“I must admit it, it sounds beautiful, in theory.”
“A real magic bullet. You go right to the heart of your disease. You reach right in and switch it off at the source. It would be like hitting the enemy’s command center with a laser-guided missile. You paralyze their whole army without losing a man. There’d be little or no toxicity either, so no collateral damage. Revolutionary, if you could actually manage it in practice.”
“I can see why Stern would be interested,” said Ford.
“Well, I’m not so sure that was what prompted the deal. I mean it was clear Helical was having major problems well before the takeover was finalized. I mean, there were no trials or anything. In fact, there were even suggestions that Helical had been deliberately talking up their progress so that they could get more money for the company. It wouldn’t be the first time. Anyway, you can bet that if they’d had any kind of usable product, they’d have come out with it. There’d be no sense keeping it to themselves.”
Ford felt disappointed. It was fun to speculate about secrets and things that were not what they appeared to be. It was less fun to be confronted with the obvious, prosaic explanations.
“So where were these problems, as a matter of interest? I mean, scientifically.”
Helen hesitated.
“It’s not confidential or anything, is it?” asked Ford.
“No, not really,” she said. “Novak and his friends published quite a few articles on their work, as a matter of fact, especially in the early days of the venture. They talked about the problems then. Degradation was a big one, I think. These oligomers are very complex compounds, and they tend to be unstable, apparently. They’re also very expensive to produce. The researchers probably found a whole lot more problems as they went on. We don’t really know.”
“You don’t?” said Ford. “How come?”
The waiter was back. Helen smiled at him as he placed the seafood linguini in front of her.
“I mean you—Stern—you own Helical, don’t you?” Ford persisted.
“Yes, what’s left of it. But you see, well, the original Helical team, not just Novak, they moved on very quickly after the company was sold. I mean, all the senior guys, anyway. By the time the rumors started going around about Omega, it was too late to ask them about it. And the information they left behind on the computers was inconclusive, to say the least. Or incomplete.”
“Omega? You said Omega? What’s—?”
“I’m sorry, didn’t I say? That was supposed to be the name of the new antibiotic, or rather the name of the project—Omega. I guess it was kind of prophetic in a way.”
“How do you mean?” said Ford.
Helen laughed. “Well, it was the last thing Helical ever worked on. You could say it finished them off.”
5
Nobody was carrying the staph. Patou tested the twelve people likely to have infected the Shark and came up with nothing. It turned out that Marvin Leonard did carry elevated levels of the bug in his nose, but he was not a broadcaster and anyway the bug was not the resistant strain responsible for the Shark’s death. He was sent home for a week with instructions to carry on washing with the antibacterial agents. Culturing of fomites and equipment from the Critical Room and the ICU was continuing but without significant results.
But in the isolation rooms on the second floor the staph seemed to be thriving. Ford monitored Officer Denny closely, paying him regular visits in the isolation room where, as the most serious of the three cases, he was being kept on his own.
Raymond Denny was a powerfully built man in his mid-twenties. About thirty pounds overweight, he had a neck like a bull and tight biceps that suggested regular gym workouts. At first he was chirpy, bantering with the doctors and nurses, behaving as if everything was going to be okay. But when they put him onto the vancomycin, explained the dangers of the drug itself, the gravity of his predicament began to sink in.
Ford told him that because of his youth and health, his immune system and the vancomycin would soon knock the staph on the head, and it was clear that Denny believed it. The bantering was replaced by a desire to cooperate and a modified, keeping-my-spirits-up cheerfulness. All he wanted to do was get better and get out of there.
He never asked why he was in a room on his own. He seemed to think it was for security reasons, many of the other patients being either black or Hispanic gangsters.
When Ford called on him Wednesday morning he was struck by the clear signs of deterioration. Denny’s boyish features were puckered in a frown, and his chunky fingers were restless on the blanket, working away at his severely bitten nails as if he wanted to remove what was left of his cuticles. The two men exchanged their, by now, habitual good-ol’-boy greeting. But as Ford checked his status chart—at no point since his operation had his temperature come off 103 degrees—Denny fell silent.
“So how’re you doing, Raymond? Sleep okay?”
Denny didn’t reply for a moment. He was staring at the bump made by his feet. Then he looked at Ford, giving his head a shake.
“What I don’t understand is how such a little slug can be giving me so much trouble,” he said.
Denny’s optimism regarding his prospects for recovery had always been based on the fact that the bullet they had removed from his thigh was from a .22. Somewhere in his personal lore was a rule that said a .22 slug in the thigh could not kill you.
“I know guys had much worse and they were okay in a couple of weeks,” he said. “Incredible stories, stories you would not believe. Guy I know from Operation Safe Streets—you know, the gang people—busts into this apartment and there’s this character holding an M52. You know that handgun?”
Ford shook his head and replaced the charts. He sat down to examine the two wounds in Denny’s leg.
