The Fifth Vial

by Michael Palmer

  Critical Acclaim for

  The Fifth Vial

  “Palmer is adept at tapping into people’s natural fear of disease, doctors, and hospitals and converting that fear into unnerving suspense…If medical thrills are what you’re after, he delivers.”

  —Booklist

  “In his entertaining twelfth medical suspense novel…Palmer, himself an M.D., does a good job of informing the reader on an important ethical issue.”

  —Publishers Weekly

  “Palmer is adept at reaching into the psyche…and knows how to wield a scalpel…chilling.”

  —Ottawa Citizen

  “Gripping and topical.”

  —Toronto Sun

  “Palmer’s latest has thrills and chills aplenty, while conveying a sobering—make that terrifying—message. Not only is this one heck of a medical thriller, it’s a scary wake-up call to what could happen if a few individuals decided to play God, a premise that scared the daylights out of me. Could this happen? Palmer makes you think so.”

  —Sandra Brown, author of Ricochet

  “The Fifth Vial is a nail-biting thriller you don’t want to miss.”

  —Catherine Coulter, author of Point Blank

  “Michael Palmer delivers a complex plot, fascinating characters, and plenty of action. The Fifth Vial is a roller-coaster ride that winds its way through the United States, Africa, India, and Brazil on the way to a terrific surprise ending.”

  —Phillip Margolin, author of Proof Positive

  “Brilliant storyteller Michael Palmer is at the top of his game, and gives us a compelling and thought-provoking tale that will have you looking over your shoulder. It’s both realistic and terrifying, and it will keep you up all night!”

  —Iris Johansen, author of On the Run

  “There’s a compelling truth at the center of this high-octane thriller. The twists keep you reading and the questions Palmer poses keep you thinking all night long.”

  —Tami Hoag, author of Prior Bad Acts

  “Michael Palmer, perhaps the best of our medical-thriller writers, has penned an action-packed tale that will have you checking all your body parts for days afterward.”

  —Terry Brooks, author of Armageddon’s Children

  and The Sword of Shannara

  To

  Zoe May Palmer, Benjamin Miles Palmer,

  and Clemma Rose Prince:

  May you grow up in a world of peace.

  And, as always,

  to Luke

  Contents

  Prologue

  Chapter One

  Chapter Two

  Chapter Three

  Chapter Four

  Chapter Five

  Chapter Six

  Chapter Seven

  Chapter Eight

  Chapter Nine

  Chapter Ten

  Chapter Eleven

  Chapter Twelve

  Chapter Thirteen

  Chapter Fourteen

  Chapter Fifteen

  Chapter Sixteen

  Chapter Seventeen

  Chapter Eighteen

  Chapter Nineteen

  Chapter Twenty

  Chapter Twenty-One

  Chapter Twenty-Two

  Chapter Twenty-Three

  Chapter Twenty-Four

  Chapter Twenty-Five

  Chapter Twenty-Six

  Chapter Twenty-Seven

  Chapter Twenty-Eight

  Chapter Twenty-Nine

  Chapter Thirty

  Chapter Thirty-One

  Chapter Thirty-Two

  Chapter Thirty-Three

  Chapter Thirty-Four

  Chapter Thirty-Five

  Chapter Thirty-Six

  Chapter Thirty-Seven

  Chapter Thirty-Eight

  Chapter Thirty-Nine

  Chapter Forty

  Chapter Forty-One

  Epilogue

  Author’s Note

  Acknowledgments

  Preview

  Prologue

  The beginning is the most important part of any work.

  —PLATO, The Republic, Book II

  Hold still, now. This won’t hurt a bit.

  Those were the only words Lonnie Durkin had heard for hours.

  This won’t hurt a bit.

  Vincent always said the same thing just before he stuck the needle into Lonnie’s arm and drew blood.

  Vincent lied. The needles didn’t hurt much, but they did hurt.

  “Take me home! Please take me home! Please, please, please.”

