Richard Mabry - Lethal Remedy

Sara hurried down one of the main halls of the medical center, deep in thought and only peripherally aware of the people around her.

It was ten minutes after one, and like most of them, she was running late. She opened the back entrance into the general internal medicine clinic and almost ran over Lillian Goodman as she retrieved a white paper bag from the floor. "Oh, sorry." "No problem," Lillian said. "I was hurrying to get here and dropped my sandwich." She straightened and the two doctors proceeded side by side toward the physicians' dictation room that served as their office during clinic hours. "No time for lunch?" Sara asked. "No, I was talking with Jack Ingersoll.

When we have a break, I'll tell you about it." Lillian dropped her purse and the sandwich at the far end of the low communal counter where the doctors sat and dictated, made phone calls, wrote chart notes, and occasionally huddled in informal consultation. Sara followed suit. She glanced at the patient list Gloria had placed at her usual station. Busy afternoon, and she hadn't helped by being late. She threw the clinic's head nurse a look of apology before she entered the exam room where her first patient awaited her. "Mrs.

Truman, I'm Dr. Miles. So very sorry to keep you waiting. How can I help you?" For the next few minutes, the woman sat on the edge of the exam table and related a set of symptoms that immediately set offalarm bells in Sara's head: slight weight gain, increasing fatigue, vague aches and pains, difficulty swallowing at times. Years ago, these would have been passed offas due to nerves, perhaps given the tag of "neurasthenia." But now they suggested a definite diagnosis to Sara.

"Have you noticed any change in your hair or skin?" Sara asked.

"Actually, yes." The woman seemed surprised that Sara would ask this, and happy that her symptoms fit. "My skin is dry. My hair is harder to manage. Matter of fact, my last perm was a disaster." Sara stepped around behind the woman and put her hands on the front of her neck.

"Please swallow… Again." A glance at the vital signs recorded by the nurse on Mrs. Truman's chart reinforced Sara's preliminary diagnosis: slow pulse, blood pressure a bit lower than normal. "Mrs.

Truman, I think your problem is due to your thyroid. It's not producing the amount of thyroid hormone that it should, even though it's enlarged to try to keep up with the demand. That enlargement is pressing on your esophagus, making it difficult for you to swallow."

"Do I need an operation?" The woman's fear was reflected in her voice and on her face. "I don't think so. We'll need to do some lab work, and if it confirms my diagnosis, we'll get you on some medicine to supply the hormone your own thyroid isn't making." Mrs. Truman's shoulders relaxed visibly. "Oh, thank goodness. First I thought I was going to die two months ago when I got blood poisoning from that cut on my foot. And now this. I-" "Where were you treated for that 'blood poisoning'?" "Why, right here at the University Hospital. The infection was from some sort of super-bacteria that nothing would touch. But they gave me an experimental antibiotic that cleared it right up. It was like a miracle." Sara bit her lip and picked up the paperwork that lay on the side table. In the block for diagnosis, she crossed out "Hypothyroidism," substituting "Hashimoto's thyroiditis."

She'd already noted the lab tests she wanted, but now she added "anti-TPO," a measure of antibodies formed against the patient's own thyroid. She had no doubt this was another autoimmune complication after Jandramycin. How many more would there be? How many patients would have their lives turned upside down, even die, as a result of Jack's wonder drug? Almost an hour later, Sara slumped in a chair in the dictation room, catching her breath before she moved on to her next patient. Lillian Goodman eased in behind her and took the next seat. "Tough afternoon?" "I just picked up another patient with a late complication after Jandramycin," Sara said. "Autoimmune, of course.

This was thyroiditis." She gave Lillian a quick summary of the story.

"And I've done about everything I can to get Jack to admit there's even a chance that Jandramycin is at fault here. We could go to the FDA with our suspicions, but while all that plays out, more people are going to be affected. Some of them may die, just like that man with autoimmune kidney failure. I don't know what to do." "Personally, I've had visions of breaking into Ingersoll's lab and holding him and Resnick at gunpoint until they give us the true story," Lillian said.

"So have I," Sara said. She stifled a giggle. "Can you imagine us doing that? Just like Thelma and Louise, two gun molls." She shook her head. "Sorry. I'm punch-drunk. Not enough sleep. Too much frustration about this Jandramycin thing." "Was your last patient allergic?" Sara frowned at her colleague. "You mean was she allergic to any meds?"

"No, did she have hay fever or asthma? Anything like that?" Sara thumbed through the chart until she came to the history sheet Mrs.

Truman had filled out. "She has seasonal hay fever, on shots once, offthem now. Both parents had hay fever and asthma. Why?" "John told me about 15 percent of patients get a late complication after Jandramycin. For some reason, it popped into my head that about 15 to 20 percent of people in the U.S. have clinical allergy. I just wondered if there was a correlation." Sara took a second to think about it. "Autoimmune disorders are basically situations where some of the patient's tissues become allergic to themselves. It makes sense that underlying allergy might let Jandramycin trigger that kind of response." She looked at Lillian with new respect. "You may be onto something." "What was the original name of the compound before it became Jandramycin?" "I had to call Rip last night to ask him about that. It was… Give me a second… It was EpAm848. Why?" "Two reasons." Lillian ticked offher points on her fingers. "First of all, experimental compounds are sometimes named for the components in them, so we should see what Ep and Am and 848 might stand for. It could give us a clue to the mechanism of action of the drug. And if we know that, we might know how to prevent these late complications." "And second?"

"Second, we don't have anywhere else to go, John is getting Jandramycin right now, and the clock is ticking toward the time when he might have a potentially lethal late effect."

John's cell phone buzzed, but he ignored it and continued to talk with the patient who sat in his exam room. Twenty minutes later, he finished his dictation, laid the chart aside, pulled his phone from his pocket, and checked the number of the missed call. There was none.

Instead, the caller ID showed "private number." There was no message.

He decided to ignore it, thinking they'd call back if it's important.

He was putting his phone back in his pocket when it rang. Once more, the caller ID showed "private number." Might as well find out what this is about. He pushed the button to answer. "Dr. Ramsey." "John, this is Mark Wilcox. I have some news about your malpractice suit. Do you want to get together tonight to talk about it?" John felt his stomach clench. "If we wait until tonight, I'll develop an ulcer while I worry about it. Just spill it." "Okay, I'll have to make it quick.

I'm between patients, and I suspect you are as well." John didn't feel the need to respond to that. He sent up a silent prayer that this would be good news, but his gut told him otherwise. "I told you the lawyer that filed the suit initially was a society lawyer, probably doing it as a favor for Randall Moore." "Who's Moore?" "Read the paperwork, John. That's the name of the man suing you. Anyway, that lawyer has now turned the action over to Lewis Robinette. Recognize the name?" "I think I've read it somewhere. Isn't he some sort of hotshot lawyer?" "You might say so. He specializes in malpractice cases, with an occasional class action personal injury suit thrown in for variety." "Is he good?" "Sort of like Ted Williams was a good baseball player. Yeah, he's very good." John massaged his temples. "So now what?" "I'll give him a day or two to contact me. If he doesn't, I'll call him. He might still be reasonable and agree to drop you from the suit." "Think that's likely?" A long pause gave John the answer, even before Mark spoke. "No."