The Blood Betrayal

Praise for The Blood Betrayal

If you have trouble sleeping, do not read this book. If you don’t have trouble sleeping, you will. THE BLOOD BETRAYAL is a compelling, creepy, complex novel about the all-too-plausible perversion of cutting-edge medical research. Donaldson paints an intriguing portrait of evil and unrestrained human ambition you will not soon forget.

—Lewis Perdue, New York Times Bestselling Author of PERFECT KILLER and THE DAVINCI LEGACY

Donaldson’s wizardry keeps the pace of this riveting, bone-chilling thriller fast and furious. The unpredictable hooks and twists and turns will keep you reading well into the night.

—Gary Birken, MD, author of PLAGUE and EMBOLUS.

THE BLOOD BETRAYAL is a thriller packing enough high voltage tension to power the Tennessee Valley Authority.

—Allen Wyler, MD, author of DEADLY ERRORS and DEAD HEAD

In THE BLOOD BETRAYAL Don Donaldson presents a bucolic, Amish-like community filled with blissful carefree people, then skillfully peels back the layers to reveal the terror and corruption beneath the surface.

—Mike Lawson, author of THE INTERNAL RING and THE SECOND PERIMETER

Praise for Don’s previous titles

Donaldson combines an insider’s knowledge of modern technology with a real flair for making the reader’s skin crawl.

—Booklist

Donaldson knows the anatomy of a thriller.

—Michael Palmer

Donaldson is every bit the nail-biting equal of Robin Cook and Michael Crichton.

—The Jackson (MS) Clarion-Ledger

Donaldson is superb at spinning medical fact into gripping suspense.

—Tess Gerritsen

[Donaldson is] a skilled practitioner of the medical thriller.

—The Memphis Commercial Appeal

Donaldson’s talent and potential as a novelist are considerable.

—New York Times Book Review

Other Don Donaldson titles from Bell Bridge Books

The Killing Harvest

The Lethal Helix

The Judas Virus

The Memory Thief

The Blood Betrayal

by

Don Donaldson

Bell Bridge Books

Copyright

This is a work of fiction. Names, characters, places and incidents are either the products of the author’s imagination or are used fictitiously. Any resemblance to actual persons (living or dead), events or locations is entirely coincidental.

Bell Bridge Books

PO BOX 300921

Memphis, TN 38130

Ebook ISBN: 978-1-61194-434-1

Print ISBN: 978-1-61194-413-6

Bell Bridge Books is an Imprint of BelleBooks, Inc.

Copyright © 2014 by Don Donaldson

Printed and bound in the United States of America.

All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer, who may quote brief passages in a review.

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Chapter 1

DAMN.

I do not want to go in there.

Death seeped under the operating room doors. It slipped through the crack between them and swirled around Carl Martin’s sweat-soaked brow. Dark wet rings were already in full bloom under the armpits of his blue scrubs.

But he’d already agreed to help.

He snatched a quick breath then swallowed hard, his coppery saliva nearly strangling him. He leaned forward and pushed, parting the doors to hell.

Inside, everyone turned to look at him. The scene froze: the bloody-gowned surgeon standing on the far side of the table, both hands in the blue-draped patient’s abdomen, the circulating nurse, the assistant surgeon, the anesthesiologist, all staring at him . . . looking to him for deliverance from the escalating disaster on the table.

Motion had ceased, but he heard the rhythmic wheeze of the respirator playing counterpoint to the cardiac monitor counting each of the patient’s heartbeats. To the right, he was aware of hissing steam escaping from the unlatched autoclave door. It was a moment he didn’t need.

Dick Crandall, the surgeon, spoke and time began flowing again. That better be you under that mask, Carl.

It is, Carl replied, hurrying to the table.

Where the hell you been? I was about to swear out a sheriff’s warrant for you.

You’re welcome . . . Guess you’ve forgotten I don’t do this kind of thing anymore. I’m only here because you fired George Lee and put your patient at risk.

