The Protocol

The Protocol

by Keith Barton


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The famed Texas Medical Community is seduced by a sociopathic doctor, beset with the delusion that he will invent the next-generation anti-psychotic to reduce violence in humans. Robert Appleton is a promising young psychiatrist who has developed the new drug, but he has a secret past. He manipulates the FDA drug research protocol to facilitate the expected outcome that will bring millions of dollars to Spencer Pharmaceuticals and to himself. However, three patients die from self-inflicted trauma and Lieutenant Mark Johnson of the Houston Police Department is called in to investigate the mysterious deaths. He is ably assisted by Harold Lucero of the sex crimes division to track the psychiatrist's secret obsession with young women whom he entices to become research subjects in his crazed experiments to study violent behavior in humans. The reader is taken through the lurid world of sex, drugs, and murder as Johnson stalks the socially inept doctor to nail him on murder one charges.

The action takes an international twist when Appleton discovers that his research colleague actually works for the CIA and that the drug is actually intended to combat terrorism. The FDA and CIA have conspired to use Appleton's drug in an intelligence mission in Jakarta, Indonesia. Unaware that Appleton has manipulated the research protocol to produce favorable results, the lives of American agents are threatened as they attempt to destabilize an Islamic terrorist group, responsible for bombing U.S. Embassies and intercontinental flights. The action moves quickly between Houston, Jakarta, Geneva, Phoenix, Antigua, and Los Angeles, as Johnson attempts to bring the deranged doctor to justice. Johnson's actions are compromised by the CIA's need for Appleton's expertise to secure the safety of American agents in Southeast Asia and Indonesia.

Corporate greed, egomania, and deception merge in this suspense thriller that relies on vivid psychological profiles, police work, and recent psychiatric research in brain chemistry.

Product Details

ISBN-13: 9780595171477
Publisher: iUniverse, Incorporated
Publication date: 03/20/2001
Pages: 272
Product dimensions: 6.00(w) x 9.00(h) x 0.61(d)

Read an Excerpt

Chapter 1

"Code Green, Code Green." The words filtered over the loudspeaker with a tone of indifference. Carol Holt found herself pinned against the wall by a woman twice her size. The attack came without warning. With precision two orderlies appeared with wrist cuffs and anklets. Two arms wrapped around the woman on top of Carol, pinning the nurse’s arms to her side while the second man grabbed her feet and applied the restraint around her ankles. A cold liquid slowly filled her veins with Haldol, an anti-psychotic that was given for rapid sedation and control. The young woman closed her eyes, and her muscles began to twitch ever so slightly. Her breathing returned to slow, rhythmic contractions, as her body became limp. The two orderlies carried her gently to her room, which was stripped of any furniture except a mattress. Her personal items were removed to prevent her from using any sharps as weapons. Monday morning began as most days for Carol Holt. A seemingly rational person had been transformed into a senseless state of paranoia and hypervigilance. She checked the chart to see who the admitting psychiatrist was—she was not surprised to learn that Doctor Robert Appleton had written the admitting orders just twenty-four hours ago. He had a reputation for dealing with borderline personality patients who had destroyed every possible human connection.

Sandy Pines Hospital was state of the art in community mental health facilities in the early nineties. State hospitals were closing as state legislatures began to rewrite commitment laws, giving patients more freedom in their admission, treatment, and discharge programs. Downtown Houston was filled with homeless men and women who had been dumped from mental hospitals in an attempt to reconnect them with the human race. But for many patients, the streets became the back wards where drugs, sex, and violence were commonplace. Doctor Appleton had established his reputation by treating sexual offenders with newer anti-psychotic drugs in controlled drug studies for the FDA as part of Phase Two protocols with double-blind treatment and placebo groups. Although seasoned veterans, the nurses were always more cautious around Doctor Appleton’s patients because of their unpredictability and predilection for violence. A week ago, a young nursing student was accosted in the admissions office by a woman who ripped the phone out of the wall and tried to extract any gastrointestinal contents from the frightened nurse.

