Marsha almost made it to the door when Danny added, “In addition, I’d like you to put a sign on the door for infection precautions. Please have someone roll the shelf underneath it with masks and gloves for anyone that enters this room. Be sure to don up yourself.”

She scurried off and when she returned with a respiratory therapist, they rolled Harold onto his side and Danny prepped his back with a bactericidal agent. With sterile gloves, he felt Harold’s lumbar intervertebral discs and slid a thin spinal needle between two of them. Harold’s cerebrospinal fluid drained easily and Danny allowed it to drip into the kit’s sterile vials. The humdrum of the ventilator drowned out the silence.

“Thanks everyone,” Danny said when they rolled Harold flat on the bed again. Danny stood quietly for a second. His colleague already showed signs of ICU breakdown with IV marks on his arms and a pasty color.

“Marsha, I’m taking this straight to the lab myself,” Danny said, snapping back to his task at hand. He ran down several flights of stairs to the first floor laboratory and went straight back, ignoring the boxes where samples were delivered like mail.

A college-aged man stood at a centrifuge and looked over at Danny. “Can I help you?”

“I’m Dr. Tilson. Can you do me a stat analysis on CSF?”

“I’ll take care of it before anything else Dr. Tilson, but it still takes time for the results.”

“Thanks, I understand,” Danny said and left with urgency.

----------

Coffee and Casey would have to wait. Dr. Lucy Talbot now took priority. Danny scoured the ER board looking for her name. He twisted his hands hoping at least she wasn’t in room 5 like Harold had been. She wasn’t, but he scowled at himself thinking a room could harbor bad luck.

No one was in room 7 with Lucy. It’s down time, Danny thought, between being seen, poked and prodded upon, and the results of what they thought and where they’d send her. He shook his head because he was one of them. However, the way hospital employees were dropping in as patients, he could soon also find himself on the other side of medical care.

A crumpled sheet covered Lucy from her waist down, the stretcher at a forty-five degree angle. The little woman’s arms hung from her shoulders like they barely belonged and her eyes protruded like a frog’s. Although they were open, she didn’t seem to register Danny’s entrance.

“Lucy,” Danny whispered up close.

A guttural sound came from her throat, but most of what came next was juicy saliva. How could someone who appeared dry be that wet in their mouth, Danny wondered. He walked to the counter for a wash cloth. He dabbed Lucy’s mouth and chin and then pulled the moisture into the towel. Dr. Talbot closed her eyes and sunk further into the pillow.

When Danny returned to the desk, the two ER docs were both seeing patients. Since he couldn’t talk to them, he took Lucy’s chart and scribbled a quick note inserting his name into the case. He wrote consults for Bill Patogue and Timothy Paltrow to also come on board with her care, and wrote for an MRI ASAP of her head.

----------

Danny didn’t have much time before meeting Bill. He dodged down the hall to the coffee room, but what remained at the bottom of the pot resembled silt. After rummaging below, he stuck a filter in the pot and scooped his choice of French roast into the top. While the water did its magic, Danny poked his head outside, and glanced up and down the hallway. Casey’s ambulance was out back.

The hot coffee charged his senses as he went outside and rapped on the ambulance door. Casey opened one side. “Hey, come on in. We’re fixing to leave in a little bit because you all are on diversion. We’re going to another hospital.”

Towards the front, where the ambulance wasn’t covered by the overhang, the rain made a pinging sound in the cab. Mark gave Danny a wave. “This is quite a carwash,” he said and went back to his paperwork.

“I don’t think we’ve ever sat and talked in your ambulance before,” Danny said.

“And I’ve been doing this since you were in training and green as avocados.”

Danny rolled out a laugh. “I knew I needed to see you. That’s the first time I’ve been able to laugh all day.”

“Glad to be of service.”

“You didn’t go near Lucy Talbot then, did you?”

“No, Mark and I brought in a store owner with angina.”

“Start taking more precautions around here. We think Harold’s got meningoencephalitis. We can’t get results or be sure about the diagnosis, or source, or transmission yet. I’m making sure I give you two the inside scoop.”

Casey brought his hand across his chin in contemplation. “You didn’t say meningitis, did you? I’ve never heard of this.”

“Most people probably haven’t. It’s extremely rare. I’m talking about a double neuro condition.” He held his coffee carefully so it wouldn’t spill. “It’s when there’s simultaneous infection or inflammation of both the brain and the meninges.”

Casey’s thick fingers entwined as he furrowed his brow.

“The morbidity and mortality rates are not good,” Danny added.

Danny slipped closer to the door ready to exit the cab. “I just want to give my future brother-in-law a possible medical alert.”

“Thanks, Danny. We appreciate it.” Mark looked back and nodded his appreciation as well. “I’ll be home after eleven,” Casey added. “Will Mary and I see you?”

“I don’t have a clue. Give Mary a hug for me, but give Dakota a biscuit and a quick walk.”

“Goes without saying,” Casey said as Danny left with his coffee.

 

Chapter 8

 

Danny beat Bill Patogue into the lounge after swinging by the lab. Timothy Paltrow, the neurologist, ambled in with his cane, along with Bill when the elevator door opened. Tim was in his seventies, holding on to working like a butterfly to wildflowers, and was bald except for a stray white hair here or there, standing up as if electrically charged.

“Let’s get as distraction-free as we can,” Danny said. “Sorry to bring you in here, Tim, especially in this nasty weather.”

“My bones don’t like it much these days,” Tim said. “But anything to keep my mind stimulated. Meeting you two is better than reading a book.”

Danny turned off the television and they went to a corner table. He felt badly about getting the old doc to come in as he glanced out the windows at the non-relenting rain. Over the next few minutes, they gave Tim a synopsis of recent events and why they consulted him.

From his pocket, Danny pulled out a lab sheet, a small pad of paper, and a pen to make notes. “I just got some of Harold’s spinal tap results and Lucy Talbot is getting her MRI right now.”

The three men leaned tightly over the table as Danny evaluated Harold’s lab values. Danny’s heart quickened as he read what he dreaded. He grinned at Bill. “Proteins and white blood cells are increased. Glucose is normal, which goes along with the MRI findings.”

Tim held out his arthritic hand for the lab sheet. “Substantial evidence for your working diagnosis, doctors. Let’s confirm if a meningoencephalitis is what’s going on with Lucy Talbot, too. Why don’t I do a spinal tap on her as soon as she comes out of the MRI?”

“Perfect,” Danny said. “And above all, let’s hope one of the CSF samples from Harold’s spinal tap grows out something in the lab that identifies the causative agent.”

“Danny, I need to get consent and do a tap on James, too,” Bill said.

“Okay, Bill, you’re right. What about Dotty Jackson? Did she have some of the same symptoms?”

Bill shook his head as he slid further back in his chair. The meeting seemed to be taking a toll on him. “She has flu-like symptoms,” he said, “complained less of a headache although she does have one. And she’s developed a fever, which is getting higher despite an antipyretic. Nothing so far has shown up abnormal on her blood work.”

“I’ll get to her after Dr. Talbot,” Tim said. “Each of these patients needs infectious disease precautions. Let’s isolate them.”

Danny rapped his knuckles on the table with a sudden thought. “Either of you have a problem if I call in Dr. Joelle Lewis?”

Tim moved his cane to the side and got up. He stepped to the right and left, unkinking his cramps. “I’ve never worked with her, but I’ve heard of her. By all means, give her a call.”

“I think we have ample concern,” Bill added, “that it’s also time to call in the CDC.”

Danny had made notes. He double checked their plan and who was going to do what. He tensed his lips, searched his colleagues faces. “I’m going to see how busy the OR is with after hour emergencies.”

Tim paused stretching and looked as quizzical as Bill. “What do you have in mind, Danny?”

“We can’t wait for Harold’s cerebrospinal fluid to possibly grow something out on a Petri dish in the lab. I need to do a brain biopsy on Harold.”

----------

After tracking down the infectious disease doc, Dr. Joelle Lewis, by phone and asking her for her expertise, there wasn’t anything more Danny could do. He put Dr. Jackowitz’s name on the OR list of after hour cases. The timing of his case also depended on other serious trauma cases that could come straight up from the ER during the night. As a backup, Danny asked the schedule coordinator to put him on the a.m. Sunday semi-elective list in case they still hadn’t gotten to Harold.

Danny hoped to get home, have a bite to eat, and grab some shut-eye. He went out the ER doors where Casey’s ambulance had been gone for hours. The thunder and lightning had stopped, a silent, gentle rain left in its place. The parking lot lights illuminated the drops, like tiny baby pearls falling from the sky. Danny took off his white coat, draped it on his arm, and did a slow run to his car. Inside, he called Mary.

“I’m stopping at a sandwich shop,” Danny said once Mary picked up. “I know it’s late, but can I get anyone something?”

“Not for me, but we ate early, so let me ask the girls, they’re right here. We’re watching a movie.”

Danny heard his girls’ indecision and then Mary got back on. “They’ll each take a six-inch BLT. Can you get a sandwich for Casey as well? He should be home shortly.”

“Sure. See you soon.”

Danny arrived home with two foot long turkey combos and a foot long BLT. It was after eleven, Casey’s car engine still warm in the garage. He entered the garage door into the kitchen but noted no greeting from Dakota. Inside, Casey sat on the ottoman in front of Mary with Dakota between his knees, still giving him a rowdy greeting.

As Danny placed the bags on the coriander counter, he admonished Dakota. “You slacker. Didn’t you hear me come in?” Dakota backed up from Casey and bounded into Danny. At the last second, he swiveled, enabling Danny’s hands to rub his rump. “I don’t want the back end. Come here, where I can see you.” Dakota kept his spot which also enabled him to sniff upward towards the warm sandwiches above him.

“You missed a good comedy,” Mary said.

“Hi Dad,” Nancy said.

“Glad you made it,” Casey said, walking towards him, “especially since you’re delivering food.”

Nancy and Annabel strode in as well. “Here girls,” Danny said. “I have the foot-long BLT.”

Nancy’s mouth curled into a frown. “Dad, I wanted a six-inch.”

“It’s right here,” Danny said, rumpling her light brown hair.

“Dad,” Annabel said, plopping herself on a stool, “you don’t get it.”

“What’s there not to get? I think a neurosurgeon can figure out a sandwich.”

“Danny,” Casey said. “Don’t you know doctors are treated like regular people when they go home to their kids?”

“I think you all are ganging up on me. I’ve had a nasty day.”

Casey glanced at him. “This is true, girls. He’s had a rough day.”

“Whatever,” Annabel said.

“Dad,” Nancy said. “What I mean is I wanted my own sandwich. A six-inch BLT!”

“You idiot,” Annabel said. “Dad doesn’t realize that you don’t know six inches is half a foot.”

“You’re the idiot,” Nancy said. “I want my own separate half-footer because I don’t want to share any sandwich with you.”

Danny shrugged his shoulders, he’d had enough. He grabbed his meal and slid between them as he walked to the big room. “Because you love me, will one of you girls please bring me a soft drink?”

Casey followed after Danny and Dakota. The dog decided to focus on Danny, resting his paw on his master’s knee with a wanton look of hunger in his eyes.

Annabel approached Danny, handing him a cola. “You were gone all day and that’s unusual for a Saturday, Dad.”

“I may be going back, too. You see what it’s like? You have plenty of time to decide your course of studies. A medical career isn’t for everyone.”

“I know.” She took a bite but had to help a piece of lettuce get unstuck from her braces.

“Listen, I’m glad I got to see you two. Thanks for waiting up and I’m sorry I was on call. We’ll make it up next weekend. It’ll be fun and different having a baby here, too.”

Nancy finished her sandwich and then the girls eyelids started to sag. Danny wrapped his arm around Nancy, gave her a squeeze, and nodded towards the steps.

“Hmm,” Nancy said. “Come on Annabel. Let’s go to bed.” Both girls uncurled their legs and said good night.

Mary was as deep in the leather chair as possible, a glass of white wine in one hand. “They put up a good show with all that bickering, but on the sidelines, they’re stuck to each other with crazy glue.”

Danny let out a laugh. “You’re probably right.” He chuckled again. “I’d have a glass of that if it weren’t for the fact that I may be operating on my colleague in the next few hours.”

“There’s a lot going on in the hospital,” Casey said while glancing at Mary.

Danny patted Dakota to move so he could get up. “We’ve called in infectious disease and the CDC,” he said with concern. “I’ll talk to you tomorrow. I better get as much sleep as possible. They’ll be calling me when they send for Harold’s case.”

----------

A little after 5 a.m., Danny’s pager went off. They were getting the medical personnel to transport Harold to the OR so Danny needed to come in. He gave ample affection to Dakota and decided to wear the same scrubs he’d worn and slept in from the day before and he’d change to fresh ones in the locker room. He let Dakota out the back door for a few minutes while he put on a pot of coffee and selected a travel mug. It wasn’t raining, but Dakota came back in with soggy paws. It would take days for the yard to dry and for local river runoff to subside.

En route to the hospital, Danny wondered about the origins of the meningoencephalitis outbreak. He felt confident that Tennessee had few mosquito transmitted diseases. The area usually didn’t have temporary, stagnant bodies of water that made for good breeding habitats.

Danny arrived and changed as Dean was still putting monitors on Harold in the OR. Dean would be getting off soon at 7 a.m. and a fresh doc would be taking his place. Danny got Harold’s head prepared the way he wanted, finished scrubbing his hands at the sink, and started surgery. With all the blue cloth covering his patient, what Danny saw of his colleague was only a few square inches of his skull. It could’ve been anyone under the drapes. How impersonal, and yet on the contrary, it couldn’t be more personal digging into his colleague’s brain.

