by Barbara Ebel
“Thanks, everyone,” Danny said when they rolled Harold flat on the bed again. Danny stood quietly for a second. His colleague already showed signs of ICU breakdown with IV marks on his arms and a pasty color.
“Marsha, I’m taking this straight to the lab myself,” Danny said. He ran down several flights of stairs to the first-floor laboratory and went straight back, ignoring the boxes where samples were delivered like mail.
A college-aged man stood at a centrifuge and looked over at Danny. “Can I help you?”
“I’m Dr. Tilson. Can you do me a stat analysis on CSF?”
“I’ll take care of it before anything else, Dr. Tilson, but it still takes time for the results.”
“I understand,” Danny said and left in a hurry.
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Coffee and Casey would have to wait. Dr. Lucy Talbot now took priority. Danny scoured the ER board looking for her name. He twisted his hands hoping at least she wasn’t in Room 5 like Harold had been. She wasn’t, but he scowled at himself thinking a room could harbor bad luck.
No one was in Room 7 with Lucy. It’s down time, Danny thought, between being seen, poked and prodded, and the results of what they thought and where they’d send her. He shook his head because he was one of them. However, the way hospital employees were dropping in as patients, he could soon also find himself on the other side of medical care.
A crumpled sheet covered Lucy from her waist down, the stretcher at a forty-five degree angle. The little woman’s arms hung from her shoulders like they barely belonged and her eyes protruded like a frog’s. Although they were open, she didn’t seem to register Danny’s entrance.
“Lucy,” Danny whispered up close.
A guttural sound came from her throat, but most of what came next was juicy saliva. How could someone who appeared dry be that wet in their mouth, Danny wondered as he walked to the counter for a wash cloth. He dabbed Lucy’s mouth and chin and then pulled the moisture into the towel. Dr. Talbot closed her eyes and sunk further into the pillow.
When Danny returned to the desk, the two ER docs were both seeing patients. Since he couldn’t talk to them, he took Lucy’s chart and scribbled a quick note inserting his name into the case. He wrote consults for Bill Patogue and Timothy Paltrow to also come on board with her care, and wrote for an MRI ASAP of her head.
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Danny didn’t have much time before meeting Bill. He dodged down the hall to the coffee room, but what remained at the bottom of the pot resembled silt. After rummaging below, he stuck a filter in the pot and scooped his choice of French roast into the top. While the water did its magic, Danny poked his head outside and glanced up and down the hallway. Casey’s ambulance was out back.
The hot coffee charged his senses as he went outside and rapped on the ambulance door. Casey opened one side. “Hey, come on in. We’re fixing to leave in a little bit because you all are on diversion. We’re going to another hospital.”
Towards the front, where the ambulance wasn’t covered by the overhang, the rain made a pinging sound in the cab. Mark gave Danny a wave and said, “This is quite a carwash,” and went back to his paperwork.
“I don’t think we’ve ever sat and talked in your ambulance before,” Danny said to Casey.
“And I’ve been doing this since you were in training and green as avocados.”
Danny rolled out a laugh. “I knew I needed to see you. That’s the first time I’ve been able to laugh all day.”
“Glad to be of service.”
“You didn’t go near Lucy Talbot then, did you?”
“No, Mark and I brought in a store owner with angina.”
“Start taking more precautions around here. We think Harold’s got meningoencephalitis. We can’t get results or be sure about the diagnosis, or source, or transmission yet. I’m giving you two the inside scoop.”
Casey brought his hand across his chin in contemplation. “You didn’t say meningitis, did you? I’ve never heard of this.”
“Most people probably haven’t. It’s extremely rare. I’m talking about a double-neuro condition.” He held his coffee carefully so it wouldn’t spill. “It’s when there’s simultaneous infection or inflammation of both the brain and the meninges.”
Casey’s thick fingers entwined as he furrowed his brow.
“The morbidity and mortality rates are not good,” Danny added as he slipped closer to the door ready to exit the cab. “I just want to give my future brother-in-law a possible medical alert.”
