Diagnosis Death (28 page)

Glasses touched, murmurs of "hear, hear." Then the conversational buzz began.

Elena leaned across the table toward Cathy. "I'm glad your OB let you come tonight."

"I'm doing well, so he decided to turn me loose for an evening. Thank you for inviting us."

To Will, she said, "I'm grateful for all your legal help, but more important, I appreciate your support. I can never repay you for all you've done."

"Consider the bill paid. You've been a great addition to Cathy's practice. Well, I guess it's yours too, now."

"Thank you for inviting me," Natalie said to Elena. "I don't have many friends in town, and even though I work in the hospital, I don't come in contact with the doctors very much."

"Maybe Marcus can help you with that," Elena said.

"I'll do my best," Marcus said. "I have to admit that the social worker's office isn't somewhere doctors like to hang out, but maybe I can buy you coffee in the cafeteria and introduce you around."

Natalie turned toward her sister-in-law and mouthed, "Thanks." And was she blushing just a bit?

Elena decided to ask the question she knew was on everyone's mind. "Will, what do you think will happen to Dr. Godwin?"

Will put down the roll he was buttering. "I heard through the grapevine that he left the police station, went home, emailed his resignation to the members of the hospital board, and started packing."

Cathy looked puzzled. "Won't he have to be here for a trial?"

"He'll be charged with a misdemeanor. I'm pretty sure his lawyer will plead it out and ask for probation. In the meantime, Nathan will probably move on to another town and most likely repeat the pattern."

"I guess repeating the pattern is pretty typical in cases like that," Elena said.

"In his case, very typical." Will replied. "One of my sources in the police department tells me this isn't the first time Nathan has done this. Marcus, is there anything you can do to spread the word about him? Ethically, of course."

Marcus nodded. "I expect the hospital board to ask me to resume the duties they gave to Nathan, so I'd be the one responding to any requests for references. I'll have to be careful what I say, but I think I can get the message across."

"Elena, I still can't believe you confronted Nathan instead of calling the police," Cathy said.

"I'd forgotten that shotgun was still at my folks' house," Will said. "But there was no ammunition for it."

"Nathan didn't know that," Elena said. "And I'll have to admit, that sound even scared me, and I was the one holding the gun."

Elena let her gaze sweep around the table. She felt blessed by the presence of these people in her life. Coming to Dainger had indeed involved danger. But the process had left her better equipped to move on with her life.

Natalie was chatting with Marcus. Cathy and Will had their heads together, whispering as only a married couple could do. Beside her, David pretended to study his menu, but she saw the glances he directed toward her.

Elena knew she had to face her feelings for David soon. Marcus had become a friend, but she was convinced that was all he'd be in her life. Frank Perrin—well, Frank was a "bad boy" who might provide a thrill, like seeing how close to a flame you could get your hand without getting burned. But she was certain the threat of a burn would always be there.

Mark's death had taken away a part of her life that could never be replaced. His infidelity, even if he had planned to end the affair, left her with a sense of distrust, but it was unfair to let that carry over to David. More and more, she felt certain that he was the best candidate to help her rebuild her life, if she'd just give him the chance.

As though he'd been tuned in to her thoughts, David leaned in toward her and whispered, "Would you like to go to church with me in the morning?"

"I'd like that."

"And sometime next week, I want to take you out for dinner and a movie."

"You mean like we used to do back in Dallas. As a friend?" Elena struggled to hide the grin she felt coming.

"Absolutely not. Like a real date."

"Sounds fine." She let the smile break through. "I think we have a lot to talk about."

S
ummer moved to fall, and winter followed. But at last spring came to Dainger. White clouds of blossoms filled Bradford pear trees. Delicate red flowers decorated the redbuds. Along the highway, bluebonnets sprang up in random profusion. The earth was green with the promise of new beginnings.

As was the case every year at Easter, the sanctuary of the First Community Church overflowed. Faithful and occasional worshipers shared pew space as they came to celebrate this holiest of days. Pastor Matthew Kennedy had no need to follow the familiar words in his hymnal, so he let his eyes roam over the congregation as he sang.

