The Fifth Vial

by Michael Palmer

  “I raced in the University Games in São Paulo, but I never made it over to Rio.”

  “Well, I was planning to go and deliver a version of our graft-versus-host paper, but my disc has been giving me a devil of a time, and Paul Engle, my neurosurgeon, has recommended against long airplane flights or car rides. I thought maybe you had some things you might want to get away from for a while, and that was even before I caught you about to mix it up with my research fellow.”

  “You want me to go to Rio?”

  “Business class.”

  “You’re not just trying to keep me and Tonya from killing each other?”

  “Firing you would be a lot less expensive.”

  Natalie felt a surge of excitement. The past three weeks had been worse even than those following her injury in the Olympic trials. Her unnecessary humiliation of the high-school runners and the angry encounter with Levitskaya were symptoms of her unraveling. She was a pressure cooker, plugged up and about to blow. There was nothing she could use at the moment more than a change of scene.

  “When do you need to know?” she asked.

  “When can you let me know?” Berenger responded.

  “How about now?”

  Five

  The true physician is also a ruler having the human body as a subject, and is not a mere money-maker.

  —PLATO, The Republic, Book I

  The child was failing. Her name was Marielle, and despite the antibiotics and the IV fluids, the oxygen and tiny feeding tube, the six-year-old was slipping away. Malnutrition was fanning the flames of infection in her abdomen, and now her nervous system as well. Dr. Joe Anson brushed some flies from her parched, cracked lips and looked up helplessly at the nurse. Working in his hospital in an impoverished area thirty miles north of the capital city of Yaoundé, Anson had seen more than a few children die. Each one pained him worse than the last, and even though there had been many victories, they never seemed to balance off the defeats.

  At that moment, though, four o’clock in the morning, the frail, malnourished girl was not the only thing upsetting Anson. Over the past hour there had been a steady increase in his own air hunger. The sensation—at its worst a horrible, strangling claustrophobia—was never completely gone anymore. After almost seven years, his primary pulmonary fibrosis—progressive lung scarring—was nearing the end of its course. PPF—cause unknown, course inexorably downhill, effective treatment none. It was a rotten, debilitating disease, and sooner or later, Anson knew, a transplant would be his only hope.

  “Claudine,” he said in fluent Cameroon French, “would you please get me a tank of oxygen and a mask?”

  The nurse’s eyes narrowed.

  “Perhaps I should notify Dr. St. Pierre.”

  “No. Let Elizabeth sleep…. I will be fine with the oxygen.”

  He had to pause between sentences for an extra breath.

  “I am worried,” the nurse said.

  “I know, Claudine. So am I.”

  Anson strapped the polystyrene mask to his face and leaned forward so that gravity would pull his chest wall down and help expand his lungs. He closed his eyes, willing himself to calm down as he waited for the oxygen to banish the dreadful hunger. Five interminable minutes passed with no change, then another five. The situation could not get much worse. The episodes of breathlessness were occurring more frequently and taking longer and longer to abate.

  At some point, some point soon it seemed, the oxygen simply wouldn’t be enough. At some point, unless he consented to a lung transplant, and of course unless an appropriate donor could be found in time, his heart would be unable to force enough blood through the scar tissue in his lungs. Medications would work for a short while, but then his heart would weaken even further and he would begin, quite literally, to drown in his own fluids. By then, even if an appropriately matched donor could be found, the transplant would almost certainly be a waste.

  Breathe in…. Slowly…. Don’t stop…. Lean forward…. Let gravity help…. That’s it…. That’s it.

  Though a self-proclaimed agnostic, Anson began praying for relief. He still had work to do here—great, important work. Clinical testing of Sarah-9 was well under way, with astounding results. The drug he had created from a soil yeast unique to this area was still experimental, but it was clearly at the forefront in the field of neovascularization—the rapid development of life-giving new blood vessels. The new circulation had already shown the potential to cure conditions as diverse as battlefield wounds, infection, heart disease, and various forms of cancer…but ironically, not pulmonary fibrosis.

