Miracle Cure

by Michael Palmer

  “This cake is just beautiful,” he said.

  “Thank you. Decorating them is one of my favorite hobbies,” she said simply.

  Then she introduced Brian to her daughter, a buoyant redhead with Nellie’s eyes and lively smile.

  “If Megan wasn’t married to the best man this side of heaven,” Nellie said, “I’d insist she give you a try.”

  Again there was laughter and applause in the clinic. Lucy Kendall caught Brian’s eye and gave him her most wicked smile. Anxious to remove himself from the center of attention as quickly as possible, Brian cut the first slice.

  “So, Nellie,” one of the patients asked, “exactly what did this tall, dark, handsome doctor do to save your life?”

  For the briefest moment, Brian saw a look of confusion flash across Nellie’s cherubic face.

  “Well,” she said, “I started having trouble with one of my arteries, and this lad opened it up.”

  Again, some people applauded, and that was that. No mention of the defective Ward-Dunlop product. No mention of the catheter tip.

  Had Nellie been spoken to? Brian wondered. Bribed in some way? Or was she just incredibly intuitive about the need for discretion?

  He led her over and introduced her to Bill Elovitz, then stepped back a pace as the two of them shared snippets of their stories. Nellie was one of the seventy-five-percenters. Get sick, get Vasclear, get well. Simple. Clean as a scalpel cut.

  But what exactly was Bill Elovitz?

  He had gotten fairly significant improvement initially, then had regressed. That pattern put him outside the twenty-five-percenters—the ones who simply had no response to Vasclear whatsoever. And now, there was the possibility that he had developed an extremely rare lung condition. Was the condition real or just a diagnostic stab in the dark? If it was real, was it a coincidence or a complication?

  And what, if any, were the implications for Jack?

  Even if Elovitz did test out as having PH, there was no way to link it definitely to Vasclear. And seventy-five percent success was seventy-five percent success. The findings in Bill were certainly no reason for stopping Jack’s treatments.

  “Nellie, tell me something,” Brian asked. “Exactly how long after you started your treatment with Vasclear did it take for your symptoms to go away?”

  “How long? Not very, darlin’. I can tell you that much.”

  “I remember exactly,” Megan chimed in. “You had your first treatment on August tenth, and your pain was gone the day of my birthday. You decorated the cake with smiley faces and hearts, remember?”

  “So how long was that?” Brian asked again.

  “Oh,” Megan replied. “My birthday’s on the twenty-fourth. It was exactly two weeks later that your pain was gone. Two weeks to the day.”

  CHAPTER SIXTEEN

  THE EVENING WAS FAR LESS EVENTFUL THAN BRIAN HAD anticipated. There had been no action on his code-call beeper, and following the Vasclear clinic, there had been only one admission to the ward, a thirty-eight-year-old man on an experimental drug for myocarditis, a viral infection of the heart muscle. The drug was still in Phase One trials—toxicity and dose adjustment. But from what Brian could tell, in this patient at least the treatment was a complete bust. The man’s congestive heart failure was worsening, and he was being treated with more and more medications. He was a candidate for a transplant, but as with many others, he was mired so far down the list that it seemed likely his disease would take him before the call came in.

  Brian took a history, did a physical exam, and wrote a set of admission orders. Then he headed to the on-call room to review the man’s chart and type out his workup on the laptop that was bolted to the workstation there. On a busy service, typing admission workups was often simply too time-consuming, and the residents were forced to dictate. But by using the laptops, the case synthesis was generally more thoughtful and complete, the printout was in the chart immediately, fewer transcription secretaries were needed in the record room, and the possibility of a clerical error was eliminated.

  Brian set the chart and a cup of resident-style coffee by the laptop, and had settled in the chair before he touched a key and saw the screen remain black. An attempt at restart, the limit of his ability to deal with any computer crisis, accomplished nothing. Dictation was a possibility, but he wanted to type out a review of the chart for his own study. He called a tape recording in the computer office and reported the malfunction. Then he decided to try the laptop in the dictation carrel in the Vasclear clinic.

