Robin Cook: Harmful Intent

Clutching his briefcase, Jeffrey descended the Essex's front steps. He avoided stepping on the poor man who was still lolling on the pavement with his brown-bagged bottle. Jeffrey turned to the right. He planned to walk the five or six blocks to the Lafayette Center, which included a good hotel. There he'd find a cab.

Jeffrey was abreast of the liquor store when he spotted a police car heading in his direction. Without a moment's hesitation, he ducked into the store. The jangle of bells attached to the door wore on Jeffrey's nerves.

As crazy as it seemed, he didn't know whom he was more afraid of, the street people or the police.

"Can I help you?" a bearded man asked from behind a counter. The police car slowed, then went past. Jeffrey took a breath. This wasn't going to be easy.

"Can I help you?" the clerk repeated.

Jeffrey bought a pint-sized bottle of vodka. If the police cruised back, he wanted his visit to the store to appear legitimate. But it wasn't necessary. When he emerged from the store, the police car was nowhere in sight. Relieved, Jeffrey turned to the right, intending to hurry. But he pulled up short, practically

colliding with one of the homeless men he'd seen earlier. Startled, Jeffrey raised his free hand to protect himself.

"Got any spare change, buddy?" the man asked unsteadily. He was obviously drunk. He had a fresh cut just by his temple. One of the lenses of his black-rimmed glasses was cracked.

Jeffrey recoiled from the man. He was about Jeffrey's height but with dark, almost black hair. His face was covered with a heavy stubble, suggesting he'd not shaved for a month. But what caught Jeffrey's attention was the man's clothes. He was dressed in a tattered suit complete with a button-down blue oxford shirt that was soiled and missing a few buttons. He had on a regimental striped tie that was loosened at the collar and spotted with green stains. Jeffrey's impression was that the man had dressed for work one day, then never gone home.

"What's the matter?" the man asked in a wavering, drunken voice. "Don't you speak English?"

Jeffrey dug into his trouser pocket for the change he'd received from his purchase of vodka. As he dropped the money in the man's palm, Jeffrey studied his face. His eyes, though glassy, looked kind. Jeffrey wondered what had driven the man to such desperate circumstances. He felt an odd kinship with this homeless person and his unknown plight. He shuddered to think of how fine a line separated him from a similar fate. The identification was made easier since the man appeared to be close to

Jeffrey's age.

As he'd expected, Jeffrey hailed a taxi easily at the nearby luxury hotel.

From there it took only fifteen minutes to get out to Harvard's medical area. It was just a little after eleven when Jeffrey walked into the

Countway Medical Library.

Among the books and narrow study cubicles, Jeffrey felt at home. He used one of the computer terminals to get the call numbers for several books on the physiology of the autonomic nervous system and the pharmacology of local anesthetics. With these books in hand he went into one of the carrels facing the inner court and closed the door. Within minutes he was lost in the intricacies of nerve impulse conduction.

It wasn't long before Jeffrey understood why Chris had highlighted the word

"nicotinic." Although most people thought of nicotine as an active ingredient in cigarettes, it was actually a drug, more specifically a poison, which caused a stimulation and then blockade of autonomic ganglia.

Many of the symptoms associated with nicotine were the same as those caused by muscarine: salivation, sweating, abdominal pain, and lacrimation-the

very same symptoms that had appeared in Patty Owen and Henry Noble. It even caused death in surprisingly low concentrations.

All this meant to Jeffrey that if he was thinking of a contaminant, it would have to have been a compound that mirrored local anesthetics to an extent, something like nicotine. But it couldn't have been nicotine, thought Jeffrey. The toxicology report on Henry Noble had been negative; something like nicotine would have shown up.

If there had been a contaminant it would also have to have been in an extremely small, nanomolar amount. Therefore it would have to have been something extraordinarily potent. As to what that could have been, Jeffrey hadn't a clue. But in his reading Jeffrey stumbled across something he'd remembered from medical school, but had not thought of since. Botulinum toxin, one of the most toxic substances known to man, mirrored local anesthetics in its ability to "freeze" neural cell membranes at the synapse. Yet Jeffrey knew he was not seeing botulinum poisoning. Its symptoms were totally different; muscarinic effects were blocked, not stimulated.

Never had time passed so quickly. Before Jeffrey knew it, the library was about to close for the night. Reluctantly, he gathered up Chris Everson's notes as well as his own that he'd just made. Carrying the books in one hand and his briefcase in the other, he descended to the first floor. He left the books on the counter to be reshelved and started for the door. He stopped abruptly.

Ahead people were being stopped by an attendant to open their parcels, knapsacks, and, of course, briefcases. It was standard practice to keep the loss of books to a minimum, but it was a practice Jeffrey had forgotten about. He hated to think what the reaction might be if the library guard got a look at his stacks of hundred-dollar bills. So much for staying low profile.

Jeffrey doubled back to the periodical section and ducked behind a shoulder-high display case. He opened his briefcase and began tojam the packets of paper money in his pockets. To make room, he pulled the pint of vodka from his jacket side pocket and packed it in the briefcase. Better to let the guard think he was a tippler than a drug dealer or thief.

Jeffrey was able to leave the library without incident. He felt a little conspicuous with all his pockets bulging, but there was nothing to be done about it just then.

There were practically no cabs on Huntington Avenue at that time of night.

After he tried for ten minutes to no avail, the

Green Line trolley came along. Jeffrey got on, feeling it was more prudent to keep moving.

Jeffrey took one of the seats oriented parallel to the car and balanced the briefcase on his knees. He could feel all of the packets of money that were in his pants, particularly the ones he was sitting on. As the trolley lurched forward, Jeffrey allowed his eyes to roam around the car.

Consistent with his experience on Boston subways, no one said a word.

Everyone stared ahead expressionlessly as if in a trance. Jeffrey's eyes met those of the other travelers who were sitting across from him. The people who sullenly returned his state made him feel transparent. He was amazed at how many of them in his mind looked as if they were criminals.

Closing his eyes, Jeffrey went over some of the material he'd just read, considering it in light of the experience he'd had with Patty Owen and

Chris's with Henry Noble. He'd been surprised by one piece of information about local anesthetics. Under a section marked "adverse reactions," he'd read that occasionally miotic or constricted pupils were seen. That was new to Jeffrey. Except for Patty Owen and Henry Noble, he'd never seen it clin- ically or read it before. There was no explanation of the physiological mechanism, and Jeffrey couldn't explain it. Then in the same article it was written that usually mydriasis, or enlargement, of the pupils was seen. At that point Jeffrey gave up the issue of pupillary size. It all didn't make much sense to him and only added to his confusion.

When the trolley suddenly plunged underground, the sound startled Jeffrey.