Malice

by Jennifer Jaynes

  What? “Different from what?” he whispered.

  From your father . . .

  Bristling, he shook the voice from his head. He looked down and realized he was still wearing his clothes from yesterday. Dammit! He struggled out of bed, trying not to wake Mia. Every inch of his body ached as he shuffled carefully toward the toilet.

  When he reached the bathroom, he noticed the shower floor was wet.

  He frowned, realizing Mia must have taken another shower after getting home.

  What’s she washing off, Daniel?

  He squeezed his eyes shut and stood silently for a moment before opening them again and turning the shower on. After dressing, he walked down the hallway to his home office and saw that his desktop computer was still on and the bottle of Jameson sat uncapped and empty next to the monitor.

  The bottle had been almost full.

  Shit. Not only had he broken his own rules, he could have killed himself. He turned his attention to the computer. He could vaguely remember being online, but he couldn’t remember why or what he’d done.

  He sat down and saw several browsers were still open. Apparently, he’d found a site called GetTheFactsAboutRespira.com and had opened several articles. He pulled up last night’s search history. All the rest of his searches had been Respira-related . . . except for one.

  He had also apparently searched Mia O’Brien.

  The conversation with Billy must have gotten to him last night. He was clicking on the search to see what results had come up when he felt warm breath on his ear. “Why are you up so early?”

  Daniel jumped. He quickly clicked off the browser window, hoping Mia hadn’t seen his search.

  “Jesus, Mia,” he said, turning to face her. “You scared the shit out of me.”

  Daniel arrived at the office earlier than usual. Still nursing a throbbing headache, he felt his way through the darkness and across the wall until his fingers made contact with the light switch. He flipped it on, and with a few flickers, the fluorescent lights came to life, casting a flat brightness over the large waiting room.

  The alcohol from last night was still circulating in his bloodstream. He needed some coffee. A lot of it. He walked into the clinic’s small kitchen and brewed a pot. He’d spoken to Mia as little as possible this morning, not wanting to let her in on the fact that he’d blacked out last night. He was ashamed of his lack of control.

  He wondered if they’d talked last night. What he might have said, especially with everything that had been troubling him lately. After pouring a cup of coffee, he went to his office and started up his computer. Once it booted, he froze, his fingers hovering above the keyboard. He debated whether he should continue his search for Mia O’Brien. Or if he should continue researching Respira instead. Teddy would be arriving in a couple of hours, and Daniel wanted to talk to him about Suzie Jacobs. He couldn’t in good conscience simply write off the second instance of the girl’s seizures.

  The child would have to be a priority.

  His personal life would have to wait.

  He vaguely remembered reading information about Respira last night that had concerned him. Information that Medscape, UptoDate.com, and Immunext’s information statement hadn’t contained. He brought up Google and did a search for Complaints about Respira. He scrolled past the CDC’s and Immunext’s websites, knowing they’d mirror the information his other go-to sites had contained. He wanted to dig deeper this time. Look at a wider variety of sources than usual.

  One of the results on the page was an article titled “Parents Concerned about Respira.” It had been posted to the website he’d visited last night at home: GetTheFactsAboutRespira.com. He clicked on it and read it, bile burning his throat. Apparently, there were many—even hundreds—of parents concerned about the drug.

  Frowning, he clicked over to an article titled “Pediatrician Speaks Out about Respira Dangers” and read that Dr. Sean Hemsworth, a pediatrician in Sherman Oaks, had discontinued the administration of Respira less than two weeks ago due to safety concerns. He also read about an adverse event reporting system and database that the CDC and FDA managed that he’d never even heard of.

  Sirens blared in his head. This is crazy, he thought, wondering why Teddy didn’t have them reporting to the database here at the practice. His situation was a little more unique than most pediatricians, because most of his office visits involved the treatment of acute illnesses or referrals to specialists and not the standard well-baby or well-child appointments that often included the administration of vaccinations. But even so, if he’d known about the database, there would have been at least a handful of adverse reactions he would have reported.

