"You look like you've lost your last friend." Rip Pearson's voice startled Sara out of her reverie. She gestured to the empty chair across from her in the hospital cafeteria. "I'm not sure how many friends I have, but you're probably my best one, and I need you now."
Rip settled his tray onto the table but didn't unload it. Instead, he braced his elbows on the table and leaned toward Sara. "I'm here, ready to listen." "I just saw Chelsea Ferguson in the ER and admitted her. She awoke this morning with severe weakness of both legs. I've ordered some tests. Anna Pearl's going to see Chelsea this evening."
Rip raised his eyebrows. "What's your best guess?" "Oh, the differential's a mile long, but I'm betting on Guillain-Barre syndrome." Rip shook his head. "That's too much of a coincidence."
"What do you mean?" "I've had calls this week about two other patients who received Jandramycin. Their private doctors saw them with some pretty serious problems." "And they have Guillain-Barre, too?" Sara asked. "No, one of them has severe headaches and visual disturbances.
The other has developed early kidney failure. But the common link is Jandramycin." He pushed his tray aside, untouched. "If you're through eating, let's go somewhere quieter where we can talk about this. I think there's a connection between our 'wonder drug' and these complications." Sara stood. "I can't eat, especially now. And I imagine that when we let Jack know about this, he'll lose his appetite, too." "That's another thing we need to talk about," Rip said as they moved toward the exit. "If we tell him about what's happening, is he going to investigate it… or deep-six it?"
Jack Ingersoll's fingers lingered over the keyboard as he mulled his next sentence. He was scheduled to present this paper to the World Conference on Infectious Diseases in Frankfurt. Then he planned to submit it to a prestigious journal-maybe the Journal of Infectious Diseases or the Journal of the American Medical Association- and with a little push from Jandra it should end up as the lead article. "Dr.
Ingersoll, Drs. Miles and Pearson are here to see you." His secretary's announcement carried through the open door like Gabriel's trumpet. He picked up his phone and punched the intercom button. "How many times have I asked you-Never mind. Send them in." He rose from behind his desk and gestured his visitors to chairs. "What can I do for you?" Sara opened her mouth, but Pearson gave her an "I got this" look. "Some of the Jandramycin patients are having some problems. We wondered if you had any information that would help us figure out what's going on." Ingersoll's smile never wavered. "What kinds of problems?" "Chelsea Ferguson has Guillain-Barre syndrome," Sara said.
"And two other patients are having problems," Pearson added. "One of them has severe headaches and visual symptoms; the other is in early kidney failure." Ingersoll spread his hands. "I'm sorry to hear that.
Are any of these patients just offthe medication?" Pearson shook his head. "No. Chelsea's more than a month out. The other two have been offthe med for six weeks or so." "Then we can't assume their problems are due to Jandramycin. Sorry." "Jack," Sara said,"you've kept all the data on this study very close to your vest. And I can't find any information from the animal studies on the compound. Is there anything there that might suggest the likelihood of late complications?" "That data is proprietary, and until Jandramycin is released, it's going to be available to only a few people on a need-toknow basis." He rose.
"Now, if you'll excuse me, I have a paper to write. And, Pearson, I believe you have some patient data to compile." "Sure, I'll get on that right away." Rip pushed back his chair and took a step toward the door. "But first, can you tell me why Jandra has already filed an NDA?
I thought they wanted a total of a hundred patients, forty from us.
The NDA was filed before we reached our target number. Where did the others come from?" Ingersoll didn't need this. He was too close.
"Look, you don't have the big picture. Nobody does except me. You just have to trust me. When Jandramycin launches, there'll be enough credit to go around, and I'll be sure you get some." He looked at Sara. "That goes for you, too. I appreciate your furnishing patients for the study. How many of yours do we have?" Sara rose and moved toward the door. "I know of five. But given what I'm hearing, the number may be entirely different when this is all over."
