Mortal Fear

CHAPTER 5

After the radio alarm had awakened him, Jason had to stand under the shower for several minutes to feel capable of facing the day. The night before, after he’d returned from the unpleasant visit to the Club Cabaret, he’d been called back to the hospital. One of his AIDS patients, a man named Harvey Rachman, had arrested. When Jason had arrived, the staff had been giving CPR for fifteen minutes. They’d kept it up for two hours before conceding defeat. The head nurse’s comment that at least the man didn’t have to suffer anymore was not much consolation to a stricken Jason. For Jason it seemed that death was winning the competition.

The only positive side of inpatient rounds later that morning was the discharge of one of his hepatitis cases. Jason was sorry to see the girl go. Now he had only a single patient who was doing well.

In the CCU, Matthew Cowen was no better. In addition to his other complaints, he was now having trouble seeing. The symptom bothered Jason. Harring and Lennox had also complained of impaired vision in the weeks before their deaths, and again the possibility of some new multisystem illness crossed Jason’s mind. He ordered an ophthalmology consult. After finishing rounds, Jason headed to pathology to see if the slides from Hayes’s autopsy were done. Maybe they would help explain why so many seemingly healthy people were suffering cardiovascular catastrophe.

He had to wait while Jackson called a report on a frozen section down to the OR. It was a breast biopsy and it was positive.

“That always makes me feel terrible,” Jackson said, hanging up the phone. Then, in a more cheerful voice, he added, “I bet you want to see the Hayes slides.” He searched around on his desk until he found the right folder. Opening it up, he took out a slide and focused it for Jason. “Wait until you see this.

“That’s Alvin Hayes’s aorta,” Jackson explained as Jason looked in. The cellular death and disorganization were evident even to his unpracticed eye. “It’s no wonder it blew,” Jackson continued. “I’ve never seen such deterioration in anyone under seventy except with established aortic disease. And let me show you something else.” He replaced the slide with another. “That’s Hayes’s heart. Look at the coronary vessel. It’s like Cedric Harring’s. All the coronary vessels are almost closed. If Hayes’s aorta hadn’t blown, he’d have died of a heart attack. The man was a walking time bomb. And not only that, he had inflammation in the thyroid, again like Harring. In fact, there were so many parallels that I went back and looked at Harring’s aorta. And guess what? Harring’s aorta was on the verge of blowing too.”

“What exactly are you saying?” Jason asked.

Jackson spread his hands. “I don’t know. There are strong similarities between these two cases. The widespread inflammation — but I don’t think it’s infectious. It has more the look of autoimmunity, as if their immune system had started attacking their own organs.”

“You mean like lupus?”

“Yeah, something like that. Anyway, Alvin Hayes was in terrible shape. Just about every organ was in a state of deterioration. He was falling apart at the seams.”

“He said he wasn’t feeling too well,” Jason said.

“Ha!” Jackson exclaimed. “That’s the understatement of the year.”

Jason left pathology, trying to make sense of Jackson’s statement. Again he considered the possibility of an unknown infectious disease despite Jackson’s opinion. After all, what kind of an autoimmune disease could work so quickly? Jason answered his own question: none.

Before starting the office patients, Jason decided to stop by Hayes’s lab. Not that he expected Helene to be helpful, but he thought she might be interested in the fact that Hayes had been so ill the last few weeks of his life. To his surprise, he saw Helene had been crying.

“What’s the matter?”

Helene shook her head. “Nothing.”

“Aren’t you working?”

“I finished,” Helene said.

All at once Jason realized that without Hayes there to give her instructions, she was lost. Apparently she’d not been apprised of the big picture, a fact that made Jason pessimistic that she would have knowledge of Hayes’s breakthrough, if there’d been one. The man’s penchant for secrecy was to be society’s loss.

“Do you mind if I talk with you for a few minutes?” Jason asked.

