Isolation Ward

by Joshua Spanogle

  This guy was definitely pissing me off.

  As I was about to rip into Yonnick, a voice came from behind me. “Dr. McCormick?”

  Alaine. I turned.

  “Why don’t we talk outside?” she said, and, without waiting for me to agree, turned away. I followed her out into the hall to an office a few yards from the lab entrance. She opened the door, but didn’t enter.

  “You should go.” Alaine’s tone was chill and businesslike. Seems Dr. Chen did a better job of compartmentalizing than I did. It was like the embrace a quarter hour ago never happened for her.

  “The room in the tape, Alaine—where was it?”

  “Dr. McCormick . . .”

  “It’s Doctor now?”

  “Nathaniel. We need to take care of some things here. I’ll talk to you about it later.”

  “Tell me about Dr. Tobel’s work. The Chimeragen work, the work with HIV.”

  “Please go.”

  “I need to find out everything she was working on. I need to know what’s going on here. For the Chimeragen work, what tissue samples are you testing? Dr. Tobel said you were at the point of human trials, so I’m assuming the samples are human. Where are these people? Are they in the community?”

  Her face stayed stony.

  “I can call the FDA and get access to all this stuff anyway.” That was a bluff. Though I could lean on the FDA to find out the protocols of Dr. Tobel’s work, it would take days, if not weeks, to do so. And I would have to make a compelling case to them that I needed the information. Compelling wasn’t necessarily what I had. . . .

  I waited a moment for Dr. Chen to crack. She didn’t; I shook my head. “Okay, Alaine. Thanks for your help.”

  I turned my back on her and walked down the hall. Before descending the steps, I turned to look at her. Our eyes met; hers betrayed nothing. A thick curtain had descended around Alaine and around the entire lab. It was impressive and creepy. And, to be totally honest, hurtful.

  “I don’t know what masters you’re serving, Alaine. You’re doing wrong, here. You know it and I know it.”

  But if her blank look was any indication, Alaine Chen did not give a shit.

  CHAPTER 60

  The car was baking hot. I sat with the door wide-open, one leg inside, one outside resting on the tire of the Porsche parked next to me. I’d just ended a call with Larry Tobel, who’d gotten into town a few hours earlier. He’d asked about the dogs, asked about the broken window at the Tobel house, and told me when and where the funeral was to be held.

  After the call, I closed my eyes, felt the sweat leak from under my arms. I tried to piece together what the hell was going on here; I felt like I was working with fifty pieces in a thousand-piece jigsaw puzzle.

  The medical library, for years one of the school’s most acute embarrassments, was blissfully unchanged. The uncomfortable chairs, the two inadequate portable air conditioners, the god-awful study bins were exactly as I’d left them ten years before. Promises of a new facility—plans were drawn and redrawn—were still clearly only promises. I wondered how long until the student body would finally crack and make a run on the dean’s office with torches, pitchforks, and malfunctioning copy cards.

  I found a computer in what was called the research alcove, an ugly little room off to one side of the library. Computers sat on blond wood tables that looked like they’d been pilfered from an elementary school circa 1975. I pulled a chair to the computer and turned the monitor to the wall. One of the portable air conditioners hummed away, creating an antarctic microclimate around me while the rest of the library fried.

  At least it will keep me awake, I thought.

  I wanted to begin my research at, well, the beginning. Luckily, the entire campus was networked to the same databases, so I was able to access Westlaw even from the medical library. I wanted to check on any court cases that might explain what I’d seen happening on the tape. I typed in rape and the name of the university. Six things came up: something about a junior baseball player who’d raped another student a couple years back; a number of cases of rapists who had taken degrees at the university. Nothing about a rape at the medical center.

  Well, I wasn’t comfortable with the law anyway. Back to medicine. I logged on to PubMed, typed in Harriet Tobel’s name, and got a list of more than a hundred publications. A quick scan through the titles showed me none of them had anything to do with the Chimeragen project. Her most recent work was interesting, but probably not relevant: HIV vaccine work in collaboration with a researcher called Bonner at the University of California, San Francisco. I printed out the articles anyway and glanced through them. The thrust of the work involved mutating the HIV virus to a nonlethal strain and inoculating monkeys. The results, according to the articles, were promising but inconclusive.

