by Barbara Ebel
Danny had Joelle’s full attention. They faced each other, knee to knee. “You mentioned him before,” Joelle said, “and we eliminated him due to his proven subdural, surgery, and confirmation. His accident happened on the boat, but did the family give you any more history?”
Danny didn’t remember Michael saying that much and his parents had taken turns. Joelle interrupted his thoughts. “Do you know if he went swimming?”
“That’s it. The mother, I think, was annoyed because he’d been doing something she wasn’t fond of. His brother and friend were with him, perhaps he was showing off. The motor was turned off, the kids were swimming, and Michael kept climbing up an island cliff and jumping into the water. The mother said it was at least a twenty-foot drop. Then they climbed back on board, the speeder came by, and Michael took a tumble.”
Joelle placed her hands together in a prayer-like fashion and touched her nose and mouth for a moment. “You’ve got it, Danny. I wish if he had done that, he’d worn nose plugs but what kid is going to? Plunging into the lake like that, from that distance, pushed the fresh water up his nostrils. This amoeba travels from the nose to the brain. It weasels its way into the central nervous system through olfactory mucosa, right through the cribriform plate of the nasal tissues.”
Joelle saddened with the horror of it. “Danny, the olfactory bulbs necrose with this monster as it scurries along nerve fibers straight up into the brain where it literally consumes brain cells. With its unique morphology, it attaches to them and sucks out their contents.”
Danny now recalled it, but had never seen a case nor personally heard of one. He fidgeted on the stool, the beginning life cycle difficult to imagine.
“Danny,” Joelle continued, “acquiring this amoeba almost always results in death.”
Joelle hated to go on with the stunning statistic. “Survival of patients is less than one percent. But I’m not finished.” She swallowed hard. “That’s the basics, although I haven’t told you the three stages of its life cycle. We have a modified version of what has been previously reported. Maybe a mutation of some sort. It has evidently also affected salivary glands, making them over-productive and probably creating another means of contamination. The change has made it even more worrisome.”
“Why?” Danny asked.
“There’s no real success with the suggested antibiotic regimen used for this organism. Yet we have to put our patients on right away anyway. But now with this alteration, we don’t stand a prayer’s chance in hell.”
Danny slumped. “So these hijackers are going to eat human brains … one cell at a time.”
----------
Finally breaking away from the lab, Danny suggested they grab a late lunch; they walked to Coffee ‘N More and bought chicken croissant sandwiches and drinks. Slipping into a corner booth, Danny began eating immediately. He was overly-hungry which made the soft, fresh sandwich taste even better.
Between bites, Danny told Joelle the last part of Michael’s story. “There’s another thing,” he said. “It sounded like Michael’s parents were infected, too. They may be in a hospital in Kentucky. Perhaps it’s who Ralph went to see. I’ll call him when I’m done.”
“That’ll be in another thirty seconds based on how you’re wolfing down your lunch.”
Danny grinned. “I should’ve eaten hours ago, but duty called.”
“If you’re correct, that’s additional - and terrible - news about his parents,” Joelle said, washing down half her sandwich with iced tea.
Danny ate a few chips and then scrolled for Ralph’s number. He answered in a few seconds with a reserved “hello.”
“I was going to call one of you in a little while,” Ralph said. “It’s been busy here and our outbreak has indeed spread.”
“It’s Michael Johnson’s parents, isn’t it?” Danny asked.
After a surprised pause, Ralph responded. “How did you know?”
“Joelle and I figured out the initial source: Michael Johnson. He’s the fourteen-year old who had an acute subdural hematoma but also kept jumping off a high cliff into lake water prior to the accident. Joelle has determined the deadly organism to be Naegleria fowleri. However, it has turned into a super-killer based her interpretation that this amoeba has mutated.”
“Hello, Danny,” Ralph said. “I leave you two alone and you work together like biscuits ‘n gravy.”