“It’s an automatic. Anyway this character starts blazing away. Puts the guy down—the Safe Streets guy—and then walks across the room to finish him off. Fires a round into the guy’s chest before the guy’s support come in through the door and take out the gangster. Now, the bullet—the bullet the scumbag fired?—it goes through the body, through the floor, through the ceiling downstairs, through a table—can you believe this?—it lodges itself so deep in the floorboards, the forensic people have to take up the floor and saw off a piece of wood to retrieve it.”
“Sounds like a powerful weapon,” said Ford, pulling back the dressing on Denny’s ankle. Even though he was prepared, he could still hardly believe his eyes. The wound that had been cut by Peter Ozal in order to access the saphenous vein was now swollen and full of pus. The cut had not been made in optimal conditions, but Ozal had been careful to clean the skin with alcohol before proceeding and the blade was perfectly sterile. After three days on vancomycin, this surgical wound looked as though it had been made with a dirty can opener and then left to fester.
“Czech,” said Denny. “Seven-point-six-two-millimeter bottleneck cartridge. Muzzle velocity of sixteen hundred feet per second.”
He was silent for a moment, watching Ford’s face. Ford struggled to adopt a neutral expression.
“And the guy who got shot, the guy on the floor?” Denny continued, “He goes into Harbor. He’s in surgery for eight hours, where they take four slugs out of him, two of them in the bowel, one in the left lung. Three months later he’s back on the job.”
“Those are the breaks,” said Ford, turning to the gunshot wound on the thigh. “Bullet can hit one thing or it can hit ten things on its way through. Makes all the…” He peeled back the dressing and had to catch purulent fluid with his sleeve rather than soil the sheets. The smell was surprisingly bad. “Makes all the difference.”
“Stinks don’t it?” said Denny, trying to sound cheerful.
“Yes, it does,” said Ford, again as neutral as possible. He looked up at Denny’s face and saw how frightened he really was.
Ten minutes later Ford was back in his own tiny office, with its dying houseplants and stacks of reports, papers, and medical recor
ds up to the ceiling.
“I realize that, Dr. Haynes,” he said into the phone, looking across his desk at Mary Draper, who had come in for a chat. “All I’m saying is that if we don’t operate, we are going to lose Denny. We may lose him anyway.”
After seeing the state of Denny’s leg, Ford had immediately gone to call Haynes. It wasn’t something he would normally do—consult the medical director on a clinical issue—but he was aware of the wider importance of Denny’s case. It was Haynes’s secretary who had given him the mobile phone number. Haynes’s Lexus was stuck in traffic somewhere. Every now and then the signal broke up, but there was no mistaking the tension in Haynes’s voice.
“Well, I hope you’re right, Dr. Ford. Because this is going to be all over the networks this evening. I hope you’ve thought it through.”
Ford nodded.
“Sir, very little thought is required here. The drug is not working. Vancomycin is not working on Denny or on the others. That is also going to be all over the networks, if not today, then tomorrow. Denny’s infection has not been checked. At this stage I believe the leg is no longer viable. If we don’t amputate and transfuse, the patient will be dead in a couple of days. He’ll go the same way Shark did.”
“And how do you know the amputation will not also be complicated by infection?”
“I don’t. All I can say is that as the doctor responsible, I firmly believe that amputation is his best chance.”
There was a long silence in which Ford heard the honking of horns and what sounded like a quiet curse.
“Okay,” snapped Haynes, and the line went dead.
Ford hung up and leaned back in his chair. There was a knock on the door.
“Go away.”
The handle turned and Conrad Allen stuck his head into the room. Seeing Mary Draper in the chair, he started to back away.
“I’m sorry; am I—”
Ford waved him on.
“No. Come in, come in. I wanted to talk to you, in any case.”
Because of the boxes of records—Ford had been holding out for a decent set of filing cabinets for two years with no luck—there was very little room and Allen had to perch on the edge of the desk. He handed Ford a sheaf of notes from the Shark’s autopsy.
“This just came back. It’s sobering stuff.”
“Oh?”
“When they opened him up, they found necrotizing fasciitis along the missile track.”
Necrotizing fasciitis was an infection caused by either streptococci or staphylococci focused on the opposed planes of wounds. The Shark’s infection had spread with remarkable speed, replacing healthy tissue with a gangrenous mush.
“I spoke to Ben Prosser. He did the autopsy. He told me the tongue was actually discovered to be detached when they unwired the Shark’s teeth.”
“Jesus,” said Draper. She stood up to leave.
The phone rang.
“Hello, Ford speaking.”
There was some rustling and then a voice Ford didn’t recognize. Mary Draper slipped out through the open door.
“You don’t know me,” the voice said. “My name is Dr. Wingate, Nathaniel Wingate. I’m the chief consultant at the Trinity Clinic.”
The voice was assured, professional, yet there was an edge to it, a breathlessness that suggested to Ford some kind of heart condition, or maybe just an attack of nerves.
“I’m sorry to bother you during working hours. I wouldn’t have dreamed of calling if I didn’t think it was a very serious matter.”
“The Trinity Clinic?” said Ford. “I’m sorry. I’m not sure where that is.”
“Um, Beverly Hills,” said Wingate. “We’re in general practice up here. Mostly just local patients, actually.”
