And add to that, she didn't actually know if he was free now or not or whatBut he'd said he had a good reason for calling—what could that be?"Stone, I read your columns in the Sentinel. So I sort of feel like I've kept in contact. I can almost hear your voice sometimes.""That makes me think you were cheating a little on our deal.""Well," she heard herself say, "some of them were pretty good. Sometimes you sounded like you knew as much as a doctor.""Don't flatter me excessively, or I might want to start believing you." He laughed. "But speaking of doctors, didn't you used to have some kind of heart issue? How is that these days?""You really want to know?""Maybe it might have something to do with why I'm calling. Best I recall, you never actually told me, even back when.""Thank you for asking," she said. "I guess it's not much of a secret anymore, with me popping nitro every other day. I have a scarred valve, coronary stenosis, and it's not getting any better. I don't know what to do about it short of going toLourdesfor a miracle.""I see," he said. Then he fell silent. Mercifully, he didn't come up with false bravado about revolutionary treatments and you never can tell, blah, blah, blah. Then he said, "So is that why you've enrolled in the clinical trials at the Dorian Institute? To be part of their work using stem cells?"What! "How the hell do you know about—""Hey, Ally, you know I can't divulge my sources. After I knew you, I grew up to be a real reporter. That was my grand plan, remember?""Then this may turn out to be a very short conversation. I have nothing to—""Okay, okay, let's start over." He paused and cleared his throat. "Ahem. Are you the Alexa Hampton who was formally entered about half an hour ago into the stage‑three clinical trials for the National Institutes of Health being held by the Gerex Corporation? Or maybe I should play dumb and begin by asking if you've ever heard of them.""Stone, why . . . why are you asking me this?"It was bizarre. How could he know? And wait a minute, what did he mean about enrolling? She hadn't enrolled in anything."Ally, I'm finishing a major—I hope—book about stem cell technology, and right now the world leader is the Gerex Corporation. I think, but I can't yet prove, that their Dorian Institute out inNew Jerseyis the site of some pretty incredible stuff. I was ... fooling around on the Internet, on the NIH Web site, looking for information about them, and—it must have been some momentary computer glitch—someone with your name popped up for a second. Along with a Nina Hampton. Which made me suspect it was you."She was incredulous. She was being entered into the clinical trials before she had even seen the place? Somebody was pushing the pace. Winston Bartlett or Van de Vliet had taken it for granted that she and her mother would enter the trials. Worst of all, it took a former lover she hadn't talked to in x‑zillion years to give her this unnerving information."Nina is your mom, right?" he went on. "I still remember her fondly. I don't think she thought much of me, however. By the way, how is she?""She's . . . she's not doing all that great." Ally was still trying to get her mind around what she'd just heard. "But why are you calling me, Stone?""If anything I've said rings a vague bell, then could we meet someplace and talk? I don't think it would be a great idea to do it over the phone. That's all I really can say now."Maybe, she thought, Stone Aimes might have uncovered a few things of which she ought to be aware. His pieces in the Sentinel showed he was a damned good reporter."I don't think what little I know about Gerex would be any help to you." She was attempting to get her mind back together. "I actually have a lot of questions about the stem cell procedure myself. I spoke on the phone just now with Dr. Van de Vliet and he described their technology to me in general terms. But maybe I should interview you. Maybe you could explain it to me using that wonderful gift you have for simplification in your columns.""Ally, I don't know anything except what's in the public domain. They're privately held, so they don't have to tell anybody zilch. I assume you've actually been out to the Dorian Institute, which is more than I can say.""Never.""But you're enrolled—""I'm not enrolled in anything." To say the least. "And it bothers me that anybody thinks so. But I am thinking about taking Mom out there tomorrow, if she still wants to go. When I talked to him on the phone, Dr. Van de Vliet wanted me to start the procedure immediately. That's scary, but he does seem to know what he's doing.""I take it, then, that you're leaning toward going through with it."She hated the way he'd just made her sound so gullible."The truth is, I'm more concerned for Mom. He claims he can help her early‑onset Alzheimer's, and that would mean a lot." Why was she telling him all this stuff? She found herself wondering if he'd ever married."I'm so sorry to hear that. But the chances are he can.""What are you thinking?" she asked finally. "And why did you call me? Really? What's going on?""I don't know yet. There's a lot I don't know." He seemed to hesitate. "Ally, is there any chance whatsoever that—while you're out there—you could get me the names of some of thepeople who've been through the clinical trials? The Dorian Institute is entirely off‑limits to the press. I tried several times to schedule an interview with Karl Van de Vliet, the guy you talked to, but no luck. I can't get past the corporate people. My only hope is to try and find some patients who've been treated and released who've completed the clinical trials. But Gerex has been ruthless about keeping their identities secret You are literally the first person I've found who has any connection with the institute and is willing to talk about it. That is,ifyou're willing.""Stone, it would be like the blind leading the blind. I don't know the first thing about the place.""Well, let me ask you this—when you were talking with him, did Van de Vliet happen to mention any occasion where a subject had been terminated from the trials?""It never came up. Why do you—?""Never mind. But when and if you go out there, you might inquire about that." He paused. "Don't get me wrong. I'm actually Gerex's biggest fan. I mean, considering merely what you told me, that they're claiming to have a procedure that treats early‑onset Alzheimer's. Think about it. I'm rooting for your mom, sure, but that's a Nobel Prize in itself, right there. We're talking major medical history in the making.""And?""And I want to publish the first book about it." He paused. "Also, a little birdie tells me that something not entirely kosher may be going on out there. No proof, just a reporter's hunch. There's a little too much sudden secrecy."Ally was having a strange feeling come over her. She was actually enjoying talking to him."Shit, Stone, I'm glad you called. I lost two men I loved very much since I knew you and I'm feeling very alone at the moment. I could use some moral support I've got a lot of people bugging me to enter those clinical trials. Even people I'd never met before, like Winston Bartlett, theNew Yorkbig shot. He's suddenly very concerned about my health. I have no idea what that's about. But it makes me uneasy."There was an awkward lull, then, "Ally, all I'm asking is that you just take the measure of the Dorian Institute when you're out there and tell me what you think about the place. Are they performing the miracles they announced as their objective?""Look, I'll help you when and if I actually can. So give me your number, okay?"He did."I can tell when I'm being blown off," he went on. "I have a very sensitive blow‑off detector. But why don't you try a test? When you're out at the institute, ask Van de Vliet or somebody why that mystery patient was terminated from the clinical trials. See if the question makes them uncomfortable.""Why does that matter so much to you?""If a patient is dropped for no good reason about the same time they clamp down on information, I think it could be fishy. Beyond that, I cannot speculate. And while you're at it, I'd love the names of some other ex‑patients. Anybody. I found a list on the NIH Web site but they're all encoded, so it doesn't do me any good. I just want to ask them if the procedure worked or not. It's information that's going to be made public eventually, no matter what. Come on, Ally, don't you want some testimonials?""Okay, look, I'll try to see if anybody there will give me any info."She was realizing she was in a comfort zone when she was talking to him. Still, so much about him remained a mystery. He had always said his mother and father were both dead, but it was still suspiciously hard to get him to speak about them. She'd gotten the impression that he didn't actually remember his father. That was the part of his life that he'd always been the most closed off about. Either that or he was repressing some horrible memories."Thanks a lot, Ally." A pause, then, "Interested in getting together sometime?""Let me think about it."She put down the phone with her mind in turmoil. She realized she hadn't asked him if he was "attached" but the next time they spoke, she was going to try to ease it into the conversation.Chapter 12Tuesday, April 79:50a.m.Ally steered herToyotaonto the ramp leading to theGeorgeWashingtonBridge, the entryway to northernNew Jersey. She was just finishing a phone call to Jennifer. She wanted her to take a look at the notes and blueprints forBartlett'sGramercyParkproject and scan them into their CAD program. After all the phone calls yesterday, she'd been too sidetracked to do it. AlthoughBartletthad declared he wasn't in any hurry, he had messengered a certified check to her office Monday afternoon. The project was a go. She wanted to get moving while everything was fresh in her mind.Before leaving her apartment this morning, she'd downloaded a map from MapQuest and from it she had estimated that the drive up to the Dorian Institute would be approximately an hour—give or take. She had begun the trip early because her mother's mind had been lucid the previous evening and she was hoping that interlude might last into this morning.Unfortunately, it had not.Nina was sitting next to her now, in full makeup but completely unresponsive, seemingly in another world. When Ally arrived at theRiverside Driveapartment to pick her up, Maria—now silent and uneasy in the backseat, reading a Spanish novel—met her at the door with a troubled look and shook her head sadly."Miss Hampton, I know she was all right when you were here last night, but this morning ... she may not recognize you. She'll most likely snap out of it and be okay later on, but right now she's just in a fog. It was all