by Dan Simmons
Kate hugged him close and glared at the woman. “All right? Satisfied that we aren’t smuggling any state secrets or gold bullion?”
The female guard gave Kate a blank look, pawed through the jumper and blanket, carefully avoided the diaper, said something to the pock-marked man, and left the booth.
“It’s cold,” said Kate. “I’m going to put his clothes back on.” She did so quickly. Beyond the curtained alcove, the shrill public address system announced her flight in a burst of static. She heard the other passengers clattering down the stairs to the boarding area.
“Wait,” said the pockmarked guard. He set Kate’s passport and papers on the counter and left with the other man.
Kate rocked Joshua and peered out through the curtain. The departure area was empty. The single clock above the door read 7:04 A.M. The flight was scheduled to leave at 7:10. None of the three security guards who had been with her in the booth were visible.
Kate took a ragged breath and patted the baby. His breathing was rapid and liquid, as if he were catching another cold. “Sshhh,” whispered Kate. “It’s all right, Little One.” She knew that the tractor that pulled the passenger trailer out to the aircraft would be leaving in a moment. As if to confirm that, an unintelligible but urgent announcement echoed out of the terminal speakers.
Without looking back, Kate grabbed her papers, held the baby tightly, left the booth, and walked across the endless expanse of terminal with her head high and eyes forward. Two lounging guards at the head of the stairs squinted through cigarette smoke as she approached.
Briskly, but not as if she had to hurry, Kate flashed her passport and boarding pass. The young guard waved her by.
At the bottom of the stairs there was another counter, another security guard. Kate could see the last of the passengers boarding the transfer jitney outside. The tractor engine started in a rush of smoke. Kate focused on the outside door and started to walk past the guard.
“Stop!”
She stopped, turned slowly, and forced a smile on her face. Joshua squirmed but did not cry.
The guard had a fat face and small eyes. His pudgy fingers tapped the counter. “Passport.”
Kate set it down without comment and tried not to fidget while the fat man looked it over carefully. There were footsteps and voices just out of sight up the stairs.
Outside, the last of the passengers and baggage had been loaded on the two trailers. The tractors roared their engines. “We’ll be late,” Kate said quietly to the guard.
He lifted his pig eyes and scowled at her and the baby.
She held his gaze in silence for the better part of a minute. The baggage jitney pulled away. The passenger jitney waited to follow it the hundred yards out to the aircraft.
When she had been a practicing surgeon, Kate had often commanded colleagues or nurses to hurry with nothing more than the strength of her gaze above the surgical mask. She did so now, putting every ounce of authority she had earned in her life and career into the look she gave the guard.
The fat man looked down, stamped the passport a final time, and brusquely handed it to her. Kate forced herself not to run with Joshua in her arms. The jitney had already begun rolling toward the aircraft, but it stopped and waited while she caught up and stepped aboard. The Polish and Romanian passengers stared at her.
They were on the aircraft twelve minutes before it taxied to the head of the runway, but Kate was sure that her watch had stopped. It seemed like hours, days. She watched out the streaked window as two security men in leather jackets joked and smoked at the foot of the stairs. They were not the two men from the terminal. But they carried hand-held radios. Kate closed her eyes and came as close to praying as she had since she was ten.
Three airport workers rolled away the stairs. The plane taxied to the end of the deserted runway. No aircraft had taken off or landed since they had boarded. The plane accelerated down the patched runway.
Kate did not breathe deeply until the landing gear was up and Bucharest was a scatter of white buildings rising above chestnut trees behind them. Her hands continued to tremble until she knew they must be out of Romanian airspace. Even at the Warsaw airport she felt her heart pounding until they changed crews and lifted off for Frankfurt.
Finally the pilot’s voice came over the intercom. He had an American accent. “Ladies and Gentlemen, we’ve just leveled off at our cruising altitude of twenty-three thousand feet. We’ve just passed over the city of Lodz and should be coming up on the German border in…oh…five minutes or so. We’ve had a bit of rough weather, as I’m sure you noticed, but we’ve just passed the tail end of that front and Frankfurt informs us that it’s sunny and very warm there, temperature thirty-one degrees Centigrade, winds out of the west at eight miles per hour. We hope you enjoy the rest of the flight.”
