by Barbara Ebel
Ralph made eye contact with his audience. “You sharp news reporters get the picture … this is not pretty.” He stopped and nodded at the petite reporter who dodged her hand up in front of her face.
“If I may ask a question, sir, what now is your utmost priority?”
“Keeping more feet out of the grave,” Ralph said.
“Are you suggesting there will be more victims?”
“I wouldn’t want to speculate about deaths, but it’s possible we’ll have more cases before squashing this like a bug.”
Another woman briefly raised her hand, and asked, “Dr. Lewis, so you all don’t know what organism is causing these infections?”
“That’s correct. The bacteria usually incriminated have been eliminated as the culprits. Certain viruses have been eliminated as well. I should have answers soon with other protocol methods we have incubating,” Joelle replied.
A tall man with a small notepad stepped forward. “Dr. Tilson, I take it you did surgery on brains this past week. Is it possible the contaminant spread right from a patient’s exposed brain, like some kind of direct contact?”
“As you know,” Danny responded, “we do all we can to prevent direct contact with exposed surgical areas. So that’s unlikely. Typically, meningitis is spread through respiratory droplets. Many of the bacteria that cause these infections colonize in the nose and throat. Viruses come into play, too.” Danny slowed a moment. The man jotted down a few words. “Viruses are present in mucus, saliva, and feces.” Danny continued. “Unfortunately they can be transmitted through direct contact by an infected person, or an object, or simply a surface. Even insect bites can transmit viral meningitis, but Dr. Lewis believes we’ve eliminated tick-borne diseases.”
Dr. Paltrow nodded at Danny’s remarks and added. “Simply put, when it comes to viruses, they can enter the body through the mouth, travel to the brain and its surrounding tissues, and multiply.”
“What is the most likely age range that this could affect?” asked the first reporter. “And how likely could it affect the general public outside this hospital?”
Ralph stayed behind the podium with one thumb behind a suspender strap. “Speaking for the majority of meningitis cases, it is more likely in little ones under five, but then hops to the sixteen to twenty-five year olds, and then to us older folks over fifty-five.” Ralph leaned to the side for a moment and lowered his voice to her. “You’re in the safe age zone, ma’am.”
“Also,” Joelle said, “certain people are more susceptible if they are chronically ill, such as with an autoimmune disease or a missing spleen. And as far as the general public question, there are no guarantees that this hasn’t affected someone else before it manifested in this hospital just a few days ago.”
Robert Madden’s secretary opened the back door and walked along the side wall up to her boss. They had a quiet discussion while a middle-aged press person from a back row pointed her finger and said, “Dr. Tilson, we understand Dr. Jackowitz was a neurosurgeon in your group. What kind of medical condition was he in before he died and do you have any insight or personal comments as to why he came down with it?”
“Dr. Jackowitz was a valued member of our neurosurgical team. He will be greatly missed. He was admitted to the hospital on Thursday and died on Sunday after lapsing into a coma. We shared some common cases and our group here is beginning to evaluate a new patient of interest.”
A casually dressed man had come closer with a TV camera rolling. Danny figured the film wasn’t going on TV live but would be edited for later programming.
Ralph veered out from his blockade, attempting to conclude the press conference. “Y’all, I hope we can work together like shrimp ‘n grits. I trust you all to be good journalists and not fly off the handle with sensationalism. Your readers deserve professional reporting just like our patients deserve quality health care.”
Robert Madden put his hand over his eyes and shook his head while listening to his secretary. He planted himself behind the podium. “Thank you all for coming. I just received word from our hospitalist that another patient with meningoencephalitis has passed away. We can’t release a name yet as next of kin is being contacted. I will continue to work with all of you in a timely fashion but - for now - good day, everyone.”
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The medical team and Robert Madden waited a few minutes for the reporters to depart. “It’s Dotty Jackson,” Robert said. “The hospitalist didn’t even expect it.” He shook his head as they all walked together to staff elevators to go their separate ways. Robert pushed an upper floor button. “I’m off to a board meeting. I have a lot of explaining to do.”
