by Betsy Ashton
Before he could escape, Johnny stepped into his way.
“What’s going on with Alex?”
“He has new symptoms,” I reminded the doctor. I had to speak, or I’d explode. “So, what is it?”
“Is Alex the only one with a rash and swollen lymph nodes?” Johnny asked.
Dr. Begay shook his head.
“From what I’ve been reading, Alex has most of the classic symptoms of hantavirus, doesn’t he?” Johnny set his hook and refused to let the doctor wriggle away.
“Yes and no. The chest congestion, body aches, fever, and gastrointestinal symptoms can be caused by influenza, hantavirus, Legionnaires’ disease, or any of several other viral, fungal, or bacterial infections.” The doctor pulled off his surgical mask. “We’re waiting for results from the CDC. Until we get them back, we’re pretty much in the dark.”
“What about the rash?” Johnny asked. “Nothing I read said anything about a rash.”
“All the more reason to wait for the CDC response. Rashes aren’t part of the syndrome.” The doctor rubbed his face against his sleeve.
“But if it’s something else, what could it be?” My pulse beat heavily in my throat; I took another swallow of water.
“We just don’t know. Right now, we have more symptoms than belong to any single disease.” He stretched his shoulders and rolled his neck to loosen taut muscles. His neck clicked.
“How many can be transmitted from human to human?” I jumped in.
“A lot of them, but if it’s hantavirus, it doesn’t jump from human to human, only from mice to us.”
Johnny eyed the doctor. “You’re wearing protective gear because whatever this is could be contagious, though, right?”
“Until we know for certain, Mr. Medina, Dr. Running Bear ordered us to follow contagious or infectious disease protocol and err on the side of caution. We’ll gear up whenever we treat one of the children, just in case. We don’t want to spread it from child to child if it turns out to be contagious. You and the rest of the parents need to take similar precautions or stay out of the ICU.”
“Fat chance of that,” I said.
The doctor leaned against the wall, his eyes moving from room to room, monitoring what the nurses were doing. Seemingly satisfied, he shed his mask and gloves like a snake molting, throwing them toward a trash bin marked with a screaming red bio-hazard warning. He missed. He sighed and picked them up. “Figures.” He turned back to us. “I emailed the changes to the CDC a little while ago. We should know something soon.”
“Which children have the rash?” Johnny slipped a paper cap over his black hair.
“Right now, Alex and two of the children who’ve been here the longest have similar symptoms. Not counting the child who died, we have eight children in the ICU and several more in the Med-Surg unit, which we turned into an isolation ward until we know what we’re dealing with and how it’s transmitted. All the children have serious chest congestion.”
That explained the body-racking coughs I heard up and down the ICU. “But they don’t all have the same symptoms, do they?” Like a terrier with a new squeaky chew toy, I wasn’t about to give up.
“It could still be the same syndrome with some children further along in the disease’s progression,” Dr. Begay said. “We’re treating the symptoms.”
Out of the corner of my eye, I saw Toby enter the ICU. He wore protective clothing and pushed a caddy with more nebulizers on it.
“I have a meeting with Dr. Running Bear in a few minutes. Either he or I will come back when we have something to report. Until then, try and keep Alex quiet and comfortable. Use the nebulizer to help him breathe.”
Leena approached and showed us how to put on the protective clothing. “I know you’ve both been here all along, but you need to do what we do.” She held out a paper gown.
My hands trembled again when I tried to tie the gown on. Johnny moved my hands aside and tied the strings behind my back. He put his on as well. We had entered a medical twilight zone.
What the hell is loose in the ICU?
###
Morning passed with no sign of Dr. Running Bear. The night physician didn’t return, and the nurses changed shifts. Alex’s cough deepened. I gave him a breathing treatment—he was allowed one every four hours. Toby arrived to take him to X-ray to rule out pneumonia again.
“You’ve been here most of the night,” I said. I’d seen Toby nearly everywhere I looked.
“We’re short-staffed. I pull double duty as an orderly when I don’t have to take lab samples,” he said. With that, he pushed Alex’s bed into an elevator and disappeared.
