Viral

by Robin Cook

  Brian laid Juliette down on the sheet-covered exam table, holding on to her lest her convulsions caused her to fall off onto the floor. To his relief word must have spread quickly because other medical personnel flooded into the room and pressed in around the table. All were dressed in scrub clothing. One youthful woman quickly asked Brian how long Juliette had been seizing.

  “I don’t know,” Brian cried. “I heard a kind of thumping from my bed for maybe five or ten minutes and couldn’t figure out what it was. How long it had been going on before it woke me up, I have no idea. Then it took about ten minutes to get here. I’m afraid it’s probably been going on at least thirty minutes, though probably more.”

  “Okay!” the woman said quickly, redirecting her attention to the medical people in the room. “We need an IV immediately or intraosseous access. Start oxygen and an oximeter! We’ll need an ECG and glucose and let’s get a body temperature, BP, and intubation setup. Draw up four milligrams of midazolam. Let’s go!”

  As a flurry of activity erupted around his daughter, a nurse pulled him back and away from the table. Brian resisted, not wanting to leave Juliette. “I’ve had EMT training,” Brian said in his defense.

  “That doesn’t matter,” the nurse said. She handed him a face mask. “You need to leave! And you have to check in properly and provide the patient’s name.”

  “She’s been seen here several times,” Brian sputtered while putting on the face mask. “In fact, she was seen here less than twenty-four hours ago. Her name is Juliette Murphy. Just look it up on your tablet.”

  “You have to check in at the front desk today as well,” the nurse said evenly, trying to calm him down.

  “But why?” Brian demanded. He knew he was beside himself and not thinking clearly. “I’m telling you, she was just seen yesterday by Dr. Arnsdorf, and Dr. Kramer the day before. Really, look it up! You can get all you need to know and then some.” As he spoke, he was trying to keep his eye on Juliette over the nurse’s shoulder. There was a lot of frantic activity, which encouraged him and terrified him in equal measure.

  “What was found on those two occasions?” the nurse asked.

  “Nothing,” Brian snapped. “Nothing was found and nothing was done. Both times we were here for more than three hours, and they wouldn’t even do a damn blood test. They insisted her symptoms were psychosomatic. Obviously, they weren’t!” He noticed more medical personnel arriving, enhancing the sense of a developing crisis and magnifying his fears. More urgent orders were called out, including a call for anesthesia and neurology consults.

  “Do I have to call security?” the nurse asked calmly but decisively. Gently she urged Brian to move toward the hallway.

  Finally, sensing the inevitable, Brian allowed himself to be led from the trauma room and then out into the waiting area. His last image of Juliette was a gaggle of medical staff hovering over her convulsing body. A few minutes later he found himself waiting to talk to one of the intake clerks. As he was waiting, the nurse who had urged him out of the trauma room returned with a set of scrub pants, shirt, and slippers. Despite his state of anxiety and irritation, he thanked her and immediately put the outfit on over his pajama pants.

  When he finally got to talk to a clerk, he felt stupid even bothering to list Peerless Health as his health insurance carrier, but he did anyway. With that out of the way, he found a seat and tried to calm himself. As he waited, time dragged. Each minute was emotionally exhausting, and he tried not to think about what was happening back in the treatment room.

  A short time later he was shocked to see Camila walk into the waiting area and search for him. He stood up and waved. Once she saw him, she came over, carrying a shopping bag.

  “How is she?” she asked when she got close, her face creased with worry.

  “I haven’t heard anything yet but hoping I will soon,” Brian said. “I’m surprised to see you. I didn’t expect for you to come back until I called.”

  “I didn’t expect to come back, either,” Camila said. “But when I got back to the house, I remembered that you were in your pajama bottoms. So I got a pair of jeans, a shirt, socks, and shoes out of your room.” She held up the shopping bag. “But I see they have supplied you with some hospital clothes, so maybe you don’t want them. I can take them back.”

