Lethal Intent

by Cara C. Putman

  The idea of subjecting her to a treatment that hadn’t been proven yet felt wrong to Brandon, but the doctors said there was nothing more they could do without a Hail Mary pass. They just needed the state to agree. He might be Bethany’s guardian, but the state would control her medical treatment until she was placed with a family.

  “Why are you frowning?” Her words snapped him from his thoughts.

  He forced a grin as he sank into the chair next to her hospital bed. “Sorry about that.”

  “You don’t need to worry about me.” She straightened the sheet under her arms. “I’ll be fine. I always am.” She jutted her chin as if that made the words truer. “How’s Gabriel?”

  “He misses you. I told him I’ll bring him to see you as soon as he’s cleared.”

  “He won’t be.” She spoke with the life experience of someone who knew. “It’s too dangerous.” She didn’t clarify whom it was more dangerous for.

  Today she was a shadow of the girl she’d been six weeks earlier when the siblings arrived at Almost Home. They’d settled into a cabin with his best house parents, but soon after the leukemia reappeared, and her body lacked the reserves to fight. She was running out of time.

  “That might be true, but I get to be here when I want to.” As long as he submitted to frequent blood tests to ensure he didn’t expose her compromised system to anything. The vinyl squeaked as he leaned back in the chair. “I can’t think of anywhere else I’d rather be right now.”

  “I can.” She said the words so deadpan, he laughed.

  “I bet you can.” He might feel helpless and inept as he tried to watch the various monitors and interpret the displays, but he could help her dream. “What’s the first thing you want to do when you get out of this place?”

  “Go to the beach and feel the sun on my face.”

  “That sounds good.” He made a mental note to take her. “You keep doing what the doctors ask, and I’ll see about getting you some sunshine.”

  She studied him as if not sure whether to believe him. “Really?”

  “Scout’s honor.” The smile she gave him signaled he’d have to make this happen somehow. He didn’t want to set her up for fresh disappointments, because he was out of his element. Almost Home didn’t host medically complicated kids. He would need skilled staff to deal with the unique needs of that population, something he couldn’t contemplate right now. Worrying about how Virginia might interpret the new federal Family First law consumed all of his attention. Depending on what the state decided, Almost Home might have to close.

  A machine started beeping. Loudly. He glanced around but didn’t know what to do, so he stood and hurried to the hallway, where he collided with a soft mass.

  Chapter 2

  Oomph.

  The air burst from Caroline’s lungs as she crashed into someone.

  Quentin steadied her. “Watch where you’re going, mountain man.”

  Caroline glanced up. “Brandon?”

  His gaze barely took her in before he latched onto the doctor. “Anna, the alarms are screaming in Bethany’s room.”

  Weariness fled the woman’s posture as she stepped into the room Brandon had exited. “Let me see what’s going on.”

  Brandon followed her with Caroline a step behind.

  Quentin tightened his hold on her arm. “You can’t go in.”

  “Yes, I can. Brandon’s my friend.” And he’d been worried about Bethany for weeks. She tugged free and stepped through the doorway, then stood aside as a woman in scrubs rushed in.

  The doctor glanced at her. “Please stay against the wall and away from the patient.” She masked up then held a quiet consultation with the nurse as she watched the various screens and monitors. Then she murmured soft words to the little girl who lay pale against the pillows.

  Brandon slumped against the wall next to Caroline, his gaze fixed on the bed.

  “You okay, big guy?”

  “I can’t make this go away.” He whispered the words into her ear.

  Caroline took in the small form on the bed. “I’m glad to see her.” She squeezed his hand. “I’m so sorry.”

  “She’s a fighter, but she’s not getting better.” He sighed and then rubbed his face with his hands. He barely glanced at Caroline before returning his attention to the bed. “I don’t know how to help her.”