Will and Cathy sat in their usual place, halfway forward and on the aisle. Next to them, Dora, the proud grandmother, gently rocked young David Matthew Kennedy in her arms.

Seated in the back of the sanctuary, Marcus Bell and Natalie Cook shared a hymnbook. He'd seen them a few times around town, but this was the first time they'd appeared together in church. He hoped things went well between them. They'd both been dealt disappointment and deserved a new chance for happiness.

At first he almost missed them, but at last he spotted Elena and David. He'd never get used to calling them Dr. Gardner and Dr. Merritt, so it was a good thing they'd granted him first-name license. At first Elena's attendance was spotty, but recently she had been right there beside David for every service. That boded well for the forthcoming marriage that the ring on her finger signified.

The hymn ended and so did his reverie. Time to open God's Word to the people.

"Before we consider the glorious event that we mark today, I'd like to share something that seems quite appropriate. There are many of you in this congregation today who've been in a tomb of your own, a dark and forbidding place from which there seemed to be no exit. But God, in His mercy and power, brought you forth into the light. Yet you fear for the future, because you're not certain He can or will do it again.

"Listen to these words from a very wise man: 'What God has done in the past is both a model and a promise of what He will do in the future; but He's too creative to do the same thing the same way twice.'

"Don't forget what's been done for you in the past. But always remember that there's more to come."

Matthew glanced up from his notes in time to see Elena give David a knowing look and reach for his hand. The pastor imagined he could read the young man's lips, as he leaned in toward his fiancée and whispered, "I can hardly wait to see what comes next."

 

1. Elena had multiple fears—a lonely house, loss of a place to practice medicine, being thought a mercy killer, perhaps being a menace to her own patients. What do you think was the most significant? What things make you afraid? Which one is the most significant? What have you done to address your fears?
   
 

2. Do you think Elena was overly sensitive about her racial background? Was that the only factor that estranged her from her mother-in-law? Was that relationship typical of any families you know? Could it have been repaired?
   
 

3. What were Cathy's major concerns about taking Elena into her practice? Did Will have different areas of concern? When taking on someone in a business or similar relationship, what factors do you consider?
   
 

4. With what characters did you most closely identify? Why? Were there characters who "turned you off" from almost the moment they were introduced? Why?
   
 

5. What is your assessment of Frank Perrin? Why do you think that? What advice would you have given Cathy about him when you first learned of their relationship?
   
 

6. What did you like about Marcus Bell? What did you dislike about Nathan Godwin? In what ways were the two men similar? What differentiated them? Did you see any of your own characteristics in either man?
   
 

7. What is your reaction to the final statement from Pastor Matthew Kennedy in the epilogue? How is that applicable to your life?
   
 

8. What single thing did you take away from this novel? Is it worth sharing?
   

In the fourth book of the Prescription for Trouble series,
an experimental drug that seemed the perfect solution to a
deadly epidemic turns into a
Lethal Remedy.

Book Four in the Prescription for Trouble Series

N
o one knew the man's name. White male, probably in his late seventies. Found in an alley off Industrial Boulevard about two a.m. and brought to the Parkland Hospital Emergency Room. Just another homeless derelict, another John Doe.

"Pneumonia, late stages," the intern said. He yawned. "Happens all the time. Drank himself into a stupor, vomited, aspirated. Probably been lying in that alley for a couple of days. Doesn't look like he'll make it."

"Labs cooking? Got a sputum culture going?"

"Yeah, but it'll take a day or two to get the results of the culture. The smear looks like
Staph.
Guess I'll give him—"

"Wait. I've got access to an experimental drug that might help. Let me start him on that."

The intern shrugged. After all, it was two a.m. He'd been on duty for almost twenty-four hours straight—why'd Johnson's wife have to go into labor today?—and he was bushed. The bum probably didn't have a snowball's chance of surviving anyway. Why not? "Sure."

"I'll take it from here. Even do the paperwork."

