Broken (46 page)

“Do you carry a purse?”

The question was so strange Lena thought she was hearing things.

“A pocketbook?” Darla asked. “Where do you keep your keys?”

Lena didn’t answer.

“I can’t take that piece-of-shit Accord out of town. The engine light’s been on for weeks. I thought I’d get a new one once the checks cleared, but …” She checked Lena’s pockets and found her key ring. Her house key was on there, in addition to the keys for Frank’s Town Car and Lena’s Celica. “You got any money on you?”

Lena nodded because there was no use lying.

Darla checked Lena’s back pocket and pulled out two twenties.
“Well, I guess that’ll pay for gas.” She tucked the cash into the front pocket of her uniform. “I’m gonna have to ask Daddy for some money. I really hate that.” She smoothed down the pink material of her uniform. “I guess I should feel some remorse about what’s happened, but the truth is that I just don’t want to get caught. I can’t go to prison. I can’t be trapped like that.”

Lena kept staring at her.

“If they’d’a just left me alone and kept quiet, none of this would’ve happened.”

Lena tried to swallow. She could hear her heart doing that weird, flopping beat in her chest. She must be more dehydrated than she thought. Her hands and feet were numb. Her legs tingled. Her body was shutting down blood flow to the extremities in order to keep the core functioning.

“Daddy and me don’t get along too good.” Darla tucked her hand into the front pocket of her smock. “I get the feeling most days he’d prefer you was his daughter, but we don’t get to choose our family, do we?” She pulled out a syringe. “This is Versed. It’ll take some of the anxiety off and put you to sleep. I’m sorry I don’t have enough to put you to sleep for good, but this should make it easier. You’re not gonna live much longer—maybe five or six hours. That infection in your hand’s spreading pretty quick. You’re probably already feeling your heart slowing down.”

Lena felt her throat try to swallow.

“What happens is, your body starts to shut down. Your nerves go crazy. Usually there’s a lot of pain. Sometimes you’re awake for it, sometimes you’re not. Do you want the shot?”

Lena looked at the capped syringe. What kind of choice was that?

“Nobody’s gonna come save you. The clinic’s not gonna open again until next Monday, and by then the smell’s the only thing that’s gonna let them know you’re here.” She glanced over her shoulder. “I guess I should leave the door exposed so they don’t have to look much. Some of the people here ain’t been too bad.”

Lena tried to speak, to form the only word that mattered in all of this:
why?

“What’s that?”

Lena groaned the word again. Her lips couldn’t meet because of the gag, but the question was clear enough to her ears. “Why?”

Darla smiled. She understood what Lena was asking, but she wasn’t about to give an answer. Instead, she repeated her offer, waving the syringe in the air. “You want it or not?”

Lena shook her head, vehement. She couldn’t black out. She couldn’t let go. Her consciousness was the only thing she had any power over.

Darla took the cap off the syringe and jabbed the needle into Lena’s arm anyway.

S
ARA WAITED IN HER CAR FOR WILL TO COME DOWN FROM THE
apartment over the garage. He had asked for a few minutes to change into clothes that were less dirty than the ones he’d worn all day. Sara had welcomed the time to regain her composure. Her anger had settled to a low simmer, but she would’ve thrown the car in gear and driven to Hare’s house right now if not for Will. Why was she surprised that her cousin was mixed up in something so seedy? Hare had never hidden the fact that he liked having money. Sara liked it, too, but she wasn’t willing to sell her soul in the process.

The car door opened. Will climbed behind the wheel. He was wearing a white button-down shirt and a fresh pair of jeans. He gave her an odd look. “Did you wash my clothes?”

Sara laughed at the suggestion. “No.”

“All my clothes are washed. And ironed.” He picked at the crease on his jeans. “And starched.”

She knew only one person who ironed jeans. “I’m sorry. My mother enjoys doing laundry. I can’t explain it.”

“It’s fine,” he said, but she could tell by his strained tone that he was slightly put out.

“Did she mess anything up?”

“No.” He adjusted the seat so his head wasn’t pressed into the ceiling. “I’ve just never had anybody wash my clothes for me before.” The gearshift had a learning curve, but he figured it out quickly, putting the engine into drive. He turned off the windshield wipers as he pulled into the street. The rain had slacked off. Sara could actually see the moon peeking out between the clouds.

