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“EMTs just shot across town to Bellevue. Pumped her stomach out and Gina will be up and about by morning. They’ll keep her a couple of days for observation and make sure she starts some inpatient psych care.”

“But she’s conscious and alert?” I was sorry to have played any role in the mounting distress that had caused the teen’s well-being to be compromised.

“Nothing to fret about. She’s fine and her ol’ man has a new punching bag.”

“You?”

“Yeah, but I think I scare him a bit more than you do.”

“Good to hear. In the meantime, while you’re there, can you check for Fyodor Zukov’s med records? His sister says—”

“I guess I buried the lede, Alex. They’re going to give me the records, subject to a subpoena that Nan can cut in the morning. It’s not what we thought.”

“You mean it wasn’t an emergency-room admission?” I said, thinking of the problems with the nerves in his hands that cut short his career on the wires. “Or it isn’t psychiatric?”

“Neither one of those,” Mercer said, discounting the two things most commonly associated with the old medical facility.

“What then?”

“Zukov’s been examined here at a new clinic. It’s for Hansen’s disease. Do you know—?”

“I know exactly what it is, Mercer. It’s leprosy,” I said to him. Then to Mike, “Our killer — who targets outcasts and pariahs and black sheep — is a leper.”

FORTY-EIGHT

“STOP the car!”

“Stop the train, stop the car — what is it with you tonight?” Mike asked.

“Zukov’s not on his way to Hyannis. Pull over and let me drive.”

“What are you talking about?”

“I know where he’s going, Mike. I can get us to Woods Hole with a blindfold on, in half the time that you can,” I said. The tiny village on the southwestern tip of the Cape is the home of the terminal from which ferries run back and forth to Martha’s Vineyard. I’d spent countless hours there walking the harbor as I waited to get over to my island on standby, with no reservation.

“Where’s he going? And why do you think you know?”

“Because this country didn’t ever have more than a handful of places that were leper colonies, and only one of those was turned into a ‘last chance’ school for delinquent boys.”

Mike pulled to the side of the road and braked the car.

“Twofers, Coop. I’ll bite. Where are you taking me?”

Mike opened the door to change seats and I answered him as I moved behind the steering wheel. “A desolate little place in Buzzards Bay where they used to banish lepers a century ago,” I said. “It’s called Penikese Island.”

FORTY-NINE

“GET on the phone to the Coast Guard. We’re going to need their help to get to the island,” I said, adjusting the rearview mirror as I made the U-turn to take us south to the tip of the Cape. “And don’t let them send a chopper up yet. We don’t want to let him know we’re coming.”

“Penikese is a smart guess, Coop. A bit of a wild card, but smart. I just don’t want to jump the gun. I’m not ready to pull any cops off Reverend Portland’s detail yet on the theory that our perp knows about this little island.”

“Here’s what you do. Call Peterson and ask him to get the feds moving. They’ll bring in the Coast Guard. Then you call the captain in Providence. I blew Oksana off when she was talking to me about Fyodor and his reform school. Have him ask her where it was. I bet she and Yuri were old enough at the time to remember.”

“How long till we get to Woods Hole?”

“With any luck and no roadkill, I’d say we’re there in less than half an hour. And the local cops—”

“How many are there? Two?”

“Off-season like this, maybe four,” I was only half joking. I had no idea what their resources might be, but Mike and I would need backup. “They’ve got to start scouring the town for an Angus truck.”

“Doesn’t really give me a lot of time to rally the troops. There’s a slew of places to dump a truck, aren’t there?”

“Ferry parking lots, marinas, residential areas, and plenty of woods that surround the little town. Get on it.”

“You like giving me orders, Coop?” Mike asked as he got on the phone.

“I love being in the driver’s seat. Get used to it.”

“I’m allergic to the idea. Brake going into these curves, will you?”

“You don’t know how many times I’ve raced this road to catch the last boat over. Stop whining and tighten your seat belt.”

“Don’t steal my lines, Coop. You’re the whiner,” Mike said as he waited for Lieutenant Peterson to answer. “You know this is going to get worse before it gets better, don’t you?”

Every trace of my smile disappeared. “I’m well aware of that.”

“I’m in charge once we get where we’re going. There’s one gun, and I’ve got it. When we get to town, you’re no longer the dominatrix. Am I understood?”

