Читать книгу Miracle Drug - Richard L. Mabry M.D. - Страница 11

Chapter 4

4

I can’t be in the hospital,” David Madison said. Although he was clad in a skimpy exam gown and sitting in a treatment room on the edge of an examining table, the man still managed to exude both authority and dignity. “I don’t feel that sick. Can’t you just put me on some medications and look in on me every day or two?”

Josh had known this might be coming. Now here it was, on his first day as physician to a former president. “Mr. President.” Seeing Madison’s lips open, he started again. “Mr. Madison, you’ve been in charge of the most powerful nation on earth. You’ve had to make decisions that involved millions of people. And most of us feel you made the right ones. But here, in this situation, in this circumstance, you’ve put your trust in me, effectively saying I’m the person most qualified to make decisions involving your health. Well, my decision is that you should be hospitalized.”

“So what’s the treatment?” Madison asked. “IV antibiotics?”

“Actually, there are a couple of antibiotics, penicillin and erythromycin, that are effective against diphtheria. Either can be given by injection or by mouth.”

“Then why can’t you give me some pills and send me home?”

“We’ll give you an antibiotic, but the treatment of choice is antitoxin, and there’s not a lot of it around. I have to locate some and start you on it.” And Rachel . . . I can’t forget Rachel. “And we need to watch you carefully.”

“Why?”

Josh studied Madison’s face, but the man seemed calm enough. Then again, what would you expect from a former president? Crisis? Deal with it. Okay, here comes the rest of the story. “The main reason to keep you in the hospital is that we need to be ready to do emergency surgery to open your windpipe if we can’t halt the progress of the disease. You could die of airway obstruction.”

Madison was silent, but Josh could tell he’d succeeded in shaking the man. When the ex-president spoke again, it was in a softer voice. “Okay. You’re the doctor. Call the CDC or whoever you need to and get the ball rolling to locate some antitoxin.” Madison was moving ahead, once more the man in charge. “And you’d better call Jerry Lang and make him a part of the planning. At hospitals like Bethesda where they take care of presidents and high-profile patients every day, they’re set up for this kind of stuff. I’m not sure you know what you’re letting yourself in for.”

I have an idea . . . and it won’t be any picnic . . . especially if the response to treatment doesn’t go well.

***

Allison Neeves wasn’t certain whether her job was easier or harder than the one Josh Pearson faced. It was never easy to give a patient the news that they had a serious illness and would have to be hospitalized. But what if the patient was in the health care field? What if they could read between the lines and imagine the worst?

Before she could tap on the exam room door, Allison was brought up short by Josh’s voice behind her. “Allison, hang on a moment.”

She watched Josh hurry down the hall. When he reached her, she said, “I was about to give Rachel the news.”

“Would you rather I do it?” Josh asked.

Allison took a deep breath. Technically, Josh outranked her, since he’d been at the clinic a year longer, but for practical purposes they were equals professionally. If this was going to be a problem, it was better to settle it now. “Josh, Rachel is your girlfriend—from what I’ve seen the past few months, probably even more than that—but that’s the very reason you shouldn’t be her treating physician. I am. And I’ll tell her.”

She saw him absorb this, accepting the fact, but uncomfortable with the implications. “Look, you can see her as soon as I’ve told her our findings,” Allison said. “And we’ll consult with each other on treatment. But you’ve got to take a step back. Trying to manage her treatment would be the worst possible thing you could do.”

“Okay,” Josh said. “I’m getting ready to hospitalize Mr. Madison. I presume we’re both thinking the same treatment: isolation, antibiotics, diphtheria antitoxin just as soon as I can get it, tracheotomy tray at the bedside.”

“Right,” Allison said. “We can cross-check each other’s orders in case we forget something.” She put one hand on the treatment room doorknob. “Now get on the phone and find some antitoxin while I tell Rachel what’s going on.”

***

David Madison might be an ex-president, but he didn’t think he was displaying much gravitas sitting on the end of the exam table. He smiled when he realized the wide-open back of his patient gown was displaying something, but it wasn’t dignity and seriousness. Nevertheless, sitting in the Oval Office for eight years had taught him to take control of any situation, and even though he was forced to accept Josh Pearson’s decisions about his treatment, he could at least control his environment while hospitalized.

“We’re getting things lined up, sir,” Jerry Lang said. “You’ll be in a private room, and there’ll be an agent outside your door at all times. Only a limited number of medical personnel will have access to you.”

“I presume I’m being registered under a false name.”

“Woodrow Wilson.”

“Very funny. Does my wife know yet?”