The doctors got off in the doctor’s lounge. “We have grieving to do over another patient,” Joelle said. “And we have to reiterate what we’re all doing. I’m going straight to the lab. And, Tim, you’re doing a meningoencephalitis work up on Troy Neal, besides working with Dr. Brown on our patient list.”
“I’m heading over with you to the lab,” Ralph said, “But by late today, I’m racing up to Bowling Green like a chicken with his head cut off.”
“Ralph,” Danny remarked. “Keep your head on. As for me, my services are sorely needed in the office. Not only did we cancel my surgeries this morning, but we have Harold’s patients. I’m sure Bruce Garner has our workload figured out by now.”
“I’ve heard about him,” Joelle said. “If I didn’t love infectious disease, he’d be a role model to lure me into neurosurgery.”
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Passing quickly through the front office, Danny acknowledged staff at the desk and went straight to Bruce’s office. “Perfect timing,” Bruce said, looking over the top part of his bifocals. “Grab Matthew. I hear him in the hallway.”
“Matthew, come in to Bruce’s office,” Danny said as Matthew was only two doors down. “Just hold off seeing the next patient.”
When Matthew stepped in, Danny closed the door.
“Take a seat, please,” Bruce said. “What a sad turn of events. Harold had many unspent years still ahead of him; he had skill, and he had success with patient’s back surgeries.” Bruce stood tall behind his desk, his face haggard like a father with bad news about a child. “Danny, you have to fill us in on the weekend and the current situation.”
Danny ran through the details, including the morning’s activities. “And above all,” Danny concluded, “keep strict adherence to infectious disease protocol over there.”
Bruce sunk into a chair and hung on every word. “Did the CDC doc give any information about the cases he’s going to see in Kentucky?”
“No, I don’t think he was provided with much information.”
“Regarding Harold,” Bruce said, “I spoke to his parents this morning and they’re having a little service at their house late Wednesday. Apparently they weren’t close. Regardless, try to get by if you can.” Bruce slipped a piece of paper with the information across the desk. “As far as our practice, I’ve got it in the pipeline we’re looking for another doc. Today, we’ll all do office hours until six. Most of Harold’s patients we’ll absorb in the next week or two. Office staff has been calling and rescheduling. A few don’t want to wait and will go elsewhere.”
“By the way,” Danny asked, “did you both have a good weekend?”
“Better than yours,” Bruce said.
Matthew gazed out the window. “Couldn’t have been better but I regret not helping you out, Danny.”
Danny scurried out, leaving his cell phone and Harold’s parents’ information on his desk, while Cheryl tailed him.
“It’s terrible about Dr. Jackowitz,” she said. “I just can’t believe it.”
“I know,” Danny said. “There are some other folks sick, too, and a nurse just passed away.” He turned to face her, taking a chart from her hands. “First patient, Wanda Robinson. Is her MRI result back?”
“Up on the computer,” Cheryl said. She darted off while Danny woke his computer and scrolled though the im
ages and then went into the first patient room.
“Hello, Mrs. Robinson,” he said.
“Look who I brought,” she said, her baby in her arms. “I had to bring her because, after your appointment, I have to take her upstairs to the pediatrician’s office for a wellness check. I have an excellent baby doctor for Carol.”
“That’s wonderful.” Danny admired the infant and noted that Wanda looked less drained than the preceding week. “I have good news for you. Your MRI shows no growth abnormalities with your pituitary gland. From a neurosurgeon’s perspective, you’re in the clear.”
“Oh, Doctor Tilson, that’s great. It’s about time I received good news.”
“And it’s about time I gave some. I will send a report to your endocrinologist. I take it she is giving you appropriate replacement therapy?”
