The Plague Within (Brier Hospital Series)
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Harmony chided herself for the passing thought, Perhaps cyanide is a reasonable suggestion.
Edna resorted to formality. “Of all people, Dr. Lane, I can’t believe you’re saying this to me. I came to you as an expert in fibromyalgia and now you’re telling me I’m crazy?”
Harmony counted to ten. “I never said ‘crazy’ and I don’t think that word relates to you in any way, Edna. I will tell you this, I believe that there is a strong emotional component to your illness, and since we’re having trouble getting it under control, a psychiatrist might be helpful.”
“I recognize a dump when I see one. Doctors have dumped me before.”
Surprise, surprise, Harmony thought. “Please calm down, Edna. I’m on your side, remember?”
“Don’t tell me to calm down. You sound just like one of them. Calm down, my ass!”
Edna dressed quickly. She stood at the door of Harmony’s consultation room. “I’m very disappointed in you, Dr. Lane. You’re a woman. I had great hopes that you could help me, but I may need to move on to someone who understands my needs better. I’ll call you if I decide to come back.”
Take your time, Harmony thought.
Harmony and Shelley Stillwell had just closed the door after the last patient. It had rained all day and the waiting room retained the residual scent of wet clothes and carpets.
Harmony brushed back her hair. “That was a tough one.”
“They’re all tough. Between you and me, darlin’, I could do with a simpler set of problems for a change, like a sore throat, an earache or high blood pressure—you know, the common problems most family docs see.”
“That’s not in the cards for us, Shelley. Our patients have special needs and in this community, we’re the only game in town. Physicians and the public have ignored women’s health issues for years, but finally there’s research on diseases unique to women. Incredibly, even today, women’s constitutional rights to control their own bodies continue to suffer from misogynistic cultural attitudes and from the excesses of fundamentalist religion.”
“Easy, girl. You’re preaching to the choir.”
“I know. I’m sorry, but it’s the life we live. We fill our office every day with neurotic and depressed women with these kooky diseases, for a reason; they don’t play well in most doctors’ offices.”
Shelly picked up a stack of mail. “Well, I’m glad this day’s over. Do you want to look at this now or wait until tomorrow? There’s still coffee left.”
Harmony had rebelled against the us vs. them character of her relationship with the medical community at large. It’s not my fault, she thought, but understanding it was easy. Each time she discussed the topics of chronic fatigue syndrome and fibromyalgia, the medical staff rolled their collective eyes. After she’d seen one physician’s patient with fibromyalgia, and they were discussing the case over coffee, she thought, he’s about to fall asleep while I’m talking. Was it reality or was it paranoia or a little of both?
When her patients began echoing her thoughts (she was sure she hadn’t said them out loud), she became concerned. The typical comments, “Dr. X just won’t take me seriously. He won’t listen to what I’m feeling. He thinks that I’m a nutcase,” and then one form or another of, “Men, and especially male physicians, come from some other planet.”
I’m developing a shared system of beliefs with my patients, she thought, or is it the coming together of the oppressed or obsessed?
Harmony sat reading her mail. When she came upon an envelope bearing the return address of an attorney’s offices, Satcher, Brown, Collins, and Regal, Attorneys at Law with an Emeryville address, she had a sinking feeling in her abdomen.
The letter was a copy. They addressed the original to Ben Davidson, M.D., Brier Hospital counsel, Alan David, and Bruce Bryant, CEO with copies to Harmony Lane, M.D., and the California Bureau of Medical Quality Assurance.
After the introductory paragraph, the letter said that Berkeley Central Certified Accountants Inc. (BCCA) had retained their firm in defense of the action brought by Tamara Piccard for workplace discrimination and being the proximate cause of her chronic fatigue syndrome through Multiple Chemical Sensitivity.
My God, Harmony thought, Tammy Piccard?