  He notified the nurses on duty where he’d be and let himself into the clinic using the keypad. The place was deserted, dark, and eerily quiet. The tiny, glass-enclosed carrel was situated just a few yards to his left. Without bothering to look for any light switches, he used his penlight to spot the door. He chose the cozier incandescent light of the table lamp, rather than the overhead fluorescent. Then he closed the door and pulled the drapes shut. A cocoon.

  It was ten-thirty, but he knew there wasn’t a chance in the world Jack would be asleep. The home health aide they had hired to fill in when the neighbors couldn’t be with him answered on the first ring.

  “So, how’s he doing, Mrs. Rice?” Brian asked.

  “No change from when you called at six. He just sits and watches sports.”

  She sounded frustrated, bored, or both.

  “Well, he used to play them,” Brian said with a deliberate edge to his voice, “and very well, too. Any chest pain?”

  “Some when he got up to go to the bathroom. He put one of those pills under his tongue. I want to give him a back rub before my shift ends at twelve, but he won’t lie down to let me do it.”

  “Could you put him on, please?”

  “Hey, Bri.”

  “Hey, Jack, why’re you giving Mrs. Rice such a hard time?”

  “She’s a nag, that’s why. Besides, I don’t need my back rubbed. I need some of that Vasclear.”

  “This is your off-night. I told you that a dozen times.”

  “Oh, I guess I forgot. I forget everything now. You know that. I wanted more of the Vasclear because I think it may be working.”

  Brian felt a rush.

  “What do you mean? Tell me.”

  “Well, I can’t explain it, but I just feel better tonight.”

  “Hey, that’s great, Pop. That’s really great. But Mrs. Rice said you took some nitro before.”

  “Just a couple. I’m telling you, Bri, the stuff is working.”

  “Well, that’s wonderful news. I’ll be bringing some more home for you tomorrow.”

  “You do that.”

  “I’ll speak to you in the morning, Jack.”

  Brian set the receiver down, leaned back, and allowed his eyes to close. It was good to hear his father saying anything other than how miserable he was feeling. But he was still popping nitroglycerin just to make a twenty-foot walk to the bathroom. Was his sense of improvement merely a transient bump in his downward course, or did it represent a significant turn for the better?

  He opened the thick myocarditis chart and had just smoothed it out beside the laptop when he heard the clinic door open. Moments later, there was the sound of voices. Through a small crack in the drapes, he could see the fluorescent overheads flicker on. He set his pen down and peered out through the opening. In seconds, Art Weber and Carolyn Jessup walked past the carrel without glancing his way. They were on either side of a tall, robust, slightly balding man, who was dressed nearly as expensively as Weber himself.

  Brian did not get a look at the taller man’s face, but there was something familiar about him. The two physicians guided him into room 1, the administration room nearest to where Brian was working. Moments later, the lights in that room winked on. Brian inched the door of the carrel open just a bit. The voices from room 1 echoed out into the corridor.

  “A quick exam to make sure everything’s all right,” he heard Jessup say, “then I think we’ll run a cardiogram before giving you your treatment.”r />
  “How have you been feeling?” Weber asked.

  “Great. The pain that brought me in to see Carolyn disappeared after just two or three weeks of treatments, and hasn’t really come back.”

  The man’s voice was familiar, too.

  “That’s excellent to hear,” Weber said.

  “You’ve got a winner in this stuff of yours, Art. A real winner. Not that there aren’t occasional twinges in one place or another in my chest, but they don’t last long.”

  “That’s perfectly natural,” Jessup said. “Everyone over the age of twenty feels an occasional twinge in the chest. The trick for a doctor is to separate true cardiac pain—angina pectoris—from a muscle spasm between the ribs, or extra acid washing up from the stomach into the esophagus, or a gas bubble trapped in the intestine beneath the diaphragm, or some inflammation of the lung, or even tendonitis around the shoulder. Sometimes it’s not so easy to do. The list of possibilities goes on and on.”

