Trigger Therapy part 1

Hasty

The bar was noisy with college students as Rick made his way to their typical spot in the back. He met his friends here every week. Sometimes they'd scope for girls, sometimes they'd just get college annoyances off their back. Rick was pre-med and it was just about the end of his sophmore year. As he reached Alex, he could see Brian and Steve were playing pool. "Hey man, what's up?" They exchanged a well-rehersed handshake as Alex handed him a beer and shrugged. which he took to mean same-old-same-old without him having to talk over the noise. "I got that big internship I was hoping for," Rick was practically yelling to be heard. Alex nodded.

"I heard you and Drew split." Rick nodded back. He had dated Drew on and off for a few months. They had meet out drinking one night and while it had been fun, they were from different places and headed in different directions. The summer coming up seemed like a good point to break it off, though Drew hadn't been in the same place about it. Alex had to shout to be heard over the noise, "Good, I need you. Those two make horrible wingmen," obviously referring to Brian and Steve. Steve was a math major, kinda of short, and a bit of a bookworm. Brian should have been a ladies man. He was almost six feet tall, attractive, and a business major, but he just didn't have the confidence to talk to girls. "I'm going to go get those two, I want the brunette." Alex gestured in the direction of two girls at a table alone before charging off towards them. Alex was Rico-Suave. He could talk an eskimo into buying ice if he had the time. It would serve him well as a lawyer if he didn't flunk out first. His powers of persuasion didn't work so well on the professors and he was currently on academic probation. They were all in the same wing freshman year in the dorms, and somehow out of all the random new friends, this motley crew lasted.

Alex was already headed back over with the girls, carrying their drinks. "Rick, this is Amber, and this is Sue. Ladies, this is Rick." Of course the brunette had the stripper name, somehow the girls Alex picked always had something. It's like he could see it from across the room. Rick wondered for a minute if maybe the girls just made those names up when they saw him coming. Rick found them both just moderately attractive, and not as cute as Drew. He certainly didn't break up with her because she wasn't cute enough. Drew was a thin, medium-height, cute-girl-next door type, definitely better than average on campus. His thought was interrupted by Alex's finely honed timing, "Rick here is pre-med. He just got a big intership working on some cutting edge medicine. Tell them about it."

Rick appreciated the introduction, but he found it awkward to talk about his own accomplishments without sounding like a jerk. He opted for humor, "It's never going to see the light of day, because Alex here is going to sue all of us doctors out of a job!" They all laughed. Laughter always softens the social boundaries, that and pints of cheap college beer. He had to get in close for them to hear him without him having to shout. "But yes, I just opened the letter today. They are working on a radical new type of long term drug therapy that can be controlled after it's administered." He realized he hadn't tried to explain it to non-med students, and had no idea how to make it sound interesting.

Amber broke in first, "you mean like a remote control? Like I have allergies, and I push a button and then I don't?" The analogy was wrong, there was no remote control device. The study used another ingested substance. It would be pointless to use it for something like allergies, because you might as well just take the allergy medicine. However, this was a bar conversation, and that was close enough. He nodded.

"How do they do that? Is it some kind of sub-cutaneous delivery device with a remote trigger?" Sue's technical jargon both surprised him and told them all she was also pre-med. Rick smiled a little. At least he'd have someone to talk to for the night.

"No no. It's actually not a remote at all. It's a substance mediated trigger. They are hoping to solve dosing problems for long term therapy. They inject a long term agent into the body, and the agent watches for substances we all eat everyday. By choosing the right trigger, they hope to control the dosing over time automatically." Sue nodded and registered some surprise and understanding. It was a pretty novel approach. Who knows if it would work or not. Alex had already pulled Amber away from the technical jargon, and I could see her flirting and touching him. Wingman's job complete.

---

Rick had just showed up for his first day of orientation. He was one of six students interning on an actual human drug trial. It was located in a small town a few hours from school, and the students were setup in cheap hotel rooms for a few weeks for on-site work. They all sat around a conference table at the makeshift summer drug administration office across the street. The speaker was one of the full time employees of the team. "You are all lucky to get a first hand look at a drug trial at the human testing stages. Most drugs never make it this far, so your classmates are probably doing injections in lab rats and cleaning mouse cages. We are almost approved, and it took us six years and tens of millions of dollars to get here. I say this, because I want to impress upon you the importance of care and correctness." He was balding, and in his mid-forties, not much to look at, but Rick was still impressed. He'd looked his name up on the Internet and the man had written more medical articles than I had time to read through. This study really had some heavy hitters.

