Miracle Drug

by Richard L. Mabry M. D.

  Josh punched in the number, then while the call rang, hit the “speaker” button. Karen leaned forward toward the phone, as though by her posture she could make someone answer more quickly.

  “Argosy Pharmaceuticals.” The woman who answered seemed to have a smile in her voice, which Josh took for a good sign. Thank goodness there was no mechanical voice saying, “Press one for this and two for that.”

  “This is Dr. Josh Pearson in Dallas, and it’s critical that I speak with someone about a drug you recently developed. It’s not in production—the FDA didn’t approve it—but it was effective against—”

  “Sir, let me stop you right there. It sounds as though you may need to talk with our Chief Operating Officer, Dr. Gaschen. He’s in a very important meeting right now, but I can ask him to call you in a couple of hours when he’s available.”

  “You don’t understand. I can’t wait. This is literally a matter of life and death.”

  “Doctor, I’m sorry, but I have strict orders not to disturb Dr. Gaschen during the meeting. I’m afraid you’ll have to wait until he’s free.”

  Josh could see Karen move closer to the phone console, but just before her lips parted to speak, he thought of something that might help. “What about your medical director? Is he there?”

  “Yes,” the operator said. “Would you like me to see if he’s available?”

  Josh felt his heartbeat slow a fraction. “Please. Tell him it’s urgent.”

  In the silence that followed, Karen asked, “What’s this about? We don’t have time for—”

  At that moment, the phone came to life. “This is Dr. Johnson.”

  Josh couldn’t believe it. If this was a fortunate coincidence, he welcomed it. Hope made Josh’s hands tingle as though he’d touched a live wire. “Would that be Dr. Derek Johnson, who did his residency at Parkland Hospital?”

  “Yes,” a puzzled voice replied. “Who’s this?”

  “This is Dr. Josh Pearson—or, as you used to call me, JP.”

  “Josh, is that you?” The man’s voice, a smooth bass that betrayed only the faintest trace of his roots in the projects of South Dallas, was warm and cordial. “I can’t believe it. Are you looking for a job? Why don’t you fly down here to Atlanta and we’ll talk?”

  Josh could just see Derek smiling—lips parted, white teeth gleaming in his brown face. He hoped that smile would still

  be there at the end of this conversation. “Nothing I’d love

  better than a visit with you Derek, but right now I’m calling on a critical matter. Remember how I used to kid you about selling your soul by going to work in pharmaceuticals? Well, I hope those words were soft and sweet, because I’m about to eat some of them.”

  ***

  Sixto hurried out the door of Rachel’s hospital room, deciding as he went that since both patients had the same infection, he wouldn’t take the time to change his gown. He spent a few seconds changing gloves, then turned right toward the room ex-president Madison now occupied. He reached out to grasp the door handle when a man in a dark suit, white shirt, and muted red tie stepped in front of him and held up his hand.

  “I’m sorry, doctor, but you’re not cleared to enter this area.”

  Sixto’s first impulse was to tell the man he was dealing not with a surgeon but with an ex-marine, skilled in hand-to-hand combat, and if he didn’t want to eat that pistol concealed by his suit coat, he should step aside. But before he could act on his impulse, the door to the hospital room opened and the nurse inside spoke a few hushed words to the agent.

  “Sorry, sir,” the man said. “They need you in there. Please go ahead.”

  On the bed lay a man Sixto had only seen before on TV. However, in those situations he’d always seemed in complete control. Now, he was sitting straight up in bed, holding a mask to his face and gasping as he struggled to take in enough oxygen. His respirations were rapid and shallow, accompanied by a noise that told Sixto the man’s airway was already severely obstructed.

  The surgeon realized he had no idea how to address an ex-president. Never mind. In this situation, protocol gave way to medical expediency. “Mr. President, I’m Dr. Sixto Molina, a colleague of Dr. Pearson’s. I’m aware of the infection both you and Miss Moore have. As you know, one of the complications of the illness is swelling of the throat that can block off the windpipe and suffocate a patient. I’ve been asked to look at you to see if we need to perform an emergency operation to prevent that. Is that all right with you?”

