Fatal

by Michael Palmer

  “Matt, you know I’d walk over hot coals for you,” Nancy Catlett said, “but we have four criticals in the unit right now, and a post-op abdominal aneurysm repair due up soon. There’s just no way I can justify keeping a patient who’s awake and alert—even one of yours.”

  “In that case, a private room.”

  “That depends on her insurance.”

  “Just find one for her. We’re going to have a guard posted outside the door. I want only people essential to her care going in there. If she needs a specific order, I’ll write it. If her plan still won’t cover the private, I will.”

  “Well now, I don’t think we’ll need to go that far,” Catlett said. “But if that’s the way you care for all your patients, I’m switching doctors to you. My HMO is terrible about paying for private rooms.”

  Matt made quick rounds on the patients he had in the hospital, and then brought the chest tube insertion kit, drainage system, intravenous bags, antibiotics, and other purloined equipment to his motorcycle. Thoughts of Nikki Solari and questions surrounding the assault on her had now bivouacked in his mind, making it difficult to concentrate on much else. When he returned to the unit, the nurses reported that Nikki had been asleep since he left, drifting back out again immediately after each of the two neuro checks they had done. Still, the moment he stepped through the doorway, she moaned contentedly and opened her eyes.

  “Welcome back,” she said, yawning.

  “How did you know I was here?”

  “Sometimes I just know things.”

  “How’s your headache?”

  “Did you ever see Riverdance?”

  “Ouch. I can have them give you some Tylenol, but I’d rather stay away from anything stronger.”

  “Tylenol will be fine. I’m tough.”

  “You don’t have to convince me of that. The police guard is all set. You were right about Bill Grimes. He feels very protective toward you.”

  “I hope he can get to the bottom of this,” she said.

  “He’s a pretty good cop.” When he wants to be. “Listen, I’ve got a house call to make, but I’m going to wait around the ICU until the guard gets here. You just go ahead and sleep. Right now that’s the most therapeutic thing you could do.”

  “In a minute. Right now I’m wide awake. Can you sit for a little while? I sort of feel like Dorothy when she looked out the window and discovered she wasn’t in Kansas anymore.”

  “I’d much rather talk with you than write progress notes.”

  “Thanks. The nurses tell me you trained at Harvard.”

  “I did my residency in medicine at White Memorial.”

  “I’m impressed. I wasn’t accepted for their surgical program.”

  “Surgery?”

  “I did a year of surg at Metropolitan then switched to pathology. I wanted my patients to lie really, really still when I was operating on them. Where did you live when you were there?”

  “Beacon Hill. The poorer part at the bottom. I liked Boston pretty much, but my heart has always been here in the mountains. I couldn’t wait to get back.”

  “That’s not hard to understand. It’s very beautiful here.”

  “When you’re not being chased by a pair of crazed killers it is. Can I ask you something?”

  “Sure.”

  “It’s about your tattoo.”

  “What about it?” she asked with a slightly defensive edge to her voice.

  “Oh, nothing. I just wanted you to know that I run into Gila monster tattoos on the top of doctors’ feet all the time around here.”

  Nikki’s eyes narrowed. Are you making fun of me? they asked.

  Matt leapt in to save the situation.

  “Uh-oh, I’m sorry,” he said. “Sounding flip when I shouldn’t is one of my less desirable talents. It gets me into more hot water than a boiled lobster. Mea culpa.” He pushed up his sleeve to reveal his own tattoo. “I’m into hawthorn trees, myself.”

  Nikki’s expression softened.

  “Sometime, you’re going to owe me a story,” she said. “Well, let’s see. I had the tattoo put on a few years ago. Some of my musician friends were getting them and I decided I wanted one, too. I picked the dorsum of my foot so that I could see it whenever I wanted to, but I could also hide it whenever I wanted. I might have thought of some other location if I had known how much that one was going to kill. It’s actually only half Gila monster. The front half is a salamander.”

  “Many of our doctors choose that variation,” he commented in spite of himself.

  Her eyes laughed. No problems this time.

  “I once saw the combination on a clay pot at a Navajo reservation in Arizona,” she went on, “and after the artist explained it to me, I ended up adopting the creation as sort of my totem. The salamander is shy, porous, vulnerable, weak, and secretive. The Gila is fearless, compact, warriorlike, determined, and so tenacious that when it grasps something with its thick jaws, one must often cut its head off to get it to let go.”

  Matt flashed on the horrible death of the beast in his dream and shuddered. He had never been one to reject the mystical or supernatural, beginning with dreams, and this one was bothering him more every second. Was the unsettling scenario merely replaying a version of the events recently past, or was it a vision of things yet to be?

  “I can see how those two men on the highway got more than they bargained for,” he said.

  There was no response. Nikki’s eyes were closed again, her brain muffled by exhaustion and the physiology of her concussion. The lingering effects of blunt head trauma were absolutely unpredictable and potentially devastating. Matt had seen professional athletes forced to the sidelines permanently, and others—intellectually sound initially with no visible changes on their MRIs—become significantly impaired over just a few days.

