by Mark Kelly
Robinson nodded and cast his eyes over the group of interns.
“Okay folks, what tests should we run?”
The suggestions came quickly.
“CBC”
“BMP”
“Electrolytes”
“Amylase”
He nodded his approval and moved to the side of the gurney to press down on the sick man’s abdomen. “He’s distended, anything else?”
“EIA?”
At the suggestion, he tapped his fingers lightly on the bloated stomach. “Yes, there are signs of gastroenteritis, an enzyme immunoassay is appropriate.”
A voice from within the group spoke. “W-w-what about an RT-PCR test?”
Reverse Transcription Polymerase Chain Reaction testing was used to detect and study RNA viruses. It was expensive and reserved for very special situations. It was not something to be used lightly.
She watched Robinson to see how he would react. Probably not well.
“Who said that?” His eyes turned hard as he spoke.
The other interns stepped aside, exposing a chubby young man in the middle of the group. He slowly raised his hand. The look on his face made it clear he knew what was coming.
Robinson stared at him for a second before asking, “What’s your name?”
“Jason…Jason Grant, the young man stammered.
“Are you a doctor?”
“No, Sir—I mean yes, Sir.”
“Was that a difficult question, Dr. Grant?” The group tittered at Robinson’s sarcasm.
Okay, that’s enough, Mei thought, annoyed at the entertainment the other interns were having at the expense of one of their own. It wasn’t that long ago that she too, as a new intern, had been on the receiving end of the Chief’s sarcasm. It came with the territory, but sometimes he went a little overboard.
“What would you test for, Dr. Grant?”
“Ebola?” the intern said weakly.
She cringed. Wrong answer.
Robinson beckoned Grant forward with a wag of his finger. “Does the patient have a fever?” he asked in a mocking tone.
The young man removed a digital thermometer from the wall near the gurney and placed it in Muir's ear. It beeped after a few seconds.
“99.8”
“A touch warm, but not much of a fever. Any history of travel to affected areas?” Robinson’s lips turned up in a smirk.
Okay…you’ve made your point. She stepped forward with the patient’s chart open, hoping to deflect some of the chief’s irritation towards her. “Nothing recorded in his passport.”
Robinson ignored her and focused his attention on the intern. He directed him closer. “Any sign of hemorrhaging? Let’s look, shall we?
It took the strength of both men to turn and hold the mass of flesh. Grant ran his eyes up and down Muir’s torso. “No signs of bleeding,” he said quickly.
“Probably not Ebola, wouldn’t you agree?” Robinson’s tone was flat, but his eyes sparkled with amusement.
Eager to escape, Grant nodded and stepped back, releasing his grip on the patient’s shoulder. The limp body flopped sideways trapping Robinson’s hand beneath it. The older man pulled free and grimaced when he saw the dark runny mess on his fingers.
Mei held back a smile as he rushed to the box of Kleenex that sat on the counter. She watched him wipe diarrhea off his hand, amused by the fastidious manner in which he ran the tissues up and down each finger.
Serves you right for not wearing gloves.
When he finished, he scrunched the Kleenex into a ball and tossed it towards a garbage pail. The throw missed and he quickly looked away before walking to the dispenser on the wall. With a couple of dollops of sanitizer in his hands, he furiously rubbed his palms together before addressing the group.
“Based on what we have seen, it would appear the patient has viral or bacterial gastroenteritis—Let’s move on to the next patient, shall we?”
“What about a GDH A/B toxin test?” Mei suggested to him as the group began to move away.
He stopped, turned slowly, and lowered his glasses. “What about it, Dr. Ling?” He approached her with a peevish look on his face.
His breath smelled of hours-old breakfast. She stepped back to escape it as she spoke. “The patient may have a C. diff infection, he has a slight fever, diarrhea...possibly cramps—”
“Cramps, really…how do you know? He's unconscious…are you psychic?” Robinson walked back to the gurney and pointed. “Look at the patient, Dr. Ling. Does he look elderly? Do you know if he's recently taken any antibiotics?”
