Critical Condition

by Peter Clement

  "But how does it work? You said these cells can become anything. What's to keep them from turning into a hunk of bone or growing a foot in the middle of my chest?"

  Downs's smile sparkled brighter than ever and her eyes practically danced with delight. "This is the miracle of stem cells, Ralph. They seem to know exactly where to go and what to do."

  "But how?"

  "There's a few theories, but let me explain it this way. Remember all the hoopla a year ago when they completed the human genome study?"

  Coady felt his spirits drop. "Yeah, they were promising great medical breakthroughs from it, then came the other shoe. It may take decades before any real benefits are actually on the market. You're not going to tell me this stem cell stuff will be disappointing like that? Not after getting my hopes up."

  "No, Ralph. But to understand how stem cells know what to do, you have to look at one of the big surprises from the genome project— that there are only about thirty thousand genes in the human body."

  "Yeah, I remember them talking about that, too. But so what?"

  "It's too few."

  "Come again?"

  "Every cell in your body has the same genetic structure. Yet some cells know to become heart tissue, some bone, some skin, just as we said. But the exact instructions with every detail of how to make a heart muscle cell, a brain cell, a kidney cell are so complex they couldn't all be contained in the mere thirty thousand genes that we have. So this information must be coming from somewhere else. We think it's in messages sent by cells already in the immediate neighborhood."

  "Say what?"

  "Heart muscle cells tell stems in their midst to become new heart muscle. Brain tissue says to the ones that happen to arrive in their vicinity to become brain. Not only that, these messages seem to be carried in the chemicals released by cells when they're injured. We think they also send out a distress signal that attracts the new cells to the site where the repairs are most needed. Hence, they know 'whereto go and what to do.' In effect the whole process is an inherent mechanism the body has to repair itself, and all we're doing is harnessing it."

  "My God," Coady said. He couldn't believe what he'd just heard. The dread he'd been carrying since he'd felt those first terrible chest pains released its hold. He tried to speak, but felt so overcome by relief that he burst into tears. "I'm sorry," he said a few moments later, "but the idea that part of my heart had died made me think I was already part corpse. To hear now that I can completely beat this thing, be whole again, that's like damn well turning back the clock, becoming young." He wiped his eyes clear of tears. "So when do we do it?"

  "Well, here's the rub," Downs said. "We have to wait until your own inflammatory response dies down and is no longer cleaning away the dead tissue left over from your heart attack. Otherwise your macrophages, a type of white cell that acts as a vacuum cleaner to sweep up organic debris, would gobble up the stem cells as well and carry them off."

  "How long?"

  "About three months ought to do it."

  His spirits once more plummeted. "Shit." He didn't say anything else right away, feeling himself shrink into the wheelchair. "Still, considering what you've offered me, it's a deal." He held out his hand to close the transaction.

  "You haven't heard it all yet," Norris said. "I'll need to see you in about six weeks to take a bone marrow sample from your femur."

  "What?"

  "That's where we're going to get the stem cells that we'll use. I'll then culture them through several generations, in order to get a sufficient number by the time Dr. Downs is ready to proceed."

  "But I thought you said the stem cells came from embryos?"

  "In the first trials they did, but not anymore, at least for our purposes here they don't have to. We now use a special type called stromal cells that all adults carry in their femoral marrow. It works just fine."

  "On mice maybe. How do you know it'll be okay in humans?"

  "Trust us," said Downs, giving him a wink and a flash of that smile that he would follow through hell and back. "We know."

  "You're sure about going ahead?" Norris asked her after she had returned Coady to CCU. "This maniac from the Legion of the Lord just might come after you or me next." Since word of the second attack on Steele had swept through the hospital this afternoon and the cops started telling the nurses that the killer might be part of the fanatical antiabortion group, he hadn't been able to think of anything else.

  "Relax, Jimmy. We talked about this," she said, keeping her voice low as they walked to his research labs.

