“How safe is the blood supply, Doctor? From contamination, I mean.”
Lodge hesitated, then repeated the litany of Nurse Glad. “The blood supply in this country is as safe as it can possibly be.”
I laughed. “I used to be a lawyer; I know an evasive answer when I hear one. The kind of answer people give when they’re afraid someone is going to sue them.”
“There have been a host of lawsuits against the blood industry of late,” Lodge replied. “Several hundred of them, in fact; Irwin Memorial’s liability insurance premium is half a million dollars a year. Many banks fear bankruptcy.”
“Are we talking about people who’ve gotten AIDS from a transfusion? Then sued the blood bank that provided the blood?”
“And the doctor and hospital and anyone else they could think of, too,” Lodge answered.
“But you say these lawsuits aren’t successful.”
“Most have not been, though there have been some large verdicts quite recently—a court in Boston just awarded a military man almost three million in a transfusion AIDS case, for example. Which is why legislatures in many states have enacted laws that limit the dollar amount of recoveries for bad blood just as they limit recoveries in medical-malpractice actions. There are also laws that declare that a blood bank which sells blood to a hospital is providing a service rather than selling a product.”
“Which means product-liability principles don’t apply—the blood banks don’t face strict liability for selling defective merchandise or for breach of warranty.”
“Correct. The only claim the victim has is negligence, which is hard to prove in these situations since it usually requires finding carelessness in the screening or testing procedures.”
“Carelessness exists though, right?”
“Unfortunately, that’s true,” Lodge acknowledged. “Recent FDA studies of both Red Cross and private blood-center operations have unearthed a number of processing deficiencies which have led some people to conclude, among other things, that the incidence of transfusion AIDS has been seriously underreported. Others dispute that, and proving it is a difficult matter. Incidentally, the Red Cross is about to announce a major reorganization of its blood program to eliminate the kinds of errors and inconsistencies the FDA turned up. The goal is to give the public increased peace of mind about the safety of the system.”
“Let’s back up a minute,” I said. “Is AIDS the only disease you can get from a transfusion?”
“Hardly. Transfusion hepatitis, which can lead to cirrhosis of the liver, has been a far greater risk than AIDS over the years. But a test for types A and B hepatitis has been employed by blood people for quite a while, and a new test for so-called hepatitis C will reduce the remaining risk substantially. A host of other viruses—everything from Epstein-Barr to malaria and Lyme disease—can be transmitted via transfusion as well. The most promising solution for these problems is a method of blood cleansing through laser and chemical-heating techniques that destroy the viruses before the blood is used in transfusion.”
“These blood baths don’t work with AIDS?”
“Not so far.”
“So the blood supply isn’t safe.”
“Not completely, but what is? Few procedures in modern medicine entail no risk whatsoever. What’s ironic is that AIDS may have been introduced into the human population during efforts to understand malaria by injecting researchers with the blood of mangabey monkeys, to see if the parasite was transmittable in that manner. Benign intentions; catastrophic results.”
“I thought there was a test for HIV in blood, so the bad stuff got screened out.”
“There is. But it isn’t one hundred percent effective.”
“Because the lab people screw up sometimes.”
“That’s the greatest risk, to be sure, but a second problem is with the test itself—ELISA it’s called: Enzyme Linked Immunosorbent Assay. It involves using a goat antibody to human IgG that has been tagged with horseradish peroxidase, then—” Lodge stopped himself, then laughed. “I won’t bore you with the science. The problem is, the test doesn’t detect the virus itself but rather the antibodies the body has produced to combat the virus. Even when supplemented by the so-called Western Blot test, ELISA results are not conclusive in terms of identifying every sample that contains HIV.”
“You can have the virus but not the antibody, in other words.”
“Precisely. Initial estimates were that antibodies didn’t begin to form until two to fourteen weeks after infection. After further research, the period was extended to six months. A recent UCLA study suggests that antibodies may not occur for up to three years after contraction of the virus, though those results are widely disputed.”
“In the interim, blood from those people will test as safe.”
“Yes. But there is initial screening for the high-risk groups, don’t forget. The chance of infection with AIDS or any other virus from a transfusion is really quite small.”
“How small?”
“Current estimates from the Centers for Disease Control say the chance of contracting transfusion AIDS is one in forty thousand. Others say the risk is larger—more on the order of one in eight thousand—because the average transfusion uses blood from more than one source, and thus the possibility of exposure is increased. Others put the odds at more like one in one hundred thousand.”
“There’s no way to test for the virus itself—not just antibodies?”
“There is such a test—a DNA polymerase chain-reaction assay. But it’s too difficult and too expensive to administer on a mass basis. Other efforts to detect the virus are still unproven.”
I thought over what I’d learned. “You don’t hear too much about all this, Doctor. Everything I read seems to say the blood supply is okay.”
“The blood supply is okay, in large part; there are fifteen million transfusions per year in this country, and most people survive the experience just fine.”
“That’s a lot of blood.”
“This is a two-billion-dollar-a-year business we’re talking about, Mr. Tanner. All the major drug companies are involved with blood in one way or another.”
