Mortal Fear

CHAPTER 3

It had not been a good night. Every time Jason had closed his eyes, he’d seen Hayes’s quizzical expression just before the catastrophe and re-experienced the awful feeling of helplessness as he watched Hayes’s lifeblood pump out of his mouth.

The scene haunted him as he drove to work, and he remembered something he’d forgotten to tell either Curran or Shirley. Hayes had said his discovery was no longer a secret and it was being used. Whatever that meant. Jason planned to call the detective when he reached GHP, but the moment he entered he was paged to come directly to the coronary care unit.

Brian Lennox was much worse. After a brief examination, Jason realized there was little he could do. Even the cardiac consult he’d requested the day before was not optimistic, though Harry Sarnoff had scheduled an emergency coronary study for that morning. The only hope was if immediate surgery might have something to offer.

Outside Brian’s cubicle the nurse asked, “If he arrests, do you want to code him? Even his kidneys seem to be failing.”

Jason hated such decisions, but said firmly that he wanted the man resuscitated at least until they had the results from the coronary study.

The remainder of Jason’s rounds were equally as depressing. His diabetes cases, all of whom had multisystem involvement, were doing very poorly. Two of them were in kidney failure and the third was threatening. The depressing part was that they had not entered the hospital for that reason. The kidney failure had developed while Jason was treating them for other problems.

Jason’s two leukemia patients were also not responding to treatment as he’d expected. Both had developed significant heart conditions even though they had been admitted for respiratory symptoms. And his two AIDS sufferers had made very distinct turns for the worse. The only patients doing well were two young girls with hepatitis. The last patient was a thirty-five-year-old man in for an evaluation of his heart valves. He’d had rheumatic fever as a child. Thankfully he was unchanged.

Arriving at his office, Jason had to be firm with Claudia. News of Hayes’s death had already permeated the entire GHP complex, and Claudia was beside herself with curiosity. Jason told her that he wasn’t going to talk about it. She insisted. He ordered her out of his office. Later he apologized and gave her an abridged version of the event. By ten-thirty he got a call from Henry Sarnoff with depressing news. Brian Lennox’s coronary arteries were much worse but without focal blockage. In other words, they were uniformly filling up with atherosclerosis at a rapid rate, and there was no chance for surgery. Sarnoff said he’d never seen such rapid progression and asked Jason’s permission to write it up. Jason said it was fine with him.

After Sarnoff’s call, Jason kept himself locked in his office for a few minutes. When he felt emotionally prepared, he called the coronary care unit and asked for the nurse taking care of Brian Lennox. When she came on the line, he discussed with her the results of the coronary artery study. Then he told her that Brian Lennox should be a no-code. Without hope, the man’s suffering had to be curtailed. She agreed. After he’d hung up, he stared at the phone. It was moments like that that made him wonder why he’d gone into medicine in the first place.

When the lunch break came, Jason decided to check out Hayes’s autopsy results in person. In the daylight, the morgue was not such an eerie place — just another aging, run-down, not-too-clean building. Even the Egyptian architectural details were more comical than imposing. Yet Jason avoided the body storage room and went directly to find Margaret Danforth’s narrow office next to the library. She was hunched over her desk eating what looked like a Big Mac. She waved him in, smiling. “Welcome.”

“Sorry to bother you,” Jason said, sitting down. Once again he marveled how small and feminine Margaret seemed in light of her job.

“No bother,” she said. “I did the post on Dr. Hayes this morning.” She leaned back in her chair, which squeaked softly. “I was a little surprised. It wasn’t cancer.”

“What was it?”

“Aneurysm. Aortic aneurysm that broke into the tracheobronchial tree. The man never had syphilis, did he?”

Jason shook his head. “Not that I know of. I’d kinda doubt it.”

“Well, it looked strange,” Margaret said. “Do you mind that I continue eating? I have another autopsy in a few minutes.”

“Not at all,” Jason said, wondering how she could. His own stomach did a little flip-flop. The whole building had a slightly fishy odor. “What looked strange?”

Margaret chewed, then swallowed. “The aorta looked kind of cheesy, friable. So did the trachea, for that matter. I’d never seen anything quite like it, except in this one guy I’d posted who was one hundred and fourteen. Can you believe it? It was written up in The Globe. He was forty-four when the First World War started. Amazing.”

“When will you have a microscopic report?”

Margaret made a gesture of embarrassment. “Two weeks,” she said. “We’re not funded for adequate support personnel. Slides take quite a while.”

