“...some official from the state health board took our patient lists from Monday until now.”
“...ordered a call-up of all our staff that have worked during the last five days.”
“...labs called and said we’re going to get our hands, fingernails, and noses cultured.”
The barrage of comments was coming from a group of twenty doctors, clerks, nurses, and residents who were all understandably angry, some quite wide-eyed with fright and a few already wearing masks and gloves.
“Look, I don’t know anything more than you guys do,” I said, pushing through them and moving toward the nurses’ station, “but if you’ll let me through to a phone, I’ll find out.”
Orderlies wearing protective gear were wheeling patients on stretchers past us and out of the department. Susanne was trotting alongside, reassuring, “It’s just a precaution, until they get some maintenance problem checked,” but the patients looked bewildered anyway. A security guard at the door pointedly stopped Susanne before letting the others through. “I wasn’t going to leave!” she said impatiently, pivoting away from him and striding back to the nurses’ station. “By what authority can they keep us here?” she demanded when she got up to me.
“I don’t know,” I answered her. On my way in I’d already been warned by a security guard not to try to leave. He couldn’t tell me why and had refused to say what would happen if I did. I turned to the clerk. “Where’s this state health official who took your patient lists?”
“Search me,” she said. “He wouldn’t come near us without gloves and a mask on. He even put the books in a plastic bag. Are we quarantined or something?”
Without answering, I stepped over to the counter behind us and grabbed a phone. I finally got through to Hurst’s secretary.
“Oh, Dr. Garnet,” she said, her voice drenched with disapproval. “Dr. Hurst definitely wants to speak with you.”
As I waited on the line, through the windows of the nurses’ station I saw a group of men and women wearing masks, gloves, and gowns enter the department carrying baskets of culture tubes. Some I recognized as our own lab techs, even with the protective gear, while the others, about a dozen in all, were strangers to me. Four of them went immediately into the resuscitation room. The rest walked up to Susanne and started talking to her and pointing to the cubicles where we normally see patients.
Hurst finally came on the line. “Well, Garnet, you really put your foot into it this time,” sneered that familiar harsh voice. “If you’d spent nearly as much effort attending to emergency cases as trying to sabotage my efforts to run St. Paul’s—”
“What the hell’s going on?” I roared.
Out in the hallway Susanne, the rest of our staff, and the lab teens all swung around to stare at me.
“I suppose you’d better join us,” continued Hurst on the phone, “but you’re about as welcome as the plague. I trust you’ll wear suitable clothing to protect the rest of the hospital from being contaminated further by your carelessness!” He slammed the phone in my ear.
“Up yours,” I said into the dead line, taking out my fury at him by banging down my receiver as well.
Susanne and her group turned away from me and started talking earnestly to one another, occasionally looking over their shoulders in my direction. I was about to walk over and see if the newly arrived techs knew what was happening but was interrupted.
“Who’s Dr. Earl Garnet?” boomed a loud male voice from near the triage area. The group with Susanne went quiet again. I instinctively moved to leave the nurses’ station and identify myself when I stopped midbreath on seeing the man who wanted me. Big was not a good enough description. The man filled the far end of the corridor. He was bald, black, and laden with half a dozen metal suitcases, one under each arm and a pair in each of his very large hands. He was dressed in a yellow-and-black jogging outfit that looked more expensive than one of my best dress suits, and on his feet were a pair of well-worn hiking boots that gave him a military air. I figured he could have worn pink bunny slippers and I’d probably still have had an urge to salute him. He was that kind of man. I was relieved to see him smile when I went into the corridor to greet him. A gray mustache accented the friendly expression he fixed on me. “Dr. Garnet?” he asked politely.
“Yes,” I said, walking toward him and offering my hand. As I got closer, I better appreciated the mass of the man’s shoulders hunched over by the weight of the cases he was carrying. I could also see some lines around his eyes that suggested he was nearer my age than I’d ever have guessed from his superb physique.
