by Barbara Ebel
Marlene thought her husband’s privacy issues were indeed strange. After all, doctors were the ones who trained and worked with naked or semi-naked people all the time. So, in her opinion, there should be little to no modesty issues for a physician. If anybody understood that human beings all had the same body parts, it was them. His behavior was odd.
George showered and padded into the bedroom wearing his favorite pajamas. Marlene closed her reading device and swung her legs to the side of the bed. “You finished?”
“Sure. I’ll be in my office for a little while.”
Marlene went into the bathroom. George’s iPhone was on the shelf next to the sink. She picked it up and poked her head out the door. “You forgot your phone.” The screen woke up as she passed it to him, and Tabitha Klondike’s picture popped up.
“Did you take a picture of a picture?” she asked.
George took the device and turned it face down. “Yes, I did. A lovely female patient of mine drew that sketch. I complimented her on her creativity and artistry. Even snapped the picture, letting her know that people may desire her work.”
Marlene smiled. “You are the best pediatrician, adding such personal touches to the doctor-patient relationship. I bet she was thrilled.”
With a wide grin, her husband nodded. “I try to be.”
“Well, you are. Whenever I visit your office, I see that side of you.”
Pleased with her remarks, George left for his home office. She showered as well and went back to bed, this time to sleep and not read. Her husband had made it to bed as well, and within minutes, he began to lightly snore.
But sleep would not come, especially since a thunderstorm added to the situation. Marlene hated when she couldn’t sleep, mostly because her activities the next day would suffer and she’d be too tired to focus correctly. And tomorrow morning, she needed to put hours in at the hospital. She read two more chapters of her current sci-fi fantasy and closed the cover of her eBook device.
Time to turn to a sleeping aid, she thought. She ambled to the kitchen and contemplated the over-the-counter pill containers in the cabinet. Although rarely needed, a white one combined with a pink one was her “color code” to sleep, so she grabbed an acetaminophen and diphenhydramine and chased them down with water. Now she waited for their effect and, in the interim, turned to go back to bed.
Marlene glanced at the hallway towards the front door. Her husband’s office door was always closed, but it was cracked open and a dim light shone from inside. That’s a first, she thought, and decided to turn off any lights.
She creaked open the door. It was only the desk lamp that was on, so she passed the other sparse furnishings and rolled the desk chair out of the way. George’s laptop cover was open. She still had a few minutes to kill, so she figured, what the heck. Perhaps a current news breaking story would pop up on the screen. She settled her fingers on the mouse touchpad and the screen came alive.
But in a second, she furrowed her brow and gasped. How could a news agency be so explicit! She was horrified at a naked young girl in a lewd posture.
Without thinking about it, Marlene hit the forward key to eliminate the story in front of her, but as she did so, she realized what she saw had no text or information.
Another picture popped up. A male youth was also without clothing and the shot appeared to be taken in a barn. The boy’s expression showed discomfort, as if someone was behind the camera making sure he did what was asked of him.
Finding it unacceptable and obscene, Marlene wanted to throw up. She couldn’t look at the boy’s act for another second, and placed her index finger on the laptop tab.
“Oh my God,” she cried, realizing she had discovered a cache of child pornography.
Her heart pounded with disgust and uncertainty about what the material in front of her meant. Some pages had more than one photo, and there was no discrimination over sex or ethnicity. Worse than that, all pediatric ages were exemplified, from infants to boys and girls more likely in their years of puberty. A huge thunderclap sounded, but it didn’t rattle her because the images in front of her gave her a jolt and took precedence.
Marlene left the computer just like she found it, turned off the desk light, and hurried to the bathroom attached to the office. She cried over the sink and trembled. For every young child she had seen, her body quaked like it was beset by a natural disaster.
How horrid, she thought. The material she witnessed was the result of poor, innocent children being used or abused by sick adults for their perverse enjoyment. And the bottom line most likely had to do with money. An illicit money-making industry where the perpetrators’ wrongful material was sold through porn sites or private websites like underground illegal drugs.