Danny’s heartbeat slowed with despondency. What if the biopsy failed to shed light on an infectious or inflammatory process? Where, when, and how had Harold picked up something so devastating that it had put him in a coma? What about the others? Did they have the same bug as Harold? Who was the first patient? He took one last look at the MRI on the view box to confirm the sample area he wanted.

When he got past bone with his drill, he surgically excised two slices of tissue, adequate enough for the pathologist. He set about finishing the case in silence. No one chatted. The fact that Harold was otherwise in good medical condition and Dean was running the anesthesia and medical care in the OR made Danny rest more comfortable. Below the drapes, Harold Jackowitz was not only a unique patient and colleague, but he was becoming more like a special friend. The amount of time he spent with his colleagues, he realized, was often greater than the time he spent with loved ones. They’d hashed out similar issues and experienced common joys and pains practicing neurosurgery together.

----------

An hour after Danny’s case, he met Bill Patogue in the ICU as Harold was being transported straight to his room to his own ventilator. They sat across from each other at the nurses station, knees close, and kept their voices low.

“Danny, I’ve made rounds and left notes on involved patients. The CDC doc took an early flight and will be here soon. I called the CEO of the hospital and the head of nursing. Twelve noon for a meeting is fine with everyone.”

“Joelle Lewis will be here as well,” Danny said.

“But Danny, I don’t feel well. My legs ache, my head hurts, and I feel warm.” Bill widened the opening of his lab coat. Danny stared at him and doubted Bill’s ability to attend.

“You need to get one of the E.R. docs to see you and you both need to wear masks just in case. I think we should do the meeting without you. All the necessary charts are going to be in the hospital’s main conference room, correct?”

Bill nodded.

“I can get the hospitalist to take over the patients you’ve been seeing if you can’t practice tomorrow,” Danny said. “Now get going.”

Bill hesitated after he stood. “But Danny, if I also have this terrible thing, there aren’t any hospital beds.”

Danny feared the same thing. As Bill despondently left, Danny wondered if and when his own first symptom would appear.

----------

The hospital board room on the top administrative floor had never been used on a Sunday afternoon. The medical personnel involved could count on work weekends, but this was a first for the CEO, Robert Madden, and he’d been the top dog for fifteen years. The phone call the day before from the internist, Bill Patogue, had been worrisome. Even more disturbing was a call that morning from a reporter.

Robert had been bombarded unexpectedly. “Was it true a surgeon was dying in their ICU due to a mysterious ailment?” The reporter went on. “Other hospital employees are clogging up medical beds, stricken with fevers and flu-like symptoms. We want to know if this is fact or rumor? Worst of all, we heard the CDC is on its way to contain an obvious medical problem. Should the general public be alarmed?”

Mr. Madden thought journalists were lackluster in their reports. But how come one of them knew the inside scoop? Too many people work at hospitals, he knew, all departments and all shifts, and all that was needed was a journalist or editor picking up a good dinner conversation from a family member.

The elongated room with cherry wood furnishings filled within five minutes with everyone who’d been invited, except Bill. Danny suspected Bill’s non-arrival confirmed the worst - the ER concurred he needed care and posed a risk to others.

After stillness enveloped the room, Mr. Madden cleared his throat. He introduced himself and began. “I was approached by a newsperson this morning and obviously could not make any factual comments. I’m going to sit through this meeting and let you medical experts discuss things from your end. I will formulate my questions and interject as needed.”

Danny surveyed all the faces again and spoke up. “Mr. Madden, Dr. Patogue is in the ER. I’ll fill in from both my standpoint and his. Much of the needed medical paperwork on the involved patients is here.” He nodded at the doctors and nurse on the other side of the table. “I’ll let you three introduce yourselves.”

Dr. Ralph Halbrow with the CDC had a receding hairline half way back along the top of his head. Along with an impressive southern drawl, he wore suspenders over an extra thirty pounds in his gut. Danny suspected he might be sharing fried chicken with him in the near future.

Dr. Joelle Lewis, on the other hand, had a snappy northeastern accent. She had moved to the middle of the country for the predominantly research oriented teaching spot at the medical department of the university. Only in her mid-thirties, many people considered her the top dog in her specialty. And she’d made the journey with lots of hurdles in the way.

Pamela Albrink, the head of nursing nodded to the others, introduced herself when the time came, and promised the department’s professionalism and help with the present circumstances. Timothy Paltrow, the neurologist, hadn’t sat down yet and leaned on his cane.

Danny’s head spun. Without Bill’s help, it would be up to him to weed through details and guide the CDC and infectious diseases as much as possible.

----------

The first thing Joelle Lewis did was remove the ornamental flower arrangement in the middle of the conference table. She slid off her long white coat, pushed back some chairs from the table and signaled Danny and Ralph to stand beside her. Most of what Danny knew about Joelle’s personal life he had learned one day having lunch with her in the cafeteria. With Danny’s encouragement, she had sputtered out a succinct recap of her family background and how she came to pursue medicine.

Joelle had grown up with a mostly absent father and a dedicated mother who allowed her three kids to develop their own interests. They lived in one of the few black neighborhoods in Queens, New York, segregated from the white folks by a geographic line of railroad tracks. Neither side of the tracks were well-to-do. Families struggled on both sides to keep their kids clothed and out of trouble. Growing up sometimes depended on luck if the kids’ parents were good role models and instilled in them a desire to want more. Joelle’s mother understood that applying oneself to getting educated was the groundwork needed for future stability.

Being the youngest, and the only girl, ended up being an asset. Her brothers spent time together in scrap yards and had enough inquisitiveness to tinker with car parts, but she spent more time with her mother, and books from the library. Those walks to the closest library on the other side of the tracks ended up transporting her to realms of the world where anything could occur, just by reading everything behind those colorful covers.

She wanted to be a nurse like Mary Eliza Mahoney and do great things. But in Joelle’s first year at a community college, her mother passed away from an infectious disease. How could a contaminated, undercooked hamburger be the source of her mother’s illness and subsequent death? Joelle felt abandoned, despondent, and angry. She strove to get accepted to medical school instead of nursing school and once achieving that, set her sights on specializing in infectious disease. After the completion of her studies and training, she moved from the northeast for the first time to Nashville, Tennessee, the music city and a medical center she grew to love.

“So far, this is every patient’s chart implicated in this outbreak?” Joelle asked.

“Bill talked with Pamela,” Danny said. “This should be it.”

“Okay, let’s first look at the folks who have had spinal taps and MRI’s.” Joelle’s silver earrings swayed as she moved quickly rearranging the charts closer. “Do you concur, Dr. Halbrow?”

“Good start,” he said.

When they pulled out a total of four spinal tap results, Danny lined up two MRI results behind them.

Dr. Halbrow pointed a stubby finger at a notebook. “We have to start a chart,” his southern drawl rang out. “And Mr. Hospital President, I’m going to start pinning on that bulletin board over there.”

Robert Madden overlooked the fact that he was the CEO and had a name, but even he couldn’t keep names straight. This was a group of professionals thrown together at the last minute and if this outbreak wasn’t contained quickly, his hospital’s name would be widely known soon, but not in a good way. “Be my guest,” he said politely to the CDC representative.

“If I can interject,” Danny said. “Substantial diagnostic evidence that we’re dealing with meningoencephalitis is right here. We now have two MRI results looking similar - Harold Jackowitz, a neurosurgeon and my partner, and Lucy Talbot, an anesthesiologist who works only at this hospital.” Danny briefly paused as Ralph wrote up columns. He had definitely done something like this before.

“What is their present condition?” Joelle asked.

“Dr. Jackowitz is in a coma.”

Dr. Paltrow leaned in, his right hand still resting on his cane. “And Dr. Lucy Talbot has succumbed to a coma as of this morning.”

Danny gulped. Time stood still and his heart sank. She looked terrible in the ER the day before. He wasn’t surprised she’d slid into unconsciousness, yet anger and sadness tangled with his mind at the same time. They had to get Lucy back, and Harold as well. Whatever this malevolent infectious organism was, it had to be identified and stopped.

Joelle broke into all their thoughts. “Spinal taps,” she said. She took four stapled sets of lab sheets. “All four of these are similar but not the same. Proteins up, white blood cells vary but mostly elevated, and glucose either normal or decreased. All look like they concur with our MRI findings that a meningitis and or an encephalitis is at work.”

Ralph began making a new column and filled in the two new patient’s names besides the neurosurgeon and anesthesiologist as Pamela Albrink added, “These two other positive spinal tap patients, Dotty Jackson and James, are both nurses in the operating room.”

“We have to link the patients together as well as find the original source and organism,” Joelle said. “Danny, what was your colleague’s schedule recently, right before he got sick?”

“He started feeling poorly sometime midweek. He was on call Sunday, I did one of his left over call surgeries Monday morning plus my own, and he covered my hospital rounds on Tuesday morning. We kind-of flip flopped patients.”

“Pamela,” Joelle said, “check nursing’s OR schedules and find out when Dotty and James were working over the last week and a half.”

“I’ll do it right after our meeting,” Pamela said.

“Let me call the OR right now,” Danny said. “I’ll ask the anesthesiologist on call what Dr. Talbot’s schedule was recently as well.” When Danny called from a desk phone outside the room, he lucked out. The doc doing a case had his monthly department’s schedule in his back pocket and rattled off Lucy’s working days.

Danny hurried back, taking his spot between Joelle and Ralph. “She worked last Sunday, the seven-to-three shift. She was the back-up doc to the main anesthesiologist call doc. And she worked on Monday seven to three, which is when she did my cases.”

“Okay, y’all,” Ralph said. “We’ve hit cheese grits. We’ve got a match of Harold and Lucy working on Sunday.”

Everyone finally smiled. Danny laughed out loud at the genuine southern CDC doc and he caught Joelle’s smile, her white teeth standing out like pearls.

“We need to get a list of all patients they worked on,” Joelle said. “And if Dotty or James was working Sunday.” She eyed Pamela who scribbled on a note pad.

“Wednesday Harold didn’t feel good,” Danny added. “Thursday I did cases and I remember the anesthesiologist, Dean, saying he thought Lucy wasn’t in because she was sick.

Joelle tapped her pen on the spotless table top. The words rushed out of her mouth. “We’re getting a narrower time frame for the outbreak of whatever we’re dealing with.”

 

Chapter 9

 

Except for Robert Madden, everyone in the room reviewed the patients’ charts and scribbled any physical complaints they had mentioned on admission or during their hospitalization. All four of the patients varied to some degree, just like the fluctuation in the CSF cell count numbers. Ralph logged the patients’ verbal complaints onto a main sheet, again using columns. Joelle stood back like a painter examining her work, and shook her head affirmatively. “Yes, we have the makings again of meningoencephalitis, headache, fever, nausea, and uncomfortable if not stiff neck.”

Ralph stuck his thumb in his right suspender. “Are we all missing anything?”

Everyone glanced around the table, searching each other for more details.

Danny searched his memory over the last bizarre week. Not one patient had complained about it, yet he thought it odd that Harold had so much saliva. Come to think of it, so did Lucy Talbot.

Danny furrowed his brow. “There may be something else. But it’s just an observation.”

“Please, Dr. Tilson, what do you have?” Joelle asked.

“Drool.”

“Drool?’ Joelle blinked her eyes and her head bobbed backwards.

“Excess saliva,” Danny said. “At least that was my impression with Harold and Lucy.”

“From the beginning?” Joelle asked.

“No, I wouldn’t say that. It came later.”

Timothy Paltrow tapped his cane on the floor. “Danny has a point. I agree. Not only them, but Bill has me involved with Dotty and James now, too. That befuddled me about them both this morning. They’ve grown secretions, besides the fact that they’re deteriorating with lethargy.”

The room hushed again, only until Robert Madden let out a big sigh. He pushed himself out of his chair and paced back and forth at the head of the table, hands enveloping each other. He had an impeccable history, this being his second hospital as a CEO. He didn’t want to retire now at sixty-five but he sensed the tail end of his career was going to snap and pop like a soda can, especially when it came to the media.

Amongst the charts and strewn papers on the table, Danny’s pager beeped and shimmied due to the vibrator mode. He reached for it and nodded his approval. “Its pathology,” he said, “must be biopsy news.” Danny strutted back out and dialed the department.

“Danny,” the pathologist said, “sorry for the delay. The incisional biopsy on Harold Jackowitz is positive for meningoencephalitis.”

Joelle wandered out of the conference room and neared Danny, with Ralph behind her. Danny focused on Joelle and her silver earrings and then turned his attention to Ralph. He nodded affirmatively to both of them, thanked the doctor, and hung up.

“The pathologist confirmed our diagnosis.” Danny said.

“As we suspected,” Joelle said. “I notice by the charts all four patients are on a good choice of antibiotics. I want to spin by the lab, check on their progress regarding organism growth, but take CSF samples over to my own lab.”

“I’d like to come along as well,” Ralph said.

Danny was just about to echo Ralph’s remark when his pager went off again. “It’s the ICU,” he said softly and dialed.

Joelle looked down the corridor at a swirling carpet pattern and an empty wall lining the other side of the conference room. Framed photographs lined the wall going down the aisle. Ralph sat down in a chair, dug into his pocket, and handed Joelle his card. She nodded and grabbed one of hers from her coat, flipped it over, and gave it to him. They both keyed in on Danny’s end of the conversation. For sure, there was a problem.

The corner of Danny’s mouth sagged. His eyes grew narrow. After a few minutes, he said, “I’ll be there.” He got off the phone and paused with silence.

Joelle cocked her head, her suspicions aroused.

“That was the hospitalist,” Danny said. “Dr. Harold Jackowitz passed away a little while ago.”

