Warning Signs

by C. J. Lyons

  “But Dr. Nelson said I was on the placebo,” Amanda protested. “And Tracey dropped out of his study.”

  “He must have been wrong.”

  “Or he lied,” Nora put in.

  Lucas continued, “I checked with Becky’s roommate and Michelle’s husband, and they were both in the same study. Michelle began taking the study drug only a few days before she died.”

  Amanda was frowning. “Idiosyncratic protein deposits. Like those babies with the calcium and antibiotic interaction.”

  “Babies?” Lucas asked.

  “Yeah. They’ve been using ceftriaxone in newborns at risk for sepsis for decades; it’s saved thousands of babies. And lots of those really sick newborns also get calcium. Recently they realized that a small number of deaths seemed to occur if the two drugs were given within forty-eight hours of each other. Some kind of genetic predisposition, probably. Anyway, those babies died because of protein deposits.”

  “Okay, same idea. I didn’t know about the babies. It was your research into shattered nerve syndrome that gave me the idea. Only Ken and I aren’t sure yet how to reverse things. Chelation may help. We think the mercury is what triggers the deposits to leave the bloodstream and collect on the muscle and nerve fibers—which would explain why Michelle’s symptoms came on faster once she was exposed to the study drug. But”—he shook his head, and the worry-knot between his eyebrows reappeared—“none of that explains why the patients suddenly decompensated and died. Ken thinks something caused a cascade reaction, and their systems were overwhelmed by the formation of the protein deposits in their bloodstream.”

  “What about a change in the blood pH?” Nora asked. “Doesn’t being exposed to either an acidic or alkalotic environment change the solubility of some proteins?”

  “Yes.”

  “Tracey got worse after the bicarb was added to her IV,” Amanda said.

  “Becky and Michelle had bicarb added to their IVs as well,” Nora told them.

  “They did? When? Who ordered that?”

  Nora frowned at Lucas. “According to their charts, you did.”

  “I didn’t.”

  “It’s your signature on the orders faxed to the pharmacy.” Nora handed him her copies.

  Lucas shuffled them, frowning, then passed them to Amanda to examine. “But I didn’t—”

  “I know,” Nora said, still not believing the implications. “It must have been the same person who gave Amanda Diamox instead of potassium supplements.”

  “Diamox?” Amanda asked, a puzzled frown on her face. “I’ve never had Diamox.”

  Lucas spun to face Nora, his face knotted with fury. “Who gave Amanda Diamox?”

  “Dr. Nelson.”

  FORTY

  Friday, 7:51 P.M.

  TREY WAS WAITING FOR LYDIA ON HER COUCH when she came downstairs from putting Deon to bed. He was wearing pressed khakis and a red polo shirt that set off his dark skin tone, making him look good enough to eat. She yearned to curl up in his lap, wrap his arms around her, close her eyes, and rock away the cares of the world.

  She settled for plunking down beside him, stretching her legs across his lap. Who knew that watching a kid all day could be so exhausting? Trey didn’t reach for her, but he did lay a palm on her knee.

  “Guess you forgot about dinner with my folks.” His tone wasn’t accusatory, more like someone accepting the inevitable.

  Shit. She still hadn’t gotten used to the idea that inviting Trey into her solitary existence also meant opening the door to his large and loving family.

  She’d never dealt with things like weekly family dinners before now. Hell, she’d never dealt with a family before. Years of living on the street with her mother followed by years in the L.A. County foster care system hadn’t prepared her for any of this.

  “I didn’t forget,” she lied. “I just forgot to call you to cancel.”

  “Uh-huh. Want to tell me what was so important that you forgot?”

  She regarded him through half-closed eyes. For a laid-back kind of guy, Trey could be funny about following rules. Not as bad as Nora, but close. “Not really.”

  He arched an eyebrow at her. “Maybe there wasn’t anything so important?”

  His tone was still totally nonjudgmental—just trying to get a lay of the land. Yet it rankled her. More because she was angry at herself for forgetting about dinner. Even worse was how much she had come to enjoy the weekly get-togethers with his family. She didn’t need a family, didn’t want that kind of complication, entanglement in her life.