“Which means they all have an interest in downplaying any problems with the product.”
“There’s no doubt that the blood people are reacting to the losses they’ve suffered from the panic of both donors and recipients because of the AIDS scare. Supplies are alarmingly low in some areas because of the concerns about safety. The nation’s largest blood bank gets twenty-five percent of its blood from abroad.”
“More balance-of-payments problems.”
“Among other things. And if the Gulf War goes the way many people fear it will, the demands on the blood supply will increase manyfold. We could be facing a crisis.”
“How long does blood last? I mean, after it’s been removed from the body?”
“Refrigerated whole blood lasts just over forty days, although a recent recommendation would reduce the storage period to half that because of fears that bacterial contamination can develop in the longer period. Red cells and plasma are usually frozen upon collection, which means they can be stored much longer.”
“One last thing, Doctor. What’s the deal with artificial blood?”
“That’s the new frontier, of course, but the news is mixed. Although dozens of pharmaceutical firms are working on it, there is as yet no FDA-approved blood substitute. Experiments in the 1970s with a fluorocarbon-based product and with artificial hemoglobin were not promising, although a fluorocarbon product has been approved for use by Jehovah’s Witnesses because they refuse human transfusions on religious grounds. Recent testing of genetically engineered clotting proteins holds the promise of freeing hemophiliacs from reliance on plasma-derived factor VIII, which has been the major source of the spread of AIDS among hemophiliacs. Just within the last few weeks, human tests of Hemopure, which is purified cow’s hemoglobin, have been authorized, though it’s too soon to tell whether adverse reactions wil
l be too severe to make that a viable substitute.”
“Cow’s blood, Doctor?”
Lodge laughed. “It has its advantages. One is that purified hemoglobin can be made without the outer shell of the red cell that envelops it, which means blood typing isn’t required and adverse reactions are reduced. Another advantage, at least in the public mind, is that cows don’t have AIDS.”
“Cows just have anthrax,” I said, and we shared a morbid moment and hung up.
Two minutes later, Jan called me back. “Did you find him?” she asked breathlessly, the bleary noise of the bar in the background.
“For a while.”
“Is he okay?”
“He seems to be.”
“What’s he doing? When’s he coming home?”
“I’m not sure what he’s doing—keeping a step ahead of the Other Side, it sounds like. We didn’t have much time to talk.”
“If you see him again, will you ask him to call me at Scanlon’s?”
I told her I would. “Listen, Jan. The stuff Nicky has been storing in your refrigerator—the stuff that was too creepy to talk about?”
She hesitated. “What about it?”
“Is it still there?”
“… Some of it.”
“How much?”
“I … Why?”
“Several bags?”
Her voice was leaden, as if the subject evoked images she would rather forget. “Yes. What about it?”
“Tom got some from you not long ago, right?”
“Yeah. What did he do with it, anyway?”
“He had it tested.”
“For what?”
I ignored her question. “I’m going to need some, too. Take three or four bags from the fridge and let them warm up. Don’t use a microwave or anything, just let them reach room temperature. I’ll be by tonight to pick them up.”
“Are you serious?”
“Totally. I’ll need you to come with me, if you can. It’ll be late. It could also be dangerous. Are you up for it?”
“Will it help Nicky?”
I couldn’t tell her what I really thought, so I made do with an evasion. “All I know is it’s the only way to learn what happened to his brother.”
THIRTY-FIVE
Guy Heskett had the easiest job—to stay awake and near a telephone. Because he smelled a breaking story and wanted an exclusive, he’d put on a pot of coffee while he was still pumping me for details. I put him off with a promise that he’d be first in line for whatever I had by tomorrow’s deadline.
Jan had gone along because she’d do anything for Nick and I’d implied my charade would help him in some vague way even though I knew that by the time the night was over I might be forced to tell her that the man she loved was doomed. I had been hoping I could at least put her in touch with him again, but true to his nomadic ways, Nicky Crandall didn’t show for our rendezvous at Glide Memorial, so he wasn’t a part of it at all. Which was probably just as well.
Clarissa was essential to the enterprise; I’d reached her as she was about to leave for the hotel. As usual, we sparred like club fighters in the beginning, but eventually she agreed to do her part, only because I told her this would end it, one way or another, and I’d be out of her life for good. I also promised no one would get hurt, which was one of many straws I was clutching at.
Tony had been the hardest to convince. I began by appealing to his regard for his fallen partner, but ultimately I had to threaten blackmail in the form of airing the more unsavory aspects of his days as a Healthways paramedic to convince him to go along. I also had to front the C-note he used to persuade the Atlas dispatcher to take his unit off-line for a couple of hours, purportedly so Tony could use it to “nail some nurse.”
By the time he honked for me in front of my apartment, Tony seemed eager to get at it, an instinct for adventure that explained his vocation and an inclination toward larceny that explained his willingness to steal an ambulance and provide the necessary equipment for a one-act drama I hoped wouldn’t take more than an hour. As we rolled through the Tenderloin on our way to pick up Jan, he regaled me with tales of murder and mayhem whose monuments were all around us. By the time we came to a stop in front of Pluto’s, I felt I’d been on a tour of Sodom under the guidance of the Marquis de Sade.
