Table of Contents
Title Page
Dedication
Praise
Prologue
I - Winter
Chapter 1
Thirteen Months Later New York City Hospital
Chapter 2
Chapter 3
Chapter 4
The Eve of the Third Millennium Rodez, France
The Plaza Hotel, New York
Chapter 5
Chapter 6
Five Weeks Later, Tuesday, February 29, 2000, 1:00 A.M.
II - Spring
Chapter 7
Wednesday, May 3, 2000, 2:00 P.M. The Outskirts of Kailua
Monday, May 8, 7:15 P.M.
Chapter 8
Chapter 9
Chapter 10
One Week Later
Tuesday, May 23, 6:55 A.M.
Chapter 11
Chapter 12
Chapter 13
Wednesday, May 24, 5:00 P.M.
Monday, June 5, 9:00 P.M.
Tuesday, June 6, 5:50 A.M.
Chapter 14
Friday, June 9, 11:46 A.M.
Five Hours Later
Chapter 15
Chapter 16
Chapter 17
Monday, June 12, 10:45 P.M.
Tuesday, June 13, 9:00 A.M.
Tuesday, June 20, 7:00 A.M. The Dean’s Office
Chapter 18
III - Summer
Chapter 19
Tuesday, July 4, 2000, 5:05 P.M.
Chapter 20
Chapter 21
6:25 P.M.
6:57 P.M.
Chapter 22
8:15 P.M. Queens, New York
9:28 P.M. East River Heliport
Epilogue
Author’s Note
References
CRITICAL CONDITION
The novels of Peter Clement
Acknowledgments
Also by Peter Clement
Copyright Page
To James, Sean, and Vyta, for being there to launch each new day
PRAISE FOR PETER CLEMENT
Mutant
“[Mutant] is steeped in the thriller traditions of John Saul, Dean Koontz, and Stephen King: pulse-quickening action, a sub-plot of good versus evil, smatterings of blood here and there, and a hero’s race against certain disaster.
—Doctor’s Review
The Procedure
“More than a piece of compelling fiction, The Procedure is a cautionary tale that will be talked about by people in the health care industry as well as those of us who come into close contact with modern American health services. An exciting and original story, well told.”
—NELSON DEMILLE
“The Procedure is an intriguing medical puzzler with memorable characters–a winning combination.”
—KATHY REICHS
Lethal Practice
“ER meets Agatha Christie as Buffalo doctor Earl Garnet is suspected of murder via a cardiac needle. Heart-pounding suspense, indeed!”
—Entertainment Weekly
“Chilling...A fast-paced, engrossing medical thriller.”
—JOHN SAUL
Too early may be too late when the geni has been released, you’ve lost control of it and don’t know how to get it back into the lamp.
Terje Traavik
“Too Early May Be Too Late”
Research report to the Directorate
for Nature Management,
Norway, 1999
Prologue
Friday, October 28, 1998, 1:00 A.M. Kailua, Oahu Island, Hawaii
His screams woke her and brought her running to where he slept.
“Mommeeee!”
Not bothering with the lights, she covered the twenty feet of corridor separating their bedrooms with a half dozen strides. “I’m here, Tommy,” she reassured, rushing to his bed. By the time she swept him into her arms, he was choking. “I’m here, darling,” she repeated, ready to tell him that he’d just had a bad dream. Even when she felt him burning up, the front of him wet through her nightgown, she figured that his cold must have gotten worse and he’d vomited from coughing. She’d always taken pride in disciplining her awareness of what could happen, not letting it cloud her objectivity or make her imagine the worst whenever he got sick. But his continued hacking and struggling to breathe began to fill her with alarm. She snapped on the light and saw bloody foam pouring from his nose and mouth as he sputtered and gagged.
Panic jolted through her. With the grip of an executioner’s current it held her immobile. “Oh, my God, no!” she uttered, as if she could protest the sight, order it away, blink it gone.
