Death Rounds (23 page)

If I could just get this group to consider the
Legionella
cases in their investigation, I thought, it might be a first step in getting them to realize what was really happening. When the discussion focused on how the CDC labs planned to investigate the aggressiveness of the superbug and determine which factors might predispose carders to becoming infected, I passed my results around the table and challenged, “What about the fact that Phyllis Sanders also had
Legionella
before the superbug took hold? And what about there being two other unexplained cases of
Legionella
at UH in the last six months? I take it you’re also aware that the physician caring for the Sanders woman himself came down with a presumed case of
Legionella
a few days ago, though his cultures aren’t ready yet. Are you going to look at this pattern?”

Rossit and Hurst immediately scowled at me. For interrupting? Or for touching on what they preferred no one look at too closely?

The distinguished chairperson from the CDC frowned as he regarded me from his end of the table. “What you’re raising are serious issues, of course, but I assure you the CDC is not here to deal with a few cases of
Legionella.
Your distinguished and most competent local ED authorities can and will guide you, as they always have, on such
routinely
reportable infections.” I presumed his emphasis on the word
routinely
was a not so subtle way of saying don’t bother him and his superstars with small potatoes. That stuff he
obviously
left to underlings.

A young man wearing red suspenders to which a Buffalo Public Health ID badge was pinned seemed suddenly to recognize his role and piped in, “We’ll certainly be looking into those cases, Dr. Garnet. And I can assure you and the rest of this group that we’ll be spending some time at University Hospital, since Phyllis Sanders worked there. We’ve already suggested to Dr. Cam Mackie that
all
personnel at UH be screened immediately for staphylococcus, just to take no chances. Perhaps we can look into rechecking the place for
Legionella
at the same time, although Dr. Mackie assured us they’d already done that. Sanders could have acquired the
Legionella
anywhere. Whatever the case, I must tell you that we are most satisfied with Dr. Rossit’s measures in response to the unfortunate
Legionella
case involving your own ICU director.”

Rossit beamed. Both he and Hurst had also seemed pleased about the attention University Hospital was scheduled to get.

“Of course we will be determining the infectivity of this bug,” the chairperson said, bringing the discussion back to the big issues that he was here for.

I tuned out the doctor-speak about the percentage of carriers likely to come down with the disease—as high as thirty-three percent in other strains—and thought about the Phantom. I shivered. We had to track him down...had to.

After the meeting broke up, I was dying to get home and see Janet and Brendan, but I had a few more jobs to do. I managed to get the telephone number where Douglas Williams was staying from a member of the departing CDC team, claiming I wanted to thank the man for the help he’d given us on Friday. Then I went up to the library, plugged into the computer Med-Line program that indexed all major medical publications, and punched in the key words “infectious diseases,” “patterns of occurrence,” “vectors,” and the name “Dr. Douglas Williams.” This particular search program summoned a list more than three pages long of abstracts of articles. Glancing at the titles, I picked a few that particularly interested me, had the librarian dig them out, and spent the next hour reading. I learned a lot about what the man was good at from reviewing his previous work. I began to have a glimmer of hope that his expertise might be a whole lot more helpful than the CDC’s.

Finally I stopped by ICU, but Stewart was sleeping. The nurses assured me he was stable and promised to tell him I’d dropped in to say hi.

* * * *

The phone woke me near midnight mat same evening. I was in my own bed at home, but at first I’d briefly thought I was back in that accursed room at the hospital where I’d spent the last two nights. I fumbled with the receiver, heard a nurse from St. Paul’s excitedly identify herself, and shook myself out of a deep sleep to concentrate on her words.

“...yet he’s febrile, in acute respiratory distress, and shocky, just like the Sanders woman,” she exclaimed, “but he won’t let us intubate him until you get here.”

I instantly thought of Deloram. “You mean Stewart’s going shocky?” I blurted out, immediately wide awake and sitting bolt upright. “But he was stable when I--”

“No, Dr. Garnet, I’m calling from ER!” she exclaimed, her voice suddenly cracking with what sounded like barely controlled sobs. “It’s Dr. Popovitch. He was brought in by ambulance a few minutes ago. He’s septic, wheezing like hell, and everyone’s afraid he’s about to shut down his airway and have a respiratory arrest. But he’s refusing to let anyone intubate him until he can talk to you. Please hurry. He’s so hypoxic he’s out of his head. He keeps insisting someone has deliberately infected him.”

