Silent Fear, a Medical Mystery

by Barbara Ebel

  “No. I’m good. Not to worry.” Peter turned to his left, handed a form to the desk secretary in exchange for another.

  “Peter, we had Harold on steroids and acyclovir as shotgun treatment before cultures and sensitivity results were back. You still had him on those, correct?”

  “Correct. Our best guess using acyclovir didn’t cut it.”

  “Infectious diseases and the CDC are involved,” Danny said. “We’re working doggedly on this. We better have answers soon.” Danny’s finger tapped the end of the desk. “I’ll keep you in the loop. Also, I bet reporters will be contacting Robert Madden. If need be, steer any news people our way.”

  ----------

  On the top floor of one of the medical complex buildings across from the medical school, Joelle Lewis and Ralph Halbrow were in their element. Here, among the lab tables, incubators, growth mediums, clear encased laboratory shelving, and the equipment needed by research medical doctors and PhDs, scientists could lose all sense of time while tracking down sinister organisms or gaining momentum on vital research.

  It gave Danny a sense of naivety walking into Joelle’s laboratory. Like other professions, medicine had many areas of expertise, it boggled his mind. So many highly trained and smart people, and yet sometimes they all depended on each other. Now they worked on one big puzzle which couldn’t be solved unless each piece, or person, was put into place.

  Joelle and Ralph were both outfitted for handling infectious diseases and Joelle had quarantined off a lab area. Ralph sat on a stool adjacent to the counter where a spectrometer and incubator lay close by. In front of Joelle, agar plates and dyes lined up in a row. She sorted samples and made notes.

  Danny first put on a mask and gloves and slipped into a thick papered white jumpsuit which zippered up the front. He drew close to the table on the other side of Joelle as she pushed a rack of delicate micropipettors back away from Danny. She’d gotten more comfortable in her own lab, changed from short heels to slip-on canvas shoes and shoe covers, and exchanged her lab coat for the full length isolation precaution.

  “Dr. Tilson,” Joelle said, “that must have been difficult going to the ICU seeing Dr. Jackowitz and helping with legalities.” She spoke speedily but didn’t look up while pointing out a plate to Ralph.

  “It wasn’t any fun.”

  “Bacteria are starting to give us feedback or lack thereof,” she said.

  Ralph leaned in, the two experts’ heads together as if they were reading the same book. “No grits or red eye gravy here,” Ralph said.

  Joelle pointed with a pipette. “Danny, what Mr. Halbrow is saying is that we’re coming up negative so far with bacteria. No Listeria monocytogenes, no Rickettsia prowazekii, no anything.”

  “Not even Neisseria meningitides?” Danny asked.

  Joelle pulled her head up, her long silver earrings dangling. “Not that either. And so far on the viral front, we’ve eliminated HIV and Herpes Simplex.” She frowned under her mask. “Even mumps,” she added.

  “Well, shut my mouth,” Ralph said. “This is getting creepier than frog’s hair.”

  ----------

  After getting home late, Danny opened the back door wide so Dakota could spring into the yard. He headed towards a chaise lounge chair while Casey quietly pulled the door closed behind them. The half-moon sky had few clouds and many radiant stars, and the temperature hovered at a perfect seventy degrees.

  “Did Mary go to bed?” Danny asked.

  Casey nodded affirmatively as he settled into a chair. Danny gave Casey the most important news first. “I think you should call Bruce,” Casey responded.

  “You’re right. Bruce and his wife should be home by now and it’s the first opportunity I’ve had all day.” Danny grinned, pulled his cell phone off his belt, and hit Bruce’s home contact number. On the fourth ring, Danny almost gave up, but Bruce answered.

  “This must be important,” Bruce commented immediately, knowing it was Danny.

  Danny heard some background noise like unpacking. “Brace yourself, Bruce. I don’t think I can deliver worse news. Harold passed away today.”

  Bruce skipped the denial phase and went straight to anger, which made Danny feel worse than he already did. “No,” Bruce said, “that makes no sense at all. A young neurosurgeon receiving steadfast care by experts and what was everyone doing? Just standing by? What exactly has the standard of care come to?”