“Yes, she is. And I’m feeling a bit better. My Sheehan’s syndrome is going to be a thing of the past.” She broke into a smile. Danny thought there’s nothing like the happiness of a new mother, even if she’s sick.
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The small hand on the clock over the front office desk pointed past 6 p.m. The last patient had left and Bruce stood at the counter. An evening news channel covered the day’s events in the waiting room as the staff began filing the last charts and packing up for the day. Cheryl stopped next to Bruce as the anchorman switched stories to Nashville’s biggest story.
“You’re on,” Bruce said towards the back of the hallway as Danny and Matthew walked single-file towards him. The four of them went into the waiting room as the rest of the staff also watched.
“There have been major developments at Nashville’s University Hospital the last two days of a neurological illness which claimed the life yesterday of a local neurosurgeon named Harold Jackowitz. Today an operating room nurse, Dotty Jackson, also died from the same disease. We take you now to a conference held earlier at the hospital with CEO Robert Madden, Dr. Ralph Halbrow from the Center for Disease Control, and other local specialists.”
Coverage then skipped to the morning’s press coverage which was scarcely shortened. Underneath Robert’s and the physicians’ comments, their names and titles streamed across the screen like live S&P numbers.
Bruce unfolded his arms and shut off the television when the entire story ended. “Nice job, Danny. However, I hope it’s not perceived by the public as a cause and effect between a doctor or a patient of The Middle Tennessee Neurosurgical Group and the outbreak of this meningoencephalitis.”
Chapter 11
Rachel got up before Leo and padded to the bathroom. It was Tuesday morning and she had finally confronted her denial the night before. Although she didn’t have firsthand knowledge about child abuse, she believed her daughter’s strange marks and behavior came from Leo’s hands. Two different times after he had taken care of Julia in her in absence, he told Rachel he had accidentally spilled a hot liquid, scalding the poor baby’s tender skin.
She admired her complexion in the mirror, washed her face, and applied moisturizer. She slipped on jogging pants and a top. When she came out, Leo was getting up, scratching his bare chest. He turned his head. “What’s your rush this morning?”
“I thought I’d make you real coffee on your way out instead of that instant stuff. And I’m going to take care of Julia, put her in the carriage, and get some fresh air.”
Slowly he made his way past her. “Too bad, we could have had a roll since you were up this early.” He eyed her, almost suspiciously, and put his hand into her hair and rubbed her scalp. It was one of the things he did to her that took her mind straight to the moment, dismissing any negative feelings she had developed for him. He let go after a long minute, gave her a once-over and said, “You look good enough to eat. Don’t get kidnapped on that walk.”
Rachel left the room as Leo disappeared into the bathroom. She put on a large pot of coffee and, as the water dripped, she realized how charming he could be when he wanted. An operator, that’s what he was; an operator whose craft of schmoozing her was finely tuned. But the time neared for her to no longer put up with his cyclical behavior and to put an end to whatever he was doing to her daughter.
Rachel went into Julia’s room to dress her. She only had three more days before handing her over to Danny on Friday night so she needed to monitor her like a hawk. She couldn’t take any chances that new signs of physical abuse appeared, making Danny skeptical about Julia’s care.
Rachel had thought about it at length the night before, the hours after dinner dragging on like they would never end even when Leo had been grinding her hard. She had tried to fend off his advances by hinting she wasn’t in the mood, but that seemed to egg him on more. As she stared at the ceiling and then into her pillow cover, her daughter’s strange skin patches and recent frightened expressions plagued her.
That’s when it had really hit her, the scary part. Barring her paternity case attorney, Phil Beckett, she’d never directly been involved with the legal system before. She’d done lots of shady things but never serious enough that someone pointed her out to the police, though she remembered Casey Hamilton threatening her with that before Julia was born.
Rachel slid out her daughter’s diaper, put on a bit of salve and powder, and carefully put on a new pink sun dress. She picked her up, patted her back all the way into the kitchen, and sat her in the high chair. Leo still hadn’t appeared. She put Julia’s bottle on the tray and eased small spoonfuls of applesauce into her mouth.
