Pathogen

by Jessica L. Webb

  “Right now that would be me, I’m Lucy. What can I do for you, Dr. Morrison?”

  “I saw on her chart that a chest x-ray was ordered, but I don’t see the films or results anywhere.”

  Lucy seemed to pale under her freckles. “The x-ray went down last night, and they’re just getting it back online now. That’s why there’s a delay. I’m sorry, Dr. Morrison.”

  “Unless you’re the one who took a hammer to the machine, there’s no need to apologize,” Kate said. “Any idea what the backlog is?”

  Lucy smiled tentatively. “About an hour, they’re running emergent cases first. I can check and see if we can get Ms. Cardiff in sooner, though.”

  “An hour should be fine, but could you do me a favour?”

  Given the stunned look on her face, Kate had to wonder if a doctor had ever uttered those words to the nurse before.

  “Of course.” Lucy recovered quickly.

  “Could you call my cell if the x-ray is going to be much longer than an hour?” she said as she wrote down her number and passed it to the nurse.

  “Yes, I can do that.”

  “Great, and if you could check in on Serena when you get a minute, she just had a bronchial spasm with mild hemoptysis, so I’d like someone to keep an eye on her.”

  “Sure.”

  “Thanks, Lucy.”

  Julia walked Kate back to the room.

  “Can I ask a question?” Julia asked quietly.

  “Julia, I can pretty much guarantee that the answer to that question will always be yes,” Kate said.

  “I know ‘hemo’ means blood, but what does the rest of the word mean?”

  Kate smiled to herself. Clearly a bright kid. One who paid attention.

  “Ptysis is the rest of the word. It means spitting. So when I told the nurse Serena had a bronchial spasm with mild hemoptysis I was really just saying she had a big cough with a little blood.”

  As they approached Serena’s room, Julia slowed her pace. “Dr. Morrison, how sick is my sister?”

  Kate stopped in the hallways and waited until Julia looked up to meet her eyes. “She’s definitely sick, and she’s not recovering as quickly as I’d expect from the flu. But right now she’s doing okay.” Kate paused. “Is that enough of an answer?”

  Julia nodded and ducked her head before she said thanks and headed into the room.

  Kate followed her in, finding Serena asleep with Nathan holding her hand.

  “She okay?” Kate asked Nathan, picking up the chart and jotting down the expectorated blood as well as the x-ray order.

  “Yeah,” he responded. He checked his watch and then rubbed tiredly at his eyes.

  “You okay?”

  “Fine. I’ve got to get to work soon, but her mom should be back from her massage appointment any minute.”

  Kate kept her expression neutral but felt surprise and judgement at hearing Natalie Cardiff had gone to a massage appointment while her daughter was in the hospital. She tuned back in to Nathan as he sighed.

  “I should head out before she gets here,” he said. He looked over at Julia, who had curled herself back in the chair. “Hey, Junior, would you sit with Serena until your mom gets here? She seems to like it when someone holds her hand.”

  Julia climbed quickly out of the chair, blushing. Nathan leaned over and kissed Serena’s forehead.

  Kate checked her watch also, realizing she had somewhere she needed to be, too. “I’ve got a meeting now, Julia, but I’ll see you later.”

  Julia nodded, but didn’t take her eyes from her sister.

  Kate followed Nathan out into the hallway, falling in step beside him.

  “Serena’s getting worse, isn’t she?” Nathan said. It wasn’t hard to hear the strain in his voice.

  “She’s not showing improvement, and she should be,” Kate said. “But she’s holding her own right now and she seems strong.”

  They reached the end of the hallways and were just about to take the main set of stairs down to the next level when Nathan stopped. Kate followed his gaze to the floor below and saw Michael Cardiff opening the door for his wife. Nathan sighed and took a few steps back down the hall.

  “I should take the back stairs,” he said, sounding resigned. “I’ll see you later, Dr. Morrison.”

