Plague

Chapter 3 Day 1, 7:45 PM

Chapter 3
Day 1
7:45 PM

Jacob took the elevator down to the basement. As he waited for the car to arrive he hoped that this meeting wouldn’t take much time. The thought of dinner made him walk a bit faster than his usual lope as he finally entered the Neuroradiology reading room, where the films were taken to be read and interpreted.
Dr. Tom Brighton was sitting hunched over the x-ray viewing box, frowning. About medium height with flaming red hair simulating rusty steel wool covering his head and most of his forehead, he did his usual frown and scowl act as he glared at the offending pictures. This made Jacob feel better, as Tom usually neared hysteria if he couldn’t easily identify even the minutest cerebral vessel on an angiogram, in which dye was x-rayed in all of the blood vessels in the brain. His normal behavior meant to Jacob that he would soon be back home.
He didn’t even turn his head when Jacob entered the room. The door slammed shut and Tom jumped, grabbed the films off of the view box and cut off the viewer lights.
Jacob’s guard went up. This was unusual behavior even for Tom Brighton, who turned and glared at him.
“It sure took you long enough.”
“What’s going on, Tom? I’ve never seen you so jumpy.”
“Sit down, Jacob. I want to give you the patient’s history and then I’ll show you the scan.”
“Forget it, Tom. Just show me the pictures so I can agree with you and we can both go home.”
The door opened again and Jacob glanced behind him to see a woman he didn’t know enter the room. Her long white coat with the stethoscope sticking out of the right front pocket gave away her avocation.
Tom spoke up. “Jacob, this is Dr. Joan Armitridge. Joan is a pediatrician; she’s new on staff. She’s on call this evening. The patient I want to tell you about was going to be transferred to her.”
Jacob stood up and extended his hand.
“Hi, I’m Jacob Wright. My friends call me Jake. Uh, how are you tonight?”
Joan smiled and Jacob forgot what he was doing in neuroradiology. His vision was clouded by the depth of her deep green eyes surrounded by the falling cascades of red hair that surrounded Joan’s face with its smooth, tanned skin and the sharp chin with the dimple a la Kirk Douglas. Her trim figure was, Jacob felt, only slightly short of perfect.
She also looked just like his former fiancé. They could have been twins.
Joan held Jacob’s hand for several seconds longer than he thought was necessary, for which he was glad. He sat down and looked at Tom Brighton.
“OK, I’m here, but I haven’t had a chance to grab some dinner. Can’t we do this later?” Jacob asked as he began to get back out of his seat.
“No,” Tom insisted. “Sit down and listen to me.
“Please, Jacob.”
Jake sat down and began to listen. Pretty soon, he stood up so he could listen even harder. He began to pace in the small office.
“The patient,” Tom began, “Was a six-year-old Mexican boy who evidently got lost in an arid area near the fields his parents work in; this was about noon yesterday. His mother remembers he didn’t come home for lunch. He still hadn’t returned by dinner-time so his parents and some friends started looking for him. After several hours they were about to give up and call the cops when the boy’s mother found him lying in a shallow gully behind some bushes.
“According to the mother, he was just lying there, and didn’t seem to recognize her when she knelt down to touch him. He just seemed to stare out at something, but not her. She lifted his head and shoulders off the ground and the kid seemed to turn his head towards her. He opened his mouth and let out a scream that startled her so much that she dropped him and ran for her husband.
“When they got him back to their car, the boy was mumbling and screaming and gnashing his teeth together. The father says he was arched up in a bow, essentially lying on the top of his head and the back of his heels. With a neighbor’s help they carried him home. After a while he quieted down and the friend left.
“The parents did everything they could to keep him warm and they tried to feed him soup. They tried to give him aspirin, the only medication they had. The kid just seemed to stare up at the ceiling, not even blinking, they said. He wouldn’t talk or cooperate at all.
“Around midnight the child seemed to fall asleep. The father went to bed too, and the mother stayed at the boy’s bedside. The father said he was awakened by his wife screaming, about three this morning. When he got to the kid’s bedroom, he found the mother hunched over the boy, trying to keep him under the blankets and on the bed.
“The way he described it, the boy was moving all of his limbs, flailing one and then another out in a bizarre way, one then another but not two at a time. The boy started screaming again and then seemed to try to talk, but the father says he couldn’t understand what the boy was trying to say. The way he described his son’s speech, it seemed to be slurred and broken.
