After the Fall

by Patricia Gussin

  “Please, Jake, we don’t have much time. We have to make a decision. Today. Now.”

  “What’s wrong, Addie?”

  She all but pushed him into the living room.

  He nudged her briefcase aside so they could sit next to each other on the sofa.

  “Let me explain, then we need to decide.”

  “Okay.” He turned toward her, taking both her hands in his. “Tell me.”

  “Orders from my father to return to Iraq. I leave on Friday. We have only two full days. Tomorrow and Thursday.”

  “He can’t just force you to go,” Jake blurted.

  “Yes, he can. I must go. Do not waste our time discussing that. I will go. No questions.”

  “I won’t let you,” Jake stated.

  “This is America. You can’t stop me,” she said. “If this were my country…but here’s the thing.”

  Jake squeezed her hands tighter. “No!”

  “Listen to me. What if we were to get married? Now. I mean, not today. But Thursday. Get our license today. I worked it all out, looked up courthouses. If we leave now, we can be in Ellicott City in an hour. There’s a courthouse there—Howard County Orphans’ Court—that specializes in marriage licenses. Nobody will know us. It’s far enough away from Rockville and all the recent publicity about your wife.” She jerked her hands out from under Jake’s, pulled a sheet of paper from her shirt pocket. “Here’s the address.” She stuffed the paper into Jake’s hands.

  Jake glanced at it as she went on, “Important thing is that we have forty-eight hours. Say we can make it there by four o’clock, we get the license.” Addie took Jake’s face in both of her hands. “We could be married on Thursday. When I go home, I’ll be your wife.”

  That’s why she wanted Karolee’s death certificate. Did what she was saying make any sense? Jake sat stunned, unable to process this. Yes, they’d be married, but she’d be in goddamned Iraq. A marriage two weeks after Karolee’s death would condemn him in the eyes of the public and perhaps the law—but without proof, so what?

  “And here’s what I was thinking,” Addie said, jumping up, grabbing her purse. “Make sure you have your driver’s license.” She reached inside her wallet and pulled hers out. “Come on, I’ll tell you in the car. About how I’ll get a leave of absence, so I can still get the money when Immunone gets approved.”

  So, she had a scheme that did involve $7.5 million. And as her husband—

  “Come on, Jake. Do you think I picked the right courthouse?”

  Jake nodded, stood, and extracted the keys to his Jeep.

  “Addie,” he said, “I’ll do anything for you.” And he would. And he had. And it had not been about the money, he reminded himself. But $7.5 million didn’t hurt. His job? Who cared anymore? Immunone’s approval schedule and all his manipulation, had that been all for nothing? It didn’t pay to think about that right now. Concentrate on getting to the courthouse before those lazy county bureaucrats close up shop for the day.

  CHAPTER THIRTY-EIGHT

  TUESDAY, MARCH 3

  Tim’s operating room team at CHOP was ready, the room set up, blood ready for transfusion, Gore-Tex patches on hand, the works. Two-month-old Malika Halabi had arrived yesterday from Riyadh, Saudi Arabia. The pediatric cardiac surgeons there had refused to operate. The little girl was born with tetralogy of Fallot, a congenital heart disease involving four heart malformations: a ventricular septal defect, an overriding aorta, right ventricular hypertrophy, and pulmonary stenosis. The father, a member of the royal family, insisted Malika be transferred to CHOP—the trusted surgical site for children of Saudi royalty.

  Tim had met the baby and her parents on the rooftop helipad at their arrival from Riyadh via New York City’s JFK airport. Cyanotic, edematous, struggling for each breath, the cardiologists needed the night to stabilize her for what would be emergency surgery as the morning’s first case, but the child literally died on her way to the OR. Tim knew the chances of the baby making it through the long and difficult surgery with such large defects at this late stage had been next to none, but when it came to children, he never gave up. Never.

  Watching children so ill and trying to quell the devastation of parents of the kids who didn’t make it—like Malika’s—so drained Tim that he’d never even contemplated being a parent himself. Exposure to such depths of agony was torture he could not accept. The closest he’d ever come to caring about kids of his own had been with Laura’s. He’d lived through health crises with two of them: Patrick, when he’d had major cardiac surgery at CHOP as a nine-year-old; Natalie, when she’d caught a drug-resistant bacteria during a bioterrorism attack in Tampa. Each time, he’d been scared beyond imagination, and he’d felt so inadequate.