“Thanks, Danny. We appreciate it.” Mark looked back and nodded his appreciation as well. “I’ll be home after eleven,” Casey added. “Will Mary and I see you?”
“I don’t have a clue. Give Mary a hug for me … and please give Dakota a biscuit and a quick walk.”
“Goes without saying,” Casey said as Danny left with his coffee.
Chapter 8
Danny beat Bill Patogue into the lounge after swinging by the lab. Shortly after they arrived, the neurologist ambled in with his cane. Tim Paltrow was in his seventies, holding on to working like a butterfly to wildflowers and was bald except for a stray white hair here or there, standing up as if electrically charged.
“Let’s get as distraction-free as we can,” Danny said. “Sorry to bring you in here, Tim, especially in this nasty weather.”
“My bones don’t like it much these days,” Tim said. “But anything to keep my mind stimulated. Meeting you two is better than reading a book.”
Danny turned off the television and they went to a corner table. He felt badly about getting the old doc to come in as he glanced out the windows at the unrelenting rain. Over the next few minutes, they gave Tim a synopsis of recent events and why he’d been consulted.
From his pocket, Danny pulled out a lab sheet, a small pad of paper, and a pen to make notes. “I just got some of Harold’s spinal tap results and Lucy Talbot is getting her MRI right now.”
The three men leaned tightly over the table as Danny evaluated Harold’s lab values and Danny’s heart quickened as he read what he dreaded. He glanced at Bill. “Proteins and white blood cells are increased. Glucose is normal, which goes along with the MRI findings.”
Tim held out his arthritic hand for the lab sheet. “Substantial evidence for your working diagnosis, doctors. Let’s confirm if a meningoencephalitis is what’s going on with Lucy Talbot, too. Why don’t I do a spinal tap on her as soon as she comes out of the MRI?”
“Perfect,” Danny said. “And, above all, let’s hope one of the CSF samples from Harold’s spinal tap grows out something in the lab that identifies the causative agent.”
“Danny, I need to get consent and do a tap on James, too,” Bill said.
“You’re right. What about Dotty Jackson? Did she have some of the same symptoms?”
Bill shook his head as he slid further back in his chair; the meeting seemed to be taking a toll on him. “She has flu-like symptoms,” he said. “Also complained less of a headache although she does have one. And she’s developed a fever, which is getting higher despite an antipyretic. Nothing so far has shown up abnormal on her blood work.”
“I’ll get to her after Dr. Talbot,” Tim said. “Each of these patients needs infectious disease precautions. Let’s isolate them.”
Danny rapped his knuckles on the table with a sudden thought. “Either of you have a problem if I call in Dr. Joelle Lewis?”
Tim moved his cane to the side and got up. He stepped to the right and left, unkinking his cramps. “I’ve never worked with her but I’ve heard of her. By all means, give her a call.”
“I think we have ample concern,” Bill added, “that it’s also time to call in the CDC.”
Danny had made notes. He double-checked their plan and who was going to do what. He tensed his lips, searching his colleagues’ faces. “I’m going to see how busy the OR is with after-hour emergencies.”
Tim paused his stretching and looked as quizzical as Bill. “What do you have in mi
nd, Danny?”
“We can’t wait for Harold’s cerebrospinal fluid to possibly grow something out on a Petri dish in the lab. I need to do a brain biopsy on him.”
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After tracking down Joelle Lewis – the infectious disease doctor - by phone and asking for her expertise, there wasn’t anything more Danny could do. He put Dr. Jackowitz’s name on the OR list of after-hour cases. The timing of this case also depended on other serious trauma cases that could come straight up from the ER during the night. As a backup, Danny asked the schedule coordinator to put him on the Sunday morning semi-elective list if they still hadn’t gotten to Harold.
Danny hoped to get home, have a bite to eat, and grab some shut-eye. He went out the ER doors where Casey’s ambulance had been gone for hours. The thunder and lightning had stopped, a silent, gentle rain left in its place. The parking lot lights illuminated the drops, like tiny baby pearls falling from the sky. Danny took off his white coat, draped it over his arm, and did a slow run to his car. Inside, he called Mary.
