Allison thanked him and hung up. Maybe there really was no connection between her cases. Maybe it was simply that Faggart had a cut on her toe she hadn’t known about, had somehow come into contact with MRSA and had become infected. And maybe her first theory about Scruggs was correct. He’d gotten a staph infection from a botched piercing.
But that didn’t explain Pringle or Cloninger. She really needed to find them and have them tested. And she’d learn more Friday when MediScan delivered the results of Spike’s lab work. In the meantime, she was bamboozled, frustrated and back to square one.
The intercom buzzed at 10 a.m.
“What?” Allison barked.
“The x-ray film company’s on the phone,” Coretha reported. “They say their film’s fine. No one else has reported any problems. They’re pointing back to the machine or, possibly, a mistake we made.”
“But we had the machine checked out.”
“That’s what I told them but that’s what they say. I thought you might want to talk with them.”
“No time,” she told Coretha. She’d had plenty of experience with the various parties responsible for her Internet service all pointing the finger at each other whenever the service went down. It was always the other guy’s fault. Discussions were futile. Besides, since the initial anomalies, x-rays had been coming out fine for days.
“Sorry for interrupting,” Coretha said, clearly hurt.
Allison hadn’t meant to come off so brusquely. Impatience had gotten the better of her again. “Sorry,” she said. “I’ll talk to them.” Perhaps, she thought, she’d get at least one answer today that made sense. She grabbed the faulty x-rays from a shelf and picked up the phone.
Ten seconds into the conversation she realized that the company rep was telling her, albeit gently, that the film was fine and that she and Coretha were likely to blame.
“What do you mean, double-exposed?” she demanded.
“Each of the sheets of film we looked at was exposed twice before it was developed,” the rep explained. “One exposure caused the ring-shaped voids that appear on some sheets and the big void in the middle of the other. The second captured your patients just as it should have.”
“Double exposure means a problem with the machine.”
“No, because not all the wrist x-rays were messed up. More likely operator error. Don’t feel bad. It happens.”
Allison hung up, dissatisfied. It wasn’t like Coretha or her to make such mistakes. Besides, if she or Coretha had mistakenly used each film twice, the exposures would show two sets of patients.
The films, she concluded, had to have been exposed to two different sources—the x-ray machine and something else.
She slid the test x-rays she’d done on Coretha into her light box. She stared at the ring-shaped void and the surrounding area which looked to have less directly exposed. It reminded her of something.
She retrieved the baggie containing Scruggs’s nipple ring from the MediScan package and compared the ring to the void on the films. They were the same size. She stacked the x-rays on top of each other. The ring was in precisely the same place on the two flawed films. On the film where the ring hadn’t appeared, the spot matched up to a part of the x-ray that included no bone. So the ring could have been there, the dark circle simply had nothing to contrast against. She recalled that Scruggs had removed his nipple ring and placed it on the counter during his first visit. Had he actually put it on a box of unexposed x-ray film?
She picked up an x-ray of Cloninger’s skull which was normal except for the tennis ball-sized void in the middle of her skull where bone should have showed up. The center of the void lined up with the position of Cloninger’s tongue stud.
Could Scruggs’s nipple ring and Cloninger’s tongue stud be the second sources of radiation exposure? And if so, how? And why?
Chapter Twenty-Nine
She was sure there had to be another explanation. The idea that the jewelry itself was giving off radiation was as improbable as it was frightening. She reminded herself that she had a theory and very little evidence. Nothing had been proven to be radioactive. She could hear her father saying, “A-s-s-u-m-e. When you assume something, it makes an ass out of you and of me.” She placed the jewelry from Scruggs, Spike and Lil’ Bob in her father’s old lead drug safe as a precaution and turned to her medical books to see if radiation exposure fit the symptoms she was seeing in her patients.
