Pathogen

by Jessica L. Webb

  Kate and the three nurses walked back into the waiting room and started talking to patients, filling in charts and giving most of them the news that it was going to be a long wait. Kate felt the shift of tension in the air before long, from generalized and dispersed to angry and focused on Kate and the nurses. As Kate wrote FS on the top of a chart and got the next one ready, she pulled out her phone and texted Andy that she needed her in the ER.

  Kate moved to the next patient. A boy, about nine, coughing and wiping his nose on the back of his sleeve, never looking up from his smartphone, fingers bashing at the screen. A dark-haired woman in worn shoes and a sweater smiled at Kate tentatively.

  “His mother is worried,” she said, with a heavy accent Kate couldn’t place. “She wants him to be seen right now. His doctor is away.” She then fished around in her purse, pulled out a cell phone. “I am to call when there is a doctor here.”

  Kate smiled back at the woman. “Let’s check him out first, okay? What’s your name?”

  “Trenton Clifton III,” the boy said, still not looking up.

  Kate rolled her eyes internally.

  “Tell me about being sick, Trenton Clifton III.”

  “I’ve been home from school for three days, and when I cough it’s gross, and when I sneeze it’s gross.”

  “Have you been particularly tired?”

  “Nope.”

  Kate turned to the woman. “Has he been sleeping a lot or hard to wake?”

  The woman shook her head.

  “Has he complained about chest pain or trouble breathing?”

  Another shake of her head.

  Kate pulled the stethoscope from around her neck and asked the boy to lean forwards. She had to close her eyes and concentrate, away from the noise of the waiting room. Still, she heard nothing.

  “I think he’s just got a cold,” Kate told the woman. “If you or mom wants him to see a doctor, it’s going to be at least three hours.”

  The woman held out her phone, looking worried. “You tell mom this. Please.”

  Kate sighed and looked over to see Andy and Constable Ferris coming in through the double doors. She waved them over.

  “Fine. Call her.” She didn’t really have time for this.

  As the woman dialed, Kate quickly explained what was happening to Andy and Ferris. She told Ferris to be friendly and calm and repeat only the information from the press release yesterday. She told Andy just to walk around. Kate figured her imposing, uniformed presence would be enough to subdue the masses.

  The call with the mother was brief and bitter. Apparently, Mrs. Clifton was sure her kid could be seen because his father was on the hospital board. Kate made it clear her son was not sick enough to jump the line and only critical patients were being sent through right now.

  That scene replayed itself in varying forms over the following two hours. People cajoled, attempted to influence, and subtly threatened when they were not seen right away. Kate gave everyone the exact same information, not even decreasing the projected wait time as people left. By the end of the two hours, Kate found only two people who qualified for the suspected virus. Neither of them had any fluid in their lungs, nor did they have any pulmonary risk factors. As Kate sorted through the pile of triaged charts, she found the same. She surveyed the ER. It was still packed, people still paced restlessly and shot Kate angry glances, but at least it was calm. At least there was some semblance of order.

  Dr. Doyle herself came to collect Kate when it was time for the meeting. Kate sent the two nurses back to the floor before following Dr. Doyle out of the ER.

  “I’m getting a lot of calls and complaints, Dr. Morrison,” Dr. Doyle said as they weaved their way around patients. “People in Hidden Valley are not used to being turned away.”

  “We’re not turning anyone away, Dr. Doyle. If they want to wait to be seen, then they are welcome to wait.”

  They passed Andy on the way out. Kate watched as she detached herself from a conversation and resolutely followed them out the double doors.

  “Well, it amounts to the same thing,” Dr. Doyle said.

  “Expect more calls, Dr. Doyle,” Kate said, trying to temper the spark of anger that flared in her stomach. “Expect more people to be angry. This hospital can’t test every hypochondriac in all of Hidden Valley and manage to catch people who are legitimately ill with a potentially fatal virus. My focus is on that last group. You asked me to stay and help. That’s what I’m doing.”

  Dr. Doyle was about to open her mouth, no doubt to give another criticism of the way Kate had managed to get control of Valley General ER, but they were interrupted by a nurse behind them calling Kate’s name. She held out a chart, her face grave. Kate immediately followed her back into the ER and listened to the details of their newest potential case.

