Silent Fear, a Medical Mystery

by Barbara Ebel

Chapter 7

  Danny tried to leave the radiology department quicker than he got there, but Bill lagged. He waved for Bill to follow him into the staircase, but Bill took a deep breath and hit the elevator button.

  “We have to talk and make a plan,” Danny said, “but first I’m going to go do a stat spinal tap on Harold. It’ll give us more information. Although we should call in a neurologist as well, we don’t have time to wait for them to do it.”

  “I agree, and James, the scrub nurse from this morning put on the vent, is in a coma.”

  Both men stepped into the elevator and Bill leaned against the wall.

  “Are you all right?” Danny asked.

  “I’m feeling hot and sweaty, but never mind about me. I’ll go get whatever lab results are back on Dotty.”

  “Why don’t we meet in the doctor’s lounge at about six o’clock?” Danny suggested. “And after the spinal tap, I better go track down Lucy Talbot.”

  “Lucy Talbot?”

  “Yes, an anesthesiologist who’s fallen prey to something, too.”

  Bill got off on the third floor and Danny continued on to the ICU. He weaved past a group of family members in deep discussion about a loved one’s care which sidetracked his thoughts. He went into intensive care with only his ex-wife on his mind. He’d get his procedure done but he gave himself the liberty of thinking only of her.

  Danny grinned as he visualized Sara’s habit of talking with her hands. His eyes twinkled as he thought about her peppered blonde hair dramatically stopping in the middle of her cheeks and her subtle smell of orange-ginger. But her mind was as powerful as her looks; and her wisdom and strength underscored the loving quality she possessed for everyone and everything. That is, unless she was betrayed, but Danny still hoped to gain her forgiveness.

  Harold’s nurse was in his cubicle so Danny went straight in, thoughts of Sara ebbing away. He looked at the nurse’s badge. “Marsha,” he said. “I’ll need your help straight away, if that’s possible.”

  She turned down the volume of the overhead monitor. “Sure, Dr. Tilson.”

  “I’m going to write some orders, hopefully get the neurologist, Timothy Paltrow, to consult on Dr. Harold Jackowitz. In the meantime, please get me a spinal tap tray and gloves. Get respiratory therapy, too, so we have an extra pair of hands for positioning him on his side and watching his endotracheal tube and ventilator connections.”

  Marsha almost made it to the door when Danny added, “In addition, I’d like you to put a sign on the door for infection precautions. Please have someone roll the shelf underneath it with masks and gloves for anyone that enters this room. Be sure to don up yourself.”

  She scurried off and when she returned with a respiratory therapist, they rolled Harold onto his side and Danny prepped his back with a bactericidal agent. With sterile gloves, he felt Harold’s lumbar intervertebral discs and slid a thin spinal needle between two of them. Harold’s cerebrospinal fluid drained easily and Danny allowed it to drip into the kit’s sterile vials. The humdrum of the ventilator drowned out the silence.

  “Thanks everyone,” Danny said when they rolled Harold flat on the bed again. Danny stood quietly for a second. His colleague already showed signs of ICU breakdown with IV marks on his arms and a pasty color.

  “Marsha, I’m taking this straight to the lab myself,” Danny said, snapping back to his task at hand. He ran down several flights of stairs to the first floor laboratory and went straight back, ignoring the boxes where samples were delivered like mail.

  A college-aged man stood at a centrifuge and looked over at Danny. “Can I help you?”

  “I’m Dr. Tilson. Can you do me a stat analysis on CSF?”

  “I’ll take care of it before anything else Dr. Tilson, but it still takes time for the results.”

  “Thanks, I understand,” Danny said and left with urgency.

  ----------

  Coffee and Casey would have to wait. Dr. Lucy Talbot now took priority. Danny scoured the ER board looking for her name. He twisted his hands hoping at least she wasn’t in room 5 like Harold had been. She wasn’t, but he scowled at himself thinking a room could harbor bad luck.

  No one was in room 7 with Lucy. It’s down time, Danny thought, between being seen, poked and prodded upon, and the results of what they thought and where they’d send her. He shook his head because he was one of them. However, the way hospital employees were dropping in as patients, he could soon also find himself on the other side of medical care.

