Altered Genes: Genesis (2 page)

M
uir landed
in New York City with a bad case of diarrhea added to his fever and stomach cramps. He pressed his hand against his stomach and winced. It felt like his gut was going to explode.

During the flight, he’d made so many visits to the airplane lavatory that one of the attendants had asked if he was all right. He wasn’t, he felt awful, worse than he could ever remember.

He cleared immigration and left the terminal, ignoring the shysters who scurried from one hapless tourist to another as they solicited rides for the gypsy cabs that circled the airport.

“Piss-off,” he muttered as he pushed past them and joined the queue at the taxi stand. For a brief moment, he considered taking one of the gypsy cabs—just to avoid the wait—but the line moved quickly and he soon found himself in the back of a yellow cab.

“Where to?” the cabbie asked with a thick accent as he turned on the meter and floored the accelerator.

Muir felt his body press back in the seat. He gulped repeatedly as he stared at the dirty rubber mats and fought off the urge to vomit.

“C'mon buddy—where to?”

“West 57th street,” he said after swallowing the bile that had collected in the back of his throat.

When they finally arrived, he made it to check-in, but not all the way to his room “Toilet?” he begged the clerk at the front desk.

The man pointed in a vague direction to the right. Muir ran, desperately searching for the sign on a door. He found it just in time and pushed open a stall door. His pants had barely hit the floor when the liquid shit ran from his body in a never-ending stream.

Relieved, even if just temporarily, he hobbled to his room and fell onto the freshly made bed, writhing in agony before he lapsed into unconsciousness.

“What do we have?”

Dr. Mei Ling looked at Dr. James Robinson, the man who addressed her. He was Chief of Emergency Room Medicine at Bellevue hospital and a faculty member at NYU.

Huddled around him were a group of first-year interns, their egos filled with the conceit that came from believing they were doctors. They weren’t, and part of Robinson’s job was to teach them that. It was a job he did well but didn’t make many friends doing it.

She scanned the chart and began to speak. “White male, fifty-five years old, found unconscious in his hotel room, brought to the ER by ambulance, signs of vomiting and involuntary bowel movement.” She continued, stating Muir’s heart-rate, blood pressure, and other vital signs.

Robinson nodded and cast his eyes over the group of interns.

“Okay folks, what tests should we run?”

The suggestions came quickly.

“CBC”

“BMP”

“Electrolytes”

“Amylase”

He nodded his approval and moved to the side of the gurney to press down on the sick man’s abdomen. “He’s distended, anything else?”

“EIA?”

At the suggestion, he tapped his fingers lightly on the bloated stomach. “Yes, there are signs of gastroenteritis, an enzyme immunoassay is appropriate.”

A voice from within the group spoke. “W-w-what about an RT-PCR test?”

Reverse Transcription Polymerase Chain Reaction testing was used to detect and study RNA viruses. It was expensive and reserved for very special situations. It was not something to be used lightly.

She watched Robinson to see how he would react.
Probably not well.

“Who said that?” His eyes turned hard as he spoke.

The other interns stepped aside, exposing a chubby young man in the middle of the group. He slowly raised his hand. The look on his face made it clear he knew what was coming.

Robinson stared at him for a second before asking, “What’s your name?”

“Jason…Jason Grant, the young man stammered.

“Are you a doctor?”

“No, Sir—I mean yes, Sir.”

“Was that a difficult question, Dr. Grant?” The group tittered at Robinson’s sarcasm.

Okay, that’s enough
, Mei thought, annoyed at the entertainment the other interns were having at the expense of one of their own. It wasn’t that long ago that she too, as a new intern, had been on the receiving end of the Chief’s sarcasm.
It came with the territory, but sometimes he went a little overboard.

“What would you test for, Dr. Grant?”

“Ebola?” the intern said weakly.

She cringed.
Wrong answer.

Robinson beckoned Grant forward with a wag of his finger. “Does the patient have a fever?” he asked in a mocking tone.

The young man removed a digital thermometer from the wall near the gurney and placed it in Muir's ear. It beeped after a few seconds.

“99.8”

“A touch warm, but not much of a fever. Any history of travel to affected areas?” Robinson’s lips turned up in a smirk.

Okay…you’ve made your point.
She stepped forward with the patient’s chart open, hoping to deflect some of the chief’s irritation towards her. “Nothing recorded in his passport.”

Robinson ignored her and focused his attention on the intern. He directed him closer. “Any sign of hemorrhaging? Let’s look, shall we?

It took the strength of both men to turn and hold the mass of flesh. Grant ran his eyes up and down Muir’s torso. “No signs of bleeding,” he said quickly.

“Probably not Ebola, wouldn’t you agree?” Robinson’s tone was flat, but his eyes sparkled with amusement.

Eager to escape, Grant nodded and stepped back, releasing his grip on the patient’s shoulder. The limp body flopped sideways trapping Robinson’s hand beneath it. The older man pulled free and grimaced when he saw the dark runny mess on his fingers.

Mei held back a smile as he rushed to the box of Kleenex that sat on the counter. She watched him wipe diarrhea off his hand, amused by the fastidious manner in which he ran the tissues up and down each finger.

Serves you right for not wearing gloves.

