Skin : the X-files (7 page)

The procedure went on for another ten minutes; when Bernstein was finally finished, he looked up from behind his surgical mask and noticed Mulder and Scully on the other side of the viewing windows. He said something to the nurse, then shut off the laser scalpel and stepped away from the patient. As the nurse moved to wrap the sensitive area of skin in antiseptic gauze, Bernstein yanked his gloves off and crossed to the OR door. He pulled his mask down as he moved into the outer scrub room where Scully and Mulder waited.

“I’m guessing you’re not here for a tattoo removal,” Bernstein said, tossing his gloves into a nearby trash can as he crossed toward the double sinks at the other end of the rectangular room. He was a tall man, slightly overweight and balding, but with handsome features and remarkably sculpted hands. He was wearing surgical scrubs and matching green sneakers. “So how can I help you?”

“Sorry to interrupt, Dr. Bernstein. I’m Agent Scully, this is Agent Mulder. We’re here about Perry Stanton.” Bernstein nodded as he ran water over his hands, carefully massaging his long fingers. Scully could see the troubled look in his eyes and the slight tremble in his 59

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round shoulders. “I’m not sure what I can tell you—

beyond what I’ve already told Detective Barrett. Mr.

Stanton was fine when I left him in the recovery room—

and when I returned, he had already gone through the window. It was a horrid sight—something I don’t think I’ll ever forget. Or understand.” Scully could sense the disbelief in his words. He reminded her of the many physicians she had known during her medical training; he didn’t quite know what to do with an experience beyond his expertise. Scully tried to make her voice as sympathetic as possible. “It’s certainly a mystery, one we’re working to understand.

Along that line, I noticed that you ordered IV Solumedol to help Mr. Stanton’s breathing—”

“Yes,” Bernstein interrupted with a wave of his hand.

“Detective Barrett called to ask me about the Solumedol after you spoke to her downstairs in the recovery room, and you’re right, I should have made it clear to her in the first place. Personally, I don’t believe the steroid had anything to do with his violent outbreak. He’d been put on similar steroids fairly recently—a bout with pneumonia, I believe it was three years ago. It’s extremely unlikely that he would have developed such a fierce allergy in such a short time.”

Scully nodded; she had asked the necessary question and had gotten the expected answer. The Solumedol still wasn’t ruled out, but as Bernstein had said, it was an extremely doubtful cause. They needed to search for other answers.

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Mulder took the cue as Bernstein turned away from the sink and grabbed a towel from a rack attached to the wall.

“Dr. Bernstein, what about the grafting procedure itself? Do you remember anything abnormal about the operation? Anything out of the ordinary?” Bernstein vigorously dried his hands. “I’ve performed hundreds of similar transplants. There were no hitches at all. The procedure took less than three hours. I cleaned up the burn, flattened out the donor skin, and stapled it onto Stanton’s thigh—”

“Stapled?” Mulder asked, his eyebrows raised. Scully could have answered, but she deferred to the plastic surgeon.

“That’s right. The device is very similar to an office stapler—except the staples are heat sterilized and made out of a specially tempered steel. Anyway, I stapled the skin over Stanton’s burn and wrapped the area in sterile gauze. I would have changed the dressing in three days—then removed the graft in about two weeks, when he was ready to accept a permanent transplant.” Scully had explained the procedure to Mulder after reading about it in Stanton’s chart, but it was good for both of them to hear it again from the expert. After all, it had been a long time since Scully’s surgical rotation, and she had spent only a few months studying transplant techniques.

“So the donor skin is only temporarily attached?” Mulder asked.

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“That’s right. The temporary graft isn’t matched to the patient—because it’s intended to be rejected after a period of a couple of weeks. Then we graft a piece of the patient’s own skin over the wound. In the meantime, the donor skin decreases the risk of infection, and it helps indicate when the burned area is ready to accept a permanent transplant.”

