Mutation

by Robin Cook

  Victor conveyed his condolences as best he could. The Murrays seemed touched that Victor had taken the time to come to the hospital, especially since they never socialized.

  “He was such a special child,” Horace said. “So exceptional, so intelligent . . .” He shook his head. Colette hid her face in her hands. Her shoulders began to quiver. Horace sat back down and put an arm around his wife.

  “What’s the name of the doctor taking care of Mark?” Victor asked.

  “Nakano,” Horace answered. “Dr. Nakano.”

  Victor excused himself, left his coat with the Murrays, and departed the waiting room with its anxious parents. He walked toward Pediatric Surgical Intensive Care, which was at the end of the corridor, behind a pair of electronic doors. As Victor stepped on the rubberized area in front of the doors, they automatically opened.

  The room inside was familiar to Victor from his days as a resident. There was the usual profusion of electronic gear and scurrying nurses. The constant hiss of the respirators and bleeps of the cardiac monitors gave the room an aura of tension. Life here was in the balance.

  Since Victor acted at ease in the environment, no one questioned his presence, despite the fact that he was not wearing an ID. Victor went to the desk and asked if Dr. Nakano was available.

  “He was just here,” a pert young woman replied. She half stood and leaned over the counter to see if she could spot him. Then she sat down and picked up the phone. A moment later the page system added Dr. Nakano’s name to the incessant list that issued from speakers in the ceiling.

  Walking about the room, Victor tried to locate Mark, but too many of the kids were on respirators that distorted their faces. He returned to the desk just as the ward clerk was hanging up the phone. Seeing Victor, she told him that Dr. Nakano was on his way back to the unit.

  Five minutes later, Victor was introduced to the handsome, deeply tanned Japanese-American. Victor explained that he was a physician and friend of the Murray family, and that he hoped to get some idea of what was happening to Mark.

  “It’s not good,” Dr. Nakano said candidly. “The child is dying. It’s not often we can say that, but in this case the problem is unresponsive to any treatment.”

  “Do you have any idea of what’s going on?” Victor asked.

  “We know what’s happening,” Dr. Nakano said, “what we don’t know is what’s causing it. Come on, I’ll show you.”

  With the hurried step of a busy doctor, Dr. Nakano took off toward the rear of the ICU. He stopped outside a cubicle separated from the main portion of the ICU.

  “The child’s on precautions,” Dr. Nakano explained. “There’s been no evidence of infection, but we thought just in case . . .” He handed Victor a gown, hat, and mask. Both men donned the protective gear and entered the small room.

  Mark Murray was in the center of a large crib with high side rails. His head was swathed in a gauze bandage. Dr. Nakano explained that they’d tried a decompression and a shunt, hoping that might help, but it hadn’t.

  “Take a look,” Dr. Nakano said, handing Victor an ophthalmoscope. Leaning over the stricken two-year-old, Victor lifted Mark’s eyelid and peered through the dilated, fixed pupil. Despite his inexperience with the instrument, he saw the pathology immediately. The optic nerve was bulging forward as if being pushed from behind.

  Victor straightened up.

  “Pretty impressive, no?” Dr. Nakano said. He took the scope from Victor and peered himself. He was quiet for a moment, then straightened up. “The disappointing thing is that it is getting progressively worse. The kid’s brain is still swelling. I’m surprised it’s not coming out his ears. Nothing has helped; not the decompression, not the shunt, not massive steroids, not mannitol. I’m afraid we’ve just about given up.”

  Victor had noticed there was no nurse in attendance. “Any hemorrhage or signs of trauma?” he asked.

  “Nope,” Dr. Nakano said simply. “Other than the swelling, the kid’s clean. No meningitis as I said earlier. We just don’t understand. The man upstairs is in control.” He pointed skyward.

  As if responding to Dr. Nakano’s morbid prediction, the cardiac monitor let out a brief alarm, indicating that Mark’s heart had paused. Mark’s heart rate was becoming irregular. The alarm sounded briefly again. Dr. Nakano didn’t move. “This happened earlier,” he said. “But at this point it’s a ‘no-code’ status.” Then, as an explanation, he added: “The parents see no sense in keeping him alive if his brain is gone.”

