by J. R. McLeay
“I know,” Rick replied, “it’s just—I promised Elias he was going to be fine. You heard him ask me before we started the operation.”
“Rick,” Jennifer said, cradling his hand, “no one could have anticipated what happened. If anybody’s to blame, it’s his own father who caused this.”
“But the slip…”
“Any other surgeon would have lost the patient in that situation,” Jennifer interrupted Rick. “You saved him—and gave him another chance.”
“Maybe,” Rick said, returning his focus to the news from the hospital. “Listen—you go ahead to Mount Sinai and look after the emergency cases. I’ll be all right. Give me a call when you have a chance to tell me what you found. And let me know if you need me for anything.”
“I will,” Jennifer said, kissing Rick gently on the cheek. “See you soon.”
When she got to the hospital, the first unusual thing Jennifer noticed was the parking lot. It was filled to capacity, and she had to park four blocks away to find an empty spot on the street.
That’s strange for a Sunday, she thought. Especially this early in the morning.
Picking up her pace, she walked briskly to the Chief of Staff’s office. Joe Morgan hung up the phone as soon as he saw her approaching.
“What’s up, Joe? I came as soon as I got your message.”
“I’m not sure, Jennifer, but I’ve never seen the ER this busy and with cases we haven’t seen in a long time.”
“Like what?”
“Multiple instances of juvenile menses for one, and nocturnal emissions.”
“What?! That’s not supposed to happen.”
“Exactly. I was hoping you could make sense of it. But that’s not all—there are other issues. Patients have been complaining about unusual swollen glands, edema, and skin lesions…”
“All of this started today?”
“Actually, we started noticing some isolated cases as early as Wednesday, but it’s been picking up all week. Today was the first day it really got out of control. Can you get down there and try to find out what’s going on?”
“I’ll head down immediately. But can you do one thing for me before I go?”
“Of course.”
“Will you call the forensics lab and ask them for an update on the patch diagnostics they started for me on Friday?”
“You think all of this might be caused by the e-patches?” Joe asked incredulously.
“I don’t know,” Jennifer replied, “but I also noticed some unusual reactions earlier in the week, and I asked the techs to run some tests as a preventive measure. They said they’d have the results for me tomorrow, but under the circumstances, if you can expedite matters, I think we need to see them as soon as possible.”
“I’ll call them immediately, and let you know as soon as they have some results.”
“Thanks, Joe. I’ll report back after I assess the situation in the ER.”
As soon as Jennifer got to the Emergency Ward, she knew something was seriously wrong. Just looking at the patients in the waiting room, she could see many telltale signs of severe endocrine imbalance. Some patients had bulging eyes, a thyroid disorder indicating periorbital edema, often caused by excessive vasopressin production. Others expressed blotchy pigmentation and acne, indicating lipotropin and testosterone imbalances. A few even exhibited pronounced brow and jawbones, an extremely rare condition caused by overdoses of growth hormones. But mostly, everybody just looked—older. Male juveniles had darkening hair on their upper lip, and some females were beginning to show bulges in unusual places. In previous years, many of these symptoms had been associated with various pituitary disorders such as tumors, but all of these patients had long ago had their pituitary removed.
“Thank heavens you’re here, Dr. Austin,” said the admitting nurse on duty when she saw Jennifer. “I have no idea how to process these patients. Our normal triage procedure doesn’t reference these kinds of symptoms. Where do I begin?”
Jennifer scanned the waiting room, trying to sort and filter the cases by severity, but she wasn’t sure either. Since nobody appeared in imminent danger, she would simply have to process them in the order they presented themselves. Then she saw a pretty female hunched in a corner of the room wearing dark glasses, and recognized her from a photograph in Rick’s office.
“I’ll start with her.”
33
By Monday morning, the press had discovered the extent of the escalating hormone problem and gone public with the story amid sensational front-page headlines proclaiming Thousands Afflicted with Mystery Disease, Epidemic of Sudden Maturities, and Hormone Disorder Causes Freak Deformities. Many more juveniles had experienced their first period or wet dream and quickly rushed to the closest hospital in a confused state of shock and bewilderment. Others were experiencing more serious symptoms of severe hormone imbalance such as goiter, pancreatitis, and hyperadrenocorticism, displaying obvious outward signs of excessively puffy faces, neck lumps, or jaundice. Everybody was panicking, and hospital emergency rooms around the country were overflowing with hysterical patients demanding immediate treatment.
At Mount Sinai Medical Center, the Chief of Staff called an emergency meeting with Rick and Jennifer to discuss the situation. At eight a.m., the three sat down in Joe Morgan’s office.
“Thanks for coming on such short notice,” Joe began. “I’m sure by now you’ve both read the morning headlines.”
“Pretty hard to miss,” Rick said. “All the front-line media outlets seem to have picked it up. If we haven’t already reached capacity, this will surely make it all the more difficult to treat everyone.”
“Exactly. But I think even more critical than the palliative issue is how we stop this thing. I’ve gotten the results back from the lab, and I think you’ll be interested to see what they’ve found.”
“Were the patches out of spec?” Jennifer asked.
