NANOTECHNOLOGY TO TREAT DEPRESSION MORE EFFECTIVELY
WASHINGTON, NOVEMBER 5, 2009 – by Marjorie Gershwin
For patients throughout the country, the use of nanotechnology to control drug dosing and monitor side effects sounds like science fiction. But every day, Argo Pharmaceuticals moves closer to making that fiction a reality.
“We are only a few short steps away from fully operational, ultra-small polymer particles capable of carrying drugs into the human body,” says Kate Dopplar, one of the top researchers at Argo. “The development of medical nanoparticles makes possible a precise feedback system that can safely regulate the release of drugs into the blood stream, which for many patients means better results and far fewer side effects.”
The research began as a project aimed at making pain relief safer for soldiers on the battlefield. Medics needed to balance the pain relief of morphine with a “counter-drug” that protected against accidental overdose. Achieving that equilibrium is a challenge outside of a hospital, and nearly impossible in combat situations.
The combination drug that Argo scientists have developed promises to make balanced treatment possible even in combat zones. “The system could also improve pain management for millions of patients with chronic illness,” says Dopplar. Argo is in the final stages of screening compounds in the search for a successful “pro-drug”, a drug that can release or become another drug. In the case of morphine, the desired counter is Naloxone, a drug now used to offset morphine’s side-effects. In laboratory tests using human plasma, Argo researchers have successfully employed the delivery method of one pro-drug that sensed blood oxygen levels and turned on or off as needed.
Chris Henry, an Argo spokesperson, has confirmed that the company is looking for other ways to use the same method in the marketplace. For now, the company is focusing on the treatment of depression and depression-related pain. Argo previously patented and tested the drug Serophim, which they hoped would be a giant leap forward in the treatment of these common conditions. But in clinical trials, a large number of patients experienced severe mood swings, increased aggression, listlessness, and an increase in addictive behaviors. “Now, with the possibility of reigning in those side effects through highly accurate dosing and the use of counter-balanced drugs, we have the opportunity to offer a truly effective treatment to patients around the world,” said Henry.
Researchers at Argo are currently proceeding with animal studies of the pro-drug’s effects using a nanoparticle platform technology previously developed at their lab. They hope to advance to more animal and eventually human studies in the very near future.
LOS ANGELES, CA – JUNE 6
It wasn’t until the building was empty that Josie nearly lost her nerve. Sitting in her car since clocking out four hours earlier had sapped the adrenaline from her system and left her feeling both edgy and exhausted. When she arrived at work that morning, she had circled the parking structure until she found a spot facing the building, anticipating the stake-out to come; from her front seat she watched the offices on the third floor – gene research, if she remembered correctly -- as colleagues she had probably never met moved in silhouette against the opaque windows, leaving in small groups until the lights finally went out. Vaguely, she wondered how much they really understood what they were working on.
She glanced at herself in the rearview mirror and wished for a moment that she could go back to the days when she left the office excited by the day’s progress, or frustrated by a problem she could discuss over pizza and beer with a few colleagues that night. For four days now, she had been looking over her shoulder, nervous and unable to enjoy a meal or sleep soundly. In retrospect, she probably should have anticipated the reaction she got at the meeting she had hastily arranged; instead, she had been caught completely off-guard.
“Ms. McCollum, you needed to speak with me?”
“Yes, sir. Thank you for taking the meeting. I wanted to discuss the Serophim research with you; I’m concerned with some of the findings—“
“Yes, I’ve been briefed.”
Sitting across from one of the senior researchers, she felt the full impact of the difference in their age and experience in his casual dismissal of her introduction. She reminded herself that her diploma said “M.I.T” on it as well, and continued.
“Then you’re aware that several of the animals are having reactions that indicate—“
“I’m aware that a few of the animals were improperly screened for cross-contaminants. They all came from the same lab previously, the same project, and we believe that the therapy they were conducting has interfered with the trial here.”
Josie frowned. The explanation was a stretch.
