Although they hadn’t slept, neither was tired as the sun streaked in through the bedroom windows.
Matt stared as Terri dressed. “Don’t tell me you’re going to work this morning.”
“Of course I’m going in. I must see Becky Norton, and Mickey Howe’s bringing Jennifer into the clinic.”
“Please don’t dismiss the emotional impact of last night, Terri. It takes its toll, and eventually you’ll feel it too.”
“That’s why I have you around. You are around, aren’t you?”
“For as long as you’ll have me.”
When Terri arrived at San Francisco General, she went to her office, grabbed her white coat and stethoscope and told the receptionist, “I’m going to see Becky Norton. Page me when Jennifer Howe gets in.”
Terri walked to the ward and found the medical team caring for Becky. The resident, a neurology fellow, and four medical students sat in the lounge while a medical student presented Becky’s case, reviewed her history and clinical course, and then presented her laboratory data and studies.
Becky showed nonspecific signs of malnutrition, and all her studies were unrevealing except for the MRI scan.
The neurology fellow pointed to the film. “We see a few high signal areas in her brain, but nobody knows what to make of it. I remember somewhere reading about this MRI finding, but I can’t recall what it is.”
A medical student raised his hand. “Is there anything in the BCG vaccine that could cause this clinical picture?”
“No,” Terri said. “All we see is low grade fever, muscle aches, and sometimes headaches.”
“Do you want to see her now, Dr. Powell?” the resident asked.
“Sure. Where is her mother?”
“Judith is with her.”
As they approached the bedside, Judith stood. “What’s wrong Dr. Powell? She was doing so great. Look at her now.”
“Why don’t you excuse us for a few minutes. I’ll be out to talk with you soon.”
When Terri turned back to the bed, Becky’s appearance stunned her. Her face showed rhythmic twitching, her arms and legs jerked, and she failed to awaken when they stimulated her.
“How long has she looked this way?” Terri asked.
“It started about an hour ago,” the neurology fellow said. “A repeat EEG shows nonspecific slow wave patterns like you’d see in anyone with coma, but no seizure activity.”
“Can you arrange for chief of services rounds as soon as possible?” Terri asked. “I don’t like whatever’s going on here.”
“Will four this afternoon be okay?”
“Perfect.”
Just as Terri was about to speak with Judith, her pager went off.
“I have Jennifer waiting,” the receptionist said.
Terri grabbed Judith’s arm and guided her into the physician’s dictation room.
Judith held her head with both hands. “I don’t know how much more of this we can stand. We’ve prepared for the end so many times before...ha! That’s a joke...preparing for your child’s death. This time may be the worse because she was doing so well. The cancer’s gone, isn’t it?”
“We’re running lots of tests and we’re going to present Becky’s case to our best people this afternoon.” Terri paused, and then grasped her hands. “I’d be lying to you if I didn’t tell you that I’m frightened for Becky. Something’s going on and we don’t know what it is. If anybody in the family wants to see Becky, they’d best do it now.”
Judith covered her mouth with her hands. “Becky really likes you, Dr. Powell. All she could talk about was how great you are. I know you’ll do everything possible for my daughter.”
When Terri got back to her office, Mickey stood outside the examination room.
“Thanks for seeing Jennifer so soon. She’s had a miserable three days.”
“It’s okay. Let’s see her.”
“Before you go in, I need to tell you something.”
“What is it?”
“You’ll see most of what is going on, but there’s something else. Something she won’t tell you.”
“What is it?”
“It’s her mind. She’s had times when she doesn’t know where she is or what’s going on. She even thought her father was still alive. I think she’s seeing and hearing things too. What’s going on?”
“I don’t know. Let’s take a look.”
Terri entered the room to Jennifer’s wandering eyes and myoclonic jerking. Terri gasped.
It’s Becky Norton...My God, it’s Becky Norton all over again! She thought.
“The voices,” Jennifer said. “I couldn’t understand a word they said.”
