Lethal Remedy

by Richard Mabry

  "How did you leave it?"

  "I hung up on him. He called back a couple of times but I didn't answer. I wondered if this sort of behavior was unusual."

  "Yes and no. Jack didn't drink much at all after we were first married. Then . . . then the baby died, and he started to drink heavily. And when he'd had a bit too much, he got really belligerent."

  "Did he . . . did he ever hit you?"

  Sara teased a tear offher cheek with her finger. "No, if I stood up to him he'd generally break down and ask me to forgive him. I suspect tomorrow morning he'll try to act like this never happened."

  "Well, I hope he doesn't have a hangover in the morning. I have to tell him we may have compromised his study protocol in Chelsea's case, and I'm going to need him to be in the best possible mood."

  "Why don't you let me break the news?" Sara said. She thought back to Jack's reaction after she'd shaken him awake to tell him his son was dead. If she could get through that, nothing Jack Ingersoll could say or do would bother her.

  Bob Wolfe eased warily into the visitor's chair across from David Patel. Wolfe's shirt was plastered to his skin, held there by the sweat that began to form the moment Patel's secretary delivered this summons. He rolled his shoulders and leaned forward, trying without success to loosen the broadcloth straitjacket. "You wanted to see me?"

  "Do you think Dr. Ingersoll got the message?"

  Typical of Patel. No time given to social niceties. No wasted words. Down to the nitty-gritty. Wolfe wanted to reach across the desk and shake the man, but instead he pasted a confident smile on his face. "I sat him down and had a heart-to-heart. He understands that the data on Jandramycin has to be good, no exceptions."

  "You use the carrot and stick?"

  "Sure. The carrot was easy. More research grants. Coauthorship on every paper on the drug. We'll write them; all he has to do is add his name. Jandra will pressure the journals to print them. No problem."

  "And?"

  "He's our number one consultant, lecturing other doctors about the drug and its uses. Trips to speak all over the U.S. When we release Jandramycin overseas, he becomes a world traveler at our expense. Everything first class, with a handsome honorarium for each lecture."

  Patel nodded once, practically an "attaboy" for him. Wolfe decided not to wait for the next question. "And the stick was even easier. If he crosses us up, we pull all his research money. No more lectures. No more papers. We could even—"

  Patel held up one finger and smirked. "How's this? If he doesn't perform, he can expect more than the loss of all those perks. We'll get the word out that, although his research was valid, it was the work of others, and he stole it. We'll systematically destroy his reputation."

  "Good idea. I'll call him in a day or two, see how things are going, and squeeze him with this."

  Patel pulled a stack of papers toward him and began signing them. As Wolfe pushed back his chair, obviously dismissed, the CEO muttered under his breath, "That's what they pay me for, Bob. That's what they pay me for."

  "Dr. Ramsey, I'm Verna Wells. I'll be working with you on the days you're here in the clinic."

  The woman sitting at the clinic nurses' station smiled, showing a row of white teeth in a face dark as rich chocolate. Her royal blue clinic jacket had a floral pattern, and there was a small gold cross on the lapel. Her only jewelry was a plain gold wedding band and a simple watch with a leather strap.

  "Thanks. I'm looking forward to being here. You're probably going to have to answer a ton of questions for me until I get my feet on the ground."

  "You'll pick up the routine fast enough. Let me show you which exam rooms you'll be using."

  After a half hour, John's head was spinning. "Verna, I give up. Do you think that's enough to let me function for my first day or so?"

  She laughed, a hearty sound that seemed to come from deep inside her. Never had the term belly laugh seemed so appropriate, because once Verna came out from behind her desk John realized she carried about two hundred pounds on a five-footfour-inch frame. "I think you'll do just fine. And if you have any questions or problems, buzz for me. Remember where the buttons are in the treatment rooms?"

  "I remember. Now how long do I have before I start?"

  She glanced at her wrist. "You've got about half an hour before your first appointment. You might want to get some coffee." Verna looked over John's shoulder. "Here comes Dr. Goodman. She generally goes for coffee every morning. Maybe she'll show you the way."

