Lou rested his head against the window and allowed his eyes to close. His thoughts wrapped around another indelible, painful image—Walter Filstrup’s disgustingly smug expression as he fired Lou from the PWO. Stunned, Lou had asked on what grounds Filstrup would tell the board of directors he was being dismissed. The answer was vintage Filstrup—dereliction of duty.
“My best friend could have died,” Lou protested.
“You shouldn’t have been out on a run in the first place,” Filstrup countered. “That demonstrated extremely poor judgment.”
“Walter, this is ridiculous. We run all the time together. It was just a freak accident.”
“You had no contingency plan, Welcome. Nothing in place in the event you were unable to perform your assigned task, which in addition to office-financed attendance at the meeting, included the presentation of a very important speech. Your failure to appear was an embarrassment to us on a national stage.”
You mean an embarrassment to you.
“I’m very sorry about that, but I wasn’t expecting to be on a med flight to Atlanta. And as far as our reputation goes, everyone I spoke to when I stopped back at the conference, and I do mean everyone, was absolutely understanding of the circumstance. Nobody felt that hearing your speech would have altered the result of the election. One of them said they were sure that next year you would win. The only concern anyone expressed was for Cap’s well-being.”
“He shouldn’t have been there in the first place. My primary obligation is to this organization, and, in my professional opinion you demonstrated a considerable lack of foresight with your actions. Now you’re hurting us again by demanding time off that you simply don’t have coming to you. Lack of foresight, lack of perspective, lack of loyalty, lack of solid judgment. Tell me when to stop.”
“Walter, the only measure by which I should be judged is my ability to reinstate licenses suspended by the board of medicine and if you measure me by that benchmark I’m the best we ever had here.”
“We’ll, since I’m the boss, I guess I get to decide which benchmarks matter most.”
“Jesus, Walter.”
Filstrup busied himself with his computer, while Lou, still dumbfounded and flushed, stood by with nothing to do but watch. When the psychiatrist finally looked up, his expression was one of utter triumph.
“I just informed Mrs. Peterbee of your termination,” he said. “She’ll take care of all of your exit paperwork. Thank you for your service, Dr. Welcome, but as of this moment, those services are no longer required. If you need a reference, I’ll be happy to provide one.”
“Well, that makes me feel so much better, thanks.”
“I hope you don’t take this personally.”
“When you come up with another way for me to take it, just let me know.”
“Please understand I have to do what’s best for the PWO.”
There was an intense buzzing in Lou’s ears. His fists clenched and loosened rhythmically. If only they were in the ring. Or perhaps he could just pretend they were, and flatten the pompous ass’s nose across his face. He loved his job and had always taken pride in doing it well. Plus he certainly needed the income. Now he’d been terminated. The entire situation felt surreal.
And worst of all, the one person he most needed to turn to was lying in a hospital bed more than six hundred miles away, sick enough so that the president of the hospital had sent for Lou.
Use your imagination to play through the situations where you might drug or drink. It was an AA tool that had helped Lou get through the hard times accompanying the early days of his recovery. Now, breathing slowly and deeply, he sank into his desk chair and let his mind wander down the alley where, nearly eleven years ago, he frequently went to meet his supplier. The man was absolute slime, but his product, which Lou bought in pill form or as nose candy, was the best. There was no fatigue, no disappointment, no stress that the drugs—heroin or amphetamine—would not make him feel better … at least temporarily. His mouth went dry. He was inhaling through his nose now, actually tasting the crystals.
I’m not doing it anymore, he heard himself say. I’m finished.
He stopped inhaling and then opened his eyes. The image faded quickly. Despite the resentment boiling inside him, the years of dedication he’d given to this job, the cases he’d be deserting, the people who might not understand, and might think the worst, Lou decided to go out with class, refusing to sink to Filstrup’s level. The people who really mattered, Emily, Renee, and Cap—they would understand. But only if he stayed clean.
