by Robin Cook
“Only about three-quarters of the charts have the surgery dates,” Janet said. “But of those, most of them match the dates and destinations of Dr. Levy’s travel.”
“Hallelujah!” Sean exclaimed. “It’s all fitting into place like a jigsaw puzzle.”
“What I don’t understand,” Janet said, “is what she did in those cities.”
“Nearly everyone who’s post-surgery is on an IV,” Sean said. “It keeps people hydrated, plus if there’s a problem the medical staff has a route for medication. My guess is that Deborah Levy gave them an injection into their IV.”
“Of what?” Janet asked.
“An injection of St. Louis encephalitis virus,” Sean said. He told Janet about the positive test for the SLE virus in Helen Cabot’s cerebrospinal fluid. He also told her that Louis Martin had had transient neurological symptoms similar to Helen’s several days after his elective surgery.
“And if you look back at the charts,” Sean continued, “I think you’ll find most of these people had similar fleeting symptoms.”
“Why didn’t they get full-blown encephalitis?” Janet asked. “Especially if it was injected through their IVs?”
“That’s the truly clever part about all this,” Sean said. “I believe the encephalitis viruses were altered and attenuated with the inclusion of viral oncogenes. I’ve already detected two such oncogenes in Helen’s tumor. My guess is that I’ll find another. One of the current theories on cancer is that it takes at least three isolated events in a cell to make it cancerous.”
“How did all this occur to you?” Janet asked. It sounded too complicated, too involved, too complex, and most of all too hideous, to be true.
“Gradually,” Sean said. “Unfortunately it took me a long time. I suppose initially my index of suspicion was so low; it’s the last thing I expected. But when you told me they started immunotherapy with a specific agent from day one, I thought something was out of whack. That flew in the face of everything I knew about the specificity of immunotherapy. It takes time to develop an antibody and everybody’s tumor is antigenically unique.”
“But it was at the Betencourts’ that you started acting strangely,” Janet said.
“Malcolm Betencourt was the one who emphasized the sequence,” Sean said. “Elective surgery, followed by neurological symptoms, and then brain tumor. Helen Cabot and Louis Martin had the same progression. Until I heard Malcolm’s story, I hadn’t realized its significance. As one of my medicine professors said, if you are painstakingly careful in your history-taking, you should be able to make every diagnosis.”
“So you believe the Forbes Cancer Center has been going around the country giving people cancer,” Janet said, forcing herself to put into words her awful fear.
“A very special kind of cancer,” Sean said. “One of the viral oncogenes I’ve detected makes a protein that sticks out through the cell membrane. Since it’s homologous to the protein that forms the receptor for growth hormone, it acts like a switch in the ‘on’ position to encourage cell growth and cell division. But besides that, the portion that sticks through the cell is a peptide and probably antigenic. My guess is the immunoglobulin they give these people is an antibody for that extracellular part of the ERB-2 oncoprotein.”
“You’re losing me,” Janet admitted.
“Let’s give it a try,” Sean said. “Maybe I can show you. It will only take a moment since I have some of the ERB-2 oncoprotein from the Key West lab. Let’s see if Helen Cabot’s medicine reacts with it. Remember that I wasn’t able to get it to react with any natural cellular antigen. The only thing it would react with was her tumor.”
As Sean quickly prepared the immunofluorescence test, Janet tried to absorb what Sean had said so far.
“In other words,” Janet said after a pause, “what makes this medulloblastoma cancer so different is that not only is it manmade, it’s curable.”
Sean looked up from his work with obvious admiration. “Right on!” he said. “You got it. They created a cancer with a tumor-specific antigen for which they already had a monoclonal antibody. This antibody would react with the antigen and coat all the cancer cells. Then all they’d have to do was to stimulate the immune system both in vivo and in vitro to get as many ‘killer’ cells as possible. The only minor problem was that the treatment probably made the symptoms worse initially because of the inflammation it would undoubtedly cause.”
“Which is why Helen Cabot died,” Janet said.
