Fatal

CHAPTER 15

Much of what I write here of my infection with the Lassa virus and my miraculous recovery I gleaned from conversations with those who cared for me during my thirty-day hospitalization. I use their accounts because I was delirious for much of the time, and remember almost nothing.

The words were those of Dr. Suzanne O'Connor, a missionary physician. She was working in the central Nigerian city of Jos in the spring of 1973 when a patient, Lila Gombazu, crazed with fever, clawed through her rubber gloves and broke the skin on the back of her hand.

Cloistered in one corner of the Library of Medicine at the NIH, Ellen Kroft read O'Connor's harrowing account with a dry mouth and an unpleasant fullness in her chest.

The poor woman who scratched through my glove went into convulsions the next day. In spite of the most heroic measures we could muster, she began hemorrhaging from her nose, womb, and rectum, and died horribly, crying out at the end for her children, two of whom, she had no way of knowing, were already showing symptoms of the disease. Twelve days after my encounter with Lila, my good health and the crush of work caring for our patients had driven the incident to the back of my mind. That day, a Monday, I mentioned to one of the nurses that I had a stuffy nose and scratchy throat, and thought I might be coming down with the flu. Tuesday was more of the same, although the discomfort in my throat was steadily worsening. I couldn't possibly take time off from my work, though. The hospital was filled to capacity and then some. I put myself on a high dose of penicillin and tried to force fluids past the inflammation and the raw, white sores that now dotted my palate and pharynx.

On Wednesday, I was making rounds on our patients when I was seized with uncontrollable shivering and profound weakness. Perspiration soaked my clothing as if I were standing in a thunderstorm. My temperature at that moment, as taken by one of the nurses, was 105 degrees Fahrenheit. Within an hour, I was a patient in my own hospital, moaning piteously from the pain in my muscles and joints, unable to take fluids because of the gaping, deep ulcers in my throat, and soiling myself and my bed with uncontrollable diarrhea. The next morning, I was delirious. My temperature had risen to 107 despite vigorous efforts to keep it down. For days, I am told, I lay unconscious, unable to take nourishment or fluids, oozing red blood from my rectum, and coughing up blood as well.

From the beginning, the diagnosis of Lassa fever was strongly suspected. My associate Dr. Janet Pickford made valiant efforts to fly experts from the CDC to Nigeria along with serum from a woman who had recovered from the disease and had circulating antibodies against it. Unfortunately, the government of Nigeria, angry about having the disease named for the village of Lassa, located along the Nigerian border with Cameroon, delayed issuing visas to anyone involved with my case. Finally, those State documents were approved, and on the tenth day of my illness I received an infusion of the woman's convalescent serum. By then I had required more than a dozen blood transfusions, and had been delirious or in a coma for almost the whole time. I had lost nearly thirty pounds from a frame that was slender to begin with, and was a mass of bruises and sores. My urine and stool were bloody, as was the mucus from my chest.

Incredibly, within just two days of receiving the serum, my condition began to improve. A miracle, everyone said. Gradually, the hideous ulcers in my mouth began to heal, and I was able to take nourishment. Over the next two weeks I regained much of my strength as well as my will to live. What I did not completely regain was my hearing, which was lost to the virus in both ears, and which has only returned slightly in my right. I would wish the illness of Lassa fever on no one, and pray that, with time, a cure or vaccine for this most terrible hemorrhagic virus might be found.

Ellen closed the book called Closer Than You Think — Infectious Diseases in a Shrinking World, and sank down in her chair, staring across the library at nothing in particular. Sixty-one. That was how many cases of Lassa fever had been reported in the U.S. over the past couple of years. Sixty-one and counting. Not that it mattered to Ellen whether the cases were here or in Africa, but for the time being at least, Omnivax was going to be administered here. And the Lasaject component of the supervaccine was, she had come to believe, the weak link in the chain. Now, a day after a very sobering, highly charged meeting at the office of Dr. Richard Steinman, she wasn't so sure.

Lynette Marquand's startling pledge that if even one of the vaccine panel's twenty-three experts expressed misgivings, release of Omnivax would be put on hold until those problems could be satisfactorily addressed had hit her life like a wrecking ball. Following the pronouncement, Ellen had done her best to continue with business as usual, but that state of existence had proven highly elusive. Less than a day after Marquand's speech, Steinman had requested that she meet with him at his office at Georgetown. When she arrived, she found the renowned physician and scientist waiting for her, along with George Poulos. On the corner of Steinman's desk was a copy of the day's Washington Post. A headline on the front page proclaimed:

First Lady promises to rethink Omnivax if panel vote is not unanimous

The article, which Ellen had read, did not mention her by name, but did say that debate among members of the select commission on Omnivax would continue until the vote, to be held in just three days. Steinman, who had a certain amount of charm and warmth, was nevertheless extremely formal, and even after nearly three years addressed all of the commission members by their title.

