“What sort of a mess did my son get himself into this time?”
“It’s a long story, but it’ll blow over,” Ben said. “Listen, we were hoping you might know what Tartaglia was involved in at Zenavax. What sorts of projects was she working on?”
“The last time I talked with Kate was the day she quit her position here. But the infectious diseases community is pretty small — things get around. Why are you asking?”
“Luke and I think she may have known something about two deaths we’re looking into.” Ben gave Elmer a sketchy synopsis and explained how Kate’s name had turned up in connection with the dead girl.
Elmer nodded. “Luke asked me to check if I’d received any e-mails from Kate. Does this have anything to do with that?”
“Bingo.” Ben gave him an expectant look.
“Well, she didn’t send any messages to me.” Elmer scratched his nose. “You know, sometimes my son has a way of making things more complicated than they are.”
“Maybe so, but I think these deaths are worth looking into. One of the cases — the boy — came from our clinic in Guatemala. Can you think of any link between Zenavax and Guatemala?”
“Malaria.”
“As in malaria vaccine?” Ben asked.
Elmer nodded.
“You gotta be kidding,” Ben said. “Zenavax is working on a malaria vaccine too?”
Elmer’s malaria vaccine project was well known to everyone at the hospital, in part because his approach was so unorthodox — turning mosquitoes into allies by using them to administer the vaccine to humans. The idea wasn’t likely to catch on anytime soon in economically privileged regions like North America and Europe, but among developing countries with small budgets and high mortality rates from ongoing malaria epidemics, the prospect of malaria-fighting mosquitoes was seen as a godsend.
The medical basis for Elmer’s vaccine was elegantly simple, and scientifically daunting. He had set out to create a genetically modified version of the ubiquitous Anopheles mosquito — one that was inherently resistant to harboring malaria parasites and endowed with saliva glands that produced a malaria-like protein. The altered female mosquitoes would inject the protein while feeding on their human prey. To work, the protein had to fool the human immune system into believing that it was being attacked by the real thing — a malaria parasite.
Initially, most thought Elmer’s quest a fool’s errand. That is, until he, Caleb Fagan, and Dr. Kaczynski, the now-deceased geneticist with whom they worked initially, proved their hypothesis with primates.
That was five years ago. Now, after successfully completing human testing, Elmer and his Chinese partners were gearing up to produce and deploy his mosquito in quantities sufficient to meet the already vigorous demand for his creation.
“Zenavax hasn’t formally announced their malaria vaccine project, but like I said, word gets around. Rumor is that they’ve just recently started testing it.”
“Sounds like they’re at least a few years behind you,” Ben said. “When do you go live?”
“Another few months. We’re testing the breeding cycle now, making sure that successive generations of our mosquito retain the modified genetic code. If we don’t encounter any unwanted mutations — and we haven’t so far — we move to full-time production at a facility in southern China.”
Ben’s thoughts came back to the reason for his visit. “Well, one thing I can tell you for sure — these two children didn’t die from malaria. The girl’s liver and spleen were normal.” Ben described the lung findings of Josue Chaca and Jane Doe. “I’m looking for something that attacks the lungs, pancreas, and bile ducts.”
“Sounds like cystic fibrosis.”
“I had the same thought, but CF alone wouldn’t explain what happened. The pathology looks nothing like cystic fibrosis. Whatever those children died from caused a massive lymphocyte response. The tissues were saturated with lymphocytes.”
“Hmmm.” Elmer puckered his mouth, as if trying to shape a thought with his lips.
“What?”
“Oh, it reminds me of something that happened when I was working on the first prototype of my flu vaccine. Lost a whole batch of mice to a runaway autoimmune reaction. The mice literally devoured themselves. The tissues looked just like what you’re describing, crammed full of lymphocytes. It turned out that they were Killer T-cells. My prototype vaccine activated some sort of self-destruct signal.”
“Apoptosis?”
Elmer nodded.
Apoptosis. Nature’s version of suicide. It was still a poorly understood frontier in medicine. In some circumstances, human cells damaged by infection, mechanical injury, or toxins announced their injured state to the body’s immune system, which promptly induced those cells to commit suicide. Specialized lymphocytes — Killer T-cells — served as the messenger of death in those instances, triggering the process of self-destruction.
“Strangest thing I ever saw,” Elmer said. “Eventually, Caleb Fagan and I came up with a way to down-regulate the reaction, to get the immune response we needed without triggering the self-destruct signal.”
“Is it possible that Zenavax is encountering a similar problem with their malaria vaccine?”
“Hardly likely. We published our findings at the time. This was before I’d ever heard of Zenavax. The solution to the problem is available to anyone who wants to read about it.”
“You’re not helping me much, partner.”
Elmer shrugged. “Well, if you’re looking for a connection between Zenavax and those two deaths, look for an alphavirus.”
“What do you mean?”
“Zenavax built their entire company on that virus, and there’s still a lot of untapped potential for using alphaviruses in future vaccines. In fact, it’s an ideal vector for a malaria vaccine. It promotes the kind of immune response you need to protect against malaria. What I’m saying is, if there’s a connection between Kate and those children, you’re likely to find the remnants of an alphavirus in their blood. Run some antibody titers, take some tissue and—”
Elmer’s gaze moved toward the door just as Ben heard the knock.
“I need to talk to you.” It was Caleb Fagan, and he was looking at Elmer. “I just got out of a Risk Management Committee meeting.”
What nitwit had come up with the euphemism, risk management? Ben wondered. The term was nothing more than a roundabout way of referring to litigation and malpractice lawsuits.
Caleb continued without bothering to excuse the interruption. “Barnesdale’s favorite attorney was there, the same jerk that rallied the troops against Luke. Of course, the Erickson thing came up and this guy tells us that the hospital is already negotiating with the football player’s attorney. Long story short — Barnesdale’s going to write a letter to the Department of Children and Family Services saying he reviewed the E.R. records for Erickson’s daughter and found no convincing evidence of child abuse.”
“What?” Ben said. “Why the hell’s he gonna do that?”
“Because when Barnesdale does that, DCFS will probably drop the investigation,” Caleb explained. “And if that happens, it sounds like Erickson will drop whatever legal action he was planning against the hospital and medical staff.”
Ben said, “I always thought that DCFS called their own shots.”
“I’m sure they do,” Caleb said, “but look at this from their point of view. The only thing that DCFS has to go on are Luke’s E.R. notes describing some bruises. There’s no other evidence — no X-rays, no pictures of the bruises, no statements by anyone. And supposedly, Erickson has no history of abuse in the past. Luke’s the only person stepping forward on this, and his scuffle doesn’t make him look very objective. If someone here at Children’s — someone with credentials like Barnesdale — looks at the records and says there’s little or no evidence of physical abuse, it weakens the case even further. DCFS is probably going to drop the investigation.”