by Ben Mezrich
Emily nodded. “I remembered he had been put on steroids during the bout with pneumonia. He hadn’t had a problem with it then, so Dr. Bernstein said it wouldn’t be a problem this time either.”
Scully leaned back in her chair. She could hear Mulder’s shoes bouncing against the tiled floor beneath the table. The new information didn’t completely rule out the Solumedol—but it certainly made it less likely. Bernstein probably hadn’t mentioned the Solumedol to Detective Barrett because Stanton had been put on it before, without adverse reaction. Still, Scully knew that people could develop sensitivities at any stage in life. Insect bites, shellfish, peanuts—and steroids—had been known to kill people who had never had any problem with these things before. The Solumedol, though more improbable, was still a possibility.
“When you saw your father in the ER,” Mulder asked, changing tack, “did anything strike you as abnormal—either in his behavior, or his appearance?”
Emily shrugged. “He had that awful burn on his leg. And he was slipping in and out of consciousness. But when he was awake, he seemed normal.”
“And after the transplant procedure—”
“I never got a chance to see him after the procedure. I was in the waiting room when I heard what happened. I couldn’t believe it. I still don’t believe it.”
“Mrs. Kysdale,” Scully asked, “is there any history of mental disease in your father’s family?”
Emily was momentarily taken aback by the question. When she finally answered, she sounded cautious, as if she realized for the first time that she was talking to two FBI agents. “Not that I’m aware.”
Scully paused; as helpful as the young woman was trying to be, Emily Kysdale wasn’t going to help them understand the cause of her father’s violence. It was obvious from Emily’s sudden change of tone: in Emily’s mind, Perry Stanton was a victim, not a murderer. Scully could tell from the way Mulder was looking at her that he agreed.
Whatever the reason for his explosion, Perry Stanton was a criminal. The cause of Stanton’s act was only important insofar as it established culpability. Even if the cause remained a mystery, it would not change the facts of the case, or Scully and Mulder’s mission. Their job was to catch the perp who had killed Teri Nestor—and at the moment, the blame still lay solely on Perry Stanton.
“Mrs. Kysdale, do you have any idea where your father might be hiding? Anywhere the police may not know to look?”
Emily’s entire body trembled, and she clenched her hands around the foam cup of coffee in front of her. She lowered her head, then took a deep breath and seemed to regain some level of control. “They’ve been to his apartment, his office, all of his friends’ houses. They’ve scoured the university. They’ve looked everywhere he used to go—even the cemetery where my mother is buried. But I can’t help them find him—because the man who killed that nurse isn’t the man I know. My father isn’t the man they’re looking for.”
Scully felt a weight inside her chest, as Emily’s grief finally broke through her veil of reserve. Mulder had his reasons for empathizing with the woman’s pain—and Scully had her own. Her sister’s murder, her own father’s death. She knew what it was like to lose a family member—and that was exactly what had happened to Emily Kysdale. The Perry Stanton she knew was gone.
Scully reached across the table and touched the young woman’s hand. Then she rose, thanking her for her help. Mulder paused for a moment, watching the woman cry over her coffee. Then he followed Scully toward the elevator at the back of the cafeteria, which would take them up to the surgical ward—and Dr. Alec Bernstein. After the double doors slid shut, Mulder spoke softly. “I believe her, Scully. Her father isn’t the man we’re looking for.”
“What do you mean?”
“You heard what she said—he was normal when he was wheeled into the ER. He was normal even after he was given the Solumedol. But he wasn’t normal when he woke up after the operation. He should have been vulnerable, groggy, in pain; instead, he was capable of unbelievable violence, of a physical act we can hardly describe, let alone understand.”
Scully tried to see the expression on his face, but all she got was his profile. He finished his thought as the elevator slowed to a stop on the fourth floor—the surgical ward. “Scully, something happened during that transplant procedure to change Perry Stanton.”
