Nano

  ALSO BY ROBIN COOK

  Death Benefit

  Cure

  Intervention

  Foreign Body

  Critical

  Crisis

  Marker

  Seizure

  Shock

  Abduction

  Vector

  Toxin

  Invasion

  Chromosome 6

  Contagion

  Acceptable Risk

  Fatal Cure

  Terminal

  Blindsight

  Vital Signs

  Harmful Intent

  Mutation

  Mortal Fear

  Outbreak

  Mindbend

  Godplayer

  Fever

  Brain

  Sphinx

  Coma

  The Year of the Intern

  G. P. PUTNAM’S SONS

  Publishers Since 1838

  Published by the Penguin Group

  Penguin Group (USA) Inc., 375 Hudson Street, New York, New York 10014, USA • Penguin Group (Canada), 90 Eglinton Avenue East, Suite 700, Toronto, Ontario M4P 2Y3, Canada (a division of Pearson Penguin Canada Inc.) • Penguin Books Ltd, 80 Strand, London WC2R 0RL, England • Penguin Ireland, 25 St Stephen’s Green, Dublin 2, Ireland (a division of Penguin Books Ltd) • Penguin Group (Australia), 707 Collins Street, Melbourne, Victoria 3008, Australia (a division of Pearson Australia Group Pty Ltd) • Penguin Books India Pvt Ltd, 11 Community Centre, Panchsheel Park, New Delhi–110 017, India • Penguin Group (NZ), 67 Apollo Drive, Rosedale, Auckland 0632, New Zealand (a division of Pearson New Zealand Ltd) • Penguin Books, Rosebank Office Park, 181 Jan Smuts Avenue, Parktown North 2193, South Africa • Penguin China, B7 Jaiming Center, 27 East Third Ring Road North, Chaoyang District, Beijing 100020, China

  Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R 0RL, England

  Copyright © 2012 by Robin Cook

  All rights reserved. No part of this book may be reproduced, scanned, or distributed in any printed or electronic form without permission. Please do not participate in or encourage piracy of copyrighted materials in violation of the author’s rights. Purchase only authorized editions.

  Published simultaneously in Canada

  ISBN 978-1-101-60666-7

  This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, businesses, companies, events, or locales is entirely coincidental.

  While the author has made every effort to provide accurate telephone numbers, Internet addresses, and other contact information at the time of publication, neither the publisher nor the author assumes any responsibility for errors, or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

  NANO is dedicated both to the promise nanotechnology brings to medicine and to the hope that any downside will be minimal.

  CONTENTS

  ALSO BY ROBIN COOK

  TITLE PAGE

  COPYRIGHT

  DEDICATION

  PREFACE

  PROLOGUE

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Chapter 22

  Chapter 23

  Chapter 24

  Chapter 25

  Chapter 26

  Chapter 27

  Chapter 28

  Chapter 29

  Chapter 30

  Chapter 31

  Chapter 32

  Chapter 33

  Chapter 34

  Chapter 35

  Chapter 36

  Chapter 37

  Chapter 38

  Chapter 39

  Chapter 40

  Chapter 41

  Chapter 42

  Chapter 43

  Chapter 44

  Chapter 45

  Chapter 46

  Chapter 47

  Chapter 48

  Chapter 49

  Chapter 50

  Chapter 51

  Chapter 52

  Chapter 53

  Chapter 54

  Chapter 55

  Chapter 56

  Chapter 57

  Chapter 58

  Chapter 59

  Chapter 60

  Chapter 61

  Chapter 62

  Chapter 63

  Chapter 64

  EPILOGUE

  PREFACE

  Smallness has been a most unappreciated attribute. We’re always implored to think “big,” and never “small.” But now smallness sits at the convergence of chemistry, physics, and biology at a place called nanotechnology, which is transforming the world of scientific research and development and which is going to have an enormous impact on medicine. Despite its emergence only at the end of the last century, nanotechnology is already a multibillion-dollar phenomenon, with more commercial applications arriving on the scene at an ever increasing pace.

  In the nanotechnology arena, small is very small indeed. The basic unit of length is the nanometer: one-billionth of a meter. Consider that if a marble were to represent a nanometer, then the entire earth would represent a meter. A hydrogen atom is approximately a tenth of a nanometer in diameter; a DNA molecule is 2 to 3 nanometers thick. Among living organisms, viruses range from 20 to 400 nanometers; bacteria are larger. Salmonella, the cause of typhoid fever and 90 percent of cases of food poisoning worldwide, is on the order of 2,500 nanometers in length and about 500 nanometers in width, with a narrow tail-like flagellum, also 500 nanometers long. The cells making up the human body are larger, with the disc-shaped red blood cell coming in at a diameter of around 7,000 nanometers, while white blood cells are 10,000 nanometers plus.

  This nano netherworld is governed more by quantum mechanics than by the laws of macro-chemistry and physics such that bonds, forces, and fields prevail over mass, gravity, and inertia. And the power of these bonds, forces, and fields is stupendous, representing the potential energy locked away from the cataclysms of billions of celestial supernova explosions that have occurred over the life span of the universe.

