Broken

by Karin Slaughter

  Will slowed the car. Even without the rain, the street was still flooded. “Don’t they need Viagra to fund the cancer stuff?”

  “Last year, the top ten pharmaceutical companies spent seventy-three billion dollars on advertising and less than twenty-nine billion on research. Tell me where their focus is.”

  “Sounds like you know a lot about this.”

  “It’s a pet peeve of mine,” she admitted. “I never wanted free pens and notepads with drug logos on them. I wanted medication that worked and that my patients could afford.”

  Will stopped the car. “You know, I think I’m going the wrong way.”

  “It’s a circle.”

  He put the car in reverse, then made a wide U-turn. Sara knew exactly where they were. If they had gone a few yards farther down the street, they would’ve passed her old address.

  “So,” Will said. “How does it work? The drug company gets a new drug it wants to test, and then what?”

  She couldn’t think how to acknowledge his kindness, so she answered his question instead. “There are two types: drugs of affluence, or lifestyle, and drugs of need.” He gave her a look. “I’m not making that up. It’s Big Pharma’s designation. The need drugs are what we tested at Grady. They’re for serious or life-threatening illnesses, chronic diseases. Usually, universities and research hospitals handle need drugs.”

  He slowed the car again to navigate the deep water. “And affluence?”

  “Generally, that’s handled by your average everyday doctor or lab. There are all kinds of announcements in medical journals. What you’d do is petition to run a study. If you’re approved, the drug company sets you up and pays for everything. TV, radio, and print ads. File clerks and office furniture. Pens and paper. And then, when it’s over, they pay the doctor to fly around the world talking about how fabulous their new drug is, all the while insisting that he’s incorruptible because he doesn’t own stock in the company.” She thought about Elliot and his Thanksgiving vacation. “That’s where the real money is. Not the stock, but the expertise. If you’re involved in an early phase of a study, you can make hundreds of thousands of dollars just by opening your mouth.”

  “So, why wouldn’t a doctor want to do this if it’s so much money?”

  “Because if you do it right, there’s not a lot of money in it. I mean, yes, you make money, but you’re doing paperwork, not medicine. We all know it’s a necessary evil, but it can be a really bad side of the business. Some doctors set up research mills. The drug reps call them ‘high-end rollers,’ just like in Vegas. Their clinics can have fifty different studies going on at the same time. There are a handful in downtown Atlanta, conveniently near the homeless shelter.”

  “I bet there are a lot of students at the college who are looking to make some fast money.”

  “Some of my indigent patients enroll in study after study. It’s the only thing that keeps them from starving. But it’s big business if you work it right. There are websites for professional guinea pigs. They fly around the country raking in sixty, eighty grand a year.”

  “The doctors don’t track the patients to make sure they’re not gaming the system?”

  “All you have to show is your license, sometimes not even that. They stick your name in a file. From then on, you’re a number. Everything they collect on you is self-reported. You can tell them you’re a stockbroker with insomnia and acid reflux when you’re really a homeless wino looking for pocket money. They’re not running background checks. There’s no central database of names.”

  “So, Tommy answers an ad and tries to enroll in one of these trials. Then what?”

  “They would screen him both medically and psychologically. There’s different criteria for each study, and each participant has to meet the guidelines, or protocols. If you’re really smart, you can fudge your way onto a study.”

  “Tommy wasn’t really smart.”

  “No, and he wouldn’t have passed the psych evaluation if it was properly administered.”

  “Wouldn’t the doctor be in charge of that?”

  “Maybe, maybe not. There are good doctors out there who do it right, but the bad doctors never see the trial participants. They’re just paperwork that has to be signed off on. They usually go in on a Sunday and ‘review’ all three hundred cases before the enforcement rep gets there Monday morning.”

  “Who takes care of everything then, nurses?”

