Lethal Remedy (6 page)

"But I had my heart set on Mount Sinai. That's where Brett's going to do his surgery residency. We had it all planned out."

"If you and Brett are really in love, you'll make the longdistance relationship work. If not, this is the way you'll find out." Ramsey leaned forward across his desk. "God has a plan. It may not always be the one we have in mind, and generally it's not on our schedule, but He's in control."

He'd been right, of course. It had taken Brett six months to become engaged to a socialite in New York, and Sara had met and married Jack halfway through her residency. Now her old mentor would be working with her, and at a time when it appeared that she might need some support. Funny how things work out.
Just like you said, Dr. Ramsey. Just like you said.

John Ramsey tried to concentrate on what Kim was saying, but his mind wandered. The office he sat in was a marked contrast to the one occupied by Dr. Schaeffer. If the administrator worked in such a small, plain space, why did the Chairman have an office big enough to garage a fleet of cars? John had always pictured working at the medical school as something that was first class all the way. Apparently, that condition was sort of like the spring showers in North Texas—present in one spot and absent in another. And he suspected that the staff sometimes resided in the dry area.

The salary on the sheet Kim handed John was decent, although nothing like what he'd made in private practice. On the one hand, he had no overhead, no personnel decisions. Of course, neither did he have benefits— not as a part-time faculty member—but that could change. He found himself wondering if this would morph into a full-time position. What was it Schaeffer said? "If it works for both of us." In other words, it's a two-way street, brother, and if you don't produce, I'll hire someone else.
Welcome to academia.

Kim paused, apparently through with what John had already decided was a canned presentation memorized through many repetitions. She looked at him and raised her eyebrows. "Any questions?"

He'd tuned out most of her spiel, but John figured he hadn't missed anything that wasn't in the packet she'd given him. "Not right now, but I'll call you if I think of any." He got to his feet. "Would it be okay if I wander over to the General Internal Medicine clinic and get the lay of the land?"

"Sure. I'll take you over to GIM and introduce you. Just remember that you can't participate in patient care until we get the last of your paperwork approved."

In the clinic, Kim sought out a middle-aged blonde in nurse's scrubs. "Gloria, this is Dr. John Ramsey. Dr. Ramsey, this is Gloria, our head nurse." And with that, she hurried off.

Gloria's smile lit up the hallway. "We're looking forward to having you with us, Dr. Ramsey. I don't know who'll be assigned as your nurse, but for now, if you need anything, just ask me."

"Thanks. Today I'd just like to see how the clinic is laid out, so I don't get lost when I come back."

"No problem." The pager on her belt let out a muted buzz.

"I've got to answer this, but I'll be around if you need me."

John peered through the open door of an exam room. It was clean, compact, and pretty much like one in his private office— when he had a private office. Of course, in that setting, when he encountered an especially perplexing problem he'd often told the patient, "I need to send you to a specialist at the medical school." Now he was that specialist, or at least one of them.

"May I help you?" The woman in the doorway was about John's age. She wore a clean white coat over a simple blue dress. Low-heeled shoes put her eyes at the level of John's chin. Those eyes, behind rimless glasses, were pale blue, the same color as Beth's. He felt tears coming, and fought them back.

"Thanks, but I'm just looking around." He extended his hand. "I'm Dr. John Ramsey."

She tucked a stray lock of salt-and-pepper hair behind her ear. "I'm Lillian Goodman, one of the GIM clinic doctors. I understand you'll be joining us here soon."

"As soon as the paperwork is finished." He made a sweeping gesture. "Apparently news travels fast around here."

"You'd be surprised at how efficient the grapevine is." Her expression softened a bit. "And on a personal note, I was sorry to hear about your loss. My husband died almost ten years ago, so I really do know what you're going through."

John was trying to frame an appropriate response when he heard footsteps in the hall—not running, but definitely moving at a fast clip. Gloria appeared in the doorway and said in a low, urgent voice, "Dr. Goodman, a woman just collapsed in the hall near the elevators."

Lillian was already in motion, and John fell in behind her, not exactly sure what his role should be but anxious to help. People milled around in the elevator foyer. John pushed through and saw an elderly woman crumpled on the floor like a marionette dropped by a careless puppeteer.