I could do to get her ready."When Ally walked in, Nina was sitting in her favorite chair, dressed in her favorite black suit. Her makeup was perfect Thank you, Maria."Hey, sweetie, you look great."Nina stared at her as though trying to place the face and said nothing. She just looked confused and very, very sad.Dear God, Ally thought, this is the first time she's completely failed to recognize me.It was so disheartening. Last night, when Ally had come up to discuss whether or not she still wanted to explore Dr. Van de Vliet's experimental treatment, Nina had been completely cognizant. Ally had tried to explain the concept of neural tissue regeneration using stem cells, which was difficult since she barely understood it herself."Mom," she had said "this might be something that could reverse some of the damage to your... memory. At least keep it from getting worse. I know it sounds scary but everybody says the conventional treatments for what you have don't work very well or very long.""Then let's go out there and talk to him, honey. Just come in the morning and take me. By then I'll probably forget everything you've said tonight."How prescient, Ally thought sadly. Now Nina was just gazing blankly ahead, silent. Does she remember anything from last night?For that matter, what was Nina thinking now? Was she conscious of the fact she was losing her mind? And whatabout the ultimate question: do we want to live longer merely to be alive, or do we want to stay alive in order to do things? To be or to do? In her mother's case, she knew it was the latter. Nina had always been full of life, ambition, and projects. Would she want to go on living if none of those things were possible? You never know for sure about other people, even your own mother, but Ally suspected she would rather not live to see that day.Now, though, was she even aware it was coming?Ally thought back about the first signs. Nina hadn't yet turned sixty‑five when she abruptly started having trouble remembering little things. She began forgetting where she'd put items, and she gave up on remembering phone numbers and dates. Initially it had just seemed like a lot of "senior moments" run together, very puzzling.But then it got worse. She'd always loved music, and she'd always played the piano. She loved Chopin, especially the nocturnes. By the time she was sixty‑six, however, she was having trouble remembering the names of her favorite composers. She also completely gave up trying to play, either from memory or with the music. When getting dressed one day, she put on her blouse completely backwards. It was bad.Ally had taken her to see four different specialists and they all had concluded that Nina Hampton suffered from what was known as familial early‑onset Alzheimer's. It was caused by a mutated gene and was extremely rare, representing only some 5 percent of all Alzheimer's cases.There were two major drugs currently on the market, Exelon and Reminyl, that could relieve some of the symptoms of Alzheimer's by boosting the action of the brain chemical acetylcholine. However, Nina had not yet declined to the stage where doctors would prescribe those drugs. To resort to them was an admission you were at endgame, since they usually were effective only for a few months.So the Dorian Institute might well be a long shot worth taking. Frankly, what's to lose?This morning, she knew, was going to be difficult. If Ninawanted to stay and checked in, there would surely be a pile of paperwork. Ally had had the foresight to acquire power of attorney for her mother three months earlier, and she'd brought along that document in case it might be needed. And Maria, the wonderful, ultimate caregiver, was there to help. The real challenge, however, might well be trying to help Nina understand what was going on and participate in the decision. This was the moment every child dreads, when you have to face, really face, a parent's mortality.As the green forests of northernNew Jerseybegan to envelop them, she slipped a CD of Bach partitas for unaccompanied violin into the CD player. She had loved to play them all her life, but now Dr. Ekelman had urged her to put her violin into storage. Hearing the violin now reminded her of the other purpose of the trip, the treatment decision she needed to make for herself.In that regard one of the things that kept running through her mind was what Stone Aimes had said about the Gerex Corporation instituting a news blackout simultaneously with a patient being mysteriously dropped from the trials. Those concurrent facts did not need to be ominous, but they also could use an explanation.What was she going to do? Was Van de Vliet's stem cell procedure on her heart really worth the risk? She honestly didn't know. Even though the violin had temporarily been taken away from her, she had hopes she could gradually get it back. There were other ways to try to strengthen a dysfunctional heart.Well, she thought, wait and hear him out.From theGeorgeWashingtonBridgeshe had taken 1‑4, which turned into 1‑208 and now the green forest held sway. It felt like she'd gone through a time warp, from the beginning of the twenty‑first century to the end of the eighteenth. Then finally, as the second partita was ending, the icy‑coldGreenwoodLakecame into view. It was associated with those longFinger Lakesgouged out by glaciers.Driving past remnants of the last Ice Age, she reflected on how insignificant humans are in the scheme of things. Suddenly she thought of Aldous Huxley's novel After Many a Summer Dies the Swan, about a wealthy madman who'd discovered a way to prolong life by eating the entrails of prehistoric fish. Maybe it was seeing the lake that made her flash on that.She was now onGreenwood Lake Road, which passed around the west side, and there were numbers on several gated driveways as she passed along. She suspected the place would be somewhere along the middle of the lakeshore, and she was right.After a few miles she came to a discreet sign announcing the Dorian Institute, and a large iron gate that protected a paved roadway leading into a forest of trees. That was it: just forest, no hint of a building, though she saw signs of some kind of industrial park farther down the road. When she drove up to the gate, she realized there was a video camera and a two‑way intercom.When she reached out of the window and pushed the talk button, she heard "Good morning." And then the gates parted in the middle and slid back.They must be expecting us, she thought, and drove through.The road was cobblestone, or rough paving brick. It wound among the trees for approximately half a mile and then widened.There, framed by the lake in the background, was a magnificent three‑story building with eight Doric columns across the front in perfect Greek Revival style. There were windows at ground level, but they were heavily curtained.Built of red brick, the building probably dated from the late nineteenth century, and it looked every bit like an Ivy League dormitory."Miss Hampton, I don't like the feeling I'm getting about this place," Maria said quietly. "It is very cold and formal from the outside, but inside I sense a place where there is bad magic.In theDominican Republic, we call it Santeria. I can always tell these things."Ally knew and respected Maria's sixth sense. But then Maria sometimes still acted like a freshly minted citizen just off a green card, and she had an innate suspicion of authority‑ evoking buildings. Her aversion to the Dorian Institute might be nothing more than that.On the other hand, Ally was having a bit of the same feeling. There was something formidable and foreboding about the place that seemed out of keeping with its supposedly benign purpose. She felt a moment of tightness in her chest.There was a parking area off to the left, and she drove into the nearest slot and turned off her engine. This was the moment she'd been both anticipating and dreading. The clock on the dash read eleven‑fifteen; she was fifteen minutes ahead of the appointed hour."Okay, Mom, how do you feel?"Nina turned and stared at her, uncertainty in her eyes. "Where are we, Ally? I don't recognize anything.""This is the institute I told you about last night. Can you remember anything we talked about then?""This is the place you were ... Didn't you say there's a doctor here who can do something for my... memory?""We're both here now to just talk to him." She turned to the backseat. "Maria, can you get Mom's purse?"She nodded, then reached hesitantly for the door. She was clearly reluctant to get out.Ally walked around and opened the door for her mother."Okay, Mom, time to stretch your legs."Ally held her hand and together they headed across the oval brick driveway. Birds were chirping around them and she could smell the scent of the lake, borne up the hill by a fresh wind. Then, through the trees, she saw two women walking up the trail that led down to the lake. They were, she assumed some of the patients.They both looked to be in their early sixties, but also athletic and nimble. One was wearing Nikes and a pale green pantsuit. The other had on a blue dress and a white cap and Ally realized she must be a nurse. She'd been taking the other woman out for a stroll.They were engrossed in conversation, but as they approached, the woman Ally had decided was on staff looked up and smiled a greeting."Can I help you?"She introduced herself and Nina and Maria. The woman smiled again but didn't introduce herself in turn."We're here to see Dr. Van de Vliet," Ally went on, "about the trials. But we're a couple of minutes early and I was wondering if we could look around a bit first? I'm trying to understand what the institute is really like.""Well, dear," the woman said, "even those of us who work here aren't allowed everywhere. You know, into the research lab in the basement. Some places here have to be completely hygienic. Of course, for patients who are in the recovery phase, strolling around outside is definitely recommended, as long as they're able. But that's getting way ahead of ourselves. First we'll have to check you in. There's a lot of paperwork for the clinical trials." She seemed puzzled. "They're almost over, you know. But come along and I'll let him know you're here. He's always down in the lab at this time of the morning. It's well after his rounds. They're so busy now."Then she turned to the other woman. "Sophie, do you think you can find your way back to your room? It's number two‑eighteen, on the second floor, remember?"Sophie appeared to be pondering the question for a long moment before she huffed "Don't be silly. I know exactly where it is."As she strode on ahead, the nurse watched her carefully, as though unsure what she might do next. She