She continued. “Either way, their reactions render the findings inconclusive at best. We’ll have to start—“
“Impossible. Funding has been very specifically allotted for certain contingencies, and we are expected to meet deadlines. We will reference the issue in the report, and continue. The animals will be treated and sent to their next destination.”
“Dr. Rhodes, I can’t imagine this—“
He cut her off with a curt wave of his hand and leaned back in his chair.
“I’ve discussed it with the board, and that’s the conclusion we’ve reached.”
In response to her skeptical, mildly accusatory glare, he slowly removed his glasses and set them on his desk. When he raised his eyes to hers again, they were hard and flat.
“Josie, you’re a rising star here. Your colleagues respect you, your superiors enjoy working with you – you’ll be running trials in no time. I’d hate to see you make unnecessary sacrifices in your professional, perhaps even personal life, because of a screening error.”
He had not said much, but the veiled threat had reverberated through her like a shock wave. The next morning when she arrived at work, the normally friendly security guards had searched her bag more thoroughly than necessary, and her access key had “malfunctioned”, temporarily locking her out of the lab. The issue had been quickly resolved, but the message had also been sent. She was being monitored.
She glanced in the mirror one more time, tucking a loose strand of dark blonde hair back into her ponytail. The orange glow of the streetlights made her look sallow, her eyes bright and feverish. Six years at MIT had qualified her for life inside the lab; there, she could anticipate outcomes, explain behaviors and quantify successes. As she checked the batteries in the tiny video camera she had purchased the night before, she felt utterly unprepared to take the steps she was about to take.
At that moment, a white van pulled into the side-street that ran parallel to the Argo Pharmaceutical building and parked near the delivery bay door.
“Shit,” she breathed, and her moment of hesitation broke. She slid out of her car quickly and pressed the door shut, then took off at a jog toward the nearest stairwell. She had waited too long; maybe some part of her brain had wanted this to happen, for the cleanup team to arrive and save her from making the hard decision herself. But as she ran, she felt with certainty that she could not let this happen.
They would know she had been in the building; the second she swiped her key, her entrance would be logged. But she couldn’t smuggle the camera in past the daytime security crew, and without video, she would be unable to make her case. All her hopes hinged on Frank, the night guard, who stood as she entered the building’s front lobby, smiling.
“Hi Frank,” she said breathlessly. “Sorry about this.”
He returned her smile with a genuine one of his own, and hope swelled in her chest.
“How’s it going, darlin’,” he asked, reaching out for the security clearance card she offered him.
“Well, you’re not going to believe this,” she put on her best exasperated face and continued, “but my boyfriend proposed to me last night. He gave me this giant ring he can’t really afford – it’s incredible. Anyways, I had to take it off in the lab today, it’s so hard to get used to having on my hand, and I left it up there. I’m meeting him for dinner in twenty minutes, and he’s just going to freak out if I don’t have it on.”
She knew she had him when he sat back down in his chair, a knowing smile on his face.
“Well congratulations, you turkey,” he said warmly, a hint of scolding in his voice. “Go run and get it. I’d be upset too if I were him.”
Josie thanked him and jogged toward the elevator, hoping she could make it upstairs before the cleanup crew got checked in themselves.
She took the elevator to the fifth floor and stepped out into the quiet hallway. The fluorescent lights buzzed quietly, but she heard nothing else, so she strode down the hallway and pulled the video camera out of her bag, hitting the record button. As she rounded the last corner before the lab, the nerves in the pit of her stomach clenched into a tight ball and her teeth began to chatter. She was feet from the door when a voice called out to her.
“Hey you! Aren’t you done for the night?”
Horrified, she recognized Jeff Norton’s voice; he worked on the same floor in a different lab, and although their work seldom overlapped, she conversed with him from time to time in the employee lounge. She swallowed hard and lowered the camera to her side, hoping desperately he had not seen it in her hand. Smoothing out the tension on her face, she turned to look at him over her shoulder.