  Danny gritted his teeth. He shook his head at Casey, cluing him in to the tirade he heard coming from Bruce. A silence ensued. Danny gathered his courage.

  “Bruce, we’re dealing with some unknown here. We had a major hospital meeting today with the CEO. The CDC came in from Atlanta. We’ve got Dr. Lewis with infectious diseases involved, neurology, and a new hospitalist. Bill Patogue, the internist involved with some of the primary care, is ill as well as another physician and hospital employees. Before I left the hospital another nurse had an MRI with confirmed meningoencephalitis.”

  Danny heard the stillness from Bruce’s end. Now there wasn’t any unpacking going on.

  “Well, this is unbelievable losing a colleague. It’s the first and it’s going to be the last time.” A pause ensued. Hopefully Bruce was gathering a more understanding response. “Obviously, we’ll have to arrange a proper remembrance. And regarding the practice, this requires sound, quick decisions. Why don’t the three of us cancel any early appointments or surgeries and meet at eight in the morning to discuss this?”

  “I can’t, Bruce. Robert Madden was approached again by news reporters tonight. The CDC, Joelle, Robert, and I have a press conference at 10 a.m. We have to prepare a statement, so we’re meeting at 8 a.m. We have to get updates from the neurologist and hospitalist before tackling the media and I need to do some hands on with patients.”

  “I hope Matthew Jacob is worth more than his running weight. This will be a test to see if our youngest neurosurgeon can fill Harold’s shoes or ours, either.”

  “You chose well, Bruce. Matthew will hold up to the pressure. Plus, he’ll be back tomorrow morning refreshed from running with his wife and a wedding.”

  “I just had an out-of-town holiday but you just undid all the good it did.”

  Danny didn’t respond. Bruce could handle a meteor hitting their office building.

  “Anything else you want to add?” Bruce asked.

  “Look for me on TV, our group’s representative.”

  “You’re more than that. You’re thick in the middle of it. And by the way, weren’t you and Harold seeing many of the same patients? How come with more years on Harold, you didn’t get meningoencephalitis and he did?”

  ----------

  “How did he take it?” Casey asked.

  “Dumfounded and irate. He wears a leather exterior, but underneath it all, he’ll mourn our partners death just like the rest of us.” Danny’s shoulders slumped in exhaustion. “Life is fickle, isn’t it? It can change in a month, a week, a day, or in a heartbeat.”

  “We see more in our jobs, too, so we’re more aware of that fact than most.”

  “Hmm, you’re right. I’m glad my sister stays home and paints. Life for her is simple, productive and with less risk.”

  “She’s so content,” Casey said. “I admire her for it.”

  “She’s always been that way.”

  Dakota came trotting up as a dark figure from deep in the yard. He slipped his head under Danny’s arm and nudged.

  “So did Sara come by today to pick up the girls?” Danny asked.

  “She did. She stayed awhile. You know Annabel will have her driving permit soon. Sara won’t be driving them back and forth so much.”

  “Point taken,” Danny said. “I’m going to flat out ask her to dinner this week. But if I still can’t get her to go out with me, I have your wedding day to look forward to.”

  “That’s true. There’s only so much she can avoid you if you’re the best man and she’s the
maid of honor.”

  Danny ruffled Dakota with more gusto, broke into a wide smile, and pelted out a rolling laugh. “If she wants to be sparse, she will. But she’s going to make my heart thunder wearing that dress Mary picked out for her.”

  ----------

  In the morning, Robert Madden called the special kitchen overseeing the hospital conference rooms and the doctor’s lounge and requested coffee and a breakfast spread for their meeting. No one entering the room passed on decaf or regular and they all selected from scrambled eggs, sausage, donuts, and yogurts from a bowl packed with ice.

  Ralph sat first and draped a napkin on his lap. Today, he’d changed his suspenders to a dark maroon. “With a breakfast like this,” he said, “Mr. Madden’s going to make me fuller than a tick.”

  “Happy to get this Monday morning off to a good start,” the CEO said after overhearing the comment.

  “Does anyone have imperative information since yesterday that we all must know,” Ralph asked, “which may influence the rest of our meeting?”

