How are you doing?” John held up his hand and turned it back and forth in front of Rip. The needle puncture wound had long since healed. No redness, swelling, or any of the cardinal signs of inflammation. “I think it’s pretty much back to normal. Don’t you?” “I do, but as you know, all our success with Jandramycin has been based on a protocol of ten days of treatment. Admittedly, that number was chosen empirically, but so far it’s worked. Theoretically, you need four more doses.” Rip waited to see if John saw the same thing that was bothering him.
Apparently, he did. “But since I’ve had the IM injection of OMAL,”
John said, “my immune system has been tweaked, hopefully to the point that the Jandramycin won’t have any further effect. The good news is that my chances of getting a late autoimmune problem may have been reduced, maybe even down to zero. On the other hand��� ” “Yeah, on the other hand, any more Jandramycin you receive would probably be ineffective against Staph luciferus if there are some still in your body.” “So I’m stuck at this point. Just wait and hope the bug’s been killed out.” John shook his head. “Guess I can add that to worrying about whether that needle-stick exposed me to HIV.” Rip reached out and gripped John’s hand. “So far, your labs look clean from that standpoint. But remember, I’m in this with you. And we won’t go down without a fight.”
Rip entered Randall Moore’s room ready for almost anything, but not for the sight that greeted him. Jack Ingersoll and Donald Schaeffer had their heads together at Moore’s bedside. Each doctor wore a white lab coat. A stethoscope dangled from Ingersoll’s neck, while Schaeffer held his at his side. Their demeanor suggested serious consultation, such as would befit two heads of state rather than two physicians at a medical center. Rip turned his eyes from them to Moore. His previously pale skin was darker now, but not with a healthy tan. His lips had a bluish cast. The man wasn’t getting enough oxygen into his blood, even with pure oxygen flowing into the mask that covered his face. His respirations were slow and shallow. Moore was dying before Rip’s eyes. “What’s going on?” Rip asked, trying to keep his voice level. “I was in the bacteriology lab and the chief technician showed me the final results from this patient’s sputum culture. He has a Staphylococcus luciferus pneumonia, which is why the nafcillin you ordered has been ineffective.” “I suspected as much,”
Rip said. “I just phoned the lab and got the final culture report myself. I’ve already talked with Dr. Miles about it, and she’s on her way to meet me here. We plan to discuss treatment alternatives with her patient.” He pointed to the man in the bed. “But I don’t think he’s in any shape for a discussion. We’d better-” Dr. Schaeffer turned to face Rip. “Dr. Pearson, the reason I’m here is that Dr. Ingersoll thought it best, given the high profile status of this patient, that he take over the case. After reviewing the situation, I tend to agree.” He frowned. “I don’t want you to think this is a criticism of Dr. Miles’s clinical ability or of yours. I just think it’s more��� expedient that the Chief of the Infectious Disease Service assume Mr. Moore’s care.” Rip knew exactly what was going on. Moore was the plaintiff in a huge suit against the medical center. Currently his treatment was under the supervision of a junior faculty member and a fellow in training. Schaeffer wanted his high-profile professor treating Moore, in hopes that a good outcome, coupled with this display of the resources available at Southwestern, would convince the man to drop his suit. “I can’t speak for Dr. Miles.
Personally, I don’t care whose name is on the chart.” Rip pointed to the small device on Moore’s index finger. “But look at the pulse oximeter. His oxygen saturation has dropped to dangerous levels. We need to get him intubated and on a ventilator.” “I’ve already put in a call for someone to do that,” Ingersoll said. “And I plan to write the orders to add Mr���” He consulted the chart in his hand. “Add Mr.
Moore to the Jandramycin study. You will, of course, draw the necessary blood work, administer the drug, all the things you’ve been doing so well.” “What about permission?” Rip asked. “He’s too far out of it to give informed consent. Let me contact his next of kin. Maybe they can sign.” “Not necessary,” Ingersoll said. “Given Mr. Moore’s inability to make that decision right now, Dr. Schaeffer and I will sign the permission, which, as you know, is possible in the case of a medical emergency where delay is unacceptable.” Rip’s guts began to churn. This was wrong, all of it. There was no need to wait for an anesthesiologist or pulmonologist to do the intubation. Rip was perfectly capable of carrying out the procedure, but apparently, Ingersoll wanted it done by another specialist-under his direction, of course. As for treatment with Jandramycin, Rip had come here with his mind made up. The only proper course was to lay out the risks and benefits of treatment with Jandramycin and let Moore decide.