John knelt at the side of the unconscious woman. Lillian assumed the same position opposite him.

"Carotid pulse is weak and irregular," he said.

"She's breathing spontaneously, but sort of shallow," Lillian replied. She looked up. "Did anyone see what happened?"

There was a general murmur in the group, a mass shaking of heads.

A rumble of wheels and rattle of equipment announced Gloria's arrival. "Here's the crash cart. What can I do?"

"Give me a second," Lillian said. "Right now she's breathing on her own. John, check her blood pressure. I'm going to do a quick neuro exam."

In a moment, John straightened. "Mildly hypertensive. Heart rate about seventy but the rhythm is grossly irregular. Probably atrial fibrillation."

Lillian didn't look up. "Atrial fib fits. She's probably had an embolic stroke."

John had already reached the same conclusion. A small clot forming on the heart wall had broken loose and made its way to the brain.

"We need to get her out of here so we can start treatment," Lillian said.

"How—?"

Lillian stood and swept her gaze over the small crowd that had gathered. "We've got a medical emergency here, folks. I'm going to ask all you visitors to clear the area. If there are physicians or nurses here, please stand by. All other medical center employees please go back to your positions."

"Do we transport her into the clinic?" John asked.

"It's a nightmare getting through all the hallways between here and Parkland. It works better if we get EMT's up here, take her down in this elevator and around to the Parkland Emergency area by ambulance."

"I'm on it," Gloria said. "I've already called 911. EMT's should be here any minute."

"Her breathing's slowed down considerably," John said. "Want me to intubate her?"

Lillian looked him in the eye. "How are you at inserting an endotracheal tube?"

"Probably a little rusty. I'm due for recertification in advanced cardiac life support."

"I had my ACLS refresher last week. I'll tube her. You start an IV."

John was adjusting the flow of IV fluid while Lillian pumped an Ambu bag to inflate the woman's lungs when the elevator door slid open and two emergency medical technicians wheeled offa gurney. His heart was still racing when Lillian left to accompany the stretcher back onto the elevator and down to the waiting ambulance. He'd hoped joining the medical center faculty would energize him, give him a reason to get out of bed in the morning, but he certainly hadn't bargained for this much excitement on his first day on the job.

Rip felt the buzz of his cell phone against his hip. He saw the number on the caller ID display and thought, "Oh, boy. Here it comes."

He punched the button and said, "Dr. Ingersoll, I'm in a patient room. Hold one second until I can step outside." He excused himself and made for a quiet corner of the nurses' station. "Okay, now I can talk. Where are you?"

"I'm sitting in McCarran Airport, listening to the racket from about a million slot machines and waiting for my flight to take off. We were diverted here for a medical emergency, and then they found some sort of mechanical problem with the aircraft that kept us here overnight."

"What kind of medical emergency?"

"A passenger—Never mind. It doesn't concern either of us. I'm calling to see how that girl we enrolled in the study is responding to the medication."

Rip interpreted Ingersoll's statement about the medical emergency not concerning him as meaning he'd sat on his hands and let someone else handle it. He'd bet he was right. And he hadn't bothered to learn his patient's name. Just "that girl." Typical. "Chelsea's doing better. She's responding well to the antibiotic." He took a deep breath. "But there's a problem that may impact her eligibility for the study."

He waited for the firestorm he was sure would ensue, but instead there was only silence. "Dr. Ingersoll? Dr. Ingersoll?" Nothing.

Rip wondered at what point Ingersoll's phone had dropped the cell. In an ideal world, it would have been right after, "responding well to the antibiotic." He waited for Ingersoll to call back, but his phone remained silent. Finally, Rip decided that his time of reckoning had been postponed for a bit. He didn't know how long—minutes or hours—but he was sure of one thing. It would definitely come.

S
ARA PUSHED AWAY THE REMAINS OF HER DINNER
. I
T DIDN'T MATTER
that she often couldn't recall what she'd eaten or what program she'd watched. The ritual—and that was what it had become— was designed to get her through one more evening. Frozen meals from the microwave, the TV for company, falling into bed, frequently awakening at four o'clock in the morning to the cries of an infant who wasn't there.

