by S. J. Gazan
“. . . and one in his eye,” Bøje said. “It was visible.”
Søren shook his head in disbelief. “Listen,” he said. “Are you saying Professor Helland didn’t die from natural causes?”
“Again I’m tempted to take a pass on guessing,” Bøje said gravely. “On the one hand, his death is exceedingly natural. His system collapsed, and it was exclusively down to his superb physical condition and strong constitution that it didn’t happen much sooner. And like I said: I don’t know enough about parasites to be specific, but if I can speak off the record, my immediate and most pressing concern is obviously: how did the little devils get into him?” Bøje narrowed one eye.
“A disturbing thought,” he went on. “On the other hand, Helland was a biologist, and who knew what he was up to? Perhaps it was a work-related injury? Perhaps he knocked over a dish in his lab?”
“The man was an ornithologist,” Søren objected.
“The source of the infection could be birds. It’s pure guesswork for my part, and I don’t enjoy that, but we have a distinguished expert, Dr. Bjerregaard, on parasitology at the Serum Institute and I’ve already spoken to her. She promised me she would embed the samples in paraffin, slice them before going home today and examine them first thing tomorrow morning. At twelve noon we’ll have the answer. And then there is Professor Moritzen at the College of Natural Science. She’s one of the world’s leading parasitologists and worked for years in South America and Indonesia, which have huge parasite problems. She’s definitely the right person to talk to. She can explain to you how all these little critters ended up inside Lars Helland.” Bøje paused, then he held up his index finger.
“Meanwhile, I have some more fascinating information to share with you. Lars Helland had a fair number of recent fractures that were left to heal by themselves; not a pretty sight in some places. He had broken three fingers on his left hand, two on his right and two toes on his right foot within the last six months. Further, he had scarring on his scalp from violent seizures and two minor hematoma in his brain, neither of them in a dangerous location, but they’re there.”
Bøje had been hunched over his papers, now he looked up at Søren. “I can also tell you he has had brain surgery, eight to ten years ago? Not that it matters and, apart from the two hematoma, there is no sign of brain disease. I just thought I would mention it. Now, about the fractures. I called a colleague of mine in the ER and asked him to check their records. He owed me a favor and, yes, I do know it’s illegal.” Bøje raised his hand to preempt Søren’s objection. “Helland never visited the ER in the last year. Not once. Obviously, he might have seen his own doctor, you’ll have to check that, but he definitely never went to the ER here, even though several of his injuries would require immediate medical assistance. The damage resembles those of victims of domestic violence, women who are too scared to see a doctor because they know it would mean a week in jail for the husband. If Helland’s body hadn’t been crawling with parasites, I would have suggested he might have been abused. Now, of course, my guess is the fractures are connected to the parasites. Why he was never patched up is a different story altogether…” Bøje gave Søren a knowing look as if to say that was Søren’s department.
“Could his injuries alone have killed him?”
“No,” Bøje said. “Lars Helland died from 2,600 uninvited organic growths in his tissue. I’m 100-percent sure.”
Søren’s knees wobbled as he stood up.
After his visit to the hospital, Søren drove home as though the devil was on his back. The sky had been gray and heavy all day, but while Søren had been in the basement with Bøje, patches of blue had broken through and the temperature had dropped. Søren rolled down the window and felt the sharp air against his face.
What the hell just happened?
He pulled behind a truck and reduced his speed.
Easy now.
Once he got home, he cooked dinner and sat down to eat. Suddenly, he felt crawling and prickling underneath his clothes. His groin itched, and after he wolfed down his food he took a shower. His cheek tingled, and so he shaved. Finally, he tried to check himself for head lice and spent ages staring at his big toenail. Did he have a fungal infection? How had those ghastly creepy-crawlies entered that poor man? He couldn’t come up with a single explanation. Had Helland eaten one of them? How had it multiplied? Had it reproduced once it was inside him? Was it airborne? Or in the drinking water? He paced up and down the living room. Then he fetched a beer and told himself to give it a rest.
