Chapter 27
Jake
H
e felt a tap on his shoulder.
“You’ve seen the newspapers, I assume.” Farley spoke in his usual way, authoritative and fearless, the way ICU docs always were. It was a voice Jake could trust.
“Yeah, read all about it.” He liked this guy. Didn’t have to second-guess his medical decisions. Farley had, after all, probably twenty-five years of experience in critical care medicine and was the fellow ultimately responsible for whatever happened to Eddie; at least for what happened while in his unit.
“Hopefully the reporters haven’t been pestering you.”
“They’ve tried, but my mother-in-law’s manning the phones at home and she’s a brick wall.”
“I’m always amazed with the fear-mongering the press applies to infections . . . Lyme disease, flesh-eating bacteria, West Nile virus, meningitis. A person is one thousand times more likely to be in a car accident than to get any of those rare infections, but . . .”
Farley stopped midsentence. “I made that up, you know. That statistic. But I bet it’s close.”
They neared Eddie’s crib. The closest side rail was down. Jake’s knee-jerk reaction was to yank it up. But there was no risk—Eddie wasn’t going to roll to the floor, wasn’t going to roll anywhere.
Anna sat beside the crib, her head resting on her arm. She lifted her eyes toward Farley with the expectant, reality-weighted look of a mother who seeks a thread of good news from a doctor, yet knows, deep down, he has none to give.
“Our day care lady’s been bothered by the reporters,” she said. “Now she’s scared to death the health department’s going to shut her down.”
“Oh, brother.” Farley shifted to the other foot. “I’ve spoken several times to their director. He’s a pretty sharp guy who has a huge mess on his hands. Even though every parent—at least every reporter—in the state thinks we have a meningitis epidemic here, apparently we don’t.”
Farley turned away from Anna, toward him. “That fellow from the health department, Klug . . . Myron or Martin or whatever his name is . . . told me just a few minutes ago that all three of the kids with bacterial meningitis—Eddie and the other two boys—have
Strep pneumoniae
, but they are different genotypes, so the cases aren’t related.” He folded his arms over his chest and then continued. “The four-year-old girl, the one on the pediatric ward downstairs, had a sterile tap. Apparently she received a couple doses of amox for otitis, so it’s not clear yet if she has bacterial meningitis or not. Klug is waiting for the enteroviral PCR on her spinal fluid from the state lab.”
Anna looked confused. Jake could tell by the twist of her jaw. She wouldn’t have understood a thing Farley had just said and would be mad about it. He wanted Farley to talk to her, to use words and concepts she could understand. He was tired of trying to explain medical information to her.
“That girl is Amanda, from Eddie’s day care.” Anna stroked Eddie’s leg. “Did she catch it from him?” Her eyes narrowed. “Or did he catch it from her?”
“Well, that isn’t clear,” said Farley, turning toward Anna. “Her culture didn’t grow any bacteria. It’s possible she has the same germ as Eddie, but the antibiotics she received for her ear infection—at first her pediatrician thought she had an ear infection—might keep it from growing in the laboratory. Even if they had the same germ, it’d be impossible to know who gave it to who . . . uh, to whom.”
Farley spoke directly to him, again. “If her spinal fluid shows enterovirus, then, of course, the cases aren’t related at all and it’s an uncanny piece of bad luck that two kids in the same day care came down with different kinds of meningitis about the same time. Since the bacterial culture is negative, if her enteroviral PCR is also negative, then we don’t know what kind of meningitis she has.”
He studied Farley’s face, the wise eyes flanked by crow’s feet, the narrow lips. News for his patients—both the good kind and the bad—slipped through those lips with aplomb, very often.
Anna shook her head and looked down at her lap. Suddenly her eyes grew huge and she sat up straight. “What about Chris? Could he get the same thing?”
“Anna, we’ve talked about that,” Jake said. “I told you
Strep pneumo
isn’t contagious. Chris wouldn’t get it from Eddie.”
“I’m asking Dr. Farley.” Her steely eyes drilled into him, daring him to interfere.
“Has Chris had the Prevnar vaccine?” Farley asked.
She shrugged. “That, again. I don’t know exactly what he’s had, except he’s gotten everything he should.” She leaned against the back of her chair. “Eddie had that vaccination and he still got the infection.”
She’s so unpredictable, he thought. First she forgets the discussion they had about contagion and now she’s invoking second-order logic.
