She returned to the two department chiefs and shrugged.
“Have you anything to offer her?” Snyder asked.
“I don’t know. I can try some of the things I did with Lisa. But no guarantees.”
Snyder glanced over at the fetal monitor. “Eli, I’ve got the anesthesiologist and the pediatrician standing by. But I want to exhaust every possibility before we go ahead with a section.”
A unit clerk raced in and handed Eli a computer printout.
“These clotting studies look remarkably like Lisa Summer’s did,” he said. “They make DIC pretty much a certainty. We’ve got to get her on heparin. Sarah, if you want, I’ll give you ten minutes—fifteen if she gets no worse.”
“I can’t promise anything, but I’ll do what I can,” Sarah said. “Someone please talk to her father and tell him what’s going on.”
Her thoughts swirling, she raced past Peter, and off the labor and delivery floor. For months she had hoped Rosa was wrong about their seeing just the tip of the iceberg; prayed that they had encountered the last tragedy from the macabre, malignant complication of childbirth. Now the lives of Annalee Ettinger and her daughter were on the line. But having studied the previous cases so intensively, Sarah had questions. Why the high fever? Why the unusual pattern in her twelve acupuncture pulses? Why the rapid evolution of symptoms?
She took the tunnel to the Thayer Building, bypassed the elevator, and raced up the five flights to her locker.
“Two spins to the right, then stop at three … left to forty …”
As always, Sarah murmured the combination to herself as she dialed it. Halfway to the forty, the dial caught momentarily. In freeing it, Sarah spun well past the number. She cursed out loud. Even in the most trying OR situations, her hands had always been her most supple, dependable allies. Now, with Annalee in such trouble, they were stiff as cold taffy. She was about to spin through the combination again when she noticed the scratches in the metal door, just beside the lock. Instead of redoing the combination, she tugged on the dial. Her pulse was throbbing in her ears as the door swung open. Her lacquered mahogany box of acupuncture needles was gone, as was the electrostimulator she occasionally attached to them. In their place was an unopened Federal Express box addressed to her care of MCB. On top of the box was a small brown paper bag.
Her hands trembling, Sarah reached into the bag and withdrew a glass vial and a receipt. The vial was empty, but its label made all too clear what was going on. It also answered the gnawing questions about Annalee’s clinical picture.
CROTALID (MIXED RATTLESNAKE) VENOM –
FOR RESEARCH
PURPOSES ONLY
CAUTION: HIGHLY POISONOUS
HAVE ANTIVENIN AVAILABLE,
AND REVIEW USAGE
The receipt, from a mail order laboratory supply house in Houston, was made out to her. Sarah dropped the vial into her clinic coat pocket and carefully tore open the FedEx package. There was no doubt in her mind what it contained. Polyvalent Crotaline Antivenin—twenty vials in all.
Badly shaken, Sarah stood alone by her open locker on the dimly lit fourth-floor corridor of the Thayer Building. In her pocket was quite likely the cause of Annalee’s hellish, imminently lethal situation. In her hands was the cure. No one was likely to believe her story that both the empty poison vial and the packaged antidote had been placed in her locker by whoever had actually administered the venom to Annalee.
If her account of Andrew’s death had strained her credibility around MCB, this latest tale would snap it.
It made much more sense to believe that Sarah had infused the rattlesnake poison in order to create a case of labor-induced DIC that was unrelated to her herbal supplement. That Annalee was supposedly her friend would impress no one—especially after Peter got through telling whatever version of their history he concocted. Why, then, had Sarah produced the antidote? Perhaps, some people would reason, she had intended to create a dramatic though sublethal condition, but had missed. Only when things were clearly on a downhill slide for Annalee had she come up with the antivenin—and the farfetched explanation that it had just shown up in her locker. Perhaps, others would claim, she had not initially cared whether the case was sublethal or lethal. But seeing Annalee’s extreme distress had brought about a sudden change of heart.