Terri stared. “What voices?”
Jennifer’s eyes fixed on Terri. “Hi, Terri. How am I doing?”
“You’ve lost so much weight.”
“I can’t eat.”
“Why didn’t you call me?”
“I had an appointment.”
“I’m admitting you to the hospital.”
“Just give me something for sleep...anything. I can’t stand this.”
“I’ll take care of it.”
When Terri left the room, Mickey said, “Do you know what’s going on?”
“All Jennifer’s findings point to something going on in her central nervous system.”
“What?”
“I don’t know.”
“You must suspect something,” Mickey said grabbing her arm.
“Get your hands off me, Mickey. Don’t try to bully me. If you’re unhappy, take her somewhere else. I’ll sign the damn papers.”
Mickey paled and turned to the wall. His shoulders shook with his sobbing.
“I’m sorry, Terri, it’s just...”
“I understand, but Mickey, I love Jennifer and I’m working my ass off to find out what’s happening.”
“I’m so afraid.”
“Me too, Mickey. Me too.”
Chapter Forty-Nine
The morning after the shooting, Matt and Shelly sat in her Berkeley office completing the forms documenting Karl Muller’s death by deadly force incident.
“They almost put me on administrative leave,” Shelly said, “but Internal Affairs Bureau cleared me right away.”
“You didn’t have a thing to worry about. I was there and saw it all. The prick raised his gun. You had no choice.”
“They want me to see a shrink, too.”
Matt smiled. “Finally, it’s about time you got some help.”
“Very funny.” Shelly stared at Matt for a moment. “I never killed a man before and I didn’t know what to expect. You’ve been through it, haven’t you?”
“Twice. I can’t say it bothered me since they were about to kill my partner and wouldn’t put down their weapons.”
“I know how I’m supposed to feel, Matt, but when that bastard pointed his gun at me and I dropped him, I felt great. I know it’s not politically correct, but I still feel great.”
Shelly’s intercom buzzed. “I have a Holiday Spice on the line for Matt Hollis.”
“Be careful, Matt. She’s got the hots for you.”
“Right. The hots plus something that requires penicillin.” He lifted the receiver. “Holiday, what can I do for you?”
“He’s really dead? Karl’s gone for sure?”
“He’s as dead as it gets.”
“Listen, Matt...can I call you Matt?”
“Of course you can call me Matt,” he said winking at Shelly who was waving her hand next to her cheek in a cool-down gesture.
“I wanted to help you guys, but Karl scared the shit out of me. He wasn’t someone you wanted to screw with.”
“Well, we’re all better off without him. Is there anything else?”
“He left something with me?”
“What?” Matt asked, suddenly curious.
“It’s a large manila envelope. He said I should give it to the cops if anything ever happened to him.”
“We’ll be right over.�
�
After Matt politely refused Holiday’s invitation to come in, they returned to Shelly’s office where they read the emails and listened to the taped conversations.
It was almost eleven in the morning when Matt and Shelly approached the security gate at PAT. A large demonstration was underway, undeterred by the light rain. The marchers held signs and chanted labor slogans.
Raymond Fish stood in their midst grunting orders through his wired teeth. His father and brothers stood nearby.
Matt turned off the windshield wipers as he and Shelly pulled up to PAT’s gates.
“What can I do for you?” Harry, the guard asked.
“What’s going on?
Matt looked at the crowd. “It’s Raymond Fish and the union. They’re out for blood this time.”
Shelly flashed her badge. “We have a meeting with the Wincotts.”
Harry smiled and turned to Matt. “They sure make ‘em pretty now. When I was on the job we only had secretaries to look at.” He paused, staring at Matt. “Don’t I know you?”
“He’s a famous author,” Shelly said.
“Now I know,” said Harry. “You’re Matt Hollis. You wrote those Matt Collins books. They’re great. Now I see why they’re so real.”
