An alarm bell intruded into Sara's consciousness, and she was on her feet before she realized where she was. A quick glance brought it all back. She was in a corner of Chelsea Ferguson's hospital room. Rip dozed in another chair next to her. Chelsea was in her hospital bed.
Her mother stood watch at her side. The bell stopped as quickly as it began. Rip roused long enough to say, "Somebody accidentally unplugged something. Nothing to worry about." He yawned and stretched. "How long has it been?" Sara needed no explanation. He meant, "How long has it been since we gave Chelsea the dose of OMAL?" She did a rapid calculation in her head. "Ninety-seven minutes." They shared a glance and a silent message passed between them. Most reactions to this drug occurred within the first ninety minutes, all within two hours. They were almost home free. "Let's wait another half hour or so to be sure," Sara said. Mrs. Ferguson tiptoed over to where Sara stood and whispered, "Can we talk outside?" Sara moved toward the door. Mrs.
Ferguson said, "Chelsea, I'm going to step outside for a minute. Dr.
Pearson is here, and I'll be right back. Okay?" Chelsea didn't break the silence she'd maintained for the past hour. Instead, she made the smallest of hand gestures to signal she'd heard. In the hall, Mrs.
Ferguson leaned close to Sara and spoke in a low whisper. "It's been almost two hours. What do you think?" Sara kept her voice low as well.
"She hasn't shown any signs of a reaction from the OMAL. That's the first hurdle. Now we have to see if the drug does what we hope it'll do." "How long will that take?" "We don't know. I'd guess at least a couple of days, maybe a week," Sara said. "Tell me again why you think this may work." "The drug is sometimes called 'anti-IgE.' The substances that carry out the body's immune responses are called immunoglobulins. There are five of them, named with letters of the alphabet, and immunoglobulin E-IgE for short-is the one that's involved in what most people think of as allergy. This compound, anti-IgE, was developed to block that immunoglobulin in susceptible individuals. It keeps it from attaching to the cells where it would ordinarily do its dirty work." "What does that have to do with Chelsea?" Mrs. Ferguson asked. "We think the Jandramycin has not only stimulated her immune system to produce special substances that kill the Staph luciferus, but also some that attack her own cells. In Chelsea's case, it's the nerves, and it leads to weakness and eventual paralysis. We hope that in this particular scenario, the anti-IgE will block those other substances as well." "Do you have any reason to think this will work?" Sara had turned that question over in her mind again and again since John proposed using OMAL for this purpose. The answer she gave was what she'd come up with. "We think there's a good chance-and we have nothing else."
John and Rip were in the back treatment room of the clinic that had become John's unofficial home for his Jandramycin infusions. This time there was no IV setup in view, no syringes and vials on the treatment table. John perched on the end of the treatment table; Rip sat on a rolling stool. It seemed that each was waiting for the other to speak. Rip took in a deep breath through his nose and let it out through pursed lips. He guessed it was up to him to talk about the elephant in the room. "John, you've had six IV doses of Jandramycin.
How are you doing?" John held up his hand and turned it back and forth in front of Rip. The needle puncture wound had long since healed. No redness, swelling, or any of the cardinal signs of inflammation. "I think it's pretty much back to normal. Don't you?" "I do, but as you know, all our success with Jandramycin has been based on a protocol of ten days of treatment. Admittedly, that number was chosen empirically, but so far it's worked. Theoretically, you need four more doses." Rip waited to see if John saw the same thing that was bothering him.
Apparently, he did. "But since I've had the IM injection of OMAL,"
John said, "my immune system has been tweaked, hopefully to the point that the Jandramycin won't have any further effect. The good news is that my chances of getting a late autoimmune problem may have been reduced, maybe even down to zero. On the other hand… " "Yeah, on the other hand, any more Jandramycin you receive would probably be ineffective against Staph luciferus if there are some still in your body." "So I'm stuck at this point. Just wait and hope the bug's been killed out." John shook his head. "Guess I can add that to worrying about whether that needle-stick exposed me to HIV." Rip reached out and gripped John's hand. "So far, your labs look clean from that standpoint. But remember, I'm in this with you. And we won't go down without a fight."