  Madison nodded weakly. He opened his mouth, but only a faint squeak issued. His lips formed the word yes.

  Sixto’s exam took less than a minute. He straightened and said, “Mr. Madison, we need to do a tracheotomy, right now.” Briefly, he described the operation, mentioned the reason behind it and the possible complications, and asked, “Do I have your permission to proceed?”

  Again, Madison nodded. The nurse, whose name pin was obscured by her isolation gown, handed Sixto a clipboard and pen, which he put in front of Madison. After the ex-president signed and the nurse witnessed the signature, Sixto said, “No time to go to the OR for this. We’ll do it now.”

  “Doctor, his wife was here not long ago. Shall we call her?”

  “Ask the agent outside to notify her. And page Dr. Marple, stat, to come assist me. Then open that trach tray and some sterile gloves. We need to get moving.”

  ***

  Josh stared hard at the phone console as though he were face-to-face with the doctor in Atlanta, instead of eight hundred miles away. “Derek, I’m going to have to depend on your discretion to keep this between us.”

  Karen Mills opened her mouth to speak, but Josh shook his head sharply. He had to handle this one, and it was going to work better doctor-to-doctor, rather than playing the political card.

  “Josh, I’m not sure what you’ve got yourself into, but it sounds like something a lot more interesting than what I had on the docket for this afternoon. Tell me what you need, and I’ll help any way I can.”

  “Okay. I’m treating two patients—ex-president Madison and a nurse, who’s also my girlfriend.”

  Beside him, Josh heard a sharp intake of breath, but to her credit, Marks remained silent.

  “Here’s what I’ve got.” Josh went on to describe the infections, the diagnostic problems he’d run into, and the eventual discovery that the patients were infected with both the diphtheria organism and Bacillus decimus.

  “I know all about your friend decimus,” Derek said, pronouncing the c as if it were a k. “That’s sort of why we went ahead with our research on robinoxine.”

  “We’ve pronounced the name of the bacteria differently.”

  “Not important. I’ll tell you later about why that name was given and how to pronounce it. Keep going.”

  “Both patients have received diphtheria antitoxin and antibiotics, and that part of the infection should be coming under control, but clinically they’re not responding. Unless I can kill out the other bacteria, they’re going to die. They already have high fevers and are bordering on airway obstruction. That’s why I need—”

  “You want to give them RP-78.”

  “RP-78? I thought you called it robinoxine.”

  “We use a shorter name here when we’re talking about what amounts to an experimental drug. By either name, I guess that’s what you want.”

  “It’s our only hope.”

  “You do know that the FDA essentially told us to stop trying to develop it because it wasn’t any better than existing antibiotics. Of course, at that point they thought Bacillus decimus had died out except for one small area in South America.”

  “Yes,” Josh said. “But now your drug is the sole chance we have to treat our two patients, both of whom have Bacillus decimus infections. I recognize it’s not fully tested. All that aside, it’s the only hope these two people have.”

  “It’s more than its not being tested. When the FDA told us unofficially there was no need to keep working on
it, we got rid of what we had, or at least most of it. There might be just a bit still around, but it would take a while, maybe several weeks, to make more.”

  “I’ll take whatever you have. Just get it to me ASAP.”

  “I’m going to have to clear this with Dr. Gaschen, our Chief Operating Officer.”

  “Call him, find him, do whatever you need to. But if I send a jet to Atlanta . . .” He looked at Marks, who nodded. “If I send a jet to Atlanta, can you get the drug—whatever you called it—can you get it on that plane?”

  Derek’s sigh sounded like a hurricane when it came through the phone line. Then he said, “How long will it take your plane to get to Hartsfield International?”

  Marks leaned in toward the phone console. “Doctor, this is Karen Marks. I’m the administrative aide for President Madison. I can make a call and have a jet standing by at Dobbins Air Base, just north of Atlanta, in less than an hour. You get the drug to Dobbins; we’ll take it from there.”

