by Barbara Ebel
After donning his white coat and sprinting across the walkways of the main medical campus, he took the elevator up to Joelle’s lab. He donned the hazardous-infectious disease clothing and entered her work area. Besides wearing the same outfit, she had strapped on an eye mask. She was stooped over agar plates, her amber with silver earrings dangling alongside her neckline. “Good morning, Dr. Danny,” she said, scarcely looking his way.
“Good morning as well,” Danny said. “I’m between cases. No better place to get an update on current developments than here.”
“Glad you could join me. See these plates? They’ve been incubated at thirty-seven degrees Centigrade and I check them daily for clearing of the agar.” Her long, latex-gloved finger pointed from one to the next.
Danny looked quizzically at her. “These non-nutrient agar plates have been coated with E. coli,” Joelle said, “and then each of them had a drop of cerebrospinal fluid added from our spinal-tapped meningoencephalitis patients.”
“I wish you could grow our bug out sooner.”
“I hear you. See these other plates?” she asked, pointing, “I’ll microscopically inspect them after several days. Just like your field, I have to take one step at a time. I really enjoy the hunt involved with scientific methods. And how I’d love to get my hands on some Watson and Crick research where I discover a groundbreaking treatment or antibiotic.”
“Half the problem with that is getting money for a project, which I’m sure you run into.”
“We do. Selling a research idea is a problem, too, and I’m not much of a sales person.”’
Danny nodded and got comfortable on the adjacent steel stool. “Have you heard from Tim about Troy Neal’s results?”
“He’s stopping by the hospital lab to get the results and bringing over a CSF sample to me as well. He should be here any minute.” She carefully picked up a tray and slipped it back into the incubator. “So where on earth do you take an ex-spouse on a date?” She goaded him on with a fun smile. “Do you go to a sports game at your kids’ school? Do you take her for pizza, or a movie, or dinner where you hash out divorce talk? Could it even be a romantic dinner somewhere?”
Danny moved a leg up to a foot beam and laughed. “We actually brought up that subject up … where to go, that is. My mom and dad owned an upscale Italian restaurant in Nashville for years. We used to go there regularly. That’s where we’re going.”
“Interesting,” Joelle said. “Sounds more like your turf than hers.”
“I don’t mean it to be. She does like it as much as me.”
“Since you’re divorced, I’m assuming you’re not happy about that. If I may say so, rekindle the romance slowly. Like overseeing my agar plates. Send her flowers or put an arrangement on the table. Men never do that anymore. It’s special and it stands out from the mundane.”
“I can do that. Tomorrow night is the night in question but a little problem has developed. I must go to the gathering given by Dr. Jackowitz’s parents first so our evening may be delayed.”
“Don’t compromise the timing. Why don’t you bring your ex-wife? She’ll understand. Besides, it will reaffirm - in case she’d forgotten or has the wrong impression - that you’re empathetic.”
“That’s the kind of advice my sister gives me. Thanks, Joelle. It’s too sad about Harold, and I understand the grief his poor parents must be feeling.” Danny thought about his oldest daughter, Melissa, who had passed away. There wasn’t a day that he didn’t think about her and he guessed it had to be the same for Sara. How could a woman bear a child, have that incomparable bond, and then lose her or him? He knew parents could also lose a child not through death, but for other reasons. What if the unmatchable relationship is severed and a parent must let a child go because they love them so much? Incomprehensibly sad as well.
From down the hallway, Danny and Joelle could hear the distinct third leg of a cane. Timothy Paltrow turned into the medicinal smell of the lab, his shiny head intermittently looking down. He had a concerned grin as he came in and stopped next to them. “I hope it’s more of a productive morning for the two of you than me,” he said.
Joelle and Danny waited on his next words. Danny gripped the edge of his white-papered sleeve.
“Danny,” he said, “it appears you did a marvelous job draining and caring for Troy Neal’s brain abscess because it is resolved on his MRI. His present infection stems from that bed sore, one health problem following another which is making his health deteriorate. Lungs and kidneys are taking a hit.”
