The Plague Within (Brier Hospital Series)

by Lawrence Gold

  After dinner at the Byrnes’ home, Beth and Sandy stayed in the kitchen cleaning up.

  “It’s so great having you here, Sandy. Jack’s enjoying Marty’s company, especially because he’s not a physician. Get docs together and all you get is shoptalk. How have you been feeling?”

  “It’s just more of the same. I have just enough symptoms to be annoying, but probably not enough to alter my treatment. I should be content especially since more advanced treatments are complicated and produce unpleasant side effects.” She paused. “I love having Jack as my doctor, but...”

  “What is it?”

  “It’s my problem, I know, but I always think of physicians, dentists, and other professionals as not merely providing services, but as friends. I know it’s not a good idea, and you know that Jack was concerned about this from the outset. Maybe he was right.”

  “What do you mean?”

  “He’s doing everything he should be doing. He’s doing exactly what other specialists have recommended over the years, but, for me, it’s not enough.”

  “Don’t go and do anything stupid, Sandy. Jack’s usually right about these things.”

  Sandy rinsed the last dish and placed it into the dishwasher. “I’ve been hearing great things about Harmony Lane and her success with lupus patients, but I don’t want to disappoint Jack who is satisfied with how well things are going with my illness.”

  “Look, Sandy, I assure you that you won’t be the first or the last to ask to see another physician or even transfer your care.”

  “I don’t want to compromise our friendship or anger Jack...”

  “Jack’s a big boy. He cares about his patients and takes pride in his work. Will he be overjoyed about your decision? I doubt it. He’ll get over it, and I promise you that it won’t affect our friendship one bit. What’s pushing you toward making a change?”

  “Intellectually, I agree with Jack about my illness and how to treat it. It’s perfectly in line with other great specialists I’ve seen before, but there’s an element to illness, especially a chronic illness, that doesn’t belong to anyone but the person who’s sick. I can live with this illness, put up with its problems, but it’s different from being well. I want to be well, Beth. You can understand that, can’t you?”

  “Of course. Do you want me to talk to Jack?”

  “Oh, no. I may be a wimp, but I’m not that big a wimp. I’m seeing him next week and I’ll bring it up.”

  When Sandy raised the idea of seeing Harmony, it disturbed Jack. After all these years of professional and material successes, was his ego still so frail? He guessed it was.

  “I can only give you advice, Sandy. It’s your life, you decide. Most physicians, me included, tend to stay away from new treatments, drugs, and procedures for a while until we’re certain that they can live up to their PR. I’ve talked to patients hundreds of times about things they’ve read or seen in the popular media. Either they never came into widespread use or turned out to be ineffective or dangerous.”

  Jack reached over to his bookshelf and pulled out a folder. “Here’s a stack of articles I’ve kept over the years brought to me by patients looking for the newest, the easiest, and the hottest approaches to illnesses. All these have gone by the wayside for one reason or the other.”

  “But what about the ones that really work?”

  “You’re right, Sandy. Sometimes my patients wait too long for a treatment that proves to be effective. I won’t deny it, and they do pay the price. Without something life threatening, I’d rather err on the side of caution. In the end, you must decide for yourself. I’m here as your doctor, and I admit it, as your friend.”

  Sandy pulled a tissue from Jack’s strategically placed box on his desk and blotted her eyes. “I’m going to see Dr. Lane. I want you to be a part of this...as much as you can be under these circumstances.”

  “I’ll always be available for you whatever the situation.”

  Sandy met Harmony two weeks later. She brought a copy of Jack’s office chart and her older medical records. Sandy felt an immediate intimacy with Harmony, her office and with Shelley Stillwell. This, her first encounter with a female physician, made it clear to her why many women preferred a woman as their doctor.

  After Harmony examined her, they sat in her consultation room.

  “I agree with Jack. I’m not sure that anything that I have available would justify the risks for you.”

