by Barbara Ebel
She shook her head. “Long story short, Nell, the life cycle is way complicated.”
“Not to worry,” Rick said. “I doubt if anything about Angiostrongyliasis is going to be on your rotation final exam. Unless, of course, some chief resident asks the test writer to throw in an extra credit question.” He winked at Annabel. “Let’s get back to humans. How do Toby’s symptoms compare to what is reported?”
Annabel turned her head towards Bob.
“Patients present just like they have a bacterial meningitis,” he said. “Which is what we thought initially. He’s had the correct symptoms of nausea, vomiting, a stiff neck, and headaches. After his trip to Florida, the incubation period fit into the timeline too. Anywhere from a day to six weeks.”
“He complained about muscle aches,” Rick said.
“Which are included as well.”
“We’re down to what is most important for our young patient. We have the high eosinophilic count from his spinal tap, but are there any tests to make a definitive diagnosis? And how are we going to treat him? The beginning of school is looming any day for this lad.”
“Sixth grade,” Bob said. “I can’t remember that far back.”
“You old man,” Annabel said with a laugh.
Rick reached for a donut and Annabel swigged down more coffee.
“I only saw mention of this in one scientific paper,” she said. “In the case in Louisiana in the 1990s, they did a serologic test. A. cantonensis was diagnosed, proved positive by enzyme immunoassay.”
“Hmm. I will have to look into that. In any case, I will report our suspicions to the CDC and they can help us out with testing if the hospital’s lab can’t.”
“Dr. Mares,” Bob said. “You probably guessed already. The only treatment for this parasitic meningitis is supportive care.”
“Why won’t antibiotics work in this case?” Rick asked Nell.
“Because it’s not a bacterial disease,” she answered.
“Also,” Annabel added, “other countries have tried anti-helminthic drugs without any success.”
“I read if those drugs do kill worms,” Bob said, “those dying worms could exacerbate a patient’s neurologic symptoms.”
“Yuck,” Nell chimed in.
Rick pointed to the box. “Finish the donuts. We’re going to go see Toby Owens.”
-----
Rick Mares rubbed his undersized chin as he forced the students to keep up with his lengthy stride down the pediatric ward. He looked over his shoulder. “Anne Owens spent another night with her son. I hope she’s still here.”
Annabel and the team geared up outside Toby’s room and Rick went in first after he finished tying on a mask. Both parents were with their son.
“I stopped by on the way to work,” Jack Owens said, standing alongside the bed. He rubbed his hands together like he wanted to play ball with his son. “I’m glad I’m here. Maybe you can give us an update on Toby’s condition.”
Anne moved an afghan and got up from the cot placed beside the other side of the bed. She held a small travel pillow.
“I really am awake,” Toby said from the bed. “Headache and all.”
“I swear his red hair looks like it’s being tossed around from that headache,” Anne said.
“No, Ma. It hasn’t been combed in days.” He let out a big sigh and turned his attention back to Rick. “Dr. Mares, I’m so tired of this.”
“You have every right to be, Toby. Since yesterday, we’ve dug up some information that we believe pertains to your case.”
Anne and Jack sidled closer to each side of the bed, waiting for Rick’s explanation. Toby cocked his head.
“We think you may have what’s called Angiostrongylus cantonensis, the parasite responsible for your eosinophilic meningitis.”
“What on earth is that?” Jack Owens blurted out.
Rick gritted his teeth. He was trying to brush over giving them some of the sordid details, such as being a lung worm of rats.
“That bad, huh?” Jack asked, not getting a response.
“We are going to inquire about a special test to confirm the diagnosis, to be certain.”
“Come on, doc,” Anne said. “How did our son get this angio parasite?”
“Probably that slug he ate.”
Anne’s motherly fury showed on her taut lips and she popped the pillow on Toby’s head.
“Ma, would you quit hitting me on the head!”
