Rupture Read online

  Three other wheel-chaired occupants sat facing a square, paved basketball court with only one goal. Two younger male attendants were shooting baskets and horsing around. Neither Henry nor any of the others spoke a word. They all smoked and watched the players as if it were a professional game.

  Eli walked to Henry’s side, bent down by his wheelchair, and placed a hand on his right shoulder.

  “Hey, buddy.”

  Henry looked at Eli, then quickly back at the game. No one else responded.

  But as Henry brought the cigarette to his lips, Eli saw a brief smile vanish to a pucker. A long drag seemed to satisfy him immensely. Henry dropped the butt at his feet and fished a pack from the front pocket of his shirt. Eli noticed a yellowing of his fingers and wondered if he were chain-smoking now. His straight brown hair was cut in an unimaginative bowl and his sideburns were long, not stylishly so, but continued with a slant toward his chin in fuzzy curls. Henry’s ears and neck were sunburned, as if all he did was smoke in the sun on a concrete deck, watching the trees or an occasional game of basketball.

  Eli did not expect Henry to speak to him. Since the day ten years ago that their mother had not come home from the hospital, his brother hadn’t spoken a word.

  CHAPTER SEVENTEEN

  GREEN HILLS STATE HOME

  3:10 P.M.

  Henry pulled another cigarette from the pack and took it to his lips with the grace and ease of a cardshark dealing a hand. But then his movements became awkward. Slowly, with ratcheting jerks, he extended his hand toward his brother. Eli looked at the pack, then at Henry, who blinked both eyes and nodded.

  During the movement, Henry had popped a cigarette out so that the butt projected unevenly. Eli pulled the cigarette from the pack and heard the strike and crackling burn of a match. Henry held the match as Eli took two quick puffs, orange embers glowing at the end of the cigarette. Except for the occasional celebratory cigar, Eli hadn’t smoked since college and he found the smell of burning tobacco and pine trees invigorating.

  Henry blew out a long stream of smoke and Eli felt a quiver of the wheelchair, a few seismic shocks before the quake. That’s when Henry began to shake. The wheelchair bucked violently. All culminated a few seconds later as Henry, with eyes closed as if to maximize the pressure and intensity, erupted with a forceful “eeeeeeee” that lasted through a full breath.

  Eli put his hand on Henry’s shoulder and he relaxed in the chair. The others continued smoking without so much as turning their heads toward Henry. Eli figured they had been around his brother long enough to know it was something Henry had to do, this release of pressure, a calming of the spirit.

  Eli knew that in his brother’s convoluted, cross-wired world, this was Henry, in his excitement, saying, “Brother, it’s damn good to see you.”

  The serenity of the moment was interrupted by the sound of footsteps. Eli turned to see a black male attendant approaching. He wore the odd combination of short white jacket and blue warm-up pants.

  “You here to get Henry?” he said as though expecting Eli’s visit.

  “To get him?” Eli questioned in return.

  “Yeah, you know, take him to his appointment.”

  “I don’t know what you’re referring to. Appointment?”

  The attendant looked at the cigarette in Eli’s hand. He realized the mistake and took a few steps back. “I’m sorry. You looked like one of them doctors come get him every month.” The attendant turned and left.

  The image of the device on the X-ray flashed in Eli’s mind, followed by a disordered, dream-like sequence of Henry being carted off to “appointments.”

  “Where do they take you, Henry?” Eli knew his question would not be replied to. But he also knew that the home was required to keep detailed records of any time an occupant went off the property. “Come on, Henry. We’re going to find out.”

  The wheelchair rolled forward.

  “No,” Eli said and he cupped his hand behind Henry’s shoulder and pulled him forward. “You can walk.”

  Slowly, Henry stood but remained bent at the waist. He grimaced and pressed on his left groin.

  “What is it?” Eli asked.

  Henry eased back into the wheelchair, letting his bottom hit the seat hard before he sucked in another breath of smoke. This time, the others watched as Henry was rolled inside the building. Eli pushed fast and Henry responded with deep humming noises, like a truck climbing a hill.

