Altered Genes: Genesis (6 page)

“And he’s feeling okay?”

The woman nodded.

Mei leaned over the bed to take a closer look. The girl’s stomach was slightly distended. Her lips were dry from minor dehydration.
It could be anything—food poisoning, a flu bug.

She spoke to the mother, explaining what she would do. “I’m going to order an IV and arrange more tests. The IV will hydrate her—give her water, liquids that she needs.”

She opened the chart to make the notations for the tests she wanted to be done.
After the events with the English patient, might as well request a GDH as well,
she thought and began to make the appropriate markings on the girl’s chart. She stopped to listen when the PA system in the ceiling activated with a chime.

“CODE ORANGE…CODE ORANGE…Multiple MVAs”

Orange meant life-threatening casualties—in this case, a motor vehicle accident. Everyone in the ER who wasn’t already attending to a critical patient would meet the ambulances as they arrived.

Mei looked at the girl and made her decision.
She can wait.

“I’m sorry,” she said to the girl’s mother. “There’s been an emergency—a very bad car accident. One of the nurses will come by shortly to run the tests and set up the IV. I have to go.” She was gone before the woman could say anything.

T
he code orange
was a collision between a concrete truck and a small bus on FDR drive. Nine victims arrived at the ER in critical condition. Five went to surgery and the other four straight to the ICU on the sixth floor.

When she returned to the nurses’s station, one of the nurses gave her an odd look and pointed at her pants. “Sure you don’t want to put on fresh scrubs?”

She followed the woman’s eyes down. The cuffs of her pants were splattered with blood. It looked like she had walked through a puddle of it. Even with the plastic gown and shield she’d been wearing, she hadn’t escaped the carnage.

“Thanks. I’ll go do that now.”

”What do you want to do about the child in 2C?” the nurse asked as she turned away.

“Are her test results ready?”

“Right here.” She handed Mei the chart.

Mei scanned it. “What about the GDH?” She flipped through the chart a second time, searching for the missing test results.

“You didn’t ask for one.” The nurse took it back and showed her the request form with the incomplete section at the bottom. “Was that supposed to be it?”

“Damn it, yes.” She took the chart back and filled out the request for a GDH test. “Can you do it now?”

“Sorry—my shift’s finished,” the nurse said apologetically. “I’ve got to run and get my kids from my mother-in-law before she flips-out. She’s a royal bitch if I’m late.” She glanced at the shift schedule. “But I’ll ask Marcy to do it. She starts in five.”

Mei nodded.
A few more minutes wouldn’t make any difference.

“Oh, Cohen’s in 4D,” the nurse added as she threw on her jacket. Cohen was one of the ER orderlies. “He’s complaining about bad stomach pains. Can you take a look at him?”

“Has he been triaged?”

“Yep.”

“Okay, I’ll go check him out as soon as I change into fresh scrubs.

She changed and a few minutes later, found him bent over retching into a garbage can in the examining room. She handed him the box of tissues from the counter when he finished.

“Thanks, Doc.” He wiped his chin and the corners of his mouth and threw the tissue into the garbage. “I feel like shit.”

“You don’t look so well either.”

She flipped open his chart. “What’s the problem? Stomach cramps?”

“And the shits,” he said with a trace of embarrassment, “since early this morning.”

That’s two…three if she included the English patient.

“When did it start?”

“Just after midnight. I was fine yesterday.”

She shone her little flashlight in his eyes.
Pupils equal and reactive to light. No problems there.
“Any tenderness?’

“My gut’s a little sore…maybe swollen too. My pants feel tight.”

“Okay, stretch out and let me take a look.”

He lay down on the bed and lifted his t-shirt. She could tell immediately from the curve of his stomach he was distended. She gently pushed down and he winced.

“Hurt?”

“Like a son of a bitch.”

She finished her examination and wrote up his chart. “Okay, hang tight. I’ve ordered some tests. Someone will be here in a couple of minutes to do your work-up.”

When she arrived back at the nurses’s station, Marcy, the nurse who had just started her shift, had the little girl’s chart in her hand.

Mei pointed to it. “Can I see that?

“Sure, I was just about to file it.”

“File it, why? I requested a GDH.”

“Don’t know anything about that,” the nurse answered. “It was in the file pile.” She handed the chart to Mei. The GDH test still hadn’t been done.

“Damn it. Sandra told me she would ask you to do it.”

The nurse shook her head and raised her palms. “She didn’t say a word…I’ll go do it now if you want.”

