The Leydig Virus: A Susan R. Turner Medical Mystery

By Richard H. Kessin

Two Women and a Virus

This is the story of two women, Susan and Anna, who have little in common. One is a scientist who studies dangerous viruses in Boston. The other is a mother and wife in an Amish dairy farming community in upstate New York.

When a new virus affects the Amish farmers; it does not kill or even make its victims very sick. Its distinguishing feature is that it attacks and kills human Leydig cells, which only men have. Leydig cells make testosterone, and their loss has consequences, male infertility being one, loss of libido another. Like Covid, the virus is very contagious and spreads, affecting all aspects of society.

The story is about the discovery and analysis of the virus, and the young scientists who do it. The story eventually brings the two women together. There are consequences—personal and professional—for Anna and Susan and their families. They meet, two stressed and exhausted people, and help restore each other. The way to deal with the virus is revealed but it is neither a vaccine nor a drug.

• Language: English
• Publisher: AuthorHouse
• Release date: Mar 3, 2024
• ISBN: 9798823020749

Richard H. Kessin

Richard H. Kessin, PhD is Professor of Pathology and Cell Biology at Columbia University, where he was also Associate Dean for Ph.D programs at the Columbia University Medical Center. He received his PhD from Brandeis, and taught genetics at Harvard. For the past 30 years he has done research in cell biology and taught molecular biology, research ethics, and the history of science at Columbia University. During 35 years of research supported by the National Institutes of Health, the Kessin Lab attracted talented students, technicians and postdoctoral fellows to conduct research in microbiology, cell development, and infection. Scientists in the lab were also interested in the cultural and ethical dilemmas that emerge from science. He writes a column for The Lakeville Journal in Salisbury CT that demystifies science. These columns, called The Body Scientific, cover topics from vaccines to evolution to genetically modified crops. The columns will soon appear in a book form. The Famine of Men describes an epidemic through the experience of young scientists. They discover and confront a virus like no other, with consequences that they had never imagined. This book is for all the graduate students, medical students, and young researchers who drive science and medicine. Galene and Richard Kessin have returned to their New England roots and live in Norfolk, Connecticut.

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© 2024 Richard H. Kessin. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 02/12/2024

ISBN: 979-8-8230-2073-2 (sc)

ISBN: 979-8-8230-2074-9 (e)

