The Last Word (15 page)

“That’s a hearty and nutritious breakfast you’ve got there,” Mark said.

“What did you have to eat?” Jesse asked.

“A Coke and a bagel.”

“Health freak,” Jesse said.

Amanda came in, balancing a cinnamon roll the size of a Frisbee on a too small plate on top of her extra-large coffee from Peet’s. She sat down carefully beside Mark and managed not to spill anything on the table in the process.

She didn’t seem the least bit rattled by her rude wake-up call. Then again, she didn’t work the kind of shifts that Jesse did and, as an adjunct county medical examiner, she was used to being awakened at all hours and sent to homicide scenes.

“Why do I feel like this is my last meal?” Amanda asked, setting the plate with her cinnamon roll down in front of her.

“Because if you eat that by yourself,” Mark said, “the fat, sugar, and calories will kill you faster than a firing squad.”

“Is that your way of saying you’d like to share this with me?”

“Only as a humanitarian intervention to save you from certain death,” Mark said.

“You want some chips, too?” Jesse asked, offering Mark the bag.

“No, thanks,” Mark said.

“What about my certain death?”

“You’re beyond saving,” Mark said. “And I’m not suicidal.”

Amanda broke her pastry in half and handed a piece to him. “I was frozen out of the CDC investigation. They said they wanted an entirely fresh set of eyes. They took all the files and samples I had and shoved me out the door.”

“Same with me,” Jesse said. “It was kind of nice having a day off.”

“You don’t look like you’ve had a day off,” Amanda said.

“I’ve been sleeping,” Jesse said. “For me, that’s a vacation, which is good, since it’s the only kind of vacation I can afford.”

“Sharpe kept me busy running around the hospital getting him every scrap of paper, X-ray, and test result we had on Corinne Adams and Ken Hoffman,” Mark said. “The CDC is creating a meticulously detailed time line, scrutinizing every action that was taken since both patients entered Community General.”

“The implication, of course, is that somebody screwed up,” Jesse said. “Gee, I wonder who they think that might have been?”

Jesse downed his Yoo-hoo, crunched the empty carton in his fist, and then tossed the carton towards the trash can across the room. He missed.

“They are just being objective and thorough,” Mark said, though privately he shared Jesse’s misgivings. They weren’t being told the whole story.

Mark’s suspicions were confirmed when the door opened and Sharpe came in, accompanied by several of his team members whom Mark recognized and one man in a dull gray suit whom he didn’t.

They were followed by Janet Dorcott, two of her assistants, and Clarke Trotter, Community General’s rotund legal counsel. Trotter kept smoothing out his tie, revealing his nervousness. Mark knew that Trotter wouldn’t be here unless the hospital felt that it was exposed to some kind of legal liability.

Sharpe and his team, and Dorcott and her team, took their seats at the table across from Mark, Jesse, and Amanda. The stranger did not. He leaned against the wall, his arms crossed over his chest, an unreadable expression on his pockmarked face. But his body language suggested to Mark that he was someone with some kind of official status who was passing judgment on them all. The fact that nobody sat on the side of the table with the three of them only added to Mark’s feeling that he, Jesse, and Amanda were facing some kind of tribunal.

“Thanks for coming in on such short notice,” Sharpe said, opening a thick file in front of him. “Our investigation has confirmed that Corinne Adams was infected with West Nile virus at the time that her organs were harvested.”

Mark wasn’t surprised, given what Sharpe had already told them and the deaths of the organ recipients from WNV-related encephalitis. The stranger didn’t seem shocked either. But Janet Dorcott and her minions reacted as if they’d had ice water splashed in their faces.

“Then how the hell did we miss it?” Janet demanded. It was the same question she’d already asked Mark. Either she hadn’t listened to the answer or hadn’t believed what she’d been told.

“Excuse me, Janet,” Clarke Trotter said, raising his pen to signal his interruption, “but I don’t think we can or should suggest, even for the sake of argument, that an error was made by this hospital or any of its employees. I would suggest that we all be careful about how we characterize this unfortunate situation.”

Spoken like a true lawyer, Mark thought.