“I’ll do it,” Mei said angrily.
That poor girl and her mother have been alone in the examining room for nearly three hours.
“You do Cohen’s. Here’s his chart.”

They stopped at the supply closet on their way to the examining rooms. She remove two test kits and handed one to the nurse. “Meet you back at the station in fifteen minutes.”

Mei jogged to the examining room. The girl’s mother looked at her and scowled. “My daughter, she is very sick. She has been crying, in pain—no one has come to help. I had to look after her myself.”

Mei apologized. “I’m sorry. It’s been very busy.”

The little girl was wrapped in a sheet taken from one of the gurneys. Her pants and dirty underwear lay on the floor. A pair of used rubber gloves sat in the bottom of the waste bin.

“Did she have an accident?”

“Accident?” the woman gave her a confused look.

“Diarrhea?” Mei explained. “Did you have to clean her up?”

The girl’s mother nodded.

Mei showed her the test kit. “This will help me figure out what’s wrong with your daughter.”

After she had collected a fecal sample, she placed it in the buffer solution as she had done the day before. “I’ll be back in a couple of minutes, Mrs. Sanchez.” She looked the woman in the eye. “I promise, okay?”

The woman gave her a worried nod.

Mei reached the nurses’s station at the same time as Marcy. She handed the girl’s test kit to the nurse. “I’ll be back in a few minutes. I’m going to set up a saline drip on the little girl.”

“Want me to do it?”

“Thanks, but I told the mother, I’d do it. It’ll only take a couple of minutes.”

She returned to the examining room, set up the IV and rushed back to the nurses’s station. Marcy’s brow was furrowed with concern. She held out the test kits.

“They’re both positive.”

Mei’s chest tightened.

“Get them prepped and moved to isolation—immediately!”

The nurse stared at her. Her eyes wide with shock.

Mei shook her head in warning. “Be careful, it’s infectious.” The tone of her voice was unmistakably grave.

“What is it?”

“I don’t know. Maybe a new strain of C. diff.”

One of the admitting nurses arrived at the station with a frazzled look on her face. She ignored Mei and spoke to Marcy. “You speak a little Spanish, right?”

Marcy nodded.

“Could you come help? There are some men in admitting. They don’t speak English but I think they’re complaining about their stomach.”

“How many?” Mei asked.

“Eight…maybe nine.”

Shit…
She turned and ran towards the elevator.

Where are you going?” Marcy yelled after her.

“To Robinson’s office.”

Robinson’s secretary frowned when she jogged through the door a few minutes later. “He’s not here, Dr. Ling”

“Where is he?” she asked, slightly out of breath. “I need to talk to him.”

“I’m not sure that it’s any of your business,” his secretary said with a pinched expression, “but he’s gone home. He wasn’t feeling well.”

“Could you call him…call him now!”

“Excuse me?”

“CALL HIM.” It wasn’t a request, it was an order. “I think he may have been infected by one of the patients in the ER.”

The phone was in the woman’s hand and at her ear in a matter of seconds. “It’s just ringing,” she said as Mei watched. “I have his voicemail. Should I leave a message?”

“Yes—“ She changed her mind. “No, call 911—have them send an ambulance to his home.”

“Do it now!” she shouted when the other woman didn’t move.

Am I doing the right thing? If he’s not ill, my career at Bellevue is over.
She pushed the thought out of her head.
That’s a problem for another day.

She pointed to his office door. “I need to file a report with the CDC.”

Ten minutes later, the verbose government form was completed. She didn’t bother filling out one for each patient but used a pen to circle the section labeled
Primary Number of Cases
and wrote four.

Next to the word
# Died
, she wrote two and then scratched it out and wrote one.
Robinson wasn’t dead yet.
She scrawled the word
**URGENT**
across the top and faxed the form to the number on the form.

S
even hundred and
fifty-eight miles away in Atlanta, Georgia, a piece of paper spilled out of a fax machine onto the floor of the Records Department at the Center for Disease Control headquarters.

It was almost missed but for a diligent clerk who picked it up and keyed the information into NORS.

Bellevue hospital now held the dubious record of being the first American healthcare facility to report an outbreak of the deadly bacteria.

Outbreaks had already been reported across the United Kingdom and India. In the coming hours and days, many more would be reported worldwide.

A
warm light
caressed her face as she ebbed back into consciousness. Saanvi slowly opened her eyes only to quickly close them. The stream of sunlight that shone through the window made them water. She blinked a few times and then cautiously tried again, cracking one eyelid open and then the other.

