Pathogen

by Jessica L. Webb

  “Laryngoscope and six millimetre tube,” Kate said. She pulled the scope through her hands, adjusting it until it sat just right in her palm. Then she spoke to the man as he sucked oxygen hungrily through his mask. “Mr. Ross, we need to put a tube down your throat to help you get oxygen. I need you to relax, don’t fight it. Dr. MacKay is going to put in a drain, and it’s going to hurt. Do you understand?”

  No response from the patient. Kate could see his eyes swimming in and out of focus. She hated to think what was about to be done to this man. Even half-conscious, it would be at best torturous. But if she wanted him to live through the next ten minutes, it was going to mean a measure of pain.

  Kate nodded at Eric and they both began their procedures. Jackson Ross didn’t fight, barely flinched as the tube slid down past his tongue, only a slight gag reflex as Kate pressed the tube past his cords. She was in, pulling the lead from the tube and attaching the ventilator handed to her by the nurse. The ventilator only offered a small increase in oxygen absorption rates. His lungs couldn’t process anything with that much fluid. So much depended on getting that fluid cleared up or cleared out. Kate watched Eric slide the flexible tubing through the small incision, his movements efficient and confident, with absolutely no hesitation.

  “Get x-ray up here,” Kate said to the nurse as she watched Eric stitch the tube in place. As he finished, they both pulled out their stethoscopes and listened as the ventilator forced air into fluid-dense lungs.

  “What’s the output?” Kate asked.

  Eric checked the bag hanging over the side of the bed.

  “Five mils already,” he told her, looking up. She shook her head, unsure if this would be enough. They both watched the monitor, waiting for his O2 saturation levels to reach acceptable levels.

  By the time the x-ray tech arrived and took the pictures, the number on the monitor had slowly started to rise. Jackson Ross was far from stable, but he was holding his own for now. For the first time, they’d been able to bring someone back, to keep the tidal wave of fluid at bay. Kate wished she could feel confident that this would be enough.

  Kate spoke briefly with Trent Ross, explaining what had happened, trying to reassure him they were doing everything possible for his brother. Leaving the room with Jackson Ross hooked up to a ventilator and Trent Ross coughing into his oxygen mask made the worry in Kate’s stomach turn to anger.

  “Let’s bring everyone up here,” she said to Eric. He complied silently while Kate went behind the nurse’s station, grabbing clipboards, paper and markers. The anger in her belly pushed her into overdrive, rapidly sorting through information, feeling like she was running the pattern algorithm faster than Jack’s computer.

  Salinger and Kellar came upstairs, their face masks not quite hiding his curiosity and her annoyance. Kate didn’t care about either. She needed their perspectives, she needed them to see what she couldn’t. A moment later Jack followed, his face mask making his curly hair stick out comically, one of his laptops tucked under his arm. That was good. She could use him right now. Writing names in big block letters with the marker, Kate attached them to clipboards and handed one to each person, pulling in a nurse and a security guard so everyone was representing one patient. Each of the four Ward B patients had a clipboard, as did the three deceased patients.

  Everyone looked at her silently, no one quite knowing what to do or say. Kate was thinking about the Go Fish game in Winnipeg, how it had helped her sort through some of the facts and categorize the information. She hoped this would do the same for the medical team.

  “Jackson Ross experienced acute onset pulmonary edema about twenty minutes ago even though he’s being closely monitored, and even though he had received initial high-dose steroids upon being admitted. Dr. MacKay was able to insert a drain and Mr. Ross is currently on a ventilator. This combination is giving him enough oxygen to keep his heart going for now, but we need to know why this is happening.”

  “Why what is happening, Dr. Morrison?” Kellar said in her impatient, superior voice. “Why you can’t predict it, or why you haven’t figured out how to treat it?” The question was asked with all the insulting implications intended.

  But Kate took a moment with the question. Kellar was right. Kate was asking too many questions. She had to pick one and follow it through.

  “How to predict it, let’s focus on that,” Kate said finally. “Everyone got a chart and a marker? Good. Bear with me on this. Okay, if your patient has the original strain of the virus, over here, mutated strain, over there,” Kate directed.