The way Wingate said it, you’d think Beverly Hills was some hick town on the wrong side of the Appalachians, where all the inhabitants wore dungarees and plaid shirts. It was as if he was afraid of a hostile reaction.
“So what can I do for you, Dr. Wingate?”
“Recently one of my patients—Edward Turnbull—came to me with a small wound. You’ve probably heard of the Turnbulls. They’re, well, you know, old Oscar Turnbull’s family. At one time they practically owned the Valley.”
Ford looked up at Conrad Allen and pressed the hands-free button so that Allen could hear.
“Hello?”
“Yes, I’m still here, Dr. Wingate. What exactly is your patient’s problem?”
“He sprained his wrist falling from a horse on the weekend. At a polo match, actually. Do you know the Will Rogers Country Club?”
Allen folded his arms, suppressing a grin.
“I’ve heard the name,” Ford said.
“Well, that’s how it is with the Turnbulls. They don’t trip on the sidewalk or strain themselves lifting patio furniture. They fall from horses. Anyway, besides the sprain, he got a small puncture in the palm of his hand. He may have fallen onto a nail or something.”
“I take it the wound became infected, then?”
“Yes. I treated it with penicillin, but it didn’t respond. The hand started to look bad, very bad. I isolated Clostridium perfringens from the wound exudate. I believe there’s a … I believe there’s a danger of myonecrosis.”
Ford and Allen exchanged a look. Suddenly Allen wasn’t smiling.
“Dr. Wingate, I’m very sorry to hear about your patient, but—excuse me for asking—but what made you decide to come to me? How did you get my number?”
“I was talking to a colleague at the clinic about the case, and he told me about the speech you gave at the NIH conference. He said there’d been cases of resistant infection at the Willowbrook. The thing is, I’ve never seen anything like this before. I was hoping to get some advice.”
“Well, without seeing the—”
“I have already recommended amputation. I told the mother this morning.”
Again Ford and Allen looked at each other.
“That sounds pretty drastic,” said Ford.
“I know. But I couldn’t see any safe alternative, and I was concerned to cover myself. You know how it is. You have to understand this thing started from nothing. And in two days it developed into a full blown clostridial infection that was apparently completely resistant to the penicillin I prescribed.”
“Did you try any other drug?”
“I felt that time was a factor. I didn’t want the gangrene to take ahold of the boy’s arm. What do you think I should have done?”
Ford pondered for a moment, thinking about the Shark’s tongue.
“Have you seen resistant clostridia at the Willowbrook?” asked Wingate.
“No,” said Ford. “No, we haven’t. We have been having problems with staphylococcus—both pneumoniae and aureus.” Ford stared at his cluttered desk, thinking hard. “What did the mother say? When you recommended amputation?”
“She was very upset. Understandably. Said she was taking him elsewhere.”
Ford shrugged.
“Look, Dr. Wingate, I’m afraid I don’t see that I can be of much help to you right now. It may be that there is some general problem in LA, but it’s a little early to say exactly how general … how serious the problem really is. It may be that your patient’s clostridium will respond to another antibiotic and is not actually multiresistant at all. All I can say is that I am reporting my cases to the health authorities and suggest you do the same. The people at the CDC stand more chance of putting together some kind of epidemiological picture. If you learn anything, though, please let me know.”
Wingate said good-bye and hung up. For a moment Ford and Allen sat in silence, listening to the hum of the disconnected line.
“Clostridium perfringens?” said Allen at last. “This is beginning to get a little scary. What the hell’s going on?”
Ford shook his head. Allen was right. It was like something out of a horror film where nature suddenly turns nasty, like the birds in the Hitchcock film.
“Look, whatever the … thing Edwar
d Turnbull has, it may not even be multiresistant. Anyway…” Ford gave himself a shake, tried to concentrate on business at hand. “Conrad, what I wanted to speak to you about was Raymond Denny. I took a look at him this—”
The phone rang again.
Ford snatched it up irritably. It was Patou. She had been reviewing the staph cases in the isolation rooms and wanted to go over the facts, she said.
“I was in with Denny this morning,” said Ford. “He doesn’t seem to be responding to the drug.”
“I agree,” said Patou. “It may be that the initial infection was far greater than we thought.”
Ford was puzzled for a moment. Was she going to drag him through an account of the operation again? Try to accuse him or his team of sloppy technique?
“I’m sorry, I don’t—”
“Well, I understand from a reliable source that there was a problem with Denny when he was admitted.”
“Dr. Patou, I—”
“Oh, come on, Dr. Ford, somebody deflated the patient’s MAST pants too quickly and he became hypovolemic. As you know, the chances of infection are greatly increased after this kind of event.”
Ford could not believe it. They were staring a powerful new pathogen in the face, one against which they had no effective weapon, and Patou was still going on about procedure. And what did she mean, a reliable source? Why not just name names?
“That’s right,” he heard himself say, trying to keep the anger out of his voice. “I was there at the time, along with six other people, all of whom you might consider reliable sources.”
“Well, we won’t go into that now. All I wanted to do was arrange a time to meet, perhaps later in the day. I can fit you in at around six o’clock.”
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