pushed a buzzer at the door and then a man in a white uniform opened it and let her in. Only after Sophie had disappeared through the doorway did the nurse turn back."I'm Elise Baker. Please forgive Sophie if she seems a little ... confused. Her procedure is still under way.""Her 'procedure'? What—""She was diagnosed with Parkinson's before she came here. She's improved an enormous amount, but we're not allowed to say so.""Why is that?""We're in clinical trials. No one is allowed to discuss our results. Everyone here had to sign a secrecy agreement."Now Maria was helping Nina up the steps. The porch, with its soaring white Doric columns, was definitely magisterial. The front door, however, was not wooden or decorative. It was solid steel, albeit painted white to blend in.Elise walked to the door, which had a video camera mounted above it, and a split second later, it buzzed, signaling it was unlocked.This is a lot of security, Ally thought, for a clinic doing research on cells. Are they worried about spies getting in, or patients getting out?But the locked steel door was just the beginning of the security. Next they entered a small room just inside the door with an X‑ray machine to see into purses and parcels."The first floor is reception and dining," Elise explained as she swept through the metal detector. "There are rooms— we call them suites—upstairs for patients, and the research lab and offices are in the . . . lower area.""What . . . what is all this security for?" Ally asked."The work here is highly proprietary. No one is allowed to bring in any kind of camera or recording equipment."The guard dressed in white looked like a retired policeman, with perhaps a few too many jelly doughnuts over his career. He had a beefy red face and a hefty spare tire. But he was certainly alert to his responsibilities, eyeing the three newcomers with scarcely disguised suspicion.In fact, Ally sensed a palpable paranoia in the air. Well, she told herself, medical research is a high‑stakes game. It's understandable they would be concerned about industrial espionage.After the security check, they went through another steeldoor and entered the actual lobby. The first thing she noticed was a grand staircase leading up to the second floor, and then to the third. Off to the right was a modern elevator with a shiny steel door.A number of patients were coming down the stairs and heading for a hallway leading to the back. They were mostly women, whose ages ranged anywhere from forty‑five to well beyond seventy.Who are these people? Ally wondered. They must have been sufferers of various kinds of debilitating afflictions, but now they were certainly ambulatory, if not downright sprightly. She wanted to talk to some of them, watching them moving along chatting and smiling, but this was not the moment."At eleven‑thirty we have meditation in the dining hall," Elise was saying as she led them through the lobby, "for those who care to participate, and after that a vegetarian lunch is served at twelve‑thirty sharp." Then she glanced back. "After you see Dr. Van de Vliet—and assuming you're admitted—there'll be an orientation and then you're welcome to begin participating fully in our activities.""Actually," Ally said, "if people are well enough to be in 'activities,' why can't they be outpatients?""These clinical trials require twenty‑four‑hour supervision," Elise explained, heading for the wide desk in the center of the room. "Now, if you would all sign in here at the desk, Ellen can take you downstairs to the medical reception."A dark‑haired woman smiled from behind the desk, then got up and came around. A sign‑in book was there on a steel stand. Ally finally noticed that light classical music was wafting through the room, Tchaikovsky'sSwanLakesuite."You must be Ms. Hampton," the woman said. "And this must be your mother. We were told to expect you."She nodded a farewell to Elise, who said, "It was so nice to meet you. Good luck."She then turned and headed for the back.Ally signed all three of them in."Good," the woman said as she checked the information."My name is Ellen O'Hara, by the way. I'm in charge of the nursing staff here. We're ready to go downstairs now."Ellen O'Hara had a knowing, earnest face that fairly lit up when she smiled. She had short brown hair streaked with gray and was pleasantly full‑figured.When they reached the elevator, she zipped a small plastic card through the reader on the wall and the doors slid open. As they emerged on the lower level, Ally realized they were in the precincts of a very sophisticated medical laboratory. Occupying most of the floor was a glassed‑in area, inside of which she could see three men and two women, all dressed in white. She also noticed rows of steel containers that seemed to be ovens or incubators of some kind as well as racks and racks of vials. At the far end of the laboratory, there was a blackboard on which one of the men was drawing something that looked like hexagonal molecules, linking them together."That's Dr. Van de Vliet," Ellen said pointing. "I'll let him know you're here. The laboratory is a special environment. The entrance there is actually an air lock. The air inside is filtered and kept under positive pressure."She walked over to a communications module, buzzed then announced into the microphone, "Dr. Vee, your eleven‑ thirty appointment is here."He turned and stared in their direction, then smiled and waved. Next he walked to a microphone near the center of the room and clicked it on."I'll be with you in a minute. Can you please wait in the receiving room? And Ellen, can you start getting them ready?""Of course." She nodded then clicked off the microphone and turned. "Receiving is just down at the end of the hall. Next to his office. Please come with me."She led them through a large wooden door, into a room with a retractable metal table covered in white paper and several chairs. It was a typical examination room, with a device on the wall to monitor blood pressure, a stethoscope, and other examination paraphernalia."If you'll kindly take a seat," Ellen said, "I'm sure he'll be here as soon as he can, in a few minutes at most. But while we wait, I need to take your temperature and blood pressure, and start a chart.""Ally, where are we?" Nina asked. Her face was becoming alarmed, and Maria reached to comfort her. "Are we in a hospital somewhere?""Yes, Mom, it's actually the institute I told you about last night The doctor here wants to see if he can do anything to... help you.""Oh," she said, "is he the one you told me about? I thought that was just a dream.""No, he's real. Whether he can help you or not that part is what’s still a dream. But we're all praying."She looked around at the pure white walls and wondered again what she was getting into. Meeting a new specialist in the sterile white cold of an examination room, could be frightening in itself. God, how many times before had she done this as she trudged through HMO hell? Maria was so unsettled she was deathly pale.Ellen took their blood pressure and temperature, including Maria's, even though she protested mildly, half in Spanish—a sign of how unsettling it was to her. Ellen had only just finished putting all the numbers on clipboard charts for each of them when Karl Van de Vliet opened the door and strode in.Chapter 13Tuesday, April 711:39 a.m.He had a high forehead and prominent cheekbones, just like in the photo. And just as in his photo, there was a genuine dichotomy between his face, which looked to be early forties and unwrinkled, and his gray eyes, which were much older. That was it. That was what seemed odd. He was different ages.Underneath his white lab coat he was wearing a black suit and an open‑necked blue shirt. Ally noticed that his fingers were long and delicate, like those of a concert pianist, and overall he had a kind of ghostly presence, as though he were more spirit than man. Although he looked exactly as he did in the photograph in the Gerex Corporation brochure, in person there was an added dimension, a kind of raw magnetism about him. It was more than simply a physician's bedside manner, it was the allure of a pied piper. The first thing you wanted to ask him wasHow old are you, really?Maybe the next thing you'd want to do was ask him to dinner.What had she expected? Maybe a self‑absorbed nerd researcher in wrinkled stained lab attire, anxious to scurry back to his test tubes. But in person Karl Van de Vliet was debonair and youthful, living proof that his photo wasn't retouched and was recent. He had to be twenty years older than she was, easily, but to look at him you'd guess he was close to the same age. She was dying to ask him about that but she couldn't think of a polite way to raise the subject.She introduced herself. "We spoke yesterday." Then she introduced her mother and Maria. "Mom and I talked last night about the clinical trials, and she said she's interested. This morning, unfortunately, I'm not sure she remembers what we discussed."He placed a hand on Nina's shoulder and studied her face as he smiled at her, embracing her with his eyes. "Well, we're going to see what we can do about that aren't we, Mrs. Hampton?""I've got a question right up front" Ally said. "Have we already been entered into the National Institutes of Health clinical trials?"He seemed taken aback for a moment, caught off guard, but then he stepped up to the question."As a matter of fact I did take the liberty of authorizing the preliminary NIH paperwork for both of you. Of course it doesn't obligate you in any way. The thing is, there's a lot of red tape, so if you do decide to participate, the sooner we get that part started the better. On the other hand, if you decide not to, we can just terminate everything at this preliminary stage and you won't even be part of the official record."Well, Ally thought, that undoubtedly explains why Stone saw our names on the NIH Web site. But why did Van de Vliet look so funny when I brought it up?He focused on Nina. "Mrs. Hampton, I'm Dr. Van de Vliet. You're a pretty lady, and we've had some luck helping other ladies like you.""Honey, if I had you in my bedroom, then maybe you could help me."Oh my God, Ally thought, she's about to go ribald on us. But that's a sign she's coming out of her funk.But then she had another thought. Maybe Nina sensed he was older than he looked. Like that paranormal perception that told her Grant was involved in something evil. So far, however, that particular perception hadn't panned out (though Grant clearly was up to something).Maria was mortified. She blushed and made a disapproving animal noise low in her throat and turned her face away, but Van de Vliet simply smiled even more broadly."Mrs. Hampton, I don't