Patel leaned back and tented his fingers. "Bob, 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 information, especially the reports from Dr. Ingersoll at Southwestern Medical Center. Very impressive."
"Well, it's sort of Ingersoll's baby. He stumbled onto it when he was doing some research here during his infectious disease fellowship at UC Berkeley. 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," Wolfe 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?" Wolfe 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 rollout 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 Wolfe. "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."
Wolfe shook his head. "You say this drug will save us from bankruptcy. I don't see that. I mean, yes, it looks like we may be in for a full-blown epidemic of Staph luciferus, but we won't sell enough—"
Lindberg silenced him with an upraised hand. "Exposure, Bob. Exposure. If we get this drug on the market, if we're the first with a cure, our name recognition will skyrocket. Doctors and patients will pay attention to our other drugs: blood pressure, cholesterol, diabetes. Our market share will go through the roof in all of them."
Wolfe could see the salesman in Lindberg take over as he leaned closer, as though to drive home his point by proximity. "We're preparing a direct-to-consumer push on all those drugs, ready to launch at the same time we release Jandramycin."
The name didn't click with Wolfe for a moment. "I . . . Well, I'll certainly do what I can."
"Do more than that," Lindberg said. "Jandra Pharmaceuticals is hurting. We're staking everything on Jandramycin."
That was the second time Wolfe had heard the term. "What—"
"Stop referring to the drug by its generic name," Patel added. "From now on, the compound is Jandramycin. When people hear the name Jandra Pharmaceuticals, we want them to think of us as the people who developed the antibiotic that saved the world from the worst epidemic since the black plague."
Lindberg eased from his chair and gave Wolfe another slap on the shoulder. "This is your project now. It's on your shoulders. The company's got a lot riding on this."
And so do I. "But what if a problem turns up?"
Patel rose and drew himself up to his full five feet eight inches. His obsidian eyes seemed to burn right through Wolfe. "We're depending on you to make sure that doesn't happen. Are we clear on that?"
Sara leaned over the sink and splashed water on her face. The paper towels in the women's restroom of the clinic were rough, but maybe that would put some color in the face that stared back at her from the mirror. Her brown eyes were redrimmed from another sleepless night. Raven hair was pulled into a ponytail because she could never find time or energy for a haircut or a perm. Get it together, Sara. She took a deep breath and headed for the doctor's dictation room, where she slumped into a chair.
"Something wrong, Dr. Miles?"
Sara turned to see Gloria, the clinic's head nurse. "No, just taking a few deep breaths before I have to make a call I'm dreading."
Gloria slid into the chair next to Sara. The controlled chaos of the internal medicine clinic hummed around them. The buzz of conversations and ringing of phones served as effectively as white noise to mask her next words. "Is it one of your hospital patients? Got some bad news to deliver?"
"Sort of. It's Chelsea Ferguson."
"The teenage girl? Is she worse?"
"Yes. The cultures grew Staph luciferus."
Gloria whistled silently. "The Killer. That's bad."
"The only thing that seems to be working in these cases is that new drug of Jack Ingersoll's."
"Oh, I get it. That's the call you don't want to make." Gloria touched Sara lightly on the shoulder. "When will you stop letting what Ingersoll did ruin the rest of your life? I can introduce you to a couple of nice men who go to our church. They've both gone through tough divorces—neither was their fault— and they want to move on. It would be good for you—"
Sara shook her head. "Thanks, but I'm not ready to date. I'm not sure if I can ever trust a man again."
Gloria opened her mouth, but Sara silenced her with an upraised hand. No sense putting this off. She pulled the phone toward her and stabbed in a number.
Dr. John Ramsey found a spot in the visitors' parking lot. He exited his car and looked across the driveway at the main campus of Southwestern Medical Center. When he'd graduated, there were two buildings on the campus. Now those two had been swallowed up, incorporated into a complex that totaled about forty buildings on three separate campuses. Right now he only needed to find one: the tall white building directly across the driveway at the end of a flagstone plaza. The imposing glass façade of the medical library reflected sunlight into his eyes as he wove past benches where students sat chatting on cell phones or burrowing into book bags. He paused at the glass front doors of the complex, took a deep breath, and pushed forward.
There was a directory inside for anyone trying to negotiate the warren of inter-connected buildings, but John didn't need it. He found the elevator he wanted, entered, and punched five. In a moment, he was in the office of the Chairman of Internal Medicine.
"Dr. Schaeffer will be with you in a moment." The receptionist motioned him toward a seat opposite the magnificent rosewood desk that was the centerpiece of the spacious office, then glided out, closing the door softly behind her.
John eased into the visitor's chair and looked around him. He'd spent forty years on the volunteer clinical faculty of Southwestern Medical Center's Department of Internal Medicine. For forty years he'd instructed and mentored medical students and residents, for forty years he'd covered the teaching clinic once a month, and today was the first time he'd been in the department chairman's office. He swallowed the resentment he felt bubbling up. No, John. You never wanted to be here. You were happy in your own world.
