Terminal
Page 1
“Like a runaway locomotive—a manically entertaining thriller. Robin Cook knows how to make the pages fly.”
—Kirkus Reviews
TERMINAL
At a prestigious Florida medical center, brain cancer patients are treated with a one-hundred-percent success rate. Sean Murphy, a young medical student, finds it hard to believe. Is it a miracle cure? Or the biggest con job in the history of medicine?
“Straight out of today’s headlines.”
—UPI
A Dual Main Selection of the Literary Guild®
DR. ROBIN COOK, a graduate of Columbia Medical School, finished his postgraduate medical training at Harvard. He is the author of Seizure, Shock, Abduction, Vector, Toxin, Chromosome 6, Contagion, and numerous other bestselling novels.
Praise for the other novels of
ROBIN COOK
ABDUCTION
Cook’s most daring novel to date—a shocking discovery changes everything we know about life, in all its forms….
“LEAVE IT TO DOCTOR-TURNED-NOVELIST ROBIN COOK TO SCARE US ALL TO DEATH.”
—Los Angeles Times
VECTOR
A disgruntled Russian émigré possesses the knowledge to unleash into the streets of New York City the ultimate terror: a modern bioweapon…
“THERE’S A FRIGHTENING LOGIC IN THE IDEA THAT YOUR NEXT BREATH MIGHT KILL YOU.”
—Publishers Weekly
TOXIN
The widespread danger of bacterial contamination from America’s meat supply drives Robin Cook’s startling and eye-opening shocker…
“A CAUTIONARY TALE…A COVER-UP OF MAJOR PROPORTIONS…THE PROGNOSIS FOR TOXIN IS GOOD.”
—Chicago Tribune
CHROMOSOME 6
In his most prophetic thriller, Robin Cook challenges the medical ethics of genetic manipulation and cloning…
“SHOCKING AND THOUGHT-PROVOKING…COOK’S BEST TO DATE.”
—The Associated Press
INVASION
A sudden outbreak defies diagnosis—because the causes are unlike anything humankind has ever seen…
“DR. ROBIN COOK CERTAINLY KNOWS HOW TO TELL A STORY.”
—The Detroit News
CONTAGION
A shattering scenario based on medical fact—a battle for survival waged in the hot zone of a deadly new virus…
“FAST…EXCITING…SPINE-TINGLING.”
—The Denver Post
ACCEPTABLE RISK
His most shocking thriller—a timely and terrifying glimpse into the dangers of antidepressant drugs…
“STERN AND BRACING…[A] SUSPENSEFUL THRILLER.”
—San Francisco Chronicle
FATAL CURE
One of the most controversial books Robin Cook has ever written—a terrifying look at the darker implications of managed health care in America…
“A RIVETING PLOT, FILLED WITH ACTION.”
—The San Diego Union-Tribune
BLINDSIGHT
How far will people go to obtain donors for eye operations? Murder is beyond comprehension. But seeing is believing…
“GRABS THE READER…MAINTAINS SUSPENSE WITH SURPRISING STORY TWISTS.”
—Pittsburgh Press
VITAL SIGNS
Dr. Cook explores the frightening possibilities of experimental fertilization—the passion to create life, and the power to destroy it…
“CONSTANT SUSPENSE…BELIEVABLE AND CHILLING.”
—Houston Chronicle
HARMFUL INTENT
The explosive story of a doctor accused of malpractice—a fugitive on the run who pierces the heart of a shocking medical conspiracy…
“A REAL GRABBER.”
—Los Angeles Times
MUTATION
On the forefront of genetic research, a brilliant doctor tries to create the son of his dreams—and invents a living nightmare…
“HOLDS YOU PAGE AFTER PAGE.”
—Larry King, USA Today
MORTAL FEAR
A major scientific breakthrough becomes the ultimate experiment in terror when middle-aged patients begin to die—of old age…
“COOK’S BEST BOOK SINCE COMA.”
