Pathogen

by Jessica L. Webb

  “Films?”

  “Portable is on its way.”

  Kate took the stethoscope from around her neck and held it up halfway, waiting for approval from the ER doctor before asking the patient to lean forwards. She didn’t have to search. The moment she pressed her stethoscope against his back, Kate could easily hear the ominous sounds of fluid infiltrates. She glanced up at Dr. MacKay, who nodded knowingly.

  “Keith, can you talk?”

  Keith shook his head, but even this slight movement caused him to bark out a long, expressed cough. She picked up his hand and held it in her own.

  “Okay, I’m going to ask you some questions. If the answer is yes, squeeze my hand. If it’s no, don’t do anything, okay?”

  Keith nodded slowly.

  “Have you been sick for more than a week?”

  Squeeze.

  “Have you been sick for more than three weeks?”

  Squeeze. This put him in the same cluster as the others. Kate filed this away.

  “Have you ever had asthma?”

  Nothing.

  Kate held the man’s hand, felt it trembling in her own. Her mind buzzed with the autopsy report, the picture of Serena’s films, the sound of the crackles in this man’s lungs, the image of Roberta Sedlak’s open, infected lung tissue.

  “Have you ever had issues with breathing or with your lungs before?”

  Keith squeezed then pulled his hand away, took hold of the bottom of his shirt. The movement triggered a spasm and Keith started to cough. It was a long, rolling, painful cough with Keith doubled over in the bed, his dark hair now plastered to his face with sweat. When the cough finally abated, a fine, pink spray covered the white sheet of the hospital bed. Kate adjusted the mask on Keith’s face, forcing herself to push away the image of Serena, bent over and coughing just one floor above them. Not this bad. Not this bad yet. As Kate formulated her thoughts, she saw Andy and Ferris arrive in the ER.

  “I want him on a CPAP machine with high-flow oxygen along with a cardiac monitor. I want to see how his heart is handling all this. Diuretics, preferably bumetanide, by I.V. and broad-spectrum antibiotics, just in case. Let’s get some blood work, full panel, and include an extra marked for Public Health.” If the ER doctor had any issues taking orders from an outsider, he didn’t show it. “Did I miss anything?” Kate directed the question at both doctors.

  “No. I’ll go check on x-ray,” Dr. Doyle answered for them both.

  Kate turned to Andy and Ferris. “Constable Ferris, is this guy a local?”

  “I don’t recognize him.”

  “Could you talk to his friends? Find out how long his symptoms have lasted, where he’s from, where he’s been, and any medical history you can get on him.”

  Ferris’s expression was serious as he backed out of the curtained area.

  “Anything I can do?” Andy asked, staying out of the way. Kate looked at her without really seeing her, then turned back to Keith, who was leaning back with his eyes closed, his breath fogging the mask every time he exhaled.

  “Just give me a minute,” Kate said, more to herself than Andy. She pulled up Keith’s grey thermal shirt, wondering at his movement a few minutes before. What had he been trying to tell her? She inspected his rib cage and his chest and was just about to pull his shirt back down, defeated, when she saw it. The small divot was very faint, just catching the overhead light and creating a shadow where the skin should have been smooth.

  “Lung biopsy.” It was a long shot. Kate didn’t know very many reasons someone so young would have had a lung biopsy. But when she’d asked about trouble with his lungs, she was sure Keith had been trying to show her something.

  Kate suddenly turned to Andy. “I need to speak to Serena’s parents. And we need those results from Public Health. Now.”

  While she waited for Natalie and Michael Cardiff, Kate leaned against the desk and compared the chest films from Roberta Sedlak, Serena Cardiff, and Keith Grange. She knew it was a bad idea. She would likely be pulled off this case tomorrow, the care of Serena and Keith in the capable hands of Valley General Hospital. Still, she scanned each one until she’d memorized every pocket of fluid and air and every dense wash of tissue and bone. Cardiff’s gruff voice pulled her from her near hypnotic trance.

  “Dr. Morrison, you wanted to see us.”