Scully wasn’t sure what he meant. “Mulder, the temporary grafting procedure is nearly as common—and certainly as safe—as an appendectomy. And it’s mainly localized to the area of the injury—Stanton’s right thigh.”
But even as she said the words, a thought hit her. The transplant procedure involved Stanton’s thigh—but certainly, there was interaction with his bloodstream and his immune system. Perhaps Mulder had a point: It wasn’t impossible that Stanton had contracted something from the graft itself. She would have to review the literature—but she was certain she had heard about certain viral diseases being transferred in just such a manner. She believed there had even been cases of cancer being transmitted through grafts—specifically, lymphoma and Kaposi’s sarcoma. It was rare, but possible. The question was, what kind of disease could cause a psychotic episode?
“Something like meningitis,” Scully murmured, as the elevator doors opened. “Or even syphilis. Something that causes the brain to swell and affects the neurological system.”
“Sorry?” Mulder said.
“If the temporary graft had been infected with a blood-borne virus,” Scully explained, “Stanton could have contracted the disease through the transplant. There are many diseases that could lead to an explosion of violence.”
“Scully, that’s not what I meant. The violence was beyond the scale of any psychotic episode. Stanton didn’t just catch a disease—he transformed. Into something his own daughter wouldn’t recognize.”
Scully knew that the words were more than hyperbole; Mulder’s ideas were never limited by the laws of science. But Scully didn’t intend to let him lead her toward another of his wild fantasies. At the moment, this was a medical mystery—not a fantasy. This investigation was on her turf.
She stepped out into the surgical ward. “Sometimes, Mulder, transformation is the nature of disease.”
Scully peered through the glass window with genuine interest as Dr. Bernstein carefully navigated the laser scalpel across the surface of the patient’s exposed lower back. The tool was pen-shaped, attached to a long, articulated steel arm containing a series of specially made mirrors. The arm jutted out of a four-foot-tall cylindrical pedestal next to Bernstein. A pedal by his heel allowed him to control the strength and depth of the beam.
“Interesting juxtaposition,” Mulder said, his face also close to the window as he surveyed the small operating room. “A five-thousand-year-old art transcended by a five-year-old technology.”
Scully watched as the red guiding light traced the edges of the enormous tattoo in the center of the patient’s bared back. The red light shivered in the thin white smoke rising from the patient’s skin as the outer cells vaporized under the intense, pinpoint heat. The patient was awake, but felt no pain; a local anesthetic was enough to deaden the area of skin beneath the tattoo. In fact, the procedure could hardly be considered surgical. Aside from Bernstein and the patient, there was only one nurse in the small operating room, monitoring the patient’s blood pressure.
“I guess nothing is truly permanent anymore,” Mulder continued. “Anything can be erased.”
“It’s a tattoo, Mulder. Hardly the raw material for a philosophical analogy.” Scully controlled a wince as the laser seared away a beautifully drawn lion’s head, then moved backward through a flowing brown mane. She thought about the image on her own lower back: a snake eating its own tail, the result of a moment of whimsy in a Philadelphia tattoo parlor during a solo field trip a little over a year ago. Sometimes, she hardly even remembered the tattoo was there; other times, she found comfort in the idea that she had found the courage to do something so unlike her perceived exterior. She wa
s a skeptic—but never a conformist. That was another part of what made her and Mulder work so well together.
The procedure went on for another ten minutes; when Bernstein was finally finished, he looked up from behind his surgical mask and noticed Mulder and Scully on the other side of the viewing windows. He said something to the nurse, then shut off the laser scalpel and stepped away from the patient. As the nurse moved to wrap the sensitive area of skin in antiseptic gauze, Bernstein yanked his gloves off and crossed to the OR door. He pulled his mask down as he moved into the outer scrub room where Scully and Mulder waited.
“I’m guessing you’re not here for a tattoo removal,” Bernstein said, tossing his gloves into a nearby trash can as he crossed toward the double sinks at the other end of the rectangular room. He was a tall man, slightly overweight and balding, but with handsome features and remarkably sculpted hands. He was wearing surgical scrubs and matching green sneakers. “So how can I help you?”