  “You’re so kind,” he said, moved by her thoughtfulness. “Thank you, but these scrubs will do, and I don’t want to go through the angst of finding a place to change.”

  “Understandable,” Camila said. Then, reaching into her pocket she added: “Oh, also, I brought your phone from your bedside table. I know I’d feel naked without mine.”

  “That I can use,” Brian said. He took the phone and turned it on. “Again, thank you for your kindness. I don’t know what Juliette and I would do without you. Truly.” Despite the fear of not knowing what was currently happening with his daughter, he marveled at the luck of having teamed up with Camila. He truly felt she’d become like family given the way she clicked with Juliette, especially with all the crises they had gone through lately.

  “It’s been a mutual win-win,” Camila said. “Do you need me to stay and keep you company? If so, there’s a problem with the car. It’s right out front in a no-parking zone.”

  “No, I’m okay,” he said. “I’ll call you when we are ready to come home.”

  “Do you expect Juliette will have to stay in the hospital?”

  “I have no clue,” Brian answered. He was trying not to think about the immediate future. “But given how serious it looked, I imagine so.”

  “It’s probably best. I’ll be waiting for your call.”

  Brian watched Camila as she walked back to the exit, wondering if he should have encouraged her to stay, given how unhinged he felt. As she waited for the sliding glass door to open, she turned and waved to him. Camila’s question of whether Juliette would need to stay in the hospital was unsettling, to say the least. Since Juliette had never had a seizure and since Emma’s EEE started with a seizure, the implications were now suddenly obvious to him. He had thought it was just a flu, but Juliette could have contracted the same horrible illness at the same fateful barbecue two weeks earlier.

  With shaking fingers, he used his phone to pull up the Wikipedia article he’d found about eastern equine encephalitis back when Emma had been diagnosed. Scrolling to find out about the length of the incubation period, he felt his stomach sink when he learned that it could take between four and ten days for symptoms to appear, which is a rather large variation. From his EMT training, he knew that such an interval was based on statistics, meaning for some cases it could take less and in others more.

  Still holding his phone but now staring straight ahead with unseeing eyes, Brian suddenly reluctantly acknowledged there was a very good chance that Juliette had been suffering from EEE the whole time, especially when he thought back to her multiple flu-like complaints over the previous ten days or so. Emma’s illness had had a faster trajectory, but started out like the flu.

  “God damn it,” he murmured through clenched teeth. This sudden very real possibility not only terrified him, but it also made him wonder why it hadn’t been considered by the doctors who had seen Juliette, especially since they knew Emma had died of EEE right here in their hospital.

  Going back to his phone, Brian quickly searched to find out whether there was a blood test for EEE. Finding out there was only fanned the growing antipathy he had for MMH Inwood. Not only had the powers that be made him and Juliette wait more than three hours on each of their two visits, but they had refused to do any testing even though it could have been key to properly diagnosing and treating her.

  Forcing himself to go back to the EEE Wikipedia article, Brian reluctantly reread with growing horror that a large portion of those patients suffering encephalitis as evidenced by a seizure or other serious neurological symptoms ended up with severe intellectual impai
rment, personality disorders, significant paralysis, and cranial nerve disfunction.

  Suddenly he stood up with the urge to run back to the treatment room where Juliette was to shout out that she could very well have EEE. But he held up, realizing that making the diagnosis at that moment was secondary to getting her seizure under control. Not only could the interruption do more harm than good, it might get him thrown out of the ED, and he needed to be there for Juliette when things settled down. As difficult as it was, Brian held himself in check. He also faulted himself for not thinking about EEE when Juliette first complained she wasn’t feeling well and for not specifically demanding the test. Had he insisted, it would have been more difficult for the two doctors to fall back on assuming all of Juliette’s complaints were psychosomatic.

  Instead of running back to the treatment room, he nervously paced back and forth. Sitting still and waiting was driving him crazy. A few people eyed him warily, but he didn’t care.

  The siren of an approaching ambulance caught his attention as it got louder and louder before trailing off upon arrival outside. A few minutes later there was evidence of a flurry of activity back in the ED’s treatment area, but it soon passed.

