Rupture Read online

  “How bad is it?”

  With this question, the situation seemed to overcome Meg Daily. She closed her eyes and cried briefly into her mask.

  Margaret’s insulin regimen was just not working. Countless doctors. Countless admissions to the hospital. Something had to be done. They just couldn’t go on like this. It was too dangerous. If it wasn’t too late already.

  “I’ll do this,” Ms. Conch said, unfolding a large blue plastic drape. “You go on.”

  “Hand me the end,” the doctor said, composed.

  Together, they pulled the drape to full length and let it descend on the corpse, a bed sheet floating down. The pathologist pulled off her mask and cap in one quick motion. She ripped her protective gown off without loosening the tie and ran out of the autopsy suite.

  Using a pair of Adson forceps, Eli Branch closed the skin incision as intern Landers fired a straight line of metal staples with a handheld gun. After the last staple was placed, Eli examined the incision and gave a tug to a crooked one that lay crimped within the umbilicus.

  “Sorry about that one,” Landers said.

  “Of all the work we did,” Eli said as he wiped Betadine scrub off the skin with a wet laparotomy pad, “the incision is the only part the patient will see, right?”

  “Right.”

  “If the incision isn’t perfect, she’ll wonder what we forgot inside.”

  After a sterile white bandage was placed and the anesthesiologist had begun extubation, Eli held out his hand, a ritual he did with the medical students and residents after completing each operation.

  Landers took it in a single congratulatory shake of gloved hands.

  “You did a good job today.”

  “Thanks,” Landers said.

  Eli nodded to the scrub nurse. “I must be living right to get you for two cases in a row.

  Roberta blinked. “It was a pleasure.”

  After the edict passed down from Fisher, Eli knew he would be seeing much less of the operating room, at least during daylight hours. But there was no reason to inform the nurses of this yet—especially after such a smooth case. He stepped back and removed his gloves, and Landers took down the drapes.

  “Heard anything from the tests?” With the whirlwind of events over the past thirty-six hours, Eli had almost forgotten about Landers’s exposure to Gaston’s blood. He could remember well the agony of waiting for the results after one of his own needle sticks.

  “No,” Landers said. “Should be back tomorrow.”

  A beeper went off in the back of the operating suite, a common occurrence for the interns and residents, who received a barrage of calls from the floor nurse for discharge orders or dosage clarifications. But this time, Eli recognized the specific tone as his beeper.

  “Will you take her to recovery?” Eli asked Landers. “I’ll talk to her family.”

  The intern applied a bandage to the wound. “Sure thing.”

  “Dr. Branch, is this your beeper?” the circulating nurse asked. She held the small black box in the air.

  “I believe so. Could you answer it please?”

  As Eli wrote a brief, two-line operative note in the patient’s chart, the nurse handed the phone to him.

  “Eli?”

  He recognized the voice and immediately closed the chart. “Yes, Dr. Daily.”

  “They’re bringing my daughter to the ER. She’s a diabetic.”

  Eli thought of the little girl in the picture. And by the tone of her voice, he knew Meg was scared.

  “She’s unresponsive.”

  “I’ll be right down,” he said. “Meg?”

  “Yeah?”

  “They’ll take care of her.”

  CHAPTER NINE

  GATES MEMORIAL HOSPITAL

  EMERGENCY DEPARTMENT

  11:02 A.M.

  Kinder Day Care was less than two miles from the hospital. Dr. Meg Daily waited at the entrance to the ambulance bay and listened to the siren approaching from Jefferson Street. The ambulance backed in and Meg stood within inches of the back door, peering through the windows to see a disheveled man strapped to the gurney. The man’s arms were folded across his chest and he mumbled incoherently. He appeared very comfortable for someone in an emergency.

  As the paramedics unloaded the gurney, the man raised his head and said, “Hey, you my doctor?”

  Meg stepped back in disbelief. Her daughter was still out there without her mother.I should have driven, Meg thought, dazed with guilt.I could have been there by now.

