Endorphin Conspiracy, The (12 page)

Chapter 19

“I don’t mean to be melodramatic, Geoff, but I thought you’d want to see this in person. It’s pretty damn exciting,” said Suzanne, smiling as she handed Geoff the biochemistry report.

Geoff studied the long glossy, white sheets of paper, across which appeared rows of thick blue lines. Some lines were faded, almost clear, others a deep blue. To the left of each row were Greek symbols:
beta
,
delta
and
sigma
. The fourth row was preceded by a question mark. Geoff was confused.

“You paged me here to show me a chromatography assay, Suzanne? What’s the big deal?”

“Taken for granted once again. Must be my fate in life, Geoff. Wasn’t it just yesterday you were all hot-to-trot about endorphin assays? Or was it my imagination?” She pulled the sheet of paper from his hands. “Guess I’ll just file it away.”

“Endorphin assays?” Geoff grabbed the report from Suzanne and examined it, his interest rising.

“Our discussion yesterday got me thinking about it, so I ran it on all three patients—DeFranco, Jessica and Smithers. DeFranco’s tissue was a bit decomposed, but you can get a feeling for what’s going on, nonetheless. I didn’t expect to find
this
.”

Geoff studied the papers. “It’s been a long time since I’ve read a chromatography assay.”

Suzanne motioned Geoff to sit down beside her at her cluttered desk. She adjusted her glasses, brushed back her auburn hair, and crossed her legs, revealing just enough of her upper thigh to draw Geoff’s attention. She was an attractive woman.

She cleared her throat. “Here. Let’s take a look at the girl’s assay first. It’s a good representation. Highly abnormal, even considering her previously comatose state.”

She pointed to the first row and traced the line with her index finger. “The first row represents her delta-endorphin level. This is really a measure of her enkephalins, similar to but not quite the same as endorphins. Her level is within normal limits, nothing unusual there. I wouldn’t expect there to be anything out of the ordinary.

“Same goes for her
gamma
assay, also relatively normal,” she said, shifting her attention to the second row.

“Her
beta
-level, the sub-group of endorphins I’d expect to be sky high considering her recent coma, is actually somewhat low, nothing remarkable in and of itself, but suggestive, nonetheless.”

Suzanne shifted in her chair, tugged on her skirt. It had inched its way upward.

“Suggestive of what?” asked Geoff.

“Suggestive of competitive inhibition with whatever the question mark represents, and I think it represents something significant, just as you surmised.”

“Oh?”

“I think we’ve discovered a new endorphin!” she said proudly, looking up at Geoff with a victorious smile.

“Look here.” She pointed to the third line. “This light blue bar represents her
sigma
endorphin level.
Sigma
endorphin receptors are almost non-existent in normal brain tissue, except in angel dust junkies, speed freaks, and some schizophrenics. As you’d expect, she didn’t have much
sigma
endorphin activity.

“But look at this,” Suzanne continued, her level of excitement rising with each word, “right next to her
sigma
band is a super-dense concentration of a similar endorphin, one thousand times as concentrated as her
beta
level.”

Geoff’s eyes squinted in doubt. “Are you sure? I mean, could it be a mistake? Tissue from the wrong patient, a contamination on the chromatography strip, something like that?”

“Those were my first thoughts as well, Geoff. I ran a second, independent assay on another tissue sample taken from the same region of the brain. The results were identical, and the other two patients demonstrate similar patterns. This is a major neurochemical breakthrough, Geoff!”

“What implication does this have?”

“We may win the Nobel Prize for this if we play our cards right.”

“I mean for the cases we’re trying to figure out, here, Suzanne. The patients who died so suddenly when everything about their progress pointed toward recovery?”

“I’m sorry for getting so carried away, but this sort of thing doesn’t happen often.”

She straightened up in her chair, removed her glasses, placed the printout on the desk. “Well, it indicates an exceedingly high level of a
sigma-like
endorphin, emphasis on
like
. One with similar characteristics in some ways, probably different in others than a true
sigma
compound. This is virgin territory here. Your guess is as good as mine.”

“How closely related does it seem biochemically?”

“Close enough that someone might have missed it on casual inspection. But as you can see, it’s a real entity.”

“I mean are we talking about a difference in a single carbon atom or an entire group of amino acids?”

Suzanne studied the printout thoughtfully. “That’s impossible to tell from just a chromatography assay. I would guess one or two amino acids and probably a slight molecular conformational change. All it takes is one amino acid substitution to entirely change the functional ability of a protein. Just look at hemoglobin and sickle cell anemia. Valine for glutamic acid, and voila, abnormal hemoglobin.”

