Artropods and Human Disease 21 page

“Only for a week, Mike dear. Just one week; that’s all.”

“No!”

“Listen to me, darling.” She urged, “Please come and sit down. And listen to me—please!”

He hesitated, then returned reluctantly to the chair at the side of the bed. Vivian let her head fall back on the pillows, her face turned sideways toward him. She smiled and reached out her hand. He took it gently, his anger dissolving. Only a vague, disquieting sense of doubt remained.

It was the fourth day since Vivian had returned from surgery, and in the meanwhile her progress had been good. The stump of her thigh was healing well; there was still some localized pain and inevitable soreness, but the big and overwhelming agony of the first two days of recovery had eased, and yesterday Dr. Grainger, with Vivian’s knowledge and agreement, had withdrawn the order for injections of demerol which had helped dim the pain over the worst period, now behind. Only one thing Vivian found distressing—a surprising thing that she had not anticipated. The foot of her amputated leg—a foot that was no longer there—itched frequently with a malicious, recurring torment; it was anguish not to be able to scratch it. At first when the feeling came she had groped with her remaining foot for the sole of the other. Then for a while, lightheadedly, she had begun to believe that there had been no amputation after all. It was only when Dr. Grainger had assured her that the sensation was entirely normal and something experienced by most people who had any limb removed that she realized her belief was illusory. Nevertheless, it was an uncanny feeling which Vivian hoped would disappear soon.

Psychologically, too, her progress appeared to be good. From the moment when, the day before surgery, Vivian had accepted the inevitable with the simple courage that had so impressed itself on Mike Seddons the mood had continued and upheld her. There were still moments of blackness and despair; they came to her when she was alone, and twice, waking at night, with the hospital around her quiet and eerie, she had lain crying silently for what had been lost. But mostly she banished the moods, using her innate strength to rise above them.

Lucy Grainger was aware of this and was grateful; it made easier her own task of supervising the healing process. Nonetheless, Lucy knew that for Vivian the real test of her emotions and spirit lay somewhere still ahead. That test would come after the initial shock had passed, when the real significance of events had had time to develop more gradually in Vivian’s mind and when the implications for the future were closer and more real. Perhaps the moment might not come for six months or even a year; but sooner or later it would, and Lucy knew that at that time Vivian would pass through the deep darkness of despair to some permanent attitude of mind beyond, whatever that might be. But that was for the future; for the present the short-term prognosis seemed reasonably bright.

Lucy knew, of course—and was aware that Vivian knew it too—that the possibility remained that the osteogenic sarcoma which Dr. Pearson had diagnosed might have metastasized ahead of the amputation, spreading its creeping malignancy elsewhere in Vivian’s body. In that case there would be little more that Three Counties Hospital, or medicine generally, could do for Vivian beyond temporary, palliative relief. But later would be time enough to learn if that were true. For the patient’s sake it seemed best and wisest at this moment to assume that for Vivian the future stretched indefinitely ahead and to help her adapt to it actively.

Today, also, Vivian’s beginning of recovery was reflected in her appearance. For the first time since her return from surgery she had put on make-up, bringing color to her face. Earlier her mother had come in to help arrange her hair, and now, wearing the same nightgown which on a previous occasion had come close to stirring Mike to indiscretion, much of her youthful loveliness was back on view.

Now, as Mike took her hand, she said, “Don’t you understand, darling, I want to be sure—sure for my own sake as much as for yours.”

“But sure of what?” On Mike Seddons’ cheeks there were two points of high color.

She said levelly, “Sure that you really love me.”

“Of course I love you.” He asked vehemently, “Haven’t I been telling you that for the past half-hour? Haven’t I said that I want us to marry—as we arranged to before”—he hesitated—“before this happened? Even your mother and father are in favor of it. They’ve accepted me; why can’t you?”

“Oh, but I do accept you, Mike. Gratefully and gladly. Whatever happens between us, I don’t believe there could ever be anything quite the same again; at any rate”—for an instant her voice faltered—“not for me.”

“Then why . . . ?”

She pleaded, “Please, Mike. Hear me out. You said you would.”

Impatiently he said, “Go on.”