“If you could give me some samples, I could have our path department process them.”

“We have to process them ourselves. I’m sure you understand.”

“I don’t mean for you not to do it,” Jason said. “I just meant we could too. It would save some time.”

“I don’t see why not.” Standing up, Margaret took another large bite out of her hamburger and motioned for Jason to follow her. They used the stairwell and went up a floor to the autopsy room.

It was a long rectangular room with four stainless steel tables oriented perpendicular to the long axis. The smell of formaldehyde and other unspeakable fluids was overpowering. Two tables were occupied, and the two others were in the process of being cleaned. Margaret, perfectly at home in the environment, was still chewing her last bite of lunch as she led Jason over to the sink. After scanning through a profusion of plastic-capped specimen bottles, she separated a number from the rest. Then, taking each in turn, she fished out the contents, placed them on a cutting board, and sliced off a piece of each with a blade that looked very much like a standard kitchen carving knife. Then she got new specimen bottles, labeled them, poured in formaldehyde, and dropped in the respective samples. When she was done, she packed them in a brown paper bag and handed it to Jason. It had all been done with remarkable efficiency.

Back at GHP, Jason headed to pathology, where he found Dr. Jackson Madsen at his microscope. Dr. Madsen was a tall, gaunt man who at sixty was still proudly running marathons. As soon as he saw Jason, he commiserated with him about Jason’s experience with Hayes.

“Not many secrets around here,” Jason said a little sourly.

“Of course not,” Jackson said. “Socially, the medical center is like a small town. It thrives on gossip.” Eyeing the brown paper bag, he added, “You have something for me?”

“In a manner of speaking.” Jason went on to explain what the specimens were, and added that since it was going to take two weeks for the slides to be processed at the city lab, he wondered if Jackson would mind running them at the GHP lab.

“I’d be happy to,” Jackson said, taking the bag. “By the way, are you interested in hearing the results of the Harring case now?”

Jason swallowed. “Of course.”

“Cardiac rupture. First case I’ve seen in years. Split open the left ventricle. It appeared as if most of the heart had been involved in the infarct, and when I sectioned the heart, I had the impression that all of the coronary vessels were involved. That man had the worst coronary heart disease I’ve seen in years.”

So much for our wonderful predictive tests, Jason thought. He felt defensive enough to explain to Jackson that he’d gone back and reviewed Harring’s record and still couldn’t find any evidence of the impending problem on an EKG taken less than a month before Harring’s death.

“Maybe you’d better check your machines,” Jackson said. “I’m telling you, this man’s heart was in bad shape. The microscopic sections should be ready tomorrow if you’re interested.”

Leaving the pathology department, Jason considered Jackson’s comment. The idea of a defective EKG machine hadn’t occurred to him. But by the time he got to his office, he discarded the notion. There would be too many ways to tell if the EKG machine wasn’t functioning properly. Besides, two different machines were used for the resting EKG and the stress EKG. But in thinking about it, he remembered something. Like Jason himself, on joining the GHP staff, Hayes would have been given a complete physical. Everyone was.

After Claudia had given Jason his phone messages, he asked her to see if Dr. Alvin Hayes had a patient chart, and if he did, to get it. Meanwhile, he avoided Sally and headed up to radiology. With the help of one of the department secretaries, he located Alvin Hayes’s folder. As he’d expected, it contained a routine chest X ray taken six months previously. He looked at it briefly. Then, armed with the film, he sought out one of the four staff radiologists. Milton Perlman, MD, was emerging from the fluoroscopy room when Jason buttonholed him, described Hayes’s death and the results of the autopsy, and handed Milton the chest film. Milton took the film back to his office, placed it on the viewing box, and flipped on the light. He scanned the film for a full minute before turning to Jason.

“There ain’t no aneurysm here,” he said. He was from West Virginia and liked to talk as if he’d left the farm the day before. “Aorta looks normal, no calcification.”

“Is that possible?” Jason asked.

“Must be.” Milton checked the name and unit number on the film. “I guess there’s always a chance we could have mixed up the names, but I doubt it. If the man died of an aneurysm, then he developed it in the last month.”

“I never heard of that happening.”

“What can I say?” Milton extended his hands, palms up.