“When I want your opinion, Clarke, I will ask for it,” Janet said, then turned back to Amanda. “I’m waiting, Dr. Bentley, to hear your explanation.”

Clarke blinked hard but otherwise maintained his composure.

The stranger in the back of the room cracked a thin smile. It seemed to amuse the guy to see the lawyer slapped down. Whoever this man was, Mark decided, he must not be all bad.

“Donors are screened for a range of infectious diseases in a manner consistent with established national organ-procurement standards,” Amanda said in a matter-of-fact way. “We followed those standards and didn’t find West Nile virus antibodies in any of our tests.”

“Why not?” Janet said.

“It takes weeks for the body to manufacture antibodies against an invader,” Sharpe said. “If Corinne Adams was infected within fifteen or twenty days of her accident, there might not have been any antibodies present in her system to see.”

“Even if there were,” Mark said, “it wouldn’t mean she was fighting an infection at the time.”

“I don’t understand,” Janet said, her tone implying that her confusion was due not to any lack of knowledge on her part but rather to someone else’s ineptitude.

“Antibodies in the blood simply indicate that the virus was once in the body. It doesn’t mean that the virus is
still
there,” Mark explained, trying not to sound patronizing. “If you had mumps as a child, you will have antibodies against the virus in your body for the rest of your life to defend you if it ever comes back.”

Janet turned to Sharpe. “Then how did you find the West Nile virus in the samples when Dr. Bentley couldn’t?”

“We used PRC testing to reveal the presence of the viral RNA in the donor rather than the antibodies created by the body to combat it.”

“Why didn’t
you
do that?” Janet asked Amanda.

“It’s not a required or routine test according to national organ-procurement protocols,” Amanda said. “And it takes time, much more than we have in a typical organ-donation situation.”

Mark had told Janet that, too, though not in so much detail. Either Janet hadn’t listened to what he said or she didn’t accept his explanation.

“If Corinne Adams was infected,” Clarke said, “why wasn’t she showing any obvious symptoms?”

“The incubation period for West Nile virus varies,” Sharpe said, “but it’s about fourteen days. If she was infected less than two weeks ago, she wouldn’t have been showing any symptoms.”

“If she had been, we wouldn’t have done the transplant,” Jesse said. “Though not everyone who is infected with the virus gets sick. So without symptoms to see or West Nile antibodies in her tests, we had no way of knowing she was infected.”

“If she wasn’t sick yet, why did the symptoms show up so fast, and to such an extreme degree, in the patients who received her organs?” Trotter asked.

“Because their immune systems were compromised by the anti-rejection drugs,” Sharpe replied. “They were extraordinarily vulnerable.”

Trotter sighed, visibly relieved. He almost smiled.

“So, if I understand you,” the lawyer said, “the CDC has determined that Corinne Adams was infected with West Nile virus and, through no fault of ours, she passed the virus along to the recipients of her organs.”

Mark had shared the same conclusion with Janet Dorcott yesterday. But the official CDC determination meant that the hospital would be free of any legal liability in the deaths, even if the media and the public might not immediately grasp the distinction.

However, neither the hospital’s liability nor the possible negative publicity was on Mark’s mind at the moment. He was thinking about fate, which was having a lot of sick fun messing with him lately.

Enough already, Mark thought. I get the point. There’s no escaping you. Is it really necessary to keep reminding me?

“I advise you to start testing every prospective organ donor for West Nile virus,” Trotter said to Janet.

“Then you might as well shut down our transplant unit altogether,” Jesse said. “The odds of someone getting infected with West Nile virus from an organ transplant are right up there with getting hit by a meteor. There are only two recorded cases of West Nile being transmitted by organ transplant.”

“I agree with our legal counsel on this,” Janet said. “Better safe than sorry.”

Mark spoke up. Her ignorance was getting harder and harder for him to take.

“It’s already impossible to get donor organs for everyone who needs them. If you raise the standards for organ donation too high, you’re going to reject a lot of viable organs, and people will die because of it,” he said. “Any organ transplant carries a risk of fatal complications. But the benefits far outweigh the risks. Organ recipients, and those waiting for donor organs, will be the first ones to tell you that.”