The two groups might argue over nuances. But clearly, there was one and only one logical explanation for Sarah’s miraculous, eleventh-hour discovery of both the cause and cure of Annalee’s DIC. Sarah herself had to have administered the toxin in the first place. No one with half a brain would believe otherwise.
For a moment, the notion flickered through her mind simply to dispose of the empty vial and the antivenin. She could say that her locker had been pried open and her acupuncture needles stolen. No one except the person who had set her up would ever be the wiser. With luck and aggressive treatment, Annalee and her child—or at least one of them—might possibly survive. And as Randall Snyder had said, with a case of DIC unrelated to Sarah’s herbal supplements, she would at last be off the hook. By the time Sarah was even aware of having that notion, she was bounding, three at a time, down the stairs to the tunnel, the precious FedEx box tucked beneath her arm like a football.
The scene in Annalee’s room was much as it had been when Sarah sprinted off, except that hematologist Helen Stoddard was now conferring with Eli and Randall Snyder. Sarah groaned at the sight of her. Since their conflict over Lisa Grayson, they had passed in the halls and sat near each other at conferences, and not one word had been exchanged between them.
Well, Dr. Stoddard, Sarah thought as she approached the three treating physicians, if you thought I was a quack before, you’re going to think I’m a positive lunatic now. And a homicidal lunatic at that!
“I need to speak with you all over here,” Sarah whispered, motioning toward the only unoccupied corner of the room. “It’s very important.”
“Not again.” Helen Stoddard moaned. “Eli, I thought you promised—”
“Helen, either shut up or leave,” Eli snapped with uncharacteristic impatience. “This girl is in big trouble. We’ve got to do whatever we can to save her.”
“What’s going on?” Snyder asked. “Are you all going to give her the heparin or not?”
“Yes,” Helen Stoddard said, quickly and definitively.
“I think you’d best hear what I have to say first,” Sarah countered.
She briefly described what she found at her locker and showed the three physicians the contents of the FedEx package.
“I was concerned about Annalee’s high temperature, the speed with which her symptoms were developing, and also the pattern of her twelve acupuncture pulses. Crotalid poisoning would explain all that.”
“You’re absolutely mad,” Helen Stoddard said. “Someone purposely placed this in your locker? How on earth can you possibly expect us to swallow—”
“Dammit, Helen,” Eli cut her off. “Would you just listen for once?”
The woman glared at him, then at Sarah. Then she whirled and stormed from the room. A moment later Peter Ettinger stormed in.
“What in the hell is going on here? Why did the hematologist leave that way?” he demanded.
Eli moved to confront him, but Sarah stopped the professor with a raised hand.
“Wait, Dr. Blankenship,” she said. “Please. I know how important Annalee is to Peter, and I know how worried he is about what’s going on. Let me talk to her for a second.” She whispered a few words in Annalee’s ear and then returned to the group. “Annalee says it’s all right with her if he stays.”
“Okay,” Blankenship growled. “But one disruptive word, Ettinger, and you’re out.”
“Peter, Annalee has been poisoned,” Sarah said. “Someone has injected crotalid venom either into her IV line or into the IV bag. I don’t know enough about crotalid venom to know which or when it was done. But I am absolutely certain of what I’m saying. It is essential that we get this antivenin into
her as soon as possible.”
“This is insane,” Ettinger said.
“How do we know the antivenin is what is in those vials?” Randall Snyder asked.
“Well, for one thing, they’re sealed. For another, if this was anything but antivenin, there would be no sense in someone placing it in my possession.”
“Assuming someone did,” Peter said.
“Dr. Blankenship,” Sarah asked, ignoring Ettinger, “do you know if there are any side effects to the antivenin?”
“An allergic reaction to the horse serum it’s made in, I would think,” Blankenship said. “Nothing else comes to mind.”
“We can handle that.”
“Here, let me see the package insert.”
Randall Snyder glanced once again at the fetal monitor. “Eli, there’s been a slight drop in the baby’s pulse. You’ve got to decide.”