Jason returned to his office, mulling over the problem. An aneurysm could balloon quickly, especially if the victim had a combination of vessel disease and high blood pressure, but when he checked Hayes’s physical exam, his blood pressure and heart sounds were, as he suspected, normal. With no signs of vascular disease, Jason realized that there was little he could do at that point besides wait for the microscopic sections. Maybe Hayes had contracted some strange infectious disease that had attacked his blood vessels, including his aorta. For the first time, Jason wondered if they were seeing the beginnings of a new and terrible disease.

Changing his suit jacket for a white coat, Jason left his office, practically bumping into Sally.

“You’re behind schedule!” she scolded.

“So what else is new?” Jason said, heading for exam room A.

By a combination of hard work and luck, Jason caught up to his schedule. The luck involved not having any new patients that needed extensive workups or old patients with new problems. By three there was even a break. Someone had canceled.

The whole afternoon, Jason could not get the Hayes affair out of his mind. And with a little extra time on his hands, he headed up to the sixth floor. That was where Dr. Alvin Hayes’s lab was located. Jason thought perhaps Hayes’s assistant would have some idea if the big breakthrough Hayes had mentioned had any basis in fact.

As soon as he stepped from the elevator, Jason felt as if he were in another world. As part of Hayes’s incentive to come to GHP, the GHP board had built him a brand new lab which occupied a good portion of the sixth floor.

The area near the elevator was furnished with comfortable leather seating, deep pile carpets, and even a large glass-fronted bookcase filled with current references in molecular biology. Beyond this reception room was a clean room where visitors were expected to don long white coats and protective coverings over their shoes. Jason tried the door. It was open, so he entered.

Jason put on the coat and booties and tried the inner door. As he expected, it was locked. Next to the door was a buzzer. He pushed it and waited. Above the lintel a small red light blinked on over a closed-circuit TV camera. Then the door buzzed open and Jason entered.

The lab was divided into two main sections. The first section was constructed of white Formica and white tile and included a large central room with several offices on one side. With overhead fluorescent lighting, the effect was dazzling. The room was filled with sophisticated equipment, most of which Jason did not recognize. A locked steel door separated the first section from the second. A sign next to the door read: ANIMAL ROOM AND BACTERIAL INCUBATORS: NO ENTRY!

Sitting at one of the extensive lab benches in the first section was a very blond woman Jason had seen on several occasions in the GHP cafeteria. She had sharp features, a slightly aquiline nose, and her hair was tightly pulled back into a French knot. Jason saw that her eyes were red, as if she had been crying.

“Excuse me, I’m Dr. Jason Howard,” he said, extending his hand. She took it. Her skin was cool.

“Helene Brennquivist,” she said with a slight Scandinavian accent.

“Do you have a moment?”

Helene didn’t answer. Instead, she closed her notebook and pushed away a stack of petri dishes.

“I’d like to ask a few questions,” Jason continued. He saw that she had an uncanny ability to maintain an absolutely neutral facial expression.

“This is, or was, Dr. Hayes’s lab?” Jason asked, with a short wave of his hand to the surroundings.

She nodded.

“And I presume you worked with Dr. Hayes?” Another nod, less perceptible than the first. Jason had the feeling he’d already evoked a defensiveness in the woman.

“I’m assuming that you’ve heard the bad news about Dr. Hayes,” Jason said. This time she blinked, and Jason thought he saw the glint of tears.

“I was with Dr. Hayes when he died,” Jason explained, watching Helene carefully. Except for the watery eyes, she seemed strangely devoid of emotion, and Jason wondered if it was a form of grief. “Just before Hayes died, he told me that he’d made a major scientific breakthrough…”

Jason let his comment hang in the air, hoping for some appropriate response. There was none. Helene merely stared back at him.

“Well, was there?” Jason said, leaning forward. “I didn’t know you were finished speaking,” Helene said. “It wasn’t a question, you know.”

“True,” Jason admitted. “I was merely hoping you’d respond. I do hope you know what Dr. Hayes meant.”

“I’m afraid I don’t. Other people in the administration have already been up here asking me the same question. Unfortunately, I have no idea what Dr. Hayes could have been referring to.”

Jason imagined that Shirley had been to see Helene first thing that morning.

“Are you the only person besides Dr. Hayes who works in this lab?”

“That’s right,” Helene said. “We had a secretary, but Dr. Hayes dismissed her three months ago. He thought she talked too much.”

“What was he afraid she’d talk about?”

“Anything and everything. Dr. Hayes was an intensely private person. Especially about his work.”

“So I’m learning,” Jason said. His initial impression that Hayes had become paranoid seemed to be substantiated. Yet Jason persisted: “What exactly do you do, Miss Brennquivist?”