“You deserve it. Jonathon wasn’t crazy enough to eat a slime ball. What were you thinking?”
CHAPTER 23
Dr. Mares corralled his team outside Toby’s room, where he addressed Annabel first. “Thank you for your input. Now go have a productive day in Dr. Gillespie’s office.”
“You’re welcome. I’ll never forget this meningitis. My dad’s a neurosurgeon and deals with ‘head’ cases all the time, so I’ll be sure to tell him about it.”
Rick nodded, and with a hand wave, guided his team to finish rounds.
Lastly, Bob turned. “Talk to you later.”
“For sure.” Annabel put a mask back on and poked her head back into Toby’s room.
“Come on in,” Mrs. Owens said.
“I’m leaving,” Jack Owens said. “My hardware store doesn’t function without me.” He patted his son on the shoulder and gave Annabel a smile as he left.
At least he didn’t clunk his son on the head, she thought. “Toby, when you eventually leave the hospital, I’m sure they’ll give you a follow-up appointment with your pediatrician. I won’t see you again at Dr. Gillespie’s office because I will only be there a few more days. Then I’ll be here in the hospital. I’m sure you’ll be discharged by then. I want to wish you luck and a smooth recovery.”
“Thanks a lot. Can you be my doctor later, when I grow up?”
“How sweet. I wish, but I’ll probably be leaving Ohio.”
“Oh,” he said sadly and looked down at his leg. “I hope when I change to a grown-up’s doctor, he or she quits checking my private parts.”
Anne Owens scowled over at him. “Doctors know what they’re doing, Toby, and some exams are tailored for the individual. When men get older, they need what’s called a prostate exam, which are done for cancer screening. Exams are for your own good.”
“There are many doctors around in every specialty,” Annabel said. “Sometimes the trick is finding one who is an excellent at his or her field of medicine, but you also like them as a person; you feel comfortable with their bedside manner. Sometimes it’s difficult to find both.”
Toby scrutinized his leg. “You haven’t signed my cast.”
“It would be an honor.”
“There’s a black magic marker over there.”
Annabel fumbled through the items on the nightstand and picked it up. She hovered over his leg about what to write.
“Mom, I’m serious about this.” Toby’s red freckles seemed to grow larger on his cheeks as he continued with authority in his voice. “Please change my doctor to Dr. Clark. I like her so much better. Jonathon goes to her too.”
For a few moments, Mrs. Owens stared at him. “That will make for an uncomfortable situation with Dr. Gillespie, but I’ll talk to Becky. Yes, if that is what you prefer, I’ll make it happen.”
Annabel smiled at him. “Your office records are all in the same place, so that makes it easy. If you would like, I can subtly ask Becky to make the transfer when I go back.”
“Thanks, Dr. Annabel,” Toby said as his mom nodded.
She glanced down and wrote in cursive: “GET BETTER and best of luck in 6th grade. Maybe someday you can be that exemplary pediatrician that you seek!”
Toby beamed. He had never thought about that. His eyes sparkled as he looked at Annabel.
“If you can get through this, even medical school will be a snap.” She winked, nodded at Anne Owens, and left. It was time to show up at Dr. Gillespie’s office.
-----
Annabel hummed to the m
usic in her car on the way out of the parking lot. The sunshine was bold and bright and the Cincinnati sky was blue and free of even a wisp of a cloud. She wished she could look into a crystal ball and find out what young Toby Owens would do with his future. Now experienced with his own surgical and medical problems, perhaps it would make an impression on him to grow up and be on the other side of patient care.
She changed channels once, sampling both country music and top pop. Parking in the back of the lot when she arrived, she left spaces out front for parents and kids.
With her lab jacket draped over her arm and carrying the rest of her gear, Annabel entered the waiting room of Gillespie and Clark’s pediatric office. Notably, there was a lack of babies in mothers’ arms, which made for a quieter area than normal. Three young children were grouped around the square rug sharing toys and a toddler played against the wall with a tall doll.
