by Barbara Ebel
“Did Mary go to bed?” Danny asked.
Casey nodded affirmatively as he settled into a chair. Danny gave Casey the most important news first. “I think you should call Bruce,” Casey responded.
“You’re right. Bruce and his wife should be home by now and it’s the first opportunity I’ve had all day.” Danny pulled his cell phone off his belt and hit Bruce’s home contact number.
“This must be important,” Bruce commented immediately, knowing it was Danny.
Danny heard some background noise like unpacking. “Brace yourself, Bruce. I don’t think I can deliver worse news. Harold passed away today.”
Bruce skipped the denial phase and went straight to anger, which made Danny feel worse than he already did. “No,” Bruce said, “that makes no sense at all. A young neurosurgeon receiving steadfast care by experts and what was everyone doing? Just standing by? What exactly has the standard of care come to?”
Danny gritted his teeth. He shook his head at Casey, cluing him in to the tirade he heard coming from Bruce. A silence ensued and he gathered his courage.
“Bruce, we’re dealing with some unknown here. We had a major hospital meeting today with the CEO and the CDC came in from Atlanta. We’ve got Dr. Lewis with infectious diseases involved along with neurology and a new hospitalist. Bill Patogue, the internist involved with some of the primary care, is ill as well as another physician and hospital employees. Before I left the hospital, another nurse had an MRI with confirmed meningoencephalitis.”
Danny heard the stillness from Bruce’s end. Now there wasn’t any unpacking going on.
“Well, this is unbelievable losing a colleague. It’s the first and it’s going to be the last time.” A pause ensued. Hopefully, Bruce was gathering a more understanding response. “Obviously, we’ll have to arrange a proper remembrance. And regarding the practice, this requires sound, quick decisions. Why don’t the three of us cancel any early appointments or surgeries and meet at eight in the morning to discuss this?”
“I can’t, Bruce. Robert Madden was approached again by news reporters tonight. The CDC, Joelle, Robert, and I have a press conference at 10 a.m. We have to prepare a statement, so we’re meeting at 8 a.m. We have to get updates from the neurologist and hospitalist before tackling the media and I need to do some hands-on with patients.”
“I hope Matthew Jacob is worth more than his running weight. This will be a test to see if our youngest neurosurgeon can fill Harold’s shoes … or ours, too.”
“You chose well, Bruce. Matthew will hold up to the pressure. Plus, he’ll be back tomorrow morning refreshed from running with his wife and a wedding.”
“I just had an out-of-town holiday but you just undid all the good it did.”
Danny didn’t respond. Bruce could handle a meteor hitting their office building.
“Anything else you want to add?” Bruce asked.
“Look for me on TV, our group’s representative.”
“You’re more than that. You’re thick in the middle of it. And, by the way, weren’t you and Harold seeing many of the same patients? How come with more years on Harold, you didn’t get meningoencephalitis and he did?”
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“How did he take it?” Casey asked.
“Dumfounded and irate. He wears a leather exterior but, underneath it all, he’ll mourn our partner’s death just like the rest of us.” Danny’s shoulders slumped in exhaustion. “Life is fickle, isn’t it? It can change in a month, a week, a day, or in a heartbeat.”
“We see more in our jobs, too, so we’re more aware of that fact than most.”
“Hmm, you’re right. I’m glad my sister stays home and paints. Life for her is simple, productive and with less risk.”
“She’s so content,” Casey said. “I admire her for it.”
“She’s always been that way.”
Dakota came trotting up from deep in the yard and slipped his head under Danny’s arm, nudging him.
“So did Sara come by today to pick up the girls?” Danny asked.
“She did. She stayed awhile. You know Annabel will have her driving permit soon so Sara won’t be driving them back and forth so much.”
“Point taken,” Danny said. “I’m going to flat out ask her to dinner this week. But if I still can’t get her to go out with me, I have your wedding day to look forward to.”
“That’s true. There’s only so much she can do to avoid you if you’re the best man and she’s the maid of honor.”
