possibility.
“VHF was already brought up,” said Dr. Navarre. “That was one of the reasons we called the CDC so quickly.”
So much for that “zebra” diagnosis, thought Marissa, referring to a medical maxim that when you hear hoofbeats, think of horses, not zebras.
To her great relief, Dr. Navarre was paged for an emergency. “I’m terribly sorry,” he said, “but I’m needed in the ER. Is there anything I can do before I go?”
“Well, I think it would be better to improve the isolation of the patients. You’ve already moved them to the same general area of the hospital. But I think you should place them in a completely isolated wing and begin complete barrier nursing, at least until we have some idea as to the communicability of the disease.”
Dr. Navarre stared at Marissa. For a moment she wondered what he was thinking. Then he said, “You’re absolutely right.”
Marissa took the seven charts into a small room behind the nurses’ station. Opening each, she learned that, besides Dr. Richter, there were four women and two men who presumably had the same illness. Somehow, they all had to have had direct contact with each other or been exposed to the same source of contamination. Marissa kept reminding herself that her method of attack on a field assignment, particularly her first, was to gather as much information as she could and then relay it to Atlanta. Going back to Dr. Richter’s chart, Marissa read everything, including the nurses’ notes. On a separate sheet in her notebook, she listed every bit of information that could possibly have significance, including the fact that the man had presented with an episode of hematemesis, vomiting blood. That certainly didn’t sound like influenza. The whole time she was working her mind kept returning to the fact that Dr. Richter had been in Africa six weeks previously. That had to be significant even though a month’s incubation was unlikely, given the symptomology, unless he had malaria, which apparently he did not. Of course there were viral diseases like AIDS with longer incubation periods, but AIDS was not an acute viral infectious disease. The incubation period for such a disease was usually about a week, give or take a few days. Marissa painstakingly went through all the charts amassing diverse data on age, sex, life-style, occupation and living environment, and recording her findings on a separate page in her notebook for each of the patients. Rather quickly, she realized that she was dealing with a diverse group of people. In addition to Dr. Richter, there was a secretary, a woman who worked in medical records at the Richter Clinic; two housewives; a plumber; an insurance salesman and a real estate broker. Opportunity for commonality seemed remote with a group this diverse, yet all of them must have been exposed to the same source.
Reading the charts also gave Marissa a better clinical picture of the illness she was dealing with. Apparently it began rather suddenly, with severe headaches, muscle pain and high fever. Then the patients experienced some combination of abdominal pain, diarrhea, vomiting, sore throat, cough and chest pain. A shiver went down Marissa’s spine as she thought about having been exposed to the disease.
Marissa rubbed her eyes. They felt gritty from lack of sleep. It was time to visit the rest of the patients whether she wanted to or not. There were a lot of gaps, particularly in activities of each patient in the days directly preceding their illness.
She started with the medical secretary, who was located in a room next to Dr. Richter’s in the ICU, and then worked her way through to the last patient to be admitted. Before seeing each case, she carefully dressed in full protective clothing. All the patients were seriously ill, and none felt much like talking. Still, Marissa went through her list of questions, concentrating on whether each patient was acquainted with any of the other people who were ill. The answer was always no, except that each one knew Dr. Richter, and all were members of the Richter Clinic health plan! The answer was so obvious she was surprised that no one seemed to have spotted it. Dr. Richter might have spread the disease himself since he might even have been in contact with the medical secretary. She asked the ward clerk to call for all the patients’ clinic outpatient records.
While she was waiting, Dr. Navarre called. “I’m afraid we have another case,” he said. “He’s one of the lab techs here at the clinic. He’s in the emergency room. Do you want to come down?”
“Is he isolated?” asked Marissa.
“As well as we can do it down here,” said Dr. Navarre. “We’re preparing an isolation wing upstairs on the fifth floor. We will move all the cases there the moment it is ready.”
“The sooner the better,” said Marissa. “For the time being, I recommend that all nonessential lab work be postponed.”
“That’s okay by me,” said Dr. Navarre. “What about this boy down here? Do you want to see him?”
“I’m on my way,” said Marissa.
En route to the ER, Marissa could not shake the feeling that they were on the brink of a major epidemic. Concerning the lab tech, there were two equally disturbing possibilities: the first was that the fellow had contracted the illness in the same fashion as the others, i.e., from some active source of deadly virus in the Richter Clinic; the second, more probable in Marissa’s estimation, was that the lab tech had been exposed to the agent from handling infected material from the existing cases.
The ER personnel had placed the new patient in one of the psychiatric cubicles. There was a Do Not Enter sign on the door. Marissa read the technician’s chart. He was a twenty-four-year-old male by the name of Alan Moyers. His temperature was 103.4. After donning protective gown, mask, hat, gloves and booties, Marissa entered the tiny room. The patient stared at her with glazed eyes.
“I understand you’re not feeling too well,” said Marissa.
“I feel like I’ve been run over by a truck,” said Alan. “I’ve never felt this bad, even when I had the flu last year.”
“What was the first thing you noticed?”
“The headache,” said Alan. He tapped his fingers against the sides of his forehead. “Right here is where I feel the pain. It’s awful. Can you give me something for it?”
“What about chills?”
“Yeah, after the headache began, I started to get them.”
“Has anything abnormal happened to you in the lab in the last week or so?”
“Like what?” asked Alan, closing his eyes. “I did win the pool on the last Lakers game.”
“I’m more interested in something professional. Were you bitten by any animals?”
“Nope. I never handle any animals. What’s wrong with me?”
“How about Dr. Richter? Do you know him?”
“Sure. Everybody knows Dr. Richter. Oh, I remember something. I stuck myself with a vacu-container needle. That never happened to me before.”
“Do you remember the patient’s name on the vacu-container?”
“No. All I remember is that the guy didn’t have AIDS. I was worried about that, so I looked up his diagnosis.”
“What was it?”
“Didn’t say. But it always says AIDS if it is AIDS. I don’t have AIDS, do I?”
“No, Alan, you don’t have AIDS,” said Marissa.
“Thank God,” said Alan. “For a moment there, I was scared.”
Marissa went out to find Dr. Navarre, but he was occupied with a cardiac arrest that had just been brought in by ambulance. Marissa asked the nurse to tell him that she was going back to the fifth floor. Returning to the elevators, Marissa began organizing her thoughts to call Dr. Dubchek.
“Excuse me.”
Marissa felt a tap on her arm and turned to face a stocky man with a beard and wire-rimmed glasses. “Are you Dr. Blumenthal from the CDC?” asked the man.
Nonplussed at being recognized, Marissa nodded. The man stood blocking her entrance to the elevator. “I’m Clarence Herns, with the L.A.
“At this point, no one knows,” said Marissa.
“Is it serious?”
“I imagine your wife can answer that as well as I.”
“She says the man is dying and that there are six other similar cases, including a secretary from medical records. Sounds to me like the beginnings of an epidemic.”