The four-page letter went on to specify Ms. Piccard’s allegations that environmental factors at BCCA, including its employees wearing perfume, and other unspecified toxins had resulted in Chronic Fatigue Syndrome and her subsequent disability. Ms. Piccard named Harmony Lane, M.D. as her physician, justifying her claims against BCCA.
This is exactly what I need, Harmony thought. Brier Hospital and its physicians are going to really love this.
Chapter Twenty-Two
Raymond Ames had been wary when Andre Keller offered him a position at PAT. He had discussed the position with his wife, Shirley.
“You’ve had his run-ins before with Andre,” she said. “You didn’t find him trustworthy then and often found him annoying. What has changed?”
“The job. It’s a fantastic opportunity for me.”
“I’m not going to stand in your way, Raymond, but you have significant benefits accumulated as a university employee.”
“That’s nothing when I compare the overall package. I’ll be working with a world-class investigator in an incredible laboratory facility. Moreover, they’re doubling my salary, offering a generous benefits package, and for the first time, I’ll be supervising my own staff. Frankly, I don’t see how I can refuse Andre’s offer.”
Shirley grasped his hand. “I trust your judgment, sweetheart. If you’re okay, I’m okay.”
Once relieved of the retroviral research, Andre and Ray focused on using their DNA vectors in aging and autoimmune diseases. Within a year, Andre had reproduced his original results in both areas and noted additional and remarkable findings; mice treated near the end of their expected lifespan showed signs of rejuvenation in their coats, activity level, cognitive function, and behavior. Mice suffering from a variety of maladies from infections to degenerative problems of aging showed significant reversals.
At first, Andre thought this reflected a slowing of cellular breakdown or maybe a stimulation of anti-aging enzymes. Soon, he and Raymond discovered it was something else; the DNA viral infected cells were producing growth factors for healing and reversal of cell aging.
Andre beamed. “Think what this means, Ray, slowing or reversal of the aging process plus healing and restoration.”
“It’s incredible, sir. We must expand the numbers, follow the experimental and control groups through their entire lifespans. Greg and Amanda Wincott will be excited to hear of our results.”
“Listen, Ray, it’s too early to discuss these finding. Let’s wait a while. They’ll be pleased enough with our longevity data.”
Raymond was concerned. “Whatever you say, Doctor.”
Six months later, Andre traveled to Atlantic City to present his data at The International Society of Molecular Biology meeting. The data were intriguing and, as one questioner commented, “Too good to be true” and “Needing further study and confirmation by other investigators.”
At his poster session afterward, an attractive young woman approached. “I’m Harmony Lane, a family practitioner in Berkeley. I’m intrigued by your data and its clinical promise.”
“Well, we’re into the early phase studies, but general clinical use is probably years away.” They talked for a while, then Andre said, “Why don’t we continue this discussion over lunch?”
Andre felt an immediate kinship with Harmony. She was bright, enthusiastic, and clearly willing to try most anything to help her patients.
They walked to the hotel’s dining room, taking an outside table with a view of the boat-filled marina. Andre talked nonstop through lunch, barely pausing enough to eat his meal. “I understand the need for careful safety and efficacy trials before we put this type of treatment into clinical use, but the delay is unconscionable.”
“But necessary,” she countered.
“Eight or nine years, I’d guess.”
“Pre-clinical testing with animals and then testing on healthy volunteers, small groups then large ones, and then it finally gets to the FDA itself. Total time, twelve years. The cost of the trip for a drug company, three to four hundred million dollars or more.”
“Incredible. Where are you on your journey?”
“We’ve finished with Phase I with healthy volunteers for dosing and toxicity. We’re preparing for Phase II with patients to see if it works.”
“I would love to participate in your clinical trials, Dr. Keller. I have many lupus patients in my practice and I’d love to see the effects of some of my more difficult patients with fibromyalgia and chronic fatigue syndrome.”
“We might find a place for your lupus patients if they fit our criteria, but those other groups, it’ll be a while before we can even begin to consider them.”
