“Does everyone need to come to the clinic?” Pia asked. “Even people who haven’t been in the biosafety unit today?”
“Absolutely. And Mr. Winston will also be gathering names of everyone who’s been here delivering supplies or takeout or whatever. We want to see everyone who has set foot inside this lab. That’s it. Thank you for your cooperation.”
The din of conversation erupted again.
“Oh my God!” Lesley said. “Did you see how they looked? It must have come on fast.”
“Dr. Yamamoto told me he didn’t feel so hot this morning,” Will said. “But yeah, I saw how they looked. I guess we better go do what the man said.”
Pia looked around. The maintenance man was hanging back, and though Pia didn’t want to talk to him, she knew he needed to follow the protocol.
“There’s a medical issue,” she said to the man. His temporary name tag read “O’Meary.” “You have to come to the clinic with everyone else.”
O’Meary looked nervous and didn’t say anything. Winston called out to Pia.
“Time to go,” he said. “We’re locking down.” There was clearly no room for argument. Pia waited for O’Meary to leave and exited in front of Winston. As the last person out, Winston pulled the door shut and talked to two figures in full hazmat suits standing outside.
“No one gets in,” Winston said. “Put up the caution tape.” The men in the hazmat suits nodded and set to work.
As they made their way to the elevator, Pia could see that the whole floor was being cleared, with other personnel being led down the stairs. There were more people in hazmat suits that looked like robots. On the elevator ride down, Pia could feel her heart beating too fast, and she had to concentrate on breathing deeply. She felt some dizziness from her shallow breathing. As she walked along the sidewalk she was gripped by what felt like panic—everything around her felt very close and incredibly far away at the same time. She had stopped walking and was holding on to someone. Voices were loud in her ear.
“Come with me,” a woman is saying. It’s a hot sunny day but Pia’s freezing cold. The woman has a nice smile and she’s holding Pia’s hand. This is a new place, Pia knows that. She hasn’t been here long. This is the first smile she’s seen, though it’s odd now—grown-ups don’t keep smiles on their faces the whole time. Pia and the woman have come inside and they’re walking up to a large door. It feels like they’re walking uphill. “This is the headmaster’s office,” the woman says. She opens the door and pushes her in. Pia can hear the lock being turned. “Hello, Pia,” says the man. He’s smiling too but it’s a twisted smile, not a smile of welcome....
Pia looked up. She was sitting on the ground on 168th Street with traffic passing by. Winston was supporting her with his hand, looking down at her.
“You okay?”
“Yes, I think so.”
“You fainted. Or almost fainted. You’re not perspiring, so I don’t think you have a fever. I think you’re okay. Ready to get up?”
Pia waited a second and allowed Winston to pull her to her feet. Then she remembered where she was and what had just happened. With disturbing clarity she saw Rothman lying on the gurney, his face looking like death, and the image terrified her. Over the course of three and a half years she’d come to rely more and more on the man’s strange friendship, particularly after their heartfelt conversation a few weeks ago. Up until then, their relationship had been akin to two people comfortably wandering around in a darkened room, occasionally sensing each other’s presence but not much else. But after the conversation and the personal revelations, she felt they’d moved to another level. Rothman had become the ersatz father she’d always pined for. Most important, she’d allowed herself to begin to trust Rothman despite having learned not to trust anyone, not to allow anyone into a position where they could betray her, like so many had done.
Now, as she stumbled along the street, Pia was overwhelmed by the thought that just when she’d allowed Rothman into her world, he was going to abandon her. Why was he doing this? And why now? It was irrational to think so, but did he do this to spite her? Did he purposely set her up? After all, he’d admitted to being depressed. She was almost paralyzed with anxiety.
At the Infectious Disease Clinic, Pia was shaking when she was handed the Z-Pak prophylactic antibiotic. She sat down in the waiting area and her head started to clear. She was aware that several people had tried to talk to her, but she didn’t hear them.
“Miss Grazdani!” a nurse called out sharply, standing directly in front of Pia. She was on the brink of calling the ER if the young woman continued in her fugue-like state, thinking Pia might have to be admitted.
Not quite awakening, Pia sat up straighter and focused on the nurse’s face.
“I’m here,” Pia voiced. “I’m sorry. What did you say?”
“I said that you can’t go back to the lab. It’s going to be closed until the CDC epidemiologists get here from Atlanta and declare it clean. What you should do, as we have advised the others, is go home, start your antibiotics, and watch your temperature. Is there someone we can call who can meet you there? Miss Grazdani? Are you okay, Miss Grazdani?”
“I’m just fine,” Pia assured her.
26.
COLUMBIA UNIVERSITY MEDICAL CENTER
NEW YORK CITY
MARCH 23, 2011, 2:37 P.M.
