A Pill to Change Your Life

Archive

In the cluttered sunroom I call my office, I store the ordinary keepsakes of my mother’s passing in a cardboard file box: her recipes, which I still consult for no-fail fudge and Swedish nut rolls; the journals she kept from her trips to Tuscany and Kyoto; love letters from my father. The keepsakes that are not so ordinary fill a whole drawer of a file cabinet: video clips from the CBS Evening News; folders of articles from major American newspapers; 5473 pages of court testimony; stacks of internal drug company memos, FDA contacts, and Rezulin death lists; a documentary by a young filmmaker, 0274: Rezulin and the Death of Monica George.

The box holds pieces of the life she chose to preserve. The contents of the file cabinet are the stuff of bestselling medical mysteries and courtroom dramas. Sometimes I have trouble believing it all belongs to me. How did she die? Why did she die? For a time, these were questions pondered by drug company lawyers, prominent liver specialists, and millions of Americans watching the evening news.

I am the only one still asking these questions now.

The dictionary defines “justice” as “the quality of being true or correct.” I believe the truth of what happened to my mother can be found in these documents. However, I am not so sure that I can “do justice” —“reflect or express the worth of properly” —to her story. In the past few years I’ve gotten used to writing fiction, finding truths in worlds of my imagining. What I’m doing now seems backwards. In trying to find truth, I’m uncovering fictions and fantasies, lies and delusions—many of them my own.

Debut

My first exhibit is a copy of The New England Journal of Medicine from May 1, 1997. The voice of the woman who handled back issues became more respectful when I told her to address it to Dr. Storey. In fact, I have a Ph.D., but I never use the title except when I’m having a little fun with the medical profession. When I was in graduate school, people always asked with a small frown what I intended to do with a degree in Japanese literature. I knew what they were really asking—where’s the money in it? I mumbled that I planned to teach, which I did for several years at an adjunct’s salary. My students told me the main thing they learned in my classes was “never trust the narrator.” I left academia after my son was born, and occasionally pondered the usefulness of my studies myself. Since Rezulin, however, the skills of the literary scholar, dissecting fiction and researching a single topic to exhaustion, have been surprisingly useful.

Leafing through dozens of ads, I find the one I’m looking for: New Once-Daily Rezulin. There’s a photograph of a glass sphere split in two, a padlock hanging from its latch, pink and mauve molecules dancing above it. Below are the magic words: “Side effects comparable to placebo.” If you look on the next page at the table for placebo-controlled clinical studies, Rezulin is, for some side effects, safer than placebo. Safer than a fiction whose only power is that we believe in it.

My mother began taking Rezulin for her adult-onset diabetes in November 1997 because her doctor was concerned about her mildly elevated blood sugars. “I want them to be perfect,” he told her. Unlike Micronase, an older diabetes pill she had tried, Rezulin did not bring on dizzy spells. In fact, it didn’t affect her blood sugar at all. A retired geriatric nurse, my mother put herself on a quarter dose of the Micronase to supplement the Rezulin. Perfection was achieved.

Why did she continue to take a pill that didn’t work? When I look at the ad, I remember how excited my mother was about Rezulin. As a member of the “penicillin generation,” she had faith in modern medicine’s miracles. Rezulin was touted everywhere as a breakthrough in the treatment of diabetes; the newspapers always quoted enthusiastic supporters whose lives were changed because they could throw away their insulin and needles. The articles in my files that document its brand-new ways of destroying the liver were published only after her death.

Before and After Photos

In early July 1998, my mother sent me a postcard of palm trees and azure waves from Barbados. “Can you imagine me on a catamaran—sailing the Caribbean Sea?” At 68 she had found a new love, a well-deserved upturn in her romantic fortunes. Her first husband, father to my two older sisters, had been killed by a drunk driver when she was twenty-five. My own father’s quick-growing brain tumor left her a widow again at forty-nine. Since then she’d had one serious relationship but after a few years she found him too rigid and controlling. Finally she had found a nice guy, someone she could laugh with. When I’d seen her in March, slim, pretty and glowing, I remember thinking: I hope I look that good when I’m her age. As a harried 36-year-old stay-at-home mom, I was in the strange position of envying my own mother all the fresh possibility in her life.

