“And, Helen, he said something about Novak wanting ‘to shortcircuit the system.’ “
Helen stared at him in silence. They both stood up.
“I think we’d better leave,” Ford said.
5
Ford was climbing out of the Buick when he saw Gloria Tyrell hurrying down the steps into the staff parking lot, carrying stacks of empty cardboard boxes. She was followed by Marlene Fuller and Norma Jackson, two of the junior Emergency Department nurses.
“Gloria?”
“Huh?”
She lost her footing for a moment and stumbled. The boxes went skidding across the asphalt.
“Oh, Lord!”
Ford knelt down to help her gather them up again. Gloria was panting. A bead of perspiration ran down her cheek.
“Gloria, what the hell is going on?”
“I don’t know. I just don’t know, Dr. Ford. It’s crazy. It’s all gone crazy in there.”
He thought for a second she was going to burst into tears.
“Haynes fired the catering company,” said Marlene Fuller matter-of-factly.
“What?”
“This morning. They’re gone.”
“They were gone anyhow,” said Norma Jackson. She’d only been with the Willowbrook for about six weeks and was still very much under Gloria’s wing. “That’s why he fired them. They wouldn’t come in. Said it was too dangerous.”
“Said they had responsibility to their staff,” said Marlene.
Ford looked at the three women.
“So—what?—You’re going shopping!”
“Then we gotta make sandwiches. For three hundred people.”
“Ain’t no one else to do it,” said Gloria, getting up again. “We’re missing people from all over. Even some of my nurses. Everyone’s taking off, Dr. Ford. Everyone’s scared.”
“Case they catch something,” added Marlene. “Press too.”
She nodded across the parking lot. It was true. Where the crush of TV crews and outside broadcast vehicles had been a couple of days earlier there was now just an empty space, littered with fast-food debris and old newspapers.
“There was a story in some magazine,” said Norma.
“Called us a ‘plague ship,’ ” said Marlene. ” ‘Plague ship adrift in South Central,’ that’s what it said.”
“On the cover,” added Norma.
“Way everybody’s been callin’ in sick, you’d think it was true.” And Ford saw that in spite of her dismissive tone Marlene Fuller was scared too.
“What about…?” He gave Gloria’s arm a squeeze. “What about Sunny?”
Gloria looked crestfallen. It was clear that in all the chaos she had momentarily forgotten about his daughter. She smiled, trying to be encouraging.
“Dr. Lee’s been keeping a real close eye on her. She … She had a peaceful night. Don’t worry about all this. You go on up now.”
And she scurried off, leaving Ford standing there with an unsteady feeling in the pit of his stomach.
The lobby was in chaos. Most wards had been closed to visitors, but the visitors refused to go home. They crowded around the reception desk, demanding to know if their loved ones were all right, shouting at the two beleaguered women trapped behind their transparent Perspex screens. Two security officers looked on, powerless to intervene.
Most of the overnight cleaning staff hadn’t come in. On the landings and corridors the waste bins were full to overflowing. Outside the elevator Ford almost stepped in a pool of coffee that was slowly spreading across the linoleum floor. On the other side of the fire doors he came across one of the pediatric nurses and a porter arguing at the top of their voices about whose job it was to do what. Outside ICU an Hispanic woman, a complete stranger, blundered into him and ran away before he could even ask what she thought she was doing there. Ford had never seen anything like it, not even during the ‘92 riots. Back then they had been short-staffed—the hospital had been in the middle of a war zone and many people just couldn’t get there—but everyone had kept their heads. There had been a camaraderie in the face of adversity that had made him proud. But something about the present crisis seemed to have the opposite effect. Maybe it was just that this time the enemy was inside the hospital, instead of outside on the streets. The Willowbrook was tainted—as much a part of the problem as a part of the solution—a plague ship, as the magazine had said, adrift and rudderless. Yet no one knew how or why. It was no wonder morale was starting to crack.