----------

After donning a mask and gloves from the isolation precaution supplies outside Harold’s cubicle, Danny slipped into Harold’s room. Respiratory therapy unplugged the ventilator, discarded tubing, and rolled the machine past Danny. He stepped to the bedside and stared at Harold’s motionless body. His eyes were closed, the sheet across his shoulders, already looking like death had consumed him some time ago. Danny could feel his own heartbeat pounding away in his ears. He put his hand over his eyes, seeking insight into the meaning of Harold’s death. But none came.

He backed up. Not only did he feel sadness for the personal loss of his colleague and he had harbored a fondness for Harold, but there would be far reaching consequences. The lethality of this meningoencephalitis was now dead clear and would be escalated to greater newsworthiness. The experts had to continue correlating their knowledge, understand more what they were dealing with and find the correct cure. Not to mention The Neurosurgery Group of Middle Tennessee. What would this do to their case loads, and the probability of having to turn new patients away?

Danny thought about Bruce. The founder of their group would be shocked after his weekend away with his wife to find out what had happened. Danny’s nerves seemed to sizzle just thinking about it.

He took a step back while silently saying good-bye for good and left the disheveled room where there’d been a recent code. At the nurses station, the hospitalist’s bald head was bent down as he filled out forms, Harold’s paperwork. He mulled over ‘cause of death.’

Danny rolled out a chair. The hospitalist looked up. “I’m Danny Tilson, I’ve never officially met you. Thanks for helping out. You’ve acquired first-hand care of some patients I’ve been involved with.” Danny looked down, “besides Dr. Jackowitz.”

“Sorry to meet officially under this circumstance. I’m Peter Brown. I had been aggressively treating Harold’s falling blood pressure today, Danny, to no avail. I ran full resuscitative measures in the end.”

Danny shook his head. “Appreciate that. I’m sure you did the best you could. You’re probably aware that Harold was one of my partners. His hospitalization this week really caught us all off guard. Now this.” Danny ran his hand along the back of his head. “Can I help you with any leftover paperwork?”

“No. I’m good. Not to worry.” Peter turned to his left, handed a form to the desk secretary in exchange for another.

“Peter, we had Harold on steroids and acyclovir as shotgun treatment before cultures and sensitivity results were back. You still had him on those, correct?”

“Correct. Our best guess using acyclovir didn’t cut it.”

“Infectious diseases and the CDC are involved,” Danny said. “We’re working doggedly on this. We better have answers soon.” Danny’s finger tapped the end of the desk. “I’ll keep you in the loop. Also, I bet reporters will be contacting Robert Madden. If need be, steer any news people our way.”

----------

On the top floor of one of the medical complex buildings across from the medical school, Joelle Lewis and Ralph Halbrow were in their element. Here, among the lab tables, incubators, growth mediums, clear encased laboratory shelving, and the equipment needed by research medical doctors and PhDs, scientists could lose all sense of time while tracking down sinister organisms or gaining momentum on vital research.

It gave Danny a sense of naivety walking into Joelle’s laboratory. Like other professions, medicine had many areas of expertise, it boggled his mind. So many highly trained and smart people, and yet sometimes they all depended on each other. Now they worked on one big puzzle which couldn’t be solved unless each piece, or person, was put into place.

Joelle and Ralph were both outfitted for handling infectious diseases and Joelle had quarantined off a lab area. Ralph sat on a stool adjacent to the counter where a spectrometer and incubator lay close by. In front of Joelle, agar plates and dyes lined up in a row. She sorted samples and made notes.

Danny first put on a mask and gloves and slipped into a thick papered white jumpsuit which zippered up the front. He drew close to the table on the other side of Joelle as she pushed a rack of delicate micropipettors back away from Danny. She’d gotten more comfortable in her own lab, changed from short heels to slip-on canvas shoes and shoe covers, and exchanged her lab coat for the full length isolation precaution.

“Dr. Tilson,” Joelle said, “that must have been difficult going to the ICU seeing Dr. Jackowitz and helping with legalities.” She spoke speedily but didn’t look up while pointing out a plate to Ralph.

“It wasn’t any fun.”

“Bacteria are starting to give us feedback or lack thereof,” she said.

Ralph leaned in, the two experts’ heads together as if they were reading the same book. “No grits or red eye gravy here,” Ralph said.

Joelle pointed with a pipette. “Danny, what Mr. Halbrow is saying is that we’re coming up negative so far with bacteria. No Listeria monocytogenes, no Rickettsia prowazekii, no anything.”

“Not even Neisseria meningitides?” Danny asked.

Joelle pulled her head up, her long silver earrings dangling. “Not that either. And so far on the viral front, we’ve eliminated HIV and Herpes Simplex.” She frowned under her mask. “Even mumps,” she added.

“Well, shut my mouth,” Ralph said. “This is getting creepier than frog’s hair.”

----------

After getting home late, Danny opened the back door wide so Dakota could spring into the yard. He headed towards a chaise lounge chair while Casey quietly pulled the door closed behind them. The half-moon sky had few clouds and many radiant stars, and the temperature hovered at a perfect seventy degrees.

“Did Mary go to bed?” Danny asked.

Casey nodded affirmatively as he settled into a chair. Danny gave Casey the most important news first. “I think you should call Bruce,” Casey responded.

“You’re right. Bruce and his wife should be home by now and it’s the first opportunity I’ve had all day.” Danny grinned, pulled his cell phone off his belt, and hit Bruce’s home contact number. On the fourth ring, Danny almost gave up, but Bruce answered.

“This must be important,” Bruce commented immediately, knowing it was Danny.

Danny heard some background noise like unpacking. “Brace yourself, Bruce. I don’t think I can deliver worse news. Harold passed away today.”

Bruce skipped the denial phase and went straight to anger, which made Danny feel worse than he already did. “No,” Bruce said, “that makes no sense at all. A young neurosurgeon receiving steadfast care by experts and what was everyone doing? Just standing by? What exactly has the standard of care come to?”

Danny gritted his teeth. He shook his head at Casey, cluing him in to the tirade he heard coming from Bruce. A silence ensued. Danny gathered his courage.

“Bruce, we’re dealing with some unknown here. We had a major hospital meeting today with the CEO. The CDC came in from Atlanta. We’ve got Dr. Lewis with infectious diseases involved, neurology, and a new hospitalist. Bill Patogue, the internist involved with some of the primary care, is ill as well as another physician and hospital employees. Before I left the hospital another nurse had an MRI with confirmed meningoencephalitis.”

Danny heard the stillness from Bruce’s end. Now there wasn’t any unpacking going on.

“Well, this is unbelievable losing a colleague. It’s the first and it’s going to be the last time.” A pause ensued. Hopefully Bruce was gathering a more understanding response. “Obviously, we’ll have to arrange a proper remembrance. And regarding the practice, this requires sound, quick decisions. Why don’t the three of us cancel any early appointments or surgeries and meet at eight in the morning to discuss this?”

“I can’t, Bruce. Robert Madden was approached again by news reporters tonight. The CDC, Joelle, Robert, and I have a press conference at 10 a.m. We have to prepare a statement, so we’re meeting at 8 a.m. We have to get updates from the neurologist and hospitalist before tackling the media and I need to do some hands on with patients.”

“I hope Matthew Jacob is worth more than his running weight. This will be a test to see if our youngest neurosurgeon can fill Harold’s shoes or ours, either.”

“You chose well, Bruce. Matthew will hold up to the pressure. Plus, he’ll be back tomorrow morning refreshed from running with his wife and a wedding.”

“I just had an out-of-town holiday but you just undid all the good it did.”

Danny didn’t respond. Bruce could handle a meteor hitting their office building.

“Anything else you want to add?” Bruce asked.

“Look for me on TV, our group’s representative.”

“You’re more than that. You’re thick in the middle of it. And by the way, weren’t you and Harold seeing many of the same patients? How come with more years on Harold, you didn’t get meningoencephalitis and he did?”

----------

“How did he take it?” Casey asked.

“Dumfounded and irate. He wears a leather exterior, but underneath it all, he’ll mourn our partners death just like the rest of us.” Danny’s shoulders slumped in exhaustion. “Life is fickle, isn’t it? It can change in a month, a week, a day, or in a heartbeat.”

“We see more in our jobs, too, so we’re more aware of that fact than most.”

“Hmm, you’re right. I’m glad my sister stays home and paints. Life for her is simple, productive and with less risk.”

“She’s so content,” Casey said. “I admire her for it.”

“She’s always been that way.”

Dakota came trotting up as a dark figure from deep in the yard. He slipped his head under Danny’s arm and nudged.

“So did Sara come by today to pick up the girls?” Danny asked.

“She did. She stayed awhile. You know Annabel will have her driving permit soon. Sara won’t be driving them back and forth so much.”

“Point taken,” Danny said. “I’m going to flat out ask her to dinner this week. But if I still can’t get her to go out with me, I have your wedding day to look forward to.”

“That’s true. There’s only so much she can avoid you if you’re the best man and she’s the maid of honor.”

Danny ruffled Dakota with more gusto, broke into a wide smile, and pelted out a rolling laugh. “If she wants to be sparse, she will. But she’s going to make my heart thunder wearing that dress Mary picked out for her.”

----------

In the morning, Robert Madden called the special kitchen overseeing the hospital conference rooms and the doctor’s lounge and requested coffee and a breakfast spread for their meeting. No one entering the room passed on decaf or regular and they all selected from scrambled eggs, sausage, donuts, and yogurts from a bowl packed with ice.

Ralph sat first and draped a napkin on his lap. Today, he’d changed his suspenders to a dark maroon. “With a breakfast like this,” he said, “Mr. Madden’s going to make me fuller than a tick.”

“Happy to get this Monday morning off to a good start,” the CEO said after overhearing the comment.

“Does anyone have imperative information since yesterday that we all must know,” Ralph asked, “which may influence the rest of our meeting?”

Danny sat next to Ralph with a steaming cup of coffee, and a plate of eggs. He couldn’t stifle a yawn as he looked around at the full attendance. He had slept well but could have used a few more hours.

Robert Madden pulled out the armchair at the top of the table for Timothy Paltrow, making it easier for Tim to sit with his cane.

“For those of you who don’t know,” Timothy said, “the hospitalist referred a nurse here named Peggy to me late yesterday. She came in with our list of symptoms, fairly lethargic, and conclusive for meningoencephalitis by MRI and spinal tap.”

A few people made notes and Joelle logged it on their master bulletin board schematic since Ralph was eating. “Pamela, what do you have?” Joelle asked.

The head of nursing sat tall and put down her coffee. “Interestingly enough, Dotty and James did not work in the OR last Sunday.”

“And Harold did,” Danny said.

“But not one patient that went to the OR last Sunday has come down with this illness,” Pamela said.

Joelle continued adding information. “For the moment, let’s then leave Sunday out of the equation,” she said, “which makes sense. Danny, didn’t Harold start to feel ill in your office on Wednesday? He was admitted to the ER on Thursday?”

“That’s correct.’

“Which means Monday and or Tuesday are the likely culprits,” Ralph said, holding off on spearing a sausage link.

“Don’t forget Lucy Talbot,” Danny said. “She worked on Sunday and Monday.”

“So,” Joelle said, “Lucy, Dotty, and James were in the OR on Monday but not Harold. As a matter of fact, it was you there, Danny.”

Something started to gel in Danny’s mind. Like when he couldn’t come up with a name but it lingered on the end of his tongue.

“I can’t figure me out in the equation,” Danny said. “However, Harold saw my post-op patients on Tuesday, the same patients that Dotty and James were exposed to in the OR on Monday.” He paused a second and then exclaimed “Who were also the patients that Peggy, the floor nurse, took care of.”

 

Chapter 10

 

Joelle put her marker back in her lab coat and stepped over to the food spread, poured orange juice and grabbed a yogurt. She sat next to the large, bald-headed hospitalist, Peter Brown.

“One more thing from my end,” Joelle said. “Last evening I also eliminated tick-borne meningoencephalitis. It’s not Lyme disease and it’s not Cryptococcus neoformans.”

“Cryptococcus neo what?” Peter asked.

“Neoformans,” Danny answered while Joelle took a spoonful of yogurt. “That’s notorious for causing fungal encephalitis.”

“Very good,” Joelle said. She looked at Danny and then Tim at the head of the table. “Nice to have an excellent neurologist and neurosurgeon in our midst.”

“There’s no time for a mutual admiration club,” Ralph drawled. “I got called before this meeting which made me nervous as a bed bug. The CDC is sending me up the road to Bowling Green, Kentucky after the press conference to evaluate hospital patients there. There may be two copy cats to our outbreak.”

Robert Madden’s back ached and he got up quickly, breaking the silence that ensued. “I hope it didn’t come from us,” he said.

“Sir,” Danny said, “the hospital has been mostly full and diverting patients away. The bad news on top of bad news is that it could be one of our own who we couldn’t admit.”

Robert swallowed hard.

“Okay, look,” Joelle said, “let’s focus on where we were going with this a few minutes ago because we still have to put our heads together for a news statement.” She bounced a finger off the table. “So Danny, who were your surgery patients on Monday that Harold saw on Tuesday?”

“A young teen named Michael Johnson and a sixty-five year old named Troy Neal.” Danny narrowed his eyes as he sharpened his thoughts. “Michael was one of Harold’s left over trauma cases from the middle of the night with an acute subdural hematoma that I simply did a bur hole on. He’s been quite droopy post-op, and Troy Neal had a brain abscess secondary to a farm implement accident, so he had an abscess drainage. He’s doing terrible post-op.”

Joelle’s graceful silver earrings dangled as she perked up in her chair and Ralph snapped his suspender.

“An abscess?” Joelle reiterated, “on a full course of antibiotics? Did he ever have a spinal tap?”

“No, he didn’t. The abscess seemed straight forward and mostly due to Staphylococcus aureus. I followed it with radiologic evidence. However, he hasn’t had a recent MRI and I’m only following him and Michael peripherally now because I handed them off to Dr. Patogue, who we now know is sick. So Dr. Brown is handling them now.”

