Devil's Cure Page 2

  “Up there, please,” Finlay said.

  Jarvis at his side, David sat up on the edge of the examination table. Finlay washed his hands, and David watched the three guards by the door. If they all held him down, there’d be no way he could resist.

  Finlay shone an ophthalmoscope into his eyes.

  “Headache or muscle pain?”

  David shook his head patiently.

  “Fever? Night sweats?”

  “No. And no coughing or any other sign of respiratory distress. No abdominal indications either. No weight loss or diarrhea. And no swelling of the lymph nodes.”

  Finlay ignored him and lifted the front of his orange prison uniform. He put the stethoscope against his bare chest and listened.

  “Deep breath, hold it. Let it out. Another deep breath, hold. Okay.”

  He went round behind Haines and pressed the stethoscope to his tunic.

  “Fabric causes distortion, doctor. That’s first-year med school.”

  Again, Finlay ignored him, listening, then let the stethoscope drop. “Lie down please.”

  David closed his eyes and allowed Finlay’s cold hands to probe his belly and check the lymph glands in his groin, under his arms.

  “You seem healthy, but I’m going to need some blood.”

  Calmly David replied, “I’ve submitted to your physical, but you’re not taking my blood. ‘The soul of the flesh is in the blood.’ Leviticus 17:11.”

  “I’m screening for infection and TB and I want a baseline liver function. That’s first-year med school too, Haines.”

  “You can do chest X-rays, and a skin test.”

  “Oh, don’t worry, I’ll do those too.”

  He saw in Finlay’s face the coward’s pleasure in victimizing a helpless man. The doctor cracked a syringe from its sterile package. “Put out your arm, please.”

  “I’ll remind you of my religious beliefs, and ask that you respect them.”

  “I’ll say the Lord’s Prayer as I take the blood.”

  “I want to speak to the warden.”

  Finlay looked up from the disinfectant swab he was peeling from its package. “He’s okay with it. I checked.”

  “You can’t take blood without my permission.”

  “We don’t need your permission on this one, Haines. This is a matter of public health. The greater good comes before God, I’m afraid.”

  David had his manacled hands around Finlay’s neck and his thumbs gouging into his trachea before the guards were upon him. They slammed him back against the examination table, pinning him flat against its surface. As he struggled, he could hear Finlay coughing and cursing.

  Jarvis had him by the shoulders, pushing hard, and even in his outrage, David understood it was what he had to do. He felt his arm get snapped out straight, past one of the guards’ waists. It was Finlay.

  “You crazy son of a bitch,” the doctor hissed. He cinched a tourniquet around David’s bicep and jabbed the needle into a vein. As the blood left his body, David could only close his eyes in silent rage against this blasphemy.

  CHAPTER TWO

  ENTERING THE OPERATING ROOM, LAURA DONALDSON FELT HER FATIGUE and anxiety evaporate, her mind and senses tuning themselves to a purer frequency. The procedure itself was routine, one she’d performed hundreds of times. But this particular operation marked the culmination of two years of research and preparation—months of in vitro trials, mouse and monkey trials, then the long battle with the FDA for permission to test her new therapy on just one person.

  “Good morning. We all ready?”

  Emily Wiltshire finished double-checking the instrument trays with the scrub nurse and nodded. Like Laura, Emily had specialized as a surgeon before becoming a research oncologist. She was the senior member of Laura’s team, and in the lab or operating room they achieved a wordless symbiosis, anticipating the other’s next thought or move effortlessly. Laura had always preferred working with women in a testosterone-free environment, free from the spasms of Paleolithic egos.

  “They’re bringing Gillian up now,” Emily told her. “Should be here in a couple minutes.”

  “All right. Sam, you’ve got everything you need?”

  Samantha was another member of her team, and this morning she was acting as pathologist. They’d set up a portable workstation to one side so that she could instantly run tests on any tissue Laura might resect from Gillian Shamas.

  “I won’t keep you waiting,” Sam said.

  “I know you won’t. Hi, Melanie.” She smiled at her anaesthetist, whom she’d worked with many times before and trusted completely.