His sarcastic tone irked her I’m not one of your interns. She forced the emotion out of her voice and spoke carefully.
“No, Dr. Robinson, I don’t know if the patient has recently taken antibiotics but a number of his symptoms match a C. diff infection—don’t they?”
She could tell from the pinched expression on his face that it pained him to agree.
“Yes, Dr. Ling, some of the symptoms do match a C. diff infection, but they also match a number of other diagnoses.”
He paused for a moment, looked at Grant and then turned back to her, a devilish smile on his face.
“That aside, do you think Dr. Grant would benefit from learning more about GDH tests?”
“I think everyone would benefit,” she said, unsure where he was going with the question.
“Of course, they would,” he replied dismissively, “But there’s not very much room around the gurney. Since it was your suggestion, would you be so kind as to instruct Dr. Grant on the GDH test protocol?”
Before she could respond, he turned and walked away. She watched the interns follow him out of the ER clustered around him like pilot fish on a tiger shark.
Pompous ass…
Grant walked over and stood beside her. He gave her an apologetic look. “You don’t have to stay, Dr. Ling. I know how to do it. I can collect the stool sample myself.”
She offered him a half-smile. It wasn’t his fault. “I’ll help,” she said as she motioned towards Muir’s limp body. “He’s a large man, it’ll take both of us.”
She left the intern and went to the supply closet. Moments later, she returned with a test kit and two pairs of gloves. She offered a pair to him and he tucked them into the pocket of his white lab coat.
“Let’s roll him onto his side,” she said.
Grant reached for Muir’s shoulder. She grabbed the intern’s arm. “Gloves—If he has C. diff, the spores could have spread.”
It always surprised her when a nurse or doctor waited until they saw bodily fluids before they put their gloves on. She was the opposite. Too anal. She never took them off.
She swabbed a minuscule sample of Muir’s diarrhea onto a collection stick, placed it into a vial full of buffer solution and shook the mixture.
“It’s a simple test, takes about ten minutes,” she explained. “If the indicator bands turn red, the sample is positive for the presence of C. diff toxins.”
“What’s next?” he asked when she was done applying a few drops from the vial onto each of the test strips.
“We wait,” she said and placed the test kit onto the table.
They stepped outside the plastic curtain that surrounded Muir’s gurney. Grant, unable to wait in silence, babbled incessantly about the trials and tribulations of life as a first-year intern—the long hours, the lack of respect, the utter fear of making a mistake.
We all went through it, she thought, half-listening and nodding as he droned on.
The large digital clock clicked over to 12:23 p.m.
“One minute,” she announced.
He stared at her blankly. “Pardon?”
“One minute to go. Let’s check the results.”
He followed her back to the table where the test kit sat. She lifted the small plastic device up and studied the indicator bands. She frowned. All three bands were red.
“What is it?” he asked as he looked over her shoulder.
�
��Positive,” she answered, “For both A and B toxins. Nothing to panic about but we need to get him into an isolation room and schedule a PCR assay to confirm it. Go get a nurse—and two surgical masks.”
LUCIA SANCHEZ STEPPED into the lobby of Bellevue Hospital and tensed at the sight of the police officers. They stood by the side of a wheelchair, their radios squawking as they guarded an injured prisoner. The younger one glanced over at her. She looked away, pretending to search for something.
She and her children were mojados, illegal aliens from El Salvador, smuggled into the country by the Calle 18 gang for money she didn’t have. She was indebted, a slave to the gangsters until they deemed her obligation paid, but right now she was just a worried mother who wanted her son examined.
Emergencias para los niños—the words were painted on the wall above two doors.
“Through here,” she said to her eleven-year-old son, Alejandro. “Take Blanca and sit. I’ll wait in line.”
He glared at her sullenly and stomped towards a pair of empty seats. The little girl followed her brother.
