by Robin Cook
He read the rest of the article, feeling sorry for Shirley. The police reported that a significant amount of heroin and cocaine was found at the South End apartment that Hayes had shared with Carol Donner.
Jason went to the hospital to find his inpatients generally in poor shape. Matthew Cowen, who had had a cardiac catheterization the day before, displayed odd symptoms alarmingly like the late Cedric Harring: arthritis, constipation, and dry skin. None of these would normally cause Jason much concern. But in view of recent events, they made him feel uneasy. They again brought up the specter of some new unknown infectious disease that he could not control. He had the feeling Matthew’s course was about to change for the worse.
After ordering a dermatology consult for Cowen, Jason gloomily went down to his office. where Claudia greeted him with the information that she had pulled the executive physicals through the letter P. She had called the patients and discovered that only two complained of health problems.
Jason reached for the charts and opened them.
The first one was Holly Jennings, the other Paul Klingler. Both had had their physicals within a month. “Call them back,” Jason said, “and ask both to come in as soon as they can without alarming them.”
“It’s going to be hard not to upset them. What should I say?”
“Tell them we want to repeat some test. Use your imagination.”
Later in the day he decided to see if he could charm some more information on Hayes out of his lab technician, but the moment he saw Helene she made it clear she was not about to be charmed.
“Did the police find anything?” he asked, already knowing the answer was no. Shirley had called him and told him after the police had departed, saying, “Thank God for small favors.”
Helene shook her head.
“I know you’re busy,” Jason said, “but do you think you could spare a minute? I’d like to ask a few more questions.”
She finally stopped working and turned toward him.
“Thank you,” he said, and smiled. Her expression didn’t change. It wasn’t unpleasant, just neutral.
“I hate to belabor the subject,” Jason said, “but I keep thinking of what Dr. Hayes said about a significant breakthrough. Are you sure you have no idea what it could be? It would be tragic if a real medical discovery were lost.”
“I told you what I know,” Helene said. “I could show you the latest map he did of chromosome 17. Would that help?”
“Let’s give it a try.”
Helene led the way into Hayes’s office. She ignored the photos that covered the walls, but Jason couldn’t. He wondered what kind of man could work in such an environment. Helene produced a large sheet of paper covered with minute printing, giving the sequence of base pairs of the DNA molecule comprising a portion of chromosome 17. There was a staggering number of base pairs: hundreds and hundreds of thousands.
“Dr. Hayes’s area is here.” She pointed to a large section where the pairs were done in red. “These are the genes associated with growth hormone. It’s very complex.”
“You’re right there,” Jason said. He knew he’d have to do a lot more reading to make any sense of it all.
“Is there any chance this mapping could have led to a major scientific breakthrough?”
Helene thought for a moment, then shook her head. “The technique has been known for some time.”
“What about cancer?” Jason asked, giving the idea a shot. “Could Dr. Hayes have discovered something about cancer?”
“We didn’t work with cancer at all,” Helene said.
“But if he was interested in cell division and maturation, it’s possible he could have discovered something about cancer. Especially with his interest in the switching on and off of genes.”
“I suppose it’s possible,” Helene said without enthusiasm.
Jason was sure that Helene was not being as helpful as she could be. As Hayes’s assistant, she should have had a better idea of what Hayes was doing. But there was no way he could force the issue.
“What about his lab books?”
Helene returned to her spot at the lab bench, Opening the second drawer at the table, she pulled out a ledger. “This is all I have,” she said, and handed it to Jason.
The book was three-quarters filled. Jason could see it was only a data book without experimental protocols, and without those, the data was meaningless.
“Aren’t there other lab books?”
“There were some,” Helene admitted, “but Dr Hayes kept them with him, especially over the last three months. Mostly he kept everything in his head He had a fabulous memory, especially for figures….” For a brief moment Jason saw a light in Helene’s eyes and thought she might open up, but it didn’t last.
She trailed off into silence. She took the data bool from Jason and replaced it in its drawer.
“Let me ask one other question,” Jason said, struggling over the wording. “As far as you could tell, did Dr. Hayes act normally over the last few weeks? He seemed anxious and overtired when I saw him.” Jason deliberately understated Hayes’s condition.
“He seemed normal to me,” said Helene flatly.
Oh, brother, Jason thought. Now he was sure Helene wasn’t being open with him. Unfortunately, there was nothing he could do about it. Thanking her and excusing himself, he retreated from Hayes’s lab. He descended in the elevator, avoided being seen by Sally, crossed to the main building, and rode up to pathology.
He found Jackson Madsen in the chemistry lab, where there was a problem with one of the automated machines. Two company reps were there, and Jackson was happy to return to his office with Jason to show him the slides of Harring’s heart.
“Wait until you see this,” he said as he positioned a slide under his microscope. He peered through the eyepiece, moving the slide deftly with his thumb and index finger. Then he stepped back and let Jason take a look.
“See that vessel?” he asked. Jason nodded. “Notice the lumen is all but obliterated. It’s some of the worst atherosclerosis I’ve seen. That pink stuff looks like amyloid. It’s amazing, especially if you say his EKG was okay. And let me show you something else.” Jackson substituted another slide. “Take a look now.”
Jason peered into the microscope. “What am I supposed to see?”
“Notice how swollen the nuclei are,” Jackson said. “And the pink stuff. That’s amyloid for certain.”
“What does that mean?”
“It’s as if the guy’s heart was under siege. Notice the inflammatory cells.”
Unaccustomed to looking at microscopic sections, Jason hadn’t noticed them at first, but now they jumped out at him. “What do you make of it?” he asked.