Joelle absentmindedly pulled at an earlobe, hanging on every word while Danny’s mind raced.
“In other words, my update? Mr. Neal’s MRI and spinal tap show no indication of meningoencephalitis.”
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Danny had to get back to the hospital for his next case but, since Tim’s neurology update was so unexpected, Danny and Joelle wanted to fix their eyes on the MRI as well. They all walked over together but slowed their pace for Tim.
“I realize,” Joelle began, “that the most important part of this medical mystery is to find out the organism that’s responsible and the correct antibiotic treatment. But it’s frustrating we haven’t pinned down the first victim, or how it got started. I’ll start some fancy biochemical methods this afternoon and, when I get somewhere, I’ll do direct fluorescent antibody stains.”
They all paused at a pedestrian walkway. A car stopped, so the three of them continued.
“I thought our bulletin board in the conference room really helped sort out names and events,” Danny said. “Maybe Ralph’s visit to Kentucky will shed some light but I sure hope that hospital doesn’t end up with the same crisis.”
Joelle shook her head. “Danny - in the meantime - if you have Peter’s number, let’s get the latest from him. Give him a call.”
Danny rang Peter’s contact number and immediately told him the negative results on Troy Neal. “Joelle and I are going to peek at the MRI with Timothy as we discuss this. How are our patients and what is your opinion about the new course of antibiotics?”
Peter cleared his throat. The sounds of beeping monitors and telephones droned in the background. “James is not responding. The floor nurse, Peggy, deteriorated early this morning, is unconscious, and now on the ventilator.”
Danny shook his head at Joelle and Tim. “And, Danny,” Peter said, “Bill Patogue’s fever is one hundred and two, and he’s only coherent on and off.”
As they forged through the front doors of the hospital, Danny finished the phone call and let out a big sigh. He enlightened Joelle and Tim as they slipped into the radiology department. “I’ll make sure I see Bill today,” Danny added. “He’s the most considerate guy. That just can’t be happening.”
Tim rummaged through the recent radiology bin and finally hung up Mr. Neal’s MRI. “You’re right,” Danny said. “There’s no inflammation and his abscess has vanished. It’s nice to see a normal MRI around here for a change.”
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As Danny worked on his next case, the staff was abuzz about their co-workers who had fallen ill. Danny didn’t mind them discussing the facts as he used the electrocautery on the woman’s back, but rumors had started circulating as well. Someone had incriminated Dotty Jackson, saying she had not properly sterilized equipment and that had resulted in the outbreak in the OR. News coverage had also made everyone’s jobs more sensational in the eyes of their friends and families, yet everyone feared being the next victim.
After the case, Danny went to make rounds on his own patients and other folks he was following as a consultant. He had one back patient to discharge and, since noon had sprung up on him quickly, he felt bad he’d kept the patient waiting to go home. He went and said good-bye to him, wrote the orders, and then prioritized Bill Patogue.
Danny reviewed Bill’s chart first. As the doctor who had been alongside him during the initial evaluations of the meningoencephalitis outbreak, Bill was now a confirmed case. He almost slamm
ed the chart closed as anger rose up in him like an irritated bee and he smacked his right fist into his left palm. In all his years of training and practice, nothing compared to the spread of this disease. He wasn’t a history buff, but he was aware of previous epidemics sweeping the country and Europe, wiping out thousands, if not millions of people.
But these were the days of modern medicine. Something like this was absolutely not supposed to happen. His thoughts tumbled ahead – chances are he was overdue to get whatever was ailing all these patients. If that were the case, he couldn’t wait to see Sara and put their relationship on better terms. She took priority in his personal life. What if he succumbed into a coma like everyone else seemed to be doing? He had to say he was sorry and ask her forgiveness.
He walked to the farthest isolated room down the hallway. The air in the room seemed stale as Danny pulled up a chair alongside Bill, who now looked older than his real age. Danny smiled, grateful that Bill recognized him when he took Danny’s gloved hand in his own.
“This is the first time I haven’t seen you wearing a bow tie,” Danny mused.
