Terminal

“Nearly everyone who’s post-surgery is on an IV,” Sean said. “It keeps people hydrated, plus if there’s a problem the medical staff has a route for medication. My guess is that Deborah Levy gave them an injection into their IV.”

“Of what?” Janet asked.

“An injection of St. Louis encephalitis virus,” Sean said. He told Janet about the positive test for the SLE virus in Helen Cabot’s cerebrospinal fluid. He also told her that Louis Martin had had transient neurological symptoms similar to Helen’s several days after his elective surgery.

“And if you look back at the charts,” Sean continued, “I think you’ll find most of these people had similar fleeting symptoms.”

“Why didn’t they get full-blown encephalitis?” Janet asked. “Especially if it was injected through their IVs?”

“That’s the truly clever part about all this,” Sean said. “I believe the encephalitis viruses were altered and attenuated with the inclusion of viral oncogenes. I’ve already detected two such oncogenes in Helen’s tumor. My guess is that I’ll find another. One of the current theories on cancer is that it takes at least three isolated events in a cell to make it cancerous.”

“How did all this occur to you?” Janet asked. It sounded too complicated, too involved, too complex, and most of all too hideous, to be true.

“Gradually,” Sean said. “Unfortunately it took me a long time. I suppose initially my index of suspicion was so low; it’s the last thing I expected. But when you told me they started immunotherapy with a specific agent from day one, I thought something was out of whack. That flew in the face of everything I knew about the specificity of immunotherapy. It takes time to develop an antibody and everybody’s tumor is antigenically unique.”

“But it was at the Betencourts’ that you started acting strangely,” Janet said.

“Malcolm Betencourt was the one who emphasized the sequence,” Sean said. “Elective surgery, followed by neurological symptoms, and then brain tumor. Helen Cabot and Louis Martin had the same progression. Until I heard Malcolm’s story, I hadn’t realized its significance. As one of my medicine professors said, if you are painstakingly careful in your history-taking, you should be able to make every diagnosis.”

“So you believe the Forbes Cancer Center has been going around the country giving people cancer,” Janet said, forcing herself to put into words her awful fear.

“A very special kind of cancer,” Sean said. “One of the viral oncogenes I’ve detected makes a protein that sticks out through the cell membrane. Since it’s homologous to the protein that forms the receptor for growth hormone, it acts like a switch in the ‘on’ position to encourage cell growth and cell division. But besides that, the portion that sticks through the cell is a peptide and probably antigenic. My guess is the immunoglobulin they give these people is an antibody for that extracellular part of the ERB-2 oncoprotein.”

“You’re losing me,” Janet admitted.

“Let’s give it a try,” Sean said. “Maybe I can show you. It will only take a moment since I have some of the ERB-2 oncoprotein from the Key West lab. Let’s see if Helen Cabot’s medicine reacts with it. Remember that I wasn’t able to get it to react with any natural cellular antigen. The only thing it would react with was her tumor.”

As Sean quickly prepared the immunofluorescence test, Janet tried to absorb what Sean had said so far.

“In other words,” Janet said after a pause, “what makes this medulloblastoma cancer so different is that not only is it manmade, it’s curable.”

Sean looked up from his work with obvious admiration. “Right on!” he said. “You got it. They created a cancer with a tumor-specific antigen for which they already had a monoclonal antibody. This antibody would react with the antigen and coat all the cancer cells. Then all they’d have to do was to stimulate the immune system both in vivo and in vitro to get as many ‘killer’ cells as possible. The only minor problem was that the treatment probably made the symptoms worse initially because of the inflammation it would undoubtedly cause.”

“Which is why Helen Cabot died,” Janet said.

“That’s what I’d guess,” Sean said. “Boston kept her too long during the diagnostic stage. They should have sent her right down to Miami. The trouble is that Boston can’t believe someone else might be better for any medical problem.”

“How could you be so sure of all this?” Janet asked. “By the time we got back here you hadn’t any proof. Yet you were sure enough to force the Masons over here by gunpoint. Seems to me you were taking a huge risk.”