Nathan didn’t have big dreams. He had big plans. He knew, and so did Tom Maloney, the difference between the two. Anyone could dream. Only the powerful could make plans. And Nathan had every reason to believe he would bring his to fruition right on schedule. After all, his name was on the door. He viewed Stein, Gelb, Hector amp; Wills Securities as the major leagues, the NFL, and he saw the rest of the financial world as his farm system, his own private version of college football. He scouted, spotted talent, watched it develop and mature, then drafted accordingly. Although Maloney didn’t know it, Nathan had his eyes on Tom for a while. Maloney was a definite first-round draft choice.
“Maloney,” said Nathan Stein, maneuvering his way next to the big Irishman. He stuck out his hand. “Nathan Stein.”
Tom said, “Good to meet you. I’m Tom Maloney.”
“I know who you are and you’ve no idea how good it is… for you.”
“Beg your pardon?” The bar was very noisy and the two had to shout at each other only inches apart to be heard. “What?”
“Come see me tomorrow, early as possible,” said Stein, handing Tom his card. “You’re coming to work for me.”
“I am?”
“Give them your notice, Tom. We’ll work it out in the morning.” Then Nathan Stein looked into Tom Maloney’s eyes in the way only the wealthy can when they see someone who is not, someone who has just hit the jackpot. “You’re a rich man now, Tom.”
That memory ran through Tom’s mind as he kneaded Nathan’s shoulder gently and looked at the lovely Indian woman. He said, “Dr. Roy, if you please, start from the beginning.”
“Yes, thank you Mr. Maloney. I shall.”
She’d stayed up all night fine-tuning her notes, preparing several dozen flip charts framing brightly printed words, illustrations, and simple diagrams. She referred to these as she went along.
“Bacteria,” she began, “is the dominant life form on earth. I’m sure you all know that cockroaches and sharks have remained essentially unchanged for hundreds of millions of years. They are newcomers, I assure you. Bacteria have been here for billions of years and will be here for billions more. Oh, yes! When our planet is only dead rock it will teem with bacteria. They will have evolved, mutated, no matter the conditions. Imagine a life form so quick to protect its own interest that when you kill it you instantly make its kind stronger, the more difficult to kill again. The more ways you find to kill it, the stronger you help it to be. Bacteria as a life form is impervious to destruction.”
She paused very briefly to gauge the room. They might be masters of money, but they were now her students. Even this disordered Stein could not resist the music in her voice, or the menace in her words.
“Did you know that NASA has tested the viability of bacteria during interplanetary travel? A species of bacteria called Bacillus subtilis withstood the rigors of space trapped in an absolute vacuum for more than six years. It emerged alive, and, as it were, ready for action.”
She flipped the NASA experiment chart over.
“And here on earth,” she continued, energized by the concentration flowing to her, “you know all about the Great Plague of the fourteenth century. Did you also know Napoleon lost an army of twenty thousand in Haiti without a single battle? Did you know twenty million died in the year 1918 from influenza? Imagine that. What we cannot imagine are all the plagues over millions of years, all the millions of humans, pre-humans, non-humans taken with none to remember and none to record.”
She took a slow, deep breath through her nose, exhaling from her mouth. It satisfied her like iced lemonade on a hot, dry day. But the ecstasy she felt was in the teaching.
“Now,” said Ganga Roy, “let us think about E. coli.”
She explained that as bacterial cells are everywhere, many will, in the normal course of their travels, acquire genetic information from various sources. The flip chart listed these sources: bacterial viruses, plasmids, slices or chunks of DNA floating around and about.
“By chance or purpose, bacteria have the knack of continuous self-improvement. They pick up information. This information may come in handy. It may help them survive, which is all that they really care about. The term ‘E. coli’ describes a group of bacteria. And that, I fear, brings us to the very unfortunate connection between E. coli and human beings.”
