The Death Detail (The Securus Trilogy Book 1)

by Anthony Maldonado

  “Well, I expect it to be an interesting day for you then. We’ll go ever the usual preparation details in a minute. First is the ground rules,” I tell her.

  “Okay,” she says, walking over to the gurney. She sits down, waiting for me to continue.

  “I’ll take care of the first couple of patients. You will shadow. We’ll talk about each case after we’re done. After that, if there’s a non-emergent case, you can evaluate them first and we’ll discuss your treatment plan,” I instruct.

  “Sounds fair,” she says.

  “You’re not to mention your plan with the patient until we have talked about it. And do not administer any intervention without my approval unless it would be harmful to wait,” I say. The amount of freedom is different with every understudy, but as inexperienced and nervous as Kesia is, I want to keep her autonomy to a minimum until she proves she can handle it.

  “Understood.” Her shoulders relax with my words. I suspect knowing she will not be left alone on her first day is comforting to her.

  “Now, you seem to be familiar with most of the standard equipment, but there are some unique pieces here as well. We’ll go over their purpose and use as time allows,” I continue.

  Before I finish the waiting room chime sounds. We both head to the waiting room to meet our first patient of the day. I wanted more time to get some background information on Kesia before we began, but that will have to wait for now.

  Outside, a worker with an arm injury waits for us. He has the sturdy build of a worker from the Deep Vents. Keeping the massive generators supplying energy to Securus is strenuous and often dangerous work. Unfortunately, the workers stationed there are frequent visitors to the infirmary. While they have a difficult job, their work is not nearly as dangerous as the Solar Panel detail. Regardless, this should be a good straightforward case for Kesia to get a feel for the process.

  “Hello, sir. I am Kagen, and this is my understudy, Kesia. Follow us to the exam room and we’ll get your arm fixed up for you. What’s your name?” I ask as we walk.

  “Dalek, sir,” he replies.

  “Just call me Kagen,” I say as we enter the room. “So, how did you injure your arm?”

  “We were moving some equipment around, and it got smashed between the two pieces.” He groans from a surge of pain.

  His arm is swollen, but not deformed. More importantly, both his circulation and neurologic function remain intact. I have Kesia roll over the portable X-ray machine. We have Dalek sit in the device while I show Kesia how to manipulate the arm to get the correct angle for the X-ray. The image shows his forearm has hairline fractures through both bones. Since the edges are not displaced, a simple splint will do.

  “Kesia, have you applied a splint before?” I ask while retrieving the reusable splint. It has a thick but moveable plastic lining we fill with a hardened matrix of foam. This foam, like many other things in Securus, is completely recyclable. Using a specific solvent it turns into a liquid and back into a firm matrix with the application of another.

  “No, I’ve only seen a demonstration,” she reluctantly replies.

  “You can do this one then, it’s pretty simple. The main part is positioning the arm correctly,” I tell her.

  I hold Dalek’s arm in place while Kesia slips on the splint and adds the solvent. The foam rapidly hardens, setting the splint. Though it is a relatively simple task, I see the pride and confidence she has from completing it. As we walk Dalek back to the waiting room, the chime sounds again. It’s going to be busy today, I think to myself.

  What awaits us troubles me deeply. Two patients are outside. Both look critically ill. They are pale, confused, and soaked with their own perspiration. The men were not even able to come here under their own strength. Instead, they have been carried up by members of the Leadership Guard. The look of these ill men is unmistakable. Apparently, Leland will not be the only one in Securus to contract this form of aggressive meningitis.

  “What happened to these men?” I ask the Guards while passing out respiratory masks and gloves to everyone in the room to lessen the chance of the infection being transmitted.

  “They’re researchers from The Caves,” the Guard says. “We found them in the lounge near The Caves like this. They looked tired when they first arrived this morning, but nothing like this.”