"I trust you have all read the brief. I will remind you that everything you learn from here on out is under NDA. That means you don't talk about it with your mom, or your girlfriend, or your school buddy, or your priest, or even the Pope." He was trying to be funny, but he really wasn't. His delivery was all off. One of the students forced a chuckle. Kiss ass. "Our trial is a radial new type of long term drug therapy. Typically these therapies are arduous for the patients to follow and administer properly. Often there are mistakes and complications arise. Our trial uses a new method we call trigger mediated delivery to target a disease called Stunted Growth Syndrome, or SGS. Most SGS cases occur because of an under-active or faulty pituitary gland leading to insufficient Human Growth Hormone. It turns out there are many checks and balances in the body that feed into HGH production levels, and a break in any one of them results in insufficient production. We isolated a protein catalyst that shortcuts to the last step in the process, triggering HGH synthesis directly against the DNA of any cell. However, we need the process controlled. Therefore, we've wrapped the catalyst up in a protein shell that only unwinds in the presence of a mediator."

"Doesn't the mediator delivery become the same problem as the therapy delivery? How is this better than simply administering synthetic HGH?" The question was from a dorky sounding kid on the far end. He obviously hadn't read the paper.

"You'd know the answer to that if you had read the brief, as you were all supposed to," the man glared, but it seemed for show. That kid was lucky the host was in a good mood. Rick had heard of Interns being fired on the spot for being unprepared. In fact he'd read and studied all the background material, including some of the prior research that looked related, just to be prepared. "Anyone can to enlighten our slacker?" The host asked, offering for one of the students to answer.

Rick's studying paid off, as he eagerly rattled off the details. "The protein shell can be designed to trigger on virtually any stable bio-inactive atom or molecule. In this trial they configured the shell to react to the element Iodine. Since we naturally ingest Iodine at a rate that is compatible with the target delivery dose, it is automatically administered. There is also the secondary effect..." The host held up his hand to stop Rick before he could point out other benefits, such as the lower cost of the mediator relative to synthetic HGH.

"I'm glad someone has done there reading. With that out of the way, you'll follow me into the lab where I'll show you the administration and measurement procedures. You'll record a number of metrics every week about each subject. You'll also take blood samples. Is everyone here comfortable with their Phlebotomy?"

---

After a month, the first phase, administration of the drug, was almost over. Soon Rick would be headed back to campus to crunch data. After the first few days, everything had been quite routine, and Rick actually found it fairly boring. The interns all had shifts to keep the check-in clinic open during extended daytime hours, including on weekends. Patients were scheduled to visit at their convenience. The only excitement was the rare occasions the interns had occasionally gone out for a drink at a local bar. Today was just like every other day for Rick, reading to pass the time, handling the administration procedure for patients, that is until his second patient. He opened the exam room door with surprise. "Drew?" He hadn't seen his ex-girlfriend in a couple months, and was shocked to see her here. From the look on her face, the surprise was mutual.

"Rick, what in the world? What are you... I'm just. Is this a joke? I sign up for this supposedly anonymous drug thing and you're here?" Of course Rick knew why she was there. The study had two types of participants, stunted growth sufferers, and control subjects. The control group was used to help judge effects of the therapy on individuals without any medical abnormalities. Because the trigger consumes some natural iodine in the body, there were many possible side-effects which Rick had memorized from repeating them so often. She was wearing a white fitted shirt and jeans and sitting up on the exam table. Rick had forgotten how cute she was.

"I'm sorry to startle you. It's no joke. I'm working as an intern on the study. Let me see if someone else is available." He immediately stepped out of the room. He knew there was no other intern available. They all worked shifts and two of them had already headed back to campus. Still he took the moment to reset the situation, as much for him as for her, before stepping back into the room. "Sorry, I'm the only one available. Let's just get started." He tried to be professional, "Drew Canter, age 20, female. I understand you're enrolled as a control subject in the study." It wasn't a question, but she nodded. "I have your consent forms here. The law requires us to verbally confirm you understand the possible side effects of the trial. Do you understand that you will be taking drugs not yet approved by the FDA, and as a result you may experience known or unknown side-effects including increased tooth decay, altered hormone levels, lowered bone density, reduced breast development, reduced metabolism, or growth spurts?" Rick was surprised growth spurts, the most likely effect of the trial, was listed last, but this is how the script had been written.