  A crumpled sheet covered Lucy from her waist down, the stretcher at a forty-five degree angle. The little woman’s arms hung from her shoulders like they barely belonged and her eyes protruded like a frog’s. Although they were open, she didn’t seem to register Danny’s entrance.

  “Lucy,” Danny whispered up close.

  A guttural sound came from her throat, but most of what came next was juicy saliva. How could someone who appeared dry be that wet in their mouth, Danny wondered. He walked to the counter for a wash cloth. He dabbed Lucy’s mouth and chin and then pulled the moisture into the towel. Dr. Talbot closed her eyes and sunk further into the pillow.

  When Danny returned to the desk, the two ER docs were both seeing patients. Since he couldn’t talk to them, he took Lucy’s chart and scribbled a quick note inserting his name into the case. He wrote consults for Bill Patogue and Timothy Paltrow to also come on board with her care, and wrote for an MRI ASAP of her head.

  ----------

  Danny didn’t have much time before meeting Bill. He dodged down the hall to the coffee room, but what remained at the bottom of the pot resembled silt. After rummaging below, he stuck a filter in the pot and scooped his choice of French roast into the top. While the water did its magic, Danny poked his head outside, and glanced up and down the hallway. Casey’s ambulance was out back.

  The hot coffee charged his senses as he went outside and rapped on the ambulance door. Casey opened one side. “Hey, come on in. We’re fixing to leave in a little bit because you all are on diversion. We’re going to another hospital.”

  Towards the front, where the ambulance wasn’t covered by the overhang, the rain made a pinging sound in the cab. Mark gave Danny a wave. “This is quite a carwash,” he said and went back to his paperwork.

  “I don’t think we’ve ever sat and talked in your ambulance before,” Danny said.

  “And I’ve been doing this since you were in training and green as avocados.”

  Danny rolled out a laugh. “I knew I needed to see you. That’s the first time I’ve been able to laugh all day.”

  “Glad to be of service.”

  “You didn’t go near Lucy Talbot then, did you?”

  “No, Mark and I brought in a store owner with angina.”

  “Start taking more precautions around here. We think Harold’s got meningoencephalitis. We can’t get results or be sure about the diagnosis, or source, or transmission yet. I’m making sure I give you two the inside scoop.”

  Casey brought his hand across his chin in contemplation. “You didn’t say meningitis, did you? I’ve never heard of this.”

  “Most people probably haven’t. It’s extremely rare. I’m talking about a double neuro condition.” He held his coffee carefully so it wouldn’t spill. “It’s when there’s simultaneous infection or inflammation of both the brain and the meninges.”

  Casey’s thick fingers entwined as he furrowed his brow.

  “The morbidity and mortality rates are not good,” Danny added.

  Danny slipped closer to the door ready to exit the cab. “I just want to give my future brother-in-law a possible medical alert.”

  “Thanks, Danny. We appreciate it.” Mark looked back and nodded his appreciation as well. “I’ll be home after eleven,” Casey added. “Will Mary and I see you?”

  “I don’t have a clue. Give Mary a hug for me, but give Dakota a biscuit and a quick walk.”

  “Goes without saying,�
�� Casey said as Danny left with his coffee.

  Chapter 8

  Danny beat Bill Patogue into the lounge after swinging by the lab. Timothy Paltrow, the neurologist, ambled in with his cane, along with Bill when the elevator door opened. Tim was in his seventies, holding on to working like a butterfly to wildflowers, and was bald except for a stray white hair here or there, standing up as if electrically charged.

  “Let’s get as distraction-free as we can,” Danny said. “Sorry to bring you in here, Tim, especially in this nasty weather.”

  “My bones don’t like it much these days,” Tim said. “But anything to keep my mind stimulated. Meeting you two is better than reading a book.”

  Danny turned off the television and they went to a corner table. He felt badly about getting the old doc to come in as he glanced out the windows at the non-relenting rain. Over the next few minutes, they gave Tim a synopsis of recent events and why they consulted him.

  From his pocket, Danny pulled out a lab sheet, a small pad of paper, and a pen to make notes. “I just got some of Harold’s spinal tap results and Lucy Talbot is getting her MRI right now.”

