Death Rounds (47 page)

“Continue checking these charts,” Williams said, patting one of the stacks on the table beside him. “Sometimes lab requisitions are initialed by whoever does the test. We’re hoping the Phantom may have slipped up and shown a requisition to his target as a way of getting her to do the procedure.”

After Riley left, I asked Williams, “Are there new cases upstairs?”

“Yeah, seven more were diagnosed with
Legionella
overnight— five orderlies, a doctor, and yet another nurse. His range of victims is wide.”

“What about purulent sputum in the cases from yesterday?”

“None,” he answered. “It’s still too early.”

* * * *

Purulent sputum developed in four of the nurses before midmorning. Six more followed the same course early in the afternoon. I heard later that they all knew what it meant without being told. Throughout the rest of the day whispered accounts about how they were doing kept coming from the ward and were relayed throughout the hospital.

“…emotionally, she’s taking it amazingly well, simply asking for a priest...”

“...desperate with fear, but who wouldn’t be, knowing you’re going to die?”

“…can’t accept it at all, raging one minute, sobbing the next, unable to get her breath...”

We heard that all of them were deteriorating medically—agitated from air hunger, plucking at their nightclothes, wracked with wheezing while coughing despite frequent treatments with bronchodilators and high concentrations of oxygen. The descriptions gave me visions of Sanders.

Statements of wishes were hurriedly obtained from them regarding what resuscitation measures they wanted performed once they stopped breathing. Some were adamant: “No tubes down my throat.” Others couldn’t face the issue and became hysterical when it was raised.

Husbands were told their wives were dying; wives were told their husbands were dying. Counselors quickly met with family members to try to prepare them for visits. Staff explained isolation procedures in hastily arranged meetings. “Of course families can touch, except infants and the very elderly,” a doctor or nurse would say, “provided you accept that you’ll be screened and kept quarantined in your home afterward.”

The reports of what was going on became more disturbing as the afternoon drew to a close.

The plea heard most often from the victims was, “Don’t let me die alone.”

“I beg you, sedate me, sedate me, please,” one of the nurses had sobbed, “so I won’t break down in front of my children.”

No one wanted to risk bringing infants into the hospital. Fosse ordered arrangements made instead so that families could carry their babies across the grounds and approach the outside windows of the isolation wing. Nurses and orderlies took mothers in wheelchairs or on stretchers to the ground floor and allowed them to take off their masks so they could try to smile at the tiny bundles held up to them on the other side of the glass. Two nurses had to support one woman as she leaned forward to catch a glimpse of her little son while her husband lifted him toward her. She bravely managed to smile down at him for a few minutes, then collapsed completely, racked by sobs and wailing, “I want to hold him. I want to hold him.” Cleaning crews standing by to resterilize the place couldn’t bear to watch.

The two ID specialists I’d met on the ward yesterday shared identical expressions now, no difference of opinion evident in their haggard, haunted looks. They both kept joining us in the archives during the intervals when nothing further could be done medically, and counselors, along with men of God, had moved in to replace them at the bedside. “I can’t stand it on that floor,” the middle-aged one confided, “but hunting the bastard who did this helps keep up my nerve to go back in.”

* * * *

The outbreak of purulent pneumonias only increased my vigilance over Janet’s progress...and my despair. During ever more frequent visits to her I kept fighting back images of what those families were going through a few floors away. Nor did I want to speak about them with her. Their agony was so close at hand and could so easily become our own that I couldn’t bear to acknowledge it. Rather I made small talk, called home with her to speak with Amy and Brendan, or simply held her hand.

I brought her news of Michael each time I came. If I stayed with her for more than an hour, she wanted another update before I left. I made those calls from the nurses’ station, not to put her through the agony of hearing a one-sided conversation as before. But it was still hard on her. She would watch me through the window of her cubicle for my nod that he was still alive.

Afterward Janet and I would huddle together, helpless in a modern ICU and left to praying that we’d all be passed over by the contagion in our midst.

