Fatal

CHAPTER 24

The massive killer moved across the floor with surprising stealth and closed in on Nikki as she slept. Her eyes opened a slit, but it was too late. Before she could make a sound, his huge, fleshy palm clamped over her mouth. His knee ground into the small of her back, increasing pressure on her spine until she knew it was going to crack in two.

Please, no! Please stop! her mind screamed. I don't want to be paralyzed!

Paralyzing her was clearly only part of what the man had in mind. He had tried to kill her before and botched it. He was not going to miss again. His moon face puffed into a lurid smile as he hooked his fingers beneath her chin and pulled her head back. His knee was pressing straight through her body.

Nikki awoke lost and totally disoriented, clawing at her pillow. The air in the strange room felt thick and stagnant. Then, as she was forcing herself to calm down, she heard the steady breathing of the man lying next to her. Startled, she sat up on the side of the bed, trying to ignore the land mines exploding behind her eyes. The sight of Matt Rutledge, sleeping deeply, his face peaceful and un-lined, brushed aside the last of what had been a series of exquisitely vivid and frightening nightmares. A piece at a time, some of the events of the night just past drifted into place. The man lying there, her doctor, had saved her from certain torture and probable death — just rode in on his motorcycle and saved her life. She wondered how much her managed-care insurance carrier allowed for that service.

The postage-stamp room featured a bed that was probably rented out as a queen, but looked smaller, and a fan-back, white wicker chair. In addition, there was a small, three-drawer bureau with some clothes neatly folded on top. Nikki padded to the tiny bathroom, washed her face with cold water, then brushed her teeth and hair with brand-new supplies that seemed to be waiting there for her. Her arms were a mass of bruises from IVs, blood drawing, and God only knew what else. There was a thick, tender scab, an inch or two long, just above her right ear. She felt certain she knew what had caused it, but with her thoughts careening about like bumper cars, she just couldn't seem to get her mind around anything specific.

She returned to the bedroom, settled onto the wicker chair, and dropped her feet heavily onto the bed. The impact was enough to visibly jar Matt, but he lay there undisturbed, his half smile suggesting that whatever his current dream, it was far removed from those that had been tormenting her. He had kicked the sheet aside, and lay there in a pair of sweat pants, naked from the hips up. He had the full waist and broad shoulders of an athlete past his prime, but managing to keep up. She had never been particularly drawn to men who wore their hair in a ponytail, but his seemed to fit his rugged features well. All in all, he was not Hollywood handsome, but he was damn attractive in most of the physical ways that mattered to her — and he had just saved her life. She knelt by the bed and studied the tattoo on his deltoid. It was — what had he said? — a hawthorn tree, about two inches high — beautifully rendered as far as she could tell. Because of her own unusual tattoo, she always paid attention to them on others. A tree was a first. There was a story there, she was certain of that. She brought her face up so that her eyes were just a few inches from his. She felt his breath and expected him to react in some way to her closeness. Nothing. He continued his sleep and, judging from his peaceful expression, his dream as well.

The clock radio on the bureau read seven-thirty, which more or less corresponded to the light filtering through the curtains. It seemed like waking her new roommate was going to take nothing short of a frontal assault, but not just yet. She shifted back onto the chair and sorted through what she could remember of the strange and deadly events since her departure from Boston. One thing, and maybe only one, was clear — Kathy Wilson was at the center of whatever was going on. She was one of at least three people from Belinda with a bizarre, terrifying, inexorably lethal syndrome. Matt was certain that a toxic exposure was responsible for the unusual constellation of signs and symptoms. His theory made as much sense as anything did, especially backed up by his discovery of large-scale toxic waste storage in a cave near the Belinda mine. But what was Kathy's connection with the mine? And why did the chief of police send men to kill Nikki and subsequently become obsessed with finding out whom she had spoken to about Kathy's condition?

