Shadow of Eden (14 page)

With an ominous look, Paul closed the door and walked over to the desk. “Oscar,” he said, “have you gotten any reports of encephalitis?”

As the safety officer, Oscar Perera collected and evaluated all reports and queries from physicians and patients regarding Trident’s only marketed drug, Eden. He pursed his lips and thought a moment. “No, I haven’t. Of course, you would be one of the first to know.”

“I’m glad to hear that.” Visibly relieved, Paul sat down in a tall-backed armchair.

Perera leaned back in his chair. “Why do you ask?”

“I got a call from an old medical school buddy who has a female patient with symptoms identical to what we’ve been watching for. His patient had delusions and myoclonus with no apparent cause that he can find.” He paused dramatically. “She was on Eden.”

Perera shrugged. “Well, if it were one of ours, it would be a chorus of one. It’s been on the market for over two years; I hardly think we’d be just starting to hear about it now.”

Paul took a deep breath, and let it out slowly. “I guess you’re right. We are pretty well out of the danger zone, aren’t we?”

“I think we are. It’s all going according to our predictions. Your worry is misplaced, Paul. I’m sure your friend’s patient must have something else.”

“Okay, good.” He stood up to leave.

“Oh, Paul,” Perera said, stopping his colleague. “Did you give your friend any idea that we might be responsible?”

Paul shook his head emphatically. “Are you nuts?”

“Good. By the way, who is he?”

“Ari Brown. Lucky guy, living the California life in San Fran.”

“Sounds like you two stay in touch.”

“Not much, really,” Paul replied. “Mostly on the holidays.”

Chapter 28

S
teve sat in the Intensive Care Unit nursing a dour mood and a Styrofoam cup of bitter coffee, heavily doused with dry creamer. He dictated his admission note on Mrs. Snyder and then sat back sipping his coffee. It was just after six in the morning and he had been in the ER since three, stabilizing her fresh stroke. True to his prediction earlier in the evening, his beeper had gone off, and with Anne still grumbling, he had kissed her and driven in to the hospital. Without time to drive back home, he would have to catch a shower and shave in the on-call room and wear ill-fitting hospital scrubs the rest of the day.

Sliding Mrs. Snyder’s CT scan off the counter, he walked over to the X-ray rack to file it. As he pushed the heavy jackets back to make room, Shirley’s MRI caught his eye. He glanced over at her room, and realized that Nancy Snyder had been put in the room next to Shirley’s.

Steve compulsively pulled Shirley’s large X-ray jacket from the file rack and slid the films out. He positioned the first sheet on the X-ray view box and snapped on the light. He sat back down and propped his feet on the counter and stared at the images trying to remember where and when he had first seen the pattern.

Since he reviewed MRI films daily, isolating that one episode would be difficult. Maybe if he associated the event with other things that were going on at the same time, he might be able to get a fix on it. Memory worked best like that, by associations and relationships, not in isolation. While it was cliché to ask what someone was doing when John F. Kennedy was assassinated, few could recall what they were doing the day before. Without the paired event or a distinct emotion, events in isolation simply did not stick.

He let his mind drift back to try and remember what he had been doing before or near to the time of the MRI. That didn’t work; so he changed tactics and thought about his emotional state at the time. His mind floated back and then settled on something. Anticipation. What for? Then he remembered—a trip. He had been looking forward to a trip somewhere.

Then it hit him. He and Anne had been about to leave for India on vacation. Years before, they had honeymooned in India and had vowed to return. They had seen the Taj Majhal, tracked free-roaming tigers in Ranthambhore National Park, and chased monkeys in Jaipur. Then, during Johnnie’s last Spring Break, they went back this time taking their son. With that establishing a time reference, he replayed the days just before leaving. Within a few moments, he had it. He had been with Dr. Goldstein.

Jeanne, Shirley’s nurse walked up and pointed at the MRI scan. “Can you show me what’s going on up there?”

“Sure.” Steve stood up pleased that he had figured out the mystery doctor’s identity. If only Dr. Goldstein could remember the patient.

