Authors: Patricia Gussin
The
Atlanta Daily Reporter
always was the centerpiece of dinner table conversation. Each of her kids worked part-time at the paper during their teens, and three stayed on for a careerâher oldest daughter, vice president of operations; oldest son, financial vice president; another son, public relations manager. Newspaper publishing was in the Goode family blood, past and future. But enough reminiscing, Emma thought. She had to get the spare bedrooms ready. Make up the bunks for the kids and check the fridge, make a grocery shopping list and what had she forgotten?
F
RIDAY
, N
OVEMBER
29
Stacy headed straight for Davis Island and Tampa City Hospital from the airport. She intended to page Laura as soon as she arrived, before calling Dr. Kellerman. She hadn't been in her job long enough to know whether she should have responded to Keller-man's demand for CDC input or not. Kellerman had insisted that Tampa City had a virulent staph outbreak, and Stacy had not wanted to bother her boss on a holiday weekend to get administrative clearance. Anyway about it, seeing her friend Laura in Tampa over a holiday weekend would give her the perfect cover if she was violating some government protocol by chasing to Tampa on the whim of a community doctor.
She never had visited Laura at the sprawling Tampa City Medical complex, the main teaching hospital of the Tampa Bay area. The hospital's island setting did not fit with the public health segment of Stacy's training. Not with the city smack in the middle of hurricane territory, not with the endless list of possible bridge catastrophes that could cut off the city's main hospital from the population.
Not her problem now. Her problem was to find Laura and Kellerman, evaluate the infectious disease phenomenon here, and get back to the CDC to take care of her cultures since Charles was too ill, or so he claimed. If the culprit here was a staph, the right antibiotic cocktail should work. Stacy thought about nature and antibiotic resistance. Too much indiscriminate use of powerful antibiotics seemed to dare Mother Nature to develop yet more resistant
organisms. Stacy's work was like a chess game with Mother Nature: predict her opponent's next move and have an antidote ready. Mother Nature was the ultimate winner; Stacy knew that any victory could only be fleeting.
Developing bad bugs to preempt Mother Nature's evolution was controversial, too, obviously. But, God forbid, America's enemies should launch a biological warfare attack, CDC management wanted to be ahead of the curve with antibiotic solutions to potential biological threats. A few years ago, the Fed bosses had gone paranoid about lab security, and the government terminated the CDC-NIH collaborative project. No question that her CDC research program was under close scrutiny by the army's biological researchers in Maryland at USAMRIID's top-secret facility.
She remembered that Keystone Pharma had hired a prominent scientist from the NIH several years ago. Norman Kantor. They wanted his promising drug discovery, ticokellin, for commercial drug development by the company. But recent disturbing news; Keystone Pharma had pulled the drug out of clinical studies because of side effects. Too bad. But not even ticokellin would work against the cultures in her lab.
When Stacy's cab pulled up to the front door of Tampa City Hospital, she decided to go to the information desk, introduce herself, and have Laura Nelson paged. But on the way to the circular desk in the center of the lobby, she was approached by an attractive man in fresh scrubs, looking to be in his forties.
“Dr. Jones?” he asked.
“Hello,” she said, looking straight into the man's blue eyes. Reddish hair on the long side, white skin with freckles, tall, maybe six feet.
“I'm Tim Robinson, a friend of Laura's,” he said. “I've heard a lot about you over the years. Laura will so glad to see you. Please, come with me.”
“Tim Robinson?” Stacy couldn't restrain a grin. “ âDr. Tim.' That's what the kids call you. Laura's annual Thanksgiving guest from Philadelphia. See, I know about you, too.”
“Thing are bad here,” Tim said right off.
“Natalie?” Stacy asked, keeping up as Tim headed toward the bank of elevators.
“Natalie's admitted, butâ”
Stacy interrupted Tim, “That infectious disease guy, Dr. Keller-man, pretty much demanded I come down here. What's going on?”
Tim held the elevator door, they stepped inside, and he pushed the third floor button. “We'll meet Laura in Natalie's room. She's seventeen, so they put her on the pediatric floor.”