"Look at you all official. Yes, I understand." Seeing Drew there made it impossible for Rick to remain detached. He wondered what the company had given members of the trial to submit to the risks. Drew was a perfectly healthy college student. What was she doing here? Still, he had no business asking.

"Very well. Please initial here." He handed her the clipboard and waited for her to finish before setting it back on the table. "I'll need to perform a baseline physical and take some blood before administering the trial drug." He held a blood pressure cuff up for her to slip her arm in, lifting it up to her bicep." Even broken up several months, being this close to Drew was causing some kind of reaction in him. He was starting to wonder if he was still interested in her before the cuff started it's automatic cycle of humming, inflating, and deflating.

A moment later he wrote the blood pressure readings onto his clipboard, 115/70. "Would you remove your shoes and step up against the measuring tape?" She flipped her shoes off, hopped off the table, and stood with her back to the wall. She looked like she wanted to say something, but kept her tongue. He wrote down the measurement, 5'6" on the money. "And finally, the scale please." She stepped onto the platform and he shifted weights back in forth to align the balance. He found himself playing a guessing game, and came in a little lower than her former 122 lbs. "Please have a seat in the chair." He gestured to a seat. His body was on autopilot administering the routine, tourniquet, needle, fill blood sample vial, label, bandage, trial drug, injection, done. She could have been any patient, except she wasn't.

Rick handed her the standard handouts, though he felt weird giving her the closing line. "If you have any problems, or you experience any of the symptoms listed in the top box, be sure to call the emergency line here first. The number is on the top of the sheet. Other than that, we'll see you in August."

He had almost made it all the way out the door without incident. Her voice stopped him, "it's good to see you Rick. I miss you ya know."

He honestly didn't know what to say. After a month held up in a motel room in a podunk town, he was feeling isolated, and in the little time he'd spent on campus, he hadn't met a girl as cute or sweet as Drew. However, he knew nothing had changed. All the reasons he had decided to split with here were still the same. He barely turned, "it's good to see you Drew. I'm headed back to campus tomorrow, good luck." Quickly stepping out of the room, he made sure he was out of sight when she left the clinic.

---

In August, Rick was back in the same crummy hotel, with the same boring routine. However, if his summer clinic shift had been boring, his time crunching numbers back at campus was mind-numbing. Campus had been empty, a ghost town. The majority of students were away. Without students, the campus had a completely different feeling, no energy, no excitement. Even most of the bars were closed.

Clinic hours had extended into an endless drudgery. He never would have made it through if not for thinking about how good this would look on his med-school applications. Despite the boredom, he took his work seriously, double and triple checking everything. His supervisors had noticed, and praised him as their best intern. He was proud of his work.

For the last few weeks he had been performing check-ups on the subjects. Reports of side effects were minor and infrequent among the patients he saw. He did receive some questions from active stunted growth subjects about when they would see some results, to which he had a full script explaining that human growth is a process that happens over time, that the trial was an attempt to nudge their growth back into action but that it would take much longer than the three months that had elapsed.

In fact, he was starting to think the therapy didn't do anything. That is until he saw Drew. He was in the lobby dismissing another patient when he saw her walk in. Unlike when he'd seen her last, this time she demanded his full attention. She somehow looked sexier than he remembered. He wondered if being alone was just making her seem more attractive, or if maybe he wasn't over her after all. He tried to remind himself that once school was back in session he'd find a new girl and forget all about her.

Drew settled into a seat in the waiting room as the receptionist handed him a clipboard for his next trial patient. Each time he returned to the lobby, he couldn't help notice Drew, and how she was fully ignoring him. Then it was her turn, "Drew Canter." She rose up and headed towards him. He got an even stronger sense of attraction to her, and noticed that she suddenly seemed taller than he remembered. He glanced down relief passed through him as he saw her tall heels. He turned and led her towards the exam room. Once, inside he indicated where she should sit with a pat of his hand. "How have you been Drew? It looks like the summer's treating you well."

Drew was beaming when she bounded up onto the exam table. "I'll say. I've had tons more energy. My sister and I have been on a regular exercise routine, so my mother says that must be it." She lowered her voice to a very audible faux whisper, "but honestly, I think it's the trial."

