The Killing Harvest

by Don Donaldson

  She pulled up at a stop sign and checked the intersecting street in both directions. As she was about to make a left turn, a horn sounded lightly behind her. Looking in her mirror, she saw Metcalf’s truck. He got out and came to her window, which she opened.

  “I did have one other thought,” he said, bending down.

  Once more enveloped in his cologne, Sarchi said, “What was it?”

  “That I’d like us to spend some time together.”

  “Unofficially, you mean?”

  “I believe it’s called a date.”

  “When?”

  “When’s your day off?”

  “Tomorrow.”

  He grinned. “It just happens I’m free. How about I pick you up at eleven thirty? We’ll have lunch at a place I know, then I want to show you something and ask your opinion.”

  “We aren’t talking about a medical problem, are we?”

  “I wouldn’t do that to you. It’s something else.”

  “Now I’m curious.”

  “Then my work here is done. Eleven thirty tomorrow. Dress for hiking.” He winked and returned to his truck.

  She made her turn and watched him in the mirror as he proceeded through the intersection and disappeared.

  Reflecting on how much the prospects for her day off had improved, a word in capital letters suddenly flared in her mind. PRIMERS. She’d forgotten the primers Sharon had sent. Damn. She turned into the next driveway and headed back home.

  Her two talks with Metcalf and the trip back to get the primers made her ten minutes late to work. In the spare moments when her hospital rounds did not require her full concentration, she thought about Metcalf and the primers, in that order. Then, as the morning wore on and her appointment with Lanza to give him the primers drew closer, her thoughts began to dwell on Latham and the reality that, except for the primers, she had no idea what to do next in that regard. What she needed was access to more of Latham’s patients. But how could she get the names? Her anonymous e-mail contact was apparently not going to communicate again.

  A little after nine o’clock she saw Harry Bright coming her way in the hall. Her first reaction was to duck into the restroom, but then she was struck by an idea. Bright’s company was huge. Drew couldn’t have been the only patient they’d sent to Latham. But why should Bright give her the other names?

  She caught his eye about ten feet before they passed and held it until they were close enough to speak. “Hello, Harry. Could I have a word with you?”

  “What about?” Bright said, his manner guarded. “The last time we talked, it seemed like you couldn’t wait to get away from me.”

  “I was just busy. I’ve been thinking about your request for a racquetball game, and I’ve decided to accept your challenge. But there’s a condition.”

  “What’s that?”

  “Let’s get out of the traffic.”

  She led him to a corner behind a building support and in hushed tones said, “If I win, you give me the names and addresses of all the patients your company sent to a clinic in New Orleans operated by a Doctor George Latham.”

  “I can’t do that.”

  “Sure you can. You wouldn’t be breaking any laws. Besides, you aren’t going to lose, remember. If you don’t lose, you don’t have to do anything.”

  “I can’t help you. And I don’t want to play anymore anyway. I have to go.”

  He turned and walked quickly away. Sarchi was surprised by Bright’s reaction. She’d expected him to be reluctant to give her the names, but had felt sure that she could at least goad him into playing. Then, when he lost, which he surely would, she could shame him into paying off. Shows how much she knew about men.

  As Harry steamed away from Sarchi, his heart raced—she was the last person he’d wanted to run into.

  A little after ten o’clock, while Sarchi was writing up her observations on a seven-year-old with a case of impetigo that had progressed to cellulitis, Kate McDaniels walked up to the nursing station.

  “Did you see Melissa Arnold this morning?” she asked.

  “Around nine o’clock, why?”

  “Did you write up your visit?”

  “I ordered her albuterol increased and made a few notes about chest sounds.”

  “You’re sure?”

  The question caught Sarchi by surprise. “Of what?”

  “That you wrote her up.”

  “My notes were the first on a new page. What’s going on?”

  “I just saw her,” Kate said, “and there are no entries for this morning.”

  “Did you check with the nursing staff?”

  “No one up there has it.”

  “When you picked the chart up was it red-flagged?”

  Kate slowly shook her head. “No.”

  “One of the nurses must have entered my orders in the computer and misplaced the page.”

  “There were no orders in the computer.”

  “Then I have no explanation.”

  “I followed up, so there’s no harm done. But we can’t have this kind of thing going on.”

  “I agree.”

  Kate’s choice of words suggested that she blamed Sarchi for the mix-up. Before Sarchi could respond, Kate excused herself to check on some of the other patients on her service.

  Unwilling to believe that her entries for Melissa Arnold were not in the book, Sarchi finished her notes on the impetigo case and went up to six west to see Arnold’s chart for herself. She found the chart in the rack and opened it to the first page of progress reports, which were in reverse chronological order with the newest entries on top. The first page was full. At the bottom was the note she’d added yesterday. Thinking that her entry for today might have somehow been misplaced in the book, she thumbed through all the progress reports.

  Not there.

  She leafed through it all, page by page.

  It simply wasn’t there.

