The Plague Within (Brier Hospital Series)

by Lawrence Gold

  “You don’t know what you’re talking about,” said Beth. “Get out of our way.”

  The man forced a sardonic smile. “You can’t hide from us—we have friends everywhere.”

  Beth shook her head in disgust and then pushed her way through the group to Sandy’s car. After she entered, she rolled down the window to face the crowd. “No God worthy of the name, could be a party to the cruelty you brought on this innocent woman today. Isn’t it Luke, reverend? Judge not, and you will not be judged.”

  Andre’s laboratory had expanded to twice its size.

  As if more space is going to make a difference, he thought.

  Archie had provided Andre with his best laboratory assistants who, though not well versed in DNA vectors, had years of experience and skill in manipulation of genetic material. They’d replaced the genetic sequence in the PAT0075 with the original sequence in Sandy’s cells and had inserted them into the same DNA adenovirus used in the trial. As the genetic viral stew grew in the glass flasks, they documented the purity of the replication and the integrity of the genetic material.

  After the first week, Archie studied the data. “Incredible work, Andre. You’ve done more in a week than many labs could have done in a year. When will you begin with the mice?”

  “We’re ready now.”

  They injected the first group, forty mice Monday. By Wednesday, all were dead.

  Chapter Forty-T wo

  Jack hadn’t seen Rachel Palmer since he’d visited her with Harmony Lane after Zoe Sims’s death. During her hospitalization, he’d been only a consultant on her case, although in essence, he was running the case until Tom and Maxine asked Harmony Lane to consult. Rachel had decided to leave her primary care physician for Harmony’s practice, another action that had not endeared her to the medical staff. Although unsaid, doctors almost universally believed that patients were possessions; not literally so, but they expended huge amounts of angst when a patient chose to leave one practice for another.

  Janet buzzed the intercom. “I have Harmony Lane on the phone.”

  “It’s Jack, what can I do for you?” This was a far more formal greeting than usual. He remained uncomfortable with the entire sequence of events, especially Harmony’s unconscionable administration of PAT0035 to Rachel. I know you can’t argue with success, but it was equally likely that if Harmony had had PAT0075 on hand, she would have used that.

  She spoke slowly as if taken aback by Jack’s formality. “I’m seeing Rachel Palmer again in the office this afternoon, and if you can get there, I’d like you to see her with me.”

  “What’s going on Harmony?”

  “I’m trying to work, but in truth, I’m barely functional. I’d like you there for three reasons; first to help me make an assessment and second, they trust you, and last, to stand by my side as I tell them everything.”

  “You’re an enigma to me, Harmony. Every time I’m sure that I understand you, you throw me a curve.”

  “It’s not really complicated. I’ve always had a tendency, no, more than a tendency, a real predisposition to think I could control everything. If I worked hard enough, my achievements were limitless.” She paused. “As I say it now, it sounds so arrogant.”

  “Many young doctors are like that. Undeterred by convention and lacking in real-world experience, they behave recklessly until one day they stop and check the graveyard for the names of those they helped put there.”

  “Not you too, Jack?”

  “Yes, but working in critical care where things happen so fast...I learned that lesson early.”

  “How’s Sandy doing?” she asked.

  “Not well.”

  “I don’t know what I’ll do if she dies. I hate myself for what I’ve done. How can I live with myself?”

  “Check your last sentence, Harm; you used the pronoun, I, four times, and myself twice. That’s a hint.”

  No way does she get absolution from me, Jack thought.

  “I was just…”

  Jack shook his head slowly. “The clinical trials, maybe I could accept your decision to participate since they presented a clear safety profile, but I’m not much into putting patients at risk for benign disease like mild lupus. The treatment of Rachel with PAT0035 was beyond the pale.”

  “You’re not telling me anything that I don’t know. I’m so sorry.” She paused for a moment. “Please, Jack meet me at three.”

