Lethal Remedy (24 page)

"I don't think I can wait much longer. If John tolerates the test dose, Chelsea will be next," Sara said. "I just pray we're not already too late."

Sara wasted no time in going to Chelsea Ferguson's room. She told Mrs. Ferguson about omalizumab.

"What?"

"It's a long word," Sara said. "Just call it OMAL, like some of us do."

"Will it work?"

Sara decided to be blunt. "We don't know if it will work. But right now it's all we have."

Mrs. Ferguson grasped at the possibility like a drowning man reaching for a piece of driftwood. "Anything that might help Chelsea. Anything."

"You recognize that this is not only what we call off-label, but it's never been used in these circumstances. Frankly, it's a shot in the dark. It may not work, but—"

"But nothing else has. I know." Mrs. Ferguson cast a glance at Chelsea, who remained immobile, staring at the ceiling. For the past two days, she'd been virtually uncommunicative, withdrawn into her own private world. "I want you to use anything that might have a chance. And I know Chelsea does."

Sara nodded her understanding. She reached down to take Chelsea's hand and was pleasantly surprised to receive a weak squeeze in return. "Dr. Ramsey is getting his dose of the medication right now. If there are no ill effects, I'll plan on giving Chelsea hers. Of course, there'll be papers to sign—"

"Do you have them with you? I'll sign now. I just . . . " Mrs. Ferguson let the words trail off, but Sara knew what they were. The woman would do anything to make her daughter well.

Sara could identify with that. She'd feel that way about her child. She felt a tear form in her eye and turned away before

Chelsea could see it. "I have to get the papers ready. I'll see you soon." She hurried outside.

Sara was in the hallway when her cell phone vibrated in her pocket. She checked the caller ID and decided she was in no mood to talk with Mark Wilcox. He was a nice guy and obviously interested in her, but right now her total attention was focused on Chelsea. Besides, she was beginning to have her suspicions about Mark. Matter of fact, she was becoming positively paranoid about almost everyone with whom she came in contact, fearing they might be involved in the conspiracy to hide Jandramycin's side effects.

Time to focus on Chelsea. It was hard for Sara to imagine the teenager's growing fears as the weakness in her limbs progressed. She could no longer walk, and the strength in her arms diminished every day. It was harder and harder for Sara to present a smiling countenance when she entered Chelsea's room. She didn't know how Mrs. Ferguson managed it, but it was obvious that she was on the verge of exhaustion.

Sara hurried back to the clinic, where she found John Ramsey in a back room sitting on the edge of the treatment table. "Have you had the injection yet?" she asked.

John nodded toward the corner of the room, where Rip Pearson was withdrawing a clear, slightly thick solution from a vial into a syringe. Lillian Goodman stood beside him, holding several alcohol sponges and a couple of packaged injection needles.

"That's a full dose," Rip said. He went through the routine to eject residual air from the syringe, changed the needle, and stepped to John's side. "Ready?"

"Let's do it before I change my mind," John said.

Rip swabbed John's upper arm with one of the alcohol sponges, pinched the tissue between his left thumb and fingers, and plunged the needle into the soft tissue of the arm. "I have to inject this slowly because it's so thick. Hang with me."

John gritted his teeth, but said nothing. Sara began counting in her mind: one, two, three . . . She'd reached twenty-seven when Rip pulled the needle free and pressed a fresh alcohol sponge against the injection site. "Hold that for a moment, then I'll give you a Band-Aid."

Sara looked at her watch and did a quick calculation. The major risk with this drug was anaphylaxis—a massive allergic reaction that could cause the airway to close off, blood pressure to drop, resulting in death if not properly managed. In the rare instance this had happened after such an injection, the signs occurred within ninety minutes or less.

"I'll stay here with John for the next couple of hours," Rip said. "You guys go ahead to your clinics. I'll let you know if anything develops." He pointed to the emergency equipment on the table in the corner, and the message was clear. He was prepared to treat any allergic reaction that might develop. Expect the best, prepare for the worst.

"I don't think—" Lillian began.

"Please," John said. "Rip will be here with me. If you two both cancel your clinic this afternoon, someone's going to talk about it. Then word will get back to Ingersoll, and we don't know what might come of that."

Lillian squeezed John's hand. "I'll check on you as often as I can."

"No," John said. "We don't need a parade going in and out of this room. Rip told the nurses he needed the room this afternoon, but they don't know what's going on. So far as anyone knows, this is just another part of the Jandramycin study. Let's keep it low-key."