  “Harris Trenholm, forty-three years old, flu-like symptoms including extreme fatigue started four days ago, began having chest pain and difficulty breathing just after midnight.” She pulled back the curtain, and Kate saw the man in a rumpled business suit, his legs hanging over the side of the bed, holding onto the O2 mask like his life depended on it. As she watched him try to breathe, Kate wondered if it did.

  “Mr. Trenholm, I’m Dr. Morrison. We’re going to see what we can do to make it easier for you to breathe.” She turned to the nurse. “Medical history?”

  The nurse turned the page silently and pointed. Kate’s heart sank. Motor vehicle accident eighteen months ago, blunt chest trauma, broken ribs, surgery, diminished lung capacity. Kate saw Keith Grange’s lungs in the autopsy. The tiniest sliver of an old biopsy had let in the infection that took over his body and eventually ended his life. She then pictured what Harris Trenholm’s lungs must look like with their multiple access points for the virus to settle, infect, and take over. Kate stared at the chart, at the man sitting on the bed, rapidly scanning the information she had, thinking about the charts she’d surrounded herself with last night, trying to come up with a plan for this exact scenario.

  She scanned down the chart to the meds section. He was on prednisone for his lungs. Interesting, she thought, let’s see what it does. “Okay, rebreather mask with high-flow oxygen. Cardiac monitor, pulse ox, and a blood panel. And Mr. Trenholm just jumped the list for chest x-ray.” Kate pulled out her stethoscope and reached down the collar of his unbuttoned shirt to listen to his lungs. Definitely fluid.

  “Mr. Trenholm, we’re going to see how you do down here, but if you don’t improve I’m going to want to admit you to a bed upstairs so we can keep an eye on you. Is there someone we can call for you?”

  The man shook his head, pulling in shallow breaths.

  “You’re in good hands. I’ll be back to check on you, okay?”

  Kate turned away and lowered her voice before she spoke to the nurse. “I want a crash cart and surgical tray near Mr. Trenholm at all times. Any changes to his breathing, page me right away, even if it seems insignificant.”

  Kate checked her watch on her way back out. She was now half an hour late for the meeting. With half her brain still back with the patient, Kate couldn’t find it in her to care all that much. Andy was waiting for her by the double doors, but Dr. Doyle was nowhere to be seen.

  “Do you know if Dr. Salinger is going to sit in on our meeting?” Kate said.

  “Yes.”

  “Good. Then may I ask why I’m getting an escort?”

  “That’s why.”

  Kate looked up to see Andy gesturing with a jerk of her head down the hallway. Dr. Mona Kellar hulked outside the office door, files clutched under her arm. When she saw Kate and Andy walking together down the hall, her eyes narrowed into angry slits and her mouth turned up into a smirk.

  “Not one minute alone with her, got it?” Andy’s voice was low and tense.

  “Yes.”

  As they came closer, Andy’s voice returned to its normal volume, though Kate could still hear the stress in her tone. “I think Dr. Doyle’s going to want to piggyback on yo
ur meeting here, try to get everyone together in an hour. Does that give you enough time?”

  “Sure, we’ll make it work.”

  They were at the door. Kate ignored Dr. Kellar and looked up at Andy. “See you in an hour.”

  Andy looked into the room, confirmed that Dr. Salinger was there, then nodded curtly and left.

  Kate didn’t care in that moment what Dr. Kellar thought, what new insult or perverted reference she was going to pull out of a simple good-bye. As she walked into the room and took her seat, Kate tried to focus on why they were here, thinking about the forty-three-year-old man sitting in the emergency room right now, fighting to breathe.

  “I thought I made it clear I don’t like to be kept waiting, Dr. Morrison,” Dr. Kellar said, following Kate into the room and taking a seat.

  “I’m not sure what has led you to believe I give two shits about your timetable, Dr. Kellar, but rest assured it’s at the bottom of my priority list right now.” Kate said it with a calmness she didn’t feel. Kate took a breath and ordered her thoughts.

  “We have three new suspected cases, one of which is exhibiting early symptoms of pulmonary edema similar to Roberta Sedlak and Keith Grange. We’re going to have to come up with a protocol quickly if we’re going to stay ahead of this.”

