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  Mortal Fear

  Robin Cook

  A harrowing medical nightmare on the cutting edge of genetic research, Mortal Fear goes into the controversial future of modern medicine. At a large Boston clinic, a world-class biologist stumbles upon a miraculous discovery, a major scientific breakthrough. Soon, healthy, middle-aged patients are dying of old age. And the ultimate experiment in terror begins…

  Robin Cook

  Mortal Fear

  ACKNOWLEDGMENTS

  This book could not have been written without the support and encouragement of all my friends who have helped me in a difficult time. You all know who you are, and you all have my heartfelt thanks.

  DEDICATION

  For my older brother, Lee, and my younger sister, Laurie.

  I’ve never been between two nicer people.

  PROLOGUE

  OCTOBER 11, WEDNESDAY P.M.

  The sudden appearance of the foreign proteins was the molecular equivalent of the Black Plague. It was a death sentence with no chance of reprieve, and Cedric Harring had no idea of the drama about to happen inside him.

  In sharp contrast, the individual cells of Cedric Harring’s body knew exactly what disastrous consequences awaited them. The mysterious new proteins that swept into their midst and through their membranes were overwhelming, and the small amounts of enzymes capable of dealing with the newcomers were totally inadequate. Within Cedric’s pituitary gland, the deadly new proteins were able to bind themselves to the repressors that covered the genes for the death hormone. From that moment, with the fatal genes exposed, the outcome was inevitable. The death hormone began to be synthetized in unprecedented amounts. Entering the blood-stream, the hormone coursed out into Cedric’s body. No cell was immune. The end was only a matter of time. Cedric Harring was about to disintegrate into his stellar elements.

  CHAPTER 1

  The pain was like a white-hot knife starting somewhere in his chest and quickly radiating upward in blinding paroxysms to paralyze his jaw and left arm. Instantly Cedric felt the terror of the mortal fear of death. Cedric Harring had never felt anything like it.

  By reflex he gripped the steering wheel of his car more tightly and somehow managed to stay in control of the weaving vehicle as he gasped for breath. He’d just entered Storrow Drive from Berkeley Street in downtown Boston, and had accelerated westward, merging with the maddening Boston traffic. The images of the road swam before him and then receded, as if they existed at the end of a long tunnel.

  By sheer strength of will, Cedric resisted the darkness that threatened to engulf him. Gradually, the scene brightened. He was still alive. Instead of pulling over, instinct told him his only chance was to get to a hospital as fast as possible. By lucky coincidence the Good Health Plan Clinic was not too far off. Hold on, he told himself.

  Along with the pain came a drenching sweat that started on Cedric’s forehead but soon spread to the rest of his body. Sweat stung his eyes, but he dared not loosen his grip on the steering wheel to wipe it away. He exited the highway onto the Fenway, a parklike complex in Boston, as the pain returned, squeezing his chest like a cinch of steel wire. Ahead cars were slowing for a traffic light. He couldn’t stop. There was no time. Leaning forward, he depressed the horn and shot through the intersection. Cars went by, missing him by inches. He could see the faces of the startled and enraged drivers. He was now on Park Drive with the Back Bay Fens and the scruffy victory gardens on his left. The pain was constant now, strong and overpowering. He could hardly breathe.

  The hospital was ahead on the right, on the previous site of a Sears building. Only a little further. Please…. A large white sign with a red arrow and red letters that said EMERGENCY loomed above.

  Cedric managed to drive directly up to the emergency room platform, braking belatedly and crashing into the concrete abutment, He slumped forward, hitting the horn and gasping for breath.

  The first person to reach his car was the security guard. He yanked open the door and after a glance at Cedric’s frightening pallor yelled for help. Cedric barely choked out the words, “Chest pain.” The head nurse, Hilary Barton, appeared and called for a gurney. By the time the nurses and the security man had Cedric out of the car, one of the emergency room residents had appeared and helped maneuver him onto the stretcher. His name was Emil Frank and he’d been a resident for only four months. A few years previously he would have been called an intern. He too noticed Cedric’s cream-colored skin and profuse perspiration.

