They paused out in the main lobby area, standing in front of the elevators.
"I cannot help but notice how quiet it seems to be," Laurie said. "There are so few people."
"That's because our census is very low, which has been progressive since the MRSA problem began. Of course, the worst was when the ORs were completely shut down. During that period we had the entire hospital staff, including the president, disinfecting everything."
"But the ORs are open now?"
"Yes, they are open now except for the OR where Mr. Jeffries was operated on."
"Was he the only case done in the room yesterday?"
"No, he wasn't. There were two others after Mr. Jeffries."
"And they are well."
"Perfectly fine," Loraine said. "I know what you are thinking. It has us baffled as well."
"Since your census is low, does that mean some of your staff doctors are choosing to do their surgery elsewhere?"
"I'm afraid so."
"What about Dr. Wendell Anderson?"
"He's one of the brave ones, or should I say loyal. He's still operating here on a regular basis."
Laurie nodded while fantasizing about tying Jack to the bed during his sleep Wednesday night. More than ever, she did not want him to have his operation.
"What is it you'd like to see?" Loraine repeated.
"How about starting out with your HVAC system?"
Loraine did the equivalent of a double take. "Are you joking?"
"I'm serious," Laurie said. "Are the operating rooms and the PACU on a separate system from the main part of the hospital?"
"Absolutely," Loraine said. "This is a state-of-the-art facility. The HVAC for the operating rooms is designed to change each OR's air every six minutes. There would be no need to do that for the whole hospital. Even the laboratory area has its own system, although not with that kind of flow."
"I'd still like to see it," Laurie said. "Particularly the OR system."
"Well, I don't see why not." They boarded a waiting elevator. Loraine pressed the button for the fourth floor. She explained that the second floor was for outpatient services, the third was the OR and PACU as well as central supply, and the fourth was for the laboratory and engineering. Engineering included HVAC and the supply of various gases for the ORs and bedside. All the floors higher than the fourth were for patient rooms. The very top floor was a special VIP section, which had slightly larger rooms and more expensive decor. The service, she insisted, was the same.
"Are all the Angels Healthcare hospitals similar?" Laurie asked.
"Essentially identical, as will be the six hospitals slated soon to be constructed: three each in Miami and Los Angeles."
"My word," Laurie said simply. She was impressed with the edifice but bemoaned that its luxury represented the enormous amount of money essentially being stolen on an ongoing basis from full-service hospitals like University or even General, which were already struggling to make ends meet. Angels Healthcare, like other specialty hospitals, was interested only in the paying patients with acute problems, not the uninsured or the chronically ill. Not only that, the fortunes being made by the businessmen owners were also being sucked out of the healthcare system and unavailable for patient care.
"Here we are," Loraine said as the elevator door opened. "Engineering is to the left."
In contrast to the elegant five-star hotel decor of the lobby, the fourth floor was the epitome of high-tech minimalist design. Everything was gleaming, high-gloss white, and the hallway was spotless. The women's shoes clicked on the composite flooring, and the sound echoed off the bare walls. There were no pictures, no bulletin boards, only closed white doors. The only color came from city-mandated institutional exit signs with red letters at either end of the lengthy corridor.
"I think I know why you are interested in seeing our HVAC system," Loraine said as they walked.
"Really?" Laurie questioned. She wasn't entirely sure herself.
What she knew of HVAC was the little she'd absorbed while the renovation of her and Jack's brownstone had been under way.
"You are thinking of airborne route of infection, which is another suggestion, as far as I am concerned, you are not the epidemiological amateur you profess to be. But let me reassure you, we have considered it also, and we have tested the water in the condensate pans for staph aureus on multiple occasions, including just this morning after yesterday's tragedy."
"Have any of the tests been positive?"
"No, none!" Loraine said emphatically. "Staph is not considered an airborne pathogen, but that did not stop us from considering it, and even though the tests were negative, we've drained all the pans and treated them."
"I didn't think staph was spread by the airborne route, either, Laurie said. "But the fact that a number of the cases seemed to have been primary pneumonias suggested the route of infection had to be airborne."
"I can't argue with that," Loraine said, "at least not from an academic perspective, but I can from a practical one. I chair an interdepartmental infection-control committee, which is just as its name suggests: interdepartmental. We have people from all departments, such as nursing, food service, engineering, and so forth. Currently, our representative from the medical staff is a surgeon, and when we were discussing the possibility of the staph being spread via the airborne route and believing the HVAC would be involved, he set us straight on an important fact. Patients undergoing endotracheal or laryngeal-mask-airway anesthesia, which all do in our hospitals when they have general anesthesia, neve: breathe operating-room air. The air they breathe always comes from the piped-in source."
"They never breathe ambient air?" Laurie questioned. There went her only theory as to how the MRSA victims were getting sick.
"Never!" Loraine confirmed.
Loraine stopped at one of the closed doors. An eye-level white plaque with incised black letters said: Engineering. "It's going to be a little loud in here," she warned.
Laurie nodded as Loraine pushed open the heavy insulated door. Once inside, Laurie scanned the large utilitarian high-ceilinged room. The walls and ceiling were concrete. A tangled web of piping, some insulated and some not, snaked out of various multicolored tanks and hung from the ceiling. Much larger ducts did the same after exiting or entering air handlers the size of small cars, each of which was mounted on rubber shocks.
"Anything in particular you'd like to see?" Loraine shouted.
"Which handlers service the ORs?" Laurie shouted back.
Loraine led Laurie down the relatively narrow walkway between the meticulously maintained equipment. Halfway to the opposite wall, Loraine stopped and patted the side of one of the air handlers. "This is the one. The coolant comes from the condensers on the roof, and the hot water comes from the furnaces in the basement."
"How do you access the condensate pan?"
"This access door," Loraine yelled. She grabbed the handle and had to pull hard to break the suction. When the door opened, they heard a whistling noise.
Laurie stuck her head into the opening and the wind wildly tossed her hair in all different directions. She had to grasp it to keep it out of her face.
"That's the condensate pan down there," Loraine shouted, while pointing over Laurie's shoulder to the base of the machine's innards.
Laurie nodded. She was interested because she knew airconditioning condensate pans were a frequent source of airborne outbreaks, such as Legionnaires' disease. She turned her head downstream into the mouth of the efferent duct, where she could see a mesh screen. "Is that a filter?" Laurie yelled.
"There are two," Loraine answered. She closed the door to the coils, and it snapped shut. She took several steps forward. There were two vertical slit-like openings. She pointed to the two of them with both index fingers. "The first is a standard filter for relatively large-sized particles. The second is a HEPA filter for particles down to the size of viruses. And to anticipate a question, we have on multiple occasions tested the HEPA filters for staph. Only twice did we get a positive result."