Amber blew out a breath and turned to face Jack. “If the phones are still functioning I could call the Outbreak Center. It’s more important to be where the patient and lab are, particularly if I want to try and identify the strain.”
She didn’t mind batting off him. It was always useful to throw ideas back and forward with another doctor and he had a completely different kind of experience from her—one that was more likely to be suited to this.
He nodded seriously as his eyes took in the weather around him. “Sounds like a plan.”
She leaned forward to the driver. “Can you get us to Lahuna State Hospital?”
The driver nodded. “It’s near the city center. We should get there soon.”
The cab wove through the streets and high-rise buildings. There were a few people practically being carried along by the wind as they rushed to get places. Some stores were already closed, shutters down and all street wares brought back inside.
A large white building with dark windows emerged through the rain. The main doors and ambulance bay had their doors closed, with security staff visible through the glass. They unlocked the door as Jack and Amber jumped from the cab.
“We’ve had to close the automatic doors,” one told her. “The wind is just too strong and a member of the public has already been injured.”
Amber gave him a grateful smile as he locked the door behind them. “Can you direct me to Infectious Diseases? I’ve been called about a patient.”
“Third floor. Elevators at the end of the corridor. Take a right when you get out.”
The hospital was eerily quiet, the main foyer deserted as they made their way through. But as they reached the corridor in the heart of the hospital they could see uniformed staff swiftly moving patients and talking in hushed, urgent voices. “I wonder if the windows will be okay?” said Jack thoughtfully as they reached the elevators.
“What?” She pressed the button to call the elevator.
“The windows.” Jack looked around him even though there were no windows nearby. “A place like this? It must have around, what—three hundred windows? How on earth do you police that in the middle of a hurricane?”
Amber blinked. She hadn’t even thought about anything like that at all. “The hotel too. Do you think they’ll tell people to leave their rooms?”
The doors slid open. “They must all have disaster plans. Won’t they just take everyone to a central point in a building, somewhere they can hunker down?”
He could almost read her mind. Both of them had rooms at the hotel that they’d literally just abandoned with no thought to the impending hurricane. If they’d had a bit more warning she might have closed her curtains and stashed her computer and valuables somewhere safer. Who knew what they would return to later?
They stepped inside and she pressed the button for the third floor. It only took a few moments to reach there and the doors to the infectious disease unit. Amber reached for the scrub on the wall outside before she entered, rubbing it over her hands.
She could already see through the glass that the unit looked in chaos.
She turned to face Jack before she pressed the entrance buzzer. “Ready?”
She felt a tiny glimmer of trepidation. She was it. She was the sole representative for the DPA. Was she asking him, or herself?
But Jack didn’t hesitate for a second. “Absolutely. Lead the way.”
CHAPTER THREE
FROM THE SECOND she walked into the unit she was in complete control. He couldn’t help but be completely impressed. Whatever the little waver was he’d glimpsed outside, it seemed to have disappeared. There were actually two infected patients. It seemed that they’d been brought in only a few hours apart. Was that the start of an epidemic?
Amber took it in her stride and reviewed them—Zane and Aaron, both eighteen, who were clearly very sick. Then she phoned the Hawaii Outbreak Center and liaised with their staff, and then asked for some instructions to find the lab.
Her face was a little paler as they headed to the stairs. “I need to find out what strain of meningitis this is. These kids have got sick really quickly.”
The lab was down in the bowels of the hospital and they had to change into white lab coats and disposable gloves before entering. It was a modern lab, with traditionally white walls, an array of machinery and computers and wide work benches. But somehow it wasn’t quite as busy as he might have expected.
“Where is everyone?” he murmured.
Amber shook her head as they walked through. “Maybe they’ve sent some staff home because of the hurricane warning.”
The head of the lab was an older man, tall but thick and heavyset; he already knew they were on their way and walked over with his hand outstretched. “Mamo Akano. I take it you’re my meningitis doctor?”
Amber nodded her head. “Amber Berkeley from the Disease Prevention Agency. Any further forward in identifying the strain?”
Mamo had deep furrows in his brow. “Maybe. The DPA just sent me some files over for you to consider. Come over here. I’ve opened them on the computer next to the microscope.”
Amber hurried over and pulled up a stool next to the microscope. She glanced over her shoulder toward Jack. “Ready for this?”
It was the first time since he’d got here that Jack had felt out of his depth. This wasn’t his forte. But he was always willing to learn. He gave a nod and pulled up a stool. “Tell me what you need me to do.”
*
Three hours later her neck ached and her brain was fried. She’d spoken to her contacts at the Hawaii Outbreak Center, and her colleagues in Chicago. Their strain of meningitis seemed to be unique. It was definitely bacterial meningitis. The cerebral spinal fluid collected from both boys had been cloudy. But the gram stains hadn’t given them the information that they needed. There was nothing like it on file—which was not entirely unusual, but just made things more difficult. It was closest to a previously identified strain of meningitis W135, but seemed to have mutated slightly. “What do we do now?” asked Jack.
