The Last Word (11 page)

If the problem was organ rejection, they would boost his anti-immune drugs to stop the heart and lungs from being attacked by his immune system. But if it
wasn’t
organ rejection, weakening his immune system would leave his body defenseless against a rampaging virus.

“I think we should play it safe and assume he’s got it all,” Jesse said, seemingly reading Mark’s thoughts. “Let’s bump up his anti-rejection drugs, the steroids, and cyclosporine, and put him on broad-spectrum antibiotics until we know exactly what we are dealing with.”

“I was going to suggest the same thing.” Mark glanced at his watch and saw that he was already late for a senior staff meeting on the annual budget. “I’ve got to go. Let me know right away if there’s any change in his condition.”

“Will do,” Jesse said.

Mark hurried off to the third-floor conference room, where the tedious meeting had already been going on for ten minutes, though it probably felt like ten hours to the unfortunate department heads who were sitting through it.

Dr. Kerry Sakmar, the head of pediatrics, was giving a Power-Point presentation on his department’s financial needs, justifying every dollar in his budget to stone-faced Janet Dorcott, as Mark slipped into the room.

Janet shifted her cold gaze to Mark as he took his seat. He felt like a high school student sneaking in late for homeroom and getting caught by his teacher.

“Sorry I’m late,” Mark said. “I was checking on a patient.”

“At least it was a patient and not a homicide victim this time,” Dorcott said. “I suppose that’s a small sign of progress.”

Mark didn’t bother to comment. Instead, he opened his copy of the proposed budget and tried to concentrate on the pediatric presentation. But his mind kept wandering back to Hoffman’s condition and his sudden, and disturbing, slide.

A half hour later, Janet was grilling Dr. Sakmar, making him justify every cotton swab and paper clip, line item by line item. It was like water torture, and every department head around the table had broken into a sweat, dreading his or her own presentation.

Except for Mark. He was calm. The other department heads were younger and more ambitious than he was, and they had more reason to play politics with Janet Dorcott. He wasn’t interested in scoring points, nor was he intimidated by her authority. He had no intention of justifying his budget to a woman with no medical experience whatsoever. Hospitals weren’t the same as discount superstores. He would present his budget as a package and she could take it or leave it. There weren’t any cuts he was willing or able to make.

But he didn’t get the chance to have that fight that morning. His beeper vibrated. It was a message from Jesse. Ken Hoffman’s condition was deteriorating fast.

Mark left the meeting and didn’t come back.

Over the next twenty-four hours, Hoffman’s condition went up and down as Mark and Jesse struggled to stop his decline and diagnose the cause of his worsening condition.

They began by intubating him and putting him on a ventilator. At first the oxygen saturation in his blood increased, giving them cause for hope, but then a few hours later it plunged even lower than before.

Desperate to stop Hoffman’s oxygen levels from plummeting further, Mark and Jesse increased the amount of oxygen he was receiving to eighty percent. His blood gases improved, but by the next morning, his O
₂
sats had dropped to just seventy-two percent, their lowest level yet.

Mark had to see for himself what was going on in Hoffman’s lungs. So he performed a bronchoscopy, sliding a specialized camera and catheter down Hoffman’s throat and into his bronchial tubes.

He was looking for indications of a bacterial or fungal infection. Patients with repressed immune systems are prone to infections or possibly even the activation of tuberculosis that’s been sitting dormant in their bodies for years.

Mark saw some nonspecific inflammation, which wasn’t a surprise, considering Hoffman’s breathing problems and cloudy chest X-rays. But he didn’t see any bleeding or signs of infection. The sputum, the fluid in the lungs, appeared to be clear.

Except for the inflammation, which had to be caused by
something
, everything looked fine. The bronchoscopy didn’t reveal a thing to Mark and only succeeded in adding to his growing frustration and infuriating sense of impotence.

He collected samples of the sputum and lung tissue and rushed them down to Amanda in pathology, hoping her tests would give them some answers.

Amanda called Mark and Jesse down to her lab a few hours later. Mark could tell from the scowl on her face as he walked in that the news wasn’t good.

