Lethal Remedy

by Richard Mabry

  "Sure. I understand." He fell in step beside her. "Any more strange noises in your house?"

  He knew it was a low blow to remind her of what her exhusband did to torment her after he left her. During Mark's classical education he'd memorized the oft-misquoted words of John Lyly, Renaissance poet and playwright: "The rules of fair play do not apply in love and war." On rare occasion, he'd applied that strategy in the courtroom. After all, weren't most legal battles a form of war? But he'd never had occasion to use it with respect to love . . . until now.

  Sara turned on the living room lights and double-locked the front door behind her. She wondered why she'd turned down Mark's invitation to extend the evening. Did she sense a danger in letting him get too close to her? Was there something about him that triggered her response? Something John said about Mark tickled at the edge of her memory—something about his consulting for pharmaceutical companies. Could one of those be Jandra?

  She dropped her purse on the entryway table, wincing at the muted clunk it made. She unzipped it and pulled out the revolver. A Taurus Ultra-Lite—one pound of metal that could be either a harmless paperweight or an engine of death.

  Sara made sure that the safety was on before she swung the cylinder open and dumped the bullets into her palm. She admired the way the copper noses shone in the light from the table lamp. She tried to visualize one of them ripping through flesh, putting an end to a human life. Finally, Sara carefully reinserted the bullets one by one. She clicked the cylinder into place with an empty chamber under the hammer, re-engaged the safety, and dropped the gun into her purse. It was ready. Was she? She wouldn't know the answer until the situation arose. And she prayed that it never would.

  At her computer, Sara logged on to PubMed. In the search box, she entered Jandramycin, and was surprised to find no hits. Then it dawned on her. She was looking for preliminary work, and the name, Jandramycin, had been applied only recently. She searched her memory in vain for the initial designation of the compound.

  She dialed Rip Pearson's home number. "Rip, hope I didn't wake you."

  "Not at all. I was about to sink into a hot bath. That collision shook me up a bit more than I initially thought, and I'm getting a little sore. What's up?"

  "What was it you called Jandramycin before Jandra applied that name?"

  "EpAm848. Does that help?"

  "It may. Enjoy that hot soak." She rang offbefore he could ask more questions. This might be a total waste of time, but she had to try it.

  Back at her computer, she opened the PubMed search box, typed in "EpAm848," then hit "enter." There were only four citations, three of them papers with Jack as a co-author along with Bob Wolfe and some others whom she took to be Jandra research staff. She struck pay dirt with the fourth. It was a preliminary report detailing the design of a study to investigate a potential new antibiotic. She ignored the abstract that followed. It contained nothing she didn't already know. Instead, Sara found a slip of paper and wrote down the names of the authors: Gruber H., Rohde H.

  18

  RIP WATCHED JACK INGERSOLL WALK ONTO THE GENERAL MEDICAL WARD as though he owned it. The man was an absolute egomaniac. The words of a Carly Simon song came immediately to mind. Something about being so vain. Rip hummed a few bars under his breath while Ingersoll paused to speak with another faculty member, undoubtedly telling him how successful his presentation had been and recounting some of his experiences in Germany.

  "Pearson, what do you have for me?" The musky scent of a popular—and very expensive—aftershave almost overpowered Rip. Ingersoll's white coat fairly crackled with starch. A single pen, probably a Mont Blanc, peeked from the crisply pressed breast pocket. The side pocket bulged ever so slightly with what Rip guessed was the latest version of smart phone.

  "While you were gone, we acquired two more patients with Staph luciferus infections. All have been placed on Jandramycin and seem to be responding well."

  "Very well. Take me to their rooms and let me meet them. I trust you explained to them the reason for my absence."

  Sure. I told them all you were on an expense-paid junket to present a paper that was probably full of fabricated data. "Yes, sir. They understand that you were an invited speaker at a prestigious international conference." The words burned Rip's tongue like a mouthful of scalding hot coffee, but he managed to spit them out with a straight face.

