Strong Medicine, Page 2

  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.”

  “What’s important?”

  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.

  Townsend went on, “You say the husband has already given permission?”

  “Yes, in writing. I got the administrator at home. He came to the hospital and had the form typed up. It’s signed and witnessed.”

  Before the signing, Andrew had talked with John Rowe in the corridor outside his wife’s room and the young husband reacted eagerly. So eagerly, in fact, that Andrew warned him not to build great hopes or expect too much. The signature on the form was wavery because of John Rowe’s shaking hand. But it was there, and legal.

  Now Andrew told Noah Townsend, “The administrator is satisfied that the other papers sent by Felding-Roth are in order. Apparently it makes it easier that the drug didn’t cross a state line.”

  “You’ll be sure to record all those details on the patient’s chart.”

  “I already have.”

  “So all you need is my permission?”

  “For the hospital. Yes.”

  “I give it,” Dr. Townsend said. “Not that I hold out much hope, Andrew. I think your patient’s too far gone, but let’s give it the old college try. Now, do you mind if I go back to a delicious roast pheasant?”

  As Andrew hung up the phone at the nurses’ station from where he had been calling, he asked, “Is everything ready?”

  The head night nurse, an elderly R.N. who worked part time, had prepared a tray with a hypodermic. She opened a refrigerator and added a clear glass drug container which the Felding-Roth saleswoman had brought. “Yes, it is.”

  “Then let’s go.”

  The same resident who had been with Mary Rowe this morning, Dr. Overton, was at her bedside when Andrew and the nurse arrived. John Rowe hovered in the background.

  Andrew explained Lotromycin to the resident, a burly Texan extrovert, who drawled, “You expectin’ a damn miracle?”

  “No,” Andrew answered curtly. He turned to Mary Rowe’s husband. “I want to emphasize again, John, this is a long shot
, a very long shot. It’s simply that in the circumstances …”

  “I understand.” The voice was low, emotion-charged.

  The nurse prepared the unconscious Mary Rowe for an injection, which would be intramuscular into the buttocks, as Andrew told the resident, “The drug company says the dose should be repeated every four hours. I’ve left a written order but I’d like you to …”

  “I’ll be here, chief. And okay, q-4.” The resident lowered his voice. “Say, how about a bet? I’ll give you even odds against—”

  Andrew silenced him with a glare. The Texan had been in the hospital training program for a year, during which time he had proven himself highly competent as a doctor, but his lack of sensitivity was notorious.

  The nurse completed the injection and checked the patient’s pulse and blood pressure. She reported, “No reaction, Doctor. No change in vital signs.”

  Andrew nodded, for the moment relieved. He had not expected any positive effect, but an adverse reaction had been a possibility, particularly with an experimental drug. He still doubted, though, that Mary Rowe would survive until morning.

  “Phone me at home if she’s worse,” he ordered. Then, with a quiet, “Good night, John,” to the husband, he went out.

  It was not until he was in his apartment that Andrew remembered he had failed to report back to the Felding-Roth saleswoman, whom he had left in the doctors’ lounge. This time he remembered her name—de Grey. Was it Cindy? No, Celia. He was about to telephone, then supposed that by now she would have found out what had happened. He would talk with her tomorrow.

  2

  Normally on Saturday mornings Andrew saw patients in his office from 10 A.M., then dropped into the hospital around midday. Today he reversed the procedure and was at St. Bede’s by 9 A.M.

  Last night’s storm and rain had been replaced by a fresh, clear morning, cold but sunny.

  Andrew was ascending the hospital front steps when, ahead of him, the main door slammed open and Dr. Overton, the resident, appeared to hurl himself out. Overton seemed agitated. His hair was disordered as if he had gotten out of bed in a hurry and forgotten about it. His voice was breathless. He grabbed Andrew’s arm.

  “Tried to call you. You’d already left. Janitor at your apartment said you were coming. I just had to catch you first.”

  Andrew pulled his arm away. “What is this?”

  The resident swallowed hard. “Never mind. Just come on.”

  Overton, hurrying, preceded Andrew down a corridor and into an elevator. He refused to speak or even look Andrew in the eye as they rode to the fourth floor. The resident hastened from the elevator, Andrew following.

  They stopped outside the hospital room where, last night, Andrew had left the unconscious Mary Rowe, her husband, the nurse and the resident.

  “In!” Overton motioned impatiently. “Go on in!”

  Andrew entered. And stopped. Staring.

  From behind him the resident said, “Should’ve taken my bet, Dr. Jordan.” He added, “If I hadn’t seen, I wouldn’t have believed.”

  Andrew said softly, “I’m not sure I believe it either.”

  Mary Rowe, fully conscious, propped up in bed and wearing a blue lacy nightgown, smiled at him. Though the smile was weak, and clearly so was Mary Rowe, her condition was so much in contrast to the deep coma of last night, it seemed a miracle. She had been sipping water; a plastic cup was in her hand. The yellow skin tone, which had deepened yesterday, was noticeably lighter. As Andrew came in her husband stood up, smiling broadly, his hands outstretched.

  “Thank you, Doctor! Oh, thank you!” That Adam’s apple of John Rowe’s bobbed up and down as Andrew took his hand.

  From the bed Mary Rowe added a soft but fervent, “Bless you, Doctor!”

