Bloodstream

by Tess Gerritsen

  “No, Mr. Emerson. You’re not a monster. You blame yourself for what happened all those years ago, but I don’t believe it was your fault. It was a sickness. You had no control over your actions.”

  He didn’t look at her, and she wondered if he had even heard her.

  “Mr. Emerson?”

  He was still gazing out the window. “It’s kind of you to visit,” he murmured. “But there’s no need to lie to me, Dr. Elliot. I know what I did.” He drew in a deep breath and slowly released it, and with that sigh he seemed to shrink even smaller. “I’m so tired. Every night I go to sleep expecting not to wake up again. Hoping not to. And every morning, when I open my eyes, I’m disappointed. People think it’s such a struggle to stay alive. But you know, that’s the easy part. The hard part is the dying.”

  There was nothing she could say. She looked down at the un touched meal tray by the window. A chicken breast in congealed gravy, a mound of rice, kernels glistening like tiny pearls. And bread, the staff of life. A life Warren Emerson no longer wished to experience or to suffer. I cannot make you want to go on living, she thought. I can force feed liquid nourishment, inject it into a tube that threads up your nostril and into your stomach, but I cannot breathe joy into your lungs.

  “Dr. Elliot?”

  Turning, Claire saw a nurse standing in the doorway.

  “Dr. Clevenger from Pathology is on the phone, trying to reach you. He’s on line three.”

  Claire left Warren Emerson’s room and picked up the extension in the nurses’ station. “This is Claire Elliot.”

  “I’m glad I caught you,” said Clevenger. “Dr. Rothstein told me you’d be driving over this afternoon, and I thought you might want to come down to Pathology and take a look at these slides. Rothstein’s on his way down now.”

  “Which slides?”

  “From your craniotomy patient’s brain mass. It took a week to fully fix the tissue. I just got the slides back today.”

  “Is it a meningioma?”

  “Not even close.”

  “Then what is it?”

  She heard the undertone of excitement in his voice. “This you’ve got to see to believe.”

  Fern Cornwallis looked up at the banner hanging from the gym rafters and she sighed.

  KNOX HIGH SCHOOL—YOUR THE BEST!!!

  How ironic that the students had gone to such effort to prepare the banner, had crawled up dizzyingly tall ladders to hang it on those rafters, but had neglected to double-check the grammar. It reflected badly on the school, on the teachers, and on Fern herself, but it was too much trouble to pull it down now and correct it. No one would notice it once the lights were turned down, the music was thudding, and the air turned to a steamy vapor of teen hormones.

  “There’s snow predicted tonight,” Lincoln said. “Are you sure you don’t want to cancel this event?”

  Speaking of hormones. Fern turned and her stomach fluttered as it always did when she looked at him. It was a wonder he couldn’t see the longing in her eyes. Men are so blind.

  “We’ve postponed this dance twice already,” she said. “The kids need some sort of reward, just for getting through this awful month.”

  “They’re saying four to six inches, the worst of it coming around midnight.”

  “The dance will be over by then. They’ll all be home.”

  Lincoln nodded, but he was obviously uneasy as he looked around at the gym, decorated with blue and white crepe streamers and silver balloons. The chilly colors of winter. A half dozen girls—why was it always the girls who did the work?—were setting up the refreshment table, lugging out the punch bowl, the trays of cookies, the paper plates and napkins. In the far corner, a shaggy student was adjusting the sound equipment, setting off ear-splitting squeals from the amplifier.

  “Please keep it down!” yelled Fern, pressing her hand to her head. “These kids are going to make me deaf.”

  “It may be a blessing, considering the music they play.”

  “Yeah, urban rap in the woods. Maybe they can mosh into a pile of leaves.”

  “Do you know how many will show up tonight?”

  “The first dance of the year? I expect a full house. Four grades, minus the thirty-eight troublemakers who’ve been suspended.”

  “It’s that many already?”

  “I’m taking a proactive stance here, Lincoln. One false move and they’re out of here for a week. Not even allowed on the school grounds.”