“Yeah, I just left something in the lab. Frank was nice enough to let me come get it.”
Jeff pulled a crooked grin and started back down the hall toward the elevators.
“Well, have a good night. See you back here bright and early!”
She waved at him as he went, the anxiety almost choking her. Stalling, she mumbled something about finding her key and fished through her purse until she heard the elevator ding. Then she lifted the camera again, unlocked the lab door, took a deep breath, and walked inside.
HALEIWA, HI – JULY 23
“Difficulty concentrating, fatigue, aches and pains, loss of interest, irritability, and anxiety,” Brandon repeated the symptoms under his breath. It had seemed fairly straightforward on WebMD, but sitting in the clinic waiting room with a clipboard in his hands, he felt less sure of himself. Everyone around him looked depressed: pallid skin, thin hair, dull eyes. He did his best to slacken his jaw and appear tired, but he knew there was no hiding his healthy tan and thick shock of dark hair. Before leaving his family’s home he had tossed on a ratty pair of jeans and a stained t-shirt in an attempt to look the part, but now it felt like a ridiculous costume. These people looked miserable effortlessly, and more important, authentically. Next to him sat a woman who might have been in her late 20’s, or her early 40’s. It was impossible to tell. Her blonde hair hung lank on either side of her face, and she sat slumped against the wall, massaging her right arm.
Brandon tried to gauge the ages of the other patients in the room, wondering if he was actually the youngest person to show up for the clinical trial. Someone who looked to be about his age sat across the room, hunched over his iPod; clad in a flannel shirt and cut-off khaki’s, he might have been in his early twenties. Everyone else looked older. He shifted uncomfortably in his chair, the faux leather cushion sticky against the backs of his legs.
Relax, he thought. Being nervous is the quickest way to get into trouble. He turned his attention to the room itself, which only added to the claustrophobic feeling of gloominess settling on his skin like fog. The white walls had a slight green tinge to them, and below the chair rail the textured wallpaper was beginning to curl at the edges. There were only two doors in the room: the front door, flanked by two small windows that looked out onto the parking lot, and a second door marked “Authorized Personnel Only: Please Turn Off Cell Phones”. He wasn’t sure where it led, since no one had come in or out of it yet. A television in the corner mumbled quietly about Argo Pharmaceuticals and their numerous medical breakthroughs over the past five years. Smiling faces, happy families, optimistic looking cancer patients flashed onscreen; it was an almost comical backdrop to the mood that hung heavily in the air.
Two weeks earlier, he had heard an advertisement for the clinical study on the radio while driving to a party with his brother Paul and few friends. Do you suffer from severe depression, and the physical pain associated with depression? Argo Pharmaceuticals is conducting a clinical trial for a new depression medication and drug delivery method and you may be eligible to participate. You may be eligible for up to $4,500 in compensation, as well as all treatment and checkups free of charge. Call 1-800-CBPHARMA for more information. They had all commented on the possibility of an easy $4,500; Brandon had quietly taken the number down and called the next day.
Technically, he wasn’t depressed. He was, however, in over his head with student loans and credit cards. Two months had passed since his graduation from college, and only four months remained before the first of his significant loan payments would come due. There was no chance of getting help from his father; the farm was struggling to stay afloat, as usual. And he hadn’t been nearly as successful finding a real job as he had expected. It seemed no one was impressed by his agricultural chemistry degree; one interviewer actually told him, “a Bachelor’s degree is the new high school diploma. Everyone has one.” He had even exhausted his resources through his college fraternity to no avail. So while he had hoped to stay on the mainland after graduation, he moved home to Oahu instead and started working for his father.
