STALKING THE DARK DANDELION

            When those who are entrusted with the public health put profits above people,

bad things happen

Sharon strides down the colorless hallway of the Ambassador Suites Hotel. Its claim to fame lies in hosting today’s Freestanding Ambulatory Surgery Center Association Trade Show each year, in Franklin, Massachusetts. Up ahead, from the grand ballroom, voices of health workers and pharmaceutical reps plying their wares bubble up the corridor like soda exploding from a bottle. She pauses at the entrance to get her bearings.

“You just missed the chorus line. If you stick around, you might catch the encore.”  Sharon looks left to find a dark-haired man in a three-piece suit lounging against the back wall. His smile reveals startling good teeth. She smiles back. 

“Nicholas Ambrosini,” he says, extending his hand. “Actually, Nick. Pharma rep extraordinaire for the Good Life Compounding Center in Braxton.” He flicks a business card into view in one deft, nearly magical motion.

“Ummm, impressive,” Sharon says.  “Is this your M.O?  Ambushing potential clients right at the front door?” Sharon grins, taking his card. “Sharon Swan, smart-ass nurse and facility director at New Horizons Outpatient Neurosurgery Center here in Franklin.”


“Umm, impressive yourself. Actually, I was taking a break. You interrupted my reverie, otherwise known as tuning out.”

“As I recall, you spoke first.”

“Only a dead man could ignore you,” he replies, pushing off from the wall.

“What? You’re not even going to try to sell me?” Sharon calls after him, oddly disappointed, yet somehow relieved.

“We’ll see each other again out there in the fray, I imagine. I’ll wait till you’re surrounded, then I’ll rescue you,” Nick chuckles, stepping away. Sharon strains to follow his silhouette until it melts into the crowd.


Spending the day wheeling and dealing with industry salespeople is exhausting. Greeting old contacts, glad-handing new ones. By the end of the day, she’s juggling gadgets, business cards, and pamphlets with both hands.

“You haven’t needed rescuing all day,” Nick says, suddenly stepping up to unburden her.

“I try not to get in positions where I require rescuing,” she says, offering up her day’s accumulation.

“You plan to spend a lonely night in your hotel room, or are you up for some company and dinner?”

Sharon wonders if he is asking a bigger question.

“If you’re nervous, I can throw in my sales pitch over dessert. A twofer!” he quips. “Game?”



Sharon laughs in spite of herself. “I never could resist a bargain. I suppose, as long as we don’t leave the hotel.”

“Hotel restaurant?”

“Fine.”



“The bar in thirty minutes?”



“Make it forty-five.”

Sharon is hastily freshening up in her room when her cell phone zings to life. It’s a message from her boss, “SAVE US MONEY!”




***




Nick raises his glass in a toast. “Here’s to our very first date, which could be the beginning of a long and beautiful relationship.” 



“I assume you mean financial.”  



“Well, that maybe depends on you,” he winks.

 “Financial,” Sharon laughs. 



Nick nods in response. “In that case, allow me to demonstrate my powers of persuasion!”

It’s purely business, Sharon sighs, but relaxes, enjoying his company.

 Nick proves to be funny and warm. After dinner, he waves down the dessert cart. “I promised you dessert,” he says, smiling broadly. 



“That’s not all you promised.” 


“Have I forgotten something?” 



“Your pitch! You promised to pitch me over dessert!” she laughs again. It feels good to laugh.


“So I did. What have you come looking for?” he asks, his eyes twinkling. 

“What have you got to offer?”

“Financially? I thought you’d never ask!”

 The two burst out laughing, unable to continue the banter.

“You know, seriously, if I can talk business for a minute, you probably use a lot of steroids in your pain management program right?” Sharon nods, so Nick continues, “I bet I can beat what you’re paying now. I’ve got an injectable methylprednisolone acetate solution that I can make a good deal on.”

Sharon is intrigued. Much of her clinic’s workday is spent injecting steroids into hips, joints, and backs. Maybe she’d lucked into a great alternative to the usual pharmacies her outpatient center uses. By the time coffee is served, the two have hammered out a deal that will save her company $1.33 per vial, and she is completely charmed by Nick’s natural good looks and good nature.

“Here’s to fabulous first dates!” she says finally, raising her cup to seal the deal. Nick toasts in reply. 



***


Mark Fisk, a supervisory pharmacist at Nick’s company, GLCC, steps over a dirty mat in an area known as the Clean Room. He prepares a 12.5 liter stock of the injectable steroid, methylprednisolone acetate. 

