Richard L. Mabry writes killer stories. His books are white knuckle reads. I literally sit on the edge of my seat and often catch myself holding my breath as I read. Â Don’t take my word for it. Â Scroll down and read the first chapter yourself.
***Special thanks to Julie Dowd (Abingdon Press) for sending me a review copy.***
Dr. John Ramsey is seeking to put his life together after the death of his wife by joining the medical school faculty. But his decision could prove to be costly, even fatal.
Potentially lethal late effects from the experimental drug send Sara and her colleague, Dr. Rip Pearson, on a hunt for hidden critical data that will let them reverse the changes before itâ€™s too late. What is the missing puzzle piece? And who is hiding it?
No one knew the manâ€™s name. White male, probably in his late seventies, found unresponsive in an alley about two oâ€™clock in the morning and brought to the emergency room. Just another homeless derelict, another John Doe.
â€œPneumonia, late stages,â€ the intern said. He yawned. â€œHappens all the time. Drank himself into a stupor, vomited, aspirated. Probably been lying in that alley for more than a day. Doesnâ€™t look like heâ€™ll make it.â€
â€œLabs cooking? Got a sputum culture going?â€
â€œYeah, but itâ€™ll take a day or two to get the results of the culture. The smear looks like Staph. Guess Iâ€™ll give himâ€”â€
â€œWait. Iâ€™ve got access to an experimental drug that might help. Let me start him on that.â€
The intern shrugged. It was two in the morning. Heâ€™d been on duty for more than twenty-four hours straightâ€”whyâ€™d Johnsonâ€™s wife have to go into labor today?â€”and he was bushed. The bum probably didnâ€™t have a snowballâ€™s chance of surviving anyway. Why not? â€œYouâ€™ll be responsible?â€
â€œIâ€™ll take it from here. Even do the paperwork.â€
â€œDeal,â€ the intern said, and ambled off to see the next patient.
Three hours later, John Doe lay on a gurney in a corner of the ER. An IV ran into one arm, a blood pressure cuff encircled the other. Spittle dripped from his open mouth and dotted his unshaven chin. His eyes were open and staring.
â€œAcute anaphylaxis, death within minutes. Interesting.â€ He scratched his chin. â€œGuess I need to make some adjustments in the compound.â€ He picked up the almost-blank chart. â€œIâ€™ll say I gave him ampicillin and sulbactam. That should cover it.â€
* * *
The womanâ€™s look pierced Dr. Sara Milesâ€™ heart. â€œDo you know whatâ€™s wrong with Chelsea?â€
Chelsea Ferguson lay still and pale as a mannequin in the hospital bed. An IV carried precious fluids and medications into a vein in her arm. A plastic tube delivered a constant supply of oxygen to her nostrils. Above the girlâ€™s head, monitors beeped and flashed. And over it all wafted the faint antiseptic smell of the ICU.
Chelseaâ€™s mother sat quietly at the bedside, but her hands were never still: arranging and rearranging her daughterâ€™s cover, twisting the hem of her plain brown skirt, shredding a tissue. Sara decided that the gray strands in Mrs. Fergusonâ€™s long brunette hair were a recent addition, along with the lines etched in her face.
Sara put her hand on the teenagerâ€™s head and smoothed the matted brown curls. The girlâ€™s hot flesh underscored the urgency of the situation. Since Chelseaâ€™s admission to University Hospital three days ago, her fever hadnâ€™t responded to any of the treatments Sara ordered. If anything, the girl was worse.
â€œLetâ€™s slip out into the hall,â€ Sara said. She tiptoed from the bedside and waited outside the room while Mrs. Ferguson kissed her sleeping daughter and shuffled through the door.
Sara pointed. â€œLetâ€™s go into the family room for a minute.â€
â€œWill she beâ€”?â€
â€œThe nurses will check on her, and theyâ€™ll call me if anything changes.â€ Sara led the way into the room and eased the door closed. This family room resembled so many others Sara had been in over the years: small, dim, and quiet. Six wooden chairs with lightly upholstered seats and backs were arranged along three of the walls. Illumination came from a lamp in the corner. A Bible, several devotional magazines, and a box of tissues stood within reach on a coffee table.