“Dr. Welcome, are you okay?”
Babs Peterbee stood by the opening to his cube, concern clouding her face. Tears were welling in her eyes.
Lou’s thoughts snapped back to the moment.
“I’m not happy, if that’s what you mean,” he said. “But I’m going to be okay if that’s what you mean. I’m going to be fine.”
“And your friend?”
“We’ll have to wait and see, but the people in Atlanta sound like they are on top of things—at least for the moment.”
“Dr. Welcome, I’m so sorry. I knew Dr. Filstrup was upset about not having his speech read, but I had no idea he would do something like this.”
Lou felt the last of his fear and anxiety blow away like mist. No projections. One of Cap’s favorite lessons crossed his mind.
In any situation, there are only two possibilities: What you want to have happen … and something else.
It was time to adjust to the something else. And then, there would be two new possibilities.
“Not to worry,” he said. “I’m going out like John Wayne, riding off into the sunset. I’m not going to throw a fit, no tears will be shed, no long good-byes said. Off into the sunset.”
Peterbee sniffed and used a tissue.
“It’s just so unfair,” she said. “I’m going to fight to get you your job back.”
Lou brushed aside the idea with a wave of his hand.
“You’ll do no such thing, my friend. I’ll be fine. Remember, I do have another job.”
“But you’re so good at this—”
“You and I will have lunch at O’Rourke’s when I get back from Atlanta. I’ll pay the tab, and you’ll tell me all about how you’re not making any waves on my account. Deal?”
“I—”
“Deal?” Lou asked again.
“Deal,” Peterbee relented as she reluctantly plunked down a set of exit papers.
Lou accepted them and took the photo of Emily from his desk. He could do without the cheesy stapler and tin of paperclips. Smiling now, he walked past the secretary and out the office door.
“I really like John Wayne,” he heard her say.
CHAPTER 23
Entitlements are like a house of mirrors: the more mirrors there are the harder it becomes to find a way out.
—LANCASTER R. HILL, 100 Neighbors, SAWYER RIVER BOOKS, 1939, P.200
Still dealing with the inner conflict of getting out from under Walter Filstrup on the one hand and being shut out from a job he loved on the other, Lou took a cab directly from the airport to the hospital. He would stop later at the hotel and remain in Atlanta for as long as Cap needed him. The department head at Eisenhower Memorial, the anti-Filstrup, had juggled the ER schedule, and had readily handed over the five days remaining in Lou’s vacation account. Lou was prepared to put his ER job on the line if he had to, but this was another of those first-things-first situations.
There was a text waiting when they touched down at Hartsfield-Jackson Airport. Hospital president Win Carter had been called out of the office, and Lou should meet Dr. Ivan Puchalsky of infectious disease at the isolation suite on Baron 7. During the ride into town, Lou read up on the man. Russian-born and educated at top U.S. hospitals, his résumé was impressive, and his area of expertise was nosocomial disease.
Nosocomial.
Infection acquired in a hospital. The word, itself, sounded nasty. It had always bothered Lou that su
ch a term even had to exist. As they weaved through the busy streets toward Arbor General, he absently tried the dictionary connected to his iPhone, and was surprised that nosocomial wasn’t in there. A nonexistent, ugly word referring to a condition that had only come into being because there were hospitals.
Nice.
After paying off the cabbie, Lou followed the signage to the Baron Building, and took one of four gleaming elevators to the seventh floor. The isolation suite was located behind a set of closed double glass doors at the end of an ominously long corridor. What he noticed immediately on exiting the elevator was the quiet. If Arbor General was a subway, this section of the hospital was the last stop on a line that headed into a very scary part of town. Not many people wanted to be around patients deemed too contagious to be cared for within the general hospital population. Lou could not believe this was where the magnificent man, who had done so much for him and for others, had been relegated.