  “I’ve talked to two patients in the trial. They’re doing great on the new treatment. I’m sick of being sick. I’m tired of the office visits, the tests, waiting for the test results and wondering when my mild case of lupus will mutate into a more malignant form.”

  Sandy stared at Harmony. “It’s my life and if I’m a suitable candidate, I want in.”

  “There’s risk involved in your participation in an experimental study.” Harmony opened her drawer and handed Sandy the consent and disclosure form from PAT. “Don’t just sign it. Read it carefully, think it over, and get back to me.”

  “But...”

  “Think it over.”

  After dinner, Sandy turned to Marty. “I trust Harmony. She’s incapable of prescribing anything that might hurt her patients.”

  “Are you sure you want to do this? Is it worth the risk?”

  “Harmony said that none of the extensive animal experiments or the early safety trials showed significant side-effects. I’m sick or the rashes and the aching. This is my chance and I want to take it.”

  A week later Sandy returned to Harmony’s office.

  “Okay,” said Harmony, “but PAT, the drug company has closed this phase of clinical trials on PAT0035. Soon I’ll have their newest Phase II drug, PAT0075, which looks even more promising. When I get the medicine and the drug information, consent forms and all, I’ll have you back, and we’ll begin treatment.”

  Chapter Twenty-Seven

  When people asked Jack how he knew that medicine was the right choice for him, the answer was straightforward. Notwithstanding the enormous clinical responsibilities, the frequent frustrations in caring for patients, and the inevitable bad outcomes, he awakened each morning delighted to face the day ahead. Now, for the first time in a while, Jack found himself dreading each morning’s visit with Rachel Palmer and her family.

  The drawn shades left Rachel’s room in dark shadows. Maxine sat on the cot the nurses supplied for the many nights she’d slept at her daughter’s bedside. As usual, Tom sat at Rachel’s side holding her hand.

  Jack didn’t know what it was, but something had changed since he saw Rachel yesterday. His examination revealed nothing new, but Tom and Maxine were oddly on edge. They stared at Jack with an intensity and an expectancy he’d seen only once before, when she was about to go into surgery, a mixture of fear and anticipation.

  Jack looked up from the chart. “Her temperature is down a little today, but I don’t see much change.”

  “Can you increase her level of physical therapy, Jack?” Tom asked. “Maybe more stimulation and better muscle tone will help.”

  Something had changed.

  “Sure, I’ll ask PT to see if she can tolerate any more activity.”

  Afterwards, Jack joined Beth in her ICU office. “Long time no see, stranger,” she said, giving him a kiss.

  “Someday, and I hope it’s soon, one of us should change schedules so I don’t have to wake up alone five days a week.”

  Beth smiled. “We still get two or three days to cuddle and whatever.”

  “I could use a little more whatever lately.”

  “Be careful about what you ask for, sweetie.”

  “I’ll deal with it.”

  Jack changed the subject. “Has any of your staff noted anything happening with Rachel in the last day or so?”

  “Clinically she’s about the same, but Maxine and Tom have been jumpy.”

  “Have they said anything to you?”

  “Nothing.”

  “Has Harmony Lane been in to se
e her?” Jack asked.

  “Yes, she comes every day, usually after her office hours in the late afternoon.”

  “I don’t know what it is, but something’s going on.”

  The next morning, it shocked Jack to see Rachel sitting upright in the lounge chair by her bedside. Her, “Jack, it’s so good to see you,” said in normal strong tones made him want to check that he was in the right room.

  “You’re looking great today, Rachel. How are you feeling?”

  “I’m not really sure, but I do feel like a great weight has been lifted from me. For the first time in ages, I feel like moving around and incredibly, I felt like eating this morning.”

  What’s going on here?

  Jack reviewed her vital sign clipboard, unchanged except her temperature had fallen to 99 degrees, near normal. Her examination showed better color to her skin, and the remaining abdominal drains showed only a trace of infected material.