Early the following morning, Søren drove to Copenhagen, bursting with pent-up energy. From the car he called Helland’s widow, Birgit. He got the answering machine. He asked her to call him as soon as possible. Then he called his secretary and asked her to find the number for Professor Moritzen, a parasitologist at the University of Copenhagen. He liked making Linda laugh, but this morning he failed. She called him back three minutes later. He had to move to the slow lane to write down the number and hoped none of his more officious colleagues were around. He called Professor Moritzen and pulled back into the fast lane.
“Hello?” Hanne Moritzen answered at the first ring. She sounded sleepy and distant. When he introduced himself, she went very quiet for a moment.
“Is Asger all right?” she whispered, almost inaudibly. Søren had done this a million times before, so he quickly reassured her.
“I’m not calling about your family.”
He heard her breathe a sigh of relief and gave her two seconds to process the false alarm before saying, “I would very much welcome your help regarding some parasites we’ve found in connection with a death. Yesterday, Bøje Knudsen, the Deputy Medical Examiner, told me no one knows more about parasites than you.”
Professor Moritzen was clearly relieved.
“Is it urgent? I drove up to my cottage late last night, and I wasn’t planning on returning to Copenhagen until Wednesday.”
Søren thought about it, and they agreed he would call her back when he knew more about just how urgent it was. Professor Moritzen wanted to know what questions he might have and Søren concluded the conversation by saying: “I’m afraid I can’t disclose that at this stage, but I’ll obviously explain the circumstances to you, if it turns out we need your expertise. For now, I would like to thank you for your time.”
Søren was about to hang up when Professor Moritzen said, “Does this have anything to do with the death of Lars Helland?”
“You knew Lars Helland?” Søren said before he could stop himself.
“Yes, we both worked at the institute, but in different departments. I’ve just heard what’s happened. I’m very sorry.” She sounded genuinely upset. They ended the conversation.
Søren parked in the basement under Bellahøj police station and was slow-clapped by his colleagues when he arrived for the morning briefing, five minutes late. He summarized Bøje’s unofficial conclusion and saw how nausea colored every face. Søren’s colleague reported on his visit to Helland’s widow and daughter the day before. This had, not surprisingly, been depressing. The daughter, Nanna, had been on her own, and the officer had stayed with her while Mrs. Helland rushed home. The girl had cried her heart out, and her mother sat on the sofa hugging her for a long time before the officer had been able to ask them questions. A family friend was called to comfort the daughter. Mrs. Helland insisted her husband was in great shape. He was a cycle-racing enthusiast, a hobby he had enjoyed for years, and he also played squash and was a runner, but then Mrs. Helland remembered Helland’s father had died from a heart attack at an early age, and soon convinced herself that a similar fate had now robbed her of her husband. At this point, everyone looked at Søren, as though a collective decision had been made that he would be the one to go back to the villa in Herlev and break the news to the widow about Helland’s uninvited guests.
No one touched the pastries, quivering with yellow custard, on the table.
At noon, Søren and Henrik arrived at the Serum Institute. It was y
et another trip through a bewildering maze of clinical corridors, and Søren gave up trying to find his bearings. The woman escorting them swept through the building with familiar ease, pressed buttons, turned corners, opened doors, and led them, at last, to a light and pleasant laboratory. A woman rose from one of the microscopes, smiled, and introduced herself as Dr. Bjerregaard. She offered them a seat in a low office at the center of the room.
“I’ve looked at the samples,” she said, once they had sat down. “And there’s no doubt the parasite is an advanced cystic stage of the pork tapeworm, Taenia solium. It takes between seven to nine weeks for a viable cysticercus to grow and, in my opinion, the patient was infected three to four months ago, at the most.” She looked briefly at the two police officers.