  There was a brief shuffle of confusion, the poor security guard being yanked by Dr. Kellar into a group. Roberta Sedlak and Keith Grange were in one group, the current Ward B patients and Jim Beckett were in the other.

  “Write it down. Next.” Kate barely allowed them to scratch the information underneath the patient’s name. “Compromised lungs from injury or illness older than a year over here, under a year over there.”

  This was more complicated. They threw questions at Kate. Did Roberta Sedlak’s tumour count as a new illness? What about Harris Trenholm’s ongoing injury? People were talking loudly, directing each other into groups, shaking their heads in disagreement.

  “Wait, enough. Sorry, that question wasn’t specific enough,” Kate said, thinking.

  “Try severity of injury, Dr. Morrison,” Dr. Salinger called out.

  “Yes,” Kate said, looking up. “Severity of injury upon being admitted, specifically. Likert scale, one to five being the least severe injuries over here, six to ten being the most severe over here.”

  More confusion, more questions, though this resolved itself much faster. In the end, only Jim Beckett and Harris Trenholm qualified for severe pre-existing injury or illness affecting their pulmonary system at time of admittance.

  “Interesting,” Dr. Salinger said, looking at the two groups. They both ignored Mona Kellar rolling her eyes.

  “Write it down,” Kate commanded. “Next, initial high-dose steroids given.”

  A quick shuffle. Only Roberta Sedlak and Keith Grange were not given high-dose steroids. Without waiting for Kate’s command, people scratched on their clipboards.

  “Of the group given the high-dose steroid protocol,” Kate said, turning to the one group, “divide yourselves into those who were already taking steroids for a pre-existing condition before they were exposed to the HV1A virus.”

  A third group split off: Harris Trenholm and Trent Ross.

  “Okay,” Kate said, eyeing the three groups.

  “Wait,” Eric called out. “Serena Cardiff should qualify for that group,” he said, indicating the most recent divide. “She was given steroids proactively a week ago, before we knew if she had the virus. So she would qualify for taking steroids before she was exposed.”

  “You’re right, yes.”

  As the nurse holding Serena Cardiff’s name moved into the third group, Kate handed her own chart to Eric to hold and stood in front of everyone. Three groups. Roberta Sedlak and Keith Grange were in the first group, both already lost to the virus. The second group held Harris Trenholm, Trent Ross, and Serena Cardiff. The last, Jackson Ross and Jim Beckett. This didn’t look good. This last group held one deceased, one currently on a ventilator. Something tugged at Kate, something wasn’t quite right.

  “It’s the timing of the steroids, not the dosage,” Dr. Kellar said, throwing her clipboard onto the desk behind her. “That’s why I’m seeing no effect in the autopsy, Dr. Morrison. Only those lucky enough to already be on the steroids prior to exposure are surviving,” she finished bluntly.

  A wave of unease moved the group as the implications of those words settled. Dr. Kellar was right, of course. The evidence was in front of them. Kate looked at the charts with Jackson Ross’s name on one and then at Serena Cardiff’s name. Had the steroids been in Serena’s system long enough before exposure to have a therapeutic effect?

  “Dr. Morrison?” Dr. Salinger was trying to get her attentio
n. “Should we stick to the protocol?”

  Kate tuned back in, to the group in front of her still holding the charts, to the buzz of hospital activity around her. The feeling that they were getting somewhere had vanished with the news that the only thing that could help their patients was utterly out of their control. But they were all watching Kate, looking for direction. Kate fought the urge to let a scream rip from her throat, admitting defeat.

  “Yes, we stick to the protocol.”

  Mona Kellar skulked away, muttering angrily under her breath, and the rest of the group broke up quietly. Kate leaned up against the nurse’s station, absently pulling the papers from each of the charts, looking at the marker scrawls.

  “You okay, Katie?” Jack asked, standing beside her.

  “We’re not doing enough, Jack. I don’t know how to treat this thing,” she told him, wanting to sag under the weight of the admission.