“That’s what I’d guess,” Sean said. “Boston kept her too long during the diagnostic stage. They should have sent her right down to Miami. The trouble is that Boston can’t believe someone else might be better for any medical problem.”
“How could you be so sure of all this?” Janet asked. “By the time we got back here you hadn’t any proof. Yet you were sure enough to force the Masons over here by gunpoint. Seems to me you were taking a huge risk.”
“The clincher was some engineer-style drawings of viral capsids I saw in the lab in Key West,” Sean explained. “As soon as I saw them, I knew it all had to be true. You see, Dr. Levy’s particular area of expertise is virology. The drawings were of a spherical virus with icosahedral symmetry. That’s the kind of capsule an SLE virus has. The scientifically elegant part of this vile plot is that Deborah Levy was able to package the oncogenes into the SLE viral capsule. There wouldn’t be room for more than one oncogene in each virus because she’d have to leave much of the SLE virus genome intact so that it would still be infective. I don’t know how she did it. She also must have included some retroviral genes as well as the oncogene in order to get the oncogene to insert into the infected cell’s chromosomes. My guess is that she transformed a number of the viruses with the oncogenes and only those brain cells that were unlucky enough to get all the oncogenes simultaneously became cancerous.”
“Why an encephalitis virus?” Janet asked.
“It has a natural predilection for neurons,” Sean said. “If they wanted to cause a cancer they could treat, they needed a tumor which they could count on giving early symptoms. Brain cancer is one of them. Scientifically, it’s all quite rational.”
“Diabolical is a better term,” Janet said.
Janet glanced over into the glass-enclosed office. Dr. Mason was pacing the room although carefully avoiding the desk and the flask in the ice bath. “Do you think he knows all this?” she asked.
“That I don’t know,” Sean said. “But if I had to guess, I’d say yes. It would be hard to run this elaborate operation without the director knowing. After all, it was a fund-raiser in the final analysis.”
“That’s why they targeted CEOs and their families,” Janet said.
“That’s my assumption,” Sean said. “It’s easy to find out which health insurance company a large firm uses. It’s also not difficult to find out someone’s social security number, especially for quasi-public figures. Once they had the subscriber’s social security number, it would be an easy step to get their dependents’.”
“So that evening when we were here copying the charts and heard the word donor, they were referring to money, not organs.”
Sean nodded. “At that moment our imaginations were too active,” he said. “We forgot that specialty hospitals and associated research centers have become increasingly desperate as NIH grants are getting harder and harder to come by. Creating a group of wealthy, grateful patients is a good way to make it through to the twenty-first century.”
Meanwhile, the immunofluorescence test involving the ERB-2 and Helen Cabot’s medicine had registered strongly positive, even stronger than it had with the tumor cells. “There you go!” Sean said smugly. “There’s the antigen-antibody reaction I’ve been searching for.”
Next Sean turned back to his hundreds of samples in the two thermocyclers.
“Can I help?” Janet asked.
“Definitely,” Sean said. He showed her how to handle a twelve-channel pipette, then gave her a series of oncogene prob
es to add to the thermocycler wells.
They worked together for almost three-quarters of an hour, concentrating on the meticulous work. They were both physically exhausted and emotionally overwrought from the magnitude of the conspiracy they suspected. After the final well was probed and analyzed for its luminescence, they’d uncovered two more oncogenes: Ha-ras, named after the Harvey sarcoma virus which normally infected rats, and SV40 Large T from a virus usually found in monkey kidneys. From the RNA studies in the second thermocycler, where Sean had run a quantitative polymerase chain reaction, it was determined that all the oncogenes were “mega” expressed.
“What an oncogene cocktail!” Sean said with awe as he stood and stretched his weary muscles. “Any nerve cell that got those four would undoubtedly become cancerous. Dr. Levy was leaving as little to chance as possible.”
Janet put down the pipette she was holding and cradled her head in her hands. In a tired voice she spoke without looking up: “What now?”
“We give up, I guess,” Sean said. As he tried to contemplate the next step, he glanced into the office at the Masons who were arguing again. Mercifully, the glass partition dampened the sound of their voices considerably.
