Richard Mabry - Lethal Remedy

Rip did some quick calculations. "It seems like maybe 15 percent of the patients are at risk. But we don't know which ones they are."

There was a muted buzz from the pocket of Resnick's lab coat. He held up one finger to Rip. "I'd better get this." It was a brief and mainly a one-sided conversation. Resnick said, "I can't tell you that" a few times and punched the button to end the call. He dropped the phone into his pocket and said, "That was Dr. Miles. She asked me the same question you did. You all should coordinate your efforts." "Carter, listen to me. Lives are at stake here. Why won't you give me this information?" "Actually, you already have enough clues. You're the diagnostician. Figure it out." With that, Resnick executed a quick about-face, opened the lab door with a key he produced from his pocket, and disappeared inside.

Lillian grabbed the chart from the plastic rack and tapped on the exam room door. Without waiting for a reply, she opened it and walked in. "I'm Dr. Goodman. What kind of-" Her usual greeting to patients died in her throat as her eyes registered the scene before her. John Ramsey lay on the exam table with an IV running into his arm. "John, what-" "Easy, Lillian. I'm fine. I'm just getting my first dose of Jandramycin." She glanced down at the name on the chart she held: John Matthew Ramsey, MD. Lillian had her finger inside the cover, ready to open the chart, when she stopped. No, John would tell her what he wanted her to know. She pulled over a stool and sat down beside John, covering his hand with her own, careful to avoid the small plastic cannula that carried medication into the vein in his forearm. "What's going on?" "It all started when this lady doctor I know thought I might be getting an infection around a puncture wound of my hand and insisted I see someone about it." He grinned, trying to rob the words of any sting. "The culture grew Staph luciferus. So, now I'm on Jandramycin." "John, I'm so sorry. But I'm glad Rip did the culture,"

Lillian said, "and even happier that we have something that will knock out the bacteria. I mean, just a few months ago we had nothing, and these infections were potentially fatal." "Right. The drug should take care of the Staph luciferus infection, and that's good. What you don't know, and I guess it's okay to let you in on the story, is that some patients who received Jandramycin are turning up with various autoimmune diseases, most of which can be fatal. So there's a chance that I may save my hand at the risk of developing something just as bad-maybe worse-down the line." That brought a dozen questions to her mind. "I thought Jandramycin was supposed to be so wonderful. One hundred percent effective against the most dangerous pathogen we've seen since the black plague, but with no side effects. Why didn't someone warn us before we began to use it?" "It's an experimental drug, Lillian," John said. "When we get informed consent to administer those compounds, all we have to go on is the information the manufacturer gives us. And in this case, that didn't include the whole truth." "Surely Jack Ingersoll had some inkling about all this." John winced, and Lillian realized she was holding his hand tightly. She relaxed her grip, just lightly covering John's hand with hers.

"Sorry." "No problem. At least the drug is painless going into the vein. To address your question, we don't know what Ingersoll knows about all this. At first, everyone involved was happy that Jandramycin worked so well and had no apparent ill effects. That's why he and Jandra Pharmaceuticals were rushing to get FDA approval. Thousands of people have already died from Staph luciferus. Every day's delay condemns more." "Surely Jack suspected something," Lillian said. "When Rip and Sara first suspected that it might cause autoimmune problems, they confronted Ingersoll about it, but he denied that any problems exist. Now it's as though he has blinders on." Lillian squared her shoulders. "Let me do some reading. Maybe there's something we can do to prevent these complications." "We're already working on it, but we haven't had much luck so far." "Who's 'we'?" "Sara, Rip, and me. Oh, and another one of my former students, Dr. Mark Wilcox. He practiced law before he went to med school. Now he's an FP." "Well, like it or not, you just added another member to your group. When and where are you going to get together next?" She rose and gave John's hand a final, gentle squeeze. "You and I can supply something none of the other three have." "And that is?" She forced a smile. "Experience.

I've been practicing medicine for thirty-five years. I guess with you it's closer to forty. We've seen situations those young pups have only read about. They don't know it yet, but they need us."

"How are you today?" Sara Miles did her best to put a smile in her voice as well as on her face as she approached Chelsea Ferguson's bedside. "About the same," Chelsea said, her tone flat, her face expressionless. Mrs. Ferguson, seated on the other side of Chelsea's bed, shook her head and mouthed the words, "Not good." She took a tissue from her pocket and wiped the corners of her eyes. Sara's neurologic exam bore out Mrs. Ferguson's words. The weakness in Chelsea's legs was much worse, and the reflexes there were virtually absent. Even more worrisome, the girl was losing strength in her arms.

This was the reason clinicians had originally given GBS the name Landry's ascending paralysis. The paralysis might progress upward until the patient was unable to move and required the assistance of a ventilator to keep breathing. Sometimes the symptoms resolved, although it could take weeks or months. But sometimes they were permanent. Still at the bedside, Sara flipped open the chart and scanned it. Anna Pearl's last note was brief, and not at all encouraging. "Progression of weakness in lower extremities, early signs in upper extremities. Will discuss adding further Rx to steroids." Sara racked her brain to come up with something more to add. She'd have to call Anna and see what the neurologist had in mind.

Sara gave Chelsea's hand a final squeeze. "You hang in there. We'll lick this yet." As she'd come to do, Mrs. Ferguson followed Sara into the hall. "She's getting weaker. Can you do something?" "I'm about to talk with Dr. Pearl about adding another medication for Chelsea. You heard what I told her. We'll lick this thing." Sara patted the woman's shoulder and turned away, hoping she'd done it quickly enough that Mrs. Ferguson didn't see the tears that strained for release from her own eyes. Anna Pearl answered her page within a few minutes. "Anna, this is Sara Miles." "Oh, yes. We need to talk about Chelsea Ferguson.

Her paralysis is progressing." "I know. I just saw her. What do you suggest we do?" A name jumped into Sara's mind. "Could we add something like methotrexate?" "Interesting that you should suggest that. I thought about an antimetabolite, but when I did a literature search, these compounds have been tried and don't add much." Ideas were coming to Sara fast and furious, and she didn't try to filter them as they entered her mind. "What about immune globulin?" "That's what I was considering. Not every study supports its use, but sometimes it helps. And one dose IV should be sufficient… if it's going to work." "A milligram per kilo?" "Make it two," Anna said. "If we're going to hit this, let's hit it hard. And keep your fingers crossed." I won't just keep my fingers crossed. I'll be praying this works- because if it doesn't, I don't know what I'll do. I'm out of ideas.

" John, you're a hard man to track down. " Mark Wilcox pulled out his bottom desk drawer and rested a polished cordovan loafer there. He switched the phone to his other hand and began to doodle on a legal pad. "We need to talk about your malpractice case." "I'm sorry I haven't returned your calls. There's been a lot going on." "I'd love to hear about it. When can we-" "Just a second." There was a muffled exchange. "Sorry. I'm still in clinic and had to answer a question for my nurse. Can we meet this evening sometime? Come by my house and we can talk over coffee." Mark scanned through the possibilities. "I've got a better idea. I have to see a few more patients, then go by the hospital for a bit. Why don't you come by my office a little after six? If Sara Miles and Rip Pearson are free, we could all meet somewhere for dinner and pool information on the Jandramycin front."