Silent Fear, a Medical Mystery

by Barbara Ebel

  “I promise,” Danny said, “to make life run as smoothly as possible for you and the girls from now on. Whether we’re living with each other or not, married or not, if you let me, I’ll look after you three like there’s no tomorrow.”

  Their eyes locked. “That’s sweet, Danny. I’ll try and believe you.” She knew it was more complicated than that. He had an infant as well, the result of the extra-marital affair he’d had with Rachel. For the first time, however, she realized the new baby wasn’t insignificant to their two girls, Annabel and Nancy. Their daughters now had a half-sister.

  As if reading her mind, Danny placed his hands on his lap. “I know. I have a baby, too. I’ll pull my fatherly responsibility and more, but that situation is separate from my first and foremost family.”

  Carrying two plates, the waiter stopped at their table, and placed the hot entrees they’d ordered in front of them. “Would either of you care for fresh parmesan cheese?”

  They both nodded, allowing him to turn the grater over their plates. “I’ll be back to check on you. Enjoy,” he said and left for another table.

  “Okay,” Danny said, “let’s eat. And thank you for finally accepting my invitation.”

  “You’re welcome. This brings back memories. Your Dad and Mom were the ultimate owners here and I miss Angelo, but this does look pretty good.”

  “He was special, wasn’t he? Now for the taste test.” Danny twirled linguini with shrimp around his fork and took a bite. He nodded. “How’s your ravioli?”

  She savored and swallowed. “Very nice.”

  They sampled each other’s pasta and Sara complimented the waiter on the food when he returned.

  “I have big news,” Sara said. “Not as important as what you do or how you’re being heralded on national TV.”

  “Sara, I just do my job, but what is it?”

  “I’m going back to work,” she beamed. “Same as years ago before I gave it up. First year biology right under the same roof as the girls.”

  “That’s fantastic. Good for you. You not only loved to teach, but you’re crazy about biology.”

  “Yes, well… anyway, I’m ready.”

  “Another toast,” Danny said. “Enjoy the second phase of your beloved career.”

  ----------

  They skipped dessert and Danny drove Sara home. He zipped around the car and opened her door, then walked her to the front entrance.

  “I bet your days lately have been extra long,” Sara said.

  “Some of them remind me of the hours I pulled during residency.” Danny gently put his hand on her shoulder as they stepped onto the porch. “Sorry we didn’t linger longer over dinner. I’ll be jumping into bed after walking Dakota as soon as I get home.”

  “No, this was perfect. The girls and I are having early days, too, before starting school next week.”

  “They’re coming over again next weekend, if that’s okay. I’m not on call and I’m picking up Julia late Friday. We’re having a fun dinner at the house Saturday night. You know you’re welcome and invited.”

  “I have plans Saturday night,” she said after a moment, in a bemused way.

  Danny cocked his head. Maybe she’d explain.

  “I have a date,” she said, causing Danny to gulp.

  “Anybody I know?” he managed to ask.

  “It’s the principal at school.”

  Danny racked his brain on the way home, wondering if he’d ever met the man and what he looked like.

  ----------

  Danny waited for Casey to catch up. They’d both left the house the same time, Danny slightly later than normal. Casey trotted upon seeing Danny outside the doctor’s parking zone, and they walked together across the asphalt into the ER back door.

  “Are you going to pry about last night?” Danny asked.

  “I figured you’d tell me if you wanted to.”

  “Things were going well until she dropped the ball. She’s got a date Saturday night with the principal of the girls school.”

  “Where she’s going to work?”

  “You knew about that?”

  Casey shrugged his shoulders. “Danny, Mary and I see her more frequently than you do. She’s been getting ready for it.”

  “Oh,” Danny said flatly.

  “And she’s a smart, pretty, sexy, and a fun lady. She’s noticeable. The men were going to show up sooner than later.” Casey pointed to the coffee room in the hallway and veered to the left. Danny followed.

  “Most of our marriage I was aware of that,” Danny said.