Then her instincts took over. Turning him facedown so the blood could run clear of his airway, she tore downstairs with him, leaving a trail of crimson on the rug. In an instant she decided that driving him to the hospital herself would be fastest, grabbing keys and a cellular phone off the kitchen table as she passed it. She dashed out of the house repeating, “Mommy’s got you. Mommy’s got you. Spit out and breathe in.” He gasped for a breath between fits of sobbing, and through her palm supporting his chest she felt tiny vibrations—the purring, she recognized, of a lung filled with fluid.
The knowledge increased her terror while her mind automatically scrolled through what he might have, the possibilities all grim. “Oh, my poor baby. That’s a good baby. It’ll be all right!” she continued, sprinting breathlessly across the lawn toward the garage. She knew that the words were lies, yet hoped the sound of her voice would reassure him. But, practiced as she was at mouthing such comforts to others, she felt so filled with dread that she gagged on the words midphrase. She knew her son to be on the brink of respiratory arrest, and they were a half hour too far from where she could save his life. The isolation and distance from the city that she’d so fervently sought when choosing her piece of paradise on the beach became his death sentence. “What’s killing him?” she whispered with all the intensity of a prayer, as if God could provide the diagnosis. In His silence she racked her own mind for the answer, but her thoughts tumbled in free fall. Yesterday he’d seemed to have only a cold. Had her obsession with not overreacting led her to miss something that could have alerted her?
By the time she yanked open the car door, got herself into the driver’s seat, and, keeping him facedown, placed him across her lap, he started to emit shrill little cries with each expiration. She jammed the key into the ignition, squealed out of the driveway in reverse, and rocketed up the road.
One hand on the wheel, the other on her phone, she punched the automatic dial button.
After two rings came the reply. “Emergency, Honolulu General—”
“This is Dr. Sandra Arness. I’m on the Pali Highway heading toward you from Kailua. It’s my son. He’s a pre-code in acute respiratory distress—from sepsis and what must be pneumonia. For God’s sake, have 911 dispatch an ambulance to meet me, and make sure they’re carrying resus equipment for a three-year-old—” She broke into a sob, unable to bear the thought of having to resuscitate him herself.
“Right away, Dr. Arness!” the receptionist crisply replied. “And I’ll alert our team.”
The boy, emitting ever weaker sounds as he struggled to breathe, raised his head from where it lay across her thighs. “Kiss it, Mommy. Kiss it and make it all better,” he whimpered in a faint wheeze that she could barely hear.
“Oh, Tommy, be brave. Mommy will help you soon.”
“Help now, Mommy.”
She held back her own tears, determined to stay in control and not frighten him further. Yet her helplessness had her in agony. As if to torment her further, they shot past the darkened remnants of the sole place on this side of the island that might once have saved him. Their local hospital had been shut down last year as a cost-cutting
measure.
Whenever she could take her hand off the wheel, she stroked his head. That was always his favorite thing—let me at least give him that, she prayed. But this part of the road snaked back and forth up a series of switchbacks as it crossed the Koolau Range separating Kailua from Honolulu. She needed both hands on the wheel to fight the car through yet another turn, and at the loss of her touch, he immediately became restless.
Emerging from the long tunnel that marks the halfway point, she saw the flashing red of the ambulance through a break in the trees as it approached on the highway far below. Behind it, in the distance, the golden lights of Honolulu cascaded down the dark hills to the shores of Waikiki—she’d once described them as a spray of fairy dust in a magic kingdom to a wide-eyed Tommy as he’d stared in wonder at the sight. Memories of his squealing with delight seared through her.
“I see the ambulance, Tommy, and the twinkling city. Mommy will help you breathe now—” She broke off, feeling him start to shake in her lap. He was seizing.
“Oh, God, no! No! No!”