  Sarchi questioned the floor staff about the missing page but found no one who knew anything about it. Yet another thing to distract her from her work.

  At one o’clock, she grabbed a sandwich at the hospital cafeteria, then set out for Carl Lanza’s lab at the university. Fifteen minutes later, she found him sitting at his inverted microscope studying the contents of a plastic tissue culture dish so intently he didn’t realize she was there.

  “Are they doing what you want?” she said.

  He looked up. “Sarchi . . . hi. Are they ever. Have a look.” He yielded his rolling chair to her. “The focus control is right here,” he said, touching a ridged silver knob at the back of the instrument.

  Sarchi nodded and leaned into the eyepieces.

  Her eyes were different enough from Carl’s that she had to touch up the focus before she saw hundreds of ghostly pancakes with branching processes spread over the bottom of the dish. She turned to Carl. “They look happy.”

  “You saw the processes?”

  “Nerve cells, right?”

  “Yes, but yesterday they weren’t.”

  “What were they?”

  “You got a few minutes to hear this?”

  Considering the big favor he was doing her in agreeing to sequence Latham’s primers, she couldn’t very well say no. Besides, Carl was virtually an encyclopedia of interesting and potentially useful information, so if he thought something was worth conveying, she was always ready to listen.

  “Educate me.”

  “First, a little background. You know how we were taught that the brain is an immunologically privileged site, and bits of brain tissue can be freely exchanged between subjects without worrying about graft rejection?”

  Sarchi nodded.

  “It’s not true. Grafts between unmatched subjects definitely provoke an im
mune response, partly because injury to the graft cells stimulates them to upregulate antigens the host doesn’t recognize. I believe that’s one reason why attempts to treat Parkinson’s with grafts from aborted fetuses aren’t more effective.”

  “They don’t use matched donors?”

  “It’s not feasible. Fetal brains are so small, it takes ten abortuses to produce enough cells for one Parkinson’s patient. So even if you wanted to use tissue-matched cells, you’d have a helluva time getting enough of them.”

  “What about antirejection drugs?”

  “Some groups use them, but it doesn’t seem to help the final outcome. And you’ve got the additional disadvantage of having an immunecompromised patient on your hands who could die any time of some opportunistic infection. Even without worrying about compatibility matching, fetal tissue is so hard to get it takes a while to accumulate enough to work with. And how do you hold the tissue you have while waiting for more?”

  “Freeze it?”

  “Exactly. Which I believe damages the cells and makes success even more remote. In addition, fetal cells don’t have the same metabolic machinery as postnatal cells, so they don’t integrate well into the host brain. But I’ve got the answer.”

  Sarchi didn’t know much about this subject, but it was clear to her that if Carl really did have the answer, he’d soon be world famous. And she hoped he did, for the sake of all those faceless sufferers of Parkinson’s, but mostly for little Stephanie Stanhill, who, because of Latham’s incompetence, likely had the disease in her future. The thought of Stephanie put the discussion on such a personal level that Sarchi couldn’t wait to hear Carl’s solution.

  “And that answer is . . . brain marrow.”

  “I never heard of that.”

  “No reason you should have. I only made up the name five minutes ago. All the cells you see in the dish were grown from a small number of special cells that lie in the area adjacent to the brain ventricles. The cells are special because even in adults they’re still embryonic, each one a blank slate waiting to be written upon and, unlike nerve cells, they still have the capacity to divide. We grew the original small number of cells into thousands, then treated them with a mixture of growth factors that turned them into nerve cells. So those few cells we started with can be made to act like stem cells, becoming an inexhaustible supply of new neurons, the same way stem cells in bone marrow make new blood cells. And being from an adult brain, they’ve got the adult metabolic machinery.”

  “Jesus,” Sarchi said. “I see where you’re going with this. Take a few embryonic cells from someone’s brain, grow them into thousands, turn them into neurons, then put them back into the same brain to replace any dead or damaged cells.”

  “That’s the plan.”

  “And humans have these cells?”

  “Those cells you looked at are human.”

  “Someone let you go into their brain to get them?”

  “In treating epilepsy, it’s sometimes necessary to remove small regions of the patient’s temporal lobe. We have an arrangement with the epilepsy center to send us the excised tissue. That’s where they come from.”

  “Carl, if you’re right, this will be big.”

  “I know.”

  “How long before something like this could be available for clinical trials?”

  “Not soon—ten years maybe, if we work hard, have a lot of luck, and NIH doesn’t cut our funding.”

  “Could these cells cure other brain diseases besides Parkinson’s?”

  “Quite possibly.”

  The thought that even if Stephanie Stanhill’s ballismus and Drew’s yawning tic didn’t clear up by themselves, there might eventually be a treatment for such disorders—one that might even benefit human vegetables like Gilbert Klyce—helped shore up the damage these cases had inflicted on Sarchi’s confidence in her profession. That her friend Carl was working on something so important raised her already-high regard for his abilities.

