by Karen Dionne
As he crumpled to the floor, he wondered: Could you die without knowing it?
Chapter 35
The guy just melted. One minute Ben was standing up, clutching his gut like he needed to go to the bathroom, and the next, his eyes rolled back and his knees quit. Ross broke off in midsentence.
“What’s wrong?” Zo craned her neck to look past him. “Holy cow! Is he—”
“Nah. He just fainted.” Ross clenched his teeth. He was so sick of her questions. Zo was as excitable as a little kid, always ready to presume the worst, her emotions ruled by a hair trigger that was forever shooting her in the wrong direction. He was tired of having to rein her in.
He crossed the room and pressed two fingers against Ben’s neck. “Pulse seems fine. Has he been drinking?”
“What, you mean alcohol? We don’t have any. At least, none that I know of.”
His jaw worked. “I meant water. He could have fainted because he’s dehydrated.”
“Oh. Well.” She pointed to the empty glass. “That was full last night. I topped it off before we went to sleep.”
Ross hadn’t slept, but he didn’t correct her. Zo would only interpret his watchfulness as chauvinism, when what had really kept him awake was the normal care and concern that any decent human being would extend toward another. He honestly didn’t know what Elliot saw in her. Sure, she was smart; tall and blondly good-looking if you were attracted to that sort of thing, and her childlike naïveté along with her earnest idealism could be mildly appealing on occasion. But most of the time she was far too prickly for his taste. Women like her were a stacked deck. Do something for yourself, and you were an insensitive boor; do something for her, and you became a macho pig. You couldn’t win.
He turned his attention to the person who wasn’t likely to give him an argument, and who would appreciate his help—or would have if he’d been conscious. Ben was still out cold, sweating, though his color was good. Ross nodded toward Ben’s feet. “Help me get him into bed.”
She flushed an angry pink, but did as he asked. He sighed. Did she have to take offense at everything? He was only trying to get the job done as expediently as possible. He supposed in her mind, he should have phrased his statement as a question, “Heads, or tails?” or at a minimum added a “please,” but it was just too tedious to have to give consideration to every sentence. Ross was a patient man, but patience had its limits, and she had no idea how close he was to reaching his. Zo didn’t like him; well, guess what—he didn’t much care for her.
She went over to the door and stood on her tiptoes to look out the window. “Still storming,” she said in a petulant voice, and went off to sulk in the area they had designated the kitchen: one big crate for a table, three smaller crates for chairs. She filled a glass from one of the jugs he’d brought over from the station, popped the top off a can of mandarin oranges, poured the syrup into a small dish and set it aside, then dipped in a spoon.
He left her to her breakfast and tucked the blanket around Ben’s shoulders. It was strange, seeing Ben again after so many years. He seemed little changed from when they’d gone to school. Funny, how one of the guys who had come to rescue them was someone he knew. Back at UCLA, he and Ben hadn’t been close; Ben was more like the friend of a friend of a friend; members of the same environmental protest group, was all. Ben hadn’t been part of the inner circle, which was why Ross was surprised yesterday when Ben confessed to a crush he’d had all those years ago on Ross’s sister. He wondered what Ben would think if he told him what his sister was planning to do to Ben’s ship.
His stomach growled. He stood up and stretched, then went over to the kitchen and dug through the food boxes until he found a low-calorie protein bar and a packet of freeze-dried coffee. He filled a mug and started it heating in the ancient microwave, then joined Zo at the table.
“I should be sick, you know,” she said.
So she was speaking again? And just when he was beginning to enjoy the peace and quiet. “I thought we decided you’re a carrier.”
“I’m not talking about the virus. I’m talking about my diabetes. I’ve been stuck in here for over a day without any insulin. I should be dizzy, thirsty, confused—all the lovely stuff that goes with hypoglycemia, and yet look.” She held out her hands. “Steady as a rock. If you knew anything about diabetes, you’d understand how strange that is. What’s really weird is that over the past few days, I’ve been needing less insulin. At first I thought it was because I was pregnant—you know, that maybe the hormone changes had thrown my blood glucose level out of whack. There’s something called gestational diabetes, where a woman without diabetes develops the symptoms during pregnancy, and I thought maybe my case was the opposite. But everything I’ve read says that pregnancy is more likely to exacerbate diabetes than not. I know diabetes doesn’t go away—yet this is the first time since I was ten that I haven’t had to take shots. It must be because of the stress.”
“Stress can affect blood sugar levels, but it wouldn’t reduce your insulin need. If anything, it would increase it. And I do know more about diabetes than you give me credit for. I’m diabetic, too.”
“You’re kidding. I had no idea.”
