Lorenzo's Oil

- One orange. - One orange.

- Chungwa moja. - Chungwa moja.

- Two oranges. - Two oranges.

- Machungwa mawili. - Machungwa mawili.

- One pineapple. - One pineapple.

Omouri! Omouri!

Here he is, the cleverest boy in the world.

- Hi, Mom. - What's this?

- It's a picture. - Oh, my goodness.

- And there's the Comoros. - Of course it is.

- Mrs Odone, may I have a word? - Very skillful, sweetheart.

- And Jupiter. - Jupiter next to the Comoros?

- I'll be right there, Lorenzo. - OK, Mommy.

- Is Lorenzo having problems at home? - Not that I know of. Why?

Today he started throwing paints around. He went wild, destroying other paintings.

- He must have been provoked. - No, it came out of the blue.

He's normally such a terrific kid.

- Darling, were they teasing you? - No.

- Were they touching your paints? - No.

- How were they annoying you? - They just were.

- Doing what? - Things.

- What kind of things? - Things that make me feel annoyed.

- Mrs Odone... - Another incident?

Yes, and today it was much worse.

Mrs Odone, is there some trouble at home?

Why do you assume the trouble's at home?

Because there's nothing here that explains his behavior. It's... disturbed.

He does present as a hyperactive.

- But don't they repeat tasks endlessly? - They perseverate, yes.

Lorenzo's activities all have a structure: beginning, middle and end.

My gosh, he's learned three languages. How could he be hyperactive?

I know it's hard to accept that a gifted child may also be disturbed.

Lorenzo needs to be referred to an IDP committee.

- What's that? - For what?

Individual Disability Placement.

Lorenzo needs to be in a special ed class.

Any special ed our son needs will be provided at home.

Anyhow, it was snowing and he began to rub my hands to warm them.

Uh-oh.

No, he then produced photos of his wife and children.

- That old routine! - Oh, Deirdre!

Had I known this was the man I would wait ten years for,

- I'd have let you pick up the check. - I did.

Excuse me! You did not!

Lorenzo's fallen off his bike and he is really bleeding.

Sh. That's a boy.

Oh, such a brave boy.

Doing just fine, here.

You're going to be OK.

It's Christmas Day, you know.

All across the country little boys are trying out their new bikes.

Hey, champ. I think you'd better tell your folks to lighten up.

What are they gonna do when you're playing for the Redskins?

The EEG is normal, the skull X-ray is normal and the CT scan is normal.

I don't know what to tell you. This boy is neurologically intact.

Doctor, we spent three years in East Africa.

- In the Comoros. - We were wondering...

Well, if he might have picked up some rare parasite.

It's possible.

Lorenzo, what are you doing?

Lorenzo!

Sweetie? Can you hear Mommy?

This may be an auditory processing difficulty.

The ears hear all right, but the brain has trouble listening.

So, this means something is affecting his brain.

But what? A tumor? Multiple sclerosis?

It could be any one of a dozen things.

Listen, my friend. I'd like you to come and stay in the hospital for three days.

Your mom and dad can come too.

We're gonna run some tests and get to the bottom of this.

Can you hear the sound?

Keep your eyes right on that spot for me. That helps me out.

All right. Now close your eyes.

Keep your eyes closed, buddy. Stay nice and still.

Of course, Easter festivals existed long before baby Jesus.

In pagan times, they marked the beginning of spring.

The egg tells us that the earth is going to be reborn, just like a little baby chick.

- I get it. - Mrs Odone. Mr Odone.

Dr Judalon is ready now.

Hey, Lorenzo, would you like to go feed the goldfish?

It's all right, sweetheart. Go ahead.

We'll be right back in just a few minutes. Go ahead.

This way, please.

Please, have a seat.

Well, we certainly don't need that noise, do we?

So...

Please, Doctor, without equivocation.

There is a family of diseases. It's quite rare.

The leukodystrophies.

Lorenzo has one of them. It's called ALD.

ALD is an inborn error of metabolism that causes a degeneration of the brain.

It only affects males, usually between the ages of five and ten.

Its progress is relentless. The end is inevitable.

All boys with ALD die, usually within two years of diagnosis.

And there are no exceptions?

I am so sorry.

- Are you absolutely sure? - Yes.