All eyes shifted to Peter Brown. The recent development working with many team players, stimulating medical cases, and CDC and press coverage kept Peter’s thoughts on overdrive and he couldn’t sleep at night. He tanked down the rest of his coffee as Danny spoke and moved the empty cup away from his plate.

“As Danny mentioned,” Peter said, “Troy Neal has had a brain abscess. The last surgical drainage Danny performed seemed to clear it up. However, he still kept running a fever and it was discovered he had a broken down area on his buttocks which he hadn’t told staff about. It’s quite nasty, actually, and he ended up septic.”

Timothy curved his hand around the top of his cane and added his thoughts. “His continued illness, however, may also be from the original abscess that needs another drainage. And did he have any symptoms like our other patients?”

“I don’t recall him complaining of a headache,” Danny said. “But he did have a fever, nausea, and vomiting. He also seemed to be a bit juicy with secretions at one point.”

“However,” Ralph piped in, “this is the oldest patient. The elderly often manifest symptoms differently.”

“Okay,” Joelle said. “Dr. Paltrow, please do a spinal tap on Mr. Neal.”

“You’ve got it,” Timothy said. “And we’ll send him for an MRI.”

----------

Mr. Madden picked a small auditorium on the ground floor of the hospital for the upcoming press conference. Since it was tucked in the back, it had privacy from visitors and patients and wouldn’t stir attention. He had water bottles, tea and coffee set up in case reporters had to wait for the meeting to start due to any key doctors getting held up after the eight o’clock meeting. They all scurried out of the conference room at nine-twenty, later than expected.

Danny left the meeting, bobbed down several flights of stairs, and cornered himself on the end sofa in the doctor’s lounge. He felt refreshed yet his heart ticked like a jittery kid. He’d given it enough thought for two days. He’d try once again to ask Sara to go to dinner with him. He chose to call her in the morning and not at night and he’d ask her out for the middle of the week, not on a weekend. It would be a relaxed invitation, yet he wanted to take her to a fine restaurant conducive to nostalgic, yet optimistic conversation. If she accepted, that is.

His cell phone was fully charged as he took the plunge. No calling the house number either, as Annabel or Nancy could answer, making it a totally different type of call. He speed dialed her cell, and took a nervous breath when she answered.

“Danny, good morning,” she said. “The girls are still sleeping, I believe. Can I have them call you?”

“I suppose that’s about to end with school starting,” Danny mused. “Actually, I’m calling you.”

“Uh-oh, not about anything which will upset me? I would prefer not to take on any of your problems right now.” She had paperwork spread out on the kitchen table and had underestimated the time she needed to get ready for her new job.

“Sara, I hope that’s not what you think of me. I’m calling to ask you to dinner, just the two of us. It’s only dinner. It can be a clean start or simply to clear the air for the future. Can we allow that to happen, please?”

Sara shifted back in her chair. Her ex-husband’s voice sounded genuine and gracious. She’d been through so much with him – good and bad. Perhaps she was ready to forgive, maybe not forget, but forgive. Isn’t that what all the experts say? Not forgiving and holding a grudge will burn a hole in your soul or something like that.

“Okay, Danny. Dinner will be fine. Let’s keep it light, though, for both of us.”

“Consider it done. Is Wednesday night okay?”

“That’s fine.”

“There’s an exceptional situation going on this week at the hospital, so if it’s okay with you, can we make it a little later than 6 p.m. in case I’m running late? Say seven o’clock? I can pick you up or we can meet at Downtown Italy?”

“I’ll meet you at Downtown Italy at seven. That will give you leeway with your timing.

“Fine, then.” Danny had relaxed enough to realize that the TV news was on low. A picture of the hospital had just flashed up on the screen with a short medical blurb which Danny didn’t hear.

“And Sara, by tonight you may hear about a dangerous meningitis outbreak here at the hospital. We’re having a press conference in thirty minutes. Just keep you and the girls out of mainstream public places or the hospital for a bit. It’s better to err on the margin of safety.”

----------

As local television and newspaper reporters gathered in the auditorium, Robert Madden waved the docs over to a hallway alcove so they could all enter the adjoining room together. He looked a distinguished sixty-five, his suit from a high-end rack. The gray around his temples and the crow’s-feet around his eyes gave him an extra look of wisdom to spearhead the important meeting.

Joelle hurried down the hallway in low heels, her hair pulled tight off her face. “Dr. Danny,” she said, pulling alongside his stride, “did you do anything as important as relieving intracranial pressure during the last half hour?”

Danny gave a light-hearted laugh. “Maybe, I asked my ex-wife on a date.”

Joelle registered a surprised look while forcing him to step up his pace. “At least that won’t be an ice breaker or a clumsy first date. I hate them myself.”

“There won’t be a lack of things to talk about.”

“And if you get tired of previous married-life talk, you can use a layperson’s version of this meningitis outbreak as a stimulating topic. I test men with my work talk. Either they become more interested in me, or I scare the hell out of them.”

He could see her doing that. Danny chuckled as they joined Robert.

Ralph Halbrow and Timothy Paltrow stepped into their little circle. Ralph was the only doctor not wearing a white coat. He seemed preoccupied looking around for a garbage can to throw away his diet soda can. Danny had grown fond of the unique CDC southerner who was smarter than he looked.

“It’s ten o’clock,” Robert said. “Let’s keep it simple and straightforward like we discussed a little while ago. I don’t know how reporters do this, but they must telecommunicate news material. There are more folks in there than I expected. From a business man’s perspective, I wouldn’t deviate into ‘what if’ scenarios and mostly keep to their questions. If they don’t ask it, don’t tell it. I gave them the facts yesterday, so we’ll reiterate and update. However, you are the medical experts and need to tell them what’s important. Ralph, in particular, should be familiar with the process.”

Danny, Joelle, and Timothy all nodded and went straight in. Robert’s description forewarned them. Where did approximately a dozen reporters come from besides two or three with video recorders?

“Good morning,” Robert said. “I spoke with some of you yesterday. I am Robert Madden, the CEO of the hospital. Also present to my right is Dr. Ralph Halbrow with the CDC and Dr. Joelle Lewis with our own Nashville infectious diseases. Dr. Danny Tilson is a Nashville neurosurgeon who primarily does surgeries at our hospital, and Dr. Timothy Paltrow is our neurologist. Dr. Halbrow will give you some opening remarks and then feel free to ask questions.”

Ralph inched behind the podium. “Thank you all for coming. The outbreak in question, ladies and gentlemen, is a combined meningitis and encephalitis. That means the patients involved have both an inflammation of an outside lining of the brain as well as the brain itself. We believe it started or originated in a patient a week ago but it didn’t manifest until a few days later. The hospital’s under infectious disease measures. However, the original antibiotics did not work. Based on the good judgment of Dr. Lewis, we are on a second compliment of antibiotics. We are hopeful they will stop this outbreak, yet skeptical. As you know, we have had one death, Dr. Harold Jackowitz. I cannot release the names of the other four confirmed cases. In addition, there are other patients that we are currently concerned about and evaluating.”

Ralph skimmed his eye contact around to all reporters. “You sharp news reporters get the picture - this is not pretty.” Ralph stopped, and nodded at the petite reporter who dodged her hand up in front of her face.

“If I may ask a question, sir, what now is your utmost priority?”

“Keeping more feet out of the grave,” Ralph said.

“Are you suggesting there will be more victims?”

“I wouldn’t want to speculate about deaths, but it’s possible we’ll have more cases before squashing this like a bug.”

Another woman briefly raised her hand, and spoke. “Dr. Lewis, so you all don’t know what organism is causing these infections?”

“That’s correct. The bacteria usually incriminated have been eliminated as the culprits. Certain viruses have been eliminated as well. I should have answers soon with other protocol methods we have incubating.”

A tall man with a small notepad stepped forward. “Dr. Tilson, I take it you did surgery on brains this past week. Is it possible the contaminant spread right from a patient’s exposed brain, like some kind of direct contact?”

“As you know,” Danny responded, “we do all we can to prevent direct contact with exposed surgical areas. So that’s unlikely. Typically, meningitis is spread through respiratory droplets. Many of the bacteria that cause these infections colonize in the nose and throat. Viruses come into play, too.” Danny slowed a moment. The man jotted down a few words. “Viruses are present in mucus, saliva, and feces.” Danny continued. “Unfortunately they can be transmitted through direct contact by an infected person, or an object, or simply a surface. Even insect bites can transmit viral meningitis, but Dr. Lewis believes we’ve eliminated tick-borne diseases.”

Dr. Paltrow nodded at Danny’s remarks and added. “Simply put, when it comes to viruses, they can enter the body through the mouth, travel to the brain and its surrounding tissues, and multiply.”

“What is the most likely age range that this could affect?” asked the first reporter, “and how likely could it affect the general public outside this hospital?”

Ralph stayed behind the podium with one thumb behind a suspender strap. “Speaking for the majority of meningitis cases, it is more likely in little ones under five, but then hops to the sixteen to twenty-five year olds, and then to us older folks over fifty-five.” Ralph leaned to the side for a moment and lowered his voice to her. “You’re in the safe age zone, Ma’am.”

“Also,” Joelle said, “certain people are more susceptible if they are chronically ill such as with an autoimmune disease or a missing spleen. And as far as the general public question, there are no guarantees that this hasn’t affected someone else before it manifested in this hospital just a few days ago.”

Robert Madden’s secretary opened the back door and walked along the side wall up to her boss. They had a quiet discussion while a middle-aged press person from a back row pointed her finger and said, “Dr. Tilson, we understand Dr. Jackowitz was a neurosurgeon in your group. What kind of medical condition was he in before he died and do you have any insight or personal comments as to why he came down with it?”

“Dr. Jackowitz was a valued member of our neurosurgical team. He will be greatly missed. He was admitted to the hospital on Thursday and died on Sunday after lapsing into a coma. We shared some common cases and our group here is beginning to evaluate a new patient of interest.”

A casually dressed man had come closer with a TV camera rolling. Danny figured the film wasn’t going on TV live but would be edited for later programming.

Ralph veered out from his blockade, attempting to conclude the press conference. “Y’all, I hope we can work together like shrimp ‘n grits. I trust you all to be good journalists and not fly off the handle with sensationalism. Your readers deserve professional reporting just like our patients deserve quality health care.”

Robert Madden put his hand over his eyes and shook his head while listening to his secretary. He planted himself behind the podium. “Thank you all for coming. I just received word from our hospitalist that another patient with meningoencephalitis has passed away. We can’t release a name yet as next of kin is being contacted. I will continue to work with all of you in a timely fashion, but for now, good day, everyone.”

----------

The medical team and Robert Madden waited a few minutes for the reporters to depart. “It’s Dotty Jackson,” Robert said. “The hospitalist didn’t even expect it.” He shook his head as they all walked together to staff elevators to go their separate ways. Robert pushed an upper floor button. “I’m off to a board meeting. I have a lot of explaining to do.”

The doctors got off in the doctor’s lounge. “We have grieving to do over another patient,” Joelle said. “And we have to reiterate what we’re all doing. I’m going straight to the lab, and Tim, you’re doing a meningoencephalitis work up on Troy Neal, besides working with Dr. Brown on our patient list.”

“I’m heading over with you to the lab,” Ralph said, “But by late today I’m racing up to Bowling Green like a chicken with his head cut off.”

“Ralph,” Danny laughed. “Keep your head on. As for me, my services are sorely needed in the office. Not only did we cancel my surgeries this morning, but we have Harold’s patients. I’m sure Bruce Garner has our work load figured out by now.”

“I’ve heard about him,” Joelle said. “If I didn’t love infectious disease, he’d be a role model to lure me into neurosurgery.”

----------

Passing through the front office quickly, Danny acknowledged staff at the desk, and went straight to Bruce’s office. “Perfect timing,” Bruce said, looking over the top part of his bifocals. “Grab Matthew. I hear him in the hallway.”

“Matthew, come in to Bruce’s office,” Danny said as Matthew was only two doors down. “Just hold off seeing the next patient.”

When Matthew stepped in, Danny closed the door.

“Take a seat, please,” Bruce said. “What a sad turn of events. Harold had many unspent years still ahead of him, he had skill, and he had success with patient’s back surgeries.” Bruce stood tall behind his desk, his face haggard, like a father with bad news about a child. “Danny, you have to fill us in on the weekend and the current situation.”

Danny ran through the details, including the morning’s activities. “And above all,” Danny concluded, “keep strict adherence to infectious disease protocol over there.”

Bruce sunk into a chair half-way through and hung on every word. “Did the CDC doc give any information about the cases he’s going to see in Kentucky?”

“No, I don’t think he was provided with much information.”

“Regarding Harold,” Bruce said, “I spoke to his parents this morning and they’re having a little service at their house late Wednesday. Apparently they weren’t close. Regardless, try to get by if you can.” Bruce slipped a piece of paper with the information across the desk. “As far as our practice, I’ve got it in the pipeline we’re looking for another doc. Today, we’ll all do office hours until six. Most of Harold’s patients we’ll absorb in the next week or two. Office staff has been calling and rescheduling. A few don’t want to wait and will go elsewhere.”

“By the way,” Danny asked, “did you both have a good weekend?”

“Better than yours,” Bruce said.

Matthew gazed out the window past Danny. “Couldn’t have been better, but I regret not helping you out, Danny.”

Danny scurried out, leaving his cell phone and Harold’s parents’ information on his desk, while Cheryl tailed him.

“It’s terrible about Dr. Jackowitz,” she said. “I just can’t believe it.”

“I know,” Danny said. “There are some other folks sick, too, and a nurse just passed away.” He turned to face her, taking a chart from her hands. “First patient Wanda Robinson. Is her MRI result back?”

