Mark? She’d only met him recently. There was no question he was interested in her, but she hesitated to bring him into this. She didn’t know Mark well enough, and vice versa. Jack? Never! Her administrative assistant? Gloria or some other nurse in the clinic?
Another doctor in the department? She chewed on the eraser end of her pencil. No matter how she looked at it, the name she kept coming up with seemed the right one. She picked up the phone and dialed.
“I’ve got bad news for you. Every one of your HIV tests came back positive, and your T cell count is already dropping. It’s like you’ve been taking placebo instead of zidovudine and lamivudine. We’re going to have to ramp up the meds.” Jack Ingersoll’s face was somber as an undertaker’s, his voice somehow an octave deeper than John remembered.
John could already feel the cold dampness of the grave reaching out to him. “There must be some mistake. Those meds are standard treatment.
Rip Pearson assured me they’d work.” Ingersoll shrugged. “Rip doesn’t know everything that goes on around here.” He grinned. “Maybe the pills you’ve been taking were compounds I’ve been working on in my lab. You don’t suppose one of the side effects could be to kill the immune system, do you? My, my. I’ll have to write that down in my journal. My secret journal.” John was drenched in sweat by now. His chest shook with the pounding of his heart. He’d call someone-Dr.
Schaeffer, Lillian Goodman, someone to talk with about this. Maybe he could call Beth. She’d know what to do. Oh, please, God. Send me someone who can help. The pounding in his chest morphed into a steady vibration from the cell phone in his shirt pocket. John’s eyes sprang open. He was alone in his easy chair, the stroboscopic flashing of images from the muted TV painting the walls of the darkened room. More by reflex than volition, he answered the phone. “Dr. Ramsey.” “John, this is Sara Miles.” His colleague’s voice shook a bit, and he wondered what was wrong. “I need your help.” John struggled to come fully awake. His feet explored the area around his chair, searching for his discarded shoes in the near dark. “Where are you? What do you need?” “I’m at home. But I need you to give me a ride to the medical center in the morning.” There seemed to be a catch in her voice that John couldn’t explain. “Sure. But what happened to your car?
Mechanical trouble?” Her laugh had no mirth in it. “Not really. But the police impounded it so they could look for the bullet.” “Whoa.
Police? Bullet?” She told him about the shooting. “Who’s there with you?” “I’m alone at home with the blinds drawn, the doors locked, and a baseball bat by the front door. But I’m still a little shaky.” John knew the simple thing to do was set up a time to pick her up in the morning, wish her well, and hang up. But that wasn’t the right thing.
By now he’d found his shoes, and he slid his feet into them. “Would it help to talk about it? Would you like me to come over?” Her exhalation sounded like a rushing wind in his ear. “I think I’d like that. Would you mind?” “Not at all. Give me your address.” John splashed some water on his face and combed his hair. He despised the way he’d let himself descend into self-pity. He could almost feel Beth in the room behind him, saying, “John, you can’t get bogged down in thinking about yourself when there are other people who need you.” Right now, Sara needed him. He was determined to come through for her. He offered up a silent prayer to that effect, grabbed his keys, and walked out the door.
11
When the doorbell sounded, Sara pulled the curtain aside a tiny crack and peeked outside. A gray Toyota sat in her driveway.
Unfortunately, she’d forgotten to ask John Ramsey what kind of car he drove, so that information didn’t do much to assure her this wasn’t her attacker, come back to finish the job. She moved to the door, but hesitated there. Hadn’t she heard about murderers waiting for the peephole to darken, then shooting through it? You’ve watched too many crime dramas. “Sara, it’s me,” the familiar voice called. She released the security chain, turned the deadbolt, and opened the door just wide enough for John to slip through before she reversed the process.
