F Paul Wilson - Novel 02 (10 page)

           
Oh, God, she thought as she took a
deep breath. Here we go.

 
          
'"Somebody's
got to,
Duncan
. They're calling all the shots. But when
they want to know what's going on with doctors and medical care, look who they
ask, insurance companies, A.M.A officers, public service doctors, VA doctors,
whoever's handy."

           
Duncan
grimaced with distaste. "Or even
worse, Samuel Fox."

           
Gin nodded. She remembered sitting
around with her fellow residents and laughing at Fox's asinine statements
during a Donahue appearance a couple of years ago. But he had a knack for PR
and had parlayed his alarmist books and press releases into a position of credibility
with Congress.

 
          
"Exactly.
Congress gets its input from doctors who aren't physicians."

           
"Stands to reason,"
Duncan
said. "Real doctors are out in the
trenches practicing medicine. They've got too many sick people on their hands
to hang around Capitol Hill."

 
          
"Too
true. But that's got to change."

           
Duncan
's jaw jutted at her. "Why?"

           
"Because the government's got
its sights on health care. The big reform package didn't fly, but that doesn't
mean the government's going to go away. It's going to keep inching in, the old
salami-slicing method. Nothing's going to stop it."

           
Duncan
sighed. "Yeah, I know. Don't get me
wrong. I'm not opposed to everyone having some sort of coverage. I hate the
thought of anyone, especially a child, going untreated. But I loathe the idea
of the kakistocracy designing and administering the program, imposing
guidelines for medical decisions that should be a matter solely between doctor
and patient." His voice took on a TV announcer's tone, "And now, from
the people who brought you the House Post Office scandal and the debatable,
Health care!" He shook his head. "I don't think so."

 
          
"Doesn't
it make sense to standardize medical care and costs across the country?"

           
His gaze was hard as steel.
"Don't you think we've got enough guidelines already?"

           
She thought of old Mrs. Thompson at
Lynnbrook
Hospital
. "Well . . . "

           
"What this bill will do is
enforce cookbook medicine. The real thrust of all this legislation isn't
quality assurance, it's cost control. They'll save a few bucks but the human
costs will be huge."

 
          
"It
doesn't have to be that way. We," Duncan glanced at the carafe and held up
a hand. "Coffee's ready." He lifted the cone from the carafe and
placed it in the small chrome sink next to the microwave. Then he filled two
thick white diner-style mugs with the fresh, steaming coffee. He handed one to
Gin.

 
          
"Now
this is coffee. Taste." Gin sniffed, the aroma was fabulous, then sipped.
Usually she drank her coffee black with a little sugar. This didn't need sugar.
The flavor was so deep, so rich . . .

 
          
"It's
. . . " She struggled for words. "It's like I've never had real coffee
before. This is amazing."

           
Duncan
beamed. "It's worth the trouble, isn't
it? An anodyne for weltschmerz. I'll grind you up some beans to take home. But
use them soon. And if you use a regular drip machine, never, never, leave the
pot on a heater. Always decant the coffee immediately into a carafe. Even the
best coffee gets bitter when it's overheated."

 
          
"Thanks.
I'll remember that." Gin had had no idea
Duncan
was such a coffee connoisseur. The rituals,
the rules . . . it was like a religion. But the result was awfully good.

 
          
They
sipped in silence for a moment. Gin wandered along the glass wall and admired
the koi pool, the rock garden, and the dwarf shrubs that lined it. She
continued on, passing his desk. The top right drawer was open. Inside was a
glass injection vial filled with a clear amber fluid.

 
          
Something
else too. Something metallic, almost like a large trocar . . .

 
          
Suddenly
Duncan
was beside her, sliding the drawer closed. "You
were saying?"

           
"Where was I? Well, the point
I was trying to make is that if I can get on a committee member's staff, I can
see to it that he gets some straight dope on how these guidelines will affect
patient care. And if I can influence him even a little, won't it be worth
it?"

           
Duncan
stared at her, slowly shaking his head.
"For some time now I've been worrying that you had no direction. I was
afraid you were just going to drift, make a career of moonlighting and locum
tenens work. Now I almost wish that were the case." Had he actually been
thinking about her?

           
"Maybe I'll simply devote myself
to lexiphania."

           
Duncan
appeared taken aback. Had she stumped him?

 
          
Lexiphania,
the tendency to use obscure and unusual words. The irony would be rich. How
wonderful to catch him with a word that described himself.

 
          
Duncan
laughed. "Where'd you find that
one?"

