Wednesday, 9 a.m., Longwood Medical Area, Boston
Jake
The Longwood Medical Area has the densest concentration of teaching hospitals and medical research buildings in the world, all jammed into a few city blocks. If you’re going to have a stroke or get hit by a car, this is definitely the place to do it.
The traffic on Longwood Avenue sucks, as usual. As I inch past the main quadrangle of Harvard Med, I don’t even bother looking up at the school's impressive Grecian façade. I’m too focused on the plain-looking lab coat crumpled in the seat next to me.
What if I’m wrong?
What if there’s nothing but reversal agent on the fabric?
Or even worse, what if I’m right but we screw up the analysis? What if, in the rush to discovery, we wind up destroying the only evidence I have?
That’s why I’m here: because there’s no one I would trust to do the extraction more than Carpteins’s ex-girlfriend.
We both met Harley Choi during our first week of medical school – back when she dressed and acted like a Catholic schoolgirl. She must have drawn the short straw, because she wound up stuck with me and Carpstein as Gross Anatomy partners. My first impression of her: cute, shy, brainy.
Fast-forward one week and we’re hunched over Leo the Cadaver, struggling to crack open the chest cavity. Harley humors our efforts for a while, then elbows Carpstein out of the way, grabs the retractor and heaves the ribcage apart with a wet crack-crunch. Then she grins up at us and says the words that made Carp fall instantly in love: “I'm fucking starved. Wanna get some barbecue ribs after this?”
Josh and Harley started dating a few weeks later, right around the time when she ditched her blouses and ankle-length plaid skirts for outfits straight out of an R-rated Japanese cartoon. Her standard wardrobe: Doc Martens, skin-tight jeans and a skimpy tank top, layered with a punk leather jacket (she’d throw on a sweater in the winter.) Within a year, she’d added nose and belly button studs, four more ear piercings, neon red highlights to her jet black hair, and some provocatively placed tattoos.
As Carpstein once summed up Harley’s attributes: brilliant, super-hot, “fuckin’ awesome” sense of humor. In short, she was his dream girl, the gold standard he’ll probably be using for the rest of his life. I’m pretty sure he never got over her, even after their third and final breakup, so I wasn’t surprised when he told me last night that they’re still in touch.
Harley runs her own research lab at the Dana Farber Cancer Institute, where I now find myself. She and Carpstein greet me at the lobby elevator, taking turns hugging and consoling me. Not one to keep a secret, Carp’s already told her everything.
“You do realize,” Harley says after I’ve answered some rapid-fire questions on the way up to her lab, “that even if we do find some evidence, it’ll be useless. You took the lab coat from the scene, so it’ll be contaminated as far as the CME’s concerned.”
“Yeah…” I say. “I thought of that. But they have the victim’s blood. If Caulder contaminated the syringes with some weird toxin they’re not looking for, I can point them in the right direction.”
“Sure,” Josh cuts in, “but even if they find freakin’ rat poison in her blood, how’re you gonna prove the bastard put it there? I mean, how do you show motive?”
“He was at the scene,” I answer. “We have a record of that. And…” I reach into my pocket to show him the thumb drive. “He mailed Jess the proof he has a motive.”
Harley purses her lips, still not convinced.
“Just point me in the right direction,” I say. “If we find a contaminant, then at least I’ll have something to tell the CME. She’ll know where to look.”
“Okay,” she says after a long pause. “Give me the lab coat we’re gonna use to nail this fucker.”
I hand it to her, recounting how I splashed the first syringe of reversal agent onto my face, then wiped it off with my right sleeve.
“Good,” she says, inspecting the fabric. “Then we’ll start there. Jeez, Jake, don’t you ever wash this thing?”
“It’s, um... It’s been in the trunk of my car.”
“Yeah, right.” She frowns. “Well, looks like we’ve got enough stains on here to keep me busy. I’ll just take a few small fabric swaths. That should leave plenty of material for you to turn over to forensics.”
