Miracle Drug

by Richard L. Mabry M. D.

  Josh had just finished checking on Madison and Rachel, whom he was now treating in tandem with Allison Neeves, when his cell phone buzzed. He finished drying his hands before he stepped to the end of the hall, away from the rooms of his patients, to answer the call.

  “JP, we might have a problem,” Derek said.

  “We’ve had problems for several days,” Josh said. “What now?”

  “I kind of assumed that whatever Karen Marks set out to get, she got. But there’s some kind of hold-up in getting Dr. Chavez and the RP-78 onto a Colombian Air Force jet.”

  “I thought she was going to contact a general and have him talk with his opposite number over there to smooth the way.”

  “Well, apparently no one in Colombia wants to take responsibility for letting a solid citizen like Dr. Andres Chavez leave the country, especially with no real advance notice. Even though his passport is in order, they seem to be afraid this is some kind of scheme for him to escape Colombia. They’re not sure he’ll come back.”

  “Why—”

  “Because his wife is dead. His grown kids live in the U.S. already. And when you talk about ‘brain drain,’ losing Chavez would be a topper in that department.”

  Josh considered the matter for a moment. “Okay. There’s one more thing we might try. I hate to do this, but if we don’t get that next dose of RP-78 here in . . .” He looked at his watch. “If it’s not here in another six hours or so, it may be too late to do any good. Wish me luck.”

  Josh ended the call and headed back for Madison’s room. Jerry Lang was back on duty, and as Josh gowned, the agent asked, “Weren’t you here just a few minutes ago?”

  “Got to ask your boss for a favor.”

  “I’m not sure he’s in any shape to be doing favors,” Lang said.

  “I hope he’s up for this one, because it’s about the last chance we have to make this thing come out okay.”

  Inside the room, Josh wondered if he should ask Mildred Madison to step outside. Other than brief breaks for food, she hadn’t left her husband’s side for a full day. No, she deserved to hear this, too.

  “Mr. President . . .”

  Madison took his whiteboard and scrawled, “You only call me that when there’s trouble. What?”

  “I need you to make a call for me.”

  Madison pointed to his tracheotomy tube and shook his head.

  “I’ve thought of that. When you get ready to call, we’ll have you breathe one hundred percent oxygen for a bit, then deflate the cuff on your trach tube, put a cork in it so you can breathe around it and talk.”

  “It must be serious,” Mildred Madison said.

  “It is,” Josh said. “You might say it’s a matter of life and death.” He looked at the ex-president, who looked anything but presidential at that moment. His hair was mussed, he was sweating profusely, his skin was pale, and his weakness was obvious to Josh. He’d give anything not to ask this favor of the man, but it was all he had. “Will you do it?”

  Madison started to write, then dropped the whiteboard and looked at Josh. He nodded and his lips shaped a single word. “Who?”

  “The president of Colombia.”

  14

  And it worked?”

  “I think so,” Josh said. He and Derek were back in his office, each with a cup of coffee in their hands, awaiting word of Chavez’s arrival. “The president of Colombia seemed surprised to get a call from Madison, but it was evident he still holds the former U.S. president in high esteem. Madison could hardly talk, but he got the idea across that this was a personal favor for him. He didn’t go into details, but he convinced the man on the other end of the phone that this was truly a matter of life or death.”

  “I’m amazed Madison could talk that long,” Derek said.

  “Actually, he laid it out to the Colombian president in a few sentences, then let me handle the details.”

  “I thought they were afraid Chavez would want to stay in the U.S.”

  “I told him that had he wanted to leave Colombia, Chavez had received invitations to speak at conferences all over the world. He turned down some of them, accepted others, but as Chavez told me when I talked with him earlier, he got his training in the U.S. so could return to Colombia and train other doctors. With his wife dead and children grown, his profession is his passion and his place is right there in Bogotá.”

  “So he’ll go right back?” Derek asked.

  “He plans to spend a couple of weeks here, visiting his kids and grandkids, renewing acquaintances with a few of his colleagues at Johns Hopkins. Then he’ll take a commercial flight back to Bogotá.” Josh looked at his watch. “Frankly, I don’t care how long he stays. I just want him to get here with that drug.”

