Bloodstream

by Tess Gerritsen

  Max, who’d also pushed into the cell, yanked a blanket from the cot and tossed it to her. Gently she raised Noah’s head and slid the blanket underneath. Many times before, when he was a child, she would find him asleep on the couch and would slide a pillow under his hair. This was not the head of a sleeping boy; with each new spasm, his neck turned rigid, the muscles taut and corded. And the blood—where was the blood coming from?

  Again, she heard the gurgle and saw his chest heave as a fresh stream of red trickled out his nostril. So he hadn’t cut himself; it was the nosebleed again. Was it blood she heard gurgling in his throat? She turned his face downward, hoping to clear any blood from his mouth, but only a trickle spilled out, mixed with saliva. The seizures were fading now, his limbs no longer jerking with such violence, but the sound of choking intensified.

  Heimlich maneuver. Before he suffocates.

  She left him lying on his side, placed one hand on his upper abdomen, and braced her other hand against his back. She gave a forceful thrust against his belly, aiming it toward the rib cage.

  Air wheezed out of his throat. It wasn’t a complete obstruction, she thought with relief. His lungs were still getting air.

  She repeated the maneuver. Again, she positioned the heel of her hand against his belly and gave a firm thrust. She heard air rush out of his lungs, heard the wheeze clear as the reason for the obstruction was suddenly expelled from his throat and spilled partway out one nostril. When she saw what it was, she jerked back with a gasp of horror.

  “Jesus Christ!” yelled the state cop. “What the fuck is that?”

  The worm was moving, lashing back and forth in a pink froth of blood and mucus. Now more of it slithered out, twisting into glistening loops as it frantically worked itself free. Claire was so shocked she could only stare as it wriggled out of her son’s nose and slid to the floor. There it coiled up on itself, one end rising like a cobra as though to test the air.

  In the next instant it whipped away and vanished under the nearby cot.

  “Where is it? Get it!” yelled Claire.

  Max was already scrambling on hands and knees, trying to peer under the cot. “I don’t see it—”

  “We need it identified!”

  “There, I see it,” said Lincoln, who’d dropped to his knees beside Max. “It’s still moving—”

  The cut-off wail of an ambulance drew Claire’s attention. She glanced toward the sound of approaching voices and the metallic rattle of a rolling stretcher. Noah was breathing easier now, his chest rising and falling without spasms, his pulse rapid but steady.

  The EMTs pushed into the cell. Claire moved aside as they went to work, establishing an intravenous line, administering oxygen.

  “Claire,” said Lincoln. “You’d better take a look at this.”

  She moved to his side and knelt down, peering into the narrow space beneath the cot. The cell was poorly lit, and it was hard to see much detail in the shadow of that sagging mattress. Where the light just slanted under the edge, she made out a few dust balls and a crumpled tissue. Beyond that, in the farthest recess, a bright green line was moving, forming hallucinogenic curlicues in the darkness.

  “It’s glowing, Claire,” said Lincoln. “That’s what we saw. That night, on the lake.”

  “Bioluminescence,” said Max. “Some worms have the capability.”

  Claire heard a restraint buckle snap into place. Turning, she saw that the EMTs had already strapped Noah on the stretcher and were maneuvering him through the cell door.

  “He seems stable,” said the EMT. “We’re taking him to Knox ER.”

  “I’ll be driving right behind you,” she said, then glanced at Max. “I need that specimen.”

  “You go on ahead with Noah,” said Max. “I’ll bring the worm to the pathology department.”

  She nodded, and followed her son out of the building.

  Claire stood in the X-ray department, frowning at the films clipped to the viewing box. “What do you think?” she said.

  “This CT scan looks normal,” said Dr. Chapman, the radiologist. “All the cuts appear symmetrical. I see no masses, no cysts. No evidence of bleeding into the brain.” He glanced up as Dr. Thayer, the neurologist whom Claire had asked to be Noah’s physician, walked into the room. “We’re just looking at the CT scan now. No abnormalities that I can see.”

  Thayer slipped on his glasses and surveyed the films. “I agree,” he said. “What about you, Claire?”