  Before leaving Brier, Jack looked out the ICU windows watching the fluffy white fog bank stream through the Golden Gate and race for the east bay. He walked the few blocks to Harmony’s office in the bright afternoon sun that would last only an hour more.

  Harmony had decorated her waiting room with earth tones. The walls displayed works of contemporary women artists, most were warm and inviting, but a few, especially the stark images of the surrealist painter Leonora Carrington, were disturbing.

  “Come in Jack,” Harmony said peering through the receptionist’s sliding glass window.

  When they entered her consultation room, Jack looked around. “You’ve done a great job decorating your office.”

  She handed him the half-inch thick record. “Here’s Rachel’s office chart. It has the latest lab work from two days ago.”

  Harmony’s office chart was a miracle of clarity and organization. It was a Problem-Oriented Medical Record designed for easy computerization. “You’re heading for a paperless office.”

  “I thought if we started our charting this way, then the transition to keeping everything on the computer would be easier.”

  Jack studied Harmony’s notes and the lab results. Rachel had a mild anemia and her white blood cell count, though normal, showed signs of a mild ongoing allergic reaction.

  Harmony’s intercom buzzed. “They’re here,” Shelly said, “in examining room two.”

  “Are they expecting to see me?” Jack asked.

  “Yes.”

  A radiant Rachel sat on the examining table wearing a powder-blue robe. She smiled. “Jack. It’s great to see you again.”

  Jack turned to Tom, and shook his hand. “She looks fantastic.”

  Tom grasped his hand. “We really never thanked you properly for all you did for Rachel. Without you, she wouldn’t have made it.”

  When Jack turned back to Rachel, her arms were open in invitation. They embraced.

  It was odd—great but odd. They’d gone their own way, done things I’d never condone; yet here she was—reborn.

  They both briefly examined Rachel. Except for the scars of her surgeries and the longstanding surgical drains, she looked normal.

  As they waited in the consultation room for Rachel to dress, Harmony turned to Jack. “I’m going to tell them everything. Fill in what you think is important and help me with their questions.”

  Rachel and Tom took their seats. “What is it, Harmony? We really haven’t recovered from our last visit. Legalities may constrain you, but when you refused to answer our questions, it drove us nuts.”

  “I’m truly sorry,” Harmony said. “You’re doing great, and I was just trying to be cautious, but things have happened, things that will soon become public. I want you to hear it from me, hear it all, and not be unnecessarily alarmed by what you’ll read.”

  Tom and Rachel looked at each other, then clasped their hands together.

  “This whole area of gene therapy is so new and our experience is so limited that it’s difficult to predict the future.”

  Harmony went on to describe in graphic detail the events surrounding PAT0075, the death and the accelerated aging.

  Rachel and Tom stared ahead, shifting uneasily in their chairs. “What does this have to do with Rachel?”

  “Maybe nothing, but the modified gene segments used in that study were the same as you received. The major difference between the studies was the virus that carried the DNA. Yours was inactivated and we hope that this explains why patients who received PAT0035 continue to do well.”

  “I don’t know what
this means for us,” Tom said. “Should we be worried? Jack, what do you think?”

  “They’re working hard on a means for treating those women who reacted badly to PAT0075, and trying to understand what happened.” He met their eyes, and continued, “It’s likely that we wouldn’t be having this conversation if it weren’t for that medication, but now we must deal with the potential for harm in a hazy future.”

  “Harmony,” Rachel said, “are you going to be in trouble for giving me the medication that saved my life?”

  “I don’t know. It was illegal for sure.”

  “We’ll never testify about any of this,” Tom said, “We’ll deny it all...deny it to our dying day.”

  Harmony thought for a moment, and then replied, “If it ever comes to that, I’ll never let you lie for me. I can’t allow you to do that, and I’m not about to deny what I’ve done—not anymore—not ever.”

