Rachel wasn’t used to being on this end of the nursing care she was receiving, but as best she could tell, Barbara was doing everything right. She relaxed a bit, yet wondered if she’d ever get over being suspicious of every new face that came her way. Was she being paranoid . . . or just cautious?
***
The group went through the cafeteria line, then found a table in the corner where there were no neighbors to hear their conversation. Josh looked down at the food on his tray and found that, despite the stressful situation in which he found himself, he was hungry. He thought back and realized he’d worked through lunch yesterday then dropped, exhausted, onto the bed in the call room before eating dinner. He’d missed a couple of meals before during his residency, but he was a lot younger then.
Josh was about to attack the scrambled eggs and sausage on his plate when out of the corner of his eye he saw Derek bow his head. Josh was used to a spoken grace before meals when he was with a group of family or friends, although it usually wasn’t his idea to initiate it. However, he’d totally ignored it in this situation. He wasn’t sure if he was reacting to peer pressure or a guilty conscience, but whatever the cause, he closed his eyes, bowed his head, and rectified the omission.
Josh wasn’t sure what Allison had done about grace, but when he raised his head and began eating he saw that she was already well into her stack of pancakes. He chewed, swallowed, and said, “Okay, at this table we have three people with above-average IQs and a significant amount of experience practicing medicine. What solutions to the current problem have we ignored?”
“We’re dealing with an unusual organism that in the past has killed everyone infected with it,” Allison said.
“Tell me something I don’t know,” Josh said, not attempting to mask his sarcasm.
“I’m getting there.” She nodded at Derek, who had almost finished eating the fried eggs and bacon he’d chosen. “You said the drug had been tried on humans only once in a very small series. But it was successful.”
Derek nodded his agreement but remained silent.
“So Derek brought all the RP-78 he could find at Argosy,” Josh said. “After one dose, which was all we had, neither Madison nor Rachel has showed signs of improvement. We need more of the drug, but the pharmaceutical company has stopped making it. So, I repeat, what can we do now?”
Allison looked over at Derek. “Were you prepared to run your series in South America for a larger number of patients than the ones that received the drug?”
“Yes. We sent down enough RP-78 to treat twenty-five men for ten days each. But, as you know, when we floated the idea of the drug past some contacts we had at the FDA, they said to forget it, because the drug would never get approved.”
Allison looked around the table, waiting for the light to dawn. Josh saw it first. “But there should be a supply of RP-78 still in South America. All we have to do is contact the doctor who was doing the work for you down there and get it flown to us.”
Derek was already shaking his head. “After Josh called me and asked for as much of the drug as I could lay my hands on, I thought of that.” He lifted his coffee cup, then put it down without drinking from it. “After the FDA rained on our parade, our study coordinator at Argosy contacted the doctor in South America and told him to destroy the remaining drug. It’s gone.”
Josh frowned. “If you can give me the name and number of the doctor who ran that study, I have an idea.”
Derek opened his smartphone and searched for a minute. Then he took a paper napkin from a dispenser on the table, pulled out a pen, and wrote something. Josh stuck the paper in his pocket and stood. “I’m going to make a phone call.” And without another word, he hurried away.
***
Josh closed and locked the door of his office. He started to turn off his cell phone, but decided that an emergency might arise that required him. This call was going to require all his diplomatic skills to bring off. He’d never done anything this important before. God, help me to get this right. Josh realized that he’d never prayed so often as he had in the past couple of days. He’d have to think about that . . . but later. Right now, he needed to make one of the most important phone calls of his life.
He encountered his first problem almost immediately. His call wasn’t simply long distance. It was intercontinental. Josh tried to convince the hospital operator this was urgent, involving the case of former president David Madison. Despite his protestations, the operator told him she’d have to get approval from the administrator on call. Josh replied that he couldn’t wait. Instead, he picked up his cell phone and dialed Karen Marks. In a few short sentences, he told her what needed to be done.
“Why can’t you persuade the operator to let the call go through?” Marks asked.
“I tried, but for some reason, she won’t believe me, and I don’t want to wait for her to track down the administrator on call. Can you help?”
“Give me five minutes, then dial it.”
Josh spent that time rehearsing what he was going to say. He had to be convincing yet diplomatic. Finally, he thought he had it. After five minutes, he picked up the phone, and following instructions he found in the front of a phone directory from the bottom drawer of his desk, he dialed the number.
“Alo?” This was followed by words in Spanish spoken so rapidly Josh had no chance of understanding. However, the female voice seemed pleasant enough. Josh hoped it was a portent of success.
“Do you or anyone there speak English?”
“I speak English,” the woman said. “How may I help you?”
“This is Dr. Josh Pearson, Señor Dr. Pearson, calling from the United States for Dr. Andres Chavez.”
“I’m sorry, but this is the doctor’s answering service. He’s not in his office on Saturday.”
Saturday. Days had become meaningless for Josh as the medical situation of his patients deteriorated. “Look, this is an emergency. I need to speak with Dr. Chavez. It’s urgent—truly a matter of life and death.”
