For the first half of his twelve-hour shift, Dr. Lewis Cole had been working feverishly to care for the predictable onslaught of Saturday night patients. In addition to the usual variety of illnesses and injuries, he was spending a lot of time reassuring one pregnant woman after another suffering from a mild headache or a runny nose that she was not the latest victim of GNS.
The ER staff checked the surgeon general’s advisories every eight hours. To date, not a single case of GNS had been reported in the entire state, which made Indiana one of only ten states where there was no documented outbreak. After sewing up a jagged laceration on a sixty-year-old man who was trying to figure out the nuances of his new power band saw, Cole strolled out of the treatment room. After a peek out into the waiting room, he made his way to the nursing station.
“The paramedics brought in Maggie Recino about fifteen minutes ago,” came a voice from behind him. “She’s in room four.”
Cole twisted in his chair and saw Patsy Ames, the nurse manager hovering over him like a Blackhawk helicopter. A woman with no airs or graces, she was twenty years his senior. Every time she sensed Cole was becoming too consumed with himself, she reminded him that she’d been the one to read to him from Charlie and the Chocolate Factory the day he broke his wrist on the playground and needed it casted.
“Connie’s daughter?” he asked.
“Yeah. She fell backward off a wall unit.”
Maggie had been born at Bedford Community. She had had her appendix out there when she was seven and had given birth to her son one floor up from where she was now lying. Her first and only job since graduating from Butler University was as the director of volunteer services at the hospital. Her mother, Connie, was a hospital administrator in charge of business development.
“Is she okay? I thought only kids did that.”
“The next-door neighbor found her and called 911. Her vital signs en route were normal but she’s still a little out of it.”
“Why didn’t you come get me?”
“Because you were kind of tied up and we’re experienced enough to triage a patient and decide if we need a physician stat or not.”
He held up his hand in surrender. “Sorry.”
“We sent her for a CT of her head just to be on the safe side. She just got back to her room a couple of minutes ago. The radiologist already called and said it was fine—no bleeding and no skull fractures.”
Cole pushed back in his chair and then stood up. “Isn’t Maggie pregnant?”
“She’s in her seventh month. Her tummy’s fine and she’s had no vaginal bleeding. We have her hooked up to a fetal monitor. Her blood work should be back in a few minutes.”
“I don’t care how smart they think they are. They still should have gotten me,” he muttered to himself, as he turned and started down the hall toward Maggie’s room.
“I’m sorry, Doctor. I didn’t quite hear that.”
“Nothing. It was nothing,” he said, wondering why he again allowed himself to fall victim to Patsy’s superhuman hearing. He made the short walk down the hall and went into Maggie’s room.
“Hey, young lady. I heard you had a little fall at home. How are you feeling?”
“Probably more embarrassed than anything else.”
“No cramps in your tummy or bleeding?”
“Nope.”
“Do you remember what happened?” he inquired.
“Kind of.”
“Tell me about it.”
“I’ve been feeling a little dizzy lately. It got worse tonight and then my vision got blurry. I had bad migraines with my first pregnancy. I just assumed it was the same kind of thing but without the horrible pain.”
“Is your vision still blurry?”
“A little.”
Cole walked over and examined her head and neck. As usual, Patsy was right. There was no bruising or swelling. She had no pain to any area he palpated. He had seen hundreds of head injuries in his career ranging from the most minor to the most grave. Even when it was only a mild concussion, there should be some visible evidence of an injury to the head.
“Are you sure you didn’t hit your head?” he asked.
“I’m positive.”
“Tell me more about this dizziness you’ve been having,”
“It started on Saturday.”
“Today’s Saturday. Do you mean it began today or you’ve had it for the last week?”
“I guess it’s been about three days, not a week.”
“Patsy said you were alone when you fell.”
“Uh-huh. My mother’s on vacation and my son’s with my sister tonight.”
“I thought your mom was in Chicago attending the meeting on operating room safety.”
“Uh…that’s right. I forgot. I guess I thought she was on vacation.”
Becoming increasingly more concerned with Maggie’s confused responses to his questions, Cole stopped his exam and studied her face. In spite of the normal CT and absence of physical signs of a head injury, it was still possible she had a concussion, but he was unconvinced.
“Have you had any muscle cramping?”
“In my legs a little. I didn’t have that when I was pregnant with Matt.”
