"It's an experimental drug, Lillian," John said. "When we get informed consent to administer those compounds, all we have to go on is the information the manufacturer gives us. And in this case, that didn't include the whole truth."
"Surely Jack Ingersoll had some inkling about all this." John winced, and Lillian realized she was holding his hand tightly. She relaxed her grip, just lightly covering John's hand with hers. "Sorry."
"No problem. At least the drug is painless going into the vein. To address your question, we don't know what Ingersoll knows about all this. At first, everyone involved was happy that Jandramycin worked so well and had no apparent ill effects. That's why he and Jandra Pharmaceuticals were rushing to get FDA approval. Thousands of people have already died from Staph luciferus. Every day's delay condemns more."
"Surely Jack suspected something," Lillian said.
"When Rip and Sara first suspected that it might cause autoimmune problems, they confronted Ingersoll about it, but he denied that any problems exist. Now it's as though he has blinders on."
Lillian squared her shoulders. "Let me do some reading. Maybe there's something we can do to prevent these complications."
"We're already working on it, but we haven't had much luck so far."
"Who's 'we'?"
"Sara, Rip, and me. Oh, and another one of my former students, Dr. Mark Wilcox. He practiced law before he went to med school. Now he's an FP."
"Well, like it or not, you just added another member to your group. When and where are you going to get together next?" She rose and gave John's hand a final, gentle squeeze. "You and I can supply something none of the other three have."
"And that is?"
She forced a smile. "Experience. I've been practicing medicine for thirty-five years. I guess with you it's closer to forty. We've seen situations those young pups have only read about. They don't know it yet, but they need us."
"How are you today?" Sara Miles did her best to put a smile in her voice as well as on her face as she approached Chelsea Ferguson's bedside.
"About the same," Chelsea said, her tone flat, her face expressionless.
Mrs. Ferguson, seated on the other side of Chelsea's bed, shook her head and mouthed the words, "Not good." She took a tissue from her pocket and wiped the corners of her eyes.
Sara's neurologic exam bore out Mrs. Ferguson's words. The weakness in Chelsea's legs was much worse, and the reflexes there were virtually absent. Even more worrisome, the girl was losing strength in her arms. This was the reason clinicians had originally given GBS the name Landry's ascending paralysis. The paralysis might progress upward until the patient was unable to move and required the assistance of a ventilator to keep breathing. Sometimes the symptoms resolved, although it could take weeks or months. But sometimes they were permanent.
Still at the bedside, Sara flipped open the chart and scanned it. Anna Pearl's last note was brief, and not at all encouraging. "Progression of weakness in lower extremities, early signs in upper extremities. Will discuss adding further Rx to steroids." Sara racked her brain to come up with something more to add. She'd have to call Anna and see what the neurologist had in mind.
Sara gave Chelsea's hand a final squeeze. "You hang in there. We'll lick this yet."
As she'd come to do, Mrs. Ferguson followed Sara into the hall. "She's getting weaker. Can you do something?"
"I'm about to talk with Dr. Pearl about adding another medication for Chelsea. You heard what I told her. We'll lick this thing." Sara patted the woman's shoulder and turned away, hoping she'd done it quickly enough that Mrs. Ferguson didn't see the tears that strained for release from her own eyes.
Anna Pearl answered her page within a few minutes. "Anna, this is Sara Miles."
"Oh, yes. We need to talk about Chelsea Ferguson. Her paralysis is progressing."
"I know. I just saw her. What do you suggest we do?" A name jumped into Sara's mind. "Could we add something like methotrexate?"
"Interesting that you should suggest that. I thought about an antimetabolite, but when I did a literature search, these compounds have been tried and don't add much."
Ideas were coming to Sara fast and furious, and she didn't try to filter them as they entered her mind. "What about immune globulin?"
"That's what I was considering. Not every study supports its use, but sometimes it helps. And one dose IV should be sufficient . . . if it's going to work."
