Richard Mabry - Lethal Remedy

"I thought this was going to be practical," Lillian whispered. "It was, for about fifteen minutes. Then he tried to show how smart he is." John glanced at the clock on the back wall. "If we can survive another twenty minutes of this, want to have lunch with me?" "Sure, but it'll have to be fast. I have clinic this afternoon," Lillian said. Half an hour later, they eased through the doors outside the food court into the patio beyond. "There's a table," John said. "Let's grab it." As they settled in with drinks and sandwiches, Lillian said,

"This is nice. It's rare for me to get outside while the sun's still up." "Me, too," John said. He went to work on the twist-top of his soft drink, trying to ignore the pain in his hand. "Can I help with that?" Lillian asked. Without waiting for a reply, she took the bottle and twisted the top free. As she set it back down, she looked at John's hand and said, "That doesn't look good. Did you see Rip about it?" John took a sip of his Coke, obviously embarrassed at having someone else open it. "He needled it and cultured the pus. The smear looked like Staph." "So are you on an antibiotic?" John shook his head. "He put me on cephalexin, but I don't think it's helped much."

"Won't the lab have a preliminary culture report by now?" "Probably, but the antibiotic sensitivities will take another day or so." He took a bite of his sandwich and washed it down with more Coke. "Let's forget my hand for now." "Fine. But don't ignore it. Do what Rip suggests." John nodded, anxious to leave the subject. "I really enjoyed talking with you the other night. And if you wouldn't mind, I'd like to do it again." He held up a hand. "Not a date, mind you. I just need someone to talk with." Lillian smiled. "John, we both know these aren't dates. I also know you feel guilty spending time with another woman. That's natural. But the more you can talk out your feelings, the better your healing will go. Believe me, I know. I've been there." "So maybe dinner tomorrow night?" "Sounds fine. We'll discuss it tomorrow. Maybe I'll cook for you," Lillian said. "How long since you've had a home-cooked meal?" John's throat tightened. He tried to blink away the moisture from the corners of his eyes. "Not since… since Beth-" "But surely one of your children-" John had to swallow hard before he could get the words out. "Beth and I couldn't have children. We thought about adoption, but somehow things kept getting in the way." He decided he'd better get all of it out.

"And before you ask, I'm an only child. My parents have been gone for several years. When Beth died, it left me-" "That's okay. We don't need to talk about it." They were leaving the table when John's pager went off. "I guess I'd better answer this." "I'll see you back in clinic, then," Lillian said. John pulled out his cell phone and dialed the number on his pager. "Dr. Pearson." "Rip, this is John Ramsey. You paged me?" "Um, right. Can you come to Sara Miles's office? I was with her when the lab paged me with a preliminary report on your culture."

John screwed up his courage to ask the question he dreaded. "What's the verdict? Is it MRSA? Do I need IV antibiotics?" "That's what we need to discuss," Rip said. "Yes, the treatment for this is giving IV.

But you don't have MRSA. The culture grew Staph luciferus."

John Ramsey wasted no time getting to Sara's office, where he found her and Rip talking in low tones. He pulled up a chair and winced at the pain that shot through his hand. He took a deep breath and said, "Whoever dumped that syringe in the trash gave me a really nice gift, didn't they? Staph luciferus. Where do we go from here?"

"Until recently, I think the decision would be clear," Rip said.

"Jandramycin is the only antibiotic that works against it. No other drug can touch it." John nodded in agreement. "But a certain percentage of patients receiving Jandramycin develop late complications-autoimmune disorders that are potentially fatal." "I know about the late problems," John said. "We've discussed them a bit already. But fatal?" "One of the Jandramycin patients, one who'd developed nephropathy, died with renal failure. There are other autoimmune disorders that can be lethal as well. We don't know how many treated patients have developed them already. The risk is real, and it's significant," Rip said. "So we have a big decision to make."