  “That will make my job easier. I’m bringing in both Dolan and Pete Sparks for patrol shift tonight, so you’ll have at least two of us here to keep an eye on things.”

  The loud crash of a tray made them both turn, and they saw broken cookies scatter across the floor. A blond girl stared down in disbelief at the mess. She spun around and focused on a black-haired girl standing nearby. “You tripped me.”

  “No, I didn’t.”

  “You’ve been bumping into me all afternoon!”

  “Look, Donna, don’t blame me if you can’t walk without falling over your own feet!”

  “That’s it!” said Fern. “Clean up that mess or you’re both suspended!”

  Two angry faces stared at her. Almost simultaneously, they said, “But Miss Cornwallis, she—”

  “You heard me.”

  The girls exchanged poisonous glances, and Donna stormed out of the gym.

  “This is what it’s come to,” Fern sighed. “This is what I’m dealing with.” She looked up, at the high gym windows. At the fading daylight.

  The first flakes of snow had begun to fall.

  Nightfall was the time of day she dreaded most, for it was with the coming of darkness that all Doreen Kelly’s fears seemed to rush forth like demons from their tightly lidded prisons. In the light of day, she could still feel flutterings of hope, and though it was thin as gossamer, she could plot out fantasy scenarios in which she was young again, charming again, and so irresistible she would surely lure Lincoln back home to her, as she had a dozen times before. Staying sober was the key. Oh, she had tried to hold the course! Again and again, she’d managed to convince Lincoln that this time she was dry for good. But then she’d get that familiar thirst, like an itch in her throat that needed scratching, and finally there’d be one little slip of the old willpower, the sweet taste of coffee brandy on the tongue, and she’d be spiraling downward, helpless to pull out of the descent. In the end, what hurt most wasn’t the sense of failure or the loss of dignity. It was seeing the look of resignation in Lincoln’s eyes.

  Come back to me. I’m still your wife and you promised to love and cherish me. Come back just one more time.

  Outside, the gray light of afternoon faded, and with it faded the hopes she’d nursed all day. The hopes that, in her more lucid moments, she knew were false. With nightfall came lucidity.

  And despair.

  She sat down at her kitchen table and poured the first drink. As soon as the coffee brandy hit her stomach, she could feel its heat racing through her veins, bringing with it the welcome flood of numbness. She poured another, felt the numbness spread to her lips, her face. Her fears.

  By the fourth drink, she was no longer in pain, no longer in despair. Rather, she was feeling more sure of herself with every sip. Liquid confidence. She’d made him fall in love with her once before; she could do it again. She still had her figure—a good one. He was a man, wasn’t he? He could be coaxed. All it took was to catch him at a moment of weakness.

  She stumbled to her feet and pulled on her coat.

  Outside, it was was starting to snow, soft and lacy flakes drifting down from a black sky. Snow was her friend; what better decoration for her hair than a few glittery snowflakes? She would step into his house with her hair long and loose, her cheeks prettily flushed from the cold. He would invite her in—he’d have to invite her in—and perhaps a spark of lust would leap between them. Yes, yes, that’s how she saw it happening, with snowflakes in her hair.

  But his house was too far to walk to.
It was time to pick up a car.

  She headed up the street to Cobb and Morong’s. It was an hour before closing, and the evening rush was on to pick up that extra carton of milk, that emergency bag of sugar, on the way home. As Doreen had expected, there were several cars parked along the sidewalk in front of the general store, some of them with their engines running, the heaters blowing. There is nothing so disheartening on a cold night than to walk out and climb into your car, only to find your engine doesn’t start.

  Doreen walked along the street, eyeing the cars, deciding which one to choose. Not the pickup—it wasn’t a lady’s vehicle, nor the VW, because she had more important things on her mind than wrestling with a stick shift.

  The green sedan. That was just the car for her.

  She glanced at the general store, saw that no one was coming out the door, and quickly slid into the sedan. The seat was nice and warm, the heater’s breath toasty against her knees. She put it in gear, hit the gas, and jolted up and off the curb. Something in the trunk gave a loud thump.

