Sara pushed away the remains of her dinner. It didn't matter that she often couldn't recall what she'd eaten or what program she'd watched. The ritual-and that was what it had become- was designed to get her through one more evening. Frozen meals from the microwave, the TV for company, falling into bed, frequently awakening at four o'clock in the morning to the cries of an infant who wasn't there. Most of the time Sara was halfway out of bed when she realized there was no baby in the house, no source of crying. That had ended almost two years ago when she found her infant son lying cold and lifeless in his crib. She knew about SIDS, of course. Sudden infant death syndrome was the fear of every reasonably intelligent mother, and as a physician she'd made sure she did all the right things. No exposure to smoke. Put the baby to bed on his back, always with a pacifier. But still, it had happened. She'd tried to lean on Jack for comfort in the days that followed the baby's death, but he withdrew, acting as though Sara was somehow to blame in the matter. It must have been her fault. She'd given him a son who was flawed, unable to survive. Jack came home later and later, usually slipping into bed after she'd cried herself to sleep. Sometimes he didn't come home at all, offering a flimsy excuse or none at all. Sara begged Jack to come with her for counseling. He refused, and eventually she stopped asking. She wasn't surprised when the divorce papers arrived, citing "incompatibility."
That was almost two years ago. Now when they spoke, it was with forced civility. He had his life, and she had hers, such as it was. Somehow the evening passed, as had all the others since Jack left her.
Eventually, it was time for bed. She almost said sleep, but corrected the words as they passed through her mind. Sleep was never a certainty any more. She padded from the bathroom in her robe, warm from the shower, but not free of the emotional chill that was the undercurrent to her life. She was turning back the covers when the ring of the phone startled her. Who could be calling? This wasn't her week on call. Certainly not family or friends. She had none to speak of.
"Hello?" "Sara, this is Rip. Did I wake you?" She glanced at the clock beside her bed. A little after ten. "Not at all. Just settling in for the night. What's up?" He cleared his throat. "I wasn't sure whether you'd want to know, but I decided-" "What is it, Rip?" "Does Jack drink?" Sara thought back to their time together. "One glass of wine and Jack relaxed. Two glasses and he turned maudlin. Three glasses freed his inner self-belligerent and self-centered." Rip's sigh came through clearly. "Bingo! He called me a few minutes ago. Apparently, he was pretty upset about all the delays in his trip. He was flying first class, and I'm guessing he couldn't turn down the free alcohol.
After he landed here at DFW, he couldn't remember where he'd parked his car, so he called and asked me to come to the airport and pick him up. I suggested he take a taxi. He ordered me to come. I politely declined and told him that wasn't in my job description." "How did you leave it?" "I hung up on him. He called back a couple of times but I didn't answer. I wondered if this sort of behavior was unusual." "Yes and no. Jack didn't drink much at all after we were first married.
Then… then the baby died, and he started to drink heavily. And when he'd had a bit too much, he got really belligerent." "Did he..
. did he ever hit you?" Sara teased a tear offher cheek with her finger. "No, if I stood up to him he'd generally break down and ask me to forgive him. I suspect tomorrow morning he'll try to act like this never happened." "Well, I hope he doesn't have a hangover in the morning. I have to tell him we may have compromised his study protocol in Chelsea's case, and I'm going to need him to be in the best possible mood." "Why don't you let me break the news?" Sara said. She thought back to Jack's reaction after she'd shaken him awake to tell him his son was dead. If she could get through that, nothing Jack Ingersoll could say or do would bother her.
Bob Wolfe eased warily into the visitor's chair across from David Patel. Wolfe's shirt was plastered to his skin, held there by the sweat that began to form the moment Patel's secretary delivered this summons. He rolled his shoulders and leaned forward, trying without success to loosen the broadcloth straitjacket. "You wanted to see me?"
"Do you think Dr. Ingersoll got the message?" Typical of Patel. No time given to social niceties. No wasted words. Down to the nitty-gritty. Wolfe wanted to reach across the desk and shake the man, but instead he pasted a confident smile on his face. "I sat him down and had a heart-to-heart. He understands that the data on Jandramycin has to be good, no exceptions." "You use the carrot and stick?" "Sure.
The carrot was easy. More research grants. Coauthorship on every paper on the drug. We'll write them; all he has to do is add his name.
