by Rob Horner
Matthis nodded. “It’s why I was here, to see if Riggs could come up with a way to neutralize the negative effects of the bacterium.”
Lowman thought for moment, then asked, “What about the aggression?”
“Aggression and communicability came hand in hand. Both started when we tried to isolate a modifier that would render certain people immune.”
“The safety net mentioned in the reports?” Lowman asked.
“Mm Hm. It was a stipulation that we first build an immunity before we could begin experimenting with prions.”
“What’s the immunity?”
“We called it ‘The O Factor.’ Type O blood is the dominant blood type in the United States, comprising roughly 38% of the population.”
“So, 38% of people would be immune?”
“Mostly. Some Rh positives might suffer transient symptoms, much like some people experience a day of mild illness after receiving the flu shot, but they will pass in short order. Rh negatives should have no symptoms whatsoever.”
“Why does Rh make a difference?”
“We aren’t sure, but it stems back to the communicability.”
Dr. Lowman checked his watch. He had five minutes before the phone conference began. “Give me the bottom line, Dr. Matthis. Please. What got released during the explosion? Why are there so many reports of aggressive attacks after the initial illness? Is this going to be self-limiting, or are we looking at an epidemic?”
“I understand the need for answers, Dr. Lowman, but I just don’t know all of them yet. We had only just come up with this stable combination and hadn’t begun trying to modify it beyond building in the immunity.”
Greg remained silent.
Matthis sighed. “It’s a combination of the Kuru prion, the Clostridium difficile bacterium, and a carrier molecule from the smallpox virus. Not the virion itself,” he hastened to add. “The carrier molecule is only there to try to make the immunity communicable.”
“So, no one can get smallpox from this?” Greg forced himself to sit back down, rubbing his knees after bumping them on the underside of his desk. The shock of hearing that smallpox was involved almost sent him into palpitations.
“No, no, not at all. But something in the combination is re-activating and changing the prion, so that when it hits the brain, it becomes aggressively virulent, multiplying at remarkable rates. It also attaches itself to the carrier virus.”
“Smallpox is airborne,” Lowman said breathlessly. “Is this—?”
“Again, no, we don’t think so. Its communicability is limited by the prion’s communicability, so it’s a direct contact kind of thing. Blood, body fluids, etcetera.”
“A scratch?”
“Conceivably, but a bite would be more in line with what we think.”
“And the abdominal symptoms?”
“We think those are limited to the people with direct exposure to the airborne particles from the explosion.”
“And why are they so…devastating?”
Matthis shifted in his seat. “We can only hypothesize that the combination of particles has made the Clostridium difficile into an extra-nasty version.”
“I’ll be sure to put that in my report,” Lowman muttered. “Extra-nasty.”
Matthis smiled. “Not very scientific, I know. But we’re dealing with guesses right now, not absolutes.”
“I get it. I didn’t mean to be sarcastic.”
“So, to put it all together, those with direct exposure will have abdominal pain, diarrhea, bloody vomit, and, from the reports, almost universal mortality.”
“Except the immune?”
“Right. Those with O-type blood will be immune.”
“And the aggressiveness?” Greg asked.
“A result of Kuru reactivating. As you are no doubt aware, prion infections are infections of the brain.”
“Neurodegenerative,” Greg said.
“Yes, quite. But it would seem this is exceedingly rapid, if the reports are coinciding with the abdominal pain complaints.”
“They are. What about the people who receive a secondary infection?”
“Only the modified Kuru should transmit, but your guess is as good as mine right now how that will manifest.”
“Will the immunity hold true?”
Matthis shifted in his seat again, which Dr. Lowman understood to mean a topic the scientist wasn’t comfortable with, either because he didn’t know the answer, or because he hadn’t predicted it.
“We haven’t been able to test that with this combination,” he said finally.
“With others?”
Matthis sighed. “In all previous testing, we’ve been able to establish a 100% immunity for primary subjects with type O blood.”
