Miracle Drug

by Richard L. Mabry M. D.

Josh Pearson and Allison Neeves stood in the hallway outside the hospital rooms of their respective patients. Josh was trying hard to keep his emotions in check, but apparently Allison was making no such effort. She smiled widely and said, “Well, so far, so good.”

  Josh’s features remained neutral. “Maybe, but we’ve still got a long way to go.”

  “So, what’s next? For instance, how long shall we treat?”

  “I talked with Derek and Dr. Chavez, who probably have as much experience with the drug as anyone in the world. They agree that since there are really no dose-ranging studies and we have enough RP-78, it’s safest to treat for ten days. But once the disease process seems to be under control, we can consider decannulation.”

  “I agree, we can remove the tracheotomies once the danger of respiratory obstruction is past. Then what?”

  “Once the patients have been free of fever for forty-eight hours, isolation won’t be necessary.”

  “Are you certain about that?” Allison asked.

  “No one is certain,” Josh said. “There’s not enough experience. But Chavez says it takes a massive exposure to infect a patient unless the bacteria are delivered by injection. Some of the convicts in the treatment study were infected by bites from wild animals acting as a host for Bacillus decimus. Others had huge exposure from inhaling the bacteria for one reason or another. In our cases, it took someone throwing a whole flask full of bacteria-laden culture medium onto Madison and Rachel to infect them.”

  “So it sounds like things are coming under control.”

  “From a medical standpoint? I think so. But there are still some questions from a law enforcement standpoint.”

  “Such as?” Allison asked.

  “Did Ben Lambert really have a heart attack, or was he killed? Why did someone want to steal and cremate his body? Who wants David Madison dead? And why?”

  16

  Rachel was surprised to see the door to her room open and Josh enter. Not that she was surprised to see him—for the past four days, since the crisis had passed, he’d visited several times a day. But this time there was no mask obscuring Josh’s face, no plastic shield that made it difficult to see his sparkling blue eyes. And since no yellow isolation gown covered his clothes, she could see he looked quite handsome in a fresh white coat over a pale blue dress shirt and tie with blue and yellow stripes.

  Force of habit made her place her index finger on the bandage that covered the site over her windpipe where the tracheotomy tube had been removed three days earlier. But that incision had already closed to the size of a pinhead, and she knew in a few days it would be fully healed over. Maybe a minor surgical procedure to minimize the scar would be necessary, but she’d worry about that later. In the meantime, she had no trouble speaking normally.

  “Josh, am I officially out of isolation?”

  “You are indeed. It looks like you’re recovering well, and the only reason we’ll continue treating you for a full ten days is because we don’t have any hard data saying a shorter course is enough.”

  “How’s Mr. Madison?”

  “He’s recovering as well. We’ll probably keep you both here until we stop the RP-78. After that, you can be discharged, but we’ll continue to keep an eye on you.”

  “Why is that?” Rachel asked.

  “Just being cautious,” Josh replied. “Our problem is that we don’t know if there are any long-term effects of the medication.”

  Rachel thought about that for a moment. What a roller-coaster ride this had been. A trip overseas, a potentially fatal infection, her life saved at the last minute by what amounted to an experimental drug, and now the prospect of waiting to see if there were any long-term ill effects from that treatment. “I guess I should be—”

  Josh held up his hand and reached into his pocket for his cell phone, which was buzzing. “Dr. Pearson.”

  Rachel could hear only one side of the conversation, but the frown on Josh’s face told her what she needed to know. Finally, he said, “I’m on my way. Are Drs. Neeves, Johnson, and Chavez aware of this? They should be at the meeting as well.”

  Josh stowed the phone and said, “Rachel, I came in here to tell you something important, but it’s not anything I want to rush. I’ll be back as soon as I deal with this situation. And we’ll talk then.”

  As Josh left the room, Rachel smiled. I’ve already heard it, Josh. I don’t know if it was a fever dream or if it was real, but in either case, I’m pretty sure I know what you’re going to say.

