Death Rounds (21 page)

But in the committee, we continued to lie. Our cover story explaining the massive screening effort was particularly disingenuous. “We’re evaluating existing isolation practices, making sure none of our patients or visitors in ER are at risk, by testing our response to a recent case of methicillin-resistant staphylococcus.” Maybe, technically, it wasn’t exactly a falsehood, but it sure as hell wasn’t the truth, and I felt dirty each time I repeated it

Finally, Williams attempted to limit outside publicity. “No bulletins over the airwaves,” he insisted. “Better we initially contact everyone we can by phone, keep the explanation low key, but stress they are obliged to come in to St Paul’s by order of the health department.” We recruited every secretary in the hospital to do the telephoning, and by 9:30 we were organized enough to begin calling in the first groups of patients.

All in all, logistically, it was an impressive response, but the truth remained that in an age of miracle drugs we were reduced to fighting this bacteria with little more than the weapons our forefathers used against pestilence—soaps, salves, and isolation.

* * * *

Her eyes tearing, her face grimacing in pain, she was trying to pull away from me. “Mommy!” she screamed. I got the culture swab out of her nose just as she started to sob uncontrollably.

“What are you doing to her?” cried her mother, sliding protective arms around the little girl’s chest and head while glaring angrily at me. The child’s name was Cynthia, she was six years old, and she’d had the misfortune of being in our ER for a sore throat the same day Phyllis Sanders had been admitted. She was in her mother’s lap, and they were both seated in front of me at one of the culturing stations. The testing of hands, nails, and nostrils—one swab per site—took minutes. The reassuring and comforting took forever. After an hour I’d barely managed to take samples from six people.

“I’m sorry,” I said to her mother. Then, facing the little girl, I cajoled, “Cynthia, you’re a brave young lady. I know it’s unpleasant, so take a little break before we do the other nostril.” While I talked, I inserted the swab I’d just taken into a tube of charcoal culture medium.

“No, I don’t want it,” cried Cynthia, burying her face in her mother’s shoulder.

Her mother cradled her head and rocked her slightly. “Couldn’t we leave it. Doctor? You’ve got samples from me, and after all, you said the chances of us getting it were remote. Why hurt her again?”

“We must get one more, I’m afraid,” I told the mother. To the back of Cynthia’s head, I added, “A few more seconds, and I’ll be through. You know, when they checked me this morning, I yelled twice as loud as you did.”

She peeked out at me.

“And I’ve got special friends in the cafeteria who will give ice cream to anyone braver than me.”

She studied my eyes. Being masked, gowned, and gloved, my appearance didn’t lower people’s anxiety any, but Cynthia must have seen something she liked, because a minute later I had my samples. “My name’s Garnet,” I told Cynthia’s mother. “Tell the cafeteria to put the ice cream on my tab.”

“Can I tell them I was braver than you?” asked Cynthia eagerly, exuberant now that her trial was over.

I laughed. “You sure can.”

“When will we know the results, Doctor?” asked her mother.

“The cultures take two days. As I said, it’s unlikely we’ll find anything.”

“But what happens if you do?”

“Oh, usually they use bactericidal soaps for the hands, and there’s an ointment that can be applied topically for organisms found in the nose,” I replied casually, trying to sound matter-of-fact.

“Thank you. Doctor,” said Cynthia’s mother, appearing comforted as she turned toward the exit and followed her daughter, who was already skipping happily out me door.

I finished labeling my specimens from Cynthia and summoned the next person in line. An elderly black woman with a cane slowly made her way to my table. “Hi, I’m Dr. Garnet,” I greeted her, “and I just need to take a few cultures. Rest assured there’s nothing to worry about. Now, if you’ll tilt your head back...” As I explained the procedure and set to work, I thought, Lord help us if anyone becomes infected and these people find out how they were lied to.

* * * *

Other problems were already starting.

