by Robin Cook
“Dr. Howard, I’m Leonard Dawen,” the man said, motioning Jason into the room. He didn’t offer to shake hands. His voice had the same commanding quality Jason remembered from the phone conversation. Compared to the tomblike austerity of the rest of the building, the conference room looked more like a wood-paneled library and seemed positively cozy until you looked at the fourth wall, which was glass. It looked out on what appeared to be a large ultramodern lab. There was another man in the room, an Oriental, wearing a white zippered jumpsuit. Dawen introduced the man as Mr. Hong, a Gene, Inc., engineer. After they were all seated around a small conference table, Dawen said, “I assume you have the lab book….”
Jason opened his briefcase and handed the ledger to Dawen, who handed it to Hong. The engineer began studying it page by page. A heavy silence ensued.
Jason looked back and forth between the two men. He’d expected things to be a bit more cordial. After all, he was doing them a favor.
He turned and peered through the glass wall. The floor of the room beyond was a story below. Much of the area was filled with stainless steel vats, reminding Jason of a visit he’d once made to a brewery. He guessed they were the incubators for the culture of the recombinant bacteria. There was a lot of other equipment and complicated piping. People in white jumpsuits with white hoods were moving about checking gauges, making adjustments.
Hong closed the lab book with a snap. “It seems complete,” he said.
“That’s a nice surprise,” Dr. Dawen said. Turning to Jason he said, “I hope you realize everything in this book is confidential.”
“Don’t worry,” Jason said, forcing a smile. “I didn’t understand much of it. What I’m interested in is Dr. Hayes. Just before he died he said he’d made a major discovery. I’m curious to know if what is described in those pages would be considered as such.”
Dawen and Hong exchanged glances. “It’s more of a commercial breakthrough,” Hong said. “There’s no new technology here.”
“That’s what I suspected. Hayes was so distraught I couldn’t tell if he was entirely rational. But, if he made a major breakthrough, I’d hate to have it lost to humanity.”
Dawen’s blunt features softened for the first time since Jason had arrived.
Jason continued, directing his attention to the engineer. “Any idea what Hayes could have been talking about?”
“Unfortunately, no. Hayes was always rather secretive.” Dawen folded his hands on the table and looked directly at Jason. “We were afraid you were going to extort us with this material — make us pay to get it back,” he said, touching the cover of the lab book. “You have to understand that Dr. Hayes had been giving us a rather difficult time.”
“What was Dr. Hayes’s role here?” Jason asked.
“We hired him to produce a recombinant strain of bacteria,” Dawen explained. “We wanted to produce a certain growth factor in commercial quantities.”
Jason guessed that was the Somatomedin.
“We agreed to pay him a flat fee for the project, as well as letting him use the Gene, Inc., facilities for his own research. We have some very unique equipment.”
“Any idea what his own research involved?” Jason asked.
Hong spoke up. “He spent most of his time isolating growth-factor proteins. Some of them exist in such minute quantities that the most sophisticated equipment is required to isolate them.”
“Would the isolation of one of these growth factors be considered a major scientific discovery?” Jason asked.
“I can’t see how,” Hong replied. “Even if they’ve never been isolated, we know their effects.”
Another dead end, Jason thought wearily.
“There’s just one thing I remember that might be significant,” Hong said, pinching the bridge of his nose. “About three months ago Hayes got very excited about some side effect. He said it was ironic.”
Jason straightened. There was that word again. “Any idea what caused his excitement?” he asked.
Hong shook his head. “No,” he said, “but after that we didn’t see him for a time. When we did see him, he said he’d been to the Coast. Then he set up an elaborate extraction process on some material he’d brought back with him. I don’t know if it worked, but then he abruptly switched to monoclonal antibody technology. At that point his excitement seemed to die.”
The words “monoclonal antibody” reminded Jason of the second lab book, and he wondered if he shouldn’t have brought it after all. Maybe Mr. Hong could have made more out of it than he had.
“Did Dr. Hayes leave any other research material here?” Jason asked.
“Nothing significant,” Leonard Dawen answered. “And we checked carefully, because he’d walked off with our lab book and the cultures. In fact, we were suing Dr. Hayes. We never anticipated he would try and contend he owned the strains that we’d hired him to produce.”
“Did you get your cultures back?” Jason asked.
“We did.”.
“Where did you find them?”
“Let’s say we looked in the right place,” Dawen said evasively. “But even though we have the strain, we still appreciate getting the protocol book back. On behalf of the company, I’d like to thank you. I hope we have helped you in some small way.”
“Perhaps,” Jason said vaguely. He had an idea he’d inadvertently found out who had searched Hayes’s lab and apartment. But why would the scientists from Gene, Inc., want to kill the animals? He wondered if the huge animals had been treated with Gene, Inc.’s, Somatomedin. “I appreciate your time,” he said to Dawen. “You have an impressive setup here.”
“Thank you. Things are going well. We plan to have recombinant strains of farm animals soon.”
“You mean like pigs and cows?”
“That’s right. Genetically we can produce leaner pigs, cows that produce more milk, and chickens that have more protein, just to give you a few examples.”
