“Exactly. But more than that, often we compound special medications for the Palace. It’s considered a means of keeping the Empress – or Emperor, as the case may be, now – in the best possible health, while maintaining security. In this particular instance, because the doctor had in mind to compensate for her sedentary, indoor lifestyle, we created a balanced blend of certain vitamins, minerals, and related nutrients, to try to boost her strength, immune system, and a couple of other functions. It’s my understanding she practiced an ancient art called tai chi chuan, so she wasn’t completely sedentary…”
“Okay, I follow you. Keep going, please.”
“So what I found, when I went back and pulled some of the assays on that supplement, is that it wasn’t what it should have been. At some point, someone had added a small dose of Aspalcaine. And marked the compounding files as amended by the physician – except we show no record of any communication from her physician which adds that medication.” She paused, then added, “And I already called the Palace medical center, and their archived records don’t show it, either. That said, there’s nothing that indicates that the doctor didn’t call and request the addition, perhaps for a short-term situation – perhaps even requested by Ms. Song herself, to get through an exceptionally busy period, as at the time, the pharmaceutical industry thought this derivative medication had done away with the worst of the cocaine-type effects – and then it simply never got removed from the compounding instructions…”
“Shit,” Ashton cursed with feeling, then understated, “That’s… not good.”
Aspalcaine was the trade name for a drug also known as disalicylcocaethylene. It was a modern derivative of cocaine, an alkaloid extracted from the coca plant, a sophisticated, forced-combination form of two older derivatives. It was a prescription stimulant used in certain medical conditions, but it had to be extremely carefully controlled, because it had some fifteen times the binding strength to the dopamine receptors as cocaine, and it was correspondingly more powerful.
And more addictive.
And more damaging.
“No, it isn’t; it’s not good at all,” Graham said, agitated. “Worse, it was in her medications for years. My team is still trying to trace the assays to find out how long. It wasn’t much… but it may well have been what led to her needing to be medicated for chronic high blood pressure in the first place.”
“Mmph. Because it’s a stimulant?”
“Yes. A powerful one. And… it gets worse,” Graham said with a sigh. “I dug into some of the medical history, and there’s no genetic history in her family of such things…”
“Keep going.”
“Well, Aspalcaine partakes of many of the same side effects as cocaine, and for the same reasons,” Graham explained. “That’s why, nowadays, it’s so rarely used. And the biggest and most dangerous one of those side effects is cardiomyopathy – damage to the heart muscle, in this case, caused by chronic inflammation from the Aspalcaine.”
“So the drug may have been the cause of her heart problems?”
“Possibly. At the very least, it would have exacerbated any pre-existing tendencies.”
And that explains that, Ashton thought. “What about the medications they gave her for the heart problems?”
“We’re still digging into all of it,” Graham said. “But… and I hate to say it… the error in compounding – and it was expressly compounded for Ms. Song – may well be what caused her death, in the end. If not directly, then certainly indirectly, via complications.”
Ashton pressed his lips together, his expression grim.
“Dr. Graham, I need you to do some things for me.”
“Please, tell me what you need.”
“I need you and your people to keep digging on those medications… and I need you to go back through the personnel files to see if you can find out who was responsible for compounding the supplements.”
“I was afraid you were going to say that,” she murmured. “All right. I’ll see what I can find for you.”
Digging Deeper
The next day, Graham had more for him.
“Empress Ilithyia the First’s blood pressure medications were messed up, too,” she told him. “It only had about half the dosage of medication it was supposed to have. Which explains why the doctor kept raising the dosage on her medication. Except the actual quantity of medication contained in the pills never increased much.”
“Was she still on the Aspalcaine at that point?”
“No… but the damage would already have been done to her heart,” Graham noted. “And that would have been evidenced by the very high blood pressure.”
“What about the heart failure medications?”
“We’re not sure yet. We’ve discovered that a lot of the assays for the cardiac meds were – well, if not outrightly falsified, they were dummied up to look legit, when they weren’t. We’ve already determined that the Imperial Council had something to do with that, pretty much directly – the people here were ordered to jimmy the assays. No, no,” she said, raising a hand as Ashton made to speak, “those people are no longer with us. They retired long since.”
“Well, that’s something, I guess. Please, keep going.”
“Yes. So since we always keep, label, and archive a good-sized testable sample of each batch that goes to the Palace for the Empress or heir apparent, we’re running additional analyses from our archives. I’ll let you know what we get as soon as I find out any more information.” She drew a deep breath. “Given the nature of all this, I’ve contacted our upper echelons, who gave me permission to pull in the current compounders for the Emperor and Empress, as well as Consul Saaret and his wife…”
“Did you double-check any medications or supplements they’re on?”
“We did. And triple and quadruple-checked. And those are fine.”
“Good. So why did you pull in the current compounders?”
“Oh. They hold the requisite clearances