The quarantined group had initially been cooperative, concerned for their own safety and not wanting to endanger their families at home. But then Rossit had begun insisting they have their noses lavaged right away without waiting for the culture results, contrary to what Williams had suggested. Suddenly the cover story that we were simply checking the effectiveness of our MRSA containment procedures was no longer sufficient to ensure everyone’s submission, even to the reasonable measures that Williams had intended. First there was a murmur, then a howl of protest against our authority to violate their personal liberty, subject them to forced confinement, and impose treatments on them without their consent.

“Rossit’s a fucking idiot!” Williams bellowed when I alerted him to the trouble.

Or a saboteur, I thought.

Williams and I went into the ward where the suspected carriers had been isolated and tried to calm them down, assuring them Rossit wouldn’t be allowed to lavage their noses, but it was too late. Teams of lawyers had already been summoned by the parties on both sides of the argument, the employees’ union and the department of health. They descended on St. Paul’s and went at each other tooth and nail somewhere upstairs.

“Nobody talks to reporters but me,” Williams growled at a hastily reconvened session of our special committee. Rossit didn’t attend.

But shortly afterward a very hostile media arrived, probably alerted by one of the individuals unhappy with the quarantine. Soon local news bulletins were also ripping into the validity of the health department demanding that citizens submit to the tests being done at St. Paul’s.

The call-in shows were the worst. “Civil liberties versus state health. Is Big Brother now Big Doctor? When the men and the women in the white coats take ‘knowing what’s good for us’ too far...” one commentator blared. Everyone in the auditorium heard him over a portable radio that a nurse had brought in. Williams happened to be there at the time, giving an interview to a newspaper reporter in an attempt to add some balance to the debate that was raging.

“Turn that crap off,” he yelled, then walked away shaking his head, looking more worried than I’d seen him so far.

By early afternoon the open revolt against compulsory compliance, stoked by the local broadcasters, was resulting in fewer and fewer patients agreeing to come in. Yet even when the whole operation was threatening to collapse, Williams persisted with his order that we keep the lid on what was really happening. “I’m afraid the panic would evacuate the hospital,” he warned, “and patients too unstable to be moved could die.”

“But evacuation’s illogical,” others on the committee protested.

“So’s panic,” retorted Williams. “You’ve seen the media zoo here today. Imagine how they’d play up an unstoppable organism that can kill in forty-eight hours and is carried unknowingly in the noses and on the hands of hospital personnel. The first impulse of patients would be to sign themselves out, and family members would insist on it. Do you really think you could control that kind of hysteria with clinical logic and measured reassurances?”

As uncomfortable as I’d been with his deception, his stark prediction of what a candid disclosure might unleash left me even more alarmed.

But then the entire exercise was salvaged in a totally unexpected way by pure luck and a nasty bit of gossip.

Small groups of patients were still responding to the call-up, enough to keep some of us busy despite the hue and cry, and a young resident was taking cultures at a table situated near my own. Suddenly he turned to some of his colleagues who were waiting for subjects and declared rather loudly, “I don’t for a moment believe what they’re telling us.”

Smart lad, I thought, continuing to take swabs from a young girl’s fingernails.

“In fact,” he continued, “I just read an article that might explain what they’re really looking for.”

He instantly had my attention. His buddies looked interested as well, and any patients within hearing distance visibly perked up. I also noticed a reporter with a microphone who’d been trying to get interviews look over from where he’ d been reading his notes.

“It’s staphylococcus all right, but a new MRSA strain.”

I was about to throw down my culture swab, run over, and quickly whisper that he keep his theories to himself when he pronounced, “It’s a nasty, virulent bug recently reported in Ontario, Canada, that infects thirty percent of its carriers. I’ll bet some Canadian shopper has brought it down here.”

I sighed my relief and went back to culturing fingernails. The so-called Ontario strain had been around for years, was causing a problem just over the border in Toronto but fortunately hadn’t been reported here yet. Most important, it was sensitive to vancomycin.

But seconds later the reporter had his microphone in the resident’s face, beaming while the young doctor expounded with absolute certainty about the Ontario strain of MRSA. “Oh yeah,” a few of the other residents added, proceeding to corroborate that they’d either read or learned during a lecture about that same organism. Some nurses who also had overheard the conversation quickly joined in the interview, expressing their own alarm and explaining they had friends caught in Williams’s quarantine. In the ensuing discussion the residents reassured them that while aggressive, this bacteria was still sensitive to vancomycin and could be treated.

