Life Support (33 page)

"It's not a healthy life."

"Yeah. Well."

"How old are you?"

"Sixteen. I'm sixteen."

"You're from the South, aren't you?"

"Yes, Ma'am."

"How did you get all the way up here to Boston?"

A long sigh. "Romy brought me. He was down in Beaufort, staying with some friends. Had this way about him, you know? These real dark eyes.

Never saw a white boy with eyes that dark before. Treated me so nice .

. ." She cleared her throat, and Toby heard the rustle of the sheet as Molly brought it up to wipe her face. The [V tube dangled, silvery, over the bed.

"I take it he wasn't so nice to you after he brought you to Boston."

"No, Ma'am. He wasn't."

"Why didn't you go home, Molly? You can always go home."

There was no answer. Only by the shuddering of the bed did Toby realize the girl was sobbing. Molly herself made no sound, it was as though her grief was trapped in a jar, her cries inaudible to anyone but her.

"I can help you go home. If all you need is the money to get there�"

"I can't." The answer was barely a whisper. The girl rolled into a tight lump under the covers. Toby became aware of a soft keening, the sound of Molly's grief at last escaping from the vacuum of the jar. "I can't. I can't . . ."

"Molly."

"They don't want me back."

Toby reached out to touch her and could almost feel the girl's pain seeping through the blanket.

There was a knock, and the door opened.

"Can I talk to you, Toby?" said Dvorak.

"Right now?"

"I think you should come out and hear this." He hesitated, and glanced at Molly's bed. "It's about the sonogram."

Toby murmured to the girl, "I'll be back." She followed Dvorak into the hall and closed the door behind her.

"Did she tell you anything?" he asked.

"Nothing that sheds any light on this."

"I'll try talking to her later."

"I don't think you'll get anything. She doesn't seem to trust men, and the reason's pretty clear. Anyway, there are too many factors that can cause fetal abnormalities. The girl can't pinpoint anything."

"This is more than just a fetal abnormality."

"How do you know?"

He gestured toward a small conference room at the end of the hall.

"I want you to meet someone. She can explain it better than I can."

Dvorak had said she, but as Toby walked into the room, the person she saw sitting in front of the video monitor looked more like a man from behind�steel gray hair, closely cropped. Broad shoulders in a tan Oxford shirt. Cigarette smoke forming a drifting wreath above the squarish head. On the monitor, the sonogram of Molly Picker's womb was slowly replaying.

"I thought you gave up the cigarettes," said Dvorak.

The person swiveled around, and Toby saw that it was a woman sitting in the chair. She was in her early sixties, her blue eyes startlingly direct, her plain features unadorned by even a hint of makeup. The offending cigarette was mounted in an ivory holder, which she wielded with comfortable elegance.

"It's my one and only vice, Daniel," the woman said. "I refuse to give it up."

"I guess the scotch doesn't count."

"Scotch is not a vice. It's a tonic." The woman turned to Toby and regarded her with a raised eyebrow.

"This is Dr. Toby Harper," said Dvorak. "And this is Dr. Alexandra Marx. Dr. Marx is a developmental geneticist at Boston University. One of my professors from medical school."

"A very long time ago," said Dr. Marx. She reached out to shake Toby's hand, a gesture one didn't expect from another woman, but one which seemed perfectly natural coming from Alex Marx. "I've been replaying the sonogram. What do we know about this girl?"

"I just spoke to her," said Toby. "She's sixteen. A prostitute. She doesn't know who the father is. And she . enies any history of exposure to toxins. The only med she was taking was that bottle of piUs."

Dvorak said, "I checked with the hospital pharmacist. He identified the code stamped on the tablets. Prochlorperazine." He looked at Dr. Marx.

"They're usually prescribed for nausea. There's no evidence they cause fetal abnormalities. So we can't blame this on the pills."

"How did the pimp get his hands on a prescription drug?" asked roby.

"You can get anything on the streets these days. Maybe she's not telling you about all the other drugs she's taking."

"No, I believe her."

"How far along is the pregnancy?"

"Based on her recall, maybe five or six months."

"So we're looking at what should be a second trimester fetus." Dr. Marx swiveled around to face the monitor. "There's definitely a placenta.

