September 29, 2018
Galveston, Texas
Louise took a few minutes to regroup after the melee of a typical morning at home. She had prepared breakfast for the kids, then moved on to their lunches. Next came a quick examination of the backpacks to see if all was in order for Cora’s kindergarten “homework” and the actual homework Noah had in second grade.
“What’s this permission slip for?” she asked Noah.
“I need it today,” he said. “Sign it. Sign it now!”
“Okay, okay! Let me see it.” Looking over the form, Louise could see it was a planned field trip to tour the U.S.S. Seawolf, a submarine that was mistakenly sunk by the U.S. Navy during World War II. Of course it was on a day she worked, and she’d miss another excursion. As she signed the form, she felt badly about being a working mother for the millionth time, yet relieved to have an out.
As the clock ticked down, the kids hurried to the car with Didier. He would drop them off on his way to the store and office, where he’d spend his day catching up on business. He had told her earlier that morning that he planned to meet with his staff to discuss inventory and their first official snowbirds fall tour. Snowbird season had been a financial success for the last five years, and Didier wanted to keep it that way.
Taking her coffee to the porch, Louise sat in a comfortable chair looking east. She surveyed the property, again lamenting her struggling garden. She had resorted to hearty survivors after her early years of trying to reproduce her mother’s garden from the family’s Fort Worth homestead. The beach climate was punishing towards her favorites—roses and black-eyed Susans. She realized she had repeated her mother’s error. Mom had attempted to grow peonies, cosmos, and hostas when she moved from New England to Texas.
Louise walked back to the kitchen for the last half cup of coffee. A framed picture that was askew among the jumble of LaSalle and Finnerty photographs on the wall caught her attention. It was of Louise and her brother, Blake, dressed up for some occasion. Maybe Blake’s high school graduation? Graduations had been a big deal in their family.
As the children of educators, it was fortunate that academics came naturally to Louise and Blake. Their parents, Claude and Nancy, weren’t nearly as directive as the helicopter parents of today. Louise and Blake were raised at the tail end of the glorious years of under-parenting. However, their parents’ hopes and expectations were clear to both children. Having majored in journalism at Northwestern, Blake took a job as a stringer for Reuters and bounced from trouble spot to trouble spot—from his parents’ perspective—reporting on tragedies and calamities.
Louise majored in geology at Boston University and to everyone’s surprise, including her own, applied to medical school after starting her masters in geology at University of Texas in Austin. The only reason she could give for this change of course was that she enjoyed working with people and liked figuring things out. Geology failed on the first but prepared her well for the latter. Louise began medical school at the University of Texas Medical Branch in Galveston the next year.
Louise remembered her resolution to read up on dengue. Plus, she had to get the guest room ready for Marnie. Better get after her research while her caffeine levels were still high. The guest room preparations could wait.
She wandered inside and sat at her desk, taking a minute to gaze out the window toward the bay. The early fall light was indirect. A soft breeze made the tall grasses lining the inlets dance and carried a salty aroma to Louise. Herons stalked through the muddy flats looking for breakfast. Even if Didier considered them common, they looked stately to her with their measured pace.
She turned her attention to her computer and got to work. Dengue was caused by a mosquito borne virus. Her reading reminded her it was most commonly an unpleasant but self-limited illness with symptoms of fever, headache, rash, with muscle and joint pains. The joint pains were severe enough to earn its common name, break bone fever. The fever would come and go twice over three to seven days. She had seen cases in the Emergency Department, mostly travelers returning from south of the border. Although rare, some patients developed severe dengue after the initial fever. Blood pressure dropped, platelet counts plummeted resulting in bleeding from multiple areas, the liver and kidneys could fail, the heart muscle was attacked, and even the brain could develop the dreaded state of disease known as encephalopathy. Diego was clearly on that trajectory. Poor boy.
She switched her computer to the hospital electronic medical record and searched for Diego in the ICU. He had the entire calamitous clinical picture. Specialists were doing their best to preserve the function of the organs for which they were responsible. Supported by IV fluids and powerful medications, his vital signs were decent. She imagined the poor kid with tubes everywhere. Thinking about the scene in the ER, she hoped a social worker had been consulted to help Diego’s mother navigate this nightmare.
Looking at her screen, Louise realized why she hadn’t seen severe dengue, aka dengue shock before this case. It was rare; only 0.3% of cases developed it. She reviewed the manner in which the disease was diagnosed. The immunological blood test results varied with the phase of the illness. They had all been ordered. The infectious disease consultant was confident of the diagnosis. Unfortunately, he was also not optimistic about Diego’s prognosis. It was a virus without a specific treatment.