The next sheet contained a blue-bordered box, surrounded by an attractive swirl of multi-colored dots. Inside it she had artfully printed these bright red letters and numerals: O157: H7
“This,” said Dr. Roy, “is the primary cause of danger to humans emanating from the E. coli world. How has it become such a dangerous organism? Long ago a single cell acquired a bacterial virus, a virus adapted to life within bacterial organisms. This particular virus had the ability to insert its own DNA into the bacteria’s chromosome without harming the bacterium, and it did, remaining there over the countless generations ever since. Each time this bacterial cell divides, the virus DNA, which is now part of the bacterial DNA, is part of every succeeding cell. These daughter cells of the originally infected bacterium constitute the E. coli strain of which we speak: O157: H7.” She decided to skip the E. coli testing process-the agar and sorbitol and smack-leave it for later, avoid another outburst. At this point she could not imagine it helping the flow. Briefly, she checked the group. She wanted no loose ends distracting them now. Nathan Stein obliged her with a swagger. “So all of these E. coli come from the first one.”
“Precisely,” she said, rewarding him with her first unguarded smile. “Much to our distress as human beings, this virus’s genetic information-the virus that is now inseparable from the bacteria-contains instructions for the production of a toxin, or poison, which is called ‘Shiga-like toxin’ or ‘SLT,’ also called ‘Vero toxin.’” By now they were all taking notes, except Tom Maloney.
As her next flip chart illustrated, “Our friend the E. coli O157: H7 has no choice at all but to produce this toxin. Why is that bad for us?” she asked Nathan Stein, paying him the improbable courtesy of suggesting that he might know. “The toxin is a protein,” she said. “That protein can cause severe damage to intestinal epithelial cells-cells that line the wall of the gut.”
“What kind of damage?” again she pretended to ask Nathan Stein, presenting her next sheet, simple but disturbing. “The protein degrades the epithelial cells, causing us to lose water and salts. But does it stop there? I am afraid not. It damages our blood vessels as well. The result? Bleeding. A very great deal of bleeding.”
She cast her glance around the room, grappling every eye to her own, preparing them for the capper:
“Hemorrhaging!” she declared, showing the sheet with the terrible word leaping off the page.
The next sheet depicted children at play-elegant, inventive, stick-figures of children.
“Those in the most danger are children. Why? They are often too small to fight the effects of blood loss and loss of bodily fluids. And what else may happen to them?”
Dr. Roy knew they were now on terrain where Nathan Stein was likeliest to rebel. They’d arrived at the section of her report entitled “Consequential Developments.” She introduced a more somber note to her voice.
“In some cases another syndrome may also be involved. It’s called hemolytic uremic syndrome, or HUS.” And there they were, all three letters: large, red, ornately inscribed. HUS
“HUS is characterized by kidney failure and loss of red blood cells, and is most dangerous to children. Perhaps 5 to 10 percent of the littlest ones will progress to this stage of disease. In the most severe of these cases, they will suffer permanent kidney damage.”
Now came two more stick figures, one in a bed, one stooping over a walking cane.
“The presence of the E. coli we are concerned with also presents potential for traumatic events among the elderly and people with chronic debilitating disease. For older people who suffer with respiratory or heart disease, or one of many conditions weakening their immune systems, t
o become infected with E. coli 0157: H7 is often deadly.”
She paused. The sudden unease in the room was positively physical.
“Deadly?” asked Louise Hollingsworth in a hushed, and surprisingly but distinctly disgusted, voice. “ How deadly? I don’t mean how do they die; I mean how many of them die.”
The next few flip charts presented the numbers.
“The latest available data from the Centers for Disease Control show seventy-three thousand cases of this kind of E. coli contamination for the latest year studied.”
Dr. Roy became brisk, even cheerful again, referring her group to the flip chart pages, and to the tables at the end of her report.
“The hospitalization rate for cases with extreme complications, meaning a progression to HUS, is a jot less than three tenths of one percent. Very few developed HUS. Among those who did, however, 28 percent died. That means the annual total of deaths attributed to O157: H7 was sixty-one. For all patients progressing to HUS, considering all causes, the death rate is between 3 and 5 percent. Among the elderly,” Dr. Roy said, “it will kill about half.”
