“Don’t be paranoid,” he said to the empty car.
He flipped on the radio, but the music did nothing to soothe him. He was approaching the Wilmington Avenue exit. With a jolt he remembered why he was there. It was Sunny he should be thinking about. What would the press say when they found out about her?
The thought of photographers trying to get pictures of Sunny in her sickbed sent him speeding down the ramp. There was a squeal of brakes and a blast of angry horns on Wilmington Avenue as he raced to beat a red light and lost.
At eight o’clock Sunny was woken by an orderly pushing a cart with the breakfasts. She watched him come to the end of her bed, blinking, trying to get the man’s face into focus. But she couldn’t do it.
“Good morning!” said the man. He sounded cheerful, friendly, but his voice was strangely muffled as if he were talking to her from behind a cushion.
Sunny struggled to raise herself against her pillow in order to eat, but she was too weak.
“What’s up, honey?”
The man put an arm underneath her and helped her sit upright. His breath smelled of orange juice.
“I ca … I can’t…”
She could not form the words. It was as if something were holding her tongue.
“I caaan’—”
Then she started to cry, the tears running down her hot cheeks. She watched as the man’s blurry face receded, unable to understand what he was saying. Then there were booming rubbery footfalls echoing in her head and the man was gone. She tried to see where he had disappeared to. His cart was still there. She could see the different colors of the dishes and fruit. But the whole thing seemed to ripple as though she were looking through water. She tried to call out, but the noise she made didn’t sound like her at all. Suddenly she was terrified.
Then she was surrounded by people. Hands were everywhere. Warped voices came through to her—insistent, urgent. A thumb was pushed against her eyelid and a bright light came on, a light that seemed to flood her head, making thought impossible.
Dr. Lee had been eating his breakfast in the hospital cafeteria when the Code Blue alert came over the intercom. When he reached Sunny’s bedside, when he saw her eyes, he was immediately aware that his initial presumptive diagnosis of the previous day had been wrong. This was no salmonellosis. The girl’s eyelids—drooping over fixed dilated pupils in a condition known as ptosis—her attempts to speak hampered by a marked inability to articulate: these two signs alone were enough to set Lee’s personal alarm bells ringing. This was not salmonellosis. It was botulism.
He had very little time.
With botulism the danger to the patient came not from the bug itself but from a toxin it released when the cell was broken. If the organism was allowed to mature in food—badly canned vegetables were the classic culprits—it released a protoxin that, in contact with stomach enzymes, became a full-fledged poison easily absorbed by the small intestine.
Clostridium botulinum was in fact a sinister family comprising eight siblings, the subspecies differentiated according to the poison they carried. West of the Rocky Mountains the sibling that held dominion was of the serological type A, the worst of a very bad bunch, a minutely small organism carrying the most powerful poison known to man.
The toxin worked by moving through the blood and lymphatic systems to the peripheral nervous system. Binding into the body’s electrical circuitry at the neuromuscular junctions, it started to effect the chemical equivalent of cutting the wires. The initial focus of the attack was in the cranial nerves, resulting in problems with eyesight, hearing, and speech. Overall weakness ensued with creeping paralysis and eventually the collapse of the respiratory system. Given Sonia Ford’s symptoms, Dr. Lee knew that there was a grave danger of her asphyxiating before his very eyes.
He stood back from the bed, taking in the serious faces of the nurses and clinicians in attendance. Apart from Carl Doxopoulos and Janet Harbin, both third-year residents, they were all pretty new to Code Blue work. Newer than Lee would have liked.
“Okay, I want this patient moved to ICU, and I want her pulmonary function monitored with particular attention to any decline in respiratory status. I want to clearly establish values for baseline vital capacity and forced inspiratory volume, and I want them every two hours. If there is any sign of decline, we will have to intubate and get her onto a respirator.”
Lee went straight to his office and called the CDC consultant on the twenty-four-hour hotline. There was a brief conversation in which the consultant set out the sample requirements for the CDC—specifying that stool samples should be taken without the use of enema, and should be kept refrigerated but not frozen—and informed Lee as to where he could obtain the CDC trivalent botulin antitoxin, stocks of which were kept at or near regional airports and Public Health Service Quarantine Stations all over the U.S. Having arranged for the delivery of the antitoxin to the Willowbrook, Lee hurried back to the pediatric ICU, where Sunny was being hooked up to a battery of monitors.
“Okay,” he said, taking up a position at the head of the bed. “Unabsorbed toxin-containing food may still be present in the patient’s stomach or lower GI tract. So I want upper and lower gastric decontamination and high enemas. Dr. Harbin?”
He faced the young red-haired woman. There was a faint sheen of sweat in the middle of Harbin’s smooth forehead.
“Yes, Doctor?”
“Your view, please, on the value of gastric lavage in cases of botulin poisoning?”
When Ford entered the ICU just after eight-thirty, Sunny was intubated and breathing with the help of a respirator. Seeing everything in the minutest detail, Ford was nevertheless unable to take it in, unable to believe what he was seeing. He had a distinct sensation of falling into the sea of blue linoleum.