* * * *

My drive into St. Paul’s was a blur of rain, speed, and gut-tying fear. Michael, septic, in shock just like Sanders, the nurse had said. How could he have let anyone near enough to infect him? Was he going to die like Sanders? Who was next?

Half the time I couldn’t see through the torrents pouring over the windshield despite the wipers, but there was little traffic, and each time I thought of Michael’s arresting before I got there I went faster. The car shuddered and pulled from side to side as the wheels plowed through deep collections of water lying across the road. My hands strained to control the steering wheel but I refused to slow down.

“Damn your stubbornness, Michael!” I yelled as spray roared up against the underside of the car. But it was myself I blamed. Why hadn’t I screamed my bloody head off days ago and forced everyone to face what Janet had suspected from the beginning? We might have frightened off the Phantom. Why the hell had I even listened to Michael’s concerns about my credibility and what Rossit could do to my career?

The car nearly careened out of control as I sped down the off ramp and flew through the deserted downtown streets. Don’t die, Michael. Don’t you damn well die, I swore, tears welling up in my eyes and blurring my vision even more.

* * * *

He stopped breathing seconds after I ran into the resuscitation room. I think he might have seen me as I burst through the door. His bearded face was lolling, his eyes were bulging as he stared in my direction, and one of his arms, hanging down off the stretcher, rose limply toward me, then dropped back. Despite a forest of IVs pumping him with fluid, the vascular collapse from sepsis had left his huge body looking as if it were made from glistening rolls of paste. Circled around him, a silent group of green-clad residents and nurses in protective gear stood alongside their neatly arranged trays of tubes, scopes, and ventilation equipment, waiting to resuscitate him from what was clearly an imminent arrest.

His eyes seemed to slide toward this array of instruments that would soon be in him and his facial muscles jerked into what appeared to be a look of terror, but it was the start of a seizure accompanying the complete halt of his respirations. It quickly spread through the rest of his body, curling and uncurling his limbs into cruel shaking spasms, then dropping him like a lifeless doll.

The team was already on him. They struggled to pry open his jaws still clamped shut in the seizure’s aftermath. While pulling on my own protective gear, I watched the monitors as his pulse dropped to thirty and his oxygen levels plummeted. Alarm bells started going off one after the other as other vital signs fell.

“We can’t get his mouth open to intubate,” yelled an anesthesia resident in panic.

Another resident at his side was trying to shove a trachea! tube into Michael’s nose and attempt a blind intubation down through his nasopharynx. In his nervousness, he forced the delicate maneuver, failed to get the airway, and produced a hemorrhage. It didn’t last long. The near dead don’t have the blood pressure it takes to bleed. All the monitors were flat but for an occasional heartbeat.

The nurses were beside themselves, screaming useless instructions.

“For Christ’s sake, get a tube in him!”

“I’ve lost his pressure. Pump him!”

“What about atropine for the bradycardia?”

But what he needed was an airway and ventilation. I finished snapping on my gloves, stepped to the head of the stretcher, and shoved aside the residents. “Give me a soft nasal pharyngeal tube,” I ordered the nearest nurse. She handed me a flexible six-inch hollow piece of latex the size of my little finger. I added some lubricant and slid it easily up the nostril that wasn’t bleeding. I felt it readily curve down along the contours of the nasopharynx and its tip push past me base of his tongue which had fallen back to block his airway. There was a slight rushing noise through the near end of the tube that was still sticking out of his nose. His chest muscles and diaphragm were reflexively starting their movements of breathing again, now that the way to the lungs was open. But the effort was weak. We helped him out with a ventilating bag, the residents pressing the mask to his face to avoid leaks while I forced oxygen through the nasal tube into his airway and filled his lungs. His pulse and blood pressure rose immediately, the seizure in his jaw broke, and his mouth dropped open, the muscles slack. Within minutes we had him intubated the regular way, on a respirator, and ready for ICU.

