John didn’t voice the rest of what he was thinking. In his case, did that risk go up to one in a hundred? One in ten? A hundred percent?
“Enough of that.” Rip made one more note on the pad in his lap. If this went well, he’d add the material to John’s chart. If it didn’t, he might end up shredding it to avoid losing his medical license.
“Tell me about Randall Moore.” John shifted on the exam table, trying in vain to find a comfortable spot. Finally, he gave up and swung into a sitting position with his feet dangling over the side. “All I know is what I’ve been told. He and his sister are the only children of a wealthy family. He inherited a good bit of that money when his father died and has been living offit ever since.” “Why is he suing?” “His mother was headed for the internal medicine clinic to see someone for a second opinion when she had a fatal stroke. Apparently, in Randall’s world, when something bad happens, filing a suit is a reflex action.
So he filed one against the medical center and every doctor involved with her from the time she hit the floor. I started an IV while we waited for the EMT’s.” John spread his hands. “So they threw me in for good measure.” Rip lowered his head and massaged his temples. “That’s just dandy. If his culture comes back Staph luciferus-and the odds are that it will-I can give him Jandramycin and probably save his life, but there’s a chance that he’ll get a life-changing and possibly fatal complication later.” He looked up. “But if I don’t, he’ll probably die. And as a physician, I can’t deny him treatment that would prevent that.” Even if it would put an end to his lawsuit against my friends. “There’s another possibility, you know.” “What?”
“This drug may work. If I don’t get a late complication, if Sara’s teenage patient starts to recover, we may have stumbled onto the answer. Give this to every Jandramycin patient after their course of treatment, and they’ll do fine.” “Sounds too good to be true, John.”
Rip shook his head. “Don’t get me wrong. I don’t want you to get a complication from your treatment. I hope and pray that Sara’s patient pulls through. But something inside me keeps telling me not to get my hopes up.” “I guess I hear a different voice,” John said. “Beth drummed it into me so often I can still hear her saying it. ‘God’s in con trol.’ We may not see His hand, but it’s there. And I think He’s got this covered.” Rip looked at his watch. “Well, in about an hour we’ll know what He’s got up His sleeve for you��� and the rest of us.”
The afternoon dragged, and Sara found it difficult to focus on her patients. As she walked out of every patient’s room, her eyes were drawn to the closed door at the end of the hall. How was John doing?
Any problems after the injection? Fortunately, no big diagnostic challenges presented themselves, and she was able to care for her patients without too much trouble. By five minutes to three, she was caught up. “Glenda, my next patient isn’t due for twenty minutes. I’m going to run over to my academic office for a minute.” Although she didn’t actually run, Sara moved quickly through the halls. She nodded a brief greeting to a few of the people she met and prayed that none of them wanted to stop and chat. Lillian was waiting in the hall outside Sara’s office, looking at the notices on the bulletin board but obviously paying no attention to them. “Heard anything?” Lillian said. “Not a thing. Shall we go in and wait?” Sara pointed down the hall. John and Rip were sauntering toward them, conversing in low tones. Neither seemed in a hurry to reach them. Come on. I need to know if everything went okay. hen they drew abreast of the two women, John spoke first. “Here I am, none the worse for wear.” W “No problems?” Sara asked. Rip answered with a smile. “None. Not even any itching or rash. Vital signs stable. He tolerated the drug with no problems.” His countenance turned somber. “Now we have to hope it has a protective action on patients who’ve had Jandramycin.” Sara ushered the group through the empty outer office. Her secretary’s desk was vacant. She must be on a break. “Come on in. I think we have enough chairs. I-” As her foot touched the threshold of her office, Sara’s scream was masked by the noise of the explosion.
Mark Wilcox scratched his head. He’d been calling Sara all day without success. No answer on her cell phone, no response to the messages he’d left with her secretary. He understood that she might be tied up, but he was hurt that she hadn’t called back. It was important to him to further his relationship with her. She had no idea how important it was, and maybe this was the time to let her know. He’d played his cards close to his vest up to this point, but he was about to change all that. Unfortunately, nothing was going to happen if she didn’t respond to his calls. Well, while he waited, maybe he could do a little legal work. He checked a number and dialed. “Lewis Robinette, please,” he told the perky female voice that answered the call. “May I say who’s calling?” “Attorney Mark Wilcox. I’m lead counsel in an action Mr. Robinette is pursuing.” “One moment, please, Mr. Wilcox.”
