Side Effects

by Michael Palmer

  Carl, aren't you sorry?"

  Jared, please help me. Help me. Help me.

  The words faded like an echo into eternity. Kate became aware of a gentle hand on her shoulder.

  "Dr. Bennett, are you all right?"

  Kate lifted her head and blearily met the eyes of night watchman Walter Macfarlane. She was at a table, alone in the hospital library, surrounded by dozens of books and journals dealing with bleeding disorders, ovarian disease, and pharmacology. 342 "Oh, yes, Walter, " she said, "I'm fine, thank you. Really."

  Her blouse was uncomfortably damp, and the taste in her mouth most unpleasant.

  "Just checking, " the man said. "It's getting pretty late. Or should I say early." He tapped a finger on the face of his large gold pocket watch and held it around for her to see.

  Twenty after two.

  Kate smiled weakly and began gathering her notes together.

  "I'll see you to your car if you want, Doctor."

  "Thanks, Walter, I'll meet you by the main entrance in five minutes."

  She watched as the man shuffled from the library. Then she discarded the notion of calling Jared, knowing that she would just be adding insult to injury by waking him up, and finished packing her briefcase. As she neared the doorway, she glanced out the window.

  Across the street, the winter night reflected obscenely in its dark glass, stood the Omnicenter.

  Sunday 16 December

  The night was heavy and raw. Crunching through slush that had begun to gel and shielding her face from blowgun darts of sleet, Kate crossed Commercial Street and plowed along Hanover into the North End. Traffic and the weather had made her twenty minutes late, but Bill Zimmermann was not the irritable, impatient type, and she anticipated a quick absolution. Demarsco's, the restaurant they had agreed upon, was a small, family-owned operation where parking was as difficult to find as an unexceptional item on the menu.

  Initially, when Kate had called and asked to meet with him, Zimmermann had proposed his office at the Omnicenter. It was, perhaps, among the last structures on earth she felt like entering on that night.

  Unfortunately if there were a list of such things, Demarsco's, his other suggestion, might also have been on it. Demarsco's was one of her and Jared's favorite spots. And now Jared was gone. "A sort of separation, but not a separation, " he had called it in the note she had found waiting for her at three o'clock on Saturday morning. He had taken some things and gone to his father's, where he would stay until leaving for business in San Diego on Monday. "A sort of separation, but not a separation."

  There was no lengthy explanation. No apology. Not even any anger.

  But the hurt and confusion were there in every word. It was as if he had just discovered that his wife was having an affair-an up-and-down, intense, emotionally draining affair-not with another man, but with her job, her career. "Space for both of us to sort out the tensions and pressures on our lives without adding new ones, " he had written. "Space for each of us to take a hard look at our priorities."

  Kate wondered if, standing in the center of his fine, paneled study, his elegant mistress awaiting him on his black satin sheets, Winfield Samuels, Jr., had raised a glass to toast his victory over Kate and the return of his son and to plan how to make a temporary situation permanent. It was a distressing picture and probably not that far from reality. However, as distressing to her as the image of a gloating Win Samuels, was the realization that her incongruous emotion, at least at that moment and over the hour or so that followed before sleep took her, was relief. Relief at being spared a confrontation. Relief at being alone to think. Someone was trying to sabotage her reputation and perhaps her career. Her close friend was lying in a hospital bed bleeding from a disorder that had killed at least two other women-a disorder that had no definite cause, let alone a cure. And now, there was the discovery that she herself had been exposed to contaminated vitamins, that her own body might be a time bomb, waiting to go off-perhaps to bleed, perhaps to die. Priorities. Why couldn't Jared see their marriage as a blanket on which all the other priorities in their lives could be laid out and dealt with together? Why couldn't he see that their relationship needn't be an endless series of either-ors?

  Why couldn't he see that she could love him and still have a life of her own?