Harmony smiled. “Keep me in mind. Like many doctors who deal with difficult illnesses, I chafe against bureaucratic delay and obstruction. How many lives could be helped or even saved while we endure the thirteen-year pregnancy needed to deliver these drugs to the public?”
When Harmony returned from her meeting to her office, she opened a letter from the department of medicine’s quality assurance committee inviting her to their next meeting to discuss the Tamara Piccard litigation. Her initial reaction, curiosity, quickly transformed into irritation, and finally into anger.
It was a few minutes before noon as Harmony walked in the sunshine toward Brier Hospital and the scheduled QA meeting.
What do they want now?
Harmony sat outside the closed door of the QA meeting room awaiting an invitation to enter. She could hear the garbled voices inside, but couldn’t make out the words. Her mood had been shifting between anxiety and outrage that they called her before the committee. This morning she was fuming, and then gradually she allowed the coals of her anger to cool.
Don’t overreact, Harmony, until you know what’s on the table.
Arnie Roth, chairman of the committee opened the door and invited her in. Arnie was a bear-like man in his mid-thirties, a family practitioner, well-liked and easy-going.
Harmony sat next to Arnie at the head of the U-shaped table stacked with medical records. Jack sat across the table.
Although she knew everyone present, the atmosphere in the room was unusually formal, the physicians somewhat ill at ease.
Arnie turned to Harmony. “If that letter inviting you here had the flavor of being called to task for something, I apologize. Brier Hospital and Ben Davidson have asked us simply to explore the circumstances leading to Tamara Piccard’s complaints.”
“What would you like to know?”
“Start from the beginning and tell us what happened.”
“Tamara was self-referred. She looked me up on the Internet, talked with several patients, and decided to see me in the office. I suspect it was because of my interest in chronic fatigue syndrome and multiple chemical sensitivity disorders. She was a tough nut, maybe even tougher in retrospect, than I thought. She was just the kind of patient many of you refer to me when you are tired of banging your heads against the wall.
“I worked with her extensively. We had an excellent relationship, I thought. Her reactions to the work environment were dramatic and predictable; coughing, sneezing, fatigue, confusion etc., and we were both convinced that something in her workplace was responsible. Tamara was sure it was perfume. I wasn’t and I don’t have a clue how she drew a connection between environmental allergy and chronic fatigue syndrome. She sure as hell didn’t hear that from me.”
Jack turned to Harmony. “This close-knit community has its advantages and its disadvantages. One disadvantage is that everyone knows your business, whether we like it or not, and elements of your practice have caused concern.”
Harmony found herself reddening. “What elements are you talking about Dr. Byrnes?”
This was not the way I’d hope this would go, Jack thought.
“Please Harmony, it’s Jack, and I’m not here as the grand inquisitor. I know you. We’ve talked before. If you were practicing traditional medicine, you probably wouldn’t be here now. Even so, you wouldn’t be here except for the Tamara Piccard case. Don’t tell me that this is completely unexpected. You knew it was coming. You’ve been through it before.”
Harmony shifted in her chair. “Look, I testified at Tamara’s hearing. They threw her case out. What more do you want from me?” She paused, regaining her composure then said, “If you have any other questions, ask them now.”
Arnie looked at his notes. “You deal with troublesome illnesses that we see in clinical practice, and since they’re often refractory to traditional treatment, it’s not surprising that you’d resort to alternative approaches. You can’t be surprised by our concern when a singular physician in our community subjects his/her patients to megavitamin dosing, treatment for systemic yeast, clinical ecology practices, and aroma therapy, and who knows what else.”
Harmony counted to ten. “Oh please. Don’t ask me to apologize for trying alternative treatments when traditional ones fail, especially when with these treatments, no one gets hurt; that’s more than I can say for many things you do to your patients. Some of these things work, and if you think I’m going to stop trying to help my patients with them, you’re crazy!”