  Lonnie leapt up from his bed, jammed his fingers through the metal wire fencing, and kicked the locked gate. He knew what a nightmare was. His mother had explained bad dreams to him when he was a boy and had begun waking up every night screaming. But he could tell that the cage was no nightmare.

  The cage was real.

  “Please!”

  At that moment, the van swung a turn that threw him hard against the wall, banging his head and his shoulder. He cried out, fell, then crawled back to the bed.

  The van was a house on wheels, like the one Uncle Gus and Aunt Diane had. But instead of a cage in the back, theirs had a nice room and a big bed and some closets. Five years ago, for Lonnie’s sixteenth birthday, they had taken him to Yellowstone in the van and had let him sleep in that bed at night for the whole trip. The bed in the cage was too small for him, and the mattress was too hard. Beside the bed there was a chair, a pitcher of water in a holder on the wall, and some paper cups. On the chair there was a magazine called MAD, which had lots of weird cartoon drawings, but way too many words for him to read. And finally, there was the clicker for the TV that was attached to the wall outside the cage. That was everything.

  Lonnie couldn’t stop thinking about his mother and father, and the men who worked on the farm. The guys knew how much he loved M&Ms, and always had some for him when he walked down to the fields to visit them, and sometimes even help them out.

  “Let me go! Please don’t hurt me! Just let me go!”

  Three sides of the cage were the walls of the van. The fourth side was the fence, made of chicken wire, just like the coop behind the barn at home. It completely filled the opening to the rest of the van and had a gate with a lock on the other side. There was a light in the ceiling just outside the cage, but no windows. Beyond the fencing was the bathroom, and just past that was a folding wall that pulled across the passageway to where Vincent and Connie were.

  Frustrated, Lonnie rose and kicked at the fence. He guessed that he had been in the cage for three days, maybe four. The van had been moving almost the whole time.

  He wasn’t really cold, but he felt that way—cold and frightened and lonely.

  “Please! Please take me home!”

  His voice was almost gone.

  Except for the needles when they gave him a shot or drew blood, neither Vincent nor Connie had hurt him so far, but Lonnie could tell they didn’t like him, either. They looked at him just like Mr. and Mrs. Wilcox in the house down the road from the farm looked at him, and once, while he was on the toilet, he had heard Vincent call him a fucking retard.

  “Let me go! I want to go home! Please, please. This isn’t fair.”

  The van slowed and pulled over to a stop. Moments later, Vincent opened the door beyond the bathroom. He was a big man with yellow curly hair—not fat the way Lonnie was, just big. He had a tattoo of a battleship on each of his arms, right above his wrists. Vincent had been so nice to him at first. Connie, too. They had stopped the van where Lonnie was walking to the rec center, and had asked him directions to the farm. Cousins of his mother, they had said they were. Otherwise he would never have gotten in the van with them. His mother had taught him about going with strangers. But these weren’t strangers. They were cousi
ns, who knew his name and his father’s and mother’s, but had just never been up to the farm.

  His hands on his hips, Vincent stood by the bathroom door. Lonnie could tell he was angry before he even spoke.

  “What did I tell you about yelling?”

  “N-not to do it.”

  “Then why are you doing it?”

  “I-I’m scared.”

  In spite of himself, Lonnie felt his eyes filling with tears. Just the other day, his mother had said she was proud of him for not crying so much anymore. Now, here he was, about to cry again.

  “I told you that you didn’t have anything to be frightened of. One more day and we’ll let you out.”

  “P-promise?”

  “Okay, I promise. But if there’s any more hollering or you give us any trouble at all, the promise is off and I’m going to take away the TV remote.”

  “The TV doesn’t work good anyhow.”

  “What?”

  “Nothing. Nothing.”

  “No more noise. I mean it.”

  Vincent spun around and left before Lonnie could say any more. After wiping his eyes with the back of his hand, Lonnie pulled the blanket over himself and drew his knees up, facing the back wall. One more day and we’ll let you out. Vincent’s promise played over and over through his head. He should have made him do a pinky promise. One more day…For a time, the tears came even though he tried to stop them. Then, gradually, Lonnie’s sobs gave way to a troubled sleep.