  The men are transported into my exam room while I call for Rana to come help. I can handle multiple cases at once, but when they are this ill, every minute matters. Rescheduling appointments is better than sacrificing precious time.

  “Okay, Kesia, stay close to me. We have a lot to do,” I tell her while preparing my equipment to obtain blood samples and begin the necessary treatments.

  I look over the men to see who is in worse condition. While I do not know their names, I do know who they are. One has an unmistakable woolly beard. The other has large glasses with a gangly appearance. These are the research workers who inadvertently distracted the Guard when I entered The Caves. The bearded man has better vital signs so I start with the lanky man. Rana will be here soon to take care of his partner.

  “Kesia, get the intravenous fluids and pour in three liters as quickly as you can,” I tell her.

  His blood pressure is low, so the extra fluids may help. My other immediate concern is his worsening confusion. He has stopped mumbling. I fear he is no longer in control of his breathing. That puts him at risk of aspirating into his lungs. Doing so would compromise another vital organ system.

  I inject specialized medications through the intravenous access to facilitate the passage of an artificial breathing tube. Using my old fashioned device, I peer into his oral cavity and find his vocal cords. There are more sophisticated devices with cameras embedded into the tip of the blade, but I prefer this approach. Somehow it feels more natural to me. The streak of white cords nestled below the floppy epiglottis is my target. I pass the tube through the vocal cords and secure it in place. Now his airway is protected and the work of his breathing can be transferred to a ventilator machine. While I was placing the breathing tube, Rana and Jace arrived to work on the bearded man.

  “Looks like Leland’s illness isn’t an isolated case after all,” Rana says to me as she works.

  “Yeah, that’s what I was thinking. These two also work in The Caves,” I mention, knowing the detail may be important in identifying the exposure site of this disease. This is something we will need to seriously consider later, after the men are stabilized.

  Kesia already has the fluids running, so we move on to the sample collection. We really need the cerebrospinal fluid, but he is in no condition to be manipulated for the procedure yet, so we run the standard battery of blood tests.

  “Ok, while we’re waiting to see if his blood pressure responds to the fluids, we should initiate a more direct treatment. What do you suggest, Kesia?” I ask while going to the cabinets to get the medicines we need.

  “Well, we should give with broad spectrum antibiotics, I think. With his confusion, fever, and unstable cardiovascular system, I would suspect some infection. Maybe he has meningitis,” she says, pointing her finger into her hands like she were recalling the words from a book.

  “That’s a good start,” I tell her while bringing over the antiviral and antibiotic medications. “We very recently had a patient with severe viral meningitis. I think these men have the same infection. However, with our limited information, we cannot yet assume we know the diagnosis. Especially since both of them became ill at the same time. Have you considered a toxidrome such as neuroleptic malignant syndrome? That could also explain his fever, altered mental status, and unstable vital signs. He’s a research worker, so he could be exposed to many chemicals. Plus, we have not yet accessed his records to see if he’s on any medications that could trigger a toxidrome.”

  “I hadn’t thought of that,” she admits.

  “It’s always good practice to run down the list of possibilities and exclude as many things as possible before narrowing your focus
to a single diagnosis,” I say, almost bumping into Rana while moving over to start the infusions.

  “Jace, what do you think about a toxidrome?” Rana asks as they continue their treatments.

  “Well, they have some features of a toxidrome, but there are inconsistencies making me doubt it. For instance, they don’t have rigid muscles you would expect with NMS,” he says.

  “Since these men work in The Caves we also must consider the possibility of a poisonous envenomation from any number of creatures. There are numerous odd insects and some small animals out there. Not all of them are benign,” Rana tells the understudies.

  All of these things are more for their education, preparing them to form their own differential diagnosis list. Both Rana and I know exactly what is going on and how fast the infection overwhelmed Leland. After the initial treatments are done, we both set up for the lumbar punctures. This time we talk our way through the procedure so Jace and Kesia will understand exactly what we are doing. If this gets as bad as I fear, they will be doing this on their own sooner than anyone expected.

