Pathogen

by Jessica L. Webb

  Andy paused and looked around the table, meeting each member’s gaze, including Mona Kellar’s. Andy was too focused, too perfectly controlled to allow any kind of distraction to pull her from her goal.

  “Dr. Salinger? You’re up.”

  “The goal of Public Health at this point is also twofold. First, we must track the spread of the HV1A virus, both in its original form and now in its mutated form.” Dr. Salinger swallowed, and Kate could only imagine how he’d taken the news the virus was now being spread person to person. “Second, to educate the public. This includes not only the general public, but also communicating with Squamish-Whistler Health and local physician’s offices. I believe quite strongly that education and understanding can go a long way in preventing the kind of wide-scale panic that Sergeant Wyles was alluding to. Something we disagree on.” Dr. Salinger said it with a small smile.

  “We don’t disagree with you, Cliff.” Ferris jumped in, apparently speaking as the only local representative of the RCMP. “We just think it’s important to have both education and a police presence.”

  “He’s right,” Dr. Din said from the other end of the room. All eyes swiveled back to the far end of the room. Dr. Din looked to Andy for permission to speak, and she gave it with a curt nod of her head. “Constable Ferris is right. Studies of pandemic viral outbreaks show that the best community outcomes are acquired through a combination of the most up-to-date and transparent information as well as a strong authority presence. What I am trying to say is that you should let the public see that you are working together.”

  Dr. Salinger and Constable Ferris looked at each other across the table.

  “We can do that, no problem.”

  Dr. Salinger simply nodded, strain still evident on his lined face. Andy looked back and forth between Dr. Salinger and Ferris.

  “The public needs to see this whole team work together, especially those of you who are residents here. Disagreements are a natural part of the process and can even help us problem solve, but they happen in here and only in here.” She tapped the table with one hand, emphasizing her point. She looked around the room. “Constable Ferris, Dr. Salinger, Dr. Doyle, Dr. MacKay, as the most visible and well-known members of this team, a great deal of that will fall to you.”

  “You should include Dr. Morrison on that list,” Dr. Doyle added. “She has proven herself enough at this hospital and in this community that I think people will look to her for guidance.”

  Kate tried not to let her surprise show. She hadn’t been expecting praise from Valley General’s chief of staff this morning. Andy looked at Dr. Doyle, then at Kate. Kate raised her eyebrows ever so slightly to convey her own shock.

  “And Dr. Morrison,” Andy conceded. “Dr. Doyle, if you could give the hospital updates. It will be the first and most visible response to our increased threat level.”

  “As of this morning, Valley General Hospital is instituting our viral threat and containment policy.” She stood and pulled a cardboard box onto the table, pulling out large white face masks, surgical gowns, and gloves. Kate’s face itched just looking at the masks. “All front-line staff will be required to wear protective gear at all times, no exceptions. We are also in the process of isolating one ward for acute patients. I’ll update you as I know more. Dr. Morrison and Dr. MacKay, I will be looking to the two of you to run the ER and the containment ward.”

  Kate looked across the table at Dr. MacKay, who shrugged playfully and smiled. Kate didn’t know much about this doctor, but she got the sense he was a bit of a cowboy.

  “Lastly,” Dr. Doyle said, “all staff is required to report any fever or related flu symptoms to their immediate supervisor. No one is to come to work sick and risk spreading this virus. I will be in contact with Squamish-Whistler Health to work out a plan for maintaining sufficient staff.”

  “Priority one is the hospital, and that’s where we are focusing our efforts right now,” Andy was saying as Dr. Doyle took her seat. “Jack is here to work on a website as a joint initiative between Public Health and the hospital. When it’s up, you’ll all be able to direct inquiries from the public and the media there. Are there any questions?”

  Silence.

  “Let’s meet tomorrow, early. Eight a.m.” No one disagreed. Andy was not an easy person to disagree with.

  As everyone else rose to put their piece of the plan into action, Kate stayed in her seat, making grooves on the empty Styrofoam cup with her thumbnail.

  “I guess we should get to know each other a little better.”