  When he awoke, the van had stopped moving. His shoulder hurt from where he had fallen, and there was a sore lump just over his eye as well. He rolled over slowly, aware that he had to return to the bathroom soon to pee. A woman was standing outside the fence, looking at him. She was wearing the kind of blue hospital clothes that the doctors who fixed his hernia wore, and over them a white jacket. Her hair was pulled back and covered with a blue paper hospital hat. Vincent was standing behind her, tapping a short, black club against his hand. The door behind him was closed.

  “Hello, Lonnie,” the woman said, adjusting her glasses and looking down at him. “My name is Dr. Prouty. Did Vincent or Connie tell you I was going to be here?”

  Lonnie managed to shake his head no.

  “Well, then,” Dr. Prouty went on, “you needn’t be afraid. I’m going to take your temperature under your tongue, and check you over the way doctors do. Do you understand?”

  This time Lonnie nodded. Despite the doctor’s quiet voice and smooth skin, there was something about her that seemed to make it impossible for him to speak. Something cold.

  “Good. Now, I want your word that if I open this gate and come in there with you, you’ll be cooperative…. Cooperative, Lonnie. Do you know what that word means? Lonnie, answer me.”

  “I…know.”

  “Good.”

  Dr. Prouty nodded to Vincent, who unlocked the gate and pulled it open, all the time keeping the club where Lonnie could see it.

  “Okay, now, Lonnie,” Dr. Prouty said, “I’m going to give you a shot and then I’m going to examine you. First I want you to get undressed and put this gown on with the strings in the back. Do you understand?”

  “I have to go pee.”

  “Very well. Vincent will help you, then he’ll help you get changed. First, though, let me give you this shot.”

  “Then I can go pee?”

  “Then you can go,” Dr. Prouty said, somewhat impatiently.

  Lonnie only moved a little when the needle was jammed into his arm. Then he went into the tiny bathroom and peed. When he had finished, Vincent took him by the arm and led him back into the cage to change into the gown. Even with it on, he felt naked. The fear that had been building inside him tightened like a band around his chest. Dr. Prouty returned from the front of the van, closing the door behind her. As she examined him, he began to feel his eyelids grow heavy.

  “He’s going out,” he heard Dr. Prouty say. “Let’s get him up front while he can still hold most of his own weight.”

  Vincent helped him to stand. Then Dr. Prouty opened the door. It was the first time Lonnie went to the front of the van since the day it had stopped for him. Things there had completely changed. A bright saucer light was attached to the ceiling, and beneath it was a narrow bed covered with a green sheet. Beside the bed stood a tall doctor, wearing a blue mask over his mouth and nose.

  “Get him up there while I scrub in,” Dr. Prouty said.

  Lonnie looked toward her voice and saw that she, too, had a mask on. He felt wobbly, barely able to stand. Vincent helped him to lie facedown on the bed and pulled a strap across his back. A sheet was lowered over him. Then the tall doctor put a needle into his arm and left it there. Lonnie’s eyes closed and refused to open. His fear subsided.

  “Now, Lonnie,” the tall doctor said, “I’m going to put a special breathing mask over your face…. Perfect. Okay, just breathe in and out. In and out. This won’t hurt a bit.”

  “The body is that of a well-nourished white male in his twenties. Height five feet nine inches; weight one hundred ninety-seven pounds. Hair brown, eyes blue. No tattoos or…”

  Pathologist Stanley Woyczek used a foot pedal and overhead mike to dictate as he worked. He was in his second term as medical examiner for Florida District 19, which included St. Lucie, Martin, Indian River, and Okeechobee counties, all located north and west of West Palm Beach. He loved the intricacies and puzzle-solving that went along with the job, but was still not at all inured to the human tragedy. Cases often stayed with him for weeks, if not years. He had no doubt that this would be one of them. A young man, carrying no identification, had run out of a grove of trees and onto a sparsely populated stretch of Route 70, where he was blasted out of existence by a tractor-trailer. The driver of the semi estimated he was going sixty-five when the man suddenly appeared as if out of nowhere, right between his headlights. Gratefully, Woyczek reasoned, the pain of the impact couldn’t have lasted more than a second or two.