  She looked up to see Serena’s parents standing uncomfortably in the doorway of the ER. Kate forced herself to smile, to give an indication of reassurance after hastily calling them down from their daughter’s room.

  “How’s Serena doing?” she asked.

  “Sleeping right now,” Natalie said, her free hand clenched tightly by her side.

  “Maybe you should tell us how our daughter is doing. I understand you’ve ordered continuous chest x-rays?” Cardiff said in the same gruff voice, bordering on rude.

  Kate closed the windows that showed the other two patient’s films, then opened Serena’s last two chest x-rays. She swiveled the monitor so the parents could see.

  “I ordered two more repeats to her original x-ray, it’s true. I may have overreacted.” She pointed to the first set of films. “Here’s the fluid that’s trapped in her lungs, most likely from an influenza-related pneumonia.” She pointed to the next set. “Two hours later, and we see no change. If x-ray is clear in another two hours, I’ll send her down again just to be sure.”

  Kate saw Natalie’s shoulders sag, her whole body folding in on itself, as if she had lost the fight to keep it together. Her husband didn’t seem to notice. His posture and stony expression remained unchanged.

  “You called us down here just to show us the results?” he asked.

  “That and I wanted to ask you about any history of respiratory issues or anything related to the chest or lungs that Serena may have experienced.”

  Natalie had just opened her mouth to speak when her husband cut her off.

  “I don’t understand, Dr. Morrison. You’ve had access to Serena’s complete medical file for three days now. Shouldn’t you be able to get that information from there without calling us down here?”

  Kate took a breath and looked him straight in the eye before answering.

  “I have your daughter’s medical chart memorized, including her birth weight of six pounds, eight ounces and hospitalization at the age of nine for appendicitis. I can repeat it verbatim if you like, but that would be a waste of everyone’s time.” Kate held the man’s gaze, counted slowly to three to give him a chance to respond before she continued. “The chart shows only injuries and illness for which Serena sought medical attention. I want parent information, the kind of things only you know about your daughter. Specifically about her breathing or her lungs. Anything.”

  Natalie looked up at her husband, pleading, thinking. Kate could see that she held something clenched in her fist.

  “The fall she took in the spring, Michael.”

  “That was her ribs, and she was fine.”

  “Tell me about it,” Kate said immediately.

  “It was back in March,” Natalie said. “Serena’s horse refused a jump, and she went over the horse’s head and landed on the poles. She got right back on. She told her instructor she was fine. It wasn’t until about two weeks later that I happened to see a bit of yellow bruised skin. Serena refused to see a doctor about it.”

  Kate made a mental picture of the event, the bruised skin, the pressure on the ribs folding against the delicate tissue of the lungs.

  “Left side or right side?” Kate asked, pulling up Serena’s x-rays.

  “Right side,” both parents answered.

  Kate moved the image around on the screen, searching silently for a long time.

  “There.” Kate pointed at the films. “A very small, healed crack. Your daughter is tough. That must have hurt to ride with.” Her voice was even but her thoughts spiked with anxiety. Was the lung bruised by that cracked rib? If the tissue was compromised…

  “What does this mean?” Cardiff said, pee
ring at the image as if he didn’t quite believe what Kate was telling him.

  As Kate figured out what she was going to say, she saw Andy come back into the ER, indicating she needed to talk to Kate.

  “It could be a complication to her recovery,” Kate said finally, knowing it wasn’t enough.

  “Does this have anything to do with the autopsy results? We are expecting to hear something.”

  “Not all the information is in from the autopsy, and I imagine the hospital and Public Health will make the decision as to if and when to release that information to the public. Serena’s blood samples are being analyzed and we are closely monitoring her condition.”

  She waited for another verbal attack, felt it building as his chest seemed to swell. Then his cell phone rang, and he glared at Kate before pulling it out and storming back through the double doors of the ER. Natalie gave Kate an apologetic smile and followed her husband.

  Kate rubbed the heels of her palms into her eyes. It had already been a really, really long day. As Andy joined her at the desk, Kate wanted nothing more than to lean in against her and have Andy massage the back of her neck with one hand. Not possible, she knew, so she settled for simply looking at her, for gaining some semblance of strength and energy from her grey eyes.

