The Fifth Vial

by Michael Palmer

  “I have some friends in the tissue-typing lab, so I decided to call in a favor or two and have them do a rush job on her.”

  “And?”

  “She’s O-positive, which as you know already puts her in a reduced recipient pool. But there’s more. I just got the preliminary analysis of her twelve histocompatibility antigens. Many of them are rare—some very rare. The odds on finding a donor are long, and even if we are willing to cut some pretty big corners in terms of donor–recipient matching, she would require a lifetime of fairly high doses of antirejection drugs. We haven’t addressed the fact yet that in her mind, she’s blown the toxicity of the medications out of proportion, but her fears aren’t groundless either.”

  Millwood grimaced.

  “So where does that leave her?”

  “It leaves her,” French said, “squarely between a rock and an extremely hard place.”

  Eighteen

  We mean our guardians to be true saviors.

  —PLATO, The Republic, Book IV

  It would do something of a disservice to the jungle surrounding the Whitestone Center for African Health to say that it was ever quiet, but over the years, Joe Anson had noticed a strange, predictable lull in the white noise between three and three thirty in the morning. Over that specific span—not much more than thirty minutes, and not much less—the peepers, popillia and stag beetles, chimpanzees and other monkeys, bees and cicadas all seemed to quiet in unison. None of the Cameroon natives was willing to substantiate Anson’s observation, but he knew what he knew.

  On this particular early morning, he leaned against the bamboo railing outside his main lab, and listened as the cacophony from the blackness all about him began to fade. The air was rich with the scents of hundreds of different species of flowering plants, as well as curry, licorice, mint, and a myriad of other spices. Anson inhaled deeply, treasuring the act.

  Life following his transplant was as Elizabeth had optimistically predicted it would be. The surgery itself was hell, but he was heavily medicated for the two or three days afterward, so even those memories were vague. The only real problem his doctors encountered occurred in the immediate postoperative period. An epidemic of in-hospital infection with an often deadly bacterium caused them to transfer him precipitously out of Amritsar, and in fact, out of India altogether. He was flown, anesthetized and on a respirator, to a renowned hospital in his native Capetown, where the rest of his recovery was uneventful. Thanks to a virtually perfect tissue match with the donor of his lung, the amount of antirejection medication he was given initially and was still taking could be kept to an absolute minimum, thus greatly reducing the chance of infection from opportunistic organisms.

  If he knew how effective the procedure was going to be in restoring his breathing to normal, Anson admitted to anyone who would listen, he would have sought the transplant several years ago.

  “This is your favorite time here, isn’t it?”

  Elizabeth had materialized beside him, and now stood with her hands on the railing and her arm just barely touching his. Following the surgery, their relationship had more or less settled back to what it always had been—a deep friendship built on mutual respect, and constantly on the verge of burgeoning into a romance. It was a comfortable, secure place to be, and with Anson’s critical research so close to clinical acceptance, neither of them seemed anxious to cross the line.

  Anson reminded her about his belief surrounding the white noise of the jungle, and then pointed to his watch. For a time, the two of them stood there without speaking.

  “Listen, now,” he said finally. “Listen to how the sound begins to build. There, there, did you hear that? DeBrazza’s monkeys. They haven’t made a peep for half an hour, now here they go again. It’s like they are renewed from a brief siesta.”

  “I believe you, Joseph. You should document your observations and we will submit them to a zoological journal. Of course, there is the small matter of the research you must complete before you can do that.”

  He laughed.

  “I understand.”

  “The British and French drug agencies are poised to approve extensive clinical trials of Sarah-nine.”

  “Yes, that’s wonderful.”

  “The FDA in America is not far behind. You are on the verge of changing the world, Joseph.”

  “I don’t often allow myself the luxury of thinking of our work that way,” he said, “but I am pleased with what is happening here and at the Whitestone facility in Europe. Of that you can be certain.”

  “Have you been sleeping at all?”

  “No need. My energy is boundless. You and your surgeons, and of course, my magnificent donor, have given me a new life. Every breath had become such an effort. Now it is as if I am running without weights on my ankles.”

  “Well, please be careful, Joseph. Just because you have a new lung doesn’t mean you are immune to the ill effects of exhaustion.”

  “Just think of it, though. We have documented cures from forms of cancer that were thought to be incurable.”

  “I think of it all the time,” St. Pierre said.

  “And heart disease.”

  His ebullience was childlike.

  “As I said, my dear friend, your work is about to change the world. Pardon me for asking, but how much investigation do you think you have left to do before you turn your notes over to Whitestone?”

  Anson stared off into the darkness, a smile in his eyes, though not yet on his lips. Over the last two or three weeks he had been battling his eccentricities—possessiveness, perfectionism, and mistrust. It was time, he kept thinking—time to thank Whitestone and Elizabeth for setting him up with everything he needed to complete his work; time to thank them for the hospital and the many whose lives had been saved there; time to sit down with their scientists and turn over all the remaining secrets of Sarah-9, time to decide upon a new direction for his life.

  “You and your organization have been very patient with me,” he said, somewhat wistfully.