“How are we going to manage the giving up?” Janet asked sleepily.
Sean sighed. “You know, I hadn’t given it much thought. It could be tricky.”
Janet looked up. “You must have had some idea when you came up with this plan.”
“Nope,” Sean admitted. “I didn’t think that far ahead.”
Janet pushed off her seat and went to the window. From there she could see down into the parking lot. “You got that circus you wanted,” she said. “There are hundreds of people out there, including a group in black uniforms.”
“They’re the ones who make me nervous,” Sean admitted. “I’d guess they’re a SWAT team.”
“Maybe the first thing we should do is send the Masons out to tell them that we’re ready to come out.”
“That’s an idea,” Sean said. “But you’ll go with them.”
“But then you’ll be in here alone,” Janet said. She came back and sat down. “I don’t like that. Not with all those black-uniform guys itching to come charging in here.”
“The biggest problem is Helen Cabot’s brain,” Sean said.
“Why?” Janet asked with a sigh of exasperation.
“It’s our only evidence,” Sean said. “We cannot allow the Forbes people to destroy the brain which I’m certain they’d do if given the chance. My guess is that I’ll not be very popular with anybody when we end this. During the confusion there’s a good chance the brain could get into the wrong hands. I doubt anyone is going to take the time to stop and hear me out.”
“I’d have to agree,” Janet said.
“Wait a second!” Sean said with sudden enthusiasm. “I’ve got an idea.”
13
March 7
Sunday, 4:38 P.M.
It took Sean twenty minutes to convince Janet that the best thing for her to do was join the Masons in the office. It was Sean’s hope that the idea she’d been coerced would be easier to put forth if she was considered a hostage. Janet was skeptical, but in the end she relented.
With that issue decided, Sean packed Helen Cabot’s brain in ice and put it in the cooler he’d used to transport it to the lab. Then with some cord that he’d found in the supply closet, he made a large parcel out of the thirty-three chart copies plus the computer printout of the Forbes Cancer Center travel file. When all was ready, Sean picked up the pass keys and with the cooler in one hand and the charts in the other, he climbed up to the administration floor.
Using the pass key, Sean went into the finance section. After taking out the shelving from the dumbwaiter, he squeezed himself in along with his two parcels. He rode the dumbwaiter down the seven floors to the basement, trying hard to keep his elbows in so they wouldn’t rub on the walls.
The chart vault was a problem. The light switch was at the entrance, and Sean had to negotiate the entire length of the room in utter blackness. Remembering at least the general layout of the shelving, he was able to move with a modicum of confidence although several times he became disoriented. Eventually, he found the sister dumbwaiter. Within minutes he was riding up the two stories to medical records in the hospital building.
When he opened the dumbwaiter door he was thankful for the lights being on but disappointed to hear someone giving muffled dictation. Before stepping out of the cramped car, Sean determined that the voice was coming from a small cubicle that was out of sight. As quietly as possible he got himself out of the hoist; then he crept into the hall, clutching his two parcels, one under each arm.
Once in the hall, Sean could sense the electricity in the air. It was apparent that the clinical chemistry and radiology departments had been informed of the hostage situation in the neighboring building; the excitement provided an almost holiday atmosphere for the weekend skeleton staff. Most of them were in the hall at the floor-to-ceiling windows opposite the elevators that faced the research building. None of them paid any attention to Sean.
Shunning the elevators, Sean took the stairs down to the first floor. When he came out into the main lobby, he felt immediately at ease. Conveniently, it was visiting hours so there was quite a mob of people clustered around the lobby entrance. Despite his bulky parcels, two-day growth of whiskers, and rumpled clothes, Sean was able to blend in.
Sean walked out of the hospital unimpeded. Crossing the parking lot to the research side he began to appreciate the number of people who’d showed up for his hostage show. They were milling about the handful of cars parked there, including his own 4×4.