“This went on for several hours; finally the kid became rigid and stopped moving and vocalizing. The father sent his wife to bed and sat up with his son until about eight this morning. The parents argued for a while about taking the boy to the hospital; the mother won and they took about four hours to get here. They have no money, and they’re probably illegal aliens, so the father was worried about being turned in or something.
“Anyway, the father carried the boy into the emergency room about three-thirty. Jenson, in the ER, found him to be comatose and unresponsive to stimulation. The kid’s neck was rigid, but so was the rest of him. Jenson figured he would get an emergency CAT scan and save Dr. Small some work. As you know, we do CAT scans rather than MRIs to rule out bleeding in the brain. He called me and I did the test.
Tom sat quietly watching his right hand tear the nails off of his left hand.
“Okay, Tom, I give up.” Jacob said. “What did you find?”
“That’s just it, Jake, I don’t know. I’ve never seen anything like it.”
“So show me,” Jacob told him.
“In a minute. Let me finish the history. I got the kid on the table and began to strap him down. All of a sudden he sat straight up and almost bent in half, with his head almost touching his knees. His arms started moving, in a really weird way, almost like they were broken. I thought he was having a seizure and gave him some intravenous valium. He went flaccid and I was able to do the scan.”
He paused again. Jacob tried to nudge him along.
“Well, what did you find?”
Tom just stared at the fingers on his left hand. Two of them were bleeding. He finally looked up at Jake and continued.
“Before I transferred the pictures to the CD Rom disks I went into the scanner room to check on him. He was still flaccid in all his extremities. It took a little bit before I realized that he wasn’t breathing. He had no pulse and his pupils were fixed and dilated. He was dead. I put him on a cart and covered him up.”
“Why didn’t you call a code blue?” Joan asked him.
“Joan, his pupils were fixed and dilated. He wasn’t breathing and his skin was cyanotic- blue! I believe he died during the test.
“I didn’t know what to say to his parents so I transferred the CAT scan pictures and also put them on film. I didn’t understand what was on the film so I enlarged them all. Finally I called you, Jake. I’ve been in here staring at the damned things ever since.”
Tom was chewing on his fingernails now. He looked at the nubs and then back at Jake and Joan. Slowly he turned around and flipped on the light of the view box. Taking the film on the top of his pile he placed it on the box and looked at Jacob.
Jake saw a normal base cut, showing the bottom part of the brain and skull. He looked at Tom and shrugged.
“It’s normal. So?” Jake said.
Tom slowly took down the first cut and put up the second.
This cut was taken a little higher in the brain than the first one. Part of the pons, a part of the brain stem at the back of the brain, above the spinal cord, was evident, separated from the cerebellum at the back of the brain by the fourth ventricle. Parts of both frontal lobes and both temporal lobes of the brain were also seen. It all seemed normal, and Jake said so. Tom pushed the film to one side and put up the next cut.
Towards the posterior part of the brain, in the right hemisphere of the cerebellum, the part of the brain that controls smooth movement, was something that looked like an inverted “V”, or an arrowhead, with an area of decreased signal intensity surrounding it, indicating damage to the brain in that area. The density of the object itself was close to that of bone. A thin line extended back several centimeters from the middle of one side of the object. The line’s density was also high and it too was surrounded by damaged brain tissue.
The next picture showed the arrowhead had moved to the left cerebellar hemisphere. There appeared to be a piece of brain missing from the region previously occupied by the strangely shaped figure. A dense line again extended from behind the back of the arrowhead figure for several centimeters, but now it had elongated and could be seen flowing up and to the left, where the CAT Scan slice ended.
The fifth cut showed more tissue missing from the right cerebral hemisphere, one of the two largest parts of the brain. The dense tip of the arrowhead-shaped figure now extended up into this higher plane and was angled towards the center of the brain.
The next three cuts were pure white, indicating the high density of blood, not normal brain tissue. The child had had a massive cerebral bleed, causing death almost instantly.
“Tom,” Jacob asked, “What was that thing? I’ve never seen anything like it.”
“Really original thought, Jake. I was hoping you could tell me. I know this sounds stupid, but the way I interpret those films, whatever that thing was, it seemed to be moving. You notice in each successive cut, as the pictures went higher in the brain, the arrowhead-shaped thing moved. First it went from right to left in the cerebellum, than it moved higher in the right cerebral hemisphere of the brain and then it seemed to turn towards the midline. Then the hemorrhage was seen.”
“I remember some of my old neuroanatomy,” Joan said, “But this is scary. It seemed to me that the arrowhead shaped thing was moving all around through the boy’s brain.”
“Yes, Joan, it did indeed,” Tom told her.
