The Fifth Vial

by Michael Palmer

  “You said the Inter-Continental,” came the reply. “This is the quick way.”

  “I don’t want the quick way. I want to go back on the highway,” she demanded, sensing that she had gotten a number of the words wrong.

  “You are a very beautiful woman,” the driver said over his shoulder in decent English.

  “Take me back to the highway this minute!” she insisted.

  “Very beautiful.”

  The man accelerated slightly. The area through which they were passing was even more dilapidated. What streetlights there were had been smashed, and most of the rickety houses and tenements were shuttered. Almost nobody was on the streets except for an occasional furtive shadow, skulking around a corner or down an alley.

  Natalie glanced at the cabbie’s license. In the gloom she could barely make out anything, and so what if she could? This was serious, serious trouble. She mentally inventoried the contents of her purse. Was there anything there she could use for a weapon? Thanks to airport security, the answer was almost certainly no.

  “Goddamn it!” she shrieked, pounding on the thick Plexiglas that separated front seat from rear. “Take me back to the highway!”

  “The customers at the House of Love will adore you. You will be very happy there…. Very happy there….”

  The words echoed eerily. Icy panic took hold. Her dizziness, never really gone, had begun to worsen. The driver’s words seemed sharp and clear one instant, thick and repetitive the next. Natalie scanned the dark, uninviting slum. It seemed like they were going thirty or forty. Could she possibly escape by jumping out of the cab, then rolling and scrambling to her feet and running? If she could somehow get out and get upright, provided her leg wasn’t broken, she could outrun anyone. With the alternative of being made a narcotics whore in some brothel, it had to be worth taking the chance. She slipped her wallet and passport from her purse and jammed them into the pocket of her jacket.

  “Money,” she pleaded. “I’ll give you money to let me out right here. Three thousand reais. I have three thousand reais. Just let me go!”

  She inched toward the right-hand door and eased her fingers around the handle, trying to visualize what she should do with her body as she hit the pavement. Around her the scene seemed to fade, then sharpen, then fade again. She shook her head, trying to clear her thoughts.

  It had to be now.

  At that instant the cab screeched to a jolting stop and Natalie’s door was ripped open by two men, both wearing black stocking masks. Before she could react, she was pulled out and forced onto her belly. The cab roared away. A needle was thrust into the muscle at the base of her neck, and the contents of a syringe were emptied into her. A narcotic, she thought—a disabling dose of some sort of narcotic, probably heroin.

  Her situation was absolutely terrifying, but she felt oddly detached from it—detached yet at the same time determined not to give in to her attackers without a fight. They each had one of her arms now and were dragging her facedown into what seemed like a narrow, unpaved alley, fetid with refuse. She screamed for help, but sensed that in this neighborhood, such cries happened often, and would nearly always go unheeded. Still on the ground, she twisted her body and pulled her arms. Instantly, the man holding her right wrist lost his grip. Natalie spun that way, pushed herself to her knees, and slammed her fist as hard as she could into the other man’s groin. His grip on her other wrist vanished and he dropped to his knees. Before either man could react, she pushed to her feet, this time punching one of them flush in the face.

  In a second she was on her feet and sprinting away from the men down the alley. Ahead of her, through dim light, she could make out two rows of darkened buildings, some of them two stories high, some three. Ahead and to the right she thought she saw a light wink on.

  From behind her, one of the men cried out in Portuguese, “Tenho uma pistola. Pare já ou eu atiro!” I have a gun. Stop right now or I will shoot! Ahead of her the alley was completely blocked by a pile of trash barrels, boxes, and refuse, propped against some sort of fence, and extending up well over her head.

  “Stop!” the voice from behind her cried.

  Natalie had scrambled up the trash heap and was reaching for the top of the fence when a shot rang out from behind her. Nothing. She grabbed the coarse wood and swung her leg over. Another shot snapped off, then another. Both times, white-hot pain exploded from the shoulder blade on the right side of her back. She was slammed forward. Her arms flew off of the fence. Grunting against the pain and gasping for air, well aware that she had been shot more than once, she toppled backward and fell helplessly into the pile of garbage.