"A milligram per kilo?"
"Make it two," Anna said. "If we're going to hit this, let's hit it hard. And keep your fingers crossed."
I won't just keep my fingers crossed. I'll be praying this works— because if it doesn't, I don't know what I'll do. I'm out of ideas.
17
JOHN, YOU'RE A HARD MAN TO TRACK DOWN." MARK WILCOX PULLED out his bottom desk drawer and rested a polished cordovan loafer there. He switched the phone to his other hand and began to doodle on a legal pad. "We need to talk about your malpractice case."
"I'm sorry I haven't returned your calls. There's been a lot going on."
"I'd love to hear about it. When can we—"
"Just a second." There was a muffled exchange. "Sorry. I'm still in clinic and had to answer a question for my nurse. Can we meet this evening sometime? Come by my house and we can talk over coffee."
Mark scanned through the possibilities. "I've got a better idea. I have to see a few more patients, then go by the hospital for a bit. Why don't you come by my office a little after six? If Sara Miles and Rip Pearson are free, we could all meet somewhere for dinner and pool information on the Jandramycin front." He scrawled a note on the pad in front of him. "Del Frisco's has a private dining room. I can have my secretary reserve it for seven thirty. My treat."
"I guess I could check with Sara and Rip."
"That would be great. When you know for sure, call my office and Karla will take it from there." Mark smiled at the prospect of seeing Sara again, even if he did have to share her with others at dinner. This time, maybe their evening together wouldn't end when the meeting broke up. "See you around six."
Mark was smiling when he shrugged into his white coat and walked out of his office to see his next patient.
"Why the worried look?" Lillian Goodman pulled out a chair and joined Sara Miles in the clinic's break room. "Thinking about a patient," Sara said. She held her Diet Coke to her forehead and closed her eyes. "Why is it always the nice ones who have the complications?"
Lillian's first thought was John Ramsey. If she had anything to do with it, he wasn't going to be one of those nice ones who didn't do well on treatment. She made a mental note to ask Rip Pearson for more information on the Jandramycin late effects John had mentioned. "Which patient is this?" Lillian asked.
"Chelsea Ferguson. She almost died from Staph luciferus sepsis, but we pulled her through with Jandramycin. Then she developed Guillain-Barré. We think the drug produces autoimmune disorders in some patients who receive it."
No need to go to Rip. This was all the opportunity Lillian needed. "And now John is one of those patients. What can we do to protect him and the others from those side effects?"
"We're checking into—Wait a second. Who's this 'we'?"
"The other day I found John in a treatment room getting his IV meds. He told me that you, Rip, and another doctor were trying to solve the problem, hopefully before he gets one of those complications." Lillian sat up a bit straighter. "I'm inviting myself into the group."
"But why—"
"Because as a doctor, I'm dedicated to healing people, not making them worse, and I've contributed a couple of my patients to the Jandramycin study. So I feel an obligation to look out for them." She pushed back her chair. "And because, frankly, I'm growing fond of John. He's been through a lot, and I think right now he needs a friend. I've volunteered for the position."
John Ramsey rattled the knob of Mark Wilcox's office door, but it didn't budge. Repeated taps on the door brought no response. He had his cell phone out when he heard footsteps in the h
all behind him.
"John, sorry to keep you waiting." Mark hurried up and pulled a set of keys from his pocket. "I got tied up at the hospital. Come on in."
When they were settled in Mark's office with soft drinks, John looked around at the office. Simple and functional, much like the one he'd had for years. "You seem to have a nice setup here."
Mark leaned back and propped one foot on his desk drawer. "I like it. As I told you, I have a limited family practice but still manage to do a little law as well."
"Do you think that as your medical practice gets more active, you'll do less law?"
