Lethal Remedy

by Richard Mabry

  Ingersoll craned his neck to look at the rear of the aircraft in time to see the lead flight attendant replacing the AED in its case, and the EMT spreading a blanket over a form stretched out in the aisle. Good thing he hadn't volunteered his services. He probably couldn't have done more than the emergency medical technician, and undoubtedly the paperwork at Las Vegas would be a nightmare. He just hoped he wasn't going to be delayed too long. Then again, he supposed a night in Las Vegas wouldn't be all that bad.

  Sara scanned the numbers on Chelsea's chart. Fever coming down. Blood pressure holding stable now. Twenty-four hours since adding the additional antibiotics to the girl's treatment regimen, and Sara could hardly believe how much improvement she saw. Had they made a good guess in choosing empiric therapy, or was EpAm848 making a definite difference in the septic shock, as well as the Staph luciferus infection?

  "How are you feeling?" Sara put her hand to Chelsea's forehead and was gratified to note that it was much cooler.

  "Okay, I guess." Was Chelsea's voice stronger, or did Sara imagine it because she wanted to see signs of recovery? No, she definitely seemed better.

  As usual, Mrs. Ferguson was at her daughter's bedside. "Whatever that new medicine is, I think it's helped. She seems stronger. And she actually ate a little this morning." She forced out what was probably her best effort at a smile.

  "How's the patient this morning?" Sara made room for Rip at Chelsea's bedside and handed him the chart.

  "Seems better," she said. "Check out her temp and vital signs."

  He nodded his approval. "Looking good."

  With a promise to return that afternoon, the two doctors stepped outside and settled into chairs at the nurses' station. Rip said, "I need to get some follow-up labs."

  "What do you want? I'll order them," Sara said.

  "Nope, I've got to draw them myself. That way, I'll know the blood gets to the right places."

  "Places?" Sara asked. "Where will it go besides the hospital lab?"

  "Some of it goes to Ingersoll's lab. Those tests are part of the study, and apparently part of his deal with Jandra is that they fund his own private research lab."

  "Where is it? I thought I knew where everything was in the internal medicine department."

  Rip gestured vaguely to the north. "He negotiated for some space in the Parkland Hospital building. Nobody is allowed in but Carter Resnick and the one tech that works there. I have to call over and let them know I'm coming. Then I knock, hand over the tubes of blood, and have the door slammed in my face."

  "Why all the secrecy?"

  "Sara, you know Jack Ingersoll as well as I do—probably better. What's his first priority?"

  Sara didn't even have to think about it. "Jack Ingersoll."

  "Right. And the fewer people who know about his research, the more secure he feels. I maintain the case log, but all I do is chart the patient responses and enter the lab results I'm given."

  Sara pondered that for a moment. "That makes me wonder. If Jack wanted to keep any data hidden . . ."

  "No, there are two parallel studies going on in Europe. Jandra sends updates to Ingersoll on a regular basis. The results are pretty much the same as the ones we're seeing. Almost identical, in fact."

  "But you don't correspond with those investigators?"

  "Don't even know their names. Jandra is keeping all that under wraps."

  Sara decided not to pursue the matter. For now, it was probably enough that Chelsea was improving. There might be a firestorm when Ingersoll returned and discovered that two antibiotics had been added to his patient's treatment regimen, but she'd deal with that when it happened. She'd handled Jack's tantrums before. As for the secrecy . . . well, if Jack was hiding anything, it certainly wasn't preventing the EpAm848 from working yet another miracle, this time for her patient. And for now, that was enough.

  Sara was deep in thought as she emerged from the medical center library. The force of the collision made her head snap up, and she found herself looking into kindly gray eyes that the lenses of wire-rimmed glasses couldn't hide. The hair was a little grayer, a little sparser. But the smile was still there, the one that had calmed her when the world seemed ready to crumble around her. "Dr. Ramsey. I'm so . . . I mean, I . . . What are you doing here?"

  "Are you all right?" John Ramsey asked. "I'm sorry I collided with you. I guess I'm sort of preoccupied."

