Thursday, April 9, 12:48 A.M.
The door to Cluster 4-B was a pocket door, like the one to the NOC, only stouter. And like the door to the NOC, it was operated electronically, with a lever to the right of the frame. Michael pressed it and the door started to slide open.
Before they could see inside the room, they heard the intermittent whining of electrical motors and the clanking of heavy machinery. The noise had been completely muffled by the sound-insulated door and the walls. As the door opened all the way, Lynn and Michael were treated to a view of what looked like a completely mechanized, highly complex assembly line in an automobile plant, with robotic arms, and a forklift-like apparatus with oversize rubber tires connected to a constantly moving conveyor system. No staff was in attendance.
With some trepidation they entered, and the door automatically closed behind them. It was a large rectangular room about the size of a small theater, with a very high ceiling. The level of sound was so loud that they practically had to yell to hear each other. The air was warm and humid.
“Can you fucking believe this?” Michael half shouted.
“It’s like a futuristic horror movie,” Lynn yelled. She was taken aback, unsure if she truly wanted to see what was in front of her. “This is automated patient care taken to the nth degree.”
“And there are eleven other rooms just like it,” Michael said in awe.
The entire right side of the room was composed of a hundred angled but mostly horizontal Plexiglas cylinders in twenty-five vertical stacks of four. Each cylinder in each stack was about four feet in diameter and seven feet deep, separated from other ones on either side by a three-foot-wide metal grate. These grates formed a scaffold as a means of access for service, and could be reached by metal ladders that were attached. The opening to the lowest cylinder was waist high and the highest was near the ceiling. Each cylinder was numbered and had a computer monitor on an adjustable arm.
As Lynn and Michael stared in horror, they could now appreciate that about half the cylinders contained a patient, each naked save for the headgear resembling a football helmet that they remembered the mannequin wearing during their second-year introductory visit.
Suddenly, through an opening high up, on the left side of the room, a supine, naked, comatose patient entered the room moving quickly on the conveyor system. He, too, had a helmet. In a manner that reminded Lynn and Michael of a modern baggage-handling system at a major airport, the patient was rapidly transported to a specific area of the room not too far away from where they were standing. With some additional clanking and grinding noises the entire conveyor system adjusted to bring the patient just outside the proper cylinder, which was the top container in the sixth row. There, the robotic arms went to work to make all the appropriate connections for the feeding tube and other embedded lines. Once all the connections were set up, which happened surprisingly quickly, the patient was slid into the cylinder like a rocket being loaded into a launcher.
Before Lynn and Michael could respond to what they had just seen, the conveyor system noisily repositioned itself seven rows away from where it had deposited the first patient, and rapidly extracted a second patient from a different cylinder. Once this second body was completely in the open, the robotic arms went to work disconnecting the various lines. Then, following a reverse route from that of the first, the second patient was zipped out of the room. Everything was accomplished in just a few minutes.
“Good God!” Lynn exclaimed when she could find her voice. “This is obscenely mechanized. There’s no humanity, no dignity! It’s against everything medicine stands for.”
“Where the hell do you suppose the bodies are going?” Michael asked.
“God only knows,” Lynn said. At that point they were treated to a repeat of the sequence, with another body coming back from parts unknown. After that, another body was taken away. The students soon got the impression that what they were witnessing was a constant process, maybe even 24/7, of bodies coming and going.
Being careful to steer clear of the huge and very active business end of the conveyor system that unpredictably moved back and forth on its oversize tires and up and down in front of the cylinders, the two students approached the last stack. Despite their horror, they felt a morbid curiosity. The cylinder at waist level was numbered 100. The one immediately above it was 99. Approaching the mouth of the hundredth cylinder, they looked inside. The patient was female, lying on a series of moving rollers to keep pressure off any given spot. While they were watching, a sprinkler system was suddenly activated inside the cylinder, rinsing and disinfecting the woman. A sucking sound came from the base of the cylinder as the fluid was drawn off. From their vantage point, they could appreciate that the container was angled down at an incline of something like fifteen degrees.
“It’s like a freaking car wash,” Michael commented with a mixture of disgust and admiration. “Somebody’s put some real thought into all this.”
“I suppose that’s why their survival rate is so good.”
The monitor to the side of the cylinder showed the patient’s home page, which included her name, Gloria Parkman; her age, thirty-two; her location, Cluster 4-B 100; RANIBIZUMAB 3+ ACTIVE; and a long list of real-time vital signs and other extensive monitoring data. The monitoring was so extensive that the students intuitively understood that the patient had to have sensor chips implanted to make it possible. There were even real-time electroencephalogram tracings.
“Hey, I just remembered something,” Michael said. “Ranibizumab was in the ophthalmology lecture yesterday. It’s used for macular degeneration and is well tolerated without allergic problems.”
