Bloodstream (35 page)

“There’s nothing in his history about foreign travel,” said Claire. “He told me he’s lived all his life in this state.”

“Which would make it a truly unusual case. I’ll run antibody tests to confirm this is the right diagnosis. If it is
Taenia solium,
he’ll have a positive ELISA test on his serum and CSE Is there any history of an initial inflammatory response? Symptoms that might tell us when he was first infected?”

“What symptoms, specifically?” asked Rothstein.

“It could be a clinical picture as dramatic as full-blown meningitis or encephalitis. Or new onset epilepsy.”

“His first seizures occurred sometime before age eighteen”

“That’s one clue.”

“What other symptoms might show up?”

“Subtler signs, possibly. It can mimic brain tumors, cause a variety of psychiatric disorders.”

The back of Claire’s neck was suddenly tingling. “Violent behavior?” she asked.

“Possibly,” said Clevenger. “I didn’t see that specifically mentioned in my references. But it could be a sign of acute illness.”

“When Warren Emerson was fourteen years old,” said Claire, “he murdered both his parents.”

The men stared at her. “I didn’t know that,” said Rothstein. “You never mentioned it.”

“It wasn’t relevant to his medical condition. At least, I didn’t think so.” She looked down at the microscope, the image of the parasite still

vivid in her mind.
An initial infection of parasitic eggs, followed by symptoms of encephalitis. irritability. Even violence.

“It’s been a long time since medical school,” she said. “I don’t remember much about
Taenia solium.
What’s the life cycle of this organism?”

“Taenia solium
is a cestode,” said Clevenger. “A tapeworm that usually lives in the intestinal tract of its host. People get it by eating undercooked pork that’s been infected with the larvae. The larva has sucking caps that hook on to the wall of the human small intestine, which is where it sets up housekeeping, absorbing food. The worms can live there for decades without causing symptoms, and grow as long as three meters—over nine feet long! Sometimes the worms will be passed or expelled. You can imagine what it’d be like to wake up one morning and find one of those critters lying in the sheets with you.”

Rothstein and Claire exchanged slightly nauseated glances. “Sweet dreams,” muttered Rothstein.

“So how does the larva reach the brain?” asked Claire.

“It happens during a different part of the worm’s life cycle. After the worm matures to adulthood in the human intestine, it begins to produce eggs. When those eggs are passed, they contaminate soil and food sources. People ingest them, the eggs hatch and penetrate the intestinal wall, and are then carried through the bloodstream to any number of organs, including the brain. There, after a few months, they develop into larvae. But it’s a dead end, because they can’t grow in that confined space, without nutrients. So they just sit there until they die, forming little cystlike pockets in the brain. The cause of this patient’s seizures?’

“You said these eggs contaminate the soil,” said Claire. “How long can the eggs stay alive outside of a host?”

“A number of weeks.”

“What about in water? Could they stay alive in a lake, for instance?”

“It’s not mentioned in any of my reference books, but I suppose it’s possible.”

“Would the
Taenia solium
ELISA test be a screen for infection? Because we should order it on another patient. A boy at the Maine Youth Center.”

“You think there’s
another
case in this state?”

“Maybe a number of other cases in Tranquility It would explain why so many of our children are suddenly showing violent behavior.”

“An epidemic of cysticercosis in Maine?” Rothstein looked skeptical. Claire’s excitement was rising. “Both the boys I admitted had the same abnormality in their white blood cell count: a high percentage of eosinophils. At the time, I thought it was because of asthma or allergies. Now I realize it was caused by something else?’

“A parasitic infection,” said Rothstein. “That raises the eosinophil count.”

“Exactly. And Warren Emerson could be the source of the infection. If he’s been harboring a nine-foot tapeworm in his intestines, then he’s been shedding parasitic eggs for years. A leak in his septic tank would contaminate the soil and groundwater. The eggs would find their way into the lake, exposing anyone who swims there. Anyone who accidentally takes in a gulp of water.”

“That’s a lot of
ifs,”
said Clevenger. “It’s a house of cards you’re building.”