  “Apparently, Dr. Salinger has samples from everyone except Chase Noonan, but Ferris has gone down to the farm where he works to see if he can bring him in.”

  “Good. Hopefully, we can get all of them in this afternoon. Do you know what happened with the samples heading to the NML?”

  “I can answer that, Dr. Morrison,” Dr. Doyle said as she put down a stack of files on the desk beside Andy. Kate noticed she was still impeccably dressed and made up, as if she’d just stepped out her front door in the morning. In comparison, Kate felt rumpled and sweaty, and she unconsciously reached up to tuck a frizzy curl behind her ear.

  “Roberta Sedlak’s sample went out about an hour after our meeting this morning. Dr. Salinger is taking it himself to Vancouver and having it shipped from there. I phoned the NML to let them know what we’re sending. I talked to a Dr. Levesque, who said the soonest we can have a result is three days.”

  Three days, thought Kate. Where would she be in three days? Back in Vancouver? Back in her own ER?

  As if reading her mind, Dr. Doyle spoke directly to Andy.

  “It looks as if we didn’t need your assistance after all, Sergeant Wyles.”

  Andy didn’t say anything. After a brief, awkward silence, Dr. Doyle picked up her files and walked away. Andy rolled her eyes, which was so uncharacteristic, so un-Andy, that Kate laughed.

  “Ah, politics,” Kate said.

  “Don’t discount it so quickly. It’s a huge factor out here.”

  “Yeah, well, it’s your factor, Sergeant Wyles. Unless it’s coughing and having trouble breathing, it’s got nothing to do with me,” Kate said, leaning back in her chair and stretching.

  Andy turned to see someone approaching the desk. She gave Kate a quick look, which Kate didn’t have time to interpret. “Wanna bet?” Andy said under her breath. She stood straighter and pulled her face back to professional neutrality.

  The man who stopped at the desk in front of Kate was young with bright, determined eyes and a closely cropped beard. He wore a clean button-up shirt and stylish jeans, and had a much-abused messenger bag slung over one shoulder.

  “Sergeant Wyles, good to see you again.” His voice held neither friendliness nor contempt. When Andy simply dipped her head in acknowledgement, he turned to Kate.

  “Are you Dr. Kate Morrison?”

  “Yes,” Kate said. She suspected she knew who this was but played along anyway. “How can I help you?”

  “Are you, Dr. Morrison, currently consulting with the RCMP on several suspected case of influenza in the Hidden Valley area?”

  “Again, how can I help you?”

  The man waited, his expression expectant, as if his silence would induce Kate to speak again. Kate said nothing. This man clearly didn’t know she’d been schooled by Sgt. Andy Wyles in the art of silence.

  “I’m Paul Sealy with the Squamish Herald, and I’m looking into the story of a viral strain of influenza.”

  Kate caught herself just as she was about to correct the journalist. Andy would never give away information, even just to correct a medically erroneous statement. The name confirmed for Kate that she should keep her mouth shut.

  “Any statements will come through the hospital PR team, as I’m sure you are already aware.”

  “And Public Health is involved also? I understand you are liaising with Dr. Salinger. We’ve interviewed him before,” Paul said.

  “Public Health also has a public relations team, and any media inquiries need to go through them,” Kate said again, more firmly this time.

  Paul’s smile slipped just a little. He seemed truly disappointed this hadn’t worked.

  “You’re pushing this a little, don’t you think?” Andy asked mildly.

  Now he looked defiant. “I’m doing my job, Sergeant Wyles. Unless you think you’ve found a link between my contempt of a system that props up the already adequately resourced with a few cases of the flu, there’s no reason for me to stop asking questions.”

  “Your boss seemed a little concerned with the way you asking more questions looked to everyone else, that’s all,” Andy said, her voice seemingly unconcerned but her eyes direct.

  “I can deal with my boss, thanks.”

  “I believe there’s nothing else to say, then,” Andy said passively.

  The reporter looked back and forth between them, then nodded his farewell and quickly left.

  Andy leaned back against the desk, her eyebrows raised at Kate. “You were saying, Dr. Morrison?”