This was a room where families received bad news: the biopsy was positive, the treatment hadnâ€™t worked, the doctors werenâ€™t able to save their loved one. The cloying scent of flowers in a vase on an end table reminded Sara of a funeral home, and she shivered as memories came unbidden. She shoved her emotions aside and gestured Mrs. Ferguson to a seat. â€œWould you like something? Water? Coffee? A soft drink?â€
The woman shook her head. â€œNo. Just tell me whatâ€™s going on with my daughter. Do you know whatâ€™s wrong with her? Can you save her?â€ Her sob turned into a soft hiccup. â€œIs she going to die?â€
Sara swallowed hard. â€œChelsea has what we call sepsis. You might have heard it referred to as blood poisoning. It happens when bacteria get into the body and enter the bloodstream. In Chelseaâ€™s case, this probably began when she had her wisdom teeth extracted.â€
I canâ€™t believe the dentist didnâ€™t put her on a prophylactic antibiotic before the procedure. Sara brushed those thoughts aside. That wasnâ€™t important now. The important thing was saving the girlâ€™s life. Sara marshaled her thoughts. â€œWe took samples of Chelseaâ€™s blood at the time of her admission, and while we waited for the results of the blood cultures I started treatment with a potent mixture of antibiotics. As you can see, that hasnâ€™t helped.â€
Sara wished the woman wouldnâ€™t be so reasonable, so placid. She wished Mrs. Ferguson would scream and cry. If the roles were reversed, sheâ€™d do just that. â€œWhile we wait for the results of blood cultures, we make a guess at the best antibiotics to use. Most of the time, our initial guess is right. This time, it was wrongâ€”badly wrong.â€
â€œBut now you know whatâ€™s causing the infection?â€ It was a question, not a statement.
â€œYes, we know.â€ And itâ€™s not good news.
Hope tinged Mrs. Fergusonâ€™s voice. â€œYou can fix this, canâ€™t you?â€
I wish I could. â€œThe bacteria causing Chelseaâ€™s sepsis is one that . . .â€ Sara paused and started again. â€œHave you heard of Mersa?â€
â€œMersa? No. Whatâ€™s that?â€
â€œItâ€™s actually MRSA, but doctors usually pronounce it that way. Thatâ€™s sort of a medical shorthand for methicillin-resistant Staphylococcus aureus, a bacteria thatâ€™s resistant to most of our common antibiotics.â€
Mrs. Ferguson frowned. â€œYou said most. Do you have something that will work?â€
â€œYes, we do. Matter of fact, when Chelsea was admitted I started her on two strong antibiotics, a combination thatâ€™s generally effective against MRSA. But she hasnâ€™t responded, because this isnâ€™t MRSA. Itâ€™s worse than MRSA.â€ She started to add â€œMuch worse,â€ but the words died in her throat.
Sara paused and waited for Mrs. Ferguson to ask the next question. Instead, the woman crumpled the tissue she held and dabbed at the corner of her eyes, eyes in which hope seemed to die as Sara watched.
â€œThis is what we call a â€˜super-bug,â€™â€ Sara continued. â€œIt used to be rare, but weâ€™re seeing more and more infections with it. Right now, none of the commercially available antibiotics are effective. These bacteria are resistant to everything we can throw at them.â€
Mrs. Fergusonâ€™s voice was so quiet Sara almost missed the words. â€œWhat do you call it?â€
â€œItâ€™s a long name, and itâ€™s not important that you know it.â€ Matter of fact, we donâ€™t use the proper name most of the time. We just call it â€œThe Killer.â€
â€œSo thatâ€™s it?â€
â€œNo, thereâ€™s a doctor at our medical center doing trials on an experimental drug that might work for Chelsea.â€ No need to mention that Jack is . . . No, let it go.
â€œCan you get some of this? Give it to Chelsea?â€
â€œI canâ€™t, but the man who can is an infectious disease specialist on the faculty here at the medical center. Actually, he helped develop it. Notice I said â€˜experimental,â€™ which means there may be side effects. But if you want meâ€”â€
â€œDo it!â€ For the first time in days, Sara saw a spark of life in Mrs. Fergusonâ€™s eyes, heard hope in her voice. â€œCall him! Now! Please!â€
â€œYou realize that this drug isnâ€™t fully tested yet. It may not work. Or the drug may cause problems.â€ There, sheâ€™d said it twice in different words. Sheâ€™d done her duty.