Three weeks after I received the postcard, I was stumbling off the red-eye at Washington-Dulles, unsure if I’d see her alive again. Her hospital room was dim in the dawn light. My eyes traveled to the bed, a huge mound of blankets, a head turning slowly toward me. It hit me then that the bulk on the bed was my mother’s body, grotesquely swollen. Dark purple bruises blossomed up and down her arms. The whites of her eyes were the color of egg yolks and her face was an odd grayish-gold color as if her skin had been painted with dye. This condition is called “jaundice,” a sign of severe liver damage. ALT, the enzyme that measures the health of liver cells, has a normal range of less than 30. My mother’s was 1,125.

Doctor’s Notes

I remember when the doctor at the first liver transplant center gave us the big news. It was my turn to spend the night shift at my mother’s side on an ancient, plastic recliner that resembled a dentist’s chair. I woke up to the sounds of her crying. “Even if I don’t die,” she said to me, “I’ll be nothing but a sick old woman. Good for nothing.” On the verge of tears myself, I assured her that wasn’t true, but it was okay to cry because it was a good way get out the toxins her liver couldn’t handle. My lame joke, or maybe my effort, made her smile.

It was early on a Sunday and the doctor strode into the room alone. Her usual retinue of earnest residents and interns scribbling on clipboards must have had a rare day off. She told us a test result had come back “very high” and she finally had an answer as to what was wrong. My mother had autoimmune liver disease, which means, in layman’s terms, that her body was attacking its own organ. Rezulin could cause liver damage, and had probably brought on this flare-up, but no one had died from it. This meant my mother would get better, and though in the natural course of her disease she would suffer similar flare-ups in the future, she could return to many years of normal life without a transplant. As she explained all of this, the morning sun shining through the curtain glimmered around the doctor’s neat head of blonde hair like a halo.

My mother went home but didn’t get better. The doctor at the next hospital told us follow-up tests did not support a diagnosis of autoimmune disease. He did not tell us that the first doctor had simply made a mistake in reading the test results. I learned this part of the story, like so much else, in a courtroom.

My mother’s medical records make up a separate file in the cabinet, a souvenir book many inches thick. Three pages are marked with yellow post-its. The first is the printout of a test used to evaluate autoimmune disease in general. My mother’s result reads 1:1600, the upper limit of “borderline significant” and a common reading for people with her type of low thyroid condition. On the next page the intern recopied the result in her notes with an extra zero as 1:16,000, which, if correct, would indeed be “very high.” The golden-haloed supervisor’s notes show yet another mistake: she mentions a completely different test as coming in “high,” which the records show was inaccurate as well. Her “big news” was based on a double error.

When this doctor was deposed for our lawsuit, she made it clear she would be hostile to both plaintiff and defendant. Our lawyers were afraid to confront her with the mistake, because she might insist she was right anyway and a jury would take her word over numbers they couldn’t understand.

After the trial, I wrote this doctor a letter, in which I did my best to be cordial and explain the mistake. I wasn’t expecting a reply, and didn’t receive one, but I like to think she’s glad to know the truth. I like to imagine she’s more careful when she reads charts now.

Body

In my “Rezulin: Miscellaneous” file I have a casket price list from the funeral home in Rockville, Maryland where we held my mother’s viewing. I kept it because of the model names: the Presidential Classic lined in suede for $8500; the Senator in velvet for $5200; the Congressional for a more attainable $4400. It struck me as very “inside-the-Beltway” —or was it a dash of Calvinism? —to aspire to membership in the elect if only in the afterlife. Even at the time I found it odd I could laugh at such a thing, when all the rest of me was numb.