—People
OUTBREAK
Murder and mystery reach epidemic proportions when a devastating plague sweeps the country…
“HIS MOST HARROWING MEDICAL HORROR STORY.”
—The New York Times
GODPLAYER
Only Robin Cook could portray with such terrifying brilliance what happens when the one place dedicated to saving lives starts taking them…
“NERVE-WRACKING HOSPITAL HORRORS.”
—Chicago Sun-Times
FEVER
A family searches for the truth from a corporation and a medical establishment all too willing to ignore the fate of their little girl…
“GRIPPING.”
—The New York Times Book Review
ROBIN
COOK
TERMINAL
BERKLEY BOOKS, NEW YORK
If you purchased this book without a cover, you should be aware that this book is stolen property. It was reported as “unsold and destroyed” to the publisher, and neither the author nor the publisher has received any payment for this “stripped book.”
This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events, or locales is entirely coincidental.
TERMINAL
A Berkley Book / published by arrangement with the author
PRINTING HISTORY
G. P. Putnam’s Sons hardcover edition / January 1993 Berkley mass-market edition / February 1994
All rights reserved.
Copyright © 1993 by Robin Cook.
Photograph of the author © 1992 by John Earle.
This book, or parts thereof, may not be reproduced in any form without permission.
For information address:
The Berkley Publishing Group, a division of Penguin Putnam Inc., 375 Hudson Street, New York, New York 10014.
ISBN: 978-1-101-20358-3
BERKLEY®
Berkley Books are published by
The Berkley Publishing Group, a division of Penguin Putnam Inc.,
375 Hudson Street, New York, New York 10014.
BERKLEY and the “B” design are trademarks belonging to Penguin Putnam Inc.
PRINTED IN THE UNITED STATES OF AMERICA
20 19 18 17 16 15
To Jean with love and appreciation
ACKNOWLEDGMENTS
I would like to thank Matthew Bankowski, Ph.D., for his patience and generosity in tolerating my questions about his arena of expertise, and for his willingness to read and comment upon the original manuscript of Terminal.
I would also like to thank Phyllis Grann, my friend and editor, for her valuable input. I would also like to apologize for any deleterious effects the lateness of the manuscript of Terminal may have had on her longevity.
Finally I would like to thank the basic science departments of the College of Physicians and Surgeons at Columbia University for providing me with the background that makes it possible for me to understand and appreciate the fast-paced developments in molecular biology.
Science without conscience is but the ruin of the soul.
—François Rabelais
Table of Contents
Prologue
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Epilogue
PROLO
GUE
January 4
Monday, 7:05 A.M.
Helen Cabot gradually awoke as dawn emerged from the winter darkness blanketing Boston, Massachusetts. Fingers of pale, anemic light pierced the darkness of the third-floor bedroom in her parents’ Louisburg Square home. At first she didn’t open her eyes, luxuriating under the down comforter of her canopied bed. Totally content, she was mercifully unaware of the terrible molecular events occurring deep inside her brain.
The holiday season had not been one of Helen’s most enjoyable. In order to avoid missing any classes at Princeton where she was enrolled as a junior, she’d scheduled an elective D&C between Christmas and New Year’s. The doctors had promised that removing the abnormally heavy endometrial tissue lining the uterus would eliminate the violently painful cramps that left her incapacitated each time she got her period. They’d also promised it would be routine. But it hadn’t been.
Turning her head, Helen gazed at the soft morning light diffusing through the lace curtains. She had no sensation of impending doom. In fact, she felt better than she had in days. Although the operation had gone smoothly with only mild post-operative discomfort, the third day after surgery she had developed an unbearable headache, followed by fever, dizziness, and most disturbing of all, slurred speech. Thankfully, the symptoms had cleared as quickly as they had appeared, but her parents still insisted she keep her scheduled appointment with the neurologist at the Massachusetts General Hospital.
