Heart Murmur and Leg Edema (1)
Syntex had committed to the investment. EpiPen production would start soon. The company was giving me a $100,000 advance and 1% of the sales revenue. Of course, it would take time before the royalties kicked in. In the future, it would amount to astronomical sums. The problem was that California home prices weren't exactly a joke either. Still, once I got that EpiPen patent advance, I'd buy a house first thing…
We walked out of the Syntex building in downtown Palo Alto. Rigelotte stretched.
"That went much better than expected."
"What were you expecting?"
"I thought we'd fail a few times? Walking out with $100,000 on patent day alone isn't easy… It's not like pharma companies are money printers."
She wasn't wrong. If you could snag $100,000 just by flashing a patent, who would bother working? Still, I'd expected success. It was a technology and design proven in the future, after all. If Syntex passed, it was their loss, not mine.
Anyway. Rigelotte looked at me and smiled.
"Let's grab dinner. My treat!"
"What're we having?"
"Sushi."
I briefly wondered if they even sold sushi in America—but then I remembered California rolls. Of course they did.
Palo Alto, even in the '70s, was a hub for several American venture companies. Rigelotte led me to a Japanese restaurant. No prices on the menu—it was all market price. First time I'd seen that… Neither in my past life nor this one had I ever set foot in a place this fancy.
She flipped the menu over.
"Anything will do."
It sounded absurd, but the waiter nodded and took the menu. Must be a regular type. The chefs seemed to be preparing a course just for her.
It came out fast. First up: flower-shaped tempura veggies. Rigelotte turned back to me.
"It's not because you're Asian that I picked sushi… California venture guys love it, you know?"
"I see."
"Maybe 'cause they import so many parts from Japan, or maybe they think it's exotic and sophisticated."
I hadn't seen raw fish since landing in America. Didn't even know it was sold. I eyed the tuna sushi from the course. Looks delicious.
"Do you like it, Rigelotte?"
"My family's pretty traditional… I like it, but I don't get to eat it often."
Rigelotte glanced over her shoulder at her bodyguard, who shrugged.
"Don't they eat?"
"Do you eat during surgery?"
Couldn't argue with that. If the job demanded it, food could wait…
Rigelotte kept the conversation going. It turned pretty everyday after that. Sushi's great, any good spots near Stanford? Working at the hospital must come with fun stories—got any? She was more ordinary girl than I'd expected. Sure, raised like nobility, with bodyguards and helicopters to beat traffic. But in the end, just human.
"Dad'll love you too. He said you'd definitely make it—though not many believed him."
"Oh. Really?"
He hadn't seemed the type. But then, the Weisemans were the ones who'd connected me with the pharma company.
"Something about seeing people right. Said smarts and drive alone don't cut it…"
With that, Rigelotte looked at me like I'd become her favorite new toy. A faint smile playing on her lips.
"Anyway. This was fun. Hope I see you again, Doctor…!"
"Sure."
I stood up.
Time to return to reality. Rigelotte's world was like a garden—or a sterile lab—crafted by hordes of people pouring in massive effort. Reality was right here.
I clocked in at the ward. Eyes turned to me immediately. James, my senior from college, walked over to the seat next to mine. He was a third-year internal medicine resident. Not a bad guy, just kinda flighty. Lacked gravitas, like he was just visiting for fun.
"Saw you walking off-campus with that girl and her bodyguard yesterday. Who was she?"
I blinked.
"Oh, that."
Rigelotte. Thought I'd escaped notice, but reality crashed back into the sterile lab.
"Girlfriend?"
"Sponsor."
"What?"
Come to think of it, "sponsor" might sound weird. I scratched my head.
"Someone from the charity that covers my tuition. Met her at a fundraiser."
"Thought she was the president's daughter or something."
"Uh… no."
As James yapped nonsense beside me, someone dashed into the ward.
"No doctors here?"
We stared at the nurse who'd run up. Like we'd leave it empty. Crazy?
The nurse from the ER handed us a brown envelope. Patient chart. I scanned the prior records. Unexplained high fever for a week, full-body muscle aches, chest pain. Legs started swelling yesterday, so they came here.
James frowned.
"Weird case. What do you think?"
"Dunno yet."
"But… you're that resident who published the Kawasaki Disease case report in The Lancet, right?"
"Yeah."
"Do it again."
Before even seeing the patient. But it was intriguing. Must've stumped local hospitals and clinics to end up in Stanford's ER.
"Cellulitis?"
Not impossible, but the sequence was off.
"Fever-causing illnesses are common, right? Probably some infection."
"Yeah."
"So the last hospital likely tried antibiotics and antipyretics. If it didn't respond to antibiotics, things get complicated… From there…"
Lots of possibilities. No concept of antibiotic resistance in the '70s. Barely any resistant bugs. Assume nothing bacterial survives antibiotics—at least not common ones. If antibiotics failed, probably not bacterial.
That widened the net. Parasites? Cancer? TB? Messy.
"Not bacterial?"
"Not your garden-variety bacteria. Lots to consider, but… deep infection with abscess or some lymph disorder could mimic this."
James looked shocked.
"How do you know all this?"
"Thought about it a bit."
I'd said it before. The bar was different. What passed for knowledge and skill in 1970s doctors was worlds apart from modern standards—especially internal medicine. Tons of undiagnosed diseases back then.
But here, the leg swelling was key.
"The leg edema?"
"That's the hook. Figure out the mechanism, and we might crack it."
What caused the swelling?
"Just DVT? Bedridden a week from pain."
"Bilateral, right? Edema's on both sides—low odds."
"True."
Deep vein thrombosis: clots blocking leg veins. Didn't explain everything here.
"I'll check the patient."
"Go for it."
Before the attending arrived. Worse than I'd hoped.
"Hello."
"Hi."
Relatively young guy, forties. Breathing sounded rough. Pale, and the leg swelling wasn't mild. Looks sicker than expected.
"What's bothering you most?"
"Legs hurt now."
"Mind if I press on your leg?"
Standard for edema. I pushed his shin. Pitted and slow to rebound… Yup. Heart failure. Heart too weak—or fluid overload—can't pump properly. Fluid pools in legs first. Could be acute damage from whatever, or post-MI.
"What treatments at the last hospital?"
"Antibiotics… dunno."
I frowned. Not good. Severe fever unresponsive to antibiotics and antipyretics, lung involvement, now heart failure. Timing didn't fully fit sepsis either.
I pulled out my stethoscope.
"Let me listen."
And there it was. A murmur in the heart sounds. Now I get it.