“I can try to locate the doctor,” she said.
Josh had been down this road with answering services here at home. Despite the urgency he tried to convey, he wondered if the message would reach the doctor. “Can you give me his home number?”
The conversation went on for another five minutes, ending when the answering service operator said, “I’ll do what I can to locate the doctor. If I do, I’ll give him your number and your message. That’s all I can promise.”
After he hung up, Josh sat at his desk and cradled his head in his hands. Why hadn’t he thought of this before? Would Chavez call back? And if he did, would Josh be able to convince him to cooperate? And if he were willing to help, would he have what was needed? Josh checked his watch. If he didn’t get a return call in half an hour, he’d have to ask Karen Marks to call in yet another favor and help locate the missing doctor. Meanwhile, all he could do was wait.
13
Jerry Lang stood at the door to David Madison’s room. He’d sent Agent Chrisman, who’d taken over guard duty there, to get some breakfast. After he got back, Lang would try to snatch a few hours of sleep. Mrs. Madison had spent the night in her husband’s room, resting in a reclining chair. Lang himself had managed about three hours of sleep in an unoccupied patient room. Once more, he wished the ex-president had listened to his suggestion that he be flown to someplace like Walter Reed or Bethesda, a hospital set up for treating high-profile patients with critical illness. But he hadn’t, so Lang would have to do the best he could with the resources at his disposal.
Lang’s cell phone rang. He saw the call was from Dr. Wayne Dietz. When Madison and Lang flew back early, they had left Dietz, an associate dean and professor of Internal Medicine at Southwestern Medical Center, in charge of leading the remaining delegation back to the U.S.
“Dr. Dietz, when did you get back?”
Dietz’s voice was a rich baritone that, even over a cell phone, carried with it a tone of authority overlaid with
a thick Boston accent. “The charter arrived at Love Field about four this morning. How’s David?”
How much did Dietz and the rest of the group know? Well, better to say too little than too much. “He and Ms. Moore are both down with an infection they apparently picked up in South America.”
“So I guess I can’t talk with him? Is that what you’re saying?”
You don’t know the half of it. “That’s correct, sir. Mr. Madison isn’t able to talk, but I’ll certainly tell him you called.”
“Maybe Monday he and I can get together and discuss the opinions of the group about the clinic David’s foundation wants to fund—you know, the location, size, staffing.” There was the briefest of pauses. “Now that poor Ben Lambert is gone, I imagine David will want to talk with me about becoming his personal physician. We’ll straighten that out on Monday as well, I suppose.”
Lang ended the call. He’d mention it to Mr. Madison as soon as he was better. If he didn’t get better . . . well, he’d cross that bridge when he came to it.
***
Rachel didn’t have access to her medical records, but she’d learned to assess the presence or absence of her own fever, even estimate its magnitude, without the use of a clinical thermometer. No longer would she cast a doubting eye on patients who said, “I know what’s going on in my body.” She was learning that was often true, based on her own experience, not something she’d been taught in nursing school.
All things considered, Rachel knew she was no better. Although she wished it were otherwise, she knew her fever had not broken after the injection Josh gave her last night. If anything, her temperature was a bit higher. She’d argued with him when he told her he was going to give her a dose of RP-78. Josh wouldn’t tell her how much of the drug he had, or whether this represented a decision on his part to treat her while withholding a dose from Madison. But she knew in her heart that was exactly what he’d done.
Part of her regretted Josh’s choice, while the rest of her loved him for it. There it was again. She loved him. The feelings she’d had for him before her trip to South America had grown in her first prolonged absence from him. Then her illness, including its potentially fatal nature, made what she felt for Josh crystal clear to her. Oh, her clinical mind could argue it was simply due to the effect the fever and other constitutional symptoms were having on her. Rachel knew differently. She was aware that she could die from this illness, although she couldn’t recall Allison or Josh coming right out and saying so. Even so, she determined that before she drew her final breath, she’d tell Josh of her love. And she’d speak the words, not write them on a whiteboard with a felt-tip pen.
***
Josh was still sitting at his desk, deep in thought, when the ring of the phone startled him into full wakefulness. Please let this be Dr. Chavez. He cleared his throat, picked up the receiver, and said, “Dr. Pearson.”
“Doctor, this is Dr. Andres Chavez. My answering service says you wanted to talk with me. They said it was urgent, and you were most insistent.”
Josh had expected to hear a heavy accent on the other end of the phone. Instead, Chavez spoke flawless English with a hint of a mid-Atlantic accent, perhaps Philadelphia or Baltimore. Josh could have kicked himself for not using the time he had to check the background of this man. Well, that ship had sailed.
“Doctor,” Josh said, “I appreciate your getting back to me. I realize this call is transcontinental, so if you’d like to give me a number, I’d be glad to call you back.”
“Not to worry,” Chavez said. “When I realized this was a
U.S. number, I drove back to the hospital where I work to return your call.”