He too was wearing latex gloves but didn’t free one of his hands to shake mine. “Excuse me, Dr. Garnet. I’ll just set my equipment over by that row of stretchers against the far wall,” he responded, stepping by me and striding to the nearest gurney where he hefted his cases onto the mattress. He quickly snapped open the smallest one, took out a stack of surgical masks and a box of latex gloves, then went back to where Susanne and the staff had gathered with the technicians. “I’m Dr. Douglas Williams,” he introduced himself in a voice that could reach the cheap seats in Carnegie Hall. He needn’t have bothered raising the volume. He’d had everyone’s attention since he entered the department. “As a precaution, until we find out what’s going on here, would everyone please put on masks and gloves from this fresh supply. Don’t use the ones in your ER as they may be already contaminated.” As he spoke, he distributed the protective gear he’d brought as nonchalantly as a waiter might pass out hors d’oeuvres at a cocktail party.
“What have we been exposed to?” asked one of the nurses nervously, breaking the silence and igniting an immediate echo of the same question from everyone standing in front of him.
“I know this is upsetting,” he answered, handing the remaining gloves and masks to Susanne and quickly raising his hands to quiet the sudden outbursts of questions, “but we’re making sure the department hasn’t come in contact with a resistant form of staphylococcus again.”
“Shit! All this for an MRSA case?”
“Why the extra fuss? We never evacuated patients before.”
“Or closed ER for that matter.”
Susanne frowned at me as Williams pressed on with his reassurances. “That’s right; it’s nothing you haven’t handled before,” he said, almost managing to sound bored while he looked around at everyone and smiled. “We’re just using a stricter protocol this time.” He caught my gaze and held it, still smiling, but I felt I’d gotten a direct order to bite my tongue. “Now,” he continued, looking directly at the group of technicians, “some of you are from state health and some are from the hospital, but for this job you’ll work my way. Do nasal passages, hands, and fingernails—all of them on everybody.” He stepped back to retrieve another of his suitcases as he talked. “I want you to use these to get under the nails and scrape,” he ordered, pulling out sterile packets of thin, wiry culture sticks normally used to insert up the male urethra and culture for VD. A few of the men in the room winced. “Dr. Garnet, I’d like to speak with you in your office,” he ordered, handing me a mask, slipping one on himself, then offering me some gloves. “And I could sure as hell use a coffee,” he added, indicating with his large hands that I was to lead the way. “Some jerk cut me off in the parking lot and I spilled the one I had all over my dash.”
* * * *
“Do you think they’ll buy it?” he asked me as soon as we were behind closed doors in my office. We’d grabbed two coffees from a pot the nurses kept brewing twenty-four hours a day. In here he seemed to think it was safe enough for us to lower our masks and load up on caffeine together.
“Not for long,” I warned. “There’s too much experience out there for anyone to believe you’d close ER simply because we treated a case with MRSA. Better we level with them now if you want to keep everyone calm and cooperating. Better yet, you can start by leveling with me.” I moved to sit behind my desk and offered him one of my visitors’ chairs. Standing, he made my
office look puny.
“What have you been told?” he asked bluntly, settling into a seat opposite me.
“Not a goddamned thing!”
“Hey, don’t get pissed at me. I was rousted from my motel about forty-five minutes ago because I happened to be in Buffalo heading up a university field trip to trace botulism in ducks,” said Dr. Williams curtly. “I don’t even belong in the Hospital Infections Program, but when your ID guy—Russet?”
“Rossit,” I corrected.
“Yeah, Rossit. Well, when he called Atlanta on our hot line about the culture results at 6:45 this morning, they rousted the program director—”
“You’re with the CDC?” I interrupted. “How come you didn’t say so?”
“Because then everyone would know this was the big deal it is and really get scared shitless.”
“Have there been more Legionella cases?” I asked, sick with imagining that the Phantom must have unleashed his organism on a large scale in both hospitals. Maybe my notion of him going berserk wasn’t so crazy after all. Janet at least had been right about this being out of a horror movie. “How many?” I braced for the answer.