“Secondary transmissions?”
Matthis hung his head again. “Immunity only confers to a negative Rh factor.”
“So only about 3% of the population will be immune?” Lowman asked incredulously.
“Only those with O-negative blood, yes.”
Chapter 17
Even with the hospital locked down, police taking staff aside one by one to ask questions, the function of the department continued. It had to. There were people counting on them to give answers, take the pain away and, hopefully, get them better.
Tina was aware of this as she sat at her computer. Austin’s labs were back, most of them, and they provided an interesting clinical picture of the patient. Digging into the numbers and trying to find the answer should have been foremost in her mind. But he was stable, for the moment, and the situation in the department was not.
Dr. Crews was in Trauma 1, trying to put together enough of Randy Sprugg’s throat to keep him alive.
Buck was standing guard with one of the security guys on Room 10, where his co-worker lay with restraints on his legs and left arm. The right arm was splinted at a ninety-degree angle and sling-swathed to his chest, to prevent him from injuring it further or using it to undo the restraint on his left arm.
And Lisa…poor Lisa. Tina felt the hot sting of tears trying to form in her eyes and angrily willed them away. Lisa had been a fixture in this hospital before Tina came eight years ago. She was a die-hard advocate for the suffering patient and a no-nonsense nurse who could smell bullshit from a mile away and was willing to call people out on it.
And she was a friend.
Lisa still lay on the floor of the hallway outside the break room, arms and legs akimbo, the last portrait she’d ever pose for being taken by a police photographer.
Then there was Jessica. She was another of those rare nurses, always at her best when caring for people at their worst. She’d been planning to get married. Would that change now, with the knowledge that her gun had cost a co-worker her life? Would it change with the loss of her job?
To be fair, she hadn’t lost it yet. But it was inevitable. You don’t get to keep working at a place with a no-gun policy after bringing your gun inside, regardless of your concealed-carry status. A lot of the people around her might lose their jobs in the next twenty-four to forty-eight hours, depending upon when someone from administration showed up to deal with this mess. No one had been allowed to leave to stash their weapons, and she knew at least three or four nurses, CNAs, doctors, and secretaries who carried something small in their purses or backpacks. Tina wasn’t sure, not having checked the nurse licensing laws lately, but it was possible a case could be brought against Jessica’s nursing license. What would that do to her?
She didn’t want to try putting herself in Jessica’s shoes. What did that say about her, that she was unwilling to attempt to empathize?
That didn’t stop her from brooding about it.
The labs on her computer screen taunted her. There were little indicators flashing over the icons for her other patients as well. The lab must have gotten a bug up their ass to get stuff done. Maybe not getting new samples from the ED because of the lockdown prompted them to finish what they had and take it easy for a while.
The nurses’ station was crowded with staff from both shifts congregating. Though 7 pm had come and gone, those who’d been there all day couldn’t leave until the lockdown was lifted. The nurse practitioners worked slightly different shifts than the nurses and doctors. James had the nine to nine shift today, running Fast Track. When he left in a couple of hours, Fast Track would close. Tina was on from 1pm to 1am, so her shift was only halfway done.
“Do you want me to check your labs?” Dr. Patel asked from beside her. “I don’t mind, since I’m stuck here.”
Tina shook her head. “No, but thanks.”
The telephone rang, the tone indicating it came from within the hospital. The night shift secretary, Genny, answered. “Tina, it’s for you. Ultrasound.”
“I’ll take it,” Dr. Patel said, then, softer so only Tina could hear, “I need to feel like I am doing something.”
Got to focus, Tina thought, opening the lab results panel on Austin Wallace’s chart.
Every lab they’d ordered populated the screen, with the name of the thing tested (protein, electrolyte, etc.), followed by the patient’s current value, and a range of numbers that told whether the lab was normal or abnormal.
“What the hell?” Tina asked.
“What is it?” Dr. Patel said, hanging up the phone.