When I last saw my mother alive, she seemed to be getting stronger. There was even hope of a liver transplant. But the day I flew home for my son’s third birthday party, she took a turn for the worse. She was put on a catheter and feeding tube, then a terrible rash broke out all over her body so her wrists and ankles were tied to the bed with canvas straps to prevent her from clawing at the devices. During daily phone calls to my sisters, I could hear her ghostly moans in the background—mercy, mercy, oh, Lord, have mercy on me. Giving her any pain medication, the doctors told us, would weaken her body further and end all hope for a transplant. On the morning after the party, while I was flying back east yet again, she died vomiting and choking on her own blood.

I saw her body a few hours later in the morgue. Her sore-speckled limbs were shriveled into sticks, her belly rose high above the gurney, an enormous mountain of fluid. Her lips were smeared with blood, although someone had obviously tried to wipe them clean, and her hair was tinted a weird, rusty pink from the roots down, as if blood had flooded the hair follicles. It was a tortured body, a death from some past barbaric age. I remember clearly what I thought at that moment: No one is supposed to die this way anymore.

We all want to be special, and now I was, a big winner in the wrong kind of lottery. My mother was the freak victim of a miracle drug.

National News

Then came the day the story changed.

It was Sunday, December 6, 1998, a bright, brisk afternoon. I was taking my son to the park and happened to glance over at a row of newspaper vending machines along the main street of our neighborhood. The Los Angeles Times’ headline leaped out at me: “ ‘Fast-Track’ Drug to Treat Diabetes Tied to 33 Deaths. ’”

I backed the stroller over to the vending machine and crouched down to read:

“Rezulin: The Food and Drug Administration dismissed explicit warnings of danger as the agency raced to approve a new diabetes drug that has been linked to at least 33 deaths due to liver injuries...”

It happened to other people, too.

To other people like my mother. All the victims profiled were older women, all as loving and “useful” to their families and communities, all similarly dismissed by their doctors when the symptoms of liver failure first appeared.

There was more. Pulitzer Prize-winning journalist David Willman reported that the first medical officer to review Rezulin intended to recommend against approval based on evidence of the drug’s toxicity to the liver and heart. Yet, after a meeting with a Warner-Lambert official in which he used immoderate language—“You can’t shine shit with words” —he was removed from the review. The drug was quickly approved with no warnings at all. When reports of Rezulin-related deaths began to mount and the drug was withdrawn in Britain, another FDA official suggested limiting the drug’s use to the sickest diabetics. This move would have saved my mother’s life. However, he relented after encountering resistance from the drug company.

As I tucked the article in a folder, the first entry in my Rezulin collection, I knew that behind the drug company’s bland assurances that all drugs have risks, there was another story. I wondered if I would ever hear it.

Death List

The file is marked simply “990274.”

“990274” is my mother. It’s her death number. This is how Warner-Lambert and the FDA know her and every victim—never by name, only by a number. Most victims’ families never know their loved ones have a posthumous identity. I know this only because my sisters and I decided to bring a lawsuit against the drug company that made Rezulin.

It wasn’t an easy decision. Before Rezulin, I shared the common notion that many lawsuits are frivolous grabs for cash by angry losers who can’t take responsibility for their own actions, like the lady who got millions from McDonald’s because she spilled coffee on herself.

No doubt about it, I was angry, not to mention a loser. Rezulin was still on the market. None of my letters to the FDA received a reply. We did receive a calendar from Warner-Lambert promising 365 days to better health with Rezulin, forwarded from my mother’s address. When my sister tried to contact the drug company to report that the recipient had died from liver failure, she got an automated survey.

We didn’t want money, we wanted answers.

A lawsuit posed the question “What really happened?” The drug company was finally required to respond by providing all the relevant documents to our attorneys. Our case was taken on by an energetic young attorney with experience representing victims of Fen-Phen, a diet drug that caused heart valve damage. As she and her associates combed through millions of documents at the drug company warehouse in Manhattan, answers came. First they found my mother’s Med Watch, the form the doctor who performed her autopsy had used to report the adverse drug reaction. This gave them the case number. They soon saw those six digits again, in an internal Warner-Lambert chart of Rezulin-related deaths. In the next column, the company expert evaluated my mother’s case as “probably related” to Rezulin. In spite of the cautious language, this is the highest likelihood any drug company will admit, the closest they will ever come to an outright confession of causality.