Sunlight had suddenly streamed through the small window. Kate kissed Joshua and allowed herself to cry.
Kate Neuman blinked away the glare from the sunlight that had made its way through Boulder CDC’s tinted windows and answered the phone. She honestly could not have said how long it had been buzzing. She vaguely remembered her secretary sticking her head in the office to announce she was running down to the cafeteria for lunch.
“Doctor Neuman,” said Kate.
“Kate, this is Alan down in Imaging. I have the newest pictures from your son’s last workup.”
“Yes?” Kate realized that she had been doodling circles within circles until her memo pad was almost black. She set the pen down. “How do they look, Alan?”
There was the briefest hesitation and Kate could imagine the red-headed technician sitting in the glare of his multiple display monitors, a half-eaten corned beef sandwich on the terminal in front of him.
“I think you’d better come down, Kate. You should see this yourself.”
There were six video monitors set into the long console and each of them displayed a slightly different view of nine-month-old Joshua Neuman’s internal organs. These were not X rays but complex images built up by Alan’s magnetic resonance imaging equipment, Kate was able to make out her child’s spleen, liver, the sinuous curves of the upper small intestine, the lower curve of his stomach…
“What is that?” she asked and stabbed a finger at the center monitor.
“Exactly,” said Alan, pushing his thick glasses up and taking a bite of his corned beef sandwich. “Now, watch when we run the sequence with the CT data from three weeks ago.”
Kate watched the primary VDT as the images coalesced, rotated in three dimensions, zoomed in for a closer look on the lower curve of the stomach, differentiated layers of stomach lining with false colors, and then ran a time-lapse sequence with digital enhancement.
A small appendix or abscess seemed to grow in the wall of Joshua’s stomach.
“Ulcer?” said Kate, knowing that it was not one even as she said the word. The magnetic resonance imaging showed solid structure in the anomaly. She felt her heart sink.
“No,” said Alan, taking a sip of cold coffee. Suddenly he saw Kate’s face and he jumped to his feet and slid a chair under her. “Sit down,” he said. “It’s not a tumor either.”
“It’s not?” Kate felt the vertigo lessen. “But it has to be.”
“It’s not,” said Alan. “Trust me. Watch. This is the CT-enhanced series from this week’s MR imaging.”
The lower curve of stomach was normal again. Colored layers proliferated, the abscess or whatever it was appeared, grew as substantial as an appendix, and then began to shrink.
“A separate growth?” said Kate.
“Same phenomenon, different time period.” Alan pointed to the data column to the right of the image. “Notice the correspondence?”
For a moment Kate did not. Then she leaned closer and rubbed her upper lip. “The same day that Josh received the plasma…” She wheeled her chair over to the monitor where the previous cycle had been frozen on the screen. Running her finger down the screen, she said, “And the
same date three weeks ago that he had a transfusion. These images show some change in the baby’s gut whenever he receives blood?”
Alan took a healthy bite of sandwich and nodded. “Not just a change, Kate, but some sort of basic adaptive process. That structure is there at other times, it just becomes more visible when it’s absorbing blood…”
“Absorbing blood!” Kate’s shout surprised even herself. She modulated her voice. “He’s not absorbing blood through the stomach wall, Alan. We give Joshua intravenous injections…we don’t give him a baby bottle with blood in it!”
Alan missed the irony. He nodded and finished chewing. “Of course, but the adaptation…organ…whatever it is does absorb blood, there’s no doubt about it. Look here.” He touched buttons and all six of the monitors blinked red near the abnormal swelling. “The gut wall there is rich with veins and arteries. It’s one of the reasons an ulcer is such a problem there. But this”—he touched the image of the tumor-like structure—“this thing is fed by a larger arterial network than I’ve ever seen. And it is absorbing blood, there’s no doubt about that.”