“I looked at his blood, and he’s got an elevated white blood cell count, which is indicative of a virus, infection, or organ rejection,” Amanda said. “I looked at his sputum and his lung tissue and saw no evidence of fungi or bacterial infection.”

“You make it sound like there’s nothing wrong with the guy,” Jesse said. “He can’t breathe. His last chest X-ray looked like a snowstorm. There’s got to be
something
causing the inflammation in his lungs.”

“I know, but whatever it is, it’s not showing up on the slides.”

“So we’re back where we started,” Mark said.

“Which is nowhere,” Jesse said gloomily. “It’s either infection or rejection and we’re already treating both. The tests haven’t told us a damn thing.”

“All we can do is continue with the course we’re on,” Mark said. “Keep him on the ventilator and treat him with steroids and antibiotics.”

“And hope for a miracle,” Jesse said without much conviction.

“They’ve been known to happen,” Amanda said.

But four hours later, it didn’t look likely that there were any miracles in store for Ken Hoffman. His lungs looked like bones in the chest X-rays and his O
₂
sats continue to drop even though he was breathing pure oxygen on his ventilator. His lungs were barely functioning.

It was a death sentence.

Mark had the grim task of informing Hoffman’s wife and two young children that his prognosis didn’t look good.

By midafternoon, two weeks after his transplant and a little more than a day after his breathing problems began, Ken Hoffman died of respiratory failure.

It became Dr. Amanda Bentley’s job to discover exactly what caused Ken Hoffman’s respiratory failure. She was getting just as frustrated as Mark and Jesse had been.

Mark tried to stay out of Amanda’s way, but his curiosity kept getting the better of him. He found excuses to stop by her lab several times over the course of the next few days, and each time she had nothing new to tell him and she was awaiting various test results.

He thought about offering to help, but he realized his presence would only make her job harder. Amanda knew what she was doing and she would find the answer eventually.

Jesse was just as frustrated, but when he stopped by the pathology lab, Amanda wasn’t nearly as polite to him as she was to Mark.

“If you come in here again, the next autopsy I perform will be on you,” she said.

Jesse took the subtle hint and stayed clear of the lab after that, even when he had a justifiable reason to be there. On those occasions, he sent Susan instead, assuming that she would do her wifely duty and snoop while she was there.

But Susan respected Amanda’s boundaries and didn’t venture a single question about the status of the Hoffman autopsy. She simply picked up whatever test results she was after, traded a few niceties, and left Amanda alone.

“Would it have killed you to snoop just a little bit?” Jesse scolded Susan after one of her legitimate forays to the pathology lab.

“I’m not the snooping type,” Susan said. “When Amanda has something to say, she’ll tell us. You have to be patient.”

“So how come you don’t practice that same patience with me?” Jesse said. “How come you’re always asking me what I feel about everything?”

“That’s different,” Susan said. “She’s performing an autopsy. I’m working on a marriage.”

“It’s the same thing,” Jesse said, then scooted away to perform rounds before Susan could swat him.

Mark and Jesse happened to be meeting in the cafeteria for lunch, two days after Ken Hoffman’s death, when Amanda paged them both.

They went down to the pathology lab, and this time Amanda greeted them with a look of satisfaction on her face. She’d solved the mystery.

“Do you know how he died?” Jesse asked, even though it was obvious that she did.

She nodded. “And you’re not going to believe it.”

“Tell me,” Mark said.

“Not so fast,” she said. “This was hard work and I want to enjoy the moment.”

She started at the beginning, explaining each step of her investigation.

It drove Jesse nuts, but Mark was fascinated. Being a detective himself, he knew the pleasure of walking others through the clues before revealing his solution. He was the last person who was going to deprive Amanda of the same pleasure.

The upshot was that Amanda found viral antibodies in Hoffman’s blood, lung tissue, brain tissue, and spinal fluid, which meant that whatever virus he had afflicted both his lungs and his central nervous system. And she’d managed to track that virus down.

“It was West Nile virus,” she said.