  “There sure is a hell of a lot that can go wrong in that part of the body,” the man said.

  Who is that? Brian asked himself, now feeling that he was close to the answer.

  “Mostly very minor and inconsequential problems, Walter,” Jessup replied. “One might even say most chest pains are the body’s normal response to the daily stresses of life. And that’s the case with you now, because fortunately, thanks to Dr. Weber and the good folks at Newbury Pharmaceuticals, your coronary artery disease is virtually gone.”

  “Terrific,” the man said.

  Walter? Brian rolled his seat just a bit closer to the crack in the carrel door.

  “This cardiogram looks like a teenager’s,” Jessup cheered. “You’re getting an excellent response. Art, I think we’re all set for the treatment. I’ll slip the IV line in if you’ll get the Vasclear.”

  “Glad to. One Vasclear cocktail coming up.”

  Weber emerged from the examining room and headed down to the medication room. Brian sat stunned, trying to sort out what he had just heard. Clearly, the man named Walter was a VIP—a VIP getting his heart disease cured by Vasclear treatments. Had he been randomized into the beta group? It seemed highly unlikely.

  Weber returned from the med room in moments.

  “Here you go, Senator,” he said. “You did say high-test, didn’t you?”

  Walter Louderman! Brian caught his breath. He rarely voted Republican, but if the rock-jawed former linebacker did get his party’s presidential nomination, he might well make an exception. There could be little doubt that Weber and Jessup had broken the code to ensure that the senator got “high-test”—the beta dosage. But almost as startling was the realization that Senator Louderman had heart disease—at least, he’d had it before his Vasclear treatment. Such a revelation would probably have put an end to his presidential aspirations.

  They should have trusted me, Brian thought angrily.

  His father’s life was on the line. Everyone knew beta was the maximum-dose group. They were cheating with Louderman. Why couldn’t they have just stowed all that randomization bullshit and put Jack on the drug, too? They could have done it in such a way that no one, not even Brian, would have ever known. Instead, Jessup had allowed the computer to randomize Jack into the damn placebo group. Then she had kept pushing for repeat bypass surgery.

  Was it worth confronting them now? What would be gained?

  Brian listened for another thirty seconds, then eased the door almost closed and pushed himself back to the laptop. He logged on to the record room and entered his password, GODEEP. After a prompt, he asked for the record of Walter Louderman. Not surprisingly, the record-room computer denied having such a chart. An alias of some sort seemed possible, but Brian doubted that a man with Louderman’s lofty political ambitions would take even that chance.

  He made a mental note to look through the film library adjacent to the cath lab. But he knew it was doubtful that Louderman’s medical record or his cardiac-cath video would be anyplace other than inside a safe in Carolyn Jessup’s office. She might even keep it at home. Suddenly he became aware of breathing and movement to his left. Art Weber was standing just outside the slightly ajar door of the carrel, peering in at him, his face an expressionless mask.

  Brian glanced back at the laptop. From where Weber was standing, there was no way he could have seen that it was Walter Louderman’s record Brian was searching for.

  “Hi, come on in,” Brian said with artificial cheer.

  Weber pushed open the door with his foot, but stayed where he was.

  “Have you been here since before we came in?” he asked.

  “I … um … yes. The computer on the ward is down. I’ve been here for a little while working on a new-admission write-up.”

  “I see. And you saw us come in with our … patient?”

  “I did, yes.”

  “And you recognized him?”

  Brian still could read nothing in the project director’s expression. He debated, then discarded, the notion of lying to Weber. Finally, Brian nodded.

  “Listen, why don’t you stay right here and continue your work,” Weber said. “I want to speak with Dr. Jessup.”

  Weber closed the carrel door behind him, then did the same with the door to room 1. Brian felt some measure of fear work its way into his anger. Could they fire him? Would they risk his telling someone what he had seen? The answers were, sadly, that he was totally expendable at BHI, and that addicts—recovering or not—were near the bottom of the world’s credibility scale.

