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  MORTAL FEAR [154-066-4.5]

  By: ROBIN COOK

  Category: Fiction Medical

  Synopsis:

  No synopsis available.

  BERKLEY BOOKS, NEW YORK

  This Berkley book contains the complete

  text of the original hardcover edition.

  MORTAL FEAR

  A Berkley Book / published by arrangement with

  the author

  PRINTING HISTORY

  G. P. Putnam's Sons edition / January 1988

  Berkley edition / February 1989

  All rights reserved.

  Copyright @ 1988 by Robin Cook.

  This book may not be reproduced in whole or in part,

  by mimeograph or any other means, without permission.

  For information address: The Berkley Publishing Group,

  200 Madison Avenue, New York, New York 10016.

  ISBN: 0-425-11388-4

  A BERKLEY BOOK'~' TM 757,375

  Berkley Books are published by The Berkley Publishing Group,

  200 Madison Avenue, New York, New York 10016.

  The name "BERKLEY" and the "B" logo

  are trademarks belonging to Berkley Publishing Corporation.

  PRINTED IN THE UNITED STATES OF AMERICA

  10 9

  ACKNOWLEDGMENTS

  This book could not have been written without the

  support and encouragement of all my friends who have

  -helped me in a difficult time.

  You all know who you are, and you all have my heartfelt thanks.

  For my older brother, Lee, and

  my younger sister, Laurie.

  I've never been between two nicer people.

  PROLOGUE

  OCTOBER 11, WEDNESDAY P. M.

  The sudden appearance of the foreign proteins was the molecular

  equivalent of the Black Plague. It was a death sentence with no chance

  of reprieve, and Cedric Haning had no idea of the drama about to happen

  inside him.

  In sharp contrast, the individual cells of Cedric Haning's body knew

  exactly what disastrous consequences awaited them. The mysterious new

  proteins that swept into their midst and through their membranes were

  overwhelming, and the small amounts of enzymes capable of dealing with

  the newcomers were totally inadequate. Within Cedric's pituitary gland,

  the deadly new proteins were able to bind themselves to the repressors

  that covered the genes for the death hormone. From that moment, with the

  fatal genes exposed, the outcome was inevitable. The death hormone began

  to be synthetized in unprecedented amounts. Entering the bloodstream,

  the hormone coursed out into Cedric's body. No cell was immune. The end

  was only a matter of time. Cedric Harring was about to disintegrate into

  his stellar elements.

  The pain was like a white-hot knife starting somewhere in his chest and

  quickly radiating upward in blinding paroxysms to paralyze his jaw and

  left arm. Instantly Cedric felt the terror of the mortal fear of death.

  Cedric Harring had never felt anything like it.

  By reflex he gripped the steering wheel of his car more tightly and

  somehow managed to stay in control of the weaving vehicle as he gasped

  for breath.

  He'd just entered Storrow Drive from Berkeley Street in downtown Boston,

  and had accelerated westward, merging with the maddening Boston traffic.

  The images of the road swam before him and then receded, as if, they

  existed at the end of a long tunnel.

  By sheer strength of will, Cedric resisted the darkness that threatened

  to engulf him. Gradually, the scene brightened. He was still alive.

  Instead of pulling over, instinct told him his only chance was to get to

  a hospital as fast as possible. By lucky coincidence the Good Health

  Plan Clinic was not too far off..Hold on, he told himself.

  Along with the pain came a drenching sweat that started on Cedric's

  forehead but soon spread to the rest of his body. Sweat stung his eyes,

  but he dared not loosen his grip on the steering wheel to wipe it away.

  He exited the highway onto the Fenway, a parklike complex in Boston, as

  the pain returned, squeezing his chest like a cinch of steel wire. Ahead

  cars were slowing for a traffic light. He couldn't stop. There was no

  time.

  Leaning forward, he depressed the horn and shot through the

  intersection.

  Cars went by, missing him by inches. He could see the faces of the

  startled, and enraged drivers. He was now on Park Drive with the Back

  Bay Fens and the scruffy victory gardens on his left. The pain was

  constant now, strong and overpowering. He could hardly breathe.

  The hospital was ahead on the right, on the previous site of a Sears

  building. Only a little further. Please ... A large white sign with a

  red arrow and red letters that said EMERGENCY loomed above.

  Cedric managed to drive directly up to the emergency room platform,

  braking belatedly and crashing into the concrete abutment. He slumped

  forward, hitting the horn and gasping for breath.

  The first person to reach his car was the security guard. He yanked open

  the door and after a glance at Cedric's frightening pallor yelled for

  help.