Lee had his chance. He couldn’t help.

You’re fortunate I was in my car and was close by.

Yeah, Crandall said. We’re all just tickled to death at our luck today.

Crandall had always been a sarcastic asshole, even out of the operating room, so Carl wasn’t surprised by his comment. Looking at the monitor panels, Carl saw that the patient was in much more serious trouble than the nurse on the phone had said. But why was everything going to hell?

He looked back at Crandall. Why’s he on the table?

Liver laceration . . . three knife wounds suffered in a mugging . . . Everything was reasonable for the first few minutes. Got a couple of suture bolts inserted with no problem and was drawing the margins of the first wound together, but then he started leaking like shit . . . even from intact areas of the organ.

Crandall seemed annoyed at having to explain things, as though he expected Carl to just wave a magic wand and bail them out of this mess.

Carl glanced at the Foley tube emerging from under the drape. Not good. The urine was tinged with blood.

Moving closer, he pulled the drape aside and looked at the IV entrance wound in the back of the patient’s hand.

Blood was oozing from the margins.

He moved to the foot of the table, lifted the drape, and examined the patient’s legs. On both shins, he saw scattered sores with fresh blood glistening in their centers.

Bleeding sores . . . but they had crusted edges . . . strange.

Staying on his side, Carl went to the other end of the table, past the blue tent that isolated the patient’s head from the rest of his draped body. He gently rolled the upper lip back from the patient’s gums. They too, were bloody. He lifted the right eyelid. What should have been pure white was punctuated with tiny hemorrhages. Thanks . . . thank you very much.

You planning to actually do anything about this problem? Crandall said. I can’t stand here and compress these bleeders forever.

Where’s the blood work?

Over here, the circulating nurse said.

Carl followed her to a stainless steel countertop. She picked up a piece of paper and handed it to him. Quickly perusing the report, he saw that the patient’s ability to form a clot was five times slower than normal. And the amount of the main clotting protein in his blood was dangerously low. A new freshet of sweat pearled out of Carl’s pores onto his forehead. This was exactly why he shouldn’t have come. He wiped at the sweat with his arm.

I guess we’ve also got peripheral smears . . .

On the computer, the nurse said, leading him to the work station tied to the blood lab.

The nurse typed in the patient’s name . . . Benjamin Rasco.

Suddenly, behind them, the cardiac monitor began to stutter. Carl’s own heart, already at a trot, kicked up to a canter. He glanced over at the monitor.

Wrong angle . . . he couldn’t read it.

Heart slipping into ventricular tachycardia, the anesthesiologist said, in a gas passer’s usual monotone.

Oh great . . . Not only was he bleeding to death, the lack of blood was now starving his heart.

Damnation, what are you waiting for? Crandall yelled. Get your ass moving.

Doctor, the images are ready.

Carl looked back at the work station computer screen and saw a menu to choose from. He clicked on the first image from the preoperative smear, and the most bizarre red blood cells he’d ever seen flicked up on the screen. Instead of smooth contours, each of these reds had a large blister on them. He clicked on the second pre-op image and saw the same thing. What the hell?

Then something in the room changed.

The cardiac monitor . . . it was back to a normal sinus rhythm. They’d just gained some time, but probably damned little.

Focus . . . focus . . .

He clicked on the first image taken from a smear made after the uncontrolled bleeding began. Now, the picture was totally different. Instead of intact red cells, there were only fragments.

That confirmed it. Shit.

The guy on the table had DIC . . . Disseminated Intravascular Coagulation . . . coined Death Is Coming by those who had to deal with it.

The trouble started when the patient’s blood suddenly began clotting all over his body. The clots blocked the tiny vessels in all his organs. Thousands of little pieces of him were now dying. With all the clotting factors in his blood consumed by the clotting process, blood was also leaking from the damaged vessels. His reds had fragmented as they were forced through the clots.

