“Why? Your project is fully funded through the Harrington Society. You don’t need to answer to anyone else.”
“I’m not
answering
to anyone. They’re helping me. Vik, you don’t get it. It’s not like I’m transporting antibiotics around the world. The drugs I’m transporting could start an epidemic or perhaps even a pandemic if they fell into the wrong hands.”
“I thought your clinics were all about treating cancer.”
She smiled. “They are, but the drugs used in chemotherapy and radiation therapy could conceivably be used in more devious ways. You know the Harrington Cancer Treatment Centers receive donations from all over the country. It isn’t all funded through you. If it were, I doubt Stewart would be as open and giving.” She put her hands in the air. “I don’t know for sure. Call it intuition, but these drugs are expensive. Anyway, hospitals, doctors’ offices, and clinics welcome a legitimate way to rid themselves of expired or nearly expired drugs as well as equipment and other resources. They want a way to write off the expense for tax purposes and not eat the loss. There’s an entire facility here in Miami devoted to nothing but receiving and cataloging those donations. I need to match those donations with the needs at our clinic in Uganda. Some items are easier to get. I mean, as a whole, medications such as Cytoxan, a common chemotherapy agent, are frequently donated. However, the cesium radioactive pellets, like what went missing a couple of years ago, were not. The facility that donated those pellets expected and deserved the tax break they should’ve received from their donation.”
I nodded. I’d heard the story from other members of the foundation. Hell, I’d spent hours on the phone with the representative from the clinic that made the donation. I obviously knew more about it than she thought. After taking a sip of tea, I said, “That’s why we now have the checks and balances. To be honest, there’s no way of knowing for certain if that clinic ever really donated the pellets or if they only claimed that they did. For your information, I’m the one who spearheaded the new facility. Now, donations are accepted, cataloged, and receipts are immediately issued. Everyone knows exactly what’s happening.” I tilted my head. “Unfortunately, there’s a lot of potential for abuse with so many volunteers. Believe it or not, I’m rather fond of what you’ve accomplished with the Harrington Society. I love that you got this all started while still in med school. And I do know what’s going on, both from you and the board. They report to me. They always have. Stewart’s never cared about the money the Harrington Society has cost; he truly never gave a damn about the foundation. However, he did like the publicity. And…” I leaned forward. “…he wasn’t happy when that was tarnished. Since that incident with the pellets, I’ve made sure nothing like that can happen again.”
“Vikki, I wasn’t implying…”
“Yes, you were, and I understand. I know I’m not a doctor, but I know my way around the world of money, taxes, and philanthropic organizations. I was thrown neck-deep into that muck over ten years ago. I think overall I’ve done damn well.”
Val reached for my hand. “Stop. Of course you’ve done well. You’re kick-ass. I’m in no way insinuating lack of knowledge or your ability to oversee. I just mean with everything happening with Stewart, well, I know you have other things to worry about than if a shipment of Adriamycin or a vial or two of powdered Cytoxan has gone missing.”
“Are those things missing?”
“No. They’re not. They’re just drugs that could be used, as an example.”
Pondering her choice of drugs, I watched my glass as the ice melted and floated near the top. “Theoretically,” I asked, “why would anyone take one of those drugs?”
Val leaned back and sighed. “Well, if we’re talking epidemic or pandemic proportions, it would take more than a vial or a shipment of twelve bottles. You see, Cytoxan is commonly used to treat breast cancer. Since it has a relatively short half-life, it’s transported in powder form. Before administering it to a patient, it’s made into a solution—a liquid.”
I rolled my eyes. “I may not have gone to college, but I know a solution is a liquid; thank you very much.”
“Well, it’s not the liquid that’s the issue. It’s the powder. It only takes a small amount of the powder to create the therapeutic dose. Yet, when in that form, this chemical is actually toxic. If that same small amount, or even less, of the powdered Cytoxan is absorbed through the skin, it can be toxic. In a very short amount of time the exposure would result in a dramatic decrease in white blood cells.” She nodded. “Which you know opens the floodgates for infection. Not just infection, like the flu or a cold: with exposure to this chemical a person’s immune system would shut down. It would be like HIV amplified. In only a matter of days, perhaps hours, sepsis could occur. Just imagine if enough was stockpiled? It could be released on an unsuspecting population, and they’d all be dead before anyone ever knew what happened.
