Weapon of Choice

by Patricia Gussin

  Why was she thinking about the past? The present needed every morsel of her attention. Laura decided to do a checklist, an exercise that always helped her cope. To-do: first, make sure Natalie gets ticokellin. She’d signed the informed consent, cringing as she read about the side effects, the most dangerous of which was aplastic anemia, a rare lethal condition that wipes out the bone marrow. There’d been three cases in the clinical trials. Perhaps simply by chance, perhaps drug toxicity, but too many for the FDA to approve the antibiotic. One case in every five hundred patients treated. Next on the list:—

  The phone rang and Tim got up to answer it, mumbled a few words, hung up the phone, and sat back down beside her.

  “Trey Standish died,” he said. “Poor Natalie. She poured out her heart today, Laura. Made me feel so much like a father. She’s so young, but she’s in love. Remember that song by Paul Anka, I think. ‘They say it’s puppy love’ or something like that.”

  “That’s where Natalie got this staph, Tim, from Trey Standish.”

  “The clerk in the ICU said the parents asked to talk to you,” Tim said, “before they were escorted to the quarantine section.”

  Laura looked at Tim. In only one day, he’d come to know more about Natalie’s life than she did. “Tim, I feel so conflicted. I have to be here with Natalie and I have to care for the ICU patients. The CDC is sending in doctors who don’t have Florida medical licenses and most of the Tampa doctors are staying as far away as possible. How can I be with Natalie and still do my job? And now with the CDC decontamination protocol, each time we move out of a patient room, we have to go through a twenty-minute process.”

  “I’ll be here with Natalie,” Tim said. “You can rotate between here and the ICU. It’s the only logical solution.”

  “You’ve done so much already, Tim. You need sleep. We’ve been up for how long?”

  “Forty hours. But it’s you I’m worried about, Laura.”

  Before she could answer, they heard a knock on the door. An apparition clothed in full-body cover: tangerine-colored, hooded jumpsuit, helmet, and face protector. So this was the new dress code.

  “Natalie Nelson. You’re her parents?” A female voice issued from under the gear. Your daughter is on the list to get ticokellin if you’ve signed the release.”

  “I’m her mother,” Laura said. “And yes, I signed the informed consent.” Without another word, Laura handed the document to the figure. A gloved hand reached out, took the form, and the figure turned to go.

  “When?” Laura asked.

  “We’ll see where she fits on the priority list,” the muffled voice said.

  Laura had always thought of Tampa City as her own hospital, her domain. Now, at her moment of greatest need, the Feds relegated her family to a priority list. Stand in line like everybody else. Natalie would have to wait her turn. For an instant, she remembered the grief in Dr. Victor Worth’s eyes when he failed to get ticokellin for his son. Now they had a supply, and she prayed the pharmaceutical company had sent enough.

  The clock on the wall said it was almost midnight. Tim would watch over her comatose daughter. Laura knew she could not abandon her patients. She spent the rest of the night rotating, just as Tim had suggested, between her daughter’s room on the pediatric floor and the ICU on the seventh. The ICU was fully staffed now with medical personnel on call from the CDC. The CDC team took charge and Laura was impressed by their competence. But they still needed her as a licensed local doctor with hospital staff privileges here, to write orders. She thought of Ed Plant, where was he? He had looked terrible the last time she’d seen him. And he wasn’t the type to walk out in a crisis. She needed to find out if he was okay. She felt responsible for him, too. As well as Michelle, and Bunnie, and the others. She’d have to drag herself back to the ICU.

  Every time she changed floors, she had to go through the time-consuming decontamination process. A total antiseptic scrub, a complete change of garb from head to toe.

  On her first two tours of Natalie’s room, she found her daughter unchanged, still febrile with a rapid heart rate, still poor oxygenation, respiration controlled by the machine.

  On each of her tours of the ICU, she’d found death. The first, Tom Mancini, the patient she’d operated on for beryllium-induced lung cancer, a victim of the toxic mineral in Standish’s factory environment. The irony, the Standish son and Mancini in the same hospital unit. Then she’d learned that the middle-aged nurse who’d had complications following a hysterectomy had died.

