The Plague Within (Brier Hospital Series)

by Lawrence Gold

  As Harmony placed her stethoscope on Zoe’s back to listen to her lungs, she made note of an unusual tattoo on the rear of her right shoulder. It was a green frog with a gold belly, red eyes, and red-tipped fingers. She touched the frog. “This is a new addition?”

  “Yes, isn’t it great? It’s a Barton Ames original. Don’t you love it?”

  “Yes, but I prefer my art work on the wall.”

  Zoe smiled. “Some people never change.”

  After her assessment, Harmony sat with Zoe. “You’re doing great. Your Lupus is quiescent. Don’t change anything. I’ll see you as a patient in six months. Call me soon, and we’ll go out.”

  A typical reaction to Harmony and her office came from one of her more recent patients, Sara Colton. “I love this office, and I love the way you practice, and Shelley, she’s a keeper, for sure. I have nothing against men or male doctors; it’s just this place seems so comfortable and I feel that I can say anything to you. You really listen to me.”

  Harmony understood that her practice offered a unique, intimate, woman-to-woman communication that was difficult for male doctors to realize. For some women, the switch to a female physician was a revelation.

  Harmony had worked with many conscientious male physicians, who, after listening to the same whining complaints month after month, year after year, told her, “I had to suppress my desire to run out of their office screaming.”

  None of it bothered Harmony. She made the same recommendations, offered the same treatments as her male colleagues, but did it with handholding and comforting embraces that male physicians found difficult. Over time and with this group of patients, she’d earned her reputation and her success.

  At lunch in the doctor’s dining room, she was sitting at the ‘woman’s table’ with friends. She looked around. “I don’t believe it…segregation in medicine.”

  “Don’t exaggerate,” said Julie Kramer, a general surgeon. “It’s guy talk. Frankly, I can do without it.”

  “I’ve made women friends since I arrived, but I can’t get close to any of the men.”

  “Look at you,” said a family practitioner. “If they’re not interested, they’re gay.”

  Harmony smiled. “Right.” She paused. “Everyone has been friendly and courteous, yet I feel somehow apart. I’ve consulted for a few physicians on their problem fibromyalgia or chronic fatigue cases, and even accepted a few for transfer into my practice.

  “I tried to get on the schedule to present at grand rounds, but they keep finding excuses for turning me down. It’s a common courtesy for new physicians, but not yet for me. I’m trying not to get too paranoid.”

  “What would you speak on?” asked Julie.

  “My special interest in common women’s disorders would be a great subject in a community where half of all patients are women. When I told them I’d like to discuss chronic fatigue syndrome and fibromyalgia, the committee did a collective rolling of their eyes.”

  Julie scanned the women at the table, and then turned to Harmony. “Not to worry, sweetie, get your slides ready.”

  At grand rounds a month later, the medical staff filed into the auditorium past the sign that read, “Fibromyalgia, Chronic Fatigue Syndrome, Fact or Fancy, Harmony Lane, M.D.”

  Ben introduced Harmony to her audience, citing her training and experience in women’s health issues.

  Harmony was nervous at first, but soon fell into the full swing of the material she knew so well. Her professionally done slides were informative and entertaining, especially the cartoons spoofing these common disorders of women.

  Harmony looked out across her audience and smiled. “I’ve always had challenging exchanges with my minister. One Sunday, after services, he approached me and said, with a smile, ‘Anything that can happen to humans is in the Bible somewhere.’”

  “With my interest in women’s health, I asked, ‘How about PMS?’”

  “He said he was sure he could find a reference to PMS somewhere in scripture.”

  “The following week he searched diligently, book by book, chapter by chapter, and verse by verse.”

  “The next Sunday I approached the minister and said, ‘Well? Any reference to PMS?’”

  “Of course,” he said smiling then opened his Bible and read, “and Mary rode Joseph’s ass all the way to Bethlehem.”

  The audience erupted in laughter.

  When finished, she’d made her main points; that fibromyalgia and chronic fatigue syndrome, though incompletely understood, were real illnesses that could have devastating effects on women. She received polite applause, then fended off the usual cynical questions about the legitimacy of these diagnoses.