  Twenty minutes later and unable to stand the wait any longer, Brian hurried back to the information desk. Forced by security to wait his turn, he demanded to know how his daughter was doing and if the seizure had been controlled.

  “What’s the name?” a bleary-eyed clerk who was nearing the end of his shift asked in a tired voice.

  “Juliette Murphy,” Brian practically shouted angrily.

  The clerk rolled his eyes at his tone before spending what seemed like an excessive amount of time on his monitor. Just before Brian was about to boil over, the clerk said, “There doesn’t seem to be any information yet, but I’m sure the doctors will be out to talk with you soon. Next!” He tilted his head to the side to get the attention of the person behind Brian.

  Hardly satisfied, Brian returned to his seat, beside himself with anxiety. Out of desperation, he took out his phone. He needed to talk to someone and for a few moments debated whom to call. It wasn’t an easy decision, since it was now five in the morning. He thought first of Camila since she’d been already disturbed by the situation, but he hesitated, thinking she might have gone back to sleep and that she’d already helped enormously. He thought about his mother but was afraid she might make things worse by being more anxious than he. He thought about some of his ESU buddies, particularly those who worked the graveyard shift, but he nixed the idea, as he’d not spoken to them in months and they might be in the middle of a call. He then thought about Jeanne, whom he knew would probably be the best choice considering her background with children, yet he wavered.

  Despite all his reservations about taking advantage of her and as a sign of his desperation, he impulsively called, especially because she was the only one who could truly sympathize with his problems from her own experience. While the connection went through, he winced at disturbing her sleep, and he struggled to think of what to say. After the fourth ring, he seriously considered disconnecting, but then she answered.

  “Uh-oh,” she said sleepily, the moment she answered. “This can’t be good news.”

  “I’m sorry to disturb you—” Brian began.

  “Don’t be silly,” Jeanne interrupted, already sounding more awake. “What’s up? Did Juliette’s fever spike again?”

  “Worse than that,” he admitted. “She’s had a seizure in her sleep, a bad one. I don’t even know how long she’d been seizing when the noise woke me up, but it might have been for a while.”

  “Mon Dieu! Where are you?”

  “I’m afraid I’m back at the MMH Inwood ED,” Brian said. “My least favorite place.”

  “How is she?”

  “I haven’t heard,” Brian said, running a hand nervously through his hair. “We’ve been here about an hour. They haven’t told me anything. They haven’t even told me they’ve stopped the seizure. Nothing!”

  “You poor man,” Jeanne said with true empathy in her voice. “Would you like me to come and join you to keep you company?”

  “Thank you for offering,” he said. “That’s a lot to ask, and besides, I imagine I’ll be hearing shortly that she’ll be admitted. I just needed to talk to someone. I’m sorry I woke you.”

  “Don’t be silly,” Jeanne chided. “I’m glad you called. And I’m going to come join you whether you want me to or not. Case closed.”

  “Are you sure?” Brian asked. He wasn’t the kind of person who normally asked for favors, and he considered self-sufficiency a virtue, but even he recognized he was particularly vulnerable at the moment. Besides, he didn’t have the mental strength to talk her out of it.

  “I’ll be there in fifteen to twenty minutes,” Jeanne said definitively.

  With a bit of surprise, Brian found that she had hung up on him. Slowly he pocketed his phone, then bent over and cradled his head in his hands. He’d never felt quite so weak in his life, and as a consequence found himself praying, not in the way he’d learned as a child, but more as an attempt to bargain with a God he wasn’t sure he believed in. He promised that he could learn to accept losing his wife and soul mate, but only if his daughter made it out of this unscathed.

  Sudden yelling interrupted his thoughts, and he straightened up. The disturbance was coming from an obviously inebriated individual who’d stumbled into emergency with his business attire askew. Uniformed hospital security personnel responded immediately by emerging from their windowed enclave overlooking the ED entrance and the waiting room. The man was efficiently corralled and escorted to a separate section of the ED. After that, an expectant peace returned.