"Well, Mrs. Kroft," Steinman began, "I appreciate your coming up here to meet with me. I hope you don't mind my having taken the liberty of inviting Dr. Poulos to join us."

"No problem," Ellen said, still smarting some from the exchange with Poulos at the final commission meeting.

"After Mrs. Marquand's speech, I, um, felt it was essential to review our conversation with Dr. Steinman," Poulos said. "I felt that in view of the First Lady's promise to the nation, he should know that the final vote might not be unanimous."

"I suppose I would have done the same thing in your position," she said, somewhat coolly.

"Mrs. Kroft," Steinman said, "I confess I was somewhat taken aback to learn that, at least before Mrs. Marquand's speech, you were planning to vote against the implementation of Omnivax. Over the years we have been meeting together, I felt that you honored your mandate as a consumer on our committee quite admirably, by questioning issues until you understood them and always being prepared for our sessions. I wondered from time to time if you might vote against approval when yours was only one ballot of twenty-three. But now that your vote can effectively stop the entire Omnivax program, I thought, if it is all right with you, that we might review together what is at stake."

Of all those on the Omnivax panel, Steinman was the one Ellen respected the most. He had guided every session evenhandedly, and had always been patient and encouraging when she began one of her "Excuse me, but as a nonphysician, I was wondering if…" questions.

"I am open to any input or point of view," she said. "Despite what Dr. Poulos may have told you."

Poulos tried unsuccessfully to inject some warmth into his grin.

"I admit that, right or wrong, I do recall your saying something to the effect that you didn't plan on voting in favor of approval."

The man was right, but holding most of the high cards, Ellen didn't feel it necessary to respond.

Steinman passed two computer-generated pages to her.

"I know how you feel about statistics, Mrs. Kroft. As malleable as chicken, I believe you said. But you still must acknowledge that often in science, statistics are all we have."

"I understand."

"This is a distillation of material we have discussed in great detail in our meetings. It is, in short, our estimate of the lives that will be saved by Omnivax over one, five, and ten years, broken down disease by disease. Please believe me when I say that this summary was put together by statisticians who are as unbiased in their opinions as it is possible to be."

Ellen scanned the list which was, as Steinman said, a summary of precisely what was at stake. Measles was included, as well as the other vaccines now legally a part of every child's immunizations. But with or without those vaccines, the number of lives to be saved was staggering. The one-year figure for Lassa fever was 240, which seemed in keeping with the statistics she knew. By five years, however, the death toll would be over eight thousand, and in ten, nearly fifty thousand. Ellen gazed out the window, thinking about Lucy and the hundreds of other tragedies represented in the files and photos of PAVE. Those were real flesh-and-blood lives, not statistics. Then there were the myriad cases of ADHD, learning disabilities, asthma, diabetes, multiple sclerosis, sudden death, Asperger's syndrome, and other forms of autism, whose possible link to their childhood shots still begged investigation.

"I'll think about this," she said, slipping the data into her briefcase.

"Ellen, look at those numbers," Poulos blurted out. "Don't you see what these numbers mean?"

"Yes, I see, Doctor," Ellen countered. "I see perfectly. But do you see what it's like to have the life of a perfectly happy, healthy child suddenly ruined or snuffed out altogether by something that was done to her by her physician?"

"George, please," Steinman said, discarding formality. "Mrs. Kroft, we do understand that. Believe me, we do. Risk-benefit ratio is the bedrock on which all medical treatment is built. And not one of us would deny that there are some immediate adverse consequences of immunizations for some children. All we can ask of you is that you do exactly as you have said you would, think things over. But I feel I must underscore all that is at stake here."

"And I do appreciate that, Dr. Steinman," Ellen said, standing to indicate that she had heard enough — especially from George Poulos. "I won't make any pronouncements about what I'm going to do, but I do promise to consider all the issues. I hope that's enough for the time being."

"It will have to be," Steinman had concluded.

Ellen had left Steinman's office in something of a daze. Why in the hell had Lynette Marquand done this to her? Things were fine when she believed that her vote would make a statement. Now that her vote could halt the project altogether, the pressure was immense.

She left Georgetown and spent much of the rest of that day in Bethesda at the NIH library. Now, after a second day of research, it was time to discuss matters with Cheri and Sally at PAVE, prior to making a final decision as to which way she was going to vote. Whatever that decision ultimately was, Suzanne O'Connor's gripping account of her battle with Lassa fever would be a strongly considered factor.