  Kate descended the stairs, wondering about the apparent strain in the relationship between Nathan Tomms and his girlfriend’s family. She was curious about his evasion, though it didn’t really set off any red flags for her. He’d been quietly open about his presence not being approved of by the family, like it was common knowledge. She was still thinking about this when she arrived at the small meeting room. Andy and Constable Ferris were seated at the far side, surrounded by paper, and Dr. Doyle and Dr. Kellar at the other side, saying very little. Kate found what she hoped was a neutral spot in the middle.

  “We’re just waiting on Public Health, Dr. Morrison. They’re just getting back from Vancouver with some results. We should be getting started in a moment,” Dr. Doyle said formally.

  Kate sat down and poured herself a coffee from the carafe in the middle of the table, busying her hands with adding milk and sugar. Taking her first sip, she looked at Andy over the rim of her cup. Andy was sitting stiffly in her seat, far from relaxed, but when she looked up to meet Kate’s eyes, she managed a small smile. Kate took another sip of coffee and she could feel Mona Kellar’s eyes drilling into her from the other side of the room. She ignored it, checked her watch, and let her mind wander to Serena’s x-rays.

  Finally a tall, thin, grey-haired man wearing khakis and a rumpled shirt walked in, nodded his hello to the assembled group, and sat down. Dr. Doyle introduced Dr. Clifford Salinger, twenty-year veteran with BC Public Health, then moved quickly to get the meeting started.

  “Dr. Kellar, if you could present your findings.”

  Dr. Kellar reached over for a remote control, flicked on a projector Kate hadn’t even seen mounted in the ceiling, and a screen came down in the corner of the room.

  “Autopsy results support cause of death as acute onset pulmonary edema.” The projector transitioned to a picture of the exposed chest cavity and Kate saw again the fluid, the infection. She reflexively pulled out her cell phone and checked for an update from the nurse, Lucy, before turning back to the pictures. “Point of infection was found here.” She clicked again, and the slide now showed a close-up of the upper left quadrant of the lung. “This is where the victim had a small tumour that had just begun to infiltrate the lining of the lung. I’ve taken a sample to confirm, but I would guess lung mets, recurring cancer. Either way, once the lung tissue was infected, it spread aggressively throughout both lungs. The general course of antibiotics and PIO diuretics and even the steroids could not possibly have stayed ahead of that rapidly progressing infection. I also concluded that other than hourly chest x-rays to monitor fluid levels, there was no way for the medical team to know how quickly the lungs were going to fill with fluid.”

  Kate felt the stirrings of a quiet, generalized alarm. She checked her phone again. Nothing.

  “Some place you need to be, Dr. Morrison?” Dr. Kellar’s voice was biting.

  “Just waiting on results for a patient,” Kate said sweetly. “Please continue.”

  She watched as the muscles on one side of Mona Kellar’s face twitched convulsively, clearly hating that Kate gave her permission to continue her own presentation.

  “What my results could not verify is the nature of the infection,” Dr. Kellar continued. “Given the victim’s symptoms previous to being admitted to the hospital, I would suspect a viral infection, but would not conclude any such statements until lab reports were back. Which is why I drove the samples myself to Dr. Salinger’s office. Dr. Salinger, I’d like to hear what you’ve got.”

  Kate couldn’t help but wonder about Kellar’s motives for driving the samples to Public Health. Were they scientific or self-interested or controlling or blaming? It could be any of those, and Kate knew she was fa
r too biased to choose the most likely and most flattering option that Dr. Kellar realized the community-wide implications of such an aggressive virus. Kate shifted uncomfortably in her seat. She wanted to talk to Andy.

  Dr. Salinger passed Dr. Doyle a memory stick, and the BC Public Health logo popped up on the screen.

  “Dr. Kellar brought us blood, lung fluid, and tissue samples yesterday afternoon. Although her methods were unorthodox, it was a good thing that she did because it gave us time to take it to the provincial CDC labs in the city.” Dr. Salinger clicked the remote and another image came up. Kate could see a single, sphere-shaped viral cell magnified significantly.

  “Here’s what we found. An as yet unspecified, non-influenza viral infection.”

  The room was silent. Kate realized this was a significant and worrying conclusion. Dr. Salinger clicked again, and the image magnified yet again to focus on the external layer of the virus.