Carl had encountered five cases of DIC in his career. He had prevailed in all of them, becoming widely known as the best blood doc in town. Crandall knew it. That’s why he’d asked for him and not someone else.

But stay in the ring long enough and even the best will catch a haymaker in the face. Carl’s keen awareness of that was why he didn’t want to be there. After losing two patients to leukemia and another to a bacterially contaminated blood transfusion in the same week, he had closed his practice, needing to be finished with battles where other lives were at stake.

Yet here he was again, up against a clotting problem that shouldn’t even be happening. So why was it? And what’s with those sores . . . and the weird red cells?

Can’t dwell on any of that now.

He returned to the operating table.

Rasco’s heart was still banging out a normal sinus rhythm. Despite being given plasma expanders, the beat was even faster now than a moment ago, as his heart tried harder to compensate for the loss of blood leaking into his body cavities.

Carl looked at Crandall. You said—

The cardiac monitor spit out four quick beeps then fell silent.

The muscles in Carl’s groin went into spasm. No. I need more time.

He stared at the monitor readout.

No EKG . . .

Another second of silence . . .

Still no sound and nothing on the screen . . .

A beep sounded . . .

Then again . . . And another, in rhythm. The EKG tracing resumed its normal pattern.

Gentlemen, the anesthesiologist said, We were lucky that time. Just so you know . . .

Carl turned to Crandall. You said Lee had his chance. What did he do?

From behind him, the circulating nurse said, He gave him thirty thousand units of heparin IV, followed twenty minutes later by twelve buttons of platelets and a unit of fresh frozen plasma.

Exactly right, Carl thought. Problem was . . . it failed. Anything else?

After that . . . She shrugged. He just stood there, sweating.

I want another thirty thousand units of heparin all at once. Two minutes later, two buttons of platelets also through the IV injection port. Then, immediately hang ten more buttons of platelets, a unit of plasma, and a unit of packed red cells.

Carl watched to make sure she followed his orders. Once the heparin was in and all the component bags were hung and delivering their contents, he began a vigil in which his eyes traveled over the monitor readings one by one.

The heart rate was still way too fast. Oxygen levels in the blood were slipping even lower. At least the sinus rhythm was holding.

He checked the Foley tube. No change . . . urine still tinged with blood.

Despite the anesthesiologist’s warning, Carl believed there was still time to win this one. But he was so tense, he could hardly get a decent breath. He looked again at the monitor readings. Damn it, pressure down another two units. Blood oxygen level still falling.

Another three minutes passed. All monitor readings stabilized. Carl’s hopes began to rise.

Suddenly, the monitor emitted a staccato series of beeps. Abnormal EKG spikes clustered on the readout, then a flat line appeared.

Carl felt a giant straw sucking at his intestines. He became a muttering cheerleader for return of a normal beat. Come on . . . come on . . . you can do it . . . You did it before . . . do it now.

Two of the longest seconds in history passed. Then, miraculously, another beep and a normal tracing. Another silent second passed, More silence. More silence.

As the anesthesiologist abruptly stood up, another beat occurred.

Three and a half seconds later, the cardiac monitor began to scream.

Chapter 2

CARL DROVE through the heavily forested valley deep in the mountains fifty miles from Little Rock hardly noticing the brilliant fall foliage, his mind ruminating obsessively over the death of Benjamin Rasco the previous day.

Goddammit. He’d given up his practice so he’d never have to watch another patient die. And what good had it done?

That bleeding just wouldn’t stop.

It should have. He knew how to handle DIC. Sure . . . he’d been called in only after Rasco was in major trouble. But there’d still been time to save him.

Why didn’t the treatment work?

And what the hell were those blistered red cells all about? Never seen anything like that before. Were they involved?

It wasn’t his nature to accept failure without knowing why it happened. He had to have answers. Then at least something worthwhile would come out of the situation. Of course, this whole trip could turn out to be a waste of time. But he had to try.