Even under the sad commentary of information, Danny had to laugh while shaking his head at Joelle.
“But they aren’t the only ones,” Ralph said. “There’s another patient up here and two more in hospitals in Tennessee and Georgia. By phone I’ve traced the patients to having visited family or friends at your all’s facility. I plan on leaving here soon after some correlating. You need to have the CEO call another press conference and I’ll be back as soon as possible.”
“I’ll schedule for early tomorrow morning,” Danny said. “In the meantime, Joelle and I will change the present treatment and start what she thinks are the best drugs.”
“Does she think it’s Chlorpromazine?”
After Joelle concurred, Ralph added, “I’ll relay this information to the other hospital physicians. Say a southern prayer we contain this demon.”
----------
Wednesday morning before 8 a.m. every doctor involved, plus Robert Madden, showed up again in the hospital’s conference room on the top floor. No one skipped the continental breakfast. Danny told Timothy to go ahead and sit, then brought him coffee and a plate of fruit and hard-boiled eggs. He went back for his own, took a napkin and glanced at the reddened and scabbed flesh on his left palm.
“What did you do to your hand?” Joelle asked as she lined up behind him. “You didn’t do that in surgery, did you?”
Danny smiled at her. “No, I’m a more careful neurosurgeon than I am with yard work. I almost sawed off my hand. That would have put me out of commission for good.”
Joelle shook her head. “Guys and their toys. You’re lucky. I hope your hands are insured!”
“That’s the problem being in a surgical specialty. Your livelihood is a lot more vulnerable than being in primary care.”
“I suppose my specialty is pretty safe, except for being more susceptible to deadly viruses.”
“You would have been fascinated with this one. Within the last twelve months, I operated on a patient’s brain that had a hydatid cyst. Echinococcus granulosas from a dog’s tapeworm.”
Joelle’s eyes grew wide as she stood there with an empty plate. “No way. I’d expect something like that from South America, but Nashville?”
“South of the border is where he picked it up.”
“You must have stopped breathing to remove it. That cyst could have ruptured, releasing thousands of parasitic particles into his brain.”
“I didn’t breathe and I didn’t blink.”
“Jeez, Danny. Remind me to go under your OR knife but not use your landscaping services.”
Robert Madden said a quick “good morning y’all” to everyone and Danny quickly took his choice of a bagel and a large black coffee.
“As you all know,” Robert said, “we’ve made huge progress in the last twenty-four hours in getting to the bottom of this outbreak. However, that was another entire day this organism has continued to spread. Ralph from the CDC is back from his quick jaunt to Bowling Green and our press conference is in thirty minutes downstairs. This is to correlate our information and make sure we’re all on the same page. I think Joelle would like to say a quick word or two first.”
Joelle placed her coffee cup farther away and stood up. “Dr. Tilson confirmed yesterday by MRI that the young man, Michael Johnson, was the original source of this outbreak and as some of you know, we’ve discovered the organism causing this meningoencephalitis. We might as well refer to it as PAM which stands for primary amoebic meningoencepahlitis. The amoeba is Naegleria fowleri or a similar derivative.”
“Joelle,” Peter said, “yesterday Dr. Tilson expl
ained to me how this organism invades a human brain. But, being a hospitalist, I don’t really know about its life cycle. Can you enlighten me?”
“Would love to,” Joelle said. She put her hand forward and gestured with three fingers. “It exists in these forms: a cyst, trophozoite, and flagellate stage. Cysts exist in the most unfavorable conditions such as extreme cold. The flagellate form is simply a trophozoite which gets transformed quickly due to changes in its ionic environment. Like sticking it in distilled water, a different ionic concentration.”
Danny noted Joelle had only sipped her coffee, but her description took on speed.
“It’s the trophozoite which is the reproductive form, proliferating by binary fission. Their pseudophila allow them to travel and change directions, feeding on bacteria in nature … but eating or phagocytizing red and white blood cells in humans and destroying tissue.”
