"I like it," Rivera said. "These long-term hospitals may be a good match for people with Guillain-Barre syndrome. They can keep them breathing and keep their pain managed. Can I call around and find out which ones have the best reputation?"
"I would appreciate that," Stoker said. "And the long-term hospital will probably allow more family visits and support," Stoker said.
Twenty minutes later, Rivera called back and recommended the Sunrise Long-term Acute Care Hospital. Stoker kissed Allie on the forehead. "I'll be back, honey. I've got a visit to make."
Stoker walked quickly out to the street. Then he took a cab to the Sunrise Long-term Acute Care Hospital in the Suburbs of Chicago. After walking in through the front door, he followed a sign to the admitting office. When Stoker walked into the simple office, a woman was on the phone. She acknowledged him with a smile, then she held up her index finger as if to say, just a minute.
Stoker picked up a brochure. Its pictures showed patients and families smiling as if staying in this hospital was akin to a night on the town. Long-term acute care hospitals, or LTACs, were a little-publicized phenomenon in the American health care system. Patients who needed a month or more of acute care qualified to stay in LTACs instead of a traditional hospital. Paralyzed patients and people in long-term comas made up a large proportion of the hospital's clientele. The brochure also included a picture of a pulmonologist who was the medical director.
The woman finished her phone call. "May I help you?"
"Yes, my name is Troy Stoker. I'm a doctor, and I would like to admit a patient here."
"Very good. Let's get that process started."
"This patient is not my patient, per se. She's my wife. Her diagnosis is Guillain-Barre syndrome. I think she's going to need to be on a ventilator in the next few hours. Can you accommodate her that quickly?"
"Assuming we can get your insurance to authorize her visit, yes," she said. "My name is Grace Dean. I'm the admitting nurse. Let's get going on some paperwork."
"I don't want preauthorization or insurance hurdles to slow the process. I’ll just pay for it. If you need anything else, just let me know.”
Grace smiled. "Thank you, Dr. Stoker."
"Yes. There's some definite urgency here. Let's do it now."
"In my opinion, we should get most of the Guillain-Barre syndrome cases," Grace said. "We have more liberal visitation policies, and our floors are much quieter than hospital ICUs."
"Great. I want my wife to walk in here under her own power while she still can. She's a strong and independent soul. She will accept her treatment better if she chooses to walk through the doors on her own.”
"Can you have her attending physician at the hospital call me?" Grace asked.
"I've got her on speed dial." Stoker dialed the neurologist, and she answered. Stoker introduced the neurologist to Grace.
After a five-minute conversation, Grace ended the call and handed Stoker his phone. "You go get your wife. I'll assign her a bed right now."
An hour later Stoker and Allie were both in a rental car, on their way to the LTAC. They pulled the car into the parking lot and parked. Allie got out of the car and began her trek into the hospital. "It's afternoon, and the temperature's about eighty-eight degrees," she said. "I guess these are my last breaths of fresh air for a few weeks." Her pace slowed. "They'll keep me cooped up in my room with a temperature of a constant seventy-two degrees or something like that." She stopped and wrapped her arm around Troy's bicep. "I don't like constant, with one exception." She transferred a fair amount of weight to her husband. The short walk had depleted most of the strength in her legs. "That exception is you, Troy. Thank you for being so constant."
"You're welcome, Allie. I like constant you, too."
"That's why the next few weeks are going to be tough for us."
"What do you mean? I'll be right here by your side."
"No, Troy." Allie stopped. "There's something bigger out there than you and me—than our desire to be constant." Allie was catching her breath. "There's a puzzle out there. There are only a few people in the world who see this act of bioterrorism in its entirety. There are only two doctors in the whole United States who are ahead of this situation. And, you are one of them. There are millions out there who need you right now. It’s easy math."
"Well, they may have to wait for a few days. I can do quite a bit right here from the hospital."
Just then, Allie's parents and sister pulled into the parking lot. "I told my parents and sister your story of the past few weeks—everything you've experienced. The Shiite extremists in Chicago, Guillain-Barre syndrome in Mexico."
