Lethal Remedy (7 page)

He eased himself from the chair like the unfolding of a carpenter's rule. Do this, and he could say good-bye to this tiny office. He envisioned a corner suite with a view—maybe even a private washroom. But tonight the community restroom down the hall would do.

The man locked himself in a stall and dug in his pocket for the dog-eared match folder he'd carried all day. He struck one match. It fizzled impotently. Two more attempts before one lit. He bent it against its fellows and the whole folder ignited. He touched the improvised torch to the papers he held and watched as they burst into flame.

Would the smoke set offthe fire alarm, activate the sprinklers? He cursed under his breath for not thinking of that. He held the flaming mass lower in the toilet and fanned the air furiously with his free hand. The ashes dropped into the water, and he breathed again. He flushed twice, and it was over.

He washed his hands, splashed water on his face, and walked back to his office. For good or for evil—probably a bit of both—it was done.

Jack Ingersoll reached out to punch the intercom button on his phone and was gratified to see that his hands were almost steady.
A lesser man would have a tremor this morning. I should have been a surgeon.
"Martha, page Dr. Pearson and tell him I'll be ready to make rounds in fifteen minutes. We'll start in the ICU."

"Yes, sir," Martha called through the open door that connected her office with his.

Ingersoll ground his teeth. Would that woman never learn to use the intercom? Oh, well. It wasn't worth the hassle of trying to get her replaced. No, he'd just wait a bit. If things went as he expected, it wouldn't be long before he'd have a nice new office, along with an administrative assistant that he didn't have to share with two other doctors, someone who would cater to his wishes. And that day couldn't come soon enough for him.

He swiveled in his chair and turned away from the windows and the bright sun that streamed in through them. The two Advil he'd washed down with black coffee seemed to be helping his headache. Another five minutes with his eyes closed, and he'd begin rounds. He hoped Pearson hadn't fouled up anything in his absence. At this point, every Jandramycin patient was pure gold. And he couldn't afford any slipups.

"Jack, got a minute?"

He opened his eyes and saw Sara in the doorway, one hesitant foot over the threshold. He couldn't recall that she'd come to his office since they'd divorced. Quick encounters on the ward or in the cafeteria, an occasional phone conversation about a patient, but never a personal visit. What was up? "Sure. Come in. Sit down."

She took one of the two visitors' chairs. "I won't keep you. I know you're about to start rounds, but I wanted to let you know what happened while you were gone."

He listened intently as she told him about the girl—what was her name? Chelsea. That was it. She told him about Chelsea's sepsis. What were the odds? Sepsis from
Staph luciferus,
responding to Jandramycin, only to be replaced by a garden-variety but potentially lethal infection from an indwelling urinary catheter. As Sara related the details, his mind raced to parse the implications.

Apparently, Jandramycin wasn't effective against
E. coli.
No harm there. It had a specific niche, and if the drug was never used against any bacteria except
Staph luciferus,
it would still have a secure position in the pharmacotherapy of infections.

The girl was still receiving Jandramycin along with the other drugs for her
E. coli
infection, and all the medications seemed to be working. That meant there was no incompatibility among them. Good to know and not the kind of information that would come up in a normal study protocol.

Would the data from this case have to be excluded because of the confounding factors of the second infection and additional antibiotics? Ingersoll thought back to his conversation with Wolfe.
We may have to be creative in the way we handle our data.
So be it, then. He might have to be creative in the way he entered this information into the database, conveniently ignoring the additional drugs, but he couldn't afford to lose even a single patient from the study. He'd handle it.

Sara seemed to be running down, so he brought his full attention back to her. "So little . . . little Chelsea is getting better. Is that right?"

"Yes. Her temp's down. White count returning to normal. No protein or cells in her urine this morning. I think she's turned the corner."

"Well, that's the important thing," Ingersoll said. "I'll look in on her this morning, but you and Pearson should be able to handle things from here on out. You can call me if there are any questions."

Sara frowned. "Jack, we were really afraid you'd erupt when you heard we had to go outside the study protocol to treat her. I'm glad you're taking it this well."

Ingersoll summoned up his most sincere look. "The patient is better. That's what's important." He rose and walked around the desk. He took his ex-wife's hand in both of his. "Sara, I appreciate your coming by to tell me in person. And I hope you won't be a stranger. I think we had something really good at one time, and I'm sorry I let it slip away while I was depressed about the death of our son. Maybe we can get it back."

