Lethal Intent

by Cara C. Putman

  “How old is he now?”

  “He turns eleven next week.”

  “The same age as Bethany.”

  The woman frowned in confusion. “I don’t know who that is.”

  “A patient I met earlier this week.” She handed the photo back to Mrs. Robbins. “Thank you for showing me Patrick’s picture. He’s a handsome boy.”

  His mother sniffled. “We’ve spent days at the children’s hospital having more tests run by your researchers. They must have taken quarts of blood.”

  Quentin cocked his head as if surprised by that fact. “Really?”

  The woman glanced at her husband and then nodded. “Monday he was hooked up to the machine that takes his blood and then returns it to him. We joked he was lighter when he left.”

  “That’s right.” Quentin nodded. “We were getting a jump on it because of his status. He can’t afford delays.”

  “You’re right. He’s a very sick boy.” Mr. Robbins squeezed his wife’s hand. “We will do anything you need to give Patrick this chance.”

  Caroline watched the interplay, then focused on Quentin. “Which therapy are you hoping will work for him?”

  “Trial CAR T 463.”

  Her heart sank. They had barely completed the application for Phase 1 trials. Like the trial they were trying to get Bethany into, the CAR T 463 therapy contained mouse DNA, which might be harmful to human recipients’ ability to accept the cells. Just yesterday the FDA had asked them for more information. They still had much to do.

  “Hopefully we’ll be ready soon. The research team is working round the clock to address the FDA requirements.” She didn’t mention it would take a miracle to get the packet back to the investigator by Monday.

  “We’ll make Patrick Patient 1.”

  The hope that flicked across Mrs. Robbins’s face threatened to be Caroline’s undoing. But she squared her shoulders and met Mr. Robbins’s gaze. “We’re still seeking approval for Phase 1 trials. Until we receive that, we can’t offer the trial or sign up Patient 1. Not yet, but hopefully soon.”

  Quentin stiffened but didn’t hesitate in his response. “That’s fine because we’ll have Patrick enter as part of the Phase 0 trial. He’s dying without treatment, so he will play an important part in telling us whether the treatment works like we anticipate.”

  “I don’t understand.” Mrs. Robbins leaned forward, desperation edging every line of her stiff body. “What do you mean by Phase 0?”

  “These are pre–Phase 1 small studies. Fewer than fifteen people, where we test whether the therapy has any intended benefits without negative toxicity.”

  She swallowed. “That sounds . . . bad.”

  “We would typically give Patrick and any other patients in Phase 0 a low dose of the treatment. We’ve got the paperwork well under way for Phase 1, but this would allow us to start treatment, albeit on a smaller level, earlier.” Quentin pointed at Patrick’s photo on the coffee table. “He may not have time to wait for Phase 1.”

  Mr. Robbins rubbed his hand on the back of his neck, then looked at his wife. “Do we have another option?”

  The desperation in her eyes pierced Caroline. “Please. We need hope.”

  Quentin leaned his elbows on his knees and clasped his hands under his chin. “I want to be very clear with you. This may sound callous, but Patrick will likely die without the therapy. The current standard of care is no better than what we can hope to accomplish. If it works, we’ll buy time to get him on a higher treatment plan.”

  Mrs. Robbins flinched at his words, but he plowed on. “My team has fully informed you both of the risks. If you give consent, Patrick is the perfect candidate to be Patient 1.” His calm smile seemed to reassure the couple. Mrs. Robbins relaxed and eased a bit away from her husband. “If necessary, I’ll fly a team to Mexico to administer the therapy, if we can’t get everything ready here in time. It will work because it has to and Patrick is out of options. This is his Hail Mary.”

  Caroline noted the phrase, the same one she’d heard Dr. Anna Johnson use in regard to Bethany. At the time she’d thought it was because Brandon was her audience. What else could you do when you were out of options besides heave the ball as hard as you could and pray for a miracle?

  Chapter 6

  “Alaina and I have accepted a job in Arkansas.”

  Jeff Stone stood with Brandon at the split-rail fence that surrounded the playground at Almost Home. Three of the boys who lived in the cottage Jeff and Alaina managed chased each other around the equipment in some high-energy form of tag. Bethany’s brother, Gabriel, seemed to be settling in as he tagged one of the others.

  Brandon shook his head slightly as if his ears needed clearing. “I don’t understand.”

  “We’re moving to a home in Arkansas.” Jeff turned to look at him, and Brandon saw the resolution in his gaze. “Especially since Ellie was born, we’re more than two young college grads saving the world one kid at a time. We have to think of our future.”

  “I need you here, making this work alongside me.”

  “I’m sorry, but we’ve waited as long as we can.” Jeff’s expression tightened as Luke picked up a stick. “Luke, be careful with that.” He returned his attention to Brandon. “Look, we believe in what you’re doing here, but chances are good you’ll lose state funds and have to shut down, and we can’t wait for that to happen.”

  “We aren’t going to close.”

  “You’ve fought to keep this model harder than anyone could ask.”