  It took more than fifteen minutes, but finally Anson began to draw in more air. Moments later, though, just as he felt the attack was over, a slight tickle in his chest led suddenly to a racking, painful cough. Damn it! In the minute or so it would take him to gain control of the cough, the air hunger would again take over. He had once been able to play hours of rugby without slowing so much as a step. It was hard to believe that half a thimbleful of sticky mucus in one bronchial tube was now enough to bring him down.

  On the narrow bed beside him, Marielle breathed sonorously. Anson stroked her forehead. Their battles were painfully similar. Would either of them win? He flexed his neck and savored a few blessed gulps of air. Although he was beyond exhaustion, and hadn’t had more than a few catnaps for almost twenty-four hours, he wasn’t even considering sleep. His patients were what mattered. Sleep, as always, was secondary.

  Born and educated in South Africa, Anson had once been handsome and dashing enough to have run with some of the most beautiful women in the world, and unfocused enough to have forsaken all but the most superficial connection to medicine. But that was long ago.

  Another fifteen minutes of oxygen and Anson sensed the insufferable band around his chest begin to loosen. Claudine, unable to stay and witness his anguish, had gone off to check on their twenty or so inpatients, many of whom—children and adults—were suffering from the complications of AIDS. Thanks to the London-based Whitestone Foundation, and their appointed administrator, Dr. Elizabeth St. Pierre, the small hospital was well maintained and equipped with almost anything that Anson and she could think to ask for.

  Fearing another relapse, Anson waited before setting the oxygen aside. The effort of pulling in enough air had left him light-headed and nauseated. It wasn’t supposed to have come to this. In nearly fifteen years he had never taken time away from work, nor had he ever wished to.

  After a particularly exhausting and depressing weekend on the party circuit, enmeshed with people he no longer cared about, doing things he more and more abhorred, Anson’s life as a dilettante and playboy ended abruptly. He used his legacy and whatever else he could borrow, and brought his vibrant wife and child into the jungle on a mission to save the people of his continent.

  Now, at fifty-five, he was physically a specter of the man he once was, and constantly frightened of having his work taken from him before it was ready, but even with diminished oxygen levels, his mind still processed information and solved problems at a torrid pace. There was no way he was supposed to stop now. As long as there was work to do, there was no way he could expose himself to the vagaries of a lung transplant and the antirejection treatments surrounding it.

  Silently promising that as soon as Sarah-9 was perfected, he would relent, Anson fit his stethoscope in place and did a careful reevaluation of his patient. The child might last a day or two, but without some sort of divine intervention, three days was a stretch. Divine intervention. The words went right to the heart of the matter. Anson did not acknowledge the power of God, but he totally embraced the power of Sarah-9, named after his only child in the hopes that someday, she would understand the choices he had made. Even though Marielle didn’t fit into any of the current clinical protocols, she might well benefit from treatment with the wondrous drug.

  There was, however, a major problem in doing that.

  Elizabeth St. Pierre, controller of the purse strings supporting
the Whitestone Center for African Health, was also in charge of the clinical testing of the drug. She had vehemently forbidden random use of Sarah-9 before the researchers at the Whitestone Foundation had completed their evaluation. The edict restricting use of the drug seemed unreasonable on the surface, but Anson knew the problem was one strictly of his own making.

  Until he relinquished his total control of its manufacture, Sarah-9 would be in precious short supply.

  Anson felt his pulse quicken at the notion of stealing his own drug. He was doing everything possible for the girl, but her disease was deeply entrenched. He needed to increase the circulation in the area of the infection in order to deliver more oxygen and more antibiotics. Sarah-9 was just the ticket. Perhaps he could broker some sort of a deal with Elizabeth, he wondered now—his secret notebooks and cell cultures in exchange for enough Sarah-9 to treat his patient.

  No, he decided. They could call him unreasonable or even paranoid, but he simply wasn’t ready to turn over his research to Whitestone. At this juncture, it would be better to ask forgiveness than permission.