“I just got off the phone with her,” Lang said. “She wanted to cancel her luncheon speaking engagement, but I convinced her it would be best for her to go ahead with it before coming to the hospital. I’d like for her to continue her normal activities as much as possible. It will keep the media from suspecting anything.”

“Good. Who on my staff besides you knows about this? The more people who are in the loop—”

“Sir, only the agents, your wife, and Karen Marks know right now.”

Madison frowned. “How does my administrative aide know? She’s still in South America.”

“She called me a few minutes ago. Somehow, she found out you were ill, so she’s flying home today.”

“And the rest of the group?”

“They’ll arrive back this weekend, on schedule.” Lang held up one finger. “But there’s something else you need to know. Right before Karen called, I got a phone call from the funeral directors we asked to pick up Dr. Lambert’s body. It’s reappeared.”

“Maybe you’d better explain that.”

“It seems that someone left it on their doorstep this morning.”

Madison had a mental picture of a casket, or even worse, a body on a gurney deposited on the porch of a funeral home. “I beg your pardon?”

“Actually, what they got was a box with cremated remains, plus Dr. Lambert’s personal effects.”

“That’s all?”

“That and a note that said simply, ‘Sorry.’ ”

Madison thought about what this latest development meant. Maybe it was all a big mistake, but maybe it was deliberate. The first thing that came to mind was that cremated remains couldn’t be autopsied. He’d have to check, but he doubted they could even be tested for DNA to confirm an identity. That brought to mind a whole new series of questions.

Well, it looked as though he was going to have a bit of time to think those questions through in the next few days.

***

Rachel had never been to this hospital before. She’d graduated from a nursing program in Houston and fully expected to be there for years. Then her fiancé dumped her, her life fell apart, and she jumped at the opportunity to take a position at Zale Lipshy University Hospital in Dallas. Working with faculty physicians from Southwestern Medical Center seemed perfect for her. And it had been, until this happened. Now she found herself in the unfamiliar territory of Prestonwood Hospital, a patient rather than a caregiver. How quickly things could change.

Of course, if she’d stayed in Houston she’d never have met Josh, and that would have been tragic. It was becoming clear to her that he was the man she’d like to spend the rest of her life with. She thought Josh felt the same—actually, she’d expected him to tell her that when she got back from this trip, but—

A tap at the door of her hospital room interrupted her thoughts. She looked up, expecting another nurse or maybe a lab tech. Instead, she saw Josh. At least, she thought it was Josh. A surgical mask covered the lower part of his face. He wore a disposable gown, and thin purple gloves covered his hands.

“Rachel.” His voice was slightly muffled by the disposable mask he wore. He advanced to her bedside and covered her hand with his own, careful not to disturb the IV running into the back of it. “I’m so very sorry this happened to you.”

Rachel shook her head. “Don’t worry about me. How’s Mr. Madison?”

“Doing okay.” Although his mask hid his features, Josh’s eyes told her more than his words.

“Something’s wrong. Tell me.”

“Actually, his illness doesn’t seem quite as pronounced as yours. But don’t worry. I’m going to get hold of some diphtheria antitoxin. We may be able to start treating you both with it as soon as tomorrow.”

“What about antibiotics? Am I getting those?”

Josh nodded. “You are, but diphtheria is so rare now that the latest study on which ones work best was done almost twenty years ago. Children now get diphtheria-pertussis-tetanus shots, and many adults get a diphtheria-tetanus booster periodically, usually when they have a tetanus scare. When patients do turn up with the infection, we depend on diphtheria antitoxin.”

Rachel shook her head. “That’s something I don’t understand. I got a DT booster before the trip. Matter of fact, I got it here. Dr. Lambert’s nurse had just given Mr. Madison his shot, so she still had the bottle of vaccine out. Why did we get sick?”

“That’s one of the reasons I wish Ben Lambert were still alive,” Josh said. “I could question him about that.” He frowned. “Did you get much of a reaction to your shot?”

“Now that you mention it, no. And usually I get a red, sore arm from almost any type of immunization.”

“We’ve ordered a test for immunity against diphtheria on both you and Madison.”

“To answer the question of whether the shot gave me protection?”

“Not really. An elevated diphtheria antibody titer could be due to either your recent immunization or to a current infection.”

Rachel started to ask Josh why he ordered the test, then she got it. There was one more possibility. If the titer was very low, she hadn’t been immunized, but what she had wasn’t really diphtheria—and the problem got even more complex.

“Josh,” she asked. “How about you? When I arrived, you hugged and kissed me. You did it again yesterday, although I tried to keep my distance. Why aren’t you taking precautions?”

