“No, not that they have mentioned, but they asked me to call them after reviewing the report to discuss further details.”
“If there were further details to be discussed, then why didn’t they put them into the report?”
“That, Dr. Kirsch, is an excellent question.”
42
Of course, it figured that the lab tech that had done the virology was not available to talk to them. Dr. Wiltshire and Kenzie both tried several methods to get ahold of him, but neither of them was having any success. The receptionist wouldn’t explain why he wasn’t available, and Kenzie wondered if he had left on vacation or called in sick since writing his report.
“We’ll just have to wait,” Dr. Wiltshire said. “We weren’t expecting to have these results today anyway, so if we have to wait a day or two to find out what he wanted to discuss, then we’re no further behind.”
“I know, but it must have been something important if he wanted you to call him back.”
“Can’t be helped. If it was important, maybe he’ll have left a message for one of his coworkers to call us. Until then, we’ll just have to do a bit of our own research and hypothesize about whether this had anything to do with Mr. Cartwright’s amyloid plaques or his death. Or both.”
“It must have something to do with it. If he had an active infection when he died.”
“That’s a leap in logic. If you have the flu and I shoot you through the heart, it isn’t the flu that killed you.”
“Well, no, but in this case, when we can’t find anything else...”
“You’re assuming a connection that we can’t just assume. It might have something to do with the cause of death, but it might not.”
“Okay. I’ll do a bit more research. But I’ve got other files to work on too.”
Kenzie’s phone chimed once, and she checked the screen for the notification. An email from Zachary. He didn’t often email or text her during the day, so she opened her phone to have a quick read and make sure nothing was wrong.
The subject line ‘you were right’ didn’t tell her anything other than that he had finally noticed the obvious. She opened the email.
Everyone and his dog is going to the masquerade ball
There was a snippet from a news article with a picture of Lola the dog. Kenzie tapped the link. The news article appeared in her browser.
It was a puff piece about how the hero dog, Lola, had been invited to attend the premier social event of the fall, along with the likes of... there was a list of minor local celebs who had RSVP’d that they would be in attendance.
It went on to describe the various charities that funds were being raised for, the prevalence of kidney disease and prominent people who had died from it, and so on. Kenzie closed the news article.
Her email back to Zachary was short.
Oh, brother
Kenzie’s desk phone rang. She looked over at it to see that Dr. Wiltshire was calling and picked it up immediately.
“Hello?”
“Kenzie, can you join me in the boardroom? They’ve finally got their ducks in a row at the lab, and it isn’t the tech who will be talking to us; it is the Executive Director. And some of his staff.”
“What’s going on?”
“I don’t know yet. But I think we’re about to find out.”
“I’ll see you in a minute.”
The boardroom was closer to her desk than to his, so she beat him there. They both put down their notepads and pens. Dr. Wiltshire had a printed copy of the lab’s report. He checked his notes and, putting the phone on the table into speaker mode, dialed the lab and gave his name. In a few minutes, they could hear the background hum of voices as they were transferred into a meeting room at the lab.
Dr. Wiltshire introduced himself formally and added Kenzie’s name. Then the Executive Director, a Pascal Savage, gave his name and position and the names of a few of the techs or assistants who were there to back him up.
“Dr. Wiltshire, we’d like to know a little more about the patient whose samples you sent us,” Savage explained. “These results were very unusual, and we need to track the source of the infection if we can.”
“I know we don’t usually look for HHV-4 in the brain,” Dr. Wiltshire agreed. “What exactly are you looking for? This was an old man; maybe his immune system was compromised. I think that while we don’t expect to see it crossing the blood-brain barrier, it’s not unheard of.”
It was like they were both feeling each other out, trying to figure out how much the other already knew. Both trying to keep their own information private.
“This wasn’t a normal HHV-4 virus,” Savage said reluctantly.
“What does that mean?”
“It was a variant we haven’t seen before.”
43
Dr. Wiltshire leaned forward, putting his elbows on the table.
“A variant?”
“We have been analyzing it. It isn’t like any version of HHV-4 we’ve seen before. We’re concerned that if this infection is in the wild, and you’re seeing people die from it, we could end up with an epidemic on our hands. No one will be immune to it. We don’t know what its spread might be since this is the first time that we’ve seen it. This victim, you say he was an elderly man? What kind of a situation was he living in? Was he a farmer or a veterinarian?”
“A farmer. No. He’s living in a nursing home. He’s been there for several years, right Kenzie? He wasn’t a new resident.”
“No. He’d been there for a few years. As far as I know, he didn’t go out anywhere. We can ask the nursing home whether he went anywhere or had any visitors that he might have caught this virus from.”
“Could it have been dormant?” Dr. Wiltshire suggested. “Something that he picked up years ago before he moved to the nursing home?”
“I think if this was an old virus, we would have seen it before,” Savage countered. “We’ve been looking through databases and other media, and we can’t find any suggestion of it having been seen before.”
