Richard Mabry: Lethal Remedy

"Resistant to every antibiotic tested. So I thought of you and your study." Ingersoll's pulse quickened a bit. Every patient he enrolled strengthened the reputation he was building as the world's authority on EpAm848. It looked to be a wonder drug, and if he could hitch his wagon to that star, there was no telling where he could go. "Does she meet the enrollment criteria?" "Yes. I checked before I called you.

The mother's anxious to get her into the protocol, and I've laid the groundwork for you. Informed consent shouldn't be a problem." He found a blank slip of paper in the morass on his desk. "Thanks. What's her name and where is she?" "She's in the ICU at University Hospital.

Name's Chelsea Ferguson." Sara cleared her throat. "Jack, she's just a kid. And the mother's worried sick. Try to upgrade your usual bedside manner. Please." Ingersoll ended the conversation with a few mumbled assurances. He thought a moment, then punched the intercom button.

"Martha, page Dr. Pearson and tell him to meet me in the ICU at University Hospital. Then call over there and get the identifying info on a patient-her name is Ferguson-and give it to Dr. Resnick. Have him make up a set of enrollment papers for the EpAm848 study and bring them to the ICU." Ingersoll swiveled away from his desk and let his eyes sweep across the horizon. New construction was everywhere at Southwestern Medical Center, girders and columns rising alongside existing massive buildings. Although the economy was rough, there were still more than enough multimillionaires in Dallas who wanted to assure themselves of the best possible care by the brightest minds in the medical field. What better way to do that than to give money to the academic medical center in their hometown? Jack Ingersoll wanted some of that. He wanted to become Dr. Jack Ingersoll, John and Mary So-and-So Distinguished Professor of Infectious Disease, with offices in the Thus-And-Such Building, his salary and research expenses underwritten by the Bubba and Sue Somebody-Or-Other Foundation. And if the EpAm848 study kept going this way, that was exactly where he was headed-if not here, then somewhere. There were portraits scattered throughout the medical center of some of the distinguished faculty members. He wanted his to join that select group. He'd be wearing a white coat, holding a beaker of brightly colored liquid, looking into the distance, contemplating the discovery that put the medical school-and him-on the map. The artist would have to minimize his developing paunch and maybe enhance his scant brown hair into a handsome widow's peak, but that was the advantage of a painting over a photograph. He unlocked the bottom drawer of his desk and pulled out a rust-colored stiffcardboard accordion file closed with an elastic cord secured over a large button. Ingersoll unfastened the closure, peered inside the file, and counted the sets of stapled pages. Twenty-one.

Twenty-one patients willing to testify that he was a miracle worker.

Twenty-one instances where EpAm848 saved a life otherwise doomed because of infection by Staphylococcus luciferus- the Devil's own Staph, "The Killer." Patients were dying all over the world from this infection. It was turning into an epidemic, but the success rate of Ingersoll's treatment was 100 percent so far. Conventional wisdom in medicine held that no therapy was 100 percent effective. He felt like a pitcher, taking a no-hitter into the eighth inning. Somewhere out there might be a case that wouldn't respond. But so far, he was throwing a perfect game, and if he could keep it up, there was no limit to how far he'd go. Martha's voice startled him from his daydreams. She never used the intercom, no matter how many times Ingersoll asked her to do so. He'd finally given up on that fight.

"Dr. Pearson just called. He's at the ICU and is reviewing the chart now." Ingersoll resealed the file and locked it in his desk drawer.

"I'm on my way. Page me if there's something urgent." He transferred his stethoscope, pens, and pocket flashlight to a freshly laundered white lab coat. He slipped his arms in, flexed his shoulders a couple of times to loosen the starched fabric, and buttoned the coat over his pale blue cotton dress shirt, leaving just enough of his rep-stripe tie showing to make a fashion statement. Sometimes a good first impression on the family was the most important part of the consultation. As he exited his office, he almost bumped into Dr.

Carter Resnick, hurrying down the hall, head down, mumbling to himself. "Resnick, watch what you're doing." Resnick rubbed his hand nervously over his shiny dome. Ingersoll couldn't understand why some men shaved their heads, but apparently Resnick thought it made him look wiser. It didn't. If anything, it accentuated his geekiness.

"Sorry, sir. I just prepared the packet for Chelsea Ferguson and took it to Dr. Pearson. Would you like me to go with you to see her? Maybe I could help." He brought his eyes up for a millisecond, but dropped them again. Whatever expression they held was hidden behind thick horn-rimmed glasses. "You know the deal," Ingersoll said. "You didn't get the Infectious Disease fellowship, but I agreed to take you on as a research assistant and promised you the inside track when the second fellowship slot opens next year. Your place this year is in the lab.

And the longer you stand here like a schoolboy begging to avoid detention, the less time you're spending in that lab." Without waiting for a reply, Ingersoll brushed past the young doctor and hurried away to the ICU. Idiot. He's good in W the lab, following orders, but he won't ever be any good at patient care. When I take on another ID Fellow, it certainly won't be him.

Dr. Roswell Irving Pearson III, generally known as "Rip," scanned his notes one last time. The position of Infectious Disease Fellow under Dr. Jack Ingersoll was a real plum, and Rip had overcome stiffcompetition to win this appointment. But Ingersoll was a stern taskmaster. He expected his ID Fellow to anticipate his every request and fulfill it perfectly. When Ingersoll said, "Meet me in the ICU at University Hospital," Rip knew that really meant "Find out which patient I'm seeing, review the chart, and be prepared to present the salient facts in the most concise fashion possible." Since this was a case involving Staph luciferus, that also meant making sure the teenage girl qualified for the EpAm848 study. Now Rip was ready. He supposed he shouldn't feel sorry for himself. He could be poor Carter Resnick. Rip wasn't sure how Carter ever got through an internal medicine residency, or why he thought he had any chance at an ID fellowship, much less one as prestigious as this one. Anyone with half a brain could see that Ingersoll was just using Carter, delighted to have a specialty-trained MD running his research lab. Well, the Carter Resnicks of the world would have to take care of themselves. Rip Pearson had his own problems, and the first one on the agenda was presenting this case to his chief. Rip looked once more at his watch.

Martha had paged him less than fifteen minutes ago, catching him already at University Hospital making rounds. He'd sprinted up the stairs to the ICU and rapidly digested the chart information on Chelsea Ferguson. He hadn't introduced himself to Chelsea or her mother, though. He'd made that mistake once, and had learned quite quickly that Ingersoll expected his ID Fellow to be seen but not heard, like an obedient child. The name of the attending physician on the case made Rip pause. He hadn't done more than nod to Sara as they passed in the halls since their last rotation as internal medicine residents. Now she was a staffmember, while his position as an Infectious Disease Fellow meant he was still in training. Would that make a difference? He and Sara had been close until she married Jack Ingersoll. Now all those relationships were topsyturvy. He wondered- "What do we have?" Ingersoll's rubber-soled shoes allowed him to approach without warning, something Rip suspected he did, hoping to catch someone bad-mouthing him. The consultant pulled out a chair and took the page of neatly printed notes Rip handed him. "Chelsea Ferguson, sixteen-year-old Caucasian female, had a dental extraction a week ago, without prophylactic antibiotic coverage. She developed progressive, severe cellulitis of the jaw, and her dentist referred her to an oral surgeon. He tried one change of antibiotics, but when he recognized early sepsis he sent her here. Pending cultures, Dr.