by Caro Carson
“My card,” Braden said, offering Lana a small rectangle of pressed linen paper.
“Thank you.” She should have offered him her card, of course, but she hadn’t had a chance to get any made. Instead, she asked the very young-looking Dr. Everson to please begin the presentation and took a seat directly across from Braden, on the opposite side of the narrow table.
As the resident began with slide number one, Lana glanced down at the card in her hand. The initials of the corporate giant formed the familiar PLI logo in gold and burgundy ink. Very expensive ink, as she recalled from the days she’d spent at stationery stores, choosing wedding invitations. She and Braden, up to their necks in med school student loans, hadn’t been able to afford colored engraving like this. They’d planned to send their wedding invitations in plain, formal black ink, like his name on this business card:
Braden MacDowell, M.D., MBA
President of Research and Development
His business card was very impressive, if one admired money-making over life-saving. She did not. She never had. It had crushed her when Braden had decided he did.
Lana pretended not to look at Braden as he patiently listened to the resident explain slide number two. Braden’s tie was a subtle symphony of colors on silk. His watch was worth as much as her worn-out car, she was certain. But his face no longer reflected enthusiasm for life, and his mouth no longer lifted in an easy smile. Chasing the almighty dollar had not been a happy way for him to spend the past six years, apparently.
Lana had made the right choice by breaking their engagement. She could not have been the right wife for this executive. He’d been heading in that profit-driven direction then; she wasn’t going to regret it now.
No—she was going to ignore him for the duration of the PowerPoint presentation, because she needed to read every slide and learn all she could about this study. Her one goal, her only goal, was to keep PLI’s funding coming into this hospital.
She slid another look at his painfully familiar profile. He was handsome, classically handsome, but her eye went to the imperfections, the ones she’d known and loved. His eyes had some crinkles at the corners, as they’d had even six years ago, from a youth spent ranching in the relentless Texas sun. His chin had a scar from being cut open too many times for him to recount them all to her. Being thrown from a horse. Getting sacked in high school football. Attempting some prank with his brother. He looked like an urbane city man now, a business tycoon in a Savile Row suit, but that scar on his chin revealed the man he’d been. Lana knew him, under that suit.
Under that suit, he was...
Warm skin and hard muscle. Every inch of him.
For God’s sake, Lana. You’re the department chair. Pay attention.
More than a million dollars were at stake. West Central was counting on her to achieve one simple goal: renew PLI’s contract.
Perhaps she ought to set a second goal. She was going to keep her heart well guarded from the dreamy Dr. MacDowell.
* * *
“Thank you for that thorough presentation,” Lana said.
She would coach Dr. Everson later about making her presentations less lengthy. In front of PLI’s president, however, Lana would point out only the positive for the sake of West Central Hospital. Thankfully, the study in question had turned out to be for a medicine she’d also been studying in Washington. Lana felt a little more secure in her knowledge. “It’s exciting that pentagab has met the midpoint goals.”
Which meant it’s exciting that we’ll be extending our contract with PLI.
“I regret that PLI will not be continuing this study.” It was the first thing Braden had said in forty minutes. Lana heard that familiar voice, still masculine, but no longer infused with affection for her. It took a moment for his words to sink in through the miasma of emotional memories.
“You’re not continuing this study?” she asked. “But this drug shows such promise.”
“I don’t believe it does.”
“But the numbers—let’s go back to that last graph—”
“The graph looks impressive, yes, but it’s just drawn cleverly. The raw numbers make the treated group appear to be doing better than the placebo group, but where is the p-value? There is no statistical significance.”
Startled, Lana looked at the screen. The bar graph looked straightforward, but sure enough, the standard line that stated the p-value between the groups was missing. The p-value was a mathematical calculation used to determine if the difference between two groups mattered. If one hundred patients responded to a medicine but ninety patients responded to a placebo, that ten-patient difference was not really a difference. Not in the world of science.
“The statistical analysis was on another slide,” she said, stalling for time. It was on one of forty-three slides. Lana flipped through her paper copies of the PowerPoint presentation, doing some frantic speed-reading. “Here it is,” she said with relief. “P equals point-zero-five. Statistically significant, and it looks like the data are trending toward a more robust end point.”
Still, she’d have to ask Everson why the p-values hadn’t been clearly listed on the graph itself, where they typically were in medical studies.
“Those numbers are wrong,” Braden said in a tone as certain as if he’d said the sky is blue.
“How can you say that off the top of your head?”
Braden only raised an eyebrow.
Of course, he knew that she knew he was a math whiz. He probably could look at a bar graph and come up with a p-value without touching a calculator, let alone performing a page of equations.
“Never mind.” Lana turned to Dr. Everson, who was looking younger and less reliable by the minute. “Who prepared these slides? Who ran our numbers?”
“Uh, well, I was instructed to do some preliminary work, and then Dr. Montgomery finalized it.”