“Whatever you may say, Mike, I’m not the same girl you met that first time we saw each other. I can’t be, ever again.” She went on softly, intensely, “That’s why I have to be sure—sure that you love me for what I am and not for what I was. Don’t you see, darling, if we’re going to spend the rest of our lives together, I couldn’t bear to think—not later on, not ever—that you married me . . . out of pity. No, don’t stop me; just listen. I know you think it isn’t true, and perhaps it isn’t; and I hope it isn’t—with all my heart. But, Mike, you’re kind and generous, and you might even be doing this—for that reason—without admitting it to yourself.”

He snapped back, “Are you suggesting I don’t know my own motives?”

Vivian answered softly, “Do any of us really know?”

“I know mine.” He took her hands gently, their faces close. “I know that I love you—whole or in part, yesterday, today, or tomorrow. And I know that I want to marry you—without doubts, without pity, without waiting one day longer than we have to.”

“Then do this one thing for me—because you love me. Go away from me now, and even though you’re in the hospital, don’t come back to see me for one week—seven whole days.” Vivian looked at him levelly. She went on quietly, “In that time think of everything—of me, what our life would be like together; how it would be for you—living with a cripple; the things we couldn’t share and those we could; our children—how it would affect them, and through them, you; everything, Mike—everything there is. Then when you’ve done that, come back and tell me, and if you’re still sure, I promise that I’ll never question you again. It’s just seven days, darling—seven days out of both our lives. It isn’t very much.”

“Goddam,” he said, “you’re obstinate.”

“I know.” She smiled. “You’ll do it then?”

“I’ll do it for four days—no more.”

Vivian shook her head. “Six—no less.”

“Make it five,” he said, “and you’ve got a deal.”

She hesitated and Mike said, “It’s positively my best offer.”

Vivian laughed; it was the first time she had. “All right. Five days from this moment.”

“Like hell from this moment!” Mike said. “Maybe ten minutes from now. First I’ve got a little storing up to do. For a young fellow with my hot blood five days is a long time.”

He moved the bedside chair closer, then reached out. It was a long kiss, alternately passionate and tender.

At the end Vivian made a grimace and broke away. She sighed and eased herself to a new position in the bed.

Mike inquired anxiously, “Is something wrong?”

Vivian shook her head. “Not really.” Then she asked him, “Mike, where have they got my leg—the gone one, I mean?”

He seemed startled, then told her, “In Pathology—in a refrigerator, I expect.”

Vivian drew in a long breath, then expelled it slowly. “Mike darling,” she said, “please go downstairs and scratch the foot.”

The hospital’s board room was crowded. News of the emergency meeting had gone swiftly around the hospital, and physicians not attending Three Counties that day had been notified in their downtown offices and at home. Rumors of Joe Pearson’s downfall and his impending departure had also traveled with equal speed and had been the subject of a buzz of discussion which had quieted as Pearson entered, the administrator and David Coleman with him.

Kent O’Donnell was already at the head of the long walnut table. Glancing around, he could see most of the familiar faces. Gil Bartlett, his beard wagging rapidly, was chatting with Roger Hilton, the young surgeon who had joined Three Counties’ staff a month or two ago. John McEwan, the e.n.t. specialist, was in what appeared to be a heated discussion with Ding Dong Bell and fat Lewis Toynbee, the internist. Bill Rufus, a tie of brilliant green and yellow marking him out from the crowd, was about to seat himself in the second row of chairs. Immediately in front, looking over a page of handwritten notes, was Dr. Harvey Chandler, chief of medicine. There were several members of the house staff, and among them O’Donnell noticed McNeil, the pathology resident. Alongside the administrator, attending the meeting by special request, was Mrs. Straughan, the chief dietitian. Nearby was Ernie Reubens, who appeared to be quizzically appraising the dietitian’s quivering, voluptuous breasts. Absent from the meeting was the familiar figure of Charlie Dornberger, who had already made known his intention to retire immediately.