  “You’re here.” Caroline leaned into his arm. This man was such a rock for everyone, including her. He was the kind of support she’d never had as a kid struggling to survive an alcoholic single mom. She would have given anything to have someone like Brandon in her life as a preteen. The least Caroline could do was let him know he wasn’t alone. “How can I help?”

  He shook his head. “I don’t know.”

  “You’re doing the right thing, being here. She isn’t alone.”

  “It’s not the same as family.”

  “Is there any way you can bring her brother?” Gabriel was one of those kids who vibrated with energy and would bring a smile to the girl.

  “It’s not safe for either of them. It seems like such a small thing I should make happen, but can't.”

  “You can’t, but you’re here. That’s something.”

  His chin lifted a bit, and his shoulders shifted back to their usual squared-off position. Her rock was back.

  “Thanks.”

  “That’s what girlfriends are for. You’re always there for everyone else. It’s nice to do that for you.”

  He roused to look at her, curiosity filling his eyes. “Why are you here? I thought you were interviewing.”

  She tilted her head toward the hall. “Come meet my new boss.”

  He grinned. “Of course they hired you on the spot.”

  “Dr. Johnson is working with one of our trials. Quentin wanted me to see what the company's work is.”

  The men greeted each other in the doorway, and Brandon stiffened before relaxing. “This is your new boss?” he whispered out the side of his mouth.

  “Yes. You know him?”

  “Not really.”

  “If it isn’t Brandon Lancaster. I didn’t recognize you at first. How’s my newest investor?”

  Brandon hesitated before extending his hand. He kept his voice down. “Good to see you.”

  Investor? Caroline let the word bounce around her mind. She’d need to remember that.

  Quentin cocked his head. “What brings you here?” He glanced into the room at Bethany. “Is she yours?”

  “Yes and no. I run a group foster home. In that sense, she’s mine.”

  “I hope she’ll be all right.” Quentin studied her as if checking for symptoms.

  “Me too.”

  Caroline looked between the two. “You didn’t mention investing in this company.”

  “Didn’t think it mattered. Didn't know it’s where you were interviewing.” Brandon shrugged, then returned his focus to Bethany while Dr. Johnson made notes in the computer.

  Dr. Johnson leaned down to speak a few more words to the girl, sentences that coaxed a smile from her, then the doctor stepped away from the monitors and approached Brandon. “She’s fine. It looks like a malfunction on one of the machines, but we will keep a close eye on it and change it out if needed.” She studied Brandon carefully. “You should go home and get some rest. We’ll call you or the caseworker if anything changes.”

  “She shouldn’t be alone.”

  “She’s lucky to have you in her corner, but if you get sick worrying about her, you won’t get to advocate for her here. Her immune system is compromised, and I won’t allow anyone near her who is sick. Anyone.” The emphasis on the last word seemed to register as Brandon stepped back.

  His transformation was instantaneous. He held up his hands and quirked the small grin that tipped the corner of his mouth and made Caroline’s heart skip every time. “All right, Doc. You’re the expert and I trust you.”

  “Just keep doing that, and we’ll be good. I’m serious, cuz. Get some rest.”

/>   “Cuz?” Caroline’s gaze bounced between the two.

  Brandon glanced down at Caroline. “This intelligent woman is related to me. Can you believe it?”

  “Is this the child you want to add to the study?” Quentin’s words jarred the space.

  Dr. Johnson nodded. She motioned everyone to step farther down the hall and lowered her voice so Bethany couldn’t hear. “I’m waiting on test results to confirm she qualifies.” A sad knowing filled her expression. “I’m going to do all I can to push her into this trial.”

  Quentin’s expression sobered. “Can we start harvesting and preparing her cells while you wait on the results?”

  “Possibly. I’ll call Samson about it right away.”

  Brandon lifted a hand. “Wait. Harvesting her cells? Help me understand.”

  Dr. Johnson’s compassionate gaze shifted to Caroline and Brandon. “I know it’s a lot to take in. The treatment I want to try from Praecursoria is autologous, which means the patient both provides and then receives her own stem cells. We would harvest Bethany’s cells, then send them to Praecursoria to be adapted to fight the cancer before returning them to her.”