He said, “I was thinking about the suicide note.”

“What about it?”

“How about if Jason wrote it, and Allison was supposed to deliver it to a drop?”

“You think they were blackmailing somebody?”

“It’s possible,” Will said. “Allison may have changed her mind about the blackmail without telling Jason.”

“So, she tears off the bottom part of the note, the bit that says, ‘I want it over,’ to leave at the drop for the killer?”

“But the killer has already made up his mind to kill her. He’s followed her into the woods. We know he’s opportunistic. He used the blanket when he killed Jason. Maybe he saw the note as another opportunity.” Will glanced at Sara. “The fake suicide note was in Jason’s handwriting at the scene of Allison’s death. Except for Tommy getting mixed up in all of this, the first person who would’ve been interviewed is the boyfriend.”

She finally put it together. “The killer wanted to frame Jason for Allison’s murder. If they were trying to blackmail him, that certainly would’ve gotten Jason off his back.”

“Tell me about these drug trials. How do they work?”

“They’re complicated, and they’re not all bad.” She felt the need to tell him, “We need drug trials. We need new medicine and new breakthroughs, but pharmaceutical companies are corporations with shareholders and CEOs who like to get paid. There’s more money in finding the next Viagra than curing cancer.” She added ruefully, “And it’s a hell of a lot more profitable to treat diseases like breast cancer rather than prevent them from happening in the first place.”

Will slowed the car. Even without the rain, the street was still flooded. “Don’t they need Viagra to fund the cancer stuff?”

“Last year, the top ten pharmaceutical companies spent seventy-three billion dollars on advertising and less than twenty-nine billion on research. Tell me where their focus is.”

“Sounds like you know a lot about this.”

“It’s a pet peeve of mine,” she admitted. “I never wanted free pens
and notepads with drug logos on them. I wanted medication that worked and that my patients could afford.”

Will stopped the car. “You know, I think I’m going the wrong way.”

“It’s a circle.”

He put the car in reverse, then made a wide U-turn. Sara knew exactly where they were. If they had gone a few yards farther down the street, they would’ve passed her old address.

“So,” Will said. “How does it work? The drug company gets a new drug it wants to test, and then what?”

She couldn’t think how to acknowledge his kindness, so she answered his question instead. “There are two types: drugs of affluence, or lifestyle, and drugs of need.” He gave her a look. “I’m not making that up. It’s Big Pharma’s designation. The need drugs are what we tested at Grady. They’re for serious or life-threatening illnesses, chronic diseases. Usually, universities and research hospitals handle need drugs.”

He slowed the car again to navigate the deep water. “And affluence?”

“Generally, that’s handled by your average everyday doctor or lab. There are all kinds of announcements in medical journals. What you’d do is petition to run a study. If you’re approved, the drug company sets you up and pays for everything. TV, radio, and print ads. File clerks and office furniture. Pens and paper. And then, when it’s over, they pay the doctor to fly around the world talking about how fabulous their new drug is, all the while insisting that he’s incorruptible because he doesn’t own stock in the company.” She thought about Elliot and his Thanksgiving vacation. “That’s where the real money is. Not the stock, but the expertise. If you’re involved in an early phase of a study, you can make hundreds of thousands of dollars just by opening your mouth.”

“So, why wouldn’t a doctor want to do this if it’s so much money?”

“Because if you do it right, there’s not a lot of money in it. I mean, yes, you make money, but you’re doing paperwork, not medicine. We all know it’s a necessary evil, but it can be a really bad side of the business. Some doctors set up research mills. The drug reps call them ‘high-end rollers,’ just like in Vegas. Their clinics can have fifty different studies going on at the same time. There are a handful in downtown Atlanta, conveniently near the homeless shelter.”

“I bet there are a lot of students at the college who are looking to make some fast money.”

“Some of my indigent patients enroll in study after study. It’s the only thing that keeps them from starving. But it’s big business if you work it right. There are websites for professional guinea pigs. They fly around the country raking in sixty, eighty grand a year.”