  Jack walked up to Harmony and shook her hand. “That was a great presentation. I really enjoyed the lecture and learned a lot.”

  “Thanks, Jack. This lecture is always a hard sell to a male and conservative audience.”

  “Berkeley, conservative—I think you’re overstating the case Harmony.”

  “Walk in my heels for a few days, Jack, it will enlighten you.”

  “Don’t take it personally. For what it’s worth, that was a great lecture. The staff is slow to warm to anything out of mainstream medicine.”

  Harmony returned to her office for what promised to be a busy afternoon. “Who’s next?” Harmony asked, as she finished her mid-afternoon cup of energy.

  Shelly handed Harmony a chart. “Her name is Tammy Piccard. You’ve finally arrived in the modern era. Ms. Piccard said she found you while surfing the Internet on one of the medical ecology support sites.”

  Harmony was sitting at her desk and when Tammy entered. She stood and offered her hand, “Harmony Lane.”

  “I’m Tammy,” said the twenty-eight-year-old, looking down at her own chest. She wore a floral frilly miniskirt with multiple layers, and a bright pink tank top with satin ribbons.

  Harmony thought that there was an inverse relationship between how well a woman got along with her mother and the number of piercings. Tammy had five in each ear, one in her right eyebrow, and a black opal bellybutton ring.

  “So nice to meet you, Tammy. How can I help you?”

  “Well, first I want you to know that I checked you out, Dr. Lane.”

  “Please call me Harmony.”

  “Anyway, I read about you on several web sites and talked with a few of your patients.”

  “And,” Harmony paused, “you decided to come anyway?”

  Tammy smiled. “See, I knew they were right. You’re the one for me.”

  “So tell me, what’s the problem?”

  “It’s my work environment—it’s killing me!”

  Harmony went on to obtain a complete history and physical and had Tammy sign a release so they could obtain her previous medical records.

  Tammy had started at Berkeley Central Certified Accountants, BCCA, two years ago as a records clerk working in one of twenty cubicles on the second floor. Approximately five months ago, she began to have coughing associated with pressure on her chest when she arrived for work each morning. At first, she believed it was a cold or an allergy, but as her symptoms persisted, she’d finally sought medical attention. Her physician, a family practitioner in Richmond, treated her for bronchitis, and then asthma, but each time she came off her medication, the symptoms would recur.

  “Every morning when I come to work, I feel fine, but twenty minutes later I can’t concentrate, I’m suddenly fatigued and lightheaded. Afterward, I sneeze and cough and various parts of my body begin to swell.

  “I’m positive,” she continued, “that it all began when they hired Amy Beck and they gave her the cubicle next to mine. It was her perfume that started it.”

  “Did you report it to anyone?”

  “Of course. First to my supervisor, then to the office nurse. They questioned Amy about her perfume, but she denied wearing any.”

  “Did they do anything else?”

  “They moved her to another cubicle across the room, but that did
n’t help. That’s when I got into the Internet and discovered that what I had sounded like multiple chemical sensitivity. That’s how I found you, Dr. Lane…I mean, Harmony.”

  After completing the standard history and physical, which was otherwise normal, Harmony had Tammy complete a ten-page questionnaire emphasizing dietary habits and exposure to environmental chemicals. Next, Harmony put Tammy through a series of provocation-neutralization tests where she exposed Tammy to suspected substances either on the skin or under the tongue. Harmony tried neutralization with varying doses of the suspected substances, elimination diets, and large doses of vitamins.

  When nothing worked, Tammy submitted a workers’ compensation claim, and when they rejected that, she sued BCCA.

  Chapter Seventeen

  As Archie Blake drove into the Molecular Research Center’s parking lot, he frowned at a crowd that had gathered before its main entrance. When he arrived at the space labeled Reserved for Professor Blake, he found an ancient VW Vanogan in his place. The bumpers and doors were plastered with pro-life slogans; It’s a child, not a choice; Abortion is homicide; All choices are not equal; Stem cells, stop playing God; Embryo research, it’s all about the money.