She went back to her thoughts as Julia finished her food then took to her bottle. What if, just what if, someone babysitting Julia put two and two together and suspected some kind of child abuse? Since she was suspicious herself, it seemed highly likely. Her heart thumped in her chest. Anyone would point a finger at her. Weren’t child abuse laws really stiff? Or was it like the rest of the criminal justice system where a person with a good lawyer could practically get away with murder and be walking on the streets?
Rachel looked toward the bedroom and decided to beat Leo out the door. She poked her head in as he sat on the bed tying a shoe. “I’ll see you later tonight. I’m going for a walk with Julia.”
After lacing tightly, Leo rose and glanced at his watch. “That’s a long way off, babe. How about a romantic dinner tonight?”
“They’re all romantic.” She flashed a smile. “Maybe. You wore me out last night. How about a dinner-only night and you’ve got a date?”
“You can’t put restrictions on spur of the moment romance.” Leo silently laughed at her naivety. Nothing that drugs can’t handle, he thought. But he’d play her game. He was probably overdue for some internet porn anyway. “I’ll wine and dine you at Maxine’s and maybe work out downstairs afterwards. Have a good walk and fend off any admirers.”
Underneath the mounted buck’s head at the front door, Rachel put a matching pink bonnet on Julia and put her in the stroller. A little fresh air may help clarify her thoughts. The carriage bumped down the front steps and neared the street. Rachel gazed above and all around at the trees lining the residential properties. The sun sat low, not a cloud lingered above, and a mild breeze made it perfect to be outdoors.
She focused again on the path and figured abuse inflicted on minors or babies must run the gamut, just like the penalties. On the one end, perhaps the legal system imposed fines. In some instances, maybe it was considered a misdemeanor. But things could go far beyond that. What if it became some kind of record and affected a person’s ability for employment? Her pulse quickened and she perspired easily. What if Julia’s symptoms warranted a felony or even incarceration for the abuser? Now she really sweated.
Rachel didn’t like her conclusion; living with Leo was dicey in a thrilling way, but it had turned too perilous. The risks now soared over the benefits. Her relationship with Leo - her cushy lifestyle with him - had to come to a screeching halt.
She made a right turn at the end of the lengthy block. Rather than waiting for a car to pass, by turning, she kept
the momentum going. Good for her streaming thoughts. Perhaps she could turn Julia over to Danny Friday night and be ready to move out. She believed she could swing it… go to work on Saturday and then not return to Leo’s place. But there must be more. He was inconveniencing her, not to mention that he had put her daughter in harm’s way. Payback is a bitch. And she’d figure it out.
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Tuesday morning in the OR, Danny stood over an exposed brain. He stepped back and forth to the images on the X-ray view box. Two cancer metastases stemming from the patient’s lungs had to be removed. He grimaced, knowing the palliative surgery would just buy the long-term smoker a few months, at best. When he finished and left the room, the anesthesiologist was in full control.
Turnover time between cases would take a bit, so Danny hustled to see his next patient in the preop holding area, and then wanted to run over to Joelle’s lab to discuss her progress. He spotted his next patient, a middle-aged, early graying woman on a stretcher and introduced himself. “I’m Dr. Tilson. I’m glad you’re letting our group do your back surgery though I’m sure you would have preferred Dr. Jackowitz.”
“That was a shocker about him but I did hear all of you are good physicians.” She fumbled with the IV tubing and sat up taller. “I just want to get this over with. Get some relief from this shooting pain down my leg. I’ve gotten a wee bit shorter so, when the bones and discs get squished enough, there’s no longer enough room for the nerves.”
Danny couldn’t hold in a low, rolling chuckle. “I’ve never heard it put quite that way.” He patted her on the shoulder. “I’ll take good care of you. We’ll probably get started in an hour.”