When he had his wallet in his hand, he pulled out two laminated cards and handed them to the guard. The first was a Georgia driver’s license, listing Derek at six feet, five inches, the second an identity card for Major Derek Johnson of the Air Force Reserve. “Are we good now, Airman Potter?” Derek said, noting the nametape over the breast pocket of the airman’s battle dress uniform.
In answer, the airman snapped a brisk salute and said, “Yes, sir. Thank you for providing the ID.” He ducked back into the guard shack, consulted a clipboard, and said, “Your bird is that F-22 Raptor over there. The crew chief will fit you with a flight suit and a helmet. Good luck, sir.”
In less than half an hour, Derek was strapped into the rear seat of the fighter jet. The small cooler containing all the RP-78 he’d been able to find after a thorough scouring of the Argosy facilities was safely stowed away. This was probably the last chance for the drug . . . and for Argosy. If RP-78 cured these two patients, one of them a former U.S. president, the FDA could almost certainly be persuaded to have another look at the compound.
Of course, if there are problems that arise from this off-label use of the drug—in other words, if this thing turns sour—I needn’t bother coming back. They’ll clean out my desk and send my things to me.
***
Fresh from a shower—or as fresh as someone could be after twenty-four hours without sleep—Josh made use of the razor and toiletries Sixto kept in his locker in the surgeon’s dressing room. Then dressed in a clean scrub suit, his dirty clothes crumpled into a pile in the corner of his hospital office, Josh tried to put his thoughts in order.
Doing what he’d done at the start of each new day during his residency training, Josh leaned back in his office chair, closed his eyes, and thought about the patients for whom he was responsible. In this case, it was a short list. David Madison remained his number one priority. Although the urgency of the past twenty-four hours had abated slightly now that Madison’s airway was no longer at risk, there was still the knowledge that an infection of this sort had been universally fatal in the past. The only hope of avoiding that fate for Madison lay in a poorly tested drug that was in a jet headed for Dallas at this moment. For the third time in less than a day, Josh let his thoughts morph into a prayer—a prayer for healing for his patients and for wisdom and strength for himself.
Shame washed over him as he realized he’d put aside thoughts of the woman he . . . the word that he was about to choose brought Josh up short. He’d recognized for some time that he was developing deep feelings for Rachel. Her absence on the trip made him even more aware of them. And now her illness brought his feelings into full focus—he loved her. Yet Josh had been so caught up with the responsibility thrust upon him as physician for the ex-president that he hadn’t told Rachel. But he would . . . soon.
That brought Josh face to face with another dilemma. RP-78, although virtually unproven, was the only hope to treat the fatal illness that infected both David Madison and Rachel. But what if there was only enough drug for one person? Karen Marks had made it manifestly clear that, so far as she was concerned, Madison’s life was the only one that mattered. But the ultimate decision would rest with Josh. Whom would he choose? The ex-president dependent on him for care or the woman he loved?
A light tap on the door interrupted his thoughts. Before Josh could speak, Jerry Lang stuck his head in. “Do you have a minute?”
Why not? He was getting nowhere with his current problem. “Sure. Come in. Sit down.”
Lang dropped into the chair on the other side of Josh’s desk, stretched, and yawned. “I think we need to talk.”
“If it’s about treating Mr. Madison—”
“Karen Marks has already told me about the RP-78. I’ll leave the medical end to you. I want to see what your opinion is about Dr. Lambert’s death.”
Josh shrugged his shoulders, wishing he could have stayed longer under the hot shower. “Honestly, I’m puzzled by the whole thing. I’ve reviewed Ben’s medical records, and there was nothing there to suggest any heart problem.”
“But without an autopsy we can’t know, can we?” Lang asked.
Josh shook his head. “No. I’ve already told Rachel it’s possible Ben Lambert was given a drug that would mimic a heart attack. But I don’t know why anyone would want to kill him.”
