by Barbara Ebel
A man in a suit and a woman in a uniform waved them over to one section of the massive building, opening the doors to a large conference room.
The group of nine who had flown in included Ralph and another researcher from Atlanta. The remaining seven were from Nashville, including Robert Madden who had come to lend a hospital’s perspective on the epidemic. After filling out name tags, the visitors sat on both sides of the table. Pitchers of water, cups, and notepads were available and all those with briefcases opened them, placing papers in front of them. Ralph passed around copies of data sheets to everyone.
A heavyset man with a gray suit began speaking.
“Welcome, everyone. I am Grant Edwards. I’ve had multiple conversations with Ralph Halbrow from the CDC. The folks in this room from the FDA represent the Center for Drug Evaluation and Research. Because we also understand your project involved canines, we have a representative from the Center for Veterinary Medicine.” He pointed to a hunched-over man nearby, and then motioned for the meeting to begin.
Joelle brought along notes of the team’s key points. “So we’re on the same page,” she said, “as we began working with this amoeba, it looked and behaved most like Naegleria fowleri, but there were differences. It also has a predilection to affect the host’s salivary glands, causing increased salivation. Coming in contact with this saliva in an unprotected way is one mode of transmission. Of course, as we all know, it wreaks havoc on brain cells. Dr. Danny Tilson, our neurosurgeon, can comment on that. You all have the mortality and morbidity stats from the CDC in front of you.”
Danny glanced at his sheet. Not only had the numbers grown but another country had been added, probably from a traveling American to Costa Rica.
“So,” Joelle continued, “we realized we were dealing with a different genus and species. This organism has now officially been named Naegleria salivi. The baptismal name had to go through the proper channels. Up until now, we’ve been calling the epidemic PAM – short for primary amoebic meningoencephalitis - but PAM doesn’t just refer to Naegleria fowleri. This particular epidemic is due to Naegleria salivi.” Joelle glanced around the table making eye contact; her discussion was for utmost clarification and announcement of the taxonomy.
“I have presented you with the essence of the scientific backing for the antibiotic we have developed. It is in the stapled packet of papers you received. All previous drugs that were helpful, but not always curative, in the treatment of Naegleria fowleri did nothing against Naegleria salivi. No other classes of antibiotics eradicated the organism either. We discovered that the Chesapeake Bay retriever breed held something in their saliva which not only penetrated the amoeba’s outer membrane, but then also penetrated and broke down the organism’s nuclei. Before that, we could not find that unique combination.”
Joelle eyed the serious faces giving her attention - it wasn’t always the case to present what she had to say without being interrupted. She smiled, glad for the freedom to forge ahead.
“What our lab has developed is a streptomycin which does exactly what I’ve told you. In vitro, this antibiotic has been tested for days on Naegleria salivi resulting in its death one-hundred percent of the time.” She switched her gaze to Robert Madden. “For any of you without a full scientific background, in vitro means ‘in the lab,’ as opposed to in vivo, which would mean testing it in a living organism. In other words, humans infected with the disease.”
Joelle took a sip of water and looked towards Ralph, who took her cue and stood up. He ran his hand over his receding hairline and then thumbed his suspenders.
“Ladies and gentlemen of the FDA, the CDC has been a step behind Dr. Joelle Lewis and her team, but has verified her results in our own lab. We are requesting that this organization sidestep all the regular channels for developing and testing this drug and make it available to the public immediately. It is our responsibility to not waste one more day. In addition, you must recognize that the people already infected for awhile are probably going to die. This is the only hope, if given early on. And I emphasize early. We think getting this antibiotic into a person’s bloodstream as soon as the diagnosis is made is key.” There was a silence.
Grant Edwards cleared his throat. “We will be candid here, Mr. Halbrow. We are the only thing that stands between a potentially harmful drug in the making, or making it a safe and effective product that is supposed to heal or improve the health of the people of this country. However, we can expedite our own testing based on information you supply us with.”
“So you’re saying,” Ralph said, “the FDA is gonna go around its ass to get to its elbow?”
Grant’s face reddened. Danny stood up.
“Mr. Edwards,” Danny said as he looked around to all the FDA members. “I have a single sheet with your packet which explains the sinister way this organism penetrates the brain. It not only travels from the contamination Dr. Lewis spoke of, but it can also occur in freshwater sources … as in the first case of young Michael Johnson jumping into a lake.”
Danny’s pulse began to quicken. He must pound them with the scary details as they had to get approval ASAP.
“Ladies and gentlemen, how would you like to be sitting here well and alert but, within a few hours, have this amoeba unsuspectedly introduced to you up your nose? First, the mucosa or tissue responsible for your smell – your olfactory bulbs - will dissolve, even hemorrhage. You know, bleed out. Then these little organisms are climbing along your nerve fibers straight through the skull area called the cribriform plate. That’s the floor of your cranium. So now it’s inside your brain.” Danny swallowed hard and looked piercingly at them all.