  With the initial infusions, analysis, and stabilization already initiated, we can transport the men to the intensive care unit. Rana’s patient is doing significantly better than mine, despite receiving identical treatment. He has not yet required the ventilator and is only requiring half the dose of medications to support his falling blood pressure.

  “Can you take these men to the ICU?” I ask Jace and Kesia hoping Rana will not object to letting them do this on their own. I want to talk to her about this new outbreak privately.

  “Sure, Rana showed us where it is when we toured the infirmary earlier,” Jace answers.

  “Tell Adara they have the same infection as Leland and that I’ll be back in a few minutes to speak with her,” Rana adds as they prepare to leave.

  She stands with her hands resting on her hips, looking at me over the top of her glasses. Apparently, she has something on her mind as well.

  Chapter 12

  “This is gonna be bad, isn’t it?” I ask Rana after the others have left.

  “Three cases so close together and all very severe. We need to notify Leadership. This looks like the start of an epidemic,” she warns. “We need to get Kesia and Jace up to speed as fast as possible. We may need their help more than we anticipated.”

  “Yeah, that’s what I was thinking. But there’s one other thing bothering me. So far, I’ve had some recent contact with all three men before they became ill,” I say, disturbed by the coincidence.

  “That’s nothing to be concerned with. If you were exposed, you would’ve showed symptoms by now. And don’t think for one second that you’re a carrier of the virus. That pathogen is too aggressive to stay dormant in a carrier,” Rana says, anticipating my concern. She pauses for a second, as if replaying something in her mind. “Wait, how did you come into contact with the two new cases?”

  “During my excursion I saw them in the lounge area by the entrance to The Caves. They unwittingly distracted the Guard long enough for me to slip out the outer door,” I tell her.

  “That’s not much contact. Sounds like you were far enough away to avoid any significant exposure,” she says.

  Rana’s words comfort me, but they do not change the potential disaster facing Securus. We are going to have to enlist Leadership to help us ensure this outbreak does not spread. I hope the Research Department is making some progress analyzing the samples we sent from Leland.

  “I’ll alert the other Healers of the new developments. In the meantime, we need to develop a treatment protocol for Jace and Kesia to follow in case we become inundated with a flood of patients. We should also have them split some time with Adara so they can flex positions to be more helpful,” she says.

  “Ok, I’ll let them know the plan. You can tell Adara when you speak with her. Let’s have them start with her now while I come up with the protocol. I’m sure you must have a backlog of appointments waiting by now,” I say.

  We make our way to the intensive care room to meet up with the others. Rana sends Kesia and Jace over to me while she speaks with Adara. I fill the understudies in on our new plan. Jace takes the news in stride and seems eager to continue. Kesia, on the other hand, looks to the floor with her shuffling feet acting up again.

  “If there are any questions or concerns, now’s the time. Don’t be afraid to speak up,” I say with a pointed stare aimed directly at Kesia.

  “It’s nothing,” she says timidly. “Just, my instructors told us we were supposed to shadow one Healer at a time, and I was hoping to stay with you.”

  I feel my face turning warm and attempt in vain to suppress the blushing caused by her words. I do not know if she is disappointed in not following her prior instructions or if she simply wanted to learn from me. Either way, her wanting to stay with me is flattering.

  “Well, we all have to be flexible in this profession, especially when faced with a possible epidemic,” I tell her. “Besides, if things calm down, you’ll both do most of your instruction as we initially planned. We need to make sure we’re prepared first.”

  Kesia looks like she has more to say but does not voice the words. Before she changes her mind, I have them return to Rana and Adara. After checking to make sure no more patients are waiting to be seen, I return to my exam room to get to work on developing a standard treatment protocol for the understudies. Even as I do, my mind keeps wandering back to the odd coincidence of the grouping of ill patients.

