Forbidden Cure Part Three

by William Rubin

  Chapter 5

  The shimmering glass building stands sixty-four stories high on Manhattan’s Upper East Side. Finance, asset management, building management, and accounting firms fill the lower fifty-eight floors. The upper six are home to Immunogenetics Offerings, a multi-billion-dollar company at the forefront of design and development of biologics, proteins genetically engineered to command and control the human immune system. Grayson Limerock’s office occupies the entire east side of the sixty-fourth floor. Limerock smiles as he looks at the meaningless dots scurrying along the street far below. Adjusting his gaze, he stares at the chilled waters of the East River, at the tangled mess that blights his otherwise pristine view. He shakes his head. North Brother Island. What a God-forsaken, fitting place for him.

  Grayson continues conversing with his chief of information technology and security as he makes his way to the wet bar, gliding past an eclectic collection of paintings, including Picasso’s Nude, Green Leaves and Bust, and Van Gogh’s Vase with Fifteen Sunflowers.

  “Are you sure we have no vulnerabilities? We can’t afford to lose even a nanobyte of our proprietary technology.”

  Jack laughs as he folds his hands over crossed legs, resting them on his finely pressed pants. “Our firewalls have firewalls, sir, so nothing is getting in, or out, without my permission.” Jack picks a strand of hair off his pants and tosses it to the floor with disdain. “You and I are the only two with unfettered access to the system.”

  “As it should be.” Grayson raises an empty tumbler and nods.

  “No thank you, sir. Bit early for me.”

  Grayson offers a wry smile. Then pressing him, he goes on, “With the ability to revolutionize treatments in the fields of rheumatology, endocrinology, and transplant medicine, there are hundreds of billions, if not trillions, at stake. We can’t afford to become the next Target, Equifax, or Uber.”

  “I understand your concerns, sir. But rest assured, we employ the most sophisticated, corrupt hackers in the world to attack our systems daily, searching for inadequacies.”

  Grayson offers a begrudging nod. “Fair enough. How about our other project?”

  Jack treads lightly. “The monitoring technology you embedded continues to yield invaluable information, and there are no signs the recipient has detected us. Has it met your expectations?”

  Grayson eyes him carefully as he sips his Scotch. “Yes, very much so.”

  Jack nods. “If there’s nothing else, sir...”

  Grayson circles in front of his laptop and powers it up. Eyes glued to the screen, he waves his hand dismissively. “Keep me appraised, Jack.”

  Limerock settles in at his desk as the door to his office closes. He depresses the intercom. “Hold all my calls for the next hour,” he says, releasing it before there is time for a reply. A crooked smile curls across his face as he slips into the server again, undetected. “Let’s see what gifts you have for me this morning, darling. And rest assured last night’s little stunt won’t go unpunished.”

  Chapter 6

  Kev grips the steering wheel with white knuckles as he navigates the steep, serpentine descent along Dad’s driveway. A steady stream of expletives erupt as the Honda lurches over patches of ice. Unrelenting, icy winds from the Hudson River below lash the car. Kev’s curses peak in intensity as the car skids around the final hairpin turn, a wheel sliding off the asphalt, dangerously close to the precipice overlooking the river below. As we enter a brief straightaway that leads to the house, a relieved Kennedy exclaims, “Love the privacy and views and all, but geez, your dad ever heard of rock salt?”

  Kev loosens his grip on the wheel as he pulls under the carport, and Dad emerges from the front door of his brown-shingled contemporary. The kids trail just behind, excitedly yelling, “Daddy!” I collect heartfelt hugs from everyone and wipe tears of joy from my eyes as Kennedy and I work our way back to the kitchen. There, floor-to-ceiling windows frame a sliding glass door. They provide a picture perfect view of the cove, Scarborough Train Station, and beyond them the Hudson River and the rolling hills and mountains of Rockland County.

  Having moved here from Arthur Avenue when I was seven, the house holds most of my great childhood memories, including the earliest days of my friendship with one Kevin Kennedy. Today, as it has many times in the past, it serves as a serene sanctuary, a place to gather my strength and renew my spirit as I convalesce.