The team discovered that Warner-Lambert had prepared a label recommending liver monitoring for Rezulin in 1996 before the drug went to market, but abandoned it before seeking FDA approval. Their first ads claimed Rezulin was “safe as placebo.” In fact, the occurrence of liver injuries among patients on Rezulin was three times higher than the placebo group. Even more troubling was the series of emails and reports of after-hours phone calls between a drug company official and an FDA team leader which revealed how the latter “buried” the first medical officer’s unfavorable report on Rezulin and helped speed the drug to market with no liver warnings.

Six months after he left the FDA, the team leader took a consulting job with Warner-Lambert.

Eye on America

On the tape of the January 2, 2002 edition of CBS Evening News I make my first appearance frowning into the wind as I trail my sisters into the County Courthouse in Rockville, Maryland. If you look closely, you can see me slipping around in my new black “court shoes,” on sale and too wide at the heel. I have another few seconds of fame in a portrait-like gathering of the family with our lawyers. Our attorneys told us not to smile in public during the trial, so I look obediently grim, far from the glamorous debut on national TV I’d dreamed of as a child. My mother, who appears in the CBS segment in old home videos as the “face” of Rezulin victims, laughing and dancing with her grandchildren, looks far more vibrant.

There is a lie in these pictures. I should have been grinning into the camera, raising my fist in defiance. Our attorneys had just won a surprise twenty-six million dollar verdict for another Rezulin case in Missouri. Ours was a far stronger case.

After jury selection, the defense had called our lawyers aside and asked them what it would take to settle. We turned them down on the spot. My sisters and I weren’t doing this for money, we’d agreed on that from the beginning. Already we’d gotten something much better. We’d made a huge drug company afraid.

Battle

The court transcript resembles the script for a play, twenty-four days long, set in the strange land of legaldom, with its own language and etiquette. By the end of opening statements, however, I felt more at home, for I realized a trial is really a battle of stories—ours versus theirs.

Our advocates were young, attractive and eloquent, straight from a TV serial—an impassioned, curvy blonde, her cooler male partner, dark and lean. Their story was sexy, too, a bestseller conspiracy of government corruption and corporate greed. In the mid-1990s, they explained to the six jurors, Warner-Lambert was in serious financial straits and needed a blockbuster drug to avoid a hostile takeover. Company officials knew Rezulin was dangerous to the liver. They also knew a drug released with liver warnings wouldn’t sell, and so they misrepresented clinical trial data and cozied up to FDA officials to get Rezulin on the market quickly and keep it there. 1 in 1800 Rezulin patients suffered serious side effects from the drug, including my mother. The drug company’s own expert, an FDA panel, and all of her doctors agreed it played a significant role in her death.

Warner-Lambert’s lead counsel was a tall, soft-bellied man with thinning hair and a sad, homely face. At first I was disappointed. I’d expected $1000 suits, salon-styled hair, an Ivy-League piranha smile. But it began to make sense to cast a kindly, put-upon fellow as the human embodiment of an honorable company that was only trying to help diabetics. Company studies showed only 1 in 60,000 suffered harm from Rezulin, the lawyer reassured the jury in a low, soothing voice, but my mother was not one of these victims. Instead she had a rare, undetectable autoimmune disease. The gold-haloed doctor said as much in her notes. Therefore the tragedy was small, self-contained. My mother’s body had destroyed itself.

The witnesses called to support each version of the story were different, too. Our side, my mother’s doctors, were willing to admit under cross-examination that it was within the realm of scientific possibility her death might have been caused by something other than Rezulin. Their witnesses, professional experts who were paid as much as $9000 a day, adamantly denied that Rezulin played any role at all.

Never trust the narrator, I used to tell my students, but our jury had to choose one side to trust over the other. They were the real audience for this play, the only critics who mattered, and their verdict had to be unanimous. Our attorneys weren’t happy with our final panel of three men and three women. We had what are known in the business as low-empathy jurors, all older, middle or upper-class whites including several with serious medical conditions who might see drug companies as potential saviors. They were educated—an engineer, a college professor, a middle school teacher, and a very rich man’s wife who directed a charity—which suggested a tendency to support the status quo. Yet, as an all-too-well educated person myself, I hoped it meant they knew how to question authority, look below the surface of a text, embrace complexity.