Danny ruffled Dakota with more gusto, broke into a wide smile, and pelted out a rolling laugh. “If she wants to be sparse, she will. But she’s going to make my heart thunder wearing that dress Mary picked out for her.”
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In the morning, Robert Madden called the special kitchen overseeing the hospital conference rooms and the doctor’s lounge, requesting coffee and a breakfast spread for their meeting. No one entering the room passed on decaf or regular, and they all selected from scrambled eggs, sausage, donuts, and yogurts from a bowl packed with ice.
Ralph sat first and draped a napkin on his lap. Today, he’d changed his suspenders to a dark maroon. “With a breakfast like this,” he said, “Mr. Madden’s going to make me fuller than a tick.”
“Happy to get this Monday morning off to a good start,” the CEO said after overhearing the comment.
“Does anyone have imperative information since yesterday that we all must know,” Ralph asked, “which may influence the rest of our meeting?”
Danny sat next to Ralph with a steaming cup of coffee and a plate of eggs. He couldn’t stifle a yawn as he looked around at the full attendance; he had slept well but could have used a few more hours.
Robert Madden pulled out the armchair at the top of the table for Timothy Paltrow, making it easier for Tim to sit with his cane.
“For those of you who don’t know,” Timothy said, “the hospitalist referred a nurse here named Peggy to me late yesterday. She came in with our list of symptoms: fairly lethargic, and conclusive for meningoencephalitis by MRI and spinal tap.”
A few people made notes and Joelle logged it on their master bulletin board schematic since Ralph was eating.
“Pamela, what do you have?” she asked.
The head of nursing sat tall and put down her coffee. “Interestingly enough, Dotty and James did not work in the OR last Sunday.”
“And Harold did,” Danny said.
“But not one patient that went to the OR last Sunday has come down with this illness,” Pamela said.
Joelle continued adding information. “For the moment, let’s then leave Sunday out of the equation,” she said, “which makes sense. Danny, didn’t Harold start to feel ill in your office on Wednesday? He was admitted to the ER on Thursday?”
“That’s correct.’
“Which means Monday and or Tuesday are the likely culprits,” Ralph said, holding off on spearing a sausage link.
“Don’t forget Lucy Talbot,” Danny said. “She worked on Sunday and Monday.”
“So,” Joelle said, “Lucy, Dotty, and James were in the OR on Monday but not Harold. As a matter of fact, it was you there, Danny.”
Something started to gel in Danny’s mind. Like when he couldn’t come up with a name but it lingered on the end of his tongue.
“I can’t figure ‘me’ out in the equation,” Danny said. “However, Harold saw my postop patients on Tuesday, the same patients that Dotty and James were exposed to in the OR on Monday.” He paused a second and then exclaimed, “Who were also the patients that Peggy, the floor nurse, took care of.”
Chapter 10
Joelle put her marker back in her lab coat and stepped over to the food spread, poured orange juice and grabbed a yogurt. She sat next to the large, bald-headed hospitalist, Peter Brown.
“One more thing from my end,” Joelle said. “Last evening I also eliminated tick-borne meningoencephalitis. It’s not Lyme disease and it’s not Cryptococcus neoformans.”
“Cryptococcus neo what?” Peter asked.
“Neoformans,” Danny answered while Joelle took a spoonful of yogurt. “That’s notorious for causing fungal encephalitis.”
“Very good,” Joelle said. She looked at Danny and then Tim at the head of the table. “Nice to have an excellent neurologist and neurosurgeon in our midst.”
“There’s no time for a mutual admiration club,” Ralph drawled. “I got called before this meeting which made me nervous as a bed bug. The CDC is sending me up the road to Bowling Green, Kentucky after the press conference to evaluate hospital patients there. There may be two copy-cats to our outbreak.”
Robert Madden’s back ached and he got up quickly, breaking the silence that ensued. “I hope it didn’t come from us,” he said.
“Sir,” Danny said, “the hospital has been mostly full and diverting patients away. The bad news on top of bad news is that it could be one of our own who we couldn’t admit.”
Robert swallowed hard.
“Okay, look,” Joelle said. “Let’s focus on where we were going with this a few minutes ago because we still have to put our heads together for a news statement.” She bounced a finger off the table. “So Danny, who were your surgery patients on Monday that Harold saw on Tuesday?”
