“I do.” She approached the table and smiled at the Robbinses. “I’ll walk through the form with you. I haven’t made any changes from the draft you picked up this weekend. Did you review it with an attorney?”
Michael Robbins nodded. “He made time for us Saturday. Told us it looked good.” He rubbed his hands down his pant legs as if his palms were slick with sweat. Then he looked at his wife and they seemed to communicate without saying a word. Then he nodded. “We’re ready to sign.”
Caroline looked at Mary. “Do you agree? You have to each agree that this is best for Patrick and that you are giving informed consent. If you have any concerns, don’t sign.”
The woman gave a couple of tiny nods like a miniature bobblehead. “I think I’m ready.”
“You can’t think you are.” Caroline glanced at Quentin. “You have to know this is the right thing to do. Once you sign, the court will look only at this.”
Samson cleared his throat and made a small “get on with it” motion with his finger.
Caroline licked her lips and forced a smile. She hadn’t had butterflies like this since her first telephonic hearing at the court. “All right. Let’s go through this paragraph by paragraph. Dr. Kleme is here to answer any medical or study questions you have. I’ll try to explain the legal aspects, but if you have any concerns you’ll want to consult your attorney again.”
And then it was signed, and she prayed that this would be the answer that Patrick needed.
* * *
Thursday, April 29
It made no sense. Bethany had been running a fever all week—not a good sign for a terminally ill girl with no functioning immune system.
As she stood beside Bethany’s bed, watching the small girl sleep, Anna wished Sarah were here. Together they would get to the bottom of this crisis immediately, as they had with a half dozen earlier trials. The mix of lab and application had created a partnership she missed.
She felt the loss of her friend deeply.
The T cells Anna had returned to Bethany came from Bethany’s body. If the process of converting her T cells to CAR T cells had been done properly, her body wouldn’t reject them. The magic of CAR T-cell therapy was that rejection shouldn’t happen. At the same time, a certain amount of rejection meant she had a functioning immune system. The challenge for Anna was detecting whether the balance was right.
The research from similar trials showed rejection did happen in a handful of cases. And it seemed to be what was happening in Bethany.
But there was also noise in the data. Numbers in Bethany’s lab work that didn’t compute.
Anna should set up a meeting with Brian Silver to sort out what she was seeing.
Anna’s hand absently trailed to her stomach, where she rubbed the bump that protected the life growing inside.
Maybe Brad had been right. Her late husband had encouraged her to move away from overseeing trials and focus on building a practice. He’d served in the National Guard and was killed in a training accident, upending her world—especially now that baby Jilly was on the way. A shift to private practice might be essential if she wanted a more manageable life when Jilly arrived. Her baby was due in two months.
How was it possible her life had changed so much in such a short time?
She missed Brad. So much. The thought of raising their daughter without him was daunting. It wasn’t the way this part of their life was supposed to happen. It should have been a partnership. But as with so much of life, the should bowed to reality. Their fairy tale had ended abruptly.
She wiped under her eyes and refocused on the monitors.
There was so much work.
Anna moved to the computer. Her fingers started clicking against the keys, forming a search string without conscious thought. There was an explanation for this nonsensical data, and she wanted a working theory before she talked to Brian. If she could figure out what it was, maybe Bethany still had a chance.
* * *
Friday, April 30
The tap at her door jolted Caroline from the patent application she’d been reading. Her head tilted and she smiled slightly at the sight of the woman in the doorway. “Anna. Can I help you?”
The doctor smiled as she shoved her hands in her pockets. “I wondered if you had time to grab coffee. I met with Samson and Brian, and we got done early.”
“Let me check.” Caroline glanced at her calendar, which had a clear slot after a week of meetings. “Spontaneous works. Want me to drive?”
“I’ll need to head back to the hospital for evening rounds.” The woman smiled and stepped backward into the hall. “Does the Sheepdog work for you? It’s a cute coffee shop not far from here.”
“I love the coffee there.” Caroline stood and collected her purse. “How much time do you have before rounds?”
“A couple hours. Plenty of time to grab a cup and then wind through traffic.” She hitched her purse higher on her shoulder. “How’s Brandon doing?”
“You’ve probably seen him since I have.” Caroline closed her door firmly, then started down the hallway. They hadn’t had more than a couple minutes to chat since the weekend. He was head down working on the new business structure, while she’d spent evenings reading files.
“Only because Bethany is my patient. Otherwise we go months between catching up.”
“And you think I’d know?”
“I’ve noticed the way he looks at you.” Her smile held a teasing edge.
Caroline laughed as they walked down the hallway. “Is this an interrogation, because if it is, I can cut it off. We’re still pretty new into our relationship.”
The woman chuckled, and it was a pleasant sound, warm and tinged with good humor. “I know Brandon better than that.”
“Don’t jinx anything for goodness’ sake. He’s one of my best friends.”
“He’s good at that.”
“What do you mean?”
“He holds people only so close and no closer. I can understand why, but I’m glad I’ve met the woman who crashed through his barriers.”