  Kate looked up to see Dr. Eric MacKay smiling pleasantly. He seemed almost cockily unconcerned about the weight and severity of what they’d just heard.

  Kate returned the smile cautiously. “I guess we should.” She extended her hand across the table. “Kate.”

  “Eric,” he said, shaking Kate’s hand. “You’re causing quite a stir here at Valley General. The redheaded doctor who is everywhere at once. Shaking things up.”

  “Not my intention, I assure you.”

  “Between the two of us, we should be able to whip this hospital into shape, don’t you think?” he asked.

  Definitely cocky, Kate decided. But not unreasonable. “I intend to lead by example, Dr. MacKay,” Kate said drily. “We’ll only bring out the whips as a last resort.”

  Kate looked over as Dr. Ahmed Din pulled out the chair beside her and took a seat. Up close, his face was much younger than his salt-and-pepper hair would suggest. His brown eyes were kind and apologetic.

  “Pardon my intrusion, but am I to understand you two will be disseminating the information to the hospital staff in terms of precautionary protocols?”

  “Yes.”

  “A word of advice then, if I may.” He posed it as a question, treading carefully. “You must find a balance between calmness and adherence. They must understand from the very beginning that there will be absolute and complete compliance with all regulations, but without causing them to panic.”

  “A healthy dose of fear, then,” Eric said, grinning at the man.

  “No, not fear,” Dr. Din said, not returning the smile. “Fear is exactly what we are trying to avoid.”

  The grin slid off Eric’s face. Kate was glad to see him knocked down, just a little. She was also glad it didn’t have to be her who did it, though she was sure Andy would have gotten around to it eventually.

  “I was in Toronto,” Eric blurted into the silence. “When SARS hit, I was working at a hospital in Toronto.”

  Dr. Din seemed to brighten at this. “That is good. Tell the staff that. Let them know you have been through this before. It will build their confidence in you as a leader.”

  “Let’s split it up,” Kate said to Eric. “You run the ER. I’ll be there to back you up, but let’s give the staff one person to focus on. I’ll take the new acute ward.” She scrawled her cell phone number on a paper in front of her, thinking briefly of doing this same thing for Chris Ozarc only an hour ago. Eric took a moment and inputted the number into his phone, quickly texting back his own. “We’ll be in close contact. Anything comes up, we’ll keep the other in the loop.”

  Eric nodded, his face serious for the first time. He stood to go. “I’m going to check in with Dr. Doyle. I think the first time the staff hears about the new safety protocols, it should come from her.”

  “Good idea. I’m going to go check on a few patients.” Kate’s thoughts instantly went to Harris Trenholm, wondering if he had checked himself out of the hospital yet or if his condition had deteriorated enough to keep him admitted.

  “Dr. Morrison?” Kate had almost forgotten about Dr. Din.

  “Yes?” Kate was curious about this man and his background. He seemed intensely focused, less so on what information was being shared than how it was being distributed.

  “I am being forward, and I apologize if I make you uncomfortable, but there is something I want to say.” He shifted in his seat, his fingers fluttering over the sleeve of his shirt. “I thi
nk I have heard and seen enough in the short twenty-four hours I’ve been here to know that Hidden Valley is precariously balanced right now. This is a community of intelligent and aware individuals but also suspicious and self-centred, I think.” He paused, and Kate had to admit he’d pretty much nailed Hidden Valley. “I think you will be key in maintaining the balance. You are a trusted outsider with a transparent agenda. I have been through enough similar scenarios to recognize a key player when I see one.”

  Kate took a moment to consider Dr. Din’s pronouncement. She’d spent less than an hour in a meeting with this man where she’d said very little. Kate decided he must be basing his conclusions on what he was hearing from others. She didn’t like the thought of other people talking about her. Empathy for Chris Ozarc welled up in her chest.

  “I’ll do whatever it takes,” she said finally. “But I’m going to need a lot of help.”

  Dr. Din patted her hand gently. “That’s what we’re here for.”