Sara looked at her watch. "It's a quarter to one now. We should know something in an hour and a half. Two hours at most. Why don't we meet in my office at three?"

There was grudging acceptance of the plan. Sara touched John's shoulder and whispered, "I'll be praying for you." As she slipped out of the door, butterflies gathered for a convention in her gut.

W
ELL, WE'VE GOT SOME TIME TO KILL,
" J
OHN SAID.
"D
O YOU WANT TO
catch up on your journals? Do chart work? Go ahead. I'll just lie here quietly and wait for my throat to start closing up and my blood pressure to plummet."

"Don't even joke about it," Rip said. "I know that we believe Jandramycin may have affected your immune system, but in regular patients the risk of anaphylaxis is tiny—maybe one chance in a thousand."

"Ah, but there's the rub. What happens in someone after Jandramycin resets some of the switches in the immune system?" John didn't voice the rest of what he was thinking. In his case, did that risk go up to one in a hundred? One in ten? A hundred percent?

"Enough of that." Rip made one more note on the pad in his lap. If this went well, he'd add the material to John's chart. If it didn't, he might end up shredding it to avoid losing his medical license. "Tell me about Randall Moore."

John shifted on the exam table, trying in vain to find a comfortable spot. Finally, he gave up and swung into a sitting position with his feet dangling over the side. "All I know is what I've been told. He and his sister are the only children of a wealthy family. He inherited a good bit of that money when his father died and has been living offit ever since."

"Why is he suing?"

"His mother was headed for the internal medicine clinic to see someone for a second opinion when she had a fatal stroke. Apparently, in Randall's world, when something bad happens, filing a suit is a reflex action. So he filed one against the medical center and every doctor involved with her from the time she hit the floor. I started an IV while we waited for the EMT's." John spread his hands. "So they threw me in for good measure."

Rip lowered his head and massaged his temples. "That's just dandy. If his culture comes back
Staph luciferus—
and the odds are that it will—I can give him Jandramycin and probably save his life, but there's a chance that he'll get a life-changing and possibly fatal complication later." He looked up. "But if I don't, he'll probably die. And as a physician, I can't deny him treatment that would prevent that."
Even if it would put an end to his lawsuit against my friends.

"There's another possibility, you know."

"What?"

"This drug may work. If I don't get a late complication, if Sara's teenage patient starts to recover, we may have stumbled onto the answer. Give this to every Jandramycin patient after their course of treatment, and they'll do fine."

"Sounds too good to be true, John." Rip shook his head. "Don't get me wrong. I don't want you to get a complication from your treatment. I hope and pray that Sara's patient pulls through. But something inside me keeps telling me not to get my hopes up."

"I guess I hear a different voice," John said. "Beth drummed it into me so often I can still hear her saying it. 'God's in con trol.' We may not see His hand, but it's there. And I think He's got this covered."

Rip looked at his watch. "Well, in about an hour we'll know what He's got up His sleeve for you . . . and the rest of us."

The afternoon dragged, and Sara found it difficult to focus on her patients. As she walked out of every patient's room, her eyes were drawn to the closed door at the end of the hall. How was John doing? Any problems after the injection? Fortunately, no big diagnostic challenges presented themselves, and she was able to care for her patients without too much trouble. By five minutes to three, she was caught up.

"Glenda, my next patient isn't due for twenty minutes. I'm going to run over to my academic office for a minute." Although she didn't actually run, Sara moved quickly through the halls. She nodded a brief greeting to a few of the people she met and prayed that none of them wanted to stop and chat.

Lillian was waiting in the hall outside Sara's office, looking at the notices on the bulletin board but obviously paying no attention to them.

"Heard anything?" Lillian said.

"Not a thing. Shall we go in and wait?"

Sara pointed down the hall. John and Rip were sauntering toward them, conversing in low tones. Neither seemed in a hurry to reach them.
Come on. I need to know if everything went okay.

hen they drew abreast of the two women, John spoke first. "Here I am, none the worse for wear." W

"No problems?" Sara asked.

Rip answered with a smile. "None. Not even any itching or rash. Vital signs stable. He tolerated the drug with no problems." His countenance turned somber. "Now we have to hope it has a protective action on patients who've had Jandramycin."

Sara ushered the group through the empty outer office. Her secretary's desk was vacant. She must be on a break.

"Come on in. I think we have enough chairs. I—"

As her foot touched the threshold of her office, Sara's scream was masked by the noise of the explosion.