Caroline swallowed hard as the words ricocheted inside. “I think I would like to be that for him, but we have some living to do first.”
“Don’t be so sure. My parents were friends through college. When they decided to date, it only took five months for my father to propose.”
“Wow. I guess the friendship accelerated the courtship.”
“Sure did, and it cemented their love. They’ve been married thirty-five years.”
They sidestepped a clutch of researchers who were huddled around a tablet of some sort. Caroline gestured down a hallway. “I’m parked this way. Meet you there?”
“Sure.”
As the doctor continued toward the lobby, Caroline pondered Anna’s comments. In some ways it was hard to imagine things between her and Brandon could move that quickly. At the same time, they had the benefit of years of friendship.
When she reached the coffee shop, she placed an order for a basic Americano rather than another macchiato, then found a table tucked in a corner.
“You look serious.”
Caroline startled as she looked up into Anna’s face. “Sorry about that.”
“Everything okay?”
“Yes.” The barista called her name, so Caroline pushed to her feet. “Have you already ordered?”
“I did.”
Soon they both had steaming mugs, and Caroline doctored her Americano with a packet of raw sugar and dollop of cream. Each mug was the creation of a local artist, giving them a unique and artistic flair.
Anna took a cautious sip of her tea, then set the mug back down on the table. “Thank you for meeting.”
“Sure. I’m always up for coffee. You can give me a download on Brandon, right? Something to keep in reserve if I ever need ammunition?”
Anna grimaced and looked everywhere but at Caroline. “We didn’t spend much time together as kids thanks to my dad’s work with the military. He had us moving all o
ver the world. Mom even lost track of Brandon’s mom for a while before she died.” She blinked away a flash of sadness. She toyed with the edge of the mug, running a finger along the top, then took another sip. “I’ve worked to reconnect with him. He’s such a good guy, but life hasn’t been easy for him.” She cleared her throat. “How are you settling in at Praecursoria?”
Caroline accepted the change of topic. “Well, I think. I have to keep reminding myself this is only my second week.”
“Is Quentin letting you do your job?”
“He’s quick to share his opinions about what he thinks the law should be. Then I remind him what it actually is. We’re hitting our stride.”
“He needs someone like you.”
“Why do you say that?”
The woman smiled as she raised and dropped a shoulder. “He’s a force to be reckoned with, so many don’t even try. I get the sense you have the backbone to take him on. He won’t like it, but he needs you.”
“Sounds like you know him well.”
“I suppose I do.” Her gaze drifted off as her hand went to her swollen stomach and rubbed in a slow circular motion.
“Is everything okay, Anna? I don’t know you well, but if there’s anything I can do or anything you need, please let me know.”
“I’m fine. Just tired.” She sighed. “I never imagined raising a child alone.” She cleared her throat. “I’ll just blame it on the hormones.” The woman met Caroline’s gaze with an earnest expression in her eyes. “The job’ll get better as you make the transition. My meeting left me with more questions than answers. I guess you could say my mind is a jumbled mess right now.”
Caroline took a sip of her coffee to create space for Anna to share more if she wanted.
Anna pushed her tea toward the middle of the table. “Did you know Sarah Hill and I worked together?” Anna continued without waiting for an answer. “We interned at Praecursoria, and when I went to medical school, she stayed. She had a brilliant mind. She could sit and imagine what might be possible. Science fiction–type things. When she died, medicine lost a beautiful mind. And I lost a longtime friend.” She rubbed her thumbs under her eyes. “In addition to losing my husband, Brad, it’s a lot to process.”
Caroline reached across the table and touched Anna’s arm. “I’m so sorry. You have so much to grieve. What happened to your husband?”
“Killed in a training accident. He was in the reserves, but I expected him to be safe here in the States. Sarah’s death seems to have been my tipping point. That combined with this pregnancy is making me crazy emotionally. I’m sorry.”
“Please don’t apologize.”
Anna took a gulp of her tea and grimaced. “Should have sipped. I’m also concerned about Bethany. I’ve monitored her closely. I always do when a patient receives an infusion of T cells. I’m still investigating, but I think it means her body doesn’t think the CAR T cells are hers. I think her body may be rejecting them.”
Caroline pictured the girl and the way Brandon had interacted with her. “Is there anything I can do to help?”
“Listening helps because I don’t have Sarah to talk it through. I’m going in circles in my mind.” Anna leaned back and her shoulders slumped as if pressed down by a weight. “How is Patient 1?” Caroline’s face must have been blank, because Anna’s voice became more insistent. “Patrick Robbins.”
“Oh, right.” Caroline turned her mug another quarter. “I don’t know. What y’all do is still far beyond my knowledge. You should ask Samson or Brian since they’re overseeing his case.” At least she thought that’s who would be overseeing his care.
“Sarah was very excited about studying Patrick.” Anna glanced away. “She said there was something very special about that boy and was upset that he wasn’t added to a trial sooner.”
“Added sooner? He felt rushed to me. I didn’t realize she worked with him.”
Anna shrugged and took a sip of her drink. “I don’t know.”