“I can’t … This can’t be…”
It was Lee who took him aside, leading him away from the bed where his daughter, once merely ill, was now battling for her life.
Lee didn’t speak until he had Ford sitting in his office. He pushed a paper cup into his hand, saying something that Ford couldn’t understand. He said it again. Ford lifted the cup. Drank. Tasted bourbon.
“Fifty grams of activated charcoal,” said Lee, dipping his head, and placing his hands in front of him as though there were something between them. He smiled encouragingly, obviously impressed by whatever it was he was showing with his empty hands.
“I like Super-Char. It really soaks up the toxins. I don’t think there’s any reason to worry,” he said.
This got through to Ford and he felt himself smile. It hurt his face, felt more like a rictus. He was out of control. He could tell. He felt as if he was about to burst into tears.
“No reason to…”
He couldn’t finish the phrase. Lee made complicated puckering movements with his mouth. Then spoke.
“Relatively speaking. It was unfortunate that it got to this stage. But as you know, botulism is pretty rare and actually very difficult to diagnose. If she had come in with the blurred vision, slurring of speech, and so forth, I would have made the right diagnosis. But as it was…”
He looked down at his empty hands. Ford was suddenly aware that Lee was embarrassed, even upset. He drained his cup and poured himself another shot of bourbon.
“I understand,” he managed to say.
Lee was absolved. He leaned back in his chair.
“I am taking her off the antibiotics. Aminoglycosides should not be used to treat secondary infections because they can sometimes have the effect of enhancing the toxin-induced neuromuscular blockade. Also you have to be careful about destroying the bug once it’s inside the body.”
“Right,” said Ford, suddenly anxious to get back to Sunny’s bedside. He felt he had reacted badly to her predicament, acted in a way he would not have expected of himself. It was the long hours, the outbreak, the Shark’s death, Denny’s death, the row with Allen, the press, Patou …. Everything was going against him, undermining him. He felt unstead
y in a way he had never experienced before. He would have to be careful with his head. He would have to be strong. If only for Sunny’s sake.
“The most likely scenario is that Sonia—”
“Sunny.”
“Is that Sunny ingested some preformed toxin. Maybe at that restaurant she mentioned.”
“Doesn’t she need the antibiotic for the bug?”
Lee pushed a hand into his black hair, which grew so thick it was like fur.
“Pardon me?”
“You were saying you wanted to take her off the antibiotics. I don’t…”
“Ah, yes. No. You have to understand botulinum needs a number of environmental conditions to be able to come to maturity. It’s not actually a very robust organism except in spore form.”
“Spores, right.” Ford was remembering his bacteriology. Botulinum was a spore-forming bacteria, a clostridium, like the bug that had gotten into Wingate’s patient.
“The spores are actually tough little mothers,” said Lee. “They can survive boiling, freezing, ionizing radiation, chemical attack.”
“You sound like you admire them.”
Lee paused for a moment. Then went on.
“But once they germinate, they don’t do so well.”
“You’re saying they’re going to die anyway. In Sunny, I mean.”
“Yes. Even if she had ingested spores, even if they had germinated, become bacteria, they would not be able to survive in her gastrointestinal tract. It’s too acidic for them. What we have to focus on is the effects of the toxin.”
“Okay.”
“As I said, we have cleaned her system out, and as soon as the antitoxin arrives, we’ll be giving her that.”
“What’s that?”
“Pardon me?”
“I mean what’s in the antitoxin?”
“It’s developed by the CDC. It comes in twenty-milliliter vials and is derived from horse serum. You can get hypersensitivity reactions from some patients—maybe one in ten—but you don’t have to worry too much about that.”
Ford stood up to leave. He had to get back to Sunny now.
“You keep telling me not to worry, Dr. Lee. That worries me.”
He tried to smile, but he could see from the look on Lee’s face that it was not a very convincing effort.
“And how long before she gets better?” he asked.
Lee shrugged.
“Well, there’s good and bad news there. I’m afraid recovery from botulism is a fairly protracted process. It could take months. Patients can complain of weakness up to a year after the end of the acute phase.”
“And the good news?”
“Well, eventually, with time, with proper care, she should make a complete recovery.”
4
When Ford got home in the afternoon, he found two television vans parked in the road and maybe a dozen journalists and photographers waiting for him. It was not quite the crowd the guy with the stepladder had expected, but it was disagreeable nevertheless. Lenses were pressed against the windshield, flashbulbs went off. Ford had to wait, grim-faced, gripping the wheel of the Buick. As soon as he got out, they were at him like a pack of coyotes.
“Dr. Ford, what’s the latest body count?”
“Dr. Ford, do you feel you are being victimized by the county health department?”
“What was the reason for your dismissal?”
Reaching his front door, Ford rounded on the clamoring pack.
“I was not dismissed. I have been suspended on full pay pending an inquiry.”
“Did you cause Officer Denny’s death?”
