Читать книгу Miracle Drug - Richard L. Mabry M.D. - Страница 12

Chapter 5

5

Karen climbed into the backseat of the limo and said, “Prestonwood Hospital. And close the partition, please.”

She dialed Jerry Lang. “Okay, I broke the news to Mrs. Lambert.”

“How did she take it?”

“We may have a problem. She insisted that if there was no Texas A&M class ring with the personal effects, she couldn’t be certain the remains were those of her husband.”

“So . . .”

“I told her the police would investigate further and get back to her. Can you take care of talking with them?”

“Sure,” Lang said. “The detective in charge is a guy named Warren. I’ll ask him to keep a lid on it for a few days.”

“Have him contact the funeral director who has the cremains we think are Lambert’s, and tell him to keep his mouth shut until he hears from us.”

“Already did that when he called me,” Lang said.

“Now what else?”

Lang’s sigh came over the phone clearly. “I’ve got a situation here.”

“Tell me about it.” I’ve been back in the U.S. for less than three hours and I’m already solving problems. Maybe one day David will realize how much I do for him.

“President Madison’s doctor needs diphtheria antitoxin to administer to both his patients. He’s talked with the duty officer at the CDC and is due to call him back in a few minutes. Frankly, he’s not sure whether to reveal Madison’s identity. If he does, it may start a rumor about Madison’s health. On the other hand, if he doesn’t, he thinks he risks getting a runaround for what I understand is a vital treatment. He was about to ask Madison, but I suggested he wait until I talked with you.”

“Do you have the name and number of the person he talked with?”

Karen jotted the information down on a small notebook she pulled from her purse. “Tell the doctor I’ll call and straighten this out. And I should be at the hospital soon. Be certain I’m cleared for immediate access to the boss.”

She leaned forward and tapped on the glass partition until the driver opened it. “If I’m still talking when we get to Prestonwood, stop in the emergency room area and keep the motor running so the air conditioner keeps it cool back here.”

“But if the guard asks me to move—”

“If he does, I’ll handle him. Now I have to make a call.” As soon as the glass was closed, Karen dialed the number Lang had given her. Actually, she didn’t mind doing battle like this. She’d had very little of it since leaving DC. It was good to get back into action.

“Dr. James,” came a voice in her ear.

“Doctor, this is Karen Marks. I’m the administrative aide for former president David Madison. I believe you spoke earlier to a doctor who needed diphtheria antitoxin for two patients. I’m calling to get that done—we need it in Dallas ASAP. How are we going to do that?”

“I . . . I was expecting Dr. Pearson to call back.”

“And instead you have a woman calling on behalf of the ex-president. I hope you understand what this means.”

“Is . . . is this for President Madison?”

“Let’s say that Mr. Madison feels it’s very important for this request to be expedited. Now, where is the material, and how do we get it here in the next few hours?”

“Uh, there’s a small supply of DAT at the CDC Quarantine Station in Houston. Their location is actually at Intercontinental Airport there. I can authorize the issuance of the vaccine as an investigational drug to Dr. Pearson.”

“Tell me what you need from this end. I’ll have a plane at Intercontinental Airport in two hours to pick it up.” She spent a few more minutes clearing up details. Her last words to the duty officer were, “Thank you for your cooperation, Dr. James. I’ll make certain your superiors know how you assisted President Madison.”

You’ve still got it, Karen. Ask how “we” are going to get this done, so the person feels they’re part of the solution. And always dangle the carrot once you’ve shown them the stick.

***

Josh sat at the desk in his hospital “office” and wished he could turn back the clock. Three days ago, he’d been like any other doctor, happy with his role in the Preston Medical Clinic’s hierarchy, looking forward to his girlfriend’s return from her travels. Then, as though someone had waved a wand to accomplish the change, he was the personal physician of one of the most important men in the world. And his patient had a real problem.

Now, although he wanted to be at Rachel’s side, to watch over her, to do everything possible to guard her from the consequences of her illness, he knew his primary duty lay with the patient in the room across the hall from Rachel’s. Never before had he so wished he could suspend the laws of physics and be in two places at one time.

Then there were his other patients. Despite Nadeel Kahn’s assurances to him that his patients would be covered, Josh couldn’t shake the obligation he felt toward them. “Just take care of President Madison,” was what Kahn said. What he really meant, of course, was “Give your best efforts to caring for the ex-president. The publicity will be good for Preston Medical Clinic.”

