Those were the days.
The climax of my self-destruction walked in with three former classmates who, at that time, were just finishing their final year in the clinics. They had already matched in their residencies, their MDs were just on the horizon. For them, life was good. They were drunk. I was pretty looped myself.
The first guy up to the counter recognized me. “Hey, man, heard about what happened. Bummer.”
“Yeah,” I said. “What can I get you?”
“How about some data? Can you cook some of that back there?” It was the kid behind him. A thick surgeon type named Pablo.
“What did you say?” I asked, a broad fake grin on my face.
“You heard me,” Pablo shot back, the soul of wit.
“Don’t mind him,” the first guy told me. “He’s got his drink on. He’s heading to UCLA for orthopedics. You know the type.”
“Sure,” I said.
But Pablo wasn’t giving up. “He’s the guy who faked the data. Got caught and booted from school. Fucking lied and then gets caught.”
The first guy turned to Pablo, but by then it was too late. I was already leaning over the counter with a good right hook that landed square in the surgeon-to-be’s face. Pain shot through my hand, and I heard a crunch as the nasal bones cracked beneath it. Pablo grabbed at his face. He kept yelping “Ah, ah, ah” over and over again as I tried to land another one. Blood streamed in a web over his fingers.
The first guy pushed me back over the counter. “What the—”
But it was over. Pablo was slumped on the floor as people gathered. A few fraternity types sidled up as if there was something to do at that point. I jammed a crooked finger at the jerk moaning on the floor, checking his nose. “Fucking cocksucker. Get them to fix it at UCLA, you cunt. You fucking cunt.”
So it was in that moment, filth pouring from my mouth, hand jabbing at the air, that my engines finally flamed out. The police came; Pablo went to the emergency room. The first guy, now an oncologist in Philadelphia, convinced kindly Pablo and the police that Pablo had been the instigator, and no one pressed charges. The rulers of the medical school were not pleased, however. They demanded I leave.
I did. I was twenty-five.
The good old Dunner Building. Fuck it. I looked at my watch, got up from the bench, and walked.
CHAPTER 44
I trudged the well-worn stairs of the Heilmann Building to the third floor. Eight years since I’d last made that climb, and the stairwell, at least, hadn’t changed. I thought I recognized some of the dirt.
As I said, Harriet Tobel’s lab was the first one in which I worked, and I would have stayed there if she hadn’t convinced me that I should broaden my experience. In those early years, I wondered if she didn’t see something wrong with me, and convinced me to go elsewhere to avoid having such a liability around. But over time she proved her loyalty to me.
I passed the Microbiology Department’s administrative offices, then stepped up the pace, hoping to avoid another Jenna Nathanson–like encounter. Labs ran along both sides of the hallway. Each was marked with a little placard that had on it the name of the PI and the postdoctoral and grad students who worked in the lab. In the corner—actually, in the corner and running for yards in either direction—was the Tobel lab. I walked inside.
Through the maze of black lab benches, I saw a thirty-something guy who was probably a postdoc and a young woman who had to be an undergrad. The postdoc was at a computer; the undergrad, gloved, was running gels, some of the most tedious grunt work in a lab.
At the far end was a wooden door with a small brass engraved plate on it: Harriet Tobel, MD, PhD. I knocked and opened the door.
“Dr. Tobel,” I said. She sat behind a desk awash in papers. Most docs’ offices are like this; no scientist or doctor worth his or her salt would be caught dead with a clean office. Tidy offices bespeak misplaced priorities.
“Nathaniel,” she said. She didn’t stand, so I walked over to her and embraced her. Her frame was small, frailer than the last time I’d seen her, it seemed. Still, age had been kind to her, and she looked very robust for a woman in her early seventies who’d been knocked into disability by a childhood bout with polio. “So good to see you,” she said. “So very, very good.”
Damn it if I wasn’t thrilled to see this woman. Sure, I hated California, but seeing Harriet Tobel almost made the trip to the dark side worth it. Almost.
