Fever

PROLOGUE

ONE

TWO

THREE

FOUR

FIVE

SIX

SEVEN

EIGHT

NINE

TEN

ELEVEN

TWELVE

THIRTEEN

FOURTEEN

FIFTEEN

SIXTEEN

SEVENTEEN

EPILOGUE

This is a work of fiction. Names, characters, places, and incidents are either the product of the author's imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events or locales is entirely coincidental.

 

FEVER

 

A
Berkley
Book / published by arrangement with the author

 

All rights reserved.

Copyright ©
1982
by
Robin Cook

This book may not be reproduced in whole or part, by mimeograph or any other means, without permission. Making or distributing electronic copies of this book constitutes copyright infringement and could subject the infringer to criminal and civil liability.

For information address:

The Berkley Publishing Group, a division of Penguin Putnam Inc.,

375 Hudson Street, New York, New York 10014.

 

The Penguin Putnam Inc. World Wide Web site address is
http://www.penguinputnam.com

 

ISBN:
978-1-1012-0375-0

 

A
BERKLEY
BOOK®

Berkley
Books first published by The Berkley Publishing Group, a member of Penguin Putnam Inc.,

375 Hudson Street, New York, New York 10014.

Berkley
and the “
B
” design are trademarks belonging to Penguin Putnam Inc.

 

Electronic edition: May, 2002

Also by Robin Cook

 

VECTOR
TOXIN
INVASION
CHROMOSOME 6
CONTAGION
ACCEPTABLE RISK
FATAL CURE
TERMINAL
BLINDSIGHT
VITAL SIGNS
HARMFUL INTENT
MUTATION
MORTAL FEAR
OUTBREAK
MINDBEND
GODPLAYER
BRAIN
SPHINX
COMA
THE YEAR OF THE INTERN

 

 

 

To the joy of my family—
it began with my parents,
now shared with my wife.

T
he poisonous molecules of benzene arrived in the bone marrow in a crescendo. The foreign chemical surged with the blood and was carried between the narrow spicules of supporting bone into the farthest reaches of the delicate tissue. It was like a frenzied horde of barbarians descending into Rome. And the result was equally as disastrous. The complicated nature of the marrow, designed to make most of the cellular content of the blood, succumbed to the invaders.

Every cell exposed to the benzene was assaulted. The nature of the chemical was such that it knifed through the cell membranes like steel through butter. Red cells or white, young or mature, it made no difference. Within some lucky cells where only a few molecules of benzene entered, enzymes were able to inactivate the chemical. In most others the destruction of the interior membranes was immediate.

Within minutes the concentration of the benzene had soared to the point that thousands of the poisonous molecules had reached the very heart of the marrow, the primitive, finely structured stem cells. These were the actively dividing units, serving as the source of the circulating blood cells, and their
activity bore witness to hundreds of millions of years of evolution. Here, being played out moment by moment, was the incredible mystery of life, an organization more fantastic than the wildest scientific dream. The benzene molecules indiscriminately penetrated these busily reproducing cells, interrupting the orderly replication of the DNA molecules. Most of these cells either halted the life processes in a sudden agonal heave or, having been released from the mysterious central control, tumbled off in frenzied undirected activity like rabid animals until death intervened.

After the benzene molecules had been washed away by repeated surges of clean blood, the marrow could have recovered except for one stem cell. This cell had been busy for years turning out an impressive progeny of white blood cells whose function, ironically enough, was to help the body fight against foreign invaders. When the benzene penetrated this cell's nucleus, it damaged a very specific part of the DNA but did not kill the cell. It would have been better if the cell had died because the benzene destroyed the fine balance between reproduction and maturation. The cell instantly divided and the resulting daughter cells had the same defect. No longer did they listen to the mysterious central control and mature into normal white blood cells. Instead they responded to an unfettered urge to reproduce their altered selves. Although they appeared to be relatively normal within the marrow, they were different from other young white blood cells. The usual surface stickiness was absent, and they absorbed nutrients at an alarmingly selfish rate. They had become parasites within their own house.