Proper sterilization procedures require exposing the drugs to high-pressure saturated steam at 121 degrees in an autoclave for at least twenty minutes. Fisk uses the autoclave for only fifteen, five minutes short of the minimum time required—a shortfall that, if extended over an eight-hour day, will allow for at least two extra batches of drugs to be produced.  Fisk extends this autoclave shortfall not for just one day, and not for two. Fisk extends it for seven months. Throughout all this time, unbeknownst to his own pharma rep, GLCC is making millions of dollars by cutting corners, and sending contaminated medicine out into the world.

***

Like any good salesman, Nick calls Sharon at least every few months. “Hey! How’s my perfect first date?” he jokes, which makes Sharon smile every time. They always flirt shamelessly, but today Sharon disengages.

“Listen, I’d love to talk longer, but I’ve got challenging new patient I need to follow up on.”



“Anything interesting?”

“Well, it’s tricky. I’ve got a young pregnant woman who was sent by her OB for her hip pain, but her pregnancy presents problems, as you can imagine. We’re trying to manage her pain with the least effect on the baby. We’ve not been very successful so far, so assessing a next step. Probably steroids at some point, but not now.”



“Well, I know you’ll do what’s best. We’ll talk later. I might be able to visit this month.”



“That’ll be great!”

As Sharon hangs up the phone, down the hall, another of her patients, Mike Hutchins, is bracing for a spinal steroid injection for a slipped disk. The doctor unwraps a sterile syringe, inserts it into a vial of liquid steroid from GLCC, and pulls back the plunger. He then carefully slides the needle into Hutchins’ back.

Sharon is making follow-up calls when she learns their long time patient, Eddie Chin, is barely clinging to life at University Hospital. His wife tells Sharon he’d suffered a mild stroke but had been expected to recover. Then his health plummeted. She and her children had been clinging to the belief that he would get better, but now, less than a month after his last steroid injection at New Horizons, they were gathering to say their goodbyes. Sharon offers condolences and solemnly whites out his name in the appointment book.



After lunch, she looks up to see one of the 2:30 appointments waddling through the front door. Maria Rojas’ pregnant belly proceeds her. “Hi Maria, how are you today?”




“The same,” Maria says. “My doctor’s being cautious about steroids until I’m farther along. I’m praying today’s the day he’ll tell me they’ll be okay. I can hardly stand the pain anymore.”



“Well, I hope you get good news.” 



“Me too,” Maria says, turning down a nearby hallway. Fifteen minutes later, she’s back, shoulders slumped. “Still too early,” she says, clearly on the verge of tears.



“I’m sorry, Maria,” Sharon says. 



 
*
**

Dr. April Stearns is perplexed. A thirty-five-year-old internist at University Hospital, she has been reviewing the medical records of newly admitted Mike Hutchins, and nothing makes sense. Hutchins had come to the hospital complaining of nausea and fatigue. After blood tests, a spinal tap, and a CAT scan, the team had diagnosed him with community-acquired meningitis, loaded him up with antibiotics, and sent him home. Now, he is back. His speech is incomprehensible. He is agitated and suffering headaches. “I’m ordering another spinal tap,” Dr. Stearns informs his family.  She follows that with an order for intravenous antibiotics.  Again Hutchins rallies, but on his sixth day in the hospital, he shows signs of seizures and his face droops.

Stearns has a thought—a long shot. Bacteria is the most frequent cause of meningitis, but could the problem be far rarer? She orders a re-examination of Hutchins’ spinal fluid. The results come back positive for Aspergillus fumigatus, a fungus usually found in decaying organic matter, like a compost heap. Somehow, it is growing inside this Massachusetts machinist, slowly killing him.

Doctors quiz the family about anything unusual he might have done in the weeks before the symptoms appeared. Someone mentions his steroid injection at New Horizons and it is duly noted in his records.

As the doctors work on piecing the puzzles together, the fungus from GLCC is tearing Hutchins apart. Brain tissue dies as vessels became blocked or leak. On the eleventh day, he abruptly becomes unresponsive and starts shaking his head rhythmically. He is placed on a ventilator, but his brain starts to swell. Doctors cut a hole in his skull and set up a catheter to drain excess liquid.  His seizures continue.



The next day, Doctor Stearns is still battling to correct Hutchins’ deteriorating condition. She emails the Tennessee Department of Health with a copy of the lab results showing the fungal infection. State officials immediately ask for more information.  She sends them her patient’s records. They notice the notation about the steroid injection, and call St. John’s Hospital, where the New Horizons Outpatient Neurosurgery Center is based.  They discover doctors there are treating two other patients for meningitis besides Hutchins. No one has connected the dots to Eddie Chin.

 Health official scramble to identify the source of the outbreak. A query phone call to New Horizons is forwarded to Sharon Swan, who immediately follows up on her out-patient Hutchins’ present condition. With shaking hands, she picks up the phone.

“GLCC. Nick Ambrosini.”



“Nick! Something’s happened!” Sharon cries, with barely controlled panic.



