Lethal Remedy (12 page)

Sara heard the tap on her office door but didn't look up from the journal she was reading. "It's open."

"Am I early?" Rip said from the doorway.

Sara looked at the clock on her desk. Five minutes to five. "No, you're fashionably on time. Come in and sit down."

Rip eased into a visitor's chair and put a worn leather portfolio on the corner of Sara's desk. "I have some pretty interesting information on the patients who've developed problems after receiving Jandramycin."

"Uh, let's wait just a minute. I sort of invited Mark Wilcox to join us. I hope that's okay."

It seemed to Sara that a frown flitted across Rip's face. "I guess not. And John did vouch for him."

"Did I hear my name?" Mark said. He ambled in, shook hands with Rip and Sara, and took the other visitor's chair. "Is it still okay that I'm participating in this get-together?"

"I was telling Rip that I invited you. And of course it's okay. We can use all the help we can get."

"Good," Mark said. "Because I've asked John Ramsey to join us."

As though on cue, John stuck his head in the doorway. Seeing that the chairs were occupied, he disappeared and returned in a moment with the chair from the secretary's desk in the outer office.

After more explanations and more assurances that everyone was welcome, Sara said, "I'll start, I guess. I decided to call Jandra to see if I could get any information on possible late complications from Jandramycin. I thought they might have seen something in the preliminary animal studies."

"And?" Rip asked.

"No dice. I spoke with their research director, a Pharm D named Wolfe, who stonewalled me. At first he said I should check with Jack, since we're at the same institution. When I kept asking questions, he clammed up. He claimed that what I wanted to know was proprietary information. He even insinuated that I might be a spy from another pharmaceutical company."

"Not unusual. Paranoia is the norm in the pharm industry. They're always looking over their shoulder for a competitor sneaking up on them," Mark said. "Did you talk with anyone else there?"

"I got as far as the secretary of somebody named Patel, who's the CEO or COO, not sure of his title. What I am sure of is that she referred me right back to Wolfe. Wouldn't even let me talk with Patel." She picked up a pen from the desk and began to twirl it between her fingers. "I think Jandra is a dead end."

Mark raised a tentative hand like a fifth grader with the answer to a problem. "Why don't I see if we can get any information from the New Drug Application Jandra has filed?"

"Are NDA's public record?" John asked.

"No. Remember what I said about drug companies being paranoid. Keeping an NDA secret is supposed to prevent competitors from stealing information." Mark grinned. "But in my legal practice I made some contacts in Washington. Maybe one of them has connections with the FDA. I'll see what I can get."

"If we suspect that Jandramycin is causing problems, shouldn't we contact the FDA directly and ask them not to act on Jandra's application?" Sara asked.

Rip shook his head. "And tell them what? We have no proof. All the clinical data here is locked up tight in Ingersoll's lab, guarded by Resnick like a dog watching over a bone. The preclinical trials were done by Ingersoll when he was doing a research fellowship at Jandra, so if there's any useful data in those records we'll never see it. Whatever the FDA has is a sanitized version of the truth, and we have no facts to refute it."

Conversation stopped when John Ramsey's watch beeped. He shrugged and said, "Sorry, got to take my medicine. My doctor tells me it's important that I don't miss a dose." He looked at Rip and managed a weak grin. "Be right back." He pulled two pill bottles from his pocket and ducked out of the room.

As soon as John was back, Rip pulled a sheet of notes from his portfolio. "I've managed to contact most of the patients who received Jandramycin. Of the ones I've contacted, all but three got the drug more than six weeks ago. Out of that group, six have what I consider serious conditions."

Sara rose. "Let's move to the conference room for this."

An hour later, names, symptoms, and pertinent lab data covered the blackboard in the conference room. "To summarize," Mark said, "we have six patients. They've developed various complications: neurologic problems, kidney failure, muscle weakness, excessive bleeding, and headaches with vision loss. Is there the common denominator?"

"Let's put specific diagnoses on the groups where we can," John suggested. "Start with the neurologic problems. Sara tells me she thinks her patient has Landry's ascending paralysis— what you younger doctors would call GBS or Guillain-Barré syndrome."

Sara wrote "GBS" and underlined it.

