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Looking up, Michael saw, attached to the ceiling about twenty feet down the hall, what he had thought was a video device when he had visited the Shapiro Institute the first time. He pointed it out to Lynn, then whispered, “Best if we ditch the raincoats!”

After he and Lynn got their overcoats off, he balled them up into the tightest bundle possible and stashed them in the far corner by the door.

Lynn was already looking at the floor plan for fifth level.

“No need for a map,” Michael said. “The NOC is straight ahead on the right. Let’s move it!”

“There’s a locker room on the left,” Lynn said, still studying the floor plan as they started forward. “Maybe we should leave the raincoats in there, instead of out here in the hall.”

“My vote is we leave them be. There’s too big a risk of running into staff in the locker room, where we’d probably end up having to have a conversation, which would mean we’d get exposed as party crashers before we started. We can only expect to get so many miles out of these Shapiro suits.”

“Maybe you’re right,” Lynn said. She looked up at the video device as they passed under it, wondering if they were already under observation. She hoped not, as it would mean their visit would be a short one.

Walking quickly, they approached the pocket door leading into the NOC.

Thursday, April 9, 12:22
A.M.

M
isha Zotov was notorious for being a deep sleeper, especially after getting very little sleep the night before, and his cell phone’s selected ring tone was almost too melodious to pull him out of Morpheus’s grasp. To make things worse, he had passed the evening imbibing considerably more vodka than usual. Over-drinking was his method of dealing with stress, which he was experiencing more than usual thanks to the series of threats to the biologics program. Up until a few weeks ago, there had been nary a blip. Unfortunately that had changed dramatically, particularly over the last week or so. The last, and possibly worst, was due to Darko’s screwup with the two medical students.

After the fourth ring, Misha was conscious enough to recognize the sound. With great effort he reached for the phone on his bedside table. As he did so, he looked at the clock and cursed loudly. Blinking madly to focus, he checked to see who was calling. When he saw it was Darko Lebedev, he started cursing anew.

Misha slapped the phone to his ear and flopped back onto his pillow. “This better be good,” he growled in Russian.

“It’s good,” Darko said, sounding strangely upbeat. “Very unexpected but good: the medical students have taken care of themselves.”

“What the hell are you talking about?”

“Timur and I have been keeping them under observation since you and I talked this afternoon. At first they seemed to be acting normally and apparently did not tell anyone about my visit last night. But then this evening they went out into the hospital garden around ten-thirty and sat for an hour in the dark on a secluded bench that had a view of the door to Shapiro Institute.”

“You think they were observing it?”

“That was our impression, because it was during the shift change.”

“So how is this taking care of themselves?”

“It gets better. After they left their observation spot, we thought we were done for the night. Then, to our surprise, Timur called me to come back because they reappeared a bit later, dressed in raincoats. They then went back outside to the same bench and after making out for a while, they went over to the Shapiro door. We had no idea what they were planning. To our shock, they opened the door and went inside!”

Misha sat up suddenly, pulling the covers off his companion for the night. “How the fuck did they open the door?”

“We don’t know. Apparently they fooled the thumbprint scanner, which isn’t all that difficult.”

“This is terrific,” Misha said. “It’s like having fish jump into the boat.”

“I thought you would be pleased.”

“Listen! Call whoever is heading up security tonight. Tell them that I have authorized a lockdown for the Shapiro until further notice. Have them electronically seal the external door and even the door through the visiting area to the hospital.”

“I already did,” Darko said. “The Shapiro is in total lockdown,
which includes all communication with the outside world except for the hotline from control center. Do you want Leonid and me to go in and take care of them?”

“No!” Misha said. He bounded out of bed. “I’ll get in touch with Fyodor. We’ll consult with Dr. Rhodes and Dr. Erikson. We should figure out a way to add these pests to the inventory.”

“Let me know if you change your mind after talking with Fyodor,” Darko said. “Leonid and I will be happy to do whatever is necessary.”

“Will do,” Misha said. “Good job!”