  “I don’t know what’s happening, but I couldn’t be more pleased. I’m ordering a battery of blood tests for this morning. I’ll see you this afternoon and we’ll go over the results.”

  Tom smiled and nodded to Maxine, but he refused to maintain eye contact with Jack.

  Before Jack left for the day, he returned to ICU. Rachel’s tests showed remarkable improvement. Her red blood cell count was up and the signs of inflammation were abating.

  When he entered her room, Rachel stood with the help of the physical therapist and the Maxine as she took three faltering steps to the chair. She’d neatly combed her hair back to one side with a shiny barrette holding it in place. Someone had applied a little lipstick and blush. It always amazes Jack how a little attention to hair and makeup could radically alter a woman’s appearance. This afternoon, Rachel was another woman.

  When Jack returned to the nursing station to write a note, Harmony Lane entered Rachel’s room. He waited until she finished and managed to catch her eye as she left. Harmony turned and started away from the ICU, and then, as if rethinking this action, she turned and approached Jack.

  Only the best could dissemble with their bodies as well as their words, Jack thought.

  “Jack. I don’t know what you’ve done, but Rachel looks great.”

  The best defense is a good offense, he thought.

  “Yes,” Jack said, “it’s incredible. In fact, I’ve never seen anything quite like it. Any thoughts?”

  Harmony brought her hands to her face, as if in thought. She stared at Jack intently, holding his gaze, her pupils dilated, and Jack knew that she was lying.

  “Is there something you’re not telling me, Harm?”

  She reddened. “I don’t know what you’re talking about.”

  Rachel’s miraculous recovery continued. Two days later, Jack removed the last of her drains and transferred her to the general medical ward.

  The news of Rachel’s recovery spread across Brier Hospital. The association between her comeback and Harmony’s participation was clear. Harmony’s star had climbed into the stratosphere.

  Everyone had questions. No one had answers.

  Jack was sitting with Ben Davidson in the doctors’ lounge. “I can’t prove it, Ben, but she gave Rachel something. It’s completely turned the case around so I’m overjoyed, but what was it? What are the risks? What do we need to watch for? How long will the effects last, and a hundred other questions? It must relate to the clinical trials Harmony’s doing with that drug company, PAT. If that’s the case, and she administered some DNA vector for gene therapy, we’re going to have a hell of a time proving it.”

  “Any virus we give to a person must produce markers or antibodies. Maybe that’s the way to go.”

  “I wouldn’t even know where to begin. Then we have the legal and moral issues of administering an unapproved treatment within the walls of Brier Hospital. If Harmony did treat Rachel, it was light-years away from any investigational protocol. The whole thing is a mess.”

  Chapter Twenty-Eight

  PAT’s halls were awash with chatter about Andre Keller’s upcoming clinical trials. The pace of discovery and their successes were distorting the basic purpose of PAT. Andre and several others, their best research scientists, had approached Greg and Amanda Wincott for permission to reorient some of their research.

  Andre sat before the CEO’s glass and chrome desk. The large view window was open to the manicured lawn of the company campus. “We have a golden opportunity here, Greg. This is the right time for gene therapy, especially if we’re successful with the therapeutics based on modification of fetal stem cells. We’re getting great publicity, and the stock price is soaring. Let’s strike while the genome is replicating.” He laughed at his own metaphor.

  “We’re moving too quickly, Andre. Dr. Blake and others on the board suggest that we slow down, evaluate our data, especially the long-term effects, and then plan our next steps. Amanda and I are also concerned that in the orphan drug category, we’re not seeing much progress.”

  I’m reporting to this fool, Andre thought.

  “Mr. Wincott, I came here with your assurances that I’d have free reign in my research. To tell you the truth, I would not have agreed to join PAT if I had known Archie Blake would be on the board. It was bad enough that I had to put up with his obstructionistic tactics at UC Davis. If you permit it, he’s going to do the same thing here.”