There's amniotic fluid. And I believe that's an umbilical cord I see here." Dr. Marx leaned forward, studying the images flickering across the monitor. "I think you're right, Daniel. This is not a tumor."

"So it's a fetal abnormality?" asked Toby.

"No."

"What else is there?"

"Something in between."

"A tumor and a fetus? How is that possible?"

Dr. Marx took a drag from her cigarette and exhaled a cloud of smoke.

"It's a brave new world."

"All you've got is a sonogram. A bunch of gray shadows. Dr. Sibley, the radiologist, thinks this is a tumor."

"Dr. Sibley has never seen one of these before."

"And you have?"

"Ask Daniel."

Toby looked at Dvorak. "What's she talking about?"

He said, "The woman who died giving birth�Annie Parini�I sent her fetus to Dr. Marx for genetic analysis."

"I've done only preliminary studies," said Dr. Marx. "We've done the tissue sections and staining. It will take months to complete the DNA analysis. But based purely on the histology of the ... thing, I have a few theories." Dr. Marx turned her chair around to face Toby. "Sit down, Dr. Harper. Let's talk about fruit flies."

What on earth is this leading up to? Toby wondered as she sank into a chair at the conference table. Dvorak, too, sat down. Dr. Marx, at the head of the table, regarded them with the severe demeanor of a professor confronting two remedial students. "Have you heard about the studies coming out of the University of Basel using Drosophila melanogaster? The common fruit fly?"

"Which research are you talking about?" said Toby.

"It had to do with ectopic eyes. Scientists have already identified a master gene that activates the entire cascade of twenty-five hundred genes needed to form a fruit fly's eye. The gene is called "eyeless" because when it's missing, the fly is born without any eyes. The Swiss scientists managed to activate the "eyeless" gene in various parts of the fly embryo. With fascinating results. Eyes popped up in bizarre places. On wings, on knees, on antennae. Fourteen eyes grew on one fly!

And this was merely from the activation of a single gene." Dr. Marx paused to stub out her cigarette. She inserted a fresh one into the ivory holder.

"I don't see the relevance of fruit fly research to this situation," said Toby.

"I'm getting to that," said Dr. Marx, lighting up. She inhaled and leaned back with a satisfied sigh. "Let's leap across species lines now.

To mice."

"I still don't see the relevance."

"I'm trying to start off on a very elementary level here. You and Daniel aren't developmental biologists. You probably aren't aware of the advances that have occurred since you left medical school."

"Well, that's true," admitted Toby. "It's hard enough keeping up with clinical medicine."

"Then let me catch you up. Briefly." Dr. Marx tapped off a cigarette ash. "I was talking about mice. Specifically, mice pituitary glands.

Now, the pituitary is crucial to a newborn mouse's survival. There's a reason they call it the master gland." All those hormones it produces regulate everything from growth to reproduction to body temperature. It secretes hormones whose purpose we don't know. Hormones we haven't even identified. Mice born without a pituitary die within twenty-four hours�that's how vital the gland is.

"And here's where the research comes in. At NIH, they're studying the pituitary's embryonic development. They know that all the different cells that form the gland arise from a single primordium. Precursor cells. But what induces those precursor cells to make a pituitary gland?" She looked back and forth at her two remedial students.

"A gene?" ventured Toby.

"Naturally. It all gets back to DNA. Life's building block."

"Which gene?" asked Dvorak.

"In the mouse, it's Lhx3. An LIM homobox gene."

He laughed. "That's perfectly clear."

"I don't expect you to completely understand it, Daniel. I just want you to grasp the concept here. Which is that there are master genes that make primoridal cells develop in certain ways. A master gene to make an eye, another to make a limb, another to make a pituitary gland."

"All right," said Dvorak. "I think we understand that much. Sort of."

Dr. Marx smiled. "Then the next concept should be easy for you. I want you to combine these two pieces of research and consider what they mean together. A master gene that kicks off the formation of a pituitary gland. And a fruit fly born with fourteen eyes." She looked at Toby, then at Dvorak. "Do you see what I'm getting at?"

"No," said Toby.

"No," said Dvorak, almost simultaneously.

