TR hated meetings. They never accomplished anything and just gave blowhards the opportunity to hear themselves talk. Because of that, he usually resented every minute he was obliged to spend in one. But today, considering the circumstances, he was interested in this one. If only his blasted headache would clear up.
“Later that evening . . .” Michael looked at Scott to see if that time frame was specific enough. Receiving a nod, he continued. “I was informed by the same nurse that Mr. Collins had developed a slight cough. By the next morning—”
“You did nothing then to treat the cough?” Scott said.
“We judged it too minor a problem to treat.”
“Thank you. Please go on.”
“By the next morning, the fever, the rash, and the cough were gone. Mr. Collins then began a rapid course of recovery, which included a return of normal liver function and a quite remarkable healing of his abdominal transplant incision. He was discharged from the hospital on the evening of the seventeenth, a week after his surgery.
“It subsequently came to my attention that one of the third-shift nurses who cared for Mr. Collins during his stay developed the same symptoms he showed the night Dr. Collins and I returned to the hospital to see him.”
Knowing she would soon be given the floor, Chris was getting nervous.
“Through some communication glitch,” Michael said, “I did not learn of this until five days later.” Michael was not surprised that this brought a quick response from Scott.
“Isn’t this just what the FDA was concerned about—the transmission of some unknown animal disease to humans?”
“Yes.”
“And didn’t you design safeguards to protect the staff?”
Trying not to let his irritation at being treated to like a child show, Michael said, “We did.”
“Then how could this have happened?”
“I agree it’s an unacceptable failure in our procedures.”
“I’d like a detailed report from you by tomorrow morning explaining how this occurred.”
“You’ll have it. May I continue?”
Scott waved his permission.
“It was Dr. Collins who suspected something was wrong, so I’ll let her take it from here.”
Hoping Scott wouldn’t go after her as he had Michael, Chris stood and told them how she’d learned that Ginny Barroso and her husband had become ill with the same symptoms her father had shown.
“At this point, we canvassed the entire staff of the hospital to determine if anyone else had experienced these symptoms. We found no one. That established Mr. Collins as the index case and pointed to the transmission of some factor from him to Ginny Barroso, and from her, to her husband.
“Suspecting that the transmissible factor might be the retrovirus known to be widely present in pig cells, I asked Dr. Ash”—she gestured to Ash, who was sitting across from her—“to test all the stored samples of my father’s blood, as well as samples from everyone who came in contact with him after his surgery, including Dr. Boyer and myself. Positive results were obtained for the Barrosos, Mary Beth Cummings, and the early post-transplant samples from Mr. Collins. The later Collins samples and those from everyone else were negative.
“The absence of virus in the later Collins samples may mean that since the virus was in his blood longer than any of the others, his immune system destroyed it. Or it may be hiding in cells outside the blood. It’s quite likely the virus will soon disappear from the blood in the other three positive cases as well. We have plans to follow that.
“The limited number of positive cases suggests there was a very small window of infectivity. I believe it was during the hours when Mr. Collins had a cough, which would explain why neither Dr. Boyer or myself were infected. Nor was the phlebotomist who drew Mr. Collins’s blood the night we were called back to see him. All three of us were in his room before the cough developed. Mary Beth Cummings and Ginny Barroso, of course, were present while he had a cough.”
“Dr. Collins . . .”
It was Norman Stewart, the medical director.
“This organism in question is a retrovirus, in the same general category as HIV. But retroviruses don’t spread by aerosolized transmission, in coughs or sneezes. Infection requires intimate contact of mucous membranes with contaminated body fluids.”
“Apparently our virus isn’t aware of that.” Realizing this sounded a little rude, Chris added, “What I mean is, rules for the behavior of a given class of organisms develop slowly, reflecting our experience with them. When that experience shows us something new, we change the rules.”
Stewart responded. “How do you reconcile the presence of this virus in the blood of the four individuals you discussed when none of the published studies on this question have found evidence this can happen?”
“I’ll let Dr. Ash answer that.”
Ash rose and said, “I found the virus in Mr. Collins and the others using the PCR technique. Without going into details, I’ll just say that this method allows detection of small stretches of the viral genome in test samples. To do this, it uses reagents based on known genetic sequences in the virus. So all it can do is reveal the presence of whatever the known sequence is you looked for. If the rest of the virus is different, the test cannot reveal that. It’s entirely possible this virus began as one of the known forms of pig retrovirus, but then changed into something with enough similarity to the original that my reagents were still able to detect it. In other words, it became infectious because it mutated. Something retroviruses are known for.”
“What are the possibilities this same mutation could occur in another human recipient of a pig liver?” Scott asked.
“Without knowing where the mutation is or how much of the genome is involved, that’s hard to say. But being it was probably a totally random event, I’d say it’s very unlikely to happen again.”
Chris saw from the look on Scott’s face that he found this answer satisfying.