* * * *

What kept me searching through records was my certainty that Michael had found proof of how the Phantom infected people. I’d also begun to suspect from our own piecemeal progress that
the pattern
which had revealed this proof to him might not be found in some single set of charts or solitary collection of records. Rather, I thought, it could be the kind of pattern that emerged only after he’d looked at a lot of sources and gathered together observations from all of them.

Around 10:00 that evening, after making no further breakthroughs with the charts in archives, I took a new tack. If Cam was the killer, then what had been done to his father in this hospital was the sole reason behind the vendetta. Could his targets have had a direct link to the way his father had been treated here? Perhaps Phyllis Sanders had been his nurse. Perhaps Brown as well. She was young, but might have been involved just before the man died. In the later pictures of Cam with his father that I’d noticed in his office, Cam had appeared to be in his mid-to-late twenties. I presumed that meant his father had died around ten years ago.

The man’s chart, I speculated, could hold a list of the intended victims. Not only would we then know who needed special protection, but we could also be ready to grab Cam when he came for those whom he hadn’t yet infected.

“It’s worth checking,” Williams agreed wearily when I told him my idea. “We’re not getting any further here.”

I figured Mackie senior’s record would be stored on microfilm in the repository with all the other dossiers of the long dead. Security and the police said that they’d let me back in but they couldn’t spare a man to stay with me right then.

“Fine, I’ve got my phone,” I told them. I’d also noticed on my previous visit that the door to the room had an inside bolt, probably from the days when a photographer worked on-site processing film and didn’t want to be disturbed.

Once I got inside, it took me a few minutes to figure out the index system, but in no time I was spooling the chart of Mr. Stephen Mackie through the view finder. It was a sobering experience. The entries were a record of one man’s encounter with one of the great scandals of U.S. health care and with the plague of the century.

Page after page documented his ordeal with hemophilia, the record showing repeated visits to ER for treatment of painful bleeds into his joints. On each occasion he had received an IV administration of cryoprecipitate, a preparation of the clotting factor he lacked which was collected from the blood of multiple donors, and on each occasion he’d had to fight for adequate treatment of his pain. The nursing notations made me wince.
Suspect patient is exaggerating complaints of discomfort: try placebo saline.
In other words, they’d injected simple salt and water, subjecting him to hours of agony before giving him the morphine he’d needed. These entries went on into the eighties and continued through the years in which thousands of hemophiliacs like him had been infected with AIDs through cryoprecipitate prepared from contaminated blood. The policy of paying individuals to give blood, which always encouraged indigents and street people to donate and lie, was never wise, but it was outright negligence to have continued the practice long after word was out in the streets that “Slims” or the “Gay Plague” also was occurring in mainline drug addicts.

Cam’s father, I read, was diagnosed in 1985, after a bout of protracted fever, diarrhea, and weight loss. At that point he was forced to stop working in the labs, and his visits to ER increased. His course was typical and quick—treatment then was primitive, limited to drugs like immuran—and he fell victim to the ravages of previously rare infections that became a familiar litany to physicians from the mid-eighties on: bizarre pneumonias caused by a protozoan organism called
Pneumocystis carinii—
treated in those years with tetracycline and Septra but never completely defeated—or lumps of other protozoa in the brain, a condition called toxoplasmosis gondii, which produced seizures as they ate into the neuronal circuitry— again diminished by toxic drugs that I could barely pronounce, and again never completely eradicated.

Each event took a piece out of him, left him farther down the slope toward death. Here too the nurses’ notes were telling, to his credit.
Patient cheerful, optimistic, spent time chatting with his son.
A few days after one such entry he died—3:10
A
.
M
., Monday, August 31,1987.

I’d found no signature of Phyllis Sanders or Brown or any of the other names I’d been keeping an eye out for. My idea was wrong. But I’d learned a lot about Cam’s father and liked all of it. I also had a good idea of the forces that had shaped Cam, but whether it was for the better, as Janet believed, or for the worse, I still didn’t know.

I was returning the roll of microfilm to its receptacle on the shelf reserved for
M’s
when my eye caught another name on the index card posted for that section.
Miller, Mrs. Phyllis Sanders.
Below that I read
Miller, Dr. Carl.

