Robin Cook

by Mortal Fear

  Descending to the street, Jason removed the parking ticket from his windshield wiper. Sliding in behind the wheel, he thought about his conversation with Detective Curran. The man had been cordial, but he obviously gave little credence to Jason’s thoughts and intuition. As Jason started his car, he remembered something else Hayes had said about his discovery. He’d said it was “ironic.” Now that was a weird way to characterize a major scientific breakthrough, especially if someone were contriving the story.

  Back at the GHP, Jason returned to his patients, going from room to room listening, touching, sympathizing, and advising. That was what he loved about medicine. People opened themselves to him, literally and figuratively. He felt privileged and needed. Some of his confidence ebbed back.

  It was close to four when he approached exam room C and took the chart. He remembered the name. It was Paul Klingler, the man whose physical exam he had done. Before entering the room, Jason quickly reviewed his workup. The man appeared to be healthy, with low normal cholesterol and triglycerides and normal EKG. Jason entered the room.

  Klingler was slender, with sandy blond hair and the quiet confidence of an old moneyed Yankee. “What was wrong with my tests?” he asked, concerned.

  “Nothing, really.”

  “But your secretary told me you wanted to repeat some. That I had to come today.”

  “Sorry about that. There was no need for alarm. When she heard you weren’t feeling well, she thought we should take a look.”

  “I’m just getting over the flu,” Paul said. “Kids brought it home from school. I’m much better. The only problem is that it has kept me from exercise for over a week.”

  The flu didn’t scare Jason. Healthy people didn’t die of it. But he still examined Paul Klingler carefully and repeated the various cardiac tests. Finally he told Klingler that he’d call if the blood work revealed any abnormalities.

  Two patients later, Jason confronted Holly Jennings, a fifty-four-year-old executive from one of the largest Boston advertising firms. She was not happy and certainly not shy about expressing her feelings. And although there was a sign specifically forbidding it, she’d been smoking in the exam room while she had been waiting.

  “What the hell is going on?” she demanded as Jason entered the room. Her physical a month ago had given her a clean bill of health, though Jason had warned her to stop smoking and take off the twenty to thirty extra pounds she had put on in the last five years.

  “I’d heard you weren’t feeling well,” Jason said mildly. He noticed she looked tired, and saw the dark circles under her eyes.

  “Is that what this is all about?” she snapped. “The secretary told me you wanted to repeat some tests. What was wrong with them?”

  “Nothing. We just wanted to do some follow-up. Tell me about your health.”

  “Jesus Christ! You drag me down here, scaring the hell out of me, making me miss two important presentations, just to have a conversation. Couldn’t this have been done on the phone?”

  “Well, since you’re here, why don’t you tell me how you’ve been feeling.”

  “Tired.”

  “Anything else?”

  “Just generally lousy. I haven’t been able to sleep. My appetite’s been poor. Nothing specific … well, that’s not true. My eyes have been bothering me. I’ve had to wear sunglasses a lot, even in the office.”

  “Anything else?” Jason asked, feeling an uncomfortable prickle of fear.

  Holly shrugged. “For some goddamn reason my hair’s been thinning.”

  As carefully as possible, Jason examined the woman. Her pulse and blood pressure were up, although that could have been due to stress. Her skin was dry, particularly on her extremities. When he repeated her EKG, he thought there might have been some very mild ST changes suggesting reduced oxygen to her heart. When he suggested they do another stress test, she declined.

  “Can I come back for that?”

  “I’d rather do it now,” Jason said. “In fact, would you consider staying in the hospital for a couple of days?”

  “Are you kidding? I don’t have time. Besides, I don’t feel that bad. Why do you even suggest it?”

  “Just to get everything done. I’d like you to see a cardiologist and an ophthalmologist as well.”

  “Next week. Monday or Tuesday. But I’ve got some big deadlines.”

  Reluctantly, Jason let Holly go after drawing some blood. There was no way he could force her to stay, and he had nothing specific enough to convince her she was in trouble. It was just a feeling: a bad feeling.