"Kidney failure can be due to lots of things, so let's put that one aside," John said. "The same with muscle weakness and bleeding disorders. But the visual loss and headaches, associated with an elevated sed rate and some response to steroids suggest—"

"Temporal arteritis," Sara almost shouted. "Everyone agree with that?" There were murmurs of assent, so she wrote "Temp art" and circled it.

"Is there a common thread to those two disorders, one that could also apply to kidney failure, muscle weakness, and excessive bleeding?"

John and Mark looked at each other, and Sara could tell the answer was forming in their minds almost simultaneously. "Autoimmune disorder," they said in unison.

"If we accept that," Rip said, "then let's see if there's a link to the others. Muscle pain and weakness?"

"Polymyositis," Mark said. "It's autoimmune, and it fits."

Sara wrote "Polymyo."

"How about bleeding?" Sara thought for a moment. "Rip, did the patient with bleeding have any purpura?" she asked, referring to the red or purple spots sometimes seen on the skin of patients with blood disorders.

Rip checked his notes. "Yes. And that leads us to—"

"Idiopathic thrombocytopenic purpura," Sara said, scrawling "ITP" on the board. "And that's autoimmune."

"That leaves kidney failure. Which autoimmune disorder can cause that?" John asked.

They kicked that around for a bit and finally settled on kidney failure with an immune cause: IgA-mediated nephropathy. Sara added "Imm neph" to the board. She stepped back, nodded in satisfaction, and put down her chalk.

The discussion continued for a few minutes, but soon it was evident that they were in agreement. The complications from Jandramycin were autoimmune—the patients had literally become allergic to their own tissue. The effects were just manifested in different organ systems.

"Okay," Sara said. "We're dealing with an autoimmune problem. We don't know why, and we need to look at how that happens. But more important, how can we treat it? Steroids can help, of course, but their effect is temporary. Is there something that will reverse the process?"

Rip shook his head and yawned. "We've got more work to do." He looked around the room. "But we're all dog-tired. Let's get some rest and reconvene here tomorrow night."

They straggled out of the building and walked in loose formation across the nearly silent plaza toward the parking garage. Mark moved beside Sara and said, "I was hoping to take you to dinner. Is that offthe table for tonight?"

Sara had to smile at the way Mark phrased his invitation. "I'm afraid so. I'm exhausted, and I'll bet you are." She slowed and half-turned toward him. "As for another night, why don't you wait until things settle down a bit? Then call me."

All three men insisted on seeing Sara safely to her car, and soon she was on her way home. A few blocks from the medical center, she remembered that she needed cereal and milk. Sara was a creature of habit, and cereal for breakfast was one of them. She scanned the businesses around her. She was almost past the grocery store when she spotted it on the right. Sara swerved into the parking lot with only a light touch on her brakes. The squealing of her tires almost covered the sound of breaking glass. She screeched to a stop in the parking lot, looked behind her, and saw the rear window was shattered. Glass shards covered the backseat. To her right, a jagged hole marred the front passenger window. It took a few seconds for the reality of the situation to set in, and when it did, Sara seemed to implode upon herself like a blown-up balloon that's lost its air.

She was vaguely aware of a number of people in the parking lot pulling out cell phones. A few eased toward her car, apparently afraid to approach too near for fear the shooting wasn't over. One man, braver than the rest, shuffled forward and called, "Are you hurt?"

She shook her head. She was still sobbing, gripping the steering wheel in a death grip, when she heard the sirens approaching.

I
N THE FACULTY PARKING GARAGE,
J
OHN RAMSEY BEEPED HIS CAR UNLOCKED
and was about to climb in when he heard someone call, "John, wait up."

"Mark? Where are you?"

Mark Wilcox's head appeared over the roof of a nearby vehicle. "Glad I caught you. I think we need to talk."

"You're right," John said. "I got so wound up in this Jandramycin thing, I almost forgot that I was being sued."

"Then it's a good thing you have a lawyer to protect your interest." Mark gestured to John's Toyota. "I'm parked down in the visitors' lot. Can we climb in here and talk for a bit?"

Once they were settled, John reached into the glove compartment and pulled out a thick sheaf of papers. "Here it is. I didn't understand all the legal language, but it was pretty clear that I was being sued, along with just about everybody else in this zip code."

Mark scanned the first few pages and nodded. "I'll go over this in detail tomorrow, but as I see it, there are several strategies we can employ."