John couldn't help comparing this room with the cubbyhole he'd called his private office. Now he didn't even have that. The practice was closed, the equipment and furnishings sold to a young doctor just getting started. John's files and patient records were in a locked storage facility, rent paid for a year.
He wondered how many of his patients had contacted his nurse to have their records transferred. No matter, she'd handle it. He'd paid her six months' salary to take care of such things. What would happen after that? He didn't have the energy to care. Things were different now.
For almost half a century he'd awakened to the aroma of coffee and a kiss from the most wonderful woman in the world. Now getting out of bed in the morning was an effort; shaving and getting dressed were more than he could manage some days. Since Beth died . . . He shook his head, trying to clear the cobwebs that clogged his brain. The knowledge that he'd never again know the happiness of having a woman he loved by his side made him wish he'd died with her. What was the use of going on?
But something happened this morning. He'd awakened with a small spark of determination to do something, anything, to move on. He tried to fight it, to roll over and seek the sleep that eluded him. Instead, he heard the echo of Beth's words: "You're too good a physician
to retire. People need you." He remembered that conversation as though it were yesterday. She'd urged; he'd insisted. Let's retire. I want to get out of the rat race and enjoy time with you. Retirement meant the travel they'd put off, the time to do things together. Only, now there was no more together.
This morning, he'd rolled out of bed determined that today would be different. It would be the start of his rebirth. As he shrugged into a robe, as he'd done each day since her death he looked at the picture on their dresser of him and Beth. She'd been radiant that spring day so many years ago, and he wondered yet again how he'd managed to snag her.
He'd shaved—for the first time in days—with special care, and his image in the mirror made him wonder. When did that slim young man in the picture develop a paunch and acquire an AARP card? When had the thick brown hair been replaced by gray strands that required careful combing to hide a retreating hairline? The eyes were still bright, although they hid behind wire-rimmed trifocals. "You're too old for this, John," he muttered. And as though she were in the room, he heard Beth's words once more. "You're too good a physician to retire. People need you."
Fortified with coffee, the sole component of his breakfast nowadays, he'd forced himself to make the call. He asked his question and was gratified and a bit frightened by the positive response. John dressed carefully, choosing his best suit, spending a great deal of time selecting a tie. He'd noticed a gradual shift in doctors' attire over the past few years. Now many wore jeans and golf shirts under their white coats. But for John Ramsey, putting on a tie before going to the office was tantamount to donning a uniform, one he'd worn proudly for years. And he—
"John, I was surprised when I got your call. To what do I owe the pleasure?" Dr. Donald Schaeffer breezed into the office, the starched tails of his white coat billowing behind him. He offered his hand, then settled in behind his desk.
"Donald, I appreciate your taking the time to see me. I was wondering—"
"Before we start, I want you to know how sorry we all are for your loss. Is there anything I can do?"
Perfect lead-in. See if you can get the words out. "As you know, I closed my office four months ago. Beth and I were going to enjoy retirement. Then . . ."
Schaeffer nodded and tented his fingers under his chin. At least he had the grace not to offer more platitudes. Ramsey had had enough of those.
"I was wondering if you could use me in the department." There. Not the words he'd rehearsed, but at least he'd tossed the ball into Schaeffer's court.
"John, are you talking about coming onto the faculty?"
"Maybe something half-time. I could staffresident clinics, teach medical students."
Schaeffer was shaking his head before John finished. "That's what the volunteer clinical faculty does. It's what you did for . . . how many years? Thirty? Thirty-five?"
"Forty, actually. Well, I'm still a clinical professor in the department, so I guess I have privileges at Parkland Hospital. Can you use me there?"
Schaeffer pulled a yellow legal pad toward him and wrote a couple of words before he pushed it aside. "I'm not sure what I can do for you, if anything. It's not that easy. You have no idea of the administrative hoops I have to jump through to run this department. Even if I could offer you a job today— and I can't—I'd have to juggle the budget to support it, post the position for open applications, get half a dozen approvals before finalizing the appointment." He spread his hands in a gesture of futility.
"So, is that a 'no'?"
"That's an 'I'll see what I can do.' Afraid that's the best I have to offer." Schaeffer looked at his watch, shoved his chair back, and eased to his feet. "Coming to Grand Rounds?"
Why not? John's house was an empty museum of bitter memories. His office belonged to someone else. Why not sit in the company of colleagues? "Sure. I'll walk over with you."
As the two men moved through the halls of the medical center, John prayed silently that Schaeffer would find a job for him. With all his prayers for Beth during her final illness, prayers that had gone unanswered, he figured that surely God owed him this one.
2
JACK, THIS IS SARA."
Dr. Jack Ingersoll hunched his shoulder to hold the phone against his ear. He removed his glasses and polished them on the tail of his white coat. The closed door of his academic office couldn't quite block out the noise as one of his fellow faculty members read the riot act to a resident about his choice of a drug for bacterial endocarditis. "Sara, so good to hear from you. How have you been?"