  The next half hour was spent meeting the patients, both of whom were indeed recovering, thanks in no small part to Jandramycin. Neither showed any evidence of side effects or complications from the treatment. Then again, it was early. Unless Rip could somehow find the true mechanism of action of the antibiotic and, even more important, come up with a treatment to prevent late autoimmune reactions, one of them, maybe both, might eventually be afflicted with such a problem.

  The two doctors stopped in the dictation room, and Ingersoll made a few brief notes on each chart. Rip knew this was more to document his presence than add anything to the treatment plan.

  "Any new orders?" Rip asked.

  "No, no. You've done well. Followed my protocol to the letter. I presume Resnick is getting the material for lab studies on a regular basis."

  "Right. I draw the blood myself, take the tubes to your lab, knock on the door, Resnick opens it a crack, I pass them through to him, and he slams it in my face."

  "I know it grates on you that you're not allowed in there," Ingersoll said. "But we're dealing with a revolutionary drug, and it's important that our data not get into the wrong hands."

  Rip figured he'd never have a better opening than that. "But I'm your colleague, your Fellow. I'm supposed to be a part of this study, but Resnick won't even share the mechanism of action of the drug with me. And it's important, because—"

  Ingersoll held up a hand like a traffic policeman. "You already know the mechanism. I told you this early on. Jandramycin breaks down the bacterial cell wall. I can't go into details, but there's a great deal more data in the New Drug Application."

  Which is probably a remarkable work of fiction. Rip decided to take a different tack. "You recall that Chelsea Ferguson, one of the patients in our series, was admitted with Guillain-Barré syndrome before you left."

  "Terrible when that happens. Refresh my memory about her."

  Rip gave Ingersoll a brief review of Chelsea's case, ending with, "It seems to me that this could be a late consequence of Jandramycin therapy. Would you like to see her?"

  Ingersoll shook his head. "No, no. I'm sure she's in good hands. And too much time has passed since her treatment to implicate Jandramycin in the problem. It's undoubtedly just one of those unfortunate circumstances."

  It was clear to Rip that Ingersoll wasn't going to admit Jandramycin could be responsible for any adverse effects. There was no need to prolong the conversation. But there was one more thing he wanted to say, and he thought he'd figured the best way to say it.

  "Dr. Ingersoll," Rip said, "I was helping Dr. Miles clean out her attic recently, and we found something you left behind when you moved out."

  "Oh? I don't recall anything being missing. It couldn't be very important. She can just keep it."

  "I'll tell her that, although neither of us could figure why you'd move out and leave a very expensive digital recorder behind. And why was it in the attic?"

  Rip was sure Ingersoll flinched for just a second before the mask dropped back in place, and he said, "I don't know what you're talking about."

  Bob Wolfe had been expecting the summons, but it came from a different source. Not David Patel this time. Instead, he was told that Mr. Lindberg would like to see Mr. Wolfe in his office at his earliest convenience—in other words, now. Wolfe thanked Lindberg's secretary, hung up the phone, and turned to look out his office window.

  It wouldn't hurt Lindberg to wait a few minutes. Wolfe was sure he was being called in to report on how things went in Frankfurt, and he wanted to be certain he had the answers clear in his mind. He reran the reel of the last couple of days t
hrough his mind and smiled when he could find no fault with what he'd done or the results. He buttoned his collar, cinched up his tie, and took his jacket from a hook on the back of his office door.

  Wolfe paused at the open door when he saw Lindberg on the phone. Lindberg's desk faced the huge windows that gave him a spectacular view. Some people might turn their desk away from such a distraction, but Wolfe had heard Lindberg say he kept that perk visible to remind him of how hard he had to work to retain it. In a down economy, people might be fired, but Lindberg was apparently determined to be the one doing the firing, not the one on the other end.

  Lindberg's conversation was animated, to say the least. "I don't care how you do it, but I want those mock-ups on my desk tomorrow. Jandramycin is the drug that's going to save this company, and that won't happen if no one knows about it. I want those ads ready for the front part of every major medical journal in the U.S. I want them to hit at the same time our reps are knocking on doctors' doors to tell them about our wonder drug. One hundred percent success against the worst infections in history, with absolutely no side effects."

