The Perfect Predator

by Steffanie Strathdee

  Dr. Abboud blanched. “We do not have enough supplies for such frequent testing,” he replied defensively. Anneke turned to him and said sharply, “Well then, perhaps you should not be in the business of running a medical clinic.”

  I was mortified, embarrassed for Dr. Abboud and yet angry that Tom’s care was not being properly managed, as I had begun to suspect. Within minutes, Inge had given Tom dextrose to increase his blood sugar and stabilize him for transport. Anneke started him on a morphine drip and IV Tylenol to bring down his fever, as well as several other mystery medications that dripped into his arm, one by one. Then Inge spoke into her cell phone in German, presumably to the pilot who was waiting at the airport. Anneke turned to us and said the words I had been desperate to hear.

  “He is fit to fly. We will depart immediately.”

  As the doctors scurried to sign the last of the required paperwork, I sat beside Tom and wiped his brow with a cool cloth. He wavered in and out of consciousness but opened his eyes briefly. “Are you seeing what I’m seeing?” he asked.

  “What do you see?” I said cautiously.

  “Angels.”

  “Yes,” I replied with a smile. “And these angels are rescuing us.”

  Tom: Interlude I

  “This is a part of what you’ll need to know to survive,” my father says to me. I believe him. He’s given me a .22 and taken me to the woods, taught me to shoot, to hunt, and to skin a rabbit for the campfire. We are at our cabin in the mountains built by my mother’s grandfather. I know the way by heart—memorized it when I was ten, trained for the day the Russians would drop a nuclear bomb on us. I can hear the air raid siren—or is that an ambulance? My classmates duck and cover, but I know that I am supposed to take off and walk the sixty miles to the cabin where we all will find our way. Find each other. In safety.

  In the cocoon of my father’s Navy-issue hammock stretched between two ancient oaks, I can smell the rotting leaves, the humus, layer on layer of leaf mold making a soft, spongy carpet around me, like the generations of my family that walked upon them before me.

  Family lore has it that my great-grandfather walked the Trail of Tears as a child. At age sixteen, my grandfather ran away from home, where he was being raised by his sharecropper uncle, to fight in World War I. The world can collapse around you, but you can survive, they tell me. Resilience is the sad, strong legacy you carry in your bones, they say. They mean well, but metaphors are not medicine. Where does it reside, exactly, in my DNA? I need to ask Steff. I can feel the world collapsing now, from the inside out.

  7

  A DEADLY HITCHHIKER

  Goethe University Hospital (Universitätsklinikum), Frankfurt

  December 3–4, 2015

  Six hours and three thousand miles later, with a brief stop to refuel the small plane in Bosnia, we taxied to a stop on a military airstrip in Frankfurt. It was night, the far end of a travel day that Tom had spent in a state of suspended animation, drugged for pain and stabilized for transport. A waiting ambulance skirted through evening traffic to the sprawling urban campus of the Goethe University Hospital, known to locals as the Uniklinik.

  A massive research hospital and premier medical center, the original buildings of the hospital had been built in 1914. If the Luxor clinic in Egypt was emblematic of the challenge of introducing modern medicine in resource-poor settings, the Uniklinik was a monument to centuries of investment and advancement in Western medical science. It was a sleek, contemporary building of glass, steel, and concrete that exuded the efficiency of German engineering. Inge and Anneke shook my hand officially and bid us farewell.

  Tom looked more rested now, ensconced in a nest of high-tech monitors and IVs, but his face was still pallid and drenched in sweat. The monitors tracked what could only be considered a fragile peace as vitals go, and IV bags of fluids, antibiotics, and pain medication hung like holiday tinsel from a rolling rack. He drifted in and out of delirium as the nursing staff came and went. Each time someone entered, they donned protective gloves and a plastic hospital gown that they discarded before leaving. They continually monitored his temperature, heart rate, oxygen level, and blood pressure. From the digital thermometer reading of 102.5 degrees Fahrenheit, I knew he had a fever, but the other readings were a mystery. A new line was inserted for IV fluids and antibiotics, and the collection bag that filled with bile from the tube in his nose was swapped for a bigger one.