  Cedric barely choked out the words, "Chest pain." The head nurse, Hilary

  Barton, appeared and called for a gurney. By the time the nurses and the

  security man had Cedric out of the car, one of the emergency room

  residents had appeared and helped maneuver him onto the stretcher. His

  name was Emil Frank and he'd been a resident for only four months. A

  few years previously he would have been called an in-, term. He too

  noticed Cedric's cream-colored skin and prohise perspiration.

  "Diaphor-esis," he said with authority. "Probably a heart attack."

  Hilary rolled her eyes. Of course it was a heart attack. She rushed the

  patient inside, ignoring Dr. Frank, who'd plugged his stethoscope into

  his ears and was trying to listen to Cedric's heart.

  As soon as they reached the treatment room, Hilary ordered oxygen, IV

  fluids and electrocardiographic monitoring, attaching the three main EKG

  leads hersele As soon as Emil had the IV going, she suggested to him

  that he order 4 mg. of morphine to be given IV immediately.

  As the pain receded a little, Cedric's mind cleared. Even though no one

  had told him, he knew he'd had a heart attack. He also knew he'd come

  very close to dying. Even now, staring at the oxygen mask, the IV, and

  the EKG machine as it spewed paper out onto the floor, Cedric had never

  felt so vulnerable in his life.

  "We're going to move you to the coronary care unit," Hilary said.

  "Everything is going to be okay." She patted Cedric's hand. He tried to

  smile. "We've called your wife. She's on her way."

  The coronary intensive care unit was similar to the emergency room as

  far as Cedric was concerned-and just as frightening. It was filled with

  esoteric, ultramodern electronic technology. He could hear his heartbeat

  being echoed by a mechanical beep, and when he turned his head
he could

  see a phosphorescent blip trace across a round TV screen.

  Although the machines were frightening, it was a source of some

  reassurance to know all that technology was there. Even more reassuring

  was the fact that his own doctor, who had been paged shortly after

  Cedric's arrival, had just come into the ICU.

  Cedric had been a patient of Dr. Jason Howard's for five years. He had

  begun going when his employers, the Boston National Bank, insisted that

  senior executives have yearly physicals. When Dr. Howard suddenly sold

  his private practice several years previously and joined the staff of

  the Good Health Plan (GHP), Cedric had dutifully followed. The move

  required changing his health plan from Blue Cross to the prepaid

  variety, but it was Dr. Howard that had attracted him, not GHP, and

  Cedric had let Dr..Howard know it in no uncertain terms.

  "How are you doing?" Jason asked, grasping Cedric's arm but paying more

  attention to the EKG screen.

  "Not ... great," Cedric rasped. It took several breaths to get out the

  two words.

  "I want you to try to relax."

  Cedric closed his eyes. Relax! What a joke.

  "Do you have a lot of pain?"

  Cedric nodded. Tears were running down his cheeks.

  "Another dose of morphine," Jason ordered.

  Within minutes of the second dose, the pain became more tolerable. Dr.

  Howard was talking with the resident, making sure all the appropriate

  blood samples had been drawn and asking for some kind of catheter.

  Cedric watched him, reassured just seeing Howard's handsome, hawklike

  profile and sensing the man's confidence and authority. Best of all, he

  could feel Dr. Howard's compassion. Dr. Howard cared.

  "We have to do a little procedure," Jason was saying. "We want to insert

  a Swan-Ganz catheter so we can see what's going on inside. We'll use a

  local anesthesia so it won't hurt, okay?"

  Cedric nodded. As far as he was concerned, Dr. Howard had carte -blanche

  to do whatever he felt was necessary. Cedric appreciated Dr. Howard's approach. He never talked down to his patients-even when Cedric had had

  his physical three weeks ago and Howard had lectured him about his high

  cholesterol diet, his two-pack-a-day cigarette habit, and his lack of

  exercise. If only Id listened, Cedric thought. But despite Dr. Howard's

  doomsday approach to Cedric's lifestyle, the doctor had admitted that

  the tests were okay. His cholesterol was not too high, and his

  electrocardiogram had been fine. Reassured, Cedric. put off attempts to

  stop smoking and start exercising.

  Then, less than a week after his physical, Cedric felt as if he were

  coming down with the flu. But that had been only the beginning. His

  digestive system began acting up, and he suffered terrible arthritis.

  Evenhis eyesight seemed to deteriorate. He remembered telling his wife

  it was as though he had aged thirty years. He had all the symptoms his

  father had endured during his final months in the nursing home.

  Sometimes when he caught an unexpected glimpse of his reflection, it was

  as if he were staring at the old man's ghost.

  Despite the morphine, Cedric felt a sudden stab of white-hot, crushing

  pain. He felt himself receding into a tunnel as he had in the car. He

  could still see Dr. Howard, but the doctor was far away, and his voice

  was fading. Then the tunnel started to fill with water. Cedric choked

  and tried to swim to the surface. His arms frantically grappled the air.