“No,” Helene said in her usual laconic manner. She motioned him into Hayes’s office. Jason followed, assaulted once again by the graphic genital photos.

“I’ve just come from pathology,” Jason began, once they were seated. “Dr. Hayes apparently was a very sick man. Are you sure he didn’t complain of feeling ill?”

“He did,” Helene admitted, reversing her previous stand. “He kept saying he felt weak.”

Jason stared across at her. She seemed softer, more open, and he realized that in contrast to the previous times he’d seen her, her hair was loose, falling to her shoulders instead of severely pulled back.

“Last time you said his behavior was unchanged,” he said.

“It was. But he said he felt terrible.”

Frustrated by this semantic distinction, Jason again was convinced that she was covering up something. He wondered why, but he felt he’d get nowhere by confronting her.

“Miss Brennquivist,” Jason said, speaking patiently, “I want to ask once again. Are you absolutely certain you have no idea what Dr. Hayes could have been referring to when he told me he’d made a major scientific breakthrough?”

She shook her head. “I really don’t know. The truth was that things had not been going well in the lab. About three months ago, the rats receiving growth hormone-releasing factors had mysteriously begun to die.”

“Where did the releasing factors come from?”

“Dr. Hayes extracted them himself from rat brains. Mostly the hypothalamus. Then I produced them by recombinant DNA techniques.”

“So the experiments were a failure?”

“Completely,” Helene said. “But, like any great researcher, Dr. Hayes was not daunted. Instead he worked harder. He tried different proteins, but unfortunately with the same fatal results.”

“Do you think Dr. Hayes was lying when he told me he’d made a breakthrough?”

“Dr. Hayes never lied,” Helene said indignantly.

“Well, how do you explain it?” Jason asked. “At first I thought Hayes was having a nervous breakdown. Now I’m not so sure. What do you think?”

“Dr. Hayes was not having a nervous breakdown,” Helene said, rising to make it clear the conversation was over. Jason had hit a raw nerve. She was not about to listen to her late boss be calumniated.

Frustrated, Jason went down to his office, where Sally already had two patients waiting for physicals. Between them Jason escaped Sally long enough to check the laboratory values on Holly Jennings. The only significant change from her earlier tests was an elevated gamma globulin, again making Jason consider a non-AIDS-related epidemic involving the autoimmune system. Instead of turning the immune system off, as with AIDS, this problem seemed to turn it on in a destructive fashion.

Midmorning Jason got a call from Margaret Danforth, who stated without preamble, “Thought you should know that Dr. Hayes’s urine showed moderate levels of cocaine.”

So Curran was right, Jason realized, hanging up. Hayes was using drugs. But whether that was related to his claim of discovery, his fear of being attacked, or even his actual death, Jason couldn’t tell.

He was forced to put aside his speculation as the heavy patient load pushed him further and further behind. The pressure was heightened by a call from Shirley, who had apparently learned of his visit to Helene.

“Jason,” she said with an edge to her voice, “please don’t stir the pot. Just let the Hayes affair calm down.”

“I think Helene knows more than she’s telling us,” Jason said.

“Whose side are you on?” Shirley asked.

“Okay, okay,” he said, rudely cutting her off as he was confronted by Madaline Krammer, an old patient who had been squeezed in as an emergency. Up until now her heart condition had been stable. Suddenly she was presenting swollen ankles and chest rales. Despite strong medication, her congestive heart disease had increased in severity to the point that Jason insisted on hospitalization.

“Not this weekend,” Madaline protested. “My son is coming from California with his new baby. I’ve never seen my granddaughter. Please!” Madaline was a cheerful woman in her mid-sixties with silver-gray hair. Jason had always been fond of her, since she rarely complained and was extraordinarily grateful for his ministrations.

“Madaline, I’m sorry. I wouldn’t do this unless I thought it was necessary. But the only way we can adjust your medications is with constant monitoring.”