  Chapter Forty-Three

  Andre was sitting in Archie’s office. He was sensing an unfamiliar emotion, worry. The pressure for a cure was coming from all corners. Each of the six study groups scattered across the country was reporting accelerated aging in a few study patients. Why some and not all patients, nobody knew. The study groups were to sign-up twenty patients each, but by the time they stopped the study, they’d enrolled a total of twelve. Some groups reported no patients with accelerated aging, while others had one or two. They had detailed medical, demographic, and personal information on all study patients, but even the computer driven multi-variant analysis had failed to distinguish why some were aging while others continued with health and rejuvenation.

  Andre put down the data analyses. “Archie, there must be some rational explanation.”

  “Well, whatever it is, it may not be within the elements of the subjects’ database.” He paused for a moment. “We have pre-treatment blood samples from every subject. Let’s take a look there to see if we can discover why some have resisted the rapid aging process.”

  They’d set up large numbers of test animal groups, infected them with PAT0075, and tried varying gene sequences in at least a dozen adenovirus vectors. All study animals died rapidly, several from an anaphylactic reaction, the most serious acute allergic reaction that kills in minutes.

  “We’re getting calls from all over the country,” Raymond Ames said. “from doctors, patients and their families, and Lord save us, the press. I discarded as many of these calls as possible. Here’s the rest.”

  Andre grasped the stack of pink message forms. “I can’t do this and have enough time for my research. Get Archie or Greg to deal with them.”

  Ray smiled and handed a pink message slip to Andre. “One’s from Angela Brightman,”

  Andre picked up the phone and dialed. “Angela,” he paused, “how are you feeling?”

  “Oh, cool it, Andre. You sound like my mother. I’m fine.”

  “I’m just concerned. Everyone’s apprehensive, and the pressure to find a cure is becoming unbearable.”

  “PAT stock keeps heading south. It’s down 50 percent from its all-time high, and we’re all taking a beating. Are you going to find a way out of this, Andre?”

  “Given enough time and all the resources we have available, we should find a cure, but I can’t tell you how long it will take.”

  “This would be a great opportunity to purchase more shares, but I won’t do it, and neither will my investors, based on your feeble promises.”

  “I’m sorry, Angela, but that’s the way it is.”

  “You’ll keep me posted?”

  “Of course, and Angela, let me know if you notice any changes. Will you promise me that you’ll do that?”

  “Yes, Mommy. You’ll be the first to know.”

  Sandy Greer sat in her La-Z-Boy chair trying to read. Her vision had been perfect, but now her arms weren’t long enough for her to read. Marty had purchased several reading glasses of varying strength and she’d settled on the +2.25 power.

  The aging process that began with cosmetic changes had spread to her entire body. By all observable parameters, she was old.

  “Give me a hand, Marty,” she said as she tried to rise from the reclined chair. “I can’t make it on my own.”

  Marty extended a hand, but she winced at the pressure of his grasp and screamed, “Ouch, be careful, Marty, you’ll break my hand.”

  Sandy had become reclusive. She’d see nobody and took calls only from close family.

  Marty hugged her and again she groaned with pain.

  “I can’t take any more of this, Marty. Even a hug is painful.”

  “I’ll be more careful.”

  “I’m as fragile as a china doll.” She paused, then stared at Marty. “When the end is near, please don’t do anything to keep me alive. That would be the cruelest joke of all. If you love me, you won’t do that.”

  He held his head down. “I’ll never let that happen, no matter what, but please, don’t give up.”

  “It’s not a matter of giving up, sweetie, I want to live. I want to be with you and the girls. I want to see you walk them down the aisle...”

  Sandy stared ahead, and then began crying. She touched her eyes then looked at her hands. “They’re dry. I’m so old I can’t even make tears.”

  Sandy heard a soft knock on the door to the den. “Yes, come in,” she said in her grandmother’s voice.

  Honey peered around the edge of the door. “Mommy, is it okay if I come in?”

  Sandy stared wistfully at her younger daughter. While only eleven, she could pass for eighteen until she opened her mouth to speak.

  “Of course darling. Why would you ask such a question? It’s always okay.”

  “I didn’t want to disturb you. You’ve been so tired.”

