Lethal Remedy pft-4

by Richard L Mabry

  But something happened this morning. He’d awakened with a small spark of determination to do something, anything, to move on. He tried to fight it, to roll over and seek the sleep that eluded him. Instead, he heard the echo of Beth’s words: “You’re too good a physician to retire. People need you.” He remembered that conversation as though it were yesterday. She’d urged; he’d insisted. Let’s retire. I want to get out of the rat race and enjoy time with you. Retirement meant the travel they’d put off, the time to do things together. Only, now there was no more together. This morning, he’d rolled out of bed determined that today would be different. It would be the start of his rebirth.

  As he shrugged into a robe, as he’d done each day since her death he looked at the picture on their dresser of him and Beth. She’d been radiant that spring day so many years ago, and he wondered yet again how he’d managed to snag her. He’d shaved-for the first time in days-with special care, and his image in the mirror made him wonder.

  When did that slim young man in the picture develop a paunch and acquire an AARP card? When had the thick brown hair been replaced by gray strands that required careful combing to hide a retreating hairline? The eyes were still bright, although they hid behind wire-rimmed trifocals. “You’re too old for this, John,” he muttered.

  And as though she were in the room, he heard Beth’s words once more.

  “You’re too good a physician to retire. People need you.” Fortified with coffee, the sole component of his breakfast nowadays, he’d forced himself to make the call. He asked his question and was gratified and a bit frightened by the positive response. John dressed carefully, choosing his best suit, spending a great deal of time selecting a tie.

  He’d noticed a gradual shift in doctors’ attire over the past few years. Now many wore jeans and golf shirts under their white coats.

  But for John Ramsey, putting on a tie before going to the office was tantamount to donning a uniform, one he’d worn proudly for years. And he- “John, I was surprised when I got your call. To what do I owe the pleasure?” Dr. Donald Schaeffer breezed into the office, the starched tails of his white coat billowing behind him. He offered his hand, then settled in behind his desk. “Donald, I appreciate your taking the time to see me. I was wondering-” “Before we start, I want you to know how sorry we all are for your loss. Is there anything I can do?”

  Perfect lead-in. See if you can get the words out. “As you know, I closed my office four months ago. Beth and I were going to enjoy retirement. Then���” Schaeffer nodded and tented his fingers under his chin. At least he had the grace not to offer more platitudes.

  Ramsey had had enough of those. “I was wondering if you could use me in the department.” There. Not the words he’d rehearsed, but at least he’d tossed the ball into Schaeffer’s court. “John, are you talking about coming onto the faculty?” “Maybe something half-time. I could staffresident clinics, teach medical students.” Schaeffer was shaking his head before John finished. “That’s what the volunteer clinical faculty does. It’s what you did for��� how many years? Thirty?

  Thirty-five?” “Forty, actually. Well, I’m still a clinical professor in the department, so I guess I have privileges at Parkland Hospital.

  Can you use me there?” Schaeffer pulled a yellow legal pad toward him and wrote a couple of words before he pushed it aside. “I’m not sure what I can do for you, if anything. It’s not that easy. You have no idea of the administrative hoops I have to jump through to run this department. Even if I could offer you a job today-and I can’t-I’d have to juggle the budget to support it, post the position for open applications, get half a dozen approvals before finalizing the appointment.” He spread his hands in a gesture of futility. “So, is that a ‘no’?” “That’s an ‘I’ll see what I can do.’ Afraid that’s the best I have to offer.” Schaeffer looked at his watch, shoved his chair back, and eased to his feet. “Coming to Grand Rounds?” Why not? John’s house was an empty museum of bitter memories. His office belonged to someone else. Why not sit in the company of colleagues? “Sure. I’ll walk over with you.” As the two men moved through the halls of the medical center, John prayed silently that Schaeffer would find a job for him. With all his prayers for Beth during her final illness, prayers that had gone unanswered, he figured that surely God owed him this one.

