“Dr. McCormick, this is a religious home. All the women who live here are unmarried. It is one of the best-run group homes in the city.”
“That didn’t answer my question.”
“No male visitors are allowed upstairs. In fact, the only male here with any frequency is my husband.”
“Ms. D’Angelo—”
“Mrs. D’Angelo. I’m married.”
“Mrs. D’Angelo, please help me out here.”
She stood. “I am helping you, Dr. McCormick. I’ll get that menu for you.”
CHAPTER 11
“What do you have?” Verlach’s voice was hushed. He was still at Baltimore Haven, the group home, bagging specimens.
“About twenty pounds of condiments, drain scum, and hand cream. How about you?”
“Got a mouse in the first ten minutes.”
“At least no rats.”
“Got one of them, too. This place is a cesspool. They tried to clean up—someone must have given them the heads-up—but even so . . . I’m calling somebody from Housing Services to look into this place. Poor girl.”
The poor girl was Deborah Fillmore, unfortunate resident of Baltimore Haven. As Verlach described it, Baltimore Haven fit my prejudices of group homes for the mentally handicapped: a dirty, miserable dumping ground.
I was standing on the sidewalk outside Open Arms, already sweating through my shirt.
“You downtown?” Verlach asked.
“Going there now.”
“I think we’re going to use CDC labs, Nate. The guys downtown will box the specimens for you.”
“Nice of you to tell me.”
“We just made the decision. And just so you know, we’re thinking about requesting more CDC on the ground as well.”
That took me aback. Not a bad decision to call in reinforcements, but it suggested someone thought we couldn’t handle this on our own. “So,” I said, “this thing is getting big.”
“Well,” Verlach said, “we made it that way.”
Which is true and, if you think about it, a little strange. We had three sick women who, if they had gone to separate hospitals, if they had not been picked up by sentinel surveillance, would have just been that: three sick women. They wouldn’t have been the beginning of an outbreak. Now a hospital was being shut down, the federal government was being mobilized, and in a few hours the media piranhas would be feeding. Disease is odd this way. It’s not like a murder or a bomb going off or a landslide. It’s hard to know when something abnormal is happening, or when an illness is just part of the warp and woof of everyday life. But when somebody—us, your public health protectors—says something is wrong, well, it’s like the explosion on the bus. It’s real and it’s frightening.
“Anything hit the news yet?” I asked.
“Not that I heard. It won’t be long, though.” Verlach paused, then asked, “What do you think?”
“I don’t, Herb. That’s why I’m so well liked.”
“You keep on like you’ve been, I’ll start to believe you.”
“Funny.” Which it wasn’t. There was silence on the phone and I tried to divine what Verlach was thinking. I said, “You thinking it’s a strike?” We don’t really like to say terrorism too much, especially when other people are around. We use euphemisms. Strike. Attack.
More silence, which I filled. “Yeah. Strike at the retarded. Bring the country to its knees.” I forced a laugh. Thought about it a little longer. “I can’t rule it out.”
“Neither can I. If you think about it, though, it’s not a bad idea.”
“Meaning . . . ?”
I heard some shuffling and assumed Verlach was removing himself to someplace quiet. His voice was hushed. “You hit slow folks—they might not be as vigilant as others, so you give them a gift or something—good start, right? They open the package, poof, the bug is in their system. So you got your first cases. But you’re smart; you want to get the biggest bang for your bug. You know these folks work in nursing homes, a bunch of immunocompromised—”
“Where did Deb Fillmore work?”
“Nursing home in Bel Air. In the kitchen.”
“Nobody told me that.”
“You didn’t ask, Grasshopper.” Verlach cleared his throat. “So we see a bunch of parents and grandparents start to die, right? Hits us where it hurts.”
“You’re scaring me, Dr. Verlach.”
“I’ve been scared for years.”
