Robin Cook - Death Benefit

George shrugged.

“We know the most about Rothman and Yamamoto’s illness even without the autopsy results and even without seeing their charts. I was in the lab when it presented, I saw them in the hospital, I talked to the doctor who was treating them, I examined Rothman myself, I diagnosed new symptoms, I spoke with the department head involved.”

“Good, yes,” George said. They had gone over all this before but under the circumstances, George was happy to do it again. Pia tore the sheets she had written on off her legal pad, crumpled them into a ball, and threw the ball in the general direction of the trash basket. She missed. Pia began writing again, more slowly this time.

“Okay,” she said while she worked. “We do have a timeline of the infection. The onset was extremely rapid. Rothman or Yamamoto pressed the panic button and there was a medical team in the lab almost at once. I saw them arrive. Rothman and Yamamoto knew what to look out for, so from the first symptom to the medical team arriving may have been only ten minutes, at the outside. Springer showed up, and he went into the lab. Then he stayed and talked to the staff while Rothman and Yamamoto were taken directly up to the infectious disease floor and put in isolation, and treatment was started. I’d say they were there in five or six minutes. And Springer told us it was classic typhoid fever-high temperature, delirium, and so on, so it was diagnosed immediately. No delays. They got antibiotics within an hour of the initial symptoms.”

Pia had the pad on her knee.

“So Rothman and Yamamoto got all the symptoms straight off. It apparently wasn’t the usual sequence where a patient gets one symptom initially and then another a few hours later. It happened like a bolt of lightning. As far as I know, that’s not the way typhoid fever develops. Then the patients got the more ominous rebound tenderness by that evening. It’s all so speeded up.”

“You said this was a particularly virulent strain,” George said.

“True. One of the zero-gravity strains. The alpha strain. But still.”

“And you also said that Rothman’s own sensitivity studies suggested that the strain should have been knocked out by the antibiotic he was given.”

“That’s right, the chloramphenicol and later the ceftriaxone.”

“So what are you saying? Are you suggesting that it can’t have been that strain of salmonella?”

“No, I’m not. The strain had to be involved since Koch’s postulates were satisfied.”

“Meaning that they managed to grow the culture from samples taken from the patient.”

“Or by using more modern DNA techniques, yes.”

“Pia,” George complained, “you’re confusing me. What’s the bottom line here? What are you trying to say?”

“I suggested to Springer that there might be a second bacteria involved, a bacteria or a virus that was actually more virulent than the salmonella typhi and that was resistant to the antibiotics. It could explain the shockingly fast clinical course Rothman and Yamamoto experienced.”

“What was Springer’s reaction to your suggestion?”

“He went bonkers on me,” Pia said with disgust. “That was the end of the interview because he went out and called in reinforcements, meaning the dean.”

Pia put down her pad and pen back on the desk.

“So you think there might have been two bacteria involved,” George said.

“Right at this moment that’s the only thing I can think of. The clinical course was just too fast, especially in the face of two antibiotics given within hours of initial symptoms and known to handle salmonella. I know it’s contrary to recognized diagnostic rules, the major one being that one should look for a single causative agent even with seemingly multiple symptoms. But it’s the only way I can explain what we’ve seen with Rothman and Yamamoto.”

She turned back to her desk and read from her notes.

“We have all the symptoms right here: fever, delirium, prostration, temperature elevation, sweating, low white cell count known to be associated with salmonella, all leading up to abdominal rebound tenderness. From intestinal perforation and finally death.”

George got up from the bed and headed into the bathroom. Pia was overwhelming him. He was amazed she remembered Koch’s postulates from second-year microbiology. He certainly didn’t. He put some of the ice that was melting in her sink into a fresh towel, rolled it up and brought it to her desk. He exchanged it for the first one he’d made. Pia was staring at the paper, her back to him.

“Here’s some more ice,” he said.

Pia swiveled around in her chair, and George winced when he saw her jaw at such close quarters.

“How’s it feel?”

“It’s not too bad. A bit better with the ice.”

Pia took the fresh towel and held it to her face. An image flashed into her mind: Rothman lying on his deathbed, sweating into his pillow, delirious . . . Suddenly she stared directly up into George’s eyes with a fierce intensity that made George look away.

“The hair loss!” Pia said slowly, with emphasis. “What about the hair loss?”

COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 25, 2011, 12:15 P.M.

Pia got up from her chair, put the ice-filled towel down on the desk, and started pacing her room, circling George. First he’d been unnerved by the intensity of Pia’s stare when she had her epiphany, whatever it was; now she was stalking around the room like a cat closing in on a mouse.

“What hair loss?” George questioned.

“Rothman’s! Remember I saw there was some hair on his pillow before we found the rebound tenderness.”

“Yes, I remember. You pointed it out to the resident, and, as I remember, she suggested it might have been due to the chloramphenicol.”

“Exactly,” Pia said.

She stood still. “Can I use your computer?” Pia’s laptop was old and slow; the year before George had invested in a new Dell with a much faster processor.

“Sure. Let’s go!” George picked up the wet towel from Pia’s desk and gestured toward her with it. Pia shook her head. George took the towel into the bathroom while Pia changed from her pajama pants into sweats. She also quickly downed more Advil.

Gathering up her notes and heading for the door, Pia paused and looked back. She’d experienced a flash of anxiety. Although her room was where she’d been attacked, she still felt safer there than outside. Her attackers were lurking out there somewhere. Perhaps they really were watching her, as they’d threatened. George sensed her trepidation and put an encouraging hand on Pia’s shoulder and squeezed lightly. They exchanged a reassuring glance. Pia breathed deeply and walked out of the room, shutting off the light as she went.

“Let’s take the stairs,” Pia said, and she and George descended the four flights, walked along the corridor, but then stopped in front of George’s door. Both had the same thought: If they knew about George, they probably knew his room number.

“What do you think?” he asked. It wasn’t crazy to imagine that the two men might have it in their mind to pay George a visit too.

“Now I think we’re being paranoid,” Pia said.

“But as you correctly said, even paranoid people have real enemies. Wait there!” George unlocked the door and pulled it fully open. He and Pia were prepared to flee if anything looked amiss. Nothing did. George entered his room, making sure nothing had been disturbed before throwing open the bathroom door. “All clear,” he said with a sigh of relief.

“Let’s get to work,” Pia said.

George booted up his laptop and checked the wireless signal before giving up his desk chair to Pia. He went and sat on the bed. His room was a mirror image of hers.