  Brandon exhaled then rubbed the back of his neck. Almost Home had been in tight spots before. There were times he’d been certain the rats had the right idea jumping overboard. Then Reid or someone would come alongside him with funding, and the organization would live for another year. The difference this time was that the organization’s future rested in the hands of lawmakers and regulators who couldn’t decide what they wanted.

  It should be a simple process. Read the new rules and spit out a perfectly formed plan, but every time he did, the proposed regs changed.

  “Look, Virginia is supposed to clarify the new regulations by the end of the summer. Then I can make some definitive plans.”

  Jeff sighed. “They’ve been telling you that for over a year.”

  Brandon felt the tension tighten his gut until the familiar surge of nausea welled up. So much rested on how Virginia interpreted and applied the federal law. He’d lived with the uncertainty, but it was plain he’d underestimated the effect on his employees.

  Wait a minute.

  “Is this place in Arkansas a group home?”

  “It is.”

  “How are they working around the new residential treatment requirements?” He’d been looking for a loophole—something that would allow him to keep sibling groups together while also providing the necessary trauma care. “I’ve thought about switching our model so my house parents like you and Alaina are the licensed foster parents. Then I’d ‘place’ the kids with you instead of Almost Home.”

  “That’s what they’re doing. Alaina and I will be licensed in Arkansas. But we’ll live on their property and rent our cottage for a nominal fee from the group care facility. In theory, it will operate like we do here, only the kids will be assigned to us rather than the larger home.”

  Brandon’s mind spun as he processed that information.

  “Who gets paid by the state?”

  “I’m guessing we do. Then it looks like we’ll pay the facility for the group meals, use of the facilities, things like that.”

  “If I committed to doing that here, would you stay?”

  “I don’t know, Brandon. If we pass on this opportunity—”

  “You and Alaina were the first couple to join me. It won’t be Almost Home without you.” He tried to do the math in his head but knew he’d have to dig deeper to see if he could actually make the numbers work. “Can you give me time?”

  “I’d have to talk to Alaina, get her buy-in.”

 
“Of course. Will you ask?”

  The man sighed, then nodded. “I’ll do that, but I’m not making any promises. Security is pretty important to her, even more so now that we have our own little girl.”

  Brandon clapped a hand on the smaller man’s shoulder. “I’m sorry I haven’t done a better job managing this. Give me at least a few weeks, okay?”

  “I’ll try, but we can’t put off accepting the offer for long.”

  “Thanks.” If needed Brandon would get down on his knees and beg. With thirty-six kids residing in the various cabins, he needed the Stones. He needed all the house parents. He felt a vibration and pulled out his phone.

  The hospital was calling.

  * * *

  If you want to break the law, it’s best to do it without an attorney looking over your shoulder.

  That was what Caroline’s professional responsibility professor had preached, but she didn’t think anyone at Praecursoria would agree with her that they edged close to that line. That didn’t stop fear and anger from coursing through her as she barely made it through the “priority” meeting—a departmental budget review she needn’t have attended after all—and returned to her office upset to have wasted precious time.

  They couldn’t give the Robbins family what Quentin had promised. How could he ignore how much trouble the company would be in if the FDA found out? The look in his eyes as she left his office indicated his displeasure that she hadn’t enthusiastically fallen in line, but that wasn’t what he’d hired her to do. Maybe this was why Reid and his group of investors had insisted the CEO hire in-house counsel.

  It would be a challenge, but she could stand firm.

  In class, ethical issues were always clear-cut and easy.

  You made the right choice, and the world kept spinning without a hiccup or bump. It sounded so much easier in a law school lecture.

  In reality . . .

  This felt like a moment in which her choices would set the course of who she was.

  As she slipped into her office her phone rang, and she scooped it from the corner of her desk. “Hello?”

  “Caroline?”

  At the mellow voice, her shoulders relaxed and she sank onto her leather chair. “Brandon.”

  “You okay? You sound . . .”

  “Flummoxed? Yeah, that’s me.”

  “So it’s a good thing I have lunch and am sitting in the parking lot?”

  She glanced at her exercise tracker. “Is it really eleven thirty? Wait. Did we have plans?”

  “I was in the area and thought I’d surprise you.” He hesitated. “A bad idea?”

  Her eyes teared up. “You have no idea how much I need a friendly face.”

  “You can explain why when you get out here. Grab your jacket and meet me at the picnic tables. The sun’s shining, and it sounds like you need vitamin D therapy.”

  Her lips curved into a smile, and she glanced at her computer. Everything could wait until after she spent time with Brandon Lancaster, the one she let into her heart and thoughts. “I’ll be out in a few minutes.”

  “Don’t wait too long. Your tomato soup will get cold.”

  “You had me at tomato.” Yep, her man had her grinning from ear to ear, all because he remembered that creamy tomato soup with Panera’s fresh croutons was her favorite comfort food. Funny how he knew she needed that today. Maybe she could bounce her predicament off him. The former football player had a clear head when it came to right and wrong.

  But this was about a company he’d invested in, so maybe she shouldn’t.

  As she pushed to her feet and swiveled to grab her leather jacket, there was a rap at her door. When she turned around, Quentin was already sitting in a chair in front of her desk. She eased back down. “Soup is waiting on me.”