  Inconclusive, good word.

  I Googled Chimeragen and cruised through its Web site. It was mostly marketing bullshit: an unending supply of organs for those in need, the dawning of “a new day in medicine” led by none other than Chimeragen, that sort of trash. The company, claimed the Web site, was backed by sterling venture capital. The market potential for “made-to-order” kidneys alone would be worth billions. Actually, it was pretty sexy stuff, the kind of revolutionary thing that made you want to throw in some disposable income, get your return, and buy that house in Martha’s Vineyard you’d always wanted.

  I went to the page that listed the officers of the company. Otto Falk—that eminent transplant surgeon—was there, of course, as Chief Science Officer. The name of the CEO, however, surprised me: Ian Carrington, Alaine’s fiancé. I guessed Carrington was part of one of the venture groups backing Chimeragen and they wanted one of their own at the helm. Understandable, I guessed. But the connections jarred me. Alaine Chen was second in command at the lab charged with independently validating the risks of the procedures financed by Chimeragen. Alaine and Ian Carrington, CEO of Chimeragen, were engaged. Conflict of interest here? Hmmm.

  After a few more minutes, I found out just how far Chimeragen had progressed. Dr. Tobel had mentioned that the company was just about to enter Phase Three. Indeed, this was corroborated by the information on the Web site. Human trials for Chimeragen had been underway for over a year now, with “extremely promising preliminary results.” I went on to the Web site’s public relations area, filled with articles that, to put it lightly, gushed about the company’s prospects. And I thought hyperbolic press coverage died with the dot-coms.

  I printed out some of the juicier stuff.

  By that time, the subzero temperatures were getting to me. But I still had some digging left to do on the Big Kahuna himself, Otto Falk, Chimeragen’s Chief Science Officer. I went to the main section of the library, to actual print and paper, to where the air-conditioning couldn’t reach. There, in the subtropical temperature, I found a few books that Falk had either written or edited. To say this guy was a leader in the field would be a disservice to him: Falk was the leader. One of the books I found had a time line of the man’s accomplishments:

  1969: Monkey-to-human kidney transplant. Patient lived five days.

  1971: Porcine kidney transplants into two patients. One lived two weeks, the other for almost a month.

  1979: Porcine pancreas transplant. Patient lived for eight days.

  1986: Baboon heart transplant into infant. Patient lived two weeks.

  And on and on. The procedures gradually became more complicated and the patients lived longer. It was truly amazing stuff.

  1998: Porcine kidney transplant. Patient lived for three months.

  1999: Porcine liver transplant. Patient lived for two months.

  2001: Porcine kidney transplant. As of this printing, patient is still alive.

  I stopped on a chapter, written by Falk, entitled: “The Case for Human Experimentation in Xenotransplantation.” Fascinating. The intro to the piece said that the text was originally presented to a gathering of the American Society of Transplant Surgeons in the midnineties an
d that it generated a storm of controversy. When I read it, I understood why.

  The gist of Falk’s speech was that the time had come “truly to test, in a rigorous and controlled manner, the promise of xenotransplantation.” For Falk, testing in a rigorous and controlled way involved putting animal organs into brain-dead individuals and observing them. He wrote: “Transplanting a porcine kidney into an otherwise healthy human and monitoring that individual for a day would yield more relevant data than performing a thousand transplants into primates and watching them for a year.” He proposed asking the families of brain-dead individuals—those grievously injured in automobile crashes, for example—to allow him to use the bodies of their loved ones.

  I thought about the woman who’d been raped. My God, I thought.

