“The protein's function isn't essential in the way you think it is, Dr. Wharton,” Asherson said. “It doesn't matter if the whole supply is wiped out—no, I take that back. It does matter, but not in the way you think. It won't hurt me, Dr. Wharton. Quite the reverse. I need that second dose, and you have to give it to me."
“You have to be more specific, Mr. Asherson,” Tom said. “I'd need a sound physiological reason for breaking protocol. You'll have to explain to me exactly what effect you think the second dose will have, and exactly how you've reached that conclusion. If the case were strong enough, I'd have to concede—but the science has to be in place. You understand that, as a biologist."
Asherson hesitated for a moment, then smiled. “Clever bugger, aren't you?” he said. “That's Sandhurst for you. Give me time, and the use of the computer, and I'll put the case together. Every i dotted and every t crossed. You mustn't worry about losing a subject from your test, Mr. Phipps. The drug works, and the subjects will demonstrate that, even if you can't find another K like me. A to J have already shown that it has a modest beneficial effect on patients in worse condition than I was, while I can offer a tantalizing glimpse of its ultimate potential, as well as serving my own purposes. It's all swings and roundabouts, isn't it, Dr. Wharton? I met my wife at the fair, you know. Is she coming to see me today?"
Tom thought very carefully before speaking. Eventually, he said: “All right, Mr. Asherson. I'll give you time to put together a case, and the use of the computer. I want you to do something for me, though. I want to download an IQ test, and I'd like you to complete it, if you would. I still need a way of tracking your progress, you see. Even if you eventually come out of the official trial, I need to monitor you very carefully. You're my patient, remember—you're my responsibility."
“Arsehole,” Asherson said. “Okay, I'll do your test. Don't be surprised if I beat you, though. I was in the SAS."
Tom reached out and took the keyboard, placing it carefully on the desk before starting to type. After a couple of minutes, he said: “It's all set, Mr. Asherson. You have an hour. I'll leave you to it—when you want me to come back, just ask Nurse Odiko to page me."
Simon Phipps wanted to start an argument as soon as they were back in Tom's office, but Tom wouldn't join in. “He's right, Simon,” he said. “He's still confused, but he's right. It would be better if the official trial showed up consistent moderate results—but if he can give us a glimpse of further possibilities without relapsing, going completely off his head or dying on us, we could be way ahead of the game."
“Three big ifs,” Phipps commented. “He's already halfway off his head, if you ask me. Remembering how to play chess is one thing, but putting together a scientific paper evaluating the function of an enkephalin is something else."
“I know,” Tom said. “That's why I asked him to do it. We're in uncharted waters here, Simon—we're not in classical experimental design mode any more, we're in kick-it-and-see-how-it-reacts mode. If his brain can continue to function in any sort of respectable and responsible fashion ... this could be big. Aren't you glad you dropped in?"
“I would be,” Phipps told him, “if I didn't suspect that a passed buck might come flying at my head any second."
William Asherson called them back after forty minutes. He hadn't stopped early because he'd finished the test, but because he'd got bored. “That's good enough,” he said to Tom. He activated the computer's automatic scorer himself, but frowned with dissatisfaction when his score came up as 151. “Shit,” he said. “I used to get that sort of score before. I thought I'd got at least two hundred now. I must have made a few mistakes. Sick sick sick."
“That's okay, Mr. Asherson,” Tom said. “It's still an amazing performance for someone in your situation. We'll try again this afternoon. If you score even higher then..."
“I will,” Asherson promised. “I won't make the same mistakes twice. You can get out again now. I need to prove to you that I'm telling the truth about the second dose—that it can't hurt me, and will do what I need it to do."
Tom obediently left the room again, taking Simon Phipps with him.
“That's one hell of an IQ score!” Phipps said. “Tom, you have got to keep that guy in the trial."
“Don't be ridiculous, Simon,” Tom said, as he hurried along the corridor to his office. “If all LAW-1917 had done was to ameliorate the symptoms of his creeping Alzheimer's, he wouldn't be able to get near an IQ of 151, even if he's telling the truth about racking up that sort of score in his youth. Something strange is happening. He has to be hypersensitive, obviously—but he might just be right about orthodox theory being based on a wrong assumption about the aberrant protein's normal function."