  “Shut up, Sergeant Wyles.”

  *

  The phone rang loudly in the dark hotel room, pulling both Kate and Andy from a dead sleep. Kate sat up in bed and turned on the light as Andy reached for her cell phone on the bedside table, next to her gun. But it was the hotel phone, ringing shrilly next to Kate. She picked up the receiver, wakefulness winning the battle against sleepiness with every heartbeat.

  “Hello?” She checked the clock—4:51 a.m.

  “Dr. Morrison, it’s Dr. Doyle. I’m sorry to wake you.”

  “Don’t worry about it. What is it?” Kate’s heart lurched at the thought of her two patients, the x-rays she had memorized lighting up her brain. She started getting out of bed, mentally at the hospital, ready to deal with this emergency.

  “It’s Keith Grange. We lost him twenty minutes ago.”

  Kate’s heart sank, the image of his chest x-ray results instantly replaced by a pair of scared brown eyes, a pale face, the shaky squeeze of his hand. She sat back down on the bed and closed her eyes, took a breath, then opened them again.

  “His lungs?” Kate asked.

  “Yes, same as Roberta Sedlak. They just couldn’t keep ahead of the infection or the fluid, even knowing this time what to watch for. It happened so fast.”

  “I’m sure they did everything they could,” Kate said robotically. She barely felt as Andy laid a warm hand against her back. It was a light touch, non-intrusive, meant to comfort. “Did Constable Ferris ever find his family?”

  “Yes, they were on vacation in Banff. Apparently they’re in transit.”

  Kate rubbed at her eyes while she processed two streams of information and questions. “Autopsy?”

  “I’d like to check in with the family first, if we can. I know we can go ahead without their permission, but let’s give it a day.”

  Kate appreciated this modicum of compassion from the stiff, almost cold woman. “Are you at the hospital right now?”

  “No, I just got the call at home. Why?”

  Kate ignored the defensive note in her tone. “I wanted to know how Serena Cardiff was doing.”

  “I already checked. No change in her status.”

  Kate gave a small prayer of thanks.<
br />
  “Okay, thanks for the call, Dr. Doyle. I guess we’ll see you in a few hours.”

  Kate hung up the phone, staring blankly at the bedside table until she felt Andy’s fingers move slightly against her back. A gentle reminder that she was there, if Kate needed her.

  “Keith Grange died,” Kate said to Andy. “Similar presentation to Roberta Sedlak.” The rest she figured Andy had heard or pieced together. Andy said nothing, just continued to run her fingers over Kate’s arm. Kate finally twisted her head around to look up at Andy.

  “We need those results back.”

  “Hopefully, we’ll find out in a couple of hours.”

  Kate shook her head. “But what it is. This doesn’t make sense.”

  She let her head fall back against Andy and stared up at the ceiling. None of this made sense. Influenza, viral loads, infections, contagion, pulmonary edema, pneumonia. Acute onset. The words repeated and rebounded in Kate’s head until she felt she’d go crazy with it.

  “What do you need?” Andy asked gently.

  “I need you to take me to the hospital.”

  *

  Kate held Sharon Grange’s hands and let the woman sob. They were sitting in Dr. Doyle’s office, Kate with Sharon and Doug Grange on one side of the table, Dr. Doyle fidgeting uncomfortably on the other. Kate reached out for the box of tissues on Dr. Doyle’s desk and handed a few to Sharon Grange, who took them without looking up. As Kate studied Doug Grange’s face, reading the signs of shock and disbelief and sadness, she wondered how many times she’d watched this scene play out. No ER physician liked this part of the job. It was dark and terrible and tugged relentlessly at the soul.

  Some doctors felt a measure of peace with the words and actions of comfort they gave to the families during such an emotional time, but Kate had been on the other side and knew there was very little to remember or absorb beyond the understanding that your loved one was gone. Nothing could cover the sensation of being ripped open. So Kate didn’t try. She held a hand, offered tissue, and stayed silent.

  Doug Grange was the first to speak, clearing his throat loudly in the silence twice before he could force enough air past his vocal cords to produce sound.