  Claire trusted both these men, but this was her son they were discussing, and she could not completely relinquish control. They understood this, and were careful to share with her the results of every blood test and X-ray. They were now sharing their bewilderment as well. She could see it in Chapman’s face as he focused once again on the films. The light box cast back twin reflections of the X-rays on his glasses, obscuring his eyes, but his frown told her he did not have an answer.

  “I see nothing here to explain the seizures,” he said.

  “And nothing to contraindicate a spinal tap,” said Thayer. “Given the clinical picture, I’d say a tap is definitely called for.”

  “I don’t understand. I was almost certain of the diagnosis,” said Claire. “You don’t see any indication of cysticercosis?”

  “No,” said Chapman. “No larval cysts. As I said, the brain looks normal.”

  “So are the blood tests,” said Thayer. “All except a slightly elevated white count, and that could be due to stress.”

  “His differential wasn’t normal,” Claire pointed out. “He has a high eosinophil count, which would go along with a parasitic infection. The other boys had high eosinophil counts as well. At the time I didn’t pay attention to it. Now I think I missed the vital clue.” She looked at the CT scan. “I saw that parasite with my own eyes. I saw it come out of my son’s nostril. All we need is species identification.”

  “It may have nothing to do with his seizures, Claire. That parasite could be an unrelated illness. Most likely it’s just a common Ascaris infection. Those can turn up anywhere in the world. I saw a kid in Mexico cough up one of those worms and expel it from his nostril. Ascaris wouldn’t cause neurologic symptoms.”

  “But Taenia solium would.”

  “Have they identified Warren Emerson’s parasite?” asked Chapman. “Is it Taenia solium?”

  “His ELISA test should be done by tomorrow. If he has antibodies to Taenia, we’ll know that’s the parasite we’re dealing with.”

  Thayer, still looking at the X-ray, shook his head. “This CT scan shows no evidence of larval cysts. True, it may be too early a stage to visualize yet. But in the meantime, we have to rule out other possibilities. Encephalitis. Meningitis.” He reached up and flicked off the light box. “It’s time to do a spinal tap.”

  An X-ray clerk stuck her head in the room. “Dr. Thayer, Pathology’s on the line for you.”

  Thayer picked up the wall phone. A moment later he hung up, and turned to Claire. “Well, we have an answer on that worm Dr. Tutwiler brought on. The one that your son expelled.”

  “They’ve identified it?”

  “They transmitted photos and microscopic sections online to Bangor. A parasitologist at Eastern Maine Medical Center just confirmed the ID. It’s not Taenia.”

  “Is it Ascaris, then?”

  “No, it’s from the Annelida phylum.” He shook his head in bewilderment. “This has to be a mistake. Obviously they’ve misidentified it.”

  Claire frowned in puzzlement. “I’m not familiar with Annelida. What is it?”

  “It’s just a common earthworm.”

  23

  Claire sat in the darkness of Noah’s hospital room, listening to her son rock side to side on the bed. Since the spinal tap earlier that evening, he had continued to fight against his restraints, and had dislodged two IVs. Thayer had finally relented to the nurses’ requests and allowed them to administer a sedative. Even with sedation, even with the lights turned off, he didn’t sleep, but contin
ued rocking back and forth, uttering curses. It exhausted her just to hear his ceaseless struggle.

  A little after midnight, Lincoln came into the room. She saw the door swing open, the light spill in from the hall, and recognized his silhouette as he hesitated in the doorway. He came in and sat down in the chair across from her.

  “I spoke to the nurse,” he said. “She says everything is stable.”

  Stable. Claire shook her head at the word. Unchanging was all it meant, a state of constancy, good or bad. Despair could be thought of as a stable condition.

  “He seems quieter,” said Lincoln.

  “They’ve pumped him full of sedatives. They had to, after the spinal tap.”

  “Have the results come back?”

