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.
George 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.
“I want to go back to the lab,” Pia said, stopping suddenly. They had just reached the corner where 168th Street turns into Haven Avenue. “I want to see if there are any clues as to why or how he got infected. He’s so careful, I don’t understand it. He’s so detailed and compulsive about his work, his organization, his technique, it’s all flawless. It doesn’t make sense.”
Still lurking in the back of Pia’s mind was the thought that Rothman had infected himself intentionally. But why would he involve Dr. Yamamoto? It couldn’t be the case, or could it? What she wanted to do was completely eliminate the idea as even a remote possibility. If Rothman died, it was going to be a betrayal of sorts, but she didn’t want it to be his betrayal. Betrayal by fate she thought she could ultimately handle. Personal betrayal by Rothman would be something entirely different.
George groaned inwardly. Visiting Rothman had been bad enough. Visiting a lab that was off-limits by order of the CDC was something else entirely. “The lab is closed,” George said in a fashion that wouldn’t brook discussion. “Order of the CDC. Let’s head up to your room. I saved the sandwich you didn’t eat.” To prove his point, George pulled the food from his pocket.
“I’m going,” Pia said.
“What on earth do you think you’re going to turn up that the CDC hasn’t?”
“I don’t know, but I can’t do nothin
g. You can come with me or not, I’m going anyway. Of course two sets of eyes may be better than one.”
George realized Pia was asking for his help, however indirectly, which was a first. Still, it wasn’t an easy decision. He was okay with bending the rules, but not breaking them like this. He couldn’t afford to get kicked out of medical school. It had been his goal as long as he could remember, and he had his family to consider. But George had no time to ponder his decision. Pia had already turned around and was heading toward the research building.
“You’re not worried about getting typhoid fever?” he asked, catching up to her.
“I was in there this morning. And there’s protective gear we can put on just like we used in Rothman’s room.”
Pia entered the building. George followed. It was like making a decision without making a decision. They showed their IDs to the security man and headed for the elevators.
As George had expected, the door to the lab was crisscrossed with yellow caution tape. “See, just as I expected. We can’t go in.”
Pia didn’t respond. She merely peeled back the necessary tape and tried the door, which was locked. It didn’t deter her. Many times over the last three and a half years, Pia had been asked to take a reading in the lab at night, or monitor an automated experiment. She took the key she’d been given for those eventualities, opened the door, and stepped over the threshold.
“Pia, this is crazy,” George said. Reluctantly he came in after her. It was dark, and very quiet.
“Relax. The security cameras are out, they’ve been working on them again for days. Who’s going to come in now? I just want to check the refrigerated storage facility in the biosafety lab and take a peek at the logbook. And before you say it, I know the CDC has probably investigated all that. They might have even taken the logbook. Be that as it may, I need to make sure they didn’t miss anything.”
Pia turned on the minimal light necessary. It was a small lamp by the communal coffee machine. She then quickly checked her own office, and Rothman’s. George trailed after her like a shadow. As far as she could tell, nothing had been disturbed in either office. Pia pointed out Rothman’s desk to George. The in-tray, the few files, the pictures—everything was just so.
“See how orderly he is?” said Pia.
All George could think about was getting out of there. An air circulator kicked on and George jumped half out of his skin. He followed Pia to the biosafety level-3 room and they donned the protective gear once more. Pia used the coded punch pad to reach the lab itself. Since there were no windows, Pia turned on the overhead lights. The ventilation system was still running and there was an eerie calm in the place. Pia checked the logbook, which the CDC had not taken. There were the usual entries; the next to last one was Panjit Singh, when he went in that morning to set up. Then there was Rothman and Yamamoto’s entry. There was nothing abnormal. She then went to the refrigerated storage unit. Using a separate keypad, she was about to open it when she heard a noise that caught her attention.
“Did you hear that?” she whispered intently to George.
“Hear what?” George said nervously.
Pia held up a hand and went to the door and cracked it open. There were quiet sounds but unmistakable—voices in the lab outside. Voices getting louder.
“In here . . . c’mon,” she said urgently.
“Shit,” George said under his breath. He’d heard the voices. “Shit on a brick,” he mumbled to himself.
Silently but urgently Pia waved for him to follow her. George saw where they were heading and beat it out through an emergency exit in the far corner of the lab. The door complained when he pushed it open as it hadn’t been opened since it was installed back when the lab was last renovated. It had also been made airtight.
Pia followed close behind George. She might have stayed and faced the music had she been there by herself, but she was well aware of George’s utter fear of authority. Where that had come from, she had no idea.
The unit’s emergency door led to the lab storeroom where Pia and George pulled off their protective gear and stumbled out into the main part of the microbiology department that housed Rothman’s lab. Staff on the evening shift at the microbiology clinical lab were curious to see two young people running by, then stunned to see them followed a minute later by three figures in full hazmat gear.
