by Barbara Ebel
When he got past bone with his drill, he surgically excised two slices of tissue, adequate enough for the pathologist. He set about finishing the case in silence. No one chatted. The fact that Harold was otherwise in good medical condition and Dean was running the anesthesia and medical care in the OR made Danny rest more comfortable. Below the drapes, Harold Jackowitz was not only a unique patient and colleague, but he was becoming more like a special friend. The amount of time he spent with his colleagues, he realized, was often greater than the time he spent with loved ones. They’d hashed out similar issues and experienced common joys and pains practicing neurosurgery together.
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An hour after Danny’s case, he met Bill Patogue in the ICU as Harold was being transported straight to his room to his own ventilator. They sat across from each other at the nurses station, knees close, and kept their voices low.
“Danny, I’ve made rounds and left notes on involved patients. The CDC doc took an early flight and will be here soon. I called the CEO of the hospital and the head of nursing. Twelve noon for a meeting is fine with everyone.”
“Joelle Lewis will be here as well,” Danny said.
“But Danny, I don’t feel well. My legs ache, my head hurts, and I feel warm.” Bill widened the opening of his lab coat. Danny stared at him and doubted Bill’s ability to attend.
“You need to get one of the E.R. docs to see you and you both need to wear masks just in case. I think we should do the meeting without you. All the necessary charts are going to be in the hospital’s main conference room, correct?”
Bill nodded.
“I can get the hospitalist to take over the patients you’ve been seeing if you can’t practice tomorrow,” Danny said. “Now get going.”
Bill hesitated after he stood. “But Danny, if I also have this terrible thing, there aren’t any hospital beds.”
Danny feared the same thing. As Bill despondently left, Danny wondered if and when his own first symptom would appear.
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The hospital board room on the top administrative floor had never been used on a Sunday afternoon. The medical personnel involved could count on work weekends, but this was a first for the CEO, Robert Madden, and he’d been the top dog for fifteen years. The phone call the day before from the internist, Bill Patogue, had been worrisome. Even more disturbing was a call that morning from a reporter.
Robert had been bombarded unexpectedly. “Was it true a surgeon was dying in their ICU due to a mysterious ailment?” The reporter went on. “Other hospital employees are clogging up medical beds, stricken with fevers and flu-like symptoms. We want to know if this is fact or rumor? Worst of all, we heard the CDC is on its way to contain an obvious medical problem. Should the general public be alarmed?”
Mr. Madden thought journalists were lackluster in their reports. But how come one of them knew the inside scoop? Too many people work at hospitals, he knew, all departments and all shifts, and all that was needed was a journalist or editor picking up a good dinner conversation from a family member.
The elongated room with cherry wood furnishings filled within five minutes with everyone who’d been invited, except Bill. Danny suspected Bill’s non-arrival confirmed the worst - the ER concurred he needed care and posed a risk to others.
After stillness enveloped the room, Mr. Madden cleared his throat. He introduced himself and began. “I was approached by a newsperson this morning and obviously could not make any factual comments. I’m going to sit through this meeting and let you medical experts discuss things from your end. I will formulate my questions and interject as needed.”
Danny surveyed all the faces again and spoke up. “Mr. Madden, Dr. Patogue is in the ER. I’ll fill in from both my standpoint and his. Much of the needed medical paperwork on the involved patients is here.” He nodded at the doctors and nurse on the other side of the table. “I’ll let you three introduce yourselves.”
Dr. Ralph Halbrow with the CDC had a receding hairline half way back along the top of his head. Along with an impressive southern drawl, he wore suspenders over an extra thirty pounds in his gut. Danny suspected he might be sharing fried chicken with him in the near future.
Dr. Joelle Lewis, on the other hand, had a snappy northeastern accent. She had moved to the middle of the country for the predominantly research oriented teaching spot at the medical department of the university. Only in her mid-thirties, many people considered her the top dog in her specialty. And she’d made the journey with lots of hurdles in the way.