  "I'm fine." She paused a beat. "Do you remember me?"

  "Of course. Sara Miles. Or is it Ingersoll now? How have you been?"

  She flinched inwardly. "It's Miles. I kept my maiden name. Which made it easier when Jack—" She hurried on before he could ask about that. "Never mind. I'm fine. After I finished my residency here, I was invited to stay on as a faculty member. I'm an Assistant Professor in Internal Medicine."

  "Wonderful. Then we'll be colleagues. I'm retired, but I'll be joining the faculty part-time, working in the General Internal Medicine clinic."

  "That's where I spend most of my time. And I look forward to working with you."

  As she watched Ramsey's retreat down the hall, Sara was transported back to her senior year in medical school, to a time when she sat in Ramsey's private office and cried until she thought there couldn't possibly be any more tears in the world.

  "I didn't get the residency I wanted," she snuffled. "I thought my interview in New York went really well. My grades are top 10 percent of the class. My letters of recommendation were perfect. Why didn't I get it?"

  Ramsey had leaned back in his chair and tented his fingers. "Sara, you matched here at Parkland. That's a fantastic internal medicine residency, and I suspect there are about a hundred medical students who'd give their right arm for the opportunity you now have."

  "But I had my heart set on Mount Sinai. That's where Brett's going to do his surgery residency. We had it all planned out."

  "If you and Brett are really in love, you'll make the longdistance relationship work. If not, this is the way you'll find out." Ramsey leaned forward across his desk. "God has a plan. It may not always be the one we have in mind, and generally it's not on our schedule, but He's in control."

  He'd been right, of course. It had taken Brett six months to become engaged to a socialite in New York, and Sara had met and married Jack halfway through her residency. Now her old mentor would be working with her, and at a time when it appeared that she might need some support. Funny how things work out. Just like you said, Dr. Ramsey. Just like you said.

  John Ramsey tried to concentrate on what Kim was saying, but his mind wandered. The office he sat in was a marked contrast to the one occupied by Dr. Schaeffer. If the administrator worked in such a small, plain space, why did the Chairman have an office big enough to garage a fleet of cars? John had always pictured working at the medical school as something that was first class all the way. Apparently, that condition was sort of like the spring showers in North Texas—present in one spot and absent in another. And he suspected that the staff sometimes resided in the dry area.

  The salary on the sheet Kim handed John was decent, although nothing like what he'd made in private practice. On the one hand, he had no overhead, no personnel decisions. Of course, neither did he have benefits— not as a part-time faculty member—but that could change. He found himself wondering if this would morph into a full-time position. What was it Schaeffer said? "If it works for both of us." In other words, it's a two-way street, brother, and if you don't produce, I'll hire someone else. Welcome to academia.

  Kim paused, apparently through with what John had already decided was a canned presentation memorized through many repetitions. She looked at him and raised her eyebrows. "Any questions?"

  He'd tuned out most of her spiel, but John figured he hadn't missed anything that wasn't in the packet she'd given him. "Not right now, but I'll call you if I think of any." He got to his feet. "Would it be okay if I wander over to the General Internal Medicine clinic and get the lay of the land?"

  "Sure. I'll take you o
ver to GIM and introduce you. Just remember that you can't participate in patient care until we get the last of your paperwork approved."

  In the clinic, Kim sought out a middle-aged blonde in nurse's scrubs. "Gloria, this is Dr. John Ramsey. Dr. Ramsey, this is Gloria, our head nurse." And with that, she hurried off.

  Gloria's smile lit up the hallway. "We're looking forward to having you with us, Dr. Ramsey. I don't know who'll be assigned as your nurse, but for now, if you need anything, just ask me."

  "Thanks. Today I'd just like to see how the clinic is laid out, so I don't get lost when I come back."

  "No problem." The pager on her belt let out a muted buzz.

  "I've got to answer this, but I'll be around if you need me."

