The Plague Within
By
Lawrence W. Gold, M.D.
The Plague Within
2013 © by Lawrence W. Gold, M.D.
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the publisher.
This book is a work of fiction. Characters names, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to any actual persons, living or dead, events, or locales is entirely coincidental.
A Grass Valley Publishing Production
Cover Art©2013 by Dawné Dominique
First print edition May 2013
Printed in the United States of America
Dedication
To my wife, Dorlis.
She likes all my novels, but this one is her favorite.
Acknowledgments
Donna Meares, great editorial assistance and suggestions.
Donna Eastman of Parkeast Literary Agency who first encouraged me to write.
Joseph Barron, a true renaissance man and my writing buddy. Gone but not forgotten.
Dawné Dominique, a gifted artist and cover designer.
Writers groups on both coasts. WOW in Palm Coast, Florida and Sierra Writers Fiction Critique Group in Grass Valley, CA
The saddest aspect of life right now is that science gathers knowledge faster than a society gathers wisdom. (Isaac Asimov )
When asked, “If you could live forever, would you and why?” as a part of the 1994 Miss USA contest, Miss Alabama is reported to have answered, “I would not live forever, because we should not live forever, because, if we were supposed to live forever, then we would live forever, but we cannot live forever, which is why I would not live forever.”
As beautifully circular, and distressingly illogical as her statement is, she is not alone. This view was somewhat more eloquently, but no less illogically expressed by Dr. Leon Kass, President George W. Bush's leading scientific advisor. He is quoted as saying, “Confronted with the growing moral challenges posed by biomedical technology, let us resist the siren song of the conquest of aging and death.”
In other words, the ethical dilemmas associated with today's technologies are so challenging to his moral sensibilities that we should abandon attempts to understand aging, slow its ravages, and prevent death. This is an extremely chilling point of view for a physician to take. But, despite what Miss Alabama and Dr. Kass may think, it is not the siren singing, but instead it is the best of what makes us human. (Stephen R. Spindler, Dept. of Biochemistry, University of California, Riverside)
PROLOGUE
Sandy Greer, was warm and secure in her queen-sized bed as the eastern sky over the San Francisco East Bay hills glowed in anticipation of sunrise. She rolled to the right, bumping against Marty’s back. He stirred and continued his soft snore. She pulled the spring-rain scented pillow over her head.
Too early; too tired.
Ten minutes later, she surrendered. That’s it for sleep this morning.
When she pulled her hands from under the warm pillow to rub her eyes, her fingers ran over scaly and thickened folds at the corners of her eyes. When Sandy explored her cheeks, the skin, normally smooth and soft, was firm and coarse.
Suddenly alarmed, she sat up.
What’s going on?
Sandy’s fingers trembled as they explored her face—My God, what’s happening to me?
She threw off the blankets, pulled up the nightgown straps that had fallen off her shoulders and groped her way, hands extended, into the dark bathroom searching, and then hesitating, as her fingers found the light switch.
Chapter One
Berkeley’s Brier Hospital sat in the East Bay hills between Berkeley and Contra Costa County to the east. The bustle of hospital life waited expectantly for sunlight’s first glimmer that foretold the dawn.
Dr. Jack Byrnes barely heard his own footsteps as he headed for the intensive care unit walking down the red-carpeted and dimly lit hospital corridor. Large swinging doors stood at the end of the long hallway with the intimidating bright yellow and red AUTHORIZED PERSONNEL ONLY sign and an intercom mounted on the wall. Jack pushed the button.
“Can I help you?”
“It’s Dr. Byrnes.”
The monitor technician at the nurse’s station sang, “Hey, good morning, Jack. Come on in.”
Jack stared at the door, looked around to insure he was alone and then smiled at the sign: Brier Hospital Intensive Care Unit, Jack Byrnes, Medical Director.
The lock buzzed open and he walked into the unit.
Through the Intensive Care Unit’s large windows was a montage of the San Francisco Bay spreading into the distance. The Golden Gate marked the horizon to the northwest while the Oakland-San Francisco Bay Bridge framed the view to the south. A panorama wasted on the suffering souls in intensive care who only had survival on their minds.
As Jack approached Rachel Palmer’s bedside, he shook his head. It was an unconscious gesture of frustration. While Jack’s mind had creative ways of milking the last drop of hope from tragedy, his gut had the prescience of a polygraph. That too familiar tightening knot in his stomach was the visceral expression of a truth his mind had been refusing to accept.
Three years ago, Jack had settled into the strangeness of Berkeley and the conservative world of Brier Hospital. He had made the difficult transition from his training program in Intensive Care Medicine at the UC Medical Center to Brier, a compromise between his desire for an academic career and the personal freedom and rewards of private practice in a community hospital, especially one with the academic standards of a teaching hospital.
Jack had taken the bad with the good when he first came here, including his collision with the psychopathic Dr. Joseph Polk and the introduction to the ICU nurse Beth Arnold, who was now his wife and the ICU head nurse.
When Jack stepped into Beth’s office, she smiled. “Long time, no see, stranger.”