“Thanks, Harry. The Wincotts?”
“Just follow the headquarters signs.”
When Shelly and Matt walked into Greg Wincott’s office, he and Amanda rose to greet them.
Greg indicated they sit. “We’re mortified by this whole situation with Karl Muller.”
“We had no idea,” Amanda said.
Shelly shook her head in disgust. “You must be kidding. The man was a walking time bomb and you two knew it.”
“I’m not a pass-the-buck type,” Greg said. “I tried to get rid of him after the confrontation in the parking lot.” He stared at his wife. “I wish it weren’t so, but we just work for Kendall. I talked with Richard Kendall, the company’s CEO, but he refused to budge.”
“Maybe you should have insisted,” Matt said.
“I did, but Kendall’s so paranoid about industrial espionage they said they needed people like Karl.”
“Terri...I mean Dr. Powell said he wanted emails, videos, and information on a sequence of numbers and letters,” Matt said, “and he was prepared to torture her to get it.”
“This is a nightmare for us,” Amanda said. “Look at what we’ve done with PAT. Circumstances forced us into bed with Kendall and although we knew that their motivation wasn’t altruistic, we never thought that two deaths, Lisa Gomez and Karl Muller, would be part of the equation. If they’re hiding something or acted in a less than ethical way, I assure you we don’t know anything about it.”
Greg passed a paper over his desk. “Kendall is pushing for Fast-Track approval on our BCG vaccine for melanoma, but I don’t have any information that puts that trial in jeopardy. You don’t think that this was all personal?”
Shelly shook her head. “No way. Muller acted in the interest of Kendall, real or perceived.”
“You need to talk with Richard Kendall,” Greg said, “and if I were in your position, I’d want to talk with Kendall’s security people. They knew Karl. They hired him and directed his activities.”
Shelly called Quinn Conner, her favorite assistant district attorney. “I have something for you to review, and then I have a favor.”
“I’m all out of favors,” Quinn said.
“Once you see what I have, you’ll thank me for the gift.”
“Come on up, girl. My door’s always open to you.”
Shelly brought Quinn up to date on her investigation, and then revealed the contents of Karl Muller’s envelope.
“Muller protected himself against everything except you, Shelly.” Quinn studied her for a moment and smiled. “Are you okay...I mean after the shooting?”
“Maybe I’m in for second thoughts or PTSD after delivering justice to that son-of-a-bitch, but for the moment, it feels great.”
“The favor?” Quinn asked.
“Interview Richard Kendall and his security people. I want to see their reaction to this material.”
Quinn picked up the phone and buzzed her secretary. “Get Richard Kendall at Kendall Pharmaceuticals in Chicago on the phone for me. Don’t take no for an answer.”
When Richard got on the phone, Quinn introduced herself. “I have important matters to discuss with you, Mr. Kendall.”
“What matters?” Richard asked.
“I think you know. I’ll expect you tomorrow afternoon, sir, and bring Mr. Hopkins and Mr. Macy, would you?”
“We’ll be on the first flight out in the morning,” Richard Kendall said. “I’d still like to know what this is about.”
“See you tomorrow,” Quinn said.
Quinn turned back to Shelly. “Don’t expect too much from this interview. These people know how to protect themselves.”
The ancient amphitheater at the UC Medical Center had a small stage and 100 seats extending up toward the overhead stained glass windows. The room was 3/4 filled with physicians and a few nurses.
As Terri scanned the room, she recognized several well-known department chiefs, specialists in infectious diseases, and research microbiologists.
If they don’t know how to help Becky, what can I do next?
Terri presented Becky Norton’s history in detail then review her recent clinical course, the laboratory findings, and the imaging studies.
“Let’s open the floor for discussion,” Terri said.
Dr. Ray Godwin, the chief of radiology rose. “Do we have the MRI?”
“Yes.”
“Why don’t you project the areas with high signals,” Godwin said.