“Seventeen. Hard to believe. Did Laura tell you that I babysat for them once when they were toddlers?” Stacy felt an icy prickle run the length of her spine. That night had ended in disaster. She had ended up in the hospital with a concussion and a dislocated shoulder.
Tim seemed to scrutinize her. “Our Laura did not share that memory with me,” he said.
Stacy had always speculated about Laura's relationship with Tim. Now as she followed him off the elevator, she imagined them as a couple. Steve had been dead for seven years, and didn't Laura deserve to have someone in her life?
And a man in my life would be nice, too
.
“Stacy, I'm so glad you're here.” Laura stood at the door to Natalie's room, gowned, her hair pushed up into a paper cap. Stacy wanted to hug Laura. But, Stacy recognized the isolation setup.
She grabbed a gown from the shelf. “Where's Natalie?” She threw on the gown over her pantsuit.
“Down for an x-ray,” Laura said. “I was going to Radiology to be with her, but now that you're hereâ”
“I'll find Natalie and stay with her,” Tim said. “You take care of business here.”
“Laura, tell me everything.” Stacy was now gloved, wearing booties and a cap as well as the gown.
They went into Natalie's private room, Stacy noting the inappropriate décor for a seventeen-year-old: clowns and cartoon characters.
“Thanks so much for coming.” Laura led Stacy to two vinyl-covered chairs in the corner of the room. “I've never faced anything like this. Patients in the ICU dying of a virulent infectious disease,
a staphylococcus, resistant to all antibiotics, including methicillin, oxacillin, and vancomycin.”
“That's what Dr. Kellerman told me,” Stacy said. “But what about Natalie? Tell me what's happening with your daughter, and then we'll focus on the ICU.” No way to make a connection, but Stacy could appreciate the tug of war between Laura's dedication to her daughter and to her patients.
“It turns out, Natalie has a boyfriend in the ICU. Yesterday morning she faked abdominal pain so I'd let her stay home. I knew as soon as Tim got into Tampa, he would check on her. But before he got to my house, she'd left to go to see the boy in the ICU.”
Stacy drew a deep breath as Laura continued, “Now he's one of the sick ones. Natalie came in close contact. His name is Trey.”
So the two are epidemiologically related. Not good at all
.
Laura's eyes brimmed with tears. “And now she's febrile with a high white count. Stacy, patients are dying up there. What if Natalieâ”
“Slow down, Laura.” Stacy needed Laura focused and logical. “You said that Natalie was inside the ICU. What was the nature of her contact with the patient?”
“I just don't know. She met the boy's father, she told me that, but Trey was her boyfriend. She said she kissed him. She went there before there was any evidence of an epidemic.”
Stacy gritted her teeth at the public health implications of the word “epidemic.”
“I'll need details,” Stacy said, shifting full gear into infectious disease control mode. “When exactly did each patient begin exhibiting signs of infection? Every symptomânurses' notes are usually the most reliable.” Stacy stood up now. “I'll need all this data charted by fifteen minute intervals. I need every health care worker who was in that room identified, and probably quarantined. Same with every visitorâto the best of our ability. We need triple infectious disease precautions. But I'm getting ahead of myself. Let's go to the ICU now.”
“I should be here when Natalie gets back.” Laura remained in her chair, twisting one plastic-gloved hand with another.
“Laura, we do need to get on top of this infection. Your daughter's life may hang in the balance if the staph in your ICU proves truly antibiotic resistant.”
Stacy watched the color drain from Laura's face. Then she nodded and got up. Both women took off their protective layers, and Laura led Stacy to the elevator that would take them to the ICU.
An older white man in green scrubs and a long white coat met them at the elevator on the seventh floor.
“The pediatric floor called to say that you were on your way up, Laura.” The man eyed Stacy. “I was on my way home to get some sleep, but they said the doctor was here from the CDC.”
Stacy read the name tag sewn on his coat. Duncan Kellerman, M.D. She didn't wait for introductions by Laura. “Dr. Kellerman, I'm Dr. Jones from the CDC. Dr. Nelson has given me a preliminary briefing, but I need every detail of what's happened in this unit.”
Stacy had seen it before and she'd see it again. The look: a black woman, telling me what to do?
