The pot was still filling, but he couldn't afford to wait. He needed to follow this line of thought now in case it eluded him again. Still contemplating it, he headed down the hallway to the lab.
Before he examined the medical records again, he needed to learn the standard protocol to know the routine for treating children with similar symptoms. This was exactly what he should have done from the start instead of opening the files and expecting something to jump out and bite him.
He resumed his station, found the number for Denver General, the largest and busiest hospital in the state, and dialed the emergency room. With the changes in health insurance over the last decade, he was certain they saw more than their share of pediatric patients.
A harried-sounding desk clerk answered after the eighth ring. Marshall identified himself and asked to speak to the charge nurse. A woman named Sandra picked up with a tone Marshall knew meant he had little time and she intended to be of even less help. She softened a bit when he explained why he was calling, and assured her that his investigation had nothing to do with her or her hospital.
"Just make it fast. We've got an MVA and a GSW en route, and I think just about every gerry in town has this stupid cough," she said.
"Will do, and thanks," Marshall said. "So what's the standard protocol for treating an eight to sixteen month-old infant with respiratory troubles, possible RSV?"
"We hook them up and check their vitals, especially pulse ox to make sure they're processing oxygen and it's reaching their bloodstream. We listen to breath sounds. Any hint of crackling or rales, or a pulse ox under ninety-two and they get a chest x-ray, which is evaluated for pneumonia or infiltrate. Sometimes we have to bring up their oh two in a hurry before we call for rays, so they get the neb."
"Neb?"
"Nebulizer. It's an Albuterol steroid treatment for the lungs to dilate the bronchi, reduce tissue inflammation, and help them more effectively re-oxygenate their blood. If we're dealing with an aggressive virus or infiltrate, it's almost a given."
"So it's a liquid converted to aerosol form?" He was familiar with the process of nebulization.
"Yeah. The Albuterol is in a small plastic container attached to a long, ribbed breathing tube. We run oxygen from the wall port straight into it and it produces what looks like steam."
"Do you take samples of the blood?"
"Generally only if we expect to find some sort of systemic infection. We can swab mucus membranes for most everything else."
"Not on every patient?"
"Nowhere near."
"What about for fever, pain-management?"
"Acetaminophen or ibuprofen, depending upon severity. And to answer your next question, by liquid suspension delivered orally."
"Single dose, factory-sealed containers?"
"Factory-sealed, but not single dose. We send the remainder of the bottle home with the patient." There was the sound of a voice over an internal speaker behind her. "Look, I've got to go."
"Can you think of anything else you would do for an infant like that? Any injections?"
"You want to try measuring doses and sticking an infant, you be my guest. We even send them to the clinics for inoculations," she said. "When it comes to kids, conservative is the rule."
"Thanks," Marshall said, but she had already hung up.
Armed with his new knowledge, he brought up the records on his laptop. All four girls had charted vitals. Blood pressure and EKG readings listed as within normal limits. Elevated temperatures between one hundred one and one hundred three. Low pulse ox readings between eighty-six and ninety percent. Each had been treated with either infant-strength Tylenol or Motrin for fever management. Chest x-rays had been performed in all cases, the radiologist's reports ruling out pneumonia and atelectasis, definitively confirming the presence of an RSV infiltrate. In each case, the recorded vitals were repeated after one hour to confirm stable BP, decreased temperature, and increased pulse oxygen levels following nebulizer treatment. Two hour vitals were logged, and all four patients were released within three hours of registration. None were admitted to any of the area hospitals and all received follow-up care with antibiotic therapy.