“If it is already an established drug, I wonder why they are giving it to her?”
“Good question,” Michael said. “Maybe there are still some allergic issues that the lecturer didn’t mention. But one way or the other, I’m beginning to think coming here might raise more questions than give answers.” Ducking his head, he moved down alongside the cylinder, between the cylinder and the wall. He was impressed by the constantly moving roller system that kept the patient’s body in motion while avoiding pressure point problems. It was a kind of massage system in a tube that encouraged circulation and protected the integrity of the skin.
“Hey!” Michael yelled to Lynn. “Come here! Look at this!” Lynn was still captivated by the monitor. She was marveling at the range of physiological data that was being followed in real time and possibly continuously run through a supercomputer.
Lynn squeezed in beside Michael. In the restricted space, the noise coming from the machinery in the room seemed even louder. Lynn tried to follow Michael’s line of sight and pointing finger. She was as impressed as he was with the roller system. “What am I supposed to be looking at?” she yelled.
“The catheter embedded in the abdomen! What do you think that could be for?”
“No idea. Do you?”
“No! But it looks to me like the abdomen is a bit distended. What’s your take?”
“Now that you mention it, it does look a bit bloated. You think they are running fluid into the abdomen? That’s not unheard of. The peritoneal cavity has quite a surface area and can even be used for dialysis.”
“True! Maybe she’s got a kidney problem. Let’s go back and look at the monitor and see if the kidney function is normal.”
Lynn backed out of the confined space first, followed by Michael. When they looked at the monitor, they could see that the kidney function was perfectly normal, including urine output. Then something from the long list of things under observation caught Lynn’s attention. She pointed to it. “This is strange. One of the stats gives her output of ascites fluid. They’re not putting anything into her abdomen with that catheter, they’re taking fluid out.”
“And she’s putting out a significant amount,” Michael said, looking at the same recording as Lynn. “The main cause of ascites is liver disease, yet her liver function is normal. Weird!”
“The second major cause of ascites is low blood protein, but hers is raised. Double weird.”
“Uh-oh!” Michael shouted. “Quick! Duck back into the cubbyhole!”
The massive conveyor system, with its oversize tires, suddenly came in their direction, its weight making the floor tremble and momentarily trapping them in alongside cylinder 100. In the adjacent stack, a body was extracted, robotically disconnected from its various lines, and whisked out of the room. Then the conveyor system trundled away for its next assignment.
A moment later, when they emerged from their shelter, Lynn surprised Michael by climbing the ladder to peer into several of the upper cylinders.
“I think we better move on,” Michael yelled up to her impatiently. “We are pushing our luck. With all this mechanical activity in here and bodies coming and going, somebody’s got to be minding this place with video surveillance.”
“I just wanted to check to see if any other patients have an intra-abdominal catheter,” Lynn said, already climbing back down. “And they all do in this stack.”
Michael stepped over to the next stack and peered in at the patient in the lower cylinder. “You’re right. Seems they all have it.”
“That’s got to mean something, but what?”
“Good question,” Michael said, “but we’ve got to break out, girl.”
“I’m not leaving until I see Carl,” Lynn said with a tone that brooked no argument.
“My personal opinion would be to let it go,” Michael said, placing his hand on her shoulder in hopes of restraining her. “Seeing Carl here is not going to help you or him. You know what I’m saying.”
“I don’t care,” Lynn said. She shrugged off Michael’s hand and started down the line of cylinders.
For a moment Michael hesitated, wondering if it was best that she go by herself for a bit of privacy with her stricken lover. But he quickly decided otherwise. It was hardly the proper environment for any attempt at intimacy, and he didn’t want to risk her getting emotional, which he thought was a significant possibility, knowing how he would feel if the situation were reversed and his girlfriend, Kianna, was one of the patients. He quickly caught up with her. As he did so, the forklift-like mechanism that pulled the patients in and out of the cylinders suddenly came in their direction.
The students had to flee back to the walkway that ran the length of the room against the wall opposite the bank of cylinders. The conveyor track taking the patients in and out of the room arched overhead.
After a patient was deposited in a cylinder close to where Lynn and Michael had been, the whole apparatus began moving to the opposite end of the room to pick up another.
“For the life of me, I can’t imagine why they are constantly moving these patients,” Michael yelled, going up on his tiptoes to try to get a peek into the black hole into which the conveyor track disappeared. “Or where the hell they are going.” When he turned back to Lynn, he saw that she was well on her way to cylinder 64. By the time he caught up to her, he could tell she wasn’t happy.
“He’s not here,” Lynn yelled over the continuous noise.
A quick glance confirmed for Michael that cylinder 64 was empty, although the monitor displayed Carl’s home page, so it was where he had been or was to be.
“Just as well,” Michael yelled back.