“You're Dr. Jones?”
“Stacy is a microbiologist at the CDC, the world's foremost expert in antibiotic resistant staph,” Laura said. “She's given us a list of precautions we must put in place if we're going to stop this epidemic.”
World's expert?
Laura was exaggerating. One of them, maybe. There were others, her boss, Stan Proctor. The boys at USAMRIID. Norman Kantor formerly of the NIH, recently retired from Keystone Pharma, and his former associate, Victor Worth, relegated to fungus research after the staph program at the NIH had been terminated. One of the first things on her to-do list was to see if she could recruit Norman Kantor out of retirement as a consultant.
“Laura, Dr. Jones, I'm exhausted. I'm going home for a couple of hours. I can't function without some sleep. I'm a lot older than either of you.”
“Dr. Kellerman, we're on a tight schedule. So let's proceed, before you go anywhere.”
“No, way, young lady,” Kellerman said, his tone resentful. “I may have called you, but not to take over. I'm in charge here, and I'llâ”
She had to shove this organization into gear before it self-destructed. She faced him down, “How many patients did you tell me have fallen ill to this infection, Dr. Kellerman? And how fast are they deteriorating? And, yes, you called me. I'm here and I know what I'm doing.”
Stacy didn't know exactly what she was doing, but who did in an emerging situation like this? Little comfort, but she was as well equipped to deal with this as anybody she could think of, other than her boss, of course, and she'd have to get him on the case immediately.
“So young and ⦔ Kellerman hesitated. “How can you have any experience?”
And so nonwhite is what Kellerman did not quite say. “I have expertise, Dr. Kellerman, so unless the hospital trustees ask me to stand downâ” Stacy was winging it now.
Hospital trustees?
“Duncan, I have a personal interest in this,” Laura said. “I just found out that my daughter was in the ICU yesterday when all this was starting. Now she's febrile with a high white count.”
“My God, Laura, how could that have happened?”
Stacy thought she detected genuine sympathy in Kellerman's tone.
“She was visiting her boyfriend, the Standish boy.”
“Oh my, he's one of the sickest,” Kellerman said. “I just spoke to his parents, tried to prepare them for worst.”
“Let's get started,” Stacy said. “I want to see the patients; I want you and the ICU head nurse to take me through every detail of every patient's course. Then, I'll get to the labs to see the cultures and the sensitivity results; meet with your infectious disease nurse and the director of nursing to go over infectious disease protocols. I'll call my boss, maybe conference in experts at the CDC.”
“Duncan, can you show Stacy the patients?” Laura asked. “I'm going to admin to get the board of directors involved. They'll need
to hear Stacy's recommendations and get this hospital locked down. And then I'm going to see Natalie. I'd appreciate it, Duncan, if you could check on her after you're finished with Stacy.”
“Laura, let's get your computer staff here, too,” Stacy said. “I'll need them to input data to the CDC system.”
Stacy, already back in sterile garb, waited as Kellerman pulled booties over his shoes.
“I'll gladly see your daughter,” Kellerman said. “Will you ask one of the nurses to call and tell my wife not to expect me home?”
If the CDC imposes a quarantine, none of us will be expected home
.
F
RIDAY
, N
OVEMBER
29
In the safety of his BMW sedan, Charles looked at the test tubes he had protected in strips of bubble wrap and placed in a Styrofoam six-pack case with a flip-up handle. He debated transporting them in the spacious trunk, but with no means to secure them there, he decided to stow them on the floor of the passenger seat. God protect him from a crash. If anything disrupted the tubes and exposed their contents, he'd be dead. And so would anybody else who came in contact with his microorganisms.
Charles rarely bothered to park in his garageâtemperate Atlanta weather wasn't rough on the car. He'd pull up to the semicircular portico leading to the front door and park there, the lord of the manor. But today, he fumbled for the remote, opened the garage door, and waited for the door to close behind him before he got out of the car. He couldn't risk a neighbor or anyone else observing him with the package. Silly. What were the odds of someone thinking,
Charles has toxic staphylococci in that little cooler
. Nevertheless, he proceeded stealthily.