“Could this have been a mutation?”

“That’s possible, but not likely,” Suzanne said.

“Why’s that?”

“Several reasons. One being that the concentration of this
sigma-like
endorphin—let’s call it
sigma-b
—was about one thousand times the concentration of her
beta
endorphin level.
Beta
endorphins are known to be high in comatose patients, and their levels were high in these patients, though somewhat lower than expected. This
sigma-b
endorphin was being produced by the enzymes in their brains at a phenomenal rate, to the exclusion of other related endorphins.”

She paused. “What was each of the patients’ behavior like while they were in the hospital?”

“Like any other patients with head injuries in the intensive care unit, frightened and confused.”

“And prior to their head injuries?”

“We know they weren’t schizophrenic. They were ordinary people without medical or neurologic histories of any significance.”

“You said they were on the road to neurological recovery until each one suddenly went sour. Tell me about it.”

“Well, with Jessica, both her vital signs and her level of mental alertness had been stable for about forty-eight hours. She became agitated in the middle of the night, presumably from a bad nightmare. According to the nurse on nightshift, she let out a shriek so loud it could be heard in the ward one floor below. Jessica became increasingly agitated, frightened, confused. Then several hours later she lost consciousness and had a cardiac arrest.”

“How did her vital signs correlate with that?”

“That’s the fascinating piece of the whole puzzle. Around the same time she had a sudden meteoric rise in the intracranial pressure, followed by significant elevations of her heart rate and blood pressure. Then she coded. The other two patients had their head bolts pulled hours before their bizarre behaviors, so we don’t know what their intracranial pressures were like before they died.”

“Any theories?” Suzanne asked.

“It’s possible it was an adverse drug reaction of some kind.

At least in the girl’s case, about an hour before all of this occurred, she was supposedly given chloral hydrate sedative by the night nurse.”

“Supposedly given choral hydrate?”

“The nurse remembers receiving the ampule on the lift from the pharmacy, then drawing up the medication, but the pharmacy has no record of dispensing it.”

Suzanne removed her glasses, massaged the bridge of her nose. “Hmm. Interesting. Chloral hydrate has been known to cause an idiosyncratic reaction that can lead to a similar picture, the agitation and elevated heart rate, but not the sudden rise in intracranial pressure. Especially to that level. It just doesn’t fit, and the toxicology screen did not indicate any chloral hydrate in her system. What else could have caused the reaction? Think theoretical now. It doesn’t have to make sense.”

“An internally hemorrhaging brain tumor could do it, but nothing like that ever showed up on her MRI or PET scans.”

“I’ve sliced the brain completely. No tumor.”

“A ruptured aneurysm. Again, nothing on scans to correlate with that.”

“No aneurysm seen at autopsy, either.”

“Brain infection like meningitis, maybe,” he offered, shaking his head doubtfully. He was reaching.

“Nope, no signs of central nervous system infection. Anything else?”

“Not really. That list runs the gamut from the unlikely to the improbable.”

Suzanne suddenly looked up from the charts at Geoff. “What about the head bolt?” she asked, a gleam in her eyes.

“Bolts can’t cause the brain pressure to elevate. They’re just pressure monitors, unless they become infected and cause meningitis. You said there was no evidence of infection.”

“That’s not what I meant. Did anyone check the bolt to see if it was working properly? I mean, what if the pressure never really spiked like that?”

“They’re flushed and calibrated every night. Hers checked out fine. It’s documented in the nursing notes.”

“So you’re sure the pressure spike was real?”

“Yes.”

“You’re becoming pretty trusting in your old age, Geoff.”

“What are you getting at, Suzanne?”

“I guess that brings us back to the only way to figure out if
sigma-b
was a mutation or was somehow introduced.”

Geoff leaned forward in his chair. “Their PET scans.”

“That’s right. We’ve got to review them right away and see how they correlate.”

“I’ve got bad news, Suzanne. The hard copies are missing, the digitalized versions inaccessible.”

Geoff thought of his meeting with Stefan. The information was out there in cyberspace.

Chapter 20

“At least
I
couldn’t retrieve the data,” Geoff said. “Maybe
you
can.”

“I don’t get it, Geoff,” Suzanne said. “We’re both physicians at the Trauma Center. We should both have the same access.”

“We probably do, by and large, except for these cases. I think I’ve been selectively deleted from the loop on this stuff. If it’s true, we’ve got a whole lot more to worry about than I thought.”

Geoff walked over to the terminal in Suzanne’s office, sat down. “Here, let me sign on, I’ll show you.” He entered the Traumanet system, signed on to Neurad. Each attempt to retrieve the PET scans on the three patients failed, “insufficient data” the response. Geoff signed off the system. “Now you try.”

