Death Benefit (24 page)

“That’s a good question,” Dr. Springer said. “Actually Dr. Rothman briefed me recently on findings he had made in his studies of antibiotic sensitivity on these zero-gravity strains. All three strains he was working on are very sensitive to chloramphenicol. That’s an antibiotic that at one time was considered the best choice for typhoid, but it went out of favor in the seventies because newer strains of salmonella were becoming resistant. Dr. Rothman said that because these strains were grown in space, they were more virulent but somehow they’d also lost their chloramphenicol resistance. He was interested because drug resistance is a big problem with salmonella.”

“Have you thought of trying ceftriaxone?” Pia asked, referring to a newer antibiotic.

Springer hesitated, giving Pia a once-over look. He’d been trying to be nice to her, as she was obviously concerned about her mentor. When he resumed speaking his voice and syntax had changed. There was an edge. “I actually wasn’t requesting a consult by speaking with you. It’s purely as a courtesy that I’m filling you in on Dr. Rothman’s condition and course of treatment. But to answer your question, if it was a question, there is some sensitivity to ceftriaxone but significantly less than there is to chloramphenicol.”

“Chloramphenicol can cause aplastic anemia,” Pia said, missing Springer’s signal that she was pushing it.

“Yes, we’ve taken into account the side effects, of course. Excuse me.” Springer suddenly got to his feet. Abruptly he left Pia, talked briefly with one of the residents helping with Rothman’s and Yamamoto’s care, then left the floor.

Pia waited for a few minutes before wandering over to the same resident, who was reading a chart.

“What do you think of Dr. Springer? Do you think he’s qualified?”

“What do I think? He’s the best in the country. I wouldn’t be here otherwise.”

Puzzled by the question, the resident walked away, leaving Pia standing by the nurses’ station, alone.

 

 

N
ews of the Rothman/Yamamoto event spread rapidly through the Columbia medical community. George Wilson, like everyone else, had heard about it, and he could only imagine the effect it was having on Pia. Concerned, he had looked for her. It took some searching but George finally managed to track her down. She didn’t answer her cell phone and neither Will nor Lesley had seen her, so he had had to physically find her. George struck gold in the library stacks, a place he knew she found comforting. After some cajoling, Pia agreed to go with him back to the dorm cafeteria.

Pia was as distraught as she could ever remember being. She was especially upset because her emotions were so conflicted. Usually in her tumultuous life, distress had a definitive cause, but now she didn’t know whether to be upset about Rothman’s dire condition or angry at his carelessness in getting infected with the bacteria he’d been working on. And there was an undercurrent: Pia was terrified about her own future, which she thought she’d been so careful about but now seemed to be in the balance. She was also furious with herself for allowing Rothman to penetrate her well-constructed protective shell. And now she had the added distraction of George, who was trying to be solicitous but making things worse with all his questions.

“I can’t sit here anymore,” Pia said suddenly, interrupting George, but she didn’t care.

“You haven’t eaten anything,” George said, looking down at her tray. “You’ve got to eat.”

“I can’t eat,” Pia complained. “Feeling I’m in control is important to me. I don’t feel in control. My life is coming apart. I’ve got to see Rothman. I have to.”

Security was essential to Pia, as was control. At the moment she felt neither.

“Is he allowed to have visitors?”

“I don’t even know if he’s conscious. But I’m not a visitor, I’m concerned about the course of treatment he’s on.”

“I’ll come with you,” George said.

Pia didn’t know whether she wanted him to come or not.

“Don’t you have things to do?”

“Nothing important. I want to help you.”

“Whatever!”

Pia jumped up from the table, leaving her tray of food untouched. George stuck her turkey sandwich, still in its wrapper, in his jacket pocket and hustled after Pia. As she marched to the hospital, George trailed along in her wake. He tried to talk to her but gave up when she wouldn’t answer. She was on a mission.

The floor housing Rothman and Yamamoto was bustling with staff and orderlies. There were few patients in evidence. Most were too sick to be up and about. Pia found the resident on duty, Dr. Sathi De Silva. As the sole infectious disease resident, she had her hands full, not just with her two celebrity patients but a ward full of others, and several more people in the emergency room awaiting her attention. Pia and George were in their medical school white coats so Dr. De Silva accepted them as students most likely on their internal medicine rotation. Dr. De Silva took her teaching responsibilities very seriously, so when Pia started asking questions about Dr. Rothman, she stopped what she was doing. “To answer your question, both Dr. Rothman and Dr. Yamamoto are dangerously ill. They’re both delirious and uncommunicative.”

