Life Support

by Tess Gerritsen

  “Scotch is not a vice. It’s a tonic.” The woman turned to Toby and regarded her with a raised eyebrow.

  “This is Dr. Toby Harper,” said Dvorak. “And this is Dr. Alexandra Marx. Dr. Marx is a developmental geneticist at Boston University. One of my professors from medical school.”

  “A very long time ago,” said Dr. Marx. She reached out to shake Toby’s hand, a gesture one didn’t expect from another woman, but one which seemed perfectly natural coming from Alex Marx. “I’ve been replaying the sonogram. What do we know about this girl?”

  “I just spoke to her,” said Toby. “She’s sixteen. A prostitute. She doesn’t know who the father is. And she denies any history of exposure to toxins. The only med she was taking was that bottle of pills.”

  Dvorak said, “I checked with the hospital pharmacist. He identified the code stamped on the tablets. Prochlorperazine.” He looked at Dr. Marx. “They’re usually prescribed for nausea. There’s no evidence they cause fetal abnormalities. So we can’t blame this on the pills.”

  “How did the pimp get his hands on a prescription drug?” asked Toby.

  “You can get anything on the streets these days. Maybe she’s not telling you about all the other drugs she’s taking.”

  “No, I believe her.”

  “How far along is the pregnancy?”

  “Based on her recall, maybe five or six months.”

  “So we’re looking at what should be a second trimester fetus.” Dr. Marx swiveled around to face the monitor. “There’s definitely a placenta. There’s amniotic fluid. And I believe that’s an umbilical cord I see here.” Dr. Marx leaned forward, studying the images flickering across the monitor. “I think you’re right, Daniel. This is not a tumor.”

  “So it’s a fetal abnormality?” asked Toby.

  “No.”

  “What else is there?”

  “Something in between.”

  “A tumor and a fetus? How is that possible?”

  Dr. Marx took a drag from her cigarette and exhaled a cloud of smoke. “It’s a brave new world.”

  “All you’ve got is a sonogram. A bunch of gray shadows. Dr. Sibley, the radiologist, thinks this is a tumor.”

  “Dr. Sibley has never seen one of these before.”

  “And you have?”

  “Ask Daniel.”

  Toby looked at Dvorak. “What’s she talking about?”

  He said, “The woman who died giving birth—Annie Parini—I sent her fetus to Dr. Marx for genetic analysis.”

  “I’ve done only preliminary studies,” said Dr. Marx. “We’ve done the tissue sections and staining. It will take months to complete the DNA analysis. But based purely on the histology of the . . . thing, I have a few theories.” Dr. Marx turned her chair around to face Toby. “Sit down, Dr. Harper. Let’s talk about fruit flies.”

  What on earth is this leading up to? Toby wondered as she sank into a chair at the conference table. Dvorak, too, sat down. Dr. Marx, at the head of the table, regarded them with the severe demeanor of a professor confronting two remedial students. “Have you heard about the studies coming out of the University of Basel using Drosophila melanogaster? The common fruit fly?”

  “Which research are you talking about?” said Toby.

  “It had to do with ectopic eyes. Scientists have already identified a master gene that activates the entire cascade of twenty-five hundred genes needed to form a fruit fly’s eye. The gene is called “eyeless” because when it’s missing, the fly is born without any eyes. The Swiss scientists managed to activate the “eyeless” gene in various parts of the fly embryo. With fascinating results. Eyes popped up in bizarre places. On wings, on knees, on antennae. Fourteen eyes grew on one fly! And this was merely from the activation of a single gene.” Dr. Marx paused to stub out her cigarette. She inserted a fresh one into the ivory holder.

  “I don’t see the relevance of fruit fly research to this situation,” said Toby.

  “I’m getting to that,” said Dr. Marx, lighting up. She inhaled and leaned back with a satisfied sigh. “Let’s leap across species lines now. To mice.”

  “I still don’t see the relevance.”

  “I’m trying to start off on a very elementary level here. You and Daniel aren’t developmental biologists. You probably aren’t aware of the advances that have occurred since you left medical school.”