Ford felt the color rising into his face. He fumbled for his keys, telling himself that he must not get drawn into another to and fro with these sociopathic sons of bitches.
“Dr. Ford, what are your daughter’s chances?”
Everyone turned, trying to see who it was who had asked the question. Obviously, they were only just learning about this themselves. A small, bald-headed man with pale eyelashes pressed forward with his microcassette.
“I said what are your daughter’s chances of recovering from the disease?”
Ford felt his blood chill. He wanted to grab the man’s cassette player and ram it down his throat.
“My … My daughter is ill with botulism. It has nothing to do with the outbreak of staphylococcus.”
“Will you be treating her?”
This was shouted down by the rest of the group. Obviously he wouldn’t be treating her; he had been suspended. Ford took advantage of the momentary diversion to slip inside the house.
Amazingly, the crowd outside continued to shout questions. Ford walked through to the kitchen at the back of the house and poured himself a cold beer.
Closing the refrigerator, he stood with his back against it, the chilled bottle held to his forehead. What were the neighbors going to say about all this? Should he call the police, at least get the bastards off his lawn?
A flash went off. For a second Ford thought he must have imagined it. Then he saw the man standing at the kitchen window. He was focusing to get another shot of the doctor at bay. He would have had to climb over a number of fences to get access to the back of the house. This was the last straw.
“Get the hell off my property!”
Ford ran through to the back door, threw back the bolts, and charged out into the garden. To his surprise, he found the man waiting for him. About six feet tall, he was wearing army-surplus clothing. He was smiling, his camera raised for another picture. Ford blundered forward, hardly knowing what he was doing. He grabbed at the guy’s camera, grabbed a fistful of clothing, pulled, twisted—the man not resisting in any way, obviously used to this, just wanting to get away with his pictures. He held on tight to his camera, but otherwise allowed himself to be led through the house, banging against walls, furniture, Ford screaming at the top of his voice, completely beside himself.
As he opened the front door, there was a barrage of flashing cameras and shouted questions. It was like the shock wave of a small explosion. Ford pushed the intruder into the crowd. Then stood there shaking, trying to catch his breath.
“You are standing on … You are standing on private property,” he shouted. “Now, back off, or I’ll call the police.”
“Dr. Ford, is there any danger of the disease spreading?”
It was as if they hadn’t heard him.
“Are you going to be leaving your daughter down there?”
Ford staggered backwards into the house and slammed the door—closed his eyes, breathed, struggled to compose himself.
“Will you be resigning?”
“Is the Denny family going to litigate?”
“Dr. Ford—?”
The questions came to him muffled by the door. Walking stiff-legged, sick now, unsteady after the surge of adrenaline, he went through all the rooms, closing the curtains, switching on the lights even though it was broad daylight.
When Conrad Allen called, Ford was in the living room, peeping out through the drapes at the few remaining journalists. Allen sounded tired.
“Marcus, hi … I just wanted to see how you were doing.”
They had not spoken since their argument. Ford sat down.
“I’m coping, thanks.”
There was an awkward pause, and then Allen went on.
“I … I’m real sorry about Sunny. I can’t believe it. I talked to Lee this afternoon. He seems to think there’s—”
“Nothing to worry about, I know. How are things in ER?”
“Patou has cohorted all the resistance cases.”
“Uh huh.”
“I guess you can imagine the atmosphere on the ward.”
He could. Perfectly. Gang members, junkies, a few innocent bystanders, but mostly people who were used to living by their wits and taking direct action to get what they wanted, all being asked to lie in bed and take whatever was coming for the good of the wider community. And they would be watching the news coverage like everybody else,
hearing the lurid details of what had happened to Denny and to the Shark’s tongue (the autopsy report had been leaked, no doubt for a handsome fee). Ford’s guess was Patou would be encouraging the liberal use of tranquilizers.
“Has the CDC been in?” he asked.
“Yeah, we’ve seen a few bug hunters down here. They walk around looking very serious, shaking their heads. I don’t think they know what to make of it.”
There was a pause.
“Marcus?”
“Yes?”
“I’ve been thinking. I know how you feel about me going up to—”
“Conrad, I was way out of line yesterday. It’s just that it came as a bit of a shock on top of everything else.”
“Sure … sure I understand. Anyway, what I wanted to say was that it would be real easy for me to arrange Sunny’s transfer up to Cedars if you wanted me to. I’m just saying it because it would make sense for you guys.”
Ford gave a sharp nod.
“How’s that?”
“Well, what’s the point of you coming all the way down here just to visit? That’s all I’m saying. If she was up near where you are, it’d be easier for you to call in.”
“I’ve been driving down to South Central for seven years. It’s no trouble, Conrad.”
“Come on, man. You know what I’m saying.”
“I’m not sure I do.”
“I think you do, though. But if you want me to spell it out, I’m saying that we don’t know what is happening here, microbiologically I mean. And that being the case, I think you would be more than justified in taking Sunny out.”
Ford closed his eyes. He should have seen this coming.
“Marcus?”
“Yeah, I’m still here. I was just thinking how that would look.”
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