  As the man wheeled by, he turned his head toward Meg. His eyes were unfocused in an intoxicated glaze.

  “I want her to be my doctor,” he said, reeking of alcohol. “Yeah, baby, you’re my doc. Come over here, honey.”

  Acknowledging her medical attire, the paramedics stopped when they saw her approach the gurney. She stood next to the man, her composure dissolving and her right hand shaking uncontrollably. He tried to speak again.

  “Hey baby, you wanna —”

  But his words stopped abruptly.

  Before she realized it, and to the amazement of the paramedics, Meg Daily, M.D., slapped the man’s face so hard that the gurney shook from side to side.

  Eli bounded down two flights of stairs from the surgical suite to the first-floor emergency room. He punched the five-digit code into the box and the doors opened to madness. Two police officers sat on metal folding chairs in the hallway beside an open door. Eli was greeted by a familiar sound in the ER, the clang of handcuffs against a gurney.

  A quick scan of the patient board informed him that she was already there—Margaret Daily, Bay 4E. At least she’s on the opposite hall, Eli thought, where it’s quieter, away from the criminally insane.

  He parted the curtain to find a flurry of white coats over the four-year-old girl. Meg stood to one side, arms folded, hands clenched, trying not to jump into the fray.

  Margaret’s body lay still. A nurse was attached to each of her arms, trying desperately to get an IV started. A resident poured Betadine across her left shin in preparation for an interosseous line.

  Eli walked behind Meg and placed his hands on the slope of her shoulders. He tightened his grasp when he felt her give way, welcoming the support. She reached back and cupped her hand over his. Eli felt short, blunt nails indent his skin.

  “I’ve got a twenty-gauge right antecubital,” a nurse called out in triumph.

  “Good,” said Dr. James Felding, the pediatric ER attending. “Start D-ten infusing at fifty cc an hour.”

  Dr. Felding approached Meg. “She should respond to this, but we don’t know how long she’s been down.”

  “They said she was jerking her head back and forth at day care.” Meg spoke in short gasps, forcing back tears.

  Felding nodded in confirmation. “Her blood glucose was undetectable when she arrived. I’m sure she had a seizure.”

  As he said this, the little girl moved for the first time, turning her head to the side to vomit.

  Meg rushed to her daughter and wiped the stream of yellow fluid from her mouth. She pushed fine dark curls away from Margaret’s pale face.

  Dr. Felding addressed the team of doctors. “Let’s get her to the ICU for monitoring. To Meg, “She’ll make it through. This time.”

  CHAPTER TEN

  NATHAN BEDFORD FORREST PARK

  MEMPHIS

  TUESDAY, 12:50 P.M.

  Harvey Stone sat at a picnic table waiting for his associate. He felt the weather-beaten wood on his fingers, deep ridges cut by a thawing freeze that lifted flat splinters, poised to pierce. He tested the point of one against his finger, pressing harder and thinking of the implications of the deaths.

  Two in less than twenty-four hours. Coincidence? Sure. Had to be.

  Then the wood punctured the center of his fingerprint and drew blood.

  The meeting was arranged for one o’clock in the afternoon, but not in a smoke-filled chamber lined with oak paneling and a long table from which to sip dark roas
t coffee. This meeting would take place in the middle of two acres of preserved greenery in a concrete world, research hospitals on one side and a parking lot on the other. The boardroom would have implied the necessary involvement of other company members, employees who didn’t have the “need to know” at this point. And the subject of this meeting could be classified as premature knowledge that, among the uninitiated, would at first alarm, then spread like fire in an oxygen-saturated tent.

  It was ten minutes to one and Stone was early. He was always early, one of his trademark virtues. First to arrive each morning at company headquarters, at his desk, always, by six A.M. Harvey Stone, the CEO of

  GlobeVac International for over two decades, had reached a point in his career when he could take chances. Big chances.