“Sorry to be so security conscious, but��� ” “I understand. Now why don’t we have some coffee and talk about this?” After they took seats at Sara’s kitchen table, she told John what she could recall about the shooting. “It was all over so fast. I never noticed a car following me. And if I hadn’t swerved into that parking lot, I guess he’d have had a clear shot right through my side window.” “Sounds like you had an angel sitting on your shoulder.” It was an offhand remark, but it triggered a thought in Sara’s mind. “You may be right. My mother always said we don’t die until we’ve done everything God put us here for. Maybe I’m not finished.” John drained his mug. He started toward the sink, but Sara stopped him. “Just leave it. I’ll clean it up later.” She snorted. “You know, we’re getting into angels and God, and it sounds like we want to talk about anything except who shot at me and why.” “Then let’s get to it.” John turned slightly and crossed his legs. “We’re both diagnosticians. Look at this situation like it was a patient with symptoms we don’t understand. Where do you start?” “With the history,” Sara said automatically. “How is the problem manifested now, what preceded it, and what’s been done about it so far?” “Let’s start with the manifestations. Someone took a shot at you. Now the simplest explanation is that it’s an isolated incident-in this case, a drive-by shooting, a case of mistaken identity. Unfortunately, nowadays that would be the most common explanation as well.” “Do you think that’s it?” John shook his head. “Doesn’t matter. When you’re making a diagnosis, do you stop with the most benign possibility?”
“No, you have to consider other causes and rule them out, especially the worst ones. You work your way down.” “Right,” John said. “The worst possible scenario is that this was deliberate. If that’s the case, we have to consider the why.” Nothing was said for a moment.
Finally, Sara broke the silence. “I can’t think of a reason why anyone would take a shot at me.” “Nothing you’ve been doing could make anyone angry?” Sara chewed on her lip. “The only thing is that for the last couple of days I’ve been trying to get information about Jandramycin.
But surely that wouldn’t-” “Let’s just follow that line of thought.
Who did you talk with yesterday about Jandramycin?” “This is crazy,”
Sara said. “We’re being ridiculous.” “Maybe,” John said. “But are you sure this isn’t a valid scenario? If this was a simple drive-by, our discussion just costs us a little time. If it was something more, you may still be in danger. Now who did you talk with about Jandramycin just before the shooting?” “Rip and I confronted Jack, but he blew us off. Then I called Jandra Pharmaceuticals, talked with a Bob Wolfe, tried to talk with the head man there, and hit a stone wall both times.” “Go back a little further-just before our lunch yesterday.
What about the irregularities in the research project? Where did that come from?” Sara nodded. “Right. Rip told us the numbers weren’t matching.” “And he got that information from-” “Carter Resnick.” John ticked the names offon his fingers. “So if we’re going to connect the shooting with your inquiries about Jandramycin, the triggering event could have come from Jack Ingersoll, someone at Jandra, or Carter Resnick.” Sara opened her mouth, then closed it. “Yes? Take it further,” John encouraged. “Well, we had our meeting yesterday to talk about all this, and Mark Wilcox was there. So I guess we have to include him.” Sara frowned. “You know, you introduced Mark to us, but we don’t really know much about him. What does he do, anyway?”
“Lawyer, doctor, very sharp, dependable.” John ticked the points offon his fingers. “He had a successful law practice, but apparently got tired of it and decided to go into medicine. I get the impression he thought he could do more good that way. Now his practice is sort of a mixed bag: a small general practice, some legal medicine, occasionally consulting for pharmaceutical companies. I’ve known him since he w
as in med school, and I think he’s okay.” “If you say so,” Sara said.
“What about me?” John asked. “I was at that meeting.” “No!” Sara felt as though she were lost at sea, with no land in sight. Only John Ramsey was a fixed point on the horizon. “I have to trust someone, and everything in me tells me I can trust you.” John gave the briefest of nods. “And I’ll make sure your trust isn’t betrayed. But there’s one more person who’s been involved in the Jandramycin saga. One more member of our little crew.” “I don’t know who-Oh! Absolutely not.” “So how do we eliminate him? Does Rip have anything to gain if Jandramycin moves forward and the side effects stay buried?” “I can’t see any benefit to him.” “I can,” John said. “Rip would be co-author of every paper of Ingersoll’s on Jandramycin. When he finishes his fellowship, think how much it would improve his chances of getting a plum faculty appointment or research job if he’d worked with Jack Ingersoll on the Jandramycin project.” “I just don’t think Rip’s that kind of person.
