They spoke very little on the way, but after she’d parked the car and reached for the door handle to get out, Wayne put his hand on her arm.
“Chris, wait. I’d like to talk before going in. After all, it could be our last opportunity.”
“Don’t be so pessimistic. Michael Boyer is an excellent surgeon.”
“I know it’s been hard on you having me around. But even though we haven’t really connected, I’ve cherished just being close to you.”
“Cherished? Isn’t that laying it on a little thick?”
“You don’t believe me?”
“You haven’t banked a lot of that kind of capital to draw on.”
“How about extending me a little credit then.”
“Which brings us back to trust. You don’t get that as a gift. You have to earn it, by being honorable and strong and reliable year after year; by going to work when you don’t feel like it so you can provide for your family; by caring for your wife and child when they’re ill; by encouraging your child when she’s convinced she’s not good enough, or pretty enough, or smart enough. You take her for walks, and you teach her things. You check out her boyfriends . . .”
“I wish now I had done those things. But it can’t all be one way. Daughters have responsibilities too. They have to understand that fathers aren’t mythical figures. They have fears and weaknesses, and sometimes they make bad decisions. Daughters should be forgiving and understanding and realize that people can and do change. When Dad makes a mistake, daughters don’t hold it against him the rest of his life. You don’t have to come in with me. Just open the trunk so I can get my bag.”
Chris pulled the trunk release lever, and Wayne got his suitcase and headed for the hospital’s front entrance without looking back.
In her car, Chris closed her eyes, leaned forward, and gently began banging her head on the steering wheel.
Chapter 6
CHRIS LOOKED AT her pager and saw Michael Boyer’s number on the display. It was 1:35 Monday afternoon. If her father’s surgery had begun at 7:30 as scheduled, they should be finished by now. She found a phone and soon heard Michael’s voice.
“It’s Chris. How’d it go?”
“Couldn’t have been better. He’ll be sedated for the next twelve hours, so there’s no point in going to see him, unless you just want to take a look. He ought to be fully awake, and hopefully responsive, for a morning visit.”
“Okay, thanks for the update.”
“Usually I’m beat after six hours in the OR, but I feel like I could pedal a bicycle up Mount Everest. Let’s do something together tonight to celebrate.”
“It’s pretty early to be so enthused.”
“I just have this feeling that he’s going to do so well.”
Chris wanted very much to accept. Instead, she said, “Let’s watch awhile and see how it goes.”
“Chris, would you like for me to stop bothering you?”
“You’re not bothering me.”
“But I’m not getting any encouragement here.”
“What is it you want?”
“I can’t answer that without knowing you better.”
“I’m not trying to be difficult. I just want to be careful.”
“I think you’re being too cautious.”
“I’m certainly willing to think about that.”
“Chris, time is like a river. I didn’t think that up. I read it, but it’s true. You can’t stand on the bank and expect that things won’t be carried downstream. There’s a moment when they can be reached, and then they’re gone.”
CHRIS LOOKED AT her father’s chart. In the twenty-five hours since his surgery, his temperature had remained within normal limits; no fever, therefore no bacterial infection. And compared to his pre-op values, his blood clotting time—a measure of how effectively his new liver was making clotting factors—was already looking better. So much for her duties as physician. Now she had to be a daughter.
Normally, the ICU is an open ward where all the patients are in a common room so they and their monitors can be observed easily at all times by the nursing staff. Wayne Collins, however, was recovering in the isolation ward Monteagle had built as part of their commitment to Boyer’s program.
In this area, behind double doors off the hall on the floor above the primary ICU ward, there was a dedicated nursing station and four private rooms. Just outside the entrance to each room was a small antechamber where all the protective apparel was kept for anyone wishing to enter the main room. In both the antechamber and the private room, the wall facing the nursing station had a large glass panel in it so the patient inside could be seen without entering either area.
Because the occupant of each patient room would be immunosuppressed, it was important that no infectious organisms be allowed to enter. In keeping with FDA concerns about unknown diseases developing in animal organ transplants, it was also necessary to ensure that no microbes be allowed to get out. This dual requirement was met by equipping the antechamber with airtight sliding doors and a HEPA filtered ventilation system that could affect a complete change of the antechamber air every thirty seconds. Thus, by the time someone wishing to enter a patient’s room had properly suited up, any airborne organisms that had entered the antechamber with the visitor would have been swept into the ventilation system. The same would apply as the visitor left. Observance of the thirty second interval for air exchange after entering from either door was enforced by a timed locking mechanism on the opposite door.
To minimize any contamination passing from the isolation ward to other wards, Wayne had been assigned a dedicated ICU nurse, who, if she needed to leave the area, could call in another nurse from the main ICU ward downstairs.
“He seems to be doing fine,” Chris said to the nurse on duty.
“Extremely well,” she replied. “I understand he’s your father.”
“An accident of biology.”
