Death Rounds (37 page)

PART THREE

Sepsis

Chapter 18

I didn’t move, couldn’t even drag my eyes from the screen. My ears seemed to amplify the sound of my own breathing, and I felt my tongue catch against the dry insides of my mouth when I tried to swallow. I don’t know how long I had been standing there— seconds? a minute?—staring and not wanting to believe what I was seeing, when I sensed someone behind me. I started to spin around, my hands reflexively drawn up in front of my face, and nearly screamed when I saw a figure walking toward me in the dark. Then I heard a familiar voice.

“Is that what Mackie found?” Williams asked.

“Son of bitch, you scared me!”

“Whoa!” he said, stopping while still a few feet away. “Man, are you ever jumpy. Why are you in the dark anyway? Turn some lights on and maybe you won’t be so skittish. What the hell’s this?” He moved closer to the computer. The blue light bathed his head in a dark glow that accentuated his broad cheeks, furrowed eyebrows, and curved down mouth. The result turned his expression into a frowning mask of polished dark wood. “Oh my God!” he exclaimed as he read. “Where’s Mackie?”

“I don’t know.” My mouth was so dry I could barely speak. “He actually called you?”

Williams quickly straightened from peering at the screen. “He said he thought you were right all along, that the
Legionella
infections were deliberately inflicted. But this? ‘It’s incubating in fifty’? C’mon! Is the message for real, or is someone stringing us along?”

“You tell me. It appeared after I got here.” I quickly related what had happened when I arrived, trying to keep my voice steady. He hadn’t heard about Janet’s being infected by
Legionella
and was visibly shaken by the news. I didn’t accuse Cam outright, but by the time I told everything else, his absence was becoming more peculiar by the second.

Williams glanced at the colonies of bacteria in the petri dish, then looked in the microscope. “So why isn’t Mackie here?” he demanded.

“Guess!” I snapped.

The harshness of my response made him start. He looked up from the binocular eyepiece, clearly puzzled. After a few seconds he said, “You’re not suggesting...” As his voice trailed off, his face seemed to work in slow motion. His jaw sagged, his eyebrows rose, and his forehead molded itself into a maze of wrinkles. “Jesus Christ! You seriously think it’s him?”

“Let’s just say I’ve got a lot of unanswered questions about the man’s behavior since this morning.” Williams’s expression grew more astonished as I explained my suspicions.

“Holy shit!” was all he said at first. He began to pace and repeatedly rubbed his hands over his scalp. Finally he said, “I have to tell you. Garnet, I’ve got a few problems with the idea of Mackie’s being the killer. For starters, why would he suddenly contact us, terrorize you about Janet in particular, and in effect reveal his murderous crusade, especially after being so successful at keeping both it and his identity hidden?”

It was a troubling question. “I don’t have a clue why,” I admitted. “But if part of his reason was that he wanted to single me out for an extra dose of panic by threatening Janet, I’ve got to tell you, it worked.”

“I’ll grant you this. If Mackie doesn’t walk in here pretty damn soon, what you’ve just suggested will sound a lot less off the wall than it does at the moment. But you haven’t a shred of proof—” Williams broke off and glanced at his watch. “Damn!” he muttered, starting for the phone. “It’s less than fifty minutes until the shift change at eleven o’clock, and that means we have to decide right now whether we let people go home. No matter who’s behind this, we’ve got to assume these bacteria are what he claims they are until we can do confirmatory tests. If we act promptly, we’ll have at least half the hospital workers effectively in quarantine. Keeping the workers who are here now and not scaring off the night shift before we can grab them as well will be tricky if not outright impossible.”

While continuing to talk with the speed of a machine gun, he picked up the receiver and punched in enough numbers for long distance. “As far as patients, visitors, and families of workers—”

“Wait a minute,” I interrupted. “How can you even consider keeping people in the hospital with a killer on the loose? He’s already threatening to infect more victims. In fact, you may end up locking him in here with us.”

Williams’s hand froze over the phone. “Jesus!” he said, aghast, staring hard at me. “I hadn’t thought of that. We’ll have to protect them somehow. But there’s no question we need the quarantine—” He stopped and spoke into the mouthpiece. From his side of the conversation I quickly learned he’d reached Doris Levitz at her home in Atlanta.

