Malice by design, p.19
Malice by Design, page 19
Jack chuckled. Raising his hands, he briefly positioned them as if he were going to strangle somebody. He then reached for his phone and made the call.
“Hi, Jack. I was wondering when I’d be hearing from you. What’s up?”
“Sorry to bug you, but Madison and I need another huge favor. What’s your schedule looking like for tomorrow?”
“My afternoon’s pretty packed, but I was planning on taking the morning off.”
“If we drive down early, can you give us a half hour or so of your time? There’ve been some developments here at Oster that we’re very anxious to get your input on.”
“I have a better idea. I’m going flying in the morning. Since, I don’t have a particular destination in mind, I’ll meet you guys at the airport in Defiance. We can talk there.” Jack had almost forgotten Leo had served as a Marine Corps pilot. When he was discharged, he decided on medicine as his next career, but he never lost his love of flying, and to this day, he remained an avid pilot.
“Great. What time?”
“Meet me at CAS Aviation at ten.”
“We’ll be there,” Jack said, sending a thumbs-up Madison’s way.
Chapter 51
Jack and Madison had been sitting in the lounge of CAS Aviation for about fifteen minutes when Leo came through the door carrying his flight bag. The same age as Jack, he had smiling blue eyes and a slight ripple to his nose. Never high-minded or calculating, he’d always been a good friend to Jack, willing to roll up his sleeves and help with any tough clinical problem.
“How was your flight?” Madison asked, as he sat down across from them.
“It was okay, but flying’s no fun unless somebody’s shooting at you,” he answered with a wink and a grin before tucking his sunglasses into the inside pocket of his shirt pocket.
“Spoken like a true military pilot,” Madison said, thinking of her cousin who flew for the Navy and how many times she’d heard him say the same thing.
Leo reached down and petted Moose’s head. “Hey, pal,” he said, scratching his ears. He glanced up at Jack while Moose flopped down at his feet. “Do you go anywhere without this pathetic creature?”
“He’s my good luck charm.”
“Try a rabbit’s foot. It’s cheaper and drools less.”
“I’ll have to think about that.”
With intrigued eyes, Leo said, “So, tell me about this new information you’ve come across.”
Jack and Madison spent the next few minutes briefing him on what they’d discovered regarding Eshan Moga’s strange clinical improvement after receiving a blood transfusion from his cousin.
“In a nutshell, the major research centers with a strong focus on prion infections haven’t taken much of an interest in prion neutralization,” Leo explained.
“Is there any serious work at all going on in the U.S.?” Madison asked him.
“There is a privately funded research facility in Montana that works on prions exclusively. About two years ago, they began an entry-level study to look into prion neutralization. Six months ago, they reported their early results at our national meeting. Most of us expected to hear that they’d dismissed the possibility of its existence, but that’s not exactly what they reported,” he explained as he stretched his lanky legs out to their limits. “They didn’t jump up and claim they’d made the most important breakthrough in prion research history, but they did say they couldn’t rule out the possibility that prion neutralization could take place under the right circumstances.”
“Which would be what?” Jack asked.
“Well, the biggest factor is the individual strains that are mixed together.”
Jack asked, “Have they started the FDA approval process?”
“They’re light-years away from that.” he answered, drawing his legs back in. “Why am I getting the feeling you two didn’t invite me up here to have a hypothetical conversation about a highly experimental and untested treatment of prion diseases?” When a deafening silence followed, Leo began tapping the corner of his mouth. “I was afraid of that.”
“Theoretically speaking,” Jack began, “could your laboratory prepare a mixture of the two prion strains that would be suitable for intravenous administration to our leukemic malnutrition patients?”
“I thought that’s where you were headed,” he answered. “Okay, from a purely theoretical standpoint, it’s possible, but without FDA approval, the only way you can give the second prion strain would be under the blanket of humanitarian use.”
“We’re in a dire situation,” Jack stated. “I can’t be certain, but I think if the use of prion neutralization is explained carefully, with full disclosure of the risks, the powers that be at Oster would give serious consideration to offering the treatment to the parents, citing humanitarian reasons for justifying its use.”
“I wish I could offer an informed opinion on that, but I can’t.”
“I hate to pin you down, but if Oster agreed to sign off on prion neutralization, and the parents gave their written consent, is there any chance your lab agree to prepare the infusion?”
“I don’t know. It’s not my decision alone, Jack. I’d have to pitch the idea to our board.”
“What’s your best guess?” Madison asked.
He edged forward in his chair. “As long as we dot every i and cross every t regarding its use for humanitarian reasons, I think they’d probably give the idea the go-ahead.”
“What about the technical aspects of preparing the infusion?” Jack inquired.
“I’d have to get in touch with the folks in Montana, but if memory serves me correctly, the process they used to prepare and administer the second strain of prion wasn’t very complicated. Let me know what your administration says. I don’t see any reason to approach my people until you give me the word you have the approval from yours.”
“It’s a deal. “I’ll speak to our leadership today. We’ll give you a call as soon as we know something.” Jack stood up and shook his hand. “Thanks for everything.”