  He followed a link to the drug’s package insert. He clicked on it and scrolled through to the Adverse Reactions section. He carefully read through the long list, noting that among the possible reactions reported by parents and practitioners after administration of the drug were cyanosis, depressed level of consciousness, anaphylactic shock, paralysis, pneumonia, arthritis, diabetes mellitus, afebrile convulsions, seizures, and death.

  He rubbed his chin.

  First, this list looked very little like the information he’d read about Respira on UptoDate.com or Medscape, and it was completely dissimilar to the information printed on the colorful vaccine information statement the clinic was handing out to parents. In fact, the two documents looked like they belonged to two very different pharmaceutical products. Second, seizures were listed as an adverse reaction. So, why was the practice’s official position that the girl’s seizures and Respira weren’t related? He was pretty sure he knew the answer, and he didn’t like it.

  You’re just opening a can of worms. Listen to Teddy, and do your job. Stop messing around with this.

  He ignored the voice and reread the list more slowly, heartened only by the fact that the reactions listed were rare. But for the first time in his career, he wondered what the word rare really meant.

  Daniel printed the manufacturer’s package insert and then clicked on another link labeled “Stories from Parents” where he found more than a hundred testimonials submitted by parents around the world who claimed their children had been damaged by Respira. He also found links to a message board and a Facebook group populated with parents talking about the drug. The post threads were charged with in-fighting and name-calling. Some of the parents were standing up for the drug, saying they were happy that their children received it and that their kids hadn’t had any issues with it. Other parents were furious, saying if they’d known their kids would have reacted to it as badly as they had, they never would have approved it for their children.

  He printed some of the comments, then tried to navigate back to the first page of the story, but he received a 404 error message.

  The article was gone.

  In fact, the entire website was suddenly down.

  Weird, he thought, frowning.

  He returned to the kitchen and poured another cup of coffee. When he was back at his desk, he leaned forward in his chair and rubbed the back of his neck. Although he understood some of the stories from parents were probably not 100 percent accurate, that some of their children’s health issues might have in fact been caused by other things, there were too many to discount. All these parents couldn’t be wrong, and they certainly deserved to be heard. He looked at his watch and realized Teddy would be in soon. They definitely needed to talk.

  Don’t, Daniel. He won’t like it.

  “I know he won’t, but he needs to know,” he said softly.

  You’ll only be asking for trouble.

  “We’re talking about children’s lives here,” he hissed.

  Daniel was slumped in his office chair, thinking, when he heard movement coming from the front of the office, then footsteps in the examination hallway. He glanced at the clock. More time had passed than he’d realized.

  Teddy’s voice rang out. “Danny? Is that you?”

  The big man poked his head into Daniel’s office an
d grinned. “Oh, shit. Don’t tell me the missus kicked you out already.”

  Daniel didn’t even bother to smile. “Can we talk?”

  The grin slid off Teddy’s face, and he stepped into the office. “Everything okay?”

  Daniel shook his head. “I think we may have a problem.”

  “What is it?”

  “My patient Suzie Jacobs. She was taken to the ER again last night. She had two seizures. One that was at least seven minutes long.”

  “Is she okay?”

  “From my understanding, yes. The seizures were contained fairly quickly, but she was admitted for a lumbar puncture and an infectious disease consult.”

  “I see. So, what’s the problem?”

  “Teddy, we administered her second dose of Respira yesterday morning.”

  Teddy’s eyes narrowed to crinkled slits, but he didn’t say anything.

  “It’s clearly the Respira, Teddy. Both times her seizures happened just hours after she received a dose.”

  “What hospital did you say she’s at?” Teddy asked.

  “Northridge,” Daniel said.

  “So, let me get this straight. You’re saying that Northridge Hospital was able to link the girl’s seizures to Respira? They determined that Respira caused the girl’s seizures?”