And he’s been working right beside me to find out more about these side effects. I can’t see him trying to stop me now.” “Okay,” John said. “I don’t think we should totally take Rip offour list, but we can move him down toward the bottom, at least for now.” Sara felt her shoulders slump. “This can’t be happening. I don’t want to live my life suspecting everyone around me. I can’t function that way.” John rose and moved to stand beside her. “Just be careful and watch your back.” “I’d like to think I’m over-reacting. Maybe this has nothing to do with Jandramycin. Maybe it was all simply random.” John patted her shoulder. “That’s enough for now. You need some rest. I’ll pick you up in the morning, and if you need a ride to pick up a rental car, I’ll take you.” Sara rose and took John’s hand. “Thanks. It helped to talk about this.” John paused in the living room. “Are you going to be okay alone here tonight? Maybe you should check into a hotel.” “I’m not going to let something like this run me out of my home,” Sara said, her words carrying more conviction than she felt. “We could call one of your female friends to stay with you. And I could ask the police to drive by your house several times tonight.” “They’ve already offered to do that,” Sara said. “No, I’ll be fine. I’ll lock up after you leave.” She gestured at the bat by the front door. “And I have my old faithful softball bat here if I need to deal with an intruder.” “Just remember, a bat won’t help if someone starts shooting at you.” “It’s what I have tonight, but I’m already thinking of��� never mind.” No need to tell John she’d already made up her mind to buy a gun. The next time someone started to shoot at her, she was determined to return fire. After she heard John’s car pull away, Sara slumped into a chair in her living room. Her mother’s Bible was on the coffee table beside her. She’d put it there after her parents were killed in an auto accident, but hadn’t opened it. Maybe this was a good time to do so. She reached for the book, and it slipped from her hands, falling open to what was apparently a frequently visited page. Sara lifted the Bible into her lap and scanned the verses. She stopped when she came to a passage marked with a yellow highlighter. Her lips moved silently as she read: “You will not fear the terror of night, nor the arrow that flies by day, nor the pestilence that stalks in the darkness, nor the plague that destroys at midday.” Thanks, Mom. I could always count on you for help.
Sara held the phone in a death grip. She dreaded this conversation in the worst way. “Dr. Pearl.” “Anna, this is Sara Miles. I went by to see Chelsea this morning. Her weakness seems to be progressing. What do you think?” “I scribbled a quick note, but I dictated a full consultation. You should get it in a day or so.” Forget the paperwork.
Give me something. Anything. “But you agree this is GBS?” “Not much doubt. And, as you know, we don’t really have any idea why these things happen. About all I can suggest right now is hitting her with high doses of steroids, and I’ve already started her on that. You know the routine: an H2 blocker to prevent a stress ulcer, a hypnotic at bedtime to combat the steroid insomnia. I wish we had something else that worked but didn’t have so many side effects.” If you only knew that this whole thing probably came as a side effect of another med.
“You’ll follow her with me?” “Of course. Call me anytime. And thanks for the consult.” So that was it. Anna agreed with Sara’s initial diagnosis of Guillain-Barre syndrome-the silent disease that came out of nowhere. It could resolve as quickly as it came on, or it could leave the patient with permanent paralysis. “No.” Sara was surprised to find she’d spoken aloud. “Something wrong, Dr. Miles?” Gloria tapped on the door of the dictation room where Sara sat. “No, just talking to myself.” Sara shrugged. “Am I through for the morning?”
“There’s a walk-in, but if you’re busy I can get one of the other doctors to see her.” “No, I’ll take it. But be sure I’m clear for the afternoon. I have to pick up a rental car, then meet with the police.”
