by Glenn Cooper
Also by Glenn Cooper
NOVELS
The Cure
WILL PIPER
Library of the Dead
Book of Souls
The Keepers of the Library
DOWN
Floodgate
Pinhole
Portal
CAL DONOVAN
Sign of the Cross
Three Marys
The Debt
The Showstone
THE CURE
Glenn Cooper
An Aries book
www.headofzeus.com
First published in the United Kingdom in 2020 by Aries, an imprint of Head of Zeus Ltd
Copyright © Lascaux Media, 2020
The moral right of Glenn Cooper to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act of 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of both the copyright owner and the above publisher of this book.
This is a work of fiction. All characters, organizations, and events portrayed in this novel are either products of the author’s imagination or are used fictitiously.
A CIP catalogue record for this book is available from the British Library.
ISBN 9781800242210
Cover design © Lisa Brewster
Aries
c/o Head of Zeus
First Floor East
5–8 Hardwick Street
London EC1R 4RG
www.headofzeus.com
Contents
Welcome Page
Copyright
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Chapter 57
Chapter 58
Epilogue
About the Author
An Invitation from the Publisher
1
It sounded like something was rattling the bars of an animal cage. Her frail, purple-veined hands were tightly wrapped around the slats of the safety rails, and she was working them with the full force of her emaciated frame. The racket made it down the empty hall to the nurses’ station.
The young nurse said, “She’s at it again.”
The ward supervisor didn’t look up from her paperwork.
“Are you sure we’re not allowed to restrain her?” the young nurse asked.
“She’s the only one on the ward. Who’s she going to bother?”
“Me?”
The supervisor told her that if she was so irritated, she could call Dr. Steadman and ask for a restraint order.
“I’m not calling him for that,” the young nurse said, horrified. “Can’t I page the fellow on call?”
“Steadman’s personally handling all her orders.”
“Well, I’m not calling him.”
“Fine.”
Then the high-pitched shouting started.
Shrieks. Rattles. Shrieks. Rattles.
The young nurse buried her face in her palms. “God, not that too. What’s she saying?”
“It’s Japanese. Do I look like I speak Japanese?”
“Can’t she speak English?”
“She did. She only remembers Japanese.”
Another nurse, this one older, emerged from the medication room and said, “I’m pretty sure she’s saying she’s hungry and wants rice.”
“How do you know?” the young nurse asked.
“Her daughter-in-law told me. It’s either that or she’s wet herself.”
“You don’t remember which?” the supervisor asked.
A shrug. “She cycles between them.”
“Would you check on her?” the supervisor asked.
The young nurse complained about having to gown up again. When she returned a few minutes later she said, “I guess she’s hungry.”
“Dry?” the supervisor asked.
“Bone dry. I just wasted twenty dollars of isolation garments to find out she wants rice half an hour after she had breakfast.”
“She forgets she’s eaten,” the older nurse said. “My father got that way.”
“What time is Steadman doing the deed?” the young nurse asked.
“Sometime this morning,” the supervisor said.
“Maybe by the time my shift starts tomorrow she’ll be using the call button and watching soaps.”
“Dream on.”
*
Roger Steadman arrived mid-morning, trailed by an entourage. He sailed down the corridor, his unbuttoned, long white coat billowing like the spinnaker of the beautiful Beneteau he kept at Baltimore’s inner harbor. His ruddy tan and fluid mobility gave him the appearance of a younger man, but he was not young. He was one of the gray-beards at the Baltimore Medical Center, a legendary figure in American neuroscience, his curriculum vitae as thick as a small-town phone book.
“Ruth?” he called out to the nursing supervisor. “Is my patient ready for her close-up?”
All three nurses stood. He was old-school. He liked them on their feet. “She is, Dr. Steadman.”
“Well, good. Get the syringe and come help me into my gear.”
“You’re going to dose her yourself?”
“I am. History’s being made today. Mark your calendars, boys and girls,” he said to the students. “Years from now, this day could be hailed as the day we began to effectively treat, maybe even cure Alzheimer’s disease. I couldn’t very well pass up the chance to administer the first dose to Patient One. Besides if it’s not me, then Dr. Pettigrew is the only other physician on my team who’s gone through virus screening. I need him to take the pictures. Tell me you brought the camera, Colin.”
His research fellow, Colin Pettigrew, raised the Nikon and said in a doleful English accent, “I’ve got it right here.”
“Remember, the left side’s my good side. The right side’s pretty awesome too.” At the awkward silence he added, “You students, it’s okay to laugh once in a while. Don’t go through life taking yourself too seriously.”