           
"Wasn't easy, believe
me."

           
"All right. I plead guilty to
compulsive grandiloquism, to singlehandedly trying to correct for the entire
language's drift into banality." Damn. He did know it.

 
          
She
said, "I don't think it's working."

 
          
"More's
the pity." He gazed at her, smiling. "Lexiphania . . . that’s
wonderful. How can I stay angry at you? But seriously, Gin, you've been trained
for a higher sort of work than being legislative aide to some pretentious pinhead
pol. I hate to see you wasting your talents."

 
          
For
a moment she was struck by how much he sounded like Peter. He'd said almost
exactly the same thing when she'd told him she was leaving
Louisiana
to get involved in medical politics.

 
          
Focusing
on
Duncan
, Gin bit her tongue and thought, I could
say the same about your facelifts.

 
          
As
if reading her mind he smiled crookedly and said, "Not that I'm one to
talk about wasting training." For an instant there was real pain in his
eyes. Her heart went out to him.

 
          
"
Duncan
. . . whatever,"

           
He held up the coffee carafe.
"Refill?"

           
"No, thanks. Can I ask,?"

           
"I don't envy you, Gin."
Obviously he didn't want to talk about Duncan Lathram. "I wouldn't want to
be starting out in medicine today and facing the terrain that's ahead of
you."

           
"All the more reason to get
involved." Why couldn't he see that?

 
          
"But
what do you hope to accomplish? What is your goal down there on Capitol
Hill?"

           
"Fair guidelines. Realistie
guidelines we can all live with."

 
          
"Never
happen,"
Duncan
said. He sighed. "I hope you know what you're doing, Gin."

 
          
"I've
given it a lot of thought."

 
          
"Have
you? They're a pretty corrupt bunch, Gin, and,"

           
"And I'm so impressionable?"

           
"No. It's not that. It's just
that, well, as doctors, we're a different breed. Our values are different. We
don't speak the same language. We don't walk in the same shoes as other
people."

 
          
"That
sounds just a little elitist to me." He shrugged.

 
          
"Maybe.
But sometimes I think the weight of the life-and-death decisions doctors have
to make sets them apart from the rest of humanity. When you've felt someone's
life draining through your hands, and you've reeled him back in and sent him home
to his family, it does something to you. You've seen things that regular folk
will never see, done things they'll never do, glimpsed them at their most
vulnerable, when they're stripped of all their pretenses. You've been master of
life and death, and that can't help but change you. It leaves you one step
removed from everybody else."

           
Gin had run up against this
gods-who-walk attitude all through her residency.

 
          
"It's
time we ditched the god thing, don't you think? We're not gods, and it's
damaging to us and our patients to foster that kind of reverence. We can do
extraordinary things, seemingly miraculous things. But we're not gods. We're
just people." He was sullen as he sipped his coffee in silence.

 
          
Finally
Gin said, "Doesn't look like we'll ever see eye to eye, does it?"

           
"No, it doesn't."

           
"Can we agree to disagree,
then?"

           
"I don't suppose I have much
choice."

           
"You could fire me."

 
          
"I
don't want to do that. But don't expect my blessing."

           
"I never did." But I want
it, dammit. I wish I didn't, but I do. "I don't even know if I'll get the
job. But if I do I'll have to adjust my schedule to,"

           
"Cassidy can take up the
slack. We'll work it out."

 
          
Gin
felt a trickle of warmth, seeping through her. This was a blessing of sorts,
wasn't it? If not, it would have to do.

 
          
"Thank
you,
Duncan
. I didn't expect,"

           
"I want to keep you nearby . .
. where I can keep an eye on you."

 
          
The
warm trickle became a chill. What was that supposed to mean?

 
          
"Just
don't let us down, Gin," he said, his blue eyes burning into hers.
"Don't betray us." He held her locked in his gaze a moment longer,
then turned away.

 
          
"I'm
glad we had this talk, Gin. The first of many, I hope. I'm sure you've got some
dictation to catch up on."

           
"Yes. Sure. I'll see you
later."

           
"Be sure to let me know as
soon as you hear from Marsden. As for me, I'm off to the links." He pulled
out a key ring and matter-of-factly locked his top drawer. "Surgery
tomorrow at eight."

           
Idly wondering why he bothered
locking the drawer, Gin waved and left him.

 
          
This
was turning out to be one strange day.

GIN.

           
EASY NOW, OLIVER SAID SOFTLY,
WATCHING OVER HER shoulder, coaching her.