“Isn’t it always?”
Chris left the nurses’ station and went into her father’s antechamber, where she put on the required protective clothing. The standing routine established by the previous infectious disease member of the team was for all visitors to wear disposable gowns, booties, head cover, gloves, and a full face respirator with HEPA filtering capacity. Chris thought the respirator was overdoing it, and that a much simpler N95 nose and mouth mask would have been sufficient, but feeling like a substitute schoolteacher in her role with the team, she was reluctant to change any of the established protocols. So she’d cooperated and gone to see the Monteagle environmental safety officer to be fit tested for a respirator. Unable to obtain an airtight fit with the Wilson model he preferred, the guy had tried a North which had worked.
There were five masks on hooks beside the metal shelves holding the disposable clothing: a large Wilson for Michael, a medium Wilson for the regular nurses, another medium Wilson for the backup nurses assigned to each shift from the main ICU ward in case an extra pair of hands was needed, a third medium Wilson for the phlebotomists assigned to the ward on, each shift, and Chris’s North. Hers being a different make from the others, the adhesive tape with her name on it was hardly necessary.
She struggled into her mask and pulled the straps tight. Following protocol, she fit-tested it by covering the HEPA filter cartridges on each side with the palms of her hands and inhaling forcefully. Then she exhaled hard. Satisfied that it was airtight, she entered her father’s room, where he still had a Swan-Ganz line in his neck to monitor his pulmonary artery pressure, cardiac output, and fluid status. There were also two Jackson-Pratt drains in his abdomen to leach off the fluid that had built up in his peritoneal cavity, and a Foley catheter in his urethra so a close watch could be kept on his kidney function. He was wired to a pulse oximeter and a cardiac monitor.
And he was awake.
Though she wasn’t recognizable in all her protective gear, Wayne knew who she was because he’d watched her dress through the glass window in his room.
“So far so good,” Chris said.
“You’ll have to speak up,” he said, weakly. “The mask muffles your voice.”
“How do you feel?” she said, putting more effort behind her question.
“Like hell,” he said slowly.
“No reason you shouldn’t.”
“It was good of you to come.”
“I’m one of your doctors. I needed to look at your chart.”
“And that’s the only reason you’re here? You could have done that and stayed out with the nurse.”
“I . . . thought you could use some emotional support.”
“I’m ready,” Wayne said. “You can start now.”
“Don’t push it, Wayne.”
“You did it,” he said, his face registering a tired expression of surprise.
“Did what?”
“Called me by name.”
“It’s not that big a deal.”
“But it is progress, Chris.”
“Don’t read too much into it.”
“You try to be a hard case, but I think it’s all a bluff.”
“A belief derived no doubt from our close association for, what was it . . . the first six years of my life?”
Wayne closed his eyes. “I don’t feel up to this. So maybe you should leave now and let me rest.”
Chris hadn’t meant for her visit to take this direction, so she stood there trying to think of a way to mitigate her behavior. Unable, or more accurately, unwilling to do so, she left without saying another word.
On the way out, she stopped at the nurses’ station to mention something about the masks.
“I noticed that the backup respirator doesn’t have any filter cartridges in it.”
“I took them,” the nurse said. “The protocols specify that we’re to change the filters in our masks at the beginning of each shift, but there are no fresh ones up here, so I stole those in the backup for mine. The record sheet shows that nobody’s used that mask. I put a call in to Central Supply for some filters, so we should be restocked soon.”
Having no cartridges in a mask was an obvious concern, but using one for more than a single shift was, in Chris’s opinion, no problem at all because they were rated for much longer than that. Continuing in her determination not to alter any procedures the staff had been instructed to follow, Chris simply said, “That’s good.”
AT EIGHT P.M., MARY Beth Cummings, the nurse on the second shift, went into Wayne’s room and interrupted the TV program he was watching to check his temperature. While he had the digital thermometer in his mouth, she noted that there was no blood in the liquid moving through his abdominal drains, and he seemed to be making urine, both good signs. But when she read his temperature, it was a bit high.
“Am I going to live?” Wayne said.
“For a very long time, I think,” Mary Beth replied, having no idea what his prognosis might be.
Because he was the hospital’s prize patient, and she was keenly aware of the FDA concerns about unknown infections from animal transplants, Mary Beth returned to Wayne’s room an hour later to see if there had been any change in his temperature.
“What, again?” Wayne said.
“You’re just so charming I can’t stay away,” she said. This time, his temperature was 99.2, up two tenths of a degree from the last reading. And was he developing . . . ?
“Mr. Collins, may I see your incision?”
“You show me yours, and I’ll show you mine.”
“Don’t be naughty.”
Mary Beth pulled the covers back and opened his gown to reveal his transplant incision, which angled from side to side under his rib cage, like a boomerang with one arm longer than the other, stainless steel staples holding the edges together. The wound appeared typical for a patient at this stage of recovery, and the rest of his skin looked the proper color. Before leaving, she put a stethoscope to his chest and listened to his breathing, which gave her no cause for concern.