  Daniel could see what Teddy was doing. “Teddy, we can’t write this off as coincidence again. That’s just not right.”

  Teddy exhaled loudly. “Listen, Daniel, not to be insensitive, but shit happens. The drug is an easy scapegoat, but there’s no way to know it caused the girl’s seizures. I mean, what is she? A year old?”

  “Eighteen months.”

  “Eighteen months. So, it’s very possible that she’s had seizures all along. Maybe her parents are just starting to notice them.”

  Daniel grabbed the printout of the drug’s sixteen-page package insert and held it up. “Teddy, it’s right here. Seizures are one of the possible adverse reactions. And from my research, they appear to be a fairly common one.”

  Teddy waved the printout away without looking at it. “Just because it’s been reported as an adverse reaction doesn’t mean you can reliably establish a causal relationship between the event and the drug.”

  “I understand that, but it’s definitely something worth looking into. Teddy, there are hundreds of—”

  Teddy held up a hand to silence him. “The last thing this clinic needs is to go on the record saying Respira is unsafe just because a patient may or may not have had a bad reaction to it. That’s just irresponsible. This drug is going to help a lot of people.”

  “But at what cost?” Daniel countered, thrusting a printout of the parents’ comments from a Facebook feed toward the other doctor.

  Teddy snatched the printout from his hand and skimmed it.

  “There are more than five thousand concerned parents in this one group alone,” Daniel said. “Look at these posts and the comments.”

  Teddy looked up. “Where did you get these?”

  “A parent support group on Facebook.”

  Teddy’s face filled with disgust. “Facebook, Daniel? Is that where you’re getting your science these days?” He tossed the printout back on Daniel’s desk.

  “No. Of course not. I checked several sources, including VAERS,” Daniel said, referring to the Vaccine Adverse Event Reporting System used by the FDA and the CDC to monitor vaccine side effects. “I have some important questions. For one, I wasn’t even aware this reporting system even existed. They never mentioned it in medical school and we’re not using it here. Why?”

  “Because we’re busy, that’s why,” Teddy snapped. “Plus, I’ve never had a parent be able to prove to me that a health issue was caused by a drug I administered.”

  “But the way I understand it is that we shouldn’t be making that determination ourselves. If a parent even thinks the drug might have caused a health issue, we should be reporting it so that the FDA and CDC can get an accurate picture of how children are tolerating these drugs.”

  Teddy waved his hand. “You’re wasting your time, Danny. Hardly anyone uses the damn thing.”

  He’s getting angry, Daniel. Just shut up about this, and do your job.

  “But, Teddy, aren’t you the least bit concerned that—”

  “Yes, I am very concerned. But what concerns me,” Teddy said, pushing his bulk out of the chair, “is that you want to deny a lifesaving drug to our patients.”

  Lifesaving?

  Teddy had obviously bought Immunext’s propaganda hook, line, and sinker. This was the common cold they were talking about. The freaking common cold. Not the big bad wolf Immunext was making it out to be. Like Mia had suggested, this drug was more for convenience than anything for most kids.

  “I didn’t say that I wanted to deny it, Teddy. I’m just saying that we should look into it. And maybe we should hold off on administering it until we can get some answers. Maybe Thomas from Immunext can come by the office and explain all of this away. I might just be missing something here. Isn’t it worth at least that? There’s already been more than six hundred of adverse events for this drug and it’s only been out for a few months.”

  Sweat was glistening on Teddy’s forehead. “Look, Daniel, six hundred reports of adverse events is peanuts considering how many kids are receiving this drug.”

  “But if as physicians we’re underreporting events to the database, then the FDA and CDC aren’t getting an accurate picture of what is happening. Can’t you see the problem here?”

  Teddy either didn’t hear his question or decided to ignore it. “Danny, this is my practice. And at my practice, we go by what I say, not the rantings of some parents looking for a scapegoat for their children’s unfortunate health issues.” He paused to catch his breath. “Again, this practice’s official position is that the girl’s seizures and Respira are not related. Got it? But, if you really feel this girl is having problems with the drug, you may discontinue it for her care. But only hers.”

