“Plasmid transfer…”
“Or transposons, jumping genes. Exactly. How staph transfers resistance to something like a clostridium, I don’t know, but maybe that’s what we’re looking at.”
“So what are you saying, Marcus? That this is the end of the world?”
Ford shrugged.
“No, of course not, but the implications for medicine … I don’t know how we’d begin to face up to them. They’re enormous. It’s like planning for the aftermath of nuclear war. Where do you begin?”
“But even if the industry, I mean the pharmaceutical industry, can’t find a way to kill this staph—which I doubt—all it would mean is we’d have to go back to the way things were sixty years ago, to the 1930s. Before antibiotics. Sure, surgery would be a lot more dangerous, but on its own that wouldn’t put mortality rates up all that much. After all, it was improved sanitation, water treatment, that kind of thing that brought them down, wasn’t it? Proper housing.”
Ford came back to the bed and lay down on top of the sheets.
“That’s the problem,” he said. “There is no going back to the 1930s. What you say about housing and sanitation is true, but only in the industrialized West.”
“I don’t follow.”
“Well, the Third World as we know it didn’t really exist back then. I’m talking about these vast cities and their spiraling populations—Bombay, Rio, Cairo, Jakarta. Did you know there are now twenty million people in Mexico City?”
“So?”
“Twenty million people, most of them without proper housing, without proper sanitation. But people who still use modern medicine to stave off illness.”
“If they can afford it.”
“Twenty million people using the antibiotics pushed at them by the big pharmaceutical companies.” He rolled over and looked at Helen’s face. “Do you know what the biggest killer of children under three years old is, I mean globally?”
Helen went on staring at the ceiling.
“I don’t know. Diarrhea maybe?”
“That’s right. About five million deaths every year. And the main cause of illness is squalor, filth. Whether the pathogen involved is viral or bacterial, the best treatment for diarrhea is oral rehydration therapy. But the drug companies have pushed antibiotics as a magic cure for the disease because they see it as a huge marketing opportunity.”
“Oh, come on. Now you are being political.”
“Listen, it’s a market worth over five hundred million dollars a year.”
“Says who?”
“There was a company—I can’t remember the name, this was back in the early eighties—it started marketing an antidiarrhea drug containing chloramphenicol and tetracycline in the form of a chocolate flavored pill. It was a big success in the Third World. And how do you think it was being used? I’ll tell you how. Child got sick, Mom got out the candy pills. Symptoms went away, Mom stopped the candy. Millions of people mixing antibiotics and potential pathogens in their guts, year in, year out. It’s like having a gigantic project for the development of resistant bacteria.”
“But what’s that got to do with your problems in South Central?”
“A lot. Because microbiologically the planet is now a world away from what it was in the 1930s too. And because of the way the world has opened up—with international trade and tourism, the ability to fly from one country to another—the whole system is permeable. Add to that the political instability and flows of refugees across national borders, and you have an unprecedented confusion of bacterial ecosystems. The whole thing about being able to rely on proper sanitation and urban planning goes out the window.”
He turned and looked at Helen. She frowned for a moment, but said nothing.
“You see my point? I mean what percentage of Los Angeles higher-income establishments have immigrant domestics? You may live in a great neighborhood and have access to the best medicine in the world, but what about the woman in your kitchen cutting vegetables? What are the sanitation arrangements where she lives, and what’s her medical history? How about the Sri Lankan guy working as a chef in the Indian restaurant you like to go to? Do we give a damn if they have healthcare even when they’re here perfectly legally? I’m telling you, Helen, the planet is a microbiological disaster waiting to happen.”
“Jesus. And you say the press sensationalizes.”
“They do. And they distort. They emotionalize; they focus on people like the Dennys and then start looking for the nearest scapegoat. They don’t understand the detail of what’s going on, and they don’t have the courage to consider the bigger picture.”
Helen turned her head, looking straight at him.
“Is that it?”
Ford smiled, embarrassed. She didn’t want to hear it, not now. It was two o’clock in the morning. He kissed her lightly on the cheek, then flopped back on the mattress.
“I’m sorry. I get worked up and then I suddenly hear myself talking, like I was on the other side of the room. Since I wrote that paper, I’ve been reading all kinds of stuff on resistance. I’m turning into a fanatic.”
“I’d say more of a proselyte.”
Ford smiled. “That’s because you have an education. I’m going to have to try to keep a lid on it, though, if I’m going to talk to experts. I mean like Novak.”
Helen sat up. “Did you get to talk to him?”
“I called him this afternoon.”
“And?”
“He invited me to meet him next Friday.”
“That’s great. You’re going over to his place?”
“No. I offered, but he said it was too far out. He wants to meet someplace near here, actually.”
“No kidding, where?”
“Pacific Palisades. Haverford Avenue. It’s some kind of condo, I think.”
Helen looked surprised.
“Hey, that’s pretty ritzy. Did he say why he wanted to meet there in particular?”
“He said he had something to show me, some research or something. He gave me the entry code to get in. Apparently the entry phone system isn’t linked up yet.”
He held up a finger. “That reminds me.”