Jeanne wrinkled her nose at the series of twenty miniature pictures laid out in sequence on the sheet of X-ray film. Jeanne and Shirley were close in age. Steve knew such patients were more emotionally draining for their nurses, especially since it was possible Shirley would not recover.

Like any long-term unit patient, the nurses had adopted Shirley, bringing her treats and gifts, including a stuffed otter that Shirley kept tucked under her arm. Jeanne’s interest, therefore, was not idle.

Pointing to the scan, she asked, “Okay, what’s this white stuff? It doesn’t look normal.”

“That’s right. It’s probably inflammation or edema. Look.” He pointed to a spot on the scan. “This is the nose. The white tracks start in the brain just above the nose, like something got into her brain through the nose and spread from there.”

“Like sniffing glue?”

“That’s right, but it doesn’t have the right pattern for glue.”

“Well, what else could it be?”

“Maybe a pesticide or a solvent, but it’s not right for them either—I can’t figure what.”

“Well,” Jeanne remarked, crossing her arms, “Shirley was on Eden. It’s sprayed into the nose.”

“Right,” Steve agreed. “But there have been no reported cases. So, that’s not likely it.”

Jeanne shrugged, unconvinced. “How can you be so sure? I mean, it goes up her nose every day.”

Steve rolled the thought over in his mind.
Eden?
Patients administered Eden by a nasal spray so it would be absorbed across the nasal membranes. Theoretically, Steve knew, it could work its way into the brain through the olfactory nerves.

“You have a good point, but Captain Palmer wasn’t on it, so it couldn’t be Eden. I need to find something common to both.”

“Who’s Captain Palmer?”

Steve yawned. “Oh, right. He was the captain who was flying the airplane I was on.”

“He’s got this too?”

“Yeah.”

Jeanne looked disappointed. “Well, then it couldn’t be Eden.”

“I just can’t see how. But it was a good thought.”

“Funny we should be talking about Eden. Just yesterday I caught my daughter—Whoops, she’s getting up. I better go check on her.” She hustled into Shirley’s room, closing the door behind her.

Steve stared at the scan, thinking about what Jeanne had said about Eden. Was that the key to Shirley’s illness? If so, then how? Jeanne’s suggestion had caught him off guard. In fact, it was an excellent suggestion, but he had been too tired to spot it. Still, he had combed through Captain Palmer’s records and there was no mention of the drug Eden. He clearly remembered when he was in the ER, Marty Walker telling him that the Captain had not been on any meds.

He sipped his lukewarm coffee and looked at Shirley through the sliding glass wall. Edith awoke with a start and climbed out of the reclining chair she had been sleeping in. Shirley began her myoclonic twitches, and was screaming with fright, although Steve could barely hear her through the closed glass doors. This was a bad spell. Edith, still in her nightgown, held Shirley’s hand, patting and stroking it, trying to calm her daughter, while Jeanne mopped her forehead with a face cloth.

A change in Shirley’s jerking caught Steve’s attention. Her twitches had turned rhythmic and violent—a convulsion!

As he raced into the room, he heard Jeanne yell for help. A flood of nurses poured in behind him, one pulling the crash cart into the room. A male nurse ushered a terrified-looking Edith out of the room.

Shirley’s body bucked and jerked with powerful muscular convulsions that prevented her from breathing. The heart monitor skewed wildly with each movement, obscuring the cardiac activity. Jeanne struggled vainly to hold down Shirley’s arms.

“Valium, ten milligrams I.V.,” Steve barked standing at the bed and taking control of the code.

“I.V. Valium, ten milligram syringe,’ the male nurse manning the crash cart repeated. He produced a pre-filled syringe from the crash cart and slapped it into Steve’s outstretched hand.

“I.V.’s out. No access!” Jeanne yelled. Steve saw blood oozing from the intravenous site in Shirley’s left arm where the catheter had pulled out.

“Why isn’t there a central line?” the charge nurse complained to no one in particular.

