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Volume 1, Issue 2
Summer 2005:

Blood Diamonds

John Sullivan

Cell 2 Soul. 2005 Summer; 1(2):a5


A statistically significant number of Acute Lymphocytic (Lymphoblastic) Leukemia (A.L.L.) cases are diagnosed in the small town of Silver Bow, Nevada. The phenomenon has attracted intense media scrutiny, congressional hearings, and systematic epidemiological study in an effort to explain linkages of toxic exposure or infection and the resulting disease process. The Center for Disease Control and the Agency for Toxic Substances and Disease Registry conducted traditional epi studies and concluded that the cluster is a probably a chance occurrence. Various toxic substances have been proposed as causative agents — among them JP8, a jet fuel used at the nearby Naval Air Station where Top Gun pilots are trained — but no definitive evidence has emerged. An above ground pipeline carries JP8 through the community to the air base; inspectors claim the pipe shows no obvious signs of leakage or undue wear. Naval authorities have denied reports of routine fuel spills on the base or purposeful fuel dumping by pilots en route to landing.

After a flurry of initial interest, the case families have been virtually abandoned by the media. The CDC verdict has absolved private jet fuel contractor, Premcor, and the U.S. Navy of any negligence or malfeasance. However, some independent scientists have suggested that innovative bio-monitoring techniques from molecular epidemiology be used to locate damage caused by toxic exposures or viral/bacterial infection and perhaps determine levels of susceptibility. This advice fell on deaf government ears until recently. A university funded epidemiological team has arrived in Silver Bow to begin such a study. The first step in this process involves contact with case families to secure informed consent for donation and analysis of DNA samples and blood, as well as a traditional health and behavior survey to assess acute and long-term exposure risks.


Rae Fallon: 28, mother of yet another child diagnosed with Acute Lymphocytic (Lymphoblastic) Leukemia in Silver Bow, Nevada, a rural town adjacent to a Naval Air station, tentatively identified as a possible cancer cluster.

Sharon Constanza, PhD.: 28, a newly minted, university-affiliated molecular epidemiologist who must visit case families in Silver Bow, Nevada to garner their informed consent for donation and analysis of DNA samples.

Travis Fallon: 32, father of an A.L.L. victim and assistant field supervisor of Premcor JP8 pipeline and jet fuel delivery operations in the Silver Bow area.

J.J. Fallon: 6 1/2, daughter of Rae and Travis, the 8th case out of 16 identified in a cluster of A.L.L. cases that have been identified in Silver Bow within 2 years.


First location: Silver Bow, Nevada. A front door opens into a combined foyer / living room. A large, well-lived in couch dominates the small room. A flexible, goose-neck reading lamp is positioned behind the couch, near one of the arm rests. A chair sits diagonally across from the couch. A large single window offers up a view of the Ruby Mountains, some 20 miles distant. A picture of "Jesus and the Children" hangs on a wall. Otherwise, the room is sparse but clean: lower middle class struggling to inch upward.

Other location: a small cement slab porch slapped onto the front of a single-story, faux brick tract house in an affordable subdivision. One step leads down to a gravel path that leads out to the street. The sidewalk is still unpaved.

The porch light may be operated from both sides of the door.

( / ) indicates a character interrupting another character.

At Rise:

(6:45 PM. Rae and JJ sit on the couch. JJ's head is hairless. She was given another course of chemotherapy this morning and she still feels nauseous and drained. Rae tries to coax some chicken noodle soup into her, very gently. Travis unpeels his work clothing and stuffs various layers into a large plastic bag.)

Rae (holds spoon of soup up to JJ's mouth): Baby, you sure smell strong today. Me and JJ are getting a powerful whiff over here.

(JJ nods up and down with the spoon in her mouth.)

Travis: Sorry about that. I should've come in the back. We had a big ol' spill at the base this afternoon. For a little while, we were prêt-near swimming in JP8...


Rae: What!

JJ: Daddy?

Travis: Whoa! Just kidding. It wasn't that bad, but it is hard to get loose of this smell.

JJ: I like that smell. I know it's not so good, but I like it.

