Cindy held his hand. “Part of your problem, Mike, is that your blood count is too low. Maybe that’s why you’re healing so slowly.”
“Why can’t they do something about it?”
“Let me talk with your doc. I think you should be on EPO, a genetically engineered medication that builds red blood cells.”
“It’ll take more than medication to pull me out of this, but I’ll do anything if it’ll help.”
They began Mike on EPO, but his blood count increased only a little. “We’ll step up the dose,” said his physician.
Why isn’t it working, thought Cindy? Mike can’t buy a break.
After two more weeks, Mike said, “EPO’s one hell of a wonder drug. It hasn’t done a damn thing for my blood.” He hesitated a moment, and then turned away. “It’s no use, Cindy. Nothing works. This whole thing is a fucking waste of time.”
She grasped his hands. “God, Mike, you’ve come too far to give up now.”
He pushed her away, grabbed the rubber drains, pulling them upward. “Look at me, Goddamn it Cindy, look at me. I’ll never be the same. I’ll never be me again.”
She sought psychiatric assistance and soon they were giving Mike Zoloft, a powerful antidepressant.
Mike smirked as he swallowed his first dose. “You’re kidding.”
“It’s going to take a few weeks, but the Zoloft will help.”
“Will it allow me to play basketball, go fishing, or camping, or go back to work?”
While Mike slept, Cindy visited with others in rehab, making friends with many patients, especially the children. Rehab introduced Cindy to Special Olympics.
Into the second month, Mike slept fifteen hours a day, and awakened sullen and angry. In spite of increasing doses of EPO, his blood count remained low. His doctor increased the dose further.
Early in his illness, Mike had regular visits from Berkeley cops, but in rehab, the number of visitors had dwindled to his partner and a few close friends. Visiting with Mike was never easy. Nobody knew what to say or how to deal with his anger.
“They’re my friends. You should see the way they look at me. Their eyes…they can’t stand to be with me, to smell me, or to have me remind them that, but for the grace of God, any one of them could be lying in my place.”
When Cindy pulled into the rehabilitation facility on a Sunday morning, flashing police lights and fire department vehicles filled the parking lot.
What’s wrong? she thought rushing to Mike’s ward.
As Cindy approached the nurse’s station, the head nurse, Betty Atkins approached stone-faced.
Cindy felt sick. “What’s wrong?”
“I’m so sorry.”
Cindy tried to rush past Betty, who held her in place.
“It’s too late, Cindy. Mike’s gone.”
Cindy felt faint. She grasped the sofa’s arm and sagged into its soft cushions.
“What happened?” Cindy whispered, tears flowing from her eyes.
“I don’t know how or where he got the gun, but Mike shot himself.”
The police interviewed Cindy, and Internal Investigations questioned the cops who’d visited with Mike, but without success. The gun had its serial numbers removed, but the FBI lab was finally able to identify the pistol as a weapon confiscated ten years earlier by the Berkeley P.D. during an arrest. They had sent it to the property room from which it disappeared.
Mike’s suicide devastated Cindy. She survived through hard work and dedication to a life helping others…
The pharmacy committee’s request to study, EPO, sent Cindy’s mind back to Mike and the drug’s failure. Something was wrong.
At our next monthly QA meeting, Cindy Hines took the pharmacy records on EPO usage and brought the associated medical records for me to review. I’d met with the kidney and cancer specialists, the largest users of EPO.
I began by pointing at Cindy’s cart stacked high with charts. “Cindy will pass these out. Look them over to see if you can find any explanation for the excessive use of EPO. I went over them quickly and to my eye, their use was appropriate. We don’t understand why these patients require so high a dose to achieve the desired effect.”
One by one, the reviewers reported that they could find nothing in these records to explain this phenomenon.
Jack Byrnes picked up Cindy’s data sheet. “Maybe the drug company has changed its manufacturing method or there’s something wrong with the product. I suggest we obtain the EPO from our usual sources and return them to the manufacturer so they can assay them for potency.”