Library of Congress Control Number: 2024901209

Credit: Turi Rostad

Cover Art by Turi Rostad

PO Box 406

Norfolk CT

Turirostad.com

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

CONTENTS

Dedication

Preface

A Note About The Leydig Virus

Chapter 1   Upstate New York

Chapter 2   A House Call

Chapter 3   Christopher Turner

Chapter 4   Susan Rogulski

Chapter 5   Kuznets and Turner

Chapter 6   The Library

Chapter 7   The National Institutes of Health

Chapter 8   The Road to Marblehead

Chapter 9   The Call

Chapter 10 Grill 23

Chapter 11 New Results

Chapter 12 Getting Settled

Chapter 13 The Meeting

Chapter 14 Tracy Wu

Chapter 15 Fusella

Chapter 16 A Reason to Call

Chapter 17 Dinner Talk

Chapter 18 The Wrestling Team

Chapter 19 Cell Cultures

Chapter 20 The Centers for Disease Control

Chapter 21 Crittenden Results

Chapter 22 More Patients

Chapter 23 Valentine’s

Chapter 24 Valentin and Irina Kuznetz

Chapter 25 Progress

Chapter 26 The Visit

Chapter 27 Aftermath

Chapter 28 Morning

Chapter 29 Anna Schultz

Chapter 30 Abe Reads

Chapter 31 Dr. Jensen

Chapter 32 Tracy and the DNA

Chapter 33 Epidemiology

Chapter 34 Publication and Response

Chapter 35 The Tally

Chapter 36 Interviews

Chapter 37 Dr. Fowles

Chapter 38 Legal Seafood

Chapter 39 Jensen to Fresh Pond

Chapter 40 Headquarters

Chapter 41 Fowles Wonders

Chapter 42 A Forced Break

Chapter 43 Large-Scale Testing

Chapter 44 Blood of the Amish

Chapter 45 A Critical Meeting

Chapter 46 Dinner in the North End

Chapter 47 Susan Calls Maisonvert

Chapter 48 The Press Awakens

Chapter 49 The Press Again

Chapter 50 The Family

Chapter 51 Susan’s Seminar

Chapter 52 That Bastard

Chapter 53 Staffing Up

Chapter 54 Blood and Vaccines

Chapter 55 Personal Progress

Chapter 56 The Tabloids

Chapter 57 The Modigliani Lady

Chapter 58 Dinner with Mrs. Lau

Chapter 59 To the NIH

Chapter 60 The Director and the General

Chapter 61 Catching Up

Chapter 62 To the Pentagon

Chapter 63 Tracy and Jensen

Chapter 64 Expansion

Chapter 65 Breakout

Chapter 66 The Summons to Congress

Chapter 67 The Chairman

Chapter 68 An Interruption

Chapter 69 Upstate New York

Chapter 70 Arriving

Chapter 71 Anna’s House

Chapter 72 Susan Stays

Chapter 73 Among Amish Women

Chapter 74 The English Bull

Chapter 75 Susan Returns

Chapter 76 Relentless Virus

Chapter 77 Hope and Anger

Chapter 78 A Press Offensive

Chapter 79 A New Idea

Chapter 80 Dalgleish, Round 2

Chapter 81 Anna’s Diary

Chapter 82 Making a Vaccine

Chapter 83 A Wedding Party

Chapter 84 The Conference

Chapter 85 Van Gelder

Chapter 86 Washington

Chapter 87 Thomas Fowles

Chapter 88 Epidemiology Redux

Chapter 89 Anna Schultz

Chapter 90 Susan

Chapter 91 Gearing Up

Chapter 92 Anna Takes Charge

Chapter 93 Abe Speaks to the World

Epilogue

Acknowledgements

DEDICATION

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To the graduate students, post-doctoral fellows,

and junior faculty who make science move.

And to Galene Kessin, who is beyond compare.

PREFACE

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S cientists write a lot: NIH or other grant proposals, scientific papers, books, and other professional obligations, but that is a limited business, a style that does not take advantage of all language has to offer—there is too much subject, verb, and predicate. Adjectives are limited. There is no dialogue—God forbid! Font requirements and margin widths are dictated. We learn about living people from a resume form, which would do for a cadaver. Scientific papers can be well or badly written, and that is important, but all that restraint got on my ne rves.

The Leydig Virus is a novel about a young woman who has just become an Assistant Professor at a university in Boston. She’s a little scared. Her story is a lab bench view of how science is done and the lives of people who do it. It is the story of young faculty, post-docs, and Ph.D students.

Our protagonist finds a virus that kills Leydig cells, after Franz Leydig, who discovered them in 1850. They live in the testes where they make testosterone—on which sperm production and male sexual responses depend. Sexual orientation, whether straight, gay, trans, or other in a non-binary sexual world is not the important point. If a person depends on testosterone for sperm or strength, they are at risk. As Leydig cells die, men lose their libidos and beards, and become less muscular. Women do not have Leydig cells and are not affected by the virus. There are other consequences—lots of them.

I taught at Columbia University’s Irving Medical Center where Jakob Franke, my long-time colleague, and I had a research lab with talented students and post-doctoral fellows. For part of that time, I was the Associate Dean of Graduate Students, charged with recruiting and tending to PhD and MD-PhD students to do research in Columbia’s many laboratories. They will recognize this story. In fact, they are the story.

I am Emeritus Professor of Pathology and Cell Biology at the Columbia University Irving Medical Center. Reach me at [e-mail] or visit see my website: RichardKessin.com. It contains many columns that I wrote for local newspapers.

Richard Kessin

Norfolk Connecticut

December 2023

A NOTE ABOUT THE LEYDIG VIRUS

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T he events in this novel preceded the SARS-CoV-2 pandemic. During that pandemic, not quite over, almost everyone, no matter their political persuasion or background, came to understand the power of viruses. They could grow by the thousands in one human lung cell; they could spread and mercilessly infect others; they could kill human lung cells and do other damage that we are still trying to understand. Millions of people died, their lungs choked by fluids and defensive cells, until a vaccine and drugs appeared. Virologists and biologists knew such an event could happen, but we thought it would be an influenza v irus.

