“This is my story, Fiona,” Kushner said, waggling her finger.
“Sorry,” Fiona said, smiling sheepishly. “It is just so cool we could do it this fast!”
“We finally decided that SHEVA turns on a gene in another chromosome. But how? We went looking … and found a SHEVA-activated gene on chromosome 21. It codes for our polyprotein, what we call the LPC, the large protein complex. A unique transcription factor specifically controls expression of this gene. We looked for the factor and found it in SHEVA’s genome. A locked treasure chest on chromosome 21, and the necessary keys in the virus. They’re partners.”
“Astonishing,” Kaye said.
Bierce ran the simulation through again, this time focusing on the action in chromosome 21 — the creation of the polyprotein.
“But Kaye — darling Kaye, that is far from the last of it. We have a mystery here. The SHEVA protease cleaves three novel cyclooxygenases and lipooxygenases from the LPC, which then synthesize three different and unique prosta-glandins. Two of them are new to us, really quite astonishing. All look very powerful.” Kushner used a pen to point out the prostaglandins being exported from a cell. “This could explain the talk about miscarriages.”
Kaye frowned in concentration.
“We calculate that a full-bore SHEVA infection could produce enough of the new prostaglandins to abort any fetus in a pregnant woman within a week.”
“As if that isn’t strange enough,” Bierce said, and pointed to series of glycoproteins, “the infected cells make these as byproducts. We haven’t analyzed them completely, but they look a lot like FSH and LH — follicle stimulating hormone and luteinizing hormone. And these peptides appear to be releasing hormones.”
“The old familiar masters of female destiny,” Kushner said. “Egg maturation and release.”
“Why?” Kaye asked. “If they’ve just caused an abortion . . . why force an ovulation?”
“We don’t know which activates first. It could be ovulation, then abortion,” Kushner said. “Remember, this is a liver cell. We haven’t even begun investigating infection in reproductive tissues.”
“It doesn’t make sense!”
“That’s the challenge,” Kushner said. “Whatever your little endogenous retrovirus is, it’s far from harmless — at least to us women. It looks like something designed to invade, take over, and screw us up royally.”
“Are you the only ones who’ve done this work?” Kaye asked.
“Probably,” Kushner said.
“We’re sending the results to NIH and the Genome Project today,” Bierce said.
“And giving you advance notice,” Kushner added, putting her hand on Kaye’s shoulder. “I don’t want you to get stepped on.”
Kaye frowned. “I don’t understand.”
“Don’t be naive, dear,” Kushner said, her eyes bright with concern. “What we’re looking at could be Biblical bad news. A virus that kills babies. Lots of babies. Someone might regard you as a messenger. And you know what they do to messengers who bring bad news.”
14
Atlanta
Dr. Michael Voight strode ahead of Dicken on long, spidery legs down the hallway to the residents’ lounge. “Funny you should ask,” Dr. Voight said. “We’re seeing lots of obstetrics anomalies. We’ve had staff discussions already. But not about Herod’s. We see all kinds of infections, flu, of course, but we still don’t have the test kits for SHEVA.” He half-twisted to ask, “Cup of coffee?”
Atlanta’s Olympic City Hospital was six years old, built at city and federal expense to take the pressure off other hospitals in the inner city. Private donors and a special set-aside from the Olympics had made it one of the best-equipped hospitals in the state, attracting some of the best and brightest young doctors, and a few disgruntled older ones, as well. The world of HMOs and managed care was taking a toll on skilled specialists, who had seen their incomes plummet in the past decade and their patient care practices controlled by accountants. Olympic City at least gave the specialists respect.
Voight steered Dicken into the lounge and drew a cup of coffee from a stainless-steel urn. Voight explained that interns and residents alike could use this room. “It’s usually empty this time of night. It’s prime time out there — time for life to lurch on and deliver its careless victims.”
“What sort of anomalies?” Dicken prompted.
Voight shrugged, pulled a chair away from a Formica table, and curled up his long legs like Fred Astaire. His greens rustled; they were made of tough paper, completely disposable. Dicken sat and held his cup in his hands. He knew it might keep him awake, but he needed the focus and the energy.
“I handle extreme cases, and most of the weird ones haven’t qualified for my care. But in the last two weeks…would you believe, seven women who can’t explain their pregnancies?”
“I’m all ears,” Dicken said.
Voight spread his hands and ticked off the cases. “Two that took birth control pills religiously, so to speak, and they didn’t work…Not so unusual, maybe. Still, there was one who didn’t take birth control, but said she hadn’t had sex. And guess what?”
“What?”
“She was virgo intacta. Had heavy bleeding for a month, it went away, then morning sickness, period stopped, she went to a doctor, he told her she was pregnant, she comes here when the whole thing goes wrong. A shy young woman living with an elderly man, a real peculiar relationship. She insisted no sex was involved.”
“Second coming?” Dicken asked.
“Don’t be profane. I’m born again,” Voight said with a twitch of his lips.
“Sorry,” Dicken said.
Voight smiled half-apologetically. “Then her ‘old man’ comes in, tells us the real story. Turns out he’s very concerned for her — wants us to know the truth so we can treat her. She’s been letting him get in bed with her and rub up against her…Sympathy, you know. So that’s how she gets pregnant the first time.”
Dicken nodded. Nothing very shocking here — the versatility of life and love.
Voight continued. “It’s a miscarriage. But three months later, she comes back, she’s pregnant again. Two months along. Her elderly friend shows up with her, says he hasn’t been rubbing against her or anything, and he knows she hasn’t been seeing another man. Do we believe him?”
Dicken tilted his head to one side, lifted his eyebrows.
“All sorts of peculiar stuff going on,” Voight said softly. “More than usual, I think.”
“Did they complain of illness?”
“The usual. Colds, fevers, body aches. I think we may still have a couple of specimens in the lab, if you want to look at them. Have you been over to Northside?”
“Not yet,” Dicken said.
“Why not Midtown? Lot more tissue for you over there.”
Dicken shook his head. “How many young women with unexplained fever, nonbacterial infections?”
“Dozens. That’s not unusual either. We don’t keep tests more than a week; if they’re negative for bacteria, we dump them.”
“All right. Let’s see the tissue.”
Dicken took his coffee with him as he followed Voight to the elevator. The biopsy and analysis lab was in the basement, just two doors down from the morgue.
“Lab techs go home at nine.” Voight switched on the lights and did a quick search in a small steel card file.
Dicken looked the lab over: three long white benches equipped with sinks, two fume hoods, incubators, cabinets neatly arrayed with brown glass and clear glass bottles filled with reagents, neatly ordered stacks of standard test kits in slim orange and green cardboard boxes, two stainless-steel refrigerators and an older white freezer; a computer connected to an ink-jet printer with an our OF ORDER note posted on it; and jammed in a back room behind a Dutch door, rolling stock steel storage shelving in standard gray and putty.