Jack shook his head. “Look, Harmony, this is what we’re up against. Nobody’s pointing a finger at you, and I’m not painting all alternative forms of medical treatments as useless and its practitioners irresponsible, but we’ve had bad examples at Brier before. One physician practicing orthomolecular medicine was giving his patients large doses of vitamins, both the water-soluble and the fat-soluble. I don’t much care how many water-soluble vitamins you give, as they all come out in the urine, but overdosing with the fat-soluble vitamins is asking for trouble. One physician, an M.D., Ph.d. in chemistry, treated a woman for three years for severe back pain with vitamins of every ilk, and painkillers. When they finally hospitalized her with compression fractures of three vertebrae in her lumbar spine, we discovered that she had severe osteoporosis. Her pain was unbearable. She may never walk again. He’d squandered years where effective treatment could have rebuilt her bones and would, in all likelihood, have prevented the fractures.”
Harmony scanned the room. “Bad medicine is bad medicine regardless the type of practitioner. Malpractice is rarely due to lack of knowledge or practice philosophy. It’s due to irresponsibility and not giving a damn about your patient. You know that, Jack.”
“You’re not suggesting that we ignore these fringe practitioners, are you?” Jack asked. “We know from experience, and the medical literature will support that we need to keep an eye on physicians practicing unorthodox medicine.”
“You must believe that everything you read is free of bias, Jack. That surprises me. What I am suggesting is that before you ramrod any physician through your QA system, get the facts first; you can distort the results later.”
Sharon Brickman, a cardiologist, laughed. “Cynical and not too smart, Harmony. You’re wrong if you think we’re scrutinizing you unfairly. Trust me, your snide remarks won’t help anything. Everyone here, and I’d guess most docs who practice at Brier Hospital, have had questions raised about their work. It’s part of the system that protects our patients and keeps us honest. Don’t overreact.”
Harmony stood and looked around the table. “I understand, more than any of you, what’s happening here today. You won’t or can’t say it directly, so I will; you disapprove of me and of the way I practice medicine. Kindly stated, I must be misguided or more forthrightly, I must be a quack or a nut.”
Harmony trembled. Her eyes filled. “I won’t let you do this to me or to my patients. Bring your charges if you have them, or just leave me alone.” Harmony stood
, turned, and walked out.
Were we off base or is Harmony hypersensitive? Jack wondered. Maybe I’d strike out too and assume a defensive posture, if they called my core beliefs into question.
Chapter Twenty-Three
Angela Brightman was a marketing vice-president for Ashley Pharmaceuticals, one of the world’s top ten drug companies. She’d rammed her way through whatever glass ceiling existed at Ashley without the slightest hesitation. The bodies of the executives, both male and female, who dared to stand in her path, lay in her wake. She’d used every trick in her predatory playbook from betrayal to sexual conquest, only to discover that the highest echelons of Ashley were off limits to anyone who was not a personal confidant of the CEO. She’d go no further.
Angela had grown up in a southwestern Texas trailer park with an abusive alcoholic father and a mentally ill mother. From the first day of school in her used and worn clothes, she rebelled against the message of her friends; “Get along, don’t stand out, don’t be too damn smart.” She was beautiful and intelligent, and learned at an early age to trade on her appeal and the charm she so easily developed and used to her advantage.
At eighteen and a junior at University of Texas at Austin, she met Mitchell McNeal, a senior, and the only son of Houston oilman, Prather McNeal. He was enchanted, and she’d played him perfectly, keeping him at arm’s length until he finally proposed marriage.
Prather was nobody’s fool. He recognized that Angela was not as she portrayed herself to be. He could have lived with her raw ambition if her love for his son were real. Everything he saw and heard told him otherwise, but Mitch refused to heed his father’s warning. Prather McNeal knew that his opposition to Angela jeopardized his relationship with his son, the one thing he’d never permit.
“At least get a prenuptial agreement, Mitchell,” Prather said.
“Not everyone is as cynical as you, Father.”