In cases of topical exposure, she learned radiation initially produced the effects she had observed—skin burns, redness, blistering, inflammation, infections, open sores and tissue death. One entry quoted John Hersey’s Hiroshima about the burns, “ . . . yellow at first, then red and swollen, with the skin sloughed off, and finally, in the evening, suppurated [to discharge or form pus] and smelly.” The description was right on target. It was as if the writer had been looking over her shoulder.
Vomiting and diarrhea usually followed a short time later—symptoms Cloninger had said were plaguing her boyfriend, Darryl Dunn.
If the exposure were long enough or the radiation intense enough, victims could expect hair loss, dehydration, disorientation and fever. And finally, as their stomachs and intestinal tracts ulcerated and sloughed off, death.
Treatment options, she read, were limited. For external exposure, decontamination was called for. To reduce damage to internal organs in cases of limited exposure, physicians could administer ferric hexacyanoferrate, known as Prussian Blue, to hasten the elimination of radiation from the body, or non-radioactive iodine to block absorption of radioactivity by the organs. Allison still had a small supply of both which the government had issued years earlier to physicians and other first-responders who’d have to handle the fallout from a terrorist nuclear attack.
For cases of severe exposure, there was no treatment. The best the medical texts could recommend was hospice care.
The crucial factor was how much exposure a person had and how quickly he or she was treated.
She reviewed her cases. She didn’t know much about Pringle but Scruggs’s symptoms fit radiation poisoning. Tissue death had come first in his case, followed by infection.
Coretha had learned that one of Faggart’s janitorial clients was an extended care facility, suggesting the typical healthcare connection for the MRSA infection in her toe. But what if Faggart had suffered a radiation injury first and her MRSA was merely an opportunistic infection that arose after radiation had already started to kill tissue? Radiation poisoning in her case could not be ruled out.
Cloninger’s visible symptoms fit, too, although they seemed to be in an early stage.
But still, she didn’t know enough. The best that could be said was that radiation exposure was possible in each case. Further tests were needed.
She told Coretha how she was using her lunch hour and drove to the home of Darryl Dunn. Except for the yellow police tape which fluttered in the afternoon breeze, the place appeared as she had last seen it. If Chief Holt had done any more than a preliminary investigation of Dunn, it wasn’t apparent. She took in the havoc Spike had wreaked in the garage—she hadn’t been able to appreciate it fully at night. Shards of metal, plastic and fiberglass littered the floor. She picked up a piece of the Corvette’s distinctive taillight and a piece of metal etched with overlapping circles.
She stepped into the house. She saw that the papers strewn about the den were pages ripped from what appeared to be a diary. She gathered the pages along with a file of bills of lading, receipts for the loads Dunn had picked up. She hoped they contained a clue to his and Cloninger’s whereabouts.
She found what she had come for in the drawer in the bedroom: Cloninger’s tongue stud. She picked it up with forceps and wrapped it in a lead apron that she used to shield pregnant women during x-rays.
Back at the clinic, she placed the stud on a sheet of unexposed x-ray film still in its light-proof
jacket. She retrieved the test jewelry pieces from the drug safe and added the pieces to the film. She waited a minute, then ran the film through the developer. The outline of Spike’s jewelry, Scruggs’s nipple ring and Candi Cloninger’s tongue stud showed up clearly. The rest of the film, including the area where she had placed Lil’ Bob’s jewelry, remained unexposed.
There was no longer any question in her mind: the jewelry belonging to Spike, Scruggs and Cloninger was radioactive. She had no doubt Faggart’s toe ring and Pringle’s earrings were, too.
But how had the jewelry become radioactive? Nuclear power plants produced trace amounts of precious metals but she knew of no nuclear plants in West Virginia. (Who needed nuclear power when there was all that coal?) She didn’t know of any nearby government nuclear facility like the Oak Ridge Laboratory in Tennessee or the Savannah River Plant in South Carolina, although it wouldn’t be unheard of for the government to have a secret installation in West Virginia. She remembered that the Greenbrier Hotel had housed an underground capitol where the President and Congress were to retreat in case of Armageddon. Its existence had been successfully kept from the public for decades.