“Nor do I, and that’s something to be investigated. I suppose we’ll have to let it wait until later, though.” Lang rose. “Right now, my primary job is protecting Mr. Madison. And I guess yours is to save his life. After that, we can look into Dr. Lambert’s death. In the meantime, be thinking of why anyone would want to kill your colleague . . . or the ex-president.” With that, the Secret Service agent turned and left.
Lang’s question was the stimulus Josh needed to follow up on the question he’d been meaning to answer. Years ago he might have checked journals and textbooks. Now he hit a few keys on his computer, scrolled down the page, then peered at the monitor. There it was, from no less an authority than the National Institutes of Health. The article was headed “Aconite poisoning.”
Aconite—sometimes called wolfsbane. Josh had heard of it, read about it (in Greek literature and Shakespeare), but never thought he’d see a case of poisoning involving it. His eyes danced over the words in the article, but stopped when he saw: “Highly cardiotoxic and neurotoxic.” Josh read further until he confirmed that, in whatever manner it was administered, aconite did indeed mimic the signs and symptoms of a heart attack.
Of course, all this was academic, because without a body for an autopsy no one could confirm or rule out the presence of aconite in the deceased. Josh’s mind moved on to other questions. Forget the manner of Ben Lambert’s death. Why would someone want to get rid of him? And why would someone try to kill David Madison? And then there was the question that wouldn’t leave Josh’s mind. Would he be next?
At that moment, the door to Josh’s office burst open and a tall, stocky man in a too-tight flight suit strode in. In one hand, he held a small personal cooler, one that might normally carry half a dozen soft drinks, in the other a duffel bag. The man tossed the bag in the corner and lowered the cooler gently onto Josh’s desk. “Well, friend, here I am.” He pointed to what he’d brought. “And, to my knowledge, this is the world’s entire supply of RP-78. Let’s hope it works.”
The two men clasped hands and clapped each other on the shoulder. “Thanks for coming, Derek,” Josh said.
“JP, you certainly know how to throw a party. I’m here, and I brought the stuff. How do you want to do this?”
“On the phone, you told me you were probably the world’s expert on Bacillus decimus. Well, I’ve called you in to consult. Tell me about this however-you-pronounce it.”
“In Latin, the c in decimus would be pronounced like a k, but in English it sounds like an s. In our lab, we used the Latin pronunciation. But you can take your choice.”
“Let’s settle for the English, because that’s how I’ve been pronouncing it. And why decimus? Was it discovered in December?”
Derek shook his head. “Remember your Bible, the plagues visited on Egypt?”
“Yes, sort of.”
“The tenth plague was the death of the firstborn. The others ranged from bad to terrible, but this one was universally fatal. When Etienne Vandiver discovered the bacteria, he recognized that it caused death in every case. So he named it for the tenth plague.”
Josh shivered as he thought of it. “Well, it appears that David Madison and Rachel Moore have both diphtheria and a Bacillus decimus infection. Would you like to see the cultures and slides?”
“I probably should, just to confirm. That way I can give you an official second opinion. And while we’re heading for the lab, you can fill me in on the clinical picture of both patients. I doubt that you’ve made a mistake, but I suspect we’d better dot our i’s and cross our t’s for this case.”
In a bit less than an hour, the two men were back in Josh’s office. Derek eased i
nto a chair and said, “Well, there’s no doubt the diagnosis is correct. Now let’s see what we can do to pull the patients through.” He pointed to a dry-erase board on the wall. “Mind if I use that?”
“Anything that might help,” Josh said.
Derek drew a line down the middle of the board and wrote Dipt on one side and Dec on the other. “You think both patients were given saline or something similar instead of DT boosters, so they were vulnerable to diphtheria infection. They’ve both received antitoxin and have been on antibiotics for about thirty-six hours. Right?”
Josh checked his watch and did some rapid calculations. “Closer to thirty hours on the antibiotics.”