  The silence lengthened. He shifted her feet to the side as he slid out from under her and stood. “I’ll see you tomorrow. Or maybe that’s too far ahead to plan?”

  Ouch. The offhand tone he delivered his question in only made it worse. “When we met, you said you didn’t want to put down roots, didn’t want to be tied down to any one place—or one woman.”

  He stared at her, his posture rigid, hands fisted as if he were holding back. Then his face twisted and he turned away. “Maybe I’ve changed my mind.”

  “Damn it, Trey. Don’t walk away.”

  “No, you’re right. You don’t owe me any explanations.”

  She grabbed his arm, but stopped short of actually spinning him around to face her again. Instead they stood there, touching but not together. She didn’t know what to say or how to say it. So instead, she slid her palm down to his hand, grasped it firmly, and began to lead him up the stairs.

  “Sex isn’t always the answer, Lydia,” he said, stopping halfway up.

  “Shhh.” She tugged, and he gave in and followed her up to the bedroom. She nudged him so that he could look through the half-open door.

  “Who the hell is that?” he whispered. “Lydia, why is there a kid sleeping in your bed?”

  AMANDA STARED AT NORA IN DISBELIEF. “NO, I don’t believe it. Dr. Nelson would never do anything to hurt me—to hurt any of his patients.”

  “Do you have proof?” Lucas asked, although from the tight tone of his voice and the way his face had gone blank—too blank—Amanda could tell he was holding back, forcing himself to be rational.

  “No. It could have been a pharmacy mix-up. But I doubt it.” Nora explained what the clerk had told her.

  “And there’s your signatures on the bicarb orders,” Amanda reminded him. “If you didn’t write those orders, then someone forged them. Maybe it’s someone trying to undermine Dr. Nelson’s research?”

  Lucas began pacing, hands dug deep into his pockets, swinging his coat wide with each turn in the tiny space. “No. Nora’s right. It has to be Nelson. He must have realized that there was a small subset of patients who reacted adversely to his supplement. What he didn’t realize is that it wasn’t because of any fault of his but rather the cross-contamination of the mercury and the chondroitin.”

  “No, not Dr. Nelson. If he saw something wrong with his supplements, he would have stopped the studies, analyzed everything… .” Amanda sat up straighter, a sudden chill overcoming her, settling deep inside her. “Oh my God—it’s all my fault. I recruited the volunteers from the boathouse. If I hadn’t posted those notices, Becky and Shelly might still be alive. Tracey wouldn’t be dying.”

  Lucas strode to the head of the bed, taking her hand in his. “You can’t blame yourself, Amanda. No one could have seen this happening.”

  His words did little to stop the guilt washing through her. She was partially responsible for the deaths of two girls. Amanda closed her eyes, trying to force back the wave of nausea generated by the thought. They had to find a way to help Tracey. And to find out who was really behind this—she couldn’t believe it could be Dr. Nelson. She opened her eyes to find Lucas staring at her, his hand squeezing hers, his gaze clear, reassuring.

  “It will be okay,” he said in a low voice. “We’ll figure something out. I promise.”

  They were only words, but somehow they made Amanda feel better. She tried to smile and failed, so she nodded grimly.

&
nbsp; “The important thing is, if we know the trigger is having an alkaline pH, can we reverse it?” Nora asked. “Amanda got better pretty fast once we got her pH back to normal—should we try to make it more acidic?”

  “I don’t know,” Lucas said. “When Ken and I found these proteins they were already deposited in the tissues. We need to find some way to dissolve them, break them down without damaging the nervous tissue.”

  He released Amanda’s hand and began roaming the room, not touching anything, his gaze darting every which way as if seeking inspiration. Nora started to say something, but Amanda held up her hand, motioning her to silence. Suddenly Lucas stopped, his stare fixed on the oxygen supply valve.

  “Hyperbaric oxygen. That might work.” He frowned. “Or it might make things worse.”

  “I doubt that,” Amanda said, gesturing to her dead leg.