With his other hand, Bill gathered copious secretions into a tissue. “They don’t easily clip onto hospital gowns.”
The words came slowly like a snail crossing a street, but Danny felt grateful for the doc’s sense of humor. He traced back the tubing coming from Bill’s forearm to the small bag of antibiotics, the recent drug of choice to fight the unknown killer.
Bill patted Danny’s wrist. “Lucy, Lucy Talbot?”
“She’s in a coma,” Danny said. He glanced towards the closed blinds, afraid to face Bill, knowing what he must be thinking. “Look, Bill, we’ve got a crackerjack team on this. The CDC is involved, samples have been sent to their lab in Atlanta, and bacteriology is in the works here and over at Joelle Lewis’ lab.”
A shiver rattled Bill as a fever-sweat broke out on his forehead. “Danny, if standard antibiotics aren’t going to work and you come up with new possibilities, you have my permission …” He cleared his mouth, continued his train of thought… “to use me as a guinea pig. Danny, I’m too young to kick the bucket, but promise me.”
There’s no way to fool a doctor when it comes to facing medical problems, Danny thought. He shook his head. “Bill, you’re not going anywhere. But I’ll let the whole team know your wishes.”
Danny stepped outside the room and disposed of his isolation outfit in the contamination bucket. He looked at his list. On his secondary notes, a name popped out. He’d seen him recently but followed him peripherally because Peter had taken charge of the fourteen-year old Michael Johnson. He leaned against the wall next to the cart, his knee bent, shoe against the scuffed-up hallway, pondering the young teen who was already as tall as him. He calculated the timing – Michael had been in the ER during the early a.m. hours of the previous Monday because he’d done his surgery that morning. It was now Tuesday, the next week. Michael already had eight days of hospitalization, the first few taken up with his reason for admission.
In front of him, a patient out of bed for ambulation made a U-turn with their IV pole and passed him going the other way. He slowed his pace and thought about Michael’s case; an acute subdural hematoma. But was it? Absolutely, he thought. It was a boating accident and he’d gone down on the console, hitting his head. The surgery had gone perfectly and the evacuation of the hematoma had been confirmed by Danny’s postop MRI. The life-threatening rise of intracranial pressure had been relieved.
His parents … he remembered she had a nice name. It was Stella, Stella and John. She had been perturbed at the boater who’d gone by too fast, causing the wake turbulence that made her son fall. But he hadn’t seen Michael’s parents since one of the first postop visits. They had gone on a ‘two day trip.’ A nurse later told him that an aunt had been filling in for the parents.
Danny straightened his leg, tapped the boy’s name with his pen, and noted the room number next to it. With his long stride and head down, he hastened to the elevator area and took the stairs up one floor. When he opened the next door, he practically tumbled over a medicine cart. He excused himself to the nurse’s aide, straightened his jacket, and hurried towards Michael’s room.
The boy lounged in the recliner between the bed and window, the foot rest up. As Danny passed the television on the wall, he heard a familiar comedy movie, but Michael wasn’t laughing. The teen looked similar to the last visit Danny had paid him, although more drawn and in need of a shower. Someone had at least brought him sweatpants and a black tee-shirt with an iconic brand logo on the front. He only registered that someone had come in when Danny half sat on the windowsill.
“Michael, it’s Dr. Tilson. Mind if I examine you?”
Michael nodded like he didn’t care. “My friend told me I should be out of here by now,” he slurred. “He says I have mono and didn’t need for you to put a hole in my head.”
“Rest assured, Michael, you needed that surgery. Like your friend, however, I’m perplexed about you, too.”
Michael raised his hand from the armrest and took a tissue to wipe his mouth. Juicy, Danny thought, but not as much saliva as he had last time. Danny caught his breath as the impact of what he was thinking hit him. Maybe the last few days they’d been barking up the wrong tree.
“Michael, are your parents back and around? I need to ask them for permission to do a spinal tap on you.”
“No. They’ve been hospitalized … in Kentucky.”
