Richard Mabry - Lethal Remedy

Sara held the phone in a death grip. She dreaded this conversation in the worst way. "Dr. Pearl." "Anna, this is Sara Miles. I went by to see Chelsea this morning. Her weakness seems to be progressing. What do you think?" "I scribbled a quick note, but I dictated a full consultation. You should get it in a day or so." Forget the paperwork.

Give me something. Anything. "But you agree this is GBS?" "Not much doubt. And, as you know, we don't really have any idea why these things happen. About all I can suggest right now is hitting her with high doses of steroids, and I've already started her on that. You know the routine: an H2 blocker to prevent a stress ulcer, a hypnotic at bedtime to combat the steroid insomnia. I wish we had something else that worked but didn't have so many side effects." If you only knew that this whole thing probably came as a side effect of another med.

"You'll follow her with me?" "Of course. Call me anytime. And thanks for the consult." So that was it. Anna agreed with Sara's initial diagnosis of Guillain-Barre syndrome-the silent disease that came out of nowhere. It could resolve as quickly as it came on, or it could leave the patient with permanent paralysis. "No." Sara was surprised to find she'd spoken aloud. "Something wrong, Dr. Miles?" Gloria tapped on the door of the dictation room where Sara sat. "No, just talking to myself." Sara shrugged. "Am I through for the morning?"

"There's a walk-in, but if you're busy I can get one of the other doctors to see her." "No, I'll take it. But be sure I'm clear for the afternoon. I have to pick up a rental car, then meet with the police."

"I'm so sorry to hear about what happened to you last night." Gloria made a dismissive gesture. "It seems like it's not safe to drive anywhere in this city anymore. Probably some gang-banger who got a new Glock and had to try it out on a moving target." "Maybe." Sara shoved herself upright. "Which room?" Forty minutes later she had a diagnosis. Not one that made her happy, especially under the circumstances, but it was clear to Sara. She figured a third-year medical student could make it. The patient was a middle-aged woman with gradual development of muscle aches and weakness, combined with a nonitching rash that covered her cheeks like a mask. Preliminary lab work was suggestive, and Sara was certain that more sophisticated tests would confirm her impression. "Mrs. York, I'm afraid you've developed lupus." "Oh, my." The woman's expression made it clear she realized the seriousness of what Sara said. "How did that happen? What can you do for it?" "There are several medications we can use to slow or stop the progression of the disease. As for how, we don't have the final answer yet. It's one of a group of disorders we call 'collagen diseases.' Doctors think they're due to the body becoming allergic to itself-what's called an autoimmune disorder." No sooner were the words out of Sara's mouth than she began to thumb through the woman's chart.

What medications was she on? What diseases had she had recently? Could it be- There it was, just as she feared. "You were hospitalized with pneumonia a few months ago?" "Yes. It was really bad. They tell me I almost died because it was some special infection that none of the usual antibiotics would help. I guess I owe my life to Dr. Ingersoll and that new medicine of his."

Rip Pearson frowned at the insistent buzz of his pager. He silenced the instrument, noted the number, and decided he'd return the call in a moment. He already had more on his plate than he could handle. Rip sat like a penitent, across the desk from Ingersoll, who frowned at the interruption. "Sorry about that." "Very well," the great man said. "Now are you clear on the things I want you to do while I'm in Germany?" "Right." Bite your tongue, Rip. Don't scratch the scab from yesterday's argument. Just get through this meeting.

"Leave the big picture to me, Pearson. I promise that if you keep the Jandramycin study going, you'll get your share of the glory." Or the blame when it comes out that your "wonder drug" had side effects that someone chose to hide. "I know how you want the study run," Rip had said. "How long will you be gone?" "Six days, I think. The conference is making the arrangements and covering all my travel expenses. First class all the way." Ingersoll rolled the words on his tongue and seemed to savor them as he would fine brandy. "An invitation to speak to an international meeting like this will mean a great deal of positive publicity for our work." Yeah, and probably a hefty honorarium. Rip knew that Jandra arranged the invitation to Ingersoll.

Pharmaceutical companies could no longer offer honoraria directly to physicians for speaking. But there were ways around those rules. One was to pay the money to a sponsoring organization with the understanding it would be funneled to guest speakers. In the case of an international meeting like this one, it was even easier to find ways around the restrictions. Ingersoll scanned the list in his hand, nodded with satisfaction, and shoved it into the pocket of his white coat. "Now I have to work on my presentations. Do you have any questions?" Why should I? I've been doing the work on this study since day one. The only thing I don't know is why the drug I'm giving people may save their lives today and sentence them to a lifelong disease or even death in the future. "No, sir. Have a safe trip." A few minutes later, Rip was in the cubbyhole of the office assigned to him as a fellow. He checked his pager and dialed the number it displayed. "Dr.

Pearson. You paged me?" "Rip, this is Sara. We need to talk." "Sure.

Go ahead." "No, I don't think this is something I want to go into over the phone. Can we get together? The sooner the better."

Sara sat on a rolling stool and Rip perched on the edge of the exam table. The door to the treatment room was closed. There were no doctors in the clinic. The nurses and administrative personnel were at lunch, returning phone calls, or otherwise occupied. "We should have some privacy here," Sara said. "Thanks for coming over." "What's up that's so important?" "Two things. As of this morning, I only had one to talk with you about, but the last patient I saw made the list longer. Do you remember a middle-aged lady named York? Pneumonia?"

"Sure. She was one of the first in the Jandramycin study. I think it was still EpAm848 then. What about her?" "I saw her today. She's developed lupus." She watched Rip's face as he connected the dots. It was almost immediate. "Another disease to add to the list. It's not a controlled study, but it's good enough for me. Jandramycin works to kill Staph luciferus, but a significant number of patients develop an autoimmune disorder within a matter of weeks." "So the question remains: what do we do?" "We've got to find out the exact mechanism of the drug. Then maybe we can figure out a way to block its ill effects." Sara hesitated. "I don't want to sound stupid, but can't we just analyze some of it?" "Sure," Rip said. "We could if we had a month or six weeks to determine the exact composition, synthesize the components, and get the proportions right, then do the lab experimentation to find out the true mechanism of action. Meanwhile, patients are dying all over the world." "What's the count up to now?"

Sara asked. Rip pulled a wrinkled note from the pocket of his white coat. "The World Health Organization has identified over three thousand cases of Staph luciferus infection, all fatal except the patients treated here and the medical center in Germany that's also testing Jandramycin." He crumpled the note and tossed it into the wastebasket. "Sara, we've got to step up our search. Doctors around the world are clamoring for that drug. When it's released, thousands of patients will receive it. We have to find out how to save those patients without exposing them to a potentially fatal side effect of Jandramycin." Sara took a deep breath. She dreaded reliving the experience, but she needed to tell Rip. "Our search may be putting us in danger, as well. You know that we confronted Jack about this, and he blew us off. Then I called Jandra but got nowhere." "Right. But I may have thought of another way to get the information we need."