Miracle Cure

by Michael Palmer

  “We’ll speak with her shortly. Meantime, just tell Dr. Holbrook if your pain’s not getting better, and he’ll give you some more medicine. Andrew, I need a Microvena snare. Quickly, please.”

  The snare was a wire loop, threaded up through a catheter, and operated by a finger trigger. It was tricky to use under the best of circumstances. But with Nellie unable to lie still for more than fifteen or twenty seconds at a time, and the fragment of catheter tubing moving with each heartbeat, the retrieval was going to be a bear.

  Brian was impressed to see that Jessup was meeting the challenge head-on. But as first one, then another pass with the snare failed to catch the tubing, he could hear the strain creeping into her voice. Her eyes were narrowed. She shook her hand to loosen the muscles.

  Nellie’s heart attack was evolving rapidly. A large portion of the muscle in the front of her heart was getting little or no blood, and that muscle was reacting to the diminished oxygen supply with viselike pain and electrical instability—continued bursts of dangerous extra beats. There was no permanent damage yet. But soon, almost certainly before she could be brought to the OR, there would be. And if two of the premature beats should fire off at the same time, her heart might well be thrown into electrical standstill—a cardiac arrest.… Brian did his best to shelve that thought.

  Jessup tried a third time … then a fourth. Her fists were clenched with frustration.

  “Lauren, are they ready in the OR?”

  “Not yet.”

  “Pressure’s dropping some,” Jennifer said quietly.

  Jessup readied the snare for another try. Then she glanced over at Brian. Her eyes looked flat, defeated. There was nothing to do, her expression was saying—nothing to do but hope the cardiac surgical team sent for Nellie before her heart gave out altogether. But even then, once Nellie was in the OR and on heart-lung bypass, another battle would be fought—the battle to salvage as much cardiac muscle as possible. With each passing second, the likelihood of her making it without massive damage was diminishing, as was the chance that she was going to make it at all.

  “Oh, please.… Oh, please.… Oh, please.…”

  Nellie was moaning continuously now.

  Brian checked her pupils and saw maximum narcotic constriction. Giving her more morphine would be risky. A narcotic-induced crash in her blood pressure or a respiratory arrest would make a grave situation even worse.

  “Any ideas?” Carolyn asked softly.

  “Just one,” Brian replied. “Try using a biopsy forceps instead of the snare.”

  “What?”

  “Andrew, do we have a BIPAL biopsy forceps?”

  “I think so.”

  “I’ve used them a couple of times for endocardial biopsies. It has two little prongs to snip off pieces of tissue. I’d like to take a crack at clamping down on the catheter tip with those prongs.”

  “I have one right here,” Andrew called out.

  “Do it, please,” Jessup ordered, stepping aside to make room for Brian.

  “The OR just called,” Lauren said through the control-room intercom. “They’re ready.”

  Jessup hesitated. A miss now would consume more time than Nellie had left, but a dash to the OR was chancy at best. For five seconds, ten, there was only silence.

  “Brian, I know it’s been a while,” she said finally. “Are you okay with this?”

  Brian looked down at Nellie Hennessey, who lay there, eyes closed, whimpering softly. Tears of pain had tracked down over her cheeks. He knew, as did Carolyn, that this was rapidly becoming the worst of disasters. If the obstruction wasn’t removed immediately, the best Nellie could hope for was life as a cardiac cripple.

  “I can try,” he said.

  “Go ahead.”

  Brian took a single calming breath and guided the two-pronged forceps up the aorta toward the fragment. Over the years, he had spent countless hours studying textbooks and models of the heart, assisting in the OR, and working in cath labs. Now, all that experience was at work, helping him to visualize Nellie’s heart in three dimensions—to see through the flat image on the monitor screen and to angle the forceps just so.

  The Board of Registration in Medicine has determined that your license to practice medicine be suspended for a period of …

  Oddly, the memory of the words on the letter from the board flashed through Brian’s mind at the moment he closed the prongs of the BIPAL. On the monitor, the catheter fragment twitched visibly.

  “I think you’ve got it,” Jessup said in a half-whisper.

