by Mark Kelly
“You should get yourself checked out,” she suggested, knowing he wouldn’t. Doctors were the worst patients.
“I’m fine, Dr. Ling, thank you.”
March 23rd, 13h40 GMT : Queens, NYC
Blanca cried out in pain and Lucia leaned over the bed. She tenderly caressed her daughter’s forehead.
"Alejandro, please get some water,” she said to her son, “a little cool but not cold.”
While he fetched the water, she brushed her daughter’s hair back from her face. It was damp with sweat and stuck to her forehead. Blanca’s eyes flickered at the touch of her mother’s hand. She cried out in pain and writhed in agony. “Mamá…Me duele el estómago.”
All night she had complained about the pain in her stomach. Nothing she had tried to relieve the pain had worked. She didn’t know what else to do.
The boy returned with the water and placed it on the nightstand. “What’s wrong with Blanca? Will she be okay?"
“Your sister—“ Lucia’s voice broke and she fought to regain her composure. "Your sister is strong. She will be fine.”
She dipped the facecloth in the bowl and squeezed the excess water out before draping the damp cloth across the child’s forehead. As she did, the little girl spasmed, exposing the diarrhea that stained her nightgown.
Lucia gently unfolded her daughter’s body to undress her. She carefully removed the soiled clothing and placed it on top of her own dirty blouse in the laundry basket.
Without being asked, Alejandro carried the basket to the bathroom. She would wash it later in the tub.
"Gracias…you're a good boy,” she said when he returned.
“What now?” he asked.
She was scared and didn’t know, but the doctors at the hospital would. It had been a little over twelve hours since they had left it. They would return—but not by bus. Time was more precious than money.
"Call a taxi.”
MAYBE ROBINSON WAS RIGHT, Mei thought as she stepped off the elevator and turned down the hallway to the nurses’s station. They’d only had a single case and strange or not, there were other diseases that could explain the British patient’s rapid death.
The ER was busy with doctors, nurses and orderlies flitting about in organized chaos. It was still early in the day, the real madness wouldn’t start until later, usually around 6:00 p.m.
She stopped and glanced at the assignment board on the wall. There was nothing beside her name yet.
“I’m back,” she said to the woman on the other side of the counter. “What do you have for me?”
“How’d it go?”
She shrugged. “About as well as you’d expect.”
The nurse nodded sympathetically. She looked at the computer screen in front of her. The display showed the status of the patients in the ER. It included those who had been seen by one of the triage nurses and were now waiting to be seen by a doctor.
“You have your pick this morning,” the nurse said, offering up choices like a waiter with the daily specials. “I’ve got an elderly man—fell and broke his arm. He’s confused and not sure where he is. Or you can have a little girl with stomach cramps and diarrhea. I’ve also got a—”
“I’ll take the girl,” Mei answered. She wouldn’t admit it openly but working with the elderly made her uneasy. Not something she was proud of.
She picked up a marker from the shelf below the assignment board and asked, “Last name?”
“Sanchez.”
Mei wrote the name on the board beside her own.
“She’s in 2C,” the nurse added.
When she arrived at the examining room, a Latino woman in her early thirties stood anxiously by the side of the bed. She looked familiar. Mei racked her brain trying to remember where she had seen her before. A teenage boy with his arm in a cast sat in the chair beside the bed.
“Hi, I’m Dr. Ling.”
The woman turned at the sound of her voice. She looked surprised when she saw Mei.
Mei opened the girl’s chart and read from it. “It says your daughter has diarrhea and is complaining of stomach cramps. Let’s take a look.” She pulled a pair of gloves from her pocket and snapped them on, pulling at the fingertips to adjust the fit.
“She is very sick.” The woman’s Spanish accent was strong.
“When did she last eat?” Mei asked.
“Last night,” the woman answered. “Same as my son.”
“And he’s feeling okay?”
The woman nodded.
Mei leaned over the bed to take a closer look. The girl’s stomach was slightly distended. Her lips were dry from minor dehydration. It could be anything—food poisoning, a flu bug.
She spoke to the mother, explaining what she would do. “I’m going to order an IV and arrange more tests. The IV will hydrate her—give her water, liquids that she needs.”
She opened the chart to make the notations for the tests she wanted to be done. After the events with the English patient, might as well request a GDH as well, she thought and began to make the appropriate markings on the girl’s chart. She stopped to listen when the PA system in the ceiling activated with a chime.
“CODE ORANGE…CODE ORANGE…Multiple MVAs”
Orange meant life-threatening casualties—in this case, a motor vehicle accident. Everyone in the ER who wasn’t already attending to a critical patient would meet the ambulances as they arrived.
Mei looked at the girl and made her decision. She can wait.
“I’m sorry,” she said to the girl’s mother. “There’s been an emergency—a very bad car accident. One of the nurses will come by shortly to run the tests and set up the IV. I have to go.” She was gone before the woman could say anything.
THE CODE ORANGE was a collision between a concrete truck and a small bus on FDR drive. Nine victims arrived at the ER in critical condition. Five went to surgery and the other four straight to the ICU on the sixth floor.