  “Why haven’t I heard that you were working on this before now?”

  “Didn’t know until today that we could make the cells differentiate into neurons.”

  The potential significance of Carl’s new line of research made Sarchi feel guilty about asking him to dilute his efforts on that to sequence Latham’s primers, especially since she had no real reason to believe anything important would come of it. In fact, her whole campaign against Latham suddenly seemed like a gnat attacking a 747.

  What was she thinking? She didn’t have the resources to take on somebody like Latham. It would be a far better use of what extra time she had to find a job.

  “Now, where are those primers?” Carl asked.

  “Are you sure you still want to work on them?” Sarchi asked. “Maybe with those new results, you won’t have time.”

  “For you, we make the time.”

  With her resolve to bring Latham to earth teetering, Sarchi thought about just leaving and taking the primers with her. But what about Sharon? What would she tell her? That she’d put her to all the trouble of getting the primers for nothing? That she hadn’t even bothered to have them sequenced? It didn’t seem right.

  In the end, she reached in her bag and gave Carl the primers. Thankfully, he was so eager to get back to his work that he didn’t press her for any details about their origin. She left feeling as though she’d abused their friendship.

  Upon her return to the hospital, Sarchi went to the library to work on a presentation of osteomyelitis she was to give on grand rounds the following day. She was deep into an article on the subject when Kate McDaniels pulled out the chair next to her and sat down.

  “Now what?” Sarchi said. “Did that chart page turn up?”

  Kate looked at her without speaking.

  “Apparently not,” Sarchi said.

  “Sarchi, I think of myself as more than your supervisor. I’ve always felt we were friends.”

  The ominous ring to this put Sarchi on edge. “This doesn’t sound good.”

  “If you’re having problems of any kind, I hope you feel you can come to me with them.”

  “What are we talking about?”

  “It wouldn’t go beyond me. We could keep it just between us. In fact, if you’d like to discuss anything, we could go to my office right now.”

  “Why are you telling me this?”

  “First, there was that incident this morning.”

  “Which I had nothing to do with.”

  “Now, I was just upstairs reviewing Kelly Miller’s chart.”

  “The cellulitis case.”

  “And I found your entry for today to be extremely inadequate. And that’s not like you. So what’s wrong?”

  “Inadequate? I don’t see how.”

  “There’s barely anything there.”

  “Show me.”

  They left the library and went up to the ward in question, where Kate pulled out Kelly Miller’s records, turned to the progress reports, and handed the book to Sarchi. The top page of the chart was full, with the first two sentences of Sarchi’s entry for today at the bottom.

  “There should be another page,” Sarchi said. “Look, my entry ends in the middle of a sentence. Why would I stop in mid-thought?”

  “That’s what I was wondering.”

  “There was another page.”

  “Where is it?”

  “Maybe with the other one we can’t find.”

  “This hasn’t happened to anyone but you.”

  “So you think I’m losing my mind?”

  “I didn’t say that. Maybe you’re just distracted by something.”

  “I’m not distracted.”

  “Then what’s going on? You think someone is stealing your charts?”

  “What other explanation is there?�
��

  “Who would that be?”

  “That’s the big question, isn’t it?”

  19

  HARRY BRIGHT SAT at his desk picking at the corner of the manila envelope containing the two charts he’d lifted from the children’s hospital the day before. Despite the impression he gave most people, he was not a complete asshole. He felt a twinge of regret knowing he’d probably made trouble for Sarchi. But Jesus, ten Gs. How could he pass that up? Still, he felt like making amends to her. But how to do it without arousing her suspicions?

  Then he thought of a way.

  He made an entry on his keyboard and waited for his computer to load the file. When that was done, he made another entry to call up the appropriate subfile. He then printed out the data and added a note at the top. He folded the paper and put it into a white envelope on which he wrote Sarchi’s name and hospital.

  Suddenly, the door burst open, and Bob Kazmerak, the other Memphis rep, blew in.

  “Kazmerak is here,” he bellowed. “Now there’ll be some work done.” He chuckled, amused as hell at himself.

  The office was small, and when Kazmerak was in it, Harry felt like he was in Pamplona or wherever the hell it is in Spain they release the bulls in the streets. And the guy farted all the time, silent little greasers that made Harry do as much of his work as he could at home or at the various hospitals he prowled. To cover his loss of hair in front, Kazmerak combed what remained forward, which fooled exactly nobody and make him look like a retard. The only thing that made the guy halfway tolerable was his affection for the River Kings.

  “Hey, you ought to see my new car,” Kazmerak said. “I got a built-in GPS. You put the address you want into the system, and it not only shows you how to get there, but a nice soft female voice tells you where to turn. I’m tellin’ you man, we’re livin’ in the future.”

  “We’ve had that feature in cars since they were invented,” Harry said.

  Kazmerak’s face morphed into a frown. “What do you mean?”

  “They’re called wives.”