

[ARCHIVE CLIP, Teri Brentnall: A 40-year-old guy came into my clinic.]

LU: Mr. X.

[ARCHIVE CLIP, Teri Brentnall: I was just finishing my ...]

TERI BRENTNALL: Very healthy looking. And he comes into my clinic and he says, "I'm worried I'm gonna get pancreatic cancer. That I'm gonna get the curse in my family." It was like "Good gooby, what are you talking about?" And he said, "Well, in my family, my father got pancreatic cancer, and my grandfather, and my four uncles, and my three cousins."

JAD: Wow, four uncles, three cousins, father, grandfather all die of pancreatic cancer?

LU: And this guy was sure he was next in line.

TERI BRENTNALL: His uncles and his father looked like the healthiest people in the world, and six months later they're dead.

LU: He was terrified.

TERI BRENTNALL: He came to me as an act of desperation.

LU: I mean it's not a feeling, I guess, that maybe I know or you know, but what happened when he walked in, like, is Teri, she knew exactly how he felt.

TERI BRENTNALL: You can't even process anything. You're just like almost in a trance.

LU: She'd gone through that before.

TERI BRENTNALL: Completely and utterly alone.

LU: She was diagnosed with breast cancer when she was 34.

TERI BRENTNALL: It's a sense of falling. It's truly a sense of falling. The world slides away from you. You literally—it's almost like it disappears from underneath you.

LU: When she got the news, the first thing her doctor did, he was a friend of hers ...

TERI BRENTNALL: He pulled out the whiskey, and he put it on the table, and we each had a shot. Which I was like, "Thank God he did that." Then he said, "I'm not gonna quit on you. We're gonna fight this thing. You are not alone." That's all I needed to hear.

LU: And so when she was sitting there with patient X, she knew exactly what to say.

TERI BRENTNALL: You have to step forward. You can't step back, you have to step forward. I was young then, and so I felt like I had fixed this thing. [laughs] I'll take that on. I can help you, I don't care how horrible it sounds.

JAD: What happens next?

LU: So Teri runs back to her office, an office she shares with another doctor, Mary Bronner.

MARY BRONNER: I'm Mary Bronner. I'm a pathologist.

TERI BRENTNALL: So I was like, "Mary, Mary."

LU: Says, "You won't believe this."

TERI BRENTNALL: "This guy, Mr. X walked into my office."

LU: And he has this outrageous, this crazy family history.

MARY BRONNER: This horrible problem.

TERI BRENTNALL: I was floored.

LU: Teri had never heard ...

TERI BRENTNALL: That pancreatic cancer could be inherited in families. I'd never heard of anything like that.

LU: Teri comes in and she's like ...

TERI BRENTNALL: I've gotta help this guy.

LU: "I have to figure out what's making these people sick, and Mary I need your help."

JAD: And Mary? What did she say?

LU: Well, she's a pathologist.

JAD: And what does it mean to be a pathologist?

LU: Well, she's the person who physically does the diagnosis.

MARY BRONNER: When your surgeon does an operation on you, or your internist takes a biopsy of you, they send that tissue to me, and I make it into glass slides to look at under the microscope.

LU: She spends her time looking at tiny pieces of Teri's patients smeared on little slides.

MARY BRONNER: I love the emotional distance that you have in pathology. You're a step removed from the misery, and it makes it so much easier for me to handle it.

JAD: Does she interact with patients?

LU: Almost never.

MARY BRONNER: Teri was right up against the misery, and she was just relaying the story to me, but I can sit very comfortably at my microscope and be very objective and just look at the tissue and decide where the cancer is because I don't know these patients.

LU: So you're like, "I gotta go do this."

TERI BRENTNALL: Come with me.

MARY BRONNER: As she usually does.

LU: How did you decide that Mary should join you?

TERI BRENTNALL: She's my science partner. That's it. [laughs]

MARY BRONNER: And I hopped in the car.

LU: So they decide in order to help this guy they need to go to where his family is.

TERI BRENTNALL: Drove across the mountains of Washington state. A long drive.

LU: They wanted to get the family together, draw their blood, look at their blood to see if there's something in there that's making all these people sick.

MARY BRONNER: And we arrive at the little tiny town in Eastern Washington.

LU: This little town called Elmo.

MARY BRONNER: They didn't even have—they're so small they don't have a single medical facility. So in order to do the blood draw we basically had to use a Subway sandwich shop in town.

JAD: Why Subway?

LU: Well they have great sandwiches. [laughs]

MARY BRONNER: One of the family members worked there, and asked the boss if the family could all come and these doctors could come and draw their blood, and could we use the shop as the meeting place. All I remember is walking in and thinking this is small.

TERI BRENTNALL: We set up a little corner booth with our box of blood drawing supplies, and they sort of come in waves.

LU: Uncles, cousins, nieces, nephews.

MARY BRONNER: And they brought their kids.

TERI BRENTNALL: We filled that Subway sandwich shop.

JAD: How many in all?

LU: About 30.

MARY BRONNER: It was funny because they hadn't seen each other in a long time. So they're like, "Oh my God, I haven't seen you in 10 years!" It's like, wow, you guys only live like five miles apart.

