by Ross Pennie
CHAPTER 24
At four o’clock that Friday afternoon, Zol hung up the phone in his office and said a prayer of thanks to the inventor of call waiting. Arlene Novak had rung off to take another call coming in at her end. Despite all scientific evidence to the contrary, the woman was convinced that her children’s school was wrapped in carcinogenic asbestos and toxic mould. She wanted the building condemned and rebuilt on a brand new site where the basement was certified free of radon gas. During Mrs. Novak’s daily calls, Zol considered it a point of honour to stay calm and keep his tone measured. No matter how shrill her voice, how outlandish her claims, Zol challenged himself to maintain his cool while not giving in to her exorbitant demands.
He gazed out of his window at the parking lot and its scrum of dented garbage cans. The gritty view was a poor inducement for daydreaming. It kept him focused on the stark matters at hand, like catching Vik Horvat with his fingers on the counterfeit meds he was dispensing to dim-eyed seniors. Natasha told Zol about Steeltown Apothecary’s suspicious blood-pressure tablets when she’d called on her cellphone. As a good citizen, and a trusted public servant, Zol knew he should blow the whistle immediately — inform his boss Peter Trinnock, the RCMP, the Ontario College of Pharmacists, Gloria and Gus Oliveira at Camelot, and the residents themselves. But he was going to sit tight and wait for the drug company to analyze Horvat’s tablets. If the meds were fake, the bastard truly was putting seniors in jeopardy all over the city. Rushing in with no hard evidence against the man would accomplish nothing but front-page drama and another black mark against everyone in the health care system. Zol prayed that Horvat’s clients could live with poorly controlled blood pressure for a few more days.
He turned to his computer screen, intending to see what emails had piled up in the past hour, but his door swung open and Colleen tiptoed in carrying two coffees and a Nitty Gritty bag of pastries, which she handed to Zol.
“Thought you could do with a Friday afternoon treat,” she said, closing the door.
Colleen herself was treat enough. Without a second thought for the computer, he set the cups and pastries on his desk, then greeted her with a squeeze. She had the knack of appearing exactly when he needed her most — professionally and emotionally. She lifted her face and offered a warm, full kiss on the lips. He drank in the arousing hints of jasmine and mandarin enveloping their embrace.
He finally let her go, then took her coat and hung it on the rack. He felt suddenly hot in his blazer and shrugged out of it.
“Mmm,” he said, ripping open the paper bag. “Marcus’s famous raisin scones.” Not only did Marcus run his Nitty Gritty Café like a well-oiled machine, he was a cheery barista and a talented baker. “Already buttered. Fantastic. Thanks.”
“Have you noticed? Marcus only makes them on Fridays.”
“Really?”
“Like DeBeers and their diamonds.”
“What? DeBeers only mines diamonds on Fridays?”
“No, silly. But they lock most of them away. Then dribble them slowly onto the market. To preserve their allure and prestige. And bolster their price, of course.”
“Then I better do the same with my thin-crust pizzas. Seems to me I’ve been serving up my quattro stagionis far too often. A certain person could start taking them for granted.”
“I didn’t say that.” He loved the way her eyes crinkled when she laughed.
He removed the lid from his coffee. “I gather things went well at Steeltown this morning? Any problems? Natasha hasn’t been in the office all day.”
“Not to worry. She was brilliant. Should have been an actress.”
“No way. I need her here.”
Colleen gave him a detailed account of their trip to the pharmacy. Zol wished he’d witnessed Natasha’s authentic South Asian accent and mannerisms. She really was a good sport. And deserved a lot smarter boyfriend than Bjorn, that goofy Swedish stockbroker she’d finally had the sense to dump. Dating him was such an obvious rebellion against her parents. Brown or white, she needed someone her intellectual equal, not a guy who played only on the strength of his looks.
Of course, who was he to talk about the suitability of love mates? He should have anticipated from the beginning that Francine, as flaky as a Parisian croissant, would be a disaster as a spouse and mother. Her last phone call had been from an ashram in India. In eight years, she’d never seen, never spoken to her son. Colleen on the other hand . . .
“Zol?”
“Sorry.” He gulped his coffee.
“I said, that’s not the only mission I had today on your behalf. Gus made his rounds again. Right on schedule.”
