Weapon of Choice (2 page)

“Mr. Mercer, first may I ask, have you ever been diagnosed with any serious infectious disease? Either bacterial or viral? Tuberculosis?”

He hesitated, shook his head, and reached for the oxygen mask. Laura helped him situate it, then checked the settings on the positive pressure machine.

At the nursing station, Laura stopped to phone Matthew Mercer's biological father. Mercer and Worth? Different last names.
What was that all about?

A male voice answered on the first ring.

“Victor Worth?”

“Yes, this is Dr. Worth.”

Laura introduced herself as Matthew's doctor, keeping her voice neutral as she detailed a dark medical picture, noted that conventional
antibiotics were not working, and told him what she wanted to do. She held back her presumptive AIDS diagnosis, not sure what she could legally share, concerned about patient confidentiality. She waited for Worth's answer.

A lung biopsy was indicated, he conceded. He was not a medical doctor, he informed her. With a Ph.D. in microbiology from Georgetown University, he had made an entire career of antimicrobial research at the National Institute of Allergy and Infectious Diseases—the NIAID—a division of the National Institutes of Health.

The man had an inflated self-image, Laura decided—but never mind. He'd agreed to her treatment plan. He seemed genuinely concerned about Matthew and promised to fly to Tampa the next day.

Worth did have one request that he insisted Laura pursue—an investigational drug trial. A clinical study was underway, he explained, at Keystone Pharma, a pharmaceutical company in Philadelphia. The drug was ticokellin for the treatment of drug-resistant staph. Could she contact a Dr. Norman Kantor at the pharmaceutical firm—and get that drug for Matthew? Worth told her that he used to work with Dr. Kantor, who may have retired, but who would vouch for him and convince his successor to provide the drug immediately under a compassionate IND—investigational new drug application. Worth offered to personally transport the drug, but he reiterated that the request must come from her, Mercer's treating physician. At this time of night she wasn't ready to explain that she was the surgeon and that Kellerman was Mercer's primary physician.

What about a drug to treat the HIV virus? Laura thought as she terminated the call.
Not likely in Matthew Mercer's lifetime
.

Before leaving the hospital, Laura booked the first operating room slot. Her chief of surgery rank did come with privileges. She would place the call to Keystone Pharma the next morning. On her way out, she looked in on Matthew. Still struggling to breathe, he nodded his assent as she told him she'd phoned Worth and they'd talked. Matthew was first on the operating room schedule tomorrow—seven o'clock.

M
ONDAY
, N
OVEMBER
25

At five thirty a.m., Laura arrived at Tampa City Hospital. She'd left notes in the kitchen for her kids. They were perfectly capable of making their own breakfast and getting off to school, but still, she felt guilty about leaving them last night and again this morning. Marcy Whitman, her housekeeper of fourteen years, would be back before noon, and all would be well in the Nelson household. Laura hoped. With twin seventeen-year-old daughters, you never knew for certain. One day you thought you did know, but the next day brought surprises, not always pleasant ones, like the birth control pills that had fallen out of Nicole's purse last week.

Laura spent most of her professional time in Tampa City Hospital on Davis Island, but she also had an office and a research lab on the main campus of the University of South Florida Medical School. After graduating from medical school in Detroit and finishing her thoracic surgical residency in Tampa, she'd pioneered lung volume reduction surgery, considered experimental then, but now moving into the mainstream. And, a year ago, the University of South Florida Medical School named her head of the surgical department. She appreciated the title Chief of Surgery, but not the administrative burdens that came with it.

Laura's research labs were located at the medical school complex in Tampa on Fowler Avenue, where she and her research fellows did experimental surgery. She dedicated Tuesdays and Thursdays to research, and usually operated at Tampa City Hospital on
Mondays and Wednesdays. When all was said and done, Laura's schedule was erratic.

Her Tampa City Hospital office was dark and empty when Laura arrived, paper cup of coffee in hand. A stack of charts awaited her signature, as did today's hospital staff meeting agenda. As usual, she would present the surgical stats for the hospital: number of procedures, length of hospital stay, morbidity and mortality rates, wound infection rates, any quality control issues. Should she share Matthew Mercer's presumptive diagnosis of AIDS with the hospital staff?