Never one to procrastinate, she spreads the coat sleeve out under a magnifying lamp, scratching at the cloth with a scalpel. Like a skilled surgeon, she cuts out three small squares of fabric, placing each sample in a separate test tube. As she works, Josh and I view the progress over her shoulder.
“Are you sure you’re comfortable doing this?” I ask. What I’ve asked Harley to do could be considered tampering with evidence. If we find any significant forensic evidence, she’ll have a hard time justifying her actions.
“For anyone else,” she answers bluntly, “I’d say no, but for you…” She glances over her shoulder to give me a genuine smile. “I’m happy to help. Now tell me again, what exactly are we’re looking for?”
I list the standard contents of the Replacidin reversal syringe: a neutralizing antibody, small amounts of epinephrine, phenylephrine and neostigmine.
“Makes sense,” she notes, jotting down the ingredients. “Pressors to counter hypotension and the neostigmine to stimulate muscle contraction, right?”
I nod, impressed as always by her encyclopedic knowledge. With Harley, it would be the same result if I’d asked her to name the pitching rotation for the 1933 Yankees. Her brain’s a freaking supercomputer.
“Well…” she says, thinking out loud. “If we wanted to do an ELISA or Western Blot, we’d need the right antibodies, and I’d have to order those. Even getting them rush would take a couple of days. And anyway, that wouldn’t help us to find any unknown contaminants.”
Carpstein frowns at this news. “So we’re stuck?”
“I didn’t say that, Josh. You can still bake brownies without a Betty Crocker mix.” She gives him a look that somehow manages to be both flirty and condescending. “We’ll just have to do things from scratch.”
“Meaning?”
“We’ll use protein fingerprinting.”
“Right, of course,” he grumbles. “Protein fingerprinting. I should’ve guessed.”
Harley rolls her eyes, turning to me. “Jake knows what I’m talking about.”
I admit I don’t. Like most people, I’ve learned everything I know about forensic analysis from CSI.
“Okay, but you did do some bench-top research as an undergrad, right?”
“I guess.”
“All right then. Walk with me through the steps. We’ve got fabric samples that should contain four proteins: an antibody, epinephrine, phenylephrine, and neostigmine. Plus there will probably be some protein and non-protein contaminants. First step?”
“We extract and then separate out the proteins.”
“That’s two steps, but you’re right. Good to see all those years of boutique medicine haven’t totally fried your brain.”
I take the backhanded compliment with a smile. Some things stay reassuringly the same. She and Carp ribbed me mercilessly when I announced I’d decided to go into derm.
“So we separate the proteins using SDS-PAGE?” I ask, eager to prove I haven’t forgotten everything.
“That’s kind of old-school, but basically… yes. We’ll use a similar technique, using gel electrophoresis to separate out the unknown proteins by molecular weight. The lighter molecules move through the gel faster than the heavier ones.” She turns back to Carpstein. “You still following us here, scalpel jock?”
Carpstein rolls his eyes again. “Yeah. Just like drag racing, right? Line up all the proteins in their separate lanes, then apply an electrical current to pull them through the acrylamide gel, and…” He gives her a grin that’s trying way too hard to be sexy. “May the fastest car win.”
“Right.” She crinkles her nose. “Something like that. Anyway, once we have the proteins separated, we get to the fun part. We take each isolated unknown, use proteolytic enzymes to cut it into fragments, extract the resulting peptides, then use MALDI to determine the peak list.”
Carpstein winces. “Hey Princess Nerdella! Could you repeat that in English, please.”
“Sure thing, Josh. Let me give you the dumbed-down version. MALDI stands for Matrix-assisted laser desorption/ionization. For the technically challenged, that’s just a high-performance mass spectrometer.” She points over her shoulder to a sleek-looking blue-and-white device, which looks like a high-end espresso maker. “When we run the unknown protein fragments through that machine on the wall over there, it’ll spit out a list of molecular weights, called the peak list. Then we’ll compare these to the Swiss-Prot database, which contains sequencing info for millions of proteins.”
