Bitter Paradise

by Ross Pennie

  He had the answer ready. “Isolation Three.”

  “I’m not working that corridor.” She paused and looked at her keycard, anxious to be on her way. Then something clicked in her mind and she looked up. “A Code Blue? How old is the patient?”

  “Seventeen.”

  Her shock was unmistakable. Code Blues on seventeen-year-old girls were a rarity in this place. This was not a war zone.

  “We heard it announced.” He pointed to the ceiling. “Over your system.”

  “I’m sure someone will be out to talk to you shortly.”

  Struggling to keep his facial expression neutral, Hosam made a point of looking at his watch. “That is what they told us an hour ago.”

  “An hour? Goodness. What was your name again?”

  He told her.

  “Are you a family doctor up there in Sudbury?”

  The world over, doors that were closed to others were often opened to surgeons. With so much at stake and so little to lose, he had to give it a try. “A general surgeon.”

  “And they haven’t told you anything?”

  “Nothing.”

  The nurse swiped her card in the lock and pulled on the door. “Dr. Khousa, please wait right here. I promise, I’ll be right back.”

  Ten minutes later, a slim young woman came through the door. She was dressed much like the nurse and wore a stethoscope around her neck. Her thick, chestnut hair was pulled into a neat ponytail. The lines around her eyes suggested she was rarely favoured with a full night of uninterrupted sleep. The name badge on her scrubs said Dr. S. Manning.

  She extended her right hand. “You’re Jamila’s next of kin?”

  Hosam pointed to Fadi and Rima huddled in their far corner of the waiting room. “Those are her parents. They have asked me to interpret for them.”

  “And you’re her uncle?”

  “A member of her extended family.” They were Syrian, they were refugees, they were neighbours. Yes, they were family.

  “I see. I suppose you heard the Code Blue?”

  “Is she still alive?”

  “It was a respiratory arrest. Not cardiac. I intubated her, and now she’s on a ventilator. Vitals are stable.”

  “Is it . . . is it meningococcemia? No one has mentioned a purpuric rash, but the parents told me she —”

  “No, doctor. It’s not sepsis. And it’s not bacterial meningitis.” She leaned toward his ear and whispered, “Our infection specialist says the clinical picture and CSF results point almost certainly to . . . well, I’m sure you’ve been hearing about the outbreak on the news.”

  Hosam cupped his hand over his mouth to stop himself announcing the diagnosis to the entire waiting room. “Polio?”

  The doctor’s face muscles relaxed into a calm solemnity. Amid the frenzies of her job, she hadn’t lost her capacity for empathy. “I’m afraid so.”

  “When can the parents see her?”

  She pointed vaguely behind her. “A portable chest X-ray is being taken at the moment. As soon as that’s done, the nurse will come and get you.”

  “All of us?”

  “You’ll have to put on gowns, gloves, and masks.” She paused while she sized up Jamila’s family clutched together and watching hopefully from across the room. “Is there anyone who can stay with the little boy?”

  “Sorry, no.”

  A different nurse, not the one from before, raced up to the doctor and tapped her arm. “Dr. Manning, Room Five, the BP is dropping again.”

  She closed her eyes for a brief moment then shook her head. “Geez, I thought we were on top of it. Turn the saline up full blast, order six units of plasma, and I’ll be there in a minute.” She turned to Hosam. “The nurse, Breanne, told me you’re a surgeon. You can explain the ventilator to the parents, right?” She paused, and a guilty look came across her eyes. “Tell them I’m sorry about her tooth. I . . .”

  Hosam gave her an understanding smile and raised his eyebrows. “You chipped a tooth in your hurry to intubate and get her breathing again?” He could picture the scene: Jamila’s lips and tongue turning darker blue by the second, her heart rate falling, her eyes rolling up into her head. “She was probably frighteningly cyanosed. Do not worry about it.”

  “You understand, then?”

  He’d chipped teeth on a number of occasions when the situation was frantic, the anesthetist was otherwise occupied, and speed was critical. “Some of these Syrian refugees haven’t seen a dentist in seven years. Their teeth are in terrible shape. Soft as butter.”