“That may take a while,” I said, “but I can’t think of any other course of action.”
After the meeting, Cindy stared at the stack of charts. Mike hadn’t responded well to EPO either, she thought. Could this be why?
The Infectious Disease (ID) committee met the next day at noon, in the same room. Edith Keller, an ID specialist, chaired. Cindy Hines supported this committee as well.
Edith held up the data folder. “We’ve recently had our tenth case of pneumococcal pneumonia in previously vaccinated patients. That’s distinctly unusual, as vaccination is highly effective in preventing the infection. We pulled the records on all patients receiving the vaccination in the last five years. When you look at this group, it’s immediately obvious that it’s those vaccinated in the last two years who are getting the infection. We took the analysis further and compared their risk factors, their ages, and all other parameters. The groups are virtually the same except for when they received the Pneumovax.”
“What about UC or Sanford,” asked Jim McDonald, “are they seeing this problem?”
Edith shook her head. “No, but two other east bay hospitals have had a few cases.”
“This is serious,” Jim said. “We give Pneumovax to our high risk patients since they handle this infection poorly. While it’s not as bad as it was in the past, people still die from this type of pneumonia. Pneumovax saves lives or at least it should.”
“Either something’s different among these groups and we’re not seeing it,” said Edith, “or something’s wrong with the vaccine.”
“Can we measure antibodies to pneumococcus in these groups?” asked Karen Small, a family practitioner.
“We can get the Pneumovax manufacturer to do this or we can find a reference lab,” said Edith. “That may not help us, since low antibodies won’t tell us if it’s the vaccine’s fault or it’s the patient’s fault. We need to know why this is happening before someone else dies.”
Chapter Twenty-Four
She feels pretty, I thought, as I watched Debbie Wallace entering my office a month later. She wore a floral sundress and her chestnut hair with small butterfly barrettes had reached the pixie-cut length. She’d taken care with her makeup and her red toenails shone in her dressy strap sandals.
“You look terrific, Debbie. It’s wonderful to see you this way.”
“I feel good, too.” She pulled up on a lock of her hair, “and it’s coming back.”
“How are things at home?”
“We’re back to normal, or what we call normal for our family.” Debbie paused for a moment then stared into my eyes. “I focused too much on being cured and when the cancer came back, it was more than I could bear. Now, I don’t think about it.”
“That’s normal, but what you mean is that you don’t obsess about it.”
“No, Arnie. Once I got through the last treatment cycle, it just isn’t part of my consciousness. Intellectually, I understand that this is the ostrich approach to illness, but I feel so good that for better or worse, I’ve taken the plunge. I chose not to post a five-year calendar and mark off each day until I’m sure the disease is behind me.”
“Okay, I’ll worry about it.”
Debbie smiled. “Good. What’s next?”
“I’ll see you for routine examinations quarterly, then once a year we’ll do blood tests and x-rays.” I stared at her for a moment and locked her eyes. “You’ll call me right aw
ay, if anything develops.”
Debbie smiled again. “You worry too much, Arnie. I’ll be fine.”
After I finished my office hours, I walked to ICU. Jack Byrnes sat at the nurse’s station reviewing a thick medical chart.
“I think you’re glued to that chair, Jack. Every time I come in here, you’re in the same spot.”
“Sometimes I get that same impression that my life’s at Brier. The rest is a side show.”
I pulled Sarah Jackson’s chart from the rack and sat beside Jack. I’d admitted her yesterday with a urinary tract infection that spread into her bloodstream, making her blood pressure unstable. Changing her antibiotics had done the trick. As I glanced across the room, a strong familiar aroma caught my attention and instantly my mind flashed to my tour as a medical officer in Desert Storm…
They brought the Iraqi prisoner to our medical clearing company for treatment. The black-bearded teenager was dirty and wasted. It looked as if he’d been ill for weeks. His right leg was heavily bandaged with a filthy encrusted gauze dressing that reeked. He’d suffered burns over 20 percent of his body, but most of those wounds had healed.