  The three men leaned tightly over the table as Danny evaluated Harold’s lab values. Danny’s heart quickened as he read what he dreaded. He grinned at Bill. “Proteins and white blood cells are increased. Glucose is normal, which goes along with the MRI findings.”

  Tim held out his arthritic hand for the lab sheet. “Substantial evidence for your working diagnosis, doctors. Let’s confirm if a meningoencephalitis is what’s going on with Lucy Talbot, too. Why don’t I do a spinal tap on her as soon as she comes out of the MRI?”

  “Perfect,” Danny said. “And above all, let’s hope one of the CSF samples from Harold’s spinal tap grows out something in the lab that identifies the causative agent.”

  “Danny, I need to get consent and do a tap on James, too,” Bill said.

  “Okay, Bill, you’re right. What about Dotty Jackson? Did she have some of the same symptoms?”

  Bill shook his head as he slid further back in his chair. The meeting seemed to be taking a toll on him. “She has flu-like symptoms,” he said, “complained less of a headache although she does have one. And she’s developed a fever, which is getting higher despite an antipyretic. Nothing so far has shown up abnormal on her blood work.”

  “I’ll get to her after Dr. Talbot,” Tim said. “Each of these patients needs infectious disease precautions. Let’s isolate them.”

  Danny rapped his knuckles on the table with a sudden thought. “Either of you have a problem if I call in Dr. Joelle Lewis?”

  Tim moved his cane to the side and got up. He stepped to the right and left, unkinking his cramps. “I’ve never worked with her, but I’ve heard of her. By all means, give her a call.”

  “I think we have ample concern,” Bill added, “that it’s also time to call in the CDC.”

  Danny had made notes. He double checked their plan and who was going to do what. He tensed his lips, searched his colleagues faces. “I’m going to see how busy the OR is with after hour emergencies.”

  Tim paused stretching and looked as quizzical as Bill. “What do you have in mind, Danny?”

  “We can’t wait for Harold’s cerebrospinal fluid to possibly grow something out on a Petri dish in the lab. I need to do a brain biopsy on Harold.”

  ----------

  After tracking down the infectious disease doc, Dr. Joelle Lewis, by phone and asking her for her expertise, there wasn’t anything more Danny could do. He put Dr. Jackowitz’s name on the OR list of after hour cases. The timing of his case also depended on other serious trauma cases that could come straight up from the ER during the night. As a backup, Danny asked the schedule coordinator to put him on the a.m. Sunday semi-elective list in case they still hadn’t gotten to Harold.

  Danny hoped to get home, have a bite to eat, and grab some shut-eye. He went out the ER doors where Casey’s ambulance had been gone for hours. The thunder and lightning had stopped, a silent, gentle rain left in its place. The parking lot lights illuminated the drops, like tiny baby pearls falling from the sky. Danny took off his white coat, draped it on his arm, and did a slow run to his car. Inside, he called Mary.

  “I’m stopping at a sandwich shop,” Danny said once Mary picked up. “I know it’s late, but can I get anyone something?”

  “Not for me, but we ate early, so let me ask the girls, they’re right here. We’re watching a movie.”

  Danny heard his girls’ indecision and then Mary got back on. “They’ll each take a six-inch BLT. Can you get a sandwich for Casey as well? He should be home shortly.”

  “Sure. See you soon.”

  Danny arrived home with two foot long turkey combos and a foot long BLT. It was after eleven, Casey’s car engine still warm in the garage. He entered the garage door into the kitchen but noted no greeting from Dakota. Inside, Casey sat on the ottoman in front of Mary with Dakota between his knees, still giving him a rowdy greeting.

  As Danny placed the bags on the coriander counter, he admonished Dakota. “You slacker. Didn’t you hear me come in?” Dakota backed up from Casey and bounded into Danny. At the last second, he swiveled, enabling Danny’s hands to rub his rump. “I don’t want the back end. Come here, where I can see you.” Dakota kept his spot which also enabled him to sniff upward towards the warm sandwiches above him.

  “You missed a good comedy,” Mary said.

  “Hi Dad,” Nancy said.

  “Glad you made it,” Casey said, walking towards him, “especially since you’re delivering food.”

  Nancy and Annabel strode in as well. “Here girls,” Danny said. “I have the foot-long BLT.”