Lost in thought, she gathered up her things and headed out to her car. Following Marquand's speech, it was certainly expected that she would speak personally with Cheri and Sally. Yet she had kept putting off that meeting. Cheri Sanderson, however, hadn't waited too long before calling her. She was hardly a fool, and Ellen's uncertainty, however minimal, still resonated loud and clear.

"This is big stuff now, Ellen," she had said over the phone. "I'd be lying if I said that it wasn't important for us suddenly to be on center stage, and that you are in a position to put us there."

A mile into the drive, Ellen used her cell phone to call Rudy.

"Peterson here."

"Rudy, it's me," she said, imagining him sitting at his desk on the second floor of his cabin.

"Well, greetings. Are you going to be famous?"

"You mean, am I going to vote against Omnivax?"

"That would certainly put you on the Oprah show."

"I suppose it might. I met with the head of the committee yesterday, and now I'm on my way to speak with the moms at PAVE."

"And?"

"I don't know anymore, Rudy. Do you have any information on Lasaject that might help me out?"

"I'm waiting for a call from a friend of mine at the CDC. All I can tell you at the moment is that the preliminary research on the vaccine was a bit sloppy in its design and severely limited in its scope. But as I said before, there are some other things that may be going on. That's what this call from Arnie Whitman at the CDC is all about."

"So when will you know anything?"

"Maybe later today, maybe tomorrow. In the meantime, all I can tell you is that the vaccine seems okay, if not squeaky-clean. When's the vote?"

"The day after tomorrow."

"I don't know. All I can say is, I'll keep in touch."

"Thanks, Rudy."

"Any plans to come by these parts?"

"As soon as this vote is over. I love it up there, and goodness knows I'll need the rest."

"Good enough. I'll keep the kettle boilin' for ya."

Ellen set the phone down. Rudy wasn't going to be the answer, at least not on this round he wasn't.

Unlike her last visit to the PAVE brownstone, this time Ellen could find no parking space. Reluctantly, she pulled into an $8 for the first half-hour lot three blocks away. There were problems with vaccines that the government and scientific community weren't addressing — pure and simple. She had absolutely no doubt that lives were being lost and destroyed because of the immediate and long-range complications of immunizations. But she also had no doubt that vaccines prevented a great deal of suffering and death.

There was no standing ovation this time when Ellen stepped into the offices of PAVE. No silliness. Suddenly, her valiant, quixotic stand on behalf of issues in which they all believed had turned serious. Ellen recalled the delightful book and movie The Mouse That Roared, in which a minuscule country with an army of two dozen or so archers wages war against America. Their plan is to quickly lose in order to reap the traditional harvest of postdefeat reparations from the American victors. Except that they win. Now what?

No one, but no one, had expected to be in a position to defeat Omnivax, even temporarily. All PAVE wanted was a platform on which to take one more baby step forward — to get concerns about vaccine safety presented to the world. And Ellen had certainly come through for them in that regard.

Now what?

"Hey, comes the conquering hero."

Cheri Sanderson bounded from her office and exchanged hugs with Ellen.

"If I'm so conquering," Ellen responded, "how come I feel like there's a lemon lodged in my throat?"

"I understand John Kennedy got physically ill right before he called Khrushchev and told him to turn the missiles around or else. Come on in. Coffee? Tea?"

"No, thanks. Sally not here?"

Cheri's cluttered office featured framed articles chronicling the remarkable ascendance of PAVE, as well as mounting public recognition that vaccinations were not as warm, fuzzy, and uncontroversial as the powers that be would have everyone believe.

"She's spending the day with her husband. She's been getting a little emotional lately about this Omnivax business, and I think she's been a little hard on him."

"I can understand. I know what she's been through with what happened to her son."

"So today it's just going to be you and me. Quite a spot Lynette put you in, huh?"

Ellen stared down at her hands. This woman, no more than five-two or — three, was a giant, chosen perhaps by God to overcome massive odds in order to make a difference. Over the past decade and a half she had spent thousands of hours cajoling, writing, researching, debating, flattering, decrying, begging, consoling, sobbing in order to help the world right what she believed was a most serious wrong. She had fought beside mothers whose children were being hauled away from them because they refused to have them vaccinated. She had sat before specially appointed masters at the U.S. Court of Federal Claims, holding hands with parents who had just received a piddling sum to care for their vaccine-injured child — the legally declared maximum according to the National Childhood Vaccine Injury Act of 1986 — or worse, no compensation at all.

Ellen gazed up at one of the framed quotes. It was from a Wisconsin mother whose son, whose dream, was horribly, irreparably damaged: The government forces us to give our children these vaccines, it read, and then when something goes wrong — too had — you're on your own.