  "But don't you see? Whoever the guy is, he's on to us. Why else would one of these fanatics kill Hamlin and Lockman? And how did he find out? I'd say Edwards or Blaine is using him to clean house and get rid of witnesses. It wouldn't be hard. These kinds of nuts are already foaming at the mouth over stem cell research as much as they ever did about abortion. They're just chomping at the bit to terrorize researchers the way they have doctors."

  "All the more reason for us to go public about doing Coady, Jimmy, tell the world we aren't using fetal tissue. Then this creep and his buddies ought to love us."

  "We might not have ten hours, let alone ten weeks if whoever sicked him on Hamlin and the others also pointed him at us."

  "So we preannounce. Hold a press conference about the advantages of stromal cells and say human trials are imminent, but we withhold Coady's name, stating patient confidentiality. That'll keep the press off his back until he's well and everything's over. And we stress how noncontroversial the process is since all we're doing is giving him back his own cells and avoiding the whole issue of embryonic tissue. Hell, as far as the actual technique goes, we can make it sound almost as if we're carrying out nothing new— autotransfusion, coronary arterial catheterization, insertion of microneedles into myocardium— claim none of it even needs FDA approval because it's old hat. Just a new application."

  Norris once again felt himself giving in to her soothing reassurances. God, she could cast a spell on him, he thought, but all he said was, "We'll need to show them some data."

  "Fine. I'll get my unpublished papers for the animal research together, you do the same. We'll look closely at the dates to see what we have to fudge to make some of the research seem recent. Let me know when you're ready." She gave him a quick kiss and went on her way down the hall toward her own office and animal lab.

  So sure of herself, he thought, watching her stride away, her head leading and hips sliding freely under her OR greens.

  It was so easy for him to submit to her, so easy to let her take charge— in or out of bed. His cheeks burned at the admission. After decades of being adrift with women who could never stand up to him she was a life force, capable of getting astride him and driving them both straight as an arrow to the limits of what they could do. He loved her for it. She carried him free of a becalmed dreariness he'd been wallowing in for most of his life, and he never felt more liberated than when he was under her control— except when he was alone. Then his old doubts surged to the fore. Was he fooling himself into believing he could trust her? He hadn't gone a dozen steps when he began to think the unthinkable: she could have rock-steady nerve because she controlled the killer. She could have set him in motion to free herself from anyone who was able to testify against her.

  And, he reassured himself, he would be okay, too. As long as he was useful, or she didn't see him as a hostile witness.

  Richard's heart was pounding with excitement. He was once again in medical records, looking now at Downs's morbidity-mortality numbers.

  He knew that research with mice the world over had demonstrated how stem cells could do everything from repairing damage in experimentally induced strokes to regenerating myocardium lost to simulated heart attacks. The marked improvements in Hamlin's patients, at least initially, could mean he'd illegally used stem cells. It had never been tried with humans in any authorized experiments, and no one could explain for certain why it worked in mice. Scientists studying the
brain hypothesized the stem cells might induce regeneration of existing tissue by serving as a supply house for substances known to stimulate recovery such as growth factors or cytokines. Researchers who had successfully demonstrated how stem cells could actually form new myocardium to replace the old tended to think it was the surrounding normal tissue that directed the process.

  Back in ICU, he'd realized that if Downs had been implanting stem cells and it had worked, her outcome statistics might show the same abrupt improvement as Hamlin's.

  And they did.

  Her overall numbers appeared too good to be true, the incidence of subsequent heart failure being half the average for the country. But how did she do it? "Franceses, you've got some 'splainin' to do," Richard muttered.

  Richard knew he was on the right track, but to be prudent he first had to make sure there weren't other explanations for Downs's success rate. After all, new drug regimens were being tried all the time. He'd better look at the charts, the way he had with Hamlin's cases.