  Over Porterhouses and beer, Dad, Kennedy, the kids and I smile and laugh. Dad winks at me. “Just a few more days till Jacobs has you cured for good.” He raises his glass in salute, Kennedy and I mirroring him. “Thank God for that.”

  After getting the kids off to bed, we sit down in contented silence, watching the moonlight reflecting off the river. A few minutes pass, then Kennedy asks, “So what’re you gonna do with yourself between now and the last treatment?”

  I look out at the river and rub my stubble-filled chin, then decide it’s time to bring Dad up to speed. “Kev’s working an interesting case for the DMC. Could be a homicide or just an unexpected fatality from an experimental drug treatment.” I turn to Kennedy. “Too early to tell, right?”

  Kennedy nods affirmatively.

  Dad sips his beer and also nods. “Sounds interesting, but what’s it got to do with you?”

  “The doctor who supplied the deceased woman the medication is the same doctor formulating my treatments for Jacobs.”

  Beer in hand, rising toward his lips, Dad freezes. “What? How long have you known this?”

  “Since just before the second treatment.”

  Dad is flabbergasted. “And you’re just telling me now? You could have been killed!”

  I air pat my hands, trying to calm him down. “Dad, there’s no evidence at this point that the other patient’s death was a homicide.”

  “Homicide or not, you could’ve been killed. Christ, what were you thinking?”

  “The treatment was my only chance at a cure.”

  Dad points toward upstairs. “You’ve got two kids who just lost their mother and who desperately need their dad right now. You can’t go off half-cocked, risking your life like that.”

  “I know, but if I don’t get better, I can’t take care of them, and I’ve been pretty much useless of late.” Then sheepishly, “Thankfully it all worked out okay.”

  Dad’s eyes bulge. “Yeah, after you almost died—twice! Who’s to say what the hell will happen next time?”

  Kennedy’s eyes dart back and forth between us, as if at a tennis match.

  “Jacobs assures me, there’s nothing to worry about with the third dose. Everyone who made it this far has done great with the last treatment.”

  “Jacobs know we may have a killer in play now?”

  “Okay, okay, let’s take a step back, not jump to any conclusions.” I look at Kennedy, then back to Dad. “Right now I need to help Kev on this case.”

  Surprise fills both their faces as I explain.

  “By looking through everything Kev has on the case, I may be able to help him sort out what’s going on, which benefits me as much as anyone.”

  Dad shakes his head begrudgingly.

  “Kev, can you get me the files to review?”

  He looks at us. “Not exactly police protocol... aw, but who the hell am I kidding? I got stuff in the car I was gonna look over tonight. You can have it as long as you get it back to me tomorrow.” His pointer finger jabs at me. “Nobody outside this room can know.”

  I motion as I say, “Cross my heart.”

  Dad: “So that’s settled.” Then sarcastically, “Any other bombshells to drop?”

  Ill at ease, I look at Kennedy, then back to Dad. “There is one other thing. We met with Durand the other day and you’re not going to believe what he said....”

  Chapter 7

  The turmoil and tension with Dad behind me, I’m holed up in my old room, sifting through everything Kev has on the Malekoviec investigation. Questions dart through my mind. Anything I can point out t
hat will help Kev solve the case? Or help me figure out if Hyslop’s treatments are a danger to his patients? Anything here to support Durand’s claims that Michelle is alive, or that he can help us solve this case?

  I blow steam off a mug of hot chocolate, then take a sip as I look through the vic’s medicals. Irina had a very aggressive, poorly controlled form of rheumatoid arthritis. Over the course of four years she went from a world class concert pianist with long, elegant fingers and magnificent dexterity, to a woman decimated by disease, with gnarled appendages reminiscent of a ninety-year-old. She had tried and failed all traditional therapy for RA, including non-steroidal anti-inflammatories, corticosteroids, and methotrexate. Hydroxychloroquine, the only med to give her any real relief, was discontinued after it caused her to lose two lines of vision in each eye. The ME, Doctor Audrey McGowan, had even found traces of gold in the joints of her fingers, which is rarely used anymore in treating RA patients. Either some doctor didn’t know what he was doing, or Irina was desperate to try anything.