I was left eyeing the colonies in the petri dish. We needed confirmation fast whether they were for real. A simple Gram stain would tell us immediately if they were staph. But a culture with sensitivity studies would take two days, and without that kind of proof, no one would believe that we were dealing with a fully resistant strain of staph. What if we were to confirm which antibiotics were in the culture medium? Identifying drug levels was a routine procedure for a big city ER, and I knew that within the hour we could at least verify whether these bacteria were growing in a soup of methicillin and vancomycin. Nobody would ignore that finding.

But staring at the small gray patches on the dark brown agar made me imagine similar colonies teeming with microbes all along the lining of Janet’s airways, ready to follow the
Legionella
into the tissue of her lungs. Or what if he was yet to plant them in her and was on the way to her room at this very moment? “Shit!” I raced over to a wall phone with more than one line and called ICU.

“Has Dr. Mackie been in to see Janet?” I blurted out as soon as a nurse answered.

“Why, no, Dr. Garnet. Not since this morning.” It was the same woman I’d spoken with ten minutes earlier. “Is something wro—”

“Please let me speak to the guard I hired! Have him take the call from her room.” While waiting for them to get a phone to her cubicle, I thought, They must think I’m nuts. When he picked up I told him there’d been a new threat and ordered him not to let anyone near Janet, Dr. Mackie included. Then I hung up.

Williams was still talking with Levitz.

“...we’ll need the National Guard as well as the police,” he said, “and certainly every available city and state public health official. You’ve got to get the CDC to give us a hot-zone treatment for this place, Doris! That means the mayor’s office and the city’s entire disaster response team will have to keep the community under control.”

My head swam listening to him, and I slumped against the counter, staggered by the implications of locking up an entire hospital. Everyone would have to be in isolation from everyone else. University Hospital would be rendered a prison. Thousands of us—orderlies, clerks, technicians, nurses, doctors, and patients— would be gloved, masked, and gowned.

“Here’s the kicker, Doris. His message says
More will follow.
This creep’s liable to be in our midst, moving about, selecting victims, trying to punish the punishers and anyone else who gets in his way, so don’t tell me I’m overreacting...”

The questions multiplied. It seemed such an illogical move— Cam’s declaring himself so openly if he intended to continue killing in secret—yet this madman, if anything, was logical in his tactics. For Cam to be the killer, there had to be a reason why he would set up what we’d found here, call us in, and then choose to disappear. What was I missing?

“Besides, Doris, we don’t even know how long we have before the first cases might hit!” Williams was yelling now. “What do
you
propose we do for the people already incubating the damn bug? Hell, Garnet’s wife may be one of them. By the time we got the results of culturing everyone again the way
you’re
insisting, we could have a pile of corpses and be doing autopsies. I warn you, unless we quarantine everyone now and wait until those who get it die, we haven’t got a chance to keep the organism within these walls—”

He broke off when he glanced my way. He’d said nothing I couldn’t figure out for myself, but his blunt statement of it jacked up my fears for Janet until the effects of panic and adrenaline were all I could feel. From the way he was staring at me, my fright must have shown in my face.

“Call me back when you’ve got confirmation for the quarantine!” Williams barked and slammed down the receiver. His own face sagged, and into his eyes seeped a terrible look of pain. “I’m sorry, Earl, I didn’t mean that to be as hard as it sounded. I had to shock them. They were talking about waiting for a forty-eight-hour confirmatory test.”

“Help me find some way to protect her,” I demanded, barely able to keep my voice from shaking. “The CDC has to know everyone in the world who’s working on resistant staph. E-mail them all— anyone who’s published anything about the superbug over the last year. Maybe one of them’s found new answers that aren’t published yet. The old answers—salves and soaps—can’t be all there is.” I hated the pleading in my voice. I’d heard it so often from patients and families who couldn’t accept there was nothing more to be done.