Misha disconnected from Darko and pulled up Fyodor’s number in his contacts. A few seconds later, he could hear the phone ringing. He knew Fyodor was going to be a bear upon awakening, but he also knew he would be pleased with what he had to tell him.

Thursday, April 9, 12:33
A.M.

L
ynn glanced up at Michael, who was looking at the monitor screen over her shoulder. They were in the Shapiro NOC, which they had found empty, as they had expected, going by Vladimir’s comments. Lynn was sitting at one of the terminals. She had quickly logged in to the Shapiro network without difficulty, using Vladimir’s user name and password, and, once connected, had first typed in Carl’s name. What had popped up was his home page, which Michael said looked the same as Ashanti’s, even with the same apparent location: Cluster 4-B, but with a different number. Carl’s was 64, whereas Ashanti’s was 32. What also was different was that it didn’t say
DROZITUMAB
+4
ACTIVE
but rather
ASELIZUMAB
PRELIMINARY
.

“What do you think?” Lynn asked.

“I think it is convenient they are both in Cluster 4-B and the number must be their bed like you suggested. We can check them both.”

“I’m asking about the ‘aselizumab’ reference.”

“I guess he is going to be given aselizumab, whatever the hell that is.”

“We’ll have to look it up later,” Lynn said hurriedly. “At least we know from the ‘ab’ at its end that it is a biologic drug.” Exiting the window, she then queried how many deaths the Shapiro Institute had logged since its doors opened in 2007. The answer flashed on the screen: 31.

“That’s incredible,” Lynn said. “Do you believe that’s true?”

“The system has serious restricted access. Why wouldn’t it be true?”

“Hell, if it is a true stat, they must be doing something right,” Lynn said. She was impressed, even a bit relieved. “Two years ago, when we visited there had already been twenty-two deaths in six years, but they had a low census, a fraction of the potential capacity. They must be full now and have had only nine deaths in two years. That’s phenomenal.”

“Find out the current census!” Michael suggested.

Lynn turned back to the screen and typed in the question. The answer came back instantly: 931 patients out of possible 1200. “There you go,” she said. “They have almost a thousand patients! And if they lose less than five patients a year, that is an incredible statistic. In my research Monday night, I found out that the mortality for people in a vegetative state is ten percent up to as much as forty percent per year. Here they are managing less than one percent, if I’m doing the math right.”

“You’re doing the math right,” Michael assured her. “In fact it is less than half of one percent. I’d say it’s a damn good advertisement for automation, which is what they had told us was key.”

“Like I said, they have to be doing something right. It’s even more impressive if they are using their patients for drug testing.”

“What did you say you found was the major cause of death in coma patients?”

“Pneumonia and other infections often stemming from bedsores. It is because the patients are so immobile.”

“Maybe keeping visitation to a minimum really works. It’s like reverse precautions for immune-compromised people.”

Lynn nodded. Michael had a good point, even though the visitation policy bothered her from a personal perspective because of Carl. “Let’s look at the other side of the coin,” she said, “and check how many people recovered enough to be discharged. Remember, trauma is a major cause of coma and around ten percent of them recover enough to go home.”

Suddenly Michael straightened up. He looked back toward the hallway.

“What’s the matter?” Lynn asked nervously. As focused as she was on what she was doing, she had forgotten where they were.

“I thought I heard something,” Michael said.

For a few moments both students listened intently, holding their breaths. All they could hear was the hum of the powerful ventilation system.

“I don’t hear anything suspicious,” Lynn said.

“Nor do I,” Michael agreed. “Okay, my mind must be playing tricks.” Nervously he glanced at his watch. “I’m thinking it’s best if we get our asses out of here. Someone someplace is going to be aware that these stats are being accessed by someone in the middle of the fucking night. What we are doing here is legally more serious than our coming into this place.”

“I’m with you,” Lynn said. “I know! But this is important. Just a few minutes more.” She went back to the keypad and quickly asked for the number of people discharged since the Shapiro had been in operation. The answer was as surprising as the death rate: none!