Grumbling but resigned, Madaline agreed. Jason told her he’d see her later, and left her in the capable hands of Claudia. By four P.M., Jason had just about caught up to his appointment schedule. Emerging from his office, Jason ran into Roger Wanamaker, whose impressive bulk completely blocked the narrow hallway.

“My turn,” Roger said. “Got a minute for a chat?”

“Sure,” said Jason, who never said no to a colleague. He led the way back to his office. Roger ceremoniously dropped a chart on his desk.

“Just so you don’t feel lonely,” he said. “That’s the chart of a fifty-three-year-old executive from Data General who was just brought into the emergency room deader than a doorknob. I’d given him one of our full-scale executive physicals less than three weeks ago.”

Jason opened the chart and glanced through the physical, including the EKG and laboratory values. The cholesterol was high but not terrible. “Another heart attack?” he asked, flipping to the report of the chest X ray. It was normal.

“Nope,” Roger said. “Massive stroke. The guy had a seizure right in the middle of a board meeting. His wife is madder’n hell. Made me feel terrible. She said he’d been feeling crummy ever since he’d seen us.”

“What were his symptoms?”

“Nothing specific,” Roger said. “Mostly insomnia and tension, the kind of stuff executives complain about all the time.”

“What the hell is going on?” Jason asked rhetorically.

“Beats me,” Roger said. “But I’m getting a bad feeling — like we’re on the edge of some kind of epidemic or something.”

“I’ve talked with Madsen in pathology. I asked him about an unknown infectious disease. He said no. He said it was metabolic, maybe autoimmune.”

“I think we’d better do something. What about the meeting you suggested?”

“I haven’t called it yet,” Jason admitted. “I’m having Claudia pull all my physicals over the last year and checking to see how the patients are doing. Maybe you should do the same.”

“Good idea.”

“What about the autopsy on this case?” Jason asked, handing the chart back to Roger.

“The medical examiner has it.”

“Let me know what they find.”

When Roger left, Jason made a note to call a meeting of the other internists early the following week. Even if he didn’t want to know how widespread the problem was, he knew he couldn’t sit back and watch while patients with seemingly healthy checkups ended up in the morgue.

En route to his final patient, Jason found himself again thinking of Carol Donner. Suddenly getting an idea, he made a detour to the central desk and found Claudia. He asked her to go down to personnel and see if she could get Alvin Hayes’s home address. Jason was confident that if anybody could do it, Claudia could.

Once again heading for his last outpatient, Jason wondered why he’d not thought of getting Hayes’s address sooner. If Carol Donner had been living with the man, it would be vastly easier to talk with her at her apartment than at the Club Cabaret, where they obviously felt rather protective. Maybe she’d have some ideas about Hayes’s breakthrough, or if nothing else, his health. By the time Jason had finished with his last patient, Claudia had the address. It was in the South End.

After all the outpatients had been seen, and Jason had dictated the necessary correspondence, he headed up the main elevator to begin his inpatient rounds. He saw Madaline Krammer first.

She was already looking better. An increased diuretic had reduced her swollen feet and hands considerably, but when he went over her again he was disturbed to find that her pupils seemed widely dilated and unreactive to light. He made a note on her chart before continuing his rounds.

Before he went in to see Matthew Cowen, Jason pulled his chart to see what the ophthalmology consult had said about his eyes. Shocked, Jason read, “Mild cataract formation in both eyes. Check again in six months.” Jason couldn’t believe what he was seeing. Cataracts at thirty-five? He remembered the autopsy had noted cataracts in Connoly’s eyes. He also remembered just seeing Madaline Krammer’s dilated pupils. What the hell were they dealing with? He was further confused when he went down the hall to see Matthew.

“Are you giving me any weird drugs?” he demanded as soon as he glimpsed Jason.

“No. Why do you ask?”

“Because my hair is coming out.” To make his point, he tugged on a few strands, which indeed came right out. He scattered them on the pillow.