  Tom’s eyes blinked open and he caught my gaze.

  “I have the worst hangover ever,” he groaned. He was dripping with sweat and asked for more pain meds; his head was pounding and his body ached down to his bones. “And I’m so bloody hungry—” he said, stopping abruptly. I must have come into focus, because he gave me a head-to-toe glance and rendered a verdict.

  “You look like hell,” he said. It was true. I was a hot mess; still in the rumpled clothes from the last few days, and frankly pretty gamey by this point. I smirked and thought of a retort my mother would give. The pot calling the kettle black.

  “You, on the other hand—a page right out of GQ?” His usual trim goatee bled into a five-day-old beard, but they’d cleaned him up at least, having popped him into a fresh blue gown with polka dots and matching blue socks. He glanced down at his gown and looked confused.

  “When did all this happen?”

  He looked around the room, trying to reconcile his last memory of our whereabouts—the spartan operating room in the Luxor clinic—with this gleaming, high-tech hospital room, every square inch packed with sophisticated medical and monitoring equipment, amid a flow of doctors and nurses and aides in familiar Western-style scrubs and uniforms. The muted sound of German voices in the hallway outside was barely audible, but offered a reassuring hum of human proximity.

  “Where are we?” he asked, in a tentative tone.

  Before I could answer, his dilated pupils shifted suddenly to the wall opposite his bed. His eyes widened, his gaze fixed on the white wall, then moved slowly up to the ceiling, and down again.

  “What are you looking at?”

  “The hieroglyphics,” he said, nodding toward the wall in front of us.

  I looked at the wall, then at him. He gazed fixedly at the blank wall.

  “Tom. We are in Germany. The Frankfurt Uniklinik, which Chip says has one of the top GI clinics in the world. We’ve lucked out. You’re gonna be okay.” I spoke soft and slow, in a tone more appropriate for a kindergartener, which would have offended him if he’d been in his right mind. “They have us in an exam room while they figure out which ward you will be assigned to.”

  “Then why are there hieroglyphics on the walls?” he asked.

  I paused and looked him in the eye, searching for some glimmer of sanity.

  “There aren’t any, honey.”

  “No, look,” he insisted. “They’re faint, but they’re there. On the ceiling, too. Here—put your hand on the wall,” he said, motioning to an area about eye level for me. This was nuts, but I humored him by holding my hand up to the wall.

  “Don’t you see them?” he asked, but disappointment had already registered on his face. “I’m losing my mind—again—aren’t I?” he said, closing his eyes. This time, I didn’t answer.

  He wasn’t ambulatory, but he insisted on trying to walk to the bathroom three feet away. I braced him in my arms and we limped over together, only to discover the door was locked. Like a marionette dangling from IV lines, Tom wavered. When I buzzed the call button for help, a nurse stuck her head into the room and pointed to a portable commode by the gurney. “No bathroom privileges. Infection control.”

  I was confused at first, then annoyed, but then understood.

  The hospital was taking universal precautions, which were standard infection control procedures. Having just arrived from Egypt, Tom could have acquired a foreign pathogen—an uninvited hitchhiker that could put other patients at risk. It was just a precaution. Or was it? Suddenly, it dawned on me that since Tom had a fever, some kind of infec
tion could be contributing to his pancreatitis. My memory flashed to how the German medevac doctor, Inge, had carefully scrubbed her hands and forearms after spending just a few minutes in the Luxor clinic. A sick feeling of dread pierced the pit of my stomach.

  Within the hour, they had a room for Tom. And not just any room. A transport team arrived to push his gurney from the ER to a room in the intensive care unit (ICU) on the third floor. Of course, Tom was sick enough to warrant an ER visit, and hospitalization was a relief so he could get the care he needed. But the ICU? Wasn’t that overkill? I traipsed along, watching one of the porters enter a code on a keypad outside the ICU’s rear entrance. The door lock mechanism buzzed, allowing us to pass through a pair of heavy metal doors that clanged shut behind us. Tom would later tell me that the sound reminded him of a psych unit, which made him panic. At the time, he was so out of it that I mistook his panic for pain, one of a long trail of miscues that left Tom alone with his terrifying fears while the rest of us focused on the vital statistics of blood and guts. Focusing on data was my way of reducing the growing crisis down to a manageable size. Tamping down my sense of alarm, I busied about Tom’s room, plumping his pillow and checking his blanket, as if this turn of events didn’t scare the bejesus out of me.

