Terminal (46 page)

First he added a biotinylated probe and the enzymatic reagents used to detect whether the probe had reacted in the series of wells containing Helen Cabot’s cerebrospinal fluid.
Then he introduced these samples into the chemiluminescence instrument and waited by the printout to see if there was any luminescence.

To Sean’s surprise, the very first sample was positive. Although he fully expected it to be positive eventually, he hadn’t expected a reaction so soon. What this established was that Helen Cabot—just like Malcolm Betencourt—had contracted St. Louis encephalitis in the middle of the winter, which was strange since the normal vector for the illness is a mosquito.

Sean then turned his attention to the other wells where he would be searching for the presence of oncogenes. But before he could start adding the appropriate probes, he was interrupted by Dr. Mason.

Although the phone had rung intermittently after he’d spoken with Sergeant Hunt, Sean had ignored it. Apparently Dr. Mason had ignored it too, because on several occasions it rang for extended periods. Sean had finally turned the ringer off on his extension. But apparently it had rung again and apparently this time Dr. Mason had answered it because he’d gingerly opened the door to tell Sean that his brother was on the line.

Although Sean hated to interrupt what he was doing, he felt guilty enough about Brian to take his call. The first thing he did was apologize for striking him.

“I’m willing to forgive and forget,” Brian said. “But you have to end this nonsense right now and come down here and give yourself up.”

“I can’t,” Sean said. “I need another hour or so, maybe two at the most.”

“What in God’s name are you doing?” Brian asked.

“It’ll take too long to explain,” Sean said. “But it’s big stuff.”

“I’m afraid you have no idea of the hullabaloo you’re causing,” Brian said. “They’ve got everyone here but the National Guard. You’ve gone too far this time. If you don’t come out this minute and put a stop to this, I won’t have anything to do with you.”

“I only need a little more time,” Sean said. “I’m not asking for the world.”

“There’s a bunch of gung ho nuts out here,” Brian said. “They’re talking about storming the building.”

“Make sure they know about the purported nitroglycerin,” Sean said. “That’s supposed to dissuade them from heroics.”

“What do you mean, ‘purported nitroglycerin’?” Brian asked.

“It’s mostly ethanol with just a little acetone,” Sean said. “It looks like nitroglycerin. At least, it’s close enough to fool Dr. Mason. You didn’t think I’d make up a batch of the real thing, did you?”

“At this point,” Brian said, “I wouldn’t put anything past you.”

“Just talk them out of any commando action,” Sean said. “Get me at least one more hour.

Sean could hear Brian continue to protest, but Sean didn’t listen. Instead he hung up the phone and turned back to the first thermal cycler tray.

Sean hadn’t gotten far with the oncogene probes when Janet came through the stairwell door trailing computer printout sheets.

“No problem finding the Forbes travel file,” she said. She thrust the computer paper at Sean. “For whatever it’s worth, Dr. Deborah Levy does a lot of traveling, but it’s mostly back and forth to Key West.”

Sean glanced at the printout. “She does keep on the move,” he agreed. “But notice all these other cities. That’s what I expected. What about Margaret Richmond?”

“No travel to Key West,” Janet said. “But moderate travel around the country. About once a month she’s off to another city.”

“What about that automated program we saw?” Sean asked.

“You were right about that,” Janet said. “It was running when I got up there, so I copied two of the numbers we thought might have been phone numbers. When I tried to call direct I could tell it was a computer link, so I used the mainframe and its modem to connect. Both of them were insurance companies: one was Medi-First; the other was Healthnet.”

“Bingo,” Sean said. “It’s all falling into place.”

“How about letting me in on the revelation,” Janet said.

“What I’d be willing to bet is that the computer searches for medical insurance companies’ precertification files for specific social security numbers. It probably does it on a nightly basis during the week and on Sunday afternoons.”

“You mean precertification for surgery?” Janet asked.

“That’s exactly what I mean,” Sean said. “In an attempt to cut down on unnecessary surgery, most if not all health plans require the doctor or the hospital to notify the insurance company of proposed surgery in advance. Usually it’s merely a rubber-stamp exercise so it’s pretty casual. I doubt there’s any concern about confidentiality. That computer upstairs is printing out proposed elective surgery on a specific list of social security numbers.”