All I could do was trust them to read it right.

Corporate Poetry

“Celebrate”
Rezulin
Billion $ Bash
Wed Sept. 2, 1998
Building 1 Cafeteria 2pm

It’s nothing more than a fuzzy computer printout, the kind of flyer you might see pinned to the bulletin board beside the coffee machine. Yet this tiny corporate poem is the jewel of my Rezulin collection, the heart of my story.

The lead defense counsel was the first to mention it. The jury shouldn’t see it, he argued, because it was irrelevant. The plaintiffs were only trying to use it to “put the company in a bad light” and show Warner-Lambert was more interested in money than safety.

Which, of course, was the premise of our case, but this argument seemed to sway the judge, his eyes unreadable behind his spectacles, his square, bland face mildly perplexed. Already he hadn’t allowed some of our most damaging evidence, including the deposition of the company’s Vice President of Drug Safety and Surveillance where she admits on tape that the death of patient #990274, my mother, was “probably” due to Rezulin.

The judge’s hesitation stretched into a long silence. Often at moments like these I wanted to jump up and shout You idiot, how can the jury decide the truth if they don’t have the whole story? But this time, my body seemed to fall through space in the stillness. Even if the jury never saw the “Bash” invitation, I had. Like classic haiku, the spare, simple words illuminated a connection I had never seen quite so clearly before that moment.

Twenty-six days before my mother died Warner-Lambert held a party to celebrate Rezulin’s official status as a blockbuster drug, with champagne, no doubt, and hors d’oeuvres, and perhaps a bit of confetti?

Twenty-six days before my mother died, she was back at home for a few weeks, the last days she would ever spend in her own house. She could barely drag her swollen body out of bed to go to the bathroom. On her best day, some time in early September, she tried to take a walk outside, but had to stop at the front stoop, where she sank to the stone step and buried her face in her hands.

“I can’t do it,” she murmured in voice grown so recently old. “I’m too weak.”

She could have no salt or sugar. Food tasted awful anyway and nothing could wash away the evil flavors of more than a dozen medicines she had to take to help her damaged body perform the simplest tasks of keeping her alive.

At about $150 a month, my mother contributed only about a thousand dollars to the festivities that September afternoon, but her donation was crucial. If Rezulin had been limited to severe diabetics who responded to no other treatment, as it was in Australia and New Zealand, there would be no billion dollars, no party, no champagne. And my mother would still be alive.

In the end the judge did admit “Bash,” but only on a technicality-because it happened before my mother died. By his rules, if the party had been held a month later, it wouldn’t have been relevant to the case at all.

Performance

On the screen across from the jury box, my mother held my older son, eight months old, a friend’s mortarboard perched on his head. In the original I was humming Pomp and Circumstance, but in court the sound was lowered so I could explain to the jury that I took this video when my mother flew out to be nanny for a month. I was still teaching and the doctor insisted we take my son out of daycare to stop his constant ear infections. It was one of many times my mother had come to my rescue.

To my surprise I was managing to keep my voice low-pitched and steady. I wasn’t gulping air or sobbing as I’d feared. For five straight nights I’d lain awake in bed in our extended-stay hotel room, watching the numbers on the digital clock creep forward, rehearsing what I would say when I finally took the stand. At the beginning of the trial, we’d been warned that smiling at or speaking with the jurors, even, literally, to give them the time of day, would be considered tampering and the defense would lodge a protest. My half hour in the witness box was the one chance to make a human connection. I had to bring my mother back to life for them, show them who she was and all she lost. I fancied myself a storyteller, and had even made a bit of money at it, but now my earlier stories seemed little more than games of make-believe and word play. This mattered. By bringing the company to court, I was putting myself on trial, too.