Travis: (Pause.) No, Honey, it's not so good.

Rae: So why not take that funky bundle back to the washer and then tell us about your day. Say what time is it?

Travis: About 8 minutes of 7.

(Travis picks up bundle, walks over to couch, stops and rubs JJ's head. He bends over to kiss the top of her head; Rae stops him short.)

Rae: Travis! Would you please wash your hands first. How many times do I have to...

Travis: OK! OK! (To JJ) I'm sorry. I forgot.

(He slings the bundle over his shoulder, wheels around and leaves the room.)

JJ: (Toward audience.) It's OK, Daddy. It's hard for you to remember. (To Rae.) Besides, I kinda' really like that smell.

Rae: Don't say that JJ. We have to help Daddy remember. That smell comes from something bad for us.

JJ: I know, Mama. That smell makes me sick.

Rae: Maybe, Honey. It's still just maybe. We don't know what makes you sick, yet.

JJ: I'm tired, Mama. I feel like a lumpy dust rag.

Rae: Limp as a dish-rag, Baby. Limp as a wet noodle. I know you're tired. You been through a lot today. For such a peanut. (Pause.) Put your little head on me and rest, Baby. (JJ lays her head on Rae's chest.) We're gonna' beat up on all those ickies in your bone marrow. You know we will.

JJ: Yeah, Mama. That's right. We will. (JJ dozes.)

Rae: (To Travis.) Hey Baby, can you give me the time?

Travis: (Off.) Just a second, I left my watch on the sink. (Pause.) It's just a few minutes after 7. (Travis appears, putting on his watch.) What's up? Something you want to watch on TV?

Rae: No. Not TV this time. We're gonna' have a visitor.

Travis: A visitor?

Rae: Supposed to be here at 7...I wonder what's keeping...

Travis: Hey now, you really are antsy. What's with this visitor? You got a date or something?

Rae: A date? Now what are you thinking? (Pause.) Travis, it's not just an ordinary visitor, it's more...you know...official than just a visitor. I asked Doctor...uh, I think her name is Dr. Constanza, to come over and explain this cancer study she wants us to join up with..

Travis: A Doctor. Another damn Doctor. You know, Rae, they're gonna' ask all those same questions about my Mom and Dad, your Mom and Dad, all our worts and stool samples and blood when we pee, where we lived, where our people lived for the last hundred years, shit, it makes me feel like some proctologist's got his thumb jammed up my butt. And you can bet they're gonna' want our blood again, and JJ's for sure...damn it Rae, why'd / you have to go and do...

(The doorbell rings; Travis startles.)

Rae: Travis, I think she means to do us some good. If it might help JJ, we got no right to pass on it. (Pause.) And you know there's blood enough in this family for one more study. It's all around us...I know you can feel it. (Pause.) That blood's on us too, Baby. (Pause.) It just is.

(Travis and Rae eye each other from opposite ends. The doorbell rings again.)

Travis: (Moving to answer the door.) Rae, you should'a told me...Why didn't you tell me (...Travis opens the door in mid-sentence...) you invited a...(...Travis stops and stares a beat at Dr. Sharon Constanza...) (To Dr. Constanza:) Uh, Hi. You're...?

(Dr. C offers hand to shake. Travis does so with some hesitation)

Dr. C: Hello, I'm Sharon Constanza. I do environmental toxicology at the university. You know, the health and medicine center? You're Travis, right? Your wife told me about / you when we met at...

Travis: Well, you seem to know all about me then? (Travis moves from doorway and gestures Dr. C to come in.) Come on in. (Gestures toward stuffed chair.) Sit down if you like.

Dr. C: Thank you. (She unslings her laptop and sits down. Dr. C looks toward Rae.)

Rae: Uh, Travis, I met Dr. Constanza...Sharon...at the Albertsons this afternoon. She saw me wheeling JJ around...see, we were just getting back from the doctors...I guess that's how we got connected, right?

Dr. C: Yes. (To Travis:) You see I'm part of a working group that just got funded to study the similarities and connections among families in Silver Bow where a child has been diagnosed with A.L.L. or some other variant form of cancer.

