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days. If I'd remembered to do repeated urine cultures, we'd have caught this earlier."

"Don't beat yourself up. We can't be perfect. No doctor can. The important thing is that we've caught it before she went into profound shock and developed multiple organ failures. We can still treat her and bring her through this."

"Okay. You're the ID specialist. What empiric antibiotics would you use for E. coli infection like this?"

Rip ran through the index cards of his mind. "I'd go with an IV quinolone like levofloxacin. And, even though we don't see any evidence of anaerobic infection, I'd add clindamycin until we get the results of the cultures, both urine and blood."

"I agree. Do you want to write the orders?"

"Sure."

"Does this mean you have to stop the Ep whatever?" Sara said.

"I don't know. It's never been given with other antibiotics, so I don't know what could happen. But if we stop EpAm848 now, the Staph luciferus could start up again."

"I have to leave the decision to you," Sara said.

And whatever I choose will probably be wrong. Putting aside the question of one antibiotic rendering the other useless, what was Jack Ingersoll going to say when he found that one of his precious study patients had been compromised? What if there were complications? How could a researcher tell if they were due to the EpAm848, the other medications, the disease itself? The patient would be dropped from the study. And to Ingersoll, every patient in the study was pure gold.

If he were here, Rip was pretty sure what Ingersoll's decision would be: Don't give anything more. He'd argue that EpAm848 was a strong antibiotic. It might be enough by itself to combat the sepsis. Just give supportive care, use IV fluids and vasopressors, administer oxygen. Give the drug a bit of time and it could pull the patient through. Another triumph for EpAm848. Another feather in the cap of Jack Ingersoll.

Rip could call Ingersoll's cell phone. Tell him the situation. Leave the decision up to him. Doing this on his own would expose Rip to his mentor's wrath big-time. He might even lose his fellowship because of it.

They reached the ICU and pushed through the doors. Both doctors were silent as they approached Chelsea's bedside. Rip nodded to Mrs. Ferguson, who continued to maintain her bedside vigil, one hand lightly touching her daughter's arm. The mother's lips moved in what Rip took to be silent prayer. He added one of his own. Please, Lord, help me make the right choice.

He looked at Sara. Then he reached down and smoothed the hair that had fallen onto Chelsea's forehead. He took a deep breath. "Mrs. Ferguson, Chelsea has another infection—a serious one in her urinary tract. It's caused her blood pressure to go down. If the infection is left unchecked, it could put her in grave danger. I think we can get on top of it, but to do that, we're going to have to use some additional medications."

"Does that mean she won't get any more of the drug you've been giving her? Until today, it seemed she was getting better."

"No," Rip said. "I promise you, she'll keep getting the EpAm848 as well." He hoped he could deliver on that promise.

 

 

The phone dragged Dr. John Ramsey up from a dream of walking through a field of bluebonnets with Beth. No, please, I don't want to leave. I just got her back. The ringing continued, and gradually reality took hold. Beth was gone. He'd never see her again this side of heaven. Sometimes—actually, often—he wished he could go there now. He'd never gone further than the idle thought, but now he understood why men and women who'd lost their spouses after many decades of marriage might find their will to live gone.

He pushed himself up offthe sofa and blinked at the TV. The program he'd been watching had long since given way to two people arguing in front of a judge. With one hand he used the remote to silence the set; with the other he lifted the receiver. "Dr. Ramsey."

"Dr. Ramsey, please hold for Dr. Schaeffer." The