“I’m stopping at a sandwich shop,” Danny said when she picked up. “I know it’s late, but can I get anyone something?”
“Not for me but we ate early. So let me ask the girls, they’re right here. We’re watching a movie.”
Danny heard his girls’ indecision and then Mary got back on. “They’ll each take a six-inch BLT. Can you get a sandwich for Casey as well? He should be home shortly.”
“Sure. See you soon.”
Danny arrived home with two foot-long turkey combos and a foot-long BLT. It was after eleven, Casey’s car engine still warm in the garage. He entered the garage door into the kitchen but noted no greeting from Dakota. Inside, Casey sat on the ottoman in front of Mary with Dakota between his knees, still giving him a rowdy greeting.
As Danny placed the bags on the coriander counter, he admonished Dakota. “You slacker. Didn’t you hear me come in?” Dakota backed up from Casey and bounded into Danny. At the last second, he swiveled, enabling Danny’s hands to rub his rump. “I don’t want the back end. Come here, where I can see you.” Dakota kept his spot which also enabled him to sniff upward towards the warm sandwiches above him.
“You missed a good comedy,” Mary said.
“Hi, Dad,” Nancy chimed in.
“Glad you made it,” Casey said, walking towards him, “especially since you’re delivering food.”
Annabel strode in as well. “Here girls,” Danny said. “I have the foot-long BLT.”
Nancy’s mouth curled into a frown. “Dad, I wanted a six-inch.”
“It’s right here,” Danny said, rumpling her light brown hair.
“Dad,” Annabel said, plopping herself on a stool, “you don’t get it.”
“What’s there not to get? I think a neurosurgeon can figure out a sandwich.”
“Danny,” Casey said. “Don’t you know doctors are treated like regular people when they go home to their kids?”
“I think you all are ganging up on me. I’ve had a nasty day.”
Casey glanced at him. “This is true, girls. He’s had a rough day.”
“Whatever,” Annabel said.
“Dad,” Nancy said. “What I mean is I wanted my own sandwich. A six-inch BLT!”
“You idiot,” Annabel said. “Dad doesn’t realize that you don’t know six inches is half a foot.”
“You’re the idiot,” Nancy said. “I want my own separate half-footer because I don’t want to share any sandwich with you.”
Danny shrugged his shoulders, he’d had enough. He grabbed his meal and slid between them as he walked to the big room. “Because you love me, will one of you girls please bring me a soft drink?”
Casey followed after Danny and Dakota. The dog decided to focus on Danny, resting his paw on his master’s knee with a wanton look of hunger in his eyes.
Annabel approached Danny, handing him a cola. “You were gone all day and that’s unusual for a Saturday, Dad.”
“I may be going back, too. You see what it’s like? You have plenty of time to decide your course of studies. A medical career isn’t for everyone.”
“I know.” She took a bite but had to help a piece of lettuce get unstuck from her braces.
“Listen, I’m glad I got to see you two. Thanks for waiting up and I’m sorry I was on call. We’ll make it up next weekend. It’ll be fun and different having a baby here, too.”
Nancy finished her sandwich and then the girls eyelids started to sag. Danny wrapped his arm around Nancy, gave her a squeeze, and nodded towards the steps.
“Hmm,” Nancy said. “Come on, Annabel. Let’s go to bed.” Both girls uncurled their legs and said good night.
Mary was as deep in the leather chair as possible, a glass of white wine in one hand. “They put up a good show with all that bickering but, on the sidelines, they’re stuck to each other with crazy glue.”
Danny let out a laugh. “You’re probably right.” He chuckled again. “I’d have a glass of that if it weren’t for the fact that I may be operating on my colleague in the next few hours.”
“There’s a lot going on in the hospital,” Casey said while glancing at Mary.
Danny patted Dakota to move so he could get up. “We’ve called in infectious disease and the CDC,” he said with concern. “I’ll talk to you tomorrow. I better get as much sleep as possible. They’ll be calling me when they send for Harold’s case.”