“That’s an understatement. There were massive overdoses of the active ingredient found in the pouches.”
“Which ones? There’s nine hormones in the mix.”
“They’ve isolated at least six so far. Growth hormone, lipotropin, testosterone, estrogen, thyrotropin, vasopressin…”
“You’re kidding?!” Jennifer exclaimed. “How can that happen? These things are supposed to be tightly controlled and checked at the manufacturer. There’s never been any discrepancy like this before.”
“How much were the overages, exactly?” Rick interjected.
“Oddly,” Joe advised, “it wasn’t the total quantity in the reservoir that was out of line—only the proportions. The technicians found significantly less buffers than specified but much higher concentrations of the active ingredients. Normally the ratio of active to inactive ingredients is about one tenth—in this instance it was two to one.”
“Buffers to hormones?” Jennifer asked.
“The other way around.”
“Oh my god,” Jennifer moaned, immediately recognizing the severity of the situation, “no wonder we’re seeing such severe reactions. If that level of infusion continues, we’ll see much more critical complications soon—not to mention many likely deaths.”
“I don’t get it,” Rick said, with a confused look on his face. “Even with that level of hormone imbalance, I’m not sure we should be seeing this degree of reaction. The patch has an embedded filter, which is supposed to modulate the quantity of medication delivered to the skin.”
“That’s the other surprise,” Joe said. “The lab also found inordinately high levels of excipients in the mix, which accelerates the transfer rate.”
“Christ,” Rick exclaimed.
“Exactly,” Joe replied. “It now seems obvious that someone has tampered with the patches. But we don’t know how many or which ones. Anybody could be at risk—including each of us.”
The three doctors glanced at each another uncomfortably.
“On the way into the meeting today,” Rick said, ‘I called my contacts at the
Centers for Disease Control to see how widespread this is. They consolidate incident reports from all around the country for this sort of thing. So far, they’ve catalogued just under ten thousand cases of endocrine poisoning.”
“That’s an awful lot,” Jennifer observed, “but it’s still relatively small, given the hundreds of millions who wear the same patch. Maybe not every patch is contaminated?”
“Let’s hope so,” Rick nodded. “Joe—did the lab by any chance send you any of the patches they tested?”
“Yes...”
“May I see them?”
Joe handed Rick a specimen jar filled with an assortment of pink and blue plastic patches. Rick took some out and began inspecting their inside surfaces.
“What are you looking for, Rick?” asked Jennifer.
“Lot numbers. Endogen stamps all of their patches with unique lot numbers for every batch they process, and I can see that all of these patches are stamped with the same number. That seems to indicate—at least so far—that this contamination is limited to only one batch.”
Joe immediately moved his hand to his lower abdomen and rubbed his patch.
“I know what you’re thinking, Joe,” Jennifer said. “But if any of us were wearing patches from the same contaminated lot, we surely would have felt or noticed something by now. It appears that the three of us got lucky.”
“We don’t know how much longer that will last,” Rick noted. “Nor how many more people might be exposed to this batch—now, or in the near future.”
“What do you think we should do, Rick?” Joe asked. The Chief of Staff was speaking more as a worried patch user than as Rick’s nominal boss. He knew Rick had far more experience and knowledge with these types of issues and that as Surgeon-General of the World Health Organization, Rick’s authority vastly exceeded his own when it came to epidemiological matters.
“First, we should notify Endogen immediately about our findings, so they can try to locate the source of the contamination and stop production of any more defective patches. They should also be able to tell us where they’ve shipped the batches from this particular lot, so we can try to recall the defective ones before they cause any more damage. I’m going to ask the Director of Communications at the WHO to issue a press release warning anyone who’s wearing a patch bearing these numbers to replace it immediately with one carrying a different stamp. We should also notify the police, since it is apparent this was the work of someone with criminal intent.”
“What do you recommend we do about the existing cases?” Joe asked. “What can we do for those who are already affected?”
Rick turned to Jennifer.
“Assuming the other patches with different lot numbers are okay,” she said, “we should be able to quickly stop the symptoms from getting any worse by returning the dosages to normal. If all the patches are affected, we’ll have to administer the hormones intravenously—though I can’t imagine how we’d deal with that many cases in such short order from our limited stores of supplementary hormones.”
“What about those who’ve already experienced menarche and spermarche?” Joe added. “Can that be reversed?”
This time it was Jennifer who looked to Rick for clarification.
“If you’re referring to the issue of arrested development and its connection to aging—this is a situation without precedent. It’s hard to say if we can reset their biological clocks. Elsewhere in the natural world, once sexual maturity has been attained, there’s never been any going back. We’ll just have to see if their mature bodies accept the lower juvenile doses.”
“At the very least, this is going to be a public relations disaster,” Joe noted. “Everyone’s come to expect a certain equilibrium and the notion of indefinite youth. I shudder to think how the affected individuals will take the news if we can’t reverse these effects. Especially if this spreads beyond the U.S.”