“Piece by piece,” Danny said, using his fingers to demonstrate, “your brain cells are being sucked in and consumed. That’s because Naegleria salivi has special suckers extending from its cell surface. As you have fewer and fewer cells for thinking, or moving, or speech, you are already in a coma, and the contents of who you were are nothing more than a parasite’s meal. This is the reality behind this silent fear which has grown to pandemic proportions. Don’t you agree that this very real amoeba is more frightening than a Stephen King novel?”
Everyone fell into silence as visual images crept over the participants’ thoughts and a few heads nodded. Grant Edwards stood.
“Can all members from the FDA follow me into the adjacent room, please?”
As they began heading toward the door, Danny spoke up again. “I have one more thing for your consideration. Even though the drug isn’t perfectly formulated yet, consider me the first in vivo patient to have received its key ingredient. I had an open wound and my Chesapeake Bay retriever thoroughly licked it, inoculating my bloodstream and brain cells with his saliva’s protection. It stands to reason why I’m on this side of the grass compared to the victims and I’m able to give you this pitch. Please give the American people and the world the same opportunity.”
Chapter 30
Danny paced back and forth behind his chair to cool off. Joelle got up and took off her linen jacket. Rhonda twirled her pen and Timothy tapped his cane on the table leg. Peter poured ice water and downed it in several minutes.
Robert sighed and leaned forward over the table. “From a businessman’s perspective, your presentation and the papers you all have submitted are top-notch. I don’t see what more you could have done if they deny your request.”
“It wouldn’t mean denying it for us,” Joelle said. “It’s denying a potential cure to the public.”
“I understand, Joelle. Let’s hope for the best. It’s certainly taking them long enough.”
Danny slid back into his chair and relaxed. The back doors finally opened and the FDA group came in, their steps reverberating across the room. Grant Edwards went back to his prior position at the head of the table and spoke.
“The FDA has decided to give both organizations - the CDC and the Nashville research team doctors - the emergency clearance they need. We’ll work with you to get an approved pharmaceutical manufacture
r who can produce a substantial first quantity of this drug as soon as possible. First, as pills and then an IV formulation. As the first round treats patients, we’ll have an understanding of how well it works … or if it even does work for humans.”
The elation was unanimous and everyone popped out of their chairs. Timothy lagged, but rose nevertheless. Danny and Joelle hugged and Rhonda joined them.
Joelle stepped back to the table and rapped a few times. “By the way,” she said, “we gave the drug a nickname in lieu of the two most important characters that influenced its development. How about we make that name official?”
“What is it, Miss Lewis?” Grant asked.
“DakTilmycin. For Dakota, the Chesapeake Bay retriever responsible for smearing his saliva on Dr. Tilson, and of course, for Dr. Danny Tilson who is responsible for helping identify the origin, the mechanism, the cure, the biopsies and patient care. Need I go on?”
“We hereby declare it DakTilmycin,” Grant said. “Let’s hope the drug is a winner.”
----------
The media swarmed them. “Is it true? Is there a cure?”
“How many more lives must be sacrificed before you all do something?”
“We heard the CDC brought a proposal to the FDA. Did they accept?
“We heard a rumor a drug has been manufactured from a dog?”
“Has the FDA swiped your research? Is it going to take months before they release their results?”
They pushed and prodded, and the docs answered. As they learned the facts, the reporters pressed with more questions. Some of them didn’t know whether to pursue the doctors or zoom to their headquarters to get their coverage live on television. Yet the public would know shortly that help was on the way. Major networks covered the details, which streamed to foreign countries, and discussions began about the believability of the cure.
The news coverage was creative. One reporter stated, “A medical catastrophe that not only began spreading like wildfire through saliva is now going to see its cure with saliva.” Another on the 9 p.m. nightly news said, “Do you know where your Chesapeake Bay retriever is? Chances are he or she is a precious commodity because what’s thought to be the cure for meningoencephalitis is coming from the breed.”
A headline blared: Now-famous Nashville neurosurgeon’s dog and hand injury may hold cure to continental epidemic. And the next day’s major national newspaper announced: The silent fear of the perfect pandemic may be drawing to a close.
----------
Back home in Nashville, the team met Monday morning at 8 a.m. at the bedside of a patient infected with Naegleria salivi. The twenty-three-year-old student had contracted it in their own hospital while training to become a nurse. She had been diagnosed by MRI the evening before but, fortunately, had not lapsed into a coma although her words were jumbled. Wearing a pretty nightgown, the young woman had a nursing book on the end table; the team hoped she’d get back to her studies in the future.
“Here, Claire,” Joelle said. “This is the new medication you and your family signed for. We hope it does what it’s meant to do.” Joelle handed her a small cup with apple juice and the patient reflexively swallowed the pill.
Leaving Claire’s room, Danny said, “I wish Bill could have been one of the first.”
“Nevertheless,” Joelle replied, “we’ll wait and see. Maybe we’ll know in a day or two.”