After three sharp taps on the exam room door, it opened just wide enough for Verna to peep in. "Dr. Ramsey, there's a Dr. Wilcox here to see you." John didn't look away from the man who perched on the edge of the exam table. "Have him wait in the doctors' dictation room. I'll be out in a minute." He waited until the door closed before he continued. "Sorry. As I said, your blood pressure's a bit high, but I think we can get it under control. I want you to see our dietitian. If you can lose twenty pounds, odds are that the pressure will come right back down." The man's face fell at the mention of a diet. He frowned.
"Why don't you just put me on some pills?" John had heard this a hundred times, but he tried to make his reply sound fresh. "Pills shouldn't be a permanent solution. They're great to attack the problem acutely, and I'll probably put you on something for now, but you need to be concerned with your long-term health." He went on to mention the benefits of a healthy lifestyle, but as the patient's eyes began to glaze over, John decided not to fight the battle right then. There'd be plenty of opportunities later. "Get dressed and meet Verna outside.
She'll have a prescription for your medication. She'll also set up an appointment with the dietitian. I want to see you back in three weeks, and we'll see what your blood pressure is then." The patient smiled, but it vanished when John added, "And we'll check to see how much weight you've lost." John paused at the door and asked the same question he'd been asking patients for forty years: "Are there any questions I've left unanswered?" There rarely were, but it never hurt to ask. After giving Verna a few instructions, John moved to the dictation cubicles where he found Mark Wilcox thumbing through a journal. "Sorry to keep you waiting." "Not at all. I'm just reading this paper by Jack Ingersoll. It's a preliminary report on the use of Jandramycin to treat Staph luciferus sepsis." Mark put the journal aside. "Isn't he on the faculty here?" "Yes, he's head of the Infectious Disease section and apparently quite a rising star. I heard the other day that he's about to be fast-tracked to full professor."
"Well, someday maybe I can meet the great man, or at least touch the hem of his garment." John frowned. "You sound a little bitter." Mark pulled a ballpoint pen from his pocket and began clicking it. "I'm not sure that's it so much as just cynical. At the time the article was submitted, he'd treated thirty-two patients with Staph luciferus sepsis with 100 percent cure and no side effects. John, we both know that the medication doesn't exist that has both those qualities. It either works most of the time and is very safe, or is effective all the time but there are risks. Call me a doubter, but I won't believe this until I see the work duplicated by another investigator." "Let's see." John picked up the journal and found the paper in question.
"Accepted for publication… hmm. They must have rushed this into publication, because it was accepted only three months ago, so the figures have to be fairly fresh." A hushed, earnest conversation just outside the door made John turn to look. Rip Pearson was talking with Sara Miles. "Well, you're in luck. There are a couple of people who should be able to give you a little insight." John stuck his head into the hall and waited for a lull in the conversation. "Rip, do you have just a second?" There was a moment for an exchange of the usual pleasantries. Then John asked, "Rip, how many patients are in the Jandramycin study now?" Rip took a deep breath and let it out as a barely audible sigh. "You know, based on what I've heard this morning, I couldn't begin to hazard a guess."
Sara stirred her chef 's salad and speared a small piece of tomato. "Mark, it was nice of you to take us all to lunch." Mark made a deprecating gesture. If you only knew how happy I am that this worked out. "My pleasure. I owed John a lunch. And after what you and Rip hinted at, I had to hear the rest of that story." The four sat in a back booth at one of the trendier eating places on McKinney Avenue.