  Since it was now past ten p.m. and I was exhausted and hungry, I kissed him on the forehead and gathered my duffel to leave.

  “You’re leaving me alone here?!” Tom yelped. The beeps on his heart monitor quickened, and I could feel my own heart do the same. Alone? In this buzzing hive of humanity? Hardly. But his sense of betrayal and abandonment shone in his eyes.

  “Family can’t stay overnight here, hon. The rules are, well, strict. But I promise I’ll be back in the morning, first thing. We both desperately need some sleep. You’ll finally be able to get some here—they’ve got morphine to make sure of that. And I’m going to find the closest hotel nearby. I’ll fill everyone in back home, and with a shower and decent night’s sleep, I’ll be better company when I see you in the morning.”

  I felt guilty but I was secretly relieved. The closest hotel was a brisk walk, about a half mile away. The duffel was packed for Egypt’s warm desert climate, not for Germany’s winter, and I was freezing cold even though I was wearing all of the clothes I had with me, in rumpled layers. The hotel lobby was decked out with a twenty-foot Christmas tree and a gingerbread house that was large enough for several small children to play inside while their parents stood idly by chitchatting. I had almost forgotten that Christmas was just a couple of weeks away. A group of carolers in traditional German costume sang “Stille Nacht.” I listened to their voices echo through the vast foyer as I waited for the elevator. Silent Night? No way, José. I was in no mood for the festivities; there was nothing to celebrate.

  Soon after my arrival, a bellman delivered a package to my room, a shipping box with my name on it. It was a care package from my UCSD staff. Pajamas, a jacket, scarf, socks, and a basket of wine and cheese. My eyes filled with tears, I was so touched by their gesture. I had a long, hot shower, pulled on the PJs, ordered room service, gulped a glass of wine, and collapsed into bed for my first full night’s sleep in more days than I could remember.

  The next morning, I made my way to the hospital early, hoping to catch Tom’s medical team as they made their rounds and discussed next steps. Chip’s colleague had arranged for me to enter the ICU outside of normal visiting hours, which were four to six p.m. daily. I was there at eight a.m. sharp. Once buzzed in, I noticed a sign posted outside the door to Tom’s room, giving instructions in German and English that no one was to enter without a protective gown and gloves. They were stacked nearby. I obeyed; we’d clearly crossed the line from the improvisational setting of a community clinic to the exacting environment of a cutting-edge critical care unit. Everything about the ICU had an imposing sense about it. Order. Attention. Expertise. Precaution. Pancreatitis alone is enough to kill you. Tom didn’t need to add a case of the flu or some other communicable disease passed along on someone’s hands or clothing. He still looked pale and drawn and now had an oxygen mask on his face, but I was relieved to see that he was in less pain. No sooner had I arrived than his nurse, a cheery fellow named Roy, stopped in and informed us that Tom was scheduled for a CT scan. His Filipino accent was familiar to me, and we shared the experience of far-flung family. Shortly, the same two porters from the transport team appeared and greeted us with smiles.

  The CT was only supposed to take a few minutes. Almost an hour later, I was still pacing the floor of the waiting room. When Tom finally emerged, the porters pushing his gurney were not their cheerful selves. Something was wrong.

  We’d barely returned to the ICU when a doctor joined us in Tom’s room, greeting us with a warm handshake. Dr. Stefan Zeuzem was tall and trim with perfectly coiffed gray hair, and looked to be about fifty-five years old. This was Chip’s colleague; a famous gastroenterologist who clearly held a lot of clout within the hospital. After a few minutes of polite chitchat, he was all business. Tom was groggy but awake.