“Up on the computer,” Cheryl said. She darted off while Danny woke his computer and scrolled though the images and then went into the first patient room.

“Hello, Mrs. Robinson,” he said.

“Look who I brought,” she said, her baby in her arms. “I had to bring her, because after your appointment I have to bring her upstairs to the pediatrician’s office for a well baby check. I have an excellent baby doctor for Carol.”

“That’s wonderful.” Danny admired the infant and noted that Wanda looked less drained than the preceding week. “I have good news for you. Your MRI shows no growth abnormalities with your pituitary gland. From a neurosurgeon’s perspective, you’re in the clear.”

“Oh doctor, that’s great. It’s about time I received good news.”

“And it’s about time I gave some. I will send a report to your endocrinologist. I take it she is giving you appropriate replacement therapy?”

“Yes, she is. And I’m feeling a bit better. My Sheehan’s syndrome is going to be a thing of the past.” She broke into a smile. Danny thought there’s nothing like the happiness of a new mother, even if she’s sick.

----------

The small hand on the clock over the front office desk pointed past 6 p.m. The last patient had left and Bruce stood at the front counter. An evening news channel covered the day’s events in the waiting room as the staff began filing the last charts and packing up for the day. Cheryl stopped next to Bruce as the anchorman switched stories to Nashville’s biggest story.

“You’re on,” Bruce said towards the back of the hallway as Danny and Matthew came single file towards him. The four of them went into the waiting room as the rest of the staff also watched.

“There have been major developments the last two days at Nashville’s University Hospital of a neurological illness which claimed the life yesterday of a local neurosurgeon named Harold Jackowitz. Today an operating room nurse, Dotty Jackson, also died from the same disease. We take you now to a conference held today at the hospital with Robert Madden, the hospital’s CEO, Dr. Ralph Halbrow from the Center for Disease Control and other local specialists.”

Coverage then skipped to the morning’s press coverage which was scarcely shortened. Underneath Robert’s and the physicians’ comments, their names and titles streamed across the screen like live S&P numbers.

Bruce unfolded his arms and shut the television off when the entire story ended. “Nice job, Danny. However, I hope it’s not perceived by the public as a cause and effect between a doctor or a patient of The Middle Tennessee Neurosurgical Group and the outbreak of this meningoencephalitis.”

 

Chapter 11

 

Rachel got up before Leo and padded to the bathroom. It was Tuesday morning and she had finally confronted her denial the night before. Although she didn’t have first-hand knowledge about child abuse, she believed her daughter’s strange marks and behavior came from Leo’s hands. Two different times after he had taken care of her in Rachel’s absence, he told her that he had accidentally spilled a hot liquid, scalding the poor baby’s tender skin.

She admired her complexion in the mirror, washed her face, and applied moisturizer. She slipped on jogging pants and a top. When she came out, Leo was getting up, scratching his bare chest. He turned his head. “What’s your rush this morning?”

“I thought I’d make you real coffee on your way out instead of that instant stuff. But I’m going to take care of Julia, put her in the carriage, and get some fresh air.”

Slowly he made his way past her. “Too bad, we could have had a roll since you were up this early.” He eyed her, almost suspiciously, and put his hand into her hair and rubbed her scalp. It was one of the things he did to her that took her mind straight to the moment, dismissing any negative feelings she had developed for him. He let go after a long minute, gave her a once over and said, “You look good enough to eat. Don’t get kidnapped on that walk.”

Rachel left the room as Leo disappeared into the bathroom. She put on a large pot of coffee and as the water dripped, she realized how charming he could be when he wanted. An operator, that’s what he was - an operator. His craft of schmoozing her finely tuned. But the time neared for her to no longer put up with his cyclical behavior and to put an end to whatever he was doing to Julia.

Rachel went into Julia’s room to dress her. She only had three more days before handing her over to Danny Friday night and needed to monitor her like a hawk. She couldn’t take chances that new signs of physical abuse appear making Danny skeptical about Julia’s care.

Rachel had thought about it at length the night before, the hours after dinner dragging on like they would never end, even when Leo had been grinding her hard. She had tried to fend off his advances by hinting she wasn’t in the mood, but that seemed to egg him on more. As she stared at the ceiling and then into her pillow cover, her daughter’s strange skin patches and recent frightened expressions plagued her.

That’s when it had really hit her, the scary part. Barring her paternity case attorney, Phil Beckett, she’d never directly been involved with the legal system before. She’d done lots of shady things but never serious enough that someone pointed her out to the police. She even remembered Casey Hamilton threatening her with that before Julia was born.

Rachel slid out her daughter’s diaper, put on a bit of salve and powder, and carefully put on a new pink sun dress. She picked her up, patted her back all the way into the kitchen, and slid her into the high chair. Leo still hadn’t appeared. She put Julia’s bottle on the tray and eased small spoonfuls of applesauce into her mouth.

She went back to her thoughts as Julia finished her food then took to her bottle. What if, just what if, someone babysitting Julia put two and two together and suspected some kind of child abuse? Since she was suspicious herself, it seemed highly likely. Her heart thumped in her chest. Anyone would point a finger at her. Weren’t child abuse laws really stiff? Or was it like the rest of the criminal justice system where a person with a good lawyer could practically get away with murder and be walking on the streets?

Rachel looked toward the bedroom and decided to beat Leo out the door. She poked her head in as he sat on the bed tying a shoe. “I’ll see you later tonight. I’m going for a walk with Julia in her carriage.”

After lacing tightly, Leo rose and glanced at his watch. “That’s a long way off, babe. How about a romantic dinner tonight?”

“They’re all romantic.” She flashed a smile. “Maybe. You wore me out last night. How about a dinner-only night and you’ve got a date?”

“You can’t put restrictions on spur of the moment romance.” Leo silently laughed at her naivety. Nothing that drugs can’t handle, he thought. But he’d play her game. He was probably overdue for some internet porn anyway. “I’ll wine and dine you at Maxine’s and maybe work out downstairs afterwards. Have a good walk and fend off any admirers.”

Underneath the mounted buck’s head at the front door, Rachel put a matching pink bonnet on Julia and slid her into the stroller. A little fresh air may help clarify her thoughts. The carriage bumped down the front steps and neared the street. Rachel gazed above and all around at the trees lining the residential properties. The sun sat low, not a cloud lingered above, and a mild breeze made it perfect to be outdoors.

She focused again at the path and the carriage and figured abuse inflicted on minors or babies must run the gamut, just like the penalties. On the one end, perhaps the legal system imposed fines. In some instances maybe it was considered a misdemeanor. But things could go far beyond that. What if it became some kind of record and affected a person’s ability for employment? Her pulse quickened and she perspired easily. What if Julia’s symptoms warranted a felony or even incarceration for the abuser? Now she really sweated.

Rachel didn’t like her conclusion – living with Leo was dicey in a thrilling way, but it had turned too perilous. The risks now soared over the benefits. Her relationship with Leo, her cushy life style with him, had to come to a screeching halt.

She made a right turn at the end of the lengthy block. Rather than waiting for a car to pass, by turning, she kept the momentum going. Good for her streaming thoughts. Perhaps she could turn Julia over to Danny Friday night and be ready to move out. She believed she could swing it - go to work on Saturday and then not return to Leo’s place. But there must be more. He was inconveniencing her, not to mention that he had put her daughter in harm’s way. Payback is a bitch. And she’d figure it out.

----------

Tuesday morning in the OR, Danny stood over an exposed brain. He stepped back and forth to the images on the X-ray view box. Two cancer metastases stemming from the patient’s lungs had to be removed. He grimaced, knowing the palliative surgery would just buy the long-term smoker a few months, at best. When he finished and left the room, the anesthesiologist was in full control.

Turn-over time between cases would take a bit, so Danny hustled to see his next patient in the pre-op holding area, and then wanted to run over to Joelle’s lab to discuss her progress. He spotted his next patient, a middle-aged, early graying woman on a stretcher and introduced himself. “I’m Dr. Tilson. I’m glad you’re letting our group do your back surgery. I’m sure you would have preferred Dr. Jackowitz.”

“That was a shocker about Dr. Jackowitz, but I did hear all of you are good physicians.” She fumbled with the IV tubing and sat up taller. “I just want to get this over with. Get some relief from this shooting pain down my leg. I’ve gotten a wee-bit shorter, so when the bones and discs get squished enough, there’s no longer enough room for the nerves.”

Danny couldn’t hold in a low, rolling chuckle. “I’ve never heard it put quite that way.” He patted her on the shoulder. “I’ll take good care of you. We’ll probably get started in an hour.”

After donning his white coat and sprinting across the walkways of the main medical campus, he took the elevator up to Joelle’s lab. He donned the hazardous-infectious disease clothing and entered her work area. Besides wearing the same outfit, she had strapped on an eye mask. She was stooped over agar plates, her amber with silver earrings dangling alongside her neckline. “Good morning, Dr. Danny,” she said, scarcely looking his way.

“Good morning as well,” Danny said. “I’m between cases. No better place to get an update on current developments than here.”

“Glad you could join me. See these plates? They’ve been incubated at thirty-seven degrees Centigrade and I check them daily for clearing of the agar.” Her long latex-gloved finger pointed from one to the next.

Danny looked quizzically at her. “These non-nutrient agar plates have been coated with E. Coli,” Joelle said, “and then each of them had a drop of cerebrospinal fluid added from our spinal-tapped meningoencephalitis patients.”

“I wish you could grow our bug out sooner.”

“I hear you. See these other plates?” she asked, pointing, “I’ll microscopically inspect them after several days. Just like your field, I have to take one step at a time. I really enjoy the hunt involved with scientific methods. And how I’d love to get my hands on some Watson and Crick like research where I discover a groundbreaking treatment or antibiotic.”

“Half the problem with that is getting money for a project, which I’m sure you run into.”

“We do. Selling a research idea is a problem, too, and I’m not much of a sales person.”’

Danny nodded and got comfortable on the adjacent steel stool. “Have you heard from Tim about Troy Neal’s results?”

“He’s stopping by the hospital lab to get the results and bringing over a CSF sample to me as well. He should be here any minute.” She carefully picked up a tray and slipped it back into the incubator. “So where on earth do you take an ex-spouse on a date?” She goaded him on with a fun smile. “Do you go to a sports game at your kids’ school? Do you take her for pizza, or a movie, or dinner where you hash out divorce talk? Could it even be a romantic dinner somewhere?”

Danny moved a leg up to a foot beam and laughed. “We actually brought that subject up, where to go, that is. My Mom and Dad owned an upscale Italian restaurant in Nashville for years. We used to go there regularly. That’s where we’re going.”

“Interesting,” Joelle said. “Sounds more like your turf than hers.”

“I don’t mean it to be. She does like it as much as me.”

“Since you’re divorced, I’m assuming you’re not happy about that. If I may say so, rekindle the romance slowly like overseeing my agar plates. Send her flowers or put an arrangement on the table. Men never do that anymore. It’s special and it stands out from the mundane.”

“I can do that. Tomorrow night is the night in question, but a little problem has developed. I must first attend the gathering given by the parents of Dr. Jackowitz so our evening may be delayed.”

“Don’t compromise the timing. Why don’t you bring your ex-wife? She’ll understand. Besides, it will reaffirm, in case she’d forgotten or gotten the wrong impression, that you’re empathetic.”

“That’s the kind of advice my sister, Mary, gives me. Thanks, Joelle. It’s too sad about Harold, and I understand the grief his poor parents must be feeling.” Danny thought about his oldest daughter, Melissa, who had passed away. There wasn’t a day that he didn’t think about her and he guessed it had to be the same for Sara. How could a woman bear a child, have that incomparable bond, and then lose her or him? He knew parents could also lose a child not through death, but for other reasons. What if the unmatchable relationship is severed and a parent must let a child go because they love them so much? Incomprehensibly sad as well.

From down the hallway, Danny and Joelle could hear the distinct third leg of a cane. Timothy Paltrow turned into the medicinal smell of the lab, his shiny head intermittently looking down. He had a concerned grin as he came in and stopped next to them. “I hope it’s more of a productive morning for the two of you than me,” he said.

Joelle and Danny waited on his next words. Danny gripped the edge of his white-papered sleeve.

“Danny,” he said, “it appears you did a marvelous job draining and caring for Troy Neal’s brain abscess because it is resolved on his MRI. His present infection stems from that bed sore, one health problem following another which is making his health deteriorate. Lungs and kidneys are taking a hit.”

Joelle absentmindedly pulled at an earlobe, hanging on every word while Danny’s mind raced.

“In other words, my update? Mr. Neal’s MRI and spinal tap show no indication of meningoencephalitis.”

----------

Danny had to get back to the hospital for his next case, but since Tim’s neurology update was so unexpected, Danny and Joelle wanted to fix their eyes on the MRI as well. They all walked over together but slowed their pace for Tim.

“I realize,” Joelle began, “that the most important part of this medical mystery is to find out the organism that’s responsible and the correct antibiotic treatment. But it’s frustrating we haven’t pinned down the first victim, and how it got started. I’ll start some fancy biochemical methods this afternoon and when I get somewhere, I’ll do direct fluorescent antibody stains.”

They all paused at a pedestrian walkway. A car stopped, so the three of them continued.

“I thought our bulletin board in the conference room really helped sort out names and events,” Danny said. “Maybe Ralph’s visit to Kentucky will shed some light, but I sure hope that hospital doesn’t end up with the same crisis.”

Joelle shook her head. “Danny, in the meantime, if you have Peter’s number let’s get the latest from our hospitalist. Give him a call.”

Danny rang Peter’s contact number and immediately told him the negative results on Troy Neal. “Joelle and I are going to peek at the MRI with Timothy as we discuss this. How are our patients and what is your opinion about the new course of antibiotics?”

