Isolation Ward

by Joshua Spanogle

  “I have a feeling things are going to heat up here,” I told Verlach.

  “Better you than me. Listen, get what you can, then get out of there. When I was there, Jefferson sent a couple of his associates to help me out. Scary-looking guys making life hard. That’s why it took me so goddamned long.”

  I looked around. The place stank, that much was true, but there were no piles of rotting garbage, no foul sludge bubbling up from the drain in the floor, nothing like that. “Herb, I think they cleaned up since you were here.”

  “I guess we could have expected that.” He paused. “I’ll have the judge work on a court order to give you emergency access to the place.”

  “Right. The judge.”

  “Well, tell them that, anyway. Should get them off your back for a little. It worked yesterday.”

  “If they hassle me, we’ll rip this place apart. We have the authority.”

  “Come on, man, don’t go running roughshod. This guy has powerful friends—”

  “Gotta go,” I said, and hung up the phone.

  In the kitchen, there was nary a rodent to be found, although I did see some mouse droppings in a few corners that the mop must have missed. I double-checked Verlach’s little pieces of gray duct tape, and sure enough, they had been broken on three of the traps. So at least we knew there were rodents. What unholy diseases they were carrying would remain a mystery for a little while longer.

  I refilled the bait caches and went into the pantry.

  Normal institutional fare—a few cloudy bottles of oil—going rancid, probably—flour, oatmeal, et cetera, et cetera. More mouse shit. Again, nothing in the traps. One trap with broken tape.

  To the basement I went. Or tried to go. The door was locked.

  “Do you have keys?” I called to the kitchen workers, both heavyset Latinas. They looked at each other. “¿Tienen llaves?” Neither moved. “Soy un doctor, de la officina de salud.” I was mangling their mother tongue here, but I hoped I got my point across. I produced my CDC badge. “Necesitan abrir la puerta,” I said. You need to open the door. Now frightened looks. I was about to use my trump card—ICE threats—but one of the women pulled a key chain from her apron and opened the door.

  “Muchas gracias,” I told her, and flicked on the lights and headed down the steps.

  Hercules’ Augean stables must have looked antiseptic compared to the basement at Baltimore Haven. Piles of institutional crap were everywhere. Old carpet rolls here, broken chairs and tables there. There were a few bags of rice that lay in the corner, split and spilling their contents onto the floor. In the midst of all this, I saw how pathetic my drawing had been. I reoriented it and made my way around the cluttered, dank cellar, trying to key the little Xs on the paper with the location of the traps.

  Behind a clutch of broken light stands, I found one. Empty. I moved along the damp wall, past cardboard boxes disintegrating in the moisture. Piles of clothes tumbled from one, broken picture frames and torn photos from another. The personal possessions of the residents? If so, I wondered why they weren’t upstairs in the rooms. Probably had something to do with stripping the residents of any last vestige of identity. The management probably called it “therapy.”

  I heard a scurrying in the shadows. Another trap, with a big mother of a rat running in mindless circles inside it. I lifted the trap and put it on a broken table in the center of the room. Quickly, I found the other cages, one of which housed another member of the class Rodentia.

  Then I heard footsteps coming down the stairs.

  Dr. Randall Jefferson stood at the bottom of the steps; behind him stood a much larger man who would most aptly be described by the term thug. Jefferson was black, his henchman white. I knew the doctor by reputation—a prominent psychiatrist and businessman in the city who, by the looks of his fifteen-hundred-dollar suit, was doing quite well for himself—and from stock newspaper photos Verlach had showed me. Last I heard, the city was paying out about three hundred dollars per day to folks like Randall Jefferson to care for the mentally disabled. Supposedly, care involved decent housing and food and, importantly, vocational training and psychotherapy. I wondered about the quality of therapy given to the man upstairs who was eating his shirt. I looked at Jefferson’s shoes, which probably cost as much as I make in a week. Hmmmmm. Let’s see: Baltimore Haven had thirty-five residents. At three hundred dollars per day per resident . . .

