"I'm on my way home right now. I should be there by late tonight."
"Excellent."
"Joe, I've had some trouble in West Virginia related to my friend Kathy — the one you autopsied."
"What sort of trouble?"
"There are two other cases down here that looked and acted exactly like hers — neurofibromas and progressive paranoid insanity."
"Well, now, that is something," Keller said. "You see, your instincts were absolutely correct in this case. I am looking at the slides of Miss Wilson's brain right now. She has unmistakable spongiform encephalopathy."
Spongiform encephalopathy. Nikki caught her breath. The degenerative, transmittable, ultimately fatal nervous-system disease had a number of forms, including a syndrome called Creutzfeldt-Jakob disease; kuru, once found in the brain-eating cannibals of New Guinea; fatal familial insomnia; and bovine spongiform encephalopathy, also known as BSE, or more commonly, Mad Cow disease.
Excitedly, Nikki stretched out and kicked Matt firmly on the sole of his foot. He bunched his pillow beneath his head and pulled his foot away. She kicked him again, even more forcefully, this time with her heel against his calf. He moaned and began to stir.
"Go on, Joe," she said, knowing better than to ask if he was sure. "This is quite incredible."
"You say there are two other cases where you are?"
"In the town where Kathy grew up, yes."
One final kick and it was clear Matt had at last ascended to a higher plane of wakefulness. If he hadn't taken some sort of drug, he was a candidate for the Guinness Book of Records. Her clients in the coroner's office were easier to rouse.
"And these other cases," Keller asked, "they had spongiform encephalopathy also?"
"I don't know. Their brains appeared normal on gross exam, so the microscopic wasn't done."
SE was caused by germs known as prions — infectious protein particles capable of reproducing themselves without DNA or RNA. One of the characteristics of SE was that despite an often spectacular clinical picture, the brain looked grossly normal until sections of it were examined under the microscope, where diffuse, sponge-like holes could be seen. Another characteristic was that the incubation period of the disease was often a decade or more, during which time the victim might well be infectious to others.
"Did these cases of yours also have neurofibromas?" Keller asked.
Matt was awake now, pawing sleep from his eyes and looking over at her quizzically. She put a finger to her lips and motioned that she would fill him in momentarily.
"Yes, both of them. From what I have been told, there was nothing unusual about them on microscopic."
"Well, maybe and maybe not," Keller said. "I tried a number of stains and stain combinations on them, and found an approach that clearly distinguishes these lesions from the reference neurofibromas in my library."
Keller the ever-curious, Keller the intellectual. Nikki smiled just picturing her boss. He was forever playing with stains and with his department's powerful electron microscope. His library, in addition to the hundreds of texts, included hundreds, probably even thousands, of unstained specimens from every organ and countless disease states, each carefully catalogued. Evidently, among those unstained tissues were some run-of-the-mill neurofibromas — the reference specimens.
Spongiform encephalopathy with unusual neurofibromas. The Belinda syndrome, Nikki speculated… Or maybe Rutledge-Solari disease.
"Joe, listen, we'll be home between ten and twelve tonight."
"I should be here then."
"If you are, great. But if not, we'll see you tomorrow morning."
"We?"
"A doctor from down here saved my life two or three times recently. He's got more than a passing interest in this syndrome. He thinks it's due to a secret industrial dump spilling toxic waste into his town's groundwater."
"Given what we know about prion infections," Keller said, "I really don't see how."
"Well, we'll talk about it when we get there. Thanks, Joe."
"I'm so relieved you are okay," Keller said. "Oh, by the way, the police had no trouble finding the man who killed your drowning victim, Roger Belanger. His name was Halliday. That was what the 'H' was for. They were friends and business associates. The police believe they fought about money. Halliday invited him over to his place to make up. He wrote a check and the two of them had a few drinks. Once Halliday got him into his pool, he got his hands around Belanger's throat and dragged him to the bottom."
"Process," Nikki said.
"Exactly," Keller concurred.
By the time Nikki set the receiver down, Matt had pulled on a new, blue sweatshirt with YALE block-printed on the front.
"Mornin'," she said.
"Mornin', yourself."
She motioned at the sweatshirt.
"Did you go there?"
"No, but while you were trying on things in that Target store last night, I bought some stuff for me. This was one they had in my size."
"Believe it or not, I remember. Well, sort of. Where did you go to school?"
"Good ol' WVU. The Mountaineers. That was the only college we could afford. Turned out to be a great place."
Nikki felt certain she recalled a nurse telling her that Matt had gone to Harvard Med, yet he didn't feel that minor factoid was worth tossing in. She gave him high marks for modesty, as if he needed any more high marks after what he had done for her.
"You sleep soundly," she said.
"People have noticed that from time to time, yes."
"If you have trouble walking today, it's from me kicking you to wake you up."
"The nurses at the hospital quiz me when they call, to be certain I'm awake. They don't know that I've mutated so that I can now answer most of their questions, even the complex mathematical ones, in my sleep. Do you remember much of last night?"
"Unfortunately, I think I do. I hope I thanked you enough for rescuing me the way you did."
"I have a thing against losing patients. So, what was that call all about?"
"I phoned my boss, Joe Keller, to tell him I was alive and well, and to see if anything had turned up in Kathy's microscopic."
"And?"
"You're not going to believe this, Matt. Kathy had spongiform encephalopathy. Joe's absolutely certain of that, and believe me, he's, like, never wrong."
Matt sank back onto the bed, incredulous. He was hardly an expert on the various versions, but he was keeping up on the condition in the medical literature — at least as much as his cramped schedule would allow.
"Prion disease?"
"Yes," Nikki said. "Quick point of interest — most people pronounce it pry-on, the way you do, but Stanley Prusiner, who won the Nobel prize for describing the beasties, pronounces it pree-on. I heard him speak a year or so ago."
"Pree-on it is. This is incredible. Do you think my two cases had SE as well?"
"How can I not?"
"Well, what in the hell?… What about the neurofibromas? Anything special about those?"
"Apparently there was. Joe Keller is sort of a stain freak. He might try a dozen different staining techniques on a piece of tissue just to see what shows up. He tells me Kathy's facial lesions take up this one obscure stain differently from the usual Elephant Man type of fibromas."
"I just don't get it."
"Neither do I. But listen, Matt, the way I see it, maybe you're still on the right track. Before we jump to any conclusions, let's go up to Boston and see what Joe has to show us."
"Give me a few minutes to get put together and we're off."
"Only as far as the nearest IHOP, though. I have this sudden, insatiable craving for pancakes drenched with maple syrup."
"IHOP, she wants," Matt mumbled as he headed to the bathroom. "First she lays prions on me, then she wants IHOP. What kind of a woman is this, anyway?"