  2

  Jack, this is Sara.” Dr. Jack Ingersoll hunched his shoulder to hold the phone against his ear. He removed his glasses and polished them on the tail of his white coat. The closed door of his academic office couldn’t quite block out the noise as one of his fellow faculty members read the riot act to a resident about his choice of a drug for bacterial endocarditis. “Sara, so good to hear from you. How have you been?” “You can skip the niceties, Jack. This is a professional call.”

  “I get the picture. So let’s keep it professional. What can I do for you?” “I have a sixteen-year-old girl with generalized sepsis. No response to the usual empiric IV antibiotics. I got the blood culture results this morning. Staphylococcus luciferus.” Ingersoll pursed his lips. “Another case. And, of course, the sensitivity studies-”

  “Resistant to every antibiotic tested. So I thought of you and your study.” Ingersoll’s pulse quickened a bit. Every patient he enrolled strengthened the reputation he was building as the world’s authority on EpAm848. It looked to be a wonder drug, and if he could hitch his wagon to that star, there was no telling where he could go. “Does she meet the enrollment criteria?” “Yes. I checked before I called you.

  The mother’s anxious to get her into the protocol, and I’ve laid the groundwork for you. Informed consent shouldn’t be a problem.” He found a blank slip of paper in the morass on his desk. “Thanks. What’s her name and where is she?” “She’s in the ICU at University Hospital.

  Name’s Chelsea Ferguson.” Sara cleared her throat. “Jack, she’s just a kid. And the mother’s worried sick. Try to upgrade your usual bedside manner. Please.” Ingersoll ended the conversation with a few mumbled assurances. He thought a moment, then punched the intercom button.

  “Martha, page Dr. Pearson and tell him to meet me in the ICU at University Hospital. Then call over there and get the identifying info on a patient-her name is Ferguson-and give it to Dr. Resnick. Have him make up a set of enrollment papers for the EpAm848 study and bring them to the ICU.” Ingersoll swiveled away from his desk and let his eyes sweep across the horizon. New construction was everywhere at Southwestern Medical Center, girders and columns rising alongside existing massive buildings. Although the economy was rough, there were still more than enough multimillionaires in Dallas who wanted to assure themselves of the best possible care by the brightest minds in the medical field. What better way to do that than to give money to the academic medical center in their hometown? Jack Ingersoll wanted some of that. He wanted to become Dr. Jack Ingersoll, John and Mary So-and-So Distinguished Professor of Infectious Disease, with offices in the Thus-And-Such Building, his salary and research expenses underwritten by the Bubba and Sue Somebody-Or-Other Foundation. And if the EpAm848 study kept going this way, that was exactly where he was headed-if not here, then somewhere. There were portraits scattered throughout the medical center of some of the distinguished faculty members. He wanted his to join that select group. He’d be wearing a white coat, holding a beaker of brightly colored liquid, looking into the distance, contemplating the discovery that put the medical school-and him-on the map. The artist would have to minimize his developing paunch and maybe enhance his scant brown hair into a handsome widow’s peak, but that was the advantage of a painting over a photograph. He unlocked the bottom drawer of his desk and pulled out a rust-colored stiffcardboard accordion file closed with an elastic cord secured over a large button. Ingersoll unfastened the closure, peered inside the file, and counted the sets of stapled pages. Twenty-one.

  Twenty-one patients willing to testify that he was a miracle worker.

  Twenty-one instances where EpAm848 saved a l
ife otherwise doomed because of infection by Staphylococcus luciferus-the Devil’s own Staph, “The Killer.” Patients were dying all over the world from this infection. It was turning into an epidemic, but the success rate of Ingersoll’s treatment was 100 percent so far. Conventional wisdom in medicine held that no therapy was 100 percent effective. He felt like a pitcher, taking a no-hitter into the eighth inning. Somewhere out there might be a case that wouldn’t respond. But so far, he was throwing a perfect game, and if he could keep it up, there was no limit to how far he’d go. Martha’s voice startled him from his daydreams. She never used the intercom, no matter how many times Ingersoll asked her to do so. He’d finally given up on that fight.