Medical students and residents congregated in the hall outside the gowning anteroom while the nursing supervisor and two doctors donned gowns, masks, booties, and gloves. Via the intercom, Steadman put on a show, thinly disguised as a Q&A session.
“Mrs
. Noguchi is the first patient in this Phase One clinical trial of a novel gene therapy for Alzheimer’s,” he said. “This is for the students, not you residents: what is a Phase One study designed to detect? Anyone. Call it out.”
An eager student raised her hand. “Safety.”
“Correct. Safety. We treat a small number of people sequentially, in this case up to ten patients with severe disease, and we do extensive safety profiling along the way. If all goes well, and I’m quite sure it will, we’ll conduct a far larger Phase Two trial designed to look for efficacy. Of course, we may get an early Christmas or Hanukkah present in Phase One and see an efficacy signal. We’ll know because we’ll be doing daily mental status and memory tests. Now, as I’ve said, this is a gene therapy trial. What are the essential components of a gene therapy?”
Another student piped up, “A targeted therapeutic and a virus for delivering it.”
Steadman let the nurse fasten his gown behind his back. “Correct. A virus and a payload. In this case the payload is a novel transcription factor, NSF-4, the recently discovered neprilysin-stimulating factor that we found to have a profound boosting effect on the natural production of neprilysin. Does anyone know what neprilysin is?”
A bearded student smoothly answered. “It’s a protease that accelerates the degradation of beta-amyloid.”
“And what, pray tell, is beta-amyloid?” Steadman asked.
Several students tried to answer but the bearded one jumped the queue. “It’s the toxic substance that builds up in the brains of Alzheimer’s patients. The protein tangles that form are thought to produce the dementia.”
“Correct,” Steadman said. “And kudos for knowing about neprilysin. You’re the first student who’s been able to answer that.”
The bearded one kept on going. “I believe NSF-4 was discovered by Jamie Abbott at Harvard.”
Steadman hid his irritation behind the surgical mask. “How on earth did you know that?”
“I got a PhD in neuroscience before going to med school.”
“From where?”
“Harvard.”
“Well that explains Dr. Abbott. Jamie is a junior colleague of mine. My contribution to the discovery and elucidation of NSF-4 is well known, of course, and the construction of this gene therapy product was exclusively my work.”
Steadman wiggled thick fingers into sterile gloves.
“All right, almost ready,” he said. “The idea here is to get high concentrations of NSF-4 into the brain to chew up the beta-amyloid tangles and reverse the Alzheimer’s dementia. Before I do the procedure, who, other than our PhD friend knows why we just don’t administer neprilysin or NSF-4 directly instead of going through all the complexity of gene therapy?”
Another student tentatively answered, “Because they won’t cross the blood-brain barrier?”
“Correct. They are large peptides that won’t get absorbed into the bloodstream if given orally and won’t get into the brain if given intravenously. So, we piggyback our payload with a novel adenovirus that is not only perfectly harmless, but this new one, developed at Indianapolis, penetrates the central nervous system like a hot knife through butter. Once there, the virus delivers its payload inside the target neurons. Our virus has no ability to integrate with or alter the host genes. After doing its job the virus simply degrades. For that reason, we plan to re-dose our patients once a month.”
Again, the bearded student: “I don’t recall other gene therapy trials needing isolation procedures. Why this one?”
Steadman answered gruffly, “In my opinion it’s overkill, but our overly cautious safety committee is requiring us to do so.” His voice rolled into sarcasm. “In their infinite wisdom, because this particular adenovirus has never been used before, they wanted to eliminate the highly remote possibility that a visitor might introduce a second virus. Hypothetically, and I stress, hypothetically, that virus might combine with our vector, creating a hybrid that could integrate into the patient’s genome, or become capable of making copies of itself. We’ve even been required to pre-screen the patient, all the medical workers, and the patient’s immediate family for active viral infections. Research is sometimes a pain in the rear, boys and girls. All right, it’s show time.”
Steadman, Pettigrew, and the nurse entered the patient’s room. Mrs. Noguchi regarded them warily, scooted to the farthest side of her bed, and began spouting off in Japanese.
“Kon’nichiwa, Mrs. Noguchi,” Steadman said, approaching the bed. He played to his audience who were listening via intercom and watching behind two sets of windows. “She has lost her ability to speak or understand English and has reverted to her native language. This has been a challenge in assessing her mental state, but we have a research nurse who speaks Japanese, so all is well. Mrs. Noguchi is seventy-eight. She has rapidly progressive disease. She has been on standard Alzheimer drugs with negligible impact. Without further experimental therapy I would expect her to be in a vegetative state within six months and dead within a year. Nurse, the syringe, please.”
