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  MINDBEND

  BY

  ROBIN COOK

  A SIGNET BOOK

  PUBLISHER'S NOTE

  This novel is a work of fiction. Names, characters, places, and incidents

  either are the product of the author's imagination or are used

  fictitiously, and any resemblance to actual persons, living or dead,

  events, or locales is entirely coincidental.

  NAL BOOKS ARE AVAILABLE AT QUANTITY DISCOUNTS WHEN USED To PROMOTE

  PRODUCTS OR SERVICES. FOR INFORMATION PLEASE WRITE TO PREMIUM MARKETING

  DIVISION, NEW AMERICAN LIBRARY, 1633 BROADWAY, NEW YORK, NEW YORK 10019.

  Copyright C 1985 by Robin Cook

  All rights reserved. This book, or parts thereof, maV not be reproduced

  in any form without permission. For information address G. P. Putnam's

  Sons, a Division of the Putnam Publishing Group, 200 Madison Avenue, New

  York, New York 10016.

  This is an authorized reprint of a hardcover edition published by G. P.

  Putnam's Sons, a Division of the Putnam Publishing Group. The hardcover

  edition was published simultaneously in Canada by General Publishing Co.

  Limited, Toronto.

  SIGNEI TRADEMARK REG, U,S. PAT OIF, AND I.R.GN COUNTRI. MASTERED

  TRADEMARK-MARCA REGISTRADA HECHO EN CHICAGO. USA.

  SIGNET, SIGNET CLASSIC, MENTOR, PLUME, MERIDIAN AND

  NAL BOOKS are published by New American Library,

  1633 Broadway, New York, New York 10019

  First Signet Printing, January, 1986

  6 7 8 9

  PRINTED IN THE UNITED STATES OF AMERICA

  For Barbara

  PROLOGUE

  FETAL RESEARCH

  BANNED

  New Regulations for Medical

  Research

  By HAROLD BARLOW

  Special to The New York Times

  WASHINGTON, July 12, 1974President Richard M. Nixon signed into law today

  the National Research Act (Pub. L. 93-348). The law calls for the creation

  of a National Commission for the Protection of Human Subjects in

  Biomedical and Behavioral Research. There has been growing concern about

  the ethics of research involving children, retarded persons, prisoners,

  the terminally ill, and particularly fetuses.

  It is hoped that by creating appropriate guidelines some of the shocking

  abuses that have been exposed of

  7

  8 ROBIN COOK

  late can be obviated, such as the purposeful infecting of a large number

  of retarded children with hepatitis in order to study the natural

  progession of the disease, or the discovery a few months ago at a Boston

  hospital of a dozen dismembered aborted fetuses.

  The first phase of implementing the law includes a moratorium on "re-

  search in the United States on a living human fetus, before or after

  induced abortion, unless such research is done for the purpose of

  assuring the survival of such fetus." Obviously the fetal issue is

  intimately tied to the highly emotional abortion issue.

  Response to the new legislation in scientific circles has been mixed.

  Dr. George C. Marstons of Cornell Medical Center welcomed the new law,

  stating that "guidelines for ethical behavior in human experimentation

  are long overdue. The competitive economic pressure for research break-

  throughs creates an atmosphere where abuse is inevitable. "

  Dr. Clyde Harrison of Arolen Pharmaceuticals disagreed with Dr. Mar-

  stons, saying that "anti-abortion politics are holding science hostage,

  preventing needed health care research. " Dr. Harrison went on to

  explain that fetal research has resulted in many significant scientific

  gains. Among the most important is a possible cure for diabetes. Fetal

  tissue injected into the

  MINDBEND

  pancreas has been proven to repopulate the islet cells that produce insulin.

  Equally important is the experimental use of fetal tissue to heal previously

  incurable paralysis resulting from spinal cord injuries. Injected into the

  site of the trauma, the tissue causes spontaneous healing by generating

  growth of new, healthy cells.

  It is too early to judge the impact of this bill until the various commis-

  sions mandated by law make their recommendations to Secretary Caspar

  Weinberger. In the area of research the new law will have an immediate

  impact by severely limiting the supply of fetal tissue. Apparently planned

  abortions have been the primary source of such tissue, though it is not

  known whether or not this need played a role in doctors' decisions to

  abort.

  NOVEMBER 27,1984

  JULIAN CLINIC, NEW YORK CITY

  Candice Harlev felt the needle pierce the skin of her lower back, followed

  by a sharp burning sensation. It was like a bee sting, only the pain rapidly

  evaporated.

  "I'm just putting in some local anesthetic, Candy," said Dr. Stephen

  Burnham, a swarthy, good-looking anesthesiologist, who had assured Candy

  that she was not going to feel a thing. The trouble was that she had

  already felt pain-not a lot but enough to make her lose a certain amount of

  faith in what Dr. Burnham had told her. She had wanted to be put to sleep.

  But Dr. Burnham had informed her that epidural anesthesia was safer and

  would leave her feeling better after the abortion and the sterilization

  procedure were over.