  “No meningitis. No encephalitis. Nothing in the CSF to explain what’s happened to him. And now the parasite theory is dead as well.” She leaned back, her body heavy with fatigue, and gave a bewildered laugh. “No one can explain it to me. How he managed to inhale an earthworm. It doesn’t make sense, Lincoln. Earthworms don’t glow. They don’t use humans as hosts. There has to be some kind of mistake …”

  “You need to go home and sleep,” he said.

  “No, I need answers. I need my son. I need him back the way he was before his father died, before all this trouble, when he still loved me.”

  “He does love you, Claire.”

  “I don’t know that anymore. I haven’t felt it in so long. Not since we moved to this place.” She kept staring at Noah, remembering all the times in his childhood when she had watched him sleep. When her love for him had felt almost like obsession. Even desperation. “You don’t know what he was like, before,” she said. “You’ve only seen him at his worst. His ugliest. A suspect in a crime. You can’t imagine how warm and loving he was as a small child. He was my very best friend …” She brought her hand up and wiped her eyes, grateful for the darkness. “I’m just waiting for that boy to come back to me.”

  Lincoln rose and went to her. “I know you think of him as your best friend, Claire,” he said. “But he’s not your only friend.”

  She allowed him to put his arms around her, to kiss her on the forehead, but even as he did she thought: I can no longer trust you or depend on you.

  I have no one now, but myself. And my son.

  He seemed to sense the barrier she had erected against him and slowly he released her. In silence he left the room.

  She stayed all night at Noah’s bedside, dozing in the chair, waking up every so often when a nurse came in to check his vital signs.

  When she opened her eyes to a startlingly bright dawn, she found her thoughts had somehow crystallized. Noah was at last sleeping quietly. Though she too had managed to sleep, her brain had not shut down. It had, in fact, been working all night, trying to explain the puzzle of the earthworm, and how it could have found its way into her son’s body. Now, as she stood at the window and gazed at the snow, she wondered how she’d missed an answer so obvious.

  From the nurses’ station, she called EMMC and asked to speak to Dr. Clevenger in Pathology.

  “I tried calling you last night,” he said. “Left a message on your home phone.”

  “Was it about Warren Emerson’s ELISA test? Because that’s why I’m calling you.”

  “Yes, we got the results. I hate to disappoint you, but it’s negative for Taenia solium.”

  She paused. “I see.”

  “You don’t sound too surprised. I am.”

  “Could the test be wrong?”

  “That’s possible, but it’s unlikely. Just to be certain, we also ran an ELISA test for that boy, Taylor Darnell.”

  “And it was negative, too.”

  “Oh, so you already knew that.”

  “No, I didn’t. It was a guess.”

  “Well, that house of cards we were talking about the other day, it just collapsed. Neither patient has antibodies to the pork tapeworm. I can’t explain why those kids are going berserk. I know it’s not from cysticercosis. I can’t explain how Mr. Emerson got that cyst in his brain, either.”

  “But you do think it was a larva of some kind?”

  “Either that or a hell of a weird artifact from staining.”

  “Could it be a different parasite—not Taenia?”

  “What kind of parasite?”

  “One that invades its host via the nasal passages. It could coil up inside one of the sinuses and hide there indefinitely. Until it’s expelled or it dies. Any biological toxins it released would be absorbed right through the sinus membranes, into the host’s bloodstream.”

  “Wouldn’t you see it on CT scan?”

  “No. You’d miss it on CT, because it would look completely innocuous. Like nothing more than a mucoid cyst.” Like Scotty Braxton’s CT scan.

  “If it was coiled up in a sinus, how would it get into Warren Emerson’s brain?”

  “Think about the anatomy. There’s only a thin layer of bone separating the brain from the frontal sinus. The parasite could have eroded through.”

  “You know, it’s a marvelous theory. But there’s no parasite that fits that clinical picture. Nothing I can find in the textbooks.”

  “What about something that’s not in the textbooks?”

  “You mean an entirely new parasite?” Clevenger laughed. “I wish! It’d be like hitting the scientific jackpot. I’d get my name immortalized for discovering it. Taenia clevengeria. It’s got a nice ring, doesn’t it? But all I’ve got is a degraded and unidentifiable larva on microscopic. And no living specimen for show and tell.”