  "Verna," Lillian Goodman said, "are you getting Dr. Ramsey squared away?"

  "Well, he doesn't seem to know much, but I think he's teachable." She grinned. "Bring me back my usual?"

  "Coffee with double cream and three sugars. Got it." Lillian looked at John. "Want to come along?"

  John followed her through a maze of corridors, and soon they were walking into a moderate-sized cafeteria. "I give up. Where are we?"

  "University Hospital. Really not too far from the faculty clinic where we started, and they have a great cafeteria."

  He shook his head. "I staffed residents at Parkland Hospital for years, but I've never been in a lot of these buildings."

  "Don't worry. You'll be able to find your way around real soon."

  They ordered, including coffee for Verna, and John insisted on paying. "Do we have time to sit down and drink this, or do we need to hurry back?"

  "We've got a few minutes." She pointed to a door in the far wall. "That's the staffdining room. It's quieter there."

  "What do you hear about the lady who had the stroke outside the elevators the other day?"

  Lillian's face clouded over. "She never regained consciousness. Died within an hour. MRI confirmed an embolic stroke, but while she was in the radiology department she had a cardiac arrest. We couldn't resuscitate her."

  "Autopsy?"

  "The family refused one. And since there were at least two possible causes of death, we chose not to push."

  John grimaced. "I guess I've lost my first patient since joining the staffhere."

  "Not really. All you did was take her blood pressure and start an IV. She wasn't really your patient." Lillian blew across the surface of her paper cup, then sipped. "And I guess you can be glad of that."

  "Why?"

  "Her family is threatening to file a malpractice suit against the medical center and every doctor who had anything to do with her treatment."

  In the midnight darkness, the lamp spilled a pool of yellow light onto the papers strewn helter-skelter over the scarred surface of his desk. The page shook in his hand as he stared at the figures scrawled in the margins. It all came down to this.

  The man scrabbled through the mass of documents and pulled another sheet. What was the line from Macbeth? "If it were done when 'tis done, then 'twere well it were done quickly." Decision time.

  He eased himself from the chair like the unfolding of a carpenter's rule. Do this, and he could say good-bye to this tiny office. He envisioned a corner suite with a view—maybe even a private washroom. But tonight the community restroom down the hall would do.

  The man locked himself in a stall and dug in his pocket for the dog-eared match folder he'd carried all day. He struck one match. It fizzled impotently. Two more attempts before one lit. He bent it against its fellows and the whole folder ignited. He touched the improvised torch to the papers he held and watched as they burst into flame.

  Would the smoke set offthe fire alarm, activate the sprinklers? He cursed under his breath for not thinking of that. He held the flaming mass lower in the toilet and fanned the air furiously with his free hand. The ashes dropped into the water, and he breathed again. He flushed twice, and it was over.

  He washed his hands, splashed water on his face, and walked back to his office. For good or for evil—probably a bit of both—it was done.

  Jack Ingersoll reached out to punch the intercom button on his phone and was gratified to see that his hands were almost steady. A lesser man would have a tremor th
is morning. I should have been a surgeon. "Martha, page Dr. Pearson and tell him I'll be ready to make rounds in fifteen minutes. We'll start in the ICU."

  "Yes, sir," Martha called through the open door that connected her office with his.

  Ingersoll ground his teeth. Would that woman never learn to use the intercom? Oh, well. It wasn't worth the hassle of trying to get her replaced. No, he'd just wait a bit. If things went as he expected, it wouldn't be long before he'd have a nice new office, along with an administrative assistant that he didn't have to share with two other doctors, someone who would cater to his wishes. And that day couldn't come soon enough for him.

  He swiveled in his chair and turned away from the windows and the bright sun that streamed in through them. The two Advil he'd washed down with black coffee seemed to be helping his headache. Another five minutes with his eyes closed, and he'd begin rounds. He hoped Pearson hadn't fouled up anything in his absence. At this point, every Jandramycin patient was pure gold. And he couldn't afford any slipups.

