Sara opened her mouth, then closed it.
"Yes? Take it further," John encouraged.
"Well, we had our meeting yesterday to talk about all this, and Mark Wilcox was there. So I guess we have to include him." Sara frowned. "You know, you introduced Mark to us, but we don't really know much about him. What does he do, anyway?"
"Lawyer, doctor, very sharp, dependable." John ticked the points offon his fingers. "He had a successful law practice, but apparently got tired of it and decided to go into medicine. I get the impression he thought he could do more good that way. Now his practice is sort of a mixed bag: a small general practice, some legal medicine, occasionally consulting for pharmaceutical companies. I've known him since he was in med school, and I think he's okay."
"If you say so," Sara said.
"What about me?" John asked. "I was at that meeting."
"No!" Sara felt as though she were lost at sea, with no land in sight. Only John Ramsey was a fixed point on the horizon. "I have to trust someone, and everything in me tells me I can trust you."
John gave the briefest of nods. "And I'll make sure your trust isn't betrayed. But there's one more person who's been involved in the Jandramycin saga. One more member of our little crew."
"I don't know who—Oh! Absolutely not."
"So how do we eliminate him? Does Rip have anything to gain if Jandramycin moves forward and the side effects stay buried?"
"I can't see any benefit to him."
"I can," John said. "Rip would be co-author of every paper of Ingersoll's on Jandramycin. When he finishes his fellowship, think how much it would improve his chances of getting a plum faculty appointment or research job if he'd worked with Jack Ingersoll on the Jandramycin project."
"I just don't think Rip's that kind of person. And he's been working right beside me to find out more about these side effects. I can't see him trying to stop me now."
"Okay," John said. "I don't think we should totally take Rip offour list, but we can move him down toward the bottom, at least for now."
Sara felt her shoulders slump. "This can't be happening. I don't want to live my life suspecting everyone around me. I can't function that way."
John rose and moved to stand beside her. "Just be careful and watch your back."
"I'd like to think I'm over-reacting. Maybe this has nothing to do with Jandramycin. Maybe it was all simply random."
John patted her shoulder. "That's enough for now. You need some rest. I'll pick you up in the morning, and if you need a ride to pick up a rental car, I'll take you."
Sara rose and took John's hand. "Thanks. It helped to talk about this."
John paused in the living room. "Are you going to be okay alone here tonight? Maybe you should check into a hotel."
"I'm not going to let something like this run me out of my home," Sara said, her words carrying more conviction than she felt.
"We could call one of your female friends to stay with you. And I could ask the police to drive by your house several times tonight."
"They've already offered to do that," Sara said. "No, I'll be fine. I'll lock up after you leave." She gestured at the bat by the front door. "And I have my old faithful softball bat here if I need to deal with an intruder."
"Just remember, a bat won't help if someone starts shooting at you."
"It's what I have tonight, but I'm already thinking of . . . never mind." No need to tell John she'd already made up her mind to buy a gun. The next time someone started to shoot at her, she was determined to return fire.
After she heard John's car pull away, Sara slumped into a chair in her living room. Her mother's Bible was on the coffee table beside her. She'd put it there after her parents were killed in an auto accident, but hadn't opened it. Maybe this was a good time to do so. She reached for the book, and it slipped from her hands, falling open to what was apparently a frequently visited page.
Sara lifted the Bible into her lap and scanned the verses. She stopped when she came to a passage marked with a yellow highlighter. Her lips moved silently as she read: "You will not fear the terror of night, nor the arrow that flies by day, nor the pestilence that stalks in the darkness, nor the plague that destroys at midday." Thanks, Mom. I could always count on you for help.
Sara held the phone in a death grip. She dreaded this conversation in the worst way.
"Dr. Pearl."
"Anna, this is Sara Miles. I went by to see Chelsea this morning. Her weakness seems to be progressing. What do you think?"
"I scribbled a quick note, but I dictated a full consultation. You should get it in a day or so."
