Ford closed his eyes, unable to believe the woman’s arrogance.
“What for?”
“Well, I wanted you to take me through the operation you performed on Raymond Denny.”
Ford felt his face grow abruptly hot. Suddenly he was standing.
“Dr. Patou, something is killing the patients in the isolation rooms, something that cannot be treated with vancomycin, which, in case you have forgotten, was the last reliable weapon we had. I have just received authorization from the medical director to go ahead and amputate the leg of Raymond Denny, an otherwise healthy twenty-five-year-old. Before doing that, I would like to notify his family. This being the case, I may not have time to sit and talk with you about what we did to Officer Denny the first time round. But in order to save time in future, I suggest you come to the OR and watch the amputation, suck air samples, culture the floor, culture any frigging fomite you feel inclined to, but don’t bother me with any more of your ridiculous requests!”
He slammed the phone down and stood there trembling. Allen smiled.
“Attaboy,” he said quietly. “Tact and charm. Wins ‘em over every time.”
6
Raymond Denny’s wife and five-year-old daughter came down to the hospital at four o’clock to see him before he went into the OR. They were accompanied by Michael Rickman, the police officer who had confronted Ford in the critical room when Denny was first admitted. The family went quietly into the isolation room in a state of shock, but Rickman stayed outside with Ford. He wanted a word.
Once again Ford found himself standing closer than was comfortable to the policeman’s tired face with its network of broken veins.
“I thought you told me he was going to be okay?” said Rickman.
“In normal circumstances I would have been right,” said Ford. He looked up and down the ICU ward. “What we are dealing with here is completely new.”
Rickman pushed his head over to one side.
“Oh, it’s not your fault. Is that what you’re trying to say?”
“That’s right. This pathogen has not responded to any of the drugs used. It is something which is beyond—”
“And what about those antishock pants?”
Ford stared.
“What about them?”
“He nearly died when you were getting those things off him. I was there, remember?”
“Mr. Rickman.”
“Officer Rickman.”
“Officer Rickman, the deflation of the MAST pants has no bearing on the development of the staphylococcus infection in Raymond Denny’s leg.”
“That’s not what I hear,” said Rickman. He stood back, tapping the side of his nose and smirking. For a moment Ford had a paranoid flash of Rickman and Patou talking together on the phone. “I know a doctor who says that hypervolema—”
“Hypovolemia.”
Ford bit his tongue. The last thing he wanted to do was provoke this man.
“Whatever. That hyper-whatever-it-is significantly increases the chances of infection. In other words, what happened in ER does have a bearing on what followed. In other words, your negligence is going to cost my partner his leg.”
Ford’s silence drew a satisfied smile from Rickman. But he couldn’t hold it. His lip was trembling, and he looked as though he might actually cry. He pointed towards the door of the isolation room.
“And I owe it to that woman … and to that … little girl to make sure this hospital pays for what it has done to them.”
Ford looked away as Rickman brushed the tears from his eyes with the back of his fist.
“Officer Rickman,” said Ford, suddenly tired, suddenly struggling under the weight of events. “You’ll do what you feel you have to. In the meantime I must ask you to excuse me. I have to go scrub up.”
The day following the operation, Raymond Denny died of septicemia, his blood seething with staphylococcus and its destructive toxins. Several Los Angeles television stations covered the story, showing pictures of the distraught wife standing outside the Willowbrook’s main entrance. At eleven o’clock that evening KNBC Channel 4 News carried an item on the Willowbrook’s recent record in postoperative infection and talked about a killer bug that was claiming lives in the intensive care unit. Curtis Lipperman, a spokesman for a South Central urban regeneration group known as the Brotherhood, appeared on KTLA news, raising the question of the treatment of blacks in South Central and at the Willowbrook in particular. Invited into the studio to air his views, he pointed out that a number of African-American patients had recently succumbed to resistant pathogens at the Willowbrook, and wondered why it was that a white policeman’s death had attracted media attention when the others had gone unnoticed.
“As the recent tragic death of Jessie Hammel proved, African-Americans are being sacrificed in South Central to government budget cuts,” he shouted. “The healthcare dollar is stained with African-American blood.”
The morning after the KTLA program, Ford was unable to park in the area reserved for staff cars. The whole parking lot was jammed with local and national media teams. Vans bristling with satellite dishes and antennae blocked access to the main entrance, while camera crews roved back and forth getting local reaction to the news about budget cuts, Jessie Hammel’s death, the danger of incurable disease in the Willowbrook, and anything else that might excite an angry response.
Ford spent ten minutes trying to park somewhere that would not be in the way of other cars, but it was hopeless. He rolled down his window.
“Excuse me!” he tapped a cameraman on the back. “EXCUSE ME!” The guy turned and Ford found himself staring directly into a lens. “Excuse me. Do you think you could get out of the way? I’m trying to park my car.”
Out of nowhere a microphone was shoved into his face. It had a dirty protective cover that looked like yeti fur.
Ford tried to push it away. At the same time somebody slapped the roof of the Buick hard.
“I said, I’m trying to get through to park!” Ford shouted.
