“The bowel looks uniformly edematous,” he said after a moment.
“Exactly,” Kathleen said. She was impressed. She’d thought she’d have to point out the pathology. “The mucosal lining is swollen for most of its length.”
Kim leaned back. “What does that tell you?” he asked. He did not like what he was seeing but had no way of relating it to clinical symptoms.
“It makes me worry specifically about E. coli 0157:H7,” Kathleen said. “You could see about the same X-ray with shigella dysentery, but the patient would probably have fever. As you know, Becky doesn’t have any fever.”
“What about antibiotics?” Kim asked. “Claude Faraday advised against them for fear of disturbing the normal flora. Do you agree?”
“I do,” Kathleen said. “Not only so as not to disturb the normal flora, but they might very well be useless. With no fever, there is a good chance the offending organisms are already gone from Becky’s gut.”
“If we’re dealing with a potential toxemia,” Kim said, “how do we make the diagnosis then?”
“There is the possibility of testing for the toxin itself,” Kathleen said. “Unfortunately AmeriCare has not authorized our lab to do the test.”
“Don’t tell me it’s a money issue,” Kim warned.
“I’m afraid so,” Kathleen said. “It’s one of those tests which is not used often enough for AmeriCare to justify its expense. AmeriCare feels it is not cost-effective.”
“Jesus H. Christ!” Kim exploded. He pounded the countertop with his fist in frustration. “If I hear that phrase ‘not cost-effective’ one more time I’m going to have a fit. From the moment Becky became sick, AmeriCare’s bottom line seems to be haunting me.”
“Unfortunately managed care is a reality we all must face,” Kathleen said. “But in this case I took it upon myself to have a sample sent out to Sherring Labs. We’ll have the results in twenty-four to forty-eight hours.”
“Hallelujah!” Kim commented. “Thank you, and I apologize for saying you weren’t doing anything. I mean, money should not be a consideration when Becky’s health is concerned.”
“What do you know about this particular E. coli and its toxin?” Kathleen asked. “Assuming that it is indeed what Becky has.”
“Not much,” Kim said. “I didn’t even know antibiotics weren’t helpful. E. coli isn’t something I’ve had to deal with in my practice. But vancomycin-resistant enterococcus is another matter. We cardiac surgeons are terrified of it.”
“I get your point,” Kathleen said. “I’m not familiar with the enterococcus problem, but I am with E. coli 0157:H7. Maybe even a little too familiar. I think you and your wife should know that it can be a very bad bug.”
“How so?” Kim asked nervously. He didn’t like the sound of Kathleen’s voice nor the implications of what she was saying. Kim didn’t even bother to correct her misconception that he and Tracy were still married.
“Maybe you should sit down,” Kathleen said. She was struggling with how best to explain her fears without unduly unsettling Kim. She could sense he was only in marginal control of his emotions.
Kim dutifully sat down in one of the desk chairs. He was afraid not to.
“If E. coli is involved with Becky’s current problem,” Kathleen said, “I’m concerned about the drop in platelets she’s had. There was only a slight drop last night, but after she’s been rehydrated, the drop is more apparent and statistically significant. It makes me worry about HUS.”
“HUS?” Kim questioned. “What in devil’s name is HUS?”
“It’s the acronym for the Hemolytic Uremic Syndrome,” Kathleen said. “It’s associated with the shigella-like toxins E. coli 0157:H7 is capable of producing. You see, this type of toxin can cause intravascular platelet coagulation as well as red-cell destruction. That, in turn, can lead to multiple-organ failure. Kidneys are the most commonly affected and hence the name uremic syndrome.”
Kim’s lower jaw slowly dropped. He was stunned. For a moment all he could do was look at Kathleen in a vain hope that she would suddenly smile and say it was all a bad joke. But she didn’t.
“You think Becky has HUS?” Kim asked quietly with a calmness he did not feel.
“Let’s put it this way,” Kathleen said, trying to ease the impact. “It’s my concern. There’s no proof as of yet. At this moment, it’s my clinical intuition that is suggesting it.”