“Let’s get some food. I’m starving,” Johnny said.
“You’re always starving.”
No sooner had Johnny and I exited the ICU than a page sounded from the intercom: “Dr. Running Bear to the lobby.”
It was repeated three more times. Odd, because most of the doctor’s pages came through his cell. Or through a coded chime. Gone were days of pages for “Code Blue.” Television had overused it as a warning for all medical personnel to head to a specific room immediately. Originally designed as a way of calling for assistance during a crisis, it had become synonymous with, “Need a crash cart STAT!”
“Now what’s happening?” I looked up at Johnny. “I hope it’s not more patients.”
Johnny’s brow wrinkled. “I doubt it. They’d come in through the emergency entrance, not the front door, don’t you think? Admitting a new patient hasn’t involved loud speakers before.”
Several nurses sprinted past us. As one, Johnny and I trotted along behind them. Through the tall windows lining one side, we saw a line of black SUVs and a limousine.
“What the hell?” Johnny picked up speed until he was running.
“What’s going on?” I asked, keeping pace.
Men in dark suits, white shirts, ties, and earpieces on leashes tucked into their collars, stood around the limo and faced outward. One opened the right-hand passenger door to allow an elegant though casually-dressed woman to step onto the sidewalk. Three men walked ahead of her; two followed. The automatic door swooshed open. Dr. Running Bear extended his hand in greeting.
“What the fuck?” Johnny blushed and looked down at me. “Sorry.”
“Don’t be. What the hell is the vice president’s wife doing here?”
CHAPTER FOURTEEN
“YOU RECOGNIZE HER?” Johnny asked.
“She’s often in the news,” I explained, wondering why she was coming to a hospital so far from big cities. She didn’t look like she needed medical attention.
We joined several nurses hanging over the railing on the second floor, gawking like teenagers when the Beatles performed so many decades ago at the Ed Sullivan Theater in New York, but without the screaming and hysteria. We peered down at the group just inside the door, a curious fan base watching an unanticipated spectacle.
“Dr. Running Bear sure doesn’t look at all happy,” I said.
He stood with arms crossed. The vice president’s wife held both palms outward to soothe the situation. Secret Service agents stood by impassively. I assumed they were watching the crowd from behind their reflective dark glasses. What do they see? Do they think baddies are hiding at San Felipe?
“Looks like we have a standoff,” Johnny whispered.
“We forgot she was coming,” a nondescript nurse said quietly. “The advance team was here about eight weeks ago to check everything out. When the kids started getting sick, none of us thought to call her office to cancel.”
“Dr. Running Bear is going to lose this argument,” Leena said. “That doesn’t happen often.”
“At least she’s a doctor, not a civilian, so if any of us get to meet her, we can behave normally and answer questions without worrying about terminology,” another nurse said.
“It doesn’t look like she’s going away.” I turned to Johnny. “Do you think her visit will interfere with treating Alex and the rest of the children?”<
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Leena shook her head. “We’re operating as if the kids in the ICU are infectious. It wouldn’t be safe for her to roam around there.”
“I can’t imagine the Secret Service letting her anywhere near the ICU. I bet she gets a quick tour, shakes a few hands, makes a statement about exciting it is to visit such a state-of-the-art facility as San Felipe, and leaves for her next public event,” Johnny said.
“I’d agree if our ICU wasn’t a poster child for how an ICU should be run,” Leena replied. Two nurses shared a look before one slipped away.
Downstairs, Dr. Running Bear bowed his head, stepped aside, and led the group away from the ICU. Several Secret Service personnel stayed outside with the cars.
“Détente wins out,” Johnny said.
The nurses returned to their respective workstations. Johnny and I retreated down our now familiar corridor. As soon as I finished putting on my gear and pushed into the ICU, I heard crying from a room across from Alex’s. Johnny peeled off to check on Alex; I looked around the room, where I saw an empty bed, vital monitoring equipment gone dark, rubber gloves, and bloody towels abandoned on the floor.