“A young teen named Michael Johnson and a sixty-five year old named Troy Neal.” Danny narrowed his eyes as he sharpened his thoughts. “Michael was one of Harold’s leftover trauma cases from the middle of the night; he had an acute subdural hematoma that I simply did a bur hole on. But he’s been quite droopy since. And Troy Neal had a brain abscess secondary to a farm implement accident, so he had an abscess drainage. He’s doing terrible postop.”
Joelle’s silver earrings dangled as she perked up in her chair and Ralph snapped his suspender.
“An abscess?” Joelle reiterated. “On a full course of antibiotics? Did he ever have a spinal tap?”
“No, he didn’t. The abscess seemed straightforward and mostly due to Staphylococcus aureus. I followed it with radiologic evidence. However, he hasn’t had a recent MRI and I’m only following him and Michael peripherally now because I handed them off to Dr. Patogue, who we now know is also sick. So Dr. Brown is handling them now.”
All eyes shifted to Peter Brown. The recent development of working with many team players, stimulating medical cases, and CDC and press coverage kept Peter’s thoughts on overdrive and he couldn’t sleep at night. He tanked down the rest of his coffee as Danny spoke and moved the empty cup away from his plate.
“As Danny mentioned,” Peter said, “Troy Neal has had a brain abscess. The last surgical drainage Danny performed seemed to clear it up. However, he still kept running a fever and it was discovered he had a broken down area on his buttocks which he hadn’t told staff about. It’s quite nasty, actually, and he ended up septic.”
Timothy curved his hand around the top of his cane and added his thoughts. “His continued illness, however, may also be from the original abscess that needs another drainage. And did he have any symptoms like our other patients?”
“I don’t recall him complaining of a headache,” Danny said. “But he did have a fever, nausea, and vomiting. He also seemed to be a bit juicy with secretions at one point.”
“However,” Ralph piped in, “this is the oldest patient. The elderly often manifest symptoms differently.”
“Okay,” Joelle said. “Dr. Paltrow, please do a spinal tap on Mr. Neal.”
“You got it,” Timothy said. “And we’ll send him for an MRI, too.”
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Mr. Madden picked a small auditorium on the ground floor of the hospital for the upcoming press conference. Since it was tucked in the back, it had privacy from visitors and patients and wouldn’t stir attention. He had water bottles, tea and coffee set up in case reporters had to wait for the meeting to start due to any key doctors getting held up after the eight o’clock meeting. They all scurried out of the conference room at nine-twenty, later than expected.
Danny left the meeting, bobbed down several flights of stairs, and cornered himself on the end sofa in the doctor’s lounge. He felt refreshed yet his heart ticked like a jittery kid; he’d given it enough thought for two days. He’d try once again to ask Sara to go to dinner with him. He chose to call her in the morning and not at night and he’d ask her out for the middle of the week, not on the weekend. It would be a relaxed invitation, yet he wanted to take her to a fine restaurant conducive to nostalgic but optimistic conversation. If she accepted, that is.
His cell phone was fully charged as he took the plunge. No calling the house number either, as Annabel or Nancy could answer, making it a totally different type of call. He speed-dialed her cell, taking a nervous breath when she answered.
“Danny, good morning,” she said. “The girls are still sleeping, I believe. Can I have them call you?”
“I suppose that’s about to end with school starting,” Danny mused. “Actually, I’m calling you.”
“Uh-oh. Not about anything which will upset me, I hope. I would prefer not to take on any of your problems right now.” She had paperwork spread out on the kitchen table and had underestimated the time she needed to get ready for her new job.
“Sara, I hope that’s not what you think of me. I’m calling to ask you to dinner, just the two of us. It’s only dinner. It can be a clean start or simply to clear the air for the future. Can we allow that to happen, please?”
Sara shifted back in her chair. Her ex-husband’s voice sounded genuine and gracious. She’d been through so much with him – good and bad. Perhaps she was ready to forgive … maybe not forget, but forgive. Isn’t that what all the experts say? Not forgiving and holding a grudge will burn a hole in your soul or something like that.
