“Pigs?” Wayne said, hardly believing he’d heard her correctly. “You want to put a pig organ in me? Is that all I am to you . . . someone to experiment on?”
“It’s the only way I could think of to help you.”
“Pigs . . . a pig organ. They can do that? And it’ll work?”
“They think so, or they wouldn’t try. But you’d be the first human they’ve ever worked with. They’ve had success transplanting pig livers to other primates, but you have to understand that the technique is entirely experimental. There’d be no guarantees.”
“Why pigs?”
“Their organs are anatomically similar to humans, and they’re the right size. And since we already use pigs for food, it doesn’t create an ethical problem.”
“How is this possible? Won’t my immune system reject the organ immediately because it’s not human?”
“They’ve altered the donor animals so their cells don’t contain the surface markers that create the worst mismatch. And they have several animal lines that mimic the various human blood types. The leader of the Monteagle team told me that the livers from their animals are as compatible as any human liver a person might receive from an unrelated donor of the same blood type, which is about the only tissue-matching requirement used for livers.”
Wayne got up and began to pace. “A pig liver . . . It sounds bizarre.”
“It is bizarre at this point. But that’s only because it’s never been done. A few years from now, it could be routine.”
“Or some factor they didn’t anticipate could go wrong, and I’ll die.”
“That’s certainly a possibility.”
Hands in his pockets, eyes on the beige carpet, Wayne resumed his prisoner’s stroll, his tongue making sucking sounds against his teeth. On his third trip over the same course, he turned and looked at Chris. “I don’t see that I have much choice. When’s the interview?”
“Three thirty tomorrow. Meet me in my office at three, and we’ll drive over there together.”
“Despite what I said earlier, I do appreciate you setting this up. It just took me by surprise.”
“I hope it works.” Chris got out of her chair and moved toward the door. “Now, it’s been a long day.”
“I understand.” Wayne walked quickly to the door, which Chris opened for him. Before leaving, he paused and touched her arm. “It’s been great seeing you.”
Chris wasn’t sure what she’d have done if he’d tried to kiss her, but fortunately, he didn’t. When he was gone, she felt the tension flow out of her. It had gone as well as it could, but the experience had drained her. She picked up the book Wayne had brought her and reread the dedication, wanting to believe it had indeed been written as dated. Then she sat down with the book, turned to the first paragraph, and began reading.
She finished the book at twelve thirty, disappointed once again. Even with the spineless-father theme pointed out to her, she found that the story contained little relevance to her own situation. Just one more instance where dear old Dad failed to deliver.
With a full day facing her tomorrow, she showered and crawled into bed, where she thought briefly about the significant potential problem with pig transplants she hadn’t mentioned to her father, mostly because she wasn’t up on the latest developments. No matter. Michael Boyer, the head of the transplant team, would certainly brief him.
But she couldn’t wait for that. Tomorrow, Boyer would want her response to the favor he’d requested when she’d called him about Wayne. And she didn’t want to be making her decision just using information he’d given her. She wanted some hard data to examine. So first thing in the morning, she’d dive into the literature.
LITTLE CHRISSY STOOD frozen at the corner, watching the crossing guard urgently motioning her forward. But her legs wouldn’t move. Across the street old Mrs. Lipinski was looking real mad. She hated Mrs. Lipinski and that terrible old closet, but if she didn’t go to her, there’d be trouble.
Chrissy looked back at the little white house next to her school, hoping to see the red truck or, even better, her father himself. She didn’t understand why he no longer lived at home, but was sure that she’d done something so terrible he didn’t want to be around her anymore. It had been a year since he’d left and moved into the white house with another woman that her mother had called a slug, or slut, once on the phone talking to Aunt Ellen. Chrissy hadn’t seen her father since the day he left, and she missed him terribly.
Even though her mother had told her never to stop there, once after school, when Mrs. Lipinski was late coming to the corner, Chrissy had knocked on the door of the white house, but no one was home. So she hadn’t even seen the woman who was a slug.
The crossing guard blew her whistle at Chrissy and began motioning to her more wildly. Mrs. Lipinski, too, was now doing the same thing. Helpless to resist, Chrissy obeyed.
When she reached the other side, Mrs. Lipinski grabbed her by the shoulders. “Child, what’s the matter with you? You think I like standing here while you daydream?”
Mrs. Lipinski’s breath smelled like cabbage, and when she was upset like this, spit flew out of her mouth.
“Now come on.” She grabbed Chrissy by the hand, jerked her around, and pulled her toward the old house with the squeaky floors and the dreaded closet.
Going up the front steps a few minutes later, Chrissy’s feet barely touched the concrete. Inside, as she did every day, Mrs. Lipinski said, “Do you have to pee?”
“No.”