Robert Appleton was young, brash, and driven to excel. He had graduated magna cum laude from Harvard University Medical School and completed his four-year psychiatric residency at Baylor. He was first in his biochemistry class, eschewing the more liberal arts approach to medicine. His bedside manners reflected his rigorous scientific training. He thought and spoke in outlines without regard for common courtesies. He demanded much from himself and his staff of young interns who had graduated with honors to work for the young doctor. It was no surprise to Appleton when he arrived Monday morning to be confronted by another incident report at the front of Susan’s chart. He quickly perused the nurse’s notes and went quickly to the incident report. All incident reports sounded the same to Appleton: Patient becomes irate and out of control; patient attacks staff; patient is sedated.v"Damn. I told you to restrain Miss Cairns upon her admission to the unit. My orders specifically called for wrist restraints."

"I’m sorry, doctor. We were swamped with ten admissions over the weekend, and we barely had enough time to transcribe the verbal orders to the medication sheets." The enterprising doctor was unwilling to compromise with Miss Holt.

"I don’t want excuses, Miss Holt. I simply ask that you do your job. If you can’t give me a hundred percent, then perhaps you might consider a transfer to the children’s unit."

The young nurse turned around abruptly, muttering under her breath. Appleton was oblivious to her movements, as he dictated the next order. "I want a twelve-hour restraint order with fifteen-minute checks by nursing staff. Bump up her Risperdal to five milligrams twice a day and increase her Ativan to two milligrams every six hours." Appleton didn’t abide by the recommended FDA guidelines found in the Physician’s Desk Reference. The guidelines were formulated for textbook patients, and none of his patients were found in books. His patients made for interesting case presentations at grand rounds on Friday mornings with the young psychiatric residents at the Baylor College of Medicine. Appleton’s cases were rejects from other doctors who had long since given up on a textbook approach to treating recalcitrant patients. His caseload consisted of patients gathered off the streets of Houston, bus terminals, and crack houses. Managed care panels did not accept his patients who had exhausted their benefits and their welcome to humanity.

Houston was hit hard in 1986 with the oil bust and downturn in the economy. Oil field equipment and sales plummeted, and Texas Gold lost much of its sex appeal on Wall Street. The extravagant spending in the seventies and early eighties came to a screeching halt with the formation of OPEC and their decision to limit oil exports. Historically, Houston was a one-service economy, and many folks filed for personal bankruptcy. Business failures were rampant. Personal services and high tech would not arrive in Houston for another ten years. The Texas Medical Center was the primary economy in 1986 with the promise of heart valves and transplants. Doctors Cooley and DeBakey were world-renowned for their pioneering efforts in prolonging human life and M.D. Anderson was fast becoming a Mecca for arresting metastatic tumors. Competition in the medical center was keen, and the best and brightest interns migrated to Houston in the hopes of establishing medical careers and living in River Oaks and the Tanglewood subdivisions of old-money Houston. Doctor Appleton found himself in Houston in the summer of 1986 as a first-year resident in Baylor’s Department of Psychiatry.

Research was starting to take off in the private sector as professors in pharmacology continued their consulting in the Woodlands community thirty miles north of Houston on the Dallas highway. Two hundred thousand-dollar stipends were common, and the brightest professors were wined and dined by pharmaceutical companies in the hopes of patenting the next wonder drug for the cure of schizophrenia, depression, manic-depression, and epilepsy. Charles Spencer was the enterprising CEO of Spencer Pharmaceuticals and was well known in academic circles as an entrepreneur with a knack for making money. His strategy was simple—incorporate; lure the brightest professors with the promise of an equity position with Spencer; pay handsome retainers for the patent rights of drugs for the next fourteen years; continue to market new pharmacologic agents in the hopes of capturing a significant market share in altering the moods and thoughts of humankind. Spencer was a medical school dropout having avoided the cadaver and laboratory for balance sheets and investment banking. Spencer’s father owned one of the largest brokerage firms on Wall Street and enticed the young son to manage a newly developed division of pharmaceuticals. The sector fund was formed with a significant commitment to R&D to bring about the next generation of mood altering drugs for the world community. The medicalization of psychiatry was the new zeitgeist, having replaced Freudian analysis. Psychiatry departments were busily recruiting medical students with a keen interest and ability in biochemistry, pharmacology, and pharmakinetics. The brain synapse was the centerpiece of psychiatric research in the late eighties, and it was against this backdrop that Robert Appleton entered Baylor’s residency psychiatry program in 1986.