In the Leydig virus pandemic, no one died. The Leydig virus, like SARS-CoV-2, grew by the thousands in one generation in Leydig cells, but its effects were quite different. It took time to appear but there was fear, despair, and denial, as the reader will see.

The Leydig Virus is also the story of a courageous young mother from an Amish farming community whose people were among the first to be afflicted. She and her community were helped by a young virologist from Boston with a new lab, who discovered the virus and began the counterattack with her students, colleagues, and a local doctor. Amish women helped our Assistant Professor find balance in a frenetic life.

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CHAPTER 1

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Upstate New York

Late November 2012

I n New York State, not far from the Finger Lakes, an Amish community prospers in the twenty-first century while obeying edicts of the eighteenth. The country of rolling hills and farms appears to sustain its owners, although the men and women of the community adhere to a simplicity that most other Americans would not endure. As for the world that surrounds them, these farmers and craftsmen watch it warily, occasionally accepting its benefits, but keeping their distance, as do their kin in Pennsylvania. In New York, as in Pennsylvania, their society is strict, the rhythms of their lives set, their religious precepts well-established, including the commandment to be fruitful and mult iply.

Thus, it was a surprise to the community that in the previous three years only a single child had been born, when it had been typical for fifteen or twenty babies to arrive each year to strengthen the community’s numbers and purpose. Still, whether aberration or God’s will, the situation did not lead to the medical authorities. The community agreed, like the cycling of the weather—some years dry, others wet—so with children.

What could not be ignored forever, in a community struggling to maintain its identity, was the birth rate. So, when, again in the third in a row, only one child was born into a community of 700—and that child beget on a local woman by an outside man, one of the Pennsylvania brethren—a quiet panic began. Prayers were offered as young men and women sank into fear and depression, but like incantations, the prayers did not change. Nor did they work.

Occasionally, a brave soul, a community maverick, thought to visit one of the local physicians, but these thoughts were rejected by the group, which was suspicious of the English, their term for those outside the Amish community. Those more acquainted with the world beyond their farms imagined that carrying their symptoms to a local physician would result in questions much different than those posed when they presented the occasional case of pneumonia or a laceration. It was this fear of personal exposure, a hesitation born of modesty, that kept them from medical assistance, despite quiet pressure from their wives. It would pass, the men said, resting on the authority that had always been theirs. Besides, physicians were for the sick, and sickness meant fever and pain, neither of which accrued to the problem at hand.

If the Amish kept largely to themselves, this is not to say that there was no exchange with the outside community. They had to sell their products—agricultural produce or furniture—and over the years, relationships had sprung up between the Amish farmers and craftsmen and the English: They traded with local merchants; dealt with lawyers for land sales; conformed to the State Department of Agriculture’s requirements for testing dairy cattle; engaged with county authorities when it came to questions of repaving roads; and, less frequently, had contact with the police. Yet, despite these contacts, it was several years before anyone in the English world realized something was amiss with their Amish neighbors.

Normally childbirth is an uncomplicated business, one the Amish midwives were well-suited to assist. But occasionally in former years, despite a midwife’s best efforts, a woman or baby had had difficulty and under these circumstances a trusted English physicians was called, a Dr. Fowles, with whom the people had established a cautious bond. The problems—most often an infection or miscarriage—were easily resolved at home and only rarely did Dr. Fowles suggest admitting a mother or a child to the hospital. In those cases, in which hospitalization seemed inevitable, a family-wide, if not community-wide, soul searching occurred. Having Dr. Fowles in their homes was one thing—sending a loved one, a member of their world, to a place inherently strange, a hospital with its formal procedures and inexplicable apparatus, was something else.

Thomas Fowles had worked to develop and then sustain his relationship with people whose alternative view of how life should be lived he rather admired. Fowles was that rare human who enjoyed having friends utterly different from himself. He kept his bills modest and took a long, quiet time explaining any treatment he proposed to an Amish patient.

