“I’ve become a counselor at the Planned Parenthood of Northern California. I work there every Thursday, sometimes more. It’s been a great experience for me, helping women to understand their options, and supporting them in their choices. I’ve made great friends at Planned Parenthood, and a few enemies, too.”
“No kids yet?”
“Jack’s ready, he’s been ready for a while, but for me, it’s not if, but when, a big step for me.”
“It’s a big step for all of us.”
“You’ve heard it before, Sandy. I’ve always been crazy for my dad, but mom and I, we never really got into sync. I’d hate to burden any child with that kind of mothering.”
“You’re not your mother, Beth. In fact, you’re about as far apart as family members can be. Your dad taught you more than you’ll ever need to know about nurturing. Physiology will teach you the rest.”
“Well, maybe,” Beth said, “but there’s my work, my nursing, my volunteer work at Planned Parenthood—that would all go down the drain.”
Now I know we’ve been apart too long, Sandy said. “I don’t know Jack, but I sure know you. Give the guy a break. He’ll come along when you do.
“Everything I do involves a tradeoff of one kind or another. You and Jack will work it out, and I know when it’s time, you’ll be a great mother. What kind of practice does Jack have?”
“He does mostly acute care medicine, the sickest patients in intensive care, but he does have a small office practice where he does hypertension, kidney diseases, and certain immune disorders like Lupus.”
“That’s lucky. I’ve had mild Lupus. I’ve been looking for a referral. Would Jack see me?”
“I’ll ask him. Generally, he prefers to avoid friends or relatives. He says that it sometimes complicates his life, but I’m sure he’d be pleased to see you.”
Beth gave Sandy Jack’s number.
Beth wrote Sandy’s numbers. “Check your schedule. We’d love to have you and Marty for dinner when you’re free.”
Chapter Nine
Rachel Palmer’s upcoming surgery hadn’t left Jack’s mind for a moment. The surgeons, Jack, and the anesthesiologist debated the sequencing of the procedures, brain then abdomen, or the reverse. Eventually, with the help of Curtis Brown, a neurosurgeon, and Julie Kramer, a general and vascular surgeon, they decided to drain the brain abscesses first. Immediately afterward, they’d then proceed to the exploratory laparotomy, opening Rachel’s abdominal cavity to search for the infection’s source.
Jack considered Mickey Katz to be the best anesthesiologist on staff. He was to visit with Rachel and Tom this morning.
Mickey approached Rachel’s bed. Tom sat at her side holding her hand.
He shook their hands. “I’m Doctor Katz. Jack asked me to visit before we take you down to surgery tomorrow. How are you feeling?”
“Tired.”
“From what I’ve seen in your medical chart, you’re entitled.” He paused for a moment. “Let me tell you what we’re planning. During the first part of your surgery, draining the brain abscesses, I’ll keep you asleep, but we need only light anesthesia for this part. When they begin to look into your belly, you’ll require anesthesia so deep that they can explore your abdominal cavity easily. This is the kind of anesthetic we use for all abdominal procedures, like removing an appendix or a gall bladder. After you’re asleep, I’ll put a tube in your throat, and I’ll get it out before you’re fully awake afterwards. You should do great. Any questions?”
“When will she go to surgery?” Tom asked.
“She’s on the schedule for eleven tomorrow morning.”
“How long will she be under?”
“Maybe two hours for the neurosurgery, but who knows how long for the abdominal part. My guess, another three to four hours.”
Rachel stared at Mickey. “Am I strong enough for that much surgery?”
The frank and honest question touched Mickey; too few patients asked. “I’ll keep the anesthesia as light as possible, but if anyone can get through this, Rachel, you can.”
After the anesthesiologist left, Maxine Clarke, Rachel’s mother, pulled Tom into the hallway. “I don’t like this, Tom. Not one bit.”
“What are you talking about, Maxine? We don’t have much choice.”
“Don’t trust doctors, never have. They promote their beliefs by ramrodding decisions down their patients’ throats. Rachel’s my baby. I won’t have it.”
