Bad blood

“The perps don’t go for it,” I said. “Most of the rest of us do.”

“Duke Quillian?” Mike asked.

“On the promise your subpoena will follow shortly.”

“You got it.”

She adjusted her glasses and got to work reading the papers in the blue folder.

“Acute leukemia, Mike. His chart begins with the usual symptoms. Fatigue, frequent fevers and infections. Nosebleeds and bleeding gums. By the second or third round of antibiotics, the local doc-a family practitioner in the Bronx-drew some blood to be tested. Got the result, made the diagnosis, and sent Mr. Quillian to us. That’s the way the disease typically presents.”

“Don’t you have to pull all kinds of strings to get into these digs?” Mike asked.

A

The word transplant caught my attention. “Duke Quillian had a transplant?”

“That was the only curable method of treating acute leukemia back in the days when he was ill, especially when the patients were as young as this guy.” A

“What’s the process?” Mike asked.

“The patient is typed for the human leukocyte antigen-HLA. And all his family members are typed, too. Did he have siblings, this guy?”

“Yes,” we both said.

“There’s a one-in-four chance of matching a family member,” A

“What’s that?” Mike asked.

“Donating marrow is an extremely painful process. It’s hard to imagine how much it hurts,” A

“And if the siblings don’t fit?”

“Then we go to the National Marrow Donor Program. Try to find a match from a volunteer donor.”

“Does it tell you what happened here?” Mike asked, ready to grab the file from A

“Patient as always, Detective Chapman,” A

She skimmed the pages to find the information we wanted. “Yes, Mike. There was a perfect match to one of Duke’s siblings-a sister named Patricia. Seems they refer to her in these records as Trish.”

Mike clapped his hands together and flashed me a victory sign. “So Trish was his donor. Duke ended up with her DNA.”

“Not so fast, Mike,” A

“I’m sorry to say I’m confused, Doctor. I don’t understand this.”

“Was he in the hospital or not? That’s what I want to know,” Mike said.

“Let me back it up. After the match was confirmed and the surgical date was set, the patient-in this case, Duke Quillian-was admitted to the hospital. Usually, about nine days before the surgery, the chemo treatment begins. The point of that is to kill off all the old bone marrow cells completely-the ones causing the disease. So from that time-Day minus 9-Duke was right here in Sloan.”

“What’s the surgery involved?” I asked.

“Two procedures are conducted on the same day, but only one was actually surgical. Trish Quillian would have been in the operating room. Two doctors were harvesting her bone marrow.”

I winced. “Harvesting?”

“She’s anesthetized, of course, Alex. Facedown on the table. Holes are drilled in her iliac crest,” A

Mike’s expression was grim. “Yeah.”

“They take what the docs remove directly up to the blood bank for processing, aligning blood types, filtering out the bits of bone from the marrow, and things like that. Runs another hour.”

“And Duke?”

“He would have been resting in his room during that process. Once the marrow was ready to be transfused, the docs just brought it to him, hung it on an IV pole, and sent it on its way, to get to work inside his system.”

A

“I thought you called it a transplant?”

“In the case of bone marrow, transplant and transfusion really mean the same thing. The stem cells are quite amazing. They have some kind of internal homing system. Once they’re transfused to the patient, they find their way-by themselves-right into the marrow. Like we docs say, the healthy stem cells set up ‘housekeeping’ exactly where they belong.”

“So from that day on, what happens to the patient?” Mike asked.

“Well, that would have been a rough period for Duke Quillian, or anyone else. Trish would have been on her way home in no time, but the next four weeks, Duke would have been under strict quarantine. He would have been isolated from other patients and even visitors-we can’t have the transplant patients exposed to infection. He was put on meds to suppress his immune system, to protect against graft-host disease, to do the best to see that he’d accept the new marrow.”

Mike was checking the records of the transfusion that A

“What do the dates tell you?” I asked.

“This damn record shows Duke Quillian was still a patient here six weeks later, until a full week after Bex was killed,” Mike said, his disappointment evident as he slammed the file shut. “Would he have been quarantined till then?”

A

“What DNA tests?” I asked.

“Routine blood exams to make certain that his sister’s bone marrow had not been rejected. That the DNA being produced in Duke was actually from the cells harvested from Trish.”

“A

She took her time, reading through the pages of fine print, vital signs, and nurses’ notes. “No. No, he wasn’t. He was moved to a room on another floor. His doctor was still doing tests. Didn’t want him discharged for another two weeks. Something about Duke’s job and the high risk of infection it posed.”

Mike was practically in her face. “So just suppose this patient was stir-crazy. Suppose he was hungry for fresh air and a walk in the park. Was he strong enough, healthy enough to do that?”

“Of course. Sure he was. He’d just have to get past hospital security.”

“Outbound? Put on his street clothes and walk out the door. You think that’s ever a problem?”

“Mike, it’s nothing our security would want to hear about.”

“I’m talking more than ten years ago, A

“Do you have an exact date, Mike?” A

Mike told her when Rebecca Hassett was murdered.