Die Before Your Time (Elia Christie / Luis Echevarria medical mysteries)

by Polonus Mucha, Susan

  Luis had been sitting on a barstool seemingly oblivious to the exchange between the two. “Wait a minute. I got in just by saying I had a reservation at the hotel.”

  The guard nodded.

  “So all anyone has to say is that they have a reservation,” Elia said. “So anyone could come in.” Before she got an answer she said, “What about someone coming to a private home? Or a renter?”

  “The homeowner calls in a pass,” the security guard answered, sounding defensive.

  Luis watched the exchange and was silent as he rocked back and forth on the stool. “Doesn't make sense. Who would call in a pass for a burglar?” He held up a hand. “Let me put it another way. Who would want his name on a pass — if he knew he was going to rob someone.”

  Elia and Luis were ushered outside. They sat on the front porch while the police were inside. An officer came out to speak to them. “You can leave. We got in touch with the owner, and he'll fly down day after tomorrow to look the place over. He'll be able to tell us what's missing.”

  “Good. We'll meet him here,” Elia said. “We have to know what not to pack.”

  “We'll let you know when we're finished here.” He looked in his notebook. “Got your contact information.” He stood there looking at them, as though he were willing them to leave.

  Elia sat looking out across the street into the wooded area that served as home for local bobcats. She was frowning.

  Chapter 22

  “You're quiet.” Luis glanced over at Elia. They rode side-by-side on the bike path on their way back to The Sanctuary. Neither seemed to admire the scenery.

  “I think we should take Vicente's girlfriend with us when we meet the owner.”

  “He wouldn't claim something of Vicente's.”

  “No. But she might notice something missing.”

  Luis nodded. They rode in silence.

  Elia broke the silence. “Motive. There's always a motive.” They had parked their bikes in racks and had sauntered down the boardwalk to the ocean and were sitting on the top step that led to the beach. “Always.”

  “What are you talking about?” Luis kept his eyes on a shrimp boat far out in the ocean.

  “When I was writing the story on violent crime investigators in Augusta that's what I heard from the police. Motive. Find the motive and it'll lead to the criminal.”

  “I guess that's what I've been trying to figure out; why?” He stood up. “Let's go back. I want to get to my computer. There's something I want to look up.”

  Thirty minutes later Luis and Elia sat on their balcony eating lunch ordered from room service. Luis bit into a crab cake sandwich, took a swallow of milk, and stared at his laptop.

  “I knew I had heard about this. Listen.” He set his milk down and sat on the edge of his chair. “This is an article written in 1968. It documents medical cases of paraplegic and quadriplegic soldiers in VA hospitals during the Vietnam War. They had all been given the same drug for spasticity related to paralysis, and some, no not some, many, developed a life-threatening liver disease.”

  Elia moved her chair so she could look at the computer screen with Luis. “What does it mean?”

  “Wait a second.” He scrolled down the page. He didn't take his eyes off the screen.

  He turned and picked up Vicente's report and flipped through the pages. Slowly the blood drained from his face.

  Luis pushed out of his chair and paced like a cat around the small balcony. “I read every word of Vicente's notes for the Bermuda conference. Every word.” He turned to look at Elia. “He was doing a rotation at the spinal center here on the neurology service. According to his notes, he treated a lot of wounded soldiers. Saw a lot of paraplegics and quads.”

  “And?”

  “And he saw a lot of hepatitis.”

  “Liver disease?

  “A life threatening liver disease.”

  “Coincidence?” Elia held a forkful of salad suspended in the air as she waited for Luis to continue.

  “Elia, it looks like the same drug. It has a different name. But what doesn't have a different name is the drug company. Pavnor.”

  Elia put her fork on the plate and turned to look out at the sea. She turned to Luis. “The same drug company… I knew it. My scuba diving accident was no accident.” She shivered. “I wonder where Aaron Scharff is now.”

  “These notes. I think there's more.” Luis was out of his chair pacing around the small balcony.

  “What?”

  “Vicente had something to say to me.”