  Doctor Jerome Gorelick, her latest rheumatologist, enrolled Irina in two drug trials, but results were poor with each. Enter Harold Hyslop. Irina’s first treatment with his medication went smoothly but was ineffective. Her second treatment was more of the same when she left her doctor’s office thirty minutes later, but the ME’s report showed she died within four hours of that injection. Consistent with what Jacobs said about one branch of the treatment failure group.

  I comb through the crime scene report. No signs of forced entry, a struggle, or a weapon of any kind. Malekoviec was not strangled or stabbed and didn’t have any entrance or exit wounds at all. The only injection site noted was the one used hours before her death to give her the medication. Along with the tox screening that ruled out a poisoning. The only physical evidence at the crime scene were diffuse, blotchy hemorrhages covering most of Irina’s body. I look through the half dozen gruesome pictures.

  Lesions look familiar but never seen them so widespread before. I sift through the papers and photos rapidly. Come on, come on, it’s got to be—ah, there it is. I hold the close-up to the light, studying the pattern of the hemorrhages on her right upper arm as I nod slowly. This photo and years of work as a trauma surgeon confirm what I suspected.

  None of the bleeding came from an external assault.

  The pattern of blood is consistent with a widespread vasculitis, a damaging inflammation that affects blood vessels of all sizes. In her early fifties, with no other medical history save the RA, Irina should never have suffered such a fate. I look up from the photo and stare out the window at the barren oaks and maple trees that dot Dad’s property. What the hell happened to her to cause this?

  I think back to my discussions with Jacobs, to the analogies and explanations regarding my own treatment. Jacobs said all of Hyslops’ treatments were immunologically based. His compounds were synthesized to control and suppress the immune system. In Irina’s case the RA caused her own body to create antibodies that attacked the joints in her fingers. Hyslop’s treatment must have been designed to turn off production of these harmful antibodies. I grab the photo and study it again, a smile spreading across my face as I realize what happened.

  Irina’s treatment didn’t contain or suppress her immune system, it unleashed it!

  I sift through the papers on the desk, tossing more photos and reports out of the way, until I find McGowan’s report again. Cause of death: widespread organ failure, precipitated by glomerulonephritis. Hyslop’s treatment worked differently than he intended. Instead of turning off production of her harmful antibodies, his medicine acted like an antigen, stimulating production. The medicine then did battle with these antibodies, attacking and destroying them.

  In essence, Hyslop’s medication created a widespread immunologic war throughout Irina’s body!

  Initially, this gave Irina great relief from her symptoms. But these antigen-antibody complexes were so immense and formed so quickly, Irina’s body couldn’t possibly get rid of them fast enough. So these massive structures came crashing out of her bloodstream, destroying the blood vessels in Irina’s skin, kidneys, heart, and many other organs throughout her body. Hence, the blotchy bleeding in her skin, widespread organ failure, and glomerulonephritis found on her post-mortem examination.

  But how could this have happened so quickly?

  Tossing papers aside again, I search for Irina’s labs from prior to both her treatments. Her BUN/Cr levels, markers for kidney function, were completely normal before treatment one. Just before the second treatment, they were still in the normal range but just barely.

  It was basic immunology at work.

  The immune system’s initial response to unrecognized invaders is minimal as the body works hard to synthesize antibodies to attack the organisms. But, a second exposure to the same antigens a short time later produces an exponential increase in the production of these antibodies. This concept forms the basis for providing immunizations against the flu, for example.

  But in Irina’s case, the treatment backfired. The first dose produced little discernible effect because it neutralized only small amounts of her existing, harmful antibodies. This caused very mild damage to her kidneys when the antigen-antibody complexes deposited there, but it also primed her immune system. The second dose caused an explosive production of antibodies in just a few hours, and the resulting antigen-antibody complexes obliterated her kidneys and decimated blood vessels throughout her body. Need to speak with McGowan, see the body and test results to be sure. Then visit Gorelick, Hyslop, figure out where it all went wrong.