“Even the time frame makes sense! The kids would have been infected during the summer, when they swam in the lake. You said the eggs take several months to develop into larvae. Now it’s fall, and the symptoms are just starting to show up. A November syndrome.” She paused, suddenly frowning. “The only thing I can’t explain is their negative CT scans.”

“Maybe it was too early in the infection,” said Clevenger. “During the acute symptoms, the larvae may still be too small to detect. And there wouldn’t be any cyst formation yet.”

“Well, there’s a simple screen for the parasite,” added Rothstein. “The ELISA test.”

Claire nodded. “If anyone shows antibodies to
Taenia solium,
then this theory is more than just a house of cards.”

“We can start by testing Warren Emerson,” said Rothstein. “And that boy at the Youth Center. if they both come back negative, that kills your theory right there. But if they’re positive.
.

Clevenger, ever the scientist, eagerly rubbed his hands at the possibility “Then we’ll get out the needles and tourniquets, folks,” he said. “Because there are a whole lot of arms we have to poke.”

20

J.D. was jeering at her through her bedroom door, calling her a slut, a cheap lay, a whore. Amelia sat on the bed with her hands clapped over her ears, trying to shut out her stepbrother’s voice, knowing that if she yelled back at him, it would only make things worse. J.D. was mad at everyone these days, looking to pick a fight with whoever was in reach.

Yesterday, the day he’d been sent home from school, she’d made the mistake of calling him a bastard. He’d slapped her so hard her ears had rung for hours. She’d run sobbing to her mother, but of course there’d been no support from Grace. “You know how he is,” Grace had said in her I’ve-got-troubles-of-my-own voice. “just stay away from him.”

All day, Amelia had kept her distance by locking herself in her room and trying to concentrate on her homework, but now it was impossible to think. Earlier that day she’d heard J.D. raise hell downstairs, shoving Eddie around, yelling at Morn, even yelling at jack. Maybe one of these days jack and J.D. would kill each other. Like father, like son. She wouldn’t mourn either one of them.

But now J.D. stood out in the hall, insulting her through the door. “You like tiny weenies? That why you doing it with that loser, Noah

Elliot? I’ll show you a big dick! I’ll show you how it’s done! Or do you want Noah’s little weenie?” He laughed, and began chanting, “Little weenie! Little weenie!” until even Jack had had enough and he veiled up the stairs, “Shut up, J.D.! I’m trying to watch TV!”

At which point J.D. went tearing downstairs to pick a fight with Jack. Amelia could hear them in the living room, their voices crescendoing to shouts. One big happy family. Now things were being knocked onto the floor. She heard furniture thudding, glass breaking. Jesus, how much worse could it get? Her mother was part of the chaos now, sobbing about her precious broken lamp. Amelia looked down at the school books spread open on her bed, at the list of assignments she’d hoped to complete by Monday, and knew she couldn’t possibly finish them. I should have gone to the dance instead, she thought. If I can’t do my homework, I might as well have some fun tonight.

Except the dance wouldn’t be any fun either, since Noah Elliot wasn’t there.

She heard another lamp smash to the floor, then her mother wailing: “Why don’t you do something, Jack? Why don’t you ever do anything?” There was a loud slap, and then Grace was sobbing.

In disgust, Amelia stuffed her books in her backpack, grabbed her jacket, and stalked out of her room. They didn’t even hear her come down the stairs. She caught a glimpse of the living room, the floor littered with broken glass, J.D. red-faced and huffing like an angry hull as he faced his father and stepmother.

Amelia slipped out the front door and into a snowy night.

She began to walk down Toddy Point Road, not caring at first where she was going, just wanting to get away from
them.
By the time she’d passed the boat ramp, the cold was starting to penetrate her clothes, and melting snow dripped down her face. She had to go
somewhere,’
walking aimlessly on a night like this was stupid and dangerous. But there was only one place she really wanted to go, one home where she knew she’d be welcomed.

Just the thought made her heart lift. She walked faster.

Since when did schoolgirls go out in public wearing fancy underwear? wondered Lincoln as he watched the students gather on the

dance floor. He remembered the school dances of his own youth, the girls in their shiny hair and pastel dresses and satin miniskirts. Tonight the girls looked like a gathering of tarted-up vampires in their black lace and spaghetti straps. A few of them had painted their lips black too, and with their white winter faces, they reminded Lincoln of corpses wandering around the murky gym. As for the boys, well, they were just as likely to be wearing earrings as the girls were.