So what the hell was her husband doing with it? Her husband, a pediatrician? Her quivering subsided as she began to get hold of herself and her own stupidity. What she had failed to admit to herself was that, for years, she suspected his behavior was more amiss than she acknowledged.
Yes, she was guilty of being in denial that her own husband was a certifiable pedophile. Her chest heaved. Should she consider herself an enabler and somewhat responsible?
No, she told herself. But now what? She had found the material by accident; this was his own private affair and computer. If it had not been for the light on in the room, she would have never entered.
Minutes slowly ticked by and Marlene finally got hold of her emotions. She slipped out and into the hallway where a night light guided her back to the master bedroom.
She had two issues to grapple with as she slid under the covers. First, what to do about what she found. Was there some action she was supposed to take? Not that she was aware of. She was also not going to confront George. In essence, their relationship was off a bell-shaped curve already, so she should leave it unchanged.
Secondly, and worse for her, she had to keep those images from popping back into her head like some kind of child abuse pornography PTSD. Under these circumstances, even a whole bottle of acetaminophen and diphenhydramine wouldn’t be able to put her to sleep.
Throughout the dark morning hours, Marlene stared up at the dark ceiling. She was afraid to close her eyes and have her mind invaded by those images as lightning lit up the sky outside.
-----
Bob was never the medical sleuth that Annabel was, but tonight his blood simmered with exhilaration as he dove into the medical and scientific world of published articles in obscure, as well as important, journals. He was deep into researching medical illnesses with high eosinophil counts in blood and spinal fluid.
He was snug in his overstuffed leather chair and ottoman with the drape open to the sliding door. The thunderstorm was the perfect backdrop for his endeavors and one that helped deter him from going to bed.
A huge clap of thunder boomed and he startled. Oh no, he realized. Another night with a significant summer storm and Annabel had storm-phobic Oliver. Bad timing, he thought, because it should be his turn to deal with and comfort Oliver. And get no sleep because of it.
He grinned because at least he had bought the dog a thunder shirt and perhaps she would be using it on him for the first time. He wondered if he should call her to ask if it was helping, but it was already 11 p.m. Maybe, just maybe, she was getting some sleep.
Bob straightened his laptop on his thighs and focused again on a paper he just stumbled on. It was a historical accounting more than anything else, published in China, and written several years ago by multiple authors.
Here it was; the first reported human case of the particular type of eosinophilic meningitis they found, discovered in Canton, China in 1933. And the parasite responsible was first detected in rats!
CHAPTER 22
“The dare, that’s it,” Annabel continued. Oliver was huddled beside her on the bed and paid no attention to her. The stormy weather was more important.
“A stupid kid’s dare. I swear Toby is sick because of that slug he tossed down his throat! Now all
I have to do is prove it.”
She went back to the literature regarding neurocysticercosis, caused from ingestion of eggs from the adult tapeworm, Taenia solium, and then gnathostomiasis caused by several species of parasitic worms in the genus Gnathostoma. After assuring herself that both eosinophilic meningitises were not what Toby had, based on geography, etiology, and other parameters, she became more resolved to find a link to raw slugs.
By midnight, Annabel exhausted the use of the textbook she borrowed from the doctors’ lounge.
“Oliver, sweetheart, I’ll be right back.”
The dog nevertheless followed her. When they settled again, she sat cross-legged on the bed, resting her laptop on a thin pillow. She wasn’t bothered one bit about the time because Oliver needed her anyway. Tomorrow, she chuckled, Bob deserved some flack for somehow avoiding Oliver’s storm nights and leaving him with her.
Now it was time to dig into the massive volume of information so graciously available to every person in the entire world. She whittled down her search to “rare infectious disease,” and dived pretty far, but never pinpointed an entity quite like Toby’s illness. Soon she narrowed things down to scientific journals reporting “tropical” diseases.
