Fatal

by Michael Palmer

  “Should we try and get him out now or check around for others?” Nikki asked.

  “We need more hands.”

  “Matt, we can only do what we can do.”

  “Then let’s try to free him up. Fred, we’re going to get these rocks off of you.”

  The pile holding Carabetta down was considerably smaller and easier to move than the one that had covered the paralyzed guard. Still, by the time they had removed enough to free him, both were perspiring heavily and working at sucking in air.

  Carabetta cried out in pain as they rolled him over. The two of them winced at what they saw. His black sweat pants and shirt were sodden with blood, most of it oozing steadily from a wound to the right of his groin.

  “With all these rocks, there isn’t even enough space to kneel down here,” Matt said. “Let’s try to haul him over near the others and work on him there.”

  “I’ll do my best.”

  “Fred, we’re going to pull you over to where we have enough room to help you out.”

  Moving the man was no small feat. Ultimately, success involved Nikki and Matt each seizing a wrist and dragging him a foot or so at a time, past the girl, who was now randomly moving all her extremities, to the area where the security guard and the man with the Belinda syndrome lay. Exhausted from the effort and from breathing through the surgical masks, they stood for nearly a minute, hands on knees, gasping for breath.

  “No more sundaes for Fred,” Matt panted.

  At that moment, with a bansheelike screech, a figure flew from the darkness, off a tall pile of rubble, onto Nikki, sending her hurtling backward, shattering one of the lanterns.

  Nikki cried out in pain as the attacker—a stocky woman—quickly set upon her, hands around her throat. From the remaining illuminated light, Matt could easily discern the dense growth of neurofibromas virtually covering the woman’s face. He dove at her, hitting her shoulder-to-shoulder, and tackling her onto the cave floor. Growling and spitting, she flailed at his face and arms, landing several effective blows. Matt hit her in the face, first with an open hand, then full force with his fist. It was the first time he had ever punched someone that way in his life. Stunned, the woman sagged backward. Matt set his knee across her throat, tore off her cotton work shirt, and used one sleeve to tie her hands tightly together and the other to bind them to her ankles. Then he used adhesive tape from the first-aid kit to immobilize her more effectively.

  “You okay?” he asked, turning to Nikki.

  “My left ankle,” she groaned, in obvious pain. “It went over when she hit me.”

  “Are you hurt anyplace else?”

  “Not badly.”

  He knelt by her and examined the injury. Swelling had already begun across the outside of the ankle. In addition, there was impressive tenderness over the lateral malleolus—the bony prominence. If the end of her fibula hadn’t broken, ligaments had surely torn. Either way, her mobility was, to all intents, gone. Nikki moaned softly as Matt wrapped the ankle with gauze. Then he activated a bag of chemical ice and secured it against the joint with an Ace bandage. A second Ace completed the bulky splint.

  With great effort, Nikki rolled onto her hands and knees.

  “Let’s get to work on Fred,” she said. “I don’t know how much longer he can stay alive.”

  “You can do this?”

  “I can try,” she replied, wincing.

  “I’m going to get that duct tape and do the other two while you check Fred out. I don’t want a repeat of Tarzana, here, when they wake up. Jesus, what a mess we’re in.”

  Moving slowly and painfully on her hands and knees, Nikki propped two lanterns on piles of rock, took two pairs of rubber gloves from an as yet unopened box, and set to work. Using a bandage, scissors, and her hands, she cut and tore away Carabetta’s clothing. If he wasn’t in shock yet, he was close—filthy, pale, bloodied, and sweating, with a pulse that was ominously rapid and faint. There were four or five lacerations over his fleshy body and tree-trunk legs, which were still oozing crimson, but the real trouble was a deep, three-inch rent in his groin, where dark blood was flowing freely.

  Breathless, Matt returned from his task.

  “Arterial?” he asked.

  “I think venous. You’re bigger. How about some pressure.”

  Matt set a wad of gauze pads over the wound and leaned down on it with all the strength he could muster. Carabetta’s thick layer of saffron-colored fat made it difficult to apply enough force. Blood continued seeping from beneath the gauze.