 
          
"That's
it. Just go easy . . . easy . . . " Gin hadn't felt like being alone this
afternoon. No word from Marsden's office, or from Gerry, so she'd arranged to
spend a couple of hours in Oliver's lab practicing her implant-filling technique.
She'd learn and get paid for it.

 
          
She
smelled garlic on his breath and wondered what he'd had for lunch.

 
          
Nothing
low cal, she was sure. Oliver had a weakness for Italian food and didn't seem
to care what effect it had on his waistline. Probably linguine and clam sauce,
don't spare the garlic, Better forget Oliver's dietary indiscretions. She
needed to concentrate on what she was doing.

 
          
Gin
had the 26-gauge needle of a tuberculin syringe inserted in the end of one of
Oliver's medium-size membranous implants and was injecting it with normal
saline. Had this been for real, she'd be working under sterile conditions and
filling the implant with Oliver's "secret sauce." Staring through the
magnifying lens centered in the round head of the fluorescent examination lamp,
she watched the half-inch-long tubular membrane swell and stretch. Like filling
the world's tiniest water balloon.

 
          
"It's
full now," Oliver said. "Feel that back pressure?" She hadn't
felt any until now, which was why half a dozen membranes lay ruptured on the
side of the tray. But this time she did feel a hint of resistance on the
plunger.

 
          
"Believe
it or not, I think I do."

 
          
"Swell!
Now it's time for the zapper." Gin repressed a smile as she reached for
the cautery handle. Did anyone else on earth still say swell? Oliver had to be
the last.

 
          
He
was a bit of an enigma. Didn't seem to have much of a life outside his lab. No
wife or family. No significant other that she knew of.

 
          
He'd
had the staff over to his house for a dinner party one night and Gin had felt
she knew less about him afterward than before.

 
          
'"Okay,"
she said. "I'm ready."

 
          
"You
know what to do. Just take your time" Gin had seen Oliver do this a
hundred times but had never got this far. She readied the flattened tip of the
cautery unit in position near the puncture site, slowly withdrew the needle,
then stepped on the round power pedal near her left foot. A tiny blue spark
arced from the tip to the implant, searing and coagulating the protein membrane
around the puncture.

 
          
She
watched through the magnifying lens, waiting for a telltale bead of fluid to
form, signaling the need for another zap. But the membrane remained dry. She'd
sealed the opening.

 
          
Success.
Finally. A tiny triumph. Hardly made up for the fiasco in Marsden's officer
Monday or Allard's accident this morning, but right now she'd take anything.

 
          
Gin
looked up and found Oliver's round face grinning at her.

 
          
"It's
going to be swell having someone else around who can fill these things. I'm
sick to death of it."

 
          
"Why
don't you just hire an assistant or two to help with the scut work?"

           
"There's really not all that
much to be done at this stage of the studies. And I'd like to limit the number
of people who know what we're working with."

 
          
"And
just what are we working with?"

           
"Secret sauce."

 
          
"Oliver,
come on. Don't you think I have a right to know."

 
          
He
thought a moment. "All right. Fair enough. But keep it under your hat.
This solution is not patentable, so I don't want anyone stealing my thunder by
beating me to market with it."

 
          
"Mum's
the word," she said.

 
          
"I'm
sure I can trust you," he murmured as if he'd just now realized it.

 
          
He
removed his thick, horn-rimmed glasses as he sat down next to her.

 
          
He
began to talk, rapidly, as if someone had opened a valve. Gin realized he must
have been dying to expound on his secret sauce.

 
          
"Are
you familiar with the work done by the Department of Cell and Structural
Biology in the
University
of
Manchester
in
England
?"

 
          
"No. Not a bit."

 
          
"Not
many clinicians are. Okay then, how about fetal surgery? Have you seen any of
that?"

           
"Some down in Tulane. It
wasn't part of the internal medicine rotation, obviously, but I picked up some
information by osmosis."

 
          
"Good.
Then you know that a fetus can have surgery in utero and be born months later
completely scar free."

           
"Yes, I remember a couple of
OB
residents talking about that. This
high-risk baby they'd delivered had had a mass removed from its abdominal wall
at about sixteen weeks' gestation and was born without a trace of an
incision."

 
          
"Exactly.
But the surgery has to be performed during the first five months. Any procedure
done later leaves a scar just as it would on an adult. Cellular biologists have
wondered about it for years. What's happening in there? What's different? What
prevents the usual excess amount of collagen from being laid down and forming
the scars we all know so well? The folks at the
University
of
Manchester
came up with the answer a few years
ago."