  “Dr. McCormick,” he said in a faux patrician accent. He knew my name. Evidently, the owner of Baltimore Haven was a bit concerned about yours truly. He continued. “You’ve gotten yourself in quite a spot.”

  I looked at the mounds of junk around me. “Don’t I know it. I have no idea how I’m going to navigate around that settee there.”

  He shook his head, a humorless, shit-eating smile on his face. “That’s very funny.”

  “I try.” There was a rat trap with rat in my hand, and I set it down on a chair with three legs.

  Jefferson said, “You spoke with one of our residents without notifying us first.”

  “I didn’t know I needed to notify you.”

  “I’d like to know the content of that conversation.”

  “I’m afraid it’s confidential. Doctor-patient privilege.”

  “Tsk, tsk, Dr. McCormick. We both know that’s not true. You’re not Douglas’s doctor, nor does an investigation like this confer on you doctor-patient privilege.” He was half-right; Douglas Buchanan wasn’t my patient. He was, in all likelihood, Dr. Jefferson’s patient.

  “But an investigation like this does allow me to enter the premises and talk to whomever I’d like.”

  “Not without a court order.”

  “I have one,” I lied. I should have had one, Verlach should have gotten one, and Randall Jefferson shouldn’t have been giving me such grief. Unfortunately, no one thought there would be problems like this.

  “Then let me see it, the court order.”

  “It’s with Dr. Verlach.”

  “Ah. I’m sure it is.” Jefferson finally let the grin fall from his face; I was amazed at how long he’d sustained it. This guy had the makings of a great politician. “Dr. McCormick, you seem like a well-intentioned man. And let me assure you that we are well intentioned, too. We want to cooperate with the public health authorities in your investigation of this terrible illness. We don’t, however, appreciate being taken for granted. We only wish that you’d call before you descend on our facilities and interrogate our residents. That way, we might help make the process easier.”

  Or hide what you need to hide, I thought. I said, “I’m sure we’ll be contacting you soon. Today, probably. And we’ll need to have another conversation with Douglas Buchanan. Again, probably today.”

  “Then I can probably help you. If you tell me the content of the conversation you just had with him.”

  I said, “Great, why don’t we go speak with Mr. Buchanan now? I still need to get a blood sample from him. And semen. Perhaps you can help with that.”

  Neither Jefferson nor his thug seemed to care for this suggestion. Coolly, Jefferson said, “Unfortunately, I think Douglas stepped out.”

  “Why am I not surprised?”

  I looked around the basement. There was perhaps one more trap to check, but I was willing to skip it. I had two in my hands already, and I didn’t expect Jefferson or his henchman to help me out with a third. I picked up the rat traps, which the rodents didn’t seem to like. They were bounding around, squeaking.

  “You’ll be kind enough to leave those here.” Jefferson pointed at the traps. “You can come back for them when you have a court order. We’ll keep them safe for you.”

  “These?” I held up my hands. “I brought these with me. I keep these little guys as pets. For company.”

  “You’re a very funny man, Dr. McCormick.”

  The thug, a bullet-headed gent of professional-wrestler dimensions, shifted his stance. I saw the overwhelming wisdom of getting out of there.

  “I sugge
st you put those traps down and contact your lawyer. You are, I believe, going to need him.”

  “Or her,” I told Jefferson. “I could be wrong, but I think they let girls study the law in this country.”

  Why do I say these things?

  “Dr. McCormick, the cages.”

  “Excuse me,” I said, as if I hadn’t heard him, and took a step toward the basement stairs. The two men stood their ground in front of me. In the cages, the rats were freaking out.

  The thug reached out to grab one of the traps. Without thinking—and I really should have thought about this—I headed for the steps. The man wrapped his thick fingers around the cage mesh and pulled. I didn’t let go. The shaking back and forth excited the rat even more. The thing started to scream and literally bounce from side to side in its prison. Again, I thought of the man eating his shirt upstairs.

  “Ah!” the thug screamed, and jerked back his hand. He pressed it to his lips. “It bit me! The fucking thing bit me!”