David Beall was Harvard-trained with a Ph.D. in biochemistry and his M.D. from Yale University. Beall followed in the family tradition of New England trained doctors. His father taught biochemistry at Yale and was on the research team that discovered Stelazine and Compazine, powerful antipsychotics which were used in the fifties to curb hallucinations and delusions, but with the untoward side effects of tardive dyskinesia which rendered its victims ataxic. Beall was recruited to head Baylor’s psychiatry program in the late seventies, and he was partial to research psychiatrists who were trained in New England. Appleton was Beall’s first choice in the 1986 class of first-year residents. Bob was highly recruited by Baylor, which barely won out over Stanford by offering the young doctor a signing bonus of fifty thousand dollars to pay off his medical school loans. With departmental grant monies made available from Spencer Pharmaceuticals, Appleton did not worry about starting his medical career in debt or trying to build a practice. The young doctor had graduated first in his medical school class at Harvard and shared the same passion for research as Beall. In four short years, Appleton had completed research trials for the newer selective serotonin reuptake inhibitors (SSRIs) including Prozac and Zoloft. It would take another five years before Paxil was on the drawing board for phase two clinical trials.

The young doctor was not particularly gifted in social communication, and for this reason, he was passed over to become the chief psychiatric resident in 1990. He had no time for politics or pleasantries. His social world was reduced to statistical protocols and milliliters of brain chemicals. He had developed an ablation technique in which the amygdala of the rat brain was removed, leaving the rat in an uncontrollable rage where the animal literally ate itself to death with the cage door opened for an easy exit. Chemical substrates from this anatomical structure that controlled sexual desire were analyzed for dopamine, serotonin and acetylcholine levels, which showed a disproportionate loss of dopamine.

Chemical pathways were carefully orchestrated with the aid of computer analyses that indicated the neurochemical shortages in the brain synapses of the amygdala. Recovery rates were carefully plotted as dopamine was supplied via a shunt to the area once occupied by the amygdala. Remarkably, brain cells began to reconnect with newly formed pathways made possible by the dopamine levels which carried the electrical impulses across the synaptic divides between dendrites and axons of adjoining brain cells. Spencer had patented a new amino acid, labeled RDA, which stood for Ribonucleic Dendritic Access, which was a precursor chemical to help protein binding for the pathway to transport the dopamine between brain cells. RDA was critical to the research protocol, because without it, dopamine could not be absorbed into adjoining brain cells and support the required electrical stimulation.

Despite the extensive interviews and psychological testing required of the incoming psychiatric residents, the personality assessments were not foolproof. Appleton was astute enough to bypass the usual validity scales that would confirm his sanity and hardiness for the grueling pace of clinical rounds and psychiatric research. Specifically, his sordid past would remain a secret. No one would suspect that he had a fondness for young children nor that he spent his spare time cruising Westheimer for young boys and girls with the enticement of hallucinogenics and wild sexual orgies. Appleton shed the sterile environment of academia and clinical practice to capture the wilder, more aggressive and sadistic persona that remained a dark, shadowy, pathetic figure known only to Appleton. He used various disguises to remove excess body hair and ingested progesterone and estrogen to soften the rough, masculine features that were attractive to women. In all his years of practice, he had yet to have one allegation of sexual impropriety brought before the Board of Medical Examiners. He was always careful enough to conceal his identity by using aliases and fake documents to remove any semblance of his noble profession.

Houston provided the impersonal backdrop for his alter egos. He especially enjoyed cruising the theater district to pick up young boys and pay them to perform fellatio on him with a ready supply of condoms to contain any evidence of impropriety. His access to the Internet allowed him to download thousands of pornographic pictures showing young twelve-year old girls and boys engaged in adult-like poses. His secret obsession was matched only by his desire to achieve power and dominion over his subjects. His laboratory of human desire expanded beyond protoplasm and chemicals into the dark recesses of childhood memories and trauma. For as long as he cared to remember, the young Robert had always been a human guinea pig. It was his mother who first seduced him at eight years while his father was out of town on business. He learned to masturbate with his mother while other boys were looking at Playboy. His sexual identity was confused as a child, and he felt drawn to other boys in ways he did not think possible. The obligatory facts of life discussion only served to confirm his sexual identity diffusion and desire to be different. Although he preferred to think of himself as bisexual, the truth dictated a finding of asexuality. Appleton was possessed by power and control over other human beings. He learned to avoid what was politically correct and to delve into the psyche of kindred souls whose thoughts were fragmented and segmented beyond rationality. His research on sexual violence only served to confirm his suspicions on human depravity. It made little difference to Appleton if he were impregnating the mind with mood-altering chemicals or the body with seminal fluid. The ultimate insult was his total control over the other person.

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