  She drove off just as a voice on the street yelled: “Hey! Hey, come back with my car!”

  It took her a few blocks of weaving back and forth to figure out how to turn on the headlights, another block to get the windshield wipers going. At last her view cleared, and she could actually see the road ahead. She accelerated, the sedan fishtailing on the newly fallen snow. She could hear things rolling around in the trunk, the sound of glass clinking together as she swerved around corners. She drove to Lincoln’s house and skidded to a stop in his driveway.

  The house was dark.

  She climbed out of the car, stumbled onto the porch, and banged on the front door. “Lincoln! Lincoln, I gotta talk to you! You’re still my husband!” She banged again and again, but no lights came on, and the door was locked. He’d taken away her key, the bastard, and she couldn’t get in.

  She went back to the car and sat there for a long time with the engine running, the heater blowing. Snow continued to fall, just a dusting of it, fluttering soundlessly on the windshield. Saturday night was not Lincoln’s usual shift, so where was he? She thought of all the places he might be spending the evening, and the possibilities gnawed at her with cruel teeth. She wasn’t stupid; she knew that Fern Cornwallis had always had her predatory eye on Lincoln. There must be other women as well, dozens of women who’d find a cop in uniform irresistible. Agitation mounting, Doreen began to rock back and forth, moaning, in her seat. Come home, come home. Come back to me.

  Even the heater wasn’t enough to ward off the chill seeping into her bones, into her soul. She longed for the warmth of brandy, for the welcome flush of alcohol in her veins. Then she remembered the clink of glass in the trunk. Please let it be something worth drinking. Something stronger than soda pop.

  She staggered out of the car, went around to the rear, and opened the trunk. It took her a moment to focus her eyes, and even when she did, she wondered if she was hallucinating. So beautiful, so green. Like jars of emeralds glowing in the darkness. She started to reach down for one, then turned at the sound of a car engine.

  Approaching headlights blinded her. Dazed, she put up her hand to shield her eyes.

  A silhouette stepped out of the car.

  Dr. Francis Clevenger was a man in miniature, smallboned, sparrow-faced, his lab coat drooping like a parent’s oversize raincoat on his frail shoulders. That, and his absolutely beardless face, made him seem far younger than he was. He looked more like a pale adolescent than a board-certified pathologist. With quick grace he rose from his chair to greet Claire and Warren Emerson’s neurosurgeon, Dr. Rothstein.

  “These slides are so cool,” Clevenger said. “It was the last thing I expected to see. Go on, take a look!” He pointed to the dual-headed teaching microscope.

  Claire and Rothstein sat on opposite sides of the scope and leaned into the eyepieces.

  “So what do you see?” asked Clevenger, practically dancing beside them in anticipation.

  “A mixture of cells,” said Rothstein. “Astrocytes, I’d guess. Plus what looks to me like an interweaving of scar tissue.”

  “That’s a start. Dr. Elliot, you see anything worth noting?”

  Claire focused her eyepiece and gazed at the field of tissue. She was able to identify most of the cells, based on what she remembered from medical school histology classes years before. She recognized starshaped astrocytes, and the presence of macrophages—the cleanup crew, whose function is to tidy up after infection. She also saw what Rothstein had noticed: there were swirls of granulation tissue or scarring, possibly the aftermath of acute inflammation.

  Reaching for the slide position knob, she shifted the field, scanning new cells. An unfamiliar pattern appeared under her gaze, a swirl of fibrous matter several cells thick, forming a microscopic rind of tissue. “I see encapsulation here,” she said. “A layer of scar tissue. Is this a cyst, maybe? Some sort of infectious process that his immune system managed to wall off and encase?”

  “You’re getting warm. Remember the CT scan?”

  “Yes. It looked like he had a discrete brain mass, with calcifications.”

  “An MRI was done here after transfer,” said Rothstein. “It showed essentially the same thing. A discrete lesion, encapsulated, with calcifications.”

  “Right,” said Clevenger. “And what Dr. Elliot has just identified is the cyst wall. Scar tissue formed by the body’s immune system, surrounding and closing off the infection.”