I stood by the gurney. “Charlie, cut that dressing off, and prepare yourself.”
Charlie Hicks was a veteran medic with years of experience. He was my right-hand man. He struggled with a bandage scissors to slice through the thick dressing. The last cut released the dressing and the room filled with a fruity, grape-like aroma that I recognized as the product of the bacterium called pseudomonas. We covered our noses and turned away.
The egg-shaped leg wound measured five by three inches. I directed the high intensity light directly onto the large skin ulcer for more detail. A white sheen covered the wound. After staring at it for ten seconds, I thought I saw fine flutter on its surface. I stared again and the wound undulated with a wavy, rippling movement. I folded a piece of sterile gauze into a surgical clamp, drew it across the wound, and gasped. As I pulled the white membrane away, the wound was alive with shiny, crawling maggots that had eaten the damaged, infected tissue, leaving a bright pink healing surface called granulation tissue.
Charlie turned, grabbed a stainless steel basin, and vomited…
“What’s the matter, Arnie? You look green.”
I shook my head, clearing it of that vivid memory—no, it was more than a memory. I had relived the experience. My hands trembled. I stood. “Come with me Jack.”
Jack looked puzzled, but rose and followed me to the first ICU bed on the left.
“Stay with me a second, Jack. I know that pseudomonas is in the unit somewhere. I’ll never forget that disgusting sweet stench.”
“I don’t smell a thing, Arnie.”
We walked past the first four beds. Each time I stopped, swung my head in an arc, and inhaled—nothing.
Then we came to bed five, Connie Rinaldi on a ventilator.
Jack turned toward me. “She’s having an exacerbation of severe chronic bronchitis.”
I stopped and stared. “It’s here. It’s pseudomonas and it’s coming from her lungs.”
Jack leaned over Connie and sniffed. “I know that odor, but I can’t detect it here.”
“Take a sample of the fluid from the breathing tube. You’ll find it. I’m sure.”
His “Okay, Arnie,” carried disbelief as he broke the connection between the breathing tube and the ventilator to get a sample.
“I’ll send it to the lab. They’ll place it on a microscope slide and stain it with dye. Then we’ll have an idea what it is before the cultures come back in a day or two.”
Fifteen minutes later, the bacteriology lab called back. “It’s a gram negative bacillus Dr. Byrnes. It looks like pseudomonas to us.”
Jack stared at me. “I don’t know what’s going on here, Arnie, but you may have saved Connie Rinaldi’s life.”
Chapter Twenty-Five
Henry Fischer rolled off Monica Kelly flushed with satisfaction. He lay next to her in the warm afterglow of their lovemaking.
Ain’t life grand, Henry thought.
Monica smiled. “You’re spoiling me.”
“I’m the one getting spoiled.” He paused for a moment. “I know we agreed that this was only for fun, no strings attached, but I’m enjoying this too much to keep our relationship recreational.”
She caressed his cheek, and smiled. “I made a promise not to get involved, but I guess I was kidding myself…I am involved. Maybe it’s because you have so little left of your marriage that I imagined what might be ahead for us.”
“Dealing with Ruth won’t be easy. She’s smart and can be vindictive. I can only assume that she has her suspicions about me, and I know she has questions about Horizon Drugs. She can screw things up for us if we’re not careful.”
“Then let’s be careful.”
Horizon Drugs was back in stride. They’d weathered the squall and clear sailing lay ahead. Their cash-flow problems were behind them, and their profitability soared 50 percent. His meetings with Brian Shands, once unendurably depressing, had become a joy as the black ink overflowed the pages of their accounting book.
Henry lifted the glass of Champagne he’d iced for the occasion. “You’re a genius, Brian. At this rate, we’re going to retire our entire debt in six months.”
Henry’s agreement with Brian was making his young partner a rich man, but Brian wanted more.
Be smart, Brian thought. Don’t screw this up.
