***
Josh closed the door of his hospital office and dropped into the chair behind his desk. He absolutely had to make a quick trip home to shower, shave, and change clothes—but first, he needed to get some help.
He ran through his mental file of people he could call. His mentor during residency, the chief of the medicine service at the hospital where he trained, had now retired, as had the man who headed the infectious disease service at that time. Were there others somewhere in the country who would know about the super-bacteria? Probably—but who would he call?
And could they be trusted to keep what Josh told them in confidence? It had been something about which David Madison was insistent, and Josh had to respect his patient’s wishes.
Josh picked up the phone and was about to call Allison Neeves, but he hung up without dialing. He and Allison had trained at about the same time, although at different hospitals. There was no reason to think she’d know more than he about Bacillus decimus. Sure, she’d have to know soon, because undoubtedly Rachel was infected with the same organism. But Josh had the lead role in this, and he felt it was up to him to find a way out of what looked like a dead-end situation.
Maybe he could find someone at the National Institutes of Health. Then he saw the notes on his desk, written when he was contacting the CDC to obtain diphtheria antitoxin. If anyone would know about infection by this organism, they would.
He considered and discarded the numbers he’d written—they were for the duty officer who controlled diphtheria antitoxin. Now he needed someone who was familiar with unusual infections. What had the book said about the bacteria? It was found in Central and South America. So he’d start with whoever was expert on those regions.
Before he could pick up the phone again, there was a light tap on Josh’s door. Without waiting for a response, Karen Marks walked in.
“Doctor, we need to talk,” she said.
“I’m sorry, but it’ll have to wait. I’m trying to save your boss’s life,” Josh said. And Rachel’s as well. Don’t forget her.
Marks pulled out the chair across the desk from Josh, eased into it, and crossed her legs. “That’s why I’m here. Don’t forget I’m the one who got you the antitoxin you needed. But from what I can gather, it’s not helping. So I’m here to grease the wheels for whatever else you need.”
“Look,” Josh said, “I appreciate your offer, but—”
Marks dropped her purse on the floor beside her with a loud thud. “Josh . . . You don’t mind if I call you Josh, do you? Josh, you’re going to have to get used to having the power of a former president behind any request you might make. And I’m the one who can make those things happen. So what do you need?”
Josh thought for a minute. To this point, he’d felt like he was trying to move a brick wall. Hadn’t Marks described herself as the person to get things done? Well, why not let her help? “Okay,” he said. “Here’s what I need.”
***
Rachel felt the fever rising within her. Her head pounded. Her joints ached. But worst of all was the realization that, despite all she could do to prevent it, her airway was gradually closing down. She made a concerted effort to breathe slowly and gently. So far there was no stridor—the semi-whistling sound that accompanied airway obstruction. But it couldn’t be far away now.
She wasn’t sure whether the gentle tap at the door of her hospital room was a product of her fevered imagination, along with some really weird dreams that had troubled her off and on through the night, or if it was real. When Rachel heard it again, she tried to call, “Come in,” but produced only a faint croak.
Apparently, that was enough. The door opened and a man entered. His clothes were almost covered by the gown he wore. His face was virtually hidden behind a mask and face shield. Paper booties covered his feet, while on his hands were the purple Nitrile gloves that had replaced conventional latex ones in this hospital.
As the man advanced toward her bed, Rachel’s heart sped up even beyond its fever-fueled rhythm. She felt for the button that would call for the nurse, all the while wondering if this intruder might accomplish what he came for before anyone could respond. Visions flashed into Rachel’s mind of the woman in South America who had started all this by throwing the contents of a flask in her face. Was this someone sent to finish the job? Had they already been in President Madison’s room, or would he be next?
The figure stopped at her bedside and reached out a gloved hand. Rachel squeezed her eyes shut like a little child who felt safer if she couldn’t see the fearsome shadows around her. Then she heard Josh’s voice, speaking softly. “Rachel, I’m so very, very sorry I’ve neglected you.” He stroked her cheek and bent closer. “I know how sick you are. And I want you to know that I’m willing to move Heaven and earth to make you better.”
Rachel opened her eyes and tried to smile. When she spoke, her voice was faint and breathy, but her words were easy to understand. “Oh, Josh. I know how tough this must be on you. How’s Mr. Madison?”
“I think he’s a bit better than you are.” He went on to explain that, although both Rachel and Madison had received diphtheria antitoxin and appropriate antibiotics, there was another factor at work. “We’re pretty certain you have a secondary infection with a bacteria no one thought was around . . . certainly not in the U.S.”
As a nurse, Rachel could immediately see the implications of what Josh was saying. “So the DAT wasn’t the whole answer,” she said. “Do you know yet how to treat this other infection?”
Josh shook his head. “I’ve got someone calling the CDC to get the latest information about treating it. Believe me, I’m checking every source, doing everything I can.”
Rachel managed a slight shake of her head, even though the movement exaggerated her headache. “I suspect you haven’t tried one source.”
“Tell me, then,” Josh said. “I’ll try anything.”
Rachel reached out and grasped Josh’s gloved hand. “Pray about it. That’s what I always do when I don’t see a way out. And so far, God’s brought me through.”
