Not to a spouse, a business partner, even in the confessional. Hands for ‘yes.’” Some hands shot up decisively. Others eased up gingerly.
But in a moment, every hand was raised.
7
How many patients in the study now? ” Ingersoll threw the question over his shoulder as he strode through the tunnel that linked the medical school with University Hospital. Rip didn’t break stride, nor did he reach for the note cards in the pocket of his white coat. He knew the number of patients who’d received Jandramycin, their names and diagnoses, and how they’d been at their last follow-up appointments. “Thirtynine counting the patient we put on Jandramycin yesterday.” “Oh, that was the woman-” “It’s a man. Mr. Rankin is a fifty-one-year-old school principal with sepsis from Staph luciferus, acquired when a cut on his foot from a camping trip became infected.
He-” “No need for all that. Thirtynine. That’s what I want to know.”
The two men walked along in silence, Rip carefully keeping a pace behind his chief. Most doctors in postgraduate programs became good friends with the men and women under whom they trained. By the time a fellowship was over, they had formed a collegial bond. That wasn’t the case here, though. From day one, Rip had received the unspoken message: You’re here to learn from watching me, but I’m in charge, and don’t you forget it. “How many cases do we need before Jandra can submit their new drug app?” Rip said. Ingersoll mumbled something.
“Sorry. I didn’t hear that.” Ingersoll didn’t slow or even turn his head. “I said the application for approval of a new drug was filed with the FDA two weeks ago.” At the doors of the ICU, both men found their way blocked by a cluster of people. The women cried, the men tried vainly to comfort them, and there was about the group an aura of defeat and despair. Rip had seen that scene too many times, but it never failed to move him. Someone didn’t make it. For the doctor, the aftermath meant an hour’s worth of paperwork. For the family, it was the beginning of a lifetime of “what if ‘s” and “if only’s.” Slowly the group moved into the waiting room, opening a path for the doctors.
Ingersoll was about to push through the swinging doors when Rip said,
“How could they apply two weeks ago? I recall being told they needed at least forty patients from us before they could file the app. Two weeks ago we had thirty-seven.” “Let me worry about that. Your job is to keep the study running smoothly.” Ingersoll strode to the nurse’s desk, where he stopped and cleared his throat loudly. “I need the chart for my patient-” He looked pointedly at Rip. “Cletus Rankin.
Room eighteen.” “For my patient, Cletus Rankin, in room eighteen,”
Ingersoll repeated, as though the nurse hadn’t heard Rip. Ingersoll took the proffered chart, scanned it, and nodded with satisfaction.
“Defervescing already. Good, good.” Just like Ingersoll. Use a five-dollar word instead of saying, “His fever’s coming down.” “Yes, he seems to be responding well. I looked in on him earlier this morning, and-” “I’ll just pop in to see him myself.” It only took Ingersoll a minute to make what Rip termed his usual cameo appearance: nod to the family, put a hand on the patient (didn’t seem to matter where, it was the touching that counted), assure everyone that things were going well, and exit. “You have the lab results from yesterday?”
“Aren’t they on the chart?” Rip said. “If they were, I would have seen them. Did you deliver the blood samples?” “Yes, sir. To both the hospital lab and Resnick.” “Then get the results, and see that they get onto the ICU chart.” “Will do.” Ingersoll pushed back his sleeve and consulted a watch that appeared to have every function except the position of the International Space Station. “I’m leaving this afternoon to attend a meeting in Bermuda, where I’ll be speaking on Jandramycin. Take care of things while I’m gone. See you Monday.” Rip ducked back into Mr. Rankin’s room to answer questions the family had apparently been hesitant to ask his chief. He checked the chart, wrote a couple of orders, and decided he’d treat himself to a mocha latte before tracking down the errant lab reports. The Starbucks in the medical center’s basement was crowded. Rip had almost decided to sit outside in the courtyard when he saw Carter Resnick at a table for two in the corner. His first inclination was to ignore the research associate, but at the last minute he veered offtoward Resnick. “Mind if I join you?” “Help yourself.” Resnick moved his briefcase from the second chair and gestured toward it. “The great one turn you loose long enough to get a cup of coffee?” Rip eased into the vacant chair.