  Brian tried to go back to his bargaining, but he found he couldn’t after the drunken disruption. His growing worry about Juliette’s condition was crowding out the possibility of any other thoughts. Twenty minutes later, Jeanne dashed into the waiting area, searching for Brian. He stood up and waved. The moment she spotted him, she hurried over. Despite the social distancing protocols and their short friendship, they embraced, holding on to each other to the point that Brian began to feel self-conscious.

  “Sorry,” he managed as he released her.

  “No need to apologize,” Jeanne said as they both sat down. “Have you heard anything?”

  “Nothing at all,” he responded. “I don’t know why they’re keeping me in the dark like this. It’s torture. They could have at least come out and told me the seizure’s been controlled but that they want to do X, Y, and Z. Hell, I’d understand. I’m all for testing. For all I know, they’re doing an MRI or some other test that takes a long time. I just wish they’d let me know.”

  “We should hear soon,” Jeanne said, trying to be encouraging.

  “With her having a seizure like this, I’m concerned she got infected with EEE just like Emma, even on that same night. I read someplace that mosquitoes prefer female hosts.”

  “You’re joking,” Jeanne said.

  “No, I’m serious. It’s true. Female mosquitoes, which are the ones that bite, prefer human female type O blood. If Juliette does have EEE, it would explain all the complaints she’s had over the last week or so, including the fever. What irks me to death is that when we brought her in here, not once, but twice, they never thought of testing her for it.”

  “That does seem surprising in retrospect,” Jeanne admitted.

  “It’s more than surprising,” Brian said. “To me it smacks of malpractice, especially when there’s a good chance they didn’t do any testing because I owe them so damn much money and they were afraid they’d not get paid. And that’s on top of treating us like second-class citizens, making us wait for so long.”

  “Maybe it’s best if we talk about something else while we wait,” Jeanne said, seeing Brian’s face flush and sensing his anxiety.

  “As if I
can think of anything else.”

  “How about talking about our upcoming investigation,” Jeanne said. “I spent some time looking at your friend Grady’s list. I counted the cases and there are almost five hundred Inwood families that have been sued or are being sued. Can you imagine?”

  “Now I can. I used to think we as a community were lucky to have MMH here, but not any longer.”

  “It should be an asset,” Jeanne said, “and it could be again.”

  “Maybe if . . .” he started. He wasn’t so sure, not with Kelley and company in charge, but he didn’t finish his thought. At that moment, both he and Jeanne saw two doctors emerge from back in the treatment area and head in their direction. They were both dressed in scrubs, although the male doctor was wearing a long white coat. As they got closer, Brian recognized the woman despite her mask. She was the one who’d called out orders back in the Trauma 1 room. Both had grave looks on their faces.

  A new burst of worry propelled him to his feet, and Jeanne followed suit as the two physicians halted about six feet away from them. The male doctor, with a name tag that said dr. anish singh, chief of emergency medicine, spoke with a lilting subcontinent-Asian accent. He identified himself and asked if Brian was the father of Juliette Murphy.

  “I am,” Brian managed as his pulse raced. He could feel Jeanne clutch his arm.

  Dr. Singh cleared his throat, obviously uncomfortable. “I’m very sorry to have to report that despite our efforts, your daughter didn’t make it. We tried—”

  With lightning speed and before the doctor could finish his sentence, Brian lunged forward, grabbed a handful of Dr. Singh’s scrub shirt and coat from the front of his chest, and practically lifted the slightly built doctor off his feet. He yanked the man’s masked face within inches of his own, all the while yelling over and over: “No! No! No!”

  Jeanne tried to pull Brian’s arm away without success. She was shocked by the suddenness of the assault and overwhelmed by his strength. Several security guards burst out of their windowed alcove and came running over. Everyone in the waiting room, clerks and patients alike, stopped whatever they were doing and stared at the sudden ruckus like a freeze frame in a movie.