He flashed back on the misty morning, a lifetime ago, when the two of them were stretching beside each other on the perfect emerald lawn of the lodge, getting ready to begin their second run into the mountains. As a doc in the ER, he had been forced to confront the ultimate truth countless times—life was all so fragile … so precious … so unpredictable. He had never managed to disengage himself from that reality, nor did he ever want to. But this was Cap.
Battling the fullness in his throat, Lou pressed the button on the intercom, announced himself, and was buzzed into the unit.
Waiting for him by the central nurses’ station was a lanky, high-jumper-tall man, dressed in a knee-length white lab coat with scrubs underneath. He was clean-shaven and youthful, although Lou put him at fifty. Above his Slavic cheekbones, his pale blue eyes were darting from left to right as though he were agitated by something—perhaps Lou’s presence. Above the eyes, his thin, straight hair was prematurely white.
“Dr. Ivan Puchalsky,” he introduced himself with a pronounced accent, probably Russian.
His handshake was like a mackerel on ice.
“Welcome. Dr. Lou Welcome,” Lou responded, imitating James Bond without meaning to.
“I was told you’d be here ten minutes ago,” Puchalsky said.
No How was the trip? No pleasantries whatsoever, for that matter. The irritation in the man’s voice made Lou wish he had tried even harder for the Bond.
“Thank you for being here to meet me,” he said.
“Coming from the chief of the hospital, it was a request I could not easily refuse, although I am not certain why he chose me. As I understand from Dr. Carter, you are an emergency room physician, and a friend of Mr. Duncan’s. Is that correct?”
I’m a clinical instructor in medicine at George Washington Medical School, with boards in internal medicine as well as in ER and addiction medicine, Lou wanted to counter, but didn’t. Puchalsky sounded determined to talk down to him regardless of his résumé.
“Correct,” he said instead.
“My work on nosocomial infections is very complex and deeply involved, even more so now that I have entered into an arrangement with the genetics department, and have opened a lab where we are sequencing the genome of dangerous bacterial pathogens to trace their origins within and outside of the hospital. So rather than explain what we do in my labs, and what we are working on with Mr. Duncan, suppose we go down the hall and you can ask me questions.”
During his years as a doc, Lou had dealt with many brilliant, caring, memorable men and women. But being in medicine, especially academic medicine, also meant dealing with overinflated egos. Clearly, Ivan Puchalsky fit in that latter category.
Suppressing the fleeting image of the Hindenburg exploding, he followed the ID specialist to the doorway of a small conference room. He wanted desperately to go in and see Cap first, but he sensed Puchalsky wasn’t ready to be left standing.
“Please tell me about Hank Duncan and the germ you’re concerned about,” Lou asked.
“Generalists such as yourself,” Puchalsky responded, “don’t often understand the nuances and contradictions involved in a case like this one. This is a complex situation, Dr.—”
Bond. James Bond.
“Welcome. Lou Welcome. Dr. Puchalsky, why don’t we pretend, just for a moment, that this isn’t a big waste of your time, and for the sake of my friend in there, clue me in about what’s going on with his infection. If it helps you to think I wouldn’t understand, feel free to use simple terms or to speak slowly.”
Lou was not sure how sarcasm translated in the Russian culture, but judging by Puchalsky’s slightly raised eyebrows, he figured the intent had registered. If anything, the man seemed resigned to extending Lou the requisite professional courtesy, albeit the minimum he could get away with.
Puchalsky sighed.
“We’re not entirely certain of the nature of this particular germ,” he relented. “The truth is, until the last six months or so, I’ve not encountered anything quite like it in all my years in medicine.”
Lou’s pulse accelerated. This was not a man to share such a thing easily. For someone with Puchalsky’s experience never to have encountered a germ of this type before had Cap sailing in stormy, uncharted waters. Lou had come to Atlanta expecting to find his friend in trouble, but the threat level here could be the medical equivalent of DEFCON-2—one step removed from nuclear war.