  Now as Laura left for the ICU, she wondered whether she should try to contact Trey Standish’s parents. Wouldn’t Natalie expect her to? But what could she say or do? Their son was dead. Ultimately, the decision was made for her when she inquired about the Standish parents’ location. A CDC responder fielded her call, explaining the strict isolation mode in force in the hospital. Those patients and personnel not exposed were quarantined in a clean area, monitored carefully. Those who’d had any exposure—which included Standish’s parents—were sent to a private room with total isolation until forty-eight hours passed with no evidence of infection and confirmed negative cultures. Laura was spared what would be a most uncomfortable encounter with Trey’s parents.

  In the meantime, the E.R. had transitioned into a dirty zone. Ambulances were redirected to the closest regional hospital.

  Tampa health care was under siege. Under the direction of the CDC, all hospitals within a sixty-mile radius had initiated cultures on all patient admissions and all staff. No visitors, except parents of small children. Laura realized that it had been Stacy who had wisely instituted these precautions. As horrible as the situation was, how much worse if this staph ran rampant in the community. She wished that Stacy had not been called back to Atlanta. She was the real hero in this tragedy and the only person Laura could trust to ensure that Natalie got ticokellin. Tomorrow the CDC big shots would arrive, causing a media circus, which Laura worried could shift the focus away from patient care.

  Rotating every two hours between visits to Natalie and to the ICU, Laura had not been to visit the additional intensive care units set up to handle secondary cases, starting with her chief resident, Michelle, and the ICU cleaning lady, Bunnie, whom she’d seen in the E.R. When she inquired, she was told that Michelle had been given ticokellin. Only two days ago, she’d asked Michelle to report back to her about ticokellin, the investigational drug Matthew Mercer’s father had so desperately wanted for his son. Thankfully, Mercer improved without it, and he’d been medevaced out of Tampa City in the nick of time. An HIV victim would not survive this aggressive staph organism, ticokellin or not.

  Bunnie wasn’t doing well, Laura was told. A woman of her age with a temperature of 104.8 degrees, delusional and hallucinating and showing signs of DIC wasn’t going to make it. Laura had wanted to follow up on whatever it was Bunnie had been trying to tell her in the E.R. Something like “a man doin’ sumthin’ to the patients like feedin’ them somethin’.” Had she said the man was a new doctor? Laura was too exhausted to remember, and now it could be too late to ask Bunnie for clarification.

  At six a.m., with only two of yesterday morning’s seven ICU patients surviving, Laura headed for Natalie’s floor. She managed to change into fresh isolation garb before she all but fell onto the closest of two cots crammed into the small room. Tim snored on the other cot, loudly, through the protective mask. Before Laura could even inquire about the ticokellin for her daughter, she’d fallen fast asleep.

  And, again, she’d neglected to inquire about her colleague, Ed Plant.

  CHAPTER FIFTY-THREE

  SATURDAY, NOVEMBER 30

  When Stacy entered the stark lobby of the CDC, she found Director Madeleine Cox chatting with the receptionist. The director, always polished and professional, looked ready to travel, briefcase in hand, a forest-green pull-along suitcase by her side. Dr. Cox was in her late fifties with steel-gray hair cut just above shoulder length, slim with broad shoulders and in three-inch heels,
taller than Stacy by half a head.

  “Stacy, I’ve been waiting for you,” she said, checking her watch. “I’m on my way to Tampa to see for myself what you’ve discovered there. I wanted to ask you some questions before I go.”

  “Of course, Dr. Cox,” Stacy said, pulling her shoulder bag closer. Inside, wrapped in layers of protective insulation, was the culture she’d taken from Tampa. Unauthorized. Against every protocol. Had the director found out?

  “I don’t have much time, so let’s talk over there.” Cox pointed to two chairs in a far corner of the lobby.

  “Nobody’s here but us at this hour.” The director’s trim suitcase rolled efficiently, her heels clicked against the polished marble floor. Stacy followed.

  “I’m most curious about how you got involved with this staph strain attacking Tampa?” Cox asked as soon as they were out of earshot of the receptionist.

