Bad blood

41

The windows in Anna Borowski’s office overlooked York Avenue, the stretch of East Side real estate from the Queensboro Bridge to Seventy-second Street-once tenements-now known as Hospital Row. It had taken us only twenty minutes to get here from the Office of the Chief Medical Examiner forty blocks downtown.

“What made you think to call me?” the doctor, whose medical specialty was blood cancers, asked Mike.

He had known Anna for several years, he told me on the ride uptown, from the time Valerie was in treatment. Mike had met his fiancée while he was giving blood at the Memorial Sloan-Kettering Cancer Center, where Val had undergone extensive chemotherapy, as well as her surgery.

“Bad blood, Doc. You know more about it than anyone in town.” Mike was looking out at the campus of Rockefeller University on the far side of the street. He turned back to the oncologist and flashed his familiar grin. “I figure I’ve given you a few pints of my best stuff. That maybe you’d go undercover for me. Get me a peek at the patient’s chart, at least.”

The tall, handsome woman, dressed in a lab coat, lowered the tortoiseshell frames of her reading glasses from the top of her head and opened the thick sheaf of medical records. “Am I just easy or does that smile work on everyone?” she asked me.

“The perps don’t go for it,” I said. “Most of the rest of us do.”

“Duke Quillian?” Mike asked.

“On the promise your subpoena will follow shortly.”

“You got it.”

She adjusted her glasses and got to work reading the papers in the blue folder.

“Acute leukemia, Mike. His chart begins with the usual symptoms. Fatigue, frequent fevers and infections. Nosebleeds and bleeding gums. By the second or third round of antibiotics, the local doc-a family practitioner in the Bronx-drew some blood to be tested. Got the result, made the diagnosis, and sent Mr. Quillian to us. That’s the way the disease typically presents.”

“Don’t you have to pull all kinds of strings to get into these digs?” Mike asked.

Anna shook her head. “People think that, I guess. Your friend Duke-looks like he had perfectly good insurance coverage from his union. More important than that, there was no medical facility in the Bronx, where he lived, that did transplants in those days. I’m not sure there’s one now. This would be the only logical place for him to wind up.”

The word transplant caught my attention. “Duke Quillian had a transplant?”

“That was the only curable method of treating acute leukemia back in the days when he was ill, especially when the patients were as young as this guy.” Anna glanced down at the file. “Mid to late twenties.”

“What’s the process?” Mike asked.

“The patient is typed for the human leukocyte antigen-HLA. And all his family members are typed, too. Did he have siblings, this guy?”

“Yes,” we both said.

“There’s a one-in-four chance of matching a family member,” Anna said. “I’ve had cases with eight children, and none of them match the patient, although a few of them match each other. There’s a second reason we start with family.”

“What’s that?” Mike asked.

“Donating marrow is an extremely painful process. It’s hard to imagine how much it hurts,” Anna said, her voice dropping to a whisper. “When you do it for someone you know and love, it’s got to ease some of that.”

“And if the siblings don’t fit?”

“Then we go to the National Marrow Donor Program. Try to find a match from a volunteer donor.”

“Does it tell you what happened here?” Mike asked, ready to grab the file from Anna’s hand.

“Patient as always, Detective Chapman,” Anna said, glancing at me. “Mike would come in every six months to give blood. He’d expect me to have cured someone before he finished his juice and cookies.”

She skimmed the pages to find the information we wanted. “Yes, Mike. There was a perfect match to one of Duke’s siblings-a sister named Patricia. Seems they refer to her in these records as Trish.”

Mike clapped his hands together and flashed me a victory sign. “So Trish was his donor. Duke ended up with her DNA.”

“Not so fast, Mike,” Anna said. “Yes-and no.”

“I’m sorry to say I’m confused, Doctor. I don’t understand this.”

“Was he in the hospital or not? That’s what I want to know,” Mike said.

“Let me back it up. After the match was confirmed and the surgical date was set, the patient-in this case, Duke Quillian-was admitted to the hospital. Usually, about nine days before the surgery, the chemo treatment begins. The point of that is to kill off all the old bone marrow cells completely-the ones causing the disease. So from that time-Day minus 9-Duke was right here in Sloan.”

“What’s the surgery involved?” I asked.

“Two procedures are conducted on the same day, but only one was actually surgical. Trish Quillian would have been in the operating room. Two doctors were harvesting her bone marrow.”

I winced. “Harvesting?”

“She’s anesthetized, of course, Alex. Facedown on the table. Holes are drilled in her iliac crest,” Anna said, pointing to her hip. “A lot of them. Two surgeons go into the holes to draw out three to five cc’s of marrow each time. The procedure can require as many as three hundred needles, filling up a container the size of a coffee can. Do you understand how much that is?”

Mike’s expression was grim. “Yeah.”

“They take what the docs remove directly up to the blood bank for processing, aligning blood types, filtering out the bits of bone from the marrow, and things like that. Runs another hour.”

“And Duke?”

“He would have been resting in his room during that process. Once the marrow was ready to be transfused, the docs just brought it to him, hung it on an IV pole, and sent it on its way, to get to work inside his system.”

Anna made it sound so matter-of-fact.

“I thought you called it a transplant?”