“Everything is normal on our guy in Trauma 2.”
“Even the urine?”
“Well, there’s blood in it, which we could see. And he’s got a slight elevation to his specific gravity—”
“So, he’s dehydrated, understandable.”
“But other than that, nothing. No drugs in his system, white cell counts are good…no sepsis or anemia…nothing.”
“And yet, he is very sick,” the doctor observed.
Tina nodded. “The only things not back are the blood cultures and the Ovum and Parasites test on his stool.”
“Did you order the C. Diff PCR test?” Dr. Patel asked.
“I did, but I don’t see the results.”
“It is a newer test and not built into the system properly, so the results come by fax,” the doctor said, spinning and rising from his chair. “I will check the fax machine. Oh, by the way, start AMA paperwork on Ms. Cumberland.”
“What happened?” Tina asked.
“The ultrasound technician would not tell her the sex of her baby, only that it was successfully implanted in her uterus, and that she is about twelve weeks along. She became irate and stormed out of the hospital.”
Tina smiled. “Thanks, Doc. First good news tonight.”
He reached the fax machine and began rifling through a half-dozen sheets of paper until he found what he was looking for. “Maybe this is more good news? His C. Diff is positive.”
“Crap. Genny, institute contact precautions on Trauma 2.”
The other three patients, the only ones left in the ED besides Mr. Sprugg, flashed into her head. Only one was hers, the young diabetic in room 15, Kristie Burleson. Her blood glucose was usually well-controlled, but she’d gone through her period of defiance, something most teenagers with the disease experience, where they want to eat like their friends, party like their friends. It’s just not fair. Tina agreed. It wasn’t fair. That last visit happened a year before, and she hadn’t been back since. Which spoke well to her maturity.
Dr. Crews was supposed to have the other two. One was Sonny Cranston, a well-known drifter and off-and-on homeless man who usually only showed up in the winter, on those rare nights when the temperature was expected to dip below freezing. A quick glance in his chart showed the same lab panels that had been put in for Kristie, so James was convinced the man wasn’t just faking.
Crapped in the triage chair.
Tina couldn’t suppress a chuckle at Tiffany’s triage note. She also couldn’t fight back a smile as she raised her voice to announce, “I’m gonna need stool samples in 16, 7, and 8.”
A chorus of groans greeted the order, which she expected.
“Have you been in the same room as 7?” China asked. The tall, thin, night-shift CNA glared daggers at Tina. “He stinks on a good day. I don’t want to have to go near his ass.”
Brandon laughed and offered to help.
“Oh, like he’s gonna want you playing around back there?” China returned.
“Contact precautions, guys,” Tina said. “Let’s assume they all have C. Diff and maybe we’ll all get to go home without it.”
“Do you think they do?” Jordyn, a mid-twenties night-shift nurse, asked.
“They all have the same presentation, so let’s assume it and stay safe,” Tina answered.
“What do you think?” Dr. Patel asked softly.
“I don’t—” Tina started to answer but was cut off by the alarm of a cardiac monitor.
“It’s Trauma 2!” Billy said, jumping up from his spot at the nurses’ station. He was the night-shift nurse replacing Lisa. “I never got a report on him because, you know—”
“We’ll talk about it inside,” Tina said, jumping up and rushing for the large trauma bay, wishing someone hadn’t pulled the glass door shut and closed the drapes. But that was silly. They’d had an active shooting and limiting the view of patients was part of the procedure.
“You just made him contact precautions,” Genny called out.
Tina ignored her. Reaching out a hand, she slid open the glass doors and pushed through the curtains. She’d had plenty of contact with him earlier. If she was going to get C. Diff, then it was just going to have to happen.
Austin was seizing, a full-blown tonic-clonic. The cardiac monitor reacted to every muscle contraction and flailing limb like it was an extra beat, which explained the alarms. The pulse showed 210.
