Food and Drug Chapter 2
Emily leaned over Elizabeth's now relaxed face and gave her mother a peck on the cheek, as had been her habit since her rebellious teenage years. Back then, whenever Emily got into trouble, Elizabeth would reprimand her daughter and ground her and withhold her allowance and car. Emily would sulk and refuse to talk to her mother for days at a time, until one night over dinner, when Elizabeth would mention something funny, like a corny science joke that she had cajoled out of her best friend at the FDA, and Emily, resistant at first, would not be able to contain her nerdy delight and would nearly choke to death on her food and drink. The fight would end with a peck on the cheek, of mother and of daughter, and their lives would go on as if no altercation had ever occurred.
Reid watched Emily and Elizabeth from the doorway of the darkened hospital room. It was 4:00 AM, and he was dead tired. He was so tired that he couldn't help feeling a bit of jealousy whenever he looked at Elizabeth Prentiss. Elizabeth slept peacefully in her hospital bed, under the influence of a barbiturate-induced coma. Until the test results came back and the doctors made the diagnosis, the coma was the last line of defense against an unknown enemy. It was an act of desperation, bringing peace to no one but the sleeping patient.
"Emily?" Reid called softly, holding out two cups of coffee.
"Hey," Emily replied, moving from her position beside the bed to the couch just inside the door. "You should go home," she accepted a cup. "You look tired. I'm OK now. I'm going to wait up for rounds in the morning."
"Oh really, Emily?" Reid asked in mock snippiness, "I should go home? I think not. I'm going to wait up for rounds in the morning too," he folded his arms across his chest in a show of stubbornness.
Emily rolled her eyes and punched Reid in the arm. She punched herself to make it up to him.
"I didn't come here to indulge your sadomasochistic fantasies," Reid slurped away half his coffee. "I came here to steal that huge binder from the nurses' station. That's your mother's chart."
"What are you talking about?" Emily asked. "Can't we just ask for the chart to look over it?"
"Apparently not," Reid replied. "I peeked into it, but the nurse, the big hulking one, gave me a dirty look. He cracked his knuckles at me. I ran away to get coffee."
"Why won't they let us look at the chart?" Emily frowned in confusion.
"I think it's 'Doctor's Orders'," Reid said. "Doctors might not want family members peeking into medical charts. It's so easy to sue for malpractice these days. Doctors have to protect themselves somehow, and their first line of defense is to restrict access to the chart. That's where the lawyers would look for evidence of mistakes...Not even blatant mistakes...More like slightly questionable decisions..."
"And what medical decision can't be questioned?" Emily caught his drift.
"Exactly," Reid replied.
"Oh yeah, one more thing," he continued. "I'm going to pretend that I know nothing about science or medicine when we see the doctor at rounds. He might be more forthcoming towards a regular guy who wouldn't have the knowledge to challenge his authority."
"You're going to pretend to be regular guy?" Emily chortled. "We'd better get Garcia over here with her video camera. Morgan's not going to believe it unless we collect documentary evidence."
"Morgan never laughs at my science jokes," Reid remarked.
"Morgan is totally uncool," Emily sank into the comfortable couch, falling into a teenage state of mind now that her mother's condition had been stabilized.
In the back of her mind, in tiny compartments that lined up in neat rows, fear, panic, and pain still floundered, looking this way and that, attempting to recruit nearby compartments onto their growing ends. Nearby compartments floundered as well, attempting to escape the rows that threatened to assimilate them. It was a battle of attrition. Sooner or later, the strongest forces, the ones driven by irrepressible emotion, would win. The light of reason was no match for them. The rational compartments would twist and twitch, re-shaping themselves until they, too, became packets of irrepressible emotion. In the meantime, Emily had only to re-order the compartments every quarter of an hour or so to deal with the tasks at hand.
"Emily?" Reid turned towards his friend in concern.
She stared at the ceiling panels without answering. He sensed her internal battle. It was a battle that was familiar to him, but he employed different methods of fighting it. He wasn't sure which method was better - his or hers. As a profiler, he knew that it was unhealthy for his friend to compartmentalize her emotions, but as a friend, he knew that he had to let things run their course. He was here to help, in whatever way he could, even if he had to pretend to be a regular guy. When Bambi failed, as Thumper knew that Bambi would fail, then Thumper would be there to pick up the slack, and when Thumper failed as well, there was still Flower, foul-smelling or not, whatever the case may be.