“In the case of bone marrow, transplant and transfusion really mean the same thing. The stem cells are quite amazing. They have some kind of internal homing system. Once they’re transfused to the patient, they find their way-by themselves-right into the marrow. Like we docs say, the healthy stem cells set up ‘housekeeping’ exactly where they belong.”

“So from that day on, what happens to the patient?” Mike asked.

“Well, that would have been a rough period for Duke Quillian, or anyone else. Trish would have been on her way home in no time, but the next four weeks, Duke would have been under strict quarantine. He would have been isolated from other patients and even visitors-we can’t have the transplant patients exposed to infection. He was put on meds to suppress his immune system, to protect against graft-host disease, to do the best to see that he’d accept the new marrow.”

Mike was checking the records of the transfusion that Anna had passed to him against the timeline of Rebecca Hassett’s murder.

“What do the dates tell you?” I asked.

“This damn record shows Duke Quillian was still a patient here six weeks later, until a full week after Bex was killed,” Mike said, his disappointment evident as he slammed the file shut. “Would he have been quarantined till then?”

Anna reached for the thick folder. “You want to get me in trouble with my administration?” she said, trying to get him to lighten up. “We can go through his chart together. It looks like Duke was clear after Day Thirty, as we call it. Day Thirty’s the critical point. That’s when the DNA tests are done. He had a cautious doctor who was trying to keep him in a safe environment before sending him out in the world.”

“What DNA tests?” I asked.

“Routine blood exams to make certain that his sister’s bone marrow had not been rejected. That the DNA being produced in Duke was actually from the cells harvested from Trish.”

“Anna,” Mike said, leaning his elbows on her desk and beaming his most earnest look in her eyes, “was he in quarantine after Day Thirty?”

She took her time, reading through the pages of fine print, vital signs, and nurses’ notes. “No. No, he wasn’t. He was moved to a room on another floor. His doctor was still doing tests. Didn’t want him discharged for another two weeks. Something about Duke’s job and the high risk of infection it posed.”

Mike was practically in her face. “So just suppose this patient was stir-crazy. Suppose he was hungry for fresh air and a walk in the park. Was he strong enough, healthy enough to do that?”

“Of course. Sure he was. He’d just have to get past hospital security.”

“Outbound? Put on his street clothes and walk out the door. You think that’s ever a problem?”

“Mike, it’s nothing our security would want to hear about.”

“I’m talking more than ten years ago, Anna. I’m not getting anyone in trouble today. On the way back in,” Mike said, pushing back to talk to me, “Duke’s already got his hospital ID and a room number. What’s to stop him from waving at the guard and going back to his room? Damn, if he didn’t ring for his bedpan during the night, who would have missed him for a couple of hours?”

“Do you have an exact date, Mike?” Anna asked.

Mike told her when Rebecca Hassett was murdered.

She studied the file again, focusing on a specific page. She scratched her forehead before looking at Mike. “I can’t say the patient didn’t have a window to-to move around. Nurses took his vital signs at the beginning and end of each shift. No other medical procedures were noted.”

Mike seemed satisfied with the doctor’s answer.

I picked up the file to look at the dates for myself. “What were you saying about DNA tests? How do they figure in this? Trish and Duke-is their DNA the same now?”

“Let me explain it, Alex. Bone marrow is what produces blood. It’s the patient’s blood that is diseased in Mr. Quillian’s kind of diagnosis, and this treatment aims to replace that blood production source entirely, with a healthy one.”

“So Trish’s bone marrow was transfused to Duke?”

“Right. On Day Thirty, Duke’s blood was checked. That’s done by DNA probes.” Anna turned the file around. “The old method at that time. RFLP, four probes.”

Restriction fragment length polymorphism, the original technique used in DNA analysis, had been replaced within the last ten years by PCR, polymerase chain reaction.

“What did that test tell them?” I asked.

“Whether the transplant had been a success. Thirty days out from the procedure, the DNA results on Duke Quillian revealed that all of his blood was produced by his sister’s bone marrow. That was great news, for him and his physicians. If he’d been relapsing, there would have been a mix of the donor’s DNA-Trish’s-with the blood still being produced by the host.”

“And for how long do they check it?”

“Six months. One year later. Maybe two or three in all. Someone young and otherwise healthy, like this Duke Quillian character was-well, we’d consider him cured after that. What his medical team would be hoping is that he’d die of old age, with his sister’s DNA, his sister’s blood,” Anna said.

“Not quite the ending he met with,” Mike said.

“So it’s like identical twins,” I said. “From the day of the transfusion on, Trish and Duke Quillian had exactly the same DNA.”

“With one twist,” Anna Borowski said. “It’s only in the blood samples of each of them that their DNA is alike.”

“What do you mean?”

“Duke’s hair, his skin cells, his saliva-even his sperm-all those tissues retain their original properties. Test any of them and they’re still unique to Duke Quillian.”

I was thinking of the skin cells from his fingers that didn’t match any of the blood extracted from the tunnel debris. Now the discrepancy was beginning to make sense.

“But his blood?” I asked.

“He had a perfect recovery from the leukemia, thanks to the bone marrow transplant from his sister.”

“And that means from that moment in time on,” I said, “that both of them-Duke and Trish Quillian-had blood with an identical DNA profile.”