Bloodstream

by Tess Gerritsen

  “It’s been a long time since medical school,” she said. “I don’t remember much about Taenia solium. What’s the life cycle of this organism?”

  “Taenia solium is a cestode,” said Clevenger. “A tapeworm that usually lives in the intestinal tract of its host. People get it by eating undercooked pork that’s been infected with the larvae. The larva has sucking caps that hook on to the wall of the human small intestine, which is where it sets up housekeeping, absorbing food. The worms can live there for decades without causing symptoms, and grow as long as three meters—over nine feet long! Sometimes the worms will be passed or expelled. You can imagine what it’d be like to wake up one morning and find one of those critters lying in the sheets with you.”

  Rothstein and Claire exchanged slightly nauseated glances. “Sweet dreams,” muttered Rothstein.

  “So how does the larva reach the brain?” asked Claire.

  “It happens during a different part of the worm’s life cycle. After the worm matures to adulthood in the human intestine, it begins to produce eggs. When those eggs are passed, they contaminate soil and food sources. People ingest them, the eggs hatch and penetrate the intestinal wall, and are then carried through the bloodstream to any number of organs, including the brain. There, after a few months, they develop into larvae. But it’s a dead end, because they can’t grow in that confined space, without nutrients. So they just sit there until they die, forming little cystlike pockets in the brain. The cause of this patient’s seizures.”

  “You said these eggs contaminate the soil,” said Claire. “How long can the eggs stay alive outside of a host?”

  “A number of weeks.”

  “What about in water? Could they stay alive in a lake, for instance?”

  “It’s not mentioned in any of my reference books, but I suppose it’s possible.”

  “Would the Taenia solium ELISA test be a screen for infection? Because we should order it on another patient. A boy at the Maine Youth Center.”

  “You think there’s another case in this state?”

  “Maybe a number of other cases in Tranquility. It would explain why so many of our children are suddenly showing violent behavior.”

  “An epidemic of cysticercosis in Maine?” Rothstein looked skeptical.

  Claire’s excitement was rising. “Both the boys I admitted had the same abnormality in their white blood cell count: a high percentage of eosinophils. At the time, I thought it was because of asthma or allergies. Now I realize it was caused by something else.”

  “A parasitic infection,” said Rothstein. “That raises the eosinophil count.”

  “Exactly. And Warren Emerson could be the source of the infection. If he’s been harboring a nine-foot tapeworm in his intestines, then he’s been shedding parasitic eggs for years. A leak in his septic tank would contaminate the soil and groundwater. The eggs would find their way into the lake, exposing anyone who swims there. Anyone who accidentally takes in a gulp of water.”

  “That’s a lot of ifs,” said Clevenger. “It’s a house of cards you’re building.”

  “Even the time frame makes sense! The kids would have been infected during the summer, when they swam in the lake. You said the eggs take several months to develop into larvae. Now it’s fall, and the symptoms are just starting to show up. A November syndrome.” She paused, suddenly frowning. “The only thing I can’t explain is their negative CT scans.”

  “Maybe it was too early in the infection,” said Clevenger. “During the acute symptoms, the larvae may still be too small to detect. And there wouldn’t be any cyst formation yet.”

  “Well, there’s a simple screen for the parasite,” added Rothstein. “The ELISA test.”

  Claire nodded. “If anyone shows antibodies to Taenia solium, then this theory is more than just a house of cards.”

  “We can start by testing Warren Emerson,” said Rothstein. “And that boy at the Youth Center. If they both come back negative, that kills your theory right there. But if they’re positive …”

  Clevenger, ever the scientist, eagerly rubbed his hands at the possibility. “Then we’ll get out the needles and tourniquets, folks,” he said. “Because there are a whole lot of arms we have to poke.”

  20

  J.D. was jeering at her through her bedroom door, calling her a slut, a cheap lay, a whore. Amelia sat on the bed with her hands clapped over her ears, trying to shut out her stepbrother’s voice, knowing that if she yelled back at him, it would only make things worse. J.D. was mad at everyone these days, looking to pick a fight with whoever was in reach.