  Following his usual routine after returning home, Jason jogged, stopped into De Luca’s Market where he got a Perdue chicken, put his meal in the oven, showered and retreated to his den with an ice-cold beer. Making himself comfortable, he continued his reading on DNA. He began to understand how Hayes could isolate specific genes. That was what Helene Brennquivist had probably been doing that morning. Once an appropriate bacterial colony was found, it was cultivated to produce trillions of bacteria. Then, using enzymes, the bacteria DNA was separated, fragmented, and the desired gene was isolated and purified. Later, it could be spliced back into different bacteria into regions of the DNA that could be “switched on” by the researcher. In that form, the recombinant strain of bacteria acted like miniature factories to produce the protein the gene was coded for. It had been this method that Hayes had used to produce his human growth hormone. He had started with a piece of human DNA, the gene that made growth hormone, cloned it by the help of bacteria, then spliced it into bacteria DNA in an area controlled by a gene responsible for digesting lactose. By adding lactose to the culture, Hayes’s recombinant strain of bacteria had been “turned on” to produce human growth hormone.

  Jason drained his beer and went into the kitchen and popped another. He was overwhelmed by what he’d learned. No wonder scientists like Hayes were strange. They knew they had the power to manipulate life. This comprehension thrilled Jason and disturbed him at the same time. The DNA technology had awesome potential to do good and harm. The direction, he thought, was a toss-up.

  Armed with this information, Jason was even more inclined to believe that Hayes, though under general stress, had been telling the truth—at least about the scientific breakthrough. Jason was not so sure about Hayes’s statement that someone wanted him dead. He wished he’d spent more time with the man over the last months. He wished he knew more about him.

  Opening the oven, Jason checked his chicken. It was browning nicely and looked delicious. He put water on to boil for rice, then went back to the den. Lifting his legs onto the desktop and tilting back his chair, he started the next chapter on the laboratory techniques of genetic engineering. The first part dealt with the methods by which DNA molecules were fragmented with enzymes called restriction endonucleases. Jason had to read the section several times. It was difficult material.

  The shrill whine of the smoke detector startled Jason. Leaping up from the desk where he’d fallen fast asleep, he dashed into the kitchen. The water for the rice had boiled away, and the Teflon lining was smoking, filling the kitchen with acrid vapors. Jason shoved it under running water, where it spattered and hissed. Turning on the exhaust fan and opening one of the living room windows slowly emptied the kitchen of smoke, and finally the smoke detector fell silent. Jason was glad the landlord was out of town as usual.

  When his dinner was finally prepared, without rice, Jason carried it to his desk in the den, pushing papers and books aside. As he started eating he found himself looking at the front of the Boston Globe with the article “Doctor, Drugs and Dancer” staring him in the face. Picking the paper up in his left hand, he looked at Carol Donner again. The idea that Hayes would have been living with the woman confounded him. Jason wondered if Hayes had fallen prey to the age-old male fantasy of rescuing the prostitute who, despite her work, had a heart of gold. Thinking of Hayes as a colleague with similar background including the same medical school, Jason found the idea of him fal
ling for such a cliché farfetched. But as Curran had said, facts were facts. Obviously Hayes had been living with the girl. Jason tossed the paper aside.

  After reading what he could find about dry skin, which wasn’t much, Jason carried his soiled dishes to the kitchen and rinsed them. The image of Carol Donner with her hand in front of her face kept popping up in his mind. He looked at his watch. It was ten-thirty. “Why not,” he said aloud. After all, if Hayes had been living with the woman, maybe she knew something that could give Jason a clue about Hayes’s breakthrough. At any rate, he had nothing to lose. Donning a sweater and a tweed jacket, Jason left the apartment.

  From Beacon Hill it was only a fifteen-minute walk to the Combat Zone. But fifteen minutes took Jason an enormous social distance. Beacon Hill was the epitome of comfortable wealth and propriety, with its cobblestone streets and gas lamps. The Combat Zone was the sordid opposite. To get there, Jason skirted the edge of the Boston Common, reaching Washington Street with its row of bottomless bars by way of Boylston Street. There were roaming packs of street people mixing uneasily with groups of boisterous students and leather-jacketed blue-collar workers from Dorchester. The Club Cabaret was in the middle of the block, nestled between an X-rated cinema and an adult bookstore with a variety of supposed sexual aids on display in its window. The TOPLESS COLLEGE GIRLS sign glowed with fluorescent paint.