Most of the time Sara was halfway out of bed when she realized there was no baby in the house, no source of crying. That had ended almost two years ago when she found her infant son lying cold and lifeless in his crib. She knew about SIDS, of course. Sudden infant death syndrome was the fear of every reasonably intelligent mother, and as a physician she'd made sure she did all the right things. No exposure to smoke. Put the baby to bed on his back, always with a pacifier. But still, it had happened.

She'd tried to lean on Jack for comfort in the days that followed the baby's death, but he withdrew, acting as though Sara was somehow to blame in the matter. It must have been her fault. She'd given him a son who was flawed, unable to survive. Jack came home later and later, usually slipping into bed after she'd cried herself to sleep. Sometimes he didn't come home at all, offering a flimsy excuse or none at all.

Sara begged Jack to come with her for counseling. He refused, and eventually she stopped asking. She wasn't surprised when the divorce papers arrived, citing "incompatibility." That was almost two years ago. Now when they spoke, it was with forced civility. He had his life, and she had hers, such as it was.

Somehow the evening passed, as had all the others since Jack left her. Eventually, it was time for bed. She almost said sleep, but corrected the words as they passed through her mind. Sleep was never a certainty any more.

She padded from the bathroom in her robe, warm from the shower, but not free of the emotional chill that was the undercurrent to her life. She was turning back the covers when the ring of the phone startled her. Who could be calling? This wasn't her week on call. Certainly not family or friends. She had none to speak of.

"Hello?"

"Sara, this is Rip. Did I wake you?"

She glanced at the clock beside her bed. A little after ten. "Not at all. Just settling in for the night. What's up?"

He cleared his throat. "I wasn't sure whether you'd want to know, but I decided—"

"What is it, Rip?"

"Does Jack drink?"

Sara thought back to their time together. "One glass of wine and Jack relaxed. Two glasses and he turned maudlin. Three glasses freed his inner self—belligerent and self-centered."

Rip's sigh came through clearly. "Bingo! He called me a few minutes ago. Apparently, he was pretty upset about all the delays in his trip. He was flying first class, and I'm guessing he couldn't turn down the free alcohol. After he landed here at DFW, he couldn't remember where he'd parked his car, so he called and asked me to come to the airport and pick him up. I suggested he take a taxi. He ordered me to come. I politely declined and told him that wasn't in my job description."

"How did you leave it?"

"I hung up on him. He called back a couple of times but I didn't answer. I wondered if this sort of behavior was unusual."

"Yes and no. Jack didn't drink much at all after we were first married. Then . . . then the baby died, and he started to drink heavily. And when he'd had a bit too much, he got really belligerent."

"Did he . . . did he ever hit you?"

Sara teased a tear offher cheek with her finger. "No, if I stood up to him he'd generally break down and ask me to forgive him. I suspect tomorrow morning he'll try to act like this never happened."

"Well, I hope he doesn't have a hangover in the morning. I have to tell him we may have compromised his study protocol in Chelsea's case, and I'm going to need him to be in the best possible mood."

"Why don't you let me break the news?" Sara said. She thought back to Jack's reaction after she'd shaken him awake to tell him his son was dead. If she could get through that, nothing Jack Ingersoll could say or do would bother her.

Bob Wolfe eased warily into the visitor's chair across from David Patel. Wolfe's shirt was plastered to his skin, held there by the sweat that began to form the moment Patel's secretary delivered this summons. He rolled his shoulders and leaned forward, trying without success to loosen the broadcloth straitjacket. "You wanted to see me?"

"Do you think Dr. Ingersoll got the message?"

Typical of Patel. No time given to social niceties. No wasted words. Down to the nitty-gritty. Wolfe wanted to reach across the desk and shake the man, but instead he pasted a confident smile on his face. "I sat him down and had a heart-to-heart. He understands that the data on Jandramycin has to be good, no exceptions."

"You use the carrot and stick?"

"Sure. The carrot was easy. More research grants. Coauthorship on every paper on the drug. We'll write them; all he has to do is add his name. Jandra will pressure the journals to print them. No problem."

"And?"