“Those are the numbers that are flashing on the screen,” Janet said.

“That’s what it has to be,” Sean said.

“So why?” Janet asked.

“I’ll let you figure that out,” Sean said. “While I continue processing these thermal cycler samples, you look at the referring histories on these thirty-three charts we copied. I think you’ll find most will mention that the patient had elective surgery within a relatively short period before their diagnosis of medulloblastoma. I want you to compare the dates of those surgeries with Dr. Levy’s travel schedule.”

Janet stared at Sean without blinking. Despite her exhaustion, she was beginning to assimilate the facts as Sean understood them and therefore starting to comprehend the direction Sean’s thoughts were headed. Without saying another word, she sat down with the charts and the computer printout she’d brought down from the seventh floor.

Turning back to his own work, Sean loaded a few more wells with the appropriate oncogene probes. He hadn’t gotten far when Dr. Mason interrupted him.

“My wife is getting hungry,” Dr. Mason announced.

With his general fatigue Sean’s nerves were raw. After all that had happened he could not abide the Masons, particularly
Mrs. Mason. The fact that they thought it appropriate to bother him with her being hungry threw him into a momentary rage. Putting down the pipette, he raced back toward the glass office.

Dr. Mason saw Sean coming and quickly guessed his state of mind. He let go of the door and backed into the office.

Sean threw open the office door so that it banged against the doorstop. He flew into the office, snatched the Erlenmeyer flask from the ice bath, and gave it a shake. Some of its contents had solidified and cakes of ice clunked against the sides of the container.

Dr. Mason’s face blanched as he cringed in anticipation of an explosion. Mrs. Mason buried her face in her hands.

“If I hear one more sound from you people I’m going to come in here and shatter this flask on the floor,” Sean yelled.

When no explosion occurred Dr. Mason opened his eyes. Mrs. Mason peeked out between her fingers.

“Do you people understand?” Sean snapped.

Dr. Mason swallowed hard, then nodded.

Disgusted with the Masons and his own temper tantrum, Sean went back to his lab bench. Guiltily he glanced over at Janet, but she’d not paid any attention. She was too engrossed in the charts.

Picking up the pipette, Sean went back to work. It was not easy, and he had to concentrate. He had to put the right probe in the right well, and he had the primer pairs and probes for over forty oncogenes, a rather extensive list.

A number of the first samples were negative. Sean didn’t know if he’d taken them from the thermal cycler after an insufficient number of cycles or if they were truly negative. By the fifth sample he was beginning to become discouraged. For the first time since he’d put this drama into motion, he seriously questioned the conclusions which by then he’d come to view as rock solid. But then the sixth sample proved positive. He’d detected the presence of an oncogene known by the designation ERB-2, which referred to avian erythroblastosis virus, a virus whose normal host was chickens.

By the time Janet finished with the charts, Sean had found
another oncogene, called v-myc, which stood for myelocytoma virus, another virus that grew in chickens.

“Only about three-quarters of the charts have the surgery dates,” Janet said. “But of those, most of them match the dates and destinations of Dr. Levy’s travel.”

“Hallelujah!” Sean exclaimed. “It’s all fitting into place like a jigsaw puzzle.”

“What I don’t understand,” Janet said, “is what she did in those cities.”

“Nearly everyone who’s post-surgery is on an IV,” Sean said. “It keeps people hydrated, plus if there’s a problem the medical staff has a route for medication. My guess is that Deborah Levy gave them an injection into their IV.”

“Of what?” Janet asked.

“An injection of St. Louis encephalitis virus,” Sean said. He told Janet about the positive test for the SLE virus in Helen Cabot’s cerebrospinal fluid. He also told her that Louis Martin had had transient neurological symptoms similar to Helen’s several days after his elective surgery.

“And if you look back at the charts,” Sean continued, “I think you’ll find most of these people had similar fleeting symptoms.”

“Why didn’t they get full-blown encephalitis?” Janet asked. “Especially if it was injected through their IVs?”

“That’s the truly clever part about all this,” Sean said. “I believe the encephalitis viruses were altered and attenuated with the inclusion of viral oncogenes. I’ve already detected two such oncogenes in Helen’s tumor. My guess is that I’ll find another. One of the current theories on cancer is that it takes at least three isolated events in a cell to make it cancerous.”