“What? No lively banter? So unlike you...”

 “NICK!” Sharon interrupts. “The CDC just called our facility about a meningitis outbreak. Do you know anything?”



“What did they say?”



“They’re asking about contaminated medicine. They think some of my patients have been infected.”

“WHAT?”



“They’re DYING, Nick! Do you know anything about this? Have I been wrong to trust you?”



“Sharon, I promise I don’t! Maybe my director knows something. Shall I ring him?”

“Put him on NOW!” Sharon commands. “I’ll get my director in on the call. We need answers!”

“Hold on.”

 Sharon and her boss drill GLCC’s director concerning the outbreak.

“This could not possibly be coming from us,” he states confidently, adding that his company complies with all sterility procedures in their state-of-the-art facility. “You should come for a visit,” he suggests. 

They take the director at his word, leaving themselves still unaware that lurking inside their surgery center’s newest vials of methylprednisolone, a deadly fungus, which under a microscope would resemble a monstrous dandelion, floats.

Within twenty-four hours, state officials alongside the U.S. Centers for Disease Control have identified eight patients with meningitis, all of whom are thought to have received steroid shots at New Horizons. A state official calls GLCC to inform it of the investigation and to identify lot numbers, but GLCC executives insist there have been no other complaints about their drugs. 

 

The next morning, state health agents raid GLCC. They are horrified by what they find. While employees are desperately scrubbing the Clean Rooms with bleach, the filthiness of the place cannot be covered up. A leaky boiler stands in a pool of stagnant water; powder hoods, designed to suck microscopic particles out of the room are covered with dirt and fuzz; and the air intake comes from vents that are thirty yards from a dust-spewing recycling plant. It’s a hotbed of contamination.

They shut GLCC down and confiscate numbered lots of steroids, announcing a massive recall, but it is too late. This same day, Eddie Chin loses his battle and becomes GLCC’s first casualty.


***

Maria Rojas has finally reached the gestation point at which her baby might safely tolerate a small steroid solution.  While she is preparing for her afternoon appointment at New Horizons, officials at the CDC receive the worst possible news. The outbreak is not limited to Massachusetts. Reports are coming in from North and South Carolina, Tennessee, Michigan, and Georgia. Two-hundred, seventy-three people have been hospitalized so far, with thirteen already dead. This number is bound to rise.
 Maria arrives at New Horizons and initials the sign-in sheet.

“How are you feeling, Maria?” Sharon asks the now familiar patient. 



“Hangin’ in there,” Maria replies, although Sharon can see the pain etched into her face.

“Well, hopefully, today you’ll get some relief. You’ve done well, for the sake of your baby,” Sharon tells her.

“God. I hope so. It’s been hell trying to make it through this much pain for so long. With every pound I gain, it just gets worse. I wasn’t sure how much longer I’d be able take it. My baby’s reached the stage where the doctor thinks we can try a tiny dose and we should be okay.” 


“Got my fingers crossed for you, honey,” Sharon says, standing to give Maria a hug and point her down the hallway to examining room #6.



“Well, today’s the day we’ve been waiting for, Maria,” her doctor says, as his nurse sets a vial of liquid steroid labeled GLCC-Lot#055721 on a metal tray, then fishes in a drawer for a syringe. “I’m being very conservative, starting with the smallest possible dose. Are you ready?” he asks. The nurse unwraps a sterile hypodermic and proceeds to draw filmy liquid up into its cavity.



“I’m ready,” Maria replies.



Sharon has just returned to her paperwork when the jangle of the phone makes her jump. The words ‘Good Life Compounding Center’ light up on her caller I.D. 

“What’s up, Nick?”

“Sharon! Something terrible has happened…”

Nick’s next words are so loud that Sharon has to hold the phone away from her ear.  “IT’S THE METHYLPREDNISONELONE!”

Sharon’s face blanches from healthy pink to chalk-white. “Oh my God. MARIA!”

Flinging the phone aside so hard it shatters, she launches herself like a torpedo from behind her desk and bolts for examining room #6. 

Inside, the nurse hands over the syringe containing the poisonous steroidal concoction as Maria winces prematurely and covers her eyes, readying for the prick.

With a resounding crash, the door to the exam room hurls open.

“STOOOOPPPP!” Sharon bellows as she lunges forward to protect her patient.




***


A month later, at a corner table in the Café Bellissimo, Sharon struggles to say what’s on her mind.  “Your phone call saved my patient’s life,” she tells Nick, looking deep into his eyes. 



“I finally found a way to rescue you,” Nick says, bowing to kiss her hand.

~ by taree Belardes

NYC Short Story Contest 2017

1 week, 2500 words,

Genre:  Thriller

Subject:  A first date

Character to include:  A pharmacist