Unfortunately, Ingersoll was totally ignoring the risk that Rip felt the drug presented, a risk of late complications that would be life-changing in all cases and fatal in some. Since Moore was unable to make that decision, Ingersoll was taking the responsibility of deciding for the patient, and Schaeffer was going along with his division chief. So be it, Rip thought. He turned on his heel and left to gather the material he’d need. He was back to drawing blood, giving medications IV, and charting vital signs. And if he was later asked why he didn’t protest Ingersoll’s actions, he guessed his response would be that he was just following orders. Wasn’t that the excuse of the prison guards at Dachau?
Sara sat in her living room, slumped in her favorite chair, when the doorbell brought her up from a half-sleep. Was this Rip again?
After he gave her the news about the decision of Ingersoll and Schaeffer to replace her as Randall Moore’s primary physician, he’d asked if he could buy her dinner. She told him all she wanted to do was go home and relax with a hot bath and a pint of Cherry Garcia ice cream. Although she hadn’t made it past the living room, she had a full-fledged pity party planned, and she resented this intrusion. She tried to ignore the bell, but whoever was at her front door apparently had more persistence than a bill collector on commission. “I’m coming,” she mumbled under her breath. She eased out of her chair and padded to the door on stocking feet. Halfway to the door, she heard the distinctive splash of rain dripping from her roof. When had it begun to rain? She put her eye to the peephole, only to discover that while she was napping, darkness had covered the world. Sara snapped on the porch light and saw a thoroughly soaked and bedraggled Mark Wilcox standing there. She unlocked the door and said, “I’m so sorry. Come in.” As soon as he was inside, she said, “Stay right there. Let me get you a bath towel or something.” Sara grabbed a couple of thick towels from the bathroom, hurried back, and handed one to Mark, who nodded his thanks. “You know, this wouldn’t have happened if you answered your phone��� or replied to my text messages��� or my voicemails.” “I’m sorry, Mark. It’s been a terrible day, and I didn’t feel like talking with anyone.” Sara took the sodden towel Mark handed her and gave him the second one. “When you’ve dried a bit, come on into the living room. I’ll make some coffee.” “Hot coffee sounds good.” Mark finger-combed his hair. “Here’s your towel back. Shall I use it to mop up the puddle I’ve made?” “Just drop it there. I’ll deal with that later.” She led him into the living room and pointed him to the couch. “Let me give you another towel to sit on, though.” “I can stand,” Mark said. “I don’t want to take all your towels.” “Don’t be silly. I got lots of them as shower gifts when Jack and I��� ” Sara felt the words clog her throat. She tried again. “I have plenty of towels.” Sara brought coffee in thick white mugs, and when they were settled in the living room she said, “So what’s so important that you’d risk drowning to come here and tell me in person?” Mark blew across the top of his mug, then sipped. “What’s going on? I thought there was some mutual attraction between us, but now it seems like you’re keeping me at arm’s length. Did I do something wrong?” Sara shook her head. “It’s not just you. Ever sinc
e Rip and I began trying to dig out the truth about Jandramycin, someone’s been after us. I’ve been shot at. Rip was almost killed in a car accident. And you don’t even know about the latest attack. Do you blame me for not enlarging my circle of friends at this point?” “I thought I was already in that circle.” Mark frowned. “And I hoped I was more than a friend.” Sara felt a tingle of apprehension within her chest. What now? She waited for Mark to go on. “My wife and I were childhood sweethearts. We married when I was in law school, and I was happier than anyone has a right to be. Then one day, I got a call from the police. She was dead, killed in an auto accident. My world crumbled. I was resigned to life as a widower until I met you.” She didn’t need to hear this. Not now.
And not from Mark. She opened her mouth, then closed it. Let him talk.
“You and I had that one dinner, and I felt like everything clicked.