  It was the resident’s turn. Overton pumped Andrew’s hand. “Congratulations!” He added, uncharacteristically, “sir.” Andrew was surprised to see tears brimming in the burly Texan’s eyes.

  The head floor nurse, Mrs. Ludlow, bustled in. Normally preoccupied and serious, she was beaming. “It’s all around the hospital, Dr. Jordan. Everybody’s talking about you.”

  “Look,” Andrew said, “there was an experimental drug, Lotromycin. It was brought to me. I didn’t—”

  “Around here,” the nurse said, “you’re a hero. If I were you I wouldn’t fight it.”

  “I ordered a blood test, stat,” the resident reported. “It showed ammonia below toxic level. Also, the bilirubin isn’t rising, so the rest of the cure will be routine.” He added to himself, “Unbelievable!”

  Andrew told his patient, “I’m happy for you, Mary.” A thought occurred to him. “Has anyone seen that girl from Felding-Roth? Miss de Grey.”

  “She was around here earlier,” Nurse Ludlow said. “She may be at the nursing station.”

  “Excuse me,” Andrew said, and went outside.

  Celia de Grey was waiting in the corridor. She had changed her clothes from last night. A soft smile played around her face.

  As they regarded each other, Andrew was conscious of a constraint between them.

  “You look a lot better with your hair dry,” he said.

  “And you’re not as stern and fierce as yesterday.”

  There was a pause before he said, “You heard?”

  “Yes.”

  “In there …” Andrew motioned toward the hospital room. “In there they’ve been thanking me. But the one we should all thank is you.”

  She said, smiling, “You’re the doctor.”

  Then suddenly, all barriers down, they were laughing and crying together. A moment later, to his own surprise, he took her in his arms and kissed her.

  Over coffee and a shared Danish in the hospital cafeteria Celia de Grey removed her glasses and said, “I telephoned our company medical director and told him what happened. He’s talked with some of our research people. They’re all happy.”

  “They have a right to be,” Andrew said. “They made a good drug.”

  “I was also told to ask: Will you write up a case report, including your use of Lotromycin, for publication in a medical journal?”

  He answered, “Gladly.”

  “Naturally, it would be good for Felding-Roth.” The saleswoman’s tone was businesslike. “That’s because we expect Lotromycin to be an important drug and a big seller. But it won’t do you any harm either.”

  Andrew acknowledged with a smile, “Probably not.”

  He was thoughtful as he sipped his coffee. He knew that through mere chance, a fluke engineered by what he now saw as this remarkable and delightful young woman seated opposite, he had participated in a piece of medical history. Few physicians ever had that opportunity.

  “Look,” Andrew said, “there’s something I want to say. Yesterday, Celia, you told me I had bad manners and you were right. I was rude to you. I apologize.”

  “Not necessary,” she told him briskly. “I liked the way you were. You were worried about your patient and you didn’t care about anything else. Your caring showed. But then you’re always that way.”

  The remark surprised him. “How do you know?”

  “Because people have told me.” Again the swift, warm smile. She had her glasses on again; removing and replacing them seemed a habit. Celia continued, “I know a lot about you, Andrew Jordan. Partly because it’s my job to get to know doctors and partly … well, I’ll get to that later.”

  This unusual girl, he thought, had many facets. He asked, “What do you know?”

  “Well, for one thing you were at the top of your medical school class at Johns Hopkins. For another, you did your internship and residency at Massachusetts General—I know only the best get in there. Then Dr. Townsend chose you out of fifty applicants and took you into his practice because he knew you were good. Do you want more?”

  He laughed aloud. “Is there any?”

  “Only that you’re a nice man, Andrew. Everybody says so. Of course, there are some negatives about you I’ve discovered
.”

  “I’m shocked,” he told her. “Are you suggesting I’m not perfect after all?”

  “You have some blind spots,” Celia said. “For instance, about drug companies. You’re very prejudiced against us. Oh, I’ll agree that some things—”

  “Stop right there!” Andrew raised a hand. “I admit the prejudice. But I’ll also tell you, this morning I’m in a mood to change my mind.”

  “That’s good, but don’t change it altogether.” Celia’s businesslike tone was back. “There are lots of good things about our industry, and you just saw one of them at work. But there are also things that aren’t so good, some that I don’t like and hope to alter.”

  “You hope to alter.” He raised his eyebrows. “Personally?”

  “I know what you’re thinking—that I’m a woman.”

  “Since you mention it, yes, I’d noticed.”

  Celia said seriously, “The time is coming, in fact it’s already here, when women will do many things they haven’t done before.”

  “Right now I’m ready to believe that too, especially about you.” Andrew added, “You said there was something else to tell me, that you’d get to later.”

  For the first time Celia de Grey hesitated.

  “Yes, there is.” Her strong gray-green eyes met Andrew’s directly. “I was going to wait until another time we met, but I may as well tell you now. I’ve decided to marry you.”

  This extraordinary girl! So full of life and character, to say nothing of surprises. He had never met anyone like her. Andrew started to laugh, then abruptly changed his mind.

  One month later, in the presence of a few close friends and relatives, Dr. Andrew Jordan and Celia de Grey were married in a quiet civil ceremony.

  3

  On the second day of their honeymoon Celia told Andrew, “Ours will be a good marriage. We’re going to make it work.”

  “If you ask me …” Andrew rolled over on the beach towel they were sharing, managing to kiss the nape of his wife’s neck as he did. “If you ask me, it’s working already.”