Death Rounds (45 page)

But another one was already on its way.

“Dr. Garnet,” said a nurse at my elbow. “I was sent to get you.” She led me away from the window. I didn’t like the look in her eye. “About a dozen people in the special quarantine ward seem to be coming down with
Legionella,”
she told me in a hushed voice.

* * * *

I scribbled a message to Riley.
Get more men on the door to special quarantine. It’s starting!
I gave it to the nurse who had found me and told her it was for his eyes only.

The wing Fosse had opened up contained two wards, each with twenty rooms, four beds to a room. I noticed a few newcomers were being led to these quarters. “Day people,” explained a nurse. “They weren’t contacted in time to be directed elsewhere.”

Even through my mask I could tell the place was beginning to have the odor of too many people not having had a shower. Fosse would have to arrange for changes of clothes and toilet articles to be brought in for everyone here as soon as possible. Civility often started with a bar of soap.

Two members of Cam’s department who hadn’t been in the archives had already confined the suspect cases I was to see in three rooms at the end of a corridor. As I got near, no one had to tell me that their symptoms included diarrhea.

“We’re sorry to call you, Dr. Garnet,” said the younger of the two physicians after they’d both introduced themselves, “but we know you’ve seen the only other case involving both organisms—the Sanders woman—and, well, the whole situation is so bizarre we wanted your opinion, to make sure we weren’t overdiagnosing anyone.”

They weren’t. While none of the twelve was very ill yet and they all had flulike symptoms similar to those of the three nurses I’d seen last night, they also demonstrated postural hypotension and the slightly abnormal blood results—namely low sodiums and albumins, with slightly elevated white cell counts—characteristic of early
Legionella.

None of them could believe something so serious could begin so benignly. Over and over I heard, “Except for a bit of dizziness when I stand up and the occasional runs, I don’t feel that bad, Doctor.” But they were scared. “Will I be all right?” they kept asking.

“I’m certain you will,” I kept saying.

Some studied my eyes, and I’m sure they saw the lie. My dread of what would become of them in the next twenty-four hours was so strong that they couldn’t have helped but sense it.

After examining everyone, I huddled in the corridor with the two ID specialists. I knew there was nothing I could tell them about the conventional treatment of
Legionella
or staph that they didn’t already know. What they wanted from me were my observations on how these particular
Legionella
and staph infections varied from the norm. “Smokers will get it the worst, of course, but even the young ones could be in trouble. The usual age ranges don’t seem to apply,” I advised them.

The older of the two—I estimated he was about my age—raised a skeptical eyebrow. “That’s hard to believe.” His junior colleague flushed above his mask. I suddenly sensed that there was a dispute between the two men and I’d been called in as a third opinion.

“Look, I’m just telling you what I’ve seen,” I said to the skeptical one. “Like you, I can’t explain how these people are being infected.”

The younger specialist whistled. “Man, however this creep’s doing it, he must be giving them a hell of a dose over a protracted period of time—”

“What else?” the older man asked me, cutting off the speculation of his younger colleague.

I answered quickly, not wanting to get drawn into their fight. “Even to know whether the oral erythromycin we started them on last night has some attenuating effect, we’ll have to wait and see. However, I think you can expect the IV treatments they’re on now to work well with the nonsmokers, as far as the
Legionella
infections are concerned. But staph remains the real problem for them all. The first sign of it will be their sputum turning purulent. At that point, they’re terminal.”

* * * *

While I wrote my clinical notes—the other staff confined to the ward had prepared charts for each of their sick colleagues—I could tell the nasal lavaging had begun. Gagging noises started coming from the direction of the rooms I’d just left, and as I endured the sound, it was all I could do to keep myself from retching.

No sooner had I walked out of the ward and headed for the exit than a figure ran toward me from the opposite hallway. “Dr. Garnet,” yelled an unpleasantly familiar voice. “Wait, please!”

She came right up to me and grabbed the front of my gown. Her eyes looked frantic. “Please, Dr. Garnet, I don’t belong here. They didn’t reach me at home in time to direct me somewhere else. Now that I’m here, they say I’ve got to stay. You’ve got to make them let me out!”