  Ten minutes later, with only a too brief, too public check-in with Andy, Kate went upstairs to what was quickly becoming a closed ward. Orderlies were moving patients through the hall, charts wedged at the foot of beds, and gowned patients inched slowly along the wall railing, supported by nurses and IV stands. Kate checked in at the nurse’s station and found Lucy typing quickly into the computer, flipping hard-copy files as she went. She looked up as Kate said her name.

  “Hey, you’re back! Sorry for the chaos. Dr. Doyle wants the viral containment ward…sorry, Ward B up by the end of today.”

  “Ward B?” Kate repeated, impressed by how the nurse could carry on a conversation and continue to input data into the system.

  “Yes, Dr. Doyle says we need to manage community fears, and that includes the consistent use of medically neutral language.” Lucy stopped typing and looked up at Kate. “Any idea what that means?”

  Kate looked into the nurse’s face, reading stress and annoyance. She didn’t blame her, especially as she could imagine how Dr. Doyle would have delivered the message. She briefly thought about her recent discussion with Dr. Din. Precariously balanced.

  “It means Hidden Valley is about to get a pretty big shock, and the public is going to look to how this hospital deals with the crisis. So we do our jobs and we do them calmly and we do them without throwing enough medical jargon around to scare the shit out of the people listening.”

  Lucy looked at her thoughtfully, then nodded. “I’m glad Dr. Doyle put me on your team,” she said. The nurse leaned back and sorted through a stack of charts before handing Kate Harris Trenholm’s chart.

  “You like this team because we’ve only got one patient,” Kate said.

  Lucy laughed. “That and I hear you had half a bakery delivered to the ER. I’m looking forward to the perks.”

  Kate paused in the act of opening the chart, staring at the nurse. Lucy met her glance, then spoke quietly. “I know it’s going to be a long haul, Dr. Morrison. But we’ve got some good people working on this. I’m hopeful.”

  Kate didn’t say anything more as she left to see her patient.

  Harris Trenholm’s condition had changed very little, and Kate decided this was more than she could have hoped for, given how much time she’d spent in the morgue recently. He was sitting up in the hospital bed, propped up by four oversized pillows, the half table meant to deliver food overflowing with files and a laptop. He looked up as Kate walked in. She shook her head.

  “Forty-eight hours…you said…” Harris said through his re-breather mask. Definitely no improvement to lung capacity, Kate decided. She looked at his O2 saturation levels for the last twenty-four hours. Not great, but steady.

  “How’s the campaign going?”

  Harris’s eyes brightened. “Exactly as planned.”

  “Except the part where you’re stuck in here.”

  Harris held up his BlackBerry and pointed at his laptop. “Wonders of modern technology.”

  This short sentence caused a bronchial spasm, but Harris just closed his eyes and sucked the high-flow oxygen through his mask until it passed. Kate held up her stethoscope, and he nodded and leaned forwards. She heard the rales, the bubbling and crackling of the fluid. It was present but controlled. Against her medical training, Kate willed them to stay that way and not reach the crisis point that had swamped Roberta Sedlak’s and Keith Grange’s lungs with fluid. She’d started thinking of it as the hantavirus tidal wave.

  “Discharged soon?” Harris asked as Kate removed her stethoscope, allowing him to lie back.

  Kate gave him a sceptical look. “What do you think?”

  “I think you’re going to be…on my ass about not…working too much.”

  Kate laughed. “Smart man. I need to see at least forty-eight hours of oxygen sats in the normal range, and I need to know that the fluid in your lungs is decreasing.”

  “And that I’m…not contagious,” Harris breathed out through his mask.

  Kate watched him intently, Harris’s eyes never leaving hers. She let it go, deciding not to get into the details of what she knew about the virus.

  Harris’s BlackBerry vibrated insistently on the table in front of him. “Pardon me, Dr. Morrison…just going to…step into my office.”

  Kate smiled and flipped his chart closed. “I’ll let myself out.”

  As she walked back to the nurse’s station, she could see a crowd had gathered. Eric and an orderly were pulling masks and face shields and gowns out of huge cardboard boxes.