Forget the paperwork. Give me something. Anything. "But you agree this is GBS?"
"Not much doubt. And, as you know, we don't really have any idea why these things happen. About all I can suggest right now is hitting her with high doses of steroids, and I've already started her on that. You know the routine: an H2 blocker to prevent a stress ulcer, a hypnotic at bedtime to combat the steroid insomnia. I wish we had something else that worked but didn't have so many side effects."
If you only knew that this whole thing probably came as a side effect of another med. "You'll follow her with me?"
"Of course. Call me anytime. And thanks for the consult."
So that was it. Anna agreed with Sara's initial diagnosis of Guillain-Barré syndrome—the silent disease that came out of nowhere. It could resolve as quickly as it came on, or it could leave the patient with permanent paralysis.
"No." Sara was surprised to find she'd spoken aloud.
"Something wrong, Dr. Miles?" Gloria tapped on the door of the dictation room where Sara sat.
"No, just talking to myself." Sara shrugged. "Am I through for the morning?"
"There's a walk-in, but if you're busy I can get one of the other doctors to see her."
"No, I'll take it. But be sure I'm clear for the afternoon. I have to pick up a rental car, then meet with the police."
"I'm so sorry to hear about what happened to you last night." Gloria made a dismissive gesture. "It seems like it's not safe to drive anywhere in this city anymore. Probably some gang-banger who got a new Glock and had to try it out on a moving target."
"Maybe." Sara shoved herself upright. "Which room?"
Forty minutes later she had a diagnosis. Not one that made her happy, especially under the circumstances, but it was clear to Sara. She figured a third-year medical student could make it. The patient was a middle-aged woman with gradual development of muscle aches and weakness, combined with a nonitching rash that covered her cheeks like a mask. Preliminary lab work was suggestive, and Sara was certain that more sophisticated tests would confirm her impression.
"Mrs. York, I'm afraid you've developed lupus."
"Oh, my." The woman's expression made it clear she realized the seriousness of what Sara said. "How did that happen? What can you do for it?"
"There are several medications we can use to slow or stop the progression of the disease. As for how, we don't have the final answer yet. It's one of a group of disorders we call 'collagen diseases.' Doctors think they're due to the body becoming allergic to itself—what's called an autoimmune disorder."
No sooner were the words out of Sara's mouth than she began to thumb through the woman's chart. What medications was she on? What diseases had she had recently? Could it be—
There it was, just as she feared. "You were hospitalized with pneumonia a few months ago?"
"Yes. It was really bad. They tell me I almost died because it was some special infection that none of the usual antibiotics would help. I guess I owe my life to Dr. Ingersoll and that new medicine of his."
Rip Pearson frowned at the insistent buzz of his pager. He silenced the instrument, noted the number, and decided he'd return the call in a moment. He already had more on his plate than he could handle.
Rip sat like a penitent, across the desk from Ingersoll, who frowned at the interruption. "Sorry about that."
"Very well," the g
reat man said. "Now are you clear on the things I want you to do while I'm in Germany?"
"Right." Bite your tongue, Rip. Don't scratch the scab from yesterday's argument. Just get through this meeting.
"Leave the big picture to me, Pearson. I promise that if you keep the Jandramycin study going, you'll get your share of the glory."
Or the blame when it comes out that your "wonder drug" had side effects that someone chose to hide. "I know how you want the study run," Rip had said. "How long will you be gone?"
"Six days, I think. The conference is making the arrangements and covering all my travel expenses. First class all the way." Ingersoll rolled the words on his tongue and seemed to savor them as he would fine brandy. "An invitation to speak to an international meeting like this will mean a great deal of positive publicity for our work."
Yeah, and probably a hefty honorarium. Rip knew that Jandra arranged the invitation to Ingersoll. Pharmaceutical companies could no longer offer honoraria directly to physicians for speaking. But there were ways around those rules. One was to pay the money to a sponsoring organization with the understanding it would be funneled to guest speakers. In the case of an international meeting like this one, it was even easier to find ways around the restrictions.