"Look," Ellen said finally, unable to couch the words, "I'm sorry for seeming so reserved, but you have no idea what I've been listening to for the past three years and who's been saying it. These men and women are not monsters or criminals or killers. They're physicians and scientists and intellectuals. They really believe in what they are doing." To Ellen's surprise, there was no knee-jerk rebuttal from Cheri. Her expression, which sometimes had the hardness of a diamond, was soft and sad.

"I know they are," she said gently.

"I won't argue the fact," Ellen went on, "that many of them get research money from the pharmaceutical companies. But does that necessarily make them wrong? For every graph I produced, they produced a dozen. For every question I asked, they offered incredibly logical, supported answers. For every expert I quoted, they brought in ten with qualifications just as sterling. When I thought my vote was going to be a token, a polite request for continued debate on the issue, that was one thing. I never wanted to be the epicenter of this controversy. I never wanted to be the linchpin."

Cheri pushed back from her desk, then walked behind Ellen and embraced her, resting her cheek on Ellen's hair. There was nothing phony in the gesture, nothing patronizing.

"Look," she said, returning to her seat, "I'm not going to say this isn't important to us. But I will say it isn't everything. It's a battle, not the whole war. There were more than five hundred in attendance at the vaccine conference we ran this year. Five hundred from all over the world — professors, pediatricians, scientists, parents, philosophers. There will be more at the next one. The press and Congress are beginning to see that we are not hysterical radicals being led around by our bitterness, hormones, and emotions, devoid of logic, unwilling to listen to reason.

"Ellen, you've done a wonderful job — more so than any of us had the right to expect. You've made Sally and me and all the others out there proud. You've already helped thousands of parents know that their opinions matter. If you vote against Omnivax, you and I both know you're headed for a feeding frenzy in the media, and maybe even the cover of Newsweek and Time. We'd be naive to think otherwise. If you vote for it, life settles back down for you, and you'll still be welcome to resume your spot on the volunteer phone. But I promise you, either way, pro or con, nothing will change in our determination to have a true, long-term scientific evaluation of immunizations. Nothing will change in our crusade for informed parental choice. Nothing will change in our commitment to find the middle ground that is safest for all people."

Ellen could tell by Cheri's expression that she wasn't playing any head games, even though she had the reputation in some quarters of being a master at it.

"My mind is nearly made up as to what I'm going to do," Ellen said, "but until I am absolutely certain, I'd like to keep things to myself."

"That's okay," Cheri replied. "It would sure be nice to know as soon as you do, and I certainly hope you deliver a blow for us."

"I intend to do what's right," Ellen added, hoping Cheri might read that things were likely to go her way.

"That's all any of us have ever asked of you," Cheri said.

As Ellen walked out past Sally's open office door, she peered in at the photos adorning the walls, and paused a moment to look at one in particular.

Ellen's home, an expanded seven-room Cape in Glenside, Maryland, southeast of D.C., was the one she and Howard had bought shortly after their marriage.

"If this is the only place we ever live, I'll be perfectly happy," he had said at the time.

Sure.

On the way home, Ellen stopped at the local superette for some eggs and milk. She loved omelets of all kinds, and with what there was in the crisper she would be able to create a gold-medal winner. Physically and mentally she was spent — as exhausted as she could ever remember being. As she was fishing out her wallet for the cashier, she glanced over at the magazine rack. Both Time and Newsweek were there. Imagine her face on the covers. Today buying eggs and milk at Kim's Korner, tomorrow her face around the world. Was she ready?

What do you think, Howie? Expect to see your new bride on a magazine cover anytime soon? Barmaid Monthly?

Ellen set her groceries on the front seat, chastising herself for her pettiness. Most of the time she managed to keep her anger and hurt in decent check. It didn't feel good at all when she had a slip. The supervaccine was too much, too fast. She thought of the horrible arithmetic Steinman had presented to her: lives lost or ruined if she voted for the drug versus lives lost or ruined if she voted against it. Based on the current level of knowledge of vaccines, it was really no contest. But that was precisely the main point for which Cheri and Sally and the others were crusading — an increase in our level of knowledge.

Ellen pulled into the garage and brought her bundle in through the kitchen door. Despite the unpleasant association with Howard, she really did love the place, from her window herb-garden, to the huge oak in the backyard, to the pesky squirrels, to the small balcony off her bedroom where she often sat and watched the first sunlight of the day filter through the trees. It was really a very lovely -

Ellen set down her package and sniffed the air. Had someone been smoking in the house? One of Howard's pet peeves with her was her overdeveloped sense of smell, and one of her pet peeves was cigarette smoke in any form. Still sniffing curiously, she walked down the short hallway to the living room. Then she cried out and stumbled backward, clutching her chest to keep her heart from exploding.