A young woman’s face was suddenly crammed into the window along with the mike and the lens. Somebody started rocking the car, pressing down on the trunk and letting go, so that Ford was bouncing, still trying to push the mike back out the window. His heart started to pound.
“Karyn Schaeffer, CNN,” said the young woman.
Ford pulled away from the mike and was astonished to see that other lenses were now staring at him through the windshield. A flash went off. Then another.
“Sir?” said the woman, struggling to keep some composure in the mob that was developing. “Are you with the hospital staff?”
Ford nodded.
“Yes, and I’m here to go to work.”
From behind the woman somebody shouted, “It’s Ford! He’s the one that took that cop’s leg off!”
A camera bumped the windshield with a sharp crack, and then suddenly questions were being shouted through the growing babble of angry voices.
“Is it true that the Willowbrook is a hotbed of disease?”
“What have you got to say to the wife of Officer Denny?”
“Why were sick patients crammed together in a single room?”
“Is there a danger to the local community?”
“Is there racial discrimination in the—”
“Look,” shouted Ford, holding up his hand against another barrage of flashes. The dirty mike was pushed against his mouth, so that he had to lean back. Magically the questions had stopped. He was being given a chance to speak. Trying to sound as professional as possible he formulated his reply: “There is no danger to the South Central community, or to people inside the hospital.”
There was a pause, and then an explosion of new questions. Ford held up his hand.
“We have recently … We have recently been encountering instances of infection with a … with a very common pathogen, a bacteria which many of us carry all the time without any harm to ourselves or others. This bacteria was, I believe, responsible for the death of Office
r Denny and—”
“What is it called?” shouted a man’s voice.
“Staphylococcus aureus.”
“Superstaph!” somebody screamed. This was a devil they knew.
“Is it a mutant strain?” shouted Karyn Schaeffer.
“Our lab people are working to culture and identify the precise biochemical characteristics of this bacteria, and as soon as they have results, I’m sure they will make them available to the press.”
“You mean, you don’t know what it can do?”
Ford shook his head. All they wanted to do was sensationalize.
“We know it is seriously pathogenic. It produces infection rapidly in open wounds and appears not to respond to any of the available drugs.”
“You mean there’s no cure?”
Cameras started to flash again, and somebody fell against the front of the car, making it rock.
“It’s a little early to say, but nothing we have tried so far seems to have an effect.”
“Professor Ford, you recently gave a speech at a conference saying that LA is in danger of being overrun by drug-resistant pathogens. Is this the beginning?”
Ford was a little taken aback at this. He felt as though somebody must have singled him out. They had already been digging around.
“My title is Doctor,” shouted Ford, “not Professor, and I didn’t…”
He was momentarily blinded by flashing cameras. It was time to get out.
“I didn’t say that. I said that the way antibiotics are distributed can encourage resistance, especially where there’s inadequate medical supervision.”
He snapped off the ignition and opened the door, having to push hard to get out. For a moment he was staring into the tiny red eyes of a dozen microcassettes.
Karyn Schaeffer was still right in his face. “Is this the beginning of an outbreak, Dr. Ford?”
“I, well … it depends how you define an outbreak,” said Ford, pushing forward towards the main entrance now.
“What do you mean?” shouted Schaeffer, following him—walking backwards, completely oblivious to any obstacles that might be behind her.
“Well, a small group of patients in a ward that all suddenly come down with the same thing—if the disease in question was fairly unusual—that would be considered an outbreak.”
Ford ploughed forward, blinking against the flashes. He reached the glass doors of the main entrance and was glad to see two of the hospital safety police on guard.
“So this is an outbreak?” Schaeffer persisted.
Ford turned in the doorway. He looked over to where he had left the Buick. He hoped it was going to be okay.
“Is it an outbreak?” repeated Schaeffer.
Ford looked at the young woman’s face.
“In the technical sense I defined, yes, it is,” he said.
For the LA media the Willowbrook story was like a temporary license to print money. News that there was an outbreak of an incurable disease, a mutant strain of a bacteria that around one third of the population carried all the time, gave television ratings and newspaper circulation a much needed boost. Many journalists focused on the serious issues raised by the incident, but many more reveled in the lurid details of what superstaph could do to its unfortunate victims.
Mary Denny, the dead policeman’s widow, was paid $40,000 by UPN News 13 for a live interview, while several of the Willowbrook staff received offers from journalists wanting to know what was really going on inside the wards and operating rooms.
The media feeding frenzy was matched by the panic in South Central among people who had friends or relatives inside the Willowbrook. Hospital security was strained to the limit controlling the crowds that turned up seeking clarification and reassurance. Many demanded that their loved ones be transferred elsewhere. Amateur video of a young woman wheeling a bed across the Willowbrook parking lot at three o’clock in the morning, complete with saline drip and wounded boyfriend, was broadcast all over the country by CBS, while a still from the same video appeared in newspapers and magazines across the country.
Three days after Officer Denny’s death, another nine gunshot and stabbing victims were discovered to be infected with the strain of staph that had killed the Shark.