Kate pushed her chair back. “My God,” she whispered.
Alan was not listening. He shoved his glasses higher on his nose. “But look at the other data, Kate. It’s not the absorption of blood that’s interesting. Look at the most recent MR series. What happens next is unbelievable.”
Kate watched the new series of MR images and flickering data columns with eyes that did not blink. When it was finished she sat in silence for a full minute.
“Kate,” whispered Alan. His voice was almost reverent. “What’s going on here?”
Kate’s eyes never left the screen. “I don’t know,” she said at last. “I honest to God do not know.” But somewhere, deep in the creative subconscious that had made her one of CDC’s finest diagnosticians, Kate Neuman did know. And the knowledge both scared her to death and filled her with a strange exhilaration.
Chapter Fourteen
KATE Neuman’s home was in a high meadow six miles up Sunshine Canyon above Boulder. Kate had always disliked canyons—she hated the lack of sunshine, especially in winter, and being at what she considered the mercy of gravity if any boulders decided to dislodge—but the road climbed out of the broad swale of Sunshine Canyon and ran along high ridgelines miles before it reached the turnoff to her home. She considered the location of her home almost perfect: high meadows laced with aspen and pine trees swept away on either side, the snow-capped summits of the Indian Peaks section of the Continental Divide loomed up ten miles to the west, and at night she could look out the gaps in the Front Range south of the Flatirons and see the lights of Boulder and Denver.
She and Tom had bought the home the year before their breakup, and while they had used her income to secure the mortgage and pay the down payment, Kate would always be grateful to Tom for suggesting they look in that particular area for a house. The structure itself was large and modern but it blended into the rocks and trees of the ridgeline, its windows framed views in all four directions, there was a wonderful patio from which she could look downhill toward the Flatirons, and while there was only a handful of houses in the six-hundred-acre residential ranch, the area was guarded by a security gate which could be unlocked only by the residents after a visitor contacted them via intercom. These visitors were usually shocked by the roughness of the gravel road beyond that security gate. The year-round residents there all owned four-wheel-drive vehicles to cope with winter snows at the seven-thousand-foot level.
On this July morning one week after her discussion with Alan, Kate rose, jogged her usual three-quarters of a mile on the loop trail behind her home, showered, dressed in her usual casual outfit of jeans, sneakers, and a man’s white shirt for CDC—she wore a suit or dress only when a VIP visit or travel was inflicted on her—and had breakfast with Julie and Joshua. Julie Strickland was a twenty-three-year-old graduate student who was currently working on her PhD dissertation on the effects of pollution on three species of flowers found only on the alpine tundra. Kate had met Julie three years earlier through Tom; the younger woman had traveled with Tom’s Mountain Challenge Tours for an entire summer of hiking and camping above treeline in some of Colorado’s most inaccessible regions. Kate was fairly certain that Julie and Tom had enjoyed a brief fling that summer, but for some reason the fact never bothered her. The two had become friends soon after meeting each other. Julie was quiet but enthusiastic, competent and funny. In exchange for watching Joshua five days a week, Julie had her own section of Kate’s five-thousand-square-foot house, was free to use Kate’s 386e PC with its CD-ROM memory for her thesis when Kate was at work, had weekends free for her field trips, and received a token salary that allowed her to buy gas for her ancient Jeep.
Both women enjoyed the arrangement, and Kate was already worrying about the winter when Julie would be finished with her dissertation. Always sympathetic to the plight of working mothers forced to scramble for daycare, Kate now had nightmares about finding adequate care for Joshua. But on this beautiful summer morning, the sun already high above the plains and free of the rim of foothills to the east, Kate put the worry out of her mind as she ate her bran flakes and fed Joshua his cereal.
Julie looked up from her section of The Denver Post. “Are you taking the Cherokee or the Miata to work this morning?”
Kate resisted a smile. She had planned to take the red Miata, but she knew how much Julie loved to drive the roadster down the canyon. “Mmmm…the Jeep, I think. Did you have any shopping to do before you dropped Josh off at CDC?”