“What’s the name of Fillmore’s employer?” Holding the steering wheel in my left hand, I flipped through my little notebook, found the name of the home where Bethany and Helen worked. “It’s not Miller Grove?” I said, hoping it was. Please, I thought, make this easy. Make it a contained, discrete cluster. If all three women worked at the same nursing home, then we were getting somewhere.
“No. She was in a place called Oak Hills.”
I found a pen sandwiched in the car seat; I wrote the name in the notebook. “After I drop this stuff off downtown, I’m heading out to Bel Air to check on the place where Helen and Bethany worked, a place called Miller Grove. I’ll start working on Oak Hills as well.”
“Okay,” Verlach said. “I’ll try to get out there as soon as I can. We may have some state people as well.”
There was silence on the phone. I could almost hear Verlach scratching his head. “It would be nice to get a read on the agent. Even symptomatically. My kingdom for a nice, discrete collection of signs and symptoms.”
“We got the hemorrhage on the trunk, in the mucous membranes, sparing the face. . . .”
“But taken together, it doesn’t match anything.”
“Or it matches too much—”
“That, too.”
“Maybe we’re dealing with a coinfection, maybe a variant.” The conversation was worrying me a bit, and I wished I had a cigarette. “Okay, okay,” I said. “What else? What else are you thinking for transmission?”
“After seeing the shithole I’m in, it could be a rodent or arthropod vector.”
“But we have two cases at Open Arms. I tell you, Herb, the kitchen there is cleaner than the OR at St. Raphe’s.”
“Not saying much. Anyway, I’m operating on the assumption that we have a common vector. Maybe the homes have mixers or something. You know, dances where the residents share needles or swap transfusion products. . . .”
“Maybe. We’ll see how close the ladies’ workplaces are. How much the personnel interact, whether they share the same supplier, cleaning or groundskeeping services. Let’s also be thinking of a human vector.”
“Why?”
“Distinct subpopulation. Contact with the same people in the same circles. Remember those weird symptomic clusters in LA and New York? Gay men. Young.” That was how AIDS first presented. And though neither Verlach nor I were in public health at that time—I was still spending my afternoons playing Dungeons & Dragons and fighting my way through puberty then—the story of how AIDS came to light was part of our profession’s lore.
“You looking for Patient Zero now, Nate?” Verlach asked.
“I sure as hell hope not,” I told him.
CHAPTER 12
I headed back downtown, to the Department of Health. A couple of techs waited with their packaging material and FedEx pouches. The airbills, I saw, already had CDC’s Atlanta address on them. I gave them the samples from Open Arms, and they set to work, labeling, repackaging, sealing. Your public servants, when they want to, can move fast.
And we needed to move fast.
I drove from downtown to Miller Grove, the erstwhile employer of Helen and Bethany, located in the Baltimore suburb of Bel Air. I cut through the city to link up with I-95, and from there, north. I like hard-core urbanism, so I’d opened my windows to let in the heat and the smells and the sounds.
A red light stopped me at an intersection next to a housing project that was—apologies to Hobbes—nasty, brutish, and short, rising only two stories from packed-dirt yards. Young men in sports jerseys g
athered on corners, shaved heads slicked in the heat, eye-fucking me as I waited for the light to change. As I said, I’d spent some time here—the last two years of medical school—and, the milling low-level threat outside the car notwithstanding, I missed the place. True, it had a murder rate that was among the highest in the nation, it had had an embarrassing and frightening syphilis problem a few years back. Race politics dominated. Summers were tropical, winters wet and gray. Compared to, say, dainty, boutique-laden San Francisco, Baltimore was hard to love.
Even so, the city was on the upswing. The downtown was being revitalized and gentrified in a way that was not without its critics. In an odd inversion, poverty was being pushed from center city to the inner suburbs as those with money realized the charms of an urban life with good restaurants, great bars, and an effervescent maritime vibe. I passed through the neighborhoods of Greektown and Butcher’s Hill, through block after block of formstone rowhouses and white marble steps that residents scrubbed weekly and that gleamed like Roman statues. I found myself hoping that this outbreak or whatever would die quickly. I hoped this because I didn’t want to see anyone else get sick. I hoped this, too, because this city didn’t need another black eye just as it was crawling back to respectability.
