Dr. Richter shook his head. Speaking was obviously difficult for him.
Marissa straightened up and pointed to the abrasion under the patient’s right eye. “Any idea what this is?” she asked Dr. Navarre.
Dr. Navarre nodded. “He was mugged two days before he got sick. He hit his cheek on the pavement.”
“Poor guy,” said Marissa, wincing at Dr. Richter’s misfortune. Then, after a moment, she added, “I think I’ve seen enough for now.”
Just inside the door leading back to the ICU proper, there was a large frame holding a plastic bag. Both Marissa and Dr. Navarre peeled off their isolation apparel and returned to the fifth-floor nurses’ station. Compulsively, Marissa washed her hands in the sink.
“What about the monkey that bit Dr. Richter?” she asked.
“We have him quarantined,” said Dr. Navarre. “We’ve also cultured him in every way possible. He appears to be healthy.”
They seemed to have thought of everything. Marissa picked up Dr. Richter’s chart to see if his conjunctival hemorrhages had been noted. They had.
Marissa took a deep breath and looked over at Dr. Navarre, who was watching her expectantly. “Well,” she said vaguely, “I’ve got a lot of work to do with these charts.” Suddenly she remembered reading about a category of disease called “viral hemorrhagic fever.” They were extremely rare, but deadly, and a number of them came from Africa. Hoping to add something to the tentative diagnoses already listed by the clinic doctors, she mentioned the possibility.
“VHF was already brought up,” said Dr. Navarre. “That was one of the reasons we called the CDC so quickly.”
So much for that “zebra” diagnosis, thought Marissa, referring to a medical maxim that when you hear hoofbeats, think of horses, not zebras.
To her great relief, Dr. Navarre was paged for an emergency. “I’m terribly sorry,” he said, “but I’m needed in the ER. Is there anything I can do before I go?”
“Well, I think it would be better to improve the isolation of the patients. You’ve already moved them to the same general area of the hospital. But I think you should place them in a completely isolated wing and begin complete barrier nursing, at least until we have some idea as to the communicability of the disease.”
Dr. Navarre stared at Marissa. For a moment she wondered what he was thinking. Then he said, “You’re absolutely right.”
Marissa took the seven charts into a small room behind the nurses’ station. Opening each, she learned that, besides Dr. Richter, there were four women and two men who presumably had the same illness. Somehow, they all had to have had direct contact with each other or been exposed to the same source of contamination. Marissa kept reminding herself that her method of attack on a field assignment, particularly her first, was to gather as much information as she could and then relay it to Atlanta. Going back to Dr. Richter’s chart, Marissa read everything, including the nurses’ notes. On a separate sheet in her notebook, she listed every bit of information that could possibly have significance, including the fact that the man had presented with an episode of hematemesis, vomiting blood. That certainly didn’t sound like influenza. The whole time she was working her mind kept returning to the fact that Dr. Richter had been in Africa six weeks previously. That had to be significant even though a month’s incubation was unlikely, given the symptomology, unless he had malaria, which apparently he did not. Of course there were viral diseases like AIDS with longer incubation periods, but AIDS was not an acute viral infectious disease. The incubation period for such a disease was usually about a week, give or take a few days. Marissa painstakingly went through all the charts amassing diverse data on age, sex, life-style, occupation and living environment, and recording her findings on a separate page in her notebook for each of the patients. Rather quickly, she realized that she was dealing with a diverse group of people. In addition to Dr. Richter, there was a secretary, a woman who worked in medical records at the Richter Clinic; two housewives; a plumber; an insurance salesman and a real estate broker. Opportunity for commonality seemed remote with a group this diverse, yet all of them must have been exposed to the same source.