  “I’ll keep this short.” He held his hands beneath his chin and studied her. “There’s something you need to understand. Something I explained during the interview, but today puts it in context. The protocols are why we exist. Yes, the FDA is important, but when we can try to save a life, we will. Work your legal magic and draft a waiver of some sort.” He waved his hand in the air as if she had one waiting on the computer. “You’re here to ensure what we do is legal and on the up-and-up.”

  “I’m not sure what you want to do for the Robbinses fits that criteria.”

  “Every law has a gray area. Find it, or this”—he gestured between them—“may not be a good fit.” He pushed to his feet. “The Robbinses will sign the release Monday morning. Put in plenty of language about them accepting the risk of treatment and that their son is terminal. Lillian has all the information you need.”

  Then he was gone.

  * * *

  Brandon cooled his heels at the picnic table for more than a few minutes. The steady hum of traffic on Virginia 123 robbed the setting of its pastoral effect. Little about Tysons Corner, the small area immediately outside the Beltway in Northern Virginia, felt planned. It was a crazy mix of government agencies, odd pockets of housing, and industry that had erupted over thirty years. Mix in the shopping center and strip malls and it was an odd conglomeration.

  Maybe this hadn’t been his best spontaneous idea. But after his conversation with Jeff, he’d needed to clear his head. Time in Caroline’s stabilizing presence was a good way to do that. When his world was upended, she could right it. He hoped she didn’t understand the power she wielded.

  All he knew for sure was he needed her, and if she distracted him, all the better.

  He hadn’t been kidding about the soup growing cold. Panera might be the way to her heart, but it was a simple fact that soup was better hot. If she took much longer, they’d have to hunt down a microwave.

  He glanced at his watch as a pair of Canada geese strutted past on their way to the retention pond. Where was she?

  He sighed as his thoughts returned to that meeting.

  He should know better than to believe he could share his burden with anyone else. Almost Home was his alone. A few of his guys tried to help, but if the Stones were ready to bail, he’d have to admit no one cared about it like he did. Maybe he should have listened to those who told him he was a fool to pour so much of his time and savings into Almost Home, but he knew better than most how critical the safe space was for kids in crisis.

  A door closed. He stood from the picnic bench and shoved his hands in his back pockets.

  Caroline looked frazzled and upset as she sprinted down the sidewalk in the ridiculous high heels she favored. One misstep and he’d be speared while she toppled on a busted ankle.

  “I am so sorry.” She emphasized each word in her southern accent. “What a day.”

  “Yeah.” She had no idea how much of a day. “What a week. I can leave if you need the time.”

  “No, I need this time with you even more than when you suggested it.” She gave him a quick side hug, and he tugged her around and closer even as he forced his thoughts to focus on what she said rather than the feel of her with him. She lingered in the circle of his arms a moment before she pushed back. He immediately felt the distance.

  “You’re here for a reason.” She focused the full wattage of her attention on him. “What’s up?”

  Such a simple question, loaded with meaning. Should he answer fully or stay on the white horse and pretend everything was okay? He didn’t know which he wanted more, but he hesitated before forging into the truth. “The Stones have an offer to leave Almost Home. They could be gone in weeks.”

  “Oh, Brandon.” She took his hand and sank onto the bench. “What can I do?”

  He plopped next to her. “Find the solution that puts us on solid ground in a week.” He pinched the bridge of his nose. “I can’t imagine the place without them. They were the first house parents I hired.”

  She looked at him, round eyes quizzical. “So talk them into staying.”

  “I’m trying, but Alaina wants security and I can’t promise that.” That was putting it mildly.

  She twirled
a strand of hair around her finger, then released it and grabbed another one. “So we look for a solution. Where are they going?”

  “Some place in Arkansas.”

  “Why there?”

  “The home seems to have found a way around the trauma-informed care requirement.”

  “That’s the part that says group homes have to be qualified treatment centers?”

  He nodded.

  “Adapt their model here.”

  “I’ll try, but I’m not sure I can do it fast enough to keep the Stones. This is my problem. It wasn’t fair to share it.”

  “Brandon, you have to accept we’re in life together. We share burdens so they aren’t as overwhelming.”

  “Hasn’t worked for me yet.” He groaned as her face blanched. “Sorry. That’s not what I meant. This has me all upside down. If they go, how will I keep the other couples?”

  She glanced at her hands as if collecting herself. When she looked up, the steel was back. “You’ll find a way. There has to be a solution. How is the Arkansas home doing it?”

  “It’s actually an idea I’ve been kicking around.” Might as well tell her his crazy idea. It was likely to be his last. “What if the house parents were licensed foster parents who rent the homes from me? They could rent them for free or a dollar? Something very nominal. Then we’re not technically a group home, but a place where independent foster parents happen to live together.”

  Caroline studied him for a minute, her face reflecting she was intrigued but thinking through his words. “Tell me more.”

  “I don’t have much. It’s only group homes that have to meet the residential treatment requirements. That prohibits me from focusing on the real needs of the kids at an individual level and requires me to give them all the same level of care.” He shrugged and infused confidence in his words. “But I think my idea would be good for the kids and fit the law.”