At the mention of his name, the baby smiled and banged a spoon on his tray. Kate wiped a bit of excess cereal from his chin.
“I thought I’d stop by the King Soopers on Table Mesa. You sure you don’t mind me driving the Miata?”
“Just be sure to use the baby seat,” said Kate.
Julie made a face as if to say, Of course I will.
“Sorry,” smiled Kate. “Maternal instinct.” She said it as a joke but instantly realized that this was precisely what prompted such obvious comments.
“Josh loves the convertible,” said Julie. She took her own spoon and pretended to eat some of the baby’s cereal, Joshua beamed his appreciation. Julie looked at Kate. “You want him there right at eleven?”
“Approximately,” said Kate, glancing at her watch and clearing her dishes. “We have the MR equipment reserved until one, so it’s all right if it’s a few minutes after…” She gestured toward Joshua’s unfinished cereal. “Do you mind…”
“Uh-uh,” said Julie, exchanging goofy expressions with the baby. “We like to eat together, don’t we, Pooh?” She looked back at Kate, oblivious to the drop of milk on her nose. “This MR stuff won’t hurt him, will it?”
Kate paused by the door. “No. It’s the same procedure as before. Just pictures.” Pictures of what? she asked herself for the hundredth time. “I’ll have him home in time for his nap.”
It was less fun driving the Cherokee down the winding canyon road than double-shifting the Miata through the turns, but this morning Kate was so lost in thought she did not notice the difference. Once in her office she asked her secretary to hold all calls and put a call through herself to the Trudeau Institute in Saranac, New York. It was a small research facility, but Kate knew that it did some of the best work on effector mechanisms of cell-mediated immunity relating to lymphocyte physiology. More than that, she knew its director, Paul Sampson.
“Paul,” she said when she had got past receptionists and secretaries, “Kate Neuman. I’ve got a riddle for you.” She knew that Paul was a sucker for puzzles. It was a trait that he shared with quite a few of the best medical researchers.
“Shoot,” said Paul Sampson.
“We have an eight-and-a-half-month-old infant found in a Romanian orphanage. Physically the child looks about five months old. Mental and emotional development seem normal. Physically we see intermittent bouts of chronic diarrhea, persistent thrush, failure t
o thrive, chronic bacterial infections as well as otitis media. Diagnosis?”
There was only the slightest hesitation. “Well, Kate, you said it was a riddle, so AIDS is out. And that would be too obvious given the Romanian orphanage. Something interesting, you say.”
“Yep,” said Kate. On the greenbelt below her CDC window, a family of white-tailed deer had come out to graze.
“Was the workup done in Romania or here?”
“Both places,” said Kate.
“OK, then we have some chance of reliability.” There was a pause and Kate could hear the soft sound of Paul chewing on his pipe. He had given up smoking the thing almost two years earlier, but still played with it when he was thinking. “What was the T- and B-cell count?”
“T-cell, B-cell, and gammaglobulin levels almost did not register,” said Kate. The data was in the file on her desk but she did not have to refer to them. “Serum IgA and IgM were markedly decreased…”
“Hmmm,” said Paul, “Sounds like Swiss-type SCID, Sad…and rare…but not too much of a riddle, Kate.”
She watched the deer freeze as a car came up the winding road to the CDC parking lot. The car passed; the deer returned to grazing. “There’s more, Paul. I agree the symptoms seem to suggest Swiss-type severe combined immunodeficiency, but the white blood cell count is also low…”
“What is the WBC count?”
“Less than three hundred lymphocytes/mu-one,” she said.
Paul whistled. “That is strange. I mean, he makes the so-called ‘boy-in-the-bubble’ case of SCID look tame. According to your description, this poor Romanian kid has three of the four types of SCID—Swiss type, SCID with B lymphocytes, and reticular dysgenesis. I don’t think I’ve ever seen a child with more than one of the manifestations. Of course, SCID itself is rare, no more than twenty-five or so kids worldwide…” His voice trailed off from stating the obvious to silence. “Is there more, Kate?”