John must have seen it, too, because he spoke up. "I've known Mark since he was a sophomore medical student. I'll vouch for him. He's sharp, he's solid, and you can trust him. I realize you may not want to share this information with either of us. If that's the case, fine. But if you want some input, Mark's got a sharp mind. And I've been around for enough years that maybe I can contribute a little senior wisdom."
Sara and Rip exchanged another look, a different one this time, and apparently a decision was reached. "Okay," Rip said. "Here's what we know. But it can't go any further."
As he listened, Mark found himself wishing for a yellow legal pad so he could take notes. Once a lawyer, always a lawyer, I guess. When Rip finished, Mark said, "So the bottom line is that somebody is fudging the data on Jandramycin. Right?"
"It seems that way," Rip said.
"And it's probably Ingersoll?"
"No, it could be his research assistant, a doctor named Resnick. Or I guess it could be coming from the other end, someone at Jandra. And for that matter, there may be others with the opportunity. Ingersoll's kept everything so secret, I don't even know who's involved in the process."
Mark shoved aside his sandwich and took a long drink of his Diet Coke. "This is the lawyer talking now. If someone's submitting manufactured data, what's your liability in it?"
Rip shook his head. "I guess I could say I'm just following orders from the man running the study. But as a practical matter, if this comes to light I'll be tarred with the same brush as Ingersoll and whoever else is responsible."
"What about a responsibility to patients?"
"That brings up another problem," Sara said. "There may be some side effects of Jandramycin that are just now coming to light."
"Explain," Mark said.
"One of the patients in the Jandramycin study has turned up with Guillain-Barré syndrome," Rip said. "There are at least two more that we know of who've developed different problems. We don't know the specifics, but it's enough to make us wonder if there are late effects of the drug that no one suspected."
"Or that they knew about but chose to keep hidden," Mark said.
"Assuming that's true, who are our suspects?" Sara asked. "Same list we've already named," Rip said. "Ingersoll, Resnick, someone at Jandra, or a person as yet unknown. Right now, all we have is questions. I think it's time to try to get some answers."
Outside the restaurant, John ransomed his car from the valet parking attendant. "Where can I drop you two? Back at the medical school?"
"Yeah, I guess I'd better start making some phone calls," Rip said. "I'm going to have to call every patient who received Jandramycin and find out if any of them have developed problems."
"Can I help?" Sara asked.
"No, a call from me will seem like a routine follow-up, but a call from a doctor not involved in the case would send up red flags. This is going to have to be completely under the radar."
"If you need anything from me, let me know," John said.
After a short drive, the three doctors climbed out of the car in the faculty parking garage. John beeped the car locked and said, "Call me when you know more. We can meet at my house to discuss it."
As a half-time faculty member, John shared an academic office with another part-timer. He decided to go back there and tackle the pile of unread journals on his desk.
When he walked in, his secretary was attacking the keyboard of her computer as though it was an enemy to be subdued. Usually, she greeted him with a smile, but today she kept her head down, barely acknowledging him. Strange.
The mystery deepened as John entered his office: a middleaged man sat across from his desk. John dropped his briefcase and took his white coat from a hook behind the door. "May I help you?"
The man rose and picked up his own briefcase from beside his chair. "Dr. John Ramsey?"
"Yes."
The man plunged his hand into the case and pulled out a sheaf of papers, which he thrust into John's hand. "You've been served." He took two steps toward the door, turned, and added, "Sorry about that. Have a nice day."
John stood immobile for a few moments, not daring to look down at the papers in his hand. Then he moved slowly to his swivel chair and dropped into it. Like a child peeking out from under the covers, afraid he'd see a boogeyman, John squinted and let his eyes scan the document he held. There, buried in unfamiliar verbiage, was his name, along with Lillian Goodman's and a number of other colleagues. True to their threat, the family of the woman he'd assisted was suing the medical center and every person remotely connected with her brief time there. And blameless or not, he knew the next few months would be terrible.