“I agree,” Rick said, standing to leave. “I’m going to make enquiries about that right away. Joe, will you notify the appropriate people at Endogen about what we’ve found, and also call the police to begin an investigation? I’ll contact the UN Secretary-General to discuss the global implications and see what she wants to do.”
Jennifer suddenly reached out and grasped Rick’s arm.
“Rick, before you go,” she said, “there’s something else you should know…”
34
Roland Jamieson was working quietly in his office when his personal intercom line lit up at eleven-thirty Monday morning.
“What is it, Kristen?” he announced distractedly to his secretary.
“There’s a Director Inzucchi from the FBI here to see you. He wants to meet with you immediately.”
Jamieson had been expecting this call since receiving a message from the Chief of Staff at Mount Sinai Medical Center two hours ago, when he was informed they’d found massive hormone overdoses in Endogen patches and that they were notifying the authorities. Soon after, he’d scrambled together his senior staff to discuss how the company should respond.
If he’d previously thought things couldn’t get much worse at Endogen, he was now almost wishing for a return to the relative peace of two weeks ago. The media had built the escalating epidemic into the most sensational story in decades and had begun to link the catastrophic symptoms with the likely influence of a defective e-patch. Class-action lawsuits were already being filed by the hundreds, with the cumulative liability vastly exceeding the net asset value of the company. The company’s stock, previously hovering around two dollars, was now trading in unprecedented volume on the New York Stock Exchange for mere pennies. Every Director of the company was being served with new civil suits for breach of conduct and fiduciary duty.
But the CEO knew it could get worse—much worse. If Endogen and its officers were found to be negligent in the manufacture and testing of the e-patch, he and others could be found liable for manslaughter or criminal neglect. Jamieson might be able to delay the FBI for a few hours, or even a couple of days, but he knew they could easily secure a warrant and that his best defense would be full cooperation.
“Have him wait a few minutes,” he paged his secretary back. “I’m going to ask Bruce and Alan to join us.”
Jamieson knew his Production Superintendent would be better able to answer many of the questions the police were likely to ask and that his Chief Counsel could provide valuable guidance on what had to be disclosed. Picking up his handset, he quickly dialed his two lieutenants. Five minutes later, Jamieson’s secretary ushered two plain-clothed federal agents into his office, where the three executives were calmly waiting.
“Mr. Jamieson?” the more senior of the two FBI agents began, as he shook Jamieson’s extended hand. “I’m Assistant Director Inzucchi of the New York district office of the Federal Bureau of Investigation, and this is Special Agent Sanchez. We have some questions concerning troubling new developments uncovered this morning regarding your company’s hormone patches.”
“Yes, of course,” Jamieson said, trying to appear relaxed. “I’ve asked our company’s head of production, Bruce Ellis, to join us, since he should be able to furnish you with more details. And this is my Chief Counsel, Alan Brache.”
After the five shook hands, the two police officers sat down and each pulled out a pen and black journal.
“Mr. Jamieson,” Director Inzucchi began, “I understand you’ve been made aware of the serious discrepancy in the chemical formulation of your patches. How long have you known about this defect?”
“I just found out this morning when I received a call from Mount Sinai Medical Center. Of course, we immediately conducted our own tests to substantiate the findings.”
“Do your findings corroborate those of the hospital?”
“Essentially, yes.”
“As I’m sure you know, this is a very serious matter, in light of the many severe health conditions that have been experienced over the last few days.”
“We don’t know for certain that t
he patch discrepancy is causing all of these problems,” Alan Brache quickly asserted.
“Sir,” Director Inzucchi stated impatiently, “all of the patients that have been examined for these disorders were found to be wearing these defective patches.”
“Everybody’s wearing our patches,” Jamieson replied. “But only a relatively small percentage seems to be affected.”
“If you call several hundred thousand people suffering serious hormone poisoning a small percentage,” Inzucchi said dryly.
“All of the affected individuals,” Agent Sanchez added, leafing through his notes, “were found to be wearing a patch with the same lot number, Lot BZ834776. Given that others wearing different lot numbers have so far not been affected, this would appear to provide conclusive evidence that the defective patches are the cause of this problem.”
“We agree it is a serious issue,” Jamieson backpedalled. “But it seems to have been corrected. As Agent Sanchez points out, the problem appears to be isolated to a single batch.”
“When did you produce that batch?” Director Inzucchi asked.
“We’ve checked our records,” Bruce Ellis advised. “All of those patches were produced last Monday morning.”
“How many patches bearing this lot number were produced in that batch?”
“About three hundred million.”
Jamieson saw the look of surprise on the two agents’ faces.
“How many of these have been shipped?!” Inzucchi asked.
“All of them,” Bruce said. “We run a just-in-time shop, where each of our twice-daily production runs is shipped out within four hours of packaging and crating, in order to maintain freshness and ensure sufficient global supply of the product.”
“Do you have records of where all of this product was delivered? We’ll need to coordinate with the necessary agencies to recall these defective patches in order to minimize any further occurrences.”
“Yes, but basically it’s shipped all around the globe. Pharmacies typically only carry two days’ worth of supply, so we ship our product daily to local distribution hubs in every country, in order to ensure fresh supply is on hand at all times.”