  Nancy’s mouth curled into a frown. “Dad, I wanted a six-inch.”

  “It’s right here,” Danny said, rumpling her light brown hair.

  “Dad,” Annabel said, plopping herself on a stool, “you don’t get it.”

  “What’s there not to get? I think a neurosurgeon can figure out a sandwich.”

  “Danny,” Casey said. “Don’t you know doctors are treated like regular people when they go home to their kids?”

  “I think you all are ganging up on me. I’ve had a nasty day.”

  Casey glanced at him. “This is true, girls. He’s had a rough day.”

  “Whatever,” Annabel said.

  “Dad,” Nancy said. “What I mean is I wanted my own sandwich. A six-inch BLT!”

  “You idiot,” Annabel said. “Dad doesn’t realize that you don’t know six inches is half a foot.”

  “You’re the idiot,” Nancy said. “I want my own separate half-footer because I don’t want to share any sandwich with you.”

  Danny shrugged his shoulders, he’d had enough. He grabbed his meal and slid between them as he walked to the big room. “Because you love me, will one of you girls please bring me a soft drink?”

  Casey followed after Danny and Dakota. The dog decided to focus on Danny, resting his paw on his master’s knee with a wanton look of hunger in his eyes.

  Annabel approached Danny, handing him a cola. “You were gone all day and that’s unusual for a Saturday, Dad.”

  “I may be going back, too. You see what it’s like? You have plenty of time to decide your course of studies. A medical career isn’t for everyone.”

  “I know.” She took a bite but had to help a piece of lettuce get unstuck from her braces.

  “Listen, I’m glad I got to see you two. Thanks for waiting up and I’m sorry I was on call. We’ll make it up next weekend. It’ll be fun and different having a baby here, too.”

  Nancy finished her sandwich and then the girls eyelids started to sag. Danny wrapped his arm around Nancy, gave her a squeeze, and nodded towards the steps.

  “Hmm,” Nancy said. “Come on Annabel. Let’s go to bed.” Both girls uncurled their legs and said good night.

  Mary was as deep in the leather chair as possible, a glas
s of white wine in one hand. “They put up a good show with all that bickering, but on the sidelines, they’re stuck to each other with crazy glue.”

  Danny let out a laugh. “You’re probably right.” He chuckled again. “I’d have a glass of that if it weren’t for the fact that I may be operating on my colleague in the next few hours.”

  “There’s a lot going on in the hospital,” Casey said while glancing at Mary.

  Danny patted Dakota to move so he could get up. “We’ve called in infectious disease and the CDC,” he said with concern. “I’ll talk to you tomorrow. I better get as much sleep as possible. They’ll be calling me when they send for Harold’s case.”

  ----------

  A little after 5 a.m., Danny’s pager went off. They were getting the medical personnel to transport Harold to the OR so Danny needed to come in. He gave ample affection to Dakota and decided to wear the same scrubs he’d worn and slept in from the day before and he’d change to fresh ones in the locker room. He let Dakota out the back door for a few minutes while he put on a pot of coffee and selected a travel mug. It wasn’t raining, but Dakota came back in with soggy paws. It would take days for the yard to dry and for local river runoff to subside.

  En route to the hospital, Danny wondered about the origins of the meningoencephalitis outbreak. He felt confident that Tennessee had few mosquito transmitted diseases. The area usually didn’t have temporary, stagnant bodies of water that made for good breeding habitats.

  Danny arrived and changed as Dean was still putting monitors on Harold in the OR. Dean would be getting off soon at 7 a.m. and a fresh doc would be taking his place. Danny got Harold’s head prepared the way he wanted, finished scrubbing his hands at the sink, and started surgery. With all the blue cloth covering his patient, what Danny saw of his colleague was only a few square inches of his skull. It could’ve been anyone under the drapes. How impersonal, and yet on the contrary, it couldn’t be more personal digging into his colleague’s brain.

  Danny’s heartbeat slowed with despondency. What if the biopsy failed to shed light on an infectious or inflammatory process? Where, when, and how had Harold picked up something so devastating that it had put him in a coma? What about the others? Did they have the same bug as Harold? Who was the first patient? He took one last look at the MRI on the view box to confirm the sample area he wanted.