“It’s not as though we wear signs on our foreheads. I told you there’s a high incidence of diabetes among Native Americans.”
“Then you should be sick, too.”
“Exactly. But what you’re describing has been my experience as well. You say this has been going on for several days. When did it start?” He had an idea, but wanted her to confirm it.
“I guess I first noticed around the time everyone started getting sick. After Mac pulled his death-by-drowning stunt and I got back to the station, I remember thinking I should check my glucose level, but I was so cold and tired, I just didn’t feel like it. I remember thinking it wasn’t all that urgent anyway, so I guess by then it was already happening enough that I’d noticed it. The last time I can clearly remember taking a full dose was the day we found Sam.”
“It’s been the same for me. There has to be an explanation. Let me think.”
He took the mug from the microwave and stirred in the coffee as he mulled the mystery. Their decreased insulin needs coincided with the day Sam died, but beyond that, it was hard to see the connection. Sam stayed so exclusively apart from everyone else at the station there was nothing linking them other than they all lived at Raney. Yet something had initiated the change.
After a moment’s reflection, he found it: Sam had died the same day Zo’s rat disappeared. The rat that was later found in the cistern. The cistern that held the station’s water supply. He looked at Zo’s water glass on the table, at the empty beside Ben’s bed, and at the mug in his hand.
“Ross,” she said.
“Be quiet. I’m almost there.”
“It’s the water.” She held up her glass. “The water is contaminated with insulin. That’s got to be it. When people drink the water, they get sick because they’re getting too much insulin. All of their symptoms, the shakiness, the drowsiness, the sweating and dizziness and blurred vision and headaches—even their personality changes and hallucinations—are all symptoms of hyperglycemia. Elliot can’t get enough candy because he’s self-medicating to compensate for the insulin in the water he’s drinking, though he doesn’t know it. I’ll bet anything the others have been doing the same. That’s why some people are sicker than others; the amount of insulin overdose they’re getting depends on how much water they drink and how much sugar they eat to counteract it. The extra insulin doesn’t bother me because I watch my glucose levels and compensate by taking smaller doses.” She put down her glass and sat back satisfied. “That’s it. I’m sure of it. Everything fits.”
He rubbed his chin. Talk about losing a horse race by a nose. Aside from a few small differences, the scenario Zo had just laid out was exactly the one he’d been about to outline.
“Close,” he said. “Remember, the insulin molecule is water soluble. A diabetic can
drink all the insulin-laced water they want, and it won’t have any effect on them because the insulin molecule gets broken down in the gastrointestinal tract and becomes inactive. But a compound with insulin-like properties that acts on human insulin receptors would behave as you’ve described.”
“Okay, so it’s a compound with insulin-like functions. I still say it’s in the water.”
“And I agree. How do you think the water got contaminated?” He was curious to see if she’d discerned the answer to that, too.
“Pinky drowned in the cistern. I think there must have been something in his body that was producing insulin—the insulin-like compound. Maybe a bacteria in his feces. As Pinky decomposed, the compound was released into the water. You’re the microbiologist. What do you think?”
“I think you’re probably very close to being right. Though most likely a virus is involved, and not a bacteria, for a whole lot of reasons I won’t go into now. The virus would have been created purely by chance, selected for like all of the other useful substances found in microorganisms. A harsh environment makes the development of novel survival strategies more likely.”
“A viral infection explains some of the other symptoms people are experiencing, like throwing up and upset stomachs. Besides suffering from hypoglycemia, the victims are just plain sick. No wonder Luis couldn’t figure it out. Too many vague and overlapping symptoms.” Her expression sobered. No doubt she was thinking of the bodies stacked like cordwood in the maintenance shed.
“Here’s how I think this works,” he said. “Nothing happens in nature without a reason, so the virus has to get a survival advantage somehow. Viruses that produce proteins tend to wear them on their sleeve, incorporating their products by displaying bits on their outer membrane as something of an emblem. These bits of protein are called epitopes, and they have good and bad functions—they allow our immune system to recognize viruses, and they often give the virus uniquely helpful properties. In this case, displaying something analogous to insulin would trick our immune systems into thinking the virus was a natural part of our bodies, so our bodies wouldn’t attack the virus and destroy it.”
“Score one for the virus.”
“Exactly. Epitopes allow the virus to stick to the cells with insulin receptors for periods of time, facilitating their entry into target tissues like muscle, fat, liver, and brain. It’s a cruel world for microbes, and anything that doesn’t contribute to their survival advantage will kill them—especially if it’s something that requires energy to produce.”
“Okay, but if the virus produces a compound that sticks to insulin receptors, and it tricks the body into thinking it is insulin, and the virus lives in the rats’ intestines, how come the rats don’t get sick?”