Pamela Albrink, the head of nursing nodded to the others, introduced herself when the time came, and promised the department’s professionalism and help with the present circumstances. Timothy Paltrow, the neurologist, hadn’t sat down yet and leaned on his cane.
Danny’s head spun. Without Bill’s help, it would be up to him to weed through details and guide the CDC and infectious diseases as much as possible.
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The first thing Joelle Lewis did was remove the ornamental flower arrangement in the middle of the conference table. She slid off her long white coat, pushed back some chairs from the table and signaled Danny and Ralph to stand beside her. Most of what Danny knew about Joelle’s personal life he had learned one day having lunch with her in the cafeteria. With Danny’s encouragement, she had sputtered out a succinct recap of her family background and how she came to pursue medicine.
Joelle had grown up with a mostly absent father and a dedicated mother who allowed her three kids to develop their own interests. They lived in one of the few black neighborhoods in Queens, New York, segregated from the white folks by a geographic line of railroad tracks. Neither side of the tracks were well-to-do. Families struggled on both sides to keep their kids clothed and out of trouble. Growing up sometimes depended on luck if the kids’ parents were good role models and instilled in them a desire to want more. Joelle’s mother understood that applying oneself to getting educated was the groundwork needed for future stability.
Being the youngest, and the only girl, ended up being an asset. Her brothers spent time together in scrap yards and had enough inquisitiveness to tinker with car parts, but she spent more time with her mother, and books from the library. Those walks to the closest library on the other side of the tracks ended up transporting her to realms of the world where anything could occur, just by reading everything behind those colorful covers.
She wanted to be a nurse like Mary Eliza Mahoney and do great things. But in Joelle’s first year at a community college, her mother passed away from an infectious disease. How could a contaminated, undercooked hamburger be the source of her mother’s illness and subsequent death? Joelle felt abandoned, despondent, and angry. She strove to get accepted to medical school instead of nursing school and once achieving that, set her sights on specializing in infectious disease. After the completion of her studies and training, she moved from the northeast for the first time to Nashville, Tennessee, the music city and a medical center she grew to love.
“So far, this is every patient’s chart implicated in this outbreak?” Joelle asked.
“Bill talked with Pamela,” Danny said. “This should be it.”
“Okay, let’s first look at the folks who have had spinal taps and MRI’s.” Joelle’s silver earrings swayed as she moved quickly rearranging the charts closer. “Do you concur, Dr. Halbrow?”
“Good start,” he said.
When they pulled out a total of four spinal tap results, Danny lined up two MRI results behind them.
Dr. Halbrow pointed a stubby finger at a notebook. “We have to start a chart,” his southern drawl rang out. “And Mr. Hospital President, I’m going to start pinning on that bulletin board over there.”
Robert Madden overlooked the fact that he was the CEO and had a name, but even he couldn’t keep names straight. This was a group of professionals thrown together at the last minute and if this outbreak wasn’t contained quickly, his hos
pital’s name would be widely known soon, but not in a good way. “Be my guest,” he said politely to the CDC representative.
“If I can interject,” Danny said. “Substantial diagnostic evidence that we’re dealing with meningoencephalitis is right here. We now have two MRI results looking similar - Harold Jackowitz, a neurosurgeon and my partner, and Lucy Talbot, an anesthesiologist who works only at this hospital.” Danny briefly paused as Ralph wrote up columns. He had definitely done something like this before.
“What is their present condition?” Joelle asked.
“Dr. Jackowitz is in a coma.”
Dr. Paltrow leaned in, his right hand still resting on his cane. “And Dr. Lucy Talbot has succumbed to a coma as of this morning.”
Danny gulped. Time stood still and his heart sank. She looked terrible in the ER the day before. He wasn’t surprised she’d slid into unconsciousness, yet anger and sadness tangled with his mind at the same time. They had to get Lucy back, and Harold as well. Whatever this malevolent infectious organism was, it had to be identified and stopped.