  The bamboo and cinderblock research facility, a series of laboratories and sleeping quarters fifty yards north of the hospital, was impressively outfitted, with state-of-the-art incubators, two mass spectrometers, and even an electron microscope. With refrigeration units and both yeast and tissue culture lines to protect, there was also a phalanx of mammoth generators automatically backing up the power that had been brought out from Yaoundé through the towering trees along the Sanaga River.

  Doing his best to mask the weakness and uncertainty in his steps, Anson caught up with Claudine as she and the other evening nurse were medicating the patients. In addition to Anson and St. Pierre, two physicians from Yaoundé and several residents worked at the hospital. They rotated nights on watch, but in truth, Claudine and the other nurses were experienced and competent enough to handle most problems.

  “So, how is our flock doing, Claudine?” he asked, subtly bracing one knee against a wall.

  The woman appraised him.

  “You are feeling better?”

  “Much, thank you. I am going to go back to my quarters to wash up and change. Then I will return.”

  “You should stay there and get some sleep.”

  “Later this morning, after the others arrive, I will catch up on sleep. Believe it or not, I am quite wide awake at the moment.”

  “We worry about you.”

  “I appreciate that, Claudine, and I need you to. Please hold down the fort. I will be back shortly.”

  Anson paused to assure himself that his little patient was stable, and then left the hospital. A uniformed security guard was waiting outside the door.

  “Good evening, Jacques.”

  “Good evening, Doctor. Long night.”

  “Sick child. Listen, you can stay there if you want. I am just going to my apartment to wash up.”

  “Sir—”

  “I know, I know.”

  Unaccompanied walks at night were forbidden. Where there was poverty, there was inevitably crime. The security force—each armed and former military—was there primarily to thwart kidnappings and any form of industrial espionage. The commercial potential of the formulas and notebooks protected in Anson’s massive safe was quite literally unlimited.

  The dirt and stone path between the hospital and the research compound was weakly illuminated by ground-level lighting. It wound through lush jungle growth, and ended at a bamboo vestibule off of which there were five wings—three of them containing research facilities, and the other two, residential quarters. Posted by the doorway to the vestibule was another security guard—well over six feet tall, broad-shouldered, and quite imposing in his starched khakis.

  “Good morning, Doctor,” he said formally. “Good morning, Jacques.”

  “Francis,” the other guard replied with a curt nod. “The doctor wishes to wash up before returning to the hospital.”

  “Then so he shall. Thank you, Jacques. I can handle things from here.”

  The guard hesitated, clearly trying to recall if there was a regulation covering the transfer of hospital personnel from one security guard to another. Finally, he shrugged, nodded at the two men, and headed back along the path. Before Anson could speak, Francis Ngale nodded minutely at the security camera, mounted in a waterproof housing midway up a palm tree facing the door. There was no need for such a reminder. Anson was well aware of the electronic security throughout the compound. The system had been put in place by Whitestone once their deal with him was finalized.

  With Ngale at his side, Anson started down the corridor to his two-room apartment. Halfway there, at a spot safe from the cameras, they stopped.

  “Pardon me for this observation, Doctor,” Ngale said, “but your breathing seems quite labored tonight.”

  “It was bad a little while ago, but now it is better. I have been battling to keep a little girl alive.”

  “Nobody fights that battle better than you.”

  “Thank you, my friend. I was quite relieved to find you on duty tonight. I need to get at the medication.”

  “For the girl?”

  “Yes. You know the rules prohibiting this?”

  “Of course.”

  “And you are willing to risk helping me?”

  “That question does not need asking.”

  Like almost everything else at the Whitestone Center for African Health, the security force was hired and supervised by Elizabeth St. Pierre. Now, although she and Anson were still as close as ever, there were times when she was forced to remind him that according to the pact he had made, it was the Whitestone Foundation that paid the bills, and the Whitestone Foundation that made the rules.