  ***

  Josh had practically lived at the hospital for the past week, and during that time this room had been his office. He’d sat behind that desk, used that phone and computer. But today he wasn’t the man in charge. When Josh opened the door and entered, Jerry Lang sat behind what Josh thought of as his desk, with Karen Marks beside him.

  “Have a seat,” Lang said, gesturing to one of the four chairs arranged today on the visitor’s side of the desk.

  Josh looked around and saw that Allison Neeves already occupied one of those chairs. He took the one next to her, but before he could speak, the door opened and Derek Johnson entered, followed closely by Andres Chavez.

  When everyone was seated, Josh said, “I think I know what this meeting is about, and—”

  Lang opened his mouth, but Karen held up her hand to stop both him and Josh. “Jerry, let me do this.” She scanned the doctors sitting before her. “On behalf of David Madison and his wife, thank you for your efforts. The Secret Service, in cooperation with the Dallas Police Department, continues to investigate this obvious attempt on former president Madison’s life.”

  Josh wondered if Karen realized she was talking as though this were a press conference. He started to say something, but she gave him no opportunity, pressing on with what seemed to be prepared remarks.

  “Meanwhile,” she said, “it seems evident that Mr. Madison’s condition has stabilized. He appears to have passed the crisis point and is moving steadily toward recovery. Now he thinks it’s best that he leave the hospital and return to his home.”

  Josh was halfway out of his chair before Karen stopped speaking. “But he’s—”

  “We’re not here to argue,” Lang said. “Mr. Madison indicated to Ms. Marks and me this morning that he’s carefully considered the matter and made up his mind. He wanted us to convey his thanks to each of you for your role in helping him recover. Now he’s anxious to leave.”

  “I talked with him when I made rounds earlier,” Josh said. “I explained to him that even though we’ve lifted the isolation precautions, we needed to keep him here for at least a full ten days’ treatment. If he continues to do well, I can follow him on an outpatient basis to watch for recurrence of symptoms or late complications from the medication.”

  Karen Marks spoke this time. “After you were there, Mr. Madison had a long phone conversation with Dr. Dietz. The two men mutually agreed it would be best if Dr. Dietz took over Mr. Madison’s care, seeing him as an outpatient at Southwestern Medical Center. After all, it’s quite a prestigious medical institution, with all the resources necessary to care for almost any problem. And Dr. Dietz is a well-known internist.”

  “But—” Josh tried to interject.

  Karen continued as though Josh hadn’t made a sound. “Mr. Madison originally chose Dr. Lambert as his personal physician because the two men had been friends since childhood.” She turned her gaze directly on Josh. “Dr. Pearson, we have no idea why Dr. Lambert chose you to succeed him. Be that as it may, we’re now asking you to transfer Mr. Madison’s care to Dr. Dietz.”

  ***

  Derek Johnson stood with Josh Pearson in front of Prestonwood Hospital and watched the motorcade pull away. “Well, JP, I guess our moment of glory has passed.”

  “I don’t care about the glory. Matter of fact, I think I’ll rest easier not having a critically ill patient with so much riding on my care of him. But I still don’t understand it.”

  “What don’t you understand?�
�� Derek asked. “It’s politics trumping medicine. We don’t know the reasons behind it, but I’ve worked in the pharmaceutical industry long enough to recognize behind-the-scenes pressure.”

  “Still—”

  “Josh, it’s out of our hands,” Derek said. “You and I tried to explain to Lang and Marks why this was premature. Even Allison Neeves came down on your side. Dr. Chavez didn’t have much to say, but you could tell by his expression he was shocked.”

  Josh shoved his hands into the pockets of his white coat and turned back toward the hospital’s front door. “Well, I guess I’ll talk with Rachel. I still think we should keep her here under observation for a bit longer.” He shrugged. “Of course, that decision rests with Rachel and Allison Neeves. I guess I’m back to being just another internist at the clinic.”