  Demarsco's was on the first floor of a narrow brownstone. There were a dozen tables covered with red-and-white checkered tablecloths and adorned with candle-dripped Chianti bottles-a decor that might have been tacky, but in Demarsco's simply wasn't. Bill Zimmermann, seated at a small table to the rear, rose and waved as she entered. He wore a dark sport jacket over a gray turtleneck and looked to her like a mix of the best of Gary Cooper and Montgomery Clift. A maternal waitress, perhaps the matriarch of the Demarsco clan, took her coat and ushered her to Zimmermann with a look that said she approved of the woman for whom the tall dashing man at the rear table had been waiting. "They have a wonderful soave, " Kate answered, settling into her seat, "but you'll have to drink most of it. I haven't been getting much sleep lately, and when I'm tired, more than one glass of wine is usually enough to cross my eyes."

  "I have no such problem, unfortunately, " he said, nodding that the ample waitress could fill his earlier order. "Sometimes, I fear that my liver will desert me before my brain even knows I have been drinking. It is one of the curses of being European. I stopped by the hospital earlier to see your friend Mrs. Sandler."

  "I know. I was with her just before I came here. She was grateful for your visit. Whatever you said had a markedly reassuring effect."

  Kate smiled inwardly, remembering the girlish exchange she and Ellen had had regarding the Omnicenter director's uncommon good looks and marital status. "Maybe I could rent him for a night, " Ellen had said, "just to parade past Sandy a time or two."

  Zimmermann tapped his fingertips together. "The lab reports show very little change."

  "I know, " Kate said. "If anything, they're worse. Unless there are several days in a row of improvement, or at least stability, I don't think her hematologist will send her home." She felt a heaviness in her chest as her mind replayed the gruesome scene on Ashburton Five during Beverly Vitale's last minutes. Ellen's counts were not yet down to critical levels, but there were so many unknowns. A sudden, precipitous fall seemed quite possible. The stream of thoughts flowed into the question of whether with Ian Toole's findings, Kate herself should have some clotting measurements done. She discarded the notion almost as quickly as she recognized it. "I hope as you do that there will be improvement, " Zimmermann said. He paused and then scanned the menu.

  "What will it be for you?" he asked finally. "I'm not too hungry. How about an antipasto, some garlic bread… and a side order of peace of mind?"

  Zimmermann's blue-gray eyes, still fixed on the leather-enclosed menu, narrowed a fraction. "That bad?"

  Kate chewed at her lower lip and nodded, suddenly very glad she had gone the route of calling him. If, as seemed possible, a confrontation with Redding Pharmaceuticals was to happen, it would be good to have an ally with Bill Zimmermann's composure and assuredness, especially considering the fragility of her own self-confidence. "In that case, perhaps I had best eat light also." Zimmermann called the waitress over with a microscopic nod and ordered identical meals. "I want to thank you for coming out on such a grisly night, " Kate began. "There have been some new developments in my efforts to |! make sense out of the three bleeding cases, and I wanted to share them with you."

  "Oh? " Zimmermann's expression grew more attentive. "You know I've had sample after sample of medications from the Omnicenter analyzed at the State Toxicology Lab."

  "Yes, of course. But I thought the results had all been unremarkable."

  "They were… until late Friday afternoon. One of the vitamin samples I had analyzed contained a painkiller called anthranilic acid. The basic chemical structure of the drug is contained in several commerical products-By mid, from Sampson Pharmaceuticals, and Levonide, from Freeman-Gannett,
to name two. However, the form contaminating the vitamins is something new-at least in this country. Ian Toole at the state lab is going to check the European manuals and call me tomorrow."

  "Is he sure of the results?"

  "He seemed to be. I don't know the man personally, but he has a reputation for thoroughness."

  "What do you think happened?"

  "Contamination." Kate shrugged that there was no other explanation that made any sense. "Either at Redding Pharmaceuticals or perhaps at one of the suppliers of the vitamin components, although I would suspect that a company as large as Redding can do all the manufacturing themselves."

  "Yes. I agree. Do you think this anthranilic acid has caused the bleeding disorders in our three women?"

  "Bleeding and ovarian disorders, " Kate added, "at least ovarian in two of the women. We don't know about Ellen. The answer to your question is I don't know and I certainly hope not."