Lynn looked back up at Michael. She was taken aback. “I’m not sure which is more incredible: the low death rate or the lack of any discharges.”

“Well, maybe they don’t take trauma patients.”

“I can’t believe that. As I said, trauma is a major cause of persistent vegetative state and coma.” Lynn laughed even though she didn’t find anything funny. “They are doing a bang-up job with survival but have a piss-poor cure rate.”

“Okay, let’s go,” Michael said. He tried to pull Lynn’s chair back from the terminal.

Lynn resisted. “Just one more thing,” she said. “Let’s see what the cause of death was for the thirty-one patients. I’d guess pneumonia will top the list.” Quickly Lynn typed in the query, and when the answer came back, she was as shocked as she had been when she found out there had been no discharges. Almost half the deaths were from multiple myeloma!

Throwing up her hands, Lynn said, “This can’t be true. No way!”

“It’s big-time weird,” Michael agreed, but at the moment he had other things on his mind even if she didn’t. With a bit more force he succeeded in pulling her chair back. “Enough data surfing if you want to try to visit Cluster 4-B and the recreation space, like we planned!” Without waiting for a response, he went to the door and opened it. When he was sure the coast was clear he said, “All right, let’s go, girl! Get your ass in gear!”

Lynn followed him out into the hallway. She looked stunned. “Those numbers are crazy! How can the Shapiro have a death rate from multiple myeloma that is one hundred times what’s seen in the general population?”

“Let’s hold off this conversation until we get out of here,” Michael snapped as he got the NOC door to close. It was a pocket door operated by a touch pad in the wall at chest height. “Come on! Let’s get to the stairway.”

For the rest of the way down to the stairwell door, Lynn held her tongue, but her mind was roiling. As soon as the stairwell door closed behind them, she stopped and said, “I’m sorry, but there is something truly weird about multiple myeloma and this institute.”

“Listen!” Michael said with exasperation. “Let’s get this visit
over with before we launch into a lengthy discussion about what it all means. You seem to be forgetting we’re on borrowed time in hostile territory.” He undid his mask for a moment to wipe the perspiration off his face. It was warm and humid in the stairwell.

“Okay, you’re right,” Lynn said. “But I wish I’d had tried to see if there is any data on the incidence of gammopathy in here. Maybe on our way out, we can stop back in the NOC. It would only take a couple of minutes.”

“We’ll keep it in mind,” Michael said, replacing his mask. “Provided, of course, we are not being chased.”

“Don’t joke about such a thing,” Lynn said.

“I’m not joking,” Michael said.

As they descended the stairs down to level four, Lynn consulted the floor plan. When they reached the landing, they paused outside the door and she showed him that there were several ways for them to get to Cluster 4-B.

“Let’s stay as far away as we can from the room labeled ‘automation control.’ My sense is that is where the staff will be holed up.”

“Good point,” Lynn said. “That means we should go left out of the stairwell and follow the hallway to the end and then turn right. I hope the doors are labeled. If they are not, it will be the fourth door on the right after the turn.”

Michael cracked the door onto the fourth floor and listened. Except for the omnipresent sound of the HVAC, silence reigned. He opened the door just enough to look up and down the hallway. It was a mirror image of the hallway above on five and just as white and brightly illuminated. Most important, it was similarly without a soul in sight. The only difference was that, at its far end, it lacked a door to the exterior. “Let’s not make this our life’s work, you know what I’m saying?”

Lynn knew exactly what Michael meant. “I’ll be right behind you,” she said.

It wasn’t a mad dash, but they moved as quickly and silently
as they could, passing under a number of what they guessed were ceiling-mounted video cameras. The doors that they passed were labeled, for the most part. They turned the corner and resumed their speed. They hadn’t needed to count. Cluster 4-B was clearly labeled on the door in black sans serif letters and numerals.

“You ready?” Michael questioned.

“As ready as I ever will be,” Lynn responded, bracing herself. Seeing Carl in this sterile, deserted place was going to be an emotional challenge.