  “Serendipity,” Stacy said. The two women settled into matching upholstered chairs, facing one another. “A friend in Tampa called me for advice on a HIV patient, the first in the Tampa area, we think. She wanted to put me in touch with the infectious disease specialist there, Dr. Duncan Kellerman. He did track me down in Detroit, where I was visiting my mom for Thanksgiving. Only he wasn’t calling me about HIV. By then, the Tampa City ICU had several patients with a virulent, resistant staph.”

  “Who is this friend?” the director asked.

  “Dr. Laura Nelson. She’s a thoracic surgeon. Chief of surgery at the University of South Florida and Tampa City Hospital. I consider her my mentor. We’ve known each other since she was a medical student in Detroit and I was in high school.” Stacy still flinched when she remembered those bad days in Detroit, how close she’d come to a life of drugs and despair.

  “So this Dr. Kellerman calls you and you drop everything and head for Tampa? Stacy, I know you earned a medical degree, but your focus now is research. Research relating to virulent, infectious staph. Doesn’t that seem like quite a coincidence?”

  Where was the woman going with this? Yes, it was quite a coincidence. But coincidences do happen.

  “There was something else, Dr. Cox,” Stacy said, starting to sweat in the small of her back.

  She must have found out that I took the staph, Stacy feared. Can I make her understand that I need to test it myself? To see whether the specific strain in Tampa is related to the strain developed initially at the NIH. Why should it be? Her thoughts raced. That research was closed down several years ago. But a crazy idea had occurred to her when she heard a Dr. Norman Kantor, a NIH scientist, was one of the infected Tampa patients. Talk about coincidences. Could he somehow have infected the hospital? But how? And why?

  “Yes?” Cox was staring at her now, a curious stare.

  “My friend, Laura—Dr. Nelson—called me back, too. She wasn’t at the hospital when the infection started; she was out of town with her family for Thanksgiving. But Dr. Kellerman called her in. She found out her teenaged daughter Natalie had been admitted to Tampa City Hospital.”

  “I’m confused. She’s out of town with her family. But her daughter’s in Tampa?”

  “Yes. Laura was worried. The daughter is seventeen and hadn’t gone away with the rest. Laura has five kids.” Stacy paused in mid-ramble. What did the director care about Laura’s family? Madeleine Cox had no kids, wasn’t married; word had it she didn’t believe a woman could be both a professional and a mother.

  “You lost me, Stacy. I don’t understand how you got yourself in the middle of this—although I’m glad you did. Because you acted fast, we had our rapid-response team already in place last night. Tampa City Hospital is in lockdown. We should have this bug contained. Next, we’ll have to characterize it. That’ll be your lab’s job. Run every bio and genetic screen that you can get your hands on. We’ll get culture material to you by mid-afternoon. In the meantime, get everything set up.”

  By mid-afternoon? Stacy let out her breath. Cox had no idea after all about the purloined culture. Stacy could start the biogenetic profile on the culture she’d taken from Tampa right away. Once she got the official culture via the CDC, she’d be well into characterizing the staph stain. And if her hunch was right, what would she do next?

  “Stan Proctor told me that you wanted to stay in Tampa to watch how all this plays out,” Cox was saying, “but I told him you’re needed here. You have talent, Stacy. I’m pleased about your promotion. Stan went to bat for you with some powers-that-be who pushed for Charles Scarlett. I’m sure we made the right choice.”

  Cox rose from her chair, again checked her watch, “I really have to go.”

  “Please, Dr. Cox,” Stacy said, almost reaching for her sleeve so she wouldn’t leave yet. “Can I make a request?”

  “Of course.”

  “Dr. Nelson’s daughter, Natalie Nelson. Will you check personally, please, that she’s doing okay?”

  “I’m going to be very tied up,” Cox said. “The media, you know. I’ll be prepped on the flight to Tampa, so—”

  “She has the staph,” Stacy blurted. “Her boyfriend was one of the ICU patients. Before anyone knew what was going around the unit, she had physical contact with him.”

  “My lord. Yes, Stacy, of course I will. I didn’t realize. Of course you didn’t want to leave your friend and her daughter. How is the boyfriend?”

  “He died. Natalie’s condition is worse. Last I heard, waiting on ticokellin. I hope you will look in on her as soon as you get there. We were able to get a limited supply of ticokellin, but I’m not sure how they’re allocating it.”