He couldn't conclusively reject the possibility of the injection of an uncharted substance, but the way Sandra had mocked his idea, he figured an injection would have been overly traumatic for the child and raised more than a few eyebrows. As the children had received their post-visit care from different pediatricians, that left three potential points of exposure: through the fever-reducing agent, the nebulizer, or the antibiotics. The prescriptions for the antibiotics would undoubtedly have been filled at different pharmacies in their home towns based on the inconvenience of their middle of the night treatments, but they could easily have been discharged with a sample packet after receiving the first dose at the clinic. He couldn't cross it off his list, but it seemed reasonably unlikely. The Tylenol and Motrin were both enteric, meaning they reached the digestive tract before being absorbed into the circulatory system. Subjecting a potential virus to such highly acidic conditions wasn't a sound risk, unless they were using contaminated medicine on all children and these were the only four that took. If that were the case, then whoever was monitoring the patients would have no way of knowing which subjects were positively infected without checking each and every one of the thousands of children that breezed through the clinic during the months of suspected exposure. It was a logistical impossibility. That left the nebulizer. It might have been sealed and self-contained, but if you could stick a tube into it, a needle wouldn't pose much of a challenge. Certainly airborne wouldn't be the most effective route of delivery for a retrovirus, but under ideal conditions, it was a remote possibility. It still boiled down to the fact that the best means of infection was through bodily fluids, and the only way he could see that was still hypothetical. Retroviruses weren't designed to spend any length of time exposed to the air outside of a host, even under the intensely aerobic conditions supplied by the nebulizer.
He was right back where he started.
Nowhere.
Marshall had been on a fishing expedition and he knew it. He still couldn't shake the feeling, however, that he was staring at the answer and just couldn't see it. Maybe he could track down the batch numbers of the antibiotics each of the girls had been prescribed, but there was no chance of following a paper trail to the pain relievers without there being an existing notation. And the nebulizer? Good luck digging up a piece of medical waste more than a decade old in hopes of testing--
What had Carver said about being on the lookout for anything relating to subsidiaries of a pharmaceutical conglomerate? He had definitely mentioned the name Dreck-Windham.
A quick internet search confirmed that Johnson and Johnson, the parent company of both Tylenol and Motrin, was in no way affiliated with Dreck-Windham. That still meant nothing. The virus could have been added after opening the bottles. He searched nebulizer manufacturers and returned a list of four companies producing Albuterol steroid solutions, two of which where wholly-owned subsidiaries of Dreck-Windham. And there were far too many variables regarding the manufacture and distribution of antibiotics to even begin a hunt for a contaminated batch from so long ago.
The nebulizer connection was something though. It may be completely random and unrelated, but it was still a thread he could grab, and with any luck a solid tug could unravel something more substantial. Before he could pursue the notion, he was going to have to figure out how a retrovirus needed to be altered in order for it to survive for any extended period of time outside a body, and how it needed to be changed to facilitate infection upon airborne exposure. Those were two very large variables, both of which, if intuition and his primitive understanding of viruses served, hinged upon the protein coat of the viral envelope.
VI
Flagstaff, Arizona
Ellie woke to the sound of commotion in the adjoining room, and all thoughts of sleep fled in an instant. Her eyes snapped open. At first she didn't recognize her surroundings, but as revelation slowly dawned, the reality of the situation returned. She sat up and nearly screamed at the sight of the man in the chair beside the bed. Heart pounding, all she could see was Emil's headless corpse under his desk, a flashback that led to the visualization of mummified remains bearing her face. She just wanted to go home, but where was home anyway? A tent in the middle of the Nazca Desert? She felt so alone, isolated from everything and everyone. Terrified. Nothing made sense. Were it not for Paxton's presence, she would have run crying into the night and just continued running until she was somewhere far away, anywhere but here. Paxton made her feel somewhat safer. He always had. She just didn't trust coincidence, and finding him here after so many years, while reassuring, stretched her belief in fate and exaggerated her natural suspicion. And now she was about to board a plane to Seattle?
She heard voices from the other room and crept to the doorway. Sitting against the wall between the rooms, just out of sight, she listened intently, hoping to overhear something that might help her understand her current situation.
"Not until you tell me how this involves Ellie," Paxton said. His voice was sharp-edged, angry.
She leaned forward just enough to see through the crack between the door and the jamb, and lowered herself to the floor.