"He's our number one consultant, lecturing other doctors about the drug and its uses. Trips to speak all over the U.S. When we release Jandramycin overseas, he becomes a world traveler at our expense. Everything first class, with a handsome honorarium for each lecture."

Patel nodded once, practically an "attaboy" for him. Wolfe decided not to wait for the next question. "And the stick was even easier. If he crosses us up, we pull all his research money. No more lectures. No more papers. We could even—"

Patel held up one finger and smirked. "How's this? If he doesn't perform, he can expect more than the loss of all those perks. We'll get the word out that, although his research was valid, it was the work of others, and he stole it. We'll systematically destroy his reputation."

"Good idea. I'll call him in a day or two, see how things are going, and squeeze him with this."

Patel pulled a stack of papers toward him and began signing them. As Wolfe pushed back his chair, obviously dismissed, the CEO muttered under his breath, "That's what they pay me for, Bob. That's what they pay me for."

"Dr. Ramsey, I'm Verna Wells. I'll be working with you on the days you're here in the clinic."

The woman sitting at the clinic nurses' station smiled, showing a row of white teeth in a face dark as rich chocolate. Her royal blue clinic jacket had a floral pattern, and there was a small gold cross on the lapel. Her only jewelry was a plain gold wedding band and a simple watch with a leather strap.

"Thanks. I'm looking forward to being here. You're probably going to have to answer a ton of questions for me until I get my feet on the ground."

"You'll pick up the routine fast enough. Let me show you which exam rooms you'll be using."

After a half hour, John's head was spinning. "Verna, I give up. Do you think that's enough to let me function for my first day or so?"

She laughed, a hearty sound that seemed to come from deep inside her. Never had the term
belly laugh
seemed so appropriate, because once Verna came out from behind her desk John realized she carried about two hundred pounds on a five-footfour-inch frame. "I think you'll do just fine. And if you have any questions or problems, buzz for me. Remember where the buttons are in the treatment rooms?"

"I remember. Now how long do I have before I start?"

She glanced at her wrist. "You've got about half an hour before your first appointment. You might want to get some coffee." Verna looked over John's shoulder. "Here comes Dr. Goodman. She generally goes for coffee every morning. Maybe she'll show you the way."

"Verna," Lillian Goodman said, "are you getting Dr. Ramsey squared away?"

"Well, he doesn't seem to know much, but I think he's teachable." She grinned. "Bring me back my usual?"

"Coffee with double cream and three sugars. Got it." Lillian looked at John. "Want to come along?"

John followed her through a maze of corridors, and soon they were walking into a moderate-sized cafeteria. "I give up. Where are we?"

"University Hospital. Really not too far from the faculty clinic where we started, and they have a great cafeteria."

He shook his head. "I staffed residents at Parkland Hospital for years, but I've never been in a lot of these buildings."

"Don't worry. You'll be able to find your way around real soon."

They ordered, including coffee for Verna, and John insisted on paying. "Do we have time to sit down and drink this, or do we need to hurry back?"

"We've got a few minutes." She pointed to a door in the far wall. "That's the staffdining room. It's quieter there."

"What do you hear about the lady who had the stroke outside the elevators the other day?"

Lillian's face clouded over. "She never regained consciousness. Died within an hour. MRI confirmed an embolic stroke, but while she was in the radiology department she had a cardiac arrest. We couldn't resuscitate her."

"Autopsy?"

"The family refused one. And since there were at least two possible causes of death, we chose not to push."

John grimaced. "I guess I've lost my first patient since joining the staffhere."

"Not really. All you did was take her blood pressure and start an IV. She wasn't really your patient." Lillian blew across the surface of her paper cup, then sipped. "And I guess you can be glad of that."

"Why?"

"Her family is threatening to file a malpractice suit against the medical center and every doctor who had anything to do with her treatment."

In the midnight darkness, the lamp spilled a pool of yellow light onto the papers strewn helter-skelter over the scarred surface of his desk. The page shook in his hand as he stared at the figures scrawled in the margins. It all came down to this.

The man scrabbled through the mass of documents and pulled another sheet. What was the line from
Macbeth?
"If it were done when 'tis done, then 'twere well it were done quickly." Decision time.