“Fascinating,” Jason said without enthusiasm. How far away could they be from genetically engineering people? He shivered again, seeing Hayes’s outsized rats and mice, especially those with supernumerary eyes.
Back in the car, Jason glanced at his watch. He still had an hour before the staff meeting being held to go over recent patient deaths, so he decided to visit Samuel Schwartz, Hayes’s attorney.
Starting the car, Jason backed out of the Gene, Inc., parking lot and worked his way over to Memorial Drive. He crossed the Charles River, stopping at Philip’s Drug Store on Charles Circle. Double-parking with his emergency light blinking, he ran into the store and looked up Schwartz’s address. Ten minutes later he was in the lawyer’s waiting room, flipping the pages of an outdated Newsweek.
Samuel Schwartz was an enormously obese man with a glistening bald head. He motioned Jason into his office as if he were directing traffic. Settling himself into his chair and adjusting his wire-rimmed glasses, he studied Jason, who had seated himself in front of the massive mahogany partner’s desk.
“So you are a friend of the late Alvin Hayes….”
“We were more colleagues than friends.”
“Whatever,” Schwartz said with another wave of his chubby hand. “So what can I do for you?”
Jason retold Hayes’s story of a purported breakthrough. He explained that he was trying to figure out what Hayes had been working on and had come across correspondence from Samuel Schwartz.
“He was a client. So what?”
“No need to be defensive.”
“I’m not defensive. I’m just bitter. I did a lot of work for that bum and I’m going to have to write it all off.”
“He never paid?”
“Never. He conned me into working for stock in his new company.”
“Stock?”
Samuel Schwartz laughed without humor. “Unfortunately, now that Hayes is dead, the stock is worthless. It might have been worthless even if he had lived. I should have my head examined.”
“Was Hayes’s corporation goi
ng to sell a service or a product?” Jason asked.
“A product. Hayes told me he was on the verge of developing the most valuable health product ever known. And I believed him. I figured a guy who’d been on the cover of Time had to have something on the ball.”
“Any idea what this product was?” Jason asked, trying to keep the excitement out of his voice.
“Not the foggiest. Hayes wouldn’t tell me.”
“Do you know if it involved monoclonal antibodies?” Jason asked, unwilling to give up.
Schwartz laughed again. “I wouldn’t know a monoclonal antibody if I walked into it.”
“Malignancies?” Jason was only fishing, but he hoped he could jog the lawyer’s memory. “Could the product have involved a cancer treatment?”
The obese man shrugged—“I don’t know. Possibly.”
“Hayes told someone that his discovery would enhance their beauty. Does that mean anything to you?”
“Listen, Dr. Howard. Hayes told me nothing about the product. I was just setting up the corporation.”
“You were also applying for a patent.”
“The patent had nothing to do with the corporation. That was to be in Hayes’s name.”
Jason’s beeper startled both men. He watched the tiny screen. The word “urgent” blinked twice, followed by a number at the GHP hospital. “Would it be possible to use your phone?” Jason asked.
Schwartz pushed it across the desk. “Be my guest, doctor.”
The call was from Madaline Krammer’s floor. She’d arrested and they were giving her CPR. Jason said he’d be right there. Thanking Samuel Schwartz, Jason ran from the lawyer’s office and impatiently waited for the elevator.
When he got to Madaline’s room, he saw an all too familiar scene. The patient was unresponsive. Her heart refused to respond to anything, including external pacing. Jason insisted they continue life support while his mind went over various drugs and treatments, but after an hour of frantic activity, even he was forced to give up and he reluctantly called a halt to the proceedings.
Jason remained at Madaline’s bedside after everyone else had left. She’d been an old friend, one of the first patients he’d treated in his private practice. One of the nurses had covered her face with a sheet. Madaline’s nose poked it up like a miniature snow-covered mountain. Gently, Jason turned it back. Even though she had been only in her early sixties, he couldn’t get over how old she looked. Since she’d entered the hospital, her face had lost all its cheerful plumpness and taken on the skeletal cast of those nearing death.
Needing some time by himself, Jason retreated to his office, avoiding both Claudia and Sally, who each had a hundred urgent questions about the upcoming conference and the problems of rescheduling so many patients. Jason locked his door and settled himself at his desk. As such an old patient, Madaline’s passing seemed like the severing of one more connection to Jason’s former life. Jason felt poignantly alone, fearful, yet relieved, that Danielle’s memory was receding.
Jason’s phone rang, but he ignored it. He looked over his desk, which was a mass of stacked hospital charts of deceased patients, including Hayes’s. Involuntarily, Jason’s mind went back to the Hayes affair. It was frustrating that the package from Carol, which had held such hope, had added so little information. It did give a bit more credence to the idea Hayes had made a discovery that at least he thought was stupendous. Jason cursed Hayes’s secrecy.
Leaning back, Jason put his hands behind his head and stared up at the ceiling. He was running out of ideas about Hayes. But then he remembered the Oriental engineer’s comment that Hayes had brought something back from the Coast, presumably Seattle. It must have been a sample of something because Hayes had subjected it to a complicated extraction process. From Hong’s comments, it seemed to Jason that Hayes had probably been isolating some kind of growth factor which would stimulate growth, or differentiation, or maturation, or all three.