  Dr. Salinger jumped in. “We’re in the process of setting up a temporary lab here at Valley General. I think there are enough suspected cases to warrant the expense involved. Also, if I may get to the purpose of the meeting, I’ve pulled some literature on similar-acting viruses and their various treatments. It’s the best I could do considering we aren’t any farther ahead in identifying what we’re dealing with.”

  “Any word from the NML?”

  “My understanding is the earliest we would hear from them is tomorrow.”

  Kate scanned the literature Dr. Salinger had passed her, skipping over the genomes, pathogenesis and virology information, and homing in on the treatment. What she saw wasn’t all that reassuring: oxygen therapy, diuretics, steroids, and time. They’d already tried the first two, to little effect. And the fourth option so far hadn’t been available to them.

  “Dr. Kellar, looking specifically at the treatment given to both patients, could you please tell us what you saw?”

  Dr. Kellar took an awkwardly long time to answer. “First a fuck you, now a please. I can’t keep up with your moods, Dr. Morrison.”

  Kate waited, letting the pause lengthen, keeping her eyes on Dr. Kellar, not even attempting to hide the contempt she felt for the woman. Finally Kate decided she’d had enough. She and Dr. Salinger would have to figure this out on their own.

  “Too little, too late,” Dr. Kellar said, just as Kate turned away. At first Kate thought the forensic pathologist was making another off topic comment, but then realized she was discussing the ER treatment.

  “What do you mean?”

  “Exactly what I said. Too little oxygen, and the diuretics barely had any effect on the fluid in the lungs. They don’t work fast enough, so either find a way to double it without killing off their kidneys or don’t bother.”

  Kate blinked at her, then flipped through the literature Dr. Salinger had pulled, simultaneously reading and recalling information from the medical charts. Keith Grange at least had been maxed out on diuretics.

  “What about the oxygen therapy?” Dr. Salinger said.

  “Same story. Too little, too late.”

  “But it wasn’t,” Kate said, thinking hard, staring down blankly at the sheaf of papers in her hand.

  “The two bodies in the morgue beg to differ, Dr. Morrison,” Dr. Kellar said.

  “No, I mean the oxygen was working fine, at least keeping them stable. But at some point, their lungs reached some kind of critical mass point, and the oxygen wasn’t enough anymore.”

  “And the fluid filled their lungs like a tidal wave,” finished Dr. Salinger. Kate looked at him, feeling helpless. This wasn’t in the literature. It didn’t make sense.

  “That’s a very poetic image, Dr. Salinger, but it doesn’t exactly get us any farther ahead,” Dr. Kellar said acidly.

  “What about steroids?” Kate threw out. “The newest unconfirmed case has diminished lung capacity from a car accident eighteen months ago, and he’s on low-dose steroids. I expected to find his lungs crackling when I listened. I heard fluid, but nothing to cause any alarm.”

  “Chest film?” Dr. Kellar said shortly.

  “I’ll check.”

  Moving to the computer in the corner of the room, Kate pulled up Harris Trenholm’s file, found the chest films, and angled the monitor so the other doctors could see.

  “Doesn’t look like much, does it?” Dr. Salinger said. Kate had to agree. Very few infiltrates, not enough fluid to be too alarmed.

  “If he’s positive for the virus, then you’ve got your protocol, I think, Dr. Morrison,” Dr. Kellar said in a voice that could almost pass for neutral.

  Kate kept her eyes on the films, memorizing them, mentally filing them away with the others. Dr. Kellar was right. There was possibly the smallest glimmer of hope.

  There was a sudden knock on the door and Dr. Doyle entered with Andy and Constable Ferris. “Sorry to interrupt, but Dr. Levesque from the NML has just phoned. She has asked for a teleconference to give an update.”

  Kate felt her stomach drop nervously. Across the room, Andy folded her long frame into a seat, resting her arms lightly on the chair. Kate knew her well enough to read the signs of stress in the grip of her right hand, the tense line of her jaw, the intense stillness of her body. When their eyes met, Kate saw very little. Andy’s guard was firmly up. Feeling Dr. Kellar’s gaze drilling into her from the opposite side of the room, it wasn’t hard to figure out why.