“Look, Maxine, I trust Dr. Byrnes. He knows what’s best for Rachel. We’ve gone too far to turn back now.”
“Postpone the surgery,” Maxine said. “I’m investigating alternatives. My natural health group in Oregon is combing their network and the Internet for better options.”
“This is crazy, Maxine. I’m not about to get a bunch of amateurs involved with their kooky ideas.”
Suddenly, Maxine collapsed into the soft lounge chair, sobbing. “She’s going to die with this surgery! I can feel it! Tom, listen to me. I’m not crazy, and you know I love Rachel every bit as much as you do. Talk it over with her. It’s her decision after all.”
They reentered Rachel’s room. She was sleeping, but awakened easily.
Maxine sat at Rachel’s side, grasped her hand, and stared at her daughter.
“What’s wrong, Mother?”
Maxine grasped Rachel’s hand. “We’ve been discussing the surgery. I...we don’t think there’s any reason to rush into this dangerous procedure especially since Dr. Byrnes was less than reassuring about the likelihood of success.”
“Wait a minute Maxine,” Tom said. “When did you go to medical school?”
“Don’t be naive, Rachel. Patients get into trouble all the time by placing absolute trust in their physicians. I, for one, don’t buy it. Some physicians are not worthy of that trust.”
“She’s not talking about Jack, is she, Tom?”
“I don’t think so, but maybe Maxine’s right just asking the question.”
“I don’t know Tom, what do you think?”
“I don’t know what to think. Jack has been completely honest with us all along, and though he’s recommending this surgery, he’s been less than sanguine about its success. Pardon this Maxine, but you know your mother, Rachel, she does have a tendency to go overboard on occasion.”
Maxine frowned, but remained silent.
Tom looked at Maxine then turned to his wife. “Looking at alternatives now is too pie-in-the-sky for me, baby.”
“Mother, I appreciate everything, but maybe we should just get this over.”
“Give me a day or two, Rachel. Dad’s already contacted several experimental surgical and pharmacological programs about surgical options and new antibiotics. The right antibiotic might make this go away.”
Rachel grasped Tom’s hand. “Tom?”
“Let’s sleep on it.”
Chapter Ten
The sunshiny day warmed Jack’s soul and added rays of hope for the final resolution of Rachel Palmer’s problems.
Jack knew something was wrong when he entered Rachel’s room to Maxine’s stern face. Rachel sat upright in her bed with Tom at her side. For the first time, both failed to meet his eyes.
“What’s up?”
Rachel looked up. “Jack, I know this is going to upset you, but we’ve decided to postpone the surgery.”
“Postpone it! Why?”
“Look Jack,” Tom said, “Maxine’s been looking into alternatives to the surgeries you’ve proposed, and we need time to consider them.”
This is unbelievable, Jack thought.
“Remember, I’ve been above board with you from the start. I’ve looked at all the possibilities.” He paused to stare at Rachel. “I’ve discussed your case with the best people around, and at the last moment you’re changing your mind. I don’t get it.”
Tom studied his feet. “Our last conversation didn’t exactly inspire confidence, Jack. I know you don’t want to overstate the positive, but you left a large enoug
h question in our minds, large enough for us to want to look at other possibilities.”
“I’m willing to discuss any approach that can help, but before we do that, let’s talk about the downside.” Jack turned back to face Rachel. “You’ve had seizures. They’re due to the brain abscesses. Those abscesses got there because we are unable to control the infection in your abdomen in spite of the most potent antibiotics available.”
Jack spun to face Tom and Maxine. “If I were you, I’d consider these facts about Rachel’s condition; bacteria spreads through the bloodstream each day and could wind up elsewhere in Rachel’s body or get totally out of control and kill her at once. These are the risks. I’m not making them up. I don’t find a good reason for taking them.”
Maxine placed her hands on her hips. “What about other antibiotics?”