think you should be talking that way in front of your daughter." He gave her a wink. "What you and I do together is none of these people's business. But I do think we should consider keeping them informed if only a couple of hints."Ally found herself wanting just to listen to his voice. There was an intelligent warmth about it that reminded her of a kindly professor atColumbia, a truly gifted architect who also could quote Keats and make you cry. You wanted to give yourself to him. My God, she thought, how am I going to stand up to this man?"There're some issues you and I need to discuss," he said turning back to Ally. "The first thing I need to do is take a look at Mrs. Hampton’s records. But whatever they say, it won't do any harm to run what we call a 'mental state examination' for her, to establish a general baseline of cognitive impairment as of now.""How long will that take?""Actually, Ellen can start in just a few minutes," he said "Of course, we'll need to hear about the usual danger signs everybody knows. Does Mrs. Hampton have recent‑memory loss? Does she get confused about places and people? Does she have trouble handling money and paying her bills?""The short answer is yes."All of those things, Ally knew, had accelerated in the last six months. It was the tragic, recognizable onset of the latter stages of Alzheimer's. Already more than once Maria had said there were times when she didn't think Nina recognized her. More and more she seemed to be confused, unable some days to find her way around the apartment, and she'd started repeating herself. She often had trouble finding the right words, and she was increasingly paranoid and suspicious. Maria, who had worked with other Alzheimer’s patients, feared she might begin hallucinating soon, seeing things that weren't there.Ally turned to her. It felt obscene to talk about her when she was sitting right there with them."Mom, sweetie, do you understand what Dr. Van de Vliet is asking? Do you think you have trouble doing everyday things?"She knew the answer but she was determined that her mother not be treated like a potted plant."Ally, you know that half the time I can't remember a blessed thing. I'm getting crazy as a bloody coot."Then Nina turned and looked Van de Vliet in the eye."I don't want to lose my mind, Doctor. I don't want to see the shade closing in. I can't do crosswords anymore. I used to do them all the time. And all the music I used to know. It was my love and now . . . now I can't tell Scriabin from Strauss half the time. It wasn't supposed to happen that way. I thought my mind would go on forever.""Mrs. Hampton, if you'll let me, what I want to do is try to work on your recollection. I don't know how much I can help you with crosswords, but then I've never been much good at them myself either. Your memory of music should improve, though. There are no guarantees, but—""Then I'm ready to try it, Doctor," she cut in. "You're all that stands between me and losing the only thing I have left, my past" Next came a burst of rationality. "Now, I hate to be a pest but could you explain what exactly it is you're going to do. I want Ally to hear this too and then maybe she can go over it with me later and help me understand it."He smiled and reached over and stroked her slightly thinning hair. "I'd be happy to try, Mrs. Hampton. It's actually pretty simple."Then he turned to Ally. "We touched on some of this on the phone. Do you want to hear it again?""Yes, I'm still trying to get it all into my simple mind.""Well," he began, "to go back to the very beginning of my interest in stem cells the focus of our research has been directed toward challenging the notorious Hayflick limit. Back in the 1960s, Professor Leonard Hayflick discovered that when tissue cells are taken from the body and cultured in a laboratory dish, those cells grow and divide about fifty times, give or take, and then they stop. They have reached old age, senescence. The physical basis of the Hayflick limit is a section of DNA known as telomere, which gets shorter each time the cell divides. Eventually the telomeres become so short that all cell division stops. It's like an internal clock telling them the game is over. They've had their innings.""And you're saying you've found a way to beat the clock, to stop the telomeres from getting shorter?""All cells possess a gene known as the telomerase gene, which can restore the telomeres to their youthful length. But in most cells the gene is permanently repressed and inactive. It is only found in egg and sperm cells, and in cancer cells." He gazed away for a moment as though collecting his thoughts. Then he turned back. "However, we've found that by isolating and inserting an active copy of the telomerase enzyme into adult stem cells, which can be found in minute quantities throughout the body, we can set their clock back to zero. We extract cells, 'immortalize' them with telomerase, and then return them to the body as a youthful infusion.""And is that what you'd be doing for Mom?""There'd be a series of injections, but given what appears to be her level of mental awareness right now, the procedure probably can be accelerated." He patted Nina on the shoulder."All right," Ally said "but can you use the same procedure for someone's heart?""Well, yes and no," he said. "Did you bring your medical records? I should have a look at them before making any pronouncements."To prepare for this moment, she'd printed off a copy of the medical files she'd scanned into her computer."There're a lot of files," she said, opening her bag. "I've got copies of my EKGs over the past eleven years. Dr. Ekelman, my cardiologist, says my condition is getting progressively worse."She took the folder out of her bag and handed it to him. He flipped through the files with what seemed an absent manner, almost as though he already knew what was in them and was just going through the motions. Then he looked up."Well, your physical condition looks pretty good. You clearly exercise. And I don't see anything here that would suggest a complication. As to how your procedure might differ from your mother's, I guess the main area of concern is simply the scale." He laid her files on the steel table. "Your heart has reached the stage of aortic valve stenosis where cardiac output no longer can keep up proportionately with vigorous exercise. And that has put an even larger strain on an already weakened condition. What we are about to undertake here corresponds to what might almost be considered an aortic valve replacement, though it is done at the cellular level. We call it regenerative medicine. Millions of cells will be involved We'll attempt to reverse the calcification and also to develop new blood vessels that supply the heart muscle.""You know, this is so risky. I remember that not long ago they tried to use fetal cell injections into the brain for treating Parkinson's disease. And it turned out that the side effects were horrendous. Why should I assume that this is any safer?"He looked pained. "I assure you we don't do anything here that is remotely like that particular, unfortunate procedure."She stared at the ceiling trying to grasp what he'd just said. "So how risky do you think this is?" she asked finally. "Truth time."He looked away again and sighed. There was a long silence in which he seemed to be pondering some extremely troubling thoughts. Finally he turned back."In medicine there Is always something that can go wrong. Even the most innocuous procedure can end up being lethal if that's what the gods want that day." He looked at her intently and seemed to try to measure his words. "But I wouldn't recommend we proceed if I didn't feel that the potential benefits far outweigh the risks."She listened wondering. Something in his voice is sounding cagey. What is he leaving out?"I still want to think about it""Of course, but we can make some preparations in the meantime," Van de Vliet said turning back to Nina. "Mrs. Hampton, do you understand anything of what I've said? Nothing is risk free.""Young man, if you'd lived as long as I have, and then felt it all slipping away, you'd be willing to take a chance with anything.""Mrs. Hampton, Alzheimer's is one of the more promising areas of stem cell research. We've already had successes here. I truly think we can help you. In fact, Ellen can start your preliminaries right now, if you like. A lot of it you may have done before. For example, there's a game where you have to memorize the names of three unrelated objects, and you have to count backwards from one hundred by sevens. Finally there's a test where you copy sentences and symbols." He chuckled and there was a warmth but also a distant sadness. "Some days I'm not sure I could even do it all myself. In any case, it's not something you pass or fail. But if we do enter you into the trials, you'll have to stay here for the duration. That's absolutely essential. We'd also like a caregiver to be here with you, as long as it's necessary."Ally looked at Maria. "Do you think you want to stay here with Mom?"Maria's eyes were very sad "I could stay for a day or two. But ... maybe we should talk.""We can arrange for someone," Van de Vliet interjected "We routinely provide caregivers from our staff when called for. And because we're still in clinical trials, there is no charge."Ally watched Nina brighten and turn to Maria. "You can bring some things from my closet when you go back. I want to start right away. I just know he can help me. I've got a feeling and you know my feelings are always right."Ellen reached and took Nina's hand. "Come, dear, we have a special office where we handle all the paperwork for admissions. We can do the tests there."Ally leaned over and kissed her mother. "I love you, Mom. And I love your spirit. You taught me how to be a fighter a long time ago. And I guess you're still teaching me."Tuesday, April 712:03p.m.Karl Van de Vliet watched the three women leave. Now he was alone with Alexa. So far, so good, he thought. With her mother checked in, we're partway there. Now what is it going to take to get her with the program? I'm not sensing commitment. She's asking too damned many questions.It looks like we may have to go to Plan B tomorrow. Too bad.After the door was closed, he turned back.
And add to that, she didn't actually know if he was free now or not or what
But he'd said he had a good reason for calling—what could that be?
"Stone, I read your columns in the Sentinel. So I sort of feel like I've kept in contact. I can almost hear your voice sometimes."
"That makes me think you were cheating a little on our deal."
"Well," she heard herself say, "some of them were pretty good. Sometimes you sounded like you knew as much as a doctor."
