Toxin

FIVE

Sunday, January 18th

Kim lifted out Harvey Arnold's hospital chart and cracked it open. It was before eight in the morning and the day-shift nursing crew was busy having its report. Consequently Kim had the nurses' station to himself save for the ward clerk.

He turned to the nurses' notes to read what had transpired during the previous day and during the night. He suppressed a smile. It was apparent from some of the entries that Mrs. Arnold was bothering the nursing staff as much as she bothered him. It was also apparent Mr. Arnold was doing fine. This impression was confirmed by the graphs of his vital signs, the input and output sheet, and the previous day's laboratory values. Satisfied, Kim slipped the loose-leaf chart back into its slot and walked down to his patient's room.

Mr. Arnold was sitting up in his bed, eating his breakfast and watching TV. Kim silently marveled at the progress cardiac surgery had made over the last couple of decades as evidenced by this individual. Here was a seventy-year-old man who less than forty-eight hours previously had been gravely ill and had had open-heart surgery. His heart had literally been stopped, opened, and repaired, and yet he was already relatively happy, mostly pain-free, and enjoying a significant improvement in the quality of his life. Kim couldn't help but feel a keen disappointment that such a miracle was being devalued in the current economic environment.

"How are you feeling, Mr. Arnold?" Kim asked.

"Pretty good," Mr. Arnold said. He wiped his chin with his napkin. When he was by himself, Mr. Arnold was a pleasant gentleman. It was when the husband and wife were together that the sparks began to fly.

Kim interrupted his patient's breakfast long enough to check on the dressing and the amount of drainage. Everything was progressing on schedule.

"Are you sure I'll be able to play golf?" Mr. Arnold asked.

"Absolutely," Kim said. "You'll be able to do whatever you want."

After a few more minutes of banter, Kim took his leave. Unfortunately he ran into Gertrude Arnold on her way in.

"There you are, doctor," Mrs. Arnold said. "I'm glad I caught you. I want a private-duty nurse in here around the clock, you hear?"

"What's the problem?" Kim asked.

"The problem?" Mrs. Arnold echoed. "I'll tell you what the problem is. The nurses on this floor are never available. Sometimes hours go by before we see one. And when Harvey rings his call button they take their sweet time."

"I imagine that's because they believe Mr. Arnold is doing well," Kim explained. "And that they are devoting their time to patients who are not doing quite so well."

"Now, don't you start making excuses for them," Mrs. Arnold said. "I want a nurse in here all the time."

"I'll have someone come to talk to you about it," Kim said.

Momentarily mollified, Mrs. Arnold nodded. "Don't make me wait too long."

"I'll see what I can do," Kim said.

Back at the nurses' station Kim told the ward clerk to page the AmeriCare administrator and have him come up to talk to Mrs. Arnold. Kim couldn't help smiling as he waited for the elevator. He would have loved to hear the conversation that would ensue. The idea of causing the AmeriCare administrators a little grief was enormously entertaining.

The elevator arrived and Kim squeezed on. It was remarkably crowded for a Sunday morning. Kim found himself pressed up against a tall, bony resident dressed in the typical "whites" and whose name tag read: JOHN MARKHAM, M.D., PEDIATRICS.

"Excuse me," Kim said. "Are there any enteric viruses making the rounds these days in school-age kids?"

"Not that I'm aware of," John said. "We've been seeing a pretty nasty strain of the flu, but it's all respiratory. Why do you ask?"

"My daughter's got a GI upset," Kim said.

"What are the symptoms?" John asked.

"It started with cramps yesterday morning," Kim said. "Then diarrhea. I've treated her with some over-the-counter antidiarrheal agents."

"Has it helped?" John asked.

"I thought so at first," Kim said. "But then last night the symptoms returned."

"Any nausea and vomiting?"

"Some mild nausea but no vomiting. At least not yet, but she hasn't had much appetite either."

"Fever?"

"Nope, none at all,"

"Who's her pediatrician?"

"It was George Turner. After the merger, he was forced to leave town."

"I remember Dr. Turner," John said. "I rotated over to the Samaritan. He was a good man."

"For sure," Kim said. "He's now back in Boston at Children's Hospital."

"Our loss," John said. "Anyway, about your daughter. It would be my guess she's got a touch of food poisoning and not a virus."

