Toxin

by Robin Cook

  Kim stepped back into the depths of the freezer and saw another open carton nestled among the sealed ones. He opened it and looked in. He could see that the wrapping was also broken on one of the inner boxes. “How come this carton is open?” he asked.

  “It was a mistake,” Paul said. “We’re supposed to use the oldest patties first so we never have to worry about the ‘use by’ date.”

  Kim looked at the label. It was similar to the previous one except for the production date. This one said “Jan. 12” instead of “Dec. 29.” “Could a patty have come from this one last Friday?” he asked.

  “Possibly,” Paul said. “I don’t remember the day it was mistakenly opened.”

  Slipping a pen and piece of paper from the pocket of his white coat, Kim wrote down the information on the labels of the two open cartons. Then he took a single patty from each. This wasn’t easy because the patties were frozen in stacks separated by sheets of waxed paper. He pocketed the patties and the paper.

  As Kim exited the freezer, he was vaguely aware of the muffled sound of a siren whining down. In his preoccupied state, he ignored it. “What’s Mercer Meats?” he asked Paul.

  Paul closed the freezer door. “It’s a meat-processing company that supplies us with hamburger patties,” he said. “In fact, they supply the entire Onion Ring chain.”

  “Is it in the state?” Kim asked.

  “Sure is,” Paul said. “It’s right outside of town in Bartonville.”

  “That’s convenient,” Kim said.

  As Kim walked back into the kitchen area, the front door of the restaurant burst open. Two uniformed police officers came charging in with their hands resting on their holstered revolvers. Their faces were grim. Roger trailed behind them, angrily gesturing toward Kim with his right hand while his left held a bloody napkin against his mouth.

  TWELVE

  Saturday, January 24th

  Weak early-morning sunlight slanted through the mote-filled air of the courtroom and created a swath of light on the floor. Kim was standing in the beam and squinting from the glare. In front of him Judge Harlowe was presiding, in his black judicial robes. Reading glasses were perched precariously on the judge’s narrow, knifelike nose. To Kim, he appeared like an enormous black bird.

  “After more than twenty years on the bench,” Judge Harlowe was saying while glaring down at Kim over the top of his spectacles, “I should not be surprised at what I see and hear. But, this is one strange story.”

  “It’s because of my daughter’s condition,” Kim said. He was still attired in his long white coat over hospital scrubs, with his surgical mask still tied around his neck. But the coat was no longer crisp and clean. From having slept in it overnight in jail, it was wrinkled and soiled. Below the left pocket was a reddish-brown stain.

  “Doctor, I have great sympathy for you given that your daughter is gravely ill,” Judge Harlowe said. “What I have trouble understanding is why you are not at the hospital at her side.”

  “I should be,” Kim said. “But her condition is such there is nothing I can do. Besides, I had only intended to be away for an hour or so.”

  “Well, I’m not here to make value judgments,” Judge Harlowe said. “What I am here for is to address your behavior in regard to trespassing, committing battery on a fast-food restaurant manager, and, perhaps most egregious of all, resisting arrest and striking a police officer. Doctor, this is unacceptable behavior no matter the circumstances.”

  “But, Your Honor, I . . .” Kim began.

  Judge Harlowe raised his hand to quiet Kim. “It doesn’t matter that you suspect your daughter’s illness might have originated at the Onion Ring on Prairie Highway. You of all people should know we have a Department of Health which is mandated to look into this kind of thing, and we have courts of law. Am I making myself clear?”

  “Yes, Your Honor,” Kim said resignedly.

  “I hope you seek some help, Doctor,” Judge Harlowe said. “I’m plainly mystified by your actions, knowing that you’re a renowned cardiac surgeon. In fact, you operated on my father-in-law, and he still sings your praises. At any rate, I’m releasing you on your own recognizance. You’re to return for trial four weeks hence. See the court clerk.”

  Judge Harlowe struck his gavel and asked for the next case.