The pay was nothing near what he had planned on making while he was an honor student at Purdue. Balancing a heavy academic load and a decent social life had only left room for a part-time job at a sandwich shop, and he hadn’t managed to save up more than a few hundred dollars. Any concern he felt about his ever increasing debt had been shrugged off with the thought of instantaneous employment after graduation by a super-farm on the mainland, which had proven to be not-so-instantaneous. His dad contributed to his savings account when he could and paid him a salary for his work on their small farm, but $4,500 would go a long way toward getting him through the end of the year. He was still sending out resumes to companies on the mainland, telling himself that he would find employment before too long. Until then, he just needed a little cushion, and it seemed that an opportunity had presented itself.
Then again, there was always the possibility he was actually depressed. A brief internet search had turned up statistics like “1 in 4 adults suffer from depression”, along with checklists and suggestions from pharmaceutical companies on how to seek treatment. All in all, the condition seemed pretty common, and he certainly exhibited several of the symptoms, most notably anxiety. The family doctor had given him the referral he needed, so he signed up for the study after giving what he considered a convincing performance on the phone to a screener.
The clinic that Argo rented was located on the windy side of the island, far enough away from his home that he felt comfortable leaving his family out of the loop. Knowing he was acting as a human guinea pig would only make his father feel guilty. So he had borrowed the truck under the pretense of a date, and made the drive across the island.
Now, sitting in the waiting room, he wondered if he really had any shot in hell of fooling the researchers. Just as he finished the last of his paperwork, the front door opened and in walked Boomer, one of Paul’s friends who had heard the advertisement as well. He caught Brandon’s eye, giving him a quick look then moving on. He shuffled into the waiting room and headed for a seat on the opposite wall. Inwardly, Brandon felt a twinge of irritation at Boomer’s arrival. Somehow it seemed to make his chances of getting into the study less likely. He assumed the look had meant they should avoid acknowledging one another, and he agreed, so he stood casually and returned his clipboard to the young woman behind the desk at the front of the room.
“Great, thanks,” she said, taking it from him. “Someone will be right out to take you back for a briefing.”
Brandon nodded. He was heading back to his chair and pointedly ignoring Boomer when the “Authorized Personnel” door swung open and a middle-aged man stepped through. He had shaggy grey hair and huge, thick, tortoise shell glasses resting on the bridge of his substantial nose. As the man surveyed the room, Brandon had the strange feeling he was being categorized. After noisily clearing his throat, the man introduced himself to everyone as Dr. Marvin Rhodes.
“I’m going to be taking you back one at a time to get briefed, sign some paperwork, and after that we’ll be administering the first dose.” Glancing down at his clipboard, he said, “Brandon Kavida?” Brandon stood and waved an awkward hello as he headed for the “Authorized Personnel” door where Dr. Rhodes waited for him.
“Hello Brandon,” said the doctor. “Thanks for coming in today.”
Brandon smiled and nodded, trying not to stare at the right side of Dr. Rhodes’ face. His right earlobe looked as if it had been torn off and healed badly; the jagged scar running along the edge of his ear and a few inches down his jaw line was an angry, swollen purple.
Dr. Rhodes smiled thinly as he shut the door behind them and led the way down the hall.
“Still healing up,” he said. “I had a small accident a few months ago.” He looked over his shoulder at Brandon, who walked a step behind.
“Oh. That sucks,” Brandon replied. The doctor shrugged and led him down a narrow, badly lit corridor.
“Here we go,” he said, opening an unmarked door. Brandon stepped into the tiny room and hoisted himself onto the exam table.
From the doorway, Dr. Rhodes said, “All right, if you’ll just wait here I’ll send Andrea along to talk to you and take some samples.” He shut the door before Brandon had a chance to respond in any way.
He found himself inexplicably disappointed by the state of the exam room. A rolling chair sat in the middle of the room, and behind it the wall was lined with the counter-top, sink, and cabinets he associated with a standard doctor’s office. An old television was mounted to the wall directly across from him. To his right, gossip rags were strewn across a small end table, along with a tissue box and a few remote controls. He considered trying to turn the TV on, then cocked his head to the side and read a few of the tabloid headlines instead. Only a few minutes passed before he heard a sharp knock at the door, and a nurse entered pushing a metal cart laid out with two rows of gleaming instruments and cotton swabs. She didn’t look much older than him, with her dark hair pulled back into a ponytail and a chubby face that implied more fast food than home cooking in her life.
