Michael Palmer - Side Effects

Jared shifted anxiously in his seat, and stared outside at the sterile, gray dawn. "How long does a gastroscopy take? " he asked. Kate, unwilling to break her fragile concentration, glanced over at him momentarily. "That depends on what they find, and on what they choose to do about it. Jared, I'm close to figuring out some things. I need a few more minutes."

"You look pretty washed out. Stop if you need to."

"I'm okay."

"Here. Here's some water."

She took a sip and then moistened her cracked, bleeding lips, then she returned her attention to the notebook. Another ten minutes passed before she looked up. Despite the pain and the drugs, her eyes were sparkling. "Jared, " she said, "I think I understand. I think I know what Estronate Two-fifty is."

"Well?"

"This is amazing. Assuming he's the one who conducted this research-or at least completed it-the late Dr. Paquette was worth his weight in gold to Redding Pharmaceuticals. Estronate Two-fifty is an oral antifertility drug that causes irreversible sterilization. It can be given to a woman by pill or even secretly in a glass of milk."

"Irreversible?"

Kate nodded vigorously, wincing at the jab of pain from her side.

"Exactly. Think of it. No more tubal ligations, fewer vasectomies, help for third-world countries battling overpopulation."

"Then the scarred ovaries weren't a mistake?"

"Hardly. If I'm right, the microsclerosis was the desired result, not a side effect."

"But what about the bleeding? What about Ellen? " e I Kate motioned him to wait. She was scanning a column marked Nebenwirkung "Look, Jared," she said excitedly. "See this word? It means side effects All these women were apparently given this Estronate and monitored for side effects. Jesus, they're crazy. Paquette, Zimmermann Horner-all of them.

Absolutely insane. They used hundreds of people as guinea pigs."

"E. Sandler, " Jared said. "What?"

"E. Sandler. There it is right at the bottom of the page."

Kate groaned. "I may be even worse off than I think I am. Twice over the page and I missed it completely. Bless you, Jared."

Ellen's name was next to last in a column of perhaps three dozen.

Halfway down a similar list on the following page, Kate found the names B. Vitale and G. Rittenhouse. She pointed them out to Jared and then continued a careful line-by-line check of the rest of the column and yet another page of subjects. "I thought those were all the bleeding problems you know about," he said. "They are."

"Well, whose name are you looking for?"

She looked up and for a moment held his eyes with hers. "Mine," she said. She checked the pages once and then again before she felt certain.

"I'm not here, Jared. I may be in some notebook marked anthranilic acid, but I'm not here."

"Thank God, " he whispered. "At least volume three's given us that much."

Kate did not respond. She was again immersed in the columns of data, turning from one page to another, and then back. From where he sat, Jared studied her face, the intensity in her eyes, the determination that had taken her through twelve years of the most demanding education and training. At that moment, more so than at any other time in their marriage, he felt pride in her-as a physician, as a person, as his "Jared, " she said breathlessly, her attention still focused on the notebook, "I think you did it. I think it's here."

"Show me."

"See these two words, Thrombocytopenie and Hypofibrinogenamie?

Well, they mean low platelets and low fibrinogen. Just what Ellen is bleeding from. There's a notation here referring to Omnicenter Study Four B. Modification of Thrombocytopenie and Hypofibrinogenamie Using a Combination of Nicotinic Acid and Delta Amino Caproic Acid."

"I've heard of nicotinic acid. Isn't that a vitamin?"

"Exactly-another name for niacin. The other is a variant of a drug called epsilon amino caproic acid, which is used to reverse certain bleeding disorders. See, look here. All together, seven women on these n three pages developed problems with their blood. They were picked up early, on routine blood tests in the Omnicenter."

"But Ellen and the other two aren't listed as having problems with their blood. There's nothing written next to their names in the side effects column."

She nodded excitedly. "That's the point, Jared. That's the key. Ellen and the two women who died were never diagnosed. Maybe they just didn't have Omnicenter appointments at the right time."

"The others were treated?"

Kate nodded. "That's what this Study Four B is all about. They got high doses of nicotinic acid and the other drug, and all of them apparently recovered. Their follow-up blood counts are listed right here. I think you did it. I think this is the answer. I just hope it's not too late and that somebody at Metro can get hold of the delta form of this medication. If not, maybe they can try the epsilon."

Jared handed her the receiver of the bedside telephone. "Just tell me what to dial, " he said. Kate's hand was shaking visibly as she set the receiver down. "Ellen's still in the operating room. Nearly three hours now."

"Who was that you were talking to?"

"Tom Engleson. He's a resident on the Ashburton Service. In fact, he's the one who called-Never mind. That's not important. Anyhow, he's been up to the operating room several times to check how it's going. The gastroscopist has found a bleeding ulcer. They've tried a number of different tricks to get it to stop, but so far no dice. They've had to call in a surgical team."

"They're going to operate?"

Kate shook her head. "Not if they can't do something with her clotting disorder."

"And?"

"Tom's gone to round up the hematologist on call and the hospital pharmacist. I'm sure they can come up with the nicotinic acid. It's that delta version of the EACA I'm not sure of. Goddamn Redding Pharmaceuticals. I'm going to nail them, Jared. If it's the last thing I do, I'm going to nail them for what they've done."

"I know a pretty sharp lawyer who's anxious to help, " he said. "I'm afraid even you may not be that sharp, honey."

"What do you mean?"

"Well, we've got this notebook and your word that it belongs to Paquette, but beyond that all we have is me, and I'm afraid my word isn't worth too much right now."

"It will be when they see this."

"Maybe."

"Either way, we're going to try. I mean somebody's going to have to come up with a logical explanation for all this that doesn't involve Redding Pharmaceuticals, and I really don't think that's possible.

Do you?"

"I hope not."

"How long do you think it will take before we hear from this resident-what's his name?"

Kate suddenly recalled a gentle, snowy evening high above Boston Harbor and felt herself blush. "Tom. Tom Engleson." Did her voice break as she said his name? "I don't know. It shouldn't be long." It had better not be, she thought. They waited in silence. Finally, Jared adjusted his cervical collar and rubbed at his open eye with the back of his hand.

"Kate, there's something else, something I have to tell you, " he said.

"It has a good deal to do with what you were saying before about your word not being worth too much."

She looked at him queerly. He held her hand tightly in his. "Kate, yesterday morning I spoke to Lisa."

Kate sat in the still light of dawn, stroking Jared's forehead and feeling little joy in the realization that, in his eyes at least, she had been vindicated. Nearly fourteen years that he might have shared in some way with his daughter had been stolen. Fourteen years. His hatred of Win Samuels was almost palpable. To her, the man was pitiful-not worth hating. She had tried her best to make Jared see that and to convince him that whatever the circumstances, no matter how much time had gone by, he had a right to be a father to his daughter. He had listened, but it was clear to her that his pain and anger were too acute for any rational planning. There would be time, she had said, as much to herself as to him. If nothing else, there would be time. The telephone rang, startling Jared from a near sleep. Kate had the receiver in her hand well before the first ring was complete. For several minutes, she listened, nodding understanding and speaking only as needed to encourage the caller to continue. Jared searched her expression for a clue to Ellen's status, but saw only intense concentration. Finally, she hung up and turned to him. "That was the hematologist, " she said. "They've started her on the drugs."