Travis: Been done already. The CDC and the Toxic Disease people said there's no cancer cluster here. It's a just a fluke. No connection at all.

Dr. C: Well we don't necessarily think that's the whole story. We'd like to look at it through a different lens.

Travis: So you got another angle? Ya'll think you know something the government don't?

Rae: Even the state health people said there should never be this many cases of something so rare in such an out-of-the-way place. Remember that?

(Travis and Rae stare at each other.)

Dr. C: Yes, it is undeniably...uh...statistically interesting. We plan to study this...I'm going to call it an unofficial cancer cluster...on a molecular level. We want to look at genetic characteristics in each family and make comparisons among case families, then sample some other families in Silver Bow with no A.L.L.

Rae: (To Travis:) What do you think? Doesn't that sound like something new?

Travis: Interesting, huh? Sounds like you'd be barking up another wrong tree.

Dr. C: This is totally different approach. No one has looked at biomarkers, or the genetics yet. Traditional epidemiology just skims the surface...you know: symptoms, geography, incidence levels. It just doesn't go deep enough. We want to look beneath the surface. (Dr. C rises, appealing directly to Travis.) Think about it: every human has a unique profile of genetic material. Suppose every toxic substance leaves a unique fingerprint that marks its effect on that genetic material, or in our organs, or in fat cells. If it's been there, maybe we can lift off its prints.

Travis: So you think something's wrong with JJ's genes? Or our family?

Rae: Travis, Baby, that's not what the Doctor said!

Travis: The Doctor said our genes are probably different from the families whose kids didn't get cancer. That's what I heard. What's it sound like to you?

Dr. C: We think the best chance of finding some clear link between a certain level of exposure to some toxic agent and all the cancer in this community may be molecular, genetic, you know, toxico-genomics.

Travis: So why should I know about toxico-genomics? How's that work?

Dr. C: Sorry. (Pause.) First we need to get tissue samples from all the case families. Buckle swabs...a swipe from inside everyone's cheek...then blood draws to confirm the exposures, or not. After that we've got to start in each home and work outward into the community to establish exposure pathways, levels, how you might have come in contact with whatever caused your child...JJ's cancer.

Travis: (Laughs.) You know, we've heard all this before. You sound like the CDC and the Toxic Disease people when they came down here to tell us that our problem was "really unfortunate," but no one's fault, really. Just like a run of bad luck. (Pause.) Not enough dead kids, I reckon.

Rae: Travis, that's not what they said. They said they couldn't establish any / concrete connection among all the...

Travis: (To Doctor C.) What was it they said...yeah, they looked at 108 cancer clusters and never found nothing. Nothing, you see what I'm saying? Pretty lame batting average, wouldn't you say? I'd sure enough fire anyone who whiffed that often, wouldn't you? (To Rae.) Rae, they said to go home and shut up. They said / there was nothing they...

Dr. C: This is different. I don't work for the CDC. All I need is your informed consent and we can explore this in the depth. Your problem...this community's problem deserves no less. You've got to believe me / this is...

Travis: (Turns slowly, faces Dr. C.) I've got to believe you? (Pause.) Doctor, I'm talking to my wife now.

(Dr. C shields.)

Rae: Travis, you're not being polite. The doctor came here in good faith to help us out.

Travis: Good faith? How do you know that? We thought the CDC came here in good faith...right?. Didn't you?

Rae: Yes, I did. And, yes, it broke my heart to hear what they did say after all those surveys and meetings and all the TV news people. (Pause.) I did think those people meant well for us. Meant to help us out. Yes. I did too.

Travis: And did all that make JJ any better? Look at her, Rae! You're holding our bald-headed little baby-girl...what's she had for the last 3 years except 24/7 misery and constant pain. Did all that CDC stuff make JJ feel an inch less pain? (Turns toward Dr. C) How does any of this help our JJ? You tell me how it gets her last 3 years back. Can she live those years over? You tell me how it guarantees that she'll be free of this...this...damn plague...I....