When he finished, he scrunched the Kleenex into a ball and tossed it towards a garbage pail. The throw missed and he quickly looked away before walking to the dispenser on the wall. With a couple of dollops of sanitizer in his hands, he furiously rubbed his palms together before addressing the group.

“Based on what we have seen, it would appear the patient has viral or bacterial gastroenteritis—Let’s move on to the next patient, shall we?”

“What about a GDH A/B toxin test?” Mei suggested to him as the group began to move away.

He stopped, turned slowly, and lowered his glasses. “What about it, Dr. Ling?” He approached her with a peevish look on his face.

His breath smelled of hours-old breakfast. She stepped back to escape it as she spoke.
“
The patient may have a C. diff infection, he has a slight fever, diarrhea...possibly cramps—”

“Cramps, really…how do you know? He's unconscious…are you psychic?” Robinson walked back to the gurney and pointed. “Look at the patient, Dr. Ling. Does he look elderly? Do you know if he's recently taken any antibiotics?”

His sarcastic tone irked her
I’m not one of your interns.
She forced the emotion out of her voice and spoke carefully.

“No, Dr. Robinson, I don’t know if the patient has recently taken antibiotics but a number of his symptoms match a C. diff infection—don’t they?”

She could tell from the pinched expression on his face that it pained him to agree.

“Yes, Dr. Ling, some of the symptoms do match a C. diff infection, but they also match a number of other diagnoses.”

He paused for a moment, looked at Grant and then turned back to her, a devilish smile on his face.

“That aside, do you think Dr. Grant would benefit from learning more about GDH tests?”

“I think everyone would benefit,” she said, unsure where he was going with the question.

“Of course, they would,” he replied dismissively, “But there’s not very much room around the gurney. Since it was your suggestion, would you be so kind as to instruct Dr. Grant on the GDH test protocol?”

Before she could respond, he turned and walked away. She watched the interns follow him out of the ER clustered around him like pilot fish on a tiger shark.

Pompous ass…

Grant walked over and stood beside her. He gave her an apologetic look. “You don’t have to stay, Dr. Ling. I know how to do it. I can collect the stool sample myself.”

She offered him a half-smile.
It wasn’t his fault.
“I’ll help,” she said as she motioned towards Muir’s limp body. “He’s a large man, it’ll take both of us.”

She left the intern and went to the supply closet. Moments later, she returned with a test kit and two pairs of gloves. She offered a pair to him and he tucked them into the pocket of his white lab coat.

“Let’s roll him onto his side,” she said.

Grant reached for Muir’s shoulder. She grabbed the intern’s arm. “Gloves—If he has C. diff, the spores could have spread.”

It always surprised her when a nurse or doctor waited until they saw bodily fluids before they put their gloves on. She was the opposite. Too anal. She never took them off.

She swabbed a minuscule sample of Muir’s diarrhea onto a collection stick, placed it into a vial full of buffer solution and shook the mixture.

“It’s a simple test, takes about ten minutes,” she explained. “If the indicator bands turn red, the sample is positive for the presence of C. diff toxins.”

“What’s next?” he asked when she was done applying a few drops from the vial onto each of the test strips.

“We wait,” she said and placed the test kit onto the table.

They stepped outside the plastic curtain that surrounded Muir’s gurney. Grant, unable to wait in silence, babbled incessantly about the trials and tribulations of life as a first-year intern—the long hours, the lack of respect, the utter fear of making a mistake.

We all went through it,
she thought, half-listening and nodding as he droned on.

The large digital clock clicked over to 12:23 p.m.

“One minute,” she announced.

He stared at her blankly. “Pardon?”

“One minute to go. Let’s check the results.”

He followed her back to the table where the test kit sat. She lifted the small plastic device up and studied the indicator bands. She frowned. All three bands were red.

“What is it?” he asked as he looked over her shoulder.

“Positive,” she answered, “For both A and B toxins. Nothing to panic about but we need to get him into an isolation room and schedule a PCR assay to confirm it. Go get a nurse—and two surgical masks.”

L
ucia Sanchez stepped
into the lobby of Bellevue Hospital and tensed at the sight of the police officers. They stood by the side of a wheelchair, their radios squawking as they guarded an injured prisoner. The younger one glanced over at her. She looked away, pretending to search for something.

She and her children were
mojados
, illegal aliens from El Salvador, smuggled into the country by the Calle 18 gang for money she didn’t have. She was indebted, a slave to the gangsters until they deemed her obligation paid, but right now she was just a worried mother who wanted her son examined.

Emergencias para los niños—
the words were painted on the wall above two doors.

“Through here,” she said to her eleven-year-old son, Alejandro. “Take Blanca and sit. I’ll wait in line.”

He glared at her sullenly and stomped towards a pair of empty seats. The little girl followed her brother.

Lucia didn’t know why he was angry at her, it wasn’t her fault he had fallen and hurt his arm. She sighed and walked over to wait in the admitting line. Forty-five minutes later, she returned to her children with a stamped form in her hand.

The seat next to her son was empty. “Where’s Blanca?”

“She was here a minute ago,” he answered with a shrug.

She clenched her jaw and gave him a withering look. She frantically scanned the waiting room. There were other children and their parents but Blanca was nowhere to be seen. Her panic grew.

“Stay here. Don’t move,” she commanded.