“For Waste Not?”
“Pickups at the Caledonian’s faculty club, and —” She stiffened, and the twinkle in her eyes dissolved at the sound of a brisk rap at the door. He’d noticed that about her before. She bristled at unexpected knocking. Three times such knocking had signalled stone- faced police officers on her doorstep, mouthing shattering news.
“Yes?” Zol called.
“It’s me.”
When Zol opened the door, Natasha was standing breathlessly. Her pupils were huge, and red blotches sprouted on her neck. She looked like an exhilarated huntress who’d chased her prey to within pouncing distance.
“Goodness,” Zol said. “What’s up?”
“Ellen just called. From microbiology. At Caledonian.”
“With results?”
“Doozies.” She gaped at Colleen, the Nitty Gritty bag, and the pair of coffee cups. She realized she’d walked in on a tête-à-tête. “Oh, I’m sorry. You’re busy.”
“No, no,” said Colleen. “I was just updating Zol on your fantastic performance this morning.”
After further encouragement, Natasha took a seat and held her notebook in her lap. Once she’d caught her breath, she asked, “Did you tell him about the shampoo?”
“All part of the authenticity you brought to the role,” Zol said. “Now, tell us. What did Ellen have to say?”
“Earl Crabtree’s blood and cerebral spinal fluid — they’re growing listeria monocytogenes.”
“That’s bad,” Zol said.
“And it makes two from Camelot in the past month, both with bloodstream infections. Earl Crabtree and Raimunda Ferreira, the manager’s mother.”
“How’s Earl doing?” Colleen asked.
“All Ellen knows is he’s still in the ICU.”
Natasha clearly had more on her mind than another case of meningitis, important as that was. She investigated these mandatory notifications of reportable illnesses routinely without getting breathless over them. These Camelot cases were getting to her personally. He should talk, he told himself — he was losing sleep over Art’s and Betty’s safety.
“Ellen dipped into her deep-freeze,” Natasha continued. “Retrieved the three dozen stool samples submitted so far this year from Camelot’s gastro cases. On a hunch, she cultured every one of them for listeria.”
“But what’s that going to tell us?” Zol cautioned. “You can find listeria in almost any normal stool. The experts say it’s pointless to look for it, except in blood and spinal fluid.”
“She ran controls as well. Samples from diarrhea patients who don’t live at Camelot.” Natasha flipped through the pages of her notebook until she found what she was looking for. Then she paused as if to say, I hope you’re ready for this.
Zol said nothing. He just let her enjoy the drama of the occasion. She really should have been an actress.
“Ellen tested thirty control stools. And she found listeria in two of them.”
Okay, thought Zol, I guess listeria isn’t that common.
“And,” Natasha continued, “from thirty-five Camelot gastro samples, she recovered listeria from . . . twenty-eight.”
Colleen grabbed the empty Nitty Gritty bag and worked out the math on the back of it. “That’s ten percent in the controls, and . . . eighty percent in the Camelots. Extraordinary.”
“Mother of God,” Zol said.<
br />
CHAPTER 25
At nine on Friday night, Hamish followed Todd out of the parking lot at the corner of James Street North and King William. Hamish’s stomach churned a toxic brew of nerves, hunger, and sleep deprivation. After Ellen’s call this afternoon, he’d told Todd he wouldn’t be joining him at the Reluctant Lion’s karaoke after all. Suddenly, there was a lot to do, and it didn’t seem proper to go out drinking as soon as they got their first break in the case. Discovering that listeria was the gastro-causing culprit they’d been looking for all along put a whole new spin on Camelot’s outbreak, and on Betty’s illness.
No wonder she was so sick. She was infected with C diff and listeria. Vancomycin — even the bona fide stuff — would never cure both infections on its own. She needed treatment with two antibiotics, and he’d wasted no time in getting the second one started.
He’d called Caledonian University Medical Centre and asked the pharmacy to send him a large carton of saline solution, syringes, and ampicillin. The drug was one of the few antibiotics predictably effective against listeria, and he needed enough of its intravenous formulation for everyone at Camelot with gastro. He’d had it with pills. He could trust only injectable ampicillin, where he could watch the drug going straight into his patients’ veins. Local pharmacies would have lots of ampicillin on hand, but only in capsules. Caledonian was the only local source of the intravenous form.