Jandra will pressure the journals to print them. No problem." "And?"
"He's our number one consultant, lecturing other doctors about the drug and its uses. Trips to speak all over the U.S. When we release Jandramycin overseas, he becomes a world traveler at our expense.
Everything first class, with a handsome honorarium for each lecture."
Patel nodded once, practically an "attaboy" for him. Wolfe decided not to wait for the next question. "And the stick was even easier. If he crosses us up, we pull all his research money. No more lectures. No more papers. We could even-" Patel held up one finger and smirked.
"How's this? If he doesn't perform, he can expect more than the loss of all those perks. We'll get the word out that, although his research was valid, it was the work of others, and he stole it. We'll systematically destroy his reputation." "Good idea. I'll call him in a day or two, see how things are going, and squeeze him with this."
Patel pulled a stack of papers toward him and began signing them. As Wolfe pushed back his chair, obviously dismissed, the CEO muttered under his breath, "That's what they pay me for, Bob. That's what they pay me for."
"Dr. Ramsey, I'm Verna Wells. I'll be working with you on the days you're here in the clinic." The woman sitting at the clinic nurses' station smiled, showing a row of white teeth in a face dark as rich chocolate. Her royal blue clinic jacket had a floral pattern, and there was a small gold cross on the lapel. Her only jewelry was a plain gold wedding band and a simple watch with a leather strap.
"Thanks. I'm looking forward to being here. You're probably going to have to answer a ton of questions for me until I get my feet on the ground." "You'll pick up the routine fast enough. Let me show you which exam rooms you'll be using." After a half hour, John's head was spinning. "Verna, I give up. Do you think that's enough to let me function for my first day or so?" She laughed, a hearty sound that seemed to come from deep inside her. Never had the term belly laugh seemed so appropriate, because once Verna came out from behind her desk John realized she carried about two hundred pounds on a five-footfour-inch frame. "I think you'll do just fine. And if you have any questions or problems, buzz for me. Remember where the buttons are in the treatment rooms?" "I remember. Now how long do I have before I start?" She glanced at her wrist. "You've got about half an hour before your first appointment. You might want to get some coffee." Verna looked over John's shoulder. "Here comes Dr. Goodman.
She generally goes for coffee every morning. Maybe she'll show you the way." "Verna," Lillian Goodman said, "are you getting Dr. Ramsey squared away?" "Well, he doesn't seem to know much, but I think he's teachable." She grinned. "Bring me back my usual?" "Coffee with double cream and three sugars. Got it." Lillian looked at John. "Want to come along?" John followed her through a maze of corridors, and soon they were walking into a moderate-sized cafeteria. "I give up. Where are we?" "University Hospital. Really not too far from the faculty clinic where we started, and they have a great cafeteria." He shook his head.
"I staffed residents at Parkland Hospital for years, but I've never been in a lot of these buildings." "Don't worry. You'll be able to find your way around real soon." They ordered, including coffee for Verna, and John insisted on paying. "Do we have time to sit down and drink this, or do we need to hurry back?" "We've got a few minutes."
She pointed to a door in the far wall. "That's the staffdining room.
It's quieter there." "What do you hear about the lady who had the stroke outside the elevators the other day?" Lillian's face clouded over. "She never regained consciousness. Died within an hour. MRI confirmed an embolic stroke, but while she was in the radiology department she had a cardiac arrest. We couldn't resuscitate her."
"Autopsy?" "The family refused one. And since there were at least two possible causes of death, we chose not to push." John grimaced. "I guess I've lost my first patient since joining the staffhere." "Not really. All you did was take her blood pressure and start an IV. She wasn't really your patient." Lillian blew across the surface of her paper cup, then sipped. "And I guess you can be glad of that." "Why?"
"Her family is threatening to file a malpractice suit against the medical center and every doctor who had anything to do with her treatment."
In the midnight darkness, the lamp spilled a pool of yellow light onto the papers strewn helter-skelter over the scarred surface of his desk. The page shook in his hand as he stared at the figures scrawled in the margins. It all came down to this. The man scrabbled through the mass of documents and pulled another sheet. What was the line from Macbeth? "If it were done when 'tis done, then 'twere well it were done quickly." Decision time. He eased himself from the chair like the unfolding of a carpenter's rule. Do this, and he could say good-bye to this tiny office. He envisioned a corner suite with a view-maybe even a private washroom. But tonight the community restroom down the hall would do. The man locked himself in a stall and dug in his pocket for the dog-eared match folder he'd carried all day. He struck one match.