“What's the right assumption, then?” Phipps wanted to know.
“I'm not sure. I'd dearly like to know what he thinks it is, though. Why is he so convinced that he needs a second dose? He could easily be barking up the wrong tree. He might have increased the speed at which he processes information very dramatically indeed, but he's still harboring delusions—and that could be a nasty combination. Efficient logic applied to false premises can lead to seriously weird conclusions."
“I don't follow,” Phipps complained.
“IQ scores are very sensitive to the speed of information processing—they measure fast thinking rather than effective thinking. IQ tests pander to that, by presenting questions that have definite answers reachable by methodical logic. Open-ended questions are a different matter. He might go off the rails when he tries to supply his newfound calculative ability to something less neatly rule-bound than chess. He still thinks he was in the SAS, even though I've told him the truth. What's all this sick sick sick stuff? I thought the first time I heard it that it was one of the idiot puns that Alzheimer's patients sometimes make, twisting six six six ... but even if it were, we'd still have to account for his fascination with six six six.” By now, Tom was sitting in his chair, swinging the rotatable seat from side to side as if the swaying might aid his fevered thought-processes.
“Don't freak out on me, mate,” Phipps said. “If you don't calm down, I'll begin to suspect that you've been sampling the merchandise yourself. What do you think is wrong with the orthodox assumption about the enkephalin whose CAG-repeat variant clogs up the neurons of Alzheimer's sufferers?"
“I'm yet to be convinced that it is wrong,” Tom told him. “Given that natural selection built the protein into the genome and limited its expression to the brain, we have to assume that it serves some neurotransmissive function, and that it continues to serve that function even in the problematic form that eventually causes it to build up into obstructive plaques—in which case, an overdose of any treatment that breaks down the plaques would be bound to sabotage normal brain function. If the new improved Asherson thinks that's wrong, he must think that even at its natural level—the level the healthier form of the protein routinely maintains in your brain and mine—the protein functions as an inhibitor, suppressing the efficiency of calculative thought, and maybe of memory too. Perhaps he thinks that if he takes a second dose, he'll become even smarter than he's already become—some kind of mental superman—or perhaps he thinks that he'll be able to improve his memory to a much greater extent than he's already achieved."
“Might he be right—or is he just crazy?"
“I don't know. If he is right ... well, LAW-1917 is more than a cure for Alzheimer's. If we can get the dose right, maybe we can all be mental supermen with perfect memories. But if that were the case, why would natural selection have equipped us with the enkephalin in the first place? If simply getting rid of it were enough to give us that kind of reward, we'd surely have got rid of it ourselves."
There was a knock on the door then, and Patricia Lockley came in without waiting for an invitation. “I just went in to see Dad,” she said. “He's.... “Words failed her. Her tone was by no means wholeheartedly enthusiastic.
“You were right and I was wrong,” Tom told her.
“It is a miracle."
“Will he be like that forever?” Mrs. Lockley said, hesitantly. Obviously, it wasn't a prospect she found totally attractive. She didn't mean “forever” literally, of course—but Tom didn't know, any longer, where the boundaries of possibility might lie.
“I have no idea,” Tom said. “In patients A to J, the effect continued to develop for several days, but your father has made such a rapid improvement that he might already have peaked—and I have no way of knowing what further effects might materialize."
“He says he's got an IQ of two hundred,” Mrs. Lockley said. “And he's convinced that he was in the SAS. He got angry when I told him that he wasn't. He said I was sick."
“Did he?” Tom asked. “If what he actually said was sick sick sick I don't think he meant you. Do you have any idea what it might mean? That or six six six?"
“That's the number of the beast in the Bible,” she said, promptly.
“Apart from that. Something that sick sick sick might mean to your father, specifically."
“No. He always used to say that he'd never been sick in his life—he was fibbing, of course. He got colds like anyone else, and when it was flu he stayed in bed, like anybody else. Shouldn't you be looking after him if there's a danger of new effects?"