  On his way out of the courthouse, Kim eyed a public phone. He hesitated for a moment, trying to decide whether or not to call the hospital. The evening before he’d tried to call Tracy, but he’d failed to reach her with the calls he had been allotted. Now, with a phone available, he dithered. He felt guilty about having been gone for so long, as well as embarrassed for what had happened. He was also afraid of what he might find out about Becky. He decided to go rather than call.

  At a cab stand just outside the courthouse, Kim caught a cab to the Onion Ring. The deserted restaurant looked completely different in the morning prior to its opening. Kim’s aging vehicle was the only one in the parking lot and there wasn’t a soul in sight.

  Climbing in his car, Kim set out for the hospital. En route he made a detour to Sherring Labs.

  Inside he approached a receiving counter and rang a stainless-steel bell. A woman appeared within seconds. She was dressed in a lab coat.

  Kim fished the two hamburger patties, now defrosted, out of his left pocket and handed them to the woman. “I’d like these patties tested for E. coli O157:H7,” he said. “Also for the toxin.”

  The technician eyed the discolored meat warily. “I think it might have been better if you’d refrigerated the samples,” she said. “When meat’s been at room temperature for more than a couple of hours it’s going to grow out a lot of bacteria.”

  “I understand that,” Kim said. “But I don’t care about other bacteria. I only want to know if E. coli O157:H7 is present.”

  The woman disappeared for a moment. She returned wearing latex gloves. She took the meat and put each sample into a separate container. Then she took the billing details. Kim used his office account.

  “How long will it take?” Kim asked.

  “We’ll have a final reading in forty-eight hours,” she replied.

  Kim thanked her, washed his hands in a restroom, and went back out to his car.

  As he neared the hospital, Kim became increasingly anxious. He started trembling as he parked his car; the tremors grew worse as he rose up in the elevator. Preferring to face Tracy after checking on Becky, he used a back route to the ICU to avoid the ICU waiting room. As he passed through the halls, people eyed him with curiosity. Kim could well understand, considering his appearance. Besides his soiled attire, he needed a shower and a shave and his hair needed combing.

  Within the ICU, Kim nodded to the ward clerk but didn’t offer any explanation. Approaching Becky’s cubicle, he found himself making a pact with God. If only Becky could be spared . . .

  Kim slipped in by Becky’s bedside. A nurse was changing her IV bottle. Her back was to him. Kim gazed at his daughter. Any faint sliver of hope of improvement he had entertained instantly vanished. Becky was obviously still in a coma. Her eyelids were taped shut and she was still intubated and being respired. What was new were large, deep-purple patches of subcutaneous bleeding under the skin of her face that made her look cadaverous.

  “Oh, my goodness, you frightened me,” the nurse said when she caught sight of Kim. She put a hand to her chest. “I didn’t hear you.”

  “She doesn’t look good,” Kim said. He kept his voice even in an attempt to hide the grief, anger, and humiliating impotence he felt.

  “I’m afraid not,” the nurse said, eyeing Kim with some misgivings. “The poor little angel has been having a terrible time.”

  Kim’s trained ear drew his attention to the cardiac monitor screen. The beeping was irregular as were the blips of the cursor.

  “She has an arrhythmia! When did this develop?”

  “Relatively recently,” the nurse said. “It started last night. She developed a cardiac effusion which quickly
brought on symptoms of tamponade. She had to be tapped.”

  “When?” Kim asked. Now he felt even more guilty for not having been available. Dealing with a cardiac effusion was something he knew about.

  “Just after four this morning,” the nurse said.

  “Are any of her doctors still here?” Kim asked.

  “I believe so,” the nurse said. “I think they’re talking to the patient’s mother in the waiting room.”

  Kim fled. He couldn’t stand to see his daughter in such a condition. Out in the corridor, he paused to catch his breath and regain some composure. Then he walked down to the waiting room. He found Tracy talking with Claire Stevens and Kathleen Morgan. As soon as they saw Kim, their conversation stopped.

  For a moment there was silence.

  Tracy was clearly distraught. Her mouth was a grim line. She had her knees pressed together and her hands clasped. She gazed at Kim with a sad, confused expression reflecting both concern and contempt. She shook her head. “You’re in the same clothes. You’re a mess. Where on earth have you been?”