  Casey poured two cups of coffee and handed a black brew to Danny.

  “Thanks,” he mumbled.

  “I could ask you how you think she felt before when …” Casey let the sentence dangle, and then added, “but I won’t.”

  “Okay, thanks for not going there.” Danny sipped. He looked at his watch. “Listen, you be careful as far as picking up any PAM patients. You and Mark should be wearing masks and gloves with every passenger you pick up, just in case.”

  “That’s a good point. I’ll tell him. So far, however, most of those patients drive in themselves, or friends or relatives are driving them in.”

  Both men stepped to the doorway where Casey peeled out the door again to his ambulance and Danny took the stairs up to the OR. He poked his head into the anesthesia office. “Who’s doing my first case?” he asked with a smile.

  Dean shut a small middle-locker on the side wall. “I’m staffing two rooms this morning, one of them is yours. Shelly will be in there.” Danny nodded, knowing her long tenure as a nurse anesthetist. “We’re all mortified this morning about Lucy,” Dean added.

  Danny leaned into the doorway. “No. I didn’t know. Not yet, anyway.” They gazed at each other in silence, Danny standing there longer than needed.

  ----------

  The group had five lumbar laminectomies which needed to be done so Danny and Matthew Jacob flip-flopped them the whole morning, which meant they had two OR rooms. They ran simultaneously only short periods of time - as one case was closing, the next case was starting. It gave Danny and Matthew a breather – write post op notes, see their next patient, and run up to the floor if time permitted.

  The five operations ran exceptionally smooth and swift due to teamwork non-preoccupied with usual concerns. Instead, they remained tentative about PAM, which caused them to only focus on the case at hand, to make it come and go without incident. The pre-op nurses double checked charts, orderlies jumped toward stretchers with patients for transport to the OR, operating room staff had few smiles and typical morning gossip, and patients glanced up and down at anyone who came near them, especially before sedation.

  Matthew Jacob kept retying his scrubs tighter as if he’d dropped weight from running before work, and Danny’s brain worked overtime. He concentrated on the open, bloody back in front of him, without the need to have one ear on OR conversation since the room was devoid of talk or music. The only sounds heard were the harmony of machines and suction.

  As Danny arched his back to change position, he glanced at each member of the case. The PAM outbreak unnerved them all, even the stoutest caretakers, and why not? What other field could cause a person to knowingly go to work and possibly subject themselves to carrying a deadly malady by the end of the day? Yes, deadly. They all harbored a silent fear.

  Danny had scant medical historical knowledge but kept thinking about the Black Death or Bubonic Plague which wiped out a serious portion of Europe’s population in the fourteenth century. The time it took to figure out the source of the infection and treatment had cost lives; many lives. Under his mask, his mouth twisted with disgust thinking that valuable time was being lost. When he saw Peter Brown that morning between cases, apparently their new antibiotic course wasn’t faring well with the current PAM patients.

  What recourse did they have now? Would the CDC have any tricks from their vast experience with epidemics? Joell
e thought outside the box – could she defy this Naegleria fowleri and work magic against it? His own hands were tied. He wished he could surgically remove the buggers but they had worked their DNA or had done what Darwin would have considered survival of the fittest by altering their morphology with appendages to suck the contents right out of human beings’ brain cells.

  He put the suction tip back on the drape and picked up the electrocautery like a pencil. Why hadn’t Michael gotten sick like the others? Like other illnesses, it must depend on the patient’s age and their health status, even DNA. And what about the symptom of salivation? He realized it must be a key, timely ingredient needed for its likely transmission. That’s why not everyone contracted it every time they neared a patient who had it at a certain time. He’d have to run his thoughts by Joelle. Yet he realized he must be the exception. He’d been around PAM patients at multiple stages of its development, even the beginning and drying up of their increased saliva.

