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By Arthur Hailey
OPEN ROAD INTEGRATED MEDIACopyright © 1984 Arthur Hailey
All rights reserved.
Dr. Jordan said quietly, "Your wife is dying, John. She has a few hours more, that's all." He added, conscious of the pale, anguished face of the slight young man before him, still dressed in his factory work clothes, "I wish I could tell you something else. But I thought you'd want the truth."
They were in St. Bede's Hospital in Morristown, New Jersey. Early evening noises from outside — small-town noises — filtered in, barely disturbing the silence between them.
In the dimmed light of the hospital room, Andrew watched the Adam's apple of the patient's husband bob twice convulsively before he managed to get out, "I just can't believe it. We're just beginning. Getting started. You know we have a baby."
"Yes, I know."
"It's so ..."
The young man nodded. A good, decent man, hardworking from the look of him. John Rowe. He was twenty-five, only four years younger than Dr. Jordan himself, and he was taking this badly — not surprisingly. Andrew wished he could comfort the other man more. Though Andrew encountered death often enough and was trained to know the signs of death's approach, he still was uncertain about communicating with a dying person's friends or family. Should a doctor be blunt, direct, or was there some subtler way? It was something they didn't teach in medical school, or afterward either.
"Viruses are unfair," he said, "though mostly they don't act the way this has with Mary. Usually they'll respond to treatment."
"Isn't there anything? Some drug which could ...?"
Andrew shook his head. No point in going into details by answering: Not yet. So far, no drug for the acute coma of advanced infectious hepatitis. Nor would anything be gained by saying that, earlier today, he had consulted his senior partner in practice, Dr. Noah Townsend, who also happened to be the hospital's chief of medicine.
An hour earlier Townsend had told Andrew, "You've done all you can. There's nothing I'd have done differently." It was then that Andrew sent a message to the factory, in the nearby town of Boonton where John Rowe was working on the swing shift.
Goddam! Andrew's eyes glanced at the elevated metal bed with the still figure. It was the only bed in the room because of the prominent "ISOLATION" notice in the corridor outside. The I.V. bottle on its stand stood behind the bed, dripping its contents — dextrose, normal saline, Bcomplex vitamins — into Mary Rowe through a needle in a forearm vein. It was already dark outside; occasionally there were rumblings from a storm and it was raining heavily. A lousy night. And the last night of living for this young wife and mother who had been healthy and active only a week ago. Goddam! It was unfair.
Today was Friday. Last Monday Mary Rowe, petite and pretty, though clearly unwell, had appeared in Andrew's office. She complained of feeling sick, weak, and she couldn't eat. Her temperature was 100.5.
Four days earlier, Mrs. Rowe told him, she had had the same symptoms plus some vomiting, then the next day felt better and believed the trouble, whatever it was, was going away. But now it had returned. She was feeling terrible, even worse than before.
Andrew checked the whites of Mary Rowe's eyes; they showed a tinge of yellow. Already areas of her skin were showing jaundice too. He palpated the liver, which was tender and enlarged. Questioning elicited that she had been to Mexico with her husband for a brief vacation the previous month. Yes, they had stayed in a small, offbeat hotel because it was cheap. Yes, she had eaten local food and drunk the water.
"I'm admitting you to the hospital immediately," Andrew told her. "We need a blood test to confirm, but I'm as certain as I can be that you have infectious hepatitis."
Then, because Mary Rowe had seemed frightened, he explained that most likely she had consumed contaminated food or water in Mexico, the contamination probably from an infected food handler. It happened frequently in countries where sanitation was poor.
As to treatment, it would be mostly supportive, with adequate fluid intake into the body given intravenously. Complete recovery for ninety-five percent of people, Andrew added, took three to four months, though Mary should be able to go home from the hospital in a matter of days.
With a wan smile, Mary had asked: What about the other five percent?
Andrew laughed and told her, "Forget it! That's a statistic you won't be part of."
Which was where he had been wrong.
Instead of improving, Mary Rowe's condition worsened. The bilirubin in her blood went up and up, indicating increased jaundice, which was obvious from the alarming yellow of her skin. Even more critical, by Wednesday tests revealed a dangerous level of ammonia in the blood. It was ammonia, originating in the intestines, which the deteriorating liver could no longer handle.
Then yesterday her mental state had deteriorated. She was confused, disoriented, didn't know where she was or why, and failed to recognize either Andrew or her husband. That was when Andrew warned John Rowe that his wife was gravely ill.
The frustration at being able to do nothing to help gnawed at Andrew all day Thursday and, in between seeing patients in his office, he kept thinking about the problem, but to no effect. An obstacle to recovery, he realized, was that accumulation of ammonia. How to clear it? He knew that, given the present state of medicine, there was no effective way.