Suzanne leaned over Geoff’s shoulder, a wisp of her hair brushing his face. She pulled her chair over, sat down beside him, signed on to Neurad. Suzanne entered Jessica’s hospital number and waited. A digitalized image of a PET scan appeared on the screen.

“Damn. I knew it!” Geoff reached over and gave Suzanne a warm hug.

“Good going, Dr. Davis,” she said.

Geoff leaned closer to the screen. “Mind if I do this?” He reached for the mouse.

“Be my guest. This is your territory anyway.” Suzanne rolled her chair over a bit to make more room for Geoff.

Geoff checked the dates on each of the three images and placed them in order: Jessica’s admission scan followed by the scan right after her bolt placement, and finally, the last study, the one taken the night before she died.

He studied the first scan. “Looks like a radioactive carbon-11 study. This is the isotope I worked on in Balassi’s lab. We used it to measure endorphin receptor saturation.”   Geoff traced the outer area of the brain, the cerebral cortex. “This royal blue indicates a very low level of endorphins in her cerebral cortex. No surprise. But look here in her deep, reticular area,” he said, pointing out a small, linear region of fiery vermillion. “This saturation is consistent with her coma and a high level of
beta
endorphins.”

Suzanne studied the film closely, repositioned her glasses. “I don’t see any indication of a
sigma-like
endorphin here, do you?”

“No, I don’t.”

“Well, that’s proof against the mutation theory. She obviously had no significant
sigma
endorphins on admission.”

“Let’s look at the second scan,” he said, shifting his attention to the middle image. “If you look at the same cut of the reticular area, you can see that the
beta
endorphin concentration is fading. It’s now a light red, consistent with when she started awakening from her coma.”

“How do you explain this?” she asked, pointing to the third and final scan.

Geoff stared at the third image on the screen, his gaze riveted in astonishment. At the base of her brain, deep within her temporal lobes, blazed an iridescent red horseshoe.

“It can’t be,” he whispered in a hushed but incredulous tone. His attention jumped to the name at the top of the screen. It was Jessica’s scan, her hospital number; the date and time were all correct.

Suzanne seemed to know the scan was abnormal, but not to what extent. She looked to Geoff. “What does it mean, Geoff?”

“The amygdaloid horseshoe. It’s a pattern we see only in schizophrenics or someone higher than a kite on angel dust.”

Suzanne seemed confounded. “I thought you said she was a normal, healthy eight year old prior to the accident?”

“She was.”

Geoff moved on to the next image. The bright amygdaloid horseshoe seemed larger and more intense. His gaze followed the sequence of slices. The enlarging horseshoe had encompassed her entire brainstem, like a rapidly expanding mass or a ruptured aneurysm. He studied the subsequent frames: first the adjacent temporal lobes were engulfed by the spreading firestorm, then the entire cerebral cortex. “I’ve never seen anything like this—or have I?”

The entire brain, from the brainstem to the cortex, was aglow a searing red.

“Does this mean her brain was supersaturated with endorphins?”

“That’s right, Suzanne, but not just any endorphin.” He pointed to the last image on the screen. “There’s your
Sigma-b!
It’s consumed her entire brain substance! Let’s print this out.” Geoff clicked on the print command.

Suzanne studied the entire sequence of frames carefully. “I know this sounds strange, but it almost looks as though her brain is pulsating.”

Geoff grabbed the color printout of the PET scan, studied it carefully.

Pulsating. A pulsating brain.
Geoff remembered his hellish nightmare. “Oh, my God,” he whispered.

“What is it Geoff?” she asked in obvious concern.

“Kapinsky was right.”

“What?” She leaned forward.

“The rabbi. Do you still have his chart?”

“Are you okay, Geoff? What’s going on?”

“The rabbi, Suzanne. The chart I asked you to hold for me!”

“Yes, I have it. Now tell me what the hell is going on here!”

“I need another favor, Suzanne. See if you can pull up PET scans on a Jesus Romero and on the rabbi for me. The computer already denied my access to Romero’s file. Do it right away while you still have access to the data.”

“I think you’ve lost me, Geoff, and unless you fill me in on what’s going on, I’m not doing you any more favors.”

“Print out all the scans, and page me when you’re done. I’ll fill you in on everything, Suzanne, I promise.” Geoff turned to leave the lab, the hardcopy of Jessica’s PET scan in hand.

“Where are you going with that scan, Geoff?”

“I’m going to show this to Balassi. He’s got some explaining to do.”