  Jason walked up to the door and went inside. He found himself in the bar, a long, dark room illuminated in the center to spotlight a wooden runway. The bar itself was U-shaped and surrounded the runway. Behind there were small booths, and rock music thudded into the room from large speakers. flanking the stairs that led to the runway from the floor above.

  The air was foul with cigarette smoke and that peculiar chemical odor which smells like cheap room-deodorant. The place was almost filled with men hunched over drinks at the bar. It was difficult to see into the booths, but as Jason passed, he glimpsed numerous women in low-cut spaghetti-strap dresses. He found a stool at the bar. A waitress wearing a white shirt and tight black shorts took his order almost instantly.

  As she brought his beer and a glass, a seminude dancer came down the stairs and pranced along the runway. Jason gazed up at her, catching her eye for a brief instant. She looked bored. Her face was heavily made up, and her bleached hair had the consistency of straw. Jason guessed her age to be over thirty, certainly no coed.

  Glancing around the room, he noticed equivalent expressions of boredom on the faces of the men as their eyes reflexively followed the progress of the dancer up and down the runway. Jason sipped his beer from the bottle. There was no way he’d allow his lips to touch a glass in that place.

  When the rock-and-roll piece ended, the dancer acted as if she’d been momentarily stranded. Self-consciously, she shifted her weight from one four-inch heel to the other, waiting for the next number. Jason noticed a tattooed heart on her right thigh.

  Heralded by the heavy beat of drums, the next number began, and the blonde immediately recommenced her gyrations. As she did so, she slipped off her brief top. Now all she had on was a G-string and her shoes. Still, the men at the bar appeared carved in stone. The only movements were those necessary to bring their drinks or cigarettes to their lips. At least until the dancer began moving along the runway. Then a few customers would hold out dollar bills.

  Jason watched for a while, then scanned the room again. About twenty feet away was a booth occupied by a man in a dark suit with a cigar, studying a ledger through dark glasses. Jason had no idea how the man could see anything at all, but decided he was management. Several body-builder types with eighteen-inch necks, wearing white T-shirts, stood on either side of the booth, their beefy arms crossed and their heads constantly turning to survey the room.

  As the music ended, the blond stripper picked up her things and ran up the stairs. There was scattered applause. When the music began again, a new dancer descended the stairs and whirled about the runway. Dressed in a flashy, voluminous gypsy costume, she could have been the first dancer’s sister—her older sister.

  Very quickly, Jason got the hang of the program. A girl would appear in some wild costume and dance, taking off more of her clothes as the number progressed. Forty-five minutes passed and Jason wondered if Carol Donner was scheduled to appear that night. He asked one of the waitresses.

  “She should be next. Want another round, mister?”

  Jason shook his head. He was content to nurse his first beer for the entire visit. Looking around, he noticed that several of the strippers had come back down to the floor. They would stop and talk to the man in the dark glasses and then wander around the room, chatting up the customers. Jason tried to imagine Hayes, the famous molecular biologist, there at the bar. Try as he might, he couldn’t.

  There was a pause in the music and the runway lights dimmed. A PA system crackled to life for the first time and announced the next performer: the famous Carol Donner. The bored patrons propped up on the bar suddenly seemed to wake up. There were a few catcalls.

  The music changed to a softer rock and a figure appeared on the runway. As the lights came up, Jason was stunned. To his amazement, Carol Donner was a beautiful young woman. Her skin had a healthy glow and her eyes sparkled. She was dressed in a body suit, headband, and leg warmers as though she were in an aerobics class. Her feet were bare. She moved down the runway with effortless grace, and Jason noticed that her smile held genuine enjoyment.