  “I will. And we appreciate how you worked with Keystone Pharma and the FDA to bring in the drug so expeditiously. Dr. Jones, you’re not only a world-class scientist, but you’ve got the makings of an administrator, too.”

  “Thank you, Dr. Cox.” Stacy reeled from the praise. Madeleine Cox, director of the CDC, was not given to compliments.

  Cox gathered up her purse and hefted her leather briefcase over her shoulder. Reaching for her rolling case, she suddenly paused. “Oh, I almost forgot. I have something for you. An invitation. For tonight. A posh affair at the Palace Hotel. Cocktails, dinner, dancing, the works. Just one problem. I have only one ticket so you can’t bring a date.”

  “I don’t think I’ll have time to go, but thanks,” Stacy said, knowing she’d be working into the night on the Tampa staph.

  Cox ignored her response, set down her briefcase, and reached into her purse for an ivory-colored envelope, one of those expensive ones, heavy paper, elaborate calligraphy. She handed it to Stacy. “High priority,” Cox said. “The Atlantic Daily Reporter banquet tonight—in honor of Emma Goode. You do know who she is?”

  In the African American community who did not know the name Emma Goode?

  CHAPTER FIFTY-FOUR

  SATURDAY, NOVEMBER 30

  Victor had been miffed when Keystone Pharma called to say no planes were available. How can that be? he’d asked. After all, he was giving up a weekend to get them out of a jam. He was told the company’s private jets had to be diverted to Tampa because of an emergency there. But he cheered up at the offer to have a limo pick him up at the airport and drive him to corporate headquarters. Quite a change of attitude from his last trip to Keystone, he mused.

  On his way to Washington National Airport, Victor had stopped at the hospital to check on Matthew, to tell him that he’d be back too late that night to see him, but that he’d be there first thing in the morning. He found Matthew breathing easier, his skin less mottled, and his attitude cheerful. They’d talk tomorrow about arrangements for Matthew’s discharge on Monday and his subsequent transfer to California.

  During the flight, Victor pondered a professional problem. In his anxiety to rid his home of all traces of the experimental staph, he had destroyed years of his clandestine research. Now, when called upon to lead Keystone Pharma’s new drug program, he no longer had the data that would propel them into the future. A shortterm solution would be to go with t
he biskellin analog rather than the more toxic, but cheaper ticokellin—but in his basement he’d been developing a whole new generation of antibiotics. How could he not have kept a backup copy of his results in a secret, safe place?

  The flight turned turbulent, and Victor was the last passenger to be served before the attendants were told to take their seats. As Victor reached for his coffee, the plane bounced, splashing the hot, brown liquid all over his white dress shirt and pale-blue tie. “Soda water,” he called. He thought he heard a hollow, “Sorry, sir.”

  So, shaken by the bumpy flight, coffee-stained, he showed up at Keystone determined to drive a hard bargain, not to be bested by the corporate honchos.

  Dr. Minn greeted Victor and introduced him to the vice president of Human Resources, Al Mills. They drank coffee in the H.R. conference room this time, served in china cups with matching saucers. Yes, he had vaulted up the food chain.

  CHAPTER FIFTY-FIVE

  SATURDAY, NOVEMBER 30

  Charles took great pride in his home, built in the French Normandy style in 1945 on three wooded acres. Bountiful clusters of midnight-blue rhododendron surrounded the white mansion and lined the drive leading from the road. Everyone commented on the rhododendron. Not that he was into gardening; the huge blue-flowering plants had been there when he purchased the place three years ago.

  Stan Proctor’s reaction yesterday had been typical. Not many thirty-three-year-olds boasted a six-bedroom house, custom-designed pool complete with gazebo, three-car garage, and lush gardens. But isn’t that what trust funds were for?

  This morning he walked outside, noting that the pool cover was sagging and that the gardener had failed to remove a ladder leaning against the trellis. Mental note: call the lazy Negro. Even in his mind, he did not use the other N word lest it slip from his lips as the wrong moment. When you work for the government these days, you had to be careful. Civil rights advocates had infiltrated every agency. He thought about Stacy Jones. Never could he have endured being subordinate to her. Nor would he be. Instead he’d infect the whole lot of partying African Americans and any whites who chose to party with them. He’d been chosen to execute the preemptive strike.