“Adriamycin is known as the red devil. It’s a chemotherapy agent used to treat many kinds of cancer, including breast, lung, ovarian, and bladder. It’s commonly used as part of a three-part regimen. It’s administered over a period of time intravenously. It has serious side effects: low white and red blood cell count, low platelets, hair loss, and mouth sores. That’s when it’s given as directed. If it were to be absorbed through the skin or ingested at higher doses, those side effects would be amplified. The effects would be similar to the Cytoxan, but the symptoms would come on slower.”
“Wouldn’t people know that they were having symptoms?”
Val moved her head thoughtfully from side to side. “Probably. They’d know something was different, but they wouldn’t know the cause. I mean, a symptom like hair loss can be brought on by something as benign as a change in hormones. Honestly, most doctors wouldn’t take it seriously, taken by itself. Besides, it wouldn’t matter. By the time the drug’s in someone’s system, nothing could stop it.” She shrugged. “Adriamycin also has been shown to have a toxic effect on the heart muscle.”
“So it could cause a heart attack?” I asked.
“Essentially.”
“Damn, you’re like a doomsday postcard.”
Val laughed. “Hey! I’m not trying to predict doomsday. It’s just that one of my professors at Johns Hopkins was big on hematology and the lack of real knowledge on blood cancers. He sparked my interest.”
“Blood cancers, like the leukemia Stewart has.”
“Yes, like that, as well as non-Hodgkin’s lymphoma, many other lymphomas, and even multiple myelomas. My professor would talk about the incidences of each etiology and how the CDC was watching for hot pockets.”
“Did they find any? Hot pockets?”
Despite missing my final, that year of advanced biology was kicking into gear. I’d always loved this kind of thing. I’d even been accepted into the University of Miami before my life took an abrupt turn. With either this kind of conversation or Stewart’s private shows as a potential use of my time, I much preferred sitting with Val and listening to her dire discussions.
“Yes,” she answered thoughtfully. “They found clusters of concentrated diagnoses in areas like Chernobyl as well as Hiroshima. The fall-out in both cases was extensive. However, even with Chernobyl being as recent as 1986, the lack of technology, compared to current day, limited the data.”
Val’s expression lit up, as it did whenever she was excited. “Actually, my professor is among a group of researchers studying the population around Fukushima, Japan. They have so many more resources today. Since the reactors only melted down in 2011, the results won’t be found for a long time, but with this incident, they have a better idea what kind of base data to retrieve.” She looked wishfully into her tea. “I’d love to know what they’ve learned. It’s all so exciting.”
“But those cases aren’t some form of bioterrorism like you were insinuating earlier.”
“No. Those were all incidences of radiation exposure. We all know that radiation is a known carcinogen. So based on the exposure, they can learn a lot. However, of course, the CDC is also on the lookout for hot pockets of unknown etiology.”
“Ha! Like a few missing drugs from our clinics could cause that.”
Val’s expression darkened. “Well, Vikki, that’s how it starts: a few drugs from one clinic, a few from another. It all adds up. Suddenly, things are happening without cause. People are losing their hair and becoming ill. Think about it: some Cytoxan in powder form, distributed through an HVAC system in a building that houses or employs thousands of people could make a real mark for a terrorist organization.”
“Would it really be that easy?”
“No. Something like that would cause residue. The perpetrators would be caught or end up killing themselves. Where it would work better and be less likely to cause red flags is on a smaller scale. For the average murder, it could work well. That makes an assassination attempt a concern.”
“God, Val, this is heavy shit. Maybe you should decide to write a crime novel?”
“It is heavy. That’s why there are so many forms to fill out and hoops to jump through.”
I shook my head. “I’m sorry to bother you with my alibi. I know you have bigger concerns.”
A candid smile came to her lips. “Honestly, Vik, I’m there for you anytime. I know Stewart isn’t the love of your life. I also know you’ve done all you can do to make the best of it. I don’t mean to concern you with the everyday shit of the clinics.”
“But,” I asked, “if you were to start U.S. clinics, would there still be so much scrutiny?”