“Sarah will page me if any new symptoms appear,” Tom told her. “Your father's working on a much harder test. He and I both needed time to think."
“What about?” Mrs. Lockley wanted to know.
“The logic of natural selection,” Tom retorted, reflexively. “If he's right, and we're all walking around with our brains permanently muffled, running at a quarter of their potential efficiency, there has to be a logic to the situation—and if we knew what that logic is, we might be able to see why it would be a bad idea to take the muffler off."
“None of the other patients reacted this way, Mrs. Lockley,” Phipps put in, trying to be helpful. “It's just him—something about him. We need to work out what it is, if we can."
“That's not the point, though,” Tom said. “Yes, it's worked much faster and more powerfully on him than it did on anyone else, mercifully without his immune system going into overdrive, so his neuronal intranuclear inclusions must be much easier to break down than the average—but we've already proved that the NIIs can be broken down in other patients. We don't know that there's anything qualitatively different about him. If it's just a matter of degree ... damn!"
He reached into his pocket and pulled out his vibrating pager. “That's Sarah,” he said. “Either Bill's ready to show me his proof, or things have begun to go sour. Let's find out."
* * * *
Tom ran down the corridor and burst into the room reserved for his trial patients. Then he stopped dead, so suddenly that Simon Phipps ran into the back of him. Phipps muttered a curse, but Tom was dumbstruck.
William Asherson was out of bed. He had torn the line out of his forearm and detached the catheter. The sleeve of his gown was stained red. He was holding the hollow needle that had been transmitting fluid into his veins to the side of Sarah Odiko's neck, threatening to drive it into the carotid artery. The nurse was terrified. Asherson's eyes were ablaze with determination.
“Dad!” Patricia Lockley protested, from the doorway. “What are you doing? You're a teacher, for God's sake!"
“I couldn't come up with a sound scientific proof, Dr. Wharton,” Asherson said, mockingly. “But I knew you were bluffing, just to gain time. I'm not. If you don't bring me a second dose of LAW-1917 right now, I'll kill your nurse. I could do it with my bare hands, but the needle seems more symbolically appropriate. Is that a good enough reason for you?"
“Yes it is,” Tom said, without hesitation. “I'll have to fetch the dose from the refrigerated locker in my office, but I'll do it right away. Don't worry, Sarah—everything will be okay."
“If you give him another dose he'll be eliminated from the trial!” Simon Phipps objected.
“I'm threatening to stab a nurse in the neck with a needle, Mr. Phipps,” Asherson pointed out. “I think we can take it as read that I'm no longer a suitable candidate for your trial, don't you?"
“Shut the door behind me, Simon,” Tom said. “Make sure no one else comes in. I'll be back in two minutes.” He wasted no further time before running back down the corridor to do exactly as he'd promised.
Tome unlocked the cooler hurriedly, and measured out a dose of LAW-1917 into a small plastic cup. Then he carried it back to the trial room. He moved swiftly but carefully, to avoid the possibility of spillage.
The tableau within the other room was exactly as he'd left it.
“Here you are, Mr. Asherson,” Tom said. “As your doctor, I have to advise you strongly against taking it. Whatever your opinion is of the quality of my assumptions, an overdose could kill you."
Asherson didn't let Sarah Odiko go. Tom had to lift the plastic cup to the old man's lips himself.
“You wouldn't be trying to fool me with a placebo, would you, Dr. Wharton?” Asherson said.
“No I wouldn't,” Tom told him. “As you said to Simon, you're no longer Patient K. You're off the program—and you're calling the shots. You take it at your own risk. You've been warned."
“Wanker,” Asherson said, and drained the tiny cup. Then he waited. They all waited, for what seemed like a ridiculously long time.
“Let the nurse go, Bill,” Tom said, exercising his very best bedside manner. “You've got what you wanted."
Asherson seemed to have drifted off into a kind of reverie, but Tom's voice brought him back to his senses. He looked at the nurse imprisoned by his left arm, and the needle in his left hand, as if he had never seen either of them before. It was as if he had suddenly reverted to the common state of Alzheimer's patients, who were notoriously prone to episodes in which they completely lost the thread of their existential continuity.