“The doctors don’t track the patients to make sure they’re not gaming the system?”

“All you have to show is your license, sometimes not even that. They stick your name in a file. From then on, you’re a number. Everything they collect on you is self-reported. You can tell them you’re a stockbroker with insomnia and acid reflux when you’re really a homeless wino looking for pocket money. They’re not running background checks. There’s no central database of names.”

“So, Tommy answers an ad and tries to enroll in one of these trials. Then what?”

“They would screen him both medically and psychologically. There’s different criteria for each study, and each participant has to meet the guidelines, or protocols. If you’re really smart, you can fudge your way onto a study.”

“Tommy wasn’t really smart.”

“No, and he wouldn’t have passed the psych evaluation if it was properly administered.”

“Wouldn’t the doctor be in charge of that?”

“Maybe, maybe not. There are good doctors out there who do it right, but the bad doctors never see the trial participants. They’re just paperwork that has to be signed off on. They usually go in on a
Sunday and ‘review’ all three hundred cases before the enforcement rep gets there Monday morning.”

“Who takes care of everything then, nurses?”

“Sometimes, but it’s not required that they have any medical training. There are CROs, Clinical Research Organizations, that offer temp staffing for doctors running studies. At least they have some training. There was a doctor in Texas who had his wife doing everything. She accidentally switched the trial drug with medication for her dog. One doctor had his mistress in charge. She told the participants to double up on missed doses and half of them ended up with permanent liver damage.”

“Okay, so Tommy makes it through the psych evaluation. Then what?”

“He goes through the medical workup. He was healthy; I’m sure he passed that. Next, he gets the pills. He has to keep his journal. He goes in to give blood and urine or just to check in, probably once a week. The person who talks to him takes his journal and her report, what’s called source notes, then enters them into the case report. The doctor only sees the case report.”

“Where would the system break down?”

“Exactly where you said. Tommy obviously had a reaction to the medication. He was getting into arguments with people, which we know from the police incident reports. His altered mood would have shown up in his journal. Whoever interviewed him during his office visits would immediately know something was wrong.”

“And if this person wanted to hide the fact that Tommy was in trouble?”

“They could lie on the case report form. It’s entered into the computer and transmitted directly to the drug company. No one would know anything was wrong unless they compared it to the source material, which gets boxed and put into storage as soon as the study ends.”

“Would it ruin the study if Tommy was wigging out?”

“Not necessarily. The doctor could classify him as a protocol
violation. That means he doesn’t meet the guidelines for being enrolled in the study. Which, with his disability, he didn’t belong in anyway.”

“What about Allison?”

“Her suicide attempt should’ve exempted her, but if she didn’t self-report, they wouldn’t know.”

“Who gets in trouble for Tommy being enrolled in the study?”

“No one, really. You can always plead ignorance to the ethics committee. By law, every study has to have an internal review board that’s in charge of maintaining ethical standards. They’re comprised of people from the community. Doctors, lawyers, local businessmen. And always a priest or a minister, for some reason.”

“The ethics committee gets paid by the drug company, too?”

“Everybody gets paid by the drug company.”

“What about Tommy? When does he get his money?”

“At the end of the study. If they paid them ahead of time, most of them wouldn’t come back.”

“So, if the trial was nearing the end, then Tommy had a payday coming. And Allison, too. Maybe Jason Howell.”

Sara didn’t want to think about who had the biggest money motivation in this sordid mess. “For a three-month trial, it wouldn’t be out of the question that they would each be looking at around two to five thousand dollars for their participation.”

Will pulled into the parking lot of the clinic. He put the gear in park. “So, where’s the problem? We’ve got doctors making lots of money. Participants getting paid. Tommy shouldn’t have been in the study but it’s not like he was going to bring the whole thing down. Why would anyone kill two people over this?”

“The key is going to be finding out how many more participants were experiencing mood alterations like Tommy. Allison was depressed. You can read that in her journal. Tommy was acting out lately, getting into arguments when he never had before. He killed himself in jail. I don’t want to let Lena off the hook, but he could’ve
been suicidal from the medication. In a study, if you get clusters of adverse events, it’s immediately shut down.”