“Crotalid poisoning,” Peter said. “Sarah, you are really crazy.”
“Ettinger, this issue has been decided,” Eli warned, glaring at the taller man from beneath his massive brow. “Either go stand on the other side of the bed or get the hell out.”
Peter hesitated and then rather meekly did as he was ordered. Eli quickly scanned the instructions and drew the contents of ten of the vials into a large syringe. Sarah explained the situation to Annalee. There was complete silence in the room as Eli slid the needle into the rubber port of the IV tubing and slowly discharged the cloudy liquid into her bloodstream.
The response to the antivenin was dramatic.
In less than five minutes, Annalee reported that the intense pain in her extremities had begun to abate. Twenty-six minutes after the injection, the bleeding from her nose and needle stick sites stopped completely. By early afternoon, her fever was gone and nearly all of her clotting studies and other laboratory tests were normal.
Six hours after the administration of the antivenin, Glenn Paris convened an emergency session of the executive committees of the hospital trustees and medical staff. After hearing the accounts of Randall Snyder, Eli Blankenship, Helen Stoddard, and the labor and delivery nurses, the participants voted unanimously to place Sarah Baldwin on immediate, indefinite, paid leave from the hospital and from her residency until the details of her involvement in Annalee’s case became known with certainty.
• • •
The body had been in the morgue at the state medical examiner’s office for three days before a definitive identification was made. Actually, body was not so apt a description of the remains as skeleton. A week before, the crew of a trawler, fishing seventy-five miles off the Massachusetts coast, had hauled it aboard along with several hundred pounds of haddock.
The skeleton had not a shred of clothing or tissue left on it, except for some cartilage on the ribs and in several of its joints. Still, the medical examiner was able to place the time of death within the past six months. He also had no problem classifying the death as a homicide. There were fracture/dislocations of two cervical vertebrae. The nature of the bony fragments strongly suggested blunt force. The ropes and diver’s weights, still tied around the skeleton’s extremities and what was once its midsection, removed what doubt remained.
Now, the ME inspected the dental X rays obtained from the Boston police. His dental forensics expert had just matched them with certainty to those films taken of the skeleton. He dictated his findings into a hand-held recorder and then called the BPD detective who had sent the X rays over.
“I think you can contact the missing man’s family and tell them he is no longer missing,” the medical examiner said. “Unfortunately, it would seem that your Dr. Truscott has done his last operation.”
CHAPTER 35
IT WAS EARLY AFTERNOON WHEN MRS. ANNIE FRUMANIAN knocked on Rosa’s door.
“It’s that charming Mr. Mulholland calling from Atlanta,” she twittered.
Mulholland, who had flown home shortly after the visit to BIO-Vir, had spent his one night in Boston at her bed and breakfast. He was an almost legendary insomniac, and had made inestimable points with Mrs. Frumanian by staying up until well past midnight listening to stories of her life. He later told Rosa that no prescription sleeping pill had ever worked as well on him.
“Ken, have you got anything?” Rosa asked, once she was certain the landlady had hung up the extension.
“An address from three years ago is the best we’ve been able to do so far,” the virologist said. “If you find our Mr. Fezler, maybe you should let him know that, assuming the social security number we used is the right one, we have inadvertently alerted the IRS that he hasn’t filed a tax return in four years.”
Fezler, the creator of the CRV113 virus, was almost certainly the skittish, stuttering little man who had tried to make contact with Sarah. However, although the old-timers at BIO-Vir remembered him as having been there for at least five years, none of them knew anything about his personal life, and there was no record in personnel that he had ever worked for the lab. From what little their inquiry around BIO-Vir turned up, Rosa and Ken had formed a picture of Fezler as an extremely solitary, very bright, and strikingly overweight man, perhaps in his late forties or early fifties. While in BIO-Vir’s employ, he lost an enormous amount of weight. He also lost an enormous number of monkeys. And much to the dismay of animal supervisor Cletus Collins, the record of those primates, like Fezler’s personnel file, had vanished.