"Well, that's good. I'll make a note, though it probably is the exercise routine." Patient reports increased energy and activity level. He set his clipboard aside and administered the blood pressure test. 116/69, no change. "Would you please step up against the measuring tape, barefoot please." She kicked her heels off onto the floor and pressed her back up against the tape. He had to double-take, first from seeing her obviously as tall as he was, and second at the measure on the tape. 5'10"? He peered down at her bare feet against the floor before again rechecking the tape. "Wow."

"What does it say? I mean, my sister and I measured at home, so I know I got a little taller. How much?" She was primed with anticipation.

"Drew, you're measuring 5'10". That's 4" of growth in three months," Rick reported with surprise. Patient experienced unusual growth spurt. "That's remarkable. I have some follow-up questions for you, but first lets get your weight measurement. Step up onto the scale." He shifted the weights back and forth, and her weight settled in, "125". From the chart he could see her weight:height proportion dropped. She had already bounded back onto the exam table, and was slipping her shoes back on. He shuffled through his papers until he found the standard questionnaire and handed it to her. "Please take a moment to fill this out." He leaned against the med-station as she quickly scribbled answers before handing back the clipboard. Rick was still in a little shock and on-autopilot as he handed her an informational sheet and read from another copy of it. "You should be aware that the trial is in your system for at least another three months. To minimize side-effects, please avoid excess consumption of canned soda, salty foods, and red meat during that time period."

"It's pretty cool isn't it?" She hopped off the table and stood a few inches taller than him in her heels. "In a couple months I could be this tall without heels. This trial is the best." She gave him a quick hug and headed headed for the door. He still felt a little blindsided and every minute felt the flood of attraction to her rising. Each moment time slipped by, he felt more of an urge to say something.

"Drew?" She turned. "I was thinking. I'm here for another week. How would you like to get together? I'm staying at the motel across the street. They keep me pretty busy here, but we could meet up and, I dunno, hang out."

"You know Rick," her lips crinkled into a funny smile, "I've spent this whole summer exercising and watching in disbelief as this little growth spurt added inch after inch." She worked her way back towards him. "All the while boys have been noticing me more and more. Here I was, alone, thinking how much I wished I had you to share it with. I even had a dream about it."

As she spoke, Rick noticed she wasn't just taller, she seemed sexier - more confident. She , close enough to be uncomfortable if not for their intimate history. The feeling of her taking his hand was familiar, but looking up at her was decidedly different.

She leaned in and lowered her voice. "In my dream I showed up on campus. I found you. I told you how much I missed you. and you know what you said?" Obviously Rick didn't know. It was her dream. He shook his head. She was standing as close as she could without touching. Rick was focused on her lips hovering next to his right eye. "You said...." She grasped his hand a little tighter, "you said. I think we're headed different places." She had already let go and started to move away. Her voice was no longer whispered and sultry, but dark and scorned. "You said, it's for the best. You said, good luck." She had one foot out the door as she let out her parting salvo. "See you on campus."

As she left, the reasons Drew broke with her flooded back into his head as defense mechanisms. Nothing had changed. She was still a small town girl, studying art history. He was going places, she was not. Sure, she got a little growth spurt from a drug trial, but her little show only proved that he should add vindictive to his list of reasons not to date her. He was glad to be rid of her.

original notes.

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(1) A university med student, Rick, is accepted to a senior internship on a radical new type of drug therapy. In the study, a very long term systemic drug is mediated by a periodic trigger substance. The first application of the technique is a study of trigger mediated pituitary stimulation to correct stunted growth. In this application, the drug was designed to use iodine as a mediator, because the typical daily intake of iodized table salt provides the right amount of constant trigger without a complicated and controlled administration procedure. He packed his bags and headed for a small town he'd never heard of for the summer.

(2) Just a few weeks in he's surprised to find a girl he recently dated Drew, who certainly did not have stunted growth, was participating as a control subject in the study. He had stopped seeing her because she seemed too much of a small-town girl to keep up with where he was headed. She was studying communications, while he was a med student soon to be heading off to med school in a big city. Despite his attempts to be friendly to her, she brushes him off, spurned because he had abruptly stopped seeing her. When he sees her again at the end of the study, the subtle nudge to her pituitary produced a not so subtle response. While she had been attractive before, she was now noticeably taller (5'10") with a sexier figure. She's also become much more confident, and her dismissing him makes him all the more regret breaking with her.