“He’s leaving for Bermuda. But there’s still plenty of work for both of us to do. What are you doing here?” “I had to get out of the lab for a bit. You can’t believe how boring it is, running lab tests on our patients, collating data. I wish Ingersoll would let me have some patient contact.” Resnick sipped his drink-he’d also opted for a latte-then swiped at the foam moustache on his upper lip. Rip tasted his coffee, found it too hot to drink, and set it aside, spilling a few drops in the process. “What do you know about the new drug application for Jandramycin?” “Not much. I know Jandra said they wanted a hundred patients before they submit.” Rip toyed with his cup, making wet circles on the table. “And how many patients have we collected?” “You know that as well as I do. Thirtynine.” “Ingersoll told me this morning that the NDA has already gone in. Where did all the patients come from?” “There are a couple of investigators in Germany, but they didn’t start collecting patients until after we did.” “So how did Jandra come up with the volume of data needed for a new drug application?” Resnick finished his drink, this time ignoring the foam moustache. It made his Cheshire cat grin more pronounced.
“It’s magic, isn’t it?”
John Ramsey had been in the medical center’s Faculty Club before, but never as a faculty member. The club wasn’t what the name implied-no dark wood, overstuffed furniture, and faculty members sitting around sipping drinks and smoking cigars. It was bright and airy and highly functional. Windows on three sides showed views of Dallas or the buildings of the Southwestern campus. Tables were set for groups of diners from two to ten. Steam tables held several entrees. There was a well-stocked salad bar. But for John, the best thing on the menu, and his lunch of choice, was a Reuben sandwich on pretzel bread, and that was what he now held. “Thanks for meeting me for lunch, Mark.” John took a bite of his sandwich, chewed, and washed it down with iced tea. “Glad to do it,” Dr. Mark Wilcox said.
“Besides, I don’t get invited to the Faculty Club at the medical center very often.” “You can thank my chairman,” John said. “He let me charge this to his account. Part-time faculty members don’t get this kind of perk.” Mark put down his BLT. “How are you doing? Be honest with me. How long as it been since you lost Beth? Three months?”
“Closer to four. And not a day goes by that I don’t miss her. But I’m trying to get my life back together. That’s why I begged Don Schaeffer for this job. Unfortunately, I may have gotten myself into trouble before I saw my first patient.” John took another swallow of iced tea, then cleared his throat. “That’s why I invited you here today. I need some advice.” “Ask away, although I doubt there’s anything in medicine I know that you don’t. I’m a lowly GP who’s fresh out of medical school, and you’re a wise old internal medicine specialist.” “Don’t sell yourself short, Mark. When I first met you on ward rounds during your third year of medical school, it didn’t take me long to realize that tall, redheaded fellow who asked so many questions was pretty sharp. Then one of your classmates told me you were a practicing lawyer before you applied to medical school. That explained your maturity, I guess, but the fact that you chose to leave a good career to start over in medicine was what really impressed me.” “Nothing to it. I just decided I could help people a lot more by trying to cure their ills than by suing doctors who hadn’t been able to.” Mark frowned at the man who’d become his mentor. “Are you in legal trouble?” “I may be.” John related his story in short, unemotional senten
ces, much as he’d present a case to a consultant. He finished with, “The family says they’re going to sue the medical center and everyone involved. So what do you think my exposure will be?” Mark tented his fingers and pursed his lips. Thinking before he talks. No wonder I thought he’d be a good doctor. “I could give you the standard lawyer’s disclaimer. I need more facts. I need to read your malpractice insurance policy, including the tail coverage. I need-Never mind. You just want my opinion. My opinion is that you assisted the physician in charge of the activity in trying to save the life of a patient. You may have done more than the average citizen, but you never went beyond your capabilities and training, never breached the standard of care. The medical center’s policy aside, you’re probably protected under the Good Samaritan Law of the state.” John let out a breath he didn’t know he was holding. “So you think I don’t have to worry?” “Oh, we always have to worry, all of us. Doctors might as well have targets painted on their backs, with signs saying ‘Sue me.’ You definitely could be named in a suit. If so, your lawyer should be able to mount a good defense. That would cost you some legal fees and some time, but you’d have a decent chance of coming out okay.” “And if I need a lawyer?” Mark took a bite of his neglected sandwich, chewed, and swallowed. “Lucky for you I’m still licensed to practice law. And I’m running a special right now: defense of one lawsuit in return for lunch. So I guess you’ve got a free one coming.” John only managed to choke down half his sandwich, but Mark seemed to have no difficulty finishing his, following it with a trip to what John had heard his colleagues call the “sin bar”-a table laden with tempting desserts.