  “Diaphoresis,” he said with authority. “Probably a heart attack.”

  Hilary rolled her eyes. Of course it was a heart attack. She rushed the patient inside, ignoring Dr. Frank, who’d plugged his stethoscope into his ears and was trying to listen to Cedric’s heart.

  As soon as they reached the treatment room, Hilary ordered oxygen, IV fluids and electrocardiographic monitoring, attaching the three main EKG leads herself. As soon as Emil had the IV going, she suggested to him that he order 4 mg. of morphine to be given IV immediately.

  As the pain receded a little, Cedric’s mind cleared. Even though no one had told him, he knew he’d had a heart attack. He also knew he’d come very close to dying. Even now, staring at the oxygen mask, the IV, and the EKG machine as it spewed paper out onto the floor, Cedric had never felt so vulnerable in his life.

  “We’re going to move you to the coronary care unit,” Hilary said. “Everything is going to be okay.” She patted Cedric’s hand. He tried to smile. “We’ve called your wife. She’s on her way.”

  The coronary intensive care unit was similar to the emergency room as far as Cedric was concerned-and just as frightening. It was filled with esoteric, ultramodern electronic technology. He could hear his heartbeat being echoed by a mechanical beep, and when he turned his head he could see a phosphorescent blip trace across a round TV screen.

  Although the machines were frightening, it was a source of some reassurance to know all that technology was there. Even more reassuring was the fact that his own doctor, who had been paged shortly after Cedric’s arrival, had just come into the ICU.

  Cedric had been a patient of Dr. Jason Howard’s for five years. He had begun going when his employers, the Boston National Bank, insisted that senior executives have yearly physicals. When Dr. Howard suddenly sold his private practice several years previously and joined the staff of the Good Health Plan (GHP), Cedric had dutifully followed. The move required changing his health plan from Blue Cross to the prepaid variety, but it was Dr. Howard that had attracted him, not GHP, and Cedric had let Dr. Howard know it in no uncertain terms.

  “How are you doing?” Jason asked, grasping Cedric’s arm but paying more attention to the EKG screen.

  “Not… great,” Cedric rasped. It took several breaths to get out the two words.

  “I want you to try to relax.”

  Cedric closed his eyes. Relax! What a joke.

  “Do you have a lot of pain?”

  Cedric nodded. Tears were running down his cheeks.

  “Another dose of morphine,” Jason ordered.

  Within minutes of the second dose, the pain became more tolerable. Dr. Howard was talking with the resident, making sure all the appropriate blood samples had been drawn and asking for some kind of catheter. Cedric watched him, reassured just seeing Howard’s handsome, hawklike profile and sensing the man’s confidence and authority. Best of all, he could feel Dr. Howard’s compassion. Dr. Howard cared.

  “We have to do a little procedure,” Jason was saying. “We want to insert a Swan-Ganz catheter so we can see what’s going on inside We’ll use a local anesthesia so it won’t hurt, okay?”

  Cedric nodded. As far as he was concerned, Dr. Howard had carte blanche to do whatever he felt was necessary. Cedric appreciated Dr. Howard
’s approach. He never talked down to his patients — even when Cedric had had his physical three weeks ago and Howard had lectured him about his high-cholesterol diet, his two-pack-a-day cigarette habit, and his lack of exercise. If only I’d listened, Cedric thought. But despite Dr. Howard’s doomsday approach to Cedric’s lifestyle, the doctor had admitted that the tests were okay. His cholesterol was not too high, and his electrocardiogram had been fine. Reassured, Cedric put off attempts to stop smoking and start exercising.

  Then, less than a week after his physical, Cedric felt as if he were coming down with the flu. But that had been only the beginning. His digestive system began acting up, and he suffered terrible arthritis. Even his eyesight seemed to deteriorate. He remembered telling his wife it was as though he had aged thirty years. He had all the symptoms his father had endured during his final months in the nursing home. Sometimes when he caught an unexpected glimpse of his reflection, it was as if he were staring at the old man’s ghost.

