“There was one thing . . . but I’m not sure it matters. I hadn’t thought of it until now. It was a little personal and I think Isabella was embarrassed about it.” Jack got the sense Audrey knew what she wanted to say but was searching for the right words. “Her breasts were getting bigger way too fast.”
Jack sighed silently. “I guess at her age it’s not too unusual for—”
“I raised two girls that now have kids of their own, Dr. Wyatt. Neither of them matured that quickly. It was almost like she really was pregnant. You asked if . . . well, I just thought it was a little unusual.” Peter moved forward and held a box of tissues out to her. In just above a whisper and with despair mirrored in her face, she added, “Isabella’s only fourteen . . . and she’s not pregnant, so there’s something different about her than all of the other women. Surely, you must have some idea what might be wrong with her.”
“We have some theories but we don’t have a specific diagnosis as yet.” Seeing her pained stare, he took her hands in his and added, “I promise you nobody’s going to give up until we figure this thing out.”
Audrey didn’t say anything. Jack released her hands and she walked to the head of Isabella’s bed. With the tear-soaked tissue clenched in her fist, she reached down and gently stroked her granddaughter’s hair as a sob escaped her lips.
35
Port-Menier, Anticosti Island
Located in the province of Quebec, Anticosti Island was home to 150,000 deer, a population that well outnumbered the 280 permanent residents. Called the graveyard of the Saint Lawrence, the treacherous gulf had claimed the lives of thousands of mariners over the years.
Alik Vosky sat on the end of his bed, staring at the blank screen of the television sitting atop his chest of drawers. He was pigeon-chested, and his stubby hands ended in fingernails that were buttery in color from years of smoking filterless cigarettes down to the last few millimeters. His father, an inconsequential bureaucrat whom Vosky had never come to love or admire, was completely bald. It was a fate he had managed to escape, having thick black hair that he wore combed hard against his craggy forehead hoping to conceal a nest of crosshatching wrinkles.
The master bedroom of the small guesthouse he’d rented on the island bore little resemblance to its spartan appearance the day he’d moved in. In less than a week, he had covered all four walls with bulletin boards of various sizes and shapes. Each was cluttered to capacity with dozens of multicolored papers and documents. The papers were a hodgepodge of handwritten and printed documents ranging in size from small Post-it notes to legal pad pages. Between the bulletin boards, Vosky had thumbtacked dozens more randomly overlapping papers to the walls. The floor, covered with a dreary olive carpet stained dark from age, had become a veritable obstacle course due to the numerous stacks of textbooks and scientific journals littering the space.
Ever since he was a child, Vosky had a strong belief in God. But in spite of his prayers, the exquisite pain he would occasionally suffer had now become a daily occurrence. Beginning as a dull ache across his entire forehead, it would quickly reach a fever pitch and then settle in as a relentless ring of pain around each eye. He massaged the bridge of his nose, but he did so more as a reflex than a remedy. His gaze shifted to his night table. An unopened pill bottle sat next to his lamp. He had placed it there the same day he’d picked it up from the pharmacy. For years he took them religiously, but now the bottle served only as a reminder of his prior life and how the medication had reined in the creative processes of his mind. It was on that same day he vowed never to push another one past his lips.
As he often did to distract himself from the endless throbbing, his thoughts drifted to his former life in Russia . . . a life he yearned to return to. But the large sum of ill-gotten money he had fled with made returning to his homeland impractical. He stood up and walked over to the small desk and sat down behind his computer. He brought up his project’s main file, which was a detailed timeline of events. To date he had achieved every milestone precisely on schedule.
Earlier in the day, he had decided to spend the evening going back over all the key calculations he had made. As his mentor at Kiev University had advised him, a great scientist steps out from amongst the trees every so often to study the forest. Vosky realized it was an observation that was uninspired and hackneyed, but he overlooked it because of his tremendous admiration for his professor.
What Vosky had created from nothing, what his colleagues in Russia had told him was impossible, he had accomplished and now had taken on a life of its own. He picked up the remote control to his television and turned on his library of video recordings. Although he had already watched it countless times, he brought up the story from the United States that featured Dr. Hollis Sinclair’s impromptu news conference. He watched the video twice before turning off the television.
In addition to being an insightful physician and researcher, Dr. Hollis Sinclair possessed charisma. Other doctors working on GNS in the U.S. would look to him for guidance and leadership. That was something Vosky knew he couldn’t allow. As proud as he was of what he’d accomplished on his own, he wasn’t naïve enough to think he could achieve ultimate success without some obstacles and setbacks along the way. What he needed to do with respect to Dr. Sinclair first entered his mind as nothing more than an intriguing idea; now, it was a moral absolute.
He got up, walked past the iron-framed double bed and stopped in front of a night table. Opening the drawer, he pushed a few envelopes and magazines aside and removed three passports. Each had cost him a small fortune, and each was an expert forgery. With a confident grin, he selected one. He then walked back to his computer and brought up his preferred travel website.