(Travis struggles to maintain semblance of composure. JJ wakes up and begins to stir. Her joints hurt and she cries softly.)

JJ: (To Travis) Please don't yell, Daddy. You woke me up. I was having a dream.

Travis: (To Dr. C) I'd say you best leave now.

Dr. C: Please. I really am here to help. I'd like to leave an informed consent letter for you two to read over and sign. If you'd like to be part of this study.

Travis: Go study someone else's pain. Doctor. I think you can see the door from here.

(Rae rises and hands JJ to Travis. Dr. C watches.)

Rae: I'll show the Doctor out, Baby. You get calmed down, OK?

Travis: Why'd you bring her here? We gotta' talk, Rae.

Rae: We will. We will, Baby. Read JJ a story. That one she likes about the bunny. (Rae kisses JJ on the forehead.) You like that one don't you?

JJ: (Through a yawn.) Yes, Mama.

(JJ presses her head into Travis' chest. Travis sits on the couch and they watch Rae usher Dr. C out the door. The door closes. Travis turns on the gooseneck reading lamp and begins to read from "The Velveteen Rabbit.")

Travis: "There was once a velveteen rabbit, and in the beginning he was...he was really splendid..." (JJ touches her father's cheek and scene freezes.)

(Lights off inside. Simultaneously, Rae flicks on the porch light.)

Dr. C: I'm sorry...I guess I upset your husband.

Rae: No you didn't. That's more or less just the way he is these days.

Dr. C: You mean you knew he would react like that? You knew, and you asked me to...why did you ask me to come over to your house and meet your family if you knew your husband would blow up like that?

Rae: I wanted you to see how we live now.

Dr. C: (Pause.) I don't understand.

Rae: You know, how we really live. How we get through our days now. (Pause.) How we look at each other on the sly. How we both take turns staring out the window at the mountains. Like something good's gonna' happen. Only it never does. Like JJ's gonna' wake up with all her hair. Like she's gonna smile at me in the morning, take a big stretch and nothing hurts. But that never happens. (Pause.) Like we never brought her here in the first place. Like we were...still...back home...

Dr. C: Where's home? How did you get here?

Rae: White Sulfur Springs...you know...back in West Virginia. Travis got a job with Premcor after we got married. 2 years or so after. We bounced from one air station to another ever since. Following the War Bucks you might say. North Carolina, Alabama, Texas...we stayed at San Antone and Beeville when we lived in Texas. Now we've fell to earth here. In the middle of...all this...loneliness, I guess. (Pause.) Premcor does military jet fuel: pipelines, tankers, maintenance, stuff like that. We've been living with that smell for 6 years and I swear...I hate it so much. (Pause.) Doctor, you tell me the truth. Did JP8 do this to JJ? Did Travis bring that damn disease home on his clothes?

(Pause. Rae and Dr. C stare at each other.)

Rae (cont.): Well, did he?

Dr. C: (Pause. Dr. C would like to move toward Rae. But she can't.) I...don't know. I can't say yes or no for sure. Benzene, perchlorates, all those volatiles...you see, acute lymphocytic leukemia...is probably ...due to a complex of different exposures? I've never heard of any direct link between jet fuel and childhood leukemia... Never. (Pause.) I...I just don't know.

Rae: You mean that? I need to know the truth

Dr. C: I mean I don't know the truth. JP8 has been provisionally linked to cancer in mice. That's all I can say for sure.

Rae: In mice, huh? (Pause.) I got to say you're a real sweet shift in the wind, Doctor. You're for sure the first expert I've ever met that just didn't for sure know. So many people say so many things they know for sure...like for sure it's the jet fuel or the arsenic in the water or the tungsten in the water or some kind of infection or for sure something else. In the end, all those sure things blow away for sure, and no one proves anything and they all go back to their own sure worlds. Except us. We still live here. And the only thing for sure is...my baby's still living under a sword and I don't know what to believe...not now. (Pause.) What do you believe, Doctor?

Dr. C: What? Me? Well...I guess I believe in...in...truth. Yeah...I do believe in the truth and our ability to get to it.

