“How many consults have you been getting a day?” Susan asked.
Ezra shrugged. “I don’t know, usually three to four a day, but lately it’s been really slow. We’re lucky to get two. And if I know surgeons, it’s not because they’re washing their hands better. It’s because of those idiot-proof antibiotics. Any bozo can treat an infection with one of the big guns.”
Susan frowned. “Are they using the broad-spectrum antibiotics that much?”
“Shit, yeah,” Ezra said, shrugging out of his white coat. It was already starting to warm up in the office. He moved to the window air-conditioner, turned the knob, and when the unit didn’t immediately stir to life, pounded it with an open fist. The machine coughed once and then sputtered, kicking out cold air with a puff of dust. “They’re all using Zosyn, vanco. Take your pick. They don’t know what they’re treating, so they use the biggest antibiotics we have, and of course, that’s going to treat their infection, because those drugs kill everything.”
Susan was outraged. “But that’s asking for antibiotic resistance.”
“Why should they care about that? They’ll be out of here, going into private practice, long before drug-resistance rears its ugly head at good old LA County.” Ezra sat down in his reclining office chair and stretched his arms behind his head, revealing two sweat-dampened armpits. “And we’ll be the poor sods dealing with the consequences.”
“What do you mean ‘we’?”
Ezra gave her a shocked look. “What? Are you flying the coop, too? What happened to all the dedicated residents who used to stay at this esteemed institution after residency to continue to serve the noble poor?”
Susan felt a flicker of guilt. “Are you staying?”
“Who me?” Ezra looked at her in surprise. “Hell no. I’m going to Cedars.”
Susan looked at him, confused. Cedars-Sinai Hospital, the fancy private hospital on the west side of Los Angeles, was where the rich and the famous went for medical care. It was the polar opposite of public, downtrodden LA County Hospital.
“But I thought you said—"
“Just a figure of speech, my dear. You never know when you’re dealing with one of those idealistic-got-to-serve-the-poor residents.”
“So you’re not staying, then,” Susan said.
“Of course not,” said Ezra, rising from his chair and heading to a small refrigerator in the corner of the room. “I’d never stay here.”
“Why?”
Ezra looked in the fridge, pulled out a Milky Way, and opened it. “Weren’t you listening? Too much drug-resistance.” He stuffed an end of the candy bar in his mouth, adding, “Besides, I’m tired of being broke.”
Chuck Vangsness, the ER doc, popped the first pill of a Z-Pack. Like many physicians, he knew the dangers of wantonly prescribing antibiotics for what was likely a viral illness, but when his own health was at risk, he felt little compunction about starting himself on therapy. He figured there was always the chance that what he had now wasn’t just a cold or a late season flu. It could be a brewing pneumonia. Whatever the case, he had to work tonight, one of his rare night shifts, and the way he was feeling this morning—well, hell, it could be a pneumonia. He coughed miserably.
He lay in the king-sized bed that he and Andrea shared, propped up by four goose down pillows and buried within the $500 down comforter that Andrea insisted they buy. It was a luxurious bed, with Egyptian cotton bedding. Matching curtains hung across the windows, muting the brilliant Reno sunlight.
The TV was on, but mid-day, there was nothing on that Vangsness wanted to watch, so he left it tuned to CNN and pushed the mute button.
Andrea walked in, a mug in her hand. “Here, darling. I thought you might like some tea.” She passed the steaming cup to him and plopped herself on the bed. “I don’t know if you should work tonight.”
He pressed a tissue to his mouth, coughed, and shook his head. “Got to work. I can’t bail out on the one night shift I have a month. That’d screw one of the other docs.”
“What about all those poor patients? You going to cough on all of them?”
He smiled. “I just took a Zithromax,” he said.
“Ah ha,” said Andrea. “The doctor has started himself on antibiotics. You must be feeling awful.” She bent over and kissed his forehead.
For a moment, Vangsness felt overwhelming love for his wife. “Not good.”
She pulled the comforter closer around his body and adjusted the pillows behind his head, the scent of her perfume lingering. “Well, why don’t you get some rest? I’ll check back with you in a few hours. I promised I’d meet Tricia down at the club for lunch.”