  GlobeVac had its standard line of drugs ranging from antireflux to chemotherapy, which boosted the bottom line quarter after productive quarter. But it was the company’s vaccine development that had garnered worldwide attention. From campaigns to vaccinate Third-World children to the production of a consistent supply of flu vaccine for U.S. citizens, it was this aspect of his company of which Harvey Stone was most proud.

  He had weathered the storms of acquisitions, lawsuits, and last year’s merger with the state-of-the-art biomedical device firm, Regent Biotech, to form Regency Biotech International. A sexy new name and global appeal. And with this merger, one of the largest in biopharmaceutical history, RBI’s stock soared to an unprecedented level. While the credibility and worldwide acclaim came from the company’s history of vaccine production for Third-World care, the profit margin was largely based on a single device, the AortaFix graft, predicted to revolutionize the treatment of aortic aneurysms.

  In the early years, Stone’s company had conducted experiments on an endovascular device, the forerunner of what would ultimately become the AortaFix developed by their sister company, Regent Biotech. The eventual merger benefited both companies. Regent Biotech needed the marketing support of well-known GlobeVac International and Stone’s company needed a financially lucrative product. The device was a windfall for the company, placing RBI in the upper echelon of biotech power. Now, Stone was ready to take his company to an even higher level.

  Embryonic stem cell therapy was the next biomedical frontier. These earliest cells, taken from a several-day-old human embryo, had the potential to grow into any type of human cell. Careful manipulation in RBI’s research facility could transform these immature cells into functional adult cells that could be ultimately transplanted to cure human disease.

  Stem cell therapy using adult cells from the bone marrow had been used for years to treat hematologic malignancy such as leukemia. While there was no moral controversy surrounding the use of adult stem cells in medicine, these cells did not hold the same curative potential as embryonic cells that could be “told” what kind of cell to become. But adult stem cell therapy did not require the destruction of human embryos. Undaunted by this obstacle, Stone had vowed, at a recent shareholder’s meeting, that RBI would be the first to conquer what many believed to be the future of medicine.

  Many of RBI’s top competitors had ratcheted down their embryonic cell research and were focused instead on engineering adult skin cells to mimic the embryonic stem cell. While this approach garnered federal funding and tempered the moral debate over the destruction of human embryos, the research with adult stem cells had proceeded slowly, with mixed results. Some early genetic manipulation experiments had produced embryonic-like cells from adult cells. But a proportion of these induced stem cells lacked important internal regulatory signals, the cells ultimately dividing out of control, like a cancer.

  Stone had grown impatient waiting for this embryo-preserving approach to result in curative therapy. While both pharmaceutical companies and academic centers withdrew resources from human embryo research, Stone diverted every possible dollar into RBI’s embryonic stem cell program. He told the investors that when RBI claimed the medical revolution of embryonic stem cell therapy, no biopharma-tech company would come close to their stratosphere. The plans were in motion. If he could just keep the right-to-lifers off his company’s back long enough to collect a freezer full of human embryos.

  His thoughts plunged back to the two deaths. Harvey Stone had never doubted his decision to merge with Regent Biotech.

  Not until now.

  Through a stand of oaks, he could see the Confederate Civil War general atop his horse looking south across Union Avenue, a manicured marble beard and mane of hair falling heavily around his ears. Stone considered the irony of Union Avenue forming a barrier to Nathan Bedford Forrest’s reign. But his attention was diverted away from history to the figure of a man ambling toward him, a burlap sack slung over his right shoulder.

  “Spare some change mister?”

  Alarmed at the suddenness of the man’s appearance, Harvey searched his empty pockets and removed a five dollar bill from his wallet. This appeased the man, and he stumbled away toward a racing green Jaguar that pulled to the curb at Manassas Street.

  Alexander Zaboyan, RBI’s first vice president, exited the vehicle carrying a black briefcase that matched a full-length overcoat. He certainly looks the part, Harvey thought, admiring the northeastern wear that Zaboyan had brought with him a few months before from New York, Regent’s home for the past seven years. Even though Harvey wore a short-sleeved golf shirt and sat in the shade of tall oaks, he was sweating in the humid park, where nothing stirred except a couple of squirrels in a garbage can. He looked again at the figure in black approaching. Black coat, black pants, Memphis summers.He’ll learn.