It was Mulholland’s idea to use FASTFIND to locate him. The FASTFIND computer network had been implemented in 1981 by a commission secretly appointed by the President. Its purpose, purely and simply, was to track down individuals for the government. It cost over $12 million to install, but in its first year of operation, the tax evaders alone that it located more than paid that bill. It functioned by rapidly integrating data from the IRS, FBI, military, police, social security administration, passport office, immigration and naturalization service, credit bureaus, unemployment offices, motor vehicle licensing offices, and a dozen national mailing lists. Rosa’s department had used the system a number of times to locate people who had been exposed to infectious processes and dangerous toxins.
“The address I got for Fezler is in a place called Brookline,” Mulholland said.
“I know where Brookline is.”
“Three thirty-one Beech; apartment two-F.”
Rosa wrote down the address and then located it on her street map.
“I found it,” she said. “Another cab ride. I don’t know which frightens me the most with all these taxis I’ve been taking: the fares or the drivers. Maybe it’s time to think about renting a car.”
“Or borrowing one. Remember, you’re on sick leave. No charging rentals to Uncle. Rosa, listen, there’s one more thing of interest. While I was in Boston, one of my people here was sneaking in some more tests on Lisa’s serum. We’re getting a little above normal blip in her level of interferon.”
“Interferon?”
Rosa took some time to process the development. Interferon, a naturally produced antiviral protein, was well known and extensively studied, but still little understood. In high doses, it had definite anticancer effects. In the lower amounts produced by the human body, it almost certainly played a role in keeping chronic viral infections like herpes and chicken pox in check.
“Ken,” she said finally, “walk me through your thoughts on this.”
“Well, the way I see it right now, Lisa’s got a subclinical, no-symptoms infection with CRV113. The growth of the virus is held in check by her own interferon, antibodies, or more likely both. Sort of a biological Mexican standoff. I suspect we all have dozens of different viral infections smoldering in our bodies like that. Some of them may even be ones that cause certain forms of cancers. Anyhow, here’s this smoldering CRV113 infection, not getting any worse, not getting any better. Then some specific stress comes along to upset the delicate balance …”
“Like labor.”
“… And bam! The virus gets the upper hand.”
“And
begins doing more and more of whatever thing its DNA tells it to do. In our cases, inappropriate activation of the clotting pathway.”
“Exactly. Then the stress is removed and the body summons up more interferon and more antibodies until balance is restored.”
“But are there ever any knockouts? I mean of the virus.”
“Maybe some,” Mulholland said. “Maybe lots. But the herpes simplex model—the one we know the most about—suggests that there are lots of draws. Anyone who has ever had cold sores or sun blisters pop out over and over again can attest to that. The whole field of chronic viral infections is still too new to know precisely how it all works.”
“Ken, this is beginning to come together.”
“Perhaps. There’s still a load of questions.”
“Only now we know who probably has the answers.”
“013-32-0885.”
“013-32-0885,” Rosa echoed.
• • •
“Matt Daniels to see Mr. Mallon,” Matt said.
He glanced past the receptionist, through the glass-enclosed library, and out at Boston Harbor. Several years before, he had actually sent in a résumé to the firm of Wasserman and Mallon. He had been granted an interview with a junior partner, who produced a ball for Matt to autograph and asked, perhaps, one or two questions unrelated to sports during their twenty-minute session. The man, whose name Matt could not remember, had not even bothered to suggest that his application would get serious consideration.
It had not been necessary for Matt to explain to Jeremy Mallon his reason for wanting a meeting. Roger Phelps had laid the necessary groundwork. Given the choice of sites, Matt had opted for Mallon’s office, perhaps in some sort of grand, ironic gesture to that sanctimonious junior partner. There was also, of course, the more practical matter of his not yet having cleaned up the glass and shattered furniture from his own office.
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