  Victor nodded, and as he did so, the cardiac monitor alarm came on and stayed on. Mark’s heart went into fibrillation. Victor looked over his shoulder toward the unit desk. No one responded.

  Within a short time the erratic tracing on the CRT screen flattened out to a straight line. “That’s the ball game,” Dr. Nakano said. It seemed like such a heartless comment, but Victor knew that it was born more of frustration than callousness. Victor remembered being a resident too well.

  Dr. Nakano and Victor returned to the desk where Dr. Nakano informed the secretary that the Murray baby had died. Matter-of-factly the secretary lifted the phone and initiated the required paperwork. Victor understood you couldn’t work here if you let yourself become upset by the frequent deaths.

  “There was a similar case last night,” Victor said. “The name was Hobbs. The child was about the same age, maybe a little older. Are you familiar with it?”

  “I heard about it,” Dr. Nakano said vaguely. “But it wasn’t my case. I understand many of the symptoms were the same.”

  “Seems so,” Victor said. Then he asked: “You’ll get an autopsy?”

  “Absolutely,” Dr. Nakano said. “It will be a medical examiner’s case, but they turn most over to us. They’re too busy downtown, especially for this kind of esoteric stuff. Will you tell the parents or do you want me to do it?”

  Dr. Nakano’s rapid change of direction in his conversation jarred Victor. “I’ll tell them,” he said after a pause.

  “And thanks for your time.”

  “No problem,” Dr. Nakano said, but he didn’t look at Victor. He was already involved with another crisis.

  Stunned, Victor walked out of the ICU, appreciating the quiet as the electronic doors closed behind him. He returned to the waiting room where the Murrays guessed the bad news before he could tell them. Gripping each other, they again thanked Victor for coming. Victor murmured a few words of condolence. But even as he spoke a frightful image gripped his heart. He saw VJ white and hooked up to a respirator in the bed where Mark had lain.

  Cold with terror, Victor went to Pathology and introduced himself to the chief of the department, Dr. Warren Burghofen. The man assured Victor that they would do everything in their power to get the two autopsies, and get them as soon as possible.

  “We certainly want to know what’s going on here,” Burghofen said. “We don’t want any epidemic of idiopathic cerebral edema ravaging this city.”

  Victor slowly returned to his car. He knew there was little likelihood of an epidemic. He was only too conscious of the number of children at risk. It was three.

  As soon as Victor got back to his office he asked Colleen to contact Louis Kaspwicz, the head of Chimera’s data processing, and have him come up immediately.

  Louis was a short, stocky man with a shiny bald head, who had a habit of sudden unpredictable movements. He was extremely shy and rarely looked anyone in the eye, but despite his quirky personality, he was superb at what he did. Chimera depended upon his computer expertise for almost every area, from research to production to billing.

  “I have a problem,” Victor said, leaning back against his desk, his arms folded across his chest. “I can’t find two of my personal files. Any idea how that could be?”

  “Can be a number of reasons,” Louis said. “Usually it’s because the user forgets the assigned name.”

  “I checked my directory,” Victor said. “They weren’t there.”

  “Maybe they got in someone e
lse’s directory,” Louis said.

  “I never thought of that,” Victor admitted. “But I can remember using them, and I never had to designate another path to call them up.”

  “Well, I can’t say unless I look into it,” Louis said. “What were the names you gave the files?”

  “I want this to remain confidential,” Victor emphasized.

  “Of course.”

  Victor gave Louis the names and Louis sat down at the terminal himself.

  “No luck?” asked Victor after a few minutes when the screen remained blank.

  “Doesn’t seem so. But back in my office I can look into it by using the computer to search through the logs. Are you sure these were the designated file names?”

  “Quite sure,” Victor said.

  “I’ll get right on it if it’s important,” Louis said.

  “It’s important.”