  “Dr. Patterson, you have acute pancreatitis with the complication of a pseudocyst in your abdomen. The cyst is an abscess approximately fifteen centimeters in diameter, which is about the size of a football. Americans love football, yes?” Dr. Zeuzem smiled. I flashed on the ghastly image of a festering cyst the size of an American football, and then I realized that he probably meant a soccer ball. That didn’t help—even a small kid-size soccer ball was still huge.

  “We suspect that you may have a gallstone, which created the cyst. You also have a good deal of ascites in your abdomen—fluid caused by inflammation. I have asked my top GI doctor to perform an emergency endoscopic procedure to investigate the cause of this problem, and to remove any possible obstruction.” He paused, then frowned slightly. “I must warn you that this is a high-risk procedure given your current state, but we believe it absolutely necessary. If you agree, the procedure will take place within the hour.”

  We agreed. What choice did we have? As unlucky as it was that a gallstone had likely caused this cyst, and that the cyst became infected, and that it flared up on vacation far from home, at least we were lucky to be where they could take care of it. Tom gestured for me to sign the required consent form on his behalf and I did so with a shaky hand.

  The GI doctor who would perform the procedure was Dr. Friedrich-Rust, who introduced herself with a brisk but cordial air of efficiency. Trim and precise in appearance as well as manner, she asked me to sign a second consent form in case Tom required a ventilator during the procedure, which I knew was a breathing apparatus used for life support. She tucked the paper into a clipboard and disappeared down the hall to the surgical unit, leaving us in the waiting room with two porters.

  I was scared to death. This was clearly a do-or-die moment. Tom’s condition was now undeniably life-threatening, and in minutes they were going to wheel him away. Would I ever see him again? He was still delirious, but aware enough to be anxious. We both needed a distraction. He lay with his eyes closed and asked me to describe our surroundings.

  “Well, it is your classic German minimalist architecture. Lots of steel, granite, and stark colors. Except, of course, for the splashes of color on our gowns.” Tom opened his eyes.

  “Your gowns?”

  His incredulous expression suggested that he thought I was talking about ballroom dancing, not hospital gowns. The porters glanced at me quizzically.

  “Yes, Marta over here is wearing a beautiful green gown, the color of spring. Me, I am wearing yellow, like the sun.” The second porter, Paulina, piped up cheerfully, “And I am wearing blue like the sky.”

  “So, it’s almost like the Four Seasons or something,” I told Tom with a wan smile. Then it was time. I gave him a quick kiss, and just like that, he was wheeled away. He gave me a little wave, and was gone.

  The procedure took over an hour, and when Dr. Friedrich-Rust was done, she joined me in the waiting room and plopped down beside me, r
emoving her face mask and surgical cap.

  “The procedure was a success,” she said, with calm reassurance. “He did not require the ventilator. I removed a small gallstone of four millimeters in size from his common bile duct; there was at least one smaller gallstone present as well. I cleaned up some necrotic tissue—dead tissue—in the pancreas. I also placed two pigtail stents in the pseudocyst so that its contents now drain into the stomach, so it will hopefully shrink. I wish I could have removed more necrotic tissue, but your husband’s breathing was very difficult, and he could not withstand more sedation.” As she disappeared down the hall, I was still running her medical update through my brain’s version of Google Translate.

  Back in the ICU, Tom was a little wonky from the sedation, but he was talking.

  “So when do we get to go to our room?” he asked me expectantly, as if we were in the hotel lounge waiting to be assigned our room at a real Four Seasons.

  “Darling, you are in your room.”

  Tom craned his neck and inspected his hospital room as if for the first time, including the huge dispenser stack of medicines attached to a contraption with giant arms that monitored his vitals. He shook his head disapprovingly and clucked. “This place could use a serious upgrade,” he said. “Go and tell TripAdvisor.”

  A few hours later, Dr. Zeuzem stopped in. He had asked Dr. Friedrich-Rust to take a sample of the fluid inside the pseudocyst, which they expected to be clear if it had only formed recently. He held up a flask that contained a murky brown fluid. The pseudocyst size and contents suggested that it had been there for at least a month. I was stunned. It didn’t take a rocket scientist to understand that this was not a good sign. The pseudocyst was “super-infected” with at least one kind of microbe, he told us. They couldn’t be sure what it was until the lab results were back in a few days.