After only twenty divisions there were over one million of these lawless cells. By twenty-seven divisions there were over one billion; they then began to break free from the mass. First a trickle of sick cells entered the circulation, then a steady stream, finally a flood. These cells charged out into the body eager to establish fertile colonies. By forty divisions they numbered over a trillion.

It was the beginning of an aggressive, acute myeloblastic
leukemia in the body of a pubescent girl, starting December 28, two days after her twelfth birthday. Her name was Michelle Martel and she had no idea except for a single symptom: she had a fever
!

A
cold January morning tentatively fingered its way over the frigid landscape of Shaftesbury, New Hampshire. Reluctantly the shadows began to pale as the winter sky slowly lightened, revealing a featureless gray cloud cover. It was going to snow and despite the cold, there was a damp sting to the air; a sharp reminder that off to the east lay the Atlantic.

The red brick buildings of old Shaftesbury huddled along the Pawtomack River like a ghost town. The river had been the support, the lifeblood of the town; it sprang from the snow-laden White Mountains in the north and ran to the sea in the southeast. As the river coursed past the town, its smooth flow was interrupted by a crumbling dam and a large waterwheel that no longer turned. Lining the riverbanks were block after block of empty factories, reminders of a more prosperous age when New England mills were the center of the textile industry. At the extreme southern end of town, at the foot of Main Street, the last brick mill building was occupied by a chemical operation called Recycle, Ltd., a rubber, plastic, and vinyl recycling plant. A wisp of acrid, gray smoke rose from a large phallic smokestack and merged with the clouds. Over the
whole area hung a foul, choking odor of burnt rubber and plastic. Surrounding the building were enormous piles of discarded rubber tires, like the droppings of a gigantic monster.

South of the town the river ran through rolling, wooded hills, interspersed by snow-covered meadows and bordered by fieldstone fences erected by settlers three hundred years before. Six miles south of the town the river took a lazy curve to the east and formed an idyllic six-acre peninsula of land. In the center was a shallow pond connected to the river by an inlet. Behind the pond rose a hill capped by a white-framed Victorian farmhouse with gabled roofs and gingerbread trim. A long winding driveway bordered with oaks and sugar maples led down to the Interstate 301 heading south toward Massachusetts. Twenty-five yards north of the house was a weather-beaten barn nestled in a copse of evergreens. Built on piles at the edge of the pond was a miniature copy of the main house; it was a shed turned playhouse.

It was a beautiful New England landscape, like a January calendar scene, except for a slight macabre detail: there were no fish in the pond and no encircling vegetation within six feet.

Inside the picturesque white house, the pale morning light diffused through lace curtains. By degrees the gathering dawn gently nudged Charles Martel from the depths of a satisfying sleep. He rolled over onto his left side, enjoying a contentment he'd been afraid to acknowledge for the past two years. There was a sense of order and security in his life now; Charles had never expected to experience this again after his first wife had been diagnosed with lymphoma. She had died nine years ago, leaving Charles with three children to raise. Life had become something to endure.

But that was now in the past, and the awful wound had slowly healed. And then to Charles's surprise, even the void had been filled. Two years ago he had remarried, but he still was afraid to admit how much his life had changed for the better. It was safer and easier to concentrate on his work and the day-to-day necessities of family life than to acknowledge
his newly regained contentment and thereby admit to the ultimate vulnerability, happiness. But Cathryn, his new wife, made this denial difficult because she was a joyous and giving person. Charles had fallen in love with her the day he met her and had married her five months later. The last two years had only increased his affection for her.

As the darkness receded, Charles could see the placid profile of his sleeping wife. She was on her back with her right arm casually draped on the pillow above her head. She looked much younger than her thirty-two years, a fact that initially had emphasized the thirteen years' difference in their ages. Charles was forty-five and he acknowledged that he looked it. But Cathryn looked like twenty-five. Resting on his elbow, Charles stared at her delicate features. He traced the frame of her provocative widow's peak, down the length of the soft brown hair to her shoulder. Her face, lit by the early morning light, seemed radiant to Charles and his eyes followed the slightly curved line of her nose, noticing the flare of her nostrils as she breathed. Watching her he felt a reflex stirring deep within him.

