Tess Gerritsen - Bloodstream

Heimlich maneuver. Before he suffocates.

She left him lying on his side, placed one hand on his upper abdomen, and braced her other hand against his back. She gave a forceful thrust against his belly, aiming it toward the rib cage.

Air wheezed out of his throat. It wasn’t a complete obstruction, she thought with relief. His lungs were still getting air.

She repeated the maneuver. Again, she positioned the heel of her hand against his belly and gave a firm thrust. She heard air rush out of his lungs, heard the wheeze clear as the reason for the obstruction was suddenly expelled from his throat and spilled partway out one nostril. When she saw what it was, she jerked back with a gasp of horror.

“Jesus Christ!” yelled the state cop. “What the luck is that?”

The worm was moving, lashing back and forth in a pink froth of blood and mucus.

Now more of it slithered out, twisting into glistening loops as it frantically worked itself free. Claire was so shocked she could only stare as it wriggled out of her son’s nose and slid to the floor. There it coiled up on itself, one end rising like a cobra as though to test the air.

In the next instant it whipped away and vanished under the nearby cot.

“Where is it? Get it!” yelled Claire.

Max was already scrambling on hands and knees, trying to peer under the cot. “I don’t see it-”

“We need it identified!”

“There, I see it,” said Lincoln, who’d dropped to his knees beside Max. “It’s still moving-”

The cut-off wail of an ambulance drew Claire’s attention. She glanced toward the sound of approaching voices and the metallic rattle of a rolling stretcher. Noah was breathing easier now, his chest rising and falling without spasms, his pulse rapid but steady.

The EMTs pushed into the cell. Claire moved aside as they went to work, establishing an intravenous line, administering oxygen.

“Claire,” said Lincoln. “You’d better take a look at this.”

She moved to his side and knelt down, peering into the narrow space beneath the cot. The cell was poorly lit, and it was hard to see much detail in the shadow of that sagging mattress. Where the light just slanted under the edge, she made out a few dust balls and a crumpled tissue. Beyond that, in the farthest recess, a bright green line was moving, forming hallucinogenic curlicues in the darkness.

“It’s glowing, Claire,” said Lincoln. “That’s what we saw. That night, on the lake?’

“Bioluminescence,” said Max. “Some worms have the capability.”

Claire heard a restraint buckle snap into place. Turning, she saw that the EMTs had already strapped Noah on the stretcher and were maneuvering him through the cell door.

“He seems stable,” said the EMT “We’re taking him to Knox ER.”

“I’ll be driving right behind you,” she said, then glanced at Max. “I need that specimen.”

“You go on ahead with Noah,” said Max. “I’ll bring the worm to the pathology department.”

She nodded, and followed her son out of the building.

Claire stood in the X-ray department, frowning at the films clipped to the viewing box. “What do you think?” she said.

“This CT scan looks normal,” said Dr. Chapman, the radiologist. “All the cuts appear symmetrical. I see no masses, no cysts. No evidence of bleeding into the brain.“ He glanced up as Dr. Thayer, the neurologist whom Claire had asked to be Noah’s physician, walked into the room. “We’re just looking at the CT scan now. No abnormalities that I can see.”

Thayer slipped on his glasses and surveyed the films. “I agree,” he said. “What about you, Claire?”

Claire trusted both these men, but this was her son they were discussing, and she could not completely relinquish control. They understood this, and were careful to share with her the results of every blood test and X-ray. They were now sharing their bewilderment as well. She could see it in Chapman’s face as he focused once again on the films. The light box cast back twin reflections of the X-rays on his glasses, obscuring his eyes, but his frown told her he did not have an answer.

“I see nothing here to explain the seizures,” he said.

“And nothing to contraindicate a spinal tap,” said Thayer. “Given the clinical picture, I’d say a tap is definitely called for.”

“I don’t understand. I was almost certain of the diagnosis,” said Claire. “You don’t see any indication of cysticercosis?”

“No,” said Chapman. “No larval cysts. As I said, the brain looks normal.”

“So are the blood tests,” said Thayer. “All except a slightly elevated white count, and that could be due to stress.”

“His differential wasn’t normal,” Claire pointed out. “He has a high eosinophil count, which would go along with a parasitic infection. The other boys had high eosinophil counts as well. At the time I didn’t pay attention to it. Now I think I missed the vital clue.” She looked at the CT scan. “I saw that parasite with my own eyes. I saw it come out of my son’s nostril. All we need is species identification.”

“It may have nothing to do with his seizures, Claire. That parasite could be an unrelated illness. Most likely it’s just a common Ascaris infection. Those can turn up anywhere in the world. I saw a kid in Mexico cough up one of those worms and expel it from his nostril. Ascaris wouldn’t cause neurologic symptoms.”

“But Taenia solium would.”

“Have they identified Warren Emerson’s parasite?” asked Chapman. “Is it Taenia solium?”

“His ELISA test should be done by tomorrow. If he has antibodies to Taenia, we’ll know that’s the parasite we’re dealing with.”

Thayer, still looking at the X-ray, shook his head. “This CT scan shows no evidence of larval cysts. True, it may be too early a stage to visualize yet.

But in the meantime, we have to rule out other possibilities. Encephalitis.

Meningitis.” He reached up and flicked off the light box. “It’s time to do a spinal tap.”

An X-ray clerk stuck her head in the room. “Dr. Thayer, Pathology’s on the line for you.”

Thayer picked up the wall phone. A moment later he hung up, and turned to Claire. “Well, we have an answer on that worm. The one that your son expelled.”

“They’ve identified it?”

“They transmitted photos and microscopic sections online to Bangor. A parasitologist at Eastern Maine Medical Center just confirmed the ID. It’s not Taenia.”

“Is it Ascaris, then?”

“No, it’s from the Annelida phylum.” He shook his head in bewilderment. “This has to be a mistake. Obviously they’ve misidentified it.”

Claire frowned in puzzlement. “I’m not familiar with Annelida. What is it?”

“It’s just a common earthworm.”

Claire sat in the darkness of Noah’s hospital room, listening to her son rock side to side on the bed. Since the spinal tap earlier that evening, he had continued to fight against his restraints, and had dislodged two JVs. Mayer had finally relented to the nurses’ requests and allowed them to administer a sedative. Even with sedation, even with the lights turned off, he didn’t sleep, but continued rocking back and forth, uttering curses. It exhausted her just to hear his ceaseless struggle.

A little after midnight, Lincoln came into the room. She saw the door swing open, the light spill in from the hall, and recognized his silhouette as he hesitated in the doorway. He came in and sat down in the chair across from her.

“I spoke to the nurse,” he said. “She says everything is stable.”

Stable. Claire shook her head at the word. Unchanging was all it meant, a state of constancy, good or bad. Despair could be thought of as a stable condition.