  Silently, he prayed for Nikki Solari and the music that she made—with and without her violin. He stood, and before he turned away, impulsively reached out to touch her hand. At the last moment, he pulled back. The gesture would be perfectly innocent and natural with nearly all of his patients. But not, he had to admit, with this one.

  CHAPTER 17

  WITH THREE QUICK RAPS, DR. RICHARD STEINMAN gaveled to order the final meeting of the select commission on Omnivax. The scene outside the closed-door session was nothing like the throng of reporters and photographers that had covered Lynette Marquand’s speech. But the media was still well represented. The drama of the First Lady’s promise to go back to the drawing board with Omnivax if even one member of the august panel voted against it, coupled with the political and medical implications of the project, had kept interest high.

  Around the elegant conference room, twenty-two physicians and scientists stopped their conversations and solemnly took their seats behind their name cards around the massive table. One place remained conspicuously empty—that of consumer representative Ellen Kroft.

  “I would like to take this opportunity,” Steinman began, “to thank each and every one of you for nearly three years of outstanding, deeply committed effort, which will culminate in this morning’s vote. You have done a great service to your country, to the medical community, and ultimately to the people of the world. The agenda for this meeting is that you will individually be given the chance to make some final remarks on whatever subject you choose relative to the work we have been doing. After that, we will go around the table and each will vote Yea or Nay. For the purpose of the First Lady’s promise to the American people, an abstention will not be viewed as a negative vote.”

  He paused, looking as if he had just swallowed an underchewed chunk of meat.

  “Before we go any further,” he said after clearing his throat and composing himself, “there is a statement I have been asked to read to you. It was delivered to me earlier this morning with a note stating that copies of it are being sent to the Washington Post and the New York Times, as well as to all four major TV networks and CNN. It is from Mrs. Ellen Kroft, who will not be here
today. I’m sorry there wasn’t time to provide each of you a copy, but one will be distributed to you by the time our session is over. I have been asked by Mrs. Kroft to read her statement to you in its entirety.”

  There was a stirring in the room and an exchange of glances. Some expressions were curious, some unabashedly disdainful. Seated next to Ellen Kroft’s empty chair, George Poulos fixed his neutral gaze steadily on Steinman.

  “There being no objections, then,” Steinman said, “I shall proceed.” He again cleared his throat, then adjusted his glasses.

  “‘Esteemed colleagues, as the lone consumer representative on the Omnivax commission I have approached my responsibilities not as the scientist and/or physician that all of you are, but as a mother and grandmother. From the day of our first meeting, I established three mandates for myself. The first was to learn as much as I was able about the process by which vaccines are developed, tested, approved, and later on evaluated once they are in general use. The second was to acquaint myself in depth with the components of Omnivax—their production, individual characteristics, and interactions one with another. And finally, to speak with a cross section of fathers and mothers in a number of communities, recording their hopes and, yes, their fears about vaccinations in general and Omnivax in particular. I would like to address these tasks in that order.

  “‘There are many, including most of you, the First Family, and HHS Secretary Lara Bolton, who believe that one of the primary benchmarks of progress in a civilized society is how thoroughly its citizens are protected against infectious diseases. As you know, but others may not, since nineteen-forty the number of required vaccine doses for our children has risen from three doses of DPT to forty doses of twelve different vaccines. And now, with Omnivax, while the number of shots will drop impressively, the number of vaccines administered will more than double. Omnivax certainly seems like one giant leap for mankind. But will there be negative consequences?

  “‘The gold standard for any new drug investigation is the double blind study, in which the subject population is divided into two groups, equal in as many demographic and medical parameters as possible. The larger the study population, the better, so long as the characteristics of each group are equivalent. One of the groups then receives the drug being evaluated, and the other a placebo. The study becomes double blind when neither the patient nor the treating physician knows who is getting what. The longer the evaluation is continued, the more reliable its results. In fact, many new drug studies have been conducted over a decade or more.

  “‘My research has shown that not once has a vaccine—any vaccine—been evaluated by a prolonged double blind study. The pharmaceutical houses are powerful, and fund much of the drug research done at our universities and medical centers. They also have polished, highly effective public relations offices that have, on a number of occasions, set out to convince the general public that we cannot afford to deprive the placebo group of the lifesaving benefits of a vaccine while waiting until a statistically meaningful double blind study can be completed.

  “‘Has this shortcut in scientific process hurt us in any concrete, medical way? That I cannot answer with any certainty. What I can say is that as vaccination rates have climbed, there has been an alarming increase in the incidence of a number of so-called immune-mediated diseases and conditions such as asthma, allergies, and juvenile diabetes, as well as others—autism, ADD, and other learning disabilities—whose classification as immune-mediated remains to be established. Is there a connection? Do vaccinations in some instances disrupt the normal development of the body’s immune system? Until long-term, double blind studies are performed on those vaccines, we may never know.’ ”

  Here, Steinman paused for some water and to make eye contact with those on his committee. Several of them rolled their eyes in exasperation at being forced to listen to the shopworn, simplistic revelations of the one member of their panel with no research credentials.