Microbiology led into the anatomy department and George and Pia crashed through the connecting doors and into the familiar surroundings. As first-year students they had spent a good deal of time in the department. George was leading, but he didn’t know exactly where he was going. All he knew was that he wanted to avoid getting caught. He ducked into the darkened anatomy room, dimly illuminated by night-lights. For the benefit of the current first-year students who were taking anatomy at the time, the room was well stocked with cadavers, most covered with oilcloth shrouds. Several torsos sat upright on the head teaching table. They’d been cut across the upper chest and then halved in a sagittal section so that half the gullet and half the brain were visible. George was eye-level with the torsos, the exposed whites of their eyes seeming to glow in the half-light.
George and Pia ducked behind the long teaching table, but there was nowhere to hide. A moment after their arrival, the banks of ceiling lights flickered and came on. Three security guards in hazmat suits stormed into the room. Pia stood up and George, very reluctantly, followed suit.
The security men were angry, demanding Pia’s and George’s identification cards. They then made several calls on their radios before turning back to the students. George was cowering, Pia taking it all in stride. “You’re coming with us,” said the nearest figure to George, grasping his arm and marching him out of the room. Pia was escorted out behind him.
The group wended their way past the few onlookers in the clinical microbiology lab and down to the street via a service elevator. George’s mind was racing but he couldn’t think of any way Pia could talk her way out of this. As they walked across the campus, the group attracted a lot of stares and comments from passersby. Some of them wondered if they were watching some med-student prank.
George and Pia were taken through a featureless corridor in the hospital bowels to the security department. They walked past a bank of TV screens being monitored by two bored-looking men, down another corridor and into a small office with a handwritten sign on the door: DUTY OFFICER. Standing up, watching a couple of monitors mounted on the wall, was David Winston, the man who’d taken charge in the lab earlier that day. He recognized Pia, having helped her when she fainted in the street.
“Ah, you again. I see you’re feeling better than when I last saw you.”
“Mr. Winston,” Pia said. “My friend and I were just retrieving some of my belongings from my office.”
Winston referred to a list on a clipboard resting on his desk.
“Miss Grazdani, and . . .” He looked at George.
“George Wilson.”
“George Wilson. Not on my list. You a fourth-year student as well?”
George nodded.
“Well, you’ll be taking antibiotics too,” Winston said. “Folks, there’s a protocol we use in these situations. You broke into a secure, potentially contaminated area. I actually saw you do it myself, sitting right here. The cameras might not be operating inside the lab, but outside they work just fine. So I see two people go into the lab, and I have to send three of my guys in full body gear to go in and find you. And it turns out to be you two. So the protocol is, I make a call to the dean of students, who loves to hear from me, as you might imagine. It’s just a heads-up because my next call is to my friends at the Thirty-third Precinct, and I’ll have a full and frank conversation about criminal trespass.”
George was aghast. If the police got involved, he was screwed.
“I don’t know why you guys went in there, and I’m not going to ask. The CDC might have cleared it, but the caution tape was still over the door. Especially you, Miss Grazdani, as you were spe
cifically told the lab would be off-limits. Frankly, I’m dumbfounded. But I’ve never understood medical students since I took over this job heading the center’s security.”
Pia started to speak, but Winston held out his hand to silence her and called the dean of students. He explained the situation. He then listened for a good two minutes and hung up the phone.
“She’s coming down. I don’t know who I’d rather deal with if I were you, the dean or the Thirty-third.”
Winston showed George and Pia into a small side room and closed the door. George was too agitated to speak; Pia started pacing around the room. She couldn’t sit still. After what seemed like an age but was in fact thirty minutes, the door opened and a tall, dark-haired woman in sweats and a ski jacket came in and shut the door behind her. Her name was Helen Bourse. She had been dean of students for almost a decade and was well liked but hardly a pushover.
“What the hell did you think you were doing? You two have made me cash in more favors than I actually own, stopping Mr. Winston from having you arrested. I want you to convince me I did the right thing.”
“I’m so sorry, Mrs. Bourse,” George said. He took one look at Pia’s defiant face and decided he should speak for the both of them.
“We’re very sorry.”
“So what in God’s name were you doing there? In a lab that was sealed and potentially contaminated.”
“The only part that might have been contaminated was the biosafety unit,” Pia said, interrupting George, who’d started to respond. “We took the necessary precautions. I wanted to look for myself. I just can’t understand how Dr. Rothman managed to get infected, knowing him as I do.”
“So you weren’t picking up your stuff as you told Mr. Winston. And what, you’re suddenly epidemiologists? We had a team of actual epidemiologists check out the lab today both from here and from the CDC. They combed the place, including the biosafety unit.”
“What did they find?”
“Nothing, but that’s not the point.”
“I’ve been working in there on and off for over three years. I wanted to check it out. If something was different, I might have been able to see it, probably better than strangers from Atlanta.”