“If the temporary graft isn’t matched to the patient,” Scully interrupted, “what precautions are taken to make sure the graft isn’t carrying something that could infect the patient with a communicable disease?” Bernstein glanced at her. She could tell from his eyes that he had already given this some thought. Stanton had been his patient—and as unfair and illogical as it seemed, he was partially blaming himself for what had happened. “Truthfully, very few—on my end. The skin is transported to us from the New York Fire Department Skin Bank; the bank is responsible for growing bacteriological cultures, and for checking the skin for viral threats. But they themselves are guided by the medical histories provided by the donor hospital.

There are a million things to look for, and it’s impossible to cover every possibility. If a donor dies from something infectious, they don’t accept his skin. But if he dies from an unrelated cause—and happens to be carrying something, there is a chance that it will be passed on through a transplant.”

“A slim chance?” Mulder asked. “Or a serious risk?

And could any of these transferred diseases affect a 62

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patient’s brain? Enough to send him into a violent rage?”

“I would call it extremely rare,” Bernstein replied, leaning back against the sinks. “But possible. For instance, undetected melanomas have been known to spread through transplant procedures. They grow downward through the dermis and into the blood vessels, then ride the bloodstream up into the brain. And certain viruses could jump through the lower layers of the epidermis into the capillaries; herpes zoster, AIDS, meningitis, encephalitis—the list is endless. But most of these diseases would have shown up in the donor patient. Such microbe-laden skin would never have been harvested in the first place.”

Not on purpose, Scully thought to herself. But people made mistakes. And microbes were often tricky to spot, even by trained professionals. A million viruses could live on the head of a pin—and viruses were extremely hard to trace, or predict. “After the procedure, did Stanton exhibit any symptoms at all? Anything that might hint at a viral or bacteriological exposure?”

Bernstein started to shake his head, then paused.

“Well, now that I think about it, there was one thing. But I can’t imagine how it could be connected to such an outbreak of violence.”

He rubbed the back of his neck with his hand. “A small circular rash. Right here, on the nape of his neck. It looked like thousands of tiny red dots. I assumed it was some sort of local allergic reaction—like an insect bite, 63

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only a bit larger. I’m not a specialist, but I can’t think of any serious disease that presents like that.” Scully wasn’t sure if the strange rash was connected—

but she filed it in her memory. She was trying to think if there was anything else they needed from the plastic surgeon when Bernstein glanced at his watch, then let out a ponderous sigh. “I’m sorry, but I’ve got an emergency surgery scheduled to start in a few minutes. If you have any more questions, I’ll be in OR Four down the hall.

And if there are any breakthroughs in the case, please let me know. Teri Nestor was a personal friend—but Mr.

Stanton was my patient. I know it’s foolish, but I feel like I failed him somehow.”

He excused himself and exited the scrub room. When he was gone, Scully turned toward her partner. Though it was now well past one in the morning, she felt a new burst of energy. Based on what they had learned in the past few hours, she felt sure they were moving closer to solving the case. It was an intriguing difference in personality: Mulder grew electric when faced with a mystery—while Scully was excited by the prospect of a solution. “I think it’s pretty clear what we need to do next. While Barrett continues her manhunt, we have to track down the donor skin and find out if it was infected with anything that could have caused Stanton’s violence.

And we have to act quickly—we don’t want any more of that harvested skin ending up on other patients.” Mulder didn’t respond right away. Instead, he moved to the sink. Bernstein had left the faucet loose, and a 64

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stream of drops spattered quietly against the basin.

Mulder reached forward and held his palm under the stream. “Scully, do you really think a virus can explain what happened in that recovery room?” Scully paused, staring at the back of his head. They had both seen the same evidence, participated in the same interviews—but it was obvious their thoughts were moving in two different directions.
As always.
“Absolutely. Dr. Bernstein corroborated my theory. It’s possible that Stanton caught something from the graft—something that could have affected his brain, and his personality. Once we track down the graft, we’ll be able to find out for sure. And then we’ll know how to deal with Stanton when we find him—and what precautions Barrett’s officers need to take in bringing him in.” Mulder shut off the sink and dried his hand against a towel from the rack. “A microbe, Scully? That’s how you want to explain this?”

