“He suspects, but doesn’t know anything. He absented himself from those activities if you recall.”
“Thanks, Brooks,” Woody said. “I’ll wire the funds to your account this afternoon.”
“It’s always a pleasure, gentlemen. I can’t see how this is going to help you much. Richard Kendall is in enough trouble as it is.”
“That’s nothing compared to the charge of first degree murder of Emile Gigot,” said Woody. “That gives us all the leverage we need.”
“I’m sorry, Mr. Kendall,” the security guard at Kendall headquarters said to Richard, the next morning, “I can’t permit you to enter.”
“Get out of my way,” shouted Richard as he moved to pass.
The guard grabbed him by the arm and escorted him out the front door. “Don’t return unless you have Mr. Brother’s permission.”
“Brothers?”
“Yes, Mr. Brothers is the new chairman of the board.”
Richard stood in the plaza and dialed Woody. “I need to see you.”
“Eddie and I want to see you, too. We’ll be down in a minute.”
They walked to a nearby park and sat on a bench.
“We’re in deep shit,” Richard said.
“Don’t use ‘we’, Richie,” Woody said.
“You guys are every bit as involved as I. Don’t forget that.”
“Are you threatening us?” Eddie asked. “That would be awful stupid.”
Richard felt his stomach cramp. “Of course not. We share the same interests. We need to help each other.”
“We don’t see it that way, Richie,” Eddie said. “We’re willing to take our chances with charges originating in the activities of Karl Muller. You demanded these security measures. You set Karl’s pattern of behavior, and we think the courts will find you ultimately responsible.”
“That’s crap,” Richard said. “I hired you to do a job. I gave you free reign.”
Woody reached into his pocket and produced a digital recorder. He pressed play, and they listened to Richard’s voice: Someone who understands loyalty and isn’t afraid to take harsh measures for a good cause.
“You son-of-a-bitch,” Richard shouted. “What about the part where I said that you’d be calling your own shots and that I had no interest in micromanaging security.”
“If you have a recording of that,” Woody said, “we’d be happy to listen.”
Richard lowered his head into his hands. “You can’t do this to me.”
Woody and Eddie shook their heads in disgust.
“One thing more,” Woody said. “If this isn’t enough, we know and can prove how you managed to obtain the BCG from Laval University. I think the charge will be murder in the first degree.”
Woody and Eddie stood. “Not to worry, Rickie,” Eddie said, “Canada abolished the death penalty in 1976.”
Chapter Sixty
Terri took three phone calls on Jennifer’s status overnight. The last one was at three a.m. and the nurse said, “Her blood pressure has gradually increased to 110/60...that’s probably normal for her, but she continues to have heart irregularities.”
“What about her urine output?”
“Zilch. Since I came on at 11 p.m., she’s put out a total of 20 ml. It’s still brown.”
“What’s her mental status?”
“She groans when I push her, but that’s it.”
“That family’s not still there, are they?”
“No, they went home at midnight after extracting my solemn pledge to call them if anything changes.”
“Have her morning labs drawn at five a.m. I’ll be in an hour or so later.”
Matt rolled over in bed. “How’s she doing?”
“She’s about the same, but very soon, her kidney failure will bring things to a head.”
Terri got to the metering lights at the Bay Bridge just as traffic began to build. The road was slick from early morning fog. She arrived at San Francisco General a little after seven and went immediately to the ICU, where Jennifer’s resident team was doing its morning assessment.
“Her labs just came back,” the resident said. “Since she’s made no urine, the tests show marked worsening of her chemistries. I think she’s completely shut down and will need dialysis later today or tomorrow.”
“Did her repeat blood cultures come back?” Terri asked.
“No growth,” the resident said, “and the original urine and blood cultures showed that the pseudomonas is sensitive to the antibiotic we’re using.”
The resident took Terri’s arm. They walked to a corner away from the others. “The house staff wants to know more about Mad Cow, about how she got it, and the possible treatment options, but considering the circumstances, they’re hesitant to ask.”
“That’s ridiculous,” Terri said. “Let me take a quick look at Jennifer then bring the team into the conference room.”
When Terri arrived at Jennifer’s bedside, her nurse said, “She looks pretty much the same.”
The nurse pulled the drapes around the bed for privacy and Terri stared at her friend, absorbing the tragic events. She watched Jennifer’s chest rise and fall with each ventilator cycle and was relieved that the machine was responding to Jennifer’s own attempts at breathing.
“At least she’s trying to breathe,” Terri said.
Terri looked at the tubes, the monitoring lines, and the IVs. Jennifer’s life, like an astronaut tethered to his space vehicle, dependent on these tubes and lines, her umbilical cord.
Terri pulled down the top sheet. Multiple skin lesions covered her body with the more advanced ones showing black at the center—gangrene.
I hope she lives long enough to have these treated by skin grafting.
Terri completed her examination. “Draw chemistries at noon. Call the dialysis center and tell them we may need to do a treatment this afternoon.”
As the interns, residents, and students took their seats around the conference room table, Terri scanned their eyes. “I really can’t get into the details about the BCG vaccine, and how it became contaminated with prions. The DA might subpoena you about what I’d said. I will tell you this, the BCG was contaminated and neither the supplier nor we knew.”