  Dr. Doyle was punching numbers into a contoured grey box in the centre of the table, once again the put-together, efficient hospital administrator. Kate considered her hasty, angry words to Dr. Doyle earlier. She added it to the list of things to worry about later. “Dr. Levesque, can you hear me?”

  “Yes? Hello?” The voice at the other end was clear with a French-Canadian accent.

  “Dr. Levesque, I’ll let you know who’s around the table. Dr. Clifford Salinger, Public Health; Dr. Mona Kellar, forensic pathologist; Dr. Kate Morrison, physician liaison with the RCMP; Constable Art Ferris and Sgt. Andy Wyles, also with the RCMP.”

  “Quite a group. Thank you all for your time.”

  “We’re all quite eager to hear what you have to say, Dr. Levesque.”

  “Then let me get started. We have the initial findings for what is now classified as HV1A-CS, to include the originator, Dr. Clifford Salinger. Let’s refer to it simply as HV1A. This virus is extremely unique. You can imagine that as an epidemiologist, this I do not say lightly.”

  Kate felt her body tighten, a long line of tension starting in her lower back and spread up her spine, to her shoulders and up through her neck.

  “We run every potentially new virus through a database, either to confirm it is one we haven’t seen before or to help us identify which classification or virus family it belongs to. HV1A hit one exact match and one partial match. This is not a natural occurrence.”

  Kate automatically sought Andy’s eyes and held them, almost unconsciously, as she listened to Dr. Levesque’s next words.

  “There can be no other explanation for it. This virus is man-made.”

  The level of tension in the room increased exponentially as each person absorbed the impact of the information.

  “Dr. Levesque, it’s Dr. Morrison. Could you tell us what the matches were?”

  “Yes. Hantavirus was the exact match, and an unidentified Influenza A was the partial match.”

  Another silence.

  “I’m going to guess by your silence that you all understand the potential severity of the hantavirus. There does seem to be good news, though. Initial reports show that the HV1A virus is not nearly as potent or deadly as the hantavirus. For reasons unknown, the cr
eator of this virus specifically chose the most non-lethal components.”

  “We have two bodies in the morgue that would beg to differ, Dr. Levesque,” Dr. Kellar cut in, reusing what she obviously considered to be a good line.

  “But it is not two hundred, which it easily could be with the hantavirus.”

  Kate thought she heard the woman on the other end of the line sigh.

  “This distance is a problem, non? It would be much easier to show you. Dr. Doyle, would it be possible to send a member of your medical team down here? Even just a day would allow us to exchange information much more effectively.”

  Kate saw Dr. Doyle looking around the room, apparently settling on Dr. Salinger. He immediately shook his head and held up his hand in a gesture of refusal.

  “I can’t leave the office unmanned at a time like this, not even for a day,” he told Dr. Doyle.

  “Dr. Morrison?” she said.

  Kate didn’t even need to think. “Yes, I’ll go.”

  “Dr. Levesque, we will arrange for Dr. Morrison to come out to Winnipeg, hopefully by the end of the day.”

  Kate didn’t listen to the uneasy thrum of panic that resonated in her body, and she didn’t listen to the end of the meeting as Dr. Doyle signed off. Kate was too busy watching Andy. Her whole posture had changed. She leaned forwards, resting her forearms on the edge of the table, her palms pressed down on the smooth surface. When their eyes met, Kate nodded slightly and Andy flicked her eyes away to address the group.

  “As of this moment, the HV1A-CS virus is no longer solely a medical and public health concern. We will also now be investigating this as an act of bioterrorism.” Kate felt a thrill of fear at the words as a weight of added urgency settled on her. “For all intents and purposes, the individuals around the table will now be considered the Public Health Emergency Management, or PHEM, team. Dr. Salinger, I’d like you to be in close contact with the Provincial Health Officer. Whatever resources and supports they can offer us from a distance, we’ll take. As of right now, though, I want no one else descending on Hidden Valley. I think it will induce the community to panic and make it next to impossible to investigate the source of the outbreak. Constable Ferris and I will work alongside the PHEM team in relation to the investigation.”