Rip entered Randall Moore's room ready for almost anything, but not for the sight that greeted him. Jack Ingersoll and Donald Schaeffer had their heads together at Moore's bedside. Each doctor wore a white lab coat. A stethoscope dangled from Ingersoll's neck, while Schaeffer held his at his side. Their demeanor suggested serious consultation, such as would befit two heads of state rather than two physicians at a medical center. Rip turned his eyes from them to Moore. His previously pale skin was darker now, but not with a healthy tan. His lips had a bluish cast. The man wasn't getting enough oxygen into his blood, even with pure oxygen flowing into the mask that covered his face. His respirations were slow and shallow. Moore was dying before Rip's eyes. "What's going on?" Rip asked, trying to keep his voice level. "I was in the bacteriology lab and the chief technician showed me the final results from this patient's sputum culture. He has a Staphylococcus luciferus pneumonia, which is why the nafcillin you ordered has been ineffective." "I suspected as much,"
Rip said. "I just phoned the lab and got the final culture report myself. I've already talked with Dr. Miles about it, and she's on her way to meet me here. We plan to discuss treatment alternatives with her patient." He pointed to the man in the bed. "But I don't think he's in any shape for a discussion. We'd better-" Dr. Schaeffer turned to face Rip. "Dr. Pearson, the reason I'm here is that Dr. Ingersoll thought it best, given the high profile status of this patient, that he take over the case. After reviewing the situation, I tend to agree." He frowned. "I don't want you to think this is a criticism of Dr. Miles's clinical ability or of yours. I just think it's more… expedient that the Chief of the Infectious Disease Service assume Mr. Moore's care." Rip knew exactly what was going on. Moore was the plaintiff in a huge suit against the medical center. Currently his treatment was under the supervision of a junior faculty member and a fellow in training. Schaeffer wanted his high-profile professor treating Moore, in hopes that a good outcome, coupled with this display of the resources available at Southwestern, would convince the man to drop his suit. "I can't speak for Dr. Miles.
Personally, I don't care whose name is on the chart." Rip pointed to the small device on Moore's index finger. "But look at the pulse oximeter. His oxygen saturation has dropped to dangerous levels. We need to get him intubated and on a ventilator." "I've already put in a call for someone to do that," Ingersoll said. "And I plan to write the orders to add Mr…" He consulted the chart in his hand. "Add Mr.
Moore to the Jandramycin study. You will, of course, draw the necessary blood work, administer the drug, all the things you've been doing so well." "What about permission?" Rip asked. "He's too far out of it to give informed consent. Let me contact his next of kin. Maybe they can sign." "Not necessary," Ingersoll said. "Given Mr. Moore's inability to make that decision right now, Dr. Schaeffer and I will sign the permission, which, as you know, is possible in the case of a medical emergency where delay is unacceptable." Rip's guts began to churn. This was wrong, all of it. There was no need to wait for an anesthesiologist or pulmonologist to do the intubation. Rip was perfectly capable of carrying out the procedure, but apparently, Ingersoll wanted it done by another specialist-under his direction, of course. As for treatment with Jandramycin, Rip had come here with his mind made up. The only proper course was to lay out the risks and benefits of treatment with Jandramycin and let Moore decide.
Unfortunately, Ingersoll was totally ignoring the risk that Rip felt the drug presented, a risk of late complications that would be life-changing in all cases and fatal in some. Since Moore was unable to make that decision, Ingersoll was taking the responsibility of deciding for the patient, and Schaeffer was going along with his division chief. So be it, Rip thought. He turned on his heel and left to gather the material he'd need. He was back to drawing blood, giving medications IV, and charting vital signs. And if he was later asked why he didn't protest Ingersoll's actions, he guessed his response would be that he was just following orders. Wasn't that the excuse of the prison guards at Dachau?
Sara sat in her living room, slumped in her favorite chair, when the doorbell brought her up from a half-sleep. Was this Rip again?
