Comfort Zone

Chapter 10

 "Why isn't the filgrastim working?" Mr. Phillips asked, jumping up from the chair next to his wife's bed when Miriam came through the door, anxiously echoing Miriam's own question to the hematologist. Ms. Phillips' coffee-colored skin glistening with sweat, but she smiled at her husband and doctor She was boiling to the touch, though still "hanging in there," as she put it.

"I don't understand," her husband continued. "It's always worked before. Is it a different brand, or a generic or biosimilar version?"

Miriam was impressed with the man's knowledge. Unlike generics, exact copies of a drug's chemical compound, so-called biosimilars were more complex products made in living organisms. They had equal efficacy and action, but different structures.

"No, it's the same injection; it's just taking longer than usual to work. Your wife's bone marrow may be too weak to respond to it now, so she can't make white cells to fight her infection."

"Are you sure she's getting the injections? She told me she is, but she's getting poked so much she might be confused."

"I'll make sure," Miriam promised, knowing they were clutching at straws.

"I ordered more tests to see where your fever's coming from, and we'll start you on powerful antibiotics right away. I also called an infectious disease consultant to help us figure things out."

"Call in the troops!" Ms. Phillips said, giving a sad smile.

"Exactly," Miriam said. As if on cue, a transporter came in the room wheeling in a gurney.

"I'm taking you to x- ray. Ready for your photo op, Ms. Phillips?" he said.

Miriam was halfway out the room with her patient when she saw Mr. Phillips sitting on the side of his wife's bed, a stricken look on his face. She came back and sat down across from him.

"We're doing everything we can," she said gently, in answer to an unspoken question.

"Could I take her to another hospital where they deal more with this thing, and may know more?"

"I wish there was one."

Mr. Phillips declined her offer of a second opinion, and Miriam took a deep breath of flowery air. The bouquets that filled the room were just starting to turn.

"There are just so many problems," she said, and started listing them, one after the other. Weak heart, low platelets, abnormal brain scan, kidney problems, and so on.

What the hell am I doing? she thought, disgusted with herself. At least remember to mention the organ or two that still seems to have some life in it, just to soften the blow!

"This must be so difficult for you,'' Miriam finally burst out.

Mr. Phillips just sat, listening and nodding. Finally, the question.

"Dr. Gotlin, is she dying?"

Miriam knew she should do the right and brave thing and just say yes, but she couldn't. She knew she had to prepare him, tell him hope had fled, that he should say the things he wanted to say to his wife before it was too late, but the words wouldn't come. So instead she told him his wife was stable for now, she wasn't in danger. We're doing everything we can, she repeated. Mr. Phillips sat in the chair and put his hands over his eyes and cried.

Just sit and shut up, she told herself. Let him cry. Instead, she murmured all the words of comfort and hope she could think of, the overpowering sweetness of the bouquets somehow giving her words life, but also lie. She doubted he heard them anyway, but when she put her hand on his shoulder he covered it with his own, squeezing tight.

Miriam conferred with the nurse after she left the room. Mr. Phillips' earlier question echoed in her mind: had her patient actually gotten the filgrastim? There were a number of reasons why she might not have. Filgrastim was an expensive medicine and nurses were required to pick it up directly from the hospital pharmacy to avoid wasting it. Sometimes nurses got too busy or forgot to get it, but Ms. Phillips' nurse insisted that their patient had gotten every single dose.

Could there be an error; a lookalike medication or the wrong dose? It wouldn't be the first time the Miami Health pharmacy department had made a mistake. Miriam's thoughts slipped back to Ursula Taylor's confidence. Well, filgrastim wasn't a narcotic. No one would steal it to inject for pleasure, unless it was a new high she didn't know about. The nurse showed Miriam the vial she was about to inject. It was clearly labeled filgrastim at the correct dose. No mistake about it.

Dubious benefit and exorbitant expense notwithstanding, Miriam ordered more injections at higher doses, making sure the nurse knew the plan.