Clinical Trial

by April Christofferson

Genres: Medical Thrillers; High-tech & Sci-fi Thrillers

Synopsis

The deadly hantavirus has killed hundreds of Native Americans, so when a reputable pharmaceutical company claims to have developed a vaccine against the deadly disease, it should be good news. But when ImmuVac asks Dr. Isabel McLain to conduct a clinical trial of the vaccine on the Blackfeet reservation in Browning, Montana, the proposal gets a distinctly mixed response from both her and the suspicious Blackfeet. Is the new drug truly safe, or are the Blackfeet being used as human guinea pigs?

Indian activist Monty Four Bear fears the worst, but Dr. McLain stakes her reputation on the trial's safety. Having taken over the poorly-funded reservation clinic after the catastrophic failure of her marriage, Isabel has fought a long, hard struggle to gain the trust of the wary Blackfeet residents of the reservation. She knows she risks everything she's accomplished by endorsing ImmuVac's clinical trial, but she's willing to take that chance if it means developing a weapon against the hantavirus.

But when corporate greed makes for questionable science, whom can Isabel truly trust with her life and her career --and the lives of the Blackfeet?



At the Publisher's request, this title is being sold without Digital Rights Management Software (DRM) applied.

Release date: April 1, 2010

Publisher: Tom Doherty Associates

Print pages: 304

Sample

CHAPTER ONE
ARLO IRON HEART wasn't exactly living up to his name. This would be Dr. Isabel McLain's second attempt to draw the blood required for a blood sugar test. In the three months that Isabel had been running the Blackfeet reservation clinic in Browning, Montana, Arlo had made, then failed to show up for, no fewer than three appointments. Finally, today, he'd arrived at the clinic without one.
His timing was rotten—Isabel was already running behind—but, as he'd been instructed to do when he made the earlier appointments, upon his arrival this morning Arlo had proudly announced that he'd fasted for the previous twelve hours. Knowing that if she sent him away she might never see him again, Isabel worked him in.
Arlo presented classic diabetes symptoms: unexplained weight loss, frequent urination, and increased thirst.
"Mr. Iron Heart, every time you look at the needle, you jerk your arm away and I have to start over. I'd suggest you either close your eyes or focus on something besides what I'm trying to do here."
"Can't help it," the old, braided Indian groused through a puckered mouth that drew down at either end. "Shoulda never come here in the first place."
When she first came to the reservation clinic, Isabel had tried an approach intended to soothe and calm patients like Arlo, offering condescendingly simplified explanations for what she was doing. When that only seemed to create more distrust, and her patience grew thin, she'd dropped any attempt at a bedside manner.
"Do you want me to help you or not? Because I can do that, help you feel better. But I can't do it until I'm sure what the problem is, and I'm not about to fight you for the ridiculously small amount of blood I need for this test."
She pushed back, ready to go on to her next patient.
The bluff worked. Iron Heart held his arm in front of him and closed his eyes.
"Be quick about it," he ordered.
With a sigh, Isabel inserted the needle. Iron Heart's blood had almost filled the tube when the door opened and her assistant, Suzanne Featherhart, appeared.
At the sound of the door opening, Iron Heart startled and jerked his arm away, spraying blood across the front of Isabel's white lab coat
Reflexively, Isabel reached for the old man's elbow, pressing her gloved forefinger against the entry site. By now, Iron Heart looked easily as pale as the fair-skinned Isabel.
Exasperated, Isabel looked up at Suzanne.
"What is it?"
"I have to leave early for lunch," Suzanne said. Suzanne had a wild head of black, spiked hair and enormous, dark eyes, but sometimes all Isabel saw when she looked at her assistant was the cherry-red lipstick she wore day in and out. "And I won't be back ' til later."
"How much later?"
Suzanne shrugged her rounded shoulders.
"Don't really know. Depends on how long the meeting takes."
"What kind of meeting?"
"Tribal business. My Aunt Mary wants me to go with her."
"And you just found out about it now? You know how busy today's going to be."
Suzanne pushed the door farther open, enabling Isabel to see someone standing behind her in the poorly lit hallway.
"That's why I asked Joe to come."
Joe Winged Foot stepped forward, out of Suzanne's shadow.
Shaking her head wearily, Isabel looked down at the tube of blood she'd withdrawn from Arlo.
"That should be enough for the test." She nodded at Suzanne. "Take over here, will you? Clean him up before you leave. And be sure to pull the charts for this afternoon."
"Already did."
Clutching his arm dramatically, Arlo Iron Heart eyed Isabel's lab coat in disgust.
"Mr. Iron Heart, these tests should be done by Friday. Please make another appointment to see me then."
Finally, Isabel turned to Joe Winged Foot and smiled. She was always glad to see Joe.
"Come with me," she told him. "I need to change into a clean lab coat."