He just stared at me, shook his head, and turned his palms to the heavens. “I’m sorry, Earl; I don’t know what to tell you.” He sounded unsure and hesitant, the authoritative tone I’d grown used to as he’d taken command over the last few days completely gone. “That sort of update we do all the time. I’ll make sure that Doris rechecks for new replies, but as of last Friday, when we first got the call from St. Paul’s, there was nothing hopeful in the pipeline. Certainly no new antibiotics will be ready for at least two years. A group in Denver is trying to develop a vaccine; the idea is to produce antibodies against the toxins by which staph does its damage to human tissue —”

“A vaccine! Listen, if it’s life or death—”

“Earl!” he interrupted. “They’re barely starting to test it on mice. Even if they had it ready for humans, remember, it’s a vaccine! It would take at least two weeks before it started being effective. Anybody infected now...” his voice trailed off.

I felt my anguish for Janet grow so profound and dark that I couldn’t move.

Williams turned away quickly, but not before I glimpsed a glistening in his eyes that I thought was tears. He obviously found it as difficult as I always did to tell hard truths.

“Dr. Garnet?” called a familiar voice at the door.

I turned and saw Reginald Fosse coming toward us. His worried expression gave his face a whole new set of creases. Behind him was the security guard I’d summoned.

“Dr. Mackie isn’t here?” Fosse asked. “He phoned and said he’d found the evidence you were after. Scared the hell out of me!”

It was hard not to notice the man was dressed in a cowboy outfit.

He saw us gawking at him. “I was in the middle of a fund-raiser,” he quickly explained, pointing to a card pinned to his left breast pocket which read
Buffalo Line Dancer Society—HOOFERS FOR HEALTH DOLLARS.
“And you are?” he asked, stepping up to Williams with his hand outstretched.

Williams introduced himself, showed Fosse the message on the computer screen, and began to explain what he intended to do about it.

I took the guard aside. He didn’t know how to trace E-mail, but he did manage to give us light, finding the switch that had escaped Williams and me. He reluctantly agreed to check all the offices in the other labs to see if any computer stations were left on only after receiving multiple reassurances that he wouldn’t “catch something” simply by looking around “down here.” I assured him he’d be fine but didn’t ask him if he had a habit of being vicious to patients.

By then the way Fosse’s color was draining from his face, leaving it a shade whiter than lard, I knew he’d understood there’d be no more hoofing for the moment. “Quarantine? Police? The mayor!” he shrieked at Williams.” What the fuck are you talking about, ‘quarantine’?”

Williams towered over the pudgy middle-sized man between us. “What I mean, Mr. Fosse, is that if those threats you just read are carried out, your whole hospital may be ground zero for what could be the worst institutional outbreak since before the advent of penicillin, and, like in those times, we’ve got dick all to fight it with!”

At that moment Harold Miller walked into the room.

Fosse’s back was to the door. “Why, this could be a prank,” he was saying, gesturing at the screen.

Williams exploded. “Testing the specimen we found in the petri dish—” He stopped himself on seeing the young technician standing in the room. He took Fosse by the elbow, whispered something to him while nodding toward Miller, and led the administrator over to the microscope.

I quickly walked over to where the young technician was standing. He was wearing a jogging outfit, much more modest than those worn by Williams, and his close-cropped hair was wet, as if he’d just taken a shower after a workout.

“Dr. Mackie left a message on my answering service about an hour ago,” he said in a low voice. “It said he’d found out something about the
Legionella
infections.” He eyed the two men arguing and whispered, “What’s up with them?”

I shrank from telling him. Not only would he learn that his mother’s death was murder, but hearing that Cam might be involved would probably be equally devastating to him. From what I’d witnessed this morning, Cam had seemed to be a father figure as well as a mentor.

“We’ve got a problem on our hands. Someone’s threatened to use microbes against certain personnel in the hospital” was all I said, promising myself that I’d take him aside shortly and level with him. Even in ER I needed a moment before breaking bad news to find the right words, and I was usually a lot less rattled there than I felt now. That Cam’s display of caring could have been a sham was bad enough. That he might have comforted the son after murdering the mother was heinous beyond telling.

“A threat? What kind of a threat?” he demanded, growing excited.

“Actually it’s good you’re here,” I continued, ignoring his question. “Find a quiet phone somewhere and call in as many technicians as you can reach. I’ll explain later, but we’re going to have to mobilize a huge operation in the labs tonight and, among other things, start a massive rescreening program.” I spoke as rapidly as possible so as not to allow him room for questions. “By the way, what happened about searching the asylum? I never got your call.”