           
Gin snapped her fingers. She
remembered something . . . where had she seen it? "Some sort of growth
factor, wasn't it?"

           
Oliver clapped his hands.
"Excellent! Transforming growth factor beta, to be precise. They
identified three types of the growth factor, and found that the third, beta
type 3, falls off sharply at the end of the second trimester of pregnancy. The
type-three molecule, I call it beta-3 for short, has been synthesized since
then and that's the key ingredient in the secret sauce."

           
"So that's the secret behind
Duncan
's incredible results."

           
''Uh-uh," Oliver said, wagging
a finger. "
Duncan
has the eyes and the hands that do the remodeling. Even without a drop
of beta-3 his patients would have minimal scarring. All I've done is find a way
to gild the lily."

 
          
"But
why the implants? Couldn't he just coat the incisions with beta-3?"

           
"No. You need it in the final
phase of healing. Remember the three stages of wound repair, inflammation,
proliferas ion, and remodeling? Beta-3 does its work in stage three where scar
tissue forms to replace granulation tissue. At suturing time, beta-3 would
accomplish nothing. You need a means of delayed release. I was, slaving away,
testing antidepressants on rats in Skinner boxes as a psychopharmacologist at
GEM Pharm during the day, and at night working in my home on a continuous
delivery system for medication. Norplant was the hot topic then, but the
Norplant implants have to be removed after five years. I thought I could
improve on that, develop an implant that would deliver its medication in a
metered dose for five years, maybe longer, and then dissolve. Great idea,
no?"

           
"I take it that didn't
happen."

 
          
"Not
completely. I developed a soft, flexible, crystal-protein matrix that would
indeed dissolve without a trace. However, it was nonpermeable. Wouldn't allow a
drop of anything on one side to pass through to the other, until it dissolved,
and then it would dump its entire contents into the surrounding tissues. I'd
come up with nothing more than a very elaborate and expensive way of giving
someone an injection. I was terribly discouraged."

           
"And then along came
Duncan."

 
          
"Right.
After his . . . well, after he left vascular surgery, I heard about
Manchester
's results with transforming growth factor
beta type 3 and saw how my imperfect slow-delivery membrane might be perfect
for delivering something else. The FDA approved us for clinical trials and the
results have been astounding."

           
Gin had seen patients on
postsurgical follow-up visits and only with a magnifying glass was it possible
to tell they'd had surgery. Suddenly Gin was struck by the enormous potential
for Oliver's implants.

 
          
"But
plastic surgery is just icing on the cake," she said. "Think of what
you could do in general surgery."

           
Oliver was nodding excitedly.
"Of course. The implants would-have the most value in trauma cases, but
they'll become routine in procedures like hysterectomies and appendectomies. A
few weeks post-op you could wear your bikini, heck, you could even go to a nude
beach if you wished, and no one would even guess you'd had surgery."

           
Gin's hand strayed to the front of
her blouse. Through the fabric she could feel the upper end of the thick, numb,
puckered ridge of scar that ran the length of her abdomen.

 
          
Duncan
's scar.

 
          
Bikini
? she thought. I've never owned even a
two-piece. Never even considered it.

 
          
"But
the biggest benefit I see is in pediatrics," Oliver was saying. "Kids
scar more than adults, and some of those scars, depending where they are, can
be disabling because they don't stretch as the rest of the body grows."
Tell me about it.

 
          
"That
sounds wonderful."

 
          
"It
will be. And the word is out. Other surgeons want to try the implant. Companies
are calling every day wanting to license it and the FDA has put it on the fast
track for approval. And that's only the start.
Duncan
came up with an innovative idea on how to
enhance the implant, and I've just about got the bugs worked out of the new,
improved model. And . . . " He raised his hand and wagged his index finger
in the air. "And . . . someone very important has taken a very personal
interest in the implant procedure."

           
"Who?"

           
"Sorry. I can't tell you. Not
yet, anyway."

           
She didn't want to care, but the
way his eyes shone with excitement piqued her curiosity. "Come on, Oliver.
You just told me about beta-3, you can trust me with this too."

 
          
"No.
Duncan
would kill me. It's his secret after all.
And it's big."

 
          
"Okay,"
she declaimed with her best forlorn sigh. "I guess I'll just have to read
about it in the papers."

           
"Oh, dear. I hope you never do
that. But I have a feeling
Duncan
may tell you himself when the time comes."

 
          
"Speaking
of
Duncan
, you started telling me about the daughter
Lisa he had. Does that mean what I think it does?"