“No shopping today?” asked Vangsness. Tricia, also a doctor’s wife, was one of Andrea’s favorite shopping partners.
Andrea smiled sheepishly. “Well, maybe a little.”
Vangsness smiled wanly. Any other time, his wife’s insatiable desire to shop would annoy him, but today he felt so sick, he didn’t give a damn. He watched her retreating figure and thought, one more reason I have to go to work tonight.
Sierra Tahoe Hospital, a modest patient care center on one of the side streets of Truckee, California, looked fairly good from the outside, but was in desperate need of an upgrade on the inside. The small-town hospital served the resorts of Lake Tahoe, as well as the thousands of residents who lived in the Truckee area year round. As a consequence, the emergency room was modernized first, with a brand new wing designed to accommodate the steady stream of injured skiers and hikers. The rest of the hospital, including the inpatient rooms and the intensive care unit, had been haphazardly upgraded since the hospital was first built in 1949.
George Mack didn’t much care about any of this. He strode through the front entrance of the hospital and barreled by the admitting area without glancing at his surroundings. He knew where he was going. As a public health officer in Reno, he had visited the hospital often as part of his investigations, and had come to know some of the staff, including many of the physicians, who also worked part-time in Reno.
He made his way for the nursing station at the medical-surgical ward. George Sparks followed.
“You have a Jason Tippett here?” Mack asked the charge nurse.
The nurse looked at him in surprise. “Family member?”
“No,” growled Mack. “Department of Public Health. You got a Jason Tippett here?”
She shrugged with the practiced equanimity of a nurse used to working with irritable physicians and family members. “Room Twelve. Doctor Taylor is in with him now.”
Mack shot a pointed look at Sparks. “Room Twelve, eh? How much you want to bet that’s not an isolation room?” But before Sparks could respond, Mack was moving down the hallway, his heavy boots squeaking against the tile floor.
Room 12 was not an isolation room, but at least the door was shut. Mack peered into the small window above the doorknob. A short man in a white coat leaned over Tippett to listen to his chest.
“Why don’t we wait out here until Doc is done?” suggested Sparks.
Mack turned and grinned at Sparks, his hand feeling for the pack of cigarettes in his shirt pocket. “What? You think the boy’s got plague?”
“No, I didn’t say that,” Sparks said uncomfortably.
Mack pulled out the pack and tapped a cigarette out. “Well, you should have. That’d be the smartest thing you said in years, Bob. I sure as hell am not going into that room without a mask.” He put the cigarette to his mouth and felt in his pocket for a lighter.
“You can’t smoke in here, George,” Sparks said mildly.
Mack looked around, shook his head. “Well, if that ain’t the dumbest thing. You know half of what they do in here is more deadly than this cigarette.” He placed the cigarette back in the packet, replaced it in his shirt pocket, and said with real irritation, “Son of a bitch.”
Doctor Taylor emerged from the room. “George,” he said, his face lighting up. “What brings you down our way? Contaminated water? Ne
w outbreak of measles?”
Mack grinned. Lionel Taylor was one of the old-time Reno internists, who worked a few days a week in Truckee, where he lived in a palatial place overlooking Donner Lake.
“No, plague. Like your boy Tippett probably has.” Mack was still smiling, a diabolical and full-mouthed grin.
Taylor paled. “Jesus, George. That’s no joke. What makes you say that?”
“We got a documented case in Reno a few days ago. A boy who stayed at the Evergreen Club Lodge. And get this.” He leaned toward the elderly internist, “It’s drug-resistant.”
“Jesus,” said Taylor again.
Mack straightened up, his face innocent. “Well, what’s your boy got?”
Taylor looked uncomfortable. “Well, I don’t know, now. We’re treating it as a bad flu. But my god, if what you’re saying is true, maybe we should put him in isolation. At least until we’re sure.”
“That’s an idea.”
“Christ,” said Taylor. “Drug-resistant plague.”
“Did you by chance check his groin or armpits for buboes?”