  ***

  Dr. Andres Chavez felt as though he’d been on the world’s longest and fastest carnival ride. He was still a bit wobbly as he climbed down the portable stairs from the plane on which he’d flown. At boarding, the pilot told the doctor this was a two-seat variant of the Kfir C7 fighter jet, and followed that with information about range and speed, all of which Chavez promptly forgot. However, he recognized the pride in the pilot’s voice, so he listened patiently as he was strapped into the plane.

  Dr. Chavez had taken a dozen unsteady steps across the tarmac when he saw a man striding toward him. His greeter wore a flight suit with eagles on the shoulders. His garrison cap bore a similar badge of rank.

  When he reached the doctor, he said, “Dr. Chavez, I’m Colonel Bryan Gardner. Welcome to Texas. Do you have the medication?”

  Chavez held up the small cooler bearing the robinoxine. “Yes. I was told someone would meet me here and take me to the hospital to meet Dr. Pearson.”

  “And that’s exactly what we’re going to do.” Gardner explained that the jet had landed at the Carswell Joint Reserve Base in Fort Worth, which was about thirty miles from Dallas. “There’s a car with a Secret Service agent waiting to take you there.” Gardner indicated a man in a charcoal grey suit who waited nearby. “And you can be assured that we’ll extend your pilot every courtesy while refueling his jet for the return trip.”

  Then Gardner reached out to shake hands with Chavez. “Doctor, on behalf of everyone in our military, you have our thanks. Mr. Madison is no longer our commander-in-chief, but we continue to respect and appreciate him.”

  Chavez, feeling very much as though, like Alice, he’d stepped through the looking glass, followed his escort to a waiting black sedan where he was ensconced in the very comfortable backseat before setting off at a high speed with two motorcycle patrolmen leading the way. He thought he’d seen it all in twenty years of medical practice, but apparently he hadn’t. Well, not yet, at least.

  ***

  The light tap at the door of Josh’s hospital office stopped him in mid-sentence as he and Derek were talking. He opened his mouth to speak, but before he could respond, the door opened widely and Karen Marks strode in.

  “Well,” she said as she pulled out a chair and sat, “your Dr. Chavez is en route here with the drug.”

  “He’s not ‘my Dr. Chavez,’ ” Josh said. “But he’s the man bringing the drug that may save the life of our two patients. And thank you for helping with the logistics to get him here.”

  “I told you before—I’d do anything for David Madison. The fact that Rachel Moore happens to need some of the medication this man is bringing wasn’t a factor in my actions.”

  She was silent for a moment, and Josh knew she was figuratively biting her tongue to avoid bringing up his decision to give Rachel the second dose of robinoxine. If he hadn’t done that, they might already have enough of the drug to give Madison a second treatment. Josh nodded at her as though to thank her for her silence.

  “Anyway,” Marks continued, “as soon as the doctor arrives, I’ll bring him to your office.”

  Josh looked at his watch. “Assuming the medication Chavez is bringing is what we need, we should be able to give both patients their second dose about tw
enty-four hours after the first.”

  “Then what?” Marks asked.

  Derek spoke for the first time since Marks entered. “Then we wait . . . and pray,” he said.

  ***

  Rachel knew her condition was worsening. She could breathe more easily after the tracheotomy, but her fever seemed to be going up even further, her limbs ached as though someone had beat her with a baseball bat, and it taxed her to even try to sit up.

  She wasn’t afraid to die. Her faith assured her that, for a Christian, death is simply passing from this world into a much better one. No, that wasn’t the reason she kept fighting for her life. She didn’t want to die before she told Josh she loved him. And so she willed herself to stay alive, to resist what the bacteria were doing in her body, until Josh could think of some way to save her . . . and Mr. Madison, of course.

  Rachel closed her eyes for a moment, but tried not to drop off. She fought sleep because she was afraid she wouldn’t wake—at least, not in this present world. For some reason, she thought that if she stayed awake she could stave off death a little while longer. Then she heard the door to her room open, heard footsteps pad across the floor, felt a presence next to her bed.