He hurried on towards pediatric ICU, squeezing his way past a trolley piled high with laundry being wheeled down the corridor by one of the Code Blue team surgeons. Sunny’s room was at the end of the corridor. A large red notice had appeared on the door, emblazoned with a black biohazard symbol and the words isolation ward—keep out. Ford peered through the glass window. Sunny’s bed was screened off behind plastic sheeting. He could just make out the impression of her motionless body beneath the bedclothes.
The door opened. It was Simon Lee. He looked exhausted, his eyes bloodshot, his face shiny with sweat.
“Dr. Ford. Good morning, I was—”
“How is she?”
Ford went to the bed, pulling back one of the plastic sheets. Sunny lay there, her eyes tight shut, a vacant, death-mask stillness in her features. He stroked her hair, looking into her face.
“I’m here now, honey,” he murmured.
The noise of the ventilator was loud beside him.
“She’s not … I think she’s asleep at the moment,” said Lee. “She seems to drift in and out of consciousness. It isn’t … It’s getting difficult to tell.”
Ford looked back at him.
“Difficult to tell?”
Lee looked down at his clipboard.
“The paralysis seems to be spreading. She’s lost the use of her arms completely, and we haven’t seen any movement in the lower body since last night. It may be that she is conscious, but just can’t … very easily…”
The idea that Sunny was awake, conscious, but unable even to open her eyes, was trapped inside a body that would not respond, was almost beyond bearing. Ford let his fingers drift down across her skin, over her eyes, moving the lids, so that the pupils became visible for a moment. Could she see him, hear him? Could she feel his touch?
“What about the antitoxin? Isn’t it working?”
“Yes, it is, up to a point. Only … Dr. Ford, do you mind…? Do you mind if we step into my office?”
Ford sighed and kissed Sunny’s forehead.
“I’ll be back in a minute, honey, okay?”
He stayed there for a moment, hoping to see something, anything that could be interpreted as a response. But Sunny remained perfectly still.
In Lee’s office Ford refused coffee and took a seat opposite the desk.
“Just as well,” said Lee. “The machine’s out of cups, and there’s no milk left. I could wash one up if—”
“Please, just tell me about Sunny. What’s happening?”
Lee ran his fingers around the inside of his collar. It was hot in his office. He glanced at the airconditioning unit by his window, but seemed to think better of adjusting it.
“The truth is we’re entering uncharted territory here. I have to be honest with you, with each day that passes the existing data on this type of problem becomes more and more … well, irrelevant. I mean, we caught this infection very early. Normally we’d have licked the problem by now. But we’re six days in and, well, at best we’re holding our own.”
“But you said the antitoxin was working.”
“I believe it is effective. We saw a big dip in her toxin level after the first dose was given to her. I should have another set of test results by now, but…”
“But what?”
“The lab … They’ve had problems. I don’t know.”
“Jesus Christ!”
“Supplies they were expecting didn’t show up, they said. And some of their technicians, they—”
“Called i
n sick, I suppose.”
“I’ve been on them all morning. The problem we have is that the botulinum itself is still there in her gut. It’s still releasing toxin. And my hunch is the amount of toxin being produced is rising. That’s why the paralysis is spreading. I think the bug may actually be replicating in Sunny’s gut—maybe only slowly, but”—he sighed—“you must see the implications.”
Ford locked his hands together and stared down at his feet. He didn’t want to think it through, but he had to. He had to know how much time he had. The botulinal antitoxins were extracted from enzyme-treated equine serum—horse serum. A substance that was so entirely alien to the human body was always likely to produce an unwelcome reaction in humans treated with it over any length of time. For twenty years the medical profession had called for the development of a treatment based on human biochemistry, but the pharmaceutical industry had declined to oblige.
“How much more antitoxin can she take, Dr. Lee?”
“That’s impossible to say. She’s had two doses so far. That’s forty mils in total. But I’m afraid we are beginning to see signs of hypersensitivity. In particular, there seems to be generalized abdominal swelling. I’m sure this is due to edema, and I’m prescribing a diuretic to deal with it, but…”
“Go on.”