“I’m a molecular biologist. Like Dr. Hayes, but nowhere near his ability. I use recombinant DNA techniques to alter E. coli bacteria to produce various proteins that Dr. Hayes was interested in.”

Jason nodded as if he understood. He’d heard the term “recombinant DNA,” but had only the vaguest notion what it really meant. Since he’d been in medical school there had been a virtual explosion of knowledge in the field. But there was one thing he did remember, and that was a fear that recombinant DNA studies might produce bacteria capable of causing new and unknown diseases. With Hayes’s sudden death in mind, he asked, “Had you come up with any new and potentially dangerous strains?”

“No,” Helene said without hesitation.

“How can you be so sure?”

“For two reasons. First of all, I did all the recombinant bacterial work, not Dr. Hayes. Secondly, we use a strain of E. coli bacteria that cannot grow outside of the laboratory.”

“Oh,” Jason said, nodding encouragingly.

“Dr. Hayes was interested in growth and development. He spent most of his time isolating the growth factors from the hypothalamic-pituitary axis responsible for puberty and sexual development. Growth factors are proteins. I’m sure you know that.”

“Of course,” Jason said. What a curious woman, he thought. At first, conversation had been like pulling teeth. Now that she was on scientific ground, she was extremely vocal.

“Dr. Hayes would give me a protein and I’d set out to produce it by recombinant DNA techniques. That’s what I’m doing here.” She turned to the stacks of petri dishes, and, lifting one, removed the cover. She extended it toward Jason. On the surface were whitish clumps of bacterial colonies.

Helene replaced the dish on its appropriate stack. “Dr. Hayes was fascinated by the on/off switching of genes, the balance between repression and expression, and the role of repressor proteins and where they bind to the DNA. He’s used the growth hormone gene as the prototype. Would you like to see his latest map of chromosome 17?”

“Sure,” Jason said, forcing a smile.

A buzzer resounded in the lab, momentarily drowning out the low hum of the electronic equipment. A screen in front of Helene flashed to life, showing four people and a dog in the foyer. Jason recognized two of them immediately — Shirley Montgomery and Detective Michael Curran. The other two were strangers.

“Oh, dear,” Helene said, as she reached for the buzzer.

Jason stood as the new arrivals filed into the room. Shirley registered a momentary flash of surprise when she saw Jason, but calmly introduced Detective Curran to Helene. As he began to question her, Shirley took Jason by the arm and steered him into the nearest office, which Jason realized must have been Hayes’s. Covering the walls were progressive close-up photos of human genitalia going through the anatomical evolution of puberty. They were all nicely framed in stainless steel squares.

“Interesting decor,” Jason commented wryly.

Shirley acted as if she didn’t even see the photos. Her usually calm face wore an expression of concern and irritation. “This affair is getting out of hand.”

“What do you mean?” Jason asked.

“Apparently last night the police got an anonymous tip that Dr. Alvin Hayes dealt drugs. They searched his apartment and found a significant amount of heroin, cocaine, and cash. Now they have a warrant to search his lab.”

“My God!” Jason suddenly understood the dog’s presence.

“And as if that’s not enough, they found out he’s been living with a woman by the name of Carol Don ner.”

“That name sounds familiar,” Jason said.

“Well, it shouldn’t be,” Shirley said sternly. “Carol Donner is an exotic dancer at the Club Cabaret in the Combat Zone.”

“Well, I’ll be damned.” Jason chuckled.

“Jason!” Shirley snapped. “This is not a laughing matter.”

“I’m not laughing,” he protested. “I’m just astounded.”

“If you think you’re astounded, what’s the board of directors going to say? And to think I insisted on hiring Hayes. The man’s death alone was bad enough. This is fast becoming a public relations nightmare.”

“What are you going to do?” Jason asked.

“I haven’t the slightest idea,” Shirley admitted. “At the moment my intuition tells me the less we do, the better.”

“What are your thoughts about Hayes’s supposed breakthrough?”

“I think the man was fantasizing,” Shirley said. “I mean, he was involved with drugs and an exotic dancer, for God’s sake!”

Exasperated, she returned to the main part of the lab, where Detective Curran was still talking intently with Helene. The other two men and the dog were methodically searching the lab. Jason watched for a few moments, then excused himself to finish office hours. He still had a handful of outpatients to see as well as hospital rounds to do.