  She put out her hand and gave his a firm shake, colleague to colleague. What he saw in her eyes was neither judgement nor pity. It was their shared humanity.

  “Before you go,” he asked her, “can you tell me what you have planned for her?”

  “She’ll be taken upstairs to the ICU. That is . . . whenever they have a bed ready.”

  “And after that?”

  She shrugged and a sad smile took over her face. “It’s a waiting game. This polio business has put us on a steep learning curve. We’re still only at the bottom of it.”

  “It is quite a challenge, I am sure.”

  “I hate to think what it was like in the early 1950s. Thousands of cases a year, and they didn’t have a clue where the virus was coming from. My grandparents had friends who . . .” She stopped. They both knew that further details would be neither helpful nor hopeful.

  The news reports had been clear. A forgotten disease was making a deadly revival. And his haircutting client, Dr. Szabo, could not say why it was happening or who would be next.

  He held the door as the doctor strode back into the fray. It seemed her unnamed patient was going in and out of shock. An uncontrolled bleeder, perhaps? At least you couldn’t blame it on a mortar bomb.

  Chapter 19

  “I know you’re upset, Mr. Petz,” Zol told the pet-store owner over the phone on Monday morning. “And I would be too if I were in your shoes. But it won’t be for much longer.”

  Petz was still in Las Vegas and not happy about being disturbed. “It’ll be your fault when the SPCA sends their lynch mob to collect my head on a platter.”

  The man was overreacting. After Zol had closed Petz Haven to the public for undisclosed public health issues on Friday night, he had made sure that the store’s custodial staff had been afforded full access to the premises throughout the weekend. “One of your employees — Terry, is it? — has been working with my team and the security company to make sure your furred and feathered friends have been properly fed and their cages cleaned.”

  “For God’s sake man, we don’t keep our companion animals in cages. They are housed in customized enclosures.”

  “As I said, we expect to get the lab test results back on the starfish later today, or tomorrow at the latest.”

  “I’ll be bankrupt by then.”

  Zol had a strong urge to call the man’s bluff and mention the significant coin he must have been dropping at the baccarat tables over the weekend. But Zol chose the professional approach that would keep him his job. “I can assure you, sir, our colleagues in Winnipeg are working as fast as they can.”

  There was a rap on Zol’s office door, and Tasha rushed in, her laptop tucked under her arm. She had a computer printout in her other hand and was waving it triumphantly. “Good news!”

  Zol pressed the phone’s mouthpiece into his palm. “From Winnipeg?”

  “With a big fat zero on the starfish.”

  He lifted his palm from the phone. “Mr. Petz, are you still there?”

  “Of course, I’m still here. Where do you think —”

  “The results have just come in from Winnipeg. I’m going to put you on hold for a minute while I have a look at them. Please don’t go away.”

  “I’m not —”

  Zol hit the hold button and se
t the receiver on his desk. Tasha returned his exasperated smile. She’d heard plenty from Mr. Petz on Saturday, again yesterday, and first thing this morning. “So,” he said, “what have you got?”

  “They performed their DNA amplification tests on the starfish I sent them. Every one of them came up negative.”

  “How did they manage to work so fast?”

  “They knew to hone in on Parvo-W from the word go. When you know exactly what you’re looking for,” she said, clicking her fingers, “DNA testing is a snap.” She shot him a sly smile. “Well, more or less.”

  With no Parvo-W in any of the starfish, the creatures had nothing to do with the epidemic. But were they infected with anything else that could be a public health hazard? Zol wondered. “What about that other parvovirus Hamish was telling us about? The one that’s killing so many starfish along the West Coast. Were the Petz Haven starfish infected with that?”

  “Negative as well. Again, Winnipeg knew what they were looking for. They’ve been helping Fisheries and Oceans track that epidemic strain as it moves through our coastal starfish populations.”

  “I can tell Mr. Petz his are perfectly healthy?”

  “Well,” she said, “the ones he has left in the store, yes. Those I sent to Winnipeg . . .”