Joelle’s voice grew grim as she looked at each individual in the room. Timothy’s hand trembled on his cane and Danny grimaced visualizing the capabilities of the amoeba. “The shocking thing for humans is they eat our brains piecemeal by a unique adaptation extending straight out from its cell like a sucking apparatus.”
Peter had put his fork down. “Aren’t I glad I asked?”
----------
After more discussion and certainty that all the involved patients were quarantined and under proper infectious disease protocols, they swiftly left for the press conference on the first floor. What awaited them had no resemblance to the last reporters’ gathering.
Robert Madden led the group. While Danny, Joelle, Ralph, Timothy, Pamela, and Peter pushed past the hordes of press and camera crews which flowed into the back of the auditorium, flashes went off and cameras started rolling. Robert already had a question hurled his way, but put his hand up signaling the crowd to wait until they formally got started. He turned in front of the crowd. Sharply outfitted in a suit and tie, he made a distinguished figure.
“Ladies and gentlemen, we have major developments in this outbreak. I am immediately introducing Ralph Halbrow with the CDC.”
Ralph went to the podium past Robert. His hectic trip to Nashville and Kentucky – along with the pressure - had caused puffiness under his eyes. “Before taking questions, we have discovered the organism wreaking havoc in not only this hospital but now in three states. We have also discovered where this organism came from.” Ralph went on to give explicit details and then introduced the other doctors and their specialties before opening up the floor for discussion.
A reporter nudged forward as soon as Ralph stopped. “Why are you finding new cases when the hospital insists that precautions are being taken to stop its spread?”
“People have obviously been around these patients before their diagnosis was made and they were put on infectious disease protocol. And we aren’t sure exactly the point in time when a person becomes infectious to others. But we have our suspicions.” Ralph took one thumb and stuck it under his burgundy suspender as he gave it another thought. “Also, you must realize the hospital has intermittently been on diversion, causing cases that would have been admitted here to land somewhere else. And, in the case of Michael Johnson - the first case - his parents unknowingly came down with it while they were away on a trip.”
A man with a CNN camera-person beside him spoke next. “So this can become an epidemic? And are you saying there is no treatment to eliminate this amoeba?”
“Sir, this is an epidemic.” Cameras clicked in a mad rush and some reporters let out a gasp. “We do have a suggested treatment,” Ralph added, “but it doesn’t seem to work. The CDC and infectious disease here are going to immediately look into finding the cure.”
“Why do you think treatment doesn’t work?” the same reporter asked.
“Naegleria fowleri may have had a slight mutation. Our outbreak involves the patients having a timely and heavy production of saliva. The organism is having an impact on the salivary glands, which are close to the nasal anatomy involved.”
Ralph signaled to a reporter in the back who had his hand raised the whole time. “Mr. Halbrow, we understand you were in Bowling Green yesterday. Who pinned down these results?”
“Dr. Joelle Lewis and Dr. Danny Tilson.”
“Couldn’t the CDC have come up with this information sooner?”
“The CDC in Georgia has had the necessary samples as well. These specialists right here in your home town are close to the history, allowing them to piece together the puzzle sooner. I assure you, Dr. Tilson and Dr. Lewis are two of the sharpest knives in the drawer.”
Chapter 13
It had been ages since Sara taught first-year high school biology. She’d quit working when the girls were small and Danny toiled in training. After the divorce settled and she re-evaluated her life, Sara had decided to get credentialed again and apply for a job. In only a few years, Annabel and Nancy could possibly be leaving for college. So she felt she’d made the right decision to go back to her own career and not suffer the pangs of an empty nest.
She sent in three applications to regional high schools and lucked out with the best possible result; the school where Melissa had gone, and Annabel and Nancy attended, asked for an interview. In addition, that was where Sara had previously worked. Within two weeks, the principal called offering her a freshman teaching spot.