Chapter 12
As he rose from the windowsill, Danny registered dread at what he’d just heard. It felt as if his legs were difficult to move, as if dragging a lead weight.
“Michael, we’ll contact your aunt. I think we need to run some tests on you.”
Michael shrugged like he didn’t care. Danny exited the room and hunted down his chart. His suspicions were aroused – was it Michael who had meningoencephalitis although he’d had a verified acute subdural hematoma? But Danny knew patients could have two things at once, something he’d come across many times and that could steer medical care in a different direction. Or perhaps - and even more likely - Michael had the subdural but the infection hadn’t yet manifested itself. It had been simmering right under Danny’s eyes.
Danny whipped down new orders and told the unit secretary they were stat. He wanted the room isolated immediately because, if his hunch was correct, people were getting exposed by the minute. They contacted Michael’s aunt for procedural approval and Danny set up for the spinal tap. The diagnosis, one way or the other, had to be based on conclusive evidence, not speculation.
The procedure went quickly, especially due to Michael’s age. A geared-up nurse helped the teen stay in a curled position as the precious cerebrospinal fluid dripped into Danny’s vials.
Danny placed all the vials into the tray with enough for Joelle, the hospital, and the CDC. He asked staff to ready Michael for a trip to the MRI machine, delivered some samples to the lab, then hurried across the campus to Joelle’s.
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Joelle got back to her lab after visiting Radiology with Danny and Tim, and continued with her agar plates and methods. At her cluttered desk, she made notes in her leather notebook after peering through the microscope on the counter for some time. She noted the date, time, specimen number, patient, and other details and then leaned back in her rolling chair.
Although Joelle felt exhilarated with the hunt for their demonic organism, she’d been burning extra hours with the chase and needed catch-up sleep. She’d never been one to run on adrenaline for too long; she had found it difficult enough getting through surgery rotations and emergency room electives while in medical school.
Closing her eyes for a moment to the silence of the lab, her thoughts deviated to her mother. If only she were still here. They had been on a course to have an even thicker mother-daughter bond. How proud she would have been with Joelle’s accomplishments and how happy Joelle would have been assisting her mother in her old age. If she could
figure out the cause of the meningoencephalitis outbreak soon, perhaps it would save someone else’s mother and not have a result like her own.
Joelle opened her eyes, yawned and returned to the black counter. She peeked again under the scope. This time, she confirmed it to herself – a clearing, or thin tracks in the agar, the non-nutrient plates having been coated with E. coli. Her pulse picked up as she checked on the direct fluorescent antibody stain nearby. Then her heart galloped like a horse.
She felt as if she’d been working toward this moment essentially all her life as she stared at the histopathology of amebic meningoencephalitis due to Naegleria fowleri, or something close to it.
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When Danny stepped into the lab and Joelle turned his way, she looked luminescent as she had just realized the diagnosis. A wide smile erupted on Danny’s face as he placed down the CSF samples and Joelle energized her forearms.
“Ha,” Joelle said, “who goes first?”
Danny laughed. “Ladies first.”
“I’ve got it, Danny! It’s an amoeba. Naegleria fowleri or a like-imposter. Look at this direct fluorescent antibody stain.”
“Joelle, great work. We had every faith in you. Show me now.”
She pointed at the microscope to show him the green shine, like some small sea-life shimmering in the dark ocean night.
“I can’t tell you how important a find this is,” she said as he looked. “Most of these rare cases are discovered postmortem.”
Danny shuddered at the thought. “You’ll have to refresh that life cycle for me. And, more importantly, where we go from here with all our patients.”
“Yes, but you’ve discovered something as well?” Her earrings sparkled when they caught the overhead light and she held her breath in anticipation.
“I think the first patient is the young teen who had the acute subdural hematoma. His surgery was last week, Monday, same day as Troy Neal. Harold went to see him the next day. The OR staff on duty for his surgery all became infected. So did Peggy, his floor-duty nurse. I’ve brought you CSF samples because I just tapped him.” The words rushed out of Danny like from a water faucet. He moved the nearby stool and sat down as Joelle perched on her own.