  “Dr. Pearson just called. He’s at the ICU and is reviewing the chart now.” Ingersoll resealed the file and locked it in his desk drawer.

  “I’m on my way. Page me if there’s something urgent.” He transferred his stethoscope, pens, and pocket flashlight to a freshly laundered white lab coat. He slipped his arms in, flexed his shoulders a couple of times to loosen the starched fabric, and buttoned the coat over his pale blue cotton dress shirt, leaving just enough of his rep-stripe tie showing to make a fashion statement. Sometimes a good first impression on the family was the most important part of the consultation. As he exited his office, he almost bumped into Dr.

  Carter Resnick, hurrying down the hall, head down, mumbling to himself. “Resnick, watch what you’re doing.” Resnick rubbed his hand nervously over his shiny dome. Ingersoll couldn’t understand why some men shaved their heads, but apparently Resnick thought it made him look wiser. It didn’t. If anything, it accentuated his geekiness.

  “Sorry, sir. I just prepared the packet for Chelsea Ferguson and took it to Dr. Pearson. Would you like me to go with you to see her? Maybe I could help.” He brought his eyes up for a millisecond, but dropped them again. Whatever expression they held was hidden behind thick horn-rimmed glasses. “You know the deal,” Ingersoll said. “You didn’t get the Infectious Disease fellowship, but I agreed to take you on as a research assistant and promised you the inside track when the second fellowship slot opens next year. Your place this year is in the lab.

  And the longer you stand here like a schoolboy begging to avoid detention, the less time you’re spending in that lab.” Without waiting for a reply, Ingersoll brushed past the young doctor and hurried away to the ICU. Idiot. He’s good in W the lab, following orders, but he won’t ever be any good at patient care. When I take on another ID Fellow, it certainly won’t be him.

  Dr. Roswell Irving Pearson III, generally known as “Rip,” scanned his notes one last time. The position of Infectious Disease Fellow under Dr. Jack Ingersoll was a real plum, and Rip had overcome stiffcompetition to win this appointment. But Ingersoll was a stern taskmaster. He expected his ID Fellow to anticipate his every request and fulfill it perfectly. When Ingersoll said, “Meet me in the ICU at University Hospital,” Rip knew that really meant “Find out which patient I’m seeing, review the chart, and be prepared to present the salient facts in the most concise fashion possible.” Since this was a case involving Staph luciferus, that also meant making sure the teenage girl qualified for the EpAm848 study. Now Rip was ready. He supposed he shouldn’t feel sorry for himself. He could be poor Carter Resnick. Rip wasn’t sure how Carter ever got through an internal medicine residency, or why he thought he had any chance at an ID fellowship, much less one as prestigious as this one. Anyone with half a brain could see that Ingersoll was just using Carter, delighted to have a specialty-trained MD running his research lab. Well, the Carter Resnicks of the world would have to take care of themselves. Rip Pearson had his own problems, and the first one on the agenda was presenting this case to his chief. Rip looked once more at his watch.

  Martha had paged him less than fifteen minutes ago, catching him already at University Hospital making rounds. He’d sprinted up the stairs to the ICU and rapidly digested the chart information on Chelsea Ferguson. He hadn’t introduced himself to Chelsea or her mother, though. He’d made that mistake once, and had learned quite quickly that Ingersoll expected his ID Fellow to be seen but not heard, like an obedient child. The name of the attending physician on the case made Rip pause. He hadn’t done more than nod to Sara as they passed in the halls since their last rotation as internal medicine residents. Now she was a staffmember, while his position as an Infectious Disease Fellow meant he was still in training. Would that make a difference? He and Sara had been close until she married Jack Ingersoll. Now all those relationships were topsyturvy. He wondered- “What do we have?” Ingersoll’s rubber-soled shoes allowed him to approach without warning, something Rip suspected he did, hoping to catch someone bad-mouthing him. The consultant pulled out a chair and took the page of neatly printed notes Rip handed him. “Chelsea Ferguson, sixteen-year-old Caucasian female, had a dental extraction a week ago, without prophylactic antibiotic coverage. She developed progressive, severe cellulitis of the jaw, and her dentist referred her to an oral surgeon. He tried one change of antibiotics, but when he recognized early sepsis he sent her here. Pending cultures, Dr.