Sitting calmly in the easy chair next to the fireplace was a large, powerfully built man. He was dressed expensively in a gray suit and black shirt — open collar, no tie — and ornately stitched cowboy boots. His head, square as a block of granite, was topped by thick, jet-black hair, combed straight back and held in place with some product that glistened. His hard, narrow eyes looked as black as his hair, and his wide mouth was accentuated by a short, thick scar that ran from the center of his upper lip to the base of his nose — possibly the result of surgery to repair a harelip.

"Golly, I'm sorry to have startled you, Mrs. Kroft," he said, with a pleasant, gravelly voice and the cheerful, easygoing manner of a used-car salesman. "Please have a seat, have a seat."

Ellen remained fixed where she was. There was no evidence the huge intruder had smoked in her house, yet the reek of cigarettes was definitely coming from him. She debated running, but in truth, she didn't have the sense that she was in any immediate danger. The man had already gotten into her home. If he had wanted to harm her, he wouldn't have been waiting placidly in her living room.

"Who are you? What do you want?" she demanded.

The man smiled patiently.

"Who I am doesn't matter. What I want at the moment is for you to sit down… over here." He motioned to the sofa next to his chair.

Ellen hesitated, then took a breath and did as he demanded. At close range, his eyes were more than dark, they were frighteningly cold. His thick, heavy-knuckled fingers rested in his lap, curled around a large manila envelope. The little finger of his left hand bore a gold ring with a square-cut diamond that must have been three carats or more.

"Now," Ellen said, "what are you doing here?"

"I represent a group that is very interested in getting Omnivax into circulation as soon as possible. That is all you need to know."

"So? What has that got to do with me?"

His expression tightened. Ellen thought she saw a brief tic at the corner of his mouth. Still, he managed a patronizing grin.

"Mrs. Kroft," he said, his tone still chillingly calm, "I have neither the time nor the patience for games. Both you and I know the significance of the unfortunate promise Lynette Marquand made to the world."

"And?"

"And I have it on good authority that you are the only person who might force her to honor that pledge."

"Who do you work for? The President? The drug people? Who?"

The huge man sighed impatiently and ignored the questions.

"Mrs. Kroft, I am going to have to insist on your word not to block the planned release of Omnivax."

"What do you have in that envelope," she asked, "bribe money?"

"Oh, I have no intention of trying to bribe you, Mrs. Kroft."

There was something chilling in the way he said the words. He passed over the envelope. Ellen opened it, removed the photographs it contained, and gasped. Inside were half a dozen sharp, professional quality black-and-white eight-by-ten snapshots of Lucy. Lucy heading into school, hand in hand with Gayle; in the playground; at home in the yard; even asleep in her bedroom.

"You wouldn't dare harm this child," Ellen rasped.

The man simply looked across at her placidly. She wanted to leap up and claw the smugness off his face.

"I will do whatever it is I have to do," he replied firmly. "Look at me and don't doubt me for a second. If you do, you and you alone will be responsible for the consequences. The people I work for have given this matter utmost priority. If you disappoint us in any way, I promise you that your granddaughter will simply disappear… forever. What happens to her after she vanishes you don't even want to speculate about. And, depending on how angry my employers are, that may well only be the beginning."

Her anger muted by the sheer arrogance of the monster next to her, Ellen could only glare at him.

"Do I make myself clear?" he asked. "Do I?" For the first time, he raised his voice.

"Y-yes," Ellen managed.

"You can go to the police if you want, but I promise you two things. Number one, we will find out, and number two, they will be able to do nothing to prevent what I have promised you will happen. Clear?"

"Yes."

"Good. We have an understanding, then?"

"Yes," she said again, now perilously close to tears.

"Wonderful," the man said, standing.

Stretched upward his full length, with his broad shoulders and massive head, the killer was daunting. As calmly as he might pick up the morning paper, he leaned down and retrieved the envelope and photographs. The cigarette stench of him at such close range had Ellen close to vomiting. He then took a cell phone from his pocket, flipped it open, and dialed a number with one button push.

"We're all set," he said simply.

Seconds later a car pulled up outside.

"I thank you for your hospitality, Mrs. Kroft," he said. "And your family, I am sure, thanks you for your levelheaded decision making. There's no need to show me out."

He closed the drapes to the picture window and, with a final grin, left. Ellen raced to the window, and stuck her head between the drapes, hoping to pick up the license plate number. But the car, a nondescript sedan, was already rolling off down the street.