It was then that Andrew sent a message to the factory, in the nearby town of Boonton where John Rowe was working on the swing shift. Goddam! Andrew's eyes glanced at the elevated metal bed with the still figure. It was the only bed in the room because of the prominent "ISOLATION" notice in the corridor outside. The I.V. bottle on its stand stood behind the bed, dripping its contentsdextrose, normal saline, B-complex vitamins-into Mary Rowe through a needle in a forearm vein. It was already dark outside; occasionally there were rumblings from a storm and it was raining heavily. A lousy night. And the last night of living for this young wife and mother who had been healthy and active only a week ago. Goddam! It was unfair.
Today was Friday. Last Monday Mary Rowe, petite and pretty, though clearly unwell, had appeared in Andrew's office. She complained of feeling sick, weak, and she couldn't eat. Her temperature was 100.5. Four days earlier, Mrs. Rowe told him, she had had the same symptoms plus some vomiting, then the next day felt better and believed the trouble, whatever it was, was going away. But now it had returned. She was feeling terrible, even worse than before. Andrew checked the whites of Mary Rowe's eyes; they showed a tinge of yellow. Already areas of her skin were showing jaundice too. He palpated the liver, which was tender and enlarged. Questioning elicited that she had been to Mexico with her husband for a brief vacation the previous month. Yes, they had stayed in a small, offbeat hotel because it was cheap. Yes, she had eaten local food and drunk the water. "I'm admitting you to the hospital immediately," Andrew told her.”We need a blood test to confirm, but I'm as certain as I can be that you have infectious hepatitis.”
Then, because Mary Rowe had seemed frightened, he explained that most likely she had consumed contaminated food or water in Mexico, the contamination probably from an infected food handler. It happened frequently in countries where sanitation was poor. As to treatment, it would be mostly supportive, with adequate fluid intake into the body given intravenously. Complete recovery for ninety-five percent of people, Andrew added, took three to four months, though Mary should be able to go home from the hospital in a matter of days. With a wan smile, Mary had asked: What about the other five percent? Andrew laughed and told her, "Forget it! That's a statistic you won't be part of.”
Which was where he had been wrong. Instead of improving, Mary Rowe's condition worsened. The bihrubin in her blood went up and up, indicating increased jaundice, which was obvious from the alarming yellow of her skin. Even more critical, by Wednesday tests revealed a dangerous level of ammonia in the blood. It was ammonia, originating in the intestines, which the deteriorating liver could no longer handle. Then yesterday her mental state had deteriorated. She was confused, disoriented, didn't know where she was or why, and failed to recognize either Andrew or her husband. That was when Andrew warned John Rowe that his wife was gravely ill. The frustration at being able to do nothing to help gnawed at Andrew all day Thursday and, in between seeing patients in his office, he kept thinking about the problem, but to no effect. An obstacle to recovery, he realized, was that accumulation of ammonia. How to clear it? He knew that, given the present state of medicine, there was no effective way. Finally, and unfairly he supposed now, he had taken out his frustration by blowing his stack at the damned drug company saleswoman who had come into his office late in the afternoon. She was a "detail man.”
Or should it be "detail woman"? Not that he cared. He didn't even remember her name or her appearance, except that she wore glasses and was young, just a kid, and probably inexperienced. The saleswoman was from Felding-Roth Pharmaceuticals. Afterward Andrew wondered why he had agreed to see her when the receptionist announced that she was waiting, but he had, thinking perhaps he might learn something, though when she started talking about the latest antibiotic her company had just put on the market, his thoughts began wandering until she said, "You're not even listening to me, Doctor," and that had made him mad. "Maybe it's because I've something better to think about and you're wasting my time.”
It was rude, and usually he wouldn't have been that way. But his intense worry about Mary Rowe was coupled with a long dislike of drug companies and their high-pressure selling. Sure, there were some good drugs which the big firms produced, but their huckstering, including sucking up to doctors, was something Andrew found offensive. He had encountered it first in medical school where students-future prescribers, as the drug companies well knew-were sought after, flattered and pandered to by drug firm representatives. Among other things, the drug reps gave away stethoscopes and medical bags which some students accepted gladly. Andrew wasn't one of them. Though he had little money, he preferred to keep his independence and buy his own. "Maybe you'll tell me, Doctor," the Felding-Roth saleswoman had said yesterday, "what it is that's so all-fired important.,' It was then he had let her have it, telling her about Mary Rowe who was critical with ammonia intoxication, and adding caustically that he wished companies like Felding-Roth, instead of coming up with some "me-too" antibiotic which was probably no better or worse than half a dozen others already available, would work on a drug to stop excess ammonia production... He had stopped then, already ashamed of the outburst, and would probably have apologized except that the saleswoman, having gathered up her papers and samples, was on the way out, saying simply as she left, "Good afternoon, Doctor.”
So much for yesterday, and Andrew was no closer to being able to help his patient, Mary Rowe. This morning he had taken a phone call from the head floor nurse, Mrs. Ludlow. "Dr. Jordan, I'm worried about your patient, Rowe. She's becoming comatose, not responding at all.”
Andrew hurried to the hospital. A resident was with Mary Rowe who, by now, was in a deep coma. Although hurrying over was the thing to do, Andrew had known before arriving that no heroic measures were possible. All they could do was keep the intravenous fluids flowing. That, and hope. Now, near the end of the day, it was clear that hope had been in vain. Mary Rowe's condition seemed irreversible. Fighting back tears, John Rowe asked, "Will she be conscious again, Doctor? Will Mary know I'm here?" "I'm sorry," Andrew said.”It isn't likely.”
"I'll stay with her, just the same.”
"Of course. The nurses will be close by, and I'll instruct the resident.”
"Thank you, Doctor.”
Leaving, Andrew wondered: Thanks for what? He felt the need for coffee and headed for where he knew some would be brewing.
The doctors' lounge was a boxlike place, sparsely furnished with a few chairs, a mail rack, a TV, a small desk, and lockers for attending physicians. But it had the advantages of privacy and constant coffee. No one else was there when Andrew arrived. He poured himself coffee and slipped into an old, well-worn armchair. No need to stay at the hospital any longer, but he instinctively put off departure for his bachelor apartment-Noah Townsend's wife, Hilda, had found it for him-which was comfortable though sometimes lonely. The coffee was hot. While letting it cool, Andrew glanced at a Newark Star-Ledger. Prominent on the newspaper's front page was a report about something called "Sputnik"-an earth satellite, whatever that might be, which the Russians had recently shot into outer space amid fanfare heralding "the dawn of a new space age.”
While President Eisenhower, according to the news story, was expected to order speedup of a U.S. space program, American scientists were "shocked and humiliated" by the Russians' technological lead. Andrew hoped some of the shock would spill over into medical science. Though good progress had been made during the twelve years since World War II, there were still so many depressing gaps, unanswered questions. Discarding the newspaper, he picked up a copy of Medical Economics, a magazine that alternately amused and fascinated him. It was said to be the publication read most avidly by doctors, who gave it more attention than even the prestigious New England Journal of Medicine. Medical Economics had a basic function-to instruct doctors in ways to earn the maximum amount of money and, when they had it, how to invest or spend it. Andrew began reading an article: "Eight Ways to Minimize Your Taxes in Private Practice.”