Miracle Cure (16 page)

But there was another reason he was having trouble concentrating. He had all but made the decision. If Jack was refused admission to the Vasclear study, or was randomized into any group other than beta, he was going to steal the first dose of beta tonight, and use various methods to continue to obtain beta doses until the code was broken, the tightly controlled study was ended, and the drug was released for general use.

It was, without a doubt, the most frightening, wrenching
choice he had made since the onset of his recovery. But what options did he have?

There was, he knew, one other decision he had to make. For more than a year, Freeman Sharpe had been there for him—first as a guide along the often poorly marked path of recovery, and then as a friend.

“All I ask,” Sharpe had said over and over, “is that before you drink, before you use, you call me.”

Unspoken was the additional plea that until Brian’s recovery was much farther along, he consult with Sharpe before doing anything emotionally risky. Would Freeman Sharpe try and talk him out of stealing the drug? Brian wondered. Was it worth putting the man in such a spot? At the moment, there was a thirty-three percent chance that Jack would be placed in the beta group and those questions would never have to be answered.

The first wave of patients were settled in and receiving their half-hour infusions. Brian took the opportunity to go over his plan one last time. There were two places the beta Vasclear for Jack could come from: the reserve supply and the doses set aside for IV infusion in the patients. As far as he could tell, the reserve supply wasn’t counted, but it was disposed of frequently. If Lucy Kendall suspected medication was disappearing, controls would surely be tightened. He had decided that every third day, at least for the first two weeks, he would substitute normal saline for Vasclear for one of the beta infusions, rather than take a vial from the reserve. Lucy Kendall had made it clear that a missed-treatment factor had been built into the entire program. One missed dose was not harmful. No problem there.

God, but he hoped this whole exercise in deception-planning would be moot.

He wandered past the active-treatment rooms to make certain there were no problems, then slipped into the med room to try the keypad lock and count the number of beta
vials on hand. The doorway was glass, so there was no reason to close it. Once inside the room, he glanced out at the corridor as he made a pretext of inspecting the shelves of various cardiac medications and the crash cart. He hated sneaking around like this.

“Eight, four, nine, oh.”

Brian knelt by the small refrigerator and whispered the numbers as he punched them in. The door released instantly. There were three low cardboard boxes—two on the middle shelf and one on the bottom, each labeled with a Greek letter. The beta box had four vials in it, not as many as Brian had hoped. Still, if he juggled things around, he would be able to make it through the first five days. After that, he would—

“Dr. Holbrook?”

The man’s greeting, from behind him, would have startled a weaker heart to an immediate standstill. Brian leaped and turned, closing the refrigerator door with the same movement. Dr. Art Weber stood just outside the doorway, smiling. He was in his early forties, and not as tall as Brian had thought from the video. But he was solidly built and undeniably good-looking, with sharp features and startling blue-gray eyes.

“Ah … yes … hi,” Brian said, quickly regaining his composure. “It’s Brian.”

“Art. Art Weber.”

His pronunciation of the
w
was a cross between
w
and
v
.

“I know,” Brian replied. “I just finished watching you on the Vasclear video.”

“And what was your impression?”

“Excellent. Just great. If Vasclear performs the way you say, cardiac medicine as we know it is about to change forever.”

“There is no
if.”

Brian stepped out of the med room and closed the door behind him.

“Well, Mrs. Nellie Hennessey is certainly testimony to that,” Brian said cheerfully, trying to deflect some of the man’s intensity. “I assisted at her cath this morning.”

“Carolyn told me what you did today.”

“I was lucky. The catheter fragment was in just the perfect position for the BIPAL forceps.”

“No, I mean sending in a defective-product report to the FDA.”

Brian groaned silently.

“I understand now that my doing so went against institute policy. I told Dr. Jessup it wouldn’t happen again.”

“Good. The same goes for Vasclear. We have encountered no significant problems, but if any do arise with any aspect of our program, I would expect you to report it to Dr. Jessup.”

“No problem there.”

“That includes our patients
and
our research animals.”