Looking toward the door, O’Donnell saw Lucy Grainger come in; she caught his eye and smiled slightly. Seeing Lucy was a reminder of the personal decision about his own future which, when all this was settled and done, he had still to face. Then suddenly he realized that since this morning he had not once thought of Denise. The hospital activity had driven all awareness of her from his mind, and he knew that for the next day or two, anyway, there would be other occasions when the same thing would be true. O’Donnell wondered how Denise herself would react about taking second place to medical affairs. Would she be understanding? As understanding, say, as Lucy would be? Fleeting as the thought was, it made him uncomfortable, as if by the mental comparison he had been disloyal. For the moment he preferred to think of present things. Now, he decided, it was time the meeting began.

O’Donnell rapped for silence, then waited until the talk stilled and those who had been standing had slipped into their seats. He began quietly. “Ladies and gentlemen, I think all of us are aware that epidemics in hospitals are not unique and, in fact, are a good deal more frequent than most members of the public realize. In a way, I suppose, one might say that epidemics are a hazard of our existence. When one considers how many diseases we harbor inside these walls, it’s surprising, really, there are not more.” All eyes in the room were upon him. He paused for a moment, then continued. “I have no wish to minimize what has happened, but I want us to keep a sense of proportion. Dr. Chandler, perhaps you’d be kind enough to lead off.”

As O’Donnell sat down the chief of medicine rose to his feet.

“To begin with, let’s summarize.” Harvey Chandler was holding his page of notes, and his glance moved theatrically around the room. Harvey’s enjoying this, O’Donnell thought; but then he always does enjoy attention. The medical chieftain went on, “The picture so far is that we have two definite cases of typhoid and four suspected. All of the cases are hospital employees, and we may count ourselves fortunate that no patients are affected—yet. Because of the number of cases I’m sure it’s evident to you, as it is to me, that we have a typhoid carrier somewhere in the hospital. Now, I may say I’m as shocked as everyone else must have been to learn that examination of food handlers here hasn’t been done for . . .”

At the mention of food handlers O’Donnell had jolted to attention. Now he cut in, quietly, as politely as he could.

“Excuse me, Doctor.”

“Yes?” Chandler’s tone made it plain the interruption was not appreciated.

Gently O’Donnell said, “We’re going to be dealing with that phase very shortly, Harvey. I wonder if, for the moment, you would outline the clinical aspects.”

He could sense the other man’s resentment. Harvey Chandler, who was virtually equal to O’Donnell in the hospital hierarchy, did not like this at all. Moreover, Dr. Chandler enjoyed talking at length; he had a reputation for never employing one word where it was possible to use two or three. Now he grumbled, “Well, if you wish, but . . .”

Suavely, but firmly, O’Donnell put in, “Thank you.”

Chandler shot him a glance which said: We’ll discuss this later in private. Then, after a barely perceptible pause, he went on, “For the benefit of those of you who are not familiar with typhoid—and I realize there will be some, because there isn’t too much of it around nowadays—I’ll run over the principal early-stage symptoms. Generally speaking, there’s a rising fever, chills, and a slow pulse. There’s also a low blood count and, naturally, the characteristic rose spots. In addition to all that a patient will probably complain of a dull headache, no appetite, and general aching. Some patients may say they’re drowsy in the daytime and that they’re restless at night. One thing to look out for also is bronchitis; that’s quite common with typhoid, and you may encounter nosebleed too. And, of course, a tender, swollen spleen.”

The chief of medicine sat down. O’Donnell asked, “Any questions?”

Lucy Grainger asked, “I take it that typhoid shots are being arranged.”

“Yes,” Chandler said, “for all employees and staff, also patients who are well enough to have them.”

“What about kitchen arrangements?” The question was from Bill Rufus.

O’Donnell said, “If you don’t mind, we’ll come to that shortly. At this point is there anything more medically?” He looked around; there was a shaking of heads, “Very well, then. We’ll hear from Pathology.” He announced quietly, “Dr. Pearson.”

Until this moment there had been background noises in the room—fidgeting, the movement of chairs, murmurs of conversation aside from the main discussion. But now there was a hush as eyes turned curiously to where, halfway down the long table, Joe Pearson sat. Since entering he had not spoken but had remained quite still, his eyes fixed directly ahead. For once he had no cigar lighted, and the effect was like the absence of a familiar trade-mark. Even now, as his name was called, he made no move.

O’Donnell waited. He was about to repeat the announcement when Pearson stirred. As his chair went back the old pathologist rose to his feet.