“According to Dr. Klug, Eddie’s germ is serotype nineteen A, which isn’t in the vaccine.” Farley proceeded to explain serotypes to her, saying that the vaccine contained only seven of the ninety types and, thus, didn’t prevent all
Strep pneumo
infections—only the most common ones. “Recently, we’ve seen a few infections with the serotypes that aren’t in the vaccine,” he added.
“So where does that leave Chris?” Anna scratched at a slub in the crib sheet. “If Eddie had the vaccine and still got the germ, couldn’t Chris get the germ even though he’s had the vaccine?”
“That’s unlikely.”
Farley was very tolerant of Anna’s inquisition, Jake thought. If Eddie were his own patient, he would have been fed up with this conversation by now. Some mothers just don’t quit.
“Unlikely?” Anna murmured, tipping her chin.
She didn’t miss an opportunity for a trap, Jake thought.
“Really, really unlikely,” Farley said. “
Strep pneumoniae
meningitis doesn’t seem to spread from person to person.”
“That’s what we discussed earlier, Anna,” Jake said, again.
“Then how could Amanda get it?”
“Uh . . .” Farley seemed to be thinking. Maybe even he had come to the end of his rope with Anna’s questions. “Well, of course, we don’t know that Amanda has it.”
“It makes no sense.” Anna’s voice became shrill as she straightened the flannel blanket that covered Eddie’s chest.
“Well, it does to me,” Jake said. Why was she asking so many questions? She was expecting explanations where there were none, at least not yet. “Chris’s fine. If he starts looking sick, we’ll race him to the ER, but otherwise we’ll just watch him carefully.”
Farley patted Anna’s arm. “That’s a good plan. Understandably, you have a lot of questions. The problem is . . . we just don’t know what’s going on with these cases right now. After we get all the information, it should make a lot more sense, both to you and to us.”
She turned away from Farley. Her brow furrowed. “Are you sure it’s okay, Jake?” Her voice was hard. Her glare was fierce. “Are you really sure or are you just saying that?”
“Yes, I’m sure.” What did he have to do to make her stop the questions?
“Well, you had it wrong the night Eddie got sick.”
“That’s the limit, Anna,” he yelled and slammed his fist against Eddie’s crib. “You’re over the line. You also had it wrong the night Eddie got sick and you were there. I wasn’t. Remember, Eddie’s my son, too, and you blew it that night.”
The sound was like a muffled scream. It came from her, from behind the Kleenex she held to her mouth. She was sobbing. He had hurt her deeply. What kind of a husband did that to the woman he loved, to the mother of his children?
“I’m sorry, Anna,” he whispered. “I need a break.” He turned from Eddie’s crib, walked past the nursing station, out the sliding glass doors of the ICU. He couldn’t help her now. Let Farley handle his wife for a while; that’s his job.
He sat at the desk in the residents’ room and dialed her number, the one he had written on the back of the pizza receipt.
A woman’s voice answered, “Pediatric office. How may I direct your call?”
He stuttered, speaking in a slightly muffled voice. “This is, uh, doctor, uh, Jacob Campbell from Michigan. I’m trying to reach Dr. Daley.”
“Is this about a patient?”
“Well . . . yes.” Eddie was a patient. That wasn’t a complete lie.
“Name? If you give me the patient’s name, I’ll get the record for Dr. Daley.”
“Oh, she doesn’t know this patient. I want her opinion about a patient here.”
“Okay, Dr. Campbell. I’ll track her down.”
In seventeen heartbeats, she was on the phone.
“This is Dr. Daley.”
He froze. That voice. It hadn’t changed a bit over the past eight years. Its melodic sound, still crisp, still somewhat husky and slightly lower than many women’s voices, paralyzed him. He couldn’t speak.
“Hello? This is Dr. Daley.”
“Hello, Monica. This is Jake Campbell.”
“Jake . . . When the secretary said it was Dr. Jacob Campbell, I didn’t make the connection.”
“I’ve been wondering about you and learned that you practice in Maine. Thought I’d call and catch up.” He sat back in his chair, tried to make himself comfortable, but his muscles refused to relax.
“I’m actually considering a move,” she said. “There’s an attractive position at a health center in Vermont and I’m thinking of relocating. The pay is good, the hours reasonable.” She said nothing about a husband.
“And, you?” she asked. “What are you up to?”
“Actually,” he said, “we’re having a tough time right now. Our baby—he’s six months old—is in the ICU with
Strep pneumo
meningitis.”
“Oh, Jake. That’s awful.” She sounded distressed, unnerved. “Just awful.”