  Slowly, ever so slowly, Brian pulled back the instrument. For an instant, the fragment seemed to be caught on something. Then, dutifully, it flicked again, indicating it was still locked between the biopsy prongs. One millimeter at a time, Brian withdrew the BIPAL out the left coronary, over the aortic arch, then down the descending aorta. Almost instantly, the dangerous premature beats disappeared from the electrocardiograph monitor screen. And even before the piece was pulled out through Nellie’s groin, she stopped her restless, pain-driven struggle.

  “Oh, my,” she said. “It’s better. The pain’s beginning to go away.”

  The cath team members exhaled in unison. Brian’s exhilaration exceeded anything he had ever experienced on the football field.

  Your license to practice medicine has been suspended …

  “Thank you, God,” Brian murmured under his mask.

  “Lauren,” Jessup said, her eyes beaming, “call the OR and tell them we won’t be needing them.”

  CHAPTER TEN

  IT WAS NEARLY TWO IN THE AFTERNOON BEFORE AN opening in Carolyn Jessup’s schedule allowed her to respond to Brian’s request to meet with her. She looked relaxed and, as always, elegant in a gray cotton suit and white blouse. Her dark hair was pulled back in a knot. Her office rivaled Pickard’s in opulence, with floor-to-ceiling bookshelves covering one wall and various certificates, testimonials, diplomas, celebrity photographs, and letters of gratitude blanketing another. One thing that Brian did not find was a photograph of family or of Jessup in any recreational setting. But with more important business on his mind at the moment, he shrugged off his curiosity about the woman. Whenever he wanted to, he could read all about her in Who’s Who in American Medicine.

  Brian settled into a low-backed leather chair across the desk from her. A pressing appointment of some kind had kept Jessup from spending any time with him after Nellie Hennessey’s remarkable save. Now, she fixed her dark brown eyes on him and nodded her pleasure.

  “You certainly have had a major impact on this place in a very short time,” she said.

  Brian gestured to his height.

  “I’ve always had trouble being inconspicuous,” he said.

  “Did you always want to be a doctor?”

  “No. Actually, I always wanted to be a professional football player. I liked science, though. And after I tore up my knee in a game, I knew I still wanted to amount to something, so I decided to take a shot at med school.”

  “I see. Well, there are two patients in this hospital who should be pretty grateful that you did. So am I.”

  “Thank you. And thanks for trusting your judgment about me down there.”

  Brian held off bringing up Jack and Vasclear, hoping that Carolyn would do it herself.

  “The truth is,” she said, “it wasn’t just my judgment about you. I didn’t think Nellie would have survived if we had to bring her to the OR. It was quite literally do-or-die. And to tell you the very absolute truth, I really didn’t think you could pull it off. But I assume, or at least I hope, you didn’t ask to see me so that I could tell you what a great job you did.”

  “No, although it’s good to hear. What I wanted to talk with you about is Jack.”

  “Sure. I’d be happy to go over his situation with you. But first there’s one thing I wanted to mention that I neglected to say in the cath lab before I had to run off.”

  “Yes?”

  “At any given time, there are a dozen
or more medications and products that are being evaluated at Boston Heart. Sometimes we are one of a number of centers working cooperatively. Sometimes we have sole responsibility for a study. Always, there is a great deal at stake—tens, even hundreds of millions of dollars. Staffing, equipment, research positions, teaching positions, your position—all of them are tied up with the economics of research and development.”

  “I understand that,” Brian said, puzzled as to where Jessup was heading.

  “Good. Now, one of the policies Dr. Pickard and his predecessor instituted, which we feel is essential for the continued growth of the institute, is that all product problems must be reported to either Dr. Pickard or myself. We will evaluate the situation and decide what, if any action, is called for.”

  Brian felt his gut begin to tighten.

  “I see,” he managed.

  “The staff in the cath lab, on the ward, and in the clinic all know that discussing any problems concerning the work we do here with anybody—inside the institute or without—is grounds for dismissal. Our reporting system is in place for a very good reason. Many times a manufacturer can correct a problem with a drug or piece of equipment in just a few weeks. But if the bureaucracy in Washington or the FDA in Rockville gets hold of something, it could take years. The staff here all know that this is institute policy, but I’m not sure anyone had spoken to you yet.”