  Candy bit her lower lip. There was another stab of pain. Again it wasn't

  severe, but she felt vulnerable and ill prepared for what was happening. At

  thirty-six, Candy had never been in a hospital, much less had an operation.

  She was terrified and had told Dr. Burnham as much. She felt the burning

  10

  MINDBEND 11

  sensation again, and by reflex she straightened her back.

  "Don't move now," admonished Dr. Burnham.

  "I'M sorry", blurted Candy, afraid that if she didn't cooperate they

  would not take care of her properly. She was sitting on the side of a

  gurney in an alcove next to an operating room. A nurse was standing in

  front of her and to the right was a curtain which had been pulled to

  isolate the alcove from the busy OR corridor. Behind the curtain, Candv

  could hear muted voices and the sound of running water. Directly ahead

  was a door with a small window through which she could see the operating

  room.

  Candy's only covering was a flimsy hospital gown, open in the back where

  the doctor was busy doing whatever he was doing. He had elaborately ex-

  plained to Candy what was going to happen, but her ability to concentrate

  was severely limited by the intimidating surroundings. Everything was new

  and frightening.

  "Tuohy needle, please," said Dr. Burnham. Candy wondered what a Tuohy

  needle was. It sounded awful. She heard a cellophane package being torn

  open.

  Dr. Burnham eyed the three-inch needle in his gloved hand, sliding the

  stylet up and down to make sure it moved freely. Stepping to the left so

  that he could make sure that Candy was sitting straight, h
e positioned

  the needle over the area he had injected with the local anesthetic.

  Using both hands, he pushed the needle into Candy's back. His experienced

  fingers could feel the needle break through the skin and slide between

  the bony prominences of Candy's lumbar vertebrae. He stopped just short

  of the ligamenturn

  12 ROBIN COOK

  flavum, the barrier covering the spinal canal. Epidural anesthesia was

  tricky and that was one reason Dr. Burnham liked to use it. He knew not

  everybody could do it as well as he could and that knowledge gave him

  satisfaction. With a flourish he pulled out the stylet. As expected, no

  cerebrospinal fluid came out. Replacing the stylet, he advanced the Tuohy

  needle another millimeter and felt it pop through the ligamentum flavum. A

  test dose of air went in easily. Perfect! Replacing the empty needle with

  one filled with tetracaine, Dr. Burnham gave Candy a small dose.

  A feel a strange sensation on the side of my leg," said Candy with concern.

  "That just means we're where we are supposed to be," said Dr. Burnham. With

  deft hands he removed the syringe with the tetracaine and then threaded a

  small plastic catheter up through the Tuohy needle. Once the catheter was

  in place, he removed the needle. A piece of paper tape went over the

  puncture site.

  "That's that," said Dr. Burnham, stripping off his sterile gloves and

  putting a hand on Candy's shoulder to urge her to lie down. "Now you can't

  say that hurt very much."

  "But I don't feel the anesthetic," said Candy, fearful they would go ahead

  with the surgery even if the anesthetic wasn't working.

  "That's because I haven't given you anything yet," said Dr. Burnham.

  Candy allowed herself to be lowered to the gurney, the nurse helping by

  lifting her legs, then covering her with the thin cotton blanket. Candy

  clutched the cover to her chest as if it would afford some protection. Dr.

  Burnham fussed with a small plastic tube that snaked out from beneath her.

  MINDBEND 13

  "Do you still feel as nervous?" questioned Dr. Burnham.

  "Worse!" admitted Candy.

  "I'll give you a little more sedative," said Dr. Burnham, squeezing

  Candy's shoulder reassuringly. While she watched, he injected something

  into her IV line.

  "OK, let's go," said Dr. Burnham.

  The gurney with Candy on it rolled silently into the OR, which was

  bustling with activity. Candy's eyes scanned the room. It was dazzlingly

  white with white tile walls and floor and white acoustical ceiling. X-ray

  view boxes lined one wall, futuristic electronic monitoring equipment

  another.

  "OK, Candy," said the nurse who'd been helping Dr. Burnham. "We'd like

  you to scoot over here." She was on the other side of the operating

  table, which she patted encouragingly. For a moment Candy felt irritation

  at being ordered about. But the feeling passed quickly. She really had

  no choice. She was pregnant with an eighteen-week-old fetus. She

  preferred to use the word "fetus." It was easier to think about than

  "baby" or "child." Dutifully, Candy moved to the operating table.

  Another nurse pulled up Candy's gown and attached minute electrodes to

  her chest. A beeping noise began, but it took Candy a while to realize

  that the sound corresponded to the beating of her heart.

  "I'm going to tilt the table," said Dr. Burnham as Candy felt herself

  angle so that her feet were lower than her head. In that position she

  could feel the weight of her uterus in her pelvis. At the same time she

  felt a fluttering which she had noticed over the previous week and which

  she thought

  14 ROBIN COOK

  might be the fetus moving within her womb. Thankfully, it stopped quickly.