The Island had had its share of mosquito borne illnesses since it was populated. Malaria and Yellow Fever were scourges into the 20th century. In the case of dengue, it had been recognized in South Texas for years, predominantly in underserved immigrant communities with inadequate sanitation facilities. A single mosquito of the Aedes aegypti family may bite several unsuspecting family members and transmit the disease from one infected subject to others.
As Louise read on, the bad news continued. The current vaccine was not very effective and could lead to more severe symptoms in some cases.
So why were they seeing this cluster of dengue shock patients if it was so rare? Climate change had invited multiple tropical diseases to the southern U.S. And here, her thoughts drifted back to Gen again. She had worked at the lab in the Insectary Division. She would’ve had some theories to spin.
Not letting herself get emotional, Louise took a quick look at her hospital email just to be sure she hadn’t overlooked any of her medical staff requirements. There was always something due.
“Damn it,” she muttered. Her flu shot was due by the end of the week. Unless she received it, she would be locked out of the electronic medical record and placed in email jail. It was best to get it today before Marnie’s arrival.
She dressed in her favorite jeans and a fitted oxford cloth blouse, an outfit comfortable enough for grocery shopping and nice enough for a visit to the hospital’s occupational medicine clinic.
After efficiently administering the shot, the clinic nurse applied the sticker to Louise’s ID badge announcing that Louise had received her flu shot for the season.
“Let’s hope it works better than last year’s shot,” the nurse added pessimistically.
A severe influenza epidemic had overwhelmed resources last winter. The surge of cases nearly doubled the ER census at times. The thought of viruses and vaccinations brought Louise back to Diego and dengue. She decided to check on him in the ICU.
The intensive care unit was never a fun place to visit. She remembered all the times she ran up three flights to respond to a code blue in the wee hours of her night shifts. That was before intensivists and hospitalists covered the in-house crises. Today, as she took the elevator, she ran into Dr. Navin Prakesh, an infectious disease specialist. She had seen his consultation on Diego’s chart.
“Well, hello, Louise,” he said kindly, holding the door open for her. “By the way you’re dressed, I can see you’re working when you’re not working.”
Navin was half a generation ahead of her. As an infectious disease specialist, he was often consulted on the thorniest cases in the hospital. Despite long days and calls at all hours, he was consistently polite and helpful. Louise couldn’t say that about many members of the medical staff.
“Good morning to you,” Louise greeted him. “It looks as if you have your hands full today.”
“I tell my son to hurry up with that MBA so I can retire, and he can take care of me.” He laughed.
Louise smiled, as this was his common refrain. “Give me a break. What would you do with all that time on your hands?”
“I would sleep like Rip van Winkle for twenty years straight, then I would finally be rested up for my retirement. But for now, we will keep working. Did you come to visit the young man you saw in the ER? One of my four patients with dengue shock, I’m afraid.”
“Four?” She nodded. “Yes. How’s he doing?”
Navin caught her up on Diego’s case. He had stabilized over the last eight hours. Now, it was a question of time to see if his kidneys, liver, heart, and central nervous system would be permanently damaged.
They left the elevator together, and then Navin sat at a desk to start his rounds on the computer.
Louise approached Diego’s room. She was relieved to see he was still breathing on his own, without the help of one of the ventilators purring away in the unit. Among the IVs supporting him, one contained blood. His platelet count was so low he had hemorrhaged into his GI tract.
He was awake and smiled at her. That was a good sign.
“You probably don’t remember me,” Louise said. “I’m the doctor who treated you in the ER a few days ago when you came in. I wanted to see how you were doing.”
Diego nodded, then closed his eyes.
“Doctora! Yo le recuerdo. I remember you!” said Diego’s mother from a chair in the corner. “Thank you for coming. I think he’s a little better. The doctors, so many doctors, say we have to wait and see if the infection caused damage. I keep praying.” She was clutching rosary beads.
“I’m so glad he’s doing better,” Louise said. “This must be a nightmare for you. Are you getting some help from social services? I know it must be impossible to keep up with it all.”
“Oh, yes. Ms. Anita has been so helpful. She tries to explain everything. She called my boss, too, and explained why I was missing work. There was also a man who came to talk to me. He asked if I had other kids. I told him three. He wanted to give me money to send them to my sister in Mexico. He said, so they don’t get sick like Diego. I asked Ms. Anita about him after he left but she didn’t know who he was.”
“Did he leave a card or phone number?” It sounded odd to Louise. She thought this guy should be reported to security.
“No. Nothing. And how did he know about my sister in Mexico? I didn’t say yes or no, and he left.”
Louise was sure that Mrs. Jimenez had enough experience to smell a raton. She looked like a survivor. As a Mexican immigrant in Texas in 2018, you had to be. Louise was glad she never needed to ask her patients about their legal status. In the ER, everyone was treated the same once they crossed the threshold of the double doors. Ms. Anita, on the other hand, might have plenty of trouble getting the teenage Diego emergency Medicaid insurance for his ongoing treatment if he turned out to be undocumented.
