it’s worth, Dr. Deborah Levy does a lot of traveling, but it’s mostly back and forth to Key West.”
Sean glanced at the printout. “She does keep on the move,” he agreed. “But notice all these other cities. That’s what I expected. What about Margaret Richmond?”
“No travel to Key West,” Janet said. “But moderate travel around the country. About once a month she’s off to another city.”
“What about that automated program we saw?” Sean asked.
“You were right about that,” Janet said. “It was running when I got up there, so I copied two of the numbers we thought might have been phone numbers. When I tried to call direct I could tell it was a computer link, so I used the mainframe and its modem to connect. Both of them were insurance companies: one was Medi-First; the other was Healthnet.”
“Bingo,” Sean said. “It’s all falling into place.”
“How about letting me in on the revelation,” Janet said.
“What I’d be willing to bet is that the computer searches for medical insurance companies’ precertification files for specific social security numbers. It probably does it on a nightly basis during the week and on Sunday afternoons.”
“You mean precertification for surgery?” Janet asked.
“That’s exactly what I mean,” Sean said. “In an attempt to cut down on unnecessary surgery, most if not all health plans require the doctor or the hospital to notify the insurance company of proposed surgery in advance. Usually it’s merely a rubber-stamp exercise so it’s pretty casual. I doubt there’s any concern about confidentiality. That computer upstairs is printing out proposed elective surgery on a specific list of social security numbers.”
“Those are the numbers that are flashing on the screen,” Janet said.
“That’s what it has to be,” Sean said.
“So why?” Janet asked.
“I’ll let you figure that out,” Sean said. “While I continue processing these thermal cycler samples, you look at the referring histories on these thirty-three charts we copied. I think you’ll find most will mention that the patient had elective surgery within a relatively short period before their diagnosis of medulloblastoma. I want you to compare the dates of those surgeries with Dr. Levy’s travel schedule.”
Janet stared at Sean without blinking. Despite her exhaustion, she was beginning to assimilate the facts as Sean understood them and therefore starting to comprehend the direction Sean’s thoughts were headed. Without saying another word, she sat down with the charts and the computer printout she’d brought down from the seventh floor.
Turning back to his own work, Sean loaded a few more wells with the appropriate oncogene probes. He hadn’t gotten far when Dr. Mason interrupted him.
“My wife is getting hungry,” Dr. Mason announced.
With his general fatigue Sean’s nerves were raw. After all that had happened he could not abide the Masons, particularly Mrs. Mason. The fact that they thought it appropriate to bother him with her being hungry threw him into a momentary rage. Putting down the pipette, he raced back toward the glass office.
Dr. Mason saw Sean coming and quickly guessed his state of mind. He let go of the door and backed into the office.
Sean threw open the office door so that it banged against the doorstop. He flew into the office, snatched the Erlenmeyer flask from the ice bath, and gave it a shake. Some of its contents had solidified and cakes of ice clunked against the sides of the container.
Dr. Mason’s face blanched as he cringed in anticipation of an explosion. Mrs. Mason buried her face in her hands.
“If I hear one more sound from you people I’m going to come in here and shatter this flask on the floor,” Sean yelled.
When no explosion occurred Dr. Mason opened his eyes. Mrs. Mason peeked out between her fingers.
“Do you people understand?” Sean snapped.
Dr. Mason swallowed hard, then nodded.
Disgusted with the Masons and his own temper tantrum, Sean went back to his lab bench. Guiltily he glanced over at Janet, but she’d not paid any attention. She was too engrossed in the charts.
Picking up the pipette, Sean went back to work. It was not easy, and he had to concentrate. He had to put the right probe in the right well, and he had the primer pairs and probes for over forty oncogenes, a rather extensive list.
A number of the first samples were negative. Sean didn’t know if he’d taken them from the thermal cycler after an insufficient number of cycles or if they were truly negative. By the fifth sample he was beginning to become discouraged. For the first time since he’d put this drama into motion, he seriously questioned the conclusions which by then he’d come to view as rock solid. But then the sixth sample proved positive. He’d detected the presence of an oncogene known by the designation ERB-2, which referred to avian erythroblastosis virus, a virus whose normal host was chickens.
By the time Janet finished with the charts, Sean had found another oncogene, called v-myc, which stood for myelocytoma virus, another virus that grew in chickens.
“Only about three-quarters of the charts have the surgery dates,” Janet said. “But of those, most of them match the dates and destinations of Dr. Levy’s travel.”
“Hallelujah!” Sean exclaimed. “It’s all fitting into place like a jigsaw puzzle.”
“What I don’t understand,” Janet said, “is what she did in those cities.”
“Nearly everyone who’s post-surgery is on an IV,” Sean said. “It keeps people hydrated, plus if there’s a problem the medical staff has a route for medication. My guess is that Deborah Levy gave them an injection into their IV.”
“Of what?” Janet asked.
“An injection of St. Louis encephalitis virus,” Sean said. He told Janet about the positive test for the SLE virus in Helen Cabot’s cerebrospinal fluid. He also told her that Louis Martin had had transient neurological symptoms similar to Helen’s several days after his elective surgery.
“And if you look back at the charts,” Sean continued, “I think you’ll find most of these people had similar fleeting symptoms.”
“Why didn’t they get full-blown encephalitis?” Janet asked. “Especially if it was injected through their IVs?”
“That’s the truly clever part about all this,” Sean said. “I believe the encephalitis viruses were altered and attenuated with the inclusion of viral oncogenes. I’ve already detected two such oncogenes in Helen’s tumor. My guess is that I’ll find another. One of the current theories on cancer is that it takes at least three isolated events in a cell to make it cancerous.”
“How did all this occur to you?” Janet asked. It sounded too complicated, too involved, too complex, and most of all too hideous, to be true.
“Gradually,” Sean said. “Unfortunately it took me a long time. I suppose initially my index of suspicion was so low; it’s the last thing I expected. But when you told me they started immunotherapy with a specific agent from day one, I thought something was out of whack. That flew in the face of everything I knew about the specificity of immunotherapy. It takes time to develop an antibody and everybody’s tumor is antigenically unique.”
“But it was at the Betencourts’ that you started acting strangely,” Janet said.
“Malcolm Betencourt was the one who emphasized the sequence,” Sean said. “Elective surgery, followed by neurological symptoms, and then brain tumor. Helen Cabot and Louis Martin had the same progression. Until I heard Malcolm’s story, I hadn’t realized its significance. As one of my medicine professors said, if you are painstakingly careful in your history-taking, you should be able to make every diagnosis.”
“So you believe the Forbes Cancer Center has been going around the country giving people cancer,” Janet said, forcing herself to put into words her awful fear.
“A very special kind of cancer,” Sean said. “One of the viral oncogenes I’ve detected makes a protein that sticks out through the cell membrane. Since it’s homologous to the protein that forms the receptor for growth hormone, it acts like a switch in the ‘on’ position to encourage cell growth and cell division. But besides that, the portion that sticks through the cell is a peptide and probably antigenic. My guess is the immunoglobulin they give
