Implant. Part 6

Lexiphaniathe tendency to use obscure and unusual words. The irony would be rich. How wonderful to catch him with a word that described himself.

Duncan laughed. "Where'd you find that one? " "Wasn't easy, believe me. ' '"All right. I plead guilty to compulsive grandiloquism, to singlehandedly trying to correct for the entire language's drift into ba.n.a.lity." d.a.m.n. He did know it.

She said, "I don't think it's working."

"More's the pity." He gazed at her, smiling. "Lexiphania . . . that s wonderful. How can I stay angry at you? But seriously, Gin, you've been trained for a higher sort of work than being legislative aide to some pretentious pinhead pol. I hate to see you wasting your talents."

For a moment she was struck by how much he sounded like Peter. He'd said almost exactly the same thing when she'd told him she was leaving Louisiana to get involved in medical politics.

Focusing on Duncan, Gin bit her tongue and thought, I could say the same about your facelifts.

As if reading her mind he smiled crookedly and said, "Not that I'm one to talk about wasting training." For an instant there was real pain in his eyes. Her heart went out to him.

"Duncan . . . whatever" He held up the coffee carafe. "Refill? "'"No, thanks. Can I ask? " "I don't envy you, Gin." Obviously he didn't want to talk about Duncan Lathram. "I wouldn't want to be starting out in medicine today and facing the terrain that's ahead of you.

"All the more reason to get involved." Why couldn't he see that?

'"But what do you hope to accomplish? What is your goal down there on Capitol Hill? " "Fair guidelines. Realistie guidelines we can all live with."

"Never happen, " Duncan said. He sighed. "I hope you know what you're doing, Gin."

"I've given it a lot of thought."

"Have you? They're a pretty corrupt bunch, Gin, and" "And I'm so impressionable? " "No. It's not that. It's just that, well, as doctors, we're a different breed.

Our values are different. We don't speak the same language. We don't walk in the same shoes as other people."

"That sounds just a little elitist to me." He shrugged.

"Maybe. But sometimes I think the weight of the life-and-death decisions doctors have to make sets them apart from the rest of humanity. When you've felt someone's life draining through your hands, and you've reeled him back in and sent him home to his family, it does something to you. You've seen things that regular folk will never see, done things they'll never do, glimpsed them at their most vulnerable, when they're stripped of all their pretenses. You've been master of life and death, and that can't help but change you. It leaves you one step removed from everybody else. ' Gin had run up against this G.o.ds-who-walk att.i.tude all through her residency.

"It's time we ditched the G.o.d thing, don't you think? We're not G.o.ds, and it's damaging to us and our patients to foster that kind of reverence. We can do extraordinary things, seemingly miraculous things.

But we're not G.o.ds. We're just people." He was sullen as he sipped his coffee in silence.

Finally Gin said, "Doesn't look like we'll ever see eye to eye, does it? " '"No, it doesn't." '"Can we agree to disagree, then? " "I don't suppose I have much choice." '"You could fire me."

"I don't want to do that. But don't expect my blessing." '"I never did." Bat I want it, dammit. I wish I didn't, but I do. "I don'teven know if I'll get the job. But if I do I'll have to adjust my schedule to" "Ca.s.sidy can take up the slack. We'll work it out."

Gin felt a trickle of warmth, seeping through her. This - was a blessing of sorts, wasn't it? If not, it would have to do.

"Thank you, Duncan. I didn't expect" "I want to keep you nearby .

. where I can keep an eye on you.

The warm trickle became a chill. What was that supposed to mean?

"Just don't let us down, Gin, " he said, his blue eyes burning into hers. "Don't betray us." He held her locked in his gaze a moment longer, then turned away.

"I'm glad we had this talk, Gin. The first of many, I hope. I'm sure you've got some dictation to catch up on. ' "Yes. Sure. I'll see you later." '"Be sure to let me know as soon as you hear from Marsden.

As for me, I'm off to the links." He pulled out a key ring and matter-of-factly locked his top drawer. "Surgery tomorrow at eight.

" Idly wondering why he bothered locking the drawer, Gin waved and left him.

This was turning out to be one strange day.

i G IN. EASY NOW, OLIVER SAID SOFTLY, WATCHING OVER HER shoulder, coaching her.

"That's it. Just go easy . . . easy . . . " Gin hadn't felt like being alone this afternoon. No word from Marsden's office, or from Gerry, so she'd arranged to spend a couple of hours in Oliver's lab practicing her implant-filling technique. She'd learn and get paid for it.

She smelled garlic on his breath and wondered what he'd had for lunch.

Nothing low cal, she was sure. Oliver had a weakness for Italian food and didn't seem to care what effect it had on his waistline. Probably linguine and clam sauce, don't spare the garlic Better forget Oliver's dietary indiscretions. She needed to concentrate on what she was doing.

Gin had the 26-gauge needle of a tuberculin syringe inserted in the end of one of Oliver's medium, -size membranous implants and was injectingit with normal saline. Had this been for real, she'd be working under sterile conditions and filling the implant with Oliver's "secret sauce." Staring through the magnifying lens centered in the round head of the fluorescent examination lamp, she watched the half-inch-long tubular membrane swell and stretch. Like filling the world's tiniest water balloon.