â€œI donâ€™t care. My little girl is dying. Iâ€™ll sign the releases. Anything you need. If this is our only chance, please, letâ€™s take it.â€
Lord, I hope I havenâ€™t made a mistake. â€œIâ€™ll make the call.â€
â€œIâ€™m going back to be with my baby,â€ Mrs. Ferguson said. She stood and squared her shoulders. â€œWhile you call, Iâ€™ll pray.â€
* * *
â€œMr. Wolfe, you can come in now.â€ The secretary opened the doors to Dr. Patelâ€™s office as though she were St. Peter ushering a supplicant through the Pearly Gates.
Bob Wolfe bit back the retort he wanted to utter. Itâ€™s Doctor Wolfe. Doctor of Pharmacology. I worked six years to earn that Pharm D, not to mention two years of research fellowship. How about some respect? But this wasnâ€™t the time to fight that battle.
He straightened his tie, checked that there were no stains on his fresh white lab coat, and walked into the office of the head of Jandra Pharmaceuticals as though he had been summoned to receive a medal. Never let them see you sweat.
Dr. David Patel rose from behind his desk and beamed, gesturing toward the visitorâ€™s chair opposite. â€œBob, come in. Sit down. I appreciate your coming.â€
Not much choice, was there? Wolfe studied his boss across the expanse of uncluttered mahogany that separated them. Pharmaceutical companies seemed to be made up of two groups: the geeks and the glad-handers. Patel typified the former group. PhD from Cal Tech, brilliant research mind, but the social skills of a tortoise. Patel had been snatched from the relative obscurity of a research lab at Berkeley by the Board of Directors of Jandra Pharmaceuticals, given the title of President and CEO, and charged with breathing life into the struggling company. How Patel planned to do that remained a mystery to Wolfe and his co-workers.
Patel leaned forward and punched a button on a console that looked like it could launch a space probe. â€œCindy, please ask Mr. Lindberg to join us.â€
Steve Lindberg ran the sales team from an office across the hall. Lindberg could memorize salient scientific material and regurgitate it with the best of them, but Wolfe would bet the manâ€™s understanding of most of Jandraâ€™s products and those of its major competitors was a mile wide and an inch deep. On the other hand, Lindberg had his own area of expertise: remembering names, paying for food and drinks, arranging golf games at exclusive clubs. No doubt about it, Lindberg was a classic glad-hander, which was why he had ascended to his current position, heading the marketing team at Jandra.
Wolfe hid a smile. Interesting. The President of the company and the Director of Marketing. This could be big. The door behind Wolfe opened. He deliberately kept his eyes front. Be cool. Let this play out.
â€œHey, Bob. Itâ€™s good to see you.â€ Wolfe turned just in time to avoid the full force of a hand landing on his shoulder. Even the glancing blow made him wince. Lindberg dragged a chair to the side of Patelâ€™s desk, positioning himself halfway between the two men. Clever. Not taking sides, but clearly separating himself from the underling.
Wolfe studied the two men and, not for the first time, marveled at the contrast in their appearance. Patel was swarthy, slim, and sleek, with jet-black hair and coal-black eyes. His blue shirt had a white collar on which was centered the unfashionably large knot of an unfashionably wide gold-and-black tie. Wolfe wondered whether the man was five years behind or one ahead of fashion trends. He spoke with a trace of a British accent, and Wolfe seemed to recall that Patel had received part of his education at Oxford. Maybe he wore an â€œold schoolâ€ tie, without regard to current fashion. If so, it would be typical of Patel.
Lindberg was middle-aged but already running to fatâ€”or, more accurately, flab. His florid complexion gave testimony to too many helpings of rare roast beef accompanied by glasses of single malt Scotch, undoubtedly shared with top-drawer doctors and paid for on the Janus expense account. Lindbergâ€™s eyes were the color of burnished steel, and showed a glimmer of naked ambition that the smile pasted on his face couldnâ€™t disguise. His thinning blond hair was combed carefully to cover early male pattern baldness. The sleeves of his white dress shirt were rolled halfway to his elbows. His tie was at half-mast and slightly askew.