He sat for a moment with his eyes closed and wished he could turn back the calendar—not a few days or a few weeks, but half a year. Then Beth would be there. And he wouldn't feel as he did now—as alone as a man on a desert island, with no sign of a ship on the horizon.
9
SARA DROPPED HER BACKPACK BY THE DOOR, KICKED OFF HER SHOES, AND collapsed into the one comfortable chair in her living room. Automatically, her hand found the TV remote, but she let it fall onto the table with a clatter when she realized she didn't need background noise or diversion—she needed quiet and a chance to think.
There was something about Jandramycin that wasn't right, something about the study and the people involved in it that set offalarm bells in her head. She had no proof, but her clinical intuition told her that the "wonder drug" had some late risks that had either been ignored or flagrantly hidden. Who would do it? Who could do it? Of course, this might have begun at the source with the people at Jandra Pharmaceuticals. She'd have to find out who had such access. She picked up a scratch pad from beside the phone, rummaged in the drawer of the small table until she found a pen, and made a note. "Jandra."
Beneath "Jandra," she wrote "Jack." Her ex-husband had control of the study, and its success or failure would have an enormous effect on his career. Then came "Resnick." She'd never liked the obsequious little doctor, and she could see him fiddling data and hiding information if it would benefit him. She tapped the pen against her teeth, fighting the urge to write the next name. No, he couldn't do such a thing. But he had almost as much access as Jack to the data. Finally, in handwriting that was uncharacteristically cramped, she scrawled, "Rip."
The ring of the telephone startled her. She dropped her pen, reached for it, and kicked it under the sofa. She'd get it later. Sara grabbed the phone just as her answering machine came to life. "Hi, this is—" She stabbed at the button to stop the message.
"Hello. Hello?"
She could almost see Rip's frown from the tone of his voice. "Sara, is this a bad time?"
"No, I just dropped— Never mind. No, this is fine."
"I missed connecting with you at the medical center, and I thought you'd want to know what I found out."
Sara tucked her feet under her and rolled her shoulders to relieve some of the tension. "Sure. Tell me about it."
"I called everyone on the list of patients who received Jandramycin. Of the thirty-nine names I had, I was able to get information about thirty of them."
"Pretty high rate of return for your calls. What did you find out?"
"Interesting," Rip said. "Of the thirty, six have developed some sort of major medical problem."
"Such as?"
"In addition to Chelsea, there's one other young man with Guillain-Barré syndrome. One woman has severe muscle pains and episodes of weakness, another has debilitating headaches and visual problems, a middle-aged man is being worked up for a bleeding disorder, and an older man looks like he's developing kidney failure."
Sara's mind was churning by now. Was there some kind of common link to these problems? And could she be sure they were all related to Jandramycin?
"Still there?" Rip asked.
"Yes. How much detail do you have on these patients?"
"Not much, but I'm going to call their doctors tomorrow and see if I can't get more. Want to meet tomorrow
about five to see if we can put this all together?"
"Sure. Let's do it in my office. That way, we have my books and computer if we need to use them."
They talked for a few more minutes before Rip rang off, pleading the same level of fatigue Sara felt herself. This had been quite a day for both of them.
She no sooner put the phone down than it rang again. "What did you forget?"
A voice she didn't immediately recognize said, "I forgot to ask you if you'd have dinner with me tomorrow night, but I thought I'd let you get home first."
Sara smiled. "Mark, I'm sorry. I thought this was Rip calling back."
"Nope, it's me. I really enjoyed our lunch together, even if it did turn into a game of 'What's wrong with this picture?' and I was wondering if you'd like to have dinner together tomorrow, just the two of us."
Sara didn't know what to say. This was all moving much too fast for her, and the addition of another person to the mix was more than she could handle. "I appreciate the invitation, and I hope you'll ask me again, but right now I've got too much going on in my life."
"So much that you don't take time to eat?"