Slowly his eyes swept the board room. They went the length of the table, then returned to its head. Looking directly at O’Donnell, Pearson said, “This epidemic should not have happened. Nor would it, if Pathology had been alert to a breakdown in hygiene precautions. It is the responsibility of my department, and therefore my own responsibility, that this neglect occurred.”

Again a silence. It was as if history had been made. In this room so many times Joe Pearson had charged others with error and misjudgment. Now he stood himself—accuser and accused.

O’Donnell wondered if he should interrupt. He decided not. Again Pearson looked around him. Then he said slowly, “Having allocated some of the blame, we must now prevent the outbreak going further.” He glanced across the table at Harry Tomaselli. “The administrator, the heads of departments, and I have formulated certain procedures to be carried out at once. I will tell you what they are.”

Now Pearson paused, and when he resumed there was a stronger note to his voice. It was almost, O’Donnell thought, as if in this single moment the old man were throwing off some of his years, as if providing a glimpse of what he had been like long ago as a younger practitioner—intense, earnest, and competent. The old sardonic humor, the air of borderline contempt, which all of them in this room had come to know so well, were gone. In their place were authority and know-how and the forthright frankness of one who accepts without question the fact that he is speaking with equals.

“The immediate problem,” Pearson said, “is to locate the source of infection. Because of the failure to check food handlers properly over the past six months it is logical that we should suspect food as a means of contamination and should begin our search there. For this reason there must be a medical inspection of all food handlers before the next hospital meal is served.” From his frayed woolen vest he extracted a watch and placed it on the table. “The time is now 2:15 p.m. That gives us two and three-quarter hours. In that time every employee who has any part in the preparation and serving of hospital food is to be given a thorough physical check. Facilities are being set up now in the outpatient clinics. I understand that all the internists and house staff were notified before this meeting.” He glanced around and there was a nodding of heads. “Very well. As soon as we are finished here Dr. Coleman”—Pearson glanced down at David Coleman beside him—“will give you your assignment to a specific room.”

Gesturing toward the chief dietitian, Pearson said, “Mrs. Straughan is arranging to assemble all the people concerned, and they will be reporting to Outpatients in batches of twelve. That means ninety-five people to be examined within the time we have.

“When you make these examinations, by the way, remember that the typhoid carrier—and we are assuming there is a carrier—probably has none of the symptoms Dr. Chandler described. What you should look for particularly is any lack of personal cleanliness. And anyone you have doubts about should be suspended from duty for the time being.”

Pearson stopped as if thinking. So far he had consulted no notes. Now he went on again. “Of course, we are all aware that physical checkups will not give us the whole story. We may be lucky and find the individual we’re looking for that way, but the chances are we won’t. Most likely the major work will come in the labs as soon as the medicals are completed. All the people you examine are to be told that stool cultures are required and stool samples must be in the hospital by tomorrow morning.” There was the ghost of a smile. “Constipation will not be taken as an excuse; and if anyone can come through with a sample today we will, of course, accept it gratefully.

“The labs are being set up now to cope with all the cultures we shall be doing. Of course, it will take us a few days—two or three at least—to handle all those stool samples.”

A voice—O’Donnell thought it was Gil Bartlett’s—said quietly, “Ninety-five people! That’s a lot of shit.” A ripple of laughter ran around the table.

Pearson turned. “Yes,” he said, “it is a lot. But we shall do our best.”

With that he sat down.

Lucy signaled with her hand, and O’Donnell nodded for her to speak. She asked, “If the source of infection is not found immediately, will we continue to use the hospital kitchens—to serve food here?”

“For the moment—yes,” O’Donnell answered.

The administrator added, “My office is checking now to see if there’s any outside caterer who could handle food supply if that were felt necessary. I doubt, though, if there’s anyone in town who has facilities—at short notice like this—to do it.”

Bill Rufus asked, “What’s our policy to be on admissions?”

“I’m sorry,” O’Donnell said. “I should have mentioned that. As of this moment we’ve stopped admissions. The admitting department has already been notified. But, of course, we’re hoping pathology can track down the source of infection quickly, and then we’ll review our admissions policy again. Anything else?”