John looked at his watch. "Shouldn't we have stayed on campus for lunch?" Sara smiled at John. "You're still new on the faculty. In private practice, you were always on call. Here, you're one small cog in a great big machine. None of us have clinic this afternoon, so we can take a longer lunch. As long as you have your cell phone and pager with you, you're fine." John shrugged. "Guess you're right." "Enough of that," Mark said. "I want to hear more about how the number of patients in the Jandramycin study is a moving target." It was impossible for Mark to miss the look that passed between Sara Miles and Rip Pearson. Who is this guy? Why should they trust him? John must have seen it, too, because he spoke up. "I've known Mark since he was a sophomore medical student. I'll vouch for him. He's sharp, he's solid, and you can trust him. I realize you may not want to share this information with either of us. If that's the case, fine. But if you want some input, Mark's got a sharp mind. And I've been around for enough years that maybe I can contribute a little senior wisdom." Sara and Rip exchanged another look, a different one this time, and apparently a decision was reached. "Okay," Rip said. "Here's what we know. But it can't go any further." As he listened, Mark found himself wishing for a yellow legal pad so he could take notes. Once a lawyer, always a lawyer, I guess. When Rip finished, Mark said, "So the bottom line is that somebody is fudging the data on Jandramycin. Right?" "It seems that way," Rip said. "And it's probably Ingersoll?" "No, it could be his research assistant, a doctor named Resnick. Or I guess it could be coming from the other end, someone at Jandra. And for that matter, there may be others with the opportunity. Ingersoll's kept everything so secret, I don't even know who's involved in the process." Mark shoved aside his sandwich and took a long drink of his Diet Coke. "This is the lawyer talking now. If someone's submitting manufactured data, what's your liability in it?" Rip shook his head.
"I guess I could say I'm just following orders from the man running the study. But as a practical matter, if this comes to light I'll be tarred with the same brush as Ingersoll and whoever else is responsible." "What about a responsibility to patients?" "That brings up another problem," Sara said. "There may be some side effects of Jandramycin that are just now coming to light." "Explain," Mark said.
"One of the patients in the Jandramycin study has turned up with Guillain-Barre syndrome," Rip said. "There are at least two more that we know of who've developed different problems. We don't know the specifics, but it's enough to make us wonder if there are late effects of the drug that no one suspected." "Or that they knew about but chose to keep hidden," Mark said. "Assuming that's true, who are our suspects?" Sara asked. "Same list we've already named," Rip said.
"Ingersoll, Resnick, someone at Jandra, or a person as yet unknown.
Right now, all we have is questions. I think it's time to try to get some answers."
Outside the restaurant, John ransomed his car from the valet parking attendant. "Where can I drop you two? Back at the medical school?" "Yeah, I guess I'd better start making some phone calls," Rip said. "I'm going to have to call every patient who received Jandramycin and find out if any of them have developed problems." "Can I help?" Sara asked. "No, a call from me will seem like a routine follow-up, but a call from a doctor not involved in the case would send up red flags. This is going to have to be completely under the radar." "If you need anything from me, let me know," John said. After a short drive, the three doctors climbed out of the car in the faculty parking garage. John beeped the car locked and said, "Call me when you know more. We can meet at my house to discuss it." As a half-time faculty member, John shared an academic office with another part-timer. He decided to go back there and tackle the pile of unread journals on his desk. When he walked in, his secretary was attacking the keyboard of her computer as though it was an enemy to be subdued.
Usually, she greeted him with a smile, but today she kept her head down, barely acknowledging him. Strange. The mystery deepened as John entered his office: a middleaged man sat across from his desk. John dropped his briefcase and took his white coat from a hook behind the door. "May I help you?" The man rose and picked up his own briefcase from beside his chair. "Dr. John Ramsey?" "Yes." The man plunged his hand into the case and pulled out a sheaf of papers, which he thrust into John's hand. "You've been served." He took two steps toward the door, turned, and added, "Sorry about that. Have a nice day." John stood immobile for a few moments, not daring to look down at the papers in his hand. Then he moved slowly to his swivel chair and dropped into it. Like a child peeking out from under the covers, afraid he'd see a boogeyman, John squinted and let his eyes scan the document he held. There, buried in unfamiliar verbiage, was his name, along with Lillian Goodman's and a number of other colleagues. True to their threat, the family of the woman he'd assisted was suing the medical center and every person remotely connected with her brief time there. And blameless or not, he knew the next few months would be terrible. He sat for a moment with his eyes closed and wished he could turn back the calendar-not a few days or a few weeks, but half a year.
Then Beth would be there. And he wouldn't feel as he did now-as alone as a man on a desert island, with no sign of a ship on the horizon.