Four decades of practicing medicine had made John a realist regarding treatment decisions. "We have three options: do nothing, try another antibiotic, or use Jandramycin. Option number one would undoubtedly allow a spread of the infection, necrotizing fasciitis or gangrene, and amputation of the hand if I didn't die first of sepsis. That's out." Rip started to speak, but John held up his hand. "We'll have the sensitivity reports tomorrow, but barring a miracle, none of the antibiotics tested will be effective against this organism. So trying another antibiotic would be an expensive way to get the same result as doing nothing." He waited to see if Rip or Sara had anything to say, but they simply nodded in silent agreement. He took a deep breath.

"Jandramycin will work. I'm not sure any of us truly believe that it's been 100 percent successful, but that's what the studies show so far.

And not every patient who received it has developed an autoimmune disorder… yet." "And suppose you're one of the unlucky few who do?" Sara asked. "There's always the option of treatment with high-dose steroids. That may not be a lifetime solution, maybe they won't work at all, but at least there's a chance. And in the meantime, someone may come up with the key that can reverse the process." John sat back in the chair, not particularly happy with the course of action to which he'd committed himself, but relieved that he'd been able to divorce his decision making from emotion and agree to what appeared to be the only viable solution. "Ordinarily, patients with this infection would be hospitalized," Rip said, "but unlike our other patients, you weren't treated unsuccessfully with one or two other antibiotics. There was no delay in administering proper treatment.

You're not toxic with the infection. I think we can do this as an outpatient." He lifted a sheaf of papers from his lap. "We might as well get you enrolled in the study, get some baseline blood work, and give you the first dose of Jandramycin. Let's go to the clinic and get started." As they filed from the room, John realized that Rip had held the papers for the Jandramycin study all along. It was truly the only option, but John was the one who had to decide to take that step. With his full knowledge of all that was involved, what he'd given was the very definition of informed consent. Very informed.

Carter Resnick opened the door to his lab a crack and peered out at Rip with one eye. "What do you need? I'm collating data right now."

"We need to talk." "I didn't think you had time to talk with a lowly research associate." Rip bit back the reply that came to his lips. He needed this information, and maybe Resnick had it. "Carter, that's not true. I've always had time for you. Surely you can spare five minutes for me." Resnick's visible eye blinked several times. Rip could almost hear him thinking. Finally, the door opened wide enough for Resnick to slip through, then closed behind him with a solid click. Resnick jiggled the knob to confirm the door was locked. He turned to face Rip and crossed his arms. "Okay, talk." "Carter, be reasonable. Can't we sit down somewhere like two colleagues and have a discussion? Why don't we go into the lab?" Resnick was shaking his head before Rip finished talking. "No way. Dr. Ingersoll only allows two people in that lab: himself and me." "I thought there was a lab technician, too." "No. When we got to a critical point, Dr. Ingersoll discharged the tech. I do all the work now. It's a matter of security." "Carter, most of that data you're collating came from me. What could be in there that I don't already know?" Resnick grinned. "That's for me to know and you to find out." Rip decided that Resnick's schoolboy response effectively closed the door-quite literally-on any hope of his getting into the lab. He leaned against the wall and fired his first salvo. "I need to know what exactly is in Jandramycin. I have to find out what its exact mode of action is." "The main thing anyone needs to know is that it kills Staph luciferus. Some people postulate that Jandramycin works by attacking the bacteria's cell wall. Its real mode of action probably won't be revealed until Dr. Ingersoll and I publish that information." There it was. Resnick figured that his work would get him co-authorship of the papers that were sure to come, papers certain to be the lead articles in JAMA and the New England Journal. Until that happened, Resnick would move heaven and earth to stay on Ingersoll's good side, and if that meant standing guard on the laboratory and the data it contained, so be it. "Look, Carter, it's important that we know how the drug works. People who received it are turning up later with autoimmune disorders that are disabling and potentially fatal." Resnick didn't seem surprised. "Everyone?" "No."