Leo reached down and picked up his flight bag “If you guys pull this off, I’ll expect you to take me out to the best steak dinner in Columbus.”
“You name the restaurant,” she said.
Jack and Madison watched as Leo exited the building and crossed the flight line toward his Cirrus SR22.
“How do you feel about all of this?” he asked Madison, as they headed toward the parking lot.
“There’s no denying that we’re almost out of both time and options. I think we’re obligated to present the treatment plan to Althea. Where she chooses to take it from there…well, I have no idea.” She held her thought for a moment. “You know what I was thinking about when we were speaking to Leo? Wouldn’t it be interesting if the two strains of prions we’ve isolated at Oster turned out to be the same ones Dr. Hartmann used in her experiment?”
“You must be reading my mind. I was thinking the same thing.” Removing the fob from his pocket, he unlocked the van. After Moose hopped in, Jack looked at Madison across the roof. “This is the longest longshot I’ve ever been involved with.”
“Maybe… but it kind of brings to mind what Wayne Gretzky was famous for saying.”
“Excuse me?”
“He said you miss a hundred percent of the shots you don’t take.”
Chapter 52
Jack and Madison exited their van in downtown Defiance and walked across Front Street to the entrance of Old Fort Defiance Park. The historic Revolutionary War site marked the former location of the fort by the same name. The park with its pathways along the Maumee River was considered by most locals to be Defiance’s most popular tourist spot. Madison had always been an American history buff and had actually read about the park when she first arrived in Ohio.
As soon as they came through the entrance, they spotted Althea jogging in place. She dropped to a walk, and a guarded smile accompanied her gesture for them to join her.
“Thanks for seeing us on such short notice,” Madison said, taking a second look at the Ohio State University hoodie she was wearing.
“You’ve discovered my secret hideaway. I try to get in an afternoon speed walk a few times a week.”
“Your secret is safe with us,” Madison assured her with a grin.
“Let’s take a stroll,” she said, pointing toward one of the paths that followed the River. “You sounded a little urgent on the phone. This is not exactly my preferred location for holding meetings, which means I’m very anxious to hear what you’ve discovered.”
Madison took the lead. “Several months ago, three patients with leukemia suddenly became seriously ill and died. Max Kubicek was one of them.”
“I’m quite familiar with those cases.”
“Then you also know the cause of their deaths remains a mystery. After reviewing their cases in detail, Jack and I were suspicious they’d died of a prion infection. The Oster lab had frozen a few tubes of blood from each of them, which we were able to acquire and send to Leo in Columbus. His lab positively verified that the samples contained a prion, but they also confirmed it was a different strain than the one that’s causing leukemic malnutrition.”
“Good god,” she said coming to a stop. “Is it really possible this problem is getting worse? Who else knows about this?”
“I obviously can’t speak for the lab personnel, but besides Leo and the three of us, I don’t know of anybody else,” she answered.
“And I assume you’re comfortable that Leo can be…”
“I’m comfortable we can rely on his discretion,” Jack assured her.
They began walking again and strolled past a crooked wooden flag pole displaying an American flag.
Jack continued, “As hard as it might be to believe, there may be a silver lining to all of this.”
“I admire your optimism. I’d be interested in hearing what that could possibly be.”
“We think it’s possible that the discovery of the second strain could offer us a clue to a treatment,” he said.
They continued at a relaxed pace along the river. Madison was surprised Althea had reacted as calmly as she had to the news, prompting her to wonder what her initial reaction to their proposal would be. They took the next few minutes to explain the details of prion neutralization and its possible use in treating leukemic malnutrition.
“So, this…this prion neutralization theory has never been verified, but a research facility in Montana is presently doing embryonic work on it.”
“That’s correct,” Jack said.
“And I assume the FDA process of approval is nowhere close to even being started.”
They each nodded in response to her rhetorical question.
Althea slowed her pace and stopped to lean against a black cannon that overlooked the confluence of the two rivers.
“I’m neither a researcher nor an expert on prions. I’m a simple pediatrician. But the idea of curing a deadly prion infection by mixing it with another strain, which is just as lethal… Well, it strikes me as an idea that’s disconnected from rational medical thinking.” Her chin dropped and she added, “Are you two asking me to seriously consider approving the use of this dangerous and unproven treatment.”
“We’re here to share with you that, from an operational standpoint, Leo feels his lab can produce the infusions,” Madison said. “The decision to proceed with is entirely up to you and the Oster leadership.”
“You’re tap dancing. I’m asking you to tell me what you think of the idea.”
Madison took a couple of steps closer. “These kids are getting worse by the hour. This would be a hundred-to-one shot but we have nothing else to offer them.”
“Well, that was direct,” she said. “I hope you both realize that it’s quite possible, if we decide to go ahead with this plan, the FDA and the Ohio Medical Board will come after us with pitchforks and lanterns.”
Jack offered, “In an otherwise hopeless situation, humanitarian reasons can justify the use of non-approved treatments. It’s both ethical and legal.”