“And you reassemble that info like a jigsaw puzzle to ID the proteins on my lab coat, right?” I ask.
Harley smiles patiently. “It’s a little more complicated than that, but basically… we’ll use a computer algorithm to get a list of possible matches, with associated probabilities.”
“Sounds great,” I say, struggling to keep up with her. “How long does the process usually take?”
Harley glances at her wristwatch. “The proteolysis is the slowest step. If I burn some rubber, I should be able to set that up overnight. That way, we’ll have something for you by tomorrow morning. In the meantime, I’ll have one of my techs run a standard tox screen on one of the other fabric swatches.”
“And you have time for all this?” I ask in a guilty voice.
“Sure,” Harley shrugs. “But I’ll expect payment in Botox. And a lifetime supply of cosmetic services, which I plan on hitting you up for in the very near future.”
I gladly agree to her terms, catching the amused look on Carpstein’s face as I thank Harley for being a lifesaver. It’s a look that says: yeah right, like she’ll ever need anything.
Still stuck on her, after all these years. Something in Carp’s expression tells me he hasn’t given up yet.
I return his grin, trying hard to sponge up some of his optimism.
Optimism that life always offers at least some hope of a second chance.
*
I crash at Josh's place overnight and we return to Harley's lab in the morning. She greets us with a tired smile, immediately announcing she has something interesting to show us. Without any further explanation, she leads us into a closet-sized room, where a freshly run acrylamide gel sits on the table.
“It’s stained with a fluorescent tracking dye,” she explains, pointing to the left edge of the gel. “The molecular weight markers will be in the far left lane, and the protein bands that I extracted from the lab coat should appear in the right lane…” – she shifts her pointing finger a few inches – “over… here.”
I hold my breath as she turns off the lights, immersing us in absolute darkness. Then, with the flip of a switch, the gel starts to glow neon pink. I peer over Harley’s shoulder, noticing the series of eight bright blue bands on the far-left side, spread out neatly like the rungs of a ladder.
“That’s the weight markers,” she whispers, like a mother proudly describing the features of her newborn. “And as you can see, we have three unknown bands.”
“Three bands?” Carpstein calls out in surprise, and I see them: three distinct bands, splayed out at varying distances along the right lane of the gel.
“Right,” Harley says. “We have three unknowns. Now this one is probably the neutralizing antibody. No surprise there."
Now that my eyes have adjusted to the ghostly lighting, I can follow her finger as it points to the unknown band closest to us.
“How could you possibly know that?” Carpstein demands.
“Because of the molecular weight, genius. If you use the markers, you can see it weighs around 190 kilodaltons. That’s about what you’d expect for an immunoglobulin.”
When she notices our blank expressions, she sighs. “You know, an antibody? Like, to fight off germs and stuff?”
She’s confirming what we already expected: that the wasted syringe of reversal agent contained an antibody to neutralize the Replacidin. I ask Harley if she can identify the specific type of antibody.
“Doubt it. Using protein fingerprinting, we’ll probably only be able to determine the general antibody class… like whether it’s IgG or something else.”
“That’s all fine and dandy,” Carpstein interrupts, “but you’re missing the main point here, Jake. You said the reversal agent contains an antibody and three other ingredients.”
Harley turns on the lights and gives him a thoughtful nod, for once looking like she’s in total agreement as he finishes his point.
“So then why are there only two other bands here?”
*****
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Hi Gray,
The medical talk didn't bother me at all. I thought you handled it well...dumbing it down for all of us who mostly do laundry all day and have no medical knowledge.
You give us an interesting clue at the end. My only concern is how much will it help in his defense? I'm thinking anything they find won't be considered evidence by investigators. Who is to say he didn't put all that stuff on the lab coat just to prove his innocence. How will he prove that coat is "the one" he wore while treating the victim? I dunno. Maybe it will be enough for the ME...I forget her name...Dr. Wilson? I'm not sure...anyway, maybe it will be enough for her to join forces with him and set a trap for the real culprit. That may be what you have in mind. OR, it could be I'm totally wrong and they will accept the coat and do tests of their own to find the same thing he's found.It seems Jake is hanging all his hopes on these tests,and maybe this is just for his own piece of mind and he's not concerned with it being considered as evidence.
