Fatal Care (8 page)

Murdock gave the explanation thought as he peeled off his gloves. “Can that be proved here?”

“No,” Joanna said. “But it’s the most likely sequence of events.”

“So there’s no doubt in your mind that Oliver’s death was cardiac in nature?”

“No doubt at all.”

The ventilation system clicked on, and Murdock felt the air stir in the special autopsy room where contaminated cases were done. He leaned against the wall and organized his thoughts. Once the frozen sections confirmed the diagnosis, he would call Mortimer Rhodes. After that, Oliver’s body would be meticulously sewn together and sent to the funeral home in the early morning hours. Then a carefully worded statement would be released to the press. There would be no need for Murdock to mention the new institute to Mortimer Rhodes. The old man would bring up the subject himself.

The door opened, and a portly, balding middle-aged man entered. He was wearing a long white laboratory coat over a green scrub suit. His name tag read DENNIS GREEN, M.D. — ASSOCIATE PROFESSOR OF PATHOLOGY.

“Thanks for coming in, Dennis,” Joanna said.

“No problem.” Green nodded to Joanna and then to Murdock, who didn’t bother to nod back. “What have you got?”

“We’re doing an autopsy on Oliver Rhodes,” Joanna replied. Then she sneezed and reached for a tissue.

Green glanced over at the body, thinking that Oliver Rhodes looked a lot larger in life than in death. He turned his attention back to Joanna. “And?”

“And,” Joanna continued, wiping her nose, “he has a pulmonary lesion and a heart lesion that appear to be malignant. We want that confirmed on a frozen section.”

Green looked at Joanna strangely. “You called me in to do a frozen section on a dead man who has carcinoma of the lung that metastasized to the heart?”

“It’s not so straightforward,” Joanna explained. “I think he’s got a primary malignancy of the heart.”

“Well, well,” Green said, becoming interested. “Do you think it’s a rhabdomyosarcoma?”

“That would be my guess,” Joanna said. “And it may be metastatic to the lung.”

“Or the lung may just be a run-of-the-mill carcinoma,” Green thought aloud. “He may have two separate cancers.”

“Exactly.”

Joanna picked up two small bottles containing small fragments of tissue. One was labeled A, the other B. “
A
is the lung;
B
is the heart.”

Green took the specimens from her. “I’ll be back in a flash.”

Murdock waited for Green to leave and then asked Joanna, “Is he as good at this as people say he is?”

“He’s the best,” Joanna assured him. “The oncology surgeons always ask for him to do their cases.”

Murdock stretched his neck, trying to relieve some of the tightness. “Was there a reason you found it necessary to mention the name of Oliver Rhodes to Dr. Green?”

“I wanted him to know why I was dragging him out in the middle of the night to do frozen sections on a corpse.”

The cell phone inside Murdock’s coat chirped. With a weary sigh, he reached for it. Mortimer Rhodes was on the other end. “Yes, Mortimer. . . . We’re almost done, and it seems that Oliver’s death was cardiac in nature. . . . Yes, yes. But we are confirming it with microscopic studies at this very moment. . . .”

Joanna gestured to Murdock and softly whispered for him to ask Rhodes if there was any family history of unusual cancers.

“And Mortimer,” Murdock continued, “there was one other disturbing finding. It seems that Oliver had a somewhat unusual lung cancer, as well. Is there any history of uncommon cancers in your family? . . . No. I see. Well, we should complete all the studies within the hour. Should I call you back then? . . . As soon as I have the results.”

Murdock put the cell phone down and then wavered on his feet for a moment. He steadied himself with a hand on the wall. Slowly he eased himself down onto a metal stool.

Joanna saw the peaked look on his face and hurried over. “Are you all right, Simon?”

“Just a little tired,” Murdock said. “It’s been a long day.”

“For all of us.”

Murdock tilted his head back against the cool wall, thinking about the death of his own son and the autopsy they did on the boy. “It’s very difficult to talk to a father about the death of his son.”

“I know,” Joanna said, studying Murdock’s heavily lined face. He was in his late sixties but seemed older with his snow-white hair and stooped posture. And like Joanna, he, too, had put in a long fifteen-hour day. Too long, Joanna thought, now wondering why she always seemed to take on more work than she could handle. Three cases at once—Oliver Rhodes, the drowning victim, and the Russian with the dead fetuses—were too much, way too much. She’d be lucky to get home before midnight.