  John peered through the open door of an exam room. It was clean, compact, and pretty much like one in his private office— when he had a private office. Of course, in that setting, when he encountered an especially perplexing problem he'd often told the patient, "I need to send you to a specialist at the medical school." Now he was that specialist, or at least one of them.

  "May I help you?" The woman in the doorway was about John's age. She wore a clean white coat over a simple blue dress. Low-heeled shoes put her eyes at the level of John's chin. Those eyes, behind rimless glasses, were pale blue, the same color as Beth's. He felt tears coming, and fought them back.

  "Thanks, but I'm just looking around." He extended his hand. "I'm Dr. John Ramsey."

  She tucked a stray lock of salt-and-pepper hair behind her ear. "I'm Lillian Goodman, one of the GIM clinic doctors. I understand you'll be joining us here soon."

  "As soon as the paperwork is finished." He made a sweeping gesture. "Apparently news travels fast around here."

  "You'd be surprised at how efficient the grapevine is." Her expression softened a bit. "And on a personal note, I was sorry to hear about your loss. My husband died almost ten years ago, so I really do know what you're going through."

  John was trying to frame an appropriate response when he heard footsteps in the hall—not running, but definitely moving at a fast clip. Gloria appeared in the doorway and said in a low, urgent voice, "Dr. Goodman, a woman just collapsed in the hall near the elevators."

  Lillian was already in motion, and John fell in behind her, not exactly sure what his role should be but anxious to help. People milled around in the elevator foyer. John pushed through and saw an elderly woman crumpled on the floor like a marionette dropped by a careless puppeteer.

  John knelt at the side of the unconscious woman. Lillian assumed the same position opposite him.

  "Carotid pulse is weak and irregular," he said.

  "She's breathing spontaneously, but sort of shallow," Lillian replied. She looked up. "Did anyone see what happened?"

  There was a general murmur in the group, a mass shaking of heads.

  A rumble of wheels and rattle of equipment announced Gloria's arrival. "Here's the crash cart. What can I do?"

  "Give me a second," Lillian said. "Right now she's breathing on her own. John, check her blood pressure. I'm going to do a quick neuro exam."

  In a moment, John straightened. "Mildly hypertensive. Heart rate about seventy but the rhythm is grossly irregular. Probably atrial fibrillation."

  Lillian didn't look up. "Atrial fib fits. She's probably had an embolic stroke."

  John had already reached the same conclusion. A small clot forming on the heart wall had broken loose and made its way to the brain.

  "We need to get her out of here so we can start treatment," Lillian said.

  "How—?"

  Lillian stood and swept her gaze over the small crowd that had gathered. "We've got a medical emergency here, folks. I'm going to ask all you visitors to clear the area. If there are physicians or nurses here, please stand by. All other medical center employees please go back to your positions."

  "Do we transport her into the clinic?" John asked.

  "It's a nightmare getting through all the hallways between here and Parkland. It works better if we get EMT's up here, take her down in this elevator and around to the Parkland Emergency area by ambulance."

  "I'm on it," Gloria said. "I've already called 911. EMT's should be here any minute."

  "Her breathing's slowed down considerably," John said. "Want me to intubate her?"

  Lillian looked him in the eye. "How are you at inserting an endotracheal tube?"

  "Probably a little rusty. I'm due for recertification in advanced cardiac life support."

  "I had my ACLS refresher last week. I'll tube her. You start an IV."

  John was adjusting the flow of IV fluid while Lillian pumped an Ambu bag to inflate the woman's lungs when the elevator door slid open and two emergency medical technicians wheeled offa gurney. His heart was still racing when Lillian left to accompany the stretcher back onto the elevator and down to the waiting ambulance. He'd hoped joining the medical center faculty would energize him, give him a reason to get out of bed in the morning, but he certainly hadn't bargained for this much excitement on his first day on the job.

  Rip felt the buzz of his cell phone against his hip. He saw the number on the caller ID display and thought, "Oh, boy. Here it comes."

  He punched the button and said, "Dr. Ingersoll, I'm in a patient room. Hold one second until I can step outside." He excused himself and made for a quiet corner of the nurses' station. "Okay, now I can talk. Where are you?"