  Derek shook his head. “Not simply another internist,” he said. “An internist who saved the life of two people with a potentially fatal disease—the first time it’s been done in the U.S., by the way. And whatever else happens, you should be proud of that.” He fell in beside Josh. “I know I would be.”

  ***

  Rachel sat in a recliner facing the door of her hospital room. For the first time in a week, she wore her own nightgown, covered by a satin robe. There were no IVs in her arms, only a tiny coil of plastic inserted in a vein and filled with heparinized saline, a heparin lock, allowing access for intravenous drugs should it be needed. She looked up from the book in her lap when Josh tapped on the doorframe.

  “May I come in?”

  “Of course,” she said. “I’ve been wondering when you’d make it back.”

  He dragged a straight chair from beside her bed and sat facing her. “It turned out to be a more complicated problem than I thought, but it’s out of my hands now.”

  “Can you tell me about it?”

  Josh shrugged. “Sure. I don’t think there’s anything classified about what’s happened. It seems that Mr. Madison, whether on his own or with some persuasion, has decided to fire me, go home, and let Dr. Dietz care for him in the future.”

  Rachel listened quietly as Josh recounted what he and the others had been told and the arguments, sometimes heated, which followed. “The bottom line is that I’m no longer the personal physician to the former president of the United States.”

  “And how do you feel about that?” Rachel asked.

  Josh stood and began pacing. “Relieved, I guess, although I think he’s making a wrong decision.”

  “So, even though you’re glad you no longer have that responsibility, you hate to see it taken out of your hands.”

  Josh shrugged. “Rachel, when I found out I was going to be the presidential physician, even if it was for an ex-president, I let it get to me. I became so consumed with that task and the position I held that I ignored other things that are important to me.” He sat again, reached out, and took her hand. “But I’m clear on my priorities now. Yes, I hate to be dismissed this way, but it might be the best thing that could happen. Because it allows me to focus on you.”

  Rachel leaned forward but remained silent. If Josh was going to say it, now was the time.

  “Seeing you deathly ill, realizing I might lose you, brought it into focus for me. Rachel, I love you. And I don’t want anything to come between us in the future.”

  “You know, it’s the funniest thing,” Rachel said. “While I was racked with fever, I thought you came into my room to tell me you loved me. And, even though I couldn’t speak because of the tracheotomy, I told you I loved you as well.” She smiled. “Now I can actually say the words to you. I love you, Josh.”

  Before Josh could respond, Rachel saw his hand dart toward his pocket. He pulled out his cell phone, frowned, and said, “It’s Karen Marks.”

  He started to reject the call, but Rachel stopped him. “No, answer it. It might be important.” She nodded. “You and I will have lots of time in the future to continue this conversation.”

  The call was brief and, judging from Josh’s responses, mainly one-sided. It ended with Josh stabbing his finger at the button that ended the call as though he were slamming down an old-fashioned phone. He shook his head. “And I thought it ended when Madison left the hospital.”

  “What?”

  “They’ve reached the president’s home and can’t find the RP-78 to give him his next injections. Everyone is looking at someone else and saying, ‘I thought you had it.’ ” Josh took in a deep breath through his nose and blew it out between compressed lips. “Karen the same as accused me of hiding the drug until Mr. Madison changes his mind about leaving my care.”

  17

  Josh, Mr. Madison’s no longer your problem,” Rachel said. “Let it go.”

  “I’ll try,” he said, but she knew he couldn’t turn it loose. Maybe this was a good time to ask her question. “Madison’s gone home. What about me?”

  “I think you should stay in the hospital for the full ten days of treatment,” Josh said. “And before you ask, Dr. Neeves agrees.”

  “Then, so long as I’m out of isolation and you promise to visit me regularly, I guess that’ll have to do,” Rachel told him.

  “I’ll be in here so much that the hospital will assign the room to me and start charging my insurance company,” Josh said. “But right now I have some things to do. I’ll see you soon.”

  In the hallway outside Rachel’s room, Josh dialed Derek Johnson’s cell phone, but the line was busy. Josh wondered to whom Derek was talking. Well, no matter.