  “Big day for you,” said Melanie.

  “Let’s hope so.”

  “And now a few words from our corporate sponsor,” said Emily quietly, as the doors swung open and Adrian Crawford entered with Tom Powell, both men, like the surgical team, gowned, gloved, and masked.

  “Adrian, Tom, we’re going to be starting in just a few minutes. Why don’t you come over here where you can get a good view.”

  She wasn’t happy about having an audience, but Adrian had been insistent, and she didn’t see how she could deny him. His biotech company, MetaSYS, had funded her research at the University of Chicago for almost three years. In fact, it was they who’d built the new research center that housed her state-of-the-art lab and hired her to run it, in a joint appointment with the university. Laura knew her position triggered envy in most of the scientific community, and rightly so; she couldn’t imagine a better setup. Connected by overhead walkway to the university’s own hospital complex in Hyde Park, her lab was unrivaled in terms of wet bench space and top-of-the-line hardware. She’d been allowed to hire the people she wanted, and they were the best. Most important of all, the private operating budget liberated her from spending a third of her time applying for research grants. Even at the National Cancer Institute, world-renowned doctors had to scrabble for funding.

  But MetaSYS’s corporate largesse was hardly without strings: they had exclusive rights to any patentable discovery she made. She knew Adrian had sunk millions into her and her research, and now he was anxious to reap the rewards.

  “You must be tremendously, tremendously excited,” Powell said to her.

  Laura had seen Tom Powell on television only a few times and had never been a fan. His easy superlatives, deeply resonant voice, and earnest, unflinching gaze all seemed a bit cynically engineered.

  “I’m very hopeful,” she said cautiously, refusing to grant soundbites.

  Despite Laura’s strong reservations, Adrian had leaked the news of her clinical protocol to “Headline,” the ABC newsmagazine that Powell hosted, and they’d leaped at the chance for an exclusive feature. Laura thought it bad form. She’d wanted to publish her final results in an accredited journal first. But Adrian needed the publicity to bolster his sagging stock price. So, six weeks ago, both Adrian and Tom Powell had been present when Laura had given Gillian Shamas her first gene therapy transfusion. At Adrian’s urging, Laura had also granted Powell a filmed interview. A few weeks later, Gillian, back at home and feeling surprisingly well, had also let Powell interview her.

  Laura glanced up to the gallery and saw Powell’s camera crew getting ready to film. She was used to cameras in her operating theaters—she used them all the time to document surgical procedures—but these images she knew would be broadcast across the continent, and she couldn’t quite shake the feeling that they were tempting fate. She banished the thought from her head: superstitious crap. Her clinical protocol would succeed or fail on its own merits.

  “I understand the scans show Gillian’s tumors have shrunk,” Powell said. “Significantly.”

  “What we’ve seen so far is promising. And this morning we’re going to verify that.”

  “What do you hope to see when you look inside?”

  “Nothing.”

  Powell chuckled. “No tumors at all, you mean.”

  “That’s right. But I’d also be happy if I saw radicall
y diminished tumors, or dead tumor tissue that I can resect.”

  “And that would mean you’ve cured her?”

  “We’d continue to monitor her.”

  “So it could come back?”

  “Sure, a recurrence is always possible.”

  “Let’s remember,” said Adrian, “this is a woman whose tumors didn’t even blink at radiation or chemo. Three months they gave her. Laura’s the only doctor in the world who could’ve helped her.”

  She met his gaze, hardly needing to see his mouth to know he was smiling at her. His eyes had a way of narrowing to crescents, exuding such warmth and affection that she felt uncomfortable now—angry, too—at this reminder of all the private smiles he’d once bestowed on her.

  Sure, he was happy to be her corporate champion right now, but MetaSYS needed another product soon and Adrian, she knew, was getting anxious for results. And if this was a failure?

  Why the doubts, always? she chastised herself. Look at the pretrial results, look at the scans, all the indications so far. But she knew the risks, too. If Gillian’s tumors weren’t significantly reduced, the FDA might stall further trials. And if Adrian didn’t get results from her, maybe he’d go elsewhere. She closed that door. Time to focus now.

