Chapter 13
Syntex had promised to invest.
EpiPen production would begin soon. The company had agreed to pay me $100,000 upfront, plus one percent of its sales.
Of course, it would take some time for the sales revenue to start coming in.
In the future, it would be worth an astronomical amount.
The problem was, housing prices in California weren't exactly cheap, either. Still, once I got the advance on the EpiPen patent, buying a house would be the first thing I did...
We walked out of the Syntex building in the busy downtown area of Palo Alto.
Lieselotte stretched.
“That went much better than I expected.”
“What did you expect?”
“I thought you'd fail a few times. Getting a hundred thousand dollars the same day you walk in with just a patent... If it were that easy, pharmaceutical companies would be cash machines.”
She wasn't wrong.
If you could walk in with a single patent and walk out with a hundred thousand dollars, who'd bother working?
Even so, I had expected to succeed.
It was a technology and design already proven in the future, after all. If Syntex turned it down, that would be their loss, not mine.
Anyway.
Lieselotte looked at me and smiled.
“Let's have dinner before we go. My treat!”
“What are we having?”
“Sushi.”
Do they serve sushi in America? The thought crossed my mind briefly. Then again, wasn't there something called the California roll?
Come to think of it, of course they did.
***
Even in the seventies, Palo Alto was home to several American venture companies.
Lieselotte took me to a Japanese restaurant.
It was a sushi restaurant without prices on the menu.
It was my first time seeing a place where everything was sold at market price... Neither in my previous life nor this one had I ever been to a restaurant this expensive.
She turned the menu over.
“Anything is fine.”
It sounded absurd, but the server nodded and took the menu.
I guess they get a lot of customers like that.
The chefs seemed to be preparing a full-course meal as Lieselotte had ordered.
The food came out quickly.
First was a flower-shaped Japanese vegetable tempura.
Lieselotte turned her gaze back to me.
“It's not like I suggested sushi just because you're Asian... California's startup entrepreneurs seem to like sushi, don't they?”
“I see.”
“Maybe because they get a lot of components from Japan, or maybe they think it's exotic and sophisticated.”
I hadn't seen sashimi once since arriving in America. I hadn't even known they served it. I looked at the tuna nigiri in the course meal.
It looks delicious.
“Do you like it, Ms. Lieselotte?”
“My family is rather traditional... I like it, but I haven't had it often.”
Lieselotte glanced over her shoulder at her attendant, who shrugged.
“Aren't they going to eat?”
“Do you eat during surgery, Doctor?”
I had no answer to that.
Well, if the job required it, they could always eat later...
Lieselotte continued the conversation.
After that, it was pretty ordinary small talk.
The sushi was good. Were there any decent places near Stanford? Hospital work must give me lots of interesting stories. Didn't it?
She was more ordinary than I'd expected.
Even though she'd been raised like an aristocrat's daughter, traveled with an attendant, and taken helicopters to avoid traffic.
In the end, she was just a person.
“My father will be pleased, too. He said you were sure to succeed, though not many people believed him.”
“Oh. Really?”
He hadn't struck me as the sort.
But then, it was Weisman who had promised to introduce me to the pharmaceutical company.
“He said he had a good eye for people, or something like that. That there was something about you that couldn't be explained by simply being smart or enterprising...”
Lieselotte looked at me as if she'd found an interesting new toy.
With a faint smile.
“Anyway. I had a lovely time today. I hope I get to see you again...!”
“Yes.”
I stood up.
***
Time to return to reality.
The world Lieselotte lived in was, in any case, a kind of garden—or... a sterile laboratory—built through the tremendous efforts of countless people.
Reality was here.
I went to work on the ward.
As soon as I got there, everyone's eyes turned toward me. James, an older schoolmate from college, came over to the spot beside where I was sitting.
He was a third-year internal medicine resident.
James wasn't a bad person, but he was a little frivolous. He lacked seriousness and gave off the impression that he'd come just to have fun.
“I saw you walking off campus yesterday with a girl who had bodyguards. Who on earth was she?”
I blinked.
“Oh. That.”