"You mean, other than telling these people they're idiots for bringing this suit in the first place? All I did was offer a helping hand to a woman who was in distress. For goodness' sake, I was just being a good Samaritan."

"Interestingly enough, that's one of the strategies I was going to mention. We could base your defense on the Good Samaritan Law."

"Would what I did qualify?"

"Probably, but I need to research it more. Why don't you try to put this out of your mind for now?"

John grimaced. "Oh, it probably doesn't matter anyway. If they win a judgment, they can just take it out of the proceeds of my life insurance."

"That's not funny. There's absolutely nothing here that's worth considering taking your own life."

"I don't have to do that. Some druggie who dropped a dirty syringe into the trash can in one of our treatment rooms will probably do it for me." He reached into his pocket, held up two prescription bottles, and shook them to rattle the pills inside. "Remember when I excused myself from the meeting to take my medicine?"

"Yes."

"Antiretrovirals. I'm on post-exposure prophylaxis for HIV. And the way things have gone lately, I don't think there's a way in the world I can avoid it."

Bob Wolfe looked around Patel's empty office and tried to relax, but his gut continued to churn. He wiped his palms on the handkerchief balled in his hand. Don't let them see you sweat, they say. Well, that wasn't so easy right now. The secretary's call had been terse: "Dr. Patel wants to see you in his office. He'll expect you in five minutes." There'd been no explanation of the summons then, and none when he showed up. Just "Go in, and close the door behind you."

Now Wolfe squirmed in one of the leather visitor's chairs. This must be how a prisoner on death row feels, waiting for the footsteps of the warden.
Stop worrying. This is probably nothing.
But deep down, Wolfe knew what this was about. It was about Jandramycin. Specifically, it was probably about that nosy doctor who'd called with her ridiculous stories about late complications. He thought he'd stonewalled her pretty well, but maybe Patel had gotten wind of that call. And if he did, there were going to be questions asked. And the answers had better be the right ones.

"Bob, thanks for coming."

Wolfe jumped to his feet and turned to see his boss stride into the office, followed by Steve Lindberg and a man who looked vaguely familiar, but whose name danced at the edge of his memory. "Of course," Wolfe said.

Patel gestured Wolfe back into his chair. Lindberg repeated the move Wolfe had seen before, pulling a visitor's chair to the side of Patel's desk and settling in as though he were an impartial observer in any conflict that might take place.

"I'm Max Berman, chief counsel for Jandra Pharma. " The third man shook Wolfe's hand, three quick pumps and release, a politician's handshake. Thousand-dollar suit, hundred-dollar haircut, soft hands with manicured nails. Now Wolfe remembered he'd met Berman once before. He hadn't liked him then, and had a feeling that wasn't going to change.

Unlike Lindberg, Max took the chair beside Wolfe. Did that mean he was an ally? No, more likely it was simply a matter of being in position to watch more closely. Well, watch away, Counselor. I'm ready for you.

"I understand you had a call from a Dr. Sara Miles," Patel said. He leaned forward, his hands flat on his desk. "Why don't you tell us about it?"

"How did you know about that?" Wolfe asked.

"Two reasons. After she talked with you, she tried to get through to me. Fortunately, my administrative assistant is well trained and very capable of fending offunwanted phone calls. It seems that I'm out of the country on company business, and my return date is uncertain at this time."

Wolfe knew Patel wanted him to ask what the second reason was, but he sat in silence.
We'll see who blinks first.
After a moment, Patel did.

"As for the other reason, I knew about the phone call while you were still talking with her." He waited like a child eager to explain the magic trick he'd learned.

Wolfe raised his eyebrows, and that was enough for Patel to continue: "I know everything that goes on in this company. Outside calls are monitored and if the content is something that should come to my attention, I learn about it immediately."

Berman spoke for the first time, and now it was fairly obvious why the man was a participant in this meeting. "In case you're wondering, this is all perfectly legal. Like most people, you didn't read your employment agreement carefully. If you had, you'd know that monitoring is carried out on a day-to-day basis. When you signed, you gave the CEO and his designees the authority to monitor telephone, e-mail, and written communications as necessary to protect the company."

"No problem. If you or one of your 'designees' . . . " Wolfe set the word offwith air quotes. "If they monitored my conversation, you know that Dr. Miles got nothing from me."