“I’m not sure. How old did you say this guy was?”
“Fifty-six.” Jason straightened up. “Is there any chance, in your estimation, that we are seeing some new infectious disease?”
Jackson thought for a moment, then shook his head. “I don’t think there’s enough inflammation for that. It looks more metabolic, but that’s all I can say. Oh, one more thing,” he added, putting in another slide. While he focused he said: “This is part of the red nucleus in the brain. Tell me what you see.” He leaned back for Jason. Jason peered into the scope. He saw a neuron. Within the neuron was a prominent nucleus as well as a darkly stained granular area. He described it to Jackson.
“That’s lipofuscin,” said Jackson. He removed the slide.
Jason straightened up. “What does it all mean?”
“Wish I knew,” said Jackson. “All nonspecific, but certainly a suggestion that your Mr. Harring was a sick cookie. These slides could have belonged to my grandfather.”
“That’s the second time I’ve heard something like that,” said Jason slowly. “Can’t you give me anything more specific?”
“I’m sorry,” said Jackson. “I wish I could be more cooperative. I’ll be running some tests to be sure these deposits in the heart and elsewhere are amyloid. I’ll let you k
now.”
“Thanks,” said Jason. “What about the slides on Hayes?”
“Not ready yet,” said Jackson.
Jason returned to the second floor and walked over to the outpatient area. As a doctor he’d always had questions about the efficacy of certain tests, procedures and drugs. But he had never had reason to question his general competence. In fact, in most situations he’d always thought of himself as well above average. Now, he wasn’t so sure. Such misgivings were disturbing, especially because he’d been using work as his major sense of self since Danielle’s death.
“Where have you been?” demanded Sally, catching up to Jason as he tried to slip into his office. Within minutes Sally had Jason buried beneath a host of minor problems that thankfully absorbed his attention. By the time he could catch his breath, it was just after twelve. He saw his last patient, who wanted advice and shots for a trip to India, and then he was free.
Claudia tried to get him to join her and some other secretaries for lunch, but Jason declined. He retreated to his office and brooded. The worst part for Jason was the frustration. He felt something was terribly wrong, but he didn’t know what it was or what to do about it. A loneliness descended over him.
“Damn,” said Jason, slapping the top of his desk with his open palm, hard enough to send unattached papers flying. He had to avoid slipping into a depression. He had to do something. Changing from his white coat to his jacket, he grabbed his beeper and descended to his car. He drove around the Fenway, passing the Gardner Museum and then the Museum of Fine Arts on his right. Then, heading south on Storrow Drive, he got off at Arlington. His destination was Boston Police Headquarters.
At police headquarters a policeman directed Jason to the fifth floor. As soon as he got off the elevator, he saw the detective coming down the hall, balancing a full mug of coffee. Curran was jacketless, with the top button of his shirt open and his tie loosened. Under his left arm dangled a worn leather holster. When he saw Jason he seemed perplexed until Jason reminded him that they’d met at the morgue and at GHP.
“Ah, yes,” Curran said, with his slight brogue. “Alvin Hayes business.”
He invited Jason into his office, which was starkly utilitarian with a metal desk and metal file cabinet. On the wall was a calendar with the Celtics’ basketball schedule.
“How about some coffee?” Curran suggested, putting his mug down.
“No, thank you,” Jason said.
“You’re smart,” Curran said. “I know everybody complains about institutional coffee, but this stuff is lethal.” He pulled a metal chair away from the wall and motioned to it for Jason to sit.
“So what can I do for you, doctor?”
“I’m not sure. This Hayes business disturbs me. Remember I told you that Dr. Hayes said he’d made a major discovery? Well, now I think there’s a good chance he did. After all, the man was a world-famous researcher, and he was working in a field with a lot of potential.”
“Wait a minute. Didn’t you also tell me you thought Hayes was having a nervous breakdown?”
“At the time I thought he was displaying inappropriate behavior,” Jason said. “I thought he was paranoid and delusional. Now I’m not sure. What if he did make a major discovery which he hadn’t revealed because he was still perfecting it? Suppose someone found out and for some reason wanted it suppressed?”
“And had him killed?” Curran interrupted patronizingly. “Doctor, you’re forgetting one major fact: Hayes died of natural causes. There was no foul play, no gunshot wounds to the head, no knife in the back. And on top of that, he was dealing. We found heroin, coke, and cash in his Southie pad. No wonder he acted paranoid. The drug scene is a serious world.”
“Wasn’t that anonymous tip a bit strange?” Jason asked, suddenly curious.
“It happens all the time. Somebody’s pissed about something so they call us to get even.”
Jason stared at the detective. He thought the drug connection was out of character, but didn’t know why. Then he remembered that Hayes had been living with an exotic dancer. Maybe it wasn’t so out of character after all.
As if reading Jason’s thoughts, Curran said, “Listen, doctor, I appreciate you taking the time to come down, but facts are facts. I don’t know if this guy made a discovery or not, but let me tell you something. If he was dealing drugs, he was taking them too. That’s the pattern. I had the Vice department run his name through their computers. They came up with zip, but that just means he hadn’t been caught yet. He’s lucky he got to die of natural causes. In any case, I can’t justify spending Homicide time on the death.”
“I still think there’s more to it.”
Curran shook his head.
“Dr. Hayes was trying to tell me something,” Jason persisted. “I think he wanted help.”
“Sure,” Curran said. “He probably wanted to pull you into his drug ring. Listen, doctor, take my advice. Forget this affair.” He stood up, indicating the interview was over.
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.