Carter Resnick opened the door to his lab a crack and peered out at Rip with one eye. “What do you need? I’m collating data right now.”
“We need to talk.” “I didn’t think you had time to talk with a lowly research associate.” Rip bit back the reply that came to his lips. He needed this information, and maybe Resnick had it. “Carter, that’s not true. I’ve always had time for you. Surely you can spare five minutes for me.” Resnick’s visible eye blinked several times. Rip could almost hear him thinking. Finally, the door opened wide enough for Resnick to slip through, then closed behind him with a solid click. Resnick jiggled the knob to confirm the door was locked. He turned to face Rip and crossed his arms. “Okay, talk.” “Carter, be reasonable. Can’t we sit down somewhere like two colleagues and have a discussion? Why don’t we go into the lab?” Resnick was shaking his head before Rip finished talking. “No way. Dr. Ingersoll only allows two people in that lab: himself and me.” “I thought there was a lab technician, too.” “No. When we got to a critical point, Dr. Ingersoll discharged the tech. I do all the work now. It’s a matter of security.” “Carter, most of that data you’re collating came from me. What could be in there that I don’t already know?” Resnick grinned. “That’s for me to know and you to find out.” Rip decided that Resnick’s schoolboy response effectively closed the door-quite literally-on any hope of his getting into the lab. He leaned against the wall and fired his first salvo. “I need to know what exactly is in Jandramycin. I have to find out what its exact mode of action is.” “The main thing anyone needs to know is that it kills Staph luciferus. Some people postulate that Jandramycin works by attacking the bacteria’s cell wall. Its real mode of action probably won’t be revealed until Dr. Ingersoll and I publish that information.” There it was. Resnick figured that his work would get him co-authorship of the papers that were sure to come, papers certain to be the lead articles in JAMA and the New England Journal. Until that happened, Resnick would move heaven and earth to stay on Ingersoll’s good side, and if that meant standing guard on the laboratory and the data it contained, so be it. “Look, Carter, it’s important that we know how the drug works. People who received it are turning up later with autoimmune disorders that are disabling and potentially fatal.” Resnick didn’t seem surprised. “Everyone?” “No.”
Rip did some quick calculations. “It seems like maybe 15 percent of the patients are at risk. But we don’t know which ones they are.”
There was a muted buzz from the pocket of Resnick’s lab coat. He held up one finger to Rip. “I’d better get this.” It was a brief and mainly a one-sided conversation. Resnick said, “I can’t tell you that” a few times and punched the button to end the call. He dropped the phone into his pocket and said, “That was Dr. Miles. She asked me the same question you did. You all should coordinate your efforts.” “Carter, listen to me. Lives are at stake here. Why won’t you give me this information?” “Actually, you already have enough clues. You’re the diagnostician. Figure it out.” With that, Resnick executed a quick about-face, opened the lab door with a key he produced from his pocket, and disappeared inside.
Lillian grabbed the chart from the plastic rack and tapped on the exam room door. Without waiting for a reply, she opened it and walked in. “I’m Dr. Goodman. What kind of-” Her usual greeting to patients died in her throat as her eyes registered the scene before her. John Ramsey lay on the exam table with an IV running into his arm. “John, what-” “Easy, Lillian. I’m fine. I’m just getting my first dose of Jandramycin.” She glanced down at the name on the chart she held: John Matthew Ramsey, MD. Lillian had her finger inside the cover, ready to open the chart, when she stopped. No, John would tell her what he wanted her to know. She pulled over a stool and sat down beside John, covering his hand with her own, careful to avoid the small plastic cannula that carried medication into the vein in his forearm. “What’s going on?” “It all started when this lady doctor I know thought I might be getting an infection around a puncture wound of my hand and insisted I see someone about it.” He grinned, trying to rob the words of any sting. “The culture grew Staph luciferus. So, now I’m on Jandramycin.” “John, I’m so sorry. But I’m glad Rip did the culture,”
Lillian said, “and even happier that we have something that will knock out the bacteria. I mean, just a few months ago we had nothing, and these infections were potentially fatal.” “Right. The drug should take care of the Staph luciferus infection, and that’s good. What you don’t know, and I guess it’s okay to let you in on the story, is that some patients who received Jandramycin are turning up with various autoimmune diseases, most of which can be fatal. So there’s a chance that I may save my hand at the risk of developing something just as bad-maybe worse-down the line.” That brought a dozen questions to her mind. “I thought Jandramycin was supposed to be so wonderful. One hundred percent effective against the most dangerous pathogen we’ve seen since the black plague, but with no side effects. Why didn’t someone warn us before we began to use it?” “It’s an experimental drug, Lillian,” John said. “When we get informed consent to administer those compounds, all we have to go on is the information the manufacturer gives us. And in this case, that didn’t include the whole truth.” “Surely Jack Ingersoll had some inkling about all this.” John winced, and Lillian realized she was holding his hand tightly. She relaxed her grip, just lightly covering John’s hand with hers.