  Yesterday, the day he’d been sent home from school, she’d made the mistake of calling him a bastard. He’d slapped her so hard her ears had rung for hours. She’d run sobbing to her mother, but of course there’d been no support from Grace. “You know how he is,” Grace had said in her I’ve-got-troubles-of-my-own voice. “Just stay away from him.”

  All day, Amelia had kept her distance by locking herself in her room and trying to concentrate on her homework, but now it was impossible to think. Earlier that day she’d heard J.D. raise hell downstairs, shoving Eddie around, yelling at Mom, even yelling at Jack. Maybe one of these days Jack and J.D. would kill each other. Like father, like son. She wouldn’t mourn either one of them.

  But now J.D. stood out in the hall, insulting her through the door. “You like tiny weenies? That why you doing it with that loser, Noah Elliot? I’ll show you a big dick! I’ll show you how it’s done! Or do you want Noah’s little weenie?” He laughed, and began chanting, “Little weenie! Little weenie!” until even Jack had had enough and he yelled up the stairs, “Shut up, J.D.! I’m trying to watch TV!”

  At which point J.D. went tearing downstairs to pick a fight with Jack. Amelia could hear them in the living room, their voices crescendoing to shouts. One big happy family. Now things were being knocked onto the floor. She heard furniture thudding, glass breaking. Jesus, how much worse could it get? Her mother was part of the chaos now, sobbing about her precious broken lamp. Amelia looked down at the school books spread open on her bed, at the list of assignments she’d hoped to complete by Monday, and knew she couldn’t possibly finish them. I should have gone to the dance instead, she thought. If I can’t do my homework, I might as well have some fun tonight.

  Except the dance wouldn’t be any fun either, since Noah Elliot wasn’t there.

  She heard another lamp smash to the floor, then her mother wailing: “Why don’t you do something, Jack? Why don’t you ever do anything?” There was a loud slap, and then Grace was sobbing.

  In disgust, Amelia stuffed her books in her backpack, grabbed her jacket, and stalked out of her room. They didn’t even hear her come down the stairs. She caught a glimpse of the living room, the floor littered with broken glass, J.D. red-faced and huffing like an angry bull as he faced his father and stepmother.

  Amelia slipped out the front door and into a snowy night.

  She began to walk down Toddy Point Road, not caring at first where she was going, just wanting to get away from them. By the time she’d passed the boat ramp, the cold was starting to penetrate her clothes, and melting snow dripped down her face. She had to go somewhere; walking aimlessly on a night like this was stupid and dangerous. But there was only one place she really wanted to go, one home where she knew she’d be welcomed.

  Just the thought made her heart lift. She walked faster.

  Since when did schoolgirls go out in public wearing fancy underwear? wondered Lincoln as he watched the students gather on the dance floor. He remembered the school dances of his own youth, the girls in their shiny hair and pastel dresses and satin miniskirts. Tonight the girls looked like a gathering of tarted-up vampires in their black lace and spaghetti straps. A few of them had painted their lips black too, and with their white winter faces, they reminded Lincoln of corpses wandering around the murky gym. As for the boys, well, they were just as likely to be wearing earrings as the girls were.

  Pete S
parks, standing beside him, said, “You’d think they’d catch pneumonia in those getups. Can’t believe their mothers let ’em out looking like that.”

  “I bet their mothers have no idea,” said Lincoln. He had seen many of the girls arrive modestly dressed, only to duck into the bathroom and emerge stripped down to the skimpiest of outfits.

  Loud music suddenly blasted from the speakers in a driving beat. After only a few minutes of that racket, Lincoln was desperate to escape.

  He stepped through the double doors of the gym, into the relative peace of a cold night.

  The snowfall was gentle, just a fluttering of silver past the streetlamp. Standing beneath the building’s overhang, he turned up his jacket collar and gratefully inhaled air that was sharp and clean.

  Behind him, the door opened and shut, and he heard Fern say, “Too much for you too?”

  “I had to take a breather.”

  She came to stand beside him. She was wearing her coat, which meant she’d come out with the intention of staying for a while.

