Allen fell silent. Ford could hear the sound of footsteps coming along a corridor. They were barely audible but perfectly distinct, perfectly reproduced. Then a door closed. When Allen spoke again, it sounded as if he had gotten closer to the phone. His voice came through in a whispered growl.
“Man, who cares how it looks? This is no time to start worrying about principles. Especially after the way you’ve been treated.”
“Conrad, to hell with the principle. I believe in the Willowbrook. I believe in the people who work there, and I’m standing with them through this thing. I’m not gonna jump ship because of a few damned reporters and a bunch of accountants at city hall.”
Allen sighed into the phone.
“Okay,” he said. “If that’s the way you want it. It’s your daughter. Your call.”
And he hung up. Ford sat staring at the folds of the drapes. He pressed his lips together and closed his eyes for a moment. Allen was right, but at another level he was wrong. You had to care about principles, and that didn’t change just because of circumstances or just because you had been given a raw deal. He looked around at the room. It was the first time he had been alone in the house in a while. He had an eerie feeling that he was being watched by Carolyn. What would she have said about his leaving Sunny down in South Central? He picked up the phone again and punched in Helen Wray’s number.
“And you know what I felt?” asked Ford, once the dishes were in the sink and he and Helen were installed on the couch with the remains of the burgundy she had insisted on bringing.
“Frustration, I guess. I know that’s what I’d feel, all those cameras pointing at me, nobody really listening.”
“Sure. That’s true too. But it came to me when I was looking at all those people that … that they were somehow angry with me. That they wished me ill. They were hoping things were going to turn out badly.”
“They couldn’t care less. They just want to sell newspapers.”
Ford sat forward on the couch, nursing the wine between his hands.
“I guess. But apart from that there was something…” He frowned, trying to understand what it was that had disturbed him so much. “Do you know what it was like?” He turned to face her, noticing how tired she looked. She had probably been looking forward to an early night—had come over to be with him in spite of that. “It was like I was something alien that was triggering … like, an immune response. You know? Like something that the histocompatibility complex had determined was nonself, different.”
“An antigen.”
“Exactly. And all these furiously active microorganisms, with their cameras and microphones and antennae, were attaching themselves to my surface, worrying away at the membrane.”
“Stop. You make it sound like a horror film.”
Ford leaned back, pushing his fingers against his tired eyes.
“I swear to God, that’s exactly what this is. A horror film.”
Helen moved closer until her dark fragrant hair was touching his face. She gently removed his hand and kissed his closed eyes.
“Mmmmnn,” growled Ford, but he was just being polite. He could not get excited the way he had been in her apartment. He was too conscious of this being the couch that he and Carolyn had bought. But he was glad she had come, nevertheless. She had put on her battered chinos again and a T-shirt that said yosemite in faded red letters. The clothes had the effect of toning down her almost strident sexuality. It was the way he liked her best.
“You have to keep some kind of perspective,” she said. “And you have to be positive.”
Ford looked at her. This close her steady, all-seeing predator’s eyes were almost hypnotic.
“Like the guy in the joke, you mean?”
“Which guy?”
“Guy falls from the top of an apartment building. He’s got ten seconds before he hits the sidewalk, and as he flashes past each floor, he keeps saying—‘So far so good, so far so good, so far so good’…”
Helen smiled.
“You’re not going to fall,” she said. “Sunny’s going to get better; Novak’s going to come up with an answer to the superstaph; you’re going to be reinstated.”
“Marshall West will find the money for a new trauma center. The hoodlums will hand in their guns. The Democrats will control Congress.”
“There you go,” said Helen, giving him a friendly squeeze. “Two months from now you’ll be up to your elbows in some crack junkie’s intestines…”
“Everything back to normal,” said Ford, nodding, hoping she was right.
5
The taco restaurant at which Sunny had eaten tested positive for Clostridium botulinum. The CDC team isolated the bug in canned corn that the restaurant owner had purchased from damaged stock at a warehouse based near Hermosillo in Mexico. Three other cases of food poisoning had been reported in LA that the CDC were able to link to the same source. The establishment was closed.
Despite Helen Wray’s reassurance, Ford did fall, was falling. That was what it felt like, anyway. Freefall. With nothing between him and the worst kind of dead-stop definitive ending. Sunny did not react badly to the CDC serum, but it didn’t seem to help her, either. He spent hours by her bedside, holding her limp hand, watching the machine feed her air. He talked to her ceaselessly, hoping that his voice would give her something to hang on to.
Three days after initial admission, Dr. Lee once again took him into his office.
He looked tired and overwrought. Everybody was acutely aware of the developing crisis in the Emergency Department. Patou’s attempts to contain the outbreak appeared to be working for the time being, but there had been three more deaths among the cohorted patients, and the media had virtually set up camp in the parking lot. Russell Haynes had been obliged to call the county sheriff’s department for additional safety police to ensure access for ambulances and staff.
Lee’s desk was piled high with medical journals and textbooks, some of which Ford remembered from med school. Seeing Ford’s curiosity, Lee picked up one of the fattest tomes.