Mamo sighed. He’d been by their side the whole time. “In theory, now we wait. But we can’t really do that.”
Jack frowned. “What do you mean?”
Amber gave a slow nod. “Mamo will need to see what the most effective antibiotic for treating this strain is. But sometimes we don’t know that for up to forty-eight hours—even seventy-two hours. We can’t wait that long. Both of these patients are too sick. I need to try and treat them now.”
Pieces clicked into place in Jack’s brain. “So, you guess?”
“Yip,” said Mamo, “Amber has to guess.” His voice didn’t sound happy.
Amber straightened up. Her voice was confident and her manner methodical. “Zane was already started on a broad-spectrum antibiotic—Penicillin G—when he was admitted. But it already looks like it hasn’t started working. Neither of these boys was immunized. So, we immunize against Men W, and we treat them with something more specific—more than likely chloramphenicol—and hope the strain’s not mutated too much.” She pointed to the phone. “Let me make one more phone call. Then I’ll go back up to Infectious Diseases to speak to the consultant. Then…” She turned to face Jack. “Then we’re on a race against time. We need to contact trace. If there are children involved they may already have been immunized against meningitis W. But because this strain is slightly mutated, I still want to give them antibiotics. I can’t take any chances with this.”
“Meningitis W is one of the most dangerous strains, isn’t it?”
She nodded. “That’s why it was included in the immunization schedule in lots of countries only a few years ago. These kids really should have had this vaccine. But not everyone agrees with vaccination. Not everyone takes their kids for them, even though they can get them for free.” She shook her head and turned to Mamo. “I need supplies. Where can I get oral supplies of antibiotics?”
Jack couldn’t help but be impressed. She was on fire. This was her speci
alty and it was clear she knew the subject matter well.
Mamo walked over to another phone. “I’ll talk to the hospital pharmacy. It’s emergency circumstances—in more ways than one. Being part of the DPA will give you visiting physician credentials. You’ll be able to get what you need.”
She nodded again in grateful thanks. Jack got that. He was a medic too and part of the army. And, although he was confident in his abilities and credentials, it didn’t matter where you were in the world—most countries had their own conditions and registrations for being a doctor. The US had different regulations for each state, so sometimes it made things difficult.
She nodded and laid her hand on Mamo’s arm as he waited for someone to answer the phone. “Thank you,” she acknowledged. He nodded as they made their way back out of the lab and to the elevators.
She leaned against the wall as the elevator ascended. A few strands of her dark pink-tipped hair had fallen around her face and shoulders, and he could practically see the tension across her shoulders and neck.
He leaned forward and touched the end of one of her strands of hair. “I never asked last night. Why pink?”
She blinked for a second as if her mind was racing with a million different thoughts, then glanced sideways as she realized he was touching her hair. “Why not?” she replied simply.
There was something about the expression on her face that made him suck in his breath. She appeared calm and methodical. He was seeing Amber Berkeley at her best.
He was so used to being in charge. But here? Here, he was just Jack Campbell. This wasn’t a trauma situation. Here, he had to let the person with the most experience lead the case. And that was hard for him. “What can I do?”
He had to ask. He wanted to help. He’d help any colleague who needed it—whether it was his specialty area or not. The army had made him adaptable in more ways than one.
She fixed him with her steady blue eyes and gave him clear instructions. “I need to get histories. I need to find out where these boys have been in the last few days in detail. I need to know every contact. I need names, addresses, dates of birth—contact details if they have them.”
Jack licked his lips and asked the first question that had danced into his brain. “And if they are too sick to tell us?”
She grimaced. “Then we ask their family. Their friends. Whoever admitted them. This is a potentially deadly strain. We can’t wait. There isn’t time.” She shook her head. “I don’t even want to think about what doing this in the middle of a hurricane means.”
He gave a swift nod and reached over to give her arm a squeeze. “I can do detailed histories. I haven’t done any for a while, but I still remember how. Let’s split it. You take one, I’ll take the other and then we can check if there’s any crossover.”
She looked down at his hand on her arm and gave a weary kind of smile. “Thank you for this, Jack. You didn’t have to offer, but I’m glad you did. Usually I’m part of a team. So outside help is appreciated.”
“You okay?”
She nodded. “The meningitis stuff? I can do it in my sleep. The hurricane stuff?” She shook her head. “I don’t have a single clue. I feel completely thrown in at the deep end.”
She gave a smile as the elevator doors slid open again. “Remember your first shift as a resident when it seemed like everyone on the ward was going to die simultaneously?”
He let out a wry laugh. Everyone felt like that their first day on the ward. “Oh, yeah.”
“It feels a bit like that all over again.”
He gave her a smile. “Well, think of me as your backup plan. You lead, I follow. Brief me. What do I need to know?”
She glanced over the notes she had. “Okay, these two kids were both part of a surf club. Zane became sick first, exhibiting some of the normal meningitis signs—high temperature, fever, signs of an early chest infection and, a few hours later, some confusion.”
“So, there are at least a few hours between the disease progression in these kids?”
