Silent Fear, a Medical Mystery (31 page)

He approached Joelle, standing with Rhonda, Peter, and Timothy. “I hope you’re all having a good time,” Danny said. “This is Sara.”

“All of us are happy to meet the Maid of Honor,” Joelle said. “Danny speaks highly of you.”

“Oh?” Sara said.

“Yes, we’re all working on a meningoencephalitis cure and sometimes we need a conversational break from bugs and microscopes, rounds and patient deaths.”

“Sara,” Danny said, “Joelle and Rhonda are very close to perfecting an antibiotic. I forgot. Have you all met the canine running around here whose saliva is a lifesaver?”
Sara registered a look of surprise.

“No,” Joelle said.

Danny scoured the area for Dakota. Spotting him closer to the house, Danny took a step outside the tent and yelled his name. The dog turned his attention from a group of guests enticing him with baby meatballs and trotted through the crowd to Danny.

“He’s beautiful,” Rhonda said, crouching down.

“Sara, Rhonda is the vet in the group. Can’t you tell?”

Joelle dropped down, too. She wore cream trousers and a soft pastel top with a drop down neckline, material gathered in smooth folds. Her silver earrings had an extra embellishment – a blue topaz dangling in the middle. “Hi, Dakota,” she said. “You’re an important boy. I’ve been working intimately with your body juices.” She laughed and ruffled his coat with Rhonda.

Danny laughed. “Good thing you didn’t bring a date… he’d be jealous.”

Timothy hoisted his cane towards Sara. “Don’t mind us, Sara. We’re all a strange bunch.”

After a glass of wine, Danny and Sara ambled along the hot buffet table and added salmon, vegetables and bread to their plates, and then joined Danny’s colleagues.

“Sara, you know Bruce and his wife, but you may not have met Matthew Jacob. And Jeffrey Foord is a new doc who started with us last Monday. And you know Cheryl, my office nurse.”

Sara shook Jeffrey’s hand.

“Danny told us you’ve gone back to teaching.” Bruce said.

“I have. At our girls high school. I forgot how much I missed it.”

“I bet you didn’t skip a beat,” Bruce said.

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With a three-quarter moon casting a glow, the wedding party ended by midnight, much later than the newlyweds had anticipated. By that time, Danny and Sara were side by side without a second thought.

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Within two days Mary and Casey took off to Alaska for their honeymoon. Danny hired more help for Julia and the pressure in the office had eased due to Dr. Foord’s employment. He still hadn’t heard from Rachel. He wondered why, although he knew any supervised visitation would be awkward for her as well as for him.

The round robin of calls between Joelle’s lab, Ralph and the CDC, Danny and Peter and Timothy continued. Sometimes Danny joined them on rounds for the newer cases of PAM. Although Danny asked them if they didn’t want his input any more, they all insisted he was integral to the project.

One day in the doctor’s lounge Joelle put her hands on her hips and told him her opinion. “Timothy is the medical neurologist but you are our physical neurologist, so to speak. If we need
someone to do surgery or brain biopsies or come with us to the FDA and explain this disease and how it eats the brain, then you must continue to be part of this team. Besides, you’ve been with this from the onset.”

Danny couldn’t argue with her. He continued to visit the lab twice a week and see for himself the progress the two women were making. Apparently, they were still one step ahead of the CDC. Finally, three weeks later, as the country’s cases soared to 870 deaths, 1,251 cases, and outbreaks reported in Canada, Mexico, and Australia, Danny was about to receive a call from Joelle.

The late afternoon office hour made Danny feel pressured to finish seeing the last of his patients, but he stood with Jeffrey in the viewing room, helping his younger colleague. “This is so subtle,” Danny said, pointing out an area of midbrain on an MRI. “It’s not only what stands out at you, but consider what you’re not seeing.”

Propping his elbow on his other hand, Jeffrey nodded.

“You’re off to a capable beginning,” Danny reassured him “The nice thing about having colleagues and not being in a solo practice, is that you can bounce things off other docs. It’s why we make a good group.”

Jeffrey pointed back to the MRI. “I see your point. No one’s presented it to me that way before. Thanks, Danny.”