  Both rats were shrieking now, and I swung a cage at the henchman to knock him back a little. I ran up the steps. Jefferson was yelling something behind me.

  Even as I jogged through the hallway to the front doors, I began cursing myself: stupid, stupid, stupid, stupid. I looked at the cages in my hands, at the rats inside them. It would be a sick irony indeed if my little friends were our vector and if I, Dr. Nathaniel McCormick, had infected someone else.

  I hoped—I prayed, actually—that my buddy had not broken the thug’s skin.

  I needed to calm down before I went back to Guilford Avenue and the Baltimore City Health Department to drop off the vermin and confer with Verlach about what I’d found. The most direct route would have been to hop the Jones Falls Expressway straight to downtown. Instead, I went through the city, toward the Baltimore campus of the University of Maryland and toward one of my favorite places for lunch. Even a medical detective on an outbreak investigation has to eat. Especially if he was just assaulted. Especially if he was worried about infecting someone with a disease.

  A few words about me and University of Maryland, Baltimore campus. First and foremost, good old Maryland is my alma mater. The latter half of my medical school training was there, which means I went through my clerkships in the university hospital, which means I learned how to be a doctor there. My preclinical training, those moderately important first two years of basic science, had been spent on the West Coast, at that famous university smack in the middle of Silicon Valley. The Farm: all sun and fun and outstanding national reputation. But I hated Northern California. For reasons that had more to do with character flaws in yours truly than anything else, I’d beaten a hasty retreat from the Golden State.

  Maryland, to their undying credit, gave me a second chance at medicine and I’d graduated. With honors. After that, I went to the University of North Carolina for an internal medicine residency and, finally, ended up at CDC in Atlanta. All in all, my life had been pretty good since I’d fled California, though I spent far too many years south of the Mason-Dixon Line for someone who breaks out in the heat and humidity.

  Anyway, there I was, back on Redwood Street at Mary’s Diner, sitting at a Formica table, chomping a two-dollar burger. The car was illegally parked out front, the windows were cracked open, and the rats were basking in their cages on the floor of the backseat. I chatted up the waitress, whom I remembered perfectly and who had no idea who I was. I stopped chatting when my cell phone vibrated.

  “Nathaniel, it’s Jean Madison.” She sounded exhausted. No formal “Dr. McCormick” now. “I have some bad news.”

  “What is it?”

  “Well . . . Whatever it is, it looks like it’s lethal.” She heaved a sigh into the phone.

  “What?”

  “Deborah Fillmore is dead.”

  CHAPTER 20

  The burger I’d eaten thirty minutes before was bubbling unpleasantly in my stomach. Perhaps it wasn’t the burger per se; perhaps it was the ambiance. I was in the path labs at St. Raphe’s.

  Hopkins and Maryland had both offered to let St. Raphael’s use their pathology labs—everyone wanted a little piece of the glory—but nobody thought it wise to transport a pathogenically hot item like Deborah Fillmore’s body any further than it had to go. The thing was, as Dr. Madison said, lethal. This changed the equation somewhat, and everyone was skittish. Consequently, we were decked out in the best protective gear the Health Department had to offer: full biohazard suits with respirators. And it still didn’t feel safe.

  At the first cut, I almost lost my hamburger, which would have been a real mess, considering the respirator over my face. As the pathology tech pushed the big knife into the abdomen, blood began to run. And run. A bolus of blood surged from the abdomen, splashing the tech’s gowned arms. Everyone jumped back and yelped; then it was silent. All you could hear was the water running on the path table and the regular inhalations through the respirators.

  I heard a whisper: “Oh my God . . .”

  “It’s all right—Juan, is it?—it’s all right,” someone said to the tech. “I’ll take care of it.” A man stepped forward. Jack Dowd, a pathologist from Hopkins who had an interest in things viral—we were ninety percent sure it was viral now—walked to the table. A pathology resident followed, as did the chief pathologist from St. Raphe’s. This was an important moment for them. Pathology isn’t surgery, and it’s not every day that a pathologist gets a chance to show how big his balls—her balls, too, excuse me—are. After a pause, Dowd began to cut, speaking low into the microphone that hung from the ceiling.