  Within the microcosm of nano-sized constructs of individual atoms and molecules, surface phenomena assume particular importance because the ratio of surface area to volume increases dramatically, essentially exposing their negatively charged electron fields and thereby their characteristics. For example, in the nano realm, gold is not the color of gold, nor is it inert. More important for nanotechnology is the element carbon, the basic building block of life, already known to be versatile in forming both diamond and graphite. In the nanotechnology domain, carbon atoms have recently been found to form other astonishing and marvelous nano-sized structures when subjected to equivalent violent conditions that exist in the interior of red giant stars. These structures, called fullerenes, include sixty-ca
rbon-atom buckyball spheres 1 nanometer in diameter, and even more important for nanotechnology, nanotubes of varying length and structure 1.3 nanometers in diameter. These surprising constructs have unique physical characteristics—amazing strength, lightness, stability, and conductivity, and will assume increasing importance as nanotechnology surges ahead.

  In nanotechnology there exists a world of possibility but also of potential threat. Not even the experts know of the environmental or health effects of nanoparticles. For example, it has been noted that concretions of carbon nanotubes, something they tend to do, resemble the microscopic structure of asbestos with its known carcinogenic tendency. The fact that nanoparticles penetrate the human body, even the brain, is a known fact. How damaging this could be is totally unknown.

  The second threat of nanotechnology is based on its immediate commercial success. In a very real sense, no one is guarding the multibillion-dollar R&D hen house. There is no oversight, like there had been with recombinant DNA research, on the potential negative impact of nanoparticles. Nanotechnology research is being done in thousands of private laboratories, each racing ahead willy-nilly to be the first to secure valuable patents in a competitive environment where secrecy is paramount and the risks are minimized or ignored.

  PROLOGUE

  CARTER LAKE LOOP, BOULDER, COLORADO

  SUNDAY, APRIL 21, 2013, 8:28 A.M.

  The cyclist decided to go for a relaxing ride—the real training would resume on Tuesday, after he underwent more medical tests. The trainers had said it was okay for him to take his bike out to work off some of the stiffness he had built up the previous day, but insisted he shouldn’t push himself too hard. They had also made sure he was wearing the usual sensors for heart rate, breathing rate, and oxygen partial pressure, as well as the GPS device so that he could be appropriately monitored.

  The route he was provided went north of Boulder to Carter Lake and back. The total trip was more than seventy-five miles, but there wasn’t much change in elevation along the way. If he and the others expected to compete at the level intended, they would have to be able to cycle seventy-five miles of predominantly flat terrain without breaking a sweat.

  After a few miles, the cyclist felt bored and restless. He knew he was supposed to take it easy, but his body felt so good, it was as if he were flying over the pavement. His legs were stronger than they’d ever been, and not only was he not out of breath, his breathing was shallow and easy like he was strolling in a park. It was a lovely spring day, and he welcomed the warmth of the sun on his back. Despite warnings to the contrary, he was ready to push himself. Why shouldn’t he take advantage of feeling this good? Perhaps they’d punish him in some form or fashion, but the cyclist was confident they wouldn’t follow through on any of the threats they made to hurt his family back home. Those sanctions were reserved for trying to escape, not for pushing oneself too hard during a workout. In fact, he thought he might even be rewarded for making such obvious progress in his conditioning.

  What the hell? the man thought, and he started to race hard, pumping his legs, picking up speed, crouching flat against the handlebars to reduce the wind resistance. He’d been cycling for only about a year, but he doubted there was anyone in the world who could do this better. Wasn’t his country about to demonstrate to the world that they could compete on a world-class level and in all endurance-based sporting endeavors?

  The route had one climb of any significance, and the cyclist attacked it hard, initially holding his breath. He didn’t slow down at all, taking the paved road as if it were flat, rather than a 6 percent incline. He was really racing now, flying, exhilarated, when, suddenly, halfway up the hill, he couldn’t breathe and there was a sharp, stabbing pain in his chest and another in his left upper abdomen. The cyclist’s hand went to his throat as he felt his airway contract. He tried to brake, but lost control and the bike veered right, hit the slight curb, and threw the cyclist hard into a downward-sloping shoulder that was half grass, half gravel. He landed awkwardly and bumped and rolled before coming to a stop. His arms and legs were scraped and cut, but that didn’t matter because, try as he might, he couldn’t catch his breath. It was as if he had breathed out but couldn’t breathe in. On top of that, he was perspiring crazily, his heart was beating at an impossible rate, and the pain was unrelenting. The man hovered on the brink of unconsciousness, unable to get up or even move.

  He had no idea how long he had been lying there, his body motionless on the outside but spiraling out of control within, like a runaway nuclear reactor. After a time—ten, thirty minutes?—he was aware of figures standing around him. Three or four people were talking at once and a hand grabbed his wrist. The man was aware that these were countrymen—he was in the United States but these people were Chinese, like him. They were part of the team. He felt his body being lifted roughly from the road and laid on a hard surface, and then a different kind of motion. The last sensation he had before finally falling unconscious was of being driven, presumably back to home base.