  “Here’s where things get more concerning. In studying the pathophysiology of the virus, we noticed the hemagglutinin cleavage factor, though in structure extremely similar to a common H1 strain found in the vicinity two years ago, does not react to human protease.”

  “You tested every one, did you Dr. Salinger?” Dr. Kellar asked, not even turning to address the man.

  “Of course not,” Dr. Salinger said mildly, still addressing the screen. “We tested it against the common ones in the throat and lungs. When it didn’t react, we concluded it was non-influenza. We still don’t know exactly how it cleaves.”

  “Or when,” Kate muttered to herself, staring intently at the screen.

  “Sorry?” Dr. Salinger said.

  Kate felt every eye on her. She hadn’t realized she’d spoken loudly enough to be heard. “I’m just thinking about the nature of the virus and the infection. When the virus enters the body, where it travels, and how long until it cleaves, or is switched on.”

  Dr. Salinger gave her a tired smile. “All things I spent most of the night lying awake thinking about, Dr. Morrison. Are you a specialist in the field?”

  Kate gave a small laugh. “No, not at all. I’m an ER physician, so right now I’m doing some fast recall from my lab rotation a few years back.”

  “Excuse me, would it be possible to get a layman’s explanation of what’s going on? You guys lost me back at hemaglues,” Constable Ferris said.

  “Dr. Morrison, why don’t you explain it to the man?” Dr. Kellar challenged from the far end of the room. “I imagine you speak cop better than the rest of us.”

  Kate turned to Ferris and Andy, ignoring the barbed jab.

  “All influenzas are viruses, but not all viruses are influenzas,” Kate started. “That part I think you probably already get. This viral infection seems to mimic a common flu bug that Dr. Salinger has seen before in this area.” Dr. Salinger confirmed with a brief nod of his head. “Each virus has unique properties. The most significant are the way in which it invades and takes over the host body, in this case, humans. Each virus has a unique trigger, something it reacts to or binds to in the human body that activates it. A protease. The activation allows the virus to set up shop, replicate itself, and wreak havoc in the human body. Although this one looks like a common influenza, it doesn’t seem to bind like an influenza.”

  “Is it infectious like influenza?” Andy asked.

  Kate could hear Dr. Kellar’s voice, low but meant to carry across the room. “It speaks.”

  Kate ignored her entirely, as did Andy.

  “No, it doesn’t seem to be.”

  “So we don’t know how Roberta Sedlak was infected?” Ferris asked.

  Dr. Salinger answered. “No. And it will be impossible to guess unless we can identify this specific strain.”

  “Dr. Salinger, what are your next steps?” Dr. Doyle asked.

  “Take samples from all the other patients presenting with similar symptoms and send them and Ms. Sedlak’s results to the NML in Winnipeg.”

  “Directly to Winnipeg? Don’t we need to run this by BC’s Centre for Disease Control?” Dr. Doyle asked.

  Dr. Salinger shrugged. “We’re taking some liberties, but I don’t think we should let this get caught up in process. So I’ll need help bypassing the usual channels,” he said pointedly.

  Dr. Doyle considered him for a moment and then acquiesced with a quick nod.

  “Lost me again,” Constable Ferris interrupted. “NML?”

  “National Microbiology Laboratory,” Dr. Salinger explained. “Canada’s version of the Centers for Disease Control in Atlanta.”

  Ferris wrote it down in his notes.

  “Constable Ferris, Sergeant Wyles, is there anything you wanted to add from the…investigative end of things?” Dr. Doyle asked with a clear note of distaste in her tone.

  With a quick nod of approval from Ferris, Andy answered. “We’ve got nothing helpful to add right now.”

  Kate took apart the meaning of every word in Andy’s brief answer. She had questions, but they would have to wait.

  “Same time tomorrow, everyone?” Murmured agreements met Dr. Doyle’s question.

  Kate stayed in her chair as Dr. Doyle and Dr. Salinger left the room. She was hoping Dr. Kellar would join them so she could have a minute with Andy and Ferris before heading back up to check on Serena. No luck. Dr. Kellar sat unmoving in her chair, staring down the table. Kate sighed and drained the last of her coffee before standing up, dropping her phone in her pocket, and heading out the door. She had almost made it into the hallway when that distinct, slimy purr of a voice caught up with her.