“But my main concern is that this edema, this buildup of fluid, suggests that Sunny had—or is developing—an allergic reaction to the antitoxin. Edema is a classic early warning of anaphylaxis. To be blunt, I’m afraid if we keep on pumping the patient—I mean Sunny—with this antitoxin, we could push her into anaphylactic shock.”
Ford felt as if the breath had been sucked out of him, and he hadn’t the strength to take another. Anaphylaxis was simply an abnormal reaction to a particular foreign substance, one in which histamine was indiscriminately pumped out into the system causing dilation of blood vessels and contraction of smooth muscle—the type found in the heart and lungs. Anaphylactic shock was an extreme version of the same thing. It could involve violent constriction of the bronchioles, heart failure, collapse of the circulatory system, death.
“Normally, there’d only be a very slim chance of such a reaction,” Lee went on, “five or six percent at worst. But normally you’d never have to take the antitoxin treatment much beyond the forty-milliliter level. Normally the toxin you start with is the only toxin you have to deal with. But this damned bug … It’s still there.”
Ford stared. The bug was slowly killing Sunny, and now Dr. Lee was telling him that the only treatment would also kill her before long. He took a breath, struggling to keep his voice steady.
“What do you recommend, Doctor?”
Lee leaned back in his chair, closed his eyes for a moment as if in pain, sighed.
“We can’t let the toxin just build up. We can’t simply surrender the entire nervous system. We have to … We have to…” For a moment it struck Ford that the man opposite him had nothing more to say, nothing more he could say. “We have to find a way to get this bug out of her system.”
Ford stood up.
“How much time do we have? In your opinion?”
Lee shook his head.
“Marcus, I don’t know. As things stand, days … a week perhaps. Then we may have to look at more drastic measures. Like I said, this is something new. There just aren’t any case histories to draw on.”
“Thank you, Dr. Lee.”
Ford started to go.
“Dr. Ford?”
Lee was standing. He looked defeated, lost. What he was about to say was clearly difficult for him. In his own quiet way he was a very proud man, proud of his skills, his profession—just like Ford himself.
“I’d be the first to admit that I’m not … that this is not necessarily the best place for Sunny to be right now. There may be other hospitals, other teams, specialists, who’ve more experience with this kind of thing. Especially since we’re … since we’re having all these practical difficulties. What I’m saying is, I’d entirely understand—I’d give my backing—if you wanted her moved elsewhere.”
Ford found his office locked up, and he didn’t have a key. He had to use a pay phone outside the kitchens. He called Helen’s direct line at Stern, but her secretary told him that she was not in, couldn’t say when she would be back. He called home, hoping to find a message on his answering machine, but Helen hadn’t called. She’d promised to let him know the moment she found out where Scott Griffen was. She was better placed to locate him, she’d said. He was supposed to have been a big fish, a leading light in the world of Pharmaceuticals. Someone at Stern would know where to find him. Ford should leave that part to her. It was better that he went back to Sunny, while Helen located Griffen. So how long could it take? It was already midmorning and she hadn’t called. What was she doing? Of course, it was possible that Griffen too had retired, just like Novak. That would make it harder. That would take a lot more asking around. And it was still only a quarter past ten.
“Marcus?”
It was Conrad Allen. He was wearing a smart black polo shirt under his lab coat, and it looked as if he’d had a haircut. He was the first person Ford had seen that morning who didn’t looked stressed.
“Hey, how’s it going?” His voice softened. “How’s Sunny?”
Ford tried to smile.
“Not so good. She’s … She…”
He couldn’t form the words. Just hearing her name seemed to touch it off. It seemed to open up a chasm inside him, a glimpse into the void that life would be without her. An existence without hope. He covered his eyes with his hand. It was all he could do not to sob. Allen put a hand on his shoulder.
“I know, I know. I looked in this morning. Lee told me the story. If … If you need anything. If there’s anything I can do, Marcus, just…”
“Thank you.” Ford took a deep breath, then another. “I appreciate it.”