Jason came forward with a thump. Remembering that Carol had said Hayes had visited a colleague at the University of Washington, Jason suddenly entertained the idea that Hayes had obtained some kind of sample from the man.
All at once, Jason decided he’d go to Seattle, provided, of course, Carol would go along. She might. After all, she’d be the key to finding this friend. Besides, a few days away sounded extremely therapeutic to Jason. With a little time left before the staff meeting, Jason decided to stop by and see Shirley.
Shirley’s secretary at first insisted that her boss was too busy to see Jason, but he convinced her to at least announce his presence. A moment later he was ushered inside. Shirley was on the phone. Jason took a seat, gradually catching the drift of the conversation. She was dealing with a union leader, handling the person with impressive ease. Absently she ran her fingers through her thick hair. It was a wonderfully feminine gesture, reminding Jason that underneath the professional surface was a very attractive woman, complicated but lovely.
Shirley hung up and smiled. “This is a treat,” she said. “You are filled with surprises these days, aren’t you, Jason? I suppose you’re here to apologize for not having spent more time with me last night.”
Jason laughed. Her directness was disarming. “Maybe so. But there’s something else. I’m thinking of taking a few days off. I lost another patient this morning and I think I need some time away.”
Shirley clicked her tongue in sympathy. “Was it expected?”
“I guess so. At least over the last few days. But when I’d admitted her I had no idea she was terminal.”
Shirley sighed. “I don’t know how you deal with this sort of thing.”
“It’s never easy,” Jason agreed. “But what’s made it particularly hard lately is the frequency.”
Shirley’s phone rang, but she buzzed her secretary to take a message.
“Anyway,” Jason said, “I’ve decided to take a few days off.”
“I think it’s a good idea,” Shirley said. “I wouldn’t mind doing the same if these damned union negotiations conclude. Where are you planning to go?”
“I’m not sure,” Jason lied. The trip to Seattle was such a long shot that he was ashamed to mention it.
“I have some friends who own a resort in the British Virgin Islands. I could give them a call,” Shirley offered.
“No, thanks. I’m not a sun person. What’s happened about the Brennquivist tragedy? Much fallout?”
“Don’t remind me,” Shirley said. “To tell you the truth, I couldn’t face it. Bob Walthrow is handling that.”
“I had nightmares all night,” admitted Jason.
“Not surprising,” Shirley said.
“Well, I’ve got a meeting,” Jason said, getting to his feet.
“Would you have time for dinner tonight?” Shirley asked. “Maybe we can cheer each other up.”
“Sure. What time?”
“Let’s say around eight.”
“Eight it is,” Jason said, heading for the door. As he left, Shirley called after him.
“I’m really sorry about your patient.”
* * *
The staff meeting was better attended than Jason had expected, given such short notice. Fourteen of the sixteen internists were there, and several had brought along their nurses. It seemed obvious they all recognized they were facing a serious problem.
Jason started with the statistics that he’d extracted from the computer printout listing all patients who’d died within a month of a complete physical. He pointed out that the number of deaths had increased in the last three months, and said he was trying to check up on all GHP clients who’d had executive physicals in the last sixty days.,
“Were the physicals evenly distributed among us?” Roger Wanamaker asked.
Jason nodded.
A number of the doctors spoke out, making it clear they feared the start of a nationwide epidemic. No one could understand the connection with the physicals, and why the deaths were not being anticipated. The acting chief of cardi
ology, Dr. Judith Rolander, tried to take much of the blame on herself, admitting that in most of the cases she’d reviewed, the EKG done during the physical did not predict the imminent problems, even when she was armed with hindsight.
The conversation then switched to stress testing as the main key to predicting catastrophic cardiac events. There were many opinions on this issue; all were duly discussed. Upon recommendation from the floor, an ad hoc committee was formed to look into specific ways to alter their stress testing in hopes of increasing its prognostic value.
Jerome Washington then took the floor. Getting heavily on his feet, he said, “I think we’re overlooking the significance of unhealthy lifestyles. That’s one factor that all these patients seem to share.”
There were a few joking references to Jerome’s weight and his affection for cigars. “All right, you guys,” he said. “You know patients should do what we say and not what we do.” Everyone laughed. “Seriously,” he continued. “We all know the dangers of poor diet, heavy smoking, excess alcohol and lack of exercise. Such social factors have far more predictive value than a mild EKG abnormality.”
“Jerome is right,” Jason said. “The poor risk-factor profile was the only negative commonality I could find.”
By a vote, it was decided to form a second committee to investigate risk-factor contribution to the current problem and come up with specific recommendations.
Harry Sarnoff, the current month’s consulting cardiologist, raised his hand, and Jason recognized him. When he got to his feet, he began to talk about noticing an increase in morbidity and mortality for his inpatients. Jason interrupted him.
“Excuse me, Harry,” Jason said. “I can appreciate your concern, and frankly I’ve had experience apparently similar to yours. However, this current meeting involves the problem with the outpatient executive physicals. We can schedule a second meeting if the staff desires to discuss any potential inpatient problem. They very well may be related.”