"Deal," the intern said and ambled off to see the next patient.

Three hours later, John Doe lay on the 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.

"Acute anaphylaxis, death within minutes. Interesting." He scratched his chin. "Guess I'd better keep this to myself." He picked up the almost-blank chart. "I think I'll say I gave him ampicillin and sulbactam. That should cover it."

The woman's look pierced the heart of Dr. Sara Miles. "Do you know yet what's wrong with Chelsea?"

Chelsea Ferguson lay still and pale as a mannequin in the hospital bed. The IVs carried their precious cargo of fluids and medications into veins in both her arms. A plastic tube delivered a constant supply of oxygen to her nostrils. Above the girl's head, monitors beeped and flashed. And all around was the antiseptic smell of the ICU.

Sara put her hand on the teenager's forehead and smoothed the matted brown curls. The hot flesh underscored the urgency of the situation. Since Chelsea's admission to University Hospital three days ago, her fever hadn't responded to any of the treatments Sara ordered. If anything, the girl was growing worse.

"Let's slip out into the hall," 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. "Let's go into the family room for a minute."

"Will she be—?"

"The nurses will check on her, and they'll call me if anything changes." Sara led the way into the room and eased the door closed. This family room was like 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 hadn't worked, the doctors weren'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. She shoved her emotions aside and gestured Mrs. Ferguson to a seat. "Would you like something? Water? Coffee? A soft drink?"

The woman shook her head. "No. Just tell me what's going on with my daughter. Do you know what's wrong with her? Can you save her?" Her sob turned into a soft hiccup. "Is she going to die?"

Sara swallowed hard. "Chelsea 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 blood stream. In Chelsea's case, this probably began when she had her wisdom teeth extracted."

I can't believe the dentist didn't put her on a prophylactic antibiotic before the procedure. But that's not important now. What's important is saving this girl's life.
Sara marshaled her thoughts. "We took samples of Chelsea's blood when she was admitted, and while we were waiting for the results of the blood cultures, I started treatment with a potent mixture of antibiotics. As you can see, that hasn't helped."

"Why?"

Sara wished the woman wasn't being so reasonable, so placid. She wished Mrs. Ferguson would scream and cry. If the roles were reversed, she'd do just that. Actually, she had done that. She took a deep breath. Not the time to revisit those memories. "While 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 wrong—badly wrong."

"But now you know what's causing the infection."

"Yes, we know."
And it's not good news.

Hope tinged Mrs. Ferguson's voice. "You can fix this, can't you?"

I wish I could.
"The bacteria causing Chelsea's sepsis is one that . . ." Sara paused and started again. "Have you heard of Mersa?"

"Mersa? No. What's that?"

"It's actually MRSA. That's sort of a medical shorthand for methicillin-resistant
Staphylococcus aureus,
a bacteria that's resistant to most of our common antibiotics."

Mrs. Ferguson frowned. "You said most. Do you have something that will work?"

"Yes, we do. Matter of fact, when Chelsea was admitted I started her on two strong antibiotics, a combination that is generally effective against Mersa. But she hasn't responded, because this isn't Mersa. It's worse than Mersa." She started to say "Much worse," but the words died in her throat.

Sara paused, waiting for Mrs. Ferguson to voice the question that was in her eyes. Instead, the woman crumpled the tissue she held and dabbed at the corner of those eyes, eyes in which hope seemed to die as Sara watched.

"This is what we call a 'super-bug,'" Sara continued. "It used to be rare, but we'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."

Mrs. Ferguson's voice was so quiet Sara almost missed the words. "What do you call it?"

"It's a long name, and it's not important that you know it."
Matter of fact, we don't use the proper name most of the time. We just call it "The Killer."

"So that's it?"

"No, there's a doctor at our medical center doing trials on an experimental drug that might work for Chelsea."
No need to mention that Jack is . . . No, let it go.

"Can you get some of this? Give it to Chelsea?"