Josh wondered what kind of hospitals were in Bogotá, and it seemed that Chavez had encountered this before. “In case you’re wondering, that’s the University Hospital of FundaciÓn Santa Fe de Bogotá. We’re a two hundred–bed hospital, offering residencies in thirteen areas of specialization. We are affiliated with the Johns Hopkins Hospital, which is where I received my own training in internal medicine.” Chavez paused to let that sink in.
“My apologies, doctor,” Josh said. This totally changed his mind about his approach. He’d pictured the man who ran the RP-78 study for Argosy as a minor functionary who would think nothing of holding back some of the drug for his own private use—and sale. This doctor didn’t fit that mold, at least not based on what was evident so far. And if that were the case, Josh’s plan to threaten him if he didn’t give up any RP-78 he’d held back wasn’t going to fly.
“Dr. Chavez, I’m sorry for my ignorance of your situation there. I didn’t have time to do my homework, and I guess it shows. I’ll put my cards on the table.” Josh tried to protect the identities of his patient, although he was prepared to reveal it if that would help him get the drug he needed. He told Chavez he was treating two patients who’d come back from South America with a diphtheria-like illness that had turned out to be caused by infection with Bacillus decimus.
“Would that be Señor Madison and Señorita Moore? I accompanied their delegation to a couple of areas in the less-settled regions of our country. They seemed to be developing some respiratory symptoms when they left.”
Josh shook his head. This was no small-time doctor, picking up a bit of extra money by running a drug study. Obviously, Chavez was what some of the people here in the U.S. would call a “wheel.” Well, it seemed to Josh the ace he’d been holding—David Madison’s identity as the patient—was useless. All that was left was to tell the truth and beg this man, professional to professional, for help.
“Dr. Derek Johnson gave me your name and number as the person who was running the RP-78 study for Argosy. He scraped together enough of the drug for me to give one dose to each patient. It hasn’t been effective so far. I’m trying everything I can think of to get more. I was hoping you could help me. According to Johnson, the remaining drug was to be destroyed and the study terminated. But if you have access to any RP-78—however little it might be—I beg you to let us have it.”
The silence on the other end of the line went on long enough for Josh to wonder if he’d been disconnected. No, because he still heard the faint echo that marked a phone call between continents. Then Chavez spoke. “Dr. Pearson, I think I can help you.”
***
The group gathered in Josh’s office included Derek Johnson and Allison Neeves, but this time Jerry Lang and Karen Marks joined them. There were normally only two chairs besides Josh’s desk chair in the room, and rather than bring in more and further crowd the office, Derek and Lang said they’d stand.
After making sure the door was closed, Josh brought the group up to date on his conversation with Chavez. “I fully expected the man to be someone who might put back some of the medication and sell it to patients with a Bacillus decimus infection. I figured I’d either be able to buy him off or frighten him into letting us have what little he’d held out. Instead, this man is a Hopkins-trained internist who works at a university hospital. He thought it was ridiculous to destroy a drug when it had worked so well in a small number of cases, so even though the study at La Modela Prison had been stopped, he put the remaining RP-78 back in case there was a need for it in the future. He’d been considering contacting Argosy to see if they’d underwrite resuming the study and then perhaps seeking a market for RP-78 in South America, since there is a small area there where Bacillus decimus is still around.”
“Man, I shouldn’t have taken the word of our research coordinator,” Derek said. “I should have called Chavez myself.”
“He might not have told you the whole truth. After all, Argosy had the power to insist that he destroy the rest of the RP-78. In this case, because two patients are in crisis—patients he had met, two people he immediately identified without any help from me—he reacted as any good physician would. He said he had several vials of RP-78. Some of the original shipment had gone out of date, but Chavez thought there were perhaps a dozen doses that were still good.”
&nb
sp; “So we have enough to give each patient maybe six more doses,” Allison said.
“Or ten doses for Mr. Madison, and—”
Josh kept his voice low, but there was an intensity to his words that no one could miss. “No. That’s already been decided. It came down to a medical decision, and I made it. These aren’t an ex-president and a nurse; they’re a man and a woman who have a potentially fatal disorder, and I want to save them both if I can. Both patients will be treated equally with RP-78.”
“How do we get it here?” Derek asked. “Is there going to be a problem getting it out of Colombia? I seem to recall that when Argosy shipped the drug in, they had to grease some palms to get it past customs.”
“Chavez said the Colombian Air Force has a base right outside Bogotá. I asked about our sending a plane there, but he said it would be better and faster if he could get on a Colombian military jet and fly the drug here. And he probably could bypass customs by doing it that way.”
“Great,” Karen said. “Every time we need something else to treat Mr. Madison, we acquire another doctor in the bargain.”
Josh didn’t raise his voice, but there was a new note of authority in it when he spoke. “I’ve made a medical decision. Now I’d appreciate it if you’d pick up the phone and make arrangements for one of our top Air Force generals to talk with his counterpart in the Colombian Air Force. When that’s done, we’ll call Dr. Chavez to make the final arrangements to get him and the drug here.” He took a deep breath. “And I don’t care how many other doctors it takes to save Mr. Madison—and Ms. Moore. Bring them on. We’ll handle it.”
***
Miracle Drug Page 12
