Damaged

CHAPTER 19

Platt stared at the dead boy's face. He looked so much younger than the nineteen years recorded on his chart. Stripped of everything, including his life, his gray body appeared small, his prosthetic leg emphasizing his vulnerabilities. It gnawed at Platt to think that this brave kid survived Afghanistan and his battle wounds only to come home and die from some mysterious disease.

Gowned up again, Platt stood beside the stainless-steel autopsy table going over the chart when he realized the pathologist, Dr. Anslo, was waiting for him. The man's almost nonexistent eyebrows were raised, their presence distinct only because Anslo's shaved head and smooth face left nothing else to forecast his emotions. His latex-gloved hands were held up in front of him, signaling that he was ready--ready and waiting for this guest who had been imposed on him.

Platt quickly found what he was searching for: the boy's name, Ronald (Ronnie) William Towers. It was a small thing, but he wanted to know how to address this young man, if nowhere else but in his own mind. It was the least he could do. Ronnie Towers deserved that small, last respect.

"I'm ready," said Platt.

This part of his job always challenged his sensibilities. It didn't help matters that he had just returned from Afghanistan and had witnessed the carnage that young men like Ronnie had to deal with every day of their tours. It battered his psyche as much as the exhaustion did. Each trip to Afghanistan or Iraq reminded Platt why, as an army doctor, he had chosen laboratories filled with vials, test tubes, and glass slides rather than the OR.

"I'll need a vial of his blood."

Anslo gave a terse nod as though Platt was wasting time telling him something he already knew. "And a tissue sample."

"Fine," Anslo said, shifting his weight in an exaggerated show of impatience as he continued to hold up his hands, waiting for instructions.

"Would you mind starting at the surgical site?" Platt asked.

The man's long, drawn-out sigh told Platt exactly what Anslo thought of his request. He didn't, however, refuse.

"If you tell me what you're looking for, perhaps I could help."

"I don't know."

"You don't know?"

"No," Platt admitted and avoided Anslo's eyes.

Since he arrived, Platt had tried to sift through as many of the files as possible looking for some common thread. All of the injuries had begun as compound bone fractures with deep tissue and bone exposed to open air for an extended period.

Dr. Anslo disconnected Ronnie's prosthetic, set it aside, and began on the surgical site just below his knee.

"Everything looks quite normal," he told Platt without glancing up at him. "If you're searching for an infection, I don't believe you'll find it here."

Initially Platt had thought it might be an airborne bacterium. In Iraq he had seen a bone infection called osteomyelitis (OM), prevalent in the Middle East. It often occurred in severe fractures where the bone was left exposed. But OM wasn't fatal or life-threatening. Sometimes, though rarely, it cost a soldier his limb. And sometimes it led to or acted as a primer for methicillin-resistant Staphylococcus aureus, MRSA.

Captain Ganz had told Platt there was now a compound, a bone cement pumped full of antibiotics, that allowed them to apply those antibiotics directly to the fracture site, reducing such infections. In addition, Ganz had tested for MRSA. The tests were negative. Platt should have known that it was too easy of an answer.

If not MRSA, Platt wondered, then what? Was it possibly another deadly pathogen that resembled MRSA and was not only resistant to antibiotics but could also lie dormant, hidden inside the cells, waiting for something to trigger it into action? Could a bone infection like OM mutate into something fatal? Given the right ingredients--like an open-air wound, a deep-tissue, bone-exposed wound--anything was possible. Platt had seen it happen before. But not like this. Invisible with no initial symptoms.

Dr. Anslo was staring at him again. The raised eyebrows showing his discontent while he waited for instructions.

"Go ahead," Platt told him. "Proceed with your normal routine." But before Dr. Anslo began the Y incision down Ronnie Towers's chest, Platt said to him, "Do you mind if I take this for twenty-four hours." He pointed at Ronnie's prosthetic.

"You want to take his leg?" This time Anslo didn't need a facial expression to show his disgust. His voice did it for him.

Without apology, Platt said, "Yes. Would that be okay?"

"I'll have the diener help you fill out the necessary form. May I proceed?" He pointed his chin toward his hands waiting over the boy's chest.

Platt nodded. As a medical doctor, cutting into live tissue was lifesaving. Cutting into dead tissue seemed ... such a waste. He was relieved when Anslo turned his back to him so he couldn't see Platt wince.