Danny’s pager beeped as the earringed doctor squeaked out of the room in his tennis shoes. He turned to the phone in the semi-lit room and called Joelle back.

“How’s it going today?” Danny queried.

Joelle let out a long sigh like a balloon getting rid of stale air. “Finally, we’ve got it.”

“Really?” Danny shot back.

“Really. Rhonda is
here, besides the two aides I’ve had the last couple of weeks. We can’t go any further unless we want to readdress every aspect of this drug over the next twelve months.”

“What chances do you give it in vivo?”

“We have to say a prayer that the FDA gives us clearance to try it without the usual hurdles. And then it’s anyone’s guess, but we’ll have no other choice.”

Danny looked at the x-ray view box, the white illumination like a sunrise in the dark. “Perfect timing,” Danny said. “Maybe you’ve discovered the north star in a stormy night.”

“I hope so. Get packed. You’re coming with us to Silver Springs, Maryland.”

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At The Food and Drug Administration’s headquarters, the chief administrators awaited the arrival of the medical doctors from Nashville and Atlanta with hope and skepticism. The pending meeting was labeled an “emergency conference,” the meeting of minds between the only existing topnotch experts directly involved with the biggest epidemic in modern times. The FDA had been told by the CDC that the epidemic so far had been miraculously spared a larger spread due to the meticulous isolation hospital precautions all around the country. Otherwise, the CDC had warned, there would have been more widespread puddle jumping of PAM causing rampant spread in most other continents.

The pack of doctors and one nurse left the Hilton Hotel’s breakfast buffet at the same time and grabbed cabs to the FDA’s base of operations. When the nine of them arrived and exited the three cabs, a swarm of reporters converged. The Saturday morning coverage would supply good fodder for the entire weekend news and it looked like no reporters stayed in bed.

It was chillier in Maryland compared to home, but Danny unbuttoned his sports coat as they single filed between the crowds. “It would be best to give you information after the meeting,” Danny said to the nearest reporters. The sky threatened rain, so they hurried along not only to push through the reporters but to escape any sudden shower.

Familiar with the complex, Ralph veered them up the steps and to the right. Joelle and Rhonda both wore heels and kept pace. Timothy brought up the rear. He stopped for a breather and gave the reporters a minute of his time. The group waited for him after they entered the building.

A man in a suit and a woman in a uniform waved them over to one section of the massive building. They opened the doors to a large conference room with a serious table.

The group of nine who had flown in included Ralph and another researcher from Atlanta. The remaining seven were Nashville people including Robert Madden, the hospital CEO, to lend a hospital’s perspective on the epidemic. The visitors, after making out name tags, sat on both sides of the table. Pitchers of water, cups, and pads of paper were available and all those with briefcases opened them up and put papers in front of them. Ralph passed copies of data sheets to everyone around the table.

A rounded man with a gray suit began speaking before he sat. “Welcome, everyone. I am Grant Edwards. I’ve had multiple conversations with Ralph Halbrow from the CDC. The folks in this room from the FDA represent the Center for Drug Evaluation and Research. Because we also understand your project involved canines, we have a representative from the Center for Veterinary Medicine.” He pointed to a hunched over man nearby, and then allowed them to begin.

Joelle brought along notes of the team’s key points. “So we’re on the same page,” she said, “as we began working with this amoeba, it most similarly looked and behaved like
Naegleria fowleri
, but there were differences. It also has a predilection to affect the host’s salivary glands, causing increased salivation. Coming in contact with this saliva in an unprotected way is one mode of transmission. Of course, as we all know, it wreaks havoc on brain cells. Dr. Danny Tilson, our neurosurgeon can comment on that. You all have the mortality and morbidity stats from the CDC in front of you.”

Danny glanced at his sheet. Not only had the numbers grown, but another country had been added, probably from a travelling American to Costa Rica.

“So,” Joelle continued, “we realized we were dealing with a different genus and species. This organism has now officially been named
Naegleria salivi
. The baptismal name had to go through the proper channels. Up until now we’ve been nicknaming the epidemic as a PAM, for a primary amoebic meningoencephalitis, but PAM doesn’t just refer to
Naegleria fowleri
. This particular epidemic is due to
Naegleria salivi
.” Joelle glanced around the table making eye contact. Her discussion was for utmost clarification and announcement of the taxonomy.