  After Louis left, Victor stayed by the computer terminal. He had an idea. Carefully he typed onto the screen the name of another file: BABY-FRANK. For a moment he hesitated, afraid of what might turn up—or what might not. Finally he pushed Execute and held his breath. Unfortunately his fears were answered: VJ’s file was gone!

  Sitting back in his chair, Victor began to sweat. Three related but uncrossreferenced files could not disappear by coincidence. Suddenly Victor saw Hurst’s engorged face and remembered his threat: “You’re not the white knight you want us to believe . . . . You’re not immune.”

  Victor got up from the terminal and went to the window. Clouds were blowing in from the east. It was either going to rain or snow. He stood there for a few moments, wondering if Hurst had anything to do with the missing files. Could he possibly suspect? If he did, that might have been the basis for his vague threat. Victor shook his head. There was no way Hurst could have known about the files. No one knew about them. No one!

  5

  Monday Evening

  MARSHA looked across the dinner table at her husband and son. VJ was absorbed in reading a book on black holes, barely looking up to eat. She would have told him to put the book away, but Victor had come home in such a bad mood she didn’t want to say anything that would make it worse. And she herself was still troubled about VJ. She loved him so much she couldn’t bear the thought that he might be disturbed, but she also knew she couldn’t help him if she didn’t face the truth. Apparently he’d spent the whole day at Chimera, seemingly by himself because Victor admitted, when she’d specifically asked, that he’d not seen VJ since morning.

  As if sensing her gaze, VJ abruptly put down his book and took his plate over to the dishwasher. As he rose, his intense blue eyes caught Marsha’s. There was no warmth, no feeling, just a brilliant turquoise light that made Marsha feel as if she were under a microscope. “Thank you for the dinner,” VJ said mechanically.

  Marsha listened to the sound of VJ’s footsteps as he ran up the back stairs. Outside the wind suddenly whistled, and she looked out the window. In the beam of light from over the garage she could see that the rain had changed to snow. She shivered, but it wasn’t from the wintry landscape.

  “I guess I’m not too hungry tonight,” Victor offered. As far as Marsha remembered, it was the first time he’d initiated conversation since she’d gotten home from making her hospital rounds.

  “Something troubling you?” Marsha asked. “Want to talk about it?”

  “I don’t need you to play psychiatrist,” Victor said harshly.

  Marsha knew that she could have taken offense. She wasn’t playing psychiatrist. But she thought that she’d play the adult, and not push things. Victor would tell her soon enough what was on his mind.

  “Well, something is troubling me,” Marsha said. She decided that at least she’d be honest. Victor looked at her. Knowing him as well as she did, she imagined that he already felt guilty at having spoken so harshly.

  “I read a series of articles today,” Marsha continued. “They talked about some of the possible effects of parental deprivation on children being reared by nannies and/or spending inordinate amounts of time in day care. Some of the findings may apply to VJ. I’m concerned that maybe I should have taken time off when VJ was an infant to spend more time with him.”

  Victor’s face immediately reflected irritation. “Hold it,” he said just as harshly, holding up both hands. “I don’t think I want to hear the rest of this. As far as I’m concerned, VJ is just fine and I don’t want to listen to a bunch of psychiatric nonsense to the contrary.”

  “Well, isn’t that inappropriate,” Marsha stated, losing some of her patience.

  “Oh, save me!” Victor intoned, picking up his unfinished dinner and discarding it in the trash. “I’m in no mood for this.”

  “Well, what are you in the mood for?” Marsha questioned.

  Victor took a deep breath, looking out the kitchen window. “I think I’ll go for a walk.”

  “In this weather?” Marsha questioned. “Wet snow, soggy ground. I think something is troubling you and you’re unable to talk about it.”

  Victor turned to his wife. “Am I that obvious?”

  Marsha laughed. “It’s painful to watch you struggle. Please tell me what’s on your mind. I’m your wife.”

  Victor shrugged and came back to the table. He sat down and intertwined his fingers, resting his elbows on his place mat. “There is something on my mind,” he admitted.