“We’ll take this up at a later date, Dr. Sloan,” Janet said, her face tight with anger. “I’m sure Dr. Sharpe and the CDC have far more important things to do than listen to us debate hospital policy.”

But Sharpe and his team didn’t seem ready to go anywhere. And neither did the unidentified man leaning against the wall.

“I agree with you, Dr. Travis,” Sharpe said. “It’s extremely rare for someone with an undetected case of West Nile virus to die of unrelated causes and then infect others with his donated organs.”

“Great. Case closed. I’m glad that’s over,” Jesse said, getting up from his seat. “Now I can get back to work.”

“So what do you think the odds would be of it happening twice in one month at the same hospital with the same surgeon?” Sharpe asked.

Mark had a terrible feeling that Sharpe wasn’t posing a hypothetical question.

“It’s never happened here before,” Jesse said, standing at the table.

“Yes,” Sharpe said. “It has.”

Jesse sat down and glanced first at Mark and then at Amanda. They were every bit as startled by Sharpe’s statement as he was. So were Janet Dorcott and her two assistants, who were rendered even more deeply speechless than they already were. Clarke Trotter began smoothing his tie, which apparently wrinkled at the slightest hint of liability.

“As part of our investigation, we reviewed the last half dozen organ-harvesting operations performed at this hospital and followed up with the recipients,” Sharpe said, referring to the file in front of him.

He went on to explain that a week before Corinne Adams’s operation, Jesse had removed two kidneys and a liver from Bruce Wethersby, a thirty-one-year-old bike rider who was hit by a car and left brain-dead. His organs went to three recipients, one in San Bernardino and two others out of state.

The recipient of the liver tested positive for West Nile RNA but hadn’t shown any symptoms yet.

“Unfortunately, the kidney recipients weren’t so lucky,” Sharpe said. “One has developed acute flaccid paralysis consistent with West Nile-related encephalitis and is in a coma. The other kidney recipient died two days ago from brain-stem herniation. Both victims have tested positive for West Nile RNA and antibodies.”

Mark noted that they weren’t being called patients anymore; they had become victims. The distinction was significant and ominous.

“We tested the donor’s tissue and fluid samples for West Nile,” Sharpe said, “and they came back positive for the virus.”

The man leaning against the wall stepped forward and began to stroll casually around the table. “It could be a big, tragic coincidence that these two organ donors were both bitten by virus-carrying mosquitoes before they showed up in this hospital and had their organs harvested by Dr. Travis. But we don’t think so.”

“Who are ‘we’?” Mark asked pointedly.

“The FBI, Dr. Sloan. I’m Special Agent William Ort. I’m also an M.D. Some people in the bureau call me Special Agent Ort. Others call me Dr. Special Agent Ort. But they all call me when there’s a federal crime of a medical nature.”

“A doctor who likes to solve crimes,” Amanda said, glancing at Mark. “Imagine that.”

“You think somebody intentionally infected these donors with West Nile virus before or after they were admitted to this hospital,” Mark said.

“I do,” Ort said.

“You think it’s me,” Jesse said.

Ort shrugged. “You’re certainly a person of interest.”

“I’d have to be one dumb killer,” Jesse said.

“I’ve seen dumber,” Ort said.

Mark was sure that Jesse wasn’t the only suspect. Amanda’s pathology lab did all the testing of the donors’ blood, tissue, and organs. There were also several interns, nurses, and orderlies who had worked with both donors in the ER, the ICU, and during the transplant surgery.

If someone outside the hospital was infecting donors, the question was whether he was doing so before or after the victims had their accidents.

Corinne Adams fell down a flight of stairs. But what if she was
pushed
?

Bruce Wethersby was hit by a car. But what if it was
intentional
?

That meant someone chose the victims, somehow injected them with the virus, and then engineered their accidents. It seemed like a massively complex undertaking. But it was doable.

If they were infected with the virus after their accidents but before they arrived at Community General, then the possible suspects would include the paramedics, the firefighters, and the police officers who arrived at the scene to treat the victims.