  "I'm sitting in McCarran Airport, listening to the racket from about a million slot machines and waiting for my flight to take off. We were diverted here for a medical emergency, and then they found some sort of mechanical problem with the aircraft that kept us here overnight."

  "What kind of medical emergency?"

  "A passenger—Never mind. It doesn't concern either of us. I'm calling to see how that girl we enrolled in the study is responding to the medication."

  Rip interpreted Ingersoll's statement about the medical emergency not concerning him as meaning he'd sat on his hands and let someone else handle it. He'd bet he was right. And he hadn't bothered to learn his patient's name. Just "that girl." Typical. "Chelsea's doing better. She's responding well to the antibiotic." He took a deep breath. "But there's a problem that may impact her eligibility for the study."

  He waited for the firestorm he was sure would ensue, but instead there was only silence. "Dr. Ingersoll? Dr. Ingersoll?" Nothing.

  Rip wondered at what point Ingersoll's phone had dropped the cell. In an ideal world, it would have been right after, "responding well to the antibiotic." He waited for Ingersoll to call back, but his phone remained silent. Finally, Rip decided that his time of reckoning had been postponed for a bit. He didn't know how long—minutes or hours—but he was sure of one thing. It would definitely come.

  5

  SARA PUSHED AWAY THE REMAINS OF HER DINNER. IT DIDN'T MATTER that she often couldn't recall what she'd eaten or what program she'd watched. The ritual—and that was what it had become— was designed to get her through one more evening. Frozen meals from the microwave, the TV for company, falling into bed, frequently awakening at four o'clock in the morning to the cries of an infant who wasn't there.

  Most of the time Sara was halfway out of bed when she realized there was no baby in the house, no source of crying. That had ended almost two years ago when she found her infant son lying cold and lifeless in his crib. She knew about SIDS, of course. Sudden infant death syndrome was the fear of every reasonably intelligent mother, and as a physician she'd made sure she did all the right things. No exposure to smoke. Put the baby to bed on his back, always with a pacifier. But still, it had happened.

  She'd tried to lean on Jack for comfort in the days that followed the baby's death, but he withdrew, acting as though Sara was somehow to blame in the matter. It must have been her fault. She'd given him a son who was flawed, unable to survive. Jack came home later and later, usually slipping into bed after she'd cried herself to sleep. Sometimes he didn't come home at all, offering a
flimsy excuse or none at all.

  Sara begged Jack to come with her for counseling. He refused, and eventually she stopped asking. She wasn't surprised when the divorce papers arrived, citing "incompatibility." That was almost two years ago. Now when they spoke, it was with forced civility. He had his life, and she had hers, such as it was.

  Somehow the evening passed, as had all the others since Jack left her. Eventually, it was time for bed. She almost said sleep, but corrected the words as they passed through her mind. Sleep was never a certainty any more.

  She padded from the bathroom in her robe, warm from the shower, but not free of the emotional chill that was the undercurrent to her life. She was turning back the covers when the ring of the phone startled her. Who could be calling? This wasn't her week on call. Certainly not family or friends. She had none to speak of.

  "Hello?"

  "Sara, this is Rip. Did I wake you?"

  She glanced at the clock beside her bed. A little after ten. "Not at all. Just settling in for the night. What's up?"

  He cleared his throat. "I wasn't sure whether you'd want to know, but I decided—"

  "What is it, Rip?"

  "Does Jack drink?"

  Sara thought back to their time together. "One glass of wine and Jack relaxed. Two glasses and he turned maudlin. Three glasses freed his inner self—belligerent and self-centered."

  Rip's sigh came through clearly. "Bingo! He called me a few minutes ago. Apparently, he was pretty upset about all the delays in his trip. He was flying first class, and I'm guessing he couldn't turn down the free alcohol. After he landed here at DFW, he couldn't remember where he'd parked his car, so he called and asked me to come to the airport and pick him up. I suggested he take a taxi. He ordered me to come. I politely declined and told him that wasn't in my job description."