  Despite the morphine, Cedric felt a sudden stab of white-hot, crushing pain. He felt himself receding into a tunnel as he had in the car. He could still see Dr. Howard, but the doctor was far away, and his voice was fading. Then the tunnel started to fill with water. Cedric choked and tried to swim to the surface. His arms frantically grappled the air.

  Later, Cedric regained consciousness for a few moments of agony. As he struggled back to awareness, he felt intermittent pressure on his chest, and something in his throat. Someone was kneeling beside him, crushing his chest with his hands. Cedric started to cry out when there was an explosion in his chest and darkness descended like a lead blanket.

  * * *

  Death had always been Dr. Jason Howard’s enemy. As a resident at Massachusetts General, he’d carried that belief to the extreme, never giving up on a cardiac arrest until a superior ordered him to stop.

  Now he refused to believe that the fifty-six-year-old man whom he’d examined only three weeks carlier and had declared generally healthy was about to die. It was a personal affront.

  Glancing up at the monitor, which still showed normal EKG activity, Jason touched Cedric’s neck. He could feel no pulse. “Let me have a cardiac needle,” he demanded. “And someone get a blood pressure.” A large cardiac needle was thrust into his hand as he palpated Cedric’s chest to locate the ridge on the sternum.

  “No blood pressure,” reported Philip Barnes, an anesthesiologist who had responded to the code call that automatically went out when Cedric arrested. He’d placed an endotracheal tube into Cedric’s trachea and was ventilating him with oxygen by compressing the Ambu bag.

  To Jason, the diagnosis was obvious: cardiac rupture. With the EKG still being recorded, yet no pumping action of the heart, a situation of electromechanical dissociation prevailed. It could mean only one thing. The portion of Cedric’s heart that had been deprived of its blood supply had split open like a squashed grape. To prove this horrendous diagnosis, Jason plunged the cardiac needle into Cedric’s chest, piercing the heart’s pericardial covering. When he drew back on the plunger, the syringe filled with blood. There was no doubt. Cedric’s heart had burst open inside his chest.

  “Let’s get him to surgery,” Jason shouted, grabbing the end of the bed. Philip rolled his eyes at Judith Reinhart, the coronary care head nurse. They both knew it was futile. At best they might get Cedric on the heart-lung machine, but what then?

  Philip stopped ventilating the patient. But instead of helping to push the bed, he walked over to Jason and gently put an arm on his shoulder, restraining him. “It’s got to be cardiac rupture. You know it. I know it. We’ve lost this one, Jason.”

  Jason made a motion to protest, but Philip tightened his hold. Jason glanced at Cedric’s ivory-colored face. He knew Philip was right. As much as he hated to admit it, the patient was lost.

  “You’re right,” he said, and reluctantly let Philip and-Judith lead him from the unit, leaving the other nurses to prepare the body.

  As they walked over to the central desk, Jason admitted that Cedric was the third patient to die just weeks after having a clean physical. The first had been another heart attack, the other a massive stroke. “Maybe I should think about changing professions,” Jason said half seriously. “Even my inpatients have been doing poorly.”

  “Just bad luck,” Philip said, giving Jason a playful poke in the shoulder. “We all have our bad times. It’ll get better.”

  “Yeah, sure,” Jason said.

  Philip left to return to surgery.

  Jason found an empty chair and sat down heavily. He knew he’d have to get ready to face Cedric’s wife, who would be arriving at the hospital at any moment. He felt drained. “You’d think by now I’d have gotten a little more accustomed to death,” he said aloud.

  “The fact that you don’t is what makes you a good doctor,” said Judith, attending to the paperwork associated with a death.

  Jason accepted the compliment, but he knew his attitude toward death went far beyond the profession. Just two years ago death had destroyed all that Jason held dear. He could still remember the sound of the phone at quarter past midnight on a dark November night. He’d fallen asleep in the den trying to catch up on his journals. He thought it would be his wife, Danielle, calling from Children’s Hospital, saying she’d be delayed. She was a pediatrician and had been called back to the hospital that evening to attend to a preemie in respiratory distress. But it had been the turnpike police. They called to say that a semi coming from Albany with a load of aluminum siding had jumped the central divider and rammed into his wife’s car head-on. She had never had a chance.