  Danny reflexively stiffened, realizing one more thing. After he had dropped Sara at home the night before, and before he had climbed into bed with Dakota on the floor beside him, he had done a quick computer medical search. Over almost the last seventy years, Naegleria fowleri had killed approximately 120 people in the United States. That was bad enough, but what they had now was a salivation-altered form, a Darwinian super monster capable of hopping from patient to patient like fleas on dogs.

  If he had the option, he’d vote for the present epidemic and not the full blown pandemic on the way.

  ----------

  Danny passed Matthew in the OR hallway going back with the next spine patient. “Joelle and Ralph Halbrow are waiting for you in the lounge,” Matthew said. “I hope they let you eat.”

  “I’ll see to it,” Danny said, but doubted it.

  In the lounge, Danny whisked over to the back table swathed in sunshine from the adjacent window where Joelle scooted back her chair and uncrossed her legs.

  “Good morning,” she said. “Can you sit a minute so we can talk? Ralph and I decided to see the PAM patients firsthand today after Peter and Tim. We only have Michael Johnson left and we’d like to drag you.” She pushed a head band further back, being careful not to disturb her looped earrings.

  “Sure,” Danny said, nodding. “You look nice today, not that you don’t usually look that way.”

  Ralph arrived and Danny pulled out a chair for him. “You look less tired today, Ralph,” he said.

  “And as opposed to Joelle, spare me a compliment,” Ralph said. “I’m living from a hotel room. When I get this long outa my suitcase, I start looking like a catfish from Mississippi mud.”

  “No. You’re still wearing clean suspenders. When they start looking like napkins, I’ll let you know.”

  Ralph grinned. “You must have heard about Lucy.”

  Danny leaned in for privacy and shook his head. “I had such a soft spot for her. I feel so terrible, she didn’t deserve this.”

  “We have more cases today,” Ralph said, “in Tennessee, Kentucky, and Georgia, as well as New York and North Carolina.”

  Danny shot a glance at Joelle. Her mouth formed a frown. “We just met with Tim and Peter. We’re sure the new treatment isn’t working.”

  A small muscle in Danny’s eye gave a nervous tic. “Come on,” Joelle said, standing with her coffee cup. “Let’s go see Michael Johnson and talk on the way. I know you’re between cases, but our youngest patient has taken a dive and is on the ventilator.”

  Michael was moved to the ICU over night after Peter had watched his breathing slow and had inserted a breathing tube. They entered his room and stood around the critically ill youth. No longer resembling a basketball player, he looked like a gaunt skeleton with sunken eyes.

  “I thought he was beating PAM,” Danny said.

  “He’s had the best resiliency,” Joelle said. She opened Michael’s chart and evaluated his medication list, ventilator settings, and nurse’s notes. She checked the bedside chart for vital signs and made a note of present infusions. Ralph decided what additional antibiotic to add to the regimen, and Danny performed a bedside neurologic exam on the nearly comatose teen. After ten minutes they congregated in a circle by the sink.

  “I’m grabbing a flight to Atlanta later,” Ralph said. “It’s time to directly oversee treatment research while macro-managing docs and CDC reps by phone in the various locations. But that still means you’re a major contributor, Joelle.”

  The steady rhythm of Michael’s heart rate beeped across the room with the drone of the ventilator. “I’m already committed, Ralph. I’ll make sure every medical resource in Nashville stands behind me while I plunge into the darkness to do this research.”

  “But first, I’ll tap into your brain Danny, metaphorically speaking. Until you’re diagnosed with PAM, Ralph and I now believe you carry some kind of immunity. Can I ask you some personal questions?”

  “No problem,” he said.

  “Have you been on any medications or over-the-counters in the last two or three weeks?”

  “No. I’m not on anything and didn’t take anything recently.”

  “You’ve taken no antibiotics before or after PAM broke out?”

  “No,” Danny assured them.

  “Have you had any medical problems at all?” Ralph asked.

  “Nothing, at least that I’m aware of.”

  The three of them gave each other a blank stare. Danny shrugged his shoulders. “If there’s anything remotely contributory you can think of,” Joelle said, “let us know.”

