Weapon of Choice (27 page)

Ignoring the quarantine sign and after a perfunctory knock, Stacy stepped inside. Several health care workers, wearing protective clothing surrounded a slim, blonde girl with skin the color of slate. The person at the head of the bed was inserting a nasotracheal tube into one of the girl's nostrils. A ventilator stood ready, a technician tweaking the settings.

Laura stood at the foot of the bed alongside a tall man in protective garb. Tim. Laura looked stricken and Stacy wanted to rush to her, but she backed up to reach for a pack of sterile clothing. Pulling her shoulder bag with the staph cultures down around her waist, she quickly donned the protective covering. Under her gown, the lethal bundle protruded as if she were a few months pregnant.

“Laura,” Stacy spoke softly, not wanting to disrupt the intense focus of the team working on Natalie.

Laura looked up, tears streaming down her cheeks. Tim put an arm around her shoulders and pulled her closer.

“She started to get worse about two hours ago,” Laura said. “Thank you, Stacy, for pushing Keystone and the FDA. The ticokellin just arrived at the Tampa airport. I have to sign the papers. I think it's her only hope.”

Laura spoke through tears. “Natalie's course has followed the others', and now she's going into rapid decline. Septic shock. Pulmonary infiltrates. Azotemia. She needs that drug before all her organs fail. I just lost another patient in the ICU and her boyfriend is—”

“On life support,” Tim finished Laura's sentence.

Stacy knew that Trey Standish would not make it. Even with the ticokellin. Once disseminated intravascular coagulation set in, you were out of options. In DIC, small blood clots form throughout the body and quickly consume all the coagulation proteins and the platelets in the blood so that internal and external bleeding is unstoppable. And the clots themselves cut off blood flow to the organs. She'd seen the boy's labs: prolonged bleeding time, no platelets. And she'd seen the boy, literally hemorrhaging from every organ in his body. No wonder DIC also stands for “death is coming.”

“I don't think he's going to make it,” Stacy said, “but, Laura, I came to tell you that I have to go back to Atlanta. My boss called and they need me. They're even sending a private plane to get me. Believe that?” Stacy wasn't sure she was getting through to Laura, but she needed to say goodbye. “The CDC is on the way, mustering all its resources. Before I go, I'll make sure that the senior clinician checks on Natalie.”

“I understand,” Laura said, “and thanks so much for getting the ticokellin released to us. If Natalie gets it in time—”

Stacy turned to leave, wishing that she could hug her friend, but touching was prohibited in that environment.

“One more thing,” Laura said.

Stacy turned. The ventilator was hooked up now, filling Natalie's lungs with oxygen-enriched gases.

“Will you promise to make sure that Natalie gets the ticokellin? Please?”

S
ATURDAY
, N
OVEMBER
30

Natalie, seemingly lifeless except for the rising and falling of her chest, tore at Laura's heart. She sat slumped forward in the bedside chair next to Tim. Keeping vigil, praying. Of her five kids, Natalie and Nicole claimed the softest spot in her emotional core. Still, she believed she loved all five of her children equally. All five had such different personalities, but she'd always felt more protective of the girls. These days she rarely thought about Steve, their father. Whereas most fathers would have cherished the adorable little twins, Steve had barely tolerated them. On the other hand, he'd been a good father to the boys. Had Natalie and Nicole's emotional development been damaged by Steve's attitude? Is that why they had such disparate personalities? Nicole, outgoing and aggressive; Natalie, sweet and compassionate? No way to know, but Laura blamed herself. She'd let Steve get away with it, too busy with her career to intervene.

Why was she thinking about the past? The present needed every morsel of her attention. Laura decided to do a checklist, an exercise that always helped her cope. To-do: first, make sure Natalie gets ticokellin. She'd signed the informed consent, cringing as she read about the side effects, the most dangerous of which was aplastic anemia, a rare lethal condition that wipes out the bone marrow. There'd been three cases in the clinical trials. Perhaps simply by chance, perhaps drug toxicity, but too many for the FDA to approve the antibiotic. One case in every five hundred patients treated. Next on the list:—

The phone rang and Tim got up to answer it, mumbled a few words, hung up the phone, and sat back down beside her.

