Strong Medicine (2 page)

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

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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 bihrubin 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 shestarted 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

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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."

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"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 ac-

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count. 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 attach~

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

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strands of wet hair which had fallen forward on her face. "What they've

developed-it's called Lotrcrmycin-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

11 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."