Several years passed before Dr. Fowles realized he had had less contact with the Amish community than he might have expected—and no calls for assistance at births. First, he thought his neighbors had shifted their business to another obstetrician. Making inquiries, he found that none of the half-dozen obstetric people in the area, nor any of the primary care doctors, had taken his place. Puzzled, he imagined that perhaps a new orthodoxy had taken root among the Amish, and they had given up modern obstetrical care entirely.

Thirty years earlier, when whooping cough swept through the community, the country medical authorities had convinced the Amish that the basic vaccinations—pertussis, measles, tetanus, diphtheria, and polio—were essential. Now, a public health nurse went to the farms periodically to administer these vaccines. It was to her that Dr. Fowles took his query, and she confirmed some of his suspicions, telling him that for the past several years, no babies were receiving vaccinations, only older children.

Thomas Fowles lived comfortably in a large colonial house with his wife Karen, two children, and an assortment of dogs and small animals. He was a contented man in his mid-forties, whose mind had once been set on academic medicine, but who now drew fulfillment from the country practice of obstetrics, gynecology, and general medicine. His land had once been a farm, but except for some apple and pear trees that he pruned and sprayed, he did not farm it. He was thinking about a horse for the children. The house had an attached barn and a horse, even two, could be installed easily, or so his son and daughter believed.

Three or four hundred yards to the west along the narrow road that led to his property a young Amish couple had bought a hundred acres. Their fields had been derelict, invaded by junipers and yellow birch. Eventually the land, like so many other fields, would have gone back to forest, but slowly, with the new family’s diligence, this tract was being restored to fertility and purpose. Fowles appreciated their labors, seeing his new neighbors as defenders against the ugliness of commercial civilization. Driving past their farm each day, he’d noted the couple’s progress as they removed the contaminating vines and junipers, planted corn for fodder, and began to impose order on the land they had taken as their responsibility. Unlike many plots of land nearby, on this piece of property, Fowles saw no clutter—no wrecks of old cars, no rusting farm implements covered by vines, no telephone poles, no heaped coils of wire. The garden was kept neatly weeded—and the farm had begun to flourish.

Fowles had met the family when, half-a-dozen years before, he had treated their son, Amos, who had been jaundiced at birth. The case was an uncomplicated one, the child restored to full health, but what had been notable—and had set this incident apart—was Amos’s mother, Anna.

Anna Schultz was inquisitive and intelligent, interested in helping in the treatment of her child, and seemingly undaunted by Fowles’ modern approach. Amos, now six, was thriving, but to Fowles’ surprise, Amos remained an only child. Fowles made it a habit to buy milk, eggs, and chickens from Anna Schultz, and though his suspicions were raised, he was hard pressed for a pretext to inquire into the Schultze’s’ small family.

When curiosity outweighed courtesy, early one Wednesday afternoon, Thomas Fowles walked from his house to the farm. He swung along easily, a big man with a face going slightly to flesh, striding down the one-lane road that connected the two houses, enjoying the bright day, not sure how—or if—he would broach his question. Either way, he intended to buy the golden-yolked eggs his neighbors’ chickens produced.

A hundred yards from the farmhouse, Thomas saw Peter Schultz at work on a barn meant to replace the sagging wreck that had come with the farm. Peter looked up and waved a hand. Fowles waved back and pointed to the house—a two-storied, gabled affair that was at least a hundred years old and had once canted slightly in the direction of the wind. The house had been braced and painted during the summer. He was about to open the gate when Anna Schultz came out to meet him.

Fowles admired her cheekbones and strong jaw that in another world would have made her beautiful or even an object of desire. Now he was struck by the seriousness of her demeanor, an attitude unusual in women her age, which was only twenty-seven or twenty-eight. Perhaps it was the stern dress she wore, or the apron and the braids, or her white cap, he thought; then decided that wasn’t it. Anna’s face revealed some level of stress that he’d not noticed before. She looked a bit thinner than he remembered. An astute diagnostician, a person’s affect was something he noticed automatically; had he missed it on his last visit?

Good afternoon, Dr. Fowles, she said, and he thought her greeting contained more warmth than one would normally expect for someone who had come to buy eggs. He might even have heard a hint of relief in her voice and thought that perhaps both the seller as well as the buyer had more to bring to this transaction than eggs.