  After the news came down about baby Malika, the surgical team had gone off to commiserate over coffee. Tim had excused himself, his emotions still too raw, needing the solitude of his office. He needed to process the baby’s death in the context of his new life. Yes, he’d avoided parenthood, but what about grandchildren? Wouldn’t he be a grandparent to Laura’s kids’ children? Would he be able to handle…this? What if…?

  Stop it, Tim. With Laura, you can get through anything.

  Laura had a bad night last night. Was it her hand or something else? To the disbelief of her hand surgeon, she was only taking Motrin for it now. He hoped she was faithful to her physical therapy. The therapist went to Keystone for the sessions. Made it easy for her but harder for him to monitor. He felt so protective of Laura; always had, even back when she was in med school, but his protective instinct had skyrocketed in the weeks since her devastating fall on black ice.

  The crisis with Patrick consumed her, he knew. The story about David Monroe—Patrick’s father—thoroughly perplexed him. Tim remembered Doctor Monroe as the God of Surgery in Detroit. The house staff all but bowed to him. Laura and Doctor Monroe? Tim could not wrap his head around that. But each time he looked at Patrick now, he saw Detroit City Hospital’s revered chief of surgery. Paradoxical that Patrick never was interested in medicine; nor were Mike and Kevin. Laura’s daughters would be the next generation of doctors in the Nelson family.

  Tim hoped Mike’s call this morning would push Laura to set things straight with the other kids. He’d observed Patrick closely during Laura’s disclosure. Yes, her son had been upset, but he hadn’t exploded in hateful anger. Laura needed to reach out to him. Should he urge her to, or just stay in the background, ready to pick up any pieces? Laura had so much on her mind now with the injury, the new job, and that incredible business about Keystone Pharma withholding key data.

  Just as Tim reminded himself that he couldn’t spend all day hiding out in his office, the intercom buzzed.

  “Dr. Nelson on your line,” the secretary announced.

  “Laura, guess who I was just thinking about?”

  “Tim, you’re in your office. I called to give you a message, knowing you had that tetralogy surgery.”

  “The baby didn’t make it,” he said. “Didn’t make it to the OR.”

  “Oh, Tim, I’m so sorry. Are you okay?” One night he’d confided his dips into despondency whenever he lost a child.

  “I’ll be okay. Feel shitty right now. The case was going to take all day. I think I’ll make early rounds and come home mid-afternoon.”

  “What I was going to tell you was that I need to fly to Tampa later this afternoon to retrieve that Immunone data.”

  Tim didn’t care if Laura could detect the note of disappointment in his voice. “If you can’t avoid it, babe, but your hand! Are you supposed to travel?”

  “Company plane. None of that airport security. I’ll—”

  “Laura,” he interrupted, “I’ll miss you tonight. I can’t believe how much I need you—”

  “Quick turnaround,” she said brightly.

  “Laura, that’s too stressful. You are pushing too hard.”

  “I only need a couple of hours on the ground. To collect the documents I need. My sec
retary will have them ready.”

  “Stay overnight, Laura. I’ll miss you, but—”

  “I want those reports in the FDA’s hands tomorrow. Mel and Louis will meet me at the airport tonight, take the documents. Their teams will work all night to collate them with their in-house documents and have them ready for submission in the morning. Lots of folks at Keystone aren’t happy with me for keeping them up all night, but that’s tough—as we surgeons well know.”

  “Bet they’ve never dealt with a whirlwind like Dr. Laura.”

  “Seriously, Tim, don’t wait up. I’ll just crawl in bed beside you.”

  “Be safe, Laura. I know my limits. I can’t dissuade you from this…madness.”

  “Oh, in this damn Keystone maelstrom, I almost forgot to tell you. I talked to Patrick. Caught him between classes.”

  Tim took a deep breath. So much of Laura’s happiness pivoted on her youngest son’s response.