  Meanwhile, Colin Morrissey’s stridor was worsening.

  “We need more hands,” Matt said again as Nikki crawled over to check on the man.

  “We have what we have,” she said over her shoulder. “Matt, this guy’s in trouble, too. I don’t think he’s going to make it too much longer without a tracheotomy.”

  “Well, I can’t maintain enough pressure to stop Freddy’s bleeding. My guess, he’s torn his saphenous vein.”

  “So what can we do?”

  “Get some narrow gauze bandage underneath the saphenous and tie it off.”

  “Have you done anything like that before?”

  “If you count my cat cadaver in comparative anatomy, I have. You?”

  “Well, between my year of surgery and my job cutting up the unfeeling, I know the anatomy pretty well.”

  “That settles it. I first-assist and you take a crack at it.”

  “What about Colin?”

  “Right now, he’s breathing. If we don’t stop this bleeding, Freddy’s toast.”

  “Okay, okay.”

  While Matt kept pressure on the wound, Nikki opened the first-aid kit and extracted a roll of one-inch gauze and a pair of forceps—the pointy-tipped kind used for removing splinters.

  “Any snaps?” Matt asked, referring to self-locking hemostats.

  “I don’t see any.”

  “A scalpel?”

  “Nope.”

  “Novocain? Xylocaine?”

  “You wish. Wait, there is a disposable scalpel.”

  “Ah, something to be grateful for. Fred, can you hear me?”

  “Help . . . me.”

  Matt abandoned the notion of a medical explanation. He leaned close to the man’s ear.

  “Fred, this is going to hurt,” he said emphatically. “Nik, how’s the ankle?”

  “Numb. As long as I don’t make any quick movements, it’s bearable. I don’t think I’m going to be able to stand on it, though.”

  “Well, I can keep pressure on this and hold the lantern, but you’ll have to serve as your own scrub nurse.”

  “I’m afraid,” she said suddenly.

  “I know,” Matt replied. “I wouldn’t trust you if you weren’t. Just do your best and do it fast.”

  “I think I need to open up the area better.”

  “Just do it.”

  Nikki shrugged and made a deep, four-inch incision at right angles to the middle of the gash. Blood oozed from the skin margins of the cut and from the bright yellow fat beneath it.

  “Oh, Jesus!” Carabetta howled as the slice was made. “Oh, fuck!”

  At the man’s scream, Nikki pulled back, but Matt shook his head.

  “You can do it,” he said firmly.

  “Okay,” she replied, “put pressure below the cut—a lot of pressure. Look, it is the saphenous vein—almost chopped through. It’s a miracle he’s still alive.”

  “You’re the miracle. Tie it off—top and bottom—then we can move on to he who cannot inhale.”

  Behind them, they could hear Colin’s labored breathing getting worse.

  “If that guy and the girl are anywhere near as crazy as Tarzana was, we’ll have our hands full when they wake up,” Nikki said.

  “This guy, then that guy, then the girl,” Matt said.

  “Right.”

  Nikki used her fingers and the blunt end of the forceps first to spread the tissue around and under the torn vessel. Then she forced the ends of two
twelve-inch lengths of gauze through the tunnel she had created. With each movement, Fred cried out, but his response to the pain was getting feebler. A large percentage of his blood volume was in his clothes and on the dusty floor. Unless his bleeding was stopped, he might have a minute or two before drifting into unconsciousness for good—maybe a little more, maybe less.

  “You’re doing great,” Matt encouraged. “Get a knot in that lower tie, and I’ll switch the pressure to stop the backflow. For someone who hasn’t touched a live patient in years, you’re pretty darn good.”

  “Come on, baby,” Nikki murmured to the vein as she gently worked the second gauze tie into place, “don’t tear apart on me now.”

  “You’ve got it! You’ve got it!”

  “I hope so, because here goes.”