  She turned to Powell. “Have you watched surgery before, Tom?”

  “On TV or live?” She noticed his words were clicking from a dry mouth; his forehead was already greasy with sweat. She hoped she didn’t have a swooner on her hands.

  “The real deal.”

  “Um, no, no, I have not.”

  “There’s a chair over there.” She pointed. “If you feel faint, I’d suggest you take a seat. The floor’s hard. And it can get quite hot in here.”

  Adrian, she knew, was solid. He’d been to medical school and had done clinical research before turning entrepreneur. Fifteen years ago, he’d taken MetaSYS public on the strength of his own time-release hypertension drug. Since then, the company had struck home with several other big hitters, including a type of beta-blocker for coronary artery disease.

  “She’s here,” said Emily.

  Laura turned as the theater doors opened and an orderly wheeled in Gillian Shamas on a gurney. To Laura’s eye, her lack of hair—the legacy of chemotherapy—only made her more beautiful, emphasizing her exquisite green eyes and the fullness of her mouth. In her green surgical smock, her slender feet clad in white cotton socks, Gillian looked as vulnerable as a child.

  You could be next, Sandra.

  The thought slithered into Laura’s head, and she clamped down on it, hard. She didn’t want anything distracting her.

  “Good morning,” Laura said. “How are you feeling?”

  “Great,” Gillian answered.

  Laura smiled. Gillian’s unflagging optimism throughout the protocol had impressed her; she was determined she would get better, and Laura hoped to God she wouldn’t be disappointing her today.

  “Well, you’re doing great.”

  Less than a year ago, Gillian had noticed a lump in her thigh. It was excised and found to be a grade 3 synovial cell sarcoma, one of the most aggressive cancers known. A few months later, they found subcutaneous metastatic lesions on her back, and three large, inoperable sarcomas on her liver. Chemotherapy and radiation both failed her. Her doctors gave her a prognosis of three months. That made her far gone enough to qualify for Laura’s clinical protocol.

  Laura checked through the instruments on her tray. Gillian was only thirty—thirty, for God’s sake, married only two years, wanting a family, and now faced with this. And so cheerful through everything, never complaining, even when, after receiving her first treatment, her temperature had soared to 105, and she’d gone into respiratory failure.

  “We’re ready to go if you are,” she told Gillian.

  Gillian nodded. “Good luck.” Their eyes met and held for a second, and Laura felt their shared pulse of anxiety and hope.

  “You too, Gillian.”

  She turned and nodded at Melanie to begin the intravenous. Everyone in the room watched silently as Gillian took a few breaths through the mask and then plunged into a deep sleep. In a few moments, Melanie had her intubated and hooked up to the ventilator that would do all her breathing for her.

  “She’s down,” said Melanie.

  The scalpel, poised between thumb and forefinger, was a cool extension of Laura’s hand as she made her primary incision, a midline vertical cut from the bottom of Gillian’s ribs to her navel. After that, Laura’s entire universe contracted to the swath of tissue and muscle opening beneath her. The ambient whisper of the air conditioning and the rhythmic sigh of Gillian’s ventilator melded with the mantra echoing softly through her head: Let this work. Make this happen.

  In principle, her experimental therapy was simple. A human’s immune system alone was inadequate to fight cancer. White cells, so efficient at combating other diseases, often didn’t recognize cancer cells as harmful, or if they did, they were still insufficient in strength and number to halt a tumor’s growth. Laura wanted to give the immune system extra ammunition.

  In the late 1970s researchers had identified something called Tumor Necrosis Factor, a protein produced by human white cells, which killed cancer cells. Over the next two decades, numerous variations had been found, and just three years ago, Laura, heading a team at Sunnybrook Hospital in Toronto, had discovered the most potent one of all, which she’d dubbed TNF-12. The problem was, she couldn’t grow enough TNF-12 in vitro to inject into cancer patients with any beneficial effect. And even if she could, TNF-12 was highly toxic—it had to be delivered to the site of the tumor itself to do any good.