  "Why?"

  "Because, Bill, the vitamins that were finally positive for something were mine. Ones you prescribed for me."

  Zimmermann paled. The waitress arrived with their antipasto, but he did not so much as glance up at her. "Jesus, " he said softly. It was the first time Kate had ever heard him use invective of any kind. "Are you sure this Toole couldn't have made a mistake? You said yourself there were any number of samples that were negative."

  "Anything's possible, " she said. "I suppose Ian Toole and his spectrophotometer are no more exempt from error than… Redding Pharmaceuticals."

  "Do you have more of a sample? Can we have the findings rechecked at another lab?"

  Kate shook her head. "It was an old prescription. There were only half a dozen left. I think he used them all."

  Zimmermann tried picking at his meal but quickly gave up. "I don't mean to sound doubtful about what you are saying, Kate. But you see what's at stake here, don't you?"

  "Of course I do. And I understand your skepticism. If I were in your position and the Omnicenter were my baby, I'd want to be sure, too. But Bill, the situation is desperate. Two women have died. My friend is lying up there bleeding, and I have been unknowingly taking a medication that was never prescribed for me. Someone in or around Redding's generic drug department has made an error, and I think we should file a report with the FDA as quickly as possible. I spoke to the head pharmacist at Metro about how one goes about reporting problems with a drug."

  "Did you mention the Omnicenter specifically? " Zimmermann asked. "I may be nervous and frightened about all this, Bill, but I'm neither dumb nor insensitive. No. Everything I asked him was hypothe ical."

  "Thank you."

  "Nonsense. Grandstand plays aren't my style." She smiled. "Despite what the papers and all those angry Red Sox fans think. Any decisions concerning the Omnicenter we make together." Kate nibbled on the edge of a piece of garlic bread and suddenly realized that for the first time since returning home to Jared's note, she had an appetite. Perhaps, after the incredible frustrations of the week past, she was feeling the effects of finally doing something. She passed the basket across to Zimmermann. "Here, " she offered, "have a piece of this before it gets cold."

  Zimmermann accepted the offering, but deep concern continued to darken his face. "What did the pharmacist tell you?"

  "There's an agency called the U. S. Pharmacopia, independent of both the FDA and the drug industry, but in close touch with both. They run a drug-problem reporting program. Fill out a form and send it to them, and they send a copy to the FDA and to the company involved."

  "Do you know what happens then?"

  "Not really. I assume an investigator from the FDA is assigned to look into matters."

  "And the great bureaucratic dragon rears its ugly head."

  "What?"

  "Have you had many dealings with the FDA? Speed and efficiency are hardly their most important products. No one's fault, really.

  The FDA has some pretty sharp people-only not nearly enough of them."

  "What else can we do? " Absently, Kate rolled a black olive off its lettuce hillock and ate it along with several thin strips of prosciutto.

  "I need help. As it is, I'm spending every spare moment in the library.

  I've even asked the National Institutes of Health library to run a computer cross on blood and ovarian disorders. They should be sending me a bibliography tomorrow. I've sent our slides to four other pathologists to see if anyone can make a connection. The FDA seems like the only remaining move."

  "The FDA may be a necessary move, but it is hardly our only one. First of all I want to speak with Carl Horner and our pharmacist and see to it that the use of any Redding products by our facility will be suspended until we have some answers."

  "Excellent. Will you have to bring in extra pharmacists?"

  "Yes, but we've had contingency plans in place in case of some kind of computer failure since… well, since even before I took over as director. We'll manage as long as necessary."

  "Let's hope it won't be too long, " Kate said, again thinking of Beverly Vitale's lifeless, blood-smeared face. "If we go right to the FDA it might be."

  "Pardon?"

  "Kate, I think our first move should be to contact Redding Pharmaceuticals directly. I think the company deserves that kind of consideration for the way they've stood up for orphan drugs and for all the other things they've done to help the medical community and society as a whole. Besides, in any contest between the bureaucratic dragon and private industry, my money is on industry every time. I think it's only fair to the Omnicenter and our patients to get to the bottom of matters as quickly as possible."