"Don't flatter me excessively, or I might want to start believing you." He laughed. "But speaking of doctors, didn't you used to have some kind of heart issue? How is that these days?"
"You really want to know?"
"Maybe it might have something to do with why I'm calling. Best I recall, you never actually told me, even back when."
"Thank you for asking," she said. "I guess it's not much of a secret anymore, with me popping nitro every other day. I have a scarred valve, coronary stenosis, and it's not getting any better. I don't know what to do about it short of going toLourdesfor a miracle."
"I see," he said. Then he fell silent. Mercifully, he didn't come up with false bravado about revolutionary treatments and you never can tell, blah, blah, blah. Then he said, "So is that why you've enrolled in the clinical trials at the Dorian Institute? To be part of their work using stem cells?"
What! "How the hell do you know about—"
"Hey, Ally, you know I can't divulge my sources. After I knew you, I grew up to be a real reporter. That was my grand plan, remember?"
"Then this may turn out to be a very short conversation. I have nothing to—"
"Okay, okay, let's start over." He paused and cleared his throat. "Ahem. Are you the Alexa Hampton who was formally entered about half an hour ago into the stage‑three clinical trials for the National Institutes of Health being held by the Gerex Corporation? Or maybe I should play dumb and begin by asking if you've ever heard of them."
"Stone, why . . . why are you asking me this?"
It was bizarre. How could he know? And wait a minute, what did he mean about enrolling? She hadn't enrolled in anything.
"Ally, I'm finishing a major—I hope—book about stem cell technology, and right now the world leader is the Gerex Corporation. I think, but I can't yet prove, that their Dorian Institute out inNew Jerseyis the site of some pretty incredible stuff. I was ... fooling around on the Internet, on the NIH Web site, looking for information about them, and—it must have been some momentary computer glitch—someone with your name popped up for a second. Along with a Nina Hampton. Which made me suspect it was you."
She was incredulous. She was being entered into the clinical trials before she had even seen the place? Somebody was pushing the pace. Winston Bartlett or Van de Vliet had taken it for granted that she and her mother would enter the trials. Worst of all, it took a former lover she hadn't talked to in x‑zillion years to give her this unnerving information.
"Nina is your mom, right?" he went on. "I still remember her fondly. I don't think she thought much of me, however. By the way, how is she?"
"She's . . . she's not doing all that great." Ally was still trying to get her mind around what she'd just heard. "But why are you calling me, Stone?"
"If anything I've said rings a vague bell, then could we meet someplace and talk? I don't think it would be a great idea to do it over the phone. That's all I really can say now."
Maybe, she thought, Stone Aimes might have uncovered a few things of which she ought to be aware. His pieces in the Sentinel showed he was a damned good reporter.
"I don't think what little I know about Gerex would be any help to you." She was attempting to get her mind back together. "I actually have a lot of questions about the stem cell procedure myself. I spoke on the phone just now with Dr. Van de Vliet and he described their technology to me in general terms. But maybe I should interview you. Maybe you could explain it to me using that wonderful gift you have for simplification in your columns."
"Ally, I don't know anything except what's in the public domain. They're privately held, so they don't have to tell anybody zilch. I assume you've actually been out to the Dorian Institute, which is more than I can say."
"Never."
"But you're enrolled—"
"I'm not enrolled in anything." To say the least. "And it bothers me that anybody thinks so. But I am thinking about taking Mom out there tomorrow, if she still wants to go. When I talked to him on the phone, Dr. Van de Vliet wanted me to start the procedure immediately. That's scary, but he does seem to know what he's doing."
"I take it, then, that you're leaning toward going through with it."
She hated the way he'd just made her sound so gullible.
"The truth is, I'm more concerned for Mom. He claims he can help her early‑onset Alzheimer's, and that would mean a lot." Why was she telling him all this stuff? She found herself wondering if he'd ever married.
"I'm so sorry to hear that. But the chances are he can."
"What are you thinking?" she asked finally. "And why did you call me? Really? What's going on?"
"I don't know yet. There's a lot I don't know." He seemed to hesitate. "Ally, is there any chance whatsoever that—while you're out there—you could get me the names of some of the
people who've been through the clinical trials? The Dorian Institute is entirely off‑limits to the press. I tried several times to schedule an interview with Karl Van de Vliet, the guy you talked to, but no luck. I can't get past the corporate people. My only hope is to try and find some patients who've been treated and released who've completed the clinical trials. But Gerex has been ruthless about keeping their identities secret You are literally the first person I've found who has any connection with the institute and is willing to talk about it. That is,ifyou're willing."
"Stone, it would be like the blind leading the blind. I don't know the first thing about the place."
"Well, let me ask you this—when you were talking with him, did Van de Vliet happen to mention any occasion where a subject had been terminated from the trials?"
"It never came up. Why do you—?"
"Never mind. But when and if you go out there, you might inquire about that." He paused. "Don't get me wrong. I'm actually Gerex's biggest fan. I mean, considering merely what you told me, that they're claiming to have a procedure that treats early‑onset Alzheimer's. Think about it. I'm rooting for your mom, sure, but that's a Nobel Prize in itself, right there. We're talking major medical history in the making."
"And?"
"And I want to publish the first book about it." He paused. "Also, a little birdie tells me that something not entirely kosher may be going on out there. No proof, just a reporter's hunch. There's a little too much sudden secrecy."
Ally was having a strange feeling come over her. She was actually enjoying talking to him.
"Shit, Stone, I'm glad you called. I lost two men I loved very much since I knew you and I'm feeling very alone at the moment. I could use some moral support I've got a lot of people bugging me to enter those clinical trials. Even people I'd never met before, like Winston Bartlett, theNew Yorkbig shot. He's suddenly very concerned about my health. I have no idea what that's about. But it makes me uneasy."
There was an awkward lull, then, "Ally, all I'm asking is that you just take the measure of the Dorian Institute when you're out there and tell me what you think about the place. Are they performing the miracles they announced as their objective?"
"Look, I'll help you when and if I actually can. So give me your number, okay?"
He did.
"I can tell when I'm being blown off," he went on. "I have a very sensitive blow‑off detector. But why don't you try a test? When you're out at the institute, ask Van de Vliet or somebody why that mystery patient was terminated from the clinical trials. See if the question makes them uncomfortable."
"Why does that matter so much to you?"
"If a patient is dropped for no good reason about the same time they clamp down on information, I think it could be fishy. Beyond that, I cannot speculate. And while you're at it, I'd love the names of some other ex‑patients. Anybody. I found a list on the NIH Web site but they're all encoded, so it doesn't do me any good. I just want to ask them if the procedure worked or not. It's information that's going to be made public eventually, no matter what. Come on, Ally, don't you want some testimonials?"
"Okay, look, I'll try to see if anybody there will give me any info."
She was realizing she was in a comfort zone when she was talking to him. Still, so much about him remained a mystery. He had always said his mother and father were both dead, but it was still suspiciously hard to get him to speak about them. She'd gotten the impression that he didn't actually remember his father. That was the part of his life that he'd always been the most closed off about. Either that or he was repressing some horrible memories.
"Thanks a lot, Ally." A pause, then, "Interested in getting together sometime?"
"Let me think about it."
She put down the phone with her mind in turmoil. She realized she hadn't asked him if he was "attached" but the next time they spoke, she was going to try to ease it into the conversation.
Chapter 12
Tuesday, April 7
9:50a.m.
Ally steered herToyotaonto the ramp leading to theGeorgeWashingtonBridge, the entryway to northernNew Jersey. She was just finishing a phone call to Jennifer. She wanted her to take a look at the notes and blueprints forBartlett'sGramercyParkproject and scan them into their CAD program. After all the phone calls yesterday, she'd been too sidetracked to do it. AlthoughBartletthad declared he wasn't in any hurry, he had messengered a certified check to her office Monday afternoon. The project was a go. She wanted to get moving while everything was fresh in her mind.
Before leaving her apartment this morning, she'd downloaded a map from MapQuest and from it she had estimated that the drive up to the Dorian Institute would be approximately an hour—give or take. She had begun the trip early because her mother's mind had been lucid the previous evening and she was hoping that interlude might last into this morning.
Unfortunately, it had not.
Nina was sitting next to her now, in full makeup but completely unresponsive, seemingly in another world. When Ally arrived at theRiverside Driveapartment to pick her up, Maria—now silent and uneasy in the backseat, reading a Spanish novel—met her at the door with a troubled look and shook her head sadly.
"Miss Hampton, I know she was all right when you were here last night, but this morning ... she may not recognize you. She'll most likely snap out of it and be okay later on, but right now she's just in a fog. It was all I could do to get her ready."
