Phil Pescoe, the 37-year-old emergency physician at Deaconess Hospital in San Francisco, becomes alarmed by a dramatic increase in the number of deaths on the East Annex (the Alzheimer’s Ward). The deaths coincide with the initiation of a new drug study on the annex where a team of neurologists have been administering “NAF”—an experimental and highly promising treatment for Alzheimer’s disease—to half of the patients on the ward.
Mysteriously, the hospital pushes forward with the study even though six patients have died since the start of the trial. Pescoe teams up with Clara Wong—a brilliant internist with a troubled past—to investigate the situation. Their inquiries lead them unwittingly into the cutthroat world of big-business pharmaceuticals, where they are threatened to be swept up and lost before they have the opportunity to discover the truth behind an elaborate cover-up.
With the death count mounting, Pescoe and Wong race against time to save the patients on the ward and to stop the drug manufacturer from unleashing a dangerous new drug on the general populace.
This is the exciting premise of Christopher Stookey’s new medical mystery, Terminal Care (Silver Leaf Books).
We interviewed Christopher to find out more about his new book. Enjoy!
Thank you for this interview, Christopher. Can we begin by having you tell us what your new book, Terminal Care, is all about?
Christopher: It’s a medical mystery thriller set in San Francisco. The book is narrated by Phil Pescoe, a thirty-seven-year-old emergency physician. Things aren’t going well for Phil. He’s recently divorced. He’s had some disciplinary problems at work. He’s in debt from medical school loans. He’s lonely.
Then, one night, Phil gets unwittingly caught up in a drug study at the hospital where he works. He’s called out to try to resuscitate a patient who is dying on the Alzheimer’s ward. He fails in his efforts, and the patient expires. He later learns a team of doctors are testing a new drug called “NAF” on the ward. NAF, he discovers, is a highly promising treatment for Alzheimer’s disease that’s manufactured by the giant drug company, Swan Pharmaceuticals. The drug study is being given great priority at the hospital.
A few weeks pass, and Phil is called out to resuscitate another patient on the ward. Again, the patient dies. Pescoe begins to wonder if the deaths on the ward might be related to the drug study. However, his concerns about the NAF study become overshadowed by a new problem. Phil is called before the “quality assurance” committee at his hospital because there are concerns he didn’t follow the proper protocols in trying to resuscitate the patients on the ward. Some of the members of the committee believe the patients who died might have lived had Pescoe followed the proper protocols.
Phil is now at a low point in his life. He’s alone, in debt, in trouble at work.
Then along comes Clara Wong, the other main character in the book. Clara is an internist at the hospital. She’s quite brilliant and also, it must be mentioned, stunningly beautiful. What’s more, she happens to be a member of the quality assurance committee that’s just taken Phil to task. However, unlike the other members of the committee, Clara believes the deaths on the Alzheimer’s ward had nothing to do with Phil’s resuscitation efforts. She believes the deaths have more to do with the new drug, NAF, they’re giving to the patients. She believes NAF might be killing people. With the arrival of Clara, Phil Pescoe’s sinking luck is about to make a dramatic turnaround.
That’s the background. The rest of the book involves Pescoe and Wong teaming up to try to find out the truth about what’s happening on the Alzheimer’s ward. Their investigations take them on a midnight trip to the hospital morgue, on a visit to the research labs at the local medical school, and on a late-night raid on the Swan offices in San Francisco. Along the way there’s the mystery of a missing heart, further deaths, a sting operation on the ward, and a high-speed car chase through the dense city fog.
Also along the way, Phil and Clara become romantically involved. Although the “miracle treatment” for Alzheimer’s remains in question, at least one ailment will achieve a definitive cure: Pescoe’s loneliness. The novel, you see, is a romance as well as a mystery.
The inspiration to write this book came from a fascination with the business ethics of the pharmaceutical industry. Would you like to tell us about your monthly ‘drug luncheons’?
Christopher: During my medical residency in the 1990s, the hospital where I worked put on, like most hospitals, a monthly “drug luncheon.” A drug luncheon is something akin to a fair where drug companies operate booths pitching their various wares, in this case, drugs. The drug companies, themselves, pay for the event. I remember how my fellow residents would get excited on drug luncheon day. There would be free food, flashy slide-show presentations, and free gifts. All the doctors, residents, and medical students at the hospital were invited to attend.