  In the room, Eli pulled the thin curtain between the twin beds and Jimmy, whose head was out from the covers, was staring at the wall. He helped his brother to a sitting position on the bed. Gradually, Henry extended his left leg, then reclined hard against the pillow with a forceful expiration. Eli removed the John Deere cap and set it on the bedside table. Henry quickly retrieved it and put it on again.

  Other than wrestling as kids and sleeping in the same bed, he had not had physical contact with his brother. He’d never examined him as a doctor. Touching Henry’s body seemed off limits somehow. Although Eli had longed for a more intimate relationship with his older brother, that relationship seemed out of reach.

  However, no matter what it took, Eli could not leave without knowing the source of Henry’s pain. Of all the patients Eli had examined, this exam would seem the most awkward. He peeled back the waist of his brother’s pants and Henry grabbed his hands.

  “Yes, Henry. Got to.”

  Eli unzipped Henry’s jeans and pulled them down enough to see a bruise across his left groin, a dark blue bull’s-eye fading to peripheral rims of yellow. In the center, just below the inguinal ligament, he discovered puncture marks. The deepest wound was closed with two silk sutures as though a large-bore catheter had been inserted and removed.

  What the hell?

  Eli covered Henry with a corner of the wrinkled sheet and went straight to the central office. A young woman with a metal ring piercing one eyebrow sat at the desk with a cup of coffee, reading a magazine. The director’s assistant. She stood as Eli abruptly entered the office door.

  Eli tried to remain calm while inquiring about the marks on Henry’s leg. The woman tried to explain that Henry had been ill.

  “He doesn’t look sick,” Eli said. “Why haven’t I been told about these doctor visits?”

  She rolled the magazine tight in her hands and used it to point at a stack of papers on the desk. “I’m sorry, but we have your signature to release him for every appointment.”

  Eli stayed with Henry for the rest of the afternoon, trying to make sense of why his brother needed monthly appointments with a doctor. But the paperwork trail was either absent or bewildering, and no one seemed to have an answer. Eli had examined “his” signatures closely. It was the best forgery job he had ever seen. Finally, he gave up and left for Memphis.

  In the parking lot of Green Hills State Home, his cell phone rang again. This time it was a familiar voice, proving that the hospital operator would give his private number to anyone—even violent mothers.

  “Hi Meg.”

  “I’ve got some new data on the Gaston case. Got a minute?”

  The word “case” struck Eli with different meaning now, straight from Meg’s stint with the ME’s office, as if the two of them were part of a crime investigation unit. He unlocked his Bronco and let the July heat inside exchange itself with the heat outside.

  “Sure, what is it?”

  “Where are you?”

  “I had to see my brother. I’m just now leaving.”

  “How is he?”

  “He’s fine at the moment.”

  “At the moment?” Meg asked.

  “There’s something wrong here,” Eli said, looking back at the unkempt facility. “I’ll tell you later. What do you have?”

  “Remember those cells I showed you? Around the holes in the aorta?”

  “Yeah, the funny-looking ones?”

  Her hesitation heightened his curiosity.

  “They’re not supposed to be there.”

&nbs
p; With his next question, Eli realized that all of his responses must sound cretin-like. “Where are they supposed to be?”

  “I haven’t figured that out yet, but I did some analysis on your funny-looking cells. Ever heard of matrix metalloproteinases?”

  “MMPs?” Eli said immediately. Now he was in familiar territory.

  Eli’s entire research effort at Vanderbilt had focused on matrix metalloproteinases or MMPs. He studied how breast cancer cells secrete the specialized enzyme to acquire invasiveness and metastasize to organs like the liver and lungs. He often wondered if the reason he had chosen the field of breast cancer research was the result of his mother’s death from the disease.

  “Yeah, I’ve heard of them,” he said, reveling in his chance to play dumb a while longer before blowing her away.