Jason picked one up, rolling it slowly between his thumb and index finger. It looked normal save for a grayness at the root. Then he examined Matthew’s scalp. It too was normal, with no inflammation or soreness.

“How long has this been going on?” he asked, remembering Brian Lennox with startling vividness, as well as Mrs. Harring’s comment that her husband’s hair had started to fall out.

“It’s gotten much worse today,” Matthew said. “I don’t mean to sound paranoid, but everything seems to be happening to me.”

“It’s just coincidence,” Jason said, trying to buoy his own confidence as much as Matthew’s. “I’ll have the dermatologist take another look. Maybe it’s associated with your dry skin. Has that improved?”

“It’s worse, if anything. I shouldn’t have come into the hospital.”

Jason tended to agree, especially since so many of his patients were doing poorly. By the time he finished rounds, he was exhausted. He almost forgot that some well-meaning friends had insisted he attend a dinner party that night so they could fix him up with a cute thirty-four-year-old lawyer named Penny Lambert. With an hour to kill, Jason decided it wasn’t worth going home. Instead, he pulled out the Boston map he kept in his car and located Springfield Street, where Hayes’s apartment was located. It was off Washington Street. Thinking it would be a good time to catch Carol Donner, he decided to drive directly there. But that was easier said than done. Heading south, he found himself caught in bumper-to-bumper traffic on Massachusetts Avenue. With persistence, he reached Washington Street and turned left, then left again at Springfield. He located Hayes’s building, then found a parking spot.

The neighborhood was a mixture of renovated and unrenovated buildings. Hayes’s was in the latter category. Graffiti was spray-painted on the front steps. Jason entered the foyer and noted that several of the mailboxes were broken and that the inner door was unlocked. In fact, the lock had been broken sometime in the distant past and never replaced. Hayes’s apartment was on the third floor. Jason started up the poorly lit steps. The smell was musty and damp.

The building was large, with single apartments on each floor. On three Jason tripped over several Boston Globes still in their plastic covers. There was no bell so Jason knocked. Hearing no response, he knocked again, harder. The door squeaked open about an inch. Looking down, Jason saw that the lock had recently been forced and that part of the doorjamb was missing. Using his index finger, Jason gingerly pushed the door open. It squeaked again as if in pain. “Hello,” he called. There was no answer. He stepped into the apartment. “Hello.” There was no noise except a running toilet. He closed the door behind him and started across a dark hall toward a partially opened door.

Jason took one look and almost fled. The place had been trashed. The living room, once decorated with attractive antiques and reproductions, was a wreck. All the drawers in the desk and sideboard had been pulled out and dumped. The sofa cushions had been slashed, and the contents of a large bookcase were strewn about the floor.

Picking his way carefully through the mess, Jason peered into a small bedroom, which was in the same condition as the living room, then went down the hall to what he assumed was the master bedroom. It too was a wreck. Every drawer had been dumped, and the clothes in the walk-in closet had been ripped from hangers and thrown on the floor. Picking some up, he noted they were all men’s clothes.

Suddenly the front door squeaked, sending a shiver down Jason’s spine. He let the clothes fall to the floor. He started to call out again, hoping that it was Carol Donner, but for a moment he was too scared to speak. He froze, his ears straining for sound. Maybe a draft had pushed the door…. Then he heard a thud, like the sound of a shoe knocking against a book or an overturned drawer. Someone was definitely in the apartment, and Jason had the feeling whoever it was knew he was there. Perspiration appeared on his forehead and ran down the side of his nose. Detective Curran’s warning that the drug world was dangerous flashed through his mind. He wondered if there was a way to sneak out. Then he realized he was at the end of a long hallway.

All at once a large figure filled the doorway. Even in the darkness Jason could tell that it was carrying a gun.

Panic filled Jason as his heart raced. But still he did not move.A second, smaller figure joined the first and together they stepped into the room. Then they advanced toward Jason, inexorably, step by step. It seemed like an eternity. Jason wanted to cry out or run.