The ambulance still looked to be several minutes away. Tommy’s life was down to a matter of seconds. Already doing a hundred, she floored the accelerator. There were fewer turns here, but hurtling downhill she nearly lost control several times, her tires slithering in the roadside grass and gravel. When she’d halved the distance between her and the oncoming flashers, she skidded to a stop, straddling a break in the median. Pulling Tommy to her, she struggled out of the car and stood in the light of its high beams with his jerking body in her arms. She could see him turning blue. More bloody froth seeped out between his clenched teeth. He seemed to be grunting, but she knew it to be the force of each convulsion pushing what little air he had left out of his lungs.
She knelt on the asphalt with him in her lap and tried to pry his jaw open with her fingers. It wouldn’t budge. She covered his lips with her mouth and attempted to blow air through them, but they were locked in their grimace. She even tried to deliver a breath to his lungs through his nasal passage, yet no matter how hard she strained, the air went nowhere. His tongue must have fallen into the back of his throat, blocking the way. The sound of the siren grew louder, like the wail of an approaching banshee.
“Tommy! Tommy!” she began screaming over the noise, out of options and feeling the pulse in his neck drop to practically nothing.
The rhythmic jerking slowed, his arms and legs still flopping as if someone were shaking him, but only once every two seconds. The vehicle roared up just as she felt him go limp.
An instant later the paramedics lifted him onto a stretcher and into the back of the ambulance. In a daze she crouched over his precious face and forced herself to practice her profession—opening his airway with a pediatric laryngoscope, suctioning away the bloody foam, sliding a tube the size of his little finger into his small trachea. They then went careening back down the mountain toward the lights, one of the paramedics riding in the back to help her.
But despite her bagging oxygen directly into his trachea, despite a young healthy heart that valiantly fluttered to come alive again, despite all his other organs being perfectly ready to spring back into action, his lungs were finished. The infection had destroyed so much of their delicate lacy tissue and membranous sacs that his blood could find no air, leaving the rest of him to suffocate cell by cell.
When they unloaded him at the ambulance entrance, she already knew that he was dead. Absently, as she ran alongside the stretcher, she noticed the breeze stir his locks of hair and heard the sound of palms rustling overhead. She glanced up, only to see the blue-black sky scattered with silver—a sight that had always welcomed her when she came off duty and headed home. Now, its beauty seemed coldly indifferent, as if God mocked her for ever having marveled at it.
Less than a week later, Dr. Julie Carr, Director of Research at the Honolulu Virology Institute, felt her pulse quicken as she stared at the mainly black-and-white image on the screen of her electron microscope. A green ovoid creature covered with thousands of spines caught her attention amid a slew of similarly shaped but gray, uncolored forms. They all resembled things that might float about in the darkness of an undersea abyss, but in fact they were viruses.
Always the consummate teacher, she called over a first-year medical student who was doing an elective in Hospital Sciences, gestured toward the screen, and declared, “It took me four days to identify the green one.”
“Four days?” replied the young man with surprise. Usually they could peg a virus within forty-eight hours.
“That’s right. Are you familiar with the Tommy Arness case?”
“Isn’t that the doctor’s son who supposedly had only a cold but died suddenly? I don’t know the details—only what I’ve overheard from the technicians.”
“At first I performed all the standard tests for the usual suspects in an acute respiratory infection. Have you read about ELISA yet?”
“No, Dr. Carr,” he answered sheepishly. “But I’ll get to it—”
“Just as police keep fingerprint records of known criminals,” she went on, not at all interested in his excuses, “virologists have antibody ‘fingerprints’ of the usual troublemakers we deal with day to day. We’ve tagged each one of these antibodies with an enzyme molecule that produces a specific color change if that antibody finds its match, thereby making a reagent that can give us visual confirmation whether a particular virus is present in sera or tissue samples. The procedure we follow while using these substances is the enzyme-linked immunosorbent assay—ELISA for short. When I added the reagent for influenza to the specially prepared specimens I’d taken from Tommy Arness’s bodily fluids and lung tissue, it lit them up as red as glowing hot embers.”
“So what killed him was influenza?”