I yammered on for a while about stupid stuff—CDC, the recent droughts on the East Coast and in my romantic life. But the words were like comfort food for me, pabulum that Dr. Tobel and I could share. I—and she, it seemed—savored the moment.
Eventually, Dr. Tobel said, “So, Dr. McCormick, tell me what brings you here.”
In two minutes I did, omitting too much.
“Well,” she said, “we’ll have time for more discussion over lunch. Many things have changed since you were gone. Have you seen the lab?”
“Just what’s between here and the hallway.”
“Well, Nathaniel, it’s grown. I took over the Kopelman lab next door when Henry moved on to UNC. Let me show you.”
She struggled from her chair and grabbed the two canes that sat propped against the desk. She unfolded her crooked legs, the legacy of polio, and I followed her out of her office.
In the lab, she pointed her chin at the postdoc and the undergrad and the three rows of benches. “Some of the work is the same as when you were here. HIV mutation and drug resistance. Things are going well with it. Yonnick”—she indicated the bearded postdoc—“is working on a paper we will submit to the New England Journal of Medicine in the next few months. Yonnick, Leyla, this is Nathaniel McCormick, an old student of mine. Nathaniel’s a mover and shaker at CDC now.”
Despite all the derailments in my life, Dr. Tobel’s sentence made me sound impressive. And I loved her for it.
Yonnick and Leyla muttered hellos. Somewhere in the background, a centrifuge whirred. God, I thought, it has been so long since I’ve been in a place like this. The sounds, the smells . . . it was like coming home.
“But this, Nathaniel, I think you’ll love.”
She moved to the next room, her canes padding on the tiled floor. The room was smaller than the first one, but far better equipped: new high-pressure chromatographs, a computer at every workstation, a PCR machine in the corner. New, expensive stuff.
“The pleasures of working with private industry.” Her wrinkles pulled into a smile. “We are well funded here.”
I heard someone tapping away at a computer across the room.
“Private industry?” I asked, but something seemed to have distracted Dr. Tobel. “You’re working for the Empire now?” I asked.
She smiled as she came back to the moment. “Have you heard of Chimeragen? The company?”
“I think so. Has something to do with xenotransplantation.”
“Still keeping up on your reading, I see.”
“Some of it.”
Xenotransplantation and xenografts are the cross-species transplantation of organs and tissues. There’s a certain amount of xenotransplantation that’s found its way into everyday medicine: heart valves from pigs, skin from pigs. But Chimeragen was going for the big stuff: solid organs, like kidneys and hearts. Experiments with this sort of thing had been going on for decades, without great results. The first recorded experiment happened in Germany in the early 1900s—a physician by the name of Unger sewed a primate kidney into a human. The recipient died immediately when his immune system revved up and blood clotted in his vessels. Then, in the twenties, an American doctor transplanted lamb kidneys into a human. The patient survived for nine days. Better, but still not standard practice. Considering that even the concept of blood typing was still new in the early part of the century, the experiments were impressive.
Primate kidneys, lamb kidneys, dead patients: this is where my knowledge stopped, basically because that’s all I could remember from a transplantation lecture I
attended a decade before.
“You’re working for Chimeragen?” I asked.
“With them, yes. They got a large grant from the NIH and significant investment from Spanna Pharmaceuticals to conduct their work. The NIH money was earmarked to study the risks of cross-species infection—viruses, prions, all those nasty things you work with. They needed someone independent to monitor their work. They called me and I jumped at the chance.”
“Congratulations,” I said, though I wasn’t exactly sure how independent Dr. Tobel could be, all things considered. “What stage are the trials? Are they clinical yet?”
“They should be moving into Phase Three”—the stage just before FDA approval for the process—“in the next year or so. It’s extremely exciting. We’ve scratched over every tissue of the current recipients and have found nothing. The patients are totally clean.”
“Who are the recipients?”
“Do you know Otto Falk?” she asked, ignoring my question.