  “Your team’s gear, Dr. Morrison. The ER has already started the fashion trend downstairs. Face masks and shields are very in this season.”

  The nurses laughed, though they also rolled their eyes, fingering the thick, itchy fabric of the face mask. Kate pulled out her own gear from the box, putting it on without saying a word.

  “We’ve got a buddy system going on downstairs,” Eric was saying, still passing out masks. “Medical professionals are notoriously bad at taking care of themselves but highly effective at managing other people’s illness. So, a buddy system. At the start of each shift, you are assigned a buddy. You check for an elevated temp, feelings of fatigue, sniffles. If your buddy passes, they get a smiley face on their gown.” Eric pulled a Sharpie out of his pocket, drew a happy face on Kate’s shoulder. More laughs from the nurses, more eye rolling. Kate looked down at the upside-down smile, then back to Eric. Kate’s confidence in the doctor kicked up another notch.

  The hospital quickly became a sea of light blue gowns and full face masks, conversations muted and swallowed by the fabric stretched from ear to ear. Kate admitted only to herself that it was annoying, that it took more time than she felt they had to offer, to slow down her speech, enunciate her words enough for patients and nurses to understand her. She could also feel a shift in the patients, in the people walking through the ER. It wasn’t panic, at least not yet. They were quiet, more subdued.

  By late that afternoon, Kate was fending off the four hundredth question about where private citizens could obtain the face masks. Kate’s explanation that the hospital-grade masks were only for front-line staff was insufficient for the frustrated, overbearing woman in front of her. Kate sighed and leaned up against the admit desk as the woman walked away, making sharp gesticulating motions in the air as she talked on her cell phone. That hadn’t gone well at all. She wondered if Dr. Doyle and Dr. Din had been wrong. Right now she didn’t seem to be holding on to any public confidence at all.

  “Dr. Morrison, could I get a consult?”

  Kate looked up to see Eric just down the hall, holding up a chart. She pushed herself away from the desk, feeling an ache in her back.

  “Jim Beckett, age seventy-two, severe emphysema, exhibiting flu symptoms, difficulty breathing, and chest pains.”

  “Ward B candidate?” Kate said, trying to remember her own medically neutral language.

  “Tests haven’t come back yet. Looks like the lab’s backed up.”

  “I take it we’ve been sending dow
n more tests than normal today?”

  Eric shrugged. “I don’t think so. I just know it’s taking about four to six hours to get results back.”

  Kate filed this away, along with the question of how they were going to address the community’s need to understand contagion and universal precautions. It was a growing list of things she had to do before her head hit the pillow tonight.

  “What do you want to do with him?” Kate said.

  “He needs to be admitted regardless. I don’t want him exposed to the virus if he doesn’t have it, but I’m not sure we should admit him to acute care and risk spreading it if he does.”

  Kate weighed the risks in her head. He should stay in emerg until the tests confirmed his viral status, but Eric was right. The ER was too busy to keep such a high-risk patient while they waited for test results. “Let’s admit him to Ward B. There are enough isolation rooms right now and only one patient. If he needs to be moved after the tests come back, we’ll deal with it then.”

  “Perfect, thanks,” Eric said, scrawling in the chart, calling a nurse over and giving the orders. “He’ll be yours in an hour.”

  “Sure,” Kate said, distracted, tapping the pen she was holding against her cheek.

  “What’s up, Red?” Eric asked, pulling her back.

  Kate raised her eyebrows. “Kate, Morrison, Doctor…any combination of those three will work for me,” Kate told him pointedly.

  “My apologies, nicknames are a bad habit with me. What’s got you going in circles, Kate?” he tried again, unabashed.

  “Labs. I’m curious why they’re taking so long. Is there any way to pull numbers off the system?”

  “Sure, no problem.” Eric moved to the computer, banged at the keys with gloved hands, cursing as he had to correct himself. “Three days ago was our peak at forty-seven submissions. Yesterday we sent down thirty-nine, and today we’re already at thirty-six, with another six hours to go until midnight,” he said, checking his watch.