That was the last thing Mark would ever have guessed, but now that he thought about the symptoms, it made some sense. West Nile virus was passed by mosquito bites and could, in extreme cases, cause encephalitis, paralysis, respiratory failure, and death.

Even so, it was hard news to accept. And Jesse couldn’t. He shook his head and held up his hands in front of his chest as if holding the news back.

“Wait a minute,” Jesse said. “You’re telling me that an infected mosquito got into this hospital and bit the guy?”

“No,” Amanda said. “West Nile doesn’t incubate that fast. He must have been bitten before his transplant.”

“Talk about bad luck,” Jesse said.

But another chilling explanation occurred to Mark.

What if Corinne Adams was the one infected with West Nile? What if she’d passed it on to Ken Hoffman with her heart and lungs?

If that was what had happened, they were facing a major catastrophe. Her organs and tissues had been implanted in at least five other people, perhaps more by now.

Ken Hoffman’s death would be only the first of many.

Mark was almost afraid to bring it up. “What if he wasn’t bitten by a mosquito? What if he contracted the virus from the organ transplant?”

Amanda gave Mark a scolding look. “Do you think if that’s how Ken Hoffman was infected that we’d be having this calm discussion right now? I’d be in crisis mode, calling every hospital that received her organs, the company that dispersed her bones and tissues, as well as the NIH, the CDC, and the PTL.”

“Why would you call the Praise the Lord network?” Jesse asked.

“Because we’d need every prayer we could get,” Amanda said. “As soon as I discovered the West Nile virus antibodies in Hoffman, I went back and checked the tissue and blood samples from Corinne Adams. I didn’t find any trace of West Nile antibodies.”

Unique antibodies are created by the body to defend against specific bacteria and viruses. If there weren’t any West Nile virus antibodies in Corinne Adams’s tissues or blood, it meant she wasn’t fighting the disease when she died.

“Did Hoffman receive any blood transfusions?” Mark asked, remembering a case a few years earlier in which a dozen people were infected by West Nile-tainted blood.

She shook her head. “We’re in the clear there, too.”

“Which means Hoffman was infected on his own,” Mark said, sighing with relief.

“The virus thrived, flaring up faster and deadlier than usual because of the anti-rejection drugs he was taking,” Amanda said.

Only twenty percent of people infected with West Nile virus ever developed any symptoms, and even for them it was usually mistaken for a bad cold or flu. Just one percent of those infected with the virus suffered its most severe consequences. But Mark knew that organ transplant patients had a forty percent greater risk of developing serious illness from West Nile than anyone else, though the odds of their contracting it were astronomical.

Ken Hoffman was the exception.

“The poor guy. He was dead whether he got the transplant or not,” Jesse said. “He never had a chance.”

It was true.

If Hoffman hadn’t received the transplant, he would have died from the atrial septal defect that doomed his own heart and lungs to fail. But because of the transplant, he died of a mosquito bite instead.

Fate.

It seemed to be stalking Mark Sloan lately. He hoped that didn’t mean that they’d be meeting soon.

Amanda immediately notified the Los Angeles County Health Department of Ken Hoffman’s death from West Nile virus. The LACHD informed the Greater Los Angeles County Vector Control District, the agency charged with wiping out disease-carrying insects and vermin. Within an hour of Amanda’s alert, Vector Control’s top man, Officer Lloyd Flegner, was on the case.

The bloodsuckers never had a chance.

Flegner was a retired LAPD detective who had spent twenty-five unremarkable years on the force, serving and protecting in virtual anonymity. So he gladly took his pension and went to work for Vector Control, where he put his unappreciated detecting skills to use finding mosquitoes, mice, bats, and rats and eradicating them.

To his awed colleagues at Vector Control, he was Columbo, Monk, and Gil Grissom all rolled into an authentic Members Only jacket, khaki cargo pants, and mud-caked Doc Martens. Flegner had an almost preternatural ability to read rat droppings. With one glance at a trail of excrement, he could assess the number of rats in the area, where they were hiding, and how long they’d been there.