  “You’re doing everything you can,” he said to her kindly.

  “And it’s not enough.” She looked down the hall to the Rosses’ room, then she sighed and pushed herself away from the desk. “I’m going to go sit with my patient. Call me if anything comes up, okay?”

  Jack patted her arm gently, his brown eyes shining sympathetically from behind the mask. Kate was glad he was here. Jack possessed a steadiness. Something about the singular way he looked at the world made her feel calm.

  Kate moved between her Ward B patients, trying to anticipate their needs and their test results. She mentally filed each piece of information, medical or personal, vital or irrelevant, adding to the growing list of things she was trying to keep in her head. Sometime after the shift change, Andy came upstairs to get her, saying she and Jack had food waiting in the meeting room downstairs. Kate compulsively checked on each of her patients one more time, comparing their most recent vitals to the last four hours, knowing she would stay if Jackson Ross even hinted towards instability. But everyone was holding steady, Ward B settling in for another long night. As she closed her last chart, Andy tugged at her hand and Kate let herself be pulled off the ward and down the stairs.

  Jack was already unpacking Styrofoam containers from the bag, passing out cutlery, racing a bottle of water down the table which Andy caught deftly as it careened off the edge.

  “So, did you hear that you’re brilliant?” Jack asked Kate, popping the lid off one of the containers. Kate shook her head, folding herself into a seat. She felt tired and nowhere near brilliant. “My algorithm came up with two variables. The first one you figured out faster than my computer, which is the one that covers patients who were on steroids before exposure to the virus. The other is whether or not they had the flu in the last six months.”

  Kate put down her fork. She’d been chewing her food without really tasting it anyway. “Tell me about that last one.”

  “I ran a scan of all the patients who had tested positive for the virus and found an overlooked pattern. Your Ward B patients not only had some kind of respiratory risk factor, but none of them had the flu last year.”

  Kate tried to compartmentalize all the possibilities. She looked from Jack to Andy, both of them staring at Kate, neither of them understanding the implications.

  “It’s local,” Kate finally blurted out.

  “What do you mean?” Andy asked.

  “It’s a local strain of influenza, or at least part of one. That’s why some people are sicker than others. That’s why the fluid build-up is so bad. The Ward B patients have double risk factors: compromised respiratory systems and no form of immunity.” Kate was talking to herself, not even sure that Andy and Jack were keeping up with her. It made sense. It didn’t help her treat her patients, but it made sense.

  “Is this good news or bad?” Jack said, taking a bite of his chicken sandwich. Very little could keep Jack from his food.

  “Neither, but it gives us more information. And possibly a way to predict who is going to get sick. If we can test for immunity to the right flu strain, we can guess the trajectory of their illness. You should send the findings to Dr. Salinger.” Kate picked up her fork again. At least it was something.

  “And it confirms that whoever made the HV1A virus is a local,” Andy added, her eyes on Kate.

  “It confirms that the strain of influenza A used to create the HV1A-CS virus was the same strain that probably went through Hidden Valley last flu season,” Kate said. She paused. “So yes, most likely a local.”

  Kate watched as Andy pulled out her notebook and wrote it down. She could see how tired Andy was. The dark circles under her eyes were getting more pronounced. They were similar that way: the more urgent and focused they needed to be, the less they slept. Kate absently stabbed at a cucumber with her plastic fork, dipping it in ranch dressing before taking a bite.

  “Tell me what they found at the Fullworth farm,” Kate said to Andy.

  Andy looked at her partner down at the other end of the table.

  “I’ll do one better, I’ll show you,” Jack said, wiping his fingers on his shirt and opening his laptop. A white square appeared on the screen beside Kate and she shifted in her chair so she could see better. Jack clicked on the mouse a few times and an image appeared. It looked to Kate like a telephoto lens, the black casing cracked and dirty. It was partially hidden in a pile of hay or straw. Kate studied it and then turned to Andy, waiting for an explanation.

  “Slater and Dr. Din discovered this in one of the outbuildings on the Fullworth farm. It seemed out of place, and when he picked it up”—Andy indicated Jack should go to the next image—“this is what he found.”