I reflexively put my hands on hers and tried to pull them off me. “Really Miss Brown, this is not appropriate. Whatever you think, this is for your own safety—”

“Safety!” she shrieked. “I just found out that whoever’s doing this—some are saying it’s the Phantom again—has already tried to kill me once, that he gave me my
Legionella
infection. I’ve got to get away. He’ll get me again, I know he will!”

“Miss Brown!” I said as loudly and as sternly as I could without actually yelling. “Get a grip on yourself, and think. He can’t get you with
Legionella.
It has a way of granting immunity, through your white cells, and you’re protected. But he’s also got a staph organism that no one can treat, and your safest place right now is here. Remember, you got ill last time when you were on vacation. We don’t know that he didn’t infect you outside of the hospital. In this ward you’re under guard.”

“No, please,” she persisted, holding my hands in a viselike grip, “I’m sorry about what happened to your wife. Please, it was an accident. I never meant that to happen. I never ever wanted that!”

All at once I felt so angry that I had to use every ounce of self-control I possessed not to tell her how much she disgusted me. “I told you, get hold of yourself!” I was shocked by the hardness that I heard in my own voice. Over her shoulder I saw Miller and his team of technicians being allowed past the guards and into the hallway where Brown and I were standing.

I don’t know if he heard much of our exchange, but he stepped over and said, “Hi, Dr. Garnet. Quite the job, isn’t it?” His mask couldn’t completely hide the pouches that had formed below his eyes from lack of sleep, but there was no evidence of fatigue in his voice. “Can I be of any help?”

I nodded at him, then suggested, “I’m sure Nurse Brown would appreciate it if you did the screenings on her yourself.” I released her hands and stepped away. She looked from me to Harold Miller, her fear still very evident in her eyes.

Miller stepped over to her, took her by the elbow, and gently said, “I’ll be glad to. Come, we can do it over here on this bench.”

While I discarded my protective gear at the doorway in exchange for a clean set, I watched Miller carefully help the woman off with her gloves and begin culturing her left hand. She nervously raised her right fingers to her mouth and started biting on her nails. He shook his head and pulled her arm back down in her lap. I could hear him talking quietly as he worked, and though I couldn’t make out the words, he must have been saying the right things, because I thought I saw Brown’s shoulders relax a little.

* * * *

I quickly ran to ICU and again checked on Janet. Once more her vitals were stable and her sputum remained nonpurulent, but this time I sensed all the nurses were more guarded in their replies to me. I knew why instantly. Lurking unspoken among them was the knowledge that today or tomorrow, as the pneumonia ran its course, they’d know whether Janet had also been infected with staph. They were instinctively taking their professional distance from both of us, preparing themselves to have the clinical objectivity they’d need if the worst happened. Janet was awake when I went into her cubicle.

“From the eyes up, you look worse than me,” she said hoarsely, then started coughing uncontrollably.

I ran through the night’s events, but not wanting to frighten her more, I left out the attack on me and Williams. Fosse had had the telephone lines reestablished, so we then called Amy at home. She was desperate for word of us, having watched all the TV coverage, but we settled her down with multiple reassurances that we were okay. When she held the receiver up to Brendan, we made tender noises at our son and listened to his happy babble, escaping for a few blissful minutes the nightmare that had trapped us. After hanging up, the feeling of being cut off from him hit me like a weight. From the desolate expression in Janet’s eyes I knew she was battling a similar feeling. I don’t know who broke into tears first, but we held each other for what seemed like a long time before either of us could stop.

“Call and check on Michael,” Janet quietly ordered me when we’d both dealt with our sniffles in the aftermath.

I punched in the number for St. Paul’s intensive care unit and endured the usual wait for someone to pick up the phone.

“ICU,” answered a woman’s voice.

“It’s Dr. Garnet. I’m calling to inquire how Dr. Popovitch is doing.”

“One moment please,” she said coolly and put me on hold.

Oh Jesus, I thought. Janet immediately sensed my alarm. “I’m on hold,” I whispered to her.