  “Does it ever feel like it’s all just too much responsibility, Lincoln? Like you’re ready to call it quits and just walk away?”

  He gave a rueful laugh. “At least twice a day.”

  “Yet you’re still here.”

  He looked at her. “So are you.”

  “Not because I want to be. It’s because I don’t see any alternatives.” She looked up at the falling snow, and said softly, “Doreen doesn’t deserve you. She never did.”

  “It’s not a matter of people deserving good luck or bad, Fern.”

  “Still, you should’ve had better. All these years, I’ve watched how miserable she’s made you, and I kept thinking how unfair it was. How selfish she was. Life doesn’t have to be unfair. We can choose happiness.” She paused, marshaling the nerve for what she had to say. He knew what it was; he’d always known, and had always avoided hearing the words spoken aloud, because he knew the aftermath would be humiliating for her, and painful for him. “It’s not too late for us,” she said.

  He released a regretful sigh. “Fern—”

  “We could pick up where we left off. Before Doreen.”

  He shook his head. “We can’t.”

  “Why not?”

  He heard the neediness in her voice, the desperation, and he had to force himself to meet her gaze. “There’s someone else I care about.”

  She took a step back, retreating into the shadows, but not before he’d seen the tears in her eyes. “I suppose I already knew that.”

  “I’m sorry.”

  “No. No, there’s no reason to be sorry.” She shook her head and laughed. “It’s just the story of my life.”

  He watched her turn back to the building. She paused to square her shoulders, regain her pride. Why couldn’t Fern have been the one? he thought. Had he fallen in love with her, had they married, it might have been a reasonably happy union. She was attractive enough, intelligent enough. Yet something between them had always been missing. The magic.

  In sorrow he watched her cross to the gym door and pull it open. At that instant, the sounds of shouting and running feet suddenly spilled out the open doorway.

  “What’s going on now?” said Fern, and she ran into the building with Lincoln right behind her.

  Inside, they found mass confusion. The punch bowl had tipped over, and a pool of strawberry-colored liquid was spreading across the gym floor. The music was still pounding away, but half the students had retreated against one wall, where they milled together in alarm. Others were clustered in a circle near the sound system. Lincoln couldn’t see what was happening at their center, but he heard a loudspeaker thud to the floor, and heard Pete Sparks and the chaperones all shouting: “Break it up! Back off, back off!”

  As Lincoln pushed into the circle, another amplifier tipped over and splashed into the river of punch. There was a deafening squeal and the crowd clapped their hands to their ears, backing away as electrical sparks shot up.

  In the next instant, the music died. So did the gym lights.

  The darkness lasted only a few seconds, but in that brief pause before the emergency lamp came on, panic seized the crowd. Lincoln felt screaming kids slam into him in their rush to reach the exits. He couldn’t see who was coming at him, could only hear the sound of stampeding. He felt someone go down near his feet, and he blindly reached down and hauled a girl back up by her dress.

  The emergency lamp at last flared on, one inadequate spotlight in the far corner of the gym. It was just enough light to see the shadowy chaos of running figures, kids stumbling back to their feet.

  Then Lincoln focused on a scene that chilled him to the marrow. Pete Sparks had fallen to his knees and seemed too dazed to notice the overweight boy standing beside him. The boy reached down and removed the weapon from Pete’s holster.

  Lincoln was too far away to disarm the boy with a tackle. He managed to take only two steps forward, then froze as the boy turned to face him, rage glowing in his eyes. Lincoln recognized him. It was Barry Knowlton.

  “Put it down, son,” said Lincoln quietly. “Just put the gun down on the floor.”

  “No. No, I’m tired of being kicked around!”

  “We can talk about it. But first you have to put it down.”

  “Like anyone ever bothers to talk to me!” Barry turned, his gaze circling wildly around the gym. “You girls, you never bother. You just laugh at me! All the time, that’s all I hear, the laughing.” His focus shot to another part of the room. “Or you, stud! What’d you call me? Fat ass? Say it now! Go ahead, say it now!”