Luckily, she stumbled on an American journal mainly dealing with tropical medicine and thumbed through indexes looking for the keywords of mollusks such as slugs or snails. Oliver’s panting increased with a close thunderclap and she managed to keep him lying next to her using her left arm.
Her eyes again rested on the computer screen to find an article with an important subtitle: “A parasitic nematode that is transmitted between rats and mollusks in its natural life cycle.”
She flipped the pages to the article and began speed reading: “Humans are accidental hosts. They do not transmit this infection to others.”
So far, as much as the medical team knew, no one else contracted the illness from Toby. She kept scanning and, finally, she came across something awful: “Eosinophilic meningitis caused by a lung worm of rats.”
“Oh my God, Oliver, listen up.” The poor dog startled, but she continued. “A lung worm of rats was first reported on the Gulf Coast only in 1985 and researchers think it came from infected rats. Rats scrambling off ships that docked in New Orleans!
“It says here this lung worm of rats is the principal etiologic agent of human eosinophilic meningitis, Angiostrongylus cantonensis.”
Annabel’s left arm left Oliver’s back and raised toward the ceiling. “Bingo! Now we’re talking!”
Ambitious to find out more, Annabel behaved like a sponge and absorbed everything presently known about angiostrongyliasis. Very few cases had been reported in the United States, the first one being a youth in a Louisiana hospital in the 1990s.
She pushed her head back into the pillow shoved against the headboard. The storm was muted and heading north, and it was time to undress Oliver from his thunder shirt. She undid the Velcro and unwrapped the material. After giving him a hug, he jumped off the bed.
“I’m finished, Oliver. I can’t read another word.” Her excitement over the information she had unearthed was only muted by tiredness. Bob was definitely asleep, but if she texted him, he’d see it first thing in the morning. She grabbed her phone:
“I think I found it … Toby’s disease. Angiostrongylus cantonensis. Rats are the definitive hosts of the parasite, and snails or slugs are the intermediate hosts. And, hell, humans are not supposed to be eating raw mollusks!”
The text zoomed off with a swish. As she wiggled under the covers, she heard a return “ding.” That can’t be, she thought. She reached again for the phone. Bob must be crazy to still be up.
“Darn you, Annabel. I found out a lot too. And btw, I hope Oliver was not too much of a burden Again!”
“Your thunder shirt helped a lot. And no, he’s a love, not a burden.” She paused to think about it. “Actually, good work comes out of my storm nights with Oliver.”
“How about that?!?Good night,” he added.
“Good night as well.”
Her eyes were so tired, but she forced them to look at one more thing on her phone, but there was still no word from Dustin.
-----
Annabel woke, aggravated as hell at her alarm clock, but, of course, it was her own fault why she was too tired to scramble up and start moving. Oliver made it impossible to catch another five minutes of rest because his snout was in her face. The morning left no residue of a storm in the sky and he wanted his walk.
She hurried getting dressed and took him downstairs. The street and sidewalk showed an aftermath of the night’s weather, with twigs, sticks, and leaves littering the wet ground. Oliver had more to sniff and was back to his normal self.
After the walk, she put on a single serving cup of coffee and began packing up for the day, when her phone dinged. Her heart rapidly beat. It must be Dustin.
No such luck. She quelled her disappointment, because at least it was Bob. Since he was on the hospital rotation, he started earlier than her, both for his own rounds on his patients and team rounds as well.
“I told Dr. Mares what we both found regarding eosinophilic meningitis. Would Dr. Gillespie excuse you for a few hours to come enlighten him/us with your input?”
“I would love to, but I’d have to ask him. I’ll get back to you.”
What fun, she thought and called the office. At least Becky should be in the office this early. She did Annabel a favor and called George at home.
Annabel texted Bob after receiving her attending’s okay. “I’ll be there.”