  “Sometimes, but it’s not required that they have any medical training. There are CROs, Clinical Research Organizations, that offer temp staffing for doctors running studies. At least they have some training. There was a doctor in Texas who had his wife doing everything. She accidentally switched the trial drug with medication for her dog. One doctor had his mistress in charge. She told the participants to double up on missed doses and half of them ended up with permanent liver damage.”

  “Okay, so Tommy makes it through the psych evaluation. Then what?”

  “He goes through the medical workup. He was healthy; I’m sure he passed that. Next, he gets the pills. He has to keep his journal. He goes in to give blood and urine or just to check in, probably once a week. The person who talks to him takes his journal and her report, what’s called source notes, then enters them into the case report. The doctor only sees the case report.”

  “Where would the system break down?”

  “Exactly where you said. Tommy obviously had a reaction to the medication. He was getting into arguments with people, which we know from the police incident reports. His altered mood would have shown up in his journal. Whoever interviewed him during his office visits would immediately know something was wrong.”

  “And if this person wanted to hide the fact that Tommy was in trouble?”

  “They could lie on the case report form. It’s entered into the computer and transmitted directly to the drug company. No one would know anything was wrong unless they compared it to the source material, which gets boxed and put into storage as soon as the study ends.”

  “Would it ruin the study if Tommy was wigging out?”

  “Not necessarily. The doctor could classify him as a protocol violation. That means he doesn’t meet the guidelines for being enrolled in the study. Which, with his disability, he didn’t belong in anyway.”

  “What about Allison?”

  “Her suicide attempt should’ve exempted her, but if she didn’t self-report, they wouldn’t know.”

  “Who gets in trouble for Tommy being enrolled in the study?”

  “No one, really. You can always plead ignorance to the ethics committee. By law, every study has to have an internal review board that’s in charge of maintaining ethical standards. They’re comprised of people from the community. Doctors, lawyers, local businessmen. And always a priest or a minister, for some reason.”

  “The ethics committee gets paid by the drug company, too?”

  “Everybody gets paid by the drug company.”

  “What about Tommy? When does he get his money?”

  “At the end of the study. If they paid them ahead of time, most of them wouldn’t come back.”

  “So, if the trial was nearing the end, then Tommy had a payday coming. And Allison, too. Maybe Jason Howell.”

  Sara didn’t want to think about who had the biggest money motivation in this sordid mess. “For a three-month trial, it wouldn’t be out of the question that they would each be looking at around two to five thousand dollars for their participation.”

  Will pulled into the parking lot of the clinic. He put the gear in park. “So, where’s the problem? We’ve got doctors making lots of money. Participants getting paid. Tommy shouldn’t have been in the study but it’s not like he was going to bring the whole thing down. Why would anyone kill two people over this?”

  “The key is going to be finding out how many more participants were experiencing mood alterations like Tommy. Allison was depressed. You can read that in her journal. Tommy was acting out lately, getting into
arguments when he never had before. He killed himself in jail. I don’t want to let Lena off the hook, but he could’ve been suicidal from the medication. In a study, if you get clusters of adverse events, it’s immediately shut down.”

  “So, it would be in the doctor’s best interest not to have one of these adverse clusters. Not if he stood to make a lot of money on the trial.”

  Sara pursed her lips, thinking of Hare. “Right.”

  She stared out the window at the clinic. The front door was illuminated by the headlights. She could see the familiar layout of the lobby.

  Will got out of the car and walked around to get the door for her. “I probably shouldn’t go inside with you. I know you’re the rightful owner and I’ve got your permission and all that, but the law is very strict about me looking through medical records. You’re going to have to play the concerned citizen and tell me what you find.”

  “It’s a deal,” she agreed, though it occurred to her that he wouldn’t be much help reading the records anyway.

  Sara walked to the front door with her keys in her hand. She couldn’t remember the last time she had been inside the building, but she didn’t have time to reflect. Just as she slid the key into the lock, she turned toward the police station. The movement was natural, something she had done every morning because Jeffrey usually waited across the street to make sure she got safely inside.