Dr. Montgomery, who couldn’t stay one more hour to take this meeting. Lana had a sinking feeling. Had Dr. Montgomery been so desperate to keep this funding that he’d do something unethical? Surely not. This had to be an honest mathematical error. An error that just happened to be in their favor.
One that, had it gone unchallenged, would have kept more than one million dollars coming into the hospital.
How badly in debt was her department? How hard would the cancellation of this study hit them? Her?
She was determined not to find out; she was going to save this study.
“Myrna, Dr. Everson. If the two of you could excuse us, I’d like to take the rest of this meeting one-on-one with Dr. MacDowell.”
Chapter Three
Lana had never groveled to Braden, not even when she’d so desperately wanted him to stay in Texas instead of moving across the country to Boston. Now she groveled. Begged.
“Please, give me a day to run these numbers again. I just left Washington, where I was involved in the sister study to this one, the pediatric study. Our results were clearly significant. If the pediatric results were good, then odds are that the adult results are as well, so if you’ll just give me time to calculate—”
“I ran the numbers myself, Lana, before I came here. Personally.”
An old, defensive feeling resurfaced. “Because you knew I’d be here? It’s been years since I needed your help to pass statistics class. I know how to interpret data.”
He cut her off before her indignation could build more steam. “I always run the numbers myself before committing millions of research dollars.”
She couldn’t stay impersonal; the memories were just too bitter. “I should have known it would come down to making a profit for you.”
His expression stayed impassive, but she caught the movement of muscle as he clenched his jaw.
Don’t bite the hand that feeds you—or feeds West Central Hospital.
Lana buried her personal feelings. “I was running that pediatric study in D.C. To be studying migraines in pediatrics was rare enough, but even more unusual, the results were po
sitive. Please, Braden, I’m pleading for a second chance here. Let the second half of the study go forward.”
“There’s no gain in—”
“We’ll gain knowledge. Practically every study has shown that adult migraine medicines work poorly in children. This could be the exception to the rule. Even if the adult trial fails, the significance of a drug working for pediatrics but not adults will be novel and worthy of further research.”
She could recall the individual faces of children enrolled in the Washington study. How miserable they were, in pain. How much happier they were when the drug started working. As their pain receded, their personalities emerged, happy kids who made her laugh. She couldn’t let them down. Losing the adult study here at West Central would hurt her professionally, but keeping the pediatric one funded was personal. Those children, her patients, mattered. Not profits.
“Even if the results are novel, who is going to fund that further research, Lana? PLI isn’t going to.”
“Why not?” She wanted to pound the table in frustration. “I’m telling you, the data in peds is rock-solid.”
“Because there’s no money in treating pediatric migraines.”
No money in it?
She’d told herself a hundred times that the man she’d once loved cared only about profits. That he’d chosen not to practice medicine with her because he’d wanted the bigger dollars offered in the business world. She’d clung to that as her justification for ending their engagement.
Always, he’d protested that money wasn’t his motive for going to Harvard Business School instead of staying with her at West Central. He’d denied that the need to excel in the corporate world was the reason he no longer wanted to open a husband-and-wife family practice in Texas. Some part of her must have believed him after all, because now, to hear him say it himself—there’s no money in treating pediatric migraines—was devastating.
Even after six years.
* * *
Braden watched the light in Lana’s eyes die, the passion in her expression fade. It was the same look he’d seen on the faces of other hopefuls whose dreams he’d had to kill. The fact that it was Lana this time didn’t make it any different.
Braden felt very tired. Too old, too wise to the ways of the world.
“This is the reality of the marketplace,” he said. “Pediatric migraineurs are only a fraction of all patients.”
“You saw these slides. They estimate over twenty-nine million Americans suffer from migraines. Even if only a few percent are pediatric, that’s still a million or more patients. That’s huge.”
“No, it’s not. Only half of your twenty-nine million even know their headaches are migraines to begin with. Only half of those will seek help from a physician, and less than half of those might be prescribed a drug like this one. Another percentage will never fill the prescription. There are barely enough adult sufferers to make a new migraine drug viable. There are not enough children.”
“To make the medicine viable? You mean profitable.”
“I mean viable. Can it begin to recoup the millions—the hundreds of millions—that were spent on bringing it to the local drugstore? I estimate that only one in five drugs that makes it to the public sells enough pills to cover the cost of inventing it in the first place.”
“I’m talking patients here. There may not be a lot of them, but there are children out there who suffer terribly from migraines. They’re in pain, Braden. They can’t play and go to school. What about them?”
At the moment, Braden hated his job with a passion. Why did he have to be the one destroying Lana’s dreams? Let someone else disillusion her.
She kept championing her cause. “The adult medicines don’t work well to relieve the pain for children. Most of the treatments aren’t even FDA approved for pediatric use—”
“As it should be. They don’t work well in pediatrics. Lana, step back and look at the big picture. When the first one or two migraine medicines ran pediatric studies, they failed. They didn’t work. Why should the other drugs in the same class throw time and money down the same drain?”