  “Put the gun down,” Lincoln repeated, slowly reaching for his own weapon. It was the last resort; he didn’t want to shoot the boy. He had to talk him down. Negotiate. Anything to keep the bullets from flying. Footsteps scurried in the shadows and he caught a glimpse of Fern’s blond hair as she rushed a group of students out the door. But there were still dozens of people trapped against the far wall, unable to flee.

  He took another step forward. Instantly the boy turned to face him.

  “You’ve made your point, Barry,” said Lincoln. “Let’s go in the other room and talk, okay?”

  “He called me fat ass.” Anguish had crept into the boy’s voice. The desolation of the outsider.

  “We’ll talk, just the two of us,” said Lincoln.

  “No.” The boy turned toward the trapped students, cowering against the wall. “It’s my turn to call the shots.”

  Claire drove with her radio turned off, the silence interrupted only by the sweep of her windshield wipers as they cleared away the dusting of snow. She had spent the hour’s drive from Bangor deep in thought, and by the time she reached the Tranquility town line, she had pieced it all together. Her theory centered on Warren Emerson.

  Emerson’s farmhouse was located on the lower slopes of Beech Hill, only a mile upstream from the lake. It was remote enough that it required its own septic system, which drained into a leach field. If a parasite had matured in his intestines, he would have been a continuing source of parasitic eggs. All it took was a leak in his aging septic tank, a year of heavy flooding, and those eggs could have been washed into the nearby Meegawki Stream.

  Into the lake.

  An elegantly logical explanation, she thought. It’s not an epidemic of madness. Nor is it a centuries-old curse on this town. It’s a microorganism, a parastic larva lodging itself in the human brain, wreaking havoc as it grows. All they needed to confirm the diagnosis was a positive ELISA blood test. One more day, and they’d be certain.

  A siren alerted her to an approaching police car. She looked up at the lights flashing in her rearview mirror, and saw a cruiser from Two Hills. It barreled past her and raced toward Tranquility. A moment later, a second cruiser screamed by, going in the same direction, followed by an ambulance.

  Up ahead, she saw that the flashing lights had turned onto the road toward the high school.

  She followed them.

  It w
as a replay of the frightening scene from a month before, emergency vehicles parked at crazy angles outside the gym, clusters of teenagers standing in the road, crying and hugging each other. But this time snow was fluttering from the night sky, and the vehicles’ flashing lights were muted, as though seen through white gauze.

  Claire grabbed her medical bag and hurried toward the building. She was stopped half a block from the gym by Officer Mark Dolan, decked out in body armor. The look he gave her confirmed what she’d long suspected: their dislike for each other was mutual.

  “Everyone has to stay back,” he said. “We’ve got a hostage situation.”

  “Has anyone been hurt?”

  “Not yet, and we want to keep it that way.”

  “Where’s Lincoln?”

  “He’s trying to talk the kid down. Now you have to move back, Dr. Elliot. Away from the building.”

  Claire retreated to where the crowd had gathered. She watched Dolan turn and confer with the police chief from Two Hills. The men in uniform were in charge here, and she was merely another annoying civilian.

  “Lincoln’s all alone,” said Fern. “And these goddamn heroes aren’t doing anything to help him.”

  Claire turned and saw that Fern’s blond hair was in disarray, the loose strands crusted with snow. “I left him in there,” said Fern softly. “I didn’t have a choice. I had to get the kids out …”

  “Who else is inside?”

  “At least a few dozen other kids.” She stared at the building, melting snow dripping down her cheeks. “Lincoln has a gun. Why doesn’t he just use it?”

  Claire looked back at the gym, the situation inside that building now vividly clear to her. An unstable boy. A room with dozens of hostages. Lincoln would not act rashly, nor would he shoot a boy in cold blood, if he could avoid it. The fact that there had been no gunfire yet meant there was still hope of avoiding bloodshed.

  She glanced at the policemen gathered behind their parked cruisers, and she saw their agitation, heard the excitement in their voices. These were small-town cops, facing a big-city crisis, and they were champing at the bit to take action, any action.