Anyhoo, the writing is good as always, so no nits from me.
~Ann
Morning Gray,
It ain't looking too good for Jake proving his innocence. Even if they show motive and the opportunity to commit the crime, they still have to find out how Coulder came to know what to add to the drug to neutralize the reversal agent. Harley Choi--Carp's gold standard(loved this comparison)--is a great character who adds a quirky dimension to your cast.
Sure, Josh cuts in, but even if they find, I don't know, freakin rat poison in her blood, how're you going to prove... *I think this reads better without "I don't know".
Well, (it) looks like we've got enough stains...
Like a skilled surgeon, she dissects out three small squares of fabric... *dissects out" sounds off. Dissection makes me think of separting tissue. maybe just "she cut out three small squares of fabric"
Even getting them rush would take a couple days. *sounds off. here's a suggestion: Best case scenario, an epedited order would take a couple of days.
You can still bake brownies without (a) Betty Crocker mix.
Walk (with) me through the steps.
I take the back-handed/backhanded compliment...
..should appear in the lane right/right lane...
"Three bands?" Carpstein calls out in surprise, and I notice they're right. *don't think you need "and I notice they're right."
take care, nathan
So happy to see Jake taking advantage of his very capable resources. I always like mysteries where (ir)regular guys figure it out.
I really liked Harley, I loved her description, I loved that they're old school mates, so they share the kind of loyalty that you only have with people you 'knew you when'. I liked her so much that as I read through the passage I kept seeing her perky brainy Asian bad girl image. (My daughter is is in a predominantly Asian HS in Silicon Valley and the super sexy smart Asian girl is a very real, very attractive, character. I keep thinking of a new Sex in the City series, but making it Sex in the Valley where everyone works at FB and deals their parents' baggage...but thats me digressing, again. Anyway, so I love the dynamic between your characters. (and the crap Jake takes for going into Derm, there really is that snobbery among MDs and MD/PhD, isn't there?).
As for the science: It was enough to sound authentic (to us who know nothing), but not too much, in other words, I was able to gloss over it, feel smart enough to follow it a little, but not get bogged down by it.
Only two small comments: Optimism that life always offers at least some hope of a second chance. That sentence seemed wordy to me (which apparently is one of my transgressions so maybe I'm training myself to spot them). Not sure why, but it slowed me down...maybe, Life always offers hope. or there's always hope, or always recovery...just the same concept, a few words less. And this passage: She’s confirming what we already expected: that the wasted syringe of reversal agent contained an antibody designed to neutralize the Replacidin. I ask Harley if she can identify the specific type of antibody." Can you make this slightly clearer, since she said she's gonna show them something interesting, and this data point is not a significantly interesting one,(I don't think), so for the less scientific minded reader "the first stripe wasn't the interesting one, it merely confirmed the expected presence of the reversal antibody." Is it significant for it to be indentified? Can that have contributed to the death?
Anyway, overall, the pacing here is good, the science sounds convincing, but not overwhelming. Of course I'm concerned that Jake will have an extremely hard time making his case if this evidence wasn't collected by the book, but it's consistent with smart people doing dumb things because they consider themselves above the rules that apply to the masses...(which I haven't gotten from Jake, but I know some Harvard types and it's not an uncommon arrogance). Anyway, all good and I want to see Jake beat this thing.
Keep going,
Simi
Well I'm glad to see what YOU'RE doing this beautiful holiday weekend! ; )
I know the Longwood area - great description! (I saw Tim Vartanian at Bet Israel Deaconess for a few years re MS - do you know him perchance?)