“Sorry.” “No problem. At least the drug is painless going into the vein. To address your question, we don’t know what Ingersoll knows about all this. At first, everyone involved was happy that Jandramycin worked so well and had no apparent ill effects. That’s why he and Jandra Pharmaceuticals were rushing to get FDA approval. Thousands of people have already died from Staph luciferus. Every day’s delay condemns more.” “Surely Jack suspected something,” Lillian said. “When Rip and Sara first suspected that it might cause autoimmune problems, they confronted Ingersoll about it, but he denied that any problems exist. Now it’s as though he has blinders on.” Lillian squared her shoulders. “Let me do some reading. Maybe there’s something we can do to prevent these complications.” “We’re already working on it, but we haven’t had much luck so far.” “Who’s ‘we’?” “Sara, Rip, and me. Oh, and another one of my former students, Dr. Mark Wilcox. He practiced law before he went to med school. Now he’s an FP.” “Well, like it or not, you just added another member to your group. When and where are you going to get together next?” She rose and gave John’s hand a final, gentle squeeze. “You and I can supply something none of the other three have.” “And that is?” She forced a smile. “Experience.
I’ve been practicing medicine for thirty-five years. I guess with you it’s closer to forty. We’ve seen situations those young pups have only read about. They don’t know it yet, but they need us.”
“How are you today?” Sara Miles did her best to put a smile in her voice as well as on her face as she approached Chelsea Ferguson’s bedside. “About the same,” Chelsea said, her tone flat, her face expressionless. Mrs. Ferguson, seated on the other side of Chelsea’s bed, shook her head and mouthed the words, “Not good.” She took a tissue from her pocket and wiped the corners of her eyes. Sara’s neurologic exam bore out Mrs. Ferguson’s words. The weakness in Chelsea’s legs was much worse, and the reflexes there were virtually absent. Even more worrisome, the girl was losing strength in her arms.
This was the reason clinicians had originally given GBS the name Landry’s ascending paralysis. The paralysis might progress upward until the patient was unable to move and required the assistance of a ventilator to keep breathing. Sometimes the symptoms resolved, although it could take weeks or months. But sometimes they were permanent. Still at the bedside, Sara flipped open the chart and scanned it. Anna Pearl’s last note was brief, and not at all encouraging. “Progression of weakness in lower extremities, early signs in upper extremities. Will discuss adding further Rx to steroids.” Sara racked her brain to come up
with something more to add. She’d have to call Anna and see what the neurologist had in mind.
Sara gave Chelsea’s hand a final squeeze. “You hang in there. We’ll lick this yet.” As she’d come to do, Mrs. Ferguson followed Sara into the hall. “She’s getting weaker. Can you do something?” “I’m about to talk with Dr. Pearl about adding another medication for Chelsea. You heard what I told her. We’ll lick this thing.” Sara patted the woman’s shoulder and turned away, hoping she’d done it quickly enough that Mrs. Ferguson didn’t see the tears that strained for release from her own eyes. Anna Pearl answered her page within a few minutes. “Anna, this is Sara Miles.” “Oh, yes. We need to talk about Chelsea Ferguson.