After almost a minute listening to saccharine strings playing an almost-familiar melody, Mark heard, “This is Lewis Robinette. Mr.
Wilcox is it?” “Matter of fact, it’s Dr. Wilcox. I’m an MD and JD. But I didn’t call to match credentials with you. I know your reputa tion in the legal community. Matter of fact, it’s because of the respect you’ve earned that I’m calling.” “Nice words, but you need to explain them.” “You’ve been engaged by Randall Moore to pursue a malpractice action he’s filed after the death of his mother. Along with Southwestern Medical Center and just about every doctor on its staff, he’s included my client, Dr. John Ramsey.” Mark transferred his phone to the other hand and wiped his moist palm on the bottom of his white coat. “If you don’t remove him from the suit, you’re going to end up with egg on your face.” The reply came without emotion-just a matter-of-fact question: “Exactly why do you say that?” Mark began to explain, emphasizing John’s limited activity in the event that preceded the death of Moore’s mother. Then, after considering the pros and cons of his action, he told Robinette that John had no insurance company behind him, so there were no deep pockets there for the plaintiffto mine. Robinette’s voice was calm. “My client is interested in only one thing: justice. He believes that the medical center and its doctors should pay for their negligence that deprived his mother of her life.” “And do you have experts who’ve reviewed the case and are willing to testify that such negligence exists? Do they think the standard of care was breached at any point in the care of Mrs. Moore?”
Mark decided to fire one more salvo. “Because I have some extremely qualified and persuasive witnesses who’ll shoot yours out of the water. And after the judge throws out the suit, we could consider filing one against your client and your firm for frivolous litigation, among other things.” “Dr. Wilcox, I believe you mentioned my reputation. I didn’t earn it by caving in when someone yelled ‘boo’ at me. I appreciate what you’re doing on behalf of your client. Matter of fact, I’d do the same thing if I were in your shoes. But as soon as you file an answer to the suit, I’ll review the situation. As of this time, I’m ready to proceed with discovery, and let the judicial process play out.” “I think-” Mark stopped when the click registered in his ear. Robinette was already gone, undoubtedly moving on to something else after making a note of the billable time he’d spent on the phone. Mark shrugged and dialed a number that was becoming familiar to him. He’d better let John Ramsey know about this latest call. There was no answer on Ramsey’s cell. The nurse in the general internal medicine clinic told Mark that Dr. Ramsey wasn’t scheduled to see patients that day. When the answering machine picked up at Ramsey’s home, Mark hung up. Sara wasn’t available. John wasn’t available. He leaned back in his chair, put one foot on an opened bottom desk drawer, and wondered at the connection. Could this have something to do with their Jandramycin investigation? He’d need to find out.
Rip crouched protectively over Sara. “Don’t move. Let me have a look.” She lay a few feet from the doorway of her office, huddled in the fetal position, s
obbing quietly. Rip looked at her legs. A scorch mark ringed the hem of the right leg of her slacks. The bottom of her right shoe was burned, and a violet coloration marred the black finish. Rip eased the shoe off. The skin on the bottom of Sara’s right foot was red, but there was no blood and no soft tissue damage.
There’d been plenty of noise, but apparently the damage had been minimal. “Can you sit up?” he asked. Sara complied, scooting back further from the doorway in the process. “What��� what happened?”
“You put your foot down and there was an explosion-a very limited one, but with plenty of flash and bang to it.” Lillian leaned over Sara and spoke in a soft voice. “I don’t know what it could have been.” “I’m pretty sure I do,” John said. He knelt at the edge of the doorway and sniffed. “Smell that? Smell like iodine to you?” At first no one seemed anxious to get close to the danger area, but eventually they crept forward and smelled the air there. There was a general murmur of assent. “Maybe it’s my misspent youth, filing away trivia about things that go ‘boom,’” John said. “Perhaps it comes from working my way through pre-med as a clerk in the chemistry department stockroom.” He pointed at a tiny area where dark brown crystals dotted the metal threshold that marked the junction of carpet in the outer and inner offices. “That’s nitrogen triiodide.” “I remember that,” Rip said. “My high school chemistry teacher did a demonstration with it.