Caroline frowned and crossed her arms. “How did she meet him? She passed away before the Robbins met with Quentin.” She shook her head. “No, that’s not right. Quentin mentioned he’d come in for preliminary testing a few months ago.”
“Exactly.”
“Sarah did that?”
“I think she’s why Quentin was so confident the study would work for Patrick. She fell in love with him and wanted to help.” She rubbed her forehead with one hand as if pushing back a headache. “She said he was the perfect candidate for many reasons.”
“We got the approval to begin the trial this morning.” It had taken hours, a meeting, and several phone calls over the week to make it happen.
“Good.” Anna blew on her mug and took a sip of tea before she continued. “Sarah would be glad.”
“Brian Silver seems to be doing a good job continuing her work.”
“He’s the lead on Trial CAR T 463.” She pulled her lower lip between her teeth, worry etched in the sudden lines on her face.
“So what do you want to know, Anna?”
Caroline’s question seemed to catch Anna by surprise as she glanced around the coffee shop. “How much do you know about the therapy we’re testing?”
“More than what you told me. This treatment with the CAR T cells is the Hail Mary for kids like Bethany who’ve had failed bone marrow transplants. This is the last-chance treatment for patients because it’s at the frontier of research.”
“There aren’t many studies like this, and they’re limited to cancers like ALL.”
“You’ll have to spell that out for me.”
“Acute lymphoblastic leukemia. Cancer of the blood.” Anna sighed. “Cases like Bethany’s push me to the limits of my knowledge and require us to explore the boundaries of current medicine.” A shadow darkened her features as if she was remembering those she hadn’t been able to save. “This first month is critical. If she survives that, then she’ll have a chance, but this fever lowers her odds dramatically. Something is wrong, but I can’t figure out what.”
“So why talk to me about it? Why ask about Patrick Robbins?”
“Because you’re in Praecursoria, but you’re new. And because Patrick was all Sarah wanted to talk about the last time we got together. She said he was going to push the limits of science.”
“What does that mean?”
“I don’t know.” She worried her lower lip between her teeth. “But I have a feeling it has something to do with Bethany fighting the CAR T cells.”
The moon glimmered on the retention pond’s surface as he walked toward it. His dog, Patches, tugged on the leash, wanting to sniff every blade of grass and squat at each tree, but he needed to keep moving. The gun weighed down his jacket pocket.
It had been easy, too easy really, to make it look like a suicide. He’d shown up unannounced to talk, and she’d foolishly let him in. While she had her back turned, he’d slipped a drug into her drink. Working for a pharmaceutical company had its advantages. Then it was a matter of waiting for the drug to take effect.
She’d tried to call the police, but the gun had stopped her cold.
He’d seen the moment she realized her fate.
Like the coward she was, she stopped fighting and waited.
He’d placed the gun to her head.
Watched the fear flare her nostrils and widen her eyes.
Then he’d laughed, forced her to finish the drugged drink, and waited until she was gone. Then he’d grabbed his gun and left.
No one was saying suicide, at least not yet, but one well-placed comment would get the rumor mill operating.
The whole mess could have been avoided.
Sarah could have ensured he was on the patent application and didn’t. Of course when he brought it to her attention and exposed her betrayal, she’d told him it was a mistake, one she’d refused to fix.
Patches pulled against the leash until they reached the edge of the water. A light breeze furled the surface, creating miniature waves that
lapped at Patches’ paws.
If it had been that easy to take care of one enemy, maybe he should consider the same for Quentin Jackson.
No, that man’s death would come in the form of his precious company.
He pulled the gun from his pocket, felt its heft in his palm, then hurled it across the surface as if skipping a rock.
Praecursoria gave the CEO the illusion that he could be a savior to many. In reality Jackson was nothing without him. He was the brains of the operation. It was his mind that found novel solutions for every problem.
All his efforts were for nothing but turning him into a pansy for the rich boy one more time. Forcing him to do Jackson’s homework through college hadn’t been enough. Jackson kept the facade going even now, years after.
Shame on him for putting himself in a position to give Jackson this kind of power over his future.
Well, it ended now.
He turned and started the walk back to his house. Even if someone found the gun, they wouldn’t connect it to him. Not when he lived three subdivisions over. Thanks to his hyperactive dog, he knew the area well enough to use the trails, but not well enough to be recognized.
He hadn’t even had to fire the gun.
There was nothing to tie him to the gun or the suicide.
He took a deep breath.
Having control felt good.
By the time he moved a few more pieces on the chessboard, Jackson would be begging him for help. Only this time he would be the one with the influence. All Jackson’s money wouldn’t matter when he finished with Praecursoria.
Jackson would be blackballed and his company would be in ruins.
Chapter 11
Friday, May 14
Three weeks passed in a blur as Caroline managed a half dozen patent applications and the legal side of FDA trials, and participated in leadership meetings with Quentin, Samson Kleme, and Hannah Newton, who oversaw HR and other company resources. Caroline was finding a rhythm to her days, as well as a better commute while slowly building friendships at work. When she arrived at her office Friday morning, she paused.
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