"They must think I'm crazy."
"No, Troy. They think you're the man for this season, and so do I. It's not by chance you were in Mexico. It's not by chance you had a detour to the hospital in Chihuahua. I’m coming to accept that I needed to be one of the first cases so you would have the conviction—the indignation—you need to go out there and save millions of other people like me."
"But, the millions of people have Errol Rivera and Z," Stoker rebutted. "Those two have the tools and information everyone needs."
"No, Troy," Allie said as they reached the front door to the hospital. Troy opened it, and she stepped through. They walked into the lobby a few steps and Allie sat down on a couch. "Look at how well you've taken care of me. You thought outside the box. I'm here in this specialized hospital, a kind of hospital I never even knew existed. I'm far away from the craziness of a big general hospital. It's peaceful here, and my family can be by my side the whole time. My parents and sister have already set up a schedule to make sure someone is always with me. They worked out their shifts. And, I asked them to exclude you, because the world needs you more than I do. You need to be out there fighting this war."
An automatic door opened. Grace, the admitting nurse, and another person dressed in scrubs emerged from a treatment area. "Welcome Mrs. Stoker," Grace said.
Allie smiled at her. "Thank you, I guess." Allie's parents and sister entered the lobby. Allie stood up, and her legs trembled. She squeezed Troy's hand. "As you can see, I have a lot of support on my admission day. I need you to go out there, solve this problem, and be here for my discharge."
Allie's dad spoke up. "You're an incredibly supportive husband, Troy."
"You can prevent moments just like this one for millions of people, Troy," Allie whispered as her eyes moistened. "It's a small sacrifice, this bookmark. Leave me here. Then come back and burst through that door when you've saved the world."
Allie was right—and he hated it. Troy Stoker, MD, then did the hardest thing he'd ever done in his life. The husband, doctor, and warrior spun around and started for the door. Each pace was resolute, and he did not look back.
CHAPTER 23
Chicago, Illinois
Dark gray clouds floated above Stoker. Looking toward downtown, he could see fog floating amongst the skyscrapers, dropping a welcome summer rainstorm on the streets of Chicago. Z navigated the rental car into the parking lot and pulled up to Stoker, who was standing curbside outside of the Sunrise Long-term Acute Care Hospital.
As Stoker crawled into the car, Z asked, "How's Allie?"
"There's not much to say. She's in a tough spot. But, she recognizes that a few million people are going to be in her same boat. So, she kicked me out with orders to go fight this battle. She wants us to save as many people as we can from this miserable disease. Now, bring me up to speed on the last few hours."
Z pulled the car away from the curb. "Not until you give me a little more detail on Allie." The windshield wipers fanned back and forth, not on the highest setting, but close. "Her parents and sister are with her," Stoker said. "We found this hospital for long-term situations like this one. She should be safe here, even when things get crazy."
"Will she be awake when she's in those worst few days, the days when the ventilator is breathing for her?"
"She'll be heavily sedated, and probably will spend s
ome time in a drug-induced coma."
"I'm so sorry for Allie," Z said. "There's not much any of us can say, other than that sucks."
"There's my update about Allie. What can you tell me to help us win this fight?"
"First, we got results back from the CDC in Atlanta. The samples from the lab in Hotel Esatto's special basement lab contained the same strain of Campylobacter jejuni we uncovered in Mexico.”
"That's no surprise," Stoker said.
"Second, we've been searching high and low for these would-be Iranian terrorists, the ones we followed in from Mexico. But, they've all disappeared. We have, however, shut down Hotel Esatto. We made the media think it was because of a significant natural gas leak. We've also arrested a bunch of Nikolas's key employees. The accounting and IT personnel have been particularly helpful. We've collected a lot of valuable intel from them."
"How did you like Hotel Esatto?" Stoker asked. "I'm referring to the experience you had before we learned it was a node of international terrorism."
"That fresh-squeezed tangerine juice tastes amazing," Z replied. "But, I think I may be allergic to it. I got a headache shortly after drinking it two days ago."
"Have your headaches gone away?"