“Half?” Stein cried out with startling force. “You mean half the old people getting E. coli are going to die?”
“No,” Dr. Roy told him, unruffled, quickly taking in the others. Pitts looked grave, but by no means threatened. The morbid cast to Louise’s brown eyes had deepened, and perceptibly. Maloney kept his focus on Stein, reacting only marginally to the unhappy news in the air.
She thought she’d made the figures clear. Perhaps they were misunderstood. Most likely, Mr. Stein had jangled their nerves and their brains. She wanted to say, “Now, everyone, take a deep breath.”
Instead, she raised her small right hand in calming benediction. “Those estimates are only for the demographic group generally referred to as elderly and infirm,” she explained, as though it were truly excellent news. “And it only includes those within that group who contact the E. coli, and then become ill and progress to hemolytic uremic syndrome, or HUS.”
She attempted a reassuring smile.
“And why is that again?” asked Wesley Pitts.
“Excellent question, Mr. Pitts.” She was handing out bon-bons to everyone now. “Contact with E. coli 0157: H7 is most often only mildly harmful. However, ingestion of it through a ground beef product introduces the bacteria to the digestive system. It may subsequently leave the digestive system and enter the bloodstream, where it may break down red blood cells with its SLT or Vero toxin. After that, the damaged cells lodge in the kidney, causing kidney failure.”
“Can you tell us,” asked Pitts, “how you assess the risk mathematically?”
She was off the flip charts now.
“If your meat was contaminated, it would be about one death for every twelve hundred people hospitalized. I said there were about seventy-three thousand people hospitalized yearly with E. coli symptoms. But that figure reflects 150 million cases of food poisoning. Maybe more. Many get sick from agents less harmful than E. coli. Among those exposed to E. coli, we’re talking only about confirmed cases with hospital admission. Many others fall ill but never go to the hospital. Even when they do, many are undoubtedly misdiagnosed. Clinical medicine is often hit or miss. The heart stops in everyone who dies, but not everyone who dies does so from heart failure.”
“So, it’s not too bad,” said Nathan Stein hopefully.
“As I understand it,” said Louise Hollingsworth, “there is some potential for a bad outcome, but the numbers are actually quite favorable.”
Dr. Roy nodded. “In my opinion, the science indicates that it would take many thousands of people with food poisoning to result in a single death.”
“I know it’s in your report,” Tom said. “Tell us again how you test for E. coli.”
“In order to do that, one must be able to make a definitive identification. For that, one must conduct a stool test using the sorbitol-MacConkey agar. This is a substance resembling gelatin, in which the test may be performed. Without such testing no positive finding for the presence of E. coli bacteria can be asserted.”
“Does that mean,” asked Maloney, “that in the absence of such a test, any claim that E. coli was present would have no legal validity?”
She smiled the smile that she always smiled when declining to render legal advice. “I am not a lawyer, Mr. Maloney. What I can say is that no scientific credibility would attach to such a claim without the SMAC test. I don’t believe a trained medical professional, Ph. D. or MD, would testify to the presence of E. coli without testing-proper testing-as I have described it.”
“Tell me,” said Maloney, “how readily available is the sorbitol-MacConkey agar in small-town hospitals in the southeastern part of the country?” Maloney had certainly read the report, quite likely more than once.
“It is readily available,” Dr. Roy replied. “I would anticipate no difficulty in testing for E. coli in even the smallest of cities. Samples could be sent to any large hospital in the region. Any doctor who suspected E. coli poisoning could get immediate help from Atlanta or Birmingham or Charlotte, for example, or any full-service general hospital.”
“We need a month,” said Stein.
“I’d like a lot longer,” added Wesley Pitts.
“Let me ask you this,” said Tom, “in your expert opinion, what would be likely to happen if a substantial supply of E. coli -infected meat was widely distributed in the southeastern states in the next week?”
She should, of course, have seen this coming.
It suddenly dawned on her that she had not been involved in a remotely normal corporate consultation. She was not, and had not been, merely an academic fan-dancer doing her stuff, as she had done so often, for corporate mediocrities whose breadth of mind encompassed little more than expensive lunches and modes of theft.