  Although it would be easy enough for him to wash his hands of the whole matter and resume his day-to-day practice of medicine, Josh felt a connection to Madison—not because of the man’s position. Thank goodness he’d moved past that. No, as a physician it troubled him that someone for whom he’d expended so much time and energy to pull them through a potentially fatal infection might now be put back in danger by something so simple as misplaced medication.

  He wasn’t certain how much longer he’d be able to use what he’d come to regard as “his” office here at the hospital, but for now no one else seemed to have moved in. Once seated behind the desk, he pulled a notepad toward him and began making a list of people who might have taken the robinoxine.

  Until Madison left the hospital, a small refrigerator in the corner of their rooms held the vial of RP-78 used to treat each patient. After isolation was discontinued, both patients were moved to new rooms and orderlies were brought in from another part of the hospital to thoroughly clean and disinfect the rooms they’d occupied. The vials were moved with the patients, and last night both patients received injections, their sixth, so Madison’s medication couldn’t have disappeared before then. But as he thought about it, Josh found no clue as to who might have taken the medication—either by accident or on purpose—and he eventually balled up the paper with his list and dropped it in the trash.

  His phone conversation with Karen Marks had consisted primarily of her not-so-subtle accusation that Josh had the RP-78 and was holding it as a sort of blackmail in return for Madison’s returning to his care. Josh was certain Karen and Jerry Lang would have compiled the same type of list he’d started and were already busy trying to solve the mystery of the missing drug. He’d leave that to them. If they found the vial, the problem was solved. If not? Well, it really wasn’t up to Josh . . . but he still wanted to give it a try.

  First, though, Josh wanted to talk with Dr. Dietz. The doctor taking over Madison’s care needed to know all that had gone before. Only then would come the big decisions. As of last night, Madison had received six doses of RP-78. Was that going to be enough to prevent a recurrence? And if not, where could they get more of the drug?

  Josh had the main number he needed, but his call was transferred three times before he got through to the doctor now caring for David Madison. “Dr. Dietz? This is Dr. Josh Pearson. We need to talk.”

  ***

  Derek Johnson stuck his head inside the door of Josh’s office. “Got a second?”
<
br />   Josh waved him in with one hand, while holding the phone to his ear with the other. “You have all my numbers if you need me,” he said to the person on the other end of the call. “And I’m sure you’ll find that between Karen Marks and Jerry Lang, you have lots of resources you can call on.”

  After the call ended, Josh gestured to the chairs in front of his desk. “Have a seat, and I’ll bring you up to date on what’s happening now.”

  Derek screwed up his face at the news, but kept silent until Josh had finished his narrative. “And Dietz isn’t alarmed?”

  “I don’t think he fully realizes the situation yet. He freely admitted that he doesn’t know anything about Bacillus decimus. He’s going to call a contact at the CDC and ask him for a crash course on the infection. I offered to put him in touch with you, but I think unless the information comes from either a government entity or one of his department chairs, he’ll have a hard time accepting it.”

  “So the question to be answered is, will six days of treatment be enough? If not, where can he get more RP-78? Right?”

  Josh nodded at his colleague’s ability to get right to the meat of the problem. “If the answer to number one is yes, no worries. But if it’s no, he won’t know until the patient starts showing symptoms again. And at that point no one can be certain another course of RP-78 will help.”

  “And even if it does help, don’t forget we have no idea what the long-term effects of that much drug will be.” Derek leaned back in his chair and looked at the ceiling. “Are you going to keep working on this, even though Dietz has officially become Madison’s physician?”

  Josh swiveled in his chair to face the bookcases to his left, cases left empty by the departure of the office’s last occupant. “Derek, if you had a patient you pulled through the acute phase of an infection, would you be willing to walk away and let someone else manage the rest of his care, especially if they didn’t seem to have an idea what to do next?”

  Derek didn’t even have to think about that one. “No. Once I started, I’d want to finish it. I guess any doctor would.”