He looked over at the clock; another twenty minutes before the alarm. Thankfully he lowered himself back into the warm nest made by the down coverlet and spooned against his wife, marveling at his sense of well-being. He even looked forward to his days at the institute. Work was progressing at an ever-increasing pace. He felt a twinge of excitement. What if he, Charles Martel, the boy from Teaneck, New Jersey, made the first real step in unraveling the mystery of cancer? Charles knew that it was becoming increasingly possible, and the irony was that he was not a formally trained research scientist. He'd been an internist specializing in allergy when Elizabeth, his first wife, had become ill. After she died he gave up his lucrative practice to become a full-time researcher at the Weinburger Research Institute. It had been a reaction against her death, and although some of his colleagues had told him that a career change was an unhealthy way to work out such a problem, he had flourished in the new environment.

Cathryn, sensing her husband was awake, turned over and found herself in an enveloping hug. Wiping the sleep from her eyes, she looked at Charles and laughed. He looked so uncharacteristically impish.

“What's going on in that little mind of yours?” she asked, smiling.

“I've just been watching you.”

“Wonderful! I'm sure I look my best,” said Cathryn.

“You look devastating,” teased Charles, pushing her thick hair back from her forehead.

Cathryn, now more awake, realized the urgency of his arousal. Running her hand down her husband's body, she encountered an erect penis. “And what is this?” she asked.

“I accept no responsibility,” said Charles. “That part of my anatomy has a mind of its own.”

“Our Polish Pope says a man should not lust after his wife.”

“I haven't been. I've been thinking about work,” Charles teased.

As the first snowflakes settled on the gabled roofs, they came together with a depth of passion and tenderness that never failed to overwhelm Charles. Then the alarm went off. The day began.

 

Michelle could hear Cathryn calling from far away, interrupting her dream; she and her father were crossing a field. Michelle tried to ignore the call but it came again. She felt a hand on her shoulder, and when she turned over, she looked up into Cathryn's smiling face.

“Time to get up,” her stepmother said brightly.

Michelle took a deep breath and nodded her head, acknowledging that she was awake. She'd had a bad night, full of disturbing dreams which left her soaked with perspiration. She'd felt hot beneath the covers and cold out of them. Several times during the night she thought about going in to Charles. She would have if her father had been alone.

“My goodness, you look flushed,” said Cathryn, as she
opened the drapes. She reached down and touched Michelle's forehead. It felt hot.

“I think you have a fever again,” said Cathryn sympathetically. “Do you feel sick?”

“No,” said Michelle quickly. She didn't want to be sick again. She did not want to stay home from school. She wanted to get up and make the orange juice, which had always been her job.

“We'd better take your temperature anyway,” said Cathryn, going into the connecting bath. She reappeared, alternately flicking and examining the thermometer. “It will only take a minute, then we'll know for sure.” She stuck the thermometer into Michelle's mouth. “Under the tongue. I'll be back after I get the boys up.”

The door closed and Michelle pulled the thermometer from her mouth. Even in that short a time, the mercury had risen to ninety-nine. She had a fever and she knew it. Her legs ached and there was a tenderness in the pit of her stomach. She put the thermometer back into her mouth. From where she lay she could look out the window and see her playhouse that Charles had made out of an ice shed. The roof was covered with new-fallen snow and she shivered at the cold scene. She longed for spring and those lazy days that she spent in that fantasy house. Just she and her father.

 

When the door opened, Jean Paul, age fifteen, was already awake, propped up in bed with his physics book. Behind his head the small clock radio played a soft rock and roll. He was wearing dark red flannel pajamas with blue piping, a Christmas gift from Cathryn.

“You've got twenty minutes,” Cathryn said cheerfully.

“Thanks, Mom,” said Jean Paul with a smile.