The pharmacist refused Hamish’s order, saying she had no authority to dispense drugs outside the hospital. The matter got settled only after Hamish phoned Jeff Suszek in Emerg and threatened to load every Camelot resident who had diarrhea into a van and park them in the hospital’s ambulance bay. Suszek got the pharmacist to see things Hamish’s way, and the ampicillin had arrived within the hour. The ICU nurse, whom Gloria had agreed to hire for twelve hours each night for two nights, got the IV ampicillin into the patients in record time. After that, Todd convinced Hamish that the best thing for his patients was a clear-headed doctor. He said if Hamish took a couple of hours off for R and R, everyone at Camelot would benefit. It didn’t have to be a late night.
So here they were, trudging through the wet snow.
The wounded heart of Hamilton gave Hamish the creeps. He rarely ventured north of King Street after dark, and he wished they’d taken a taxi to the door instead of leaving the Saab in an outdoor lot. Wet snow was falling, and it would probably turn to freezing rain. In an hour or two he’d be assaulting the Saab’s windshield with an ice scraper. He hated that.
The streetlights, half of them burnt out, lit the graffiti scrawled on the abandoned storefronts along King William Street. Hamish knew this strip of gashed doors and boarded windows was a Canadian reality, but his heart ached at the way it taunted his own picture-postcard version of his country. It was hard to believe that only three blocks away City Hall flaunted its polished floors and the Sheraton its Egyptian cotton sheets.
He gave a wide berth to two winos sprawled on the sidewalk. They dozed against the pockmarked brickwork, their tattered shopping bags piled beside them. Labelling them homeless didn’t begin to capture the complicated stories he’d heard from men like these when he’d worked his shifts in Emerg. He glanced at his car and pressed the lock button on the key fob for the fourth time, then edged closer to his well-muscled protector.
“That’s the place,” Todd said, pointing to a black facade half a block ahead. The Reluctant Lion proclaimed itself in gold letters painted above the door. It looked too nice a place for this neighbourhood. The clientele must not be hung up on geography. Hamish wondered how far the Wizard of Oz theme would be carried inside the bar. Would the bartenders be Munchkins?
A tall, square-jawed man, mid-twenties, greeted Todd at the door with a high five. He wore a white shirt with the cuffs rolled back and a black waiter’s apron over blue jeans. His short haircut glistened with gel; Hamish was relieved it wasn’t dyed pink or magenta. In fact, the few patrons at this still-early hour looked like regular guys. Hamish felt the weight of the waiter’s scrutiny as he swept the snowflakes from his flat-top and stepped around a stain on the hardwood. Introduced as Conor, the man led them past the stand-up bar to a two-man booth in a quiet rear corner.
Hamish pulled off his coat and slid onto the bench. Conor wiped the table, handed them menus, then posed for a moment, his hairless pecs peeking between the unfastened buttons at the top of his shirt. He flashed Hamish a smile along with that look of recognition Hamish often got but tried to ignore. In here, he decided, that look was okay. Here, it was safe to be himself. He hoped the place didn’t fill up with in-your-face drag queens when the karaoke got going.
“I’m starving,” Todd said. “What do you feel like? They don’t have full-course meals, just killer appetizers.”
They settled on nachos with all the fixings and a double order of deep-fried zucchini, Cajun style. When Todd ordered a pint of local draft, Hamish asked for the same, his pulse quickening at his bold choice of beer over Pepsi. This place felt edgier than Ken’s matronly Town and Gown. And light-years away from the hospital cafeteria where most nights Hamish dragged his supper out of vending machines.
Conor delivered the beers almost immediately and explained that he’d be right back with the nachos, but the zucchini would take longer.
Todd raised his glass. “Here’s to finding the listeria.”
“And to following hunches,” Hamish added. “Let that be a lesson.”
They clinked their glasses, and Hamish took a sip, then gulped eagerly. This stuff was good. No bitter aftertaste. He pulled his scribbler from his briefcase, asked Todd to repeat the name of the brew, and wrote it down. He hoped they had it at the Town and Gown.
“And,” Todd continued, “to Betty McKenzie looking a bit better by tomorrow.”
