The Fifth Vial

by Michael Palmer

  He had read and reread Beth Mann’s two-hundred-page report on Natalie Reyes, her family, and even on the new man in her life. He had studied the numerous articles, dating back to Natalie’s days as a student athlete at Harvard. He had watched videos of several of her races. And finally, he had walked beside her, close enough to brush her sleeve.

  Oh, yes, the time was absolutely right.

  Natalie Reyes, and possibly Ben Callahan as well, were perfect to oversee the bringing in of new management for the hospital, and to control the fate of Sarah-9. After she recovered from the surgery, she—and if she wanted, Callahan—would be summoned to his attorney’s office to receive his notebooks and a detailed DVD he had recorded for her.

  She would be under no obligation to stay in Cameroon indefinitely, but he suspected that once she breathed the wonderful air of the jungle and met the people, she might want to. She and Callahan were everything the would-be philosopher kings of Elizabeth’s and Douglas Berenger’s sad organization were not. They were true Guardians.

  Anson flicked on the inside light and checked the time. Then he opened the notebook on his lap and read aloud.

  “The world can be hard, full of trickery,

  Full of deceit,

  Full of injustice,

  Full of pain.

  But there is an emptiness waiting, my friend—a great,

  glowing emptiness,

  Soft and fragrant with the essence of peace,

  The essence of serenity.

  You are almost there, my friend.

  The magnificent emptiness is the eternal harbor for your

  soul.

  Take my hand, friend.

  Take my hand and take a step, just one more step,

  And you are there.”

  Anson lifted his cell phone and dialed.

  “Ms. Mann,” he said, “you may start timing now.”

  Without waiting for a reply, he set the phone aside, shut off the light, turned on the ignition, and placed his notebook down on a well-worn copy of Plato’s Republic.

  Author’s Note

  My goal in writing suspense is first and foremost to entertain my readers and to transport them, however transiently, from the stresses and cares of their lives to the highly stylized world of the novel. My secondary goals are to inform and to present, without resolution, issues of social and ethical importance.

  I sincerely hope you have found The Fifth Vial thrilling and provocative entertainment. Now, I thank you for taking time to read this afterword note and for discussing its contents with your loved ones. It deals, as you would suspect, with organ donation, and the importance of your participation in an act that I feel defines humility and righteousness—that is, making your organs available to others in the event of your scientifically diagnosed, documented, and redocumented brain death.

  The subject might not be fun to think about, but it is crucial.

  Almost every one of us would opt for a transplant to save our life or that of a loved one. Acknowledging that fact, it is nearly impossible to believe that the vast majority of us haven’t registered to be donors in the event that illness or trauma renders us clinically dead—that is to say, irreversibly brain-dead according to the most sophisticated neurological testing available to physicians. Thousands of potential recipients currently wait for an organ. Many of them will die before one comes available. During that time, countless organs will have been lost to the casket or the flame simply because proper arrangements had not been made in advance.

  The organs and tissue donated by just one person can improve or save the lives of up to fifty others.

  Fifty!

  It costs nothing to be a donor, and can add meaning and majesty to what is otherwise a sad, confusing, tragic inevitability.

  Becoming a potential organ donor is as simple as indicating your intent on your driver’s license, or carrying an organ donor card, or contacting your state or national donor registry, or merely discussing your desire with your family members.

  Here are some brief answers to frequently asked questions:

  Who can be an organ donor?

  People of all ages and medical histories should consider themselves potential donors.

  What organs and tissues can I donate?

  Organs that can be donated include heart, kidneys, pancreas, lungs, liver, and small intestine. Tissues that can be donated include corneas, skin, heart valves, tendons, and veins.

  Can I sell my organs?

  No. Federal law makes it illegal to sell organs and tissues as such buying and selling might lead to inequitable access, with the wealthy having an unfair advantage.

  Does the donor’s family have to pay any part of the cost of donating an organ or tissue?