36
Jack walked slowly around the hospital gift shop, browsing for another Christmas present for his daughter. Being apart from her, especially during the holidays, was becoming increasingly difficult. He had even contacted the American Hospital in Paris to see if a consulting position could be arranged for a few months, but the amount of bureaucratic hurdles to leap over made the prospect near impossible.
After a few more minutes of perusing the store’s inventory, he decided on a rainbow unicorn stuffed toy. He was just about to sign the credit card receipt when he noticed Madison walk into the store.
“How did your meeting with Isabella’s grandmother go?”
“No revelations,” he answered, handing the pen back to the volunteer. “She did mention Isabella was having some lower abdominal and pelvic pain for the past few weeks. She spoke to her family physician about it, but he wasn’t concerned.”
“Did he order an ultrasound or a CT scan?”
“No. He didn’t think any tests were necessary.” Jack grinned.
“What?” she asked.
“It was nothing. I asked her if she had noticed anything at all out of the ordinary and she told me Isabella had been experiencing very rapid breast development of late.” He added, “I assured her that wasn’t what was making Isabella sick.”
Staring steadily at Jack, Madison eased the container of coffee away from her lips.
“You’re sure about the pelvic pain?” she asked.
“Yeah.”
“And the rapid breast development?”
“Of course I’m sure. I may be getting a little senile, but I still remember how to take a medical history.” A little taken back, he asked. “What’s going on?”
Madison handed her coffee cup to Jack, grabbed her cell phone and dialed Marc.
While she waited for him to answer, she paced back and forth.
“C’mon, Marc, pick up your damn phone.” Finally, on the sixth ring, he answered. “Marc, find an ultrasound machine right now and meet me in Isabella’s room. Don’t ask me any questions. I’ll explain everything when I see you.” She drew a sharp breath, gestured toward the lobby and said, “C’mon, let’s go.”
“What’s goin
g on?”
With a smile that couldn’t be contained, she answered, “Well, if I’m right, you may have just stumbled across our first real clue for finding out what’s causing GNS.”
37
University Medical Center
Birmingham, Alabama
One year ago, quite by chance, Dr. Mary Grandeson, director of toxicology services, stumbled upon the perfect hideaway. The small library in the old rehabilitation unit had, for all intents and purposes, been forgotten and abandoned. The furnishings were sparse, consisting of a black metal desk, two upholstered chairs and a saggy corduroy couch. In spite of the hint of must in the air, the small library was the perfect escape from the constant barrage of interruptions, and for Mary, the perfect place to work.
As all of the physicians who had been asked by the surgeon general to serve on the elite GNS task force had done, Mary had shelved all of her other projects in order to devote herself entirely to the current GNS crisis. After her presentation at the CDC in Atlanta, she had heard from many of the attendees who expressed their strong conviction that the cause and the cure for GNS might very possibly come from her work in nanotechnology.
One of the few people who was aware of Mary’s hideout was her senior research associate, Wright Zarella. Prematurely bald with curled shoulders, Wright had earned his M.D. and had completed a pathology residency in Minneapolis. Because of his special interest in the threat of nanotoxins and e-waste products, he applied to and was accepted to Mary’s department as a Ph.D. candidate.
Working on her laptop, she barely noticed when he strolled into the library.
“I think I’ve come across something that might interest you,” he told her, pulling up a chair.
She barely looked up from her laptop. “I’m listening.”
He slid a manila file across the desk. She picked it up and shook her head. “Just how many of those awful sweater vests do you own?”
“I don’t know,” he answered looking down at the sweater. “About a dozen I guess. You never said anything before.”
“That’s because they’re terrible,” she said with a quick roll of the eyes as she opened the file. “Toxicity of cosmetic skin care products? C’mon, Wright, we’ve been over this ground so many times it’s trampled beyond recognition.”
“Well, there may be one small patch we missed. Keep reading.” She looked at him with a measure of skepticism as she waited for him to continue. “A few years ago, when certain skin care product manufacturers began using nanoparticles, concern was raised that these particles could theoretically penetrate the skin and be toxic to the user.”
“I’m familiar with the theory. As you may recall, I’m the one who taught it to you. But the key word is theoretical, and as far as I know, nobody’s ever been able to prove it.”
“That’s true, but all of those studies were done on normal skin.”
“What other kind is there?”
“Well, being pregnant changes the hormonal balance in the body. Maybe that includes the skin,” he said with arched eyebrows. He pointed to the file in front of her. “Last month an article appeared in an obscure European medical journal. The research group is from Magdeburg, Germany. They studied skin penetration of nanoparticles, but with a slightly different slant. Instead of normal skin, they studied it in a number of different situations.”
“Like what?”
“Well, amongst others—pregnancy. Their conclusion was that these particles easily penetrate the skin.”
“Did they offer an explanation as to why?”
“Nothing definite. They can only speculate that the hormonal changes during pregnancy affect the normal skin barrier in some way that allowed these particles to pass through and get into the bloodstream.”