When Ally walked in, Nina was sitting in her favorite chair, dressed in her favorite black suit. Her makeup was perfect Thank you, Maria.
"Hey, sweetie, you look great."
Nina stared at her as though trying to place the face and said nothing. She just looked confused and very, very sad.
Dear God, Ally thought, this is the first time she's completely failed to recognize me.
It was so disheartening. Last night, when Ally had come up to discuss whether or not she still wanted to explore Dr. Van de Vliet's experimental treatment, Nina had been completely cognizant. Ally had tried to explain the concept of neural tissue regeneration using stem cells, which was difficult since she barely understood it herself.
"Mom," she had said "this might be something that could reverse some of the damage to your... memory. At least keep it from getting worse. I know it sounds scary but everybody says the conventional treatments for what you have don't work very well or very long."
"Then let's go out there and talk to him, honey. Just come in the morning and take me. By then I'll probably forget everything you've said tonight."
How prescient, Ally thought sadly. Now Nina was just gazing blankly ahead, silent. Does she remember anything from last night?
For that matter, what was Nina thinking now? Was she conscious of the fact she was losing her mind? And what
about the ultimate question: do we want to live longer merely to be alive, or do we want to stay alive in order to do things? To be or to do? In her mother's case, she knew it was the latter. Nina had always been full of life, ambition, and projects. Would she want to go on living if none of those things were possible? You never know for sure about other people, even your own mother, but Ally suspected she would rather not live to see that day.
Now, though, was she even aware it was coming?
Ally thought back about the first signs. Nina hadn't yet turned sixty‑five when she abruptly started having trouble remembering little things. She began forgetting where she'd put items, and she gave up on remembering phone numbers and dates. Initially it had just seemed like a lot of "senior moments" run together, very puzzling.
But then it got worse. She'd always loved music, and she'd always played the piano. She loved Chopin, especially the nocturnes. By the time she was sixty‑six, however, she was having trouble remembering the names of her favorite composers. She also completely gave up trying to play, either from memory or with the music. When getting dressed one day, she put on her blouse completely backwards. It was bad.
Ally had taken her to see four different specialists and they all had concluded that Nina Hampton suffered from what was known as familial early‑onset Alzheimer's. It was caused by a mutated gene and was extremely rare, representing only some 5 percent of all Alzheimer's cases.
There were two major drugs currently on the market, Exelon and Reminyl, that could relieve some of the symptoms of Alzheimer's by boosting the action of the brain chemical acetylcholine. However, Nina had not yet declined to the stage where doctors would prescribe those drugs. To resort to them was an admission you were at endgame, since they usually were effective only for a few months.
So the Dorian Institute might well be a long shot worth taking. Frankly, what's to lose?
This morning, she knew, was going to be difficult. If Nina
wanted to stay and checked in, there would surely be a pile of paperwork. Ally had had the foresight to acquire power of attorney for her mother three months earlier, and she'd brought along that document in case it might be needed. And Maria, the wonderful, ultimate caregiver, was there to help. The real challenge, however, might well be trying to help Nina understand what was going on and participate in the decision. This was the moment every child dreads, when you have to face, really face, a parent's mortality.
As the green forests of northernNew Jerseybegan to envelop them, she slipped a CD of Bach partitas for unaccompanied violin into the CD player. She had loved to play them all her life, but now Dr. Ekelman had urged her to put her violin into storage. Hearing the violin now reminded her of the other purpose of the trip, the treatment decision she needed to make for herself.
In that regard one of the things that kept running through her mind was what Stone Aimes had said about the Gerex Corporation instituting a news blackout simultaneously with a patient being mysteriously dropped from the trials. Those concurrent facts did not need to be ominous, but they also could use an explanation.
What was she going to do? Was Van de Vliet's stem cell procedure on her heart really worth the risk? She honestly didn't know. Even though the violin had temporarily been taken away from her, she had hopes she could gradually get it back. There were other ways to try to strengthen a dysfunctional heart.
Well, she thought, wait and hear him out.
From theGeorgeWashingtonBridgeshe had taken 1‑4, which turned into 1‑208 and now the green forest held sway. It felt like she'd gone through a time warp, from the beginning of the twenty‑first century to the end of the eighteenth. Then finally, as the second partita was ending, the icy‑coldGreenwoodLakecame into view. It was associated with those longFinger Lakesgouged out by glaciers.
Driving past remnants of the last Ice Age, she reflected on how insignificant humans are in the scheme of things. Suddenly she thought of Aldous Huxley's novel After Many a Summer Dies the Swan, about a wealthy madman who'd discovered a way to prolong life by eating the entrails of prehistoric fish. Maybe it was seeing the lake that made her flash on that.
She was now onGreenwood Lake Road, which passed around the west side, and there were numbers on several gated driveways as she passed along. She suspected the place would be somewhere along the middle of the lakeshore, and she was right.
After a few miles she came to a discreet sign announcing the Dorian Institute, and a large iron gate that protected a paved roadway leading into a forest of trees. That was it: just forest, no hint of a building, though she saw signs of some kind of industrial park farther down the road. When she drove up to the gate, she realized there was a video camera and a two‑way intercom.
When she reached out of the window and pushed the talk button, she heard "Good morning." And then the gates parted in the middle and slid back.
They must be expecting us, she thought, and drove through.
The road was cobblestone, or rough paving brick. It wound among the trees for approximately half a mile and then widened.
There, framed by the lake in the background, was a magnificent three‑story building with eight Doric columns across the front in perfect Greek Revival style. There were windows at ground level, but they were heavily curtained.
Built of red brick, the building probably dated from the late nineteenth century, and it looked every bit like an Ivy League dormitory.
"Miss Hampton, I don't like the feeling I'm getting about this place," Maria said quietly. "It is very cold and formal from the outside, but inside I sense a place where there is bad magic.
In theDominican Republic, we call it Santeria. I can always tell these things."
Ally knew and respected Maria's sixth sense. But then Maria sometimes still acted like a freshly minted citizen just off a green card, and she had an innate suspicion of authority‑ evoking buildings. Her aversion to the Dorian Institute might be nothing more than that.
On the other hand, Ally was having a bit of the same feeling. There was something formidable and foreboding about the place that seemed out of keeping with its supposedly benign purpose. She felt a moment of tightness in her chest.
There was a parking area off to the left, and she drove into the nearest slot and turned off her engine. This was the moment she'd been both anticipating and dreading. The clock on the dash read eleven‑fifteen; she was fifteen minutes ahead of the appointed hour.
"Okay, Mom, how do you feel?"
Nina turned and stared at her, uncertainty in her eyes. "Where are we, Ally? I don't recognize anything."
"This is the institute I told you about last night. Can you remember anything we talked about then?"
"This is the place you were ... Didn't you say there's a doctor here who can do something for my... memory?"
"We're both here now to just talk to him." She turned to the backseat. "Maria, can you get Mom's purse?"
She nodded, then reached hesitantly for the door. She was clearly reluctant to get out.
Ally walked around and opened the door for her mother.
"Okay, Mom, time to stretch your legs."
Ally held her hand and together they headed across the oval brick driveway. Birds were chirping around them and she could smell the scent of the lake, borne up the hill by a fresh wind. Then, through the trees, she saw two women walking up the trail that led down to the lake. They were, she assumed some of the patients.
They both looked to be in their early sixties, but also athletic and nimble. One was wearing Nikes and a pale green pantsuit. The other had on a blue dress and a white cap and Ally realized she must be a nurse. She'd been taking the other woman out for a stroll.
They were engrossed in conversation, but as they approached, the woman Ally had decided was on staff looked up and smiled a greeting.
"Can I help you?"
She introduced herself and Nina and Maria. The woman smiled again but didn't introduce herself in turn.
"We're here to see Dr. Van de Vliet," Ally went on, "about the trials. But we're a couple of minutes early and I was wondering if we could look around a bit first? I'm trying to understand what the institute is really like."
"Well, dear," the woman said, "even those of us who work here aren't allowed everywhere. You know, into the research lab in the basement. Some places here have to be completely hygienic. Of course, for patients who are in the recovery phase, strolling around outside is definitely recommended, as long as they're able. But that's getting way ahead of ourselves. First we'll have to check you in. There's a lot of paperwork for the clinical trials." She seemed puzzled. "They're almost over, you know. But come along and I'll let him know you're here. He's always down in the lab at this time of the morning. It's well after his rounds. They're so busy now."
Then she turned to the other woman. "Sophie, do you think you can find your way back to your room? It's number two‑eighteen, on the second floor, remember?"
Sophie appeared to be pondering the question for a long moment before she huffed "Don't be silly. I know exactly where it is."