Soon a rumor about the “Ontario strain” swept through St. Paul’s and rapidly established itself as the official “secret” reason behind the patient recall and the need to quarantine some of the personnel. By 2:30 the rumor had been on the news, frightening people enough to come in, but, since the newscaster stressed the organism could be treated, the panic that Williams had feared was avoided. By 3:00 compliance was soaring, but the lawyers upstairs, I was told, continued to wrangle.

“I couldn’t have planted a better story if I’d tried,” Williams commented, grinning in relief when we finally had a private word together late in the afternoon. We were standing in the corridor outside the auditorium. Patients were arriving, everything at the testing stations was running smoothly for the moment, and there was a lull in the incessant demands on both of us. I’d asked him to meet me, determined to convince him about the connection between Sanders and the other
Legionella
cases.

But it was not to be.

“Dr. Williams,” Hurst interrupted from twenty feet away. He strode up to us, ignoring me but taking Williams by the arm. “Your CDC colleagues have just arrived from Atlanta. They’re waiting for you upstairs,” he informed him curtly.

Williams excused himself and quickly walked toward the elevators. Hurst waited until the man was far enough down the hall not to hear. Then he glared at me and said very softly, “My only consolation in this mess that you’ve caused is that I’ll finally be rid of you.” Then he pivoted and hurried after Williams.

* * * *

“That’s about what it was like here, except mothers with newborn babies are a whole lot more panicky,” Janet said over the phone after I’d described my own day’s activity. I’d called her during a break for supper. As a member of the Infection Control Committee at University Hospital, she’d received the same confidential briefing about the superbug that morning as I had and had spent the day taking cultures much as I had done. She was tired, her voice sounded strained, and like me, she was frightened.

“What about the rest of your staff members?” I asked.

“Much the same as at St. Paul’s—a few women showing symptoms of what is probably the flu are spending forty-eight hours here in a closed ward as a precaution until the cultures are finished. But we got one break. For the past few months since the
Legionella
cases, Cam had stepped up screening programs for all possible hospital-acquired infections, and the most frequent testing was for MRSA. All the personnel on the obstetrical unit were checked five weeks ago and everyone was negative then, including Sanders. That meant she’d only been a potential risk as a carrier going near patients and other staff for the three weeks before her vacation.”

“That also narrows when she herself was infected,” I added. “If we traced her activity in that period, we might get some idea as to how she contracted either
Legionella
or staph.”

“Yeah, if we can ever get any of these CDC types to consider she was murdered. That kind of ‘tracing’ needs a lot of work hours.”

“Did you talk to any of them about the
Legionella
cases?”

She sighed. “Not yet. And there’s no way anyone’s going to consider anything today but the superbug. I figure we’ll have a better chance when the initial screenings are done and everyone’s sitting around waiting for results. But I think Michael’s finally as worried about the connection between the three nurses as we are. He attended our ID meeting this morning. After Cam dropped the bombshell about Sanders’s staph organism, Michael leaned over and apologized for rejecting my scenarios simply because they were bizarre and previously unheard of. He looked quite shaken and asked where the records of the Phantom’s previous victims were. I’ve been too busy reassuring mothers and culturing tiny noses to see how he’s doing.”

I felt a flash of alarm. “Should he be down there alone?”

“Hey, I still can’t tell that friend of yours anything. I asked him the same question. He laughed, and said, ‘No Phantom’s going to make a move with the CDC all over the place. These guys are like the cavalry,’ ” Janet mimicked, catching the impatient tone Michael used when anyone opposed him. “I suppose he’s right,” she added, sounding nervous.

Maybe, I thought, maybe not. The cavalry wasn’t looking for the Phantom, didn’t even know he existed, and that could still leave him room enough to be dangerous, especially if all the scrutiny was making him feel threatened.

Janet interrupted my thoughts. “Right now I’ve got to get back to work. By the way, my secretary told me there was a bunch of flowers in my office this morning. I never got there to read the card. Did you send them?”