"It's full now, " Oliver said. "Feel that back pressure? " She hadn't felt any until nowwhich was why half a dozen membranes lay ruptured on the side of the tray. But this time she did feel a hint of resistance on the plunger.

"Believe it or not, I think I do."

"Swell! Now it's time for the zapper." Gin repressed a smile as she reached for the cautery handle. Did anyone else on earth still say swell? Oliver had to be the last.

He was a bit of an enigma. Didn't seem to have much of a life outside his lab. No wife or family. No significant other that she knew of.

He'd had the staff over to his house for a dinner party one night and Gin had felt she knew less about him afterward than before.

'"Okay, " she said. "I'm ready."

"You know what to do. Just take your TIME" Gin had seen Oliver do this a hundred times but had never got this far. She readied the flattened tip of the cautery unit in position near the puncture site, slowly withdrew the needle, then stepped on the round power pedal near her left foot. A tiny blue spark arced from the tip to the implant, searing and coagulating the protein membrane around the puncture.

She watched through the magnifying lens, waiting for a telltale bead of fluid to form, signaling the need for another zap. But the membrane remained dry. She'd sealed the opening.

Success. Finally. A tiny triumph. Hardly made up for the fiasco in Marsden's officer Monday or Allard's accident this morning, but right now she'd take anything.

Gin looked up and found Oliver's round face grinning at her.

"It's going to be swell having someone else around who can fill these things. I'm sick to death of it."

"Why don't you just hire an a.s.sistant or two to help with the scut work? " "There's really not all that much to be done at this stage of the studies. And I'd like to limit the number of people who know what we're working with."

"And just what are we working with? " "Secret sauce."

"Oliver, come on.

Don't you think I have a right to know.

He thought a moment. "All right. Fair enough. But keep it under your hat. This solution is not patentable, sodon't want anyone stealing my thunder by beating me to market with it."

"Mum's the word, " she said.

"I'm sure I can trust you, " he murmured as if he'd just now realized it.

He removed his thick, horn-rimmed gla.s.ses as he sat down next to her.

He began to talk, rapidly, as if someone had opened a valve. Gin realized he must have been dying to expound on his secret sauce.

'"Are you familiar with the work done by the Department of Cell and Structural Biology in the University of Manchester in England? "

"No.

Not a bit."

"Not many clinicians are. Okay then, how about fetal surgery? Have you seen any of that? " "Some down in Tulane. It wasn't part of the internal medicine rotation, obviously, but I picked up some information by osmosis."

"Good. Then you know that a fetus can have surgery in utero and be born months later completely scar free.

" "Yes, I remember a couple of OB residents talking about that. This high-risk baby they'd delivered had had a ma.s.s removed from its abdominal wall at about sixteen weeks' gestation and was born without a trace of an incision."

"Exactly. But the surgery has to be performed during the first five months. Any procedure done later leaves a scar just as it would on an adult. Cellular biologists have wondered about it for years. What's happening in there? What's different? What prevents the usual excess amount of collagen from being laid down and forming the scars we all know so well? The folks at the University of Manchester came up with the answer a few years ago." Gin snapped her fingers. She remembered something . . . where had she seen it? "Some sort of growth factor, wasn't it? " Oliver clapped his hands."Excellent! Transforming growth factor beta, to be precise. They identified three types of the growth factor, and found that the third, beta type 3, falls off sharply at the end of the second tnmester of pregnancy. The type-three moleculeI call it beta-3 for shorthas been synthesized since then and that's the key ingredient in the secret sauce." '"So that's the secret behind Duncan's incredible results. "

''llh-uh, " Oliver said, wagging a finger. "Duncan has the eyes and the hands that do the remodeling. Even without a drop of beta-3 his patients would have minimal scarring. All I've done is find a way to gild the lily."

"But why the implants? Couldn't he just coat the incisions with beta-3? ' "No. You need it in the final phase of healing. Remember the three stages of wound repair, inflammation, proliferas ion, and remodeling?

Beta-3 does its work in stage three where scar tissue forms to replace granulation tissue. At suturing time, beta-3 would accomplish nothing.

You need a means of delayed release." as, slaving away, testing antidepressants on rats in Skinner boxes as a psychopharmacologist at GEM Pharm during the day, and at night working in my home on a continuous delivery system for medication. Norplant was the hot topic then, but the Norplant implants have to be removed after five years. I thought I could improve on that, develop an implant that would deliver its medication in a metered dose for five years, maybe longer, and then dissolve. Great idea, no? " "I take it that didn't happen."

"Not completely. I developed a soft, flexible, crystalprotein matrix that would indeed dissolve without a trace.

However, it was nonpermeable. Wouldn't allow a drop of anything on one side to pa.s.s through to the otheruntil it dissolved, and then it would dump its entire contents into the surrounding tissues. I'd come up with nothing more than a very elaborate and expensive way of giving someone an injection. I was terribly discouraged. ' "And then along came Duncan."