Good afternoon, Mrs. Schultz, he said, bowing slightly, allowing the normalcy of his greeting to override the tension she’d exhibited. And how is young Amos?

Amos is well, thank you. He is doing very well in school. Did you need eggs?"

Yes, Thank you. A dozen? You have that many?

I do, she smiled.

She stepped into the house and returned with his eggs in a small basket, each egg an individual, a slightly different size and color from its mates. He knew that the yolks would each have slight differences in their deep yellow color, which gave him pleasure.

Handing Anna the bills he had ready, Fowles hesitated, afraid to ask his real question. Mrs. Schultz? She had already turned toward the door but came back to face him.

Yes, Dr. Fowles?

There’s something I’d like to ask you.

Perhaps, Peter ...

No, it’s this. Fowles rushed the question because he thought he stood a better chance without her husband. Am I correct in thinking that no children have been born in the Amish community lately?

Anna’s smile collapsed, the effort to maintain it deserted her, and she stared at him, unblinking, as if he had just accused her of a crime. Fowles remained still. Would she ignore him and return to her kitchen, leaving him standing? For a moment, Anna didn’t move, except to flick a quick glance to her husband, working on the barn. Finally, she answered, and when she did, he heard relief he’d noticed when she had greeted him.

How did you know? she asked quietly.

I used to come four or five times a year to the community for medical reasons, and at least some of those calls were for help with a mother or child in distress. For quite a while, I have not had a birth call, and I talked to the county nurse, who told me that she has not been vaccinating babies over this same period. It’s not a question of business. I’m just concerned that you might not ask for medical help if you need it.

I’m not sure it is for me to tell you, she said softly, her hands now clasped in front of her, her arms trembling in distress.

It will be in strict confidence, he assured her. Really, not a soul."

Still, she hesitated, and Fowles feared that she would not go on. But Anna took a breath, and with another glance at her husband, spoke. It’s true. Only a few children have been born among us in three or four years.

By choice?

Choice? She seemed insulted. We love children, Dr. Fowles. It is perhaps a thing that comes from God, this curse. We do not understand it. It has caused trouble between husband and wife.

He had been right, Fowles thought, and he was amazed that Mrs. Schultz was talking to him. They were still standing just inside her gate; he was holding the eggs. She looked both eager and anxious to ask for his help.

It is a problem of the men, she said, her voice dropping even more.

A problem of the men?

I asked Peter to visit a doctor, to see you, but he has refused. They have all refused. I would like more children.

He was curious and hoped the arena he was about to enter would bear his English scientific weight. Why do you think it’s a problem of the men?

They are uninterested in us as women. They do not do their duty. Perhaps they cannot. My own Peter is so affected, as are all the others. His beard grows only a little.

His beard? Fowles felt a fool not to have noticed the thin beard of his neighbor. Anna shifted her position slightly so that the roofline of the house blocked her view of her husband. Fowles also moved so that he could no longer be seen from the barn, hoping to prolong their conversation. Uninterested in his wife sexually? Beard falling out? No children?

Is this happening throughout the communities, the two near here in New York? he asked.

It is. Not just Peter. Not just our community. It is a curse. There is nothing that you can do. We will perish if it does not stop. She was near tears, hesitating between flight and the man who might help them.

Perish? He didn’t want to give the impression that he didn’t believe in curses and alienate the woman standing before him, but he explained that some diseases, although not accompanied by fever or pain or coughing, could still be at work on the human organism, and that, although some of these were insidious, they could still be treated.

Do you believe this is so, Dr. Fowles? Anna seemed willing to be consider the possibility of a medical rather than a biblical cause for the community’s curse.

I do, Mrs. Schultz. Thomas Fowles knew he had to talk to Peter. Not that Peter Schultz would want to talk with him. He began his campaign, by asking for Anna’s help. Could you convince Peter to come visit me? Or I will come here, as you wish. It won’t be as difficult as he thinks. But I believe it is time for you, for him, for your community to find help.

I will think of a way to talk to him, Anna said. The men, they are accepting it as a virtue. They call it humility before God, but I call it false pride.

She turned to go, but Fowles wanted to fix their next meeting.