Asherson reacted to the revelation of what he was doing with candid horror. He screamed, and hurled the needle at the wall behind the bed. He released his prisoner and cowered back—as if it were him, not her, who had the right to be terrified.
“Sick sick sick,” he said, in a tone redolent with astonishment. “Sick sick sick.” The second rendition was more plaintive than the first, almost agonized.
William Asherson covered his face with his hands, clutching at his eyebrows. It was almost as if he were trying to tear out his own eyes, but couldn't quite get a grip on them. He wailed, but not loudly. It was more like an animal in despair than one in pain.
Patricia Lockley came forward and put her arms around Sarah Odiko protectively, as if to offer a guarantee that no further harm could come to her.
“It's okay, Mr. Asherson,” Tom was quick to say. He reached out a hand as if in reassurance, but his legs refused to take a step forward. He was frightened of what his patient might do, if the old man's next abrupt change of mood proved to be less self-accusing.
“What the hell do you know?” Asherson demanded. “Just because you've been to Sandhurst."
“I've never been to Sandhurst,” Tom told him, quietly. “I'm Dr. Thomas Wharton—Tom. I went to Bristol University Medical School. I work here, at St. Jude's Hospital, carrying out clinical trials on behalf of an assortment of biotech companies. There's nothing to be afraid of, Mr. Asherson. Please get back into bed."
Asherson's hands came away from his face, and he looked Tom straight in the eye. “I was never in the SAS,” he whispered. “I was so sure ... but I'm a liar. I'm just a liar, too stupid to see through his own lies. I fooled myself. No one else—just myself. Why?"
The color seemed to have drained from the old man's previously florid face, and for a moment or two Tom was certain that his patient was about to faint. That certainty enabled him to take a step forward, anticipating that he might have to catch Asherson as he fell—but Asherson didn't fall. Instead, he moved, faster than anyone could have anticipated.
Asherson shoved Simon Phipps aside in order to clear a route to the
door that wouldn't compel him to bowl over his daughter and Sarah Odiko. Tom had closed the door behind him when he'd come back with the second dose of LAW-1917, but Asherson seized the handle and twisted, then slammed the door back against the wall so hard that Tom heard the hinges splinter.
Asherson was already running down the corridor.
Tom grabbed hold of Simon Phipps to prevent him from falling over. “Look after Sarah and Mrs. Lockley,” Tom instructed him, tersely. “Shut the door. Don't let anyone in until I come back.” He didn't really expect to be obeyed, but he wanted to feel that he was still in control.
* * * *
Tom followed William Asherson, running as fast as he could. He knew that he wouldn't be able to outpace the old man unless and until they got to an open space where his strength and stamina would give him a clear advantage, but he figured that it was only a matter of time.
Asherson didn't head downstairs. Instead he went up—and then further up, toward the roof. The hospital building they were in, Tom knew, was seven stories high. If Asherson's intention was to hurl himself off the roof, he'd have no difficulty in finding a strip of bare concrete to aim at. There was no chance whatsoever of a man of his age surviving such a fall.
The door to the roof was locked, but Asherson smashed the lock. He was an old man, but he'd been teaching PE for most of his life. He still had powerful muscles, and he was possessed by the recklessness of absolute determination.
Tom couldn't latch the door behind him, but he was able to pull it to. Their chase had been observed and noted by half a hundred people, so someone would undoubtedly have notified security, but Tom was reasonably confident that anyone following him would be very discreet in opening the door to see what was happening, even if Simon Phipps wasn't there to explain. This was by no means the first time the hospital had had a potential jumper on the roof, and the procedure for trying to prevent a jumper from taking the irrevocable step was almost as well known and well respected as the drug trial protocols.
Mercifully, Asherson was still sane enough to hesitate when he reached the parapet protecting the edge of the roof. He was still sane enough to look back at Tom. Tom was reassured to see that the old man now looked rueful, ashamed of his own stupidity
Asimov's SF, July 2007 Page 4