"I told you they separated the children of Auschwitz. They thought they had hidden them well enough," Hawthorne said. "Those children grew into adults. Married. Had kids. Lived completely normal lives. Most are even still alive today, men and women fully aware of their unique heritage and committed to keeping their past a secret for the safety of their families."
"So Ellie's descended from one of them?"
Ellie knew a little about Auschwitz, but she had never discussed anything about it with her mother. She thought for a moment. There was no way her mother could have been there. She hadn't been born until 1951.
"I'm getting there," Hawthorne said. "I said they
thought
they had hidden the children well enough. They were wrong. In 1968, Vaclav Korolenko was killed in a car collision in Buffalo. He was one of the men in my grandfather's unit, one of the men entrusted with the task of protecting their charges. The accident had seemed random, but we suspect this was when his records were compromised. Nothing happened for more than a decade after that, and they thought no one knew anything. It was business as usual.
"By this time, the children were in their thirties. Of the nineteen that survived, fifteen were married. Twelve had children, and despite the odds against it, five had produced twins and a sixth was pregnant with them. Twins are supposed to skip a generation if you didn't already know. Perhaps it was the byproduct of their genetic manipulation. No one really understands why. Suddenly there were more than twice as many people to keep track of and protect, and only five men left to do so. None of them even suspected their security had been compromised. Not until intelligence pulled the name Henrich Heidlmann from a list of passports received at Belmopan, Belize. By then it was too late."
"Who's Henrich Heidlmann?" Paxton asked.
"He was a Blockführer at Auschwitz, a guard responsible for maintaining order among the prisoners. He was an eighteen year-old enlistee at the time and never saw the front lines. His tenure at the camp overlapped Mengele's by only six months, and he was long gone before the Russians even crossed into Poland. He was nowhere near the top of the list of Nazi war criminals and not even on the International Military Tribunal's radar, so he was never hunted for trial at Nuremburg. Apparently six months of working under the Angel of Death had made a lasting impression though.
"No one ever saw it coming."
Ellie wanted to stand up and tell them that they had to be talking about someone else's family. Her mother had been born in Boise, Idaho. Her grandparents had been French-Canadian immigrants who had died before Ellie was born. There were pictures for God's sake! She even had her family genealogy tucked away somewhere. She decided to let them talk. With every word they said she became increasingly certain that they were talking about someone else, that her involvement here was a mistake and they could send her back to her real life any time now.
"So far as we can tell," Hawthorne said, "they'd been planning the kidnappings since killing Korolenko. It was a simultaneous, coordinated strike. All of the second generation twins were taken on the same night. Eight year-olds from Savannah, Georgia. Two year-olds from Birmingham, England and Toronto, Ontario. Two sets of infants from Tampa, Florida and Little Rock, Arkansas. And one woman five months pregnant with the final pair from Langley, Virginia. With the exception of the expectant mother, all of the parents were killed on sight. What was left of them was found in their homes. There had been no further experimentation on them, no torture to extract information. They were executed and their offspring abducted. Just like that. The only parent who survived was the husband of the pregnant woman, a Colonel in the Army who had been on a tour through Iran during the Islamic Revolution and scheduled to return two days prior. His departure had been delayed following a resurgence in violence.
"It took them more than four months to find where the twins had been taken, even though the Colonel and the Foundation used every tool at their disposal. Through satellite recon and a paper trail of customs receipts for questionable equipment, they tracked Heidlmann to the remote jungles of Guatemala. Again, he was already gone when the Colonel's elite unit arrived. They found a laboratory under the ruins of a Mayan temple filled with the equipment, everything from microscopes to a primitive forebear of a gene sequencer. There were cryogenic freezers filled with tissue samples, both human and animal. All of them were infected with an unidentifiable virus, including the vivisected remains of the Colonel's wife. They found the children in a room down the corridor, only Heidlmann had known they were coming, and had taken one child from each set of twins with him."