But all good things come to an end, and after fifteen minutes, the city gave way to a nondescript swath of strip malls and housing developments that are the true hallmark of twenty-first-century America. Suburbs and exurbs had metastasized through the whole country, and I could have been on the outskirts of Minneapolis or Boston or anywhere in LA.
Off one of the major arteries in Bel Air—between a T.J. Maxx and a Circuit City—I found the turnoff for Miller Grove.
Dan Miller, senior administrator, put on his best game face—a pretty good one, actually, with capped teeth and dark tan—but I could tell he was sweating this one out. His head nurse, Gina Hatcher, was a thin black woman in crisp nurse’s whites, which pegged her as someone from the old school. Both sat rigid as I told them about the biological meltdown of two of their employees. Actually, three employees. It seemed the Miller family owned four nursing homes in the area, including Oak Hills, where Deborah Fillmore worked. Oak Hills was just across the street.
Miller was savvy enough to know the shit through which we were wading was deep and getting deeper. Savvy enough, too, not to put up a fight, despite the fact that something like this could wreck him if he made poor choices or just had a run of bad luck.
“And you’re acting with whose authority?” Miller asked nonconfrontationally.
“CDC and Baltimore City Department of Health.”
“Ben Timmons?” Timmons was the health commissioner for Baltimore.
“And Herb Verlach. Dr. Verlach’s heading up the investigation.”
“Great. Know ’em both, both good men. Well, Dr. McCormick, you’ve succeeded in scaring the pants off us. What do you want us to do?”
“Answer some questions.” I pulled out my notebook and fired: Any illnesses out of the ordinary? How many new admissions? New staff members? What kinds of contact did staff have with the patients? What were the details of laundry duty? Of kitchen duty? The answer to each question was either negative or not illustrative.
When I’d mined enough of Dan Miller and Gina Hatcher, I said, “I’d like to talk to the staff and I’d like to collect samples from Miller Grove and Oak Hills. Mr. Miller?”
“Yes?”
“I’d like you to put the word out that the kitchen staff shouldn’t throw any food away. Have your people gather and hold the mail, too.” I glanced at my watch; it was three thirty.
“Is everyone still here? The staff, I mean.”
“Most everyone,” Miller said. “We run three nursing shifts, so—”
“That’s fine. We can get to any stragglers later if we need to. Can we gather everyone who’s here?”
“Now?”
“No time like the present.”
“Let’s wait until after dinner, if we can. We can still serve dinner, can’t we?”
I thought for a moment. I had—directly or indirectly—been responsible for the shutdown of a hospital earlier that day, and I didn’t want to be responsible for delaying dinner for hundreds of elderly and infirm. “Sure. Just make sure the staff doesn’t use any old food or condiments. Tell them to open everything new.”
“I’ll make the announcement,” Gina Hatcher said.
I pushed up from my chair. “I’ll begin collecting samples and setting rodent and insect traps.” The nurse stood and started toward the door. I followed, but stopped at the doorway. “I want to thank both of you for this. You’ve been . . . well, you’re making a difficult situation a lot easier.”
Miller stood. “We know what you’re dealing with—” He pointed proudly to a diploma on the wall. “Master’s of Public Health. Hopkins, ’78.”
CHAPTER 13
At five o’clock, after swabbing and collecting in the kitchen at Miller Grove, I was standing in a small chapel, looking out over the gathered staff from two of the four Miller nursing homes. It was a motley collection, racially and developmentally. Just from the look of it, a quarter of the staff must have been “slow.” I admired Dan Miller for his progressiveness; I also wondered what kinds of awesome tax breaks he was getting.
I introduced myself and explained why I was there. Though I cautioned against talking to reporters—“because we don’t know much”—I was worried that the media had already caught wind of what had happened and were encamped downtown, outside St. Raphe’s or outside the Department of Health. What we didn’t need was forty more sources of information springing from the Miller homes.