But his rising temperature made her uneasy. She thought about paging Michael Boyer, but didn’t want to act precipitously, so she decided to wait another hour.
Because she only had one patient to care for, she’d brought her contract law textbook to study. If everything went according to plan, eventually, there’d be a JD to follow the RN after her name. Then there’d be one more champion in the world to fight for all the people who had been damaged by careless, arrogant MDs. It was a day she longed for.
But because of Wayne, she couldn’t concentrate on her book. Fifteen minutes dragged into twenty, then thirty. If his temperature goes up even a tenth of a degree, I’m calling Dr. Boyer, she thought. And if it stabilizes, well, I don’t know. I’ll decide about that when it happens.
Finally, the hour was up. She returned to Wayne’s room, where she instantly saw that her earlier suspicions were correct. Wayne read her reaction in her eyes. “What’s wrong?”
“You’ve got a rash.”
“I do? It doesn’t itch.”
“How do you feel?”
“A little warm now that you mention it.”
Without asking, Mary Beth pulled the covers back and opened Wayne’s gown. The rash was all over his chest and abdomen. She checked his temperature and found that it had risen to 99.6, up four tenths of a degree.
“THE HOSPITAL PHARMACIST has looked over his meds and doesn’t see any potential adverse drug interactions,” Chris said to Michael Boyer as they stood outside her father’s room.
“Maybe it’s a reaction to a single drug,” Boyer said.
“His temp was 99.6 when you were first called, and it’s holding steady.” She looked at Mary Beth. “How would you describe his rash now compared to what it was when you alerted Dr. Boyer?”
“It’s about the same.”
Chris turned back to Boyer. “So whatever it is, it doesn’t appear to be getting any worse, and he isn’t having any respiratory problems. Let’s get a diff count and blood culture and watch him over the next hour to see how he does.”
“I’m going to stay close,” Boyer said. “How about you?”
“I don’t want to leave yet. At least not until I see the white cell counts.”
“Let’s go down to the cafeteria.”
“Okay.”
Boyer looked at Mary Beth. “Would you please get that blood work underway and let us know when the counts are back. And call us immediately if his situation changes in any way.”
Michael and Chris headed for the elevators.
“Damn, I hope this isn’t anything serious,” Michael said.
“His temp isn’t very high, and he seems stable,” Chris said. “So I wouldn’t be too worried.”
In the nearly empty cafeteria, they had their choice of tables.
“Seems like coffee down here is the only way I get to see you socially,” Michael said.
“And I’m not sure this counts,” Chris replied, smiling.
“Well now,” Michael said, perking up. “I haven’t seen that nice a smile from you in a long time.”
Shying away from that line of conversation, Chris said, “Did you know he asked me to give him part of my liver?”
“Your father? You couldn’t.”
“Obviously I agree. But it took me a while to decide that. And I can’t help but feel guilty about not helping him.”
“You don’t understand. There wasn’t any decision to make. He’s not a large man, but he’s too big for you to be a donor. The anatomy of the liver only allows it to be divided into two unequal portions. So when we’re dealing with a living donor, we take sixty percent and leave forty. Your six
ty percent wouldn’t be enough to satisfy his metabolic needs. You’d have to be about the same size to be a donor for him.”
“Why didn’t I know this?”
“You don’t make your living doing liver surgery. So now you can stop feeling guilty.”
“It’s not that easy. When I turned him down, I thought it was possible. So what you’ve just told me doesn’t help.”
“Those are pretty high standards you’ve set for yourself.”
“Believe me, if I could, I’d lower them in a minute.”
They were still there twenty minutes later when Mary Beth paged Michael. Picking up a nearby house phone on the wall, he learned that the blood counts were back.
They returned to the transplant ward and called up the results on the computer at the nursing station.
“There’s no evidence here of any infection,” Chris said.
“Then what is it?”
“Let’s check his temp again and take another look at that rash.”
When they were gowned and gloved and masked, they all trooped into Wayne’s room.
“I thought this was a private room,” Wayne said. “What’s the verdict?”
“Don’t have one yet,” Michael said. “We wanted to see your rash again and get another temp reading.”
While Wayne incubated the thermometer, Chris and Michael leaned close and examined his face, then checked his chest and abdomen.
“Looks the same to me,” Chris said.
“I agree.”
The nurse retrieved the thermometer and read it aloud. “Ninety-nine point six.”
Michael patted Wayne on the shoulder. “Thanks.”
“Unh-uh. I’d rather you stayed in here to discuss this.”
“Fair enough.” He looked at Chris. “Your call.”
She turned to Wayne. “The rash still doesn’t itch?”
“No.”
“I don’t see a need to do anything right now, except watch and wait,” she said to Michael.
The Judas Virus Page 6