Once on the stand, however, I felt a strange calm. All I had to do was tell was the truth. My testimony was, apparently, having some effect. The only female attorney on the defense team, whom I later learned had just lost her own mother, rushed from the courtroom in tears.

But when I turned to the jury, daring for the first time to look into their faces, my chest tightened, as if a fist had closed around it. What I saw then was a row of eyes as cold as stones.

Million-Dollar Question

The closet-sized witness preparation room was crowded with three plaintiffs and two attorneys, but it was the only place we could have privacy. The defense had approached us with a second settlement offer, exceeding the Maryland cap on compensatory damages of 1.5 million dollars, with a hint we could bargain up. It was our last chance to take the money.

Our attorney told us she was willing to fight on. It was up to us.

For a moment, no one spoke.

To be honest, I was tempted. Not because I’d turned greedy. In my rather active imagination, those millions would arrive in unmarked bills in a briefcase, soaked in blood. But by the fourth week of the trial, the judge’s dislike of our lead attorney was painfully obvious. One of the jurors laughed when the defense made a joke at her expense and his vote alone would scuttle our chance for victory. It wasn’t as easy as it had seemed at first. And I knew the rules. If you get a lot of money—whether for a formulaic bestseller, for marriage to a man you don’t love, or for churning the brokerage account of an ignorant widow—you can laugh, or cry, all the way to the bank. If I had gone the way of most of the decisions in my life, the no-risk way, the nice girl, A-student way, I’d have taken it.

My sister Andrea broke the silence. “We have to see this through to the end.”

I knew she was right. Or rather, I felt it, a click in my solar plexus, followed by a wave of exhilaration that crept out to my fingers and toes. If we took their money, we’d be just like them. “How far would you go for a million dollars?” was no longer a hypothetical question for a lazy afternoon. I did have a limit. All it took was a simple pill to show me.

Verdict

In the file marked “Trial Expenses” I find a receipt from the Burger King at Dulles airport. I was glad to discover I kept it. The time stamp—2/05/02; 19:11—brings back that cold February evening, the colored lights of the runways through the airport window, the taste of grease and salt on my tongue. Strange that this is the sliver of experience I remember most clearly: the moment before.

The trial ended that afternoon with closing statements, well-attended by the press. With such a complex case, we expected the jury to take days to make their decision. My husband and I were going home to California, to put our young sons back in school, to return to normal life. As I was leaving, we got some good news. The alternate jurors had been polled and both said they were leaning towards a verdict for us, but wanted to study the documents first. Nearly every document was ours. As we drove to the airport, I remember looking out into the deep blue winter evening. It had been weeks since I could appreciate its beauty. Everything might turn out all right in the end after all.

A little after 7:11 that evening, as I was helping my kids with their boxes of orange juice, my husband’s cell phone rang. It wasn’t the call he’d been expecting from the office. It was my sister. He handed me the phone.

“Donna,” she said.

It was only one word, but I knew what she’d say next. In less than 45 minutes, without examining a single document in evidence, the jury had found for the defendant, Warner-Lambert.

Preponderance of Evidence

“The very first question called for us to say with 100% certainty that Rezulin killed Monica George and we could not do that... There are no winners in this situation but I feel like we [the jury] all slept well that night.”

I have before me notes from an interview with one of the jurors, the wife of the wealthy businessman. Given the verdict, some of her answers-that the underreporting of a few liver problems in clinical trials was no big deal, that no company would sell a deadly drug or they’d go out of business--were predictable.

One surprised me. She and the other jurors who consented to be interviewed all thought they had to be 100% certain to decide in our favor. In fact, the legal burden of proof was “preponderance of evidence,” the slightest nudge over 50% likelihood, that Rezulin played a role in my mother’s death. Like the extra zero on the lab test or the judge’s whims, what was so important to me, my mother’s life and justice in her name, came down to the absurdity of human error.