  The streetlights were bright, the night air crisp, finally clear of rain. She saw a shadow standing by the window to Jeffrey’s office. The man turned. Sara gasped. Her knees started to give.

  Will got out of the car. “Sara?”

  She ran without thinking, pushing past Will, going down the hill toward the station. “Jeffrey!” she screamed, knowing it was him. His broad shoulders. His dark hair. The way he walked like a lion ready to pounce. “Jeffrey!” She stumbled as she reached the parking lot. The asphalt ripped her jeans. Her palms were scraped.

  “Aunt Sara?” Jared jogged toward her with his father’s easy gait. He knelt in front of her, hands on her shoulders. “Are you okay?”

  “I thought you were—” She put her hand to Jared’s face. “You look—” She threw her arms around his shoulders and pulled him as close as she could. Sara couldn’t help herself. She wept like a child. All the memories she had kept at bay for so long came flooding back. It was almost too much to bear.

  Jared rubbed her back, soothing her. “It’s all right,” he whispered. “It’s just me.”

  His father’s voice. Sara wanted to close her eyes and pretend. To lose herself completely. How many times had she stood in this parking lot with Jeffrey? How many mornings had they driven to work together, kissed each other goodbye in this very parking lot? And then he would stand at the door to the station, watching her make her way up the hill, checking to see that she got inside safely. Sometimes, she could feel his eyes following her, and it took everything Sara had not to run back across the street for another kiss.

  Jared asked, “Are you all right?” There was a tremor in his tone. She was scaring him. “Aunt Sara?”

  “I’m sorry.” She dropped her hands into her lap. She didn’t know why she was apologizing, but she kept repeating the words. “I’m so sorry.”

  “It’s all right.”

  “I thought you were—” She couldn’t finish the sentence. Couldn’t say his father’s name.

  Jared helped her stand up. “Mama says I look just like him.”

  Sara couldn’t stop the tears streaming down her face. “When did you find out?”

  “It’s kind of hard to hide.”

  She laughed, the sound high-pitched and desperate in her ears. “What are you doing here?”

  He glanced at Will. Sara hadn’t noticed him walk up. He stood a few feet away, obviously trying not to intrude. She told him, “This is …” She forced herself to say the name. “This is Jeffrey’s son, Jared Long. Jared, this is Will.”

  Will’s hands were shoved deep in his pockets. He nodded at the boy. “Jared.”

  “Why are you here?” Sara asked. “Is it because of Frank?”

  Jared scratched his eyebrow with his thumb and forefinger. Sara had seen Jeffrey make the same gesture countless times. It meant he was upset, but didn’t quite know how to talk about it. Jared looked at Will again. There was something going on between them that Sara couldn’t follow.

  She repeated her question. “Why are you here?”

  Jared’s voice cracked. “Her car is here. I don’t know where she is.”

  “Who?” Sara asked, but she already knew the answer. Lena’s Celica was still in the lot.

  “She was supposed to be home six hours ago.” He directed his words to Will. “I’ve been to the hospital. I tried to get in touch with Frank. I can’t find anybody who knows where she is.”

  “No,” Sara breathed.

  “Aunt Sara—” Jared reached for her but she put her hand flat to his chest, holding him back.

  “You can’t be seeing her.”

  “It’s not what you think.”

  “I don’t care. It’s wrong.”

  He reached for her again. “Aunt Sara—”

  She stepped back, stumbling into Will. “You can’t do this.”

  “It’s not what you think.”

  “Not what I think?” she demanded, her voice rising in anger. “What am I thinking, Jared? That you’re sleeping with the woman who murdered your father?”

  “It’s not like—”

  Will grabbed Sara by her waist as she lunged at Jared. “She killed him!” Sara screamed, pushing Will away. “She killed your father!”

  “He killed himself!”