AS JOE FOLLOWED her into her office, Isabel glanced at her watch. Eleven forty-five.
"How'd you manage to get out of school so early?"
"Suzanne wrote me a note." Joe grinned, sliding his lanky form through the door and flopping like a rag doll into the chair next to Isabel's desk. "Besides, graduation's only a coupla weeks off. No one's payin' attention anymore. Mrs. Andrews, she likes that I come to visit you so much. She says I can learn a lot here."
As he spoke, Joe's basketball sneakers drummed a staccato beat on the linoleum flooring. Despite his height—just five feet nine inches—Joe served as the point guard and star of the Blackfeet high school team that had lost in overtime to a Missoula team in the state championship. He took great pride in his basketball skills and his team's successful season, frequently, like today, wearing his championship jersey layered over another T-shirt. Isabel thought all the Blackfeet youngsters a pleasure to look at, but Joe's lively brown eyes, perfectly etched nose, and ready grin made him unusually appealing.
Isabel crossed the cramped room to the closet and grabbed a white lab coat fresh from the dry cleaner.
"You and Suzanne set me up, didn't you?" she said, turning to eye Joe good-naturedly.
Despite her chagrin at her assistant, Isabel found Joe's broad smile infectious. Still, today it seemed just a tad less blinding than usual.
"You feeling okay?"
"Sure. Just a little tired from a late pickup game last night. You gonna let me give some shots today?"
Isabel slipped into the fresh lab coat as she ushered Joe back out into the hallway.
"'Fraid not. But I might let you take a temperature or two."
Grinning, Joe continued down the hall to the reception area to find Isabel's next patient. Watching Joe, Isabel could not dispell the impression that he seemed somehow subdued. She made a mental note to question him further.
Joe reappeared moments later with Eli Walker.
"Jason Little Turtle just showed up without an appointment," Joe told Isabel. "Thinks he's got the flu."
"There you go:" Isabel smiled. "Why don't you take Jason into the other exam room and get his temperature?"
When Joe hesitated, Isabel added, "The thermometer's in a glass container on the counter, but you need to put a disposable shield over it first. They're in the drawer next to the sink. Think you can handle that?"
"'Course," he answered none too certainly, turning back toward the waiting room.
Isabel ushered Eli into the exam room.
"How's that leg doing, Eli?" she asked.
Eli had recently been hospitalized for a deep venous thrombosis—a large blood clot in his right femoral vein.
"Still sore some," Eli answered, eyes glued to the floor. "But I don't see why I gotta come in here so much."
"I told you," Isabel said. "The anticoagulant the doctors in Cutbank put you on will keep you from getting more clots, but we have to monitor it. We don't want your blood getting too thin."
Isabel pricked the tip of Eli's index finger and directed two drops of falling blood onto the protime monitor. Within seconds, a number indicating the time it took his blood to clot flashed on a small screen.
"Eleven. That's high." Isabel had been standing in front of a seated Eli, but now she lowered herself to his eye level.
"You look like crap, Eli. Have you been drinking?"
The stale odor of alcohol wafted to her nostrils from Eli's person and clothing.
Eli did not raise his gaze to meet hers.
"Mebbe a little," he mumbled to the floor.
Isabel straightened up and placed her hand on her right hip.
"What am I going to do with you? Don't you realize that alcohol plays havoc with the anticoagulant you're taking? We need to get you within the acceptable protime range and keep it there. Right now, you could bleed to death over something as insignificant as a bump on the head. Just how much did you have to drink?"
Eli shrugged his shoulders.
Isabel felt like shaking some sense into him, but instead she reached out and touched Eli under the chin.
"Look at me, Eli." When he finally raised heavily lidded eyes to hers, she continued. "Be honest with me. Is there a chance in hell that you can stop drinking for the six months you'll be on the anticoagulant?"
A blank stare gave her her answer, but Eli also managed a weak, "Not really."
"Okay, then. How about this? You keep it to two drinks a day. Understand? But you have to be consistent. You have to drink those two drinks every single day."
For the first time, Eli perked up.
"Ya mean you want me to drink every day?"
"No, that's not what I said. But I can't get your coagulation levels steady if you can only manage to abstain a couple days before going on another binge. It would be better to have you drink a moderate amount consistently. At least that way I have half a chance of adjusting your medication to keep you within an acceptable range."
"What about three drinks?" Eli said hopefully. "Or four?"
"Two. That's the deal. Take it or leave it."
Eli fell silent for a moment as he appeared to study the floor.
"Didja mean that? That I could bleed to death?"
"We've already been over this, Eli. Yes, I do mean it. Right now your blood's about as thin as the chicken soup they serve down at Sandy's Diner. Blood that's too thin is almost as dangerous as blood that can throw a clot. In some ways, more. But I can fix that. If you'll just cooperate with me. What do you say?"
"'Spose two drinks a day's better than none," he finally muttered. "Or bleedin' to death …"
"You bet it is. Now listen to me closely. I want you to skip your regular dose of anticoagulant for the next two days. Then come back in here for another reading. Do you have any questions? Two days without your medicine, two drinks a day, then come back in and we'll see if your protime's back where we want it."
After getting a mumbled acknowledgment from Eli, Isabel moved on to the next room, where Jason Little Turtle sat on the exam table with a thermometer sticking out of his tightly clenched mouth.
Jason and Arlo turned out to be the first of four unscheduled patients that afternoon. Isabel and Joe moved quickly from one room to another, with Joe ushering patients in, then cleaning up the rooms between visits. There was little time for small talk.