“Maybe really old?” Kenzie suggested, “from when he was a kid or a young man? We don’t know what exposures he might have had that far back. There wouldn’t be any records showing you the genome of this virus. Some herpesviruses go into dormancy and then pop up again years later when the patient is stressed or there is some other activating trigger. Maybe triggered by the presence of another herpesvirus. Did you find anything in the serum sample we sent previously?”
“Was there a serum sample for this patient?” Savage addressed his own people, but no one seemed to have an answer.
“We sent it earlier,” Kenzie explained. “Before the brain tissue. But it has the same patient number on it.”
There was some back and forth among the lab folk before Savage broke in again. “It looks like it hasn’t been processed yet if we did receive it.”
“I can send another sample if you think it got lost.”
“I’ll have someone get back to you to either let you know that we’ve got it or that we need you to send a second sample. Blood is more backed up than brains at the moment.”
“What?” Kenzie asked blankly. Then she realized he meant that it was taking longer for the lab to process blood samples, probably because they received a lot more of them. That was why the brain had been processed first. “Oh, I got it. Sorry.”
“Nothing to apologize for,” Savage said. “I’m sorry we don’t have the serum results on hand yet. That would have been helpful.”
“We had another patient with similar symptoms to this one,” Dr. Wiltshire told Savage and his people. “From the same nursing home unit. They died a couple of days apart.”
“You need to send me his samples as well. To be processed as soon as possible.” Savage swore. “If this is highly contagious... you know how endemic herpesviruses are...”
Dr. Wiltshire looked at Kenzie.
“His brain samples have already been sent in,” Kenzie confirmed. “I’ll send you the patient n
umber.”
“That would be helpful. We’ll get right on it.”
“There have been other deaths at that nursing home recently. But there always are. It’s a nursing home. That said, it was the independent living unit, so we didn’t expect to see as many deaths there.”
“How many deaths?”
“We had a few through here—more than I had thought. But even more were just handled by the nursing home as doctor-attended deaths and didn’t come through our office. I’m not even sure where to start.”
“With the samples we have,” Dr. Wiltshire said with a shrug. “We’ll need to assemble any samples from nursing home patients in the last... let’s start with three months. We can send the tissue samples in for testing. Do you want blood samples too?” Dr. Wiltshire directed this question to the speakerphone.
“Yes. I think it’s important to see how many people were infected and what percentage of those had the virus in their brains. Does this virus migrate to the brain? Do we only see it when it reaches a certain level in the body? Only in the immunosuppressed? We need to start gathering data.”
Kenzie jotted a few notes down on her pad of paper, thinking through everything that had been said during the phone conversation.
“Dr. Savage... you’re obviously very concerned that this could spread. Is it just because it is a variant you haven’t seen before and you don’t know how infectious the new variant is? Because it may be associated with our patient’s death?”
The background noises on the speakerphone ceased as if everyone in the room at the lab had gone still. No more shuffling papers or whispered conversations. Kenzie looked at Dr. Wiltshire, and they both waited for Dr. Savage’s answer.
“I am most concerned,” Savage said slowly, “because it would appear that this virus was engineered in a laboratory.”
44
Kenzie and Dr. Wiltshire looked at each other.
“What makes you think it was engineered in a lab?” Dr. Wiltshire asked. “Or rather, how can you tell it was engineered in a lab?”
“This is highly confidential,” Savage warned. “Is there anyone else within earshot? I need your promise that this will not be written down or communicated to anyone else.”
“We are alone,” Wiltshire said, with a glance at the open boardroom door. Kenzie got up and shut it. “And of course, you have my word that I will not communicate any confidential information outside of this office.”
There was silence as Savage apparently considered this wording. Then he spoke. “There is a protein sequence in the RNA of this virus that constitutes... a signature, if you will. In the same way as you can recognize an artist by his brushstrokes or a computer programmer by specific subroutines that he reuses from one program to the next, we can tell that these proteins were edited in a lab. They are a different sequence than you would find in any virus in nature.”
“Can you trace them back to a specific lab or scientist, then?” Dr. Wiltshire asked.
“We’re working on that. Experimental material does get transferred from one lab or project to another, so there’s a bit of detective work to do... lab A passed it on to lab B and C for subsequent studies, lab B passed it on to E, and C to F... It’s going to take some time, especially if the transfer wasn’t well-documented or a sample was mislabeled or mixed up. If, for instance, they were supposed to send out a non-engineered virus and sent out the engineered one instead.”
Kenzie reached to write something down on her notepad. Dr. Wiltshire caught her eye and shook his head. Savage had asked them not to write down anything about the virus being engineered.
“The next question is how did our patient contract the virus?” Dr. Wiltshire said. “Did he take part in an experimental program? Or is it in the wild? Has it mutated from the form that the lab developed?”
“All good questions,” Savage agreed. “We are concerned that it may be in the wild. Were you aware of your patient taking part in any medical testing?”