  “What do you mean?”

  “They made the ultimate sacrifice and won’t be making the return journey, poor things.”

  One of the many things Zol loved about Tasha was the way she made him chuckle, especially when she wasn’t doing it on purpose. “I don’t think he’ll care about that.” He pointed to the empty chair beside his desk. “Have a seat while I give him the good news and send him back to his gaming tables.”

  “Mrs. Simon will be relieved.”

  “She gambles too?”

  Tasha threw him her Earth to Zol look.

  “Oh yeah. I forgot about Mrs. Simon’s aquarium at Cathcart Elementary. Her starfish are also in the clear?”

  “And so are Pancho and Pedro.”

  “Oh my God, you didn’t courier her parrots —”

  She rolled her eyes then shook her head. “Just samples of their feces.”

  “Oh yeah. But we’ll have to tell her about the missing starfish.”

  Zol took Mr. Petz off hold and gave him the good news. They agreed that Zol would call off the police and the security company, and Mr. Petz would give instructions to his employees about reopening the store. As they ended their conversation, there was, of course, no congenial Thanks, Dr. Szabo, for doing your best to safeguard the health of our community under trying circumstances and mounting pressure from the public.

  Zol put down the phone. “Okay, my bride-to-be,” he said, inhaling the joyful notes of her sandalwood scent. “We’re back to square one.”

  “I think it would help to make a fresh review of the ten cases we have so far. It’s been a few days since we looked at them as a group.”

  “I guess it’s worth a try.” The two new cases from the weekend might point them to something they’d overlooked.

  Zol saw epidemiology as a game of commonalities. When you were seeking the source of your epidemic, you looked for the thing or things the victims shared in common. When parasite-infested raspberries on a wedding cake had caused thirty cases of crippling diarrhea, the commonalities that solved the case were attending that wedding and eating that cake. But life was always throwing curveballs. A straightforward investigation often got derailed by misconstrued perceptions, poor memories, overlooked details, and the fact that some people were hardwired to lie to conscientious government officials.

  “While you’re getting your ducks in order,” he suggested, picking up the phone again, “I’ll tell the police and the private security company they can cancel their guards at Petz Haven.”

  A few minutes later, Tasha had Zol’s wall-mounted flatscreen mirroring her laptop.

  “Okay,” she said, pressing a small remote controller she held in her hand. “Here are our cases in the order they presented.”

  Boy, age 11, born El Salvador, Grade 7 Cathcart School in Beasley neighbourhood, in Canada 4 years, Recovered

  Girl, age 10, born Haiti, Grade 6 Cathcart School in Beasley, in Canada 1 year, Outpatient Physiotherapy

  Woman, age 38, born Ghana, Teacher’s aide Cathcart School, lived in Limeridge neighbourhood, in Canada 3 years, Deceased

  Woman, age 27, born Philippines, Nanny, lives in Dundas, in Canada 4 years, on Mechanical Ventilator in ICU

  Woman, age 30, born Philippines, Nanny, lives in Dundas, in Canada 2 years, Stable condition on hospital ward

  Man, age 56, born Canada (Caucasian), Retired labourer, lives in Beasley, in Canada entire life, on Mechanical Ventilator in ICU

  Man, age 34, born Canada (Caucasian), Janitor, lived in Limeridge, in Canada entire life, Deceased

  Man, age 63, born Canada (Caucasian), Laid-off menswear salesman, lives in Dundas, in Canada entire life, on Mechanical Ventilator in ICU

  Man, age 19, born Pakistan, Visitor (Gas Station Attendant?), lives in Stoney Creek, in Canada about 6 months, Acute stage of illness

  Girl, age 17, born Syria, Student Sir John A. Macdonald HS, lives in Beasley, in Canada <1 year, on Mechanical Ventilator in ICU

  “And here I’ve grouped their demographic characteristics.” She clicked the remote and a another data table appeared.