After he gave her the news about the decision of Ingersoll and Schaeffer to replace her as Randall Moore's primary physician, he'd asked if he could buy her dinner. She told him all she wanted to do was go home and relax with a hot bath and a pint of Cherry Garcia ice cream. Although she hadn't made it past the living room, she had a full-fledged pity party planned, and she resented this intrusion. She tried to ignore the bell, but whoever was at her front door apparently had more persistence than a bill collector on commission. "I'm coming," she mumbled under her breath. She eased out of her chair and padded to the door on stocking feet. Halfway to the door, she heard the distinctive splash of rain dripping from her roof. When had it begun to rain? She put her eye to the peephole, only to discover that while she was napping, darkness had covered the world. Sara snapped on the porch light and saw a thoroughly soaked and bedraggled Mark Wilcox standing there. She unlocked the door and said, "I'm so sorry. Come in." As soon as he was inside, she said, "Stay right there. Let me get you a bath towel or something." Sara grabbed a couple of thick towels from the bathroom, hurried back, and handed one to Mark, who nodded his thanks. "You know, this wouldn't have happened if you answered your phone… or replied to my text messages… or my voicemails." "I'm sorry, Mark. It's been a terrible day, and I didn't feel like talking with anyone." Sara took the sodden towel Mark handed her and gave him the second one. "When you've dried a bit, come on into the living room. I'll make some coffee." "Hot coffee sounds good." Mark finger-combed his hair. "Here's your towel back. Shall I use it to mop up the puddle I've made?" "Just drop it there. I'll deal with that later." She led him into the living room and pointed him to the couch. "Let me give you another towel to sit on, though." "I can stand," Mark said. "I don't want to take all your towels." "Don't be silly. I got lots of them as shower gifts when Jack and I… " Sara felt the words clog her throat. She tried again. "I have plenty of towels." Sara brought coffee in thick white mugs, and when they were settled in the living room she said, "So what's so important that you'd risk drowning to come here and tell me in person?" Mark blew across the top of his mug, then sipped. "What's going on? I thought there was some mutual attraction between us, but now it seems like you're keeping me at arm's length. Did I do something wrong?" Sara shook her head. "It's not just you. Ever since Rip and I began trying to dig out the truth about Jandramycin, someone's been after us. I've been shot at. Rip was almost killed in a car accident. And you don't even know about the latest attack. Do you blame me for not enlarging my circle of friends at this point?" "I thought I was already in that circle." Mark frowned. "And I hoped I was more than a friend." Sara felt a tingle of apprehension within her chest. What now? She waited for Mark to go on. "My wife and I were childhood sweethearts. We married when I was in law school, and I was happier than anyone has a right to be. Then one day, I got a call from the police. She was dead, killed in an auto accident. My world crumbled. I was resigned to life as a widower until I met you." She didn't need to hear this. Not now.
And not from Mark. She opened her mouth, then closed it. Let him talk.
"You and I had that one dinner, and I felt like everything clicked.
I've wondered if somehow my finding that digital device in your attic made you feel ashamed to be around me, ashamed I'd find out the kind of marriage you had." "No, I-" "All that made me feel was angry, so angry at Jack Ingersoll that I wanted to shake him. How could anyone do that to you?" Mark leaned forward, his coffee forgotten. "Sara, I'm serious about this. If you want to hold me at arm's length until this Jandramycin thing is settled, I'll wait. But I'm not going away."
Sara's head was spinning. She had to admit, there was an attraction there, but there was also an element of doubt. It was hard to trust anyone she didn't know. And hadn't John told her Mark's practice was a blending of medicine and law, including some consulting for pharmaceutical companies? Was one of those Jandra? Could Mark-No, she couldn't think about this right now. "Are you going to say something?"
Mark asked. "I've spilled my guts, but I have no idea what you're thinking. Where do we stand, Sara?" Sara held her mug in both hands and brought it to her lips. The coffee was cold by now, but she needed something to buy time. She finished the coffee and reluctantly set the mug aside. "Mark, I like you. I can see us possibly going forward in a relationship at some point, but not now." "So you don't trust me?" The hurt in his voice was plain. "I don't trust anyone! Especially someone who might have ties to the company that's quite likely behind efforts to kill me, the way they're willing to risk killing patients in the name of science." Sara bit her lip. "I'm sorry. That's not fair. But this is a terrible time for you to want to take our relationship to another level. Can't you understand? Can't you be patient?" Mark stood and placed his mug on the table gently, as though it were made of fine china. "Can't I understand? No, frankly, I can't. I thought you trusted me. Less than a week ago I sat with you, Rip, John, and Lillian and talked about working together to solve the Jandramycin puzzle. Now you're freezing me out-out of that group and out of your life." His shoes made a soft squishing as he stalked toward the door.
"Well, I can take a hint." He closed the door softly behind him, leaving Sara alone. She padded to the front door and listened until his car pulled away. She wanted to call him back. Instead, she knelt with a towel and began to mop up the puddle of water where he'd stood, a puddle dotted with tiny circles from her tears. Not for the first time, Sara wished she could hit the rewind button on her life.