At the moment, she didn't have the wisp of an answer to any of her own questions. But knowing Joe Keller as she did, if there was a clue in the anatomy of Kathy's nervous system, he would find it. There was a phone on the bureau with a note taped to it that local calls were free and long-distance calls had to be collect or credit card. Holding her breath, she dialed 1-800-COLLECT and placed a call to what she hoped her disrupted memory had held on to as Joe Keller's direct line. If the clock radio was correct, her boss would have been at the office for an hour already — possibly two — sipping his thick black coffee and working out anatomic and biochemical puzzles.

"Bless you," she muttered when his voice came on the line and accepted the prompt to say "yes."

"Joe, I'm all right," she said quickly.

"Thank God. People have been very worried about you. We even called the police."

Nikki started to explain that a chief of police was, in fact, responsible for her trouble, but quickly stopped herself. There would be time.

"I'm on my way home right now. I should be there by late tonight."

"Excellent."

"Joe, I've had some trouble in West Virginia related to my friend Kathy — the one you autopsied."

"What sort of trouble?"

"There are two other cases down here that looked and acted exactly like hers — neurofibromas and progressive paranoid insanity."

"Well, now, that is something," Keller said. "You see, your instincts were absolutely correct in this case. I am looking at the slides of Miss Wilson's brain right now. She has unmistakable spongiform encephalopathy."

Spongiform encephalopathy. Nikki caught her breath. The degenerative, transmittable, ultimately fatal nervous-system disease had a number of forms, including a syndrome called Creutzfeldt-Jakob disease; kuru, once found in the brain-eating cannibals of New Guinea; fatal familial insomnia; and bovine spongiform encephalopathy, also known as BSE, or more commonly, Mad Cow disease.

Excitedly, Nikki stretched out and kicked Matt firmly on the sole of his foot. He bunched his pillow beneath his head and pulled his foot away. She kicked him again, even more forcefully, this time with her heel against his calf. He moaned and began to stir.

"Go on, Joe," she said, knowing better than to ask if he was sure. "This is quite incredible."

"You say there are two other cases where you are?"

"In the town where Kathy grew up, yes."

One final kick and it was clear Matt had at last ascended to a higher plane of wakefulness. If he hadn't taken some sort of drug, he was a candidate for the Guinness Book of Records. Her clients in the coroner's office were easier to rouse.

"And these other cases," Keller asked, "they had spongiform encephalopathy also?"

"I don't know. Their brains appeared normal on gross exam, so the microscopic wasn't done."

SE was caused by germs known as prions — infectious protein particles capable of reproducing themselves without DNA or RNA. One of the characteristics of SE was that despite an often spectacular clinical picture, the brain looked grossly normal until sections of it were examined under the microscope, where diffuse, sponge-like holes could be seen. Another characteristic was that the incubation period of the disease was often a decade or more, during which time the victim might well be infectious to others.

"Did these cases of yours also have neurofibromas?" Keller asked.

Matt was awake now, pawing sleep from his eyes and looking over at her quizzically. She put a finger to her lips and motioned that she would fill him in momentarily.

"Yes, both of them. From what I have been told, there was nothing unusual about them on microscopic."

"Well, maybe and maybe not," Keller said. "I tried a number of stains and stain combinations on them, and found an approach that clearly distinguishes these lesions from the reference neurofibromas in my library."

Keller the ever-curious, Keller the intellectual. Nikki smiled just picturing her boss. He was forever playing with stains and with his department's powerful electron microscope. His library, in addition to the hundreds of texts, included hundreds, probably even thousands, of unstained specimens from every organ and countless disease states, each carefully catalogued. Evidently, among those unstained tissues were some run-of-the-mill neurofibromas — the reference specimens.

Spongiform encephalopathy with unusual neurofibromas. The Belinda syndrome, Nikki speculated… Or maybe Rutledge-Solari disease.

"Joe, listen, we'll be home between ten and twelve tonight."

"I should be here then."

"If you are, great. But if not, we'll see you tomorrow morning."

"We?"

"A doctor from down here saved my life two or three times recently. He's got more than a passing interest in this syndrome. He thinks it's due to a secret industrial dump spilling toxic waste into his town's groundwater."

"Given what we know about prion infections," Keller said, "I really don't see how."