Peter cleared his throat. The sounds of beeping monitors and telephones droned in the background. “James is not responding. The floor nurse, Peggy, deteriorated early this morning, is unconscious and now on the ventilator.”

Danny shook his head at Joelle and Tim. “And Danny,” Peter said, “Bill Patogue’s fever is one hundred and two and he’s only coherent on and off.”

As they forged through the front doors of the hospital, Danny finished the conversation with Peter and let out a big sigh. He enlightened Joelle and Tim as they slipped into the radiology department. “I’ll make sure I see Bill today,” Danny added. “He’s the most considerate guy. That just can’t be happening.”

Tim rummaged through the recent radiology bin and finally hung up Mr. Neal’s MRI. “You’re right,” Danny said. “There’s no inflammation and his abscess has vanished. It’s nice to see a normal MRI around here for a change.”

----------

As Danny worked on his next case, the staff was abuzz about their co-workers who had fallen ill. Danny didn’t mind them discussing the facts as he used the electrocautery on the woman’s back, but rumors had started circulating as well. Someone had incriminated Dotty Jackson, saying she had not properly sterilized equipment and that had resulted in the outbreak in the OR. News coverage had also made everyone’s jobs more sensational in the eyes of their friends and families, yet everyone feared being the next victim.

After the case, Danny went to make rounds on his own patients and other folks he was following as a consultant. He had one back patient to discharge and since noon had sprung up on him quickly, he felt bad he’d kept the patient waiting to go home. He went and said good-bye to him, wrote the orders, and then prioritized Bill Patogue.

Danny reviewed Bill’s chart first. As the doctor who had been alongside him during the initial evaluations of the meningoencephalitis outbreak, Bill was now a confirmed case. He almost slammed the chart closed as anger rose up in him like an irritated bee. He smacked his right fist into his left palm. In all his years of training and practice, nothing compared to the spread of this disease. He wasn’t a history buff, but he was aware of previous epidemics sweeping the country and Europe, wiping out thousands, if not millions of people.

But these were the days of modern medicine. Something like this is absolutely not supposed to happen. His thoughts tumbled ahead – chances are he was overdue to get whatever was ailing all these patients. If that were the case, he couldn’t wait to see Sara and put their relationship on better terms. She took priority in his personal life. What if he succumbed into a coma like everyone else seemed to be doing? He had to say he was sorry and ask her forgiveness.

He walked to the farthest isolated room down the hallway. The air in the room seemed stale as Danny pulled up a chair alongside Bill, who now looked older than his real age. Danny smiled, grateful that Bill recognized him when he took Danny’s gloved hand in his own.

“This is the first time I haven’t seen you wearing a bow tie,” Danny mused.

With his other hand, Bill gathered copious secretions into a tissue. “They don’t easily clip onto hospital gowns.”

The words came slowly, like a snail crossing a street, but Danny felt grateful for the doc’s sense of humor. He traced back the tubing coming from Bill’s forearm to the small bag of antibiotics, the recent drug of choice to fight the unknown killer.

Bill patted Danny’s wrist. “Lucy, Lucy Talbot?”

“She’s in a coma,” Danny said. He glanced towards the closed blinds, afraid to face Bill, knowing what he must be thinking. “Look, Bill, we’ve got a crackerjack team on this. The CDC is involved, samples have been sent to their lab in Atlanta, and bacteriology is in the works here and over at Joelle Lewis’ lab.”

A shiver rattled Bill as a fever sweat broke out on his forehead. “Danny, if standard antibiotics aren’t going to work and you come up with new possibilities, you have my permission …” He cleared his mouth, continued his train of thought… “to use me as a guinea pig. Danny, I’m too young to kick the bucket, but promise me.”

There’s no way to fool a doctor, Danny thought, when it comes to facing medical problems. He shook his head. “Bill, you’re not going anywhere, but I’ll let the whole team know your wishes.”

Danny stepped outside the room and disposed of his isolation outfit in the contamination bucket. He looked at his list. On his secondary notes, a name popped out. He’d seen him recently, but followed him peripherally because Peter had taken charge of the fourteen year old Michael Johnson. He leaned against the wall next to the cart, his knee bent, shoe against the scuffed-up hallway, pondering the young teen who was already as tall as him. He calculated the timing – Michael had been in the ER during the early a.m. hours of the previous Monday because he’d done his surgery that morning. It was now Tuesday, the next week. Michael already had eight days of hospitalization, the first few taken up with his reason for admission.

In front of him, a patient out of bed for ambulation made a U-turn with their IV pole and passed him going the other way. He slowed his pace and thought about Michael’s case - an acute subdural hematoma. But was it? Absolutely, he thought. It was a boating accident and he’d gone down on the console, hitting his head. The surgery had gone perfectly and the evacuation of the hematoma had been confirmed by Danny’s post-op MRI. The life-threatening rise of intracranial pressure had been relieved.

His parents - he remembered she had a nice name. It was Stella, Stella and John. She had been perturbed at the boater who’d gone by too fast, making the wake turbulence, causing her son to fall. But he hadn’t seen Michael’s parents since one of the first post op visits. They had gone on a ‘two day trip.’ A nurse later told him that an aunt had been filling in for the parents.

Danny straightened his leg, tapped the boy’s name with his pen, and noted the room number next to it. With his long stride and head down, he hastened to the elevator area and took the stairs up one floor. When he opened the next door, he practically tumbled over a medicine cart. He excused himself to the nurse’s aide, straightened his jacket, and hurried towards Michael’s room.

The boy lounged in the recliner between the bed and window, the foot rest up. As Danny passed the television on the wall, he heard a familiar comedy movie, but Michael wasn’t laughing. The teen looked similar to the last visit Danny had paid him, although more drawn, and in need of a shower. Someone had at least brought him sweat pants and a black tee-shirt with an iconic brand logo on the front. He only registered that someone had come in when Danny half sat on the windowsill.

“Michael, it’s Dr. Tilson. Mind if I examine you?”

Michael nodded like he didn’t care. “My friend told me I should be out of here by now,” he slurred. “He says I have mono and didn’t need for you to put a hole in my head.”

“Rest assured, Michael, you needed that surgery. Like your friend, however, I’m perplexed about you, too.”

Michael raised his hand from the armrest and took a tissue to wipe his mouth. Juicy, Danny thought, but not as much saliva as he had last time. Danny caught his breath as the impact of what he was thinking hit him. Maybe the last few days they’d been barking up the wrong tree.

“Michael, are your parents back and around? I need to ask them for permission to do a spinal tap on you.”

“No. They’ve been hospitalized … in Kentucky.”

 

Chapter 12

 

As he rose from the windowsill, Danny registered dread at what he’d just heard. It felt as if his legs were difficult to move, as if dragging a lead weight.

“Michael, we’ll contact your aunt. I think we need to run some tests on you.”

Michael shrugged as if he didn’t care. Danny exited the room and hunted down his chart. His suspicions were aroused – was it Michael who had meningoencephalitis although he’d had a verified acute subdural hematoma? But Danny knew patients could have two things at once, something he’d come across many times, and could steer medical care in a different direction. Or perhaps even more likely, Michael had the subdural but the infection hadn’t yet manifested itself. It had been simmering right under Danny’s eyes.

Danny whipped down new orders and told the unit secretary they were stat. He wanted the room isolated immediately because if his hunch was correct, people were getting exposed by the minute. They contacted Michael’s aunt for procedural approval and Danny set up for the spinal tap. The diagnosis, one way or the other, had to be based on conclusive evidence, not speculation.

The procedure went quickly, especially due to Michael’s age. His back lacked aged changes which make spinal needles more difficult to slip between vertebrae. A geared-up nurse helped Michael stay in a curled position as the precious cerebrospinal fluid dripped into Danny’s vials.

Danny placed all the vials into the tray with enough for Joelle, the hospital, and the CDC. He asked staff to ready Michael for a trip to the MRI machine, delivered some samples to the lab and hurried across the campus to Joelle’s.

----------

Joelle got back to her lab after visiting Radiology with Danny and Tim and persisted with her agar plates and methods. At her cluttered desk, she made notes in her leather notebook after peering through the microscope on the counter for some time. She noted the date, time, specimen number, patient, and other details and then leaned back in her rolling chair.

Although Joelle felt exhilarated with the hunt for their demonic organism, she’d been burning extra hours with the chase and needed catch-up sleep. She’d never been one to run on adrenaline for too long. She found it difficult enough getting through surgery rotations and emergency room electives while in medical school.

She closed her eyes for a moment to the silence of the lab while her thoughts deviated to her Mother. If only she were still here. They had been on a course to have an even thicker mother-daughter bond. How proud she would have been with Joelle’s accomplishments and how happy Joelle would have been assisting her mother in her old age. If she could figure out the cause of the meningoencephalitis outbreak soon, perhaps it will save someone else’s mother, and not have a result like her own.

Joelle opened her eyes, yawned and returned to the black counter. She peeked again under the scope. This time she confirmed it to herself – a clearing, or thin tracks in the agar, the non-nutrient plates having been coated with E. coli. Her pulse picked up as she checked on the direct fluorescent antibody stain nearby. Then her heart galloped like a horse.

She felt as if she’d been working toward this moment essentially all her life as she stared at the histopathology of amebic meningoencephalitis due to Naegleria fowleri, or something close to it.

----------

When Danny stepped into the lab and Joelle turned his way, she looked luminescent as she had just realized the diagnosis. A wide smile erupted on Danny’s face as he placed down the CSF samples and Joelle energized her forearms.

“Ha,” Joelle said, “who goes first?”

Danny resonated a laugh, “ladies first.”

“I’ve got it, Danny! It’s an amoeba. Naegleria fowleri or a like-imposter. Look at this direct fluorescent antibody stain.”

“Joelle, great work. We had every faith in you. Show me now.”

She pointed at the microscope to show him the green shine, like some small sea life shimmering in the dark ocean night.

“I can’t tell you how important a find this is,” she said as he looked. “Most of these rare cases are discovered post mortem.”

Danny shuddered at the thought. “You’ll have to refresh that life cycle for me. And more importantly, where we go from here with all our patients?”

“Yes, and you’ve discovered something as well?” Her earrings sparkled when they caught the overhead light and she held her breath in anticipation.

“I think the first patient is the young teen who had the acute subdural hematoma. His surgery was last week, Monday, same day as Troy Neal. Harold went to see him the next day. The OR staff on duty for his surgery all became infected and his floor duty nurse, Peggy, as well. I’ve brought you CSF samples because I just tapped him.” The words rushed out of Danny like from a water faucet. He moved the nearby stool and sat down as Joelle perched on her own.

Danny had Joelle’s full attention. They faced each other, knee to knee. “You mentioned him before,” Joelle said, “and we eliminated him due to his proven subdural, surgery, and confirmation. His accident happened on the boat, but did the family give you any more history?”

Danny didn’t remember Michael saying that much. The parents had taken turns. Joelle interrupted his thoughts. “Do you know if he went swimming?”

“That’s it. The mother, I think, was annoyed because he’d been doing something she wasn’t fond of. His brother and friend were with him, perhaps he was showing off. The motor was turned off, the kids were swimming, and Michael kept climbing up an island cliff and jumping off. The mother said it was at least a twenty-foot drop. Then they climbed back on board, the speeder came by, and Michael took a tumble.”

Joelle placed her hands together in a prayer-like fashion and touched her nose and mouth for a moment. “You’ve got it Danny. I wish if he had done that, he’d worn nose plugs, and what kid is going to do that? Plunging into the lake like that, from that distance, pushed the fresh water up his nostrils. This amoeba travels from the nose to the brain. It weasels its way into the central nervous system through olfactory mucosa, right through the cribriform plate of the nasal tissues.”

Joelle saddened with the horror of it. “Danny, the olfactory bulbs necrose with this monster as it scurries along nerve fibers straight up into the brain where it literally consumes brain cells. With its unique morphology, it attaches to them and sucks out their contents.”

Danny now recalled it, but had never seen a case, nor heard of one personally. He fidgeted on the stool, the beginning life cycle difficult to imagine.

“Danny,” Joelle continued, “acquiring this amoeba almost always results in death.”

Joelle hated to go on with the stunning statistic. “Survival of patients is less than one percent. But I’m not finished.” She swallowed hard. “That’s the basics, although I haven’t told you the three stages of its life cycle. We have a modified version of what has been previously reported. Maybe a mutation of some sort. It has evidently also affected salivary glands, making them over productive and probably creating another means of contamination. The change has made it even more worrisome.”

“Why?” Danny asked.

“There’s no real success with the suggested antibiotic regimen used for this organism - which we have to put our patients on right away anyway. But now with this alteration, we don’t stand a prayer’s chance in hell.”

Danny slumped. “So these hijackers are going to eat human brains – one cell at a time.”

----------

Finally breaking away from the lab, Danny suggested they grab a late lunch. They walked to Coffee ‘N More right between the hospital and lab and they bought chicken croissant sandwiches and drinks. Slipping into a corner booth, Danny began eating immediately. He was overly hungry, which made the soft, fresh sandwich taste even better.

Between bites, Danny told Joelle the last part of Michael’s story. “There’s another thing,” he said. “It sounded like Michael’s parents were infected, too. They may be in a hospital in Kentucky. Perhaps it’s who Ralph went to see. I’ll call him when I’m done.”

“That’ll be in another thirty seconds based on how you’re wolfing down your lunch.”

Danny’s beam spread across his face after a wholesome laugh. “I should’ve eaten hours ago, but duty called.”

“If you’re correct, that’s additional terrible news about his parents,” Joelle said. She washed down half her sandwich with iced tea.

Danny ate a few chips on the side and then scrolled for Ralph’s number. Joelle nodded as he placed the call. Within a few seconds, Ralph got on with a reserved “hello.”