  Teddy charged to Daniel’s office door and spun around once he reached the hallway. “Don’t think for one goddamned minute that you’ll get a penny of that bonus if you’re not willing to pull your weight around here. If you don’t help us meet that quota, you can kiss your bonus goodbye. Along with any partnership.”

  CHAPTER 18

  MIA

  MIA WATCHED INTENTLY as blood swirled down the drain. She’d been so distracted by her thoughts, the glass she’d been holding had slipped from her hand. She’d still been distracted when she bent to pick up the pieces, and she’d sliced the inside of her hand on an errant shard.

  She switched off the faucet and watched the blood ooze from the wound for a few seconds, then reached for a clean dish towel. Earlier, she thought she’d caught Daniel doing a search on her name online, but she’d been too exhausted to be sure. What she did know for certain was that he’d deleted his search history before leaving for work. In all the months they’d been together, he’d never cleared his history, so why now?

  Probably for the same reason why he’d been doing a search on her.

  Her hand throbbed as she watched the blood soak into the white dish towel, and she wondered if the wound would need stitches.

  If Daniel had been searching her name, he wouldn’t have found anything of substance on her. Only a photo that had been posted on social media by a coworker at Jiminy’s. He’d find no social media, no home listings, no schools attended, or anything else of real consequence—which she realized could be a problem. There’d be questions, but she had crafted a response to those types of questions months ago.

  What she was far more concerned about was the reason why he would have been looking her up. Was it because of her little slip, or had he learned something? Every time she tried to think of possibilities, her thoughts slogged through quicksand. She was trying to function on less than an hour of sleep. Her mind was mush.

  She went back up to the bedroom, grabbed her purse, and dug inside for a vial of
sleeping pills. She tossed two on the back of her tongue and swallowed them. She’d get some rest; then she’d try to figure things out. Sleep was critical. She had to be sharp enough to piece things like this together. Just one little misstep . . . just one . . . was all it would take for her perfectly crafted world to come tumbling down.

  The only thing she was completely sure of right now was that the energy between her and Daniel had shifted. It seemed to have begun the night of their dinner with Claire and Ben. The way Daniel had snapped at her in the car on the way home that night had her worried. It was the first time that he’d ever raised his voice to her. She’d been treated much worse by others, of course, but Daniel had never come close to speaking to her like that before. He was more considerate of her feelings. Maybe the spell that she’d so carefully constructed was starting to wear off.

  She grabbed the first aid kit, then went downstairs. As she wrapped her hand, a cold, icy rain beat against the house and thrummed steadily against the tall windows that faced the ocean. It had been raining all morning. The type of weather you weren’t supposed to get much of in Southern California.

  After she was done bandaging her wound, she stepped closer to the window and peered out at the sea and watched it angrily toss water against the shore. She wasn’t sure what was gloomier, the morning outside or the thoughts that were fermenting inside her head.

  The chill in the air reminded her again that Christmas was only a few weeks away. Just days ago, she was excited about decorating, but now she couldn’t be farther from the mood. She turned to face the lamplit living room. Grabbing an afghan and her Kindle, she curled up on the couch.

  Bruce sprung up and lay his big head on her hip. She massaged the dog’s ears, and he closed his eyes and sighed loudly. She stared at his nub, remembering Daniel telling her that Bruce has been hit by a car as a puppy and left on the side of the road. Daniel had discovered him at the animal shelter and adopted him just hours before he’d been scheduled to be euthanized.

  She turned her thoughts to her Kindle. She powered it up and checked Facebook. She had opened several social media accounts under two aliases over the years and used them to keep track of a few people from her past. She scrolled her news feed, and a headline caught her attention: “Questions Remain after Suspected Murder-Suicide of Pediatrician’s Family.”