  As her number progressed, she removed her leg warmers, a silk sash around her waist, and then the body suit. The sodden audience actually cheered as she danced topless back up the stairs. As soon as she disappeared, the customers sank back into their torpor. Jason kept waiting for Carol to appear on the floor like the other girls, but after twenty minutes he decided she might not. He pushed off his stool and walked back to the man in the sunglasses. One of the body-builders noticed his approach and unfolded his arms. “Excuse me,” Jason said to the man with the ledger. “Would it be possible to talk with Carol Donner?”

  The man removed his cigar. “Who the hell are you?” Jason was reluctant to give his real name, and while he hesitated, the man in the dark glasses motioned to one of the body-builders. Jason felt large hands take hold of his arm and urge him toward the door. “I only want …” But he didn’t get to say any more. He was grabbed by his jacket and hastily escorted the length of the bar and through the dark curtain, his feet barely touching the floor. With a good deal of humiliation, he found himself propelled out into the street.

  5.

  After the radio alarm had awakened him, Jason had to stand under the shower for several minutes to feel capable of facing the day. The night before, after he’d returned from the unpleasant visit to the Club Cabaret, he’d been called back to the hospital. One of his AIDS patients, a man named Harvey Rachman, had arrested. When Jason had arrived, the staff had been giving CPR for fifteen minutes. They’d kept it up for two hours before conceding defeat. The head nurse’s comment that at least the man didn’t have to suffer anymore was not much consolation to a stricken Jason. For Jason it seemed that death was winning the competition.

  The only positive side of inpatient rounds later that morning was the discharge of one of his hepatitis cases. Jason was sorry to see the girl go. Now he had only a single patient who was doing well.

  In the CCU, Matthew Cowen was no better. In addition to his other complaints, he was now having trouble seeing. The symptom bothered Jason. Harring and Lennox had also complained of impaired vision in the weeks before their deaths, and again the possibility of some new multisystem illness crossed Jason’s mind. He ordered an ophthalmology consult. After finishing rounds, Jason headed to pathology to see if the slides from Hayes’s autopsy were done. Maybe they would help explain why so many seemingly healthy people were suffering cardiovascular catastrophe.

  He had to wait while Jackson called a report on a frozen section down to the OR. It was a breast biopsy and it was positive.

  “Tha
t always makes me feel terrible,” Jackson said, hanging up the phone. Then, in a more cheerful voice, he added, “I bet you want to see the Hayes slides.” He searched around on his desk until he found the right folder. Opening it up, he took out a slide and focused it for Jason. “Wait until you see this.

  “That’s Alvin Hayes’s aorta,” Jackson explained as Jason looked in. The cellular death and disorganization were evident even to his unpracticed eye. “It’s no wonder it blew,” Jackson continued. “I’ve never seen such deterioration in anyone under seventy except with established aortic disease. And let me show you something else.” He replaced the slide with another. “That’s Hayes’s heart. Look at the coronary vessel. It’s like Cedric Harring’s. All the coronary vessels are almost closed. If Hayes’s aorta hadn’t blown, he’d have died of a heart attack. The man was a walking time bomb. And not only that, he had inflammation in the thyroid, again like Harring. In fact, there were so many parallels that I went back and looked at Harring’s aorta. And guess what? Harring’s aorta was on the verge of blowing too.”

  “What exactly are you saying?” Jason asked.

  Jackson spread his hands. “I don’t know. There are strong similarities between these two cases. The widespread inflammation—but I don’t think it’s infectious. It has more the look of autoimmunity, as if their immune system had started attacking their own organs.”

  “You mean like lupus?”

  “Yeah, something like that. Anyway, Alvin Hayes was in terrible shape. Just about every organ was in a state of deterioration. He was falling apart at the seams.”

  “He said he wasn’t feeling too well,” Jason said.

  “Ha!” Jackson exclaimed. “That’s the understatement of the year.”

  Jason left pathology, trying to make sense of Jackson’s statement. Again he considered the possibility of an unknown infectious disease despite Jackson’s opinion. After all, what kind of an autoimmune disease could work so quickly? Jason answered his own question: none.