“Hi Brandon,” she said cheerfully, letting the door swing closed behind her. He caught a glimpse of one of the other patients from the waiting room following Dr. Rhodes down the hall just before the door clicked shut. The nurse he assumed was Andrea headed for the TV and opened one of the cabinet doors on the stand to reveal a DVD player.
“I’m going to put in this DVD for you to watch while I take a few samples, okay?” she said. Brandon bristled slightly at her tone. Any second now she’s going to offer me a SpongeBob Band-Aid and a lollipop, he thought. In an effort to maintain appearances, he nodded slowly, doing his best to look listless.
“So, your chart says you reported some anxiety, irritability, and some fatigue to your family practitioner,” she said as she wheeled the cart toward him.
“Yeah, and I have trouble concentrating. I’m tired all the time. Lots of aches, too. I just don’t feel like doing anything,” he mumbled. In the back of his mind, he hoped he wasn’t over doing it.
“Well, those are all classic symptoms of depression,” she said briskly. “Have you ever been treated for depression before?” She was making notes on her clipboard as they spoke.
Brandon shook his head. “No. No, I guess I just thought I’d snap out of it.”
“Well, I’m glad you decided to try some treatment,” she replied, picking up the DVD remote from the end table next to him. The television came on with a friendly beep, and Brandon saw the Argo Pharmaceuticals logo spinning slowly over a DVD menu.
“I’m going to have you watch this brief introduction to the project. You okay with needles?” she asked.
He shrugged. No one’s really okay with needles, he wanted to say, but instead remarked, “I guess so.”
The nurse smiled again. “Good. I have to take a blood sample first,” she said, and set about getting things ready.
Brandon turned his attention to the video as it played. A friendly-faced woman appeared on the screen and greeted him, then quickly launched into an explanation of Argo and the current clinical trial. He found that he understood very little. The screen changed to show researchers bent over samples, charts demonstrating the effect of a drug called Serophim, computer animated graphics of a blood stream; all while the friendly-faced woman talked about polymer particles and “a revolutionary new drug delivery method”.
The nurse inserted the needle and he flinched, sucking in air. She murmured an apology as she collected three test-tube sized samples of his blood. The friendly-faced woman on the screen was explaining a double-blind research method when the nurse asked him to open his mouth so she could swab his cheeks. By the time the two women were done with him, he was ready to go home.
“So,” the nurse said as she labeled her samples, “I’m going to take you to the back and they’ll give you the first dose. Like the DVD said, you have to come back in thirty days for your second dose, and report any side effects you experience. Especially anything personality related, okay?”
Brandon frowned. “Isn’t an anti-depressant supposed to affect my personality?”
She chuckled. “Well, like the DVD said, if you have anynegative mood swings or things like that.” Then she opened the door and motioned for him to follow.
They walked further down the hall to a door marked “LAB”. Once inside, Andrea left him with a youngish man in a white coat sitting on a tall rolling chair in the center of the room. A row of small nasal spray canisters sat on the counter next to him, perfectly white except for a label too small for Brandon to read.
Rather than introducing himself, the researcher handed Brandon several forms to sign, saying, “Okay, this drug is administered via a nasal spray. Have you ever done this before?”
Brandon told him he had not, and the researcher gave him the first helpful explanation he had received.
“First I’m going to have you blow your nose.”
He obliged, feeling self-conscious and childish as he took a tissue from the box the lab tech offered.
“Okay, now take this,” the young man said, handing Brandon one of the bottles. “Tilt your head forward and plug up your right nostril. Now start breathing in, and squirt one spray in your left nostril.”
Brandon did as he was told, bracing himself in anticipation of the new sensation. He sprayed the drug, flinching as the liquid shot up his nostril. Whatever was in it was freezing cold, and felt like alcohol evaporating on his skin.