Her paralysis is progressing.” “I know. I just saw her. What do you suggest we do?” A name jumped into Sara’s mind. “Could we add something like methotrexate?” “Interesting that you should suggest that. I thought about an antimetabolite, but when I did a literature search, these compounds have been tried and don’t add much.” Ideas were coming to Sara fast and furious, and she didn’t try to filter them as they entered her mind. “What about immune globulin?” “That’s what I was considering. Not every study supports its use, but sometimes it helps. And one dose IV should be sufficient��� if it’s going to work.” “A milligram per kilo?” “Make it two,” Anna said. “If we’re going to hit this, let’s hit it hard. And keep your fingers crossed.” I won’t just keep my fingers crossed. I’ll be praying this works-because if it doesn’t, I don’t know what I’ll do. I’m out of ideas.
17
” John, you’re a hard man to track down. ” Mark Wilcox pulled out his bottom desk drawer and rested a polished cordovan loafer there. He switched the phone to his other hand and began to doodle on a legal pad. “We need to talk about your malpractice case.” “I’m sorry I haven’t returned your calls. There’s been a lot going on.” “I’d love to hear about it. When can we-” “Just a second.” There was a muffled exchange. “Sorry. I’m still in clinic and had to answer a question for my nurse. Can we meet this evening sometime? Come by my house and we can talk over coffee.” Mark scanned through the possibilities. “I’ve got a better idea. I have to see a few more patients, then go by the hospital for a bit. Why don’t you come by my office a little after six? If Sara Miles and Rip Pearson are free, we could all meet somewhere for dinner and pool information on the Jandramycin front.”
He scrawled a note on the pad in front of him. “Del Frisco’s has a private dining room. I can have my secretary reserve it for seven thirty. My treat.” “I guess I could check with Sara and Rip.” “That would be great. When you know for sure, call my office and Karla will take it from there.” Mark smiled at the prospect of seeing Sara again, even if he did have to share her with others at dinner. This time, maybe their evening together wouldn’t end when the meeting broke up.
“See you around six.” Mark was smiling when he shrugged into his white coat and walked out of his office to see his next patient.
“Why the worried look?” Lillian Goodman pulled out a chair and joined Sara Miles in the clinic’s break room. “Thinking about a patient,” Sara said. She held her Diet Coke to her forehead and closed her eyes. “Why is it always the nice ones who have the complications?”
Lillian’s first thought was John Ramsey. If she had anything to do with it, he wasn’t going to be one of those nice ones who didn’t do well on treatment. She made a mental note to ask Rip Pearson for more information on the Jandramycin late effects John had mentioned. “Which patient is this?” Lillian asked. “Chelsea Ferguson. She almost died from Staph luciferus sepsis, but we pulled her through with Jandramycin. Then she developed Guillain-Barre. We think the drug produces autoimmune disorders in some patients who receive it.” No need to go to Rip. This was all the opportunity Lillian needed. “And now John is one of those patients. What can we do to protect him and the others from those side effects?” “We’re checking into-Wait a second. Who’s this ‘we’?” “The other day I found John in a treatment room getting his IV meds. He told me that you, Rip, and another doctor were trying to solve the problem, hopefully before he gets one of those complications.” Lillian sat up a bit straighter. “I’m inviting myself into the group.” “But why-” “Because as a doctor, I’m dedicated to healing people, not making them worse, and I’ve contributed a couple of my patients to the Jandramycin study. So I feel an obligation to look out for them.” She pushed back her chair. “And because, frankly, I’m growing fond of John. He’s been through a lot, and I think right now he needs a friend. I’ve volunteered for the position.”
John Ramsey rattled the knob of Mark Wilcox’s office door, but it didn’t budge. Repeated taps on the door brought no response. He had his cell phone out when he heard footsteps in the hall behind him.