The door swung open, and Dennis Green returned.

“It’s straightforward,” he announced. “There are two different cancers in Mr. Rhodes. The lung is an adenocarcinoma; the heart, a sarcoma.”

Joanna asked, “Was it a rhabdomyosarcoma?”

“Probably,” Green replied. “I’ll know for sure when we do the routine stains.”

Murdock pushed himself up from the stool. “And you believe that caused his death?”

“Oh, yeah,” Green said with certainty. “It was a nasty-looking malignancy that extended way into the septum. He died a cardiac death beyond any question.”

Joanna shook her head sadly. “And his heart looked so good from the outside, like the heart of an athlete. And his coronary arteries were wide open.”

“It’s kind of ironic,” Lori said, more to herself than to the others. “He undergoes a risky procedure to clean out his coronary arteries so he’ll have a heart that will last for another fifty years. Instead, the organ that was supposed to prolong his life ends up killing him.”

Green’s eyebrows went up. “He underwent that experimental artery-cleansing procedure? The one where they use the enzyme?”

Joanna nodded. “He had it done a year ago. So what?”

“So he represents the second case of cancer I’ve seen in this group. That’s what.”

“Are you telling us that you’ve seen two sarcomas of the heart in patients who’ve undergone this procedure?” Joanna asked carefully.

Green thought back and then shook his head. “The first patient had her cerebral arteries cleaned out and later developed an astroblastoma.”

“A what?” Murdock asked.

“An astroblastoma,” Green answered. “It’s a very rare form of brain cancer.”

The group went silent, each person lost in his or her own thoughts. The ventilation system overhead clicked off. The air became still.

“We’ve got trouble here,” Joanna said gravely.

“Not necessarily,” Murdock said at once. “We have only two cases of cancer occurring in this group.”

“Two cases of very rare cancer occurring in a very
small
group,” Joanna corrected him. “That’s not happenstance, Simon.”

“But it doesn’t prove cause and effect,” Murdock argued.

Joanna ignored him, trying to put the pieces of the puzzle together. Two rare cancers pop up in patients whose only common denominator is that they both had their arteries cleaned. But how could that cause a malignancy? “How many people have had this procedure?”

“The NIH allowed us to do ten patients initially,” Murdock replied. “The results were so encouraging, they granted permission for us to include another twenty patients in the study.”

Joanna quickly calculated numbers in her head. Of the thirty patients in the artery-cleansing study, two had developed malignancies. A cancer rate of one in fifteen—an astronomical incidence. “You’ll have to report this to the NIH, Simon.”

“Oh, I will,” Murdock said, his mind racing ahead. The NIH would insist that the artery-cleansing study be discontinued until the matter was thoroughly investigated by a scientific committee at Memorial. And the news was certain to be leaked to the press, who would have a field day throwing mud at Memorial. Then there would be the multimillion-dollar lawsuits that were sure to follow. And, until all questions were answered, there would be no new cardiac institute in memory of Oliver Rhodes. The consequences of an adverse finding by the committee would be staggering.

Murdock felt his world crumbling around him. Quickly he gathered himself. The first thing to do was to keep the investigation quiet and in-house.

“The NIH will almost surely ask you to form a committee to investigate,” Joanna said, as if she were reading his mind.

“I’m certain they will,” Murdock said, now seeing his opening. “And I would like you to head that committee.”

“Whoa!” Joanna blurted out. “This is not my area of expertise.”

“But you’re a very good scientist,” Murdock countered, and meant it. Joanna had headed similar committees for Murdock in the past. She was bright and incisive and, most important, she knew how to be discreet. “You’ll chair the committee. And you can include Dr. Green here, since you say he’s such a fine oncology pathologist.”

Dennis Green groaned to himself. The last thing he needed was to sit on another committee, particularly one that would be so time consuming. But he had no choice other than to gracefully accept, if he wanted to stay on Murdock’s good side. “I’d be glad to help.”

“Do you know anything about the method they use to clean out the arteries?” Joanna asked Green.

He shrugged. “Damn little. But I think they remove the blockage with a laser, then add an enzyme to clean the fatty deposits of the artery walls.”