“What?” snapped Douglas Williams. He was so startled by my question he nearly sloshed his coffee into his lap again. “What are you talking about, Legionella?”
Another chill was starting a slow crawl up my spine. “Why are you here?” I asked, not answering his question and keeping my voice as steady as I could
He spotted the MMB article I’d left lying on my desk, frowned, and tapped it with his forefinger. “We’re here because of this,” he answered, seeming puzzled by my own confusion. “On the reports they faxed me, you’re listed as the doctor on record who was astute enough to order the sensitivity rechecked by the minimal inhibitory concentration method. You obviously suspected something.”
“What?” It was my turn to nearly slosh my coffee.
“The vancomycin sensitivity test you ordered on the staphylococcus organism in a patient named...Saunderson?”
“Sanders,” I said without thinking. My voice sounded far off. My throat was too dry to swallow. “My God, we’ve got a vancomycin-inhibitmg strain.”
But it couldn’t be. How could the Phantom have been involved with such an exotic organism? It was too rare, too improbable. Even testing for it had made sense in only an academic way, and the most compelling reason for me had been Miller’s peace of mind.
While my thoughts raced, I grew even more queasy. Williams was continuing to look at me as if I were nuts. “Holy shit,” he said, running a large hand over his shiny head, “you really don’t know what’s happened this morning?”
It was still an effort to keep my voice steady, but I tried. “I presume it’s another vancomycin-inhibiting strain of MRSA from the patient Phyllis Sanders, like they had in Tokyo, Michigan, and New Jersey.”
He looked at me and swallowed.
My queasy feeling graduated to the burn of bile rising in the back of my throat.
“I hate to be the one to break the news to you, Dr. Garnet,” he began, speaking quietly, “but what your ID man discovered this morning in the test you ordered seems to be the superbug itself—a staphylococcus organism completely resistant to everything.”
* * * *
My instinctive reaction was more denial. Now I was sure there’d been an error. A too zealous lab tech must have misinterpreted the culture results. Then came fear, like nausea, waves and waves of it, despite my best effort to resist the realization sweeping over me. A killer with a superbug? It wasn’t possible. The organism was some theoretical nightmare in an article. How could it be here?
“March out in front of your troops,” Williams was instructing me, “and cheerfully be among the first to get cultured.” But I was having difficulty focusing on what he was saying. I barely noticed he was out of his seat and leaning over my desk until I felt him lever me out of my chair, his left hand wrapped easily around most of my upper arm.
“The organism’s unstoppable?” I asked, my own voice sounding distant and shaken. It was a silly question, born out of my refusal to accept what I’d just heard. That aspect of a superbug needed no repeating.
But Williams, obviously unaware of the full implications of his bombshell, ignored my incredulity and instead marched me back toward ER, instructing, “The key to getting through an operation like this is bluff—big, bold-faced lying bluff—that you are calm, in control, and not feeling a shred of panic. We have to make sure that not a single bacterium of that organism has passed onto one of your staff or is lying in wait somewhere in your department. Until then, ER is closed. So plug in your happy voice. Chief. Your surgical mask will hide how miserably glum you really look.”
The scope of what he was setting out to do so staggered me I could barely grapple with how the Phantom figured in it all. “Dr. Williams, there’s more you have to know. Something much graver is going on here than you suspect—”
“Hush! No talking in front of the children,” he whispered curtly as we joined my own staff assembled in the area that several technicians had set up to conduct testing.
Soon a good five inches of a ten-inch Q-tip was up my nose and moving through places I didn’t know I had way in there.
“Don’t move. Dr. Garnet,” ordered a steely-eyed woman glaring at me over the top of her mask.
My eyes were streaming with tears while she finished probing my left nasal passage. “Just give me a minute before you start on the right,” I heard myself beg, but my mind was swirling with other thoughts, rushing ahead, unbidden, to grasp the terrible new dimensions of killing that such an organism implied.