Drifting back to sleep Helen heard the barely perceptible click of her father’s computer keyboard. His study was next to Helen’s bedroom. Opening her eyes just long enough to see the clock, she realized it was just past seven. It was amazing how hard her father worked. As the founder and chairman of the board of one of the most powerful software companies in the world, he could afford to rest on his laurels. But he didn’t. He was driven, and the family had become astoundingly wealthy and influential as a result.
Unfortunately the security that Helen enjoyed from her family circumstances did not take into account that nature does not respect temporal wealth and power. Nature works according to its own agenda. The events occurring in Helen’s brain, unknown to her, were being dictated by the DNA molecules that comprised her genes. And on that day in early January, four genes in several of her brain’s neurons were gearing up to produce certain encoded proteins. These neurons had not divided since Helen was an infant, which was normal. Yet now because of these four genes and their resultant proteins, the neurons would be forced to divide again, and to keep on dividing. A particularly malignant cancer was about to shatter Helen’s life. At age twenty-one, Helen Cabot was potentially “terminal,” and she had no idea.
January 4, 10:45 A.M.
Accompanied by a slight whirring noise, Howard Pace was slid out of the maw of the new MRI machine at the University Hospital in St. Louis. He’d never been more terrified in his life. He’d always been vaguely anxious about hospitals and doctors, but now that he was ill, his fears were full-fledged and overwhelming.
At age forty-seven Howard had been in perfect health until that fateful day in mid-October when he’d charged the net in the semifinals of the Belvedere Country Club’s annual tennis tournament. There’d been a slight popping noise, and he’d sprawled ignominiously as the unreturned ball sailed over his head. Howard’s anterior cruciate ligament had snapped inside his right knee.
That had been the beginning of it. Fixing the knee had been easy. Despite some mild problems his doctors ascribed to the aftereffects of general anesthesia, Howard had returned to work in just a few days. It had been important for him to get back quickly; running one of the nation’s largest airplane manufacturing firms was not easy in an era of sharply curtailed defense budgets.
With his head still stabilized in the vise-like apparatus for the MRI, Howard was unaware of the technician’s presence until the man spoke.
“You okay?” he asked as he began to release Howard’s head.
“Okay,” Howard managed to reply. He was lying. His heart was thumping in terror. He was afraid of what the test would reveal. Behind a glass divider he could discern a group of white-coated individuals studying a CRT screen. One of them was his doctor, Tom Folger. They were all pointing, gesturing, and, most disturbing of all, shaking their heads.
The trouble had begun the day before. Howard had awakened with a headache, a rare occurrence unless he’d “tied one on,” which he hadn’t. In fact, he’d not had anything to drink since New Year’s Eve. After taking a dose of aspirin and eating a bit of breakfast, the pain had abated. But later that morning in the middle of a board meeting, with no warning whatsoever, he’d vomited. It had been so violent and so unexpected, with no preceding nausea, that he’d not even been able to lean aside. To his utter mortification, his undigested breakfast had spewed over the boardroom table.
With his head now freed, Howard tried to sit up, but the movement caused his headache to return in full force. He sank back to the MRI table and closed his eyes until his doctor gently touched his shoulder. Tom had been the family internist for over twenty years. He and Tom had become good friends over the years, and they knew each other well. Howard did not like what he saw in Tom’s face.
“It’s bad, isn’t it?” Howard asked.
“I’ve always been straight with you, Howard…”
“So don’t change now,” Howard whispered. He didn’t want to hear the rest, but he had to.
“It doesn’t look good,” Tom admitted. He kept his hand on Howard’s shoulder. “There are multiple tumors. Three to be exact. At least that’s how many we can see.”
“Oh, God!” Howard moaned. “It’s terminal, isn’t it?”
“That’s not the way we should talk at this point,” Tom said.
“Christ it isn’t,” Howard snapped. “You just told me you’ve always been straight with me. I asked a simple question. I have a right to know.”
“If you force me to answer, I’d have to say yes; it could be terminal. But we don’t know for sure. For the present we’ve got a lot of work to do. First thing we have to do is find out where it’s come from. Being multifocal suggests it’s spread from someplace else.”