Mark returned with a piece of pecan pie. “Sure you don’t want something?” he asked. “No, I think I’d better just watch you.” John waited while Mark took a bite. “Tell me honestly. Do you miss practicing law? Do you ever wonder if it was a mistake to give that up, go to medical school for four years, and have to start all over again building a practice?” Mark chewed his pie and swallowed.
“Sometimes I think that being a lawyer is sort of like being a member of the Mafia. You know, ‘Once in, never out.’ As it turns out, I’m sort of melding medicine and law. I have a small family practice, but I also review malpractice cases for insurance companies that cover doctors. I do a little consulting for pharmaceutical companies.” He grinned. “And I help out old friends who have legal problems.” Mark finished his pie and pushed the plate aside. “Why don’t I drop by your clinic next week? You can give me your malpractice policy, and I’ll have a chance to see how the faculty operate their private clinics.
Remember, all my medicine clinics were at Parkland.” “Honestly, the surroundings may be nicer, but we pretty much practice the same brand of medicine we teach the residents. Anyway, you’re welcome to drop by.
Monday is my next day in the clinic, and I’ll bring the policy then.
If you come around noon, maybe I can talk Donald Schaeffer into springing for another lunch at the Faculty Club.” Outside, the two men stood in front of the elevators when John heard, “Dr. Ramsey. How are you?” John turned and saw Sara Miles standing behind them. “Sara, were you in the Faculty Club?” “Hardly. I had a sandwich in the food court.
I’m just waiting for Rip-er, Dr. Pearson to bring some papers for me to fill out. I have a patient in his drug study.” She looked pointedly at Mark, and when neither of the men moved, she stuck out her hand.
“I’m Sara Miles, one of John’s colleagues.” “Mark Wilcox. Dr. Ramsey was sort of a mentor to me while I was in med school. And it’s a pleasure to meet you.” “He mentored me, too, so we have that in common.” Sara looked at her watch. “Well, Rip must have gotten delayed. I guess I’ll have to track him down.” She extended her hand again. “Dr. Wilcox-” “Please, it’s Mark.” “Mark, it was nice to meet you. John, I’ll see you Monday.” Mark ignored the ding of the elevator and moved away from the opening door. “So that good-looking lady is one of your colleagues?” “Yes. But she’s a little young for me.” “I wasn’t thinking about you,” Mark said. He stepped into the elevator.
“See you Monday.”
It was Monday morning, and Sara was trying without success to get her engine revved up for the week ahead. She slumped in a chair at the doctors’ dictation station in the clinic. Her second cup of coffee was at her elbow while she looked over the charts for her appointments that day. Gloria tapped on the doorframe, entered, and handed her a pink phone message slip. “You have a call from one of your Jandramycin patients. Mrs. Ferguson. She’s worried about Chelsea.” “Chelsea’s been out of the hospital for over a month. This is probably something entirely different.” She dropped the slip on the desk and picked up her pen. “I’ll call her at noon, after I’ve finished seeing patients.”
Gloria didn’t move. “I’d call her now. Mrs. Ferguson was almost hysterical.” Sara had come to trust Gloria’s assessment of situations like this. She nodded, picked up the phone, and punched in a number.