“Sorry to interrupt, Dr. Bernstein. I’m Agent Scully, this is Agent Mulder. We’re here about Perry Stanton.”
Bernstein nodded as he ran water over his hands, carefully massaging his long fingers. Scully could see the troubled look in his eyes and the slight tremble in his round shoulders. “I’m not sure what I can tell you—beyond what I’ve already told Detective Barrett. Mr. Stanton was fine when I left him in the recovery room—and when I returned, he had already gone through the window. It was a horrid sight—something I don’t think I’ll ever forget. Or understand.”
Scully could sense the disbelief in his words. He reminded her of the many physicians she had known during her medical training; he didn’t quite know what to do with an experience beyond his expertise. Scully tried to make her voice as sympathetic as possible. “It’s certainly a mystery, one we’re working to understand. Along that line, I noticed that you ordered IV Solumedol to help Mr. Stanton’s breathing—”
“Yes,” Bernstein interrupted with a wave of his hand. “Detective Barrett called to ask me about the Solumedol after you spoke to her downstairs in the recovery room, and you’re right, I should have made it clear to her in the first place. Personally, I don’t believe the steroid had anything to do with his violent outbreak. He’d been put on similar steroids fairly recently—a bout with pneumonia, I believe it was three years ago. It’s extremely unlikely that he would have developed such a fierce allergy in such a short time.”
Scully nodded; she had asked the necessary question and had gotten the expected answer. The Solumedol still wasn’t ruled out, but as Bernstein had said, it was an extremely doubtful cause. They needed to search for other answers.
Mulder took the cue as Bernstein turned away from the sink and grabbed a towel from a rack attached to the wall.
“Dr. Bernstein, what about the grafting procedure itself? Do you remember anything abnormal about the operation? Anything out of the ordinary?”
Bernstein vigorously dried his hands. “I’ve performed hundreds of similar transplants. There were no hitches at all. The procedure took less than three hours. I cleaned up the burn, flattened out the donor skin, and stapled it onto Stanton’s thigh—”
“Stapled?” Mulder asked, his eyebrows raised. Scully could have answered, but she deferred to the plastic surgeon.
“That’s right. The device is very similar to an office stapler—except the staples are heat sterilized and made out of a specially tempered steel. Anyway, I stapled the skin over Stanton’s burn and wrapped the area in sterile gauze. I would have changed the dressing in three days—then removed the graft in about two weeks, when he was ready to accept a permanent transplant.”
Scully had explained the procedure to Mulder after reading about it in Stanton’s chart, but it was good for both of them to hear it again from the expert. After all, it had been a long time since Scully’s surgical rotation, and she had spent only a few months studying transplant techniques.
“So the donor skin is only temporarily attached?” Mulder asked.
“That’s right. The temporary graft isn’t matched to the patient—because it’s intended to be rejected after a period of a couple of weeks. Then we graft a piece of the patient’s own skin over the wound. In the meantime, the donor skin decreases the risk of infection, and it helps indicate when the burned area is ready to accept a permanent transplant.”
“If the temporary graft isn’t matched to the patient,” Scully interrupted, “what precautions are taken to make sure the graft isn’t carrying something that could infect the patient with a communicable disease?”
Bernstein glanced at her. She could tell from his eyes that he had already given this some thought. Stanton had been his patient—and as unfair and illogical as it seemed, he was partially blaming himself for what had happened. “Truthfully, very few—on my end. The skin is transported to us from the New York Fire Department Skin Bank; the bank is responsible for growing bacteriological cultures, and for checking the skin for viral threats. But they themselves are guided by the medical histories provided by the donor hospital. There are a million things to look for, and it’s impossible to cover every possibility. If a donor dies from something infectious, they don’t accept his skin. But if he dies from an unrelated cause—and happens to be carrying something, there is a chance that it will be passed on through a transplant.”