"Reid?" Emily waved her cup at her friend as he stared at the fake potted plant beside the couch.
"Emily!" Reid awoke from his daydream, finding Emily awakened from hers as well. "I meant to ask you this earlier, but it was too hectic with all the nurses and doctors going in and out of the room. Let's play Doctor and Patient. Can you detail your mother's medical history for me?"
"Yes, Doctor," Emily re-ordered her compartments. "My mother has always been very healthy. She eats right, exercises, sleeps well. You can tell that she looks young for her age, right? The only thing that she's ever been concerned about is our family history of Alzheimer's Disease."
"Oh," Reid perked up, "I didn't know that you had a family history of Alzheimer's Disease. Is it familial Alzheimer's, one of those autosomal dominant mutations that the affected parent has a 50% chance of passing down to his children? Familial Alzheimer's is quite rare, making up only 1%..." he cut himself short, realizing the inappropriate nature of his intellectual exuberance.
Emily would not wish to discuss her family history of Alzheimer's Disease in terms of statistics, just as Reid would not wish to discuss his family history of schizophrenia in the same terms. Reid did not wish to discuss his family history of schizophrenia in any terms. He had compartmentalized that into the dumpster of his brain, where he also occasionally dwelled on drugs and how fun it was to shoot up on them.
"It's not any of the known familial types," Emily explained. "My grandfather, my mother's father, had Alzheimer's, and so did his sister, my mother's aunt. I think that their mother, my great-grandmother, might have had it as well, but in her time, the disease had not yet been discovered."
"That's a hefty family history," Reid considered. "So your mother has gone in for genetic testing to exclude any of the known mutations?"
"Yeah," Emily replied, "She's always been proactive about her health. She says that she won't let the fear of the disease take over her life. She says that it's always better to know, no matter what the results. And I think that she did all those tests to take the burden off me...So that I wouldn't be faced with taking them when I got older. As long as she didn't have the mutations, I wouldn't have them either."
"Your mother is a very smart woman, Emily," Reid said. "As far as you know, she hasn't been suffering any symptoms, has she?"
"No, no symptoms at all," Emily replied. "She's gone to her neurologist for annual screening since she turned 60. I'm not sure exactly how they screen for Alzheimer's, but I think it involves neuropsychological tests for cognitive function and long-term memory. So far, she's passed all the tests with flying colors, so they've never had to..."
"She's never had any neuroimaging tests done?" Reid interrupted. "No MRIs, no PET scans, no analysis of cerebrospinal fluid for amyloid beta or tau proteins?"
"She never told me about any of those," Emily said. "She doesn't want me to worry about it or think about it too much...for myself, you know..."
"I really want to see her medical records from the neurologist," Reid said. "Oh, don't worry, Emily," he answered her concerned expression, "I don't think that this current crisis has anything to do with Alzheimer's. I mean, I'm not a medical doctor, so I shouldn't even be making these pronouncements. I'm supposed to be a regular guy. But seizures aren't associated with Alzheimer's. They're associated with epilepsy, but your mother has never been diagnosed with that either, and the doctor said that the seizures did not match the pattern of any class of epileptic seizures. Whatever is going on, I don't think it has to do with any common neurological disorders."
"And we're still waiting on the test results for infection," Emily said. "Maybe it's meningitis, something treatable with antibiotics or antivirals."
"Or steroids if the cause is inflammation rather than infection," Reid suggested.
"Steroids for inflammation?" Emily asked. "That makes it sound like my mother's going to become a bodybuilder."
"No, these are not performance-enhancing drugs like anabolic steroids," Reid answered. "I'm talking about corticosteroids, like dexamethasone, that suppress an overactive immune system. Inflammation is the true enemy in meningitis. Inflammation is what causes swelling and brain damage. Regardless of whether the cause is bacterial, viral, or autoimmune, the inflammation is what has to be stopped. Corticosteroids are the main treatment for any type of inflammation anywhere in the body. But all the steroids are related. They all have the same four-ringed sterane skeleton, whether dex or estrogen or cholesterol."
"Cholesterol!" Emily realized something.
"What is it?" Reid asked anxiously.