  “But you have his report; that's good, isn't it?” Elia set her salad aside and turned back and forth in her chair to follow Luis as he paced. “Doesn't that tell you?”

  “Why would he be murdered? Why would his place be ransacked? Over a drug?” He shook his head. “Pharmaceuticals are big business, but there has to be more.”

  “Maybe if we knew what those people were looking for, we'd know what Vicente wanted to talk to you about.” She swiveled to keep her eyes on him. “Isn't that what you mean by ‘has to be more’”?

  He stopped prowling. Maybe so. But how would we ever know.” He slammed his hand down on the railing. “Damn! Why didn't I let him talk when he wanted to.”

  “Oh no, you don't.” She stood and put her hand over his. “Don't even think it. He was sick and shouldn't have been talking.” She stepped back. “Please let's not go there.”

  He nodded. “We'll let Burnside know about the break-in. And the police are out at Vicente's right now.” He patted his pockets and pulled out a card. “Here it is. One of the cops handed this to me.”

  “And what would you tell him? That your wife thinks someone sabotaged her scuba gear in Bermuda? That'll go over big.” She shook her head in dismissal and sat down to pick at her salad.

  “Got another idea?” Luis sat down opposite his wife and looked at her with raised eyebrows.

  “No. I guess you'd better make those calls.”

  Chapter 23

  “W should talk to Angel. Vicente said she knew about his problem.”

  “And we have to offer our condolences. Besides, she really should come with us to the house when the owner's there.” Elia leafed through the phone book. “I'll try her at work.” She found what she was looking for, wrote the number in her notebook, and dialed the number to Charleston Spinal Center.

  When she asked for Angel Carter, Elia's call was transferred to the Physical Therapy Department. A few minutes later, Elia carried on a short conversation.

  Luis looked at her, as she replaced the receiver. “Well?”

  “She's there, but was busy with a patient. She gets off work at seven. I left a message that we would be there by seven, and that we'd like to meet her.” Elia looked questioningly at Luis. “Maybe we can take her to dinner? And since we're going to the hospital, we could see Riser before we see Angel. Good plan?”

  “Good plan.”

  “I'll try to reach him.” She placed the call and set up a six-thirty meeting at the hospital.

  It wasn't difficult to find the spinal center; in fact, they had passed it on the way from the airport. It sat back from the road almost hidden by a thick stand of trees. The color of old putty, it blended in with the landscaping.

  They entered the hospital through the front door. Inside, soft colors added a calming effect to the lobby.

  They followed the receptionist's directions and

  walked down a carpeted hallway to Dr. Riser's office. Passing them as they approached an open door was a slim blonde woman. She glanced at Luis and seemed to gasp. But she kept walking.

  Dr. Riser was standing behind his desk when they knocked at the open door. He seemed startled to see them.

  “We're not early, are we?” Luis asked from the door.

  “No, no. Come in.” Riser cleared his throat. He reached out and shook their hands. “Luis, Elia. Welcome to Charleston. I'll let Bonnie know you're in town. We'll have to get together.” He motioned to the door. “That was Angel
Carter, Vicente's girl.”

  “Oh, that was Angel?” Elia stepped back through the door and looked down the hall. She was gone. “How is she? We'll be seeing her later this evening.”

  “Distraught.” He settled in the chair behind his desk and motioned for them to sit down. He looked at Luis. “What can I do for you?”

  “After we saw you in Bermuda, Elia and I ran into some trouble.”

  “Trouble? Such as?” Riser leaned forward in his chair; a frown creased his brow.

  “We were chased by some lunatic on a motorcycle, someone broke into our cottage, and —”

  Elia jumped in. “And someone ransacked Vicente's house on Kiawah.”

  Riser seemed to lose some color. He took off his glasses and slowly ran his hand over his face. He shook his head. “Do you know why?” His voice was raspy.

  Elia put her hand on Luis's knee and answered quickly. “We thought you could tell us.” She watched him closely. “Vicente was having a problem at work, wasn't he? Do you know what it was?” She tried not to sound confrontational.