When she returned to the nurses’s station, one of the nurses gave her an odd look and pointed at her pants. “Sure you don’t want to put on fresh scrubs?”
She followed the woman’s eyes down. The cuffs of her pants were splattered with blood. It looked like she had walked through a puddle of it. Even with the plastic gown and shield she’d been wearing, she hadn’t escaped the carnage.
“Thanks. I’ll go do that now.”
”What do you want to do about the child in 2C?” the nurse asked as she turned away.
“Are her test results ready?”
“Right here.” She handed Mei the chart.
Mei scanned it. “What about the GDH?” She flipped through the chart a second time, searching for the missing test results.
“You didn’t ask for one.” The nurse took it back and showed her the request form with the incomplete section at the bottom. “Was that supposed to be it?”
“Damn it, yes.” She took the chart back and filled out the request for a GDH test. “Can you do it now?”
“Sorry—my shift’s finished,” the nurse said apologetically. “I’ve got to run and get my kids from my mother-in-law before she flips-out. She’s a royal bitch if I’m late.” She glanced at the shift schedule. “But I’ll ask Marcy to do it. She starts in five.”
Mei nodded. A few more minutes wouldn’t make any difference.
“Oh, Cohen’s in 4D,” the nurse added as she threw on her jacket. Cohen was one of the ER orderlies. “He’s complaining about bad stomach pains. Can you take a look at him?”
“Has he been triaged?”
“Yep.”
“Okay, I’ll go check him out as soon as I change into fresh scrubs.
She changed and a few minutes later, found him bent over retching into a garbage can in the examining room. She handed him the box of tissues from the counter when he finished.
“Thanks, Doc.” He wiped his chin and the corners of his mouth and threw the tissue into the garbage. “I feel like shit.”
“You don’t look so well either.�
��
She flipped open his chart. “What’s the problem? Stomach cramps?”
“And the shits,” he said with a trace of embarrassment, “since early this morning.”
That’s two…three if she included the English patient.
“When did it start?”
“Just after midnight. I was fine yesterday.”
She shone her little flashlight in his eyes. Pupils equal and reactive to light. No problems there. “Any tenderness?’
“My gut’s a little sore…maybe swollen too. My pants feel tight.”
“Okay, stretch out and let me take a look.”
He lay down on the bed and lifted his t-shirt. She could tell immediately from the curve of his stomach he was distended. She gently pushed down and he winced.
“Hurt?”
“Like a son of a bitch.”
She finished her examination and wrote up his chart. “Okay, hang tight. I’ve ordered some tests. Someone will be here in a couple of minutes to do your work-up.”
When she arrived back at the nurses’s station, Marcy, the nurse who had just started her shift, had the little girl’s chart in her hand.
Mei pointed to it. “Can I see that?
“Sure, I was just about to file it.”
“File it, why? I requested a GDH.”
“Don’t know anything about that,” the nurse answered. “It was in the file pile.” She handed the chart to Mei. The GDH test still hadn’t been done.
“Damn it. Sandra told me she would ask you to do it.”
The nurse shook her head and raised her palms. “She didn’t say a word…I’ll go do it now if you want.”
“I’ll do it,” Mei said angrily. That poor girl and her mother have been alone in the examining room for nearly three hours. “You do Cohen’s. Here’s his chart.”
They stopped at the supply closet on their way to the examining rooms. She remove two test kits and handed one to the nurse. “Meet you back at the station in fifteen minutes.”
Mei jogged to the examining room. The girl’s mother looked at her and scowled. “My daughter, she is very sick. She has been crying, in pain—no one has come to help. I had to look after her myself.”
Mei apologized. “I’m sorry. It’s been very busy.”
The little girl was wrapped in a sheet taken from one of the gurneys. Her pants and dirty underwear lay on the floor. A pair of used rubber gloves sat in the bottom of the waste bin.
“Did she have an accident?”
“Accident?” the woman gave her a confused look.
“Diarrhea?” Mei explained. “Did you have to clean her up?”
The girl’s mother nodded.
Mei showed her the test kit. “This will help me figure out what’s wrong with your daughter.”
After she had collected a fecal sample, she placed it in the buffer solution as she had done the day before. “I’ll be back in a couple of minutes, Mrs. Sanchez.” She looked the woman in the eye. “I promise, okay?”
The woman gave her a worried nod.
Mei reached the nurses’s station at the same time as Marcy. She handed the girl’s test kit to the nurse. “I’ll be back in a few minutes. I’m going to set up a saline drip on the little girl.”
“Want me to do it?”
“Thanks, but I told the mother, I’d do it. It’ll only take a couple of minutes.”
She returned to the examining room, set up the IV and rushed back to the nurses’s station. Marcy’s brow was furrowed with concern. She held out the test kits.
“They’re both positive.”
Mei’s chest tightened.
“Get them prepped and moved to isolation—immediately!”
The nurse stared at her. Her eyes wide with shock.
Mei shook her head in warning. “Be careful, it’s infectious.” The tone of her voice was unmistakably grave.
“What is it?”
“I don’t know. Maybe a new strain of C. diff.”