Sara brushed up on high school biology, as well as state mandates on curriculums and preparations for the first day of school. She recognized her other good fortune as well. Annabel was entering her senior year and Nancy her sophomore year, so she wouldn’t have a potential conflict of interest with one of them in her class. They could also travel back and forth to school together when possible.
She figured it all added up as, lately, life without Danny was a win-win situation. Joining the work force again, keeping in good shape, and having two remarkably good teenagers boosted her self-confidence that had taken a hit during the last months of her marriage. Looking in the mirror, Sara liked what she saw. Only two years younger than Danny, she wore forty-four years well. Her peppered true blonde hair stopped midway along her cheeks and her skin drank moisturizer with sun protection first thing in the morning, giving her complexion a boost.
As she applied a rosy-colored gloss to her lips in the bathroom, the sunshine danced along the sink top, broken by the fluttering leaves outside. She slid a belt through light gray capris and, after some deliberation, opened the top button of her sporty white blouse. School would start next Monday and Sara was headed in this Wednesday morning to sign a document needed for health care insurance and to put the finishing touches on her classroom. She stopped in the kitchen and gathered her things.
“Where ‘ya going, Mom?” Annabel asked.
“To our school to do last minute work before the big day. I hope you two are ready; I haven’t been quizzing you on that subject.”
“That’s because we’re not kids anymore,” Annabel said.
Nancy turned around from buttering toast. “I’m not a child, but that doesn’t apply to you.”
Annabel gave her a piercing stare without her mother’s knowledge. “Bye, Mom, we’ll see you later.”
“You girls are on your own for dinner. I’m meeting your father.”
Annabel kept a smile from creeping over her braces. “How come?”
“Just to discuss things.” Both girls stood shoulder to shoulder staring at her. “And simply to eat dinner,” she added.
“Where?” Annabel asked.
“Downtown Italy.”
“Sounds interesting,” Annabel said.
“Interesting enough for you to bring us home some Italian pastries,” Nancy added.
----------
Fond memories stirred as Sara as she walked under the front entrance canopy of the two-story brick building and made her way inside. She’d had enough big changes in her life the last two years, so she counted her blessings that she would again work in familiar surroundings. She made a right turn into the fron
t office. “Good morning, Mary Ann,” she said to the first woman at a desk. “Who should I see about my health insurance form?”
Mary Ann fumbled through papers in front of her. “You know, Mrs. Tilson, I think Mr. Robinson has it.” She checked the light on his phone extension. “He’s free so you can go back there now.”
Sara rapped on the principal’s door and saw him wave through the open-blinded window to come in. Ross Robinson stood, walked around his desk, and extended his hand. “A formal on-board greeting to our new teacher,” he said, giving her a warm handshake. Her impression after meeting him the first time had stuck; he seemed the rugged, outdoorsy type. One whose office only substituted for a campground.
Ross pointed to the leather chair in front of his desk. As they both took their seats, Sara noticed the pictures on the back wall of an American eagle and a black bear, prints similar to National Geographic pictures. He massaged his sparse beard and mustache, narrowing his eyes to take a better look at her.
“Thank you, Mr. Robinson. I’m on the way to my classroom and Mary Ann said you have my insurance form for signature.” Suddenly she realized it strange that he had that paperwork and she could swear she blushed. He was good-looking and seemed pleasant enough. His pitch-black hair twisted in curls like rope and he had pencil thin eyebrows. He wasn’t skinny, but wiry, like a thin yoga master.
“Ahh, yes, it’s here somewhere.” His eyes darted downward but he leaned back in his chair. “I don’t know if I mentioned it. I’ve been the principal here for five years so I contacted the former principal, Mr. Baldwin, for a recommendation and he had only good things to say about you.”
Sara replied, “His tenure was much appreciated by everyone here. How is he doing?”
“Bored from retirement and wishes he hadn’t left. I guess you missed being away, too.”