"Really?" Kim questioned. "I thought food poisoning generally came on like gangbusters. You know, like the proverbial staph in the picnic potato salad."

"Not necessarily," John said. "Food poisoning can be present in countless ways. But whatever the symptom complex, if your daughter has had acute onset diarrhea, chances are it's food poisoning. Statistically it's the most likely cause. To give you an idea of its prevalence, the CDC estimates there are two to three hundred million cases a year.

The elevator stopped and John disembarked.

"I hope your daughter feels better," John said as the doors closed.

Kim shook his head. He turned to another resident. "Did you hear that? Two to three hundred million cases of food poisoning every year! That's crazy!"

"That would mean that just about everyone in the entire country gets it each year," the resident said.

"That can't be true," a nurse getting off duty said.

"I think it is," another resident said. "Most people take the symptoms in stride and attribute it to the 'stomach flu.' Of course, there isn't any such thing as the stomach flu."

"It seems astounding," Kim said. "It makes you think twice about eating out."

"People get food poisoning in their own homes just as easily," a woman from the back of the elevator said. "It comes from leftovers to a large degree, although inappropriate handling of raw chicken is another major source."

Kim nodded. He had the uncomfortable feeling that everyone else on the elevator knew more about the issue than he did.

When the elevator reached the ground floor, Kim got off and left the hospital. As he drove home, he couldn't help but ponder about food poisoning. He continued to marvel at the shocking idea of there being two to three hundred million cases a year in the United States. If such a statistic were true, it seemed incredible that he'd not come across it in any of his medical reading.

Kim was still mulling all this over as he came through his front door and tossed his keys on the console table in the foyer. He thought he'd get on the Internet and see if he could substantiate the food-poisoning statistic, when he heard the sound of the TV coming from the kitchen. He walked in.

Ginger was at the kitchen counter, struggling with the wall-mounted can opener. She was dressed in a spandex workout suit that left little to the imagination. Both Saturdays and Sundays she did aerobics religiously. Becky was sprawled on the couch in the family room, watching cartoons. She had a blanket drawn up around her neck. She looked slightly pale against the dark green wool.

They'd spent the previous evening at home because of Becky's condition. Ginger had made a chicken dinner, of which Becky had eaten very little. After Becky had gone to bed early, Ginger had stayed over. Kim hoped they'd gotten along okay while he was at the hospital. He'd expected them still to be in bed by the time he got back from rounds.

"Hello, everybody," Kim called out. "I'm home."

Neither Becky nor Ginger responded.

"Damn!" Ginger exclaimed. "This thing is a piece of trash."

"What's the trouble?" Kim asked as he stepped over to Ginger. Ginger had abandoned her efforts with the can opener and had her hands on her hips. She looked exasperated.

"I can't get this can open," she said petulantly.

"I'll do it," Kim said. He picked up the can, but before putting it under the opener, he looked at the label. "What is this?" he questioned.

"It's chicken broth just like it says," Ginger replied.

"What are you doing with chicken broth at nine o'clock in the morning?" Kim questioned.

"It's for Becky," Ginger said. "My mother always gave me chicken broth when I had the runs."

"I told her I wasn't hungry," Becky called from the couch.

"My mother knew what she was doing," Ginger said.

Kim put the can of broth back on the counter and walked around the central island and into the family room. When he got to the couch, he put his hand on Becky's forehead. Becky moved her head to try to keep the TV in view.

"Feeling any better?" Kim asked. She felt warm, but he thought it might have been because his hand was cold.

"About the same," Becky said. "And I don't want anything to eat. It makes my cramps worse.

"She's got to eat," Ginger said. "She didn't eat much dinner."

"If her body is telling her not to eat, she shouldn't eat," Kim said.

"But she threw up," Ginger added.

"Is that right, Becky?" Kim asked. Vomiting was a new symptom.

"Just a little," Becky admitted.

"Maybe she should be seen by a doctor," Ginger said.

"And what do you think I am?" Kim responded hotly.

"You know what I mean," Ginger said. "You're the best cardiac surgeon in the world, but you don't have much chance to deal with children's tummies."

"Why don't you go upstairs and get me a thermometer," Kim said to Ginger.

"Where would I find it?" Ginger asked agreeably.

"In the master bath," Kim said. "The top drawer on the right."

"How about your cramps?" Kim asked.

"I still get them," Becky admitted.

"Are they any worse?"