I’ll return your basket on Friday, after Thanksgiving,

Anna gave him a long look then nodded and disappeared into the quiet of her home.

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CHAPTER 2

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A House Call

November 23

F owles set out for the Schultz farm with his empty egg basket tucked under his arm. He worried that Mrs. Schultz’s openness had been momentary, or that, despite her efforts, she had not been able to convince her husband to meet with him. To the Amish, Fowles’ way of life, his family’s way of life, was foreign, if not sinful. The Schultz’s had a six-year-old boy, as did Fowles and his wife Karen, yet so different were their world views, that the two boys, children who shared a hill in rural New York, had rarely met because Amos Schultz’s parents believed that the simple, agrarian life they had established for him would be damaged by meeting with his own child, whose head was filled with television and video games. Perhaps the Amish were right. Perhaps his own son should lead a simpler less electronic life. Chess per haps.

The hill on which both families lived was isolated and there was no traffic on the road. It was a warm day for late November, and Thomas unzipped his down vest. Walking along the road, he watched the stone walls for small animals. The walls had been there for almost two centuries, and trees had grown among the rocks, slowly shoving them out of place so that they rolled into the fields, destroying the work of early nineteenth-century farmers.

As he approached the Schultz property, he saw a horse and yellow carriage with a covered cab tied in the yard. Were they expecting him? Was it the wrong time? He had his hand on the gate bell when Peter Schultz came out. Behind him, waiting in the door frame was an older man with a thin-lipped Old Testament face, not cruel exactly but immobile. Fowles felt that things were about to go badly, that these men did not welcome his intrusion.

Hello, Mr. Schultz, Thomas said.

Dr. Fowles. This, in turn, was a statement not a welcome. Still, Peter Schultz motioned him to enter. Fowles walked into a parlor that was simply furnished, not meant for loungers, where he was invited to sit in a high-backed wooden chair. The older man followed and took a seat across the room, where Peter, too, settled. Fowles couldn’t decide if the man was depressed or whether he was scowling. Anna Schultz, not to be seen, announced her presence with the rattle of crockery from the kitchen. To Thomas, it seemed a long time before the man spoke.

How did you know about the problem? he asked, lips barely moving, not disturbing the mask of his face.

It was a simple deduction, Fowles replied. You may be wrong if you think medicine can’t help.

We are a simple community which does not desire any outside interference in our lives. What God wills we will accept. We will maintain our humility and live according to God’s laws. Fowles was annoyed. He was certain Anna Schultz wanted all the help she could get.

"As far as I can tell this community has had, what? one? two? babies in nearly three years? In a community of 700? I know that you love children. You know that I can be trusted. Doesn’t it seem possible that we could find a way to help your community together?

When the older man didn’t respond, Fowles added, I should tell you that I’m not the only person who has noticed this famine.

The older man registered surprise at this revelation, and at the biblical word famine, which Fowles had chosen deliberately, a twitch disturbed the impassive mask of his face.

Peter, sitting in his own parlor, looked uncomfortable. Was he interested in his neighbor’s medical point of view? After another long silence, Peter Schultz stammered, I ... I ... would like to hear what he has to say, Samuel.

Fowles slipped in his assurances. Anything you tell me will be in confidence. I won’t discuss your problem with anyone without your permission. Perhaps modern medicine can help; perhaps not. We don’t know yet what the problem is.

After another pause, the older man relented, giving the smallest nod.

You will answer some questions? Thomas asked.

Another hesitation, then another nod. Quickly Fowles established the history of the disease: In the older man, Samuel, the symptoms had appeared almost three years before. He had not been the first, but he was among the first. Peter’s symptoms had appeared six months after that. They couldn’t remember having any diseases at the time, perhaps a cold just before it happened.

Do you recall cold symptoms? Stuffy nose and coughing? Or was it something a little worse, like the flu? Did you have a fever? Perhaps a headache?

I remember a little fever, not terrible, but for one or two days I did not work, Peter said.

Samuel nodded, again, seeming to mean that he had had the same experience. Still, three years was a long time to remember slight symptoms.