“Remember this? Haddad and Winchester. As you can see, I’ve been doing a little reading.”
“To good effect, I hope,” said Ford, soberly. He wasn’t in the mood for professional banter.
Lee shrugged, returning the book to its teetering stack. He leaned back in his chair and brought his smooth, effeminate hands together over his stomach.
“To be honest with you, Dr. Ford, Sunny’s case is … well, it’s causing me some confusion.”
So far so bad, thought Ford.
“How so?”
“Well—and you have to understand I’ve been looking at the detail in close consultation with Rita Benowitz at the CDC; she’s their expert on this organism—I … Look, I’ll start with the facts. Last night, after you left the hospital, the lab people informed me that they had found high levels of botulinum in Sunny’s stool. In spore form, but also as mature organisms.”
“She’s infected. We already knew that.”
“No, I’m not talking about the samples we took when she was admitted. This sample was taken yesterday. If anything, the bug seems to be present in slightly higher concentrations now than it was when she was first admitted.”
“It’s multiplying?”
“Apparently. Unless, of course, it has just come down with the last of the food she ingested. But I doubt that. In fact I would say that was extremely unlikely.”
“But you said that couldn’t happen. You said that her GI tract would be too acidic.”
“That’s right. Normally speaking, that would be the case. In infants up to six months botulinum can replicate because of the relative sterility of the intestinal lumen and the low acidity. In adults the bug cannot normally survive. However—and this is direct from Dr. Benowitz; this is the current position—for a while now the CDC has been employing a fourth category for the disease, which they term Botulism Classification Undetermined or BCU.”
Ford gave a wry smile.
“That’s right. They’ve had cases that were outside the norm, including infected adults. They wanted to describe the indescribable, and that’s what they decided to call it. The people in this group—people said to be infected by BCU—have to be over one year old and cannot have any foodstuff or wound as the source of their disease.”
“I don’t understand. Sunny got it from food.”
“Just bear with me a second. The important issue here is not really where Sunny got it but whether or not the thing can replicate in the GI tract. We know where and how she picked this up, but we don’t know why it’s surviving—apparently even breeding inside her. Now, this is all fairly virgin territory, you have to realize. There are few certainties. Benowitz believes that most cases of BCU represent an adult variant of infant botulism. Usually the patients have some abnormality in the GI tract that could facilitate spore germination. Low acidity or relatively sterile intestinal lumen as a result of pretreatment with broad-spectrum antibiotics are often factors.”
“Sunny is a perfectly normal child,” said Ford blankly.
Lee watched him for a moment.
“No history of antibiotic use?”
“Nothing out of the ordinary. In fact, I’ve always discouraged them except where there’s no alternative.”
Lee looked down at his linked hands. With a slow, meditative gesture he opposed his delicate thumbs.
“So what do we do?” asked Ford.
Lee didn’t have to reflect for long. He had obviously already made up his mind about the options.
“It’s a difficult call to make. As long as she has the right systemic support, she is in no immediate danger. However, there is a point at which prolonged use of the antitoxin could become … problematic. We can go on administering the current levels for a while, but the longer we do, the greater the risks of an adverse reaction. I certainly wouldn’t want to step up the doses.”
“How long do we have?”
Lee tried to smile.
“Let’s see what happens.” He was rounding up now, concluding the meeting, looking for the positive payoff. “At some point the number of organisms is going to fall.”
“And if it doesn’t?” asked Ford.
“Then we will have to consider some way of attacking the bug.”
“Attacking? With antibiotic therapy, you mean?”
“Right. Penicillin is theoretically contraindicated because if you rupture the cell wall of this thing, you release more toxin, and her system does not need more toxin. But there are alternatives. Chloramphenicol, metronidazole … vancomycin.”
Ford was starting to get a feeling of deja vu. The names came up like road signs leading to disaster. Getting a grip, he told himself that Sunny’s infection had nothing to do with what was going on in the Emergency Department. Lee was still talking.
“… giving us a degree of leverage. Chloramphenicol, as you know, inhibits peptide bond formation; it stops the bug in its tracks without tearing it to pieces. I think that that’s what I’d go with initially.”
Ford stared hard and long at Lee’s face. He wanted to find something there that would give him hope.
Lee looked away.
They tried Chloramphenicol. But material and fluid from Sunny’s GI tract continued to culture positively for botulinum. Four days into her illness she suffered a brief and alarming episode of cardiac fibrillation. At two o’clock in the morning her heart’s normal sinus rhythm was lost, as the heart’s muscle fibers flickered in spasm. A Code Blue was called, and the doctors administered digoxin. Within two minutes normal contraction resumed.
Ford was by Sunny’s bedside that morning when he was told what had happened. It sent him into a flat spin. Raising his voice, drawing looks from other patients on the ward, he insisted that he was not going to leave Sunny’s bedside again.
“I should have been there,” he said. “I’m a doctor, for Christ’s sake. I could have helped. What if the Blue team had been dealing with something else? What if—?”
“They were here within a minute of the call,” said Lee firmly. “There’s nothing you could have done that they didn’t do.”