One of the admitting nurses arrived at the station with a frazzled look on her face. She ignored Mei and spoke to Marcy. “You speak a little Spanish, right?”
Marcy nodded.
“Could you come help? There are some men in admitting. They don’t speak English but I think they’re complaining about their stomach.”
“How many?” Mei asked.
“Eight…maybe nine.”
Shit…She turned and ran towards the elevator.
Where are you going?” Marcy yelled after her.
“To Robinson’s office.”
Robinson’s secretary frowned when she jogged through the door a few minutes later. “He’s not here, Dr. Ling”
“Where is he?” she asked, slightly out of breath. “I need to talk to him.”
“I’m not sure that it’s any of your business,” his secretary said with a pinched expression, “but he’s gone home. He wasn’t feeling well.”
“Could you call him…call him now!”
“Excuse me?”
“CALL HIM.” It wasn’t a request, it was an order. “I think he may have been infected by one of the patients in the ER.”
The phone was in the woman’s hand and at her ear in a matter of seconds. “It’s just ringing,” she said as Mei watched. “I have his voicemail. Should I leave a message?”
“Yes—“ She changed her mind. “No, call 911—have them send an ambulance to his home.”
“Do it now!” she shouted when the other woman didn’t move.
Am I doing the right thing? If he’s not ill, my career at Bellevue is over. She pushed the thought out of her head. That’s a problem for another day.
She pointed to his office door. “I need to file a report with the CDC.”
Ten minutes later, the verbose government form was completed. She didn’t bother filling out one for each patient but used a pen to circle the section labeled Primary Number of Cases and wrote four.
Next to the word # Died, she wrote two and then scratched it out and wrote one. Robinson wasn’t dead yet. She scrawled the word **URGENT** across the top and faxed the form to the number on the form.
SEVEN HUNDRED AND fifty-eight miles away in Atlanta, Georgia, a piece of paper spilled out of a fax machine onto the floor of the Records Department at the Center for Disease Control headquarters.
It was almost missed but for a diligent clerk who picked it up and keyed the information into NORS.
Bellevue hospital now held the dubious record of being the first American healthcare facility to report an outbreak of the deadly bacteria.
Outbreaks had already been reported across the United Kingdom and India. In the coming hours and days, many more would be reported worldwide.
8
AWAKEN
March 24th, 08h25 GMT : Ahmedabad, India
A warm light caressed her face as she ebbed back into consciousness. Saanvi slowly opened her eyes only to quickly close them. The stream of sunlight that shone through the window made them water. She blinked a few times and then cautiously tried again, cracking one eyelid open and then the other.
“I'll draw the blinds,” a voice said.
Saanvi raised her hand to block the light and searched for the person who had spoken. A man with a British accent…where am I?
A translucent tube was taped to the back of her hand. Her eyes followed it to a plastic bag that hung from a metal rack. The room dimmed as the blinds were drawn and her surroundings became clearer. She was in a small room with pale yellow walls. There were flowers in a vase on the nightstand next to the bed. The air had an antiseptic smell.
“Good morning. You’re at the Ahmedabad Civil Hospital.”
The doctor who spoke moved away from the window and into her line of sight. His face was covered by a white surgical mask, only his eyes showed.
“I'm Dr. Brar…Your aunt and uncle brought you to the hospital two days ago,” he said as he stepped forward.
Two days…was I asleep the whole time? She blinked away the confusion.
“Where are they?”
“In the waiting room. I'll fetch them in a few minutes. How are you feeling?”
“Okay, I guess…my stomach hurts a bit.”
“That’s to be expected. You were quite ill. I’d like to do a quick examination before your aunt and uncle come in. Tell me if you feel any pain or discomfort.”
She tensed as he began to examine her and winced when he touched her lower abdomen. “Ow, that hurt.”
His eyes twinkled sympathetically as he spoke. “Your stomach is still distended but not nearly as much as when you arrived. You’ll be tender for a few more days.”
“What’s wrong with me?”
“You have an infection in your gastrointestinal tract,” he answered. “Let me get your aunt and uncle and we’ll go over everything in more detail. They’re quite anxious to see you.”
He left the room and returned a few minutes later with them. They both wore yellow plastic gowns with surgical masks on their face, blue gloves covered their hands.
Her chest tightened as she watched her aunt’s eyes dart nervously around the room, finally coming to rest on the IV tube. The older woman took a cautious step forward and stopped at the end of the bed.
“Hello, dear.”
“Why are you dressed like that?” she asked nervously as a knot formed in her stomach.
“It’s just a precaution,” the doctor answered. He stepped closer as if to make the point that no one had anything to fear from her. “You're in an isolation room. The infection you have is contagious.”
She bit her lower lip as the tears began to well up in the corner of her eyes. “I don’t understand.”
He pulled a chair from the wall and sat down beside her. “There’s a bacteria called Clostridium difficile in your colon. It made you sick, but we've started to treat it.”
“How did I get it?” she sniffed.
He shrugged. “We don’t know. Your mother told us you had pneumonia earlier this year. It's very possible the antibiotics you were given to treat the pneumonia also killed the good bacteria in your stomach, making it easier for the C. diff to grow.”