“How did all this occur to you?” Janet asked. It sounded too complicated, too involved, too complex, and most of all too hideous, to be true.

“Gradually,” Sean said. “Unfortunately it took me a long time. I suppose initially my index of suspicion was so low; it’s the last thing I expected. But when you told me they started immunotherapy with a specific agent from day one, I
thought something was out of whack. That flew in the face of everything I knew about the specificity of immunotherapy. It takes time to develop an antibody and everybody’s tumor is antigenically unique.”

“But it was at the Betencourts’ that you started acting strangely,” Janet said.

“Malcolm Betencourt was the one who emphasized the sequence,” Sean said. “Elective surgery, followed by neurological symptoms, and then brain tumor. Helen Cabot and Louis Martin had the same progression. Until I heard Malcolm’s story, I hadn’t realized its significance. As one of my medicine professors said, if you are painstakingly careful in your history-taking, you should be able to make every diagnosis.”

“So you believe the Forbes Cancer Center has been going around the country giving people cancer,” Janet said, forcing herself to put into words her awful fear.

“A very special kind of cancer,” Sean said. “One of the viral oncogenes I’ve detected makes a protein that sticks out through the cell membrane. Since it’s homologous to the protein that forms the receptor for growth hormone, it acts like a switch in the ‘on’ position to encourage cell growth and cell division. But besides that, the portion that sticks through the cell is a peptide and probably antigenic. My guess is the immunoglobulin they give these people is an antibody for that extracellular part of the ERB-2 oncoprotein.”

“You’re losing me,” Janet admitted.

“Let’s give it a try,” Sean said. “Maybe I can show you. It will only take a moment since I have some of the ERB-2 oncoprotein from the Key West lab. Let’s see if Helen Cabot’s medicine reacts with it. Remember that I wasn’t able to get it to react with any natural cellular antigen. The only thing it would react with was her tumor.”

As Sean quickly prepared the immunofluorescence test, Janet tried to absorb what Sean had said so far.

“In other words,” Janet said after a pause, “what makes this medulloblastoma cancer so different is that not only is it manmade, it’s curable.”

Sean looked up from his work with obvious admiration.
“Right on!” he said. “You got it. They created a cancer with a tumor-specific antigen for which they already had a monoclonal antibody. This antibody would react with the antigen and coat all the cancer cells. Then all they’d have to do was to stimulate the immune system both in vivo and in vitro to get as many ‘killer’ cells as possible. The only minor problem was that the treatment probably made the symptoms worse initially because of the inflammation it would undoubtedly cause.”

“Which is why Helen Cabot died,” Janet said.

“That’s what I’d guess,” Sean said. “Boston kept her too long during the diagnostic stage. They should have sent her right down to Miami. The trouble is that Boston can’t believe someone else might be better for any medical problem.”

“How could you be so sure of all this?” Janet asked. “By the time we got back here you hadn’t any proof. Yet you were sure enough to force the Masons over here by gunpoint. Seems to me you were taking a huge risk.”

“The clincher was some engineer-style drawings of viral capsids I saw in the lab in Key West,” Sean explained. “As soon as I saw them, I knew it all had to be true. You see, Dr. Levy’s particular area of expertise is virology. The drawings were of a spherical virus with icosahedral symmetry. That’s the kind of capsule an SLE virus has. The scientifically elegant part of this vile plot is that Deborah Levy was able to package the oncogenes into the SLE viral capsule. There wouldn’t be room for more than one oncogene in each virus because she’d have to leave much of the SLE virus genome intact so that it would still be infective. I don’t know how she did it. She also must have included some retroviral genes as well as the oncogene in order to get the oncogene to insert into the infected cell’s chromosomes. My guess is that she transformed a number of the viruses with the oncogenes and only those brain cells that were unlucky enough to get all the oncogenes simultaneously became cancerous.”

“Why an encephalitis virus?” Janet asked.

“It has a natural predilection for neurons,” Sean said. “If they wanted to cause a cancer they could treat, they needed a
tumor which they could count on giving early symptoms. Brain cancer is one of them. Scientifically, it’s all quite rational.”