  “These cells are little MMP factories. They’re loaded with the stuff.”

  Eli searched his mental files. Most of his knowledge of MMPs centered on the deleterious effects of the enzyme when cancer cells were overzealous secretors. But then a file popped up on MMPs and aortic aneurysms. One of the enzymes had been implicated in weakening the aortic wall, thereby allowing an aneurysm to form.

  “Let me guess. MMP-nine.”

  “The PCR is still cooking,” Meg said, deflating Eli’s chance to shine. “But if it is number nine, you’ll be one lucky son of a —” Meg stopped to laugh uncharacteristically, “anatomy professor.”

  “Oh, you’re proud of that one, aren’t you?”

  “I have my moments.”

  Eli sighed. “Okay, so the cells make MMPs, probably just a reaction to the endograft.”Always the skeptic.

  “I don’t think so. We’re talking supraphysiologic levels. I mean, the enzyme ate holes in this guy’s aorta, for crying out loud. Basically killed him.”

  Eli knew that MMP-nine could be activated in the laboratory and that investigators were studying how the enzyme contributed to the development of aortic aneurysms, how it degraded the aortic wall until it ballooned out in a weakened state. But the body could not produce enough of the enzyme, under normal conditions, to blow out an aorta.

  “Meg, I appreciate your effort in his case, especially since I knew Gaston.” As he said this, Eli thought of the call from the Credentialing Office and Meg’s supposed employment history. “But you should focus on your job. I’d hate for there to be problems.”

  “Look Eli, his death bugs the hell out of me. Something’s not right. I just can’t prove it—yet.”

  Now she was talking like a medical examiner. Trying to prove things.

  “One more thing and I’ll hang up,” Meg said. “There’s another body here in the morgue waiting for autopsy. Death certificate says aortic rupture.”

  She waited, but Eli said nothing.

  “I checked out his X-rays from the file room, an abdominal film.”

  “Don’t tell me, the same kind of graft?” Eli waited through a silent drumroll.

  “You got it. See a pattern here? Better stop by when you get back to town.”

  CHAPTER EIGHTEEN

  HARBOR TOWN

  THURSDAY

  6:59 A.M.

  The limousine arrived at exactly seven o’clock. Eli watched from the front window of his house as it pulled up slowly to the curb. It was the standard length, not outrageously long, and business black. RBI in the familiar gold letters was stamped on the first passenger door. The driver got out, lit a cigarette, and leaned against the vehicle, facing Eli’s front door.

  When he had called RBI to arrange the meeting, Eli first gave his laboratory address. But he changed it to his home when he considered that Fisher might witness the limousine pick up.Why call attention to myself when I’m already in trouble?

  When he saw the auspicious limo complete with driver in a black suit and obligatory cap, Eli thought maybe this was just the attention he needed on the medical campus. Then he would get some respect.Who does that new guy, Branch, think he is?

  Eli wished that he had told Meg about his absence from the medical center. She would wonder, later this morning, why he wasn’t coming to see the body she had called about. But at this point, he didn’t want anyone, not even Meg, to know that RBI had requested his visit.

  “Dr. Branch?” the driver asked, crushing the cigarette butt with his foot.

  They shook hands briefly. Eli wasn’t sure if shaking the hand of your chauffeur was the proper thing to do but it seemed natural. He stepped into the limo, and his driver shut the door behind him. At his right hand, a steaming cup of coffee waited with a hot silver carafe next to it. Eli balanced a tiny pitcher of cream as the limo pulled away from the curb. He started to compliment the service when a solid black window rose behind the driver, isolating Eli in the back. Not much for conversation I guess. Mozart started abruptly and what Eli thought was a black window flashed on as a plasma video screen. The flipping RBI logo appeared and the classical piece became louder.

  The video was a sleek segment about the wealth of the company and how much RBI contributed to the health of society. It came off as superficial and self-congratulatory. Eli figured he was just one of many special guests riding in this limo who had to watch the instructional video, like a preparatory infomercial.