“I gather from everything I’ve heard, that there is presently no danger of the four infected people casually passing the virus to anyone else,” Scott said.
With the conversation back on medical rather than technical matters, Chris rose, and Ash returned to his seat. “I believe that’s true,” she said. “And when it disappears from the blood in all those infected, as I think it will, the possibility of transmission will be extremely remote.”
“What are the chances the two nurses and the husband could have passed the virus to anyone else during the infectious period?”
“I’ve considered that. But all three were at home, so it couldn’t have happened. Even though the two nurses were well beyond the infectious period and obviously didn’t pass the virus to anyone else on the staff during the time we were unaware they were carrying it, I’ve put them both on leave until we’re sure the virus is cleared from their blood.”
“Thank you, Dr. Collins,” Scott said. “If everyone would just excuse me for a moment.” He motioned to Dewitt and Bechtel, and they left their chairs and huddled at the front of the room while everyone else exchanged questioning looks. After less than a minute, the three-man caucus turned to face everyone else, and Scott said, “Dr. Boyer, I want those three remaining infected individuals tested daily. And as soon as the results of those tests are known, I want to be informed. Dr. Ash, I assume you have the expertise to do a complete sequence on this new virus . . .”
“I should be able to do that.”
“Get started on it right away. Now Mr. Dewitt has a few comments for Dr. Boyer and the other members of his group.”
Dewitt cleared his throat and said, “As you may or may not recall, the agreement you all signed when you joined Monteagle as an employee or as a physician with privileges here specified that any patentable discovery produced in connection with your hospital duties becomes
the property of Monteagle. As the hospital will soon be entering discussions with several major drug companies to license all rights to the therapeutic effects of the mutated virus, we thought it useful to remind you of the agreement in force. If you have any questions about this, Mr. Bechtel will be happy to remain after the meeting and discuss them with you.”
Dewitt scanned the group for any response. Seeing none, he looked at Scott, who said, “Then we’re adjourned.”
No one from Michael’s group went over to Bechtel. They all formed their own huddle at the foot of the long table.
“Why didn’t I hear anything about any of this before the meeting?” William Hessman, the vet, said.
“Sorry about that, Bill,” Michael said. “With you spending most of your time in the animal facility several miles away, that puts you out of the loop. It’s one of the reasons I called the meeting. And I wasn’t sure how much of the story the rest of you knew.”
“What does all this do to the program?” Hessman said.
“I’m not sure,” Michael responded. “I need to discuss this with the FDA. And Eric, we need that sequence data so we can figure out exactly what happened. So for now, we’re on hold.”
“It occurred to me in a very general way that there might be some money to be made from the therapeutic effects of this virus,” Sidney Knox said. “Scott certainly didn’t waste any time exploiting that.”
“It seems premature to me to be trying to sell the rights to this virus,” Chris said. “It’s so early yet, there’s no way to tell what the long-range effects might be. It looks therapeutic now, but where does the virus go when it disappears from the blood—the heart, the brain, the bone marrow?”
“Or nothing could go wrong, and the hospital will make a fortune from it,” Ash said.
“Or that,” Chris agreed.
“I hope you’ll keep all of us informed from this point on about the status of the program,” Hessman said.
“I’ll try to do better, Bill,” Michael said.
The group dispersed, leaving just Michael and Chris behind.
“I’ll keep everyone better informed if there still is a program,” Michael muttered.
“Why do you say that?” Chris asked.
“The pig virus wasn’t supposed to do something like this. Even if it is a good thing, it shows that in humans, the virus is unpredictable. So there’s bound to be renewed concern about the potential dangers involved in animal-to-human transplants. There’s no telling how long debate will rage now over that issue. This could derail the whole program. And if your prediction that even the mutation we’ve got will turn ugly comes to pass . . .”
Though she tried to suppress it, Chris felt a burst of tenderness for Michael. Seeing him despondent like this over the turn his work had taken weakened the wall she tried to keep between them. She reached out and touched his hand. “It wasn’t a prediction,” she said gently. “Merely a possibility. And I’m sorry now I said it.”
Michael looked down where her hand still rested against his. And with that, the moment passed. Face reddening, she hastily pulled her hand away and folded her arms over her chest. “Just a possibility,” she said, almost in a whisper as Michael looked hard into her eyes, trying to figure her out. Then he remembered another problem.
“What the hell am I going to tell Scott about how this happened? What did those two nurses do that got them in trouble?”
Something about the way he’d phrased the question made Chris think of the backup respirator with no filters in it she’d seen when she’d visited her father the morning after his surgery. She had no idea how that could have led to the two nurses becoming infected, but it was an irregularity that ought to be investigated.
“Let me do some checking around and see what I can come up with,” she said. “Is the isolation ward open?”
“There’s no one there, so it’s locked,” Michael said. He pulled a key ring from the pocket of his white coat, removed a large brass key, and gave it to her. “Hope you find something.”