Man, that produced a bigger bang than anything I’d seen, even bigger than when we dropped a sliver of sodium metal into a bucket of water.
But how did someone make this? And why put it here?” “Nitrogen triiodide is the easiest thing in the world to make, if you don’t care whether you lose a few fingers in the process,” John said. “Mix a couple of common household chemicals, filter out the precipitate that forms, and as long as it’s wet it’s supposed to be stable. But when it dries, the slightest touch, sometimes even a drop of water landing on it or a strong breeze, can set it off. I’ve heard of snowflakes detonating nitrogen triiodide. Depending on the amount involved, you can do quite a bit of damage with it.” “Should we call the police?”
Lillian asked. “We can if you want to have the building evacuated while bomb-sniffing dogs go through it and the bomb squad detonates the rest of this stuff,” John said. “If you just want to make the area safe, I suggest you call someone you trust in the biochem department.
I seem to recall that you can deactivate this stuffwith chemicals like sodium hydroxide or sodium thiosulfate.” By this time, Sara had risen from the floor and stood next to Rip, leaning on him to take weight offher right foot. “Let’s get this cleaned up and move ahead with our plans. I’m not going to let a ruined pair of shoes stop me. We’re too close.” Lillian looked at her watch. “I’m due back in clinic, and Sara, you are, too. We need to take care of that first.” Rip had his cell phone out already. “I’ve got a friend in biochem that I think will handle this for us. I’ll call him.” “And I’ll stay here to keep you company,” John said. “Meet back here at five?” Sara said. “And Lillian, walk back with me, would you? I’ve got to come up with a story to explain this burned right shoe.”
By five o’clock, an instructor in the biochemistry department assured the group clustered around the secretary’s desk that they could safely enter Sara’s office. “I neutralized the nitrogen triiodide, then disposed of it. You’re good to go.” He fixed Rip with a serious gaze. “Don’t you think this should be reported to the police?” “We’re trying to keep it quiet.” “Well, I’ll tell you. I’ve done some work with nitrogen triiodide, and this guy meant business.
If your lady friend had stepped a little more to one side or the other, she’d be walking on crutches for a while. This was no prank.”
“I know.” Rip didn’t want this conversation to go on much longer. He moved toward the door and was grateful when the visitor followed.
“Thanks again, Fred.” “No problem. Makes a change from grading freshmen medical students’ mid-terms.” “And you’ll keep this under your hat?” “Sure thing. Dinner at Ruth’s Chris Steak House will get you all the silence you want. I’ll call you to set it up.” Fred touched his finger to his forehead in a mock salute and sauntered away. The group shuffled into the office, eyes down, watching for telltale brown specks on the carpet. Finding none, they settled into chairs. Sara took the chair behind her desk. She leaned back and closed her eyes. Rip broke the silence. “Who could have done this? And when?” “When my secretary got back, I asked her about that,” Sara said. “She said she got a call to go to Shipping and Receiving to sign for a package. When she arrived, there was no package, but because that’s two blocks away from this building, the trip took her out of the office for almost forty-five minutes.” “And anyone could have had access during that time,” Rip said. “Let’s try to refocus on the problem at hand,” Sara said. “John, are you still feeling okay?” “Now that my pulse is back to normal, I’m doing fine. I tolerated the OMAL with no problem. Of course, we don’t know if I was in line to get a late complication anyway, and if I were, it would occur several weeks down the line, so this doesn’t prove anything except that patients who’ve had their immune system modulated by Jandramycin can tolerate a dose of that drug.” “That’s good enough for me,” Sara said. “I told Mrs. Ferguson I’d give Chelsea her dose tomorrow, but I don’t want to wait. I’m going over to her room and administer the OMAL now. I don’t have anything else to do, so I’ll stay with her tonight until I’m sure she’s going to be okay. Then we just watch and wait, and pray for improvement.” “I’ll stay with you,” Rip said. “Are you sure?” “I don’t have anything on the docket. Nobody is waiting for me at home either.”