I’ve wondered if somehow my finding that digital device in your attic made you feel ashamed to be around me, ashamed I’d find out the kind of marriage you had.” “No, I-” “All that made me feel was angry, so angry at Jack Ingersoll that I wanted to shake him. How could anyone do that to you?” Mark leaned forward, his coffee forgotten. “Sara, I’m serious about this. If you want to hold me at arm’s length until this Jandramycin thing is settled, I’ll wait. But I’m not going away.”
Sara’s head was spinning. She had to admit, there was an attraction there, but there was also an element of doubt. It was hard to trust anyone she didn’t know. And hadn’t John told her Mark’s practice was a blending of medicine and law, including some consulting for pharmaceutical companies? Was one of those Jandra? Could Mark-No, she couldn’t think about this right now. “Are you going to say something?”
Mark asked. “I’ve spilled my guts, but I have no idea what you’re thinking. Where do we stand, Sara?” Sara held her mug in both hands and brought it to her lips. The coffee was cold by now, but she needed something to buy time. She finished the coffee and reluctantly set the mug aside. “Mark, I like you. I can see us possibly going forward in a relationship at some point, but not now.” “So you don’t trust me?” The hurt in his voice was plain. “I don’t trust anyone! Especially someone who might have ties to the company that’s quite likely behind efforts to kill me, the way they’re willing to risk killing patients in the name of science.” Sara bit her lip. “I’m sorry. That’s not fair. But this is a terrible time for you to want to take our relationship to another level. Can’t you understand? Can’t you be patient?” Mark stood and placed his mug on the table gently, as though it were made of fine china. “Can’t I understand? No, frankly, I can’t. I thought you trusted me. Less than a week ago I sat with you, Rip, John, and Lillian and talked about working together to solve the Jandramycin puzzle. Now you’re freezing me out-out of that group and out of your life.” His shoes made a soft squishing as he stalked toward the door.
“Well, I can take a hint.” He closed the door softly behind him, leaving Sara alone. She padded to the front door and listened until his car pulled away. She wanted to call him back. Instead, she knelt with a towel and began to mop up the puddle of water where he’d stood, a puddle dotted with tiny circles from her tears. Not for the first time, Sara wished she could hit the rewind button on her life.
24
John Ramsey matched Lillian’s slow, measured pace as they walked together toward the medical center’s parking garage. The rain of the past two days had left behind puddles to trap the unwary. It was fully dark now, and the security lights on the buildings he passed cast shadows that made John think of the childhood night terrors he experienced after reading a ghost story at bedtime. Only this time, the terrors were with him day and night, and had nothing to do with scary tales. No, they stemmed from the work of evil men-he had no idea how many-who were more interested in their own gain than the well-being of countless patients. “John, you don’t have to walk me to my car,” Lillian said. “I can look out for myself. I’m a grown woman.”
“With Mace in her purse, I’d wager.” “Matter of fact��� ” He caught a glimpse of her grin in the reflected glow of headlights as cars began to stream out of the parking structure. John decided to risk it.
“Would the unafraid, grown woman like to have a cup of coffee, or even dinner, with the courtly gentleman who insists on escorting her through the shadows?” There was a hiatus in the parade of cars. Now darkness veiled Lillian’s face. Was she frowning, smiling, what? Then John felt her hand take his. “I’d be pleased to, John. Remember, though-right now I’m just a friend.” “I know. And I appreciate your sensitivity. But a friend is what I most need.” Half an hour later, they were seated in a back booth at Amberjack, one of the nicer restaurants in town. Lillian looked at John over her menu and said,
“I’ve always wanted to come here, but I could never bring myself to dine alone at one of these places.” “I know. I tried it once after Beth died. Since then, I don’t think I’ve eaten out anywhere except fast-food restaurants. They sort of look at you funny, don’t they?”
“You’re exactly right,” Lillian said. She returned her attention to the menu. “I think another reason I don’t try to eat out alone is that there’s no one to split an entree with me. My late husband and I used to do that all the time. I guess I could take half my meal home and heat it up later, but it never tastes as good as when it’s fresh.”