“I have presented you with the essence of the scientific backing for the antibiotic we have developed. It is before you in the stapled packet of papers. All previous drugs that were helpful, but not always curative, in the treatment of
Naegleria fowleri
did nothing against
Naegleria salivi
. No other classes of antibiotics eradicated the organism either. We discovered that the Chesapeake Bay retriever breed held something in their saliva which not only penetrated the amoeba’s outer membrane, but then also penetrated and broke down the organism’s nuclei. Before that, we could not find that unique combination.”

Joelle eyed the serious faces giving her attention. It wasn’t always the case to present what she had to say without being interrupted. She smiled, glad for the freedom to forge ahead.

“What our lab has developed is a streptomycin which does exactly what I’ve told you. In vitro, this antibiotic has been tested for days on
Naegleria salivi
resulting in its death one hundred percent of the time.” She switched her gaze to Robert Madden. “For any of you without a full scientific background, in vitro means ‘in the lab,’ as opposed to in vivo, which would mean testing it in a living organism. In other words, humans infected with the disease.”

Joelle took a sip of water and looked towards Ralph, who took her cue and stood up. He ran his thick hand on top of his receding hairline and then planted his thumb at the junction of his suspenders. “Ladies and gentlemen of the FDA, the CDC has been a step behind Dr. Joelle Lewis and her team, but has verified her results in our own lab. We are requesting that this organization side step all the regular channels for developing and testing this drug and make it available to the public. It is our responsibility to not waste one more day. In addition, you must recognize that the people already infected for awhile are probably going to die. This is the only hope, if given early on. And I emphasize early. We think getting this antibiotic into a person’s bloodstream as soon as the diagnosis is made is key.” There was a silence.

Grant Edwards cleared his throat. “We will be candid here, Mr. Halbrow. We are the only thing that stands between a potentially harmful drug in the making, and making it a safe and effective product that is supposed to heal or improve the health of the people of this country. We can expedite our own testing based on information you supply us with.”

“So you’re saying,” Ralph said, “the FDA is goin’ to go around its ass to get to its elbow?”

Grant’s face reddened. Danny stood up.

“Mr. Edwards,” Danny said as he looked around to all the members of the FDA, “I have a single sheet with your packet which explains the sinister way this organism penetrates the brain. It not only travels from the contamination Dr. Lewis spoke of, but it can occur from fresh water, as in the first case of young Michael Johnson jumping into a lake.”

Danny’s pulse began to quicken. He must pound them with the scary details. They had to get approval.

“Ladies and gentlemen, how would you like to be sitting here well and alert and within a few hours, have this amoeba introduced unsuspecting to you, into your nose? First, the mucosa or tissue responsible for your smell, olfactory bulbs, will dissolve, even hemorrhage. You know, bleed out. Then these little organisms are climbing along your nerve fibers straight through the skull area called the cribriform plate. That’s the floor of your cranium. So now it’s inside your brain.” Danny swallowed hard and looked piercingly at them all.

“Piece by piece,” Danny said, using his fingers to demonstrate, “your brain cells are being sucked in and consumed. That’s because
Naegleria salivi
has special suckers extending from its cell surface. As you have fewer and fewer cells for thinking, or moving, or speech, you are already in a coma, and the contents of who you were are nothing more than a parasite’s meal. This is the reality behind this silent fear which has grown to pandemic proportions. Don’t you agree that this real amoeba is more disgusting than a Stephen King novel?”

The room erupted in silence as visual images crept over the participants’ thoughts. A few heads nodded. Grant Edwards stood. “Can all members from the FDA follow me into the adjacent room, please?”

As they began heading toward the door, Danny spoke up again. “I have one more thing for your consideration. Even though the drug isn’t perfectly formulated yet, consider me the first in vivo patient to have received its key ingredient. I had an open wound and my Chesapeake Bay retriever thoroughly licked it, inoculating my bloodstream and brain cells with his saliva’s protection. It stands to reason why I’m on this side of the grass compared to the victims and I’m able to give you this pitch. Give the American people and the world the same opportunity.”