Cathryn paused, looking down at the boy, and her heart melted. She felt like rushing in and swooping him into her arms. But she resisted the temptation. She'd learned that all the Martels were somewhat chary about direct physical contact, a fact that initially had been a little hard for her to deal
with. Cathryn came from Boston's Italian North End where touching and hugging was a constant. Although her father had been Latvian, he'd left when Cathryn was twelve, and Cathryn had grown up without his influence. She felt 100 percent Italian. “See you at breakfast,” she said.

Jean Paul knew that Cathryn loved to hear him call her Mom and gladly obliged. It was such a low price to pay for the warmth and attention that she showered on him. Jean Paul had been conditioned by a very busy father and seen himself eclipsed by his older brother, Chuck, and his irresistible baby sister, Michelle. Then came Cathryn, and the excitement of the marriage, followed by Cathryn's legal adoption of Chuck, Jean Paul, and Michelle. Jean Paul would have called her “grandmother” if she wanted. He thought he loved Cathryn as much as his real mother; at least what he could remember of her. He'd been six when she died.

Chuck's eyes blinked open at the first touch of Cathryn's hand but he pretended sleep, keeping his head under his pillow. He knew that if he waited she'd touch him again, only a little more forcibly. And he was right, only this time he felt two hands shake his shoulder before the pillow was lifted. Chuck was eighteen years old and in the middle of his first year at Northeastern University. He wasn't doing that well and he dreaded his upcoming semester finals. It was going to be a disaster. At least for everything but psychology.

“Fifteen minutes,” said Cathryn. She tousled his long hair. “Your father wants to get to the lab early.”

“Shit,” said Chuck under his breath.

“Charles, Jr.!” said Cathryn, pretending to be shocked.

“I'm not getting up.” Chuck grabbed the pillow from Cathryn's hands and buried himself.

“Oh, yes you are,” said Cathryn, as she yanked the covers back.

Chuck's body, clad only in his undershorts, was exposed to the morning chill. He leaped up, pulling the blankets around him. “I told you never to do that,” he snapped.

“And I told you to leave your locker-room language in the
locker room,” said Cathryn, ignoring the nastiness in Chuck's voice. “Fifteen minutes!”

Cathryn spun on her heel and walked out. Chuck's face flushed in frustration. He watched her go down the hall to Michelle's room. She was wearing an antique silk nightgown that she'd bought at a flea market. It was a deep peach color, not too different from her skin. With very little difficulty, Chuck could imagine Cathryn naked. She wasn't old enough to be his mother.

He reached out, hooked his hand around the edge of his door, and slammed it. Just because his father liked to get to his lab before eight, Chuck had to get up at the crack of dawn like some goddamn farmer. The big deal scientist! Chuck rubbed his face and noticed the open book at his beside.
Crime and Punishment.
He'd spent most of the previous evening reading it. It wasn't for any of his courses, which was probably why he was enjoying it. He should have studied chemistry because he was in danger of flunking. God, what would Charles say if he did! There had already been a huge blowup when Chuck had not been able to get into Charles's alma mater, Harvard. Now if he flunked chemistry . . . Chemistry had been Charles's major.

“I don't want to be a goddamn doctor anyway,” Chuck snapped, as he stood up and pulled on dirty Levi's. He was proud of the fact that they'd never been washed. In the bathroom he decided not to shave. He thought maybe he'd grow a beard.

 

Clad in a terrycloth lava-lava, which, unfortunately, emphasized the fifteen pounds he'd gained in the last ten years, Charles lathered his chin. He was trying to sort through the myriad facts associated with his current research project. The immunology of living forms involved a complexity which never failed to amaze and exhilarate him, especially now that he thought he was coming very close to some real answers about cancer. Charles had been excited before and wrong before. He knew that. But now his ideas were based on years of
painstaking experimentation and supported by easily reproducible facts.

Charles began to chart the schedule for the day. He wanted to start work with the new HR7 strain of mice that carried hereditary mammary cancer. He hoped to make the animals “allergic” to their own tumors, a goal which Charles felt was coming closer and closer.

Cathryn opened the door and pushed past him. Pulling her gown over her head, she slipped into the shower. The water and steam billowed the shower curtain. After a moment she pulled back the curtain and called to Charles.