The nurse who’d spoken to me on the phone led me into the corridor outside the resuscitation room. Her eyes were red, and she still was having trouble keeping her voice from shaking.

“Will he make it?” she asked.

“I hope so” was all I could tell her.

Then she started to cry and turned away. “I’m sorry,” she said, fumbling for a tissue, “but I’ve never had to resuscitate one of our own before. And Michael’s such a powerhouse here. It’s hard to see him like mat...” Her voice trailed off, and she had to use her tissue again. “He was barely able to talk more than a whisper,” she continued when she had control over her tears, “and even then, he could only gasp out a word at a time. As I said, he was obviously delirious. But he was desperate to speak with you. He got increasingly afraid he wouldn’t hold out until you got here and begged for a pen and notepad.” She reached into her pocket and handed me a folded piece of paper.

I thanked her, quickly turned away, and unfolded what was a scrawled message.
The Phantom is real. Check the charts! The pattern!

PART TWO

Prodrome

Chapter 12

A glance at my watch told me it was 1:00
A
.
M
. I was at a loss what to do. I wanted to know what charts Michael had been checking— wanted to see them for myself—but didn’t even know for sure which charts he meant. Janet said on Friday he’d gone to look at the records of the Phantom’s first victims—the same records Janet had wanted me to see the night I got attacked in the subbasement. But he’d done that a couple of days ago. Had he found something else in the meantime? Had he been poking around during the weekend?

“Dr. Garnet,” one of the nurses said, touching my arm.

I was leaning against the wall just outside the resus room, still staring at Michael’s note, lost in desperate thoughts.

“Dr. Garnet,” I heard her repeat, “we put Dr. Popovitch’s wife, Donna, in the grieving room, to give her some privacy. She came in with him in the ambulance and is obviously upset. Could you speak to her about her husband?”

At that moment an orderly wheeled Michael out of resus and down the corridor toward the elevator that would take him to ICU. He was completely still, the tube protruding from his mouth distorting his lips and cheeks into a grotesque sneer that made me think of the rictus of death. “Oh, Michael, my poor friend,” I said softly, watching the winking lights of the monitors recede up the dark passage.

I tried to prepare what I would say to Donna as I crossed the waiting area. Even at this hour there were more than two dozen people in the place, waiting either to see a doctor or to receive lab results and the final verdict of their examination.

When I opened the door to the grieving room. Donna looked up, saw me, and said, “No!”

“He’s alive, Donna,” I quickly told her. “We got him full of IVs; he’s breathing on a respirator and being pumped full of erythromycin as we speak.” I walked over and put my arm around her shoulders, continuing to talk, afraid to give her time to ask questions. I didn’t trust my usual capacity to hide from a family member how frightened I was for his or her critically ill loved one. “He’ll be in ICU and you can see him there in a few minutes. But remember, he’ll be sedated to keep him comfortable on the respirator. When he gets a bit better...”

While I talked she stared at me, her brown eyes brimming with tears. Black curls, cut off at shoulder length, framed her attractive face, but fear had driven away the flush of pregnancy. The contrast between dark hair and pale skin left her looking ghostly. “What does he have. Earl?” she interjected. “And tell me straight what it means, especially if there’s any risk for the baby.”

In other words, cut the crap. I took a breath and leveled with her. “We presume he has
Legionella,”
I told her solemnly. “Healthy adults like you shouldn’t get it. There’s never been a case recorded of person-to-person transmission, so you and the baby are in no danger.”

She seemed to sit up straighter, swallowed, and tremulously asked, “Isn’t that what killed the nurse from UH whose infection he was investigating?”

“She had two infections, Donna, one of them a very virulent form of staphylococcus. It’s not the same with Michael. His airway wasn’t full of pus when we intubated him. We’ll do a Gram stain on the scanty bit of sputum he does have just to be sure, but I’m certain it will be negative, unlike what we found in the nurse.” A little later, so as not to scare her more now, I would suggest she be screened for staph, simply as a precaution.