  “I’m glad my patients don’t have this much trouble talking,” Marsha said. She reached across to lovingly touch Victor’s arm.

  Victor got up and went to the bottom of the back stairs. He listened for a moment, then closed the door and returned to the table. He sat down, and he leaned toward Marsha: “I want VJ to have a full neuro-medical work-up just like he did seven years ago when his intelligence fell.”

  Marsha didn’t respond. Worrying about VJ’s personality development was one thing, but worrying about his general health was something else entirely. The mere suggestion of such a work-up was a shock, as was the reference to VJ’s change in intelligence.

  “You remember when his IQ fell so dramatically around age three and a half?” Victor said.

  “Of course I remember,” Marsha said. She studied Victor intently. Why was he doing this to her? He had to know this would only make her concerns worse.

  “I want the same kind of work-up as we did then,” Victor repeated.

  “You know something that you are keeping from me,” Marsha said with alarm. “What is it? Is there something wrong with VJ?”

  “No!” Victor said. “VJ is fine, like I said before. I just want to be sure and I’d feel sure if he had a repeat work-up. That’s all there is to it.”

  “I want to know why you suddenly want a work-up now,” Marsha demanded.

  “I told you why,” Victor said, his voice rising with anger.

  “You want me to agree to allow our son to have a full neuro-medical work-up without telling me the indications?” Marsha questioned. “No way! I’m not going to let the boy have all those X-rays etcetera without some explanation.”

  “Damn it, Marsha!” Victor said gritting his teeth.

  “Damn it yourself,” Marsha returned. “You’re keeping something from me, Victor, and I don’t like it. You’re trying to bulldoze right over my feelings. Unless you tell me what this is all about, VJ is not having any tests, and believe me, I have something to say about it. So either you tell me what’s on your mind or we just drop it.”

  Marsha leaned back in her chair and inhaled deeply, holding her breath for a moment before letting it out. Victor, obviously irritated, stared at Marsha, but her strength began to wear him down. Her position was clear, and by experience he knew she’d not be apt to change her mind. After sixty seconds of silence, his stare began to waver. Finally he looked down at his hands. The grandfather clock in the living room chimed eight times.

  “All right,” he said finally as if exhausted. “I’ll tell you the whole story.” He sat back and ran his fingers through his hair.
He established eye contact with Marsha for a second, then looked up at the ceiling like a young boy caught in a forbidden act.

  Marsha felt a growing sense of impatience and concern about what she was about to hear.

  “The trouble is I don’t know where to begin,” Victor said.

  “How about at the beginning,” Marsha suggested, her impatience showing again.

  Victor’s eyes met hers. He’d kept the secret surrounding VJ’s conception for over ten years. Looking at Marsha’s open, honest face, he wondered if she would ever forgive him when she learned the truth.

  “Please,” Marsha said. “Why can’t you just tell me?”

  Victor lowered his eyes. “Lots of reasons,” he said. “One is you might not believe me. In fact, for me to tell you we have to go to my lab.”

  “Right now?” questioned Marsha. “Are you serious?”

  “If you want to hear.”

  There was a pause. Kissa surprised Marsha by jumping up on her lap. She’d forgotten to feed him. “All right,” she said. “Let me feed the cat and say something to VJ. I can be ready in fifteen minutes.”

  VJ heard footsteps coming down the hall toward his bedroom. Without hurrying, he closed the cover of his Scott stamp album and slipped it onto the shelf. His parents knew nothing about philately, so they wouldn’t know what they were looking at. But there was no reason to take any chances. He didn’t want them to discover just how large and valuable his collection had become. They had thought his request for a bank vault more childish conceit than anything else and VJ saw no reason to make them think otherwise.

  “What are you doing, dear?” Marsha asked as she appeared in his doorway.

  VJ pursed his lips. “Nothing really.” He knew she was upset, but there was nothing he could do about it. Ever since he was a baby he realized there was something she wanted from him, something other mothers got from their children that he couldn’t give her. Sometimes, like now, he felt sorry.

  “Why don’t you invite Richie over one night this week?” she was saying.