"They did. So yesterday I took a risk and drank more tangerine juice."
"And, it gave you a headache again?"
"Yes. But, I also felt some stiffness in my neck."
"If it was just headaches, I may be willing to entertain your allergy diagnosis. But, the stiffness in your neck would steer me more toward an infection of some kind. Perhaps a virus. Have you had any other symptoms? Skin rashes, nausea, or swelling?"
"No, just the headaches and stiffness in my neck."
"No fever?"
"None I can think of."
"Okay. Just let me know if you get any other symptoms." Stoker thought for another minute. "Have you been working out?"
"Almost every day," Z replied as he maneuvered the car around a right turn at a busy intersection.
"Is there any part of your workout feeling out of kilter? Like, have you noticed any part of your strength or stamina decreasing?"
"Strength and stamina when I lift weights are good. My legs have felt a little rubbery lately. I've been favoring my left leg a bit."
"How about running?" Stoker asked. "Have you noticed any difference there?"
"Yes. During my workout at Hotel Esatto’s gym a couple of days ago, I just didn't feel as good when I was running. I'm slower."
"Okay then, let's have Rivera and me take a better look at you this afternoon," Stoker said.
The weakness in Z's legs, a common Guillain-Barre syndrome symptom, concerned Stoker, but he did not want to cause his friend any alarm. "I suspect you've got some kind of virus," Stoker said to placate Z. "You're just such a tough guy. A little virus isn't going to keep you down. What else can you tell me about the latest investigation here in Chicago?"
"There's not much more to tell you. Ahmadi's FBI agents have been scouring the streets.
Stoker pointed up at the clouds in the sky. "At least her agents won't have to be working the streets in the rain. It looks like this storm is letting up."
Z turned the car onto Interstate 55 and drove toward downtown Chicago. "Yes, it is. The clouds are lifting. But, I welcome rain in the summer."
Z and Stoker continued down the freeway. Most of the conversation was Z updating Stoker on minor details. Suddenly brilliant rays of sunshine broke through the clouds. Z squinted. Then he let loose a pain-laden yell while holding up a hand to shield the sun from his eyes. It was all he could do to keep the car under control.
Stoker looked over at him. "Are you okay? You're acting like a vampire sunbathing on a beach."
"No, I'm not okay." Z veered the car over into the right emergency lane and decelerated to a rapid stop. "The sunlight just triggered a beast of a headache," Z said as he rubbed his temples and kept his eyes closed. Stoker chose to remain silent. Z gritted his teeth and exhaled between audible murmurs. Then suddenly he bolted up in his seat, opened the door, jumped out of the car and ran to the right edge of the freeway shoulder. Stoker followed him. By the time he caught up to Z, the young tech enthusiast was bent over with his hands on his knees, puking up the contents of his stomach onto the rain-washed asphalt at the edge of Interstate 55.
Stoker came up behind him and placed his strong hand on Z's shoulder. "Don't worry, man. We're going to get this taken care of." When Z finished vomiting he slowly straightened from his hunched over stance. Then Stoker helped him over to the car, and Z leaned against the passenger-side door.
"Whoa. I don't know what just hit me. It came from nowhere, just out of the blue."
"Let me check you out a bit," Stoker said as he reached out and put his left hand behind Z's neck. "Just go with me here. I'm just going to move your head. Move with me." Stoker pushed Z's head to one side.
"Ouch. That kind of hurt," Z replied.
Stoker pursed his lips, furrowed his forehead, and reached his hand up to feel Z's forehead. "Your temperature feels a little high. We call your response to the sunlight photophobia. It's a symptom of a few things, including certain infections. Where's Rivera?"
"He's working out of the FBI field office."
"With the weakness in your legs, photophobia, the stiffness in your neck, and the headaches, you've got something going on. Let's get you treated ASAP—get you better. We need you on the team during this critical time."
"You're driving," Z said as he opened the passenger door and slumped into the car.
Less than thirty minutes later, Z had Stoker and Rivera poking and prodding him. After a few questions, Rivera spoke calmly. "We need more information than we can capture here in the field office. Let's take you to the hospital and run a few more tests. This should all be pretty routine stuff we can do right from the emergency room.”