“John, sorry to keep you waiting.” Mark hurried up and pulled a set of keys from his pocket. “I got tied up at the hospital. Come on in.”
When they were settled in Mark’s office with soft drinks, John looked around at the office. Simple and functional, much like the one he’d had for years. “You seem to have a nice setup here.” Mark leaned back and propped one foot on his desk drawer. “I like it. As I told you, I have a limited family practice but still manage to do a little law as well.” “Do you think that as your medical practice gets more active, you’ll do less law?” “I don’t see that happening,” Mark said. “Things have settled into a pattern, some medicine, some law, sometimes a combination of the two. For instance, I’m a consultant to the in-house counsel at one of the private hospitals in the city. The reason I was delayed was because he and I were meeting with the administrator and the chief of staff. There’s a rather sticky problem with one of the physicians who has privileges there.” “So what’s new with my case?”
John asked. “I’ve been in touch with the attorney representing the plaintiff. Frankly, he’s never handled a malpractice action, and I think he filed this as a favor to the guy who brought the suit. They move in the same society circles.” Mark lifted his can of soda, found it empty, and put it down. “If it looks like we’re going to trial, he’ll probably turn it over to someone who does this kind of thing all the time.” “If it comes to trial? So it may not?” “Filing the suit is only the first step in the dance. This is what I used to call an ‘I’ll get you for this’ suit. From what I can tell, the son of the woman who died thinks everything around him should be perfect, and if it isn’t, someone has to pay. Never mind that his mother refused to follow her own doctor’s advice and wasn’t taking her medications. Matter of fact, she was visiting the faculty clinic at the med school for a second opinion because her daughter insisted on it.” Mark picked up a pen and began twirling it between his fingers. “The daughter, by the way, opposes this suit.” John’s heart hammered against his sweat-soaked shirt. “What happens now? Can you get the court to remove me from the suit? All I did was start an IV.” “Not likely to happen. A suit like this is filed against every person and entity involved. The plaintiff-that is, the person who sues-could amend the suit, but I doubt that will happen while there’s a possibility of getting something out of you. And the courts probably wouldn’t allow it anyway. They prefer one trial for everyone.” “And if it comes to trial?” “One thing they teach us in law school is to always try for a settlement, because there’s really no way to predict what a jury will do. A trial is the last thing we want, and my goal is to avoid one.” “Does this mean I might end up paying to settle a suit against me that has no merit?” Mark spread his hands. “I’m going to do my best for you, John. I’ll let you know what happens. And I’ll warn you, these things can drag out for months, sometimes a year or more.” So there it was. John had come here hoping to hear good news, but there was none. Just like everything else that happened to him lately, the only thing to do was wait. John wondered how much more of this he could take. And as quickly as the thought flashed into his mind, the answer came. The same answer he and Beth had given each other whe
n the tough times came over four decades of marriage. I don’t know. But God’s in control. Mark looked at his watch. “We’ve got a few minutes before it’s time to head to the restaurant. May I ask you a question?” “Sure.” “Is Sara Miles seeing anyone?” John ran that through his mind and came up blank. “I’m not sure I’d know if she were, but I’ve never heard her mention anyone. I think she’s still hurting pretty badly from the loss of her baby and her divorce.” “But that was��� how long ago? A couple of years?”
“About that. But people heal at different rates. Why do you ask?” Mark cupped his chin in his hand for a moment. “You may recall that when I was in medical school, I was married.” He held up a hand that bore no ring. “Now I’m not.” “I didn’t want to say anything, but yes, I noticed.” “My wife died almost two years ago in a head-on crash with a driver who was going the wrong way on Central Expressway.” “Mark, I had no idea,” John said. “I’ve never even looked at another woman until I met Sara. And ever since then, I can’t get her out of my mind.” “So the fact that she was the target of a shooter-” “It almost killed me to hear about it. And if she feels about me the way I do about her, I don’t plan to let her get away. I feel like this is a second chance for me. Maybe it’s a second chance for both of us. And I’m not going to waste it.”
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