“Both nostrils,” the young man reminded him.
He repeated the process with his right nostril and tossed the canister into the bin the young man held out. A twinge of nerves ran through him when he saw the word BIOHAZARD in small red letters on its side, but then he reminded himself that was standard on most waste receptacles at a doctor’s office.
Ten minutes later, Brandon walked out of the clinic into the waning afternoon light. He took a deep breath of the soft Hawaiian air, catching a whiff of plumeria and the gritty scent of wet soil from the hills behind him. He smiled. While he had loved being on the mainland for college and intended to return once he got a job, he would always love the way the air smelled at home.
He plopped down into the driver’s seat of the truck and let out a long breath. He had made it through the first steps of the trial, and no one seemed to suspect him in the slightest. A cheerful girl in blue scrubs and a white lab coat in the waiting room had assured him that his $4500 would be paid out in halves, one at each check-up. He rubbed his nose as he started up the truck. The unpleasant sensation had only lasted a second after he had sprayed the drug, and then he had been asked a few questions and turned loose.
He shrugged to himself as he pulled out of the parking lot and thought, “That was easy.”
HONOLULU, HI – OCTOBER 16
It had taken Miles three hours of panhandling in Waikiki to gather enough money for his next hit. Three hours standing beneath the giant banyan tree near the entrance of the International Market Place, asking tourists for bus fare to meet his family at Waimea Bay. He was always more successful with those tourists who were leaving, newly-hatched-pearl jewelry in hand, their eyes glazed over with the fever of money spending. The outrageous prices they paid for imitation ukuleles and sarongs made it that much easier for them to dole out their last bits of cash to a young father who had stupidly locked his wallet in his hotel room.
He smiled to himself, thinking how shocked those same tourists would be if they took a short bus-ride out of Waikiki and inland. The huge manicured palm trees disappeared from sight almost immediately. Out in Trent’s neighborhood where Miles usually scored, shabby houses and rusted-out cars replaced the perfectly-aged architecture of the Waikiki hotels and the sleek rentals that lined the streets.
Now, inside his dealer’s house, Miles chewed on a hangnail, shifting his weight slightly while Trent dug out the right sized bag. The air in the room smelled dark, tinged with cigarette smoke and chemicals. The muted television was the only light source in the room. Flickering colors bounced off the foil-covered windows, making Miles feel as though someone were standing behind him, moving in and out of the light too quickly to really be seen. He glanced over his shoulder briefly, making sure they were still the only two in the room.
Trent turned on the desk lamp so that it shone into the open drawer; sweet-scented smoke curled around the bulb, moving like ink in water. He finally plucked out a baggie and held it up, fingers pinching the ends of the cellophane. Miles held out his hand, noticing briefly that he had ripped the hangnail and started to bleed. He shoved the baggie in his pocket and stuck his thumb in his mouth again.
“Thanks man,” he muttered around the digit.
Trent just jerked his head and returned to flop down on the sagging plaid couch. Miles wasn’t sure if the motion was a response or an indication to get out. He stuck a cigarette between his lips and lit it slowly, waiting for more direct instructions from Trent. After a moment, he took a few steps back, then turned and walked down the short hallway to the front door.
He squinted and lowered his head as he opened the door into the setting sun. Trent’s house sat at the top of a gently sloping street that faced directly west, and the rain that had been falling when Miles arrived left a sheen on the street. The wet asphalt shot sharp gold shards of light into his eyes, and he blinked rapidly a few times to clear his vision. He pulled the moisture-laden air through his cigarette, down into his lungs and held it there, feeling the heat and ache of the smoke settle deeply into his chest.
For a minute he concentrated on the feeling of his pupils contracting, squeezing against the stabbing sunset. He was trying to place the feeling with another memory when he was distracted by frantic motion on the driveway. Miles blinked to clear his vision, and saw that a figure lay twitching on the ground, silhouetted by the sun. It was difficult to tell, but he thought he saw foam on the figure’s lips and chin; he heard swallowed cries, as if the figure’s throat had closed around his voice.