Finally, and unfairly he supposed now, he had taken out his frustration by blowing his stack at the damned drug company saleswoman who had come into his office late in the afternoon. She was a "detail man." Or should it be "detail woman?" Not that he cared. He didn't even remember her name or her appearance, except that she wore glasses and was young, just a kid, and probably inexperienced.
The saleswoman was from Felding-Roth Pharmaceuticals. Afterward Andrew wondered why he had agreed to see her when the receptionist announced that she was waiting, but he had, thinking perhaps he might learn something, though when she started talking about the latest antibiotic her company had just put on the market, his thoughts began wandering until she said, "You're not even listening to me, Doctor," and that had made him mad.
"Maybe it's because I've something better to think about and you're wasting my time."
It was rude, and usually he wouldn't have been that way. But his intense worry about Mary Rowe was coupled with a long dislike of drug companies and their high-pressure selling. Sure, there were some good drugs which the big firms produced, but their huckstering, including sucking up to doctors, was something Andrew found offensive. He had encountered it first in medical school where students — future prescribers, as the drug companies well knew — were sought after, flattered and pandered to by drug firm representatives. Among other things, the drug reps gave away stethoscopes and medical bags which some students accepted gladly. Andrew wasn't one of them. Though he had little money, he preferred to keep his independence and buy his own.
"Maybe you'll tell me, Doctor," the Felding-Roth saleswoman had said yesterday, "what it is that's so all-fired important."
It was then he had let her have it, telling her about Mary Rowe who was critical with ammonia intoxication, and adding caustically that he wished companies like Felding-Roth, instead of coming up with some "me-too" antibiotic which was probably no better or worse than half a dozen others already available, would work on a drug to stop excess ammonia production ...
He had stopped then, already ashamed of the outburst, and would probably have apologized except that the saleswoman, having gathered up her papers and samples, was on the way out, saying simply as she left, "Good afternoon, Doctor."
So much for yesterday, and Andrew was no closer to being able to help his patient, Mary Rowe.
This morning he had taken a phone call from the head floor nurse, Mrs. Ludlow.
"Dr. Jordan, I'm worried about your patient, Rowe. She's becoming comatose, not responding at all."
Andrew hurried to the hospital. A resident was with Mary Rowe who, by now, was in a deep coma. Although hurrying over was the thing to do, Andrew had known before arriving that no heroic measures were possible. All they could do was keep the intravenous fluids flowing. That, and hope.
Now, near the end of the day, it was clear that hope had been in vain. Mary Rowe's condition seemed irreversible.
Fighting back tears, John Rowe asked, "Will she be conscious again, Doctor? Will Mary know I'm here?"
"I'm sorry," Andrew said. "It isn't likely."
"I'll stay with her, just the same."
"Of course. The nurses will be close by, and I'll instruct the resident."
"Thank you, Doctor."
Leaving, Andrew wondered: Thanks for what? He felt the need for coffee and headed for where he knew some would be brewing.
The doctors' lounge was a boxlike place, sparsely furnished with a few chairs, a mail rack, a TV, a small desk, and lockers for attending physicians. But it had the advantages of privacy and constant coffee. No one else was there when Andrew arrived.
He poured himself coffee and slipped into an old, well-worn armchair. No need to stay at the hospital any longer, but he instinctively put off departure for his bachelor apartment — Noah Townsend's wife, Hilda, had found it for him — which was comfortable though sometimes lonely.
The coffee was hot. While letting it cool, Andrew glanced at a Newark Star-Ledger. Prominent on the newspaper's front page was a report about something called "Sputnik" — an earth satellite, whatever that might be, which the Russians had recently shot into outer space amid fanfare heralding "the dawn of a new space age." While President Eisenhower, according to the news story, was expected to order speedup of a U.S. space program, American scientists were "shocked and humiliated" by the Russians' technological lead. Andrew hoped some of the shock would spill over into medical science. Though good progress had been made during the twelve years since World War II, there were still so many depressing gaps, unanswered questions.
Discarding the newspaper, he picked up a copy of Medical Economics, a magazine that alternately amused and fascinated him. It was said to be the publication read most avidly by doctors, who gave it more attention than even the prestigious New England Journal of Medicine.
Medical Economics had a basic function — to instruct doctors in ways to earn the maximum amount of money and, when they had it, how to invest or spend it. Andrew began reading an article: "Eight Ways to Minimize Your Taxes in Private Practice." He supposed he should try to understand such things because handling money, when a doctor finally got to earn some after years of training, was something else they didn't teach in medical school. Since joining Dr. Townsend's practice a year and a half ago, Andrew had been startled at how much cash flowed monthly into his bank account. It was a new and not unpleasant experience. Although he had no intention of letting money dominate him, just the same ...