“That’s scary,” a student said. “I know they screen meat for prions, but as far as I know, that’s about it.”
“That’s going to change with the appearance of blood tests for prions. They will screen all material having its origin in susceptible animals. You can’t imagine how much material of that type is in foods, cosmetics, biologicals etc.”
“I understand,” the resident said, “that your advanced melanoma patients have had an excellent response to the vaccine.”
“I can’t recall a better use of the word, irony,” Terri said. “Terminal cancer patients cured by a vaccine that causes Mad Cow Disease.”
“What about treatment?” another student asked.
“I could talk for an hour about all the compounds, antibiotics, antimalarials, and immune sera that we’ve tried. Researchers have even tried chelation therapy with drugs like penicillamine. Nothing works. All clinical diseases related to prions are 100 percent fatal.”
Another senior resident stared at Terri. “Why then are we wasting all our efforts and the incredible expenses for a disease 100 percent fatal?”
Terri heard a few gasps then the room fell silent.
The resident reddened. “I’m sorry, I just...”
“Don’t,” Terri said. “It would have disappointed me if someone didn’t ask that most logical of questions. I don’t have an adequate answer, except to say that medicine is full of the unexpected and those surprises tend to come with diseases we don’t fully understand. As an oncologist, I face this question almost every day—how much is enough? Mostly, nature takes its course so we’re not forced to make these impossible decisions.”
“What about the brain biopsy,” the resident asked.
“Let’s let her condition stabilize. If she needs
dialysis, let’s get it started, and then we’ll go ahead with the biopsy.”
The same senior resident again raised his hand. “What are you going to do if the biopsy shows Mad Cow Disease?”
Terri smiled. “Now you’re beginning to piss me off.”
The room exploded in the laughter of relief—black humor.
When Mickey and Marlene arrived later that morning, Terri summarized Jennifer’s condition.
“Why is Jennifer having so many heart irregularities?” Mickey asked. “She’s young and has never had any evidence of heart disease. I saw the heart monitor and how many times they treated her to control her heart. What’s wrong with it?”
“Nothing,” Terri said. “Many things can cause cardiac irregularities, especially when’s someone’s as sick of Jennifer.”
“Are the dialysis treatments dangerous?” Marlene asked.”Will it make her heart problems better?”
“No,” Terri said. “Now that her blood pressure is stable, it’s perfectly safe.”
“How long will she need them?” Mickey asked.
“Until she starts to produce urine on her own. That could take days, or up to three weeks.”
“What about her brain biopsy?” Mickey asked.
Terri placed her hand on his shoulder. “Tomorrow, if she’s stable. Then we’ll know.”
Chapter Sixty-One
The Lawrence Berkeley National Laboratory occupied a 200-acre site in the hills above the University of California, Berkeley.
Chester McCoy sat at the conference room table looking over reams of neutron activation analysis (NAA) data. Bombarding samples with neutrons, NAA accurately determined the concentration of elements in a sample. The unique aspect of NAA is that it doesn’t destroy the test sample. Among its many uses is the analysis of works of art and historical artifacts.
Chester moved his ruler down the list of results highlighting those of interest. When he reached the specimen from Jennifer Howe, he stopped.
What the hell is this, he thought. This must be an error. I need to run this again and maybe recalibrate the equipment.
The dialysis nurse rolled the hemodialysis machine to Jennifer’s bedside. She inserted clear plastic tubes into a series of pumps and detectors, then opened several gallon jugs and placed them in the rear of the machine.
Jack Byrnes, the director of the ICU and a kidney specialist, came to Jennifer’s bedside where Marlene and Mickey stood and introduced himself.
“Can we watch?” Mickey asked.
“Let me insert the catheter for dialysis first,” Jack said, “then you can come back.”
After they left, Jack prepped Jennifer’s groin with antiseptic then placed a large bore double lumen catheter into her femoral vein. The nurse handed him the plastic lines to the machine and they pumped blood into and out of her body.
“Tell the family they can come back,” Jack said.
When Jennifer’s blood circulated through the machine, Marlene nearly fainted.
“We don’t need a second patient,” said the nurse, moving an easy chair in place for Marlene.
“I’m fine,” Marlene said. “It’s all that blood.”
Mickey looked at the dialysis nurse. “What’s happening?”
“The machine removes Jennifer’s blood and passes it through the dialysis cartridge that removes waste products. We return the cleansed blood to her body. Most of the complicated dials and gauges are for safety reasons, making sure the procedure is going as we plan.”
“How long will it take?” Marlene asked.
“Three hours today,” Jack said, “and a little more tomorrow. Stay as long as you wish. I’ll be back in an hour.”
Marlene and Mickey watched as the nurse scurried around the machine. She constantly checked Jennifer’s vital signs to insure that the equipment was performing as expected. Several times the machine alarmed as Jennifer’s blood pressure fell as her irregular heartbeats continued.
“The machine removes fluid and also waste,” she said, “I have to be careful not to remove too much fluid at once.”
Mickey nodded off several times while Marlene sat wringing her hands.