  The campus police officer, Henry Burks, a retired police officer in his 50s, had parked his golf cart beside the van and was issuing a ticket and arranging to tow the vehicle. “It’ll be just a moment, professor. We’ll get this piece of crap out of your way.”

  “What’s happening at the MRC this morning, Henry?”

  “It’s one of them stupid demonstrations against research. They don’t want no stem cells or gene treatment. It shouldn’t be too much longer. They didn’t get no permit for this, so the Davis police are on their way to get rid of them.”

  Archie walked toward the entrance. Approximately twenty demonstrators, many wearing rosary beads and carrying crucifixes, walked in a circle in front of the main entrance, chanting and carrying signs; Obey God’s moral law; No good can come from doing evil; Murderers pay for their crimes with their own lives.

  Archie detoured around the group when a well-built man dressed as a minister or priest stepped in his path, blocking his way. “Are you a Christian, sir?”

  “What I am, and what I believe is none of your business. Get out of my way!” Archie tried to get around the man who again blocked his path. “May I have your name?”

  “My name is Reuben Trask, and I’m blessed to be the leader of Evangelicals for Life. We’re here to do God’s work.”

  It’s a waste of time, Archie thought. “We do God’s work here to save lives and reduce human suffering.”

  “No good can come from your Nazi-like human experimentation. Obey Him. Don’t torture and kill the babies, and then flush them down the sink.”

  Archie felt his eyes rolling up then turned back to see Henry Burks, who had followed him to the entrance. Henry placed himself between Reuben and Archie. “Go ahead, Professor Blake. He won’t bother you again.”

  Reuben smirked. “Nice to meet you, Professor Blake. We’ll meet again soon, I promise.”

  When Archie entered the MRC, the demonstrators had obviously achieved one of their goals; they’d temporarily interrupted the center’s activities. When he entered his office, his secretary was obviously upset. Her eyes were red from crying. “They called me a baby killer. They said I’d be going to hell.”

  Archie placed his hand on her shoulder. “Don’t do this to yourself.”

  “I’m sorry, Dr. Blake, I’m just not used to this.”

  “We can’t ignore them, though that’s what they deserve. Keep in mind that everything we do at the Molecular Research Institute is for the benefit of mankind and that the lunatics outside represent the extreme views of some evangelical Christians not shared by most of the world. Remember that well before we unpacked the first test tube and centrifuge, our program had to pass the university’s highest standard for ethical research. If that’s enough for me, it should be enough for you.”

  The phone shook Archie awake the next morning. He looked at the LEDs on his clock that read 3:15 a.m.

  “Hello,” he muttered.

  “It’s the campus police, Professor. We need you to come down to the MRC right away.”

  “What’s wrong?”

  “We had a break-in. We need you, ASAP.”

  Archie dressed and arrived at the MRC twenty minutes later. University and Davis police cars sat at the entrance their strobe lights flashing. The intense lights dispersed their rays through the early morning fog and reflected off the trees and the buildings in an eerie pattern.

  Andre Keller paced at the entrance. “They broke into the lab. The control and test mice are gone.”

  “Calm down for a moment, Andre, and tell me where you were with these mice.”

  “We’d recently injected them with an adenovirus vector carrying gene fragments. This was a live virus. They have ruined months of work.”

  Archie grasped his head. “Stupid…stupid…,” he cried. “What a waste.”

  As they walked into the animal storage facility, row after row of cages were empty. The laboratories had broken glass scattered everywhere, with spilled chemicals, paper files, and documents strewn across the floor. The walls were spray-painted in bright red with, Murderers; Baby killers; Stem cells—no longer defenseless.

  Archie looked around the lab. “Did they get to the freezers or tissue culture labs?”

  “No, thank God.”

  Archie shook his head in disgust. “I’d be careful about invoking God today, Andre.”

  Chapter Eighteen

  Jack put out a call for blood to Rachel Palmer’s family. They responded rapidly with twenty units. Fresh blood was best for use in surgery and to replace her diminished platelet count.