  She raised her hand to slap his face. Jared stood absolutely still, facing her, waiting for the blow. For her part, Sara felt frozen. She couldn’t strike him, but she couldn’t drop her hand, either. It divided the air between them like a knife waiting to fall.

  “He was a cop,” Jared said. “He knew what the dangers were.”

  She dropped her hand, because now she really wanted to hurt him. “Is that what she told you?”

  “It’s what I know, Aunt Sara. My father loved being a cop. He was doing his job, and it got him killed.”

  “You don’t know who she really is. You’re too young to understand what she’s capable of.”

  “I’m not too young to know I love her.”

  His words were like a punch to her chest. “She killed him,” Sara whispered. “You don’t know what she took from me. From you.”

  “I know more than you think.”

  “No, you don’t.”

  Jared’s voice turned sharp. “He was doing his job, and he pissed off the wrong people, and nobody could’ve stopped him. Not you, not Lena, not me, not anybody. He made his own decisions. He was his own man. And he was stubborn as hell. Once he made up his mind, there was no talking him out of doing exactly what he wanted to do.”

  Sara didn’t realize she was backing up until she felt Will behind her. She gripped his arm, forcing herself not to falter. “She’s twisted the story to fool you into feeling sorry for her.”

  “That’s not how it is.”

  “She’s a master at manipulating people. You can’t see that now, but it’s true.”

  “Stop saying that.” Jared tried to take her hand. “I love her. And Jeffrey loved her, too.”

  Sara couldn’t speak to him anymore. She couldn’t be here. She turned into Will, burying her head in his chest. “Get me out of here. Please, just take me home.”

  Jared said, “You can’t leave. I need your help.”

  Will kept his arm around Sara as he guided her across the street.

  Jared jogged to keep up. “You’ve gotta help me find her. I don’t know where she is.”

  Will’s voice was hard. “You need to move on, son.”

  “Somebody sliced her tires. She’s not answering her cell phone.”

  Will kept his arm around Sara, helping her up the hill. She looked down at the grass on the front l
awn. The roots had been washed out. Clumps of mud slipped beneath her shoes.

  Jared said, “She called me on her cell at six o’clock. She said she’d be home in an hour.” He tried to block their path, but Will swept him away with one hand. “She quit her job!” he screamed. “She told me she quit!”

  They had reached the clinic parking lot. Will opened the car door and helped Sara inside.

  Jared slammed his hand on the hood. “Come on! She’s missing! Something’s wrong!” He rushed around the car and got on his knees in front of the open door. His hands pressed together as if in prayer. “Please, Aunt Sara. Please. You’ve got to help me find her. Something’s wrong. I know something’s wrong.”

  There was so much anguish in his face that Sara felt herself falter. She looked at Will, saw the concern in his expression.

  His voice was low, steady, when he told her, “She hasn’t checked in with me.”

  Jared was crying. “Please, just check the clinic for me. I know her hand was hurting her this morning. Maybe she went for help. Maybe she fell down or she’s sick or—”

  Sara closed her eyes for a moment, trying to separate her emotions. She wanted so badly to leave, to never hear the name Lena Adams again as long as she lived.

  Will said, “Sara.” Not a question, more like an admission of guilt.

  “Go,” she told him. There was no use fighting it.

  Will cupped his hand to her face so she would look at him. “I’ll be right back, okay? I’m just going to check the clinic for him.”

  Sara didn’t respond. He closed the car door and she leaned back in the seat. The engine was off now, but the moon was so bright in the sky that she didn’t need the headlights to see the two men at the front door of the clinic. Lena didn’t even have to be present to control the men in her life. She was like a succubus, her siren song clouding their logic.

  Will glanced at Sara as he turned the key in the lock. She studied Jared with some detachment. He was thinner than his father. His shoulders hadn’t filled out. His hair was longer than Jeffrey had kept it, more the length he’d worn in high school. An image flashed in her head: Lena’s hand gripping Jared’s hair. She had taken everything now. Her path of destruction had ripped through every part of Jeffrey’s legacy.