He told her about the serotype 19A strain, about the events of the ICU stay. “He may be extubated soon and seems to be holding his own. We don’t know about neurologic sequelae, but, as you can tell, it doesn’t look real good.” Talking to her was like swimming in a calm, warm lagoon. She understood Eddie’s disease, knew all the devastating possibilities. He could use their medical language, didn’t have to define any of the technical terms.
She said she wished he and his family didn’t have to go through all this.
“If you move, what about your family? I guess I’m asking . . . do you have a husband and kids that have to move, too?”
“No. Neither. I’m still running solo. I enjoy my freedom, enjoy traveling with my friends. We—my friends Al and Michael and I—just returned from Tunisia. It was a great trip . . . Hold a sec, Jake.”
She must have muffled the phone with her hand. He could hear her talking but couldn’t make out the words.
“Sorry for the interruption. Nurse had a question.”
“I know you’re busy and this isn’t a great time to talk. Perhaps we can catch up in more detail later.”
“That would be great.” She was quiet, then continued. “I’ve been thinking of a trip to Michigan to visit my mother—she still lives in the Thumb. I’d like to see you again.”
His heart was pounding. Was that what he wanted? Was that why he called her?
Finally, he said, “Thanks, Monica. I’m glad we had the chance to talk. When you’re in Michigan, give me a call and maybe we can have lunch or something. I hope all goes well with your move.”
“Good-bye, Jake,” were her final words.
What could it hurt if they had lunch? Chances were good she wouldn’t call on her next trip home. Likely she’d returned to the Thumb during the intervening eight years and hadn’t contacted him.
He was very tired. His head ached.
Chapter 28
Anna
N
ow what day was it? Sunday? Monday? She had lost her sense of the earth’s rhythms. The arrival of morning, the coming of night seemed to have no meaning. Time stood still in the waiting room, that bottomless dungeon without windows. She closed her eyes to banish the view but she was still there. The coughing, the scraping of shoes on the indoor-outdoor carpet, the rustle of papers, the squeal of the seat cushions—endlessly, endlessly. They never stopped. Those sounds wrapped around her like a prickly sweater.
She opened her eyes and watched Charlotte step into the room—she held a cardboard cup of coffee in one hand, a bagel in the other—trailed by her husband with a hot dog and a can of Vernors. The father who wanted Eddie’s liver for his little girl snored softly on the couch beneath his blanket. These people, as oppressive as sweaty shirts or smelly socks, were suffocating her. What time was it, anyway? Did it matter?
Earlier, as she sat in the chair beside Eddie’s crib, the portable X-ray machine had rumbled into the unit. Later—was it two minutes or two hours later?—she had been jolted awake by the sound of the machine being pushed back out between the beds. How many X-rays had the technician taken? One? Four? Thirty?
Even earlier, the nurse had drawn a blood sample from Eddie’s IV line, then another nurse emptied his urine bag, recording the volume on his bedside chart. “I’ll see you tomorrow,” one nurse said when her shift ended. Another had said, “I’m off the next three days—if Eddie hasn’t moved to the pediatric ward, I’ll see you Friday.“ Round and round they went.
She should have been accustomed to crazy hospital schedules; that was the way Jake worked—all night every third to fifth night except the month he had been on a pathology rotation; sometimes on weekends, sometimes not. Before Eddie got sick, she longed for regularity and predictability and order but had to adapt to Jake’s unscheduled schedule because she couldn’t change it. She still longed for regularity and predictability and order, but she wanted it for herself. Now Jake’s schedule had little impact on her.
Slowly, she turned the pages of a magazine, watched the colors move first from right to left and then become buried in the pile of preceding pages. Photos of dining rooms, of ski vacation retreats, of greenhouse windows alive with amaryllis blossoms passed before her.
What had happened to her plants? she wondered. She had coaxed the gardenia along since last Mother’s Day; the Christmas cactus had burst into a torrent of fuchsia after Thanksgiving. Sunday was her usual plant-watering day. Then she remembered—she had watered them on Saturday afternoon when she was home.
What was today? She had gone home on Saturday. The days melted together—like butter in the sunshine—into a very long stretch of endless time. She glanced again at the magazine in her lap, the January issue, with recipes for beef stew and chicken ’n’ dumplings and gourmet macaroni and cheese—hunker-down food for dark, cold winter days. She knew it wasn’t January; they had had that month already. But, they hadn’t had Easter yet.
