Робин Кук: Cell

T he insulin molecules invaded like a miniature marauding army. Rapidly infiltrating the veins, they rushed headlong into the heart, to be pumped out through the arteries. Within seconds the invasion spread throughout the body, latching on to receptors on the cell membranes and causing the cellular gates for glucose to open. Instantly glucose poured into all the cells of the body, resulting in a precipitous fall of the glucose level in the bloodstream. The first cells to be adversely affected by this were the nerve cells, which cannot store glucose and need a highly regulated, constant supply of the sugar to function. As minutes passed and the insulin onslaught continued, the neurons, particularly those of the brain, rapidly became starved of their lifeblood glucose and their function began to falter. Soon they began either to send errant messages or to send none at all. Then they began to die...

WESTWOOD, LOS ANGELES, CALIFORNIA

MONDAY, APRIL 7, 2014, 2:35 A.M.

Kasey Lynch lurched awake. The nightmare had been a bad one, filled with progressing anxiety and terror. She was disoriented, wondering where she was. Then she remembered; she was sleeping in the apartment of her fiancé, Dr. George Wilson. She’d been staying at George’s place two or three times a week for the past month, whenever he wasn’t on call as a third-year radiology resident at the L.A. University Medical Center. He was sleeping next to her now. She could hear his soft, rhythmic, slumber-infused breathing.

Kasey was a graduate student specializing in child psychology at L.A. University, and for the past year she’d been volunteering in the pediatric department at the medical center. It was there that she met George. When she brought her pediatric patients into the radiology department for imaging studies, she immediately took note of George’s easy confidence and his way with patients, particularly children. The handsome face and crooked smile didn’t hurt, either. He was warm and personable, qualities she liked to think were part of her own personality. Just a mere four weeks before, they’d become engaged, although they still hadn’t set a specific date for the wedding. The proposal was a pleasant surprise, perhaps because of her careful nature in all things “permanent,” due to the reality of her health issues. But both she and George had been smitten, and they joked that the rapidity of their relationship was because they’d been unknowingly searching for each other for years.

But Kasey was not thinking any of this at 2:35 in the morning. Instead she knew instantly upon waking that something was wrong, very wrong! This was far worse than just a bad nightmare, especially because she was sopping wet with sweat. Having had type 1 diabetes since she was a child, she knew all too well what it was: hypoglycemia. Her blood sugar was low. She had experienced it on a number of occasions in the past and knew she needed sugar, and needed it fast.

Kasey started to get up, but the room began to spin. Her head flopped back against the pillow as a brief overwhelming dizziness engulfed her and her heart pounded rapidly. Her hand groped for her cell phone. She was always careful to have it within reach and had left it charging on the bedside table. Her thought was that she would speak with her new doctor for reassurance while she ran to the kitchen to get some orange juice. The new physician was incredible, available even at this hour.

As her dizziness lessened she sensed this episode was worse than usual, probably because she had been asleep, giving the problem a chance to progress much further than it would have had she been awake and able to recognize the earliest symptoms. She always kept some fruit juice on hand for just this kind of an emergency, but she had to get it. She tried again to get up, but she couldn’t. The symptoms were progressing with horrifying rapidity, draining the strength from her body. Within seconds she was helpless. She couldn’t even hold on to her phone. It slipped from her fingers and landed on the carpet with a dull thud.

Kasey quickly realized she needed help and tried to reach over to wake George, but her right arm seemed to weigh a ton. She couldn’t even lift it off the bed, much less across her body. George was lying so close, but facing away from her, completely unaware of her swiftly deepening crisis. Using all her energy, she tried again, this time with her left arm; all she could manage was to extend her fingers slightly. She tried to call his name, but no sound came out. Then the dizziness came back with a vengeance, even worse than it had been moments earlier. Her heart continued to pound as she struggled to suck air into her mouth. It was getting harder and harder to breathe; she was being progressively paralyzed and suffocating as a consequence.

At that point the room started to spin faster, and there was ringing in her ears. The sound kept growing louder as darkness descended around her like a smothering blanket. She couldn’t move, she couldn’t breathe, she couldn’t think...

George’s smartphone alarm went off a little after 6:00 A.M., rousing him from a peaceful sleep. He quickly turned off the alarm and slipped out of bed intent on not disturbing Kasey. It was their routine. He wanted her to sleep to the last possible moment, since she frequently had trouble falling asleep. He padded over to the bathroom, taking his phone with him. As with most people nowadays, the device never left his side. Ensconced in the tiny room, he showered and shaved in just under his usual ten minutes. He was proud of his self-discipline; it had served him well throughout his seven years as a medical student and resident — a grueling endurance race in which “survival of the fittest” was much more than just an abstract turn of phrase.

Six twenty A.M.! Time to wake Kasey. He opened the bathroom door while briskly drying his hair and noticed that her eyes were open, staring up at the ceiling. That was unusual. Kasey was a heavy sleeper; it often required several attempts to rouse her.

“Been awake long?” George called, still drying his hair with his bath towel.

No response.

George shrugged and went back into the bathroom to brush his teeth, leaving the door ajar. He wasn’t surprised that Kasey was in a kind of trance; he’d seen it before. When she was really concentrating on something, she had a tendency to zone out. Over the past couple of weeks she’d been consumed in a struggle to come up with a topic for her PhD thesis. So far she hadn’t been successful. They’d just had a long talk about it last night before George had nodded off to sleep.

He walked back to the bedroom. Kasey hadn’t moved a muscle. Odd. He approached the bed, still brushing his teeth, trying to keep from drooling on himself.

“Kasey?” He half gurgled. “Still worried about the thesis?”

Again, there was no response. She was staring upward, unblinking, with what looked like dilated pupils.

A shiver of fear shot down George’s spine. Something was wrong; something was terribly wrong! She was much too still. Panicked, George yanked his toothbrush out of his mouth and bent over the bed. Was she having a seizure?

“Kasey! Can you hear me? Wake up!” He grabbed her shoulders and gave her a firm shake, sensing an abnormal stiffness in her body. That was when he realized she wasn’t breathing!

“Kasey, honey! Please, please, God...” George leaped onto the bed, searching for a pulse in Kasey’s neck. The coldness of her skin unnerved him. He fought back a growing dread as he tore back the covers to start CPR. On the very first attempt, he sensed an unusual resistance and noticed her eyes were not just open, they were frozen that way.