  Carolyn Jessup emerged from room 1, tapped lightly on the glass door, then nudged it open and moved just inside the carrel. Brian warned himself to stay cool. He moved back and sat on the edge of the desk.

  Eyeing him, she folded her arms across her chest. He noticed her makeup was understated and expertly applied. Her nails were manicured and polished a glistening scarlet. If Phil Gianatasio was intimidated by Teri Sennstrom, then this woman must be absolutely terrifying to him.

  “Well, Brian,” she began, clearly choosing her words carefully, “here we are again, talking about things that need to be done for the good of Boston Heart Institute.”

  “So it seems.”

  “Dr. Weber tells me you are well aware of the identity of our mystery guest.”

  “Senator Louderman is not easy to overlook.”

  Jessup’s smile was noncommittal.

  “Yes, I agree,” she said, unfolding her arms, but never taking her dark eyes off his. “The senator was referred to me some time ago for ill-defined chest pains. I did a treadmill, expecting it to be negative, but it wasn’t. He clearly had cardiovascular disease. Given the … delicate nature of his political position and plans, he was catheterized secretly by me, at which time a ninety-percent occlusion of his left anterior descending artery was documented, along with lesser blockages in the right and circumflex. He was begun on Vasclear immediately and has had such a remarkable result that I would doubt his health will be an issue at all—private or public—should he seek national office.”

  “Ninety percent,” Brian said. “That’s a fantastic result. I’m sure it means a great deal to have Vasclear work so well on a man as powerful as the senator.”

  “It always helps to have friends in high places,” Jessup replied calmly. “A little like the BHI friends you have in Dr. Pickard and myself.”

  The threat was thinly veiled and Brian responded quickly.

  “I told you before, Dr. Jessup, I’m very grateful to Dr. Pickard and to you for giving me the chance to get back on my feet. The last thing I would ever want is to jeopardize my position here. There’s just too much at stake for me.”

  “Well said. In that case, Brian, in the interests of that career of yours and a great deal more, you must promise to refrain from mentioning Senator Louderman to anyone. And I mean anyone. Word getting out of his treatment here could be disastrous—to him and to us.”

  “I understand.”

  “Excellent.”

  Jes
sup glanced over her shoulder.

  “Art, do you have anything to add?”

  Weber stepped to the doorway of the carrel.

  “I just want to applaud you, Brian, for appreciating the seriousness of this situation,” he said. “If there’s ever anything either of us can do to thank you, you need only say so.”

  Brian hesitated a moment, but knew he was not going to be able to remain silent.

  “Actually, there is one thing,” he said. “I … assume Senator Louderman wasn’t randomized into the beta Vasclear group.”

  Weber and Jessup exchanged glances.

  “Brian, we’re talking about a man who might well be our next president,” Jessup said. “There was no way we could take the chance of including him in the double-blind study.”

  “Right,” Brian replied. “But as important as the senator is, the most important man in the world to me is my father.”

  “Of course. And you want him to be placed in the beta group.”

  “That was my desire all along, and it still is. But whatever your decision is about that, I want to assure you again that I understand the need for secrecy as far as the senator is concerned.”

  There was a surprising but unmistakable look of respect—of admiration—in Carolyn Jessup’s eyes. Welcome to the club, Dr. Holbrook, they seemed to be saying. It would appear you have what it takes to succeed here.

  “Well, Brian,” she said, “that’s not too much to ask, not at all. Suppose we start your father’s treatment tomorrow afternoon, say, at five. I’ll notify the nurses that he has been randomized into the beta group.”

  “I think the trip into the city may be a bit much for him right now. If it’s all right with you, I’d like to start his treatments at home.”

  “As long as you know that my recommendation is still surgery, and as quickly as possible.”

  “I understand. I haven’t looked at her films, Dr. Jessup, but from your description, Nellie Hennessey’s arteriograms were just as bad as my father’s. I saw her today in the clinic. She’s nearly six years older than Jack and looks and acts a decade younger. I want to give him at least a reasonable try with Vasclear.”