"Right. After his . . . well, after he left vascular surgery, I heard about Manchester's results with transforming growth factor beta type 3 and saw how my imperfect slow-delivery membrane might be perfect for delivering something else. The FDA approved us for clinical trials and the results have been astounding." Gin had seen patients on postsurgical follow-up visits and only with a magnifying gla.s.s was it possible to tell they'd had surgery. Suddenly Gin was struck by the enormous potential for Oliver's implants.

"But plastic surgery is just icing on the cake, " she said. "Think of what you could do in general surgery." Oliver was nodding excitedly.

"Of course. The implants would-have the most value in trauma cases, but they'll become routine in procedures like hysterectomies and appendectomies. A few weeks post-op you could wear your bikiniheck, you could even go to a nxde beach if you wishedand no one would even guess you'd had surgery." Gin's hand strayed to the front of her blouse. Through the fabric she could feel the upper end of the thick, numb, puckered ridge of scar that ran the length of her abdomen.

Duncan's scar.

Bikini? she thought. I've never owned even a two-piece. Never even considered it.

"But the biggest benefit I see is in pediatrics, " Oliver was saying.

"Kids scar more than adults, and some of those scars, depending where they are, can be disabling because they don't stretch as the rest of the body grows." Tell me about it.

"That sounds wonderful."

"It will be. And the word is out. Other surgeons want to try the implant. Companies are calling every day wanting to license it and the FDA has put it on the fast track for approval. And that's only the start. Duncan came up with an innovative idea on how to enhance the implant, and I've just about got the bugs worked out of the new, improved model. And . . . " He raised his hand and wagged his index finger in the air. "And . . . someone very important has taken a very personal interest in the implant procedure." ' Who? " "Sorry. I can't tell you. Not yet, anyway." She didn't want to care, but the way his eyes shone with excitement piqued her curiosity.

"Come on, Oliver. You just told me about beta-3, you can trust me with this too."

"No. Duncan would kill me. It's his secret after all.

And it's big."

"Okay, " she declaimed with her best forlorn sigh. "I guess I'll just have to read about it in the papers." '"Oh, dear. I hope you never do that. But I have a feeling Duncan may tell you himself when the time comes."

"Speaking of Duncan, you started telling me about the daughter Lisa he had. Does that mean what I think it does? " Oliver nodded glumly.

"She was just eighteen when she died five years ago." From her days as a teenaged file clerk in Duncan's office, Gin vaguely remembered anoccasional mention of his two children, a boy and a girl, both younger than she.

"Five years ago . . . I was away in medical school then. I never heard about it. What happened? " "A fall. She never regained consciousness. It was terrible. Duncan was devastated. It was the straw that almost broke his back."

"Why? Was there something else?

" "I've said enough. If Duncan wants you to know, I'm sure he'll tell you. He's put it all behind him." His gaze wandered away. "He's put a lot of things behind him." He took a deep breath. "But as for the here and now, why don't you solidify your technique by filling a few more membranes? Then call it "Will do, " she said, and patted his shoulder. "One thing's for sure, Oliver, it looks to me like these implants are going to make you a very rich man."

"Oh, I hope so."

"What are you going to do then? " "Get as far away from here as I can.

" "Really? Where? Hawaii? " He sighed. "Anyplace where I don't have to watch Duncan wasting his talents like he is . . . prettifying twits and playing . . . golf! " And then he hurried out with his white lab coat flapping around him.

Gin stared after him in shock.

DUNCAN.

DUNCAN GRIPPED THE LITTLE GIRL'S CHIN BETWEEN HIS thumb and forefinger.

He tilted her head up, then down, then rotated it left and right.

Her name was Kanesha and she was six. She wouldn't meet his gaze directly, and her hand kept rising and fluttering about the left corner of her mouth, hovering there like a hummingbird that had found a nectar-loaded blossom. Only there was nothing sweet or flowerlike about the thick wad of scar tissue ma.s.sed at that corner of her mouth.

Her skin was a glossy milk chocolate, her eyes huge and a deeper brown, the color of espresso. She had big white teeth and a smile that would have been knockout beautiful if not for that scar, fusing the lips at the corner, cutting every smile in half.

Her skin was scrubbed, her hair was braided, her s.h.i.+rt and shorts had been ironed. Kanesha and her mother had dressed up for her visit to the doctor.

Duncan liked that, not simply because it showed respect for him, but for themselves as well. Some of the people he saw in the clinic had estranged relations with all species of the soap genus and didn't give a d.a.m.n. What the h.e.l.l, it was a free clinic, right' Right. The maxillofacial clinic occupied a fifth-floor corner of one of D. C.

General Hospital's older buildings. The seats and fixtures in the waiting room were worn but clean, the examining room smelled faintly of the bleach that had been used to wipe the counters, its sickly yellow paint was chipped, its examination table needed reupholstering, but the staff was efficient and, more important, they cared.

Duncan turned to Kanesha's mother. "When did this happen, Mrs.

Green?