Major advance in understanding risky but effective multiple sclerosis treatment"I took another drink of my Coke. Sometime back, I saw a Newsweek article that mentioned someone doing bone marrow transplants with some success, but I can’t find anything on it in my journals. I don’t know who did the research, but I’ve got to find it, to see what they did, and if it really worked. I feel like it could be her last chance.
Published: Wednesday, March 27, 2013 - 17:22 A new study by multiple sclerosis researchers at three Canadian centres addresses why bone marrow transplantation (BMT) has positive results in patients with particularly aggressive forms of MS...
" Krauss wrinkled her nose and nodded slowly. Aye. I’ve seen something about that. Wait a minute, let me think. She got up and turned slowly around the room, not really focused on anything, looking for all the world as if she was listening to someone I could not see. “Let’s see,” she muttered, continuing the slow spin. “Here.” She stabbed a pile of journals with a finger like a divining rod.
" I shook my head although I had seen the strange ritual before. Housekeeping was absolutely banned from the office. Years ago, she’d nearly gotten one poor girl fired for coming in and cleaning off her desk. “Here it is.” She pulled a journal from somewhere near the bottom of a stack and handed it to me. “They didn’t do it here at Emory, but it looked like a good study. I think the general conclusion was that it was effective in survivors, but too risky for the average MS patient because the mortality was rather high.”
"I slouched in my chair and flipped through the journal. “I guessed as much, but she is dying. It’s hardly increasing her
risk.” Suddenly, all I could see was Sarah Summer’s wasted body at her last visit. She had vision in only one eye; a plaque on the optic nerve blinded the other. Her crumpled posture in the wheelchair spoke volumes, accusing me of failure. Even her graying skin haunted me. Sarah had been my patient for years, beginning when I was still a resident. Then she followed me to my new practice, after she wound up in Rome herself. Her loyalty gave my professional pride a boost in my first year of practice, but the price of that boost was the crushing sense of responsibility I felt now. Her life and mine were linked; her decline felt like mine as well.
Things would have been so much easier if I had known that the condition I was treating was in fact, murder. The outcome for the patient, well— all involved, but especially the patient— could have been so much better. I don’t blame myself for this… anymore.Right up front, Gabrielle Black tells readers that this is a murder mystery--no real suspense but, hey, a great murder mystery for us to solve, if we can! The other important thing that Dr. Lane shares is that this patient is special to her personally. I gather that is somewhat of a no-no, but the relationship had evolved since Sarah Summers had been one of her first patients during her residency. Sarah had even followed her as she first went into practice. I don't know about you, but I followed my doctor when he relocated--anybody who is lucky to find a compatible as well as competent doctor soon realizes those advantages. But now, after having responded to treatment so well, Sarah had relapsed and was getting worse at a rapid pace...
Veronica and Sarah discussed the potential of a bone marrow transplant and mutually agreed it was best that they proceed to plan for it. Easy decision for them, but not for the insurance company!
Dr. Lane immediately began to have problems in getting coverage because of how new the procedure was and the coverage of Sarah's policy. And they also had to worry about obtaining a donor... In other words, Dr. Lane was proceeding to do all that was necessary to treat her MS patient...
But while the arguments with the insurance company continued, Sarah had been hospitalized...but died...
Dr. Lane was looked at regarding her activities! A normal procedure, but in this case, there were questions that immediately arose...
"Dr. Peter Zacker appeared around a corner, still too far away to see my distress. I gave him a grave nod and looked back at my chart, hoping he would see that I was busy, and not stop to chat. He was a member of my call rotation and we spoke frequently, but we were not close, and I was not feeling sociable, to say the least.
“Hi, Veronica. How’s it going?”
"I looked up with another stiff smile, pretending as always that his high-pitched voice didn’t grate on my nerves. “Hi, Peter. I’m just reviewing the chart on my patient.”
“Was that the code I just heard up here?”
“Yeah, it was.” I flipped a page and tried to look occupied.
"Sally, the nurse who had been in charge of Sarah Summers, chose that moment to appear. She cleared her throat to get my attention. “Dr. Lane, I can’t believe how she died. I’ve worked the cancer ward for eleven years, and I’ve never seen a patient go like that. One minute she was cheerful and talking, the next she was dead.” Sally stopped and looked at me clearly expecting an explanation.
“What time did she get her chemotherapy?” I frowned in thought.
“Two o’clock. The meds were delayed getting to the floor.” I scratched my head. “That’s about enough time for an allergic reaction, not much else, but I didn’t notice any edema or urticaria. Did she have any other symptoms?”
"Sally shook her head. “No. Nothing. She was smiling and talking at four-fifteen when I checked the room. I came back right after five and she was gone.” Before I could respond, a call bell rang and pulled Sally away to other duties.
"Zacker remained, hovering by my elbow during the exchange. He raised an eyebrow. “What was her story?”
“We were going to do a bone marrow transplant for multiple sclerosis.” I answered.
“You’re kidding?” Zacker’s voice screeched in disbelief. “What in hell were you thinking? Bone marrow transplant? Why weren’t you using Rebif?”
"I eyed him narrowly. Peter Zacker was a cookbook man. He carefully followed the path and pattern of those who had gone before. To him, practicing medicine was like following a recipe. It was satisfactory medicine, and I could trust my patients to his care when he was on call, but it lacked heart. Modern medicine was built on the backs of great innovators. Zacker’s kind would still be bleeding the evil humors out of people if they were the only practitioners. I blew my bangs off my forehead in consternation, one of my nervous habits. “I tried it. She failed everything, and this was her last shot. She knew the risks.” I closed the chart with a snap and stood in preparation to leave. I really didn't feel up to a debate of philosophy.
"Zacker obligingly stepped back, but I noticed that he tipped up the chart and read the nameplate as I started down the hallway to finish my rounds.
She lives with her family and a menagerie of crazy farm animals. Visit her website at www.veronicalanemd.com to learn more about the world of Dr. Veronica Lane.
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