  “Isn’t leukemia usually treated with a bone marrow transplant?” Caroline felt her neck flush. “Sorry to interrupt, but I want to understand.”

  “No need to apologize. Bone marrow transplants are usually the first type of immunotherapy we try. They’ve been used since 1956, but they’re not perfect. Unfortunately, this has failed twice for Bethany. Here’s what happens.”

  Anna pulled a small notebook and pen from her lab coat and started sketching. She drew a large circle and labeled it stem cell. “You hear a lot of talk about stem cells. Stem cells found in bone marrow can make red and white blood cells as well as platelets.” She drew three more circles connected to the stem cell and labeled these red, white, and platelet. She pointed to the white cell. “In bone marrow transplants we take healthy white blood cells from a donor and give them to the patient. In a successful transplant those healthy white blood cells can strengthen the patient’s immune system, but it doesn’t always work. Sometimes the cells aren’t available in a format the patient can accept.”

  Caroline nodded as she studied the sketch. “You mean there isn’t a match between donor and recipient?”

  Anna smiled. “Exactly. That can lead to complications, especially with blood-borne cancers. For example, graft-versus-host disease happens when the patient’s body attacks donor cells.”

  “So you want to treat Bethany’s cancer with her own white blood cells?”

  “That’s right. But specifically, we want her T cells, which is something the white blood cells make.” She drew two more offshoots from the white cell and labeled one of them with a T.

  “How can you do that if the cells aren’t healthy in the first place?”

  “That’s where CAR T-cell therapy comes in. We genetically modify the patient’s T cells to recognize and fight cancer cells—turn them into those superhero ninjas—then reintroduce them to the body. The results have been exciting, but it’s all still early. In the beginning, CAR T-cell therapies used mouse cells to modify the patients’ T cells, and some bodies rejected them.”

  “So what is Praecursoria’s therapy, specifically?”

  Quentin spoke up. “We’ve found a way to hide the mouse cells inside the patient’s own cells.”

  Dr. Johnson nodded. “If it works, Praecursoria will be on the cutting edge of what we in oncology are calling the fifth pillar of cancer treatment. But bone marrow transplants will remain the first-line standard of care until we get more therapies and better longitudinal studies. We need data and time to support that CAR T-cell therapy can be used as an alternative to bone marrow transplants rather than a last-ditch option.”

  Caroline looked into Bethany’s room. “This trial is her only option?”

  “Her Hail Mary. I hate to be so blunt, but yes.” Dr. Johnson’s shoulders lifted and fell. “If Samson—Dr. Kleme—agrees, we could start harvesting her T cells tomorrow in anticipation of the test results coming back positive.”

  “And the state approving her treatment,” Brandon added.

  “That too.” Dr. Johnson sighed. “Every day matters for her.”

  So this was what Praecursoria did. Offered terrible hope to those who had none.

  Chapter 3

  Wednesday, April 21

  The next morning Caroline sat in her Mustang on I-495 and realized she’d need two things for her new commute to Praecursoria: more time to battle traffic and audiobooks. Or a route other than 495, one that involved back roads that moved. By the time she rushed through the doors at Praecursoria’s generic building, she felt behind. She got turned around twice trying to find her office, and her phone rang the moment she walked in.

  Over the phone Quentin’s assistant informed her she was late for a meeting. When Caroline finally found a pen and the right room, she stood outside the closed office door and exhaled, then turned the knob and entered.

  “Good morning, everyone.” She tried for a breezy tone, but no one smiled. Alrighty then.

  Quentin gestured to the empty chair next to him. “Join us here. Everyone, this is Caroline Bragg, Praecursoria’s new general counsel. She comes to us from the courts, where she clerked for a judge and managed a caseload. Now she’ll help us navigate the legal land mines of getting our trials approved and therapies on the market.”