Whatever this was, the brilliant Dr. Ganga Roy felt entirely out of her depth. She was now almost certainly being asked about real people dying.
She rallied, but not without effort, not without some of the mischief deserting her spirited manner. “The symptoms of this type of food poisoning caused by E. coli O157: H7 usually begin appearing in two to four days. Serious complications within a week; deaths thereafter.”
She felt a little lightheaded now, but plucked up the courage to ask, “What do you mean by ‘widely distributed?’”
“Hard to say, exactly,” said Maloney. “These people make ground beef for a variety of brand names. Most of them house names, named for whatever chain it’s being sold in. It’s hard to keep track of everything.”
“Not entirely,” said Louise Hollingsworth, her voice more robust than before. “Competing supermarkets in the same city sell the same product under their own names. Shoppers don’t know where it comes from. But the company knows. And the distributors know. They know where every bit of it goes. Of course, at the store level, it often gets mixed together with meat from other suppliers, and that could make positive identification difficult.”
“They said that it was only one line,” said Nathan Stein. “How much meat could that be?”
Dr. Roy had command of herself again. “If we are talking about a processing plant, there is no such thing as a small problem involving a single machine or production line.”
Magically, she seemed to have forgotten the tangible corpses at issue and focused again on relatively cold facts. “Let us say that a single line has reported a problem. Those on other lines may or may not have recognized it as well. They may or may not have seen fit to report what they saw or suspected. Inspectors may find some and miss others. Moreover, if one machine or one product line has E. coli, it is likely to have spread. The entire plant is suspect.”
“And that means what, Dr. Roy?” said Maloney, not bothering, or able, to suppress the slight quaver that persisted as he spoke. “Let’s say that tens of thousands-perhaps hundreds of thousands-of pounds, maybe millions, get distributed to hundreds of outlets, maybe more. That means what?”
She did not respond.
“Dr. Roy?” The others were bearing down, straining from their seats, Louise on her feet, Stein poised to spring like a feral cat, restrained only by Tom Maloney’s heavy hand. But it was Maloney who spoke again.
“Let us say, Dr. Roy, that a universe of three hundred thousand people eat this meat. If everyone among the three hundred thousand gets sick, and I realize that’s farfetched, and let’s say that half are children and elderly, about nine hundred would end up in the hospital. Am I right? Of the nine hundred, perhaps forty-five would advance to HUS. Of that group, with a death rate of 3 to 5 percent we might expect between one and a third and two and a half deaths. Since we can be fairly certain that all three hundred thousand will not become ill-if only half do-that brings the projected deaths to less than one person, doesn’t it?”
“You must understand,” she said. “If the numbers give us one death for every twelve hundred infected people, that doesn’t predict which of the twelve hundred will die. It could be the first or the last. It could be the first ten who die, then ten thousand who don’t.”
She continued, looking to Maloney as the only one with whom she had any personal link. “Based on your scenario, it is not realistic to suppose that there will be no deaths. There will be deaths. People will die. Some people will die.”
“And what’s the worst that could happen?” Maloney asked, shockingly calm again.
“Well, the worst,” she said, looking over their heads, thinking what she had just said was already in the worst class, “would be that you are not dealing with E. coli as we know it. The very worst, if that is what you are asking, would be a newer, stronger, heat-resistant E. coli. Bacteria are killed by heat. That is why steam at high temperature is employed in the slaughter of beef. If you cook beef to a hundred and sixty degrees you will kill the E. coli. Not all bacteria are killed at the same temperature. Salmonella, for instance, requires a higher temperature than E. coli. If our E. coli bacteria mutated to the point at which it could withstand higher temperatures, we could have quite a crisis. Other mutations are also possible, perhaps probable. You should be aware that this deadly strain of E. coli was first identified in 1982, and, while we have learned much about it, that is not long ago. A newer, mutated form of the bacteria may also have a highly increased level of quorum sensing.”
The Knowland Retribution l-1 Page 8