Dr. Marx sighed. "All right. Let me just tell you what I found on tissue section. I dissected that specimen Daniel sent to me�what he thought was a malformed fetus. I'd never seen anything like it, and I've examined thousands of congenital abnormalities. Now, the human genome is made up of a hundred thousand genes. This thing appears to possess only a fraction of the normal genome. And what was present was greatly disrupted. Something catastrophic happened to that entire genome. The result? It's as if you took apart a fetus and then tried to reconstitute it in no particular order. Arms, teeth, cerebrum, all lumped together."

Toby felt queasy. She looked at Dvorak and saw that he had paled.

The image conjured up by Dr. Marx sickened them both.

"It wouldn't survive. Would it?" asked Toby.

"Of course not. Its cells were kept alive purely by placental circulation. It was using the mother as its nutrient source. It was a parasite, if you will. But then, all fetuses are parasites."

"I never thought of it that way," murmured Toby.

"Well, they are. Mother is the host. Her lungs oxygenate the blood, her food intake provides glucose and protein. This particular parasite�this thing�could stay alive only as long as it remained in the womb, connected to the mother's circulation. Within moments of being expelled, its cells began to die." Dr. Marx paused, her gaze drifting upward to the rising coil of cigarette smoke. "It was not, in any way, an independent organism."

"If it's not a fetus, what would you call this thing?" asked Toby.

"I'm not sure. We prepared multiple sections of tissue. The slides were stained and examined by myself as well as by a pathologist in my department. We both concurred. One particular type of tissue appeared again and again, in organized clusters of cells. Oh, there were other tissues as well�muscle and cartilage, for instance, even an eye. But those seemed random. What was organized, and well differentiated, was the repetitive cell clusters. Glandular tissue we haven't yet identified. Identical clusters, all apparently in the midgestational stage." She paused. "This thing, in short, looked like a tissue factory."

Dvorak shook his head. "I'm sorry, but this sounds pretty crazy."

"Why? It's been done in a lab. We can make eyes grow on fruit fly wings! We can turn on or turn off a pituitary master gene! If it can happen in a lab, it can happen in nature. Somehow, in this girl, human embryonic cells developed multiple copies of the same gene. It meant, of course, that the embryo didn't differentiate properly. So there are no legs, there's no torso. What's growing instead are these specific cell clusters."

"What could cause this abnormality?" asked Toby.

"Outside of the lab? Something devastating. A teratogenic agent we've never seen before."

"But Molly doesn't remember any exposure. I asked her several times�" Toby paused, her gaze swerving toward the door.

Someone was screaming.

"It's Molly!" said Toby, and she shot to her feet. Dvorak was right on her heels as she pushed out of the room and sprinted down the hallway.

By the time she reached Molly's room, a nurse was already at the bedside, trying to calm the girl.

"What happened?" asked Toby.

"She says someone was in her room," the nurse said.

"He was standing right here by the bed!" said Molly. "He knows I'm here. He followed me�"

"Who?"

"Romy."

"The lights were off," the nurse calmly pointed out. "You could have been dreaming."

"He talked to me!"

"I didn't see anyone," said the nurse. "And my desk is right around the corner�" The slam of a door echoed in the hallway.

Dr. Marx poked her head in the room. "I just saw a man run into the stairwell."

"Call Security," Dvorak said to the nurse. "Have them check the lower levels."

Toby was right behind Dvorak as he ran into the hall. "Dan, where are you going?"

He pushed through the stairwell door.

"Let Security handle this!" She followed him into the stairwell.

Somewhere below, Dvorak's footsteps pounded down concrete steps.

She started down after him, tentatively at first, then picked up her pace as determination took hold. She was angry now, at Dvorak for this insanely reckless pursuit, and at Romy�if it was Romy�for daring to pursue the girl into the sanctuary of a hospital.

How had he tracked her down? Did he follow them from Dvorak's office?

She picked up her pace, flying past the second-floor landing. She t heard a door bang open, then slam shut again.

"Dan!" she yelled. No answer.

At last she hit the first floor, pushed through the door, and emerged next to the ER loading platform facing Albany Street. The blacktop was glistening with rain. She squinted as wind gusted at her face, lifting the tang of wet pavement.