FINALLY, AROUND THREE-THIRTY, just as Isabel finished her exam of a four-year-old girl who'd suffered an asthma attack the night before, Suzanne reappeared.
"I'm back," she announced, crossing the room to help the wide-eyed child down from the exam table while the young mother bounced her wailing two-year-old brother on her knee.
"Good," Isabel answered. "Did you let Joe know that he can leave when he wants?"
"He's already gone."
"Oh."
The rest of the afternoon proved even more chaotic than the morning had been—too chaotic to worry about Joe. Late in the day, when she went into the storage closet and opened a supply cupboard, Isabel almost had a heart attack when a furry projectile shot straight out, as if aimed squarely at her face.
A mouse.
Luckily it fell short.
She sent Suzanne down to Standing Bear Hardware for traps, then raced off from her last patient to her quarterly meeting with the tribal council, leaving Suzanne to bait the traps with peanut butter, as instructed by Dan Standing Bear.
It was much later—almost midnight—before Isabel had time to give serious consideration to the fact that Joe had left the clinic without saying goodbye. When she dropped into bed, completely and utterly -exhausted, it was the first thing to come to mind.
It was so unlike Joe to leave today without saying goodbye.
She would make a point of taking time to visit with him tomorrow—surely he'd drop by after school—to make sure that everything was all right.
She was so fond of Joe, had such great hopes for him, as did everyone else in the town. Joe Winged Foot was the Blackfeets' shining light—college bound, intelligent, determined to make something of himself. He had recently told Isabel he might become a doctor, come back to the reservation and take care of his people. After he "got done playing in the NBA."
Nagged with a vague, unsettling worry about Joe, Isabel had difficulty getting to sleep. But finally exhaustion set in and she fell into a deep, profound slumber.