  Nikki pulled the gauze tight, and a moment later Matt released the pressure he had maintained through most of the procedure. There was some oozing from the incision and the gash, but the area around the lacerated vein was dry. The saphenous was the vein usually harvested for cardiac bypass grafts. Collateral veins would take over the job of returning blood to the heart. If Carabetta made it through this episode and out of the cave—both enormous ifs—he might be left with little more than some periodic ankle swelling.

  “Nicely done,” Matt said. “Getting around that vein without ripping it in two was really something.”

  At that moment, Colin Morrissey’s breathing seemed to become even more labored.

  “We might need to trach him,” Nikki said. “Can you go check him again?”

  “I would, but Fred here still needs pressure on this wound.”

  “I’ll do that,” a voice beside them said. An older woman, battered as the rest of them, had crawled over from some part of the cave they had yet to inspect. “You go check the boy,” she said. “I’ll do my best here. My name is Ellen. Ellen Kroft.”

  CHAPTER 32

  NIKKI KNEW HER ANKLE WAS BROKEN. SHE HAD felt the crack of bone and the explosion of pain when the woman Matt was calling Tarzana—160 or 170 pounds—blindsided her. Now she simply bit at the inside of her lip and did her best to cope with the pain. They were in a fearsome predicament with a finite air supply and no obvious way out of the cave. The last thing the others needed was to worry about her.

  The newcomer, Ellen Kroft, essentially uninjured, kept pressure on Fred Carabetta’s wound while Matt used his ear as a stethoscope to examine the lungs of Colin Morrissey.

  “I think he’s moving enough air,” he said, “at least for the moment. His coma seems to be getting a little lighter, too.”

  “Let’s hope he’s sane when he wakes up.”

  “With his larynx swollen nearly shut, I don’t think he’s going to pose much of a problem. How’s your leg?”

  “Fine,” Nikki said perhaps a bit too quickly, adding, “It aches some.”

  “Think you can put weight on it?”

  “I . . . I doubt it.”

  “I watched you working on this man from over there,” Ellen said, gesturing toward the darkness to her right. “You’re both doctors?”

  “I’m Matt Rutledge, an internist from Belinda, and this is Nikki Solari from Boston. She’s a pathologist.”

  “How many others are there in here besides us?”

  “Do you know of any?”

  “No. I was tied up here for a time, then injected with something that knocked me out. When I came to, I was covered with dust and pieces of rock. I assume Grimes untied me while I was unconscious, then blew up the cave. He’s the police chief here.”

  “Oh, we know who he is. You assume right about him. In addition to that guy and the four of us, there are two people—a woman and a girl—with lumps on their faces like his. They don’t seem to be badly hurt, but the woman is pretty wild. We’ve tied her up for now. The girl’s still unconscious.” Matt lowered his voice. “Then there are two security guards from the mine over there. One of them’s dead, the other probably paralyzed.”

  “And two more men who came in with us are missing,” Nikki added.

  “Do you know why Grimes did this to us?” Ellen asked.

  “I don’t know why he included you,” Matt replied, “but as you can see, the local mine has been illegally storing toxic chemicals in here. We were about to expose the whole business. Grimes is in bed with the mine owners.”

  With Kathy’s fatal prion disease not adequately accounted for, Nikki had never felt completely comfortable with Matt’s contention about the mine.

  “Not to muddy the water,” she said, “but what Matt didn’t say was that a number of people from this area have developed a syndrome of horrible facial lumps and progressive paranoia. Matt thinks it has something to do with these chemicals. I’m not as certain about that as he is. Do you have something to do with the mine?”

  “No. I’ve never been in this area before.”

  “Then, why?”

  “Well, believe it or not, I came because a man broke into my home in Glenside, Maryland, and swore he would kill my granddaughter unless I did what he wanted me to. I was able to learn who he might be, and traced him back here to Tullis, but I needed to get a look at him before I could be certain he was the one. Your police chief was supposed to help me do that and also take a statement from me, but we never got that far.”

  “I don’t understand,” Matt said, turning back to check on Morrissey. “Who was the man you came about?”

  “His name was Sutcher. Vinyl Sutcher.”

