by Barbara Ebel
She tapped on “photos” and, since last week, the only picture that showed up appeared to be a half-finished black-and-white sketch. She shook her head at why he bothered to take a picture of it, but it was none of her business.
Marlene went to the kitchen and doled out a stir-fry chicken dish for dinner.
“I liked that,” George said when he finished. “New recipe?”
“Yes, and I made extra.” Although she had nowhere to go the rest of the evening, she reapplied her lipstick when she got up to do the dishes. George helped her bus the plates to the sink and then went straight back to his office.
He had brought home no medical paperwork that needed attention. After reaching for his phone, he opened up the pictures and stared at Tabitha Klondike’s sketch. More importantly, he went to his list of contacts and scrolled to the Klondikes … the entry he had discreetly entered as they left the office.
He stared off into space and formulated what he would say on the phone and placed a call.
Margaret Klondike answered. “Hello?”
“Mrs. Klondike, this is Dr. Gillespie. Every once in a while, I call a patient and the family in the evening to make sure there were no problems with their appointment in my office during the day. Like a post-medical call survey. Were the girls at the front desk friendly, etc., etc.?”
Margaret took a few seconds to process the reason for his call. “The visit went smoothly, thank you.”
“I picked your visit specifically tonight because your family is brand new to the area. I want to make sure you are satisfied with your beautiful daughter’s new medical care.”
“Yes, like I said, everything was fine.”
“I wish I could thank your daughter for letting me snap a picture of her lovely sketch.”
“She’s around here somewhere.”
George waited. He heard noise and voices in the background and then the sweet voice of Tabitha Klondike sounded in his ears.
“Hello? Dr. Gillespie?”
“Tabitha, honey, I wanted to personally thank you. Your sketch on my phone is your personal present to me. It’s the most glorious photo in my whole collection. On your next visit, please do show me the finished project.”
Tabitha beamed with delight. No one had ever made a big deal about her artwork like him before. “I will finish it before my mom brings me again.”
George’s free hand went to his crotch. His hardened crotch.
“I look forward to it.”
He couldn’t keep talking and taking care of his crotch at the same time. “Bye, then,” he said, and hurried into the bathroom.
-----
Annabel and Bob left Toby with his mother and friend Jonathon, and went to the nurses’ station. Bob first made a copy of his patient’s LP results and then stuck the original in the lab results section of his chart. Both students huddled at the side of the counter.
“I’m pretty sure I would not have taken that Florida kid up on his dare,” Annabel said. “Kids do crazy things to avoid humiliation.”
“At his age, I might’ve,” Bob said. “It is possible to chuck something small down your throat really fast, like a slug or a snail, and avoid tasting it.”
“Not only are they disgusting, but think where they’ve been.”
“What’s disgusting?” Rick Mares asked, stepping up behind them.
“Eating a slug or a snail,” Bob answered.
“Surely neither of you lost your mind and did such a thing. Mollusks are distasteful, I’m sure, and gross. Slugs secrete a film of mucus for their own protection … to keep stupid human beings from eating them.”
Annabel cocked her head at him and he said, “I graduated from college with honors in biology. My studies included terrestrial mollusks. Come on, let’s sit somewhere. Bring Toby’s lab sheet.”
“It’s dinnertime,” Bob said. “Any objection to going to the doctors’ lounge? I rarely make it in there to eat scrumptious free food.”
“Excellent idea. However, did you tell Toby about his confirmed diagnosis?”
“We did, along with his mom and friend.”
Rick nodded and peeled down the hallway in front of them with his long stride and opened the door. “This is a great time of day to go in here. It will be half as busy as lunchtime.”
A round center table inside was stocked with cheese and crackers and fruit, but two tables against the wall had hot food and soup. They fixed a plate, grabbed drinks, and gathered around their own table. Only a handful of doctors remained, some watching the news. Nell was hidden from view on the couch and popped up.
“Hey,” she said. “Can I join you? And are we otherwise done for the day, Dr. Mares?” She half sneered at Annabel while she placed two cookies on the empty spot on her plate.
“Yes, you can go,” Rick said. “We’re finished, except for my discussion with Bob regarding his consult.”
“Then I’d love to stay. Toby Owens is the only possible pediatric case of meningitis I’ve seen.”
“For all of you,” Rick said, “now a confirmed case.” He tapped his finger on the table and Bob immediately produced his copy of Toby’s results.
“Miss Linnell, Bob’s patient’s CSF white count is two hundred and eighty-two.”
“Did we prescribe the correct antibiotic?” Bob wondered. “One that we can keep using on Toby?”
Wide-eyed, Rick stared at the sheet and dropped his fork.
“What’s wrong, Dr. Mares?” Annabel asked.
He raised his head slowly and turned solely to Bob. “You neglected to tell me the breakdown percentages of the type of white blood cells in Toby’s fluid. I have never seen this before.”
Bob ducked his head and tapped his forehead in disapproval of himself. Obviously, he goofed up.
“No harm done,” Rick said. “I am simply flabbergasted and this is an opportunity for the three of you to review the basics. So what are the five types of white blood cells?”
