Robin Cook - Death Benefit

Pia quickly went online, typed “hair loss” and “chloramphenicol” into the search engine and scrolled through the results for a few minutes. “There’s nothing that lists hair loss among chloramphenicol’s side effects. Actually, there are some alternative healers who sell chloramphenicol to reverse hair loss. Wow, De Silva was so wrong when she said chloramphenicol might be the cause of the hair loss.”

Pia continued surfing. “Springer attributed it to fever and stress,” she said as she read. “It seems that stress can cause hair loss. But I don’t think it could be involved in this case. I mean Rothman and Yamamoto were certainly being stressed with their fevers and all, but for stress to cause hair loss I think it has to be over a period of months, not hours.”

Pia continued her search. George couldn’t see the screen from his vantage point, but he could see the light flickering on Pia’s face as page after page flashed by. Suddenly there was a steady light, and Pia leaned forward in her chair. “Yeah, here we are. Hair loss and stress. Yup, I was right.” Pia read out loud: “‘Unless the stressed patient is pulling his own hair out, severe stress merely changes the hair follicle from an active state to a resting state. The hair doesn’t fall out immediately but rather over a period of months.’ ”

Pia looked over at George. “Clearly Springer’s suggestion wasn’t much better than De Silva’s.”

“So what are you thinking?”

“Since I’ve never heard of salmonella causing hair loss, we have to think of something else to explain it, bringing us back to the second-agent idea, like another bacteria or a virus. But if there was another microbe involved, it would have to be one whose clinical symptoms mimic typhoid fever because all the other symptoms were consistent with typhoid fever. Are you following me?”

“I think so.”

“I’m saying that we have to come up with an agent that mimics typhoid fever symptomatically but which also causes hair loss and can kill in hours in the presence of chloramphenicol and possibly ceftriaxone. Of course, without access to the charts, I can’t be sure they ever got the ceftriaxone, but for the sake of argument, let’s assume they did.”

“You know what I wish?” Pia said after a few minutes of silence. “I wish that we examined Yamamoto as well as Rothman. Just to be sure he was suffering from the same signs and symptoms.”

“Maybe we can ask Dr. De Silva’s opinion.”

“I don’t think she’s going to want to hear from me. Let’s keep going.”

Pia looked up at the corkboard on the wall behind George’s desk. A business card for a taxi service was tacked next to a picture of George’s mother and grandmother. There was a postcard from Hungary alongside it. Suddenly Pia snapped around again.

“What are the usual causes of hair loss besides what I’ve mentioned?”

“This sounds like internal medicine rounds, which I’d like to forget. That was one venue where I did not shine in the slightest.”

“Come on,” Pia said. “What causes hair loss?”

“Er, hormonal changes, alopecia areata, stress like you said.” Pia motioned for George to come up with more. He thought harder.

“Dermatological diseases of the scalp, particularly cicatricial diseases. Wow, that’s a good one. That’s the kind of response that would have gotten me kudos on rounds. Trouble is I always choked up.”

“What else?” Pia commanded. She waved her hand, indicating she wanted more.

“Okay, certain drugs.”

Pia nodded and looked expectantly at George, as if she knew the answer and was waiting for him to get it. It was like a game of charades.

George became impatient, ready to give up before he remembered something else.

“What about chemotherapy and radiation?” George sounded uncertain. Sure, they caused hair loss, but what could be the relevance?

“Right on!” Pia exclaimed. “Radiation! You saw people undergoing radiation when you were on oncology during internal medicine.”

George nodded.

“Chemotherapy and/or radiation destroys the hair follicles and the hair falls out immediately.”

“What are you getting at?” George noticed that Pia’s face had brightened considerably.

“I said I was wondering if Rothman could have been infected with another bug besides the salmonella, another bug that was not sensitive to chloramphenicol or the third-generation cephalosporin he was given.”

“Right, the ceftriaxone.”

“I suddenly don’t think there was another microbe,” Pia said. “Damn it, George, you said it yourself, remember? You said they had to autopsy the bodies the same day the men died because they were ‘hot.’ I thought at the time it was a strange word to use, but I think you were more right than you knew. I don’t think they were hot because they were full of bacteria. I think they might have been hot because of radiation.”

OFFICE OF THE CHIEF MEDICAL EXAMINER 520 FIRST AVENUE, NEW YORK CITY MARCH 25, 2011, 12:32 P.M.

Laurie Montgomery had been sitting in her office at the Office of the Chief Medical Examiner catching up with an old friend, Detective Captain Lou Soldano, when the phone rang. She saw it was her boss, apologized, and took the call. She was soon rolling her eyes, and Lou smiled.

Laurie Montgomery had been back at the OCME for eleven months, since the harrowing events of the infamous Satoshi Machita case, involving both the New York mob and the Japanese Yakuza, which led to the kidnapping of her infant son, John Junior. The story had been plastered all over the media for several days as the details of the case unfolded. After JJ’s rescue, Laurie had come back to work but only after she had found a live-in nanny, Paula, who immediately proved to be a godsend. With Paula looking after JJ, Laurie felt secure. Right now, her husband and fellow ME, Jack Stapleton, was working in the same building, and JJ was safe with Paula at the couple’s home on 106th Street. It didn’t hurt that she and her husband had friends like Detective Captain Lou Soldano either. Right after the kidnapping, he’d insisted on a twenty-four-hour security detail for the Stapleton home.

From Laurie’s side of the conversation and from knowing Laurie’s boss, Dr. Harold Bingham, Lou sensed he’d be in for a wait. He took his copy of the New York Post from his briefcase and flipped through it until he saw the story: IVY SPACE GERM DOCS DIE. He quickly reread the first few paragraphs. He had wanted to show the article to Laurie, which was one of the reasons he’d stopped by.

“Sorry, Lou,” Laurie said, hanging up the phone. “That was Bingham.”

“I assumed as much. No problem. Did you see this article?” He held up the paper.

“Yes, but not that one specifically. There was the same story in the Times .”

“Crazy and scary at the same time. It says that two researchers at Columbia contaminated themselves in a lab with some virus grown in the space station or something. The bodies were supposedly brought here to OCME. Is this all true?”

“Most of it. But the contamination agent wasn’t a virus. It was a bacteria called salmonella typhi that causes typhoid fever. Jack did both autopsies yesterday. Very sad. I understand they were stem cell researchers who were making huge strides growing human organs.”

“That’s what I understand,” Lou said. “Anything unique about the autopsies? There were some wild theories about the deaths in the article. Apparently one of the guys was a big-deal researcher who was not particularly liked by his colleagues.”

“Jack didn’t mention anything other than that he was impressed with the pathology. He’d never seen an entire gut in both patients in such bad shape. Typhoid fever isn’t usually so generalized. Anyway that was the case I was just talking to Bingham about. He expects there will be some political fallout. If there’s a press conference scheduled, he wanted to give me a heads-up that he might want me to host it. He knows Jack hates doing it and isn’t the most diplomatic.”