Lucia didn’t know why he was angry at her, it wasn’t her fault he had fallen and hurt his arm. She sighed and walked over to wait in the admitting line. Forty-five minutes later, she returned to her children with a stamped form in her hand.
The seat next to her son was empty. “Where’s Blanca?”
“She was here a minute ago,” he answered with a shrug.
She clenched her jaw and gave him a withering look. She frantically scanned the waiting room. There were other children and their parents but Blanca was nowhere to be seen. Her panic grew.
“Stay here. Don’t move,” she commanded.
She rushed across the waiting room and stopped for a moment in the doorway as the two police officers passed by. The younger one gave her second look, more suspicious this time. She ignored him and stepped into the busy corridor, pivoting her head left and right as she searched for her daughter.
She could be anywhere—out in the street, taken by someone. She began to run, her throat tight with panic. She had almost reached the main entrance when a cry from behind filled her ears. “Mamá!…Mamá!”
She stopped mid-step and turned as her daughter broke free from the doctor who held her hand and ran to her. Lucia swept her up and held her tight against her chest.
“You scared me, don't stray again.” She kissed Blanca on the forehead and brushed the hair from her eyes. The little girl giggled and struggled to get free. Lucia felt her tiny fingers tugging on the back of her blouse.
The young-looking Asian doctor who had held Blanca’s hand smiled. “I’m Dr. Ling, we found her playing near one of the examining rooms.”
“Thank you…thank you so much,” Lucia said as she lowered Blanca to the floor.
The doctor dropped to one knee and smiled at her. “Be good and stay with your mother, okay?”
“Dr. Ling, the room’s ready,” a voice called.
The Asian doctor winked at Blanca and then stood. She turned and walked towards the nurse and doctor who had called to her. Lucia watched her take a surgical mask from her coat pocket and place it over her mouth before joining the other two who also wore masks. They pushed a gurney with a patient on it down the hallway.
When they had disappeared around the corner, she looked down at her daughter and spoke. “Don’t do that again, okay?”
Blanca nodded and wiped a hand on her shirt. It left a small dark stain. Lucia sighed heavily. She grabbed Blanca by her other hand and dragged her to where Alejandro sat.
“Sit and stay here,” she said, directing the words to both of the children. She walked to the admitting desk, grabbed a handful of kleenex from a box on the desk and squirted hand sanitizer on them. She returned and scrubbed her daughter’s hands clean.
March 22nd, 22h30 GMT : Queens, NYC
Five hours later they returned to their dilapidated apartment in Queens. Lucia checked the time on her cell phone.
Mierda…Estoy tarde!
She was late and that wasn’t good.
She went to the bedroom they all shared and closed the door. A pair of black meshed stockings and short red skirt lay on the floor. She left her blouse on and quickly changed into the skirt and stockings before applying a thick coat of garish red lipstick. She looked in the mirror, ashamed by what she saw—not a mother, just a filthy puta.
With a heavy heart, she walked to the rickety nightstand that sat beside the bed. She gently removed a set of rosary beads from a small wooden box.
She cupped them in her hands and knelt, taking comfort in their familiarity. The beads were a gift from the family's priest in Santa Ana. They gave her strength and helped her accept the ungodly things in her life.
She ran her fingers over the small wooden cross at the end of the string of beads and began.
“In the name of the Father, and of the Son, and of the Holy Spirit. Amen. I believe in God, the Father almighty, creator of heaven and earth; and in Jesus Christ, His only Son, our Lord...”
After she had finished praying, she left the bedroom and found the children sitting at the kitchen table, drawing pictures on Alejandro's cast. Blanca used a red marker to fill in the outline of a dragon her brother had carefully drawn.
She stood quietly for a moment watching them as they played together, the troubles from earlier in the day long forgotten. They were her life, her reason for being. She wanted to stay and watch her children just be children, but couldn’t. She stepped from the doorway and interrupted them.
