The Final Dose
Episode 28
At the Hospital
Detective Mack Johnson sighed as he surveyed the sterile hospital room, now a scene of quiet grief. The patient, a middle-aged woman undergoing chemotherapy for gastric cancer, had passed away unexpectedly. Her husband sat by her side, his head in his hands, replaying the last moments in his mind.
Turning to YOU, Mack says, “We’ve got the chart, but it’s hard to make sense of some of this without your expertise. Was this just a complication from her treatment? Or is there more here than meets the eye?”
Autopsy Analysis
Dr. Rick Ricketts peered through his microscope, brow furrowed. “There’s something off here,” he murmured to YOU. “Her heart rate spiked hours before her passing, and her liver shows signs of unexpected toxicity.”
YOU examine the initial autopsy report Rick handed you. His notes reveal elevated toxicity levels suggesting a possible medication interaction or miscalculated dosage. You spot something concerning and point it out to Rick, asking him to dig deeper on liver enzyme levels.
Lab Results
Dr. Emily Torres reviews the lab reports, noticing a spike in enzymes typically related to metabolic stress. She flags YOU and Mack over. “This level of toxicity isn’t typical, even with cisplatin,” she explains. “But look here—she was on a cocktail of drugs. One might have triggered an interaction.”
“Could an antiemetic cause this reaction?” YOU ask, flipping through her medication list.
Emily nods thoughtfully, “Aprepitant was added two days ago. It's usually safe, but in rare cases, if combined with certain other drugs…” She trails off, lost in thought. YOU suggest that they look into any other drugs that might have been involved.
Meeting with the Family
The team speaks to the husband, still devastated and searching for answers. Liz Harper, taking careful notes, gently asks, “Was there any recent change in her medications or symptoms?”
The husband nods slowly. “She had nausea, so the doctors added a new anti-nausea drug two days ago. She seemed okay at first, but yesterday she was tired, couldn’t keep anything down.”
YOU make a mental note of the symptoms as they align with some known side effects of cisplatin combined with certain antiemetics.
Pub Gathering
As the team gathers at the local pub, the atmosphere is relaxed, contrasting the intensity of their earlier investigation.
Emily Harper raises her glass, a playful smile on her face. “So, Emily, I saw that amazing dinner you had the other night at that new restaurant in New York. It looked incredible! Where was it?”
Dr. Emily Torres laughs, her eyes lighting up. “Oh, that was at Le Bernardin! I’ve been wanting to try it for ages. The seafood was out of this world!”
“You’ve got to take me there sometime,” Emily Harper replies, sipping her drink. “Your Instagram feed is always filled with the best places.”
Just then, the conversation shifts as the pharmacist (you) interjects, recalling the earlier discussion about the case. “Speaking of seafood, have we discussed how the chemotherapy can affect a patient’s appetite and nutritional status?”
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Liz chimes in, “I’ve heard stories of meds affecting people differently, even in similar doses. But isn’t it rare for such a severe reaction?”
YOU share what you know about cisplatin, its antiemetic requirements, and how certain drugs like aprepitant can interact under certain conditions. The team discusses the balance between treatment efficacy and side effects, emphasizing how small missteps can have fatal outcomes.
Additional Testing
Back in the lab, Dr. Torres runs a detailed assay on the patient’s blood samples. She flags YOU and Rick. “Her levels of aprepitant were way too high. Looks like her body wasn’t metabolizing it properly—possibly a genetic predisposition.”
YOU and Rick exchange a glance. This discovery opens a new angle: genetic testing may have revealed the risk, but it was never conducted. A missed precaution that proved fatal.
Clue from the Pharmacy
YOU visit the hospital pharmacy, talking with the pharmacist who handled the patient’s prescriptions. He confirms the correct dosage was dispensed, but mentions that he noticed an error in the original prescription that was later corrected.
“Wait,” YOU say, “what kind of error?”
The pharmacist lowers his voice. “They initially prescribed a higher dose of aprepitant but adjusted it hours later. I didn’t think it would matter since she only took one dose.”
Reviewing the Case
The team regroups in Mack’s office, laying out all the clues. YOU go over the details with the others, emphasizing the late addition of aprepitant and the metabolization issues.
“This wasn’t a typical overdose,” YOU explain. “It was a combination of an unusual reaction, a possible genetic issue, and the dose adjustment timing.”
Rick leans back. “A perfect storm of tragic missteps.”
Decision Time
Rick turns to YOU with a somber expression. “So, what’s your call? Could it have been prevented?”
Liz adds, “She was trying to survive the cancer, but the treatment itself…” She shakes her head. “Was it a fatal error or just bad luck?”
YOU have all the information in front of you. It’s up to you now—was this an unfortunate reaction, or could better precaution have changed the outcome?