“Drugs act differently on different species. It’s entirely plausible that the compound has a much more limited effect on rat receptors than human. If you don’t believe me, try giving a sleeping pill to a cat.” Ross was speaking from experience. When he was a teen, one of the family cats needed to be put down, and Ross had volunteered to do the deed. Out of kindness to the cat (and to make the job easier on himself), he’d wanted the cat unconscious first. But after shoving three Sominex tablets down its throat, instead of going to sleep like a good, little victim, the cat was completely wired, flying around the house like a Tasmanian devil on speed. Later, when Ross researched the experience on the Internet and confirmed that sleeping pills have the opposite effect on cats, he got his first lesson in pharmacology.
He smiled faintly at the memory. “There have to be advantages to the rats for harboring the virus. Our rats are on a severe carbohydrate restrictive diet. Some scientists believe that increased basal insulin function helps process glucose more efficiently.”
“Sorry. You lost me now.”
“Remember back when Oprah and others were promoting all those low-carbohydrate fad diets? The thought is that somehow, high carbs cause high insulin, and that makes people gain weight. Gaining weight is generally considered a bad thing in our society, but it’s a terrific idea if you’re a rat without a lot of food.”
“So somewhere between the time the first rats jumped ship and now, this virus/compound/rat symbiosis developed. It’s been working fine for decades. Everybody gets a survival advantage; nobody’s hurt; everybody’s happy. Then humans enter the picture, and everything goes to hell. And we’d never have figured it out if the helicopter hadn’t crashed and the rats hadn’t chased us in here.”
“That’s about the gist of it.” He shrugged. “Other major discoveries have been just as serendipitous.”
She shook her head in amazement. “Do you realize what we’ve done? We’ve just discovered a cure for diabetes.”
“Not a cure. The compound couldn’t be used to regulate blood sugar because the pulsatile flow would be all over the map. But it certainly represents an entirely new class of pharmaceutical agent. Most of our current drug strategies use similar techniques—finding something that works on a receptor of a related hormone or drug. In the drug world, a tiny selective advantage means you capture all of the market share until your patent runs out. If this drug were studied, maybe modified slightly, it could yield a whole new class of diabetes medications. It could be worth billions.”
“I can’t believe the solution is so simple.” She picked up the dish of discarded syrup and hurried over to Ben. Ross held him by the shoulders while Zo parted his lips and dribbled the syrup in.
Ben coughed, then groaned. After a moment his eyes fluttered and he sat up. “What happened?”
“You fainted,” Ross said. He caught Zo’s eye and shook his head. She was positively glowing and he knew that given half a chance, she’d start blabbing all the details. Their discovery was amazing and marvelous and all of the splendid and magnificent things she was no doubt thinking and feeling, but it was far too early to say anything about it—particularly to the latest victim.
“Huh,” Ben said. “I’ve never fainted before. First time for everything, I guess.”
“We’ve got to get back to the others,” Zo said. “We can cure them. We can save them.” She ran to the door and peered out. “Our luck’s finally changed. Look! You can see the moon.”
Chapter 36
She turned around. Ross was already digging through the food boxes.
“We need something sweet,” he said. “Something liquid or semiliquid that’ll be easy to dispense and carry.”
She crossed the room and tore through the boxes. Now that they knew what to do, there had to be survivors. They’d only been gone twenty-four hours. Some had to be hanging on, self-medicating by eating sweets, or unconscious and unable to drink and reinfect themselves. Please, God. Let one of them be Elliot.
She found a box of condiments—condiments in an emergency shelter—and took out a teddy bear-shaped plastic squeeze bottle. “What do you think?”
“Perfect,” Ross said. “Are there more? We should each have a bottle.”
She looked through the box again. “Just one.”
“That’s okay. Ben and I will work the men’s rooms together, while you check the women’s. Give everyone at least two teaspoons. If they’re not conscious, squeeze a little through their lips; then give them the rest as soon as they’re able to swallow. We want people to recover, not choke them to death.”
She stuck the bottle in her pocket and bit back a retort. What was it with men and control issues anyway? She thought Ross had softened, and was ready to treat her as an equal. Instead, he’d gone right back to taking charge and issuing orders. So much for old dogs making changes.
Ben was sitting on the edge of the bed with his head in his hands. He looked surprised when she put her hand on his shoulder. She knew how he was feeling. Coming out of an episode of insulin shock entailed an emotional collapse that was hard to describe to someone who hadn’t experienced it: A vague, vulnerable sensation as though you’d been peeled open and the layers whittled down until your very soul was exposed. It was a feeling
she had experienced only twice, and hopefully never would again.