"My mother also told me that she's been helping her best friend who works at the FDA. She's been participating in a clinical trial for a drug that reduces LDL, bad cholesterol, but may also prevent Alzheimer's."
"One of the statin medications?" Reid asked in excitement. Emily gazed quizzically, so he explained, "They're trying to cure everything with statins now. It's become a miracle drug in the research community. Its original purpose is to inhibit the cholesterol synthesis pathway. Yeah, we all make our own cholesterol," he explained away another quizzical gaze. "We make our own when we don't eat enough of it. Cholesterol isn't just a Big Bad. It has actual cellular functions. Without it, we'd all die. Actually, we wouldn't even exist without cholesterol."
"Anyway, about the statins," Reid continued. "I'm guessing that your mother doesn't know whether she's getting the drug or the placebo. And the participating physicians wouldn't know that either, because clinical trials are double blind studies. Otherwise, the physicians might be biased about the results."
"Do you think that she's having an adverse drug reaction to the statin medication?" Emily asked.
"Statins have been shown to be quite safe," Reid replied. "They do cause liver and muscle problems in a small percentage of patients, but they've never been associated with life-threatening side effects, such as heart attacks and certainly not seizures or other neurological symptoms. That's why doctors prescribe them for otherwise healthy people who might have a moderate LDL problem. Like in those Lipitor and Crestor commercials that we see on TV all the time...Those are statin medications."
"She just started the clinical trial last month," Emily said. "And now this happens. What if this is a new side effect that no one's ever seen before?"
"It's entirely possible," Reid said. "I really wish that I knew for sure whether she was taking the drug or the placebo. But I can't just barge into the FDA and demand information about an ongoing clinical trial. Which statin is being tested?"
"A new one, I think," Emily said, "Maybe it was called 'Vitator'?"
"Vorastatin, also known as Vitator to sound 'good' to patients," Reid air-quoted. "I have an idea," he declared. "I know it's wrong, but if the patient information is stored in databases..." he glanced sideways at Emily.
"Then Garcia could hack into them for us and figure out whether my mother was taking the drug or the placebo," Emily completed the thought.
"I'll call Garcia after rounds," Reid said.
"We can all go to prison together for computer felony fraud counts!" Emily clapped happily. "I bet you'll become someone's bitch."
"Au contraire!" Reid rejected the enticing notion. "I'm just a regular guy now, so I'm not planning to become anyone's bitch. In fact, I'm thinking about acquiring some bitches of my own."
"Oh please," Emily rejected the obviously impossible idea. "As soon as you let fly one of your quantum physics knock-knock jokes..."
"You're right, Emily," Reid set down his empty coffee cup and leaned his head back to clear away his delusions. "I've run out of coffee, and it's starting to affect my intelligence. This is an unacceptable state of affairs. It's your turn to get coffee for us."
"Are you trying to make me your bitch?" Emily asked in mock bitchiness. "Just this one time, Regular Guy," she said on the her way out the door. "By the way," she poked her head back into the room, "Thanks for being here, Reid."
By then, Reid was already asleep on the couch. Coffee was a moot point.
While he slept, Reid dreamt about Thumper, Bambi, and Flower. The three furry friends engaged in an endless conversation that replayed all the bits of data that his brain had picked up over the course of the night. The bits of data fell into a bin, where they were arranged and re-arranged, until they took on a semblance of meaning. They were no longer disordered bits and pieces. They became ordered vesicles, each amorphous little blob holding a crucial collection of related factoids. Reid would not find true meaning in them until all the blobs merged and all the factoids crystallized into a precise molecular structure, like the tertiary structures of proteins that formed bodies, minds, and selves. When the proteins went haywire, whether through their own faults or through the faults of their nucleic acid partners-in-crime, it became the duty of regular guys like Reid, scientific doctors and medical doctors, to intervene to put them right again.
In the face of fear, panic, and pain, everyone had a last line of defense, used to protect one's own sanity. For Emily, it was compartmentalization of her emotions away from her intellect and her imagination. For Reid, it was three furry friends to egg him on in his dreams. With Thumper, Bambi, and Flower at his side, Reid was eager to attack the problem head on. He was no regular guy. He was a genius whose intelligence could barely be quantified, so it was his duty and his duty alone to see the problem, own the problem, and solve the problem.