I swerved to avoid a raccoon — his beady eyes reflecting in our headlights as he lumbered across the road.

“Loo? We got a change in plans. Coop’s brain is on double-overtime. Don’t ask me to explain, Boss, just go with it and put some pressure on the locals,” Mike said, and then answered the question Peterson asked him, winking at me as I looked up from the road. “Yeah, I do trust her. Just go with it.”

“Thanks for that,” I said.

“Eyes on the road. Tell me first what Mercer said about Zukov’s diagnosis. And then you’ve got about twelve minutes to make me an expert on every inch of this little island.”

“I’ll start with the disease.”

“Shoot.”

“Zukov saw a doc in Atlanta after he dropped the girl during their trapeze act. Admitted to him — but not to his family — that he’d lost sensation in his hands from time to time. That fact, combined with the lesions on his face, caused the physician to send him to New York.”

“In December?”

“Exactly. The diagnosis was made at the Bellevue clinic, one of the few in the country that specializes in the disease. Mercer read me the notes.”

“How was it diagnosed? How advanced is it?”

“To begin with, the germ that causes leprosy attacks the skin and the nerves. The skin lesions developed first, a couple of years ago. They were small initially, then became larger and larger — festered and blistered. But because of the tendency for Fyodor to use makeup for performances, he was able to cover it up.”

“He must have been in complete denial. That — and the fact that nobody thinks about leprosy today, except in third-world countries.”

“Mercer says Bellevue’s got five hundred people in their program, right in New York City.”

“And Fyodor Zukov is one of them?”

“No. They wanted him to be treated, but he was so devastated by the diagnosis that he didn’t come back. Not until the day that Naomi Gersh disappeared.”

“Why then?” Mike asked.

“For pain medication.”

“Shit. And they gave it to him?”

“Yes, he promised to enroll in the program, and they gave him a scrip for pain meds,” I said, thinking of the drugged and drowsy voice of Chat Grant. “Oxycodone. A two-week supply.”

“It’s a narcotic and a painkiller, right?”

“Oh, yeah. It would do the job on our vics.”

“But if they were offering to treat him, why would he skip out?”

“The nurse who talked to Mercer interpreted the doctor’s notes. The disease has progressed pretty aggressively. Even though Fyodor couldn’t face telling his siblings — and certainly not circus management — he’d never be able to work again. The sensory impairment of his nerves — nerve paralysis, in fact — has already caused permanent deformities.”

“Where?”

“In addition to the weakness in his wrists, his fingers have begun to claw.”

“That’s what it’s called?” Mike asked.

“Irreversible clawing, yes, of the fingers and toes. It’s no wonder he dropped his partner,” I said. “The infection eventually invades the bones and destroys them. Without treatment, he’ll lose his extremities.”

“I’d be pretty devastated too.”

“The other thing was his eyebrows. Remember Faith telling us he had no eyebrows?”

“Yeah.”

“Classic symptom of leprosy.”

“But he’s got a full head of hair,” Mike said.

“That’s ’cause the head is warm. The bacteria invade the eyebrows because they’re much cooler than head hair.”

The road had narrowed from four lanes to two. Fog was settling in over the treetops and I could smell the saltwater as we neared the shoreline.

“Let me tell you about Penikese.”

It was hard to see the pavement for the thickening fog, and I slowed my pace briefly. I centered the car on the yellow line in the middle of the road and pressed down on the pedal.

“It’s one of the Elizabeth Islands, just north of Cuttyhunk. It’s only seventy-five acres.”

“The whole thing? Central Park’s more than eight hundred acres. You’re right about tiny,” Mike said. “You’ve been there?”

“Scores of times, mostly as a kid.” I could see Cuttyhunk and its three sister islands from the deck of my Vineyard bedroom. Penikese was out of sight, on the far north side of Cuttyhunk.

“There’s a ferry?”

“No ferry. No regular service at all.”

“Great. You planning a swim?”

“No. There’ll be something moving in the harbor,” I said. “My father kept his sailboat on the Vineyard. A Herreshoff — a twenty-eight-foot ketch. My brothers and I spent a lot of time exploring the islands. Then I fell in love with Adam, and he was a sailor too. Penikese held a fascination for him ’cause he was a medical student, so the diseased history of the place and its tragic sadness drew him there. But it somehow terrified me.”