  Stunned, Nikki and Matt stared at one another.

  “Perhaps you’d better tell us more,” Nikki said.

  Fred Carabetta had lapsed into unconsciousness. His steady, sonorous breathing formed the background for Ellen’s account of her place on the blue-ribbon Omnivax commission; of Lynette Marquand’s politically motivated pledge to the American people; of her terrifying encounter with Vinyl Sutcher; and finally, of the fruits of Rudy Peterson’s dogged pursuit of the truth behind the outbreaks of Lassa fever. For a time after she had finished, nothing was said. Matt’s eyes closed as he spun through the kaleidoscope of his memories, searching to connect with something . . . something he knew was there.

  Suddenly he looked up at the two women, his expression grim.

  “The Lassa fever vaccine was tested here,” he said.

  “What?”

  “I don’t know exactly when, sometime between when I left for college and when I came back to practice. A drug company paid all the doctors in the valley for each patient they could convince to get the shot. After I came back to go into practice here, a bunch of the older docs were joking about it one day in the lunchroom at the hospital. Here none of them had ever even seen a case of Lassa fever in their lives, and now, with a bunch of the town immunized, none of them ever would. That was the gist of what they were laughing about. A couple of them didn’t even know what the disease was, even though they signed up a number of their patients and gave them the shot. I actually think I remember them saying that they got a hundred dollars a head, and that some of them shared that money with the patients. It was all perfectly legal as far as I know—docs and patients are both paid all the time for participating in research protocols or drug testing. I don’t know how many in the valley were given the test shots.”

  “Four hundred,” Ellen said. “Four hundred of all ages. I saw the summaries of the field trial, but I never noted down where it was conducted.”

  “How many years ago?” Nikki asked.

  “I don’t know,” Matt replied. “Maybe ten.”

  “Oh, God,” she exclaimed.

  “What?”

  “Matt, don’t you see? Prions. The latent period between exposure to the germ and development of symptoms can be as much as ten years or even longer. That’s where the Belinda syndrome is coming from—from the vaccine, not from these barrels of poison. The tissue culture cells that the virus was grown on must have been contaminated with prions right from the start. It seems likely they would have used monkey tissue.
If so, maybe the monkeys that the cells came from originally were infected.”

  “But—”

  “You were right all along about the mine storing toxic waste. You were right and you were passionate about what you believed. Grimes knew about this dump and probably sent you that note to keep pushing you in this direction so you wouldn’t ever search for the truth about the cases you discovered.”

  “But why would he do that?”

  “He must have a stake in the vaccine.”

  “If he does,” Ellen said, “he’s on the verge of becoming an extremely wealthy man. Lasaject is one of the most expensive components of Omnivax. In the next year, especially when older children and adults are immunized in addition to newborns, tens of millions of doses are going to be administered. What’s this about prions? What are they?”

  “The germs that cause Mad Cow disease and other neurologic illnesses as well,” Nikki said. “We think they’re responsible for the condition that man has, and also the woman who attacked me, and the girl over there. The symptoms don’t appear for years after exposure, and there’s essentially no test to see if someone without symptoms has contracted the disease.”

  “You think everyone who gets the vaccine will get infected with prions?”

  “I doubt it. Those who get the disease probably have some sort of genetic predisposition to the effects of the prions. In Britain, despite the hundreds of thousands of people who ate contaminated beef, relatively few cases of Mad Cow disease have been reported.”

  “How many of the original four hundred do you think have developed prion disease?”

  Nikki shrugged. “Let’s see,” she said. “Matt and I have encountered six cases, including these three. If, say, an additional six cases have disappeared thanks to the handiwork of Grimes and his men, that would make twelve.”

  “Three percent,” Ellen said.

  “That may be higher than with Mad Cow disease,” Matt said, “but the jury is still out on the rest of those exposed, because we don’t know how variable the latency period of the disease is. And the British ate the germ. These people had it injected.”

  “Three percent at a minimum,” Ellen said. “That’s terrible. Do either of you know the date and time right now?”