Uncomfortable as they seemed, speaking in the most inconclusive vagaries, Fowles suspected it would be close to impossible to elicit any sort of comprehensive description of their sex lives. The most Peter and Samuel were willing to share—and Thomas could tell this was a stretch for them—was the fact that their testicles didn’t feel right and that they had a little breast-like tissue.

A blood test would tell us quite a lot, he said, not even broaching the possibility, at this point at any rate, of these men subjecting themselves to his examination.

It would be necessary to come to your office? Peter asked.

Among a group of pregnant women? Good grief, no. I could get what I need and come here. It only takes a few minutes. I could be back in an hour. Fowles was not about to give them time to change their minds.

The men conferred; heads bent towards one another. Then Samuel looked up. We will do it. But no one will hear of this.

Fowles was gasping as he burst into his house looking for his car keys. He’d started to run when he was out of sight of the farmhouse but hadn’t managed to keep it up. Maybe his wife was right. Certainly, compared to the lean figures of Peter and Samuel, he was out of shape. But now was not the time to be concerned with that. Not even stopping to write notes, he spun the Jeep out of the drive and headed into town.

At his office he collected syringes and vacuum tubes, alcohol, and a tourniquet. He checked his computer to make sure of the tests to order. He was back at the Schultz farm in less than an hour, this time driving to their gate. They were waiting, and now Mrs. Schultz had joined them. While the men remained stern-faced, she smiled at Fowles and greeted him warmly. Would they ever know if she had forced the issue?

The blood was drawn in minutes, but Dr. Fowles did not know how long it would take to get the results. He promised to come when he knew.

Once home, he stored the samples in his own refrigerator, explaining to his wife that it was a special favor to their neighbors. Karen didn’t question him beyond an assurance that the tubes were safe, stored in Tupperware. On Monday he would take the blood to the lab.

After replacing the names with initials to keep his vow of confidentiality, he settled in his study and wrote everything that he could remember from his interview, then made a rough calculation of the number of affected men. There were approximately 700 members of the community, about 350 of them, male. If 200 of those were children, that left 150 cases. What could all these men have in common? Would it have to do with agriculture? A new pesticide? Some new fertilizer? A vitamin deficiency? But did all the affected men work in the fields? Or did some of them have other jobs?

There was so much he didn’t know, but all he could do was travel the course he’d set. He dated the notes and locked them in his desk. Monday the samples would be at the lab.

CHAPTER 3

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Christopher Turner

December 7

D r. Christopher Turner, feet on his desk, leaned back in his chair and stretched to loosen the muscles in his neck. He had been immobile for some time, looking down on the Charles River from his office window on the 10 th floor. A curtain of swirling snow had begun to restrict his view, and he had lost sight of Boston’s science museum. Next to it, where the river was dammed, small icebergs had collected, but they too were disappearing into the vail of snow.

An email pinged on his computer screen. He glanced at it in irritation. It was from his nurse, who wrote, Leaving. Check Kuznets results. Referral from Dr. Sorensen. Coming Monday.

He glanced back at the window; even the river was lost behind the wall of snow that had begun to pile onto Storrow Drive. Half-melted sleet had refrozen on his window, a line of ice creeping up.

The snow calmed him, let his mind ramble, jump from one thought to another. The first thought that arose had to do with boredom. He rejected that. Men in his position were not supposed to be bored; they were doing important work. He was doing important work. Therefore, he wasn’t bored.

His mind kept trying, this time throwing out the word restless. This, he turned over, examining it like an old coin. Restless was satisfactory. That was it. He was restless. It was distinctly better than, more dignified than, bored or depressed or lonely.

Seeing that the snow on the window ledge had built to six inches, Turner laced on his boots, pushed out of the safe warmth of his office and, stepping onto Charles Street, turned toward home, bending into the snow blowing off Beacon Hill. He made his way slowly, scuffing through the dry snow, ski hat pulled low so he could just peer out from under the knitted rim. He avoided the few other pedestrians who bent into the storm as if it were a malevolent force. It was not malevolent to him; the elements were a relief.