“Okay, although we can’t see clinical evidence of a response because of the other infection, we can assume that by tomorrow they should be non-infectious from the standpoint of diphtheria.” He entered a few notes in a sort of shorthand on the left side of the board. “That leaves Bacillus decimus. Madison has a tracheotomy, so his airway is safe for now. Rachel’s is still borderline. It will take twenty-four to forty-eight hours for them to respond to RP-78, if it’s going to work. Until then, the main thing to watch for is Rachel’s airway closing off and either of them going into septic shock. If they exhibit high fever with convulsions, we’ve probably reached endgame.”
“And if the drug doesn’t work?”
“We’ll cross that bridge when we come to it, won’t we?” Derek said. “Now let’s talk about dosing.” He pointed to the cooler. “As I said, what I brought is what we have.”
“Do you have data on optimum dosage?” Josh asked.
“We have limited dose-ranging studies in lab animals. The clinical studies were on seven volunteers serving life sentences in a South American prison. They understood the risks, but without treatment they were going to die. All of them recovered.” Derek scribbled some figures in the otherwise blank right column of the board. “We think the dose is one milligram per kilogram of patient body weight, given once daily intramuscularly.”
“For how long?” Josh asked.
“We have no idea. As you know, duration of dosage goes back to studies that show ten days is optimum for strep infections. Of course, some of the newer antibiotics, given for other infections, work well after three days, some after only one. But we always start with ten.”
“How about in your volunteers?”
“We had enough of the medicine to give it for ten days, so that’s what we did, but they all showed improvement within twenty-four to forty-eight hours. Unfortunately, we don’t know if they would have relapsed if we’d stopped it then,” Derek said. “If we had enough drug, I’d say give it for at least three days, seven would be better, and ten would be best.”
“Let’s check the medical records.” Josh tapped some keys on the computer on his desk. In a moment he said, “Madison weighs one hundred eighty-five pounds, Rachel one hundred ten. That’s about . . . let’s see. That’s one hundred thirty-four kilograms total for them both. Now to the most important question,” Josh said. “How much do you have?”
Derek swung open the lid of the cooler to reveal a small, rubber-stoppered vial containing a pitifully small amount of clear, amber-tinted liquid. It rested amid three blocks of blue ice. He carefully lifted out the vial. “This is two hundred seventy milligrams of RP-78. That’s enough for one dose for each of those patients or two doses for one of them. You make the choice.”
11
David Madison opened his eyes and, for a moment, had no idea where he was. He could tell from his surroundings he was in a hospital room, but was he still in South America? Then it gradually came back to him, the whole story. He felt the fever. He heard the whistling as air moved in and out through the tube in his windpipe. He swallowed and felt the dull ache of the recent surgical incision in his neck. Then when he moved his eyes to scan the area around him, he saw Mildred sitting quietly at his bedside. Her eyes were closed, but her lips moved slightly. She was praying . . . undoubtedly, for him.
Madison tried to speak, but the only thing that came out was a rush of air. He lifted his hand. Mildred’s eyes remained closed. He felt for the nurse call button at his side but didn’t press it. It was ridiculous to call for help simply to get the attention of the woman who sat only six feet away from him.
For the first time in many years, David Madison, the man who at one time was leader of the free world, felt helpless. As he ascended the ladder of politics from local to state to national, eventually assuming the office of president, he’d grown accustomed to having people around him to do his bidding. He thought of the Bible story of the centurion who came to Jesus, begging Him to heal the man’s dying daughter. The centurion had people he told to come or go, and they obeyed. But his power over men and events didn’t translate into healing for his loved one.
Madison knew he was receiving the best possible medical care, but he was also struck by his helplessness in the situation. So, one of the most powerful men in the nation closed his eyes and joined his wife in prayer. It was all he could do.
***
Rachel tried to delay it as long as possible, but she realized she was playing with fire by putting it off. She’d tried to hide it from the nurse who checked on her every hour, sometimes every fifteen or twenty minutes, although she couldn’t really say why. But her difficulty breathing was becoming more obvious. The nurse would see it the next time she came back, so Rachel pushed the call button to get her in the room now.
