"They were afraid a major epidemic was brewing here in the States."
"I know, only it didn't happen — at least not then it didn't. Well, there are no major problems with the vaccine that I can tell, but it sure hasn't been tracked very thoroughly."
"I already know about that," Ellen said, hoping her tone didn't reflect her deep disappointment. "That's what you have?"
Rudy took her reaction in, though, and for a few seconds he just sat there. Then shook his head and grinned proudly.
"Nope," he said. "As a matter of fact it isn't what I have at all. I made some calls. One of them was to an old pal from the CDC I used to do projects with. His name's Arnold Whitman and he's an epidemiologist and a microbiologist. Arnie's been looking at these outbreaks of Lassa fever for us on the QT. If he gets caught mucking around in someone else's territory it could be his job. Anyhow, what he found may be nothing, but Arnie doesn't think so, and Arnie is very high on my list of very smart people who aren't wrong about science a hell of a lot."
"You should be on that list," Ellen said.
"Oh, I am. Seriously, listen to this. The incubation period for Lassa fever from exposure to symptoms is seven to fourteen days, twenty-one days tops. Eighteen of the cases in the U.S. appear to have brought the infection in with them from Africa. The rest of the cases are believed to have caught the virus from those eighteen. Given the known incubation period, it seems as if every one of the eighteen cases became infected on or about the very day they left Africa for the U.S."
"Weird."
"More than weird, my friend. This is the stuff my statistics were born to make sense of. And guess what?"
"They can't?"
"Precisely! They can't make sense of those eighteen cases all becoming infected as they are about to leave for the U.S., because something's wrong."
"But what?"
"That is the conundrum. I can't say, at least not yet. But wait, there's more. In the countries where it occurs frequently, Lassa fever has a clear-cut seasonal predominance for the months of January and February. In fact, here's a little graph I put together with cases that occurred three years ago, which I got from a Sierra Leone health ministry report via my pal Arnie."
"Impressive," Ellen said.
"Not overwhelming, but the January/February pattern the textbooks write about is certainly there. Now look at our eighteen cases."
Ellen held the second graph next to the first. There was only one case in January, none in February. Most of the rest were in the summer.
"And your statistics say?"
Rudy pressed an imaginary buzzer, adding the sound effect.
"Once again the numbers say that something's wrong. And need I remind you that these are my numbers, and my numbers never lie. From what I can tell, in the months of May, June, and July, you have a much greater chance of catching Lassa fever by flying to the U.S. than you do by staying in Africa."
"What do we do with this information?"
"We try and turn it into a working hypothesis," he replied, "a scenario that fits and explains the data. We need to come up with some facts."
"Starting where?"
"I would say starting at the Sierra Leone embassy in D.C. A friend of mine in the State Department tells me they have access to a passenger manifest of every flight out of their country. Plus, I'd be interested in how many Americans got Lassa fever in Africa as opposed to after they came home. I believe you could get that information from the Sierra Leoneans as well. Data! I crave data!"
Ellen jumped up and threw her arms around Rudy's neck.
"I knew you'd come through. Rudy, you've been just the best friend in the world to me."
"That's not exactly the hardest thing I've ever had to do," he said, looking away.
CHAPTER 18
Code Blue, ICU… Code Blue, ICU… Matt was on Med/Surg 2, writing orders regarding Nikki's transfer to a private room, when the code call sounded. There was little doubt in his mind that the subject of the code was the sixty-something woodsman who had taken her bed. Matt had passed him in the corridor as he was being brought into the unit, and had noticed the pallor around his mouth and slight mottling of his skin, suggesting that his heart was not pumping effectively.
Matt raced to the unit, arriving simultaneously with two nurses and the respiratory therapist. Although he didn't regret the decision to switch from the one-patient-after-another approach in the ER to the more intense, in-depth relationships of primary care, he remained something of a hybrid, and the intense action surrounding a code blue or multiple trauma still brought a welcome rush.
He was in the room before he realized that the cardiologist at the man's bedside was Robert Crook. Matt hadn't seen his nemesis at all since the ill-fated meeting at BC amp;C. Crook greeted his arrival with a scowl and a derisive shake of his head.
"Need help?" Matt asked with accentuated cheeriness.
"I think I have enough," Crook grumbled.
From behind him, nurse Julie Bellet vehemently shook her head and mouthed the word "Stay!"
"Why don't I hang around just in case."
"Suit yourself. Get ready to shock at four hundred joules, please."
One twenty-five should \)e enough, Matt was thinking. Bellet looked over at him imploringly, but all he could do was shrug. The 400 was definitely overkill, but not a serious enough breach to go to war with Crook over.
The cardiologist plowed ahead, setting the defibrillator paddles against the man's chest.
"Clear!.. Ready, shock!"
Julie Bellet depressed the button delivering 400 joules of electricity through the woodsman's chest. Almost immediately, the chaotic spikes of fibrillation were replaced by a rapid, regular rhythm.
"Okay," Crook said in a purposefully matter-of-fact tone, "he's now in a nice, supraventricular tachycardia. Let's give him a milligram of propranolol IV."
No! Matt's mind screamed. Wrong diagnosis, wrong treatment. He moved forward next to Crook.
"Robert," he said, softly enough so that most of those in the room weren't even aware he was speaking, "that's V tach. I'm certain of it. Xylocaine, not propranolol."
Crook glared at him.
"A milligram of propranolol IV," he ordered again. "Make that two. Give it slowly."
Damn! Matt thought, unsuccessfully trying to avoid Julie Bellet's desperate gaze as she and another nurse responded slowly, clearly stalling. War was about to break out.
"Robert," he whispered again, "get some Xylocaine in him and you might be able to keep him from fibrillating."
Crook's sideways look was, if anything, more piercing than before.
"I'll thank you to — "
At that instant, with a flurry of ineffective beats, the woodsman's unstable ventricular tachycardia rhythm degenerated into immediately life-threatening ventricular fibrillation.
"Four hundred joules," Crook ordered, pointedly looking away from Matt. "Get a hundred of Xylocaine into him also. Let's hold off on the propranolol for now."
At that moment, the resuscitation, which should have been straightforward and successful, could easily have gone either way. Fortunately, a power greater than any in the room decided it simply wasn't the old woodsman's time. The electrical countershock was followed by the Xylocaine he should have gotten in the first place, which was then followed by another shock, and suddenly there they were — a decent monitor pattern and a functional blood pressure.
"Nicely done," Matt said.
There was no response from Robert Crook.