THE TRIBAL HEADQUARTERS business offices were located within a three-square-block area on the north side of Browning, half a mile from the clinic.
Suzanne and her Aunt Mary lived together in a trailer just off Highway 2, seven miles southeast of town. Mary had arranged for a neighbor to pick her up and drop her off at the Blackfeet Health and Safety Corps building, where the meeting was taking place. As Suzanne approached the dark brown, U-shaped log structure, she could see her frail aunt huddled outside on a bench next to a colorful sign that featured a large turquoise circle around a white, block-style cross. Overlaid upon the cross were an American flag, a turquoise star, and, in bold black letters, BHSC.
"Why are you sitting out here?" Suzanne scolded as she walked across the wet grass from the parking lot. "It's cold and wet."
"I was just waiting for you," Mary Talking Horse answered quietly. It had stopped raining but her thin powder blue sweatshirt offered little protection from the wind and fifty-degree temperature.
"But you could have waited inside."
With Suzanne holding one arm, Mary used her other hand to cling tightly to the iron railing as the two women climbed half a dozen cement steps to the building's front door. Inside, several familiar faces lingered in the hallway. Suzanne nodded at Sumner Willow and his daughter, Ann. A large hand-lettered cardboard sign read TRUST AFFAIRS MEETING and pointed down the hallway.
As they approached an open door two-thirds of the way down the corridor, Suzanne heard voices. She steered Mary inside, where at least a dozen tribal members sat on folding chairs arranged in four rows.
"Here's Mary Talking Horse now," a strong, resonant baritone announced from the front of the room. "And Suzanne."
Both Suzanne and Mary turned toward the speaker. In three long strides, Monty Four Bear crossed the room to greet them.
When Suzanne heard that Monty would be chairing today's meeting, her aunt's request that she accompany her became all the more palatable. She'd known the handsome lawyer since they were children.
"Thanks for coming," Monty said. He placed a hand on Mary's bony shoulder and nodded to Suzanne over Mary's gray head of hair.
"Hey."
"Hey," Suzanne replied.
As Suzanne directed her aunt to a chair, both she and Mary nodded respectfully at Sky Thomas, who was seated dead center in the front row.
Sky was the oldest living member of the Blackfeet tribe. She lived in a two-room wood frame house just off Main Street and, at ninety-three, still walked to tribal functions and meetings in town—even those, like the one today, that did not pertain directly to her. Sky was widely believed to have visionary powers. Age had not dulled her good mind, and she enjoyed great respect from her Blackfeet family.
As Monty returned to the front of the room, Sumner and Ann Willow slipped into the room, coffee cups in hand.
"I think everyone's here now," Monty said, grabbing an empty chair. "We might as well get started."
Turning the chair backward, he eased himself, saddle-style, onto it. Six feet tall and lean, Suzanne couldn't help but notice that Monty still moved with the grace of the track star he'd once been. In faded blue jeans and well-scuffed cowboy boots, his long black hair parted neatly in the middle and pushed behind both ears, the sight of him stirred memories of the girlhood crush she'd had on him when she was twelve and he was eighteen.
"I think I've had one-on-one conversations with just about everyone in this room before today," Monty began. "Lester Wolf Spirit first came to me about the problems he was having getting information on his trust account over two years ago. After I looked into it for Lester, I guess word got out, and pretty soon more of you started coming to me. Before long, I kind of became a poster boy for this thing. Unfortunately, I haven't had much success—for Lester, or the rest of you."
"At least them people at the Bureau, they listen more to you than they do to us," Wolf Spirit called from the last row. "After you started callin' 'em, they sent me a letter. There wasn't no money with it, but it's the first time I got anything on paper from them in the forty years since my father died and passed that land on to me."
"I get statements a couple times a year, but I don't trust what they put on there anyway," Sumner Willow huffed from where he and Ann had settled. "I know damn well that the B and N is payin' somebody to run trains across my property. But I haven't seen a penny of it."
Suzanne felt her aunt's body stiffen. Usually quiet and much too shy to talk in public, Mary surprised her by standing.
"I get a check here and there from the Bureau," she said, slowly straightening into her usual erect posture. "Most of you know of my great-grandfather Black Bull. When the government divided the land up, Black Bull and his brother got a hundred-sixty acres. That's been passed down to me. I know that land is producing money 'cause every once and again I get a little check from the Bureau. It's never much. Usually just enough for me and Suzanne to splurge a little, buy some groceries so we can get a break from commodity food. Or maybe take a trip into Kalispell."
When she paused, the group remained silent and attentive.
