“You said it might show something you could treat,” Mickey said.
“It might. I’m waiting for more test results and a few more days to see how she does.”
When Terri returned to her office, her secretary said, “You’d better get line one. It’s about Jennifer.”
“I just left there,” said Terri, picking up the flashing line.
“You’d better get back here, Doctor,” said the nurse. “Jennifer just went into shock!”
Chapter Fifty-Seven
Word of the meeting between the district attorney and Richard Kendall had spread through PAT and the University of California. Researchers and clinicians devoted to understanding and dealing with disease felt that they’d become part of something squalid, something that debased them and their mission.
How did I let myself get into this mess? thought David Birch. What’s going to happen when Richard tells all?
David left PAT at six for the drive home. His mind was too preoccupied to indulge himself with his usual irritation at the traffic at the Caldecott Tunnel. He parked in front of his condominium in Lafayette, picked up his mail, and entered his darkened home.
He sensed it at once, but too late as someone grabbed him from behind and placed a gauze soaked with ether over his face.
David had no idea how long he was out. When he awakened, he was bound to a chair with duct tape. He shook his head to clear it and looked across the room at a shadow sitting on the couch. The figure, backlit by the streetlight shining on the window, was indistinct.
“I’m sorry,” the friendly voice said, “but this was necessary.”
“What do you want?” David asked. “I don’t have much. Take my money, my watch or whatever.”
“All I want is a little information. Give it to me and this will be an entirely forgettable experience. Refuse me, and—you don’t want to do that.”
“I’m no hero. What do you want?”
“Tell me about Laval Laboratories and their BCG.”
“I don’t know what you’re talking about.”
The shadow crossed the room and before David could utter a word, the man delivered a blow to his face.
David’s head exploded in pain as the chair fell backward and his head hit the hardwood floor. David began to cry.
The man raised David’s chair and returned to the couch.
“Do you think I like this?” the man with his soft voice asked. “I hate to do this to such a fine gentleman and scholar. It’s demeaning to both of us. Do I need to repeat the question?”
David coughed as mucous ran down his throat and out through his nose. He felt dizzy as the room spun before his eyes.
“What do you want to know?”
“Everything.”
“I just provided information. I’m a scientist and researcher. I told Richard Kendall about the potential in Laval University’s strain of BCG. I don’t know what he did about it.”
The shadow stood.
“Wait! Wait! No more. I’ll tell you what you want.”
“I’m waiting, Doctor.”
“He arranged to steal the BCG, but I never thought it would come to murder. I’m not sure if even Richard knew that. Too much was on the line for him. Kendall Pharmaceuticals was in trouble. The BCG offered unlimited financial potential if the research was successful.”
“Do you know who killed Emile Gigot, the BCG courier?”
“I don’t have the slightest.”
“What do you know about Lisa Gomez?”
“I don’t know anything.”
The man stood again.
“Don’t. Please don’t. I suspect that Karl Muller may have had something to do with her death, but that’s only a suspicion. I know nothing for certain. Please understand that I removed myself from any discussion of such activities. I’m a scientist.”
The man stood.
David shook. “Please,” he begged.
The man moved closer. “You don’t have the stomach for this Doctor. Our lives are frail. Be smart.”
David saw the white gauze in the man’s gloved hand and tried to lean back. Soon he smelled the ether, then nothing.
Terri heard the throbbing Code Blue alarm as she rushed back to Jennifer’s room. She gasped when she saw the crowd.
Terri forced her way in.
“She was about to code, Dr. Powell,” the nurse said. “Her pressure was in the fifties and her breathing looked terminal.”
The respiratory tech held a plastic mask over Jennifer’s mouth and nose with one hand, and held the Ambu bag in the other. He squeezed it to inflate her lungs. Her heart monitor showed rapid beats streaming across the screen.
“How’s her blood pressure?” Terri asked.
The senior resident in charge of the code said, “I gave her some volume expanders and her pressure came up to 76/40.”