  Brian felt himself plummeting earthward from a great height.

  “Actually, nobody had.”

  “And?”

  “Well, I spoke to Phil Gianatasio about what happened. He and I have known each other since residency.”

  “I know. That’s no problem. Philip is one of the best, most loyal people on this staff. He’s up for tenure.”

  “I’m sure he’ll get it. Um … there’s more. I’ve always been pretty obsessive about not allowing work to pile up any more than it absolutely has to, especially paperwork. I dictated the op note of the cath before I was even out of my scrubs. The note included the rescue of the cath-tip fragment, although I didn’t say that I was operating the BIPAL forceps.”

  “No problem,” Jessup replied. “Once transcription gives you your copy, just send it up to me. I’ll do the dictation over myself so you don’t have to worry about it.”

  Brian was beginning to feel genuinely ill about what he still hadn’t disclosed. He considered lying by omission, simply not telling her what else he had done. But certainly word would get back to her sooner or later. And when it did, he might well be finished at BHI.

  “I’m afraid there’s one more thing,” he said.

  Jessup’s expression darkened.

  “Go on,” she said.

  “Well, after I finished the dictation, I noticed there was a stack of FDA MedWatch forms in a holder on the desk. As long as I was tying up the case, I filled one out and sent it in.”

  Brian could see the muscles in Jessup’s face harden.

  “Submission of that form is strictly voluntary,” she said.

  “I know. I’ve always felt that doctors were too busy or lazy to report most problems with drugs and products, and so I’ve always gone out of my way to do it.”

  That was very foolish of you.

  Had Jessup actually said those words, Brian wondered, or had he imagined them?

  “Exactly what did you do with the envelope?” she asked.

  “Excuse me?”

  “The envelope. The envelope with the MedWatch report.” Jessup’s voice was harsh. “Did you mail it?”

  “I … yes. Yes, I dropped it off at the mail room on my way up to the ward. Dr. Jessup, I’m really sorry. If I had known—”

  Jessup had already snatched up the phone and asked the operator for the mail room. After several minutes of waiting in silence, looking anyplace except at Brian, she set the receiver down.

  “The mail’s gone out,” she said flatly. “We had an understanding with Ward-Dunlop that we would allow them first crack at correcting any problem with the catheter. That’s the way we do business. That catheter is due for government approval later this year. By January, hospitals all over the world will be using it.”

  But it’s flawed, Brian was thinking. And hadn’t Jessup said something about a previous similar episode at another institution?

  As if reading his thoughts, Jessup softened a bit.

  “Brian, I know you meant well, and I totally approve of physicians protecting their patients from defective or dangerous products and pharmaceuticals. But there’s a much better, more efficient, and certainly more cost-effective way of doing it than relying on what may be the most inept, bureaucratically snarled agency in the entire government. What we encountered in the cath lab was probably nothing more than an isolated defect in an isolated product, not a design flaw.”

  “I understand. Believe me, it won’t happen again.”

  “Well, I hope not. The people at Ward-Dunlop will do what they can to deal with the impact of your report.” She checked her calendar and then her watch. “Was there something else?” she asked.

  There was no doubt in Brian’s mind that she was still peeved.

  “My father?” he asked.

  “Oh, yes. He seems to be holding his own on the change of medications I instituted.”

  “Actually, I think he’s still somewhat unstable. Certainly the quality of his life’s not very good. Looking at Nellie’s cath this morning made me wish more than ever that Jack could get put on Vasclear.”

  “He needs surgery, Brian.”

  “Dr. Jessup, my father bets on things. It’s sort of a hobby. Give him the seventy-five percent chance that Nellie Hennessey had when she started her Vasclear, and he’d choose Vasclear over surgery every time.”

  “Brian, please. I’m his doctor, and I’m recommending repeat bypass. Could I make myself any clearer?”

  “You said you’d speak with Dr. Weber.”