  Wolfe faintly heard the murmur of words rattling forth from the phone when Lindberg broke in. "No, you can't have more time. The FDA is moving this thing forward triple speed, and you don't want to know how we managed to get that done. When they give their approval—and they will—I want those ads ready to roll with the next issue. Is that clear?"

  Apparently it didn't matter whether it was clear, because Lindberg slammed down the phone without waiting for an answer.

  Wolfe tapped on the doorframe. "You wanted to see me, Steve?"

  Lindberg swiveled his chair around and in that split second managed to go from hard-nosed boss to jovial colleague. "Bob, come in. Sorry to keep you waiting." He waved at one of the chairs across the desk from him. "Have a seat."

  Wolfe pulled up a chair but decided to let Lindberg take the conversational lead. He didn't have to wait long.

  "Tell me about the meeting in Frankfurt."

  "Huge attendance, representatives from the U.S., the UK, Germany, France, Belgium—"

  "Okay, it was well attended. And our people had a booth where we reminded people of all the great products we have and told them we are coming out with a blockbuster. And so forth. You know what I want to hear."

  Not much question there. Wolfe decided to be equally direct. "Ingersoll toed the company line perfectly. I stayed up all night before his presentation reviewing his slides, and they were perfect. Figures matched the ones we sent to the FDA in our new drug app. Conclusions in line with ours, including the lack of adverse reactions."

  Lindberg nodded. "And—"

  "And the Q&A ended with him being asked if he was aware of any complications associated with Jandramycin. He parroted back what we gave him." Wolfe smiled, remembering the way he'd reminded Ingersoll who was buttering his bread. But there was no need to mention that to Lindberg. Such actions were expected. He figured the marketing director had done similar things in his time, and probably a lot worse.

  "Now to another part of our problem. We've had no more calls from that snoopy Dr. Miles, but I understand she's still convinced Jandramycin is responsible for a number of severe late complications in some of the patients receiving it. Now that you're back from enjoying sauerbraten and beer, why don't you contact your source and get an update on that situation? And let me know what you find out."

  Lindberg rose and extended his hand, as close to a "thanks for a job well done" as Wolfe expected to receive. Before he was out the door, Wolfe heard Lindberg on the phone once more. "What do you mean, our reps can't get in to see the doctors? Tell them to bring lunch for the staff. Hang around with them while they eat. I've never known a doctor who wouldn't drift back and nosh a bit. That's when—"

  "How are you today?" Sara plastered a smile on her face as she approached Chelsea Ferguson's bed. For a change, the girl's mother was not at the bedside. "Your mother not here?" Chelsea's reply was so weak Sara had to ask her to repeat it. "My sister's sick. Mom kept her home from school and had to stay with her."

  "No problem. If you need anything, ring for the nurse. They'll be right here for you." Sara flipped open the chart. "How are you doing after the immune—I mean, that medicine we gave you the other day?"

  "Not much different." Chelsea's lower lip trembled. A tiny tear formed at the corner of one eye. "I . . . I still can't move my legs. And my arms are weak."

  Sara pulled a reflex hammer from the pocket of her white coat and checked Chelsea. No reflexes in the legs, and definitely weakened responses in the arms. The immune globulin was reported to work most of the time in cases of severe GBS. But so far it hadn't seemed to help. There must be something different about the syndrome that Jandramycin triggered. And she had no idea what that difference was.

  "Well, we have a few more tricks up our sleeve. I'll see you again this evening when I make rounds. Meanwhile, you keep your chin up."

  Chelsea nodded weakly, then turned her face to the wall. Sara eased from the room, feeling lower than she'd ever felt as a physician. God, I absolutely don't know where to go from here. Got any suggestions?

  Lillian Goodman paused outside the treatment room door. This time she was well aware of who was inside, but still she hesitated to enter. John was getting his daily IV dose of Jandramycin.