John felt his eyes growing moist. “Beth and I split entrees all the time.” He drank some water, then wiped his mouth and used the motion to touch his napkin to the tears on his cheeks. “I’ll be happy to pay for whatever you want, but I have to ask. Would you like to split an entree tonight?” “I’d love it.” Their discussion went back and forth like an engaged couple picking out a silver pattern. John had been here before and knew that the side dishes were large. When the waiter returned, he said, “We’d like to split the Hawaiian snapper, with a side order of potatoes and vegetables. And please have them divide that in the kitchen.” “I’m sorry, sir, but our chef says that splitting an order disturbs the presentation of the dish.” John tried hard to maintain a stern expression. “You can ask the manager to come to the table, and I’ll discuss your policy with him as well as anyone else within earshot. Or you can convey my compliments to your chef and tell him that we’re more interested in the taste of the food than its appearance. And, by the way, the longer we sit here without something to eat, the more testy I tend to become.” “Very well, sir. I’ll ask the chef to divide the order for you.” “Thank you��� ” John squinted at the nametag the man wore. “Thank you, Henry. I appreciate your doing that. I’ll be certain to remember it when we’ve finished.”
As Henry hurried off, undoubtedly to tell the chef about the demanding customer in booth twelve, Lillian giggled behind her hand. “John, you should be ashamed of yourself for coming down on that poor man that way.” “No,” John said. “The restaurant should be ashamed of itself for such an obvious ploy to make people order more food than they should eat.” He helped himself to a roll and buttered it. “Besides, what good is having a dinner companion if you can’t show offfor her a little bit?” As they chatted, waiting for their meal, John realized that for the first time in several days he wasn’t worried about his HIV tests, or his recovery from Staph luciferus, or the person or persons unknown who didn’t want him and his colleagues to discover the truth about Jandramycin. He had a friend-someone to talk with, someone to encourage him, someone who might��� No, that would be later, if at all. For now, a friend was more than enough.
The three men gathered in Dr. David Patel’s office showed no outward evidence of the stress they bore. Patel presided from behind his desk, the coat of his gray pinstripe suit unbuttoned to show a pristine expanse of dress shirt on which a black and gold rep-stripe tie nested. Dr. Bob Wolfe was seated across the desk from Patel. A white lab coat with his name embroidered over the breast pocket covered his blue oxford-cloth button-down shirt worn open-collared.
His dress signified that, although he was a professional, he worked in the trenches with the lab techs and others he supervised. Steve Lindberg had taken his usual seat at the edge of Patel’s desk, halfway between the other two men-neutral in all respects, the Switzerland of Janus Pharmaceuticals. A Grateful Dead tie hung at half-mast on a wrinkled dress shirt. His jacket had been deposited on the back of his office door when he arrived this morning, and he wouldn’t retrieve it until he left the building. “Gentlemen, this meeting will be brief,”
Patel said. “Bob, what’s the status of our NDA for Jandramycin?” Wolfe cleared his throat. “Because of the unusual circumstances, the FDA appointed a special advisory committee to consider it. They’ve received clear marching orders from on high to fast-track it and recommend approval. They’re working on it, and as I understand it, they’re scattering exceptions and waivers along the way like beads from a Mardi Gras float. The wheels have been greased for approval.”
He rubbed his thumb and fingers together in a symbol everyone recognized. “It’s costing-” “I don’t need to hear that,” Patel said.
“We’ll approve the amount, whatever it is.” He swiveled toward Lindberg. “And the marketing campaign?” Lindberg beamed. “First rate, if I do say so myself. The ad agency came up with some great slogans and visuals. We have ad space reserved in every major medical journal, and until we have approval to market we’re using it to ‘tease’ the forthcoming breakthrough that’s the biggest antibacterial advance since penicillin. Our sales force has been trained. We’ve brought key docs and thought leaders to resorts for what we call ‘advisory panels.’ We make them sign a confidentiality agreement, then bombard them with information about Jandramycin so when it launches we have a ready-made set of lecturers. We’ll send them out to national meetings and saturate the medical community with our message.” “Again, whatever you need to spend, I’ll approve it,” Patel said. “I’ve received word that the scientists at Darlington Pharmaceuticals are on track to develop a compound that is as effective as Jandramycin against Staph luciferus. Not only that, it has better activity against other bacteria than our drug, and although there is a risk of minor immediate reactions-rash, GI upset, and so forth-there’s not a hint of severe or late problems.” He waited for the import of those words to sink in. “We all know that the first drug on the market gets an almost unbeatable advantage on the ones that follow, even if they’re better.
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