“Taenia solium is a member of the phylum Platyhelminthes, or as they’re more commonly known, flatworms. In its adult stage, Taenia solium is a parasite in humans where it feeds on intestinal fluid. Inside the intestines, it deposits proglottids, as they are called, which leave their host through feces. Each proglottid contains approximately forty thousand fertilized eggs. From human feces, the eggs access the secondary host, also known as an intermediate host, which, in the case of Taenia solium, are pigs. Pigs acting as intermediate hosts, by the way, are the primary reason why Taenia solium cysticercosis is mainly found in countries where animals and humans are in close contact, for example, in households in developing countries where people defecate in areas accessible to pigs. We know of hardly any cases in the West, where animals and humans live separately, nor in Muslim or Jewish areas, where pork isn’t consumed.”
Again she looked briefly from Søren to Henrik, and didn’t appear to have much faith in their ability to keep up with her. She seemed to be contemplating something; then she rose and produced a whiteboard, which descended silently from the ceiling. She grabbed a felt-tip pen and accompanied her explanation with simple drawings.
“Inside the pig, the egg hatches and the bloodstream transports the larva until it attaches itself to muscle tissue, nervous tissue, or subcutaneous connective tissue, where it develops into a cysticercus, a dormant cyst, whose further development isn’t triggered until the pig is eaten—by humans, for example.” Her hands flew across the board. “Inside the human stomach, the cysticercus wakes up from hibernation, attaches itself to the intestines where it grows into a tapeworm, thus completing its life cycle.”
Søren felt nauseated. He stared at his notepad, where he had scribbled down a few words. He was about to say something, but Dr. Bjerregaard beat him to it. She put the cap back on her pen.
“A tapeworm is harmless and won’t necessarily cause its host to fall ill,” she said. “As a result, you can host even very long tapeworms for a long period of time without knowing that you’re infected. In the vast majority of cases, the tapeworm is discovered by chance, during an operation or an autopsy. They normally grow six to eight feet long, and when a tapeworm is discovered, the host is given medication that kills the tapeworm and it’s expelled from the host with feces. Unpleasant, certainly, but as I said, quite harmless.”
Søren was close to retching. At the same time his brain was troubled by a discrepancy.
“I’m not sure I quite understand,” he stuttered. “Professor Helland didn’t have a tapeworm, but carried…” Søren checked his notes, “cysticercus.” Dr. Bjerregaard waited patiently.
“That’s correct. However, I haven’t finished my explanation,” she said calmly. “The life cycle of parasites is a complex area, even for a great many biologists, and in order for you, as lay people, to understand what I’m telling you, I need to give you some basic information.” She suddenly looked at the two men as though she was enjoying herself tremendously.
“Yes, of course. Sorry,” Søren said. Henrik looked sick.
Søren expected Dr. Bjerregaard to launch into the second half of her disgusting lecture, but she merely said, “The logical conclusion is… ?” She looked sternly at the two men.
“That Helland ate shit,” Henrik blurted out. “Gross.”
Søren glared at Henrik.
“It means,” he said, addressing Dr. Bjerregaard, “that Helland somehow ingested a tapeworm egg.” On realizing the implications, he fell silent.
“Or, to be precise, 2,600 eggs,” Dr. Bjerregaard interjected. “If that’s the number of cysticerci Bøje found in the tissue of the diseased, then it would equal 2,600 eggs.”
Søren managed to suppress his revulsion to such an extent that he could follow her logic. “But he didn’t ingest a whole…” he checked his notes again, “proglottid?”
“That would be impossible to know.”
Søren detected a microscopic smile at the corner of her mouth.
“If the proglottid carried more than forty thousand eggs, you would have expected many more than 2,600 cysticerci. However, there might be several factors why only 2,600 managed to develop.” She shrugged. “The point is Lars Helland acted as the intermediate host, and that happens very rarely in these latitudes. During my thirty years here, I’ve only come across three cases of human intermediate host infection, and they were all discovered in people who had recently returned from countries with a high prevalence of Taenia solium, such as Latin America, non-Islamic Asia, and Africa. Do you know if Helland spent time in a high-risk country?”