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A little after 5 a.m., Danny’s pager went off. They were getting the medical personnel to transport Harold to the OR so Danny needed to come in. He gave ample affection to Dakota and decided to wear the same scrubs he’d worn and slept in from the day before; he’d change to fresh ones in the locker room. He let Dakota out the back door for a few minutes while he put on a pot of coffee and selected a travel mug. It wasn’t raining but Dakota came back in with soggy paws. It would take days for the yard to dry and for local river runoff to subside.
En route to the hospital, Danny wondered about the origins of the meningoencephalitis outbreak. He felt confident that Tennessee had few mosquito-transmitted diseases. The area usually didn’t have temporary, stagnant bodies of water that made for good breeding habitats either.
Danny arrived and changed as Dean was still putting monitors on Harold in the OR. Dean would be getting off soon at 7 a.m. and a fresh doc would be taking his place. Danny got Harold’s head prepared the way he wanted, finished scrubbing his hands at the sink, and started surgery. With all the blue cloth covering his patient, what Danny saw of his colleague was only a few square inches of his skull. It could’ve been anyone under the drapes. How impersonal and yet, on the contrary, it couldn’t be more personal digging into his colleague’s brain.
Danny’s heartbeat slowed with despondency. What if the biopsy failed to shed light on an infectious or inflammatory process? Where, when, and how had Harold picked up something so devastating that it had put him in a coma? What about the others? Did they have the same bug as Harold? Who was the first patient? He took one last look at the MRI on the view box to confirm the sample area he wanted.
When he got past bone with his drill, he surgically excised two slices of tissue, adequate enough for the pathologist. He set about finishing the case in silence. No one chatted. The fact that Harold was otherwise in good medical condition and Dean was running the anesthesia and medical care in the OR made Danny rest more comfortably. Below the drapes, Harold Jackowitz was not only a unique patient and colleague, but he was becoming more like a special friend. The amount of time he spent with his colleagues, he realized, was often greater than the time he spent with loved ones. They’d hashed out similar issues and experienced common joys and pains practicing neurosurgery together.
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An hour after Danny’s case, he met Bill Patogue in the ICU as Harold was being transported straight to his room to his own ventilator. They sat across from each other at the nurses’ station, knees close, and kept their voices l
ow.
“Danny, I’ve made rounds and left notes on involved patients. The CDC doc took an early flight and will be here soon. I called the CEO of the hospital and the head of nursing. Twelve noon for a meeting is fine with everyone.”
“Joelle Lewis will be here as well,” Danny said.
“But Danny, I don’t feel well. My legs ache, my head hurts, and I feel warm.” Bill widened the opening of his lab coat. Danny stared at him and doubted Bill’s ability to attend.
“You need to get one of the ER docs to see you and you both need to wear masks just in case. I think we should do the meeting without you. All the necessary charts are going to be in the hospital’s main conference room, correct?”
Bill nodded.
“I can get the hospitalist to take over the patients you’ve been seeing if you can’t practice tomorrow,” Danny said. “Now get going.”
Bill hesitated after he stood. “But Danny, if I also have this terrible thing, there aren’t any hospital beds.”
Danny feared the same thing. As Bill despondently left, Danny wondered if and when his own first symptom would appear.
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The hospital board room on the top administrative floor had never been used on a Sunday afternoon. The medical personnel involved could count on work weekends but this was a first for Robert Madden, the CEO, and he’d been the top dog for fifteen years. The phone call the day before Bill Patogue, had been worrisome. Even more disturbing was a call that morning from a reporter.
Robert had been bombarded unexpectedly. “Was it true a surgeon was dying in their ICU due to a mysterious ailment?” The reporter went on. “Other hospital employees are clogging up medical beds, stricken with fevers and flu-like symptoms. We want to know if this is fact or rumor? Worst of all, we heard the CDC is on its way to contain an obvious medical problem. Should the general public be alarmed?”