Ingersoll scanned the list in his hand, nodded with satisfaction, and shoved it into the pocket of his white coat. "Now I have to work on my presentations. Do you have any questions?"
Why should I? I've been doing the work on this study since day one. The only thing I don't know is why the drug I'm giving people may save their lives today and sentence them to a lifelong disease or even death in the future. "No, sir. Have a safe trip."
A few minutes later, Rip was in the cubbyhole of the office assigned to him as a fellow. He checked his pager and dialed the number it displayed. "Dr. Pearson. You paged me?"
"Rip, this is Sara. We need to talk."
"Sure. Go ahead."
"No, I don't think this is something I want to go into over the phone. Can we get together? The sooner the better."
Sara sat on a rolling stool and Rip perched on the edge of the exam table. The door to the treatment room was closed. There were no doctors in the clinic. The nurses and administrative personnel were at lunch, returning phone calls, or otherwise occupied. "We should have some privacy here," Sara said. "Thanks for coming over."
"What's up that's so important?"
"Two things. As of this morning, I only had one to talk with you about, but the last patient I saw made the list longer. Do you remember a middle-aged lady named York? Pneumonia?"
"Sure. She was one of the first in the Jandramycin study. I think it was still EpAm848 then. What about her?"
"I saw her today. She's developed lupus."
She watched Rip's face as he connected the dots. It was almost immediate. "Another disease to add to the list. It's not a controlled study, but it's good enough for me. Jandramycin works to kill Staph luciferus, but a significant number of patients develop an autoimmune disorder within a matter of weeks."
"So the question remains: what do we do?"
"We've got to find out the exact mechanism of the drug. Then maybe we can figure out a way to block its ill effects."
Sara hesitated. "I don't want to sound stupid, but can't we just analyze some of it?"
"Sure," Rip said. "We could if we had a month or six weeks to determine the exact composition, synthesize the components, and get the proportions right, then do the lab experimentation to find out the true mechanism of action. Meanwhile, patients are dying all over the world."
"What's the count up to now?" Sara asked.
Rip pulled a wrinkled note from the pocket of his white coat. "The World Health Organization has identified over three thousand cases of Staph luciferus infection, all fatal except the patients treated here and the medical center in Germany that's also testing Jandramycin." He crumpled the note and tossed it into the wastebasket. "Sara, we've got to step up our search. Doctors around the world are clamoring for that drug. When it's released, thousands of patients will receive it. We have to find out how to save those patients without exposing them to a potentially fatal side effect of Jandramycin."
Sara took a deep breath. She dreaded reliving the experience, but she needed to tell Rip. "Our search may be putting us in danger, as well. You know that we confronted Jack about this, and he blew us off. Then I called Jandra but got nowhere."
"Right. But I may have thought of another way to get the information we need."
"Don't rush into it. I think I've already stirred up a hornet's nest. Last night, someone took a shot at me."
Rip rose and moved around the desk. She stood to meet him. He grasped her shoulders and said, "Are you okay? Did you call the police? What can we do to protect you?"
Sara didn't try to move his hands. "Yes, yes, and I don't know. But in the interim, we need to be careful who else knows about our efforts."
Rip relaxed his hold on her and moved back to his chair. "That's a pretty limited group so far. Besides you and me, there's Jack Ingersoll, and whoever you talked to at Jandra."
"Don't forget Mark Wilcox and John Ramsey. They were in our little session last night."
"I guess John's okay, but I don't know Mark Wilcox. For all we know, he's on the Jandra payroll."
Sara shook her head. "John brought him in, and I trust John's judgment. But I agree, we probably should be a little cautious around Mark in the future." She picked a pink message slip offher desk and began to fold and unfold it. "But you said you thought you had a way to find out the mode of action of Jandramycin. What's that?"
