“Five.” He rubbed the bridge of his nose under his glasses. “Over what period?”
“Going back six weeks. Before that, nothing from the samples we sent.”
“So we didn’t miss a whole bunch of cases. That’s helpful, at least.”
Kenzie nodded.
“And any mention of how they are doing at the lab? Back-tracing it to the source of the contagion?”
“No, no word on that. I guess they didn’t think we needed to know.”
“Not necessarily,” Dr. Wiltshire said with a forced smile and a slight shake of his head. “I’m sure it is long, tedious work. And not just a search that can be done on the computer. They’ll have to do a lot of interviews to figure out each transfer point. And any labs or scientists that didn’t follow proper protocol and might have been an infection point aren’t going to want to talk to anyone. Not without a subpoena or some kind of order from public health.”
“But we can’t afford for it to take a long time. People are dying.”
“So far, it doesn’t appear to be widespread. Champlain House is currently the only known outbreak.”
“As far as we know. But most doctors are not going to do a test for HHV-4 or to collect brain samples when a patient comes in complaining of memory issues or vertigo,” Kenzie snapped back.
“No. You’re absolutely right. No one is going to know what to look for until it is announced. But an announcement cannot be made based on what we have so far. We’re going to need to find out any commonalities of the six victims. If they were all in the same part of the unit, all played poker together, or had something else in common. We don’t know yet how the infection is spread. Person to person contact. Surface contact. Large droplet. Aerosol. Epstein Barr is typically spread through saliva. But the new variant could be different. We need to get a better idea of whether those patients all knew each other and were in close contact with each other. Or whether... I don’t know... it’s in the heating ducts or the shower heads. Or on the doorknobs.”
“Okay... I’ll give them a call and see if I can get anywhere.”
“Good. And I will call and see if I can get any more information from Dr. Pascal Savage.”
49
Kenzie hadn’t gotten advice from Dr. Wiltshire as to how to go about talking to the staff of Champlain House without letting the cat out of the bag about the possibility of an outbreak. Exactly how was she supposed to gather information on those six particular residents without the staff wondering what was going on? It had to be clear that Kenzie was not just being nosy and using her position with the Medical Examiner’s Office to ask idle questions.
She tried to play down the six deaths and any connections between them as much as possible.
“We’re doing an audit of a random selection of cases we have received from Champlain House over the past few weeks,” she told Nurse Summers. “Just to make sure that everything has been handled correctly by the Medical Examiner’s Office. We have to perform self-checks to ensure thoroughness and consistency of results.”
“This seems like make-work,” Summers objected. “I and my staff are very busy. We don’t have the time to be answering a bunch of unimportant inquiries. We have quite enough work to do without your office adding their own requirements into the mix. I don’t think there’s any legal requirement for us to answer your questions when they aren’t even connected to a case.”
“They are connected to a case. We have six different cases that we are examining. I realize it’s an inconvenience. It is for me too. Believe me, I don’t want to be wasting my time and adding extra busywork into my schedule either.”
“Yet here you are,” Summers said acidly, “taking up my time on the phone.”
“Would you prefer that I come there in person? It would probably be a good idea if I do anyway. Then I can talk to everyone who is in and see the various rooms and common areas in the unit.” She thought about the various potential points of infection.
“No, I don’t need anyone poking around here, either.”
“I will probably need to do a quick walkthrough, at the very least. But I’ll start with the phone interview. The more information you can give me, the quicker it will all be over.”
“Now is not a good time.”
“What time would you like me to call you back?” Kenzie tried to pin her down. “What time are you off? Maybe that would work better.”
“No, I’m not spending my off-time dealing with this.”
“Whatever time you prefer, just let me know...”
“How about never?”
“Nurse Summers,” Kenzie let some of her frustration and impatience into her voice and formed the words very precisely. “If you are impeding a legitimate investigation by the Medical Examiner’s Office...”
“What? You’re going to throw me in jail?”
Kenzie had no idea what the penalties might be for something like that. She strongly suspected that the penalties for refusing to talk to an ME’s office were not very harsh. “Do you really want to find out?”
Nurse Summers sighed. “Fine. What exactly is it you want to know?”
“I have a list of patients here. The first thing I am going to need are the room numbers for each.”
“The room numbers?”
“Where their living quarters were?” Could a nurse really be that dense?
“Fine.”
Kenzie ran through the list of six, and on each patient page, noted the room they had slept in. “Great, that’s very helpful. And now, I don’t know what the options are for food. Does everyone eat meals together in a common room? In their own room? Are they allowed to bring in outside food?”
“A combination. Most of the residents in our room take meals together in the common room. They like to socialize. Some residents prefer to take meals in their rooms, or have occasional outside meals brought in by family or friends. But that is less common.”
“I have the same six patient names and would like to know where they took their meals.”