Terri pulled down Jennifer’s sheet. Her skin was covered with red circles with white in the center. The centers of several circles were turning black. She touched several. “I think these are going to turn into gangrene.”
The resident nodded. “Ecthyma, I think. I read about them in Harrison’ Textbook of Medicine. These skin lesions are a dreadful complication of bacterial invasion of the blood stream. Most often, they’re due to a bacterium called pseudomonas.”
“This must be pseudomonas sepsis from her bladder or kidneys,” Terri said. “Let’s give her an aminoglycoside antibiotic and get her up to ICU.”
Mickey and Marlene stood in the hallway holding hands.
“Terri...” he said.
“It’s bad, Mickey. She has an infection that entered her bloodstream and caused shock. I’m moving her to the Intensive Care Unit.”
“She’s dying,” screamed Marlene.
“Not if I can help it,” Terri said.
Chapter Fifty-Eight
The door flew open as the ward staff and Terri pushed Jennifer’s bed into the ICU. Marlene and Mickey trailed behind.
In two minutes, they transferred Jennifer into an ICU bed, hung her IVs, and adjusted her monitoring lines. The automated blood pressure machine beeped and blinked, its red LEDs reading 64/40.
Suddenly, the cardiac monitor alarmed as the heart tracing showed her normal pattern replaced by a chaotic wavy line.
“She’s in ventricular fibrillation,” yelled the nurse.
“Push the code button and get the defibrillator,” Terri said in a calm voice. “Get the family out—now.”
The room resounded with the pulsating beat of the code blue alarm as the room filled with physicians, nurses, and a respiratory care technician.
“Pump her and get her ventilated,” Terri said adjusting the defibrillator. She watched the voltage rise and when the machine lights turned green, she placed pads on Jennifer’s chest and paddles on top of them. “Clear,” she shouted, then pressed the red button.
Jennifer’s body jerked spasmodically, and then relaxed.
“What’s she got?” Terri asked.
“She’s back to a normal rhythm,” the nurse said.
“I’m having a hard time ventilating for her,” the respiratory technician said. “I think her lungs are full of fluid. She needs to be intubated.”
Terri looked around for someone with more experience at placing a tube into a patient’s trachea, but saw nobody. “Where’s the ER doc?” she asked.
“He’s on another code,” a nurse said.
Terri stepped behind the bed. “Get me the tray.”
The nurse pulled the headboard out giving Terri access to Jennifer’s head.
Terri put on her gloves. “Extend her head,” she shouted, “and someone get ready to press on her Adam’s Apple, the thyroid cartilage.”
Terri grasped the stainless steel laryngoscope, flipped out its blade and passed it under Jennifer’s tongue and lifted to visualize her vocal cords. Her heart raced as she searched for the two parallel vocal cords. She pulled and lifted, but still saw nothing. Terri panicked.
“Push
down on the thyroid cartilage—now,” she shouted.
Amidst the pinkish flesh and folds, the vocal cords miraculously appeared. She pushed the tube through and said, “Inflate the cuff.”
As she pulled out the laryngoscope, the respiratory tech had attached a bag to the end of the endotracheal tube and was filling Jennifer’s lungs with oxygenated air. He looked up at Terri and touching his index finger to his thumb, giving the okay sign.
They placed Jennifer on the ventilator.
“How’s her pressure?” Terri asked.
“It’s 78/50,” said the nurse.
“Let’s give more plasma expanders,” Terri said, “and set up a bag with dopamine if we need it to control her pressure.”
Terri moved a chair and an overbed table to Jennifer’s bedside, keeping herself but a few feet away from her patient. She took a deep breath, wiped the sweat from her brow, and raised her shaking pen to write ICU admitting orders. When she got to page two of Jennifer’s orders, Terri recognized that every one of them related to her infection and the associated shock. None related to her underlying prion disease.