The technician sighed, rammed the swab she’d been using into its container, and splashed the charcoal medium back up onto the front of her gown. “This is going to take forever,” she complained to Williams. In a far corner about a dozen of her previous victims were commiserating, identified by their red eyes above their masks, some of them still tearing. Obviously I wasn’t the first to complain.
Williams nodded toward the unhappy group and told the woman in front of me, “As soon as they’ve recovered, start getting them organized to help take cultures with you. We’re going to need everyone on the ER staff to pitch in given the huge number of patients we’ll be calling in for testing.”
My God! I hadn’t thought of this bacteria breaching isolation precautions and reaching the public. The idea sent a veneer of cold sweat down my back.
The technician nodded, coolly uncapped yet another long Q-tip, and eyed my nostrils. After she’d finished reaming the other side of my nose, scraping under my nails, and swabbing the backs and palms of my hands, I immediately reapplied my mask and gloves.
“We ask all ER personnel to remain on the premises and in isolation garb,” Williams announced, “until Dr. Garnet and I return from some serious paper shuffling upstairs in the boardroom.” Murmurs of discontent protested this order, but he kept on speaking, his massive voice easily rising above the angry muttering. ‘Today’s exercise is going to include the call back and screening of hundreds of patients. Since all of you will assist with the taking of these samples, I suggest you get ready.” He turned toward the door, crumpled up his empty Styrofoam cup and lobbed it twenty feet into a wastebasket located in an empty examining cubicle. At the entrance we paused to remove our protective gear, dropping everything into a large cardboard drum. Activating the automatic doors, he flashed his ID to the security guard stationed outside in the corridor. “Dr. Garnet’s with me!” he snapped.
“ER personnel have to put on clean protective gear to go into the rest of the hospital, Dr. Garnet.” The guard gestured toward a cart stacked with masks, gowns, and a box of gloves. Such precautions, called reverse isolation, were meant to protect the rest of St. Paul’s from anyone in ER already infected.
“Okay, Chief, take me to your leaders,” quipped my escort when I’d finished dressing.
Some of the people we passed in the hallways gave me curious glanc
es. Even in a hospital, anyone outside a work area with gloves, a gown, and a mask in place was a little unusual. “You might as well hang a goddamned bell around my neck,” I muttered to Williams, but he ignored me.
A few colleagues, recognizing who I was despite the mask, stepped up and asked what was going on.
“Oh, we seem to have a problem with MRSA again,” I told them breezily, trying to hide my own anxiety and increasing my pace so as not to give them time for more questions.
“But why did you close emergency?” one of them called after me.
I turned, shrugged, and, walking backward a few steps, said, “Hey, it wasn’t my idea. Someone must have overreacted.”
In my heart, I desperately hoped someone had. I kept recoiling from visions of what a serial killer could inflict with this microbe. Again, I grasped at the straw of human error. “Maybe there’s a more likely explanation, like a mix-up in the lab,” I exclaimed, resuming my stride alongside Williams. “After all, it’s so improbable that the staphylococcus found in Sanders is some dreaded strain foreshadowed by an outbreak in Japan. Shouldn’t we redo the culture first—”
“Of course,” he cut me off with a wave of his hand. “A whole crew’s on the way here from Atlanta not only to do that but also to double-check and reconfirm everything about the woman’s infection, both here and at University Hospital where she worked. City and state health officials should already be on both sites setting up what we’ll need. But if you don’t mind my asking, if you were suspicious enough to order the test in the first place, why are you so skeptical about the results?”
“Someone else thought of the test. I simply agreed to sign the order,” was all I answered. I was suddenly reticent to tell him the heart of the matter. After all, blurting out that the organism which ate away Sanders’s lungs was not only unstoppable but also in the possession of a maniac wasn’t exactly going to establish my credibility with the man. Better to be cautious about how I broach the subject of the Phantom, I decided, and said instead, “It’s too fantastic.” I continued, “Even the MMB article implied that if such an organism did occur, it wouldn’t happen until two years from now. How could it have gotten here from Tokyo so fast?”
Death Rounds Page 15