She searched her computer. The nearest nuclear power plants were on Lake Erie in northern Ohio. None had experienced serious incidents or leakages. A uranium processing plant in Fernald, Ohio had dangerously polluted the surrounding area for almost forty years beginning in the 1950s, but Fernald was hundreds of miles away and, supposedly, the site had been decontaminated. She read that super-accurate measuring devices used in coal mining contained radioactive material. That was a possibility, although Winston was a ways from coal-mining country.
She Googled “radioactive contamination.” Much of the first page was devoted to links to articles about the 2011 earthquake and reactor meltdowns in Fukushima, Japan. The top listing on the second page led to a Norwegian government site, which noted, “The Chernobyl accident in 1986 resulted in substantial radioactive fallout in parts of Norway. Radioactivity is still being transferred from the soil to plants and animals. The concentrations of cesium-137 are measured in meat and milk to ensure that food is safe.”
She refined the search to “radioactive contamination injuries.” The first listing took her to Gideon & Ceizlak, P.A. “Think you’ve been injured by radiation?” the firm’s website asked. “Click here to talk to a lawyer ready to fight for you!”
She noticed that a number of headers referenced something called “Goiania.” She clicked on one, a 1988 report from the International Atomic Agency in Vienna.
“In 1987, scavengers dismantled a radiotherapy machine at an abandoned clinic in Goiania, Brazil. Children spread cesium-137 over their bodies so that they glowed and sparkled. Two hundred forty-four people were contaminated, fifty-four seriously enough to be hospitalized. Four died, their bodies overwhelmed by pneumonia, blood poisoning and hemorrhaging.”
The scientific journal article called the Brazil incident “a nuclear disaster second only to Chernobyl.”
Of course, that was before Fukushima. Still, Allison was amazed. She had never heard of it.
She was comforted that all three events had happened outside the United States, until she came upon an August 1, 2007 article in the New York Times.
The article reported that radioisotopes were lost by commercial users in United States an average of once every day “through theft, accidents or poor paperwork.” The article, by researchers at Kings College London, called for the banning of the form of cesium used in blood sterilizers and cancer therapy machines. “Just a few drops of contaminated water on the mouth are enough to cause radiation poisoning,” the article noted.
A February 2008 report from the Nuclear Regulator Commission revealing the precise number of radioactive sources lost, stolen or abandoned in the United States: 4,363 over the prior decade. More than one a day.
Allison pushed back from her desk. With so many possible sources of radioactive contamination she had no idea where to start.
Chapter Thirty
Josh felt a tap on his shoulder. Furbee made a telephone with her thumb and pinkie finger and mouthed, “Allison.” Josh signaled Jimmy Mayes to start the press. It was 3 p.m. Thursday. Right on time. He followed Furbee from the pressroom and picked up a wall phone in the hallway.
“Spike’s jewelry is radioactive. We have to tell Chief Holt.” Allison sounded rattled.
“Slow down.”
Allison took a breath and started over, adding details of the MediScan findings, her return trip to Dunn’s and her tests on the jewelry.
Josh listened patiently. The notion of radioactive jewelry fell into the category of what had been known during his heyday in Atlanta as The Two-Minute Mile Rule.
The Two-Minute Mile Rule had been named for an apocryphal news story reporting that a human had run a mile in less than two minutes—almost twice as fast as the world record. The rule held that if something seemed too fantastic to be true, it probably wasn’t true. Tough editors invoked the rule to head off time-wasting reporting forays and prevent embarrassing mistakes at the expense of the newspaper’s credibility. A loss of credibility was the ultimate newspaper sin, he knew too well.
Radioactive jewelry sounded about as believable as a report of a mile being run in two minutes. Still, he couldn’t think of an alternate explanation for what Allison was describing. She was a scientist—analytical, cool, careful, objective, never prone to speculation or hyperbole. He wanted to know more.