TERI BRENTNALL: We'd bring them over to our little tiny booth and we'd introduce ourselves. I'm Teri Brentnall ...

MARY BRONNER: And I'm Mary Bronner.

TERI BRENTNALL: I'm a GI doctor.

MARY BRONNER: I'm a surgical pathologist.

TERI BRENTNALL: The purpose of our work today is that we are trying to find the cancer gene that causes the disease in your family. With your permission today we'd like to take a small blood sample. It's about the size of two tablespoons.

MARY BRONNER: You will not get any results back from this blood test. I want to be really clear about that. It's all for us to try and find the gene. I can't even promise that we'll definitely find the gene. Here's your sandwich, and now may I have some blood?

TERI BRENTNALL: As we were waiting for most of the family to show up, Teri and I were sitting in this one booth with one of the family members who we had already identified as having the disease.

MARY BRONNER: He was young. He was in his 30s. And all I could think was you have a time bomb inside your body. And then this little boy comes running into the Subway sandwich shop, just runs up to this guy that we're talking to, this patient of family X. Throws his arms around his daddy's neck, and kisses him and then all I could think was oh my God, this beautiful little child, he has a 50 percent chance of having this hideous disease. And I was so upset about that. I was just so torn apart inside, but I couldn't really, you know, start bawling right there in the restaurant. That wouldn't have been professional. I held it together until we were driving home, and I was telling Teri how sad I was about that little boy, and how it just really hit me. She said, "Oh, him? Don't worry about him. He's adopted." [laughs]

LU: You have to remember Mary doesn't come face to face with patients very often.

MARY BRONNER: It's not something a pathologist does very frequently. Pathologists have a—I don't even know if I want to tell you this. This is sort of like the black side of pathology. [laughs]

LU: Black humor to get you through, or what do you mean?

MARY BRONNER: Yeah. Really black humor. You know, we'll say things like, "Somebody better tell this patient not to buy the big tube of toothpaste." Teri's laughing, but that's why we do it, because it's so horrible.

LU: I spent an afternoon with Mary going through slides, looking at pancreatic tissue.

MARY BRONNER: This looks pretty ...

LU: Trying to figure out, like, you know, if this person has cancer or not. Dozens of patients.

MARY BRONNER: Now this is another case with a terrible, terrible cancer.

LU: And that's when I really kind of got it, like, why she'd want to keep herself distant.

MARY BRONNER: Oh, this cancer is even worse than the last one. This person, if they can, should go to a beautiful place on planet Earth and just stay there 'til it's over.

JAD: What happened after Subway though? I mean, were they able to figure out what's causing this thing?

LU: Well, once they got the blood they worked on it for about five years.

JAD: Five years, whoa!

LU: They went chromosome by chromosome, collaborated with all these other researchers, and at the end of the day they discovered that the thing that causes familial pancreatic cancer comes down to a mistake. One little mistake, on one ...

MARY BRONNER: One molecule.

LU: ... molecule.

TERI BRENTNALL: That's all it comes down to.

LU: One tiny molecule, yes.

[ARCHIVE CLIP, Teri Brentnall: So our discovery is—we're titling it "Paladin mutation causes familial pancreatic cancer and suggests a new cancer mechanism."]

LU: So they write a paper, they have a press conference.

[ARCHIVE CLIP, Teri Brentnall: First of all I want to acknowledge ...]

LU: And they celebrate.

JAD: So in the end do they find a cure?

LU: Well, no. Not yet, not yet. They're working on it though. But ...

JAD: Can they at least test for it now?

LU: Well, they can test but ...

JAD: What?

LU: You know, most pancreatic cancer isn't hereditary like this. This is actually a small subset.

JAD: Huh.

LU: Mm-hmm. Yeah.

JAD: So where does that leave Mary and Teri? I mean, where are they now?

LU: Mary's really glad that the research phase is over and that she doesn't have to be with patients anymore. Teri knows they have more work to do and they can't really give up.

JAD: Mm-hmm.

LU: But she's really tired, and thinks about it a lot.

TERI BRENTNALL: You know, the stakes are so high in this. Sometimes it's almost unbearable, sometimes I think I should quit.

LU: Really?

TERI BRENTNALL: Yeah, totally. I've talked to Mary about it.

MARY BRONNER: Yeah. She has. But you know what? I know she'll never stop doing it. Right Teri?

TERI BRENTNALL: Sometimes it's just too much. Mary and I love to garden, so sometimes we think about being landscape architects.

MARY BRONNER: Yeah.

TERI BRENTNALL: And then the worst thing that does is, "Oh, I killed the bush." We're like, "You loser. You killed the bush." [laughs] Yeah.

JAD: Thanks to Lu Olkowski for reporting that story.

ROBERT: The next story concerns a dad and his little boy. There's something about this little boy that is not quite right. But there's something about the dad that doesn't want to say so.

JAD: That's coming up in about a minute. I'm Jad Abumrad.

ROBERT: And I'm Robert Krulwich.

JAD: Radiolab will continue.

[MARY BRONNER: Radiolab is funded in part by the Alfred P. Sloan Foundation, the Corporation for Public Broadcasting and the National Science Foundation.]

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