No Inner Limit

by David Kersey

CHAPTER SEVEN – NIL?

  Irene Ralston, RN, took time out from her rounds to join Doctor Senen in the visitor’s lounge. When the good doctor saw that Irene was approaching he saw his chance to gracefully escape. But the miraculous recovery of little Pamela made for an extended, happy confrontation unlike the sad ones that normally prompted surgeons like himself to run and hide. This was a joyous, but tearful, announcement that seven year old Pamela was cancer free. It’s what kept a medic like himself going. The doctor congratulated them. They would see their courageous daughter in a wedding dress someday and hold grandbabies in their arms eventually. Doctor Senen excused himself rather than dampen the elated spirits of the parents by warning them that recurrence was likely. Complete remission, no lymphocytic leukemia cells found, was nonetheless a victory even if only temporary. A big win over a tough opponent. Mrs. Tompkins ran to embrace Irene who also had acquired an ample amount of tears. She always did at times like these.

  After the exodus of the doctor she directed the Tompkins to a consultation room and explained the post-remission therapy and schedule for return visits to monitor blood cell development. They were told that there would be ongoing chemotherapy in the form of a pill regimen taken at regular intervals over a twelve to sixteen week period. She tried her best to give them high hopes; but remission from ALL, the acrostic for acute lymphocytic leukemia, was rarely everlasting. Mr. and Mrs. Tompkins nodded with understanding and assured Irene that they would do whatever was needed, and that they were so very thankful for what all the staff at the Greenview Regional Hospital had done. Mr. Tompkins, the quiet one, then said they’d be sure to keep her on the NIL, the God-sent dosage that he was convinced was the answer to their prayers. That was an alarming announcement to Nurse Ralston. Mixing another type of unknown treatment with cytarabine could have dire consequences, even a fatal reaction.

  “Mr. and Mrs. Tompkins, please know that you should never administer a secondary drug without the doctor’s implicit approval; it can be catastrophic to Pamela’s health and recovery.”

  “Oh, NIL isn’t a drug. It’s just something healthy to drink,” said the husband squeamishly. Alice Tompkins slapped him on the knee, a move not unnoticed by Irene.

  “I can’t urge you strongly enough. Do not play doctor at home. I want you to bring me this NIL thing as soon as you can, but DO NOT use it until we see what it is, you hear?”

  “Don’t worry, Irene. Virgil has forgotten that we stopped the NIL long before she entered the hospital. We live about two hours away from Bowling Green, so would you mind if we delayed bringing it to you until our first scheduled visit?”

  “That will be fine. But please don’t play God on this, please? Oh, and don’t forget your daughter. She’s all ready to go and there’s a wheelchair right at the door to her room.”

  “We will follow your instructions to the letter, and thank you so much.” Alice rose out of the chair and lifted Virgil by the elbow.

  After the goodbyes, hugs, and handshakes were over Irene walked a straight line to the nursing center. This wasn’t the first time she had heard the word NIL, but she couldn’t remember the patient, some two months ago, only that the attendant doctor had written ’What is NIL?’ on the time sheet.

  “Marie, what is NIL?

  “Oh, that’s what I get out of my husband.”

  “No, seriously, have you ever heard of a drug called NIL?”

  “No, honey, let’s look it up.” Marie, the station nurse, grabbed the PDR and turned several pages. “I don’t see anything in here named that, unless it’s new. Let me go online and check on that. Umm, let’s see, NIL, no darlin’, nothing like that on the update here.”

  “A couple of months ago I saw that word written on a patient’s time sheet but I can’t remember who it was. It was on my shift so it might have been Stevens on duty. Is he here tonight?”

  “Yeah, he’s here somewhere.”

  “If you see him would you tell him I’d like to speak with him? Better yet, ask him if he was the one who wrote “What is NIL?” If so, I need to talk with him right away. Ok?”

  “Sure thing, Irene.”

  Alice Tompkins, volcanically hot under the collar, royally reamed out her husband as they sat in the car. “You know we weren’t supposed to say anything about that. What if they find out we were sneaking it in all the while she was here? Damn, Virgil, where is your head at? Never mind, I already know the answer to that.”

  “I’m sorry, Pumpkin, it slipped out and I didn’t know how to recover.”

  “Dammit, Virgil, Autry will skin us alive if he finds out.”

  “Mommy, do you have some NIL with you? I missed taking it today.”

  “Sure thing, honey.” Alice reached inside her handbag and produced the vial.

  “You wanted to see me?”

  “Oh, yes, Doctor Stevens, I do. About two months ago I saw on a patient’s time sheet ‘What is NIL?’ Did you write that? The reason I’m asking is that I heard the same word tonight with the Tompkins girl.”

  “Yes, I wrote that. It was something mentioned by the parents as I remember. That was a Hodgkin’s remission case, Humphries the last name. Marie will have the file.”

  “I am beginning to wonder if it is a Mexican wonder drug finding its way up here.”

  “We’d better find out. That could be a monster headache for everyone concerned.”

  “I’ll get on it.”

  “Be sure to check the samples. If it’s a drug it will show up in the blood, but I can’t remember anything suspicious with the Humphries case.”

  Doctor Senen, whom the staff had surreptitiously nicknamed Pepe, the lover, joined the huddled group. “What’s up?”

  “Have you heard of something called NIL?” Irene asked.

  “Yeah, it’s the amount of improvement in my golf game.”

  “I think we’d better lay the files side by side and examine the lab work,” Stevens added.

  “What are you talking about?”

  “Seems like two of our patients, both in remission, were, and are self-medicating. One of them is mine, the other yours.”

  The two doctors examined the files, glancing at each other’s for comparison. “Look at this, damn near the same in every marker, like they were taken from the same person. Look at the high level of nitric oxide. You know what, these are phytochemical markers. We’re looking at a neutraceudical concoction. Marie, check to see if there’s a NIL listed in the phyto-supplement market. If not, we’re probably looking at a snake oil. Where does your patient live? Mine is listed as Beulah Heights.”

  “Mine is Parkers Lake. I’ve never heard of either place. Where are they?”

  “Marie, find out where these two places are. I’ll be back after a while.” Doctor Senen walked off to attend to room 205.

  Stevens stuck around while Marie did the search. “They are both little hamlets in McCreary County, and the two places are like five miles apart, way out in the sticks. McCreary is south of Somerset and borders the Tennessee line.”

  “Not much we can do about it, but Marie, get Legal on the hook and see what they think.”

  “What stands out to me is that both patients are CR, complete remission,” Irene remarked.

  “Marie, see if we currently have anyone from around that immediate area admitted, ok? I’ll be back later.” Stevens and Ralston both left the station and went their separate ways.