  Danny sat next to Ralph with a steaming cup of coffee, and a plate of eggs. He couldn’t stifle a yawn as he looked around at the full attendance. He had slept well but could have used a few more hours.

  Robert Madden pulled out the armchair at the top of the table for Timothy Paltrow, making it easier for Tim to sit with his cane.

  “For those of you who don’t know,” Timothy said, “the hospitalist referred a nurse here named Peggy to me late yesterday. She came in with our list of symptoms, fairly lethargic, and conclusive for meningoencephalitis by MRI and spinal tap.”

  A few people made notes and Joelle logged it on their master bulletin board schematic since Ralph was eating. “Pamela, what do you have?” Joelle asked.

  The head of nursing sat tall and put down her coffee. “Interestingly enough, Dotty and James did not work in the OR last Sunday.”

  “And Harold did,” Danny said.

  “But not one patient that went to the OR last Sunday has come down with this illness,” Pamela said.

  Joelle continued adding information. “For the moment, let’s then leave Sunday out of the equation,” she said, “which makes sense. Danny, didn’t Harold start to feel ill in your office on Wednesday? He was admitted to the ER on Thursday?”

  “That’s correct.’

  “Which means Monday and or Tuesday are the likely culprits,” Ralph said, holding off on spearing a sausage link.

  “Don’t forget Lucy Talbot,” Danny said. “She worked on Sunday and Monday.”

  “So,” Joelle said, “Lucy, Dotty, and James were in the OR on Monday but not Harold. As a matter of fact, it was you there, Danny.”

  Something started to gel in Danny’s mind. Like when he couldn’t come up with a name but it lingered on the end of his tongue.

  “I can’t figure me out in the equation,” Danny said. “However, Harold saw my post-op patients on Tuesday, the same patients that Dotty and James were exposed to in the OR on Monday.” He paused a second and then exclaimed “Who were also the patients that Peggy, the floor nurse, took care of.”

  Chapter 10

  Joelle put her marker back in her lab coat and stepped over to the food spread, poured orange juice and grabbed a yogurt. She sat next to the large, bald-headed hospitalist, Peter Brown.

  “One more thing from my end,” Joelle said. “Last evening I also eliminated tick-borne meningoencephalitis. It’s not Lyme disease and it’s not Cryptococcus neoformans.”

  “Cryptococcus neo what?” Peter asked.

  “Neoformans,” Danny answered while Joelle took a spoonful of yogurt. “That’s notorious for causing fungal encephalitis.”

  “Very good,” Joelle said. She looked at Danny and then Tim at the head of the table. “Nice to have an excellent neurologist and neurosurgeon in our midst.”

  “There’s no time for a mutual admiration club,” Ralph drawled. “I got called before this meeting which made me nervous as a bed bug. The CDC is sending me up the road to Bowling Green, Kentucky after the press conference to evaluate hospital patients there. There may be two copy cats to our outbreak.”

  Robert Madden’s back ached and he got up quickly, breaking the silence that ensued. “I hope it didn’t come from us,” he said.

  “Sir,” Danny said, “the hospital has been mostly full and diverting patients away. The bad news on top of bad news is that it could be one of our own who we couldn’t admit.”

  Robert swallowed hard.

  “Okay, look,” Joelle said, “let’s focus on where we were going with this a few minutes ago because we still have to put our heads together for a news statement.” She bounced a finger off the table. “So Danny, who were your surgery patients on Monday that Harold saw on Tuesday?”

  “A young teen named Michael Johnson and a sixty-five year old named Troy Neal.” Danny narrowed his eyes as he sharpened his thoughts. “Michael was one of Harold’s left over trauma cases from the middle of the night with an acute subdural hematoma that I simply did a bur hole on. He’s been quite droopy post-op, and Troy Neal had a brain abscess secondary to a farm implement accident, so he had an abscess drainage. He’s doing terrible post-op.”

  Joelle’s graceful silver earrings dangled as she perked up in her chair and Ralph snapped his suspender.

  “An abscess?” Joelle reiterated, “on a full course of antibiotics? Did he ever have a spinal tap?”