  “No good-bye kiss?”

  Chapter Seven

  Kate stared at the x-rays on the monitor. She’d been staring for twenty minutes. Nothing had changed in that time, but she continued to look as if it could help her predict the next few hours. The silver ring on her finger was almost hot from the friction of being constantly twisted against her skin. Kate leaned back in the chair, her eyes not leaving the monitor. She was sitting at the nurse’s station, almost completely oblivious to the world around her. Serena’s results showed fluid on her lungs, and her high white cell count only indicated she was fighting off something. They wouldn’t know until tomorrow if it was the same infection as Roberta Sedlak. This thought made Kate twist the ring around her finger harder. She wanted to be able to do something now, not wait until tomorrow.

  “Hey.”

  Kate swiveled in her chair to see Andy leaning against the desk.

  “Hey, yourself. You were quiet in the meeting this morning.”

  “Not much to say.”

  “Nothing from your meeting with the journalist this morning?”

  Andy looked around briefly, then turned back to Kate. “Not much. We met with Sealy and his boss from the paper. Other than the ‘unfortunately phrased tweet’—his boss’s words, not mine—we still don’t have anything. No link to any virus, no threat to the community.”

  “And no real reason to be here.”

  Andy shook her head. “We’re going to follow up on a few more leads this afternoon, but I’m going to set up a call with Finns and Heath tomorrow. So, yeah, it looks like we’ll wrap this thing up.”

  Kate stole a look at the monitor again, at the films from her patient. Her patient. She struggled briefly with the responsibility, the possession. Then she looked back to Andy.

  “Serena will be in good hands,” Andy said quietly, knowingly.

  “I know she will.”

  They were interrupted by Lucy arriving back at the nursing station. Andy straightened. “I’ll let you get back to it. Want a coffee?” she said to Kate.

  “Sure, please.”

  “Lucy? Can I get you anything?”

  Lucy blushed faintly but simply shook her head.

  With a quick smile, Andy headed back down the hallway. Kate forced herself not to watch. She went directly back to Serena’s chest film. In an instant, she heard Dr. Kellar describing how the doctors couldn’t have known about the fluid build-up
unless they’d had hourly films. Kate looked around her slowly, the fancy equipment, the shiny electronics. She looked up at Lucy, who was inputting orders into a chart.

  “Lucy, I’m going to have Serena go down for two more films, spaced one to two hours apart. Could you call down to x-ray and see if that’s possible?”

  “Sure, Dr. Morrison, I can do that.”

  Kate twisted her sister’s ring around her finger, captivated again by the images on the monitor. She almost didn’t hear Lucy addressing her.

  “She’s all kinds of intimidating.”

  Kate swiveled in her chair to look at the red-haired nurse. “Who? Sergeant Wyles?”

  “Don’t you think she’s intimidating?”

  Kate smiled and half turned back to the monitor. “Not once you get to know her,” she murmured.

  Lucy didn’t pursue it and Kate let it drop. Moments later, the phone rang. “It’s Dr. Doyle,” Lucy said, “she wants you in the ER immediately.”

  Kate ran down the stairs into the ER. A nurse directed her towards a curtained area where a young male doctor with sandy-blond hair was fitting a mask over a man’s face. The patient seemed to be in his early twenties, his hair and eyes dark, his skin extremely pale, especially considering the energy he was expending simply to draw a breath. He was wearing cargo pants that were dirty at the knees, a serious-looking pair of hiking boots, and a thermal shirt. Kate looked around the curtain to see two others in similar gear, sitting in plastic chairs, looking tired and stressed.

  Dr. Doyle quickly introduced Kate to Dr. Eric MacKay, then began reeling off information about the patient.

  “Keith Grange, age nineteen, complained of flu symptoms for the last few weeks but decided to go camping with his friends anyway. He reported trouble breathing this morning which progressed rapidly. His friends barely got him down from the campsite.”

  Kate flipped through the chart as she listened to Dr. Doyle. She watched the patient’s chest heave with strain.