What more can I do? If she has it, there’s nothing I can do anyway.
Terri’s sense of Jennifer changed the moment she went into shock. She knew the experience and hated it. It was the gradual waning of Jennifer’s humanness, the first step toward accepting death’s sovereignty.
That evening as Terri and Matt stood at the bedside looking at Jennifer’s expressionless face, the endotracheal tube protruding, Terri said, “It’s not that Jennifer’s lost her humanity as she turned critical. It’s more that I’m left with an image of Jennifer as she had been, her smile, her laugh, and her kind caring nature.”
“I’m so sorry,” Matt said. “This has to be more difficult when the patient is a friend.”
“It is, and it isn’t. Of course it’s more difficult to lose a friend, but if I can control my emotions and maintain objectivity, I’m capable of so much more. Modern medicine says I should treat the person, not the disease, but the person is a memory and the disease is real and stands in the way of seeing my friend again.”
“The change in Ronnie’s face as he died in my arms still haunts me,” Matt said. “In a second, he’d become a Madam Tassaud wax figure, accurate in every detail, yet empty of the essence of what made Ronnie human.”
Matt turned and looked behind. “It’s Marlene and Mickey.”
Marlene’s eyes were red.
Mickey’s mouth was pinched and drawn against his teeth. He hadn’t shaved in days. “Give us good news, Terri, Anything.”
“Her blood pressure’s in the 90s. That’s a start.”
“The infection’s from her urinary tract?” Mickey asked.
“We’re sure. I just called the lab and they’re 99 percent sure that it’s pseudomonas bacteria and that it’s sensitive to the antibiotics we’re using.”
“When’s the neurosurgeon coming to see Jennifer?” Marlene asked.
“He was in this morning.”
Mickey stared at Terri. “When will he do the brain biopsy?”
“He won’t.”
“I don’t get it, Terri,” Mickey said. “You’re stalling. Why?”
“I am,” Terri said. “It’s difficult to explain. Medicine is not always the sum of its parts. After we do everything, examine the patient, look at the laboratory tests, the scans, the x-rays etc. what remains is an ‘X’ factor. It’s something that tells me that all’s good or bad, or that we’ve missed something. The mind had great capacity to assess the totality of a situation beyond the obvious. I think it’s the essence of the art of medicine and I’ve learned over the years not to ignore it.”
“How long will you wait?” Marlene asked.
“Once we have this infection under control and Jennifer’s stable, we can assess her mental status and move from there.”
“Can we see her now?” Mickey asked.
“Of course. I’ll be back in a few minutes.”
As Terri and Matt walked away, Mickey shouted, “Terri, what wrong with Jennifer’s urine. It’s brown.”
“What are you talking about?” Terri said returning to the bedside.
“Look,” said Mickey pointing to the clear plastic tube connecting Jennifer’s bladder catheter to the hourly collection meter.
When Terri looked, she saw dark brown urine in the tube and a tiny amount in the collection meter. “How long has her urine looked this way?”
“What way?” responded the nurse.
Terri pointed.
“It was a little cloudy 50 minutes ago,” the nurse said as she lifted the drainage tube and allowed its contents to fill the hourly meter. “Fifteen ml. That’s all the urine she’s produced in nearly an hour.”
Terri felt her stomach tighten as she drained the small amount of urine into a specimen container. She carried it to the lab where she examined it under the microscope. The brown pigment wasn’t blood in the urine, it was, as she feared, the pigment from the breakdown of muscle cells called myoglobin, and it had caused Jennifer’s kidneys to fail completely.
“Her kidneys have what?” Mickey shouted.
“We’re trying to promote the flow of urine, but I think it’s a waste of time. They’re going to be shut down for a while.”
“Will she need dialysis?” Marlene asked.
“She might, but the overall prognosis for her kidneys is good if we give them enough time to heal.”
“What next,” Mickey cried. “What the hell else can happen?”