  “No, he didn’t. The abscess seemed straight forward and mostly due to Staphylococcus aureus. I followed it with radiologic evidence. However, he hasn’t had a recent MRI and I’m only following him and Michael peripherally now because I handed them off to Dr. Patogue, who we now know is sick. So Dr. Brown is handling them now.”

  All eyes shifted to Peter Brown. The recent development working with many team players, stimulating medical cases, and CDC and press coverage kept Peter’s thoughts on overdrive and he couldn’t sleep at night. He tanked down the rest of his coffee as Danny spoke and moved the empty cup away from his plate.

  “As Danny mentioned,” Peter said, “Troy Neal has had a brain abscess. The last surgical drainage Danny performed seemed to clear it up. However, he still kept running a fever and it was discovered he had a broken down area on his buttocks which he hadn’t told staff about. It’s quite nasty, actually, and he ended up septic.”

  Timothy curved his hand around the top of his cane and added his thoughts. “His continued illness, however, may also be from the original abscess that needs another drainage. And did he have any symptoms like our other patients?”

  “I don’t recall him complaining of a headache,” Danny said. “But he did have a fever, nausea, and vomiting. He also seemed to be a bit juicy with secretions at one point.”

  “However,” Ralph piped in, “this is the oldest patient. The elderly often manifest symptoms differently.”

  “Okay,” Joelle said. “Dr. Paltrow, please do a spinal tap on Mr. Neal.”

  “You’ve got it,” Timothy said. “And we’ll send him for an MRI.”

  ----------

  Mr. Madden picked a small auditorium on the ground floor of the hospital for the upcoming press conference. Since it was tucked in the back, it had privacy from visitors and patients and wouldn’t stir attention. He had water bottles, tea and coffee set up in case reporters had to wait for the meeting to start due to any key doctors getting held up after the eight o’clock meeting. They all scurried out of the conference room at nine-twenty, later than expected.

  Danny left the meeting, bobbed down several flights of stairs, and cornered himself on the end sofa in the doctor’s lounge. He felt refreshed yet his heart ticked like a jittery kid. He’d given it enough thought for two days. He’d try once again to ask Sara to go to dinner with him. He chose to call her in the morning and not at night and he’d ask her out for the middle of the week, not on a weekend. It would be a relaxed invitation, yet he wanted to take her to a fine restauran
t conducive to nostalgic, yet optimistic conversation. If she accepted, that is.

  His cell phone was fully charged as he took the plunge. No calling the house number either, as Annabel or Nancy could answer, making it a totally different type of call. He speed dialed her cell, and took a nervous breath when she answered.

  “Danny, good morning,” she said. “The girls are still sleeping, I believe. Can I have them call you?”

  “I suppose that’s about to end with school starting,” Danny mused. “Actually, I’m calling you.”

  “Uh-oh, not about anything which will upset me? I would prefer not to take on any of your problems right now.” She had paperwork spread out on the kitchen table and had underestimated the time she needed to get ready for her new job.

  “Sara, I hope that’s not what you think of me. I’m calling to ask you to dinner, just the two of us. It’s only dinner. It can be a clean start or simply to clear the air for the future. Can we allow that to happen, please?”

  Sara shifted back in her chair. Her ex-husband’s voice sounded genuine and gracious. She’d been through so much with him – good and bad. Perhaps she was ready to forgive, maybe not forget, but forgive. Isn’t that what all the experts say? Not forgiving and holding a grudge will burn a hole in your soul or something like that.

  “Okay, Danny. Dinner will be fine. Let’s keep it light, though, for both of us.”

  “Consider it done. Is Wednesday night okay?”

  “That’s fine.”

  “There’s an exceptional situation going on this week at the hospital, so if it’s okay with you, can we make it a little later than 6 p.m. in case I’m running late? Say seven o’clock? I can pick you up or we can meet at Downtown Italy?”

  “I’ll meet you at Downtown Italy at seven. That will give you leeway with your timing.

  “Fine, then.” Danny had relaxed enough to realize that the TV news was on low. A picture of the hospital had just flashed up on the screen with a short medical blurb which Danny didn’t hear.