She half-expected an argument. After all, during the year they’d been going out, Josh had never said much about his relationship with God, even though she’d given him opportunities. However, his reaction this time surprised her. Silently, Josh dropped to his knees at her bedside.
***
In the hall outside Rachel’s room, Josh once more encountered his friend, Sixto Molina. He almost wished he hadn’t seen the surgeon, because now it would be more difficult than ever for him to ignore what his eyes and ears told him. Part of him, the very human part, wanted to do just that. But the doctor in Josh kept coming back to one of the first lessons he’d learned in medical school. If you think about it, you need to do it.
“Sixto, do you have a minute?”
“Sure. I was just hunting for you to see if I could help. What’s up?”
Josh looked around him. Two Secret Service agents stood guard in front of Madison’s room. The door across the hall, the entrance to the room that was now a crime scene, was closed, but voices issued from behind it. “Let’s find someplace a bit more private,” he said.
He and Sixto found an empty patient room at the end of the hall and ducked inside. “You know my girlfriend, Rachel, don’t you?” Josh asked.
“Yes. We’ve met a couple of times. Why?”
Josh wondered how much he could confide in his friend. In the end, he decided he had to trust Sixto’s discretion in order to get the help he needed. In as few words as possible, he sketched out the events that led to the former president and Rachel occupying adjacent rooms in this wing of the hospital. “Between the antitoxin and the antibiotics, their diphtheria should be coming under control, but the secondary infection is getting worse. Right now, Rachel seems to be nearing the point of airway obstruction. I’m working on treating the infection.” Josh shook his head. “That’s not true. Actually, Allison Neeves is treating her, but I tried to call her a minute ago. She�
��s back at the clinic, tied up with an emergency. Meanwhile—”
“Meanwhile you think Rachel needs a tracheotomy,” Sixto said.
“She may need one,” Josh said. “But I can’t make that decision dispassionately. And even if I could, I’m not the person to do it.”
“I presume you have a trach tray at the bedside.”
“It’s all there. If you think it needs to be done, I can assist.”
“No, you stay out of this. If I need to do a trach, I’ll get someone else to assist me. It should be simple . . . if I do it before it becomes an emergency.”
“I’m hoping it won’t come to that, but if it does . . .”
“If it does, I’ll handle it.” Sixto clapped Josh on the shoulder. “Meanwhile, why don’t you see about finding out how to treat your patients?”
Josh turned without a word and strode away, wondering which one was supposed to make him feel better—praying with Rachel or asking his friend, the surgeon, to take over the burden of deciding when and if she would require surgery to keep her airway open.
***
“Thank you. You’ve been quite helpful.” Karen Marks cradled the phone. She scanned her notes, then pushed away from the desk and tilted back in the chair to think. Since Dr. Pearson had left her in his office, she’d managed to cut through about a mile of red tape at the CDC. Now she pondered her next move.
The door opened and Pearson entered. She thought briefly about moving from behind his desk, but he didn’t give her a chance. He dropped into the chair across from her like a marionette whose strings had been cut. “Please tell me you have some good news,” he said softly.
“Yes and no,” Karen said. She consulted her notes. “I’ll leave out all the times I was transferred or had to call a different number. The bottom line—I hate that expression—the substance of what I learned is that the only place this bacteria of yours is still found is in some of the less urbanized areas of South America. The CDC knows about a few cases of individuals infected by it over the past half-dozen years, and all have been fatal.”
Pearson was half out of the chair. “I need to research this. There’s got to be an answer.”
“Please sit down,” Karen said. “I may already have your answer.” She moved one page of notes aside and looked at the next. “I finally talked with a Dr. Gruber at the CDC. It appears that he’s one of the world’s experts on this infection. It’s true that in the past it’s been universally fatal, but he told me that not long ago Argosy Pharmaceuticals talked with the FDA about getting approval for a new antibiotic. The folks at the FDA told them not to bother trying to continue testing it because it was no better than any of the existing drugs. Its—what did he call it? Oh, yes, its spectrum was essentially the same as several other antibiotics already approved and on the market.”
Pearson leaned forward. “So what does this—”
“Let me finish,” Karen said. “There was one important exception. The drug worked where nothing else did in infections with—what’s this one’s name?—with Bacillus decimus. But since there’d never been a case in the U.S., the FDA advised Argosy not to bother.”
“So this new drug was effective?”
“They think so,” Karen replied. “Gruber said the drug worked in the lab, and a few patients in South America had been through limited phase-two testing, whatever that is, against this superbug. But more research was needed, including long-term studies looking for late consequences from it. Those would come if the FDA gave a preliminary thumbs-up, which it told them wouldn’t be forthcoming.”
“But it worked in the few patients in whom they tried it,” Pearson said. He seemed to cling to the idea like a drowning man clutching at a life preserver.
“Yes, it worked. And if you’re willing to gamble on the limited data available, and if the pharmaceutical company still has some of the drug available, Gruber thought we might be able to get some. But it would probably be a very small amount.”
“What are you saying?”
“Think it through,” Karen said. “We don’t know how much of the drug is still available. My guess is that most of it’s gone. We may only be able to get enough of the drug to treat one patient.” She looked straight at Pearson. “And if that’s the case, you know who should be treated.”
