Fever (20 page)

“We already know what you discovered about the toxicity of Canceran,” said Dr. Ibanez, taking a short puff on his cigar and unknowingly undermining Charles. “We realize that Dr. Brighton's estimates are not entirely accurate.”

“That's a generous way of putting it,” said Charles, realizing with dismay that his trump card had been snatched from him. “Apparently all the data in the Canceran studies done by Dr. Brighton has been falsified.” He watched the reaction of the Weinburgers out of the corners of his eyes, hoping for a response but seeing none.

“Most unfortunate,” agreed Dr. Ibanez. “The solution is salvaging what we can and going forward.”

“But my estimates suggest the drug is extremely toxic,” said Charles desperately, “so toxic, in fact, that it might have to be given in homeopathic doses.”

“That's not our concern,” said Joshua Weinburger, Jr. “That's a marketing problem, and that's the one department at Lesley Pharmaceuticals that is outstanding. They could sell ice to Eskimos.”

Charles was dumbfounded. There wasn't even the pretense of ethicality. Whether the product would help people made no difference. It was business—big business.

“Charles!” said Dr. Morrison, speaking for the first time. “We want to ask if you could run the efficacy and toxicity studies concurrently.”

Charles switched his gaze to Dr. Morrison and stared at him with contempt. “That kind of approach would be reducing inductive research to pure empiricism.”

“We don't care what you call it,” said Dr. Ibanez with a smile. “We just want to know if it could be done.”

Joshua Weinburger, Sr. laughed. He liked aggressive people and aggressive ideas.

“And we don't care how many test animals you use,” said Morrison generously.

“That's right,” agreed Dr. Ibanez. “Although we'd recommend you use mice since they're considerably cheaper, you can use as many as you'd like. What we're suggesting is doing efficacy studies at a very wide range of dosages. At the conclusion of the experiment, new toxicity values could be extrapolated and then substituted for the falsified data in the original toxicity study done by Dr. Brighton. Simple as that, and we'd save lots of time! What do you say, Charles?”

“Before you answer,” said Morrison, “I think I should warn you that if you refuse, it will be in the best interests of the institute to let you go and seek someone who will give Canceran the attention it deserves.”

Charles looked from face to face. His fear and panic had disappeared. Anger and contempt remained. “Where are my lab books?” he asked with a tired voice.

“Safe and sound in the vault,” said Dr. Ibanez. “They are the property of the institute but you will get them back as soon as you finish Canceran. You see, we want you to concentrate
on Canceran and we feel that having your own books might be too much of a temptation.”

“We can't emphasize enough the need for speed,” added Joshua Weinburger, Jr. “But as an added incentive, if you can have a preliminary study done in five months, we'll give you a bonus of ten thousand dollars.”

“I'd say that is very generous,” said Dr. Ibanez. “But you don't have to decide right this moment. In fact, we have agreed to give you twenty-four hours. We don't want you to feel coerced. But just so you know, we will be making preliminary inquiries into finding your replacement. Until then, Dr. Charles Martel.”

With disgust, Charles whirled and headed for the door. As he reached it, Dr. Ibanez called out: “One other thing. The board of directors and the administration want to convey their condolences regarding your daughter. We hope she recovers quickly. The Institute health plan, by the way, only holds while you are actively employed. Good day, doctor.”

Charles wanted to scream. Instead he ran the length of the administrative department and thundered down the metal fire stairs to his office, but once there, he didn't know whether he wanted to stay. For the first time he felt that being part of the Weinburger Institute was a disgrace. He hated the fact that they even knew about Michelle. On top of that they were using Michelle's illness as leverage against him. It was an outrage. God!

He looked around his laboratory, his home for the last eight years. He felt as if he knew every piece of glassware, each instrument, every bottle of reagent. It didn't seem fair that he could be rudely plucked from this environment at whim, especially now that he was making such progress.