If she was right and her new patient had the HIV virus, there'd be a steep learning curve as the hospital coped with confusion and chaos—all while trying to prevent transmission to healthcare workers. She'd decided to wait for the biopsy result, to know for sure.

HIV, as an infectious disease, would come under the purview of the internal medicine service. But as chief of surgery, she needed to do everything she could to protect the operating room personnel from contamination, as well as patients in the recovery room and on the surgical floor. She had to do that now, this morning, before she raised what could be a premature alarm.

With a presumptive diagnosis of HIV, the issues were complex. Not much was known about the retrovirus, how it spread, what precautions should be taken, not even how to definitively diagnose it. A test had been recently patented, intended to test the blood supply, but was not yet commercially available. And, she'd read in the lay press about certain problems swirling around the issue of confidentiality. Because HIV was associated with homosexuality, afflicted patients clamored for anonymity. Was it even legal to chart the diagnosis? Activists already were challenging everything about the controversial HIV virus. Laura could be heading into a public health and a public relations nightmare.

A few sips of coffee and she felt her brain function again. When she felt perplexed, Laura resorted to lists. Write down your priorities. What really
must
happen today, what can wait?

6:00: call her friend, Dr. Stacy Jones, at her CDC office in Atlanta. With a Master's in Public Health and an M.D. degree
and working in the hub of cutting-edge research at the Centers for Disease Control and Prevention, Stacy would be as up-to-date as anyone on both the science and politics of HIV. She needed Stacy's advice.

6:15: call the O.R. nurse-supervisor to request that she personally supervise every detail of infection control in the operating suites that morning.

6:30: call home, in case the kids overslept.

6:31: check Matthew Mercer's vital signs, labs, blood gases, x-rays, meds, and the patient himself before they wheel him into the operating room.

6:45: scrub in for the procedure and reassure herself that every member of the team is properly gowned, gloved, and masked.

6:55: brief the anesthesiologist and the surgical team, emphasize infection control—a valid concern, because the patient had an infection not responding to antibiotics, probably due to a resistant strain of staph.

She had agreed to call that pharmaceutical company. If they had a new, better drug for resistant staph, now would be the time to get it to this patient, but she cringed at the thought of the administrative quagmire. Laura had been an investigator in experimental drug trials in the past—bronchodilators, anti-inflammatories, and an antibiotic—and she knew perfectly well how the massive paperwork would sabotage her schedule. Moreover, she knew that no one at the company would pick up the phone before eight o'clock. By then she'd be exploring Mercer's lungs. The Keystone Pharma call would have to wait.

Between now and 6:30: sign as many charts as possible to make the paperwork go away.

Noon: chief of staff meeting, mandatory—unless life-and-death kept her confined to the O.R.

How long would this morning's procedure take? Not long. Get in, drain the fluid, biopsy whatever was in there, culture everything,
and get out as fast as possible. On a surgical risk scale of one to ten, this patient was a nine. If he wasn't so young, she'd put him at a ten. Losing him on the table would not be good for her statistics, but the only way they could help him was to get into his lungs and find out what lurked there.

1:00 or 1:30: if her look inside Mercer's chest and the micro and histology results more or less confirmed AIDS, she'd meet with her counterpart, the chief of medicine, and Kellerman, the infectious disease specialist. How to proceed with Mercer would be their decision. Maybe she could persuade one of them to call Keystone Pharma about the new drug; if not, she would, as promised.

2:00: lung reduction procedure

5:00: lung biopsy, suspected carcinoma, complicated by beryllium toxicity

6:00: dictate surgical notes

6:30: round with residents—critical patients, only

7:30: home for dinner, go over Patrick's and the twins' homework; call Mike at Notre Dame, she'd missed his call yesterday from South Bend, but she had caught up with Kevin at the University of Michigan in Ann Arbor. Both would be home on Thanksgiving, only four days away.