“I’m so sorry to hear about what happened to you last night.” Gloria made a dismissive gesture. “It seems like it’s not safe to drive anywhere in this city anymore. Probably some gang-banger who got a new Glock and had to try it out on a moving target.” “Maybe.” Sara shoved herself upright. “Which room?” Forty minutes later she had a diagnosis. Not one that made her happy, especially under the circumstances, but it was clear to Sara. She figured a third-year medical student could make it. The patient was a middleaged woman with gradual development of muscle aches and weakness, combined with a nonitching rash that covered her cheeks like a mask. Preliminary lab work was suggestive, and Sara was certain that more sophisticated tests would confirm her impression. “Mrs. York, I’m afraid you’ve developed lupus.” “Oh, my.” The woman’s expression made it clear she realized the seriousness of what Sara said. “How did that happen? What can you do for it?” “There are several medications we can use to slow or stop the progression of the disease. As for how, we don’t have the final answer yet. It’s one of a group of disorders we call ‘collagen diseases.’ Doctors think they’re due to the body becoming allergic to itself-what’s called an autoimmune disorder.” No sooner were the words out of Sara’s mouth than she began to thumb through the woman’s chart.
What medications was she on? What diseases had she had recently? Could it be-There it was, just as she feared. “You were hospitalized with pneumonia a few months ago?” “Yes. It was really bad. They tell me I almost died because it was some special infection that none of the usual antibiotics would help. I guess I owe my life to Dr. Ingersoll and that new medicine of his.”
Rip Pearson frowned at the insistent buzz of his pager. He silenced the instrument, noted the number, and decided he’d return the call in a moment. He already had more on his plate than he could handle. Rip sat like a penitent, across the desk from Ingersoll, who frowned at the interruption. “Sorry about that.” “Very well,” the great man said. “Now are you clear on the things I want you to do while I’m in Germany?” “Right.” Bite your tongue, Rip. Don’t scratch the scab from yesterday’s argument. Just get through this meeting.
“Leave the big picture to me, Pearson. I promise that if you keep the Jandramycin study going, you’ll get your share of the glory.” Or the blame when it comes out that your “wonder drug” had side effects that someone chose to hide. “I know how you want the study run,” Rip had said. “How long will you be gone?” “Six days, I think. The conference is making the arrangements and covering all my travel expenses. First class all the way.” Ingersoll rolled the words on his tongue and seemed to savor them as he would fine brandy. “An invitation to speak to an international meeting like this will mean a great deal of positive publicity for our work.” Yeah, and probably a hefty honorarium. Rip knew that Jandra arranged the invitation to Ingersoll.
Pharmaceutical companies could no longer offer honoraria directly to physicians for speaking. But there were ways around those rules. One was to pay the money to a sponsoring organization with the understanding it would be
funneled to guest speakers. In the case of an international meeting like this one, it was even easier to find ways around the restrictions. Ingersoll scanned the list in his hand, nodded with satisfaction, and shoved it into the pocket of his white coat. “Now I have to work on my presentations. Do you have any questions?” Why should I? I’ve been doing the work on this study since day one. The only thing I don’t know is why the drug I’m giving people may save their lives today and sentence them to a lifelong disease or even death in the future. “No, sir. Have a safe trip.” A few minutes later, Rip was in the cubbyhole of the office assigned to him as a fellow. He checked his pager and dialed the number it displayed. “Dr.
Pearson. You paged me?” “Rip, this is Sara. We need to talk.” “Sure.
Go ahead.” “No, I don’t think this is something I want to go into over the phone. Can we get together? The sooner the better.”
Sara sat on a rolling stool and Rip perched on the edge of the exam table. The door to the treatment room was closed. There were no doctors in the clinic. The nurses and administrative personnel were at lunch, returning phone calls, or otherwise occupied. “We should have some privacy here,” Sara said. “Thanks for coming over.” “What’s up that’s so important?” “Two things. As of this morning, I only had one to talk with you about, but the last patient I saw made the list longer. Do you remember a middleaged lady named York? Pneumonia?”
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