Suddenly he came to a big white sign with bold red letters beside the road:

ATTENTION: This means you. Visitors are required to pick up a guest pass for their vehicle at the information kiosk. Pass must be displayed at all times. NO EXCEPTIONS. God loves you.

Carl’s eyes shifted from the big sign on the shoulder to the razor wire-topped chain-link fence ahead that ran off into the woods on each side of the two-lane road.

Now what?

He nudged the gas and proceeded to the little, gray cedar shake, white-trimmed building dividing the lanes.

Through the big window in the side of the kiosk, a strapping young guy in khaki fatigues waved, then came outside carrying a clipboard. On his hip he wore a nasty-looking sidearm. Carl rolled down his window.

Good Morning, sir. May I inquire about the nature of your business?

This deep in the mountains, Carl had expected to hear an Ozark twang. But this guy sounded like big-city Midwest. And he was one healthy-looking specimen.

I’m not sure I’m in the right place. I’m looking for Artisan, the town.

It’s just down the road.

Inside that fence?

We’re a company town . . . like the old coal mining villages, except we make furniture. Who did you want to see?

I’m Dr. Martin, from Arkansas Pharmaceuticals. I’d like to speak with the director of the hospital.

Sir, I’ll need to see some identification.

Of course.

Carl shifted in his seat, got his wallet, and held out his Arkansas Pharm ID.

Are you expected?

No. I didn’t call ahead because I couldn’t find a number.

The guy perused the ID, then looked at Carl with cold gray eyes. And what will you be discussing with the director?

A man named Benjamin Rasco.

Wait here, please.

Carl was there because he’d learned that Rasco’s body had been claimed by two locals, the director of the town hospital and the pastor of the town’s only church, who had been looking for Rasco since he’d disappeared from Artisan nearly a week ago. Since this was where Rasco lived, it seemed likely the hospital would possess at least some information on his medical history.

The guard went back to the kiosk and Carl saw him pick up a phone.

IN THE ARTISAN hospital, the director spun his head around and stared at the ringing phone. He walked slowly to his desk, a premonition warning him this was the fallout he’d feared might come from Benjamin Rasco’s death. He gingerly picked up the phone and slowly put it to his ear. Meggs speaking.

He listened to the guard on the other end, and the temperature in the room began to soar. It was about Rasco. And of all people, Carl Martin was at the gate. Carl Martin . . . Damn it.

How much did he know? What did he suspect?

Meggs tried to tell himself the visit was benign, and Martin had some innocuous reason for coming. But that didn’t play. The man had followed Benjamin Rasco’s body, and he was a hematologist. He was almost certainly here about Rasco’s red cells and what had happened.

That was bad enough, but was he aware of the rest?

No, he couldn’t know. It had been months ago. And everyone involved had been satisfied. There’d been no problems at all . . . none . . . But could you ever really know that? You do everything you can think of, but there could always be something you missed.

Multiple thoughts careened through his mind like ball lightning, ranging from turning Martin away to killing him now. Meggs let the lightning rattle and roar for a few more seconds then said into the phone, Let him in.

THE GUARD CAME out and returned Carl’s ID. You’re looking for Dr. Meggs.

Meggs . . . The name set off a grass fire in Carl’s brain, just as it had when the clerk at the hospital in Little Rock had mentioned it. And once again, he was sure he’d come across that name before in some other context. But he still couldn’t remember where.

Just stay on this road, the guard said. About a quarter of a mile from here, you’ll reach the town center. Follow the road around the fountain, past Matthew Street, Mark Street, Luke, and John. That will bring you to Corinthian Avenue. At the fork, bear left on Second Corinthian. You’ll see the hospital down on the right. He handed a yellow placard through the window. Put this on your dash.

Matthew, Mark, Luke, and John, Carl thought as he drove on. His lab tech had said Artisan was some kind of reclusive religious enclave. She was certainly right about that. But what’s with the security? What are they protecting?