  “I’m sorry, I haven’t had the chance. But he’s very protective of the study. I know he’ll say that we’re not taking post-bypass patients.”

  “Why can’t you start another subset?”

  “Even if we do take him, he’ll have to be randomized just like all the other patients. That only gives him a thirty-three percent chance to get the results you talked about.”

  “That’s the same chance Nellie Hennessey had, and look what happened to her. Dr. Jessup, I want my father back, and I don’t want him to suffer like he did after his last bypass.”

  “Dr. Randa, for all of his personality flaws, is definitely a cut above Dr. Clarkin.”

  “I’m sure Randa has disasters, too.”

  “God, but you’re persistent. I’ll tell you what. Dr. Weber’s been away, but I think he’s back now. Will you be around later in the afternoon?”

  “Actually, I’ll be covering the Vasclear clinic.”

  “Okay. For what you did this morning to save Nellie, I’ll do my best. I’ll speak to him and get in touch with you at the clinic.”

  “That’s the most I can ask for.”

  “And no more FDA reports?”

  “No more.”

  “Fine. That’ll be all, then.”

  Brian turned to go, then turned back.

  “Dr. Jessup, that persistence you spoke about?”

  “Yes?”

  “I learned it from my father.”

  CHAPTER ELEVEN

  THE IWO JIMA MEMORIAL OVERLOOKED THE POTOMAC from a spot near the National Cemetery at Arlington. As instructed, Dr. Alexander Baird took the limo that had been sent for him, allowed the driver to decide where he should be dropped off, and walked past the magnificent statue to a particular bench. There, secluded from the footpaths and walkways by a small grove of evergreens, he sat and waited.

  Baird’s day usually began at six with a jog around the streets of Georgetown, followed by breakfast with his wife. Today, much to his irritation, it was necessary to deprive himself of both pleasures for an early trip to the office in Rockville. Throughout the morning, he
had continued his ongoing review of two stacks of paperwork, amounting to nearly five feet of Vasclear-related reports and research results.

  It was just after one in the afternoon and except for a few runners, the park was deserted. Across the river, morning sun glinted off the Jefferson and Lincoln memorials and sparkled off the top of the Capitol. From a distance, D.C. was alabaster perfection. But Baird had come to realize that being lulled by any aspect of the city—its appearance, its power, its sense of purpose—was not unlike becoming mesmerized by the beauty, symmetry, and easy movement of a cobra.

  Four days had passed since the hearing before Walter Louderman’s oversight committee. During that time, as he had promised, Baird had augmented Teri Sennstrom’s staff by transferring three additional research examiners from their projects to the job of reviewing the Vasclear research and cardiac-catheterization data. But Senator Louderman, like most of those in Washington, it seemed, trusted no one but himself.

  Memos had begun to circulate suggesting that larger, more established pharmaceutical houses than Newbury were pressuring Baird to keep Vasclear out of general distribution for as long as possible while their scientists searched for a compound chemically different from Vasclear, yet similar in action and effectiveness. At the same time, articles began proliferating in the lay press all over the world, extolling the remarkable results of the wonder drug and estimating the loss in lives and health-care dollars for every single day it remained locked in Newbury warehouses. Fountain of Youth Reduced to a Trickle, the headline in one New York tabloid declared.

  If Louderman’s people were to run his presidential campaign as efficiently as they did this one, the incumbent’s reelection was in serious trouble. Just enough references were made in the press to the anti-AIDS drug AZT to spur a flood of letters to the editor and mail to congressmen demanding that a medication aimed at healing the heart of America be afforded the same priority by the FDA as one directed at the germ some of the more depraved protesters called God’s virus.

  The media blitz couldn’t have been more effective. Suddenly, even the most medically unsophisticated seemed to know that AZT was approved in 1987 after less than two years of clinical testing and three months of FDA review. And although he was teaching medical students in Missouri at the time, Alexander Baird was being portrayed as responsible for hurrying it through in a manner much different from the way he was handling Vasclear. Finally, not at all to Baird’s surprise, White House Chief of Staff Stan Pomeroy had called and set up this meeting.