  “No. Seriously, it can have complications. Pneumothorax, blindness, brain damage. We’d need to try it first, maybe on an animal model, get approval from the Institutional Review Board and the ethics committee.”

  “Lucas.” He stopped his rambling, his gaze returning to fix on her. “We don’t have that kind of time. Tracey is in a coma—if she follows Becky’s pattern she won’t make it past morning.” Amanda didn’t add that there was a good chance she’d soon follow. From the expression on his face, she didn’t have to. It was funny. She was the one who should be scared, but she felt strangely calm, as if all this were happening to someone else.

  “At least let me try—”

  “No,” she interrupted him. “You can’t waste time. And you can’t risk trying it on Tracey first. Tonight. You’ll try it on me. Tonight.”

  He spun around, staring at the wall, his shoulders hunched.

  Nora sat down on the bed beside her. “Amanda, do you know what you’re asking? Lucas could lose his job, maybe even his license, if he uses the chamber without authorization. And the risks to you—”

  “I don’t care about the risks to me. I just want this over. I want you to keep your promise to Tracey,” she said as Lucas slowly spun around, hands free of his pockets, hanging empty at his sides. “We can’t let her die, Lucas. Not if there’s a way we can save her.”

  He blew out his breath then nodded. “Let me see what I can do. In the meantime, I’ll start you on the mercury chelation protocol.”

  She watched him leave, finally able to relax once the door shut behind him. Nora took her hand and squeezed it tight. Amanda felt relieved that she could feel Nora’s touch—that hand was following the same intermittent pattern that her leg had before it went totally dead.

  “Are you sure?” Nora asked.

  Amanda nodded, unable to speak as the fear she’d been waiting for sneaked up and choked her into silence.

  FORTY-ONE

  Friday, 8:18 P.M.

  GINA HAD CALLED HER FATHER’S CAR SERVICE to drive her home after leaving the ER. It wasn’t like she could ask Trey to drop her off in the ambulance, not after he’d practically fired her. As the driver sped her through the streets of East Liberty and to her house in Point Breeze, she wondered if she still had a career—probably not, not once Trey tattled to Lydia about kicking her off his squad. Lydia would make good on her threat to fire Gina if Gina didn’t get her act together. No second chances there. She should know better. Moses was right: you have no one you can count on but yourself.

  She couldn’t help but wonder if this was all part of Moses and LaRose’s plan to free her from her squalid existence as an ER doctor. But no, there was no one to blame but herself.

  Her cell phone rang several times: Lydia and Nora. She didn’t want to talk to either of them, so she let the calls go to voice mail without listening. When the car pulled up in front of her house, she jumped out without waiting for the driver to open the door, left it hanging open, and didn’t look back as she bounded up the steps and into the house.

  It was empty. Shit. Where the hell was Amanda? Probably still playing Mother Teresa at Angels.

  Gina paced through the house, denying herself the pleasure of ice cream or even a beer. She took a long shower, hoping to wash off the stench of the brothel, and changed into jeans and a tank top. Still no calls from Amanda—although there was one more from Nora. Seemed like Lydia had given up on her; no surprise there.

  She tried Jerry’s cell, but it went to voice mail. Too busy to talk with her. Great.

  The house echoed with self-pity. She stamped down the steps, grabbed her car keys, and headed over to Diggers, the dark and dingy tavern where most of the workers from the medical center hung out. The food stank and the atmosphere was nonexistent, but it offered plenty of privacy and the drinks weren’t watered down.

  There she found the usual crowd following the change of shift at the hospital. She toyed with the idea of joining a few other EM residents in a game of pool, but instead took a booth in the back where she could get down to some serious eating while waiting for Pete Sandusky.

  “Gina!” Pete emerged from the shadows surrounding the bar and approached her, carrying a mug of beer. “Glad you could make it. Seems like I’m persona non grata at Angels, thought maybe you could fill me in. How’s your patient?”

  “The jumper?” Gina realized that she didn’t even remember the man’s name. Lydia would have, a tiny whisper taunted her from the guilt center of her brain. She shook her head, to both clear her thoughts and express her sorrow. “Didn’t make it.”