I see Jakes dilemma - the coat could exonerate him, but he IS tampering with evidence, Hmmm...
words that made Carp fall instantly in love: “I'm fucking starved. Wanna get some barbecue ribs after this?”>> Ha! Who wouldn't fall in love with someone who says that after cracking open a cadaver?? Shudder - you docs have SOME sense of humor! ; ) The reason I chose law school instead! ; )
In short, she was his dream girl, the gold standard he’ll probably be using for the rest of his life>> even her name is awesome!
Not one to keep a secret>> watch this - otherwise Jake shouldn't have confided in him at all, right?
You took the lab coat from the scene, so it’ll be contaminated as far as the CME’s concerned >> exactly, Harley. I'm liking her,too!
yes. We’ll use a similar technique, using gel electrophoresis to separate out the unknown proteins by molecular weight. The lighter molecules move through the gel faster than the heavier ones.>> all good stuff, and I'm not lost in the jargon at all
Let me give you the dumbed-down version. MALDI stands for Matrix-assisted laser desorption/ionization. For the technically challenged, that’s just a high-performance mass spectrometer.” She points over her shoulder to a sleek-looking blue-and-white device, which looks like a high-end espresso maker. “When we run the unknown protein fragments through that machine on the wall over there, it’ll spit out a list of molecular weights, called the peak list. Then we’ll compare these to the Swiss-Prot database, which contains sequencing info for millions of proteins.”>> not sure why shed diss a surgeon, other than because of their past, but in any event, here, her methods start to get a bit dense, I'd suggest shortening now
I return his grin, trying hard to sponge up some of his optimism.~Optimism that life always offers at least some hope of a second chance.>> I like this - great vehicle for Jake's thoughts. Wouldn't separate the sentences, though...
After the last sentence, I went back to this: "I list the standard contents of the Replacidin reversal syringe: a neutralizing antibody, small amounts of epinephrine, phenylephrine and neostigmine." >> I'd clarify to the antibody plus three other ingredients, or something to make the ending more glaring
This is a really solid chapter,akin to the Clark death scene. Exciting, great use of med stuff interspersed with personal drama.
Great job!
Terri
Hi Gray,
Not too much nitty-gritty....
I chuckled when you mentioned the cadavers... Reminds me of, remember the TV show - Quincy ME - with Jack Klugman, gosh I think in the 80's...? Anyway, in the beginning they show med students lined up and then when they bring on the cadavers, they start dropping like flies... Well, when my cousin was in medical school, and he gave us all a chuckle because he said it really happened just like that on his first day... Now, my cousin, Skip, said he was cool, it was just the other's... LOL...that had a problem, so, I only have his word that it really happened the way he says it did.... He on occasion could blow hot air.... Just sayin' cuz.... LOL...!
Last I heard, Skip is in research studying the brains of bugs..! Yikes...! He went to medical school to end up studying bug brains.... Gotta love it...
I'm sorry, I got off on a tangent and went with it... Anyway, I thought you did a good job of explaining the particulars but not too overdone... Adding the little bit with Carp and his old girlfriend helped to take away from the clinical as well...
Another good chapter Gray... Happy Writing & Keep Smilin'... Jax
Hi Gray, I have a question about logic of the discussion of the lab coat. At first they say, the lab coat is useless as evidence because Jake took it from the scene and could have tampered with it. Then a little later, they say Harley could get in trouble for tampering with evidence. Isn't there some sort of contradiction here?
Haley is so snarky about Josh the surgeon I'm surprised she doesn't call him a sawbones.
Nits: [delete], (add)
<We’ll use a similar technique, using gel electrophoresis to separate [out] the unknown proteins by molecular weight.> I suppose you could say spread out.
I had to find one nit in the technical section to show you I was following some of this. I'm not familiar with medical technology, but am familiar with other technical issues so I may not be the best judge, but I think you did enough explaining for the layman.
And all and all, Jake and his friends are definitely on the path to salvation (or maybe it's Led Zep's Stairway to Heaven.