Two nurses pushed the bed away from the wall so that they could get to Shirley’s face and put a plastic airway in her mouth. Oxygen would follow.

Shirley’s seizure showed no signs of slowing down. If she did not stop soon, she would get extensive brain damage from the lack of oxygen. Valium had to be given intravenously and there was no time to start an I.V.

“I’ll inject it,” Steve growled. “Let’s get going. Time since seizure started?”

“One minute forty seconds,” responded the chart nurse.

Steve capped the Valium and slid the syringe into his shirt pocket. “Tourniquet, please.” He held out his hand and a flat rubber strap appeared in it.

He sat on the bed and tightly wrapped the tourniquet around Shirley’s right arm. He felt for a vein in the slender white shallow of the elbow region and found nothing except for a delicate blue streak, under the skin. It was a small, pitiful excuse for a vein, but it would have to do.

“Alcohol, please.” Another nurse, anticipating his request, swiped an alcohol pad over Shirley’s arm.

“Countdown by fifteen second intervals to four minutes since she started,” Steve instructed. Shirley’s lips and fingertips were turning blue, a sign of low oxygen.

“One minute and thirty seconds remaining.”

“Prepare to intubate her at my order,” Steve directed. The senior anesthesia resident slid into place at the head of the bed with his tackle box of equipment and began setting up.

Steve pulled the Valium out of his pocket and yanked the rubber cap off with his teeth.

“Okay,” he muttered, “hold her still.”

Jeanne held Shirley’s arm as tightly as possible but still the arm danced around. He held the needle over the vein, trying to move in concert with her writhing, and plunged it through her skin. Shirley’s arm unexpectedly twisted, dislodging the needle.

“One minute and thirty seconds.”

A nurse had connected a pulse oximeter to Shirley’s other hand. The red LED readout flashed a warning and beeped its alarm. “Pulse ox, sixty-two,” the nurse reported. Normal was one hundred. Shirley was fast running out of oxygen.

Steve held his breath and with the needle’s point, followed the vein still dancing before his eyes. With a smooth movement, he expertly slid the needle in. A telltale flashback of blood in the syringe hub told him he was in.

Jeanne snapped off the tourniquet, and he began pushing the Valium. Shirley bucked, but Steve, gingerly holding the syringe, moved with her, keeping the needle in place. While injecting ten milligrams of Valium should take at least a minute, Steve did not have that long; he pushed it in faster than recommended. “Two milligrams in,” he called out.

“One minute.”

“Pulse ox, fifty-five.”

By now, the crowded room had become stuffy and sweat dripped off Steve as he concentrated on holding the needle in place. Shirley continued jerking as Steve pushed more Valium in. “Six milligrams,” he reported.

“Six milligrams at oh-five-sixteen,” the chart nurse chanted in response. Shirley made a vigorous jerk. “Easy now,” Steve pushed in another half milligram and saw the telltale bulge of extravasated medicine under the skin. The needle had slipped out of the vein after the last jerk.
Damn.
“Lost the vein.”

“Total six milligrams in?” The chart nurse queried.

“Yes. Get a line in her other arm.” He jabbed the exposed Valium needle into the mattress in frustration and watched the still convulsing Shirley. Fearing the Valium on board was insufficient to stop her seizures, he called for the second line drug.

“Ativan, please.” Ativan given intramuscularly would control seizures, but it worked slower than the intravenous Valium. He swabbed alcohol on her thigh for the injection.

“Thirty seconds.”

“Pulse ox forty-eight.”

“Intubate, please,” Steve ordered and watched as the resident fitted the clear plastic tube smeared with KY jelly into Shirley’s left nostril.

“Ativan, two milligram syringe,” the male nurse reported, handing Steve the syringe. Steve pulled the cap off with his teeth and bent over Shirley’s thigh to inject it.

She stopped jerking.

Everyone held their breath and watched. She jerked once again and then stopped. Shuddering, Shirley took a deep breath.

Steve watched her closely as her breathing resumed, deep and rapid.

“Pulse ox, seventy eight.”

The color began returning to Shirley’s face and fingers.