  “Then we can arrange a meeting with our scientists?”

  Anson did not answer right away. Instead, he looked up past the panoply at the sky, which had, in just a few minutes, gone from black to a rosy gray. Dawn was so beautiful in the jungle. It was time to cooperate with Whitestone, he acknowledged to himself. But he had another agenda that he wanted attended to first—an agenda that had everything to do with his being able to appreciate sunrise in the jungle.

  “Actually,” he said, “there is something I need from you first.”

  “Something we haven’t already provided for you?”

  “I know that may be hard to believe, but yes, there is one thing. I want to meet the family of the man who gave me back my life, and to help them financially in any way that I can.”

  St. Pierre did not respond right away. When she did, she spoke firmly.

  “Joseph, I hope you really do know and appreciate how tolerant and patient Whitestone has been with you.”

  “I do.”

  “We own world rights to Sarah-nine and anything else that comes out of this laboratory, yet we have allowed you to keep to yourself the methods and cell lines that you use. We know that most of the vats of yeast in your lab are not used in the production of the drug.”

  “And I am grateful for th—”

  “Joseph, please. Listen to me. The patience of the development people and board of directors at Whitestone is running very thin. Our protocols have been limited by the fact that all of the Sarah-nine we get for our research here and in Europe comes from you. You can say that you are supplying the drug fast enough, but that is simply not so. Every day of delay in getting this wonderful treatment onto the world market translates into millions of dollars lost. I know that you don’t care a bit about money, but think of the lives that are lost as well. We need to complete the circle, Joseph. We need the microbes and the source of the recombitant DNA, and we need your notes so that we can finish our clinical testing and begin mass producti
on. We promise that you will get full credit for having created Sarah-nine.”

  “You know that doesn’t matter to me.”

  “Joseph, I don’t really know what matters to you anymore. If what matters to you is getting the drug onto the market where it can help the many, many people who need it, then you need to take some action. It boils down to this. You want something more from Whitestone, and we wish something more from you.”

  “Be specific, please.”

  “Okay. Provided the widow of the donor of your lung approves, we will arrange for you to fly to Amritsar to visit her, and possibly her two children as well.”

  “And me?”

  “Upon our return from India, we shall fly a research team down here from England along with the equipment to bring your cell line back to our facility there. While they are here, you must go through your notebooks with them—not the dummy ones I know you have so meticulously created, just the real ones. We have paid and paid handsomely for this research, and it is time that we became the proprietors of it.”

  “You may disagree, Elizabeth, but I believe strongly that the secrecy I have maintained around my work is both justified and in everyone’s best interest. Since I have been solely in charge, things have been done my way, without the confusion of multiple captains, and also without the danger of espionage from the pharmaceutical industry. But I agree with you that it is time for the secrecy to end.”

  “So we have a deal, then?”

  “We have a deal.”

  “Thank you, dear Joseph. On behalf of the world, thank you.”

  St. Pierre embraced him, then brought his lips to hers and kissed him briefly but tenderly.

  “We have been through a lot together,” he said.

  “The end to this phase of our work is near. You should be very proud of what you have accomplished. I know that I am. Now it’s time for me to get a little rest. I am on the schedule at the clinic today. And so, as a matter of fact, are you.”

  “I’ll be ready,” Anson said, taking a deep, delicious breath.

  St. Pierre returned to her quarters, a single room and shower down the covered corridor from Anson’s suite. She was tiring of the small space and the mold that continually reappeared on the bathroom tile, and she stayed there as little as possible, preferring her elegant house, high on a verdant hill overlooking Yaoundé. Whether she’d stay in Cameroon or not after the Guardians’ use for Anson was done was still uncertain. Either way, she was due a bonus that would make her a wealthy woman, and stock options in the new Whitestone pharmaceutical company that would make her positively rich. Not bad for a few years’ work baby-sitting an eccentric, mistrusting genius.

  Using a private line, she called a number in London.

  “The deal’s been made,” she told an answering machine. “We bring him to India to visit the family, and he sits down with our people for the final transfer of his notebooks and cell cultures. I believe him. He’s always kept to his word, and there’s nothing in it for him financially that would cause him to hold back on us. Not that he cares about money, but the stock options he’ll get in Whitestone Pharmaceuticals should be enough to keep this place functioning indefinitely.

  “It has been a very long haul, but it is almost over. My biggest error when I started here was that I just never anticipated the depth of the man’s paranoia or the extent to which he would go to protect his work from the very people who were funding it. It is good that I have found ways to work around his madness and to encourage his genius. Try to push my darling Joseph, and he is just as likely as anything to push right back.”

  Nineteen

  The mind more often faints from the severity of study than from the severity of gymnastics.

  —PLATO, The Republic, Book VII

  Natalie wasn’t going to make it through the session and she knew it. It was stupid to have agreed to get back into physical and pulmonary therapy so soon after the ordeal of the fire. She checked the elapsed time on the treadmill clock and then glanced up at the one on the wall just in case the electronics had failed. Seventeen minutes at zero incline. This is bullshit, she thought. There was no sense in prolonging the charade. Her lung wasn’t working well. It was as simple as that. Rachel French could talk all she wanted to about healing burns and recovery of function, but it just wasn’t going to happen.