Joelle broke into all their thoughts. “Spinal taps,” she said. She took four stapled sets of lab sheets. “All four of these are similar but not the same. Proteins up, white blood cells vary but mostly elevated, and glucose either normal or decreased. All look like they concur with our MRI findings that a meningitis and or an encephalitis is at work.”
Ralph began making a new column and filled in the two new patient’s names besides the neurosurgeon and anesthesiologist as Pamela Albrink added, “These two other positive spinal tap patients, Dotty Jackson and James, are both nurses in the operating room.”
“We have to link the patients together as well as find the original source and organism,” Joelle said. “Danny, what was your colleague’s schedule recently, right before he got sick?”
“He started feeling poorly sometime midweek. He was on call Sunday, I did one of his left over call surgeries Monday morning plus my own, and he covered my hospital rounds on Tuesday morning. We kind-of flip flopped patients.”
“Pamela,” Joelle said, “check nursing’s OR schedules and find out when Dotty and James were working over the last week and a half.”
“I’ll do it right after our meeting,” Pamela said.
“Let me call the OR right now,” Danny said. “I’ll ask the anesthesiologist on call what Dr. Talbot’s schedule was recently as well.” When Danny called from a desk phone outside the room, he lucked out. The doc doing a case had his monthly department’s schedule in his back pocket and rattled off Lucy’s working days.
Danny hurried back, taking his spot between Joelle and Ralph. “She worked last Sunday, the seven-to-three shift. She was the back-up doc to the main anesthesiologist call doc. And she worked on Monday seven to three, which is when she did my cases.”
“Okay, y’all,” Ralph said. “We’ve hit cheese grits. We’ve got a match of Harold and Lucy working on Sunday.”
Everyone finally smiled. Danny laughed out loud at the genuine southern CDC doc and he caught Joelle’s smile, her white teeth standing out like pearls.
“We need to get a list of all patients they worked on,” Joelle said. “And if Dotty or James was working Sunday.” She eyed Pamela who scribbled on a note pad.
“Wednesday Harold didn’t feel good,” Danny added. “Thursday I did cases and I remember the anesthesiologist, Dean, saying he thought Lucy wasn’t in because she was sick.
Joelle tapped her pen on the spotless table top. The words rushed out of her mouth. “We’re getting a narrower time frame for the outbreak of whatever we’re dealing with.”
Chapter 9
Except for Robert Madden, everyone in the room reviewed the patients’ charts and scribbled any physical complaints they had mentioned on admission or during their hospitalization. All four of the patients varied to some degree, just like the fluctuation in the CSF cell count numbers. Ralph logged the patients’ verbal complaints onto a main sheet, again using columns. Joelle stood back like a painter examining her work, and shook her head affirmatively. “Yes, we have the makings again of meningoencephalitis, headache, fever, nausea, and uncomfortable if not stiff neck.”
Ralph stuck his thumb in his right suspender. “Are we all missing anything?”
Everyone glanced around the table, searching each other for more details.
Danny searched his memory over the last bizarre week. Not one patient had complained about it, yet he thought it odd that Harold had so much saliva. Come to think of it, so did Lucy Talbot.
Danny furrowed his brow. “There may be something else. But it’s just an observation.”
“Please, Dr. Tilson, what do you have?” Joelle asked.
“Drool.”
“Drool?’ Joelle blinked her eyes and her head bobbed backwards.
“Excess saliva,” Danny said. “At least that was my impression with Harold and Lucy.”
“From the beginning?” Joelle asked.
“No, I wouldn’t say that. It came later.”
Timothy Paltrow tapped his cane on the floor. “Danny has a point. I agree. Not only them, but Bill has me involved with Dotty and James now, too. That befuddled me about them both this morning. They’ve grown secretions, besides the fact that they’re deteriorating with lethargy.”