  “My visit to the Onion Ring took a lot longer than I thought it would.” He looked at Claire. “So Becky has now developed pericarditis.”

  “I’m afraid so,” Claire said.

  “My God!” Kim exclaimed. “What next?”

  “At this stage, just about anything,” Kathleen said. “We’ve confirmed that this is a particularly pathogenic strain of E. coli that produces not one but two extraordinarily potent toxins. What we’re seeing is full-blown HUS.”

  “What about the plasmaphoresis?” Kim asked.

  “Dr. Ohanesian made an impassioned plea to the AmeriCare Review Board chairman,” Claire said. “But as we warned, the committee probably will not give the okay.”

  “Why not?” Kim demanded. “We’ve got to do something, and I said I’ll be willing to pay for it.”

  “Your being willing to pay doesn’t matter,” Claire said. “From their point of view, it would set a dangerous precedent. They could then be forced to offer it to families that couldn’t or wouldn’t pay.”

  “Then let’s get Becky to someplace where it is offered,” Kim snapped.

  “Dr. Reggis,” Claire said sympathetically. “Becky is in worse condition today than she was yesterday, and yesterday she was in no condition to be transferred. But plasmaphoresis is not totally out of the question. There’s still hope they could give the green light. We’ll just have to wait.”

  “Wait and do nothing,” Kim said with a scowl.

  “That’s not true,” Claire said hotly. Then she caught herself and sighed; talking with Kim was a chore she did not relish. “We’re supporting her every way possible.”

  “Meaning you’re sitting on your hands and treating complications,” Kim spat.

  Claire stood up and looked at Tracy and Kathleen. “I think it’s time for me to see the rest of my inpatients. But I’ll be available if needed: just page me.”

  Tracy nodded. Kathleen responded that she’d be doing the same thing in a few minutes. Claire left.

  Kim collapsed into the chair vacated by Claire and buried his head in his hands. He was struggling with a roller coaster of emotions: first anger and then sadness, then back to anger. Now sadness returned. He fought back tears. He knew he should be seeing his own inpatients, but for the moment he was incapable.

  “Why did your visit to the Onion Ring take so long?” Tracy asked. As irritated as she was by his behavior, she couldn’t help but be concerned about him. He looked pitiful.

  “Actually, I was in jail,” Kim admitted.

  “Jail!”

  “If you want me to tell you that you were right, you were right,” Kim said. “I should have calmed down before I went.”

  “Why were you in jail?” Tracy asked.

  “I lost my temper,” Kim said. “I went there to find out about the possibility of tainted meat. The manager’s self-righteous denial drove me up the wall.”

  “I don’t think it’s the fast-food industry’s fault,” Kathleen offered. “With this E. coli problem the fast-food restaurants are as much a victim as the patrons who are infected. They get contaminated hamburger.”

  “I figured as much,” Kim said, with his face still buried in his hands. “My next visit will be to Mercer Meats.”

  “With Becky’s condition, it’s hard for me to think,” Tracy said. “But how can there be contaminated meat? Aren’t these places continually inspected? I mean, doesn’t the USDA certify the meat?”

  “They certify it,” Kathleen said. “But in this day and age, it’s an unfortunate assumption to believe that it’s not contaminated.”

  “How can that be?” Tracy asked.

  “For a lot of reasons,” Kathleen said, “chief of which is that the USDA has an inherent conflict of interest.”

  Kim lifted his head out of his hands. “How so?”

  “It’s because of the USDA’s mandate,” Kathleen said. “On the one hand, the agency is the official advocate for U.S. agriculture, which includes the powerful beef industry. That’s actually the USDA’s main job. On the other hand, it has inspectional obligations. Obviously the two roles don’t mix. It’s a genuine case of asking the fox to guard the henhouse.”

  “This sounds incredible,” Kim said. “Is this something you know for a fact, or is it something you’ve heard and are just passing it along?”

  “I’m afraid it’s something I know about firsthand,” Kathleen said. “I’ve been looking into the problem of food contamination for over a year. I’ve gotten active through a couple of consumer groups who are fighting an uphill battle to do something about it.”