"Probably true," Patel said. "But the very fact that she called raises a question. She voiced the concern that treatment with Jandramycin may lead to late complications. Is there any truth in that?"

The group remained silent. Patel leaned forward and gripped the edge of his desk hard enough to blanch his knuckles. "Our NDA is moving forward as we speak, and I might add, at great cost to this company. We've put pressure on some of our friends on Capitol Hill, called in every possible favor, and . . . Well, I won't go into detail." He relaxed back into his chair and began to swivel back and forth. "Jandramycin must be brought to market ASAP. We can't have any snags now."

Wolfe decided that there was no question there, so he gave a quick nod and waited for Patel to make his point. This meeting was for a reason, and Patel just now seemed to be getting there.

"David, you know we're all on the same page here." Lindberg's comment was unnecessary, but apparently the man couldn't sit through a meeting for longer than five minutes without saying something.

Patel raked the two men sitting nearest him with a gaze that could cut glass. "I've asked Max to meet with us for a very specific reason. Max?"

Berman rose and cleared his throat. Wolfe and Lindberg turned slightly in their chairs. The attorney addressed them both: "Let me explain. Dr. Miles brought up a scenario that could be very problematic for Jandra Pharmaceuticals. If such side effects exist, it's imperative that we know of them. And if they do not exist, it's equally important that we are firm and forthright in our denial of any such charges. So the question everyone in this room needs to answer is this: Are you prepared to state that you are unaware of any side effects from Jandramycin such as the ones mentioned by Dr. Miles?"

Lindberg almost leaped to his feet. "Absolutely. I'm unaware of any such side effects as Dr. Miles mentioned."

"Nor do you have knowledge of any, and will so state should the occasion arise?" Berman said.

"Correct," Lindberg said.

Berman looked pointedly at Wolfe.

Wolfe nodded, but that wasn't enough for Berman. "Please answer aloud." He smothered a smile. "Sorry, that's a holdover from court. Witnesses have to answer aloud, so the court stenographer can record their responses. Reflex action on my part, I guess."

Nevertheless, he fixed Wolfe with an expectant look. Wolfe took a deep breath and said, "Yes, I'm prepared to state that I know of no such side effects."

As Wolfe made his way back to his office, he wondered how Lindberg could know about the "side effects Dr. Miles mentioned." Maybe he'd been Patel's "designee," monitoring Wolfe's calls in some way.

And why was Patel the only one who didn't respond to Berman's question? Wouldn't he, above all people in the company, have no hesitancy in going on record?

Finally, Wolfe found it strange the way Berman had phrased his question. Not "Are there any side effects?" He'd steered clear of that particular question, as though he already knew the answer. Instead, he'd asked everyone to state their willingness to go on record that there were no such adverse consequences. And despite Berman's attempt to cover his insistence that a nod wouldn't do, Wolfe knew full well the reason for requiring a verbal response. That meeting, especially the responses at the end, was being recorded. He wondered how Berman and Patel might use such a record.

Wolfe tugged at his collar, but the tightness in his throat remained.

The policewoman paused at the end of the walk and looked at Sara. "Are you sure you're going to be okay here by yourself?"

"I'll be fine. Thanks for everything."

"Can you arrange transportation for tomorrow?"

"I'll call a co-worker to pick me up in the morning. How long do you think it will be before my car's available?"

"Depends on how busy the evidence techs are. Couple of days, I'd guess. You say you only heard one shot, and it appears to have gone completely through and out the opposite window. But in case more shots were fired and there's a slug hiding in there somewhere, we want to dig it out, so we have it if there's ever something to match it to."

"Guess I'd better talk with my insurance company about this. I'll need to have the windows replaced and arrange for a rental car."

Like a reluctant beau after a first date, the officer lingered on the front porch. "I know I'd be really shaken if this happened to me. Would you like me to have a patrol car cruise by a few times this evening?"

What Sara really wanted to say was, "Please. And maybe a policeman could sit up in my living room all night, and take me to work tomorrow." Instead, she said, "I'll be fine. Really."

"Okay." The officer took a card from the breast pocket of her uniform. "If there's a problem, call this number, and we'll send someone to check." She pulled a pen from the same pocket and scribbled something on the back of the card. "Here's my cell number, too."

"Thanks again."

The policewoman touched a finger to the bill of her cap, turned, and walked slowly down the sidewalk.