"No, but—" She could see how this man would be good in the courtroom. He obviously thought well on his feet. "Listen, I already have something going on tomorrow afternoon, and I don't know how long it's going to take. Can we talk about this another day?"
"Sure. And while I have you on the phone, have you discovered anything more about Jandramycin's side effects?"
John Ramsey's words came back to her. "He's sharp, he's solid, and you can trust him." Maybe three heads would be better than two. "Listen, are you free tomorrow afternoon?"
"Dr. Ramsey, are you ready to start seeing patients?"
John wanted to tell Verna that he wasn't ready, might never be ready again. You work for forty years and never have a complaint lodged against you, much less a malpractice suit filed, and then one day, Bam! You're sued for trying to save the life of a woman experiencing a non-survivable event.
He was ready to walk out of the clinic, go home, forget about practicing medicine. Instead, John did what he'd been doing for years, rain or shine, good mood or bad. He followed his calling. "Sure. Who's first?"
Somehow John made it through the morning, pleased to find that he was still able to compartmentalize, putting his personal worries into quarantine while his professional self handled problem after problem.
"That's it. You had one more patient, but he was a no-show."
"Thanks, Verna. I'm going to return these phone messages, then I'll get some lunch."
John sighed when he saw the pink slips Verna had left in his dictation cubicle, held down by a paperweight advertising the latest wonder drug from some pharmaceutical company or other. But first things first. He dialed the number for Mark's office. After four rings, he heard the rhythm of the rings change and realized the call was rolling over to an answering service or voicemail. Oh, it's lunchtime. He hung up without leaving a message and dialed Mark's cell phone.
John let it ring until he heard, "This is Mark Wilcox. Please leave a message."
"Mark, this is John Ramsey. I've been . . . I've been served. I guess we need to talk. Are you available this evening? Call my cell and leave a message."
John had hardly hung up when his cell phone vibrated in his pocket. Was Mark getting back to him already? "Dr. Ramsey."
"Doctor, this is Bill Alexander."
He'd almost forgotten about his earlier call to his malpractice insurance carrier. Maybe his coverage extended to the incident at the medical school. Maybe things were going to work out. A spark of hope flared. "Yes. Thanks for getting back to me."
"You won't thank me after you hear what I've found out." The spark flickered and died, leaving nothing in John's heart but a chill that no sun could warm.
"Let me guess. I'm not covered."
The conversation lasted another five minutes, but the upshot was what John originally feared. His malpractice coverage was not in force for new events. And it was the opinion of the company's lawyers that it was unlikely the medical center would cover the actions of an employee who hadn't even officially gone to work yet. In other words, John was on his own. He thanked Alexander and hung up. He wondered what would happen if he just walked out, packed a suitcase, and took off for parts unknown.
"John, God's in control. Hang on."
Beth's words were as real as though she were in the room with him. Those words seemed to be her solution for everything bad that happened in their lives: an employee who embezzled a huge chunk of money from his practice, the sudden deaths of his parents in a terrible accident, the news that John's brother had terminal cancer. All these were times when he wanted to walk away from it all. And Beth always reminded him—God's in control. So he'd hung on. And sure enough, things worked out. Maybe they would this time, as well.
He squared his shoulders and began to work his way through the message slips. He was wrapping up a conversation with an insurance claims representative, trying to keep his temper in check while convincing her that the presence of asthma in childhood didn't constitute a pre-existing condition in the case of a patient with pneumonia, when Verna appeared outside his door. He held up one finger in a "just a minute" gesture and ended the conversation, gratified that he'd been able to convince the sentry on the other end of the phone to let his patient pass into the realm of the insured.
"What's up?" he asked.
"That no-show is here. I'm not sure how he got into the general internal medicine clinic, though. He's got an infected wound on his arm that looks pretty bad. Probably needs debridement and some antibiotics. Want me to send him to general surgery?"
John was already on his feet. "No, he's here. I'll take care of it. In forty years of practice, I've seen my share of infected wounds."