Josh looked at his watch: a bit after four in the afternoon. Lang had suggested he wait to call the CDC duty officer back until the agent could run the situation by Karen Marks and discuss whether to invoke Madison’s name. It seemed Karen was the “get it done” person on the ex-president’s staff. Well, Josh hoped—

His thoughts were interrupted by a brisk knock at his closed door. Josh brought his swivel chair upright and planted his feet squarely on the floor. He shrugged to ease the fit of his white coat—it had never seemed so uncomfortable—and took a deep breath. What now? “Come in,” he called.

The woman who entered was striking, to say the least. Josh’s gaze was immediately drawn to sparkling blue-green eyes accented by a just a hint of mascara. Her pale blonde hair fell to her shoulders in soft waves, framing a beautiful face. A faint amount of make-up was applied to porcelain-like skin.

At first glance, Josh decided she could have been a model or a movie star. But when he looked more closely, he saw something more. There was ice in the sparkling eyes. Her features were exquisite but displayed no emotion. Josh sensed she would be a dangerous enemy.

She stepped forward and extended her hand. “Dr. Pearson? I’m Karen Marks. Nice to meet you.”

Josh took the proffered hand. At first, he wondered if he was supposed to shake it or kiss it. He settled on the former, and she gave him what he decided was a politician’s handshake—grasp the other person’s hand as far in as possible, to avoid getting your own hand crushed; one quick squeeze, neither too strong nor too gentle; then release.

He figured that Karen Marks was probably slightly on the far side of forty, but she could easily be mistaken for thirty—that is, until you looked into her eyes. Within them he could see experience and something more. He wasn’t sure what else he saw, but it told him he didn’t want to challenge this woman.

“Please, sit down,” Josh said, indicating one of the two side chairs opposite his desk.

She smoothed the skirt of her perfectly tailored navy business suit and lowered herself with ease. “Jerry Lang explained you needed some . . . what did he call it? Oh, yes. Diphtheria antitoxin. DAT, I think he said. Anyway, I’ve talked with the CDC. Your antitoxin is in Houston. I arranged for Agent Gilmore to fly down, pick it up, and deliver it here.” She reached into her handbag and extracted a sheaf of papers. “I had these faxed here. After you’ve signed them, give them to Jerry or me and we’ll see they’re faxed back. The last two pages are instructions for administering the DAT.”

Josh had that feeling again, the same one he had in the limo when he first met David Madison. Things were going too fast for him. On the one hand, he thought he needed to regain control of the situation. On the other, he appreciated this newfound ability to simply say, “I need something” and it was done. No question, this was a different world.

“Thank you,” Josh said. “Did you have to use President Madison’s name?”

“I used his influence, but there was never any suggestion that the drug was for him,” Marks replied. “You’ll learn how to do that, too.”

Yes, and probably to lie and cheat a bit if I’m not careful. “Look, I’m happy that you got the DAT for President Madison and Miss Moore, but let me be clear. All I want to do is practice the best medicine possible. If there’s any political maneuvering to be done, I want to know about it ahead of time.”

Marks gave him a sweet smile that was totally devoid of mirth. She rose, smoothed her skirt, and picked up her purse. “I think you’re telling me to stand aside. Well, I promise I won’t challenge your medical judgment or interfere with your treatment. But I guess I should warn you, if you haven’t already got the message. I’ll do anything for David Madison.” At the door, she turned and said over her shoulder. “Anything!”

***

Josh found Allison Neeves in her office at the clinic. She was working her way through a pile of charts, dictating from a stack of notes scattered across her desk. Allison looked up when Josh tapped on the frame of the open door.

“Come in,” Allison said. “I checked on Rachel and she seems to be holding her own. But if we’re going on a presumptive diagnosis of diphtheria, we need to get her started on some diphtheria antitoxin.” She put down the chart she was holding. “And the same for President Madison, of course.”

Josh dropped into a chair across the desk from Allison. “Look,” he said, “this could get awkward, and I don’t want it to be. I’m Madison’s doctor. I didn’t lobby for the position, but I’ve got it. You know that he and Rachel probably have the same infection. I’d like to treat her too, but I agree that would present something of an ethical problem. However, you and I need to stay on the same page. Can we do that?”

“I think what you’re saying is that you’d like to call the shots for both patients, with me acting like your intern on Rachel’s case—writing the orders, reporting to you.” She leaned back in her chair and sighed. “I’ll try to cooperate, but you should realize that Rachel is my patient, not yours, and I have to make the final decisions about her treatment.”

