Jason left pathology, trying to make sense of Jackson’s statement. Again he considered the possibility of an unknown infectious disease despite Jackson’s opinion. After all, what kind of an autoimmune disease could work so quickly? Jason answered his own question: none.
Before starting the office patients, Jason decided to stop by Hayes’s lab. Not that he expected Helene to be helpful, but he thought she might be interested in the fact that Hayes had been so ill the last few weeks of his life. To his surprise, he saw Helene had been crying.
“What’s the matter?”
Helene shook her head. “Nothing.”
“Aren’t you working?”
“I finished,” Helene said.
All at once Jason realized that without Hayes there to give her instructions, she was lost. Apparently she’d not been apprised of the big picture, a fact that made Jason pessimistic that she would have knowledge of Hayes’s breakthrough, if there’d been one. The man’s penchant for secrecy was to be society’s loss.
“Do you mind if I talk with you for a few minutes?” Jason asked.
“No,” Helene said in her usual laconic manner. She motioned him into Hayes’s office. Jason followed, assaulted once again by the graphic genital photos.
“I’ve just come from pathology,” Jason began, once they were seated. “Dr. Hayes apparently was a very sick man. Are you sure he didn’t complain of feeling ill?”
“He did,” Helene admitted, reversing her previous stand. “He kept saying he felt weak.”
Jason stared across at her. She seemed softer, more open, and he realized that in contrast to the previous times he’d seen her, her hair was loose, falling to her shoulders instead of severely pulled back.
“Last time you said his behavior was unchanged,” he said.
“It was. But he said he felt terrible.”
Frustrated by this semantic distinction, Jason again was convinced that she was covering up something. He wondered why, but he felt he’d get nowhere by confronting her.
“Miss Brennquivist,” Jason said, speaking patiently, “I want to ask once again. Are you absolutely certain you have no idea what Dr. Hayes could have been referring to when he told me he’d made a major scientific breakthrough?”
She shook her head. “I really don’t know. The truth was that things had not been going well in the lab. About three months ago, the rats receiving growth hormone-releasing factors had mysteriously begun to die.”
“Where did the releasing factors come from?”
“Dr. Hayes extracted them himself from rat brains. Mostly the hypothalamus. Then I produced them by recombinant DNA techniques.”
“So the experiments were a failure?”
“Completely,” Helene said. “But, like any great researcher, Dr. Hayes was not daunted. Instead he worked harder. He tried different proteins, but unfortunately with the same fatal results.”
“Do you think Dr. Hayes was lying when he told me he’d made a breakthrough?”
“Dr. Hayes never lied,” Helene said indignantly.
“Well, how do you explain it?” Jason asked. “At first I thought Hayes was having a nervous breakdown. Now I’m not so sure. What do you think?”
“Dr. Hayes was not having a nervous breakdown,” Helene said, rising to make it clear the conversation was over. Jason had hit a raw nerve. She was not about to listen to her late boss be calumniated.
Frustrated, Jason went down to his office, where Sally already had two patients waiting for physicals. Between them Jason escaped Sally long enough to check the laboratory values on Holly Jennings. The only significant change from her earlier tests was an elevated gamma globulin, again making Jason consider a non-AIDS-related epidemic involving the autoimmune system. Instead of turning the immune system off, as with AIDS, this problem seemed to turn it on in a destructive fashion.
Midmorning Jason got a call from Margaret Danforth, who stated without preamble, “Thought you should know that Dr. Hayes’s urine showed moderate levels of cocaine.”
So Curran was right, Jason realized, hanging up. Hayes was using drugs. But whether that was related to his claim of discovery, his fear of being attacked, or even his actual death, Jason couldn’t tell.
He was forced to put aside his speculation as the heavy patient load pushed him further and further behind. The pressure was heightened by a call from Shirley, who had apparently learned of his visit to Helene.
“Jason,” she said with an edge to her voice, “please don’t stir the pot. Just let the Hayes affair calm down.”
“I think Helene knows more than she’s telling us,” Jason said.
“Whose side are you on?” Shirley asked.
“Okay, okay,” he said, rudely cutting her off as he was confronted by Madaline Krammer, an old patient who had been squeezed in as an emergency. Up until now her heart condition had been stable. Suddenly she was presenting swollen ankles and chest rales. Despite strong medication, her congestive heart disease had increased in severity to the point that Jason insisted on hospitalization.
“Not this weekend,” Madaline protested. “My son is coming from California with his new baby. I’ve never seen my granddaughter. Please!” Madaline was a cheerful woman in her mid-sixties with silver-gray hair. Jason had always been fond of her, since she rarely complained and was extraordinarily grateful for his ministrations.
“Madaline, I’m sorry. I wouldn’t do this unless I thought it was necessary. But the only way we can adjust your medications is with constant monitoring.”
Grumbling but resigned, Madaline agreed. Jason told her he’d see her later, and left her in the capable hands of Claudia. By four P.M., Jason had just about caught up to his appointment schedule. Emerging from his office, Jason ran into Roger Wanamaker, whose impressive bulk completely blocked the narrow hallway.
“My turn,” Roger said. “Got a minute for a chat?”
“Sure,” said Jason, who never said no to a colleague. He led the way back to his office. Roger ceremoniously dropped a chart on his desk.
“Just so you don’t feel lonely,” he said. “That’s the chart of a fifty-three-year-old executive from Data General who was just brought into the emergency room deader than a doorknob. I’d given him one of our full-scale executive physicals less than three weeks ago.”
Jason opened the chart and glanced through the physical, including the EKG and laboratory values. The cholesterol was high but not terrible. “Another heart attack?” he asked, flipping to the report of the chest X ray. It was normal.
“Nope,” Roger said. “Massive stroke. The guy had a seizure right in the middle of a board meeting. His wife is madder’n hell. Made me feel terrible. She said he’d been feeling crummy ever since he’d seen us.”
“What were his symptoms?”
“Nothing specific,” Roger said. “Mostly insomnia and tension, the kind of stuff executives complain about all the time.”
“What the hell is going on?” Jason asked rhetorically.
“Beats me,” Roger said. “But I’m getting a bad feeling — like we’re on the edge of some kind of epidemic or something.”
“I’ve talked with Madsen in pathology. I asked him about an unknown infectious disease. He said no. He said it was metabolic, maybe autoimmune.”
“I think we’d better do something. What about the meeting you suggested?”
“I haven’t called it yet,” Jason admitted. “I’m having Claudia pull all my physicals over the last year and checking to see how the patients are doing. Maybe you should do the same.”
“Good idea.”
“What about the autopsy on this case?” Jason asked, handing the chart back to Roger.
“The medical examiner has it.”
“Let me know what they find.”
When Roger left, Jason made a note to call a meeting of the other internists early the following week. Even if he didn’t want to know how widespread the problem was, he knew he couldn’t sit back and watch while patients with seemingly healthy checkups ended up in the morgue.