The patient was a middle-aged man, lean and tough as a buggy whip. He wore a flannel shirt with the sleeves rolled past the elbows. A folded baseball cap peeked out of the hip pocket of his jeans. "Sorry I was late, Doc. Had trouble with those valet parkers out there." He pronounced the word valett. "Told 'em I was gonna have to pay to see you, pay for my medicine, and I wasn't about to pay for some guy to park my pickup when I could do it myself."
John smothered a smile. He'd had the same thought a number of times. "No problem. You're here now. Let's see that arm. What happened?"
While the patient related a story of coming out second best in a fight with a piece of rusty machinery at his auto repair shop the preceding week, John slipped on a pair of gloves and examined the man's left arm. It was swollen, hot to the touch, red from the elbow to the wrist. A weeping crust covered a six-inch gash on the side of the forearm. "Thought it would be okay if I kept a bandage on it and used some of that antee-beeotic ointment. Looks like I was wrong."
"I'm going to clean that up and get you on some pills to fight the infection," John said. "I may have to snip away some dead tissue, but I don't think it will hurt enough to need a local anesthetic. Think you can take it?"
"I've had worse," the man said.
While Verna cleansed the wound with peroxide and painted it with antiseptic, John took the dirty bandage from the treatment table and looked around for a spot to dispose of it. Blood, tissue, pus, and similar material were to be placed in a special container, one that was lined with a red plastic bag prominently labeled "biohazard."
"Over in the corner," Verna said, nodding in that direction. "Thanks." John opened the container to drop in the bandage, but it hung on the rim. He swatted the dirty gauze into the almost overflowing bag, but when he did he felt a sharp pain in his hand. "Ow!"
"What happened?" Verna asked.
John took a pair of forceps from the treatment table and stirred the top layer of debris in the biohazard bag. His throat tightened when he saw the glint of a syringe and needle peeking out of the container.
He tried to keep his voice calm. "Verna, I'm going to need to talk with someone in Infectious Disease. Could you pag
e them while I finish cleaning up this wound?"
"Sure. Is it about the antibiotic for this wound?"
"No, it's about our needle-stick protocol. It's for me."
"Jandra Pharmaceuticals, how may I direct your call?" The voice was cheery, but the inflection told Sara that this was a message the woman repeated a hundred times a day.
"This is a doctor in Dallas, calling about one of your new drugs. Is there someone there who can give me some details about Jandramycin?"
There was a moment's silence. "I'm sorry. I don't believe we have a drug by that name. Are you sure?"
Sara shrugged to relieve the tension that had become a permanent fixture in her shoulder muscles. "I'm sure. Jandra Pharmaceuticals, Jandramycin. Think about it." She decided on a different tack. "Who's your public relations manager?"
"That would be Mr. Olson, but he's on vacation."
Sara waited, but apparently that was as much help as she was going to get. "Okay, your director of research?"
"That would be Dr. Wolfe. Would you like me to ring him?" "Please."
If she says, "Have a good day," I'll scream. Just before the telltale buzz of a phone ringing, Sara heard "Have a good—" and gritted her teeth. It apparently wasn't going to take much to get on her nerves today. But if she wanted to coax any information out of this Wolfe guy, she'd better be on her best behavior.
"Bob Wolfe." The voice was a deep baritone, the accent definitely East Coast.
"Mr. Wolfe, this is—"
"Dr. Wolfe. I'm a Pharm D."
"I'm terribly sorry. Yes, the operator did give me your title. I apologize."
"No problem. Who's this?"
"This is Dr. Sara Miles. I'm on the internal medicine faculty of the Southwestern Medical Center in Dallas. I have a question about Jandramycin."
This time the pause was long enough that Sara thought she'd been disconnected. Finally, Wolfe said, "If you're at Southwestern, I'd suggest you talk with our principal investigator, Dr. Ingersoll. He's on the faculty there, too. Would you like his number?"
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