He climbed out of bed and went across to the chair where he had hung his jacket. He rummaged in the pockets and came up with a scrap of paper on which he had written Novak’s instructions.
“Don’t want to lose this,” he said.
Ford got home just after three and went straight through to his bedroom. Sunny listened to him close his door. Then, as quietly as possible she went down the hall to the bathroom. She felt terrible. Something was churning in her guts, making the perspiration flood out of her. She kneeled down and leaned over the toilet bowl, pushing the door closed with her foot. Ford slept heavily until the alarm went off at five-fifteen, undisturbed by the sound of his daughter being sick.
PART THREE
POISON
1
THE WILLOWBROOK MEDICAL CENTER
Ford was sitting alone in the cafeteria when Conrad Allen came in, holding his gray cardboard tray in both hands. It was only eleven-thirty and the place was empty, except for a trio of nurses in the far corner.
“Kind of quiet in here,” he said. “All it needs is tumble-weed and a gunslinger in a poncho.”
Ford looked up from the remains of his salad and gave Allen a weary smile.
“I got tired of sitting in my office waiting for … for something to happen.”
Allen put down his hamburger and coffee.
“I never thought I’d find myself short of things to do, not in this place. I guess that’s what happens when they stop sending you any patients.”
“Or medical students,” said Ford.
“No students? How come?”
“All student visits to the Emergency Department and ICU are out. Dr. Patou’s orders.”
Allen shook his head in disbelief.
“She afraid they’ll catch something?”
“Yeah,” said Ford. “Bad habits, I expect.
From me.”
Allen laughed. If he knew about the investigation and the threat of suspension, he wasn’t letting on. But there was something, a gentleness about his manner, that suggested sympathy.
“So what have you heard?” said Ford. “I mean about me?”
Allen lifted the bun off his hamburger, looked at what lay beneath, and replaced it.
“I heard the county’s trying to pin that patrolman’s death on you. I heard they’re mad about you talking to the press.”
Ford nodded.
“Who told you?”
“Everyone knows. Haynes’s office leaks like a sieve. I’m surprised you couldn’t hear all their ears flapping when you were in there.”
“Come to think of it, there was a draft,” said Ford, trying to keep his composure. He’d suspected that word would get out pretty quickly. That was another reason he’d stayed in his office most of the morning. He could bear the idea of carrying on as if nothing had happened so long as he was the only one who knew. But if everybody knew, it would seem futile, ridiculous to go through all that pretense. Silence, the very fact that he was capable of suppressing his indignation, might even look like an admission of guilt.
Sitting there, he wondered how Conrad Allen would have handled it. In the operating theater he was always a model of cool efficiency. No matter how stressful things got, he was always the same. It took genuine carelessness on somebody’s part to get him to even raise his voice.
“Marcus, everyone knows it’s bullshit too. I mean everybody who understands anything. There’s no way they can blame you.”
“But they can suspend me, apparently, pending investigation. I’ve been waiting for the bad news all morning.”
“Well, the team’s right behind you. You don’t have to worry about that.”
“Really? My phone hasn’t exactly been humming with messages of support.”
Allen waved away the objection. “The Vulture’s got everybody running around. But I’ve talked to them. They’ll back you up all the way.”
“Thanks, Conrad. I appreciate it.”
Allen shrugged and tore open a package of ketchup with his teeth.
“No sweat.”
“The only problem is…”
“What?”
“Well, if the CDC finds anything they don’t like about our procedures—and you can bet Loulou’ll do her best to see they do—then the whole team will be discredited. And since I’m in charge of the team … That’s what worries me.”
Allen leaned closer, lowering his voice.
“Marcus, there’s nothing wrong with our procedures. Loulou hasn’t found a thing, and she won’t. Have a little faith, will you? This is the Code Yellow team we’re talking about. They don’t come any better than us.”
They exchanged a look. That was how Ford saw it, for sure. He had trained most of the team himself, and their experience, their belief made them something special in his eyes. But did Conrad Allen still see it that way? Lately he had seemed so distracted, so preoccupied … Ford was sure it had something to do with trouble at home, but they still hadn’t gotten around to having the talk Allen had started outside the ICU. Watching Allen season his sad-looking burger, Ford decided the time had come to get things straight.
“Conrad, I … You remember the other day? You said you wanted to talk to me. Did we talk? I mean, maybe I missed it, but it seems to me—”
Allen picked up his hamburger in both hands and gave it a long look as though he were counting the sesame seeds. It was easier to do that, Ford knew, than to look at him.
“No, we never got round to that particular conversation,” Allen said. “With everything that’s happening here, there never seems to be a good time.”
He heaved a sigh and put the burger back on the plate.
“Well, this is a good time…” said Ford, smiling. “Hey, if Loulou gets her way, you may never see me again, anyway.”
Allen tried to smile, but Ford could see that he had become very uncomfortable. He stared at his burger for a moment and then put his elbows on the table, leaning forward a little. Ford decided to take the plunge.
“Look, Conrad, if ever … I mean if you ever want to stay at the house, you’re more than welcome. Me and Sunny, we’d love to have you.”
Allen looked confused.