Nurse Summers listed a few off before stopping to ask, “And who else? I didn’t catch them all the first time.”
Kenzie mentioned the additional names. She wrote the responses on each of the sheets of paper. As Summers had said, most preferred to take their meals in the common room, but a couple took some or most of their meals in their rooms. There wasn’t an obvious pattern. But from what Kenzie could interpret from the nurse’s answers, everybody went to the common room to eat at least sometimes.
“Extra-curricular,” Kenzie announced next. “Did these patients play games together? Visit with each other? Keep to themselves?”
“With each other?” Nurse Summers tapped her nail impatiently on the phone. “No, they weren’t all a secret club, if that’s what you mean. They might play a game together now and then, but not regularly.”
“What kind of games do you have? How are they sanitized?”
“How are they sanitized?”
“Disinfected. Are they wiped down after the residents use them?”
“No. Of course not. That would be a lot of extra work for the staff, and I’m not sure you could wipe down cards or puzzles. I don’t understand what you are looking for. Do you think one of these patients had Hep B or staph? The residents are responsible for their own hygiene. We haven’t had any lockdowns due to infections in this unit. Not even flu or pneumonia.”
“That’s a great record. Please don’t take these questions as a criticism of your practices; that’s not my intention. I’m just trying to learn what I can about these patients we have selected and how thoroughly their deaths were investigated.”
“It sounds more like you want to check on our practices than yours.”
“Let’s move on to contact with staff. I know that this is the independent living unit, so they do not require significant nursing care, but they must still have some contact with the nursing staff and housekeeping.”
“Of course.”
“Can we go over each patien
t and the extent of the care they had from the nursing staff? None of them were assigned any particular nurse, is that right?”
“No. All of the nurses are available to deal with residents as needed. Some might need a bit of help with showering, or need someone to give them their pills so they don’t get mixed up, that kind of thing.”
“Can you go through each of these patients and tell me what kind of assistance they needed?”
“I don’t know if this is appropriate for me to be talking to you about under the privacy laws.”
“They are dead and this is part of our investigation into their deaths. You are not required to get any consents to communicate information to the Medical Examiner’s Office.”
“So you say.”
Kenzie waited. Nurse Summers sighed in exasperation and began to list each of the patients to describe what care they needed or may have had with the nursing staff before their deaths.
“Is that everyone?”
“You haven’t mentioned Mr. Sexton yet.”
Summers summarized Sexton’s information briefly.
“That’s great. Now, what about contact with the housekeeping staff?”
“The residents don’t have any contact with the housekeeping staff.”
“Housekeeping enters their rooms to clean, don’t they?”
“Not while they’re there. If they are in their rooms, they are asked to go for a walk until housekeeping is done.”
“And they pick up their laundry. And what else? I assume they wear gloves to avoid contamination with soiled clothing?”
“I don’t know. I suppose so.”
“Do they change their gloves between rooms? What is the protocol for handling soiled items?”
“I don’t know what their practices are. That is all dictated by administration, not nursing. Of course they will protect themselves from contaminants.”
“And are the residents’ laundry items all kept separate from each other, or all washed together?”
“They are kept separate, just like washing at a laundromat or at your house. They are removed from the resident’s room in a marked laundry basket and returned to them washed and folded in the same basket.”
“And is the basket sanitized?”
“I don’t know. You would have to talk to housekeeping about that part.”
Kenzie looked for other areas she might have missed. “And they disinfect all high-touch surfaces in the residents’ rooms?”
“I assume so.”
“How often?”
“Residents’ rooms are cleaned once a week unless there is a specific problem requiring the housekeeping staff’s attention.”
“Do residents visit each other in their rooms? Or only in the common areas?”
“They are allowed to visit with each other privately. We don’t supervise interpersonal socialization unless there are known to be problems.”
“Like what?”
“What do you mean?”
“What kinds of problems?”
“Just like anyone else, residents don’t always get along together. Some of them, they have disagreements or don’t like each other. As much as we try to provide a good environment, we can’t make everyone like each other.”
“Are we talking about arguments or physical altercations?”
“Most of them are too old for a physical fight... but we have had a few of them.” Nurse Summers blew out her breath. “Some men... you would think their testosterone would be low enough by the time they get here that we wouldn’t have fights. But there you are.”
“And have you had any problems with any of the patients on my list? With physical altercations?”
“Well... I feel like I’m telling tales out of school. You know what they say about not speaking ill of the dead...”
“We’re not making any judgments about them. Just talking about how they got along together, what the interactions between the patients were like.”
“You really need to know this for your report? What does this have to do with how your office investigated these deaths?”
“Well, I know I was the one who came and talked to you about Mr. Cartwright. But I never thought to ask whether he had been in any fights with other residents there. Now that we’re having this conversation, I can see that’s an area that should be addressed in the future.”