"Well, we'll talk about it when we get there. Thanks, Joe."

"I'm so relieved you are okay," Keller said. "Oh, by the way, the police had no trouble finding the man who killed your drowning victim, Roger Belanger. His name was Halliday. That was what the 'H' was for. They were friends and business associates. The police believe they fought about money. Halliday invited him over to his place to make up. He wrote a check and the two of them had a few drinks. Once Halliday got him into his pool, he got his hands around Belanger's throat and dragged him to the bottom."

"Process," Nikki said.

"Exactly," Keller concurred.

By the time Nikki set the receiver down, Matt had pulled on a new, blue sweatshirt with YALE block-printed on the front.

"Mornin'," she said.

"Mornin', yourself."

She motioned at the sweatshirt.

"Did you go there?"

"No, but while you were trying on things in that Target store last night, I bought some stuff for me. This was one they had in my size."

"Believe it or not, I remember. Well, sort of. Where did you go to school?"

"Good ol' WVU. The Mountaineers. That was the only college we could afford. Turned out to be a great place."

Nikki felt certain she recalled a nurse telling her that Matt had gone to Harvard Med, yet he didn't feel that minor factoid was worth tossing in. She gave him high marks for modesty, as if he needed any more high marks after what he had done for her.

"You sleep soundly," she said.

"People have noticed that from time to time, yes."

"If you have trouble walking today, it's from me kicking you to wake you up."

"The nurses at the hospital quiz me when they call, to be certain I'm awake. They don't know that I've mutated so that I can now answer most of their questions, even the complex mathematical ones, in my sleep. Do you remember much of last night?"

"Unfortunately, I think I do. I hope I thanked you enough for rescuing me the way you did."

"I have a thing against losing patients. So, what was that call all about?"

"I phoned my boss, Joe Keller, to tell him I was alive and well, and to see if anything had turned up in Kathy's microscopic."

"And?"

"You're not going to believe this, Matt. Kathy had spongiform encephalopathy. Joe's absolutely certain of that, and believe me, he's, like, never wrong."

Matt sank back onto the bed, incredulous. He was hardly an expert on the various versions, but he was keeping up on the condition in the medical literature — at least as much as his cramped schedule would allow.

"Prion disease?"

"Yes," Nikki said. "Quick point of interest — most people pronounce it pry-on, the way you do, but Stanley Prusiner, who won the Nobel prize for describing the beasties, pronounces it pree-on. I heard him speak a year or so ago."

"Pree-on it is. This is incredible. Do you think my two cases had SE as well?"

"How can I not?"

"Well, what in the hell?… What about the neurofibromas? Anything special about those?"

"Apparently there was. Joe Keller is sort of a stain freak. He might try a dozen different staining techniques on a piece of tissue just to see what shows up. He tells me Kathy's facial lesions take up this one obscure stain differently from the usual Elephant Man type of fibromas."

"I just don't get it."

"Neither do I. But listen, Matt, the way I see it, maybe you're still on the right track. Before we jump to any conclusions, let's go up to Boston and see what Joe has to show us."

"Give me a few minutes to get put together and we're off."

"Only as far as the nearest IHOP, though. I have this sudden, insatiable craving for pancakes drenched with maple syrup."

"IHOP, she wants," Matt mumbled as he headed to the bathroom. "First she lays prions on me, then she wants IHOP. What kind of a woman is this, anyway?"

Nikki was impressed with his attempt at cheeriness, but she knew Joe Keller's revelation had stung. From what Matt had told her last night, he was determined to expose the directors of the Belinda mining corporation for all the shortcuts they had taken over the years, and all the people they had harmed along the way. The bizarre cases were just the catalyst he had been looking for to bring them down — proof that mishandling of organic toxins was causing serious biologic injury. But it was going to be hard connecting the mine with prion infection. Well, she reminded herself, nothing was decided yet.

If there were answers, though, Joe Keller would have them.

Matt returned to the room scrubbed and shaved and looking very good. He had stripped off the Yale sweatshirt and replaced it with a black T and the denim jacket he had been wearing when he rode to the cabin in the woods and rescued her. Nikki liked the change. He was much more denim than Ivy League.