This way, he would make up for past failures. In the past, one mother had been failed. Reid had grown up since then. He was not going to fail another.
"She was in the drug group?" Reid spoke into his cell phone on a bright cold Saturday morning outside the hospital doors. "Are you sure about that?"
"Of course I'm sure!" Garcia replied in mock offense. "This is me! I! Technical Analyst Penelope Garcia! Need I remind you that this is the Office of Unmitigated Superiority?"
"Oh sorry," Reid apologized, "I thought I was merely speaking to the Office of Unfettered Omniscience."
"Pffffffft," Garcia blew him off, "The two are one and the same! Hey Reid," she asked seriously, "Should I call the others? I think that Hotch would want to know what's going on with Emily, and he knows Ambassador Prentiss too."
"Um..." Reid considered for a moment, looked around for Emily to return with yet another cup of coffee, saw no activity near the hospital doors, reached a decision that he had no right to reach. "Yeah, call Hotch. Tell him what's going on. Tell him that we, Emily and I, might need time off over the next few days to deal with this."
"Did Emily say that it was OK to call Hotch?" Garcia asked.
"Not exactly," Reid replied. "But come on, it's Hotch we're talking about here. He probably woke up in the middle of the night with a telepathic vision of something going wrong. He's only going to worry about it over the weekend if we don't inform him right away. He'll respect Emily's privacy if she wants him to."
"Just like you're doing right now?" Garcia asked.
"We, Emily and I, agreed together to call you so you could hack into the FDA databases for the drug information!" Reid defended himself.
"Justify, justify, justify," Garcia said. "You just wait until we all go to prison together. I'm sure you're going to end up as someone's bitch."
"Obviously," Reid accepted the enticing notion. "Now, let me ask you one last time. You're sure that Elizabeth Prentiss, age 65, is a patient in the Vitator for Alzheimer's Prevention clinical trial who received the drug and not the placebo?"
"For the last time, Sub-Genius, yes, I'm sure!" Garcia answered in total exasperation.
"Alright, alright, I believe you," Reid jerked his ear away from the angry voice. "Will you be around later today if I need to consult the Office of Blazing Eye-Popping Brillance?"
"Verrrrrrry good!" Garcia was placated by the new terminology. "I sit in a constant state of blazing eye-popping brilliance, awaiting further orders from Mr. Regular Guy," Reid could hear her air-quoting through the cell phone.
"Alright, talk to you later," Reid hung up as Emily approached with four cups of coffee, two for now, two for imediately after the first two. "Hey Emily, feeling better?" he asked.
"Yeah, a walk in the morning air really cleared my head," Emily replied. "Were you just talking to Garcia on the phone? Did she get the information about the drug?"
"She did," Reid said. "I think we have a problem. According to the patient information in the databases, your mother was definitely taking the drug. But when Hank went home after his night shift...Hank's the big hulking nurse who cracked his knuckles at me...I'm afraid of him. Anyway, after Hank left, I took a peek at the latest test results that came in after rounds. None of the tests showed any trace of vorastatin. You specifically asked the doctor to test for it this morning, but it's not showing up in the results. I don't know what medication your mother was taking, but it definitely wasn't vorastatin. I couldn't begin to understand why..."
"Call Hotch," Emily interrupted. "I don't want to drag him away from Jack over the weekend, but something's going on, and we need his approval to go forward."
"To go forward?" Reid raised his eyebrows.
"That clinical trial needs to be investigated," Emily replied, anger and excitement building in her dark brown eyes. "Don't look at me like that, Reid. I'm not going to take no for an answer. That trial needs to be investigated, not just for my mother's sake, but for all the other patients too. These people are volunteers. They signed up to be human guinea pigs. They're doing the pharmaceutical companies and the government a favor by participating in all these clinical trials. If those drugs are contaminated with something else, if that something else is causing the symptoms, they're not going to hear the end of it from me. I don't care if I have to...infiltrate the FDA to...I don't even know..."
"That's an idea, Emily!" Reid spilled half his burning coffee out of his cup as he waved his hand around. "Ow, ow, ow!"
"Here, let me hold that," Emily grabbed the cup while Reid dried his hand on his pants.
"What were you saying?" Emily asked, "What's an idea?"
