Richard Mabry: Lethal Remedy

Miles began empiric antibiotic therapy for presumed MRSA with IV vancomycin plus gentamycin. Intraoral cultures grew out Staph luciferus, and blood cultures have reported the same organism, resistant to all conventional antibiotics. The patient now has generalized sepsis, is spiking temps to between 40 and 41 degrees Celsius, and her condition is deteriorating." "Eligibility for the study?" Trust Jack Ingersoll to cut to the chase. Not "What else can we do?" Not "What about the white count, or sed rate, or blood sugar or any other lab test?" No other questions except, "Is this another case I can enroll in the EpAm848 study?" Rip swallowed the retort that was on the tip of his tongue. "Yes, sir. She meets all the criteria.

And according to Dr. Miles's notes, her mother has been warned that there are risks and potential side effects." "Nonsense. None of the patients treated so far have so much as turned a hair. This is really a wonder drug." "Yes, sir. But there's always a first time." "Negative thinking, Rip. We'll have none of that." Ingersoll stood. "We have to project a positive attitude. It's important that patients have confidence in their doctors." A faint buzz issued from under Ingersoll's coat. He pulled an iPhone from his pants pocket, looked at the display, and frowned. "I have to take this." Ingersoll hurried away from the nurses' station, ducked into the family room, and closed the door. Rip wondered what could have been so important. In his experience, nothing trumped enrolling another patient in the study.

Whatever it was, it didn't take long. In less than five minutes, Ingersoll was back. "Let's talk with these people," he said. "Then I have to leave and catch a plane. I'll be gone for a couple of days, so you'll need to administer the medication and gather the follow-up data. Think you can handle that?" Rip swallowed the acid that boiled up in his throat. Since the study began, he'd been the one doing just that. He'd mixed every dose of EpAm848 and sat by the patient's bedside while the IV ran in. He'd drawn blood and taken it to Ingersoll's lab for all the necessary tests, made sure the vital signs were monitored, and logged the data that chronicled the patient's response. This might as well have been his study, not Jack Ingersoll's. It bespoke of his mentor's huge ego that he'd even ask such a question. He choked out, "Yes, sir," and managed to sound humble while doing it. Ingersoll was already moving toward Chelsea Ferguson's room. Rip fell in step behind him like an aide-de-camp trailing a general at a respectful distance. A woman that he took to be Chelsea's mother was sitting at the bedside, systematically shredding a tissue. "Mrs. Ferguson, I'm Dr. Jack Ingersoll. I believe Dr. Miles told you to expect me." "Doctor, this is Chelsea." The girl on the bed opened her eyes, managed a weak nod, then closed them again. The camera of Rip's mind's eye automatically recorded the patient's status: pale, slightly undernourished girl in her late teens, sweating profusely, movements slow and listless. An IV in her left arm was dripping at a regular rate. Her breathing was shallow, and a plastic cannula delivered what he assumed to be oxygen to her nostrils. "Chelsea is very seriously ill." Ingersoll turned from the patient and addressed his words to Mrs. Ferguson. "She has an infection in her bloodstream that will almost certainly kill her if we can't eradicate it." If he saw the mother's shudder and the girl's grimace, he ignored them. "Our only chance for that is the administration of an experimental medication. We've had remarkable success-actually a 100 percent cure rate-with it. Although side effects and complications are possible, we've seen none of these. I need your permission to proceed." "What if…?" "The details are spelled out in the consent forms that Dr. Pearson will go over with you. If you don't wish to sign them, of course, the choice is yours, including responsibility for the consequences. If you proceed with treatment, Dr. Pearson will administer the first dose today."

Ingersoll looked at his watch. "I'm afraid I have to leave now, to attend a consultants' meeting. I'll look in again in a couple of days, should you consent to treatment for your daughter." Rip watched Ingersoll turn on his heel and march out the door as though going into battle. He didn't know what this "consultants' meeting" represented, but he was certain of one thing. As of thirty minutes ago, it had not been on Ingersoll's agenda. It was a result of that phone call. And it was a command performance.

Sara frowned as she searched the chart rack at the ICU nurses' station. The slot for Room 6 was empty. Was it misfiled in the hurry of ICU routine? No, Chelsea's chart wasn't in any of the other slots.

Maybe it was on the ward clerk's desk, awaiting execution of an order for lab tests or an adjustment of treatments. But no one except Sara or her resident, Luke Sutton, would have written such an order. And Luke was out today, at home nursing a lower respiratory infection that appeared to verge on pneumonia. "Dr. Miles?" Sara turned to see Janice, one of the ICU nurses, holding out a chart. "Are you looking for Chelsea's chart?" Sara took the proffered chart. "Thank you. Is there something new?" "Dr. Ingersoll and Dr. Pearson were here earlier. They started Chelsea on EpAm848. Dr. Pearson drew her baseline labs himself, and then sat with her while she got the first dose of her medicine. You just missed him." Sara took a deep breath.

The good news was that Chelsea was now getting the antibiotic that could save her life. The double-barreled bad news was the possibility of a side effect or complication-all the reassurances notwithstanding-as well as the likelihood that her ex-husband's bedside manner hadn't improved. Sara hated to think of the psychological damage Jack Ingersoll might have inflicted on the sixteen-year-old girl in that bed. Sara thanked Janice and carried the chart with her into Chelsea Ferguson's room. In stark contrast with her attitude when Sara left her this morning, Mrs. Ferguson seemed calm and serene. She was brushing her daughter's chestnut hair. Sara wasn't sure-maybe this was wishful thinking-but there appeared to be a bit of color in Chelsea's cheeks, color that had not been there since the day of her admission. Sara smiled at the mother and daughter. "The nurse tells me that Dr. Ingersoll was here earlier, and that you decided to go ahead with the drug treatment he offered." Mrs. Ferguson looked up from her task. "He made an appearance, acting like we should be grateful that he spared us a few moments. I know that he must be affected by seeing so many seriously ill patients, but that's not an excuse for just plain rude behavior." "I'm sorry. Dr. Ingersoll is a very busy man nowadays, and I'm afraid his bedside manner isn't the best. But he's the sole source for…" Sara paused and tried to choose her words carefully. "Dr. Ingersoll controls the use of the experimental drug that gives us the best hope of licking this thing."

"He put it a bit more bluntly than that." Mrs. Ferguson gave a particularly vigorous swipe with the brush, and Chelsea flinched.

"Sorry, dear." "But Chelsea's receiving the medication. That's all that matters now." "Thank goodness for that nice Dr. Pearson. He told us what to expect, answered our questions, and sat with Chelsea while she got her first dose of the medicine. I think he's the one we'll actually be seeing." She laid aside the brush and kissed her daughter's forehead. "At least, I hope that's true." "Yes, I suspect Dr. Ingersoll will be by from time to time, but you'll see Rip-that is, Dr. Pearson-on a regular basis. If you need anything, ask the nurse to page him or me." "I'll do that." She patted her daughter's arm, carefully avoiding the IV site. "Chelsea, I'm going to step out for a minute, maybe get a cup of coffee at the nurses' station. Are you okay?" "I'm fine, Mama." The voice was weak, but these were the first words Sara had heard her patient speak in over twentyfour hours, and to her they were beautiful. In the hall, Mrs. Ferguson took Sara's arm in a grip that was surprisingly strong for such a frail woman. "Is there anything I can do to report the way Dr. Ingersoll acted? He seemed to have no more feeling for Chelsea or me than he would for a lab animal." "I'd wait until Chelsea's on her way to recovery.