His eye fell on the culture he'd set up with Michelle's leukemia cells. With great effort he went over to the incubator, peering in at the rows of carefully arranged glass tubes. It appeared to be progressing well, and Charles felt a much-needed sense of satisfaction. As far as he could tell, his progress of isolating and augmenting a cancer antigen seemed to
work as well with human cells as it did with animal cells. Since it was already time for the next step, Charles rolled up his sleeves and tucked his tie inside his shirt. Work was Charles's anesthetic and he bent to the task. After all, he had twenty-four hours before he'd have to bow to the demands of the administration. He knew but did not want to admit to himself that he had to give in for Michelle's sake. He really had no choice.

C
oming back from Beth Israel Hospital where she'd paid an unsuccessful visit to Marge Schonhauser, Cathryn felt she was being stretched to the limits of her endurance. She'd guessed that Marge must have been bad off or she wouldn't have been hospitalized, but she was still not prepared for what she found. Apparently some vital thread had snapped in Marge's brain when Tad had died, because she had sunk into an unresponsive torpor, refusing to eat or even sleep. Cathryn had sat with Marge in silence until a feeling of tension drove Cathryn away. It was as if Marge's depression were infectious. Cathryn fled back to Pediatric Hospital, going from the casualty of one tragedy to the beginning of another.

Rising in the crowded elevator to Anderson 6, she wondered if what happened to Marge could happen to her or even to Charles. He was a physician and she would have guessed he'd be more capable of dealing with this kind of reality, yet his behavior was far from reassuring. As difficult as she found hospitals and illness, Cathryn tried to gird herself against the future.

The elevator arrived at Anderson 6 and Cathryn struggled
to reach the front of the car before the doors closed. She was impatient to get back to Michelle, because the child had been very reluctant to let Cathryn leave. Cathryn had talked Michelle into letting her go after lunch by promising she'd be back in half an hour. Unfortunately it was now closer to an hour.

Michelle had clung to Cathryn earlier that morning after Charles had left, insisting that Charles was angry with her. No matter what Cathryn had said, she'd not been able to change Michelle's mind.

Now Cathryn pushed open Michelle's door, hoping the child might be napping. At first she thought perhaps she was, because Michelle didn't move. But then Cathryn noticed the child had kicked off the covers and slid down in the bed with one leg tucked under her. From the doorway Cathryn could see that Michelle's chest was heaving violently and worst of all, her face had an alarmingly bluish cast with deep maroon-colored lips.

Rushing to the bedside, Cathryn grasped Michelle by the shoulders.

“Michelle,” she cried, shaking the child. “What's wrong?”

Michelle's lips moved and her lids fluttered open but only whites showed; her eyes were rolled up in their sockets.

“Help!” cried Cathryn, running for the corridor. “Help!”

The charge nurse came from behind the nurses' station followed by an LPN. From a room beyond Michelle's came another RN. They all rapidly converged on Michelle's room, pushing past the panic-stricken Cathryn. One went to either side of the bed, another to the foot.

“Call a code,” barked the charge nurse.

The nurse at the foot of the bed sped over to the intercom and yelled for the clerk at the nurses' station to call a code.

Meanwhile the charge nurse could feel a rapid, thready pulse. “Feels like V-tack,” she said. “Her heart's beating so fast it's hard to feel individual beats.”

“I agree,” said the other nurse, putting the blood pressure cuff around Michelle's arm.

“She's breathing but cyanotic,” said the charge nurse. “Should I give her mouth-to-mouth?”

“I don't know,” said the second nurse, pumping up the blood pressure cuff. “Maybe it would help the cyanosis.”

The third nurse came back to the bed and straightened out Michelle's leg while the charge nurse bent over and, squeezing Michelle's nose shut, placed her mouth over Michelle's and blew.

“I can get a blood pressure,” said the second nurse. “Sixty over forty, but it's variable.”

The charge nurse continued to breathe for Michelle but Michelle's own rapid respiration made it difficult. The nurse straightened up. “I think I'm hindering her more than helping her. I'd better hold off.”

Cathryn remained pressed against the wall, terrorized by the scene in front of her, afraid to move lest she be in the way. She had no idea what was happening although she knew it was bad. Where was Charles!

A woman resident was the first doctor to arrive. She came through from the hallway so quickly that she had to grab the edge of the door to keep from falling on the polished vinyl floor. She ran directly to the bedside, grasping Michelle's wrist for a pulse.