When the MRI image flashed onto the screen, Ray Godwin pulled his red-laser pointer from his shirt pocket and moved the red dot to several areas of Becky’s brain. “These areas show a deposit pattern, something’s in the tissue. I don’t know if it’s infection, tumor, or the kind of deposits we see in several forms of dementia.”
“You mean amyloid protein,” Becky’s resident said, “like we see in Alzheimer’s Disease.”
“And lots of other neurological diseases,” Kirby Cox, the chief of neurology, said. “This whole case is bizarre,” he continued, “Has anyone heard of Fatal Familial Insomnia (FFI)?”
“When you hear the sound of hoof beats in California, you don’t think of zebras, Kirby,” said the chief of internal medicine. “That’s a rare neurological disease. Only a handful of cases exist in the medical literature.”
“I’m a neurologist. I live for the zebras. When we combine insomnia, hallucination, myoclonic jerking, the weight loss and this MRI which could be showing the deposits of amyloid protein, we have to consider prion related diseases.”
The word ‘prion’ and the image of Mad Cow Disease shocked Terri. The jolt—the fear was akin to turning around in a busy department store and finding Abbie missing.
“How would she get infected with prions?” Terri asked.
“I’m not saying she did,” Kirby said, “only that the clinical picture fits.”
Terri reddened. “How about a diagnosis we can do something about.”
“Two things don’t fit,” Kirby said. “First, the rapid progression of the disease is unusual for FFI, and second, we have only a single case. Any infectious disease, including prions, would likely involve others.”
My God, thought Terri—Jennifer—Jennifer.
Terri was about to ask for more input when, a medical student on the team handed her a note.
“Go on,” Terri said, standing. “I’ll be right back.”
Terri smelled it when she got to Becky’s room...the scent of impending death.
Becky had been unresponsive for days and had begun to show ominous signs, seizures, fever, worsening kidney and liver function—her body was failing.
Terri had called Becky’s family that morning, and they now sat at her bedside.
When Terri explained the
situation, they surrendered emotionally. They were powerless to help and were left with agony, watching the sun setting below the horizon of their daughter’s life.
Terri held Becky’s cool hand and watched her resting face awaken every twenty seconds with a twitch or a seizure. Soon Becky’s mouth opened wide and her breaths were deeper as her brain tried to draw life into her lungs.
“I can’t stand this,” Becky’s mother said. “Do something—please, do something.”
Terri looked back at Becky’s agonizing last breaths then all became quiet.
Terri thanked God for giving her the foresight to ask for an autopsy beforehand since she knew how difficult that would be now for Becky’s family.
When Terri returned to the amphitheater, her voice choked as she faced the group and said, “Becky Norton died five minutes ago.”
The crowd went silent.
“I’m so sorry, Terri,” Kirby said. “This is going to sound callous, but I don’t mean it that way. Let’s get to that autopsy and see what happened.”
I’ll never get used to it, thought Terri as she left the autopsy suite with the pathologist. Becky’s pale inert body on the stainless steel table made it difficult to believe it had once been alive.
“I’ll do some frozen sections of the brain, Terri, but I don’t think it’s going to answer your questions. We’ll do better when the regular sections come back for examination tomorrow.”
Terri watched as he moved several small pieces of brain tissue into the freezer chamber placing them in a metal chuck. Once frozen, the pathologist used a microtome to make thin slices for examination under the microscope.
Terri looked through one head of the two-headed teaching microscope as the pathologist started his examination moving each slide under the lens. He said nothing until he reached a part of the middle brain called the putamen, and the slide movement suddenly stopped.
“What the hell...” he said.
“What is it?” said Terri, for she’d been looking too and saw nothing.
“You see those holes in the tissues? See how they coalesce into larger holes we call vacuoles? They look like holes in a sponge.”
“What does it mean?”
“Terri, these are the characteristic finding we call spongiform encephalopathy...the typical changes we see in Mad Cow Disease.”
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