"I don't see that happening," Mark said. "Things have settled into a pattern, some medicine, some law, sometimes a combination of the two. For instance, I'm a consultant to the in-house counsel at one of the private hospitals in the city. The reason I was delayed was because he and I were meeting with the administrator and the chief of staff. There's a rather sticky problem with one of the physicians who has privileges there."
"So what's new with my case?" John asked.
"I've been in touch with the attorney representing the plaintiff. Frankly, he's never handled a malpractice action, and I think he filed this as a favor to the guy who brought the suit. They move in the same society circles." Mark lifted his can of soda, found it empty, and put it down. "If it looks like we're going to trial, he'll probably turn it over to someone who does this kind of thing all the time."
"If it comes to trial? So it may not?"
"Filing the suit is only the first step in the dance. This is what I used to call an 'I'll get you for this' suit. From what I can tell, the son of the woman who died thinks everything around him should be perfect, and if it isn't, someone has to pay. Never mind that his mother refused to follow her own doctor's advice and wasn't taking her medications. Matter of fact, she was visiting the faculty clinic at the med school for a second opinion because her daughter insisted on it." Mark picked up a pen and began twirling it between his fingers. "The daughter, by the way, opposes this suit."
John's heart hammered against his sweat-soaked shirt. "What happens now? Can you get the court to remove me from the suit? All I did was start an IV."
"Not likely to happen. A suit like this is filed against every person and entity involved. The plaintiff— that is, the person who sues—could amend the suit, but I doubt that will happen while there's a possibility of getting something out of you. And the courts probably wouldn't allow it anyway. They prefer one trial for everyone."
"And if it comes to trial?"
"One thing they teach us in law school is to always try for a settlement, because there's really no way to predict what a jury will do. A trial is the last thing we want, and my goal is to avoid one."
"Does this mean I might end up paying to settle a suit against me that has no merit?"
Mark spread his hands. "I'm going to do my best for you, John. I'll let you know what happens. And I'll warn you, these things can drag out for months, sometimes a year or more."
So there it was. John had come here hoping to hear good news, but there was none. Just like everything else that happened to him lately, the only thing to do was wait. John wondered how much more of this he could take. And as quickly as the thought flashed into his mind, the answer came. The same answer he and Beth had given each other when the tough times came over four decades of marriage. I don't know. But God's in control.
Mark looked at his watch. "We've got a few minutes before it's time to head to the restaurant. May I ask you a question?"
"Sure."
"Is Sara Miles seeing anyone?"
John ran that through his mind and came up blank. "I'm not sure I'd know if she were, but I've never heard her mention anyone. I think she's still hurting pretty badly from the loss of her baby and her divorce."
"But that was . . . how long ago? A couple of years?"
"About that. But people heal at different rates. Why do you ask?"
Mark cupped his chin in his hand for a moment. "You may recall that when I was in medical school, I was married." He held up a hand that bore no ring. "Now I'm not."
"I didn't want to say anything, but yes, I noticed."
"My wife died almost two years ago in a head-on crash with a driver who was going the wrong way on Central Expressway."
"Mark, I had no idea," John said.
"I've never even looked at another woman until I met Sara. And ever since then, I can't get her out of my mind."
"So the fact that she was the target of a shooter—"
"It almost killed me to hear about it. And if she feels about me the way I do about her, I don't plan to let her get away. I feel like this is a second chance for me. Maybe it's a second chance for both of us. And I'm not going to waste it."
Sara looked at her watch for what must have been the tenth time in the past half hour. Where was Rip?
"We'll wait until everyone's here to order," Mark said. The waiter nodded, deposited drinks on the table, and walked away. The group sat in a small private dining room, centered at a table that would accommodate eight, with Mark and Sara on one side, John across from them. A fourth place setting marked the spot where Rip would sit.
"I guess we'll wait until Rip gets here to start sharing information," Sara said, "but I'm sorry to say I don't know a lot more than I did when we met last."
John fiddled with the silverware in front of him. "The same goes for me."
"I have a few things to—" Mark stopped as Rip hurried into the room.