"I can't, but the man who can is an infectious disease specialist here at the medical center. Actually, he helped develop it. Notice I said 'experimental,' which means there may be side effects. But if you want me--"

"Do it!" For the first time in days, Sara saw a spark of life in Mrs. Ferguson's eyes. "Call him! Now! Please!"

"You realize that this drug isn't fully tested yet. It may not work. Or the drug may cause problems."
There, she'd said it twice in different words. She'd done her duty.

"I don't care. My little girl is dying. I'll sign the releases. Anything you need. If this is our only chance, please, let's take it."

Lord, I hope I haven't made a mistake.
"I'll make the call."

"I'm going back to be with my baby," Mrs. Ferguson said. She stood and squared her shoulders. "While you call, I'll pray."

"Mr. Wolfe, you can come in now." The secretary opened the doors to Dr. Patel's office as though she were Saint Peter ushering a supplicant through the Pearly Gates.

Sam Wolfe bit back the retort that was on his tongue.
It'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 wasn't the time to fight that battle.

Dr. David Patel rose from behind his desk and beamed, gesturing toward the visitor's chair opposite. "Sam, come in. Sit down. I appreciate your coming."

Not much choice, was there?
Sam 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 Berkley 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 was still a mystery to Sam and his coworkers.

Patel leaned forward and punched a button on a console that looked like it could launch a space probe. "Cindy, please ask Mr. Lindberg to join us."

Steve Lindberg ran the sales team from an office across the hall. Steve could memorize salient scientific material and regurgitate it with the best of them, but Wolfe was willing to bet the man's understanding of most of Jandra Pharma's products and those of its major competitors was a mile wide and an inch deep. On the other hand, he had his own area of expertise: remembering names, paying for food and drinks, arranging golf games at exclusive clubs. No doubt about it, Steve was a classic glad-hander, which was why he had ascended to his current position, heading the marketing team at Jandra.

Sam hid a smile.
Interesting. The president of the company and the director of marketing. This could be big.
The door behind Sam opened. He deliberately kept his eyes front. Be cool. Let this play out.

"Hey, Sam Wolfe. It's good to see you." Sam turned just in time to avoid the full force of a hand landing on his shoulder. Even the glancing blow made him wince. Steve Lindberg dragged a chair to the side of Patel's desk, positioning himself halfway between the two men. Clever. Not taking sides, but clearly separating himself from the underling.

Patel, the geek. Lindberg, the glad-hander. Different in so many ways. But both men shared one characteristic. Sam knew from experience that each man would sell his mother if it would benefit the company, or more specifically, their position in it. The two of them together could mean something very good or very bad for Sam Wolfe. He eased forward in his chair and kicked his senses into high gear.

Patel leaned back and tented his fingers. "Sam, I'm sure you're wondering what this is about. Well, I wanted to congratulate you on the success of EpAm848. I've been looking over the preliminary Phase II information, especially the reports from Dr. Ingersoll at Southwestern. Very impressive."

"Well, it's sort of Ingersoll's baby. He stumbled onto it when he was doing some research here with us during his infectious disease fellowship at UC Berkley. I think he wants it to succeed as much as we do."

"I doubt that." Patel leaned forward with both hands on the desk. "Jandra is on the verge of bankruptcy. I want that drug on the market ASAP!"

"But we're not ready. We need more data," Sam said.

"Here's the good news," Patel said. "The FDA is worried about the killer bacteria outbreak. I've pulled a few strings, called in a bunch of favors, and I can assure you we can get this application fast-tracked."

"How?" Sam said. "We're still doing Phase II trials. What about Phase III? Assuming everything goes well, it's going to be another year, maybe two, before we can do a roll-out of EpAm848."

"Not to worry," Patel said. "Our inside man at the FDA assures me he can help us massage the data. We can get by with the Phase II trials we've already completed. And he'll arrange things so we can use those plus some of our European studies to fulfill the Phase III requirements."

Lindberg winked at Sam. "We 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."

Sam could see the salesman in Lindberg take over as he leaned closer, as though to drive home his point by proximity. "And I'm going to start our PR people on a launch campaign that will put this drug into orbit."