“We’re using the most potent ones available. I even looked into obtaining Phase IV antibiotics, not yet available to the public, but nothing looked promising enough.”
“Through a personal contact, Rachel’s father, Richard, has discovered exciting Phase II and Phase III antibiotics at the University of Maine. We’re trying to get some for Rachel. They’re potent relatives of Cefoxitin,” Maxine said emphatically.
“I don’t know how long that will take. Moreover, hundreds of Phase II and III drugs are under investigation. It’s difficult in these early trials to see how effective they are, and more important, we’re often unsure about their safety, especially with Phase II antibiotics.”
I can’t stand this discussion, Jack thought. I feel like a salesman or an attorney making an argument to a jury. That’s no way to practice medicine.
Jack turned to Rachel. “I’m sorry, but I’m withdrawing from your case. Find someone else who’s willing to watch you die.”
Tom paled.
Rachel burst into tears.
Maxine smirked.
“You have 48 hours to find a new physician.”
As Jack walked from ICU, Tom followed. “Please Jack…don’t do this. Rachel depends on you. You can’t abandon her now.”
Jack studied Tom. “I just…”
Tears ran from Tom’s eyes. “Please, Jack…”
Jack and Tom returned to ICU and Rachel’s bedside. She grasped Jack’s hand, kissed it, and whispered, “Thanks, Jack.”
Tom looked at Rachel. “Richard says we can get CT1356, a phase II antibiotic, and we can get it in thirty-six hours. We want to give it a try.”
“Rachel?” Jack said.
“Please Jack, I want to do this, and I want to do it with your help.”
“I’m your doctor and your friend. I’ve had my say. I’ll review the supporting information on CT1356 and I’ll administer it if I feel it’s safe.”
Maxine crossed her arms. “And, Doctor, if you don’t feel it’s safe...”
“I’m through. No second chances. You’ll have to transfer your care to another physician.”
Tears ran down Rachel’s cheek. “Please, Jack...don’t. I can’t go on without you.”
I’m screwed, Jack thought.
Jack grasped Rachel’s hand. “We’ll see...”
Rachel opened her arms to Jack and placed a soft kiss on his cheek. “Thanks, Jack.”
Jack was about to leave, but couldn’t until he had his final say. “Don’t think for a moment that I’m buying into this. You’re a free agent and you can do as you wish, but let me go on record; I think this is a terrible mistake.”
Jack was late returning to his office this morning. Janet, his office manager, had paged him several times. This was her less-than-subtle message that he was keeping patients waiting. Sometimes Jack didn’t know whose side she was on. They both hated having patients sitting in the waiting room and sought to avoid it as much as possible, but Janet was a fanatic.
The smell of freshly baked pork buns told Jack instantly who would be hiss first patient this morning. Henry Chan’s routine was to stop at his local bakery in Chinatown before bringing his younger brother, Ronald, to Jack’s office.
The pork buns were still warm. Jack grabbed one and a cup of coffee, then sat at his desk. He tore one open revealing the shiny red roasted pork within. Several big bites were all it took to make the bun history. The fat, carbohydrate, and the red dye No.2 would not dissuade him from the delicious treat, several, in fact.
Bringing food was a universal gesture of appreciation and had constantly thwarted Janet’s and Jack’s forays into dieting, or, at least, it gave them a credible excuse. The holiday season was the worst, with boxes of candy, cakes, and large bins of popcorn selections, wine, cheeses, and expensive liquor. Jack had three bottles of Johnny Walker Black and two bottles of Chivas Regal, gifts from prior years.
As Jack worked through the morning, the nightmarish situation with Rachel wouldn’t leave his conscious mind.
He had no noontime obligation, a rarity, so he joined Beth for lunch in her ICU office. She’d brought in sandwiches from Domenico’s Italian Deli. They fought for the opportunity to visit this exquisite deli if for nothing more than for the smell of what was soon to arrive on their palates.
Jack paraphrased the Palmers’ decision. “It’s dead wrong to delay surgery based on the vaguest of promises.”