“Alejandro, there are Pupusas in the refrigerator. Please heat them for you and your sister.” She had made the cheese-filled tortillas earlier that day. They would fill the children’s stomach until the morning.
After lovingly kissing both of them on the top of their head, she whispered, “Be good...lock the door behind me. I won’t be back until late.”
A few minutes later, she stood in the graffiti filled lobby. A drunk lay curled up on the floor half blocking the door. His pants were wet and he smelled of urine. As she stepped over him, he grabbed at her leg, his leering eyes staring up her skirt.
“Pervertido!”
She kicked free and then gave him a second kick for good measure.
The jet black Chevy impala low-rider waited for her, its eight-cylinder engine rumbling with impatient anger. The driver was a bald Latino man with the number eighteen tattooed across his skull. He leaned across the seat and motioned her into the back of the car with a flick of his finger.
“Lo siento...I'm sorry—”
“Shut up and get in,” he snapped.
She opened the rear door and squeezed in next to the other women. The door had barely closed when the car sped away, its tires squealing as it rounded the corner. She was quiet. She knew she would pay in one way or another for her lateness.
They arrived at a semi-abandoned housing project. She and the other women climbed out of the car and entered the building.
Each had her own space in an apartment on the second floor. Privacy, or what passed for it, was afforded by a handful of ragged blankets that hung over ropes strung across the room. The soiled mattresses on the floor had no sheets.
Their customers, all men, would come in a steady stream and make payment to the Calle 18 gang members who stood watch by the door.
Her first client of the evening arrived. She turned to avoid his face. His breath smelled of cigarettes and rotten teeth, the stench so putrid she gagged. He slapped her and groped at her blouse before pulling down his pants. His meaty hands squeezed the flesh of her breasts, and she bit her lip to stop from crying out.
She knew if she made any noise, her keepers would stomp in, their tattooed faces tense with anger. They’d pull the man off, kicking and punching him before they emptied his wallet and sent him away. Then, they would do the same to her, but not as hard, she was property.
She closed her eyes and withdrew, letting the hours pass.
WHEN SHE RETURNED to the apartment, t
he children were asleep and she stood in the doorway quietly watching them as the tub filled with hot water.
After a few minutes, she returned to the bathroom and turned the water off. A single fluorescent bulb hung from the ceiling, casting its harsh light on her. She stared at herself in the cracked mirror, ashamed of what she had become.
She removed her blouse, only then noticing the small brown stain on the back of it. Curious, she raised the garment to her face and cautiously sniffed.
It smelled of shit. One of those dirty animals.
The anger welled up and she threw the blouse down in disgust before climbing into the tub. She would wash it later.
March 23rd, 04h50 GMT : Bellevue Hospital, NYC
Mei wearily closed the door to her locker. It was late, nearly midnight. She was exhausted from her double-shift, sixteen straight hours without a break.
Every night at Bellevue was busy with the homeless and hypochondriacs, but tonight more so than ever—a couple of shootings, three stabbings and a handful of overdoses.
Her route out of the hospital took her past the isolation rooms. She stopped to look at the Englishman’s chart. It had been eight hours. He was still unconscious with no improvement in his condition.
She scanned the chart for his meds—250 mg of metronidazole, four times a day. The antibiotics will help…should be an improvement by tomorrow. She put the chart back and headed home for a frozen dinner and a few hours of sleep. She’d check in on him again in the morning.
4
THE SARI
March 23rd, 11h30 GMT : Ahmedabad, India
Saanvi cringed as her aunt moved to the front of the dark brown wicker chair. I’m going to look ridiculous, she thought, anticipating the worst.
"Hold still, dear, I’m almost finished,” the older woman said.
She felt her aunt’s finger press against her forehead as the older woman touched up the bright red bindi she had applied.
“You look like a true Hindu girl now, come see.”
She stood and followed her aunt to the mirror, wincing with each step. She didn’t feel well. The stomach ache and embarrassing trips to the toilet had started just after she arrived in India.