  "Jack, got a minute?"

  He opened his eyes and saw Sara in the doorway, one hesitant foot over the threshold. He couldn't recall that she'd come to his office since they'd divorced. Quick encounters on the ward or in the cafeteria, an occasional phone conversation about a patient, but never a personal visit. What was up? "Sure. Come in. Sit down."

  She took one of the two visitors' chairs. "I won't keep you. I know you're about to start rounds, but I wanted to let you know what happened while you were gone."

  He listened intently as she told him about the girl—what was her name? Chelsea. That was it. She told him about Chelsea's sepsis. What were the odds? Sepsis from Staph luciferus, responding to Jandramycin, only to be replaced by a garden-variety but potentially lethal infection from an indwelling urinary catheter. As Sara related the details, his mind raced to parse the implications.

  Apparently, Jandramycin wasn't effective against E. coli. No harm there. It had a specific niche, and if the drug was never used against any bacteria except Staph luciferus, it would still have a secure position in the pharmacotherapy of infections.

  The girl was still receiving Jandramycin along with the other drugs for her E. coli infection, and all the medications seemed to be working. That meant there was no incompatibility among them. Good to know and not the kind of information that would come up in a normal study protocol.

  Would the data from this case have to be excluded because of the confounding factors of the second infection and additional antibiotics? Ingersoll thought back to his conversation with Wolfe. We may have to be creative in the way we handle our data. So be it, then. He might have to be creative in the way he entered this information into the database, conveniently ignoring the additional drugs, but he couldn't afford to lose even a single patient from the study. He'd handle it.

  Sara seemed to be running down, so he brought his full attention back to her. "So little . . . little Chelsea is getting better. Is that right?"

  "Yes. Her temp's down. White count returning to normal. No protein or cells in her urine this morning. I think she's turned the corner."

  "Well, that's the important thing," Ingersoll said. "I'll look in on her this morning, but you and Pearson should be able to handle things from here on out. You can call me if there are any questions."

  Sara frowned. "Jack, we were really afraid you'd erupt when you heard we had to go outside the study protocol to treat her. I'm glad you're taking it this well."

  Ingersoll summoned up his most sincere look. "The patient is better. That's what's important." He rose and walked around the desk. He took his ex-wife's hand in both of his. "Sara, I appreciate your coming by to tell me in person. And I hope you won't be a stranger. I think we had something really good at one time, and I'm sorry I let it slip away while I was depressed about the death of our son. Maybe we can get it back."

  6

  SARA SNUGGLED BENEATH THE COVERS. LIFE WAS GOOD. SHE AND JACK had a lot of good years ahead of them, and the prospect made her smile. Maybe she'd give up her practice at the medical school to be a real stay-at-home mom. That was something a lot of her female colleagues talked about, and although none of them had actually made that move, it was obvious to Sara that deep down, most of them would like nothing better.

  She rolled over and reached across the bed, but a cry stopped her arm in mid-reach. Her mother's instinct drove her out of bed, and in a few seconds she was shrugging into her robe as her feet darted here and there in search of her slippers. Don't turn on the light. Don't want to wake Jack.

  The cries were louder now, and Sara quickened her steps. She paused at the doorway of the nursery, and the cries stopped as suddenly as they began. She shuffled across the carpet and peered over the edge of the crib. The bundle it held was jammed up against the far corner. She lifted the corner of the blanket and reached forth a hesitant hand to touch the angelic face. It was cold and unmoving as marble.

  Her cry began as a low moan deep in her throat and escalated into a siren-like shriek.

  Sara sat up in bed and reached for the light at her bedside. Another nightmare. No, not another one. The same one. The same dream that had tormented her since the original scene played out.