She handed him a pre-filled syringe attached to a thin catheter.
“Hold her head, please,” Steadman said. “You can’t imagine the paperwork if the dose winds up on her cheek.”
With her head clamped tightly, and Pettigrew pressing repeatedly on his shutter button, Steadman inserted the catheter all the way into one of her nostrils and pushed the plunger.
“That’s it,” Steadman said triumphantly. “Patient One has been dosed. Did you get all the pictures I wanted, Colin?”
*
The young Japanese man approached the nursing station. It was almost 9 p.m. The night nurse, with only one patient on the research ward, was absorbed in her book.
“Excuse me,” the man said.
The nurse was startled. “How can I help you?”
“I know it’s past visiting hours, but I was hoping I could see my grandmother.”
“Mrs. Noguchi?”
“Yes. Is it possible?”
“Visiting hours were till eight.”
“I know. I’m sorry. I just got back from a trip. I heard she got treated today and I wanted to see her.”
The nurse sighed. “Are you on the list? I can’t let you see her if you’re not on the list.”
“I’m her grandson.”
“What’s your name?”
“Ken Noguchi.”
She scanned the card taped to the desk. “I’ve got Kenji Noguchi.”
The young man smiled. Kenji was his father. “That’s me.”
“Have you visited before?”
“I haven’t.”
The nurse sighed again. “All right. Let me show you how to put on the isolation clothes. They’re very strict around here. I’ll let you have ten minutes. You speak Japanese?”
Another smile. “I think so.”
“Good, ’cause I can’t get through to her. Be a dear and find out if she wants her pudding.”
The nurse let him enter the anteroom. Via the intercom, she gave him instructions on gowning. As he dressed, he coughed and wiped a few beads of sweat from his forehead.
“You’re not sick, are you?” she asked. “If you’re sick you can’t go in.”
“No, I’m not sick. It’s an allergy.”
He took off his shoes.
“You don’t have to do that. You put the booties over them.”
“It’s respectful to take off your shoes.”
He finished with the booties and gloves.
“All right,” she said, “you can go in. I’ll be back.”
He slid the booties over the floor and stood by the bed, waiting for his grandmother to open her eyes. He would have stood there for the full ten minutes without disturbing her, but he began to cough into his mask.
She opened her eyes and seemed terrified.
“Grandmother it’s me,” he said in Japanese.
She gripped the bedrail and began tugging at it.
“Don’t be scared, it’s your gra
ndson.”
She kept trying to get away from him. He looked over his shoulder to make sure the nurse wasn’t looking and pulled down his mask.
“See, it’s me.”
She stopped rattling the rail and tried to focus her watery eyes. “Kenji, my son?”
“No, grandmother, it’s Kenneth, your grandson.”
She smiled vacuously.
“I was doing my work in Japan, grandmother. I have just returned. I came from the airport.”
“Do you know why I am here?” she asked, searching the room. “Who are these people? Why are they hiding behind masks?”
“You are here to get a new medicine. They are trying to help you.”
“Do you know why I am here?” she asked again.
“To receive medicine,” he repeated.
“You are my grandson, you say? Give me a kiss.”
He leaned over to kiss her forehead and when he did, he coughed again.
“Sorry,” he said, taking a step back and pulling up the mask.
The aerosol from his mouth dispersed at a speed of fifty feet per second. It coated her blinking eyes with the finest of mists. The virus particles he carried from Japan settled on her shimmering, pink conjunctivae. Even before he left the room, they began to enter her bloodstream.
By the morning her grandson’s virus had overwhelmed her immune defenses and had sliced through her blood-brain barrier. Inside her brain, millions of virus particles infected millions of neurons and some of them came in contact with the gene therapy viruses that had already taken up residence. Where they met, the two viruses stuck like glue and fused membranes. Instantly, their genetic material began to combine.
The new virus that formed didn’t have a name.
*
Dr. Steadman fast-walked down the hall with Dr. Pettigrew loping at his heels. The nursing supervisor joined the procession.
“How long has she been like this?” Steadman asked.
“Thirty minutes. I called as soon as we saw the change.”
On her early morning vital-sign check, Mrs. Noguchi had registered a minor fever. By mid-morning her temperature had climbed, and she began to cough. When informed, Steadman ordered an infectious diseases consult.
“The ID fellow isn’t on the pre-screened list,” the nurse had told Steadman.