Without looking away, Miles called over his shoulder, “Hey Trent, you got somebody tweaking on your driveway.”
There was no response from inside the house. Miles took a step forward onto the sparse lawn. Down the street, the sunlight flickered like the television, as if a shadow had passed in front of it. The movement of the light only registered in Miles’ peripheral vision, and once again he was struck by the feeling that someone was moving behind him. On the driveway, the tweaker convulsed again, thrashing this time, and let out a long gargled wail through clenched teeth. Miles’ flicked his cigarette away.
“Hey man, you need an ambulance, or what?” Trent would not be happy to have sirens pull up at his house, but he’d be even less thrilled if they were attached to a police cruiser.
A trash can fell off a curb a few houses down, and Miles jumped at the sound. His eyes flicked up for a moment, then returned to the tweaker. Another long shadow flitted across the shining road, but Miles was too engrossed with the man on the driveway to notice. He had never seen an overdose quite like this before; he was rooted to the spot, morbidly fascinated. Suddenly the movements changed, became more violent, and the tweaker threw his head back and let out a choked scream.
At that moment, Miles knew what was meant by the term “bloodcurdling”.
And then a sudden, brutal impact hurled him to the ground, knocking the wind out of his lungs. He tried to shout, struggling against his attacker and wondering briefly if Trent had let his dogs loose. There was a snarling in his ear, and then teeth sank into the flesh at the nape of his neck. The pain was unlike anything he had ever felt. It exploded, like a fireball, and ran in shuddering torrential waves down his shoulder and over his scalp. Under the razor sharp agony he felt the crushing, choking pressure of the teeth as they sunk deeper into his flesh. A gulp of air reached his lungs, and Miles screamed like an animal caught in a trap. Desperately, he swung an elbow up, trying feebly to knock away whatever had him pinned. He connected with soft flesh, and heard a grunt. Between waves of panic and pain he realized, horrified, that his attacker was human. Before he had a chance to move or react, two fists grabbed clumps of his hair and slammed his forehead into the pavement. White, searing pain exploded behind his eyes, and he let out a weak, terrified shout for help. But in the back of his mind he knew the people who lived in this neighborhood kept their shades, and mouths, shut.
I’m going to die. The thought rang through the agony like a bell.
With a desperate surge of energy, Miles bucked hard and managed to toss his attacker to the pavement. Shaking with adrenaline and shock, he pushed himself onto his hands and knees, scrambling for Trent’s front door. It was like a nightmare. Panic left him sobbing and unable to cry out. He could barely move, and all around him he saw smears of his own blood. A snarl rose up from the driveway behind him, and he looked to see his attacker regain his footing. Miles had expected some huge, hulking PCP addict. Instead, he saw a middle-aged man with thick grey hair, wearing what had probably been a white lab coat. It was now covered in dirt, and a large dark spot spread across the crotch of his pants. Shoving away his confusion, Miles continued his panicked scramble toward the door. The attacker bared his teeth and jabbered at Miles as he advanced. A small detached part of Miles’ brain saw that the attacker was missing most of his right ear and wondered if that meant he wasn’t the madman’s first victim.
Miles jerked his head at the sound of another gurgling cry. Behind them on the driveway, the tweaker he had so quickly forgotten was struggling to follow. He too was shouting incoherently, working his jaw from side to side as he clambered across the pavement, swiping at Miles’ feet. He couldn’t form any coherent thoughts through the pain; the last of his strength drained out of him as he realized that he would not make it to Trent’s door.
The last thing he saw clearly was the attacker lunge forward, mouth gaping. The force of his assault slammed Miles’ head into the pavement again. His vision shrank to the size of pinholes. As the day darkened around him, he felt his skin tearing away, the pain reaching him slowly as if from a great distance. He was conscious much longer than he wanted to be.