  Eight

  “And who is best able to do good to his friends and evil to his enemies in time of sickness? The physician.”

  —PLATO, The Republic, Book I

  Yaoundé was just four degrees north of the equator. Joe Anson had never handled the heat and humidity of Cameroon as well as those who were born there, but this day, with monsoon season just a couple of weeks away, was the worst he could remember. The air-conditioning units in the hospital were fighting a losing battle; the odors of illness were intensified throughout the building; flies were everywhere; and worst of all, the air was just about too heavy for him to breathe.

  If there was a bright spot in the oppressive day, it was the girl, Marielle, who had responded remarkably to her clandestine treatment with Sarah-9, and was now sitting up in a chair by her bed, taking fluids and nourishment. The drug was an absolute miracle, just as he had known from the beginning it would be. Another day, perhaps, and the Whitestone Center for African Health van would bring her back to her mother, along with enough rice and other staples to improve the health and well-being of the village until the monsoons hit. After that, the cycle of malnutrition and illness would begin anew.

  “Okay, dear one,” Anson said, placing his stethoscope on the girl’s back, “breathe in, breathe out…. You are doing so well. So well. Maybe tomorrow you will go home.”

  The child turned and threw her arms around Anson’s neck.

  “I love you, Dr. Joe,” she said. “Love, love, love, love, love.”

  “And I love you, too, dear peanut.”

  The few words took more out of Anson than he would ever care to admit to anyone. He handed Marielle a picture book and inched away from her bedside to the small office he shared with whichever doctors were on call. What in the hell was going to happen to him? What should he do? After thirty seconds, with his air hunger mounting, he used the emergency two-way radio he always carried to summon help.

  “This is Claudine, Dr. Anson,” the nurse said. “Where are you?”

  “Doctor’s office…in the hospital.”

  “You need oxygen?”

  “Yes.”

  “One minute.”

  It was half that when Claudine raced in pulling a green 650-liter tank of the precious gas, dropped into a frame on wheels. She was a tall woman nearing fifty, with a regal bearing, caring eyes, and a smooth, richly dark complexion. She had been at the hospital almost since its inception.

  “You are working the day shift?” Anson managed as she set his mask in place and started the oxygen flow at maximum.

  “Just breathe,” she said. “I…um…one of the other nurses got sick. I am working for her.”

  Anson missed her deeply troubled expression. He withdrew a cortisone inhaler from the top drawer and took two deep breaths from it, followed by two puffs from a bronchodilator.

  “It is good to see you,” he said.

  “You are feeling better?”

  “The humidity makes it hard.”

  “The humidity is only going to get worse until the rains start.”

  “Then it will be worse still. A hundred percent humidity. I do not know how I will ever deal with that.”

  Again, a shadow crossed the nurse’s face.

  “You are going to be all right,” she said with more than casual determination.

  “Of course I am, C
laudine.”

  “You are scheduled for your Wednesday lunch with Dr. St. Pierre. Should I cancel that?”

  “No, no. I do not cancel things. You know that.”

  Anson, once no more reliable than the wind, had become a creature of absolute discipline and unwavering habit. On Wednesdays at noon—every Wednesday—he met with St. Pierre in the small hospital dining area, where he ate conch chowder and a green salad, drank a bottle of Guinness Cameroun, brewed in Yaoundé, and finished his meal off with a scoop of chocolate ice cream. It was there they informally discussed the business affairs of the hospital, clinic, and laboratory, as well as his Sarah-9 research and, over recent years, his health.

  “Excuse me for saying so, Doctor,” Claudine said, “but your breathing is as labored as it has been for some time.”

  “It is…unpredictable.”

  “And there is no other treatment I can get for you?”

  “I…am…on so much…medication I…am jittery…most of the…time.”

  “Please, just relax and breathe. Perhaps I should get Dr. St. Pierre, or a respirator.”