  “Well, that’s true,” admitted Toby. “It’s hard enough keeping up with clinical medicine.”

  “Then let me catch you up. Briefly.” Dr. Marx tapped off a cigarette ash. “I was talking about mice. Specifically, mice pituitary glands. Now, the pituitary is crucial to a newborn mouse’s survival. There’s a reason they call it ’the master gland.’ All those hormones it produces regulate everything from growth to reproduction to body temperature. It secretes hormones whose purpose we don’t know. Hormones we haven’t even identified. Mice born without a pituitary die within twenty-four hours—that’s how vital the gland is.

  “And here’s where the research comes in. At NIH, they’re studying the pituitary’s embryonic development. They know that all the different cells that form the gland arise from a single primordium. Precursor cells. But what induces those precursor cells to make a pituitary gland?” She looked back and forth at her two remedial students.

  “A gene?” ventured Toby.

  “Naturally. It all gets back to DNA. Life’s building block.”

  “Which gene?” asked Dvorak.

  “In the mouse, it’s Lhx3. An LIM homobox gene.”

  He laughed. “That’s perfectly clear.”

  “I don’t expect you to completely understand it, Daniel. I just want you to grasp the concept here. Which is that there are master genes that make primoridal cells develop in certain ways. A master gene to make an eye, another to make a limb, another to make a pituitary gland.”

  “All right,” said Dvorak. “I think we understand that much. Sort of.”

  Dr. Marx smiled. “Then the next concept should be easy for you. I want you to combine these two pieces of research and consider what they mean together. A master gene that kicks off the formation of a pituitary gland. And a fruit fly born with fourteen eyes.” She looked at Toby, then at Dvorak. “Do you see what I’m getting at?”

  “No,” said Toby.

  “No,” said Dvorak, almost simultaneously.

  Dr. Marx sighed. “All right. Let me just tell you what I found on tissue section. I dissected that specimen Daniel sent to me—what he thought was a malformed fetus. I’d never seen anything like it, and I’ve examined thousands of congenital abnormalities. Now, the human genome is made up of a hundred thousand genes. This thing appears to possess only a fraction of the normal genome. And what was present was greatly disrupted. Something catastrophic happened to that entire genome. The result? It’s as if you took apart a fetus and then tried to reconstitute it in no particular order. Arms, teeth, cerebrum, all lumped together.”

  Toby felt queasy. She looked at Dvorak and saw that he had paled. The image conjured up by Dr. Marx sickened them both.

  “It wouldn’t survive. Would it?” asked Toby.

  “Of course not. Its cells were kept alive purely by placental circulation. It was using the mother as its nutrient source. It was a parasite, if you will. But then, all fetuses are parasites.”

  “I never thought of it that way,” murmured Toby.

  “Well, they are. Mother is the host. Her lungs oxygenate the blood, her food intake provides glucose and protein. This particular parasite—this thing—could stay alive only as long as it remained in the womb, connected to the mother’s circulation. Within moments of being expelled, its cells began to die.” Dr. Marx paused, her gaze drifting upward to the rising coil of cigarette smoke. “It was not, in any way, an independent organism.”

  “If it’s not a fetus, what would you call this thing?” asked Toby.

  “I’m not sure. We prepared multiple sections of tissue. The slides were stained and examined by m
yself as well as by a pathologist in my department. We both concurred. One particular type of tissue appeared again and again, in organized clusters of cells. Oh, there were other tissues as well— muscle and cartilage, for instance, even an eye. But those seemed random. What was organized, and well differentiated, was the repetitive cell clusters. Glandular tissue we haven’t yet identified. Identical clusters, all apparently in the midgestational stage.” She paused. “This thing, in short, looked like a tissue factory.”

  Dvorak shook his head. “I’m sorry, but this sounds pretty crazy.”

  “Why? It’s been done in a lab. We can make eyes grow on fruit fly wings! We can turn on or turn off a pituitary master gene! If it can happen in a lab, it can happen in nature. Somehow, in this girl, human embryonic cells developed multiple copies of the same gene. It meant, of course, that the embryo didn’t differentiate properly. So there are no legs, there’s no torso. What’s growing instead are these specific cell clusters.”