“I'll draw the blinds,” a voice said.

Saanvi raised her hand to block the light and searched for the person who had spoken.
A man with a British accent…where am I?

A translucent tube was taped to the back of her hand. Her eyes followed it to a plastic bag that hung from a metal rack. The room dimmed as the blinds were drawn and her surroundings became clearer. She was in a small room with pale yellow walls. There were flowers in a vase on the nightstand next to the bed. The air had an antiseptic smell.

“Good morning. You’re at the Ahmedabad Civil Hospital.”

The doctor who spoke moved away from the window and into her line of sight. His face was covered by a white surgical mask, only his eyes showed.

“I'm Dr. Brar…Your aunt and uncle brought you to the hospital two days ago,” he said as he stepped forward.

Two days…was I asleep the whole time?
She blinked away the confusion. “Where are they?”

“In the waiting room. I'll fetch them in a few minutes. How are you feeling?”

“Okay, I guess…my stomach hurts a bit.”

“That’s to be expected. You were quite ill. I’d like to do a quick examination before your aunt and uncle come in. Tell me if you feel any pain or discomfort.”

She tensed as he began to examine her and winced when he touched her lower abdomen. “Ow, that hurt.”

His eyes twinkled sympathetically as he spoke. “Your stomach is still distended but not nearly as much as when you arrived. You’ll be tender for a few more days.”

“What’s wrong with me?”

“You have an infection in your gastrointestinal tract,” he answered. “Let me get your aunt and uncle and we’ll go over everything in more detail. They’re quite anxious to see you.”

He left the room and returned a few minutes later with them. They both wore yellow plastic gowns with surgical masks on their face, blue gloves covered their hands.

Her chest tightened as she watched her aunt’s eyes dart nervously around the room, finally coming to rest on the IV tube. The older woman took a cautious step forward and stopped at the end of the bed.

“Hello, dear.”

“Why are you dressed like that?” she asked nervously as a knot formed in her stomach.

“It’s just a precaution,” the doctor answered. He stepped closer as if to make the point that no one had anything to fear from her. “You're in an isolation room. The infection you have is contagious.”

She bit her lower lip as the tears began to well up in the corner of her eyes. “I don’t understand.”

He pulled a chair from the wall and sat down beside her. “There’s a bacteria called Clostridium difficile in your colon. It made you sick, but we've started to treat it.”

“How did I get it?” she sniffed.

He shrugged. “We don’t know. Your mother told us you had pneumonia earlier this year. It's very possible the antibiotics you were given to treat the pneumonia also killed the good bacteria in your stomach, making it easier for the C. diff to grow.”

She looked at her aunt. “Is my mother here?”

“No, dear, your parents are still in England,” the older woman said as she stepped forward and stood beside the doctor. “They are trying to arrange funds to come, but it’s a great deal of money. Don’t worry, your uncle and I will look after you.”

“When can I leave?”

“Not for a while,” the doctor answered, “The treatment is working, but you’re still contagious.”

Contagious—the word scared her. I don’t want to be contagious. I don’t want to be here.
She began to weep softly.

The doctor stood and pushed his chair back against the wall. “We should let you rest,” he said in a gentle voice. “I’ll come see you later, and your aunt and uncle can visit again in the morning.”

After everyone had said their goodbyes, the door closed with a firm click, leaving her with only the muffled sounds from the corridor for company. If she listened carefully, she thought she could hear the faint rumble of traffic from the street below.
She was alone. She closed her eyes and cried.

The Latino woman knelt by the side of the bed, her yellow plastic gown folded around her body. Her gloved-hands were clasped together as she prayed in silence. When she finished, she made the sign of the cross and lay her head down on the blanket that covered her daughter’s still body.

A neon green line displayed the child’s heart rate on a monitor by the side of her bed. Her vitals were stable—for the time being. The catheter inserted in her femoral vein supplied her with liquid nutrients and the IV drip kept her hydrated.

Mei stood on the other side of sliding glass door and watched.
I should have got her on antibiotics sooner
. She didn’t know if it would have made any difference.
But it might have.

The orderly, Cohen, lay in the bed next to the girl. He was just as sick as the child. Excluding the British man, and two others who had died, there were now nineteen cases in the hospital. All had come in the last twenty-four hours. New cases were arriving every hour. Some were hospital staff, others were illegals—mainly Latino men. All were grievously ill.