  “I'm not sure.” Riser took a deep breath and replaced his glasses. “He talked to me about a medical problem, yes, but I don't see how that would cause all of this trouble.”

  “What kind of medical problem? His performance?”

  “No, no. He did fine at work. In fact, Paul Kittrick seemed to think highly of him.” He looked as though he wanted to say more.

  “Yes? Paul Kittrick?” Elia asked.

  “I had heard Dr. Kittrick — Kitt — was going to tap Vicente for chief resident.”

  “But?” from Luis, who was now leaning forward in his chair.

  “But he didn't.” He held up his hands, palms out. “Don't know why.”

  “No idea?” Elia asked.

  “No idea.”

  Luis pursued another avenue. “The medical problem he talked to you about. What was that about?”

  “He wasn't well. Had an ulcer.”

  “That's it? How about a different kind of medical problem?” Luis asked.

  Riser sat very still. “What do you mean?”

  “The conference. I read his notes for his paper — the one he was going to present in Bermuda.”

  “And?”

  “You read the finished paper?”

  “I did.”

  “I'm curious.” Elia jumped into the exchange. “Who presented his findings? I understand someone was going to read his paper.”

  Riser looked away from the couple. He took another deep breath, then said in a voice barely audible, “No one.”

  “What?” Luis jumped up from his chair. “Why? Cyptolis is killing people.” Anyone walking in the hall would have heard his outburst.

  Elia reached up for his hand and tugged him back into his chair. Now it was his turn to take a deep breath. He shook his head, as though he couldn't believe what he had just heard.

  Riser had gotten up and closed the door during Luis's outburst and returned to his place behind his desk. “I wasn't in charge of that meeting. I had no say about the speakers.”

  “But didn't you give any credence to his findings?” Luis whipped out the report from his jacket pocket. He flipped a couple of pages, and began reading about side effects.

  “Look. I did want him to present the paper. I'm just saying I didn't push it after he died.”

  “I don't get it. Vicente was dead. At least don't you think you could have read the paper out of respect for him and the work he put into his research?” Luis willed himself to speak calmly.

  Riser shook his head. “Maybe you're right. But I think he should have done more research before he put the treatment of so many of our soldiers on the line. And I'm not the only one who shares that opinion.

  “Paul Kittrick wasn't particularly happy with his paper.” He hesitated. “You asked why Vicente wasn't appointed chief resident. I think it had to do with the fact that your friend wasn't afraid to speak up when he thought something wasn't right. He didn't mind rocking the boat. Kittrick doesn't like rocky boats.”

  “But his findings —” Luis began.

  Riser interrupted. “My god, man, these young people were over in Iraq and Afghanistan fighting for us. We should give them anything we can to make them more comfortable. Dr. Pereda jumped the gun.”

  “Wait a minute.” Elia held up a hand to stop Riser. “Just exactly what does Cyptolis do? And why do you single out soldiers?”

  “We don't just give it to soldiers, but the majority of our patients in the spinal cord unit are just back from the wars. I'm sure if you checked with other doctors in civilian hospitals, they use Cyptolis for their spinal cord patients.”

  He looked at Elia. “It successfully treats stroke, multiple sclerosis and cerebral palsy patients as well. You want to know what Cyptolis does? First you have to understand what these men and women are going through.

  “Let's talk about spinal cord injuries, because that's what Vicente saw a lot of at this hospital.” He leaned across his desk. “A big percentage of spinal cord patients experience spasticity, and due to this spasticity about half of them experience pain and limitation of activities. Just the word spasticity suggests the other illnesses I mentioned; do you see?” He addressed his question to Elia.

  She nodded, but said nothing.

  “I know Luis is familiar with this, but one component of spasticity is these patients have exaggerated tendon jerks. This is an upper neuron syndrome.

  “To further answer your question, this is considered to be the only motor neuron symptom to respond to therapy.” Riser again directed his attention to Elia, not even glancing at Luis.

  “There has been more research, of course, and more conclusions, but just this one idea is enough to help doctors seek a readily available treatment for spasticity.” Now he looked at Luis. “And one of those treatments is Cyptolis.”