Saturday she had been home. Rose Marie had visited on Sunday; she’d come just as the loudspeaker announced mass in the hospital chapel. So, today must be Monday.
She saw a flash of movement straight ahead—the wave of a hand or the nod of a head—and looked up from her magazine. There, across the room in the doorway, stood Chris. She set the magazine on the table beside her and started up from her chair.
The hem of his
Lion King
T-shirt hung almost to his knees. His shoes—the kind that blinked when he walked—stood motionless. A deep frown shrouded his eyes.
Yet, he looked like a prince. A long-missing, now-found treasure. It was like a dream—her son here at last. “Chris, honey,” she called, “come here.”
“No,” he said. She could barely hear him. His body remained still, framed by the doorway.
“Honey, come here,” she called again, trying to mold her voice into a kind and welcoming sound. She knew it was a B-movie voice, phony and saccharine. But maybe it would draw him to her.
Jake appeared behind Chris and prodded him forward. The boy’s chest arched into the room under the pressure of his father’s hand, but his feet remained planted in the doorway. “I don’t wanna,” he murmured in a whiny voice. His eyes looked past Anna. His face was contorted into an ugly, defiant scowl.
“Move it, buddy.” Jake pushed against his son’s shoulders.
Chris tried to wiggle away from his father’s grip, but his feet stayed put. “NO,” he called.
“What’s wrong, Chris?” Anna asked. Why didn’t he want to see her? “Come here.” Why was he being so difficult? He seemed bedeviled. “Show us how your shoes blink.”
Chris clapped his hands over his ears and squeezed his eyes shut.
Dark energy, an ominous, threatening force, wove through the room. The usual sounds—murmuring, running water, scraping chairs, slamming doors—were gone, replaced by a cold, expectant silence. The other parents were staring at her, waiting to see what she would do about her naughty child.
“For Christ’s sake,” Jake said, “what’s wrong with you?” He lifted Chris by the waist and carried him to her chair. The boy thrashed his arms and pedaled his feet. His loose shoelace jerked beside his foot like a rat’s tail.
Jake set Chris on the floor in front of her. She wrapped her arms around him and drew his tense, reluctant body to hers. “Poor baby,” she whispered, kissing his earlobe.
“Don’t let him get away with that,” Jake said.
She pulled Chris into her lap, turned a lock of his hair around her finger, and let him nuzzle into her chest. The warmth of his body was soothing and familiar. “He’s frightened.”
“I don’t care what he is. We can’t let him act this way.”
She glanced toward the other parents and then whispered, “Please, Jake.”
He sighed and dropped into a nearby chair, his lips drawn into a firm line.
“Tell Mommy what’s wrong,” she murmured to Chris. “Are you scared about something?”
Chris slowly shook his head.
“Are you mad Mommy left you?”
His eyes narrowed.
She rocked him back and forth, repeating in a singsong voice, “It’s okay, Chris, it’s okay. It’s okay, Chris, it’s okay.” Over and over. Slowly he relaxed, his arms and legs loosened. He smelled fresh as clean laundry.
While she sang Chris’s name, she turned toward her husband. His eyes were rimmed in red, his mouth was now pursed, the hollows of his cheeks were deeper than she had seen them before. She hugged Chris even closer against her chest.
“Jake, please don’t be like that.”
He said nothing.
“Please.”
“Like what?” He refused to look at her.
“Like a jackass.”
Jake closed his eyes and leaned his head against the back of his chair.
Chris shifted in her lap, drove his knee into her belly. She groaned and then moved his leg. She heard the sound of rushing water from the other side of the wall—the flush of a toilet. Chris lifted his head at the noise, then buried it against her again.
“This visit hasn’t worked out very well, has it?” Jake said. “I told you it wasn’t a good idea for Chris to come here.”
“Where’s Eddie?” Chris spoke into the folds of Anna’s blouse.
“He’s in the other room.” She pointed toward the door into the ICU. “Over there.”
Jake’s pager sounded. He unhooked it from his belt, squinted at the message, sighed, and pulled himself up from his chair.
“Gotta run. This’ll be quick and then I’ll take Chris back home. Okay, buddy?”
“Yeah,” Chris answered. His voice was timid, quiet.
Back home. Chris would have to go back home. She felt as if she’d been ripped apart. Chris had to go home. Eddie had to stay here. It was a twist on the Solomon story. Rather than threatening to chop the baby in two, for her, the mother was being chopped in two. If there was a Heaven, Solomon was up there in his white robes telling Saint Peter that Anna Campbell was destined to hell.