Mrs. Ferguson answered on the first ring. “This is Dr. Miles. My nurse said you had some concerns about Chelsea.” The normally calm woman was obviously distraught. “This morning, she couldn’t get out of bed. It was like the muscles in her legs wouldn’t work. I had to carry her down the stairs. She’s lying on the sofa right now, crying.” “Did this come on suddenly?” “Yes. She was fine yesterday. This morning, she can’t walk.” “And nothing out of the ordinary happened to her yesterday? No injury, even a slight one? She didn’t eat something unusual?” “No. We went to church in the morning. I remember telling friends I was so thankful Chelsea was back to normal.” Sara’s mental Rolodex began to flip. “Is she in pain?” “Not really. She says her legs tingle and feel numb. Mainly she’s scared and frustrated.” “Any other signs? Headache? Nausea? Visual symptoms?” She went through a list of symptoms, getting a negative response to all her questions.
“What is it? Is she having a stroke? Could she have been poisoned or something?” Sara shook her head until she realized the woman on the other end of the phone couldn’t see it. “We don’t know,” she said.
“I’ll have to see her. Can you get her here, or do we need to call an ambulance?” “I’ll bring her in the car. Shall I bring her to the clinic?” Sara checked her watch. Her patients for the morning were already arriving. The odds of having to admit Chelsea for evaluation and treatment were pretty good. “No, bring her to the Emergency Room here at the medical center. I’ll let them know you’re coming so they can call me.” Fortunately, Sara’s first few patients were follow-ups that required very little concentration on her part. While she adjusted medication doses, reviewed lab reports, and took care of a few minor problems, her mind churned with the differential diagnosis of sudden and unexplained weakness. Finally, at midmorning, Gloria tapped on the exam room door, as Sara was finishing with a patient.
“Excuse me, Doctor. The ER just called. They’re ready for you.”
“Thanks. Would you tell the patients who are waiting to see me that I’ve been called away for an emergency? I should be less than an hour.
Offer to reschedule them if they don’t want to wait.” Sara hurried through the tunnels connecting the buildings in the medical center, turning right and left without conscious thought until she reached the Emergency Room. She found Chelsea on a gurney in one of the exam rooms, her mother beside her. “Can you help?” Mrs. Ferguson asked.
Sara forced a smile. “Don’t worry. We’ll get to the bottom of this.” A quick neurological exam confirmed what Mrs. Ferguson had said: Chelsea had very little strength in the muscles of her lower limbs, and her reflexes there were diminished. Her upper extremities seemed to be working normally. Sara had been thinking about this and was ready with her decision. “We’re going to need a number of tests, and we can get started on those right now. But I’m also going to ask one of our neurologists to consult on the case.” Mrs. Ferguson’s face fell.
“Neurologist? So is this a stroke? Or a tumor?” “I don’t really
know what it is yet. But something has affected this set of muscles. Dr.
Pearl is more experienced in this area, so it’s a simple matter of two heads being better than one.” Sara addressed Chelsea: “They’re going to draw some blood from you. Then you’ll be going to the radiology department for an MRI. That’s sort of scary, because you’re in a tunnel kind of thing and have to hold still for about fifteen minutes.
I don’t want to give you anything to sedate you, because we don’t know what’s going on yet. Think you can handle it?” Chelsea bit her lip, then nodded. A frightened child had once more replaced the smiling teenager, and it tore at Sara’s heart. Sara decided not to mention some of the other tests. A spinal tap. Electromyography and nerve conduction studies, with needles in the muscles to check their function. Probably more blood tests-a lot more. Chelsea and her mother had been through so much, and now this. It wasn’t fair. God, why did this happen? Sara saw the agony on Mrs. Ferguson’s face, and her mind drifted to her own loss. No mother should ever suffer the death of a child, and this woman wasn’t going to if Sara could do anything to prevent it. But first she had to find out what was going on. She answered a few questions, then stopped at the nurses’ desk to write some orders. She’d call Dr. Pearl later today, after some of the reports were back. For now there was only one thing Sara could do.
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