Hey, Gray - Interesting hook at the end. Only two other bands, indicating that instead of finding an added adulterant, one of the ingredients that are supposed to be there appears to be missing. Unless...the pollutant combined with one of the ingredients to make a new molecule? I thought the technical stuff was logical, since Choi is explaining it to medical types. The only thing I felt was off was Jake's and Josh's puzzlement at the word immunoglobulin. They would certainly know that. For the reader, you could have Choi say, "...immunoglobulin, meaning the antibody, of course." Or something like that.
- ...more than Carp(s)tein's ex-girlfriend.
- "[Just point me in the right direction," I say.] {You had just used that phrase, and I don't think it's needed here.}
Take care,
Jack
Gray....Finally back to reviewing work and I wanted yours to be one of the first. Loved this chapter from start to finish and loved the introduction of Harley. And of course you know I am a big fan of Carp. Dialogue was natural and even tho you know I love all that medical stuff, you really evened it out well with humor between Carp and Harley and their relationship really crackled all the way thru the chapter. You seamlessly weaved the medical jargon in the dialogue so that it made for a fast yet informative read. Hope all is good with you and will be moving forward to the next chapter soon....Denise
Although technical, it flowed well and I could easily follow the basic ideas. The interactions between the 3 were handled well - liked Harley's put down of both the dermatologist AND the surgeon.
So now we have a deeper mystery. Something wasn't added to the vial, something was left out, pointing to a deeper conspiracy. That was a nice twist.
You mentioned in the review to my story about fearing you're getting too close to stereotype with Harley. Smart Asian girl who's also cute and likes to dress like a slutty Japanese Manga heroine? Not that I don't like it, but it is bordering. Some ideas to reduce the stereotype - not Asian - maybe blonde. Maybe dresses in boots and jeans, but is smart as a whip. Oops, sorry, just described Lisa and Jennifer Watkins from my books! ;) guess I have a stereotype, too.
Point is, she may border on cliche with her initial description, but her words and actions make her to a character, one I like.
Cheers,
Don
I don't have much to add here. Good chapter. I liked the medical jargon and the whole CSI feel to it. It's a nice twist that Jake might be able to use the lab coat to prove he wasn't too blame.
I'm moving on to the next chapter now.
Author
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Relieved to hear the medical jargon didn't come across as too dry, since you're exactly my target audience (i.e. sharp/knowledgeable and able to follow medical details without necessarily being a scientist or physician). The lab coat angle may be a bit of a stretch, but I wanted to empower Jake to do something about his predicament rather than being one of those passive "heroes" who just sits back while bad things happen to him... Take care, Gray
Hello, Gray. Well, the technical was not crystal clear, but that's on me, Gray. But I get the gist or gists of what they're talking about...the last chapter portion was quite intriguing. RC and the Greenspecks are on top of things, unfortunately.
Harley is a trip:-) Funny how she shook off her "blahness" and put on the "cool and casual look"...
Off to the next one...:-)
CHEERS!!
Mike
Author
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Thanks, Mike. I'll have to work on those tech details to simplify. Medicine is my real job, but I had to dig back to my school days for some of these scientific details. It's always a fine line to walk between losing your readers with jargon and failing to keep it real. Michael Crichton was such a master at doing this -- making complex, speculative science easy to understand and thrilling instead of snooze-inducing. I've read most of his thrillers, but that's not to say I've picked up his talent... Take care, Gray
Good chapter - I must admit I skimmed over the lab stuff and the introduction to Harley, but that's just me. It just felt like we were on a high in the last chapter, and this slowed the pace. But I like that Jake is taking his situation into his own hands and thinking about saving his own ass since Jess is now gone. Hope she stays gone, btdubs.
Maybe there could be a melding of the next chapter with this one, although I like the way this one ended. It would be a good scene ender too.
Moving on
Lauren
Author
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The lab stuff is probably too technical, so I'll try to simplify.
Thanks for the suggestion!
Gray
No
Ann Everett