He meant Lieselotte. I thought I'd left that world behind, but reality and the sterile laboratory had collided again.
“Your girlfriend?”
“My sponsor.”
“What?”
Come to think of it, saying “sponsor” could sound strange.
I scratched my head.
“She's with the charity that paid my tuition. I met her at a fundraiser.”
“I thought you were dating the president's daughter or something.”
“Um... no.”
While James was saying pointless things beside me, someone came running into the ward.
“Is there a doctor here?”
We looked at the nurse who'd rushed in. Of course there were. Was she out of her mind?
***
The nurse from the ER handed us a brown envelope.
The patient's medical records.
I looked over the patient's previous records.
For the past week, the patient had had an unexplained high fever, generalized muscle aches, and chest pain. Yesterday his legs started swelling, and eventually he came here.
James frowned.
“Strange case. What do you think?”
“I'm not sure yet.”
“But... you're the resident who got that case report on Kawasaki disease into The Lancet, right?”
“Yes.”
“Do that again.”
He hadn't even seen the patient yet.
But it was an interesting case. Hadn't the patient come to Stanford's ER after the local hospital or public health clinic couldn't figure it out?
“Could be cellulitis.”
It wasn't impossible, but the sequence was odd.
“Fever is a common symptom, right? It's probably some kind of infection.”
“Right.”
“Then the previous hospital probably tried antibiotics and antipyretics. If the disease doesn't respond to antibiotics, things get a lot more complicated. From there...”
There were a number of possibilities.
In the seventies, the concept of antibiotic resistance didn't exist. There were hardly any antibiotic-resistant bacteria, either.
You could assume there were no bacteria that antibiotics couldn't treat. At least, not among ordinary bacteria.
If antibiotic treatment had failed, the cause was probably not bacterial. That opened up a much wider range of possibilities. Parasites? Cancer? Tuberculosis?
It had become a complicated problem.
“So it's not bacteria?”
“It's not an ordinary bacterial infection. There's a lot to consider, but... a deep infection that has formed an abscess, or certain lymphatic disorders, could cause these symptoms too.”
James looked surprised.
“How do you know all this?”
“I've thought about it.”
Like I said, the standards were different.
The level of knowledge and ability expected of an ordinary doctor in the 1970s was worlds apart from what was expected in modern times.
Especially in internal medicine.
A great many diseases simply hadn't been discovered yet. But the swelling in his legs was a symptom worth thinking about.
“What about the leg swelling?”
“That's the interesting part. If we figure out what caused the swelling, we might have the answer right away.”
What was making his legs swell?
“Could it just be deep vein thrombosis? He's been lying down for a week because he was sick.”
“Isn't it on both sides? Since the edema is bilateral, I don't think that's very likely.”
“True.”
Deep vein thrombosis is a condition in which a blood clot forms in the deep veins of the leg. But that couldn't explain everything going on here.
“I'll go see the patient.”
“Okay.”
Let's take a look before the professor gets here.
The situation was worse than I'd expected.
“Hello.”
“Hello.”
A relatively young male patient, around forty.
His breathing sounded abnormal. He was also rather pale, and the swelling in his legs didn't look mild.
He looked worse than I'd thought.
“What's bothering you the most?”
“My legs hurt right now.”
“I'll press on your leg.”
If the legs were swollen, this was the first thing to try.
I pressed on the patient's shin. If it left a dent that didn't immediately spring back...
Hmm, yes. Heart failure.
His heart was weak—or there was too much fluid in his body for it to circulate properly. That's why fluid was pooling in his legs first.
His current illness might have damaged his heart or put it under sudden strain, but he might also have had a myocardial infarction.
“What treatment did you get at the other hospital?”
“Antibiotics, and... I don't really know.”
I frowned.
This didn't look good.
A high fever that didn't respond to antibiotics or antipyretics, pulmonary involvement, and heart failure. And given the timeline, it didn't seem like sepsis alone could account for it.
I took out my stethoscope.
“Let me listen to your heart.”
As expected, I heard a murmur. I think I have a better idea what disease this is now.