Earl
. Brian quickly decided not to pick up the gauntlet. The animal keeper clearly wasn’t bluffing about having connections in high places.

“I understand completely,” Brian said.

He sensed the moment he had been waiting for was at hand.

“Excellent,” Weber said. “Excellent. We’re getting closer and closer to being allowed by our statisticians to break the code of our double-blind study. From that point, we hope it will only be a short while before the FDA approves Vasclear for general sale.”

“That would be wonderful.”

“Yes, it would. And needless to say, to get a bureaucracy like the FDA to shortcut their prolonged evaluation process requires impeccable data and an impressive, irrefutable risk-benefit ratio.”

“Which you have.”

“Which we have,” Weber echoed. “So, from now on, all reports of any problems go through us, yes?”

“Yes,” Brian said, forcing himself to maintain eye contact.

“Now, I understand from Carolyn that you have expressed the desire to have your father included in the Vasclear study.”

“Yes.”

“She has gone over his history with me, including her recommendation that he undergo repeat bypass surgery.”

“He had a terrible time with the first procedure. He’s willing to endure almost anything not to have another.”

“Well, he may want to reconsider, Brian. I felt deeply sorry for your father and his problem, and I did all that I could. I asked the statistician in charge of our double-blind study to randomize him into it, and this is the result.”

He reached into his jacket pocket and extracted a small card, about three-by-five. Computer-printed on the card were Jack’s name, birth date, sex, cardiologist’s name, and a number, seven, reflecting the severity of his coronary disease. Below that information, in capital letters, was a single word: ALPHA.

Alpha
. Almost certainly the placebo group. Brian felt himself sag.

“There’s no way he can be put into the beta group?” he asked.

Weber shook his head.

“I’m afraid not,” he said. “I know it sounds absurd, but until we are statistically allowed to break the code identifying the doses received by alpha, beta, and gamma patients, we must behave as if we don’t yet know which of the groups is which. At this point, with our results so striking, it seems like a charade. But we just don’t have a
large enough number of patients in our three groups to terminate our study unless we get FDA approval.”

“Do you have any idea how long it will be before you break the code?”

“Soon. Maybe just a couple of weeks. The FDA is sending one of their people up to meet with me, Dr. Jessup, and our statisticians.”

“Is there any sense in Jack participating in the study even in the alpha group? I mean, will that help your statistics?”

“The truth is, probably not. By the time his addition would matter, the study should be over. My suggestion is that you follow Dr. Jessup’s recommendation and get your father in for surgery.” Weber read Brian’s disappointment and added, “I’m sorry. I truly am.”

“Thanks,” Brian said.

But the Vasclear project director had already turned and started off. Brian glanced back at the refrigerator, then checked the time and hurried to the phone in the dictation carrel. He had five minutes before the next wave of Vasclear patients, and he wanted to talk with Freeman Sharpe.

It took five rings before Sharpe came on the line. As always, his smooth baritone had an immediate calming effect.

“Freeman, it’s Brian.”

“Hey, my man. Is there a doctor in the house?”

“Oh, yes. The doctor is in. Got a minute?”

“You taking care of yourself?”

“Of course.”

“Then I got a minute.”

“They admitted Jack into the Vasclear study, Freeman, but he got randomized into the group I’m sure is getting the placebo.”

“Too bad. Any chance they’ll just change their minds and put him on the good stuff?”

“I don’t think so, no. They want Jack to have the repeat bypass.”

“And you think he should get the drug.”

“This morning I helped do a cath study on a woman who’s about five years older than Jack. She had coronary disease at least as bad as his, even though she never had a heart attack or bypass. She got randomized into the maximum-dose group, and now she’s got arteries like a forty-year-old, and no symptoms.”

Sharpe whistled softly.

“So we’re thinking about what, stealing the drug?”

“I can’t get it any other way.”

“Can you get enough of it?”

“For two weeks, three at the very outside. But that may be all I need. I think the FDA’s going to approve the drug soon. If it works on him even slowly, Jack could probably make it.”

“If it doesn’t?”

“According to the results they’ve gotten so far, he’s got a seventy-five percent chance that it will. He likes those odds. So do I.”