  It feels good to be useful, contributing again, albeit in an unofficial capacity. A couple of weeks on the sidelines have shown me how much I miss it. But I temper my enthusiasm. Reviewing paperwork in the comfort of my old room is easy, with none of the stresses and risks of The Job. Risks to me and my health to be sure, but to my family as well.

  Michelle knew those risks better than anyone. I shudder as my mind flashes back to the scene at the East River, to our first confrontation with Durand. Victory seemed at hand when Michelle lay Durand out by suddenly opening a car door in front of him. But a moment later, he sprang back up, grabbed her, and slit her throat, escaping into the water below. Tears flow down my cheeks as the pain takes hold. My hands ball up into fists, my anger flowing as freely today as the blood from her wound did then. I shake my head, trying to rid myself of the images. But it’s no use. Something from that night calls out to me, haunts that part of my psyche that can’t let go of Michelle, can’t move on without her.

  I grab the papers and photos and throw them against the wall. As they scatter in every direction my fists pound the desk, wishing it was Durand’s skull, wishing there was some way to bring Michelle back.

  Chapter 8

  Todd Zigler disembarks from the shuttle boat, another grueling but rewarding day in the lab done. He wraps his winter coat tightly around his neck, bracing himself from the strong, cold breeze coming off the East River as he trudges toward his car at the far end of the parking lot.

  The figure lurks in the corner of the lot, dressed in darkness, observing Todd’s every move. The young man works incredibly hard, that much is certain. The observer shifts position to improve his view and further his concealment behind another car. But where do his allegiances lay? There’s far too much at stake to leave that all-important question left unanswered.

  Zigler climbs into his black Mazda and turns over the engine. His teeth chatter while he waits for the car to warm enough so he can turn on the heater. He makes a mental note to get the remote starter he picked up a few weeks ago installed over the weekend. With a range of a six hundred meters, he can start his car from North Brother Island while still in the lab and have it toasty warm by the time he reaches shore.

  The observer watches Todd punch the parking lot access code into the keypad. A moment later the metal gate grinds open and Todd drives off. The observer smiles as he watches Todd’s car disappear into the
night. Very soon you’ll give me all the answers I need—and then some.

  Chapter 9

  Kennedy slides the papers off to the side of his desk, rubs his face with a meaty hand, then rotates his neck to release the tension. The reports from Detectives Riley and Goldberg were as expected, perfunctory. The three deaths in Hyslop’s lab occurred in a span of four months beginning eighteen months ago. It was the early, pre-Ravello days of the DMC, when the unit was in utter disarray. It was also the twilight of the detectives’ careers. As with all the detectives on the DMC at the time, Riley and Goldberg had no medical training whatsoever, leaving them incapable of appreciating the nuances of the cases. In the end they labeled the three deaths accidental, a result of poor reactions to their treatments, and rode off into the sunset of their retirements.

  The FDA was not so kind. They issued a scathing report which cited multiple deficiencies in how Hyslop ran his lab, and they placed his program on probationary status for one year with regard to the lab’s fast track status with the FDA. The three patients were all experiencing transplant rejections just after surgery with an unidentified surgeon from Washington General. Hyslop did intake on the patients with no documentation whatsoever, just a verbal history provided by the referring physician, whose identity he fiercely protected throughout the inquiry. Hyslop formulated medications for each victim with little help from his two technicians, carried out the quality testing himself, and hand delivered the compounds to the surgeon he worked with. The patients died within hours of their second doses, just like with Irina Malekoviec.

  Hyslop kowtowed to the FDA’s demands to hire a senior lab tech who would take sole responsibility for intaking patients; hiring and supervising technicians; overseeing quality control testing; sending the medications off to the treating physicians; and reporting serious patient side effects directly to the FDA. Todd Zigler was that technician, and single-handedly he restored the lab’s reputation as he nursed it through its probationary period. Without his Herculean efforts, the lab could never have survived. Hyslop continued to be the brains of the operation and direct the lab’s overall efforts while Todd shielded him from many of the day-to-day details of running the lab. It was a system that worked beautifully and heralded a remarkable expansion in the lab’s volume of patients and safety profile—until now.