"At this stage, just about anything," Kathleen said.
"We've confirmed that this is a particularly pathogenic strain of E. coli that produces not one but two extraordinarily potent toxins. What we're seeing is full-blown HUS."
"What about the plasmaphoresis?" Kim asked.
"Dr. Ohanesian made an impassioned plea to the AmeriCare Review Board chairman," Claire said. "But as we warned, the committee probably will not give the okay."
"Why not?" Kim demanded. "We've got to do something, and I said I'll be willing to pay for it."
"Your being willing to pay doesn't matter," Claire said. "From their point of view, it would set a dangerous precedent. They could then be forced to offer it to families that couldn't or wouldn't pay."
"Then let's get Becky to someplace where it is offered," Kim snapped.
"Dr. Reggis," Claire said sympathetically. "Becky is in worse condition today than she was yesterday, and yesterday she was in no condition to be transferred. But plasmaphoresis is not totally out of the question. There's still hope they could give the green light. We'll just have to wait."
"Wait and do nothing," Kim said with a scowl.
"That's not true," Claire said hotly. Then she caught herself and sighed; talking with Kim was a chore she did not relish. "We're supporting her every way possible."
"Meaning you're sitting on your hands and treating complications," Kim spat.
Claire stood up and looked at Tracy and Kathleen. "I think it's time for me to see the rest of my inpatients. But I'll be available if needed: just page me."
Tracy nodded. Kathleen responded that she'd be doing the same thing in a few minutes. Claire left.
Kim collapsed into the chair vacated by Claire and buried his head in his hands. He was struggling with a roller coaster of emotions: first anger and then sadness, then back to anger. Now sadness returned. He fought back tears. He knew he should be seeing his own inpatients, but for the moment he was incapable.
"Why did your visit to the Onion Ring take so long?" Tracy asked. As irritated as she was by his behavior, she couldn't help but be concerned about him. He looked pitiful.
"Actually, I was in jail," Kim admitted.
"Jail!"
"If you want me to tell you that you were right, you were right," Kim said. "I should have calmed down before I went."
"Why were you in jail?" Tracy asked.
"I lost my temper," Kim said. "I went there to find out about the possibility of tainted meat. The manager's self-righteous denial drove me up the wall."
"I don't think it's the fast-food industry's fault," Kathleen offered. "With this E. coli problem the fast-food restaurants are as much a victim as the patrons who are infected. They get contaminated hamburger."
"I figured as much," Kim said, with his face still buried in his hands. "My next visit will be to Mercer Meats."
"With Becky's condition, it's hard for me to think," Tracy said. "But how can there be contaminated meat? Aren't these places continually inspected? I mean, doesn't the USDA certify the meat?"
"They certify it," Kathleen said. "But in this day and age, it's an unfortunate assumption to believe that it's not contaminated."
"How can that be?" Tracy asked.
"For a lot of reasons," Kathleen said, "chief of which is that the USDA has an inherent conflict of interest."
Kim lifted his head out of his hands. "How so?"
"It's because of the USDA's mandate," Kathleen said. "On the one hand, the agency is the official advocate for U.S. agriculture, which includes the powerful beef industry. That's actually the USDA's main job. On the other hand, it has inspectional obligations. Obviously the two roles don't mix. It's a genuine case of asking the fox to guard the henhouse."
"This sounds incredible," Kim said. "Is this something you know for a fact, or is it something you've heard and are just passing it along?"
"I'm afraid it's something I know about firsthand," Kathleen said. "I've been looking into the problem of food contamination for over a year. I've gotten active through a couple of consumer groups who are fighting an uphill battle to do something about it."
"How did you get involved?" Tracy asked.
"It would have been hard for me not to," Kathleen said. "Food contamination and the illness it causes have become a major part of my practice. People in general seem to want to keep their heads in the sand about all this. But it's a problem that is getting worse by the day."
"This is unbelievable!" Kim exclaimed as anger again overcame his sadness.
"There's more," Kathleen said. "Not only is there a conflict of interest with the USDA, but from what I've seen, the USDA and the beef industry are much too close."
"What are you implying?" Kim asked.
"Exactly what I said," Kathleen added. "Particularly in middle-management positions, there's a kind of musical chairs with people moving back and forth to make sure the industry is interfered with as little as possible."
"This is all for profit, no doubt," Kim said.
"To be sure," Kathleen said. "The beef industry is a multibillion-dollar business. Profit maximization is its goal not the public health."
"Wait a second," Tracy said. "How can all this be true? In the past, the USDA has uncovered problems and has done something about them. I mean, not that long ago with Hudson Foods…"
"Excuse me," Kathleen interrupted. "The USDA was not responsible for discovering the E. coli contamination involving Hudson Foods. It was an attentive public health official. Normally what happens is the USDA is forced to make a show after an outbreak occurs. Then they make a big deal to the media to give the impression that they are on the job of protecting the public, but unfortunately nothing substantial ever gets done. Ironically enough, the USDA doesn't even have the power to recall meat it finds contaminated. It can only make a recommendation. Nothing it determines is binding."
"You mean like with Hudson Foods?" Tracy asked. "At first they recommended that only twenty-five thousand pounds of meat be recalled."
"Exactly," Kathleen said. "It was consumer groups that forced the USDA to up the recommended recall to over a million pounds. It wasn't the USDA who was the instigator."
"I'd had no idea about any of this," Tracy said. "And I like to think of myself as a reasonably informed person."
"Perhaps the worst part," Kathleen continued, "is that when the USDA talks about contamination with its inspectional services, they're generally talking about gross contamination with visible feces. The industry has fought against any microscopic or bacteriologic inspection for years. Now there is supposed to be some culturing, but it is only a token."
"It's hard to believe," Tracy said. "I guess I've always just assumed that meat was safe."
"It's a sorry situation," Kathleen said. "With tragic consequences.
For a few moments, no one spoke.
"How well we know," Tracy said, as if suddenly realizing this was no idle conversation. Her daughter was no abstraction. A fresh tear streaked down her cheek.
"Well, that settles it," Kim said. He abruptly got to his feet.
"Settles what?" Tracy managed. "Where are you going now?"
"To Bartonville," Kim said. "I'm going to pay a quick visit to Mercer Meats."
"I think you should stay here," Tracy said with exasperation. "You know better than I that Becky's condition is grave. Dr. Stevens and Dr. Morgan have impressed upon me there might be some difficult decisions to be made."
"Of course I know Becky's condition is grave," Kim snapped. "That's why I have so much trouble sitting here doing nothing. It drives me crazy. I have trouble even looking at Becky, knowing there is nothing I can do medically to help. Besides, hearing all this about the beef industry and the USDA makes me furious. I said I was going to find out how she got sick. I'm going to follow this E. coli trail wherever it leads; at least I can do that for Becky."