She slipped into the front office and approached Becky.
“How did it go? Was your morning as mentally stimulating as this place?” Becky slipped a file into the vertical folders on a tall shelf. Her bun was tighter than normal and swirled to hide much of her premature gray.
“Kind of. Dr. Gillespie’s patient, Toby Owens, is in the hospital with an interesting meningitis from a parasite. He also has a leg fracture. When it rains, it pours.”
“My goodness. I’ve known that family for some time. Poor Toby. Nice kid. Are they taking good care of him?”
“Yes, and Toby and his mom have a request for after his discharge, that you switch over his records and future care to Dr. Clark. Toby would prefer not using Dr. Gillespie anymore; you may confirm that with them. I’m only the messenger, the middle-man.”
“Hmm. These days, I’m thinking of switching the order of their names on the sign outside to ‘Heather Clark, M.D. and George Gillespie, M.D.’”
Annabel narrowed her eyes.
“Every once in a while, a mother or older pediatric patient finds his behavior unpalatable,” Becky whispered. “The Owens are not the first family to switch care.”
Becky sat and Annabel wanted to ask her more, but it was not her place. She repeated her recent mantra to herself. “Only a few more days.”
“Is Stuart in a room with a patient?” she asked.
Becky craned her neck to the hallway. “I believe so. Dr. Clark is sharp as a tack this morning. We’ve phoned several prescriptions into pharmacies, admitted a girl to the hospital, and Xeroxed a bucket load of back-to-school paperwork for her patients.”
“I’m sharing Toby’s case with him because we students are learning pediatrics together. I’ll tell Stuart later.”
The fax machine on the desk came alive and a report started streaming out. The paper landed face down and Becky took a peek. “George is waiting for this one. He’ll be out of his office soon to check if it’s here.”
Becky stood and glimpsed over the counter. A four-year-old was dwarfed in the seat of a chair, grasping an iPad. The volume was up and game music roared across the waiting room. The child’s mother sat next to him, but she isolated herself from the problem. She was plugged in with earbuds to her iPhone hung on her waist.
Other parents rolled their eyes and a stir of remarks filtered through the room. “How rude that we must listen to this,” a woman said to her husband. “Some people don’t care what their kids do,” he replied.
“As long as it doesn’t affect her,” she said. She stuffed the magazine she tried to read back in the rack and picked up her toddler.
Becky sighed as she lowered herself back in the chair. “During my twelve years working here, I have watched first-hand the decline of public social manners. But the descent is everywhere. Have you taken a flight recently? Waiting for a plane is an exercise in futility. Some guy will get on his cell phone a half an aisle away from you and will talk so loud that his private conversation is broadcast publicly. You can’t read a book or a magazine, or think straight to use your own phone for a quiet call or a text message.”
She cleared her throat and went to the door. “Sweetheart, would you mind turning that down a bit?”
The little boy looked confused and continued on just the same. Becky shook her head, turned, and looked down the hallway. “Annabel, on second thought, please go back to Dr. Gillespie’s office, let him know you’re here, and hand this fax to him. Wait and see … then he’ll be up here in a jiffy to tell me what to do about this.” She waved the paper once and handed it over.
Annabel slipped out. As she went down the hallway, she passed two of George’s exam rooms with half open doors and patients. Although she was surprised that Becky confided in her about a few of Dr. Gillespie’s patients, the woman’s remarks did not shock her. But the best news was that the office staff could transfer Toby’s care without a hassle.
Annabel fully rapped on George Gillespie’s door.
“Come in.”
When she stepped in, George popped his head from around his computer screen and gazed fixedly at her. “You’re back.”
“Yes, and Dr. Mares said ‘thank you’ for letting me join their medical team this morning.”
“Anything in the name of a medical student’s education.” He cleared his throat. “I’ll be out in a moment. We have patients waiting for us.”
“Becky sent this in for you.” She marched to the edge of his desk and handed it over.
