Richard Mabry: Lethal Remedy

No one knew the man's name. White male, probably in his late seventies, found unresponsive in an alley about two o'clock in the morning and brought to the emergency room. Just another homeless derelict, another John Doe. "Pneumonia, late stages," the intern said.

He yawned. "Happens all the time. Drank himself into a stupor, vomited, aspirated. Probably been lying in that alley for more than a day. Doesn't look like he'll make it." "Labs cooking? Got a sputum culture going?" "Yeah, but it'll take a day or two to get the results of the culture. The smear looks like Staph. Guess I'll give him-"

"Wait. I've got access to an experimental drug that might help. Let me start him on that." The intern shrugged. It was two in the morning.

He'd been on duty for more than twenty-four hours straight-why'd Johnson's wife have to go into labor today?-and he was bushed. The bum probably didn't have a snowball's chance of surviving anyway. Why not?

"You'll be responsible?" "I'll take it from here. Even do the paperwork." "Deal," the intern said and ambled offto see the next patient. Three hours later, John Doe lay on a gurney in a corner of the ER. An IV ran into one arm; a blood pressure cuffencircled the other. Spittle dripped from his open mouth and dotted his unshaven chin. His eyes were open and staring. "Acute anaphylaxis, death within minutes. Interesting." He scratched his chin. "Guess I need to make some adjustments in the compound." He picked up the almost-blank chart. "I'll say I gave him ampicillin and sulbactam. That should cover it."

The woman's look pierced Dr. Sara Miles's heart. "Do you know what's wrong with Chelsea?" Chelsea Ferguson lay still and pale as a mannequin in the hospital bed. An IV carried precious fluids and medications into a vein in her arm. A plastic tube delivered a constant supply of oxygen to her nostrils. Above the girl's head, monitors beeped and flashed. And over it all wafted the faint antiseptic smell of the ICU. Chelsea's mother sat quietly at the bedside, but her hands were never still: arranging and rearranging her daughter's cover, twisting the hem of her plain brown skirt, shredding a tissue. Sara decided that the gray strands in Mrs. Ferguson's long brunette hair were a recent addition, along with the lines etched in her face. Sara put her hand on the teenager's head and smoothed the matted brown curls. The girl's hot flesh underscored the urgency of the situation. Since Chelsea's admission to University Hospital three days ago, her fever hadn't responded to any of the treatments Sara ordered. If anything, the girl was worse. "Let's slip out into the hall," Sara said. She tiptoed from the bedside and waited outside the room while Mrs. Ferguson kissed her sleeping daughter and shuffled through the door. Sara pointed. "Let's go into the family room for a minute." "Will she be-?" "The nurses will check on her, and they'll call me if anything changes." Sara led the way into the room and eased the door closed. This family room resembled so many others Sara had been in over the years: small, dim, and quiet. Six wooden chairs with lightly upholstered seats and backs were arranged along three of the walls. Illumination came from a lamp in the corner. A Bible, several devotional magazines, and a box of tissues stood within reach on a coffee table. This was a room where families received bad news: the biopsy was positive, the treatment hadn't worked, the doctors weren't able to save their loved one. The cloying scent of flowers in a vase on an end table reminded Sara of a funeral home, and she shivered as memories came unbidden. She shoved her emotions aside and gestured Mrs. Ferguson to a seat. "Would you like something? Water? Coffee? A soft drink?" The woman shook her head. "No. Just tell me what's going on with my daughter. Do you know what's wrong with her? Can you save her?" Her sob turned into a soft hiccup. "Is she going to die?" Sara swallowed hard. "Chelsea has what we call sepsis. You might have heard it referred to as blood poisoning. It happens when bacteria get into the body and enter the bloodstream. In Chelsea's case, this probably began when she had her wisdom teeth extracted." I can't believe the dentist didn't put her on a prophylactic antibiotic before the procedure. Sara brushed those thoughts aside. That wasn't important now. The important thing was saving the girl's life. Sara marshaled her thoughts. "We took samples of Chelsea's blood at the time of her admission, and while we waited for the results of the blood cultures I started treatment with a potent mixture of antibiotics. As you can see, that hasn't helped." "Why?" Sara wished the woman wouldn't be so reasonable, so placid. She wished Mrs. Ferguson would scream and cry.