Thursday, April 9, 12:48
A.M.

T
he door to Cluster 4-B was a pocket door, like the one to the NOC, only stouter. And like the door to the NOC, it was operated electronically, with a lever to the right of the frame. Michael pressed it and the door started to slide open.

Before they could see inside the room, they heard the intermittent whining of electrical motors and the clanking of heavy machinery. The noise had been completely muffled by the sound-insulated door and the walls. As the door opened all the way, Lynn and Michael were treated to a view of what looked like a completely mechanized, highly complex assembly line in an automobile plant, with robotic arms, and a forklift-like apparatus with oversize rubber tires connected to a constantly moving conveyor system. No staff was in attendance.

With some trepidation they entered, and the door automatically closed behind them. It was a large rectangular room about the size of a small theater, with a very high ceiling. The level of sound was so loud that they practically had to yell to hear each other. The air was warm and humid.

“Can you fucking believe this?” Michael half shouted.

“It’s like a futuristic horror movie,” Lynn yelled. She was taken aback, unsure if she truly wanted to see what was in front of her. “This is automated patient care taken to the nth degree.”

“And there are eleven other rooms just like it,” Michael said in awe.

The entire right side of the room was composed of a hundred angled but mostly horizontal Plexiglas cylinders in twenty-five vertical stacks of four. Each cylinder in each stack was about four feet in diameter and seven feet deep, separated from other ones on either side by a three-foot-wide metal grate. These grates formed a scaffold as a means of access for service, and could be reached by metal ladders that were attached. The opening to the lowest cylinder was waist high and the highest was near the ceiling. Each cylinder was numbered and had a computer monitor on an adjustable arm.

As Lynn and Michael stared in horror, they could now appreciate that about half the cylinders contained a patient, each naked save for the headgear resembling a football helmet that they remembered the mannequin wearing during their second-year introductory visit.

Suddenly, through an opening high up, on the left side of the room, a supine, naked, comatose patient entered the room moving quickly on the conveyor system. He, too, had a helmet. In a manner that reminded Lynn and Michael of a modern baggage-handling system at a major airport, the patient was rapidly transported to a specific area of the room not too far away from where they were standing. With some additional clanking and grinding noises the entire conveyor system adjusted to bring the patient just outside the proper cylinder, which was the top container in the sixth row. There, the robotic arms went to work to make all the appropriate connections for the feeding tube and other embedded lines. Once all the connections were set up, which happened surprisingly quickly, the
patient was slid into the cylinder like a rocket being loaded into a launcher.

Before Lynn and Michael could respond to what they had just seen, the conveyor system noisily repositioned itself seven rows away from where it had deposited the first patient, and rapidly extracted a second patient from a different cylinder. Once this second body was completely in the open, the robotic arms went to work disconnecting the various lines. Then, following a reverse route from that of the first, the second patient was zipped out of the room. Everything was accomplished in just a few minutes.

“Good God!” Lynn exclaimed when she could find her voice. “This is obscenely mechanized. There’s no humanity, no dignity! It’s against everything medicine stands for.”

“Where the hell do you suppose the bodies are going?” Michael asked.

“God only knows,” Lynn said. At that point they were treated to a repeat of the sequence, with another body coming back from parts unknown. After that, another body was taken away. The students soon got the impression that what they were witnessing was a constant process, maybe even 24/7, of bodies coming and going.

Being careful to steer clear of the huge and very active business end of the conveyor system that unpredictably moved back and forth on its oversize tires and up and down in front of the cylinders, the two students approached the last stack. Despite their horror, they felt a morbid curiosity. The cylinder at waist level was numbered 100. The one immediately above it was 99. Approaching the mouth of the hundredth cylinder, they looked inside. The patient was female, lying on a series of moving rollers to keep pressure off any given spot. While they were watching, a sprinkler system was suddenly activated inside the cylinder, rinsing and disinfecting the woman. A sucking sound came from the base of the cylinder as the fluid was drawn off. From their vantage point, they could
appreciate that the container was angled down at an incline of something like fifteen degrees.