“Don’t, Mickey,” Terri said. “I’m not giving up and neither should you.”
Chapter Fifty-Nine
The Kendall board sat around the dark walnut conference room table in silence as they listened to Lionel Kendall.
“That’s all of it,” Lionel said. They passed knowing glances at each other trying to assimilate Lionel’s revelations, the activities of their CEO, Richard, and the results of the PAT phase I trial.
Bernie Brothers, a senior board member said, “Let me get this straight. Project Rosetta, our BCG vaccine works. It could be a major breakthrough in the treatment of advanced cancer and your activities may have screwed Kendall out of the picture. Millions...maybe billions and we may not see dollar one.”
Lionel had run the board like George Steinbrenner ran the N.Y. Yankees and never needed to justify any of his actions. “We’ve spent millions to assemble extensive tissue culture and animal experimental data, and we have the Phase I trial itself. We’re in a better position than anyone else to restart the trial with uncontaminated BCG if we could get some.”
“Make Laval University a deal they can’t refuse,” Brothers said.
“Henri Charles wouldn’t support our research when we asked for the BCG in a normal manner,” Lionel said. “It’s laughable that he’d agree now under these circumstances.”
“Are there no other sources?” another board member asked.
“One or two, but they won’t deal with us either,” Lionel said.
“Can we produce our own BCG vaccine?” Brothers asked.
“Yes, but that would take two to three years,” Lionel said. “If we don’t get approval of the vaccine within the next six months to a year, we’ll never get it.”
“Can’t we put all our effort into pushing our lobbyists to persuade the FDA to approve the vaccine?”
Lionel shook his head. “They can’t approve a vaccine contaminated with prions.”
“With or without, what difference does it make?” Brothers asked.
Lionel had run out of patience. “They’re not going to put their approval on anything that causes disease, especially something like Mad Cow Disease. For all we know, the prions may have controlled the cancer. One of our own scientists suggested that possibility.”
Bernie Brothers looked around the boardroom and understood full well what was on the minds of its members. “You know the numbers as well as we do, Lionel. If we can’t salvage something from this fiasco, w
e may need to seek the protection of the courts. Once we do that, there’s no room for you in the business. No court-ordered reorganization would permit that.”
“I built this company with my own bare hands. It bears my name and I’ll be damned if I let anyone take it away from me.”
“The stockholders will run you out of town once they discover how you and that moron son of yours destroyed the company. I wouldn’t worry about the name either. If we go through reorganization, the name of Kendall will be the first thing to go.”
“We’ll see,” Lionel said as he stood.
“One more thing, Lionel.”
“Yes.”
“We’re not spending a penny to defend your idiot son.”
At the same time as the board meeting, Woody and Eddie sat in the security chief’s office.
“What can we do, Woody?”
“It all depends what’s on Karl’s tapes.”
“Nobody specified violence. The phrase, ‘I want you to take care of it’ is ambiguous enough, especially if Karl recorded our subsequent reaction to Lisa’s death.”
“Who knows what he recorded or when,” Woody said. “Our attorney could make the case that the unrecorded sections contained our specific disapprovals of Karl’s actions.”
“Sure, the court’s going to believe that.”
Woody’s intercom buzzed. “I have a Mr. Brooks on the line,” Woody’s secretary said. “He won’t tell me what it’s regarding.”
“Put him through.”
Woody picked up the blinking line. “Brooks, how are you doing?”
“Better than you guys.”
“Tell me what you got.”
Brooks told them about the information he obtained from David Birch. “Richard arranged for the theft of the BCG from Laval, but David denied any knowledge about the death of the courier. I believe him. He doesn’t have the guts for that. One thing for sure, Birch was the motivating force behind Richard’s actions to get the BCG. Birch waved megabucks at a company in trouble. He’s a manipulator, you know the type. They never get their own hands dirty.”
“What does he know about Lisa Gomez?” Eddie asked.
A Simple Cure Page 26