The phone clicked. “Earl, it’s Stewart Deloram speaking.”

My fear reached the screaming point.

“Stewart, why are you there?”

“I’m half back in the saddle, helping out a bit,” he said quickly. “But I’m afraid I’ve bad news. Michael’s sputum became purulent overnight. We’ve done Gram stains of course, and the only glimmer of hope is we can’t see staph. The pus may be debris from parts of the lung where the
Legionella
has knocked off the circulation, but in any case he’s not doing well.”

The words thudded on me like rocks at a stoning. I could barely speak. “Does Donna know?” I asked. Janet’s eyes widened in panic on hearing the question. “He’s alive,” I whispered, covering the mouthpiece for a second.

“Yes, of course. She’s handling it very well.”

There was nothing more to say. Stewart was initiating the routine to prepare the family for death.

“Stewart, I’m glad you’re there,” I told him, then hung up before he could ask me anything about the situation here.

This time Janet and I didn’t cry. I think we felt too emptied by the shock. We simply held each other and rocked.

* * * *

Williams had prevented a riot, but he hadn’t managed to defeat his greatest nemesis—panic. Despite his best attempts to get everyone to stay rational—the media, the crowds of people outside, and most of all me politicians—he couldn’t convince them that the isolation procedures and the plan to replace our own staff with outside personnel were measures enough to keep the patients safe.

It was a little after 10:00 when I found him standing by the same window I’d been looking out earlier. He was slumped against its frame, shaking his head, and staring at the scene below. “The mayor and governor folded to the pressure,” he said forlornly without turning his head. “They’ve ordered the evacuation of the patients.”

Below us was the largest number of ambulances I’d ever seen parked in one place. The drivers were lounging against the doors, chatting and waiting—all of them wearing masks, gowns, and gloves. Farther out a few dozen army trucks had been backed up to the edge of the parking lot, their tailgates down. Those drivers were also in protective gear as they relaxed, sat around, and in some cases even snoozed in their cabs. The media and crowds had pulled back toward the outer edge of the property. Half hidden in the mist, they stood quietly observing us, waiting for our next move, like a chorus fallen momentarily silent but still ready to offer its commentary.

“We’re to start moving out the patients at 10:30,” Williams informed me as he walked away.

* * * *

Once the word was given to get ready for the evacuation, the patients had gotten more nervous, not less. During the hurried preparations, I saw masks half tied, gowns left open at the back, and gloves not pulled up properly over the ends of sleeves. If by a remote chance one of the evacuees had already contracted the superbug, these half-assed measures wouldn’t be much protection against it being spread around once he or she got outside.

Those who could walk milled about the exits while waiting to leave, some pushing their own IV poles. Those who weren’t mobile sat in wheelchairs, orderlies standing at the ready. Staff had transferred the bedridden to stretchers and would roll them to the backs of the waiting trucks. It looked like the starting line for a bizarre race.

Williams had told me that hospitals all over the county were making isolation facilities available to receive our transfers; even military installations had opened up. Off-duty medical personnel from other institutions, called in to take over, would care for the patients we’d be sending them. The staff of UH, including those not in the target group, were meant to remain in quarantine here, until the culture results cleared them to leave.

At 10:30, floor by floor, they started out. Despite shouted orders to go slow, the people who could walk inexplicably rushed to get downstairs, crowded into elevators, or tried to pass the person in front of them as if a few seconds longer in the place could be fatal. The ones on wheels were at the whim of their drivers. The whole process was as frantic as if someone had cried, “Abandon ship!”

I was asked to join with other physicians to assess high risk patients in critical-care areas—unstable cardiacs, patients in shock, those on respirators, the list was endless—and pronounce on their suitability for transfer. It didn’t take long to see that in some cases the trip would kill them. On the issue of no risky transfers being made the physicians stood firm. ICU here would remain fully operational, security would be provided around the clock, and nobody would be allowed near any of the remaining patients without an order countersigned by two other doctors. Acute resuscitations would only be done by the two intensivists on site. In other words, no one could come close to a patient on his or her own initiative and slip them something.