“I didn’t buy that. The influenza bug which attacks the mucosal lining of the nose, throat, and lungs in humans is capable of causing a bloody exudate, but I’ve never encountered a strain producing the degree of hemorrhage and destruction I witnessed at Tommy Arness’s autopsy. His lungs had turned to a bloody pulp.”
“My God!” exclaimed her student.
“Was this some new virulence in an old bug? I wondered. But in the manner of most physicians encountering something they’ve never seen before, I initially succumbed to doubts about my own database and attributed the strangeness of it to gaps in my knowledge. ‘Probably someone’s already reported this, and I’m simply not up-to-date,’ I told myself.”
Her young protégé grinned, obviously delighted at this admission of a shared failing by his teacher.
“That is certainly not a habit that I’m suggesting you can afford to emulate,” she added sternly, wincing at the thought of all the unread journals stacked in her office. In an era of cutbacks, even chiefs must assume extra duties, and keeping up with the literature is usually the first casualty. “I just want to be sure you understand the logic behind my thinking this problem through, mistakes and all, so you’ll learn the process of attacking a clinical puzzle.”
His smile vanished. “Of course, Dr. Carr. I never meant any disrespect—”
“Then I had another thought. Perhaps what the boy’s mother figured to be a cold had in fact been the flu. Such a scenario would explain the presence of the influenza and leave open the possibility that something else caused the catastrophic meltdown in his lung—an esoteric organism which came along at the same time but for which I hadn’t the means to test.”
The young man’s eyes widened. “An esoteric organism?”
“But almost immediately I discarded the idea, sharing the well-founded skepticism of most doctors toward invoking coincidence and diagnosing more than one disease to explain symptoms we don’t understand.”
His puzzlement folded into his brow. “So what did you do?”
“The hardest thing for a doctor to do: admitted I was stymied and called for help. I contacted the Centers for Disease Control and Prevention in Atlanta. After the CDC reviewed the boy’s c
linical findings and autopsy results, the people in the viral infection group couriered me the ELISA reagents for all the uncommon microbes they could think of which might cause such a rapid destruction of the respiratory system. Also, to save the time of confirmatory tests for the moment, they included electron micrographs of each bug—as grisly a set of mug shots as I’ve ever seen. Most have never been reported before in the U.S.”
She paused, as all good storytellers do, to let her listener’s curiosity intensify. She smiled inwardly as she observed him lean ever so slightly toward her from his stool, his head cocked in anticipation. “The third reagent in the CDC’s kit nailed the culprit, glowing a bright green the second a few drops of the stuff hit the sample well,” she continued, lowering her voice to draw him in further. “The label on the test solution’s bottle gave the bug a name; H5N1, aka an influenza strain that normally infects and kills only birds, particularly domestic fowl, such as chickens. It’s been the scourge of farms in Asia for the better part of the decade. A year and a half ago, however, it gave the world a scare when, in Taiwan, it jumped the species barrier and infected a young girl, killing her in a matter of hours, her lungs filled with blood. The media christened it bird flu, and the moniker stuck, especially after authorities there carried out the slaughter of a million chickens in an attempt to contain the lethal organism. The story carried around the globe.”
“I remember reading it!” said her pupil. “Fortunately there were no more cases.”
“Until now,” stated Julie as she strode to the wall phone in her laboratory. Punching in the number for the CDC and working her way through innumerable layers of receptionists, she regarded the flush of excitement on her student’s face. Who knows, she mused, perhaps my melodramatic teaching methods ignited enough enthusiasm in the future doctor that he’ll at least do his reading.
“Confirmation by more elaborate and lengthy testing procedures I’ll leave to you,” she informed the virologist who took her call. The computer-enhanced green specimen on the screen, taken from the lung tissue she’d treated with the ELISA reagent for H5N1, provided proof enough for her that the bird flu had jumped the species barrier once more. “We’ll have our hands more than full here trying to contain it.”
Mutant Page 1