Mary slid the article from the folder. “What type of nanoparticles did they use?”
“They chose three; all of which are commonly used in cosmetic skin creams.”
Grandeson pushed her chair closer to the desk and then read every word of the article.
“This is a pretty small study group but it seems well done from a scientific standpoint.” She tossed the article back on the desk. “Assuming the study is correct and some of these nanoparticles can penetrate the skin. Even if they do, there’s still no evidence they cause any harm.”
“But there’s no evidence they don’t.”
Grandeson exhaled gradually, stood up and strolled over to the only window in the room.
“So, you’re postulating that a nanoparticle that has never been proven to be harmful can penetrate the skin of pregnant women and cause GNS.”
“I’m simply saying it’s a possibility.”
“Okay, let’s follow your logic pattern for a moment. I have two questions. The nanoparticles used in this research have been around in cosmetic products for the last five years or so. If they’re the cause of GNS, why has it taken this long for the first cases to appear?”
Wright remained silent for a few seconds and then with a wrinkled forehead asked, “What’s your second question?”
“Why have all of these cases presented within days of each other?”
“I have no answer for that one either,” he responded.
“Any idea of the type of cosmetic product we might be looking for?”
“Nope, but there are just so many new skin care lotions and other products hitting the market monthly. If we go back six months, it shouldn’t be too difficult to come up with a list.”
Mary leaned forward and replaced the article in the folder. “I don’t suppose we already have information in the National Patient Registry regarding the cosmetic products our GNS patients were using.”
“Unfortunately, none of the hospitals thought to include those questions in the basic family interview.”
“Before we send the whole country into a frenzy with a theory that may be nothing more than a good bedtime story, let’s reinterview the GNS families here in Alabama regarding skin care and other cosmetic products.”
“You’re talking about a few hundred patients, and time is something we don’t have a lot of. We’re going to need some help.”
She sent an easy nod in his direction. “You’re an industrious young man, Wright. I’m sure you’ll be able to muster all the assistance you’ll need.”
With a dubious grin, he answered, “I’ll put a questionnaire together for the families and run it past you before we get started.”
“Sounds good. Our next meeting’s in Atlanta in a few days. It would be nice if we had some preliminary information on this stuff to present.”
“Shouldn’t be a problem.”
He jumped to his feet and headed for the door. Grandeson closed the lid to her laptop. Her mind was doing backflips, wondering if there could be any possibility Wright was onto something. There were hundreds of brilliant minds in the country working tirelessly to solve the enigma that was GNS. All of them were feeling the mounting pressure from countless national and state medical organizations and elected officials to come up with an answer. You couldn’t turn on the television or pick up a newspaper without being inundated with the latest GNS horror stories. Mary was no different than millions of other people in the country—the usual joy of the holiday season was conspicuously missing from her life.
Her eyes drifted to the far wall. She thought about her pregnant sister in Oklahoma she had been calling twice a day since the first case of GNS was reported. She was five months pregnant and, so far, perfectly healthy. Staring at a framed photograph of her sister and her on a ski vacation, she wondered if Wright could possibly be correct, which would mean the solution to GNS had been staring her in the face right from day one.
38
By the time Jack and Madison reached Isabella’s room, Marc had already powered up the ultrasound machine and applied a generous layer of jelly to her lower abdomen.
“I’m all set,” he said, selecting one of the probes that hung from the side of the machine. “It might help if I knew what I was I looking for.”
“I want to see her ovaries,” Madison said, looking over her shoulder at Jack. “What side did you say her pain was on?”
“Her right.”
She looked back at Marc. “Start on the left.”
“She’s very thin. We should get a pretty good view,” he said, using a practiced touch to tilt the probe in various directions and angles across her abdomen. “There,” he said, gesturing at the screen. “There’s the left ovary. Size and appearance seem fine. Looks like a normal ovary to me.”
“I agree,” Madison said. “Let’s have a look at the uterus and then the right ovary.”
Marc eased the probe toward the right. “The uterus appears normal.”
To Jack’s untrained eye, the blending of the gray, black and white shades and shadows looked more like a complex weather map than the female reproductive organs.
It took Marc only a few seconds to locate the right ovary. He was still making the final adjustments to sharpen the image when Madison jumped forward. “There it is,” she said, pointing to the central portion of the screen. “It’s not the biggest ovarian tumor I’ve ever seen, but it’s real and it’s right there.”
Marc held the probe perfectly still. “I’d say it’s about two centimeters.”
“Three,” she stated with certainty “Make sure you get some good pictures.”
“Have I ever let you down before?” he responded with a broad smile.
Feeling invisible, Jack asked, “What are you guys talking about?”
“Isabella has a tumor on her ovary,” Madison explained. “Some of these tumors produce large amounts of hormones, which are the exact same hormones that normal pregnant women produce. So, it would seem likely from a hormonal standpoint that there’s no difference between Isabella and every woman in the country with GNS.”
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