“What type of enzyme?”

Green shrugged again. “I think it’s a lipolytic enzyme which is produced by gene splicing.”

Joanna sighed deeply. She had no laboratory experience with gene splicing. None. It was a subject she’d only read about. From what she could recall, the technique consisted of isolating a segment of a human chromosome that contained the gene responsible for the production of a given protein. The chromosome segment was then inserted into
E. coli
bacteria and became incorporated into the microorganism’s DNA. The bacteria would then begin producing the human protein in quantity. Human insulin was now being made this way and was commercially available.

Joanna sighed again, unhappy with the position she’d been placed in. Her knowledge of gene splicing was little more than rudimentary. “I’m really not qualified to head this committee, Simon.”

“Yes, you are,” Murdock insisted. “And I know you’ll do a fine job for us. Now, I want you to pick your people carefully and keep the committee small. I want everything kept under wraps until the findings are in.”

Joanna sighed once more and gave in. “I’ll need an expert in tumor induction and another in biogenetics.”

“Fine,” Murdock said agreeably. “But I want them to be from Memorial, and I want to talk with both before you give them any details.”

“You won’t be able to keep this quiet, Simon,” Joanna told him. “Sooner or later the news will surely leak out.”

“We’ll see,” Murdock said, and hurried for the door.

Jake and Lou Farelli entered the mini mart in south Santa Monica. The store was empty except for the cashier behind the counter. Jake opened his notepad and studied it. The cashier’s name was Freddie Foster. He had been on duty the night the Russian was murdered.

Farelli leaned over to Jake and said in a low voice, “The cashier looks like death warmed over.”

“The flu will do that to you,” Jake commented.

“Let’s hope it didn’t affect his brain.”

They walked over to the counter and flashed their badges. Up close, Freddie Foster looked even sicker. His face was pale, and he was sweating through the front of his Santa Monica College T-shirt.

“Do you want to sit down?” Jake asked the young cashier.

“I’ll be okay,” Freddie said. “But I’d sure like to get rid of this virus.”

“Bad, huh?”

Freddie coughed and swallowed back phlegm. “I couldn’t even walk across the bedroom. I swear to God, it was like a truck hit me.”

Jake began flipping through pages in his notepad. “Freddie, we’ve been trying to reach you for the past couple of days, but you weren’t at your apartment. Most sick people stay home.”

“I did,” Freddie said at once. “I went to my mom’s house in the Valley.”

Jake nodded and briefly studied the young cashier. The kid was thin, in his early twenties, with long brown hair and silver earrings. “You work here every night?”

Freddie nodded back. “From four to eleven.”

“And you were here Monday?”

“Right.”

Jake showed the cashier a Polaroid photograph of the dead man found at the bottom of the excavation site. “Do you recognize him?”

Freddie peered at the photograph. “The top of his head looks funny.”

“That happens when somebody puts two slugs into it.”

Freddie continued to stare at the picture. “His face is kind of familiar, but I can’t place it.”

The front door swung open, and two Hispanic gangbangers walked in. They were heavily muscled and wore tight-fitting white T-shirts. Their arms and necks were covered with tattoos. “Hey,” the older one yelled out. “Where’s your beer?”

Lou Farelli turned to the pair. “He’s busy. You’re going to have to wait.”

“Yeah? For how long?”

Farelli gave the pair an icy stare. “It might be best for you two assholes to come back later.”

It took the gangbangers a moment to realize they were facing a cop. “Yeah, yeah,” the older one muttered. “We’ll be back later.”

Farelli watched the pair leave and then turned back to the cashier. “You get that kind in here a lot?”

“All the time,” Freddie said.

“Do they pay in cash or credit cards?”

“Always in cash,” Freddie answered. “They don’t buy that much. Usually beer and chips and stuff like that.”

“If they start using credit cards, particularly ones that have funny-sounding European names, you let us know.”

Jake grinned to himself. He hadn’t thought of that. The Hispanic gangbangers were probably stupid enough to use a credit card with a Russian-sounding name on it. He looked back at the cashier. “So you can’t place this guy?”

Freddie studied the photograph again. “I think I served him in here, but I can’t be sure.”

“What if I told you he had metal teeth and a tattoo of a cross on his forearm?”