"Ready to go?" he asked.

She stood and set her hands on his shoulders. His eyes immediately found hers.

"You were very cool and very brave last night," she said.

"If I had thought about what I was doing, I probably would have fainted."

"I doubt it."

There was much more that she had planned to say, much more she wanted to know about him, but suddenly she was on her tiptoes, her arms around his neck.

"Thank you, Matthew Rutledge," she whispered. "Thank you for saving my life."

Maybe she had known all along that she was going to kiss him. Maybe she had promised herself, clinging to him on that motorcycle, that if they survived and somehow escaped, she would kiss him whether he wanted her to or not. Still, the actual act of placing her lips against his, briefly and tenderly, was as surprising to her as it was exciting. She drew away just far enough to read his eyes, and saw no doubt in them. Their second kiss was deeper, more prolonged, and more passionate. His muscular arms enfolded her as his lips and tongue explored hers. She set her hands against the sides of his face and ran her fingertips over his cheeks and jaw. When at last they broke apart, she could barely stand.

"I don't remember the last time I wanted to kiss a woman so much," he said.

"In that case, I'm glad I came along when I did."

"Very funny. Actually, that was very funny. You know, I have no recollection of the exact words, but doesn't kissing my patient violate some paragraph or other of that Hippocratic Oath we took?"

She kissed him again, this time playfully.

"Call it mouth-to-mouth resuscitation," she said. "I think my HMO might even cover it."

He looked over longingly at the bed, but made no move to lead her there.

"There'll be time," she whispered gently. "I promise you that. But right now we have work to do."

"Work to do, pancakes to eat. God, but you kiss splendidly."

"As do you. Tell you what, we'll practice every hundred miles or so, just in case we can perfect the art a little more."

"That certainly would do wonders for my road rage. Oh," he added, "here." He handed over the Yale sweatshirt. "I actually bought this for you. It's a large, but that's the only size they had."

"And why Yale?"

"Because that's the only one I could find that didn't have some silly foreign version of an English phrase on it, like Sport Tough or Big Run."

"Well, you're much more West Virginia than Yale anyway, and coming from me that's a high compliment."

"How so?"

She pulled on the sweatshirt, then kissed him on the cheek.

"Because," she said, underscoring the four block letters with her palm, "I graduated from here."

Nattie and Eli Serwanga lived in a modest Cape in an integrated neighborhood of Evanston, just up the Lake Michigan coast from Chicago. Ellen sat at the dining room table, sipping tea with honey and trying to remember the last time she had felt this sad. There was the situation with Rudy, and the incredible guilt and humiliation she was feeling over having opened his letter. But that situation paled in light of what these two had been through. As they talked, she flashed over and over again to Dr. Suzanne O'Connor's incredible account of the horrors of her battle with Lassa fever.

In their early forties, Ellen guessed, the Serwangas were kind and generous toward her, and clearly in love with each other — the perfect couple to have and raise children. Only they had none and weren't ever again going to get the chance. Deepening their tragedy was irrefutable evidence that Nattie was responsible, albeit inadvertently, for the deaths of two eight-year-old children who attended the day-care center at the hospital where she worked. Nice stuff.

"Tell me again, Nattie," Ellen asked, "when did you know you were sick?"

Nattie pulled a tissue from a half-empty box and dabbed at some embryonic tears. She was a beautiful woman — large and expansive, with huge, expressive eyes, and ebony skin.

"It was nearly two weeks after we got back from Africa," she said. "We came back on a Tuesday, and I first felt the sore throat two Mondays after that. Ten days later I was in the operating room. They delivered the baby, but he was stillborn. Then they tried to save my womb, but there was just too much bleeding."

Eli, who was still wearing his suit and tie from work, rose and moved behind her to comfort her. It was his relatives they had been visiting in Sierra Leone, and he expressed some guilt at having talked her into staying for an extra week while he straightened out some family business — the week in which the doctors believed she became infected. Ellen sipped at her tea and reflected on the impact of her own newly acquired guilt.