“What’s so unique about the germ?” he asked, barely controlling the quaver in his voice.
“Did you by any chance read in Time magazine six or eight weeks ago about a cheerleader who had surgery on her fractured elbow after a nasty fall during a cheerleading competition?”
“As a matter of fact, my daughter, Emily, showed me a video of the fall on YouTube. It was just awful, and at the time I saw it, there had already been something like two or three million views.”
“Well, the girl was cared for at White Memorial Hospital in Boston, which as you know is as good as any hospital in the country. A week or so after her open repair, she developed an infection with an unusual bacteria. As you may know, with very rare exceptions, all bacteria are classified as either Gram positive, or Gram negative, depending on whether they become purple or pink when stained.”
Inwardly, Lou groaned. This was introduction to undergraduate microbiology stuff. He nodded, keeping his expression blank. Puchalsky had to be allowed to do it his way.
“Please go on,” he said.
“What is unusual about this germ is that it appears to fluctuate between the two states. There is no pattern that we can discern to this fluctuation. Nothing we can find that is cause and effect. But the result is an organism that isn’t consistently sensitive to any antibiotics.”
Lou went cold. The Doomsday Germ. He had read a newspaper article about it, but had seen nothing in the medical literature, and had categorized it in his mind as a variant of MRSA—methicillin-resistant staph aureus.
“What happened to the girl?” he asked.
“She lost her arm, and then one leg. She was extremely ill at the time of that operation, and she died on the table.”
Jesus. Cap was in isolation because of a nosocomial infection—a germ he had caught from simply being in the hospital.
“Have there been many other reported cases?”
“Some. We had one at this hospital about six months ago—an elderly diabetic woman who came in for treatment of a foot ulcer and got a secondary infection with the bacteria. She died quite rapidly and unpleasantly.”
“What do the sensitivities of Hank Duncan’s cultures tell you?” Lou asked.
Apparently Puchalsky liked the way the question was phrased. His impatient demeanor lightened just a bit.
“The antibiotic sensitivities are inconsistent and not encouraging. We’ve tried methicillin and two different carbapenems, individually and in combination. Next will be vancomycin. But so far nothing seems to be working. At the present moment, I am not entirely sure how to battle this particular germ. I have no idea of its origin, ho
w it managed to infect your friend, or how many people may be at risk for exposure now. We’ve contacted the CDC of course, and are working at it in my lab over in the Smith Pavilion.”
“What’s the current situation?” Lou asked, his voice breaking in spite of himself.
“The infection is getting worse. Mr. Duncan’s surgeons have put in drains, but we’re contemplating opening the incision.”
“And your investigation?”
“The germ is actually easy to grow in culture, but with the resistance it is showing to our drugs, it’s seeming clearer and clearer that we will have to go in another direction.”
“Such as?”
Puchalsky sighed again.
“Dr. Welcome, this just is not the time to go over my work with you or anyone for that matter. I mean you no disrespect, sir, but I am just too busy for this. And I will get even busier the moment a third case crops up in our hospital. And believe me, doctor, it is only a matter of time before that happens. Feel free to visit with your friend. Stay in his room as long as you like, but if you have any questions specific to his condition, I ask that you direct them to his attending physicians, or his nurses. I plan on delivering a similar message to Dr. Carter. Are we in agreement here?”
Puchalsky clearly wanted Lou just to dry up and blow away. That didn’t matter. Lou had plenty of experience with people who, for one reason or another, wanted the same thing. Besides, the man had reminded him that just down the road was a resource that could prove far more helpful than he was—bacteria-worshiping Sam Scupman of the CDC’s Antibiotic Resistance Unit. But before he let the incorrigible infectious disease specialist walk away, Lou had one more question.
“At the rate Hank Duncan’s infection is progressing, what’s the next logical course of treatment if a new antibiotic remains elusive, and combinations of existing antibiotics continue to be ineffective?”
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