“They’d have done that in the ER. I got no report of buboes.”
“But did you look?”
Taylor’s tone was pained. “Of course not, George. We thought this was flu.”
“Well, let’s have a quick look. You never know what you might find.”
They grabbed N95 respirator masks from the supply room and went into the room. Tippett, a long-haired man in his early thirties, lay listlessly in bed, his face pale and exhausted. “What’s with the masks, Doc?” he asked weakly.
“Just a precaution, Jason,” Taylor said, his voice once again the calm, confident voice of a lifelong physician. “We need to check your lymph nodes in your groin and armpits. They sometimes get swollen when you’re sick.”
Mack handed Taylor a pair of gloves. “Just a precaution, Doc,” he said helpfully.
“Of course,” Taylor said quickly, pulling on the gloves and drawing back the sheets that covered Tippett.
Tippett’s hospital gown had slipped up his legs, leaving his groin exposed. There was no need to examine him any further. A bubo, swollen and shaped like a walnut, protruded from his groin crease.
The shaking chills started a few hours after Andrea left. Chuck Vangsness woke from a restless sleep, desperately cold and shaking uncontrollably. Geez, he thought. I must have a helluva fever. He put a hand to his forehead and was stunned to find himself burning up.
He felt a deep and powerful exhaustion, unlike any he had known in his life, and he wondered fleetingly if this really was pneumonia. Every muscle in his body ached. His head throbbed, and, incredibly, instead of feeling better with the Zithromax, he felt worse. He coughed, and the weakness of it worried him.
Maybe he needed IV antibiotics. The Zithromax was oral. It would take longer to absorb, and the way he was feeling—geez, people still died from pneumonia.
He reached for the bedside phone and groaned, the effort unleashing a paroxysm of wet coughing. Vangsness fell back against the pillows, his breathing shallow and labored.
Those poor sods, he thought miserably, remembering all the sick patients he had treated in his life. I never had any idea how they really felt.
He put the phone in front of his face and forced himself to focus on the numbers. His hands seemed to be under someone else’s control. He tried to dial, but his fingers kept missing the numbers. Finally, he called Andrea’s cell phone.
A mechanical version of Andrea’s voice answered with a cheerful recorded greeting. Hi, you’ve reached Andrea Vangsness. I can’t take your call right now, but if you leave a message, I promise I’ll call you back as fast as I possibly can. Bye-bye!
Vangsness dropped the phone, defeated. A little shopping, she had said. Wouldn’t want to leave the phone on to interrupt, would she? He cursed the phone, cursed Andrea, cursed the world. His head throbbed as though someone were tightening a steel band around it, and he closed his eyes, willing it to pass.
She’d be home soon. Andrea wouldn’t be gone long. She said lunch and a little shopping. It had been nearly three hours, now. How long could lunch and a little shopping possibly take?
He reached for the bottle of ibuprofen that Andrea had left on the bedside table. He popped four tablets and swallowed them down with the tea Andrea had left him. The tea was cold and disgusting, but Vangsness didn’t care. He wished for deliverance. He wished for relief.
He wished Andrea would come home.
The medical student did show up, although he was fifteen minutes late. He ran through the door of the Infectious Disease Department at LA County Hospital as though he was running the last leg of the 4 x 400 meters relay in the Olympics, his short white coat flapping behind him, his breath bursting from his open mouth, his torso leaning forward as if to cross the finish line.
Susan stared at him in wonder.
“Jesus, Andy,” said Ezra.
“I’m sorry,” gasped the young man, who was now bent over, his hands on his knees, desperately trying to catch his breath. “The elevators aren’t working. I had to take the stairs.”
Susan’s eyebrows rose. The Infectious Disease department was on the twelfth floor, which meant the pudgy med student had just pushed his deconditioned body to its maximum effort trying to get to the department in time. If Susan read Ezra’s expression right, Andy had failed, and not for the first time.
“In my day,” said Ezra, who Susan thought couldn’t have been more than seven years older than Andy, “medical students anticipated problems when planning our arrivals. We factored extra time in. We didn’t hold up the team.”