  “Come to Mamma, sweetheart.”

  Honey walked slowly toward her mother. When Sandy extended her hand to her daughter, she caught the split second slight involuntary jerk away from the aged, withered limb.

  She can’t look at me. My own daughter finds me repulsive. Sandy wept.

  “No, Mommy, don’t cry. Everything’s going to be okay...please Mommy, don’t cry.”

  Sandy brought her hands to her face. “Look at me! I’m old. Getting older by the day. I can’t go on this way.”

  “I love you, Mommy. Nothing can change that. I’ll always love you, no matter what.”

  “I love you too, sweetheart. Don’t be upset.”

  Honey took her mother’s hand. She continued to look at her feet and said softly, “Mommy, are you going to die?”

  Everything has just changed, Sandy thought. It’s all Honey now. What can I say? What will she remember of me? I can’t end this with a lie.

  Sandy brought Honey into her arms. She held tightly for a minute. “Mommy’s very sick. The doctors are working hard to stop this and make me better, but if I don’t make it, sweetheart, I want you to remember that I’ve loved you from the day you were born. I loved watching every day as you’ve grown to be a young woman. No mother could have a better daughter. You’re everything I could have wanted you to become. I’m so proud.”

  Sandy wiped her tears away and sniffled. “Daddy loves you every bit as much as I do. Trust him. Help him if I’m not here. You’ll never have a better or more loving friend in the world than your Daddy.”

  The QA room had a street level view of the sidewalk. Pedestrians passed by in the sunlight heading for lunch. By the time Jack arrived, most of the docs had finished their lunch and were reviewing Harmony’s credential file and the summary of her actions he’d prepared about the PAT trials and the care of Rachel Palmer.

  Jack knew everyone at the meeting. Some only professionally and others socially as well. They were approximately 50 percent medical specialists, balanced by general internists and family practitioners. Personality and character, more than training or experience, were the determining factors in how effectively physicians functioned in this setting.

  Most were committed to the QA process, but varied acros
s the spectrum in their willingness to make tough decisions. Some could forgive everything, except murder, while others thought the guillotine appropriate for even minor infractions. When Jack first came to Brier, it surprised him to discover that women were more willing than men to confront other physicians, a refreshing and valuable asset to the committee’s success.

  Ben Davidson had picked Arnie Roth, a family practitioner, as chairman. Arnie was honest, hardworking, and only a little too deferential to the specialists on his committee. Ben, the department chair, had gently coerced Arnie into this position and he had risen to the occasion.

  Jack stood at the head of the table. “Reality has outdone fiction at Brier Hospital.”

  He outlined Rachel Palmer’s case and Harmony’s role. “She admitted to me that she’d used the experimental drug, PAT0035 in Rachel’s care. She did it without the hospital’s consent and without any attempt to conform to PAT’s indications for use of this investigational drug. She knew it was wrong, but did it anyway.”

  “Why did she do it, Jack?” Arnie asked.

  “For the simplest of reasons, she wanted to help her patient. The family, especially the patient’s mother, Maxine begged Harmony to help—she really did a trip on her. In addition, the drug’s developer convinced her that the drug posed no risk, so she went ahead.”

  Sharon Brickman, a cardiologist and one of the more critical members of the committee, spoke bluntly. “She must have been out of her mind to let a desperate family make her forget her principles.”

  Harmony Lane had screwed up. Disciplinary action could be the least of her problems. Her license and even her freedom was at stake.

  “Let me give you a personal appraisal of this physician. Take it for what it’s worth. When we evaluated Dr. Lane as she applied to the staff, we noted her willingness to go to any length in attempting to help her patients...there was a certain refreshing appeal to that. She did it during her residency, and she did it at Brier. I can’t justify her behavior, but I’ve come to know her well and I wouldn’t like to see this serious mistake become a fatal one. We have the ability to destroy her professionally, but there’s much to save here. She’s smart, compassionate, and committed to her patients. Whatever we think of her type of practice, it fills a need in our community.”