• • •
"How come I'm just learning about this Guillain-Barre syndrome epidemic now?" yelled president James Riddell in the face of his Secretary of Health and Human Services. "Come on Albert. I have confidence in you. Help me cut to the chase and get to the bottom line. What's your hunch?"
"Mr. President, my instincts tell me this is big. My hunch is this infection's not natural. Someone with sinister motives is the catalyst here."
"I'm issuing an executive order," the president said. "I want every new case of Guillain-Barre syndrome reported to state health departments within twenty-four hours of diagnosis. States will have twenty-four hours to forward those results to the Centers for Disease Control. I want daily updates." The President paused for a moment before he asked, "What else should we do?"
"Two things, sir. First, we need to get lab experts looking into what is causing this spike in cases. Second, we should have you meet with two doctors who have been raising a stink about this issue for a few days now. One is a military physician, Colonel Rivera. The second doctor is a psychiatrist from South Dakota, a Dr. Stoker. The FBI is crediting them with preventing tens of thousands of infections."
"I want a meeting with these doctors, ASAP," the President ordered. "What have they been saying?"
"They stumbled onto an epidemic in Chicago," explained the Health and Human Services Secretary. "And they have preliminary data about an inordinate number of cases in other metropolitan areas. Dr. Stoker's wife developed Guillain-Barre syndrome. They also mention some tie to Mexico. But my people need more time to verify the Mexican link."
"Have Stoker and Rivera bring any and all information they have. These guys don't sound like they're just playing doctor. They sound pretty serious. If what they're saying is true, we could have a national horror to deal with."
• • •
The emergency room doctor started to examine Z. "Your symptoms are interesting. A couple of them match up with an illness called Guillain-Barre syndrome, such as the weakness in your legs. We've seen a sudden spike in the number of Guillain-Barre cases here in Chicago, and the CDC has put out a
n alert."
"Guillain-Barre syndrome crossed our minds very early on," Stoker said. "But, Z's photophobia and neck pain are bothering me—"
The emergency room doctor interrupted Stoker. "I agree. Those two significant symptoms make me think it is much less likely to be Guillain-Barre. Let's check this out again," the doctor said. He grabbed the overhead exam light and tilted it down into Z's face.
"Ouch!" Z winced, closed his eyes and covered them with his forearm.
Then the emergency room doctor took hold of the back of Z's neck and pushed his head backward and then forward. Again, Z complained. "That really hurts, Doc."
The emergency room doctor looked over at Stoker and Rivera and raised one eyebrow in an expression of concern.
"I hope you're good at spinal taps, Doc," Rivera said. Z flinched at the mention of a spinal tap.
"I think I'm pretty good at them," the ER doctor said.
"No way!" Z said. "No spinal taps." Z stood up and reached for his clothes. "I'm getting dressed and going back to my hotel."
"Relax loco," Rivera said.
"I've done hundreds of these," the ER doctor said. "I believe it will hurt a lot less than you think. I'll do my best to keep the pain down. Besides, we need to do this little procedure. But, let's get a CT scan first."
They gave Z an injection of lorazepam to diminish his anxiety. Then he had his CT scan. The spinal tap went well, and Z was pleased it hurt less than he had heard. During the next three hours, Z also had some other tests and exams, including an MRI. The results from his spinal tap showed elevated lymphocytes and an increased protein concentration—both evidence of infection in his brain or spine.
Finally, Z waited in the exam room while the three doctors reviewed his MRI. "Look at that lesion," Rivera said.
"It's sitting barely behind the prefrontal cortex," the ER doctor added. "He's also got some edema."
"Let's show Z what we're looking at," Stoker said.
The ER doctor swung a large monitor toward Z. It displayed many images of Z's brain. The doctor pointed to an area just to the side of the center of his head. This is the part of your brain that controls motor function. We suspect your leg weakness is due to a lesion you have at this location." The doctor circled his finger around an area on the MRI colored much lighter.
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