If the roles were reversed, she'd do just that. "While we wait for the results of blood cultures, we make a guess at the best antibiotics to use. Most of the time, our initial guess is right. This time, it was wrong-badly wrong." "But now you know what's causing the infection?"

It was a question, not a statement. "Yes, we know." And it's not good news. Hope tinged Mrs. Ferguson's voice. "You can fix this, can't you?" I wish I could. "The bacteria causing Chelsea's sepsis is one that…" Sara paused and started again. "Have you heard of Mersa?"

"Mersa? No. What's that?" "It's actually MRSA, but doctors usually pronounce it that way. That's sort of a medical shorthand for methicillin-resistant Staphylococcus aureus, a bacteria that's resistant to most of our common antibiotics." Mrs. Ferguson frowned.

"You said most. Do you have something that will work?" "Yes, we do.

Matter of fact, when Chelsea was admitted I started her on two strong antibiotics, a combination that's generally effective against MRSA.

But she hasn't responded, because this isn't MRSA. It's worse than MRSA." She started to add "Much worse," but the words died in her throat. Sara paused and waited for Mrs. Ferguson to ask the next question. Instead, the woman crumpled the tissue she held and dabbed at the corner of her eyes, eyes in which hope seemed to die as Sara watched. "This is what we call a 'super-bug,'" Sara continued. "It used to be rare, but we're seeing more and more infections with it.

Right now, none of the commercially available antibiotics are effective. These bacteria are resistant to everything we can throw at them." Mrs. Ferguson's voice was so quiet Sara almost missed the words. "What do you call it?" "It's a long name, and it's not important that you know it." Matter of fact, we don't use the proper name most of the time. We just call it "The Killer." "So that's it?"

"No, there's a doctor doing trials on an experimental drug that might work for Chelsea." No need to mention that Jack is… No, let it go. "Can you get some of this? Give it to Chelsea?" "I can't, but the man who can is an infectious disease specialist on the faculty here at the medical center. Actually, he helped develop it. Notice I said 'experimental,' which means there may be side effects. But if you want me-" "Do it!" For the first time in days, Sara saw a spark of life in Mrs. Ferguson's eyes, heard hope in her voice. "Call him! Now!

Please!" "You realize that this drug isn't fully tested yet. It may not work. Or the drug may cause problems." There, she'd said it twice in different words. She'd done her duty. "I don't care. My little girl is dying. I'll sign the releases. Anything you need. If this is our only chance, please, let's take it." Lord, I hope I haven't made a mistake. "I'll make the call." "I'm going back to be with my baby,"

Mrs. Ferguson said. She stood and squared her shoulders. "While you call, I'll pray."

"Mr. Wolfe, you can come in now." The secretary opened the doors to Dr. Patel's office as though she were St. Peter ushering a supplicant through the Pearly Gates. Bob Wolfe bit back the retort he wanted to utter. It's Doctor Wolfe. Doctor of Pharmacology. I worked six years to earn that Pharm D, not to mention two years of research fellowship. How about some respect? But this wasn't the time to fight that battle. He straightened his tie, checked that there were no stains on his fresh white lab coat, and walked into the office of the head of Jandra Pharmaceuticals as though he had been summoned to receive a medal. Never let them see you sweat. Dr. David Patel rose from behind his desk and beamed, gesturing toward the visitor's chair opposite. "Bob, come in. Sit down. I appreciate your coming." Not much choice, was there? Wolfe studied his boss across the expanse of uncluttered mahogany that separated them. Pharmaceutical companies seemed to be made up of two groups: the geeks and the glad-handers.