  But cardiac surgeons could ream out or bypass clogged arteries a lot faster than neurosurgeons could dissect out vascular malformations. And the incidence of heart attacks was about a thousand times that of hemorrhagic strokes from capsular hemangiomas. Compared to the 18 dossiers of Hamlin's that he'd looked at, Downs had 503.

  "Jesus," he said under his breath. What a job. But he set out through the stacks to retrieve the files, just as he had the previous night. He might have felt deja-anxious if it hadn't been for the armed policeman standing guard at the door— and a sense he'd found the hot trail that just might save Kathleen's life.

  He awoke with a start in complete darkness. It took him a few seconds to realize where he was.

  After entering the hospital, he'd gone directly to the basement wing that housed the Department of Cellular Research, a sprawling maul of large, low-ceilinged laboratories interspersed with warrens of small offices. As he had passed the many open doors, he saw researchers in white coats hunched over their benches or desks, each dwarfed by the massive amounts of scientific equipment surrounding them. No one looked up when he walked by.

  It had changed some in the two years he'd been away, but he'd been able to guess what went on in each room by what he saw. Outside one, a wall of cages lined the hallway, some containing white rats, a few of which stood on their hind legs and watched him pass, their pink noses twitching busily through the wire mesh. A few feet farther on was a steel table on wheels loaded with bottles of clear liquid marked chloroform and a big glass jar surrounded by piles of cotton balls.

  Death chamber, he concluded.

  Next came a lab in which he saw what looked like a kid's chemistry set, flasks connected to one another with coiled plastic tubing and dark red fluid coursing through it. At its center, suspended like a fly caught in a web, was another lab rat, but with a pair of needles in its chest. The lower of the two carried dusky maroon blood to a set of cube-shaped machines. Bright crimson plasma returned to the site below the creature's neck where the root of the aorta and circulatory system would be. The equivalent of a heart-lung machine, he thought.

  Through another door he saw rows of benches where there were microscopes with overhead viewing screens, semicircles of scalpels arranged on an assortment of instrument trays, and dissecting basins set in the stainless steel countertops. Self-explanatory.

  The adjacent room had a centrifuge the size of an oil drum, racks of automated pipettes dipping repeatedly into trays of sample wells, and more spirals of plastic tubing, these carrying a variety of colored fluids to automated analyzers. This was the end of the line where the remnants of the rodents, reduced to body juices, yielded up their secrets, and their truths would spew over broad sheets of digital printouts enumerating the chemical contents.

  Through a set of swinging doors he came to a separate suite of facilities for humans. A small OR, an examining table parked beneath an overhead silver surgical lamp, and the equipment trays lining the stainless steel countertops here covered by sterile green towels. Beside them were open racks of test tubes with red, orange, or blue stoppers. Clear specimen containers filled the glass cabinets mounted on the wall. Ventilation hoods ran the length of the room, stacks of small culture dishes the diameter of poker chips piled within it. What looked like the doors to a half dozen freezer lockers all in a row lined the other side of the hallway. He could feel the chill off them as he passed.

  The administrative offices at the end of the corridor looked the same as always. Using his knowledge of the nooks and crannies in the place, he had found an unlocked storage closet opposite Norris's office where he could settle down to wait for his next quarry.

  But he had had trouble keeping his eyes open since he hadn't slept for two and a half days. Despite his best efforts, he kept nodding off as he sat in the dark little cubbyhole. Wide awake now, he snapped on his pen light and stared at his watch in disbelief. It read 8:50 P.M. He'd been asleep over three hours.

  Oh, God, he prayed. Forgive me! Let it not be too late.

  But he knew it likely was. Norris had a reputation for spending every waking hour in the lab, still he'd probably gone home by now. He'd wait a while longer, he decided. God might still deliver Norris to him.

  Around nine o'clock Edwards decided it was time.

  Still raging at Downs, he hurled the statue that had sat on his desk since 1978 against the dark wood paneling beside his bookcase. It hit with the sharp crack of a baseball bat, denting the smooth surface before landing on the carpet with a dull thud.