There were no more questions. Looking down the table, O’Donnell asked, “Dr. Coleman, do you have anything to add?”

David Coleman shook his head. “No.”

O’Donnell closed the file which had been open in front of him. “Very well, ladies and gentlemen, I suggest we get started.” Then, as chairs scraped back and conversation began, he asked Pearson, “Joe, could I have a word with you?”

Together they crossed to a window, away from the others who were filing out through the door. O’Donnell said quietly, making sure his voice did not carry, “Joe, naturally you’ll remain in charge of Pathology during this outbreak. But I think I must make clear to you that, concerning other things, nothing has changed.”

Pearson nodded slowly. “Yes,” he said, “I’d already figured that.”

Twenty-two

Like a general appraising his forces ahead of battle, Dr. Joseph Pearson surveyed the pathology lab.

With him were David Coleman, the pathology resident Dr. McNeil, Carl Bannister, and John Alexander. Pearson, Coleman, and McNeil had come directly from the emergency staff meeting in the board room. The other two, acting on earlier instructions, had cleared the lab of all but immediate, essential work.

When Pearson had completed his inspection he addressed the other four. “Our problem,” he announced, “is one of detection. Out of a field of approximately ninety-five people—the food handlers—it is our business to track down a single individual whom we believe to be spreading typhoid germs within this hospital. It is also a problem of speed; the longer we take, the worse the epidemic will be. Our means of detection will be the stool specimens which will start coming in today, with the bulk of them arriving tomorrow.”

He addressed Roger McNeil. “Dr. McNeil, your job for the next few days will be to keep the lab clear of non-essential work. Check all routine requisitions coming in and decide how many of them should have priority and which can be postponed, at least for a day or two. The lab items which in your opinion are urgent can be handled by Carl Bannister. Work with him as much as you can, but don’t load him with any more than is essential; the rest of the time we’ll use him on our major project.” Pearson continued as McNeil nodded. “You yourself will have to take care of all surgical reports. Process those which appear urgent and accumulate anything that can wait. If there’s any diagnosis about which you’re not absolutely sure, call Dr. Coleman or myself.”

“Right. I’ll check with the office now.” McNeil went out.

To the others Pearson said, “We shall use a separate plate for each single stool culture. I don’t want to take the risk of putting several cultures together, then having one overgrow the others; it would mean we’d lose time and have to start again.” He asked Alexander, “Do we have sufficient MacConkey’s medium ready to handle close to a hundred cultures?”

John Alexander was pale and his eyes red-rimmed. He had returned from Elizabeth only a half-hour before. Nevertheless he responded promptly, “No,” he said, “I doubt if we’ve more than a couple of dozen. Normally that’s several days’ supply.”

When he had spoken, realizing that his reaction to a question about the lab had sprung from habit, John Alexander wondered what his own feelings were toward Dr. Pearson. He found he could not define them. He supposed he should hate this old man whose negligence had caused his own son’s death, and perhaps later on he would. But for now there was only a dull, deep aching and a sense of melancholy. Maybe it was as well for the time being that a great deal of work appeared to be facing them all. At least he could try to lose himself in some of it.

“I understand,” Pearson said. “Well, then, will you work in the media kitchen and stay with it until all the plates are ready for use? We must have them all by the end of today.”

“I’ll get started.” Alexander followed McNeil out.

Now Pearson was thinking aloud. “We shall have ninety-five cultures, say a hundred. Assume that 50 per cent will be lactose positive, leaving the other 50 per cent to be investigated further; it shouldn’t be more than that.” He glanced at Coleman for confirmation.

“I’d agree.” Coleman nodded.

“All right then; we shall need ten sugar tubes to a culture. Fifty cultures—that means five hundred subcultures.” Turning to Bannister, Pearson asked, “How many sugar tubes are ready—clean and sterilized?”

Bannister considered. “Probably two hundred.”

“Are you sure?” Pearson looked at him searchingly.

Bannister colored. Then he said, “A hundred and fifty anyway.”

“Then order three hundred and fifty more. Call the supply house and say we want them delivered today, and no excuses. Tell them we’ll take care of the paper work later.” Pearson went on. “When you’ve done that, begin preparing the tubes in sets of ten. Use those on hand first, then the others when they come. Check your sugar supplies too. Remember you’ll need glucose, lactose, dulcitol, sucrose, mannitol, maltose, xylose, arabinose, rhamnose, and one tube for indole production.”