  “Infection by what organism?” asked Rothstein, raising his head to look at Clevenger.

  “Well, that’s the mystery here, isn’t it?”

  Slowly Claire moved the slide, shifting the field again. What appeared through her eyepiece was so startling her gaze froze in amazement. “What on earth is this?” she said.

  Clevenger made a sound of almost childish delight. “You found it!”

  “Yes, but I don’t know what it is.”

  Rothstein pressed his face back to the eyepiece. “My god. I don’t know what it is, either.”

  “Describe it for us, Dr. Elliot,” said Clevenger.

  Claire was silent for a moment as she shifted the position knob and slowly scanned the field. What she saw was a strangely twisted architecture, partially calcified. “It’s some sort of degraded tissue. I don’t know if this is all artifact or what—it’s as if some organism collapsed into an accordion shape, and then became petrified.”

  “Good. Good!” said Clevenger. “I like that description—petrified. Like a fossil.”

  “Yes, but of what?”

  “Back off, look at the larger picture.”

  She reduced magnification, trying to get an overall view. The shape took more complete form, became a spiral that had folded upon itself. The realization of what she was looking at made her straighten in shock and stare at Clevenger. “It’s some sort of parasite,” she said.

  “Yeah! And isn’t it cool?”

  “What on earth was a parasite doing in my patient’s brain?” said Rothstein.

  “It’s probably been there for years. Invaded the gray matter, caused a temporary encephalitis. The immune system launched an inflammatory response. You get an influx of white blood cells, eosinophils, everything the host can muster to fight back. Eventually the host wins, and his body walls off the critter, encases it in granulation tissue, forming a sort of cyst. The parasite dies. Parts of it become calcified—petrified, if you will. Years later, that’s what you have left.” He nodded at the microscope. “A dead parasite, trapped in an envelope of scar tissue. It’s probably the reason behind his seizures. The mass effect of that little pocket of dead worm and scar.”

  “What parasite are we talking about?” asked Claire. “The only one I can think of that invades the brain is cysticercus.”

  “Exactly. I can’t conclusively identify this species—it’s too far degraded. But this is almost certainly the disease cysticercosis, caused by the larva of Taenia solium. The pork tapeworm.”

/>   Rothstein looked disbelieving. “I thought Taenia solium was only found in underdeveloped countries.”

  “For the most part it is. You’ll find it in Mexico, South America, sometimes in Africa and Asia. That’s why I was so excited when I saw that slide. To find a case of cysticercosis here, in northern Maine, is unbelievable. It’s definitely worth an article in The New England Journal of Medicine. What we need to figure out is when and where he got exposed to pork tapeworm eggs.”

  “There’s nothing in his history about foreign travel,” said Claire. “He told me he’s lived all his life in this state.”

  “Which would make it a truly unusual case. I’ll run antibody tests to confirm this is the right diagnosis. If it is Taenia solium, he’ll have a positive ELISA test on his serum and CSF. Is there any history of an initial inflammatory response? Symptoms that might tell us when he was first infected?”

  “What symptoms, specifically?” asked Rothstein.

  “It could be a clinical picture as dramatic as full-blown meningitis or encephalitis. Or new onset epilepsy.”

  “His first seizures occurred sometime before age eighteen.”

  “That’s one clue.”

  “What other symptoms might show up?”

  “Subtler signs, possibly. It can mimic brain tumors, cause a variety of psychiatric disorders.”

  The back of Claire’s neck was suddenly tingling. “Violent behavior?” she asked.

  “Possibly,” said Clevenger. “I didn’t see that specifically mentioned in my references. But it could be a sign of acute illness.”

  “When Warren Emerson was fourteen years old,” said Claire, “he murdered both his parents.”

  The men stared at her. “I didn’t know that,” said Rothstein. “You never mentioned it.”

  “It wasn’t relevant to his medical condition. At least, I didn’t think so.” She looked down at the microscope, the image of the parasite still vivid in her mind. An initial infection of parasitic eggs, followed by symptoms of encephalitis. Irritability. Even violence.