  Preliminary screens for alcohol and drugs of abuse were already back, and were negative. Assuming the more extensive toxicology was also going to be unrevealing, there would probably still be two glaring questions when this postmortem was completed: Who? And why?

  “There is a well-healed scar over the left inguinal canal, presumably from the surgical repair of a hernia. There is a seven-inch laceration and compound fracture of the skull above the left ear, and a twelve-inch-long vertical tear through the left chest, through which a severed portion of the aorta can be seen.”

  Woyczek motioned to his assistant that it was time to turn the victim over. They did so with care.

  “Posteriorly, there is a deep abrasion across the right scapula, but no other—”

  The pathologist stopped speaking and peered down at the top of the man’s buttock, just above his right hip…then at an identical area on the left.

  “Chantelle, what does that look like to you?”

  The assistant studied both areas.

  “Puncture wounds,” she said.

  “No doubt about it.”

  “No, Dr. Woyczek. There are six on each side, maybe more.”

  “We’ll do a microscopic on some of them to set the age, but these punctures are recent. I’m sure of it. I think we have something here.” He stepped back and stripped off his gloves. “Hold the fort for a couple of minutes, Chantelle. I want to get the detectives to come over. I might be wrong, but I don’t think so. Sometime in the last day, two at the most, John Doe here was the donor for a bone marrow transplant.”

  One

  The partisan, when he is engaged in a dispute, cares nothing about the rights of the question, but is anxious only to convince his hearers of his own assertions.

  —PLATO, Phaedo

  “Go ahead and sew him up, Ms. Reyes.”

  Natalie stared at the slice down Darren Jones’s forehead, across his eyebrow, and down his cheek. Until this moment, the largest knife wound she had ever seen was one she had accidentally inflicted on her o
wn finger. Treatment then had been a couple of Band-Aids. She forced herself not to make eye contact with Cliff Renfro, the surgical senior resident in charge of the ER, and followed him out to the hallway.

  In her three years and one month as a medical student, she had sutured countless pillows, several varieties of fruit, some ragged stuffed animals, and recently, at what she considered great peril, the seat of a pair of her favorite jeans. Renfro’s order didn’t make much sense. She was only two hours into her second day on the ER rotation at Metropolitan Hospital of Boston, and although Renfro had checked her diagnostic skills out on several patients, he had yet to see her sew.

  “Dr. Renfro, I…um…think maybe I should go over things with you before—”

  “Not necessary. When you’re finished, write a scrip for him for some antibiotic—any one. I’ll sign it.”

  The resident turned and was gone before she could respond. Her classmate and good friend, Veronica Kelly, who had already finished her surgical rotation at Metropolitan, had told her that Renfro was in his final year before taking over as chief surgical resident at White Memorial, the flagship of the medical school’s many famous teaching hospitals. After years of training, he had the air of one who had seen it all and was burnt out on what he considered the lowlife patient population of Metro.

  “Renfro’s smart and damn competent,” Veronica had said, “and he’ll take the really messy trauma cases. But he couldn’t care less about the routine stuff.”

  Apparently he considered a black teenage loser in a gang fight to be routine. Natalie hesitated outside the boy’s room, wondering what the fallout would be if she chased Renfro down and asked for a demonstration of his skill.

  “You okay, Nat?”

  The nurse, a gravel-voiced veteran of years in the ER, had given a portion of yesterday’s student orientation, including the tradition that in a hardscrabble place like Metro, almost all the staff used first names. Hers was Bev—Bev Richardson.

  “I asked for this rotation because I heard the students got to do a lot of procedures, but sewing up a kid’s face on my second day is a bit more than I had expected.”