Patel, the geek. Lindberg, the glad-hander. Different in so many ways. But both men shared one characteristic. Wolfe knew from experience that each man would sell his mother if it might benefit the company, or more specifically, their position in it. The two of them together could mean something very good or very bad for Bob Wolfe. He eased forward in his chair and kicked his senses into high gear.
Patel leaned back and tented his fingers. â€œBob, Iâ€™m sure youâ€™re wondering what this is about. Well, I wanted to congratulate you on the success of EpAm848. Iâ€™ve been looking over the preliminary information, especially the reports from Dr. Ingersoll at Southwestern Medical Center. Very impressive.â€
â€œWell, itâ€™s sort of Ingersollâ€™s baby. He stumbled onto it when he was doing some research here during his infectious disease fellowship at UC Berkeley. I think he wants it to succeed as much as we do.â€
â€œI doubt that.â€ Patel leaned forward with both hands on the desk. â€œJandra is on the verge of bankruptcy. I want that drug on the market ASAP!â€
â€œBut weâ€™re not ready. We need more data,â€ Wolfe said.
â€œHereâ€™s the good news,â€ Patel said. â€œThe FDA is worried about The Killer bacteria outbreak. Iâ€™ve pulled a few strings, called in a bunch of favors, and I can assure you we can get this application fast-tracked.â€
â€œHow?â€ Wolfe said. â€œWeâ€™re still doing Phase II trials. What about Phase III? Assuming everything goes well, itâ€™s going to be another year, maybe two, before we can do a rollout of EpAm848.â€
â€œNot to worry,â€ Patel said. â€œOur inside man at the FDA assures me he can help us massage the data. We can get by with the Phase II trials weâ€™ve already completed. And heâ€™ll arrange things so we can use those plus some of our European studies to fulfill the Phase III requirements.â€
Lindberg winked at Wolfe. â€œWe may have to be creative in the way we handle our data. You and I need to get our heads together and see how many corners we can cut before the application is ready.â€
Wolfe shook his head. â€œYou say this drug will save us from bankruptcy. I donâ€™t see that. I mean, yes, it looks like we may be in for a full-blown epidemic of Staph luciferus, but we wonâ€™t sell enoughâ€”â€œ
Lindberg silenced him with an upraised hand. â€œExposure, Bob. Exposure. If we get this drug on the market, if weâ€™re the first with a cure, our name recognition will skyrocket. Doctors and patients will pay attention to our other drugs: blood pressure, cholesterol, diabetes. Our market share will go through the roof in all of them.â€
Wolfe could see the salesman in Lindberg take over as he leaned closer, as though to drive home his point by proximity. â€œWeâ€™re preparing a direct-to-consumer push on all those drugs, ready to launch at the same time we release Jandramycin.â€
The name didnâ€™t click with Wolfe for a moment. â€œI . . . Well, Iâ€™ll certainly do what I can.â€
â€œDo more than that,â€ Lindberg said. â€œJandra Pharmaceuticals is hurting. Weâ€™re staking everything on Jandramycin.â€
That was the second time Wolfe had heard the term. â€œWhatâ€”â€œ
â€œStop referring to the drug by its generic name,â€ Patel added. â€œFrom now on, the compound is Jandramycin. When people hear the name Jandra Pharmaceuticals, we want them to think of us as the people who developed the antibiotic that saved the world from the worst epidemic since the black plague.â€
Lindberg eased from his chair and gave Wolfe another slap on the shoulder. â€œThis is your project now. Itâ€™s on your shoulders. The companyâ€™s got a lot riding on this.â€
And so do I. â€œBut what if a problem turns up?â€
Patel rose and drew himself up to his full five feet eight inches. His obsidian eyes seemed to burn right through Wolfe. â€œWeâ€™re depending on you to make sure that doesnâ€™t happen. Are we clear on that?â€
* * *
Sara leaned over the sink and splashed water on her face. The paper towels in the womenâ€™s rest room of the clinic were rough, but maybe that would put some color in the face that stared back at her from the mirror. Her brown eyes were red-rimmed from another sleepless night. Raven hair was pulled into a ponytail because she could never find time or energy for a haircut or a perm. Get it together, Sara. She took a deep breath and headed for the doctorâ€™s dictation room, where she slumped into a chair.