“You can do this without getting caught?”

“Probably.”

“And without hurting anyone?”

“I think so.”

“This is an old tape for you, I’m sure you know, rippin’ off drugs from the hospital. Can you keep from dancing to it?”

“With your help.”

“God’s help, my man. Asking me is smart, but you’d best have a quiet chat with your higher power, too.”

“I’ll do that. Thanks, Freeman. You take care, now.”

“You know what you’re going to do?” Sharpe asked.

“I know,” Brian replied.

Brian set the Receiver down and made his way back to the med room. It took only a couple of minutes to empty two beta Vasclear vials into 10-cc syringes, make tiny marks on the vials, and refill them with saline. He then tucked the filled syringes into his clinic coat pocket and headed back to see more patients. An hour later, having put the syringes and an IV infusion set into his briefcase, he called home.

“Jack, how’re you holding up?”

“Same old, same old.”

“Well, I’ve got good news. You’re going to start on high-dose Vasclear tonight.”

“Hey, great. Dr. Jessup did that?”

“No. Another doctor. Actually, you’ve got to promise not to say anything to Dr. Jessup about it.”

There was a prolonged pause.

“Whatever you say,” Jack said finally.

“Perfect. I’ll be home in a couple of hours. And Jack?”

“Yes?”

“I owe you ten bucks.”

“For what?”

“I had a save today—two of them, actually.”

B
RIAN ADJUSTED THE MAKESHIFT IV POLE NEXT TO
Jack’s chair, took a syringe full of Vasclear, and shot it into a 250-cc bag of dextrose and water.

“Ready for another jolt of joy juice?” he asked.

Jack laughed sardonically.

“Some joy juice,” he said. “It’s not working, is it?”

“Hey, come on, Pop. At this point we shouldn’t be forming any conclusions at all. Just don’t get discouraged. You’ve only had six treatments. From what I’ve been able to learn, with most people, it’s taken quite a bit longer than that for their symptoms to begin to improve. In fact, some people have continued to have symptoms for months even though their stress tests have returned almost to normal.”

“Eight to five says I’m not going to make it.”

“Dammit, Jack, stop talking like that. Your attitude has a lot to do with whether you make it or not.”

“I’m tired, Brian. I’m tired of being sick.”

“One more week, Coach. One more week and I’ll bet you see definite improvement.”

“And if I don’t?”

“If you don’t, we go see Randa.” Seeing the bleak look on Jack’s face, he added, “But I think this week it’s going to start working.”

For the past week, Brian had encountered no difficulties in manipulating the reserve supply of beta Vasclear in the clinic refrigerator. In addition, he had exchanged saline for Vasclear once with each of two patients. Both were well into their second year of treatment. It seemed impossible that there could have been any harm done to either of them. Still, doing such a thing at all went against every instinct.

He held on to the hope that if he could just buy a little time, the need for deception would soon be over. At noon tomorrow, White Memorial grand rounds was scheduled to be a Vasclear presentation by Art Weber and others, coupled with a response from a representative of the FDA. Brian anticipated getting some indication as to how soon Jack might legitimately go on full-dose Vasclear, provided, of course, the current treatment showed promise.

At work, his tumultuous first two days had mellowed into a comfortable, if busy, routine. He enjoyed managing the clinical ward and was regaining confidence in himself as a doctor with each new patient workup he completed and each crisis he dealt with. Phil Gianatasio was a huge help, and always seemed to show up just as a situation was getting tense. He was a bear of a worker, and had a tremendous attitude that included seeing the humor in almost any circumstance. He was also as cool and unflappable in a crunch as anyone Brian had ever worked with.

“Jack, any pain where that stuff is running in?”

“Nope.”

Brian checked his father’s blood pressure, which remained on the low side, and his pulse, which was fine. He had placed a thin catheter in a vein in Jack’s forearm, capped it, and kept it open with anticoagulant between treatments. Although Jack kept maintaining he was feeling no better, Brian did notice that he might be using fewer nitroglycerins. In addition, he had gone out in the yard once with his granddaughters and once on his own.