  • • •

  THE TECHNICIAN IN THE VAN switched off the GPS device. It had worked—the combined tracker and vital-signs register had sounded the alarm, and the team knew at once that number five was in distress and where he was located. He had been easy to find off the public road, and luckily no one had seen him fall or stopped to help him. The crash had taken him clear of the road and down a small embankment where he wasn’t visible to passersby. The doctor in charge had been grateful for that.

  Now the subject was displaying a highly unusual assortment of signs, but nothing they hadn’t seen before. The GPS showed what speed he had been going—much too fast for that phase of the training cycle. It looked as if they were losing him, but the doctor knew a fresh batch of subjects were conveniently scheduled to arrive that very day. On the other hand, it was a shame; this one showed some promise, as he had been an athlete before getting in trouble with the law.

  Within twenty minutes they had reached their destination. The van backed into a loading dock where another medical team was waiting, and they transferred the cyclist into a windowless room full of emergency medical equipment. As he lay unconscious on a gurney, one orderly cut away the man’s cycling gear while another wheeled over what resembled a dialysis machine. By the time it was hooked up, the EEG monitor showed that there was no brain function, but that was of secondary importance—they had to make sure that the heart kept working so that they could recycle the blood and figure out exactly what had gone wrong, even though they had a pretty good idea.

  A half hour later, the cyclist was technically dead, but his breathing and heart and vital functions were being maintained mechanically. His body would most likely be worked up and kept with the others in this state for as long as it was useful. The man’s blood was running through a system that centrifuged it in 100 cc samples, separating out the usual components and the additives before reintroducing the cells and the plasma back into his artificially maintained circulation.

  A surgical team entered the room, gloved and gowned as if for a regular operative procedure. The only difference was that none of the team was terribly concerned with sterility, and the scrub had been perfunctory at best. Without ceremony, a splenectomy was performed on the dead man and a lung sample was taken. Both the spleen and the lung sample were immediately sectioned and examined in the same room by one of the senior scientists on the staff. Under the high-powered microscope, he could see what he knew would be there, a profusion of microscopic, sapphire-blue spheres blocking the capillaries. The scientist checked his watch. He knew the boss was out of the country, but he’d need to hear about this right away.

  1.

  BOULDER, COLORADO

  SUNDAY, APRIL 21, 2013, 11:53 A.M.

  The woman is desperate and defenseless. A large man is sitting on her chest, restraining her, his head turned while watching the other end of a long room. The man’s blocking her vie
w, but she knows that whatever’s going on is bad. She senses that someone she knows and cares for is going to die. As she struggles with the weight on top of her, she looks at up at her tormentor’s face. He’s a man she knew at one of the foster homes and institutions in which she was raised, a man who got too close. She looks away and then back at him. Now he’s another man, her uncle, the worst of the men who have affected her life, and he’s holding the video camera she came to hate.

  The uncle she so despises says something in Albanian to a colleague who is somewhere in the room. It’s a language she recognizes but no longer understands. The look on his face, with its cruel smile, is that of a predator, with her being the prey. Enjoying his victim’s terror, he speaks again, but now in English. “Do it!” he snarls to his compatriot. “Shoot him!” The woman lifts and twists her head unnaturally to get a view. A hooded man is tied to a chair with duct tape. He jerks back and forth as he tries to free an arm or a leg, like a desperate insect caught in a spiderweb. The other man has a gun. He’s walking around the chair, shouting in Albanian, lunging forward with the gun outstretched, poking the bound man, teasing him as a cat teases a captured mouse. With his free hand the armed man reaches over and tears off the hood and then looks back toward his partner. The woman recognizes the bound victim. It is a former medical school classmate named Will. And now she can see the gunman and recognizes him as well. It’s her father. He sees her and turns back toward Will, and as she fills the world with a screamed “No!” he shoots the prisoner in the head.

  —

  Just as suddenly as it appeared, the weight left her chest. The heavy, molecular immunology textbook that she had been reading thudded to the floor. The woman sat up from the sofa, momentarily disoriented, sweating, shivering in the coolness of her apartment’s living room. She became aware of an unfamiliar sound, not screams or gunfire, but a penetrating ring. It was her doorbell, which had been pressed possibly twice in the eighteen months she’d been living there.

  Still confused, the woman unsteadily got to her feet and walked to the narrow entryway of her apartment. Who on earth could be ringing her doorbell? Looking through the peephole, she recognized her visitor. She turned and leaned her back against the door, stunned anew. The doorbell’s raucous sound echoed around her mostly empty apartment, seeming louder than it actually was, but as she recovered from the anxiety and tension of the nightmare, it was easier to bear. She fortified herself with a deep breath as her visitor gave up on the doorbell and loudly knocked three times in quick succession. He always was very persistent. With a sigh, she turned and opened both locks on her door and pulled it open.