Carl drove for a while through another stand of dense forest, looking forward to his arrival at the hospital. Then, the trees began to thin. Soon, the woods opened onto a picturesque, manicured little valley so pretty he forgot for a moment to be upset at himself. Looking up, he noted that whatever he was going to do needed to be done quickly. The sky, clear when he’d left the city, was now heavily laden with rain clouds the color of a day-old bruise.

On his right, was a sprawling two-story building clad in fieldstone. White lettering over the entrance identified the place as Valley Furniture, apparently the factory the guard had mentioned. Two young men in coveralls tending the meticulously groomed landscaping stopped work and stared at him as he passed.

On the opposite side of the road was a baseball diamond with a small section of bleachers. The infield was perfectly raked and the vibrant green outfield was mowed in an alternating grid. Not a single scrap of debris could be seen. Nor were any people around.

Attractive but lifeless, Carl thought. Like a corpse all decked out for the viewing.

It shouldn’t have, but his analogy took him by surprise. "Oh . . . you’re in a good mood," he muttered.

Looking back toward the factory, he saw a small parking lot with rows and rows of bicycles neatly parked in metal stands. Beyond the factory was a short strip mall with similar architecture. He didn’t see anyone over there either . . . not a single soul . . . not even through the Food Mart window. Where were the shoppers? Was everything closed? Why would it be?

Across the road stood Manna From Heaven, apparently a restaurant. Next to that was Bread Upon the Water, another restaurant. And finally, The Word, which, judging from the cup with steam rising from it on a signboard out front, was a coffee shop.

Silently quaint and tidy all. Powdered and rouged.

For the next few hundred yards, the road ran through a park dotted with picnic benches and anchored by a little lake with an island in the center.

Finally . Yeah . . . there you go . . . more people: two young guys toiling with rakes, and a third, pushing a manual lawnmower. Like the first two he’d seen, they all found him more interesting than either their work or the impending storm.

On impulse, he offered a friendly wave. No one returned the gesture. Nor did any of them go back to work. Moving nothing from the neck down, they just turned their heads in unison to follow his progress.

Nice choreography, boys, he thought, trying to dismiss the creepy feeling they gave him. Needs a little more hand movement though. And where are those famous Artisan smiles? He turned his full attention back to the road.

On the other side of the park, just past a little two-story cottage with a white sign out front identifying it as the library, he came to the fountain the guard had mentioned. And what a mammoth and gorgeous thing it was . . . a bronze forest with water shooting out of the tops of the larger trees drenching an under-story of smaller ones. In the pool surrounding the fountain, a flock of swans royally swam the circuit.

Swans . . . that’s all . . . no people to watch them. Weird.

Growing more curious about the town, he turned onto Matthew to see what the houses looked like. Each of the forty homes on the street was a simple saltbox with gray cedar shakes and white trim like the kiosk at the front gate. Except for individual landscaping, they were all exactly the same, and all were immaculate. As perfect as everything looked, it would have been natural to see at least one homeowner puttering around outside. Or maybe someone pushing a stroller or walking a dog. But by the time he’d reached the end of the street, which abruptly ended at a thin woods in front of a chain-link fence bordering what looked like a large canyon, he still hadn’t seen another soul.

He turned around in one of the driveways and went back to the fountain, again seeing no one on the return trip. By now, his curiosity about Artisan had been replaced by the distinct feeling there was something malignant about this town. The ominous sky could have had something to do with it, certainly the way those workmen had stared at him was a big part of it. He didn’t much care what it was. He just wanted to finish his business here and go home.

Traveling around Fountain Circle a moment later, the hairs on his neck suddenly prickled. He jerked his head to the left, thinking he was being watched from the fountain. But there was no one there.

Idiot, he mumbled to himself. Grow up.

But he wasn’t an idiot, for a hooded figure was indeed watching him, not from the fountain, but from the porch of the library, where the watcher’s eyes were shining with an eager light.