"Sorry to be late. It appears that my attempts to find out more about Jandramycin stirred up a hornet's nest." He dropped into the vacant chair and drank deeply from the glass of iced water in front of him.
Sara leaned across toward him. "What happened? Are you all right?"
"Yes, but no thanks to whoever drove the SUV that sideswiped me and pushed me into a concrete abutment." Rip pulled a handkerchief from his pocket and wiped his brow. "My car will need some body work, but I managed to keep it under control. Otherwise, I'd have bounced out into the road and been broadsided by another vehicle."
"Could it have been an accident?" John asked.
"I saw the SUV in my rearview mirror just before he hit me. I'm pretty sure he was aiming right at me, trying to sideswipe my car."
Mark leaned back in his chair. "So there've been attempts aimed at Sara and Rip. John, I guess you've been spared."
"Because I haven't been asking around. There's the difference."
"So who have we asked?" Rip said. "Jack Ingersoll, Carter Resnick . . . "
"The higher-ups at Jandra," Sara added.
"And, of course, there could be someone else who knows what we're doing, someone we don't even know about," Mark added.
"What do we do about it?" Sara asked.
Mark tented his fingers under his chin. "Rip, I suppose your accident was investigated by the police."
"Yeah, they came out. Said they'd file a report, put out a bulletin to body shops. I don't look for anything to come of it, though."
"And we know the shooting involving Sara was reported," Mark added. "I could talk with the police and try to tie those together, see if they're willing to investigate further."
"But that's not likely. Right?" John said.
"Not really," Mark replied.
"Forget it," Rip said.
Mark nodded his agreement. "So I guess we either stop digging—"
"Never!" both Sara and Rip answered in unison.
"Or be careful," Mark said.
"You started to tell us what you've found," Sara said. "What was that?"
"One of the guys in my law school class ended up at the FDA. He sort of owes me—I coached him through his last year—so I gave him a call. Could he get a copy of Jandra's NDA for Jandramycin? No way. Apparently they've pulled some strings with the FDA and gotten it not only fast-tracked but protected from everyone but the small group that's due to review it."
"Makes no difference," Rip said. "The mechanism of action they
quote for the drug is probably cell wall destruction, and we know that's just a smokescreen. We need the real mechanism if we're going to figure out how to block the late complications."
Mark nodded. "And we can't get that from Jandra."
"Never going to happen," Rip said.
"Or from the investigators," Mark concluded.
"And I understand that we don't have time to analyze the compound we have on hand, then do the animal experimentation to show its mechanism of action," Sara said.
Mark shook his head. "I believe we've tried every legal means available to get the information we need."
As she pondered that last phrase, Sara decided that maybe it was time to think outside the box. She had a couple of ideas— but she decided she'd better keep them to herself for now.
Mark signed the bill, retrieved his American Express card, and closed the folder. "Thank you all for coming."
John dropped his napkin beside his empty coffee cup.
"Thanks for dinner. It was good to throw around some ideas and share information, but I'm afraid we're no closer to a solution of our problem than we were before we started."
One by one, the group pushed back their chairs and stood.
Rip declined a ride with John, saying that although his car looked terrible it was still drivable. "I'll call my insurance company in the morning and see about getting a rental while mine's in the shop."
Mark was happy to see that Sara was the last in the group to move toward the door. He touched her on the shoulder. "I was wondering if you might like to go somewhere for a—I was about to say a drink, then I remembered—for another cup of coffee? We haven't really had a chance to talk with each other tonight."
He could see Sara consider the offer. Her frown told him the answer before she spoke. "Mark, I like you. Under more normal circumstances, I'd say yes. But I'm really in turmoil about this whole Jandramycin thing. Until it's settled, I'm not ready for any kind of a relationship. For now, can we just stay friends?" She smiled, obviously trying to take the sting out of her response.
Lethal Remedy Page 17