Reaching for the dispenser beside the door, she pulled out a pair of nitrile gloves and yanked them on.
“Seizure,” she called out behind her. “Get 2 milligrams of Ativan.”
“On it,” Jordyn replied.
“What’s his deal?” Billy said, coming into the room beside Tina, slipping gloves on his hands.
“Let’s get him on his side,” Tina said.
“Right or left?”
“Doesn’t matter, but we want to keep his backside pointed away from us.”
“Ooh, one of those,” Billy said. “He’s got a lot of lines for a diarrhea.”
Tina and Billy worked quickly, moving to the left side of the bed—their left. They reached over Austin and pulled on his shoulder, logrolling him onto his right side.
“He’s positive C. Diff, came in EMS this afternoon after being found DFO in the parking lot of the mall. Attacked Buck when they tried to get a line on him.”
“Is that why Buck’s got the Man-dana?”
“Yeah, this guy took off part of his ear,” Tina replied.
“No shit?”
“Got the Ativan,” Jordyn said, coming into the room.
“2 migs?” Tina asked.
“Yup.” Jordyn hurried over to the side opposite Billy and Tina, tearing open an alcohol swab as she reached for the IV port. “Swabbed and pushing it in now.” Cellophane rustled as she produced a saline flush from her scrubs pocket. “Flushing the line.”
“Dude’s pretty hot,” Billy observed.
“I hadn’t noticed,” Tina said dryly.
Billy laughed. “You know what I mean. He’s burning up.”
“Temp was normal when he got here,” Tina said, shifting her grip to place a hand on his forehead. “But you’re right, he feels like he’s burning up.”
“Want a rectal while I’m over here?” Jordyn asked.
The shakes were beginning to subside as the Ativan worked its calming magic.
“Better put on a splash guard if you’re going spelunking,” Billy quipped.
Tina glanced at the cardiac monitor. The heart rate was dropping as the seizure passed, transient spikes disappearing.
But that wasn’t a normal rhythm underlying the seizure activity. It was barely a sine wave, disorganized and
with noise along its course, greater at the upper and lower voltages.
“He’s in V. Fib. Call a code!” Tina said.
“Calling it in,” Genny said from the nurses’ station.
Jordyn raced to the side of the room and grabbed the crash cart. Dr. Patel burst into the room behind them as the overhead speaker blared to life. “Code Blue, ED. Code Blue, ED.”
They still haven’t canceled the Code Black, Tina thought idly as Dr. Patel began spouting out instructions.
An exercise in futility, Tina thought.
They’d coded Austin Wallace for twenty minutes, shocking him three times before he went to asystole. Dr. Patel finally called Time of Death at 7:45.
It made no sense. People didn’t die from dehydration that quickly, especially not with the amount of fluids they’d pumped into him since his arrival shortly after five.
Tina’s arms ached from the effort of repeated turns at chest compressions, and she couldn’t help but wonder what they could have done differently to achieve a different outcome.
“Don’t let it get to you,” the doctor said in his soft voice.
Before Tina could respond, before she could begin to formulate a response, a wordless cry of surprise sounded from room 15. Tina, Dr. Patel, and two of the nurses started moving. A crash came from the room, something metallic falling to the floor. Then they were around the station and reaching for the door, but it was jerked open and a harried and bleeding Tonya came running out.
“She just flipped—”
A scream of rage came through the open door, and another of pain. Kristie’s mother was leaning over her daughter, trying to pin her to the bed. “I’m sorry, so sorry, she’s never like this!”
Tina came into the room with Dr. Patel and saw Kristie with her teeth buried in her mother’s shoulder, red already staining the yellow fabric of the shirt around her mouth. The look on the young girl’s face was electrifying, a snarl of rage unlike anything the nurse practitioner had ever seen before.
“She just slapped at me while I was checking her blood pressure,” Tonya said. “But she had her claws out, you know?”
“Tina, grab that arm,” Patel said, moving around to the right.