He stuck in a “thumbs-up” emoji and wrote, “Find us in the team’s office.”
She gave Oliver a big kiss on his head. “Mind the house, boy.”
With the notes she wrote in the middle of the night, her normal backpack material, and a reused fast-food coffee cup with her brew, she rushed out the door and took her own car, knowing there was no time to call a car service.
Inside the lobby of the hospital, she chucked her empty coffee cup and went upstairs. With purpose to her steps, she came around the pediatric nurses’ station and heard the team conversing inside.
“Annabel Tilson,” Dr. Mares said, “welcome again. Thank Dr. Gillespie for me. It was thoughtful of him to share you with us.”
Annabel pulled out a chair. Bob smiled at her. Three other students were there, including Linnell. The team’s white board on the wall was crammed with names of their patients. At the bottom was Toby’s name listed as “orthopedic consult.”
“I’m happy to be here.” She put down her dependable notebook.
“Toby Owens, your original patient, is still worthy of our attention. I hunkered down with the subject of meningitis caused by parasites last night as well, but was deviated by calls from the hospital. Share with us what you found in the literature. Bob highlighted his end of it, but you can start from the beginning.”
The team all had coffee cups. Donuts dusted with white powdered sugar sat in the middle of the table.
“They are small enough to eat by the handful,” Rick said. “Help yourself.”
Bob popped up and poured her a coffee. She thanked him and, with two bites, ate one donut.
“From what I’ve heard,” Rick said, “you’re a damn smart medical student. If you don’t mind, in the essence of time, I’ll ask you in stages what we need to know. If you know it, that is.
“Such as … what are the risk factors and epidemiology for an angiostrongylus infection?”
“Bob and I learned yesterday that Toby ate a raw slug in Florida on a dare. That’s a red flag, since the actual reported risks are the ingestion of undercooked or raw snails or slugs infected with the parasite. It can even be pieces of those that accidentally end up in vegetables or salads, or foods contaminated by their slime.
“The epidemiology is creepy because this parasite is a worm, a rat lung worm, that is transmitted between rats and mollusks in its natural life cycle. Humans can’t transmit the disea
se; they are unfortunate accidental hosts. Reports indicate that Angiostrongylus cantonensis has been spread to around thirty countries, mostly because of rats transported on ships.”
Annabel took a sip of coffee. She was tired from lack of sleep, but the coffee, subject matter, and audience helped boost her eyes open.
“Bob told us about rats with the parasite from the early nineteen hundreds,” Rick said, “first discovered in China. It’s making its way around the globe.”
“But very few cases have been discovered in the U.S., and only in the south. Terrible cases have ended up in children’s hospitals near the Gulf Coast of Louisiana and Mississippi. Perhaps this is the first case more east, but I’m not sure. The CDC does recommend that these patients get reported, but it is not a mandatory reportable disease.”
Rick nodded. “Absolutely. If Toby has it, we will call it in. And his case would be a clear example of how a person’s travel history is important and how a traveler could pick this up when outside the country.”
Bob shook his head. “Like on a Caribbean vacation.”
Annabel nodded. “Yes, the parasite has been found there.”
“Ugh. Maybe I should reconsider my medical school graduation trip.”
“If you can get it in Florida,” Rick said, “I wouldn’t change my plans.”
Bob laughed “Just kidding; a trip there is wishful thinking.”
Nell pulled her braid forward and stroked the end. “Does this parasite have anything to do with a rat’s lungs or do they just call it that?”
Annabel thought about another donut but waited to pick one up. “The adult worms live in their pulmonary arteries.”
“Too gross,” one of the other students said.
“I agree. The females lay eggs, they hatch into larvae, which travel to the pharynx. There, they are swallowed and eventually pass into feces. Next, they either penetrate or are ingested by the intermediate host … our snails or snugs.” She opened her notebook and checked the second page. “In a definitive host, a third-stage larvae migrate to the brain, eventually to become young adults.”