  Back at the computer, I ran a PubMed search of Otto Falk’s articles. I was looking for anything he’d published on clinical trials using xenotransplants. Not surprisingly, I found nothing; what I did find were the case reports on the one-offs he’d done with sick individuals and a bunch of animal studies. I wondered, though, if the human trials that Chimeragen was conducting had anything to do with brain-dead individuals. If Falk was conducting the studies with Chimeragen, it meant he could keep the progress under wraps with nondisclosure agreements. Even exchanges with the FDA could be corralled and controlled.

  It was getting late and I wanted to do a little more digging in the hospital before everyone left for the day. Specifically, I wanted to talk to the functionary who would know about all goings-on in his or her domain, someone whose language I could speak.

  CHAPTER 61

  “Could you tell me where to find the hospital epidemiologist?” I was standing near the main entrance to the hospital, talking to an elderly black lady in a fantastic pink hat.

  My question seemed to throw her for a second; the poor woman was probably wondering what kind of crackpot complaint I had that I needed an epidemiologist. She blinked twice, then fished a large book from under her table. It took her a few minutes to find the room and telephone numbers. She scribbled the digits on a small scrap of paper.

  “G wing is down to the right. It’s somewhere over there. I’ve never been there, so you’ll have to ask around.”

  Okay, a medical truth: all hospitals are impossible to navigate. I’ve seen a lot of them and have come to the conclusion they were all designed by the same madman, or at least by his architectural firm. Add to this that I hadn’t done my rotations at this medical school, in this hospital, so I didn’t know the surgery wing from the medicine wing from my elbow.

  It took me ten minutes and as many requests for directions to find the epidemiologist’s office—off the main hallway, tucked deep in a warren of offices and narrow corridors. Surprisingly, the doctor was in, her door open. I knocked on the door frame and Elizabeth Perry, MD, spoke without looking up from her computer. “Yes?”

  I introduced myself. “CDC” got her attention, and she stopped noodling away on the keyboard.

  “Is there a problem?”

  “No,” I said. “At least I don’t think so.”

  Perry, a large woman with glorious skin and a perfect coiffure, sat rigidly in the chair. Then she asked, “How can I help you?”

  “I understand you house a few comatose or vegetative patients in the hospital . . .” I let the statement fade, hoping she’d fill in the details.

  “Yes,” Perry said, not filling in the details.

  “Where are these patients located?”

  That seemed to confuse her, not because she wasn’t sharp but because my question was sort of asinine. “I’m not sure I follow you, Doctor. We have patients in the CCU and ICU in comas. On the medicine ward—”

  “Any patients in a persistent vegetative state here?” PVS, as it’s called, is different from a coma. Strictly defined, it is “wakefulness without awareness.” In layman’s terms, it means that almost all brain function has ceased except for the normal sleep cycle and basic reflexes.

  “If they’re in a PVS, we usually ship them to long-term care facilities.”

  “But do you have any patients here?”

  “What’s this about, Doctor . . . ?”

  “McCormick.”

  “Dr. McCormick. I’m sorry I’m distracted. You caught me in the middle of dousing a small fire. We had a Serratia outbreak on the cardiac care unit last month and, well, you know the paperwork.”

  “That’s what medicine is, right? Paperwork.”

  “Sad but true. Can you tell me why you’re here?”

  “Nothing official,” I said, gearing up for another lie. “I went here for medical school and happened to be in the area. One of my pet interests at CDC is infection control measures for PVS patients. Just thought I’d pop in to see if you house any people here.”

  Dr. Perry looked doubtful.

  “Like I said, this is for my own satisfaction,” I blathered on. “Eventually, I might do a cross-institutional study on protocols and procedures”—lie—“but for now I just wanted a heads-up as to what was going on. I figured it was worth checking out my alma mater.”

  “Fair enough.” She relaxed a bit and sat back into her chair, but I noticed she still hadn’t invited me to sit. “Like I said, we usually ship patients to long-term care if they’re in a PVS for longer than a few weeks. However”—she swiveled and batted a few things into the computer—“we do have some folks you might be interested in. It’s not a normal situation, really, but it shows what we’re doing with infection control.” She was frowning slightly. “If you want to look at our protocol for the intensive care unit, where you’ll find a lot of comatose patients, I can give you all our paperwork.”