â€œSomething wrong, Dr. Miles?â€
Sara turned to see Gloria, the clinicâ€™s head nurse. â€œNo, just taking a few deep breaths before I have to make a call Iâ€™m dreading.â€
Gloria slid into the chair next to Sara. The controlled chaos of the internal medicine clinic hummed around them. The buzz of conversations and ringing of phones served as effectively as white noise to mask her next words. â€œIs it one of your hospital patients? Got some bad news to deliver?â€
â€œSort of. Itâ€™s Chelsea Ferguson.â€
â€œThe teenage girl? Is she worse?â€
â€œYes. The cultures grew Staph luciferus.â€
Gloria whistled silently. â€œThe Killer. Thatâ€™s bad.â€
â€œThe only thing that seems to be working in these cases is that new drug of Jack Ingersollâ€™s.â€
â€œOh, I get it. Thatâ€™s the call you donâ€™t want to make.â€ Gloria touched Sara lightly on the shoulder. â€œWhen will you stop letting what Ingersoll did ruin the rest of your life? I can introduce you to a couple of nice men who go to our church. Theyâ€™ve both gone through tough divorcesâ€”neither was their faultâ€”and they want to move on. It would be good for youâ€”â€
Sara shook her head. â€œThanks, but Iâ€™m not ready to date. Iâ€™m not sure if I can ever trust a man again.â€
Gloria opened her mouth, but Sara silenced her with an upraised hand. No sense putting this off. She pulled the phone toward her and stabbed in a number.
* * *
Dr. John Ramsey found a spot in the Visitorâ€™s Parking Lot. He exited his car and looked across the driveway at the main campus of Southwestern Medical Center. When heâ€™d graduated, there were two buildings on the campus. Now those two had been swallowed up, incorporated into a complex that totaled about forty buildings on three separate campuses. Right now he only needed to find one: the tall white building directly across the driveway at the end of a flagstone plaza. The imposing glass faÃ§ade of the medical library reflected sunlight into his eyes as he wove past benches where students sat chatting on cell phones or burrowing into book bags. He paused at the glass front doors of the complex, took a deep breath, and pushed forward.
There was a directory inside for anyone trying to negotiate the warren of inter-connected buildings, but John didnâ€™t need it. He found the elevator he wanted, entered, and punched five. In a moment, he was in the office of the Chairman of Internal Medicine.
â€œDr. Schaeffer will be with you in a moment.â€ The receptionist motioned him toward a seat opposite the magnificent rosewood desk that was the centerpiece of the spacious office, then glided out, closing the door softly behind her.
John eased into the visitorâ€™s chair and looked around him. Heâ€™d spent forty years on the volunteer clinical faculty of Southwestern Medical Centerâ€™s Department of Internal Medicine. For forty years heâ€™d instructed and mentored medical students and residents, for forty years heâ€™d covered the teaching clinic once a month, and today was the first time heâ€™d been in the department chairmanâ€™s office. He swallowed the resentment he felt bubbling up. No, John. You never wanted to be here. You were happy in your own world.
John couldnâ€™t help comparing this room with the cubbyhole heâ€™d called his private office. Now he didnâ€™t even have that. The practice was closed, the equipment and furnishings sold to a young doctor just getting started. Johnâ€™s files and patient records were in a locked storage facility, rent paid for a year.
He wondered how many of his patients had contacted his nurse to have their records transferred. No matter, sheâ€™d handle it. Heâ€™d paid her six monthsâ€™ salary to take care of such things. What would happen after that? He didnâ€™t have the energy to care. Things were different now.
For almost half a century heâ€™d awakened to the aroma of coffee and a kiss from the most wonderful woman in the world. Now getting out of bed in the morning was an effort, shaving and getting dressed were more than he could manage some days. Since Beth died . . . He shook his head, trying to clear the cobwebs that clogged his brain. The knowledge that heâ€™d never again know the happiness of having a woman he loved by his side made him wish heâ€™d died with her. What was the use of going on?