Basically, what I wanted from these folks was: 1) whether they had seen anything unusual, like packages, rats in the kitchen, sicknesses; 2) what they knew about the three sick women; and 3) whether they knew the three sick women as more than just coworkers. Miller told them overtime would be paid to everyone, and cab fare given to anyone who needed a ride home. This was all the crowd needed to sit tight. Miller—fast becoming my favorite person in Baltimore—had pizzas trucked in from a local joint.
By the time I started to interview, fifty-plus people sat in the pews. It was going to be a long night.
I was into my third interview, stumbling through a give-and-take with a laundry worker named Rosa whose command of English was as bad as my command of Spanish, when the pizza arrived. Like any normal, hungry human, Rosa instantly lost interest in me and I let her go fight her way toward the food line. When she’d gotten her two pieces of pepperoni, she returned. We were about to continue the interview when I noticed a good-looking young white man stand up, muscle his way to the front of the line, and grab an entire box. He opened the box, took out a piece, and made his way to the back of the chapel. I’d kept an eye out for this sort of thing; you don’t want someone who could help bolting before you had the chance to talk. Besides, the guy had just snatched an entire pie. Fairness, if nothing else, determined that I intervene.
“Who’s that?” I asked Rosa. “¿Quién es?”
“Douglas,” she said. “El novio de Debbie.” El novio. Debbie’s boyfriend.
I stood quickly. “Esperar. Esper—” I gave up and raced after him. “Excuse me, Douglas?”
He turned to me. He was big, black hair; his chiseled jaw was slightly slack.
“You must be hungry,” I said.
He dropped the piece of pizza he was eating into the box, closed the lid.
“I’ll get to you next. Five minutes. Can you wait? Can I talk to you in five minutes?”
“No, no. I—”
“You know, there are a lot of people to feed in there.” I was trying to figure out if he was mentally handicapped or not. “Why don’t we take it back inside, you take a couple slices, and we talk.”
Nervously, his head switched left and right, as if he were looking for his wingman to get him out of the situation.
“Okay, I can talk to you now. You mind if I have a piece?�
�� I reached for the box, and Douglas began to walk. Guess he did mind.
I followed him. “Someone told me you know Debbie Fillmore. Do you know Debbie?”
“No, no. I don’t know her.”
“Debbie Fillmore. Your girlfriend. Debbie.”
“No. I don’t know her.”
Something was definitely wrong here. He was lying; that was obvious. And he was sweating like a marathoner.
“Why did you want to talk to me?”
“No I didn’t.”
“You waited for an hour to talk to me.”
“No I didn’t. I wanted . . .”
You wanted the pizza, didn’t you, Douglas? I thought.
He was moving fast now, not toward the exit, but anywhere that was not near me. We turned down a long hallway. I powered through with the interview.
“Do you know if someone sent Debbie a package?”
“No.”
“Did she get a package in the mail? Did she get a package from a friend?”
“I don’t know,” he said, looking straight ahead. “No!”
We clicked left, down another hallway. Douglas began to jog; I kept up.
“Was Debbie your girlfriend?” I was on his heels now; I could smell his sweat. “Did you ever kiss her?”
Frustrated with the running, wanting to slow this whole thing down, I put my hand on his shoulder. Mistake. Like a running back tossing a lineman, Douglas pivoted, swung his arms and the box of pizza at me, slamming his left arm into my trunk. I am not a small man, but it was enough to send me reeling. I bounced off the opposite wall, regained my footing, and he ran.
And then I stopped, realizing the futility—the near comedy—of the situation. There I was, racing down the hallway in a nursing home, chasing a retarded man who clutched a Papa John’s box, being knocked around like a pinball, and, I noticed, being gawked at by a couple of nurses up the way.
My conversation with Douglas would have to wait.
Isolation Ward Page 5