"Back a couple years ago," she continued, "when my husband Charlie got so sick and I needed money to go back and forth to Cutbank for dialysis, I figured if I could find this land of Black Bull's, I could see for myself what was goin' on on it. Far as I know they could be pumpin' oil out of the ground. I heard stories like that, Indians living with their windows all boarded up 'cause they can't afford to fix them, while just outside—if they had glass in there, they'd be able to see it—trucks are hauling oil off their property by the barrel. Same thing could be happening to any one of us here. My family hasn't actually lived on Black Bull's land for generations. My mama forgot just where it was. So I tried calling the Bureau to get some information on it. 'Course we all know how that is, trying to get someone to talk to you on the phone. They got this thing they call …" She turned to Suzanne, a scowl creasing her already deeply lined brow, and Suzanne whispered, "Voice mail."
"Voice mail. They call it voice mail. Well, it made me half glad I couldn't afford a phone back then ‘cause if that's what you get when you call for help, I don't need it. I got dizzy tryin' to figure out what they were tellin' me, which button to press and so on. Anyway, I never did talk to a real live person and I never heard from anyone after I left a message.
"You all know Charlie finally died. Suzanne here, she moved in to help me out and now at least the bills get paid and we got a phone. But it's no life for a young girl like Suzanne. If I got a little more money from that land, on a regular basis, she could move out and have a life of her own."
Suzanne stared at the old woman. She had no idea Mary considered herself a burden. It was the Blackfeet way for family to take care of family. Mary was Suzanne's deceased mother's only sister, and when Uncle Charlie died there had never been any question in Suzanne's mind that she would move in with Mary. She would have preferred Mary to come live with her in her apartment in town, but Mary refused to leave the trailer she'd called home for four decades. And so Suzanne had moved to the trailer, where she slept in the living room, a curtain hung between it and the kitchen for privacy.
After that one time, the situation was never discussed again.
Suzanne grabbed her aunt's hand to help her back into her seat. It was cold, and it shook.
"What I wanna know is what're we gonna do about it," Wolf Spirit said. "Can you help us, Monty? 'Cause you're about the only one of us who knows how to deal with this kind of stuff."
Heads nodded around the room.
"We can always count on Monty," Mary Talking Horse murmured.
Monty had remained silent, monitoring the mood in the room.
"It's obviously not an easy situation to correct," he finally offered. "Everyone knows how long this has been going on. For over a century. And while it's become politically correct to voice concern about how our people have been treated, no one's really stepped up to the plate to make any kind of changes. At least none that really make a difference. And even if they were to make them now, even if they correct things from here on out, there's still the matter of the money that was rightly due all of you in the past. There's only one way I know to recover that." His eyes measured each of the room's occupants. "And that's sue."
"We can do that? We can sue them?" Ann Willow asked.
"There's been talk for a while now among many tribes about a class action suit, for mismanagement of Indian assets. Maybe even fraud. I think we've taken this long enough. It's time to make them listen. I believe a class action suit will do that."
"Let's sue," Wolf Spirit grunted.
"You bet," Sumner Willow called out. "Sue them bastards."
Excited chatter broke out across the room, but when Sky Thomas lifted her thick cane and brought it down hard on the wood floor, not once, but twice, the room grew completely still.
"'Course we deserve what we got comin' to us," she said in a croak of a voice. "Monty here, he does a good job of looking out for us, and if he thinks we should sue, most the time I'd be right behind him." She'd twisted her aged body to get a look at the others. "But trouble's coming."
Next to Suzanne, Mary Talking Horse drew in a short, sharp breath and pressed a hand to her heart. Sky's pronouncement caused a number of raised eyebrows as well, even among the usually stoic men.
"What kind of trouble, Sky?" Monty asked. There was no hint of skepticism or disrespect in his tone.
"I can't tell you that," the old woman answered grumpily. "I just know it's comin'. And I've seen what happens when our people try to fight too many battles at once. You gotta choose your battles. That's all I'm tryin' to say."
She turned back around to face the front of the room.
The room fell silent again as Monty studied the faces turned toward him, looking for answers.
"A lot of preparation goes into a lawsuit," he finally said. "Especially a class action. There's no need to rush the actual filing. I can get started with some of the groundwork, and then we can meet again, let's say in six months, to reevaluate. How does that sound?"
"That sounds like a good plan," Suzanne said.
"We better just wait 'til we see what the heck Sky's talkin' about," Sumner agreed hesitantly.
Copyright © 2000 by April Christofferson