“Trey Standish died,” he said. “Poor Natalie. She poured out her heart today, Laura. Made me feel so much like a father. She's so young, but she's in love. Remember that song by Paul Anka, I think. ‘They say it's puppy love' or something like that.”

“That's where Natalie got this staph, Tim, from Trey Standish.”

“The clerk in the ICU said the parents asked to talk to you,” Tim said, “before they were escorted to the quarantine section.”

Laura looked at Tim. In only one day, he'd come to know more about Natalie's life than she did. “Tim, I feel so conflicted. I have to be here with Natalie and I have to care for the ICU patients. The CDC is sending in doctors who don't have Florida medical licenses and most of the Tampa doctors are staying as far away as possible. How can I be with Natalie and still do my job? And now with the CDC decontamination protocol, each time we move out of a patient room, we have to go through a twenty-minute process.”

“I'll be here with Natalie,” Tim said. “You can rotate between here and the ICU. It's the only logical solution.”

“You've done so much already, Tim. You need sleep. We've been up for how long?”

“Forty hours. But it's you I'm worried about, Laura.”

Before she could answer, they heard a knock on the door. An apparition clothed in full-body cover: tangerine-colored, hooded jumpsuit, helmet, and face protector. So this was the new dress code.

“Natalie Nelson. You're her parents?” A female voice issued from under the gear. Your daughter is on the list to get ticokellin if you've signed the release.”

“I'm her mother,” Laura said. “And yes, I signed the informed consent.” Without another word, Laura handed the document to the figure. A gloved hand reached out, took the form, and the figure turned to go.

“When?” Laura asked.

“We'll see where she fits on the priority list,” the muffled voice said.

Laura had always thought of Tampa City as her own hospital,
her domain. Now, at her moment of greatest need, the Feds relegated her family to a priority list. Stand in line like everybody else. Natalie would have to wait her turn. For an instant, she remembered the grief in Dr. Victor Worth's eyes when he failed to get ticokellin for his son. Now they had a supply, and she prayed the pharmaceutical company had sent enough.

The clock on the wall said it was almost midnight. Tim would watch over her comatose daughter. Laura knew she could not abandon her patients. She spent the rest of the night rotating, just as Tim had suggested, between her daughter's room on the pediatric floor and the ICU on the seventh. The ICU was fully staffed now with medical personnel on call from the CDC. The CDC team took charge and Laura was impressed by their competence. But they still needed her as a licensed local doctor with hospital staff privileges here, to write orders. She thought of Ed Plant, where was he? He had looked terrible the last time she'd seen him. And he wasn't the type to walk out in a crisis. She needed to find out if he was okay. She felt responsible for him, too. As well as Michelle, and Bunnie, and the others. She'd have to drag herself back to the ICU.

Every time she changed floors, she had to go through the time-consuming decontamination process. A total antiseptic scrub, a complete change of garb from head to toe.

On her first two tours of Natalie's room, she found her daughter unchanged, still febrile with a rapid heart rate, still poor oxygenation, respiration controlled by the machine.

On each of her tours of the ICU, she'd found death. The first, Tom Mancini, the patient she'd operated on for beryllium-induced lung cancer, a victim of the toxic mineral in Standish's factory environment. The irony, the Standish son and Mancini in the same hospital unit. Then she'd learned that the middle-aged nurse who'd had complications following a hysterectomy had died.

Now as Laura left for the ICU, she wondered whether she should try to contact Trey Standish's parents. Wouldn't Natalie expect her to? But what could she say or do? Their son was dead. Ultimately, the decision was made for her when she inquired about the Standish parents' location. A CDC responder fielded her call,
explaining the strict isolation mode in force in the hospital. Those patients and personnel not exposed were quarantined in a clean area, monitored carefully. Those who'd had any exposure—which included Standish's parents—were sent to a private room with total isolation until forty-eight hours passed with no evidence of infection and confirmed negative cultures. Laura was spared what would be a most uncomfortable encounter with Trey's parents.

