Silent Fear, a Medical Mystery (12 page)

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.”

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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.”

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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.”

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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.”

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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.”