She took Chrissy through the parlor and opened the closet door, where a chrome kitchen chair sat surrounded by old water-stained cardboard boxes in which they lived. Chrissy didn’t want to go inside, but if she didn’t, Mrs. Lipinski would poison Chrissy’s dog, Buddy. And would do it, too, if she told her mother about the closet.
So, in she went. For Buddy’s sake.
Mrs. Lipinski shut the door and turned the key in the lock.
Darkness . . . Heavy . . . Musty . . .
Meditation, Mrs. Lipinski called it. Said it was good each day to sit quietly and think about all the bad things you had done or thought about doing, and concentrate on being a better person.
As usual, in less than a minute, Chrissy heard Mrs. Lipinski’s car start. The engine revved, then faded as the car backed out of the driveway. It would return in two hours, just before Chrissy’s mom came from work and took her home.
Only two hours. That wasn’t so bad. Or it wouldn’t have been if it wasn’t for them.
It never took very long. By the time Chrissy counted to a hundred, she could feel the first silverfish crawling like a tickling feather up her leg. Then they came by the scores, exploring her . . . so many and so curious, she couldn’t brush them all away.
They didn’t bite, so she just let them have their way, holding in the scream that pushed at the back of her throat as they traveled over her skin. Today, for some reason, it seemed more horrible than usual, their feet more probing, their numbers larger.
She kept her sanity during this time by putting her eye against a hole drilled, a long time ago, for a phone line that was no longer there. Through this opening, Chrissy could see her father’s little white house, and she would look at it and imagine him inside.
Today, when she looked, there was her father’s red pickup in his driveway, the first time she’d ever seen it since he left.
He was there.
Just across the street.
So close.
She never spoke while in the closet. What was the point? But today, with her father so near and the silverfish so numerous, she moaned, “Daddy . . . help me. Please . . . save me.”
In her bed, Chris, still asleep, hugged her pillow, the events of so long ago recurring with vivid clarity in the dream she had not had for nearly eight years.
Sti
ll lost in slumber, her lips moved against her pillow. “Daddy . . . save me.”
Chapter 3
THE NEXT DAY, Chris spent the morning on her computer trying to determine what was currently known about the potential threat for infection that transplanted pig organs posed to human recipients. The basic problem was that during their evolution, pigs had been infected with a unique class of viruses known as retroviruses, which had inserted their genes into the chromosomes of the pig’s reproductive cells, so that the virus was now passed to every member of every litter of pigs from the moment of conception. The consequence was that most every pig cell in the world carried up to fifty copies of the complete genetic sequence of a virus that routinely caused those cells to shed infectious particles. The virus didn’t seem to harm the pig, but what would it do in a human? That’s what Chris wanted to know.
The question was extremely important, because history is replete with examples of viruses that were relatively harmless in animal hosts, but produced devastating effects in humans. The most notorious was the flu virus of 1918, which killed more than 20 million people after mutating from a virus that evolved in pigs. Moreover, the necessity of giving her father immunosuppressive drugs so he wouldn’t reject the transplant could allow a pig virus that his body wouldn’t normally tolerate to become established in him. There, it could flourish and possibly mutate into a more human-adapted form, which would allow it to infect people with normal immune systems.
These were issues that would interest Chris, even if her father were not potentially in line to be the world’s first recipient of an indwelling pig liver. But she had another reason as well.
When she’d called Michael Boyer to discuss the possibility of getting Wayne into the program, Michael had told her that the infectious disease member of the team had recently dropped out, and they needed a replacement. Then he’d asked her to take his place.
It wasn’t something she wanted to do. She had enough responsibilities already. When she’d said this to Boyer, he’d responded with a low blow.
“Chris, you realize that if you were a member of the team, you’d not only have a vote on whether we accept your father, but your presence could have a lot of influence in how the others feel about him.”
“That’s blackmail.”
“I prefer to think of it as a cooperative venture with a mutual benefit to both of us.”
“Like I said, blackmail.”
The first pertinent information Chris found in her search was disturbing. A group of researchers in England had found that when pig kidney cells were cultured in the same dish with several types of human cells, the latter became infected with the pig retrovirus, proving that at least those human cells possessed surface characteristics the virus could exploit to gain entrance. She soon found an additional paper from a German group establishing that human cells could also be infected from the cells that line pig blood vessels.
This certainly wasn’t good news. Chris leaned back in her chair and mulled over what she’d just learned. Surely Michael Boyer knew about these papers, yet he was still ready to proceed with a transplant.
Of course, cells in a dish and cells in an entire organism were not the same thing. Maybe there was newer data relative to that point.
Moving on through the databases, she quickly found a study that showed no evidence of pig virus infection in ten people who had received insulin-producing pig cells to treat their diabetes. Another paper reached the same conclusion for two people with kidney failure, who had briefly had their bloodstream connected to a pig kidney.