  Later, Cedric regained consciousness for a few moments of agony. As he

  struggled back to awareness, he felt intermittent pressure on his chest,

  and something in his throat. Someone was kneeling beside him, crushing

  his chest with his hands. Cedric started to cry out when there was an

  explosion in his chest and darkness descended like a lead blanket.

  Death had always been Dr. Jason Howard's enemy. As a resident at

  Massachusetts Ge n*eral, he'd carried that belief to the extreme, never

  giving up on a cardiac arrest until a superior ordered him to stop.

  Now he refused to believe that the fifty-six-year old man whom he'd

  examined only three weeks earlier and had declared generally healthy was

  about to die. It was a personal affi-ont.

  Glancing up at the monitor, which still showed normal EKG activity,

  Jason touched Cedric's neck. He could feel no pulse. "Let me have a

  cardiac needle," he demanded. "And someone get a blood pressure." A

  large cardiac needle was thrust into his hand as he palpated Cedric's

  chest to locate the ridge on the sternum.

  "No blood pressure," reported Philip Barnes, an anesthesiologist who had

  responded to the code call that automatically went out when Cedric

  arrested. He'A, placed an endotracheal tube into Cedric's trachea and

  was ventilating him with oxygen by compressing the Ambu bag.

  To Jason, the diagnosis was obvious: cardiac rupture. With the EKG still

  being recorded,. yet no pumping action of the heart, a situation of electromechanical dissociation prevailed. It could mean only one thing. The

  portion of Cedric's heart that had been deprived of its blood supply had

  split open like a-squashed grape. To prove this hortendous, diagnosis,

  Jason plunged the cardiac needle into Cedric's chest, piercing the

  heart's pericardial covering. When he drew back on the plunger, the

  syringe filled with blood. There was no doubt. Cedric's heart had burst

  open inside his chest.

  "Let's get him to surgery," Jason shouted, grabbing the end of the bed.

  Philip rolled his eyes at Judith Reinhart, the coronary care head nurse.

  They both knew it was futile.

  At best they might get Cedric on the heart-lung machine, but what then?

  Philip stopped ventilating the patient. But instead of helping to push

  the bed, he walked over to Jason and gently put an arm on his shoulder,

  restriaiming: him. "It's got to be cardiac rupture. You know it. I know

  it.

  We've lost this one, Jason."

  Jason made a motion to protest, but Philip tightened his hold. Jason

  glanced at Cedric's ivorycolored face. He knew Philip was right. As much

  as he hated to admit it, the patient was lost.

  "You're right," he said, and reluctantly let Philip and Judith lead him

  from the unit, leaving the other nurses to prepare the body.

  As they walked over to the central desk, Jason admittea that Cedric was

  the third patient to die just weeks after having a clean physical. The

  first had been another heart attack, the other a massive stroke. "Maybe

  I should think about changing professions," Jason said half seriously.

  "Even my inpatients have been doing poorly."

  "Just bad luck, Philip said, giving Jason a playful poke in the

  shoulder.

  "We all have our bad times. It'll get better."

  "Yeah, sure," Jason said.

  Philip left to return to surgery.

  Jason found an empty chair and sat down heavily. He knew he'd have to

  get ready to face Cedric's wife, who would be arriving at the hospital

  at any moment. He felt drained. "You'd think by now I'd have gotten a

  little more accustomed to death," he said aloud.

  "The fact that you
don't is what makes you a good doctor," said Judith,

  attending to the paperwork associated with a death.

  Jason accepted the compliment, but he knew his attitude toward death

  went far beyond the profession. Just two years ago death had destroyed

  all that Jason held dear. He could still remember the sound of the phone

  at quarter past midnight on a dark November night. He'd fallen asleep in

  the den trying to catch up on his journals. He thought it would be his

  wife, Danielle, calling from Children's Hospital, saying she'd be

  delayed. She was a pediatrician and had been called back to the hospital

  that evening to attend to a preemie in respinatory distress. But it had

  been the turnpike police. They called to say that a semi coming from

  Albany with a load of aluminum siding had jumped the central divider and

  rammed into his wife's car head-on. She had never had a chance.

  Jason could still remember the trooper's voice, as if it had been

  yesterday. First there'd been shock and disbelief, followed by anger.

  Then his own terrible guilt. If only he'd gone with Danielle as he

  sometimes had,. and read at county Medical Library. Or if only he'd

  insisted she sleep at the hospital.

  A few months later he'd sold the house that was haunted by Danielle's

  presence and his private practice and the office he'd shared with her.

  That was when he had joined the Good Health Plan. He'd done everything

  Patrick Quillan, a psychiatrist friend, had suggested he do. But the