Jack checked his watch. “Right, it’s been a long ninety minutes.”
“Have you seen Rachel, yet?”
“No, but I’m run out of options with her. I’ve challenged the best doctors I know with her case, and even presented it at UC Medical Center Grand Rounds, but Rachel’s isn’t an “interesting case.” It lacks the esoterica they love at UC. Everyone knows all what happened and what we need to do. Rachel’s lingering illness has left her physically depleted, mentally exhausted, and lingering at death’s threshold. Tough management problems like Rachel’s aren’t sexy enough for the university elite.”
“C’mon, Jack. Three years ago you were an elitist, too.”
“Maybe, but now this is personal.”
Rachel had been in her third year teaching fifth grade and had worked right up to the thirty-ninth week of her pregnancy. If she could have forced her swollen feet into her shoes, she could have gone from her elementary school classroom right to labor and delivery. Afterward, she retired to be a stay-at-home mother, a mixed blessing. She missed teaching, but flourished in the strong maternal bond with Carrie, the most beautiful baby she’d ever seen.
Six years later, Rachel and her husband Tom, had been considering another addition to their family when, one morning on awakening and without warning, Rachel turned to Tom. “My stomach’s really aching this morning. Did we eat anything unusual yesterday?”
“No. I ate the same stuff. I feel fine.”
As Rachel rolled out of bed, she screamed and clutched her abdomen. “Oh God, Tom! So
mething’s happening. This pain…I can’t stand it!” Suddenly Rachel was retching uncontrollably. The pain with movement and breathing was so severe that Tom could barely get her back into bed. He brought a cold washcloth to her face wiping away the vomit, and then brushed away the auburn hair covering her hazel eyes that were ablaze with fear.
Tom dialed 911.
When the ambulance arrived, they lifted Rachel from her bed to the gurney while she screamed in pain. Moments later, they were on their way to Brier Hospital.
One hour later, the ER physician, and Julie Kramer, a general surgeon on call, stood before the computer screen examining Rachel’s abdominal x-rays.
Julie stood before Rachel’s images pointing at once to black shadows beneath both diaphragms. “Look at that. It’s air below the diaphragms. She’s ruptured some part of her digestive tract.”
When they returned Rachel to the ER, Julie Kramer pulled Tom aside. “The x-ray shows air under her diaphragm.”
“Air?” asked Tom.
Julie sat Tom down at a table. “The only way air gets into the sanctity of the abdominal cavity is through the break in the large or small intestine, stomach or the large intestine. Rarely it can be due to a gynecological problem.”
Tom clenched his jaw. “What’s your best guess? It’s not cancer, is it?”
“Cancer at Rachel’s age isn’t likely. I’m betting on a ruptured diverticulum. A diverticulum is a small pouch off the intestinal wall. It’s common, but when one ruptures, it’s trouble.”
Julie placed her small hand on Tom’s shoulder. “We need to operate immediately. Delay will only make things worse for your wife.” She paused, and then in soft and ominous tones said, “If she has any family close by, they ought to get here as soon as possible.”
Julie’s words stunned Tom. He’d been fortunate with his family and friends who’d been in good health. Now, for the first time, he had to deal with life-threatening illness in the person who meant the most to him.
Tom faced Julie. “Wait one damn minute. This is all going too fast for me. I need a moment to adjust.”
“We don’t have the luxury of time, Mr. Palmer. We need to operate now.”
Tom fell back into the chair. “You’re scaring the shit out of me.”
Julie sat beside him. “I know this thing came out of nowhere, but delay puts Rachel at greater risk. Don’t do that to her.”
Forty minutes later, in the operating room, the anesthesiologist placed Rachel under deep general anesthesia to allow for easy exploration of her abdominal cavity.
“We’ll know soon,” Julie said to her surgical assistant as she placed the shiny scalpel blade against Rachel’s abdominal skin, drawing a straight bloody line as the skin parted. Bright yellow fatty bubbles separated as she dissected down to the membrane protecting the abdominal cavity, the peritoneum. As she cut through the membrane, Julie turned her head in repulsion as the foul smell of feces filled the air. “That’s it! It’s her colon.”
“This is a mess,” Julie said as she explored the large intestine, finally finding the rupture site. She brought the bowel to the abdominal wall creating a colostomy, a connection between the large intestine, the colon, and the outside world. The entire abdominal cavity showed peritonitis or widespread inflammation. “This woman’s in trouble.”
Julie’s opinion was prophetic.
“We did all the right things, Beth, and look where we are today.”
Beth grasped Jack’s hand. Don’t do this to yourself.”
“Aggressive surgery and powerful antibiotics, but Rachel continues to suffer the consequences of continued peritonitis, multiple abscesses, and connections between the colon and other organs well call fistulas.”
“Nobody could have done more.”