“I think she has V-tack,” said the charge nurse. “She's a leukemic. Myeloblastic. Day two of attempted induction.”

“Any cardiac history?” demanded the woman resident, as she leaned over and elevated Michelle's eyelids. “At least the pupils are down.”

The three nurses looked at each other. “We don't think she has any cardiac history. Nothing was said at report,” said the charge nurse.

“Blood pressure?” asked the resident.

“Last time it was sixty over forty but variable,” said the second nurse.

“V-tack,” confirmed the woman resident. “Stand back a second.”

The woman resident made a fist and brought it down on
Michelle's narrow thorax with a resounding thump that made Cathryn wince.

An extremely young-looking chief resident arrived followed by two others pushing a cart filled with all sorts of medical paraphernalia and crowned with electronic instrumentation.

The woman resident gave a terse explanation of Michelle's condition while the nurses rapidly attached EKG leads to Michelle's extremities.

The charge nurse leaned over to one of the other nurses and told her to page Dr. Keitzman.

The electronic box on the top of the cart began to spew forth an endless strip of narrow graph paper on which Cathryn could see the red squiggles of an EKG. The doctors grouped around the machine, momentarily forgetting Michelle.

“V-tack all right,” said the chief resident. “With the dyspnea and cyanosis she's obviously hemodynamically compromised. What does that mean, George?”

One of the other residents looked up, startled. “Means we should cardiovert her immediately . . . I think.”

“You think right,” concurred the chief resident. “But let's draw up some Lidocaine. Let's see, the kid's about fifty kilograms, no?”

“A little less,” said the woman resident.

“All right, fifty milligrams of Lidocaine. Also draw up a milligram of atropine in case she goes into bradycardia.”

The team functioned efficiently as one resident drew up the medications, another got out the electrode paddles, while the third helped position Michelle. One paddle went under Michelle's back, the other anteriorly on her chest.

“All right, stand back,” said the chief resident. “We'll use a fifty-watt second shock to start, programmed to be delivered at the R-wave. Here goes.”

He pressed a button and after a momentary delay Michelle's body contracted, her arms and legs jumping off the surface of the bed.

Cathryn watched in horror as the doctors stayed bent over the machine, ignoring Michelle's violent reaction. Cathryn
could see the child's eyes open in utter bewilderment and her head lift off the bed. Thankfully her color rapidly reverted to normal.

“Not bad!” yelled the chief resident, examining the EKG paper as it came out of the machine.

“John, you're getting good at this stuff,” agreed the woman resident. “Maybe you should think about doing it for a living.”

All the doctors laughed and turned to Michelle.

Dr. Keitzman arrived breathless, hands jammed into the pockets of his long white coat. He went directly to the bed, his bespectacled eyes quickly scanning Michelle's body. He snatched up her hand, feeling for a pulse.

“Are you okay, chicken?” he asked, getting out his stethoscope.

Michelle nodded but didn't speak. She appeared dazed.

Cathryn watched as John, the chief resident, launched into a capsule summary of the event in what was to Cathryn incomprehensible medicalese.

Dr. Keitzman's upper lip pulled back in a characteristic spasm as he bent over Michelle, listening to her chest. Satisfied, he checked a run of EKG paper offered by John. At that moment he caught sight of Cathryn pressed up against the wall. Keitzman glanced at the charge nurse with a questioning expression. The charge nurse, following his line of sight, shrugged.

“We didn't know she was in here,” said the charge nurse defensively.

Dr. Keitzman walked over to Cathryn and put a hand on her shoulder.

“How about you, Mrs. Martel?” asked Dr. Keitzman. “Are you all right?”

Cathryn tried to talk but her voice wouldn't cooperate, so she nodded like Michelle.

“I'm sorry you had to see this,” said Dr. Keitzman. “Michelle seems fine and she undoubtedly did not feel anything. But I know this kind of thing is shocking. Let's go out in the hall for a moment. I'd like to talk to you.”

Cathryn strained upward to see Michelle over Dr. Keitzman's shoulder.

