Death Benefit

26.

COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 23, 2011, 2:37 P.M.

It wasn’t a warm day, but Pia had wanted to sit outside. She had found a bench set in a small rectangle of public cement, what in New York City is called a park, and sat down, hands in her coat pockets, her chin down, hood pulled over her eyes. Her mind played over the scene she had just witnessed several times. There was a surreal quality to it, like it was one of her nightmares. Unfortunately it was real.

After she had gotten herself reasonably calmed down, Pia got up from the bench and started to walk toward the dorm. She got halfway, changed her mind, and turned and headed back to the hospital. There she took the first two of her antibiotic tablets at a water fountain before heading to the internal medicine floor.

At the main nurses’ station, she asked for Dr. Rothman and was directed to the infectious disease wing a floor above, where Rothman and Yamamoto had been admitted. She wanted to check on Rothman’s status, hoping that he’d revived with treatment, and if so, she wanted to ask him if he knew how he and Yamamoto had become contaminated. Pia knew the epidemiologists would certainly be asking the same questions, but she had a personal reason for finding out-the crazy thought that he’d done it on purpose, an idea she knew to be irrational but which demanded, in her mind, to be investigated.

Pia had another concern. Experience had taught her to absolutely distrust authority in any institution and to assume that nothing would happen the way it should. She knew Rothman was disliked by almost one hundred percent of his colleagues in the medical center. He was rude, seemingly arrogant, and antisocial. While medical protocol and simple human decency demanded that each patient receive the undivided attention of medical staff and the best care available, she couldn’t help but think Rothman’s reputation might degrade the standards.

Pia used her medical student credentials to get on the floor and found that the two researchers were in adjoining, negative-pressure rooms where air flowed in but not out. They were in strict isolation but there was no one guarding the rooms. Pia started to put on the isolation gear in the anteroom-the gown, hat, mask, gloves, and booties-but just as she was about to put on her mask, Dr. Springer emerged from Rothman’s room. He undid his mask and stared at Pia.

“What on earth are you doing here? You’re Rothman’s student, aren’t you? You’re supposed to be home.”

“I took my antibiotics and my temperature’s fine. I know I’m clean-I wasn’t in the biosafety unit today, or even in contact with Dr. Rothman or Dr. Yamamoto. It’s very important I speak with Dr. Rothman.”

“Good God! Of course you can’t speak with him. The only people allowed in are medical staff assigned to his case. No family, no friends, and certainly no medical students.”

“There’s no one in there looking at him now. Are you sure of the diagnosis? Is this the best place to treat his condition?”

“What do you mean, ‘is this the best place?’” Springer shook his head in disbelief.

“I know what people around here think of Dr. Rothman-”

“Young lady, I don’t know what you’re implying but everyone at Columbia Medical Center gets the same superb care as everyone else, friend or foe, rich or poor. It makes no difference whatsoever. And I happen to like Dr. Rothman.”

“Okay, okay. Sorry, I’m just upset.” Pia didn’t want to get thrown off the floor. “I’ve been working with both men for more than three years on the salmonella strains that are probably involved, and I thought I might be able to help.”

“Okay,” said Springer. He relaxed a degree. He sensed Pia’s intentions were good even if totally unrealistic.

“I have to tell you that both men are delirious. Even if I let you in there, you wouldn’t get anything out of Dr. Rothman. Follow me.” Springer took off the protective gear and tossed it into the covered hamper. Pia did the same.

Springer took Pia back to the nurses’ station and, sitting down, itemized the laundry list of tests that had been ordered, including a complete blood count, electrolytes, blood cultures, urine cultures, stool cultures, stat DNA microbiology tests, and the appropriate X-rays. At that point the tests that had come back confirmed that the infectious agent was one of the salmonella strains Rothman and Yamamoto were working on, which Rothman had named the alpha strain, the most virulent of the three grown in space. He also mentioned that the white cell count showed a mild leukopenia, meaning the white cell count was mildly depressed, something often seen with typhoid fever. He declared the electrolytes, meaning primarily sodium, chloride, calcium, and potassium, were normal. Springer concluded by telling Pia that Rothman’s and Yamamoto’s temperature, heart rate, blood pressure, degree of oxygenation of blood, urine output, and central venous pressure were being monitored, and that at the moment the only thing abnormal was the temperature.

“They’re both in bad shape, especially considering how quickly the illness came on,” Springer added.

“What antibiotic are they on?” As Pia knew from her studies with Rothman, there was debate about which was the best to use in serious salmonella cases.

“That’s a good question,” Dr. Springer said. “Actually Dr. Rothman briefed me recently on findings he had made in his studies of antibiotic sensitivity on these zero-gravity strains. All three strains he was working on are very sensitive to chloramphenicol. That’s an antibiotic that at one time was considered the best choice for typhoid, but it went out of favor in the seventies because newer strains of salmonella were becoming resistant. Dr. Rothman said that because these strains were grown in space, they were more virulent but somehow they’d also lost their chloramphenicol resistance. He was interested because drug resistance is a big problem with salmonella.”

“Have you thought of trying ceftriaxone?” Pia asked, referring to a newer antibiotic.

Springer hesitated, giving Pia a once-over look. He’d been trying to be nice to her, as she was obviously concerned about her mentor. When he resumed speaking his voice and syntax had changed. There was an edge. “I actually wasn’t requesting a consult by speaking with you. It’s purely as a courtesy that I’m filling you in on Dr. Rothman’s condition and course of treatment. But to answer your question, if it was a question, there is some sensitivity to ceftriaxone but significantly less than there is to chloramphenicol.”

“Chloramphenicol can cause aplastic anemia,” Pia said, missing Springer’s signal that she was pushing it.

“Yes, we’ve taken into account the side effects, of course. Excuse me.” Springer suddenly got to his feet. Abruptly he left Pia, talked briefly with one of the residents helping with Rothman’s and Yamamoto’s care, then left the floor.

Pia waited for a few minutes before wandering over to the same resident, who was reading a chart.

“What do you think of Dr. Springer? Do you think he’s qualified?”

“What do I think? He’s the best in the country. I wouldn’t be here otherwise.”

Puzzled by the question, the resident walked away, leaving Pia standing by the nurses’ station, alone.