Miracle Cure

by Michael Palmer

  Jack pushed his hand through the side rail of the gurney, and Phil took it.

  “Your memory’s absolutely amazing,” Phil said. “Dad’s still got the restaurant, and Joanne is still the pretty, dark-haired wife … but alas, not mine.”

  “Brian’s divorced, too,” Jack said, making no attempt to mask his dismay.

  “No more Phoebe?” Phil cocked an eyebrow.

  “Separated two years ago. Officially divorced a little over a year ago,” Brian said, feeling his elation start to fade. “We have two little girls.”

  “Doesn’t sound like you’re too happy about it.”

  Brian shrugged. “The breakup certainly wasn’t my idea, if that’s what you mean. Phoebe married me expecting little doc on the prairie, and she ended up with little doc in the rehab.”

  Phil laughed ruefully.

  “Joanne got big doc in the hospital—all the time. Especially since I landed here three years ago.”

  “Kids?”

  “Maybe next time. But enough about me. Mr. Holbrook, do you know what your son just did? In those few minutes while you were snoozing away, he plucked an incredibly obscure diagnosis out of thin air and saved a sweet little old lady’s life.”

  “That’s nice,” Jack said, with no enthusiasm.

  He rolled over and faced the wall.

  Phil looked over at Brian, who could only shake his head. He should never have mentioned rehab. Jack was tough as nails in most areas, but not that one.

  “Later,” he mouthed.

  Phil nodded sympathetically. He was a doctor. He had a father. He knew about the pressure of expectations.

  “Well,” Phil said, clearing his throat for transition, “as you can tell, the news from next door is good. Real good. Endocrine is with her now. He totally agrees with the diagnosis and treatment. The thyroid-storm buzz has already started zipping throughout the hospital. This place absolutely lives for cases like this one. And there I was, right in the middle of it, and I missed it.”

  “You were too close. You had to worry about keeping her alive.”

  “You always were kind.”

  “It’s the truth.”

  Brian was interrupted by his father, who answered the question about his wakefulness with an Olympian snore.

  “You used to sound just like that in the on-call room,” Gianatasio said. “I had no idea it was genetic.”

  “Phil, tell me about this Vasclear.”

  Gianatasio’s expression became intense.

  “It’s the real deal, Brian. The closest thing medical science has come up with to a fountain of youth.”

  “What is it?”

  “Part phospholipid, part enzyme. Originally taken from a tree bark this guy Art Weber found in South America. Now it’s been synthesized by the chemists over at Newbury Pharmaceuticals on the south side of the city. Brian, it unplugs arteries.”

  “For real?”

  “The before-and-after arteriograms are stunning.”

  “What’s the downside?”

  Gianatasio shook his head.

  “I know this is hard to believe, but Boston Heart is just nearing the end of tightly controlled, double-blind Phase Two clinical trials, and so far, there is no downside.”

  Brian sensed his pulse quicken. He was like an oncologist suddenly hearing of a universal cure for cancer with none of the side effects of conventional chemotherapy. Despite Jack’s sonorous breathing, he lowered his voice to an urgent whisper.

  “Phil, how can I get my father put on it?”

  “I’m not sure. Who’s his doctor?”

  “He hasn’t got one yet. The resident was phoning the guy on call after you.”

  “Oh, God, no. Bart Rutstein takes private patients only because he can’t get enough research money to keep his gene-splicing lab going and feed his five kids. I’ll take care of your dad if you want. But I have a better idea. Carolyn Jessup is the clinical director of the Vasclear program. She has a huge private practice, and a lot of her patients are in the study. We should see if we can get her to accept your dad as a patient.”

  “Carolyn Jessup! Getting her to take care of Pop under any circumstances would be great. I took her cardiac-cath course a couple of years ago. It was the best one of its kind I’ve ever been to.”

  Brian flashed on the tall, elegantly dressed woman of fifty or so, striding confidently across the stage of the lecture hall before 150 cardiologists from all over the world—a consummate teacher and clinician, still graced with the cool good looks of a high-fashion model.