As she strode on ahead, the nurse watched her carefully, as though unsure what she might do next. She pushed a buzzer at the door and then a man in a white uniform opened it and let her in. Only after Sophie had disappeared through the doorway did the nurse turn back.
"I'm Elise Baker. Please forgive Sophie if she seems a little ... confused. Her procedure is still under way."
"Her 'procedure'? What—"
"She was diagnosed with Parkinson's before she came here. She's improved an enormous amount, but we're not allowed to say so."
"Why is that?"
"We're in clinical trials. No one is allowed to discuss our results. Everyone here had to sign a secrecy agreement."
Now Maria was helping Nina up the steps. The porch, with its soaring white Doric columns, was definitely magisterial. The front door, however, was not wooden or decorative. It was solid steel, albeit painted white to blend in.
Elise walked to the door, which had a video camera mounted above it, and a split second later, it buzzed, signaling it was unlocked.
This is a lot of security, Ally thought, for a clinic doing research on cells. Are they worried about spies getting in, or patients getting out?
But the locked steel door was just the beginning of the security. Next they entered a small room just inside the door with an X‑ray machine to see into purses and parcels.
"The first floor is reception and dining," Elise explained as she swept through the metal detector. "There are rooms— we call them suites—upstairs for patients, and the research lab and offices are in the . . . lower area."
"What . . . what is all this security for?" Ally asked.
"The work here is highly proprietary. No one is allowed to bring in any kind of camera or recording equipment."
The guard dressed in white looked like a retired policeman, with perhaps a few too many jelly doughnuts over his career. He had a beefy red face and a hefty spare tire. But he was certainly alert to his responsibilities, eyeing the three newcomers with scarcely disguised suspicion.
In fact, Ally sensed a palpable paranoia in the air. Well, she told herself, medical research is a high‑stakes game. It's understandable they would be concerned about industrial espionage.
After the security check, they went through another steel
door and entered the actual lobby. The first thing she noticed was a grand staircase leading up to the second floor, and then to the third. Off to the right was a modern elevator with a shiny steel door.
A number of patients were coming down the stairs and heading for a hallway leading to the back. They were mostly women, whose ages ranged anywhere from forty‑five to well beyond seventy.
Who are these people? Ally wondered. They must have been sufferers of various kinds of debilitating afflictions, but now they were certainly ambulatory, if not downright sprightly. She wanted to talk to some of them, watching them moving along chatting and smiling, but this was not the moment.
"At eleven‑thirty we have meditation in the dining hall," Elise was saying as she led them through the lobby, "for those who care to participate, and after that a vegetarian lunch is served at twelve‑thirty sharp." Then she glanced back. "After you see Dr. Van de Vliet—and assuming you're admitted—there'll be an orientation and then you're welcome to begin participating fully in our activities."
"Actually," Ally said, "if people are well enough to be in 'activities,' why can't they be outpatients?"
"These clinical trials require twenty‑four‑hour supervision," Elise explained, heading for the wide desk in the center of the room. "Now, if you would all sign in here at the desk, Ellen can take you downstairs to the medical reception."
A dark‑haired woman smiled from behind the desk, then got up and came around. A sign‑in book was there on a steel stand. Ally finally noticed that light classical music was wafting through the room, Tchaikovsky'sSwanLakesuite.
"You must be Ms. Hampton," the woman said. "And this must be your mother. We were told to expect you."
She nodded a farewell to Elise, who said, "It was so nice to meet you. Good luck."
She then turned and headed for the back.
Ally signed all three of them in.
"Good," the woman said as she checked the information.
"My name is Ellen O'Hara, by the way. I'm in charge of the nursing staff here. We're ready to go downstairs now."
Ellen O'Hara had a knowing, earnest face that fairly lit up when she smiled. She had short brown hair streaked with gray and was pleasantly full‑figured.
When they reached the elevator, she zipped a small plastic card through the reader on the wall and the doors slid open. As they emerged on the lower level, Ally realized they were in the precincts of a very sophisticated medical laboratory. Occupying most of the floor was a glassed‑in area, inside of which she could see three men and two women, all dressed in white. She also noticed rows of steel containers that seemed to be ovens or incubators of some kind as well as racks and racks of vials. At the far end of the laboratory, there was a blackboard on which one of the men was drawing something that looked like hexagonal molecules, linking them together.
"That's Dr. Van de Vliet," Ellen said pointing. "I'll let him know you're here. The laboratory is a special environment. The entrance there is actually an air lock. The air inside is filtered and kept under positive pressure."
She walked over to a communications module, buzzed then announced into the microphone, "Dr. Vee, your eleven‑ thirty appointment is here."
He turned and stared in their direction, then smiled and waved. Next he walked to a microphone near the center of the room and clicked it on.
"I'll be with you in a minute. Can you please wait in the receiving room? And Ellen, can you start getting them ready?"
"Of course." She nodded then clicked off the microphone and turned. "Receiving is just down at the end of the hall. Next to his office. Please come with me."
She led them through a large wooden door, into a room with a retractable metal table covered in white paper and several chairs. It was a typical examination room, with a device on the wall to monitor blood pressure, a stethoscope, and other examination paraphernalia.
"If you'll kindly take a seat," Ellen said, "I'm sure he'll be here as soon as he can, in a few minutes at most. But while we wait, I need to take your temperature and blood pressure, and start a chart."
"Ally, where are we?" Nina asked. Her face was becoming alarmed, and Maria reached to comfort her. "Are we in a hospital somewhere?"
"Yes, Mom, it's actually the institute I told you about last night The doctor here wants to see if he can do anything to... help you."
"Oh," she said, "is he the one you told me about? I thought that was just a dream."
"No, he's real. Whether he can help you or not that part is what’s still a dream. But we're all praying."
She looked around at the pure white walls and wondered again what she was getting into. Meeting a new specialist in the sterile white cold of an examination room, could be frightening in itself. God, how many times before had she done this as she trudged through HMO hell? Maria was so unsettled she was deathly pale.
Ellen took their blood pressure and temperature, including Maria's, even though she protested mildly, half in Spanish—a sign of how unsettling it was to her. Ellen had only just finished putting all the numbers on clipboard charts for each of them when Karl Van de Vliet opened the door and strode in.
Chapter 13
Tuesday, April 7
11:39 a.m.
He had a high forehead and prominent cheekbones, just like in the photo. And just as in his photo, there was a genuine dichotomy between his face, which looked to be early forties and unwrinkled, and his gray eyes, which were much older. That was it. That was what seemed odd. He was different ages.
Underneath his white lab coat he was wearing a black suit and an open‑necked blue shirt. Ally noticed that his fingers were long and delicate, like those of a concert pianist, and overall he had a kind of ghostly presence, as though he were more spirit than man. Although he looked exactly as he did in the photograph in the Gerex Corporation brochure, in person there was an added dimension, a kind of raw magnetism about him. It was more than simply a physician's bedside manner, it was the allure of a pied piper. The first thing you wanted to ask him wasHow old are you, really?Maybe the next thing you'd want to do was ask him to dinner.
What had she expected? Maybe a self‑absorbed nerd researcher in wrinkled stained lab attire, anxious to scurry back to his test tubes. But in person Karl Van de Vliet was debonair and youthful, living proof that his photo wasn't retouched and was recent. He had to be twenty years older than she was, easily, but to look at him you'd guess he was close to the same age. She was dying to ask him about that but she couldn't think of a polite way to raise the subject.
She introduced herself. "We spoke yesterday." Then she introduced her mother and Maria. "Mom and I talked last night about the clinical trials, and she said she's interested. This morning, unfortunately, I'm not sure she remembers what we discussed."
He placed a hand on Nina's shoulder and studied her face as he smiled at her, embracing her with his eyes. "Well, we're going to see what we can do about that aren't we, Mrs. Hampton?"
"I've got a question right up front" Ally said. "Have we already been entered into the National Institutes of Health clinical trials?"
He seemed taken aback for a moment, caught off guard, but then he stepped up to the question.
"As a matter of fact I did take the liberty of authorizing the preliminary NIH paperwork for both of you. Of course it doesn't obligate you in any way. The thing is, there's a lot of red tape, so if you do decide to participate, the sooner we get that part started the better. On the other hand, if you decide not to, we can just terminate everything at this preliminary stage and you won't even be part of the official record."
Well, Ally thought, that undoubtedly explains why Stone saw our names on the NIH Web site. But why did Van de Vliet look so funny when I brought it up?
He focused on Nina. "Mrs. Hampton, I'm Dr. Van de Vliet. You're a pretty lady, and we've had some luck helping other ladies like you."
"Honey, if I had you in my bedroom, then maybe you could help me."
Oh my God, Ally thought, she's about to go ribald on us. But that's a sign she's coming out of her funk.