  Just an earthworm.

  On the drive back to Tranquility, she realized she was still missing a number of pieces to the puzzle. Max Tutwiler would have to supply them. She would give him the opportunity to explain in private; he had been her friend, and she owed him the benefit of the doubt. She’d been married to a scientist, and she knew the fever that sometimes consumes them, that intense rush of excitement when they scent the first whiff of a discovery. Yes, she understood why Max might hoard the specimen and replace it with another, might keep it a secret until he could confirm it was a new species. What she could not understand, and could never forgive, was the fact he had concealed information from her, and from Noah’s physicians. Information that might have been vital to her son’s health.

  She was growing angrier by the mile.

  Talk to him first, she reminded herself. You could be wrong. This could have nothing to do with Max.

  By the time she reached the Tranquility town line, she was too agitated to put off the meeting any longer. She wanted to have it out with him now.

  She drove directly to Max’s cottage.

  His car wasn’t there. She parked in his driveway and was crossing to the porch when she noticed, off to her right, footprints tracking away from the building. She followed them a short distance into the woods, where they halted at a churned up section of snow mixed with dirt. She squatted down, and with her gloved hand dug into the disturbed snow. About six inches deep, she reached a layer of loose soil and dead leaves. She picked up a handful of dirt and saw something glistening, moving in her palm. An earthworm. She buried it and retraced her steps out of the woods.

  On the porch, she glanced around for a shovel, knowing one had to be there. She spotted it, along with a pickaxe, leaning against the woodpile, frozen soil still caked to the blade.

  The door was unlocked; she stepped into the cottage and saw at once why Max hadn’t bothered to secure the place. It had been cleaned out of almost all his belongings. What remained—the furniture, the cookware—had probably come with the rental. She walked through the bedrooms, the kitchen, and found only a few of his things left: a box of books, a basket of dirty clothes, and some food in the refrigerator. And tacked to the wall, his topographical map of the Meegawki Stream. He’ll be coming back for these things, she thought. And I’ll be waiting for him.

  Her gaze fell to the box of books. To the corporate mailing label still affixed to the ca
rdboard flap: ANSON BIOLOGICALS.

  It was the name of the reference lab that had analyzed Scotty’s and Taylor’s blood, and had returned negative reports on both their drug screens. False negatives? she wondered, and if so, what were they trying to hide? It was the same lab that had recently paid a grant to the Two Hills Pediatric Group, to collect blood samples from the area’s teenagers. What was Anson’s interest in the children of Tranquility?

  She took out her cell phone and called Anthony at the Knox Hospital lab. “What do you know about Anson Biologicals?” she asked him. “How did it end up with the contract for our hospital?”

  “Well, it was a funny thing. We used to send all our GC-MS and radioimmunoassay tests to BloodTek, in Portland. Then about two months ago, we suddenly switched to Anson.”

  “Who made the decision?”

  “Our chief of pathology. The change made sense, since Anson’s charges are discounted. The hospital couldn’t resist. We’re probably saving tens of thousands of bucks.”

  “Could you find out more about them? I need to know as soon as possible. You can reach me on beeper.”

  “What do you want to know, exactly?”

  “Everything. Whether they’re more than just a diagnostic lab. And what other ties they have to Tranquility.”

  “I’ll see what I can find out.”

  She hung up. Even with the electric heat turned on, the room felt cold. She built a fire in the woodstove and made breakfast out of Max’s meager food supplies. Coffee and buttered toast and a slightly shriveled apple. By the time she’d finished eating, so much warmth was radiating from the woodstove, she was starting to feel drowsy from the heat. She called the hospital again to check on Noah’s condition, then she sat down by the window to wait.

  He couldn’t avoid her forever.

  It seemed like only moments later when she startled awake in the chair, her neck hurting from uncomfortable slumber. It was three o’clock, and the morning sunlight had shifted to the slanting rays of afternoon.

  She rose and massaged her neck as she wandered restlessly around the cottage. Into the bedroom, back to the kitchen. Where was he? Surely he’d come back for his dirty laundry.