"You can skip the niceties, Jack. This is a professional call."
"I get the picture. So let's keep it professional. What can I do for you?"
"I have a sixteen-year-old girl with generalized sepsis. No response to the usual empiric IV antibiotics. I got the blood culture results this morning. Staphylococcus luciferus."
Ingersoll pursed his lips. "Another case. And, of course, the sensitivity studies—"
"Resistant to every antibiotic tested. So I thought of you and your study."
Ingersoll's pulse quickened a bit. Every patient he enrolled strengthened the reputation he was building as the world's authority on EpAm848. It looked to be a wonder drug, and if he could hitch his wagon to that star, there was no telling where he could go. "Does she meet the enrollment criteria?"
"Yes. I checked before I called you. The mother's anxious to get her into the protocol, and I've laid the groundwork for you. Informed consent shouldn't be a problem."
He found a blank slip of paper in the morass on his desk. "Thanks. What's her name and where is she?"
"She's in the ICU at University Hospital. Name's Chelsea Ferguson." Sara cleared her throat. "Jack, she's just a kid. And the mother's worried sick. Try to upgrade your usual bedside manner. Please."
Ingersoll ended the conversation with a few mumbled assurances. He thought a moment, then punched the intercom button. "Martha, page Dr. Pearson and tell him to meet me in the ICU at University Hospital. Then call over there and get the identifying info on a patient—her name is Ferguson—and give it to Dr. Resnick. Have him make up a set of enrollment papers for the EpAm848 study and bring them to the ICU."
Ingersoll swiveled away from his desk and let his eyes sweep across the horizon. New construction was everywhere at Southwestern Medical Center, girders and columns rising alongside existing massive buildings. Although the economy was rough, there were still more than enough multimillionaires in Dallas who wanted to assure themselves of the best possible care by the brightest minds in the medical field. What better way to do that than to give money to the academic medical center in their hometown? Jack Ingersoll wanted some of that. He wanted to become Dr. Jack Ingersoll, John and Mary So-and-So Distinguished Professor of Infectious Disease, with offices in the Thus-And-Such Building, his salary and research expenses underwritten by the Bubba and Sue Somebody-Or-Other Foundation. And if the EpAm848 study kept going this way, that was exactly where he was headed—if not here, then somewhere.
There were portraits scattered throughout the medical center of some of the distinguished faculty members. He wanted his to join that select group. He'd be wearing a white coat, holding a beaker of brightly colored liquid, looking into the distance, contemplating the discovery that put the medical school—and him—on the map. The artist would have to minimize his developing paunch and maybe enhance his scant brown hair into a handsome widow's peak, but that was the advantage of a painting over a photograph.
He unlocked the bottom drawer of his desk and pulled out a rust-colored stiffcardboard accordion file closed with an elastic cord secured over a large button. Ingersoll unfastened the closure, peered inside the file, and counted the sets of stapled pages. Twenty-one. Twenty-one patients willing to testify that he was a miracle worker. Twenty-one instances where EpAm848 saved a life otherwise doomed because of infection by Staphylococcus luciferus—the Devil's own Staph, "The Killer."
Patients were dying all over the world from this infection. It was turning into
an epidemic, but the success rate of Ingersoll's treatment was 100 percent so far. Conventional wisdom in medicine held that no therapy was 100 percent effective. He felt like a pitcher, taking a no-hitter into the eighth inning. Somewhere out there might be a case that wouldn't respond. But so far, he was throwing a perfect game, and if he could keep it up, there was no limit to how far he'd go.
Martha's voice startled him from his daydreams. She never used the intercom, no matter how many times Ingersoll asked her to do so. He'd finally given up on that fight. "Dr. Pearson just called. He's at the ICU and is reviewing the chart now."
Ingersoll resealed the file and locked it in his desk drawer. "I'm on my way. Page me if there's something urgent."
He transferred his stethoscope, pens, and pocket flashlight to a freshly laundered white lab coat. He slipped his arms in, flexed his shoulders a couple of times to loosen the starched fabric, and buttoned the coat over his pale blue cotton dress shirt, leaving just enough of his rep-stripe tie showing to make a fashion statement. Sometimes a good first impression on the family was the most important part of the consultation.
As he exited his office, he almost bumped into Dr. Carter Resnick, hurrying down the hall, head down, mumbling to himself.
"Resnick, watch what you're doing."
Resnick rubbed his hand nervously over his shiny dome. Ingersoll couldn't understand why some men shaved their heads, but apparently Resnick thought it made him look wiser. It didn't. If anything, it accentuated his geekiness.
"Sorry, sir. I just prepared the packet for Chelsea Ferguson and took it to Dr. Pearson. Would you like me to go with you to see her? Maybe I could help." He brought his eyes up for a millisecond, but dropped them again. Whatever expression they held was hidden behind thick horn-rimmed glasses.
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