"Excuse me, Doctor."
A woman's voice. Andrew turned his head.
"I went to your office, Dr. Jordan. When you weren't there, I decided to try the hospital."
Dammit! It was the same drug company saleswoman who had been in his office yesterday. She was wearing a raincoat, which was soaked. Her brownish hair hung dripping wet, and her glasses were steamed. Of all the gall — to barge in here!
"You seem to be unaware," he said, "that this is a private lounge. Also I don't see salespeople —"
She interrupted. "At the hospital. Yes, I know. But I thought this was important enough." With a series of quick movements she put down an attaché case, removed her glasses to wipe them, and began taking off the raincoat. "It's miserable out. I got soaked crossing the parking lot."
The saleswoman — he observed again that she was young, probably no more than twenty-four — tossed the raincoat onto a chair. She spoke slowly and carefully.
"Ammonia, Doctor. Yesterday you told me you had a hepatitis patient who was dying from ammonia intoxication. You said you wished —"
"I know what I said."
The saleswoman regarded him levelly with clear gray-green eyes. Andrew was aware of a strong personality. She wasn't what you'd call pretty, he thought, though she had a pleasing, high-cheekboned face; with her hair dried and combed she would probably look good. And with the raincoat off, her figure wasn't bad.
"No doubt you do, Doctor, and I'm sure your memory is better than your manners." As he started to say something, she stopped him with an impatient gesture. "What I didn't — couldn't — tell you yesterday is that my company, Felding-Roth, has been working for four years on a drug to reduce ammonia production by intestinal bacteria, a drug that would be useful in a crisis situation like your patient's. I knew about it, but not how far our research people had gone."
"I'm glad to hear someone's trying," Andrew said, "but I still don't see —"
"You will if you listen." The saleswoman pushed back several strands of wet hair which had fallen forward on her face. "What they've developed — it's called Lotromycin — has been used successfully on animals. Now it's ready for human testing. I was able to get some Lotromycin. I've brought it with me."
Andrew rose from the armchair. "Do I understand you, Miss ..." He couldn't remember her name and, for the first time, felt uncomfortable.
"I didn't expect you to remember." Again the impatience. "I'm Celia de Grey."
"Are you suggesting, Miss de Grey, that I give my patient an unknown, experimental drug which has only been tried on animals?"
"With any drug, there has to be one first human being to use it."
"If you don't mind," Andrew said, "I prefer not to be the pioneering doctor."
The saleswoman raised an eyebrow skeptically; her voice sharpened. "Not even if your patient is dying and there isn't anything else? How is your patient, Doctor? The one you told me about."
"Worse than yesterday." He hesitated. "She's gone into a coma."
"Then she is dying?"
"Look," Andrew said, "I know you mean well, Miss de Grey, and I'm sorry about the way I spoke when you came in here. But the unfortunate fact is, it's too late. Too late to start experimental drugs and, even if I wanted to, do you have any idea of all the procedures, protocols, all the rest, we would have to go through?"
"Yes," the saleswoman said; now her eyes were blazing, riveting Andrew, and it occurred to him he was beginning to like this forthright, spunky girl-woman. She continued, "Yes, I know exactly what procedures and protocols are needed. In fact, since I left you yesterday I've done little else but find out about them — that, and twist the arm of our director of research to let me have a supply of Lotromycin of which, so far, there's very little. But I got it — three hours ago at our labs downstate, in Camden, and I've driven here without stopping, through this lousy weather."
Andrew began, "I'm grateful," but the saleswoman shook her head impatiently.
"What's more, Dr. Jordan, all the necessary paperwork is taken care of. To use the drug, you would have to get permission from this hospital and the next of kin. But that's all."
He could only stare at her. "I'll be damned!"
"We're wasting time," Celia de Grey said. She had the attaché case open and was pulling out papers. "Please begin by reading this. It's a description of Lotromycin prepared for you by Felding-Roth's research department. And this is a memorandum from our medical director — instructions on how the drug should be administered."
Andrew took the two papers, which seemed to be the first of many.
As he began reading, he was immediately absorbed.
Almost two hours had gone by.
"With your patient in extremis, Andrew, what have we got to lose?" The voice on the telephone was Noah Townsend's. Andrew had located the chief of medicine at a private dinner party and had described the offer of the experimental drug Lotromycin.
Excerpted from Strong Medicine by Arthur Hailey. Copyright © 1984 Arthur Hailey. Excerpted by permission of OPEN ROAD INTEGRATED MEDIA.
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