  “How did you get involved?” Tracy asked.

  “It would have been hard for me not to,” Kathleen said. “Food contamination and the illness it causes have become a major part of my practice. People in general seem to want to keep their heads in the sand about all this. But it’s a problem that is getting worse by the day.”

  “This is unbelievable!” Kim exclaimed as anger again overcame his sadness.

  “There’s more,” Kathleen said. “Not only is there a conflict of interest with the USDA, but from what I’ve seen, the USDA and the beef industry are much too close.”

  “What are you implying?” Kim asked.

  “Exactly what I said,” Kathleen added. “Particularly in middle-management positions, there’s a kind of musical chairs with people moving back and forth to make sure the industry is interfered with as little as possible.”

  “This is all for profit, no doubt,” Kim said.

  “To be sure,” Kathleen said. “The beef industry is a multibillion-dollar business. Profit maximization is its goal not the public weal.”

  “Wait a second,” Tracy said. “How can all this be true? In the past, the USDA has uncovered problems and has done something about them. I mean, not that long ago with Hudson foods . . .”

  “Excuse me,” Kathleen interrupted. “The USDA was not responsible for discovering the E. coli contamination involving Hudson Foods. It was an attentive public health official. Normally what happens is the USDA is forced to make a show after an outbreak occurs. Then they make a big deal to the media to give the impression that they are on the job of protecting the public, but unfortunately nothing substantial ever gets done. Ironically enough, the USDA doesn’t even have the power to recall meat it finds contaminated. It can only make a recommendation. Nothing it determines is binding.”

  “You mean like with Hudson Foods?” Tracy asked. “At first they recommended that only twenty-five thousand pounds of meat be recalled.”

  “Exactly,” Kathleen said. “It was consumer groups that forced the USDA to up the recommended recall to over a million pounds. It wasn’t the USDA who was the instigator.”

  “I’d had no idea about any of this,” Tracy said. “And I like to think of myself as a reasonably informed person.”

  “Perhaps the worst part,” Kathleen continued, “is that when the USDA talks
about contamination with its inspectional services, they’re generally talking about gross contamination with visible feces. The industry has fought against any microscopic or bacteriologic inspection for years. Now there is supposed to be some culturing, but it is only a token.”

  “It’s hard to believe,” Tracy said. “I guess I’ve always just assumed that meat was safe.”

  “It’s a sorry situation,” Kathleen said. “With tragic consequences.”

  For a few moments, no one spoke.

  “How well we know,” Tracy said, as if suddenly realizing this was no idle conversation. Her daughter was no abstraction. A fresh tear streaked down her cheek.

  “Well, that settles it,” Kim said. He abruptly got to his feet.

  “Settles what?” Tracy managed. “Where are you going now?”

  “To Bartonville,” Kim said. “I’m going to pay a quick visit to Mercer Meats.”

  “I think you should stay here,” Tracy said with exasperation. “You know better than I that Becky’s condition is grave. Dr. Stevens and Dr. Morgan have impressed upon me there might be some difficult decisions to be made.”

  “Of course I know Becky’s condition is grave,” Kim snapped. “That’s why I have so much trouble sitting here doing nothing. It drives me crazy. I have trouble even looking at Becky, knowing there is nothing I can do medically to help. Besides, hearing all this about the beef industry and the USDA makes me furious. I said I was going to find out how she got sick. I’m going to follow this E. coli trail wherever it leads; at least I can do that for Becky.”

  “What if we need you?” Tracy asked.

  “My cellular phone is in my car,” Kim said. “You can call me. Anyway, I won’t be gone that long.”

  “Yeah, just like yesterday,” Tracy said.

  “I’ve learned my lesson,” Kim said. “I’m not going to lose my temper.”

  Tracy didn’t look persuaded. “Go if you have to,” she said irritably.

  Kim stormed out of the ICU waiting room. Not only was Becky’s relentless downward course weighing on him, but so was Tracy’s hostility. Just the day before, she’d professed to understand his frustrations. Now it was as if she’d forgotten she’d ever said anything.