  The rest of the morning passes quickly while I am engrossed in my work. A few more patients come in but none of them are infected with the new virus. By the time I have finished the protocol, it is already time for my lunch break. The morning was so busy it slipped my mind that I am supposed to meet Hadwin and Sayda soon. I have not had a chance to figure out what to say.

  Before leaving for lunch, I stop by Rana’s exam room to let her know where I will be in case she needs to call me back to help. Afterward, I head to the decontamination chamber. As I am about to activate the decontamination, Kesia catches up to me.

  “Hey Kagen, you headed to lunch? I was gonna go now too. Do you mind if I go with you?” she asks.

  Normally it would not be a problem for her to tag along except the coming conversation is not for her ears, so I think of an excuse. “I’ll meet you there. First, I need you to get the treatment protocol on the computer in my exam room and get a copy to Jace. You both need to get started studying it right away,” I say to her obvious disappointment.

  After enduring the decontamination chamber, I leave the infirmary to go meet with Sayda and Hadwin. We all arrive to the hall at nearly the same time. Without many words, we pick up our food before going to a more private area to talk. I urge them to hurry so we have as much time as possible, and more importantly, so we can disappear before Kesia finds us.

  Sayda’s quarters are the closest to the lunch hall, so after we pick up our food we make our way there. Sayda has been quiet so far, but at least she has not attacked me yet. I consider that progress. When we get into her quarters, Hadwin and I search the area to make sure nothing is out of the ordinary. We need to be sure her room is not under surveillance. The search does not take long since the room is so bare. When I am satisfied we can safely talk, I turn to Sayda. To this point she has appeared calm and composed. But looking into her eyes now, she is anything but calm. This is not going to be easy.

  “Hadwin told you what really happened the night Merrick died?” I ask.

  “Yes,” she says suspiciously. “He also said you told him there was more to the story.”

  Hadwin and I sit on a bunk while Sayda continues to stand.

  “Ok, so you already know there were some soldiers in the passage, equipped with guns and body armor. But, they were not the only unexpected thing in that chamber. I saw a set of rail tracks behind the collapse. I don’t know where they lead, but they were definitely there.” I tell them.

  “Are you sure you didn’t see some
flashing lights or were so traumatized you could’ve imagined it?” Sayda asks. Her words are not meant to be insulting, she is just naturally skeptical.

  “I’m positive. I snuck back into The Caves to investigate, that’s how I broke my ribs,” I say clutching my chest and glancing at Hadwin.

  “I was wondering how that happened. You fell, right?” Hadwin asks, assuming the injury was self-inflicted.

  “No, I wish it was that simple. I ran into the soldiers again. When I went back into the tunnel, the collapse had been reinforced to form a complete wall and the tracks were hidden. So, I was photographing the area through the cracks when a door opened out of the rocks. They came in from there,” I say.

  Now they both listen intently, no longer wanting to interrupt. Though she listens, Sayda continues to stand over me. The anger has not left her eyes. I am not out of danger yet.

  “The same two soldiers were patrolling the area. I saw them open another door to what they called a supply room. There’s no question in my mind it was the same men. I will never forget their voices. The only thing I could do was crouch behind the rubble, but my movement accidentally dislodged a rock. When they heard it, they shot through a crack in the wall, attempting to scare me out. Luckily, they didn’t see me. They assumed it was only a loose rock that had fallen, so they stopped looking. That was great, but during the commotion their gun blast dislodged another rock. It fell right onto my chest. It took everything I had to stay silent and still,” I whisper while showing them the healing injuries. With some time to heal, the bruise has darkened and dispersed, making it look even more impressive. Sayda flinches at the site of it.

  I retrieve my camera to show them the images. Hadwin looks on with anticipation while Sayda’s face remains full of disbelief. I point out the manipulated wall and the area where the man-made tunnel was. A slightly protruding rock marks the spot where I saw the men trigger a mechanism to open the door to the supply room. Unfortunately, the images of the soldiers are useless because the glare made them invisible.