“I suppose so,” Nurse Summers agreed grudgingly. “But your Mr. Cartwright wasn’t in any fights during the week before his death, so I don’t think that was a contributing factor.”
“Not in the week before his death? So he was one of the patients that did sometimes get into fights?”
“He had, in the past, been involved in the occasional argument that got physical. Old military man, you know, they have been conditioned to react physically to what they perceive as a threat.”
Kenzie jotted down this note on her page for Willie Cartwright. “Does that mean that he had PTSD?”
“PTSD? No, men his age were never diagnosed with PTSD. But I can tell you... if he perceived a threat, he would react.”
“Physically. By attacking someone.”
“By defending himself. Yes.”
“And the other patients that we picked out? Any of them have any physical altercations in the past?”
“I don’t think so. Margaret Ashbury, that nice old English lady, she was a spitter. Cross her and see where it got you! A big loogie straight to the eye, if you didn’t watch out.”
Kenzie made a note of this too. They knew the virus was likely to be spread through saliva. “That’s great. Thank you for all the details. Anything else that you can think of with any of the other residents we talked about that I should know about? Health problems? Psychiatric or neurological symptoms, negative interactions with other residents?”
“No. I mean, they all had health problems. They were old. They needed to be in assisted living. But most of them were in pretty good physical condition. Until they died.”
Kenzie rolled her eyes. “Maybe we can just quickly run through each of them and you can let me know if they had any diagnosed issues or if there was anything that you noticed that you think should have been diagnosed.”
“Is this the last question?” Summers asked in a long-suffering tone.
“I think so. Unless it triggers another thought.”
“Well, let’s hope it doesn’t.” Summers ran through each patient briefly to discuss any conditions that they might have had before they died. There were many issues with blood pressure, weight, diabetes, and other issues for being a relatively healthy lot. Kenzie scribbled them all down quickly so that she wouldn’t have to ask again.
“Now, if that’s everything, I would like to get back to my actual work.”
“Of course. If you could just email me a floor plan of the unit so I can see where each of the rooms was in the unit. That would be very helpful. Aside from that... I guess I’ll let you know if anything else occurs to me. And I’ll probably stop by in the next day or two to touch base briefly with the other nursing staff and housekeeping. Just to make sure that we haven’t missed anything.”
“You have been very thorough,” Nurse Summers said, and Kenzie didn’t think it was meant as a compliment.
50
Kenzie was logging in test results received via email and was surprised to see one that had come from a lab she was unfamiliar with. She opened it to scan through the information and was also unfamiliar with the doctor’s name. She looked to the patient name, pretty sure by now that it had been forwarded to the wrong Medical Examiner’s Office. She started to type a reply to the email to let them know of the error when the pieces began to fall into place.
Lola Canine was, of course, not one of the bodies that they had dealt with, but she was certainly part of their ongoing investigation into the deaths of Cartwright, Sexton, and now four other subjects. Lola the dog, from the care center. She didn’t recognize the doctor or lab names immediately because they were veterinary rather than those s
he usually dealt with. She deleted her reply and paged down into the report to see what they had discovered.
She didn’t even remember tapping Dr. Wiltshire’s name into the phone keypad, but she had the phone to her ear and was waiting for him to answer.
“Kenzie?”
“Dr. Wiltshire... I just got in a report from the veterinary lab on Lola, the dog at Champlain House.”
“Oh. Anything interesting in the results?”
“Well, yes... it says that she is positive for HHV-4, as well as a couple of other viruses.”
She heard Dr. Wiltshire put something down with a clack. Maybe his coffee mug or his fountain pen. “She’s positive? You’re sure? For HHV-4?”
“Yes. That’s what the serology shows. I didn’t even know that dogs could get HHV-4. I mean, it is Human Herpesvirus 4. Can dogs get it?”
“Apparently, they can in this case. I would have to look at the research to see if it is common. I’m afraid I’m not up on my canid virology.”
“Maybe it’s just this novel variant. I’m really surprised. Once we identified the possible culprit as HHV-4, I assumed that the dog was out as the source of the infection.” Kenzie shook her head at herself for not looking into it further.
“Did you find anything out about her history?”
“There was a bit of back and forth. I guess she was a friend of a friend’s dog or something like that, they couldn’t take care of her, she needed somewhere stable to live, Nurse Ellie who took him couldn’t have dogs in her building... blah, blah, blah, so Lola ended up being the mascot of the independent living center.”
“You’re going to need details. We still don’t know how Lola got HHV-4. She might have contracted it from one of the patients rather than giving it to them. Most viruses don’t jump between families of the animal kingdom. We still need to find out where the virus came from, if it came from some laboratory, so that we know what has been done with it, its transmission pathways, and what the mortality rate is.”
“Right.” Kenzie jotted down notes on her computer scratchpad. “I will start getting names and addresses and see if we can find any association with a lab.”
Doctored Death Page 21