  She opened her eyes, but her vision was hazy. She could see enough to know there was a gowned and masked figure at her bedside, but she wasn’t able to identify him.

  Then he spoke, and she recognized his voice. “Rachel, it’s me. Josh.”

  Relief swept over her. Now she could tell him. Then, if death won the struggle that had gone on in her body for days without end, at least Josh would know she loved him. She opened her mouth and tried to talk, but the only sound she produced was a loud whoosh of air through the tracheotomy tube. Rachel had forgotten for a moment that she was unable to talk.

  Her hands scrabbled around on the covers seeking the whiteboard, but she couldn’t locate it. She tried to sit up to look for her means of communication, but the effort was too much for her.

  “Rachel, I want you to know that soon we should have more of the RP-78, the drug that we hope will get you through this infection. I’ll be back to give you that injection, but in the meantime I’m going to pray . . . for you and for Mr. Madison.”

  She tried once more to speak. Her lips formed the words, “I love you, Josh,” and even though her communication was silent, Rachel hoped the message came through.

  Maybe it did, because Josh bent lower and whispered, “I love you. Hang on.”

  ***

  Josh was headed down the hospital hallway when the buzz of his phone against his leg stopped him. He checked the caller ID and saw a hospital extension with which he was becoming all too familiar. He ducked into a quiet corner and answered.

  “Ethan, this is Dr. Pearson. What’s up?”

  “Even though it’s the weekend, I decided to take a chance that the reference lab would have the results of the diphtheria antibody titers we sent them two days ago.”

  Josh felt his heartbeat speed up for a moment before he realized the titer wouldn’t really tell him anything. The second infection, the one with the potentially fatal Bacillus decimus, was the problem now. Nevertheless, he said, “And the results?”

  The technician cited some numbers, but Josh didn’t jot them down. He only needed to know one thing. “I could look this up, but you can probably tell me. Are they low or high?” he said.

  “They’re quite low,” Grant said. “I don’t really know what to make of them.”

  Josh thanked the tech and ended the call. I know how to interpret them. And they tell me that neither patient received a real DT booster. As he thought it through, Josh realized the low antibody titer indicated something else as well. If Madison and Rachel had a diphtheria infection, and it appeared from their cultures they did, it was a mild one, already coming under control when the blood was drawn for the test, possibly because of immunizations they’d received in the past. The significant infection was with Bacillus decimus, an infection that would kill the two patients if the RP-78 didn’t work.

  ***

  Derek was in a vacant conference room trying once more to reach Dr. Gaschen, the COO of Argosy, in order to give him a status report. “I don’t know if I’ll have a job when this is over,” he’d told Josh, who replied that if Madison and Rachel pulled through, he was pretty sure Derek could write his own ticket in a number of areas.

  Karen Marks was on her cell phone in yet another empty room, fielding calls and trying to minimize the number of people who knew David Madison was critically ill. When Josh asked her why this was so important, she told him it was Madison’s specific request.

  “But why?” he asked.

  “David Madison may be an ex-president, but he’s still a very powerful man in domestic and world politics. Leaders everywhere respect his opinion. His foundation dispenses huge amounts each year. There are people who’d like him out of the way, either to silence his influence or throw his foundation into chaos until someone else takes over.” To Marks, it was a no-brainer that her boss be perceived as a strong leader, firmly in control of everything with which he came in contact.

  Josh was dozing in his swivel chair with his feet on his desk when the door opened and Lang led a man into the room. The newcomer was a Latino in his late fifties, probably no more than five feet six or seven inches tall but weighing two hundred pounds or more. He was dressed in an embroidered white shirt and black trousers. Josh had a similar shirt in his closet, a gift from a friend who’d gone to Guatemala. Evidently, this was what passed for business wear in a tropical climate.

  “Dr. Chavez?” Josh asked as his feet hit the floor and he pushed himself upright.

  “Dr. Pearson?” The man stepped forward and extended his right hand.

