Altered Genes: Genesis (5 page)

S
till bleary-eyed
from the previous day’s double-shift, Mei waved a half-hearted greeting to the nurse behind the counter of the nurses’s station.

The isolation room beside it was empty.

“Where's Mr. Muir?”

“Surgery—went into septic shock this morning.”

She frowned.
He was stable last night. The antibiotics should have helped
. “Are the results from his lab work-up handy?”

“Have them right here,” the nurse said and handed them to her.

Her eyes widened as she scanned lab report.
The concentration of A/B toxins in his intestines was high—off-the-chart high. 1,603 micrograms per liter for the A toxin and 247 for the B toxin—nearly thirty times normal. At those levels, his gastrointestinal tract would be falling apart.

“These don’t look right,” she said, confused by the results.

The nurse shrugged. “Do you want them re-done?”

She nodded and continued to flip through the chart.
His white blood cell count was nearly eleven-times normal as well. But was that the C. diff or something else?
“Any signs of leukemia or other infections?”

The nurse opened his file on the computer and looked. “Nothing listed here.”

She re-read the chart.
Something’s wrong, either the test results are haywire—it wouldn’t be the first time—or Mr. Muir has the worst C. diff infection ever recorded.

She dropped the folder on the counter and started towards the bank of elevators. “I’ll be back in ten minutes.”

She stepped off the elevator on the fifteenth floor and looked at the schedule posted on the wall. Muir was in OR-2. She hurried to the observation deck and quietly joined a group of surgical interns. They were intently watching the procedure taking place in the operating room below.

“What's the prognosis?” she whispered

“Toxic megacolon,” an intern whispered back.

“How severe?”

“Very…multiple perforations and sepsis.”

That explains the high white blood cell count,
she thought.
His immune system was producing them to fight the infection. But C. diff rarely resulted in toxic megacolon. She couldn’t remember the last time she had seen it—maybe never.

The empty chairs in the observation deck filled quickly as more interns came to watch the rare procedure.

The operating team had turned on the microphones. The entire room watched in silence as the surgeons worked on Muir, removing chunks of his colon as they fought to save his life. Unable to keep up with the furious pace of the infection, they failed. His organs shut down, one by one.

“Let’s call it.” The lead surgeon said as he pulled off his gloves and threw them in a disposal bin. "Time of death…8:26 am.”

Confused, she slouched back in her seat.
Muir had been ill. There was no doubt about that but something was wrong. No one dies from a CDI that quickly.

Robinson needed to know but she had no idea what to tell him. She took one last look at Muir’s body and jumped from the seat. Her tiredness was gone.

Ten minutes later, she sat in the waiting room outside of Robinson’s office tapping her foot impatiently
.
“He’s very busy,” his secretary had scolded her, “You can’t just show up and expect a meeting, Dr. Ling, but I’ll see what I can do.”

The more Mei thought about it, the more it bothered her. She didn’t see a lot of C. diff patients in the E.R. but even so, everything about this case seemed wrong. The patient was middle-aged, not elderly. There was nothing to suggest he was at risk. Most surprising of all was how quickly the infection spread through his intestines.

The phone buzzed and the woman at the desk picked it up, listened for a second and then spoke. “You can go in now.”

Mei stood and steeled herself for the inquisition that would come. Robinson’s office was on the north side of the 16th floor of the administration building. It had a commanding view of the city. Through the large plate glass window, she could see the iconic spire of the Empire State Building towering over the streets of Manhattan.

The walls were covered with artwork, mostly prints of famous renaissance works she recognized but had no idea who the artist was. His degrees and awards were displayed in glass-covered plain black frames and filled the wall behind his desk. A large floor globe on an ornate stand sat in the corner.

She half-expected him to be sitting in a smoking chair puffing on a pipe. But he wasn’t, he was sitting behind a large oak desk glaring at her.

He beckoned her forward. “This couldn’t wait until the staff meeting on Friday, Dr. Ling?” he asked with an impatient huff.

“Sit…Sit,” he added even more impatiently.

She pulled out one of the ornate chairs and sat.

“You have my undivided attention,” he said as he clasped his hands together and looked at his watch, “for the next fifteen minutes. What can I do for you, Dr. Ling?”

She didn’t waste any time. “The British patient from yesterday—I’d like to request an autopsy and file a NORS report.”

He pushed his bifocals down to the tip of his nose and peered at her over them. “What British patient?”

“The one with the C. diff infection. You saw him during rounds yesterday. He died this morning.”

“The obese man with diarrhea,” she added, jogging his memory.

Robinson wore a look of distaste on his face as he remembered and frowned. “What about him?”

“I think we should file an outbreak report with NORS and request an autopsy.”

The National Outbreak Reporting System (NORS) had been launched a few years earlier to track gastrointestinal outbreaks across the country.

“A report?” he scoffed. “One foreigner with a C. diff infection is hardly an outbreak.”

“Or have there been others?” He leaned forward suddenly, his brow wrinkled as he studied her.

He was worried about his ER, it’s reputation. No hospital wanted the stigma of a C. diff outbreak.
She shook her head. “No, no other cases.”

He relaxed.