  There was no hope of sleep now. She shoved aside the bedclothes, grabbed her robe, and padded on slipper-shod feet into the kitchen. Maybe a snack would help. She passed the bathroom and remembered the bottle in the medicine chest. One at bedtime as needed for sleep. Her doctor prescribed them after the baby died, but Sara refused to take them. No, she wanted to feel the full force of her grief. Jack, on the other hand, took them regularly. She'd watched him lie there in drug-induced sleep and hated him for it. How could he ignore the loss . . . their loss?

  The prescription was old now. Would the pills still be good? Why had she kept the half-full bottle anyway? She had no intention of drugging herself to sleep. Of course, there were times when she'd wanted to take all of them and fall into that deepest and most permanent of sleeps. But not tonight. She wasn't that desperate. Not yet.

  Sara shivered, even though the house was warm, and hurried into the kitchen. She spread a stack of crackers with peanut butter, poured a glass of milk, and eased into her accustomed chair in front of the TV. Maybe there'd be something on that would help her relax.

  Sara munched on a cracker and wondered why she'd dreamed about being in bed with Jack. After the baby died, she'd gone out of her way to avoid him, even made an effort to exclude him from her dreams. Why had she let him back in now? Was it because of what he'd said? "I think we had something really good. . . . Maybe we can get it back."

  Then again, Jack seemed different today, more interested in what she said. He actually remembered the name of their mutual patient, asked how Chelsea was doing. Could he have changed? Was it even possible for Jack Ingersoll to change? And was she willing to take that chance?

  As she pondered the question, Sara flashed on the end of her meeting with Jack. What was it he said? He was depressed over "the death of our son." Our son! He had a name, Jack. Actually, he had your name: Jack Jr. But you just called him "our son."

  What was it the Bible said? "Can the leopard change his spots?" No, and apparently neither could Jack Ingersoll.

  Dr. John Ramsey looked for what seemed like the hundredth time at the file folder on his kitchen table. The label read "Malpractice Insurance." A few days ago, he'd rescued it from one of the boxes of files he'd brought home from his office and shoved into a corner of his garage. He'd blown the dust offit and put it on the table, but today he decided it was time to open the folder and face what was inside.

  He took one last sip of cold coffee, picked up the phone, and dialed the number he'd printed with a Sharpie on the cover of the folder.

  "Insurance office."

  "This is Dr. John Ramsey. I need to speak with Mr. Alexander about my malpractice insurance."

  "Is this about a claim?" The woman's voice was flat, almost bored. She must have these conversations
every day, but to John this was a new, and rather scary, situation.

  "It's about a possible claim. I need some information. That's why I need to speak with Mr. Alexander."

  "May I have your policy number?"

  John figured he might as well talk to a wall. "I've canceled my original policy, but I have tail coverage. And I need to ask Mr. Alexander a question about that policy."

  Nothing seemed to faze this woman. "And what is that policy number?"

  After giving her the number of his policy and waiting through a series of clicks, followed by three minutes of what passed for soft rock music on hold, John heard a familiar voice.

  "Dr. Ramsey, I hope you're enjoying retirement."

  "Not as much as I was before I began talking with your secretary." John reined in his desire to vent. No benefit there. "I have sort of an unusual question."

  Alexander listened without comment as John explained his visit to the clinic at the medical center and the part he'd played in the scenario that followed. "Now I'm hearing that her family may file suit against everyone involved. And I guess my question is whether I'm covered."

  The silence on the other end of the line made John wince. What he was hoping for was a quick, "Of course." Instead, he heard only the rattling of paper.

  "Are you there?" John asked.

  "Yes, I'm looking through your contract. Of course, you canceled your original malpractice insurance when you retired, so that wasn't in force when this incident occurred. However, you bought tail coverage to insure you against claims brought after that original policy ended. But this is a new incident, so in that case . . . Hmmm. Tell you what. I don't want to say anything until I run all this by one of our attorneys. Can I get back to you?"

  John gave Alexander his phone number and hung up with a deep sense of foreboding. If the agent had to do that much research, there was a good chance that his position in malpractice litigation arising from the incident at the medical center was going to be pretty much what his patients always complained about when they had to wear a hospital gown: uncovered and vulnerable.