S
ARA SNUGGLED BENEATH THE COVERS.
L
IFE WAS GOOD
. S
HE AND
J
ACK
had a lot of good years ahead of them, and the prospect made her smile. Maybe she'd give up her practice at the medical school to be a real stay-at-home mom. That was something a lot of her female colleagues talked about, and although none of them had actually made that move, it was obvious to Sara that deep down, most of them would like nothing better.

She rolled over and reached across the bed, but a cry stopped her arm in mid-reach. Her mother's instinct drove her out of bed, and in a few seconds she was shrugging into her robe as her feet darted here and there in search of her slippers. Don't turn on the light. Don't want to wake Jack.

The cries were louder now, and Sara quickened her steps. She paused at the doorway of the nursery, and the cries stopped as suddenly as they began. She shuffled across the carpet and peered over the edge of the crib. The bundle it held was jammed up against the far corner. She lifted the corner of the blanket and reached forth a hesitant hand to touch the angelic face. It was cold and unmoving as marble.

Her cry began as a low moan deep in her throat and escalated into a siren-like shriek.

Sara sat up in bed and reached for the light at her bedside. Another nightmare. No, not another one. The same one. The same dream that had tormented her since the original scene played out.

There was no hope of sleep now. She shoved aside the bedclothes, grabbed her robe, and padded on slipper-shod feet into the kitchen. Maybe a snack would help. She passed the bathroom and remembered the bottle in the medicine chest. One at bedtime as needed for sleep. Her doctor prescribed them after the baby died, but Sara refused to take them. No, she wanted to feel the full force of her grief. Jack, on the other hand, took them regularly. She'd watched him lie there in drug-induced sleep and hated him for it. How could he ignore the loss . . . their loss?

The prescription was old now. Would the pills still be good? Why had she kept the half-full bottle anyway? She had no intention of drugging herself to sleep. Of course, there were times when she'd wanted to take all of them and fall into that deepest and most permanent of sleeps. But not tonight. She wasn't that desperate. Not yet.

Sara shivered, even though the house was warm, and hurried into the kitchen. She spread a stack of crackers with peanut butter, poured a glass of milk, and eased into her accustomed chair in front of the TV. Maybe there'd be something on that would help her relax.

Sara munched on a cracker and wondered why she'd dreamed about being in bed with Jack. After the baby died, she'd gone out of her way to avoid him, even made an effort to exclude him from her dreams. Why had she let him back in now? Was it because of what he'd said? "I think we had something really good. . . . Maybe we can get it back."

Then again, Jack seemed different today, more interested in what she said. He actually remembered the name of their mutual patient, asked how Chelsea was doing. Could he have changed? Was it even possible for Jack Ingersoll to change? And was she willing to take that chance?

As she pondered the question, Sara flashed on the end of her meeting with Jack. What was it he said? He was depressed over "the death of our son." Our son! He had a name, Jack. Actually, he had your name: Jack Jr. But you just called him "our son."

What was it the Bible said? "Can the leopard change his spots?" No, and apparently neither could Jack Ingersoll.

Dr. John Ramsey looked for what seemed like the hundredth time at the file folder on his kitchen table. The label read "Malpractice Insurance." A few days ago, he'd rescued it from one of the boxes of files he'd brought home from his office and shoved into a corner of his garage. He'd blown the dust offit and put it on the table, but today he decided it was time to open the folder and face what was inside.

He took one last sip of cold coffee, picked up the phone, and dialed the number he'd printed with a Sharpie on the cover of the folder.

"Insurance office."

"This is Dr. John Ramsey. I need to speak with Mr. Alexander about my malpractice insurance."

"Is this about a claim?" The woman's voice was flat, almost bored. She must have these conversations every day, but to John this was a new, and rather scary, situation.

"It's about a possible claim. I need some information. That's why I need to speak with Mr. Alexander."

"May I have your policy number?"

John figured he might as well talk to a wall. "I've canceled my original policy, but I have tail coverage. And I need to ask Mr. Alexander a question about that policy."

Nothing seemed to faze this woman. "And what is that policy number?"

After giving her the number of his policy and waiting through a series of clicks, followed by three minutes of what passed for soft rock music on hold, John heard a familiar voice.

"Dr. Ramsey, I hope you're enjoying retirement."

"Not as much as I was before I began talking with your secretary." John reined in his desire to vent. No benefit there. "I have sort of an unusual question."