  “I can see what you’re thinking,” Steinman said, “but I am going to finish Mrs. Kroft’s statement. She has done us all a great service by deciding to abstain from this vote. In our laboratories and clinics, we are powerful and influential. But in the court of public opinion, the consumer representative has more clout than almost any of us. When this meeting is over and our vote has been taken, we are each going to have to respond publicly to the issues she is raising. Any questions?”

  “Just get it over and let’s vote,” one of the pediatricians groused.

  “Thank you, Mel,” Steinman said. “That is just what I intend to do.” He straightened his glasses and took another drink.

  “‘And what about Omnivax?’ Mrs. Kroft goes on. ‘First, let me say how impressed I am with the research and medical technology that has gone into the development of this amazing product. But once again, I must ask, Where is the double blind study? Where is the long-term evaluation? Once a drug or vaccine is released, the CDC and FDA rely on a post-marketing evaluation system of physician adverse reaction report forms. Studies have shown that only a small percentage of doctors have ever filled out such a form, despite knowing or sensing that many conditions they have encountered may be vaccine- or medication-related. Some are too busy or simply can’t put their hands on a form at the moment they need one. Those who fill out such forms generally do so only when the suspected reaction occurs within a short time after the medication is taken and, more often than not, is spectacular. I would be remiss not to point out that there is no evidence at this juncture that Omnivax has caused problems in preliminary test subjects of a magnitude that even remotely approaches the mortality of the diseases it is preventing. But I would also be remiss not to point out that Omnivax is only as strong as its least extensively evaluated component.

  “‘Thirty vaccines, no double blind research. But also no obvious major adverse effects. For me those three facts make the decision on Omnivax a tough call.

  “‘That brings me to my final task, that of being a true consumer representative. Parents are frightened that government agencies and the pharmaceutical industry are keeping information on vaccine side effects from them. Those parents who wish to decline vaccinating their children are prosecuted sometimes even when they can show that doing so violates their basic religious beliefs. This shouldn’t be happening in America. Wherever I go, parents are clamoring for three things: information, research, and choice.

  “‘So where does that leave us? We have a remarkable product that will unquestionably save lives. We have a basic, essential research design that has been skipped over just as it has for every other vaccine or vaccine combination we have ever used. We have parents wanting more information and more control over what is injected into their children’s bodies.

  “‘After reviewing all these facets and issues, I have decided I can neither wholeheartedly endorse Omnivax nor vote to deprive the American public of its lifesaving gifts. I therefore have decided to abstain from the final vote on its approval. I wish my colleagues on the commission all the best and thank them for their forbearance and education over these past thirty-two months.’ ”

  Richard Steinman set his glasses aside. Around the room, expressions clearly said that none of the participants were the least bit moved by what Ellen had written. After several silent seconds, George Poulos raised his hand and spoke.

  “I would like to move at this time that we dispense with the final comments and proceed right to a vote.”

  “Second,” a weary voice called out.

  “Objections?” Steinman asked. “Okay, then. George, suppose we start with you.”

  “I vote Yea.”

  AT THE MOMENT of the historic vote, Ellen was a hundred miles to the north of the FDA building, driving in no particular hurry through the lush landscape of Maryland’s Catoctin Mountains, headed for the cabin of Rudy Peterson. Two hours before that, she had picked up Lucy at her home and driven the child to a small wooded park, bisected by a gently flowing stream. There she led her to a bench and sa
t beside her, holding her close, rocking in synchrony with her. Not far away, on a small playground, half a dozen children were playing on the swings and jungle gym. Lucy’s gentle scent, scrubbed and clean, was no different from those kids’, Ellen thought. Her hair, her skin, her beautiful eyes—all were perfectly normal. Yet here she was, as different from those children as if she had come from another planet.

  Ellen scanned about, wondering if she and Lucy were being followed and observed. The notion made her queasy. There was no obvious candidate that she could see, but that meant nothing. The people up against her were professionals.

  “I’m going to find that man, honey,” Ellen whispered softly. “I’m going to find that man and I’m going to find out who hired him, and I’m going to hurt them. I’m going to hurt them like they have never been hurt in their lives.”

  For fifteen minutes, they sat there, Ellen’s tears dampening her granddaughter’s hair. The children had all raced off to class. The playground was empty. Lucy, rocking less than usual, stared vaguely off in that direction.

  “I love you, baby,” Ellen said finally, helping the girl to her feet and back toward the car. “Come on, let’s get going. Gayle is waiting for you at school.”

  AT ELEVEN, ELLEN was just a few miles from Rudy’s cabin. She flipped on the radio and found a static-filled news broadcast just in time to catch the report from Rockville. In the unanimous vote promised by First Lady Lynette Marquand, general use of the Omnivax multivaccine had been approved. In just a few days, she would be present at a Washington, D.C., neighborhood health center as Secretary of Health and Human Services Dr. Lara Bolton administered the first injection of the drug. After that, inoculation with Omnivax would be required for all newborns and eventually for all older children as well.

  Let the games begin, Ellen thought bitterly.

  She felt anxious but keyed up as well. There really had been no choice for her. She had done what she had to do. If she had plowed forward with a negative vote on Omnivax, and something had happened to Lucy, she would simply have been unable to go on.