“I understand they’re on chloramphenicol. What’s your feeling about such a choice?”

Dr. De Silva shrugged. “I think it’s a good choice. Yes. It’s a unique situation because there are newer antibiotics, but in this case we have sensitivity studies that show the involved strains of salmonella to be uniquely sensitive. Dr. Springer believes it’s our best hope. We’re monitoring for side effects, but we haven’t seen anything. If there are any problems, we can always switch to one of the newer, third-generation cephalosporins.”

“Strange case,” Pia commented.

“One of the strangest,” Dr. De Silva agreed. “And not a little ironic.”

“Do we know how they got infected?”

“If we do, I haven’t heard anything. I know the CDC epidemiologists went through the lab and particularly the level-three containment area where the salmonella strain was kept. I think their initial concerns were about a malfunction of the hood, but apparently it was working fine. There was some bacteria in the hood itself, but you’d expect that. They took cultures, I know, and we’ll get results in twenty-four hours. I’m hearing all this secondhand. My job is to look after them.”

“Of course,” said Pia. “Has the CDC finished with the lab?”

“Dr. Springer said an hour ago that most of them were already headed back to Atlanta.”

Dr. De Silva’s cell phone beeped, and she glanced at a text message. “Oops, gotta go! Nice talking with you.”

“Can we see Dr. Rothman?”

“I don’t see any harm, but you’re not going to be seeing much,” Dr. De Silva said, already walking away. “As I said, he’s delirious. If you do go in, just make sure you put on all the gear and don’t bring anything out!”

Eagerly Pia set off toward Rothman’s room. George stumbled after her.

“What are you doing?” George complained. “You can’t go in there. He’s sick, he can’t tell you anything. Why take a chance?”

Pia didn’t answer. She suited up as per the Universal Precautions established by the CDC, which were posted on the outer door. George continued to try to talk Pia out of the visit, but she ignored him. He found a set of protective gear for himself and followed Pia into the room. As they passed through the door they could feel air entering with them.

Pia walked directly over to the bed. Several IVs were running, each laced with antibiotic.

“Dr. Rothman? . . . Dr. Rothman?”

Rothman stirred and half opened his eyes.

“Dr. Rothman, can you hear me?”

“What are you
doing
?” George’s nerve was failing him on many counts. Neither of them was on an internal medicine rotation, so they had no business or excuse to be there, and why was Pia trying to talk to Dr. Rothman? The man was delirious. Apart from the trouble they could get into, George was nervous about the salmonella that was making Dr. Rothman sick. The man looked gravely ill, with an ashen coloring and loose strands of hair matted to his pale forehead.

“He doesn’t look good at all,” Pia commented.

“Tell me about it,” George said nervously.

“My gosh, look! He’s losing some hair.” Pia pointed to tufts of hair on Rothman’s pillow, but George wasn’t interested. Rothman had become agitated now, twisting against his restraints while mouthing some words. Pia grabbed his chart and was flipping through the pages.

“His temperature’s up—not a lot, but up nonetheless.”

“Pia . . . let’s
go
!” George stage-whispered.

“You go, George, I’m not leaving. Not yet.” From working with Rothman, Pia had learned a great deal about typhoid fever and its cause, salmonella typhi. She knew the danger signs of the illness and the fact that the disease attacked the small bowel, concentrating in lymphoid tissue in the small intestine called Peyer’s patches. Rothman’s gown was pulled over to one side, and Pia exposed Rothman’s abdomen a little more. She slowly pushed in on his upper abdomen, and Rothman squirmed and moved his head from side to side.

“He’s definitely showing signs of discomfort, maybe pain in his abdomen,” Pia said. “This is not a good sign.”

George was beside himself. He could see a few people passing by in the outer hall through the wire-embedded windows in the two doors of the isolation room. He walked over and closed the blinds, hoping to buy Pia some time. When Pia suddenly let up on the pressure she was exerting, Rothman reacted slightly, to Pia’s surprise, as if that caused more discomfort.