  “Great,” I enthused.

  “And you’re more than welcome to roam around up there if you like. I’ll call and get you a visitor’s pass.”

  “That’s terrific,” I said. “But I’m more interested in the situation you were telling me about before. The one that wasn’t normal?”

  “Well, I spoke too soon. There’s relatively tight security down there. A faculty member here is conducting a study with a few PVS patients, and no one’s allowed to see the patients but family and those involved with the study.”

  “What’s the study about?”

  “Oh.” She shook her head. “The study. I would wash my hands of this, Dr. McCormick, except for the fact that it’s in my hospital and I’m responsible for infection control. But I must tell you, I do not approve of what’s going on here. The ethics are—how shall I say?—debatable, to say the least.”

  “So, why is the study continuing?”

  “Money and glory, simple as that. And I don’t like it.” She narrowed her eyes and studied me. “Another reason I don’t like it is that I’m worried I’m sitting on a bomb. May I see your CDC credentials, please?”

  The non sequitur took me aback. But I managed to find my badge and hand it over. She perused it, looked hard at the picture, then hard at my face. As she handed it back, she said, “I was an EIS officer many moons ago.”

  “Where?”

  “Austin, Texas, of all places. Where are you?”

  “I’m in Atlanta. I’m Special Pathogens, so I get to go all over.”

  “You’re out here for work?”

  “Well, yes, but like I said, I’m here right now to satisfy my own curiosity.” I just kept shoveling more of it. From her look, I could tell she didn’t buy it.

  “Well, that’s too bad, actually. If you were here on official business, I would feel obliged to show you all you wanted to see. But if this is just personal . . .”

  We stared at each other.

  “But if it were official,” I said, “it might alert some people who, at this time, I’d rather not alert.”

  “Then I wonder,” she replied, “if it would be possible to make this an official visit only if we needed to.”

  “You mean . . . ?”

  “I mean if any shit hits any fan, Dr. McCormick, I will be able to cover for myse
lf and the hospital. Forgive the profanity.”

  “I have an amazing ability to draw shit in my direction,” I said. “Forgive the image.”

  Elizabeth Perry laughed. “All right, then, Doctor, I think we understand each other. I want you to know that I don’t believe anything untoward is going on; if it were, I’d scream bloody murder. But I also don’t care for the secrecy surrounding this. Medicine should be an open book, and I figure the more people know, the better.”

  She picked up the telephone and dialed a number. “This is Dr. Perry. Who is this?” she asked. “Okay, Tom. I’m sending someone down to you. Dr. McCormick. He’s just coming to look around.” She paused. “I don’t know if he’s cleared or not, but he’s cleared by me, all right? Dr. McCormick’s an epidemiologist checking out our stellar infection control down there.” She listened for a moment. “Thanks. Oh, another thing, Tom—I don’t want to deal with the darn paperwork, so do me a favor and don’t tell anyone from the company or the Tobel or Falk labs that Dr. McCormick was there.” Another pause. “Thanks.” And she hung up the phone.

  “Tobel or Falk labs?” I asked.

  “Yes. You’re familiar?”

  “You could say that.”

  She scribbled something on a slip of paper. “Here’s the suite number. It’s in the basement, near the morgue. Fitting, no?”

  Fitting or not, I didn’t know, but some things were coming together for me. Though I thought I knew the answer to my question, I asked it anyway. “What is this ethically dubious study? You never told me.”

  Dr. Perry opened her arms in a mocking way, like she was presenting something grand to an audience. “Pigs, Dr. McCormick. They’re putting pig parts into brain-dead people down there. In my hospital.”

  CHAPTER 62

  In ten minutes, I was standing at what looked like a nurses’ station. To the left were two double doors with a key card lock to the side.

  The nurse, a big white guy in his forties who looked like he might moonlight as a heavy for the Corleones, was reading a book. He raised his eyes as I approached the desk.