We would walk into the large conference room where the luncheon was held, and we would immediately be assaulted by the smell of simmering casseroles and by blue-suited drug salesmen, the so-called “drug reps.” We would pile our plates with free food, then the drug reps would invite us to visit their booths where we were promised a variety of gifts. The gifts would range to include free drug samples, free stethoscopes, and free trips to tropical places. Nearly every drug rep offered you a complimentary pen with the company logo on it. There were also free penlights, free centimeter rulers, free tee-shirts, and free coffee mugs—all with the company logo, of course.
All we had to do in exchange for the free food and gifts was listen to a four- or five-minute sales pitch by this or that drug rep regarding his company’s newest and greatest wonder drug just brought to market. In addition, there were lectures and videos promoting featured drugs.
I always came away from these luncheons feeling a little “unclean.” Had we all just been pawns in a big brain-washing scheme, a scheme to get us to prescribe the drugs pitched at the luncheon? My fellow residents all answered this question with a resounding, “No!” They all said their prescribing habits were not in any way influenced by these luncheons. They were just there for the free food and gifts.
But, I wondered: if no one’s drug-prescribing habits were influenced by the free food and gifts, then why were the drug companies spending so much money to put these luncheons on in the first place? Was it simply because they liked us? I suspected the truth was the marketing departments at the drug companies had thoroughly researched the answer to the question, and the answer was a resounding, “Yes! Drug luncheons do influence prescribing behavior.”
Yet, if the luncheons influenced prescribing, was this ethical? Shouldn’t doctors be prescribing medications based what’s best for their patients—rather than on a free lunch and a fountain pen?
As you researched into pharmaceutical ethics, you became concerned about questionable practices of the pharmaceutical industry. Can you mention what you uncovered in your research?
Christopher: I found out there are a lot of people, including a lot of physicians, who feel the same way I do about pharmaceutical ethics. Take, for example, Dr. Marcia Angell, who happened to be the editor-in-chief of the prestigious New England Journal of Medicine and who wrote a book called The Truth About Drug Companies.
The book is a searing indictment of drug companies. It makes mention of the drug luncheons I talked about, but it goes far beyond that. There’s the fact that drug companies now sponsor a large number of the clinical drug trials done these days. This means the studies performed to see if a drug is effective and safe are sponsored by the drug companies, themselves. The drug companies are the ones paying the doctors to do the studies. This results in an obvious conflict of interest. My book revolves around just such an industry-sponsored drug study, and it satirizes the way physician-researchers are susceptible to bias and reaching pro-drug-company results when the work they’re doing is being sponsored by the people who make the drugs they’re testing.
Even though your book is fiction, are there elements of truth that we all must be aware of?
Christopher: Yes. As just mentioned, the book is in large part a satire on actual practices in the world of pharmaceutical research. Drug companies really do fund clinical trials. The researchers doing those trials really do have a vested interest in reaching results that will please the drug companies because they know which side their bread is buttered on. Drug companies really do sometimes suppress negative study results–something that occurs, prominently, in my fictional account.
If you had to pick out the most intense part of the book, what would that be?
Christopher: This would have to be the sting operation that occurs near the end of the book. Without giving too much away, I’ll say this. Clara and Pescoe have reason to believe that a death is going to occur at a certain time and a certain place on the Alzheimer’s ward. They instigate a bait-and-switch plan which, if successful, will reveal the truth about what’s really behind the deaths on the Alzheimer’s ward. I’d love to say more, but I’m afraid it would give too much away.
Finally, I like to ask authors this question…what is your passion? What is it that you’re more passionate about than anything else?
Christopher: At the risk of sounding a bit corny, I would say the thing I’m the most passionate about is my marriage. Marriage and work–but, if I had to pick one of the two, I’d say marriage. My wife and I have been married nearly eighteen years (first marriage for both of use), and I would say marrying Sandy–my wife’s name is Sandy–was the best thing that’s ever happened to me. Sort of, now that I think of it, sort of like how Pescoe’s meeting Clara is the best thing that’s ever happened to him. My wife is my pillar of strength, a sweet breath of sanity in this crazy world. Yeah, she’s my passion. As the line from the song ["You Are So Beautiful"] goes, “The guiding light that shines through the night.”
Thanks for coming, Christopher! Do you have any final words?
Christopher: Thanks for having me. Excellent questions. I enjoyed the interview.