“Do you want to see if Ashanti is here?”
“I don’t see any point,” Michael said without hesitation. “For the tenth time, let’s get a move on.”
“All right,” Lynn said, but still she hesitated. She had suggested seeking out Ashanti as a way to stall. Her irrational side wanted to wait for Carl to be returned as part of the continuous stream of patients coming and going on the conveyor system. At the same time, Lynn’s rational side agreed with Michael that they needed to leave. For a moment she struggled with her indecision, and as she did so her eyes caught the various color-coded and labeled lines that would be robotically connected to Carl when he was brought back to monitor him and keep him alive. There was the intravenous line in blue, an arterial line in red, a gastrostomy line for nutrition in green, and an intraperitoneal line in yellow.
Michael grasped Lynn’s upper arm. “I know it’s tough for you to leave, but it isn’t going to be any easier if you see him. We have to go!”
“I know,” Lynn shouted with a degree of resignation. “But look! Carl already has an intraperitoneal line!” She pointed to the yellow connector. “Why? He certainly doesn’t have ascites. Not yet, anyway.”
“We can debrief when we get out of this freaking place. We’ve got a lot to process.”
“You know what I think?” Lynn said with sudden urgency and a renewed degree of horror.
“I don’t, but I can tell you are about to tell me. But tell me out in the hallway, where I can hear you. This racket in here is driving me crazy.”
“All right!” Lynn yelled. The noise in the room was beginning to get to her as well. She let Michael pull her toward the walkway. It was just in time, because the conveyor system suddenly lurched in their direction again. When they reached the walkway, Lynn turned back to make sure the patient that was being brought in was not Carl, as the machine positioned itself in front of Carl’s stack. But the patient went into cylinder 62, not 64.
Quickly, they retreated to the door they had used to enter the room. When it closed behind them, their ears were ringing in the comparative silence. Immediately Lynn blurted out, “I think I know what the hell Sidereal is doing. They’re not experimenting on these patients, like we thought. They are fucking using them in a much more perverse way!”
“Okay, okay,” Michael soothed. “What do you mean?”
“You remember how monoclonal antibody drugs like ranibizumab are made.”
“Sure!” Michael said. He was taken aback by Lynn’s sudden passion. He could hear it in her voice and see it in her eyes. “They are made by mice tumors called hybridomas.”
“Which are?”
“What is this, a freaking test? Tell me what you are thinking.”
“Answer my question! What are hybridomas?”
“A kind of cancer made by fusing mouse lymphocytes with mouse multiple myeloma cells and injected back into mice.”
“And where are they injected?”
“Into the abdomen.”
“And why are pharmaceutical companies required to jump through so many hoops to humanize the mouse-generated drugs?”
“To lower the chance of allergic reactions when they are taken by humans.”
Lynn stared at Michael without blinking, waiting for him to connect the dots. It was all there, hanging in the air.
“Mothafuckas!” Michael snapped after a moment when all the pieces of the puzzle fell into place in his mind. He shook his head with repugnance.
“It all fits,” Lynn said with equivalent disgust. “All of it. Sidereal Pharmaceuticals and Middleton Healthcare are in bed together. It’s why so many people going into Middleton Healthcare hospitals are getting gammopathies. It’s why their patients have such a sky-high incidence of multiple myeloma. And here in the Shapiro it’s one hundred percent. They must be using all thousand patients to make truly human monoclonal antibody drugs, which don’t have to be humanized. They are already human!”
“And, worse yet, they must be behind these anesthesia-induced comas,” Michael said. “It must be a new method of recruiting healthy bodies they can tap twenty-four/seven. I’m sorry I have to say this, because of Carl.”
“I’m afraid you’re right,” Lynn said. Her voice reflected both anger and loss. She took a deep breath to stay in control. “Carl’s vegetative state wasn’t an accident. I was afraid as much when I found the looping. Now I know for sure. What I can’t understand is why we didn’t see all this earlier. When I think about it, it’s been staring us in the face.”
“The question now becomes what to do,” Michael said. “Who do we turn to?”
“This is a major conspiracy,” Lynn said. “We can’t go to anybody here in the medical center. There is no way to know who is involved and who isn’t. We’ve got to go to Carl’s father, Markus Vandermeer, and we have to do it tonight. In fact . . .” Lynn pulled out her cell phone. When she turned it on, she immediately saw there was no service. “Damn! I’ll have to call him as soon as we get outside.”
“Let’s go!”
“Wait! As long as we’re in here, I want to at least glance into the so-called recreation space. That’s sick humor if I ever heard it. There can’t be anything recreational about this place, but my thought is that maybe Carl is there.” Lynn pulled out the floor plans and quickly studied them. “Okay! I see where we have to go. It’s really close, and will only take a minute.”