  Why am I doing this? What do they want with me?

  He watched the Memphis Pyramid as they passed it, a near-blinding spark of sun reflecting off the point. He had heard of physicians leaving their practice to become scientific directors of biopharmaceutical companies. But young surgeons were not usually on the short-list. Soon after the video ended, the plasma screen descended and cigarette smoke poured out.

  “Dr. Branch,” the driver said, looking into the rearview mirror. “I got a call from RBI. Mr. Stone was scheduled to arrive from D.C. on his early morning flight.” The matter-of-fact tone suggested this was a frequent occurrence. “But his plane’s a few minutes late. They have arranged a tour of the facility for you until he arrives.” The driver looked again in the mirror as if to confirm that the information had been received.

  “Okay. Thank you.”

  His flight? Eli envisioned a Lear jet with RBI stamped on the wing. This was the first Eli was hearing of any agenda for his day. He had assumed that he would meet with Stone, but the tour was apparently a change in plans.How long will this take? Eli thought of Meg and the body-in-waiting.

  “Excuse me,” Eli said when the black window began to close again. But it shut before he could ask any questions. Limited, one-way communication. It seemed to be the trend.

  The limo gained speed on the Hernando-Desoto Bridge, and Eli looked back at the line of buildings and shops along Riverside Drive. Freight trucks were backed up to the loading docks and an owner was opening his store for early-morning patrons.

  Below the bridge, the river appeared as a mass of shifting land, rippled brown water moving toward the Gulf like a nation itself. To the north, Eli could see the hazy border of Sand Dollar Reef surrounded by mist that rose from the water, soon to be scorched by a July sun. A barge trudged toward a channel that led around the side of the island.

  Sand Dollar Reef was an eleven-acre, vine-infested mound of mud that somehow held its ground and forced the largest river in North America to part its waters around the jagged shore. The isolated land mass sat in the middle of the river between Arkansas and Tennessee, just north of the Hernando Desoto bridge carrying Interstate 40 west. It was not a reef, nor was a sand dollar ever found in the mud. RBI had poured an excessive amount of money into clearing the land, reinforcing the river bank, and replacing all but a concealing perimeter of trees with concrete.

  The piece of land had often been associated with misfortune. Eli remembered the five o’clock news stories from his years as a medical student; a barge run aground into its boggy banks or a homicide victim’s body found weeks after buzzards had eaten the eyes. In earlier years, the island served as a site of prison camps for some of the Mid-South’s most hardened criminals.

  In downtown bars
and along Beale Street, a popular specialty drink was the Sand Dollar Slew, so named because the mixture of coffee, Kahlua, and Jack Daniel’s, when topped with a rim of whipped cream, looked like foam on muddy water. There was even a song that celebrated the life of the island’s only known inhabitant. More fraternity chant than song, the tune was most appreciated after several drinks.

  Eli began to recite it to himself, like a poem, in nervous repetition. When he thought about the words, he realized the song was appreciated only very late at night, after many, many rounds.

  Sand Dollar Jennie lives out on the Reef.

  Smells like a slew but she sure can screw.

  Go Jennie, Go Jennie.

  Screw, Screw, Screw.

  The limo traveled into West Memphis, Arkansas, a land of factories, trucking companies, and greyhound racetracks. Eli felt a nauseous twinge of the unknown, as though he were leaving home.

  They crossed the narrow bridge to the island and turned onto a concrete drive. A line of willow trees seemed to obscure the view rather than provide scenic relief. A guardhouse was positioned in the center of the road with gates blocking vehicles coming or going. A uniformed guard stepped out of the house and motioned for the limo to stop. He was a large man, with bulky shoulders and overdeveloped forearms, like a professional wrestler. When the driver opened the passenger door, Eli noticed a holstered pistol at the guard’s side.

  “We need to step out here for a few minutes,” the driver said.

  Eli complied, as though he had a choice, and was escorted into the guardhouse.

  “Just a formality required by RBI security,” the driver assured him.