  Kate looked at the newest image. The telephoto lens casing was just that, a shell. Inside was a smooth metal cylinder with a small screw-on top. It looked almost like a flask.

  “You can just see traces of residue, most likely dry ice, which John at the NML had told us to look out for.”

  Kate kept looking at the picture, thinking of the HV1A virus living in that small, innocuous container. She pictured it being opened, the virus spreading and adapting. She couldn’t imagine who had let this go. “You found a print?”

  “Yes. And an hour ago we got a match.”

  Kate looked back to Andy, tearing her eyes away from the image on the screen. She waited.

  “It’s Roberta Sedlak,” Andy said. “Her prints are in the system because she had to get periodic vulnerable sector checks to work in the school system.”

  Kate’s eyes narrowed. She thought about the sixty-four-year-old retired teacher, someone who had lived most of her life in Hidden Valley. “You don’t think she had anything to do with spreading the virus, do you?” Kate asked.

  “I’m not ruling anything out,” Andy said automatically. She then paused, changed her tone, like she’d just remembered who she was talking to. “I’m thinking that Roberta Sedlak had contact with whoever had this container in their possession. We need to know where she was the day of the fair.”

  “I take it we’re heading to see Al Sedlak tomorrow, then,” Kate said.

  “He’s expecting us in the morning.”

  Kate absently picked up some more food, looking at the image still projected on the screen. “Did you get anything else from this? Can you track any of the components down, where it was made, that kind of thing?” Kate said. She caught Andy’s tired smile.

  “Thinking like a cop now, are you?”

  “Yeah, well, you’re rubbing off on me.” Kate tried to return the smile while pressing her palm into her left eye, trying to stop the pounding. Andy’s smile disappeared, replaced by a look of concern. Kate headed her off. “So, can you get anything else?”

  “I’ve got someone on it,” Andy said, keeping her eyes on Kate’s face but answering the question. “Now that we know where and what, Slater and I are going to try to narrow down who had access to that area of the barn and who had access to this kind of equipment. If we can find out—”

  “And if they wear a men’s size eleven MEC hiking boot,” Jack added, lookin
g up from his laptop. “Results just came in from the boot print you picked up. The suspect who tried to break into your truck.”

  “Make sure that gets to Slater,” Andy said automatically, then checked her watch. “Now, if you don’t mind.”

  Jack put his head down and typed away.

  “Ready to head out?” Andy asked Kate quietly.

  Kate wanted nothing more than to leave with Andy, to crawl into bed and feel warm fingers against her skin, to kiss Andy gently and longingly until nothing else could compete with the feel of her lips. But something tugged at Kate, the patients in Ward B, the image of Jackson Ross hooked up to the ventilator, his latest O2 sat levels, the EKG showing how hard his heart was working. Kate sighed and looked into Andy’s grey eyes.

  “I think I’m going to stay here tonight,” Kate said, and then she waited for the argument.

  Andy opened her mouth to protest but closed it again. Kate watched her struggle, to fight her instincts to run interference. After their conversation in the car this morning, Kate realized how often Andy jumped in to try to protect her. Because apparently I never do it myself, Kate thought as she waited for Andy to say something.

  “I guess crashing together in the on-call room isn’t an option.”

  “We’re already pretty high on the gossip list.”

  “Yes, we are,” Andy said quietly.

  “Just for tonight,” Kate reasoned, though Andy hadn’t asked for an explanation. “Just until I know Jackson Ross is stable.”

  “Do what you need to do, Kate,” Andy said softly. “You can call me anytime, and I’ll be here first thing in the morning with your coffee.”

  Kate stood and walked around to Andy’s side of the table. Andy pushed her chair back and Kate sat in her lap, putting her arms around Andy’s neck. Andy wrapped her arms around Kate’s waist, and they sat like that for a long time, not saying anything. Kate listened to the sound of Andy’s heartbeat, wondering when she’d gotten used to cuddling up to soft body armour. Eventually Kate stood and kissed Andy lightly on the lips.