“There’s nothing you can do, Jack. It’s her life after all.”
He smiled. “Look who’s getting mellow with age. You’ve been a tiger when it comes to your patients and what you believe to be right.”
“You had your say. Don’t make things worse by compromising your great relationship with Rachel and Tom.”
“Don’t forget Maxine.”
“I’m not sure that anyone can get along with Maxine.”
The Phase II protocol for CT1356 came over Jack’s fax early in the afternoon. He sifted through the sixty-page document, the animal, and the early safety and effectiveness studies. Rachel would be patient number ninety-eight, and since she fulfilled their acceptance criteria, they would provide Jack with the drug by compassionate release. CT1356 looked good in early trials, especially since the patients treated were among the sickest and most resistant to antibiotics. The side effect profile was acceptable, except for five serious complications; two patients had developed kidney failure, two had severe allergic reactions, and in one, the drug had suppressed the patient’s bone marrow.
Jack tried an Internet search, but with a drug so new, it didn’t surprise him to find no useful information. CT1356 would arrive tomorrow morning.
Chapter Eleven
Over the first two years of their working relationship, Professor Archie Blake found his association with Andre Keller had produced new and innovative approaches to their research. They’d coauthored several research papers, presented their data at conferences, and Archie had become a supporter of Andre’s grant applications. Although they’d spent many hours together reviewing data, writing reports, and designing experiments, their relationship never rose above cordiality. This was troubling to Archie who’d always enjoyed strong personal bonds with his associates, especially his protégé, Payton Wexler.
Payton had been with Archie through his graduate training. Archie served as his mentor until he finally obtained his Ph.d. Archie asked Payton to join his research staff and they’d been close associates afterwards. Payton and his life partner, Sean St. Pierre, a graphic artist, were frequent visitors at Archie’s home for dinner and sporting events like the Super Bowl.
When Archie hired Andre, it incited a not too subtle competition between Andre and Payton for attention and support. Archie found it a bit amusing and he used their rivalry a bit to push each man to higher levels of achievement.
“Why don’t you and Elizabeth join us for dinner Andre? Nothing formal, maybe we’ll go for pizza.”
“No thanks, Archie. I have too much to do tonight. Maybe some other time.”
Andre’s “some other times” were never to be.
They’d had their differences. Usually this related to Andre’s interest in exploring t
he potential of the DNA viruses, while Archie had invested his entire career in HIV research. In spite of his reservations, Archie was funding Andre’s work with his own grants. Archie suspected that Andre’s work would soon be self-supporting.
Over time, Archie noticed that his relationship with Andre had become a one-way street—all roads leading to his young associate and his work. Maybe that’s the way of things in a mentor-acolyte relationship.
Archie didn’t know if it were insensitivity or an I-don’t-give-a-shit attitude, but Andre never missed an opportunity to be dismissive or overtly critical of Archie or Payton, especially Payton’s lifestyle. “I know whose ass that fag is kissing now,” was typical of him.
Archie smiled at the predictable responses from the intelligent and mostly liberal scientists, residents of the Davis area who worked at the university. One went something like, “Why don’t you shut the fuck up, you homophobic son-of-a-bitch.”
Archie saw that negative reactions to Andre’s behavior did not disturb him. He would continue in this vein to whoever would listen. He was unabashedly and overtly critical of Archie’s work as well.
Archie’s disappointment reached annoyance and then anger when Andre’s gratuitous and critical comments reverberated through the halls of academia and back into his ears.
No good deed goes unpunished, Archie thought.
While 90 percent of Archie Blake’s work involved retroviruses like HIV, the remaining studies involved other viruses. These fascinated Andre.
Elizabeth Brown and Andre sat under a tree behind the lab. It was a warm clear day and they’d shared a picnic lunch that she’d prepared. They’d been seeing each other for the last three months and had grown closer. They’d become friends, but Elizabeth wanted more. Every time she drew close, Andre would pull away.
The Plague Within (Brier Hospital Series) Page 6