  The abdominal CT scan images failed to show any localized infection, and the brain images showed slight enlargement of the two abscesses.

  Jack had stopped the CT1356 and began a cocktail of the most potent broad-spectrum antibiotics, a holding action until surgery.

  The surgical team, headed by Julie Kramer, a general surgeon, and Curtis Brown, a neurosurgeon, with Jack in a supportive role had discussed Rachel’s case with Mickey Katz, Brier’s top anesthesiologist. Together, they decided to postpone surgery until this morning. They had hoped she’d be more stable and that her platelet count would be higher. It wasn’t.

  Tom sat on Rachel’s bed holding her hands and bringing them to his lips.

  She looks so frail, so helpless, Tom thought, yet I love her today more than ever.

  “I’m so frightened,” Rachel said. “This whole thing has sapped my spirit.” Rachel hugged him. “I’m so tired, Tom, I just want this over, one way or the other.”

  “You scare me when you talk that way, honey.”

  Rachel straightened up in bed. “Look, Tom, if things go wrong...I mean if I wind up on a ventilator, I expect you to carry out my wishes. If I can’t live anything near a normal life...I want no part of it. I’ve discussed this with Jack and signed my advanced directive for health care.”

  “Listen to me...”

  “No, you listen,” she sobbed. “I know you love me; that you’d do anything for me, so please don’t fail me in this. I’d rather be dead than a vegetable. If you love me, you won’t do that.”

  Beth walked beside the transport gurney transport that would take Rachel to surgery. Beth kissed her. “I’ll stay with Tom through the surgery. Don’t worry, I’ll take good care of him. We’ll see you afterward.”

  Beth took Tom’s hand and turned to Maxine. “Why don’t you both wait in my office. You’ll have some privacy. Jack will call here with his progress report.”

  Fortunately, for Curtis Brown and Rachel, the brain abscesses were superficial and well localized, minimizing the potential for brain injury from the surgery itself. He drilled burr holes through the skull over the affected areas and removed the lesions. The thickness of the abscess wall made it easy to see why antibiotics might have
difficulty in penetrating and attacking the infection.

  Jack had given Rachel twelve packs of blood platelets before the first incision. The bleeding was minimal and he felt encouraged as Curtis began closing the scalp incisions leaving drains in place.

  Ninety minutes later, Jack called Beth’s office. “We’re just about done with the brain surgery. She’s doing great so far.”

  Tom took the phone. “What did it look like, Jack? Was there any brain damage getting the infection out?”

  “I don’t think so, Tom. The abscesses were superficial and well localized. Curtis is encouraged. We’re getting ready to explore her abdomen. Keep your fingers crossed.”

  Beside the fact that Julie was a great surgeon, she had another advantage; her tiny, skillful hands allowed a much smaller incision and easier access when exploring the abdomen than her male colleagues. This was even more important for Rachel since the scans of her abdomen had failed to pinpoint the sites of infection.

  Once finished with the neurosurgery, Mickey Katz switched his anesthetic to another more appropriate to abdominal surgery and the depth of relaxation of the abdominal muscles that would allow detailed exploration. As Julie poked and prodded Rachel’s internal organs trying to find the site or sites of infection, Mickey became increasingly concerned.

  Mickey looked over the green barrier. “Something’s going on, Jack. Her pulse is rising, and her blood pressure is falling. There’s not enough blood loss to explain this. I’ve checked her monitor lines and I’m giving her plasma expanders.”

  “I’m not too concerned, Mickey. She’s frail and just the anesthesia and the rummaging around inside her abdomen probably explains these changes.

  A minute later, Jack asked, “What’s her pressure and temperature, Mickey?”

  “98/50; temp’s 101.8 degrees.”

  Jack turned to Julie. “Don’t like either of those. What’s happening?”

  “Rachel’s belly’s filled with lots of fibrous adhesions from infection, inflammation, and her previous surgery. It’s a slow process getting through them without causing additional damage. She’s bleeding a little more, now.”