“I was going to call one of you in a little while,” Ralph said. “It’s been busy here and our outbreak has indeed spread.”

“It’s Michael Johnson’s parents, isn’t it?” Danny asked.

After a surprised pause, Ralph answered. “How did you know?”

“Joelle and I figured out the initial source, Michael Johnson. He’s the fourteen year old who had an acute subdural hematoma but also kept jumping off a high cliff into lake water prior to the accident. Joelle has determined the killer organism to be Naegleria fowleri. However, a killer has turned into a super killer based on Joelle’s interpretation that this amoeba has mutated.”

“Hello, Danny,” Ralph said. “I leave you two alone and you work together like biscuits ‘n gravy.”

Even under the sad commentary of information, Danny had to laugh while shaking his head at Joelle.

“But they aren’t the only ones,” Ralph said. “There’s another patient up here and two more in hospitals in Tennessee and Georgia. By phone I’ve traced the patients to having visited family or friends at your all’s facility. I plan on leaving here soon after some correlating. You need to have the CEO call another press conference and I’ll be back as soon as possible.”

“I’ll schedule for early tomorrow morning,” Danny said. “In the meantime, Joelle and I will change the present treatment and start what she thinks are the best drugs.”

“Does she think it’s Chlorpromazine?”

After Joelle concurred, Ralph added, “I’ll relay this information to the other hospital physicians. Say a southern prayer we contain this demon.”

----------

Wednesday morning before 8 a.m. every doctor involved, plus Robert Madden, showed up again in the hospital’s conference room on the top floor. No one skipped the continental breakfast. Danny told Timothy to go ahead and sit and brought him coffee and a plate of fruit and hard boiled eggs, went back for his own, took a napkin and glanced at the reddened and scabbed flesh on his left palm.

“What did you do to your hand?” Joelle asked as she lined up behind him. “You didn’t do that in surgery, did you?”

Danny smiled her way. “Ha, no, I’m a more careful neurosurgeon than I am with yard work. I almost sawed off my hand. That would have put me out of commission for good.”

Joelle shook her head. “Guys and their toys. You’re lucky. I hope your hands are insured!”

“That’s the problem being in a surgical specialty. Your livelihood is a lot more vulnerable than being in primary care.”

“I suppose my specialty is pretty safe, except for being more susceptible to deadly viruses.”

“You would have been fascinated with this one. Within the last twelve months, I operated on a patient’s brain that had a hydatid cyst. Echinococcus granulosas from a dog’s tapeworm.”

Joelle’s eyes grew wide as she stood there with an empty plate. “No way. I’d expect something like that from South America, but Nashville?”

“South of the border is where he picked it up.”

“You must have stopped breathing to remove it. That cyst could have ruptured, releasing thousands of parasitic particles into his brain.”

“I didn’t breathe and I didn’t blink.”

“Jeez, Danny, remind me to go under your OR knife but not use your landscaping services.”

Robert Madden said a quick “good morning y’all” to everyone and Danny quickly took his choice of a bagel and a large black coffee.

“As you all know,” Robert said, “we’ve made huge progress in the last twenty-four hours in getting to the bottom of this outbreak. However, that was another twenty-four hours that this organism had continued to spread. Ralph from the CDC is back from his quick jaunt to Bowling Green. Our press conference is in thirty minutes downstairs and this is to correlate our information and make sure we’re all on the same page. I think Joelle would like to say a quick word or two first.”

Joelle placed her coffee cup farther away and stood up. “Dr. Tilson confirmed yesterday by MRI that the young man, Michael Jackson, was the original source of this outbreak and as some of you know, we’ve discovered the organism causing this meningoencephalitis. We might as well refer to it as PAM which stands for primary amoebic meningoencepahlitis. The amoeba is Naegleria fowleri or a similar derivative.”

“Joelle,” Peter said, “yesterday Dr. Tilson explained to me how this organism invades a human brain. But being a hospitalist, I don’t really know about its life cycle. Can you enlighten me?”

“Would love to,” Joelle said. She put her hand forward and gestured with three fingers. “It exists in three forms – a cyst, trophozoite, and flagellate stage. Cysts exist in the most unfavorable conditions such as extreme cold. The flagellate form is simply a trophozoite which gets transformed quickly due to changes in its ionic environment, like sticking it in distilled water, a different ionic concentration.”

Danny noted Joelle had only sipped her coffee, but her description took on speed.

“It’s the trophozoite which is the reproductive form, proliferating by binary fission. Their pseudophila allow them to travel and change directions, feeding on bacteria in nature, but eating or phagocytizing red and white blood cells in humans and destroying tissue.”

Joelle’s voice grew grim as she looked at each individual in the room. Timothy’s hand trembled on his cane and Danny grimaced visualizing the capabilities of the amoeba. “The shocking thing for humans is they eat our brains piecemeal by a unique adaptation extending straight out from its cell - a sucking apparatus.”

Peter had put his fork down. “Aren’t I glad I asked?”

----------

After more discussion and certainty that all the involved patients were quarantined and under proper infectious disease protocols, they swiftly left for the press conference on the first floor. What awaited them had no resemblance to the last reporters’ gathering.

Robert Madden led the group. While Danny, Joelle, Ralph, Timothy, Pamela, and Peter pushed past the hordes of press and camera crews which flowed into the back of the auditorium, flashes went off and cameras started rolling. Robert already had a question hurled his way, but put his hand up signaling the crowd to wait until they formally got started.

Robert turned in the front of the crowd. He was sharply outfitted in a suit and tie. Along with his salt and pepper gray, he made a distinguished figure. “Ladies and gentlemen, we have major developments in this outbreak. I am immediately introducing Ralph Halbrow with the CDC.”

Ralph went to the podium past Robert. His hectic trip to Nashville and Kentucky, and the pressure of the disease, had caused puffiness under his eyes. “Before taking questions, we have discovered the organism wreaking havoc in not only this hospital but now in three states. We have also discovered where this organism came from.” Ralph went on to give explicit details and then introduced the other doctors and their specialties before opening up the floor for discussion.

A reporter nudged forward as soon as Ralph stopped. “Why are you finding new cases when the hospital insists that precautions are being taken for its spread?”

“People have obviously been around these patients before their diagnosis was made and they were put on infectious disease protocol. And we aren’t sure exactly the point in time when a person becomes infectious to others. But we have our suspicions.” Ralph took one thumb and stuck it under his burgundy suspender as he gave it another thought. “Also, you must realize the hospital has intermittently been on diversion, causing cases that would have been admitted here to land somewhere else. And in the case of Michael Johnson, the first case, his parents unknowingly came down with it from their son while they were away on a trip.”

A man with a CNN camera person beside him spoke next. “So this can become an epidemic? And are you saying there is no treatment to eliminate this amoeba?”

“Sir, this is an epidemic.” Cameras clicked in a mad rush and some reporters let out a gasp. “We do have a suggested treatment,” Ralph added, “but it doesn’t seem to work. The CDC and infectious disease here are going to immediately look into finding the cure.”

“Why do you think treatment doesn’t work?” the same reporter asked.

“Naegleria fowleri may have had a slight mutation. Our outbreak involves the patients having a timely heavy production of saliva. The organism is having an impact on the salivary glands, which are close to the nasal anatomy involved.”

Ralph signaled to a reporter in the back with his hand raised the whole time. “Mr. Halbrow, we understand you were in Bowling Green yesterday. Who pinned down these results?”

“Dr. Joelle Lewis and Dr. Danny Tilson.”

“Couldn’t the CDC have come up with this information sooner?”

“The CDC in Georgia has had the necessary samples as well. These specialists right here in your home town are close to the history, allowing them to piece together the puzzle sooner. I assure you, Dr. Tilson and Dr. Lewis are two of the sharpest knives in the drawer.”

 

Chapter 13

 

It had been years since Sara taught first year high school biology. She’d quit teaching when the girls were small and Danny toiled in training. After the divorce settled and she evaluated her life over the summer, she decided to get credentialed again and apply for a job. In only a few years, Annabel and Nancy could possibly be leaving for college. She’d have made the right decision to go back to her own career and not suffer the pangs of an empty nest.

She sent in three applications to regional high schools and lucked out with the best possible result. The school where Melissa had gone, and Annabel and Nancy attended, asked for an interview. In addition, that was where Sara had previously worked. Within two weeks the principal called, offering her a freshman teaching spot.

Sara brushed up on high school biology as well as state mandates on curriculums and preparing for the first day of school. She recognized her other good fortune as well. Annabel was entering her senior year and Nancy her sophomore year, so she wouldn’t have a potential conflict of interest with one of them in her class. They could also travel back and forth to school together when possible.

She figured it all added up - lately life without Danny was a win-win situation. Joining the work force again, keeping in good shape, and having two remarkably good teenagers boosted her self-confidence, which had taken a hit during the last months of her marriage. Looking in the mirror, she liked what she saw. Only two years younger than Danny, she wore forty-four years well. Her peppered true blonde hair stopped midway along her cheeks and her skin drank moisturizer with sun protection first thing in the morning, giving her complexion a boost.

As she applied a rosy-colored gloss to her lips in the bathroom, the sunshine danced along the sink top, broken by the fluttering leaves outside. She slid a belt through light gray capris and after deliberation, opened the top button of her white sporty blouse. School would start next Monday and she was headed in this Wednesday morning to sign a document needed for health care insurance and put the finishing touches on her classroom.

Sara stopped in the kitchen and gathered her things.

“Where ‘ya going, Mom?” Annabel asked.

“To our school to do last minute work before the big day. I hope you two are ready, I haven’t been quizzing you over your preparations.”

“That’s because we’re not kids anymore,” Annabel said.

Nancy turned around from buttering toast. “I’m not a child, but that doesn’t apply to you.”

Annabel gave her a piercing stare without her mother’s knowledge. “Bye, Mom, we’ll see you later.”

“You girls are on your own for dinner. I’m meeting your Father.”

Annabel kept a smile from creeping over her braces. “How come?”

“Just to discuss things.” Both girls stood shoulder to shoulder staring at her. “And simply to eat dinner,” she added.

“Where?” Annabel asked.

“Downtown Italy.”

“Sounds interesting,” Annabel said.

“Interesting enough for you to bring us home some Italian pastries,” Nancy said.

----------

Fond memories stirred for Sara as she walked under the front entrance canopy of the two-story brick building and made her way inside. She’d had enough big changes in her life the last two years, so she counted her blessings that she would again work in familiar surroundings. She made a right turn into the front office. “Good morning, Mary Ann,” she said to the first woman at a desk. “Who should I see about my health insurance form?”

Mary Ann fumbled through papers in front of her. “You know, Mrs. Tilson, I think Mr. Robinson has it.” She checked the light on his phone extension. “He’s free, you can go back there.”

Sara passed the two desks and rapped on the principal’s door. She saw him wave to come in through the open-blinded window. Ross Robinson stood, walked around his desk, and extended his hand. “A formal on-board greeting to our new teacher,” he said, giving her a warm handshake. Her impression after meeting him the first time had stuck – he seemed the rugged, outdoorsy type - like his office only substituted for a campground.

Ross pointed to the leather chair in front of his desk. As she sat, Sara noticed the pictures on the back wall of an American eagle and a black bear, prints similar to National Geographic pictures. He massaged his sparse beard and mustache and also sat, narrowing his eyes to take a better look at her.

“Thank you, Mr. Robinson, I’m on the way to my classroom and Mary Ann said you have my insurance form for signature.” Suddenly she realized it strange that he had that paperwork. She could swear she blushed. He was good-looking and seemed pleasant enough. His pitch black hair twisted in curls like rope and he had pencil thin eyebrows. He wasn’t skinny, but wiry, like a thin yoga master.

“Ahh, yes, it’s here somewhere.” His eyes darted downward but he leaned back in his chair. “I don’t know if I mentioned it. I’ve been the principal here for five years. I contacted the former principal, Mr. Baldwin, for a recommendation and he had only good things to say about you.”

Sara crossed her legs and raised her hand in acknowledgement. “His tenure was much appreciated by everyone here. How is he doing?”

“Bored from retirement, so he wishes he hadn’t left. I guess you missed it being away, too.”

“Circumstances change. I think I’m going to love it, especially if I get a group of great kids.” A pause settled, allowing Sara to wonder about him searching for the form.

“Sara, I thought about letting you get settled into the job, but upon reconsideration, I would like to ask you out now. A casual date. In other words, I’d like to ask you out the first time while you’re not a school employee. I’d feel more comfortable this way.”

He smiled tentatively at her. “I’ve probably said too much already. However, just in case you aren’t aware of it, I’m a widower, not a married man hitting on you.”

Sara’s hand encircled the end of the arm rest. The surprise request and flattery registered with her pulse picking up all the way to her fingertips. “Oh, I’m so sorry. May I ask what happened to your wife?”

“She died from malignant melanoma.”

Sara bowed her head for a moment. “Okay,” she said. “A casual date would be nice.”

Ross shook his head as his eyes twinkled. He picked up the form smack in front of him and handed it to her across his desk.

----------

After the reporters and news camera people left the auditorium, the docs peeled out. Danny got in his Lexus and drove to the office a few minutes away. The schedule would be jammed, and they had to finish by 5 p.m. in order to make Harold’s family memorial in time.

Danny put his cell phone and brief case in his office as Cheryl tagged after him. “I’ve got two patients in rooms waiting on you,” she said, “and Bruce wants a quick word after he finishes dictating for a patient’s chart.”

As Danny slipped into his white coat he entered Bruce’s office. Bruce looked over his bifocals while finishing his microphone entry and handed Danny a file folder. The inside didn’t hold a patient’s history, but a resume on a Dr. Jeffrey Foord. Danny scanned the C.V. – a Knoxville trained doc who just finished his residency.