  “That course fills up the day it’s announced,” Phil said. “For good reason. Jessup’s a bit on the distant side, she can be a little intimidating at times, but she’s a really fine doc. When I came here, they were searching for a new chief of the institute. Everyone thought she was a shoo-in for the job. I still don’t know why she didn’t get it. Maybe her manner—she can be pretty aloof—maybe her gender, maybe she’s not political enough. Goodness knows she’s published enough.”

  “Ernest Pickard got the job, right?”

  “From the NIH. Exactly.”

  “Well, he’s no small fish, himself.”

  “Hardly. And he’s actually done a great job with this place. It’s to both their credit that there’s been no acrimony between them since he took over. And you know the hospital grapevine as well as I do. If there’d been so much as a sideways glance from one at the other, someone would have picked up on it and started the drums beating.”

  “Could you call her?” Brian asked.

  “I could and I will. If she’s not around this evening, she’ll surely be in tomorrow. However, I ought to explain that although I am up for tenure, and she certainly knows who I am, I’m still a few dozen rungs below her on the academic ladder.”

  “Hey, tenure at the world’s greatest medical school and Boston Heart! God, Phil, that’s great. I’m really proud of you.”

  There was a moment of awkward silence.

  “Brian, I wasn’t shoving that tenure business in your face,” Phil said finally. “I hope you know that.”

  “Believe me,” Brian replied, “if I know nothing else, I know that. Besides, I had my chances and made my choices just like you did. I maybe could have gotten help sooner, but I never thought there was anything wrong, or at least anything I couldn’t handle. I don’t ever want you or anyone else walking on eggshells around me because of what’s happened. For as long as I can remember, I was leading my life in fast-forward, like one of those space rockets that has to go a certain speed to break free of the earth’s gravity. Now, I’ve gotten to see that the trick for me is learning how to achieve breakthroughs in my life by going slower. I’m still not very good at it—my lowest gear is still higher than most people’s highest—but I’m getting better.”

  “I can tell,” Phil said. “I can see it in your eyes. Listen, about Vasclear.”

  “Yes?”

  “Like I said, the drug’s still in a double-blind study of three treatment strengths—low-dose, high-dose, and placebo. The treatment groups are labeled alpha, beta, and gamma, but because the double-blind code hasn’t been broken yet, nobody knows for certain which is which, not Jessup, not even Art Weber, the guy who discovered the drug. He’s the project director from the pharmaceutical company.”

  And Brian knew that was as it should be. A double-blind study was the only completely valid way to evaluate a new drug. To eliminate bias as much as possible, neither the patient, nor the treater, nor the evaluators of the treatment knew whether the medication being given was active or placebo. That information belonged only to the computer that set up the treatment groups and dispensed the drug. Ideally, there would also be a crossover midway through the study time frame, when the group being treated with placebo and the group getting the active drug would be switched, still maintaining secrecy as to which was which.

  “But if the drug is doing as well as you say,” Brian pointed out, “surely everyone must have an idea which group is which.�
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  “There’s no question in our minds that the beta group’s on the high dose. That’s where most of the remarkable results are coming from. But the computer hasn’t seen enough data to authorize breaking the code. I think that’s because the number of patients is still so low. Since they went to Phase Two a couple of years ago, there’ve only been about six hundred patients. That’s two hundred in each treatment group. But even so, I’ve been hearing rumors that the code may be broken soon. I’ve even heard the drug may end up on the market before long—the results are that good.”

  “Well, that’ll be great for the world, but maybe too late for Jack. Make it happen if you can, Phil. Please. The poor guy’s been through a lot.”

  “So the resident tells me.” Gianatasio checked the time. “Well, I’d better see how things are going with Stormy. That’s how Violet Corcoran will now and forever be known at WMH. Jack’s going up to the CCU soon. I’ll be up to see him as soon as—”

  A softly cleared throat from the doorway got their attention. A tall, angular, well-dressed man was standing there.

  “Ernest,” Phil exclaimed.