“About six months ago, I stepped on a nail while working at a Habitat for Humanity project. I asked Nell, my nurse, to give me a diphtheria-tetanus booster, and I had a marked local reaction to it. I’m guessing I have plenty of antibodies right now.” He touched the crook of his left arm. “I had an antibody level drawn earlier today, but I think I’m pretty well protected. Besides,” he added, “I’ve already started prophylactic antibiotic therapy with erythromycin. I’ll be fine.”

Rachel realized Josh was gambling a bit, but she also knew he wasn’t going to go into isolation right now . . . that wasn’t in keeping with his nature. In his mind, as in that of so many doctors, he couldn’t get sick—he was invulnerable. She looked at him and said so softly that Josh probably didn’t even hear it, “I hope you are.”

***

Karen Marks climbed into the rear seat of the limo and had her phone out even before the trunk slammed shut on the suitcases her escort had shepherded through customs. It was amazing how much power David Madison’s name carried. Although it was more than two years since he’d sat behind the desk in the Oval Office, he still had clout.

Karen punched in a speed-dial number. Before it could produce a ring, the driver turned toward her and asked, “Where to, Miss Marks?”

“I’ll tell you in a moment. In the meantime, just sit here and—” She signaled for him to close the soundproof glass partition, and at the same time said, “Jerry? Karen Marks. I’m on the ground in Dallas. Give me a sitrep.”

She’d never dropped the habit of using abbreviations that were standard procedure in government. Lang would know she meant “situation report.” And he’d give it concisely, without added verbiage. Given her choice, she preferred to deal with people who had worked in the White House. Barring that, at least let them have government experience. Those people were familiar with the chain of command, and most of them knew when to keep their mouths shut. She missed that in post-

government life.

As she expected, the report Lang gave her was short and to the point. When he’d stopped speaking, she said, “So, who knows Madison’s sick and in the hospital?”

“I talked with Madison’s wife, of course, and she’ll be here later today. Other than that, not many people know. The doctors treating Madison and Rachel Moore, a few nurses, maybe one or two other medical personnel—all vetted by me and all sworn to secrecy.”

“So what can I do?”

“You can help with a problem with Dr. Lambert’s body,” Lang said.

Karen closed her eyes in order to concentrate as he told her about the cremated remains that had turned up. “Have you been able to keep this information quiet so far?”

“I’ve told the president about it, but so far no one else knows except the funeral director who called me. I haven’t even had time to notify the police. And I don’t know what we’re going to do about Mrs. Lambert.”

There was always something, wasn’t there? Then again, Karen knew that was what she did. Now she’d handle this problem the way she had done so many others. She sighed into the receiver, not caring if Jerry heard it. “You keep things buttoned up there at the hospital. I’ll take care of this. Give me the name and address.”

“Are you—”

“Jerry, have I ever let you or the president down? You’ll hear from me soon.”

Karen closed the phone and tapped on the glass partition. “I need to make a phone call. While I’m doing that, take me to this address.” She gave him one in the University Park area. Before the car was moving, she had her phone open again and was dialing.

***

When David Madison was admitted to Prestonwood Hospital, not only were a number of security measures necessary, but accommodations for his family and his medical staff were put into place. One of those measures was the designation of a small office for the exclusive use of his physician.

Now Josh sat in that office, the door closed. He’d given strict orders that he wasn’t to be disturbed. He had none of his material from his own office at the clinic at his disposal, but fortunately he had all he needed: a computer and a phone. He used the first to find a number, then the second to make the call to the Centers for Disease Control and Prevention . . . the CDC.

This was his first direct contact with this agency, although he’d heard about it since medical school. Josh hoped he would be able to navigate the labyrinth of departments without too much difficulty. Then again, it was a government agency.

After his call was transferred several times, Josh was finally connected with the appropriate duty officer. He identified himself and said, “I need enough diphtheria antitoxin to treat two patients.”

“We don’t get much call for that,” the doctor on the other end said. “Let’s talk about the indications for DAT treatment of patients.”

Josh patiently provided information until at last he said, “Look! I’m a board-certified internal medicine specialist. I’ve examined the patient. I’ve looked at the slides. These people have airways that are at risk. Now, how soon can I get the DAT?”

“I’ll have to check the database to locate it,” the duty officer said. “Let me get back to you shortly.”

Josh was caught on the horns of a dilemma. If he hid the identity of his patient, it might take a day, even a couple of days to get the antitoxin. On the other hand, he was certain David Madison wasn’t anxious for the whole world to know the details of his illness. “Let me emphasize that this is a genuine medical emergency,” Josh finally said. “I need that antitoxin today. ASAP. Stat. If necessary, I’m prepared to send a private jet to pick up the antitoxin and fly it back here.”