  Miles began empiric antibiotic therapy for presumed MRSA with IV vancomycin plus gentamycin. Intraoral cultures grew out Staph luciferus, and blood cultures have reported the same organism, resistant to all conventional antibiotics. The patient now has generalized sepsis, is spiking temps to between 40 and 41 degrees Celsius, and her condition is deteriorating.” “Eligibility for the study?” Trust Jack Ingersoll to cut to the chase. Not “What else can we do?” Not “What about the white count, or sed rate, or blood sugar or any other lab test?” No other questions except, “Is this another case I can enroll in the EpAm848 study?” Rip swallowed the retort that was on the tip of his tongue. “Yes, sir. She meets all the criteria.

  And according to Dr. Miles’s notes, her mother has been warned that there are risks and potential side effects.” “Nonsense. None of the patients treated so far have so much as turned a hair. This is really a wonder drug.” “Yes, sir. But there’s always a first time.” “Negative thinking, Rip. We’ll have none of that.” Ingersoll stood. “We have to project a positive attitude. It’s important that patients have confidence in their doctors.” A faint buzz issued from under Ingersoll’s coat. He pulled an iPhone from his pants pocket, looked at the display, and frowned. “I have to take this.” Ingersoll hurried away from the nurses’ station, ducked into the family room, and closed the door. Rip wondered what could have been so important. In his experience, nothing trumped enrolling another patient in the study.

  Whatever it was, it didn’t take long. In less than five minutes, Ingersoll was back. “Let’s talk with these people,” he said. “Then I have to leave and catch a plane. I’ll be gone for a couple of days, so you’ll need to administer the medication and gather the follow-up data. Think you can handle that?” Rip swallowed the acid that boiled up in his throat. Since the study began, he’d been the one doing just that. He’d mixed every dose of EpAm848 and sat by the patient’s bedside while the IV ran in. He’d drawn blood and taken it to Ingersoll’s lab for all the necessary tests, made sure the vital signs were monitored, and logged the data that chronicled the patient’s response. This might as well have been his study, not Jack Ingersoll’s. It bespoke of his mentor’s huge ego that he’d even ask such a question. He choked out, “Yes, sir,” and managed to sound humble while doing it. Ingersoll was already moving toward Chelsea Ferguson’s room. Rip fell in step behind him like an aide-de-camp trailing a general at a respectful distance. A woman that he took to be Chelsea’s mother was sitting at the bedside, systematically shredding a tissue. “Mrs. Ferguson, I’m Dr. Jack Ingersoll. I believe Dr. Miles told you to expect me.” “Doctor, this is Chelsea.” The girl on the bed opened her eyes, managed a weak nod, then closed them again. The camera of Rip’s mind’s eye automatically recorded the patient’s status: pale, slightly undernourished girl in her late teens, sweating profusely, movements slow and listless. An IV in her le
ft arm was dripping at a regular rate. Her breathing was shallow, and a plastic cannula delivered what he assumed to be oxygen to her nostrils. “Chelsea is very seriously ill.” Ingersoll turned from the patient and addressed his words to Mrs. Ferguson. “She has an infection in her bloodstream that will almost certainly kill her if we can’t eradicate it.” If he saw the mother’s shudder and the girl’s grimace, he ignored them. “Our only chance for that is the administration of an experimental medication. We’ve had remarkable success-actually a 100 percent cure rate-with it. Although side effects and complications are possible, we’ve seen none of these. I need your permission to proceed.” “What if���?” “The details are spelled out in the consent forms that Dr. Pearson will go over with you. If you don’t wish to sign them, of course, the choice is yours, including responsibility for the consequences. If you proceed with treatment, Dr. Pearson will administer the first dose today.”