Josh rose. “I don’t think we need to argue right now. That DAT should arrive—” He looked at his watch. “It should be at the hospital in a couple of hours. Is it okay if I write the orders for both patients to receive it?”

Allison shook her head. “Just call me when it comes in. I’ve already reviewed the protocol. I’ll check Rachel and write the orders for her; you take care of Madison.”

“If that’s the way you want it,” Josh said. He rose, turned, and headed for the door. I don’t know what I did to step on her toes, but I can’t worry about that. I’ve got to give David Madison the best possible care. And Rachel, of course.

***

“Mr. Madison,” Josh said as he entered the ex-president’s hospital room. “How are you feeling?”

“Not great,” Madison admitted. “My throat’s getting pretty sore.”

Josh noted a raspiness in his patient’s voice—something that hadn’t been there before. “Any difficulty breathing?” he asked.

“Not . . . well, maybe occasionally.”

“Okay. The diphtheria antitoxin has arrived, but before we give it to you, I have to ask you some questions, then do a skin test.” Seeing the confusion in Madison’s eyes, Josh said, “The DAT is made from horse serum, so I have to be certain you won’t have a reaction to it.”

Josh went through the litany, using the checklist he’d made so he wouldn’t forget anything. Hay fever? No. Asthma? No. Hives? No. Madison couldn’t recall previously receiving any products made from horse serum.

The skin tests were negative, as Josh expected. Now it was time. A nurse brought in a small bag of sterile saline and Josh added DAT to it. He attached a needle to the tubing and piggy-backed the mixture into the IV already in Madison’s hand, then started the material flowing.

“Will you be checking back on me from time to time?” Madison asked.

Josh inclined his head toward the upholstered chair in the corner of the room. “No. That chair reclines. I’m going to sit in it for the next several hours.” Madison didn’t realize it, but Josh knew that if anything went wrong, minutes—no, seconds—

would count. He looked at the crash cart in the corner. It contained everything needed to treat emergencies, including an anaphylactic reaction. Atop it was a wrapped set of sterile instruments for an emergency tracheotomy, an operation to open the obstructed airway of a patient. From its external appearance, the red-painted Craftsman rolling cabinet didn’t look particularly unique, but at this moment it was the most important piece of equipment in the United States. And Josh was the most important person.

***

As Ethan Grant prepared to leave for the day, he went through his usual routine, scanning the petri dishes one by one, looking for anything out of the ordinary. He knew that, like that of an airline pilot, his job here in the bacteriology lab of Prestonwood Hospital might be routine most of the time, but it had the occasional moment when he needed every ounce of skill and experience, because he was dealing with, quite literally, a life-or-death situation.

The round, flat glass dish he lifted from the incubator contained a gel-like substance on which scattered colonies of bacteria grew. This was the culture from a swab or specimen that would help him identify the organism and then define the antibiotic to which it was sensitive.

This particular set of plates wasn’t even twelve hours old. It would probably be tomorrow or the next day before Ethan could definitively name the species of bacteria growing on them and say with certainty what antibiotics would work best to treat the patient from which the specimen came. But despite the short time involved, these colonies were already growing more vigorously than usual. Ethan toyed with the idea of making a slide to see if the organisms on the petri dish were the same as what he and Dr. Pearson saw earlier that day.

Before he could act on his thought, the phone rang. Ethan replaced the petri dish in the incubator and reached for the phone. The call was from a physician who suspected his patient was suffering from septicemia—bacteria infecting the bloodstream. Could Ethan check the blood cultures drawn the previous day?

Ethan looked at each of the three specimens carefully. It was too early to call them negative, but he could see no growth. He replaced the bottles and returned to the phone. “Doctor, they look negative. There’s no growth in any of them.”

“You’re sure?”

Of course I’m sure. I’ve been doing this for . . . Never mind. “Yes, sir.”

“Well, keep an eye on them.”

Ethan’s routine was the same followed by most, if not all, laboratories in the U.S.: monitor specimens for five days. If there was any indication of growth, he’d do a slide and Gram stain it. He could explain this to the doctor, but there was no need. The man was worried about his patient. Ethan could understand that.

After he hung up, Ethan wondered if he should follow through with making and examining another slide from the culture taken from Josh’s patient. Then he looked at the clock. It was already almost six, nearly an hour past time for him to leave. He decided to put that on the back burner until morning. It probably wasn’t important, anyway.