“Why?”

“It’s jinxed — it’s always been that way. It’s got a miserably sad past.”

“How so?”

“Leprosy is one of the most dreaded conditions of humankind,” I said. “Until very recently, people believed it was contagious. Incurable and contagious.”

“It’s not?”

“Very rarely. There’s a genetic susceptibility.”

“So Zukov’s siblings might be in line?”

“It’s possible. Ninety-five percent of all people are immune to the bacillus. But in the old days, lepers were sent off to live in quarantine.”

“Leper colonies.”

“Isolated from their communities. And islands were the ideal solution. There was one in the East River, another off the coast of San Francisco, and the infamous colony on Molokai. People were shipped off forever, separated from their families, to live the rest of their lives — and to die — among strangers suffering with the same affliction. There was no coming back.”

“Penikese was one of them?”

“In 1905, Massachusetts created the Penikese Island Hospital on this lonely rock in the middle of the bay. Two doctors volunteered to staff it, and five patients — ripped from their homes and their children — were forced to be sent there.”

“How did they live?”

“The patients had to build their own shacks — small, wooden ones. They don’t exist anymore. Fishing boats would drop off fresh food from the mainland, once a week, depositing it at the end of the dock. Letters from home, that sort of thing. One-way service only.”

“And no one ever returned?”

“Not a single soul. The tombstones and crosses are proof of that. Most of the wooden markers have rotted away.”

“What scared you there, Coop?”

“As a kid it was the idea of plague pits. My older brothers would tie up the boat and we’d sneak ashore. I was afraid to go with them, and more afraid to wait alone. Everyone says the island has ghosts. Even a haunted mansion, way back in time.”

“Mansion? In a leper colony.”

“No, no. Before the state took it over. Long gone, but my brothers used to play in the old shafts and tunnels beneath it. That didn’t worry me — I was just too claustrophobic to go down into them — but the sad stories of the lepers really got to me.”

“Sounds like it.”

“The boys used to taunt me — tell me that if I stepped on one of the graves, the ghost of the leper would rise up and, well — kill me. When I was ten, eleven — I believed that.”

“You’ve been to ghost islands before.”

“Not so full of death as Penikese. Not with such a painful past. It’s one of the loneliest little outposts in the world.”

“How long did the hospital last?”

“Only about fifteen years. The government built a leprosarium in Louisiana. This pitiful place went out of business pretty fast after that. Then, about thirty years ago, someone had the idea to use the desolate setting as a school for delinquent boys — really dangerous ones. Kids who needed complete isolation to attempt to resocialize them. The success rate has been less than enviable.”

I could make out fog lights on the road ahead and I braked again, getting over to the right to avoid a pickup truck coming the opposite way. When I reached the traffic light in Falmouth, I could see that no one was approaching the intersection and I ran through the red signal. There was only one more stop sign between where we were and the harbor, then a twelve-mile boat run to Penikese Island.

“It’s biblical, you know,” Mike said. “Leprosy, I mean. Maybe that’s what’s haunting our killer.”

“It was considered a mark of God, wasn’t it? A sign to the priests that the leper was someone who had sinned.”

“Your boy Moses started the whole phobia, Coop.”

“I guess so. I remember in Leviticus, he directed the Israelites to exile lepers, to exile all those who had offended their God.”

Mike knew as much of the Old Testament as the New. “ ‘ Whosoever shall be defiled with the leprosy and is separated by the judgment of the priest… shall dwell alone without the camp.’ ”

“Father Bernard might smile on you after all.”

The fog swirled around the car as we crested the hill that overlooked the Woods Hole ferry terminal. The sturdy old Islander was sheltered in its dock below us, dark and still, out of service until the first run of the morning.

Off to the right, in Quissett Harbor, the red bubble atop a police cruiser was spinning in the haze, setting off an eerie glow.

“There,” Mike said. “Head for that patrol car.”

“I see it,” I said, nosing the car past the row of stores and restaurants, beyond the scattered buildings of the Oceanographic Institute.

A solo officer was pacing the sidewalk at the end of the dock, talking to someone on his radio, when he saw us get out of the Rhode Island trooper’s car.

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