“I couldn’t be more pleased, Henry. Everything’s going better than we thought.” Brian paused, and then continued, “I don’t want to cause problems, Henry, but when I first joined you, my deal came with the implied promise that one day I’d share in Horizon Drug, that is, have an equity position.”
“I think you’ve earned a position in the company, Brian, but I’ll need to deal with the timing and work out the agreement with our shareholders. You know I can’t act on my own. I have responsibilities to the partnership.”
Brian recognized bullshit when he heard it, but he knew that it was a mistake to push Henry too hard, too fast. “Henry, you’re too smart to let this get between us since you already agreed that I’ve earned a share of the action. I know you’ll find a way to make this happen.”
Henry worked through the permutations of keeping Brian happy. It would be simple and clean if Brian didn’t get greedy. In addition, Henry recognized that forces beyond their control bound him and Brian together.
Tino Ruiz was on the schedule to work late.
Brian slipped on his sports jacket. “Can you close, Tino? I’ve got a date, and I’m late.”
“No problem. I’ll see you tomorrow afternoon.”
A date? Tino thought. Brian has many dates for a married man.
Soon after Brian left, the private line rang. “Hi, Tino. It’s Lilly. Is Brian there?”
Shit, Tino thought. I can’t hurt her. “He just left. I think he has a meeting.”
“If he comes back or phones in, please have him call me.”
“Sure Lilly.”
After a moment’s hesitation, Lilly said, “How are you doing, Tino? How’s school?”
“Straight A’s, Mrs.…I mean Lilly. Thanks for asking.”
What a sweet woman, Tino thought. That fucking Brian Shands.
Tino placed the large medication jars back on the shelf, refilling those whose levels were low. He checked the vials, labels, instruction sheets, and phone-in prescription pads, and restocked those that were low. When he looked for more prescription labels, he could find none. He checked the storeroom for the packages with the name, Colfax Printers, the company that did all their printing, but found none. As a last shot, he looked toward the clean room, but hesitated remembering Brian’s admonitions. Finally, he entered, checked the shelves, and then saw a box turned at an angle showing the word, ‘Printers’.
There they are, he thought.
When Tino brought the box down, he saw the full name, Colonial Printers, with a return address of Guadalajara,
Mexico. He lifted the lid and examined the contents. Inside, he recognized the printed labels for three drugs, EPO, Taxol, and Pneumovax. These weren’t the common usage labels affixed to prescriptions, but exact replicas of the proprietary brand labels. Perhaps Brian used them to replace labels damaged in shipping or in preparation, or is it possible they were for something else?
He replaced the lid and returned the box to its exact position on the shelf. He’d ask Brian for more labels tomorrow, but would say nothing about his discovery.
I never thought it would come to this, thought Ruth Fischer as she stood before the smoked glass door that read, Sam Spade Detectives, Reggie Brand, Owner: Confidential Investigations, Surveillance, Criminal and Civil, Cheating Spouses.
All she knew of private investigators came from movies and television, so it surprised her to see a thin, balding man in his late forties sitting behind a large oak desk. He looked like a bookkeeper.
He stood and extended his hand. “Reggie Brand,”
“Ruth Fischer,” she said staring at the man.
“I know,” Reggie laughed. “I’m not anyone’s image of the hard-nosed private eye. That’s what makes me effective. I look ordinary. What can I do for you?”
“This is embarrassing. I’ve never done anything like this before.”
“Few women have. Tell me what you need.”
“This isn’t a matter of finding out my husband’s been cheating. I assume that as a fact. What I want to know is how long and with whom. In addition, I share considerable material assets with Henry Fischer, much more than the usual community property. I have a significant position in my husband’s business, Horizon Drugs, and I want to protect those interests. He’s hiding things from me. I need to know what and why.”
Reggie smiled. “The first part will be simple, that’s my bread and butter. The second part is problematic.”
The Sixth Sense (Brier Hospital Series Book 3) Page 11