It fizzled impotently. Two more attempts before one lit. He bent it against its fellows and the whole folder ignited. He touched the improvised torch to the papers he held and watched as they burst into flame. Would the smoke set offthe fire alarm, activate the sprinklers?
He cursed under his breath for not thinking of that. He held the flaming mass lower in the toilet and fanned the air furiously with his free hand. The ashes dropped into the water, and he breathed again. He flushed twice, and it was over. He washed his hands, splashed water on his face, and walked back to his office. For good or for evil-probably a bit of both-it was done.
Jack Ingersoll reached out to punch the intercom button on his phone and was gratified to see that his hands were almost steady. A lesser man would have a tremor this morning. I should have been a surgeon. "Martha, page Dr. Pearson and tell him I'll be ready to make rounds in fifteen minutes. We'll start in the ICU." "Yes, sir," Martha called through the open door that connected her office with his.
Ingersoll ground his teeth. Would that woman never learn to use the intercom? Oh, well. It wasn't worth the hassle of trying to get her replaced. No, he'd just wait a bit. If things went as he expected, it wouldn't be long before he'd have a nice new office, along with an administrative assistant that he didn't have to share with two other doctors, someone who would cater to his wishes. And that day couldn't come soon enough for him. He swiveled in his chair and turned away from the windows and the bright sun that streamed in through them. The two Advil he'd washed down with black coffee seemed to be helping his headache. Another five minutes with his eyes closed, and he'd begin rounds. He hoped Pearson hadn't fouled up anything in his absence. At this point, every Jandramycin patient was pure gold. And he couldn't afford any slipups. "Jack, got a minute?" He opened his eyes and saw Sara in the doorway, one hesitant foot over the threshold. He couldn't recall that she'd come to his office since they'd divorced. Quick encounters on the ward or in the cafeteria, an occasional phone conversation about a patient, but never a personal visit. What was up?
"Sure. Come in. Sit down." She took one of the two visitors' chairs.
"I won't keep you. I know you're about to start rounds, but I wanted to let you know what happened while you were gone." He listened intently as she told him about the girl-what was her name? Chelsea.
That was it. She told him about Chelsea's sepsis. What were the odds?
Sepsis from Staph luciferus, responding to Jandramycin, only to be replaced by a garden-variety but potentially lethal infection from an indwelling urinary catheter. As Sara related the details, his mind raced to parse the implications. Apparently, Jandramycin wasn't effective against E. coli. No harm there. It had a specific niche, and if the drug was never used against any bacteria except Staph luciferus, it would still have a secure position in the pharmacotherapy of infections. The girl was still receiving Jandramycin along with the other drugs for her E. coli infection, and all the medications seemed to be working. That meant there was no incompatibility among them. Good to know and not the kind of information that would come up in a normal study protocol. Would the data from this case have to be excluded because of the confounding factors of the second infection and additional antibiotics? Ingersoll thought back to his conversation with Wolfe. We may have to be creative in the way we handle our data. So be it, then. He might have to be creative in the way he entered this information into the database, conveniently ignoring the additional drugs, but he couldn't afford to lose even a single patient from the study. He'd handle it.
Sara seemed to be running down, so he brought his full attention back to her. "So little… little Chelsea is getting better. Is that right?" "Yes. Her temp's down. White count returning to normal. No protein or cells in her urine this morning. I think she's turned the corner." "Well, that's the important thing," Ingersoll said. "I'll look in on her this morning, but you and Pearson should be able to handle things from here on out. You can call me if there are any questions." Sara frowned. "Jack, we were really afraid you'd erupt when you heard we had to go outside the study protocol to treat her.
I'm glad you're taking it this well." Ingersoll summoned up his most sincere look. "The patient is better. That's what's important." He rose and walked around the desk. He took his ex-wife's hand in both of his. "Sara, I appreciate your coming by to tell me in person. And I hope you won't be a stranger. I think we had something really good at one time, and I'm sorry I let it slip away while I was depressed about the death of our son. Maybe we can get it back."