Mark Wilcox scratched his head. He'd been calling Sara all day without success. No answer on her cell phone, no response to the messages he'd left with her secretary. He understood that she might be tied up, but he was hurt that she hadn't called back.

It was important to him to further his relationship with her. She had no idea how important it was, and maybe this was the time to let her know. He'd played his cards close to his vest up to this point, but he was about to change all that. Unfortunately, nothing was going to happen if she didn't respond to his calls.

Well, while he waited, maybe he could do a little legal work. He checked a number and dialed.

"Lewis Robinette, please," he told the perky female voice that answered the call.

"May I say who's calling?"

"Attorney Mark Wilcox. I'm lead counsel in an action Mr. Robinette is pursuing."

"One moment, please, Mr. Wilcox."

After almost a minute listening to saccharine strings playing an almost-familiar melody, Mark heard, "This is Lewis Robinette. Mr. Wilcox is it?"

"Matter of fact, it's Dr. Wilcox. I'm an MD and JD. But I didn't call to match credentials with you. I know your reputa tion in the legal community. Matter of fact, it's because of the respect you've earned that I'm calling."

"Nice words, but you need to explain them."

"You've been engaged by Randall Moore to pursue a malpractice action he's filed after the death of his mother. Along with Southwestern Medical Center and just about every doctor on its staff, he's included my client, Dr. John Ramsey." Mark transferred his phone to the other hand and wiped his moist palm on the bottom of his white coat. "If you don't remove him from the suit, you're going to end up with egg on your face."

The reply came without emotion—just a matter-of-fact question: "Exactly why do you say that?"

Mark began to explain, emphasizing John's limited activity in the event that preceded the death of Moore's mother. Then, after considering the pros and cons of his action, he told Robinette that John had no insurance company behind him, so there were no deep pockets there for the plaintiffto mine.

Robinette's voice was calm. "My client is interested in only one thing: justice. He believes that the medical center and its doctors should pay for their negligence that deprived his mother of her life."

"And do you have experts who've reviewed the case and are willing to testify that such negligence exists? Do they think the standard of care was breached at any point in the care of Mrs. Moore?" Mark decided to fire one more salvo. "Because I have some extremely qualified and persuasive witnesses who'll shoot yours out of the water. And after the judge throws out the suit, we could consider filing one against your client and your firm for frivolous litigation, among other things."

"Dr. Wilcox, I believe you mentioned my reputation. I didn't earn it by caving in when someone yelled 'boo' at me. I appreciate what you're doing on behalf of your client. Matter of fact, I'd do the same thing if I were in your shoes. But as soon as you file an answer to the suit, I'll review the situation. As of this time, I'm ready to proceed with discovery, and let the judicial process play out."

"I think—" Mark stopped when the click registered in his ear. Robinette was already gone, undoubtedly moving on to something else after making a note of the billable time he'd spent on the phone.

Mark shrugged and dialed a number that was becoming familiar to him. He'd better let John Ramsey know about this latest call. There was no answer on Ramsey's cell. The nurse in the general internal medicine clinic told Mark that Dr. Ramsey wasn't scheduled to see patients that day. When the answering machine picked up at Ramsey's home, Mark hung up.

Sara wasn't available. John wasn't available. He leaned back in his chair, put one foot on an opened bottom desk drawer, and wondered at the connection. Could this have something to do with their Jandramycin investigation? He'd need to find out.

Rip crouched protectively over Sara. "Don't move. Let me have a look."

She lay a few feet from the doorway of her office, huddled in the fetal position, sobbing quietly. Rip looked at her legs. A scorch mark ringed the hem of the right leg of her slacks. The bottom of her right shoe was burned, and a violet coloration marred the black finish. Rip eased the shoe off. The skin on the bottom of Sara's right foot was red, but there was no blood and no soft tissue damage. There'd been plenty of noise, but apparently the damage had been minimal.

"Can you sit up?" he asked.

Sara complied, scooting back further from the doorway in the process. "What . . . what happened?"

"You put your foot down and there was an explosion— a very limited one, but with plenty of flash and bang to it." Lillian leaned over Sara and spoke in a soft voice. "I don't know what it could have been."

"I'm pretty sure I do," John said. He knelt at the edge of the doorway and sniffed. "Smell that? Smell like iodine to you?"

At first no one seemed anxious to get close to the danger area, but eventually they crept forward and smelled the air there. There was a general murmur of assent.