Then she found an even larger study that looked for evidence of pig virus in the blood of 160 people who had been exposed to pig cells or tissues up to twelve years earlier. In addition to the two kinds of exposure covered in the previous papers, this one included individuals whose blood had been allowed to pass for a time through a pig spleen, and others who had received temporary pig skin grafts. More significantly for Chris, the study also reported on people with liver failure whose blood had been run through a device composed of pig liver cells enclosed in a semipermeable membrane. There was even one patient whose blood had been allowed to course through an entire intact pig liver.
Bottom line: Once again, there was no evidence in any of those people that they had been infected with the pig virus. This included thirty-six patients who had received drugs to suppress their immune systems.
This was good. So in all likelihood, there was no viral danger in proceeding. But even as she shut off her computer, the skeptic in Chris whispered, But no one has yet been transplanted with a whole, internal pig organ. That kind of exposure could be very different from what’s already been done. And the pig virus is a retrovirus, a group that readily mutates. Look at HIV. If it weren’t for its mutability, we might already have a vaccine against it.
There was a knock at the door, and Paula, the office secretary, leaned in. “This just arrived for you.”
Paula came in and handed Chris a thick manila envelope bearing Michael Boyer’s return address at Monteagle Hospital.
“Thanks. I was hoping that would get here this morning.”
Inside was the investigational new drug application Boyer’s team had filed with the FDA for permission to perform pig liver transplants. Chris spent the next thirty-five minutes reading it.
From the contents, it was obvious the FDA was very concerned that transplanting animal organs into people might unleash a plague that would decimate the human population. Practically the entire application dealt with this issue, covering every conceivable facet of the procedure, from maintenance and screening of donor animals to the lifelong clinical surveillance of donor and recipient, including a provision for archiving tissue samples of both upon their death from any cause.
Boy. Was this more responsibility than she wanted. But could she really say no? She’d already cut off one possible avenue to her father’s survival. Didn’t she owe him this?
The part of her still angered over being abandoned quickly chimed in, You don’t owe him anything.
There was another knock at the door. This time it was Dale McCarthy, one of her partners in the practice.
“Hey kid, I need a favor.”
Though they were nearly the same age, he always called her “kid.” McCarthy was one of the most open, likeable people she’d ever known, but he was also the worst dressed, favoring polka-dot bow ties, shirts a size too big, and suits with wrinkled pants held up by garish suspenders you could see every time he reached for the pager clipped to the elastic waistband. But he was a great infectious disease man.
“Don’t tell me,” Chris said. “You can’t take the new patient rotation today.”
“God, I love working with understanding people,” McCarthy said. “Diane’s car broke down in Talking Rock, and she has no way to get home. There’s no telling how long it’ll take me to get this straightened out. And Jerry’s off today.”
“How many new cases do we have?”
“Three. I could come back tonight and do them, but I don’t want their care to be delayed because of my personal problems.”
“Okay, I’ll handle it.”
“I knew we did the right thing when we brought you in.”
“Needed someone with a low threshold for a sad story, did you?”
“That was certainly at the top of my list. Paula has the skinny on the new cases. I’ll see you later. Thanks.”
Chris saw the three new patients before lunch and made rounds afterward of the cases already in her care, pushing herself so she’d finish before meeting her father.
At eight minutes till three, she called the micro lab to check on the results of the sample she’d taken from Tom Doyle’s scalp. She learned that blood agar cultures had supported the growth of a beta hemolytic bug, indicating strep A, as she had expected. Though it was just a formality to fully close out
her investigation, she told them to proceed with tests to compare the Doyle strain with the bug found in the three infected patients. Barely three minutes after that, she had Doyle on the line.
“Tom, it’s official. You’re the carrier.”
“I’ll be damned.”
“You need to treat yourself right away with a course of penicillin and see a dermatologist.”
“How long before I can operate again?”
“Three days after you start treatment.”
“A little forced vacation, huh? I’m not happy about this, but I’m with the program. You will keep this to yourself . . .”
“I’ll have to put your name in my report, but that’s a limited-access document, and I’m certainly not going to talk about it.”
WAYNE SHOWED UP in Chris’s office precisely at three, wearing a conservative blue suit, white shirt, and tie, but he hadn’t cut his hair, so the suit didn’t work.
“Do I look okay?” he asked.
“I’m sure the effort you exerted will be noticed.” She told Paula where she was going, and she and Wayne headed for the parking lot.
Monteagle Hospital was north of Buckhead on so-called Pill Hill, where it towered over St. Joseph and Northside Hospitals, its golden facade reflecting a benevolent light on the sick and weary. Determined to be one of the world’s leading medical centers, Monteagle was underwriting the entire cost of the pig liver transplant program, mostly, Chris believed, for the publicity any success would bring.
They reported to the general surgery waiting room and identified themselves to the woman behind the reception desk. Recognizing their names, she immediately summoned a nurse, who took them to an empty examining room, where Wayne sat on the examination table and Chris took the only chair.
The Judas Virus Page 3