Patrick's baseball game: She'd have to miss it—but she had spent almost the whole weekend with his team.

M
ONDAY
, N
OVEMBER
25

Victor Worth had not slept at all after hearing from that woman doctor last night. Matthew, his son, dominated his thoughts. Victor only had learned of Matthew's existence a month ago, but in that short time Victor's life had turned around. No longer was he the self-focused individualist, caring for no one, convinced that no one gave a damn about him. Until that letter arrived from Cindy, Matthew's mother, Victor had never had reason to consider how being a father could affect him—could dramatically change his life. How could he? Matthew, flesh of his flesh—a reality Victor had dismissed as impossible. If he'd only known in time about Matthew, his son's life would have been so different.

Cindy Mercer, a shy, unassuming girl, could not be expected to raise a manly son. Bereft of a male role model, Matthew had turned gay. Victor didn't blame Cindy, but neither did he blame himself. He hadn't even received her letter, introducing him to Matthew, until after her death. But he couldn't help wondering what he'd have done had he known at the time, during the blackest moments of his life, that Cindy was pregnant? Back then he'd had to use every iota of his emotional and physical reserves to battle testicular cancer.

The arrival of the posthumous letter transformed his life, shook him to his core. According to Cindy, he had a son. Now thirty-two years old. The birth year coincided with Victor's only sexual relationship ever—in his senior year at the University of Virginia, with a student nurse named Cindy Mercer. In her letter, Cindy explained
openly, yet sensitively, that their son was a homosexual, a sweet, vulnerable young man who was ill. She'd pleaded with Victor to help his son.

With uncharacteristic impulsiveness, surprising even himself, Victor had traveled to Clearwater, Florida, to meet the boy. One glance had been enough. Victor felt an immediate surge of love and compassion for the thin young man with the curly auburn hair and the most amazing blue eyes. But thanks to Victor's medical background, one look also made him suspect that his son was a victim of the disease known as AIDS.

Infectious diseases—though not viruses, per se—had been his life's work. Right out of his Ph.D. program at Georgetown, he'd started at the NIH, working first with staphylococcal organisms and then with pathogenic fungi. His government research position gave him access to the top resources in the D.C. area capable of treating AIDS. He planned to head back to Clearwater over Thanksgiving weekend and convince Matthew to transfer to George Washington University Hospital. Victor could get him the best of care. But before Victor could make the preliminary arrangements, first he'd have to broach the subject of AIDs with Matthew—in effect, deliver a death sentence to his own son. Victor had never envisioned Matthew ending up in a Tampa hospital so soon.

The dire prognosis of AIDS notwithstanding, Victor vowed to do anything in his power to prolong Matthew's life, to give them some time together.
His son
. He still was in disbelief. And during the night after Dr. Nelson's call, Victor had charted his first step. Matthew's immune system, damaged by the HIV virus, struggled to stave off other organisms, one of which Dr. Nelson thought was a resistant staphylococcus. With Victor's connections, he could get his hands on a new, not yet commercially available, antibiotic against staph: ticokellin was the generic name.

M
ONDAY
, N
OVEMBER
25

Laura adjusted the water temperature, about to start her surgical scrub, when the operating room clerk handed her the phone. “Eileen Donovan.”

“Just in time. What's going on, Eileen?” Laura's secretary was one of her three “moms.” Peg Whelan, her real mother; Marcy Whitman, her housekeeper; and Eileen, each in her early sixties. Laura knew she could hardly function without all three generous, smart women in her corner.

“You must have been in before dawn to sign all those charts, Laura. Good girl. Sorry your schedule got all botched. I know Marcy is away, so I double-checked on the kids. All three are on schedule. Med school dean's office left a reminder message: don't be late for the noon staff meeting. And I'm going to call and tell the kitchen to make sure they bring you a big salad.”

“I'll eat whatever they serve. Just expedite those charts so Medical Records stops breathing down my neck. Seriously though, the case this morning has the potential to go bad in more ways than one. Did Dr. Stacy Jones at the CDC return my call? I left her a message early this morning.”