  There is no cost to the donor’s family or estate for organ and tissue donation.

  If I am a donor, will that affect the quality of my medical care?

  If you are sick or injured and admitted to the hospital, the number one priority is to save your life. Organ and tissue donation can only be considered after you die.

  Will organ donation disfigure my body?

  Donation does not disfigure the body and does not interfere with having a funeral, including open-casket services.

  Can I be an organ donor if I have a preexisting medical condition?

  Your medical condition at the time of death will be assessed by medical professionals to determine what organs and tissues can be donated.

  The Internet is a valuable place to get more in-depth answers to these and other questions, and to further separate myth from fact regarding organ donation and transplantation. Listed below are a few Web sites you will find helpful in this regard. After having your questions answered and your misgivings assuaged, I hope you will feel ready to do the right thing.

  With thanks and warmest wishes,

  Michael

  United Network for Organ Sharing, www.unos.org

  U.S. Department of Health & Human Services, Organ Donation Initiative, www.organdonor.gov

  National Marrow Donor Program, www.marrow.org

  National Minority Organ Tissue Transplant Education Program, www.nationalmottep.org

  New England Organ Bank, www.neob.org

  Donate Life America, www.shareyourlife.org

  American Kidney Fund, www.kidneyfund.org

  American Lung Association, www.lungusa.org

  American Liver Foundation, www.liverfoundation.org

  American Organ Transplant Association, www.a-o-t-a.org

  And finally…

  Organ Guard, Professor Alice Gustafson’s watchdog agency depicted in this novel, was inspired by Organs Watch, an independent university-based research and medical human-rights project designed to monitor justice and fairness in organs procurement and distribution. Organs Watch documents the global traffic in human organs and tissues; identifies medical human-rights violations and abuses in the procurement and transplantation of organs and tissues; and works with medical, governmental, and international entities concerned with ethics and safety in organs procurement and transplant. For more information on ways you can get involved with and/or support this project, please contact:

  Nancy Scheper-Hughes, Ph.D.

  Director, Organs Watch

  Medical Anthropology Program

  University of California, Berkeley

  305 Kroeber Hall

  Berkeley, CA 94720

  nsh@berkeley.edu

  sunsite.berkeley.edu/biotech/organswatch/

  Also by Michael Palmer

  The Sisterhood

  Side Effects

  Flashback

  Extreme Measures

  Natural Causes

  Silent Treatment

  Critical Judgment

  Miracle Cure

  The Patient

  Fatal

  The Society

  Acknowledgments

  The friends, family, and resources set down on this page are not listed in order of importance…except for the first two.


  Jane Berkey, founder of the Jane Rotrosen Agency, has been the guiding force in my writing for more than twenty-five years.

  Jennifer Enderlin, my editor at St. Martin’s Press, has shepherded The Fifth Vial through its creation, evolution, and publication without ever losing sight of my vision for the book.

  Thanks also to:

  Sally Richardson, Matthew Shear, George Witte, Matt Baldacci, and everyone else at St. Martin’s Press.

  Don Cleary, Peggy Gordijn, and the gang at the agency.

  Eileen Hutton, Michael Snodgrass, and their crew at Brilliance Audio.

  Matt Palmer, Daniel James Palmer, and Luke Palmer. It would be sweet someday for all of us to meet on the Times list.

  Drs. Joe Antin and Geoff Sherwood, readers Robin Broady, Mimi Santini-Ritt, and Dr. Julie Bellet, private investigator Rob Diaz, and firefighter Cindi Moore.

  Bill Hinchberger of BrazilMax.com, “the hip guide to Brazil,” and humorist Alexandre Raposo.

  Professor Nancy Scheper-Hughes, founder of Organs Watch and director of the medical anthropology program at the University of California, Berkeley.

  Various experts in organ donation, who have asked to remain anonymous.

  Bill Wilson of East Dorset, Vermont, and Dr. Bob Smith of Akron, Ohio. I suspect that you fellows know why you’re being included here.