  Kate sipped pensively at her wine. "I see what you mean… sort of," she said. "Couldn't we do both? I mean contact Redding and notify the FDA?"

  "We could, but then we lose our stick, our prod, if you will. The folks at Redding will probably bend over backward to avoid the black eye of an FDA probe. I know they will. I've had experience with other pharmaceutical houses-ones not as responsive and responsible as Redding. They would go to almost any length to identify and correct problems within their company without outside intervention."

  "That makes sense, I guess, " she said. "You sound uncertain, Kate.

  Listen, whatever we do, we should do together. You said that yourself.

  I've given you reasons for my point of view, but I'm by no means inflexible." Zimmermann drained the last half of his glass and refilled it. Kate hesitated and then said, "I have this thing about the pharmaceutical industry. It's a problem in trust. They spend millions and millions of dollars on giveaways to medical students and physicians.

  They support dozens upon dozens of throwaway journals and magazines with their ads. I get fifty publications a month I never ordered. And I don't even write prescriptions. I can imagine how many you get."

  Zimmermann nodded that he understood. "In addition, I have serious questions about their priorities-you know, who comes first in any conflict between profit and people."

  "What do you mean?"

  "Well, look at Valium. Roche introduces the drug and markets it well, and the public literally eats it up. It's a tranquilizer, a downer, yet in no time at all it becomes the most prescribed and taken drug in the country. Unfortunately, it turns out to be more addicting than most physicians appreciated at first, and lives begin to get ruined.

  Meanwhile, a dozen or so other drug houses put out a dozen or so versions of Valium, each with its own name and its own claim. Slower acting. Faster acting. Lasts all night. Removed more rapidly. Some busy physicians get so lost in the advertising and promises that they actually end up prescribing two of these variants to the same patient at the same time. Others think they're doing their patients a big favor by switching.

  Some favor."

  "Pardon me for saying it, Kate, but you sound a little less than objective."

  "I'm afraid you hear right, " she said. "I had some emotional stresses back in college, and the old country doctor who served the school put me on Valium. It too
k a whole team of specialists to realize how much my life came to revolve around those little yellow discs. Finally, I had to be hospitalized and detoxed. So I just have this nagging feeling that the drug companies can't be trusted. That's all."

  Zimmermann leaned back, rubbed his chin, and sighed. "I don't know what to say. If speed is essential in solving this problem, as we both think it is, then the route to go is the company. I'm sure of that."

  He paused. "Tell you what. Let's give them this coming week to straighten out matters to our satisfaction. If they haven't done so by Friday, we call in the FDA. Sound fair?"

  Kate hesitated, but then nodded. "Yes, " she said finally. "It sounds fair and it sounds right. Do you want to call them?"

  Zimmermann shrugged. "Sure, " he said, "I'll do it first thing tomorrow.

  They'll probably be contacting you by the end of the day."

  "The sooner the better. Meanwhile, do you think you could talk to some of your Omnicenter patients and get me a list of women who would be willing to be contacted by me about having their medications analyzed?"

  "I certainly can try."

  "Excellent. It's about time things started moving in a positive direction. You know, there's not much good I can say about all that's been happening, except that I'm glad our relationship has moved out of the doctor-patient and doctor-doctor cubbyholes into the person-person.

  Right now I'm the one who needs the help, but please know that if it's ever you, you've got a friend you can count on."

  Zimmermann smiled a Cary Grant smile. "That kind of friend is hard to come by, " he said. "Thank you."

  "Thank you. Except for Tom Engleson, I've felt pretty much alone in all this. Now we're a team." She motioned the waitress over. "Coffee? " the woman asked. "None for me, thanks. Bill? " Zimmermann shook his head.

  "In that case could I have the check, please?"

  "Nonsense, " Zimmermann said, "I won't… "-the reproving look in Kate's eyes stopped him in mid-sentence-"… allow you to do this too many times without reciprocating."