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stepped out of the room. She addressed both doctors, swiveling her head from one to the other. "We were helping Chelsea out of bed and into a chair so we could change her linens, and she fainted. Now her blood pressure's down to eighty over sixty, pulse a hundred. I paged you both and drew blood for some stat blood work. They're getting her back into bed now."

Rip hesitated. Technically, Sara was still the doctor in charge of the case. But since Chelsea was in the study, Jack Ingersoll would undoubtedly insist he be involved in all treatment decisions. And in Ingersoll's absence, Rip had that responsibility.

Sara made it easy. She turned to Rip and said, "She's your study patient, and she's going into shock. Want to take the lead here?"

"I can't see EpAm848 causing her blood pressure to drop. Never been a problem before, and we've given it to some pretty sick people. Let's have a look at her."

Ten minutes later, Sara and Rip huddled in the hall outside Chelsea's room. "I think it's septic shock," he said. "She's had an indwelling catheter for a while, and my money's on sepsis from a urinary infection." Catheters in the bladder could eventually cause infection, and sometimes those bacteria spread to the bloodstream with disastrous results.

Sara opened the chart she held. "I'll order blood cultures, a urinalysis and culture, along with the lab work Janice already requested, but those will take a while. Why don't we get some urine, spin it down, do a Gram stain, and see what we've got?"

"That's scut work, Sara. You're faculty. I'm a fellow. I'll do it."

Sara shook her head. "If you hadn't decided to get postgraduate training, you could be on the faculty as well. We're equals, Rip. We've been together through four years of med school and three years of residency. I don't want to hear any more of that."

"Okay. You get the sample. I'll speed up the IV's and tweak the medications. Want to start a vasopressor drip?"

"What do you think?"

"Let's piggyback some Dopamine into her IV and run it as needed to get her blood pressure to better levels."

"Do it," Sara said.

There had been a time when every clinical ward in a hospital had a small lab space where medical students, interns, and residents could do simple procedures themselves. At University Hospital, that space had long since been co-opted for other uses, so Rip and Sara ended up in the hospital's clinical laboratory.

"Let me do that," the head technician said. "I do this every day. Neither of you has done it for years."

It seemed to take an eternity, but finally the tech gestured to a binocular microscope. "There it is. Want to take a guess before I tell you what you've got?"

Sara looked through the eyepieces and frowned. When she stepped away, Rip removed his glasses, adjusted the 'scope, and felt his heart skip a beat as red rods came into focus. He couldn't be certain based on the microscopic picture alone, but he'd looked at hundreds of slides with dozens of organisms, and he was almost sure of the diagnosis. "What do you think? E. coli?"

The tech nodded. "Yep. Escherichia coli. I plated out some of the sample you brought, and in a couple of days I'll have a culture confirmation and some preliminary antibiotic sensitivities."

Rip looked at Sara. They both knew what that meant. They didn't have thirty-six or forty-eight hours to wait before starting treatment. They had to begin antibiotic therapy now.

Sara thanked the tech and they both began to make their way back to the ICU. "Does your drug, whatever the name is, have any effect on E. coli?"

"It's EpAm848, and the answer is that nobody knows for sure. We've only used it against Staph luciferus. But look at it this way. If it were effective against E. coli, we wouldn't be having this conversation. This wouldn't have developed."

Sara bit her lip. "I'm at fault here. I didn't keep an eye out for other causes of Chelsea's fever and all her other symptoms. She's probably had that urinary infection for several