  “Patient name: Deborah Fillmore. MR number: 7716321. Time of death: thirteen ten, July fifteenth. Patient is an African-American woman. . . .”

  And we watched as steel-balled Jack Dowd cut. Technically, what killed Debbie Fillmore was multiple organ failure, which is pretty much what it sounds like. The kidneys can’t filter the blood, and the balance of fluid and electrolytes in the system goes haywire. Other organs starve for blood. Finally, the lungs go, the heart goes, the brain goes.

  What caused the multiple organ failure is what we call shock—Debbie couldn’t generate enough blood pressure to perfuse all her organs. And what caused the shock was her internal bleeding, secondary to the rupture of capillaries and larger vessels. All the blood that now poured from her body cavity should have been in her arteries and veins.

  Each organ was carefully removed and weighed, then sliced apart. Carefully is the operative word here; no one wanted to slip with the knife and end up like Debbie Fillmore.

  After a half hour, I’d learned what I needed, basically that this thing killed like a viral hemorrhagic fever. I showered in the path lab showers, now makeshift decontamination showers. Smelling of disinfectant, I left.

  “Goddamn it, Nate, why didn’t you just let him take the cage?”

  “They’re trying to stymie an outbreak investigation.”

  “Well, this sure isn’t helping. It could, in fact, be a real problem.” Verlach drummed a pen against his desktop. “Tell me again: he tried to grab the trap . . . ?”

  I recounted the story again.

  “This sure as hell isn’t helping anything. Are you sure the bite didn’t break the skin?”

  “No,” I said.

  “Damn it. I’ll call Jefferson, make sure his friend got cleaned up.”

  “You know him?”

  “Somewhat. You’re black, you’re a doc, you’re in Baltimore, you know each other.” Verlach looked at me and I dropped my gaze. “Aw, shit, Nate, why’d you have to . . .” He trailed off, and his hand ran back and forth over his bald head. “Listen—Jefferson—whatever else he is—is a doctor. He should know what to do. He should also know what the hell we’re dealing with. The shit he pulled was . . . He’s a freaking sleaze, that’s all.”

  We were sitting in Herb Verlach’s tiny office, which had barely enough room for the metal desk and all the medical journals stuffed into it, much less two grown men; my foot was pressed against a t
rash can. Verlach sighed. “Okay, until we know more, we’ll assume the gentleman just got a little pinch.”

  “Fine.”

  “What are your thoughts on human vectors?”

  A word on the incident with the rat. Though Verlach was being kind—very kind, actually—in giving me no more than a light chastisement, the situation was not looking good for yours truly. Whether or not the rat bite broke the skin, there would be hell to pay. Public health officials should not be caught up in things like this. And though I felt justified in what I’d done, and though the bite itself was a product of Jefferson’s man’s stupidity more than anything else, and though, in the end, I would be cleared of any wrongdoing, it was not, as they say, good form. Jefferson and his lawyers could make trouble. That’s why Verlach was pissed.

  Anyway, back to human vectors. I said, “Sure looks like there’s something there. One man had contact with three sick women. Douglas Buchanan.”

  “If Buchanan’s the source, why hasn’t he been ill?”

  “Some sort of immunity, perhaps.” Diseases have different effects in different people. To wit: West Nile virus causes encephalitis in only about one percent of people who pick it up. Only a subset of those die. “Might be that the disease only strikes a certain genetic subpopulation. Maybe it just strikes women, has something to do with estrogen or testosterone levels.”

  “Could be.”

  “Or he’s dormant now and soon will come down with something. We don’t know there’s not someone else out there who’s been playing in the same ballparks.”

  “The odds are against it,” Verlach said.

  “Not really. The whole community seems to be sexually charged.”

  “And you know this for a fact.”

  “Yeah, Herb, I’ve been screwing the mentally handicapped for years. Seriously, though, I’ve been talking to these people for two days now. It seems like everybody’s been sleeping with everybody. Has surveillance turned up anything at the other hospitals?”