But then she had another thought. Maybe Nina sensed he was older than he looked. Like that paranormal perception that told her Grant was involved in something evil. So far, however, that particular perception hadn't panned out (though Grant clearly was up to something).
Maria was mortified. She blushed and made a disapproving animal noise low in her throat and turned her face away, but Van de Vliet simply smiled even more broadly.
"Mrs. Hampton, I don't think you should be talking that way in front of your daughter." He gave her a wink. "What you and I do together is none of these people's business. But I do think we should consider keeping them informed if only a couple of hints."
Ally found herself wanting just to listen to his voice. There was an intelligent warmth about it that reminded her of a kindly professor atColumbia, a truly gifted architect who also could quote Keats and make you cry. You wanted to give yourself to him. My God, she thought, how am I going to stand up to this man?
"There're some issues you and I need to discuss," he said turning back to Ally. "The first thing I need to do is take a look at Mrs. Hampton’s records. But whatever they say, it won't do any harm to run what we call a 'mental state examination' for her, to establish a general baseline of cognitive impairment as of now."
"How long will that take?"
"Actually, Ellen can start in just a few minutes," he said "Of course, we'll need to hear about the usual danger signs everybody knows. Does Mrs. Hampton have recent‑memory loss? Does she get confused about places and people? Does she have trouble handling money and paying her bills?"
"The short answer is yes."
All of those things, Ally knew, had accelerated in the last six months. It was the tragic, recognizable onset of the latter stages of Alzheimer's. Already more than once Maria had said there were times when she didn't think Nina recognized her. More and more she seemed to be confused, unable some days to find her way around the apartment, and she'd started repeating herself. She often had trouble finding the right words, and she was increasingly paranoid and suspicious. Maria, who had worked with other Alzheimer’s patients, feared she might begin hallucinating soon, seeing things that weren't there.
Ally turned to her. It felt obscene to talk about her when she was sitting right there with them.
"Mom, sweetie, do you understand what Dr. Van de Vliet is asking? Do you think you have trouble doing everyday things?"
She knew the answer but she was determined that her mother not be treated like a potted plant.
"Ally, you know that half the time I can't remember a blessed thing. I'm getting crazy as a bloody coot."
Then Nina turned and looked Van de Vliet in the eye.
"I don't want to lose my mind, Doctor. I don't want to see the shade closing in. I can't do crosswords anymore. I used to do them all the time. And all the music I used to know. It was my love and now . . . now I can't tell Scriabin from Strauss half the time. It wasn't supposed to happen that way. I thought my mind would go on forever."
"Mrs. Hampton, if you'll let me, what I want to do is try to work on your recollection. I don't know how much I can help you with crosswords, but then I've never been much good at them myself either. Your memory of music should improve, though. There are no guarantees, but—"
"Then I'm ready to try it, Doctor," she cut in. "You're all that stands between me and losing the only thing I have left, my past" Next came a burst of rationality. "Now, I hate to be a pest but could you explain what exactly it is you're going to do. I want Ally to hear this too and then maybe she can go over it with me later and help me understand it."
He smiled and reached over and stroked her slightly thinning hair. "I'd be happy to try, Mrs. Hampton. It's actually pretty simple."
Then he turned to Ally. "We touched on some of this on the phone. Do you want to hear it again?"
"Yes, I'm still trying to get it all into my simple mind."
"Well," he began, "to go back to the very beginning of my interest in stem cells the focus of our research has been directed toward challenging the notorious Hayflick limit. Back in the 1960s, Professor Leonard Hayflick discovered that when tissue cells are taken from the body and cultured in a laboratory dish, those cells grow and divide about fifty times, give or take, and then they stop. They have reached old age, senescence. The physical basis of the Hayflick limit is a section of DNA known as telomere, which gets shorter each time the cell divides. Eventually the telomeres become so short that all cell division stops. It's like an internal clock telling them the game is over. They've had their innings."
"And you're saying you've found a way to beat the clock, to stop the telomeres from getting shorter?"
"All cells possess a gene known as the telomerase gene, which can restore the telomeres to their youthful length. But in most cells the gene is permanently repressed and inactive. It is only found in egg and sperm cells, and in cancer cells." He gazed away for a moment as though collecting his thoughts. Then he turned back. "However, we've found that by isolating and inserting an active copy of the telomerase enzyme into adult stem cells, which can be found in minute quantities throughout the body, we can set their clock back to zero. We extract cells, 'immortalize' them with telomerase, and then return them to the body as a youthful infusion."
"And is that what you'd be doing for Mom?"
"There'd be a series of injections, but given what appears to be her level of mental awareness right now, the procedure probably can be accelerated." He patted Nina on the shoulder.
"All right," Ally said "but can you use the same procedure for someone's heart?"
"Well, yes and no," he said. "Did you bring your medical records? I should have a look at them before making any pronouncements."
To prepare for this moment, she'd printed off a copy of the medical files she'd scanned into her computer.
"There're a lot of files," she said, opening her bag. "I've got copies of my EKGs over the past eleven years. Dr. Ekelman, my cardiologist, says my condition is getting progressively worse."
She took the folder out of her bag and handed it to him. He flipped through the files with what seemed an absent manner, almost as though he already knew what was in them and was just going through the motions. Then he looked up.
"Well, your physical condition looks pretty good. You clearly exercise. And I don't see anything here that would suggest a complication. As to how your procedure might differ from your mother's, I guess the main area of concern is simply the scale." He laid her files on the steel table. "Your heart has reached the stage of aortic valve stenosis where cardiac output no longer can keep up proportionately with vigorous exercise. And that has put an even larger strain on an already weakened condition. What we are about to undertake here corresponds to what might almost be considered an aortic valve replacement, though it is done at the cellular level. We call it regenerative medicine. Millions of cells will be involved We'll attempt to reverse the calcification and also to develop new blood vessels that supply the heart muscle."
"You know, this is so risky. I remember that not long ago they tried to use fetal cell injections into the brain for treating Parkinson's disease. And it turned out that the side effects were horrendous. Why should I assume that this is any safer?"
He looked pained. "I assure you we don't do anything here that is remotely like that particular, unfortunate procedure."
She stared at the ceiling trying to grasp what he'd just said. "So how risky do you think this is?" she asked finally. "Truth time."
He looked away again and sighed. There was a long silence in which he seemed to be pondering some extremely troubling thoughts. Finally he turned back.
"In medicine there Is always something that can go wrong. Even the most innocuous procedure can end up being lethal if that's what the gods want that day." He looked at her intently and seemed to try to measure his words. "But I wouldn't recommend we proceed if I didn't feel that the potential benefits far outweigh the risks."
She listened wondering. Something in his voice is sounding cagey. What is he leaving out?
"I still want to think about it"
"Of course, but we can make some preparations in the meantime," Van de Vliet said turning back to Nina. "Mrs. Hampton, do you understand anything of what I've said? Nothing is risk free."
"Young man, if you'd lived as long as I have, and then felt it all slipping away, you'd be willing to take a chance with anything."
"Mrs. Hampton, Alzheimer's is one of the more promising areas of stem cell research. We've already had successes here. I truly think we can help you. In fact, Ellen can start your preliminaries right now, if you like. A lot of it you may have done before. For example, there's a game where you have to memorize the names of three unrelated objects, and you have to count backwards from one hundred by sevens. Finally there's a test where you copy sentences and symbols." He chuckled and there was a warmth but also a distant sadness. "Some days I'm not sure I could even do it all myself. In any case, it's not something you pass or fail. But if we do enter you into the trials, you'll have to stay here for the duration. That's absolutely essential. We'd also like a caregiver to be here with you, as long as it's necessary."
Ally looked at Maria. "Do you think you want to stay here with Mom?"
Maria's eyes were very sad "I could stay for a day or two. But ... maybe we should talk."
"We can arrange for someone," Van de Vliet interjected "We routinely provide caregivers from our staff when called for. And because we're still in clinical trials, there is no charge."
Ally watched Nina brighten and turn to Maria. "You can bring some things from my closet when you go back. I want to start right away. I just know he can help me. I've got a feeling and you know my feelings are always right."
Ellen reached and took Nina's hand. "Come, dear, we have a special office where we handle all the paperwork for admissions. We can do the tests there."
Ally leaned over and kissed her mother. "I love you, Mom. And I love your spirit. You taught me how to be a fighter a long time ago. And I guess you're still teaching me."
Tuesday, April 7
12:03p.m.
Karl Van de Vliet watched the three women leave. Now he was alone with Alexa. So far, so good, he thought. With her mother checked in, we're partway there. Now what is it going to take to get her with the program? I'm not sensing commitment. She's asking too damned many questions.
It looks like we may have to go to Plan B tomorrow. Too bad.
After the door was closed, he turned back.