She stepped forward and extended her hand. “Dr. Pearson? I’m Karen Marks. Nice to meet you.”
Josh took the proffered hand. At first, he wondered if he was supposed to shake it or kiss it. He settled on the former, and she gave him what he decided was a politician’s handshake—grasp the other person’s hand as far in as possible, to avoid getting your own hand crushed; one quick squeeze, neither too strong nor too gentle; then release.
He figured that Karen Marks was probably slightly on the far side of forty, but she could easily be mistaken for thirty—that is, until you looked into her eyes. Within them he could see experience and something more. He wasn’t sure what else he saw, but it told him he didn’t want to challenge this woman.
“Please, sit down,” Josh said, indicating one of the two side chairs opposite his desk.
She smoothed the skirt of her perfectly tailored navy business suit and lowered herself with ease. “Jerry Lang explained you needed some . . . what did he call it? Oh, yes. Diphtheria antitoxin. DAT, I think he said. Anyway, I’ve talked with the CDC. Your antitoxin is in Houston. I arranged for Agent Gilmore to fly down, pick it up, and deliver it here.” She reached into her handbag and extracted a sheaf of papers. “I had these faxed here. After you’ve signed them, give them to Jerry or me and we’ll see they’re faxed back. The last two pages are instructions for administering the DAT.”
Josh had that feeling again, the same one he had in the limo when he first met David Madison. Things were going too fast for him. On the one hand, he thought he needed to regain control of the situation. On the other, he appreciated this newfound ability to simply say, “I need something” and it was done. No question, this was a different world.
“Thank you,” Josh said. “Did you have to use President Madison’s name?”
“I used his influence, but there was never any suggestion that the drug was for him,” Marks replied. “You’ll learn how to do that, too.”
Yes, and probably to lie and cheat a bit if I’m not careful. “Look, I’m happy that you got the DAT for President Madison and Miss Moore, but let me be clear. All I want to do is practice the best medicine possible. If there’s any political maneuvering to be done, I want to know about it ahead of time.”
Marks gave him a sweet smile that was totally devoid of mirth. She rose, smoothed her skirt, and picked up her purse. “I think you’re telling me to stand aside. Well, I promise I won’t challenge your medical judgment or interfere with your treatment. But I guess I should warn you, if you haven’t already got the message. I’ll do anything for David Madison.” At the door, she turned and said over her shoulder. “Anything!”
***
Josh found Allison Neeves in her office at the clinic. She was working her way through a pile of charts, dictating from a stack of notes scattered across her desk. Allison looked up when Josh tapped on the frame of the open door.
“Come in,” Allison said. “I checked on Rachel and she seems to be holding her own. But if we’re going on a presumptive diagnosis of diphtheria, we need to get her started on some diphtheria antitoxin.” She put down the chart she was holding. “And the same for President Madison, of course.”
Josh dropped into a chair across the desk from Allison. “Look,” he said, “this could get awkward, and I don’t want it to be. I’m Madison’s doctor. I didn’t lobby for the position, but I’ve got it. You know that he and Rachel probably have the same infection. I’d like to treat her too, but I agree that would present something of an ethical problem. However, you and I need to stay on the same page. Can we do that?”
“I think what you’re saying is that you’d like to call the shots for both patients, with me acting like your intern on Rachel’s case—writing the orders, reporting to you.” She leaned back in her chair and sighed. “I’ll try to cooperate, but you should realize that Rachel is my patient, not yours, and I have to make the final decisions about her treatment.”
Josh rose. “I don’t think we need to argue right now. That DAT should arrive—” He looked at his watch. “It should be at the hospital in a couple of hours. Is it okay if I write the orders for both patients to receive it?”
Allison shook her head. “Just call me when it comes in. I’ve already reviewed the protocol. I’ll check Rachel and write the orders for her; you take care of Madison.”
“If that’s the way you want it,” Josh said. He rose, turned, and headed for the door. I don’t know what I did to step on her toes, but I can’t worry about that. I’ve got to give David Madison the best possible care. And Rachel, of course.
***
“Mr. Madison,” Josh said as he entered the ex-president’s hospital room. “How are you feeling?”
“Not great,” Madison admitted. “My throat’s getting pretty sore.”
Josh noted a raspiness in his patient’s voice—something that hadn’t been there before. “Any difficulty breathing?” he asked.
“Not . . . well, maybe occasionally.”
“Okay. The diphtheria antitoxin has arrived, but before we give it to you, I have to ask you some questions, then do a skin test.” Seeing the confusion in Madison’s eyes, Josh said, “The DAT is made from horse serum, so I have to be certain you won’t have a reaction to it.”
Josh went through the litany, using the checklist he’d made so he wouldn’t forget anything. Hay fever? No. Asthma? No. Hives? No. Madison couldn’t recall previously receiving any products made from horse serum.
The skin tests were negative, as Josh expected. Now it was time. A nurse brought in a small bag of sterile saline and Josh added DAT to it. He attached a needle to the tubing and piggy-backed the mixture into the IV already in Madison’s hand, then started the material flowing.
“Will you be checking back on me from time to time?” Madison asked.
Josh inclined his head toward the upholstered chair in the corner of the room. “No. That chair reclines. I’m going to sit in it for the next several hours.” Madison didn’t realize it, but Josh knew that if anything went wrong, minutes—no, seconds—
would count. He looked at the crash cart in the corner. It contained everything needed to treat emergencies, including an anaphylactic reaction. Atop it was a wrapped set of sterile instruments for an emergency tracheotomy, an operation to open the obstructed airway of a patient. From its external appearance, the red-painted Craftsman rolling cabinet didn’t look particularly unique, but at this moment it was the most important piece of equipment in the United States. And Josh was the most important person.
***
As Ethan Grant prepared to leave for the day, he went through his usual routine, scanning the petri dishes one by one, looking for anything out of the ordinary. He knew that, like that of an airline pilot, his job here in the bacteriology lab of Prestonwood Hospital might be routine most of the time, but it had the occasional moment when he needed every ounce of skill and experience, because he was dealing with, quite literally, a life-or-death situation.
The round, flat glass dish he lifted from the incubator contained a gel-like substance on which scattered colonies of bacteria grew. This was the culture from a swab or specimen that would help him identify the organism and then define the antibiotic to which it was sensitive.
This particular set of plates wasn’t even twelve hours old. It would probably be tomorrow or the next day before Ethan could definitively name the species of bacteria growing on them and say with certainty what antibiotics would work best to treat the patient from which the specimen came. But despite the short time involved, these colonies were already growing more vigorously than usual. Ethan toyed with the idea of making a slide to see if the organisms on the petri dish were the same as what he and Dr. Pearson saw earlier that day.
Before he could act on his thought, the phone rang.