  She held up her hand to knock, then dropped it to her side. Would John appreciate some company during the time he received the IV? Or would he prefer to be alone? This is silly. I'm just visiting a friend. She tapped on the door.

  "Yes?"

  Good enough. Lillian entered and closed the door behind her. She tried to put a smile in her voice as she approached the treatment table where John lay. "How are you?"

  "Not too bad." He held up the arm that wasn't receiving the IV and wiggled his fingers. "My hand is pretty much back to normal. No redness. No swelling. Not even a little tenderness. Rip thinks it's healing fine, and I agree. So the magic medicine is doing its thing, even against the superbug."

  The words hung in the air as they both considered the possible late consequences from the drug now running into John's veins.

  Lillian tried to find words to change the subject, but they wouldn't come. Negative thoughts crowded out anything positive about the situation.

  John must have sensed her struggle. "Look, I know everyone's worried that I might be going from the frying pan into the fire with this treatment," he said. "But look at it from my side. If we do nothing, we know what would happen. We've been over that. It's either accept a 100 percent chance that the disease will kill me, or at least make me lose my hand, versus a 15 percent chance of some sort of autoimmune response that could possibly be controlled with steroids or something else." He shrugged. "It's a no-brainer."

  Something clicked in Lillian's mind. "You came out with that 15 percent figure awfully quickly. Where did that come from?"

  "Rip was able to contact almost all the thirty-nine patients in Ingersoll's study. Of those, six had complications we think are due to the Jandramycin. Simple math. Six of thirty-nine. Fifteen percent chance of problems."

  "Which poses the bigger question. What is it about that 15 percent of patients that makes them vulnerable to this sort of response?" Lillian pulled a straight chair to the side of the treatment table and sat down. "Has your group come up with any answers?"

  John recounted what had been done and the dead ends they'd encountered. Every time Lillian suggested a possible avenue of investigation, John countered with the roadblock that stopped them getting the information they needed.

  She stood and began to pace. "So it appears that we need to know how Jandramycin really works before we have any realistic chance to figure out how to prevent that 15 percent of patients getting late complications."

  "Right. And if you have any ideas, you're welcome to contribute them." He raised himself on one elbow. "And would you please sit down? I'm getting dizzy watching you pace."

  Lillian eased i
nto the chair again. She reached into the pocket of her white coat and extracted a small notebook with a pen stuck into the ring binding. "I'm going to do some investigating of my own. Do you happen to know the original name of the compound? Not Jandramycin. What they called it in the beginning."

  "Not really. Why do you ask?"

  "Because I may be able to backtrack from there and get information about the mode of action of the drug. There's usually a reason for the names investigators give these compounds." She put the notebook back into her pocket. "Besides, unless you have a better idea, it looks like we don't have anywhere else to go short of holding Ingersoll or Resnick at gunpoint until they give up their secrets."

  John said something, but Lillian only half-heard it. Her mind pictured the scenario she'd mentioned so off-handedly, and wondered if it just might work. After all, her late husband's gun was still at home in the back of a drawer under her winter sweaters. And how difficult could it be to use it?

  19

  DOES ANYONE THERE SPEAK ENGLISH?" SARA REALIZED SHE WAS SHOUTING into the phone and made an effort to moderate her tone. Although reason told her that talking louder didn't increase the chance the person on the other end of the line would understand her despite the language barrier, the longer she talked the more frustrated she became and the louder she spoke.

  The woman seemed calm enough, not at all flustered by the conversation or lack thereof. Neither her tone of voice nor her answer changed. "Bitte, Ich verstehe nicht."

  By now, the phrase was familiar to Sara. The woman didn't understand. This was the end of a tedious process, and it looked like it would be wasted effort.

  Sara had dug deep on the Internet to find that Drs. Gruber and Rohde were internal medicine specialists on the faculty of a medical school in Ulm, Germany. Then it was a matter of finding the contact information for that medical center, looking up the process for making an international call, calculating the time difference between Texas and Germany, and finally placing the call from her home phone because Southwestern Medical Center would undoubtedly look askance at an unauthorized transatlantic phone call from her office phone.