Kim swallowed loudly. His mouth had gone dry. “What can we do?” he asked.
“Not a lot, I’m afraid,” Kathleen said. “I’ve sent the sample to the lab looking for the toxin. Meanwhile I will suggest hematology and nephrology consults. I don’t think it is premature to get their opinions.”
“Let’s do it!” Kim blurted.
“Hold on, Dr. Reggis,” Kathleen said. “Remember I’m only a consult. Any other consult requests have to go through Claire Stevens. It’s her decision. AmeriCare is very clear on this.”
“Well, let’s call her for chrissake,” Kim sputtered. “Let’s get the ball rolling.”
“You want me to call her this minute?” Kathleen asked.
“Absolutely,” Kim said. He reached for the phone and pushed it in front of Kathleen.
While Kathleen used the phone, Kim cradled his head in his hands. He felt weak with sudden anxiety. What had been a nuisance, albeit a bothersome, scary nuisance requiring Becky to suffer and come into the hospital, had now become something else entirely. For the first time in his life, he was on the patient side of a major medical problem; one that he didn’t even know much about. He was going to have to learn and learn fast. He quickly thought of ways he could do it.
“Claire’s in full agreement,” Kathleen announced as she replaced the receiver. “You are lucky to have her. She and I have handled several cases of HUS in the past.”
“When will the consults see Becky?” Kim asked urgently.
“I’m sure as soon as Claire can arrange them,” Kathleen said.
“I want them right away,” Kim stated. “This afternoon!”
“Dr. Reggis, you have to calm down,” Kathleen said. “That’s why I brought you down here, so that we could talk calmly, one professional to another.”
“I can’t calm down,” Kim admitted. He breathed out noisily. “How common is HUS?”
“Unfortunately it’s become relatively common,” Kathleen said. “It’s usually caused by E. coli 0157:H7 of which there are about twenty thousand cases a year. It’s become common enough to be the current major cause of acute kidney failure in children.”
“Good Lord!” Kim commented. He nervously massaged his scalp. “Twenty thousand cases a year!”
“That’s the CDC estimate of the E. coli 0157:H7 cases,” Kathleen said. “It’s only a percentage that go on to HUS.”
“Is HUS ever fatal?” Kim forced himself to ask.
“Are you sure we should be talking about this aspect?” Kathleen questioned. “Remember the E. coli diagnosis has not been definitively made. I’ve just wanted to prepare you for its possibility.”
“Answer the question, goddamn it!” Kim said hotly.
Kathleen sighed with resignation. She’d hoped Kim would be smart enough not to want to hear the disturbing details. The fact that he did, left her with no choice. She cleared her throat. “Between two hundred and five hundred people, mostly kids, die from E. coli 0157:H7 every year,” she said, “and it’s usually from HUS.”
Perspiration broke out on Kim’s forehead. He was stunned anew. “Two to five hundred deaths a year,” he repeated. “That’s unbelievable, especially since I’ve never heard of HUS.”
“As I said, these are CDC estimates,” Kathleen said.
“With that kind of mortality, how come all this isn’t better known?” Kim asked. Intellectualization had always been a coping mechanism for Kim in dealing with the emotional burdens of medicine.
“That I can’t answer,” Kathleen commented. “There’s been a couple of high-profile episodes with this E. coli strain, like the Jack-in-the-Box outbreak in ‘ninety-two and the Hudson Meat recall in summer ‘ninety-seven. Why these and other episodes haven’t raised general awareness and concern. I don’t know. It is rather mystifying.”
“I remember those two episodes,” Kim said. “I suppose I just assumed the government and the USDA took care of the problems.”
Kathleen laughed cynically. “I’m sure that’s what the USDA and the beef industry hoped you’d believe.”
“Is this mostly a problem with red meat?” Kim asked.
“Ground meat, to be precise.” Kathleen said. “Ground meat that is not cooked through and through. But it’s also true that some cases have been caused by such things as apple juice and apple cider and even unpasteurized milk. The key problem is contact with infected cow feces.”