  Anson motioned her to stay calm and wait. The nurse backed off to one side of the room, but her dark eyes, moist with caring and concern, never left him. Unseen by Anson, she reached into the pocket of her uniform and nervously fingered the vial of clear liquid that was there.

  Exactly one-point-four cc’s—no more, no less.

  That was the instruction.

  Exactly one-point-four…

  Lunch was scheduled for noon, but it was a quarter after before Anson had enough breath to set the oxygen aside and make his way to the dining area. The room was empty save for St. Pierre, who was seated at one of the three small tables, eating a tuna sandwich, drinking a tall iced tea, and going over some ledgers. She wore khaki shorts and a white tee that accented her alluring breasts. For a few moments, Anson was actually diverted from his respiratory difficulty. Over the years, he had often felt their relationship was about to move beyond a close friendship, but that had yet to happen. He settled in at the table, and moments later the cook reverently set his meal in front of him, a reminder that there was no one in the hospital or lab at the center whose life had not in some way been touched by the man.

  “I’ll never know,” he said to St. Pierre in English, pausing once for air, “how you manage to look so fresh in the face of this humidity.”

  “I suspect you would look fresher if you were breathing at something better than an oxygen saturation of eighty percent.”

  “I have managed to put in a full day’s work.”

  “I fear that won’t last much longer.”

  “Who can say? Lungs adjust.”

  “Not with pulmonary fibrosis they don’t, Joseph, and you know that as well as I do.”

  Anson picked at his salad and, as was his habit, took a lengthy pull straight from the bottle of his Guinness Cameroun. Elizabeth was right, he was thinking. She was always right when it came to his health. Still—

  “It just isn’t the time for me to submit to a transplant. The monsoons are almost upon us. Our work in the lab is going so well. I simply have too much to do.”

  “You are risking death every day from sudden heart failure or even a stroke.” She reached over and placed her hand on top of his. Her expression left no doubt that her concern for him was personal as well as professional. “You have done so much for so many, Joseph. I don’t want anything more to happen to you. Your breathing is getting worse, and it is destined to get even worse still. If matters deteriorate much more, any operation will become far more risky.”

  “Perhaps.”

  “The recovery from surgery won’t be nearly as lengthy as you think. The doctors with whom I have been working are some of the greatest transplant surgeons in the world. They are standing by to ensure that you get the best care possible.”

  Anson drained his bottle, hoping for at least a little fortitude in the battle to convince Elizabeth that the medical indications for a transplant were not overwhelming, and the timing was poor.

  “I’ve had several good days in a row,” he tried.

  “I beg you to get honest with yourself. Just because you haven’t stopped in the middle of the day for therapy on a respirator doesn’t mean you’ve had a good day. Look at you now. You are an intellectual, a scholar, yet you don’t say half the things that are on your mind because you don’t have enough breath to get the words out.” Again she took his hand in hers. “Joseph, listen to me, please. The doctors at Whitestone have learned of a donor—a twelve out of twelve donor, Joseph—a perfect tissue match for you. It’s what we’ve been searching the world for. You will be on virtually no antirejection medication. That means no debility or side effects. You will be back here at work before you even know it.”

  Anson stared across at her. This was the first time a donor had actually been located, let alone one who was a virtually perfect tissue match. Elizabeth and the others with whom she had been consulting had just increased the ante in this high-stakes game.

  “How long have you had people looking for someone?”

  “Ever since we tissue-typed you and realized that your profile was unusual and rare.”

  Anson slumped back, shaking his head.

  “Where is this match?” he asked.

  “India. Amritsar, India. It’s in Punjab State, north and west of Delhi. A man lies on machines in the hospital there. He is brain-dead from a massive cerebral hemorrhage. His hospital wants to move forward with the harvesting of his organs, but we have begged them to wait.”

  Anson stood and walked across the room. The short distance strained his breathing, but, he rationalized to himself, the humidity was intense.