She gave a slow nod. “They were worried they might have to sedate Zane, but the lumbar-puncture procedure went smoothly and they started him on IV antibiotics straightaway.”
“And the second kid?”
“Aaron came in a few hours after Zane with symptoms of shock. One of the other young guys had gone to see why he hadn’t joined them and called 911 when he found him still in bed. The ER physician connected the cases pretty quickly. Neither of them had been vaccinated against Men W, and both had been bunking down at one of the local student residences.”
Jack let out a slow breath. “Darn it. Close contacts?”
She nodded. “Close contacts. We need names and to find the rest of the kids who were in that residence.”
“What else should I be looking for with close contacts?” He realized he was firing questions at her but he couldn’t help it. He wanted to make sure he covered everything.
“The rules are generally people who’ve slept under the same roof, nursery or childcare contacts, and anyone they’ve shared saliva or food with. Dependent on age, they all need a two-day course of rifampicin.”
Jack pulled a face. “Shared saliva with? You mean anyone they’ve kissed? For two teenage boys at a surf school we might have our work cut out. How far back do we need to go?”
“Seven days from first symptoms.”
“Let’s hope the surf school kept good records, then, and let’s hope the boys know who they kissed.”
The lights around them flickered and they both froze. “Please don’t let us lose power,” said Amber quietly. “This could be a disaster.”
Jack sucked in a breath. He could tell the thought of the hurricane was making her nervous. Truth was, it made him slightly nervous too. But he had to believe that the authorities would have plans in place to take care of things. They couldn’t control the weather. They also couldn’t control time, and it was rapidly slipping away from them. “We have two cases. We can contact trace for these two cases and try and get antibiotics to anyone we think could be affected. Hopefully any younger kids will already be immunized.”
Amber pulled a face. “Usually we would spend a few hours discussing this with the local outbreak center and the DPA. The impending hurricane doesn’t help. What if we can’t get to the people that need antibiotics? We can’t ask people to leave their homes as a hurricane is about to hit. And who knows how long it will last?” She shook her head.
“It’s a disaster,” he said simply.
“Just pray it isn’t an epidemic,” she said swiftly. “Then it really would be a disaster.”
*
By the time they reached the infectious disease unit again it was in chaos. Bed mattresses had been piled against the windows. The curtains around the beds had been taken down and also stretched across the windows with large Xs taped on the glass. A few of the patients who’d been there earlier had been moved out, but Zane and Aaron were still attached to all their monitors.
There was only one adult walking between both beds. Amber and Jack walked over to meet him. “I’m Amber Berkeley with the Disease Prevention Agency. Are you Zane or Aaron’s parent?”
He shook his head. “Ty Manners from the surf school. They’ve both been with me for the last ten days. I can’t believe they’re both sick.”
He glanced toward the covered windows and put his hands on his hips. It was clear he was stressed. “Everything has just happened at once. I should be down at the surf school making it ready—and sorting out the other kids.”
Jack saw Amber word her question carefully. “Ty, I’m sure you’re worried about all the kids in your care, and the surf school. Do you have any records? Do all the kids that go to the surf school stay in the same place? We really need to trace all the contacts that Zane and Aaron have had for the last seven days. It’s really important we find out if other people have been immunized, and that we get some antibiotics to them if appropriate.”
“It’s definitely meningitis?�
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Amber nodded. “It is. Both of their lumbar punctures were positive. And it’s important that we treat things as quickly as possible. We don’t want anyone else to get sick.”
One of the nurses came and stood at Amber’s shoulder with a clipboard in hand. “I’ve contacted both sets of parents. Zane’s mother stays on Oahu. There’s no way she can get here with the imminent hurricane weather but we’re keeping her as up to date as we can. Aaron’s mother and father live just outside Hilo. That’s a two-hour drive to Kailua Kona. State police have told them not to leave their home but I have a horrible feeling they won’t listen.”
Amber walked over to the window and peeled back a tiny corner of the curtain. “Oh, my,” she breathed as she looked outside.
The wind had picked up even more. Enormously tall palm trees were bending in the wind like drinking straws. Public trash cans were rolling down the street like empty soda cans. She watched as an awning at the café opposite was torn away before her eyes by the force of the wind and the red and white material disappeared like a kite being ripped from its string.
It made her heart beat a little faster. She turned to face the nurse. “How soon is the hurricane due to hit?”
The nurse glanced at her watch, then over to a TV screen they had in the corner of the unit. “In about an hour or two. It won’t just be the winds. It will be the rain too. It’s already started but this is nothing. Once it really hits we usually have floods. No one should be out there.”
This was nothing? The rain she’d witnessed as they’d left the hotel had been bad enough. Even with the wipers at maximum their driver had barely been able to see out of the windscreen.
Amber spoke slowly. “But tell that to a parent that thinks their child is at risk.” She closed her eyes for a second. “I wish I’d got a chance to speak to them. Maybe I could have played things down. Given them enough reassurance to wait.”
Locked Down with the Army Doc Page 5