Rae: Truth with a big T, is that it? Now what kinda' truth would that be? And how do you get to that kind of truth?

Dr. C: I never really thought about it. It's more of a habit...sort of...it's the way my mind works. I try to be...you know...honest about what I see. I try to stick with the evidence. I don't say anything is true if I can't support it with real evidence. Anything else would be just...wrong.

Rae: Is my baby's pain true? Do you have enough evidence to prove it? Or is it maybe...wrong?

Dr. C: That's not what / I mean when...

Rae: When I sit in my chair and stare out the window at the mountains...all by myself...sometimes I do that for hours and hours...I feel the wind off those peaks right through the glass and it's like I'm floating on a deep, lonely ocean. You know what I'm saying? I've never even seen an ocean but I can still feel it under me. Is that enough evidence?

Dr. C: (Pause.) I really don't know what to say. I don't have a sick daughter. I can't feel what you feel. I do care, but I guess...I guess I can only watch.

Rae: You guess? I thought you didn't do that. (Pause.) Hey, like I'm pulling your chain, Doctor. My evidence is just different. Like our eyes are just different. See?

Dr. C: But I do care.

Rae: I know that. You passed the test. I think you've got enough heart to walk with us. (Pause.) If you'll walk with us, we'll sign up for your study.

Dr. C: Your husband...he as much as said he won't have anything to do / with me or...

Rae: (Stops her.) Travis...yeah, Travis...of course he will. He wants your help. He was crying out for it, didn't you hear him? He needs to believe the whole world's not gone cold to us. And he can't. I think he's lost his way. (Pause.) I'll work on it with him. I've been guiding him through this all along. My head's still on straight: I owe it to JJ.

Dr. C: You know it won't be easy to find the cause of JJ's leukemia. Even if we can show significant chromosome damage, that probably won't be enough to prove anything.

Your case family numbers are so small here in Silver Bow...we have to show a two-fold increase in the overall norm for A.L.L. to validate the cluster. And we don't really know what we should be looking for yet. The scientific bar is so high. Then there's the legal bar...

Rae: Legal! What does legal have to do with the truth?

Dr. C: Well I suppose you'll want to file a class action toxic tort with the other families, and make it stick. It's real hard, even when it seems so easy to see. It takes time, and lots of money.

Rae: This has nothing to do with torts or lawyers or money, and we damn sure got no time to spare. My baby's pain has a deep thirst for justice, Doctor. Something caused her to get cancer, and I...we... we want to know what it is. If there's some responsible party on the other side of what caused her leukemia...be it a bad actor or just a complete idiot, doesn't matter which...well, we'll cross that bridge when we get there.

Dr. C: Do you mean that? You're really not interested in damages.

Rae: Damages. (Laughs.) I guess you could say we're all pretty damaged over here. I guess there's evidence enough to say that, huh, Doctor? (Pause.) Yeah, and I just want to repair the damage to both my babies, and myself. Tell you what: it's got so bad we all the time now confuse laughing, or hoping for some kinda' change, or just simple light in the morning with a door wide open for more damage to just walk right into our life. (Pause.) But if we ever did get any money, I'd take it to the bank like a shot. That's right. (Pause.) You watch much TV, Doctor?

Doctor C: Not much. But you know, the first thing I ever heard about this cancer cluster was on TV. It was Hillary Clinton, I think, and someone else from / the Senate with...

Rae: Yeah. They were all here for a little while. (Pause.) I saw this show the other night. It shook me up, I couldn't sleep afterwards. I saw these babies in...somewhere in Africa playing soldier with real guns. (Pause.) Doctor, these kids were ordered by adults to cold murder people. Execution style. And I remember this little skinny girl, about 14 or so...she held up her arms for the camera and one of her arms was just a stump. Cut off just below the elbow. Some adult cut it off ‘cause she tried to run away, she didn't want to do the troops.

Doctor C: That's evil. Kids are so defenseless...anyone who would do that is evil.

