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GRACE WHITE WAS A LIGHT-skinned black woman, thin and in her late 20s. “Please, call me Grace,” she said, first thing.
He had been, but he appreciated the courtesy. “Then I’m Glenn.”
She shook her head and smiled. “No, I’ll stay with ‘Doc.’” Her voice was raw.
He asked her straight out how she identified herself ethnically, so he could put it correctly in his records. “Mom’s white,” she said. “‘Mixed race’ is usually what I mark. Does it matter?”
“Usually not, but sometimes—rarely—a disease will strike one ethnic group harder, so we keep track so we know how to help people best.”
“Mom was pretty much a mutt. English, Irish, German. Dad, black for at least three generations back, but who knows back in slave times.”
“Thank you.”
He had commandeered an empty room on a medical floor and did the exam himself. He wore his own mask and a borrowed eye shield. This was no way to make someone comfortable, but he had to protect himself. He had found an O2 monitor in a drawer, and a blood pressure cuff was part of the room equipment; he traveled with his own stethoscope. Her temp was 38, her BP 100/70, and her O2 sat 90. No, she wasn’t a smoker. He listened to her lungs. She was talkative, so he had a hard time getting her to shut up for long enough to hear breath sounds. A little bit of a crackle. He didn’t think her lungs were in terrible shape from the sounds, but he wanted an X-ray to make sure, and that would mean he had to engage with the financial system of the hospital. So once again, he would run into the problem of the patient not having good insurance.
He phoned the infection control officer for the hospital, Ms. Ellis, introduced himself and his problem, and she said she’d take care of it. Five minutes later, she was there in person, and she walked Grace through the X-ray herself. Glenn looked her up online while they were gone—an MSN in nursing, a solid background, and now this cutting-through-the-bullshit ability. He wished everyone he had to deal with on the job was like this.
He had skipped lunch. Realizing he was losing the ability to focus, he went in search of food. He found the cafeteria and got himself a plate of hard-to-ruin food—cottage cheese, canned peaches, and lime yogurt. While he ate, he tried to catch up on emails. Nothing yet from the lab at the CDC on identifying the sample they’d been shipped over the weekend, and he thought it’d be at least another 24 hours before he received any information at all. The samples he’d collected, he’d overnight.
Most of his email, he didn’t open. Others he opened and forwarded to Makayla, begging her to deal with it. Some of this wasn’t typically her job, but this was non-medical stuff she could handle and did from time to time, when someone in his unit was out on an assignment. He opened his to-do list and added buying Makayla a thank-you gift. She’d take on more work if things got worse.
His sense was, things would get worse. This cluster of people was only the tip of the iceberg. There was no reason to panic yet. It might be localized and limited. But if it was a flu, that could be bad. Flu killed about 25,000 Americans every year. A good year might be a third of that and a bad year three times that. People worried about diseases based on whatever panic the media was trying to spread—Ebola or Zika or whatever disease of the month. But often those diseases would kill five or ten people and get thousands of column inches in the papers. Flu killed 25,000 every year and hardly a word was said about it.
He had come to dislike the press in his years at the CDC for just this reason. They could educate, but they frightened instead. They could be accurate, but they often published rumors more than facts. They could phone the CDC public information office to get accurate information, but often they did not. Some of them seemed not to know the difference between reliable medical sites online and bizarre conspiracy theory sites. Wasn’t there some sort of training for being a journalist? Apparently not.
And that was the printed press—or online press, more than likely these days. TV? Hell, it was all fictional programming, including the news. He didn’t watch it anymore, and when he read something reported on not in his field, he didn’t believe it until he could replicate the information at reliable sources, of which television was certainly not one. The BBC and Canadian TV both did a much better job. But American TV had devolved over his lifetime to some free-for-all of yelled disinformation. He’d seen Hollywood celebrities interviewed about medical matters rather than qualified doctors. Whoever screamed the most bizarre lie loudest felt he had won. And he supposed they had, if “winning” for television news was keeping more people around to buy whatever piece of crap was being advertised next.
He took his tray to the collection point at the side of the dining room and cringed when he saw a four-year-old child reach out and touch a half-eaten piece of cake left on a tray and then lick his finger. Great way to spread disease. You couldn’t blame the child—or even his father, who was carrying a baby and a diaper bag as well. Glenn smiled at the child but took up the offending tray and smacked it against the trash can so that the cake fell in, perhaps disappointing the child but striking a minor blow against contagion.