“Money. Always money. What about the patients?”
“I am thinking about patients. There is only so much money out there. What should we spend it on? Who needs it most?” He’d heard her words a dozen times before. She’d always maintained that if he cared about people, he’d be a physician, not a corporate executive.
He felt himself sucked into a time warp of sorts. Felt himself once more losing the woman he loved as she accused him of placing money before all else.
As he had a dozen times before, he tried to make her understand. “This is what I do, Lana. These are the life-and-death decisions I make now. Should I fund a pediatric migraine study that might—and I emphasize might—improve the quality of life for a fraction of a percent of all children? Or should I take those same funds—because by God, there are only so many dollars out there—should I take those same funds and invest them to develop a cardiac medicine that could prevent millions of deaths?”
He was standing, he realized, as was she. They were glaring into each other’s eyes, battling for supremacy. Again. Always.
“You make that call, Lana. Should I help three million kids who have episodes of pain, or should I help eighty million adults, the parents and grandparents of those children, who are facing death? You choose, because I don’t have enough money to do both.”
She stayed silent, but she didn’t back down, not in her body language, and not in her glare. Why had he thought this time would be different?
Braden berated himself for letting her bait him into this debate. None of it mattered. Their entire conversation wasn’t going to change the fact that PLI was withdrawing further funding. He wasn’t going to throw more money at an unlikely solution to what amounted to a rare problem in the universe of medical crises.
And Lana was not going to understand him now any more than she’d understood him then. He’d had six years to stop wanting her to understand him. Wanting her to respect his career. Wanting her to trust him, to support him.
Wanting her.
She was so damned vibrant, so passionate, so beautiful. The temptation to end this match with a crushing kiss was overwhelming. That physical attraction had become a crutch for them, toward the end. They couldn’t agree on their careers and their future, so they’d fall into bed and have silent, soul-searing sex.
In Lana’s opinion, they’d had sex one time too many. The last time had had consequences neither of them had been ready for.
Still, he found himself craving the smoothness of her skin, the curves of her body, the surrender of herself. Six years hadn’t been long enough apart. He needed another six to kill his desire for Lana Donnoli—and he wasn’t going to spend it waiting for absolution and understanding in this conference room.
“I regret to inform you that Plaine Laboratories International has decided to end all trials of NDA zero two one zero six one. West Central’s contract will expire in accordance with our prior arrangements, and no renewals will be pursued. Goodbye, Dr. Donnoli.”
* * *
Braden’s decision was final. Lana knew it; she watched him close his laptop case with a single click of a lock.
He’s leaving, and I failed.
The expression on his face was no longer fierce, no longer focused on her. He looked withdrawn. Remote. He was already gone, although he was still in the room with her. Then he picked up his briefcase and was gone for real. The door closed after him with a firm, controlled click.
I failed him.
Him? Not only the hospital, but him?
Somehow, he’d been disappointed in her, yet Braden had no right to expect anything from her. What had he wanted?
Professionally, her failure was simple to define. She’d failed to keep this hospital’s study going. Failed in her new responsibility to get financing for the research branch of West Central Texas Hospital.
Is it west or is it central? You can’
t have both.
She couldn’t have the migraine trials, but could she have something else instead? They had the facilities. They had the staff, the patient flow—there must be other studies that PLI needed a site like West Central for. There were other funds she could secure for her department.
She stopped debating with herself and started walking after Braden. Quickly. She needed to talk to him today, before he walked out of the hospital completely, like he’d once walked out of her life.
Breathless from catching up to his much longer strides, she followed him to the bank of elevators. The doors started to slide open before she could reach him.
“Braden, don’t go!”
The back of his head jerked up, just a bit. He turned her way and stood still, not moving away from the elevator, but not stepping into the car, either. She was suddenly so afraid he might leave without her, she jogged the last few steps to him and put her hand on his sleeve.
“Don’t go yet. Please.”
He placed his warm hand over hers. There was a clear question in his eyes, a concerned tilt of his head, a softening of the hard mask of his face. “Why not, Lana?”
“I want a second chance. I want to talk to you about PLI.”
He removed his hand to stab the button to recall the elevator. “The decision is made. I can’t explain it any better. If you don’t understand, that’s your problem.”
“No—no, that’s just it. I do understand. PLI only has a limited amount of research dollars to go around. But I want a second chance.”
The elevator doors opened and Braden walked into the waiting car, away from her. She followed, grateful that the car was empty.
“Listen, Braden, please. I just got into town. Dr. Montgomery walked out, literally, minutes after I arrived this morning. I haven’t had a chance to get my bearings or take stock of what we have here, but I know West Central has a lot to offer in the way of research facilities and staff, far more than it did when we were residents here.”
She made her best case while she had him trapped in the elevator. “Give me the rest of today to review my department. PLI and West Central can use each other, I’m sure of it. You must have dozens of studies under way, and there is always a need for another enrollment site.”