The room hushed again, only until Robert Madden let out a big sigh. He pushed himself out of his chair and paced back and forth at the head of the table, hands enveloping each other. He had an impeccable history, this being his second hospital as a CEO. He didn’t want to retire now at sixty-five but he sensed the tail end of his career was going to snap and pop like a soda can, especially when it came to the media.
Amongst the charts and strewn papers on the table, Danny’s pager beeped and shimmied due to the vibrator mode. He reached for it and nodded his approval. “Its pathology,” he said, “must be biopsy news.” Danny strutted back out and dialed the department.
“Danny,” the pathologist said, “sorry for the delay. The incisional biopsy on Harold Jackowitz is positive for meningoencephalitis.”
Joelle wandered out of the conference room and neared Danny, with Ralph behind her. Danny focused on Joelle and her silver earrings and then turned his attention to Ralph. He nodded affirmatively to both of them, thanked the doctor, and hung up.
“The pathologist confirmed our diagnosis.” Danny said.
“As we suspected,” Joelle said. “I notice by the charts all four patients are on a good choice of antibiotics. I want to spin by the lab, check on their progress regarding organism growth, but take CSF samples over to my own lab.”
“I’d like to come along as well,” Ralph said.
Danny was just about to echo Ralph’s remark when his pager went off again. “It’s the ICU,” he said softly and dialed.
Joelle looked down the corridor at a swirling carpet pattern and an empty wall lining the other side of the conference room. Framed photographs lined the wall going down the aisle. Ralph sat down in a chair, dug into his pocket, and handed Joelle his card. She nodded and grabbed one of hers from her coat, flipped it over, and gave it to him. They both keyed in on Danny’s end of the conversation. For sure, there was a problem.
The corner of Danny’s mouth sagged. His eyes grew narrow. After a few minutes, he said, “I’ll be there.” He got off the phone and paused with silence.
Joelle cocked her head, her suspicions aroused.
“That was the hospitalist,” Danny said. “Dr. Harold Jackowitz passed away a little while ago.”
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After donning a mask and gloves from the isolation precaution supplies outside Harold’s cubicle, Danny slipped into Harold’s room. Respiratory therapy unplugged the ventilator, discarded tubing, and rolled the machine past Danny. He stepped to the bedside and stared at Harold’s motionless body. His eyes were closed, the sheet across his shoulders, already looking like death had consumed him some time ago. Danny c
ould feel his own heartbeat pounding away in his ears. He put his hand over his eyes, seeking insight into the meaning of Harold’s death. But none came.
He backed up. Not only did he feel sadness for the personal loss of his colleague and he had harbored a fondness for Harold, but there would be far reaching consequences. The lethality of this meningoencephalitis was now dead clear and would be escalated to greater newsworthiness. The experts had to continue correlating their knowledge, understand more what they were dealing with and find the correct cure. Not to mention The Neurosurgery Group of Middle Tennessee. What would this do to their case loads, and the probability of having to turn new patients away?
Danny thought about Bruce. The founder of their group would be shocked after his weekend away with his wife to find out what had happened. Danny’s nerves seemed to sizzle just thinking about it.
He took a step back while silently saying good-bye for good and left the disheveled room where there’d been a recent code. At the nurses station, the hospitalist’s bald head was bent down as he filled out forms, Harold’s paperwork. He mulled over ‘cause of death.’
Danny rolled out a chair. The hospitalist looked up. “I’m Danny Tilson, I’ve never officially met you. Thanks for helping out. You’ve acquired first-hand care of some patients I’ve been involved with.” Danny looked down, “besides Dr. Jackowitz.”
“Sorry to meet officially under this circumstance. I’m Peter Brown. I had been aggressively treating Harold’s falling blood pressure today, Danny, to no avail. I ran full resuscitative measures in the end.”
Danny shook his head. “Appreciate that. I’m sure you did the best you could. You’re probably aware that Harold was one of my partners. His hospitalization this week really caught us all off guard. Now this.” Danny ran his hand along the back of his head. “Can I help you with any leftover paperwork?”