"It is curious," Jack said as he opened Jordan 's deposition and began rapidly flipping through the pages to get to the section involving the events of September eighth.
"There are a couple of snakes whose venom contains a powerful specific cardiotoxin capable of causing direct myocardial necrosis. Can you imagine what that would do to the level of cardiac biomarkers?"
"Really?" Jack questioned with sudden interest. "What kind of snakes?"
Latasha cleared a trench through the material on the desk, and, after turning the textbook around, she pushed it over in front of Jack. She used her index finger to point to the names of two types of snakes on a table comparing snake venom virulence. "The Mojave rattlesnake and the Southern Pacific rattlesnake."
Jack glanced at the table. The two snakes she pointed out were among the most poisonous of those listed. "Very interesting," Jack said. His interest faded as quickly as it had arisen. He pushed the book back. "However, we are not dealing with an envenomation. Patience wasn't bitten by a rattlesnake."
"I know," Latasha said, taking the book back. "I'm only reading about venom to get ideas for various classes of compounds to consider. I mean, we are looking for a cardiotoxin."
"Uh-huh," Jack said. He had already gone back to the deposition and found the part he was looking for. He began to read more closely.
"Actually, the most interesting venomous animals are a group of amphibians, of all things," Latasha said.
"Really," Jack said without actually hearing. He'd come across the mention of abdominal pain in the deposition. Jordan testified it was "lower" abdominal pain, more on the left than the right. Jack amended Latasha's entry on the yellow legal pad.
"It's the Colombian poison dart frogs that take the cake," Latasha said, flipping the pages in the textbook until she came to the right section.
"Really," Jack repeated. He skipped ahead in Jordan 's deposition until he got to where Jordan was talking about the evening symptoms. Jack was particularly looking for the section where Jordan talked about the numbness Patience had experienced.
"Their skin secretions contain some of the most toxic substances known to man," Latasha said. "And they have an immediate toxic affect on heart muscle. Are you familiar with batrachotoxin?"
"Vaguely," Jack said. He found the reference to numbness, and it was apparent from Jordan 's description that it was paresthesia, not the absence of feeling, and it involved her arms and legs. Jack wrote the information on the yellow pad.
"It is the worst toxin of all. When batrachotoxin comes in contact with heart muscle, it stops all activity immediately." Latasha snapped her fingers. "In vitro, one minute cardiac myocytes are pumping away, and the next instant, after exposure to a few molecules of batrachotoxin, they are completely stopped. Can you believe that?"
"It's hard to believe," Jack agreed. He found Jordan 's reference to floating and, interestingly, it was associated with the paresthesia and had nothing to do with being in liquid. It was a sensation of not being grounded and floating in air. Jack wrote the information on the yellow pad.
"The poison is a steroidal alkaloid rather than a polypeptide, for whatever that's worth. It's found in several frog species, but the one that has the highest concentration is called Phyllobates terribilis. It's aptly named, since one tiny frog has enough batrachotoxin to kill a hundred people. It's mind-boggling."
Jack found the section where Jordan discussed Patience's weakness, which, it turns out, didn't refer to a diminution of any particular muscle group. Rather, the weakness was a more global problem. It started with difficulty walking and progressed to difficulty sitting up in short order. Jack added the information to the yellow pad.
"There's something else you should know about batrachotoxin if you don't already. Its molecular mode of action is to depolarize electrical membranes like heart muscle and nerves. And do you know how it does it? It does it by affecting sodium transport, something you thought was esoterica. Remember?"
"What was that about sodium?" Jack asked as Latasha's comments penetrated his concentration. When Jack was thinking hard about something, he often could be oblivious to his surroundings, as Latasha had experienced.
"Batrachotoxin latches onto nerve and muscle cells and causes the sodium ion channels to lock in the open position, meaning the involved nerves and muscles stop functioning."
"Sodium," Jack repeated, as if in a daze.
"Yes," Latasha said. "Remember we were speaking…"
All of a sudden, Jack leaped to his feet and scrabbled madly through the litter spread around the table. "Where are those papers?" he demanded in a minor frenzy.
"What papers?" Latasha questioned. She had stopped speaking in mid-sentence and had leaned back in her chair, surprised by Jack's abrupt impetuosity. In his haste, he was knocking deposition transcripts off the table.
"You know!" he blurted, struggling to come up with the right word. "Those… those papers!"
"We've got a lot of papers here, big guy. God! How many Diet Cokes did you drink anyway?"
"Screw it!" Jack sputtered. He gave up on his search. Instead, he reached out toward Latasha. "Let me see that toxicology text!" He demanded rashly.
"Sure," Latasha said, mystified at his transformation. She watched as he riffled through the pages of the massive tome to get to the index. Once there, he hastily ran his fingers down the columns until he found what he was looking for. Then he went back to rapidly leafing through the book so fast that Latasha had a fear for its integrity. He found the correct page and was silent.
"Would it be asking too much for you to tell me what you are doing?" Latasha scoffed.
"I think I've had what you would call a eureka moment and I would call an epiphany," Jack muttered while continuing to read. "Yes!" he cried after a few moments, raising a triumphant fist in the air. He slammed the book closed and looked across the table at Latasha. "I have an idea of what to ask Allan to look for! It's weird, and if it is present, it might not fit all the facts as we know them, but it fits some of the most important ones, and it would prove Craig Bowman did not commit medical negligence."
"Like what?" Latasha demanded. She couldn't help but feel some irritation that Jack was being so coy. She was in no mood for games at almost five o'clock in the morning.
"Check out this strange symptom you wrote," Jack said. He reached over with the yellow pad and pointed to the notation "sensation of floating."
"Now, that's not your run-of-the-mill complaint of even the most dedicated hypochondriac. That suggests something truly weird was going on, and if Allan is able to find what I'm thinking, there would be the suggestion that Patience Stanhope was either a die-hard sushi fan or a crazed devotee of Haitian voodoo, but we're going to know differently."
"Jack!" Latasha said irritably. "I'm too tired for this kind of joking."
"I'm sorry" Jack said. "This apparent teasing is because I'm afraid I might be right. This is one of those situations, despite the effort involved, where I'd rather be wrong." He reached out for her. "Come on! I'll tell it to you straight while we hurry over to Allan's lab. This is going to go right down to the wire."
23
Jack nosed his worse-for-wear Hyundai to the curb behind a brown UPS truck. It was a loading area on busy Cambridge Street in front of a long, arcaded, curved building facing Boston City Hall. Jack thought the chances of getting a parking ticket, even though he was planning on being as fast as he could, were close to one hundred percent. He was hoping the car wouldn't be towed, but in case it was, he took his carry-on bag with him along with a large envelope with the return address of the Office of the Chief Medical Examiner printed in the upper-left-hand corner.