Passing near his Isuzu, Sean contemplated dropping the brain and the charts off. But he decided it would be better to give them directly to Brian. Sean was confident his brother was still there despite his threats to abandon him.
The police had stretched the yellow vinyl crime scene tape from vehicle to vehicle all the way around the front of the research building. Behind the building they used trees to seal off the area completely. All along the tape at regular intervals uniformed police officers stood guard.
Sean noticed that the police had set up a command central at a card table positioned behind a group of squad cars. A crowd of several dozen police officials were gathered in the vicinity in the central spot. Off to the left was the black-suited SWAT team, some of whom were doing calisthenics, others checking an assortment of impressive weaponry.
Sean paused at the tape and scanned the crowd. He was able to pick Brian out instantly. He was the only man dressed in a white shirt and paisley suspenders. Brian was off to the side locked in an animated conversation with a black-suited SWAT team member with black face paint smeared under each eye.
Stepping over to one of the uniformed police officers manning the crime scene tape, Sean waved to get his attention. He was busy clipping his nails.
“Sorry to be a bother,” Sean said. “I’m related to the individual who took the hostages and that’s my brother over there talking with a member of the SWAT team.” Sean pointed toward Brian. “I think I can help resolve the dilemma.”
The policeman raised the tape without saying a word. He merely gestured for Sean to enter. Then he went back to his nails.
Sean kept clear of Deborah Levy and Robert Harris, who he spotted near one of the squad cars. Fortunately they weren’t looking in his direction. He also steered away from one of the men he’d locked in the closet in Key West, the same man who’d been waiting on the Sushita jet in Naples, whom he saw near the card table.
Sean went directly to his brother, coming up behind him. He caught bits and pieces of the argument which dealt with the issue of storming the building. It was obvious they held contrary views.
Sean tapped Brian on the shoulder, but Brian shrugged the intrusion off with a disinterested shrug. He was busy making a point by pounding a fist into an open palm. He continued his emotional monologue until Sean drift
ed around into the corner of his vision. Brian stopped in midsentence, his mouth agape.
George Loring followed the line of Brian’s gaze, sized Sean up as a homeless person, then looked back at Brian. “You know this guy?” he asked.
“We’re brothers,” Sean said as he nudged the shocked Brian aside.
“What the hell…?” Brian exclaimed.
“Don’t make a scene!” Sean warned, pulling his brother further away. “If you’re still mad about me tagging you, I’m sorry. I didn’t want to hit you, but you left me with little choice. It was an inconvenient moment for you to pop up.”
Brian threw a quick but concerned glance toward the command post a mere forty feet away. Redirecting his attention to Sean, he said: “What are you doing here?”
“I want you to take this cooler,” Sean said, handing it over. “Plus these chart copies. But it’s the cooler that’s most important.”
Brian adjusted his posture to deal with the weight of the charts. “How on earth did you get out of there? They assured me the place had been sealed off: that no one could go in or out.”
“I’ll tell you in a few minutes,” Sean said. “But first about this cooler: it’s got a brain in it. Not a very pretty brain, but an important one.”
“Is this the brain you stole?” Brian asked. “If it is, it’s stolen property.”
“Hold your legal blarney,” Sean said.
“Whose brain is it?”
“A patient’s,” Sean said. “And we’ll need it to indict a number of people here at Forbes Cancer Center.”
“You mean it’s evidence?” Brian asked.
“It’s going to blow a lot of people’s minds,” Sean promised.
“But there’s no appropriate chain of custody,” Brian complained.
“The DNA will solve that,” Sean said. “Just don’t let anybody have it. And the chart copies are important too.”
“But they’re no good as evidence,” Brian said. “They’re not authenticated copies.”
“For crissake, Brian!” Sean snapped. “I know it was thoughtless of me not to have had the foresight to have a notary with me when I copied them, but we can use them for the grand jury. Besides, the copies will show us what we need to subpoena, and we can use them to be sure they don’t change any of the originals.” Sean lowered his voice. “Now, what do we do to end this carnival with no loss of life, particularly mine? These idle SWAT team guys give me the willies.”