Louise told the woman that she’d continue to follow up on Diego and assured her that he was in good hands. She caught Navin across the unit as he was donning a paper gown to enter a room with isolation precautions.
“So, you have four cases of dengue up here?”
“Sadly, yes, Louise. We let the city health department know about the cluster of cases and I hope they go up the ladder to the state. My brother in Corpus Christi says it’s the same down there.”
He’d told her once that his brother was an internist 200 miles south along the coast.
“Global warming, right?” Navin said. “The mosquitoes are immigrating faster than our current leaders can stop them. These bugs are the criminal element we should be denying entry to, not the people looking for a better life. But our current administration still seems doubtful about the existence of climate change. Don’t get me started…”
He was well beyond started. Louise couldn’t help finding pleasure in a camaraderie based on mutual disgust with the current administration’s abysmally anti-intellectual approach to just about everything.
She looked at her watch. After placing a call to hospital security about Mrs. Jimenez’s visitor, she headed out. She had enough time to get to the grocery store before picking up the kids from school. The guest room was still a mess.
Rotterdam Titan Oil Rig
After crossing off two full days of work on his calendar, Travis was up in time to see the sunrise over the Gulf on day three. The morning haze cast a spectacular rosy light show across the eastern horizon. The old rhyme “Red sky in morning, sailors take warning, red sky at night, sailors delight” always haunted him on sunrises like this. Though he was settling in, he couldn’t get the image of Dr. Drake’s escape from Suzy-Q out of his mind. What a fuck up.
Even after twelve hours of heavy-duty work, Travis had a hard time getting to sleep. He knew it was risky, but he kept a few tabs of Oxy, some Fentanyl patches, and some heroin in a secret pouch in his duffle. He needed just a little something to maintain his equilibrium. So, the night before, he opened a patch and chewed up a little bit of the contents. He relished the rush of well-being and ended up sleeping like a baby.
After a hearty breakfast of eggs, bacon and Texas toast, he reported to his safety and crew meeting and received his work assignment for the day. He wasn’t happy to learn that Maples had joined his team. The way Maples glared at him in the mess hall and around the rig, made it clear the guy hadn’t forgotten about the previous run-in.
Travis kept his cool and headed off to the container they were working on. Once the oil was extracted it was pumped into enormous reservoir tanks, which would be loaded onto oil tankers and transported to shore for refinement. The tanks were always coming up for inspection and repair as needed. As a welder, Travis had been doing this work since the first day he set foot on a rig. He was a dry welder which meant that he worked on the surface. Wet welders worked underwater, making repairs that required diving equipment. Needless to say, the wet welders earned more than the dry ones. The differential wasn’t enough for Travis to want to get the training. He’d seen too many underwater accidents, in the navy and on the rigs.
Today’s assignment was to continue work on the seams of a tank. Since the tanks were huge, the welders had to use ladders to cover the entire length of some seams. Travis was up about six feet with his welding arc in one hand and his chipping hammer in his apron pocket. The pointy chipping hammer was used to remove rust and slag. He kept it in his front apron pocket for easy access. Travis bent to the left to get a good view of what needed to be done. As he bent at the waist, his hammer fell and glanced off Maple’s welding arc, causing sparks to fly and knocking Maples off balance. He fell against a tank of muriatic acid used for rust removal.
“What the fuck!” screamed Maples. “You trying to kill me, you clumsy yahoo!”
“Oh, grow a pair! It was an accident. The tank’s still sealed. Nobody got hurt,” Travis replied as he rolled his eyes.
Maples immediately left to make a report to the foreman. He made it sound as if he was a boy scout, reporting a near miss just like they told them to in the safety meetings. It was standard operating procedure for Travis’s foreman to request a drug screen on both men.
Travis failed, as he knew he would. There were no extenuating circumstances to a failed drug screen on the rig. Per his contract, he was to be shipped off the rig immediately. After the meeting with his supervisors, he agreed to follow through with all the requirements to return to work. Counseling, Narcotics Anonymous meetings, random drug screens all loomed ahead. As if a return to shore, with his loss of income, wasn’t bad enough, things got worse.
When he went to pack his gear, he was met by Tibo and two supervisors right there in his room. Tibo sadly shook his head, “Listen Travis, you really messed things up for yourself. You should just be grateful that nobody got hurt. You know that with a positive drug screen we were going to search your room, right? We found your stash. We had to notify Gulf County PD. They’re gonna meet you when you get to shore. You gotta kick this thing, son.”
Travis wasn’t surprised to see Maples leaning against the wall outside his room. He was chuckling.