Any story has limitations. This essay is the sum of my struggle to choose my truth from a blizzard of words, feelings and impressions. Have I chosen the most important parts of the story? Can I trust my memories of her illness, colored as they are by what has come after? Can six strangers determine “truth” with such a partial, sanitized view of my mother’s story? Surely if they had taken the time to examine all of those papers, piled as high as a body on the gurney the clerk wheeled into the jury room, the spirit of curiosity alone would have worked in our favor.

Still, in a way, I am glad the jurors didn’t bother to look or read or think. Their verdict is easier to accept when I know it means nothing.

Business Dinner

For months after the trial, I was up by three every morning, wrapped in a blanket in front of my glowing computer screen as I reread the entire transcript and studied copies of key documents. For six weeks the story had been out of my hands, a matter of public record governed by the rule of law, with millions of corporate dollars at stake. Suddenly it was all mine. I was on familiar ground, immersed in “useless” knowledge that would bring no profit, a scholar of my mother’s death.

While the jurors slept, I finally got what I’d wanted all along: a glimpse into what really goes on behind the press releases and the glossy magazine ads. The human face of legal drug regulation, everything they don’t want us to see. The truth.

My favorite is Trial Exhibit #0186, a memo dated twelve days before my mother died, from Warner-Lambert’s FDA liaison about his dinner with the FDA team leader who shepherded the drug to market. The memo was written at 10:27 pm. Apparently the liaison couldn’t wait to share the gossip. The first scoop concerned an FDA doctor who was regarded as “dangerous” by his superiors because he expressed concern about Rezulin’s dangers to the press and consumer groups. This “Jeckel-Hyde” [sic] character was not to be trusted because he was “clearly on the side of what he perceives to be the greater good.” There was also mention of the team leader’s new consulting office now that he’d left the FDA. He promised to send his card to the company when it was available.

Three sentences at the end of the email caught my attention: “We spent quick [sic] a bit of time talking about what we in regulatory do. [The FDA team leader] kept saying how much he learned! It was actually a little upsetting!”

This is when I felt, oddly, my first twinge of fellowship with the memo writer. It worried me, too, that an FDA official doesn’t really understand what drug companies do. Then, in the darkness, I got to thinking, dreaming. What did the two men eat that night? I imagined lamb, with a good red wine to lubricate their fellowship. Would they be unsettled to know a victim’s daughter would be listening in on their dinner conversation four years in the future, wrapped in her blanket and a sorrow that never seemed to fade? Did they ever wonder if they did the right thing late at night when they were alone? Or did they tell themselves what they tell the newspaper reporters—Rezulin’s victims had to die for the sake of medical progress. It has nothing to do with me.

These are things I will never know.

But these men did tell me one thing they may not have intended over their fine dinner. The imagination is not useless or frivolous. It has value beyond measure in captains of industry as well as artists. Without imagination and its emotional complement-empathy--it is too easy to lose sight of the human consequences behind test results, studies, and balance sheets. For me this has been Rezulin’s beneficent side effect. I can imagine more fully and deeply than before, not only airy daydream fancies, but the pain and loss others suffer from arrogance, false promises, and war. Before Rezulin I rarely cried for strangers. Now, I’m moved to tears by these stories every day. I believe this is a good thing.

Answers

There are times when I’m driving alone at dawn or dusk and the light is soft, I think of what happened to my mother’s body and then again what happened to her memory in that courtroom. It is then I ask myself questions. What if I could go back in time? Would I take the settlement? No, I count that the bravest moment of my life. Would I save myself the pain of the lawsuit? No, we owed my mother that fight. Would I go back even further and turn my head away from the L.A. Times headline so I would never know my mother’s death was part of something bigger? Never.

However the answer changes when I travel back to the moment when my mother held that first Rezulin pill to her lips. This part I would do differently. I’d take the pill from her and I’d tell her: This little pill will earn two billion dollars and make some lucky drug company executives millionaires thirty times over. It will silently injure and even kill untold numbers of diabetics who put their faith in medical miracles. But those things won’t concern you. You’ll live to 95 like your own parents. You’ll dance at your grandsons’ weddings. And death, when it finally comes, will be peaceful and painless. This pill won’t change our lives.

That’s not our story.

Published in Fourth Genre (Fall 2006)