"If my questions upset you too much," she said, "you must tell me."

"We're doing okay," Eli replied. "But it would be good if you could tell us where all this is leading."

Ellen set the passenger manifest on the table. During the flight from D.C. to Chicago, she had managed to curtail the attempts at conversation by the recently divorced, totally self-absorbed appliance salesman seated next to her long enough to scan all the flights, searching for matches — passengers who had been on more than one flight with a soon-to-be-victim of Lassa fever. There were at least six.

"I have reason to be suspicious that Nattie may have gotten infected with the Lassa virus either just before or just after leaving Sierra Leone, or else on the plane ride home."

"But how?" Nattie asked.

"I don't know."

"Do you mean," Eli said, "that you think somebody deliberately infected her?"

"That's the possibility I'm looking into. Please, both of you, I beg you not to say anything to anyone about my suspicions until I can finish my search. It's a matter of life and death. Can you give me your word on that?"

"Yes," they said in unison. "Of course," Nattie added.

"Thank you. I'm looking into the possibility that someone on the flight home transmitted the virus to you. Nattie, this is a list of the people who were on your flight from Freetown to Ghana, and then from Ghana to the States. Do any of these names ring any bells? As you can see, there were forty-six on the first leg, including the two of you, and thirty-seven of those among the hundred and sixty on the flight to Baltimore. Do any of these names stand out as someone you remember?"

Nattie shook her head.

"It's been three years," she said. "Plus I think I lost some of my memory when I was sick. I'm afraid I can't help you. I'm sorry."

"Your memory is just fine," Eli countered. "These names mean nothing to me, either. Tell me, do you think this infection was random, or do you think my wife was singled out?"

Ellen considered the question for a while.

"You know, I never thought of that."

She searched for the words to speak about the ten cases of Lassa fever that Nattie was believed to have caused through her job as a dietary worker — including two that died. Nattie saved her the trouble.

"If someone did want to spread the infection, someone with a job like mine would be perfect, provided they somehow knew what I did for a — "

"What is it?" Ellen asked, noting the odd expression on the woman's face.

"Eli, remember that man on the flight from Sierra Leone? The big man who talked to me outside the rest room. He was on the other plane, too."

"The white man?"

"Exactly. He sold something. Insurance, I think. You mentioned how scary-looking he was."

"I do remember him, yes."

"He was a smiler and a talker, that one — asked me all sorts of questions about myself. Made it a game, like he was such an experienced insurance salesman that he could guess things about me."

Ellen felt a little burst of adrenaline.

"Anyone else?" she asked just in case.

"No one that I can think of."

She remembered the memory exercise Rudy had done with her.

"Okay," she asked, "can you bring me a paper and pen?"

"Certainly."

Eli brought in several sheets of typing paper.

"Okay," Ellen said, "I'm going to go and sit in the living room. I'd like you to put your heads together and write down every descriptive word you can remember about this man — what he looked like, what he acted like, even the things you've already told me. Just relax your minds and free-associate. I know it's been a long while, but just do your best. Take as much time as you need, and if you disagree on something, write down both opinions."

"We'll try our best," Nattie said.

Fifteen minutes later, the Serwangas were out of recollections. They called Ellen back to the dining room and apologetically handed her their description.

Big

Tall

Strong

Slick

Smooth

Smiling

Glad-hander

Thick hair

Flat face… like a cartoon character hit with a frying pan

Deep voice

Maybe a Texas-type accent

Scar on face

Ellen felt her heart stop.

"The scar," she asked, her voice trembling. "Can you tell me about the scar?"

"That's Nattie's," Eli said. "I don't remember any scar."

"Well, there was one. I'm sure of it. Right here."

She pointed to the space between her nose and upper lip.

"That's him," Ellen said.

"Who?"

"A very bad man. I think we're onto something."

"Well, I just thought of another word we should have put on the list — clumsy."

"What do you mean?"

"I was standing waiting for the rest room. He came up the aisle, tripped, and slammed into me. The man nearly knocked me out of the plane."