  “What could cause this abnormality?” asked Toby.

  “Outside of the lab? Something devastating. A teratogenic agent we’ve never seen before.”

  “But Molly doesn’t remember any exposure. I asked her several times—” Toby paused, her gaze swerving toward the door.

  Someone was screaming.

  “It’s Molly!” said Toby, and she shot to her feet. Dvorak was right on her heels as she pushed out of the room and sprinted down the hallway. By the time she reached Molly’s room, a nurse was already at the bedside, trying to calm the girl.

  “What happened?” asked Toby.

  “She says someone was in her room,” the nurse said.

  “He was standing right here by the bed!” said Molly. “He knows I’m here. He followed me—”

  “Who?”

  “Romy.”

  “The lights were off,” the nurse calmly pointed out. “You could have been dreaming.”

  “He talked to me!”

  “I didn’t see anyone,” said the nurse. “And my desk is right around the corner—”

  The slam of a door echoed in the hallway.

  Dr. Marx poked her head in the room. “I just saw a man run into the stairwell.”

  “Call Security,” Dvorak said to the nurse. “Have them check the lower levels.”

  Toby was right behind Dvorak as he ran into the hall. “Dan, where are you going?”

  He pushed through the stairwell door.

  “Let Security handle this!” She followed him into the stairwell.

  Somewhere below, Dvorak’s footsteps pounded down concrete steps.

  She started down after him, tentatively at first, then picked up her pace as determination took hold. She was angry now, at Dvorak for this insanely reckless pursuit, and at Romy—if it was Romy—for daring to pursue the girl into the sanctuary of a hospital. How had he tracked her down? Did he follow them from Dvorak’s office?

  She picked up her pace, flying past the second-floor landing. She heard a door bang open, then slam shut again.

  “Dan!” she yelled. No answer.

  At last she hit the first floor, pushed through the door, and emerged next to the ER loading platform facing Albany Street. The blacktop was glistening with rain. She squinted as wind gusted at her face, lifting the tang of wet pavement.

  Off to her left, through a soft drizzle, a silhouette appeared. It was Dvorak. He halted beneath a streetlamp, glancing left, then right.

  She jogged up the sidewalk to join him. “Where did he go?”

  “I caught a glimpse of him in the stairwell. Lost him right after he left the building.”

  “You’re sure he did leave the building?”

  “Yes. He’s got to be around here somewhere.” Dvorak started across the street, toward the hospital power plant.

  The squeal of tires made them both swing around.

  The van came straight at them, barreling out of the darkness.

  Toby froze.

  It was Dvorak who shoved her sideways, who sent her tumbling, scraping across blacktop.

  The van roared past, taillights fading away down Albany Street.

  As she struggled back to her feet, she found Dvorak already reaching for her arm, steadying her as he helped her back to the sidewalk. The impact of her fall was just beginning to register as pain, first as a vague throbbing in her knees, then the sting of nerve endings scraped raw. They stood beneath the streetlight, both of them too shaken at first to speak.

  Dvorak said, “I’m sorry I shoved you so hard. Are you all right?”

  “Just a little banged up.” She glanced up the street, in the direction the vehicle had just vanished. “Did you get the license number?”

  “No. I didn’t get a look at the driver, either. It all happened so fast—I was trying to get you out of the way.”

  They both turned as an ambulance pulled up to the ER loading dock, lights flashing. Somewhere in the distance, the wail of a second ambulance was drawing closer.

  “It’s going to be chaos in that ER,” said Dvorak. “I’ve got a first aid kit in my office. Let’s go there and clean up your knees.”

  With Dvorak holding her by the arm, she limped across the street, the pain worsening with every step. By the time they’d made it upstairs to his office, she was dreading the first dab of antiseptic.

  He moved aside his papers and sat her down on the desk, next to the photo of his fisherman son. The smell of rubbing alcohol and iodine rose up from the open first aid kit. Crouching in front of her, he moistened a cotton ball with peroxide and gently dabbed the abrasion.

  She gave a start of pain.

  “Sorry,” he said, glancing up. “There’s no way to do this without hurting you.”