DOWN THE HALL, TR was heading directly for his office to take another pill for his headache. Painful as it was, it didn’t keep him from thinking hard about the surprise Scott had pulled on everyone at the meeting. He didn’t like the man, but had to admit he had vision and knew how to seize an opportunity.
But Chris Collins had said something interesting. “It seems premature to be trying to sell the rights to this virus.” Now there was something to think about.
It took the pill about fifteen minutes to work, and when his headache had cleared, TR sat at his desk with his feet up, doodling on a notepad, converting the fantasies spooling through his brain into boxes and arrows and ink drawn Slinkies, ignoring his duties.
TR’s knowledge that Scott had ordered the examination of Dominic Barroso’s knee was but a hint of how diligently TR worked the hospital gossip mill and picked the fruits of its grapevine. The amount of personal information he had accumulated on the staff was truly impressive. He knew that Michael Boyer had quit smoking when he was twenty-two, that Chris had graduated from medical school fifth in her class, and that Chuck Alford, the head of public relations, had once been arrested for shoplifting. But he was most interested in financial matters, and he could tell you the current salary to the penny of every Monteagle administrator.
From the dossiers he had accumulated on all the key hospital personnel, he had learned that people who were undergoing a lot of stress and hardship in their lives rarely self-destructed as he almost had after the events in Kazakhstan. Others usually hid their problems remarkably well. He’d seen an excellent example of that just this morning. The man in question had recently lost his home as well as half his income and other assets in a divorce. So he was now living in a cheap three-room apartment without enough money to satisfy his basic needs, which included a significant cocaine habit and lap dances from a girl named Amber. Yet you couldn’t tell any of that from just looking at him.
Feeling as though he’d had a very productive morning, TR reached for the phone to call that man.
Chapter 10
CHRIS UNLOCKED THE doors to the transplant isolation ward and went inside. She turned on the lights and stood for a moment listening to the whisper of the ventilation system. Then she walked over to her father’s anteroom and pressed the button controlling its airtight door. Entering, she saw that the backup respirator was hanging right where she’d last seen it, but it was now completely equipped with a filter cartridge in each socket. She looked on the metal shelves and found a box of North filters and two boxes of filters for the Wilson masks.
She thought back to her conversation with the day nurse the morning the filters had been borrowed from the backup. Filters had been ordered from Central Supply and would soon be there, the nurse had said.
But had they arrived?
She tried to remember. Did the backup have filters in it that night when she and Michael checked on her father’s condition following Mary Beth’s call reporting his fever? She closed her eyes and attempted to see the masks that night.
No good. They wouldn’t come into focus.
But suppose the filters had still been missing because no new ones had been delivered. It wouldn’t mean anything. The old ones could be used with perfect safety for many shifts. They didn’t have to be changed so often.
Even though she knew that, her mind wouldn’t set the filter issue aside because the nurses thought the filters had a one-shift life. What would they have done if there were no replacements available? There must be a log book somewhere up here with filter-replacement records in it.
She left the anteroom and went to the nurses’ station where she quickly spotted a clipboard holding the records she wanted. The sheet for the nurses’ respirator was on top.
According to the records, the nurse who’d taken the filters from the backup respir
ator had made no note of that, but had simply written down the time she’d changed filters and added her initials as though the filters she’d used had come off the shelf.
But there was a note by Mary Beth’s entry for her shift that gave Chris a jolt: “Filters from Engineering.” And the time noted was after she and Michael had gone home that night.
Filters from Engineering. Did they use HEPA filters? She had a horrible feeling that they didn’t.
Chris snatched up the phone and had the hospital operator connect her with Engineering. The phone rang five times, and then six, with no answer.
“Come on, come on,” Chris mumbled.
On the ninth ring, a man picked up.
“Yeah. Ed Sumner.”
“Ed, this is Dr. Collins. May I speak with the shift supervisor?”
“You already are.”
“Do you use full face respirators for anything?”
“Sometimes.”
“What color are the rims on the filter cartridges?” She asked him this question because HEPA filter cartridges were color coded with purple rims.
“I dunno,” Sumner said. “Never thought about the colors.”
“Could you check, please?”
“Hold on.”
While she waited for the bad news, Chris felt an escalating sense of dread, because if Mary Beth had to get filters from Engineering, that meant the backup respirator was probably still without them that night.
And if it was, Chris felt she should have noticed that when she and Michael came to check on Wayne’s fever. Then she could have explained to Mary Beth that it was okay to use the same filters for more than one shift. Transmission of the virus had so far not harmed anyone. But it shouldn’t have happened. Ultimately, as the team’s infectious disease specialist, she had to bear the responsibility. Even though she’d come on board late, she was supposed to protect everyone. Now, on her watch, a poorly understood animal virus was loose in four people. And if the engineering filters did not have purple rims, she could have easily prevented it.
The Judas Virus Page 9