In the meantime, the E.R. had transitioned into a dirty zone. Ambulances were redirected to the closest regional hospital.

Tampa health care was under siege. Under the direction of the CDC, all hospitals within a sixty-mile radius had initiated cultures on all patient admissions and all staff. No visitors, except parents of small children. Laura realized that it had been Stacy who had wisely instituted these precautions. As horrible as the situation was, how much worse if this staph ran rampant in the community. She wished that Stacy had not been called back to Atlanta. She was the real hero in this tragedy and the only person Laura could trust to ensure that Natalie got ticokellin. Tomorrow the CDC big shots would arrive, causing a media circus, which Laura worried could shift the focus away from patient care.

Rotating every two hours between visits to Natalie and to the ICU, Laura had not been to visit the additional intensive care units set up to handle secondary cases, starting with her chief resident, Michelle, and the ICU cleaning lady, Bunnie, whom she'd seen in the E.R. When she inquired, she was told that Michelle had been given ticokellin. Only two days ago, she'd asked Michelle to report back to her about ticokellin, the investigational drug Matthew Mercer's father had so desperately wanted for his son. Thankfully, Mercer improved without it, and he'd been medevaced out of Tampa City in the nick of time. An HIV victim would not survive this aggressive staph organism, ticokellin or not.

Bunnie wasn't doing well, Laura was told. A woman of her age with a temperature of 104.8 degrees, delusional and hallucinating and showing signs of DIC wasn't going to make it. Laura had wanted to follow up on whatever it was Bunnie had been trying to tell her in the E.R. Something like “a man doin' sumthin' to the patients
like feedin' them somethin'.” Had she said the man was a new doctor? Laura was too exhausted to remember, and now it could be too late to ask Bunnie for clarification.

At six a.m., with only two of yesterday morning's seven ICU patients surviving, Laura headed for Natalie's floor. She managed to change into fresh isolation garb before she all but fell onto the closest of two cots crammed into the small room. Tim snored on the other cot, loudly, through the protective mask. Before Laura could even inquire about the ticokellin for her daughter, she'd fallen fast asleep.

And, again, she'd neglected to inquire about her colleague, Ed Plant.

S
ATURDAY
, N
OVEMBER
30

When Stacy entered the stark lobby of the CDC, she found Director Madeleine Cox chatting with the receptionist. The director, always polished and professional, looked ready to travel, briefcase in hand, a forest-green pull-along suitcase by her side. Dr. Cox was in her late fifties with steel-gray hair cut just above shoulder length, slim with broad shoulders and in three-inch heels, taller than Stacy by half a head.

“Stacy, I've been waiting for you,” she said, checking her watch. “I'm on my way to Tampa to see for myself what you've discovered there. I wanted to ask you some questions before I go.”

“Of course, Dr. Cox,” Stacy said, pulling her shoulder bag closer. Inside, wrapped in layers of protective insulation, was the culture she'd taken from Tampa. Unauthorized. Against every protocol. Had the director found out?

“I don't have much time, so let's talk over there.” Cox pointed to two chairs in a far corner of the lobby.

“Nobody's here but us at this hour.” The director's trim suitcase rolled efficiently, her heels clicked against the polished marble floor. Stacy followed.

“I'm most curious about how you got involved with this staph strain attacking Tampa?” Cox asked as soon as they were out of earshot of the receptionist.

“Serendipity,” Stacy said. The two women settled into matching upholstered chairs, facing one another. “A friend in Tampa
called me for advice on a HIV patient, the first in the Tampa area, we think. She wanted to put me in touch with the infectious disease specialist there, Dr. Duncan Kellerman. He did track me down in Detroit, where I was visiting my mom for Thanksgiving. Only he wasn't calling me about HIV. By then, the Tampa City ICU had several patients with a virulent, resistant staph.”

“Who is this friend?” the director asked.

“Dr. Laura Nelson. She's a thoracic surgeon. Chief of surgery at the University of South Florida and Tampa City Hospital. I consider her my mentor. We've known each other since she was a medical student in Detroit and I was in high school.” Stacy still flinched when she remembered those bad days in Detroit, how close she'd come to a life of drugs and despair.