She shook her head. “No… and yes. No matter where the clinic is located, everything needs to be accounted for. However, there’s a normal, acceptable amount of natural attrition. I mean, shit happens. Solutions are mixed incorrectly and vials are discarded. Of course, it should all be documented, but sometimes the nurses get overwhelmed and things happen. That’s all taken into consideration during audits.” She reached out and grabbed my knee. “Besides, it doesn’t matter. I haven’t had time to put together the proposal for the U.S. clinics yet.”
“Honey, I like that idea much better than having you traipse all over the world. I mean, if terrorists groups are looking for these drugs, I don’t like the idea of your traveling with them.” Changing the subject, I stood and walked to Val’s shelf of pictures. I lifted the picture in the middle; it was a photograph of the two of us, taken during my senior year of high school at the academy. We both looked so young, so innocent. There were also pictures of Marcus and Lyle and one of mom and Randall. That reminded me of something. “Guess who’s been trying to contact me?”
Val looked down. “I know. She’s called me too.”
I spun. “Why? Why the hell would she be bothering you?”
“Because she can’t reach you. She asked me to ask you to call her.”
I pinched the bridge of my nose. “Do you know what she wants?”
“No,” Val answered curtly. “I can guess.”
“Tell me that she hasn’t asked you for money.”
“She hasn’t. Well, not since the time you laid her out and explained the difference between my work as a doctor and Randall’s.”
“Good,” I said matter-of-factly.
“I believe it has to do with money for Marcus’ education.” Val volunteered. “She’s very excited that he’s attending the University of Miami. It’s very difficult to get into.”
“I know,” I said dryly.
“Yes, I know. You were accepted there too. Well, I’m guessing her constant calling has to do with the tuition. The second semester will be coming due soon. Mom blew through Randall’s life insurance money pretty fast.”
I shook my head. “What kind of a mother blows through millions of dollars when she has two sons who need an education?”
Val shrugged. “I’m going out on a limb here, but I’d say one who has a daughter who could buy the damn university if she wanted.”
“Fuck,” I mumbled under my breath. As much as I didn’t want to save her skinny ass, I also didn’t want Marcus or Lyle to suffer. I mean, damn, he’d been accepted on his own merit.
My mother blamed me for her second husband’s early demise.
Another body to my count
, as she so eloquently put it the afternoon of the funeral. I’d been the one to turn down Randall’s request for cash. It wasn’t enough that I’d sold my body and soul for them once. He had the audacity to fall into the same trap: over a million in debt to a bookie.
Stewart left the choice to me. All I needed to do was say yes and Randall’s debt would’ve been paid. But, damn! I’d done that once, as well as secured Val’s education. And what thanks did I receive? Marilyn and Randall played the perfect parents pretending to be the one helping their daughter through undergrad and medical school.
So when faced with the decision again, I decided to be the one to place the bet. After all, perhaps it was time I was the one to enjoy the exhilaration of gambling. Besides, there’d always been a part of me that doubted that the inability to pay a debt would truly result in a death. This wasn’t the Wild West, was it?
Two days after I placed that bet, I lost. Randall’s car drove off an embankment into high tide. The investigation showed an accelerator malfunction, which allowed my mother to receive the life insurance money. A significant portion went to paying off Randall’s debt; however, that still left her with more than enough to save and invest.
Marilyn Sound and I have only spoken occasionally since Randall’s funeral; however, according to Lisa and now Val, she still felt the right to approach me for money. I’m sure that if you asked her, she’d say she was entitled.
Stopping the tirade of thoughts, I looked at my watch. “I need to get home before Stewart wakes. He wasn’t pleasant this morning.”
Her expression mellowed. “Vikki, I’ve watched many patients go down the same road as Stewart. His diagnosis was especially difficult on him. It’s understandable. Statistically, he’s too young for the aggressive type of cancer he has. I’m sure that’s made it even more difficult for him. He’s a man who’s used to getting his way; nonetheless, neither his money nor standing could save him.
“What I’ve learned in my practice is that with a diagnosis like Stewart’s, he hasn’t just had to come to terms with dying. He’s also had to face loss of control. It doesn’t matter if someone is a seventy-year-old grandmother or the fifty-year-old CEO of Harrington Spas and Suites—it’s difficult.