Pearson had rattled off the names without hesitation. With the ghost of a smile he said to Bannister, “You’ll find the list and table of reactions for Salmonella typhi on page sixty-six of laboratory standing orders. All right, get moving.”

Hastily Bannister scurried to the telephone.

Turning to David Coleman, Pearson asked, “Can you think of anything I’ve forgotten?”

Coleman shook his head. The old man’s grasp of the situation, as well as his celerity and thoroughness, had left Coleman both surprised and impressed. “No,” he said, “I can’t think of a thing.”

For a moment Pearson regarded the younger man. Then he said, “In that case, let’s go and have coffee. It may be the last chance we’ll have for quite a few days.”

Now that Mike Seddons had gone, it came to Vivian just how big a gap his absence left behind and how long-drawn-out the next few days were going to seem without him. She believed, though, she had been right in asking Mike to remain away for a time. It would give them both a chance to adjust and to think clearly about the future. Not that Vivian needed any time to think herself; she was quite sure of her own feelings, but it was faker to Mike this way. Or was it? For the first time it occurred to her that by acting as she had perhaps she was asking Mike to prove his love for her, while accepting her own without question.

But that was not what she had intended. Vivian wondered uneasily, though, if Mike had taken it that way—if she had appeared to him untrusting and unwilling to accept his devotion at face value. He hadn’t seemed to, it was true; but perhaps after thinking things over, as she herself was doing at this moment, he might decide that was the way it was. She speculated on whether she should call him or send a note explaining what she had really intended—that is, if she were sure herself. Was she sure though—even now? At times it was so difficult to think clearly; you started out doing what you thought was right, then you wondered if someone else might misinterpret, might look for hidden meanings that you had never considered yourself. How could you be really sure what was the best thing to do about anything . . . anywhere . . . ever . . . ?

There was a light tap on the door and Mrs. Loburton came in. Seeing her, suddenly Vivian forgot that she was all of nineteen, adult, able to decide things for herself. She held out her arms. “Oh, Mother,” she said, “I’m so terribly mixed up.”

The physical checkups on food handlers were proceeding briskly. In a small consulting room—the first of a row of similar rooms in the outpatients’ department—Dr. Harvey Chandler was concluding his examination of one of the male cooks. “All right,” he said, “you may get dressed.”

At first the chief of medicine had not been sure whether it would be dignified for him to handle some of the physicals himself or not. But eventually he had decided to, his attitude being somewhat that of a commanding officer who feels morally bound to position himself at the head of his troops during a beach-head assault.

Actually Dr. Chandler had been inclined to resent the dominance of the situation up to this point by Drs. O’Donnell and Pearson. O’Donnell was, of course, the medical-board president and entitled to be concerned with the over-all welfare of the hospital. All the same, Chandler reasoned, he was merely a surgeon and typhoid was essentially a matter for internal medicine.

In a sense the chief of medicine felt deprived of a starring role in the present crisis. In some of his more ultimate thoughts Dr. Chandler sometimes pictured himself as a man of destiny, but opportunities to prove the point were all too rare. Now, with an opportunity at hand, he was being relegated, if not to a minor role, at least to a secondary one. He had to admit, however, that the arrangements made by O’Donnell and Pearson appeared to be working well, and at least they all had the common aim of ending this deplorable outbreak of typhoid. Frowning slightly, he told the cook who had now dressed, “Remember to be especially careful about hygiene. And practice absolute cleanliness when you’re working in the kitchen.”

“Yes, Doctor.”

As the man went out Kent O’Donnell came in. “Hi,” he said. “How’s it going?”

Chandler’s first inclination was to reply huffily. Then, he decided, perhaps there was not really that much to be concerned about. And apart from the minor fault of O’Donnell’s being—in Chandler’s opinion—a little too democratic at times, he was a good man to have at the head of the board and certainly a big improvement over his predecessor. Therefore, amiably enough, he answered, “I lost count some time ago. I suppose we’re getting through them. But there’s nothing to show so far.”

Date: 2014-12-21; view: 653