  Chapter 15

  Rachel’s adrenaline zipped through her bloodstream like a fish in a stream after a heavy rain. She had schemed all week, and now that Friday morning had arrived and Leo had left for work, she’d execute her strategy. So far, so good, except for the incessant drizzle which had started at sunrise.

  For three days she had scouted places to rent. She settled on an apartment in the same complex she’d lived in before shacking up with Leo, but in a different building overlooking the Tennessee River and not far from work. The most complicated part of leaving Leo would be acquiring a baby sitter for Saturdays, but right now she didn’t have to worry since this weekend Julia would be with Danny.

  Of course, she’d have to start paying rent, but in essence that would be paid by Danny’s child support. Other than Danny, her plan involved a big payoff, a hefty retribution.

  For one hour she folded clothes and stuffed toiletries into a suitcase which she hadn’t been able to do under Leo’s surveillance. Julia had been easier because her toys were kept in a container in the other bedroom. For the large items like the crib, high chair and playpen, she hired two college boys with a small moving business to come in at 10 a.m., a safe time after Leo left and with enough time to pack up the small truck and cart everything over to the new apartment.

  By 9 a.m. she had the bulk of everything packed while Julia stayed preoccupied with a plastic rattle and her bottle. Now came the tricky part, the note she must write with the details which could make or break her idea.

  She took an 8 ½ by 11 inch sheet out of the printer and sat at Leo’s desk. She edged his laptop back, careful not to trigger it awake, where she’d have the displeasure of perhaps seeing his porn sites pop up. She selected a pen and began.

  Hi Leo,

  I just wanted to write you a letter since I decided to move out sooner than I thought. I have enjoyed most of the time we’ve spent together and thank you very much for letting my daughter and me live with you. Things were going quite well for a time! However, after much deliberation, I have decided our relationship has gotten a bit too intense. I hope we can stay friends. I’m sure I’ll see you at the hospital any time I happen to come by during the week.”

  She put the paper at arm’s length and read it several times. Satisfied with the tone, striving to not anger him, she liked what she’d written and continued.

  “There’s only one thing
I hope we can solve. Recently my baby Julia has developed outright signs of being hurt. It always shows up after the day I work, which is Saturday, and you have taken care of her. Evidence is on her arms and bottom and I don’t believe the hot coffee story. I think medical people, lawyers, or a court of law would coin it ‘child abuse.’

  However, I won’t seek assistance with this issue at present or maybe never. I can come by Maxine’s on Wednesday night at 7 p.m. to meet you for a quick drink. I will expect a sack with ten grand (cash) which will insure my silence. You are such a smart man, I don’t need to write down the implications for you if I report the aforementioned.”

  Rachel stopped again, still tormented about the blackmail amount. At first, she thought a few grand. But that didn’t make sense because that would be petty change for him. He’d committed a punishable crime which would dent his career forever, smear any fictitious nice-guy reputation he had, and perhaps put him on one of those neighborhood watch child abuse lists. Hell, ten grand to get out of this was cheap.

  Finishing, she put pen to paper again.

  “Looking forward to seeing you on Wednesday night. I’ll also bring you the house key I have for your place.

  Sincerely,

  Rachel

  Once again she read it. Satisfied, she placed it in an envelope with Leo’s name and placed it next to his cigarettes on the counter.

  Rachel looked at Julia sitting like a princess. One hand juggled her bottle to her lips and with the other, her fingers played with her toes. One thing was for sure, this child wasn’t even a year old yet and she was already bringing in a contribution towards Rachel’s cost of living, and more.

  ----------

  A stack of little white phone call slips graced the top of Danny’s desk. Unusual, because when patients scheduled appointments they got handled by the office and he never had such a volume of personal messages. He picked up the group and weeded through them. They certainly weren’t from friends or family, they came from the Atlanta Journal and New York Times to the Vanderbilt University student paper. The callers would appreciate a few words with him, if possible. He slipped the notes into his shirt pocket.