  She sank into the chair and looked around the table. “I’m excited to join the team.”

  After quick introductions, everyone resumed their discussion of the status of trial applications with the FDA. She took furious notes as she listened. She felt like a blank slate when it came to the technology, but when Chief Science Officer Samson Kleme talked, Caroline kept seeing Bethany dwarfed in the hospital bed. Even in the child’s version, she looked small.

  “I’ve heard of three other companies working on similar therapies.” Samson tapped the legal pad in front of him. “We’ve got to push fast or we’ll lose the market.”

  “Do whatever you need to make that happen.” Quentin’s hair flopped in his face as he jotted something down. “I can’t emphasize strongly enough that even with the latest round of funding, we’ve got months at most to get this off the ground.”

  Caroline swallowed hard at the thought she’d started a job with an unstable company. What had she done? She set her pen down as her fingers trembled.

  Quentin caught her expression. “Do you have something to add?” He shifted toward her as he pushed back from the mahogany table.

  Was this what it felt like to be called on at King Arthur’s Round Table? Her stomach dropped to her toes and she waited for the words “Off with her head!” Wait, she’d mixed her children’s stories. When she’d taken the job with Praecursoria, she’d hoped to land in a safe place, not a fire.

  “We can’t shortcut the approval process.”

  Everyone at the table inhaled. Their faces swam in front of Caroline as she searched for the words to explain how terrible the CEO’s idea was. The fact her new colleagues had just consumed all the oxygen didn’t help her rattled nerves.

  Samson whatever-his-name-was steepled his manicured fingers. “You’ve been here how long?”

  “A couple of hours.” She would not be intimidated by him.

  “You’ve attended how many meetings?”

  “This is the first.”

  “And that makes you the expert?”

  She tipped her chin. The arrogant man had asked the wrong question. He might be a scientist, but she was the one with the legal experience. “Actually, yes. I’m here because none of you are lawyers.” She glanced around the table and tried to make eye contact with each person there. “My job is to make sure you stay within the guardrails of the law and regulations. The work you’re doing is too important to have the FDA halt it because we didn’t follow the right process.”

  The scientist leaned back and smirked. “Even if it means saving the li
fe of a child who will be dead within a week if we do nothing?”

  His words sliced into her heart. She knew what he expected her to say. Quentin had taken her to see Bethany, after all. She had a face and name to put with the company’s work, but that didn’t mean she could ignore what she was hearing, even if he currently knew the FDA trial process better. What the team at the table didn’t understand yet was that she’d managed several cases for Judge Loren that involved disputes related to FDA trials. Smug Samson could look at her like she was some dumb young thing, but she’d prove to him she knew the legal process better than he did.

  She glanced around the table and confirmed no one else seemed to understand the issues she’d spotted. “I’m not saying do nothing. Exactly the opposite. The research y’all are conducting is too important to get sloppy. If we shortcut any of the FDA’s processes, you could lose your license and the ability to test this or any future drugs and therapies.”

  Quentin doodled on his legal pad as his attention switched to the science officer. “Kleme, she has a point.”

  The man’s jowls sank into heavy lines of sadness. “We exist to ensure other children don’t die needlessly like my son. I’ve invested my life in developing the science so that today we could prevent his death.” He focused on Quentin. “What’s the name of the girl that Anna wants us to add to the trial?”

  Quentin hit a button and a picture of Bethany, happy and healthy, projected on the wall behind him. “Bethany Anderson. She’s eleven and in her third bout with leukemia. Two failed transplants and she relapsed four weeks ago.” He shook his head as he studied the image. “She’s the same age Jordan was.”

  Samson pushed to his feet. He was taller than Caroline expected. “That’s exactly why we have to get her in the trial now. I don’t want to wait until she’s beyond hope, not if we can give her a real chance.”

  “Of course.” Quentin moved his hands in a placating gesture before he directed his attention back to Caroline. “But if we do this in the wrong way, we jeopardize everything the company exists to achieve.”