“I’m sorry,” said Andy again, real remorse on his flushed face.
Ezra shook his head, disgusted. “Ah, forget it. You’re in luck, anyway. There aren’t any consults this morning.”
Andy looked surprised. “Again?”
“Yeah,” growled Ezra. “But that doesn’t mean you get the day off. You’ve still got old cases that need to be followed.”
“Of course,” said Andy quickly, valiantly trying to wipe the look of disappointment off his face.
“Why don’t you show Dr. Barry here your cases? She’ll be with us for the next month. Might as well get her used to the service.”
The med student looked at her with an earnest, friendly expression. “Hi, Dr. Barry. I’m Andy.” They shook hands, Andy enthusiastically pumping hers up and down.
“Call me Susan,” she said.
“Sure. I’ve got a couple good cases going. Disseminated TB and cysticercosis. You wouldn’t believe—"
Ezra interrupted. “Just take her downstairs, Andy. You don’t need to give her the whole story up here.”
“Oh, right,” said Andy.
Susan rose from the couch, pulled on her white coat, and followed the medical student out the door as he went on about the liver transplant patient with disseminated TB and the El Salvadoran housekeeper with cysticercosis. As she pulled the door shut behind her, she saw Ezra look at the empty candy wrapper, frown, and then throw it in the garbage.
“What are you going into?” Susan asked.
She and Andy walked down the long central hallway of the hospital’s tenth floor. On either side, several wards stood vacant. Only the wings, jutting out at right angles from both ends of the corridor, still held patients.
“Infectious Disease,” said Andy.
“Really?” said Susan probingly. It was a well-known phenomenon that medical students often falsely claimed to be going into the specialty they were rotating in at the moment because they believed it would improve their grade.
“Really,” said Andy, his face guileless enough that Susan believed him. “What about you? You doing a fellowship?”
“Nope,” said Susan.
“General internal medicine then, huh?” said Andy.
“Looks like.”
“That’ll be fun,” said Andy. “Getting to know all your patients. Developing relationships.”
<
br /> Susan smiled. She found the positive attitude of medical students endearing. Of course, their idealism would soon be corrupted by the long hours of residency and the reality of practicing medicine in a money-driven world. But it was nice while it lasted. “Yeah, I guess so.”
A voice broke into their conversation. “Hi, Susan.”
She looked up at Brian’s face. He was dressed for the OR, in scrubs and foot coverings. His hair was not yet mashed against his forehead, the way it would have been if he had been wearing a surgeon’s cap, and Susan knew that meant his first case of the day had been delayed. He would be irritable.
Oddly, she felt her heart lurch at the sight of him. “Not in the OR yet?”
He shrugged. “Naw. Anesthesia can’t get their act together.” He peered at her steadily, oblivious to the medical student who stood at her side.
She felt heat rush to her face and hoped it didn’t show. They stood there awkwardly for a moment, neither speaking.
“I thought we might have dinner this week,” he said finally.
“Sure,” she said, pleasure and surprise warring with one another inside, but neither of these emotions showed on her face.
“I’ll call you,” he said abruptly. He moved down the hallway toward the OR suite at the end. Bemused, Susan watched him walk away.
After he was gone, Andy asked, “Who was that?”
Susan turned back to the med student. “Brian Cain. He’s a CT fellow. He’s my boyfriend,” Susan said, as if to explain the strange, stilted exchange.
“Had a fight, huh?”
Susan looked at Andy in surprise. “Yes. How’d you know?”
The red-headed medical student grinned. “I’ve got a girlfriend too, you know.”
Susan couldn’t help smiling. She didn’t care what Ezra said. She was going to like this medical student. She could just tell.
The coughing was horrible, even to the hardened ears of a guy like Jim Carson.
He stood in Yoshiki’s ICU room, the sliding glass door closed behind him, the nurse next to him. Yoshiki was so weak now that his coughing did little to clear the phlegm gathering in his respiratory tract. It sounded as though he was drowning in it.
DRYP Trilogy | Book 1 | DRYP [The Final Pandemic] Page 6