He removed his stethoscope. “How’s your mom?” he asked again on purpose.
“She’s fine. I should have called her to meet me here.”
Taking note of her answer, Cole quickly shifted his exam to her eyes. They appeared normal. He then moved straight to his neurologic assessment. Before he tested her ankle and knee reflexes, he examined her thighs. It was barely perceptible but there was a fine tremor of the muscles. He swallowed against a tightening throat and took a step back. His fingers quivered from the bolus of adrenaline filling his bloodstream.
“How long have your legs been twitching like that?”
Her eyes were closed and she didn’t respond. Cole renewed his question but she again failed to respond. He quickly checked her vital signs. According to the cardiac monitor, her blood pressure and pulse were normal. She was breathing without difficulty and the level of oxygen in her blood was fine.
His sense of urgency climbing, Cole walked over to the other side of the room and picked up the phone.
“Have one of the nurses come down and sit with Maggie,” he told Patsy in a calm voice. “No, Patsy. Right now.”
He walked back to the bed. A few seconds later one of the nurses hurried into the room.
“Keep an eye on her, please. I’ll be right back.”
Cole quietly closed the door behind him and made his way back to the control desk.
“What’s going on?” Patsy asked.
Cole said nothing at first. Instead, he studied a bulletin board, which contained dozens of advisories, lab bulletins and memoranda. When he found the posting from Illinois Memorial in Chicago he was looking for, he removed it from the board and picked up the phone.
“I’m worried about Maggie,” he said, dialing the number.
“What do you mean?”
He covered the receiver and then touched his index fingers to his lips.
“Illinois Memorial transport team. This is Chris speaking.”
“Good evening. This is Dr. Cole. I’m calling from Bedford Community Hospital in Indiana. I’d like to arrange an emergency transfer. I believe the patient may have GNS.” Patsy sat down next to him. Her stare was intense and her lips widely parted. “Yes, I’ll hold.”
“The nearest reported case of GNS is over a hundred miles from here,” she said in just above a whisper.
“Up until now,” he said, again cupping the mouthpiece with his palm. “Get on the phone and alert the other hospitals in the county that this may be the beginning of a local outbreak.” He again raised a restraining hand to her. “Yes, this is Dr. Cole. Thank you for taking my call. I’m seeing a twenty-seven-year old in her seventh month whom I believe has early GNS. She has a several- day history of intermittent confusion. On physical examination, she has a fine tremor of her thigh muscles. She has no rash or fever.” He paused for a few moments to take a breath and to listen to Dr. Gaylord Smithey’s response. “Yes, I realize there have been no cases in Indiana, but I’d still like to transfer this young lady up to your facility as soon as possible. She’s stable for transport.” He nodded his head while he listened. “Thank you, Dr. Smithey. We’ll expect the helicopter within the next hour or so.”
Cole hung up the phone and came to his feet.
“Are you going to call Connie?”
“If you can track her down for me, I’ll speak with her. I’ll tell her to meet us in the emergency room in Chicago.”
“Us?” Patsy asked with raised eyebrows.
“I’m going with her. The ER physician said I could accompany her. Once she’s tucked in, I’ll rent a car and drive back.” Cole started back down the hall. “Would you give Dr. Almont a call and tell him I’ll need him to cover the rest of my shift?”
“Sure, but this still doesn’t make any sense. Emergency rooms are being flooded with cases. They’re not seeing one isolated case here and there.”
“I think Maggie has GNS,” Cole insisted. “But I’m happy to let the folks in Chicago sort things out.”
Maggie was awake when Cole walked back into her exam room. In spite of her confusion, he expected she’d understand everything he was about to tell her. He pulled up a chair and took her hand in his. Taking his time to explain his concerns to her, Cole emphasized that his desire to send her to Illinois Regional was only out of an abundance of caution. Cole couldn’t be sure how much Maggie understood. In front of his eyes and in a matter of minutes, she was worsening. He could sense that she was struggling to keep her eyes open.
Lewis Cole was no different from any other physician. Making a difficult diagnosis always evoked a sense of pride and accomplishment. But tonight was an exception. Every optimistic cell in his body hoped he was dead wrong, and that he’d be getting a call from the doctors at Illinois Regional in the days to come that Maggie Recino was doing fine and that she didn’t have GNS. But his pragmatic side, the one that had been engrained in him through medical school and residency, was telling him something entirely different.