“Why don’t we get some coffee? They still have coffee back there—if you get it yourself, that is.” He began leading Ford towards the cafeteria. “Maybe we can even find something to put in it. A little bourbon, maybe, or—”
“Conrad.”
They stopped.
“Conrad, what you said, the other day—about moving Sunny to Cedars-Sinai.” Allen nodded, then looked down at his feet. “I want you to arrange it. If you can.”
“Marcus—”
“You were right. I was wrong. I shouldn’t have … I want the best for her, Conrad. The best.”
“Marcus—”
“I don’t care what it costs. Can you do it?”
Allen sighed, ran his fingers across his forehead.
“Marcus, I already tried. I already talked to them. Yesterday. Just in case you changed your mind.”
“And?”
“They won’t do it.” Ford stared, uncomprehending. “I’m sorry. They said they couldn’t take the risk. It’s the same everywhere. Nobody wants these resistance cases. They’re afraid they’ll end up with the same problem. We can’t even organize transfers to other public hospitals. It’s health department policy, apparently.”
“What is?”
“No movement of infected patients. Marcus, they’re trying to ring-fence the problem, stop it from spreading. Each hospital’s gotta fight its own corner. I checked with Haynes this morning. There was supposed to be an announcement, but…” He shrugged, despairingly. “I don’t know.”
“But this problem is not nosocomial.” Ford was almost shouting. “Haven’t they grasped that yet? It’s out there, coming in here. Staff, patients. They aren’t going to escape it like this.”
“I know, Marcus, I know.”
“They want to keep this thing out, they’ll have to close down completely. Either that or screen all incoming patients, turn away the infected ones. Leave them out on the street.”
“Some of them already are. That’s what I heard. Patients carrying that strep are on their own, as far as some places are concerned. Yes, that’s right, Marcus, your strep checked
out. I talked to the laboratory people. Had them take a look. It looks like your strep is the guilty party.”
“So what are they going to do about it?”
“The health department is supposed to be talking to the CDC about some kind of game plan.”
“Great. Meanwhile I can’t even get into my fucking office.”
“I’m sure that’s only a matter of time, Marcus. They can’t—”
“I don’t have time. I don’t have time.” He turned and went back to the phone, lifted the receiver. “I have to find that drug. I have to find Griffen. How do you…? How do you find somebody when you…? How do you find somebody when you don’t know where the fuck to begin?”
Allen rested a firm hand on Ford’s forearm.
“What number…? What’s the fucking number for…? How do you get—”
“Marcus. Calm down. Calm down.” For a moment they stood in silence, Ford aware only of the pounding of his heart. “What exactly are you looking for?”
Ford replaced the receiver.
“I need to locate a man named Scott Griffen. Dr. Scott Griffen. He works in Pharmaceuticals, or did until a few years ago. I think … I think there’s a chance he could help Sunny.”
Allen looked at him. Ford sensed the inevitable skepticism. How could Griffen help? Wasn’t Ford just clutching at straws?
“All right,” Allen said. “Then I suggest we start with the in-house pharmacy people. God knows, they’re not too busy right now. Paloma Jimenez. She’s been in the business for years. If she can’t help you, nobody can.”
6
Paloma Jimenez had been more than helpful. She’d A given him a promotional document produced by a company called Apex Inc. The corporate headquarters, it turned out, lay just a few miles away in Century City. The brochure was entitled Apex Horizons, and it was supposed to get you excited about the company’s research-and-development effort. There were lots of photographs of people in white coats looking through microscopes or working with brightly colored chemicals, interspersed with pictures of happy, healthy children, pregnant women, and squeaky-clean senior citizens. On the first double-page spread was a picture of three executive types in dark suits gathered around the end of a shiny boardroom table. The caption read “Dr. Arthur T. Ross (Director, Healthcare Policy), William B. Donnelly (Chief Executive Officer, Apex Inc.), Dr. Scott R. Griffen (Director, Research & Development).”
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