“We’re done,” the dialysis nurse said as she returned Jennifer’s blood into her body.
“Will you remove that tube in her groin?” Mickey. asked
“No. We’ll need it until Jennifer’s kidneys recover.”
When Terri came in afterward, she said, “That wasn’t too bad, was it?”
“I think the thought is worse than the reality,” Mickey said. “What’s next?”
“We’ll do another dialysis treatment in the morning, and then the neurosurgeon will come and do the brain biopsy.”
Marlene grimaced. “I can’t stand the thought of someone sticking a needle into Jennifer’s brain.”
“That too, like dialysis,” Terri said, “sounds worse than it is.”
That night after dinner, Terri sat with Matt.
“I don’t know what it is,” she said, “but the brain biopsy scares me, too.”
“The procedure or the results?”
“The results, of course. The presence of prions is Jennifer’s death warrant.”
Jennifer’s condition remained unchanged over night except for her heart irregularities. Terri looked at every possible explanation for them, but couldn’t find one. She knew that heart irregularities often accompanied severe illness. Jennifer’s kidneys had failed to produce more urine.
Dr. Jack Byrnes and the kidney nurse were in by 8 a.m. and began her dialysis.
Afterward, Terri said, “I’m going to have the lab evaluate Jennifer’s clotting system to make sure there’s no chance of bleeding after the brain biopsy.”
“Bleeding?” Marlene said. “She could bleed?”
“It’s only a precaution. Bleeding is extremely unlikely.”
Two hours later, Terri said, “We’re taking her down to the radiology department for the biopsy.”
“Can I watch?” Mickey asked.
“No. You don’t want to do that anyway. I’ll come back afterward. It’ll be a day before the pathologist can tell us anything.”
The neurosurgeon and interventional radiologist flittered around the room preparing their equipment. They placed Jennifer’s head into a stainless frame with calibration marks in three dimensions. They took a few preliminary x-rays then the neurosurgeon inserted a twist drill into a stereo arc. They’d drill through her skull to make access for the biopsy equipment.
“We’re ready,” the neurosurgeon said, grasping the drill.
Terri nodded. “Go ahead.”
Terri gritted her teeth as she watched the drill bit twist into Jennifer’s skull. The cutting lands shined in the bright light.
“We’re in,” the neurosurgeon said. “Get me the biopsy needle.”
A circulating nurse entered the room. “Dr. Powell, I have a call for you.”
“Not now,” said Terri.
“It’s a Chester McCoy from the Lawrence Berkeley National Laboratory. He says it’s urgent. He says he must talk with you right now. By the sound of his voice, Doctor, I’d talk with him.”
“Wait just a moment,” Terri said to the neurosurgeon. “I’ll be right back.”
Chapter Sixty-Two
Terri picked the wall phone. “This better be important, Chester. We’re just starting a procedure.”
“On Jennifer Howe?”
“Yes, now what is it?”
“I’m trying to understand this,” Chester said. “Does Mrs. Howe have signs of neuromuscular irritability?”
“Yes.”
“Does she have cardiac irregularities?”
“Yes.”
“Does she have muscle cramps, ataxia, seizures or mental problems like overt psychosis or disorientation?”
“Yes, yes, yes, and yes. Now tell me what this is all about before I come over and wring it out of you.”
“You remember the samples I took of Mrs. Howe’s blood?”
“Chester...”
“I ran the neutron activation analysis three times. I even recalibrated the equipment to be sure the results were correct...I’ve never seen anything like it...nobody around here has...”
“I’m going to strangle you, Chester.”
“The red blood cell and the white blood cell levels of magnesium are the lowest anyone has ever seen. One of our scientists said these results were incompatible with life.”
“You made a mistake,” Terri said.
“There’s no mistake. I ran the specimen three times with known controls. There’s no mistake!”
Terri felt her legs weaken as she pulled a nearby chair and sat. “Her serum magnesium was a little low, but many of her electrolytes were abnormal. The platinum and maybe even the antibiotics could have made her lose magnesium...”
“I’m not a doctor, Terri...well not your kind of doctor, but I wouldn’t do anything dramatic to her until you correct this incredible total body magnesium deficiency.”
Terri’s mind raced...magnesium deficiency...my God, maybe it’s not Mad Cow after all!
“I have one request,” Chester said.
“Yes, you can have my first born...”
After a moment of silence, Chester said, with an exaggerated twang, “I don’t think that’s necessary, but I’d like to get more specimens as you correct her deficiency.”
“Chester, if Jennifer makes it through this you can take blood from the whole academic faculty, and...” she paused, “thank you, thank you, thank you.”
When Terri returned to the radiology suite, she said, “I’m cancelling the biopsy.”
“What are you talking about?” the neurosurgeon said.
Terri told them of Chester’s findings.
“I’ve never heard anything like this,” the surgeon said.
“Neither has anyone else. Plug the hole in her skull and let’s get her back to ICU so I can begin to correct this deficiency.”
Mickey and Marlene sat next to Jennifer’s bed as they returned her to ICU.
“How did it go?” Mickey asked.
“It didn’t,” Terri said. “I cancelled it.”
A Simple Cure Page 27