“What do you make of the tissue loss around the object,” Jacob asked. “It appeared to extend the length of whatever that thing is.”
“I just don’t know, Jake. Maybe it was artifact, or machine noise. Or maybe the tip of that thing dissolved the tissue.”
Jacob felt it was time to lighten things up a bit.
“Maybe whatever that thing was just ate it.”
Tom looked at Jacob and then at his nails. He looked at Jake again and grinned, looking a bit sick as he did it.
“Yeah, that’s what I thought, too.”
Well, Jake thought, his sense of humor was never that good anyway.
“The most obvious reason is artifact, or a false image. Let’s go check out the machine. I want to take a look at the body, anyway,” Jacob said.
He and Joan followed Tom down the hall to the scanner room. Outside the double doors was a cart pushed to one side of the hall with a couple of blankets covering the boy’s body.
“Why don’t you check out the machine while I give the kid’s body the once over,” Jacob suggested to Tom.
Tom pushed quickly through the doors while Jake drew the blankets back. Granted, the hallway of a hospital is no place to look carefully at a corpse, but Jacob wasn’t planning to do a thorough job. Not yet, anyway.
Joan moved to the head of the gurney and followed Jacob’s movements carefully.
The boy’s face looked composed in death. But then again, Jake had rarely seen a dead face that didn’t seem serene.
There were no bruises on the boy’s head; Battle’s sign, indicating a fracture at the base of the skull, was absent. There was no neck rigidity now; in fact the entire body was limp. There were some bruises on the boy’s knees and side, and some scratches on his hands and arms. Jacob looked carefully again at the head, behind the ears and at the base of the neck. There were no signs of trauma, no penetrating wounds and no blood in the external parts of the boy’s ears. He drew the blankets up to the boy’s neck while he went searching though the boy’s hair, looking for some sort of scalp wound.
He found nothing out of the ordinary.
The CAT scan room door opened and Tom came out. He seemed to go out of his way not to look at the small face unveiled on the cart.
“I’ve double checked it and there’s nothing wrong with the calibrations of the machine,” Tom said. “Come in and see for yourself.”
He turned and went back into the room and Jake followed, without thinking. Joan followed the two men.
Tom went through the relatively complex controls as if he were driving his car. He finally looked up at Jake and said, “I still can’t find any problems.”
They began discussing other possible types of error that they couldn’t find when an orderly stuck his head through the open door and asked for directions to the Pediatrics Unit. He was evidently new on the job and said that he was transporting a child from the emergency room. He had taken the elevator down instead of up. Joan told him, and he left.
After another few minutes of tests and discussion, the three physicians agreed that they had to start looking for answers somewhere else.
“We need a good post-mortem on the body,” Jacob said.
“Jacob, we have to get permission from the parents first.”
“No, we don’t,” Jacob told Tom. “The boy died within 24 hours of admission which should make him a candidate for the coroner’s office. They usually don’t mind if we help them by reducing their work load. I’ll call the pathologist and then talk to the family, if I can find them,” Jake said.
“They said that they would wait in the Chapel,” Tom told him.
Jacob called Stephan Johns, and found him at home, absorbed in the middle of a movie mystery on television. He carefully asked about the possibility of Stephan’s coming into the hospital to do an autopsy.
“After seven-thirty at night? Are you crazy? I’m sure if you ask nicely, the body will agree to wait until the morning to be cut open,” Johns told Jacob.
“Look, this is a special case, Stephan. You might even get a research paper out of it.”
“Really? What is so special about a six-year-old Mexican boy?”
“I don’t know,” Jake said. “That’s what’s so special.”
“I don’t get it, Jacob.”
“That’s all I can tell you. Trust me.”
“Do you really think I can get a publication out of this?” Johns asked.
“Does a bear shit in the woods?”
“Well, I’ve seen this mystery before. The blind alcoholic transvestite did it. Okay, Jake, I’ll be there in fifteen minutes.”
Tom was still sitting down but now attacking the fingers on his right hand.
Joan sat still, a fixed smile on her face; her eyes seemed to be looking at something hundreds of miles away.
“If you two are hungry, let’s bring the body down to the morgue first and then get some coffee in the cafeteria,” Jacob suggested.
After both physicians agreed, they went out to the corridor. Jacob covered the boy’s head and then the two men wheeled the cart down the hall to the elevator that would bring them to the Pathology Department in the hospital’s sub-basement. On the way, Jake told Tom and Joan he’d meet them in the cafeteria.
He wanted to speak with the boy’s family.