Chris Turner realized he was watching his own body plodding through the storm; he become an impartial observer, and, for a moment didn’t know which he preferred, acting the spectator or the walker. He knew that psychiatrists called his condition dissociation. But the squeak of his boots pressing into the dry snow brought him back and he was just one Chris, the Chris who was not sure if this effect of suddenly slipping loose and watching himself, an event which had happened more than once recently, was a sign of stellar mental health. He’d thought of consulting a psychiatrist but thought a shrink would tell him he was depressed; depression was something, they knew how to treat. He doubted they could deal with a condition called restless.

As he slipped around the corner and strode up Joy Street’s slope, the wind pierced his overcoat, and he felt suddenly unhappy about spending the evening alone in his apartment. Was there even anything to eat? Maybe in the freezer. Perhaps he would eat and then play his piano, he thought. Force yourself to play the piano, he told himself, and for a moment his disembodied twin reappeared, as if to record the vow. Yes, that was something he could do. And he had a good book—Catherine the Great, by that Massie fellow who’d written those great naval books. The two thoughts cheered him. It wasn’t until he arrived at the stoop to his apartment that he remembered, despite his nurse’s admonition, he had forgotten to look at the Kuznets results.

CHAPTER 4

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Susan Rogulski

December 7

O n that December evening, Susan Rogulski stood in the living room of her apartment in the Back Bay considering which box to unpack first. Instead, she poured herself a drink. The movers had left most of the furniture in reasonable spots, but there were piles of boxes filled with books, lamps, and dishes to be opened and emp tied.

Her mother had already arranged Susan’s clothes in the closets, neatly, slacks and blouses, separated and all facing the same direction. Now, her second Dewar’s and soda in hand, Susan had lost enthusiasm for digging through boxes. She would leave it until morning. She’d sent her mother home when the snow started and was grateful for the solitude. The bed was made, but she wasn’t ready to sleep, and, instead, settled onto the cushion in the bay window, rubbed at the condensation, and sipped her drink. Commonwealth Avenue was empty, the parked cars slowly losing shape under the silencing snow. Branches near her window were piled with ridges of snow; even the smaller twigs had two inches of lacework that no wind had disturbed. Below her, on the Commonwealth Avenue mall, a chef’s hat of snow grew on the head of the statue of William Lloyd Garrison.

She looked up, pulling back to examine her reflection in the glass. She looked all planes and angles, the hollows beneath her cheekbones shadowy, her dark hair, parted starkly, made her look, to her own eyes, strong, but tired and thin.

Susan had almost forgotten her fight at the lab. Now the scene swam back to her through a haze of scotch. Professor Maxwell had been furious with her—although she wasn’t quite sure why. An imperious man in his late sixties, Maxwell had been a titan in the biological study of the structure of proteins. He was famous for constant work. A wife, long departed, had left him to science. He was estranged from a son and a daughter. But in his own laboratory he was a king as well as a martyr, and he could scold his graduate students and postdoctoral researchers for being inadequate to his quest for a Nobel Prize. They called him Il Duce.

When Susan had announced her departure, his fury had surprised her. Sick of his misogyny, bruised by his mean spirit, she’d lashed back, matched his invective. Everyone had heard, the noise echoing beyond his office, into the lab, into the corridor. She knew the others would be on her side—So Susan’s finally letting him have it!—but his brutality and raw sarcasm still bit through the armor she’d developed. Now, snug in her new apartment, she replayed the scene. It hadn’t been dignified, but it had been necessary. And he’d had it coming, You will go nowhere in science, he’d screamed.

Just watch me, she’d countered. Then, loudly, You old prick.

Why she’d chosen to apprentice under Maxwell was something that she often asked herself. He had been so friendly at her interview, and who questioned Harvard Medical School? She had been an excellent Ph.D. student, with a good thesis and several papers to her name, and she knew her molecular biology and virology. She’d known his reputation for difficulty, but it was only for three years, and it was good training, she’d told herself. And she had stuck it out, adapted, learned that if she had two experimental results, she should never give him both on the same day; one was always saved in a bank on which she could draw to keep Maxwell happy.

Under Maxwell, Susan had studied a virus that causes tumors in mice. After three years of work on the question of how one virus becomes hundreds or thousands, Susan had solved the problem; her contribution to the solution of how DNA and several enzymes combine to copy and produce more of the