  READ ON FOR AN EXCERPT

  FROM MICHAEL PALMER’S NEXT BOOK

  THE FIRST PATIENT

  AVAILABLE NOW FROM

  ST. MARTIN’S PRESS

  The rotors of marine one slowed, then stopped. Dust clouds billowed into the still air, then settled quickly. A minute later, a second identical helicopter landed twenty yards away. A short staircase was lowered to the parched ground. A Marine sergeant in formal dress left the shelter of the first chopper and took a position at attention at the base of the staircase. The door of the chunky Sikorsky Sea King swung open.

  And with no more fanfare than that, the most powerful man on earth, his ubiquitous, well-publicized dog at heel, stepped out into the warm Wyoming evening.

  Fifty feet away, still in the saddle, Gabe Singleton calmed his horse with a few pats behind the ear. The mid-morning appearance of a Secret Service agent at the Ambrose Regional Medical Center had given him warning that the presidential drop-in was going to take place, but the man hadn’t been specific about the time, and, following an exhausting all-nighter caring for two patients in the ICU, even a visitor of this magnitude couldn’t keep Gabe from his customary ride out into the desert and back.

  “Hey, cowboy,” President Andrew Stoddard called out, descending the stairs and sincerely saluting the lone Marine as he passed, “whattaya say?”

  “I say you and your choppers scared the crap out of this world-weary old nag…. Frightened my horse, too.”

  The two men shook hands, then embraced. Stoddard, whom Gabe felt looked presidential even when they were first-year roommates at the Naval Academy, showed the stress of three and a half years in office in the silver highlighting his razor-cut dark brown hair and in the deep crow’s feet at the corners of his iridescent blue eyes. Still, he was every bit the man in charge—the decorated Desert Storm pilot and former governor of North Carolina, whose star had been on the ascendancy since the day he took his first privileged breath.

  “One of the downsides of the job,” Stoddard said, gesturing toward his entourage. “Twin helicopters so that any wacko who decides to take a bazooka shot at one of them has only a fifty-fifty chance of blowing me away; Secret Service studs checking out every inch that’s gonna be stepped on by these size elevens and every toilet seat that’s gonna be graced by these presidential cheeks; plus a medical team trained to know that it’s not if something terrible happens to their boss, it’s when.”

  “If you’re looking to make a job change, I could use a wrangler on my ranch.”

  “How many do you have working for you now?” Stoddard asked, glancing about.

  “You would be the first. I’m afraid our benefits package is a little thin, too, starting with that you’d have to pay me to work here.”

  “Hey, put me on the list. I don’t know if you follow the polls or not, but I haven’t got a hell of a lot of job security at the moment. Got some time to talk with an old pal?”

  “If you’ll let me put my other old pal Condor, here, in the stables.”

  “Fine-looking horse.”

  “And that’s a fine-looking pooch. Liberty, right?”

  Gabe patted the dog’s rock-solid flank.

  “Good memory,” Stoddard said. “Liberty’s making quite a name for himself, tagging along with me and changing people’s misperceptions about pit bulls, just like we’re changing people’s misconceptions about America. I’ve had dogs all my life, Gabe, but Liberty, here, is the best. Strong as a tiger, wise as an owl, and as gentle and dependable as that horse of yours.”

  “Maybe you should have named him Simile.”

  The president laughed out loud.

  “I love it. This here’s my trusty dog, Simile. He’s tough as a Tennessee hickory nut, but gentle as baby powder. Carol will think that’s very funny, too, especially since, unlike her husband, she’s actually likely to know the difference between a simile and a metaphor. Hey, Griz,” he called out.

  A thick-necked, barrel-chested, balding Secret Service man wearing the obligatory black suit and reflective shades seemed to materialize from nowhere.

  “You rang?”