“Thirty-nine point two,” muttered the evening nurse as she pulled the thermometer away from Eddie’s armpit. “Wonder what that’s all about.”
“Huh?” Anna stood at the window, and watched night creep over the hospital grounds below. Someone lowered the window shade in the opposite wing of the hospital. An ambulance screamed down the street and around the corner. She turned toward the nurse. “What did you say?”
“Eddie’s temperature is thirty-nine point two.”
“What’s that in Fahrenheit?”
“Let’s see . . .” The nurse stared into the corner of the room, tipped her head first to the left, then to the right. “About one hundred two.”
“That’s way too high.” She scrambled from the window to Eddie’s side. “Why does he have a fever?”
“Don’t know.” The nurse shrugged. “I’ll tell the resident on call. I don’t think they ordered anything for fever.”
Eddie’s forehead seemed more flushed than usual. The skin on his chest was blotchy. She laid her palm on her son’s leg and felt the heat of his body. She drew her hand away. He was too hot.
A sour taste tinged the back of her throat. She swallowed hard. Maybe the meningitis was back. Maybe he had a new infection. She touched his flushed forehead. It also was too warm. How could anything else possibly go wrong?
For the next half hour, she stroked his skin, trying to rub away the fever. Her fingers tracked the curve of his hip, the mound of his belly, the plane of his chest that rose and fell with the rhythm of the ventilator. She avoided his left wrist so she wouldn’t disturb his arterial line. Her touch lingered on the right side of his neck, where the skin was soft as dough and she could feel the reassuring throb of his pulse.
The nurse checked his temperature again. “Thirty-nine point six this time.” She wrote the number on his bedside chart.
Anna glared at the nurse, at her raw hands, at the strands of gray threaded through her dull hair. How could she be so blasé about this? He had had a high fever a week ago and it was meningitis. He had almost died. He could still die, and this nurse seemed unconcerned about the fever.
“Why should he have a fever now?” She wanted to grab the nurse’s wattly neck, to make her care about the fever.
“Could be lots of things. I’ll see if I can get something ordered for it.”
The nurse disappeared around the wall of Eddie’s cubicle.
Anna dropped into the rocking chair, covered her face with her hands. She felt hollow, empty as a grave. She tried to keep from weeping, was tired of crying. She needed to stay strong.
“Mrs. Campbell?” A woman in a long white clinical coat, its bulging pockets accentuating her hips, turned the pages of Eddie’s bedside chart as she approached his crib. “I’m Dr. Boyd. I see Eddie has a bit of a fever. Looks like it just started this afternoon.”
“What’s causing that?” Anna’s words jerked out in little gasps. She couldn’t get enough air. “Is it the meningitis again?”
“Well, I doubt that. Let’s see . . . he had
Strep pneumo
that was sensitive to ceftriaxone, so he’s been on the right antibiotic.” She turned another page. “And he’s getting a generous dose.”
Dr. Boyd ran her hand over the soft spot on Eddie’s head, listened to his chest, prodded his stomach, and tapped below his kneecaps with the edge of her stethoscope. She stepped back from Eddie, twisted her lips, rapped her pen on the crib rail twice, and finally said to the nurse, “We need to check a CBC, a blood culture, urine culture, chest X-ray.” She paused a moment and then continued, “We’d also better get a head CT.” She glanced at her watch. “Probably can’t get one tonight, but we’ll order it for the morning, and if he still has the fever, we’ll go ahead with it then.” She spoke quickly, robotically, as if she were a pilot reciting the checklist preparatory to takeoff.
“Why can’t he have it tonight?” The specter of delay flapped around her like an injured bird. “This is serious. If he needs the scan, do it now.” Never again would she wait before acting on something that seemed wrong with Eddie.
Dr. Boyd smiled. “We understand your worry about this fever. There are many possibilities, most of them not at all worrisome.”
“Like what?”
The young doctor returned the bedside chart to its hook. “Maybe he caught a virus here in the hospital. Or, maybe he’s reacting to one of his medications. Or he may have a mild pneumonia from lying so still or maybe a urinary tract infection from his bladder catheter. We’ll check a few tests to make sure he doesn’t have another serious infection, but I’m not worried about anything bad happening. His ventilator settings are normal, the nurses aren’t suctioning ugly stuff out of his trach tube, his heart rate and blood pressure are stable. Basically, his only symptom is a fever.”
Anna closed her eyes and shook her head. How could this be happening? She slumped again into the chair beside Eddie’s crib.