“Sounds like either you or your patient have resources most of us don’t.”

Please don’t let this guy throw a monkey wrench into the works just because he’s envious. “I’m not at liberty to disclose the identity of the patients involved,” Josh said. He hardened his voice. “I’m going to say this once more. This is a medical emergency. Give me your name and your direct number. I’m going to call you back in thirty minutes, and I want you to get me sufficient diphtheria antitoxin for two patients. Do you understand?”

After Josh hung up, he wondered if he’d handled the situation the right way. Should he have used Madison’s name and invoked his influence? Maybe he should have checked with Jerry Lang before making the call. Josh reached for his cell phone, where he’d entered Lang’s number. If Ben Lambert weren’t dead . . . but he was, and Josh was on his own. I guess I have a lot to learn about caring for an ex-president.

***

Karen Marks exited the limousine as soon as the driver opened the door for her. “Wait here. I shouldn’t be long,” she said.

The neighborhood where they were wasn’t in the same league as the estate where David and Mildred Madison lived, but it certainly wasn’t a poor one, either.

The home was a rambling, one-story house in a nice neighborhood—not pretentious, not opulent. Probably bought it as soon as they could after Ben graduated from med school. If there were children, they were long since gone.

She squared her shoulders and rang the doorbell. Karen had done lots of difficult tasks for David Madison at all his stops in government service. It never got easier, but she’d learned that a direct approach was best. It was sort of like ripping off a bandage. Get it done and move on.

The woman who answered the door was probably in her mid-sixties. Her black hair was neatly combed and styled. She’d made no effort to hide the streaks of gray that ran randomly through it. The woman wore a simple black dress, and reading glasses with red horn-rimmed frames dangled from a chain around her neck.

“Yes?” the woman said.

“Mrs. Lambert?”

“Yes.”

“I’m Karen Marks. I’m David Madison’s administrative aide—sort of a chief of staff, I guess you’d say. May I come in? I need to give you some news about your husband.”

The woman stepped back and gestured Karen into the house. “I don’t know how much worse any news could be than that my husband is dead,” she said. There was neither rancor nor self-pity in her voice. This was a woman who’d already shed her tears in private. Perhaps her husband’s relationship with the ex-president had schooled her in facing the world in good times and bad.

“Is there somewhere we can sit and talk?” Karen asked.

Mrs. Lambert nodded and escorted Karen into a living room, where she took a side chair and Karen perched on the couch. “What have you come to tell me?” Mrs. Lambert asked.

“One of our party—a nurse who participated in the attempts to revive your husband—escorted his body home. After Mr. Lang, the head of the Secret Service detail, talked with you, he contacted Sparkman Hillcrest and arranged for a funeral director to meet the chartered aircraft and take charge of the body. But another hearse got there first.”

“What are you saying?”

“Someone took your husband’s body.”

Other than a sharp intake of breath, Mrs. Lambert showed no emotion. “I called Sparkman Hillcrest this morning,” she said. “They told me Ben’s body wasn’t ready for viewing and I should call tomorrow. I guess that’s why.”

“There’s more,” Karen said. “This morning, cremated remains were left on the doorstep of the funeral home, along with your husband’s watch, wallet, and wedding ring.”

Mrs. Lambert slowly shook her head. “Why would anyone—”

“My guess is there was a terrible error. For instance, the body these people expected to receive might have been someone who died of a highly communicable disease. Immediate cremation was called for and carried out. In the meantime, the police had been in contact with every funeral director in town, looking for your husband’s body. When these people went through the personal effects that accompanied the body, they realized their error. It was too late to stop, so they did what they could. They delivered the cremains to the right funeral home with the personal effects and a note that said they were sorry.”

Mrs. Lambert sat silent, shaking her head, her lips pursed. Then she said, “You said the personal effects were a wallet, a watch, and a wedding ring?”

“Yes. The wallet was your husband’s, with identifying material inside. The watch had his name engraved on the back, apparently a gift of some kind. And the wedding ring bore his initials and yours inside it.”

“What about his class ring?”

Karen shook her head. “All we have is what I’ve described.”

Mrs. Lambert looked away. “Ben did his pre-med at Texas A&M. That senior ring was more precious to him than his wedding band. He never took it off.” She fixed Karen with a steady gaze. “If there was no A&M senior ring with the personal effects, I can’t believe that those cremated remains are those of my husband.”