  After another silence, Derek said, “Okay, but tell whoever you talk to at Dobbins that they’re going to have to fly more than some medication. I’m coming, too.”

  “Are you sure?” Josh asked.

  “Yep. I probably know more about RP-78 and Bacillus decimus than anyone else in the world,” Derek said.

  “We’ll take all the RP-78 you can find, and your help would be welcome,” Josh said. “Just hurry.”

  “I’m not sure what Dr. Gaschen is going to say when I tell him I’m sending what he have left of the drug and going with it, but I guess the worst that can happen is that he fires me. I was getting sort of tired of working for a pharmaceutical company anyway.”

  10

  When Josh ended his conversation with Derek Johnson, he had to resist the inclination to heave a sigh of relief. Yes, this was a positive step, but the battle had just begun.

  “Good work, Dr. Pearson,” Karen Marks said. “You handled that pretty well.”

  “Thanks, but we’re a long way from being out of the woods here. Will you make the arrangements for the jet at Dobbins and someone to meet it here?”

  “That’s what I do,” she said. “It’s what I’m good at. Your job is to keep your patient alive until the ribo-whatsitsname arrives.”

  “Actually, I’m interested in two patients,” Josh reminded her.

  Marks narrowed her eyes. “While I’m only interested in one of them.”

  Josh didn’t have a reply for that one. Besides, he was too wrung out to argue further. “I’m going to clean up and change into a scrub suit. Call me when you know something more about the drug’s arrival.”

  ***

  Rachel came awake and noticed that some things had changed. Sometime while she was asleep, someone had adjusted her bed so she was sitting more upright. They’d also slightly increased the flow of moist oxygen being delivered by the mask that sat loosely on her face. She tried increasing the depth of her respirations and heard none of the squeaking stridor she’d noticed before when she tried to breathe too deeply.

  The man standing over her bed spoke in a voice that was soft, somewhat at odds with his physical appearance. “Awake, are we?”

  “Dr. Molina? Sixto? Is that you?”

  “Sorry I had to leave in such a hurry, but they needed me next door.”

  “How is Mr. Madison?” Rachel asked.

  Sixto didn’t say anything, and it was as though Rachel could see him thinking, Do I want to upset her, since she’s got the same problem?

  The rush call for the doctor, her own fight with air hunger, plus her knowledge of the natural history of diphtheria, supplied her answer despite his silence. “Did you have to trach him?” Rachel asked.

  “How are things in here?”

  Rachel smiled at the familiar voice. In addition, she could almost see the relief on Sixto’s face, despite its being partially covered by a mask. Now there was no need for him to answer.

  Josh moved to her side and put his gloved hand into her own. There was tenderness in his touch, a tenderness she’d missed.

  “I’m doing okay,” Rachel said, being careful to speak gently and breathe slowly. She didn’t want Sixto to have to perform another emergency tracheotomy today.

  Josh turned to his friend. “Sixto, I appreciate your looking in on Mr. Madison and taking care of him. I was on the phone, lining up what I think may be the treatment we need to get these patients on their way to recovery.”

  “Can you . . . can you explain?” Rachel asked. She was concerned because her voice seemed to be weaker. She wasn’t

  anxious for a tracheotomy, but she had to ask. Maybe the two men would leave soon, and she could rest.

  Sixto looked at Josh and raised his eyebrows, the only expressive part of his face that Rachel could see. Apparently, he didn’t know this part of the story either.

  “Rachel, it seems that you and the ex-president are infected with both diphtheria and another bacteria—one everyone thought until now was confined to a few cases in South America.”

  Rachel raised her own eyebrows, hoping it would keep Josh talking while letting her conserve her energy and her breath. Evidently it worked.

  “I’ve been in touch with the CDC,” he said. “They mentioned that a pharmaceutical company was working on an antibiotic that could possibly work in this case. A friend of mine, a doctor who’s the medical director there, will be on a jet in a few minutes with as much of that drug as he can put his hands on. As soon as we get it, we’ll start treatment.”