Bruce stopped, pushed back, and draped one long leg over the other. “What do you think?” he asked.

“Most programs finish this time of year and residents have jobs lined up. This would be too good to be true and timely. But why didn’t he have a job already?”

“He had a position in Indiana all ready to go, but there was a snag and that state license didn’t come through in time. They gave his spot away to someone else. He’s coming in shortly for me, or us, to interview him.”

Danny nodded and smiled as he put the folder back on Bruce’s desk. “He’ll be green around the gills getting out in the real world but there are advantages. He may be someone who stays with us a long time, he’s younger with perhaps new ideas and concepts, and the timing is perfect.”

“My sentiments exactly. So, how did the press interview go?”

Danny gave Bruce the highlights as well as an update. Bruce opened his top drawer and took out his notepad. He wrote under his previous notes, putting the day and date, number of cases and where, and the new antibiotic. “This is just so I keep abreast of the current facts, not what I hear from the rumor mill. Speaking of which, patients are asking intelligent questions and I’m hearing concern about being seen in this office.” Bruce’s voice turned somber, but he shot the next statement to Danny in one breath. “So try to assure patients today we’re not spreading infectious diseases.”

“I’ll do my best.”

Bruce pushed his glasses back up the bridge of his nose. “Actually, I’m worried about you. Based on what you say, this is deadly and won’t go away with an aspirin. One person can do major damage to others. Are you harboring even a trace of a symptom that tells me you shouldn’t be here?”

Danny leaned forward, running his hand over his temple. “Not even an infinitesimal grain. I feel fine, maybe more healthy these days than usual.”

“But you were proactively treating the pod of people catching it from each other.”

Danny had nothing more to add as they both rose with quizzical expressions and went to see patients.

----------

After Danny saw two patients for follow up visits post cancer surgery, he stepped into an examining room for a young man who’d been in the ICU two weeks after a motorcycle accident. His mother sat across from the twenty-year old. She still wore a grateful look that her son had escaped near death.

“It pleases me to see you both under different circumstances,” Danny said, “and I’m happy to report your last MRI is totally normal.”

“Thanks, Dr. Tilson,” the man replied, holding his cell phone on his lap.

“It’s not my business to police patients in their private lives,” Danny said, “but please reconsider wearing a helmet if you get back on a motorcycle.”

The boy’s mother nodded. “He’s lucky to be alive,” she interjected. “That’s what I told him from the beginning.”

The boy twisted his mouth. “Dr. Tilson, I don’t want to go through this again. You’ve got a deal.”

Danny shook his hand as Cheryl rapped on the door and stuck her head in. “Dr. Tilson, in case I miss you between patients, please see Bruce again in his office.”

After completing the patient’s visit, Danny returned to Bruce’s office to find Jeffrey Foord, a short man alongside Bruce at his window. Bruce pointed to the various medical buildings nearby. When he turned, Danny noted him to be a baby-faced thirty-one year old with dark red hair, fluffy around the ears and neck, with a few matching freckles.

Bruce introduced them and invited them to sit down at the round mahogany table. Danny enjoyed seeing the originality of his one small ear ring, unusual for a neurosurgeon, but the sneakers along with a coat and tie for an interview took him by surprise. He wondered how Bruce would interpret it.

“Matthew Jacob is another member of our group,” Bruce said, “We need to get back to four of us instead of three. I contacted your program in Knoxville and they gave you flying colors. Why do you think we should hire you?”

Jeffrey had already posed his right elbow in the palm of his left hand and had his fist by his chin, like a sturdy listener. “We’re both in the market for what the other has to offer. I work well with colleagues and yet I’m independent with my own cases. I’m born and bred in Tennessee and will slip right in. The only reason I was leaving the state was because nothing turned up here.”

“You have any areas of interest?” Danny asked.

“Yes, awake craniotomies and electrophysiologic monitoring.”

“I’ve done a few myself,” Danny said.

After ten minutes, Bruce cut the interview short. “We’re on a short time frame,” he said, “and there’s a remembrance at six o’clock for our colleague who passed away. I’ll give you a call by tomorrow night.”

Jeffrey got up on cue and shook their hands. “I’m sorry to hear about your other partner. It’s all over the news in Knoxville. We also just confirmed two cases in our teaching hospital today after talking with someone at the CDC in Atlanta yesterday. Apparently the other case in Tennessee outside here is in Chattanooga?”

“That’s correct,” Danny said. “How sick are the patients in Knoxville?”

“Practically went straight into comas on admission.”

----------

The office closed promptly at five and Danny headed straight home. Casey pulled his Jeep into the driveway ahead of him but drove into the garage. Danny parked in the driveway.

“You must have been seven to three today,” Danny said, “but I never saw your ambulance as I went back and forth to the hospital.”

Casey walked toward him with his gym bag. “Mark and I only made one run there at the end of the shift, an elderly lady with a broken hip. And I avoided getting up close and personal with not one, but three ER admissions they just received - hospital staff with probable meningoencephalitis.”

“Damn,” Danny said, leaning against his car. Anger welled up … how he hated this spreading disease. What else could he do? The situation seemed hopeless. Even the CDC was stumped. Casey stared at him. “We have to get three doses of the new antibiotic into the current diagnosed patients before they can possibly turn around.”

Casey grabbed Danny’s upper arm and tugged. “Come on, let’s go in. Dakota’s barking at the door.”

“Joelle Lewis said it’s got an acronym called PAM,” Danny said. “And by the way, I swear you’re getting more ripped.”

“I only just did an hour, but yeah, I’ve slimmed and am muscling up for the wedding.”

Danny grinned as they opened the house door. Dakota’s tail waved feverously as he pushed his back end into them, blocking their entrance. Casey dropped his black bag and hoisted the dog into his arms. “How’s this for a view, Dakota? See, you’re not the strongest body in here.” Casey took several steps and then placed him on the floor by the French doors. Dakota put his rump up in a play bow, taunting Casey to try it again.

Danny savored the show.

“Leave the milk out,” Casey said as Danny poured a glass. He stepped away from Dakota, pulled out a big container from the closet, and poured powder and milk into a blender. He turned on the machine, poured the contents into a large glass, and downed the protein drink while Danny still had milk to finish.

“Isn’t tonight the night Howard’s family has an open house?” Casey asked.

Danny crouched down face to face with Dakota and with both hands massaged the dog’s neck. “Yes, I’ve come home to change my shirt and spruce up. I’m taking Sara out, but I never called to tell her we’re stopping there first.”

“Really?” Casey said surprised. He put the glass in the sink and smiled. “Tell her hi and have a great time, which should be a no brainer unless you screw it up.” Before he gave Danny a chance to respond, he ran up the stairs to see Mary.

----------

Hushed conversations lingered inside the Jackowitz’s home. Most of the staff from The Neurosurgery Group of Middle Tennessee made an entrance, giving condolences to close family members and sharing office stories about Harold. Although no one mentioned it, Harold’s remains sat on the fireplace in a keepsake urn surrounded by flowers and sympathy cards. His emotionally wrought mother sat very close in an armchair as if she couldn’t put distance between her and her son.

After making appropriate rounds, Danny went to Harold’s mother and crouched beside her. “Mrs. Jackowitz, it grieves me every day what happened to Harold. We didn’t see this deadly epidemic coming. I am so sorry.” Her hand rested on the arm rest and Danny clutched over it and squeezed.

“My son was happy working with all of you. I know you helped take care of him in the end. Thank you.”

“You have every reason to be proud of him.”

Sara stood alongside him, grim and weary over the young physician’s demise. There’s nothing worse than a child’s death, she knew. She gave Mrs. Jackowitz a slight hug after Danny got up.

All of Danny’s co-workers knew Sara. He introduced her to other family members and his friends by simply giving her name and not mentioning her as his ex-wife.

After fifteen minutes, Danny, Matthew, and Bruce stood in a partial circle near the dining room buffet.

“Matthew, you didn’t meet him,” Bruce said, “but Danny and I interviewed Jeffrey Foord today. He’s straight out of residency and looking for a neurosurgery position.” Bruce turned to Danny. “What do you think?”

Danny cracked a smile. “He’s a bit unique for the specialty.”

“But … that doesn’t matter, does it?”

“No, not in the least, although he may spice things up a bit.”

“Hire him?”

“Hire him.”

A hand tapped Danny from the side. In a low voice to the three of them, Cheryl said, “This morning’s news conference is on. In there.” She pointed toward the den.

Danny nodded to Sara to follow as they moved to the next room. A TV sat in a shelf opening, broadcasting the nightly news. A middle aged reporter with an English accent spoke from the street in front of the hospital entrance. “The death count and reported new cases in the unusual meningitis outbreak continues to climb. This epidemic claimed one more life here a short time ago, there are three more cases suspected, and two more confirmed in Knoxville. We go now to the medical news conference highlights, which took place here this morning.”

The major network aired the meeting while their names appeared at the bottom of the screen. Sara wringed her hands as she found it difficult to take the next breath. What Dr. Lewis seemed to be saying was that the prognosis for patients and their recovery looked dim if the present course of antibiotics failed. The coverage ended with the last statement from the CDC.

“I assure you,” Dr. Halbrow said, “Dr. Tilson and Dr. Lewis are two of the sharpest knives in the drawer.”

 

Chapter 14

 

Sitting at a window table in Downtown Italy, Danny broke apart garlic bread and handed Sara the other half. He took a bite and raised his wine glass for a toast. “To a nice dinner together,” he said as he clinked her glass. “I hope you didn’t feel uncomfortable earlier at the Jackowitz’s. Going there wasn’t something I planned on when I asked you out.”

“I understand. The circumstances are extraordinary. Do you know who died this afternoon?”

“No, I’ll find out tomorrow. It’s too grim to speculate. Perhaps we can talk about the girls and the upcoming wedding, about nice weather and fishing, and even about us.”

Sara hid behind her wine glass, then put it down and brushed her hair behind her ear. Her eyes went to the table, but not for long as she leaned in and spoke softly. “Danny, life comes without guarantees. Things don’t always work the way we plan them. I realized that when Melissa died.” On the brink of crying, she buried her forehead under her hand.

Danny ran his fingertips in the soft hair near her temple. He savored the special moment looking at her and smelling her orange-ginger aroma. The ivory flowered necklace draping her neck - he remembered they’d bought it on a trip - and the peach cotton pullover with a V-neck she wore adorned her complexion. A few intimate seconds seemed like an hour.

“I promise,” Danny said, “to make life run as smoothly as possible for you and the girls from now on. Whether we’re living with each other or not, married or not, if you let me, I’ll look after you three like there’s no tomorrow.”

Their eyes locked. “That’s sweet, Danny. I’ll try and believe you.” She knew it was more complicated than that. He had an infant as well, the result of the extra-marital affair he’d had with Rachel. For the first time, however, she realized the new baby wasn’t insignificant to their two girls, Annabel and Nancy. Their daughters now had a half-sister.

As if reading her mind, Danny placed his hands on his lap. “I know. I have a baby, too. I’ll pull my fatherly responsibility and more, but that situation is separate from my first and foremost family.”

Carrying two plates, the waiter stopped at their table, and placed the hot entrees they’d ordered in front of them. “Would either of you care for fresh parmesan cheese?”

They both nodded, allowing him to turn the grater over their plates. “I’ll be back to check on you. Enjoy,” he said and left for another table.

“Okay,” Danny said, “let’s eat. And thank you for finally accepting my invitation.”

“You’re welcome. This brings back memories. Your Dad and Mom were the ultimate owners here and I miss Angelo, but this does look pretty good.”

“He was special, wasn’t he? Now for the taste test.” Danny twirled linguini with shrimp around his fork and took a bite. He nodded. “How’s your ravioli?”

She savored and swallowed. “Very nice.”

They sampled each other’s pasta and Sara complimented the waiter on the food when he returned.

“I have big news,” Sara said. “Not as important as what you do or how you’re being heralded on national TV.”

“Sara, I just do my job, but what is it?”

“I’m going back to work,” she beamed. “Same as years ago before I gave it up. First year biology right under the same roof as the girls.”

“That’s fantastic. Good for you. You not only loved to teach, but you’re crazy about biology.”

“Yes, well… anyway, I’m ready.”

“Another toast,” Danny said. “Enjoy the second phase of your beloved career.”

----------

They skipped dessert and Danny drove Sara home. He zipped around the car and opened her door, then walked her to the front entrance.

“I bet your days lately have been extra long,” Sara said.

“Some of them remind me of the hours I pulled during residency.” Danny gently put his hand on her shoulder as they stepped onto the porch. “Sorry we didn’t linger longer over dinner. I’ll be jumping into bed after walking Dakota as soon as I get home.”

“No, this was perfect. The girls and I are having early days, too, before starting school next week.”

“They’re coming over again next weekend, if that’s okay. I’m not on call and I’m picking up Julia late Friday. We’re having a fun dinner at the house Saturday night. You know you’re welcome and invited.”

“I have plans Saturday night,” she said after a moment, in a bemused way.

Danny cocked his head. Maybe she’d explain.

“I have a date,” she said, causing Danny to gulp.

“Anybody I know?” he managed to ask.

“It’s the principal at school.”

Danny racked his brain on the way home, wondering if he’d ever met the man and what he looked like.

----------

Danny waited for Casey to catch up. They’d both left the house the same time, Danny slightly later than normal. Casey trotted upon seeing Danny outside the doctor’s parking zone, and they walked together across the asphalt into the ER back door.

“Are you going to pry about last night?” Danny asked.

“I figured you’d tell me if you wanted to.”

“Things were going well until she dropped the ball. She’s got a date Saturday night with the principal of the girls school.”

“Where she’s going to work?”

“You knew about that?”

Casey shrugged his shoulders. “Danny, Mary and I see her more frequently than you do. She’s been getting ready for it.”