“It’s like a freaking car wash,” Michael commented with a mixture of disgust and admiration. “Somebody’s put some real thought into all this.”

“I suppose that’s why their survival rate is so good.”

The monitor to the side of the cylinder showed the patient’s home page, which included her name, Gloria Parkman; her age, thirty-two; her location, Cluster 4-B 100;
RANIBIZUMAB 3+ ACTIVE
; and a long list of real-time vital signs and other extensive monitoring data. The monitoring was so extensive that the students intuitively understood that the patient had to have sensor chips implanted to make it possible. There were even real-time electroencephalogram tracings.

“Hey, I just remembered something,” Michael said. “Ranibizumab was in the ophthalmology lecture yesterday. It’s used for macular degeneration and is well tolerated without allergic problems.”

“If it is already an established drug, I wonder why they are giving it to her?”

“Good question,” Michael said. “Maybe there are still some allergic issues that the lecturer didn’t mention. But one way or the other, I’m beginning to think coming here might raise more questions than give answers.” Ducking his head, he moved down alongside the cylinder, between the cylinder and the wall. He was impressed by the constantly moving roller system that kept the patient’s body in motion while avoiding pressure point problems. It was a kind of massage system in a tube that encouraged circulation and protected the integrity of the skin.

“Hey!” Michael yelled to Lynn. “Come here! Look at this!” Lynn was still captivated by the monitor. She was marveling at the range of physiological data that was being followed in real time and possibly continuously run through a supercomputer.

Lynn squeezed in beside Michael. In the restricted space, the noise coming from the machinery in the room seemed even louder. Lynn tried to follow Michael’s line of sight and pointing finger. She was as impressed as he was with the roller system. “What am I supposed to be looking at?” she yelled.

“The catheter embedded in the abdomen! What do you think that could be for?”

“No idea. Do you?”

“No! But it looks to me like the abdomen is a bit distended. What’s your take?”

“Now that you mention it, it does look a bit bloated. You think they are running fluid into the abdomen? That’s not unheard of. The peritoneal cavity has quite a surface area and can even be used for dialysis.”

“True! Maybe she’s got a kidney problem. Let’s go back and look at the monitor and see if the kidney function is normal.”

Lynn backed out of the confined space first, followed by Michael. When they looked at the monitor, they could see that the kidney function was perfectly normal, including urine output. Then something from the long list of things under observation caught Lynn’s attention. She pointed to it. “This is strange. One of the stats gives her output of ascites fluid. They’re not putting anything into her abdomen with that catheter, they’re taking fluid out.”

“And she’s putting out a significant amount,” Michael said, looking at the same recording as Lynn. “The main cause of ascites is liver disease, yet her liver function is normal. Weird!”

“The second major cause of ascites is low blood protein, but hers is raised. Double weird.”

“Uh-oh!” Michael shouted. “Quick! Duck back into the cubbyhole!”

The massive conveyor system, with its oversize tires, suddenly came in their direction, its weight making the floor tremble and
momentarily trapping them in alongside cylinder 100. In the adjacent stack, a body was extracted, robotically disconnected from its various lines, and whisked out of the room. Then the conveyor system trundled away for its next assignment.

A moment later, when they emerged from their shelter, Lynn surprised Michael by climbing the ladder to peer into several of the upper cylinders.

“I think we better move on,” Michael yelled up to her impatiently. “We are pushing our luck. With all this mechanical activity in here and bodies coming and going, somebody’s got to be minding this place with video surveillance.”

“I just wanted to check to see if any other patients have an intra-abdominal catheter,” Lynn said, already climbing back down. “And they all do in this stack.”

Michael stepped over to the next stack and peered in at the patient in the lower cylinder. “You’re right. Seems they all have it.”

“That’s got to mean something, but what?”

“Good question,” Michael said, “but we’ve got to break out, girl.”

“I’m not leaving until I see Carl,” Lynn said with a tone that brooked no argument.