“Not that we know of. It wouldn’t be normal course to be testing a virus on seniors unless they are targeting a disease that would normally only be found in seniors.”
“Like Alzheimer’s Disease?” Kenzie asked him softly, her face turned away from the phone so they wouldn’t pick up her question. Dr. Wiltshire’s eyes widened as he considered the possibility.
“What makes you think it is in the wild?” Kenzie asked. “Do you have anything to back it up? Have you seen it somewhere else?”
“We are working on identifying the origins of this virus. The sequencing suggests that the HHV-4 has recombined with at least one other virus to form a new variant. Of course, it is possible that it was recombined in a laboratory setting, but usually, a lab wants to maintain more control than recombining two viruses would allow. They splice specific gene sequences rather than the larger chunks that we are seeing. What happens when two viruses recombine is too unpredictable.”
“So it has mutated, and now you don’t know what properties it has.”
“Yes,” Savage agreed, his voice suddenly lower and gravelly like he’d been up all night talking. As he probably had. “Your case confirms that it is contagious. How contagious it is, we don’t yet know. Epstein Barr is usually transmitted through saliva. That’s why mono is called the kissing disease. Did it contribute to the death of your patient? If it did...”
“There may be an outbreak at the nursing home and they don’t even know it yet. And it could be fatal.”
“We have no idea how many people may have it already. A nursing home is a perfect environment to spread an infectious agent. Lots of vulnerable people close together on a daily basis. Outside visitors, doctors, nurses, cleaning staff, volunteers, lots of ways for viruses to get into—and out of—the nursing home. Kids with runny noses visiting grandma...” Savage made a noise of disgust. “You couldn’t engineer a much better environment for spreading a novel virus.”
45
Kenzie’s head was whirling after they hung up the phone. She and Dr. Wiltshire just sat there for a while, saying nothing, considering everything they had heard. Dr. Wiltshire wrote a number of notes on his pad of paper. Kenzie didn’t interrupt him, not wanting to break his concentration. Eventually, he put his pen down and looked at her.
“I don’t know what to think,” Kenzie said. “This is incredible.”
“We have a list of things to do, including sending them Mr. Sexton’s ID number so that they can test his samples next, and pulling samples for any other cases from the nursing home that we have handled in the last three months. That is going to take a while. I have some other calls and research I would like to do while you get started on that.”
“What about talking to the nursing home?”
Dr. Wiltshire’s lips pressed together tightly as he considered this. “We don’t want to start a panic. But we have to be responsible and prevent harm wherever possible. It’s too early to recommend a quarantine. Not until we have more data. For all we know, Mr. Cartwright did take part in a medical experiment and it is not contagious at all. One dead man with this novel HHV-4 does not constitute an outbreak.”
“But that’s not what the lab thinks.”
“And since they are the ones who discovered it and have the expertise, it falls on them to inform the Vermont Center for Disease Control and to make recommendations on quarantines or other measures to be taken.”
Kenzie scribbled on her notepad. Not words, just shapes and scribbles, trying to get her mind around all of the issues. “What if we told the nursing home that there is a particularly virulent strain of the flu around and that might be what killed Cartwright and Sexton?”
“That’s not exactly honest. It would be a breach of ethics.”
“But so would not telling them.”
“We might be able to get away with slightly different wording... a virus that we are trying to identify. Something that they should take extra measures to avoid transmission from one patient to another. Hand-washing, staff wearing mask
s, and so on.”
“And you don’t think that will cause panic or spread to the news media?”
Dr. Wiltshire shook his head, not liking the question. They were in trouble either way. They couldn’t ignore the potential for an outbreak, but they didn’t want to cause unnecessary panic. No matter how careful they were in their wording of a warning to the nursing home, the staff there could overreact or underreact.
“We need more data,” Dr. Wiltshire said finally. “We don’t know what we’re looking at or what the danger is until we have more. We can’t make an informed decision without the facts. Then we can make a careful, informed decision. If the lab hasn’t already issued a warning. And they may do that once they know enough. It really is their responsibility. Or that of the lab that released the virus. It isn’t the place of the Medical Examiner’s Office to give warnings about contagions.”
Kenzie nodded slowly. “Okay. But if it turns out there is an outbreak of this new, engineered virus... we can’t ignore it.”
“We won’t.”
Kenzie stood up and picked up her notepad. “There’s one thing that the lab didn’t say, and we didn’t ask.”
Dr. Wiltshire nodded his agreement. “Why was this virus created? Was it part of a study to prevent disease or part of a bioterrorism program?”
Kenzie walked back to her desk, a knot in her stomach. She knew why they hadn’t asked the question.
46
At the end of the day, there was nothing to do but wait. Kenzie had sent the information and samples that Savage and his team needed to the lab. Dr. Wiltshire was making his phone calls and doing research, but she didn’t know who he was consulting with or exactly what he wanted to know about the virus.
Doctored Death Page 19