Alexander listened without comment as John explained his visit to the clinic at the medical center and the part he'd played in the scenario that followed. "Now I'm hearing that her family may file suit against everyone involved. And I guess my question is whether I'm covered."

The silence on the other end of the line made John wince. What he was hoping for was a quick, "Of course." Instead, he heard only the rattling of paper.

"Are you there?" John asked.

"Yes, I'm looking through your contract. Of course, you canceled your original malpractice insurance when you retired, so that wasn't in force when this incident occurred. However, you bought tail coverage to insure you against claims brought after that original policy ended. But this is a new incident, so in that case . . . Hmmm. Tell you what. I don't want to say anything until I run all this by one of our attorneys. Can I get back to you?"

John gave Alexander his phone number and hung up with a deep sense of foreboding. If the agent had to do that much research, there was a good chance that his position in malpractice litigation arising from the incident at the medical center was going to be pretty much what his patients always complained about when they had to wear a hospital gown: uncovered and vulnerable.

Sara entered the hospital room and her heart leaped when she saw Chelsea sitting in a chair smiling back at her. Gone were the IV's. The hiss of oxygen was wonderfully absent. The only reminders of Chelsea's stay in the ICU were several potted plants that hadn't yet been loaded in the Fergusons' car.

"Ready to go home, Chelsea?" Sara had a hard time believing this was the same teenager who'd seemed at death's door not so long ago.

"Doctor, we can't thank you enough," Mrs. Ferguson said. "Dr. Pearson was by earlier this morning. He said because Chelsea was in the study for that new drug—Jana somethingor-other—he'd need to see her in a couple of weeks to draw some blood for follow-up studies. Frankly, if that Dr. Ingersoll had said that, I'd tell him to forget it. But Chelsea says she has no problem coming back if you or Dr. Pearson say she should."

"Is that right, Chelsea?" Sara said. "Will you come back?" Chelsea nodded. Even after she was out of the ICU and well on her way to recovery, Sara couldn't recall hearing the girl speak more than a dozen words.

"I think it would be a good idea to do that," Sara said. "If you'll call my nurse, she can set up an appointment to see me in the clinic. Either Dr. Pearson or I can draw the blood samples while you're there, so you don't have to spend a lot of time waiting in the lab."

Sara did one last exam of her patient and pronounced her fit to go. "I'll just sign the order, and a nurse's aide will put you in a wheelchair and take you downstairs. Chelsea, are you okay here by yourself while your mom brings the car around?"

"Sure." When she finally spoke, Chelsea's voice was soft, her speech hesitant. Well, a near-death experience would probably do that to you.

Sara was halfway to the nurses' station when Mrs. Ferguson hurried up behind her. "Doctor, I want to thank you again. I'm sure you and Dr. Pearson saved Chelsea's life. If there's ever anything I can do—"

"No need to thank me. The fact that Chelsea is able to go home will be reward enough."

"And when we come back, I want to find out how to lodge a complaint against that terrible Dr. Ingersoll."

Sara hesitated. "We'll talk about that later. After all, it was the medication that Dr. Ingersoll helped develop that saved Chelsea's life. And maybe he was having a bad day when he first saw her."

As she pulled the chart from the rack and began to write discharge orders, Sara wondered why she'd defended a man she'd hated for so long.

Dr. Lillian Goodman passed a steaming paper cup to Verna Wells. "Have you seen Dr. Ramsey this morning?"

Verna took a sip and nodded approvingly. "You always get it right. Thanks, Dr. Goodman." She moved aside a stack of files and set the cup carefully on the desk at the nurses' station.

"Dr. Ramsey won't be here today. The schedule Gloria gave me shows him working three days a week."

"Oh. Well, I just wanted to see how he was doing. I know it can be intimidating, getting used to a new practice location."

Verna eased herself out of her chair and followed Lillian down the hall. "I know he'll appreciate your help. He seems to be getting the hang of things just fine, but I'm really glad to see you two becoming friends."

Lillian drained her own cup and tossed it in a wastebasket. "We're just colleagues, Verna. I'd do the same for any new doctor, male or female."

"Dr. Goodman, it's time you thought of getting a life outside these four walls. Dr. Ramsey's a nice man. There's nothing wrong with noticing that . . . or even doing something about it."

Lillian was shaking her head before Verna finished talking. "John Ramsey is trying to recover from the death of his wife. He's vulnerable."