  The reporter shrugged, sliding into the booth, taking the side facing the door and the crowd. “Too bad. I’m guessing the Post-Gazette will still be putting your picture front and center. They should after what they paid for it.” He stopped and looked her up and down. “You look beat. Let me buy you a drink.”

  She considered. Jerry wouldn’t be home for hours—if he made it home at all. And who knew what Amanda was up to? Probably curing cancer or the like. She loved Amanda, but sometimes it was damn tiresome living with a freaking saint. “Sure, why not?”

  “What will you have?” Pete asked, settling himself back in his seat and waving over a waitress.

  He was one of those average white guys—not too tall, not too skinny, not too handsome. His main features were his salt-and-pepper hair and craggy eyes, both reminiscent of George Clooney in a vague sort of way. What George might look like if he were a normal guy.

  “Maker’s Mark.” Gina’s father hated bourbon almost as much as he detested beer. She glanced at the menu even though she knew exactly what she wanted. She’d promised Lydia she wouldn’t purge, but she didn’t remember saying anything about bingeing. Anyway, it wasn’t really bingeing if she hadn’t eaten all day.

  Like a dull itch just below the surface, aching to be scratched, adrenaline buzzed through her. What Lydia didn’t know wouldn’t hurt her. Besides, it was Gina’s life—Lydia had no control over what she did, no right to interfere, much less try to dictate to Gina or threaten her career. As she stared at Pete, a glimmer of a plan began to form. Lydia couldn’t very well fire the Hero of Angels, could she?

  It was a plan that stood for everything she hated. A plan her father would have been proud of. She’d hit some lows in her life, but this was scraping bottom.

  Pete was prattling on about something to do with his blog and freelance work and the rich and famous Pittsburghers he hobnobbed with. Gina caught just enough to realize that the world of freelance journalism mirrored her father’s world: “friendships” based on favors owed and disdain.

  The waitress brought their drinks, serving Gina a Jim Beam. That was all Diggers carried, but still she always asked for what she wanted, even if she knew she’d be destined to settle for less.

  Irritation, anger, adrenaline, and need combined into an intoxicating mix stronger than the bourbon. Gina found herself ordering food despite the nausea that wracked her at the thought of eating it and the knowledge that she’d feel awful—bloated, fat, defeated, dirty, a failure—afterward. It couldn’t be worse than how she felt already.

&
nbsp; Pete stopped talking as the waitress brought the food, filling the table with plates piled high with potato skins laden with cheese, bacon, sour cream, and chives; deep-fried pierogies stuffed with onions and cheese; chicken wings slimy with sauce; a mountain of French fries; and deep-fried mozzarella sticks coated in bread crumbs, cheese oozing from the ends, congealing on the plate.

  “Great idea,” he said, digging in and matching Gina bite for bite. For a while. Then he sat back and sipped at his beer as she continued her death march through the jungle of grease.

  “Don’t know how you do it,” he said, starting on his second beer. “You’re as skinny as a model from one of those fancy magazines.” He tilted his head at her. “Why didn’t you become a model? Why a doctor—and at Angels of all places? With your dad’s money you could have done anything you wanted.”

  She smiled around a mouthful of pierogi. “What makes you think I haven’t? Done exactly what I wanted.”

  “Dunno. You just don’t seem to quite fit in around there. Too polished, too smooth. But at least for all your money, you’re not a snob. Not like Lydia Fiore. You know she won’t even take my calls or give me a heads-up on stories? After all I’ve done for her.” He shook his head. “If I weren’t such a nice guy, I’d take it personally, feel betrayed. I helped her out and this is the way she pays me back?”

  Gina grabbed another wing, popped it in her mouth before the sauce could drip, and sucked the meat from the bone. Pete had gotten her a second drink—or was it a third? She couldn’t remember, her senses overwhelmed by the food. Resentment flared through her at Pete’s words—he wasn’t the only one who had stood by Lydia before.

  “Sometimes I don’t think she’s a team player,” she admitted, flashing on the memory of Lydia telling Gina she’d drop her from the residency program if Gina didn’t follow her rules. “Lydia always has to go it alone, be right about everything.”