“Then let’s get on with it,” Howard said. “If there’s a chance, I want to beat this thing.”
January 4, 1:25 P.M.
When Louis Martin first awoke in the recovery room, he felt as if his throat had been scorched with an acetylene torch. He’d had sore throats before, but nothing had even come close to the pain he’d felt as he tried to swallow after his surgery. To make matters worse, his mouth had been as dry as the central Sahara.
The nurse who had materialized at his bedside seemingly out of nowhere had explained that his discomfort was due to the endotracheal tube the anesthesiologist had inserted prior to his operation. She gave him a damp washcloth to suck on and the pain had abated.
By the time he was wheeled back to his room, a different pain had started, located somewhere between his legs and radiating into the small of his back. Louis knew the cause of that discomfort. It was the site of his surgery to reduce an enlarged prostate gland. The damn thing had been forcing him to get up to urinate four or five times each night. He’d scheduled the surgery for the day after New Year’s. Traditionally that was a slow time for the computer giant he ran north of Boston.
Just as the pain was getting the best of him, another nurse gave him a bolus of Demerol through the IV which was still attached to his left hand. A bottle of fluid hung on a T-shaped pole protruding from the head of his bed.
The Demerol put him back into a drugged sleep. He wasn’t sure how much time had passed when he became aware of a presence next to his head. It took all his strength to open his eyes; his eyelids felt like lead. At the head of his bed was a nurse fumbling with plastic tubing coming from the IV bottle. In her right hand was a syringe.
“What’s that?” Louis mumbled. He sounded inebriated.
The nurse smiled at him.
“
Sounds as if you’d had one too many,” she said.
Louis blinked as he tried to focus on the woman’s swarthy face. In his drugged state, the nurse was a blur. Yet she was correct about how he sounded.
“I don’t need any more pain medicine,” Louis managed to say. He struggled to a half-sitting position, leaning on an elbow.
“It’s not pain medicine,” the nurse said.
“Oh,” Louis said. While the nurse completed the injection, Louis slowly realized he still didn’t know what he was being given. “What kind of medicine is it?” Louis asked.
“A wonder drug,” the nurse said, quickly capping the syringe.
Louis laughed in spite of himself. He was about to ask another question, but the nurse satisfied his curiosity.
“It’s an antibiotic,” she said. She gave Louis’s shoulder a reassuring squeeze. “Now you close your eyes and rest.”
Louis flopped back onto his bed. He chuckled. He liked people with a sense of humor. In his mind he repeated what the nurse had said: a wonder drug. Well, antibiotics were wonder drugs, there was no doubt. He recalled that Dr. Handlin had told him he might be put on antibiotics as a precaution after his operation. Louis vaguely wondered what it had been like to be in a hospital before antibiotics had been discovered. He felt thankful that he was living when he was.
Closing his eyes, Louis followed the nurse’s suggestion and let his body relax. The pain was still present, but because of the narcotic, it didn’t bother him. Narcotics were wonder drugs as well, and so were the anesthetic agents. Louis was the first to admit he was a coward when it came to pain. He could never have tolerated surgery back when none of the “wonder drugs” were available.
As Louis drifted off to sleep, he wondered what kind of drugs the future would bring. He decided he’d have to ask Dr. Handlin’s opinion.
January 4, 2:53 P.M.
Norma Kaylor watched the drops fall into the millipore chamber hanging below her IV bottle. The IV ran through a large-bore catheter into her left arm. She had such mixed feelings about the medicine she was getting. She hoped the powerful chemotherapeutic agents would cure her breast cancer which, she’d been told, had spread into her liver and lungs. At the same time she knew the medicines were cellular poisons, capable of wreaking havoc on her body as well as on her tumor. Dr. Clarence had warned her about so many dreadful side effects that she’d made a conscious effort to screen out his voice. She’d heard enough. She’d signed the consent form with a feeling of numbed detachment.