Silent Fear, a Medical Mystery Read online

  “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.”

  ----------

  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.”

  ----------

  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.”

  ----------

  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.”

  “By the way,” Danny asked, “did you both have a good weekend?”

  “Better than yours,” Bruce said.

  Matthew gazed out the window past Danny. “Couldn’t have been better, but I regret not helping you out, Danny.”

  Danny scurried out, leaving his cell phone and Harold’s parents’ information on his desk, while Cheryl tailed him.

  “It’s terrible about Dr. Jackowitz,” she said. “I just can’t believe it.”

  “I know,” Danny said. “There are some other folks sick, too, and a nurse just passed away.” He turned to face her, taking a chart from her hands. “First patient Wanda Robinson. Is her MRI result back?”

  “Up on the computer,” Cheryl said. She darted off while Danny woke his computer and scrolled though the images and then went into the first patient room.

  “Hello, Mrs. Robinson,” he said.

  “Look who I brought,” she said, her baby in her arms. “I had to bring her, because after your appointment I have to bring her upstairs to the pediatrician’s office for a well baby check. I have an excellent baby doctor for Carol.”

  “That’s wonderful.” Danny admired the infant and noted that Wanda looked less drained than the preceding week. “I have good news for you. Your MRI shows no growth abnormalities with your pituitary gland. From a neurosurgeon’s perspective, you’re in the clear.”

  “Oh doctor, that’s great. It’s about time I received good news.”

  “And it’s about time I gave some. I will send a report to your endocrinologist. I take it she is giving you appropriate replacement therapy?”

  “Yes, she is. And I’m feeling a bit better. My Sheehan’s syndrome is going to be a thing of the past.” She broke into a smile. Danny thought there’s nothing like the happiness of a new mother, even if she’s sick.

  ----------

  The small hand on the clock over the front office desk pointed past 6 p.m. The last patient had left and Bruce stood at the front counter. An evening news channel covered the day’s events in the waiting room as the staff began filing the last charts and packing up for the day. Cheryl stopped next to Bruce as the anchorman switched stories to Nashville’s biggest story.

  “You’re on,” Bruce said towards the back of the hallway as Danny and Matthew came single file towards him. The four of them went into the waiting room as the rest of the staff also watched.

  “There have been major developments the last two days at Nashville’s University Hospital of a neurological illness which claimed the life yesterday of a local neurosurgeon named Harold Jackowitz. Today an operating room nurse, Dotty Jackson, also died from the same disease. We take you now to a conference held today at the hospital with Robert Madden, the hospital’s CEO, Dr. Ralph Halbrow from the Center for Disease Control and other local specialists.”

  Coverage then skipped to the morning’s press coverage which was scarcely shortened. Underneath Robert’s and the physicians’ comments, their names and titles streamed across the screen like live S&P numbers.

  Bruce unfolded his arms and shut the television off when the entire story ended. “Nice job, Danny. However, I hope it’s not perceived by the public as a cause and effect between a doctor or a patient of The Middle Tennessee Neurosurgical Group and the outbreak of this meningoencephalitis.”

  Chapter 11

  Rachel got up before Leo and padded to the bathroom. It was Tuesday morning and she had finally confronted her denial the night before. Although she didn’t have first-hand knowledge about child abuse, she believed her daughter’s strange marks and behavior came from Leo’s hands. Two different times after he had taken care of her in Rachel’s absence, he told her that he had accidentally spilled a hot liquid, scalding the poor baby’s tender skin.

  She admired her complexion in the mirror, washed her face, and applied moisturizer. She slipped on jogging pants and a top. When she came out, Leo was getting up, scratching his bare chest. He turned his head. “What’s your rush this morning?”

  “I thought I’d make you real coffee on your way out instead of that instant stuff. But I’m going to take care of Julia, put her in the carriage, and get some fresh air.”

  Slowly he made his way past her. “Too bad, we could have had a roll since you were up this early.” He eyed her, almost suspiciously, and put his hand into her hair and rubbed her scalp. It was one of the things he did to her that took her mind straight to the moment, dismissing any negative feelings she had developed for him. He let go after a long minute, gave her a once over and said, “You look good enough to eat. Don’t get kidnapped on that walk.”

  Rachel left the room as Leo disappeared into the bathroom. She put on a large pot of coffee and as the water dripped, she realized how charming he could be when he wanted. An operator, that’s what he was - an operator. His craft of schmoozing her finely tuned. But the time neared for her to no longer put up with his cyclical behavior and to put an end to whatever he was d
oing to Julia.

  Rachel went into Julia’s room to dress her. She only had three more days before handing her over to Danny Friday night and needed to monitor her like a hawk. She couldn’t take chances that new signs of physical abuse appear making Danny skeptical about Julia’s care.

  Rachel had thought about it at length the night before, the hours after dinner dragging on like they would never end, even when Leo had been grinding her hard. She had tried to fend off his advances by hinting she wasn’t in the mood, but that seemed to egg him on more. As she stared at the ceiling and then into her pillow cover, her daughter’s strange skin patches and recent frightened expressions plagued her.

  That’s when it had really hit her, the scary part. Barring her paternity case attorney, Phil Beckett, she’d never directly been involved with the legal system before. She’d done lots of shady things but never serious enough that someone pointed her out to the police. She even remembered Casey Hamilton threatening her with that before Julia was born.

  Rachel slid out her daughter’s diaper, put on a bit of salve and powder, and carefully put on a new pink sun dress. She picked her up, patted her back all the way into the kitchen, and slid her into the high chair. Leo still hadn’t appeared. She put Julia’s bottle on the tray and eased small spoonfuls of applesauce into her mouth.

  She went back to her thoughts as Julia finished her food then took to her bottle. What if, just what if, someone babysitting Julia put two and two together and suspected some kind of child abuse? Since she was suspicious herself, it seemed highly likely. Her heart thumped in her chest. Anyone would point a finger at her. Weren’t child abuse laws really stiff? Or was it like the rest of the criminal justice system where a person with a good lawyer could practically get away with murder and be walking on the streets?

  Rachel looked toward the bedroom and decided to beat Leo out the door. She poked her head in as he sat on the bed tying a shoe. “I’ll see you later tonight. I’m going for a walk with Julia in her carriage.”

  After lacing tightly, Leo rose and glanced at his watch. “That’s a long way off, babe. How about a romantic dinner tonight?”