  “I’m such a wimp,” she muttered, clutching the edge of the desk. “Go ahead, just do it.”

  He continued dabbing her knees, one hand resting on her thigh, the other gently cleaning off dirt and gravel. As he worked, she focused on his head, bent in concentration, his dark hair close enough to ruffle with her hands. His breath felt warm against her skin. At last I have him alone, she thought. No crises, no distractions. This may be my only chance to make him listen. To make him believe me.

  She said, “You think I hurt my mother, don’t you? That’s why you won’t talk to me. Why you’ve avoided my calls.”

  He said nothing, just reached for another ball of cotton.

  “I’m being set up, Dan. They’re using my mother to get back at me. And you’re helping them, without even listening to my side.”

  “I’ve been listening to you, Toby.” He’d finished cleaning her abrasions. Now he took out a roll of adhesive tape and began tearing off strips of it, taping squares of gauze on her knees.

  “Then why won’t you tell me if you believe me?”

  “What I think you should do,” he said, “is talk to your attorney. Lay it all out, everything you know. And let him discuss it with Alpren.”

  “I don’t trust Alpren.”

  “And you think you can trust me?” He looked up at her.

  “I don’t know!” She exhaled, her shoulders drooping forward as she realized it was hopeless, trying to make him care. “I did talk to Alpren, this afternoon,” she said. “I told him what I told you. That Brant Hill’s getting back at me. They’re trying to ruin me.”

  “Why would they bother?”

  “Somehow I’ve scared them. I’ve done something, said something to make them feel threatened.”

  “You have to stop blaming Brant Hill as the source of all your problems.”

  “But now I have proof.”

  He shook his head. “Toby, I want to believe you. But I don’t see how your mother’s condition is connected to Brant Hill.”

  “Listen to me. Please.”

  He snapped the first aid kit shut. “All right. All right, I’m listening.”

  “The woman I hired to take care of my mother isn’t who she says she is. Today I spoke to someone who worked with Jane Nolan years ago—the real Jane Nol
an.”

  “As opposed to what?”

  “The fake one. The one I hired. They’re completely different people. I’ll get Vickie to back me up.”

  He remained silent, closed off, his gaze focused stubbornly on the first aid kit.

  “I saw a photograph, Dan. The real Jane was about a hundred pounds overweight. That’s not the woman I hired.”

  “Then she’s lost weight. Isn’t that possible?”

  “There’s more. Two years ago, the real Jane worked for a nursing home run by the Orcutt Health chain. I just learned that Orcutt is part of an umbrella corporation—owned by Brant Hill. If Jane was Brant Hill’s employee, then they had her résumé in their files. They’d know she left Massachusetts. It’d be easy for them to slip another woman into my house under Jane’s name. With Jane’s credentials. If I hadn’t seen that photograph, I never would have guessed the truth.”

  He said nothing, but his gaze had lifted to hers now. At last he’s listening to me. At last he’s considering my side of it.

  “Have you told all this to Alpren?” he asked.

  “Yes. I told him that all he had to do was talk to the real Jane Nolan. The problem is, no one knows where she’s living or what her married name is. I’ve tried to track her down, but I can’t even find out if she’s still in the country. Obviously Brant Hill chose someone they knew would be hard to find. If she’s even still alive.”

  “Social Security records?”

  “I suggested that to Alpren. But if Jane’s not currently employed, it could take weeks to track her down. I’m not sure Alpren wants to put out the effort. Since he doesn’t believe me in the first place.”

  Dvorak rose to his feet. He stood looking at her for a moment, as though seeing her, really seeing her, for the first time. He nodded. “For what it’s worth, I’ll talk to him.”

  “Thank you, Dan.” She gave a sigh, the tension leaving her body in one exhilarating rush. “Thank you.”

  He held out his hand to help her off the desk. She grasped his arm and allowed him to steady her as she rose to her feet. Still holding on to him she looked up and met his gaze.

  That’s all it took, that meeting of gazes. She felt his other hand come up to touch her face, his fingers slowly gliding down her cheek. And she saw, in his eyes, the same longing she felt.