At Corinthian Street, Carl tapped the brake. What’d that guard say? Oh yeah, the hospital was on Second Corinthian, to the left, where the street forked.

Reaching the fork, he looked to the right and saw at the end of the street, a large white church with a tall steeple punching into the dark sky. By now, even that seemed portentous.

He turned onto Second Corinthian and nudged the gas.

Behind him the hooded figure that had watched him from the library darted behind the sycamore tree on the corner, her breathing now rapid and irregular.

Surprisingly, the hospital was a sleek, modern brick building with smoked glass windows. There was only one car in the small parking lot. The rack provided for bicycles held a single occupant.

Carl parked and headed for the front door, musing at the poor choice of location for the town cemetery, which he could see about thirty yards away at the end of the street. As he turned his attention back to the hospital entrance, he collided with a pretty young woman leaving the building.

Finally, a female. He was beginning to wonder if there were any in this town. Sorry, he said. I should have been watching where I was going.

Without acknowledging his apology, she veered off onto the grass to avoid him, her eyes wide and round, her mouth agape. Seeing her reaction, he half expected her to point at him and screech like the pod people in Invasion of the Body Snatchers. But she just hurried to her bicycle, yanked it from the parking stand, and pedaled furiously for the street. Apart from her strange reaction, Carl was struck by how healthy the girl appeared. So maybe she wasn’t there because she was ill, but was just a hospital employee, heading off to lunch. It was about that time.

But why the devil did she behave like that? Is anybody in this town normal?

Everyone he’d seen had given off a strange vibe . . . like they were not flesh and bone, but more like . . . flesh and shadow.

A lilting bell apparently wired to the door or the mat under his feet signaled Carl’s entrance into the hospital’s plain and utilitarian lobby. Now in bright, well-lit surroundings, he felt much less apprehensive.

Looking around for an information counter, he noticed a man wearing a white coat come out of a door down the hall. The guy saw Carl and smiled briefly, then started for the lobby, his expression now neutral, the kind of look that would keep a patient from knowing you were bringing bad news. And he appeared normal, at least he wasn’t dragging one foot and witch-washing his hands.

As he drew closer, Carl could see from the wear on the man’s face he was probably in his mid-fifties. The same story was in his hair, once brown, but now shot with gray, a color also creeping into his full beard and mustache. Even though his hairline was receding, he continued to comb his hair straight back, a defiant act suggesting he was a man not given to compromise.

Dr. Martin, he said, extending his hand. I’m Dr. Meggs. Have any trouble finding us?

There doesn’t appear to be many places where one can get lost in this town, Carl responded, matching Meggs’s firm handshake.

The smile made a return appearance as Meggs chuckled and withdrew his hand. Very true.

From the letters sewn in red script on Meggs’s white coat, Carl saw that his first name was Patrick. Yeah . . . Patrick Meggs . . . that was the name he remembered in that other context, whatever it was. Doctor, have we met before?

Apparently without even thinking about it, Meggs said, I’m sure we haven’t. What brings you to my hospital?

Shading his role in what happened, Carl said, I was one of the doctors present in the OR when Benjamin Rasco’s heart stopped.

Meggs’s congeniality faded. Really . . .

Carl hesitated a moment while he castigated himself for not telling Meggs the truth straight up. Then he said, I guess you’re aware he died of DIC during surgery to treat a liver laceration he suffered in a mugging. I was the hematologist called to treat his DIC. Actually, I was the second one brought in.

And?

I was consulted, because frankly, I’m pretty good at treating that condition. But I couldn’t save him. And I’m trying to understand why.

DIC is a mysterious and complex malady. I don’t think anyone fully knows how it works.

We’re still learning, that’s true, Carl said, grateful that Meggs appeared not to blame him for failing to save Rasco. But there were a couple of puzzling things about the case.

Such as?

"For one, his injuries were localized to the liver. We know that trauma can kick off DIC, but that usually