  “Are you aware about a thirty-year-old study about this exact same drug?” Luis asked Riser.

  Riser frowned. “What are you talking about? I've read the literature. This drug has only been out a short time. The trials have just been completed. We expect full FDA approval any time now.”

  “I don't understand how it can be given to patients if it's not fully approved,” Elia said.

  “Nothing new, Elia. Jake knows this. It wasn't until the early 1960s that the FDA began tightening its review of drugs. Congress ordered the FDA to review all new medications. Drugs before then are now supposed to be evaluated, but some companies insist they're grandfathered in. So drugs that go back decades are still on the market.

  “Jake, remember the vitamin E injectible from back in the 80s?” Luis turned to Elia. “One of those grandfathered drugs, E-Ferol, a high potency Vitamin E injection, was routinely given to premature babies. But when about a hundred had serious reactions from the drug, and forty died, it woke up the FDA. It began to scientifically test the grandfathered drugs.”

  Riser added, “The FDA says it's trying to expel them from the market.”

  “Well that's a good thing,” she said.

  “Not good enough,” Luis said. “Plenty are still being used and we are paying for them.”

  “Excuse me?” she said.

  Luis glanced at Riser, who was nodding in agreement. “Medicaid pays for them.”

  “He's right, Elia. I've seen data that reported that within a recent three year period Medicaid paid nearly $198 million for more than 100 unapproved drugs.”

  “And most of them were for common conditions — colds, pain.” Luis had picked up the tutorial. “The FDA admits there might be thousands of unapproved drugs on the market.

  “What makes it worse,” Elia said, “is that Medicaid patients are poor. It's like they're not important.”

  “That's not it. Private insurance plans cover them, too.” Luis looked disgusted. “Some medications don't help, and some make people sicker.”

  “And some kill,” Elia said

  Luis still had the papers in his hand. “What are t
he contraindications for Cyptolis?”

  “It's safe. Common side effects. Drowsiness, dizziness, weakness. But they're usually transient.”

  “But what are the contraindications?” Luis pressed.

  “The usual. Watch for hepatic involvement. We always look for that with returning soldiers. It's hard to know what is endemic to a region. Seems as if a strain of hepatitis might be in the Middle East.”

  “Why do you say that?” Elia asked.

  “Because many of our soldiers have developed the disease, that's why.”

  “Did anyone besides Vicente think the hepatic involvement might be from Cyptolis?” Luis asked.

  “I haven't heard.” Riser stood, a preamble to the end of the meeting. “I really have to get back to work. Again, I'm sorry about Vicente's death. He was a good doctor.” He walked to the door, opened it.

  “I'd like to read the completed paper,” Luis said at the door.

  “If you read his notes, you know everything that was in his paper.” Riser paused.

  Luis didn't move, just stared at Riser.

  “I'll try to get you a copy.”

  They were out the door when Elia stopped and turned back to Riser. “Dr. Kittrick. Did he ever sign in for the meeting?”

  “I didn't see him, maybe.” He stood at the door until Elia and Luis were halfway down the hall. Then he closed the door, turned off the lights, and sat in the dark behind his desk.

  Chapter 24

  Angel Carter stood in the doorway of the nearly empty lobby and looked over the room. She wore scrubs and had dark circles under her tired-looking eyes. But even so, she looked like a model — a young Christie Brinkley. Elia and Luis stood when they saw her; Elia walked over to her.

  “Angel?” Elia held her arms out and wrapped them around the woman who had been so important to Vicente. Angel crumpled against Elia and cried.

  She sobbed to the sounds of soft music playing in the background. Elia took her hand and led her to a chair in the corner of the lobby and introduced her to Luis.

  Angel was quiet for a few moments. She dried her eyes, and smiled at Luis and Elia. “I thought it was you when I passed you earlier in the hall. Vicente told me he was going to your wedding.” She turned her attention to Luis. “And when I saw you in the hall, I knew you were Peruvian. You remind me of Vicente.” She took a deep breath. “He was looking forward to meeting you. Even though he didn't know you, he was sure he could trust you.”