“A slim chance?” Mulder asked. “Or a serious risk? And could any of these transferred diseases affect a patient’s brain? Enough to send him into a violent rage?”
“I would call it extremely rare,” Bernstein replied, leaning back against the sinks. “But possible. For instance, undetected melanomas have been known to spread through transplant procedures. They grow downward through the dermis and into the blood vessels, then ride the bloodstream up into the brain. And certain viruses could jump through the lower layers of the epidermis into the capillaries; herpes zoster, AIDS, meningitis, encephalitis—the list is endless. But most of these diseases would have shown up in the donor patient. Such microbe-laden skin would never have been harvested in the first place.”
Not on purpose, Scully thought to herself. But people made mistakes. And microbes were often tricky to spot, even by trained professionals. A million viruses could live on the head of a pin—and viruses were extremely hard to trace, or predict. “After the procedure, did Stanton exhibit any symptoms at all? Anything that might hint at a viral or bacteriological exposure?”
Bernstein started to shake his head, then paused. “Well, now that I think about it, there was one thing. But I can’t imagine how it could be connected to such an outbreak of violence.”
He rubbed the back of his neck with his hand. “A small circular rash. Right here, on the nape of his neck. It looked like thousands of tiny red dots. I assumed it was some sort of local allergic reaction—like an insect bite, only a bit larger. I’m not a specialist, but I can’t think of any serious disease that presents like that.”
Scully wasn’t sure if the strange rash was connected—but she filed it in her memory. She was trying to think if there was anything else they needed from the plastic surgeon when Bernstein glanced at his watch, then let out a ponderous sigh. “I’m sorry, but I’ve got an emergency surgery scheduled to start in a few minutes. If you have any more questions, I’ll be in OR Four down the hall. And if there are any breakthroughs in the case, please let me know. Teri Nestor was a personal friend—but Mr. Stanton was my patient. I know it’s foolish, but I feel like I failed him somehow.”
He excused himself and exited the scrub room. When he was gone, Scully turned toward her partner. Though it was now well past one in the morning, she felt a new burst of energy. Based on what they had learned in the past few hours, she felt sure they were moving closer to solving the case. It was an intriguing difference in personality: Mulder grew electric when faced with a mystery—while Scully was excited by the prospect of a solution. “I think it’s pretty clear what we need to do next. While Barrett continues her manhunt, we have to track down the do
nor skin and find out if it was infected with anything that could have caused Stanton’s violence. And we have to act quickly—we don’t want any more of that harvested skin ending up on other patients.”
Mulder didn’t respond right away. Instead, he moved to the sink. Bernstein had left the faucet loose, and a stream of drops spattered quietly against the basin. Mulder reached forward and held his palm under the stream. “Scully, do you really think a virus can explain what happened in that recovery room?”
Scully paused, staring at the back of his head. They had both seen the same evidence, participated in the same interviews—but it was obvious their thoughts were moving in two different directions. As always. “Absolutely. Dr. Bernstein corroborated my theory. It’s possible that Stanton caught something from the graft—something that could have affected his brain, and his personality. Once we track down the graft, we’ll be able to find out for sure. And then we’ll know how to deal with Stanton when we find him—and what precautions Barrett’s officers need to take in bringing him in.”
Mulder shut off the sink and dried his hand against a towel from the rack. “A microbe, Scully? That’s how you want to explain this?”
“You have a better explanation?”
Mulder shrugged. “Whenever doctors run into a mystery they can’t explain, they blame a microbe. Some sort of virus or bacteria, something you can see only through a microscope—or sometimes not at all. If you ask me, it’s a convenient way of thinking. It’s a scientist’s way of pretending to understand something completely beyond his grasp.”
“Mulder,” Scully interrupted, frustrated, “if you have a better plan of action, I’m listening.”
“Actually, I agree with you, Scully. We need to track down that graft. We need to find out what changed Perry Stanton into a violent killer. But I’m not so sure we’re going to need a microscope to find what we’re looking for.”
Scully watched as he moved toward the door. “What do you mean?”