“You have a better explanation?” Mulder shrugged. “Whenever doctors run into a mystery they can’t explain, they blame a microbe. Some sort of virus or bacteria, something you can see only through a microscope—or sometimes not at all. If you ask me, it’s a convenient way of thinking. It’s a scientist’s way of pretending to understand something completely beyond his grasp.”

“Mulder,” Scully interrupted, frustrated, “if you have a better plan of action, I’m listening.”

“Actually, I agree with you, Scully. We need to track 65

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down that graft. We need to find out what changed Perry Stanton into a violent killer. But I’m not so sure we’re going to need a microscope to find what we’re looking for.”

Scully watched as he moved toward the door. “What do you mean?”

He glanced back at her. “It would take a pretty big microbe to crush a nurse’s skull.” As Scully followed Mulder out into the hallway, she failed to notice the tall, angled man watching from the now-deserted operating room on the other side of the viewing windows. The man was dressed in a blue orderly uniform, most of his young face obscured by a sterile white surgical mask. His skin was dark and vaguely Asiatic, his black hair cropped tight beneath a pink antiseptic cap.

His narrow eyes followed the two agents until they disappeared from view. Then he reached into his pocket and pulled out a tiny cellular phone. He dialed quickly, his long fingers flickering over the numbered keys. A few seconds later, he began to speak in a low, nasal voice. The words were foreign, the tone rising and falling as the syllables chased one another through the thin material of the young man’s surgical mask. There was a brief pause, then a deep voice responded from somewhere far away.

The young man nodded, slipping the phone back into his pocket.

An anticipatory tremor moved through his shoulders.

Then he grinned, his high, brown cheeks pulling at his 66

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mask. For him, the task ahead was more than an act of loyalty, or of duty—it was an act of nearly erotic pleasure.

His fingers curled together as he followed the two FBI agents out into the hospital hallway.

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4

X Forty minutes later, Mulder shivered against a sudden blast of refrigerated air as he pursued the ample ME’s assistant into the cold-storage room lodged deep in the basement of New York Hospital. It had been a relatively easy task to trace the skin graft back across the Fifty-ninth Street Bridge, but in the process he and Scully had run into the first sign that their investigation was not going to take a simple route—and at the same time, the first strike against Scully’s growing belief that the case would soon be explained by a conventional medical query. As Mulder had predicted, Stanton’s transformation would not be solved through a quick trip to the New York Fire Department Skin Bank.

“Missing,” Scully had said, hanging up the phone as she and Mulder had exited through the Jamaica Hospital 68

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ER. “They’re unable to locate the six trays of harvested skin from which Stanton’s transplant was taken.” The administrator of the skin bank had assured Scully that the FBI would be notified the minute the missing trays had been located. He had also insisted that this was not a matter for alarm; the grossly understaffed and underfunded skin bank dealt with hundreds of pounds of skin on a weekly basis, and mistakes like this were not uncommon. And although he hadn’t been able to find the harvested skin, the administrator had been able to give Scully the name and location of the donor corpse: Derrick Kaplan, a current inhabitant of the New York Hospital morgue.

While Scully had accepted the administrator’s comments at face value, Mulder had felt his own suspicions rising. He didn’t believe Stanton’s behavior could be explained by any known microbe—and the missing skin seemed like too much of a coincidence. Still, he and Scully had been left with a lead to follow. While the NYPD continued their search for Perry Stanton, he and Scully would follow the skin graft back to its source.

After Scully had hung up on the skin bank, she and Mulder headed directly to New York Hospital. After a short stop at the front desk, they had located the ME’s assistant half-asleep in his office two elevator stops below the ER. Short, unkempt, with curly blond hair and thick lips, Leif Eckleman was exactly the type of man Mulder had expected to find working the basement war-ren of a hospital morgue. Likewise, Mulder hadn’t been 69

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surprised to see the neck of a half-empty fifth of Jack Daniel’s sticking out of the open top drawer of the man’s cluttered desk; alcohol went with the territory. Mulder tried not to pass any judgments.