When the ambulance was snug against the curb, Tony glanced out the window. “Pluto’s, huh? Knew a lady worked a booth there once. Her thing was pudding. Stuffed a scoop of tapioca up her cunt, then let it drip into a beer mug and charged twenty bucks for a taste. Sandra was her name. Nasty.”
I told Tony to honk his horn.
A few seconds later, Jan emerged from the door to Pluto’s left. She was wearing a denim miniskirt and an orange top and was carrying a shopping bag with MACY’S branded on the side. The way they moved as she trotted toward us made the bulbous contents of the bag seem reptilian and alive.
I got out of the ambulance, thanked Jan for coming, relieved her of the bag, then gestured to my left. “This is Tony. Tony, Jan.”
In tribute to the miniskirt, Tony flashed his smile. “Yo, Little Mama. Some fun, huh? Bet you never went partying in an EMU before.”
Pale and frightened, Jan was beyond the courtesy of a smile.
“Do you mind riding in back?” I asked her. “It won’t be far.”
She shook her head, then climbed in the cab without a word and squeezed between the seats and sat on the floor beside the stretcher. When I was back in the cab myself, I put the Macy’s bag on the floor between my legs and told Tony to head for Cleveland Street. I took one last look at Jan. As we got under way, she reached for the oxygen cylinder at her side, embracing it as though it would save her from whatever was coming next. If I was anywhere close to the right answer, it might take a lot more than oxygen to save her.
I told Tony to park on Seventh Street within sight of the entrance to the Sandstone Club, then wait for further developments. The wait was long enough for me to learn more than I wanted about Tony’s sexual prowess and to worry that Jan was going to have second thoughts.
When her anxieties seemed about to erupt in flight, I told her she was the only one who could give my scheme the verisimilitude it needed, and that she’d be free to look for Nicky in an hour. When I finished my pitch, she rested her head against the stretcher and nodded reluctantly—Jan was used to quixotic behavior. A few minutes later, she asked Tony how the resuscitator worked, initiating a seminar that carried us over the minutes until RS-1 turned into Cleveland Street the way the Yorktown used to turn into Hunter’s Point.
It was déjà vu all over again. The limo glided to a stop beside the awning; Lex Chadwick got out and helped Clarissa Crandall to the street as well; the limo vanished around a corner; and Lex and Clarissa hurried inside the club. When Tony reached for the ignition, I told him to wait, then got out of the ambulance and walked to the corner. The Escort was about where I figured it would be; I walked up to it and knocked on the window.
Predictably, Garth Standish was already asleep—it took three taps on the window and a bang on the roof to wake him. In the grip of panic, he was tugging at the strap on his shoulder holster before he finally recognized me. I smiled and waved and made a face.
Standish rolled down the window with a grunt. “What do you want?”
“I’m relieving you again.”
“Like hell—you hung me out to dry the last time, asshole.”
“Sorry about that—I told her it wasn’t your fault.”
“Right.”
“You’re still on the job, aren’t you?”
“You bet your ass.” His brow furled in imitation of thought. “Why do you want rid of me?”
I came up with an answer Standish could understand. “I need to bill for my time, and Deirdre won’t like it if we double up.”
“You keep the whole fee, is that it?”
“I’ll split it with you.”
He was inclined to dicker some more, but the prospect of sleep was
too good to pass up. “If she bitches, I’m going to tell her you called me off,” he threatened bravely.
“Tell her something else while you’re at it.”
“What?”
“That this would be a good time to junk her marriage.”
I left Standish to wend his way to Slumberland and returned to the ambulance and listened to Tony and Jan discuss a succession of medical procedures that had me half-nauseous before they were finished.
Half an hour later, two limousines materialized beneath the Sandstone awning. Six minutes after that, five people exited the club and were whisked away in style—two couples and my old friend Lex. A moment later, the carriage lamps flashed off and on.
“This is it,” I said to Tony. “Put on your mask and gloves, then pull up in front of the awning.”
Macho to his core, Tony resisted disguise. “Someone got the plague, or what?”
“If this goes bad, the guy in there can have you in jail in a minute if he knows who you are.”
“So how come you’re not making like a bandit?”
“Because he knows who I am already.”
Tony shrugged. “It’s your show, man; just don’t make it an opera—I got to get the rig back by four.”
Tony and Jan put on their masks and rubber gloves, and Tony eased the ambulance into Cleveland Street and stopped in front of the club. Gear in neutral and engine idling easily, he looked at me for instructions.
“Where’s the IV stuff?”
Tony reached under the seat and pulled out an oblong package wrapped in a cotton towel. “You know how to use this thing?” he asked.
“Not really.”
“Then I better handle it.”
“It’s a battery, Tony. I’d better do it myself.”
“Better that than a homicide. I’ll handle it.”
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