  After taking a last look at the domain he was abandoning, he decided the foot-high figure was probably the only thing he wanted to bring with him anyway. He retrieved it from where it lay and dropped it into his briefcase. Then he slipped out of his office and into the nearest stairwell. At this hour he'd be less likely to meet anyone here than in the elevators. Reaching the landing for the subbasement, he poked his head through the doorway into the hall.

  Nobody.

  He stepped into the dimly lit corridor and made his way toward the lab complex where Downs's office was located. His steps echoed loudly along the length of the deserted passageway, but hearing no other footfalls, he figured there wasn't a soul nearby and didn't bother to tiptoe.

  On the way he passed the closed doors of many other investigative divisions— virology, bacteriology, pathology— all of which were shut down for the night. Approaching the entrance to the autopsy rooms he accelerated his pace and scooted by, the aroma of formaldehyde tickling the inside of his nose and almost, but not quite, obliterating the sweet odors of decay emanating from the morgue.

  He reached the entrance to the area marked DEPARTMENT OF CELLULAR RESEARCH and used the pass card that Norris had issued him in happier, more trusting times to let himself in. "That way you can come and go at all hours of the night," the lanky researcher had told him. "It'll make it easier for you to sneak in as many stolen embryos from your fertility center as you can."

  And so he had, slipping down here all hours of the night and secreting frozen alliquots of life from his own liquid nitrogen freezers into Norris's. Babies seemed to want to be born in the wee hours. Since he was so often in the hospital between midnight and dawn doing deliveries, it was easy to carry out these surreptitious side trips without drawing attention to himself. In return, Norris grew the samples through multiple generations, thereby keeping Hamlin and Downs well supplied in pluripotent stem cells. The experience Norris gained culturing them made it possible for him to start harvesting stromal cells, once reports of their unique potential began to appear in scientific journals. The initial patients post-op at Blaine's institute achieved results way beyond expectations, and most returned home, thanks to her aggressive rehab techniques. It had promised to be so perfect, the six of them preparing to make medical history together, yet it had all turned to shit.

  Edward's bitterness at the shambles they'd made of their big chance hit him with renewed force.

  Well, at least he'd come up w
ith a way to profit from the mess.

  He walked by the liquid nitrogen freezers to which he'd brought so many offerings, their chill making him shiver.

  Arriving at Downs's office door he tried the handle. Locked, as expected, and his pass card wouldn't work here.

  Taking off his lab coat, he balled it around his hand, then smashed the window with the tire iron. The glass splintered and the shards shattered onto the linoleum floor.

  He reached in and turned the handle.

  The room was as severe and ascetic as the woman herself. Lining three of the walls were meticulously ordered bookshelves with glass doors where not so much as a pamphlet dared stand at anything less than attention. Several yards of locked filing cabinets bracketed the entrance in which he stood. Her computer sat on an otherwise bare metal desktop, and the only other furniture in the room was a pair of spartan metal chairs opposite her own, a modest swivel back covered in black cloth.

  He was looking for a set of compact discs outlining in detail the techniques she'd used to infuse pluripotent and stromal stem cells into her patients. He'd seen these records when she'd presented her data to the group, and knew they were in containers labeled REGENERATION. He went to work on the nearest metal drawer and pried it open.

  Lots of paper, but no CDs. One after the other, he forced his way in, the locks giving with a loud pop each time, but still he found nothing.

  He was halfway through when he heard the crunch of someone stepping on glass behind him.

  He spun around in time to see a dark-haired man with a broad face and a small mustache stride into the room. He gasped. The man held a machete over his head.

  "Doctor Edwards," said the approaching figure, a smile breaking out and making his features appear even wider. "What a surprise to see you here. It saves me the trouble of finding you later."

  Edwards heard his own scream as if it came from someone else. The cry quickly diminished to a whimpering noise as he reeled backward, crashing up against a bookcase. Instinctively he raised the tire iron to defend himself, but cowed before his attacker.