“Peter and Timothy,” Danny said, “I’ll order an MRI on her for two days from now. You all call me to let me know how she’s doing.” Everyone stopped in the hallway, ready to part. “That’s it, then,” Danny said. “The writing’s on the wall in two days?”
“In two days,” Joelle said.
----------
It was 5 p.m. mid-week. Danny’s desk overflowed with files and messages. Other than seeing patients, his office work had piled up. He scoured the notes of people who had called, knowing he could be picky choosing his news interviewers.
Bruce rounded the corner.
“Come on, the MRI you’ve been waiting for just came in.”
Danny jumped out of his chair and followed Bruce to the viewing room where the large gray envelope sat on the aluminum table.
“She’s only twenty-three. A nursing student,” Danny said. He jimmied the new film onto the viewing box along with the last two films for comparison. Bruce adjusted his bifocals and studied the films.
For a second, Danny hesitated with fear. What if DakTilmycin hadn’t done a thing?
“You all have made a medical breakthrough,” Bruce said, looking at the film and interrupting his thoughts.
The inflammation of the patient’s meninges had subsided and Danny felt his pulse subside. He saw the beginning of a marked brain improvement and tried to dampen his excitement although he wanted to shout like a kid.
Bruce shook his hand. “I think by tomorrow you’ll have a confirmed cure. Congratulations, Danny.”
----------
Arriving at home, Danny pulled into the driveway alongside Sara’s car and sprang out of his vehicle. When he opened the door, Nancy handed him Julia and Dakota gave him a rambunctious hello. He pulled Nancy’s head towards him, gave her a kiss, and squeezed Julia. His fingers inched into the baby’s hand and he mimicked a dance with her.
“We came over, Dad, because Mary just got back her wedding pictures and we haven’t seen their honeymoon pictures. We’re not staying long though, because Annabel and I haven’t done our homework yet and Mom has school stuff to do, too.”
“Well, I’m glad you’re here.”
“Dad, I’m not kidding. At school, it’s like we’re the daughters of some medical rock star.”
Danny shot her a glance. “I’m sorry. I hope that’s not a bad thing.”
She shrugged her shoulders. “I can live with it.”
Danny walked toward the coffee table where Casey, Mary, Annabel, and Sara gloated over an album.
“Come see the pictures,” Mary said as his pager went off.
“I’ll be right there.” Danny held his breath. It was Joelle, calling from her condo. He placed Julia on the counter facing him, her little hands patting his face, as he used his cell phone.
“Joelle,” he said. “The MRI looks so much better. I can’t say great, but the meninges swelling is less pronounced. Please, tell me, does that correlate with the clinical picture?”
“Hallelujah,” she said. “Our first experimental patient to take DakTilmycin has had four doses of the drug and her neuro-status has improved. Meaning, I had an almost perfect conversation with Claire an hour ago. Peter, Timothy, and I are very pleased. We believe it’s working and there seem to be no problems. Even her labs are better.”
Danny hung on every word as he watched Julia smile. He tried not to cry but he couldn’t help it, and two tears made their way down his cheek.
“I don’t know what to say.”
“Then don’t say anything. I’ll see you tomorrow, Danny Tilson. Why don’t you go spend the evening with your family?” she asked, eyeing Bell.
“I will. And Joelle?”
“Yes?”
“Your mother would be proud.”
Joelle closed her eyes. “Thanks, Danny. I appreciate that.”
----------
Danny slinked into the room so as not to disturb everyone’s delight over the group pictures. Annabel crunched on a potato chip and gave him a little wave. He sat next to Sara, cross-legged on the floor, and Dakota nestled in behind him.
“Hey,” Casey said. He sat on the couch hovering over the pictures, pointing from one to the next with a wide smile. “Here you are with the girls and Dakota on the back lawn,” he said.
Danny’s eyes settled on his ex-wife. “Nice.”
“Does that go for the picture as well as for Sara?” Casey asked.
“For sure.”
“How is the new drug working out?” Mary asked.
“Like a charm,” Danny said.
He cradled Julia with his left arm and
his right hand went to Sara’s on the floor between them. He laced his fingers through hers and she surprised him by raising his hand to her lips, planting the most meaningful kiss he’d received in a long time.
END
COLLATERAL CIRCULATION: A Medical Mystery: Book Three
The Dr. Danny Tilson Novels
Barbara Ebel, M.D.
Collateral Circulation Copyright © 2015 by Barbara Ebel, M.D.
http://barbaraebel.weebly.com
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License Notes
All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.
This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.
However, this novel from the credible medical fiction writer is based on an organism that really exists.
ISBN-13: 978-0-9977225-9-8
For Brendan
.
*****
Chapter 1
Danny Tilson had performed surgery on many brains during his career but never before had he been as mystified about a patient’s arterial anatomy as now. His afternoon case was all he thought about as the automatic doors of the ER slid open to the fading daylight and he stepped outside. He scanned the vehicles at the curb looking for the ambulance operated by Casey, his best friend and brother-in-law.