  In Greg’s business experience, and with his initiation into the scientific arena, he’d had his conflicts with aggressive overachievers, but Andre was setting a new standard for insufferable behavior. Weakness would only inflame the situation, so he replied in flat tones, “This is still my company, Dr. Keller. I run it with the assistance of my board and those scientists I trust. If you want out of your contract, I’ll put my attorneys to work on your severance agreement. You must understand in advance that you will not take with you any of the stock options we’ve put aside for you, and all your work, and I mean all of it, remains the property of PAT.”

  Greg stood from his desk and stared at Andre. “Give me your answer, and we’ll begin to choreograph your departure.”

  Andre was shocked. I’ve misjudged this man. I’m so stupid. If I ever leave this organization, it’ll be on my terms. Even better would be to show the Wincotts to the door.

  “Excuse me, Greg. You know me. Sometimes my enthusiasm gets the best of me in my zeal to pursue clinical cures. I apologize. There’s no way I would jeopardize our goals.”

  “We understand your success comes, in part, from your incredible drive. We appreciate that. If you’ll be patient, in due time you’ll find everything you need.”

  In due time? My God!

  The board of directors authorized the Annual Report to Stockholders to emphasize their recent successes with the DNA vectors and their promising future. The Wincotts still had a controlling interest in the company so when they complained that PAT had strayed from the search for orphan drugs, the board grudgingly went along with their desires to reemphasize research in this area.

  Pressure to change PAT’s mission statement had come as well from stockholders, including Angela Brightman, a major stockholder herself, and the group she represented. If they played their cards well, they might take over the company.

  Angela continued to meet with Andre and knew more about his research than anyone on the board of directors. Andre’s recent results with lupus and the rejuvenating effects of the DNA vector had made her even more determined to get control of this company.

  First, I have to get some of that stuff for me, Angela thought when she looked into the mirror.

  In defiance of Andre’s strict orders, Raymond Ames kept monitoring the mice receiving the activated DNA vector through to their deaths. In a few, he was beginning to see alarming and unexpected changes.

  He tried again to tell Andre. He held up the thirty-page data book. “Look at these results. Some mice near the end of their new prolonged life cycle went into a rapid aging phase. It’s like they were trying to catch up with
time.”

  Andre scoffed. “Toss that stuff out, Ray. I told you that beyond the time parameters of the study there’s no data that we can trust, certainly not end of life phenomena when cells are dying.”

  “But...”

  “Toss it out, Ray. I said, toss it out.”

  Like hell I will…

  Twenty-N ine

  The first patient to receive PAT0075 was Zoe Sims. She was thirty-four with mild lupus limited to her skin and joints. As Harmony’s patient and close friend, Zoe had been after her to get into the clinical trial.

  Zoe crossed her legs as she sat in front of Harmony’s desk. “You’d have thought that having a friend in the business would have put me on the short list for one of these new medications, but you continued to turn me down. Why is that Harmony?”

  “That’s one problem I discussed with you, Zoe, before I agreed to be your physician. Taking care of friends and family is like grandma’s Chihuahua; as soon as you relax or turn your back on the little beast, it bites you in the ankle. Personal relationships color my choices and that cuts both ways; maybe you get more of my time and attention, and maybe I get too conservative or too cautious, not doing what needs to be done.”

  “I know you, Harm. If you weren’t satisfied with this medication and its safety, you wouldn’t give it to anyone. Anyway, I need it.”

  “No, Zoe, you don’t need it. You want it.”

  “Okay, I want it. Happy now?”

  “I’m more secure about its safety than I am about its effectiveness. The clinical trial should make that clear.”

  Zoe worked for Hawkins International, an upscale interior design firm in San Francisco where appearances of all types were paramount. She’d been using cortisone creams on her facial rash, but had to cut back because they were making her skin thin and fragile. She hoped PAT0075 was her answer.