9
Rachel opened her eyes when she heard the door to her hospital room open and close. It seemed she was sleeping more and more. Was it the effect of the fever? Or was this the way someone died from whatever infection she’d contracted? Would she just go to sleep one time and never wake up?
In her head, Rachel knew that if that happened, she’d awaken in a better place, in the presence of her Lord. But she was surprised to realize that, although she was confident in her ultimate fate after death, she wasn’t ready to leave this life yet. She wondered why. Was it because of the attraction between her and Josh? Did she want to experience more of that? Was her ultimate desire marriage, motherhood, a family? Well, whatever happened, God was in charge.
“Rachel, do you remember me?”
The voice, an unfamiliar one, came from above her bed. By now, she had a certain facility at looking beyond the isolation protection garb and discerning who was visiting her room, but this man wasn’t one she’d seen there before. He was huskier and shorter than Josh. What she could see of his face above the mask wasn’t familiar. “I’m afraid I can’t—” Rachel was both frustrated and frightened when she discovered her voice had become so raspy she couldn’t get the words out.
“I’m Josh’s friend and colleague—Sixto Molina. We met a couple of months ago at a party.” The man moved a bit closer. “Josh asked me to look in on you because he was afraid you were having some trouble breathing. I’m going to see if we can do something about that.”
Despite her fever, Rachel felt a chill. He’s going to do a tracheotomy. She had been trying to ignore that possibility for several hours now, but the nurse in her was well aware of the likelihood such a procedure would be necessary.
If Rachel’s airway became compromised to the point where there was a danger, it would close off and smother her, the solution was an operation, a tracheotomy. A doctor would surgically open a hole in the trachea—her windpipe, a layperson would call it—and insert a metal or plastic tube into it. She’d be able to breathe freely through the hole in her neck, but with a tracheotomy tube in place there, no air would go upward past her vocal cords. Rachel would be reduced to writing notes and silently mouthing words until such time as the tube was removed.
She dreaded the possibility, but if the procedure was what it would take to keep her alive . . . with a silent prayer, Rachel mouthed the words, “Do what you have to.” Then she added, “Thank you.”
***
Sixto straightened from his exam of Rachel and looked down at her. “Rachel, your airway is borderline right now,” he said. “We may be able to get by without doing a tracheotomy, but if you get much worse, what would otherwise be a scheduled, elective procedure might turn into an emergency one done at the bedside. As a nurse, you know that would multiply the chances for something to go wrong—bleeding, airway obstruction before we get the tube in, even post-op infections.”
He waited to see if she would respond, but Rachel continued to lie perfectly still, her eyes closed, her breathing a bit more rapid than normal. The faintest sound of stridor accompanied every respiration, signaling impending obstruction of her airway. Sixto knew that Josh had been right to ask him to see Rachel, to make the decision that Josh was unable or unwilling to make. But it was still difficult to do, given the friendship that existed between the two doctors.
“Rachel,” he said, when it was obvious she wasn’t going to respond, “I think we should—”
“Dr. Molina, are you in there?”
The urgency in the voice over the intercom from the nursing station stopped Sixto in mid-sentence. “I’m here, but I’m trying to talk—”
“We need you in the room next door,” the nurse c
ontinued. “Mr. Madison is having a great deal of difficulty breathing. I think he needs a trach, and we can’t locate Dr. Pearson.”
So now, he had two patients who needed him, one with an airway that might become compromised at any moment, the other who appeared to have reached that point already. Sixto patted Rachel’s hand. “Can you hang on? If you feel any difficulty breathing, push the call button. We’ll get help to you, stat. Do you understand?”
Rachel gave a minimal nod, and Sixto hurried through the door.
***
Josh was glad the person to whom he was about to talk couldn’t see him. Undoubtedly he looked as grungy as he felt. It seemed as though he wasn’t going to make it home to clean up. Maybe after this call he could take a few minutes in the surgeons’ dressing room to shower. He might even borrow Sixto’s razor and some toiletries from his locker there.
The thought of his friend brought Josh to the thing he’d been trying to ignore for the past half hour. Although he was happy to have another doctor make the decision about a tracheotomy for Rachel, Josh somehow couldn’t rid himself of the guilt that went with abdicating that decision. He felt like he’d betrayed her by not handling that problem himself.
“Are you going to make the call, or have you changed your mind and want me to do it?” Karen Marks asked.
“No, I’ll make it. I just needed to gather my thoughts first,” Josh said.
“Are you sure I shouldn’t be the one talking with them? After all, I can bring the former president’s influence to bear.”
“This is a job for a doctor,” Josh said. “I’ll put it on speaker and let you listen in.”
When Josh had knelt at Rachel’s bedside, it was the first time he’d prayed since his freshman year in med school. He didn’t realize how far he’d gotten from God, and he regretted that it took something like this—something he couldn’t control, something he couldn’t fix—to bring him back. He vowed not to drift that far again. But meanwhile, he had to move forward. With a silent prayer for God’s help once more, he found the number in Karen Marks’s notes and prepared to dial.
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