Michael Palmer - The fifth vial

The two men shook hands warmly, and then Berenger left Culver in the room as he made calls and wrote out referrals. Finally, he sent Levitskaya back with the paperwork and instructions to move to the next patient when she was finished.

"Tonya's a very good surgeon," he said when he and Natalie were alone.

"I believe she is."

"Did you really threaten to flatten her nose across her face?"

"I wasn't using my people skills. Sorry. This isn't the time for me to act smart. It was my fault. I was feeling angry at the world and sorry for myself, and I goaded Tonya into fighting."

"I see. Well, you're both too valuable to my work to have you duking it out. I'm paying you to do battle with the mysteries of science, not with each other. No more incidents."

"No more incidents," Natalie echoed.

"Besides, I suspect ol' Tonya would be a real brawler."

Natalie grinned.

"I was thinking the same thing."

"So, how would you like to get away from all this for a while?"

"Excuse me?"

"Away."

"But not away as in I'm fired?"

"You're going to have to do a heck of a lot worse than threaten Tonya to get me to fire you. How's your Portuguese?"

"Third grade, maybe. Possibly fourth. I'm half Cape Verdean, but I was infamous for never doing anything that might have pleased my mother, and she desperately wanted me to speak the language."

"You probably won't need it anyhow. There's an international transplant meeting next week in Brazil — Rio to be exact. Have you been there?"

"I raced in the University Games in Sao Paulo, but I never made it over to Rio."

"Well, I was planning to go and deliver a version of our graft versus host paper, but my disc has been giving me a devil of a time, and Paul Engle, my neurosurgeon, has recommended against long airplane flights or car rides. I thought maybe you had some things you might want to get away from for a while, and that was even before I caught you about to mix it up with my research fellow."

"You want me to go to Rio?"

"Business class."

"You're not just trying to keep me and Tonya from killing each other?"

"Firing you would be a lot less expensive."

Natalie felt a surge of excitement. The past three weeks had been worse even than those following her injury in the Olympic trials. Her un-necessary humiliation of the high-school runners and the angry encounter with Levuskaya were symptoms of her unraveling. She was a pressure cooker, plugged up and about to blow. There was nothing she could use at the moment more than a change of scene.

"When do you need to know?" she asked.

"When can you let me know?" Berenger responded.

"How about now?"

The child was failing. Her name was Marielle, and despite the antibiotics and the IV fluids, the oxygen and tiny feeding tube, the six year-old was slipping away. Malnutrition was fanning the flames of infection in her abdomen, and now her nervous system as well. Dr. Joe Anson brushed some flies from her parched, cracked lips and looked up helplessly at the nurse. Working in his hospital in an impoverished area thirty miles north of the capital city of Yaounde, Anson had seen more than a few children die. Each one pained him worse than the last, and even though there had been many victories, they never seemed to balance off the defeats.

At that moment, though, four o'clock in the morning, the frail, malnourished girl was not the only thing upsetting Anson. Over the past hour there had been a steady increase in his own air hunger. The sensation — at its worst a horrible, strangling claustrophobia — was never completely gone anymore. After almost seven years, his primary pulmonary fibrosis — progressive lung scarring — was nearing the end of its course. PPF — cause unknown, course inexorably downhill, effective treatment none. It was a rotten, debilitating disease, and sooner or later, Anson knew, a transplant would be his only hope.

"Claudine," he said in fluent Cameroon French, "would you please get me a tank of oxygen and a mask?"

The nurse's eyes narrowed.

"Perhaps I should notify Dr. St. Pierre."

"No. Let Elizabeth sleep…I will be fine with the oxygen."

He had to pause between sentences for an extra breath.

"I am worried," the nurse said.

"I know, Claudine. So am I."

Anson strapped the polystyrene mask to his face and leaned forward so that gravity would pull his chest wall down and help expand his lungs. He closed his eyes, willing himself to calm down as he waited for the oxygen to banish the dreadful hunger. Five interminable minutes passed with no change, then another five. The situation could not get much worse. The episodes of breathlessness were occurring more frequently and taking longer and longer to abate.

At some point, some point soon it seemed, the oxygen simply wouldn't be enough. At some point, unless he consented to a lung transplant, and of course unless an appropriate donor could be found in time, his heart would be unable to force enough blood through the scar tissue in his lungs. Medications would work for a short while, but then his heart would weaken even further and he would begin, quite literally, to drown in his own fluids. By then, even if an appropriately matched donor could be found, the transplant would almost certainly be a waste.

Breathe in…Slowly…Don't stop…Lean forward…Let gravity help…That's it…That's it.

Though a self-proclaimed agnostic, Anson began praying for relief. He still had work to do here — great, important work. Clinical testing of Sarah-9 was well under way, with astounding results. The drug he had created from a soil yeast unique to this area was still experimental, but it was clearly at the forefront in the field of neovascularization — the rapid development of life-giving new blood vessels. The new circulation had already shown the potential to cure conditions as diverse as battlefield wounds, infection, heart disease, and various forms of cancer…but ironically, not pulmonary fibrosis.

It took more than fifteen minutes, but finally Anson began to draw in more air. Moments later, though, just as he felt the attack was over, a slight tickle in his chest led suddenly to a racking, painful cough. Damn it! In the minute or so it would take him to gain control of the cough, the air hunger would again take over. He had once been able to play hours of rugby without slowing so much as a step. It was hard to believe that half a thimbleful of sticky mucus in one bronchial tube was now enough to bring him down.

On the narrow bed beside him, Marielle breathed sonorously. Anson stroked her forehead. Their battles were painfully similar. Would either of them win? He flexed his neck and savored a few blessed gulps of air. Although he was beyond exhaustion, and hadn't had more than a few catnaps for almost twenty-four hours, he wasn't even considering sleep. His patients were what mattered. Sleep, as always, was secondary.

Born and educated in South Africa, Anson had once been handsome and dashing enough to have run with some of the most beautiful women in the world, and unfocused enough to have forsaken all but the most superficial connection to medicine. But that was long ago.

Another fifteen minutes of oxygen and Anson sensed the insufferable band around his chest begin to loosen. Claudine, unable to stay and witness his anguish, had gone off to check on their twenty or so inpatients, many of whom — children and adults — were suffering from the complications of AIDS. Thanks to the London-based Whitestone Foundation, and their appointed administrator, Dr. Elizabeth St. Pierre, the small hospital was well maintained and equipped with almost anything that Anson and she could think to ask for.