  Laura’s plan was to inject the gene for TNF-12 directly into the cancer cells, using a modified retrovirus as the vehicle. Once inside the cancer cell’s nucleus, the TNF-12 gene would splice with the native DNA and start producing its deadly proteins on site, killing the tumor from the inside out. The poetic justice pleased Laura: cancer reprogrammed to commit suicide.

  Six weeks ago, Gillian had received an intra-arterial liver infusion of over a billion engineered retroviruses. Before the protocol began, Laura had outlined the risks to her. There were many; this was uncharted territory. But without treatment, Gillian would surely die.

  “Here we are,” Laura said. “The liver.”

  Adrian had asked her to do some basic narration for Powell’s benefit. Emily quickly pulled back the skin and hooked away the other internal organs to give Laura a clear view of the liver. Immediately, Laura’s focus was pulled to the three sarcomas. Just by looking at them, she could tell their outer surface was dying, and that they were being replaced by healthy tissue. Relief washed through her, and there was a slight tremor in her voice as she spoke.

  “We have definite shrinkage in number one, number two, number three,” she said. “I’m going to resect …”

  Her voice trailed off as her eyes strayed from the tumors. Jesus Christ. Studded across the surface of the liver were hundreds of tiny gray nodules, so small and so numerous that she hadn’t noticed them at first. She felt as if she’d been suddenly wrenched from her own body and was hovering overhead, staring down dispassionately, like Powell’s cameras. It’s not happening; it’s just something on television.

  “What the hell are those?” she heard Emily say softly.

  A horrible leaden silence descended on the theater. Laura came back to herself, her heart breaking into a gallop. She was aware of everyone’s eyes on her. The quiet wheeze of the ventilator was suddenly thunderous.

  “Why didn’t we see them on the scan?” Emily said.

  “Too small,” said Laura, her mouth parched. They were less than a tenth of an inch in diameter, and could easily have escaped detection on the CT or MRI scans. She felt her stomach give a quick, sickening clench.

  “What are they?” It was Adrian, all the confidence and joviality stripped from his voice.

  “I don’t know yet.” Without hesitation she carefully resected one of the nodu
les, making sure not to puncture it. “Sam, tell me what this is, please.”

  Sam took the specimen back to her workstation and quickly started breaking it down. It would take only minutes. Laura looked at Gillian’s face, asleep, oblivious. Please don’t let this be what I think it is.

  “Laura?” It was Adrian again.

  “We may have some new malignancies.”

  “I don’t understand,” Adrian said. “You said they were shrinking.”

  She ignored him. “Let’s take a look at the pancreas, please.”

  Emily met her eyes and understood. If there were further metastases they’d missed, the pancreas was a good place to start looking.

  Despite the air conditioning, Laura felt feverishly hot. The scrub nurse dabbed the perspiration from her brow as Laura maneuvered her way through the abdominal opening. Gently she began exploring the tucks and folds of the pancreas, her fingertips sensitive as antennae. She swallowed and looked up at Emily. With horrifying frequency, the pads of her fingers were grazing what felt like minuscule hard pellets.

  “We’ve got more on the pancreas.” She turned quickly to her pathologist. “Sam, have you got an answer for me?”

  Laura heard the horrible verdict echoing in her head even before her pathologist uttered it.

  “It’s a hepatoma.”

  “Oh my God,” said Emily.

  “What’s happened?” Adrian asked.

  I’ve killed her, Laura thought. That’s what’s happened.

  “You gentlemen should leave now,” she said tightly.

  Powell, his face green, at least had the decency to turn and make for the door; he had his story, and maybe, as far as he was concerned, a sad ending was as good as a happy one. But Adrian hesitated, looking at her, his eyes above the surgical mask beseeching.

  “Please,” she said.

  She stared at the surface of Gillian’s liver, the hundreds of tiny gray hepatomas. You little bastards. How could she have known? Yes, her liver function tests had been abnormal before the operation, but she’d attributed that to the three sarcomas she’d already known to be present, albeit shrinking.

  “It’s our retrovirus,” said Emily softly. “It must be.”