  St. Pierre had brought Francis Ngale on board, but she was unaware that Anson had once saved the man’s father from a nearly fatal episode of meningitis. Of all the security guards, Ngale was the only one Anson could completely trust.

  After a brief stop in his apartment to shower and change into a fresh set of scrubs, Anson met Ngale back in the corridor. The first blush of dawn had begun to dispel the dense night. Side by side, the two men crossed the vestibule and proceeded toward the cinderblock room containing two vaults—both set in four feet of concrete. The timing was as good as it could be. The security man assigned to the banks of video monitors would be half-asleep and easily distracted. Anson checked his watch.

  “Five-oh-two,” he said.

  “Five-oh-two,” Ngale agreed.

  “I will need three minutes. No more. Begin at five-oh-seven.”

  “Three minutes. I will get you that. My friend, Joseph Djemba, is on watch. He loves nothing more than talking Cameroon Indomitable Lions football.”

  “The team is very good again, yes?”

  “They must play to their potential, Doctor.”

  “As must we, Francis,” Anson whispered, pointing at his watch and motioning Ngale down the hall to the security office. “As must we.”

  Access to the vault room was by keypad. The combination to the vault on the right, containing Anson’s notebooks and other research materials, was known only to him and an attorney in Yaoundé. In the event of his sudden death, the contents of the vault would be turned over to St. Pierre along with the information to break the code in which they were written.

  The other vault—the one to the left—was refrigerated, and contained vials of Sarah-9, each carefully labeled, numbered, and catalogued. It seemed bizarre that he was forced to steal a drug that he had developed, but the process of synthesizing it from viral packets and yeast was complicated and extremely slow, and until Whitestone was allowed by him to develop mass production, it would always be in preciously short supply.

  Anson stayed back just inside the entryway until exactly five-oh-seven, then approached the vault. Just thirty feet away, in the security office, was a bank of twenty-four monitors—three rows of eight. Hopefully, at that moment, Francis was seeing to it that Joseph Djemba was looking somewh
ere other than at the screens.

  Anson fished a folded piece of paper from his pocket, knelt by the safe, and whispered the combination as he dialed. He exhaled audibly when the tumblers clicked into place and the heavy door swung open. Through a waft of cold air, he could see that there were eight vials of medication—the product of two or three days of laboratory work. Each vial, sealed with a rubber stopper, contained enough Sarah-9 for a week of intravenous treatment. In many instances, though, positive results were apparent in as little as two or three days. Hopefully, he would be able to keep his patient alive that long.

  As he slipped one of the chilly vials into his shirt pocket, Anson wondered how closely Elizabeth kept count. Knowing the woman as he did, it was doubtful the missing vial would go unnoticed. Deny, deny, deny. That would have to be his strategy. If he was firm enough, Elizabeth would at least have to consider the possibility she had miscounted. With a minute to spare, he silently closed the vault door and returned to the corridor. A few seconds later, Francis left the security office and joined him.

  “You are safe, Doctor,” he said.

  “At least for the moment.”

  “The security video is a loop that erases itself every twenty-four hours. If you can keep Dr. St. Pierre at bay for that length of time, the proof you were inside the safe will be gone.”

  Anson returned to the hospital, his breathing much easier than when he left. Whether it was changes in blood flow to his damaged lungs, mucous plugs, or a bronchial spasm, it was unfathomable even now how much better he could feel from one hour to the next—or sometimes even from one minute. He used the increasingly rare periods of minimal symptoms to convince himself that there was still time—plenty of time—before drastic measures would be called for.

  Marielle was as Anson had left her, although her spiking temperature was, for the moment at least, down to near normal. She could respond to a loud voice, or to being moved about in bed, but otherwise remained almost motionless. Her mother, from a village on the river to the north of the hospital, had lost two of her three children to the fallout from malnutrition. Hospital social workers had been doing all they could to prepare her for Marielle’s return, but the one time Anson had met her, it was clear that although she was hoping for the girl’s recovery, she was expecting the worst.