"Why don't we, you and I, infiltrate the FDA?" Reid widened his eyes. "We can find out what's going with the trials, and maybe we can find a cure for your mother as well. The doctors here don't have a clue. They're just treading water at this point. We could do something about it ourselves," his eyes grew as he stared into Emily's eyes.
"I bet Hotch could arrange it," Emily said confidently. "I'm going to call him right now..." she reached into her pocket for her cell phone.
"No need, Emily," Reid interrupted. "I told Garcia to call Hotch already. He should be calling you soon."
"You told Garcia to call Hotch without asking me first?"
"Uh...I'm sorry, Emily...I know that it wasn't my place...I was just really excited about the fact that the patient information and the test results didn't match up...I promise that I won't do it again...I'm so sorry...I don't even know why I asked Garcia to call Hotch...I was afraid that you'd kill me if I called him myself while you were getting coffee...I thought something fishy was going on, and I wanted to swing things into action right away...I don't know what came over..."
"Reid, Reid! Get a hold of yourself!" Emily clamped Reid's mouth shut. "I swear this whole Regular Guy act is dumbing you down. Of course we have to call Hotch. Who else is going to authorize and arrange our covert operations in the Food and Drug Administration?"
"The more I think about it, the more I think that it's the right thing to do!" Reid exclaimed. "All the information about the clinical trial is at FDA headquarters in Silver Spring, Maryland. The administrators are there, and the scientist in charge of the trial is currently a visiting scholar there. He's got a temporary office at the FDA to oversee the beginning of the trial. If we can get menial jobs at the FDA, then we can access their offices at night and..."
"What's this about menial jobs?" Emily asked.
"I think we'll have to sneak in under the radar," Reid explained, "As janitors or something..."
"Hmmmmmmm," Emily considered, "I guess you're right. While you're doing both of our toilet-cleaning jobs, I can get into people's offices and look through their computers and notebooks."
"I'm going to ask Hotch to get me a job as a lab technician," Reid decided, "That'll get us access to the labs as well as the offices. You're the one who's going to be cleaning toilets."
"Not if you do both our jobs, Regular Guy!" Emily emphasized Reid's new title.
"Emily," Reid whispered softly into Emily's ear, "I think you're forgetting something. I'm only pretending to be a regular guy to the doctors here. To you, I'm still Dr. Spencer Reid, current super genius and future world dominator."
"In your dreams, Prison Bitch," Emily came up with a new title for Reid, "How are you going to be a future world dominator if you can't even beat me at chess?"
"I can beat you at chess!" Reid screeched. "I played all the possible games in my head. I'm sure I can beat you now!" he followed Emily back through the hospital doors.
"Yeah, whatever," Emily assumed her teenage persona.
She walked down the hallway towards the elevator, eager to return to her position on the couch in the hospital room. It had been a whole thirty minutes since she had seen her mother, and she needed to check back in, just to make sure that nothing had changed in the interim. Emily held out no hope that things had taken a turn for the better. The doctor, the Head of Neurology, had been completely baffled by Elizabeth's condition. The cure would not come from him. It was no longer a cure that Emily needed. Cures were too magical, and magic did not exist in real life. What Emily needed was a solution. Solutions were not magical. Solutions were built up, from cleverness and diligence, from trial and error, from long nights and weekends in the lab or in the office or in the field.
As a profiler, Emily didn't understand her own cognitive processes - how she built solutions to problems represented by rows of gory images tacked up on a bulletin board. It was some mysterious process that had yet to be elucidated. All she understood was her own focus. It had been less than twelve hours since Elizabeth had collapsed, but Emily had already compartmentalized the problem to perfection. Her emotions had been sealed up in boxes and lined up in rows, leaving behind only intellect and imagination. The solution, if she was clever enough and diligent enough, would come to her. If it didn't come to her, it would come to Reid. There was no question in Emily's mind that Reid was clever enough and diligent enough to find a solution. Emily entertained her irrational thoughts as she sipped her coffee in the elevator. Fear, panic, and pain were not so easy to repress after all. She was so absorbed in her irrational thoughts that she didn't even hear Reid explain his own thoughts to her. All she heard was something about a dream that he had this morning, something about how he was Thumper, she was Bambi, and Morgan was Flower. It was the weirdest thing that she had ever heard, but like most of the things that came out of Reid's mouth, it fascinated her.
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