“My personal opinion would be to let it go,” Michael said, placing his hand on her shoulder in hopes of restraining her. “Seeing Carl here is not going to help you or him. You know what I’m saying.”

“I don’t care,” Lynn said. She shrugged off Michael’s hand and started down the line of cylinders.

For a moment Michael hesitated, wondering if it was best that she go by herself for a bit of privacy with her stricken lover. But he quickly decided otherwise. It was hardly the proper environment for any attempt at intimacy, and he didn’t want to risk her getting emotional, which he thought was a significant possibility, knowing how he would feel if the situation were reversed and his girlfriend, Kianna, was one of the patients. He quickly caught up with her. As
he did so, the forklift-like mechanism that pulled the patients in and out of the cylinders suddenly came in their direction.

The students had to flee back to the walkway that ran the length of the room against the wall opposite the bank of cylinders. The conveyor track taking the patients in and out of the room arched overhead.

After a patient was deposited in a cylinder close to where Lynn and Michael had been, the whole apparatus began moving to the opposite end of the room to pick up another.

“For the life of me, I can’t imagine why they are constantly moving these patients,” Michael yelled, going up on his tiptoes to try to get a peek into the black hole into which the conveyor track disappeared. “Or where the hell they are going.” When he turned back to Lynn, he saw that she was well on her way to cylinder 64. By the time he caught up to her, he could tell she wasn’t happy.

“He’s not here,” Lynn yelled over the continuous noise.

A quick glance confirmed for Michael that cylinder 64 was empty, although the monitor displayed Carl’s home page, so it was where he had been or was to be.

“Just as well,” Michael yelled back.

“Do you want to see if Ashanti is here?”

“I don’t see any point,” Michael said without hesitation. “For the tenth time, let’s get a move on.”

“All right,” Lynn said, but still she hesitated. She had suggested seeking out Ashanti as a way to stall. Her irrational side wanted to wait for Carl to be returned as part of the continuous stream of patients coming and going on the conveyor system. At the same time, Lynn’s rational side agreed with Michael that they needed to leave. For a moment she struggled with her indecision, and as she did so her eyes caught the various color-coded and labeled lines that would be robotically connected to Carl when he was brought back to monitor him and keep him alive. There was the intravenous line
in blue, an arterial line in red, a gastrostomy line for nutrition in green, and an intraperitoneal line in yellow.

Michael grasped Lynn’s upper arm. “I know it’s tough for you to leave, but it isn’t going to be any easier if you see him. We have to go!”

“I know,” Lynn shouted with a degree of resignation. “But look! Carl already has an intraperitoneal line!” She pointed to the yellow connector. “Why? He certainly doesn’t have ascites. Not yet, anyway.”

“We can debrief when we get out of this freaking place. We’ve got a lot to process.”

“You know what I think?” Lynn said with sudden urgency and a renewed degree of horror.

“I don’t, but I can tell you are about to tell me. But tell me out in the hallway, where I can hear you. This racket in here is driving me crazy.”

“All right!” Lynn yelled. The noise in the room was beginning to get to her as well. She let Michael pull her toward the walkway. It was just in time, because the conveyor system suddenly lurched in their direction again. When they reached the walkway, Lynn turned back to make sure the patient that was being brought in was not Carl, as the machine positioned itself in front of Carl’s stack. But the patient went into cylinder 62, not 64.

Quickly, they retreated to the door they had used to enter the room. When it closed behind them, their ears were ringing in the comparative silence. Immediately Lynn blurted out, “I think I know what the hell Sidereal is doing. They’re not experimenting on these patients, like we thought. They are fucking using them in a much more perverse way!”

“Okay, okay,” Michael soothed. “What do you mean?”

“You remember how monoclonal antibody drugs like ranibizumab are made.”

“Sure!” Michael said. He was taken aback by Lynn’s sudden passion. He could hear it in her voice and see it in her eyes. “They are made by mice tumors called hybridomas.”

“Which are?”

“What is this, a freaking test? Tell me what you are thinking.”