Ford could not understand. He stared at Lee’s impassive face. The smaller man’s lips were moving, sounds were coming out, but Ford could make nothing of it. Then he found himself being eased into a chair next to Sunny’s bed. A nurse appeared with a cup and what looked like a tranquilizer. It was crazy. They were treating him like a patient. With a flush of embarrassment, Ford realized that this was because he was behaving like one. He was behaving like someone who had no understanding of what was going on, someone for whom the only reference points were emotional. He took the tranquilizer and washed it down with the tepid water.
“Okay,” he said, wiping his mouth. “Okay. It’s all right now. I understand.”
Lee backed off a step. Ford turned and looked at his daughter. He stroked her fine blonde hair. Her irises were just visible under the prolapsed eyelids. She looked impossibly fragile.
“You’re only going to make yourself ill,” said Lee.
“The doctor’s right,” said a deep, maternal voice.
Ford turned and saw Gloria Tyrell. She was standing at the end of the bed, a legal pad clutched to her matronly bosom.
“You’ve got to be strong for her,” she said. “She’s goin’ to be needin’ you when she gets out of here.”
Ford got to his feet.
“Jesus, Gloria,” he said. “It’s good to see you.”
Gloria shrugged her heavy shoulders. She too was looking tired.
“Just thought I’d say hello,” she said.
“How’re things in ER?”
She rolled her eyes expressively.
“Aren’t you breaking quarantine?” asked Ford.
Again there was the expressive roll of the eyes.
“Dr. Allen told me you’d be here. So I thought you ought to have this.”
She handed him the legal pad. On the top of the first sheet of paper, a telephone number had been scribbled and next to it the name Wingate.
“Man keeps calling. I explained about what’s going on here. He wanted your home number, but I thought it would be better if you called him.”
“Okay. Yes. Thank you.”
Ford looked blankly at the sheet. It was a moment before he made the connection between the name and the doctor who had called from Beverly Hills. He tore off the page and folded it into his pocket.
“I’d like to look after Sunny,” said Gloria, addressing herself to Lee.
Ford looked at her big friendly face. He found himself smiling again, partly at the warmth, but also at the confidence she inspired. Looking at her, this mountain of a woman, with her large, practical hands, you could believe that there was no illness she couldn’t nurse you out of.
“I’m afraid that would not be allowed,” said Lee. “Not my decision, of course. The chief of infection control would have to be consulted.”
Once it was clear that Sunny’s botulinum was multiresistant—neither chloramphenicol nor metronidazole appeared to have any impact—Patou was brought into the case, as a matter of course.
There was a terse interview in Lee’s cramped office, Patou for some reason sitting in Lee’s place, while the two men perched on the other side on plastic chairs. Patou was clearly uncomfortable talking to Ford as the parent of a patient rather than the professional rival—enemy even—that she had come to see him as. Ford, numbed by the news of the botulinum’s resistance and the prospect of Sunny’s going onto vancomycin, listened quietly to Patou’s evaluation of the situation in the Emergency Department. There had been another death during the night. This time of a young woman thought to be part of a local gang. She had been admitted with two stab wounds to the lower abdomen four days ago and had succumbed to a staphylococcus infection in the early hours of the morning. The superstaph had now taken eight lives in two weeks.
Finally Patou came to the subject of Sunny. As she spoke, she kept her eyes on the page of her notepad.
“It now appears that Dr. Ford’s daughter is suffering from a multiresistant pathogen. Of course, we don’t yet know how it may respond to vancomycin, and I’m sure we all hope for a … positive outcome. If, however, it does not respond, it will clearly represent an alarming new departure. Resistant wound infections are one thing. Staph, as we know, comes into constant contact with antibiotics, especially within the hospital environment, but botulinum does not. According to the CDC, there has been an increased incidence of wound botulism particularly among the intravenous drug users where a degree of pathogen/antibiotic interfacing may have taken place. That, I think you’ll agree, is a matter for reflection.”
Ford sat up at this. It seemed to be an acknowledgment of his own views on the development of resistant bacteria.
“But whatever the mechanisms involved, I suggest Sonia Ford be isolated. Not with the cohorted staph cases, obviously, but on her own.”
Ford nodded his appreciation of this.
At the end of the interview, rounding up, Patou mentioned the fact that three other hospitals in the metropolitan area had reported cases of resistant staphylococcus.
For a moment Ford thought he must have misunderstood. To him it seemed like headline news, but Patou had slipped it in like an aside, a footnote. She was shuffling papers, making ready to leave.
“You mean resistant to vancomycin, to everything?”
Patou stopped what she was doing.
“I believe so.”
“I don’t understand.”
“What don’t you understand, Doctor?”
“You’re saying this is happening all over the city? Where?”
Patou calmly addressed her notebook.
“Saint Francis, Daniel Freeman, Centinela.”
Ford sat back in his chair, making it crack.
“But this changes everything.”
“Oh?”
“Well…” Ford gestured with his hands, his mind racing. “Well, it means that your theory that this thing was nosocomial, that we somehow, through sloppy procedure, cooked it up in-house … that all goes out the window.”
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