“Okay, Danny. Dinner will be fine. Let’s keep it light, though, for both of us.”
“Consider it done. Is Wednesday night okay?”
“That’s fine.”
“There’s an exceptional situation going on this week at the hospital so, if it’s okay with you, can we make it a little later than 6 p.m. in case I’m running late? Say seven o’clock? I can pick you up or we can meet at Downtown Italy?”
“I’ll meet you there. That will give you leeway with your timing.
“Fine, then.” Danny had relaxed enough to realize that the TV news was on low. A picture of the hospital had just flashed up on the screen with a short medical blurb which Danny didn’t hear.
“And, Sara, by tonight you may hear about a dangerous meningitis outbreak here at the hospital. We’re having a press conference in thirty minutes. Just keep yourself and the girls out of mainstream public places - or the hospital - for a bit. It’s better to err on the margin of safety.”
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As local television and newspaper reporters gathered in the auditorium, Robert Madden waved the docs over to a hallway alcove so they could all enter the adjoining room together. He looked a distinguished sixty-five, his suit from a high-end rack. The gray around his temples and the crow’s-feet around his eyes gave him an extra look of wisdom to spearhead the important meeting.
Joelle hurried down the hallway in low heels, her hair pulled tight off her face. “Dr. Danny,” she said, pulling alongside. “Did you do anything as important as relieving intracranial pressure during the last half hour?”
Danny gave a lighthearted laugh. “Maybe. I asked my ex-wife out for dinner.”
Joelle registered a surprised look while forcing him to step up his pace. “At least that won’t be an icebreaker or a clumsy first date. I hate them myself.”
“There sure won’t be a lack of things to talk about.”
“And if you get tired of previous married-life talk, you can use a layperson’s version of this meningitis outbreak as a stimulating topic. I test men with my work talk. Either they become more interested in me or I scare the hell out of them.”
He could see her doing that and Danny chuckled as they joined Robert.
Ralph Halbrow and Timothy Paltrow stepped into their little circle. Ralph was the only doctor not wearing a white coat. He seemed preoccupied, looking around for a garbage can to throw away his diet soda can. Danny had grown fond of the unique CDC southerner who was smarter than he looked.
“It’s ten o’clock,” Robert said. “Let’s keep it simple and straightforward like we discussed a little while ago. I don’t know how reporters do this, but they must telecommunicate news material. There are more folks in there than I expected. From a business man’s perspective, I wouldn’t deviate into ‘what if’ scenarios and mostly keep to their questions. If they don’t ask it, don’t tell it. I gave them the facts yesterday, so we’ll reiterate and update. However, you are the medical experts and need to tell them what’s important. Ralph, in particular, should be familiar with the process.”
Danny, Joelle, and Timothy all nodded and went straight in. Robert’s description forewarned them. Where did approximately a dozen reporters come from besides two or three with video recorders?
“Good morning,” Robert said. “I spoke with some of you yesterday. I am Robert Madden, the CEO of the hospital. Also present - to my right - is Dr. Ralph Halbrow with the CDC and Dr. Joelle Lewis with our own Nashville infectious diseases. Dr. Danny Tilson is a Nashville neurosurgeon who primarily does surgeries at our hospital, and Dr. Timothy Paltrow is our neurologist. Dr. Halbrow will give you some opening remarks and then feel free to ask questions.”
Ralph inched behind the podium. “Thank you all for coming. The outbreak in question, ladies and gentlemen, is a combined meningitis and encephalitis. That means the patients involved have both an inflammation of an outside lining of the brain as well as the brain itself. We believe it started or originated in a patient a week ago but it didn’t manifest until a few days later. The hospital’s under infectious disease measures. However, the original antibiotics did not work. Based on the good judgment of Dr. Lewis, we are on a second compliment of antibiotics. We are hopeful they will stop this outbreak, yet skeptical. As you know, we have had one death, Dr. Harold Jackowitz. I cannot release the names of the other four confirmed cases. In addition, there are other patients that we are currently concerned about and evaluating.”