“What happened?” I asked the woman sitting crumpled in a chair. She had spent every hour with her daughter since she was brought in two days earlier. The girl wasn’t one of the original patients.
“My daughter sat up in bed, threw up blood, and died. Just like that.” The grieving woman stared at the stained, rumpled bed as if hoping that her daughter would somehow appear. “The doctors tried to revive her, but she was gone.”
I held out my arms. She leaned her head on my shoulder and sobbed. I rocked her gently, secretly relieved that her pain wasn’t mine. I turned to Johnny standing in the doorway. “Is Alex all right?”
“He’s not in his room. Neither is his bed.” He took a step toward the nurses’ station to ask.
“We haven’t been gone more than an hour, if that. Johnny, how could a child die and be removed in such a short time?” Tears trembled on my lower lashes before they spilled over. I laid my cheek on the woman’s head. Her grief made my heart ache.
The elevator dinged. Toby pushed Alex’s bed down the hall and into his room.
“Did you know he was going down for tests?” Johnny demanded.
“No one told me,” I said, mystified. I continued to pat the sobbing woman on her back. Like a baby, her sobs gave way to hiccups, slowed, and stopped. She pulled herself upright and went in search of the bathroom.
“Seems like Alex is getting a lot of tests,” I suggested as I stood in the door to Alex’s room and tried not to appear judgmental—I didn’t trust anyone at this point. Toby hooked up the oxygen line and leads for the monitors before leaving, frustratingly silent. Alex slept. I passed worried and closed in on a full-throated temper tantrum. “What the hell is going on?” I looked at my grandson, so still and small in his bed, not the hyper-active Captain Chaos we all loved. “What do we do?”
“We wait.” Johnny put his arm across my shoulders. “Together.”
“If waiting is all that’s left, it’s feeding my panic. I need answers, and I need them now.” I squeezed my eyes shut, trying to block the memory of the empty bed in the other room and the grieving face of the mother who’d just lost everything. “Yesterday would have been better, but right this damned minute will have to do. I feel so damned helpless.”
“We all do, pretty lady. We all do.”
I couldn’t use my normal response of calling Johnny “funny man” right then. Comforting as Johnny’s strength was, it wasn’t enough. With Alex asleep, I sat by his bedside and texted updates to Emilie and Ducks, anxious to discuss my concerns and not simply set them aside. Johnny went on a coffee run.
Nothing new to report, except Alex is getting all sorts of tests, I texted Ducks. I don’t understand why
Ask Dr. Running Bear. Emilie added to the conversation. Either he ordered them, or someone is acting on his own.
Someone? The only person who took any of the patients to X-ray is Toby, I texted.
Watch him, Ducks texted.
Yes, Emilie agreed.
I updated the Great Dames. True to their natures, Raney and Eleanor offered to take the next flight out. I assured them that a trip was unnecessary. “All you could do is sit and watch me fret.”
“We could fret together,” Eleanor said.
“If you’re sure . . . ” Raney didn’t like not being able to help me.
“I am. Just be there when I need someone to talk to.”
They promised. “Although, if you need us—”
I broke off the direction the conversation was heading—they’d been my solace after Merry was murdered. “We’re not going to bury anyone this time. No way, no how.”
###
The day dragged on with no change in Alex’s condition. I was desperate enough to take no change as a good sign. We didn’t know anything about his most recent X-rays—no one had come to talk to us. An unfamiliar doctor treated a child on the other side of the ICU, but no one was rushing around. There didn’t seem to be an emergency. The next time I glanced up, the doctor was gone.
We entered a period of stasis. Sometime later, Leena approached Johnny and me. We were cloaked and covered lest a germ attack us. I wished I could find my sense of humor, because we looked like we were prepared for an alien invasion.
“I’m kicking myself for forgetting we had the vice president’s wife coming on a goodwill visit,” Leena said. “One of her main interests is the Indian Health Service. She’s the first Native American—and the first surgeon—in such a visible position. From what I hear, her grandmother was Choctaw and a traditional healer.”