“Did you see that? He recoiled. Would you say he recoiled?”

Pia repeated the maneuver and got the same result.

“He definitely recoiled.”

“Whatever it is you’re doing, it’s going to get both of us kicked out of school if we don’t leave right now. We’re pushing the limits on a couple of celebrity patients.”

“It’s rebound tenderness,” she said. “It’s a sign of peritonitis, inflammation of the lining of the abdominal cavity. It means the bacteria have penetrated the lining of the small intestine.”

Pia reached over and punched the intercom button. The nurse at the station picked up.

“Is Dr. De Silva available? If she is, get her in here stat. The patient has developed rebound tenderness.”

George was hopping from one foot to the other.
Now she’s really done it
, he thought.

At once, Dr. De Silva came in the room, palpated Dr. Rothman’s abdomen and confirmed Pia’s finding.

“And look, he’s losing some hair,” Pia said.

“That could be the chloramphenicol. But regardless, the rebound tenderness suggests the chloramphenicol is not controlling the infection. We’ll have to change the antibiotic. I’ll call Springer and get his suggestion. Thanks for your help.”

Dr. De Silva ducked out of the room.

“He’s getting worse,” Pia said, looking at Rothman forlornly.

“Rebound tenderness isn’t a good sign, I know that,” George said. “But you’ve done all you can do. Let’s go. You heard her, she’s calling Springer.”

By the time George and Pia took off their gear and got back to the nurses’ station, Dr. De Silva was on the phone with Springer. Pia stood where she could hear Dr. De Silva’s half of the conversation. It sounded like Springer was doing most of the talking.

“Okay, ceftriaxone . . .” she said. “. . . And the hair loss . . . Right, of course we’ll stop the chloramphenicol.... Okay. I’ll see you soon, and I’ll call Dr. Miller.”

Dr. De Silva turned and saw Pia. She hung up the phone and redialed immediately. She covered the receiver with her left hand and talked to Pia as the phone rang.

“Dr. Springer’s on his way in. He wants to check the rebound tenderness for himself—Oh, hello. I need Dr. Miller. . . . Dr. Miller, this is Dr. De Silva in Infectious Diseases. I’m treating Dr. Rothman and Dr. Yamamoto. Dr. Springer would like a consult. We’re seeing rebound tenderness in Dr. Rothman and may have to remove the infected bowel.... No, just Dr. Rothman at the moment . . . His temperature is up slightly. Other levels—blood pressure, pulse, oxygenation—are the same. Okay, thanks.”

Dr. De Silva hung up the phone and exhaled. She was a small woman of Sri Lankan descent who prided herself on running a tight ship. She was embarrassed that a medical student had picked up an important sign that she’d missed. “I just checked him a few minutes before you two showed up. Temperature was holding steady,” she said, half to Pia, half to herself. She turned to Pia.

“It can come on very quickly. Dr. Miller, the chief surgical resident, is coming in. And Dr. Springer’s on his way over. So, who’s your preceptor? I should at least give you credit for what you found. And how did you know what to look for? I’m impressed.”

“Actually I’m not on internal medicine at the moment.”

“Are you on an infectious disease elective? If you are, I haven’t heard your name.”

“I’m not on an infectious disease elective either.”

George was desperately trying to get Pia to shut up. Out of Dr. De Silva’s line of sight he was frantically making a time-out gesture like a football official.

“Well, what brought you here?” Dr. De Silva asked.

“I just happen to know a lot about salmonella.”

“Really? From whom?”

“Dr. Rothman,” Pia said, as George grabbed her arm and literally pulled her away, angling her toward the elevators.

 

 

G
eorge felt a sense of relief as they left the hospital. With as busy as Dr. De Silva was, he hoped she wouldn’t say too much about the two mysterious med students, one of whom had been very helpful. Actually he doubted she would. He knew that there hadn’t been any negligence on Dr. De Silva’s part, but he knew that in the competitive atmosphere of the academic center, she was probably chagrined that she’d been, in a fashion, upstaged by a medical student. Pia had detected the change in Dr. Rothman’s condition before she did. But George’s relief was short-lived.