I knew the name, and he was definitely not one of the recipients. Falk was a big transplant surgeon who came over from Johns Hopkins fifteen or sixteen years before. He was famous as an advocate for xenotransplantation. It was from his lecture, in fact, that I learned about the early experiments.
“He lectured me once,” I said. “So you’re working with pigs? Falk loved pigs, if I remember.”
“Yes. Closest in size and morphology to human organs. Yes. The noble pig.”
I heard the person across the lab swear quietly.
“How big is your Chimeragen team?” I asked, trying to get a better glimpse of the woman—from the voice, I was sure it was a woman—through the shelves of catalogs and bottles of reagents.
Dr. Tobel didn’t answer me. “Why don’t we head to lunch? It’s nearly two and I haven’t had a bite all day. I’ll give you the full tour afterwards.”
The woman swore again, and I heard her push out her chair and begin walking around the bench toward us. She rounded the corner and stopped cold when she saw me. And I, for a moment, thought I’d died.
“Hello, Nathaniel,” she said.
“Alaine,” I said.
There was a thick silence. Finally, Dr. Tobel said, “Dr. Chen is one of our team members.”
Unable to think of anything at all, I nodded.
“How have you been?” Alaine asked.
“Okay,” I said. My voice quivered.
“Lunch, Nathaniel. The café closes in a few minutes.”
“Good to see you,” Alaine said as we left the lab.
I nodded.
In the elevator, Harriet Tobel touched my arm. “I’m sorry, Nathaniel. Alaine wasn’t to be here today. And she wasn’t at her usual bench. If I had known—”
“That’s okay. It was a long time ago.” Not long enough, though. Forever wouldn’t be long enough.
CHAPTER 45
We went to a small café in another lab building, presumably in the interest of preventing another chance encounter with the woman who’d broken my heart. The medical school is filled with these—small sandwich shops and cafés—each building seeming to have one with a different theme. A captive clientele meant good margins for the outfits lucky enough to get the concessions contracts.
To keep up appearances, I ordered a sandwich, but was unable to make much of a dent in it. Though I didn’t want to talk about the outbreak or Douglas Buchanan or Gladys Thomas, I sure as hell didn’t want to talk about Alaine Chen. So I began to weave the tale for Dr. Tobel. Besides, I thought, she was a microbiologist. She’d worked for CDC back when they were called the Communicable Disease Center; she’d done some early work with viral hemorrhagic fevers before HIV strode into town attracting much of the funding and many of the best minds. She might be able to shed some light.
As I talked, Dr. Tobel became quieter. For a woman who’d spent much of her life investigating AIDS, any talk of sex and death would be sobering. I finished up with the facts and went on to the theory of bioterrorists sowing a disease into the population through sex. “Does it sound far-fetched?” I asked.
“I’m not an expert in that.”
“But what do you think?”
“I think it sounds quite sinister.”
“Yes. And the patient population it’s attacking is unexpected. I’m worried about what’s going on, Dr. Tobel. Have to say I’m pretty worried.”
“You’re trying too hard, Nathaniel. The unexpected does not necessarily make for efficacy. You’re not writing a Tom Clancy novel, you know.”
No, I wasn’t writing a Tom Clancy novel. No, bioterrorism wasn’t the most likely scenario. But it might have been the worst, and something very wrong was going on here. I guess my discomfort must have showed, because Dr. Tobel’s face softened. “It’s good that you’re thinking this way, though. I’m glad the government has you working for them.” She smiled. “You said a doctor named Randall Jefferson was involved in all of this?”
“Yes.”
“Well, I will call him. I’m sure he’s told you everything he knows, even if he didn’t tell you in the most pleasant way.”
“You know him?”
“We were acquaintances—not friends, really—when I was at Johns Hopkins.” She looked across the room. “He’s a good man, Nathaniel. You just got on his wrong side.”
“Doesn’t seem hard to do.”
“Well, he has a lot to protect.”
“Including cesspool group homes?”
Her face remained impassive. “I know you’re concerned. I am, too.” Her mouth drew to a sad smile. “I know you hate having been taken off the investigation, but it’s probably for the best.”