The nurse, Mary Wynn, hurried in. “Do you need something?”
Rachel nodded. She forced herself to speak slowly and quietly, fearing that if she pushed herself to any degree her vocal cords would go into spasm and close off her airway completely. “I think you’d better get Dr. Neeves or Dr. Molina. He was here earlier—”
The nurse frowned. “Don’t try to talk.” She pushed the button to elevate Rachel’s head further, then turned up the oxygen even more. “I’ll page them stat. Just hang on.” As she hurried from the room, Rachel saw her cast a sidelong glance at the tracheotomy tray nearby, making sure it was ready.
***
Josh sat behind his desk with his eyes closed. He knew he had to make a decision, but another couple of minutes wouldn’t hurt. He wished he could postpone it even more. “Derek,” he said. “I appreciate your coming and bringing the RP-78. I never asked how Karen arranged everything.”
“Once I got to Dobbins Air Force Base and got past the airman guarding the flight line, everything else was pretty simple.” Derek stretched and yawned, then put his feet on Josh’s desk. “A Secret Service agent, I think his name was Gilmore, met me at Love Field with a police escort to bring me to the hospital. That was kind of neat. On the way here, he told me that when I was ready to go back, Ms. Marks would arrange to fly me to Dobbins where I left my car.”
“Won’t your wife worry?”
The smile left Derek’s face. “You haven’t heard, have you? Robin died of ovarian cancer last year.”
“Oh, man, that’s . . . that’s tough. I’m so sorry,” Josh said. He hesitated, then decided to share his own news with his friend. “You may recall my wife, Carol. Well, she was killed in a car crash two years ago, along with our unborn child.”
“It’s rough, isn’t it?” Derek said.
“And I’m not sure we ever get over it,” Josh replied. “But now I have Rachel, and I hope there’s someone out there for you as well. I know Robin would want you to be happy.”
“Thanks,” Derek said. “When we got the diagnosis, I’d just received an offer from a multi-specialty group in the Atlanta area. Good salary, great benefits, paid time for meetings and vacation. But when Robin’s cancer was discovered, I decided to stay with Argosy.”
Josh couldn’t help but ask what to him was an obvious question. “Why?”
“To keep my insurance going. To avoid changing anything else in Robin’s life. But mainly, I guess I was hoping I could come up with some sort of cure for cancer patients.” He stood and began t
o pace. “I didn’t, of course. I guess I was foolish to think I could succeed where some of the best minds in the world had been unsuccessful. But maybe RP-78 will turn out to be my magic bullet against Bacillus decimus.”
Josh stood and picked up the cooler. “I guess I can’t put off my decision any longer. It’s time to give the RP-78 to . . . well, to one or both of them.”
“I wish I could help you make the decision,” Derek said.
Josh’s cell phone rang. He looked at the caller ID, then answered. “Allison, what’s up?”
Allison Neeves spoke in hushed tones, and Josh could hear voices in the background. “I’m calling from right outside Rachel’s room.”
Josh’s pulse quickened. “What’s happened?”
“Sixto just did an emergency tracheotomy on Rachel,” Allison said. “She still has a high fever, but at least her airway is protected until you can figure out how to treat her.”
Josh mumbled, “Thanks,” and ended the call.
He was still faced with the decision of how to distribute the RP-78, and if anything, this new development hadn’t made the choice any easier. Now both patients seemed to be in exactly the same situation. It came down to this—give two doses, which might be enough, to the woman he loved or to the former president of the United States. Or give each of them one dose and possibly sentence them both to death for lack of more of the drug.
***
Detective Stan Warren and Agent Jerry Lang sat in an isolated corner of the hospital cafeteria and sipped from cups of coffee that might have been fresh six hours ago. Warren had consumed so many bad cups of coffee over the years that he had come to accept whatever was available. Besides, he harbored the hope that, with the aid of the strong brew, he might be able to get through a few more hours without sleep as he tried to unravel the mystery surrounding this latest attempt on the life of David Madison.
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