7
Ford was summoned to see the medical director at ten o’clock in the morning, but when he got there, he was told he would have to wait. Russell Haynes was on the phone, his door firmly shut. In the open-plan office outside, the normally chatty corps of administrative staff went about their work in silence, speaking only when their work demanded it, and then in whispers. Ford got the unmistakable impression that they were avoiding his gaze.
There came a low-tech electronic buzz, and then Ford heard Haynes’s voice coming simultaneously through an intercom and his office door: “Ask Dr. Ford to come in, please.”
Ford thought he knew why Haynes wanted to talk to him. The staphylococcus emergency threatened to have a profound impact upon the running of the hospital, not least because such a high percentage of its patients were admitted via the Emergency Department. The presence of a bacterial pathogen in the hospital also posed a particular threat to obstetrics—which accounted for a quarter of all admissions—because babies and mothers in labor were especially vulnerable to infection. Whatever the source of the problem, hard choices were going to have to be made about which facilities stayed open and which were shut down.
“Russell?”
“Take a seat, Marcus,” he said, looking not at Ford, but rather at waist-level space a couple of feet in front of him.
Haynes’s gaunt, pockmarked face wore an expression of impatience, as if the matter before them was not one he was going to spend a lot of time discussing, whether Ford liked it or not.
Ford sat down without saying anything. Haynes was upset about something, and it wasn’t just the fate of the patients.
“Marcus, I’m…” He sighed and pushed himself back from the edge of his desk, as if trying to distance himself from the seat of his responsibilities. “I’m afraid this situation is getting out of control.”
For a moment there was silence.
“I mean, way out of control. I just got off the phone with the chief deputy director at the health department. They’re mad as hell down there. Mad as hell about how this whole situation’s been handled.”
Ford blinked. What did Haynes mean, handled?
“Russell, we’ve done everything we can. We’ve never had to deal with anything like this before. Don’t they understand—?”
“I’m not talking about the outbreak.” Haynes was almost shouting. “I’m talking about the press. The publicity, goddammit. In less than two weeks time the board of supervisors is going to decide whether or nor to accept the health department’s restructuring plans, plans which stave off the worst of the cuts in return for a leaner system long-term. This crisis could derail the whole deal, not to mention a year’s negotiations with Washington.”
Ford stared at Haynes, unable at first to take in what he was saying. Here they were, dealing with a medical emergency, and all the health department was bothered about was the press. He could only assume that the death of Raymond Denny had taken on some new political significance.
“With respect, I don’t see that we can be held responsible for how the public reacts to what’s happened. Our job is to—”
Haynes slapped a copy of the Los Angeles Tribune onto the desk. On the front page, just below the latest on a celebrity rape trial, a headline read: epidemic threatens south central. It looked like the most alarmist report so far, but worse than that, it carried a photograph of Ford alongside it, talking into a battery of microcassettes.
“The article cites you as saying that cuts in the healthcare budget are contributing to the crisis. It’s right there in quotation marks.”
Ford stared at the article in horror.
“But … but…” he stammered, “I never said that. They just asked me what was happening.”
“And
you told them that the epidemic was at large among the South Central population—in effect, out of control—and that the county was responsible.”
“I didn’t say a damn thing about the county. I don’t know how … They must have spoken to one of the people at that conference. I was talking about the need for supervision of antibiotic therapy. About access to health care.”
Haynes closed his eyes, shaking his head in disbelief.
“Russell, it was a professional forum.” Ford searched for the right words. “Nothing I said was in any way political.”
And as he spoke he remembered what Helen Wray had said, that his whole speech had been political, with a small p. Suddenly it felt as if his work as a surgeon was no longer just about the patients and their needs. It had levels of significance, touched upon priorities and considerations, that he knew little or nothing about. It was a bad feeling.
Haynes did not look impressed. “Well, I can understand just why Dr. Patou was so anxious to hear what you proposed to say before you gave that speech,” he said. “I wish I had taken her objections more seriously at the time.”
Ford bit his lip. It was a deliberate dig; it had to be.
“Of course, in making a statement on our infection problem without her say-so, you’ve strayed onto her territory yet again. I deliberately put her in charge of dealing with the media on this thing.”
“Look, they jumped me in the parking lot. I wasn’t ready for them. I’ve refused all calls from the press since then.”
“Well, I should damned well hope so.”
“I suppose Dr. Patou has complained again?”
“Not to me, not yet. But I’m sure she’ll eventually get around to it.”
Haynes took a handkerchief from his pocket and dabbed at the perspiration on his brow. The edge had come off his temper. Now he just looked tired.
“Look,” said Ford, “if you want me to talk to her, I’ll talk to her. But she’s got to understand—”
“I’m afraid it may be a little late for that. She’s gone over my head this time.” Haynes sighed and tucked the handkerchief back into his pocket. “She has connections in the health department, you know. And with this Raymond Denny thing, well, she’s got them pretty stirred up—not that they weren’t stirred up already. She’s also taken her concerns to our chief executive. Of course, I’d have preferred it if she’d have come to me, but … well, it’s too late now.”
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