Pete Sparks, standing beside him, said, “You’d think they’d catch pneumonia in those getups. Can’t believe their mothers let ‘em out looking like that.”

“I bet their mothers have no idea,” said Lincoln. He had seen many of the girls arrive modestly dressed, only to duck into the bathroom and emerge stripped down to the skimpiest of outfits.

Loud music suddenly blasted from the speakers in a driving beat. After only a few minutes of that racket, Lincoln was desperate to escape.

He stepped through the double doors of the gym, into the relative peace of a cold night.

The snowfall was gentle, just a fluttering of silver past the street-lamp. Standing beneath the building’s overhang, he turned up his jacket collar and gratefully inhaled air that was sharp and clean.

Behind him, the door opened and shut, and he heard Fern say, “Too much for you too?”

“I had to take a breather.”

She came to stand beside him. She was wearing her coat, which meant she’d come out with the intention of staying for a while.

“Does it ever feel like it’s all just too much responsibility, Lincoln? Like you’re ready to call it quits and just walk away?”

He gave a rueful laugh. “At least twice a day.”

“Yet you’re still here.”

He looked at her. “So are you.”

“Not because I want to be. It’s because I don’t see any alternatives." She looked up at the falling snow, and said softly, “Doreen doesn’t deserve you. She never did.”

“It’s not a matter of people deserving good luck or bad, Fern.”

“Still, you should’ve had better. All these years, I’ve watched how miserable she’s made you, and I kept thinking how unfair it was. How selfish she was. Life doesn’t have to be unfair. We can choose happiness.” She paused, marshaling the nerve for what she had to say. He knew what it was; he’d always known, and had always avoided hearing the words spoken aloud, because he knew the aftermath would be humiliating for her, and painful for him. “It’s not too late for us,” she said.

He released a regretful sigh. “Fern—”

“We could pick up where we left off. Before Doreen.”

He shook his head. “We can’t.”

“Why not?”

He heard the neediness in her voice, the desperation, and he had to force himself to meet her gaze. “There’s someone else I care about.”

She took a step back, retreating into the shadows, but not before he’d seen the tears in her eyes. “I suppose I already knew that?’

“I’m sorry.”

“No. No, there’s no reason to be sorry” She shook her head and laughed. “It’s just the story of my life.”

He watched her turn back to the building. She paused to square her shoulders, regain her pride.
Why couldn’t Fern have been the one?
he thought. Had he fallen in love with her, had they married, it might have been a reasonably happy union. She was attractive enough, intelligent enough. Yet something between them had always been missing. The magic.

In sorrow he watched her cross to the gym door and pull it open. At that instant, the sounds of shouting and running feet suddenly spilled out the open doorway.

“What’s going on now?” said Fern, and she ran into the building with Lincoln right behind her.

Inside, they found mass confusion. The punch bowl had tipped over, and a pool of strawberry-colored liquid was spreading across the gym floor. The music was still pounding away, but half the students had retreated against one wall, where they milled together in alarm. Others were clustered in a circle near the sound system. Lincoln couldn’t see what was happening at their center, but he heard a loud-

speaker thud to the floor, and heard Pete Sparks and the chaperones all shouting: “Break it up! Back off, back off!”

As Lincoln pushed into the circle, another amplifier tipped over and splashed into the river of punch. There was a deafening squeal and the crowd clapped their hands to their ears, backing away as electrical sparks shot up.

In the next instant, the music died. So did the gym lights.

The darkness lasted only a few seconds, but in that brief pause before the emergency lamp came on, panic seized the crowd. Lincoln felt screaming kids slam into him in their rush to reach the exits. He couldn’t see who was coming at him, could only hear the sound of stampeding. He felt someone go down near his feet, and he blindly reached down and hauled a girl back up by her dress.

The emergency lamp at last flared on, one inadequate spotlight in the far corner of the gym. It was just enough light to see the shadowy chaos of running figures, kids stumbling back to their feet.