It took me a moment to realize what I was looking at. The chart of Phyllis Sanders was still on the table where I’d been looking at it yesterday. It wouldn’t be microfilmed. Then I understood. When she’d resumed the use of her maiden name after her husband had died, they had made a new file, the one I’d already seen. In effect, she’d buried the medical record of Mrs. Carl Miller alongside her dead husband’s. I wondered if it had helped her bury the memories of living with an alcoholic.

The silence in that room was absolute, befitting a record hall for the deceased. Not even overhead plumbing dared to disturb the stillness.

I felt drawn, almost morbidly compelled to know more about the woman who’d become such a nemesis in my life. My impulse to look at the record made me uneasy, as if I’d caught myself wanting to find something in her past that, if I learned it, would explain or excuse my inexcusable reaction to her. But I wasn’t in the habit of trying to hide from my mistakes. Part of the psychological price of going to work in ER every day was learning from my errors in judgment and living with having made them. I’d like to believe my compulsion to look at her record came from another impulse, a need to understand her, to do her the justice of seeing beyond what I’d found so annoying about her. It was a service I owed her, maybe even one I owed myself.

Spooling through the clinical notes of an alcoholic’s wife is predictably agonizing. Her depression, her anxiety, her need for ever-increasing amounts of antidepressants and tranquilizers—the entries read like an Al-Anon brochure. She too had had many visits to ER—for sprains, bruises, and even for a few black eyes—all the events accompanied by improbable explanations of clumsiness, tripping, or walking into a door. Social workers had interviewed her several times about whether she was being subjected to physical abuse at home, but she’d adamantly denied it.

One therapist had interviewed Harold in his mother’s presence when he was around ten years old. Questions about his eating, sleeping, and performance at school had gotten pretty ordinary answers. The interviewer noted that Harold appeared well cared for, that he answered inquiries forthrightly, and that he appeared to be appropriately affectionate with his mother. This interviewer then documented asking a question of Harold about whether he was prone to accidents. Both he and his mother denied this. At the bottom of the page the interviewer had written
No evidence of need for intervention on child’s behalf, but FU?

I spooled ahead, yet as far as I could see, no follow-up had occurred. Had the social worker backed off, because Carl Miller was a doctor on staff, or was there nothing to follow up? Even if there hadn’t been legal cause for concern, growing up between Carl and Phyllis Miller had to have been difficult for Harold at best. No wonder he was so awkward.

Phyllis had fewer visits to staff health after that and no more visits to ER with suspicious bruises. Had Carl Miller stopped abusing her? It was unlikely, but maybe the threatened intervention of the social worker had frightened him. The chart ended with a minor entry about her receiving a hepatitis B vaccination sometime in 1985. I’d been spooling so quickly at that point I didn’t realize at first that her chart was finished, and I overshot into the portion of the film showing Dr. Carl Miller’s chart. There wasn’t much to see in the section I inadvertently looked at—a few scanty notes documenting his visits to staff health dated years apart, occasional blood results showing his worsening liver enzymes, and a few referrals to psychiatry for what had been coded as stress but were probably attempts to get him help for his alcoholism. None of the appointments had been kept.

I knew I had no business looking at his file, but I was tempted to keep going. It was, after all, the subtext of Phyllis Sanders’s story. Nothing would excuse the way she’d vented her anger on helpless patients and had become a punisher, but abuse begets abuse.

I brought more of his chart into view.

What I expected to see was a chronicle of increasingly frequent ER admissions for the catastrophes of excessive drinking—GI bleeds, pneumonias, seizures, delirium tremens, cirrhosis—but he must have gone to another hospital for those. What I was looking at was a single ER entry on the night of his death. Like ten percent of alcoholics, he died by trauma—in this case a tumble down his basement steps, resulting in a fractured skull. He’d been pronounced DOA in emergency. An autopsy had confirmed the fracture and determined that the cause of death from the trauma was a massive intracranial hemorrhage, aggravated by the way cirrhosis leaves drinkers prone to bleeding.