  “He was polite, Tim, even pleasant. I got up the nerve to suggest that family pow-wow—to talk about, you know, this weekend. And whew—he said okay. Just like that.”

  “I do think he wants to clear the air.”

  “Do you think they will forgive me? All five of them?”

  Tim caught Laura’s tone change to dejection. He had wondered the same thing. If he had to predict, the girls would have a harder time than the boys. But how to know?

  “Dear God, I want this to be done,” she said. “And, Tim, thanks for being there for me, again.”

  “I love you, Laura. I’ll always be here for you. Count on it.”

  After Laura hung up, Tim drew a large heart on his desk pad. Inside he inscribed: “Laura + Tim.” Yep, just like a teenager.

  CHAPTER THIRTY-NINE

  TUESDAY, MARCH 3

  Howard County Orphans’ Court in Ellicott City, Maryland. Marriage license applicants: fill out a white form, stand in line E, have your documents ready. Eleven couples in front of Jake and Addie. The clock was ticking. Now 3:45. The court closed at 4:30. “Do you think we’ll make it to the front in time?” Addie whispered in Jake’s ear.

  Addie’s mind had been reeling with thoughts of her future in Baghdad. Would she ever be able to get out? To join her husband? Would he take proper care of her money, or would he steal it, find a new woman, and disappear into a life of Western opulence?

  She could imagine his thoughts. Paranoid by nature, he’d be worrying about what the FDA officials would say about their marriage. And he certainly seemed much too concerned about what the police would do to him when they found out he’d married so soon after Karolee’s death. They would find out, wouldn’t they? She wanted to ask, but not now. During the ride to the courthouse, Jake had seemed on edge, shaken; not the public image she knew, the confident government official.

  “Yes.” Jake’s single word response came out like a hiss. Addie looked around. All the couples in front of them looked star-struck happy. Except one who seemed to stare at each other in open hostility. At least she and Jake did not repulse each other. Addie thought of her fate should she not marry Jake. When she returned to Iraq, her mother would fly into a frenzy to schedule a marriage. Or did her parents already have a husband in mind? Addie would have no say. None. That’s why she and Jake had to get this license now. Today.

  “Jake,” she said, tugging at his arm. “Are you okay? I know this is sudden.”

  “Yes, Addie,” he pulled her to him. “I want to marry you. I can’t live my life without you. That’s why…” he stopped. Addie turned to look at his face, her heart breaking when she saw a lone tear. He really loves me. I will be safe with him.

  “Then smile,” she said, leaning in to kiss him chastely on the cheek. “Be happy, my wonderful Jake.”

  There were three couples ahead of them and two behind. Someone had blocked the end of the line with a chain. “Should we schedule the marriage while we’re here? Would it be good to get married here?” Addie asked, sniffing the stale air. “Or could we go somewhere else? A more romantic someplace?”

  “We have to wait forty-eight hours. I think we could find a nicer place, but Addie, we have almost no time. Once we are married, you said you had to leave, that going to Iraq to see your father was nonnegotiable.” Jake pulled her in tighter to his body. “We’ll only have one night before—”

  “Don’t think about that. As soon as I see my parents, I’ll tell them about us. They’ll be happy for me,” she said. Addie knew they would not. There would be hell to pay for her and maybe her parents too. The punishment for marrying an infidel varied according to officials’ moods. Perhaps, if her father needed her for important research, the regime would go easy on her. They may even honor her Western marriage and allow her to return once whatever mission they had for her was accomplished. But what would be the state of the world with all the talk of nuclear, chemical, and biological welfare?

  The clock ticked, the queue moved, and Addie and Jake walked out with a Maryland marriage license.

  CHAPTER FORTY

  TUESDAY, MARCH 3

  The FDA was requesting from Keystone Pharma documentation on the thirteen patients in the clinical trials who had died. Four on Immunone; nine on placebo. Laura, as lead investigator for the trials, had her own simplified records system. She had every record on every patient, and she could access them. Not only in computer databases but in hard copy. She had every scrap of data on each patient death, had pored through each case, had documented that the drug had not contributed to any of the deaths.