But something happened this morning. Heâ€™d awakened with a small spark of determination to do something, anything, to move on. He tried to fight it, to roll over and seek the sleep that eluded him. Instead, he heard the echo of Bethâ€™s words: â€œYouâ€™re too good a physician to retire. People need you.â€ He remembered that conversation as though it were yesterday. Sheâ€™d urged, heâ€™d insisted. Letâ€™s retire. I want to get out of the rat race and enjoy time with you. Retirement meant the travel theyâ€™d put off, the time to do things together. Only, now there was no more together.
This morning, heâ€™d rolled out of bed determined that today would be different. It would be the start of his rebirth. As he shrugged into a robe, as heâ€™d done each day since her death he looked at the picture on their dresser of him and Beth. Sheâ€™d been radiant that spring day so many years ago, and he wondered yet again how heâ€™d managed to snag her.
Heâ€™d shavedâ€”for the first time in daysâ€”with special care, and his image in the mirror made him wonder. When did that slim young man in the picture develop a paunch and acquire an AARP card? When had the thick brown hair been replaced by gray strands that required careful combing to hide a retreating hairline? The eyes were still bright, although they hid behind wire-rimmed trifocals. â€œYouâ€™re too old for this, John,â€ he muttered. And as though she were in the room, he heard Bethâ€™s words once more. â€œYouâ€™re too good a physician to retire. People need you.â€
Fortified with coffee, the sole component of his breakfast nowadays, heâ€™d forced himself to make the call. He asked his question and was gratified and a bit frightened by the positive response. John dressed carefully, choosing his best suit, spending a great deal of time selecting a tie. Heâ€™d noticed a gradual shift in doctorsâ€™ attire over the past few years. Now many wore jeans and golf shirts under their white coats. But for John Ramsey, putting on a tie before going to the office was tantamount to donning a uniform, one heâ€™d worn proudly for years. And heâ€”
â€œJohn, I was surprised when I got your call. To what do I owe the pleasure?â€ Dr. Donald Schaeffer breezed into the office, the starched tails of his white coat billowing behind him. He offered his hand, then settled in behind his desk.
â€œDonald, I appreciate your taking the time to see me. I was wonderingâ€”â€
â€œBefore we start, I want you to know how sorry we all are for your loss. Is there anything I can do?â€
Perfect lead-in. See if you can get the words out. â€œAs you know, I closed my office four months ago. Beth and I were going to enjoy retirement. Then . . .â€
Schaeffer nodded and tented his fingers under his chin. At least he had the grace not to offer more platitudes. Ramsey had had enough of those.
â€œI was wondering if you could use me in the department.â€ There. Not the words heâ€™d rehearsed, but at least heâ€™d tossed the ball into Schaefferâ€™s court.
â€œJohn, are you talking about coming onto the faculty?â€
â€œMaybe something half-time. I could staff resident clinics, teach medical students.â€
Schaeffer was shaking his head before John finished. â€œThatâ€™s what the volunteer clinical faculty does. Itâ€™s what you did for . . . how many years? Thirty? Thirty-five?â€
â€œForty, actually. Well, Iâ€™m still a clinical professor in the department, so I guess I have privileges at Parkland Hospital. Can you use me there?â€
Schaeffer pulled a yellow legal pad toward him and wrote a couple of words before he pushed it aside. â€œIâ€™m not sure what I can do for you, if anything. Itâ€™s not that easy. You have no idea of the administrative hoops I have to jump through to run this department. Even if I could offer you a job todayâ€”and I canâ€™tâ€” Iâ€™d have to juggle the budget to support it, post the position for open applications, get half a dozen approvals before finalizing the appointment.â€ He spread his hands in a gesture of futility.
â€œSo, is that a â€˜noâ€™?â€
â€œâ€Thatâ€™s an â€˜Iâ€™ll see what I can do.â€™ Afraid thatâ€™s the best I have to offer.â€ Schaeffer looked at his watch, shoved his chair back and eased to his feet. â€œComing to Grand Rounds?â€
Why not? Johnâ€™s house was an empty museum of bitter memories. His office belonged to someone else. Why not sit in the company of colleagues? â€œSure. Iâ€™ll walk over with you.â€
As the two men moved through the halls of the medical center, John prayed silently that Schaeffer would find a job for him. With all his prayers for Beth during her final illness, prayers that had gone unanswered, he figured that surely God owed him this one.