“I’m due in Columbus this evening to see about getting some relief on Katie’s hospital expenses,” he said. “Maybe we can get together after that.” He told her about the conversation with Mrs. Dunlap and his intention to pursue all options including Pepper’s suggestion that they talk with the hospital about moderating the bills.
Allison felt terrible. She wondered if Josh had any idea of the expenses he was facing. The immediate cost of Katie’s treatment was likely to exceed one hundred thousand dollars. And the bills would keep coming for a long time.She didn’t say so but she felt his trip was likely to be futile. Providers weren’t known for taking voluntary pay cuts. And the insurance company, not the hospital, was behind the no-pay ruling. On top of everything else, Josh could be looking at financial ruin.
Why was it that so many bad things had happened—were still happening—to such a good man? It wasn’t fair.
“Maybe I can help,” she said. “Advise you about what to pursue, what to ask for. There are research budgets to tap, grants to apply for. We can start with the Sparrow Foundation. I’m going with you.”
Chapter Thirty-One
“Josh and I are making a quick trip to Columbus,” she told Coretha.
“You have a date!” Coretha said, pressing her palms together and raising her eyes to the sky. “Thank you, Jesus!”
Allison hoped her attraction to Josh wasn’t becoming obvious. “It’s not a date. But thank Jesus, anyway.”
She found Josh waiting in the Volvo.
Main and River Streets were clogged with teams of workers unloading tents and pipe and drape for vendor booths. It took several minutes to circumvent the congestion.
Just a few days until hell breaks loose, Allison thought. Everyone else in town might love it, but River Days was not a time of year to which she—or her father, for that matter—had ever looked forward. On top of its normal business, the Winston Medical Clinic could count on a ten-day deluge of tourists with cut feet, upset stomachs, severe sunburns, sometimes even heart attacks and, of course, out-of-town insurance plans.
Now was when she should be making sure supplies were adequate and getting paperwork up-to-date, not trying to find money for Katie’s operation or playing public health investigator. One of her father’s mantras popped into her head: A little precaution before a crisis is preferable to a lot of fixing up afterwards—his way of avoiding the cliché, An ounce of prevention is worth a pound of cure
. In this case, she rationalized, the ounce of prevention was ensuring Josh didn’t go broke from medical expenses and finding the source of the radioactive jewelry. She found her phone and left a message for Chief Holt.
The hospital’s vice president of external affairs was running late. Josh and Allison were offered coffee and ushered to seating near the administrative offices. Josh recognized it as the same waiting area he wandered into during his first visit with Katie. He was fascinated that Allison handled the wait the same way he had—by reading the hospital memos, these not on a desk but on a bulletin board.
Allison was halfway through one on Medicaid reimbursements when a notice about an inventory of blood sterilizers caught her eye. She recalled the incident in Brazil and the caution the Kings College researchers had issued about blood sterilizers—refrigerator-sized machines used to kill diseases in donated blood. Underneath that memo was one about the shipping and transport of radioactive materials.
If you were looking for a source of radioactive contamination, Allison was reminded, you couldn’t ignore healthcare.
She voiced her thinking to Josh, starting with a primer. Radioactive isotopes, she explained, were used in literally millions of treatments and diagnostic procedures in most medical facilities in the United States and worldwide. The most common isotope was technetium, a diagnostic tracer that is injected or swallowed and which allows physicians using x-rays, MRIs and CT scans to get clear pictures of soft tissues and organs.
“Could something like that could affect the public?” Josh asked.
“Most of these radiopharmaceuticals decay within the patient. Technetium’s half-life is just six hours.”
Radioisotopes played an important role in treating diseases as well as diagnosing them, Allison said. Cobalt-60 was used in external beam radiotherapy machines. She knew Josh didn’t need reminding that Sharon had received intensive radiation during her breast cancer treatments.
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