“After two months in the hospital the reserves of this previously healthy thirty-three-year-old woman are gone.” Jack paused a long moment. “My strategy, in retrospect, was naïve. It was simple, just stabilize her infections by medications or surgery, and then rebuild her nutritional status for healing. Some great plan. I’m tangled in a web of frustration. Just when she starts to eat and tolerate the nutritional tube feedings or adjusts to intravenous feedings, and our hopes rise, we reach another dead end as the infection returns—A cruel joke on all of us.”
“How’s Tom holding up?”
“Better than I am. He’s been steadfast and optimistic throughout, but lately he’s showing signs of weakening. This is normal and appropriate, and a much better reaction than denial.”
“What about Maxine, Rachel’s mother? Beth asked “We can’t keep her away from the bedside.”.
“Why ask me? You see her more than I do. Ten days ago, she was grateful for our efforts, but now she questions everything we do. She’s expanded her role from supporter to advocate, from believer to skeptic, and from questioner to interrogator. I wish she’d go back to her farm in Oregon.”
“Jack,” Beth said, “Maxine has become a real pain-in-the-ass.”
Maxine Hastings and Richard Clarke met their junior year at the University of California, Berkeley. Richard was a business administration major and Maxine was into library sciences. They were an unlikely couple. He was free spirited and fully into the social activism of the Berkeley campus. She was more reserved and embarrassed to admit to friends and relatives that she might be part of the craziness that characterized Berkeley internationally.
“I never really knew what I wanted in a man,” Maxine had said to her roommate. “You know, the specific personality and character traits that would make up my ideal mate, but now I know...it’s Richard.”
Although never comfortable and always a bit embarrassed by it all, Maxine threw herself, at Richard’s side, into the student political maelstrom. To her eternal mortification, she had to explain to her conservative family why she’d associated herself with those people, and why they had arrested her at demonstrations on campus. She knew, as did her family, that she must be crazy about this guy to have strayed so far from her roots.
Maxine felt relief as the war in Vietnam ended and political dissent decreased on campus. Finally, they could focus on what was important—their futures.
After graduation, they married and managed, with difficulty, to complete graduate training, finally settling down in Concord, California, a suburb of the San Francisco. He went to work for a large national accounting firm and she took a job as an assistant librarian in the Concord library system.
Rachel, their only child, was born soon after they settled down. Maxine took a three-month leave of absence, and then arranged for childcare and returned to the work she loved. As natural as breathing, Maxine transformed herself into the stereotypic librarian. She’d become formal, rigid, and humorless. Colleagues swore that she was a shoe-in as their best entry into the international librarian’s shushing contest, having the clearest and most piercing psst anyone had ever heard.
Richard never fully cast off the idealism of his youth. He hated his work and what they were becoming as a couple. Rachel was the one ray of light in his dreary, overcast days. Rachel, a real daddy’s girl, found in their relationship the love, affection, and the acceptance she’d never found in Maxine. For Richard, Rachel could do no wrong; for Maxine, straight A’s and all her attempts to please her mother were never enough.
“I can’t live my life this way,” Richard said one evening when Rachel was ten. “I hate my job, I hate my life, and I need to change something before this kills me or us.”
None of this was a surprise to Maxine. She knew Richard, and while she was intransigent about many things, she loved him, and put their relationship first. “I know, Rich, and I’m open to any suggestion.”
Richard embraced his wife. “If it wasn’t for you, baby, I’d have long ago run off with one of my secretaries.”
Maxine smiled. “Your secretaries are men.”
“Well, this is the San Francisco Bay, after all. And,” he paused, “running away would have been my biggest mistake.
I know now that these fantasies were only symptoms.”
Maxine grasped his hand. “Tell me what you want to do.”
“You’ll laugh.”
“Try me.”
Richard studied his wife for a long moment. “I want to get as far away from the traffic and the crowding of the Bay Area as possible. If I never again saw a financial report or a spreadsheet, it would be too soon for me. Here’s the fantasy, let’s move to Oregon. We can buy a small farm that I can run myself. Let’s be near enough to a small city for Rachel’s education and for you to find a position in a local library. Think about it, peace and a new meaning in life before it’s too late for us and for Rachel.”
Maxine turned to her husband and smiled. “Okay, let’s go for it.”
Jack encouraged the family’s participation in the care of a loved one. Normally, that’s a good idea, sometimes lifesaving, but Maxine’s discontent and mistrust had become palpable, and Jack feared, counterproductive. Maxine’s negative aura and her critical diatribes had created an intense desire in the staff to escape from Rachel’s room. This thwarted the staff’s natural tendency to spend time talking and supporting Rachel and her family.
Jack asked to meet with Tom alone at his office in Brier Hospital.
Let Tom deal with Maxine, Jack thought.
Tom sat across from Jack’s disorganized desk looking at him with the “What next?” question. He’d substituted the “when can we get her home?” questions, with the “what are her chances?” questions.
Tom was an energetic and active man. Today he had black rings under his eyes and his face showed three days of stubble. He’d lost weight from his already too-lean frame. He was optimistic by nature, but Jack had not seen his natural smile for weeks. He brushed back prematurely grey hair as he sat by Jack’s desk.
The Plague Within (Brier Hospital Series) Page 1