Lorenzo shows the definitive sign:

An abnormally high level of fat in his blood, certain long-chain saturated fats.

Oh.

Uh...

These fats... destroy his brain?

But how?

There is an enzyme that should metabolize these fats,

but in ALD boys it's defective.

So they collect in the nerve cells, a little bit like a cluster on the arteries.

And... in some way

this liquefies the white matter of the brain.

"Some way liquefies"? Could you be more specific?

Well, to be honest, we're not quite certain just how it works.

- You know what myelin is? - No.

Myelin is the fatty... sheath that insulates the nerves.

It's a little bit like plastic around electrical wires.

Without it, the nerves cannot conduct an impulse.

What ALD does is strip away the myelin. It corrodes it, if you like.

This causes degeneration of the brain and the body loses its functions.

But surely someone, somewhere, must be working on this, no?

- We would go anywhere. - Yes.

Ten years ago the disease hadn't even been identified.

We're still trying to understand just what it is.

I would like to offer you some hope, but...

Then there's absolutely no treatment?

Normally at this point we try to be constructive.

We try to focus on what can be done.

But in this case...

When we get home, can we read a story?

Of course, my darling.

Lorenzino, let's go home.

Mr Odone? I have a Dr Judalon on line three.

- Good. Put him through. - They're waiting for you in the meeting.

All right, thank you.

- Hello? - Augusto?

I just got off the phone to Gus Nikolais,

a professor of neurology at the Institute of Childhood Diseases.

If there is a so-called "world expert" on the leukodystrophies, Nikolais is it.

- Ah, good. - I don't want to raise false hopes,

but he's working on an experimental protocol based on a diet.

Wonderful.

Peanut butter, red meat, cheese...

Unpeeled fruit, spinach, olive oil... But these are healthy foods.

Yes, but they contain very long-chain saturated fats.

I...

I still do not understand why they are so harmful to Lorenzo.

- Why are they so destructive? - How can spinach make the difference?

The human body needs these fats in order to create cells,

and the excess is burned off. That's normally, of course.

But in the case of an ALD boy, these saturates can't be broken down

and they build up in the brain.

And somehow this buildup strips the myelin covering.

Yes, exactly. And, for the moment, we don't know why this is.

But we feel that, by withdrawing the saturated fats from the diet,

we will prevent them accumulating in the brain.

And if we could?

There's no way to reverse neurological damage.

All we can hope for is to slow the cascade of symptoms.

But if it's any consolation to you, you'll be helping us

understand the biochemistry of this heartless disease.

So, can we enroll Lorenzo in our trial?

I suppose so.

Good. Then I will pass you over to our dietitian

and meanwhile we should arrange some genetic counseling.

Oh, Dr Nikolais, it's highly unlikely that we will have another child.

No, but your sisters and their daughters may all be carriers.

- We need to test them. - Only my family? What about his?

No, no. ALD is passed only through the mother.

But I thought you understood all this.

We knew it was inborn, but

we assumed that meant a combination of our genes.

That's true in other inherited diseases,

but ALD is only carried on the female chromosome.

Excuse me.

Are you saying that Lorenzo got this directly from me?

Well, in the sense that ALD is sex-linked, yes.

It goes from mother to son.

- And how did I get it? - The woman gets it from her mother.

And if I inherited the defect, why don't I have the disease?

No, the woman is only the carrier, nothing else.

But with each conception, she has a 50-50 chance of passing on the defect.

And when that happens...

It's the cruelest kind of genetic lottery.

- Lottery? - Yes, a clumsy word.

I use it because it's... so arbitrary, you know.

- No one is to blame. - Um...

If Michaela's mother had this,

and her mother's mother,

why was there no warning?

Well, I suppose if you went back into the family tree, you'd...

But remember, a short time ago this disease didn't even have a name.

Mrs Odone, you have enough to put up with without...

You have nothing to blame yourself for.

Thank you.

It's not a good idea.

All right, so she doesn't want me. What about Mother? She's packed and ready.

Kenise, Michaela doesn't want anybody around.

What about Father Killian? He can come.

Hell, no. She's not even going to Mass now.

- Deirdre, what is happening there? - Just let it rest, OK?

No. What will they do for Lorenzo's birthday?

- I'll call you. Bye. - No. Deirdre!

This is wrong. More than ever she needs her family here.