  It was probably a good thing that Josh’s features were partially obscured by his mask, because Rachel sensed that there was more to the story than what he was telling. But for now, she simply nodded and let her head fall back on the pillow.

  “Look, I’m sorry I haven’t been able to look in on you, but believe me, I’ve been really busy.” Josh readjusted the mask to her face, turned up the oxygen level even higher, and said, “The nurses will keep checking on you. I’m going to shower, shave, and change into a scrub suit.” He shrugged his shoulders in a way that told Rachel they were tense or tired or both. “I think I have another long night in front of me.”

  When Josh and Sixto had left the room, Rachel lay silent, breathing slowly, trying not to give in to the air hunger she was starting to feel. There was one thing she could do, something that wouldn’t require exertion or speaking. She silently prayed.

  ***

  Before finally heading for that long-awaited shower, Josh changed to fresh protective garb and approached the room now occupied by the ex-president. The agent at the door—Josh couldn’t recall his name—said, “Sir, would you mind pulling your mask down so I can check your identity before you go in?”

  Josh complied, and the man said, “Thank you, Dr. Pearson. I think you can see why that’s necessary.”

  “Right,” Josh said. “I guess I’m not used to all this security.” He realized he’d gotten in the habit of deferring to anyone wearing a dark suit and an earpiece. He studied the agent’s face carefully, and asked, “And tell me your name.”

  “Rutledge, sir.”

  “Thanks.” Josh, vowing not to be as trusting as he’d been to this point, pushed through the door. His patient was lying in bed, evidently still recovering from the shock of what had just happened. “Mr. Madison, are you feeling okay?”

  Before the ex-president could reply, a woman, her features hidden by a mask and facial shield like the ones Josh wore, stood up from the bedside and walked toward him, her hand out. “Doctor, I don’t think we’ve had the opportunity to formally meet. I’m Mildred Madison.”

  Josh took the gloved hand. “Mrs. Madison, I apologize if I haven’t talked with you before this, but I thought—”

  “You had your hands full trying to save my husband’s life, and for that I thank you. Jerry Lang and Karen Marks have kept me informed.” She inclined her head toward the bed where David Madison was scribbling rapidly on a white dry erase board. “And please convey my thanks to the doctor who did th
e emergency operation on David. It not only probably saved his life, it left him dependent on writing his thoughts instead of voicing them . . . every one of them.”

  Josh couldn’t see Mrs. Madison’s expression, but he was willing to bet she was smiling. “I’d better see what my patient wants to say.” The two of them approached the bedside.

  David Madison held up the white board on which he’d written, “How long does this thing need to be in my neck?”

  “Let me explain things to both of you,” Josh said. “It’s hard to tell how much of your airway obstruction is due to diphtheria and how much is from the secondary infection. The DAT we gave you plus the antibiotics you’re receiving should take care of the diphtheria, probably by tomorrow.” When Madison started to write, Josh hastened on. “We’ve determined the identity of the secondary infection, and at this moment a supply of a drug we think will treat it is on its way here via military jet, together with a colleague of mine who is something of an expert in its use.”

  Before her husband could write, Mrs. Madison said, “So . . .”

  “You’ll hear from me when we have the drug, and I’ll keep you both informed as things go on.” Josh had never been a good poker player, but fortunately his features were hidden when he delivered his next comment. “I think things are coming under control.”

  ***

  “I’m sorry, but you’ll have to show some identification.”

  Derek Johnson fixed the airman second class standing guard at the entrance to the flight line with a glance that would melt steel. He took in the airman’s armband that said AP and the holstered pistol he carried. Realizing the guard was only following orders. Derek reached slowly for his wallet and brought it out using two fingers. He noticed that when he made a move for his hip pocket, the Air Police Officer stepped back and unsnapped the safety strap on his sidearm. Derek supposed that a large and somewhat intimidating man trying to enter a sensitive area might raise a red flag or two.