  The two men shook. Josh looked at Lang and said, “Thanks for getting him here quickly.”

  Lang simply nodded and walked out the door, leaving the two men in the middle of the room, each waiting for the other to speak.

  “Doctor,” Josh said, “let’s get right to it. How much RP-78 did you bring?”

  “I found a total of two thousand milligrams of the drug that was still usable.”

  “And no one has breached the rubber dam sealing each bottle?” Josh asked, his heart in his throat. He had visions of the precious drug being contaminated as patients with Bacillus decimus received treatment.

  “No, these are in sealed vials that haven’t been entered.”

  “Well, you’ve brought enough RP-78, but why did so little remain usable?” Josh asked.

  “Argosy originally sent twenty-five individual bottles, each containing one thousand milligrams of drug. When we admitted a patient to the study, we weighed him and assigned a vial of RP-78 to him. When he finished his course, any remainder in that vial was destroyed. That accounted for seven thousand milligrams. Another sixteen bottles have become unusable for one reason or another, leaving two bottles—enough to treat your two patients for ten days each.”

  Josh started to argue that it was virtually impossible for sixteen sealed bottles stored in proper conditions to go out of date or become unusable this quickly, but then he saw what Chavez had done. The doctor had calculated how much RP-78 was needed for the two patients here, and had brought that much. Josh was willing to wager that the remaining drug was hidden away somewhere for Chavez to sell or barter. Maybe Josh’s initial assessment hadn’t been too far off.

  “Very well,” Josh said. “Let’s get busy.” He looked at his watch. “If we’re to give the second dose of the drug twenty-four hours after the first, we have less than an hour to do it.”

  ***

  Derek saw that the door to Josh’s office was open, so he walked in. Josh was in earnest conversation with a man who had to be Dr. Chavez. “Sorry,” he said. “Am I interrupting?”

  “No, it’s probably good that you’re here,” Josh said. After introductions had been completed, he asked, “What did Gaschen say?”

  “No answer on his cell phone. I left a message, but
I think he’s pretty much decided that if this works, that’s great. If it doesn’t, there’s not going to be a job for me at Argosy. And he doesn’t want to be involved one way or the other until it’s all over.”

  “Then that’s one more reason it has to work,” Josh said.

  Derek perched with one haunch on Josh’s desk and watched Dr. Chavez carefully remove two vials of clear, faintly amber liquid from the miniature cooler he’d brought. “I’d have thought there would be more of the RP-78 left,” he said.

  He caught Josh’s tiny shake of the head, so he hurried on. “But you’ve brought enough to complete the treatment. I’m glad you ignored the communication from our study coordinator and didn’t destroy all the drug.”

  Josh picked up one vial. “Why don’t we assign one vial to each of the patients? That way, even though we’re observing sterile technique, we’ll avoid any possible cross-contamination.” When no one voiced any opposition, Josh took a pen from his pocket and marked one vial with a “DM” and the other with an “RM.”

  “Dr. Chavez,” Josh said, “we gave the first dose intramuscularly, because Dr. Johnson said that was the way Argosy suggested it be administered when they designed the protocol. But you actually treated the patients. Do you agree?”

  “Yes, with one exception. If the patient was moribund, often their circulation wasn’t adequate to carry the RP-78 where it needed to go. In those cases, I actually administered the drug intravenously.”

  “Good thought,” Derek said. “That’s why we like to let the doctors dealing with the subjects being treated make decisions like that.”

  “Each patient has already received one dose of RP-78 with no adverse consequences that we could see. Is there anything we should watch for with this second dose?” Josh asked Chavez.

  “Acutely, no,” Chavez said. “Long-term? We haven’t followed the treated patients long enough to know.”

  When Josh looked at him, Derek shook his head. “JP, this is the ultimate off-label use of this medication. It’s barely been tested, it’s not FDA-approved, and we don’t know about its long-term side effects.” When he saw Josh prepare to speak, he hurried on. “Despite all that, it’s your only chance. If you want a second opinion, someone to agree with your using RP-78, you have my vote. Because if this doesn’t work, those two people in there are going to die.”