I laughed, then stopped when I saw she wasn’t joking. “I can’t believe you’re saying that. You just said it was good the government has me working for them.”
“And it is.” She paused, uncomfortable. “But, Nathaniel, you’re still young. You’re a little too ambitious, even for a field populated with ambitious people. The shortest direct route is not always the best.”
It wasn’t hard to read between the lines of what she was saying: the same character flaws that had me bolting from medical school got me kicked out of Baltimore. But there was one major difference. “I didn’t do anything wrong this time,” I said.
“Except alienate those who could help you. This club we’re in is a small one, Nathaniel. Everyone knows everyone, and everyone protects everyone. Especially from the prying eyes of a public that doesn’t take the time to understand what we’re doing. It’s all black-and-white to them.” She took a small bite of her sandwich. “Otto Falk plasters one side of his office wall with the hate mail he’s gotten and the other side with letters from people who are dying as they wait for their kidneys. ‘Burn in hell, you Nazi bastard’ or ‘Please hurry, my brother is going to die without the kidney.’ He’s a devil or an angel in their eyes. But really, he’s just a man. And you—” She looked directly at me. “You don’t understand why everyone doesn’t roll over when you, in a self-righteous fog, browbeat them for information. Dr. Jefferson, for example. You serve two masters, Nathaniel, and I thought they would have told you this in your training. You need to protect the health of a society, sure, but you also need to protect society: its laws and its grant of individual rights—”
“What about the right of people not to be infected?”
“Oh, it would be wonderful if we lived in a police state where any home could be searched and swabbed. Where anybody could be compelled to divulge all the dirty secrets of his or her life to stop an outbreak that may or may not be relevant to the dirty secrets. Have there been any new cases?”
“I don’t know.”
“Well, you should.” She picked up half her sandwich, considered it, and put it down. “Perhaps this is an isolated incident. Perhaps one of the sick women picked it up from someone who traveled in South America and who brought back a new strain of Machupo different enough from the known virus to be missed by your assays. Perhaps this strain is transmi
tted only through sex and blood. If it is, and if it moves as fast as you say, then thank God. It will burn itself out. But if you had your way, we would quarantine all of Baltimore, throw Randall Jefferson in prison, and be done with it.”
I was annoyed now, so I said, “Maybe that’s what we should do.”
“And maybe you see everything in black-and-white. Not a good trait in a scientist or an epidemiologist.”
We ate in silence, me nibbling halfheartedly at my sandwich, getting angrier with each bite. Of all the people who I thought might understand, Harriet Tobel would be the one. “You can’t have everything, Dr. Tobel. And I’m willing to sacrifice some individual rights for the greater good. Forced quarantines work. So damn me if you want. But if we had found Douglas and locked him away for a while, none of this might have happened.”
“But you don’t even know if this Douglas is the key,” she said sharply. I flinched at the vehemence in her tone. “Nathaniel, Nathaniel, Nathaniel.” She smiled, reached across the table, and patted my forearm. “You are such a work in progress, young man. It has been—and is, I must say—beautiful to watch you develop.”
“I think I’m sick of developing. Someone put me in the stop bath, pull me out, let me dry.”
“But that wouldn’t be half as interesting, would it? And you wouldn’t be half the man you will be.”
“I’m glad you have faith.”
“I’ve always had faith. And with you I always will.” She leaned back in her chair. “Well, I will place a call to Randall Jefferson. I imagine there’s not much I can do, but I can try to calm him down. Maybe he’ll tell me something about this young man in whom you’re interested.” She pulled out a PDA and scratched something into the screen. “You said the man’s name was David Buchanan?”
“Douglas. Or Casey. I forgot to tell you that. It’s what he was called out here. It’s pretty damned confusing—” I stopped because of an odd look on Dr. Tobel’s face. “What?”
“Casey? You’re sure it was Casey?”
“Yes. Why?”
“Nothing. Casey what?”
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