The vice president’s wife was touring several IHS hospitals and spent a lot of time at the headquarters in Maryland. Leena went on to say how excited the doctors and nurses had been when they heard about the visit.
“Is this her first trip?” I asked.
“Yes. Our facility is one of the newest hospitals. Her coming here gives us publicity. Maybe we can expand what we can do.”
“I hope I get to meet her,” said a nurse in passing.
“Being blunt, her timing sucks,” Johnny said. “I mean, this is a state-of-the-art ICU, and she won’t be able to see it.”
By now, the ICU had ten Native American or Hispanic children and one white boy, all of whom were gravely ill, all of whom were being treated for an unknown biological predator or predators.
No one counted on how strong the vice president’s wife’s commitment to Native American health care was—an hour later, the doors to the ICU swung outward, and Dr. Running Bear led a small entourage into a now-crowded space. Over his surgical mask, his eyes told everyone who knew him not to interrupt.
Leena murmured observations while she finished her check on Alex’s condition: unchanged. “Watch how he shepherds our guest straight through the ICU, even though her presence is a gross imposition in what has been a smooth process for caring for the children. He’ll never let her know he doesn’t want her here, never let his emotions show. He has polished that stoic expression until it’s a masterpiece.”
“I hear you. I wouldn’t want to mess with him when he’s being his implacable strongest. As for me, my chin is my warning sign. When it’s thrust out, either get out of my way or duck,” I said.
“I’ll remember.”
Two Secret Service agents, distinctly uncomfortable in their gowns, guarded the exit door, their collective rigidity screaming disapproval. The vice president’s wife, fully dressed in the same clothing we wore, a mask hanging loosely around her neck. On her, the clothing looked natural; on the detail, it looked like something they wanted to rip off before ushering their charge the hell away from harm.
“Everyone, may I have your attention, please?” Dr. Running Bear repeated his statement in Spanish and what I assumed was a local Native American language. His voice reached every corner of the unit. The patients may have been oblivious, but parents poked their hea
ds out of rooms. Nurses gathered at the central station. Johnny and I drifted over.
“It is our great pleasure to have Dr. Sharon Anderson, the wife of the vice president, with us today. As you know, Dr. Anderson is a strong advocate for our work here. I’d like you to answer any questions she may have about what we do here in the ICU.”
“With all due respect, Dr. Running Bear, I know how an ICU works. I’m still a surgeon.” She smiled to take any harshness out of her words. “Thank you, though. I can see how busy you are, so I’ll try not to be an impediment.”
Dr. Anderson moved into the nurses’ station and perched on the edge of a desk. With records in electronic format, the clutter of bygone eras was absent. After a few starts and stops, the nurses talked about their jobs, the good they were doing in the community, and how educational outreach was making slow but steady inroads to chronic lifestyle problems.
“Good,” Dr. Anderson said. “What do you need?”
“Another care-flight helicopter and EMT team for bringing patients to the hospital. A trauma surgeon. Sometimes, we have too many injuries for Dr. Running Bear to handle by himself.”
The nondescript nurse I’d talked with over the lobby railing called out from the back, “More nurses and orderlies, too. We often pull double shifts when we have a wreck, a series of accidents, or a flu outbreak.”
I could attest to needing more staff. I rarely saw more than two nurses on at the same time in a unit with eight beds. That ratio was too great, especially with the cases coming in quickly. When Merry was at the Virginia Commonwealth University hospital, the ratio was one nurse to two patients. At San Felipe, one to four was the norm. I didn’t know whether this ICU generally handled as high a volume as the one in Virginia. Perhaps it was normal not to staff it so heavily.
“And we need to do more with community outreach,” the nurse continued. “Drug counseling, nutritional education, diabetes and obesity counseling, alcohol treatment. We can prevent many negative life-choice conditions if we just had enough outreach counsellors.”
Another nurse added to a growing laundry list of needs. “We need some sort of community-wide communications network. This would help us better manage an outbreak.”