“We’ll be checking that. The parasite theory is still very new to us,” he said, by way of apology, and continued, “How can you tell how long the cysticerci have been in Helland’s tissue?”
“The host body forms calcium capsules around the cysticercus, to protect itself from the foreign object, and in the capsule, the cysticercus awaits its next developmental stage. You can determine the exact age of the cysticercus by measuring the thickness of the calcium shell. This would normally take place in pigs, which will be eaten sooner or later, and this places an upper limit on how calcified the capsule becomes. However, humans are unlikely to be eaten, aren’t they? The growth of the cysticercus is generally very slow, and as Helland’s cysticerci were fairly large, I would estimate that they’d developed over a long period of time. The capsules were thick and the cysticerci would undoubtedly have demanded more and more room. To begin with, they would have caused Professor Helland only mild irritation, but in time they would have become a pathological condition, and I can’t imagine how he coped with it. Cysticerci have a preference for the central nervous system, and from records—from Mexico, for example, where the occurrence of humans infected with cysticerci is high—82 percent of cysticerci had attached themselves to nerve tissue. Otherwise they prefer muscular and subcutaneous tissue, in that order.”
“What about symptoms?” Søren asked. Bjerregaard pursed her lips.
“The symptoms of an infected patient depend on several factors. Generally, you’ll expect to find a positive correlation between the number of cysticerci and the extent of the symptoms. However, it depends on where the cysticerci are located. Forty thousand cysticerci located exclusively in muscle tissue can, in theory, cause less damage to their host than five unfortunately located cysticerci in nerve tissue. Muscular tissue tolerates the uninvited guests surprisingly well, and their presence may not cause muscular pain until the very late stages. However, if they are located in the central nervous system, it’s a completely different matter. As the cysticercus grows, it takes up more room and diverts blood supply from the surrounding tissue, and the tissue in the central nervous system is of far more critical importance for functionality than muscular tissue, for example. If the central nervous system is attacked, the patient will experience severe seizures of an epileptic nature, the same as have been observed in brain tumor patients. In addition, the patient will experience sudden blackouts, and very likely suffer from severe motor problems and spasms. Bøje Knudsen informed me the deceased had a fairly high concentration of cysticerci in his brain tissue, and he showed signs of multiple fractures and falls. That makes perfect sense.”
She allowed the conclusi
on to hang in the air before she continued. “If the cysticerci are discovered in time, the patient will be given medication and/or surgery, depending on the number of cysticerci, their location, and how advanced their development is. In the case of the deceased, the cysticerci weren’t discovered which, in itself, is incredible. To me, it’s a physiological mystery how the deceased managed to go to work on the day he died.”
A moment of silence followed, then Dr. Bjerregaard said, “Anything else I can do for you gentlemen today?”
Søren was taken aback. He wasn’t used to being shown the door before he had announced he had no further questions. Dr. Bjerregaard glanced at her watch and pursed her lips again.
“Can you explain how Helland was infected?” Søren said, refusing to be brushed off.
“No,” Dr. Bjerregaard replied. “I certainly can’t.”
She sounded almost hurt, and Søren realized what a stupid question it had been. It was the equivalent of asking the mechanic what caused a car crash.
“But, like I said,” she carried on, giving Søren a final look, “either he ingested feces, or something which had been in contact with infected feces—and all things considered, that’s highly unlikely. Or he worked with live tapeworms and was accidentally infected, which doesn’t really add up, either. There are parasites that infect their host through the skin, the blood-sucking Japanese mountain leech, for example, which causes bilharziasis, but Taenia solium has to be ingested via the digestive tract to complete its life cycle, so even if we assume the deceased had a work-related accident, I still can’t see how he could have been infected. You would expect a biologist who happens to drop a test tube to take precautions immediately, and you would most certainly not expect him to go to lunch without washing his hands after an accident involving Taenia solium. My guess is Professor Helland must have spent time in a high-risk area within the last six months, and that was where he was infected. It’s still hard to imagine how, but as I said, it does happen.”