  But after meeting with her staff about the alleged missing information at the FDA, Laura was less than confident that by tomorrow morning they could find all the needed documents. Apparently, Keystone’s files were stored in different places, in different formats, under different protocols.

  Prior to the Advisory Committee Meeting, she’d had an extended teleconference with the two Immunone medical reviewers, FDA Doctors Ridley and Hayes. The clinical trials had convinced the FDA reviewers that Immunone was lifesaving. Even though twice as many patients in the trial took Immunone versus placebo, the Immunone patients had less than half the number of total deaths. And an efficacy rate of 90 percent rejection-free on Immunone, versus 60 percent on placebo. Clinical data, they agreed, does not get any better than that.

  Rather than hope the Keystone staff would locate their records in time, Laura would go to Tampa, get her records, load them on the plane, and personally deliver them to the FDA head of drug approvals tomorrow. No more dealing with Jake Harter. The bureaucratic wimp, whining about being unable to find documentation of blood electrolyte levels and QT intervals on the electrocardiograms. Ridiculous. She knew right where they all were in her old office, which her former secretary had assured her still was unoccupied, intact.

  An ulterior and opportunistic motive competed for Laura’s attention as she set up a meeting with Ed Plant, now the senior pulmonary surgeon in Tampa. Whether the administration would make him chief of surgery was doubtful, but hierarchical medical politics were no longer her problem. Her intent: secure Lonnie Greenwood’s son the top spot on the lung transplant list. But would this be the first of unending demands from someone who could unravel the fabric of her life? He’d sounded pleasant, articulate, a caring father, but… But, she had to get on with her day.

  The company plane was reserved, set to fly Laura to Tampa, but she’d have to skip her hand rehab. The throbbing pain had diminished to a low growl, except when put through the excruciating exercises devised by physical therapy. For these sessions, she only took Motrin, and even they were getting more bearable.

  She’d been packing up her briefcase with her good hand when her secretary buzzed. “Driver’s waiting to take you to the airport, Dr. Nelson, but there’s a Philadelphia detective to see you. I told him you’re on your way out of town. But he insists; says he’ll be quick.” In a whisper she added, “I think it’s about Dr. Minn.”

  “Okay, then,” Laura said, “as long as he’s already here.”

&nbs
p; The door to her office opened and a middle-aged man in a rumpled flannel suit and an old-fashioned hat strode inside. “I’m already here,” he said, taking off the hat, revealing a perfectly round bald spot. “Thank you, Dr. Nelson. Detective Simon Smith. I just have a couple of questions. Mind if I sit down?”

  “Sure,” Laura said, snapping shut her briefcase, ready to go whenever Detective Smith finished.

  “I’ll come right to the point. Your predecessor, Dr. Minn. Could you go over step-by-step what happened the night he was killed? We know you were the last to see him alive.”

  Laura felt a surge of guilt. Fred Minn had been so kind to her throughout her work on the clinical trials, and then he’d guided her through her prep for the FDA presentation. On that last night, he had tried hard to recruit her as his successor. How could anyone have foreseen what catastrophes finally would result in her sitting in his chair? She had been so focused on the pain of losing her profession, the physical pain, and now the challenges of a complex new job—his old job. The hit-and-run had slipped to the back of her mind.

  “Almost three weeks,” the detective was saying, “and we’re no closer to finding the vehicle that struck him. My partner and I tried to interview you the day after he was struck down.”

  Struck down. She thought he’d say something in cop-speak like vehicular homicide.

  “Thought you’d returned to Tampa…and then, well, we learned about the accident.” Smith nodded toward her arm, in the sling-like device that kept the hand at the level of her heart to prevent edema. “And we never followed up.”

  “If I thought I could be helpful, I’d have called,” Laura said, hoping this interview would be brief. She had a plane to catch. But she realized with a smug sensation, this plane would wait on her.

  “Could you review the evening for me?” Smith requested, his tone respectful. “Everything from your arrival in the dining room until when you left Dr. Minn by taxi right outside the hotel?”

  “Yes,” Laura confirmed. “I asked him if he’d like to share the cab. He said ‘no,’ he only had a block to go.” Laura glanced at her injured hand. “Now I know I should have insisted.”