Richard Mabry - Lethal Remedy

Monday is my next day in the clinic, and I'll bring the policy then.

If you come around noon, maybe I can talk Donald Schaeffer into springing for another lunch at the Faculty Club." Outside, the two men stood in front of the elevators when John heard, "Dr. Ramsey. How are you?" John turned and saw Sara Miles standing behind them. "Sara, were you in the Faculty Club?" "Hardly. I had a sandwich in the food court.

I'm just waiting for Rip-er, Dr. Pearson to bring some papers for me to fill out. I have a patient in his drug study." She looked pointedly at Mark, and when neither of the men moved, she stuck out her hand.

"I'm Sara Miles, one of John's colleagues." "Mark Wilcox. Dr. Ramsey was sort of a mentor to me while I was in med school. And it's a pleasure to meet you." "He mentored me, too, so we have that in common." Sara looked at her watch. "Well, Rip must have gotten delayed. I guess I'll have to track him down." She extended her hand again. "Dr. Wilcox-" "Please, it's Mark." "Mark, it was nice to meet you. John, I'll see you Monday." Mark ignored the ding of the elevator and moved away from the opening door. "So that good-looking lady is one of your colleagues?" "Yes. But she's a little young for me." "I wasn't thinking about you," Mark said. He stepped into the elevator.

"See you Monday."

It was Monday morning, and Sara was trying without success to get her engine revved up for the week ahead. She slumped in a chair at the doctors' dictation station in the clinic. Her second cup of coffee was at her elbow while she looked over the charts for her appointments that day. Gloria tapped on the doorframe, entered, and handed her a pink phone message slip. "You have a call from one of your Jandramycin patients. Mrs. Ferguson. She's worried about Chelsea." "Chelsea's been out of the hospital for over a month. This is probably something entirely different." She dropped the slip on the desk and picked up her pen. "I'll call her at noon, after I've finished seeing patients."

Gloria didn't move. "I'd call her now. Mrs. Ferguson was almost hysterical." Sara had come to trust Gloria's assessment of situations like this. She nodded, picked up the phone, and punched in a number.

Mrs. Ferguson answered on the first ring. "This is Dr. Miles. My nurse said you had some concerns about Chelsea." The normally calm woman was obviously distraught. "This morning, she couldn't get out of bed. It was like the muscles in her legs wouldn't work. I had to carry her down the stairs. She's lying on the sofa right now, crying." "Did this come on suddenly?" "Yes. She was fine yesterday. This morning, she can't walk." "And nothing out of the ordinary happened to her yesterday? No injury, even a slight one? She didn't eat something unusual?" "No. We went to church in the morning. I remember telling friends I was so thankful Chelsea was back to normal." Sara's mental Rolodex began to flip. "Is she in pain?" "Not really. She says her legs tingle and feel numb. Mainly she's scared and frustrated." "Any other signs? Headache? Nausea? Visual symptoms?" She went through a list of symptoms, getting a negative response to all her questions.

"What is it? Is she having a stroke? Could she have been poisoned or something?" Sara shook her head until she realized the woman on the other end of the phone couldn't see it. "We don't know," she said.

"I'll have to see her. Can you get her here, or do we need to call an ambulance?" "I'll bring her in the car. Shall I bring her to the clinic?" Sara checked her watch. Her patients for the morning were already arriving. The odds of having to admit Chelsea for evaluation and treatment were pretty good. "No, bring her to the Emergency Room here at the medical center. I'll let them know you're coming so they can call me." Fortunately, Sara's first few patients were follow-ups that required very little concentration on her part. While she adjusted medication doses, reviewed lab reports, and took care of a few minor problems, her mind churned with the differential diagnosis of sudden and unexplained weakness. Finally, at mid-morning, Gloria tapped on the exam room door, as Sara was finishing with a patient.

"Excuse me, Doctor. The ER just called. They're ready for you."

"Thanks. Would you tell the patients who are waiting to see me that I've been called away for an emergency? I should be less than an hour.

Offer to reschedule them if they don't want to wait." Sara hurried through the tunnels connecting the buildings in the medical center, turning right and left without conscious thought until she reached the Emergency Room. She found Chelsea on a gurney in one of the exam rooms, her mother beside her. "Can you help?" Mrs. Ferguson asked.

Sara forced a smile. "Don't worry. We'll get to the bottom of this." A quick neurological exam confirmed what Mrs. Ferguson had said: Chelsea had very little strength in the muscles of her lower limbs, and her reflexes there were diminished. Her upper extremities seemed to be working normally. Sara had been thinking about this and was ready with her decision. "We're going to need a number of tests, and we can get started on those right now. But I'm also going to ask one of our neurologists to consult on the case." Mrs. Ferguson's face fell.

"Neurologist? So is this a stroke? Or a tumor?" "I don't really know what it is yet. But something has affected this set of muscles. Dr.

Pearl is more experienced in this area, so it's a simple matter of two heads being better than one." Sara addressed Chelsea: "They're going to draw some blood from you. Then you'll be going to the radiology department for an MRI. That's sort of scary, because you're in a tunnel kind of thing and have to hold still for about fifteen minutes.

I don't want to give you anything to sedate you, because we don't know what's going on yet. Think you can handle it?" Chelsea bit her lip, then nodded. A frightened child had once more replaced the smiling teenager, and it tore at Sara's heart. Sara decided not to mention some of the other tests. A spinal tap. Electromyography and nerve conduction studies, with needles in the muscles to check their function. Probably more blood tests-a lot more. Chelsea and her mother had been through so much, and now this. It wasn't fair. God, why did this happen? Sara saw the agony on Mrs. Ferguson's face, and her mind drifted to her own loss. No mother should ever suffer the death of a child, and this woman wasn't going to if Sara could do anything to prevent it. But first she had to find out what was going on. She answered a few questions, then stopped at the nurses' desk to write some orders. She'd call Dr. Pearl later today, after some of the reports were back. For now there was only one thing Sara could do.

There in the midst of the busy ER, clutching Chelsea's chart to her heart, she closed her eyes and voiced a silent prayer.

"You look like you've lost your last friend." Rip Pearson's voice startled Sara out of her reverie. She gestured to the empty chair across from her in the hospital cafeteria. "I'm not sure how many friends I have, but you're probably my best one, and I need you now."

Rip settled his tray onto the table but didn't unload it. Instead, he braced his elbows on the table and leaned toward Sara. "I'm here, ready to listen." "I just saw Chelsea Ferguson in the ER and admitted her. She awoke this morning with severe weakness of both legs. I've ordered some tests. Anna Pearl's going to see Chelsea this evening."

Rip raised his eyebrows. "What's your best guess?" "Oh, the differential's a mile long, but I'm betting on Guillain-Barre syndrome." Rip shook his head. "That's too much of a coincidence."

"What do you mean?" "I've had calls this week about two other patients who received Jandramycin. Their private doctors saw them with some pretty serious problems." "And they have Guillain-Barre, too?" Sara asked. "No, one of them has severe headaches and visual disturbances.