“She'll be okay for a moment,” assured Dr. Keitzman. Then, turning to the charge nurse, he said, “I'll be just outside. I want a cardiac monitor in here, and I'd like a cardiac consult. See if Dr. Brubaker can see her right away.” Dr. Keitzman gently urged Cathryn out into the corridor. “Come down to the nurses' station; we can talk there.”

Dr. Keitzman led Cathryn down the busy corridor to the chart room. There were Formica Parsons tables, chairs, two dictating telephones, and the massive chart racks. Dr. Keitzman pulled out a chair for Cathryn and she gratefully sat down.

“Can I get you something to drink?” suggested Dr. Keitzman. “Water?”

“No, thank you,” managed Cathryn nervously. Dr. Keitzman's extremely serious manner was a source of new anxiety and she searched the man's face for clues. It was hard to see his eyes through his thick glasses.

The charge nurse's head came through the door. “Dr. Brubaker wants to know if he can see the patient in his office.”

Dr. Keitzman's face contorted for a second while he pondered. “Tell him that she just had an episode of V-tack and I'd prefer he see her before she's moved around.”

“Okay,” said the charge nurse.

Dr. Keitzman turned to Cathryn. He sighed. “Mrs. Martel, I feel I must talk frankly with you. Michelle is not doing well at all. And I'm not referring specifically to this latest episode.”

“What was this episode?” asked Cathryn, not liking the initial tone of the conversation.

“Her heart speeded up,” said Dr. Keitzman. “Usually it's the upper part of the heart that initiates the beat.” Dr. Keitzman gestured awkwardly to try to illustrate what he was saying. “But for some reason, the lower part of Michelle's heart took over. Why? We don't know yet. In any case, her heart suddenly began to beat so fast that there wasn't time for the heart to fill properly, so it pumped inefficiently. But that seems to
be under control. What is worrying me is that she does not seem to be responding to the chemotherapy.”

“But she's just started!” exclaimed Cathryn. The last thing that Cathryn wanted was for her hope to be undermined.

“That's true,” agreed Dr. Keitzman. “However, Michelle's type of leukemia usually responds in the first few days. On top of that Michelle has the most aggressive case that I've ever seen. Yesterday we gave her a very strong and very successful drug called Daunorubicin. This morning when we did her blood count, I was shocked to see that there was almost no effect on the leukemic cells. This is very unusual although it does happen occasionally. So I decided to try something a little different. Usually we give a second dose of this medicine on the fifth day. Instead I gave her another dose today along with the Thioguanine and Cytarabine.”

“Why are you telling me this?” asked Cathryn, certain that Dr. Keitzman knew she would not understand much of what he was saying.

“Because of your husband's response yesterday,” said Dr. Keitzman. “And because of what Dr. Wiley and I said to you. I'm afraid your husband's emotions will interfere and he'll want to stop the medicines.”

“But if they're not working, maybe they should be stopped,” said Cathryn.

“Mrs. Martel. Michelle is an extremely sick child. These medicines are her only chance for survival. Yes, it's disappointing that as yet they have been ineffective. Your husband is right in saying her chances are slim. But without chemotherapy, she has no chance at all.”

Cathryn felt the stabbing pain of guilt; she should have brought Michelle to the hospital weeks ago.

Dr. Keitzman stood up. “I hope you understand what I'm saying. Michelle needs your strength. Now, I want you to call your husband and have him come over. He's got to be told what's happened.”

• • •

Even before the automatic radioactivity counter began to record the electrons emanating from the series of vials, Charles knew that the radioactive nucleotides had been absorbed and incorporated into the tissue culture of Michelle's leukemic cells. He was now in the last stages of preparing a concentrated solution of a surface protein that differentiated Michelle's leukemic cells from her normal cells. This protein was foreign to Michelle's body but was not rejected because of the mysterious blocking factor that Charles knew was in Michelle's system. It was this blocking factor that Charles had wanted to investigate. If only he knew something about the method of action of the blocking factor, perhaps it could be inhibited or eliminated. He was frustrated to be so close to a solution and have to stop. At the same time he realized that it was probably a five-year project with no guarantee of success.