Richard Mabry - Lethal Remedy

Her visit with John as he received his Jandramycin took most of Lillian's lunch time, so she decided to pick up a sandwich in the food court and snatch a few bites between patients this afternoon. Lillian made her purchase and was on her way out when she saw Jack Ingersoll and Carter Resnick at a table by the wall, deep in conversation. As she watched, she realized it wasn't really a conversation. It was a monologue, as Ingersoll held forth and Resnick listened, occasionally jotting a note in a dog-eared notebook. Lillian approached their table, but neither man appeared to notice. "Having a little instruction time, Jack?" She was surprised when Ingersoll turned, recognized her, and stood. Apparently his egocentric personality hadn't totally overwhelmed principles of courtesy undoubtedly learned as a child. Maybe it was because she was a woman. Maybe it was the touch of gray she allowed to remain at her temples when she put the Clairol to work. At any rate, it was good to see a glimpse of humanity in Jack Ingersoll. "Lillian, good to see you," he said. Ingersoll looked pointedly at Resnick, who struggled to his feet. "You know Dr.

Resnick?" "We've met," Lillian said. "Please, sit down. I have a question for you both." Both sat and looked up at her expectantly. "I believe you have three or four of my patients in your study of that new antibiotic. Of course, I'm grateful, as I'm sure they and their families are. After all, you cured them of an infection that would otherwise be a death sentence." Ingersoll nodded gravely. "Happy that we could do it." "But now I'm hearing rumors of some very serious late reactions in some of the patients that received Jandramycin." Lillian hurried on, ready now to appeal to Ingersoll's ego. "I don't believe in rumors, of course, and I thought that if anyone could give me the straight word, it would be you." "Thank you for your confidence. Yes, I'm probably the world's authority on Jandramycin, so I'm glad you came to me instead of paying attention to those silly rumors that keep floating around." He pulled a chair from the next table and motioned to her. "Please sit. This may take a moment." Lillian looked at her watch and decided that being five minutes late for clinic was a fair trade for information that might save patients from some pretty terrible consequences. She sat. "As you may know, after I left Southwestern, I took an infectious disease fellowship at UC Berkeley.

While I was there, I did some research with a pharmaceutical company in the area. I was working on… Never mind, it isn't important."

Lillian leaned forward to signal her interest. Get on with it, Jack. I don't have time for your life history. "Go on." "Anyway, some of the compounds that were supposed to be effective in that area turned out, at least in my lab experiments, to have a marked antibacterial activity. Specifically, they were effective against Staph." Lillian saw her chance and took it. "What compounds were those?" Ingersoll shook his head vigorously. "Sorry, Lillian, I can't say. Anyway, I put some of them together in various proportions and tried them out." "In lab animals, I presume." "Er, oh, yes. In lab animals at first."

Ingersoll took a sip from the almost empty glass in front of him. "I have to admit, there were some unpleasant results at times, but I kept modifying the preparation until I came up with what we now know as Jandramycin. When the epidemic of Staph luciferus broke out, I got permission to try the drug on some patients. Since the infection was tantamount to a death sentence without treatment, there was no objection. Imagine how gratified we all were when it was 100 percent effective in eradicating the infection, with no side effects." Lillian nodded and sneaked a peek at her watch. "So you never encountered any adverse reactions to the drug? Either during treatment or afterward?"

Ingersoll rubbed his chin, and Lillian could see he was choosing his words carefully. "Not once I developed the final compound. None at all." "Does that hold true for the earlier compounds you put together?" He waved away the question. "Oh, that's ancient history. As I recall, your question was about the safety of Jandramycin."

Ingersoll pushed back his chair. "I really need to go, and I'm sure Carter should get back to the lab. Have I answered your question?"

"Yes, thank you." And raised a bunch more. Lillian grabbed her purse and the bag with her sandwich, and hurried away, more determined than ever to find out what Jack Ingersoll was hiding. Somehow she had the feeling she'd just heard a clue, but she had no idea what it was.

"Okay, let me flush this out, and you can sit up." Rip Pearson disconnected the IV tubing that had carried the Jandramycin into John Ramsey's vein, then injected a small amount of solution into the tiny plastic catheter that remained in the vein, its end taped to John's forearm. "You've got four more doses to go. Want me to change the site of your heparin-lock?" John touched the skin around the site. "No tenderness or redness. Let's leave it for now." He perched on the edge of the exam table and rolled down his sleeve. "My hand feels pretty much back to normal. Is there any chance we can discontinue the Jandramycin early?" Rip shook his head. "None of us know for sure how effective a shorter course would be. I'll admit that ten days is an arbitrary number, but it's worked in everyone so far. I'd hate to change that." He took offthe thin rubber gloves he'd worn and flipped them into a waste container. "Besides, do you want to be the one to tell Jack Ingersoll that we changed his protocol?" "Don't you think Ingersoll would just report that I'd had the full ten days of treatment? I mean, it sounds like he's not above fudging his reports anyway." "If you quote me I'll deny it, but you're probably right."

Rip gestured for John to roll up the sleeve on his opposite arm.

"Let's get your lab work drawn, then you can be on your way." "What are all these labs, anyway? I know this is a study, but isn't this overkill?" He pointed to the test tubes lined up on the treatment table beside the equipment for drawing the blood to fill them. "And why do you need lab work after every dose of the drug?" While Rip pulled on a fresh pair of gloves and busied himself with the blood draw, he considered John's question. "You know, in the time I've been an infectious disease fellow I've probably helped run half a dozen of these studies. I get so used to doing things that are specified in a protocol for a study it never occurs to me to question them." "To get back to my original question-" John flinched as the needle pierced his vein. "Ow, that one stung. Anyway, what lab studies are you doing?"

"Honestly, I don't know. The hospitalized patients get the routine stuff- CBC and chemistries mainly. Those are done in the hospital lab and the results go on the patient chart, but there's another set of tests that go to Ingersoll's lab. I take the tubes to Resnick; he runs the tests and records the results. Then I guess he forwards the data to Jandra." "And no one will tell you what the tests are?" "Never asked, but I suspect that I'll be told I don't need to know right now." Rip removed the needle and put a square of sterile gauze over the puncture site. "Hold that for a minute, then I'll put a bandage on it." "You know, every one of those tubes is used to collect blood for a specific set of tests. I know that in our lab a red-top tube is for serology, a lavender-top is for hematology. Think we could figure it out from the tubes you collect for Resnick?" "Nope. These are special tubes sent from Jandra. The colors of the tops are different from any I've seen before." Rip lifted the gauze from John's arm. Satisfied that there was no bleeding, he applied a bandage. "That should do it."

He tossed the gloves in a waste container and washed his hands. John shook his head. "So much for that. I was hoping that the lab tests would give us a clue to what the drug does and what can go wrong in patients receiving it. I mean, we're pretty sure the problem is autoimmune, but we don't know why some patients get it and others don't. And we have no idea about prevention or treatment." Rip shrugged. He eased the test tubes into the pocket of his white coat with a dull clank. "I'm trying to find out more, but so far it's not working out. Maybe our best bet is to break into Resnick's lab one night and get the data offhis computer." Rip smiled at his attempt at humor. Then he looked at John, and noticed that he wasn't smiling at all. "John, I wasn't serious." John slipped into his white coat. "I am." He opened the door and strode away like a man on a mission.