On the way home, even though he was more convinced than ever that Hayes had been on the verge of a nervous breakdown, rather than a breakthrough, Jason stopped at the library and took out a slim volume titled Recombinant DNA: An Introduction for the Nonscientist.

Rush hour traffic was the usual dog-eat-dog Boston rally, and when Jason stepped on the emergency brake in his parking place in front of his townhouse, he felt the usual relief that he’d survived unscathed. He carried his briefcase up to his apartment, and put it on the desk in the small study that looked out onto the square. The now leafless elms were like skeletons against the night sky. Daylight Saving was already over, and it was dark outside even though it was only six forty-five. Changing into his jogging clothes, Jason ran down Mt. Vernon Street, crossed over Storrow Drive on the Arthur Fiedler Bridge, and ran along the Charles. He ran to the Boston University Bridge before turning. In contrast to the summer, there were few joggers. On the way back he stopped at De Luca’s Market and picked up some fresh, local bluefish, makings for a salad, and a cold bottle of California Chardonnay.

Jason liked to cook, and after taking his shower, he prepared the fish by broiling it with a small amount of garlic and virgin olive oil. He tossed the salad, then rescued the wine from the freezer where he’d put it to give it an icy kick. He poured himself a glass. When all was ready he carried it into the study on a tray. Thus prepared, he opened the small book on recombinant DNA and settled in for the night.

The first part of the book served as a review. Jason was well aware that deoxyribonucleic acid, better known as DNA, was a molecule, shaped like a twisted, double-stranded string. It was made up of repeating subunits called bases that had the property of pairing with each other in very specific ways. Particular areas of the DNA were called genes, and each gene was associated with the production of a specific protein.

Jason felt encouraged as he took a sip of his wine. The book was well written and made the subject matter seem clear. He liked the little tidbits like the fact that each human cell had four billion base pairs. The next part of the book dealt with bacteria, and the fact that bacteria reproduce easily and rapidly. Within days, trillions of identical cells could be made from a single initial cell. This was important, because in genetic engineering bacteria served as the recipient of small fragments of DNA. This “foreign” DNA was incorporated into the bacterium’s own DNA, and then, as the cell divided, it manufactured the original fragments. The bacterium with the newly incorporated DNA was called a recombinant strain and the new DNA molecule was called recombinant DNA. So far so good.

Jason ate some of his fish and salad and washed it down with wine. The next chapter got a little more complicated. It talked about how the genes in the DNA molecule went about producing their respective proteins. The first part entailed making a copy of the segment of DNA with a molecule called messenger RNA. The messenger RNA then directed the production of the protein in a process called transcription. Jason drank a little more wine. The last part of the chapter got particularly interesting, since it explained the elaborate mechanisms that turned genes on and off.

Getting up from his desk, Jason walked across his living room into the kitchen. Opening the freezer, he poured himself another glass of wine. Back in his study he stared out the window, seeing the lights across the square in St. Margaret’s Convent. It always amused him that there was a convent on the most desirable residential square in Boston: Give up the material world, become a nun, and move to Louisburg! Jason smiled, then looked back down at the recombinant DNA book. Sitting down again, he reread the section on the timing of gene expression. It was complicated and fascinating. Apparently, a host of proteins had been discovered that served as repressors of gene function. These proteins attached to the DNA or caused the DNA to coil, to cover up the involved genes.

Jason closed the book. He’d had enough for one night. Besides, the section on the control of gene function was what he’d been unconsciously looking for. Reading that section brought back Hayes’s comment that his main interest was “how genes turned on and how they turned off.” Helene had said the same thing but in different words.

Taking his wine, Jason wandered into his living room. Absently fondling the cut-glass sconces over the fireplace, he allowed his mind to consider the possibilities. What could Hayes have meant when he said he’d made a major scientific breakthrough? For the moment Jason dismissed the idea of Hayes having delusions of grandeur. After all, he was a world-class researcher, and he was working prodigious hours. So there was a chance he’d been telling the truth. If he’d made a discovery, it would be in the area of turning genes on and off, and probably have to do with growth and development. The image of the photos of the genitals clouded Jason’s mind for a moment.

Jason was brought out of his reverie by the phone. It was the head nurse in the coronary care unit. “Brian Lennox just died. He had a terminal episode of V-tack that progressed to asystole.”

“I’ll be right over,” Jason said. He hung up and thought of the nurse’s scientific jargon, recognizing that it was an emotional defense. Once again the shadow of death hung over him like a noxious cloud.