  “I was doing some work in the office when word filtered up to me of a remarkable save down here. I came down to thank the men responsible for it.”

  Phil introduced Brian to the BHI chief as the man who really deserved the credit for what went on in room 4.

  “I’d love to take the bow,” Phil said, “but the only truly brilliant thing I did was to call in my old friend here for a consult.”

  “Sometimes, calling in the right consult is the only truly brilliant thing one can do. I’m pleased to meet you, Dr. Holbrook.” Pickard’s handshake was confident, his speech measured and cultured. “But unless I’m mistaken,” he continued, “we’ve met before.”

  “Excuse me?”

  “In a manner of speaking, that is. I was at the Harvard game when you threw five touchdown passes against us. That was you, yes?”

  “It was.”

  “Well, that was quite a performance.”

  “Maybe, but your guys had much higher SAT scores than we did.”

  Pickard’s bass laugh was genuine.

  “Probably so,” he said. “Probably so. The day I saw you play, I thought for sure you’d end up in the pros, you were that good.”

  Brian exchanged a glance with Gianatasio, then said simply, “It didn’t happen.”

  “Well, that was medicine’s gain, and our gain in particular, if what I’ve been hearing is true. So, please, tell me what went on in there.”

  “If it’s all right with you, Ernest,” Phil interjected, “I’ll go check on the lady in question. Come down after you two have had the chance to talk.”

  Pickard pulled the two chairs in the room away from the bed, and motioned Brian to one of them.

  “That’s your father, I understand.”

  “He was our coach during that game you watched.”

  “He must be very proud of you.”

  Brian wondered how much Pickard knew about him and his situation. He glanced at Jack, then at the monitor screen.

  “Sometimes,” he said.

  “He’s stable right now?”

  “For the moment.”

  “Excellent. Well, I’ve been told you diagnosed thyroid storm after just a two-minute exam in a lady who was in extremis.”

  “I saw a case during my fellowship. She looked exactly like that one.”

  “Remarkable. Take me through what you saw.”

  For a man of his stature and responsibilities, Pickard seemed relaxed and unhurried. Brian took him step-by-step through his evaluation, noting the clues in Violet Corcoran’s history, cardiographic pattern, and physical findings that led him to the diagnosis.

  The BHI chief listened intently. When the tale was completed and a few clarifying questions answered, he stood and shook Brian’s hand.

  “That was a wonderful piece of deduction under pressure,” he said. “I congratulate you, and hope you’ll repeat your part in this case when she’s presented at Grand Rounds.”

  “Of course.”

  “And if there’s ever anything I can do, please feel free to ask.”

  Pickard turned to leave, then turned back when Brian said, “As a matter of fact, there is. I’ve been told that Dr. Jessup is the director of the Vasclear study.”

  “Correct.”

  “I wonder if you could prevail on her to take my father on as her patient.”

  “I believe I can do that. Carolyn is at home right now. I spoke to her not an hour ago. But I must caution you that I have no influence whatsoever as to who gets put in the Vasclear program and who doesn’t. That’s strictly up to Dr. Weber and Dr. Jessup.”

  “I understand.”

  “Very well, then,” Pickard said. “I’ll give Carolyn a call as soon as I’ve seen this patient of yours.”

  Again he turned to leave. Again he turned back when Brian spoke.

  “Dr. Pickard, there is one more thing,” Brian heard himself saying.

  “Yes?”

  “If it’s at all possible, I really need a job.”

  CHAPTER FOUR

  THE GLEAMING, STATE-OF-THE-ART CARDIAC CATHETERIZATION laboratory of the Boston Heart Institute was located on the basement level. Brian walked alongside his father’s gurney as Jack was wheeled through the corridors of White Memorial and over to Boston Heart.

  Two days had passed since Jack’s small coronary, and as his new doctor, Carolyn Jessup, had predicted, he had encountered no complications. Now it was time to take a look at the status of his coronary arteries and to make some decisions about his future treatment. The one treatment option that would not be available to them was Vasclear. Through Ernest Pickard’s intervention, Jessup had agreed to take Jack on as a patient. But the protocol for the Vasclear study, which was being followed to the letter, specifically excluded patients with a history of bypass surgery.