It wasn’t a warm day, but Pia had wanted to sit outside. She had found a bench set in a small rectangle of public cement, what in New York City is called a park, and sat down, hands in her coat pockets, her chin down, hood pulled over her eyes. Her mind played over the scene she had just witnessed several times. There was a surreal quality to it, like it was one of her nightmares. Unfortunately it was real.
After she had gotten herself reasonably calmed down, Pia got up from the bench and started to walk toward the dorm. She got halfway, changed her mind, and turned and headed back to the hospital. There she took the first two of her antibiotic tablets at a water fountain before heading to the internal medicine floor.
At the main nurses’ station, she asked for Dr. Rothman and was directed to the infectious disease wing a floor above, where Rothman and Yamamoto had been admitted. She wanted to check on Rothman’s status, hoping that he’d revived with treatment, and if so, she wanted to ask him if he knew how he and Yamamoto had become contaminated. Pia knew the epidemiologists would certainly be asking the same questions, but she had a personal reason for finding out—the crazy thought that he’d done it on purpose, an idea she knew to be irrational but which demanded, in her mind, to be investigated.
Pia had another concern. Experience had taught her to absolutely distrust authority in any institution and to assume that nothing would happen the way it should. She knew Rothman was disliked by almost one hundred percent of his colleagues in the medical center. He was rude, seemingly arrogant, and antisocial. While medical protocol and simple human decency demanded that each patient receive the undivided attention of medical staff and the best care available, she couldn’t help but think Rothman’s reputation might degrade the standards.
Pia used her medical student credentials to get on the floor and found that the two researchers were in adjoining, negative-pressure rooms where air flowed in but not out. They were in strict isolation but there was no one guarding the rooms. Pia started to put on the isolation gear in the anteroom—the gown, hat, mask, gloves, and booties—but just as she was about to put on her mask, Dr. Springer emerged from Rothman’s room. He undid his mask and stared at Pia.
“What on earth are you doing here? You’re Rothman’s student, aren’t you? You’re supposed to be home.”
“I took my antibiotics and my temperature’s fine. I know I’m clean—I wasn’t in the biosafety unit today, or even in contact with Dr. Rothman or Dr. Yamamoto. It’s very important I speak with Dr. Rothman.”
“Good God! Of course you can’t speak with him. The only people allowed in are medical staff assigned to his case. No family, no f
riends, and certainly no medical students.”
“There’s no one in there looking at him now. Are you sure of the diagnosis? Is this the best place to treat his condition?”
“What do you mean, ‘is this the best place?’” Springer shook his head in disbelief.
“I know what people around here think of Dr. Rothman—”
“Young lady, I don’t know what you’re implying but everyone at Columbia Medical Center gets the same superb care as everyone else, friend or foe, rich or poor. It makes no difference whatsoever. And I happen to like Dr. Rothman.”
“Okay, okay. Sorry, I’m just upset.” Pia didn’t want to get thrown off the floor. “I’ve been working with both men for more than three years on the salmonella strains that are probably involved, and I thought I might be able to help.”
“Okay,” said Springer. He relaxed a degree. He sensed Pia’s intentions were good even if totally unrealistic.
“I have to tell you that both men are delirious. Even if I let you in there, you wouldn’t get anything out of Dr. Rothman. Follow me.” Springer took off the protective gear and tossed it into the covered hamper. Pia did the same.
Springer took Pia back to the nurses’ station and, sitting down, itemized the laundry list of tests that had been ordered, including a complete blood count, electrolytes, blood cultures, urine cultures, stool cultures, stat DNA microbiology tests, and the appropriate X-rays. At that point the tests that had come back confirmed that the infectious agent was one of the salmonella strains Rothman and Yamamoto were working on, which Rothman had named the alpha strain, the most virulent of the three grown in space. He also mentioned that the white cell count showed a mild leukopenia, meaning the white cell count was mildly depressed, something often seen with typhoid fever. He declared the electrolytes, meaning primarily sodium, chloride, calcium, and potassium, were normal. Springer concluded by telling Pia that Rothman’s and Yamamoto’s temperature, heart rate, blood pressure, degree of oxygenation of blood, urine output, and central venous pressure were being monitored, and that at the moment the only thing abnormal was the temperature.
“They’re both in bad shape, especially considering how quickly the illness came on,” Springer added.
“What antibiotic are they on?” As Pia knew from her studies with Rothman, there was debate about which was the best to use in serious salmonella cases.
“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.
27.
COLUMBIA UNIVERSITY MEDICAL CENTER
NEW YORK CITY
MARCH 23, 2011, 7:38 P.M.
News 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.