Lillian looked at John. “Actually, that goes for us, too. Want us to keep watch with you?” Sara shook her head. “No, I don’t think so. We can stay in touch by cell phone. You two go ahead home.” After John and Lillian departed, Rip said, “Okay, truth time. How are you feeling after all that?” “Actually, other than a little soreness of my foot and being royally ticked at the damage to my favorite pair of shoes, I’m doing pretty well.” “Are you sure you don’t want to go home and get some rest? Another day probably won’t make that much difference in Chelsea’s status.” Sara was on her feet before Rip finished speaking.
“On the contrary, I don’t think I can rest until I’ve given her the injection. But you don’t have to hang around.” There’s nothing I’d rather do than hang around. “Call it professional curiosity if you want to, but I’d like to see this thing through with you.” Rip pushed back his chair and stood. “Let’s get going.”
23
An alarm bell intruded into Sara’s consciousness, and she was on her feet before she realized where she was. A quick glance brought it all back. She was in a corner of Chelsea Ferguson’s hospital room. Rip dozed in another chair next to her. Chelsea was in her hospital bed.
Her mother stood watch at her side. The bell stopped as quickly as it began. Rip roused long enough to say, “Somebody accidentally unplugged something. Nothing to worry about.” He yawned and stretched. “How long has it been?” Sara needed no explanation. He meant, “How long has it been since we gave Chelsea the dose of OMAL?” She did a rapid calculation in her head. “Ninety-seven minutes.” They shared a glance and a silent message passed between them. Most reactions to this drug occurred within the first ninety minutes, all within two hours. They were almost home free. “Let’s wait another half hour or so to be sure,” Sara said. Mrs. Ferguson tiptoed over to where Sara stood and whispered, “Can we talk outside?” Sara moved toward the door. Mrs.
Ferguson said, “Chelsea, I’m going to step outside for a minute. Dr.
Pearson is here, and I’ll be right back. Okay?” Chelsea didn’t break the silence she’d maintained for the past hour. Instead, she made the smallest of hand gestures to signal she’d heard. In the hall, Mrs.
Ferguson leaned close to Sara and spoke in a low whisper. “It’s been almost two hours. What do yo
u think?” Sara kept her voice low as well.
“She hasn’t shown any signs of a reaction from the OMAL. That’s the first hurdle. Now we have to see if the drug does what we hope it’ll do.” “How long will that take?” “We don’t know. I’d guess at least a couple of days, maybe a week,” Sara said. “Tell me again why you think this may work.” “The drug is sometimes called ‘anti-IgE.’ The substances that carry out the body’s immune responses are called immunoglobulins. There are five of them, named with letters of the alphabet, and immunoglobulin E-IgE for short-is the one that’s involved in what most people think of as allergy. This compound, anti-IgE, was developed to block that immunoglobulin in susceptible individuals. It keeps it from attaching to the cells where it would ordinarily do its dirty work.” “What does that have to do with Chelsea?” Mrs. Ferguson asked. “We think the Jandramycin has not only stimulated her immune system to produce special substances that kill the Staph luciferus, but also some that attack her own cells. In Chelsea’s case, it’s the nerves, and it leads to weakness and eventual paralysis. We hope that in this particular scenario, the anti-IgE will block those other substances as well.” “Do you have any reason to think this will work?” Sara had turned that question over in her mind again and again since John proposed using OMAL for this purpose. The answer she gave was what she’d come up with. “We think there’s a good chance-and we have nothing else.”
John and Rip were in the back treatment room of the clinic that had become John’s unofficial home for his Jandramycin infusions. This time there was no IV setup in view, no syringes and vials on the treatment table. John perched on the end of the treatment table; Rip sat on a rolling stool. It seemed that each was waiting for the other to speak. Rip took in a deep breath through his nose and let it out through pursed lips. He guessed it was up to him to talk about the elephant in the room. “John, you’ve had six IV doses of Jandramycin.
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