“I don’t…”
“No big deal,” said Ford, shrugging, pushing back from the table. Then he was confused too. It came to him that maybe he had misread the signs. “I just thought … You said Ellen was … I got the impression maybe you two were having problems.”
“Oh, Christ,” said Allen blankly. He looked Ford straight in the eye. “Marcus, I’ve been offered a position at Cedars-Sinai as director of trauma.”
Ford blinked. Tried to smile. Couldn’t.
“They’re willing to hold the position open for me for a while, but I said I could be free by the end of October.”
“The end of…”
Ford’s voice trailed off. Suddenly he had a headache. Again he tried to smile, tried to understand what Allen was saying. But he just couldn’t take it in. The words this is disastrous came into his mind with a vocalized clarity. It wasn’t just that Allen was the most valued member of the Code Yellow team, his right-hand man. He was also his friend. He looked at the other man’s face, registering the confusion there. He had an abrupt sense of the way he himself must be looking.
“Conrad, I’m sorry … I … That’s great news.”
Allen stared, his face close to Ford’s in the harsh light of the cafeteria. It was as if they were speaking in a foreign language.
“You really—?”
“That’s great,” said Ford again, realizing as he said it that that was exactly the opposite of what he felt. “When are you going, did you say?”
“The end of October. Next month. I thought after our trip. I decided to take your advice about going away with Ellen. We’re going walking in the Grand Canyon. This place owes me a little vacation.”
“That’s fucking great,” said Ford, suddenly, irrationally jealous of Ellen. The obscenity seemed to release something, and his voice flooded with anger: “Fucking brilliant. And … I can’t … What about the Willowbrook, Conrad? What about this place?”
Allen appeared to move his tongue around inside his mouth. When he finally spoke, his voice came out squeezed.
“What about it?”
“Well…” Ford made a vague gesture, turning his hand to show the empty palm and curled fingers. “Now, of all times. When we’re really up against something big.”
“Come on, Marcus, I’ve been planning this for months. It’s got nothing to do with what’s going on here.”
“But I thought this … I thought this was a commitment. I thought coming in here every day was a commitment. And now you say…” Ford realized he wasn’t making any sense. He stared at his hand. “I mean, how are we supposed to feel about this?”
“Marcus, the Emergency Department is not going to close down because I leave.”
“Don’t … Don’t flatter yourself, Conrad. We’ll get along fine. I’m just realizing … I’m just seeing how wrong I was about your—”
“Whoa, whoa. Hold on there. Hang on just a second. We’re talking about a career here. That’s all. I’m a doctor. I’m being given an opportunity to carry on my work somewhere else. So what? It’s not like I’m becoming a stockbroker or an arms dealer or something.”
“No, but this is where you’re needed. Here, not in Beverly Hills. A doctor goes where he’s needed.”
“If they didn’t need me, they wouldn’t—”
“What about your commitment, Conrad, your responsibility to this community?”
Allen smiled, but it was a tight, angry smile.
“You mean my responsibility as a black man to the black community?”
For a moment neither of them spoke. Ford felt his blood pulsing in his temples.
“That sounds just a bit racist, Marcus. Just a bit. I may be b
lack, but I’m also American. It’s okay for me to care for Americans.”
“You know I didn’t mean that.”
“I’m not sure I know what you mean.”
Allen paused. Seeing Ford’s discomfort, he softened a little.
“And what about my responsibility to my family?”
“To Ellen?” said Ford. “She believes in what we do here as much as I do.”
“So do I. And I’m not talking about Ellen, or the kids—though God knows they’d be delighted for me to take the job, for me to get out of this war zone—I’m talking about my parents. I’m talking about the sacrifices they made to put me through med school. I’m talking about the dreams they had for me.”
“Right,” said Ford. “Of course the money’s got nothing to do with it.”
Allen got to his feet.
“Earning the money is part of my responsibility. And, since we’re on the subject, what about your responsibilities?”
“What about—?”
“Sunny must be the only kid in your neighborhood who doesn’t go to a private school. What about your responsibility to her?”
This hurt. Ford felt the injustice of it like a slap in the face. He sent Sunny to Alexander Hamilton not because he couldn’t afford a private school—he earned over $100,000 a year, for Christ’s sake—but because he believed in the state education system and because Sunny would have exposure to kids from other ethnic backgrounds there. The wrongness of what Allen had said stalled him for a moment. He felt his heart jolting in his chest and didn’t know what to say.
“Fine,” was the word that came out in the end, said with all the bitterness of a curse. “Fine. You want to turn your back on these people, Conrad, that’s your business.”
Allen drew trembling fingers across his mouth.
“You know what your problem is, Marcus? Your problem is guilt. You feel guilty about what’s happening in this city. Well, you want to work out your white man’s guilt in this place, that’s your problem, man. Not mine.”
There was the sound of a tray clattering to the floor and a shouted curse. Then a high, squeaking punt-punt-punt sound. Allen turned. Gloria Tyrell appeared around the corner, wide-eyed, hurrying towards them, her face shiny with perspiration. In all this time at the Willowbrook, Ford had never seen her so much as break into a trot. He got to his feet.
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