Dr. Gillespie held the paper. “I’ll join you in the hallway. First, I’ll attend to this.” He popped out of his chair and wobbled out the door, but as he did so, a pile of papers fell to the floor.
Annabel hesitated but didn’t want to disturb him. She could place the papers back up on his desk herself. She stepped around to the other side and crouched down on the floor mat of the rolling chair. After tucking the folders and loose papers neatly together, she stood and slid them on the empty space.
Her eyes fell on the laptop screen. What the hell? She gasped. It took only a moment to wrap her head around the video in front of her. Not just any film clip, but a live video, in a physician’s office.
For there was Stuart in his white jacket along with Dr. Clark in her doctor’s coat.
Additionally, a young girl approximately six years old was on the exam table and a mother was standing by the door.
Heather had a stethoscope on the girl’s chest and was asking her to take a deep breath. The sound was muted so that Annabel had not picked up on it before.
How creepy, she thought. Does Dr. Clark know that her partner is watching her physical exams of children? Do families know their children are being recorded and viewed by another person … the other doctor in the office?
She was frozen with fear at the implications of what she saw. As she stepped away, it felt like her legs were dragging lead weights.
-----
Annabel kept her eyes peeled for Stuart, but Dr. Gillespie was soon ready to see the next patient. Although she accompanied him into the room, her mind was still blindsided by the video streaming on his laptop. The patient’s chief complaint, as reported by her father, went over her head.
The problem, she thought, might be a bigger issue in her mind than it really was. But she had no idea. It would be best to talk to Dr. Clark, but maybe that was not even appropriate. She should talk to Stuart first. Was he told at the beginning of the rotation that any or all of the exam rooms were being spied on? She wasn’t told any such thing. Perhaps Dr. Clark had video access to Dr. Gillespie’s rooms as well?
The afternoon wore on. Finally, during a short break when she grabbed a cup of tea and opened a book in the tiny room beside the kitchen, Stuart walked in.
“Hey,” he said. “How did this morning go?”
“In a nutshell, fine.” She focused past him, and seeing no one close at hand, she said, “Close the door.”
Stuart scrunched up his face and shut the door silently. “What’s up?”
“Just between you and me, I found something disturbing. When we started here the beginning of last
week, did anyone tell you that any of the rooms are monitored by video cameras?”
Surprised by the question, Stuart fumbled for an answer. “Not at all.”
Annabel bit her bottom lip. “Do you think you could ask Dr. Clark a question really subtly? Like work it into a conversation without making her suspicious or sound an alarm off in her brain?”
“Depends on what it is, Annabel. You’re talking pretty cryptic.”
“Look, somehow find out if she knows about any videotaping in the office. For instance, if she has video access to Dr. Gillespie’s exam rooms or he has a camera on her rooms and can see her examine patients. If I ask her, she would think I’m crazy or the questions would raise a red flag. You’re the one shadowing her.”
“You’re wigging me out, but I can try. These questions must be important to you.”
“As significant as each and every child that comes to this office.”
“You’re serious. Okay.” Stuart focused on the floor. “I have an idea; how to ask her without raising suspicion about whatever you’re suspicious about.”
Annabel chuckled. “Stuart Schneider, the Dr. Columbo of Medicine.”
-----
Alongside Heather Clark, Stuart peered at the folder that she had open on their next patient. She was chewing on the last piece of vanilla cookie in her mouth, so Stuart saw an opportunity to talk.
“Leukemia is unfair for anyone to deal with, but especially for your next patient so young. Looks like you’ve been seeing her for some time.”
Heather swallowed. She licked her lips and agreed. “Two years, to be exact.”
“I learn a lot from your patients with sorrowful diagnoses. It would be interesting, as a student, to see the progression of her care. Do you or Dr. Gillespie ever do anything like videotape patients’ visits? It could serve as a record, a teaching tool to students, or as documentation.”