"Well, it may not be as great an idea as I thought, since your efforts got you shot at. Carter Resnick tells me he's become pretty good at hacking into computer systems. I was thinking about trying to wangle some cooperation from him."
"So you think he could get into the FDA's computer and access the new drug app for Jandramycin?"
"No, I think that information's fabricated. I was going to see if he could get the information from Jandra's system."
"Why wouldn't that be a good idea?" Sara asked.
"Resnick has been sort of off-again, on-again giving information to me. On the one hand, he seems anxious to take down Ingersoll. On the other, he guards the research data from his lab with a passion. I think young doctor Resnick has his own agenda. I don't know what it is, but in light of recent events I think I'd better be careful around him."
Sara leaned back. "I think we'd both better be careful around anyone else until this thing is settled."
12
SARA, THIS IS MARK WILCOX." MARK BRACED HIS PHONE AGAINST HIS shoulder and reached into his desk drawer for a fresh legal pad. He might be practicing medicine now, but old habits die hard. "Do you have a second to talk?"
"Just about that long. Your page caught me between my last clinic patient and afternoon hospital rounds. What's up?"
"I was wondering if you'd like to have dinner with me tonight. There's a great new restaurant I've heard about, and I'd love to take you there."
Mark wasn't sure how to interpret the silence that followed. Was Sara looking for a graceful way to say "No"? Of course she could be checking her schedule to see if she was free. He began to doodle on the legal pad.
"I . . . I'm not sure how good my company would be tonight."
"Tell you what. If you're a terrible dinner companion, we'll split the check. But I'm betting it will be an enjoyable evening for both of us. Goodness knows, I can use one, and I'll bet you can, too."
Another silence, but a shorter one this time. "Okay. But I have to go by and pick up a rental car after work, so maybe I should meet you there."
"Why a rental car?"
As Sara told him about the shooting the night before, Mark pressed harder with his pencil until it broke, sending splintered pieces flying offhis desk. "Are you all right? Did you call the police? And who would do something like this? Why?"
"I'm fine. The police came and took a repor
t. And as for the who and why, I'm still working on that."
Mark was leaning back in his swivel chair. He came forward and his feet hit the floor with a dull thud. "Tell you what. Let me pick you up at the medical center. I'll take you to get your rental car. We can drop it offat your house and go to dinner together. How's that?"
He was getting used to the silences. Obviously, Sara was working on overload right now, and she was thinking through all her responses. Finally, she said, "I guess that would work. And I have to eat sometime. Can you pick me up at the plaza outside the Clinical Science Building about six? No, make that six thirty."
"Six thirty it is. I'll see you then. And in the meantime, be careful."
After he hung up, Mark tore the page offthe legal pad, crushed it into a tight ball, and slammed it into the wastebasket. He couldn't believe this was happening.
Lillian Goodman emerged from the treatment room into the hallway of the clinic and almost bowled over John Ramsey. "Oh, sorry," she said. "Afraid I was thinking about this last patient."
"No problem. I think about patients all the time. But it's good to have something to occupy my mind. Keeps me from feeling sorry for myself."
Lillian looked into John's eyes and read the sadness there. "Look, it's none of my business, but I'm a widow. I've been down the road you're walking. I know it seems like you're never going to get past what you're feeling now, but believe me, you will."
"I appreciate what you're saying, but I don't think I'll ever get over losing Beth."
"I didn't say 'Get over,'" Lillian said. "I said 'Get past.' When you lose a spouse, or any loved one, your world never gets back to where it was. But eventually you have to adjust to the new normal."
"I'm afraid I'm not doing very well at adjusting. I thought going back to work would help, and I guess it has, but still there are times when I feel overwhelmed with my sense of loss."
"And those times will continue to come. You can feel sorry for yourself. You can even cry. But the fact remains that you're still alive, and you ought to make good use of every day. Did it ever occur to you that maybe God left you here because there are some things God wants you to accomplish?"
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