  “I can’t do it,” he said finally. “I just can’t. There’s work to do here and Sarah to notify and…and…”

  “Please, Joseph,” St. Pierre said firmly. “Please stop! If this is something you’re not ready to do, then that’s the way it’s going to be. Why don’t you go on back to your apartment and rest for an hour until afternoon clinic? I’ll cover for you here.”

  “O-okay,” Anson said, his tone almost a baby’s. “I’m glad you’re not angry with me.”

  “I’m worried for you, Joseph, and I’m worried for our Sarah-nine project, but I am hardly angry. Let me get the security guard to accompany you to your room. Would you like a wheelchair?”

  “No!” Anson snapped. As he turned away, a sudden wave of weakness and profound fatigue swept over him. “On second thought, maybe a wheelchair would be best,” he capitulated.

  By the time the guard entered the dining area and helped Anson into a wheelchair, his fatigue had intensified, and he was barely able to take in any air at all. He strained to breathe, but it was as if his mind had decided it could no longer be involved in such an effort. He tried to speak, to call for help, but no words emerged.

  The room was whirling as the guard wheeled the chair out the doorway and onto the path to the living quarters. Just a few feet into the journey, Anson realized his breathing had stopped altogether. The scene around him dimmed, then grew black. Helpless and rapidly losing consciousness, he toppled forward out of the chair, landing face-first on the gravel.

  The guard, a stocky man with massive arms, scooped Anson up as if he were a rag doll and raced back into the hospital crying for help. In seconds, the physician’s limp form was supine on a stretcher in the critical care room, and Claudine had readied the well-equipped crash cart. St. Pierre, a cool head in even the most dire medical emergencies, ordered a cardiac monitor, urinary catheter, and IV, then positioned Anson’s head chin up, and began inflating his lungs with a breathing bag and mask. One of the medical residents from Yaoundé offered to take over for her, but St. Pierre declined.

  “No matter how proficient you are, Daniel,” she said, “I will never trust your technique in situations such as this as much as I trust my own. Without this man, we are all lost. Check his femoral artery for a pulse. Claudine, prepare for me
to intubate. A seven-point-five tube. Be certain to check the balloon on it before giving it to me.”

  There was a momentary, silent spark between the two women, unseen by anyone else in the room.

  “He still has a pulse,” the resident said. “Faint at one-twenty.”

  “Help get the monitor running and see if you can get a blood pressure.”

  St. Pierre continued breathing effectively for Anson, whose color had marginally improved, although his level of consciousness had not. Claudine inflated the balloon used to seal the breathing tube in place inside the trachea and found it to have no leaks. Then, still as composed as if she were selecting fruit at the market, St. Pierre crouched at the head of the stretcher, had the resident hold Anson’s head steady in the chin-up position, set a lighted laryngoscope blade against her colleague’s tongue, and in just seconds, slid the tube between the delicate half-moons of his vocal cords. A syringeful of air inflated the balloon and sealed the tube in place.

  St. Pierre then replaced the mask on the breathing bag with an adapter that hooked to the tube, and breathed for Anson until the tube could be taped in place and attached to a mechanical respirator. With six people working so closely and intensely, the heat and humidity in the small room was staggering. Only St. Pierre showed no external signs of being affected, although once she removed her glasses and wiped them on the hem of her shirt.

  For fifteen minutes a tense silence held sway. There was no change in Anson’s appearance, but his vital signs steadily improved. Then, with obvious effort, Joe Anson opened his eyes.

  One by one, St. Pierre thanked her assistants and the nurses, and asked each to leave the room. Then she bent over the stretcher and positioned her face just a few inches from his.

  “Easy does it, Joseph,” she said when they were at last alone. “The heat and humidity were too much for you. You just had a complete respiratory arrest. Do you understand? Don’t even nod if you do. Just squeeze my hand. Good. I know that tube is uncomfortable. I’ll give you some sedation in just a few minutes. As long as the tube is in place, the danger of disaster is greatly lessened.