“Come see me when you have more cases—even one more would be a good start.” He removed his glasses and placed them on the desk. ”And what’s this nonsense about an autopsy—an autopsy for what?”

“The patient died suspiciously.” She cringed at her unfortunate choice of words.

He frowned. “What was suspicious about it? I thought you said he died from a C. diff infection.“

“Actually, it was toxic megacolon that killed him but the root cause was the infection,” she replied, digging herself a deeper hole.

“How can you possibly know that, Dr. Ling? C. diff infections aren’t the only cause of toxic megacolon and even if it was the cause, were you the attending physician?”

“No,” she said reluctantly, knowing the conversation was over.

“Have the next of kin been contacted?

“I don’t know.”

“Then you don’t know if an autopsy was requested or if they approved one?”

“No.”

“Well, then I think, we’re finished with this discussion.” He pushed his bifocals up the bridge of his nose and leaned back in his chair.

“What about the department of health? You could ask them to request one.”
Now she was grasping at straws.

His eyes widened as he looked at her. “And be laughed at? Come see me when you have more, Dr. Ling.”

He pushed back his chair to stand and was half-way to his feet when he winced and stumbled forward.

“Are you okay?” She was on her feet, moving towards him.

He held out his hand to stop her and clenched his jaw. “I’m fine—something I ate. It’s not agreeing with me.”

He stepped around his desk and he took her arm. “You have to leave now,” he said as he escorted her to the door. “I have another meeting scheduled.”

“You should get yourself checked out,” she suggested, knowing he wouldn’t.
Doctors were the worst patients.

“I’m fine, Dr. Ling, thank you.”

Blanca cried out in pain and Lucia leaned over the bed. She tenderly caressed her daughter’s forehead.

"Alejandro, please get some water,” she said to her son, “a little cool but not cold.”

While he fetched the water, she brushed her daughter’s hair back from her face. It was damp with sweat and stuck to her forehead. Blanca’s eyes flickered at the touch of her mother’s hand. She cried out in pain and writhed in agony. “Mamá…Me duele el estómago.”

All night she had complained about the pain in her stomach.
Nothing she had tried to relieve the pain had worked. She didn’t know what else to do.

The boy returned with the water and placed it on the nightstand. “What’s wrong with Blanca? Will she be okay?"

“Your sister—“ Lucia’s voice broke and she fought to regain her composure. "Your sister is strong. She will be fine.”

She dipped the facecloth in the bowl and squeezed the excess water out before draping the damp cloth across the child’s forehead. As she did, the little girl spasmed, exposing the diarrhea that stained her nightgown.

Lucia gently unfolded her daughter’s body to undress her. She carefully removed the soiled clothing and placed it on top of her own dirty blouse in the laundry basket.

Without being asked, Alejandro carried the basket to the bathroom. She would wash it later in the tub.

"Gracias…you're a good boy,” she said when he returned.

“What now?” he asked.

She was scared and didn’t know, but the doctors at the hospital would. It had been a little over twelve hours since they had left it. They would return—but not by bus. Time was more precious than money.

"Call a taxi.”

M
aybe Robinson was right
,
Mei thought as she stepped off the elevator and turned down the hallway to the nurses’s station.
They’d only had a single case and strange or not, there were other diseases that could explain the British patient’s rapid death.

The ER was busy with doctors, nurses and orderlies flitting about in organized chaos. It was still early in the day, the real madness wouldn’t start until later, usually around 6:00 p.m.

She stopped and glanced at the assignment board on the wall. There was nothing beside her name yet.

“I’m back,” she said to the woman on the other side of the counter. “What do you have for me?”

“How’d it go?”

She shrugged. “About as well as you’d expect.”

The nurse nodded sympathetically. She looked at the computer screen in front of her. The display showed the status of the patients in the ER. It included those who had been seen by one of the triage nurses and were now waiting to be seen by a doctor.

“You have your pick this morning,” the nurse said, offering up choices like a waiter with the daily specials. “I’ve got an elderly man—fell and broke his arm. He’s confused and not sure where he is. Or you can have a little girl with stomach cramps and diarrhea. I’ve also got a—”

“I’ll take the girl,” Mei answered. She wouldn’t admit it openly but working with the elderly made her uneasy. Not something she was proud of.

She picked up a marker from the shelf below the assignment board and asked, “Last name?”

“Sanchez.”

Mei wrote the name on the board beside her own.

“She’s in 2C,” the nurse added.

When she arrived at the examining room, a Latino woman in her early thirties stood anxiously by the side of the bed. She looked familiar. Mei racked her brain trying to remember where she had seen her before. A teenage boy with his arm in a cast sat in the chair beside the bed.

“Hi, I’m Dr. Ling.”

The woman turned at the sound of her voice. She looked surprised when she saw Mei.

Mei opened the girl’s chart and read from it. “It says your daughter has diarrhea and is complaining of stomach cramps. Let’s take a look.” She pulled a pair of gloves from her pocket and snapped them on, pulling at the fingertips to adjust the fit.

“She is very sick.” The woman’s Spanish accent was strong.

“When did she last eat?” Mei asked.

“Last night,” the woman answered. “Same as my son.”