  Oh sure, Lefty, you’re going to be pitching real good again before you know it—just as soon as that ol’ missing arm of yours regenerates.

  “Come on, Nat,” her therapist urged. “Five more minutes. You’re doing great.”

  “I’m doing sucky, and you know it.”

  “You’re wrong. The pulmonary people tell me that your function tests have largely stabilized, and that there should be steady improvement in them for some time to come.”

  “Nobody in medicine ever predicts improvement,” Natalie snapped, pausing to get an extra breath. “In fact they usually go…out of their way to predict no improvement. That way they’ll either look smart and tuned in…or they’ll look like heroes when things do get better.”

  “You know, you’re not going to help yourself very much thinking negatively all the time.”

  “Correction,” Natalie said, flicking off the power. “I’m not going to help myself at all…. Thanks for your time…. I’ll call when I feel ready to come back.”

  She snatched up her warm-up towel and stormed from the unit, sensing the woman might actually be coming after her. She knew she was acting like a jerk, but in truth, she really didn’t care. She had accepted the tragic loss of her lung with grace and spirit, and a positive philosophy. But at the moment, even though her mother and niece were alive because of her, and cards were continuing to flood in, and testimonials were being planned, there simply didn’t seem to be enough grace or spirit remaining to undo what had been done.

  She sped home, half hoping that a cop would have the temerity and bad fortune to try to ticket her. Perhaps with time, her feelings of despair and self-pity would yield to a renewed sense of purpose and perspective. Meanwhile, somewhere, some mathematician who probably couldn’t get a job teaching in junior high was preparing to pull out his calculator to determine her lung allocation score.

  Let’s see, plus twenty-two and she limps along indefinitely, stopping every few feet to catch her breath. Plus twenty-eight and she gets to wait on tenterhooks for the privilege of taking poison that will blot out her immune system, and make riding in a public elevator a potentially lethal affair….

  Hermina, with two plastic bags of cleaning supplies at her feet, was writing a note to her at the dining table.

  “Hi, baby,” she said. “I didn’t expect you home so soon.”

  “Jenny here?”

  “She’s in the car. I was just getting set to drive her over to the new digs. I think we might sleep there tonight.”

  “That’s great, Mom.”

  “Honey, I’m really sorry for all this. I know you’re furious with me, and you have every right to be.”

  “Things happen. I’m just grateful you and Jenny are okay. If you’re feeling bad about what happened to me, you know what to do about it.”

  “I know, and so far I’m doing it.”

  “I hope so.”

  “You want to come over?”

  “Maybe tomorrow.”

  “The rehab therapy go all right?”

  “Terrific.”

  “Pardon me for saying it, but you don’t sound so terrific.”

  “I’m fine.”

  “Believe me, if I could turn back the clock and either stop smoking a year ago or just crawl into a closet during that fire and get burned up, I would.”

  “That’s nonsense. You’ve stopped smoking. That’s what matters. And now, I want you to stop saying you wish you had burned up. That doesn’t help anything.”

  “Nat, please, come help me fix up the new place.”

  “Mom, I’m fine. Really.”

  “Did they say you’re getting better?”
/>   “Yes, they did. Steady improvement, that’s what they said.”

  Clearly sensing the truth, Hermina put her arms around her daughter, and Natalie made some pretext of responding.

  “Baby, I’m sorry. I really am.”

  “I know you are, Mom.”

  “You sure there’s not anything—?”

  “I’m positive. I need to get some rest, that’s all.”

  “Well…I don’t want to leave Jenny sitting in the car too long. Do you think maybe you could come over later for dinner?”

  “No, no. I have some studying to catch up on after I nap.”

  “Thanks for the loan you gave us to get set up in the apartment. I’ll pay you back as soon as the insurance comes through.”

  “That’s okay.”

  “No, I really want to.”

  “Okay, Mom. Pay me back whenever you want.”

  Natalie stood for a time in the dining area even after the front door had closed. At some point she would surely end up in the shower, but she really hadn’t even broken a sweat in rehab. Finally, she pulled off her tee, threw it onto the floor, thought about putting on some music, then just sank heavily into the deep recliner in her living room. Across from her, just above the ornate marble mantel of her small gas fireplace, was a large, framed color photograph, remarkable for its composition, clarity, and detail. It had been taken by a professional at the Pan Am Games in Mexico City seven years ago, just as Natalie was breaking the tape at the finish of the 1,500 finals. Her arms, fists clenched, were extended skyward, and a true description of the sublime exhilaration on her face would have defied words.

  Never again. Not on the track. Not in the operating room. Probably not even in the bedroom, for chrissakes…. Never again.

  She reached across with her left hand and massaged the still-sensitive scar on the side of her chest. What did that song from M*A*S*H say? Suicide is simple? Suicide is painless? Maybe it was suicide is easy. Simple…painless…easy. Hardly words anyone would ever apply to pulmonary rehabilitation after burning up your only lung.