"About the same," Becky said. 'They come and go."

"What about your diarrhea?" Kim asked.

"Do we have to talk about this?" Becky asked. "I mean, it's like embarrassing."

"Okay, Pumpkin," Kim said. "I'm sure you'll be feeling your old self again in a few hours. But what about eating?"

"I'm not hungry," Becky said.

"Okay," Kim said. "Just let me know when you want something."

It was dark by the time Kim turned into Tracy 's street and pulled to the curb at the base of her lawn. He got out and went around to the passenger side to open Becky's door. Becky had herself wrapped up inside a blanket so that it formed a hood over the top of her head.

Kim helped his daughter out of the car and up the walkway to the front door. She'd spent the entire day on the family-room couch in front of the TV. Kim rang the bell and waited. Tracy opened it and started to say hello to her daughter. She stopped in mid-sentence and frowned.

"What's the blanket for?" she asked. Her eyes shot to Kim for an explanation and then back to Becky. "Come in!"

Becky stepped inside. Kim followed. Tracy closed the door.

"What's going on?" Tracy asked. She turned back the edge of the blanket from Becky's face. "You're pale. Are you sick?"

Single tears formed in the corners of Becky's eyes. Tracy saw them and immediately enveloped her daughter in a protective hug. As she did so, she locked eyes with Kim.

"She's feeling a little punk," Kim admitted defensively.

Tracy pushed Becky out to arm's length so she could again look at her face. Becky wiped her eyes. "You're very pale," Tracy said. "What's the matter?"

"It's just a minor GI upset," Kim interjected. "Probably just a touch of food poisoning. At least that was the opinion of a pediatric resident I spoke with."

"If it's so minor, why is she so pale?" Tracy questioned. Tracy put her hand to Becky's forehead.

"She doesn't have a fever," Kim said. "Just some cramps and diarrhea."

"Have you given her anything?" Tracy asked.

"Sure," Kim said. "She's had Pepto-Bismol, and when that didn't seem to do the trick, I gave her some Imodium."

"Did it help?" Tracy asked.

"Some," Kim said.

"I have to go to the bathroom," Becky said.

"Okay, dear," Tracy said. "You go on upstairs. I'll be up in a minute."

Becky hoisted the edge of her blanket and hurried up the stairs.

Tracy turned to Kim. Her face was flushed. "My God, Kim! You've only had her for less than forty-eight hours and she's sick. What did you do with her?"

"Nothing out of the ordinary," Kim said.

"I should have known better than to leave town," Tracy snapped.

"Oh, come off it," Kim said, becoming angry himself. "Becky could have gotten sick whether you left town or not. In fact if she's got a virus, she could easily have contracted it before the weekend when you were here."

"I thought you said it was food poisoning," Tracy said.

"That was just a statistical guess by a pediatric resident," Kim said.

"Did Ginger make food this weekend?" Tracy asked.

"As a matter of fact she did," Kim said. "She made a wonderful chicken dinner last night."

"Chicken!" Tracy exclaimed. "I could have guessed. That must have been it."

"So you're already blaming Ginger," Kim said mockingly. "You really dislike her, don't you?"

"No, I don't dislike her," Tracy said. "Not anymore. At this point, I'm indifferent to her. But the fact of the matter is, she's young and undoubtedly hasn't had much experience in the kitchen. Those of us who have, know that you have to be very careful with chicken."

"You think you know everything," Kim said. "Well, for your information Becky hardly touched the chicken. Besides, she'd been feeling punk since Saturday morning. That means that if she's got a touch of food poisoning, then she got it from the Onion Ring out on Prairie Highway, the place that your new boyfriend bragged to Becky that he owned."

Tracy reached around Kim and opened the door. "Goodnight, Kim!" she said sharply.

"There's something else I'd like to say," Kim spat. "I resent you implying to Becky that I'm some kind of ogre for encouraging her to compete in the Nationals."

"I never made a value judgment about your wishes for our daughter," Tracy said. "When Becky informed me of her reluctance to face that kind of competition, I supported her. I also told her that you might try to change her mind. That was all I said."

Kim stared daggers at his former wife. The air of psychological superiority she assumed whenever they argued enraged him, especially in this instance when she felt she had to warn their daughter about what he might say to her.

"Goodnight, Kim!" Tracy repeated. She was still holding the door open.

Kim spun on his heels and left.