  The next instant the door to the corridor burst open and Dr. Lawrence Foley

  backed in, holding up his dripping hands just like surgeons did in the

  movies. "Well," he said in his peculiarly inflectionless voice, "how's my

  girl?"

  A don't feel the anesthetic," said Candy anxiously. She was relieved to see

  Dr. Foley. He was a tall man with thin features and a long straight nose

  that sharply tented the front of his surgical mask. Soon all Candy could

  see of his face were his gray-green eyes. The rest was hidden, including

  his silver-white hair.

  Candy had been seeing Dr. Foley on an infrequent basis for her routine

  gynecological care and had always liked and trusted the man. She had not

  had a checkup for eighteen months prior to her pregnancy, and when she had

  gone to his office a few weeks ago she had been surprised to see how much

  Dr. Foley had changed. She'd remembered him as being outgoing and not

  without a touch of dry humor. Candy wondered how much of his "new"

  personality was due to his disapproval of her unmarried pregnant state.

  Dr. Foley looked at Dr. Burnham who cleared his throat: A just gave her 8

  milligrams of tetracaine. We're using continuous epidural." Stepping down

  to the end of the table, he lifted the blanket. Candy could see her feet,

  which appeared exceptionally pale in the bright fluorescent light from the

  X-ray view boxes. She could see Dr. Burnham touch her, but she felt nothing

  as he worked his way up her body until he wasjust under her breasts. Then

  she felt the prick of a needle and told him so. He smiled and said,

  "Perfect!"

  MINDBEND 15

  For a moment Dr. Foley stood in the center of

  the room without moving. No one said anything;

  ever ' vone just waited. Candy wondered what the

  man was thinking about, since he seemed to be

  looking directly at her. He'd done the same thing

  when she'd seen him in the clinic. Finally, he

  blinked and said, "You've got the best anesthesiol

  ogist in the house. I want you to relax now. We'll

  be finished before you know it."

  Candy could hear some commotion behind her, then the snap of latex gloves

  as she watched Dr. Burnham fit a wire frame over her head. One of the

  nurses secured her left arm to her side with the sheet covering the OR

  table. Dr. Burnham taped her right arm securely to a board that stuck out

  from the table at right angles. That was the arm with the IV. Dr. Foley

  reappeared in Candy's sight, gowned and gloved, and helped one of the

  nurses spread large drapes over her, effectively blocking nine-tenths of

  her view. Straight up she could see her IV bottles. Behind her, if she

  rolled her head back, she could see Dr. Burnham.

  "Are we ready?" asked Dr. Foley.

  "You're on," said Dr. Burnham. He looked down at Candy and winked.

  "You're doing fine," he reassured her. "You may feel a little pressure

  or some pulling, but you shouldn't feet any pain."

  "Are you sure?" asked Candy.

  "I'm sure,"

  Candy could not see Dr. Foley, but she could hear him, especially when

  he said, "Scalpel." She heard the sound of the scalpel slapping the

  rubber glove,

  Closing her eyes, Candy waited for the pain. Thank God it didn't come.

  All she could feel was the sensation of people leaning over her. For the

  16 ROBIN COOK

  first time
she allowed herself the luxury of thinking that this whole

  nightmare might actually pass.

  It had all started about nine months previously when she had decided to go

  off the pill. She'd been living with David Kirkpatrick for five years. He

  had believed she was as devoted to her dancing career as he was to his

  writing, but sometime after her thirty-fourth birthday she had begun

  nagging David to marry her and start a family. When he refused, she decided

  to try getting pregnant, certain he would change his mind. But he had re-

  mained adamant when she had told him of her condition. If she continued the

  pregnancy, he would leave. After ten days of weeping and countless scenes

  she had finally agreed to this abortion.

  "Oh!" gasped Candy as she felt a stab of whitehot pain somewhere deep in

  her being. It was akin to the feeling when a dentist finds a sensitive spot

  in a tooth. Thankfully, the stab didn't last long.

  Dr. Burnham glanced up from his anesthesia chart, then stood to look over

  the ether screen at the operative site. "Are you guys pulling on the small

  bowel?"

  "We just packed it away out of the operative field," admitted Dr. Foley.

  Dr. Burnham sat back down and gazed directly into Candy's eyes. "You're

  doing just great. It's common for someone to feel pain when the small

  intestine is manipulated, but they're not going to do that anymore. OK?"

  "OK," said Candy. It was a relief to be reassured that everything was going

  as it should. Yet she wasn't surprised. Although Lawrence Foley's manner

  seemed to lack the old warmth, she still had every confidence in him as a

  doctor. He'd been wonderful to her from the start: understanding

  MINDBEND 17

  and supportive, especially in helping her decide about the abortion. He'd

  spent several sessions just talking to her, calmly pointing out the diffi-

  culties of raising a child as a single parent and underlining the ease of

  having an abortion, though Candy was already in her sixteenth week.

  There was no doubt in Candy's mind that it had been Dr. Foley and the

  people at the Julian Clinic who had made it possible for her to go through