  “Griz, this is my old college roomie, Gabe Singleton. Doctor Gabe Singleton. It’s been five years or so since we last saw one another, but it seems like yesterday. Gabe, this here’s Treat Griswold, my number-one protector and probably the number-two man in the whole Secret Service. Obsessive to a fault. Swears he’s telling the truth when he says he’ll take that proverbial bullet for me, but with that crooked smile and those beady little eyes of his, I just don’t believe him.”

  “In that case, sir, you’ll just have to wait and see,” Griswold said, stopping just short of pulverizing the bones in Gabe’s hand at the same time. “I’ll be happy to get Condor settled in, Doctor. I used to muck out stables and ride warm-ups when I was a kid.”

  Gabe liked the Secret Service agent immediately.

  “In that case you’ve come a long way,” he said, handing over the reins. “Tack room’s in the barn. Maybe we can go for a ride sometime.”

  “Maybe we can, sir,” Griswold said. “Come on, Liberty, let’s put this big ol’ fellow to bed.”

  Stoddard took Gabe by the arm and led him to the back door. The house, seven rustic rooms that still had the feel of the cabin it was before some additions, was Gabe’s cut from the end of his five-year marriage to Cynthia Townes, a bright, vivacious nurse from the hospital, who had loved him to pieces from day one to day last. Her mistake.

  Cinnie’s last words to him before she handed over her keys and took off for a teaching job in Cheyenne were to beg him to finish dealing with his past before he made any further attempts to build a future with anyone. For seven more years he had taken her at her word, and so had carefully avoided another in-depth connection. He might be done dealing with his past, but he had serious doubts it was ever going to be done dealing with him.

  “Sorry I haven’t gotten out here for so long,” Stoddard said. “I used to really enjoy the evening rides and our fishing trips up into those mountains.”

  “The Laramies. There’s no place on earth quite like them. But stow the apologies, matie. From what I’ve heard, you’ve had a few other things on your plate—like saving the world.”

  Stoddard grinned wistfully.

  “It’s a little bigger job than I once thought,” he said, settling in at the round oak table in the kitchen, “but I still intend to make a dent in it.”

  “I remember you talking like that during our first or second night of bar-hopping together at the Academy. I kept trying to stay cynical and believe that you were an idealistic jerk, but this little voice inside me k
ept saying that this was a guy who might actually be able to do it. Then, when you drank me under the table, I really decided to give you the benefit of the doubt.”

  “That was beginner’s luck, and you know it. You must have had a virus or something.”

  “Speaking of which, it should come as no surprise that I can’t offer you a beer, but I can brew you some coffee, or—or some tea.”

  “Tea would be great,” the president said, placing a manila folder in front of him. “While I’m in apology mode, sorry I couldn’t make it in for your dad’s funeral. I appreciated your letting me know he had passed.”

  “And I appreciated that you would take the time to call from South America.”

  “Your dad was a bit…quirky, but I always did like him.”

  “He was very proud of you, Drew, you being a fellow Annapolis grad and all.”

  The instant he spoke the words, Gabe wished he hadn’t. Cinnie’s pleas notwithstanding, he had done what he could to deal with Fairhaven and his father’s reaction to it. He hadn’t meant the statement to come out the way it did.

  “I’m sure he was very proud of you, too, Gabe,” Stoddard said, a bit uncomfortably, “what with your MD degree and all those medical missions you’ve been on, and that youth foundation you’re running.”

  “Thanks. Hey, speaking of sires, how’s yours doing?”

  “Same old LeMar. Still trying to micromanage everything, including me. He tells me he’s bought his way onto a Russian space shot. Fifteen million and he becomes the first seventy-five-year-old to soak his hemorrhoids in the international space station tub.”

  “Fifteen million. God bless him.”

  “Hey, come on. When we’re talking about my father, it’s like Monopoly money. Just do the math. The ten billion or so he’s worth minus the fifteen million or so he spent is—um—take away three, carry the one—still ten billion or so. I wouldn’t be surprised if he paid in cash with bills he pulled out of his sock drawer.”