Rae: I hear you. The broadcast said these wars are financed by diamonds. Black market diamonds...they call them Blood Diamonds because they bankroll bloodshed. Lots of people buy these diamonds...everywhere, and they don't know what that money does. Or do they?

Doctor C: What do you mean? No one would do that if they knew.

Rae: You think so? Seems like everyone's got their price, no? Everyone sells off part of their soul for some kinda' Blood Diamond deal somewhere, sometime. (Pause.) That's what's eating Travis. He's not sure he didn't cause JJ's leukemia with all that jet fuel all those years...on his clothes, maybe in the air we're steady breathing...all the time, that sweet, sickly smell...all the time, following the War Bucks for Premcor. (Pauses and stares directly into Doctor C's face.) He could've done something else, but this paid too good. And it was way easy. Now he needs that goddam Premcor health insurance to finance JJ's chemo, and all the rest of it. (Pause.) Blood Diamonds...Blood Diamonds is where you kill something innocent and true just to be secure or safe. (Pause.) Doctor, we've gotta' know. Even if Travis brought it home, we can't live right ‘til we know.

Doctor C: I'll tell you what I know when I know it. I can't say the truth will set you free, but it's better than never knowing why.

Rae: So you say, Doctor, so you say. (Pause.) You do know what you're biting off here, Doctor. You sure you can chew it?

Doctor C: I think so. The CDC just didn't have enough precise tools when they struck out on all those other cluster investigations. Now we can identify genetic biomarkers and monitor toxic blood levels down to parts per trillion. We can look at how toxins and infections and susceptibilities make some people get sick when others don't. I still don't know how we'll map out the exposure pathways but / I think we can...

Rae: That's not what I mean. You're talking about the easy part.

Doctor C: That's how I do what I do. I don't know what else you mean.

Rae: I mean I think you're gonna' find it's hard to sit on fences around here. I mean there's people gonna' be pulling on you: our people, Premcor and the Navy, state health people, your own university, maybe TV news will find its way back here. When everyone starts shoving on you, what are you gonna' do? Roll over for Premcor? Be a "solid" scientist, crack this cluster, write a beau coup paper, keep your name on that grant?

Doctor C: I have to document what we find, and how we found it. That's the way science works.

Rae: And careers? That too. I'll bet.

Doctor C: Well, yes. That's our process. We study things, then we publish our results. We try to get it right...you know...it's peer reviewed. We try to show hidden levels...how the world actually is. (Pause.) Is it wrong to want a career doing that?

Rae: No, Doctor; sounds fine to me. All I mean is folks and situations around here are gonna' try you sorely. Might could hurt you even. Are you gonna' walk with us when it comes to that? Have you got that much try in you, Doctor?

Doctor C: I promise, I'll tell you the truth.

Rae: There goes that word again. I sure do hope we're both talking about the same thing. (Pause.) Doctor, we're all worn out. We feel like we been "rode hard and put up wet a few times too many." This town just wants to be whole again. Can you help us get to that place? Can you help us make our soul right?

Doctor C: (Long Pause.) No. I can't do that. Science doesn't work for those kind of questions. (Pause.) I can't even do that for myself...I wish I...

Rae: Now I know I can work with you, Doctor...Sharon. (Rae takes Dr. C's hands and holds them palms up and stares at them.) And I can read your lines, too. My mama taught me how to see your fate in your palm. Your lines say we're gonna' be one double-tough team.

Doctor C: (Looks at her lines.) Do they? (Pause.) I'm not sure what you...do they really say that? How does that work?

(Travis opens the door.)

Travis: Rae, it's getting late. We need to put JJ to bed. C'mon in, OK?

Rae: You're right, Baby. It is getting late. Chilly too. The sun really drops like a rock out here. (Pause.) Would you give me a call...Sharon? I'm right here most all the time. (Rae turns, walks up to Travis, kisses him on the neck.) I think we've got some serious walking to do. (Rae walks through the door.)

(Travis stares at Doctor C. She stares back and lifts her hand to wave. He ducks inside abruptly and closes the door. She turns into profile and looks at the palm of her half-raised hand. She drops her hand and looks out toward the mountains.)

(Lights down.)


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