He found a quiet corner and had just finished some quick interviews with the primary care doctors of the admitted patients when the phone rang. The number was local. He answered.
It was Ms. Ellis. “I’m admitting your patient.”
“What’s the X-ray show?”
“Fluid building up in her lungs. It’s just the start of it, but they had to intubate Mr. Washington a couple hours ago, so I recommended to the ER doc that he write orders for admission for Ms. White.”
Damn. He had been asked to be informed of changes in Washington’s status. But then, staff may have changed at 3:00 and that message might not have gotten through to the afternoon shift. He’d go up there and make sure his contact info was on the chart, insisting politely until he was certain that they knew he was to be kept in the loop.
“How’s Grace taking it? And she’s not my patient. You’ll need to contact her primary care provider.”
“I know. She was reluctant to agree to stay, but I had an ICU nurse take a photo of Mr. Washington with the breathing tube in place and email it to me, and that seemed to do the trick. It was terrible of me.”
“But effective, it seems. I haven’t finished interviewing her about contacts.” He checked his watch. He had an appointment at the Washington home in less than an hour. “And I won’t be able to right now.”
“Tell me what to ask. I’ll do it.”
“Ellis, you’re terrific. I hope they tell you that.”
“Not nearly often enough. Contacts for the past week, and what else?”
“Job. Pets. Travel. Hobbies. Anything at all about contact with animals—if she petted a dog, or has to set out mouse traps at home.”
“Will do.”
Glenn was relieved to pass this one duty over to someone so competent. “Tell her I’ll visit her tomorrow, okay?”
“Of course.”
He went back to the parking lot and realized he had forgotten where he had parked. Worse, he had forgotten what he was even driving. The idiot alarm on the key fob did the trick, leading him to a white sedan. He took five minutes to set up the Bluetooth in the car for his phone and made a call to the county Director of Public Health, Jose Alverez, whom he’d called earlier to ask to gather information on similar cases at other hospitals and clinics.
“We found fourteen possible cases,” Alverez told him. “Six from ERs, and one admitted to the hospital today, an elderly gentleman. There are also eight from one walk-in clinic and two from another. All this weekend or today.”
“That’s all?” It didn’t sound bad.
“No, it probably isn’t all. We haven’t heard back from the other acute care clinics, of which there are half a dozen more. I don’t have the staff to keep after them. Budget cuts, you know.”
“My people will get the info tomorrow if you can’t by then.”
“Do you think it’s something to worry about?”
“It’s definitely something, and I don’t like how sick it’s making these two young, otherwise healthy people I saw today.”
“How bad is it going to be, do you think?”
“We’ll know more by the end of the day tomorrow. I wouldn’t call it anything but a limited cluster yet, though who knows what we’ll be seeing by the end of the week. You and I both know that with these twenty likely cases, there are more sick people out there we haven’t heard from yet. And a lot more coming.”
“Should I send out a press notice?”
“Let’s meet face to face at, say, five tomorrow evening when I have more info for you.”
“Kid has futbol right then. I’ll do it at six-thirty, if that’s okay.”
“Good with me. I’ll call you back with a location. I’ll have to arrange that too.” He signed off. He’d need a local incident command center. Maybe the hospital had a conference room, or maybe his hotel would. He saw a liquor store ahead with a big parking lot and swung in to park and make another two notes on his to-do list.
He’d be five minutes late to his appointment at the Washingtons’ if he made the call back to Atlanta, but he thought he should.
“Emile. Still at the office? Yeah, I’m on my way to look at the family that, so far, seems to be the center of this cluster. I need two EIS people here before eight tomorrow morning if you can get them on the red-eye up here.”
“It’s serious?”
“The numbers aren’t bad yet. Twenty likely cases. Until we get the virus nailed down, I can’t say how serious. But Emile, I am worried. Not the numbers, but how sick the people in the hospital are.”
“We have a few people free. I may need to send you someone fairly new.”
The system of rising through the EIS—Epidemic Investigation Service—was one that depended a great deal on mentoring. Glenn knew this, and he owed more than he could ever repay to his own mentors. This was how you repaid—paying it forward, over and over again, generation after generation passing on hard-won wisdom to the new people. “No prob. I have to get to this meeting. Can I call you later if I need to?”
“I have to take my wife out to dinner, but after 10:00 is good. Don’t call after midnight if you can help it.”
“At least we’re in the same time zone this time.”
“Catch you later,” Emile said.