  As he walked, Zaboyan stroked the sides of a finely trimmed goatee. Stone had observed this gesture, this stroking, petting motion of his, any time that a power move was at hand—which included whenever Alex Zaboyan had a lot to lose. He sat down on the bench across from Stone and flipped back the wings of his coat like a gunslinger.

  “Quite an auspicious setting for a conference.”

  “Just wanted you and me on this one,” Stone replied.

  Zaboyan looked at the empty bench beside him. “You got me,” his hand stroking his face. “What’s the agenda?”

  “Two items.” Harvey Stone slid a plain manila folder along the corrugated wood between them, removed a sheet of paper, and handed it to Zaboyan.

  “First is a Mr. Bernard Lankford; some of us knew him as Bernie.”

  Zaboyan examined the paper, which displayed a picture of Lankford with a description of his biomedical device below.

  “Yes, tragic. It was all over the TV. Overseas wasn’t it?”

  “St. Martin.”

  “Ah, yes.” Another stroke of his beard.

  “Uncanny that he died just a few months after having his aneurysm repaired with one of our own grafts.”

  Zaboyan did not respond to this.

  “For the past five years,” Stone continued, “Bernie has been developing our Stem Cell Division. We had investors pouring in money from all over the world. We were right on the cusp of the first stem cell transplant.” The CEO leaned forward as he made his conclusion. “Now, we’re dead in the water.”

  Zaboyan exhaled and leaned away from Stone. “I didn’t know him that well, but they say Lankford was a superb scientist. A very likable man.”

  Stone ignored Zaboyan’s accolades as if they were unworthy. “The second is a fellow named Gaston. . .” Harvey hesitated until the sheet of paper was in the hands of Zaboyan. “This one didn’t make the nightly news. Just an old man.”

  Zaboyan cleared his throat and pinch-rolled his chin hair as he looked at the information before him. The spec sheet listed Gates Memorial as the institution that had placed the aortic device in 1975. It was the first model and was placed in Gaston even before the experiments in animal models using pigs were completed. Besides Stone and Zaboyan, only a handful of people knew about Gaston. Most of those-in-the-know were dead.

  “Harvey, you know as well as I that device failure
can occur. It’s on every device label—in plain English.”

  When the device was first approved by the FDA for the treatment of abdominal aortic aneurysms at risk for rupture, vascular surgeons were skeptical. Could threading the device through the vasculature and allowing it to expand inside the aorta replace the traditional method of sewing in a synthetic graft through a large abdominal incision? But when patients on the trials showed fewer complications and were able to leave the hospital after a day or two, use of the device became common, and patients began to request the less invasive method. Since the approval, thousands of aortic aneurysm patients had been walking around with confidence that they were safe from the catastrophic event of aortic rupture. For the CEO of RBI and its vice president of device production, maintaining that confidence was paramount.

  Zaboyan continued to make his case. “And besides, who says it’s the device? These patients all have a plethora of diseases that could kill them—diabetes, coronary artery disease, or a recurrent aneurysm. I’m confused, Harvey. What’s the big deal?”

  Harvey Stone handed a third sheet to Zaboyan. “I misspoke. There are three items on the agenda.”

  Zaboyan read the handwritten, paragraph-long memo from the company’s chief legal counsel. “This surgeon —” Zaboyan stopped to find the name again. “— Branch. He is asking questions.” Again at the memo, goatee twisted in a tight twirl. “Based on one case? This old man, Gaston? What the hell, Harvey?”

  “I’m not sure he knows all the questions to ask—yet.” Stone cleared his throat for emphasis. “You see, Branch knew Gaston. He worked in his father’s anatomy lab on campus for three decades.” Stone looked behind him at the medical school, and for emphasis he pointed in the direction of Anatomy Hall. “Then, as surgeons are apt to do, Branch operated on the old man. Pulled out the AortaFix when his aorta ruptured around the device.”