  Jason could still remember the trooper’s voice, as if it had been yesterday. First there’d been shock and disbelief, followed by anger. Then his own terrible guilt. If only he’d gone with Danielle as he sometimes had, and read at Countway Medical Library. Or if only he’d insisted she sleep at the hospital.

  A few months later he’d sold the house that was haunted by Danielle’s presence and his private practice and the office he’d shared with her. That was when he had joined the Good Health Plan. He’d done everything Patrick Quillan, a psychiatrist friend, had suggested he do. But the pain was still there, and the anger, too.

  “Excuse me, Dr. Howard?”

  Jason looked up into the broad face of Kay Ramn, the unit secretary.

  “Mrs. Harring is in the waiting room,” Kay said. “I told her you’d be out to talk with her.”

  “Oh, God,” Jason said, rubbing his eyes. Speaking to the relatives after a patient died was difficult for any doctor, but since Danielle’s death, Jason felt the families’ pain as if it were his own.

  Across from the coronary care unit was a small sitting room with outdated magazines, vinyl chairs and plastic plants. Mrs. Harring was staring out the window that faced north toward Fenway Park and the Charles River. She was a slight woman with hair that had been allowed to go naturally gray. When Jason entered, she turned and looked at him with red-rimmed, terrified eyes.

  “I’m Dr. Howard,” Jason said, motioning for her to sit. She did, but on the very edge of the chair.

  “So it is bad…” she began. Her voice trailed off.

  “I’m afraid it is very bad,” Jason said. “Mr. Harring has passed away. We did all we could. At least he didn’t suffer.” Jason hated himself for voicing those expected lies. He knew Cedric had suffered. He’d seen the mortal fear in his face. Death was always a struggle, rarely the peaceful ebbing of life portrayed in film.

  The color drained from Mrs. Harring’s face, and for a moment Jason thought she would faint. Finally, she said, “I can’t believe it.”

  Jason nodded. “I know.” And know he did.

  “It’s not right,” she said. She looked at Jason defiantly, her face reddening. “I mean, you just gave him a clean bill of health. You gave him all those tests and they were normal! Why didn’t you find something? You might have prevented this.”

  Jason recognized the anger, the familiar
precursor to grief. He felt great compassion for her. “I didn’t exactly give him a clean bill of health,” he said gently. “His lab studies were satisfactory, but I warned him as I always did about his smoking and diet. And I reminded him that his father had died of a heart attack. All these factors put him in a high-risk category despite his lab values.”

  “But his father was seventy-four when he died. Cedric is only fifty-six! What’s the point of a physical if my husband dies just three weeks later?”

  “I’m sorry,” Jason said softly. “Our predictive abilities are limited. We know that. We can only do the best we can.”

  Mrs. Harring sighed, letting her breath out. Her narrow shoulders sagged forward. Jason could see the anger fading. In its place came the crushing sadness. When she spoke, her voice was shaking. “I know you do the best you can. I’m sorry.”

  Jason leaned forward and put his hand on her shoulder. She felt delicate under her thin silk dress. “I know how hard this is for you.”

  “Can I see him?” she asked through her tears.

  “Of course.” Jason got to his feet and offered her a hand.

  “Did you know Cedric had made an appointment to see you?” Mrs. Harring said as they walked into the corridor. She wiped her eyes with a tissue she’d taken from her purse.

  “No, I didn’t,” Jason admitted.

  “Next week. It was the first available appointment. He wasn’t feeling well.”

  Jason felt the uncomfortable stirring of defensive concern. Although he was certain no malpractice had been committed, that was no guarantee against a suit.

  “Did he complain of chest pain when he called?” Jason asked. He stopped Mrs. Harring in front of the CCU door.

  “No, no. Just a lot of unrelated symptoms. Mostly exhaustion.”