  Demographic Characteristics of Polio Cases

  Gender: 5 male, 5 female

  Age (yrs): 10, 11, 17, 19, 27, 30, 34, 38, 56, 63

  Ethnicity: Caucasian 3, Filipino 2, South Asian 1, El Salvadorian 1, Haitian 1, Ghanaian 1, Syrian 1

  Hamilton Address: Beasley 4, Stoney Creek 1, Dundas 3, Limeridge 2

  Yrs in Canada: 0.5, <1, 1, 2, 3, 4, 4, 34, 56, 63

  Occupation: Student 3, Nanny 2, Gas Station 1, Teachers’ aide 1, Ex-salesman 1, Janitor 1, Retired 1

  Outcomes: Still ventilated 4, Deceased 2, Recovered 2, Acute phase 1, Stable 1

  Their cases were all over the map, demographically speaking. What, Zol wondered, could an eleven-year-old boy from El Salvador have in common with a retired labourer or a mid-sixties menswear salesman?

  After giving Zol a chance to study the table, Tasha aimed her pointer at the flatscreen and circled the home addresses and occupations with the laser.

  “There seemed to be some clusters here that I didn’t notice before, so I made a new chart while you were on the phone with the police.”

  “Great! Let’s have a look.”

  “I put them on a separate slide.” She pressed the clicker and up came her new chart.

  Clusters of Poliomyelitis Cases in Greater Hamilton

  Living in Beasley neighbourhood: 1 Boy, 2 Girls, 1 Retired man

  Attending school in Beasley: 1 Boy, 1 Girl, 1 Teachers’ aide

  Living Limeridge neighbourhood: 1 Janitor, 1 Teachers’ aide

  Working at Limeridge Mall: 1 Janitor, 1 Ex-salesman

  Living in Dundas: 2 Nannies, 1 Ex-salesman

  Family’s gas bar near Dundas: 1 Young Man, “Visitor”/Mechanic

  The data in Tasha’s table was so clearly displayed that it didn’t take him long to see her point. It was also a bit unsettling that it had taken this long to appreciate what had been staring at them all along. That was the thing about connections — they were only obvious when someone pointed them out to you. Their polio cases had strong connections to only three areas of the city: Beasley, Dundas, and Limeridge.

  “It looks like the virus is spreading by . . .”

  “Word-of-mouth?” Tasha suggested.

  “But that
’s impossible.”

  “Unless . . .” She paused for a moment. “What if people are inadvertently coming in contact with Parvo-W because it’s hidden in some person, place, or thing they’re hearing about by word-of-mouth?”

  “You mean they’re being recommended — coerced, maybe? — to go somewhere, do something, or purchase something that happens to be contaminated with Parvo-W?”

  Zol studied the data again with their new hypothesis in mind. “How about this?” he said. “The janitor at Limeridge Mall talks to the salesman who worked at the mall’s major department store until it went bankrupt earlier this year. The laid-off salesman, now with plenty of time on his hands, chats with one of the nannies when he runs into her near his home in Dundas. She tells the other nanny who also lives in Dundas and is a member of the same Filipino community.”

  Tasha’s eyes were sparkling with renewed enthusiasm “And what if the janitor also tells the teacher’s aide who lives near his apartment? And then she tells the two kids at her school.”

  “Or their parents, anyway.”

  Tasha flipped through the data-crammed binder she assembled for each investigation. “The janitor and the teacher’s aide live, um . . . yes . . . in adjacent apartment blocks on Mohawk Road. We need to talk to them again.”

  Zol pointed to the flatscreen. “Except . . . go back two slides?” She pressed her clicker twice. “See? Cases number three and seven? The teacher’s aide and the janitor? They’re dead.”

  Tasha looked crushed for a moment, then returned to the binder and flipped a few pages. “And they lived alone, both of them. The teacher’ aide and the janitor. Nuts.”

  “What about the laid-off salesman?” Zol asked as they scrutinized the slide together.

  “Case number eight. He’s still in the ICU. On a ventilator.”

  “Does he have family we can interview again?”

  She consulted her bible. “Divorced and living alone.” She closed the binder and tapped her pen on its bright blue cover. “Do you think the virus’s source is associated with something shameful or illegal?”