  “Five to two says she kills me down there,” Jack said.

  Jack groused constantly about having the catheterization, but Jessup had met surprisingly little resistance in talking him into it. It seemed to Brian that the coach might be developing something of a crush on his elegant physician. The notion made him smile.

  “Nonsense,” Brian replied. “She’s the best there is at this.”

  “I thought you were the best there is.”

  “That doesn’t count.”

  Although the prospect of getting Jack treated with Vasclear seemed dim at the moment, Brian’s chances for a job at BHI were getting a bit brighter. Yesterday, between his shifts at Speedy and Aphrodite, he had gone up to Ernest Pickard’s fifth-floor corner office, overlooking the Charles, and had spent nearly half an hour with the BHI chief, talking about his life, his addiction, and his recovery. In the end, Pickard gave no indication of what he was thinking, but later that evening Brian had found a message on his answering machine from his former partner Gary Gold, saying that Pickard had called to get Gary’s opinion of him.

  The man from transportation wheeled Jack to the holding area. Brian, invited to observe by Jessup, went to the carpeted locker room, changed into scrubs, and then entered the lab. Of the many areas of cardiology, he had always enjoyed catheterizations the most. There was an energy and tension in performing the procedure he had always found akin to what he used to feel playing quarterback. There was the need for steady hands and a delicate touch, plus the ability to transpose the two dimensions seen on a TV monitor into the three dimensions of a patient’s heart. And of course, there was the ever-looming specter of a cardiac crisis.

  Now, alone in the lab, he mentally walked himself through the cath that Carolyn Jessup would be performing on his father. The first step would involve local anesthesia to Jack’s right groin and the “blind” insertion through the skin of two long, thin, hollow catheters—one into his femoral vein, then up the vena cava, and into the right atrium and ventricle of the heart; and the other right next to it, into his femoral artery, then
up the aorta, and into the two corresponding chambers on the left side of the heart. The separate catheters were necessary because, except in certain congenital and disease conditions, there was no direct connection between the right chambers, which pumped blood to the lungs, and the left, which received blood from the lungs and pumped it through the aorta to the coronary arteries and the rest of the body.

  Once the catheters were in place, as verified by a squirt of X-ray dye, blood pressures would be measured in the various chambers and vessels. Next, the left-side catheter would be repositioned inside Jack’s right, then left, coronary arteries, the two main vessels that branched off the aorta to supply blood to the heart muscle. X-ray contrast material would be injected into the arteries while a video camera recorded the flow and simultaneously projected it onto the monitor screen. The arteries would then be viewed from eight different angles.

  Grateful to be back in his milieu, if only as an outsider, Brian examined the mechanized table, the powerful X-ray camera, and the various types of catheters hanging in sterile cellophane packets from labeled hooks along one wall. He was looking over the crash cart when his father was wheeled into the room by the cath tech, a tall, rail-thin black man who introduced himself as Andrew.

  “Dr. Jessup left word to expect you,” he said. “She’ll be down shortly. Welcome to the lab.”

  “How about you put me down as a no-show and take me back to my room,” Jack said.

  “Is your father always like this?” Andrew chided.

  “Oh, no. Not at all. He’s probably this mellow because he’s been premedicated.”

  The room, which seemed quite spacious when Brian wandered it alone, began filling rapidly. The console-room nurse arrived next, took her place behind the glass wall, and began readying her monitoring and recording equipment. Moments later, the scrub nurse entered from the women’s dressing room, gowned herself, then pulled on a pair of gloves and began preparing her instrument tray. Brian helped Andrew move Jack from the gurney to the mechanized fluoroscopy table.

  “Jesus, Brian, this is like being set down on a slab of ice. There’s no reason they couldn’t put a little heating coil in these tables. None at all. A little cushioning, too. Don’t X rays go through cushioning? Hey, Andrew, how about a pillow. I can have a pillow, right?”