“I didn’t know how I was going to face Zol if she . . .”
“I checked her abdomen before we left. Still tender, but less distended than yesterday. I’m not sure her diarrhea is any better, but she did manage to keep down a can of that high-protein shake. She’s one feisty lady. Told me she doesn’t dare go yet — hasn’t finished her memoirs.”
“I like your optimism.” There was a lot to like about Todd — tons of positive energy and intelligence packed into a great-looking body. Too bad he was off limits, at least until he graduated. So much of Ken’s energy was negative. All that courtroom bickering, week after week.
Hamish checked to be sure no one was watching, then placed Ellen’s one-page fax of Camelot’s listeria results on the table. “We’ve spent so much time this week on Mountain Wing reacting, but too little time thinking.” But what could he expect with half a dozen critically ill gastro cases and almost no support. “This listeria thing may seem like the breakthrough we’ve been hoping for, but Zol’s gang has been through the Lodge on their hands and knees. I don’t see how listeria can be coming out of that kitchen.”
“I’m puzzled about listeria turning up in all those stool cultures. I thought the bug wasn’t supposed to cause gastro.”
“It’s there in the textbooks, but in really fine print. Filed under ‘febrile gastroenteritis.’ But I agree, as a clinician, I never think about listeria causing diarrhea. Ellen used a selective culture medium she ordered specially, otherwise she’d never have detected it.”
“How many residents have been affected?”
“That’s the strange thing. The gastro episodes have been reoccurring over and over in the same twenty-one residents. Seventeen others have remained completely unaffected.”
Todd peered at the rough notes in Hamish’s scribbler. “Did all twenty-one have listeria in their stools?”
Hamish looked carefully at Ellen’s fax. Not every stool sample submitted from Camelot contained listeria, but all twenty-one residents with gastro had at least one sample that was positive.
“Correct,” Hamish said. “But we don’t know yet if it’s the same strain each time, or a series of different strains. Ellen’s going to tell us next we
ek after she genetically fingerprints the listeria in each specimen. We’ll need those fingerprints to definitively link the cases to the source.” He smiled ruefully. “When and if we find it.”
“Sounds like Ellen’s got a lot of work ahead of her.”
Conor set a mountain of nachos on the table, and both men dug in. Hamish was amazed how great the salsa and guacamole tasted with the beer, which was going down very quickly. Good thing Conor had brought two more pints. The stuff was getting more delicious with every swallow.
“Tell me,” Todd said, “how does listeria tie in with those heavy-duty arthritis meds?”
The medication survey showed that officially, eighteen of the twenty-one residents with recurrent febrile gastroenteritis were taking the arthritis drug Xanucox. Only one of the seventeen gastro-free residents was taking it. Unofficially, Betty had been taking Xanucox from Raimunda’s supply, which put the real figure at nineteen, or maybe even higher if other residents were sharing their medications. Hamish couldn’t help wondering how many residents shared their pills the way Raimunda had done. Perhaps there was so much pill swapping at Camelot that the medication survey was too inaccurate to be useful.
Todd smiled as he washed down a mouthful of nachos. “Is it possible that many of the residents have been silently infected with listeria, but only those taking Xanucox have been getting obvious symptoms?”
Xanucox, a remote cousin of aspirin, was a second-generation NSAID, a non-steroidal anti-inflammatory drug that fought arthritis by tinkering with the body’s immune system. When reined in by a drug like Xanucox, the immune system lost a lot of its punch.
“I suppose the Xanucox could be inhibiting the immune response enough to allow the listeria to go a bit wild in the gut — stir up fever, nausea, and diarrhea. But not wild enough to kill anyone.”
“But,” Todd said, “Durimab is the true blockbuster, eh? Controls rheumatoid arthritis by stopping the immune system almost dead in its tracks. I noticed that four of the residents have been on it.”
When the body’s inflammatory response was paralyzed by a drug like Durimab, the pain and swelling of arthritis quickly vanished, and microbes had a heyday. Germs usually too weak to cause even minor illness became a major threat because the body couldn’t fight them. “You’ve been doing your homework. With Durimab on board, a bout of listeria could progress from mild gastro to life-threatening meningitis overnight.”