Bob was still making amends with himself and Nell had stuffed half a cookie in her mouth, so Annabel took the gamble. “Basophils, lymphocytes, monocytes, eosinophils, and neutrophils.”
“Correct. Now, which cells are disproportionately increased above normal values during a bacterial infection?”
“Neutrophils,” Bob said.
“And which cells are increased during a viral infection?”
“Lymphocytes.”
“Toby does not have higher numbers of either in his cerebrospinal fluid, flat out eliminating a bacterial meningitis or a viral meningitis. So, in answer to your question, Bob, the IV antibiotic Toby is receiving is incorrect because it is meant to stampede out a bacterial infection.”
“So which other type of white blood cell is increased?” Annabel asked. “What on earth strange infection does he have?”
“The differential shows thirty-two percent eosinophils. He has an eosinophilic meningitis! Even I am going to need to investigate this further, because high eosinophils point to one thing. And one thing only – parasites!”
-----
Rick suddenly got up. “I must go write an order to discontinue the antibiotic and leave a note on Toby’s chart. Have a good night.”
“I’m leaving,” Nell said. “Bob, are you coming?”
“Annabel isn’t finished with her chicken sandwich. I’ll catch you tomorrow.”
Linnell stopped at the center table, wrapped up some snacks to-go, and flashed a final smile at Bob.
Annabel grinned. “We’ll be like Rick one of these days. Residents pull longer hours than we do. It’s like their work never ends.”
“Are you saying that we better enjoy medical school while we still can?”
“Something like that. I better get going too. Poor Oliver must be waiting patiently.” She chewed the last bite while Bob contemplated.
“Rick seems stumped by Toby Owens. We should have talked about calling in an infectious disease specialist.”
“You’re right. And you and I don’t have the
resources to figure out rare medical conditions. I wish we were close by to the campus medical library.”
Bob turned around. “Doctors and foundations do lend books in here.”
“I forgot about that. I’m rarely in this lounge.” She also turned to take note of the book shelves on half the wall on the other side of the room.
“Wonder how old some of them are.”
“Let’s check.” The students bused their trash and studied the spines of the textbooks. Annabel opened a few. “The publishing dates are relatively new and the older ones are recently edited.”
“Here’s an option.” Bob pulled out a navy blue text. “Modern Infectious Diseases.”
“Perfect,” Annabel said. “Another option is checking with the government disease control site.”
“I’ll do one and you do the other and we can compare notes.”
“I’ll snuggle with Oliver and the book later tonight after I walk him and do some other pediatric reading.”
“I can come over and snuggle with the two of you too,” he chanced saying.
“My bed isn’t big enough for three.”
“Actually, Oliver can stretch out and hoard an entire bed just by himself!
-----
Annabel bounded up the two flights of stairs and inserted her key in the door. It was a normal occurrence when Oliver stayed with her. Before she even cracked open the door, the biggest smile of her day would spread across her mouth.
She pushed straight in with her bag and textbook from the doctors’ lounge. “Oliver, look at you! You are an impeccable young watch dog.” After giving him an exuberant petting and taking a walk, they went back to the apartment.
Annabel changed and settled by the headboard of her bed and was grateful not to cook or to heat up leftovers for dinner. “Come on up, Oliver. Curl up next to me and watch for our Mr. Squirrel outside the window. I must research a nasty disease.” Oliver had no problem heeding her request and he turned belly up with his snout nuzzling her.
It took time, but Annabel finally weeded out a pertinent eosinophilic disease from the book and then remembered it from medical school. Called “cysticercosis,” it was an infection caused by the adult tapeworm, Taenia solium, acquired through poor hygiene and eating raw pork. What she had forgotten was that it could affect the central nervous system and then it was called neurocysticercosis.
However, she thought, there was a slim chance that Toby had this one. The disease was most prevalent in Africa, China, India, and Latin America and seventy to ninety percent of the patients presented with seizures. Toby had no history of seizures since his illness began.
Annabel’s hand rested on Oliver’s fur as she indexed another eosinophilic meningitis. The diseases were rare and she had never heard of the next one. Maybe because it reared its ugly head in Asia, Central America, and South America, and particular spots in Africa, and not the United States. Called “gnathostomiasis, the disease was caused by parasitic worms acquired by eating undercooked or raw reptiles, birds, frogs, eels, and freshwater fish.
She pondered over the food sources and wondered if a slug would count. However, on further reading, she eliminated it as Toby’s disease. The most common symptoms were migratory swellings under the skin and Toby had no dermatologic manifestations. One other awful symptom was when the nematode entered a patient’s eyes, causing blindness. She shook her head. At least, thankfully, Toby did not have gnathostomiasis meningitis.
The sun had long set and only a street light illuminated her favorite tree outside. She slinked off the bed without disturbing Oliver and closed the blinds, but her true intent was to check her phone. She left it in place on the kitchen counter and pressed messages. The last ones were between her and Bob. There was still no return message from Dustin after she had texted him during lunchtime.