“I’m aware of the doctrine, and I assumed you would bring it up, but even so, the scale of what you’re proposing would be unprecedented.”
“What’s the alternative?” Jack was quick to ask. “The best minds in this hospital agree that leukemic malnutrition will prove to be fatal in all cases in a relatively short period of time. More importantly, there’s absolutely no other treatment option on the horizon. At least from a theoretical standpoint, prion neutralization has a chance.”
“I understand we’re in dire straits, but we have to be vigilant and not allow ourselves to become the victims of some senseless panic.” Althea’s shoulders slumped like an exhausted prizefighter. She massaged her brow and let out a heavy sigh of capitulation. “I’m going to set an emergency meeting of both the focus group and the board of trustees. Let’s at least see what they think of the idea. I’m going to need your help at both meetings. I’d like to have a go or no-go answer on this within the next twenty-four hours.”
“As we mentioned, Leo is standing by. If we get the go-ahead, we’ll call him immediately,” Madison said.
“Let’s confine our description of the treatment to the research being done in Montana, Leo’s willingness to help, and the article from the Russian literature. I’d prefer to keep the existence of Dr. Hartmann and the contents of her journals strictly between the three of us for now. If I’m right, this proposal will be contentious enough without throwing that oddity into the mix.” She gave the cannon’s black muzzle a couple of pats. “I’m going to finish up my walk, do a little more thinking on this matter, and then call Robert. I’ll let you know what his reaction is as soon as I speak with him. It’s possible he might kill the whole idea right there on the phone, which would obviously mean no meetings will be necessary.”
“Is that what you think he’ll do?” Madison asked her directly.
“Knowing Robert as well as I do,” she said with a wave of her hand. “I don’t believe that’s what he’s going do, and I’ll further predict the three of us will be attending an emergency meeting of the entire board before you can say prion neutralization.”
Madison held up crossed fingers as the corners of her mouth rounded into a smile.
“By the way, Madison, do you two know who built Old Fort Defiance?”
“It was General ‘Mad’ Anthony Wayne.”
With a note of surprise in her voice, she said, “That’s absolutely correct. I only hope when this thing’s over my medical colleagues don’t assign the same nickname to me.”
Chapter 53
The Oster executive auditorium was used exclusively by the hospital trustees and board members for their meetings. It was an ultramodern space containing plush theater-type seating for sixty people, integrated lighting, and a high-end video conferencing system. When Jack and Madison entered the room, all of the trustees were already seated on the podium. Kendric and Althea sat center stage, directly facing the audience. Jack and Madison settled into a couple of seats that had been reserved for them in the first row. There wasn’t an empty seat in the auditorium.
Each of Oster Children’s Hospital’s five board members served without financial compensation. Being appointed to the board was an honor, and it went without saying that each new member was expected to make a generous yearly contribution to the Oster Family Foundation. The only Oster family member on the board besides Robert was Sarah Oster Everson, his first cousin. She had never demonstrated much of an interest in the family’s business interests, but she was passionate about its many philanthropic initiatives. Robert made no secret of the fact that he only intended to serve as chair for another year or two, and it was his strong recommendation that Sarah succeed him.
“I’d like to call the meeting to order,” he announced, striking the gavel against the sounding block twice. The side conversations subsided, and the room faded to silence.
“The purpose of tonight’s meeting is to discuss a possible treatment for leukemic malnutrition. This illness has unquestionably been the most difficult and challenging problem our hospital has ever faced. It has evoked a tremendous amount of emotion, not only in our patients’ families but in the entire Oster staff as well.” Robert paused and adjusted his butterfly-style bowtie. “I’d like to make it perfectly clear from the outset that we shall not approve any treatment plan unless it has the unconditional support of our physician leadership. That being said, I’d like to turn the meeting over to our chief of staff, who’ll brief us on this innovative treatment.”
“Thank you, Dr. Oster,” Althea said, pulling her microphone a few inches closer. “As you already know, we have conclusive evidence that the cause of leukemic malnutrition is a previously unrecognized prion disease. We now have good reason to believe that several months ago three of our hospitalized patients died of an infection caused by a different prion strain.” As soon as the buzz in the conference room subsided, she continued, “Recently, we’ve learned that there may be an experimental intravenous infusion that could be an effective treatment for the disease.”
As Jack listened to her explain the proposed therapy in detail, he suspected the board members weren’t listening to anything they hadn’t already been briefed on unofficially. Jack took special note of how cautious Althea was to make it abundantly clear that prion neutralization had never been tested in humans, and if the hospital decided to move forward with the idea, its use would fall under the umbrella of a humanitarian treatment.
“Thank you, Althea” Robert said. “I’d like to take as much time as necessary to offer our board members the opportunity to ask any questions they may have.”
Carson Bivens, an industrialist and real estate developer who had business interests in every county in Ohio, was the first member Robert recognized. Bivens, a man who never left anything unsaid, could be difficult and high-minded, but he was usually faster than his fellow board members to move on an issue.
