Richard Mabry - Lethal Remedy

"It's an off-label usage for a preparation that might-I emphasize might-do what we want it to do. It's expensive, and we don't know how many doses it might take. Most important, there's risk in using it on patients whose immune system has probably already been modified by Jandramycin." Rip frowned. "Wouldn't we have to get the approval of the IRB?" "It would take weeks to get a proposal before the Investigational Review Board," Sara said, "and if we did, they might not approve it." She looked down at her clasped hands. "And I have a little girl who, despite large doses of steroids, is losing a fight with ascending paralysis with each day that passes." "That's why I'm making this suggestion. And it can't go beyond the four of us in this room." He waited until he'd received nods of assent from the others.

"I want to volunteer to test it on me." "But you haven't developed any complications," Rip said. "No, but I have a history of allergy, so I'm in line to do just that. I'll take it. If there are no adverse effects, if it doesn't appear that the Jandramycin has set me up to react adversely to the drug, that's a big step. Then if I don't develop an autoimmune complication, that tells us even more." He spread his hands. "Sure, it's not a double-blind, placebo-controlled study, but it's all we've got." "How soon do you think we'd know something?" Sara asked. "It generally takes effect within a few days.

But if there are going to be complications from it, they'll show up within an hour or two," John said. "And if it works, maybe I could give it to Chelsea?" Sara asked. "Do you have something better?" John asked. The silence in the room effectively answered the question.

Finally, Rip spoke. "Since I'm what passes for the secondin-command on this investigation, and none of us trust the principal investigator, I'll speak up. Go for it." "I'm going to talk with Chelsea Ferguson's mother about giving it to her," Sara said. "I'm pretty sure she'll jump at the chance." "Don't you want to wait-" Rip said. "I don't think I can wait much longer. If John tolerates the test dose, Chelsea will be next," Sara said. "I just pray we're not already too late."

Sara wasted no time in going to Chelsea Ferguson's room. She told Mrs. Ferguson about omalizumab. "What?" "It's a long word," Sara said.

"Just call it OMAL, like some of us do." "Will it work?" Sara decided to be blunt. "We don't know if it will work. But right now it's all we have." Mrs. Ferguson grasped at the possibility like a drowning man reaching for a piece of driftwood. "Anything that might help Chelsea.

Anything." "You recognize that this is not only what we call off-label, but it's never been used in these circumstances. Frankly, it's a shot in the dark. It may not work, but-" "But nothing else has.

I know." Mrs. Ferguson cast a glance at Chelsea, who remained immobile, staring at the ceiling. For the past two days, she'd been virtually uncommunicative, withdrawn into her own private world. "I want you to use anything that might have a chance. And I know Chelsea does." Sara nodded her understanding. She reached down to take Chelsea's hand and was pleasantly surprised to receive a weak squeeze in return. "Dr. Ramsey is getting his dose of the medication right now. If there are no ill effects, I'll plan on giving Chelsea hers. Of course, there'll be papers to sign-" "Do you have them with you? I'll sign now. I just… " Mrs. Ferguson let the words trail off, but Sara knew what they were. The woman would do anything to make her daughter well. Sara could identify with that. She'd feel that way about her child. She felt a tear form in her eye and turned away before Chelsea could see it. "I have to get the papers ready. I'll see you soon." She hurried outside. Sara was in the hallway when her cell phone vibrated in her pocket. She checked the caller ID and decided she was in no mood to talk with Mark Wilcox. He was a nice guy and obviously interested in her, but right now her total attention was focused on Chelsea. Besides, she was beginning to have her suspicions about Mark. Matter of fact, she was becoming positively paranoid about almost everyone with whom she came in contact, fearing they might be involved in the conspiracy to hide Jandramycin's side effects. Time to focus on Chelsea. It was hard for Sara to imagine the teenager's growing fears as the weakness in her limbs progressed. She could no longer walk, and the strength in her arms diminished every day. It was harder and harder for Sara to present a smiling countenance when she entered Chelsea's room. She didn't know how Mrs. Ferguson managed it, but it was obvious that she was on the verge of exhaustion. Sara hurried back to the clinic, where she found John Ramsey in a back room sitting on the edge of the treatment table. "Have you had the injection yet?" she asked. John nodded toward the corner of the room, where Rip Pearson was withdrawing a clear, slightly thick solution from a vial into a syringe. Lillian Goodman stood beside him, holding several alcohol sponges and a couple of packaged injection needles.

"That's a full dose," Rip said. He went through the routine to eject residual air from the syringe, changed the needle, and stepped to John's side. "Ready?" "Let's do it before I change my mind," John said. Rip swabbed John's upper arm with one of the alcohol sponges, pinched the tissue between his left thumb and fingers, and plunged the needle into the soft tissue of the arm. "I have to inject this slowly because it's so thick. Hang with me." John gritted his teeth, but said nothing. Sara began counting in her mind: one, two, three… She'd reached twenty-seven when Rip pulled the needle free and pressed a fresh alcohol sponge against the injection site. "Hold that for a moment, then I'll give you a Band-Aid." Sara looked at her watch and did a quick calculation. The major risk with this drug was anaphylaxis-a massive allergic reaction that could cause the airway to close off, blood pressure to drop, resulting in death if not properly managed. In the rare instance this had happened after such an injection, the signs occurred within ninety minutes or less. "I'll stay here with John for the next couple of hours," Rip said. "You guys go ahead to your clinics. I'll let you know if anything develops." He pointed to the emergency equipment on the table in the corner, and the message was clear. He was prepared to treat any allergic reaction that might develop. Expect the best, prepare for the worst. "I don't think-" Lillian began. "Please," John said. "Rip will be here with me.

If you two both cancel your clinic this afternoon, someone's going to talk about it. Then word will get back to Ingersoll, and we don't know what might come of that." Lillian squeezed John's hand. "I'll check on you as often as I can." "No," John said. "We don't need a parade going in and out of this room. Rip told the nurses he needed the room this afternoon, but they don't know what's going on. So far as anyone knows, this is just another part of the Jandramycin study. Let's keep it low-key." Sara looked at her watch. "It's a quarter to one now. We should know something in an hour and a half. Two hours at most. Why don't we meet in my office at three?" There was grudging acceptance of the plan. Sara touched John's shoulder and whispered, "I'll be praying for you." As she slipped out of the door, butterflies gathered for a convention in her gut.

" Well, we've got some time to kill, " John said. "Do you want to catch up on your journals? Do chart work? Go ahead. I'll just lie here quietly and wait for my throat to start closing up and my blood pressure to plummet." "Don't even joke about it," Rip said. "I know that we believe Jandramycin may have affected your immune system, but in regular patients the risk of anaphylaxis is tiny-maybe one chance in a thousand." "Ah, but there's the rub. What happens in someone after Jandramycin resets some of the switches in the immune system?"