CHAPTER 21
Dustin Lowe’s night couldn’t be worse. Death and violence was part of his job, but he was always the objective observer to other peoples’ losses. His partner’s death, however, made him just like everybody else he consoled, especially when folks had told him late in the day, “I’m sorry for your loss.”
He felt especially alone. Not in the mood to eat any dinner, he grabbed a container of milk, measured two scoops of protein powder, and mixed the drink in the blender. He sipped it over a half hour on his most comfortable chair and, for the time being, didn’t even feel like talking to Solar.
The bird pranced around on the table in the middle of the room. When he commented, “What’s your problem,” Dustin closed his eyes. Never before was the bird’s question so relevant.
“Too much for you to listen to, Solar. I can’t handle Sean’s death and breaking up with Annabel all in one week. You just go about having a bird’s life with nothing to worry about.”
He felt doubly saddened by the fact that he had spent the most amount of time with Sean than anyone else and, yet, he would have no say in his funeral arrangements. Of course, families took care of those details, but he would love to know if they were contemplating cremating or burying him. He and Sean had once jokingly talked about death and his partner mentioned how petrified he was of fire. “After my life is dead and gone,” he said, “no way do I want my dead body to face burning flames.”
Dustin wondered if Sean ever said anything like that to his wife. Long after he finished his protein shake, he thought of all the advice Sean had given him. He hoped he had been as good a friend to him in return. His heart also yearned to call Annabel to tell her what happened, especially each time he re-read her message from earlier in the day. But the relationship was over and he wasn’t yet ready to confront her or call her to make that crystal clear. At present, he was too vulnerable.
He could depend on his mom. She’d still be awake, especially since a thunderstorm approached both their locations from the south; she would be affected as well. The telltale signs of a stormy night were already present with distant rumbling skies and lightning, so he decided to call.
“It’s late,” she said when answering. “Is everything okay?”
“No, Ma, far from it. The worst thing happened today. If it weren’t for me buying my partner a cup of coffee, something might not have happened ... ”
-----
It seemed like Annabel found the most medically known, yet rarest, eosinophilic parasitic brain offenders, so she canned her search for the next hour and read from the rotation-assigned pediatric book. With disappointment, she glanced over at the clock; it was past bedtime. To show up at a private practice in the morning looking like some post-call medical student would not be professional.
She jumped into the shower, but as she dried herself off, rumbles sounded, coming from the direction of the river. When she opened the bathroom door, she needed to shove it a bit, and found Oliver standing in the way. He wore a frightened appearance. Since lightning and thunder was headed their way, his quivering had begun.
“Oh, no, Oliver. Bad timing.” She grimaced as she pulled a pajama top over her head. “Actually, since I’m a doctor-in-training, no timing will ever be appropriate.”
After she pulled on the other half of her pajamas, she crouched down in front of him. “Don’t get me wrong, boy. I don’t hold a grudge. Your characteristics are embedded in your DNA and we can’t change that. I’ll take care of you through thick and thin. Even when you’re old, tired, and arthritic.”
Oliver plowed past her and walked into the wet shower stall. He circled around and, finding no better security against the pressure change and approaching storm, he exited with wet paws.
Annabel then remembered. “Bob bought you something that may help!” She bit her lower lip; where the heck did she put it?
Her apartment was too small to lose anything, so she opened the closet accordion doors and remembered throwing the Thunder shirt box on the top shelf. After she grabbed the end, it fell to the floor. She let Oliver stay cowering in the closet while she read the instructions and straightened out the material. After grabbing
him by the collar and closing the doors, she put the article on the dog step-by-step. He made no fuss and didn’t seem to mind.
The thunderstorm ramped up as Annabel climbed back into bed and Oliver again took to her mattress and nervously circled. Over the next half hour, the storm continued to grow worse, but the dog’s panting didn’t.
Her phone dinged and she scurried past Oliver. Hoping beyond any other wish, she wanted to see a message from Dustin. But no such luck. A weather alert pinged for severe weather in her area. No kidding, she thought.
She scrambled back and, in time, she realized that both the thunder shirt and paying attention to him helped Oliver better tolerate the noise and light show.
Sleep for her, however, was useless. Her mind wandered back to the two parasitic diseases she had read about earlier, the first one involving the pork tapeworm. But the idea of the second one, the gnathostomiasis, nagged at her. For some reason, there seemed to be some fact she had overlooked, she had missed. Something not to be disregarded.
“You idiot,” she said clearly. The undercooked or raw sources of the parasitic worms, especially the frogs and eels, was the important piece to the puzzle. The etiology of Toby’s problem may have been stark and evident, handed over to her and Bob in outright dialogue in Toby’s hospital room earlier in the day, like a spoiler alert to a murder mystery novel.
“A Florida raw slug!” she exclaimed to Oliver.
It was midnight, but the search had just begun.
-----
The last few years, George Gillespie’s bedtime routine stayed prim and proper and as dependable as a faithful employee who never took a day off. He went to bed at nine o’clock whether he attended an evening meeting or not, and always after showering and a last look at his computer.
George and Marlene’s master bathroom was extra spacious, but he had made it clear earlier in their marital years that bathrooms were for one person at a time.